i
iiii
4
THE
MEDICAL RECORD
A Weekly jfoiuiial of Medieuie and Surgery
J
EDITED BY
GEORGE F. SHRADY, A.M., M.D.
SURGEON TO THE PRESBYTERIAN AND ST. FRANCIS HOSPITALS, NEW YORK, AND CONSULTING SURGBON TO
THE HOSPITAL FOR RUPTURED AND CRIPPLED, NEW YORK
JANUARY 6, 18S3 — JUNE 30, iS8j
NEW YORK
WILLIAM WOOD & COMPANY
188.^.
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Trow's
Printing and Bookuindinc Company,
201-213 East 12.'/; Slrcet,
New York.
LIST OF CONTRIBUTORS TO VOL XXIII,
Agnew, Dr. C. R., New York.
Ai-DERSON, ]^r. M. E., Russelville,
Ky.
Armstrong, Dr. John A., lirooklvn,
N. Y.
Axi-ORD, Dr.\Vii.i.i.\M I,.,Cliicago, 111.
r.ARTHOi.ovv, Dr. RoDERTs, Philadel-
phia, Pa. ;'
Beach, Dr. Wooster, New York.'
Bei.fiei.d, Dr. William 'P., Chicago,
Jll.
BiGELow, Dr. HoK.vrio R., Washing-
ton, D. C.
BoswoRTH, Dr. V. H., New York.
Bradner, Dr. N. Roe, Philadelphia,
Pa.
Brandeis, Dr. Richard C, New
York.
Brandon, Dr. G. W., Milford, Neb.
Brandt. Dr. W. J., Brooklyn, N. Y.
Bru.sh, Dr. F,. F., New York.
Buck, Dr. A. H., New York.
BucKi.iN, Dr. C. A., New York.
Burke, Dr. Martin, New York.
Bvrd, Dr. Harvev ].., Baltimore, Md.
Cammann, Dr. D. M., New York.
Carpenter, Dr. Wesley M., New
York.
Carroll, Dr. Alfred L., New
Brighton, N. Y.
Chapin, Dr. John B., Willard, N. Y.
Cheesman, Dr. William T., .A.uburn,
N. Y.
CippERLV, Dr. J. H., Troy, N. Y.
Ci.app, Dr. J. G., New York.
Ci.eborne, Dr. C. J., U. S. Navy.
Clendinen, Dr. A., Fort Lee, N. Y.
Corning, Dr. J. Leonard, New York.
Corwin, Dr. F. M., New York.
Couch, Dr. L. R., Nyack, N. Y.
Crothers. Dr. T. D., Hartford, Conn.
Curtis, Di. H. Hoi.brood, New
York.
Gushing, Dr. Clinton, San Fran-
cisco, Cal.
Cutter, Dr. Geo. R., lirooklyn, N. Y.
Daly, Dr. W. H., Pittsburg, Pa. j
Dana, Dr. Charles L., New York.
Dandridge, Dr. N. P., Cincinnati, O.
Dessau, Dr. S. Henry, New York.
Dietz, Dr. William D., New York.
Dorman, Dr. H. W., Ashtabula, O.
Drew, Dr. C, Jr., Jacksonville, Fla.
Dukeman, Dr. W. H., Clean, N. Y.
Emerson, Dr. J. B., New York.
Farnham, Dr. H. P., New York.
Faulkner, Dr. Richard 15., Pitts-
burg, Pa.
Ferguson, Dr. E. D., Trov, N. Y.
Fisher, Dr. Harris, Eastman, Ga.
Fowler, Dr. George R., Brooklyn,
N. Y.
Franks, Dr. S. C, Bentonsport, Iowa.
Fry, Dr. H. D., Washington, D. C.
Gaunt, Dr. 'P. 'P., New York.
Gilliford, Dr. R. H., Alleghany, Pa.
GiRDNER, Dr. John PL, New York.
Glass, Dr. J. H., Utica, N. Y.
Grant, Dr. Frank Sargent, New
York.
C.RUENiNci, Dr. p;.MiL, New Y'ork.
Halderman, Dr. Davis, Columbus, O.
Hayes, Dr. Rokert 'P., Rochester,
N. Y.
Higgins, Dr. P. J., Wilkesbarre, Pa.
Holt, Dr. L. Emmett, New York.
Holmes, Dr. K. L., Chicago, 111.
Howe, Dr. J. W., New York.
HuBiiARD. Dr. E. 'P., Madison, N. H.
Hubbard, Dr. V. .A., Taunton, Mass.
HuRD, Dr. K. P., Newburyport, Mass.
Ingals, Dr. E., Chicago, 111.
Jacop.i, Dr. A., New York.
Iacobson, Dr. Nathan, Syracuse,
N. Y.
Jackson, Dr. George T., New York.
Jarvis, Dr. William C, New York.
Jenkins, Dr. J. F., Tecumseh, Mich.
Johnston, Dr. W. H., Selnia, Ala.
Jones, Dr. Henry E., Portland,
Oregon.
JuDsoN, Dr. .\. B., New York.
Kahn, P)r. S. S., San P'rancisco, Cal.
Kings.vian, Dr. D. N., Columbus, O.
Kinnicutt, Dr. Frank P., New York.
Knapp, Dr. H., New York.
Kucher, Dr. Josef, New York.
Lacy, Dr. Horace P., Smithville, Va.
Le Fort, Dr. Leon, Pans, France.
Little, Dr. David, Rochester, N. Y.
Lydston, Dr. G. V., Chicago, 111.
McChesney, Dr. J. N., New York.
McCormack, Dr. J. N., Bowling
Green, Ky.
MacGaughey, Dr. J. D.,Wallingford,
Conn.
MacGuire, Dr. C. J., New York.
I Mattison, Dr. J. B., Brooklyn, N. Y.
I Mattocks, Dr. Brewer, Faribault,
Minn.
Meyer, Dr. Alfred, New York.
Moffat, Dr. Henry, New York.
Morris, Dr. Robert T., New York.
MuNDli, Dr. P. F., New York.
Myers, Dr. P. L., P'ostona, O.
Nelson, Dr. E. M.. St. Louis, Mo.
NoYES, Dr. Henry D., New York.
Parsons, Dr. R. L., Cireeninont-on-
the-Hudson, N. Y.
Partridge, Dr. Charles G., Piellows
Falls, Vt.
Peabody, Dr. George L., New York.
Peck, Dr. E. S., New York.
Phelps, Dr. C. H., New York.
Polk, Dr. W. M., New York.
PooLEY, Dr. J. H., Toledo, O.
Post, Dr. S. E., New York.
Prudden, Dr. 'P. Mitchell, New
York.
Pryor, Dr. J. W., Lexington, Ky.
PuTZEL, Dr. L., New York.
Rachel, Dr. George W., New York.
Raymond, Dr. H. I., U. S. Army.
Rice, Charles, Ph.D., New York.
Ripley, Dr. John H., New York.
Robertson, Dr. J. Newell. Walcott,
Robinson, Dr. Beverley, New York.
Rockwell, Dr. A. D., New York.
Roe, Dr. J. O., Rochester, N. Y.
Rohi5, l")r. Geor(;e H., Baltimore, Md.
RooSA, Dr. D. B. St. John, New York.
Roosevelt, Dr. J. West, New York.
Ryerson, Dr. G. Sterling, Toronto,
Canada.
Salmon. D. E., D.V.M., .Asheville,
N. C.
Satterthwaite, Dr.'PHOMAS E., New
York.
Saundby, Dr. Robert, Birmingham,
England.
Schapringer, Dr. A., New York.
S£e, Dr. Germain, Paris, P'rance.
Se.xton, Dr. Samuel, New York.
Shufeldt, Dr. R. W., U. S. Army.
Simmons, Dr. Horace M., Baltimore,
Md.
Smith, P^r. J. Lewis, New York.
S.MiTH, Dr. Stephen, New York.
Spalding, Dr. J. A., Portland, Me.
ScjuiRE, Dr. T. H., Elmira, N. Y.
Stein, Dr. Alex. W., New York.
IV
CONTRIBUTORS TO VOL. XXIII.
Stewart, Dr. J. T., Peoria, 111.
Stickler, Dr. J. W., Orange, N. J.
Stillman, Dr. Chas. F., New York.
SuTPHEX, Dr. T. Y., Newark, N. J.
Taylor, Dr. Henry Lino, NewYork.
Thomas, Dr. Frank W., Marion, O.
Thompson, Dr. W. G., New York.
Trudeau, Dr. E. L., Saranac Lake,
N. Y.
VanderPoel, Dr. John, New York.
Van Santvoord, Dr. R., New York.
Von Ramdohr, Dr. C. A., New York.
Wackerhagen, Dr. G., Brooklyn,
N. Y.
Wall, Dr. O., St. Louis, Mo.
Wallian, Dr. Samuel S., Blooming-
dale, N. Y.
Ward, Dr. Charles S., New York.
Webster, Dr. David, New York.
Webster, Dr. J. O., Augusta, Me.
Welch, Dr. Geo. T., Keyport, N. J.
Welch, Dr. W. B., Fayetteville, Ark.
Wendt, Dr. Edmund C., NewYork.
White, Dr. Frances E., Philadelphia,
Pa.
AVhiting, Dr. Guy F., New York.
Wilder, Dr. Burt G., Ithaca, N. Y.
Wv.man, Dr. Hal C, Detroit, Mich.
Institutions and Societies from 7vhich
Reports have been received.
American Laryngological Associ-
.■vtion.
American Medical Associ.\tion.
American Neurological Associ-
-•iTION.
American Surgical Association.
Bellevue Hospital.
Connecticut Medical Society.
German Congress of Interna-
tional Medicine.
German Surgical Society.
Illinois State Medisal Society.
Indiana State Medical Society.
London Hospitals.
Massachusetts Medical Society.
Materia Medica Society.
AFedical Association of Georgia.
Medical and Chirurgical Faculty
of ^^ARYLAND.
Medical Society of New Jersey.
Medical Society of Pennsylvania.
Medical Society of West Virginia.
Medical Society of the County of
New York.
Medical Society of the State of
California.
Medical Society of the State of
New York.
Michigan State Medical Society.
Mississippi State Medical Associa-
tion.
Missouri Medical Association.
National Associ.viton for the
Protection of the Insane and
Prevention of Insanity.
New York Academy of Medicine.
New York Acade.my of Sciences.
New York Pathological Society.
Practitioners' Society of New
York.
South Carolina Medical Associa-
tion.
State Medical Society of Arkan-
I SAS.
s\ Francis' Hospital, New York.
Texas State Medical Association.
Toronto Medical Society.
The Medical Record
A Weekly Jotirnal of Medicine and SiLrgery
Vol. 23, No. I
New York, January 6, 1883
Whole No. 635
(i)viaiual Articles.
THE TREATMENT OE ACUTE RHEUMATISM.
By ROBERTS BARTHOLOW, M.n., LL.D.,
mOFESSOR OF MATKKIA MEDICA AND GENEKAL THERAPEUTICS IN THE JEFFERSON
MHDICAI. COLLEGE OF I-HII.AIJKLI'HLA, KTt.
In a discussion of the treatment of acute rheumatism,
liie pathogenetic relations of tlie disease may seem to
be a rather remote subject ; but, to render my position
clear, it is necessary to formulate, as briefly as may be,
my conception of the nature of the rheumatic diathesis.
The chemical theory which refers the joint troubles and
the cardiac complications to an acid circulating in the
blood, receives support from clinical facts and from the
results of experiment. No theory can be true, however,
which does not reconcile ail tlie facts, and there are
many which cannot be included in this chemical theory.
There is an influence behind those chemical jirocesses,
which, in the so-called rheumatic diathesis, is concerned
in the secondary assimilation to produce an excess of
acid. That influence, we have many reasons for believ-
ing, proceeds from the nervous system. There are nu-
merous facts which go to show that certain i)arts of the
cerebro-spinal axis cause, when irritated, affections of
the joints not unlike rheumatism. We owe more espe-
cially to Charcot' the accurate description of these joint
diseases as they occur in connection with posterior spi-
nal sclerosis, or locomotor ataxia. Long before Char-
cot's appearance on the medical stage, a neurotic theory
of rheumatism had been propounded by that acute clini-
cian, the late Prof. J. K. Mitchell, M.D., of Jefferson
IVfedical College, Philadelphia. An account of his
theory, based on the then existing knowledge of nervous
pathology, may be found in a volume, prepared with a
pious deference to a father's memory, by the more dis-
tinguished son, Dr. S. Weir Mitchell, of Philadelphia.
It has happened, curiously enough, that the son has
greatly enlarged the evidence on which the father's the-
ory was based.
In his volume on " Wounds and Injuries of Nerves,"
Dr. Weir Mitchell gives many striking examples of joint
troubles resulting from nerve and spinal injuries. Char-
cot, in connection with Joffroy,^ Ball,' Weir Mitchell,'
Buzzard,' and others, have published numerous exam[)les
of arthropathy, in many features resembling the joint af-
fection of acute rheumatism, only more severe and pro-
founder in the depth and extent of the lesions. It is
important to note in this connection that the joint
changes of locomotor ataxia belong to the initial stage of
tabes — to the stage of pains, and before the disorders of
motility come on. It is evident, therefore, from this
fact, that the spinal lesion is rather in the nature of an
irritation. We may form a suspicion of the nature of
the trophic lesions of joints due to centric affections by
an examination of the nutritional changes wrought by
irritation or inflammation of nerve-trunks. The data to
be obtained on this point are very numerous. I can
here hope to refer to the best-established facts as a
groundwork on which to base my conception of the neu-
rotic origin of rheumatism. In addition, then, to the
' Lectins siir les M.-»ladies du Systfeme Nerveux. Paris. 1873.
^ Archives de Physiologic, Normale et Pathologique, 1868, i86r, and 1870 ;
also Lemons, etc.
^ Gazette des Hopitaux. various numbers during 1868 and iS6g.
* The American Journal of the Medical Sciences. April, 1875.
^ Clinical Lectures on the 1 liscases of the Nervous System. 188^.
evidence furnished by the development of certain joint
changes in the initial stage of tabes, we have some strik-
ing facts in regard to affections of joints produced by
irritation of nerve-trunks. Thus, swelling of joints due
to effusion has been observed in cases of neuritis. In-
deed, Erb ' afiirms that these joint affections are in no
way distinguishable from rheumatism. Eriedreich," in
his monumental work, has collected a vast array of evi-
dence showing the influence of nerve-inflammation on
the nutrition of parts. Without occupying further space
and time with this question, it may be affirmed that joint
affections closely related to rheumatism are caused by
certain spinal and nerve lesions, and hence we may re-
gard it as iirobable, if not proved, that in the treatment
of acute rheumatism we have to deal with a neurotic
affection. Whilst it is a fundamental maxim in thera-
l)eutics to direct the remedies against the central lesion,
the wise physician will not fail if he can remove the
more prominent symptoms, for, in the jiresent state of
our knowledge, we are not often able to separate the
lesion from its most accentuated symptoms in respect to
the administration of remedies.
Having thus tried to establish the therapeutical diag-
nosis, the next point is to indicate the remedies which
will supply the conditions thus furnished. There is no
specitic for rheumatism. We are, therefore, reduced to
the necessity of i.)roposing remedies for centric or peri-
pheral nervous lesions, and for the more prominent
symptomatic expression of these lesions.
No one can give anything like attentive consideration
to the types of rheumatic cases without perceiving that
they may be resolved into three groups, as regards the
characteristics of tlie individuals composing them :
First. — Spare persons of considerable bodily vigor,
good muscular development, and having a distinct family
history of neurotic or rheumatismal disorders.
Second.— Oh^fiit subjects, addicted to malt liquors and
good living, sometimes with — more often without — an
inherited predisposition to rheumatic diseases : the gela-
tinous descendants of albuminous parents, as they have
been entitled.
Third. — The feeble, pale anemic subject, depressed
by poor diet, and evil hygienic surroundings, including
dampness and bad air.
No one can treat cases of rheumatism successfully
unless he recognizes the type before him and adapts his
remedies accordingly.
The first tyjje is comparatively frequent, and found
amongst the jjest elements of our mongrel population.
Besides the inherited tendency, such subjects are prone
to indulge in a rich diet of animal food, sauces, and
wines, and to pursue rather sedentary occupations, or an
indoor life. In these cases, salicylic acid, or the salicylate
of soda, renders an incontestible service. It would be
quite impossible to enter into details regarding this
remedy's modtts operandi just here, except to say that
its antipyretic and antiseptic actions are quite inadequate
to explain its curative effects in these cases of acute
rheumatism. There can be little doubt that its curative
effects are rather referable to its power to diminish the
irritation of the trophic nervous system. There are,
however, some practical details regarding its administra-
tion of great moment in respect to the permanency of
1 Ziemssen's Cyclopaidia, vols. xi. and xiii. ., , ,,
2 Ueber progressive Muskelatrophie, ueher wahre und fal.sche Muskelhypcr-
trophie. Herhn : llirschwald. 187^.
THE MEDICAL RECORD.
[January 6, 1883.
the results. It is quite certain that in this group of rheu-
matic cases, full niediciiial doses of salicylic acid, or of
the salicylates, will speedily arrest the i)ain and diminish
the lever. The lowering of the temperature seems 10
bear a constant ratio to the diminution of the pain. It
is not possible to express in figures with exactitude the
doses necessary ; the curative effect is attained by that
quantity which reduces the pain and the tem|)erature.
In suitable cases, the administration of tliis remedy re-
moves all of the more prominent symptoms and estab-
lishes convalescence in three or four days. Unfortunately,
in a considerable ]iroportion of cases, the disease mani-
fests a strong tendency to relapse, after a marked sub-
sidence of the acute symptoms apparently indicates the
beginning of convalescence. A rule of practice has been
distinctly formulated since this tendency to relapses has
become well known. It is this: Give the remedy for
several da)s after the acute syjnploms have ceased. I
have attemi)ted, from my own experience, to give numer-
ical expression to this rule, with the following result :
Salicylic acid, or the salicylates, shoidd be given after
the subsidence of the acute symptoms, and the cessation
•of the fever and pain, for the same number of days as
the acute attack lasted. Thus, if the decline of fever
and pain occurred on llie fourth day, the remedy should
be continued as njaiiy days thereafter, or for four days
■subsequent to the apparent cessation of the acute symp-
toms.
The mannei' of its action is by no means clear. The
])ain ceasing coincidently with the decline of the fever,
and the joint swelling disa|)pearing at the same time,
indicate that the action occurs simultaneously, or that
the one is a consequence of the other. It may be, that
the remarkable relief afforded by salicylic acid and the
salicylates, is due to the arrest of action caused by an
antiferment ; but it must be admitted that we are, as yet,
far from a true explanation.
The second class of rheumatic subjects contains the
obese, or those of full habit, the rotund addicted to malt
liquors and to good living, all of whom are apt to suffer
from a form of acid indigestion. The cases of rheuma-
tism occurring in such subjects are, as a rule, much
benefited by the alkaline treatment. This method is an
empirical attempt to cure a disease characterized by an
excess of acid in the various secretions. As the substi-
tution of the alkaline remedies, for the spoliative treat-
ment before employed, residted in gieat benefit to these
rheumatic patients, and as the system had an air of
scientific precision, it is not surprising that it became
widely popular, and that, until the salicylic acid treat-
ment was introduced, unquestionably occupied the first
place in the professional esteem. Dr. Fuller, the author
of an excellent w'ork on rheumatism, has been the most
prominent advocate of the alkaline method. In a paper
in the Practitioner,^ he shows that much of the practice
passing under that name, is not a proper ap|)lication of
the alkaline plan. As it is important to have a clear
conce|)tion of the limitations of this method, I transcribe,
from the i)aper referretl to. Dr. Fuller's definition :
"By the 'alkaline treatment,' " says Dr. Fuller, "I
mean a plan of treatment in which alkalies play an nn-
porlant part, but which consists not only in the adminis-
tration of alkalies, but in the carefid regulation of the
secretions, the stiictest attention to diet, and the admin-
istration of tonics, such as quinine and bark, as soon as
the patient can bear them. . . . My ))raclice is to
give not less than an ounce and a half of the alkaline
carbonates, either alone or in cojn.binaiion with a vege-
table acid, during the first twenty-four hours of treat-
ment. . . . More connnonly two drachms are or-
dered to be taken in effervescence every three or four
hours in combination with an ounce of lemon-juice, or
with lialf a drachm of citric acid dissolved in four ounces
of water. At the same time, if the bowels are torpid, ten
grams of colocynth and calomel pill [British Pharm.] are
prescribed at bedtime. As soon as the urine, when
freshly voided, ceases to show an acid reaction — which is
usually the case after twenty-four horns — the quantity of
the alkali is diminished by one-half, six drachms only
being administered during the. succeeding twenty-four
hours. At the expiration of that time, if the urine re-
mains alkaline, three drachms only are given in the next
twenty-four hours ; and on the fourth day, if the urine
still shows an alkaline reaction, the form of the mec'v;ine
is altogether changed. The treatment ceases to be es-
sentially alkaline ; either a cinchona draught is ordered
to be taken three times a day, containing a scruple or a
half drachm of bicarbonate of jjotash — a little more or a
little less, according to the condition of the mine, which
should be kept nearly neutral — or three grains of quinine
dissolved in lemon-juice is given three times a {lay in
effervescence, with half a drachm of bicarbonate of pot-
ash or soda. . . . The diet is restricted to beef-tea
or broth, with soda-water and milk, and barley-water as
a drink, as the smallest quantity of solid food, given a
day before the tongue has thoroughly cleaned, is apt to
induce a recrudescence of the disease. Wine and spirits
are strictly forbidden, though ex[)erience has convinced
me that wine and spirits prove less hurtful than the
smallest quantity of solid food."
I have thus given the details of the alkaline treatment
in the words of its chief promoter, at the risk of weary-
ing my readers, because of a conviction that, in this
country as in England, the method is very inadequately
carried out. Considerable experience in it justifies me
in saying that, in the class of subjects now under con-
sideration, it is of the utmost value. Although relief to
pain, the disappearance of the joint swelling, and the
subsidence of the fever, are the evidences of improve-
ment, no one who has had any considerable clinical
experience with acute rheumatism, is unaware of the
fact that relapses of varying severity, a tedious conva-
lescence— slow repair of the damages — are to be consid-
ered in an)' just estimate of the relative value of different
[ilans of treatment. That these cases are relieved by
salicylic acid, is undoubted ; but they tend to relapse, and
the process of recovery is slow, often imperfect. In my
ex)jerience, the special peculiarity of acute rheumatism
in these obese subjects is the tendency to assiune a sub-
acute character and to be delayed in the progress toward
recovery. They are also more liable to heart complica-
tions. The alkaline treatment, carried out as above
described, gives better results in respect to relief to
suffering, to duration of the disease, and freedom from
comijlications. Stated numerically, the results, in my
experience, may be conqxared with those of Dr. Fuller.
"In ninety-four consecutive cases," says Dr. Fuller,
"which were tabulated with a view to this inquiry, the
average duration of the disorder after the commence-
ment of treatment was only eleven days." Some statis-
tics of Dr. Dickinson,' are even more conclusive : The
tables embrace cases treated by venesection, by mercury,
by salines, by salines and mercury, by a partial alkaline
treatment, and b)- the true alkaline method. The num-
ber of cases of heart complication was greatest in those
treated by venesection, being 50 per cent., and least in
those treated by the true alkaline i)ian, being one in
twenty-three cases, or 4.3 per cent. The average dura-
tion of the disease bore the same ratio, the miniuium
being those cases treated by the alkaline plan. At that
time (1869) salicylic aciil had not been suggested as a
reme<lv for rheumatism — hence in the foregoing com-
parative statements, there are no cases treated by means
of it.
If the relation between the action of alkalies and the
neurotic disturbance called rheumatism, be demanded,
we are not without resources for an ex[)lanation. Pllii-
ger's phenomena of electrotonus were long ago ex-
1V0I. xi., p. X29: The Alkaline Treatment of Rheumatic l-'cver.
> The Lancet, January 33 and 30, and Februaiy 6, 1869.
January 6, 1883.]
THE MEDICAL RECORD.
idained by ^fatleucci, and the explanation confirmed by
Becqiierc-I on the ground of the clieinical action devel-
oped by the jiassage of the ciineiit. Hnniboldt was the
firbt to show that the excitability of a nerve is increased
by contact with an alkaline solution, and diminished by
contact with an acid sohitioii. Now, as the condition
called rheiunatism may signify a depressed state of the
trophic functions, the good effects of alkalies are at once
apparent — that is, the increase of the ftnictional activity
— and thus coiniteract the depression.
Besides the administration of the alkaline remedies,
there are other thera]) iitical questions to be answered in
res|3ect ■ to the treatment of the second group of rheu-
matic subjects ; but these will be more properly consid-
ered hereafter.
The third type of rheiniiatic cases and numerically the
most important ; jirohably, also, pathologically, the most
serious, is the feeble and anaemic subject. A rheumatic
of this kind is i)a!e, rather thin, the muscles weak and
wanting in firmness, the chest narrow and somewhat flat,
the joints prominent and lax. In such persons an ex-
tension of the rheimiatic inflammation from joint to joint,
until almost all the joints of the body are involved, is to
be feared, as it is of frequent occurrence. Cardiac com-
])lications are relatively frecpient. It need hardly be
observed that in such subjects the depressing effects of
salicylic acid and of the alkalies are to be dreaded.
Here clinical experience is in entire accord wiih theory.
We owe to Dr. Russell Reynolds, of London, the intro-
duction of a remedy for acute rheumatism, which is es-
pecially suited to this group of cases. I refer to the
tincture of the ctiloride of iron. To be etTective it must
be given in fidl doses — from 3 ss. 3 j. in suflicient water
every four to eight hours. It lessens the swelling and
pain of the joints, lowers the fever, diminisl;es the ten-
dency to heart complication, and, above all, sustains the
vital powers in their struggle against the encroachments
of the riieumatic disease.
I am far from denying that cases of iheumatic fever in
these an;emic subjects would not be relieved by salicylic
acid, but 1 do affirm that so nuich depression would re-
sult that relapses would occur, and the convalescence
woukl be prolonged owing to the remarkable depression of
the nutritive fimctions. The same state of things results
from the administration of alkalies. The blood is de-
spoiled, the heart enfeebled, and complications of vari-
ous kinds invited. On the other hand, very conspicu-
ous benefit results from tiie vigorous administration of the
tincture of iron. Besides its influence over the course
of the disease — shortening its duration by checking waste,
and |)reventing complications by maintaining the vital
resources — the tincture of iron, as shown by the late Dr.
Anstie, has a distinct proph)laclic eftect, so that, when an
attack is threatened, it will, by timely administration, pre-
vent it.
During the period of convalescence from acute rheu-
matism, after the treatment by salicylic acid and by al-
kalies, the tincture of iron in the full doses already ad-
vised renders an important service. The tenderness and
effusion about the affected joints, the subfebrile temper-
atuie, and the condition of anjemia, are alike greatly
improved by its administration in efficient doses. 1 have
repeatedly observed that cases which lingered long on the
hands of the physician after the acute symptoms had sub-
sided, quickly improved and recovered when efticieiU
doses of thi; tincture of iron were administered, and, at
the same time, suitable blisters were applied to, or about,
the affected joints.
Independently of the considerations above expressed
regarding the utility of blisters, the "blister treatment"
of acute rheumatism is deserving of careful consideration.
Blisters in various ways, and ajuilied in accordance with
various notions, have long been used in the treatment ;
but the " blister treatment," properly speaking, of acute
rheumatism has been systematized by Dr. Davies, of the |
London Hospital, and Dr. Dechilly, of I'Vance. The
latter, however.. applied a large blister to cover the joint,
and permitted it to remain on until sufficient inflammation
occurred to produce abundant serosity. Dr. Davies, on
the other hand, was content to apply the blisters around
rather than on the joint itself. It is a remarkable fact
that blistering brings about a neutral or alkaline condi-
tion of the urine, how acid soever it may have been be-
fore the blisters were applied. More or less strangury
occurs in some instances. So remarkable is the relief to
pain produced by the blisters that patients petition for
their renewal from time to time. Cardiac complications
are comparatively infrctiuent, and the duration of the
disease is reduced to the limits of the favorable cases.
Indeed, I may sum up the testimony as to the efficiency
of this method in the words of Dr. Clreenhow, who affirms
that the treatment of rheumatism by blisters is quite as
successful and less objectionable than by salicylates.
The good etfects of the blister treatmpnt afford a strong
justification of the neurotic theory. When first ascer-
tained, the result was ascribed to the withdrawal of a
quantity of acid serum from the neighborhood of the af-
fected joints. The change in the character of the urine'
induced by successive blisters, rendered further explana-
tion nec.essary. The increase of our knowledge respect-
ing the influence of ])eripheral irritation on the state of
the nerve-centres, and especially on the trophic system,
has paved the w.ay to a better appreciation of the ficts ;
nevertheless the final explanation remains to be made.
A combination of the blister tieatment with salicylic
acid, with alkalie.=, or with the tincture of iron, may often
be made with sigrjal advantage.
The importance of a proiier diet is not less than is
stated by Dj-. Fuller in the quotation made from his
paper. Solid food should not be allowed in any case.
Liquids composed of starchy and saccharine matters are
only less hiirtfiil. Milk and animal broths are the articles
to be depended on chiefly until the cessation of all joint
troubles will permit the gradual restoration of a solid
dietary. Lemonade ai:d carbonic acid water are allow-
able, unless thev jModuce flatulence, when they will ex-
cite fresh joint mischief. Anodynes are to be avoided if
possible ; when necessary, atroiiine is preferable to mor-
pliine, if adequate to relieve the pain, which it usually
succeeds in doing. The complications which may arise
in the course of rheumatic fever demand more careful
treatment than I can give them at the conclusion of this
article.
THE SIGNIFICANCE OF TEMPI'.R.XTURE
AFTER OVARIOTOMY.'
By CII.\liLES S. WARD, M.D.,
attending physician new york lying-in asylum ; assistant sukgeon
woman's hosiital, etc.
So much has been written on ovariotomy and the care of
patients after that operation, that to some of you I fear
the subject will appear hackneyed ; to others I hope the
short consideration of certain |)oints in the diagnosis and
treatment of conditions arising after, and, for the most
part, due to that procedure, may not be without interest.
It will be impossible, in the brief time allotted, to do
more than epitomize even a few points in the after treat-
ment, nor will it allow of illustrative cases.
Ovariotoni)' may be one of tlie simplest operations in
the whole domain of surgery. On the other hand, it may
be, and often is, one of the most difficult. At times it
presents such problems for solution as to demand not
only the calmest judgment, but that acquaintance, per-
sonal and traditional, with w^hat has been done in similar
cases, which we call ex|)erience, m order to give the pa-
tient the best possible chance for recovery, or to extricate
the operator from some serious dilemma. So also the
(7//c'/--lreatment presents its problems, some of which we
siiall attempt to solve.
I Read before tlie New York Practitioners* Society, December i, 1882.
THE MEDICAL RECORD.
[January 6, 188;;
With the completion of ovariotomy the operator's
anxieties are but just beginning. Ahhough they may
exist actively during tliat procedure, he is in a position
to deal promptly with comjjlications which he can see,
and which develop, so to speak, under his hand. He is
then in a more special degree the active agent, control-
ling f/ie physical conditions which he meets or creates ;
while after the operation he has to wait upon certain
vital forces, which are variously modified by age, tem-
perament, the physical condition of the patient, and the
traumatism in each individual case. These factors ex-
hibit themselves in unequal projjortions and give color to
the case as one or the other jiredominates.
In order to intelligently conduct a case we should
have a clear idea of the processes set in operation by-
our surgical interference, that we may know in what di-
rection to expect this or that manifestation and its im-
port, and be ready to meet unfavorable symptoms at
their very inception.
For practical purposes we may separate all cases into
two classes :
First. — Simple cysts with few or no atlhesions.
Second. — All other ovarian tumors, whether cystic or
solid, having such parietal or visceral attachments as to
necessitate much injury to surrounding structures on de-
tachment, or whose contents are in themselves irritating
or of such a character (thick colloid) as not to be readily
removed from the peritoneal cavity, should they escape
into it.
In the first class, assuming that by dexterous opera-
tion and careful ligation we have secured ourselves
against shock and hemorrhage, there remains ordinarily
but one source of danger — peritonitis — and that from the
limited abdominal incision or the severed pedicle.
In the second class our list of dangers is largely in-
creased, the principal ones being : i. Shock: due to ac-
tual severity of case from violence done ; due to hemor-
rhage ; due to unnecessary and prolonged exposure from
indecisive procedure. 2. Hemorrhage : From pedicle ;
from severed adhesions ; from viscera from which adhe-
sions have been torn ; from hemorrhage occurring within
the pedicle from incautious traction. 3. Peritonitis : vis-
ceral, parietal. 4. Septicemia with concomitant peri-
tonitis. 5. Cellulitis.
I have mentioned but five sources of elevation of tem-
perature. There are others, but I speak of the principal
and usual ones.
Shock and hemorrhage we shall nut discuss, they being
not included in the limited range ot this pajier, which
deals with the inflammatory processes and their order of
manifestation.
Each of the above conditions, excein shock and
hemorrhage, expresses itself by an elevation of tempera-
ture ; but, as is known to all, the value or import of the
same degree of elevation of temperature is quite differ-
ent, according to whether it be due in the one case to a
peritoneal or a cellular inflammation ; hence the great
importance of an early and correct diagnosis of the con-
dition develoi)ing, as manifested by increase of tempera-
ture. In one case, tile cellular, we may rest at ease,
quite sure of the competency of nature to bear without
risk a certain elevation, and equally sure of a limitation ;
while in another — the peritoneal — we have with no greater
elevation, perhaps, a constant menace, if not from the
violence or area of inflammation itself, from failure of a
very impressionable ganglionic system induced b)- that
inflammation.
In diflercntial diagnosis we are greatly aided by the
time which has elapsed since operation, when the eleva-
tion of temperature first manifested itself, as well as the
character of the case. If simple, with no adhesions, and
no accident has occurred, or unnecessary invasion of the
peritoneal cavity by the operator's hands or instruments,
we have ordinarily but one source of danger, that from
peritonitis, and we know, as a matter of clinical experi-
ence, that such a peritonitis would necessarily manifest
itself within seventy-two hours, and usually within forty-
eight. But suppose, in such a case, from the fourth to
the sixth day, and even many days later, we have a be-
ginning elevation attended by some pain, not colicky,
and tenderness, with absence of tympanites, what are we
to expect usually ? Not a peritoneal inflammation, for
that is prompt in declaring itself, as the peritoneum is
quick to resent any injury. We must look for causes ex-
tra-peritoneal, inflammation in a less impressionable tis-
sue, namely, the areolar tissue, and that, too, in the
abdominal wall alongside of the incision. Now this is
readily determined by gentle palpation and inspection.
The abdomen will usually be found soft in the iliac re-
gion ; but as the fingers approach the median line they
will appreciate that there is more firmness, if not already
induration, which might, from the fact of the line of in-
cision running between the recti muscles, give rise to a
longitudinal cellulitis, thus suggesting, perhaps, that it is
one or the otlier recti which is felt. The error will at
once be corrected when we remember that at such a time
the recti are not as readily detected, owing to their lax-
ness from long stretching by the tumor. We shall also be
aided in our diagnosis by the expression elicited from
the patient, who will complain of this or that point as
being tender to the touch ; these points will generally
be at or about the sutures. Later on, one may see an
asymmetrical elevation of the abdominal wall, caused by
the cellulitis. Having discovered these indurations we
may dismiss much of anxiety from our mind, as it is the
areolar tissues above the dense transversalis fascia which
are involved, and yield more readily than it to the pus
which almost invariably seeks an outlet alongside one
or more of the sutures.
In the treatment of such a condition as just related, we
should seek, by prudently abundant diet, to sustain the ■
patient, having no fear, as in peritonitis, of exciting peri-
stalsis, to the great injury and suftering of the patient.
Abscesses in such cases have usually but small influence
on the general progress of the case, are usually limited
in area and duration, being the result of a surgical in-
jury, and not of pyemia. As to temperature, it usually
ranges from 100.5*^ to 102°. Local applications are
rarely needed, though warmth is often agreeable, and
may be applied by means of spongio-piline, wrung out
of hot carbolized water, poultices, the hot water bag, or
the hot water coil — quite the opposite in principle to
the treatment of peritonitis, as will be seen. Resort to
the bistoury in such cases is rarely necessary, as i)us
very rarelv forms before time for removal of the sutures
on the eighth or ninth day, and it is through the tract of
the sutures that pus escapes.
Our study of the peritonitic inflammations will be
aided later on by the march of symptoms, as portrayed
in a simple uncomplicated recovery after ovariotomy.
In such, during the first twelve or fifteen hours, the in-
toxication and vomiting occasioned by ether — the latter
perhaps increased by the morphia given — are usually the
only disagreeable symptoms. There is acceleration of
pulse from ether stimulation, with a range of from one
hundred to one hundred and thirty per minute, the skin
remaining cool, temperature 99° to 100.5°. After lapse
of the time mentioned the temperature varies but little,
reaching perhaps as high as 100° during the first twenty-
four hours, then dropping down to 100° or 99°, there to
remain, or tending to approach more nearly still the
normal as time advances. The dressings tind sutures
may be removed on the eighth day, when, if the abdomi-
nal walls are thin, we may expect to find a perfect line
of union, and have now to wait but a few days before our
patient is quite well, so far as the operation is concerned.
The two great sources of elevation of temperature in
tumors of the second class are [jeritonitis and septi-
c:emia. It is an interesting clinical fact, that many of
the worst forms of tumors, whose attachments to the
parietes, deep in the pelvis, and even omental and intes-
tinal, are so firm and universal, seem to escape peritonitis.
January 6, 1883.]
THE MEDICAL RECORD.
Whether this is due to the fact, as I believe, that the
peritoneniii has not only k)st its special intolerance of
intrusion, but even its distinctive anatomical structure,
I cannot here discuss. Be this as it may, there are many
such cases where the violence done is so great as to
make one say at once, this patient must certainly die of
peritonitis, yet we often see such cases make rapid and
[lerfect recovery with a thermometric range not having
gone above ioi° F., and where, as I believe, the repair
of injury done is more like that following an injur)- to
the areolar tissue, possessing clinically none of those
evidences which we regard as characteristic of peritoneal
inflammation. But in such cases where /fr//w//'/V does
declare itself after ojjeration, it is usually witliin the
twelve or fifteen hours immediately after. There is no
chill, but within that time the temperature has steadily
risen to ioi° : the stomach rejects the little fluid re-
ceived ; the |5ulse continues high, and must not be mis-
taken for that of ether stimulation. Pain may be com-
plained of, but is not necessarily present, I suppose, from
the fact that the abdominal walls are so lax, that the
friction of peristalsis is reduced to a minimum, and that
often the peritonitis begins as pelvic, affecting the parietal
layer, the least impressionable by reason of its niore
passive state, so that the visceral, especially the intes-
tinal, is not affected in this variety. Generally within
ten or twelve hours more the temperature has risen to
102° to 103°; some tympanites now shows itself, wliile
the nausea is increased and the pulse continues its high
range. In patients of apparently good constitution this
condition may last three or four, or even five days, with
progressive severity of symptoms. 'l"he facies then begin
to express the serious impression made upon the system ;
dark rings encircle the eyes, which become sunken; the
pulse becomes more and more rapid, while the increasing
tympanites embarrasses the respiration, making it shallow
and thoracic ; the tongue is dry and parched, the mind
wanders, and the final collapse occurs. Such is the
usual march in pronounced cases'; in others the patient
will be seen to lose ground from day to day with little
elevation of temperatuie, and yet on autopsy will present
evidence of intense peritonitis. 1 mention this variety,
as one inexperienced in the peritonitis following ovari-
otomy might be quite unaware of the peril of his patient.
You will notice that I spoke of [leritonitis in this class
of cases, as beginning promptly, though perhaps not an-
nouncing itself by violent pain or excessive temperature.
It is in reference to the time in dilTerential diagnosis that
I would call your attention. It announces itself too early
for mural cellulitis, and too earl)- for septic£emia usually,
and the time of announcement should be for us positive
and pathognomonic of the condition, and should urge
us to immediate efforts to control at its very inception a
process so dangerous. Now the resources at our com-
mand are unfortunately mainly but two^morphia to con-
trol peristalsis and "the pain induced by it as well as
from the traumatisnii This must be given to absolute re-
lief from pain, not suffering the patient to be conscious
of such for one moment, in order that that element may
not be the one to destroy the repose of the patient. .\
more important matter of treatment is the application of
cold to the abtlomen, which is best made by the rubber
tube coil laid upon the abdomen, through which a continu-
ous current of ice-water flows, or by the use of the Kib-
bee cot, the latter a very disturbing and troublesome
method, and one, as I have almost uniformly seen, pro-
vocative of diarrhoea. The application of the coil should
be resorted to, where the character of the case is one to
warrant the belief that peritonitis will be excited, just as
soon as the temiJerature reaches ioo°, and the effort
made to keep it, the temperature, there. If peritonitis is
to be controlled by this means it must be taken at its
very inception, and before it has impressed the gan-
glionic system. We must protect the patient from the
danger due to the high temperature, regardful that there
comes a time when control of temperature is of no
avail, and that the patient sinks from peritoneal changes
or failure of ganglionic system as before mentioned. In
the early application of the coil we emjiloy it as a true
antiphlogistic. I do not say that cold will cure ])eritonitis
or always prevent it. I believe, intelligently applied, it
often does so modify its severity as to give the jjatient a
chance for recovery when it might have gone beyond
control.
I have thus far spoken of pure traumatic |)eritonilis, if
3'ou will let me for the time so call it, in contra-distinc-
tion from septicsemia with concomitant jjeritonitis.
Septicemia, as a rule, appears later than uncompli-
cated peritonitis, beginning very like it, and usually more
or less complicated by it. The temperature is usually
early more uniform or expressive of a mild inflanmiatory
process, for the reason that it takes some little time to
establish the condition septicemia, for nature is not over-
thrown at one blow in this more than in other diseases;
but once let that condition be established, and then but
a small septic absorption, be it continuous, is sufficient
to maintain it. Its usual period of manifestation is from
the third day on, and the usual picture is the following :
A patient with a temperature which has not gone above
ioi° to 102", whose stomach has not behaved badly be-
gins to show an increase of temperature, irritability of
the stomach, rapidity and feebleness of the pulse, devel-
oping tympanites, and then a peculiar hue spreads over
the face, one hard to describe, something between a
bronze or coppery hue, the result of a vasomotor paraly-
sis. This peculiar hue in such cases cannot be mistaken
by one familiar with it. The eyes sink, the tongue be-
comes at times red and very dry, at others dry and
brown, at times the eyes appear jaiindiced, and such a
tint sometimes oversjireads the body; but tlie usual hue
is the one mentioned, and called, for want of a better de-
scriptive name, coppery. If we follow the stage out, diar-
rhoea— a most usual accompaniment of septicemia — ap-
pears, and vesical irritation, when septic fluids bathe its
inverting peritoneum, delirium of a very mild type (I
am now speaking-of ovariotomy cases), and lastly coma,
blueness of skin, and death. I spoke of increased tem-
perature manifesting itself usually about the third day ; it
may appear before. It usually announces itself then by a
rapid elevation, followed at times by equally as rapid a
decline. When abdominal drainage is practised by
proper drainage-tubes in efficient hands, it is marvellous
at times to see the effect of removal of septic fluids from
the cavity through the tube, and the long continuance of
moderate temperature when that well into which the
tube enters is thoroughly washed out with either pure or
carbolized water. The cases which recover from such
abdominal drainage are septic cases, due to decompos-
ing fluids which have oozed from disrupted vessels from
various sources, or from ovarian fluids not of the dense
colloid variety ; in other words, fluids which will gravitate
to the well which the drainage-tube occupies. Unfortu-
nately where there has been an escape of dense colloid
material, drainage accomplishes but little, and septi-
caemia once established, as it surely will be, is fatal.
In the curable forms of septicemia our aim must be
the removal of septic fluids, control of temperature by
the coil, relief of pain by mori)hia, and cautious admin-
istration of nutriment either by stomach or bowel.
The limits of this paper will not allow of a full de-
scription of any of the inflammatory complications ; its
purpose is to show that there ought to be no uncertainty
in the mind of the clinician as to the origin and time of
manifestation of the usual manifestations after ovario-
tomy, and that certain definite resources are at his com-
mand.
Now there are other sources of elevation less impor-
tant, but complicating the diagnosis. Among these are
menstruation, cystitis, nephritis, and rarely subacute
tetanus, to say nothing of intercurrent diseases, particu-
larly malaria, pneumonia, and as the result of either and
exposure, bronchitis. The possibility of the occurrence of
THE MEDICAL RECORD.
[January 6, i88j
these should be borne in mind, and in doubtful cases care-
fully eliminated.
To sum up, simple cases, where the injury done is
only the abdominal section and severance of pedicle, ad-
mit, usually, of but two manifestations — peritonitis and
mural cellulitis.
The peritonitis will surely manifest itself before the
expiration of forty-eight, or at most, seventy-two horns ;
after the expiration of that time any elevation due to
0|)eration will be due to mural cellulitis.
In cases of the second class, ]jeritonitis may begin at
once, and still recovery take place luomptly ; while an
elevation which begins after the third day either an-
nounces scpiicamia or septo-peritonitis, or the more
harmless mural cellulitis, according to symptoms, the
differential points of which have been alluded to.
As a matter of course, either of the above conditions
may encroach somewhat upon the limits of the other, but
the main fact, the time of manifestation of each, remains.
I have given no space in this short paper to the dis-
cussion of the meiits of quinine as an antipyretic in septi-
ciEniia, for it avails very little and must not be relied on
as such ; the septic material must be removed, and can-
not be counteracted or neutralized by this or other so-
called antipyretics, though they may do something to-
ward maintaining the system in a general way. A fuller
consideration of matters germane will shortly be published.
THE ABSORPTION OF NUTRIENT ENEMATA.
By CHARLES L. DANA, iM.D.,
Nn.W "iORK.
The physiological process by which nutrient enemata
are absorbed is still a matter of dispute. Three theories
are offered : First, that the food is digested by ferments
which have descended from the upper parts of the ali-
mentary tract ; second, that the food is carried back by
" retrostalsis : " third, that it is digested by a local pro-
cess.
First. — The theory of the descent of ferments is cjuite
untenable, because the gastric and pancreatic ferments
are secreted ijiternuttently and only upon local stimulus ;
and further, because it is made (juite jjrobable by the
experiments of Langley that these ferments are destroyed
before they reach the colon.
Second. — Dr. Henry F. Campbell, of Georgia,'^ has
advocated with much force the theory that there is a
reversed peristaltic motion, or as he terms it, " retrostal-
sis," which carries the injected food into the small intes-
tine, where it meets some of the digestive secretions.
Considerable plausibility was given to this theory by
the interesting experiments of Professor Hal. C. Wynian,
of Detroit.^ He injected two dogs, one living, the other
dead, with a jjint and a half of colored milk ; and found
that in each case the milk passed up the whole length of
the small intestine. In two other living dogs he injected
four ounces of colored milk, and found that the fluid
passed up to the middle of the duodenum in one, and to
the middle of the jejunum in the other. \ fifth dog was in-
jected in the same way. .\ portion of the milk was im-
mediately rejected. The remainder passed no farther
than the ileocajcal valve. In the case of a man with a
fistula in the colon and another in the ileum, it was found
that half a pint of milk injected into the rectum was car-
ried lo the ileocaical valve, "and probably farther."
In fiirther support of the theory of retrostalsis, are
some clinical facts which show that, sometimes at least,
enemata may ))ass back into the small intestines,* or may
even reach the stomach and be vomited.'
Before commenting upon these I will record my own
experiments.
First. — Took a fifteen-pound living dog ; injected one-
* Kcad at the meeting of the Practitioners' Society, Dccctnljcr i, 1882.
' Gynccolog. 'I'rans.ictiniis, vol. iii., p. 268.
' Kort Wa> ric Juvirnal of the Medical Sciences, vol. i.. No. i., July, 1881, p. 4.
* Meti. and Surp. Hist, of the War, part ii., p. 836.
•R. ISaltry. Virg. Med. Monthly, 1878, p. 531.
half ounce carmine-colored milk. Examined two and one-
half hours later : Staining half way to ileoc;\;cal valve.
Seioiui. — Ten-pound dog, living (as were all those ex-
perimented upon). Injected as in first. Half hour later :
Staining to ileocecal valve.
Third. — Ten-pound dog. Injected as above. Bowel
full of fffices. Half hour later : Could not detect any
passing back of the fluid.
Fourth. — Fifteen-pound dog ; injected as above. Two
and one-half hours later : Most of milk in last half of
large intestine; slight staining just ahove ihocacal valve.
Fifth. — Twelve-pound dog. Injected one ounce of
carmine-colored milk. Two and one-lialf hours later ;
Bowel full of freces ; nothing above the ileocrecal valve.
Si.xtli. — Fifteen-pound dog. Injected as in fifth. Two
and one-half hours later: Some milk had passed eight t<f
ten inches above ileoccecal valve.
Sei'enlh. — Ten-pound dog. Injected one-half ounce
carmine-colored milk. Two and one-half hours later:
Milk had gone up only a little distance ; large amount
of fpeces in the bowel.
Eighth. — Ten-pound dog. Injected two ounces of
colored milk with some force. Two and one-half hours
later : Injection had passed up into the stomach.
Ninth. — Twelve-jjound dog. Injected one-half ounce
carmine-colored milk. Three hours later : It had passed
half-way up large intestine.
Tenth. — Ten-pound dog. Same as ninth.
Eleventh. — Twelve-i^ound dog. Same as ninth.
T^velfth. — Ten-pound dog. As in ninth, but injection
went to ileocecal valve.
Thirteenth. — Fifteen pound dog. Same as twelfth.
Fourteenth. — Ten-pound dog. Injected two ounces
iodized starch and water. Two and one-half hours later:
Injection went a little way beyond ileoccecal 'valve.
Fifteenth. — Twelve-])ound dog. Injected one ounce
colored milk. Three hours later : It had not gone be-
yond ileocffical valve ;. bowel full of faces.
Sixteenth. — Fifteen-pound dog. Previously had given
a cathartic which produced a passage. Injected one
ounce colored milk. Three hours later : It had not gone
above the ileocascal valve ; bowel not empty.
The injections were given with an ordinary hard rub-
ber syringe, and no especial force was used.
There was a source of error in Dr. Wyman's experiments,
in that he used very large injections. Even my own were
proportionately very large, two or three drachms being
as much for a dog weighing ten i)ounds as four or five
ounces for a man.
My experiments therefore showed :
First. — That large injections, forced in, may cause a
"retrostalsis" which will carry the mass by the ileo-
cecal valve and even into the stomach.
Second. — That ordinary nutrient injections of two,
three, or four ounces, pass back some distance.' and may
even reach the ileocecal valve, but do not go farther.
77//;v/. — That the injection is carried back much better
when the lower bowel is eiiipty, or comparatively so.
The few clinical observations which show that retro-
stalsis can take place, show also that it takes place only
under peculiar conditions, such as intestinal obstruction,
the use of large, forced or very stimulating enemata, in-
verted posture, etc. The assertion of some patients that
they taste the food given by enemata proves nothing.
Since we cannot explain the absorption of enemata by
retro-peristalsis, it must be that the process is local.
It is an established clinical and pliysiological fact that
nutrient enemata are absorbed. Bauer, for example,
found that in dogs enemata of pure albumen and acidu-
lated or saline meat were absorbed. In my cases about
one-half of the milk injected was absorbed within three to
four hours. The colon is quite vascular and has a large su[)-
ply of lympliatics. It is not an e-xcreting organ, as stated
by Dr. D. W. Bliss, but its function is to absorb. In soli-
* Dr. A. H. Smith has shown this to take place in biiinaii beings.
January 6, 1883.]
THE MEDICAL RECORD.
peds it lias a powerful digestive function. The secreted
juice lias in man a feeble proteolytic power (Eicliorst).
Albuminous food, wlien injected, speedily unilergoes
chemical changes and decomposition. In some of the
early stages of this process it is quite possible that the
changed albumen passes into the surrounding vessels.
Normal peptic digestion is only a decomposition with
many stages in it, during some of which the allniminous
matter is absorbed. It is not necessary that albumens
be maiie perfect peptones before they can ditTuse into the
• blood-vessels and lynijihatics.
Fats cannot be absorbed to any great e.xtent in the
colon or rectum. It is not necessary to iii<]uire whether
starches can be changed to glucose, since it is always
possible to add some form of ammal sugar to the enema
if that be thought necessary.
So far as my clinical experience goes, injections of
milk and beef-tea, especially the former, are very nearly
as etTective as the peptonized preparations, especially
those prepared with acid and pepsin. Dr. Bliss has pub-
lished some cases which seem to show that mixtures of
peptone and beef extracts are very effective. Such mix-
tures were Vecommended twelve years ago by I.eube
and M. Mackenzie, but they are costly. Doubtless solu-
tions of the iiowdered meat or milk, as used by Debove
and Dujardin-Beaunietz, would be useful. 1 have been
unable to convince myself tliat there is any magic in
peptone preparations or that they are absorbed nmch
more rapidly than carefully pre])ared and finely divided
meat preparations.
ON THE
DIAGNOSTIC VALUE IN PREGNANCY OF
VARIATIONS IN THE FREQUENCY OF THE
PULSE DUE TO CHANGES OF BODILY
POSITION.
13v II. D. FRY, Ml).,
WASTIINGTOX, D.C.
In June last Joiisenne stated {Archives de Tocolog'w) that
he had discovered a new sign of pregnancy, and claimed
to have been able by its means to diagnosticate the pres-
ence of that condition when there existed no other cor-
roborative evidence than the missing of a single cata-
nienial period.
According to his observations, and contrary to the
physiological law, the radial pulsations during pregnancy
number the same irrespective of the woman's position at
the time of examination. He directs that the pulse
should be counted "for the space of fifteen seconds whilst
the patient is standing, then sitting, and then reclining.
The order may then be reversed, and uniformly the same
number of beats will be recorded." '
The publication of this observation has attracted the
attention which the importance of such a statement is
sure to demand. It is especially in the first months of
gestation that the physician stands in need of reliable
evidence to assist him in the recognition of its existence.
At present he can, alas ! in too many cases, only stale
the prflbabilities and await the sequence of an ui'icertain
prediction which is to bring either hapjiiness or sorrow to
the unfruitful wife or sinning Eve. F'or this reason we
should endeavor to add to the means already at our dis-
posal any symptoms indicative of the presence or ab-
sence of a fecundated ovum within the uterine cavity;
and, when such a one is found, to ascertain its comparae
five value and appreciate it accordingly. By doing this
we may throw some light upon the subject of diagnosis
and prevent ourselves from being led astray by the un-
certain glimmer of an ignis fatuiis.
Shortly after reading a notice of Jorisenne's experi-
ments I had an opporlunitv to test the sign in a young
woman who was fearing the consequences of having
yielded to advances made soon after the cessation of her
menstrual flux of the previous month. The next cata-
' American Journal of Obstetrics, p. 316. Clctoher .Supplement, 1882.
menial period had then arrived, and not venturing to ex-
press a negative opinion based merely upon the absence
of this sign, I withlield the comfort which Nature brought
four days tardily. The cases of jiregnancy that came
under observation at a sufficiently early period were then
examined for this as well as other evidence indicative of
such a condition, and I purpose to show the value of the
sign in (piestion as presented in the histories of the cases.
The report embraces the observations made in ten
cases of pregnancy. Of these, seven had missed but one
menstrual period ; two had missed two ; and one had
missed three. It was in the first of these series of cases
that I wished more particularly to ascertain the value of
Jorisenne's sign. In order to attach any importance to
the results obtained we must be satisfied that the women
were pregnant. It is now ten weeks since these investi-
gations were commenced, and the subsequent histories,
which have been closely followed up, confirm the diag-
noses of pregnancy made at that time. Eight of the ten
women are married and have proved themselves "good
breeders." Two cases afterward aborted.
The number of the radial pulsations in the minute in
the different positions, for the first series, was as follows :
Case I -
Cnse
IV
Ca^e
V . . _
Case Vr _.
Ca'p
VII
Ca^-e
IX.
Case
X
Sitting.
Standing.
80
84
Si
8i
84
86
66
70
72
90
94
108
76
92
In Cases IV., V., and X. the jjulsations numbered less
standing than in the recumbent position. In I., VI.,
VII., and IX. they were more standing than lying; in
the first an increase of four beats, in the next of ten, in
the next of seventeen, and in the next of twenty. The
jnilse was the same in Case IV. standing and sitting, and
in Case I. sitting and lying. In Cases V. and X. it was
less sitting than either lying or standing, and in Cases VI.,
VII., and IX. greater sitting than lying, and greater
standing than sitting.
In the women who had missed two menstrual periods
the records were :
Lying.
Sitting.
Standing.
Case II
76
• 104
76
104
79
88
Case VIII
In one we see the [luisations were increased three
beats by assuming the upiight jiosition, and in the other
thev were diminished sixteen by the same change. In
both they numbered the same lying and sitting. The
remaining Case (HI.) in which pregnancy had advanced
beyond the third month the pulse was 82, 84, and 86 for
the corresponding positions.
Taking the ten cases we find that in five of them the
pulse varied, in the different positions, from three tt. six
beats, and in five cases from six to twenty.
These resurts certainly do not place Jorisenne's sign
very high in our scale of valuation. The number of ob-
servations is too limited to show exactly what, if any,
degree of confidence can be placed in this sign, but its
fallibility is proved beyond a doubt. Moreover, the same
examinations, repeated at subsequent limes, gave different
results. For instance. Case V. was, at the first examin-
ation, 88, 84, 86, and at another, 86, 94, 102.
These examinations were all carefully made and veri-
fied at the time by repetition. The inilse was counted
by the minute, and not the tVaction thereof, and in every
instance sufficient time was allowed for the circulation
to become settled al'ter each change of \Kisition.
8
THE MEDICAL RECORD.
[January 6, 1883.
A NOTK 0.\ IHE SULPHO-CARHOl.ATES,
And Especially on the Want of Uniformity in Prkp-
ARATIOXS BEARING THE SAME NaME.'
By H. p. FARNHAM, M.D.,
NEW YOKK.
It was 111)- intention to write a general paper on the want
of uniformity as to strength and qiiaUty in remedies bear-
ing the same name ; and the frequent injury to patient,
and disajipointment and annoyance to physician, arising
therefrom. To this end I had made some notes, which
in the turmoil occasioned by house alterations and re-
pairs have been mislaid ; and I shall be obliged to beg
the Society to excuse a short and hurried paper. There
are many articles of the Materia Medica which we should
never prescribe without knowing whe're the patient will
obtain the remedy, as we all know tliat manv accidents
occur from the fact that the different preparations vary
so in virtue that one may prove quite inert, and another
do serious injury from its une.xpected strength.
My especial aim this evening will be to call your at-
tention to the great difference in the compound salts
known as the sulpho-carbolates of soda and of zinc ; two
remedies that some of you know 1 have advocated for
several years as of great value in diphtheria, more es-
pecially in the earlier stages of the disease, always pro-
vided that the salts are properly prepared ; and this is
the essential point of this jiaiier.
The history of the origin of these salts is well known.
After the discovery of the anti-zymotic i)owers of the sul-
phites by Polli, in 1857, many experiments were made to
impro\e upon them and unite witii them the more power-
ful antiseptic carbolic acid, which was considered the
most efficient agent known for local use, but not avail-
able for internal administration, as it was not tolerated
by the stomach nor absorbed into the blood in sufficient
quantity to serve any good purpose.
After many unsatisfactory trials. Dr. A. E. Sansoni, of
London, succeeded in producing the double salts of car-
bolic acid, and exhibited specimens of them before the
Medical Society of London, reading a paper which was
reported in The Medical Tunes and Gazette^ Febrnar}' 22,
1868. In this paper he considered the sulphites as the
most easily absorbed of our internal antiseptics, and car-
bolic acid the most powerful, and '• that the great de-
sideratum was a salt wliich should combine the two, and
this desideratum he had succeeded in fulfilling in the
sulpho-carbolates.''
1 was much interested in these contributions of Dr.
Sanson! and gave the new salts several thorough trials —
at first always finding them disagreeable to my patient,
and unsatisfactory in their results. At length considering
it very prcjbable that it might be owing to some fault in
the diug itself I ordered the sulpho-carbolates from
Morson's, of London, and for the past eight or ten years
have prescribed no other.
Other chemists may prepare the salts as well, but
these have always given me satisfaction, and I have never
used any other that did not disappoint me.
In spite of the words Morson's only, always under-
scored, my i)atients liave several times been vomited and
prostrated by a mixture utterly unlike that prescribed in
smell, taste, and effects, and when 1 took the bottle on
one occasion to the apothecary wlio had dispensed it,
he excused liiniself by saying it was Merck's iJieparation,
and that Merck was as good a chemist as there was in
Europe.
I thought my little patient would certainly die from the
prostrating effect of the nauseous dose, and sent imme-
diately for the medicine I had ordered, which acted
promptly and favorably, and would not have been recog-
nized by an) body as the same prescription.
Wlien in London last year J called at Morson's estab-
lishment to make inquiries as to the cause of this great
' A paper read before the Materia Medica Society of New York.
difference, and was referred to the manager of their
manufacturing house. I went there and was informed
that their sulplio-carbolates were made precisely accord-
ing to the published formula, and the only probable
cause suggested for any superiority over some others was
that they were always most careful to make use of the
very purest carbolic acid.
Dr. Sanson! gives the method of producing the sulpho-
carbolates as follows :
" Sulpho-carbolic acid {Syn. Sulpho-phrenic acid,
C^H^jSOJ is produced by the admixture in equivalent
proportions of sulphuric and carbolic acids. I have ob-
tained the pure double acid in the form of very long,
colorless, finely acicular crystals, which are very deli-
quescent.
" The sulpho-carbolates are produced by neutralization
with the various bases."
He goes on to say under the head of '■ Preparation. —
I have found many specimens lacking the true character-
istics of a sulpho-carbolate. The danger is contamination
with : I, the sulphate of the base employed ; 2, the car-
bolate which evolves the odor of carbolic acid ; 3, free
sul|)huric acid ; 4, free carbolic acid. The»best method
is to produce, first, a definite sulpho carbolic acid by
taking equivalent weights of its components, and to
neutralize with the calculated weights of the o.xides em-
ployed. Crystallization should take place slowly with-
out heat.
" Tests. — Each suliiho-carbolate should possess a defi-
nite and decided crystalline form. They should give
off scarcely any odor of carbolic acid ; they should give
no precipitate with barium chloride," etc'
The specimens I present difl'er so decidedly from each
other that they can hardly be considered as belonging to
the same family. Examine the soda salts particularly.
That of Morson corresponds closely with the description
quoted above from Dr. Sansom, while the other does not
answer to it either in physical properties, taste, smell,
chemical or remedial eflects ; and it seems to me that
while it may be a mixture of the component parts of the
double salt, it is not chemically a true sul|)ho-carbolate
of soda.
To the eye -Morson's salt is in the form of beautiful clear
crystals ; the other is an amorphous powder. The for-
mer makes a perfectly clear, the latter a muddy solution,
in water. The former is a remedy that any one can take
without repngnance, the latter causes disgust and some-
times terrible vomiting and prostration. In a word, one
is a powerful antiseptic, that can be introduced into the
economy without any disagreeable effects, while the other
may have similar antiseptic properties, but with such
drawbacks as render it entirely unavailable as a substitute
for Morson's i)re[)aration.
Studying the Muscular Sense of Different Indi-
viduals.— Mr. Francis Gallon has been investigating
the muscular sense of various classes of individuals. He
used weights, the object being to find what difierence
could be detected by the persons handling certain weights.
These are his provisional results, subject, of course, to
correction, but surprising enough for all that : i. Intel-
lectually able men had more discriminating power on the
whole than women of a like cast of mind. 2. Men, as a
rule, had a greater ability of estimating accurately tiian
women. 3. VV' iiat appears strange is that women of very
sensitive natures did not seem to be more capable of dis-
tinguishing between different degrees than their more
callous sisters. 4. What is stranger still is that the
investigator says he found the blind, as a whole, were not
peculiarly sensitive to the test, but rather the reverse.
Some of the gentlemen in charge of our luiblic institutions
might profitably employ their leisure on such inquiries.
The (iicts would be probably of unexpected importance.
I Practitioner, vol. iii., pp. Sand 9.
January 6, 1883.]
THE MEDICAL RECORD.
^voQVCBs 0t ^edical Mcienci^.
The Operative Treatment of Pneumothorax. —
The following rules are laid down by Professor Weil, for
the treatment of pneumothorax occurring in phthisical
subjects : i. Most cases of this kind offer but little en-
couragement for operative interference. Yet in some
of even the most hopeless ones an operation may be the
means of prolonging life. 2. In some cases with a rel-
atively favorable prognosis, operative procedures may
not only prolong life, but may even lead to a complete
cure. 3. In the first five or six weeks after the develop-
ment of pneumothorax, an operation should not be
undertaken, unless the dyspnoea become so urgent as to
threaten life. 4. If the dyspnoea become severe soon
after the onset of the pneumothorax, and be not con-
trollable by narcotics, then puncture of the chest-wall is
necessary. If the dyspnoea speedily return, as it usually
does, owmg to nonclosure of the opening into the lung,
an incision must be made. 5. If several weeks later
asphyxia threatens, it is due to an accumulation of fluid,
which must be withdrawn by aspiration. Should this
prove unsuccessful, then there is nothing to do but to
make a free incision. 6. In cases with relatively favor-
able prognosis, it is advisable to operate, even though
there be no danger of life. In such cases, however, it
is better to wait from four to six weeks, as then the
fistula in the lung will probably be closed, and the fever
will also have subsided. Various procedures must be
adopted, according to the chaiacter and amount of the
exudation. 7. In cases where the fluid is in excess, and
the air has nearly disappeared, the indication is to draw
off the fluid in small quantities at a time, 8. In sero-
fibrinous exudations we should draw oft' small quantities
from time to time by simple puncture or by the aspira-
tor. 9. If the exudation become purulent, Senator's
method nuist be practised. 10. If a reaccumulation of
pus soon take place — the conditions being otherwise
favorable — incision must be practised at once. 11. If
the fluid remain scanty and the air be unabsorbed at the
end of five weeks or more, it would seem to be the most
rational plan to let out the gas through the aspirator
needle, and so bring the case under the seventh category,
where the conditions for further treatment are more
favorable. 12. If the case become stationary with a
moderate amount of fluid and considerable gas, the
withdrawal of both by the aspirator is indicated. —
Wiener Med. Wochenschr., No. 39, 1882.
Caffein for Hypodermic Use. — The ordinary prep-
arations of caffein are unsuitable for hypodermic use,
because of their slight solubility in w-ater. The so-called
acetate and lactate of caffein are in reality not salts, but
merely solutions of caffein in acetic and lactic acids.
The salts formed with the inorganic acids are unstable,
and not adapted for subcutaneous use. The fact that
this substance exists in coffee in the form of a double
salt of caft'ein and potassium, in combination with an
acid resembling benzoic, cinnamomic, and salicylic acids,
led Dr. Tanret to prepare similar combinations. He
found that caffein united readily with benzoate, cinna-
momate, or salicylate of soda, forming a double salt
readily soluble in water. The salicylate contains sixty-
one per cent, of caffein, and has been injected subcuta-
neously without causing the slightest irritation. — Schmidt' s
Jahrbiicher, No. 7, 1882.
Phenic Acid and Iodine in the Treatment of
Typhoid Fever. — Dr. Klamann {^AUgem. Med. Central-
Zeitiing, No. 81, 18S2) claims e.xceilent results in the
treatment of typhoid fever by carbolic acid and iodine..
To avoid carbolic-acid poisoning he gives very small
doses, as in the following formula : Tlnct. iodi., gr. viiss.;
acid, carbol. c. glycerin, gtt. x.; alcohol, dilut., 3 iiss.
From five to ten drops of this mixture are taken in coffee
or tea every hour or two. When diarrhoea is troublesome
the remedy is administered in tincture of rhatany. The
treatment should be begun early in the disease, in order
to obtain the most favorable results.
A similar plan of treatment is recommended by Dr.
Rothe (Alemorahilien, vol. xxvii.), who reports a number
of cases, in some of which the initial symptoms were very
grave, but all of which resulted favorably. The formula
employed by him is as follows : .\cid. carbol. et alcohol.,
aa TTj, viiss. to xv. (according to the age of the patient,
the intensity of the fever, etc.) ; tinct. iodi., gtt. x. to xv.;
aq. menth. pip., 3 iii ; tinct. aconiti, TTlxv. to xxx.; syr.
aurant. cort., 3 'v. Of this mixture the dose is a table-
spoonful every hour ; for children under ten years of
age, a teaspoonful. Owing to the aconite in this mix-
ture, however, it is difficult to determine how much of
the good effect is to be attributed to the carbolic acid
and iodine.
Tolerance by the Uterus of Traumatic and Sep-
tic Influences. — Dr. Valenta relates a case in which
the head of a full-term child, together with the jjlacenta,
was retained in the cavity of the uterus for six weeks.
The child presented by the shoulder, and after version
was delivered as far as the head. The latter resisting all
efforts made to extract it, the medical attendant simply
cut it off and went his way. After numerous attemiUs to
remove it, the head was finally extracted piecemeal after
remaining in the uterus for forty days. During this whole
period there were no signs of reaction, the pulse and
temperature remaining normal. — Schmidts JahrbUcher,
No. 7, 1882.
Leuc^mia and P.seudo-Leuc^mia. — Senator con-
tends that the only difference between leucremia and
pseudo-leucasmia is one of degree, according to the
greater or less proportion of white corpuscles in the
blood. The chaipge from one form to the other is not
unconmion. In cases of chronic anaemia, with enlarged
spleen, in which the number of white corpuscles is about
normal, the diagnosis is pseudo-leucjeinia (splenic anas-
mia). When, under the same conditions, the white cor-
puscles are increased in number, the disease is leucaemia.
Senator states that leucasmia is as common in children
as in adults. The question as to whether heredity or
unfavorable surroundings can be regarded as etiological
factors, the author is unable to decide. He denies any
dependence of leucKmia upon rickets, otherwise, he says,
since rachitis is so common a disease, leucsemia and
pseudo-leuctemia should be met with much more fre-
quently than is the case. — Deutsche Medicinal-Zeitung,
No. 42, 1882.
The Prognostic Value of the Tubercle Bacillus.
— Drs. Fraentzel and Balmer sum up the conclusions
derived from their investigations as follows : i. A defi-
nite prognosis in pulmonary tuberculosis may be made
from the number and stage of development of the tubercle-
bacilli found in the sputa. When they are numerous and
well developed the prognosis is grave. 2. The number
of bacilli in the sputum increases proportionately with
the advance of the destructive process in the lung, and
attains its maximum as the end approaches. 3. The
distribution of bacilli is not the same in all cases. Some-
times they are evenly scattered about in the sputum, and
sometimes are collected together in groups. 4. Their
appearance is not constant. They are often small, ill-
developed, and without spores. In such cases their
number is always small. 5, Such bacilli are found m
cases where the disease is progressing but slowly or has
been checked. 6. In all rapidly advancing cases of pul-
monary tuberculosis with high temperature, night-sweats,
etc., the bacilli are large and rich in spores. 7. In every
case in which the bacilli were plentiful there was high
fever, and the converse was also true. 8. The difference
in the quantity of bacilli in the fluid of a cavity and that
in the lung-tissue surrounding the excavation was very
lO
THE MEDICAL RECORD.
[January 6, i88j
marked. In the former they were very numerous, in the
latter scanty. 9. From this it appears that the sputum
affords a more favorable place of growth than does the
still living lung-tissue. 10. We may not ascribe the rich
development of bacilli in the lung-cavity to the presence
of oxygen, for they are equally abundant in the iniru-
lent secretion of a tuberculous joint. — Berliner Kiui'tsche
Wochensehrift, November 6, 1882.
St'RGic.AL Treatment of Intestin.al Obstruction.
— Dr. Kronlein relates several cases of obstruction of
the bowels successfully relieved by operation. Where
the occlusion is caused solely by obstinate constipation
he recommends massage, cathartics, and eneniata ; but
in acute obstruction he advises that no time be lost
through trial of these measures, but that an operation be
resorted to at once. Simple laparotomy and search for the
point of obstruction is, according to Dr. Kronlein, usually
unavailing, because of the marked meteorism. Laparo-
enterotoniy is the operation which he prefers. An inci-
sion is made in the right iliac region, and the portion of
the gut which presents at the opening is seized and
stitched to the abdominal wall. If the intestinal canal
become permeable again the artificial anus may be closed ;
but, in any event, the author does not consider that life
with an artificial anus is so unendurable as many are
accustomed to suppose. — Correspondenzblatt fiir Schwei-
zer Aertze, Nos. 15 and 16, 1882.
Cretefaction of the Ganglionic Cells i.n Myeli-
tis.— Dr. Friedlaender relates three cases of poliomyeli-
tis in which a cretefaction of the cells of the anterior
horns was observed. The author believes, on the strength
of his own investigations and those of others, that calci-
fication of the ganglionic cells is always present in acute
myelitis. He thinks that the alteration of the cells in
poliomyelitis is due to some infectious agent ; and he is
inclined to regard it as an infectious disease, a view of
which many of the symptoms of the affection, he thinks,
are confirmatory. — Centralblait fiir Klin. Med., No. 28.
1882.
Prophylaxis of Tuberculosis. — .\ccepting the in-
fectious nature of phthisis. Dr. Veraguth advises the fol-
lowing prophylactic measures : The sputa should always
be disinfected. Those predisposed to tuberculosis should
avoid health-resorts which are frequented by phthisical
subjects. Great care should be taken to procure milk
from perfectly healthy cows, both for infants and adults.
Lastly, Dr. Veraguth thinks that the State should forbid
the marriage of all persons suffering from phthisis or of
those predisposed to the disease. — Centralblatt fiir Kliti.
Med., No. 28, 1882.
Influence of various Irritants upon the Intes-
tinal Muscular Fibres. — From a large number of e.x-
periments undertaken to determine the influence e.xerted
by various salts upon the smooth muscular fibres of the
intestine. Dr. Nothnagel has formulated some important
conclusions. He states that the effects of the potassium
salts are very different from those of soda when applied
locally to the wall of the intestine in living animals. Af-
ter the application of a salt of potassium, a strictly local
contraction ensues, while the irritation from sodium salts
results in a contraction tliat is propagated along the in-
testine for some distance upward toward the pylorus.
In the latter case it was often noticed that the contrac-
tion commenced several lines distant from the point of
irritation, while the point itself was not affected. This
never occurred when potassium was used. The contrac-
tion after sodium was slower, less marked, and of siiorter
duration than that from potassium. The only other salts,
of a number tried, that caused a similar effect to the
sodium salts, were those of ammonium. As to the ques-
tion, whether these contractions arise from direct irrita-
tion of tlie muscles, or through some nervous influence,
Nothnagel asserts that the potassium salts act directly
through the muscles, but that the effect of the sodium
compounds is to be otherwise e.\plained. In a living
animal, after the mesentery has been stripped off, the re-
action of the muscular coat of the intestine occurs as be-
fore. But in animals killed b)' breaking up the medulla,
while the contraction after application of the potassium
salts is unchanged, that from sodium is either entirely
abolished or has lost its peculiar character. This fact,
together with the peculiarities before mentioned, would
seem, in the author's opinion, to point to a nervous inter-
position in the reaction following irritation from sodium
compounds. Dr. Nothnagel is as yet unable to ac-
count for the curious fact of the ascending contractions.
The experiments were made on rabbits and cats. — Cen-
tralblatt fiir Klinische Medicin, No. 29, 1882.
Acetonuri.a.. — Dr. Jaksch asserts that acetone is a
normal constituent of the urine, and occurs as a constant
product of tissue changes. In health it is found in very
small amount (about one-sixth grain only, in the twenty-
four hours), but in certain pathological conditions it may
rise to an appreciable quantity. Acetonuria exists not
only in diabetes, but is also almost constantly present in
high continued fevers. The amount of acetone, usually
several grains, bears a pretty constant proportion to the
height of the fever. The author has never seen the ex-
cretion of acetone in appreciable amounts in apyretic
conditions, except in certain cases of carcinoma, hy-
drophobia, and diabetes mellitus. Gerhardt's chloride of
iron test (a red color of the urine upon the addition of
ferric chloride) does not, according to Jaksch, indicate
the presence of acetone, but of acetic acid. The latter
very readily, however, becomes converted into acetone
under the condition of warmth and in the process of dis-
tillation. The author has occasionally observed the X.vio
substances together in the urine in diabetes, measles,
scarlatina, and pneumonia. He recommends Lieben's
iodoform test for the qualitative determination of the
presence of acetone in the urine. From a half to one
pint of urine is mixed with a moderate amount of hydro-
chloric acid and put into a retort. The first few drops
that are distilled over are treated with caustic soda and
biniodide of potassium, with the result, if acetone be pres-
ent, of the formation of a cloud of iodoform. The sub-
stance is easily recognized by its odor, and further, if the
fluid be made to boil, it rises with the steam and is con-
densed on the cool glass in crystals of six-sided plates,
or six-pointed stars. When acetone is present in large
amount, previous distillation is not always necessary. To
estimate the quantity of acetone in a given specimen of
urine, the author gives the following directions : The en-
tire quantity of acetone in a measured amount of urine
must be transformed into iodoform by the addition of
sufficient caustic soda and biniodide of potassium. The
resulting cloud is to be compared to that obtained in a
proof solution containing a known amount of acetone,
and the two deposits made of equal density by the addi-
tion of water to one or the other solution. The propor-
tion of acetone can then be determined by the formula,
;c= v'; j;=the quantity of acetone to be determined,
a = the amount of acetone in the proof solution, v = the
entire volume of the fluid containing the distilled urine,
t/ = the entire volume of the proof solution. — Centralblatt
fiir Klinische Medicin, No. 29, 1882.
Influence of Intrabronciiial Pressure upon
THE Circulation. — Professor Sommerbrodt states, upon
the strength of a number of experiments made by himself,
that rapid respiratory movements, inhalation of com-
pressed air, speaking in falsetto, or any other act which
causes an increased pressure of air within the bronchi,
will give rise to dilatation of the blood-vessels and accel-
, eration of tlie heart's action. He explains this effect as
due to a reflex loss of tone of the vasomotor system,
consequent upon irritation of the pulmonary nerves.
The purposes served by this arrangement are thus set
forth by the author : i. It contributes to the freer blood-
January 6, 1883.]
THE MEDICAL RECORD.
II
supply of the muscles. Muscular exertion causes deeper
res|)iration, and this in turn increases the rapidity and
volume of the circulation. 2. It projnotes the rapid ex-
cretion of waste material through the kidneys. 3. It
serves to regulate the temperature of the body by reason
of the increased peripheral circulation. 4. It guards
against the dangers of venous engorgement, which is the
first result of intrabroncliial pressure, by the compensa-
tory arterial dilatation and increased cardiac action. — •
Correspondenzblatt fiir Sclnveizer Aerzte^t^o. 20, 1882.
Reduction of Strangulated Hernia without
Operation. — The following simple procedure is stated
by Dr. Finkelnstein to have been successfully employed
in the reduction of a large number of cases of strangu-
lated hernia : The patient is placed in the ordinary po-
sition upon the back, and every fifteen minutes one or
two tablespoonfuls of ether, mixed with a little oil, are
poured upon the tightly stretched skin over the intestine.
In the course of an hour the bowel usually slips back of
its own accord into the abdominal cavity. This action
is explained by the author in cases where the strangula-
tion is caused by contraction at the orifice of the hernial
sac, as due to relaxation of the inguinal ring fiom the
ether. In other cases, where no contraction exists. Dr.
Finkelnstein refers the favorable result to a double ac-
tion of the cold in causing a diminution in size of the
knuckle of intestine and in setting up forcible peristaltic
movements. The oil is added to the ether, in the pro-
portion of 20 parts to 100, simply to prevent local irrita-
tion of the skin. — All gem. Med. Ccntral-Zeitiing, No-
vember 4, 18S2.
Clinical Significance of Peptonuria. — ^Dr. Jaksch,
Jr., records the results of a number of examinations
made to determine the presence of peptone in the urine.
In leucocythfemia, although peptone was found in the
blood, it was not in the urine. This fact, he thinks, to
be confirmatory of Hofmeister's view, that peptone cir-
culates in the blood in connection with the white cor-
puscles. The latter are not broken up, hence the pep-
tone is not set free. Peptonuria existed in a number of
cases of empyema, but as a rule only in those in which
the conditions were favorable for the reabsorption of the
pleural exudation. As regards the prognostic value of
peptonuria, the author thinks that the excretion of pep-
tone in the course of pneumonia, acute articular rheuma-
tism, meningitis, etc., indicates that the inflamjiiatory pro-
cess is subsiding. — Wiener Med. Wochenschr., No. 42,
1882.
Influence of Excision of the Primary Induration
upon the Subsequent Course of Svphilis.— In cor-
roboration of the views expressed by Dr. Morrow, in a
paper read recently before the New York Academy of
Medicine, the following conclusions of Dr. Tomaschewski
{IVra/se/i, Nos.i6and 17, 1882), derived from observations
upon upward of fifty cases, may be of interest : i. The pri-
mary induration is to be regarded not as a local affec-
tion, but as the first objective symptom of syphilis. 2.
The excision of the chancre, at whatever time it may be
practised, does not protect the patients against subse-
quent manifestations of the disease. 3. The wound left
after the removal of the induration heals usually by first
intention. 4. In the majority of cases the induration
does not return after excision. 5 and 6. Excision cuts
short the duration of the local sore, but has no effect
upon the general disease. 7. The period of incubation of
the secondary symptoms is not sensibly modified. 8.
The general character of the gland affections is un-
changed, g. The secondary affections of the skin and
mucous membranes are influenced in no way by excision.
10. The influence of syphilis upon the general health is
ajjparently the same. ii. The cure of the disease is not
hastened. 12. Relapses, whether as regards their char-
acter, intensity, or time of occurrence are unaffected by
excision of the primary indurated sore. x\s opposed to
these conclusions may be mentioned a communication of
Dr. Saccharewitsch {Ibid., No. t,-^., 1882). The writer states
that he has performed excision of the indurated chancre
in a small number of cases, with the effect of either pre-
venting further manifestations of syphilis or materially
shortening their duration. He therefore recommends
the practice to be followed in all cases.
Relation P>et\veen Certain Eve Diseases and
Affections of the Female Generative Organs. —
The frequent occurrence of diseases of the eye during the
progress of various disorders of the female generative
apparatus has been noted by Dr. Rempoldi [Journal de
Medicine de Paris, November 4, 1882). Among the
menstrual disorders which may be accompanied by con-
junctivitis, simple or phlyctenular keratitis and iritis, the
author mentions es|5ecially amenorrhoea. But suppres-
sion of the menses from various causes may also be at-
tended by affections of the choroid, by optic neuritis,
retinitis, and glaucoma. In the course of inflammatory
diseases of the sexual organs are frequently observed
iritis and sclerotitis with trigeminal neuralgia. During
pregnancy and lactation, Dr. Rempoldi has observed
conjunctivitis and pannus. Among the diseases appear-
ing toward the cessation of lactation, are noted corneal
ulcerations, retinal hvperassthesia, disturbances of ac-
commodation, photophobia, and retinitis. The author
includes hysteria in the list of sexual disorders, and men-
tions asthenopia with retinal hyperesthesia, and ptosis
with retinal anesthesia, as having been observed at differ-
ent times in hysterical subjects. Finally, he notices the
ocular disturbances dependent upon the albuminuria of
jiregnancy, and amblyopia consecutive to uterine hem-
orrhages.
Pathology and Treatment of Uterine Displace-
ments.— The following practical points are set forth by
Schultze, in a recent monograjih upon uterine displace-
ments : The normal condition of the uterus is one of
very free movement, as can be readily demonstrated in
the living subject. Changes of position that are perma-
nent are pathological deviations. Restriction of normal
movements is the characteristic sign of displacements.
These consist in (i) fixation of the organ through in-
flammation, and (2) malposition resulting from relaxation
of the ligaments. In the first class, treatment should be
directed against the inflammation, in the second, the
weakened ligaments should be assisted by mechanical
means. DysmenoiThoea and sterility in anteflexion and
anteversion arise not from change of position, or sup-
posed stenosis, but are due wholly to the coexisting
metritis or parametritis. Treatment should be directed
against the inflammation, and not against the assumed
stenosis or the malposition. In retroflexion, on the
contrary, mechanical treatment is indicated. — Berliner
Klin. Wochenschr., No. 32, 1882.
Avoidance of Iodoform Poisoning. — In a prolonged
discussion on the utility and disadvantages of iodoform,
at a recent meeting of the Berliner Medicinische Gesell-
schaft. Dr. Steinauer had occasion to make some prac-
tical suggestions. Iodoform, he stated, when applied
locally was always absorbed, though very slowly, and its
action was a cumulative one. Hence it was advisable
to remove the dressings after five or six days, and sub-
stitute some other antiseptic agent — carbolic acid, thymol,
salicylic acid, or the like. Iodoform ai)pears in the urine
in the form of iodine, in combination with an alkali.
We can readily determine its presence by adding nitric
acid and starch to the urine, and shaking the mixture,
when the blue color appears. We have thus a simple
means of estimating the amount of iodoform absorbed,
and can judge whether danger of poisoning exist or not.
The lethal dose in man is difficult to determine. In
animals it is stated to be as follows : Guinea-pigs, thirty
grains ; rabbits, forty-five grains, and dogs, one drachm.
— Berliner Klin. Wochenschr., No. 42, 1882.
12
THE MEDICAL RECORD.
[January 6, i88j
The Medical Record:
A Weekly Journal of Medichte and Stir gery.
GEORGE F. SHRADY, A.M., M.D., Editor.
Published by
WM. WOOD &. Co., Nos. 56 and 58 Lafayette Place.
New York, January 6, 1883.
THE NEW VOLUME OF THE RECORD.
With the present issue The Medical Record materi-
ally increases its size and correspondingly improves its
general appearance. The adoption of a larger page and
a longer column will enable us in future to devote more
space to communications, while the change in the general
arrangement of the journal will give us even better op-
portunities than formerly of publishing the latest import-
ant news up to the last moment of going to press. By
all these means we hope to add to the general usefulness
of The Record as a medical newspaper, and make it,
in this respect, more acceptable than ever to our readers.
Our corps of special correspondents both at home and
abroad has received such additions as will guarantee us,
by letter and telegraph, the latest information concerning
the matters of medical interest transpiring in the different
medical centres of the world. The larger amount of
space at our disposal will afford us e.xtra facilities for the
prompt insertion of a greater number of communications,
better opportunities for the discussion of medical sub-
jects while they are fresh and interesting. In these re-
spects we shall be better able to meet the more urgent
demands of the journalism of the day, and to minister
to the pressing needs of the active, practical, and pro-
gressive workers in our ranks. With such aims in view
the character and variety of material furnished will be
such as shall be most useful and instructive to the larger
number of professional readers.
In this connection we are pleased to state that extra-
ordinary pains have been taken to secure for our
readers during the year a largely increased variety of
practical articles. We have conceived the idea of
gathering anew some of the more recent views concern-
ing the pathology and treatment of many of the com-
moner diseases which are met with in general practice.
Papers on these different subjects will be prepared
specially for The Record by many distinguished gentle-
men in this and otlier cities. In tiiis way we hope to
compass a good part of the field of practical medicine
and give to the general reader a guide for his treatment
of such diseases as he meets from day to day. These
articles, taken collectively, may serve to furnish him
with a text-book of more than ordinary value added to
the other features of The Record. Many of these com-
munications are already in hand, while the remainder,
the subjects of which have been selected with especial
care, are promised when the time for their publication
arrives.
We believe this to be a departure in medical jour-
nalism which will be duly appreciated by every one who
desires to hear the opinions of experts in these different
branches of medicine. Even if there is nothing new to
most of our readers in the treatment of this or that dis-
ease, it is a comfort to know the fact and to be assured
that they are working side by side with men of larger
experience whose general results tally with those of the
average practitioner. In any case the reader can be
assured that the subjects will be presented with the
view of bringing out the new and practical points con-
nected with them. In another place the list of these
subjects and their authors is announced. It is perhaps
unnecessary to say in addition that everything which
can be, will be done to make The Record attractive
and maintain its previous character as a faithful and im-
partial exponent of the medical opinions of the day.
We simply owe this to our subscribers and it shall be
our constant aim to do what we consider a plain and
pleasurable duty.
COLD IN THE TREATMENT OF FEVERS.
At the recent German Medical Congress ( Verhandlungen
des Congresses fiir Inner e Medic in, 1882) a prolonged
discussion was had upon the treatment of fevers, and
especially of typhoid, by the antipyretic method. Lie-
bermeister was quite naturally the first to be heard and
he stated the following propositions : In many fevers
there exists in the elevated temperature an immediate
danger to the patient. In such cases the problem for
the physician is to overcome by suitable means this men-
acing condition. The foundation of all antipyretic treat-
ment consists in the withdrawal of heat from the body,
by means of cold baths. In many cases the administra-
tion of antipyretic drugs, such as quinine or salicylic
acid, is also judicious. The speaker unhesitatingly ad-
mitted that there might have been some patients injured
by too energetic bathing, but he contended that- their
number was quite insignificant in comparison with the
thousands whose lives had doubtless been lost through
the neglect of this mode of treatment.
He was ready to welcome any method that would
accomplish the desired result, i.e., the reduction of a dan-
gerously high temperature. But he considered the treat-
ment by cold baths to be the simplest and most effica-
cious means to that end. The danger of an elevated
temperature lay in its long continuance. So that, if we
could induce a marked remission, even if it were only
for a short time, the peril was thereby greatly lessened.
His own habit was to have the baths given during the
night, sometimes as often as once in every hour. But in
the day time he usually let the fever take its course. The
patient was placed in the bath whenever his temperature
rose to 104°. The speaker in concluding said that he
wished to correct an erroneous impression that seemed
to have arisen, namely, that he treated everything anti-
pyretically, and only antipyretically. If there were a
specific remedy for typhoid fever he would gladly employ
it, but until it was discovered he should treat the symp-
toms as they arose.
January 6, 1883.]
THE MEDICAL RECORD.
13
Riess, of Berlin, thought that we should try not only
to obtain remissions of the fever, but to reduce the py-
rexia to the lowest possible degree throughout the entire
course of the disease. A large experience had led the
speaker to prefer the cool bath to the internal adminis-
tration of antipyretic remedies. He used water of a
temperature of about 87°, and he kept the patient lying in
a sort of hammock, suspended in the bath sometimes for
an entire day. Such a long immersion was seldom ne-
cessary after the first day of treatment. Afterward the
patient was placed in the bath whenever the rectal tem-
perature rose to 101°, and removed again when it had
fallen to 99°. The discussion was continued by Jiirgen-
sen, Gerhardt, and others, and of course the speakers
differed somewhat as to the relative merits of cold water
and internal antipyretics. Tlie general consensus of
opinion, however, seemed to be to the effect that, in
certain cases, the employment of the cold bath was of
the highest utility, not only in shortening the duration of
fevers, but also in saving life, especially where there was
danger from hyperpyrexia.
We can certainly not presume to ijuestion the accu-
racy of these German observers, nor yet doubt the hon-
esty of their conviction. Nevertheless v/e should re-
member that,- though faithfully tried in our country, the
cold-bath treatment of typhoid fever has not yielded re-
sults that have popularized this therapeutic plan with us.
Thus it would seem that we are driven to conclude
that climatic or constitutional influences of a peculiarly
American character prevent us from reaping the bene-
fits which tlie cold bath appears to yield in other
countries.
Certainly a direct abstraction of heat from an over-
heated body appeals to the mind as a rational method
of treatment. But in the human body we are at no time
dealing witli purely physical problems. There can be no
doubt that the chilling effect of inniiersing the entire
bodv in cold water must profoundly impress the nervous
•system. And often, no doubt, the shock thus ex-
perienced may prove potent for evil. The steady use
of the wet sheet seems, alter all, a more harmless, and so
perhaps equally efficacious procedure.
In this connection we are also reminded of a sugges-
tion recently made by Dr. J. VV. Stickler, of Orange,
N.J. He has described a bed (see Medical Record,
April 15, 1S82) which allows the patient to be put under
the cooling influence of cold air, continuously applied.
This method of reducing high temperatures seems, a
priori, a convenient and rational one. We are not
aware, however, that it has ever been extensively em-
ployed. But it would certainly seem to deserve a fair
trial. And perhaps it may eventually prove a good and
safe substitute for the cold bath with its inherent dangers
and inconveniences.
THE PARIS EPIDEMIC AND ITS LESSONS.
The epidemic of typhoid fever has subsided in Paris,
although the disease is still present, and there were quite
lately over one hundred deaths per week from it alone.
The doctors of Paris have been busy of late in dis-
cussing the subject and trying to draw some conclusions
that will be profitable to themselves and the world.
The epidemic, it is said, was malignant in its " mor-
bidity," but benign as regards mortality. The disease
was characterized by some peculiar features, such as the
frequent development of thrush and of bed-sores, and the
tendency to relapse after convalescence had set in.
In the matter of treatment it seems to be confessed
that no evitlence had been found to prove peculiar effi-
cacy for antiseptics, antipyretics, or any other special
methods. The statistics offered by various persons are
of little value. No better results were obtained by anyone
than by Dujardin-Beaumetz, who reported 87 cases with
4 deaths, under the expectant plan. M. Lancereaux,
who ado|)ted the traitement des indications, reported 57
cases and only 5 deaths.
The conclusion to be drawn from the Paris epidemic, as
regards the therapeutics of typhoid fever, is that the dis-
ease must be watched, not actively treated. " L' expecta-
tion armi'e" was the term happily chosen as their best
therapeutic guide by several who discussed the matter.
We believe that the sooner this view is taken, and typhoid
fever is looked upon as a disease like small-pox or scarlet
fever, whose course the physician cannot greatly modify,
but whose dangers we can, in part, avert, the better it
will be for our science and our credit.
The matter of etiology has received much discussion
from our French brethren. There has not been, hereto-
fore, entire unanimity among them, as to the contagious-
ness of typhoid fever in cities. The history of the recent
epidemic showed, however, that such contagiousness ex-
isted in a very mild degree. Among attendants in the
hospitals, 24 caught the disease ; of these 8 were patients,
1 1 nurses, 4 nuns, and i a medical student.
The origin and raind spread of the disease are ascribed
to tlie overcrowding of human beings, filth, and bad
drainage. Some were disposed to add another factor : a
peculiar modifying influence of the atmosphere. It ap-
pears to have been quite impossible to trace the spread
of the disease from house to house, or family to family,
or to ascribe it to any specially infected drinking-water.
The vague element of " epidemicity " has, therefore, to
be called upon.
THE IMMIGRANT .AND SMALL-POX.
Dr. John H. Rauch, in his last monthly report as Su-
perintendent of the Immigrant Inspection Service, lays
down the following propositions upon which he bases ar-
guments for the continuation of his service :
'■^ First. — The immigrant is a prime factor in the origin
and continuance of small-pox in the United States — on
the one hand, even if protected himself, often being the
bearer of the contagion in clothing and other effects ; and,
on the other, if unprotected, frequently becoming a vic-
tim to the disease and propagating it to others.
" Second. — Local effort and expenditure, either by States
or munici|)alities, are inadequate to the control of small-
pox in any given community or commonwealth, so long
as the contagion and the material for the propagation of
the contagion continue to be replenished by repeated ac-
cessions of unprotected or imperfectly protected immi-
grants.
" Third. — K continuous sanitary surveillance of im-
migrant travel, from the port of arrival to the point of
ultimate destination — such surveillance to consist of re-
H
THE MEDICAL RECORD.
[January 6, 1883,
peated inspections, vaccination of all unprotected, s_vs-
tematic observation of suspicious sickness, prompt re-
moval and isolation of discovered small-pox or other
contagious cases, disinfection of baggage, clothing, cars,
etc. — is essential to supplement whatever preventive
measures can be secured before embarkation, during the
voyage, or at the port of arrival."
Regarding the point that the immigrant is the chief
source of small-pox in the United States, considerable
evidence is adduced, yet hardly enough to establish the
claim that is made. Dr. Elisha Harris writes that in
New York State thirty per cent, of all the outbreaks have
been traceable to immigrants. The evidence from West-
ern health officers is not so comprehensive.
In discussing his second and third propositions, Dr.
Ranch criticises unnecessarily the views we have taken
regarding his service. We quite concede the importance
of his work and should regret to see it stopped. It ap-
pears, however, to be irrational for the United States
Government to establish inland quarantine for the pro-
tection of certain districts of the country, leaving other
quarantines neglected. There should be, rather, inter-
national quarantine regulations and a uniform and mari-
time quarantine ; then, if this does not suffice, let eacii
State take care what diseases enter its boundary. The
results of depending upon surveillance after arrival and
distribution of innnigrants begin is shown in Dr. Rauch's
own figures. Among 130,000 persons who in the past
six months were added to the population of the North-
west, 23,000, or nearly one-fifth, escaped inspection in
the Western District.
It seems somewhat futile to inspect four-fifths of the
immigrants and leave the rest to disseminate disease as
they will. We trust, therefore, that our Government will
attack the evil nearer its source. At the same time we
can hardly blame Dr. Rauch for being optimistic, and
perhaps a little egotistic, over his own very excellent work.
A R.\D1C.\L HE.^LTH ORDINANCE.
The authorities of Paterson, N. J., have had a hard
struggle with contagious diseases during the past year.
With regard to small-pox, especially, the efforts made
for its control have been so unsuccessful as to give rise
to much criticism.
An ordinance has recently been passed, however,
which is evidently expected to place health matters upon
a very solid basis. These new regulations provide for
a most stringent compulsory notification of infectious
diseases. Section I. requires every physician to report
to the Board, in writing, the particulars of each case of
contagious disease upon which he is in attendance ; if
death occur, another notice must be given by the
people's very good servants — their doctors.
Similar notification of the presence of contagious dis-
ease must be given by all hotel and boarding-house
keepers. School-teachers are forbidden knowingly to
permit the attendance of children suffering from any
contagious disease. The same prohibition is put upon
parents and guardians.
The most stringent regulation, however, relates to
Section VII., wliich reads as follows :
" It shall be the duty of liie Health Inspector, imme-
diately upon report being made to the Board that any
person is sick with small-pox, or any other pestilential
or contagious disease which may be considered by the
Board to be dangerous to the public health, to affix or
cause to be affixed to the front part of the house in
which such sick person niay be, a sign, upon which shall
be painted or printed in large distinct letters the words
'small-pox,' or such other disease, as the case may be."
The '"other contagious diseases" which are to be thus
advertised are : scarlet fever, diphtheria, typhus, vario-
loid, cholera, yellow fever, or any other disease publicly
declared by the Board of Health to be dangerous.
This plan of home-advertisement of contagious disease
has been tried in Chicago, if we remember correctly- It
there failed, because the people did not like it, and there
were constant evasions of the law. It may do better in
Patterson, although we confess to being skeptical. It is.
not wise for the sanitarian to invade the domestic hearth
too aggressively.
A NEW CITY INSANE ASYLUM.
At last our city authorities are beginning to realize that
some change must be made in the care of its insane. The
Board of Estimate and Apportionment have received
from the City Charity Commissioners a communication'
asking that provision be made for the purchase of a large
farm near the cit}' upon which a new asylum can be
built.
It is proposed that plain, substantial buildings be put
up here, and that the chronic, able-bodied insane be
transferred to them. Such a place could be made to
furnish occupation, care, and shelter for one-third or
more of the inmates of the City Insane Asylum orv
Ward's Island. It is recommended that the site be
upon tlie water front, so as to be more accessible.
There are now over twelve hundred occupants in the
Ward's Island Asylum, a number which greatly over-
crowds its capacity. The project of establishing a sep-
arate asylum for chronic cases has been several times
urgtd by us. We are glad to learn that it now promises- _
to be adopted.
Similar provision will soon have to be made also for
the chronic female insane upon Blackwell's Island.
The asylum there contains a still larger number of pa-
tients than lliat on Ward's Island, and the necessity for
separate care and treatment of the chronic cases is very
great.
BROKEN THERMOMETERS.
The misfortunes of our correspondent. Dr. A. A. Lyon,
with his thermometers, have called forth much sympathy
and advice. We are in receipt of numerous letters from
various readers, describing their instructive experiences
and the way m which they have finally succeeded in
averting the catastrophes that have so overwhelmed Dr.
Lyon.
We can hardly do justice to the suggestions of all of
our correspondents. And we must be especially brief
with some of our enterprising instrument-makers, whose
concern over broken thermometers is not, we fear, en-
tirely free from commercial calculation.
The following embody the chief points made on the
subject in hand :
January 6, 1883.]
THE MEDICAL RECORD.
15
Dr. \V. R. Fisher, of Hoboken, recommends the use
of a German silver case, with a small wad of cotton
placed in either end ; as a further precaution, the tlier-
mometer should be carried in the pocket-case.
Dr. T. ¥. Houston, of Clarkesville, Ga., Dr. Foster,
of IVfoosup, Conn., and others, recommend the same
plan, which, we believe, is a connnon one, and as re-
gards the pocket-case, it is not always practical or conve-
nient. One correspondent carries his thermometer in
the upper vest pocket, the edge of which is stitched,
leaving just enough space for the instrument to slip in.
A rubber strap twisted about the case helps to prevent
it falling out.
Dr. Charles C. F. Gay, of Buffalo, calls attention to a
specially devised case manufactured by Tiemann & Co.,
of this city. This case contains, among other things, a
place for a clinical thermometer, in which that instru-
ment can be carried with security. Any case can be
lined with flannel, however, and made more secure. It
is only necessary to cut a strip of the cloth wide enough
to reach half around the interior. This is covered with
mucilage on one side and the end carried to the bottom
of the case by the aid of a tenaculum.
Dr. VVm. R. Leonard, of this city, describes a special
thermometer case made of black walnut, steamed and
fashioned on a mould. It is lined with velvet, and has
a padded silk top. Shepard & Dudley are the makers.
Dr. Leonard has used a case of this kind for four years,
and it has answered its purpose well.
The foregoing suggestions cover the matter suf-
ficiently, and will, we doubt not, be fruitful in saving
many thermometers.
A NEW ANTISEPTIC.
The importance of possessing a powerful antiseptic
which is at the same time harmless to the general system
is very great.
Indeed, the discovery of such an agent is the great
aim of the modern bacterial pathology. That so potent,
and yet accommodating a drug, should ever be found is
improbable, yet we chronicle with interest the various
new claimants for the important discovery.
Somewhat over ten years ago, Mr. C. T. Kingsatt, of
London, began to study the antiseptic properties of per-
oxide of hydrogen. He reported the result of a series
of experiments, to the British Medical Association, in
1876. In 1878 the antiseptic properties of this sub-
stance were rediscovered by Guttmann and Fraenkel, in
Germany ; and quite recently the same thing was done
in France, by MM. Baldy, Bert, and Regnard. The
practical uses of this agent have been most demonstra-
ted in this latter country. Under the name of eau oxy-
genic it has been widely used in surgery. M. Pean oper-
ates in an atmosphere of the oxygenated water, instead
of carbolic acid. M. Baldy employs gauze and wool
soaked in the peroxide. Many PVench surgeons have
used it as an agent for washing and dressing ulcers and
abscesses. It has been very successfully used by ophthal-
mologists. Its value internally has not yet been demon-
strated. Dr. Day, of Geelong, has given it in diabetes,
gout, and rheumatism, claiming that it increases oxygen-
ation— a view which is wholly hypothetical. Mr. Lennox
Browne has used the water in nasal, throat, and aural
troubles. It has been found superior to carbolic acid
as a dressing for venereal ulcers.
On the whole, the pero.xide of hydrogen has been
shown, thus far, to be a harmless yet powerful antisep-
tic. It is hardly to be claimed for it that as yet any
great su|)eriority over other antiseptics has been proved.
In a recent communication to the British Medical
Journal, however, Mr. Kingsett announces a new prepa-
ration which he calls, unfortunately, by the apparently
proprietary name of " Sanitas " oil. It is, he says, an
organic peroxide, which will continually yield pero.xide
of hydrogen to water on being placed in contact there-
with. If placed upon moist surfaces, it keeps them in
an atmosphere which is claimed to be of an extremely
antiseptic character. Its slow and constant action, to-
gether with the great antiseptic intensity, which many
times exceeds that of the aqueous pero.xide, offer, the
discoverer says, peculiar advantages. Much is hoped
for it as an agent for inhalation in pulmonary troubles,
as well as a local application for wounds, ulcers, and the
like.
OLD DISEASES WITH NEW NAMES.
The remarks contained in the recent address of Sir
James Paget, as referred to by our London correspon-
dent, are full of sound sense and must commend them-
selves to the medical thinkers of the day. In this age,
when only novelties are sought after, it is somewhat
comforting to hear from one of the masters in the profes-
sion that their importance is more relative than positive.
The old-fashioned diseases still claim our attention ;.
the old facts connected with them still remain, interpret
them as we please. The novelty is simply in the differ-
ent methods by which we may explain their phenomena.
We are glad to hear the distinguished orator emphasize
so strongly the necessity of collecting facts for their own
sake, and we admire afresh the candid spirits of the old
investigators who gave themselves so contentedly and s»
unostentatiously to such work. The lesson of their
lives cannot be too strongly enforced in this day, when
only such facts are collected as may serve to explain
some pet theory or bolster some absurd notion. No
more striking illustration of the opposite course could be
offered than the preservation of John Hunter's gummy
tumor, none that could more effectually prove the folly
of throwing away what we may not at the time fully
understand.
FILTHY CROTON WATER.
According to recent reports, particularly in the Herald,
there is constantly going on more or less pollution of our
water supply — hardly enough, it is true, to affect the
taste of the water itself, but sufficient at least to give
considerable concern to New Yorkers, and to emphasize
the necessity of exercising more than ordinary vigilance
in correcting the evil. At Brewsters it is said that filth
of a particularly offensive character is dumped into the
east branch of the Croton River, which flows through
that village. For instance, on Wednesday a colored man
was seen cleansing cuspidors, taken from a hotel bar-room,
in this stream. On another occasion a number offish were
being cleaned in the same stream. In fact, notwith-
standing an inspector has been appointed to prevent such
occurrences, little or nothing has been done in that line.
i6
THE MEDICAL RECORD.
[January 6, 1883.
SHIP-SURGEONS AND VACCINATION OF IMMIGRANTS.
The Nautical Gazette, quoting our editoiial upon tlie
subject, criticises ship-surgeons rather too severely. It
says :
" The average ship-siirgeon is a species of medical
fraud, so far as the practice of medicine is concerned.
He goes to sea because he could not earn his salt on
shore. There are some, however, who stand liigh in
their profession, and take great pride in having a clean
passenger list. We are quite prepared to believe that
' some steamship companies buy cheap virus in large
quantities and keep it until it is all used up.' Some of
them would be satisfied to vaccinate their passengers
with mucilage or sour flour paste for that matter, so as
to save a penny. There needs to be an inspection of
ship-surgeons as well as of iirimigrants. This we know
from experience."
ELECTRICITY AS A CARDIAC STIMULANT.
A FACT of the greatest importance, practically — espe-
cially with reference to the treatment of threatening death
by chloroform — has just been determined by Professor
von Ziemssen. In investigating the eflect of electricity
upon the heart, he has discovered that the induced cur-
rent has no influence whatever upon the frequency or
force of the cardiac contractions, whilst the continuous
or battery current most distinctly affects them. Many
tracings of the movements of the heart under different
conditions were first made, and a careful record was ob-
tained of the effect of physical disturbance of the various
parts of the cardiac surface. The influence of the differ-
ent forms of electricity was then thoroughly investigated,
cardiographic tracings being taken simultaneously. The
most interesting fact determined was the complete failure
of the faradic current to alter the action of the heart, or
to disturb in any way its sensibilit}', whilst the direct bat-
tery current produced a marked effect.
THE COST OF FUNERALS.
It is claimed In' one writer that one and one-fourth moje
money is expended annually in funerals in the United
States than the Government expends for public school
purposes, anil that funerals cost annually more money
than the combined gold and silver yield of the country
in the year 18S0. This does not include the cost of
cemetery lots and burial-fees. While it is quite natural
to properly re\erence the dead, it is certainly unneces-
sary to make extravagant expenditures in their behalf.
Many poor families cripple themselves for months in or-
der to make a last show of respect for the departed.
The carriages, flowers, and music could be used to much
better advantage when the poor body was animated and
could really appreciate such luxuries.
^nus of the MlccU.
TAPPING OF THE PERICARDIUM.
Dk. 11. Rendu, in L' Union M'edicah, reports that "the
doubtful position and value of this operation makes the
case of interest. The patient suft'ered from a pericar-
ditis with efl'usion, produced by exposine to cold. The
symptoms of pressure were severe, a puncture was made
and a litre of liquid removed. A month later the patient
had a double pleurLsy. He finally recovered with peri-
cardiac adhesions."
THE DEATH OF GAMBETTA.
So far as can be learned the death of Gambetta must have
been anticiimted by his medical attendants long before
hope was publicly given up. The distinguished patient
had suffered for some time from diabetes. He had not
taken proper care of himself, and his constitution had
been sapped of its vigor. The pistol- wound in his wrist
precipitated an acute illness. The symptoms described,
as proved by post mortem examination, were those of a
perityphlitic inflanunation, which was followed by pysemia,
the patient succumbing finally from cardiac thrombosis.
It was not thought advisable to operate, on account of his
exhausted condition, death being considered inevitable.
The names of Dis. Lannelongue, Paul Bert, Charcot,
and Fienzal are mentioned as attending Gambetta. This
is sufficient evidence that all which was possible was
done for the lamented champion of French Republic-
anism.
.\NOTHER PROTECTIVE VIRUS.
M. Pasteur has read a paper on rouge, or tnal rouge,
of pigs before the French Academy of Sciences. The
disease he treats of has been very destructive in France.
In the Valley of the Rhone, this year, it destroyed not less
than twenty thousand pigs. Dr. Klein, in 1879, gave an
account of it, and designated \t pneumo-enteritis. Pasteur
takes exception to Klein's account of the nature and char-
acteristics of the parasite which produces the illness, hold-
ing that it has a dumb-bell shape, and bears a close resem-
blance to that which produces the cholera of fowls, but
is less easily detected. He claims inoculation by a di-
luted form of the virus affords a protection. If this is
true, it is a matter of importance in this country, where
thousands of pigs die yearly from the disease in question.
THE NEW PRESIDENT OF THE COLLEGE OF PHYSICIANS
OF PHILADELPHIA.
On Wednesday evening of this week (January 3d), Dr.
Alfred Stille was elected President, and Dr. J. M. Da
Costa, Vice-President of the College of Physicians of
■Philadelphia. Professor Stille will sit in a chair that has
had but eight incumbents in ninety-five years. The Col-
lege of Physicians was born in 1787, and became mori-
bund about fifteen or twenty years ago. The fact is that
this institution, with an invaluable library of over twenty-
three thousand volumes and a fine museum, committed the
error of re-electing one president over and over again,
until he died, after serving thirty-one years. This distin-
guished man. Professor George B. Wood, was for many
years an invalid who only left his home in a carriage at
rare intervals. During a considerable period the duties
of the office were of necessity performed by the vice-
president, who was in a similar manner perpetually his
own successor. The same suicidal policy was adopted
in filhng most of the offices and committees.
Hence the meetings were unattended by a sufficient
number of Fellows to make a quorum, except on rare
occasions ; not enough new Fellows were added to fill
the breaches made by death ; few scientific papers were
read ; and the occasional gilt-edged vohinie of Transac-
lanuary 6, 1883.]
THE MEDICAL RECORD.
17
tions became a collection of obituary memoirs. The last
vokiiiR", which should have been bound in black, shows
for two years seven papers (79 pages), seven obituary
notices (132 pages), and two committee reports.
Within the past year additional nominations for officers
and committees have been made, old traditions have
been trampled under foot, the Constitution and By-laws
have been recast, new P'ellows have been added, so
many papers have been presented that some could only
be read by title, the papers are promptly publislied in
the various medical journals, the building has been
altered to provide for the long-needed and surprisingly
successful Directory for Nurses, the telephone and tele-
graph have been admitted to Fellowship, the hours for
opening the library have been extended so that now it
can be used in the evening, and a social or smoking-room
has been established. It is also probable that in a short
time an additional story will be added to the building to
better accommodate the Mutter Museum.
THE DOOM OF THE BACILLUS TUBERCULOSIS.
Dr. H. D. Schmidt publishes in the December number
of tlie Chicago Medical Journal and Examiner an elabo-
rate account of his researches regarding the bacillus
tuberculosis.
Dr. Schmidt's views, as lias been already announced,
are that the alkaline solutions and aniline oil used in
preparing the tuberculous specimens, lead to the pro-
duction of minute fatty crystals. These have naturally
a faint bluish tinge, which has been mistaken for stain-
ing. That the so-called bacilli, however, are not really
stained at all is thought to be proved by the fact, ad-
mitted by Koch, that they lose their ajsparent color and
disappear from sight in a few weeks. By submitting the
stained sections to boiling ether, the pseudo-bacilli dis-
appear, being, as Dr. Schmidt claims dissolved. The
case against the bacilli is a strong one, and will be al-
luded to again. Meanwhile, it is but fair to say that
other observers, after causing the bacilli to disappear by
means of ether, have reproduced them by staining the
sections again, showing, presumably, that the ether only
washes out the coloring matter.
A policlinic in PHILADELPHIA.
Medical Philadelphia has been considerably stirred of late
by rumors of a new college about to be established for the
clinical instruction of graduates. The name is The Phila-
delphia Policlinic and College for Graduates in Medicine.
It looks as though the organizers had utilized the names of
both of New York's recently founded institutions, and
were afraid that the metropolis would be universally re-
cognized as ///(■ medical centre. The faculty of the new
college is said to be composed of those well known in
medical and surgical specialties, but the details have been
kept very quiet. It will be an unusual circumstance in
collegiate history if all the professors are of the best ma-
terial. Some weak link is pretty sure to be put into
every chain. Success is assured for a Graduates' Col-
lege in Philadelphia if it is started with enough money
and brains. It cannot be Successful unless the Faculty
is composed of men who are known as scientific workers
in special lines and as experienced clinical teachers.
Those favorably known to the Alumni of the University
of Pennsylvania and Jefferson College will therefore un-
doubtedly be selected. Such men as Cohen, Burnett,
Levis, Mills, Wilson, Van Harlingen, Thomson, Roberts,
Morton, Smith, Leffmann, and Longstreth would make a
strong organization, as they are all recognized as prom-
inent in their particular branches.
THE governor's MESSAGE AND STATE CHARITIES.
The discussion of our State Charities by Governor
Cleveland, in his recent Message, and tiie recommenda-
tions there made are disappointing and unsatisfactory.
The vital questions of the supervision of lunatic asylums
and the change in the commitment laws are referred to
in vague terms, and the recommendations made may be
interpreted as meaning anything or nothing.
The number of the insane in the asylums and poor-
houses is reported to be 10,443, ''•" increase of 384 over
the previous year. The Governor naively says that this
indicates an increase in insanity, when it really indicates
chiefly an increase in popidation.
The other State Charities are referred to with no es-
pecial comment.
The New York. Medical Journal. — The N.eic York
Medical Journal is transformed at the commencement of
this year from a monthly into a weekly periodical. It
comes to us in fine dress as a double-columned royal
octavo of twenty-eight pages, and is filled with well-se-
lected and interesting articles. It opens with a lecture
by William B. Carpenter on " Human Automatism," which
article is followed by a series of papers on " Antisepsis
in the Treatment of Wounds," by Drs. Willard Parker, H.
B. Sands, R. F. Weir, J. Willston Wright, and W. T. Bull.
"A Rare Case of Osteoma of the Conjunctiva" is con-
tributed by Dr. E. G. Loring. The editorial articles are
exceedingly well written, and are models of their kind.
The quarterly report on Ophthalmology is made by
Dr. C. S. Bull, after the style of similar ones in the
monthly. The report of the Medical and Surgical So-
ciety is, as usual, quite full and accurate. Altogether,
ihe Jour?tal is a credit to medical journalism, not only of
this city, but of the country. The Journal continues
under the control of its former editor, Dr. Frank P. Fos-
ter, who brings to the discharge of his new and responsi-
ble duties every requisite qualitication.
Improving the Lunacy Laws. — The permanent
commission of the Medico-Legal Society on the lunacy
laws recommended, at the meeting of the society on
Wednesday evening, that certificates of insanity shall be
given by Commissioners in Lunacy only; that asylum
patients shall have the freest communication with their
friends, and have the privilege of being examined by
physicians outside of the asylum every six months. It is
also urged that the intermittent cases be kept apart from
the chronic insane.
Insanity and Expert Testimony. — Although Henry
Prouse Cooper, after a long contest, has been judged
sane and is now at liberty, we are confident that his will
.prove another Gosling case, and that Mr. Cooper him-
self will be demented or dead within a few years. Every
i8
THE MEDICAL RECORD.
[January 6, 1883.
medical man of prominence, so far as we can learn, tes-
tified to his insanity.
The case illustrates again the defects both in our
method of getting expert testimony, and in the laws
regarding commitment. Mr. Cooper, though not a felon,
was confined for several weeks in jail, and his trial cost
him $8,000.
St. I^ouis Vital Statistics. — The total number of
deaths in St. Louis for the year was 7,817. This makes
the annual death-rate 19.5 per 1,000, estimating the
population at 400,000. The number of births daring
the year was 8,441 .
Hospital for Contagious Diseases. — The Board of
Estimate and Apportionment has appropriated $50,000
for the erection of a hospital for children suffering from
contagious diseases.
Farm for the City's Chronic Insane. — The sum of
$25,000 has been a|.ipropriated for buying a farm on
which buildings are to be erected for the chronic insane
now in the city asylum.
New York's Charities.— The sum of $1,029,953
has been appropriated for the public charities of this city
during 1S83.
Another Medico-Legal Society. — It is rejjorted
that another Medico-Legal Society is to be organized in
this city, and is to be called the New York Society of
Medical Jurisprudence. As there is already one large
and well-sustained medico-legal society in this city, it
is not easy to understand the need of a second.
The proposed society will make the third scientific
medicolegal organization in the world.
SiMALL-POX in Baltimore. — Small-pox is quite preva-
lent in some parts of Baltimore. Seventy-one deaths
occurred last week. The Health Board is blamed for
negligence and incapacity in the matter.
Professor Austin Flint has been in I'hiladelphia
delivering a course of lectures to the general profession,
under the auspices of the Philadelphia County Medical
Society, on the " Physical Exploration of the Lungs by
means of Auscultation and Percussion." The first lec-
ture drew such an unexpected crowd that there were not
accommodations for one-half the audience, and about
two hundred gentlemen were unable to get into the hall.
Arrangements were accordingly made to have the other
lectures delivered in the very large amphitheatre of the
Jetferson College Hospital, and tickets of admission
were issued. The scholarly and practical character of
Professor Flint's lectures will be evident when they are
published. A complimentary dinner will be given to
him at the Social Art Club on January 12th, tlie evening
previous to his last lecture. It will doubtless be wortliy
of the distinguished physician who has honored Philadel-
phians by his presence among them.
The Late Dr. Henry Ashland Clay, who was shot
by his partner. Dr. Etienne Evetzky, was born in Brooklyn,
N. Y., in 1851, and graduated from the College of Pliy-
sJcians and Surgeons in New York City, in 1876. He
served at the Roosevelt, and Nursery and Child's Hos-
pitals, and was a pupil of Dr. Win. H. Draper, of New.
York. In 1879 1'^ .went to Leadville, Col., and estab-
lished a practice there ; during the following year and a
half he was quite successful, and made many friends by
his genial demeanor, and evident knowledge of his pro-
fession. P'rom there he went to Durango, where he con-
tinued to follow his profession, and was the pioneer phy-
sician of the town. Not very long ago he forim^d a
partnership with Dr. Evetzky.
DE.iTH OF Surgeon Henry R. Silliman. — Assistant-
Surgeon Henry R. Silliman, United States Army, died
in Philadelphia on January ist, in his tifty-first year.
An Obstetrical and Gynecological Society has
been formed in Washington, D. C.
The Boston Water Supply is reported bad, and a
commission has been appointed to see what can be done
to secure improvement.
The First Aid to the Injured. — The Committee
of the State Charities Aid Association for " First Aid to
the Injured" has made preparations to resume the classes
as organized last year.
Death of Dr. Corvisart of Paris. — A cable de-
spatch from Paris announces the death of Dr. R. F. E.
Corvisart, of that city. He had been in delicate health
for the last few years. He was the author of works on
phthisis and dyspepsia.
The New Deputy Coroners. — The coroners-elect
have named as deputy-coroners : Drs. M. J. B. Mes-
semer, Wm. T. Jenkins, Philip E. Donlin, and Wm. A.
Conway.
A New Hospital in Yonkers. — There is to be es-
tablished, under the medical directorship of Dr. S. Water-
man, of this city, a hospital connected with the Hebrew
Home under the auspices of the B'nai B'rith, a society
comprising New York and New England States, and
having a membership of ten thousand. The grounds at
Yonkers comprise nearly ten acres, and command a fine
view of the river. The building thus far erected is
200 X 80 feet. The hospital will be supplied with all the
appliances necessary.
The following gentlemen have been appointed to the
medical and surgical staffs : Dr. S. Waterman, Medical
Director ; Dr. A. Jacobi, New York, Dr. S. Swift, Yon-
kers, N. Y., Consulting Physicians; Dr.H. B. Sands,
New York, Dr. G. F. Shrady, New York, Consulting
Surgeons ; Dr. Hockheimer, Dr. Walhich, Dr. Meyer,
and Dr. Loewingood, Visiting Staff.
Licenses to Practise in Illinois. — The lUinois
State Board of Health has just given notice that after
the current scholastic year license to practise medicine
in Illinois will be granted to graduates of those schools
only whose requirements include a preliminary exami-
nation on the essentials of a common school education.
As but one medical school in the State conforms to this
requirement, even on paper, at present, there is some
stir in the various faculties as to ways and means for
complying with the letter of the law.
The Low Price of Quinine at jjresent prevailing
should be known to physicians and tlieir patients.
Quinine is selling now, according to Neiv Remedies, at the
rate of $1.65 per ounce. *llie decline in price is due
largely to the importation of German quinine.
January 6, 1883.]
THE MEDICAL RECORD.
19
Reports 0f J>0ci0ti£S.
NEW YORK PATHOLOGICAL SOCIETY.
Stated Meeting, December 13, 1882.
George L. Peabodv, M.D., Vice-President, in the
Chair.
Dr. Peabody presented, in behalf of a candidate, a speci-
men illustrating
UTERINE FIBRO-MYOMATA, WITH A CYST OF THE LEFT
BROAD LIGAMENT.
Dr. p. F. Chambers presented a
DERMOID CVST OF THE OVARY,
accompanied by the following history : The specimen
was removed by Dr. T. G. Thomas at his private hos-
pital. The jjatient was thirty-four years of age, married,
and the mother of two children. Up to within one
month of the birth of her first child she was apparently
perfectly well. At that time she began to suffer pain in
the left side, which passed off a few months after the
birth of her child, and recurred at about the same time
previeus to the birth of lier second child. The second
child was two years and a half old. Since that time she
had complained of constant pain in the back, especially
upon the left side, and, for the last year, of difficulty in
walking and standing. She had also become excessively
nervous. On examination a tumor was found, about the
size of a turkey's egg, in the left posterior cul-de-sac,
tender upon pressure, and movable. An operation was
advised for its removal, and three days afterward it was
performed in the usual manner. The pedicle was ligated
and dropped. Antiseptic precautions were observed.
The patient made a rapid recovery. The tumor con-
tained hair, no bone or teeth. It contained but a small
quantity of fluid, the soft contents, measuring about an
ounce, presenting the appearance of vaseline.
Dr. H. M.4RION Sims presented a
DERMOID CYST OF THE OVARY,
with the following history: On November i, 1882, Dr.
Vanderveer, of Somerville, N. J., brought the patient
to his office. She was fifty-two years of age, and had
been married sixteen years. Up to the time of mar-
riage her menstrual periods had always been regular,
and she had enjoyed the best of health. Two years
after marriage she became pregnant, and all went well
up to the seventh month, when a miscarriage took place,
the child being removed with instruments. It had been
dead in utero apparently for some little time. This
miscarriage was followed by a violent attack of perito-
nitis, from which she did not fully recover for two years,
and at times her life was despaired of. Her menstrual
periods returned with her strength and were regular until
she had change of life five years ago. From that time
she was perfectly well until eight months ago, when she
noticed a hard " lump " growing in the left iliac region.
She did not have any severe pain in it, but complained
of a great deal of backache. She noticed the lump to
be growing rapidly.
When Dr. Sims lirst saw her, he diagnosed the tumor
as a nuiltilocular ovarian cyst and advised its removal, as
it was then rapidly increasing in size. The operation
was performed on Saturday, November 25th, and under
the carbolic spray. He was assisted by Dr. Gill Wylie,
Dr. Henneberger, of the United States Navy, Dr. Van-
derveer, and Dr. Payton, of Oregon. Dr. Nash ad-
ministered the ether. The usual abdominal incision be-
ing made, a firm, hard cyst was exposed to view. On
introducing the hand he found there were adhesions in
all directions. He plunged the large trocar into the
cyst, and, much to his surprise, only brought away about
three quarts of a milky colored thin fluid. He then en-
larged the opening into the cyst, and on introducing his
hand was much sur|)rised to feel a quantity of soft mor-
tar-like material. This was all pulled out and found to
contain a large quantity of silky, golden hair. When
fresh, the color of this substance was exactly that of oleo-
margarine, and its consistency about the same. It was
odorless. It was very greasy to the touch, and burned
like grease when thrown into the fire. Nine pounds of
this material were removed, after which he felt some-
thing more solid attached inside, about midway between
the top and bottom of the sac. When this was removed
it proved to be a piece of skin, resembling a human
scalp, and to which was growing a beautiful blonde curl
about a foot in length. On the under side of it, and en-
cased in fat and muscle, was a molar tooth, the only one
found in the tumor. Efforts were then made to enucle-
ate the sac, and he succeeded in doing so on the sides
and in front, behind the bladder. The sac was so friable
that it was feared it would be torn to shreds in trying to
detach its posterior adhesions, and, at Dr. Wylie's sug-
gestion, he determined to stitch the edges of the sac to
the abdominal wound, and put a Thomas' drainage-tube
inside the sac, and another into the pelvic cavity at the
lower angle of the abdominal incision. The wound be-
ing closed in the usual w-ay, the patient was put into bed,
and he did not dare believe she would occupy that bed
much more than thirty-six hours. Much to my delight,
however, she rallied well, and her temperature has never
risen above 102^° F'., nor her pulse above 103 since
the fourth day. There was no drainage from the tube in
the pelvis, and it was removed on the fifth day. From
the one in the sac, there is now very little discharge, but
he washed it out once a day with carbolized warm water.
On this (the nineteenth) day she is taking plenty of
nourishment, her bowels are moved daily, and she says
she feels very well. Her pulse and temperature are nor-
mal. Dr. G. L. Peabody had examined the skin, and
made the following report :
" The epidermis, the Malpighian layer, the derma, and
the subcutaneous fat layer are all present. It differs,
however, from normal skin in several important respects:
(a) The derma has no papillre ; (b) there is a very
unusually large number of sebaceous glands in it ; (c)
in numerous sections examined no sweat-glands have
been present ; (d) certain of the hairs and hair-follicles
have undergone atrophic changes, by which the epithe-
lium has disappeared and the hair become homogeneous
and translucent ; {e) the fat-cells are smaller than those
of the normal adult tissue."
Dr. Wylie said the case illustrated beautifully what
could be done where very strong adhesions were found.
It had been his fortune to see four cases in which it was
impossible to remove the posterior portion of the sac,
and in all the sac was drawn up tightly and stitched into
the lower angle of the wound without using any ligature
whatever. Then a drainage-tube was introduced and the
cavity was washed out three or four times a day accord-
ing to the amount of discharge. The i^resent case
differed from those referred to in the fact that so many
of the adhesions had already been torn away that it was
deemed advisable to put in an extra drainage-tube.
One end of it was in Douglas' cul-de-sac and the other
passed out at the lower angle of the abdominal incision.
The peritoneal tube had been removed, but the one
within the sac still remained.
Dr. R. E. Van Gieson presented a
DERMOID CYST OF THE OVARY — CANCER OF THE STOMACH,
accompanied by the following history, furnished by Dr.
E. H. Wilson, House Surgeon of St. Catharine's Hos-
pital, Brooklyn :
C. F , native of Germany, fifty-three years of age,
married, was admitted October 19, 1882, complaining
chiefly of pain in the region of the caput coli, nausea
without vomiting, and general debility. Examination re-
vealed a tumor in the right iliac fossa, ovoid in shape.
20
THE MEDICAL RECORD.
[January 6, i88^
nodular at one end, about as large, ajsparently, as a
goose-egg, not readily movable, and painful on pressure.
Morphia;, one-sixlh grain, was given every four hours and
the diet restricted to fluids.
This was the only treatment for several days, after
which she began to vomit both medicine and nourish-
ment, and the bowels became obstinately constipated.
The vomiting was partially controlled by lime-water, and
soon a very large spontaneous passage from the bowels
followed, nearly filling the vessel. The pain continued
severe, and at times lancinating, and was usually re-
ferred to the situation of the tumor. Vomiting also con-
tinued at somewhat longer intervals. The ejected mat-
ter never contained blood. The stomach finally rejected
the morphine altogether, and from this time it was given
hypodermically until the pain was relieved. Finally,
nourishment was also almost entirely rejected. She soon
began to lose flesh and strength rapidly, and died of ex-
haustion November 22, 1S82.
Necroscopy, twenty hours after death : The tumor was
found to occupy the anterior fold of the broad ligament.
At the point where it leaves the pelvic wall the tissues
were matted together and strongly adherent. The caput
coli was also adherent to the growth by old and strong
adhesions. It was in no way connected with the ovary,
which was normal in size and shape. The Fallopian
tube was also normal in size, but bound down by adhe-
sions and not connected with the tumor, which seemed
to be of independent origin.
Further examination revealed an unexpected and en-
tirely different morbid growth in the stomach, occupying
the pylorus, involving the greater and lesser curvature,
and part of the posterior wall, undoubtedly, judging
from simple inspection, carcinomatous. The mesenteric
glands were en'arged, and the seat of cancerous infiltra-
tion. There were no secondary deposits found in the
liver.
CROUP AND DIPHTHERIA.
Dr. Van Gieson also presented a specimen illustrat-
ing the difficulty in diagnosis between so-called mem-
branous croup and diphtheria. It was accompanied by
the following history, which had been furnished him by
Dr. C. Fulda, the attending physician : George K ,
six and a half years of age, had been troubled with a
croupy cough for some time. Dr. F. was called to see
the patient first on November 29th. On examination
he found a small patch of membrane on each side of
the pharynx behind the tonsils. The tonsils were not
enlarged, nor were the fauces inflamed. Dyspnosa was
not very marked ; still the parents were informed of the
probable danger. For the next six days there was no
noticeable change in the clinical history of the case, with
the e.xception of the disappearance of the patch of mem-
brane on one side. There was no fever nor acceleration
of the pulse. The boy was livel}' and cheerful, and on
the sixth day he seemed to be so well that he was allowed
to leave the room. On December 7th, at 6 p.m., Dr. P".
was summoned to see the patient, and found him suf-
fering from extreme dyspnoea. He called Dr. Van Gie-
son in consultation, who performed tracheotomy at
I A.M. on December 8th. The temperature rose to
100° F., the pulse to 160, and the respiration to 60.
Quantities of bronchial secretion and purulent-looking
material were discliarged through the tube. On the 9th
the temperature rose to 102° F., the pulse 160 to 170,
the respirations 60 to 70. The patient's strength was
evidently failing. No more secretion was discharged
through the tube, and at 7.30 p.m. he suddenly expired.
Neither before nor after the operation were there no-
ticed any symptoms of diphtheritic toxemia. After the
operation there were some symptoms of bronchial pneu-
monia. Dr. Van Gieson remarked that, in this instance,
the laryngeal stenosis was almost entire, and the dysp-
noea when tracheotomy was performed was very marke<l.
He performed the operation as low down as possible,
hoping to get below the exudation, but he met with some
difficulty on account of the prominence of the thymus
gland. He believed that any person examining this
child's throat at this ]jarticular stage, unless exceedingly
careful, would have failed to detect any a[)pearance of
membrane.
Dr. J. Lewis S.mith thought that the history pointed
to diphtheritic exudation rather than membranous croup.
Dr. Van Gieson remarked that he had seen cases
where no membrane could be discovered above the glot-
tis, but by inspection of the larynx a membranous ex-
udation could be detected, and by questioning the
parents they had given a history of having seen a mem-
branous exudation prior to the call of the physician.
Dr. Smith remarked that doubtless such cases did
occur, although they were very rare. He had one in
mind at the present time, and it was one in which he
watched the patient from the very inception of the dis-
ease, and there was no membrane visible, but at the
autopsy the membranous exudation was found in the
larynx. He believed it to be a case of diphtheria, and
one of the evidences in tavor of that belief was the fact
that the disease also extended to other members of the
famil}'.
Dr. Van Gie.son further remarked that he had seen a
single case in which there was no appearance of mem-
brane in the throat, but he ventured the diagnosis of
diphtheria, and it was only tvvent3--four hours before
death that membrane could be seen, and then only one
or two patches on the posterior border of the epiglottis.
Dr. Garrish asked in what percentage of cases of
tracheotomy in croup or diphtheria recovery took place.
Dr. Van Gieson replied that Dr. Fulda, the attending
physician in this case, had informed him that while study-
ing in Vienna and Berlin he found the prevailing senti-
ment in favor of the early performance of tracheotomy,
and that the percentage of recoveries there during the
past eighteen months had been somewhat more favorable
than in years gone by.
Dr. J. Lewis S.mith thought that the percentage of
recoveries varied in different epidemics. If the disease
was of a mild type it was much greater than when of a
severe type. As an average probably not more than
one in five or six recovered after tracheotomy.
Dr. Peabody remarked that when a student in Vienna
it was the custom in the Children's Hospital to have pres-
ent at the Christmas-tree the children upon whom tra-
cheotomy had been performed. . On the particular
occasion when he was present, there were seventeen
children who were either then wearing tracheotomy tubes-
or upon whom the operation had been performed. It
was the rule in the institution under the direction of
Wiederhofer to operate early in all cases in which the
laryngeal dyspnoea was at all marked.
Dr. Wyeth asked what percentage of the patients v,-ere
unable to attend the Christmas-tree.
Dr. F". V. \\'hite asked Dr. Smith whether the sec-
ondary renal trouble was common or exceptional.
Dr. Smith replied that according to his observation
in all severe cases albuminuria was present.
Dr. White remarked that out of a large number of
cases which he had seen, in only two had evidence of
nephritis existed.
OSTEO-SARCOM.\ OF THE FEMUR AMPUTATION OF THIGH.
Dr. George F. Shr.auy piesented a specimen ob-
tained by amputation of the tliigh. It was accompanied
by the following history : The patient was twenty-two
years of age, a native of New Jersey, and had been well
up to one year ago, when he injured the right knee by
jumping upon a snow-plow. From this injury he was
laid up for two or three weeks, then appeared as well
as usual, and suffered no inconvenience from the knee
until August, 1882, when the pain returned, and upon
examination there was found a small swelling upon the
inside of the joint just above the condyle of the femur.
January 6, 1883.]
THE MEDICAL RECORD.
21
He consulted a ph)'sician in his locality, who told him
that it was the coiiimencenient of white-swelling, ami
that he would be obliged to subject himself to a long
course of treatment. At that time he felt very well and
deferred treatment. In the meantime the swelling began
to increase and continued to increase up to the time when
he was admitted to the Presbyterian Hospital, about the
middle of October, 1S82. Dr. Shrady then found a swell-
ing just above the horizontal plane of the left knee and
over the internal condyle of the femur. It was globular
in shape and about the size of a small orange. It was
circumscribed, of elastic feel, was firm in consistence,
and apparently homogeneous in structure. It was deeply
attached, and the overlying skin was apparently perfectly
healthy. There were no enlarged superficial veins in the
neighborhood, neither was there any evidence of lym-
phatic involvement. Krom the history of the case and
from the situation of the tumor and other characteristics
which it presented, he diagnosticated osteo-sarcoma and
advistd ampntation of the tliigh. The (latient went avva)',
but returned to the hospital at the end of two or three
weeks, when Dr. Shrady agained examined the limb and
found that the tumor had increased in size, that the pain
was more pronounced, necessitating the use of morphine.
A consultation was held, the diagnosis was confirmed,
and amputation was advised. With the hope of saving
the limb, if possible. Dr. Shrady made an exploratory in-
cision, when it was found tliat the tumor was firmly at-
tached to the bone. Before the amputation was performed,
however, Dr. W. H. Porter examined microscopically
sections made from the growth, and decided that it was
a case of spindle-celled sarcoma. Amputation was then
])erformed at the middle of the thigh, and at the present
time the patient was doing exceedingly well. The speci-
men exhibited the gross ap|)earances of periosteal sar-
coma of the femur, the periosteum was separated from
the bone, and at one place the gro\vth had evidently in-
volved the medullary cavity. The epiphyseal cartilage and
adjacent tissues were also invaded, 'i'he bone at the point
where ttte am|)utation was made was a|)parenlly healthy.
Dr. Shrady regarded the prognosis in these cases as ex-
ceedingly unfavorable.
Dr. C. C. I.ke asked Dr. Shrady with reference to the
general prognosis in bony sarcoma.
Dr. Shradv remarked that sarcomas connected with
bone were generally of a very malignant character, par-
ticularly was this the case with the spindle-celled perios-
teal variety. According to Dr. S. W. Gross that special
form of osteosarcoma recurred in about six-tenths of all
cases in which amputation was performed, while the giant-
celled sarcoma returned in one out of every twelve cases.
In answer to a question by Dr. Ridlon, he stated that
there was a partial arrest of development of the atTected
femur, in consecpience of the involvement of the ei)i-
physeal cartilage in the disease.
PERSISTENT FORAMfN OVALE.
Dr. Ferguson presented portions of two hearts which
illustrated persistent foramen ovale. One opening ad-
mitted a tube half an inch in diameter.
He also presented a specimen which illustrated a
method of preparing aneurisms for museum purposes.
urethral strictures — RETENTION OF URINE ASPIRA-
TION OF THE BLADDER MUCOUS MEMI3RANE STUDDED
WITH SMALL CALCULI.
Dr. Ferguson also presented the bladder and ]jenis
removed from the body of a man, forty years of age,
single, and a native of the United States, who was ad-
mitted to the New York Hospital, September 24, i8Sr,
in a very bad general condition. He gave a history of
having suffered from dribbling of uiine for two weeks,
with lack of projectile force, ability to pass his water in
only a small stream, and with frequent desire to mictu-
rate. These symptoms became aggravated, and twenty-
four houis before admission he was unable to void an\'
urine. When examined by the house surgeon on ad-
mission, the bladder was found distended so as to reach
as high as the umbilicus. The bladder was asj^irated,
and a large quantity of bloody urine removed. On the
following morning an attempt at catheterism failed.
Aspiration was again i)erformed and ten ounces of urine
removed, and the operation was repeated in the evening,
when twelve ounces were withdrawn. In the coarse of
that night the patient voided his urine voluntarily, and
on the following morning it was possible to introduce a
small silver catheter, which was used during the remain-
der of the patient's life. At the autopsy the bladder con-
tained ten ounces of urine, llie mucous membrane was
hypertrophied, i^resented a sloughy appearance in places,
and all over the surface could be seen small calculi.
There were two urethral strictures, one two and one-half
inches from the meatus, but not very close, and the other
at the bulbo-membranous junction. About one inch an-
terior 10 the deepest stricture were two false passages.
"Mr. .'Vi.lchin, of London, asked Dr. Ferguson why he
supposed that tlie blood in one of his specimens passed
from one auricle to the other. He had seen the lesion
very frequently, and sup])osed tliat it had been generally
accepted that jjressure of the blood in both cavities was
so nearly alike that it kept the opening snl^ciently closed
to prevent any evidence that the blood passed from one
auricle to the other.
Dr. Ferguson replied that it seemed to him the ar-
rangement of the tissues around the opening in this in-
stance were such that, while pressure upon one side would
close the opening, jiressure upon the other would open
it, and that unless the jiressure was exceedingly nicely
adjusted the blood would probably flow from the right
into the left auricle. Whether from a physiological stand-
point this view would be correct he was unable to say
positively, but from the geneial arrangement of the tis-
sues he thought that there was no impediment to the flow
of blood from one cavity to the other.
Dr. Wyeth remarked, with reference to the specimen
of urethral stricture presented by Dr. Ferguson, that a
case came under his observation recently at the poly-
clinic in which a stricture had existed twenty years. At
one time the patient had been catheterized with a certain
degree of violence, but no urine was drawn. About a
week afterward the urine escaped through a fistula in the
perineum. When he first saw the patient it was with
very great difficulty that even a filiform bougie could be
introduced into the bladder, but starting from that point
he practised continuous dilatation and the patient went
on and made a rapid recovery. At the present time the
calibre of the urethra had been so increased in size as to
admit a No. 18 without difticulty. The opening in the
urethra was just behind the triangular ligament. It was
interesting to know that some of these cases, at least,
could be relieved by continuous dilatation.
(To be continued.}
Small Doses. — The following are recommended by
Dr. A. A. Smith, of New York : Castor-oil, five drops,
rubbed up with sugar and given every two liours in in-
testinal irritation of children. Tincture of hamainelis,
one drop every fifteen minutes as a sedative in children.
Tincture of Pulsatilla, one drop in dysmenorrhcea every
fifteen minutes, also in orchitis and epididymitis. Fow-
ler's solution, one-half drop in nausea of pregnancy and
after a drunken debauch. Tartar emetic, one grain in a
quart of water. Dose, one teasponful every fifteen min-
utes in the bronchitis of children. Calomel, one-fiftieth
of a grain in syphilitic headache, without gummata, every
fifteen minutes. Also in children with vomiting, accom-
panied with mucous discharges, one-half grain bichloride
of mercury in a pint of water, and administered in tea-
spoonful doses every fifteen minutes ; good for the same
aftections. Fluid extract of ergot, one drop every fifteen
minutes in menorrhas-ia. — Medical News.
THE MEDICAL RECORD.
[January 6, 1883.
PRACTITIONERS' SOCIETY OF NEW YORK.
Sla/cd Meet in i^, December i, 1882.
Jas. B. Hunter, iM.I)., Prksident, ix thk. Chair.
A PAPER (see p. 3) was read liy Dr. CuARr.i-.^ S. \\'.\rd,
entitled
THE SIGNIFICANCE OF TE.MPERATURE AflER OVARIinOMV,
AND THE TREATiMENT (IF CONDITIONS, CIVINC RI.^E TO
THERMAL VARIAFIONy.
The paper being o|)en for discussion.
13k. ^VARD, in answer to inquiries, said tiiat the anioimt
of morphine used after operations varied great! v. He
had had a case where eighteen minims of iVIagendie's
solution were given at a dose and repeated within an
hour. A dose of ten minims every four hours would rep-
resent about the average. The dose was regulated by
the amount of pain, the number of pulsations and respi-
rations.
Dr. Hunter said tliat in a case of his just recovering
the respirations had fallen to five per minute.
Dr. Hunter said that he had seen the class of cases re-
ferred to by Dr. Ward, in which the fever was not at all
high, and yet after death there was every evidence of
peritonitis ; and he could confirm Dr. Ward's statements
regarding them.
Dr. G. I.. Peabodv suggested that these cases had
their parallel in those forms of idiopathic peritonitis
where there were no symptoms at all. Dr. Peabodv
described briefly some cases of this nature which he had
seen.
Dr. Ward, in response to an inquiry regarding the m-
frequency of shock, said that this depended upon the
case and the operator. Where the operator was skilful,
rapid, and unhesitating in his work, shock very rarely
occurred, even if the case were a severe one. On the
whole, he had not seen it very often.
Dr. Hunter had not often seen shock after ovariotomy.
He referred to one class of symptoms which used to be
seen, viz., those produced by carbolic acid jwisoning.
Now the spray is abandoned or is not brought so near
the patient, and the solution is made weaker.
Dr. Beverly Robinson showed a patient who was a
deaf-mute with CONTRACTION OF UPPtR AND LOWER
PHARYNX, PROBABLY FOLLOWING CONGENITAL SYPHILIS.
The history of the case was as follows :
W. L. P) came to my oflice on November 27,
1882, sent by Dr. E. Burke Haywood, of Raleigh, N. C,
to be treated by me for chronic rhinitis.
The patient inuiiediately informed me, by writing, that
he was nineteen years old, resided in Mechanicsville.
N. C, where he intended to become a farmer, and had
been a deaf mute from two years of age. He was a tall,
vigorous-looking young man, and after careful outward
examination presented no marks of antecedent disease,
other than the scars of a glandular abscess on one side
of the neck. Even in ordinary breathing, however, it
was immediately noticed that inspiration and e.\piration
through the nasal passages was noisy and obstructed,
and the lips and teeth were separated most of the time.
He complained not only of this obstruction in his nose,
but also of water running frojn the eyes, of bad odor
from his nose (told him by others, since he has lost his
sense of smell), and of cough. He snuffled almost con-
tinually wlulst writing these statements. He informed
me that he had good hearing at the time of birth. When
he was two years old he contracted a cold in the head,
.which was followed by loss of hearing. He lias four
brothers living, one sister, and his mother. His father
died of congestive chills, and one of his brothers of
inflammation of the bovvels (?).
Four years ago he had a sore throat, which appeared
serious for a lijne, but was ultimately cured by a local
practitioner. He remembers having had his throat cau-
terized on several occasions during this attack with
nitrate of silver. .At that time and subsequently he took
cold with great facility. Two years ago he began to
suffer from a catarrhal affection of the nose, which had
lasted without intermission ever since. Last year he
noticed for the first time a fetid odor of the breath from
his nose. \ physician gave him a carbolic wash to cor-
rect this symptom, and he has made almost daily use of
it since that time.
One d.iy, some months ago, whilst at dinner, he felt a
sharp pain in his throat, and upon e.Kamination found it
was caused by a piece of bone, which was readily ex-
tracted by a physician. Later on he had a somewhat
similar sensation, and was able himself to take from his
mouth a jiiece of bone — thin, lamellar, and about half an
inch square, which is, without doubt, a iiortion,or nearly
the whole of the vomer. This piece of bone, moreover,
according to the patient's statement, seemed to come
down from the back of his nose. Frequently during the
night, whilst lying down, yellow matter discharges from
his nose. In the morning when he awakes he has a bad
taste in the mouth. If he goes into the open air watery
fluid runs over his cheeks from his eyes. Last summer
he went to the mountains, and during his sojourn there
his nose sto])ped discharging and his nasal affection was
evidently improved. Last autumn, when he had been
home a few weeks, yellow pus came again from his nose,
and a red effloresceiTce appeared on the left outer surface
of it. U])on firm pressure in this region he has an un-
easv feeling, but not absolute i)ain. He has very con-
siderable and constant difficulty of breathing through the
nasal passages, which is increased markedly with every
fresh cold. This difficulty of nasal respiration has now
lasted two years, and seems almost stationary in its in-
tensity during the past few months. Patient went to
school at eight years of age, and was, at that time, quite
a delicate boy. He does not remember to have suffered
from " snuffles," but had a scrofulous abscess of the neck,
and was occasionally unable to do much work on account
of headache, dyspepsia, and colds on the chest. He
never had sore eyes or any cutaneous eruption. He has
had, however, at times, swelling of the bones of the lower
extremities. His brothers and sister all suffer from re-
]ieated sore throats, as did his father ]irevious to his death.
One of his brothers is a mute, like himself, and possibly
his condition of mutism was due originally to sore throat
in early infancy.
Physical examination shows by inspection and jjalpa-
tion that the patient's nose is of good configuration and
presents no apjireciable enlargement or depression. Thd
red blush still exists, and over this region there is decided
pain on moderate [iressure. Both the redness and the
pain have increased somewhat within a few days. An-
terior rhinoscopy shows a large, open perforation of the
nasal septum, and far back in the nasal jjassages the
])robe detects a rough, unequal, resisting substance which
has the aspect and <iuality of diseased bone, probably
undergoing necrosis. Upon opening the mouth, with the
light reflected into it from a laryngeal head mirror, the
pharvnx presents a remarkable scarred appearance, and
a series of slightly elevated bands radiate as it were from
the median line toward the lateral walls. The anterior
pillars of the fauces are prominent ; the posterior ones
have disajipeared, and the tonsils are so small as to be
scarcely clistinguishable. A small orifice is found between
the free margin of the soft palate and the posterior
pharyngeal wall, which makes the oral and naso-pharynx
communicate with each other. This orifice is large
enough to admit with slight pressure a steel sound, or
guide, of about thirty four French in calibre — on either
side of this orifice, which is on the median line, the soft
palate is intimately adherent to the walls of the pharynx
by resisting cicatricial bands. By passing the distal ex-
tremity of the sound through this opening and carrying
it to the left and right, in different directions, it was easily
determined that the posterior septum of the nose had
January 6, 1883.]
THE MEDICAL RECORD.
23
disappeared. This manoeuvre was only slightly painful.
It was also noted, by forcibly depressing the back of the
tongue and throwing the reflected light downward from a
small laryngeal mirror, that the lower pharynx was some-
what contracted by cicatricial hands, although not to the
same degree as it was in its superior portion.
An attempt was made upon the day following tlie first
examination (November 28th) to gain a further insight
into the posterior nasal passages by passing cords
through the nose and exercising continuou.s traction
upon the palate (method of Philip S. Wales). 'I'liis
proved ineffectual. A tupelotent of large diameter, but
cut quite short, was then introduced into the contracted
upper orifice of the pharynx, and held in place by means
of twine, with a plug of lint occluding the anterior nares,
in a similar manner to that followed for the arrest of pro-
fuse epistaxis. The tupelotent was allowed to remain i/i
situ during the remainder of the day and following night.
November 29th. — It was found that the tent jiad not
remained fixed in place, but had slipped above the con-
tracted orifice, and found lodging in the naso-pharvngea!
space. With considerable eflorts of traction it was pulled
through the orifice and drawn out through the mouth.
Since this date the following treatment has been
adopted : Daily passage of steel sound as large as the
contracted orifice woidd acconnnodate ; applications of
tincture of iodine and glycerine (two drachms to one
ounce) to the entire interior surface of the nasal jiassages ;
the employment each mornmg of a carboli/.ed tlouche of
tepid watei', and snitfing through the nose cverv niglu of
an ointment thus composed :
IJ . Vaselini 3 ss.
Crlycerini 3 j.
Acid, carbohci liq lllij.
M.
Further, one granule of bichloride of mercury (one one-
hundredth of a grain) has been taken four times daily,
fifteen nnnutes after eating, together with five grains of
iodide of potash, largely diluted in water.
December 12, 1882. — The ])atient now breathes with
considerably more ease, and his nasal respiration is cer-
tainly less noisy. Crusts do not form so frecpiently as
they did two weeks ago, and they are far less adherent.
His general aspect is healtliier, and the redness and soie-
ness outside of the nose have almost disappeared. The
contracted orifice, if let alone for a single day (as it was
unavoidably one day), shows great tendency to contract.
It is proposed in a few days to give the patient a prop-
erly adapted dilating instrument, or a series of graduated
steel sounds, by means of which he shall be able himself
daily to dilate the contracted pharyngeal orifice, or, at
all events, to prevent it from growing smaller.
The feasibility of a surgical operation was suggested to
the members of the society, and their opinion was re-
quested in regard to it. It was looked upon by Dr.
George F. Shrady and others pre-ent as not to be thought
of for the time, or until the general constitutional condi-
tion was brought into subjection. Moreovei', it was
stated by some members that such operations had
usually been followed by imperfect success, owing to the
extreme difficulty of keeping the contracted orifice of the
pharynx in a dilated condition. Sooner or later, if a
wound were made, it would heal, and when it did, the
likelihood was that even greater cicatricial contraction
would ensue than what already existed.
The subject being open for discussion.
Dr. G. F". Shrady said that in his opinion the patient
was suffering from congenital syphilis, and was not at
present in a condition for an operation, even were such
advisable.
Dk. Samuel Sexton said that he had seen a number
of cases similar to the one presented ; they were, how-
evei, quite rare. They were all due to syphilis, but in all
cases except one, the disease was acquired, not inherited.
In this last gunnnata had developed in the pharynx and
produced lesions similar to those in Dr. Robinson's pa-
tient. He believed, however, that it might be found that
Dr. Robinson's (latient had actpiired syphilis, and that
the lesions had developed in the usual manner; that the
deafness, if one were to be guided by the appearance of
the drum-heads, had originated in otitis media catarrhalis
early in life, for they were retracted and there was the
usual arrest of development which arises from imperfect
intra-tympanic aeration, together with the not infrequent
trophic changes to be seen in such cases.
These cases had always consulted him on account of
the existing deafness, and, indeed, in most of the in-
stances the ])atients themselves had not-been aware of
the oio-])haryngeal occlusion. The deafness in these
cases, which was usually very marked, occurred in two
ways: one by extension of the catarrh from the pharynx,
and the other by interference with the performance of
the physiological functions concerned in the air-renewal
of the tympanic cavity. Hence the tympanic mem-
branes presented the appearances characteristic of
chronic catarrhal inflammation of the middle ear, an<l
were retracted by tiie unopposed pressure of air upon their
outer surface. Then in most of these cases there is a
damming-up of the nasopharyngeal secretions, giving rise
to obstruction of the Eustachian tube.
As regards operations in these cases, he had made a
good deal of ineiuiry, and had not been able to find that
they did any good, the cicatricial contraction having
been in all cases so great that no opening could be long
maintained between the moutli and the pharynx. One
of his patients had been slightly improved by the fre-
quent use of a bougie passed from the mouth up thiough
a minute opening (which is generally found to exist in
these cases) into the vault of the pharynx, thus giving
vent to secretions.
Dr. C. S. Ward thought that, owing to the great
tendency to contraction of all mucous surfaces, any
operation in the present c^se for enlargement would be
followed by a contraction that woulil eventually make
the condition as bad as at first.
Dr. Shrady said that, in suitable cases for operation,
much benefit might result from small nuiltiple incisions
into the cicatricial bands, and the subsequent dilatation
of the parts by bougies.
Dr. C. L. Dana read a paper (see p. 6) entitled the
absorption of nutrient enemata.
In the discussion Dr. Robinson related the case of a
small child suftering from intussusception, which he had
seen with Dr. Cleveland. The patient was suspended
head downward and water was injected into the rectum.
Suddenly there was a gush of water from the child's
mouth and the obstruction disappeared. The child died
twenty-four hours later. He had wondered whether it
was jjossible that the injection went the whole length of
the canal. He had at first been incredulous, but sub-
sequently was led to believe that it .was possible.'
The Results of Koch's Discoveries, writes Dr.
Formad (Phila. Med. Times), are now a matter of im-
portant consideration. In Germany, by imperial order,
in military hospitals phthisical patients are separated from
other cases as carefully as small-pox |)atients ; so a gentle-
man tells me who has just come from (Germany. Even
here the community, begins to regard Ihe disease as
eminently contagious. I know of an instance of a young
woman suffering from phthisis being locked up and avoided,
perhaps neglected, by the members of her own family,
for fear of the contagium. I have learned of several con-
sumptives who have become worse from the mortification
of having their friends avoid them, some even going so
far as not to shake hands with them. The moral -efiects
must certainly be most deleterious to these unfortunate
creatures and to those who surround them.
^ Vide case by Gilk-lte: New York Medical Journal.
24
THE MEDICAL RECORD.
[January 6, 1883.
CciriTsp 0 u clcn c c.
LONDON LETTER.
(From our Special Correspondent.)
THE DEATH OF SIR THOMAS WATSON SIR JAMES PAGETS
0R.4TI0N OLD DISEASES AND NEW NAMES FACTS
AGAINST THEORIES.
London. L^ecember 23, 18S2.
The Nestor of British Medicine, as he has often been
termed, lias passed from among us. As you ah-eady know,
he died quietly on the evening of Monday, December ii,
at his son's residence at Reigate. No other than a fatal
termination to his illness could indeed have been expected
from the first, considering his advanced age. He doubt-
less foresaw this clearly himself, as, when first attacked,
his remark was that it was " the beginning of the end."
His good constitution enabled him to struggle against
his malady for some time, though suffering much pain.
He was interred on the Friday following his death in the
parish churchyard at Reigate. Numerous members of
the profession attended his funeral, including the Presi-
dent of the College of Surgeons, Mr. Spencer AVells, and
the Registrar of the College of Physicians, Dr. Pitman,
and all the medical attendants of the deceased in his
last illness, viz., Drs. Walters, George Johnson. Green-
how, and Holman, and Mr. Lister.
His son, who succeeds him in the baronetcv, is not a
medical man.
Born in Devonshire, in 1792, and educated at Burv St.
Edmund's Grammar Sciiool and St. John's College, Cam-
bridge (whence he graduated as tenth wrangler), he only
began the study of medicine at the age of twenty-seven.
He entered St. Bartholomew's Hospital, where he studied
under Abernethy, afterward studied at Edinburgh, and
finally graduated at Cambridge (1825). He married and
started in practice in Henrietta Street, in which street he
lived till his death, though not in the same house. He
was elected a Fellow of the College of Physicians in
1826, and Physician to the Middlesex Hospital. He was
Professor of Clinical Medicine for two years at University
College, and of Forensic .Medicine for five 3'ears at King's
College. He is, perhaps, best known to the world as
the author of the classic "Lectures on the Principles
and Practice of Medicine," which he delivered there, as
Professor of Medicine, from 1836 to 1S40.
He was made a baronet in 1866, and was president of
the College of Physicians for five years, dating from 1862.
He attended the late Prince Consort, was Physician Ex-
traordinary to the Queen, and took charge of Sir Walter
Scott on his last voyage from London to Edinburgh.
Sir Thomas, although unprepossessing in appearance,
was genial in manner, upright in conduct, and a sound
and skilful practitioner. He had at one time a large
private practice. It is, however, nearly thirty years now
since he began to retire. .At that period he announced
that he would not in future visit patients, but he con-
tinued to see patients at his house for several years, a
privilege of which many availed themselves.
It is related of a Northampton physician — the late Dr.
Robinson, I believe — that, wishful to retire, he removed"
to a house a mile from the town and charged two guineas
instead of one, as before, a procedure which instead of
lessening doubled his practice.
Sir Thomas' last public appearance was at the Col-
lege of Physicians at the installation of Sir W. Jenner as
president, when, as the senior Felfow present, he took
part in the ceremony. He wrote at intervals in the
medical periodicals till within a short time of his death.
He admired Abernethy, whom he said he had heard
Lawrence once term the only genius in surgery he had
ever seen. Liston consulted him in his last illness. It
is worth mentioning that in Sir Thomas' last illness,
when suflfering from blai'der trouble, he specially re-
quested that Mr. Lister might see him, and under Mr.
Lister's treatment the local trouble improved. His faith
in the antiseptic treatment was thus evidently strong, and
shows that though retired from active practice he inter-
ested himself in the literature of the profession to the
last.
A recent event of interest has been the delivery of the
first "Bradshawe Lecture" at the College of Surgeons,
by Sir James Paget, Bart. The oratorical powers of " the
golden-mouthed Chrysostom of the profession " (as he
was recently termed by Sir W. Jenner at the banquet to
the .Army Medical Officers engaged in the Egyptian ex-
pedition) are well known, and a large audience assem-
bled on the 13th. About four hundred members of the
profession were present. .Most of the leading men were
in attendance, but Sir W. Jenner was conspicuous by his
absence. Every seat was occupied, and several distin-
guished members of the profession had to stand. The
lecture occupied an hour and concluded precisely at
four.
An ex-president of the college, who sat near me, re-
marked : "There he is — exact to ihe minute — I can't
think how he does it." Sir James, although not possess-
ing by any means a powerful voice, speaks very distinctly,
so that every word was easily heard, and he made few
references to his notes. Taking for his subject '• Some
Rare and New Diseas2s," he remarked that some diseases
were not really new but old, although only differentiated
in modern times. As an instance he mentioned t)pho;d
fever, the exact nature of whicli was only determined by
Stewart and Jenner, both of whom are living, but John
Hunter put up a specimen showing a typhoid ulcer of the
intestine which is still in the College Museum. The dis-
ease was therefore existent though not recognized. A
specimen of a syphilitic gumma in a muscle was also pre-
pared and preserved by John Hunter, a lesson. Sir James
Paget remarked, to all of us not to throw away what we do
not understand. On the other hand, we had some almost
certainly new diseases, viz., osteitis deformans and Char-
cot's disease of the joints. The lecturer remarked that
these diseases might be produced b)' a process of de-
velopment from other diseases — possibly by the blending
of tlie characters of two or three diseases. He urged that
we should study diseases as Darwin studied. Patient
observation was necessary.
Unusual specimens of disease should not be neglected.
It was erroneous to say " the exception proves the rule."
It should be rather for surgeons to say "the exception
probes the rule." As the Scripture says, " Prove all
things."
."Vccuracy in diagnosis should be aimed at. Drugs
were often blamed and thrown aside as untrustworthy
when the fault really lay in ourselves — in our diagnosis.
The value formerly ascribed to mercury in many internal
affections was alluded to — the fact being, that since the
visceral lesions of syphilis have been studied many of
these affections have been shown to be syphilitic, and
the action of mercury in many of these cases was thus
explained.
ORIGIN OF CYSTS IN THK KIDNEY.
To THE Editor of The Medical Record.
Sir: My attention has been drawn to a communication
made by Dr. Heitzmann at the New York Pathological
Society, of the researches of his pupil. Dr. Jeannette B.
Green, on this subject, published in your journal for Oc-
tober 21, 1882, p. 470. To quote from your report. Dr.
Green says, "The way in which cysts are formed is as
follows : first, the interstitial as well as the epithelial tis-
sue of the tubides breaks down with inflanuuatory or
medullary corpuscles, and thus an embryonal tissue is
|)roduced, sometimes occupying large territories of both
the cortical and pyramidal substance. Next a transfor-
mation of the medullary into myxomatous tissue takes
place, marked by the presence of a light, nearly homo-
geneous basis substance, which is traversed by nucleated,
January 6, 1883.]
THE MEDICAL RECORD.
25
bioplasson strings. In further growth these delicate
strings perish, and a cavity is formed filled with an albu-
minous liquid."
In the "Transactions of the Pathological Society of
London for 1880," you will find a paper by me on the
" History of Granular Kidney,'' from which I quote the
following : " Another mode in which the destruction of
tubules is completed is shown in Fig. 8, which rejjre-
sents a comparatively early stage of the ])rocess. The
drawing shows cross sections of several convoluted tu-
bules filled with round cells, which are not so closely
packed as in Fig. 6. The sections vary very much in
diameter, some of the tubules being evidently dilated.
In some there are very few cells, in others none, the
whole lumen being filled with a hyaline material, stain-
ing very feebly with carmine. These appearances,
which may be very readily seen, were first described by
M. Simon more than thirty years ago, as 'cystic degen-
eration of the kidney,' but have not received due atten-
tion. They are, in fact, due to the formation of a myxo-
matous or gelatinous tissue from the young cells filling
the lumen, by which the basement membrane is distended,
and a cyst is formed."
Again, under the changes in the Malpighian bodies, I
say, "The cellular mass has become converted into a deli-
cate gelatinous tissue containing stellate elements. Still
later the contents may be quite hyaline and stain feebly
with carmine, forming a little mucous or colloid cyst,
the W'hole process being quite analogous to that which I
have described in the tubules, with this exception, that
these Malpighian bodies are not enlarged, or, at least, to
any notable degree.''
The same descriptions are to be found in my i^ajjer in
the "Transactions of the International Medical Con-
gress, for 1881," of which I enclose you a copy.
1 am glad to find that my statements have received
this valuable confirmation, and am much obliged to you
for allowing this opportimity of directing attention to
them, as, although published in widely circulated Trans-
actions, they appear not to have been known to Dr.
Heitzmann or his pupil.
1 am, yours faithfully,
ROBEl^T S.\UNDBV, M.D.
47 Niiw Halls. Bikmingham, England, December 5, 1882.
HOOKS FOR THE
EXTRACTION OF FOREIGN liODIES FROM
THE EYE, EAR, AND NOSE.
To THE Editor of The Medical Record.
Dear Sir : While reading Dr. A. H. Buck's instructive
case of removal of a locust bean from the ear canal by
partial detachment of the auricle,in The Medic.ii- Record
of December 16, 1882 (p. 676), and Dr. S. Sexton's re-
marks on the same subject in The Medical Record of
December 23, 1882 (p. 721), I thought I might say a
few words on the usefulness of a small blunt hook, the
concave side of which is roughened and hollowed out.
This little instrument. has rendered me good service on
so many occasions that I always have it in my ordinary
pocket-case. I demonstrated it to the American Ophthal-
mological Society in 1873 (" Transactions," 1873, p. 108),
mentioning its advantages in extracting foreign bodies from
the interior of the eye. It is of flexible silver, so as to be
curved according to necessity, yet of sutificient strength
to exert a greater traction than seems required for the
extraction of any foreign body from the cavities men-
tioned above. Every one who has had some exjierience
in the removal of foreign bodies from the interior of the
eye knows how unavailable in general toothed forceiis
are ; they almost invariably slip oft", unless the foreign
body be embedded in soft tissue, such as the iris, with
which they can be extracted in common. The numer-
ous ingenious kinds of canula forceps which were con-
structed twenty and thirty years ago, have, as far as I
am informed, almost completely got out of u.^c. llctter
are the roughened anatomical forceps, which, offering
a larger surface of contact, have a firmer grasp and
hold on the foreign body. In most cases it is, how-
ever, still surer to pass a blunt hook behind the body
and draw it toward the opening in the corneo-scleral
capsule.
The same holds good for the ear and nose. Hooks
have been employed in att'ections of these organs for
many years, and are recommended in every text-book.
They are easily introduced, as in almost all cases there
is a chink somewhere between the foreign body and the
walls of the canal. Malgaigne, ' who considers them to
be the most appropriate instruments for extracting foreign
bodies from the ear, points out that in children the ear
canal is broadest horizontally, in adults vertically. N. Rau"
says that the best of the numerous instruments is a hair-
needle curved at its closed end, as Deleau " recom-
mends.
This, as all kinds of curette or spoon-like instruments,
will, I think, do very well when the foreign body is near
the external orifice of the canal, so that the curved end
can be passed around it. For those situated deeper, a
hook which can be introduced on tlie fiat, and during its
advancement pressed against the canal, a])pears more
serviceable. \Vhen behind the foreign body it is turned
so that the curved portion grasps the body from behind.
A blunt hook, such as is recommended by Lister and
others, and with which also Dr. Buck succeeded in his
above-mentioned case, is, however, more likely to sli))
off than one whose concave side is roughened and
hollowed out. This condition I have found of advan-
tage in seizing angular or smooth bodies which are quite
likely to escape an instalment with rounded and even
surfaces, but are firmly held by one which is provided
with a roughened groove. Though the modification ap-
pears insignificant, it bears on a jjractical point which in
certain cases may determine the success of the opera-
tion.
Experience makes us skilled in tlie use of difterent in-
struments, and I do not doubt that soft bodies may be
extracted with Dr. Sexton's or other toothed forceps. In
dealing with hard bodies I would never attempt the use
of any kind of forceps, for the probability of pushing
them deeper into the canal is almost a certainty. The
verdict of the profession in this regard is nearly univer-
sal. The case of Dr. Joy, which Dr. Sexton quotes in
support of the use of his forceps, is by no means a felici-
tous one, as I have convinced myself by reading the
original publication in The American Journal of Otology,
vol. iii., \>. 144. The locust bean had lain in the ear
canal surrounded by pus and granulation tissue for over
two months — time enough to sot'ten as much as possible.
"The patient was etherized, and several small pieces of
the shell and of the fruit were removed with Dr. Sexton's
new forceps. The boy disappeared from observation
for five months. There was a free discharge of pus, and
several polypoid growths obstructed the canal. These
were removed by the snare, and all but a small portion
of the bean was removed by the forceps, the fragments
coming aw-ay piecemeal in thin, rather tough sections.
The case is still under observation, and the remaining
portion will probably soon pass out of the canal without
surgical interference." So far the report of this case,
which produces an entirely different impression from
what one receives by the woodcut in Dr. Sexton's letter,
where the whole bean is beautifully in the grasp of the
instrument.
As to the removal of foreign bodies from the ear in
general, 1 do not remember a single case in which I
failed by syringing or the hook. My experience, as that
of any one man, is, of course, limited. I may fail in my
endeavor to-morrow. If the grooved hook prove insuffi-
1 Cazette des H6pitau.v. No. 58, 1841.
- Lehrbuch der Ohreiiheilkunde, p. 374, 1856.
=* Memoire siir les Corps elraiigers d;iiis le Conduit, aiidilif Gaz. Mud. de
I'lris. v>. 161. 1^31-
26
THE MEDICAL RECORD.
[January 6, 1883.
cient, I would not be in a hurry, but have a hook con-
structed that could be introduced straight, having an end-
piece which, when beyond the foreign body, would by
means of an articulation and a stem divide into two
small ])rongs directed at right angles to the stem, and
applying themselves fiimly to the posterior surface of the
foreign body, say a glass bead. I would make the end-
piece of this instrument thin, so as to jjass easily through
a narrow fissure between the foreign body and the w'all
of the canal. The surfaces touching the foreign body
may be slightly concave and rougliened. Such an in-
strument with one blade has, however, been recom-
mended by Leroy d'EtioUes.' A hook with two i)rongs,
which are closed while being introduced but open by
pressure when behind tlie foreign body, can be con-
structed in different wiys — for instance, according to the
pattern of Liebreich's or Matthieu's iris forceps.
Delay in removing a foreign body from the ear is only
exceptionally connected with any danger. Certain sub-
stances which swell by imbibition may produce inHamma-
tion and prevent the secretion from escaping. Politzer
says,^ " the enlargement from syringing with water may be
prevented by immediately iiouring alcohol into the ear."
Not only in that case, but in every other when a swell-
ing foreign body produces inflammatory intumescence of
the walls of the meatus, nay, even in perforations of the
menibra-na tympaniand in |Hirulentotitis media, is alcohol
an excellent remedy for relieving all those symptoms, as
nobody knows better than Politzer himself Absolute
alcohol i)oured into the ear several times daily will ab-
sorb the waier from the swollen foreign body as well as
from the inflamed tissues around it, make both of them
shrink, and thus create free space and facilitate the re-
moval of the intruder.
H. Knapp, M.D.
December 24, 1S82.
To THE Editok of The Medical Record.
Sir : In my article, " A Case of Foreign Body in the
External Auditory Canal," published m The IVIedical
Record of December i6th, I drew certain conclusions
which, as will be seen by the subjoined extract of a let-
ter, reflected unjustly upon the physician who first saw
the case. 1 am now convinced that my remarks upon
this physician's interference were not well founded, and
in simple justice to a professional brother, may I ask you
to |)ublish this brief communication.
Albert H. Buck, M.D.
{Extract from letter.)
" 1 may say that no efiorl was made by me to remove
the bean, but instruments were used sim])ly to dilate
the opening in order to see the bean, if possible, and
to gel an idea of its position. The first instrument used
bv mvself was an Anel's probe ; with this I discovered
that there certainly was something in the ear, about an
inch from the external meatus, and got the impression
that it was firmly lodged. I at no time saw the bean.
The first instrument used was a l»ir-pin, in the hands
of a nurse or one of the lady guests at the house, who
thought to remove it widiout alarming the mother.
The next instrument used was a crochet-needle, m the
hands of one of the gentlemen guests. The only instru-
ment used by me with the idea of getting the bean, or
that touched it, besides the probe sijoken of, was one
borrowed from a dentist, and very similar to the one
shown in your article ; but as the boy cried the moment
the bean was touched, and as some of the beans had
been placed in water for some time and found not to
swell, it was thought a few hours' delay would do no
harm, and the mother 7uas advised by me to go to the city.
I am positive that the bean was impacted
when I first saw the boy, and that I did not move it in
the slightest degree."
' kccucil di; I.<;tlit;s e; (Ics ML-llioires. Paris. 18^4.
- 'l'cxt-b(>uk, l-^tiglish tr.'inskuidii, p. 62S, lySj.
Iit^iuy ^cms.
Official List of Cliaiigi^s of Stations and Duties of Officers
of the Medical Department, United States Army, from
December 23, 1882, to December 30, 1882.
Perin, Glover, Lieutenant- Colonel and Surgeon.
Granted leave of absence for one montii from Decem-
ber 19th. S. O. 217, Department of Dakota, December
20, 1882.
Bill, Joseph H., Major and Surgeon. Will report to
the Commanding Officer Fort Omaha, Neb., for duty.
S. O. 134, par. 4, Department of the Platte, December
21, 1882.
Kilbourne, H. S., Captain and Assistant-Surgeon.
Granted leave of absence for one month, with permis-
sion to apply t.irough Headquarters Military Division
of the Missouri for an extension of two months. S. O.
218, De|)artment of Dakota, December 21, 1882.
Reed, Walter, Captain and Assistant-Surgeon. Re-
lieved from duty as Attending Surgeon Head(iuarters
Department of the Platte, and will report in person to
the Commanding Ofiicer F'ort Omaha, Neb., for duty.
S. O. 134, Department of the Platte, December 21,
1882.
Turrii.l, H. S., Captain and Assistant-.Surgeon. Up-
on being relieved from duty at Fort Omaha, Neb., will
proceed to Fort Fred. Steele, Wyo., and report to the
Commanding Officer of that post for duty thereat. S. O.
134, par. 5, Department of the Platte, December 21,
1882.
Hopkins, William E., Assistant-Surgeon. Granted
leave of absence for two months, to commence January
I, 1883, with permission to apply for an extension of
two months. S. O. 88, par. i, Military Division of the
Atlantic, December 28, 1882.
2^XctTiciil Items.
Contagious Diseases — Weekly Statement. — Com-
parative statement of cases of conlagious diseases re-
ported to the Sanitary fiurcau, Health Department, for
the two weeks ending December 30, 1882.
^ ^ 2.
— X >
>
CJ
Week Endincj
' (A
3
0
I ^
s>
>^
! H
r*
tr.
II
December 23, 1882 1 o j 9 I 55
December 30, 1882 o 13 45
59 61 o
40 35 ; o
The Bacili,us Tuberculosis not a F'at-Crystal. —
]5r. J. O. Hirschfelder, Professor of Clinical Medicine,
Cooper Medical College, San Francisco, sends us the
following very interesting letter : " In No. 23, \'ol. xxii. of
The Record I find a statement of investigations of Dr.
H. D. Schmidt, of New Orleans, i)roving the bacillus tu-
berculosis of Koch to be simply a fat-crystal. If this as-
sertion were true it v,-ould cast a shadow of doubt upon
all the bacteriological work done within the past few
years. 1 have confirmed the investigations of Koch
upon the sputa of a large number of cases under my
charge, finding the bacillus in every case of phthisis in
my wards during the last three months, besides many in
private jiractice. I have emi)loyed Ehrlich's method, and
have experienced no difficulty in demonstrating the or-
ganism. In order to test the statement of Dr. Schmidt, I
January 0, 1883.]
THE MEDICAL RECORD.
27
first prepared a specimen of sputum by Elirlich's method,
finding numerous bacilli ; I tlien- placed the pieparation
in ether and again examined it, no bacilli were visible.
Tiie natural inference was not that the bacilli were dis-
solved, but that the color was washed out by the ether.
The preparation was therefore restaiiied like a fresh spe-
cimen and the bacilli were found as before. I likewise
prejinred two covers by spreading sputum upon one of
them, breaking it up as well as possible, placing a
second thin cover upon the first, and drawing tiie two
rapidly apart so that the covers should be as nearly
alike as possible. One cover was then stained in the
ordinary way, the other was placed in boiling ether, in
which it remained for about twenty minutes, and was then
washed thoroughly with fresh ether, so tiiat no fat should
remain. This si>ecimen was then stained by Ehrhch's
method, and the two covers were com])ared. I fouiul
and readily demonstrated to the medical gentlemen
present not only that the bacilli were not dissolved by
the ether, but that, on the contrary, they stood out more
plainly in tlie specimens treated with ether on account
of tlie washing out of the fat-granules which otherwise
slightly obscure the field."
An Acgrievkd Correspondent, of Rochester, N. Y.,
writes us as follows : '■ In The jMedical 1!ecord of the
i6th inst., p. 690, you did an iiijust-ice in quQting the
I'hysio-Medical College, of Cincinnati, O., as being an
eclectic institution, which is false ; it has never been rec-
ognized by the Eclectic Society."
The 'Wayneflete Chair ok Physiology at Ox-
EORD. — The \Va)'netlete Chair of Physiology has been
filled by the election of Dr. J. Piurdon Sanderson, F.R.S.,
who will henceforth regularly deliver lectures on .Ainimal
Physiology and Histology to members of the University.
The endowment of the Chair is maini)' deiived out of
funds set apart for the purpose from the income of Mag-
dalen College, the emoluments of two Fellowships form-
ing the principal stipend.
Dr. Herman Boskowhz died December 26th, at his
home, in Brooklyn, N. Y., after a long illness. Dr. 15os-
kowitz was a remarkable looking man in appearance, be-
ing little more than a dwaif in stature. For forty years
he enjoyed an extensive practice. Before the war he
was an active abolitionist, enjoying the personal friend-
ship of Horace Greeley and other distinguished republi-
cans. Early in his career Dr. Boskowitz earned a great
rei>utation by curing one of the Clydes, of the great
ship building firm, of blindness. Dr. Boskowitz, who was
seventy years of age, was a native of Vienna, but came to
this country when very young.
The Subject of Wound-Dressing, the old time-
honored subject of debate among surgeons, still crops up
from time to time. At one time water-dressings were in
favor ; then came carbolic oil, antiseptic gauze, tow. etc.
The senior surgeon at one of the large London medical
schools always ai)plies a poultice to his stumps the day
following amputation, and with very excellent results.
The weathercock of professional favor is now veering
round to infrequent dressing with some dry absorbent
material, and absolute rest. Pressure is also steadily
gaining ground. The two latest contributions on the
subject of wound-dressing are those of Dr. P)dward Thom-
son on puff-ball, and Dr. Lockhart Gibson on salicylic
silk. A surgeon of large hospital experience told me the
other day, in the course of conversation, that recently he
had, after amputation, alvvays tightly bandaged over the
stump a large sponge which had been diiiped in carbolic
oil and wrung out till nearly dry. This he left on for a
fortnight or more, with very excellent results. — Cor. of
American Practitioner.
Ozone and the Blood. — Professor Binz some time
ago announced that ozone, when inhaled cautiously, had
a hypnotic effect. He has recently made further re-
searches regarding the eftect of ozone on the blood. It
has usually been asserted that ozone introduced into the
blood had a tendency to injure it by forming metluenia-
globin. Binz finds that ozone ]>assed through blood does
not have very much effect any way.
The P'lectricai. Society is the name of a new organ
ization recently started in Chicago.
"Mineral" Organi.s.vis. — During the past year, the
French chemists, D. Monnier and C. Vogt, presented,
through M. Robin, to the French Academy of Sciences
the results of some experiments, showing that the forms
peculiar to plants and animals also appear under certain
circumstances in purely inorganic things. Dr. H. D.
Valiii has repeated these experiments [Chicaf^o Medical
Journal and Examiner) and made the following observa-
tions : In a flask full of soluble glass were placed frag-
mentsof sulphate of iron, ten grains in weight, w-hichimme-
diately began to assume a colloid condition on the outside,
and shot tubular prolongations, colloidal and cellular,
which grew at the rate of half an inch in twenty-four
hours. Some attained to tsvo inches in length, and were
about one twelfth of an inch in diameter. AW these pro-
longations shot a number of slender filaments from vari-
ous points of their surface, and these attained a length of
a few inches in a few hours. After some days or weeks,
all thesi organisms assumed a crystalline condition, and
become empty inside. Some of them rose to the surface
of the licpiid. They were insoluble in water ; they re-
mained intact when exposed to air, and when introduced
in a newly prepared flask at the same time with fresh
fragments, they hastened the metamorphosis of these.
The addition of water to the soluble glass rendered the
exi)eriments more easy, and saved time.
Secondary Hemorrhages and their Cause. — Dr.
Charles C. F. Gay communicates a valuable paper on this
subject to the Buffalo Medical and Surgical Journal.
Dr. Gay is inclined to doubt the accepted views regard-
ing the qause of secondary hemorrhage. He .says :
"The tendency of the blood-current is, I believe, at
first to pass through arterial anastomoses rather than to-
ward the capillaries. In 'St. Bartholomew's Hospital
Reports' I tind the following experiment, reported by
William Harrison Cripps. He says : 'If water be in-
jected into the common iliac artery of a rabbit it will
circulate through the capillaries, returning by the vein.
If the external iliac and the superficial femoral be now
tied, the water will still return by the vein, only much
more slowh'. If the femoral artery be now divided be-
low the ligature and water still injected by the common
iliac, it will be found that a greater quantity of the water
will return through the cut (lower) end of the femoral
than by the iliac vein.' This experiment shows, at least in
the case of the rabbit, that even with the iliac vein open,
less resistance is afforded by the anastomoses of the ar-
teries than is afforded by the capillaries. This writer has
collected filty-three cases from various sources and clas-
sified them according to the [ilan of treatment. The re-
sult of treatment is thus shown :
• ^ _ Died. Recovered.
Ligation of external iliac 12 2
Aiin)utation 2 3
Re-opening wound 7 5
Pressure and bandaging 3 12
No treatment 4 o
I'otal 50
The percentage of recoveries, as here shown, is great-
ly in favor of suppressing hemorrhage by pressure and
bandaging, the method recommended by Dr. Gay. Re-
ligation, being found unnecessary to control hemorrhage,
constitutes in itself, I think, a [jartial concession to the
theory that the hemorrhage is venous in these cases, and
not arterial ; or, if not venous, then arterial from rupture
of a branch of the anastomotic system of vessels, from
which the blood derives its scarlet hue."
28
THE MEDICAL RECORD.
[Janiiar) 6, 1883.
A Quinine Journal. — The Monthly Review of Medi-
cine ami Pharmacy will hereafter take the name of The
Qiiinologist. The New York medical man is reputed to
be a good deal that sort of thing.
Peri-uterine Cellulitis with Ab.sces.s Pointing
IN Middle Line. — Dr. Frank \V. Thomas of Marion,
O., sends us the history of a case of a woman aged
rhirty-seven, who at her si.xth confinement was delivered
of a dead foetus sixteen days after the first beginning of
labor pains. Three weeks later the patient was attacked
with phlegmasia alba dolens ; this disappeared in about
four weeks, and then there developed symptoms of a
pelvic cellulitis, the whole abdominal surface becoming
hardened For three months the ])atient suffered greatly
from pain in the lumbar region and pelvic organs : mor-
phine was resorted to and used continuously for months.
The jiatient suffered from the chronic cellulitus for over
a year. In about the fifteenth month the abscess
pointed at a place about midway between the pubes and
umbilicus. It was opened and two quarts of pus es-
caped. The patient then rapidly recovered. Our cor-
respondent, who treated the case in the last months,
very pertinently asks whether pointing could have been
brought about sooner.
Policlinic or Polyclinic. — The word policlinic is
derived from TroAts, a town, and kXiwj, a bed. If means,
therefore, and always has, since its introduction as a word,
a city clinic or hospital. A frequent mode of spelling
the word in American medical literature is pol\clinic.
This assumes, arbitrarily and incorrectly, that the word is
composed of -oXd?, many, and kAu ?;.
The Frequency of and Danger from Narrow
Pelves. — Dr. VV. Fishel read a paper before the Ger-
man Medical Society of Prague, in whicli he stated that
the usual estimates of the frequency of narrow pelves in
(iermany were too high. These estimates made the
proportion vary between 14 and 20 ])er cent. Hecker,
of Munich, found the percent, to be only i.5;«Muller,
in Berne, 16 ; Goenner, in Basel, 7 ; Winckel, in Dresden,
3 ; Fishel, in Prague, 15.6. In Breisky's clinic, at Prague,
the mortality in these cases was only 1.5 percent.
Tinctura IODOFOR.\n Co.MPosiTA. — Under this title.
Dr. G. Beck describes in his "Therapeutical Almanac,
1880-81," a very useful formula for a solution of iodo-
form and iodide of potassium, which can not only be
taken internally (three times a day, fifteen drops in .sug-
ared water), but is in place in all cases where the iodine
treatment seems to be adapted for external application,
and is capable of causing a radical disappearance of tu-
mors of various kinds, as also of inflamed glands, etc.
The original formula — iodoform, i part ; potassii iodid.,
70 parts ; glycerin, 70 parts ; spir. vim rect., 100 parts
— is pharmaceutically incorrect, because the iodoform is
not completely dissolved in this solution. The following
modification is recommended, which, while not lessening
any of its effects, represents a complete solution, to
which Balsam of Peru is added as a corrigens to the iodo-
form :
R. Iodoform 8 grms.
Balsam Peru 3 "
Solv. in spir. vin. rect 20 "
Solutioni aduiisc.
Kalii iodid 7° "
Ft. solut. in aqu;e dest..
Glycerin pur I'lii 35 "
F'ilter.
Doctor and Druggist — A Singular Litigation. —
Not long since, a physician in this city who had invested
money in a retail drug store was obliged, by the failure
of its proprietor, to take the stock as "collateral" for
his investment and sell it to some one else. After the
bargain had been completed, so we are informed, he said
that he would be very glad to send the [nirchaser what
prescription business he could. Whether our informa-
tion is correct or not as' to the foregoing details we can-
not say, but the purchaser of the store lately brought suit
in the Court of Common Pleas, for the recovery of $5,000,
as damages for an alleged breach of contract. The com-
plainant states that the doctor promised to send him all
his (irescriptions to be filled, but, in fact, he has never
sent him any prescriptions at all. The doctor demurred
to the complaint on the ground that the contract, if
made, was void, as impossible of performance, and im-
moral. On November 20th, Judge J. V. Daly handed
down a decision on the demurrer, in which he holds that
the contract is such as may support an action, and that
the demurrer must be overruled. Judge Daly says-
that there is nothing improper in a physician contracting
to advise his patient to go with his prescriptions to a
particular drug shop. In action for damages, for a
breach of such a contract, there might be much difficult)'
in getting the necessar)' evidence, but that fact did not
furnish any reason why the action could not be main-
tained.
The Pathogenesis of Secondary Tumors. — We
have received from Dr. Henry Wile a pamphlet upon
the above subject and embodying the results of the
author's elaborate researches. Dr. Wile furnishes strong
evidence in favor of the view that secondary timiors are
developed by metastasis and not by virtue of any dys-
crasia. He states in a note that prior to Dr. M. T. Prud-
den he discovered that adult cartilage when transplanted
may continue to grow.
Phthisis Conveyed from Dogs to Man. — Dr. E. G.
Janeway relates a number of cases of phthisis {Archii'es
of Medicine) illustrating its possible contagiousness.
Among others was the case of a phthisical young man
who kept a ]iet dog. He was accustomed to sleep with
the dog nestling in his arms. The animal became af-
fected w-ith a cough and subsequently died. Another
dog shared the same fate ; a third dog suffered from a
cougli, but its owner died of phthisis and the dog subse-
quently recovered.
Dr. Polk's Remarks before the Academy of Medi-
cine.— Dr. W. M. Polk wishes to make the following
corrections in the report of his remarks before the Acad-
emy of Medicine, December 21st :
In first paragraph, for " supposed difficulties in the
performance of either the Cesarean section or Porro-
Miiller's operation,'' read '-Thomas's operation for Ca;-
sarean section.'
In the next paragraph, the last two sentences should
read: "With regard to the difficulties in performing
Thomas's operation, he referred to the remarks of Dr. Har-
ris, of Philadelphia, one of the ablest advocates of Cesa-
rean section, who sjjoke of Thomas's operation as one that
was difficult and scientific, requiring extraordinary ana-
tomical skill. Dr. Polk, however, had reached the con-
clusion that it was a very easy operation to perform
when placed in contrast with Cesarean section, or any
of its modifications."
The Therapeutic (i.\ZErrE occupies a unique and
uselul place among medical journals. It deservedly
congratulates itself upon the successfiil closing of its
sixth year.
The Pacific Medical College has recently been re-
incorporated under the name of the " Cooper Medical
College." This change is the result of a nuinificent gift
by Dr. L. C. Lane to the college. This gift is a new
building valued at $100,000. The school was asked by
Dr. Lane to be called the Cooper Medical College, after
Dr. E. S. Cooper, one of the fathers of medical education
on the Western Coast. Dr. Lane's action is a most gen-
erous one in every way.
We are glad to learn ihat the new school has adopted
an obligatory three-years' course.
The Medical Record
A Weekly yournal of Medicine and S2irgery
Vol. 23, No. 2
New York, January 13, 1883
Whole No. 636
(Dvirjinal ^vticlcs.
GROWTHS IN THE NASAL PASSAGES.'
By/. H. BOSWORTH, M.D.,
l*KOFESSOR OF DISEASES OF THE THROAT IN THE BELLEVUE HOSPITAL MEDICAL
COLLEGE, NEW YORK.
It is not my intention this evening to go over the whole
subject of neoplasms in the nasal passages, but simply to
ask your attention to some of the commoner forms of
growths, met with in every day practice, and to bring be-
fore you some suggestions in the way of treatment. By
the nasal passages, it should be understood, is meant the
whole of the nasal air-tract, extending from the nostrils
in front to the border of the soft palate posteriorly. This
tract being from a physiological point of view a single
channel for the passage of the inspired air, whatever the
anatomical boundaries may be. By far the most com-
mon of all growths occurring in this tract is the so-called
ADENOID OF THE VAULT OF THE PHARYNX.
I think it is a somewhat general impression that this af-
fection is a rare and obscure one, and moreover, that it
gives rise to a train of symptoms peculiar to itself. The
point of view to which I ask your attention to-night is
rather that the disease is an exceedingly common one, and
that it is one of the various, and perhaps the most frequent
of the morbid conditions which give rise to an abnormal
discharge from the nose, and hence is obscured and lost
sight of under that very vague and indefinite term " nasal
catarrh." Nasal catarrh is an exceedingly meaningless
term. In former years, when our means of diagnosis
were imperfect, and our methods of exploring the nasal
passages were very crude, it is not to be wondered at
tliat all diseases which give rise to a discharge from the
nasal cavities were grouped under this general designa-
tion. Of late years our means of diagnosis have been so
far perfected that it is possible in every case, unless pos-
sibly in very young infants, to bring under ocular inspec-
tion the whole of the lining membrane of the upper air-
passages from the nostril to the trachea. I say every
case, and I think the assertion a perfectly safe one, for
even the most irritable throat, by the exercise of a little
patience and deftness, will easily be so far brought under
control as to admit of a satisfactory rhinoscopic examina-
tion. Tliis thorough examination, then, will reveal to us
in a very large majority of cases, some definite morbid
condition, to account for the " catarrh," the removal of
which will be followed by a radical cure of the disease.
Among the common conditions which may cause a catar-
rhal discharge may be mentioned rhinitis hypertrophica,
rhinitis atrophica, nasal polypus, deviated septum, syph-
ilitic ulceration or necrosis, strumous ulceration, the
[presence of foreign bodies, adenoid of the pharynx, etc.
Chronic catarrhal inflammation of the mucous mem-
brane lining the nasal i)assages develops in two varieties,
the hypertrophic and the atrophic form. Hypertrophy,
involving the mucous membrane of the nasal cavities
proper, has been well designated rhinitis hypertrophica.
The same hypertrophic process developing in the vault
of the jjharynx has been called adenoid of the pharynx.
Nature has been very lavish in her endowment of the
upper air-passages with numerous glands and follicles,
^iRead before the New York Academy of Medicine.^January 4,^1883.
whose function is to pour out upon the mucous mem-
brane an abundant mucus, by which it is kept in a soft,
moist, and pliable condition, otherwise, the constant pass-
ing to and fro of the inspired air, often dry and irritating,
would tend to rob it of its moisture and cause a dryness
by which its proper functions would be seriously impaired.
These glands and follicles manifest a tendency to aggre-
gate themselves together in various localities. The most
notable instance of tiiis is between the pillars of the
fauces, constituting what is called the faucial tonsils. Quite
a large group of glands is found at the pharyngeal
vault. Wherever we find these masses of glands, we find
them manifesting a tendency to become the seat of
chronic inflammatory changes. These changes in the
pliaryngeal vault always result in hypertrophy. I have
never met with a case of atrophy. A description of the
normal glandular structures, which exist in this region need
not be entered upon. They were first fully described by
Luschka, and hence the mass is often spoken ofasLusch-
ka's tonsil. The condition to which I invite your atten-
tion consists in the development in this region of more or
less well marked, distinctly outlined growths, which vary
from the size of a coffee grain to that of a large chestnut,
or even larger. Loewenberg and Meyer describe these
as consisting of adenoid or true glandular tissue, while
Woakes considers them to possess certain features of the
papillomata, and gives them the name of adeno-papil-
loina. In this view I believe he is quite alone. Their
true nature is, undoubtedly, adenoid. They consist in a
true hypertrophy of the normal glandular structures
which are found in this region.
The following description has been furnished me by
Dr. Heitzmann, of this city, who has very kindly made
microscopic examinations of a number of these tumors
which I removed.
Microscopical examination of the pharyngeal tonsil. —
Five growths of the pharyngeal tumor were handed to
Dr. Hqitzmann by myself. He examined them after
they were hardened in chromic acid and embedded in a
mixture of paraffin and wax.
On transverse section a number of features are ob-
served, common to all the five growths. These are :
First, they are covered by a layer of columnar ciliated
epithelia which exhibits the features of stratified columnar
epithelium. The single columnar epithelia greatly vary
in height, and exhibit sometimes long, sometimes short,
bent cilias. Between the elongated feet of the epithelia
irregular corpuscles of varying shape are visible, such as
occur throughout the mucous layer of the aerial passages,
the larynx, the trachea, and the bronchi. Only in one
specimen was one side of the tumor covered by a narrow
layer of stratified epithelia, probably corresponding to
the medial aspect of the tumor, without cilia, with a
gradual transition into columnar epithelia.
Second, all the tumors exhibit a lobate appearance,
the fissure between the lobes being sometimes shallow
and at other times very deep, dividing the whole mass
into a number of longitudinal ridges. Each ridge may
again exhibit a varying number of shallow papillary pro-
trusions. Under the microscope correspondingly we ob-
serve large protrusions, which are caused by the follicu-
lar formation of the tissue, and small ridges of a papillary
aspect caused by narrow protrusions of the subjacent
tissue.
Third, the main mass of the tumors is composed of
lymph tissue, formerly termed adenoid tissue, from the
3°
THE MEDICAL RECORD.
[January 13, 1883
mistaken idea that tiiis tissue is glandular in nature. No
epithelial formations enter, however, the structure of the
tumor, save the depressions and furrows between the
lobes, sometimes penetrating very deeply into the mass
of the tissue, and there producing manifold secondary
convolutions. Beneath the epithelial cover there is no
fibrous connective tissue around the lobes, while the
papillary elevations are produced by a delicate fibrous
connective tissue freely supplied with lymph corpuscles.
According to the general stiucture of lymph follicles
and lymph ganglia, we find in the tumors under consider-
ation a varying number of lymiih follicles, consisting of
an accumulation of lymph corpuscles, and supplied with
a comparatively small number of blood-vessels. The
follicles are separated from each other and enclosed by
what is known as interfollicular strings. In these bcjth a
myxomatous reticulum and the fibrous variety of the
connective tissue is more developetl than in the follicles,
and the blood-vessels are someivhat more numerous.
Only in one of the specimens was there a marked tibrous
interfollicular tissue with comparatively few lymph cor-
puscles. In all others the fibrous connective-tissue was
but little developed, which feature would account for the
comparative softness of these new formations.
With high power of the microscope in all specimens the
features common to Ivmph tissue are discernible. There
is a myxomatous reticulum ill-defined and crowded with
lymph corpuscles in the meshes within the follicles. There
is a more developed myxomatous or fibrous reticulum
with comparatively less lym[)h corpuscles in its meshes
within the interfollicular strings.
In one case a cyst was observed in the tissue near the
surface, just perceptible to the naked eye, the size of a
small pin's head. This cyst is lined on one side by flat-
tened e[)ithelia, on which even cilia; are still recognizable,
while the opposite side lacks an epithelial cover, but is
composed of lymph corpuscles m connection with a
delicate myxomatous tissue, filling in part the cyst.
This latter feature indicates that the cyst has not
arisen simply from an obstruction of an interlobular fis-
sure, but is tlue to a transformation of the epithelial cover,
at least on one side, into a medullary, and from this into
a myxomatous tissue.
The examination proves the formations under consider-
ation are no tumors, in the proper sense of the word,
but a hyperplasia of the lymph tissue, which constitutes
the so-called pharyngeal tonsil. A ditiference between
hyperplastic faucial tonsils and pharyngeal tonsils is that
in the former the fibrous connective tissue is, as a rule,
far more developed than in the latter.
This explains the fact I have noticed in operating with
the snare, that the faucial tonsil is cut with the extremest
difticulty, while the latter are severed with the greatest
ease, oft'ering but trilling resistance to the wire.
As a matter of course, formations of a simple hyper-
plastic nature are benign. This is in accordance with
the clinical fact that their extirpation, in the great ma-
jority of cases, is not followed by recurrence. The
lymph tissue is, however, the sample of a malignant type
of tumor proper, the so-called lymiiho-sarcoma, or
lympho-myeloma. Should, by a continuous growth, the
lymph tissue keep increasing, no doubt it will establish
a malignant tumor, such as has been observed by several
writers in this region.
During the past eighteen months I have met with 75
cases of adenoid disease of the pharyngeal vault. C){
these there were :
Under the age of 10 5
Between the ages of 10 and 15 16
" " 15 " 20 27
" " 20 " 30 23
" " 30 " 40 2
" 40 " 50 I
Above the age of 50 i
Of these 49 were females and 26 males. We tiius see
that the larger number occur about the age of pu-
berty, it being very rare in small children, and also in
adults beyond the age of thirty. The deduction from
this is ([uite obvious, viz.: that the growths gradually
shrink and disa|ipear with the development which sets in
at puberty. We thus find a very striking analogy be-
tween this affection and hypertrophy of the faucial ton-
sil, not only as regards its normal histology and pathology,
but also in its development and clinical aspects.
In a large proportion of the cases which I have seen
it occurs as a separate and independent afteclion, less
than one-half showing any morbid condition in other por-
tions of the nasal passages. The most frequent condi-
tion with which it is associated is rhinitis hypertrophica
or chronic infiammation of the mucous membrane lining
the nasal cavities proper. In ten cases it was associated
with enlargement of the faucial tonsils. 'In four cases it
was met with in connection with rhinitis atrophica or dry
catarrh, three of these having readied the stage of ozoena.
The cause of these growths lies simply in the tendency
toward hypertro|)hy as the result of inflammatory changes
which characterizes the lining membrane of the upper air
tract and its appendages, under the stimulus of repeated
colds. I do not believe it ever to be a manifestation of a
systemic dyscrasia, but rather that il is purely a local
disorder. It occurs in children more frequently than in
adults, for the same reason, that all glandular structures in
childhood are more prone to take on morbid changes.
This diagnosis is usually quite easy. Meyer and Loew-
enberg both insist on a digital exploration in addition to
the use of the rhinoscopic mirror. This I have often
done, but have never found it absolutely essential. The
introduction of a finger, forcibly as it needs must be, be-
hind the palate of a child very naturally excites pain,
often retching, and always terror and ap[)rehension, and
it seems to me much better to retain the confidence of
the child by resorting to simpler measures when all that
can be desired is accomplished by such. In all cases,
even in children of seven or eight years of age, with the
exercise of a little patience, I have succeeded in obtain-
ing a thorough inspection of the pharyngeal vault, by this
means gaining, I think, a fairer estimate of the size,
shape, and location of the growth than can be gained by
digital exploration. I should say, however, that as a
rule, it is important to make use of sunlight or the cal-
cium light in making the examination, as the ordinary
gas-jet is not suflicient to thoroughly illuminate the cavity
of the pharynx, especially if a small mirror is used.
Sy»iptoi>is. — The prominent and most troublesome
symptom to which the presence of these growths gives
rise is an excessive discharge of mucus or muco-pus ; in-
deed, nearly all the cases which have come under my
care have come for nasal catarrh. The source of the
discharge is, undoubtedly, in the hypertrophied glands
themselves, their normal secretory function not being
destroyed by the morbid process, which has given rise to
the hypertrophy, but is, on the contrary, greatly increased.
We find them, therefore, pouring out large quantities of
mucus or muco-|)us, which in the larger proportion of
cases makes its way into the lower pharynx. In those
cases in which the growth has attained a large size,
the discharge makes its way through the nasal cavities
proper, and is voided through the nostrils.
Voice. — Another symptom which may be traced directly
to the existence of these growths, and perhaps the first to
be noticed will be the altered character of the voice. This
is changed into what .Meyer calls the dead voice. It is the
voice of one with a cold in the head, that is the nasal twang
is more or less completely abolished. In this way " m "
and " n " become " cb '' and " ed." In order to give rise to
this, the growth need not be large. It may occlude but
a small portion of the posterior nares. If you will glance
at the diagram, you will see that in order that the voice
shall have its full nasal resonance, the vault of the phar-
ynx should be (piite clear. If but a slnall growth i)ro-
jects from its wall it seriously interferes with the sound-
January 13, 1883.]
THE MEDICAL RECORD.
31
waves, wliich in nasal sounds should have a clear lield
from the vocal cord to the roof of the nares. If diey
impinge upon tlie slight projecting shoulder of a growl h
located in the pharyngeal vault they are to an extent
smothered, and the whole tone of the voice deadened.
The manner in which the singing voice is affected
by these growths in the pharyngeal vault otTers many
points of great interest. Nature is very lavish in her en-
dowment of the various organs of the body by which tlieir
different functions are performed, and so supplies an or-
gan capable of doing vastly more work than it is usually
called upon to perform. The larynx when called upon
for an ordinary voice responds readily, and will supiily
apparently a clear, healthy, conversational voice for years,
even when there may exist very marked morbid change.
Let the voice be taxed by a prolonged and labored
effort, as in a sermon or address, and the weakness soon
makes itself felt. I have little doubt that many in this
room to-night, who are not called upon to make any es-
pecial use of the voice, and who are conscious of no
noticeable weakness, were they called upon to take
pastoral charge of one of our city pulpits, would at
the end of the season find it necessary to seek a six
months' vacation in Europe at the hands of their con-
gregation for a clergyman's sore throat. The singing
voice taxes the very highest powers and cai)abilities
of the larynx, and demands not only a healthy lar-
ynx, but a healthy condition of the whole upper air-tract.
The recognition of this latter trudi I believe to be of the
utmost importance. The vocal waves are set in motion
by the vibration of the vocal cords, the pitch of the tone
is regulated by the tension of the cords, and Iiere in the
main, the function of the larynx ceases, unless we add
perliaps quantity or loudness of voice. These qualities
of the voice which we call tiiiibre, its character and
resonance, are given it by the pharyngeal and nasal cav-
ities. These should be entirely clear of any obstructing
morbid condition or changes in their lining.
In the lower or chest register, so called, the nasal and
pharyngeal cavities are of comparatively little importance.
The voice depends largely on the larynx. In the mid-
dle register a healthy pliarynx is of im|)ortance, but in
the head register a healthy nasal and pliaryngeal cavity
are absolutely essential. The manner in which the sing-
ing voice soon breaks down under the action of a pha-
ryngeal growth is quite simple. As soon as a note in
the upper register is attempted, the singer is conscious
of something wanting, the tone is muffled, from the fact
that the vocal waves striking upon the mass are sup-
pressed as it were, the sounding board function of the
pharynx is destroyed. The singer, therefore, in order to
overcome this obstacle, attempts, though generally with-
out success, to increase the power or volume of the voice.
The larynx is taxed beyond its strength, and raptured
capillaries or ruptured muscular fibres result, and a
chronic laryngitis is the consequence. It is much as if
the rector of (Irace Church should attempt to make him-
self heard by a church full of people with a feather mat-
tress fastened into the sounding-board over his pulpit.
It is a very noticeable fact witii singers that it is the
head register which becomes first impaired in a failing
voice, and in many cases it is the head register alone
which is weak, the middle and chest notes being taken
with ease and in clear voice. This illustrates the truth
of what I have for a long time urged in my teaching.
The nasal ))assages are the first to become the seat of
catarrhal disease, and the tendency is very marked for
this to extend downward, and furthermore, that in the
very large majority of instances, so-called chronic laryn-
gitis is but a secondary condition, resulting from disease
in the nasal cavities, the laryngitis being a symptom, as
it were, of the disease in the parts above.
The effect of the growths on the sense of hearing has
been long recognized. In eight of the cases which I
have seen, the impairment of hearing was quite marked.
In a larger number of others the impaired hearing was
not complained of, but was determined by the ordinary
watch test, twenty of the cases presenting ear symiitoms.
In two of the cases there had been severe attacks of otitis
media, while in six there had been complaint of frequent
attacks of earache.
I scarcely feel justifictl in saying much of this feature
of the disease, from a lack of familiarity with ear diseases,
yet in making a very large number of rhinosropic exam-
inations I have necessarily inspected the P'ustachian ori-
fices and observed the functions and muscular move-
ments of that region.
Impaired hearmg from the presence of adenoid growths
in the pharyngeal vault has been attributed to i)ressure
on the Eustachian orifice. These growths are of a soft,
pulpy consistency, while the eminences which surround
the Eustachian orifice are hard and dense ; hence, any
pressure exerted upon them by an adenoid growth would
have but slight, if any effect. I think a far more plausible
explanation of the symptoms is in the interference with
renewal of air in the middle chajiiber caused by their
presence in the pharynx. Any cause which interferes
with free nasal respiration, if continued sufficiently long,
is liable to cause im|)aired hearing, by its interference with
this function. The method in which this occurs, I take
it, is that nasal stenosis, arresting the to-and-fro current
though the nasal passages, causes a stagnation in the
pharyngeal vault, and necessarily a certain amount of
rarefication of air in that region. Moreover, the free ac-
tion of the levator palati muscles is interfered with by
the presence of these growths, and this movement is of the
utmost importance in accomplishing this mechanism of
air renewal. In studying these parts by the rhinoscope,
the impression is gained that the tendency of nmscular
movement here is to force air into the middle ear. The
constant and almost ceaseless impulse of sound-waves
u])on the tympanum must necessarily cause a rarefication
of air in the middle ear, and this loss is compensated for
by the mechanism above alluded to.
That the ear symptoms are due to an extension of
catarrhal inflammation to the Eustachian tube, I think is
very cpiestionable. I am disposed to think this is an
extremely rare occurrence. Certainly it is very rare to
find the lining membrane of the Eustachian orifice in a
condition of catarrhal inflammation. In one case which
has been under treatment, there was very distressing
tinnitus aurium. In this case the adenoid pressed upon
the Eustachian orifice; the symptom was very markedly
relieved by the removal of the growth, though not en-
tirely removed. In this case there was no impairment
of hearing.
Nasal stenosis is quite a prominent symptom of this
affection, and is present in cases where the growth has
not attained an unusual size. This may not be so notice-
able during waking hours, but during sleep, when the
voluntary muscles of respiration are not brought into
play, it is more prominent, and the patient sleeps with
mouth open. The vicious eftect of this I need not enter
upon at full. Habitual mouth-breathing, especially dur-
ing sleep, I believe to be a most prolific source of throat
catarrh, and liability to bronchial disorders.
It is a very noticeable fact that these growths show
noticeable change 'in size when examined at different
periods, which would indicate simply that under the in-
fluence of damp weather or other causes, they are liable
to become the seat of an active turgescence or distention
of their blood-vessels, by which their size is temporarily
increased.
This occurrence, especially in children, is attended
with an increase of secretion, with obstruction to nasal
breathing.
Cough is present in certain cases, esijecially if there
is much secretion, which has made its way down the
pharynx into the larynx, exciting a laryngitis. The
cough, again, may be the result of tlie habitual mouth-
breathing.
In one case which came under my care about a month
32
THE MEDICAL RECORD.
[January 13, 1883.
ago, a young latly of twenty, the only symptom was a
persistent hoarse, dry, barky cough. The only morbid
condition discoverable in lung- or air-passages was a
small adenoid. This I removed with almost inmiediate
relief, and since then the cough has gradually disap-
peared.
In this case the cough was undoubtedly of a reflex
origin, something in the nature of the ear-cough which
we occasionally meet with, due to an accumulation of
cerumen in the outer ear, or some other aural irritation.
Treatment. — This consists in their total extirpation.
The only question that arises is as to the best method
of its accomplishment. Chemical agents, chromic acid
especially, have been recommended by several writers
on the subject. I have tried this method and find it
to be utterly unsatisfactor)'. The cutting forceps, as
recommended by Cohen, of Philadelphia, Woakes, of
London, and others, I have never used, but it always
seemed to me a somewhat formidable instrument, ditfi-
cult of nice manipulation, and morever harsh and pain-
ful. The curette recommended by Mackenzie I formerly
used with considerable satisfaction, but it did not seem
adapted for use with the larger growths.
Meyer, of Copenhagen, Michael and Hartmann, of
Berlin, recommend the use of cutting instruments intro-
duced through the nares and manipulated by means of
the finger passed behind the palate. Meyer's instrument
•consists of a stout ring with an inner cutting edge, the
Avhole mounted on a stout rod. The other instruments
mentioned are of a similar construction. Meyer further-
more advises, after the removal of the growth, that the
remaining fragments be separated by a curved instru-
ment with a rasp surface, which is passed around the
palate and the base of the growth rasped as it were.
Finally he advises the cauterization of the denuded sur-
face. These procedures I can only refer to without
comment other than that they seem somewhat unneces-
sarily severe. I have never made use of them.
Voltolini, of Breslau, Michel, of Cologne, and Loewen-
berg, of Paris, give preference to the galvano-cautery.
There are two methods in which this may be used — first,
the removal by the burning through the base with a heated
wire, and second, the destruction of the growth by means
of an incandescent button-electrode.
The first method 1 do not regard as feasible, although
Michel claims success in it.
As regards the absolute destruction of these growths,
or in fact any morbid growths of any size by the galvano-
cautery, I have only this to say. It is an immensely
overestimated instrument, and, in my experience, has
utterly failed to accomplish what we formerly anticipated
from it.
If we apply a cold electrode to a tumor and then close
the circuit, the loss of heat is so great that, as a rule, a
more than very dull heat is not obtained, the result is
but a very superficial charring of the mass. In the vault
of the pharynx this procedure only is applicable, as a
rule, for it would require very nice manipulation to pass
a heated electrode to the point desired without touching
healthy portions of the passages. Still, if this were done,
and an electrode were used in which the heat were de-
veloped before entering, there is yet but a very super-
ficial destruction accomplished, and the ablation of even
a small tumor by this means becomes a tedious process,
occupying weeks and months, reciuiring an interval be-
tween each application for the exfoliation of the slough,
and this may be attended by the unpleasant accompani-
ment of an offensive discharge. Moreover, I believe we
should always recognize the fact that the application of
the galvano-cautery is attended oftentimes with a very
severe reaction, setting up renewed inflammatory pro-
cesses, by which the tumor may be stimulated to new
development, and a part at least of what has been ac-
complished may be counterbalanced by the renewed
process of growth.
There remains only to describe a very simple method.
which I have practised exclusively in the last year, and
which, it seems to me, possesses marked advantages over
any other device. This consists in the use of a modification
of Jarvis' snare ecraseur, which I show (Fig. i). As will be
seen, I have had
constructed an
^ ordinary snare
with a distal
tube of six in-
ches length : the end of this is curved
in a quadrant of a circle whose radius
is one and one-fourth inch. This is
now mounted with a No. 5 piano-
wire, which I regard as by far the
most useful number, as combining
elasticity, strength, and resistance.
Having observed the growth and
carefully estimated its size, a loop
is formed which will embrace it, and
is then bent forward over the end
of the instrument, in order to give
it a decided kink. The wire is now-
played out of the snare about an
eighth of an inch, and the whole
loop is now thrown backward toward
the handle of the instrument, giving
it another bend. As will be seen,
it is in a position for easy introduc-
tion behind the palate, without
touching the part, and may be passed
immediately to the base of the
growth. The palate of course is
now immediately retracted by reflex
irritation, but only embraces the tube
of the snare, without in any degree
hampering the manipulation.
The instrument is now held firmly
in place, while the loop is rapidly
drawn in by turning the screw. The
action of the bends in the wire loop
is now perceived. As the wire is
drawn in the loop is thrown back-
ward with considerable vigor, and
embraces and severs the growth.
In this manner even a broadly ses-
sile growth is easily seized and extirpated. There is but
trivial hemorrhage, but little pain or retching, and the
whole manipulation is accomplished very easily, simply,
and speedily. After the withdrawal of the instruilient,
the tumor is expelled through the nose by blowing. Oc-
casionally it drops into the pharynx below, but this is
very rare. In no case has any patient experienced the
slightest annoyance from the growth dropping too far
down in the air-passage, nor do I regard this as an ac-
cident that is liable to happen. The operation by this
method has never required an anssthetic.
In three cases of children, in whom the control of the
faucial movements prevented the manipulation, I was
compelled to give an anresthetic and resort to another
method, which may be described in a few words. In
these cases the growth was severed by passing an ordin-
ary straight snare through the nose. Having mounted
the snare with the wire, the loop was bent sharply down
over the end of the instrument, giving it a kink, and
then drawn within the tube until a loop only remained
sufficiently small to ])ass through the nares ; this was
passed vertically until the loop was in the pharynx,
when the instrument was turned, bringing the loop into a
horizontal position, with the side undermost toward '
which the larger loop had been bent. The wire was
now played into the pharynx, when the bend which had
already been given it threw the loop downward, nearly
to a right angle. The whole instrument was now pressed
firmly against the pliarynx, which, as will be seen, threw
the loop over the growth. Holding the instrument firmly
pressed against the pharynx, the screw was rapidly tinned
Kig. I.
January 13, 1883.]
THE MEDICAL RECORD.
3i
and the growth severed. As soon as the instrument was
with(]rawn the child's head was drawn over the table with
the face downward, and the trifling hemorrhage allowed
to go on until the child could be aroused, when the
tumor was expelled by blowing the nose.
In this manner, as a rule, the whole growth may be
removed, but irl the first-described manipulation portions
may be left. This is easily ascertained by examination
as well as their location, and the manipulation lepeated.
This may be done a number of times at one sitting, en-
tailing but little annoyance or weariness to the patient.
As regards recurrence, I have never in any of my cases
seen any sucii tendency. Perhaps it is too early to
hazard an opinion, but certainly I think it safe to as-
sume that the method of operating described, if thoroughly
done, leaves a far less liability to recurrence than the
use of forceps, caustics, or the galvano-cautery. The in-
flannnatory reaction after these methods is certainly very
notable. In the use of the snare, whether in adenoid
or other growths, I have never in any single case
noticed the slightest reaction occur, with the sole excep-
tion of some few cases where I removed tonsils by it.
This question of reaction after removal of growths I
regard as one of exceeding importance, and desire to lay
especial stress on the fact of its absence after operations
by the snare.
The next variety of growth in the nasal passages to
which I will call your attention is
NASAL POLYPI.
Nasal polypus means properly a tumor of the nasal
cavity attached to the parts beneath by a narrow pedicle.
As a matter of clinical observation, the only jjeduncu-
lateil tumor with which we meet in this region is the
myxoma. A more exact classitication would demand
that to each variety of growth the name should be given
which describes its pathological character. In this way
we would do away with that very careless classifica-
tion which describes nasal polypi as well as naso-
pharyngeal polypi. 1 have never met with a case of
polypus in the naso-pharynx ; the growth which is de-
scribed under this heading being usually a fibroma, which
is always a sessile tumor.
Nasal polypus has been recognized since the days
of Hippocrates, and consists in the development in the
nasal cavities of soft, rounded, jelly-like tumors, re-
sembling as much as anything the pulp of a grape. They
generally occur in both cavities, though occasionally are
found in but one. When they are confined to one cavity,
it is n)y observation that they have been present but a short
time and are few in number. From this I would infer that
they commence in one cavity, and that their presence
there very soon leads to their development in the other.
A single polypus is a very great rarity, as they seem to
develop in clusters.
During the past year there were treated at my clinic
for diseases of the throat 1,641 cases, of which 19 were
cases of nasal polypus. During the same time I saw
and operated upon 16 cases in my private practice.
Of these 35 cases there were two under 20 — it and 15
years.
1
Twenty were males and fifteen females.
It is essentially a disease of adult life, and occurs more
frequently among males than females.
There were two cases under the age of 20, viz.: 11 and
15 years, respectively. These cases were of interest, as
showing a somewhat immature development of the tumor.
The individual tumor had not developed, but the growth
shows, as it were, a cluster of seeds, a small central
mass, about which are gathered a large number of small
bead-like excrescences.
Between
the
ages
of
20
and
30.. .
9 cases.
it
((
30
"
40. . .
. 2 "
U
40
a
50. . .
. 12 "
Li
u
SO
"
60...
. 6 "
(I
1(
60
"
70...
. 4 "
The peculiar shape of nasal polypi is probably due
to their soft consistency. Under the influence of gravity,
and perhaps the traction of the to-and-fro movement of
the respired air, they are drawn out, as it were, from their
attachment, and assume the |}ear shape which is peculiar
to them. They rarely develop to a large size in the
nasal cavity, simply because they have no room to grow.
Occasionally they spring from the posterior portion of the
cavity, and dropping into the pharynx, where they have
abundant room for growth, they develop to a very large
size, as is seen in the two specimens I show you, nearly
the size of a hen's egg. These were operated u])on
through the nares, but of course removed through the
mouth. Their source is usually the middle turbinated
bones, but occasionally they are attached to the lower.
In only two instances have I ever found a nasal polypus
attached to the septum. The attachment is not on the
convexity of the turbinated bones, but is in the recess
between the under surface of the turbinates and the outer
wall of the cavity.
As to the cause of nasal polypus, I know of none.
It is a disease of the nasal mucous membrane peculiar to
itself. There is certainly no relation between it and any
of the constitutional dvscrasire. It is a purely local dis-
ease. It is very commonly taught that it is one of the
results of chronic rhinitis. It very frequently occurs in
connection with rhinitis, but quite as frequently, I think,
independently of it. In three cases which I have seen it
occurred in connection with atrophic rhinitis, which would
certainly argue that it bore no especial relation to the
commoner form of rhinitis, the hypertrophic variety.
In a number of instances I have removed single nasal
polypi from the border of syphilitic ulcers in the nose,
but the cause of the polypi here was not in the con-
stitutional condition, but undoubtedly in the local mor-
bid process.
Symptoms. — As regards the symptoms of nasal poly-
]nis, they are familiar to all, and demand no lengthy
notice. The prominent symptom, of course, is the
blocking up of the nasal passages, together with the
profuse watery discharge. Their hygroscopic character,
by which they swell up and pour out an increased quantity
of watery serum under the influence of damp weather, is
well known.
Prolonged, and oftentimes distressing attacks of sneez-
ing is a symptom, the prominence of which is not generally
recognized. The irritability of the nasal mucous mem-
brane in chronic rhinitis is usually much diminished, I
think, and sneezing does not occur in this affection. The
presence of nasal polypi, however, gives rise to these
attacks of sneezing in nearly all cases. This is es-
pecially prominent in the early stage of the develop-
ment of these growths, and hence the occurrence of this
should always excite suspicion as pointing to this affec-
tion.
The occurrence of spasmodic asthma as a reflex
symptom due to the presence of polypi in the nose has
been noticed only within the last ten years. I am dis-
posed to think this is of more frequent occurrence than
is generally supposed. Of the thirty-five cases which I
have seen in the last year, four were attended by this
symptom. The attacks were those of ordinary spas-
modic asthma, giving rise to the same physical signs and
attended with the usual nocturnal exacerbations. The
asthma is generally cured by the removal of the polypi.
In one of my cases, however, in which the disease had
lasted two years, the asthmatic symptom was only re-
lieved by the administration of iodide of potassium for
about three months after the removal of the polypi.
Voltolini first called attention to this reflex symptom of
nasal polypus in i88i. Since that time similar observa-
tions have been made by Holden, Spencer, Porter, Todd,
and others.
Diagnosis. — The diagnosis is usually quite simple.
An inspection of the anterior nares with a good illumina-
tion revealing the characteristic grayish mass presenting
34
THE MEDICAL RECORD.
[January 13, 1883.
between the turbinated bones and tlie septum. In
many cases, however, the mucous membrane covering
the polypi is of a red congested color, almost identical
with that of the mucous membrane over the turbinated
bones. In tliis case a probe will clear up the diagnosis,
for by touching the presenting mass it will be found to be
freely movable if it be a ])olypi. This manipulation also
reveals the point of attachmeut, and should always, 1
think, be resorted to for the purpose of revealing not
only the point of attachment of the growth, but also its
size.
Treatment. — It seems somewhat strange that the ear-
liest method of removing nasal i)olypi, that suggested by
Hippocrates, should be practised at this late day, but 1
believe it is a procedure not infrequently adopted. This
consists in passing a cord through the nares into the
pharynx and out at the mouth ; to this is attached firmly
a |)iece of sponge, which is then drawn from behind
forward through the nasal passages. This results un-
questionably in removing many of the growths, and to
an extent in clearing the channel, but it is certainly a
very rude and unsurgical method. I saw this operation
done in my first year of attendance upon medical lec-
tures, with, I confess, a feeling of admiration for the forti-
tude of the patient, but far more of dismay at the work
for which I was jMeparing nivself. Local applications of
astringents, mainly in the form of jiowders, have been
recommended by many writers, the claim being that un-
der their influence these growths shrink up and drop off.
The most efficacious of these, it is claimed, is tannin. I
have never been able to satisfy myself that local astrin-
gents had any but a most temporary influence upon the
disease.
Of late years we have seen frequent notices in the
journals of the efficacy of injections into the body of a
polypus, under the action of which they sloughed off.
Acetic acid, tincture of iodine, persuli)hate of iron, a
solution of corrosive subhmate, etc., have been recom-
mended for this purpose. There is no question but a
polyp can be destroyed by injecting it with acetic acid or
probably many other drugs, but the process is a very
tedious one. The injection creates a slough which re-
mains in the passages for from three to five days, giving
rise to an oftensive odor and fetid discharge. This, of
course, is a period of considerable discomfort to the pa-
tient. And, moreover, it is not possible to inject more
tiian one or two polyiii at a sitting, for it is not ordinarily
possible to bring into view but one or two of them. It
is then necessary to prolong the treatment over a con-
siderable period of time.
By far the most common method ol removing polypi
from the nose is by tlie use of the forceps. Tliey are
recommended b)' the oldest writers on surgery, as well as
by most modern text-books. The direction generally
given is to pass the instrument up and seize the pedicle. 1
believe this to be an impossibility. The pedicle of a
polyp is generally under the turbinated bone and not on
its convexity, and there is very rarely sufficient room to
pass the instrument. Moreover, it is not possible to see
the pedicle of a polyp. 1 do not think 1 have ever seen
one until after the growth was removed from the nares.
The nasal passages are exceedingly sensitive, and the
introduction of any instrument, even a probe, is very pain-
ful. The introduction of a pair of forcejjs, which are
made to grope about blindl)- in the passages until they
have seized something, which, as a rule, the operator can-
not know whether it be a i>olyp, or a i)ortion of the
healtliy tissues, and then their forcible withdrawal with
whatever tissue they may happen to have grasped, it
seems to me is a most harsh and unsurgical procedure.
1 do not think this is an exaggeration. It may be
possible to remove a I'olyp very near the nostril with a
pair of forceps witliout much injury to healthy i)arts, but
the first introduction of the instrument bruises the parts
somewhat and excites hemorrhage, and the field then be-
comes so entirely obscuied that any t'urther operating
must necessarily be groping in tlie dark. Furthermore,
I do not think it is feasible, as a rule, to remove all the
growths with tlie foiceps. The smaller ones are situated
so deeply in the cavity, or are concealed so deeply be-
neath the turbinated bones, that they cannot be seized.
For this reason it is often recommended that a portion of
the turbinated bones be removed. I know of no justifi-
cation for this procedure. The removal of bone in-
volves the removal of healthy mucous membrane also.
These tissues have an important function to perform in
the nasal cavities and their removal is not justified unless
they are diseased. In a majority of cases I believe
them to be perfectly healthy in tliis disease. Even in
very extensive removal and mutilation of the turbinated
bones by the forceps operation, the jiolypi are liable to
return. The most aggravated cases which come under
my notice are those on which the forceps have been
used.
As regards the use of the galvano-cautery, as recom-
mended so strongly by Voltolini and Middledorpf, it has
always seemed to me a (londerous and elaborate method.
The use of an instrument in the nasal cavity heated to
a white heat, invariably excites great inflammatory re-
action, which oftentimes does much mischief. The more
I see of the use of this instrument, I am the more inclined
to entirely reject it. It unquestionably oftentimes does
great harm, and moreover the cases are exceedingly rare
in which simpler methods cannot be adopted %vith far
better results.
A very great advance in the treatment of nasal i>olypi
was made when Hilton devised the snare, which has
been so extensively used since his day. This was a thor-
oughlv surgical jirocedure. There were two features of
this instrument which imi)aired its efficiency. It was
mounted with soft annealed wire, which was passed over
the growth, and the loop being drawn tight the jiolypi
was torn from the attachment. The wire was soft, flex-
ible, and easily bent ; it was not easy, therefore, to pass
to the base of the tumor. The loop was not sufficiently
rigid to manipulate. Moreover, when the poly|)us was
torn away, the polyp tissue being soft and friable, it
would give easily and a ])ortion of it would be left, from
which a new growth would be liable to develop. The
Jarvis snare-ecraseur furnishes us with an instrument pos
sessing all the advantages of the Hilton snare, and none
of its disadvantages. This is mounted with steel [liano-
wire which gives us a strong firm loop which can be
easily manipulated, and, therefore, carrietl to any jiortion
of the nasal cavity. .'\ very important featiue of this 'de-
vice I believe to be in the i)rinciple of the ecraseurin con-
tradistinction from that of the snare. The loop is car-
ried over the i)olyp, and being ))ressed firmly against the
mucous membrane from which the polyp springs tlie
pedicle is slowly severed, and at the same time a small
)5ortion of the fibrous tissue of the membrane is torn out.
This is very well seen in the specimens I show. I do
not believe much in what is called the root of a tumor,
but if there is such a thing it is shown here.
Kig. a.
The only objection I find with the use of the Jarvis
snare is that the hand is necessarily in the line of inspec-
tion, the instiument being straig^it. To obviate this 1 have
had constructed the instrument shown (Fig. 2). The tube
January 13, 1883.]
THE MEDICAL RECORD.
35
is bent in such a manner that the loop can be kept in
view during the manipulation. Moreover, it is arranged
so that the loop can be drawn up by traction with the
fingers until tlie pedicle is embraced, when the removal is
completed by turning the screw. As will be perceived,
the device is merely a combination of Jarvis' and Wild's
snares.
A nasal )>olyp, if removed in this manner, does not re-
cur at the point of removal ; the whole growth is removed,
and no tissue remains from which a new develo])ment may
occur. Moreover, the operation is accomi)lisbed with
but little pain or hemorrhage, and by slosvly taking one
growth after another the nasal -passage can be cleared at
the first sitting sufficiently to give the greatest rehef to
respiration. The cavities cannot, however, be cleared
at a single sitting. My usual jirocedure is to continue the
operation until the jiatient is tired, or the passages become
too much irritated, and tlien dismiss my ])atient for a few
days or a week. If hemorrhage occurs a pledget of cotton
can be inserted, and the bleeding will be arrested in a
few minutes. It is possible with good illumination to see
every jiortion of the nasal cavities. And if a polyp can
be seen, no matter liow deeply it is attached it can be
removed. In this ni.inner, therefore, 1 believe the disease
can be entirely eradicated in usually about si.K or eight
sittings. The question of course arises. Do these growths
recur ? I do not tliiiik they do if they have been thor-
oughly extirpated. I generally request my cases to i)re-
sent for examination a month after the operations have
been finished, when, if I find no growths, I feel quite
safe in assuring them that the disease is radically re-
moved.
The principle, therefore, on which this affection should
be treated is that of weeding a garden. The whole ground
is to be gone over until every vestige of the tumors has
been removed.
As to any local api)lication to prevent recurrence, or
escharotics to destroy the so-called roots, 1 do not believe
them necessary. 1 have occasionally used the galvano-
cautery or acetic acid after operating on cases which
had previously been operated upon with forceps, but in
other cases I have not found this necessary.
Of the thirty-five cases referred to there has been
but one of recurrence. This was a ])atient whose tur-
binated bones had been much torn and mutilated by the
forceps. It is too early, jjerhaps, to assert tliat the other
cases are cured. Many of them 1 have examined since
operating and find no evidence of disease. Others were
patients at my clinic, of whom 1 have lost sight. I believe,
however, 1 am perfectly justified in claiming a very large
percentage of radical cures by the metliod described.
.'\STHMA. — Dr. Win. M. Welsh {Medical Bulletin) gives
Ih f following formula for the treatment of asthmatic
attacks :
]J Stramonii foliarum 3 x.
Potassa; nitratis 3 v.
Seminis foenicuU 3 ss.
Sacchari 3 ij.
M.
The stramonium leaves and the fennel seeds should be
ground to a powder, not very fine, and passed through a
sieve so as to get rid of the stems and coarser fragments.
All tiie ingredients should then be rubbed together in a
mortar, without producing a very fine powder. The mode
of using the material is to place a small portion of the
jjowder on a disli and ignite it with a match. It should
burn slowly and somewhat irregularly, emitting fumes as
it burns, which, of course, are to be inhaled. The fumes
may be conducted to the mouth of the patient by means
ot a paper hood placed over his head. It combines, the
author claims, the good effects of nitre and stramonium.
CESOPHAGITIS AS A DISEASE OF INFANCY.
By E. F. brush, M.D.,
ATTHNDING PHYSICIAN TO THE NEW YORK INFANT ASVLOM.
H.AVINO had a case in an infant where death was due to
softening and rupture of the oesophagus, in which the
ante-mortem S3mptoms were mistaken for those of an-
other disease, and where the death certificate would
have certified to such, had not a post-mortem examina-
tion revealed the lesion. I think it is very important
that attention be called to the latter, which, taking the
most recent books on children's diseases as indica
tions, is hardly recognized. I may add that, having
visited the New York liureaii of Vital Statistics with a
view of ascertaining its comparative frequency, I found
that in the experience of the jjresent official, ceso])hagitis
as a cause of death had never been reported during his
connection with the bureau. This ignoring of a ])re-
viously recognized disease in the ordinary text books is
very remarkable when we go back to Billard "On Dis-
eases of Infants," a work written in 1S28. Tliis close
and accurate observer devotes twelve jjages to the con-
sideration of oeso|)hagitis, citing five cases in infants
where the autopsy revealed disease of the oesophagus
as the cause of death. He says in introducing his re-
marks on this disease, "This is not a work of im-
agination— a record cf abstract and preconceived ideas
— but it is our wish to be a close and faithful interpreter
of nature, and to speak only from facts before us. Let
us begin, then, with the history, a dry one, it is true, but
not the less indispensable, of the facts which we have
collected in relation to the diseases of the oeso|)hagus in
new-born children." He goes on to say that it is rare
in adults, but "is less rare in young infants: the reason
of which is that this organ is almost always the seat of
congestion to a greater or less extent. On this account
it is more disposed to disorganization and inflammation.
When inflammation exhibits no other sign than redness,
it will be extremely difliciilt to distinguisli it from the
habitual congestion of the oesophagus, but when with this
redness there are also present some lesions, or some of the
products of phlegmasia, no doubt ought to exist that the
membrane of the cesophagus is then inflamed. Thus
the symptoms which during life accompany the develop-
ment of these lesions ought to be considered as proper
to oesophagitis, and serve to settle the diagnosis of this
disease."
The first case he cites is that of a child six weeks
old, who had suffered almost from birth from diarrhoea.
He first saw her on July nth, her condition was general
paleness, tension of the abdomen, cry feeble but perfect,
and constant vomiting without nausea On the isth the
face became livid, the child refused to diink, and the effort
to make her do so caused pain ; the milk was vomited
almost as soon as given. This condition continued till
the 17th. On the i8th the face became pinched, the
forehead wrinkled, the cry very feeble, skin cold, pulse
scarcely perceptible. Death took place in the night.
The autopsy revealed the pharynx injected, the oesoph-
agus of a vivid red at the upjier third, on a level with
which the epithelium was entirely destroyed, the re-
mainder of the canal i^resenting a number of red stria;.
The mucous membrane of tlie stomach was of an ash
color, and the mucus which covered it thick and very
adherent. At the termination of the ilium there were
eight slate-coloreil, tumefied follicular patches. "This
child," he concludes, " succumbed to oesophagitis."
The next case is that of an infant six days old. It
was first noticed on the 2d of May with an "abundant
diarrhoea of green color, almost constant vomiting of
glairy matter, frequent regurgitation after drinking."
"The child rested in the cradle as if without life." On
tlie 4th it vomited a green liquid in great abundance and
died during the night. An autopsy revealed "a well-
marked injection of the upper part of the oesophagus
36
THE MEDICAL RECORD.
[January
[3, 1883.
with a longitudinal ulceration at its inferior extremity,
six lines long and four broad, the bottom of which was
yellow, the borders thick and red, as if bloody, and the
mucous membrane was destroyed in the centre of this
solution of continuity, the bottom of which was formed
by the cellular membrane."
The third case was a child one month old, affected with
ophthalmia. This child cried very little, did not ap-
pear to suffer much, but vomited almost everything
which was given as drink. The constant vomiting con-
tinued, the marasmatic condition became profound, a
change of position caused a regurgitation of milky fluid,
sometimes mixed wuh white, pasty, grumous matter, and
death took place in twenty- two days from the time he
first noticed the case. At the autopsy the cesophagus
exhibited here and there irregular patches of a bright red
and in certain points a complete destruction of the epi-
thelium ; there was besides in almost the entire extent of
this membranous canal a considerable number of points
of miiguet, the whiteness of which appeared in strong
contrast with the intense redness of the cesophagus ; this
niuguet ceased at the epithelium.
The fourth case was one of aphthous condition of the
cesophagus ; the fifth was gangrene of that organ.
All these cases occurred in arliticially fed children,
which during their sickness had been fed on sweetened
gum-water and milk-and-water.
Condie, coming after Billard, the author above quoted,
in his edition of 1S47 (p. i7S)> says : "Billard was the
first to point out the frequency and describe the diag-
nosis of CESophagitis occurring in the first periods of in-
fancy.'' Condie had never been able to verify, by an
autopsy, his diagnosis of the disease, but from Billard's
description he thinks he has seen several cases. It is
safe to infer from this statement that all Condie's cases
recovered. This is valuable testimony, as he treated
the disease in a manner than which thirty-five years have
suggested none better, namely, by injections of milk and
broth.
Dr. J. Lewis Smith says disease of the oesophagus in
infancy and childhood is comparatively rare. It is most
common in infants uncier three or four months, who are
dejirived of the breast milk and are given a diet which is
with difficulty digested, and perhaps taken too hot or too
cold. He has discovered it chiefly at the autopsies of
young bottle-fed infants, whose symptoms indicated dis-
ease or derangement of the digestive functions. He also
says, the symptoms are not well pronounced.
All this testimony is in strong conflict with Vogel,
who says it scarcely ever occurs in children under one
year of age, because they are too simply fed. Meadows,
in his revised edition of Tanner, does not make mention
of oesophagitis. W'est does not include it in his list of
infantile diseases. Meigs and Pepper omit it. Steiner
devotes three pages to diseases of the oesophagus, but
he does not teach that oesophagitis occurs in infancy ; he
speaks of abscesses, strictures, and so forth occurring in
children, but the instances he gives are all traumatic, and
he says the diagnosis is easy when the disease is severe.
Since 1 have had my attention directed to this disease
I have performed autopsies on the bodies of eighteen
children, and have found lesions of the cesophagus only
in the case of two.
In the first instance, that of a child eleven months old,
exceedingly nervous and irritable, who had suffered
somewhat, alternately from diarrhoea and constipation.
It had on September 20th a temperature of 100^° F., four
movements of the bowels during the preceding twenty-
four hours, frequent moaning and occasionally vomiting.
Was ordered half a grain of quinine every two hours.
September 21st, temperature 104", constant vomiting of
everything given (foods — beef-solution, cooked malt-
water, whey, cream, kumyss) ; tongue seemed swollen
and blue ; child had only four teeth, which he struck to-
gether so violently that they were chipped. -All food
per mouth was stopped, and three ounces in ecpud por-
tions of beef-solution and milk injected /^r rectum every
three hours. This treatment was began at 10 .A..M. The
efforts at vomiting continued till about 10 p.m., and the
child died a little after midnight. The autopsy revealed
both lungs considerably collapsed ; the cesophagus dull
vermilion color throughout its entire length, presenting
the appearance of the fauces when the diphtheritic mem-
brane is torn off; at the junction of its mucous membrane
with that of the stomach, there was a white, irregular
fringe which hung into the stomach, in appearance being
exfoliating mucous membrane; the stomach was small
and puckered up, forming deep rugK, some of which on
the top had long lines of recent inflanmiation. These
inflammatory stripes were few in number, and not
intense ; no other lesions of this organ coidd be discov-
ered. The duodenum was easily torn, the entire diges-
tive tract below the stomach almost bloodless, conse-
quently jiresenting a white appearance, except a few
inches above the sigmoid flexure, where it was slightly
inflamed, and containing the food which had been thrown
there a few hours before death. No other prominent
lesions were found.
This case I certified to as one of cesophagitis.
My second case was a child, seven months old, bottle-
fed, not well nourished. He first came under my notice
June 23d, with a mild conjunctivitis and frecjuent at-
tacks of vomiting. He was undergoing no particular
treatment, except that different foods were being tried at
intervals, in hopes of finding something which his stomach
would retain ; he gave no evidence of pain at this time,
neither were the bowels disturbed. On July 12th, when
making my rounds, I noticed the child in a profound
condition of collapse. My attention had not been called
to him for a week. In the last few days he had had
three or four alvine discharges, green mixed with yellow.
Twenty-four hours previously the vomiting had become
more violent, and every particle of food administered
was rejected, unchanged, almost immediately. We made
an effort to put him to the breast, but he would not
nurse. July 13th, condition of collapse continues ; res-
piration panting, revulsion to food continues ; clonic
movements of the entire trunk commenced this morning
and continued without any interruption. July 14th, vom-
iting continues ; five movements of the bowels in the
last twenty-four hours, watery and mud color. There
has been no abatement from the profound collapseil con-
dition ; the choreic movements continue, but intermit-
tently ; the head is rolling constantly ; during the inter-
mission of the movements the left hand is laid on the
forehead. July 15th, died this p.^r.
Autopsy, eight hours after death. — Pleural cavity on
the right side containing about two ounces of food and
blood mixed, the odor of the food being quite percepti-
ble. The lung at its approximation to the posterior
mediastina was the seat of recent ulceration ; that is,
there was a soft, ashy gray spot about half an inch in
diameter, fading away into the bright-colored lung. The
bronchi were plugged with food and mucus, which had
found its way there through the trachea, as there were
no lesions in the tubes. This lung was collapsed in
large patches. Left lung also considerably collapsed,
but pleural cavity clear and normal. Two inches above
the diaphragm, opposite the lung ulcer, is a small open-
ing through the mediastinal walls and into the cesopha-
gus. Looking at it from this cavity, it looks like a cut
across the tube. On removing the tube it was found
lacerated about half way across its diameter just within
the lower half of its length. Its internal surface was pale
and covered with soft catarrhal-appearing mucus. The
stomach was adherent to the spleen by strong fibrous
bands, and contained some food. There were tliree in-
vaginated portions of the intestines, none of which ap-
peared to have existed many hours before death.
With regard to this case, I may say that some medical
gentlemen who had seen it before death pronounced it a
case of cholera infantum.
January 13, 1883.]
THE MEDICAL RECORD.
Zl
A case almost exactly parallel to this was reported to
the London Pathological Society by Mr. Stanley Hoyd.
The ruiiturein his case took place in a child four months
old, and he stated that there was no food in the pleural
cavity.
It seems to have been a settled question some time
aijo that these ruptures of the oesophagus are due to post-
niortem digestion. This seems untenable when we recol-
lect that these children in whom the ruptures take place
are in a feeble condition, and the evidence that the pep-
tonic action of the stomach is suspended is proved by the
unchanged condition of the food which is returned from
the stomacli. We can hardly suppose that a stomach
that will not coagulate milk would have the power to di-
gest an oesophagus.
There is no reason why the oesophageal tract should
not be subject to special disease, as it is a distinct struc-
ture. Its development shows this, for in the sixth week
of fcetal life it is a tube closed at both, ends, and only
later joins the stomach and pharynx. Its mucous mem-
brane is different from that of the stomach or pharynx
by the fact that it is firmer in texture and paler in color.
Its structure is more simple than that of either of the
cavities with which it is connected, and therefore is at
once less liable to be attacked by disease, and less able
to resist disease when it is attacked. It has been com-
pared to the urethra, and the simile is not altogether a
bad one, so far as structure and sensation goes, for the
pain, as described by those who have suffered from in-
fiammation of either tract, is very similar. Now, as the
urethra is subject to special forms of inflammatory action,
so is the oesophagus.
But the diagnosis of oesophageal diseases presents far
greater difficulties, especially in the infant. There are
some classic descriptions of the excruciating pains caused
by inflammation of this organ in the adult, which seem
to be of such agonizing acuteness as to lead to the con-
clusion that if they occurred in infancy they would be
sufticient to produce shock. I have no doubt that the
state of profound collapse in which I found the infant in
my second case was caused by the severity of the pain it
was suffering, for the rupture in this instance could not
have taken place more than a few hours before death,
otherwise the pleura would have given evidence of irri-
tation. The evidence of pain in my first case was
strongly marked in the facial expression ; but, as a diag-
nostic point of disease in infancy, this, of course, amounts
to very little, as it is associated with so many other con-
ditions. Thus far, with my limited knowledge, I would
indicate the following points in the diagnosis of oesopha-
gitis : P'irst and foremost, an antipathy to food, and
when food is taken lachrymation takes place. This is a
point to which attention has not been previously drawn ;
but when we remember diat the ingestion of irritating
substances produces tears in the eyes of the adult, we
can readily understand that any irritation in the oesoph-
agus may produce them also in the case of an infant.
On reference to BiUard's first case I notice he says " the
cry was feeble but perfect," and we must infer from this
that the cry was accompanied by tears ; and as in pro-
found gastro-intestinal lesions the cry is unaccompanied
by tears, and one of the favorable prognostic indications
of recovery from these diseases is a reappearance of
tears, a constant lachrymation accompanied by these pro-
found symiitoms may be a valuable diagnostic point.
Referring to Billard's third case, we find the child af-
fected with ophthalmia, and my second case also was
suffering from ophthalmic irritation. There is no doubt
that constant wetting of the eye with tears is sufficient to
produce conjunctivitis. Even in Gregory's time this fact
was recognized. He says "bile and sordes in the stom-
ach have also occasioned ophthalmia. The purulent
ophthalmia of infants has been attributed by some to
this source ; " doubtless by the lachrymation produced
by the irritation in the oesophagus. All who have suf-
fered from severe heartburn must remember the tears
that suffuse the eyes when the irritating fluid regurgitates
into the oesophagus.
The second important diagnostic sign is the character-
istic vomiting ; that is, the food taken into the stomach
is returned almost inunediately and quite unchanged.
This vomiting ditt'ers from that caused by gastro-intes-
tinal irritation by being apparently unaccompanied with
nausea, and it differs from the vomiting due to cerebral
irritation by being not so powerfully ejaculated.
These are the two most characteristic diagnostic
points. The other points it is hardly necessary, perhaps,
to enumerate in this connection, as they simply consist
in exclusion.
The question of treatment we need not enter into mi-
nutely ; but as the disease almost invariably occurs nr
bottle-fed children, and one of the prime causes is the
ingestion of food too hot, it is worth remarking that cold
food can be administered to children without any bad
effect. This plan of feeding children that require artificial
feeding or cold food has been followed for some years by
Surgeon King, U.S.A., and highly reconmiended by
him. In my own practice, in cases where children have
been entrusted to nurses of careless habits, I have di-
rected the children to be fed with food not warmed, and
I have perceived no effects forbidding me to continue to
do so.
SOME INTERESTING CASES IN GYNAECOLOGY.
By HORATIO R. BIGELOW, M.D.,
WASHINGTON, D. C.
Case I. — On November 30th I was summoned to attend
a patient in New Jersey. After arranging some necessary
business I arrived on the evening of December 2d
(Saturday).
History. — Patient single, thirty-four years of age. Had
been treated some years previously for ulceration of cer-
vix, and was operated upon in Philadelphia for. stenosis
of internal os and consequent dysmenorrhcea. Single
and only coitus last May ; missed her regular sickness
in June. Quickening November ist. Since November
23d has felt no foetal movement. Muco-purulent dis-
charge, with bearing-down pains for three days prior to
my arrival. On December ist had a free discharge of
water per vaginum. Conception took place at first con-
nection, as previously to this, and subsequently, she had
no intercourse with her lover.
On Sunday I called Dr. Johnson, of Ocean Grove, in
consultation. Manipulation of abdomen defined head
in first position, with enlargement equal to sixth month
of gestation. There was no foetal heart-beat which we
could distinguish. Digital examination disclosed a me-
dium-sized fibrous polypus lying in the vagina, with long
pedicle springing from cervical canal. The cervix was ul-
cerated, and although the external os was w^idely dilated,
the free niargm surrounding the pedicle was horny and not
easily distensible. During the day the patient had two
convulsions, with severe cutting and bearing-down pains,
the head slipping down seemed to be pressing upon the
internal os, which refused to dilate. Removed polypus
on Sunday afternoon with spoon saw. Little or no bleed-
ing. External os well dilated, but marked stenosis of
internal os. Pains through the night severe, patient be-
coming exhausted. On Monday determined to dilate
and deliver. Internal os rigid, contracted, and refusing
to admit smallest size Peaslee dilator. Introduced small-
est size Barnes dilator through external os, hoping to
convey dilatation upward by the reciprocal influence of
the contiguous structures. Monday night was able to
get in the closed blades of P211inger, and expanded gradu-
ally for several hours. Continued dilatation with Barnes'
dilators and with two fingers of left hand until Wednes-
day, then used largest size Barnes, and gave ergot freely.
Patient delivered Friday of a dead fcetus, already under-
going decomposition. Discharge oft'ensive. Placenta
broken down and cord friable. vVashed out vagina and
38
THE MEDICAL RECORD.
[January 13, 1883.
uterus with carbolized water twice a day for two days.
Ui) to this time, one week after delivery, patient is do-
ing well and suffers no inconvenience.
The interesting points of this case, are : i. The con-
ception following a single, and, as the patient told me,
an unsatisfactory and painful coitus, conjoined to a re-
markable stenosis of the internal os, complicated by a
fairly large polypus. 2.. The long duration of labor, and
the difficulty experienced in dilating. 3. The subse-
quent favorable progress of the patient. That no metri-
tis or septic absorption followed delivery may be attrib-
uted to good nursling and to the use of vaginal and
uterine irrigation with carbolized water.
Case II. — Fibro-cystic tumor. — On November 15th
was sent for by Mary B , colored, widow, no cliil-
dren, thirty-eight years of age. Nine years ago noticed
swelling in lower part of abdomen, which has regularly
increased to its present bulk. Has had nienorrhagia,
hydrorrhcea, numbness of extremities, shortness of breath,
and loss of constitutional tone.
Present condition. — The facies uterina described by
Kceberle is well marked. No very general emaciation.
The abdominal walls are exceedingly tense, hard, and
marked by glistening stria;. The swelling reaches from
lower part of abdomen to ensiform appendage. It meas-
ures as follows : around umbilicus, 50 inches ; around
upper border of tumor, beneath ensiform appendix, 36^-
inches ; between ensiform appendix and umbilicus, 45
inches ; around hips and symphysis pubis, 46! inches ;
from symphysis pubis to ensiform appendix, 24 inches.
The tumor has a variable consistency, and pressure up-
ward gives the peculiar cystic sensation to the hand.
The sound passes four inches into the uterine canal and
moves in synchrony with the external abdominal man-
ipulation. The uterus is fixed, prolapsed, and displaced
backward ; the solid portion predominates over the
cystic ; umbilicus very prominent, which is rare in
fibro-cysts, but common to ovarian cysts. Diagnosis :
Subperitoneal fibro-cyst ; estimated weight seventy-five
pounds ; weight of patient, two hundred and ten pounds.
At my request Dr. P. J. Murphy, surgeon in charge of
the Columbia Hospital for Women, was kind enough to
see the case with me upon the following day, and fully
confirmed the diagnosis. Ordered five grains nniriate of
ammonia, three times a day, with five grains aq. ext. ergot,
by suppository, every five hours. Restrict diet to stale
bread and meat, with a goblet of hot water at each meal.
Persistent friction over abdomen with an ointment of the
biniodine of mercury and vaseline. This treatment has
been persisted in up to the present time (December
i8th), with occasional doses of iron when indicated, and
more recently a pill of quinine, arsenious acid, strychnia,
and iron to ward oft" a threatened attack of malaria, to
which she is subject. The tumor now measures (five
weeks from commencement of treatment), over umbili-
cus, 49 inches ; ensiform appendix, 36 inches ; between
umbilicus and ensiform appendix, 44^ inches ; over sym-
physis pubis, 46^- inches ; from symphysis pubis to ensi-
form appendix, 23^^ inches. The patient can sit on tlie
chamber and urinate, which she had not been able to do
for some weeks. The abdomen is softer and more pli-
able. The waist-line is more perfectly defined, and
there is much less downward bagging. Patient still un-
der observation. The suppositories will be replaced by
hypodermic injections of ergotin.
Case III. — Acute antejiexion of the uterus. — Mrs.
S , referred to me by Dr. Boislini6re, of St. Louis,
who furnished nie with the following history : Widow ;
thirty-two years of age : two children, oldest four years ;
labors normal ; weight, one hundred and ten pounds ;
duration of present illness, eighteen months.
Present condition when examined by Dr. Boislinierc.
— Menstruation appeared at fifteen years of age, irregu-
lar at first ; missed catamenia for six months when six-
teen years of age, at a boarding-school in Paris, and
again for same period after crossing tiie ocean. Dura-
tion, about one day ; very scanty in amount ; character,
pale ; used to i)ass clots. Has now grumous discharges ;
has pain preceding the flow, which is insufficient and
scalds vaginal walls.
Physical examination. — Right ovary prolapsed to side
of uterus ; uterus anteflexed ; cervix soft and normal in
size and shape ; pain at fundus.
By speculum. — Cervical erosion ; white, albuminous
discharge from vagina ; discharge from uterine cavity
strongly alkaline, from vagina, less so ; marked ante-
flexion ; moderate stenosis of os internum ; depth of
cavity, if inch; depth of cervix, i inch. Location ot
pain, at fundus.
General symptoms. — Good family history ; stomach,
bowels, and lungs, healthy ; slight hypertrophy of heart ;
dysuria, diurnal and nocturnal, aggravated by being on
her feet.
Diagnosis. — Anteflexion ; endometritis ; cervical ero-
sion ; uterine catarrh ; chronic cystitis and vesical catarrh.
Chemical examination of the urine shows : specific
gravity, 1.030 ; reaction, slightly acid ; contains mucus
and phosphates.
This very full and satisfactory history was entirely con-
firmed by examination on September loth, when the
patient presented herself at my office. The cystitis was
treated with iodoform application to urethra and with the
following capsule ordered by Dr. Boisliniere :
3 . Potass, carb 3 ij •
Pulv. caniph 3 j.
Allen's ext. bellad gr. iij.
M. Fill thirty capsules, one to be taken four or five
times a day.
I made one application of chromic acid (chromic
acid and water, equal parts) and four of a mixture of
carbolic acid, iodine, and chloral hyd. to the fundus, at
varying intervals. Treated cervix with Churchill's iodine,
a paste of subnit. of bismuth and glycerine, and applied
tampons soaked in glycerine of tannic acid, and later the
same saturated in a mixture of fl. ext. eucalyptus globulus,
glycerine, and iodoform, for the purpose of healing the
erosions, of depleting the cervix, of relieving pain, and of
accustoming the vagina to the presence of a foreign body.
The endometritis and cystitis were relieved in about six
weeks, and the erosions disappeared under treatment and
with the better position of the uterus by dilatation and
support. The ante-flexion was a potent factor in the
causation of the cervical erosion and turgidity, acting as
a constricting band, while the dysuria was in great measure
due to the pressure upon the bladder. I used Gehrung's
pessary with much satisfaction, but as it did not accom-
plish all that I wished I used forcible dilatation with
Wilson's instrument, and later made use of the (Jehrung,
which the patient still wears. The forcible dilatation was
followed by no bad results. The patient remained in bed
a week or more after the operation and had massage and
general faradization. She gains in weight about one and
one-half pound each month, has no dysuria or back-
ache, menstruates normally, and is much improved in
appearance. The flexion is not yet entirely cured, and
probably never will be. Forcible dilatation, if stripped
of any subsequent mischief, approaches nearer to a per-
manent cure than any other measure, but it is verv apt
to be followed by alarming inflammation. It is diflicult
beforehand to make out the exact sensibility of any
uterus to operative interference. Gehrung's pessary is a
most satisfying instrument and gives great relief. I do
not believe, however, that under any plan of treatment
these cases are ever thoroughly and permanently cured.
The question of forcible dilatation is one which every
gynecologist must settle for himself; one man may have
unvarying success in a series of cases, while another,
equally scientific, will have reason to repent his first |
operation. This is, in a great measure, due to varying I
conditions of temiierament, which render any operation "
serious in some people, while in others they are unattended ;
with danger.
January 13, 1883.]
THE MEDICAL RECORD.
39
gvcitjvcss of |]tXcrticnl J^cicncc.
s
Intestinal Cysts. — Two theories have been advanced
concerning the origin of cysts in the intestinal canal. The
first is that they arise from degenerated Lieberkiihn's
glands through retention of the secretion, the second,
that they are due to a process of softening of the solitary
follicles. On the strength of careful observations made
in a case of this rare affection, Dr.^ Fraenkel {Central-
blatt fiir Klinische Medicin, No. 29, 1882), decides in
favor of the former theory. The cysts were due to re-
tention of the secretion in the glands of l.ieberkiihn,
consecutive to a chronic catarrhal inflammation of the
large intestine.
Naphthol in Skin Diseases. — Kaposi states that
care should be observed in the use of naphthol in skin
diseases to avoid surfaces denuded of epithelium, and
never to apply it to the entire body. When these pre-
cautions are observed, the remedy is wholly without
danger, and is of great value in many affections. In
eczema it is indicated only in the squamous stage, when
the diseased parts are but slightly hyperasmic or even
pale. In scabies, one application of naphthol, coml)ined
with chalk, green soap, and lard, is usually sufficient for
a cure. In the various forms of acne, good results follow
the employment of naiihthol. The remedy is of especial
value in the parasitic affections of the skin, as herpes
tonsurans and favus. Pediculi are quickly exterminated
by a ten per cent, solution of naphthol in olive oil. —
Frailer Med. Wochcttschr., No. 33, 1882.
C.\RDIAC Tumor. — Dr. Manero reports, in the Gacela
de los Hospitales of Valencia, an interesting case of ma-
lignant tuuior springing from the cardiac substance, and
protruding as a pulsating swelling through the walls of
the chest. The patient was, at the time of his death,
aged fifty-one. The first indications of disease appeared
four years previously, in the form of constant lancinating
pain in the precordial region, without obvious physical
signs. In about a year a bulging of the precordial re-
gion was noticed, with increased pulsation, attributed to
dilatation of the ventricle, and this steadily increased,
with increasing pain and gradual emaciation. When seen
by Dr. Manero, there was a firm pulsating tumor in the
precordial region, about the size of a well-developed vir-
gin breast. It was very painful to touch ; the skin over
it was healthy. On auscultation of the tumor the normal
heart-sounds were heard exaggerated, but not otherwise
altered. The pain suffered is described as intense. It
seems to have been of the character of that of angina
pectoris, and was attended by constant formication in
the left shoulder and upper extremity. Death occurred
after the patient had been under observation some
months, during which time the tumor had steadily grown,
without at all involving the skin. No diagnosis was
made during life.
At the autopsy the pectoral muscles were found healthy.
On removing the front of the thora,x, the lower and front
part of the pericardium was found to be the cause of the
thoracic bulging, which is described as forming a hernia
through the walls of the chest, an oval opening being
caused by erosion of the third, fourth, and fifth costal
cartilages, with portions of the corresponding ribs and
sternum. Within this hernial sac of the pericardium, the
greater portion of the heart was found enormously en-
larged, apparently in all its cavities. It presented on
section the appearance of a melanotic sarcoma, in con-
sistence for the most part like that of a sebaceous tumor
crossed by pigmented bars and lines, and having numer-
ous large and small pigmented deposits. The growth
appeared to be highly vascular. The valves, columnas
carneaj, openings, etc., are said to have been hardly dis-
tinguishable. It is not stated how much, if any, of the
normal heart-structure was left ; neither is mention made
of any microscopic examination.
Peculiar Gummy Tumors. — Dr. Lewin, of Berlin,
relates (Charite Annalen, vol. vii., 1882), three cases in
which syphilitic persons had tumors in the palms of the
hands, which he considered to be gummata. In the first
case, that of a man aged forty-five, who had previously
been under Dr. Lewin's care for syphilitic affections of
the pharynx and larynx, three swellings appeared several
years after contagion, on the right palm, and at a later
period a swelling on the second phalanx of the thumb.
These swellings, as well as another near the internal
condyle of the left humerus, were still present when the
man was again seen in 1881, ten years after contagion.
All of them were diagnosed by the author to be gum-
mata. Subcutaneous injections of mercury, under which
the earlier symptoms had subsided, were prescribed.
But after a month there was little change in the tumors.
After an interval, inunction of one drachm of mercurial
ointment daily was tried, and this also failed to benefit.
After a further interval, iodide of potassium was given in
a daily dose of thirty grains, gradually increased to forty-
five grains. Under this treatment the swellings began
sensibly to diminish, some to one-half and others to a
quarter of their original size. No further particulars are
given.
In the second case, a man, aged thirty, noticed, five
years after contagion, two swellings in his right palm,
and soon afterward a tumor near the left olecranon.
Later still, another swelling appeared near the last, and
finally a fifth tumor appeared in the left palm. All these
swellings were present when the patient, who also had
been treated by the author for his earlier symptoms, re-
turned to consult him. There was now, in addition, a
swelling of the size of a hen's egg over the second cer-
vical vertebra. Nothing is said about the treatment or
termination of this case. In the last case, that of a man
aged thirty, nine years after contracting syphilis, two
tumors, about the size of a hazel-nut, appeared in the
right palm, and one in the left palm. The swellings
were almost as hard as cartilage. There was another
swelling near the internal condyle of the left humerus.
Under iodide of potassium the swellings became some-
what less hard, but did not diminish in size.
Trichinosis Nodules. — M. Rathery, in Le Journal
de Med., November 4, 1882, describes the case of a
man who had numerous subcutaneous nodules of the size
of peas, situated exclusively on the supradiaphragmatic
parts of the body. On excising one of these tumors, it
turned out to be a trichinosis cyst. The patient had
never suffered from any general or local symptoms of
trichinosis.
Home-Made Koumiss. — The following directions are
given for its manufacture : Fill a quart champagne bottle
up to the neck with pure milk ; add two tablespoonfuls
of white sugar, after dissolving the same in a little water
over a hot fire ; add also a quarter of a two-cent cake of
compressed yeast. Then tie the cork on the bottle
securely, and shake the mixture well ;, place it in a room
of the temperature of 50" to 95° Fahrenheit for six hours,
and finally in the ice-box over night. Drink in such
quantities as the stomach may require. It will be well
to observe several important injunctions in preparing the
koumiss, and they are : To be sure that the milk is pure ;
that the bottle is sound ; that the yeast is fresh ; to open
the mi.xture in the morning with great care, on account
of its effervescent properties ; not to drink it at all if
there is any curdle or thickening part resembling cheese,
as this indicates that the fermentation has been prolonged
beyond the proper time. Make it as you need to use it.
The virtue of koumiss is that it refreshes and stimulates,
with no after-reaction from its effects. It is often almost
impossible to obtain good fresh koumiss, especially away
from large towns. The above makes it possible for any
physician to prescribe it. The cost is about fifteen cents
per quart. — Chicago Medical Review.
40
THE MEDICAL RECORD.
[January 13, i88j
The Medical Record
A Weekly yonrnal of Aled id ne and Surgoy.
GEORGE F. SHRADY, A.M., M.D., Editor.
Published by
WM. WOOD &. Co., Nos, 56 and 58 Lafayette Place.
: New York, January 13, 1883.
THE NEW PHARMACOPCEIA.
V\'e have already alluded to some of the characteristics
of the Pharmacopoeia of 1880. A work of so much im-
portance and of so wide a circulation naturally receives
much criticism, and we venture to offer here some of the
conclusions that have been arrived at regarding it.
For the first time, says Dr. L. Genois, in the College
and Clinical Record, there has been given a concise but
explicit description of vegetable and animal drugs, pre-
vious Pharmacopceias having omitted this feature. The
new work abandons the old division into primary and
secondary drugs and preparations. Instead of this, the
list is arranged in alphabetical order.
A large number of articles are dismissed, the total
being about two hundred and thirty. Our esteemed con-
temporary, the Philadelphia Medical Times, mourns the
loss of many of these in a manner most pathetic, and
publishes the entire list, giving them in fact all the obit-
uary ceremonies except a black border.
We hardly share in our contemporary's gloom. With
hardly half-a-dozen e.vceptions, the drugs or preparations
omitted we are well rid of. For the rest, there is noth-
ing that will seriously embarrass druggist or physician.
Perhaps the latter will most miss the liquor mor[)hi;B
sulphatis, and santonin — for which latter the santonate
of sodium is substituted.
The number of new articles introduced is about two
hundred and fifty. The additions are for the most part
judiciously made. A new class of preparations has been
introduced which are called " abstracts," a name which we
regard as a most unfortunate one. The term " abstract "
has become a part of medical periodical literature, and it
at once suggests scissors and second-hand articles. To
associate it with a powdered drug will require the beating
out of new cerebral paths in medical minds.
A prominent feature in the Pharmacopoeia consists in
the adoption of parts by weight in the ))rocesses for phar-
maceutical preparations. This change is of more inter-
est to druggists than physicians, however ; except as it per-
haps foreshadows an adoption later of the metric system.
Valuable tables of the solubility of chemicals in water
and alcohol, of saturation of alkalies by acids, and of
acids by alkalies, are given.
Some alterations have been made in the relative pro-
portions of active constituents to the finished preparations.
The alterations affect chieSy the tinctures. Dr. Genois
has drawn up a table showing the most important of
them. These changes will not affect the dosage very
much, the actual change even in the opium preparations
being less than has been somewliat sensationally an-
nounced.
There has been a change made in the terminal nomen-
clature of the organic alkaloids, the sufiix "ina" being
uniformly used instead of " ia," as in " quinina " for
quinia. This will make little practical difference in
prescription writing.
The diluted mineral acids are all to be prepared with
a strength of ten per cent. This makes hydrochloric
acid one-fourth stronger, and sulphuric acid one-sixth
weaker. Spirits of camphor has been weakened one-
third. The tincture of aconite root is reduced one-
seventh, and its name has been changed to simple tinc-
ture of aconite. The extract of aconite is now to be made
from the root instead of the leaves, and is said by Dr.
Wood to be nearly one-half stronger than the old extract
of the leaves.
The Pharmacopceia has been subjected to very search-
ing criticisms, and has come out of the ordeal remarkably
well. It is a work requiring a vast amount of technical
knowledge, exact and careful statement, and good judg-
ment. All these qualities have been shown by its au-
thors, and it may be positively stated that on the whole,
it is the best work of the kind in" any language.
TREATMENT OF MALIGNANT LYMPHO-SARCOMA OF
THE NECK BY MEANS OF KERN'S C.ATAPLASM.^TA.i
The very unfavorable results which were obtained in
oi)erations, as well as by electrolysis, and from injec-
tions of medicated substances (acetic acid, alcohol, solu-
tion of iodine, arsenic), caused Prof. Busch to try in
some fresh cases of malignant lympho-sarcoma, also in
some older ones, the application of Kern's cataplasma,
under vifhich he saw buboes reabsorbed while a military
surgeon. The poultices of Kern are an admixture of
powdered mustard and black soap (i to 4 or 5), and
cause at first a severe erysipelatous inflammation of the
skin. They are applied for many hours (four, five, .or
twelve), enclosed in a small piece of gauze. The cau-
terized spot is then thoroughly covered with roseline and
cotton. A diagnostic error is not to be feared, if one
examines for the symptoms of malignant lympho-sar-
coma. A person in the prime of hfe, formerly strong
and in the best of health, presenting no previous dispo-
sition to glandular affection, is affected with a rapid, in-
creasing swelling of the cervical glands, which coalesces
with the surrounding tissues, and thus becomes more or
less fi.xed. It develops through and encloses neighbor-
ing structures so as to cause their fusion into a hard,
compact mass. Where these symptoms develop in a
few weeks, it is sure that a malignant lympho-sarcoma is
the explanation of it. In .some cases softening, suppura-
tion, and rupture may occur ; in others the tumor be-
comes always softer and more doughy, without produc-
ing any fluctuation. It becomes movable, always smaller,
and finally disappears through the absorption of its con-
tents. Prof. Busch tries to explain this surprising effect
of the irritating poultice on an organized neoplasm.
1 Lecture of Prof. Busch, Session of the Niedcrrhcin, Gcs. fiir Vtr. d. EUk., ia
Bonn, 1880.
January 13, 1883.]
THE MEDICAL RECORD.
41
Malignant lymphoma consists essentially of roimd cells,
with individual cheesy foci.
A very strong man, aged fifty-three years, observed in
the first days of July a hard swelling beneath the left
angle of the lower jaw. Presuming it to be an inflamma-
tion of the tonsils, he used hydro-therapeutics. On August
13th Prof. Busch was consulted, and was startled at the
patient's appearance, as two months previous he was the
picture of health and strength. From the middle line of
the neck to the spinal column, from the lower jaw to the
internal half of clavicle, a hard, already immovable
tumor extended. The pulsations of the carotid artery
could not be felt, as it was included in its whole course.
The larynx was pushed to one side of the middle line.
The pains characteristic of these tumors predominated
upon the occipital and frontal bones, caused evidently
by the continued stretching of the posterior auricular
and occipitalis magnus nerves. The voice had become
hoarser, on account of pressure upon the pneumogas-
tric or recurrent nerves. Busch states : "With all these
symptoms and the extensive, rapid growth of the tumor,
I could but express my opinion that in all possibility the
patient's life would be terminated in a few weeks. If
something had to be advised, I would try the poultices
of Kern, which did me great service in light cases ; per-
haps in this instance they would have no action, and if
such should be the case after a few days, there was no
necessity to torment the patient." Busch commenced
his vacation-trip the next day, turning the case over to
Dr. Schaefer for further treatment. The poultice was
so well endured by the afflicted man that it remained
twelve hours, instead of four or five, upon the tumor.
In the evening the burned spot was dressed with roseline
and cotton, and morphine given internally. Already, on
August 27th (fourteen days afterward), a decided de-
crease of the tumor and great movability was recognized.
The cataplasmata was then continued for only four
weeks, and the iodide of potassium was given. As soon as
the tumor had nearly disappeared, some iodoform \vas
applied with the brush. Prof. Busch saw the patient
again, on October ^d, who was then cured, though he
did not expect to fiml him still among the living.
OBSERVATIONS UPON DIPHTHERIA.
In a paper read before the Berlin Medicinische Gesell-
schaft. Professor Henoch remarked {Berliner Klin.
Wochensehr., No. 40, 18S2) upon the innumerable
methods of treatment of diphtheria that had been ad-
vanced by different writers since the time of Bretonneau.
He thought this diversity arose in part from the hope,
entertained by many, of discovering a specific remedy
for the disease. This hope, the author believed, would
never be realized, as it had never been in the case of
scarlet fever or measles. Another difficulty in the way
of a universal agreement upon the therapy of diphtheria,
was the lack of unanimity among authors, as to what
constituted the disease. In this connection. Professor
Henoch expressed his decided conviction that diphtheria
and membranous croup were two essentially distinct
■diseases. The relation between diphtheria and scarla-
tina was dwelt upon at length, and illustrated with the
reports of several cases. The speaker incidentally called
the attention of his liearers to a point of some importance
in the study of scarlet fever. He stated that he had oc-
casionally observed the fever to persist for some days after
the disappearance of the scarlatinal eruption. No cause
for this continued high temperature could be discovered,
and the subsequent course of the disease was without
complications. Professor Henoch thought it might be
analogous to the evening exacerbations in typhoid fever,
after the morning temperature had become normal — the
expiring effort, as it were, of the materies morbi.
ERGOT IN DELIRIUM TREMENS.
Dr. Arnoldow {Deutsche Afedieitial-Zeitung, No. 43,
1882) relates the case of a man suffering from ha;moptysis,
who was also threatened with delirium tremens. Chloral
had been given for the sleeplessness, but wi.iout effect.
Upon the administration of ergotine, not only did the
hemorrhage cease, but the symptoms of alcoholism also
subsided. This happy result induced the author to give
ergot in several other cases of mania-a-potu, in all of
which the delirium was speedily controlled. Dr. Arnol-
dow explains this actiou by the contraction of the blood-
vessels of the brain induced by ergot.
THE COLLECTIV'E INVESTIGATION OF DISEASE.
We have occasionally referred to the work undertaken
by the British Medical Association of collectively investi-
gating various diseases. The method adopted is to draw-
up cards and explanatory memoranda regarding certain
subjects, such as chorea, pneumonia, rheumatism, etc.
These are sent to each member of the Association with
the request that he answer the inquiries, and return the
cards to the secretary. Reports on several diseases for
the year 1882 will soon be made.
One cannot read of the work thus mapped out with-
out wishing that a similar line of investigation could be
started in America. For the present, however, it seems
impracticable. We must wait for some genius to galvan-
ize the American Medical Association into a united body
of scientific workers.
DIAGiNOSTIC USE OF THE STOMACH-PUMP IN
SUSPECTED CANCER.
In the Centralblatt filr Klin. Medizin., November 27,
1882, Dr. Rosenbach states that in carcinoma of the stom-
ach a diagnosis may be made by examination of the fluid
removed by the stomach-pump or expelled in the act
of vomiting. He says that this fluid always, or at
least very frequently, contains small particles of the new
growth. These pieces may readily be distinguished with
the naked eye from other substances found in the matter
removed. Their upper surface is dotted with red, red-
dish brown, or even black, points — the marks of former
hemorrhages — the coloration sometimes extending deeply
into the substance of the separated particles. This
surface is smooth, thereby differing from that of any por-
tion of the mucous membrane, which may have been torn
off by unskilful employment of the stomach-punq).
42
THE MEDICAL RECORD.
[January 13, 18S3.
TRANSPLANTATION OF THE CONJUNCTIVA OF A
RABBIT.
Ax interesting operation was recently performed by Dr.
W. S. Little, at the Jefferson Medical College Hospital.
It consisted in transplanting the conjunctiva of a rabbit
into the eye of a man who was brought into the hospital a
couple of months ago, suffering from a severe burn that
had entirely destroyed his sight. He is a young Irish-
man, named Michael McMullin, twenty-eight years old,
a strong, well-formed, healthy fellow, but as helpless as a
child in his blindness. Shortly after arriving in this coun-
try he secured employment in a large laboratory, and while
handling strong sulphuric acid the fluid spla.shed up over
his face, head, and chest, burning him terribly, and sud-
denly and completely blinding him. The right eye was
destroyed entirely, and the left one so injured that anky-
loblepharon resulted, that is, the lids grew fast to the
ball, the b 'rn having destroyed most of the conjunctiva.
It was decided to resort to this rare operation, with the
hope of restoring the ball and lids to their normal con-
dition, and afterward of securing sight to the injured left
eye. Both patient and rabbit were etherized. The
eyelid of the man was dissected up and a piece of the
rabbit's conjunctiva stitched upon the raw place.
SUCCESSFUL RESECTION OF THE STERNUM.
Dr. F. Konig reports in the Centra/l'latt fiir Chirurgif,
No. 42, 1882, a successful case of removal of the ster-
num, on account of a large osteochondroma. Both the
pleural and pericardial sacs were opened during the
course of the operation. They were, however, imme-
diately closed with little wads of gauze. The cut edges
of the integument were brought in apposition by sutures
from below upward, and as the openings into the serous
cavities were reached, the wads were withdrawn and
compresses applied over the line of suture. The patient
made an e.xcellent recovery. The entire sternum, from
the manubrium to the ensiform cartilage, was removed.
The chief interest of this case lies in the demonstration
of the fact that the serous cavities of the thorax may be
opened, under proper precautions, without untoward
result.
THE EFFECT OF ELECTRICAL LIGHTS ON THE HEALTH.
Dr. KrUss, at the Hygienic Congress of Hamburg,
recently discussed the above subject, and took views
somewhat different from those heretofore expressed. He
did not think that this light had any injurious effects upon
the eyesight. There is doubtless a great difference
according as the light is small and steady or large and
flickering.
STAMPING OUT DISEASE ON AN EXPENSIVE SCALE.
The report of the Treasury Cattle Conuiiission, recently
made to Congress, describes the sites selected for quaran-
tine stations for imported cattle at Portland, Boston,
New' York, and r.altimore. The report says that " it is
vain to iiojie that England will remove the restrictions
imposed so long, as we fail to show that t!ie last vestige
of pleuro-pneunionia has been wi))ed out from our land,"
and, further, "that nothing short of the absolute and
undeniable extinction of this disease in the United States
will reopen the British market to our live cattle, and save
us those millions that we are now every year prodigally,
and we might almost say insanely, throwing away." The
commission estimates the sum required to stamp out the
lung plague at $2,000,000, and recommends the requisite
legislation.
DEATH FROM DICHLORIDE OF ETHIDENE.
A WEAKLY looking man, aged twenty-six, came to the
Liverpool Eye and Ear Infirmary for the purpose of having
a piece of steel extracted from the lens. He was placed
under dichloride of ethidene, and became entirely
anaesthetized. Suddenly the pulse became very weak,
respiration ceased, and the patient died. Post-mortem
examination showed a flabby heart with thin walls, and
granular degeneration of the substance.
Ethidene had become quite popular at the infirmary in
question on account of its pleasant effects. It had been
successfully used four or five hundred times.
DIRECTIONS REGARDING ADMINISTRATION OF MEDI-
CINES.
During the past week a girl, fourteen years of age, met
her death by poisoning, the result of a misunderstand-
ing regarding the manner in which her medicine should
have been administered. She had been suffering from fol-
licular inflammation of the fauces, for which a mixture
was prescribed, to be taken in teaspoonful doses three
times daily. In addition, the physician, according to the
report of the coroner's inquest, told her to get " five
cents worth of chlorate of potash, and to dissolve two
teaspoonfuls in a tumbler of water." With the latter she
was to gargle her throat at intervals. The mother mis-
interpreting the directions, gave the potash internally in
doses of two teaspoonfuls of the saturated solution four
times daily, with an equal quantity of the mixture. The
day following, symptoms of poisoning developed them-
selves and the child died in consequence. The coroner's
jury exonerated the physician. The disastrous result was
evidently due to the mistake on the part of the mother.
Had the directions been properly followed, no accident
would have occurred. But we cannot help thinking how-
even this mistake might have been prevented by a little
extra pains on the jiart of the medical attendant in pre-
venting any misunderstanding. This could have been
done by giving the directions in writing, and not trusting
to the memory of patients or friends. This is a rule with
a great many practitioners, and an exceedingly good one.
It reduces the chances of misinterpretation to a mini-
mum, causes the medicine to be given proi)erly, at reg-
ular intervals, checks haphazard prescribing, and on the
whole, although such is the least important calculation,
saves a great deal of time for all parties concerned. It
is often difficult to remember all the details of treatment
in each case. Especially is this so when a number of
patients are sufiering from tlie same disease, and the
written direction of one may serve at once to refresh the
memory for the next visit, and insure accuracy in pre-
scribing which can scarcely be attained by any other
means. The written directions should also include those
for diet and other details which may be necessary.
January 13, 1883.]
THE MEDICAL RECORD.
43
A NEW METHOD OF ANTISEPTIC OPERATION.
Ever since the value of certain rigid i)i'ecautions in sur-
gical operations became fully known, surgeons have been
seeking for the perfect antiseptic. This interesting search
still continues. We may conclude, therefore, that the
substance in question has not yet been found. That it
will some day be discovered is a proper subject for de-
vout hope. A completely satisfactory method of insur-
ing antisepsis, or more correctly speaking, of maintaining
it, must be conceded to be still forthcoming. Mean-
while, new agents and novel modes of applying old ones
are constantly published on the daily bulletin board
of medical discoveries. Our German confreres are es-
pecially active and proportionately prolific in this depart-
ment of human enterprise. But, as already stated, the
ideal antiseptic has yet to be found.
The most recent method of antiseptic procedm'e is
that advocated by Kocher ( Volkmann' s Klinisclie Vort-
rage. No. 224, 1882). He claims that with his method
primary union is always obtained, or at least obtainable.
The drainage-tube is discarded, and the wound is closed
by suture throughout its entire extent. The substance
he employs after having made the usual experiments to
determine its antiseptic properties is subnitrate of bis-
muth. The following is the mode of its employment, as
described by Kocher :
During the operation the wound is from time to time
sprinkled with water, holding the bisiiuith in suspension.
The same is done in any subsei-iuent dressings that may
be required. When the operation is completed and all
oozing from the cut surfaces has ceased, the wound is
closed with sutures and the line of incision sealed w'ith a
bismuth paste. Then the usual dressings, wet with the
bismuth mixture, are applied. In all large wounds,
where there is much oozing of blood or serum, the su-
tures are inserted, but are not at once drawn tightly.
Drainage-tubes are never used, but cavities are filled
with wads of gauze. The parts are then covered with
the bismuth dressing. After usually from twelve to
twenty-four hours the dressings are removed and the
surface once more sprinkled with bismuth. The sutures
are then tightened and the antiseptic dressings reap-
plied. This step in the new method is designated as that
of " secondary suture " [Seciinddniaht).
Bismuth in powder is not used, as it was found in some
instances to give rise to diarrhoea, nephritis, stomatitis, or
other disturbances. It is simply held in suspension in
water, in the proportion of ten per cent., and the mixture
sprinkled upon the parts by means of a bottle such as is
ordinarily used by barbers. In this way the surface of
the wound is covered with a thin film of the drug, sufficient
to insure antisepsis, without, it is asserted, in any degree
interfering with primary union. One great advantage in
the employment of bismuth, in addition to its antiseptic
properties, lies, according to Kocher, in its astringency.
Not only are all septic influences warded off, but the
secretions of the wound are dried up, thus facilitating
primary union and obviating the disadvantages of drain-
age. The paper concludes with the histories in brief of
a rather large number of cases of severe operations, con-
ducted according to this method. In nearly all rapid
healing occurred without suppuration, and with scarcely
any rise of temperature. Kocher's procedure certainly
has the great merits of simplicity and ease of application.
]5ut time and a more extended trial must determine
whether we are to regard it as the long-desired means
of securing perfect wound-healing, or whether it is only
another of the many ephemeral methods that have proved
nearly worthless in all hands save those of their original
advocates.
ONE MORE BACILLUS.
At the instigation of Drs. LoefHer and Schiitz, of the
Berlin Imperial Sanitary Bureau, the etiology of farcy has
been carefully investigated. As was anticipated, the
S])ecific micro-organism of this disease was soon discov-
ered. Numerous " culture " experiments have already
been made, and horses have been successfully inoculated
with the isolated germs.
One by one the contagious diseases are wheeling into
line. The time seems not far distant when they will have
been all safely captured by the bold and ever active bac-
teriologists.
THE USELESSNESS OF HYPODERMICS OF ETHER IN
IMMINENT DEATH FROM HEMORRHAGE.
.•\t the last meeting of the Paris .-Vcademie de Medicine
{Bulletin de V Academie, December 24, 1882) Professor
Hayem read a communication on the above subject.
From a large number of carefully conducted experiments
he had reached the conclusion that ether produced no ap-
preciable eflect upon animals artificially exsanguinated.
On the other hand, transfusion of unaltered blood, or
even with blood diluted with serum, often resulted in the
resuscitation of apparently dying animals. The practical
inference to be drawn from his observations is that in
cases of danger transfusion should be at once resorted
to, and precious time should not be wasted by watching
the effects of ether.
A NEW MERCURI.AL FOR HYPODERMIC USE.
-After several years of experimental and practical trials,
Professor O. Liebreich has at length devised a prepara-
tion of mercury, which is especially serviceable for hypo-
dermic use. He announced his discovery at the recent
meeting of the Berlin Medical Society. The name of the
new compound is formamid of mercury, or hydrargyrum
for ma mi datum solutum. Liebreich has found that about
thirty injections of a one per cent, solution suffice for
ordinary cases of syphilis. Given internally, the drug is
inert.
THE STATE OF THE LUNGS IN PLEURISY.
In an article on the state of the lungs in pleuritic at-
tacks. Dr. Grancher {L Union Medicale) expresses the
opinion that the physical signs over the upper i)art of
the chest are not given sufficient attention in this dis-
ease. Thus he states that if the lung be healthy, the
subclavicular tympanitic resonance will be found to cor-
respond with an increase of the vocal fremitus and
respiration. If, on the other hand, there is congestion,
then respiration is generally weak ; and this happens
most frequently in tubercular cases. He points out also
that both the vocal vibrations and the resinration may
be diminished from various causes. Most prominent
among these he finds is pulmonary cedema and com-
pression of the bronchi.
44
THE MEDICAL RECORD.
[January 13, 188;;
^cius of the oSlcck.
CONVICTION UNDER THE ADULTERATION ACT.
The .first conviction for selling adulterated food was ob-
tained by the Health Board of this city, on Tuesday.
The charge was made against Henry Fulle, a grocer, for
selling adulterated cream of tartar to Dr. E. G. Love. It
was proved that the particular article contained ninety-
five per cent, of gypsum and five per cent, of tartaric acid.
It was obtained by the retailer from a wholesale dealer, who
had disposed of large quantities. One man present in the
Court-room said that he alone sold every year $[So,ooo
worth of the alleged adulterated article to the trade. The
case was a perfectly clear one for tlie prosecution, and
the ruling was in strict accordance with the evidence of-
fered. The defendant's counsel, who also represented
the interests of the wholesale dealers, took some curi-
ous exceptions in the course of the trial. It was
necessary for the prosecution to fix upon a standard of
purity for the article alleged to be adulterated. Accord-
ingly the United States Pharmacopoeia was put in
evidence as the authority. The defendant's counsel re-
fused to admit such evidence, claiming that there was no
direct proof that the volume in question was the one
published by the authority of the pharmacopoeial con-
vention. They refused to be satisfied until the original
minutes of the Convention authorizing the publication
should be produced. Of course, this was a mere legal
quibble in the face of the sworn testimony of experts,
regarding the identity of the book, and the objection
was overruled. It is understood, however, that the case
will mainly be carried on this point upon appeal. A
fine of ten dollars was imposed upon the vender of the
article, who was paroled into the custody of his counsel.
The Board of Health deserves great credit for the manner
in which it has conducted the prosecution, and proves
its eminent fitness for handling similar cases. So far a
good precedent has been established.
PRACTISING WITH A DEAD MAN's DIPLOMA.
The act to regulate the practice of medicine in Illinois
has, since its enforcement, exposed over thirty individuals
who have been falsely swearing to be graduates of foreign
universities. The most recent case of the sort was that
of a barber who assumed a dead doctor's name (Henry
A. Luders), and who practised with the dead man's
diploma. The latter was issued to Dr. Heinrich Andreas
Luders, May 15, 1866, by the University of Gottingen.
The pretender presented the dii)loma for verification, but
owing to some informalities in the affadavit, no certificate
was issued at the time. The diploma was found to be a
genuine document, and being finally accompanied with
recommendations as to the professional character of the
holder, a certificate was finally issued to him by the
State Board two years after his first application was made.
After a time suspicions were aroused concerning the
medical qualifications of the man and his right to the
diploma m his possession. Incpiiry was made of the
dean of tlie University of Gottingen, resulting in the
answer that the real Luders had graduated in 1866 and
had died in November, 1878. These facts coming to
the knowledge of the State authorities, it was resolved to
prosecute the quack for felony. Unfortunately, before
this could be done the sham doctor escaped.
It has since been learned that the rascal's proper name
is Lambrecht, and that he is a barber by trade ; but how
he became possessed of the real Dr. Liiders' diploma
and other papers has not yet been ascertained. The
letters of recommendation finally forwarded by the fellow
are pronounced forgeries.
Some shocking instances of the miscreant's malpractice
have come to light since his flight, among the most
recent being the brutal butchery of a mother in labor
and her unborn offspring. From the testimony of friends
of the unfortunate woman, it appears that he used a stick
and piece of string, in place of forceps, and, failing to
eftect delivery by this means, he eviscerated the infant
with a common, rusty case-knife, finally hacking it to
pieces with the same instrument and taking it away
piecemeal. The wretched mother was terribly injured
during this performance, and died shortly after.
The villain is now at large, and will doubtless settle in
some adjoining State having no medical registration act.
ADULTER.\TED TEA.
A BILL has been introduced into Congress to prevent the
importation of adulterated tea. This bill has been drawn
up by a number of prominent importers who claim that
some positive measures are needed to keep out of this
country the vast amount of tea and rubbish now sent
here. Of the total yearly importations of tea, which
amount to about eighty million pounds, we are told that
twenty per cent, is unfit for healthy consumption. The
actual yearly consumption of tea in the United States is
only 65,000,000 pounds, so that if rubbish were excluded
there would still remain enough to supply our needs.
England has passed a law similar to the one now de-
sired in this country. As a result, in 1881, 44,443 pack-
ages of tea were refused entrance, and no doubt a large
part of this finally reached the United States, forced
upon the country by cheap auction sales and palmed off
as good to the poorer classes.
There is nothing in the real facts of tea adulteration
to cause alarm or start a sensation. Tea is very rarely
adulterated. Among sixty-one samples examined by Dr.
S. A. Lattimore, for the New York State Board of Health,
no foreign substances were found. Many of these were
of the cheapest and most inferior quality, however ; and
there is no question that vast amounts of such tea-dregs
and rubbish are foisted upon us. The country should
be protected from such impositions, but whether the
health is really injured by cheap tea may be questioned.
THE NEW YORK COUNTY .SOCIETY AND THE PROSECU-
TION OF QUACKERY.
The last fasciculus of the published minutes of the
Society has been distributed to members. It includes
the minutes of the September, October, November, and
December meetings, and one of its most interesting
features is the report of the Board of Censors, which in-
cludes the report of Mr. Ripley, the Counsel of the So-
ciety. In it we find that a score or more of illegal
practitioners have been successfully prosecuted under
January 13, 188^
•]
THE MEDICAL RECORD.
45
the Medical Act of 1880. Most of them were fined and
compelled to seek other i)astures. This was accom-
plished at an expense to the Society of less than eight
hundred dollars, and yet we noted that at the annual
meeting there were members who objected to the special
assessment of two dollars which is requisite to the further
prosecution of the good work. In other words, there are
members of tlie society who appear to be unwilling to
curtail quackery at an individual expense of about ten
cents per quack.
In this connection we may note that the entire expense
of the attempt to rid the city of illegal practitioners has
been borne by the members of this Society.
We cannot too highly commend the energy and ac-
tivity displayed by the officers of the New York County
Society, and have every reason to believe that it will be
maintained during the present year.
SUFFOCATED BV A SHIRT-STUD.
Edward Olider was suffocated last week by a shirt-
stud which he was holding in his mouth and which
accidentally found its way into the trachea. This is the
old story with persons who persist in using the mouth as
a convenient recejitacle for all sorts of foreign articles.
Of course immediate tracheotomy would have saved him,
but unfortunately the means to the end were, as usual,
not at hand.
ADULTERATED MILK.
Several wealthy farmers around Camden, N. J., are
being prosecuted for selling adulterated milk. The
chances are that the jury will find it hard to agree on a
verdict, as the ordinary Jerseynian has had comi)aratively
small experience in testing lacteal fluids in their purity.
Even to settle on the average standard would require
the consideration of very many qualifying conditions.
THE SANITARY CONDITION OF NEWPORT, R. I.
It would appear from reports recently received that the
sanitary condition of Newport is far from what it should
be. The Newport Sanitary Protective Association, which
has during the past year beeji so active in its efforts to
remedy the sewerage of that city, has just published a
document, in which it advises all persons who intend to
hire houses or parts of houses in and around Newport, to
ask for evidence that the premises have been pronounced
safe by one of their inspecting engineers. It is under-
stood that the recommendation is to be applied to all
hotels and boarding-houses. The plan is certainly a
good one if it can be consistently carried out, and under
the latter conditions it commends itself to the attention
of sanitary committees everywhere.
NOTIFICATION OF INFECTIOUS DISEASES IN LONDON.
We learn from our London correspondent, in a letter,
dated December 28th, that the question of notification of
infectious diseases is being warmly agitated in the medical
circles of that city. The oisposition to the measure is
evidently on the increase. The element of compulsion
is the notable and objectionable one. Aside from this, it
is claimed that it makes doctors spies on, and informers
against, their patients. The latter, in the way of pre-
venting trouble, will be induced to conceal a case of
infectious disease, and struggle through without a doctor,
rather than be informed against. It is also urged that it
increases the number of certificates medical men will
have to write, either for nothing, or, at best, for a nominal
fee ; that, in some cases, medical officers of health have
taken advantage of tiieir position to interfere with the
jiatients of another medical man ; that questions may
often arise as to accuracy of diagnosis, and discredit be
thus cast upon the family attendant. For instance, the
medical man may find himself in doubt as to whether a
given case is, or is not, scarlet fever. " If I notify,"
he says, "and it turns out not to be scarlet fever, I shall
have annoyed my patient for nothing, and the medical
officer of health may call and have the opportunity of
blaming me before my patient or his friends for an error
in diagnosis. On the other hand, if it is the disease and
I do not notify, I shall be fined." The objections are
certainly well taken.
TRAIN-WRECKING AS A CAPITAL CRIME.
Assuming as correct the comprehensive and octopus-
like character of certain recent descriptions of insanity,
it is hard to see how a train-wrecker can ever be proved
sane. \Viih due respect to science, however, society is
obliged to look at these men for the present as vicious
and responsible ; and Governor Butler, in his inaugural,
urges that laws be enacted for their suitable punishment.
" There is," he says, "one crime which indicates such
depravity of heart, such disregard of life, such malice
toward all mankind, that the doing of it should be visited
with the swiftest and most condign punishment."
Every one will, we believe, approve of this sentiment,
and heartily wish that the legislation asked for will be
<;ranted.
MEDICAL REFORM IN MASSACHUSETTS.
Governor Benjamin F. Butler, of Massachusetts,
in his inaugural address discusses many vital questions
of reform pertaining to State government. Altogether,
he proves himself to be a man of large grasp, and one
who thoroughly appreciates the necessity for radical re-
forms in the management of State charitable institutions.
The abuses in regard to the latter to which he calls at-
tention are those connected with the difficulty of fixing
responsibility for mismanagement where it should prop-
erly belong. In this connection he takes occasion to
protest against commissioners in general. His argument
is that these commissions shift responsibility from one
member to the other. In this way the whole Board
allows acts and expenditures which no single responsible
person would have dared to tolerate.
As to the mooted question whether the conjoint Board
of Lunacy, Health, and Charity shall be divided into in-
dependent bodies, we gather that the Governor would
dissolve the whole organization, and substitute single
responsible individuals.
Governor Butler is certainly right in many of his
charges against Boards, Commissions, and Committees.
There are, however, a good many objects for which such
bodies can work much better than single persons. And
many of General Butler's objections could be met under
46
THE MEDICAL RECORD.
[January 13, i88j
a system which made Boards more directly responsible
than is usually the case.
We regret not to find any reference in the message to
the subject of medical legislation and registration. Our
Massachusetts brethren will be derelict if they allow the
session to pass without an attempt to render impossible
such institutions as the Bellevue Medical Hospital of
Massachusetts.
Dr. \Villiam Hunt's Address before the Phii.a-
DELPHi.-\ Academy of Surgery. — On .\fon(.lay evening
of this week the annual address of the Philadelphia Acad-
emy of Surgery was delivered by Dr. William Hunt, Sur-
geon to tlie Pennsylvania Hospital. He discussed Es-
march's criticism of American surgery, contained in the
latter' s recent lecture on President Garfield's wound. The
assertions and strictures of the German Professor, after
being translated by Dr. Hunt, were commented upon in
a very witty manner, and rebutted by points from the
well-worn pages of the history of the case. The hack-
neyed and unsavory subject was given renewed interest
by Dr. Hunt's novel treatment of the theme ; but the
value of prolonging such discussions is questionable.
The latter part of the address was devoted to Koch's
bacillus tuberculosis. The lecturer expressed doubt as
to its etiological relation to phthisis, though he did not
deny its e.xistence. In an adjoinmg room were e.xhibited
a large number of microscopic preparations showing the
bacilli of Koch, and the pseudo-bacilli of Schmidt, of
New Orleans. Schmidt, as our readers know, affirms
that the bacillus described by Koch is nothmg but a fat-
crystal. The pseudo-bacillus shdes shown were prepared
by Schmidt himself Some of the others were prepared,
we believe, by Koch, or those who had worked under
his supervision ; hence, an opportunity was given for
those present to compare the objects seen and described
by the two micrologists.
Even to untrained eyes it was apparent that Schmidt
had never seen what Koch has described. In other
words, the pseudo-bacilli of Schmidt, shown in his own
preparations, are said not to resemble the bacilli of Koch,
as shown in his preparations. Hence, Schmidt's deduc-
tions must be erroneous ; for he evidently has not seen a
true Koch bacillus to compare with his own so-called
pseudo-bacilli which are doubtless nothing but fat-crystals.
New York. Acade.mv of Medicine — Election of
Officers. — At the annual meeting, held January 4, 1883,
the following officers were elected : President, Fordyce
Barker, M.D., LL.D.; Vice-President, H. P. Farnham,
M.D.; Recording Secretary, W. H. Katzenbach, M.D.;
Corresponding Secretary, J. G. Adams, M.D.; Treasurer,
William F. Cushman, M.D.; Trustee, Gouverneur M.
Smith, M.D.; Treasurer of Board of Trustees, Charles
Wright, M.D.; Member of Committee on Admissions, E.
L. Partridge, M.D.; Member of Committee on Ethics, H.
E. Crampton, M.D.; Member of Committee on Education,
J. C. Dalton, M.D.; Member of Committee on Library,
A. McLane Hamilton, M.D.
Amending the Penal Code. — Already two bills have
been introduced into the Assembly amending the Penal
Code. One of them, by Assemblyman Murphy, com-
promises the matter somewhat by striking out the flagrant
absurdities, and the other, by Assemblyman Campbell,
advocates the freest possible license for trade. The lat-
ter measure is one which the Puritanical code makers
have deliberately precipitated.
New York Ophthalmological Society. — At the
Annual Meeting, held January 8, 1883, the following
officers were elected : President, George R. Cutter, M.D. ;
Vice-President, David Webster, M.D. ; Secretary and
Treasurer, Jas. L. Minor, M.D.
Charity Hospital, New York. — At the annual
meeting of the Medical Board of Charity Hospital, at
the Academy of Medicine, the following officers were
elected for the current year: President, Dr. John H.
Ripley ; Vice-President, Dr. T. F. Ferguson ; Secretary,
Dr. Edward S. Peck.
The Spread of Small-pox. — Small-pox has, during
the last two or three days, spread from Baltimore to
several small ports along the Chesapeake Bay. The
disease has also broken out in the lumbering shanties in
upper Ottawa, Canada, and the woodmen are dispersing
to neighboring districts.
New York Pathological Society. — The following
officers were elected at the annual meeting held on the
evening of January loth : Dr. George F. Shrady, Presi-
dent ; Dr. R. E. Van Gieson, Vice-President ; Dr. Wesley
M. Carpenter, Secretary ; Dr. John H. Hinton, Treas-
urer, and Dr. John C. Peters, Editor of Transactions.
Drs. F. R. S. Drake, J. H. Ripley, J. H. Hinton, V. P.
Gibney, and J. C. Peters, Committee on Admissions and
Ethics; Drs. J. C. Peters (Editor of Transactions), W.
M. Carpenter, J. H. Hinton, E. C. Wendt, Beverley
Robinson, and the president, Committee on Publication.
New York's W.^ter Supply. — The Mayor of the
city of New York is requested by the State Assembly
to select and appoint immediately five citizens of this
city, who, in conjunction with himself, shall without de-
lay examine into a plan for increased water supply, and
report to this body within twenty days as to the practi-
cability of the proposed plan, the probable cost, the time,
required for its e.xecution, and such other views and rec-
ommendations as they may deem proper.
Professor Schroeder of Berlin. — It is authorita-
tively denied that Professor Schroeder, of Berlin, has
been summoned to London to attend the Princess of
Wales.
Typhoid Epide.mic in London. — London is suffering
from the efl'ects of a slight epidemic wave of typhoid
fever, the weekly deaths varying from 31 to 42. The
disease is said to be more malignant than is usually the
case.
Dr. Warren Stone, a prominent physician of New
Orleans, died suddenly on January 3d. The deceased
was thirty-nine years of age.
Small-pox in Atlanta. — A telegram from Atlanta,
Ga., states that small-pox which appeared in that city
two weeks ago is spreading, and among the whites. No
precautions are taken by the authorities to suppress the
disease, the pest-house wagon being driven at all times of
the day tiirough the most crowded and unprotected
thoroughfares.
January 13, 1883.]
THE MEDICAL RECORD.
47
llcpox'ts of Societies.
NEW YORK PATHOLOGICAL SOCIETY.
Stated Meeting, December 13, 1882.
George L. Peabody, M.D., Vice-President, in the
Chair.
(Continued from page 21.)
Dr. \V. Gill VVylie presented a specimen of
CYSTIC FIBROMA OF THE OVARY.
" M. D , aged twenty-four, single. I tirst saw the
patient in June, at tiie request of Dr. S. Baruch. At this
time she was in good general health. On examination,
a very firm abdominal tumor, about the size of a cocoa-
nut, was readily made out. It was freely movable, and
was not directly attached to the uterus, which was nor-
mal in size.
" On account of the season and the small size of the
tumor, and absence of pain and other serious sym|)toms,
she was advised to wait until the fall for its removal.
During the summer, in August, she had a sharp attack of
peritonitis, and was in bed several weeks.
".September 20th. — She was admitted to my ward at
Bellevue Hospital. The tumor had increased to several
times its former size, and was firmly fi.xed in place, and
to- some extent painful to touch.
•'October 17th. — -About six weeks after acute peri-
tonitis had subsided the tumor was removed. The usual
incision in the median line was made. The peritoneum
was very much thickened, and the whole surface of the
tumor was covered with adhesions. About a gallon of
dark bloody fluid was evacuated by a trochar, and the
tumor was then slowly pulled out of the incision. The
adhesions were torn loose, and when thick or strong
were put upon the stretch and divided by actual cautery.
When the pedicle was reached it appeared to be attached
to the right Fallopian tube ; it was firm and much smaller
than was expected in a tumor so vascular and with such
thick walls. The pedicle and two ragged ends of the
omentum were tied with silk ligatures and dropped back
in the abdomen. The wound was kept open about an
hour after this, in order to clear the cavity of all blood,
and a glass drainage-tube was inserted and the wound
closed with silk sutures.
" Patient was not allowed any food for forty-eight hours,
and only small quantities of water in drachm doses were
given for intense thirst. After this she was fed on kou-
miss, and after a few days other food.
" She recovered without a bad syrapton, and in ten
days was removed to the general ward from the rooms
used for such cases.
" One point of practical importance was discussed
before the operation, namely : In case of peritonitis com-
plicating ovarian tumors, when one has the choice, at
what time is it best to operate ? Should the operation
be done a short time after the peritonitis, or should it be
longer delayed? In this case the adhesions were ex-
tensive, but were not tough, nor so ditficult to separate or
tear loose as in those cases which I have seen the opera-
tion done long after peritonitis. I have seen four cases
where the adhesions were so strong, compared with the
sack of the tumor, that most of the sack could not be re-
moved, and after a part had been cut away the remainder
was sewed to the edges of the abdominal wound and the
cavity washed out once in eight hours with a drainage-
tube. All of these cases gave a history of chronic peri-
tonitis, and all recovered.
" In dealing with adhesions much depends upon the
thickness and strength of the walls of the tumor ; and
the strength of the adhesions will depend upon the dura-
tion of the peritonitis."
Report of examination made by Dr. IV. H. Welch. —
"The tumor is a unilocular cyst measuring 18 ctm.
in diameter. The wall of the cyst varies in thickness
from 2 to 10 mm. Its average thickness is about 3 mm.
The external surface of the tumor [jresents nearly every-
where the remains of old adhesions in the form of mem-
branous shreds. In other respects this surface is smooth
and glistening. From a point corresponding to the
attachment of the pedicle of the tumor proceeds a hard
fibrous cord 3 mm. in diameter, which can be traced for
a distance of 10 ctm. over the surface of the tumor, with
which it is closely incorporated. This cord probably
represents the remains of the Fallopian tube, but it is
impervious. Near the same situation a sessile mass pro-
jects from the surface of the tumor. This measures 4
ctm. in length, 2 ctm. in breadth, and 2^ ctm. in height. It
has much the shape and appearance of an ovary ex-
ternally, but internally it consists of a soft reddish mass.
" The wall of the cystic tumor is not divisible into separate
layers, but presents throughout its thickness the appear-
ance of dense fibrous tissue. The inner portion of this
wall, however, is in most places of a reddish-brown color,
indicating old extravasation of blood in this situation ;
the outer portion of the wall is gray in color.
" The inner surface of the cyst is thickly set in most
places with little fibrous elevations, often pedunculated,
and looking like papillomatous growths. These little
growths are firm in texture and of a reddish color, like
the inner portion of the cyst wall from which they spring.
" There are no evidences of secondary cysts in the wall
of the main cyst, so that the tumor is strictly unilocular.
Microscopical. — " The most careful examination of the
inner surface of the cyst, both in the fresh state and
upon section after hardening, fails to reveal any epithelial
lining.
" The wall of the cyst is made up throughout of dense
fibrous tissue. The connective-tissue fibres are coarse
and interlace in all directions, but have a tendency to
run parallel to the surface of the cyst. Between these
fibres are fusiform and branched connective-tissue cells,
with, in places, a considerable number of round cells.
There are also blood-vessels to be observed in the wall.
The inner reddish-brown portion of the cyst wall is com-
posed of dense fibrous tissue, with few cells, but with an
abundance of yellowish-brown pigment granules (h«ma-
toidin) between the fibres. The papillomatous excres-
cences are made up likewise of fibrous tissue with blood
pigment. Further than the blood-pigment there is no
especial difference in structure between the outer and
the inner portion of the cyst wall.
" An interesting feature in the anatomy of the tumor is
the presence of rows of cubical epithelial cells upon its
external surface. These epithelial cells resemble those
covering a normal ovary. They often lie imbedded in
the tissue in consequence probably of the growth of ad-
hesions over and around them, in this way they often
appear to line spaces like glandular cavities. There is
nothing resembling them in the inner portion of the cyst
wall. Smooth muscular fibre is found only in the cord
representing the Fallopian tube.
Diagnosis. — "The tumor is probably a cystic fibroma
developing from the ovary. The ovarian origin is rendered
probable (aside from the relations noted at the time of
the operation) by the relations to the Fallopian tube, by the
presence of cubical epithelium in the outer wall of the
cyst, and perhaps by the existence of a portion of the
ovary in the outer wall of the cyst. The last point, how-
ever' cannot be established positively in consequence of
the destruction of the parenchyma by old hemorrhages.
"The fibromatous character is established by the struct-
ure of the cyst wall and the absence of any epithelial
lining to the cyst. The tumor is certainly not an ordi-
nary ovarian cystoma. The uniform character of the
cyst wall, the absence of epithelium on the inner surface,
and the unilocular structure, preclude this.
"The mode of development of the cyst cannot be deter-
mined. Extravasations of blood would seem to have
played a role in this process, as evidenced by the abun-
dant blood-pigment in the inner portion of the cyst wall.
48
THE MEDICAL RECORD.
[January 13, 1883.
The fluid contents of the cyst were not sent to me. Tliey
are said to have been thin, watery, solid, and of a reddish-
brown color."
Dr. J. Lewis Smith presented a laryn.x and trachea
which illustrated
DIPHTHERI.\ COMPLIC.'iTING SCARLET FEVER.
One point of interest in the clinical history was tlie
clearness of the voice ; so niuch so that the existence of
a pseudo-membrane in the larynx and trachea was not
suspected. The membranous exudation was shown dis-
tinctly upon the the inner surface of the trachea and
larynx. Tlie question arose, was it diphtheria compli-
cating scarlet fever, or was there a scarlatinous pseudo-
membranous laryngitis and tracheitis ? Dr. Smith thought
the nature of the condition was not yet fully understood,
but inclined to the opinion that this was a case of diph-
theria complicating scarlet fever.
CHRONIC BRIGHT'S DISEASE — DILATATION OF THE
HEART — PERICARDITIS.
Dr. Beverly Roeixson presented the heart and kid-
neys taken from a woman who presented during life tlie
physical evidence of enlargement of the heart without
valvular lesion, double pleurisy with effusion, and chronic
Bright's disease. They were accompanied by the fol-
lowing history, furnished by Dr. Charles Beacli, junior
assistant on the medical division of St. Luke's Hos]iital :
H. G had had numerous rheumatic attacks, invol-
ving one or both ankles. The last attack occurred eight
months ago, when the knees were involved. It lasted six
weeks. She had never had any cardiac symptoms. 'In
July, 1882, she was exposed to cold and damp air, since
which time she had been failing in strength. Micturition
had been frequent, spots floated before her eyes, and she
had suffered from nausea. Two months ago she began to
have dyspnoea, somewhat paroxysmal in character, and
oedema of the feet, legs, hands, and face appeared. At
various times she had had moderate pain in the left side
of the chest. On admission the patient had marked
cedema of the face and extremities, was suftering from
extreme dyspnoea, had a very weak pulse, no appetite,
and her temperature was elevated. Digitalin and whis-
key were administered hypodermically. The urine had
a specific gravity of i.oio, acid reaction, contained fifteen
per cent, of albumen, but the microscopical examination
was negative. Both pleural cavities were about half
filled with fluid. Examination of the heart was negative.
Thirteen ounces of fluid were withdrawn from the right
side of the chest. Immediate and marked relief followed.
Examination by Dr. Robinson : Respiration 32, jnilse
loS and tense, the apex beat could not be felt. Pericar-
dial friction-sounds were heard midway between the ape.x
and the left border of the sternum. The first sound of
the heart was prolonged. There was evidence of pericar-
dial effusion, and also of fluid in the left ])leural cavity.
The spleen was slightly enlarged. The dyspnoea was be-
lieved to be chiefly uremic. A milk diet was ordered.
Half an ounce of whiske)* was administered every six
hours. One minim of a one per cent, solution of nitro-
glycerin was ordered every four hours.
October 27th. — The patient had a chill this morning
lasting fifteen minutes ; also vomiting. During the last
twenty-four hours she has passed sixteen ounces of urine.
The nitroglycerin was reduced to one drop three times
a day. The vomiting persists. The bowels were moved
by enemata, cups were applied to the loins.
November ist. — Physical examination revealed dulness
up to the angle of the scapula. Nitroglycerin was dis-
continued. Over the apex of the heart tliere could be
heard, on inspiration and expiration, a rubbing sound, not
affected by the heart motion, but still believed to be
probably jiericardial. The urine had a specific gravity
of 1.008, neutral reaction, and contained thirty per cent,
of albumen. The patient had passed twenty-four ounces
during the past twenty-four hours.
On November 2d the cardiac sounds were distant and
indistinct, crumpling sounds were still heard. Cardiac
dilatation, localized ]iericarditis. Whiskey was con-
tinued three times a day. The fluid extract of convallaria,
ten minims, were administered every six hours. From
November 4th to November 9th the patient received
whiskey and the fluid extract of convallaria and the quan-
titv of urine passed varied from twelve to twenty-two
ounces in the twenty-four hours. On that date pericar-
dial friction-sounds were noticed preceding the second
sound of the heart. Pulse, 96.
On November nth the right side of the chest was
aspirated and thirty-five ounces of fluid were withdrawn.
On November 12th the patient passed ten ounces of
urine which had a specific gravity of r.014, was alkaline,
and contained sixty percent, of albumen. On November
15th the cedema of the feet and legs had increased. On
November i6th there was cedema of the vulva. Patient
passed fourteen ounces of urine. A creaking sound was
heard over the pericardium. November iSth the pericar-
dial friction-sound had almost entirely disappeared. The
jxitient's jnilse was 72 and regular ; she passed twelve
ounces of urine. The convallaria and the iodide of
ammonium which had been administered since Novem-
ber 8th, in doses of two grains, were then discontinued.
On November 19th the hot-air bath was administered.
On November 20th the patient passed only eight ounces
of urine, and had pain in the back and lumbar region.
P"rom this date to November 22d there was no marked
change in the condition of the patient, and on the
24th she died.
At the autopsy the abdominal walls were found infil-
trated with serum, and the abdominal cavity contained
about eight ounces of fluid. There were about ninety-
eight ounces of serous fluid in the pleural cavities. There
was about one ounce of serum in the pericardium, over
the apex of the heart anteriorly. Just to the left of the
septum was a small patch, about the size of a split pea,
of thickened plastic exudation. On the posterior surface
of the aorta, just above the reflexion of the pericardium,
were seen patches presenting the same appearance. The
right ventricle was distended and contained dark and
white clots. The left ventricle was hypertrophied. The
valves were apparently normal. The heart weighed fifteen
and a half ounces. The lungs were more or less com-
l)ressed and the pleura was thickened. The spleen was
enlarged and the capsule thickened, weight nine ounces.
The capsule of the liver was thickened, especially about
the inferior ligament, and the surface showed white streaks
with some increase of connective tissue. The kidneys
were the seat of chronic diffuse nephritis. Both were
reduced in size, the left weighing only an ounce and a
half. There were cysts in both ovaries.
Dr. Robinson also presented the heart and kidneys fron»
a patient who was admitted to St. Luke's Hospital, Decem-
ber 10, 18S2. They were accompanied with the following
history, furnished by R. J. Devlin, Senior Assistant on the
Medical Division. The patient was forty-four years of
age, and was able to give only an imperfect history. His
first and only attack of rheumatism occurred seven years
ago, which involved the ankles and hands, and lasted,
including relajises, four months. He had never suffered
any pain or distress in the region of the heart, nor pal-
jjitation. During the last two years he had been obliged
to rise from four to six times during the night to pass
water. No change had been noticed in the appearance
of the urine. The patient thinks that the daily quantity
has been excessive. During the last six months he has
suffered considerable from sweating and diarrhoea. Last
August he was seized with sudden failure of vision in the
left eye, followed in about two months by similar changes
in the right eye, and at the time of his admission his vision
was not sufficiently good to enable him to read print. GEde-
ma of the extremities appeared for the first time two months
ago. On December 2d, the abdomen being very tense,
he was tapped, and twenty ounces of fluid were removed^
January 13, 1883.]
THE MEDICAL RECORD.
49
From this date to December 8th there was a gradual
decline of the patient, pericardial friction-sounds and
valvular nuirmurs were distinctly heard, the cedema in-
creased, there was no increase in the How of urine, the
patient became delirious, finally comatose, and died. At
the autopsy tiiere was found some thickenings of the
cardiac valves, with atheromatous degeneration of the
anterior coronary artery, and the kidneys were the seat
of cystic degeneration.
Dr. Robinson directed attention, especially in con-
nection with the first case, to the use of convallaria
and nitroglycerin. Both these remedies were used, and
there was no noticeable increase in the quantity of urine
passed. Evidently under the influence of convallaria
the cardiac action was increased in force and the heart
was made to do its utmost, and apparently the woman
would have been benefited except for the condition of
the kidneys. While the patient was taking the iodide
of ammonium a pericardial friction-sound disappeared,
and at the autopsy it was believed that the evidence of
disappearing peiicarditis was found.
Dr. Wveth asked whether there was anything in the
condition of the kidney which explained why Uie digitalis
and the other remedies did not increase the secretion, but
at the same time increased the force of cardiac action.
Dr. Robinson believed that in those cases where we
find a low specific gravity of the urine, and its quantity
cannot be increased by the best known cardiac stimu-
lants, we have reason to believe that the atrophic kidney
exists, and he should be prepared to assume that with
a small quantity of urine with nothing specially abnor-
mal about the specific gravity, and failure on the part of
the kidneys to respond to cardiac stimulants, as in the
case recited, we might reasonably expect to find that
form of kidney degeneration, perhaps not so exagger-
ated as seen in the specimen presented.
CEREBRAL MENINGITIS.
Dr. Peabody presented a brain with the following
history : A. C , forty-three years of age, a native
of the United States, and a widow ; no occupation.
She had had alopecia, pharyngitis, iritis, and indefinite
pains, but no rash or initial lesion, or glandular enlarge-
ments or scars. Her tibiae were nodular when she came
under observation. She had rheumatism four years ago,
and had smce experienced vertigo and tinnitus aurium,
but had had no oedema, no palpitation of the heart or
other indication of involvement of that organ. On De-
cember 4th, at night, she had a severe chill, followed by
high fever, headache, photophobia, and a feeling of gen-
eral soreness all over the body. On the following day
she began to suffer from nausea and vomiting, which have
continued steadily up to the time of her admission to the
New York Hospital on December 7th. At the same
time with the development of these gastric symptoms her
left wrist became very tender, swollen, hot, and stiff.
No other joint was affected, but she had severe pain in
the lumbar and inguinal regions, together with pain in
the popliteal spaces, and in the calves of the legs. There
was no special spinal or cervical tenderness, but there
was some stiffness of the neck. On the day after the
chill she became quite deaf, and continued so. On ad-
mission she was well-nourished, and presented a number
of suggestive symptoms. Her left pu[)il was slightly
larger than the right, and there was slight left exophthal-
mus. Her left wrist was swollen, stitf, hot, and painful.
Its color was normal. No lesion of the thoracic or ab-
dominal viscera was detected. Her temperature was
102° F.; her respirations were 20, and her pulse was
78. She was unable to pass water. She was then given
ext. ergot, f 3 j. q- 3 hours, and also morphine ]ier os to
relieve her pam.
December 8th. — At 9 a.m.: Temperature, io2.'5° F. ;
respiration, 26, and pulse, 80. 12 m. : Temperature,
102.6° F. 5 P.M.: Temperature, 101.6° F.; resjiiration,
28, and pulse, 70. .Slight herjietic eruption on upper V\\i
Slight facial contortions noted. Patient has relapsed
into a semi-comatose state and can hardly be made to
take medicine.
December 9th. — No rash ; herpes spreading ; no joint
symptoms ; stupor deepening ; cardiac action excellent.
9 A.M.: Temperature, 102.4° F. : respiration, 26, and
pulse, 80.
December loth. — Temperature yesterday in p.m. was
not above 102.8° F. This a.m. temperature, 102.8° F. ;
respiration, 36, and pulse, 80. Respiration labored ;
stupor complete. Patient cannot be roused and medi-
cine is given with difficulty. During the past three days
a rapidly developing keratitis has invaded both eyes and
has now become intense. It has been treated by atrojiia
locally in solution. Was given whiskey r ij. last night.
Still no muscular twitchings or joint symptoms ; no rash.
5.30 P.iM. : Temperature, 102.9° F.
December nth. — 10 a.m.: Temperature, 102.9° F. ;
respiration, 36, and pulse, 90. She is now comatose.
Pulse growing feeble. Ordered whiskey, ? iv. in the day
and 3 iij. in the night. No change in symptoms. Kera-
titis worse, infl.Tmmation intense. Herpetic eruption in-
volves most of the uiiper lip. Still swallows.
December 12 th. — Patient com]iletely comatose.
Heart's action growing more feeble. Pulmonary cedema
developing. Ordered ether, 3 ij- (hypodermically), q.
three hours and enemata of whiskey, 3 j. Amnion, car-
bonat, gr. x. (given twice). Intravenous injection of aq.
amnion, and digitalin hypodermically. Heart's action
fairly sustained, but temperature slowly rose. 11 a.m. :
Temperature, 102.8° F. 2 p.m.: Temperature, 103.2° F.
6 p.m. : Temperature, 104.6° F. 10 p.m. : Tempera-
ture, 105° F. Pulmonary cedema increased. Heart
finally failed, and at 3.15 a.m., December 13th, she died
(temperature, 107.4° F-)-
The autopsy was made a few hours after death. The
only organ of interest was the brain. The pia was in-
tensely congested and there was a large amount of pus
in the cross meshes of the pia at the base, and extending
thence into the fissures of Sylvius. The lateral ventricles
contained also much thick pus, chiefly in the meshes of
the choroid plexuses. Inasmuch as rheumatic symptoms
occurred a few hours after the initial chill, in this case the
question had arisen. Might this be considered a case of
rheumatic meningitis ?
The Society then went into executive session.
NEW YORK ACADEMY OF MEDICINE.
Stated Meeting, January 4, 1883.
Fordvce Barker, M.D., LL.D., President, in the
Chair.
Dr. ¥. H. BoswoRTH read a paper (see page 29) on
GROWTHS IN THE NASAL PASSAGES.
Being called upon by the President to open the dis-
cussion. Dr. Lefferts said that to a number, perhaps the
majority, of points made by Dr. Bosv/orth in his paper,
no exception could be taken. They were such as were
well understood and adopted by all specialists. Others,
however, were open to question. Some must be contro-
verted. The latter two classes alone needed discussion.
First, as to adenoid vegetations, the profession, the lec-
turer tells us, believes them to be rare. This can hardly
apply to its reading members, for the subject has of late
been treated of in journals and monographs (/(/ nauseam.
He believes them to be exceedingly common — the most
frequent of the many conditions which give rise to an
abnormal discharge from the nose — and his statistics and
the wonderful array of specimens upon the desk seemed
to iirove his assertion ; but the truth, according to Dr.
Lefferts' experience, lay between the two extremes. We
must be careful not to confound simple irregularities of
the tissue at the pharyngeal vault, hardly to be called
abnormalities, especiallv m the young subject, with true
^o
THE MEDICAL RECORD.
[January 13, 1883.
hypertro])hies deserving of the name. Excessive hypei-
trophy, giving rise to veritable tumor and to all the symp-
toms so graphically described by the author of the jwper,
are not very common. Moderate hypertrophy is fre-
quently met with in tlie catarrhs seen in young children,
but still in a large proportion of them it does not exist.
He had not met with it in anything like the frequency
indicated by Dr. Bosworth, even in children. In tlie
adidt he believed it to be a very rare nlanife^tation ; and
here a practical point arose, bearing in n)ind the fact — one
not always ai)preciaied, even if recognized by specialists
— that these growths disappear, as a rule, with the ad-
vent of puberty. Is it always necessary to interfere with
them by oj)erative, and, in children, often formidable
means, simply because they do exist ? He believed
•not, refening, of course, to cases where the grade of
the hypertrophy was moderate. If excessive and giving
rise to both local and general disturbances, operative
measures were indicated, nay, demanded, beyond ques-
tion. In these days he did not fear that not enough
would be done. He deprecated the tendency to do too
much, and to rather over- than under-estijuate the signifi-
'cance of the disease.
As to the means of treatment, Dr. Bosworth was a
warm advocate, as was shown in his recent writings, of
the " Jarvis " snare, an excellent modification and adap-
tation of some pre-existing forms of appaiatiis. There
"was no question as to its value in many varieties of
nasal disease, especially hypertrophies, but it demanded,
notably in the naso-pharyngeal space, much manual dex-
terity, and hence was not of general applicability. Cer-
tainly it was not generally recommended nor used by
the special operators of to-day. Perhaps it ought to be.
A new model of a biting forceps lately introduced had
in his hands answered an excellent (jurpose. It was
Avarmly reconuiiended by operators of large experience
abroad. It could be used even by those without special
•training, and in cases in young children where the adjust-
ment of the wire snare would be a matter of great diffi-
cult)', if not impossibility. As to the use of the galvano-
'cautery for desiro) ing these growths, he would only ask
his hearers to try it once in young children, and thus
purchase their experience with discomfort, danger, and
•difficulty. In advising a method of treatment it was of
great importance to select one both practical and piac-
ticable.
Time did not permit him, as he would like to do, to
criticise some of Dr. Bosworth's statements in regard to
nasal polypi-myxomatous growths. One point only: Did
not the frequency with which he had met with these tu-
mors depend partly upon the fact that he had diagnosed
and removed some, in a state, if he liad rightly under-
stood his expression, of rudimentary development ?
The title of the paper, "Tumors of the Nasal Passages,"
permitted him to call attention to two forms of growths
not mentioned by Dr. Bosworth, viz. : cystic growths, and
l)a|)illomata. The former are rare, it is true, but possess
a piactical interest from an oiJerative point of view; they
resemble exactly the ordinary gelatinous i)olypus ; but
seized by forceps or otherwise burst, discharge their con-
tents, and the sac alone is torn away ; the operator be-
lieves this to be but a i)ortion of the tumor, and renews
his efforts now to remove the remainder of what does
not exist. Laceration of normal structures is the result.
He willingly, therefore, endorsed the practical suggestion
of Dr. Bosworth, always lo /00k and work carefully when
removing a nasal growth ; b)' not so iloing he lumselt
had made the mistake alludeil to.
The second form of tumor, the papilloma, is not un-
common, and gives rise to ])ersistent, often, apparently,
unex|)lamable episiaxis. This fact alone shows the import-
ance of its recognition ; it is readily seen in its usual lo-
cation u|)on tile nas.d septum, far down toward the orifice
of the nostril, and is as readily removed by clipping with
scissors and cauterization of its base.
l''inally, notwithstanding Dr. Bosworth's poetical illus-
tration, used in support of his position, that nasal disease
is the cause of the change in the upper register of the
singer's voice, and that the latter is the first to become
affected, as the voice shows signs of impairment, he must
take exception to the statement. The middle register,
experience shows, he thought, was the one to become
first affected ; if this were so, the theory built up by Dr.
Bosworth was overthrown, it not wholly, at least in part.
This subject was, however, a large one, and could not now
be entered iriion, especially as he had consumed already
so much valuable time, for which tresiiass he apologized,
and pleaded in excuse the interest of the subject, so well
treated of by Dr. Bosworth.
Dr. R. C. Brandeis thought that wath either intlamnia-
tion of the ))haryngeal tonsil, or the existence of the ade-
noid growths, there must be some inflammation of the
adjacent structure, and further, that the inflammation
was as liable to extend upward into the PLustachian tube
as downward into the pharynx. He, therefore, believed
that impairment of hearing, in these cases, was due
largely to obstruction of the Eustachian tube produced
by the congested or swollen mucous membrane. In
consequence of such obstruclion the air was removed
from the cavity of the middle ear, thus ))ermitting pres-
sure upon the external drumhead to produce distortion
of that membrane. II the orifice of the Eustachian tube
was only tenijiorarily congested, its walls were brought
into contact with each other, the air in the cavity was
gradually absorbed, and impaired hearing was the result
of malposition of the drum.
With regard to the use of the galvano-cautery in the
naso-jjharyngeal space, he hid not met with any evil
consequences in resorting to it. He had adopted it
frequently for the removal of nasal polypi, and believed
that in those cases it subserved a double pui pose, namely,
it acted as an ecraseur and at the same time as a caus-
tic. He regarded it as necessary to destroy the roots of
nasal ])olypi entirely, if the liability to their return was
to be entirely obviated.
Dr. R. p. Lincoln thought it was generally conceded
that there were many tumors in the nasal passages which
were dangerous to the patient, and that the harm which
they produced was far-reaching. With regard to the
necessity of operation for the removal of growths in the
post-nasal region, particularly of adenoid tissue, it seemed
to him that it depended entirely upon the fact as to
whether they were the source of any impairment of
health or produced any special discomfort. The neces-
sity for the removal of these growths might be alone the
discharge which they produced, because that discharge of
itself caused harm, not only in the pharynx, but as he be-
lieved, also in the stomach, giving rise to indigestion. Be-
sides, they might i)ioduce a reflex influence upon distant
parts, as had already been mentioned by Dr. Bosworth,
and might give rise to asthma. It was also astonishing
how small a grow th would produce asthmatic symptoms.
Another evil effect due to obstruction of nasal breathing
was a malformation produced in children while the\- were
quite young ; that is, previous to six, eight, or nine years
of age. He had seen a number of cases in which it
seemed to him that no other explanation could be given
for the malformation of the chest, than that it was conse-
quent upon the difficulty of breathing through the nose.
He believed it was a practical point with which every
medical man should be made familiar.
With reference to treatment, he took issue with Dr.
Bosworth's statement that "all other methods than the
use of the wire ecraseur were inadecpiate." He had em-
ployed the galvano-cautery and also chromic acid with
very satisfactory results, and had published quite a large
series of such cases in which these methods of treatment
had been adopted. He thought also there were other
remedies which could be used advantageously for the
same purpose. For exam|)le, the Vienna paste had been
and could be used with success for the removal of en-
larged tonsils and also for the removal of the growths
January 13, 1883. J
THE MEDICAL RECORD.
51
under coiisideiation. Jaivis' snare-ecraseur, however,
was certainly a most valuable instrument. He himself
used it more than any other instrument, both in the an-
terior and posterior nares. He did not believe that any-
thing else could be devised which would replace it.
There were, however, other remedies which would ac-
plish perfectly satisfactory results, especially when the
fact was taken into consideration that most of the growths
in the posterior cavity of the nares ilisappear after pu-
berty. A remedy which he had recently used, and one
to wliich he wished to direct special attention, was boracic
acid, especially where the growth was small and yet gave
rise to a jjrofuse, anno) ing discliarge. This remedy might
be used, finely powdered, pure or diluted with subcar-
bonate of bismuth, and by the aid of one of the many
port'der-blowers.
Dr. B RouiNSON remarked that while it was true most
were familiar widi Jarvis' snare ecraseur, and perhaps we
had been led chiefly to use it from the fact that it had been
so strongly recommended by Dr. Bosworlh, yet the fact
remained that it was not the only instrument which could
be made use of in destroying these growths. It was,
however, probably the best. In cases in which tlie
growth was of some size he thought it was decidedly
the best instrument which could be employed. Where
the growths were siiuill, flat, and sessile, and did not
cause any distressing symptoms, he thought the galvano-
cautery or some methods of removal by scraping could
be used satisfactorily. But for removal of the growths of
the size exhibited by Dr. Bosworth, certainly the Jarvis
wire-ecraseur was the best instrument which could be
employed.
There was one point which he believed had not been
sufficiently impressed, and that was the continued suck-
ing out of the breast, so to speak, when the nasal pas-
sages were obstructed, and this was true without refer-
ence to what the cause of the obstruction was, provided
the obstruction took place in the anterior i)art of the
nasal passages.
Personally, he believed that there was such a thing as
propagation of the catarrhal intlamniatory condition
directly from the affected jiarts to the Eustachian tubes,
ami in that way to the middle ear. To such an exten-
sion of the inrtanimatory process he attributed many of
the cases of impaired hearing.
Du. Bosworth, in closing the discussion, said, with
reference to the question as to whether or not we should
operate when there was only a moderately large adenoid
growth present, that doubtless many of the growths
atrophied at about the age of puberty. But that period
might be at some distance, and the child might be suffer-
ing from certain symptoms which should be relieved. The
tendency in many of these cases was to ])roduce sleepless
nights, weak throats, impeded respiration, etc., and he be-
lieved it to be the duty of the surgeon to relieve the pa-
tient of such symptoms, even if he felt certain that the
growth would atrophy within a few months or within a
year. Furthermore, we were not absolutely certain that
they would disappear.
\Vith regard to the use of the force|)s and the snare, he
thought that the forceps could not be made to reach the
entire growth on account of its peculiar anatomical
situation. He had never seen a pair of forceps with
which the entire growth could be reached.
With reference to the register of the singing voice lirst
affected, his conclusion that it was the upper register
which was first involved had been based largely upon the
statement made by singers themselves.
With regard to the extension of catarrhal disease
through the Eustachian tube, he thought it was a good
l)oint, but, at the same time, in the examination of a
very large number of cases he had rarely seen evidence
of catarrhal inflammation at the trumpet-shaped extrem-
ity of the Eustachian tube ; that is, there had been neither
swelling nor redness, nor had there been evidence of
pain or heat.
With reference to impairment of hearing, he believed
that the levator jjalati muscles played an important part
in the admission of air into the middle ear, and that the
adenoid growths in the vault of the pharynx interfered
with the proper jierformance of their function. The in-
ference was that the growths should be removed.
The Academy then adjourned.
SECTION IN PRACTICE.
Stated Afeetin;^, December 19, 1882.
.\ndrkw H. Smuh, M.D., Chairman.
THE COMPLICATIONS, SEQUEL/*;, AND TREATMENT OF
SCARLET FEVER.
Dr. J. Lewis Smith read a paper on the above subject,
in which he directed attention first to the complications
affecting the nervous s\stem. These were of two varie-
ties : I, those which develo|)ed during the early days of
the disease, and 2, those which a|)|)eared in the declining
stage, when the\- occurred from urajmia chiefly. The
occurrence of delirium or convulsions during the first
days generally indicated the presence of a sufficiently
severe type of the disease to prove fatal speedily. The
l)rognosis, however, in such cases was much more favor-
able than in former times, and the improvement was due
to our better understanding of the application and the
effects of agents employed for the relief of certain symp-
toms, such as high temperature, as well as for the con-
trol of the complication itself. The use of cold was
recommended for the control of the temperature, api)lied
in the form of sponging, or the pack, or the full bath,
whenever the thermometer registered above 103° F.
For the convulsions, bromide of jiotassium could be ad-
ministered with impunity in large doses repeated fre-
quently, and if it failed, the use of hydrate of chloral by
the rectum would almost surely prove successful. Use
a small glass syringe, and to children from one to three
years of age five grains of chloral dissolved in two
drachms of water could be given.
SEVERE PHARVNGITIS, CERVICAL CELLULITIS, AND
ADENITIS.
Dr. Smith had never met with a case of scarlet fever
in which there was not evidence of pharyngitis before
the appearance of efflorescence upon the skin. Pharyn-
gitis, therefore, was not regarded as a complication un-
less it attained that degree of severity in which the
inflammation extended into the tissues of the neck and
produced destructive tissue change. There were two
forms which occurred as complications : i, an aggra-
vation and extension of the inflammatory process always
present, and 2, true diphtheria. The first usually be-
comes considerable, if it is to exist as a complication, at
about the close of the first week, sometimes within the
first two days. In some cases the tumefaction is so great
that the mouth can be opened only with very great diffi-
culty. In mild cases resolution occurs ; in the severer
ones ulceration, possibly gangrene.
UIPHTHEUIA
occurred frequendy as a complication of scarlet fever.
In localities where the former disease prevailed, from
one-third to one-half of the cases of scarlet fever became
coiniilicated with diphtheria, without the probability of
an exposure to the ])oison of the latter disease, or to the
influence of sewer-gas. The complication had occurred
so frequentl)- in his practice that Dr. Smith had come
to regard scarlet fever itself as a cause of diphtheria in
a locality where diphtheria prevails. The reverse, how-
ever, he did not think was true. Usually, the compli-
cation did not api)ear until the third or fourth day, but
sometimes it began almost simultaneously with the scar-
let fever.
52
THE MEDICAL RECORD.
[January 13, 1883.
OTITIS MEDIA,
as a complication of scarlet fever, was attributable to
extension of the intiammation along the Eustachian tube
from the naso-pharyngeal surfaces.
SCARLATINOUS RHEUM.iiTISM.
This usually commenced at the close of the first or the
beginning of the second week, and commonly affected
the wrists and ankles. It did not seem to retard conva-
lescence, but its chief danger was the liability to cardiac
complication.
PERICARDITIS
occurred as a complication more frequently, probably,
than was generally supposed.
PLEURISY
was one of the most important complications. It de-
veloped usually in the desquamative stage and was apt
to be suppurative.
DILAT.\TION OF THE HEART,
coincident with quick feeble pulse. .\t autopsies firm
whitish clots were found closely adherent to the column.x
carneffi, and extending into the large vessels.
NEPHRITIS.
In a mild form it occurred according to his observa-
tion much more frequently than had been formerly sup-
posed. Renal catarrh might occur without urinar\' evi-
dence. Special reference was made to Steiner's cases.
The complication usually began in the desquamative
stage, and Dr. Smith believed that exposure to cold was
one of the causes. According to Klein a tubal or paren-
chymatous nephritis occurred early, and after about nine
days interstitial nephritis existed. Reference was also
made to the glomerulo-nephritis described by Klebs, and
to the criticisms made by Klein, who did not accept
Klebs' views upon this point. With reference to
PROPHYLACTIC TREAT.MENT,
he thought there was no remedy which could prevent the
spread of the disease. Concerning the use of water, cold
or lukewarm, with sjionge, pack, or bath. Dr. Smith re-
marked that he regarded it as one of the most valuable
agents that could be employed for reducing temperature
and affording general relief to the patient. Inunction
was serviceable, especially in the desquamative stage,
and with such substances as vaseline or carbolized ajipli-
cations. On the use of water. Dr. Smith also read Hen-
och's views, recently published in German.
Dr. L. Weber thoiight| that the scarlet fever poison
never produced true diphtheria, and that when the two
affections existed in the same patient it was a coincidence.
He believed that the condition of the mucous membrane
of the throat in scarlet fever might be such as to induce
the invasion of diphtheria. He was of the opinion that
Henoch, just quoted by Dr. Smith, believed that these
two diseases might co-exist in the same person, but that
scarlet fever never caused dipiitheria.
Dr. Weber had seen erosion of the jugular vein as the
result of suppuration of cellular tissue and adenitis in
scarlet fever.
Dr. E. G. Janeway recalled a case which illustrated
how mistakes were sometimes made. The child was said
to have syphilis from vaccination because there was en-
largement of the cervical glands. The complete history
of the case proved it to be one of undoubted scarlet fever,
and the practitioner who made the statement concerning
syphilis had hit upon the time when there was enlarge-
ment of the cervical glands without efflorescence of the
skin, and besides the child had been vaccinated. Again,
when scarlet fever [jrevailed attacks of sore throat were
frequent among ciiildren. Such cases, wlien observed
independent of scarlet fever, would usually be called
follicular faucitis. Yet it was probable that many of them
continued the spread of the disease. He had seen puru-
lent inflammation of joints instead of the ordinary rheu-
matic inflammation in several cases.
ORIGIN OF HEART-CLOTS.
With reference to clots in the heart, spoken of by Dr.
Smith in connection with dilatation of the heart, firm,
whitish, usually entangled somewhat in the chords ten-
dinere, and often regarded as ante-mortem, he had doubts
about their being of that character. The mechanical
conditions were very much the same as that obtained
when blood was placed in a vessel and allowed to co-
agulate ; the buffy coat formed at the surface and the dark
blood sank to the bottom ; so when the circulatory organs
were in position the buffy coat formed in the heart and
the dark blood sank into the pulmonary arterv. Still
further, a man in his wards in Bellevue Hospital had
symptoms which led him to suppose that the right heart
was overloaded with blood. Feeling that benefit might
follow the withdrawal of blood from the overloaded heart
cavity he introduced a hypodermic syringe and removed
a certain quantity. That which was drawn oft' was jnire
fluid black blood. The heart had ceased beating before
the syringe was introduced, and the withdrawal of the
blood was not followed by cardiac action. Dr. Janeway
then injected a solution of carbonate of ammonia into
the same cavity, but it also failed to excite the heart to
action. At the autopsy there was found a firm white
clot entangled in the chordte tendine.x and the columnae
carneas and not any dark fluid. Immediately after the
heart ceased beating the right cavity contained fluid black
blood ; at the autopsy there was no fluid black blood in
the same cavity, but a firm white clot, entangled in the
muscular and tendinous structures. The case, therefore,
seemed to prove conclusivelv that, in some cases at least,
the white, and particularly the whitish, clots found in the
heart at autopsies were not ante-mortem.
With reference to prophylaxis, Dr. Janeway believed
that there were exceptions to the general belief that
within the first few hours of scarlet fever no danger from
contagion existed. Again, the latter part of the desqua-
mative stage seemed not to be contagious in some cases.
There was no definite rule that could be laid down. As
a matter of safety advantage should be taken of all pre-
cautionary measures. Inunction during the desquama-
tion stage was beneficial and should be adopted.
Dr. C. E. Billington believed that the co-existence
of scarlet fever and diphtheria was very common, but he
thought that the condition of the throat in scarlet fever
favored the accession of diphtheria. He had frequently
seen cases, regarded as diphtheria, which had developed
upon the sore throat accompanying scarlet fever. One
evidence that the cases were priniarilv scarlet fever was
the occurrence of otitis media, which rarely developed
in connection with simple cases of diphtheria. He re-
garded inunction as very valuable in scarlet fever.
Dr. J. C. Peters always directed attention to the
throat, the kidneys and the skin in all cases of scarlet
fever. He believed that the so-called jjeriod of incuba-
tion was merely the working of the poison through the
mucous membrane of the throat. When it had found its
way througii, and entered the blood, the symptoms at
once began to develop. He believed that the blood was
unaffected during the six or eight days of incubation, and
therefore directed especial attention to the throat. Of
course, he had not prevented the disease in that way,
but he thought he had modified its course. With refer-
ence to the skin, inunction was very serviceable. The
kidneys should receive early attention. He accepted
the view that desquamation occurred in the uriniferous
tubules, the same as upon the external surface of the
body, and that it did not necessarily lead to nephritis.
.Sweet spirits of nitre and syrup of tola was a favorite
combination with liim. Besides the inunction he used
tepid baths, the temperature of the water never being less
than 90° F. He had been afraid to use cold baths.
January 13, 1883.]
THE MEDICAL RECORD.
53
Dr. Kurram, spoke of the use of antiseptic appli-
cations to the throat.
Dr. a. S. HuN'i'KK favored simply wetting the surface
with warm water, and then exposing it to the air, as a
means for reducing temperature.
Dr. Putzkf. believed that the frequent co-e.\istence
of scarlet fever and diphtheria mentioned was an excep-
tion to the rule concerning infectious diseases, because it
was exceedingly rare for two infectious diseases to run
their course in the same person at the same time. He
thought that the mistake had occurred, perhaps, in con-
founding anatomical diphtheria with clinical diphtheria.
The occurrence of a diphtheritic exudation upon mu-
cous surfaces did not necessarily indicate the presence
of true diphtheria.
The Chairman directed attention to marked dyspnoea
as a complication, without apparent obstruction to
either the respiration or the circulation. It seemed to
be due to the effect which the poison produced upon
the blood-corpuscles, rendering them unable to perform
their function as oxygen-carriers.
Dr. Janeway remarked that these cases of dyspniea
had been described under the head of unumic dyspncea.
\\'ith reference to the co-existence of scarlet fever and
di|ihtheria, the decision turned largely upon the answers
to be given to the question, What is clinical and
what is anatomical diphtheria ? That anatomical
diphtheria — that is, a false membrane upon the surface
and invading the substance of nnicous membranes — could
occur without true diphtheria, he believed to be well
established.
Dr. J. Lewis Smith, in closing the discussion, referred
to the difficulty in making a differential diagnosis, es-
pecially in cases of scarlatina anginosa, where there was
destructive inflammation of the mucous membrane in the
throat. Still he believed that the two diseases did
occur undoubtedly in the same patient at the same time.
Of course, such cases were somewhat rare, but of their exist-
ence he had become fully convinced. At the same time,
he did not suppose the co-existence would be seen where
diphtheria did not exist. He would be pleased to re-
ceive information upon this point from rural practitioners
who had had to deal with the two diseases. He thought
that one of the avenues by which the poison of scarlet
fever gained admittance to the system was through the
lungs ; that the access was by no means confined to the
throat.
The Section then adjourned.
The Prognosis of Idiocy. — The late Dr. E. Seguin,
who was the highest authority, although somewhat over-
sanguine, said regarding the results of attempting to train
idiots : Not one in a thousand has been entirely refrac-
tory to treatment ; not one in a hundred who has not
been made iiappy and healthy ; more than thirty per cent,
have been taught to conform to social and moral law,
and rendered capable of order, of good feeling, and of
working like the third of a man ; more than forty per
cent, have been capable of the ordinary transactions of
life under friendly control, of understanding moral and
social abstractions, of working like two-thirds of a man ;
and twenty-five per cent, come nearer and nearer to the
standard of manhood, till some of them will defy the
scrutiny of good judges when compared with ordinary
young women and men.
The Gospel of Fatness. — Dr. Clouston, of Edin-
burgh, says : " All acute mental diseases, like most nervous
diseases, tend to thinness of body, and therefore all foods
and all medicines and all treatments that fatten are good.
To my assistants and nurses and patients I preach the
gos|)el of f:itness as the great antidote to the exhausting
tendencies of the disease we have to treat, and it would
be well if all people of nervous constitution would obey
this gospel."
(£0 vvcsp 0 n cl en c c.
ON THE STRENGTH OF OPIUM.
To THE Editor of Thk Medical Record.
Dear Sir : In your valued journal of December 9th,
reference is made to an article contained in Dr. Squibbs'
Ephfineris, of November, 1882, and some remarks are
appended in regard to the "inexcusable oversight in the
Pharmacopoeia Committee," which call for an answer, as
both the Epiteincris article and your comments are at
fault.
Dr. Squibbs compares the lowest percentage of mor-
phine strength of opium permitted by the last Pharma-
copoeia with the average percentage allowed by the
new, an evidently unfair comparison. It would have
been fairer to compare the lowest percentage allowed by
both Pharmacopceias. The assay process of opium of
1870, in average hands, gave poor results, so that an
opium which assayed ten per cent, was more nearly
twelve per cent, in actual strength, and, therefore, nearly
identical with twelve per cent, opium as assayed by
the present superior processes. But the Pharmacopoeia
of 1870 did not require opium to be of ten per cent,
strength, but " not less than ten per cent.," clearly making
opium of sixteen per cent, or more come within its pro-
visions. There simply was no upper limit to the strength.
Little of the opium in the market contains only ten per
cent, of morphine without being of so poor a quality as
to be rejected for pharmaceutical uses on account of its
appearance alone, and such an opium is but just strong
enough to pass the inspection of the United States Cus-
toms Drug Examiners.
The average strength of fair specimens of opium to be
obtained in the market has always been far above the
lowest grade permitted by the old Pharmacopoeia, and it is
safe to say that this average strength has been about
thirteen or fourteen per cent, for many years past. Dr.
Squibbs himself has all along aimed to furnish an opium
of thirteen and one-half per cent, strength, and has stated
that he would not sell any of less than twelve and one-
half per cent, strength, which would be from twenty-five
to thirty-three |)er cent, higher than the grade with which
he now compares the standard of the new Pharmacopoeia.
If, therefore, a physician prescribed opium, and Dr.
Squibbs' opium was dispensed, the patient received a
twenty-tive to thirty-three per cent, stronger article than
designed, thus exposing the patient to the dangers now
pointed out in the article in Epliemeris, or rather, he
would have been so exposed, if the average grade of all
oiiium had not been fully up to Dr. Squibbs' opium.
The statement that " of course, a pound bottle of the
new preparations will be equal to a pound and a half of
the old " is wrong. The market is a sensitive thermom-
eter of the actual value of opium preparations, and while
a rise in cost may occur, due to fluctuations in opium
value, we dare predict that no marketl rise will occur on
the ground of variation in the pharmacopceial standard.
In other words, the strength of opium is not changed
by the present Pharmacopoeia, but the description of
opium has been simply made to correspond to the actual
trade conditions.
The opium the physician will hereafter use will be
practically the same as that which he has heretofore em-
ployed, while a few of the preparations have been slightly
raised in strength, but not sufficiently so to affect the
doses.
Besides, as a matter of fact, and regardless of the
question of propriety or impropriety, it may be stated
that physicians do not prescribe opium, grading their
dose with reference to any particular opium strength,
and least of all do they base their dose upon a uniform
strength of ten per cent. Nor is it necessary that they
should so calculate, because they know that the average
54
THE MEDICAL RECORD.
[January 13, i88j
opium that is apt to be dispensed on their prescriptions
will have an average effect to which they are accustomed.
It is therefore |)robable that the change to which atten-
tion has been called is altogether confined to the pages
of the Pharmacopceia, and that physicians will goon pre-
scribing opium just as heretofore, and will obtain the same
effects.
Very truly yours,
O. A. Wail, M.D.
St. Louis, Mo.
TRACHEOTOMY IN YOUNfr CHILDREN.
To THE Editok of The Medical Record.
Dear Sir : Your repoit of a successful tracheotomy in
a child only eleven months old stimulates me to fur-
nish you, for the benefit of those who may be interested
in gathering statistics in the future, the histories of two
little patients, each twenty-two months old, who devel-
oped laryngeal complications during diphtheria. That
the affection was genuine diphtheria was proven by the
sequel to each, namely, paralysis of several muscles, such
as the eye and also of the throat and pharynx. These
two cases were in the practice of my associate. Dr. .A. J.
Dower. I assisted at the second operation, and also
saw patient during his subsequent treatment.
Case I. — Charles F , aged twenty-two months.
He had been sick about four or five days before Dr.
Dower saw him.
On his first visit he found marked diphtheritic infiltra-
tion of pharyn.N, tonsils, etc. In addition he had infil-
trated cervical glands. In two days from when first seen
laryngeal obstruction began. This was doubtless due
• to the usual manner, of extension of inflammation to
larynx.
After this condition of things had lasted for forty-eight
hours nearly, and was increasing, Dr. Wallace was called
in consultation. It was decided, after examination,
that it would be well to still wait and continue same
treatment. As there was no improvement, tracheotomy
was performed. The asphyxiated state, as manifested
by generally engorged condition of veins and contraction
of inferior portions of chest with snjjra-clavicular de-
pressions, was immediately relieved thereby.
Assisting the <loctor at this operation were Drs. Jarvis,
Wright, and McCorkle.
With the exception of three days, convalescence was
immediately established. Only moderate amount of
bronchitis ensued from operation. Paralytic manifesta-
tions occurred as sequeke to this disease as usual. Uni-
lateral strabismus as well as paralysis of soft palate and
epiglottis. It w-as attempted to remove tube on the
seventh day, but dyspnoea ensued as soon as it was re-
moved and so it was left to the tenth day. Wound grad-
ually closed in and was healed soon.
Case II. — .Andrew J. E , aged twenty-two months.
He was sick six days before the tracheotomy was per-
formed with marked infiltration of tonsils and pharynx,
tiradually laryngeal inflammation and stridor set in.
Preceding the laryngeal stricture he had had the usual
anti-diphtheritic treatments. The laryngeal obstruction
increased, as manifested by the rarefication of air in the
chest, by supra-clavicular depressions during inspiration,
as well as the same condition over the interior portion
of the chest, and a general venous obstruction, as mani-
fested by blue prolabia, etc. Coma increased. Opeia-
tion of tracheotomy done with immediate relief to as-
phyxia. Subseciuemly the progress of case was not
interfered with and good recovery ensued. Hat] paralysis
after operation of the soft palate and uvula, allowing milk
and medicine to enter the larynx and emerge by tracheal
tube. This lasted a few days, and later in convalescence
he had facial paralysis. Only moderate amount of bron-
chitis followed tracheotomy.
W. J. Branpt, i\r.D.
i.ate House Surgeon Chttrity Hos/'ital,
ISkcoklvn, N. Y. .. Bl.uk-.feU-s Island.
ON THE REMOVAL OE FOREKiN BODIES
FROAL THE EAR.
To THE Editor of The Medical Record.
Dear Sir : When recommending my aural fc>reign-body
forceps in a communication published in The Medical
Record of December 23, 1S82, I certainly did not ex-
pect its employment would meet with the vehement op-
position which is shown in Dr. Knapp's letter in The
.Medical Record of January 6, 1SS3, especially as the
writer thereof seems never to have given it a trial. It
was scarcely necessary for Dr. Knapp to chaw our atten-
tion to the P'rench and German devices of the past fifty
years, for the removal of foreign bodies, inasmuch as the
extensive circulation given by Wood's Library of Stand-
ard Authors to Poulet's " Foreign Bodies in Surgery "
places a very e.xhaustive list before the profession. The
real question is, not the removal of foreign bodies as
found by the expert just as introduced by the child, but
it is, how shall they be treated when deeply impacted ?
It is in such cases that one often finds the parts lacerated
by previous efforts at removal, the swollen walls of the
external auditory canal so closely embracing the foreign
body that neither hooks or spoons can be easily or safely
passed ; a state of things, in fact, which a careful perusal
of Dr. Knapp's letter does not convey the idea that he
has as yet encountered. When the deeply impacted
foreign body completely obstructs the canal, as is often
the case, the operator, after forcing his instrument be-
yond it, finds himself working in the dark and unable to
operate skilfully : he cannot determine how near the
foreign body lies to the druin-membrane, and when it is
situated very near to that delicate structure no one pos-
sesses the requisite delicacy of touch to always avoid its
laceration — an injury the consequences of which are in-
flammation of the middle ear and its attendant evils.
.\nd it should be borne in mind just here that no serious
result need be usually apprehended from the presence of
a foreign body in the canal of the ear unless it be pushed
down upon the drum-membrane, or into the middle ear,
thus injuring these parts, or unless the middle ear be in-
jured by poking instruments behind the object. Should
the instrument which Dr. Kna|)p, in his letter, pro-
Ijoses to have made so as to open its prongs when
thrust back behind a foreign body, ever be made and
brought into use in these difficult cases, one can scarcely
foretell the destruction such a device would be capable
of doing, even in his skilful hands. In regard to the,
seemingly disparaging quotation made by Dr. Knapp
from The American Journal of Otology, it may appear
to be an ingenuous argument to those who have not
access to the files of that journal against the efii-
ciency of my forceps ; but the extract is garbled and dis-
ingenuous, for Dr. Joy expressly states, in referring to the
first attempt to remove the locust-bean before it became
disintegrated by maceration in the secretions surrounding
it in the canal: "I am positive that if we could have
used these forceps (referring to Dr. Sexton's) in the first
operation, the bean would have been removed in its en-
tirety.' And Dr. Joy reports, in the same article, another
case where an impacted brass mounted glass-stud was
removed with these forceps after other kinds had been
unsuccessfully tried.
The former case was referred to as the one which sug-
gested the construction of the forceps which has been
subsequently used so successfully in a large number of
similar cases.
In conclusion, it may be stated that the forceps here
alluded to by me will not only grasp such beans as
shown in the cut which accompanied my letter in The
Medical Record of December 23, 1S82, without ne-
cessarily pushing it farther in, but it will also retain its
hold while very great traction is made.
With means of this kind at hand — which are also ap-
' American Jcurn.-»l of Otology, vcl. iii., p. 145, iSSi.
January 13, 1883.]
THE MEDICAL RECORD.
55
plicable to the extraction of foreign bodies from the nose
— I shall, until something better is found, prefer to ope-
rate in these cases by seizing the presenting portion of
the object, and thus exert tractive force, to adopting the
plan offered by Dr. Knap]), wliich consists in applying a
pushing power from behind. Yours sincerely,
Samuel Sexton, M.D.
New York, January 6, 1883.
^vmy and |Xauy iXcius.
Official List of Changes of Stations and Duties of Officers
of the Medical Department, United States Army, from
December 30, l88a, to January 6, 1883.
i\[cKee, J. C, Surgeon. To report on or before Jan-
uary I, 1883, to the CoiiHiianding Officer, Fort Winrield
Scott, California, for assignment to duty as Post Surgeon.
S. O. 197, par. I, Department of California, December
28, 1882.
GoRGAS, VV. C, Assistant Surgeon. Relievetl from
the temporary duty to which assigned imder S. O. 137,
par. 4, Department ot Texas, and will report to the
connnanding officer, Fort Brown, Texas. S. O. 140, par.
2, Department of Texas, December 26, 1882.
Official List of Changes in the Medical Corps of the A'avy
for the week ending January 6, 1883.
TiBBS, Henry B,, Assistant-Surgeon.
U. S. S. Jamestown.
Ordered to the
litedicaX Items.
Contagious Diseases — Weekly Statement. — Com-
parative statement of cases of conLigious diseases re-
ported to the Sanitary Bureau, Health Department, for
the two weeks ending January 6, 1883 :
Week Ending
v.*
5!
1
1.
U
s
t
1
S
(/2
1)
>
December 30, 1882
January 6, 1883
0
0
13
6
45
64
6
10
40
46
35
52
0
0
0
0
The Manage.ment of the Texas Epidemic. — Dr.
J. B. Hamilton, Surgeon-General U. S. ATarine Hospital
Service, writes, regarding the Texas yellow-fever epi-
demic : " You were mistaken about the United States
not quarantining the Rio Grande between Laredo and
Brownsville, though it did not quarantine in Mexico, as
has been charged. Please correct this point, as the safety
of Texas is due, we think, to that cordon. The Mexicans,
after they saw the good effects of quarantine in Texas,
adopted similar means of arresting the disease on their
side and with success."
A New Use for the Condum. — Dr. J. Newell Ro-
bertson of VValcott, N. Y., writes: " F. A. came to my
otRce on the evening of December 6th with a piece of
bone in the lower fourth of the oesophagus which lodged
there the evening before while eating a ' boiled dinner.'
1 introduced several sizes of flexible catheters, could feel
the substance distinctly, and succeeded in pushing it
down about one inch. I then fastened a piece of tissue
rubber to the end of a catheter, passed it below the sub-
stance, inflated it, then withdrew it, doingit several times.
I then, at the suggestion of Dr. Wilson, employed a
condom in the same way. Failing as with the first, I
inflated it abone the substance, jnishing it gently down,
and found to my satisfaction that the ' Ixjne of conten-
tion ' passed easily before it."
Shakespeare on Death. — Of the deaths by poison-
ing two are minutely described. One .takes place off
the stage, and is only named to us ; two are sudden — the
Queen in "Hamlet," and Romeo. In these last cases
the agent was clearly hydrocyanic acid in some form, a
vegetable extract, such as laurel water, killing almost at
once, and painlessly, leaving no time for thought, but
only for the certainty of ([uick-coming death. King
John, on the other hand, is poisoned by a corrosive irri-
tant, (irobably mineral, comi)aratively >low in its action,
of which burning heat is the chief symptom :
"There is so Iiot a -Summer in my bosom,
'I'hal all my bowels crumble up to dust.
. . A^amst this fire
Do I shrink up ?
None of you will hid the Winter come,
To thrust his icy fingers in my maw,
Nor let my kingdom's rivers take their course
Through my burned bosom, nor entreat the North
To make his bleak winds kiss my parched lips ? "
The elder Hamlet, again, dies by vegetable poisonings
There is a strong reason for thinking that the true read-
ing of the (hug is not the usual " hebenon," but " heb-
ona," or yew juice, for the symptoms are precisely those
caused by this, and by no other. Whether, in the then
state of anatomy, Shakesjieare really believed, contrary
to the truth, that such a juice [loured into the ear would
so course through the body, is not clear. It is probable
that he took the old story, so far as lie needed to do so,
but having made it responsible for the mode in which the
foreign element was introduced into Hamlet's frame,
used then his own observation and curious plant-lore for
the etforts which the body made to cast it out. The
many cases of death by steel are very closely studied
from nature. Those who have carefully examined the
dead on a battle-field, or in the streets after an emeute,
are struck with the fact that while the expression on the
faces of those who have died by gunshot wounds is one
of agony and distress, the dead by sword have a calmer
expression, though their wounds often seem more pain-
ful to the eye. ."V very careful observer, who was through
the Indian mutiny, entirely confirms this. After giving
several instances, he says : " .\ rapid death by steel is
almost painless. Sabre edge or point divides the nerves
so quickly as to give little pain. A bullet lacerates."
This is in entire accordance with Shakespeare's diag-
nosis. York, in ''Henry IV.," dies "smiling"; so
young Talbot, in i "Henry VI.," "Poor boy! he
smiles." In the great majority of cases there appears to
have been no acute pain ; and such distressful sensations
as were felt, when there was time to feel anything, were
those of cold. Death, therefore, resulted from hemor-
rhage, of which an exceeding chilliness, without jiaiii, is
always the consequence. Hotspur and Warwick both
speak of this chill, " the earthly and cold hand of death,"
the "cold, congealed blood." The only instances in,
which acute pain wrung "groans" from the sufferer were
those in which death was long delayed, when, as^svith
Clifford, " the air has got into my deadly wounds," and
Montague also groans from the delay. There is a most
striking passage in Jeremy Taylor's sermons in which he
si)eaks of wounds to the same effect, but attributes the
painlessness of a wound at first, wrongly as it would
seem, only to the heat and rage of the fighter, who has
no time to feel. " I have known a bold trooper fight in
the confusion of a battle, and, being warm with heat and
rage, received from the swords of his enemy wounds open
as a grave ; but he felt them not, and when, by the
streams of blood, he found himself marked for pain, he
refused to consider then what he was to feel to-morrow ;
but when his rage had cooled into the temper of a man>
56
.THE MEDICAL RECORD.
[January 13, 1883.
and clammy moisture had checked the fiery emission of
spirits, he wonders at his own boldness, and blames his
fate, and needs a mighty patience to bear his great ca-
lamity." Shakespeare carefully discriminates between
the wounds which pierce the heart and are at once fatal,
and those which allovv a few minutes, or even moments,
of life. A stab which causes instant death wrings from
the dying person one sharp cry of momentary agony, or
sometimes purely spasmodic and mechanical, and then
all is silent ; and with the cry there is a sharp, convulsive
movement of the limbs. So, Polonius utters one loud
'■ Oh ! I am slain ! " Aaron imitates the squeal of the
dying nurse, " Weke, weke ! " Pnnce Edward, in " Rich-
ard 111.,'' ''sprawls," after his first stab. Those who do
not die at once, but bleed to death, or are choked in
blood, speak a little, know they are dying, but are not
in pain, and have no convulsive movements. — The Spec-
tator.
The Proper Way to Give Aconite. — Dr. William
Murrell makes some judicious observations on the correct
plan for administering aconite so as to secure its most
advantageous action. He observes that aconite acts
best in small doses frequently repeated. Many practi-
tioners get no good from aconite because they do not
know how to use it. The dose of the tincture recom-
mended in the British Pharmacopoeia — from five to fifteen
minims — is absurdly large, and no one with any regard
for his patient's safety or his own reputation would ever
think of giving it. The best way is to put half a drachm
of the tincture in a four-ounce bottle of water, and to tell
the patient to take a teaspoonful of this every ten minutes
for the first hour, and after this hourly for some hours.
Even smaller doses may be given in the case of children.
The great indication for the use of aconite is elevation of
temperature ; the clinical thermometer and aconite bottle
should go hand in hand.
Crying of the Fcetus in Utero. — Dr. A. Harlow,
a well-known and highly esteemed physician of Detroit,
Mich., reports a case [^Michigan Medical News) in which
he positively avers that the child while yet unborn
uttered several distinct cries — at the time the mem-
branes were ruptured and the child's head was in the
superior strait. It was subsequently safely delivered by
the forceps.
Small-pox in Hayti and the Protective Power
of Vaccination. — A private letter from Dr. J. B. Terres,
of Port-au-Prince, Hayti, gives some interesting facts
regarding the prevalence of small-po.\ in that island. Dr.
Terres says that the first case of sniall-pox was brought
to the city of Cape Hayti from Port Plate, a city in the
Spanish province, in the latter part of October, 1881,
and from that point it spread rapidly over the entire isl-
and, not a city or even a plantation escaping the dread-
ful visitation. The first case appeared in Port-au-Prince
on November 15, iSSi, and the disease soon spread
throughout the entire city. The largest jiroportion of
the cases was of the confluent form, and the mortality
was very great. From the best information Dr. Terres
is able to obtain he estimates that the number of deaths
on the island from small-pox lias reached fully fifty
thousand, and the disease is still doing its deadly work.
No active means were taken to check its spread until
about January 23, 1882, and even when the necessary
measures were adopted by the Medical Jury there formed,
it was found impossible to carry them out satisfactorily.
The great trouble experienced was to make the masses
understand that the spread of the disease was chiefly
owing to the free intercourse of well persons with their
sick friends.
Regarding the eft'ect of vaccination Dr. Terres says :
In Hayti vaccination has proved to be an almost abso-
lute protection from the disease. A few exceptions have
been noted, but these he attributes to the fact that the
vaccine did not take properly. There were but few phy-
sicians at the time who could obtain vaccine matter, the
supply furnished to those few was limited, and as the
greater part of the matter was worthless the natural con-
sequence was that with a majority of the people vaccinated
it did not take. Dr. Terres used the bovine virus in tubes,
quills, and on ivory points. He was most successful with the
tubes, owing to the fact that the virus was better protected
from the air, and was therefore less susceptible to atmos-
pheric changes. 'J'he other forms, not being so well
protected, lost their virtue soon after being imported to
this warm climate. •' I can say," he writes, " that I did
not find one death occurring in cases that had been
properly vaccinated, and from all the information that I
have been able to gather from other physicians they up-
hold my statements."
Ophthalmological St.\tistics in the United States.
— The following interesting statistics are given by Dr. W.
S. Little in a recent article : The statistics of ophthal-
mic hospitals and ophthalmic work in general hospitals
in the leading cities of the United States afford the fol-
lowing : Of 107. 3S3 eye cases, 19,037 required surgical
procedures, of which 862 were enucleation of the eye for
some of the many forms of objective traumatism ; prin-
cipally on account of the dread of, or presence of, sympa-
thetic irritation or sympathetic ophthalmia of the other
eye ; some for intraocular conditions, and a few for cos-
metic purposes.
Thus 17.7 percent, of ophthalmic work is operative,
and 4.5 per cent, is enucleation of the eyeball. This
percentage for the operation of removal of the eyeball
should be higher than the statistics derived from the pub-
lic clinics indicate, as this class of cases is more apt to
seek private advice.
The importation of artificial eyes is about ten thou-
sand annually, and recently the manufacturing of them
has become a home industry. — Philadelphia Reporter.
Cerebral Hemorrhage and Fracture. — An inter-
esting medico-legal case was brought to the Pennsylva-
nia Hospital recently. A man of intemperate habits was
found drunk on the streets, and soon became comatose.
He was brought to the hospital with symptoms of com-
pression of the brain without evident hemiplegia, but
with irregular pupils (right strongly contracted), and
stertorous respiration, followed by death. There was no
discernible wound of the scalp. A hemorrhagic effu-
sion under the membranes, coinciding with a fracture of
the right parietal bone, was found in the interior of the
left hemisphere, and also a recent clot. It was believed
that the small clot first caused apoplexy, and in falling
the fracture of the skull was produced. It is further in-
teresting as showing the relation between alcoholic poi-
soning and cerebral hemorrhage.
EsERiNE AND BELLADONNA IN Tetanus — Dr. Layton
reports in the Neic Orleans Afedical Journal a. case of teta-
nus cured with the following prescription : Suliihate of ese-
rine, one-half grain ; ]jure glycerine, two fluidrachms ;
syrup of orange flowers, fourteen fluidrachms; water, two
ounces. M. S. Teaspoonful, which contained one sixty-
fourth grain or one milligramme of eserine, every hour.
The glycerine was added to prevent the decomposition
of the eserine, because this drug is affected even by expos-
ure to the atmosphere. From January loth, in the
evening, the doses of eserine were given at intervals of
an hour and a half ; later, the time was increased to two
hours, the remedy was continued until January 17th,
when the child had taken, in all, three grains of eserine ;
the prescription was then discontinued, the only remain-
ing trace of the attack being some rigidity of the jaws,
which had entirely disappeared by January 30th.
Dr. Whiteley rejiorts two cases of tetanus in the Brit-
ish Aledical Journal, which he claims to have cured by
belladonna in large doses. From twenty to thirty min-
ims of the tincture were given every two hours.
The Medical Record
A Weekly yournal of Medicine and Surgery
Vol. 23, No. 3
New York, January 20, 1883
Whole No. 637
(DvininaX Xcctxircs.
ON RESPIRATORY MEDICAMENTS.'
By professor GERMAIN SEE,
MEMBKR OF THE FACULTY OF MEDICINE, MEMBER OF THE ACADEMY OF MEDI-
CINE, HTC, PARIS. FRANCE,
Part I.
Gentlemen : Aniong the caiiliac medicaments there
are few that may not modify the respiratory function in
diseases of the heart. Digitalis, convallaria maialis,
chloral, bromide of potassiimi, have this power in a
marked degree, but their influence is indirect, being ex-
ercised through the medium of the circulation, or rather
by their action on the lieart, whose energy the most of
them, and especially digitalis and convallaria, augment,
causing the disappearance of general stasis, as well as
passive congestions of the lungs.
By the side of these cardiac respiratory medicaments
(or rather at their head) certain medicaments properly
called respiratory deserve to be placed, and to which I
directed attention three years ago when discoursing of
the treatment of asthma by iodine. Thus far they have
never been grouped or studied from the point of view of
their common property, which consists in facilitating the
respiratory function.
Foremost in this list ought to be mentioned :
I. Iodine, and its derivatives, iodide of potassium,
and iodide of ethyl.
II. Arsenic, to which has been attributed from all time
a favorable effect on the respiration.
III. Injections of morphme, which I have employed
for ten years, and which were introduced into therapeu-
tics by Huchard."
IV. Erythrophleum, of which the physiological study,
made with M. Rochefontaine, was published in 1880, in
the " Memoires de rinstitut." The active principle, ery-
throphleine, extracted three years before from this plant
by Gallois and Hardy, has been made the object of new-
researches in my laboratory. The plant and its alkaloid
have been for two years the subject of clinical studies
which have not yet received publicity, but which show
clearly the action of this medicament on respiration, as
moreover in animals it possesses a manifest action on the
circulation.
V. Pneumotherapeutics, by the aid of portable ap-
paratuses.
VI. Quebracho. This is the bark of a member of the
Apocynacea; family, which grows in South America.
Penzold has employed it in the form of an alcoholic e.K-
tract (10 grammes of the bark, 100 grammes of alcohol) ;
this extract is diluted with twenty parts water and given
in teaspoonful doses. In emphysema he has had marked
success ; in other dyspnoeas the effect is less pronounced.
Furthermore, the active principle is not yet known ; as-
pidospermine (obtained from the bark) being a product
not well defined. Having been unable to procure the
plant in order to verify the somewhat contradictory
assertions of divers experimenters, I cannot speak from
experience of the effects of this respiratory medicament.'
* Delivered in the Hopital La Charity, and translated, with permission of the
Professor, from advance sheets, b>-"E. P. Hurd, M.D., Newburyport, Mass.
- Journal de I'hcrapeutiqiie, 1877.
2 [This new remedy is now largely prescribed in tile United States for dyspncea
of all kind?, it is given in teaspoonful doses of the tincture of the bark ; is very
disagreeable to The taste, and almost always produces nausea. The Therapeuti-
L PREPARATIONS OF IODINE.
I. Iodide of Potassium. — Iodide of potassium acts
in an evident manner on the respiratory mucous mem-
brane, and on the nervous mechanism of respiration. It
is the x^mediv par excellence for asthma, and it consti-
tutes the most useful medicament to combat dyspnoea of
cardiac origin. If the lesion be a valvular one, its ef-
fects are less marked than if the lesion be one of the car-
diac tissue itself; nevertheles, in both cases it generally
suffices to banish, at least for a time, the element of
dyspncea. Put before pronouncing on the existence of
an asthma or of a cardiac dyspnoea, it is important to
take into account a fact which I have often observed,
and which has aforetime led me into error. In a great
number of asthmatics you observe at the apex of the heart,
more rarely at the base, a very soft but distinct systolic
murmur, which may cause you to apprehend a lesion of
the valves ; now this murmur, which seems to be located
in the valves of the right heart, disappears altogether,
and in a few days' time, by the sole fact of the disap-
pearance of the asthma under the iodine treatment.
The other mistake, which consists in taking a case of
simple cardiac dysimcea for one of true asthma, is fre-
quently made, as I had occasion to remark at the begin-
ning of this course, when treating of the diagnosis of the
pulmonarv forms of heart disease.' This confusion, so
prejudicial from the double point of view of diagnosis
and prognosis, has not, ])ractically, grave consequences,
as far as therapeutics are concerned, for the same agent
renders good service in both cases.
Formtikc and doses. — One gramme and a cjuarter
[about nineteen grains] per day ; the dose to be gradu-
allv increased to two or three grammes. Prescribe the
iodide in aqueous solution (1-20) or with syrup of bitter
orange (10 parts of the salt to 200 of syrup or water) ;
dose two to four teaspoonfuls every day, each teaspoon-
ful to be diluted in a glass of water.^
If, by reason of the bad taste of the salt, some patients
prefer to take it in wafers or capsules, they ought imme-
diately afterward to drink freely of some diluent to pre-
vent the irritant effect of the salt on the gastric mucous
membrane.
lodism. — ^The following are some of the inconveni-
ences attending the prolonged use of the iodide : i. A
sanguinolent oozing from the buccal, and even from
the bronchial mucous membrane, never amounting to an
hajmoptysis, unless it be in the case of a tuberculous pa-
tient (beware how you prescribe iodine preparations to
such patients). 2. Loss of flesh. This, instead of being
a disadvantage, is often an advantage, especially when
your patient is too stout ; the excess of adipose being
made to disappear, one obstacle to the free circulation
of blood in the peripheral regions is removed. Other
inconveniences are : 3. Loss of strength, which contra-
indicates a further use of the remedy. 4. Loss of appe-
cal Society of New York, in June, iS8i, gave a favorable report on Quebracho. It
was tried in thirty-two cases, embracing spasmodic asthrna, with or without em-
physema, cardiac dyspnoea, the dyspncea of Hrtght's disease, aneurism, pneu-
monia, etc., and of these relief to a greater or less extent was aftorded in twenty-
one, no relief in ten, and in one the dyspncea was increased. The respiratory
centre was believed to be the seat of its action. Vide New York Medical Journal,
September. 1881 (Dr. .\. H. Smith's report). Also The Mkdical Record, vol. xx.,
pp. 304 and 559- — Trans.J
1 I'ide my work on cardiac diseases (Diagnostique et traitement des Maladies du
Cceur), p. 24 et seq. O. Doiy. Paris, 1SS3.
2 [This formula may be expressed in terms of the old system as follows :
IJ. Potassii iodidi 3 Ijss.
Syrup aurantli corticis J nj.
M. Signa. — .-V teaspoonful three times a day in a glass of water. Dose to be
gradually uicreased to two and even three teaspoonfuls. — Trans.]
58
THE MEDICAL RECORD.
[January 20, 1883.
tite, which indicates a provisional suspension of the
treatment. 5. Eruptions of various kinds.
2. Tincture of Iodine. — It is without doubt the
iodine wiiich is remedial when we give iodide of potas-
sium. To assure myself of this I have often prescribed
(and with benefit) iodine alone, according to the follow-
ing formula :
IJ. Tincture of iodine 5 grm. (gr. Ix.w.)
Syrup of horseradish 150 grm. (3V.)
Syrup of popiiies 150 grm. ( 5 v.)
M. Signa. — Three teaspoonfuls a day; dose to be
doubled as required.
The syrup of horseradish masks the taste of the iodine.'
3. Iodide of Ethyl. — This com])ound, discovered in
1825 by Gay Lussac, is a mi.\ture of two parts by volume
of alcohol and one of hydriodic acid. Tiiis ether, which
is without acid reaction, has an odor of chloroform, a pi-
quant savor : it is volatile, boils at 64° centigrade, with-
out being inflammable ; e.xposed to the air, it turns a
light brown color, from the setting free of a little iodine.
Its chemical formula is C,H J. Eor twenty years it was
forgotten, till Huette experimented with it on himself and
on one of his friends, with the object of replacing iodine
in the treatment of phthisis, a disease which rarely calls
for the employ of the iodine preparations. Since 1850,
however, nothing more was heard of this substance till 1
conceived the idea of applying it to the treatment of
dyspncea from asthma or trom other causes.
F/iysiological effects of iodide of ethyl. — In healthy
individuals, and patients afl'ected with dyspnoea, who
have been made to breathe six to ten dro])s of iodide of
ethyl six or eight times a day, the following results have
been observed : After a few seconds the individual
breathes with greater facility, and continues to do so for
several hours. This effect, more marked when the per-
son is laboring under dyspnoja, is quite perceptible in a
perfectly healthy person. There is no anaesthetic or so-
porific action. The heart and circulation undergo no
modification, and yet absorption of the medicament takes
place immediately, for at the end of ten minutes iodine
may be found in the urine. Sometimes an attack of
coughing comes on at the commencement of the inhala-
tion.
Modus operandi. — Iodide of ethyl, as well as iodide
of i)otassium, has an incontestable action on the bron-
chial secretion, which it augments,, at the same time
that it increases its fluidity, thus facilitating the entrance
of air into the pulmonary alveoli. Under its influence
the respiratory murmur (before absent) returns, the tym-
panitic resonance of emphysema disappears, the dry feeble
rales of bronchial asthma give place to mucous rales.
This is the first effect of the iodide ; its next action is
on the respiratory centre by the medium of the circula-
tion, which is now rendered more active. The respiratory
centre, in the presence of an increased supply of blood, is
re-enforced in function, and this explains the greater ease
of respiration. In the third place, the ether in combina-
tion with the iodine, by its stimulus, enhances respiration,
which becomes deeper and more energetic. These, then,
are the indisputable advantages which this remedy pos-
sesses, not only in attacks of asthma, but in cardiac dysp-
noea as well, and 1 have thought it deserving a very
foremost rank among the medicaments of this group.''
^ [A very good preparation containing iodine, much employed in this coimtrv'.
and especially connnended for its palatableness, is the syrnp of hydriodic acid. It
is not mentioned in our text-books on therapeutics and materia mcdica. but it is
sold all through the United Slates, and is in much repute as a reniedv for asthma
and for chnnuc bronchitis. The preparation which is most frequently prescribed
in this rejjion is Gardner's Syrup (manufactured at 170 Wilham Street, New
York), which is certainly an elegant preparation, and has been given both in spas-
modic and in bronchial astluna with very satisfactory results. The syrup contains
40 minims of the dilute acid to the ounce, representing 6.66 gi;ains of iodme. Two
leasj-oonfuls is an average dose. Many of our apotliecaries make a syrup of
liydriodic acnl, which keeps well and can hardly be distinguished from Gardner's.
Ciiildrcn take this syrup readily. It never irritates tile stouiach. Set; Wylic's article
on Hydriodic Acid a Substitute for Iodide of J'otassiutn, in this journal, vol.
XV., p. 454.— Trans.]
'■* IDr. William Stjuirc, of London, uses bromide of ethyl in similar cases. He
drops on a square piece of lint twenty to lliirly drops, which he requires to be in-
haled. In renal dyspno:;!. laryngeal spasm, some kintls of vertigo, and all dis-
eases where there is vaso-motor sjiasni, he Iinds it useful. — Tkans. j
II. ARSENIC.
Arsenic has a very certain action on the respiratory
muscles and on tlie bronchi, but it is slower in produ-
cing its effects than is iodine. Its effects on the heart,
are, moreover, uncertain ; it is not known just how the
circulation is affected by it, or how it influences the
oxidations of the economy. In general terms it is a med
icainent which spares the forces in staying the processes
of denutrition, as is proved by the diminution in the
production of urea and carbonic acid which attends its
use. This property, however, does not attend the ad-
ministration of tlie medicament in large doses, and ceases
to manifest itself when tlie arsenical treatment is long
continued. G.-ethgens has, in fact, sometimes found an
augmentation of urea eliminated in the urine ; this is in
accordance with what I have taught these twelve years.
It cannot be depended upon, then, for an)' certain and
constant effect in retarding oxidation, and thus lessening
denutrition in the economy.
Lucien Papillaud has advised, as regular and system-
atic treatment of the cardiopathies, arsenic in combi-
nation with antimony, prescribing for each day two pills,
each containing one milligramme of arsenious acid. It
seems probable that the antimony affects more directly
the central organ of the circulation than the arsenic, but
the curative results of this treatment have never been
proved, nor has it been shown to have been beneficial
against the dyspntea.
III. HYPODERMIC INJECTIONS OF MORPHIA.
Morphia, used subcutaneously, is a powerful respiratory
stimulant, but its action in facilitating respiration is not
lasting, and grave inconveniences follow its persistent use :
1. It is sure to impair the appetite, digestion, and nutrition.
2. That morbid habit of the system, rightly called morphin-
ism, with all its evils, will certainly be engendered. 3.
The urinary secretion will be lessened ; this is a great dis-
advantage in heart-maladies. 4. That dangerous form of
respiration called Cheyne-Stokes respiration has been
known (according to Filehne) to manifest itself in cer-
tain cases. Subcutaneous injections of morphia, then
should only be resorteii to during and for a paroxysm of
dysjincea.'
IV. ERYTHROPHLEUM AND ERYTHROPHLEINE.
Physiological experimentation. — Erythrophleine, dis-
covered by Gallois and Hardy in 1876, is the active
princiiJle of the bark of Erythrophhrum guineense, of the
family of Leguminos;e. It is an alkaloid which Has
been experimentally shown to possess considerable toxic
power and a remarkable action on the heart.
This action on the heart, as determined by experi-
ments on animals, suggested to me the . idea of introdu-
cing erythrophleine into the therapeutics of cardiac affec-
tions, but it was necessary as a preliminary undertaking
to test by new experiments the toxic jjower of this alka-
loid, and especially to study its principal physiological
effects, notably those which are capable of registration
by means of the hajmodynamometer, the sphygmograph,
and the pneumograph.
This is the result of this investigation (I reproduce the
summary report lately made by me to the Academy) :
" Researches, commenced with frogs, have been con-
tinued with hares and dogs.' We mention only experi-
' [Some of the most formidable attacks of cardiac dyspnoia which have ever
occurred in my practice have been associated with aortic insufficiency, with di-
lated left heart, and fiequcnlly with dilated atheromatous aorta. In these cases
hypodermic morphia is the remedy Jiar ^.Tf^Z/fwc^-— generally every other measure
is impotent. I have been in the habit of using for an adult a saturated solution
of sulphate of morphia in cherry-Laurel water, commencing with live drops and in-
creasing to twenty or even thirty. The larger dose is frequently required. Ma-
gendie's solution (^sixteen grains to the ounce), is a very convenient preparation,
of this, ten drops is an ordinary dose for hypodermic use. I have sonietiiiies ad-
ded, and with benefit, one one-hundredth grain of atropine to the injection, not be-
lieving in the therapeutical antagonism of the two drugs. Morphine subcuta-
neously is the most efficacious remedy against the cerebral anxmia as well as the
dyspncca of Corrigan's disease. 1 nave, however, observed all the evils which
Professor S<ie above describes follow this treatment, to wliich I was compelled to
resort to mitigate the violence of the attacks. — Tkans.]
* [These experiments were made with M. Rochefontaine. — ^I'kans.J
January 20, 1883.]
THE MEDICAL RECORD.
59
ments performed on the latter animals by the aid of
hypodermic injections of a determinate solution of ery-
throphleine, since the limits of this article do not permit
lis to report experiments made on other animals by the
same method or by other means of introducing the toxic
agent into the organism. One centigramme of erythro-
phleine introduced under the skin of a dog weighing nine
kilogrammes had no appreciable effect. Two centigrammes
killed in two hours another dog weighing fourteen kilo-
grammes. In other words, in the dog the hypodermic
injection of a solution of erythrophleine the strength of
one milligramme per kilogramme of the animal did not
])roduce evident toxic effects ; one milligramme and a
half, however, was fatal in two hours. Many experi-
ments on different animals have proved that the toxic
power of erythrophleine is about the same as that of the
amorphous digitaline of Homolle and Quevenne.
"The first signs of intoxication consist in a slight de-
gree of agitation and restlessness, followed by a period
of prostration, which is succeeded by efforts of vomiting.
The latter constitute the real initial symptoms of the
poisoning. If the dose of the toxic agent be not too
large, the vomiting ceases, and the animal rapidly re-
covers his normal condition. The circulatory apparatus
is disturbed in its function as well as the digestive appa-
ratus. We observe augmentation of the intra-arterial
blood-pressure, irregularity, then slowing of the pulse,
results which we find already recorded in the memoir of
Gallois and Hardy. The period of retardation of the
pulse is remarkable by reason of the regularity of the
heart's action, the energy of each pulsation, and the uni-
formity of the intra-arterial blood-pressure. This pres-
sure, in fact, is not modified by the respiratory move-
ments, as it is ordinarily in the normal state, for the
tracings of the h;emadynamometer and sphygmograph
show that the rndulations which, in an animal not sub-
jected to the action of the poison, result from the influence
of respiration on the blood-pressure, are not observed in
the animal to which the erythrophleine has been admin-
istered. This period is followed by another, during
which the pulse is extremely weak and rapid ; the oscil-
lations of the pressure under the influence of respiration
reappear ; this pressure diminishes gradually ; the beat-
ings of the heart, becoming more and more feeble, cease
by moments, then are arrested definitely, and the blood-
pressure becomes nil.
" The respiratory movements seem influenced directly
by erythrophleine, although they are influenced second-
arily by cardiac affections. In a general way they are
at first somewhat retarded and of greater amplitude.
When the cardiac pulsations are accelerated in the ter-
minal period of the intoxication, the respiratory move-
ments are extremely energetic and more frequent. In
almost all the experiments, if not in all, the respiratory
movements ceased at the moment of arrest of the heart.
Several times at this moment the animal gave a loud cry.
One, two, and even three minutes after the heart ceased
to beat the respiratory movements reappeared, still
energetic, lasting two or three minutes, then were ar-
rested permanently.
" The functions of different parts of the nervous system
seem disturbed by erythrophleine. Thus the faradic ex-
citation of the thoracic ends of the pneumogastric nerves
in the cervical region did not determine arrest of the
heart in an animal poisoned by erythrophleine as it does
in a well animal. The sudden fall of blood-pressure
which accompanies the faradization is, however, mam-
lested equally in both cases. The inhibitory or moder-
ating action of the pneumogastric nerve on the heart is
then modified by erythrophleine, and one can with this
substance dissociate, as it were, physiologically the two
circulatory phenomena which result from excitation of
the cardiac filaments of the vago-sympathetics.
"The faradic excitation of the cephalic ends .of the
pneumogastrics, in an advanced stage of the into.xication,
does not provoke that acceleration of pulse which it de-
termines (from the very first) in the animal that is in
sound condition, but it acts on the arterial tension as it
acts ordinarily, that is to say, by augmenting it ; here we
see a disjunction of physiological effects, under the influ-
ence of the poison.
" Faradization of the cardiac ends or of the cephalic
ends of the vago-sympathetic nerves induces, then, in an
animal in the normal state, the same modifications of
pressure which it induces in an animal that has been poi-
soned by erythrophleine. The rhythm of the heart, on
the contrary, is respected by these faradic excitations in
the animal intoxicated by this alkaloid.
"In an animal killed by erythrophleine, the necropsy
shows the heart in diastole, flaccid, and yet full of blood.
Sometimes the ventricles are animated by a tremulous
movement like that which succeeds to faradization of
these ventricles. Generally the heart has not lost its
electric contractility. The pneumogastric nerve has re-
tained its action on the stomach. The excito-motricity
of the phrenic nerves is ordinarily diminished, or even
sometimes abolished, while that of the sciatic or of the
cervical sympathetic is not lessened.
"To sum up, physiology demonstrates that erythro-
phleine acts not only on the heart but also on the respira-
tory a])paratus, and this double action on functions so
important incites us to make application of it to clinical
medicine, and more particularly to the treatment of car-
diac and respiratory affections.''
Clinical applications. — Ail the facts which I have col-
lected for the past three years enable me to affirm aug-
mentation of the respiratory function in dyspnceic patients
under the influence of one gramme (or thereabouts) of
the alcoholic tincture of erythrophleum — I give this prepa-
ration in preference to the alkaloid, which is harder to
obtain and to manage. In simple or cardiac asthma the
movements become slower and of greater amplitude.
The effects on the heart are less marked than in the
case of animals ; the arythmia does not disappear as it
does under the influence of digitalis and convallaria ; the
pulse is not slowed ; the valvular murmurs do not undergo
modification ; the diuresis is wanting. As a cardiac rem-
edy, then, it presents no advantage ; as a respiratory med-
icament it may to a certain extent supply the place of
iodine and the iodine preparations.
A Medical Confidence Man in New York.. — The
House Physician of Roosevelt Hospital, Dr. Van 'Vred-
enburgh, writes : "A young man of about twenty-five
years, low-sized, thick-necked, and rather common-look-
ing, with a very confidential manner of speaking, has
visited this hospital twice in the last few months, and is,
I learn, canvassing the dift'erent physicians' offices of
this part of the city. He described himself at his first
visit here as surgeon to one of the Inman Line steamers,
and at the second visit as assistant-purser to the City of
Chester, Inman Line. He always purports being sent
by some prominent physician, or else by a personal friend
of the person to whom he applies. The first time he
came here he oflered to purchase surgical instruments
and bring them in free of duty, claiming that as surgeon
to the ship he could do so readily. The second time he
had some "very good brandy" to sell, some that he
claimed to have bought abroad, and more than sulficed
for his own use. He desired the money with which to
make his purchases advanced to him, but on neither oc-
casion did he receive any commission. I wrote to
Mr. J. G. Dale, agent of the Inman Line, and in his an-
swer he disclaimed any knowledge of the man other than
that he had heard of him and his doings. Said that
there was no man by the name of ' Morton ' (the name
he gave here) attached to any ship of the line in any
such capacity — I believe he said in any capacity."
A Large Collection. — Professor Virchow has in his
museum, at Berlin, a collection of six thousand skulls.
It will be difficult for any one to get ahead of him.
6o
THE MEDICAL RECORD.
[January 20, 1883.
©viiTiinal ^vtidcs.
REPORT OF A CASE IN WHICH A MYXO-
LIPOMA WEIGHING EIGHTY POUNDS WAS
REMOVED FROM THE ABDOMINAL WALL.
By N. P. DANDRIDGE, M.D.,
CINCINNATI, O.
Early in September, Sarah H , colored, was brought
to Cincinnati and placed under my care by Dr. H. T.
Bell, of Bethel, Kentucky. She was sufiering from a
tumor hanging from the left sitie of the abdomen, which
had reached such an enormous size that it was necessary
to suspend it in a strong sack, which was secured around
her waist when she assumed the erect position. Most
of her time was spent in bed, the tumor lying beside
her. By my advice she entered the Cincinnati Hospital,
and the following history is taken from the record of the
case made by Mr. Lewis and Mr. Christopher, resident
physicians, who at different times had charge of her :
S. H , colored, aged forty. Moderately well
nourished and developed, married, and mother of nine
children, one of whom died when one week old, one at
two weeks, and one at six montiis. When the tumor
was not larger than an egg she aborted at one month.
Eight years ago she states that she first noticed a small
elastic tumor, the size of a goose-egg, in her side. It was
located, according to her statement, to the left of the
median line, and midway between the umbilicus and
symphysis. It was freely movable beneath the integu-
ment, and was quite painless. At the end of two months
the tumor was fully nine inches in diameter, and at this
time she noticed a swelling to the left of the symphysis,
which soon attained the size of a hen's egg, and Re-
mained that size until about two months ago. The exact
relation of this second growth to the first she cannot
clearly give. During all this tijiie she has been able to
make it disappear by pressure, when it appeared to enter
the larger growth. During the menstrual period it would
at times seem to increase in size. For the last two
months it has been rapidly increasing in size, and now
she is no longer able to reduce it. .\t present it mea.s-
ures 1 1 inches in circumference, and 7 inches from its
apex to the spine of the pubis, and forms a mass, which
presents to the left of the vulva.
During the last two years the larger tumor has also
rapidly increased. Before that time she was able to do
general field and house work, and the tumor, according
to the statement of her physician, was about the size of
a " ten or fifteen pound water-melon." About this time
an incision was made into it, for the purpose of explora-
tion, with however, only negative results, the incision
healed readily. Menstruation has always been normal,
and her bowels quite regular. She has never suffered
any pain, and her general health has been good. She
lies most of the time in bed, and only occasionally at-
tempts to get up, and then always has to suspend the
tumor in a large sack, which is fastened around her waist.
In the recumbent position, the tumor lies beside her on
the bed, and by its weight has drawn the umbilicus and
linea alba considerably to the left. The line of attach-
ment extends from above the anterior superior spine
of the ilium to the symphysis, and the tumor as it lies
on the bed seems a semi-Huctuating mass, which readily
changes its shape on being moved. The integument
over it is freely movable, and the growth appears to be
encapsulated and lobulated.
September 22d. — Dr. J. C. Mackenzie, at my reiiuest,
dictated the following as the result of his examination :
" Liver dulness normal, and liver ajjpears to occupy its
normal position. Splenic dulness normal in extent and
position. The umiailicus is drawn to the left of the
median line 2^ inches. Above tiie umbilicus the Imea
alba is found in the median line, below it curves to the
left. The ])oint of greatest divergence is about four
inches below the umbilicus, where it is 4 inches from
the median line ; opposite the symphysis it is displaced
^^' inches. The line limiting the area of abdominal
tympanites corresponds with the arc of a circle whose
centre is 6^ inches below the ensiform cartilage, and
whose radius is 6 inches. The line limitmg the tym-
panites intersects the true linea alba 5 inches below,
and a little to the left of the umbilicus. The above
measurements were taken with the woman lying on her
back, but slightly inclined to the left side, her shoulders
supported, and the tumor on the bed beside her.''
The followmg measurements were taken at this time :
Long axis of tumor (nearly jjaiallel with the axis of the
body), 35 inches ; circumference around the long axis,
56 inches ; greatest circumference, 67^^ inches ; circum-
ference of pedicle, 32 inches; short axis from line of tym-
panites, 16 inches. To the inner side of the large mass
is a siualler one, apparently occupying the labia majora
of left side, pear-shaped, 6^ inches in length, 4 inches
in breadth, and 12^- inches in circumference at its broad-
est ]iart. The consistency of the main tumor is different
in dift'erent parts. In places there seems quite a distinct
sense of fluctuation. The aspirator needle, however,
introduced brought away only a small amount of clear
lymph-like fluid, a similar clear fluid escaped drop by
drop from some punctures made by a hypodermic
needle.
The surface of the tumor is uneven, indicating a di-
vision into lobules. Between two of these, in a slight
depression across the growth, a cord-like body can be
traced from a jjoint two inches below, and to the right of
the umbilicus, for a distance of fourteen inches, until it is
lost in the thickened integument. Sixteen inches from
the umbilicus is a shallow circular ulcer about one and a
half inch in diameter, which is covered with a dry scab.
This ulcer is said to have existed unchanged for two
years. The integument over the tumor ])resents dift'er-
ent degrees of thickening in different parts. Near to the
abdomen, on the anterior surface, it jircsents a natural
appearance. Toward the periphery of the mass it be-
comes thickened and indurated, and its surface presents
small depressions. Even in its thickest portions the in-
tegument can be made to move readily upon the under-
lying growth, showmg that the tumor is surrounded by a
loose connective-tissue capsule. Within the line limiting
the area of tympanites coughing gives an impulse to the
hand on the abdominal wall from the underlying intes-
tines. This cannot be felt outside this line; From the
under surface of the tumor there escapes at times 'a
lymph-like fluid.
The tumor was seen by my colleagues of the hospital
staft"and a large number of other physicians, and the di-
agnosis of a subcutaneous fatty tumor generally concurred
in, although a sub|)eritoneal origin was regarded as more
probable by some. Various views were expressed as to
the exact relation with the abdominal cavity, a]id wiiether
or no some of the abdominal organs might not be found
in the mass. Diametrically ojiposite views were enter-
tained in regard to the propriety of attempting its re-
moval. After careful observation my own conclusion
was that the abdominal wall had been simply dragged
down by the weight of the tumor, and that the line of
tympanites marked the limits of the abdominal cavity.
This reached some distance over the front of the tumor.
The smaller tumor was supposed to be a hernial pro-
trusion, though the i)ossibility of its being simply a lobule
of the general growth was kept in view. The woman
was exceedingly importunate that an attempt should be
made for its removal, and was not the less determined
when the great dangeis were explained to her. So with
the consent of my surgical colleagues 1 determined upon
operating.
The mass was so heavy and so unwieldly that it was
difficult to determine how best to handle it during tlie
operation. A number of experiments were made by
January 20, 1883.]
THE MEDICAL RECORD.
61
strapping it securely to a board, but all proved unsatis-
factory, so finally it was decided to place it upon a small
stand beside the operating table and allow tlie tumor to
overhang each entl ; in this way it was found the pedicle
could best be exposed without the necessity of moving
the entire mass. Jt was decided to make an incision
over the anteiior surface, separate the tumor from the
abdominal wall, and complete the operation by cutting
through the integument covering the under surface from
within outward. The especial dangers which were fore-
seen and had to be provided for were, in the first place,
the possibility (or probability) of opening the abdominal
cavity and the escape of intestines. In case this acci-
dent occurred large tiat sponges were provided, by which
the opening could be closed and the bowel prevented
from escaping, or if that was not possible, at least pro-
tected until the removal of the tumor was completed.
The danger to be feared was the extreme loss of blood.
To provide for this, a large number of hajmostatic force])s
\
..J*^— "
were to be provided, and all bleeding points at once se-
cured, and, where it was possible, it was determined to
ligate all large vessels before cutting them. Pressure by
means of broad sponges was expected to control ca-
pillary hemorrhage ; and finally, as an extra precaution,
the rubber tourniquet of the Esmarch bandage was to be
thrown loosely round the pedicle to be tightened if
necessary.
In case of collapse from hemorrhage or shock, two of
the assistants were at once to apply Esmarch bandages
from the toes to the hips, while stunulants were to be
given, if necessary, hypodermically and by the rectum,
and if these means failed a battery was ready to be used,
if needed.
October 8th. — The tumor was compressed by a number
of Esmarch bandages, but no information of importance
was gained by this.
October 12th was appointed for the operation. The
day previous the patient developed a malarial attack, fol-
lowed by some dysenteric symptoms and the appearance
of the menstrual How. This, of course, necessitated the
postponement of the operation. The unfavorable symp-
toms soon subsided, and the 19th was determined on t"or the
removal of the tumor. On the i8th there was a renewal
of the malarial attack, though in a milder form. Quinine
was now freely given, and as the outbreak had occurred
after an interval of exactly seven days, it was thought
best to let that period pass over before deciding upon a
date for the operation. October 25th she was quite well,
so Monda)', October 30th was fixed. These delays in no-
wise affected her spirits, or her determination to have
the operation at least attempted. About this time she
succeeded one day in reducing the smaller tumor. Ex-
amination showed that the mass had not been fully re-
duced, but the hand could enter what seemed to be a
large hernial opening. This opinion was afterward
shown to be an entire mistake.
October 29th. — Dr. Mackenzie examined her heart and
found an indistinct systolic bruit at apex, transmitted to
the left, and some occasional irregularity in the heart's
action. The apex beat was heard outside of the nipple
line. The general plan of operation was fully discussed
with my colleague. Dr. Walker. The anangements were
all entrusted to Mr. Christopher, who, as interne, had
charge of the case, and proved to be most satisfactory,
every emergency being readily met without involving
any delay whatever in tlie operation. The tumor was
removed October 30th, at 11 a.m., in the amphitheatre of
the hospital in the presence of the medical class and a
large number of the physicians of the city. A hypoder-
mic of morphine one-fourth grain, and atropine one ninety-
sixth grain, was given about fifteen minutes before the
administration of ether was conujienced. Dr. E. W.
Walker and the entire resident staft" acted as assistants.
As decided beforehand, the tumor was allowed to lie
upon a small stand by the side of the operating table. A
sheet, rolled up, was placed beneath the pedicle, so as to
raise it somewhat from the body, and the rubber tourni-
quet of the Esmarch bandage was thrown loosely around
it, to be tightened in case of necessity. The main body
of the tumor was removed in fifteen minutes and the
entire dressing completed in forty-two minutes.
The tumor weighed seventy-one pounds immediately
after removal, and as a considerable quantity of mucoid
substance escaped and was lost its actual weight must
have been, at least, eighty pounds.
The incision was commenced on the anterior surface,
well to the outside of the left anterior spine of the ilium,
and carried at once down to the surface of the tumor.
62
THE MEDICAL RECORD.
[January 20, 1883.
It was extended for ten or twelve inches, and the por-
tion of the tumor thus exposed was found to be sur-
rounded by loose connective-tissue, which was readily
broken down with the hand, and the separation of the
growth from the abdominal wall easily aftected. All
bleeding points were at once secured. The incision was
carried rapidly across the whole anterior surface, follow-
ing a line about three inches outside of the line of tvm-
panites, all bleeding being controlled as we proceeded.
The separation of the tumor was now continued, and ef-
fected principally by the hand, though at times the knife
was necessary. The separation was readily effected ;
before, however, we had proceeded very far I suddenly
found a considerable mass of intestines at the bottom of
the wound, which had escaped from a large hernial open-
ing. Without waiting to reduce them Dr. Walker at
once covered the mass with a large flat sponge, and so
protected them during the remainder of the operation,
which was proceeded with without delay. Indeed, so
successful was he in this that only very few persons knew
that this complication had arisen. The circulation now
began to flag, and soon the pulse at the wrist entirely
disappeared. Esmarch bandages were at once applied
from the toes to the hips by assistants who were ready
for this emergency, if it occurred, and two ounces of
whiskey thrown into the rectum. While these measures
were being carried out, the work of separating the mass
continued without interruption. As we approached the
smaller tumor great circumspection became necessary,
until it could be definitely determined whether we should
encounter a hernial sac or only an independent lobule of
the general mass. Before proceeding to a minute exam-
ination on this point, the main growth was separated
partly by cutting, but pnncipally by tearing through the
portion connecting it with the smaller growth, and then
the separation was completed by rapidly cutting through
the integument and tissues which remained on the under
surface, and as the attachments were severed, two assist-
ants grasped the mass with large butchers' meat-hooks,
and swung it free from the body. Large sponges were
at once crowded against the exposed surface, while the
smaller tumor was explored and found to be only a lobule
of the general growth and easily removed. The protrud-
ing intestines were now returned. They were found to
have escaped from what was evidently an old hernial
opening an inch and a half in diameter. This was
securely sewed up by a continuous suture of catgut.
The bleeding points were now rapidly secured, and the
surface of the wound washed off with a weak solution of
carbolic acid, and the edges of the integument accurately
adjusted by sutures, after a large-sized drainage-tube had
been secured in place, and the whole covered with a
thick mass of absorbent cotton. Hot bottles were at
once applied, and the patient was covered with blankets.
The Esmarch bandages were allowed to remain in place,
and the foot of the bed elevated, and a rectal injection
of two ounces of whiskey given. The shock of the oper-
ation was very profound, and she rallied slowly.
By I P.M. she was fully conscious ; pulse weak and
108. She complained so much of the pain given by the
rubber bandages, which had been allowed to remain in
place, that they were removed. 2 p..\i. — Pulse, 92, weak
and intermittent ; temperature, 98. Complains of some
pain in the w'ound, for which a hypodermic of one-fourth
grain of morphia was given.
During the afternoon she passed several ounces of
blood from her bowels. No blood in urine, which was
freely passed. This hemorrhage from the bowels was, I
think, vcr)' possibly due to the rupture of some of the
hemorrhoidal veins, caused by the, increased blood press-
ure i)roduced by the compression of the lower extremi-
ties by the rubber bandage.
October 31st, a.m. — Temperature, 98; pulse, 108. Slejit
well. Pulse stronger. Dressing unchanged. About
noon she became restless, and was given morphia one-
fourth grain, champagne and ammonia carbonate every
hour. 4 P.M. — The dressing was removed, and the
wound covered with large, flat sponges, soaked in^ a
saturated solution of boro-glyceride, and held in jilace
by bandages. The wound was free from odor ; there
was no pus, and the edges were in close apposition. A
warm one-half per cent, solution of carbolic acid was
syringed through the drainage-tube, washing out some clots
of blood. Temperature, 99.2 ; pulse, 108. This washing
out was ordered repeated every two or three hours.
At 6 P.M. the tube was found impervious, and no fluid
could be forced through ; at 7 p.m. a long cylindrical
clot was washed out, and at 11.30 the tube was found
quite free. The circulation continued feeble, the pulse
ranging at a little more than a hundred. There was at
no time any elevation of temperature. The surface of
the wound looked well. The edges were well apposed,
though slight traction easily separated them, showing
that repair was not going on. Only once was there any
odor. Champagne and carbonate of ammonia, and milk,
were alternated every hour. At times there was some
tympanites. The slight pain which was complained of
was easily controlled by morphia.
November 3d. — Has had a natural stool, and passed
a considerable quantity of flatus.
On the morning of the 4th I found her abdomen
greatly distended, her countenance pinched, and respira-
tion rapid and shallow. An injection was ordered, which
brought away a good deal of flatus, which was followed
by some relief
During the night she became restless, complained of
pain iu the abdomen, which could not be controlled by
morphine. She died Sunday morning, six days after the
operation.
The autopsy was made by Dr. Joseph Eichberg, pathol-
ogist of the hospital.
" Body that of a colored woman, somewhat emaciated,
and above medium size. Rigor mortis marked. Au-
topsy twelve hours after death. In the external abdomi-
nal wall, on the left side, beginning above and behind
the crest of the ilium, and extending downward almost
to the symphysis, was an incised wound fourteen inches
long, the edges of which had been united by sutures
almost the entire lengtli. Erom the ends of this cut ex-
tended the extremities of a large-sized drainage-tube.
Hanging down over the pubes was a pouch covered with
integument, 5^^ inches long, 3 inches in breadth. Taking
out the stitches, the edges of the wound were found to
be in a sloughing condition, and the wound itself filled
with a broken-down, decomposing tissue. .Xo union'
had at any point taken ])lace. The pouch was filled
with a very offensive fluid, com|)osed of broken-down
tissue. At one point the floor of the wound was con-
stituted of peritoneum, the edges of which had been
stitched together by a continuous suture. This point
was found to correspond to the internal inguinal ring.
On opening the abdominal cavity the intestines were
found enormously distended with gas, and the diaphragm
was pushed up to the third intercostal space. The in-
testines were glued together by recent lymph, present
in a very slight amount. In the internal inguinal ring of
the left side, which had not been completely closed by
the suture, was found a hernial isrotrusion of the intes-
tinal wall involving only the unattached border, and
forming a protrusion like a glove finger ; length, three-
fourths of an inch.
•' This part of the intestine was situated twelve inches
above the ileociecal valve. There was no interruption
in the intestinal canal at the seat of hernia. The mesen-
tery did not project through the opening, and was not
connected with the tumor. The edges of the opening in
the peritoneum had not become adherent, as shown by
removing the suture.
•' Lungs were congested and slightly emphysematous.
" Heart was soft and flabby, and the right ventricle
filled with a large and ]>artially decolorized clot.
'■ Kidney congested and slightly fatty : liver, normal.
January 20, 1883.]
THE MEDICAL RECORD.
" Both large and small intestines contained yellowish
fluid fajces ; mucous membrane normal ; stomacli dis-
tended with gas ; spleen small and firm ; brain not ex-
amined. Cause of death peritonitis and failure of heart."
The innnediate cause of death was undoubtedly the in-
terference with the action of the heart and lungs, due to
the great distention of the small intestine. The hernial
protrusion did not involve the whole calibre of the
bowel, and did not offer a mechanical obstruction to the
passage of the intestinal contents. It probably, however,
produced a paralysis of the peristaltic action, and thus
allowed the over-distention, which was probably the im-
mediate cause of the peritonitis. From this examina-
tion it is apparent that there was no depurative action in
the wound itself, even the surfaces of the i)eritoneuni, when
they were brought together at the hernial opening, did
not adhere, but fell apart as soon as the suture was re-
moved. After the operation the circulation was always
feeble. Her moral condition throughout was excel-
lent, and one morning she expressed herself as feeling
" splendidly." .She did not, however, possess vitality-
enough to repair the immense wound left b^' the oper-
ation. The magnitude of the operation will be appre-
ciated from the fact that the cut edge of the integument,
measured on the tumor after removal, was sixty-two
inches.
Dr. Eichberg further reports : " The tumor presents, on
microscopical examination, the appearance of a growth
made up of several kinds of tissue, small lobules of adi-
pose tissue are intersected and separated from each
other by tracts of a pearly opaijue color, and in the cen-
tral part of many of these tracts a soft, gelatinous, trans-
parent, semifluid substance is found. The skin is freely
movable over the tumor, with which it is connected by
loose cellular tissue. Immediately after removal a large
quantity of this gelatinous fluid escaped. There is not
any distinct investing capsule, though the outer portion
of the growth is made up of a tolerably thick band
of this pearly substance. The circumference of the skin
flap is sixty-two and one-half inches, the largest di-
ameter twenty-eight inches, the transverse nineteen,
and the thickness of the growth is nine inches. Judged
by the microscopical appearances only, the tumor ap-
pears to be a compound of myxoma and lipoma, an as-
sociation not infrequently met with in subcutaneous
growths examined under the microscope. The com-
pound nature of the growth is veiy evident. A very
large part cf the growth is lipomatous structure. The mass
of fat-tissue is intersected by bands made up of longitudi-
nal fibres and spindle-shaped cells with long oval nuclei.
In places these bands acquire a very considerable size, so
that they fill almost the whole field of the microscope, and
remind one strongly of a spindle-celled sarcoma. In other
places, small groups of what appear as round cells may
be seen — these groups are possibly only the above bands
of tissue cut across. The greater part of the pearly
opaque bands is made up of a very fine, wavy connective
tissue, which in parts has evidently undergone mucoid
softening, all trace of fibres here being lost, and the speci-
men presenting the characteristic stellate cells in a large
mass of homogeneous intercellular substance. The vessels
ramify in the bands of connective tissue, and their walls
are thickened. From its macroscopic and microscopic ap-
pearances, then, we may classify the tumor as a myxo-
lipoma, the nmcoid change being evidently a secondary
degeneration.
"The only doubtful point would be in reference to the
nature of the bands of spindle cells, which are probably
connective-tissue cells in process of fibrillation, the con-
nective tissue being, like the other parts of the tumor, in
a condition of active growth."
The tumor which has thus been described is the largest
lipoma of which I have been able to find a record.
Ashhurst speaks of one referred to by Gross, which
weighed seventy poiyids. The largest mentioned by
Bocca weighed twenty-three kilogrammes (about forty-
six pounds). In the majority of cases where fatty tumors
have reached such an enormous size, they have been sit-
uated n[)on the hack. The question of operation in the
above case involved peculiar responsibility. The opin-
ions expressed by those who saw the case presented very
diverse views on this point. While the nature of the tu-
mor was generally agreed on, its relation to the abdominal
cavity was a question upon which there was decided
difference, and whether or not the mass contained intes-
tines, or even some of the other abdominal organs.
Whether the growth could be removed without fatally
comjjromising the abdominal cavity, and whether the
woman could support so violent a shock as the operation
would necessarily involve, were points upon which I had
to encounter a variety of expression. The decision to
operate was only arrived at after six weeks of careful
daily observation, and the result, I feel, fully justified the
attem|)t.
The illustrations, taken from photographs, give a very
exact idea of the size and attachment of the tumor.
EPIDEMIC OF IMPETIGO CONTAGIOSA.
By WOOSTER BEACH, M.U.,
ATTENDING PHYSICIAN, NORTHEASTER.N DISPENSARY, NEW YORK.
About a month ago a child was brought to the dispen-
sary with two or three peculiar s]3ots on the calf of the
leg that appeared to be the remains of rather superficial
pustules. They a|)peared to residt from ecthyma, and I
entered them on the record as that disease, but with an
interrogation mark after the name.
About two weeks afterward two more cases presented
themselves, in which the appearances observed in the
first case were seen, but besides there were numerous
other lesions sufticiently well marked for me to be able
to render a diagnosis of impetigo contagiosa with cer-
tainty.
Soon after this three more patients, attacked in the
same waj', coming to the dispensary, it struck me as
probable that the origin of the trouble might be traced
to a single source. Instituting incjuiries I found that the
last three patients had recently removed from Stein way's
settlement, near Astoria, where, I was informed, there had
been an outbreak of the disorder, affecting some forty or
fifty persons.
Proceeding to this place with my friend Dr. Carter, we
were somewhat disappointed to find our anticipated field
of study narrowed down to about half a dozen cases.
Some forty to fifty families had left the place within the
preceding two months, in consequence of a labor strike,
carrying with them a number of the objects of our search.
However, a description of some of the examples that
were left will probably prove as instructive as if a larger
number had been reported, as the lesions mentioned in
those examined would simply have to be repeated in a
more extended number of observations.
Case I. — Willie B , aged three years, a healthy-look-
ing, well-nourished child of German parentage, has had the
disease a little over a month. His mother states that
about a week before its first appearance he was seen to
kiss a little companion whose face was broken out.
On Willie's chin are two patches, of rather irregular
outline, but inclining to an oval shape, liaving their
centres beneath each angle of the mouth and nearly
meeting, so as almost to cover the front part of the chin.
They have a moist appearance, and are partly covered
with a soft, yellowish crust, broken irregularly, and
streaked with blood ; evidently changed by scratching.
On the upper lip are three, and on the other parts of
the face five pustules, varying in size and development,
none of them very recent. Also on the face were eight
dark red, non-elevated spots, with edges fading oft" into
sound skin, evidently the vestiges of pustules. On the
head were ten patches, distributed irregularly over the
64
THE MEDICAL RECORD.
[January 20, 1883.
scalp. They were all of nearly equal size, about half an
inch in diameter, covered with a thick, dirty-yellowish
crust, in which the hair was matted. Detaching these
crusts, which were slightly adherent, a dry, faintly red-
dish base was e.xposed. On the extensor surface of the
right forearm and wrist were five, and on same aspect of
left corres])onding parts were six, pustules of quite
recent origin. They were from split-pea to finger-nail
in size, roundish, flat, covered with crusts looking like
soaked thick brown paper. Their circumference occa-
sionally showed a line of redness. The crusts did not
fully e.xtend over the pustules in some instances, pus
showing at its edges — so to say, it was not quite large
enough to tit. There was no well-marked umbilication
observed, except in one pustule on the left arm.
With this patient, as in all the other cases, there was
a good deal of itching, especially' on the chin, after the
disease had existed some three or four weeks.
Case II. — Henry B , f(jur years old, a)iparently in
good health. Eruption confined to chin, beneath the
right angle of the mouth, and presents same appearances
as the similarly located lesion in Case I. Said to have
been comnnmicated by kissing.
C.\SE III. — Sarah S , four years old. Reported to
have caught the disease from Willie B . It com-
menced two months ago on the cheek, once extended to
the chin, beneath the angle of the mouth, the only loca-
tion it occupies now. There are five other children in
the family to which this patient belongs, one an infant.
No means to prevent contagion has been taken. They
frequently kiss each other, sleep together, and come in
close contact in other ways, yet but the one member of
the family is affected.
Case IV. — Miss R , ten years old. Had the dis-
ease for about three weeks ; at present it has almost
entirely disa]ipeared. She is attending school.
Case V. — William Y , healthy-looking, very well
nourished child, three years old. His mother states that
four weeks ago a breaking-out appeared on the chin, then
crept along as far as the ear, by a succession of sores, in
about two weeks. Now, December 8th, the broken pus-
tules have much the same appearance as those alreadv
described.
Case VI. — Ann Y , sister of the above. Ap-
parently healthy. The first lesion made its api)earance
over the eyebrow, from which place it has extended by
successive crops to the cheek. The disease has also ap-
peared on her arm.
Case VII. — Mrs. Y- , the mother of Cases V.
and VI. The disease appeared about a month ago on
the chin and has not extended. It resembles an ecze-
niatous patch that has been scratched and torn by the
finger-nails, and this description will apply to most of the
older ]3atches in the cases related.
In Cases V., VI., and Vll. an ointment of oxide of
zinc was ordered to be applied freel)- to all the diseased
surfaces. A week later the old lesions had nearly dis-
appeared, but one new i)ustule on the leg of each of the
children had made its appearance ; about two weeks later
quite a plentiful crojj appeared on the forehead of pea-
sized pustules, most of them umbilicated. New jnistules
also broke out on the body.
There seemed to be no evidence to support the claim
that this disease depends on vaccination as a cause.
Some of those affected had been vaccinated at various
periods preceding the time that they were attacked, while
others had not been vaccinated at all.
The site of this e|)idemic is a recently built-up district
on the south shore of Long Island Sound. Malaria, as
usual in so many suburban i)laces, is the bane of the in-
habitants. All the cases that I saw and could learn of were
located on a single avenue of two blocks, directly exposed
to the winds blowing from the water and over salt mead-
ows and sunken lands.
Impetigo contagiosa is seldom confined to single cases
in i s attacks, two or more ha])pening together; but it is
rather unusual for it to assume proportions that are ex-
tensive enough to be called epidemic.
Most writers on the skin represent the affection as
self-limited ; lasting about ten days. But one of my
cases recovered in less than three weeks, and most of
them have been afflicted more than two months. Fur-
ther, the lesions are said not to give rise to itching, but
this symptom has been prominent in most of the patients
after the eruption is about two weeks old.
The disease has been described by so many able and
distinguished dermatologists, since 1864, when Tilbury
Fox first called attention to it in the British Medical
Journal, that the present article may be regarded as a
superfluity. To redeem it from a charge of this kind,
I may say that some phases of the disease in the cases
presented are either novel or are not noticed by writ-
ers. A furtber necessity of drawing attention to the
disorder at this time is, that it is contagious. The fami-
lies with their children still suffering from it are dis-
tributed through the city, and some of them will pretty
certainly fall under the notice of physicians who, in all
probability, will be quite unprepared to make a diagnosis.
The breaking out of a "catching" disease with which
the public are not acqua.inted occasions alarm and con-
sternation, and a rush is made to the physician generally
with greater anxiety to ascertain if it is dangerous than to
ask for treatment.
To those moderatel)' informed on skin diseases the di-
agnosis is not difficult. It may be mistaken for ecthyma,
pustular eczema, impetigo (same name, but quite distinct
disorder), varicella, and in its later stages possibly for
herpes febrilis (fever cases). If the contagious element
is discovered a mistake can scarcely happen.
In the following table I have endeavored to present
the differential diagnosis, so that the lesions and symp-
toms of im))etigo contagiosa may contrast directly with
those resembling it of the diseases named :
Pustular ^impt'ti^hioui) eczema.
Minute pustules agglomerating,
very itchy.
On head, usually numerous, in-
clined to coalesce and cover large
surface.
Impetigo contagiosa.
Small, roundish, flat, discrete,
variously sized pustules.
On head, isolated and few in
number.
Favorite location on face, then
on arms, superficial ; slightly in-
flamed base : may occur in the
robust.
Pustules flat, inclined to spread
at periphery, to unite when close
together.
Ecthyma.
Lower extremities usually at-
tacked; somewhat deep; firm, sen-
sitive, inflamed base; mostly af-
fects the debilitated.
Impetigo.
Pustules full and rounded ; do
not increase in size, nor rupture
nor coalesce.
Varicella.
Usually small vesicles on face
and body.
Recovery after a Low Temperature. — Dr. F. A.
Hubbard, of Taunton, Mass., sends us the following in-
teresting case : "An intoxicated man S])ent the night of
December 18th in an open coal-shed. He had the i)ro-
tection only of ordinary clothing, and when found, late
the next forenoon, was apparently dead. Closer inspec-
tion revealed signs of life, and after about six hours our
efforts to restore him were successful. His temj^erature
was taken about four hours after he was found. The
thermometer was a verified, self-registering one, gradu-
ated from 90° upward. The register could, however, be
shaken down for a space equal to 5° more. It was so
fixed and placed in the rectum, where it remained for
seven minutes. The register was not lifted at all. The
patient's temperature, therefore, did not exceed 85°.
We cannot say how nuich lower it was. Shortly after
consciousness was regained the axillary temperature
was 100. j". The patient was attended by Dr. F. D.
Tripp and myself. The means used were flagellation,
external heat, hypodermic administration of digitalis,
atropia, and strychnia, with aromatic ammonia by the
mouth."
January 20, 1883.]
THE MEDICAL RECORD.
65
TISSUE METAMORPHOSIS AND SLEEP.
By GEORGE W. RACHEL, M.D.,
NKW YORK.
The excellent article in a recent issue of Thk Medical
Ri'.coRD by Dr. J. Leonard Corning, on "Sleep," I have
read with great interest. Since I have given the subject
some thought and attention, I may be permitted to say
something about it.
In order to approach the matter from the right direc-
tion, it will be best to refer to " exhaustion " of the tis-
sues in general. The word in use with German physiol-
ogists, Eimudung (= fatigue), is probably more correct,
because it implies only tlte iiiahility of the tissue to per-
form its function (secretion, contraction, cerebration,
etc.), but does not imply that tlie cause of this inability
is exhaustion of material available for such functional
activity. For example, we know that, in experimenting
on muscles, such a state of " fatigue " is induced by ]5ro-
longed artificial tetanus. A muscle thus treated will at
last no longer respond to the application of the elec-
trodes, and no contraction will ensue. If the muscle is
still part of the living body, a short rest will cause a
restitution of functional activity, and a contraction will
be produced by a renewed a|)plication of the electrodes.
Now, it might be surmised that this "fatigue" is due to
actual exhaustion of the nmscular tissue, and that the
period of rest had served to cause a restitution of the
wasted material. That such is not the case is shown by
experiinenting on a muscle which is cut out of the body.
If such muscle is reduced to the state of " fatigue " by
tetanizing, it may be regenerated, made contractile again
by washing it out, either with blood or with a o. 7 per
cent, solution of sodium chloride, which is rendered
feebly alkaline by a little sodium carbonate or kreatin-
ine. By slowly injecting this alkaline fluid, the products
of tissue-waste are taken up and removed, and the acid
condition of the '-fatigued" nmscle changed into one
that is alkaline. Now the muscle will again respond to
an electric discharge.
Professor Johannes Ranke, of Munich, has made,
among others, these relations a special study, and has
shown that the "fatiguing" substances are principally
carbonic acid, lactic acid, potassium biphosphate, and
other acids and acid salts, i.e., the products of the tissue-
metamorphosis which sustains the functional activity of
the muscle. Ranke was enabled to show by direct ex-
periment that the action of these substances is that which
causes " fatigue." For this purpose he impregnated a
fresh muscle with beef-broth, which contains them, and
thereby reduced it instantly to an extreme state of
"fatigue," exactly equal to that produced by prolonged
functional activity.
It is not necessary to go into detail with regard to
these processes ; suffice it to remind the reader once
more that it has thus been demonstrated that the " fa-
tigue" produced in the muscle is not "exhaustion."
From these experiments it follows, furthermore, that the
material utilized during functional activit)' is not derived
from the blood supplied to the muscle, but is present in
its tissue. Otherwise it would be impossible for an iso-
lated muscle to contract after the " fatiguing " sub-
stances have been removed by injecting the alkaline
fluid. The oxygen, as well as the oxidizing material, are
contained in the substance of the muscle, independent of
the blood-supply, and only after these give out (more
especially the former, the oxygen) can there be actual
"exhaustion."
Fortunately, we have a series of valuable experiments
bearing on this matter, recorded by Pettenkofer & Voit,
which confirm Ranke's views in this respect. In these
it was shown that the amount of oxygen inhaled has not
a direct influence on the amount of carbonic acid ex-
haled during a given time. The subjoined figures will
speak for themselves :
Day of Rest.
Oxygen in- Carbonic acid
h.iled. exh.i!cd.
6 A.M. to 6 p.M 234.6 grms. 532-9 grms.
6 P.M. to 6 A. M 474-3 " 378-6 "
Work-Day.
6 A.M. to 6 P.M 294.8 grms. 884.6 grms.
6 P.M. to 6 A. M 659.7 " 399-6 "
Thus it is seen that the oxygen used in the course of
the day has for the greater part been " stored up," as it
were, during the preceding night. For this pur|)ose it
uuist become an integral part of the tissue, must be a
component element of the chemical combinations con-
stituting such tissue.' The imijortance of this fact will
be perceived at once.
In the first place, the part played by the blood must
materially differ from what it is usually conceived to be.
Its importance as a purveyor of oxygen during activity
is greatly reduced, while its purifying function, by which
the " fatigue-producing " substances are removed, can
hardly be over-estin)ated.
On the other hand, oxygenation by the blood during
rest must appear in a very different light, since we know
that it is greater at this period tlian during activity. For,
while during the latter state all the oxygen of the blood
is consumed, in addition to that present in the tissues,
this is not the case during rest. Here all the oxygen
supplied is not applied to tissue metamorphosis, a com-
paratively small part only being thus employed ; the
balance goes to the tissues and becomes an integral part
of the various substances composing it, a most important
process, which has hitherto, at least to my knowledge,
not been duly recognized, more especially in its bearings
on the subject of sleep.
This cannot be said of the other task performed by the
blood ; it has always been known that the purifying ac-
tion of the latter partly consists in its absorbing the pro-
ducts of tissue waste. But we shall understand it more
fully in the light of the experiments above alluded to.
This action goes on incessantly during rest, as well as
during activity ; but it is essentially different in the two
states. During functional activity of the organ, it is of
great importance by preventing too great an accumula-
tion of the waste products then constantly forming at a
rapid pace, which would otherwise lead to such an in-
crease of their "fatiguing" action as might entirely pro-
hibit activity. During rest, on the other hand, it is
evident that the waste products then carried away by
the blood are of an entirely different character; they
constitute all the fixed acids and acid salts which, al-
though being oxidized, are still held by the tissues, and
may be considered the surplus which cannot be elimin-
ated by the blood during activity, its capacity in this re-
spect being Umited.
This surplus is of the utmost importance for our con-
sideration, since it is the direct cause of sleep. For this
slow accumulation of " fatigue-producing " material must
take place in every organ of the body, especially in those
which are incessantly active, until its amount is so great
as to render further activity impossible. This may possi-
bly occur at the time when the amount of disposable
oxygen in the tissue is nearly exhausted, although we
have as yet no means to know that. (Ranke" contends
that : " Fatigue due to want of decomposable material
has as yet not been observed ; although many physiologists
assume that such a state does exist, its existence is more
than improbable.)
Of all the tissues of the human body, the brain is cer-
tainly an incessantly active one. While we are awake,
1 That such is actually the case, is best illustrated by Valentin's observations on
hibernating animals. He found that during hibernation marmots would at cer-
tain times show a slight gain in their weight, although they had been giving off
small amounts of carbonic acid and water. Uur readers will perhaps recall the ex-
perience of Dr. Tanner, who was also reported to have gained in weight slightly,
a paradox easily explained by an accumulation of intra-molecular oxygen,
'^ Grundzuege der Physiologic des Menschen. Second edition, p. 107.
66
THE MEDICAL RECORD.
[January 20, 1883.
our brain is constantly occupied, either with receiving
external impressions, or with calling up from our vast
store of former impressions those that suggest themselves
by the association of ideas. This incessant mental ac-
tivity is the psychical equivalent of a multitude of chemical
processes in the ganglionic cells and nerve fibres, which,
to the number of man)- millions, constitute the cerebral
tissue. The general tendency of these chemical jiro-
cesses is the same as in all other tissues, viz : oxidation.
The waste products, therefore, are similar ; Carbonic
acid, potassium, biphosphate, and other acid salts are
also formed here, only tlie fixed acid differing from that
found in the muscles (lactic acid).' Thus the brain, as
well as the muscles, shows an acid reaction after a long
period of activity, while both when at rest have a slightly
alkaline reaction. They differ, however, in this : The
brain normally contains a greater proportion of water
than blood, while with muscular tissue the reverse ob-
tains ; and further, the brain is drained of its water
during activity, while the muscles are rendered riciier in
water by continued exercise. The important influence
of this on endosmosis and exosmosis will be readily
perceived.
After having thus roughly sketched the various con-
ditions found in certain tissues before, during, and after
tissue metamorphosis, we may now refer to the part
which tissue metamorphosis plays in the production of
sleep.
We have had occasion to point out one of its chief
causes, if not the chief cause, viz. : The gradual accu-
mulation of certain jiroducts of tissue waste, which, as a
rule, are not wholly removed by the blood during ac-
tivity. These we have found to be such as have the
physiological property of inducing "fatigue," if a certain
amount of them be present. This explanation has been
anticipated by Durham, whom Dr. Hammond cites as
saying : " A probable explanation of the reason why qui-
escence of the brain follows normally its activity, is sug-
gested by the analogical fact that the products of chemi-
cal action interfere with the continuance of the action
by which they are produced."
It, however, is not absolutely necessary that the
substances which exert a " fatiguing " influence on
the brain must have been produced in the brain it-
self We have seen that the waste products are very
similar all over the body, i.e., results of oxidation.
Therefore a ]3erson may have done very little real
brain-work during the day, and yet he or she will be
just as sleepy, or even more so, than another who has
done a certain amount of literary or other mental la-
bor only. The explanation of this apparent paradox
is, that the "fatiguing" products accumulating in the
muscular system are partially taken up by the blood and
carried to all other organs. Now, the brain normally
contains more water than the blood, and although this
condition is somewhat modified through the tlaily brain-
action even of a person occupied with muscular work,
the result still will be a slow imbibition of this " fa-
tiguing" substance. But the latter also acts on the heart
and on the vascular system generally. The heart's ac-
tion is thus retarded, not only by their direct action when
they pass through it in the bloo<l, but also by a partial
paralysis of the vaso-motor system of nerves. This low-
ers the "tonus" of the vascular system, the arteries
principally, and thereby diminishes inira-arterial press-
ure, a condition which is always speedily responded to
by a reduction in the force and number of the heart's
.contractions.
A similar effect is [iroduced on the medulla, and its
reflex action retarded, so that the number of respirations
is diminished, while their volume is generally increased
in compensation of such diminution.
Thus we see that the fatigue-producing material, de-
* The nitrogenous principles, resulting from the decomposition of albuminous
matters, have been omitted because they arc pretty constant and do not have im-
portant physiological effects.
rived from tissue metamorphosis during activity, is the
one cause underlying all the various changes in the sys-
tem observed during natural sleep. It is not so much
the want of oxygenation of the brain by the blood, as the
want of intra-molecular oxygen, combined with the fa-
tiguing action of the tissue waste accumulated during
activity.
The view, also cited by Dr. Hammond, as expressed
by Harthez, that : " During slee|) there is a general
plethora of the smaller blood-vessels of the whole body," is
probably near the truth. This would apply especially to
those organs in which a restitution of the material con-
sumed during activity can only take place during sleep,
i.e., brain and muscles in particular. We know that the
deposition of the intra-molecular oxygen to be consumed
the following day does take place during sleep principally,
and it is imperative, therefore, that a fair supply of blood
should circulate in these organs. This condition of pas-
sive hyperemia is also one, the production of which is
certainly favored by the decrease of intra-vascular press-
ure. And this gives the key to the apparently anaemic
condition of the brain. The cerebro-spinal fluid which
pervades the subarachnoidean space and the lymph which
fills the perivascular spaces create conditions wliich nnist
make us careful in diagnosing cerebral anxmia from out-
ward appearances. The production of both is certainly
dependent on the intra-vascular pressure to which they
simply furnish a passive compensation, and since this
pressure is diminished during slee[), the amount of both
n)ust also diminish. Although the larger vessels may
therefore seem only moderately filled and the bulk of the
cerebral mass may apparentl}- be unchanged or even re-
duced, the small vessels and capillaries must not neces-
sarily be as anasmic as we may be led to conclude from
those appearances.
• As to the experiment of jjroducing sleep by compres-
sion of the carotid, which is held to be corroborating
evidence to the theory of cerebral anxmia as the principal
cause of sleep, this must be viewed differently in the light
of our previous reasoning.
It is not the want of oxygenation to which the causa-
tion of sleep thus induced must be ascribed, but to the
imperfect removal of the " fatigue-producing" products on
the one hand and the additional decrease of intra-vascular
pressure, with all its above-described concomitant effects,
on the other. The former action is accepted by Dr.
Corning himself to a certain extent, since he found "that
a certain degree of compression of the carotids is much
more fruitful in the production of soporific effects toward
evening than in the early hours of the morning." He
very correctly ascribes it to " an exhausted condition of
the ganglia" — although he is not sure whether it is " a ces-
sation of interplasmatic activity due to the collection of
debris within the ganglia," or" molecular inertia," or some-
thing else ; and, furthermore, to a certain amount of avail-
able explosive energy, hoarded up, which renders the
ganglia in a measure independent of the necessity of ex-
tensive assimilation from the plastic materials of the
blood-stream — at least, for a time.
Ranke has acquainted us with the real facts as far as
the former — the "fatigue-producers" — are concerned,
while Pettenkofer and Voit's experiment teach us that
the latter — the "explosive energy'' — is due to the intra-
molecular oxygen, stored up in the brain tissue during the
previous night's rest.
As to the action of a full meal producing drowsiness
and sleep, it is evident that this is due to the over-supply
of nourishing material to the blood during digestion.
The albuminous material being first and quickly attacked
in the stomach, its inorganic and extractive matters —
the very same " fatigue-producing " substances — first enter
the circulation and display their action on the tissues, the
brain tissue more particularl)-, for reasons stated above.
The "fatigue " produced induces sleep, in spite of a con-
dition of the vascular system different from that during
sleep, following tissue waste by activity, viz.: partial con-
January 20, 1883.]
THE MEDICAL RECORD.
67
gestion. The latter is due to tlie increase of iiitra-vascu-
lar pressure caused by the greater amount of blood, and
also by the irritation of the sympathetic system, the great
splanchnic in particular.
This would show that anremia is not a necessary re-
quirement for the initiation of sleep, and, therefore, would
tend to support the view detailed in the foregoing re-
marks, vi/.. : That certain chemical processes are the
actual cause of sleep in the manner indicated above.
The peculiar action of certain drugs and chemicals to
produce fatigue and sleep would add to the evidence ad-
duced in favor of our view.
progress 0f pXMicaX Science.
The Albuminuria of Epilepsy. — Dr. Saundby {Lon-
tion Medical Record, December 15, 1882), after referring
to the contradictory statements of previous observers,
says that out of twenty-seven observations of the urine
of twenty chronic epileptics, albumen was found on
twenty-two occasions. The test employed was simply
boiling and acidulating with acetic acid. The quantity
varied from a copious precipitate to a faint trace, but as
a general rule was small. Five examinations were made
directly after a fit ; of these albumen was absent in two.
He does not regard the albuminuria as having any dis-
tinct relation to the fits, but connects it with the age of
his patients (the average age being eighteen), the dys-
pepsia and ansmia which were so common among them,
and the fact that the urine was examined after they had
been walking. Pulse-tracings were taken in ten cases,
but in two only was the tension liigh.
The Treatment of Drop.sy. — Dr. Leech, in a paper
read at the last annual meeting of the British Medical
Association [Lo/idon Afedical Record, December 15,
1882), discusses the treatment of cardiac, hei:)atic, and
renal dro|)sy. Firstly, as to the advisability of removing
the fluid either by mechanical means or by the eliminants
of water, such as diaphoretics, diuretics, and purgatives :
every case has to be considered as to the real cause of
the dropsy, the stage it has reached, and the condition
of the patient and his tissues. For without this the mere
routine treatment by eliminants of water may not only
not do any good, but actual harm may result. Thus, in
the earlier stages of heart-disease with anasarca, diuretics
may succeed admirably. Later on, as the general health
fails, they lose their power, even though there be no
evidence of increasing obstruction of the circulation.
And at last it may happen that we cannot drain the
water from the cedematous tissues, even when they are
pricked or tapped. Secondly, as to the modes of elim-
ination : of these, speaking of paracentesis. Dr. Leech
believes that, vvhen dropsy is due to a block in the portal
vein, tai)ping is almost necessarily followed by a recur-
rence ; in acute cirrhosis, when the distention causes
great discomfort to the patient, this operation does not
give even temporary relief, nor has he seen any good re-
sult from it in advanced cases of ascites due to cirrhosis,
where symptoms of coma had developed. Diuretics
rank next to paracentesis, but they can only act when
the kidney is functionally competent, and when the tis-
sues are in such a condition as to be able to give up
their water. In hepatic dropsy, copaiba, which can be
given for a long time with advantage, and caffein are
most useful. Digitalis and saline diuretics in cardiac,
and diaphoretics are of most value in renal, dropsy.
Syphilis in Children. — In some clinical remarks
published in the Allgem. Wiener Med. Zcitiatg, No. 29,
1882, Dr. Widerhofer points out that a child may be (i)
born with signs of syphilis, or (2) born dead, or (3) may
only show signs of disease during the second or third
month after birth. Children born with syphilides show
only the papular or pustular forms. Those in whom
signs do not a\)pear for several weeks, usually have the
macular form, and this usually develops during the
second month. In most cases swelling of the nasal
mucous membrane is the first sign of inherited syphilis ;
the child becomes pale and sleeps badly, and then, some
days later, the macular syphilide appears. The spots
are most numerous on the face, forehead, outer aspects
of the extremities, and on the buttocks. Papules often
appear among the macula:. The pustular is the gravest
form of syphilide ; it is usually present at birth. When
it is limited to the palms and soles, it is called syphilitic
pemphigus.
In the diagnosis of a syphilitic rash, polymorphism is
the most valuable sign. The swelling of the nasal mu-
cous membrane is also a sign of great diagnostic value.
As regards the sequels of syphilis, a syphilitic child, as
a rule, becomes rickety, and hydrocephalus often follows.
The child's nutrition, also, is affected generally ; hence
the tendency to rickets. Paralysis and lesions of the
cellular tissue may also occur, and, after the first year,
scrofulous aff'ections. The glandular system is but
slightly affected during the early months, and changes in
the glands do not occur until the child is a year old.
Abscess of the thymus is very rare. The author himself
has seen only one case ; the child in that instance lived
thirty-six hours ; but, in five other cases within his know-
ledge, the children were all born dead. The ijrognosis
of inherited Syphilis is favorable as regards life when no
signs are present at birth ; but much depends on proper
management of the diet.
A Common Mistake concerning Chloride of Po-
tassium.— It is well known that chlorate of potassium is
a very good remedy to gargle the throat, but compara-
tively few physicians are aware of the fact that it is not
this remedy which is so successful in mercurial stomatitis,
but chloride of potassium.
Dr. \Vertheim draws the attention of physicians espe-
cially to this fact. He reminds them that the formula
of the first is KCIO3, but that of the second KCl. He
says that the chlorate should never be used, as in con-
centrated solution it may even prove very harmful, while
the chloride is very innocent ; a specific in sore throat,
and especially in mercurial sore mouth, and very analo-
gous to common salt, which is simply a chloride of sodium,
instead of potassium. In America the chlorate is com-
monly used ; no wonder, therefore, that it is not found
here as efficient as in France and Germany, where they
use the chloride.- — Medical and Surgical Reportex.
The Organisms of Typhoid. — Maragliano, of Genoa,
has published in the Centralblatt filr die Med. Wissen-
schaften, an important note on the uniform occurrence of
organisms in the blood of patients suffering from typhoid.
He has found them in the blood of the spleen as well as
in that of the general circulation. The blood was ob-
tained by means of a hypodermic syringe, the middle of
which was passed through the abdominal wall into the
substance of the spleen. Dr. Sciamano, of Rome, first
showed that blood may be thus obtained from the sub-
stance of the spleen during life without any injurious
consequences. The blood of the genera! circulation was
taken from the tip of the finger. In each method every
precaution was taken to avoid the accidental introduction
of organisms. The examination, in this way, of fifteen
patients gave the following result : At the height of the
disease the blood of the general circulation contains
micro-organisms both isolated and grouped. These con-
sist, almost exclusively, of spherical bodies, which have a
delicate contour, appear to be homogeneous, and are
analogous to micrococci. Some of them are mobile.
Similar organisms, again, were seen in the blood of the
spleen, and in it, too, were others, rod- shaped, also with
delicate outlines, perfectly corresponding to those de-
scribed by Eberth and Klebs. During convalescence
these micro-ors;anisms lessen in number in both the
68
THE MEDICAL RECORD.
[January 20, 1S83.
splenic and systemic blood. When quinine was given to
the patient in large doses, the organisms either disap-
peared from the blood, or were present in it only in small
number. The blood from both the finger and the spleen
was treated by the method of fractional culture, and a
large number of rods were then obtained, similar to those
seen in the fresh blood, e.\cept that some of them were
of greater length. The presence of such organisms in the
blood of the sjileen after death had been previously estab-
lished by Sokoloff and Fishel, but Maragliano is the tirst
who has demonstrated their presence in the splenic blood
during life. He avoids the expression of any opinion as
to their relation to the disease. — London Lancet, Octo-
ber 28, 1S82.
PHemorrh.\ge into the Cavity of the Arachnoid.
• — The subject of hemorrhage into the inter-arachnoid
space has been a sorely puzzling one to pathologists.
A variety of explanations, more or less plausible, have
been put forward to account for its occurrence. But
apart from its pathological interest there is also a decid-
edly practical aspect of the matter. And from a medico-
legal point of view the subject may at any time claim our
attention. Dr. Morris, in the Lancet, November n,
1882, presents a fair statement of our knowledge on this
condition, and his conclusions are to the following effect :
I. That spontaneous effusions into the cavity of the
arachnoid — /.^., effusions of blood from disease or excite-
ment— are very often not distinguishable l"i;om traumatic
effusions. 2. That post-mortem examination does not
always explain the cause or the source of the effusion,
and that the state of the blood-clot is only a very rough
test as to the age of the effusion. 3. Extravasation of
blood between the dura mater and bone, as also extrava-
sations beneath the visceral arachnoid, accompanied by
brain bruising, are almost certainly traumatic, whether
fiacture co-exists or not. Extravasations into the sub-
stance of the brain and into the ventricles are almost
certainly spontaneous when no fracture and no brain
bruising co-exists, and are probably so even when fracture
■without bruising of the cerebral surface is found. 4.
Spontaneous effusions may occur without there being any
naked eye evidence of disease of the cerebral or menin-
geal vessels. 5. Spontaneous effusions into the arach-
noid cavity from disease or excitement have occurred as
early as the twelfth year of life, and at all ages subsequent
to puberty. Inter-arachnoid hemorrhage occurs at any
age from violence. 6. In slight injuries to the head, such
as small scalp wounds without fracture of the skull, or
bruisiug of the surface of the brain, the surgeon should
be extremely cautious in attributing inter-arachnoid e.x-
travasation to a blow, and more especially when the in-
jured person is of intemperate habits.
The Hot Pack in Puerperal Eclampsia. — Dr.
Brens (Archiv fiir Gyndkologie, vol. xix., 18S2) believes
that for the cure of puerperal eclampsia either in the
puerperium or the last months of pregnancy, active dia-
jjhoresis alone, induced by a hot bath, 40° to 45° C,
followed by the pack, is all sufficient. The bath must
not be prolonged over half an hour, and two to three
hours suffices for the envelopment in the pack. This
method properly carried out will, according to Brens,
also cause cedema and albuminuria to disappear without
interruption of pregnancy.
Cardiac Typhoid. — M. Bernheim recently read a
communication before the French .Association for the Ad-
vancement of Science upon the cardiac form of typhoid
fever (Pro^res Medical). The author intends to desig-
nate by this term case^ in which, without notable
organic alteration of the heart, without pulmonary
C()m[)lications, or others capable of explaining the phe-
nomenon, the pulse becomes small, frequent, and de-
pressible. The patient succumbs to this paralytic ac-
celeration of the heart, which may be produced either at
the beginning of the fever, with or without concomitant
nervous advnamia, or at a more or less advanced period
of its evolution. The axillary temperature may be mod-
erately febrile, normal, or even subnormal. M. Bernheim
considers this nervous asystole in typhoid fever to be
due to a direct action of the poison or typhoid microbe
on the centre of cardiac innervation. In typhoid fever
the pulse is usually slower than in other pyrexias, as
though the specific poison, like digitalis, had a slowing
action on the pulse. It may be conceived that this virus,
acting with great energy on the cardiac nervous centre,
can produce paralytic acceleration. This theory would
also explain the fact noted by the author, that digitalis
in these cases is not only inefficacious but dangerous,
and that even given as a prophylactic it does not pre-
vent the manifestation of the cardiac phenomena. The
author bases his conclusions on the observation of six
cases with autopsies. Sudden death in certain cases of
typhoid fever where we find no appreciable alteration
of the heart, may thus be due to the concentration of the
poison upon the cardiac centre. This is the foudroyante
variety of the cardiac form.
Tricuspid Stenosis. — .\t a recent meeting of the
London Pathological Society {Lancet, October 21,
1882), Dr. Bedford Fenwick showed a specimen of tri-
cuspid stenosis from a woman aged thirty, who had
rheumatic fever at fifteen, and afterward suffered from
winter cough and dyspncea ; she went on from bad to
worse until admitted into the London Hospital under
Dr. S. Fenwick. There was marked distention of jugu-
lar veins, but no cyanosis, cardiac dulness very wide to
the right, a well-marked presystolic apex thrill and pre-
systolic and systolic apex murmurs ; proceeding to the
right another presystolic and systolic murmur was de-
tected. At the post-mortem both auricles, but especially
the right, were found very much dilated, the ventricles
small. The tricuspid and mitral valves were greatly
thickened, shortened, and agglutinated together, causing
marked stenosis. W\ the organs were congested. The
spleen was during life tender to pressure and pulsated.
Cases of this kind were now known not to be very rare.
Since his table of forty-six cases he had been able to
collect twenty-three more cases, twenty of whom were
females, averaging in age 31.7 years. In every case the
mitral valve had been more changed than the tricuspid,
and in all cases the general health had been good ; the
great dilatation of the right auricle caused increase of
cardiac dulness to the right, and afforded a means of
diagnosis.
Iodide of Lithia. — For a long time, the salts of
lithia have been considered efficacious in cases of gout.
Dr. Kendall has found the iodide by far the most useful
of them all. It is most efficacious in cases of actual
gout, and may be used with benefit in other cases of a
gouty nature. He has known small doses of the iodide
to act with benefit in cases of gouty eczema, and in
those cases of dyspepsia which may be due to a gouty
diathesis the use of this salt is followed by excellent re-
sults.— British Medical Journal, October 21, 1882.
Paroxys.mal Stercoraceous Vomiting. — Dr. Rosen-
stein relates the case of a nine year old boy who suffered
from peculiar tetanoid seizures, accompanied by uncon-
sciousness, during which the bowels were moved and
vomiting of firm brown-colored fecal masses occurred.
The attacks came on suddenly during jilay or in sleep.
There was marked opisthotonos with occasional tetanic
movements of the arms and legs. .After the vomiting
the patient complained chiefly of abdominal pains. A
cure was obtained by means of injections and the ex-
hibition of large doses of bromide of potassium. The
reporter thinks that the condition present was that of a
spasmodic stricture of the intestine, from which proceeded
strong contractions of the bowel upward and downward,
setting up both peristaltic and antii)cristaltic movements.
— Centralblatt fiir Chirurgie, No. 43, 1882.
January 20, 1883.]
THE MEDICAL RECORD.
69
Coagulation of the Blood. — Dr. Hayem, already
well known for his numerous contributions to the physi-
ology and pathology of the blood, has recently published
a series of articles in Z' Union Medicale on the process
of coagulation of this fluid. He opposes the theory of
A. Schmidt and declares that an increase in the number
of white corpuscles stands in no relation to a greater
coagulability of the blood. He further states that an
anatomical element, the hrematoblast, is constantly pres-
ent in the blood and plays the most im[>ortant role in
coagulation, tiie rapidity and degree of this process being
in proportion to the number of hajmatoblasts circulating
in the Huid. Upon the strength of his last series of experi-
ments Dr. Hayem formulates the following conclusions :
ist, when the blood in fresh sections of vessels retains
its fluidity, it is because the h;T;matoblasts remai_n un-
changed ; 2d, when these bodies become broken up in
the plasma, the stagnant blood in the vein coagulates as
readily as it would in an open vessel, in spite of the in-
tegrity of the walls of the blood-vessel.
Etiology of Congknital Talipes Equino- Varus. —
Dr. H. W. Berg advances the following theory of the
origin of congenital talipes equino-varus : " In early
foetal life the lower e.xtremities look directly backward,
and are brought into their normal position by a process
of gradual rotation of the thighs. During this process
the thighs are flexed strongly ujion the trunk, but ow-
ing to the extreme outward rotation the legs are retained
from full flexion by contact witli the abdomen. They
cross each other, and the feet lie in the position of marked
equino-varus with their soles in contact with the belly of
the child. In the process of normal development the ro-
tation inward of the thighs continues, the legs become
fully flexed, and the feet turn into a position of strong
flexion, their plantar surfaces looking forward and a
little outward. But if this process be arrested through
any cause, full rotation does not occur and the child is
born with talipes." — Arcliivcs of Medicine, December,
1882.
Cardiac Complications in Acute Articular Rheu-
matism IN Children. — From observations made in a
series of cases of acute articular rheumatism in children,
Dr. Vohsen ( Wiener Med. IVochenschrift, November 1 1,
1882) formulates the following conclusions : i. In nearly
one-half of the cases observed endocarditis occurred and
resulted in marked valvular insufficiency. 2. The mitral
valve was the one most frequently aftected. The endo-
carditis appeared usually in the first and second weeks of
the disease. Pericarditis was also a frequent complica-
tion. 3. Salicylate of soda, while it exerted a favorable
influence upon the joint affection, seemed not to prevent
tlie cardiac complications. 4. The mild forms of articu-
lar rhematisni are especially liable to be followed by car-
diac disease, hence a very careful examination of the
heart would seem to be necessary in the light cases.
Secretion of Mucus in the Trachea. — Dr. M. J.
Rossbach, upon the occasion of the recent jubilee of the
Wiirzburg University, presented a paper containing the
results of his investigations undertaken to determine
the physiological laws governing the secretion of mucus
in the air-passages. The trachea was opened by a longi-
tudinal incision, and the edges of the wound retracted so
as to present an unobstructed view of the mucous mem-
brane. He stated that the secretion of mucus occurred
only when the thin film of fluid lining the trachea was so
far removed as to permit of irritating influences acting
upon the mucous membrane. The mucus itself also
protects the underlying membrane by holding the foreign
bodies entering with the inspired air. Dr. Rossbach was
enabled to obtain the mucus pure and,unmixed with pus
or saliva. He stated that it was of alkaline reaction, free
from albumen, glycogynic ferments, and corpuscular
bodies, but containing a large amount of mucine. The
secretion of mucus was asserted by him to be indepen-
dent of central nerve-irritation, and to occur when all
connection with the central nervous system was severed.
The mucous glands either possessed peripheral nerve-
centres situated in the membrane itself, or else their ac-
tion was independent of nervous influences. He also
determined in these investigations that vaso-motor fibre's
pass to the tracheal mucous membrane through the
superior and inferior laryngeal nerves, and that the
secretioxi of mucus stands in close relation to local hy-
peremia. .-Xs to the influence of cold, he found that upon
the abstraction of heat from the skin a refle.x influence
was exerted upon the mucous membrane, finding expres-
sion in intense venous congestion. This condition ex-
cited a profuse mucous secretion. From this the author
concluded that laryngeal and bronchial diseases, occur-
ring after taking cold, might be regarded as due to refle.x
influences. The occurrence of the death-rattle he at-
tributed to the venous engorgement preceding dissolution.
Dr. Rossbach experimented further with a view to ascer-
tain the influence of various therapeutical agents upon the
tracheal secretion. He found that alkalies injected into
the veins caused anajmia of the nnicous membrane and
diminished the secretion. Hence they were not to be re-
garded as expectorants, but as remedies which reduce
hypenemia and thus lead to a cure by overcoming the
morbid process. Locally applied, their influence was nil.
The only exception was in the case of ammonia prepara-
tions, vvliich exhibited a local irritant effect. Nitrate of
silver diminished the secretion — an effect precisely the
opposite of that exerted upon the other mucous mem-
branes. Oil of turpentine, in aqueous solution, increased
the amount of secretion, but lessened the hyperajmia.
Apomorphia, rue, and pilocarpine excited a profuse
mucous secretion, especially the last-named drug, which
the author regards as a typical expectorant and prefers
to all others. Atropine caused a dryness of the mucous
membrane, as also, though in a less degree, did morphine.
Combinations of apomorphia and morphia, or of atropia
and morphia, according to the indications, tlie author rec-
ommended most strongly. E.xperiments conducted with
the electric current were without result.
Trichlorophenol. — Dr. Dianin obtains chloro-
phenysic acid by treating carbolic acid with chloride of
lime. This substance is a phenol in which three atoms
of hydrogen have been replaced by three atoms of
chlorine (C„H„CljOH). The writer claims the following
advantages for it as a disinfectant : i. The disinfecting
properties of trichlorophenol are twenty-five times more
])0werfal than those of carbolic acid. 2. A minute quan-
tity will arrest the most active fermentative processes.
3. It is a powerful antiseptic, far exceeding others in or-
dinary use — salicylic acid, thymol, carbolic acid, etc. 4.
It is a deodorizer as well as a disinfectant. Its own odor
may be disguised by oil of lavender (five drops to the
ounce). 5. Even when applied in substance it has but
slightly irritant properties, and when in solution does not
irritate the tissues in the least. 6. The good eflects of
chlorophenysic acid in soft chancre, diphtheria, etc., the
author claims, are indubitable. 7. Every physician can
prepare this substance for his own use. 8. The salts
possess the same disinfecting properties as trichloro-
phenol itself. The soda salt is odorless. 9. The lime
salt is cheaper than carbolic acid. — Centralhlatt fiir
Klin. Med., No. 27, 1882.
A Palatable Cough Mixture. — The most elegant
and palatable cough mixture ever prescribed by that
accomplished therapeutist, Dr. J. Milner F"othergill, is,
he says, the following :
3 . Syr. ScilLx 3 j.
Acid, hydrobromic. dil 3 ss.
Spirits chloroform 3 ss.
AquK 3J-
70
THE MEDICAL RECORD.
[January 20, 188^
The Medical Record
A Weekly yojirnal of Aledicinc and Surgery.
GEORGE F. SHRADY, A.M., M.D., Editor.
Published by
WM. WOOD & Co., Nos. 56 and 58 Lafayette Place.
New York, January 20, 1883.
WATER SUPPLY OF NEW YORK CITY.
The Legislature of the State of New York will probably
take immediate action in regard to the various schemes
for increasing the water supply of New York City. There
are no less than eight plans for effecting this object, and
when we state that one suggests bringing water from
Paterson, N. J., with an aqueduct to the Palisades,
which would have to be tunnelled, and also a tunnel
under the North River, some estimate of the many mil-
lions of dollars which will be recklessly spent can be
made.
One of the most remarkable features of the case ap-
))ears to be the fact that such an outlay is advised in the
face of authentic reports from the public departments
that the present supply of water to New York City al-
ready exceeds the rational needs of the population, and
is even sufficient to meet the demands of increased popu-
lation for many years to come.
The fault, therefore, appears to lie, not svith the quan-
tity of water, but with the methods of distribution, which
permit a constant and extravagant waste of probably
one-fourth of the whole supply. In view of this circum-
cumstance it may well be questioned whether increasing
the supply of water would mitigate tlie evil at present
complained of, for if the increase of the waste was to
keep pace with increased supply, nothing would be
gained.
The practical man, therefore, naturally asks : Is there
any method of distributing the water supply of New Vork
City which will give every house all the water it can use,
and at the same time cut off the unlimited waste which
now exists ? We answer that such a method of distribu-
tion is in practical use in one of the largest cities in the
world, and that the three millions of people in London
find it answers all their purposes and satisfies all their
^^•ants.
The English plan is to cause every house to provide
cisterns to contain the supply of water for their daily
use, which are neither limited in number or capacity.
Thus every house under this system commands all the
water which is required. Water is turned on to these
cisterns twice daily in summer, and once daily in winter,
when a less supply is necessary ; and it is the practice
to allow the water to run for some time after the cisterns
are filled, which daily flushes out the waste-|>ipes of
fvery house and the drains in every street.
Londoners pay water-rates according to the number
of cisterns erected in each house, which is an equitable
arrangement, and if one tenant wastes all the water in
his house, he does not rob his neighbor. Those using
large quantities of water can also pay water-rate, calcu-
lated by a metre, if preferred.
Such a system is connected with pumping the water to
create a high pressure throughout the city. This fills
the cisterns on the upper floors of every house. No
pumping or carrying of water is necessary — an almost
unknown comfort and convenience in New York City
under the present system.
It may be claimed that the London system involves
the placing of cisterns in ever}- house in the citv. In
reply, it may be said, that the New York system appears
also to require the use of cisterns. There is, however,
one difference which appears im|)ortant. The Londoner
has his cisterns filled twice daily, without any ettbrt on
his part, whereas, except in favored districts, the New
Yorker has to perform the agreeable (?) duty of himself
pumping the water from the basement to his upper floors.
There may be objections to this plan which we have
not presented, and we do not suggest that it is better
than to have an unlimited supply from the water mains
in the streets ; but it appears to meet the requirenrents
of a city having abundance of water for all purposes,
which is run to waste in such quantities as to cause in-
convenience, and at times a water famine.
We have no desire to discuss the engineering details
of the various plans for increasing the water supply, but
will offer a few suggestions on the sanitary and hygienic
points involved. We trust that any increased supply of
water may be drawn from a river source ; in such a case
the quantity would be without limit, and delivered fresh
to the city. It is unnecessary to add that in such a case
the water should be drawn at a point beyond the pollu-
tion of any city or town.
The analysis of Croton water shows its perfect adap-
tability for a city supply, and, if sufficiently abundant at
all seasons to be delivered direct, it would be the best
supply of water supplied to any city in the Union. But
the method of storing water in shallow lakes for long
periods is an abomination, especially in districts in which
fever and malaria are prevalent. Its effect on our Cro-
ton water is too often manifest to our sight, taste, and
smell, and possibly is often the cause of both fever and
malaria in this citv.
EPIDERMIC MEDICATION WITH THE OLE.ATES.
The "medicinal oleates " and their use in ei)idermic
medication is the subject of a series of articles in the
Ephemeris.
By epidermic medication is meant the application of
remedies to the unbroken skin for the purpose of obtain-
ing local or constitutional eftects. "Dermic'' medica-
tion is a term appropriated by specialists in skin diseases,
and "endermic" is to be applied to medication when
the cuticle is removed.
The use of various oils and ointments for the intro-
duction of medicines into the system is not a new thing ;
but we are told tliat it is only since 1872, when Mr.
John Marshall called attention to the value of the oleates
of mercury and morphia, that epidermic medication has
been .systematically attempted. Even now, the observa-
January 20, 1883.]
THE MEDICAL RECORD.
71
tions that have been made are neither numerous nor scien-
tifically accurate. There are, however, certain striking
advantages in the epidermic use of oleates, so that, ac-
cording to the writer, they deserve a wide trial.
Epidermic medication is based upon the peculiar fa-
cility with which the skin absorbs oleic acid and alkaloid
salts dissoli^ed in it. This oleic acid is obtained from the
"red oil " of the makers of stearin candles. It is an oily
liquid of the color of pale sherry, having a peculiar odor
and taste, free from acridity. It is thinner than the oils,
and has a specific gravity of about .900. Applied to
wood, porcelain, or cloth, a greasy spot is made, which
lasts as long as a similar spot made with oils or glycerin ;
but, curiously, when applied to the skin, oleic acid wets
it almost like water, and disappears so rapidly that it
seems as if it had evaporated.
Oleic acid combines with the various medicinal alka-
loids in very large proportions, taking up from 50 to 69.6
per cent. The ordinary oleates, therefore, are weak solu-
tions of oleates of atropia, aconitia, etc., in an excess of
oleic acid. In some rare cases where this excess of acid
is irritating, a bland oil may be added.
Oleic acid may be made to combine with various
metals, such as iron, copper, zinc, lead, mercury, etc.
With the exception of the last-named substance, such
combinations are not likely to be of much use.
The activity of these oleic acid solutions is best illus-
trated by the oleate of aconitia. This is a two-per-cent.
solution of that alkaloid. Each minim of it weighs eight-
tenths of a^rain, and contains about one-sixtieth of a
grain of aconitia. A drop from the thin lip of a vial is
equal to about half a minim (gr. 3-^^) of aconitia. Now,
if twice the quantity which the end of the vial's cork
will carry be rubbed over half a square inch of skin, a
glow of warmth is almost instantly felt. This will dis-
appear in about half an hour. If twice this quantity be
apjilied, there will be prompt tingling in the nerves of the
part followed by a sense of heat and prickling and then
numbness. The symptoms last for an hour. Such ex-
periments illustrate the potency of the preparation and
its mode of use in cases of neuralgia.
Most of the other oleates of the alkaloids are made in
the strength of two per cent., e.g., strychnia, veratria,
and atropia. They all act with rapidity, though hardly
so promptly as the aconitia solution. Five minims of
the oleate of atropia applied to the knee-joint produces
dilatation of the pupil in a short time. This oleate
rubbed upon the skin and covered with oiled silk or
gutta-percha tissue acts very much like a good bella-
donna plaster.
The oleate of morphia is made with a strength of five
per cent. Five to ten minims applied to the abdomen
and covered with oiled silk is the usual dose for children
of one to four years. There is considerable evidence
that opium acts very well administered in this way, pro-
ducing very little constipation or gastric disturbance.
The oleate of quinia contains, or should contain, about
twenty-five per cent, of quinia in solution. A fluidrachm
would contain about seventeen grains (gr. xvij.) of the
salt. The preparation may be used hypodermically or
epidermically. In the latter case as much as two
drachms must be rubbed in at a time, and it should be
covered with oiled silk. A person can get the tonic ef-
fects of the quinine by rubbing the oleate upon himself
morning and night.
The epidermic medication by the use of oleates evi-
dently deserves attention, if only to determine the limits
of its usefulness. The skin is normally a protective, not
an absorbing organ, and it can never be depended upon
as a medium of medication like the iirimre vi;e ; but it
can, no iloubt, be utilized more often than is now done,
and to the savins; of more delicate tissues.
WOUNDS IN THE COURSE OF DIABETES.
The recent death ofGambetta, who was reported to have
been a sufferer from glycosuria, revives the interest in the
question of operations in diabetes. That wounds occur-
ring in diabetic patients are prone to resist treatment, and
to be followed by phlegmonous inflammation, has long
been known. The frequent occurrence of gangrene and
unhealthy inflammatory processes in such cases was first
observed by a French military surgeon, Marchal de
Calvi, in 1853. ^sn years later, he had already col-
lected a series of one hundred and thirty-three illustrative
cases. He made the observation that it was generally
the otherwise healthy and robust-looking patients, and
especially those of middle age, who were most fre-
quently affected in this way.
Nelaton and Verneuil, and, later, Peyrot, have also
recorded corroborative cases. In Germany, Wagner and
Oriesinger, have in turn discussed the subject. More
recently, a work by Dr. Roser has appeared, in which he
states his conviction that the development of inflamma-
tory processes, in the course of diabetes, is due wholly
and solely to the altered condition of the blood. He
believes the gangrenous and phlegmonous processes to
be entirely ditterent from those of the non-diabetic, being
altogether independent of the possible entry of septic
germs from without. Hence antiseptic treatment is not
sufticient alone to ward off septic inflammation. Only
when coupled with strict antidiabetic diet is it of any real
value.
Other German writers, as Kraske and Konig, believe,
however, that the infection takes place from without.
But they atfirm that the condition of the blood in dia-
betes is especially favorable to the further development
of the morbid processes. Indeed, it is often favorable to
such an extent that antiseptic treatment is of no avail.
Still more recently, Dr. Mtiller has given his attention
to this subject (Aerztliches Intelligenzblatt ,'i'io. 41, 18S2).
From the consideration of a large number of cases, col-
lected from various sources, he finds that strict antidia-
betic rules of diet are of the utmost importance. Indeed,
the antidiabetic treatment is far more conducive to the
healing of the wound than the antiseptic treatment of the
wound itself
The author's paper suggests once more the question,
whether operations ought to be undertaken upon diabetic
patients or not. The opinions of Marchal, Verneuil, and
Roser may be accepted in answer. They all agree that
operations should never be performed in such cases un-
less they are absolutely necessary ; and only then if
some imiirovement has been found to follow uiion a
course of dietetic treatment, and if the patient be other-
wise in fair health. Careful dieting, therefore, should
72
THE MEDICAL RECORD.
[January 20, 1883.
invariably be enforced both before and after the opera-
tion.
In view of such unequivocal testimony we may
well question the propriety of recent German strictures
upon the treatment which Gambetta received at the
hands of his attending physicians and surgeons. The
spirit that prompts such utterances as those of Dr. P.
Niemeyer (who, it will be remembered, directly accused
Gambetta's physicians of indirectly causing his death by
unduly postponing an operation) cannot be too severely
censured.
THE KINGSTON MEDIC.\L SCHOOL AND MEDICAL CO-
EDUCATION.
An event occurred at the Kingston Medical School, not
long ago, which furnishes an unpleasant picture of medical
students and medical education in Canada. The Kings-
ton Medical College some time ago organized a course
of lectures for female students. Matters went on
smoothly enough until December last, when the lecturer
on physiology touched upon the subject of castration.
His remarks were received with cheers and stamping, all
eyes being turned on the seven female students present.
The latter finally left the room in a body and complained
to the Faculty. The male students held an indignation
meeting and sent a memorial to the Faculty, which was
offensive in tone, and which ended with the declaration
that, unless the female students left, the male students
■would go themselves. The Faculty, very properly, re-
fused to be dictated to. But while a discussion was
going on, the Trinity Medical School, at Toronto, made
an offer to take the Kingston students who had already
paid their dues for nothing, and the rest for half-price !
This forced the Kingston Faculty to yield to the demands
of the students.
If the above account of the affair, which we take from
the Canadian Practitioner, be true, and there is no reason
to doubt it, invective is hardly strong enougli to fitly
characterize the action of the Trinity School. To take
advantage of another's distress, to strike a mnn when he
is fallen, is considered by honest men as the last e.xcess
of infamy. Unless this Trinity College can e.xplain it-
self, it will always have the flavor of carrion about it in
American nostrils.
The dean of this school, to be sure, says that the Faculty
thought that the Kingston medical students had entirely
withdrawn from their school. But it is not explained
why credit was offered for lectures of which certificates
were refused by the professors, or why their offer was
made with such haste and such absence of consideration
for a sister Faculty.
The affair is a serious drawback to medical co-educa-
tion in Canada.
THE HOSPITAL SATURDAY AND SUXD.W COLLECTION.
It is very evident that the Hospital Saturday and Sun-
day movement is not responded to by the public in a de-
gree that corresponds with its merits. The sum collected
this year, up to January 15th, was only $26,354.92, out
of which about $1,200 is to be taken for expenses. Fur-
ther sums are expected, but it does not seem possible to
reach even the sum contributed last year, which was about
$40,000.
This is in marked contrast to the collections made in
London, which amounted in 1S81 to $170,730, this sum
being contributed by 1,338 congregations.
There is in London a much more hearty co-opera-
tion of the churches than in New York. The Catholics
unite in the work there, but do not do so here. A very
extraordinary indifference was shown by Protestant
churches also. Thus, of 38 Baptist churches only i re-
sponded ; of 21 Lutheran churches none; of 55 Meth-
odist, only 4; of 50 Presbyterian, only 5 ; of 71 Protes-
tant Episcopal, only 43 ; and of 20 Reformed Dutch
churches, only 5.
^cuis of the ^Xcch.
Kings County Medical Society on the Instruc-
tion TO Delegates.- — At the meeting of the Kings
County (N. Y.) Medical Society held on Tuesday even-
ing, January i6th, the resolution instructing the dele-
gates to the State Medical Society to vote for the old
Code was rescinded by 49 to 26. Dr. Lewis S. Pilcher,
an avowed opponent of the old Code, was elected as one
of the delegates to fill a vacancy.
Tariff on Quinine and Cinchonidia. — It is re-
ported that the Committee on Ways and Means have
stricken quinine and cinchonidia off the free list.
The Pension Bill was passed by Congress January
13th. The following are some of the item^: For army
pensions, $80,000,000; for navy pensions, $1,000,000.
Fees and expenses for examining surgeons, $275,000.
The allowance of from $12 to $35 jier month is made
for the loss of an eye, and $50 per month for both eyes,
while the loss of hearing is estimated at $25 per month.
More Bodv-snatching in Montre.-\l, Canada. —
Four bodies stolen from the cemetery at St. Marline, have
been discovered, packed in boxes, in St. Jean Baptiste
village. They were duly returned to their vaults. No
arrest has yet been made.
Cerebro-spinal Meningitis in Indiana. — Spotted'
fever prevails in Rush County, Ind.
Care of the Insane in Wisconsin. — Governor
Jeremiah M. Rusk, of Wisconsin, in his annual message,
January nth. calls attention to the necessity of caring
for the insane in properly equipped State hospitals, and
strenuously advises against the employment of jails and
almshouses as asylums.
Cow-pox in B.-\ltlmore County. — Spontaneous cow-
pox is said to have broken out in a herd of Alderney
cattle in Baltimore County, Md.
Dr. D. W. Butler, of Connerville, i\rd., injured by
the cars on Saturday last, is reported in a critical condi-
tion from supposed internal injuries.
Scarlet Fever prevails as an epidemic in Walla
Walla, I. T.
Burning of a S.mall-pox Hospital. — The Sailors'
Smallpox Hospital, near Crisfield, Md., was destroyed
January 13th, by fire, caused by the upsetting ofakerosene
lamp by a delirious patient. The latter subsequently
died from exposure. No other lives were lost.
January 20, 1883.]
THE MEDICAL RECORD.
73
The Dispensary for Nervous Diseases in Baltimore,
under the charge of Dr. John Van Bibber, is reported to
be a thousand dollars ahead of its expenses during the
past year. The small fee system appears to e.xplain the
result.
Steam-Heating and Foul Odors. — Some of the busi-
ness men in the lower part of the city have complained
of foul odors which arise from the steam-heating pipes.
The Health authorities have found that in laying the
pipes gas has been liberated from the saturated ground,
and that the composition of tar and other materials with
which the pipes have been covered also give out a sicken-
ing smell when lieated.
A Baby-Show in Hamburg, on the American plan,
is about to be inaugurated under very promising
auspices.
Mutual Aid Societies in Vienna and St; Peters-
burg.— At Vienna and St. Petersburg Physicians' Mu-
tual Aid Societies have at length been organized.
The Philadelphia County Medical Society. — The
Philadelphia County Medical Society has elected its offi-
cers for 1883. They are : President, Dr. William M.
Welch ; Vice-Presidents, Dr. W. R. D. Blackwood and
Dr. A. Hewson ; Secretary, Dr. Henry Leffmann ; Treas-
urer, Dr. Louis K. Baldwin. This society has about
four hundred members, and with three meetings every
month accomplishes a great deal of work. As it is the
only body competent to send delegates to tiie Medical
Society of the State of Pennsylvania and to the Ameri-
can Medical .Association, it includes ii> its membership
nearly all the active medical men of the city.
Policlinic in Baltimore. — Following the e.xample
of New York and Philadelphia, a Policlinic is to be estab-
lished in Baltimore.
First Aid Society. — The Police and Fire Commis-
sioners respectively recommend the members of their
forces to attend the lectures given by the First Aid
Society.
A Liberal Donation to the German Dispensary.
— It is rumored that Mrs. Oswald Ottendorfer, a wealthy
German lady of New York, has donated one hundred
thousand dollars to the German Dispensary of this city.
This will materially increase the usefulness of this thriving
institution, by enabling its managers to obtain a larger
building, which is much needed.
F"ees for Legal Services to Government. — Over
seventy thousand dollars have already been paid lor ex-
tra legal services in the Star Route case, and the end is
not yet. How does this sum compare with the beggarly
amount that was paid the physicians who so faithfully
attended the late President Garfield. Is there no com-
mittee sufficiently competent, before whom these legal
claims can be brought for proper adjustment regarding
true value received ?
The Assembly Standing Committees. — The ap-
pointments to the following committees will be of more
or less interest to members of the medical profession
throughout the State :
Public Health. — Messrs. Nelson of Cortland, Dele-
hanty of Albany, Craig of Steuben, Sheridan of Kings,
Murray of Fulton and Hamilton, Roesch of New York,
MuUaly of New York, Derrick of Rensselaer, Benjamin
of Steuben, Wertelman of New York, and Mulholland of
Kings.
Stale Charitable Institutions. — Messrs. Bartlett of
Broome, Odell of Orange, Roesch of New York, Burns
of Kings, Emans of Dutchess, Nelson of Cortland, Bene-
dict of Ulster, Page of Wyoming, and Geddes of Onon-
daga.
General Laws. — Messrs. Townsend of Oneida, Searl
of Steuben, Burns of Kings, Higgins of Niagara, Snyder
of Schoharie, Wilcox of Erie, Quinn of New York, Arm-
strong of Washington, Boynton of Essex, Cleveland of
Yates, and Brooks of Putnam.
The National Association for the Protection
OF the Insane and the Prevention of Insanity
holds its annual meeting in Philadelphia, on January
25th, at the College of Physicians. There will be an
afternoon and evening session. The Address of Wel-
come will be (Jelivered by Samuel D. Gross, M.D. The
following papers will be read : " Functions of the Medi-
cal Staff of an Insane Hos|)ital," by Prof. Traill Green,
M.D., of Easton, Pa. ; " Preventable Causes of In-
sanity," by Dr. J. S. Jewell, of Chicago ; '' How to Pro-
tect the Insane," by Dr. Josepli Parrish, of Burlington,
N. J. ; " The Duty of Medical Colleges and the General
Practitioner toward Mental and Nervous Diseases," by
Dr. C. K. Mills, of Philadelphia; "Obligations of the
Sane toward the Insane," by Rev. R. Heber Newton ;
"The Prevention of Insanity in Certain Cases of Ner-
vous and Hysterical Women," by Dr. H. Marion Sims;
"The Legal Rights of the Insane," by Clark Bell, Esq.,
of New York; "The Prevention of Insanity by the
Rational Treatment of Inebriety," by Dr. T. D. Crothers,
of Hartford, Ct. Remarks will be made by Hon. H.
M. Hoyt, ex-Governor of Pennsylvania.
A New Anatomy Act for Pennsylvania. — The
Anatomists' Association of Philadelphia expects to have
a new Anatomy bill introduced during the present ses-
sion of the Pennsylvania Legislature. This bill will
give the unclaimed bodies of all counties to the profes-
sion for scientific investigation and for educational pur-
poses. At present the Philadelphia colleges, with their
hundreds of students, have no legal supply except from
the city of Philadelphia ; yet the colleges advertise for
students, claiming to have an abundant supply of mate-
rial. The inertia of these institutions, since the imper-
fect Anatomy Act of 1867 was passed, is remarkable.
The Philadelphia County Medical Society has opened
a correspondence with all other county societies in the
State, requesting co-operation in an endeavor to have
the new bdl passed. Unless petty jealousies weaken
the force of the movement, the united force of the pro-
fession will be able to accomplish much good at Harris-
burg.
A Bill to Provide for the Proper Incarceration
op Lunatics has been presented in Assembly by Mr.
Hodges, of Brooklyn. It provides that no person shall
be confined as a lunatic without first having been tried
by a jury before a Court of Record.
74
THE MEDICAL RECORD.
[January 20, 1883.
Pasteur announced at the meeting of the Academy
des Sciences that 85,000 sheep had been inoculated for
anthrax. The niortaHty from this disease had fallen
from 9 per cent, to 0.75 in consequence.
JouRN.M,iSTic Changes for the Year. — There are
few new medical journals this year, but a good many
changes in the old ones. Our wide-awake and interest-
ing contemporary, The Michigan Medical News, has
consolidated with The Detroit Clinic. The combination
is to be called The Medical Age, and is to be published
by Mr. G. S. Davis. We are glad to learn that Dr. Mul-
heron is to continue as managing editor. The Rocky
Mountain Medical Times has cliosen a less rugged title,
and a|ipears as The Denver Medical Times, Dr. F. Mar-
quand Trask being added to the editorial stat^'. The
Canadian Journal of Medical Science has become The
Canadian Practitioner. The Sanitarian has become a
weekly. It is published in quarto form, double cohnnn,
sixteen pages. Dr. S. N. Bell continues as editor, and
Dr. T. P. Corbally as associate. The journal has secured
a large list of collaborators, including many of the i^ronii-
nent sanitarians of the country. The Sanitary Neics is
a new weekly recently started in Chicago. The Inde-
pendent Practitioner starts out with a new editorial staft"
consisting of Dr. Leigh H. Hunt and W. C. Barrett,
D.D.S., M.D. The Planet is the title of a new monthly
medical journal ])ublished in New York, and edited by
Dr. C. E. Nelson. Contrary to what its title indicates,
it will not shine by reflected light, but will contain only
original articles. The American Medical Bi-Weckly has
become The American Medical Weekly, and under its
experienced editor will doubtless continue to take a front
rank in medical journals.
Aluminium. — The recent discoveiy of a process by
which aluminium can be manufactured cheaply in large
quantities has created much excitement. It will be well
for ingenious members of the medical profession to re-
member the properties of this metal. Aluminium is a
white metal having a somewhat bluish lustre when
polished. It is very malleable and ductile, 3-et very
tough, and is about as light as glass or porcelain. It is
very sonorous, and an excellent conductor of heat and
electricity. It is unaltered by exposure to air — even
moist air. It is not attacked by nitric or sulphuric acids,
but hydrochloric acid rapidly dissolves it. It has been
chiefly used in the arts as an alloy for making bronzes,
etc.
The Bellevue Training-School for Nurses held
its tenth annual meeting last week, and gave diplomas to
twenty nurses. There have now been graduated one
hundred and sixty-eight in all. Three of these have re-
cently gone to Italy to establish a training-school in
Rome.
A State Board of Pharmacy. — .'\t the meeting of
the Erie County Medical Society, T. M. Johnson, tlie
President, delivered an address in whicli he urged the
necessity for the creation of a State Board of Pharmacy.
The Counties of New York and Kings now have laws
regulating pharmacy, but in the other counties alniohi
any one may sell drugs and [)oisons. .\ bill will bo sent
to the Legislature for the correction of this state of
things.
Smai.l-pox. — Small-pox is on the increase in Balti-
more, Montreal, Atlanta, Roanoke County, Va., and
in different parts of Kentucky.
Regulating Pharmacy in Pennsylvania. — A bill
has been introduced in the Pennsylvania Legislature for
the purpose of regulating the practice of pharmacy, the
sale of poisons, and preventing adulterations.
Surgeon-General of Massachusetts. — Dr. O. G.
Cilley, of Boston, has been appointed Surgeon-General
on General Butler's staff.
Dr. Ebenezer Dearborn, of Nashua, New Hamp-
shire, one of the oldest physicians in the State, died on
Monday, aged ninety years.
Death of Samuel A. .Mudd. — Dr. Samuel \. Mudd;
the physician who set the leg of Wilkes Booth, the as-
sassin of President Lincoln, died on Wednesday, at Bry-
antown, Charles County, Maryland. He was fifty years
old, a member of an old Maryland family.
Dr. Y,. .Mussev Hartwell has been selected in-
structor of the proposed gymnasium for the muscular
development of the students at the Johns Hopkins Uni-
versity. On January 10th he introduced his course of
lectures by one on "The Development of the Human
Body." A large audience was present.
The Florida Medical Associ.ation held its annual
session at Jacksonville, on the i6th.
Bitten by a Squirrel. — Dr. ^V. G. Stedman, of
Southington, Conn., was bitten last week in the hand by
a pet squirrel; severe lymphangitis ensued, and it was
feared he would' lose his arm.
Bad W.\ter in Philadelphia. — The drinking-water of
Philadelphia is reported to be unwholesome.
Suit for Libel by a Physician. — Dr. William A.
McDonald, of Lynn, Mass., has sued a Roman Catho-
lic priest of that place for libel. It is claimed that the
latter charged the physician with being unskilful and ad-
vised persons not to employ him.
Stricken with Hemiplegia. — Dr. Samuel R. Rixey,
a prominent physician of Culpepper Court House, Va.,
has been stricken with hemiplegia.
Prosecution of Druggists for Practising Medi-
cine.— Several druggists in Quebec are to be prose-
cuted for practising medicine without licenses.
East River Medical Association. — An interesting
paper was read before the East River Medical Associa-
tion last evening, at the house of Professor J. D. Bryant,
by James R. Taylor, M.D. Subject, " The Fractures of
the Long Bones." The doctor had quite a number of
well-executed engravings i)repared expressly to illustrate
his views, which were distributed during the reading. He
also exhibited several entirely original mechanico-surgi-
cal appliances, which he uses in his practice. The paper
was well received by those present, and generally en-
dorsed as a valuable contribution to the literature of the
subject.
American Pork. — The authorities at Berlin are dis-
cussing the jiropriety of prohibiting the importation of
.American pork, which is said to be largely infected with
trichina:.
January 20, 1883.]
THE MEDICAL RECORD.
75
^Icuicius and Notices.
Microscopical Morphology of the Animal Body
IN Health and Disease. By C. Heitzmann, M.D.,
late Lecturer on Morbid Anatomy at the University
in Vienna, Austria. With .^80 original engravings.
8vo, pp. S49. New York : j. H. Vail & Co.' 1883.
Under the above title Dr. Heitzmann has collected and
published some twentv-two chapters of varied matter, in-
tended to be illustrative of the experience acquired by
" ten years' intense labor." A more curious medley of
strange assertions, premature conclusions, and extrava-
gant theories it has rarely been our lot to peruse. At
times we feel constrained to l.ielieve that the author is
merely an artful satirist, so keen and rich is the quality
of his humor. But there are other passages in the book
that present the stolid front of undisputed and indisput-
able fact, where real science is not made to blush in the
presence of pseudo-scientific posing.
Dr. Heitzmann evidently felt unequal to the task of
writing single-handed so great a work on microscopy.
He has accordingly secured the invaluable collaboration
of such well-known histologists as Schoney, Hassloch,
Hoeber, Klsberg, Tauszky, Frankl, Miiller, Johnstone,
and other eminent scientists. It is perhaps not sur|)ris-
ing, therefore, that the result achieved by the combmed
eftbrts of so many able and competent observers should
be in many respects a truly brilliant one.
The preface is a masterpiece in its way. It must be
read and studied from beginning to end, in order to be
fully appreciated. Dr. Heitzmann. it should be remem-
bered, scored a brilliant fiasco in Europe as regards the
recognition of his flights of fancy. But then he informs
us that " European microscopists are, to a great extent,
prejudiced bv the teachings of the older masters." The
new master has " received in New York much encourage-
ment from students and co-workers." He has also
" been magnanimously supported by a friend, who is not
a medical man, but a prince in character and wealth,
and who surpasses most European princes in that he
will not allow me (Heitzmann) to inscribe his name u|)on
the dedicatory page." But in addition to this interest-
ing, imjiortant, and withal graceful personal explanation,
" The United States," we are told, " are ahead whenever
new ideas of practical importance are to be acknow-
ledged." Now, as regards histology, .America is ever
ready to concede to Europe a well-earned pre-eminence.
Moreover, even America is by no means prepareil to
accept Heitzmann's morphological vagaries as the gos-
pel of scientific truth in microscopy.
Most of the articles in this volume have already ap-
peared elsewhere, and not a few are translations of papers
published in German years ago. In all essential feat-
ures, the author still adheres to his former peculiar views
on protoplasm, or, as he now prefers to call it, " bio-
plasson." But the network of living matter, which he
holds to be the morphological foundation of all animal
life, is by the vast majority of competent microscopists
accepted only as the reticulum of cellular death.
It may not be amiss to illustrate by a few quotations
the author's style and some of his hasty assertions.
Tearing and teasing of tissues he utterly condemns as a
most objectionable method of preparation. All working
histologists know, however, that it is an indispensable
procedure for many examinations, and that perhaps no
other single method has yielded so many and such prac-
tical results as this one. Glycerine is the only licjuid
which he fully recommends for permanent mounting.
This again runs counter to universal experience, which
has found in the various balsams the best means for
permanent mounting. Glycerine is of special value for
hasty and temporary mountings. In this connection
Heitzmann also writes (p. 81) as follows : " The process
of mounting in glycerine is simpler and easier than any
other method, and, if all precautions mentioned are
carried out witli care, no change," etc. " True glycerine
specimens need more careful handling than balsam spec-
imens." The contradiction contained in these state-
ments is apparent at once. " Ammoniacal carmine
solution is the most satisfactory for staining specimens
obtained after hardening in chromic acid." Most histolo-
gists have found ha;matoxylon, eosine, and other dyes far
superior to carmine for chromic acid specimens, ".^fter
Elsberg's at present almost generally adopted designa-
tion, we shall term the molecules of the living matter
• )5lastidules '" (p. 13). So far fron) being generally
adopted, Elsberg's designation is as little known as his
competency as a histologist is widely recognized. On
page 17 this well-known laryngologist is also preferred
to Darwin and Hajckel as a successful theorist on pro-
toplasm. And here we may mention that although
Heitzmann rejieatedly asserts that he has discarded the
term protoplasm altogether, he almost constantly em-
ploys it throughout the volume.
By looking at a pus-corpuscle Heitzmann is able to tell
" whether the person from whom the pus comes is healthy
and strong, or weakened by chronic disease, as tuber-
culosis" (p. 32). We doubt whether any conscientious
histologist would dare to imitate this wild feat. But
in hundreds of such examinations (p. 59) Heitzmann has
diagnosed constitutional conditions from the appearance
of the network in leucocytes. And as he modestly adds,
" I was right in every instance ; not one mistake has oc-
curred.'' And again, " To-day ray hopes have turned
into accomplished facts," meaning his pus-corpuscular
hopes, expressed some three years ago. "Thus I have
arrived at a point of perfection which allows me to tell
the constitution of a person without knowing anything of
his former life" (p. 60). " The bioplasson is one unin-
terrupted mass throughout the body, and is connected
from the top of the head to the heels, in what we call tis-
sues " (p. 61). "The animal body, as a whole, is one
protoplasmic mass, in which are imbedded a relatively
small number of isolated protoplasmic corpuscles, and
various other non-living substances" (p. 131). Now all
this uninterrupted mass strikes us rather as an uninter-
rupted and unmitigated mess. Moreover, it is the veriest
jihysiological heresy to assert that the healthy normal body
contains dead ingredients in a morphological sense. All
non-living particles would necessarily act as foreign bod-
ies in healthy tissues or organs. On page 135 we learn
that the " cell-theory had to be abandoned in the light of
my investigations." As a matter Of fact this theory is
still largely dominant, and certainly no more acceptable
explanation of various histological and pathological phe-
nomena has yet been advanced. Biologists will doubtless
be pleased to know that "on cartilage-tissue have mainly
rested, for the last forty years, our biological views " (p.
141).
It is clearly impossible, within the limits of the present
notice, to particularize more fully the numerous extrava-
gant notions and eccentricities container] in the pages of
the work before us. One is surprised also at the spirit
in which it is conceived and written. For nobody can
fail to read between the lines the bid for laboratory stu-
dents, and the too evident desire at self-advertisement.
Witness only the following selections: "A few months'
— nay, a few weeks' — thorough study under the direction
of a reliable teacher will suffice to enable every one to
see what really can be seen in the plastids," etc. (p. 60) ;
" Life insurance should be based upon microscopical
examination" (p. 6r) ; "Marriages should be allowed in
doubtful (?) cases only upon the permit of a reliable nii-
croscoiiist" (p. 61); "Many examinations, etc., have
enabled me to reach a certain degree of positiveness in
the diagnosis of the diseases of the genito-urinary tract.
The microscopic analysis of the urine also requires a
thorough study, which, however, is greatly facilitated by
the guidance of a reliable and experienced teacher."
In justice to the author it must be said that his work
76
THE MEDICAL RECORD.
[January 20, 1883.
is not without redeeming features. Many of the draw-
ings are beautifully executed, and cannot fail to be ad-
mired. Practical suggestions as to methods of prepara-
tion are found among others which are the reverse of this.
Although no attempt at a systematic presentation of the
facts of normal and pathological histology has been made,
nevertheless scarcely a living issue in these branches is
left untouched. Here and there some really valuable
expression of opinion may be found — valuable rather in
its stimulating further thought and study than in direct
worth. In their jiresent status Heitzmann's notions may
be likened to some turbid solution, in which time and
calm repose may yet allow the formation of clear crystals
representing scientific thought and truth. It is to be
hoped that this much-needed time and repose may be given
before a second edition of Heitzmann's book appears.
The Pharmacopceia of the United States of Amer-
ica. Sixth Decennial Revision, b)' Authority of the
National Convention for Revising the Pharmacopoeia
held at Washington, a.d. 1880. New York : Win.
Wood & Co. i88'2.
In most civilized countries, the necessity for some
standard as to the quality and preparation of drugs that
are in use by the profession, has led to the publication of
some work that may be regarded as the authoritative ex-
position of this standard. In most European countries
the government gives the necessary authority for the
preparation of the work, which, wlien published, receives
the name of The Pharmacopeia. In America, however,
the Federal Government does not itself possess the
power to authorize the publication of such a work, this
power pertaining to the respective States. If, however,
each State should establish its own Pharmacopeia, in-
evitable confusion would result. To obviate this, a plan
was devised fifty years ago, and has been in successful
operation ever since. Every ten years a convention is
held in Washington, which convention is composed of
representatives appointed by the several State societies,
medical colleges, and pharmaceutical associations. The
last convention was held in May, 1880, at which time a
general plan for revising the pharmacopoeia was agreed
on, and a committee, consistmg of twenty-five physicians
and pharmacists was appointed to carry it out. This
committee were w'ell known in their respective profes-
sions, and well qualified for the special task before them.
On examining the list we find all sections of the country
represented, Massachusetts and New York at the East
and North, North Carolina and Missouri at the South and
VV'est. The committee devoted a little more than two
years to the work of revision, and the result of their la-
bors is now before us. On examining the work we are
at once struck with the important dift'erences that exist
between it and its predecessors.
The previous Pharmacop(.eias were mere skeleton
works, of comparatively little use to pharmacists, and of
still less utility to physicians. As a consequence, it was
rarely met with in the libraries of the latter. The new
Pharmacopoeia,on the other hand, is indispensable to drug-
gists, and is at the same time one of the most practically
useful books of reference with which we are acquainted.
The arrangement of its contents is alphabetical, and un-
der the name of each crude drug we find a list of its
officinal preparations. Under each drug we also find a
very complete description of its physical appearances, so
that it may be readily recognized and distinguished from
spurious and adulterated articles, chemical tests being
given where necessary. A large number of obsolete
drugs and preparations have been dropped, and about
an equal number of new ones have been added, as well
as several entirely new processes for their preparation.
Among these latter we notice abstracts, triturations,
tinctures of fresh plants, etc. Abstracts are milk sugar
preparations, each grain of which represents two grains
of the crude drug. Triturations, on the other hand, pos-
sess one-tenth the strenL'th of the original. The former
are well adapted to the dispensing of belladonna, digi-
talis, etc., while the latter render the dispensing of the
stronger alkaloids, etc., more safe and accurate, and will
prove useful in jirescribing some of the metallic salts. In
many cases patients find it more convenient to have
their medicine in a dry or solid form, that can readily be
carried about the person. Especially when travelling is
the ordinary bottle medicine a nuisance, and many are
averse to the old-fashioned pill. These two preparations
in powder form are likely to become popular with pa-
tients, even if they are slow of adoption by physicians.
We note that the strength of some of the preparations
varies a little from the former Pharmacopceia — notably in
the case of the fluid extracts, which are about five per
cent, weaker, a difference of three or four drops to the
teaspoonful. The opium preparations will be somewhat
stronger, but at the same tiuie more uniform.
The arsenical solutions have a uniform strength of
one per cent.
As a rule the formula; are indicated in parts by weight,
as in most of the Continental Pharmacopceias ; in the case
of pills, however, absolute weights are used, and a double
formula — troy and metric — is given, the result in either
case being the same.
There are a few changes in the nomenclature that it
would be well for the careful prescriber to familiarize
himself with.
Many useful tables will be found at the end of the
volume — such as a table of elementary substances, with
their symbols, atomic weight, and equivalents ; a table
of thermometric equivalents according to the Centigrade
and Fahrenheit scales ; tables of percentage and specific
gravity, including alcohol, acetic acid, hydrobromic acid,
hydrochloric acid, nitric acid, sulphuric acid, [ihosphoric
acid, etc.; a table of the solubility of chemicals in water
and in alcohol, and saturation tables. There is a list of
articles added to the pharmacopoiia and one of those
dismissed from it; lists of changes of officinal Latin and
of officinal English titles ; a table exhibiting differences
of strength of the preparations, as made according to the
last and the present pharmacopceia; and, finally, tables
of weights and measures.
If once on the physician's table, this w-ork will prob-
ably be more frequently consulted as an aid to prescrib-
ing than any other book in his library, for it represents the
results of the latest scientific researches. The committee
who had this work in hand deserve great credit for bring-
ing the work up to the present needs of the profession.
Owing to the alphabetical arrangement of the articles ,
described the work will be found to be exceedingly con-
venient for reference, and in addition there is a very
complete index appended to the volume. It is issued
in capital style.
Barbers' Basins and Sewer-Gas. — A new danger
has been discovered by the Lancet, a danger of breath-
ing sewer-gas from the waste-pipes of barbers' basins, when
being shampooed. The danger is the more serious be-
cause the whiff of germ-laden gas would pass unnoticed
among the scents and sweet odors of the barber shop,
and the unconscious victim while breathing rose and jas-
mine, would also be absorbing the bacteria of various
diseases. Probably the basins of the average barber
shop are no better plumbed than other fixtures are, un-
trapped w^astes and siphoned traps may make as many
open connections with the drain as are found in the
average of other buildmgs, but, on the whole, we regret
that the Lancet has directed attention to this subject,
because it gives opportunity to the barber to ask the
man in the chair to take one more article than is on the
list now. When the present category of oils and scents,
bay rum and hair reviver is gone through there will here-
after remain the inquir)-, whether the m. c. will not take
a little disinfectant through an atomizer? On behalf of
the shaved community we protest. — Sanitary Engineer,
November 23, 1882.
January 20, 1883.]
THE MEDICAL RECORD.
n
^cpoi'ts of J>ocicticj5.
%
NFAV YORK PATHOLOGICAL SOCIETY.
Stated Meeting, December 2J , 1882.
George L. Peabody, M.D., Vice-President, in the
Chair,
report of the committee on microscopy.
Dr. W. R. Birdsall, of the Committee on Microscop)-,
reported that they liad examined tlie microscopic sec-
tions of the tumor presented by Dr. Ferguson, and sus-
tained his report, which is herewith submitted :
"CARCINOMA OF THE FUNDUS UTERI.
" Abnost the entii'e fundus of the uterus is occupied by
a soft tumor, nearly pear-shaped, the antero-posterior
diameter of which is one and three-fourths, and the
vertical diameter three and one-fourth inches. From
its base of attachment at the fundus it extends down-
ward, polypoid in form, distending the body and neck of
the uterus, and presenting by a blunt terminus at the
external os. This projecting portion of the tumor is
constricted circularly, the constriction corresponding to
the internal os. The consistency of the tumor is uniform
throughout, and both its consistency and appearance are
characteristic of a medullary carcinoma.
"The examination of sections made from different
parts of the tumor, especially regions of most recent ori-
gin, shows it to be composed of epithelial cells and a
connective tissue stroma.
"The alveolar arrangement of this stroma is charac-
teristic of carcinoma, the alveoli differing in size and
shape.
"The alveolar walls vary mucli in thickness, and con-
tain nunieious young cells and few connective tissue
nuclei.
" Certain areas in the interior of the tuinor have un-
dergone retrograde changes.
" In places throughout the tumor are seen limited
areas of uterine tissue, in which the morbid growth was
developed.
" The cells which fill the alveoli difter in different
places ; they are large cuboidal or low cylindrical cells,
where they line the walls which limit the~ alveoli. They
are smaller in the centres of the alveoli, where they are
irregular in shape. Each cell is furnished with a distinct
large nucleus.
" The tissue of the tumor is not very vascular, but it is
worthy of note that the tissue of the uterus in the neigh-
borhood of the growth is much more bountifully supplied
with blood-vessels than the uterus elsewhere, or than the
normal non-pregnant uterus.
" (Signed) F. Ferguson."
Dr. \V. H. Porter suggested that this growth, which
now presents the characteristics of a carcinoma, proba-
bly originated in a papilloma, the alveolar ap|)earance
represeiiting the remains of the former interpapillaiy
spaces.
The vaginal tumor presented by Dr. Tauszky at the
stated meeting, November 22, 1882, showed, on section,
an abundant development of apparently new epithetial
corpuscles, witli many bundles of fibrillated connective
tissue. At one point there were large cells, with smaller
ones arranged in a concentric manner around the large
central cells, but no well-developed epithelial nests were
seen. Tiie growth, however, presented a suspicious appear-
ance, although there was no positive evidence that it
was an epithelioma.
cancer of the omentum, mesentery, PANCREAS, AND
STOMACH.
Dr. VanGieson presented the liver, the kidneys, the
spleen, the pancreas, a portion of the small intestines,
with the mesentery, and the right lung removed from the
body of a man who, when he first saw him, was sitting in
a chair and had evidently been a great sufferer for a long
time. He was sitting with his head leaning forward and
occui)ying the position usually assumed when suffering
from great dyspncea. His dyspncea was extreme, but it
was somewhat relieved by inhalations of nitrite of amyl.
The patient died on December igth and the autopsy
was made on the 21st. Dr. VanGieson learned that the
man had, for three years, been more or less an invalid.
For a long time he was treated for dyspepsia without re-
lief, and for the last year he had been compelled to remain
at home at least three or four days each week from his
work. His occupation was that of a turner, and during
his business he was accustomed to press his abdomen
against the material on which he was at work. The en-
tire history of the case was that of one in which the
patient had suffered from some form of malignant disease
of the abdominal organs. Dr. Joseph Hilton, of New
York, was the last of many physicians who saw him, and
was the one who first made a correct diagnosis. A some-
what remarkable feature of the clinical history was cedema
of the right arm and left leg, while the left arm and right
leg were unaffected. At the autopsy the omentum was
found filled with carcinomatous growth, also the intestine
and mesentery was studded with numerous cancerous
nodules, and the head of the spleen was infiltrated with
cancerous deposits. There was also cancer of the stom-
ach, but there were no secondary deposits of the liver.
The kidneys were apparently healthy. In the right pleural
cavity there were about three pints of clear serous fluid.
The right lung was compressed and was adherent at the
upper portion of the chest wall. The bronchial tubes
were thickened. The single symptom which led Dr.
VanGieson to make the diagnosis of mesenteric cancer
was the fact of oedema of one limb, without disease of the
heart or kidneys. In a similar case, the specimens from
which he presented to the Society seven or eight years
ago, cedema was quite characteristic, whereas he believed
in simple cancer of the stomach, cedema was very rare
unless some other organs were involved, as the kidneys
or the heart. There was no ascites.
Dr. Van Santvoord said that Trousseau had directed
attention to cedema of one of the lower extremeties as a
symptom of malignant disease within the abdominal
cavity, and regarded it as a valuable aid in making a
diagnosis in case of obscure abdominal affections.
fibro-mvomata OF the uterus of the sea-lion.
Dr. Liautard presented the uterus and its appendages
removed from a sea-lion belonging to Barnum's collection
of animals. The animal had exhibited no special symp-
toms of disease, and had a good appetite up to twenty-
four or thirty-six hours before death. At the autopsy
there were found double pneumonia and parasites in the
small intestine, and at the junction of the left horn with the
body of the uterus there was found a large tumor which
presented the gross appearances of fibromyoma as it
occurs in the human subject.
CYST containing HAIR.
Dr. Liautard also presented a cyst containing hair
which he had removed from the side of a saddle-horse, a
little posterior to the left shoulder. At that point there
was a movable elongated tumor, about the size of an
English walnut. After making an incision through the
skin the tumor was easily enucleated, and when opened
it was found to contain a large amount of curly hair,
mixed with sebaceous material. Another tumor, similar
in feel, and about three inches in length, was removed
from another part, and on opening it, it was found to
contain material which presented the appearance of pus.
He had been unable to find the record of any case of
cyst containing hair occurring in the horse.
carcinoma of the rectum.
Dr. Janeway presented a specimen with the following
history : It was removed from the body of a man
78
THE MEDICAL RECORD.
[January 20, 1883.
twenty-eight years of age. Last June he suffered from
dysentery, which continued up to the time of his death.
Upon closer examination it was found that he had suf-
fered from constipation for two years, and that from Jan-
uary to June, 1S82. the constipation was such as to
oblige him to strain severely before he could have a pas-
sage from the bowels. Nothing more definite could be
obtained with reference to the character of the dis-
charges than that they were rather small. When Dr.
Janeway first saw the patient he was very much emaciated,
his abdomen was swollen and contained fluid. There was
also a certain amount of tympanites, and there was pain
upon pressure. There was no doubt concerning the exist-
ence of chronic peritonitis. On making rectal examination
he found, four inches from the anus, a stricture into which
he could just introduce the end of his linger. The con-
dition of the abdomen was such as to prevent a bimanual
examination with one finger in the rectum. Near the
umbilicus a tumor was found which was firm, hard, and
situated in the deeper tissues. The skin was movable
over it ; it was of a flat, oval form, apparently about two
inches in diameter and about one inch in thickness.
The examination provoked a desire to have an evacua-
tion from the bowels, and it was then seen that the size
of the discharge was about that of an ordinary lead pen-
cil. Dr. Janeway diagnosticated malignant disease. The
patient lived two years from the time of the first de-
velopment of notable constipation, and died of heart
failure.
At the autopsy there was found chronic peritonitis, and
the peritoneum was also studded with nodular growths,
which presented somewhat the appearance of miliary
tubercle. There was new growth in the rectum, begin-
ning about four inches above the anus and extending up-
ward, so that the stricture measured four inches in
length. The sigmoid flexure was likewise involved in the
thickening and was also narrowed, so that the entire nar-
rowed portion of the intestine, from the anus upward, was
about six or seven inches in length. Another point of
interest was a fistulous communication between the small
intestine and the rectum. Another point of interest was
that the cajcum and the ascending, the transverse, and
the descending colon, were impacted with exceedingly
hard masses of fKces. Another point of interest was
the fact that there was only slight ulceration of the mucous
membrane of the intestines, the chief lesion being simple
catarrh. There were one or two spots of ulceration in the
rectum below the stricture. The mucous membrane was
markedly thickened. The omentum was transformed
into a cancerous mass, and could be felt as a tumor
througli the abdominal wall. The lungs were normal.
There was no change in the pleura. One interesting and
important clinical feature of the case was the fact that the
patient came for treatment sup|)osiiig that he was suffer-
ing from diarrhoea or dysentery. Dr. janeway thought
that every case of cancerous stricture of the rectum he
had seen had given the history of treatment for chronic
and sometimes for acute dysentery.
Another point of interest with reference to the s|ieci-
men was the reaction given by the material of which the
omental mass was composed. It had the glistening gross
appearances of coUoid material, but when acetic acid was
used the reaction was that of mucous rather than of col-
loid substance.
Dr. Briddon remarked that he had seen many cases
of cancer of the rectum, but he had not seen one occur-
ring in a patient under forty-five or fifty years of age.
Dr. Jankwav remarked that he had seen one case oc-
curring in a man twenty-five years of age.
Dr. Bozeman referred to a case at present imder liis
care in which the patient was seventy years of age. The
disease occupied the anterior wall of the rectum, about
two inches above the anus. In that instance the patient
had been told that she had, and had been treated for,
henjorrhoids. Hemorrhoids existed, but the cancer was
the essential disease.
Dr. Peabodv then presented a specimen of
CHROXIC HYDROCEPHALUS, WITHOUT SYMPTOMS.
The brain was removed from the body of a man who
died as the result of injuries caused by his being crushed
between railroad cars. He was a vigorous man, about
thirty years of age, in good health at the time of the ac-
cident. His pelvis was crushed and his urethra was
lacerated. Following this came infiltration of urine. He
died forty-eight hours after the accident.
The only organ of interest at the autopsy was the
brain. After removal of the dura mater the convolutions
presented a normal appearance. During the process of
removing the brain from the skull there was an escape of
fluid from the ventricles through the rent in the base
which occurred just in front of the optic commissure.
Inuiiediately thereafter a large deisression was found in
the convolutions of each hemisphere, anterior to the fis-
sure of Rolando. Upon openmg the lateral ventricles
the cause of this depression became apparent. Their
cubic contents must have been fully as great as usual,
their walls being much thinner than normal — nowhere
more than an inch in thickness. The third ventricle was
also dilated. The fourth ventricle appeared normal.
The ependyraa of the lateral ventricles was normal. The
brain tissue itself was normal in consistency and color.
There was no abnormality in the shape or appearance
of the skull.
The case was of interest in showing the extent to which
chronic hydrocephalus could exist without symptoms
which would lead to a suspicion of its presence. Un-
fortunately, of the man's mental capacity no history h?.d
been obtained.
Dr. F. W. Jackson referred to a case which came
under his observation while an interne at the Roosevelt
Hospital. A man, twenty-two years of age, gave the
history of having been perfectly well up to eight years
before admission, when he fell forty or fifty feet, as he
stated, and struck upon his head. Beyond a certain
amount of concussion he suffered but little from the fall,
and remained as well as usual up to six months before
seeking admission to the hospital, when he began to have
attacks of severe headache, which increased in severity
and frequency. On examination no apparent cause
could be found for the headache. The attacks had
become so frequent that they recurred nearly every half
hour, and the pain was extremely severe. The man died
suddenly. At the autopsy, made by Dr. Delafield, dila-
tation of the ventricles of the brain, nearlv as marked as
in the specimen presented by Dr. Peabody, was the only
abnormal condition.
Dr. Gibnev had noticed spastic contractions in cases
of chronic enlargement of the head, the majority of cases,
however, in which such contractions occurred being in
microcephalic children. He asked if the comparative
frequency had been noted.
Dr. Janeway remarked that his attention had not
been especially directed to such cases associated with
enlarged heads.
Dr. Van Santvoord said that a few years ago, while
looking u)) the literature of spastic contractions, he read
the history of a case of dilatation of the lateral ventricles
in a man, forty years of age, which apparently dated from
an injury received at twenty years of age. There was
some feebleness of mind, and, besides, spastic paralysis
without any lesion of the spinal cord. The writer re-
ferred to the spastic condition and the internal hydro-
cephalus as having the relation of cause and eflect.
Dr. Janeway thought it difficult to prove that the
spastic condition depended upon the dilatation of the
ventricles unless there existed descending degeneration of
the lateral tract. He had seen quite a number of cases
of chronic hydrocephalus in adults without any such
lesion, nor was there spastic contraction. He also re-
ferred to the case of a boy with an exceedingly large
head, and at the autopsy the thickness of brain substance
January 20, 18S3.J
THE MEDICAL RECORD.
79
between the ventricles and the external surface was not
more than one-eighth of an inch. There was also pachy-
meningitis of recent date with the liydroccphalus, but
there had not been spastic contraction.
Dr. Birds.'\li, had seen a number of spastic cases, and
scarcely any of the patients had heads larger than normal,
while one or two were decidedly microce|)halic. He had
noticed the e.xistence of spastic condition in children
which were born at eight months, or less than full term.
The Society then went into executive session.
(To vvcsp 0 u rt cu c c.
OUR PARIS LETTER.
(From our .Special Correspondent.)
THE EPIDF.MIC OF TYPHOID FEVER IN I'.\RIS, .•\ND ITS
LESSONS THE CONTRACTILITY OF THE UTERUS UNDER
ELECTRICAL CURRENTS CHARCOT ON THE SITUATION
OF OVARIAN PAIN AND THE ORIGIN OF HYSTERICAL
ATTACKS — CREMATION IN FRANCE DEATH OF CORVI-
SART PRESENTATION TO MONSIEUR DUMAS.
Paris, December 29, 1882.
The epidemic of typhoid fever which has been raging in
Paris for some months past is, I am glad to say, steadily
on the decline, and, if it has had no other result, it is
worth noting that it has aroused the attention of the mu-
nicipal and medical authorities to the sanitary condition
of this great city, which is, in many respects, so notori-
ously defective and far behind that of many other cities
of less im]:)ortance. The etiology of the disease has
been fully discussed at the Academy of Medicine and
the different medical societies here, and, judging from
the various opinions expressed, it is evident that the
French medical men are becoming converted to the
theory of the f;ecal origin of typhoid fever, though at
the same time they do not lose sight of the other possible
causes, such as foul air and water, overcrowding, and
everything that would tend to debilitate the constitu-
tion. From the discussion on therapeutics it mav be
gathered that among medicinal agents quinine takes the
lead, and it is considered by some almost as much a
specific for the disease in question as it is for intermit-
tent fever.
Other defects have come to light during tlie discus-
sions, and the authorities are qinte puzzled as to the
carrying out of the sanitary measures proposed. The
want of a more competent authority than the Municipal
Council is also greatly felt — that is to say, a sort of
State Board of Health, which, for some unaccountable
reason, does not exist m Paris. This desideratum has
been brought to the notice of superior authority, and it
is hoped that ere long the " centre of civilization " will
be endowed with a regularly organized body of medical
men who will have proper control over all matters con-
cerning the iKiblic health, instead of leaving them, as at
present, in the hands of laymen.
At the last meeting of the Academy of Medicine, Dr.
Onimus communicated the results of some experiments
that he had made on the contractility of the uterus under
the influence of electric currents, which may be summ.i-
rized as follows ; In the ordinary state it is difficult to
determine uterine contractions l)y electric currents or
by other excitants. In the gravid uterus, on the con-
trary, it is easier to do so ; but even then it is necessary
that, from whatever cause, physiological contractions
niust have already begun in it. This difference in the
results produced is of the highest importance in a
medico-legal point of view, as well as in their thera-
peutic aiiplications.
Professor Charcot has been trying some experiments
at the Salpetriere Asylum in order to prove that ovarian
pain in hysterical subjects is really situated in the ovary
itself, and that the various phenomena, such as the arrest
of hysterical fits, the rousing of hypnotized subjects, etc.,
which are determined by pressnre over the iliac regions,
are really due to the ovary itself. In continuation of his
statement he read a pajier before the Soci6te de Biologic
in which he gives the cases of two hysterical women who
were in the family-way, and in whom the painful spots
were rather higher than in women in the unimpregnated
state. They rose according to the development of the
uterus, and descended to their usual position after par-
turition.
Cremation does not seem to make much progress in
France, notwithstanding the strenuous efforts made by
some of its partizans in support of it. An attempt is be-
ing made to make it a matter for legislation by having
the subject laid before Parliament, with the view of ren-
dering this mode of sepulture legal. The proposition is
to be submitted by M. Casimir Perier, and in the name of
other distinguished men who are in favor of cremation.
Baron Corvisart, late physician to Napoleon III., died
suddenly on December 26th, at his residence at the
Champs Elysees, in Paris. He was the son of the cele-
brated Baron Corvisart, who was physician to Na[)oleon
I. He had not done much in the way of practice, and
lived quite retired since the fall of the Empire.
The Minister of Public Instruction has ordered a bust
of the late Professor Bouillaud to be placed in the hall of
the Institute.
The President of the Academy of Sciences has had the
satisfaction of presenting to Monsieur J. B. Dumas a
casket containing three medals — of gold, silver, and
bronze, respectively — and each bearing an effigy of the
illustrious chemist, to celebrate the fiftieth anniversary
of his membership of the institute. Monsieur Dumas
has been Permanent Secretary of the Academy of Sci-
ences for several vears.
OUR LONDON LETTER.
(From our Special Correspondent.)
THE QUESTION OF LONDON DOCTORS SUPPLYING THEIR
OWN MEDICINES — THE PROPRIETORSHIP OF PHYSI-
CIANS* PRESCRIPTIONS.
London, January 4, 1883.
The question of doctors supplying their patients with
medicine as well as with advice is a vexed one, and one
about which there has lately been renewed discussion.
In this country it is almost universally done — that is, by
general practitioners. Consultants, of course — whether
physicians, physician-accoucheurs, surgeons, or si)ecial-
ists — invariably write prescriptions, which their patients
take to a druggist to have dispensed. The patient,
therefore, first pays his doctor's fee, and then purchases
his medicine at a druggist's. The general practitioner,
on the other hand, usually runs bills, and when he makes
out his account makes an inclusive charge for advice
and medicine. Formerly — /. <'., thirty years ago — the
custom was to charge for the medicine only, and not
charge for advice. The usual thing now is to charge so
much for each consultation or visit, varying the charge
somewhat according to the position of the patient, and
not make anv charge for the medicine. The result is
much the same in either case. A practitioner who re-
fuses to supply medicine and writes prescriptions, soon
finds that it does not pay. A patient consults his family
doctor, say for bronchitis, and is charged from half-a-
crown to seven shillings. If he receives a prescription,
he takes it to a druggist's, who charges him, say, two
shillings. In three or four days he wants another bottle,
and pays a second visit and second fee — not to his
doctor — but to his druggist. If the case is not serious
the patient may continue his visits to the druggist until
cured. The latter then may receive from a patient
during a bronchitic attack fifteen shillings or a pound,
three-fourths of which will be profit, while, the niedica
attendant may only receive his fee for a single consulta
8o
THE MEDICAL RECORD.
[January 20, 1883.
tion. When the latter is only five shillings (and it is
only in very good class general practice that more can
be charged), it will readily be imagined that his practice
will not prove very profitable. Some medical men send
their prescriptions tiiemselves to a druggist to be dis-
pensed. They make their own arrangement with the
druggist, paying him so much a bottle all round. Their
patients pay them as in other cases, so the only differ-
ence between this and the ordinary method is that they
are saved the trouble of doing their own dispensing,
although in the eyes of their patients they still supply
medicines. This plan has had to be abandoned by
almost every medical man who has tried it, on account
of the rates druggists usually charge them in such cases.
Another objection is, that the druggist may supply the
medicine on his own account ; and lastly, and this is per-
haps the greatest objection of all, he may actually under-
take to prescribe for the patient, and the medical man may
thus lose his patient altogether. Where the patient re-
ceives a prescription and is free to go where he likes to
get his medicine, thtse objections are still stronger. The
patient will get it repeated time after time without further
advise, and this kind of practice, on small fees, does
not pay. A patient who pays his physician a guinea and
receives a prescription, regards that prescription as his
property. If he derives benefit from it he will continue to
use it, and that, not only himself, but may copy it for, or
lend it to his friends afflicted with a similar, or, it may
be, dissimilar complaint. The consequences in some
cases may be imagined. Unless seriously ill, or unusu-
ally fidgetty about himself, he will not pay his physician
a second visit at all. Of course, a medical man who
receives a guinea for every prescription is better off than
a general practitioner, who attempts to do a prescribing
practice, and charges only a fourth of that sum. Still it
is a difficulty, and an increasing one, in consulting prac-
tice. Those who write prescriptions so as to be under-
stood by one druggist alone, to whom they recommend,
or ratlier send, all their patients, are tabooed by their
medical brethren. In this case, it is, of course, under-
stood between the doctor and the druggist that the latter
is not to repeat without orders from the former, and
rumor has it, that in some cases the medical man has
actually condescended to receive a percentage of the
druggist's profits. Still, even here, the druggist is mas-
ter of the situation if he choose to be dishonest and
break his agreement. The system of writing for one
particular druggist alone cannot be commended. What
is a desideratum, however, is that no druggist should re-
peat any medical man's prescription, either at his own
or the patient's suggestion. The prescription should be
retained by the druggist, and afterwards returned to the
practitioner. Even here, the patient could not be jjre-
vented from copying it. Moreover, the public will not
agree to it. A patient says : '' I have paid Dr. So-and-
so a guinea for this prescription, and it is mine — my
property to employ as I please either on myself or on
any one else."
The subject is certainly one on wiiich improvement is
possible. 1 do not see how much can be expected, how-
ever, when our leading journal takes the following posi-
tion : " .\ medical man either dispenses or prescribes.
If he prescribes, the prescription ought to be the prop-
erty of the jjatient, to be used when and ho-ic he pleases,
and ought to be written so that it may be compounded
by any legally qualified chemist." The italics are my
own.
ABSTRACTION OF BLOOD FRO.M RIGHT
HEART.
'lo THK EulTOR OF ThK MkOICAL RhcoKD.
Sir : I liave been greatly interested in Dr. Westbrook's
article " On Abstraction of Blood from the Right Heart as
a Means of Relieving Intense Pulmonary Congestion, '
which appeared in your valuable journal of December
23, 1882. 1 regret the unfortunate termination of the
case upon which he operated, but believe, that so far as
that particular case was concerned, the ordinary, time-
honored method of performing vivisection, would have
given greater promise of successful issue.
Dr.'Westbrook deserves great credit for boldly de-
monstrating " that the right auricle may be readily as-
pirated, and that the introduction of a canula into its
interior is not accomimnied by alarming symptoms, or fol-
lowed by unhappy results.'' The nearest approach to
priority in this discovery, I believe to be in the soiiie-
what vague reports concerning the temerity with which
the Chinese practise acupuncture of thoracic and ab-
dominal viscera ; but I am not aware that they have de-
Hberately marked out the boundaries of the right auricle
with the avowed purpose of puncturing it. Now, I de-
sire to use your instructive columns for the purpose of
making a few suggestions, which are not inconsistent
with the points established by Dr. Westbrook's opera-
tion, and which he may feel constrained to carry out. I
want to ask him to abandon the idea of abstracting blood
from the right heart for the purpose of relieving the in-
tense pulmonary congestion incident to pneumonia,
retain the important point that the introduction of a
canula into the cavity of the heart is not attended by
unhappy results, and use it in the treatment of valvular
disease of the heart. I need not remind him that the
famous " Dublin Committee," when studying the causes
of the heart-sounds, thrust needles and hooks through
the cardial walls, and pushed aside and held back the
several valves of the hearts of living dogs and sheep and
bullocks. It would revolutionize the treatment of mitral
regurgitation and aortic insufficiency. In a little while the
average ])rofessor of surgery would divulse the insuffi-
cient aortic opening, and stitch up the delinquent mitral
valves with the same audacity that he now cripples the
urethra or closes a lacerated cervi.x.
H.AL. C. Wv.MAN-, M.D.
Detroit, Mich., January 5, 1SS3.
To THE Editor of The Medical Record,
Sir : I cannot refrain from asking through you one or
two questions suggested by the article in your issue of
December 23, 1882, entitled "On Abstraction of Blood
from the Right Heart as a Means of Relieving Intense
Pulmonary Congestion.''
The writer describes a severe case of croupous pneu-
monia of the right upper lobe, which had lasted five days
when he first saw the patient, a vigorous German. The .
next evening (of the sixth day) pulmonary oedema
threatened, and to relieve the heart of a portion of its
burden, aspiration of the right auricle was attempted —
an operation, we are told, which had suggested itself to
the author about a year previously. It met with poor
success, but later in the evening the needle was re- intro-
duced, and a little over three ounces of blood were
withdrawn from the auricle. Relief seemed to follow,
but the patient died suddenly next morning. At the
autopsy, in addition to the pulmonary lesions, the courses
of the two ])unctures into the heart were made out, and
claret-colored serum and pink coagula were found in the
pericordial sack. These were in part referred by the
writer to leakage — ha5nio-pericardium. Two facts are
claimed as hereby established : first, that it is easy to nee-
dle the right auricle ; second, that no unhappy results,
immediate or remote, ensue.
I should like to ask how this latter conclusion can be
justly drawn from the experiment. \Vas the h;«mo-peri-
cardium, however sliglit, not an "unhapi^y result?" And
is there no risk in an operation involving such a contin-
gency ? Bearing in mind the tenuity of the auricular
wall, and the danger that it shall tear itself by motion
against the needle (not a fancit"ul danger by any means),
can we consider its puncture other than a most ha/.ardous
expedient ?
It has, I believe, been usually so regarded. With a
January 20, 1883.]
THE MEDICAL RECORD.
81
patient in the very act and article of death by yjuhnonary
cedema, with no time to spare for phlebotomy, but when
instant relief must be given to the very heart itself, it is
conceivable that pneumatic as)jiration of the right auricle
may be justified ; and 1 have known of its being resorted
to in such an extremity. But in the case described, the
patient was not in ariicitlo mortis — he survived the
second needling some twelve hours. If blood-letting,
therefore, were indicated, there was jilenty of time to take
it from a vein in the ordinary way. What was here to be
hoped from aspiration of the heart which could not be
accomplished by bleeding from its feeders ? Why bleed
from the heart rather than from the arm ? Was it easier,
safer, more efficient ?
Wm. T. Cheesman, M.U.
Auburn, N. Y.
THE CARE OF THE CHRONIC INSANE.
To THK Editor of The Medical Record.
Sir : An article appeared in The Meimcal Record of
December 23d inst., on " The Care of the Chronic In-
sane," which I would not have felt called upon to notice,
except in commendation of its general objects, if the
writer had not gone so far as to make statements calcu-
lated to arouse distrust, ill-founded and unwarranted ap-
prehensions, in regard to existing institutions of the State.
When it was proposed, for good and sufficient reasons,
to create an asylum for the chronic insane in this State,
fifteen years ago, it w^as quite the fashion to make pre-
dictions similar to those contained in this article. It is
true that at that time there had been no experience on
which to base any intelligent opinion, but since the re-
sults, direct and indirect, of the operation of the Willard
Asyhini have been before the public, it may be a fair
question whether Dr. Agnew is justified in taking coun-
sel wholly from his apprehensions or the fears of others.
Certainly, no one of the pro|)hetsof evil consequences to
result from the establishment ot this asylum, or any of
the watchers, have so far felt called upon to remind the
public or the profession of his jirescience. Dr. Ag-
new may be assured his fears are groundless, so long as
the public asylums of the State are surrounded by |)roper
safeguards. Neither do I agree with the statement that
it has been demonstrated that it is "unscientific," "in-
humane," or "bad as it can be in an economic point of
view " (strong expressions), to place the acute insane in
one institution, and the chronic in another. If any re-
sult has been clearly demonstrated in this State, it has
been quite the other way.
The article seems to have been suggested by resolu-
tions of the Supervisors of Dutchess Count)', " pointing
out the necessity of caring for the chronic insane nearer
their homes," and urging the necessity of creating a de-
partment for them in connection with the Hudson River
Hospital at Poughkeepsie. It is, however, suggested
that one thousand to one thousand five hundred patients
be transferred from the New York Asylums to the Hud-
son River Hospital, which would be practically a removal
from the vicinity of their homes, and a conversion of one
or the other asylum into a chronic asylum, which Dr.
Agnew sees no objection to in this particular case.
One word upon the general question of the care of the
chronic insane. Those of your readers who recall the
history of lunacy legislation in this State (and others
should be reminded of the fact), will remember that it was
the original design of the managers of the Hudson River
Hob]iital, publicly announced, that it should be a /los-
pital for the treatment of recent cases, and not an asylum
for the chronic insane. It was adherence to this policy,
and the exclusion of the chronic class by this and other
hospitals, and their return to county poor-houses, that led
to the creation and enlargement from time to time of the
Willard Asylum, in order that some system of care might
be provided other than that shown by official reports to
exist in those receptacles.
About the time the Hudson River Hospital (of which
Dr. Agnew was then, as now, a manager) was ready to re-
ceive patients, application was made by the Supeiintend-
ent of the poor of Dutchess County for the admission of
certain patients into the Willard Asylum. He was, in
reply, requested to apply for the reception of these cases
into the Hudson River Hospital, as they w-ere almost
beneath its shadow. A second letter of application was
received, to state that the coming winter and insufficient
heating apparatus in the County House would expose
these persons to suffering, and that, having applied at
the Hudson River Hospital, admission was denied on the
ground that the hospital was intended for recent cases.
Among the transfers made from that county was the
case of a man who had worn shackles and a chain at-
tached to the floor for a period of fifteen years.
The following case illustrates another phase of this
question: On December 20th, inst., a man was ad-
mitted into the Willard Asylum, who had been a [latient
in the Hudson River Hospital, and afterwards removed
to a county ].)Oor-house, perhaps, for the reason that he
could be maintained there cheaper than at the hospital.
In the County House this man wore iron handcuffs,
shackles of iron about his legs, and a chain connecting
the shackles with the floor. All this, too, in the State of
New- York !
The experience of these two counties in which pro-
ceedings were taken as prescribed by law, presents the
practical suggestions : first, that the work of caring for the
insane must not proceed on a scheme which is purely
"scientific;" and, second, when plans of construction
are devised that will not be too expensive to execute ;
not involve too much expense to administer when com-
pleted ; and a standard of care and maintenance adopted
more in accordance with the reasonable views of the
taxpaying portion of the community, it is quite safe to
predict every incomplete asylum in the State will be
speedily finished, and county care of the insane aban-
doned, but not before.
Resi)ectfully yours,
John B. Chapin.
Willard, N. Y., December 30, 1882.
THE QUESTION OF RETROSTALSIS AND THE
ABSORPTION OE ENEMATA.
To THE Editor of The Medical Record.
Sir : 1 enclose a few notes upon a (jeculiar case of seeming
retrostalsis, after rectal injections, which came under my
observation in the medical ward of St. Luke's Hospital last
winter. It seemed to be of interest in connection with
Dr. C. L. Dana's paper upon that subject in The Medi-
cal Record of January 6th.
The case, briefly stated, was as follows : Sarah B., aged
twenty-three, single, house-work, admitted February 6,
1882. Dr. Wm. C. Campbell, house physician. Besides a
slight pleuritis, she was suffering from well-marked symp-
toms of peri-uterine cellulitis, going on to the formation of
abscess, which opened into the rectum March ist. By
March 6th the purulent discharge had ceased, and examin-
ation showed the uterus and vagina to be still held firmly
bound by inflammatory material, but no localized col-
lections of pus. No opening into the rectum could be
discovered. Bowels became very constipated, and the
previous flatulence and vomiting became more severe.
Nothing could be retained upon the stomach. After con-
sultation with several members of the visiting staft" of the
hospital, it was deemed advisable to open the bowels
thoroughly; so, on March r3th, at 10 a.m., a stimulating
enema was given (ol. ricini, rj.; spt. terebinth., 3 ss.;
ol. oliva;, 3 ij.; aqu:e, Oj.). No result. Two hours later
another enema was given, with an increased amount of
turpentine and castor-oil. Result, a free movement,
followed in a short time by vomiting and symptoms of a
collapse. The vomiting soon became stercoraceous, and
the vomited material smelt strongly of turpentine, and
82
THE MEDICAL RECORD.
[January 20, 1883.
was somewhat of the consistency of paint. Upon the sur-
face free oil was floating. In about two hours this disap-
peared, and collapse gradually became* more profound.
March 14th, 3 30 p.m., patient died.
At the autopsy the large intestine was distended with
foeces, and at the lower border of the transverse colon,
near the hepatic flexure, a perforation had taken place
with e.xtravasation into the peritoneal cavity. Stomach
normal in appearance and empty.
Henry Moffat, M.D.,
House Physician, St. Luke's Hospital.
New York City, Jaiiuarj- 7, 1883.
JivmB ^Icius.
official List of Changes of Stations and Duties of Officers
of the Medical Department, United States Army, from
January 6, 1883, to January 13, 1883.
Skinner, John O., Captain and Assistant-Surgeon.
Granted leave of absence for one month. S. O. 5, par. 2,
A. G. O., January 6, 1S83.
Wood, jVL^rshall W., Captain and Assistant Surgeon.
Granted leave of absence for one month. S. O. 4, par.
3, Department of the East, January 8, 1883.
Johnson, R. W., P'irst Lieutenant and Assistant-Sur-
geon. Granted leave of absence for one month. S. O.
4, par. 2, Department of Dakota, January 5, 1SS3.
Munday, Benjamin, First Lieutenant and Assistant-
Surgeon. Assigned to duty at Fort Klamath, Oregon.
5, O. 195, par. 3, Department of the Columbia, Decem-
ber 29, 1882.
medical items.
Contagious Diseases — Weekly Statement. — Com-
parative statement of cases of contagious diseases re-
ported to the Sanitary Bureau, Health Department, for
the two weeks ending January 13, 1S83 :
Week Ending
January 6, 1S83 o
January 13, 1883 5
y
t^
o;
•0
^
J3
a
^
ui ;
6
64
9
75
64 10 46 I 52
I 1 64 54
The New York. Medico-Legal Society. — In liis in-
augural address, recently delivered, Mr. Clark Bell said
that the society's membership had increased during the
past year from 177 to 267; that 367 volumes and 564
pamphlets had been added to the library, and that four
members,Drs. J. R. Wood and Hagan, e.x-Minister E. M.
Stoughton, and Assistant United States District Attorney
Ilernck, had died during the year. He recommended
that legislation be secured through the action of the
society to amend the lunacy laws and the law relative to
coroners, to decide who are experts and wiiat is proper
expert testimony, and looking toward improving the
sanitary condition of school buildings. He also advised
tile publication of a medico-legal quarterly under the
auspices of the society, and the establishment of the office
of a State Chemist, at a salary not to exceed $to,ooo a
year, and the establishment of a State chemical laboratory
under his charge, where all analyses needed in criminal
cases shall be made for either the State or the defence.
Suicide of a Medical Student. — A young medical
student, Mr. Norman W. Smith, who was studying at the
Medical College in Atlanta, Ga., committed suicide on
January 7th. He was a young man of excellent character
and habits, and was in apparent good health at the time.
He left no explanation of the act : but the scrupulous
care and unusual attention to all the possible post-mortem
contingencies betrayed a morbid mind, however.
Consumption of Tohacco. — According to Les Mondes,
it appears that in Russia, France, and England, the con-
sumption amounts to i lb. per inhabitant. In Italy it is
rather higher, lA- lb. Austria comes next with 2 2-5 lbs. In
the United States and Germany the consumption amounts
to 3 lbs., in Belgium to 4 4-5 lbs., while Holland has the
privilege of heading the list with a consumption jier in-
habitant of more than 5^ lbs.
C.ARDl.\c Neur.\sthenia. — In some cases of exhaustion
from continuous overwork, the symptoms centre chiefly
about the heart. The symptoms are feeble cardiac ac-
tion, giddiness, weakness, intermittent beat. Palpitations,
dyspnoea, and even syncope, may be present. A physi-
cian who suft'ered in this way for some time writes to the
British Medical Journal that he was relieved entirely by
the following prescription : IJ. Quinin. sulph., gr. xxiv. ;
mist, caniph., ad 3 vj. ; acid, hydrobromic. dil., 3 iij- ;
tinct. digital., 3 ss. ; liq. aurant., 3 j. ; tinct. nuc. voni.,
3 ij. M. Sig., 3 ss. three times a day.
Rectal Examin.ation in Vesic.\l Calculus. — The
Edinburgh Medical Journal calls attention to R. Volk-
mann's article in Centralb. fiir Chirurg. In children
suffering from vesical calculus a bimanual method of ex-
amination through the rectum and above the symphysis is
of great value. Anaesthesia is necessary, and the abdom-
inal walls should be thoroughly relaxed. The fingers of
the left hand in the rectum raise the stone, the bladder
being empty, and the right hand guides it to the symphysis
pubis. If the stone is not too large, it may be so far
raised that a string could actually be passed around it.
In adults the operation of course would not be so suc-
cessful. — Chicago Medical Revieiv.
The New York Skin and Cancer Hospital. — .-\n
hospital under the above name was incorporated in this
city last month. Among the trustees are Dr. James
Rnight, Dr. C. R. Agnew, Edward Winslow, G. H.
Scribner, and others. The hospital physician is Dr.
Bulkley, and Drs. Robert F. Weir and Edward L. Keyes
are operating surgeons. In a circular asking for money
the trustees say that they do not ask merely enough for
the current expenses of their present small building, but
they desire to purchase immediately real estate, already
selected, upon which to erect a structure suitable for the
purpose for which the hos|iital was incorporated. An
idea of the proposed building is given in the statement
that "a capacity equal to that of the New York or
Roosevelt Hospital could be utilized at once."
The Results of Improving the Milk. — As a re-
sult of the improved quality of milk now brought to this
city, the mortality among children under five years of
age has decreased from 52 per 1,000 to 46 per 1,000.
Severe Poisoning by Belladonna Plaster — Re-
lief BY Morphine. — Dr. W. H. Mather, of Suflield,
Conn., sends us the history of a very interesting and some-
what unicjue case. Last March Mrs.W. had a severe attack
of bronchitis with much coughing and expectoration. One
of the remedies used was a belladonna plaster about seven
by seven, which was placed over the left lung. It re-
mained on for six weeks, when it began to annoy her, and
she occasionally raised part of it and rubbed the surface
of the skin beneath. Dr. Mather writes : " I removed
the plaster entire one evening and rubbed the surface
freely with my dry hand. The plaster was then replaced.
On the morning following my jjatient could not see
clearly. .\t 9 a.m., she went to bed and ordered the
January 20, 1883.]
THE MEDICAL RECORD.
83
servant to look in upon her now and then lest she might
not be in her right mind when she should awake (she
never went to bed in the forenoon before). After one
hour she awoke in a terrible dread — suffered a sense of
suffocation — of impending danger — of imminent death.
Sensation was nearly gone from the extremities ; the
throat was dry, the pupils dilated, the pulse could not
be found. The heart had almost stopped, and was fee-
ble beyond experience. Had it not been for whiskey,
vigorously applied externally with friction, and internally
slie would probably have died before help could be had.
She felt impending suftbcation, as if she were fighting for
dear life every breath she could get. This fear and pros-
tration lasted four liours. Then cpiiet continued until
forty-eight hours after, when, on making exertion to dress
and walk down stairs, the same symptoms recurred.
Three physicians attended her during the half-day. One
believed that morphine would be fatal. I said I would
risk it. No sooner had the morphine been absorbed
tiian a calm quiet supervened. The feelings of dread,
fear, and terror were banished. The whole system was
severely shaken for two weeks. Digestion was impaired
and constipation was complete ; the mind was weak.
She complained constantly of being 'so tired, so tired.'
Large quantities of uriii.e were passed during the stage
of greatest prostration." The ])atient had been asking
for glasses for a week, but the plaster was not thought of.
Dr. Mather thinks that he broke off many little papules
when the skin was rubbed.
Dr. Rosebrugh's New Medical Battery. — Dr.
Almon Clark, of Sheboygan, Wis., sends us a letter criti-
cizing Dr. Rosebrugh's new medical battery, as de-
scribed on page 641, Medical Record of December 2,
1882. He claims.
First. — That by using bearings attached to the cover of
the battery case, instead of the spring posts and clamping
nuts. Dr. Kosebrugh only adapts a plan earned out in
Dr. Mcintosh's cheap domestic machine, but not in his
larger batteries, because for the latter it is an inefficient
arrangement.
Second. — That Dr. Rosebrugh's method of iunnersing
the elements is of such little advantage that it does not
counterbalance the inconvenience of the increased length
of the box.
Third. — That when Dr. Rosebrugh says : " Some bat-
teries are provided with an extra acid-cell and an extra
pair of elements for the faradic coil, the extra cell being
placed to the right of the coil. When this is the case, a
space for the overlapping of the hydrostat plate is af-
forded by simply uncovering this extra acid-cell," he
simply suggests a new method of using the battery, but
does not, according to Dr. Clark, the writer of the letter,
improve the said battery.
Suicide in Denver, Colorado. — At a meeting of
the Denver Medical Association on December 12, 1882,
Dr. Steele read a paper on the "Prevention of Suicide."
Seventeen cases had occurred in Denver alone during
the past year, which makes an enormous ratio. A com-
mittee on Medical Legislation was appointed, to
whom the paper was reported. The object is, if pos-
sible, to secure certain medical legislation in regard to
the sale of poisons by druggists ; to punish those who
attempt suicide and fail, also those who in any way aid
or assist those contemplating self-destruction.
Anointing with OiL.^There are several well-es-
tablished faith-cures in this city, and they are doing, we
are told, very effective work. To the list is now added
the anointing with oil process introduced by the Moun-
tain Evangelist Barnes, who is now preaching here.
This gentleman, after the anointing ceremony, lets a lit-
tle light U|ion the rationale of his success by laying the
following injunction upon his patients. He says : " Dis-
trust symptoms, they are tests of your faith. Whether
you feel better or worse, say ' I am healed by faith,' and
it will be so."
Grand River Medical Ethics. — At a meeting of
the Grand River Medical Society, December 5th,
charges were preferred against Dr. Hanna, for consult-
ing with an irregular practitioner. The charges were
found to be sustained. On motion. Dr. Hanna was en-
joined not to repeat the offence. Dr. Hanna acknowl-
edged his error, thanked the Society for letting him off
so easily, and said he would not do it again.
Policlinic or Polyclinic. — Dr. John A. Wyeth
writes : On page 28 of The Record for January 6, 1883,
occurs the following :
" Policlinic or Polyclinic. — The word policlinic is de-
rived from 7to\i^, a town, and kXidj, a bed. It means
therefore and always has, since its introduction as a
word, a city clinic or hospital. A frequent mode of spell-
ing the word in American medical literature is polyclinic.
This assumes arbitrarily, and incorrectly, that the word is
composed of TroAv?, many, and kXlv/j."
Your assertion that the word "policlinic" means a city
clinic, no one will contradict, but the other assertion that
it is "arbitrary and incorrect" to assume that the word
polyclinic may be a compound of ttoAus, many, and kAivt;,
is not correct.
When the New York Polyclinic was being organized,
the construction of this word was discussed carefully and
at length by the faculty. The conclusion arrived at was
that the name of the " School of Practical Medicine and
Surgery" should convey the idea that its plan of study
consisted of many clinics. As for the construction of
the word there are many precedents. For instance, the
noun polypharmacy, from toXu?, many, (pap/xaKov, medi-
cine ; or the adjective polyphonic, from ttoXvs, many, and
^wvr], sound, xoAv<^<dvos, "consisting of many sounds." I
hold that it is just as correct to name a school of medicine
the polyclinic school, as to name a dictionary a polyglot
lexicon.
[We publish Dr. Wyeth's letter with pleasure, but find
nothing in it that would lead us to modify our first
opinion, which is simply this : The word " policlinic,"
derived as we stated, is a jxirt of the medical language of
Germany, France, England, and America. Its etymology
is authoritatively given in Dunglison's Dictionary as we
gave it.
Our correspondent, like all free-born citizens, has the
inalienable right of coining a new word if he chooses,
but we believe it will be admitted that it is arbitrary and
incorrect, as regards taste at least, to take a word whose
spelling and usage have been established, and, by
changing a single letter, make a new thing out of it. It
leads to confusion, and the necessity of the change is
not apparent. The Vienna Poliklinick has always gotten
along well enough with the old-fashioned word. — Ed.]
Inebriety and Dr. Crothers. — Dr. J. B. Stair, of
Spring Green, Wis., writes : " A few weeks ago I had
the honor to publish in this journal a short article in
opposition to an idea of which Dr. Crothers, of Hart-
ford,, seems to be the chief exponent, in regard to the
causation of inebriety. In the last number of The Record
I see a note from the doctor, presumably in answer to
what I had written. It is scarcely necessary to say that
it is a direct evasion of the points suggested in my letter ;
in fact, the doctor says the ' doubts ' I raise ' cannot be
answered by argument,' but that it is simply a question
of fact, daily demonstrable, clinically. Dr. Crothers has
probably spent as much time as any other man in trying
to show, by argument, that his view of the question is
the correct one ; but when arguments are offered upon the
other side of the question, he suddenly finds that it is not
a debatable subject, nor a matter of opinion, but one of
fact. His opponents will doubtless claim that their po-
sition, as a matter of fact, is the right one, but think it
is a fit subject for discussion. Dr. C. should not forget
that his theory is an innovation, and though it be a fact,
it will have to stand the test of thorough discussion and
sharp criticism before finding a place in the favor of the
84
THE MEDICAL RECORD.
[Januarj 20, 1883.
profession. I am not a caviller, neither do I ^eek to
call in question theories simply because they are new,
but 1 can but regard the objections which I urged in op-
position to Dr. Crothers's position as pertinent ones, and
humbly submit that they, with many others, must be re-
futed— or must stand. The points raised in my letter
are no more matters of opinion than are those urged by
Dr. Crothers, and if facts alone are to be considered, we
must be permitted to examine all the facts, pre and con.
There are some questions which, in their nature, cannot
be entirely taken out of the field of moral discussion.
This is one of them."
Sir James Paget, in proposing the toast, "Pros|)erity
of the British ALedical Association," at the recent Jubilee,
uttered the foUowmg beautiful sentiment : "Do not let
our disputes be very noisy on the scientific side. Re-
member always that it is only through clear and undis-
turbed water that you can see what lies at the bottom.
In storms of controversy there is nothing to be found but
the billow that moves to mischief and the foam that dis-
appears."
An Appeal for the Ventilation of Churches. —
Our contemporary. The Christian Weekly, publishes a
ver_v effective, though not strictlv graumiatical or scien-
tific, appeal to the sexton for a better ventilation of the
churches. We quote some of the lines :
'• O Sexton \
You shet 500 men women and children
Speshily the latter, up in a tite place,
Sum has bad breths. none of em aint loo sweet.
Sum is fever^', sum is scroflus, sum has bad teeth
And sum hamtnone, and sum aint over clean :
But evry one of em brethes in and out and out and in
Say 50 limes a mmnet. or i million and a half breths an hour :
Now how long will a cherch full of are last at that rale ?
I ask you; say fifteen minuets, and then what's to be did?
"I put it to your konshens,
Are is the same to us as milk to babies.
Or water is to fish, or pendlnms to clox.
Or roots and airbs unto an Injun doctor,
Or little pills unto an omepath.
Or Boize to gurls. Are is for us to brethe.
What signifies who preaches ef I cant brethe ?
Whats Pol ? What Pollus to sinners who are ded ?
Ded for want of breth ? "
Pharmaceutical Chemists. — A wealthy New York
importer of drugs characterizes the pharmaceutical
chemists of Europe and America as follows : " The Ger-
man chemists are the most thorough in the world, but
they always deal in an inferior original article, their
meanness being equal to their science. America excels
in her experinientalism. The French administer nothing
but simples, especially aft'ecting ptisans."
The Pay of Ship Surgeons. — The pay of the medical
officer on the steamship lines between England and
America is grossly inadequate to the service and respon-
sibility of the position. It is said that, on the line which
carries more passengers than any other, he is paid less
than the chief steward, and the same as the steerage
steward and \X'\& fifth engineer. In this connection it is
interesting to note that the proportion of deaths to those
embarked by each steamship line in i88i was :
On the Barrow Line i died in every 509 embarked.
" Monarch I.ine i " 751
" American Line ' i " S67 "
" Anchor Line i " 1,346 "
" (niion Line 1 " 1,362 "
" Dominion Line i " 1,435 "
" State Line 1 " 1,461 "
" National Line 1 " i-,659 "
" Allan Line 1 " 2,575
" White Star Line 1 " 2,754 "
" Cunard Line i " 2,990 "
" Inman Line i " 3,313 "
Not included in this rate are the deaths of ten infants
born during tiie voyage, and of fourteen members of the
crews, besides seventeen others, com])osed of passengers
and crew, who were drownetl or committed suicide.
> British ships.
Kola Nuts and Inebriety. — The temporary ])opu-
larity of coca as a remedy for the opium habit, seems
likely to find a parallel in the use of the kola nut for
inebriety. Some enterprising temperance people of
London have imported a large amount of these nuts
from Africa, and are proposing to use them in the cause
of temperance. The kola nut (sterculia acuminata]
contains a considerable amount of a volatile oil, and
about two or three per cent, of thein. It is therefore
allied in properties to cofiee, tea, guarana and coca. It
is much used by the natives of Africa for its agreeable
stimulating eftects.
The German Medical Mind. — Dr. J. F. Jenkins, of
Tecumseh, Mich., writes : "Dr. Beard stated at a recent
meeting of the American Academy of Medicine that
'the German physicians are the best educated physi-
cians in the world, both in general and special train-
ing.' He also stated that ' the Germans are non-
therapeutists.' The assertion that a class of physicians
are the best in the world, notwithstanding they are
non-therapeutists, is not the prevailing opinion rela-
tive to the qualities that make an educated physician.
It is difficult to conceive how a man can be a first-class
physician and a non-therapeutist, unless he is a homoeo-
pathist. Dr. Beard claims for Germany that nothing
counts but originality. If he means the crude hypotheses
that are found so thickly scattered through the volumes of
' Ziemssen's Cyclopaedia ' to pass for original thought, then
we must confess that Germanv is the country par excel-
lence. ' This work has been sold by thousands in this
country, while only a few hundred have been sold in
England.' This statement does not by any means
prove that the English physician is not up to the times,
for very few busy practitioners have leisure to wade
through these seventeen volumes foj what little original
thought he will find to benefit his patients. , The fol-
lowing quotation is, we think, not quite correct ; ' Out-
side of a small circle of German-taught experts, the
medical literature and the medical practice of England
is from five to fifteen years behind Germany and
America.'
" If the above is a fair statement of facts, it would be
difficult to account for the large percentage of English
medical works that are used in our colleges. If I mis-
take not, the busy physician of the da)-, when surrounded
by difficulties in diagnosis and therapeutical indications,
almost invariably consult:^ his American and English
authors. The learned specialist may find in German
pathology and medical philosophy (where no two of.
them agree) ' original thought ' that the common medi-
cal mind cannot grasp."
The Silica Spinal Jacket is recommended by Dr.
George R. Fowler {Annals of Anatomy ami Surgery) as
a substitute for the i)laster-of-Paris. It is applied just
as silica bandages usually are, but over this jacket tem-
porary plaster-of- Paris bandages are wound and left on
for four or five days until the silica is dry. The silica
jacket is light and strong. It is cut open in front
and then laced. Dr. Fowler does not find it necessary
to suspend the patients entirely, but lets the toes touch
on the floor.
The Danger of the Oleander. — Dr. J. A. Wes-
singer calls attention (Detroit Clinic ) to the poisonous
properties of the Nerium Oleander, a jilant so much cul-
tivated in this country for ornamental puri)oses. Con-
tact of the face with tlie leaves or chewing the leaves
may cause fever, anorexia, and an eruption with papules
and blebs which are very irritating.
The poisonous principle if the oleander exists in the
leaves, bark, and flowers, but most largely in the bark.
This principle is of a resinous nature, and not volatile,
and is found more largely in the wild than in the cul-
tivated plant.
The Medical Record
A Weekly yournal of Medicine and Siirgery
Vol. 23, No. 4
New York, January 27, 1883
Whole No. 63
(Dviginal Jivticlcs,
THE TREATMENT OF ACUTE RHEUMATISM—
THE COMPLICATIONS.
By ROBERTS BARTHOLOW, M.D., LL.D.,
PROFESSOR OF MATERIA MEDICA AND GENERAL THERAPEUTICS IN THE JEFFERSON
MEDICAL COLLEGE OF PHILADELPHIA, ETC.
Notwithstanding the aiiparent severity of acute rheu-
matism, because of the pain, and the e.xtent of the joint
mischief, the mortality — as all the world knows — is very
small. The circumstances inducing a fatal result are
immediate and remote ; complications which are at once
incompatible with life form one group ; those inducing
changes, which ultimately jirove fatal, constitute the
other group. Excluding the latter, which cannot be nu-
merically estimated, the proportion of cases fatal to the
whole number is about three per cent. The remote
causes of mortality are, nevertheless, the more important.
In considering the treatment of the comylications it i.-;,
of course, understood that reference is had to those aris-
ing during the acute symptoms ; for example, the condi-
tion of hyperpyrexia, endo- and exo-carditis, myocar-
ditis, embolism, embolic pneumonia, cerebral embolism,
etc. I purpose, then, to consider these in turn, from the
therapeutical standpoint ; but as no proper therapeutical
diagnosis is possible without a true conception of the
pathological state, it is necessary to express my view of
this state in order to establish a groundwork on which
the therapy may be properly projected.
Irritation of a hypothetical heat-centre is surely too
entirely theoretical to justify us regarding it as an ade-
quate explanation of the hyperpyrexia of some rare cases
of acute rheumatism. The extraordinary rise of tem-
perature, the circulatory disturbances, and the cerebral
oppression rather signify the onset of some inflanmiatory
complication, as meningitis or i)neumonia. That they
may not be recognized, is true enough, but that they ex-
ist is equally certain. The therapeutical problem is
how to diminish the extraordinary body-heat, rising, as
it does in extreme cases, to io8°, 109° Fahr., even
higher. Until the influence of excessive heat in the pro-
duction of "parenchymatous degeneration" had been
recognized, these cases of hyperpyrexia were looked upon
as hopeless. Now, it is known that the timely use of
antipyretics may obviate the tendency to death. The
chief antipyretic is the cold bath, and next quinine and
digitalis. The mode of employing these, their limitation
and effects, are now so well known that it is not neces-
sary to enter into details on these points. The bath
cools the superficial layer of blood, quinine and digitalis
depress the temperature — the result being the lessening
of the body-heat sufficiently to prevent the disastrous
parenchymatous degenerations. At the same time the
inflammatory complications — the meningitis, the pneu-
monia, etc. — are improved. These therapeutical results
are due, not to an action on a supposititious heat-centre,
but to the impression made on the course of the compli-
cating malady.
Much more frequent, and therefore more important from
the point of view of practical therapeutics, are the cardiac
complications, the endo- and exo-carditis — endocarditis
and pericarditis. The relative proportion of cardiac
complications cannot be exactly stated ; but here we are
concerned with the management of these com|)lications.
Our object is to determine the plan of treatment which
will yield the best results. We must, therefore, seek to
obviate the ill effects of a condition in which the blood
is changed in its constitution ; in which the pericardium
and the endocardium are thickened and roughened, and
in which the propelling power of the heart is impaired.
Good results are attributed to various plans of treatment,
because of the disappearance of a murmur, almost con-
stantly present during the maximum of any case of
rheumatism. This murmur may be of little consequence..
The damaged membrane and valves, and the excess of
fibrin and leucocytes in the blood, are the important
points, and the questions for the therapeutist to consider
are, how change the constitution of the blood, how
modify the morbid process going on in the inflamed
membrane, and how prevent the damage in distant
parts, whether it be exo- or endo-cardial inflammation,
with which we have to deal.
In endocardial inflammation it is most necessary to
render the blood as alkaline with ammonia as can be
effected. The potash salts are too depressing to the ''
heart to be employed for this purpose, and ammonia is a '
necessary constituent of the blood, serving in part to y
maintain its fluidity. The more promptly the ammonia
is introduced, the less the damage to the valves, and i
the less the danger of embolisms. In pericarditis the \
same plan is useful in a somewhat less degree. In both
endo- and exo-cardial inflammation the muscular struc-
ture is involved to some extent, and the power of the
heart weakened, hence remedies such as digitalis which
raise the peripheral tension of the vascular system, are
not desirable, may be, indeed, dangerous. Veratrum
viride, on the other hand, by lessening the amount of
work reciuired of the heart, serves a useful end ; but, it
seems to me clear, that aconite, judiciously used, is, on
the whole, the most effective remedy for the inflamma-
tory process. Quinine, in antipyretic doses, with mor-
phia, if rightly timed, may do gi eat good at the initiation
of the endo- or exo-cardial inflammation, but the period
passed, small doses only are indicated to sustain the
waning power of the heart. Coincidently with the ad-
ministration, of these remedies, a succession of small
blisters, at or about the prnscordia, will do good. The
proper way to conduct the blistering is to apply a blister
about two inches square ; allow it to vesicate slightly,
and then put another on in the neighborhood ; thus a
succession can be kept up, and a continuous influence
maintained. The curative eftect consists in the irrita-
tion of the cutaneous nerves, and not in the withdrawal
of serum. The influence of blisters in causing an alka-
line state of the urine has been mentioned ; but this is
only a part of the effect produced : the trophic centres
are stimulated or depressed according to the extent or
persistence of the vesication — stimulated by mild and
transient irritation, depressed by deep and protracted
irritation. Meanwhile a proper alimentation and the
sustained support which a suitable food supply only can
accomplish are most necessary to the successful issue of
the case.
Endo- and exo-carditis are to be considered not only
in respect to their immediate, but also to their ulterior
eftects. It would lead me far from my present purpose
to consider these ulterior effects ; but it would be taking
a very narrow view of the pathogenetic relations of the
subject to e.xclude the immediate results. I have merely
86
THE MEDICAL RECORD.
[January 27, 1883.
referred to rhe myocarditis, whereby the muscular sub-
stance of the heart is damaged, so that its propulsive
power is diminished. When endocarditis coexists with
pericarditis, intiammation extends by contiguity of tis-
sue to the muscular substance, it undergoes granular de-
generation to a less or greater extent, and its contractile
elements are consequently weakened. Hence it is in
some — fortunately, rather infrequent — cases that the
work of the heart is done very imperfectly ; the action
is rapid but wanting in power. Under these circum-
stances some alcoholic food is highly useful — wines of
good body and rich in ethers, old brandy or whiskey
— and those muscular stimulants which increase at the
same time the power and the nutritive energies of mus-
cular tissue — especially nux vomica or its alkaloid, strych-
nine, the tincture of iron, quinine, and in some instances
atropine.
When the valves of the heart are fringed with fibrinous
vegetations, embolism of various organs must result. It
is now perfectly well known that an embolus detached
from the left valves, will usually lodge in (he left middle
cerebral arter)', or some of its branches ; and from the
right valves, in some part of the parenchyma of the lungs.
This accident will be the less likely to occur, if the treat-
ment above indicated is faithfully carried out. Never-
theless, during the course of the cardiac complications of
acute rheumatism, hemiplegia, with aphasia, embolic
pneumonia, or embolic obstruction of some peripheral
vessel may occur as a complication. The treatment of
such a complication consists first, in efforts to restore the
continuity of the obstructed vessel, and second, to obvi-
ate the local, vascular disturbances and consequent
nutritional disorders. The only measure which promises
even an approximation to success consists in the use of
solvents of the fibrinous plugs or emboli, of which
ammonia must be regarded as the chief. I know of no
clinical experience in support of the practice of the
intravenous injection of ammonia for the solution of
fibrinous emboli, but as this method has been repeatedly
resorted to with entire safety under other circumstances,
it is in a high degree probable that it would be very
beneficial in this case. One part of aqua animoniiv,
diluted with two parts of water, is an ammoniacal solu-
tion which has been injected into the blood re])eatedly
without any ill eftects of any kind. If the intravenous
injection may not be desirable, the usual means for
securing the admission of ammonia to the blood — by the
stomach — may be resorted to. Although the point of
contact is minute, the impact of the alkalized blood
may gradually bring about the solution of the embolus.
In considering the treatment of the embolic processes,
besides the obstruction at the point of lodgment of the
•embolus, our attention must be directed to the results.
So much depends on the position of the embolus, as
respects the office of the " terminal arteries," that no
adequate conception of embolic obstruction of vessels
can be had, which does not include in its purview the
conditions known as " collateral hypera;mia and (edema."
When, therefore, in consequence of endocarditis, embolic
obstruction occurs, it is very important from the ])rognos-
tic point of view, to know whether or not a " terminal
artery" has been blocked. If a terminal artery, it is
certain that the considerable area of devastation pro-
duced by the collateral changes must be added to those
due to the mere obstruction. When, therefore, in the
course of acute rheumatism with endocarditis, right
hemiplegia with aphasia occurs, we may have to deal
with a transient impairment of motility, or a more lasting
hemiplegia, with accompanying disorders of motility,
sensibility and speech. In the former we have a right to
assume that the obstruction has occurred in an artery
having numerous anastomoses, some of which have
assumed the duty of supplying the obstructed area with
its proper complement of blood. In the latter, we must
conclude that the obstructed vessel is a terminal artery,
and that to the localized an.-uinia thus induced is sui)cr-
added the phenomena of collateral hyperajmia and cedema.
In the former the powers of nature may be adequate to
the restoration of function ; in the latter, art must inter-
pose. Any remedy administered in the former condition, at
the right time, may seem to have accomplished marvels.
In cases of cerebral embolism the chief point is to
prevent the mischief produced by the collateral hypere-
mia and cedema. The best results are obtained from a
combination of quinine, ergot, and digitalis, for the col-
lateral mischief, and ammonia to effect the solution of
the obstructing plug. The latter should be used in ac-
cordance with the princi^jles already laid down, and the
former should be kept up until some evidence of a satis-
factory change in the local hyperemia and oedema is
manifest. It need hardly be observed that the caustic
alkali, ammonia, should not be given at the same time
with the ergot and digitalis. These principles are equally
applicable to the treatment of embolic pneumonia.
In cases of acute rheumatism, complicated with endo-
carditis, one of the modes of dying is by embolic pneu-
monia. In this condition we have an adequate explana-
tion of the hyperpyrexia in some cases. The peculiar
shape and appearance of the inflamed area, are not with-
out importance from the therapeutical standpoint, for
here, it is obvious, there are conditions present which
clearly sejiarate embolic from the form of pneumonia
called fibrinous or croupous. The latter, indeed, seems
to be a specific disease — a self-limited malady — whilst
the former belongs to the general class of inflammatory
reactions due to non-specific, non-infective emboli. Em-
bolic pneumonia should therefore be managed with strict
reference to the nature of the local morbid process. Er-
got, quinine, digitalis, morphia, are the remedies to
check or prevent the change in the circulation of the
part affected so long as such an action is possible ; af-
terward, to favor the retrograde changes, attention must
be given to the support of the natural powers.
During the course of the various secondary changes
due to endo- and exo-carditis, an important element is
the condition of the heart-muscle. I have already re-
ferred to this as a part of the morbid aftection of the
organ which must be considered in dealing with endo-
carditis and pericarditis. This condition has, however,
wider applications. Myocarditis enters into the question
of treatment, as of prognosis, in all the complications of
acute rheumatism secondary to endocarditis and peri-
carditis, but, besides, in embolic pneumonia, the element
of obstruction in the pulmonary circuit must be re-
garded.
Case of Subpericr.^nial Cephalh.em.atoiMA. — Dr.
M. H. Battershall, of Attleboro, Mass., sends us the his-
tory of a case of the above nature. Dr. li. attended a
primapara in labor, the pains having begun about two
hours previously. Examination showed a slightly con-
tracted pelvis, OS dilated half an inch, child's head in
second position. Fains continued four hours more, when
the child was delivered. A caput succedaneum was pres-
ent but disappeared within twenty-four hours. There was
then seen on the site of the left parietal bone a fluctuat-
ing tumor covering its whole extent. The skin present-
ed its natural appearance. Cold lotions and spiritous
washes were applied but to no avail in diminishing the
size of tlie tumor. Compression also failed. He .next
aspirated the tumor and drew off two ounces of very
dark sanguineous fluid, then applied a compress, which
was removed at the end of three days, revealing a
healthy normal condition. The ccphalhaiinatoma was
attended with pain, as the child cried almost continuously.
Paralysis Agitans. — Professor Brandes, of the Gen-
eral Hospital at Copenhagen, writes to the Gazette Aled-
icale lie Paris that he has cured two recent cases of
paralysis agitans by the continuous a|)i)lication of cold
to the back of the neck. In older cases the method
failed.
January 27, 1883.]
THE MEDICAL RECORD.
87
CONVALLARIA MAIALIS.
The Results of Clinical Experiments at the Roose-
velt Hospital, New York.
By henry ling TAYLOR, M.D.,
LATE HOUSE PHYSICIAN, ROOS'^-VELT HOSPITAL.
^rY attention was first called to the drug, convallaria mai-
alis, by an article by Dr. E. P. Hard, of Newburyport,
Mass., which appeared in The Medical Record of
September 9, 1882. Soon after I was requested by Dr.
Francis Delafield, then attending physician to Roosevelt
Hospital, to give the convallaria a trial in cases which
should seem appropriate. Convallaria was accordingly
employed, under Dr. Delafield's direction, in the medical
service of the hospital, almost to the exclusion of digi-
talis, in cases needing a heart tonic, from the middle of
September, 1882, to the end of November. The cases
in which the convallaria was employed were :
First. — Cases of Bright's disease, where the circulation
seemed at fault. Six cases.
Second. — Cases of deficient circulation from organic
cardiac disease. Five cases.
Third. — Cases of heart failure from pneumonia in old
people. Two cases.
Fourth. — Cases of heart failure in typhoid fever. Five
cases.
Fifth. — Two cases of emphysema and bronchitis (one
of them with asthma) where the pulmonary condition
offered an obstruction to the circulation.
These are all the cases in which convallaria was tried du-
ring the period mentioned, with the exception of five, where,
for various reasons, only a very few doses were given.
The preparation used was the fluid extract of the flow-
ers, furnished by Messrs. Parke & Davis, except from the
period from October 5 th to October 7th, when a specimen
procured from Eimer & Amend was employed. It may
be proper to state here that, so far as I know, Parke &
Davis's preparation is as yet the only reliable one fur-
nished in this country, and I am informed that their ma-
terial is nearly or quite exhausted, and cannot be replen-
ished until a new stock is collected next season.'
The dose employed in these experiments varied from
TIL v. t.i.d. to y\, XX. q. 4 h., and in two cases (IV. and XI.)
3 j. t.i.d., was given with good results, vvhcre smaller
dosage failed. I think I would have had better success
in several instances if I had run the dose u[) higher than I
did. In no case were any toxic symptoms observed.
Vomiting was much less frequent than in i)atients under
fairly large doses of digitalis, and could hardly be traced
to the convallaria in a single instance, as it only occurred
where symptoms of chronic gastric congestion or inflam-
mation were marked (Cases I., V., and VIII.). As be-
fore mentioned, two patients were kept on 3 j. of the
■convallaria t.i.d. for several weeks with much benefit and
without the slightest toxic symptom.
I will now give a synopsis of the histories of the pa-
tients treated with convallaria, leaving for the conclusion
a discussion of the .results. Temperatures are axillary
unless otherwise stated.
Case I. — -Chronic Brighfs disease. — Cecilia J ,
aged fifty-three ; Ireland ; widow ; domestic. Admitted
September 19, 1882. Dys]jncea, palpitation, cough,
headache, vomiting, and cedema of legs at times for the
last four months. Urgent dyspnoea, last night or two.
Present Condition. — Orthopncea ; jnilse weak and ir-
regular : cedema of legs. Physical examination : hyper-
trophy of heart ; no murmurs. Subcrepitant rales bases
•of both lungs.
Treatment. — Rest in bed. Infusion of digitalis, 3j.>
and acetate of potash, gr. xxx., q. 4 h.
September 2olh. — Temperature 103.7° F. Urine,
1,012, alkaline, albumen forty per cent. Feels better.
Digitalis and acetate of potash stopped ; given conval-
laria. Til ij. q. h.
September 2 2d. — Temperature normal since the morn-
1 Vide note by Dr. Hurd in The Medical Record, November ii, 1882.
ing of the 20th. Pulse slower and stronger; breathes
easily.
September 24th. — Patient entirely comfortable and
able to sit up. Convallaria stopped last evening.
October 17th. — Patient has been getting along very
comfortably, except for headache, which is worse to-day,
and patient vomits. Ordered convallaria q. 2 h.
October 21st. — Convallaria discontinued on account
of nausea.
October 25th. — Patient went out on pass and did not
get fatigued.
November 5th. — Patient very short of breath and nau-
seated.
November 6th, p.m. — Commencing cedema of lungs.
Cupped over chest.
November 7th. — Put on convallaria, ni x. q. 4 h. Pa-
tient is passing sixty ounces of urine a day, or more.
November 13th. — Amount of urine not increased since
the 4th. Patient much more comfortable ; convallaria
stopped.
November 28th. — Urine, 1,008, alkaline; albumen,
trace.
December 12th. — Patient under treatment for prolap-
sus uteri, no urasmic symptoms. She is very comfortable.
Date.
Re-ipi-
ralions.
September 20th, a.m. (Convallaria, TH^ij. q. h.)
September 20th, p.m
September 21st, a.m
September 2 1st, P.M
September 22d, A..M ,. . . .
September 22d, P.M
September 23d, a.m. (Convallaria stopped.).
September 23d, P.M
September 24th, .\. M
September 24tli, r. M
104
104
92
84
76
80
So
72
72
30
38
30
24
26
24
26
30
26
27
Urine,
ounces.
IS
44
* The urine is measured from 6 a.m. to6 a.m. The asterisk, in this and the fu"-
lowing tables, denotes that some of the urine of the previous twenty-four hours was
lost.
Pulse and respirations kept on this way. Urine in-
creased to sixty or seventy ounces by October ist.
Date.
Re.spi-
Urine,
rations.
ounces.
22
24
42
24
18
58
22
18
SO
20
26
28
45
26
38
20
24
28
45
22
46
October i8tli, a.m. (Convallaria, TT^x. q. 4 h.)', 84
October iStli, p.m ! 76
October 19th, A.M 84
October I9tli, p.m 72
October 20th, .\. M 80
October 20th, P. ,\i 72
October 2ist. .i.M. (Convallaria stopped. ). . 72
October 2ist, P.M 76
October 22d, a.m 84
October 22d, P.M 1 96
October 23d, A. M • 80
October 23d, P. M 76
October 24th, a.m 92
October 24th, p. M 72
Case II. — Chronic Bright's disease. — Mary A ,
aged thirty-two ; Ireland ; married ; house-work. Ad-
mitted September 12, 1882. Has complained of dysp-
noea and palpitation for seven )-ears. Slight dry cough
last six months. Two weeks ago had a creeping chill
and cold sweat, followed by constant vomiting and great
pain in epigastrium.
Present Condition. — Pain and tenderness over lower
half of sternum. Catching dyspncea. Poor circulation
in extremities. Pulse very small and thready ; regular.
Pupils not responsive. Pulse, 84 ; respiration, 26 ; tem-
perature, 97.5, a.m. Urine, 1,016; acid; albumen, 5 jser
cent.; no casts found. Physical examination : Prolonged
respiration at both apices ; some sonorous breathing over
right lung. Heart-sounds very weak ; no murmur.
September 13th. — Put on milk diet; bicarbonate of
soda, gr. x. t.i.d., and tincture of digitalis, IT], x. t.i.d.
88
THE MEDICAL RECORD.
[January 27, 1883.
September 14th. — Ordered a pearl of amyl nitrite
daily.
September 15th. — Tincture of digitalis increased to
Til XV. t.i.d.
September i6th. — Condition about the same as on en-
trance.
Present medicine stopped ; ordered convallaria, TI], xx.
q. 4 h.
September 19th. — Convallaria TT], xv. q. 4 h. Xo al-
bumen in urine.
September 2 2d. — Pulse about the same, though jiatient
feels much better and breathes move easily.
September 23d. — Convallaria stopjied.
September 25th. — Patient much better than on en-
trance. Discharged improved.
Date.
Pulse.
Res-
pirations.
September 12th, .a.m ' S4
September 12th, r.yi 56
September 14th
September 15th
September i6th. .\..m. (Convallaria, TT^^ xx.
q. 4 'ir- )
September i6th, r. m So
September lytli, .\. m 76
September I7tli, p. m So
September iSth, .\. >r y2
September iSth, p. m gi
September 19th, a.m. (Convallaria, TT^ xv.
'1- 4 lir. ) 104
September 19th, P.M 112
September 20th, a.m 104
September 20th, p. m 88
September 21st, A.. \i 84
September 21st, p. m So
September 22cl, a.m 88
September 22cl, P.M ()^
September 23d, .a.m. (Conval. stopped). 100
September 23d, P.M 64
September 24th, .\..M 104
September 24th, P.M y(,
September 25th, a. .M 108
26
42
26
18
18
22
20
22
22
26
22
21
iS
20
23
20
20
16
18
18
Urine,
ounces.
22
io*
20
Lost.
28
28
40
42
34
28
Case III. — Cltronit: Bright' s disease. — Francis W ,
aged thirty-three ; Ireland : married ; compositor. Ad-
mitted September 25, 1882. Feet and face began to
swell four months ago. Eyesight has failed for three
months. Occasional attacks of occipital headache. No
nausea ; no change in quantity of urine.
Present Condition. — Face pale ; tongue lightly coated ;
appetite good ; bowels regular ; pitlse full and' regular ;
face, legs, and genitals cedematous. Pulse, 80 ; respira-
tion, 18 ; temperature, 98°, p.m. Urine, 1,015 ; neutral ;
albumen, 30 per cent.; casts. Physical examination :
Double cardiac impact and double first sound. Lungs
normal.
Treatment. — Milk diet ; convallaria. Til, v. four times
a day.
September 26th, a.m. — Urine for previous twenty-four
hours, sixty-three otmces. Pulse, 80 ; respiration, 20.
P.M. : Pulse, 80 ; respiration, 18.
September 2 7th — Five general clonic convulsions last
evening, between 7 and 11 o'clock. Morphia, chloral
and bromide of potassium, p. r. n. Urine, sixteen
ounces. A.M.: Pulse, 80 ; respiration, iS. p.m.: Pulse,
72 ; respiration, 20.
September 28th. — Patient maniacal ; nearly blind ;
general pruritus.
September 29th — U. S. solution of morpliia, 3 j., night
and morning.
October ist. — Patient doing well.
October 4th. — O.xygen, gal. v., night and morning.
October 7th. — Patient is up. Pulse goes up to 100"
occasionally. Urine has averaged tliirty to forty ounces
since Septetnber 28th ; today sixty ounces.
October loth.— Pulse, 84. Convallaria stopped. Put
on the syrup of the iodide of iron.
October i6tli. — Patient very nervous. Pulse, 120 to-
day ; it has increased in rapidity since the convallaria
was discontinued.
October 17th. — Still very nervous. Ordered TIlj. of a
one per cent, alcoholic solution of nitro-glycerine, given
in 3 ij. water, t.i.d. Urine, 1,010; acid; albumen, 30
per cent.; casts.
October iSth. — Nitro-glycerine made patient dizzy ;
felt like falling after each dose ; had a feeling of a band
around the head. Nervousness lias disajjpeared. a.m.:
Pulse, 112; respiration, 24. Urine forty-four ounces.
P..M.: Pulse, 108 ; respiration, 22.
October 20th. — .At own request discharged improved.
Case IV. — Chronic Brighfs disease — Cirrhosis of
liver. — Isabella McG •, aged forty ; Ireland ; mar-
ried. .Admitted October 27, 1882. Well up to De-
cember, 1881 ; after that had nausea and vomiting for
two months. Swelling of feet and legs since May, and of
abdomen since June. Since then urine has been dimin-
ished. No headache.
Present Condition. — \^ery pale ; face puffy ; bowels reg-
ular ; appetite poor ; pulse weak ; cedema of legs and
ascites. Pulse, 116; respiration, 24 ; temperature, 98.5°.
Uiine, t,oi2 ; acid; albumen, 60 per cent.; granular,
fatty, and hyaline casts ; pus and blood. Physical
examination : heart and lungs negative ; liver dulness
diminished ; fluctuation over abdomen.
Treatment. — Pot. acetat., 3 ss.; inf. tritic. repent. O. j.
Sig-) J ij Q- 2 h. Rest in bed ; bowels kept open.
October 30th. — .\bdonien measures forty-one inches.
November ist. — .Acetate and triticum stopped.
November 6th. — Patient about the same. Put on fluid
extract convallaria, TTl -x. q. 4 h.
November 9th. — Nausea and sleeplessness.
November 13 th. — .Abdomen forty-one inches. Con-
vallaria, TI], XX. q. 4 h.
November 1 7th. — Convallaria, 3 j- t.i.d.
November 20th. — .Abdomen forty inches. Feels better
and passes more urine. Has a uterine fibroid size of
child's head, or larger.
December i2th. — Still on convallaria, jj-t-i-d- -Aver-
ages about thirty ounces of urine daily. Urine to-day,
1,016 ; acid ; albumen, 60 per cent. ; casts as before.
Up and about and comfortable. Urine was measured
daily since entrance. L^p to November 15th, the daily
average was about fifteen ounces, never over twenty ;
after this as follows :
Urine,
D.\TE. ounces.
November 1 5 tli 22
November i6th 24*
November 1 7th 30
November iSth 18
November 19th 17
November 20th 32
November 2 1 st 34
November 22d 17
November 23d 32
November 24th 36
November 25th 34
November 26th 1 30
Case V. — Phthisis — Chronic Brighfs disease. — Ella
VV , aged forty ; United States ; widow ; dressmaker.
Admitted July 10, 1882. Hemoptysis two years ago.
Cough for a year. CEdema of feet and legs and dyspnoea off
and on for seven months. Now has anasarca below
waist and cedema of right arm, dyspncea and cough.
Pulse feeble, 1 12; respirations, 22; temperature, 97°; urine,
1,020 ; neutral ; albumen, 60 per cent. ; granular casts.
Physical examination showed dulness over whole right
lung and at left apex. Subcrepitant and coarser rales
over both lungs in front and behind. Cavernous breath-
ing at extreme left apex.
This patient went along with periods of comiiarativecom-
fort, alternating with attacks of increased tedeina, partial
suppression of urine, dyspncea, etc. Convallaria, TTl ij.-iv.
q. h., afterward Til X- q- 4 ''• ^^'^s tried for tliese attacks after
Sejitember, but they seemed to run about the same course
as before. The pulse and urine ditl not seem to be affected.
January 27, 1883.]
THE MEDICAL RECORD.
89
Patient died November 14th, in an iirjemic attack with
suppression of urine ; convallaria was given up to TTl, v.
q. h. in 3 ss. of whiskey. Autopsy showed large white
kidneys (the two weiglied twenty-one ounces) and chronic
miliary tuberculosis of lungs.
Case VI. — Chronic Brig/it's disease and mitral re-
giirgHation. — John P , aged fifty-five; Ireland ; wid-
ower ; 'longshoreman. Admitted September 20, 1882.
CEdenia of legs for two and a half months. Worked up
to a month ago, when began to have dyspnoea and feet
swelled very much. At times has passed very much at
other times very little urine for past two months. Con-
stant drinker, never to into.xication.
Present Condition. — A'ery pale ; lower limbs and geni-
tals very oedematous ; tongue clean, appetite poor. Pupils
contracted and unresponsive. Breathing labored. Facial
muscles twitching. Pulse feeble and irregular. Pulse,
100; respiration, 32; temperature, 100, p.m. Urine,
1,002 ; acid ; albumen, : 7 per cent. Physical examination :
Mitral systolic murmur ; coarse friction rales left side
behind ; rough breathing on right side.
Treatment. — Milk diet. Rest in bed. Fluid e.\tract
convallaria, 11], xv., four times a day.
September 2rst, a.m. — Temperature, 98.5°.
September 24th. — Pulse and urine not atTecled by tiie
drug. Gidema of lower limbs and dyspnoea marked.
September 25th. — Convallaria stopped; put on pot.
iod., gr. X. t.i.d.
SejJteniber 27th. — Iodide reduced to gr. v. t.i.d.
Se|)teniber 28th. — Patient very stupid. Pulse, 100-
108 since entrance. Urine passed mostly in bed; about
fifteen ounces daily measured.
October 2d. — Patient unconscious.
October 4th. — Died 2.30 a.m.
Autopsy by Dr. Delafield. — Large white kidneys. The
two weigh sixteen ounces. Mitral insufficiency ; small
vegetations on aortic valve ; cardiac muscle yellow, as
if fatty.
Case Vii. — Mitral regurgitation. — Mary McG ,
aged fifty ; Ireland ; single ; domestic. Admitted Sep-
tember 19, 1882, for the third time. Patient has had
symptoms of cardiac disease for over three years. For
a year has had dyspnoea and for eight months oedema of
legs, off and on. Urine diminished at times. Present
attack of oedema, dyspnoea, etc., has lasted several weeks.
Is already getting better of it.
Present Condition. — Tongue clean, appetite good,
bowels regular. Urine passed in fair amount. Pulse
feeble, irregular, and intermittent. Pupils normal, mod-
erate dyspnoea. Pulse, 116; respiration, 38; tem-
perature, 98.2°, P.M. Urine, 1,018; acid; no albumen;
urine containeil albumen last May. Physical examination:
Mitral systolic murmur. Some cardiac enlargement.
Treatment. — Convallaria, V\ x. t.i.d. Rest in bed.
September 23d. — Patient's feet less swollen; sat up
to-day.
September 24th. — Patient now has no dyspnoea and
sleeps well.
September 25th. — Patient feels fairly well. Discharged
improved.
This attack rather milder than previous ones, when
patient recovered on digitalis.
Date.
September 19th, p.m.
September 20th, A.M.
September 21st
September 22d, A.M.
September 22d, r. M.
September 23d, A.M. ,
September 23d, p.m. .
September 24th, A.M.
Septemtier 24lh, p.m.,
September 25th, a.m.,
Respi-
rations.
n6
,38
104
36
112
52
84
30
96
36
92
28
«4
30
88
32
88
20
Urine,
ounces.
10
29
18
16*
20
(To be continued.)
RUPTURE OF ABDOMINAL WALLS— PROTRU-
SION OF STOMACH AND INTESTINES-
OPERATION— RECOVERY."
By p. J. HIGGINS, M.D.,
WILKESUARRE, PA.
J. V , male, aged forty, Irish-American, was thrown
from a locomotive over an embankment about twenty
feet in height, August 21, 1879. The engine was a small
narrow-gauge, working around the rolling mills of the
L. I. & C. Company, at Scranton. There were seven
men aboard at the time it left the rails, all of whom were
more or less injured. The track ran along the edge of a
bank, at the foot of which was a level space some ten
feet in width. Along the level ran a second track, and
some eight feet below flowed a broad and shallow
stream. Of the men injured, two jumped off when the
engine became derailed, and escaped with a few bruises ;
one went over with it and was thrown into the creek,
while the others were thrown off only when it capsized
ujjon the level. One of these latter had his foot so bad-
ly injured that amputation had to be performed ; an-
other walked home, but was injured internally and died
that night ; a third had serious scalp wounds, while the
fourth was found lying insensible beside the wreck. To
this patient, Dr. L. Wehlan was called, who requested
my assistance.
When the clergyman had administered the last rites of
the Church, we examined the patient's injuries and found
a transverse rupture of several inches in the epigastrium,
through which a large portion of the inflated stomach
was protruding. Orders were given to take the injured
man to his home, a distance of more than half a mile.
As there was no conveyance at hand (the Act of Assem-
bly requiring the maintenance of ambulances at mines,
etc., was not jjassed till the following session) a broad
board was jjicked out of the mud by the roadside, the
patient was placed thereon, and carried by loving hands
as tenderly as possible. We went on ahead to make
some simple, hasty preparations.
The patient was placed upon a high table in a good
light, his clothing cut away, and his injuries more
thoroughly examined. The rent in the epigastrium
measured about four inches. There was another rent, of
over six inches, stretching in an irregular line from the
descending arch of the colon nearly to the crest of the
ilium, through which a knot of about twenty inches of
intestine was protruding. There was also a scalj) wound
of the vertex, severe, but not considered serious.
The injuries were desperate — besides, others were, as
a matter of course, suspected to exist internally, and no
hopes of recovery were held out. The indications were
to wash clean both stomach and intestines, carefully
return them to the abdominal cavity by gentle manipula-
tion, sew up the rents, and combat the liability to perito-
nitis by full doses of opiates. As the patient was un-
conscious, no anaesthetic was administered. A solution
of chloride of sodium in tei)id water — temperature,
about 100° F'ahr., was prepared, the stomach washed
clean by squeezing the solution upon it from a sponge,
and then reduced by the gentle yet firm pressure of
palms and fingers over its whole extent. The pressure
of gas within the organ was quite strong, and great care
was necessary to maintain the reduction and prevent
wounding the viscus when introducing the sutures. This
was done by constant pressure of the open hand, and
the insertion of the finger between it and the parietal
layer of the peritoneum, when taking the stitches. Com-
mencing at both ends of the rent at the same time, to
insure an exact coaptation of the lips of the wound,
four interrupted sutures of stout silk, doubled to pre-
vent cutting through, were inserted and drawn tightly.
The edges were torn, but not ragged, and were readily
brought together. It was promptly decided to include
the parietal layer of the peritoneum in inserting the
^ Reported to the Luzerne County Medical Society, January 10, 1S83.
90
THE MEDICAL RECORD.
[January 27, 1883.
sutures, so as to have two serous surfaces in contact, in
order that adhesive inflammation might, in a few hours,
be set up and the cavity of the abdomen again securely
sealed. This was considered the cardinal and all-im-
portant point in closing the wouijd.
It is a serious matter to drive a needle and pull a su-
ture through the peritoneum, usually so exceedingly sen-
sitive to injury, especially to puncture. But e.\perience
has shown that when two injured serous surfaces are
closely and firmly applied, an abundance of lymph is
quickly exuded, and adhesions are rapidly formed. Much
trepidation is usually experienced by the young surgeon
■ — the old surgeon occasionally ditto — in operations
involving the peritoneum, lest he should not promptly
recognize this membrane when he reaches it. i5ut in its
natural condition it is very difficult to mistake the smooth,
glistening tissue of slightly bluish satiny sheen for any
other.
By gentle and steady manipulation for several minutes,
the protruded intestines — in which the well-filled lacteals
showed beautifully — were reduced, inch by inch, and the
edges of the rent approximated. Commencing at both
ends at the same time as before, eight interrupted sutures
were inserted with the same precautions. One good
feature, so far, was the absence of bleeding, or oozing
from the woimds, even from the insertion of the needles.
Altogether, as far as could be observed, scarcely two
grammes of blood had been lost during the operation.
In order to prevent the intra-abdominal pressure from
tearing the stitches, two large strips of clean linen were
folded into pads, or compresses, and placed over the
lines of union, while, to keep them in place and supply
counter-pressure, a broad piece of sheeting was doubled
and applied round the trunk, from the hijjs to the arm-
jiits, drawn tightly and firmly secured by safety-pins.
The bandage over the pads was saturated with carbolized
oil. One stitch secured the scalp-wound.
In less than five minutes afterward the patient became
conscious, and realized his condition and surroundings.
The pulse was ninety, soft and full ; the temperature
normal. A quarter-grain of morphia was given, and he
soon after sunk into a quiet slumber. During the opera-
tion he vomited several times, but afterward his stomach
soon quieted.* Nothing was given to get rid of the intes-
tinal gases, as the pressure and counter-pressure main-
tained upon the line of the wounds was considered of
great service in preventing hemorrhage and hastening
adhesions.
Late that night, no bad symptoms had made their
appearance. Next morning the temperature was found
to be 99° F., and the pulse loo. An enema of brandy
and beef-tea was given, and repeated every four or five
hours during the day. Majendie's solution was substi-
tuted for the morphia, and enough given to control pain,
but not to maintain narcosis. The second and the third
days went by without any symptoms of peritonitis appear-
ing. The temperature at no time rose above 99° F.,
and the case progressed without a single untoward symp-
tom. Three weeks after the accident the patient was
able to sit up, and soon after was considered convales-
cent.
Here were two extensive rents made in the parietal
layer of the peritoneum, while at least sixty square
inches of the visceral layer were exposed to the atmo-
sphere for over half an hour, and freely manipulated for
more than five minutes. In addition to this, twenty-four
punctures were made along the lines of injury. There
was no spray, and no antisepsis save the carbolized oil
over the dry dressings. To what is the favorable result
after such fearful injuries to be attributed? And how
could such injuries be produced without serious or fatal
damage to internal organs .' Except the wounds already
noted, there was not a single scratch upon the body.
The abdominal walls were not cut, but torn clear
through, as if burst, not from without, but from within.
The patient was a vigorous, healthy, temperate man,
which certainly contributed materially to his recovery ;
but the method of inserting the sutures was undoubtedly
the main factor in the case.
These were inserted in such a manner, and drawn
sufficiently tight to produce a slight pouting of the lips
of the wound, thus shutting off the silk from the cavity
of the abdomen, which the exuded lymph, aided by the
double pressure, soon sealed air-tight once more, thus
preventing the entrance of pus, blood, or other irritating
or foreign matters.
[In the discussion which followed, Dr. R. Davis spoke
of one of his cases of ovariotomy in which the peritoneum
was found united, though the patient never rallied from
the shock of the operation, and died in ten hours after-
ward.]
A STUDY OF HERPES ZOSTER. WITH SPECIAL
REGARD TO ITS ETIOLOGY.
By GEORGE THOMAS J.\CKSON, M.D.,
NEW YORK.
Zoster is a form of herpes specially distinguished by the
severe neuralgic ]5ain that usually accompanies it ; by its
lesions occurring in well-marked groups along the course
of nerves; by being in the vast majorltv of cases unilat-
eral ; in rarely attacking the same individual a second
time ; and in often leaving scars as a sequel. It difters
from the other forms of herpes in the above points, and
in commonly avoiding those situations usually affected by
them, viz. : the lips, nose, and genitals.
Zoster, from the Greek word meaning a belt, was so
named on account of the tendency it manifests to form a
belt about the body, generally a one-sided belt.
Etiohgy. — By the ancients, herpes was regarded as
due to " yellow bile becoming fixed unmixed with other
humors in a part." They taught that if the bile were
thick and acrid, it would ulcerate the whole skin down
to the flesh, forming what they named " Herpes Exe-
dens" ; but if it was thin, less acrid and hot, it would
merely raise small blisters on the surface like millet seeds,
and this form the)-, named "Herpes ATiliaris." This
opinion may be found in the writings of Galen, ^-tius,
Paulus ^-Egineta, and others.
Quite early in the era of modern medicine the fact
that the zoster groups were located along the course of
certain nerves, and these mostly of the spinal system, led
observers to surmise that there was some disease of the
cerebro-spinal, or at least, the spinal nervous system at
the bottom of the trouble. At last, Barensprung, about
the year 1861, originated the theory that zoster was due
to disease of the ganglia on the posterior roots of the
spinal nerves, or of the Gasserian ganglion of the trigem-
inus nerve, and since then this theory has been substanti-
ated by himself and others. It is now held that the
ganglia become inflamed, and the irritation thus set up
is carried along the nerves with secondar)' results on the
skin. In some cases hemorrhage takes place into the
ganglia. The ganglia being on the posterior or sensitive
roots of the nerves, their inflammation would account for
the severe pain experienced in zoster. But disease of
the nerve-ganglia is not sufficient to account for all the
cases of zoster. This may also be caused by disease of
the central nervous system, and thus can be explained
the occurrence of rare cases of bilateral zoster. It may
also be caused by injury or disease of a branch from the
main nerve, and be limited to its distribution, or by can-
cerous or other deposits in the bones of the spinal col-
umn. Finally, it may result from atmospheric changes,
damp wet weather, sudden arrest of profuse perspiration,
poisoning by arsenic, etc.
In stuching a number of consecutive cases that have
been under my care, 1 liave found in the majority of them
so marked a liistory of mental anxiety, nervous strain or
worry, as to lead me to ask myself the question : " Is not
mental anxiety a too much neglected factor in the etiol-
ogy of zoster ? " Of course it would, no doubt, be easy
January 27, 1883.]
THE MEDICAL RECORD.
91
by inquiry to find anxiety and worry in a vast number
of ailments, and in many cases they would be but mani-
festations of the physical state of the patient. But in zos-
ter, some of my patients have given me the history of
anxiety without my asking, and the anxious appearance
of others has led me to the inquiry. A state of mental
unrest will be found noted in four of the cases reported
below. Besides these, I have recently seen two other
cases having the same factor ; one a married lady, enjoy-
ing usually the best of health, who was attacked suddenly
with a very painful zoster after great anxiety in caring
for the sick child of a friend ; and the other a young
man nmch depressed mentally while passing through
the secondary stage of acquired syphilis.
Pathology. — In Virchoiv's Archives, vol. 86, part iii.,
1881, I,esser ("Beitrag zur Lehre von Herpes Zoster '')
publishes an account of several autopsies upon the
bodies of patients dying of zoster, and by microscopical
examination of the affected spinal ganglia substantiates
the statements made by other pathologists, a summary
of which has just been given under the head of Etiology
in this article. In regard to the secondary changes tak-
ing place in the skin, he makes the following (condensed)
statement: "The principal changes are in the epider-
mis, first an increase in the size of the epithelial cells,
each one swelling up, in some cases to even five times
its usual size, and also an increase in the number of
cells ; probably by division (Thciliuig). Then little cav-
ities form, containing the altered epithelium, the partition
walls being composed of flattened cells ; these walls at
last break down and disappear, and thus the vesicles are
formed. In the corium under the vesicle there is an in-
filtration of cells, most marked at the periphery of the
vesicle. The blood-vessels are engorged, and in some
places he found hemorrhages. All these changes are
due to an increased nerve-supply, an increased activity
in the nutrition of the cells, followed by degenerative
changes, and finally, a giving way of the cells under an
increase of exudation from the vessels of the corium.
The locality of the eruption will depend upon the
nerve aftected, and may be anywhere on the body, face,
trunk or extremities. From the localization of the
groups the varieties of zoster derive their names, which
sufficiently explain themselves, as : Zoster frontalis ; Z.
pectoralis ; Z. dorso-lumbalis, etc.
The eruption consists of groups of vesicles upon red
bases, the vesicles varying in size from that of a pin-head
to that of a pea, or larger, with clear, watery contents at
first, becoming in the course of a few days opaque, then
purulent, and at last drying into brownish yellow scabs.
Each group remains intact eight to ten days, but as new
groups are apt to start up, the disease may last several
weeks. The vesicles in themselves do not tend to rupture,
but are often broken by the rubbing of the clothing. The
number of the groups is very variable. In very intense
outbreaks some of the vesicles or groups may be hem-
orrhagic, and cicatrices are apt to remain on healing.
The course of the disease is acute, rarely lasting m all
more than one month. The eruption is often preceded,
accompanied, or followed by severe neuralgic pain, re-
ferred at times to the seat of the eruption, at times to the
back, etc., as in Z. pectoralis we often find one painful
point in the neighborhood of the spinal column, another
in the axillary line where the ribs bend forward at their
sharpest angle, the place of bifurcation of the anterior
branch of the spinal nerve into its superficial and deep
branches, and less frequently a third point near the an-
terior median line of the chest, where the final spreading
out of the terminal branches of the nerve takes place.
The pain at these points is aggravated by breathing,
thus sinuilating the pain of acute pleuritis, the diagnosis
being at times rendered still more uncertain on account
of the pyrexia which may accompany the disease, but, of
course, all doubt will fade away on the appearance of
the eruption. If the vesicles should break, raw surfiices
will be left, which by their attending pain will greatly ag-
gravate the suffering of the patient. The disease is not
contagious.
Sequela. — In some bad cases, after the lesions proper
to the disease have entirely healed, the neuralgic pain
will continue for an indefinite period, or there will be
laming of certain muscles, falling out of the hair, or of
the teeth. Happily such cases are rare, and the rule is
that there will be no sequela;.
Treatment. — -If the patient suffers much pain, especial-
ly if his rest is disturbed by it, he must be kept quiet by
the use of opium. Tonics, as iron, strychnia, quinia, etc.,
are to be used according to the indications present.
Phosphide of zinc in doses of one-third of a grain every
three hours has recently been recommended. For the
neuralgic pains, especially those remaining after the lo-
cal lesion has healed. Fowler's solution in fine drop doses
is, perhaps, the best remedy. The constant electric cur-
rent applied to the seat of the eruption and along the
course of the nerves is well spoken of by Duhring, who uses
five or ten cells for fifteen or thirty minutes every day, or
twice a day, to the relief of the pain, both during and
after the eru])tion, the positive pole being placed over the
point of emergence of the nerve, and the negative brushed
over the terminal filaments. Locally our object is to
protect the delicate walls of the vesicles from rupture,
and to this end it is well to use some dusting powder,
such as starch, lycopodiuni, oxide of zinc and lycopodi-
um ; one containing morphia and camphor, etc., applied
liberally, and then covered with a bandage to prevent
the rubbing of the clothing. If the vesicles have burst,
leaving a raw surface, powders are still useful, or some
simple ointment or unguent zinc oxid, or some anodyne
lotion containing opium, belladonna, and canqjhor, or
ac. carbol, gr. 13 or 15 to the ounce of water. Morphia,
gr. 10, to flexible collodion, 3 j., is also good, being paint-
ed over the part.
Below I have added the histories of five cases, illus-
trative of mental worry as an etiological factor in zoster,
and of the disease in general.
Case I. — Herpes Zoster Dorso-Pectoralis. — E. F ,
aged eight ; United States. September, 1S82. On the
evening of September 5th the child complained of a burn-
ing pain in left side, and on the next morning the mother
noticed the eruption of vesicles.
General health good. Child well nourished. No his-
tory of strain, rheumatism, or injury, .■\ppetite good ;
bovvels regular. Up to one year ago child had fits fre-
quently, but none now.
The eruption is located on left side, following the
course of the eighth intercostal nerve from spine to
sternum. It still burns and keeps child awake. It
forms an almost unbroken line of large and small vesi-
cles, with serous contents on a red base. All the vesi-
cles unbroken.
\Vas ordered a dusting-powder of lycopodiuni and zinc
oxid, and a sleeping draught containing opium and pot.
broniid.
Case II. — Herpes Zoster Fcmoralis. — Bridget H ,
aged forty-six ; Irish. October, 1 88 1. For three or four
years past she has had dyspepsia and patches of acne
rosacea on nose and both cheeks. She is frequently
troubled with rheumatism, but says her appetite is good,
and bovvels regular. She works very hard in her house-
hold cares, and for the past year she has slept badly.
No history of any injury or strain.
Patient appears careworn and anxious. Acne rosacea
upon end of nose and both cheeks, the patches being
small. Upon the anterior and inner surface of left thigh
are two groups of herpetic vesicles, the vesicles being not
very closely (pressed together. In the groin of same side
an enlarged inguinal gland is seated. Upon touching
the groups the patient complains of pain, otherwise they
give her so little trouble that she came to the clinic solely
on account of the enlarged gland.
A dusting powder of starch was ordeied.
Case III. — Herpes Zoster Inguinalis. — October,i88i.
92
THE MEDICAL RECORD.
[January 27, 1S83.
H. C. M , aged thirty-three ; American ; no busi-
ness. General history good, bowels regular, no trouble
with his digestion, and no account of any injury or
strain. Patient said that he knew he was " going to
the devil " through his bad habits, and is very nervous
and worried.
Five days ago, while in his usual health, he was at-
tacked with a sliarp pain in his left leg, and noticed a
couple of patches of vesicles in liis groin, since which
time he has slept very poorly and the pain in leg has
continued.
Patient of nervous temperament, and has a wild, wor-
ried look. Upon examination two groups of herpes
vesicles are found, one immediately over inguinal
glands, and the other below and to the inner side.
The groups, oval in shape, upon a slightly inflamed
base, are of nearly equal size, and about two and one-
half inches in their longest diameter ; composed of pin-
head size vesicles closely pressed together, of turbid
contents, and on each group one large bulla rising up
prominently from about the centre.
Treatment consisted of a protecting ointment and a
tonic.
Case IV. — Herpes Zoster Femoralis. — October, 1881.
Wm. C , aged sixty ; Irish ; no business. Patient
has been dyspeptic for some time, being troubled with
pyrosis, etc. Bowels regular. (>eneral health otherwise
good, though he sutTers from sleeplessness. No history
of bruise or strain. Says he is a good deal worried by a
son who leads a wild life.
Two days ago, while in his usual health, he had a se-
vere sharp pain in the small of his back and right leg,
and noticed that a number of little vesicles appeared
suddenly upon his right leg. Pain in back still con-
tinues.
Patient a well-nourished man for his time of life. On
examination there is found on the anterior surface of
right thigh, principally in the area of distribution of the
middle and internal cutaneous branches of the anterior
crural nerve, six groups of herpes vesicles, varying in
size, some having no more than three or four vesicles in
them. A'esicles are pin-head size, with clear serous con-
tents, the groups being seated upon reddened bases.
Treatment merely palliative.
Case V. — Herpes Zoster Brachialis. ' — Mr. C ,
aged 64; butcher. August 9, 1882. His general health has
always been good. About four days ago the present
eruption suddenly appeared. Jlad been feeling unwell
for a few days before, and had consulted a physician, who
gave him " blue " pills, which he took on the third day
preceding the eruption. The next day he had a pain on
the top of his right shoulder, and felt lame there, and for
this he was rubbed by his son. The next day he felt i^am
shooting down his arm towards the ulnar aspect, and an
intense stinging in the little finger, upon which there is a
scar from an old cut. On the morning of the next day
noticed red spots " under the skin " on ulnar side of
palm, then a group of vesicles on ball of thumb, soon fol-
lowed by others on palm, and middle, ring, and little
fingers. During the first twenty-four hours the eruption
was confined to hand, then began to spread on wrist, and
has steadily advanced up the arm, continuing most
marked on its first seat. Has had no neuralgic pain
since beginning, but a good deal of burning, principally
in palm, and arm has felt uncomfortable when hanging at
the side. Sleep undisturbed. Has never had any erup-
tion like this before ; has taken no arsenic nor other
medicine of late. A son of his has recently caused him
a great deal of trouble and anxiety.
Present eondition. — The right hand is considerably
swollen. Upon the jialm are large vesico-papules mostly
isolated, looking like variola eruption. Upon ulnar side
of wrist the vesicles are various sized, confluent, and of
light i)ink color. On back of wrist, hand, and ring and
1 T am indebted for this case to the courtesy of Prof. G. H. Fox, M.T>.
small fingers eruption very well marked, consisting of
vesicles, and small bulL-e upon a reddened swollen base.
Upon middle finger the eruption is slight, there being only
one or two groups of vesicles and a few isolated ones.
Thumb and forefinger perfectly free from eruption and
feel natural. The eruption upon forearm and arm is
more easily recognized as that of zoster, consisting as it
does of numerous groups of vesicles, most of which seem
at their height, seated upon red patches along the course
of the internal cutaneous and musculo-spiral nerves.
He was given a i)lacebo and cautioned against ruptur-
ing the vesicles.
"September 7th.— Up to date patient has called several
times, and made steady progress toward recovery, till
now there are but few traces of the eruption remaining,
these principally on the palm in the form of fresh skin
under the ragged remains of old vesicles. The patient
complains of numbness and slight loss of power in the
little and ring fingers of the aftected hand, an actual
paralysis due probably to a neuritis. The patient now
passed under the care of Dr. V. P. Gibney, surgeon to
the " Hospital for Ruptured and Crippled," by whom he
was originally sent to Dr. Fox, and at last report he was
doing well under electrical therapeutics.
Coiielusion. — It will be noticed that in four out of these
five cases there was a marked element of anxiety or
nervous strain, one on account of a dissipated life, two
on account of a wayward son, and one from the hard
struggle for existence.
These cases will also serve to illustrate the diversity in
the symptom of pain. In Nos. i and 3, the pain pre-
ceded the eruption, was continuous for some days, and
was located in the seat of the eruption ; in No. 2, it was
complained of only upon contact ; in No. 4, it was located
principally in the small of the back ; while in No. 5, it
was felt only just before and during the appearance of
the eruption.
In all the cases there was a marked absence of any
history of injury or strain of the nerve, and in but one
was there any evidence of the rheumatic diathesis.
14 East Thirtv-first Street.
Expert Testimony in Lunacv Cases. — The recent
trial in Chicago of a prostitute for the murder of her
"lover" has forced upon inibhc attention some serious
defects in our present medical expert system. The de-
fence took refuge in the well-tried and old reliable plea .
of insanity — probably with some justice, since two
most eminent and experienced neurologists affirmed
its truth. "Sane," "legally sane and medically in-
sane," "legally and medically insane," were some of
the opinions offered by various experts. In a recent
paper, before the Chicago Medical Society, Dr. D.
R. Brower presented a caustic criticism of the judi-
cial proceedings whereby Mark Gray was recently
released from an insane hospital. Gray acquired con-
siderable notoriety some years ago by firing several shots
at Edwin Booth during a performance at Mc\'icker's
Theatre. Gray was adjudged insane by the court, and
after two years' confinement in a State hospital was re-
leased, in spite of the o|)position of the medical officers
of the hospital, by a judge in a distant part of the State.
Since his release. Gray has manifested the same delu-
sions as before and during his confinement ; in fact, he
was released merely because he affirmed his own sanity.
Guaiac in Acute Tonsillitis. — Dr. W. E. Totten, of
Si)ringfield, O., writes us that an item giving Dr. Morell
Mackenzie credit for tire introduction of the guaiac treat-
ment of tonsillitis is incorrect. Dr. Totten refers to Dr.
A. Patton as the original discoverer of its application in
tonsillitis. He has used it many times himself with great
satisfaction.
In our item we gave Dr. Mackenzie credit for recom-
mending, not originating, the use of guaiacuni in tonsillitis.
January 27, 1883.]
THE MEDICAL RECORD.
93
'^xoQV&ss at ^Mical Mcii^nci^.
Intermittent Mania. — Dr. Ribas relates the case of
a man who suffered from maniacal attacks occurring with
great regularity every second day. The delirium was
sometimes quiet, at other times violent. In the lucid
intervals, beyond a slight confusion of ideas in the morn-
ing, which disapiieared in a few hours, the patient was
apparently rational. On his sane days he was accus-
tomed to go about without any restraint, and no one
seeing him at such times would imagine that he had been
a raving liianiac the day before, and would become one
again the following day. Quinine in every form was
employed, with no effect beyond modifying slightly the
intensity of the paroxysms. — Re'iista de Medicina y
Cirurgia Practicas, No. 152, 1882.
Abnormal Presence of Uric Acid in Various
Secretions. — An e.xcessive elimination of uric acid
through various organs has been supposed to occasion a
number of morbid conditions, the most generally recog-
nized of which is gout. In many of these, however,
though their dependence upon urica^mia has been strongly
suspected, it has never been actually demonstrated. Dr.
Boucheron now claims to have determined the presence
of uric acid in the secretions of nimierous patients sup-
posed to be suffering from uricKiiiia, and thus to have
established the relation, hitherto only conjectural, be-
tween these morbid conditions and uric acid poisoning.
He has found this substance in the nasal and pharyngeal
secretions, in the uterine discharges, in the sweat, in the
matters vomited during morning sickness, in the men-
strual blood of women suffering t'rom uterine disorders,
anil in the saliva. In the last named secretion especially,
he found uric acid in abundance in the various forms of
uriciiimia, by whatever cause excited. — Journal de Mcde-
cine de JSruxelles, Vol. 75, 1882.
Significance of Albumen in Ascitic Fluid. — Pro-
fessor A. Hoftman states that the amount of albumen in
the fluid of aA:ites is of diagnostic import. He divides
cases of this condition into three groups, as follows : i.
So-called cachectic ascites (especially that occurring in
chronic nephritis). In this form the fluid contains over
2.5 per cent, of albumen, and has a specific gravity of
less than loio. 2. That which is known as inflammatory
ascites, in which there is over 2.5 per cent, of albumen
and a specific gravity exceeding 1014. 3. Ascites from
obstructed circulation, which occupies a position between
the first and second groups. He relates a case of ascites
occurring with albuminuria, which, from the amount of
albumen in the exudation and the specific gravity, seemed
to conflict with this classitication. But after death, it
was discovered that the patient had cancer of the liver
and stomach, so that the ascites really belonged to the
form tVom obstruction, to which the amount of albumen
and specific gravity would consign it. — Allgein. Med.
Ceiiiral-Zeitung, December 16, 1882.
Diphtheria of the Bladder without Infection
IN A Rabbit. — In order to determine the time within
which fibrinous casts appear in the urine in retention of
this fluid. Dr. Aufrecht instituted some experiments in a
rabbit. The prepuce was closed with adhesive plaster,
so as to cause absolute retention. This was removed
after twenty-four liours and the urine analyzed. The
process v.'as repeated four times, each time retention
being continued for twenty-four hours. Shortly after the
rabbit died. Upon the mucous membrane of the bladder
were found several patches of a dirtj' gray color, resem-
bling exactly diphtheritic false membrane. Under the
microscope was seen a large number of micro-organisms,
some round and some rod-shaped. The rods were either
single or in pairs, and often were united in a long chain.
The urethra presented a normal appearance. From this
experiment Aufrecht concUules that bacteria of disease
may be developed in the bladder without, as has been
hitherto supposed, gaining entrance through the urethra.
The condition of the canal in this case, he states, pre-
cluded any such source of infection. He thinks that this
lends weight to the theory of Billroth and others, that the
bacteria existing normally in the tissues may, under
proper conditions, develop into noxious organisms. But,
especially, he thinks that it confirms his previously ex-
pressed opinion, that it is not the mere presence of bac-
teria, but their retention and development in the or-
gans, that give rise to infectious diseases. — AUgem. Med.
Central-Zeitung. December 13, 1882.
H.tMOPTVsis Dependent upon H/Emorrhoids. —
Dr. Lewin recalls the views of the older writers as to the
relationship existing between hremorrhoids and attacks
of bleeding from the lungs. He relates two cases occur-
ring in his practice in which hajmoptysis took place.
There was no cough, and physical examination by him-
self and others gave absolutely no signs of bronchial or
pulmonary disease. In both cases the hemorrhage was
considerable, yet both recovered without any subsequent
lung aftection. Both patients suffered from hemorrhoids.
I.ewin thinks that many cases of hemoptysis, without
apparent cause, may be thus explained. He argues that
in a hyperajinic condition, such as hemorrhoids, if local
bleeding do not occur, the distended circulatory appa-
ratus must be relieved by vicarious action. He in-
stances some observations of Rlihle, in which hemojitysis
in hemorrhoidal subjects was arrested by leeches applied
to the a.nns.— Berliner Kliii. Woehenschrift, December
18, 1882.
Perforating Ulcer of the Stomach in a Child.
— Only five cases of perforating gastric ulcer have hith-
erto been published as having occurred in children. Dr.
Julius Eross, of Buda-Pesth, publishes a sixth. It was
observed in a twelve year-old girl, who was suffering
from miliary tuberculosis. At the post-mortem three
circular ulcers were found occupying the posterior wall
of the stomach. The largest, having a diameter of one
inch, had perforated into the omentum. The presence
of these ulcers had not been suspected during life, but
inquiries instituted after the death of the patient elicited
the fact that she had been suft'ering for a year from pain
in the region of the stomach, which occurred at irregular
intervals and lasted for hours at a time. Her appetite
had steadily decreased, but at no time had there been
either nausea or vomiting. — Orvosi Hetilap, December
24, 1882.
Treat.ment of Whooping Cough with Eucalyptus.
— Dr. Witthauer reports four cases of pertussis, treated
with tincture of eucalyptus globulus, which recovered in
a little over three weeks. The dose for children from
two to four years of age was 5-8 drops. One of the
patients, eighteen months old, suffered from well-marked
rickets. After taking the eucalyptus for four weeks, not
only was the whooping cough cured, but the enlarged
epiphyses were reduced, and .the child, who had never
before attempted to stand on its feet, learned to walk. —
Memorahilien, November 15, 1S82.
Vertigo as a Reflex Symptom in Hypertrophy of
the Tonsils. — Dr. Weiss relates the case of a boy, twelve
years of age, who had suftered from vertigo lor three
years. The attacks were induced by stooping, and weie
sometimes accompanied with vomiting. Nothing abnor-
mal could be discovered in any of the organs, except an
enlargement of both tonsils. As pressure upon the
carotids and vagi might account for the vertigo, m the
absence of any other apparent cause. Dr. Weiss ampu-
tated the tonsils. The attacks at once ceased. — Meino-
rabilieii, November 15, 1882.
Transfusion of an Alkaline Solution. — Dr. Bis-
choft' has injected a six per cent, solution of chloride of
sodium, a little potassa being added, into the radial
artery of a woman sinking from post-partum hemorrhage.
94
THE MEDICAL RECORD.
[January 27, 188^
The operation lasted an hour, during which forty ounces
of the solution were injected. The woni.Tn recovered.
The following are the conclusions of the author regarding
this operation : i. ."^s compared with transfusion of
blood, it is more simple, less dangerous apdofmore easy
application, because of the difficulty of finding a donor of
blood in every case. 2. The quantity of solution inject-
ed should be not less than a pint. 3^ The fluid should
be injected into the arteries rather than the veins, as thus
it is made to traverse the capillary system before reach-
ing the heart. It acquires a proper temperature, and
the danger of sudden cardiac distention is averted. —
Journal de Mcdccine de F<rr!S, December 2, 1882.
Effect of Strychnine upox Dilatation of the
Heart.— Professor Maragliano formulates the results of
the exhibition of strychnine in cardiac dilatation, as fol-
lows : I. In one or two days the size of the heart was re-
duced, and in five or six days very considerable dilatations
were caused to disappear. 2. If, immediately upon a re-
duction in size of the heart, the strychnine were with-
held, the dilatation was frequently reproduced. 3. The
daily dose of sulphate of strychnine required was from
•jV to -bL- grain. — Memorabilien, November 15, 1S82.
Salicylic .A.cid in Night-Sweats. — The following
powder is reconniiended by Dr. Konhorn in the night-
sweats of phthisis : Acid, salicyl. gr. 45, starch, 3 2^,
chalk, r 2^-. The entire body of the patient is dusted
with this powder at bedtime. The author claims to
have obtained great success by this treatment. The
same pow^der is employed in the Austrian army in sweat-
ing of the feet. — Me7noral>ilien, November 15, 1882.
Tincture of Cobw^eb in Intermittent Fever.—
In an analysis of a large number of cases of intermittent
fever treated with the tincture of cobweb. Dr. Oliva
formulates the following conclusions: i. This agent is
capable of curing malarial fevers of quotidian or tertian
t)iie. It was of no value in several cases of quartan
lever. 2. In doses of 30 minims for adults and 15
minims for children, it usually arrests the fever at the
second paroxysm. 3. Its action being less prompt than
that of quinine, it should never be used in jjermcious
levers. 4. Being tasteless, it is easily administered to
cinldren.— /ci///«,?/ de Med. et Chir. Pratiques, Decem-
ber, 18S2.
Caffeine in Heart Disease. — Dr. Huchard claims
excellent results in the treatment of cardiac dropsy by
caffeine. He begins with a dose of 7 grains, gradu-
ally increasing to 15, 30, or even 45 grains per diem.
He says, however, that such large doses often cause
severe pains in the stomach. — Archives Generales de
Medecine, December, 1SS2.
The Pathology of Death from Burning. — Zillner
has published more extended reports of the examinations
made by him of the corpses of those who perished in the
burning of the Ring Theatre, in 1881. All the bodies,
even those which exhibited no external marks of injury,
were more or less covered w'ith a thick layer of soot.
The U|)per extremities were strongly abducted from the
-shoulder, the elbows were bent, and the forearms pronat-
ed, so that the backs of the hands lay near the face. A
fighting attitude was thus simulated in some cases.
This was due to shrivelling, and consequent shortening
of the muscular fibres, by the action of heat. The large
cavities, and more especially that of the abdomen, were
often burst, even in bodies not otherwise much injured,
and the bowels protruded. In females, the tym[ianic
stat,e of the abdomen frequently simulated a stale of
pregnancy.
The blood showed every grade of consistencv, from
the normal, through the viscid state, up to a coinpletely
friable dry mass, in which last condition the blood-pigment
was found to be in an insoluble state. Occasionally,
the blood formed a dull lustrous luass in the uninjured
heart and blood-vessels. E.\amined spectroscopically,
the blood always showed the bands of carbonic-oxide-
hajmoglobin, even in the case of bodies which had
remained buried beneath rubbish for a month. In all
the bodies which were incinerated, the heart was found
in diastole, and rigidly distended with clotted blood.
This sometimes gave rise to a suspicion of concentric
hypertrophy ; but the thin walls of the organ at once
revealed the nature of the appearance.
The bones exhibited every stage of burning, from a
simple combustion up to complete calcination. The jaw
was mostly firmly closed. The muscles, where the skin
was unbroken, had a boiled appearance ; but, where they
were charred, the odor was that of smoked meat. The
drying up of the flesh, and its permeation by pyrogenous
products, obviously retarded the advent of putrefaction.
In the eye, the application of lower grades of tempera-
ture manifested itself as a turbidity of the cornea, and
complete opacity of the lens, giving the appearance of
cataract. The larynx, trachea, and nostrils, were often
filled with foreign material from the stomach, perhaps
due to the vomiting excited by carbonic oxide. The
urinary bladder was often full of urine, even when the
abdomen had burst. Occasional!}-, where the bladder
was empty of urine, it contained a gelatinous substance
with embedded blood-corpuscles. This was found by E.
Ludwig to consist of gelatin, probably derived from the
connective tissue by the action of heat. Similar gelatin-
ous masses were found in the uterus in some cases ; and
this organ was found to be very resistant to the action of
heat. — London Medical Record, December 15, 1882.
Epileptic Phenomena in Ataxia. — Vulpian (Revue
de Medecine, No. 2, 1882) relates the case of a man,
aged twenty-eight, who, in the course of a few months,
had repeated attacks of loss of consciousness, with, on
one occasion, right-sided facial paralysis with aphasia,
and, a month later, right-sided hemiplegia and aphasia,
with feeling of laryngeal constriction. All these symp-
toms disappeared later on, and decided tabes made its
api^earance. He had marked gastric and laryngeal crises,
also contraction of the lower extremities, and tremulous
movements, as if the lateral columns were involved. There
were no knee or foot phenomena. Later, special groups
of muscles, especially the abductors of the thighs, became
weak, but were improved by faradization. Then the
knee-joint swelled and filled with fluid ; later on, the
affected joints crepitated. The question of the rheumatic
or specific nature of this joint-affection is discussed.
The patient benefited greatly by bromide of uranium in
doses of one-sixtieth to one-fifteenth grain daily, espe-
cially in respect to pain.
Cerebral Symptoms Produced by Ascaris Lum-
bricoides. — Dr. Samada reports (El Sentido Catolico en
las Ciencias Medicas) a case in which severe symptoms
were produced by the presence of a large number of
ascarides lumbricoides. The patient was a lad about
eight years old. His attack connnenced with severe
headache, attributed to a fall sustained a few days before.
This was followed by jihotophobia, conjunctival injec-
tion, and later by profound coma. Constipation was
present, and, as a saline purgative did not jiroduce au
evacuation, calomel and aloes were administered. This
produced several evacuations, each containing about
thirty ascarides. The head-symptoms ceased from the
moment the bowels were purged, " as if by magic."
P.UHOLOGICAL .'\NAT0.MV OF GENERAL PARALYSIS. —
Dr. Rey has found (Ann. Med.-PsychoL), in fifteen
brains of general paralytics, separation of the cortex
from the underlying while matter, as described bj- M.
Baillarger. Dr. Rey relates six of his observations in
detail. It is remarkable that he should have found this
lesion existing only in the frontal lobes, whereas the
former writer described it as most common on the pos-
terior lobes of the cerebrum.
January 27, 1883.]
THE MEDICAL RECORD.
95
Action of Iodoform on Leucocytes. — ^Dr. Binz
(Virchow's Archiv, vol. Ixxxi.K., 1882) has performed
some ex|)eriments which would seem to show that iodo-
form checks suppuration by paralyzing tlie white blood-
corpuscles, and so preventing their wandeiing through
the walls of the vessels. He maintains that (jumine, and
carbolic and salicylic acids, have a similar effect.
DisouiSKD Syphilis. — In an article on this subject
{Medical and Surgical Reporter, September 30, 18S2), the
importance of remembering that syphilis is not of neces-
sity a venereal disease is insisted on. In illustration, a
case is related of a lady who, when two months pregnant,
received into her family a young female relation who had
been brought up in Germany. This relation was suffer-
ing from an eruption on the scalp, which was dressed by
the lady, who subsequently noticed that a pin-scratch on
her finger became intiamed and angry-looking, and in a
short time a nut-like swelling appeared on the inner
aspect- of the elbow. Afterward she began to lose fiesh ;
her appetite failed ; the throat became sore ; she suffered
from headache and debility, and albumen appeared in
the urine. The patient cpiickly recovered under bini-
'Odide of mercury and iodide of potassium.
Congenital Absence of the Spleen. — At the City
Hospital of Buda-Pesth a woman, aged seventy, recently
died. At ihe post-mortem examination it was ascer-
tained that the spleen was entirely absent. Since the
complete destruction of a i)reviously existing spleen could
be excluded, it was concluded that her case was an in-
stance of congenital absence of this organ.
Sugar of Milk as a Laxative. — Traube recommends
sugar of milk as a mild and trustworthy laxative in doses
of two or three drachms, dissolved in half a tumbler of
warm milk, taken before breakfast.
The Aluuminuria of Fevers. — Dr. Eckstein distin-
guishes three varieties of albuminuria accompanying the
febrile state {Deutsche Medizinische Wochenschrift) :
First, albuminuria caused by acute nephritis ; second,
the so-called febrile albuminuria ; and third, albuminuria
caused by venous hyperemia. The last form, in which
the urine is small in quantity and of high specific gravity,
occasionally containing casts and renal epithelium, is
•diagnosed mainly by the presence of other symptoms
pointing to venous hypera;mia, such as cyanosis, enlarge-
ment of the liver, and dyspnoea. The author opposes
the belief that venous hyperemia is the sole cause of
albuminuria in febrile disease. He believes that it is re-
sponsible for the albuminuria occurring in acute croupous
pneumonia, and in rapidly formed pleuritic eftusion, the
local aflection acting mechanically, first on the right side
of the heart, then on the venous system generally. Acute
ne|)hritis Dr. Eckstein believes to be a metastatic in-
flammation, an infective process, in which the micro-
organism, although it has not yet been demonstrated, as
in kidney affection from diphtheria or pyremia, will at no
distant liate be isolated. The result of acute nephritis is
either comijlete recovery or death, very rarely chronic
nephritis.
In the so-called febrile albuminuria, which Dr. Eck-
stein mainly considers, the amount of urine is but slightly
diminished, according to the severity of the fever itself ;
the amount of albumen is moderate, and the normal ex-
cretory constituents of the urine are not diminished.
That the albuminuria in such cases is caused by hyperaj-
mia of the kidney, either active or passive, seems to Dr.
Eckstein improbable. For the first result of a conges-
tive hypera;mia would be an increased amount of urine
which is not present ; and on the other hand, there is no
reason to suppose a passive hyperajmia, except in such
cases as have already been classed under albuminuria
from direct venous congestion. Runeberg has lately ex-
plained the diminished secretion and albuminuria in
febrile diseases by the degeneration of the heart-muscle
and consequent fall of arterial tension. But, as Dr.
Eckstein points out, in many diseases where the arterial
tension is reduced to a very low point, there may be ab-
solutely no albumen in the urine. That the albuminuria
is caused simply by the abnormal temperature, or by an
alteration of the albumen of the blood, is not. Dr. Eck-
stein believes, supported by fact. For the albuminuria
is frecpiently in no relation whatever to the temperature,
and the albumen in the great majority of instances in no
way differs from the serum albumen of the blood.
Dr. Eckstein sums up his views as follows : Febrile
albuminuria depends on a local process in the kidneys of
an inrtammatory nature, or at least closely related to in-
flamraation, and having its site mainly in the epithelium
of the kidney, cloudy swelling, albuminous infiltration, or
parenchymatous inflammation. This process is probably
caused by an infection of the kidneys, either from the
passage through them of low parasitic organisms, or from
the inflammatory action of soluble toxic substances
passing through them. The same infection acting in a
stronger degree can i)roduce acute nephritis. Acute
infective nephritis, therefore, and febrile renal affection,
are only different degrees of the same process, or, in
other words, the febrile renal aflection is an aborted
acute infective nephritis.
H/EM0PHiLL-\. — Dr. Thos. D. Dunn reports a number
of cases of this disease in the American Jour)ial of the
Medical Sciences for January, 1883, from which he draws
some interesting conclusions. Thus, he shows that sex
is an important predisposing cause in haemophilia,
femates being much less prone to the disease than
males, and in women, also, the danger to life is much
less marked ; the females, however, of bleeder families,
even though themselves exempt from the disease, are
much more apt to tVansmit the tendency to hemorrhage
to their children than are the males, even when them-
selves bleeders. Dr. Dunn also points out that there
are three forms of the disease : i. The aggravated form,
in which there is a tendency to severe spontaneous,
traumatic, and interstitial hemorrhages, associated with
swelling of the joints. This form, seldom seen in
females, generally lasts throughout life, and usually is
the cause of death. 2. 'J'he intermediate form has no
tendency to the joint aflection or traumatic hemorrhages,
but frequent spontaneous ones from mucous surfaces
and subcutaneous ecchymoses. This form frequently
disappears at puberty. 3. The third form is lowest in
degree, and seen only in females ; it manifests itself in
ecchymoses, and in earlv and prolonged menstruation.
Malaria or Sepsis. — Dr. \V. B. Welch, of Fayette-
ville, Ark., writes us as follows : In vol. xxii., No. 22,
p. 608, of The Medical Record, a case, entitled " Per-
nicious Remittent Fever after Parturition," is detailed by
Dr. J. Lewis Smith before the New York Academy of
Medicine (Obs. Sec). I have read with pleasure Dr.
Smith's report of the case, and must say that I, and I
believe many others, will dift'er ivith him as to his diagno-
sis of the case. A case of malarial fever, where the pa-
tient survived eighteen days, and in which from thirty to
sixty grains of quinine were given per orein, and ten
grains of quinia; et ureae muriatis given hypodermically
every twenty-four hours ! All this time the temperature
rising higher and higher with each daily paroxysm, and
the sioeatings becoming more and more copious and e.x-
hausting. Those of us who have much to do with mala-
rial fevers may be pardoned for being slow to believe that
quinia would be so very little efficacious in so prolonged
an opportunity in any case of malarial toxremia. More
especially are we led to so conclude from reading Dr.
Smith's case, as we think there can be no doubt that his
was a case of very malignant i)uerperal sepsis or pyaemia
— in {a.ci, classical m its distinctness of detail and marked
symptomatology.
96
THE MEDICAL RECORD.
[January 27, iSS^
The Medical Record
A Weekly yo7i7-}iaI of Alcdicitic and Szirgcry.
GEORGE F. SHRADY, A.M., M.D., Editor.
Published by
WM. WOOD &. Co., Nos. 56 and 58 Lafayette Place.
;_New York, January 27, 1883.
CHARCOT'S CRYSTALS AND THE ASTH-
A[ATIC PAROXYS.\r.
It will be remembered that, in 1872, Leyden announced
his discovery in the sputa of asthmatic patients of pecu-
liar crystals, first described by Charcot and Robin. The
bodies seen by Le3'den were colorless, rather long, oc-
tahedra, of varying size. They were found mi.\ed in
little plug-shaped masses with brownish gianular cells.
He thereupon advanced the theory that asthma arose
from an irritation of the terminal filaments of the vagus
in the alveoli and bronchioles. This irritation, he
claimed, was directly attributable to the presence of the
fine sharp crystals in question. Leyden's theory met
with little favor at the time, and few subsequent writers
have made mention of his discovery.
The subject was revived, however, at the first Con-
gress of German Physicians, held in the spring of 18S2.
Dr. Ungar, of Bonn, there read a paper embodying his
views of the causal relation of those crystals to the asth-
matic paroxysm. He found the crystals present in the
sputa in every one of thirty-nine cases of spasmodic
asthma examined by him. And he determined further
that they were not always present in fresh sputum, but
were formed after keeping the expectorated matter for
two or three days in a moist atmosphere. The longer
the sputa were preserved, the more numerous and the
larger were the crystals. In the course of his investiga-
tions the author also discovered other objects in the e.x-
pectorated matter. These were long thread-like masses,
sometimes stretched out like strings, and at others mat-
ted and twisted up into little balls. They were com-
posed, like the plugs described by Leyden, of granular
cells, and in fact the plugs were but detached fragments
of these slender cylinders. The corpuscles in the centre
of the cylinders were more granular and less distinctly
outlined than those at the surface. Moreover, it was
precisely in the centre, where the disintegration of the
cells was most advanced, that Charcot's crystals were
found in greatest abundance. Hence Ungar concludes
that these bodies occurring in the sputa of asthmatic
patients are the product of cell-degeneration, just as those
found in ieucaimic blood were proved to be by Zenker.
Hut, though rejecting Leyden's theory, Ungar does
not admit the generally accepted neurotic nature of the
asthmatic seizure. He explains the paro.xysms of d\sp-
ncea in this wise. The larger bronchi, as is well known,
are firm unyielding tubes. But as we pass down to the
smaller branches, the cartilages gradually disappear and
we find only a thin wall of fibrous tissue mi.xed with
slender muscular elements, and lined by a mucous mem-
brane. Now, the lumen of the bronchioles is constantly
varying in size with the movements of respiration. E.x-
pansion is due to the suction action of the thorax in
inspiration, and the subsequent contraction to the in-
herent elasticity of the walls of the bronchioles. The
muscular fibres serve merely as stays to prevent over-
stretching of the elastic tissues. They can never act
with force sufficient to produce a spasmodic constriction
of the tubes. Now, when a plug of this exudation com-
pletely occludes a bronchiole at rest, during inspiration
the calibre of the tube is increased and air may pass the
obstruction. But as soon as the suction force of the
chest-walls is relaxed, the bronchiole returns to its for-
mer size and the air is imprisoned.
This valvular action may also be called into play in
the following manner : The exudation at times consists
of a number of fine filaments com])ose<l of agglutinated
cells and crystals too small to block up the bronchiole.
These threads are attached to the wall of the tube by
one extremity only. Now, during inspiration they float
freely in the entering air-current, offering no serious ob-
stacle to its passage. But, during expiration, when the
current is reversed, these strings are pushed back and
twisted up into little balls, thus thoroughly obstructing
the return of air. In this way an acute emphysema, as
it were, is produced by a sort of reversed air-pump ac-
tion. And now the asthmatic paroxysm is ushered in.
The depression of the diaphragm is merely a result of
the expansion of the lungs and plays no part whatever
in the causation of the dyspncea. Dr. Ungar's theory is,
to say the least, a novel and ingenious one. But, like
many other well reasoned hypotheses, it needs some
substantial confirmation before it can hope to meet with
any general acceptance.
THE MICROSCOPICAL APPE.\R.\XCES OF GUITEAU'S
BRAIN".
The editor of the Journal of Mental Science, Dr. Geo.
H. Savage, makes the following comment upon the mi-
croscopical appearances observed in a section from the
frontal convex of Guiteau's brain : " I should say there
is nothing that I have seen which is not compatible with
mental health. It is true there are changes about the
vessels and their walls, but these and similar changes are
commonly found in the bodies of persons dying or being
killed when past middle age. There are no marked
general changes in the nerve-cells, and I can only repeat
that the specimen examined would not have any weight
with me, in causing me to reconsider my judgment on
the sanity of the assassin."
The facts seem to be, that while there was some
chronic disease in and about the blood-vessels, there was
nothing indicative of any form of insanity ; while, on
the other hand, nuich more serious changes are not
infretjuently found in the brains of i)ersons who had been
perfectly sane. Account must be made also of the tact
that Guiteau had been suffering from malarial poisoning,
and that he suffered death from strangulation. Guiteau's
insanity, if it existed, was confessedly chronic ; therefore-
January 27, 1883.]
THE MEDICAL RECORD.
97
all acute changes found, would have no weight in esti-
mating their etiological bearings on the alleged mental
disease. The severest form of the vascular disease was
apparently the corpora striata, a place where ])hysical
troubles would not be excited, while it is well known
that the disease did not disturb any function known to
pertain to those ganglia.
The view that the changes found were at all signifi-
cant or characteristic of commencing general paresis is
unfounded, and quite unworthy of serious discussion.
The same remark must be made regarding Dr. Godding's
surprising statement that the arachnoid's oj^acity was in-
dicative of mental disease.
There have been some rather labored attempts to
prove the brain atypical. The convolutional develop-
ment, however, as we are told, though deficient in
some ])arts, was compensated for by fuller adjacent gyri.
So far as the eye and some rough measurements could
tell, the two hemispheres showed no asymmetry. Tlic
fundamental fact in the present case for the determi-
nation of atypy, viz., the comparative weight of the
two hemispheres being absent, it would not be allow-
able nor in accordance with scientific honesty to make
positive statements regarding the matter.
The futile and decidedly ex-parle attempt to show
pathological cranial asymmetry hardly needs comment.
In fact, Guiteau's mental condition must be decided by a
study of his words and actions when alive. If these did
not ])rove him a lunatic and irresponsible, the post-mor-
tem findings will not help the case.
of skirts. Care need only be taken that there be no
constriction or binding. Tlie shoulders sliould be al-
lowed to do a nnnor part of the work. Woman's dress
is, as a rule, unnecessarily heavy, but it will not be in our
generation that fashion bows to sanitary rules.
THE QUKSTION OF WOM.-\N'S DRESS.
Woman's dress furnishes jjeriodically a valuable topic for
the preacher, the satirist, and the physician. Just at
present it is medical opinion which in particular is being
luminously offered upon tlie matter. The Lancet speaks
paternally to British women, and tells them not to hang
so much on their hips during the present cold weather.
The New York Titnes, taking up the subject, has sent a
reporter to various large retail stores where ladies' dress
and undergarments are sold. Samples of these were
carefully weighed, and their modes of attachment to the
female anatomy studied. The reporter subsequently in-
terviewed a number of physicians upon the important
and obscure matter of how woman should best wear her
clothes.
From all this we learn that woman's winter clothes
weigh from si.x to ten pounds, and that she carries a
heavier weight than man by one-fourth or one-third. It
is noted also that this weight when hanging from the hips,
constricting the waist and confining the legs, does harm.
We are inclined to believe that the constant reiteration
of the charges against woman's dress, together with the
wider diffusion of physiological knowledge, is having some
slight eftect upon woman's dress. It is all the more im-
portant that medical opinions given regarding it should
not be sensational or incorrect. Little good is done, for
•example, by wholesale denunciations of the corset /fr se,
when they should be directed rather against those which
are tight and ill-fitting. So as regards the wearing of
■clothes upon the hips. The hips of women most
naturally and easily support the greater pari of the weight
OVER-WORK AGAIN AMONG AMERICANS.
The views ex|)ressed by Mr. Herbert Spencer upon
the high-pressure mode of life followed by Americans
'have been widely criticised. To be sure, no American
medical autjiorities have ventured to dispute his conclu-
sions. For Mr. S|)encer has, in fact, only said again,
and even unconsciously plagiarized, what American doc-
tors have long ago noticed and publicly discussed.
Mr. Seymour Haden, however, an English surgeon
and artist now visiting America, lias flatly contradicted
the statement that Americans work too fiercely, or live
too little in the present, and too much in the future.
Dr. Batty Tulse, also, in a recent public address, an-
nounced the not very original view that it is not over-
work but worry which kills.
Now, the daily newspapers and English tourists may
discuss glibly the pros and cons of this question, but,
with practical physicians, who every day meet the busi-
ness men of our cities, there is no question to discuss.
Every one has seen the victims of over-work, and knows
that the persistent, untiring application to business,
wears men out. It may not be the work alone ; there
is technical truth in saying that worry, not work, is the
most serious danger ; or that dry air or ph)sical neglect
help on the trouble. But this is mere quibbling, for
there are few who can work actively and continuously
without some worry or neglect of sanitary rules.
The conditions of our life require that Americans
should be more than ordinarily active and industrious,
but all the same we should be a happier and healthier
people for a little more of the gospel of recreations.
The lazy may seize this as an excuse, but our sanitary
evangelists must say that their gospel does not apply to
the lazy, who in America are greatly in the minority.
THE CARE OF PROSTITUTES IN CLEVELAND.
Much excitement has recently been created in Cleve-
land, O., by the action of the Board of Health upon the
matter of the sanitary care of prostitutes. An ordinance
was passed favoring the establishment of a hospital where
diseased women found in houses of ill-fame should be
taken and cared for, at the expense of tlie owner of the
property. It was also voted that physicians should make
weekly examinations of the women in the brothels.
This new move has been condemned by many of the
citizens of Cleveland. The women especially have
banded themselves together to fight against it. They
insist that men, as well as women, who visit brothels
while diseased, should be sent to the hospitals for trea^--
nient.
The results, so far, of attempts to regulate prostitution
in American cities are well known. It must be admitted
that the plan is utterly oiiposed to the judgment of the
better and more respectable part of society. The meth-
ods adopted in Cleveland have failed elsewhere, and
98
THE MEDICAL RECORD.
[January 27,. 1883.
will, we presume, fail here, because it is based upon a
one-sided policy. It officially cares for the women after
they have become diseased, but takes no notice of the
men who infect them.
Many sanitarians seem incapable of understanding
that the question of prostitution is not a purely sanitary
one, but is a sociological problem, involving many fac-
tors. The prevention of disease is not the only element
in human progress.
The establishment of lock hospitals for women is in
many cases advisable and useful ; but we doubt if in this
country the forcible sending of women to Jhese places
will be tolerated.
Many sanitarians, although they aim to be " advanced,"
fail to see that as intelligence increases a private regu-
.lation and examination of brothels will largely become
adopted. Adultery will follow the law of supjjly and
demand everywhere.
We suspect that the Cleveland Board of Health has
tried to be "|)rogressive,'' without knowing very much
about the project it has undertaken.
MICROSCOPES ON THE T.\RIFF FREE LIST.
The Committee of Ways and Means at Washington are
now considering the provisions of the new tariff bill, and
some of their conclusions have been made public. We
notice that philosophical instruments will in future pay a
duty of forty per cent., an exception being made in the
case of those imported for the use of institutions and soci-
eties incorporated for educational or religious purposes.
The duty on scientific instruments must yield a very
small return, and be imposed only as a jirotective meas-
ure, to aid the home industry of such manufactures.
Desiring, as we do, that every medical practitioner
should irossess a microscope, not as a mere adjunct to
his office, but as a necessity in making a diagnosis of
many complicated diseases, we would ofier a few sugges-
tions to those revising the tarift" laws, with the liope that
such instruments may be in future imported free.
There is little merit in the making of the stands of
microscopes, a good design being furnished, an ordinary
brass-worker can carry out the mechanical jiart. The
case is difterent in regard to the manufacture of micro-
scope objections, as we find in this department that sci-
entific knowledge and great teciinical skill is requisite.
Spencer being dead, we have, therefore, but three really
original workers, liaving aa .American reputation for
making objectives, viz., Grunow of New York, Tolles of
ISoston, and Cundlach of Rochester. The question may
be asked, would they suffer by such a reduction of the
tariff as we propose? We believe not. As a matter of
fact, those who re(|uirc to possess an objective con-
structed by Tolles, have to wait from six to twelve
months before receiving it. The free list will surely liave
no efiect ujion such men who are capable of incori)orat-
ing their individuality in their work, and with three ori-
ginal manufacturers of microscoiJe objectives and two or
three of indifferent merit, amjile work must be in store
for tiiem under any circumstances.
We believe that not only the medical jirofession, but
the microscope trade itself, would be benefited by tlie
change we propose. Ail purchasers would be placed on
the same footing, and colleges, with other institutions
now making their selection abroad, would probably iii
the future give their patronage to the home manufac-
turers.
The discrimination proposed in favor of certain
wealthy institutions is both unnecessary and unjust, for
it affords relief in a direction where it is neither required
nor appreciated, and doubles the cost of the instruments,
in the case of the poor student, or the young physician
who is starting on a career calling for constant outlay
and yielding small returns during its earlier stages. We
understand that the proposition to place microscopes on
the free list, without discriminations in favor of an)- class,
was brought to the notice of the Tariff Commission by
Mr. John Afichels, and that a prominent member of the
House of Representatives has promised to introduce
such a resolution when the measure is discussed. There
appears, therefore, some prospect that practical results
may be accomplished in this direction.
TENEMENT HOUSE CIG.^RS.
It is not an agreeable thought for smokers of domestic
brands of cigars, that the specimen they hold between
their lips was perhaps manufactured in some fever den,
amidst the filth and stench of an Italian tenement house.
Could the purchaser of the five-cent '■'■regalia " view the
home of its birth, with all the surroundings of vice, dirt,
and misery, he would possibly decline to kick with his
foot the cigar he places in his mouth.
We notice that a Society of Progressive Cigar Makers
met last Monday at the Cooper Union, to protest against
the system of manufacturing cigars in tenement houses,
making their appeal in the name of " health, science, and
humanity." We do not pretend to explain, or even to-
know, the exact motives which have inspired the " Prog-
ressive " cigar makers to this crusade on their more
humble fellow workmen. The proceedings, however, in-
dicated that the reformers were " aggressive " as well as
" progressive,'' and the taint of a trade union spite was
apparent, rather than file true "Havana" odor of sin-
cere sanitary reform.
This is clearly a case for the control of the Board of
Health, and we are not surprised that the Legislature
"laughed at the efforts" of the Progressive Cigar Makers^
Although smoked, a part of every cigar is necessarily
chewed, and tiie pressure of the teeth on the moistened
tip must extract a certain amount of tobacco juice.
Cigars, therefore, may in one sense be classed with
articles of food, and a law should be passed enabling the
Board of Health to prohibit their manufacture in sleeping-
rooms. Such an arrangement would, perhajjs, satisfy the
Progressive and Aggressive Cigar Makers' Union.
PUDDINGS .-VNO PIES.
The Latuct struck a most responsive chord in the British
bosom recently when it announced that plum-pudding
was a wholesome and nutritious article of diet. It con-
tains, says this authority, force equivalent to two hundred
and fifty foot-tons ; and the opposition to utilizing such
an appetizing form of energy is characterized as " middle-
age prejudice."
Now what the plum-pudding is to English hearts of
January 27, 1883.]
THE MEDICAL RECORD.
99
oak and stomachs of similar robustness, the pie is to the
American. We should, perhaps, say to the American
Yankee; but this individual has distributed himself and
his pies so universally that a distinction is now hardly
needed. And the American 'pie deserves a word of en-
comium cjuite as much as the English pudding.
There is a " middle-age prejudice" also among us
against pies ; but it is, we are sure, quite as irrational as
that aganist puddings. There is not quite so much po-
tential energy in the former as in its equivalent weight
of the latter. But man does not eat for the sake alone
of storing up solid " chunks " of force. And certainly,
there is much about the pie to make it more digestible
than the inidding, if it is not quite so compactly nu-
tritious. Out of the records of a very large clinical
experience we have been able to collect no facts which
prove that pie properly made ever caused dyspepsia.
It is a general custom, and a wise one, to prohibit
pastry and cakes and puddings when dyspeptic symp-
toms appear ; but we should be inclined to hold on to
the pie longer than to the other forms of sweetness.
Dyspepsia is confessedly very common among Americans,
and the ubiquitous pie has been sometimes cliarged with
being a potent factor in these gastric ills. But only su-
perficial philosophers will thus malign an article of diet
which has brought so nnich real sweetness and comfort
into the life of the hard-worked Yankee. Dyspepsia
prevails as much among the rural populations of some
Southern districts, where life is jneless, and (to Yankee
apprehension) meaningless, as in the North.
In fine, pie, well-made pie, is digestible, and may be
taken with impunity by those to whom plum-pudding is,
peptically, a terror. If made with fruit, it is antiscorbutic ;
if with other materials, decidedly nutritious. Under any
conditions it is more wholesome than that leviathan of
culinary art the plumqjudding. Nor do we feel confi-
dent that The Lancet's recommendation of this latter
article should be taken by .-Vmericans without great
caution.
A Remedv for Asthm.a. — The leaves of euphorbia
pilulifA'a, L., a plant growing in Queensland, are reported
to be a sure remedy for asthma and other aftections of the
chest.
Cook County Hospital. — The capacity of Cook
County Hospital, Chicago, will shortly be increased from
three hundred and fifty to five hundred beds by the com-
pletion of two additional pavilions and the e.xecutive
building, now in process of construction.
Tropic Fruit Laxative is the name of a proprietary
article having about the following composition :
3. Jalap tubers, powdered 5 parts.
Senna leaves 5 "
Sugar 5 "
Pulp of E. I. tamarinds 30 "
The preparation is said to be liable to get worm-eaten.
Prof. Virchow is reported to be seriously ill.
Twelve Cases of Scurvy were recently brought
to San Francisco, Cal., on the ship Anna Camp of New
York. Investigation having disclosed the fact that the
sickness had resulted from a violation of law in regard to
this disease on the part of the captain of the vessel, the
District Attorney of San Francisco has been instructed
to proceed against him.
The Price of Books. — Publishers will hereafter
IJlease state the price of books sent for review.
mctus of tht ^5SJccT^.
Small-pox in New York. — Two cases of small-pox
were reported to the City Health OflSce on January 2olh.
These are the first cases of small-pox in the city since
November 6th. The patients were living on Second
Avenue, near One Hundred and Fourteenth Street.
Money for St. Vincent's Hospital. — The Sisters of
Charity in charge of St. Vincent's Hospital report that
the Fair, recently held, netted )S22,407.i7.
Professor Tyndall is lecturing at the Royal Institu-
tion, London, on " Light and the Eye."
Explosive Hvpophosphites. — As Dr. H. Gifford. of
Syracuse, was engaged recently in triturating a mixture
of hypophosphite of lime, three parts, and hypophosphite
of soda, one part, the compound exploded like gun-
powder, the fine particles flying into his face and eyes
and severely burning his eyelids and eyeballs. His in-
juries are likely to result in the loss of his left eye.
The Autopsy on Gambetta. — Further details of the
autopsy on Gambetta confirm the view of the nature of
his troubles which we based on the earlier and somewhat
incoherent descriptions. The physicians in charge re-
port " he succumbed to a perityphlitis, complicated by
a pericolitis, to which was added a slight peritonitis ma-
nifested during his last moments. Any surgical inter-
vention would have been useless. It could have had no
other effect than to abridge his life." The autopsy was
conducted by Drs. Brouardel and Cornil, and in the
presence of Drs. Charcot, Lannelongue, Gille, Fienzal,
Siredey, Trelat, Verneuil, Liouville, Mathias Duval, La-
borde, Guerdat, and Gibier, who signed the report, as
did also Paul Bert, who fainted during the operation.
One Hundred and Eighty Lunacy Commissioners.
■ — The spirit of lunacy reform has rather run away with
itself. Gen. Spinola has presented a bill, in the State
Assembly, authorizing the creation as Commissioners in
Lunacy, in every county of the State, of only rejjutable
physicians of at least twelve years' standing. For New
York three commissioners are to be appointed by the
Mayor, who are to receive $5,000 salary apiece. No
provision is made for the salaries of conniiissioners in
any of the other counties. This would create one hun-
dred and eighty lunacy commissioners. While we should
be pleased to know that so large a number of our noble
profession were occupying valuable sinecures, in the
interests. of the State we can by no means advise such a
measure. It is cumbersome, expensive, and unneces-
sary.
Short-weight Quinine Pills. — .A " Connnission "
recently published in the Medical News of Philadelphia
the results of examinations and analyses of quinine pills,
and announced that there was very generally a short
weight. Messrs. W. H. Schieffelin & Co., of New York,
now state in a card that the charge is not true so far as
their pills are concerned. The " Commission " in ques-
tion is accused of having used a faulty method of anal-
ysis, of being guilty of mathematical mistakes and
misleading comparisons. McKesson & Robbins make
similar statements.
lOO
THE MEDICAL RECORD.
[January 27, 1883.
Seats for Female Employes. — A sensible bill has
been introduced in the Minnesota Senate, providing for
seats for all female employes in factories or stores.
A School of Pharmacy for Women has been opened
in Louisville, Ky.
Pay for the Experts in the Guiteau Trial. — The
four medical experts summoned by the Government in
the Guiteau trial — Dr. Gray, of Utica ; Drs. Macdonald
and Allan McLane Hamilton, of New York ; and Dr.
Kempster, of Kenosha, Wis. — are to be paid each at the
rate of $25 per day. The total amount will reach $13,000.
Small-pox in Baltimore. — Small-pox, which has pre-
vailed so extensively in Baltimore, is now said by the
authorities to be under control. Vaccination is carrieii
on by wholesale, and the new cases of variola are prompt
ly and efficiently quarantined.
Sent to a Small-pox Hospital with Measles. —
Dr. M. M. Walker, of Germantown, Pa., has been sued for
damages by a female patient, who, having measles, was
sent by him to the small-pox hospital as a case of small-
pox. The diagnosis was made in the early period of the
eruption. The patient recovered from the measles, suf-
fered an attack of varioloid, the result, as is alleged, of
the exposure to the disease in the hospital, and finally
left the hospital cured. It was properly claimed that the
mistake in diagnosis was not, under the circumstances,
absolutely avoidable. Five similar instances are said to
have occurred in Baltimore during the past week.
Bad Drinking-water in Philadelphia. — Commu-
lycations have been received by the Philadelphia authori-
ties from the commissioners of Fairmount Park touching
the imiHU'ity of the Schuylkill water. These have been
referred to the Finance Committee, in order that a request
for an appropriation of $200 to make chemical tests may
be properly considered.
Anti-dissection Bill. — A bill has been introduced
in the Michigan legislature, providing that the bodies of
unclaimed paupers shall not hereafter be sent to the
Medical College at .\nn Harbor for dissection. It is
supposed to be inspired by some sentimental buncombe
in the (iovernor's message. As might have been ex-
pected, the measure meets with much opposition from
sensible citizens.
St.\te Board of Health for Pennsylvania. — A
movement has been made for the establishment of a
State Board of Health for Pennsylvania. A bill intro-
duced into the legislature of that State provides that the
Governor api)oint six persons (a majority physicians) to
inspect sanitary and jjublic institutions and suggest
amendments to the sanitary laws, and supervise the regis-
tration of births, marriages, deaths, and jirevalent diseases.
A Post Mortem on Dr. George M. Beard was held
Wednesday afternoon. It was conducted by Dr. T. F.
Satterthwaite, assisted by Dr. W. H. Porter. It was found
that the disease causing deatli was an embolic pneumo-
nia, originating in an abscess of the ujjper maxilla. The
right lung was, in large part, consolidated. The left lung
was dark, very soft, and would soon have become gan-
grenous. 'l"he funeral takes place to-day (Saturday) at
II A.M.
Instruction to Delegates and the Medical So-
ciety of the County of New York. — At a meeting of
the Afedical Society of the County of New York, held
January 2 2d, a motion to instruct the delegates to the
State Society was defeated by a vote of 31 to 9.
Dr. Oliver Wendell Holmes, of Boston, is about
to visit England. The distinguished author will be sure of
a hearty welcome.
Wanted — A New Health Resort. — Commenting on
the fact that the West Indies has been forbidden Mr.
Vanderbilt, as being too warm, the " Broadway Lounger"
says : " We much need a Northern watering-place in the
South less flabby than Florida, with better hotels than
San Antonio, with less visible disease than Hot Springs,
with more security than New Orleans, and more outlet
than Fortress Monroe." Plainly, the writer can never
have seen the Atlantic City newspapers, in which two or
three hundred Philadelphia physicians, in good ethical
standing, have endorsed that resort.
iUmunns and 31oticcs.
A Treatise on Fractures. By Lewis A. Sti.mson,
B.A., M.D., Professor of Surgical Pathology, Medical
Faculty, University of the City of New York ; Surgeon
to Bellevue and Presbyterian Hospitals. With 350 illus-
trations. 8vo, pp. 59S. Philadelphia: Henry C.
Lea's Son & Co.
The work comes to us without a ]>reface, and with
none of tiie usual apologies for its publication. In most
cases such apologies are needed more than in the present
instance. It claims for itself nothing more nor less than
can be learned from it by careful reading. The author
has a thorough conception of what should constitute a
practical treatise on fractures, and carries it out in a man-
ner that must prove satisfactory to the student and prac-
titioner. His subjects are arranged in a systematic man-
ner, and the different mooted points in the pathology and
treatment are on the whole very well discussed. In the
laudable effort to be concise, he shows a tendency to drift
into forms of expression which are somewhat dogmatic.
Especially does this appear to be the case when ^he con-
clusions arrived at are seemingly based rather on theo-
retical grounds than on the results of actual personal ex-
perience. But the reader is quite ready to overlook this
disposition on the |)arlof the author, in view of the admir-
ably exhaustive ri'suine which he gives of the experience
of others. It must not be inferred, however, that our
author has not improved his own opportunities for obser-
vation to the utmost. The results of these are presented
here and there throughout the work in a becomingly
modest manner, and independently positive form. Some
of his special studies into the causes of deformities, notably
those about the wrist and elbow, are of much value, show-
ing ingenious reasoning, which has a desirably practical
turn.
The subjects of repair in fractures, and tlie complica-
tions and remote consequences of fracture are very
clearly presented, as are also the general considerations
of the treatment of tliese lesions by various aiiparatus.
The fractures of special bones are systematically consid-
ered in turn, and their causes, symptoms, diagnosis and
treatment fully described. The illustrations, which are
numerous and for the most part original, are exceedingly
good. They represent all the leading features of general
and special fractures, as well as most of the recognized
methods of treatment for the same. .Altogether it is a
work which will be read with interest and profit by the
student and general practitioner.
January 27, 1883.]
THE MEDICAL RECORD.
lOI
(jUAiN's Elements of Anatomy. Edited by Allen
Thomson, M.D., D.C.L., LL.D., F.R.S., Edward
A. ScHAFER, F.R.S., and Ceorge D. Kane. In two
volumes. Ninth Edition. New York : Wm. Wood
&: Co. 1882.
A WORK on anatomy which has, within a comparatively
short period, reached its ninth edition, scarcely needs
the commendation of the reviewer. Before the fact of
well-earned success, praise seems but a task of superero-
gation. We may briefiy note, however, in what respects
the present edition ditTers from previous issues, and
whether the new Quain has taken due cognizance of the
advances made in the various branches of anatomy.
A critical analysis at once reveals the thoroughness with
which the work has been revised. Some obsolete
opinions have 'been entirely discarded, and wherever
necessary, new matter has been introduced. Neverthe-
less, while material alterations were thus made, the orig-
inal form of the book has been retamed.
One of the best features of the new edition is the
excellency of those portions which relate to embryology,
histology, and the cerebro-spinal system. These branches
are, as a rule, so inadecjuately treated, even in standard
te.xt-books, that it is a pleasant surprise to find them fully
up to date in the work before us.
The illustrations are satisflfictory throughout the volume,
and the edition contains many new ones. .VU in all, the
new Quain can be cheerfully recommended to student
and practitioner as a complete, practical and readable
treatise on anatomy, better than which none e.xists in the
English language.
Des Inoculations Preventives dans les Maladies
Virulentes. Par le Dr. E. Masse, avec une planche
hors te.xte. Paris : G. Masson. 1883.
In this work of ninety-five pages, Dp. jMasse gives a his-
tory of what has been so far done in attenuating virus
and studying its effects. The book is a useful and timely
one, although Dr. Masse presents the Pasteur side alone
of the subject.
©Iritttavy.
GEORGE MILLER BEARD, A.M., M-.D.,
^NEW YOKK.
The death of Dr. Geo. M. Beard, which occurred at his
home in this city on Tuesday morning, as the result of
pleuro-pneumonia, takes from the ranks of the medical
profession a bright and shining light. The news of his
sudden taking off startled his friends, very few of whom
knew that he was even ill. It was only as yesterday
that his voice was heard in discussion, that he was met
in apparent good health, and was filled with his usual
enthusiasm for his life-work. It seems hardly possible
that the end should have been so near. Death was,
however, not unexpected to him, and toward the last he
philosophized upon the rapidly progressive changes ot
his dying condition, expressing the wish to record the
thoughts of a dying man. During his illness he was in
his usual cheerfulness, although most of the tune suffer-
ing great pain. His main concern referred to what he
considered his unfinished work, and almost his last
words ex\)ressed the hope that others might continue it.
Dr. Beard was born at Montville, Conn., and was the
youngest of four children. His father, the Rev. S. F.
Beard, was a Congregational clergyman. His grand-
father was a ijhysician. Dr. Beard prepared for college
at Phillips Academy, Andover, Mass. Before entering
Yale College in 1858 he spent two years in teaching.
He was graduated trom college in 1862. He then stud-
ied for one year in the Medical Department of Yale
College, and in 1866 was graduated from the College of
Physicians and Surgeons in this city. Dr. Beard at once
settled down in this city, and, with Dr. A. D. Rockwell,
made electro-therapeutics and nervous diseases his spe-
cialty. Dr. Beard was a voluminous writer, his first lite-
rary attempt being a paper on " Electricity as a Tonic,"
written in 1866. From that time to the day of his
death he wrote constantly, adding many works of singu-
lar merit to medical literature, .'\mong his most impor-
tant works were " Our Home Physician," published in
1869 ; two popular treatises entitled respectively "Eat-
ing and Drinking," and "Stimulants and Narcotics,"
1871 ; " Medical and Surgical Electricity,'' 1875, with
Dr. A. D. Rockwell ; " Hay Fever ; or. Summer
Catarrh," 1876 ; in 1877, a monograph on "The Scien-
tific Bases of Delusions, Being a New Theory of Trance
and Its Bearing on Human Testimony ; " in 1880, a prac-
tical treatise on "Nervous Exhaustion;" in i88[, a
work on sea-sickness, and in the same-year " American
Nervousness, with Its Causes and Consequences ; " in
1882, " Psychology of the Salem Witchcraft Excitement
and Its Practical .-Application to Events of Our Times."
Among his later writings were a work on " Sexual Neu-
rasthenia," " The Physiology of Mind-reading," and a
host of pamphlets relating to electrology, neurology,
and psychology. He also made constant contributions
-to the North American Revie7V, the Popular Science
Monthly, and The Medical Record.
In 1863 and 1864, during a period of eighteen months,
Dr. Beard was .Acting .Assistant Surgeon in the West
Crulf scjuadron of the United States Navy, and in 1868
became a lecturer on nervous diseases in the University
of New York. From 1873 to 1876 he was physician to
the Demilt Dispensary in the department of electro-
therapeutics and nervous diseases. Dr. Beard was also
one of the originators of the National Association for the
Protection of the Insane, and was a founder of the New
York Neurological Society. He was a Fellow of the New
York Academy of Medicine, a member of the County
Medical Society, the New York Medico-Legal Society,
the American Neurological Association, the American
.\cademy of Medicine, and of the American Association
for the Cure of Inebriates.
He paid several visits to Europe and made there the
acquaintance of many European authorities in science.
He was several times a delegate to foreign scientific as-
sociations, presented papers to the British Medical Asso-
ciation, and in 188 r, was a delegate to the International
Medical Congress in London. He was connected pro-
fessionalh', as- an expert, with the trials of Guiteau and
Cadet Wi-iittaker.
In the Whittaker case he testified for the defence, tak-
ing the position that Whittaker, when found with his ears
cut, was really unconscious, and that the unconscious-
ness was the result of fright vvhich came from the attack
during the night. Dr. Beard's position in the Guiteau
case was that the assassin was insane ; that the insanity
was of a hopeless and incurable character — religious
monomania — and that Guiteau was irresponsible abso-
lutely for the deed. This ground he took in an article
in the North American Review, but when he was going
on the stand to testify to that effect his testimony was
ruled out on a legal technicality. He was, also instru-
mental in preparing the jietition for a stay of proceedings
just before the hanging of the assassin.
Dr. Beard's writings have been especially influential
in Germany, and his most important works have been
translated into the German language. All his works
have been original coi tributions upon the subjects of
which they treat.
No man made for himself so enviable a reputation
in his profession by more honest work than did the
subject of our sketch. Few who did not know his habits
could understand how he accom]ilished so much. But
he was constantly and contentedly busy wherever he
might be. He never allowed himself, however, to feel
the strain of work. His elastic spirit and calm philoso-
phy always served him in good stead, even upon his
death-bed.
I02
THE MEDICAL RECORD.
[January 27, 1883.
^>cpovts of J'joci^ti^s.
NEW YORK ACADE.\[Y OF MEDICINE.
Stated Meeting, January )S, 1S83.
R. F. Weir, M.D., Vice-Preside.vt, in the Chair.
Dr. Charles Milne presented to the Academy a
beautiful engraving of John Hunter, a copy of the
original portrait painted by Sir Joshua Reynolds. On
motion of Dr. John G. Adams, the thanks of the Acad-
emy were extended to the donor.
Dr. Paul F. Mund^ then read a paper on
secondarv puerperal hemorrhage.
The majority of obstetric authorities scarcely referred
to the possibility that alarming uterine hemorrhage
micht occur as late as several weeks after confinement,
and only the standard works of Barker, Winckel, Play-
fair, Spiegelberg, and Barnes devoted a fair amount of
space to this accident. In September, 1S80, at the an-
nual meeting of the American Gynascological Society,
Dr. Theophilus Parvin read an elaborate essay on this
subject. The fact that so little had been written con-
cerning it, and also the fact that the accident was com-
paratively rare and grave, were sufficient reasons for re-
porting the following case, which presented certain
l)eculiarities not referred to by Dr. Parvin.
On August 2, 1882, he saw, in consultation with Dr.
S. Kohn, a patient who was in great danger from uterine
hemorrhage. She was twenty-five years of age, the
mother of three children, and had always been healthy.
She was taken in labor on July 16th, with her fourth child.
Labor progressed slowly, and after it had lasted twenty-
one hours, the head almost resting upon the perineum,
and no advance being made, an attempt made to de-
liver with the forceps failed. The cranium was then
opened and the forceps again used, but they refused to
hold. The head was then delivered with the cephalo-
tribe. The cause of the difficulty was hydrocephalus.
Hemorrhage was quite profuse, but soon ceased. The
placenta was adherent to the right side of the fundus and
required complete separation by the hand, special care
being taken not to leave any fragments behind. Two
riuid drachms of ergot were administered by the mouth
and all hemorrhage ceased. On examination it was
found that the anterior lip of the cervix was quite badly
torn. The patient appeared to be doing well for the
neit six days, although the temperature varied from loi^
to 102° F., and the pulse averaged 120. The lochia
were fetid from the third day on. Uterine injections
washed away numerous small shreds and coaguli until
the lochia lost their offensive odor. On July 28th, the
lochia again became offensive, the discharge diminished in
quantity, was serous, and contamed a reddish-black fiuid.
On the sixteenth day after labor, a profuse hemorrhage
began, and when Dr. K saw the patient, four hours
and a half afterward, she was almost exsanguinated. The
bleeding was arrested for a moment by intra-uterine
injections of hot. water, but it soon reconnnenced. It
was again checked by injections of hot water and tam-
ponadmg the vagina. When Dr. Munde saw the patient
he foiuid her with low head, perfectly pallid, face, hands,
and feet cold and clammy, pulse 120, very weak, and
consciousness unimpaired. The fundus of the uterus
was on a level with the umbilicus, irregular in outline, the
ri-ht horn extending several inches above the navel, and
there was moderate tenderness. After prejjaring fresh
carbolized tampons, procuring a few ounces of the pure
tincture of iodine, and a fountain syringe filled with
hot carbolized water, he rapidly removed the tampons,
and at once passed his hand into the dilated vagina and
through it into the distended uterine cavity, which he
foimd filled with soft coaguli, exceedingly offensive, dark
colored, and largely mixed with shreds of decidua. The
internal surface of the uterus was soft, pulpy, and the
nnicous membrane apparently very much thickened.
Great caution was necessary, in order to avoid injuring,
perhaps perforating, the pulpy wall of the organ. After
em|)tying the uterine cavity, he introduced a long metal-
lic tube, and washed it out with carbolized water from
the fountain syringe, the water being as hot as the hand
could bear. The i)atient did not complain of the heat.
He then introduced a large cylindrical speculum, through
the tube of a long cervical syringe, and then injected
half an ounce of pure tincture of iodine into the uterine
cavity, using some force in order to insure the thorough
distribution of the iodine. Cotton tampons joined with
a cord were again applied, merely as a safeguard against
further hemorrhage, in case the iodine failed to check
it, and he directed that they be removed in six hours.
The injection of iodine gave no pain whatever, nor was
it followed by shock. Six hypodermics of brandy were
given, and ten drops of aromatic spirits of ammonia, five
drops of spirits of camphor, and a teaspoonful of brandy
were ordered in ice water every half hour. A hypoder-
mic syringe full of Squibb's fluid extract of ergot was in-
jected into the subcutaneous cellular tissue of the abdo-
men, and an ice-bag was placed over the uterus. A
bottle of hot water was placed at the feet. Directions
were left to inject the uterine cavity very gently with tep-
id carbolized water after removing the tampons, for the
purpose of preventing the decomposition of the coaguli
produced by the iodine.
On visiting her twenty-four hours later he learned that
no further hemorrhage had occurred, and that the uterus
had been washed out several times. There was hectic
flush and a peculiar sweetish odor about the patient,
which sustained the conviction already expressed, that
the patient was suffering from septic endometritis. Tepid
injections of a one-sixth per cent, solution of perman-
ganate of potash were made into the uterus every
three hours, more or less, according to the offensiveness
of the discharge. Ten grains of salicylate of soda were
to be administered every two hours, in case the tempera-
ture should rise above 102^ F.,and the stomach did not
reject it. Stimulants as might be required. Nutritious
enemata. Prognosis unfavorable. In the course of the
subsequent treatment, intra-uterine injections of the sul-
phate ofquinine [sulphate of quinine, one drachm to
the quart of water] were used at the suggestion of Dr.
Kohn, and apparently with marked benefit. The offen-
sive lochia continued several weeks after the hemor-
rhage. The patient recovered slowly, and at the end of
five weeks convalescence was complete.
Dr. Munde then reviewed several points of interest in
the case reported.
First. — The causes of secondary puerperal liemor-
rhage. Constitutional; hasmophilia, mental emotion, func-
tional disease of the liver, incautious use of stimulants,
sudden assumption of the erect position. Local : irregu-
lar and inefficient contraction of the uterus, clots in the
uterine cavity, portions of retained placenta or mem-
branes, retroflexion of the uterus, laceration of the
vagina or vulva, laceration or erosion of the cervix, in-
flammatory ulceration of the cervix, malignant disease
of the cervix, pelvic cellulitis, inversion of the uterus,
premature sexual intercourse, loaded rectum. To these
he added distended urinary bladder. Besides these
malarial poisoning was a well-recognized cause of sec-
ondary puerperal hemorrhage, (ieneral febrile disturb-
ances were also causes of secondary metrorrhagia. An-
other cause, so far as he had been able to learn spoken
of by Winckel only, was disease of the inner surface of
the uterus, chiefly endometritis. Dr. .Munde believed
that his case belonged to this class.
Seeomi. — The date of hemorrhage after delivery. The
time at which secondary hemorrhage is liable to occur
varies greatly, according to the character of the labor,
the care taken in the tliird stage, precautions employed
during childbed, and accidental circumstances. Barker
January 27, 1883.]
THE MEDICAL RECORD.
103
refers to instances as late as the fifth or sixth week
after dehvery, and Heifer speaks of one during the
fourth week.
Third. — The significance of secondary heniorriiage
depends partly on the amount of blood lost and escap-
ing, and partly on the origin of the blood. Hemorrhage
dc^pending on mere temporary atony of the uterus is less
serious than if due to sloughing off of the placenta, uter-
ine thrombi, or the bursting of a dilated vein. The oc-
currence of serious or fatal hemorrhage at a later date
than the fourteenth day after delivery was certainly very
rare. The evil consequences of protracted secondary
hemorrhage were the debilitating eiTect upon the woman,
and subsequent uterine disease of some form or other.
Fourth. — The means employed to check hemorrhage.
He recommends the method of injecting iodine through
a cylindrical speculum, as a means of saving the vagina
and vulva from inevitable contact with the fluid if the
latter is simply injected into the uterus under the guid-
ance of the finger. With reference to the application of
the tampon after labor, it need scarcely be said that it
should never be done unless the uterus was so contracted
and constantly watched that no internal hemorrhage
could take place. He applied the tampon temporarily
as a possible safeguard against external hemorrhage until
the patient Iiad liad time to rally a little, and with the
positive understanding that the fundus uteri should be
carefully watched until the tampon was removed. As a
rule, it might be assumed that the same remedies and
measures which are used to check primary uterine hem-
orrhage will be effectual in the secondary variety. For a
protracted bloody lochial discharge, or a constant san-
guineous oozing due to subinvolution, he had, in a num-
ber of instances, used successfully the pure tincture of
iodine applied to the uterine cavity, about twice a week,
on cotton-wrapped applicators.
Dr. Munde concluded his paper by making reference
to the means of preventing these hemorrhages, primary
and secondary. The following rules were given for the
management of the third stage of labor and the early
puerperal state :
1. Always keep the hand on the fundus uteri from the
moment the head appears at the vulva until the placenta
is expelled.
2. Do not hasten the ex[)ulsion of the placenta too
much.
3. Always watch the uterus with the hand, using gentle
friction occasionally, for at least one liour.
4. Always give ergot by the mouth immediately after
the birth of the child. If chloroform has been given,
or if the labor has been unusually tedious, give ergot liy-
podernhcally, injecting a syringe full of the fluid extract
to the depth of one inch near the umbilicus.
5. If the uterus shows a reluctance to remain contract-
ed, rub the fundus gently with a i)iece of ice, or insert a
cone-shaped piece into the cavity.
6. Always make sure by palpation and percussion that
the uterus contains no coaguli.
7. Apply the child to the breast early.
8. Apply an equably tight binder, and, if there be ten-
dency to hemorrhage, a pad should be placed over the
fundus to secure its steady compression.
9. If there be laceration of the cervix or vagina, future
oozing may be checked by mild astringent injections, or,
if need be, by applications through the speculum. Im-
mediate suture for laceration of the cervix aijpeared to
him to be rarely feasible.
10. Do not allow the lying-in woman to leave her bed
before the tenth day.
. II. See that the bladder is empty, and is not interfering
with uterine contraction.
12. See that the nozzle of the syringe is not introduced
too far, and that too much force is not used in giving the
customary cleansing injection.
Dr. W. M. Polk, on invitation, opened the discussion,
and said that he had seen but one case of secondary
puerperal hemorrhage, meaning thereby hemorrhage suffi-
ciently profuse to produce marked exhaustion in the
course of twenty-four hours, and in that instance if oc-
curred fifteen days after confinement. He applied a
tampon because the uterus was firmly contracted, not
large, and besides he watched the organ very closely.
He had a misfortune with it, which he believed was wor-
thy of being borne in mind. The tampon was wet with
a solution of persulphate of iron in water, three parts of
water and one of the liquid preparation of the iron. It
remained in position about twelve hours, and after its re-
moval he instructed the nurse to thoroughly syringe the
vagina, but she neglected to do so, and the consequence
was complete atresia of the vagina, which required a
secondary operation for its relief. Dr. Polk also referred
to a second case which occurred in the jiractice of one of
his friends, in which the hemorrhage occurred on the fifth
day after confinement, and followed an intra-uterine an-
tiseptic injection given through an ordinary catheter. In
that case hemorrhage was so profuse that death took
place almost immediately. He thought that the jjossi-
bility of the occurrence of this accident should always be
borne in mind in the usual habit of washing out the uter-
us with antiseptic solutions after confinement. Dr. Polk
believed that the causes of this form of hemorrhage could
be arranged under two heads : first, local ; second, con-
stitutional. His rule has been, whenever he had to deal
even with milder degrees of septic inflammation of the
endometrium, to be closely upon his guard against the
occurrence of this accident. The tendency to improper
contractions of the uterus in consequence of septic dis-
ease, and a failure to establish proper organization of the
clot for the complete closure of the vessels, renders very
trivial causes sufficient to produce hemorrhage. The
conditions likely to interfere with the proper organization
of the coaguli in the ends of the uterine sinuses are,
unfortunately, very numerous. In die first jilace, all sep-
tic inflammations belonging to the uterus in the parturi-
ent state exert a marked infiuence in this direction. The
other causes were chiefly constitutional, and were sum-
med up under the head of cachectic states, such as ma-
larial poisoning, or poisoning from any of the minerals,
as mercury, lead, etc. He did not approve of the prac-
tice which formerly prevailed, of forcing the uterus back
into the hollow of the sacrum by means of heavy com-
presses and bandages, for the reason that such mechani-
cal pressure gave rise to congestion of the organ, and was
liable, sooner or later, to be followed by hemorrhage.
Dr. Polk also preferred hot water to cold. He had seen
a good deal of prostration produced after prolonged use
of cold, and he had not seen any ill effects follow the use
of hot water. Water into which the hand could be placed
and retained was not too hot tor the uterus, and he thought
this was a sufficient test for the temperature of the water.
So far as immediate operations upon the cervix were con-
cerned, he agreed with the author of the paper, that they
were out of place. He thought the observations made by
Dr. C. C. Lee had proved conclusively the correctness
of this conclusion.
Dr. E. L. Partridge directed attention to some of the
less severe cases than those which had been mentioned
by Dr. Munde and Dr. Polk. He thought that only one.
half of the question had been stated when it was said that
secondary hemorrhage was due to retention of clots and
portions of the secundines, etc., and that the real ques-
tion wa?,^What is the condition that allows this improper
uterine Antraction ? He then proceeded to speak of
the predisposing causes, both local and constitutional,
which might give rise to secondary uterine hemorrhage.
For example, a woman who suHered from such symi)toms
as would naturally be attributed to disorders of the circu-
lation, such as headaches due to an:cmia, attacks of syn-
cope, etc., would be liable to the occurrence of hemor-
rhage after labor. With regard to local predisposing
causes, he mentioned chronic uterine diseases of various
kinds, chronic cellulitis which led to an increase in the
I04
THE MEDICAL RECORD.
[January 27, 1883.
size of the organ due to the preponderance of tibroiis
structure which was liable to interfere with perfect con-
traction of the organ at the termination of labor. The
only alarming case of secondary puerperal hemorrhage
which he had seen occurred on the ninth day after
labor. It occurred suddenly, and was found to be the
result of an annular slough which involved the entire
vaginal end of the cervix. The loss of blood was suffi-
ciently profuse to seriously jeopardize the patient's lite.
The history of the labor was that of early rupture of the
membranes. And with regard to early rupture of the
membranes, he had found that the persistence of the
hemorrhagic element in the lochial discharge was very
likely to exist, and it might be sufficient afterward to
produce what might be called hemorrhage. In such a
case as that reported by Dr. Munde he would not hesi-
tate to use a tampon, but, generally speaking, he would
not hasten to apply a tampon until he was convinced
that all other methods for controlling the hemorrhage
were futile, because he thought there was a liability to the
absorption of septic material. Dr. Partridge then madf
special reference to the importance of compressing the
uterus for some time after the completion ot labor, and
for the purpose of preventing the occurrence of second-
ary hemorrhage.
Dr. H. T. Hanks concurred in nearly all the state-
ments made by Dr. Munde, and made reference to cases
of undoubted malarial origin which had come under
his observation. In one the hemorrhage occurred four-
teen days after delivery. It was controlled by the use
of a battery and injections of hot water. He agreed
with Dr. Polk that hot water was the more easily ob-
tained, and more agreeable to the patient, and more
effectual than cold. It could be easily injected through
Chamberlain's long glass tube, or a small gum elastic ca-
theter. He did not approve of the use of the tampon.
He also thought it unnecessary to give a drachm of ergot
in all cases of labor. If there was any evidence of impend-
ing danger, certainly the ergot should be used, but if the
patient was all right, why give something which produced
uterine colic ?
Dr. Munde, in closing the discussion, said he did not
concur with Dr. Polk with regard to the eftect produced
by the binder and pad. He thought their use was simply
the application of the same principle which was so fre-
quently applied for the arrest of hemorrhage in any other
part of the body. With regard to the use of heat or ice,
he did not wish to be understood that he would use ice-
water, but he would simply take a piece of ice and rub it
over the fundus, or introduce a piece into the cavity of
the uterus. It had been his experience that the patient
complained more with regard to the use of hot water
than tlie use of cold. Dr. Partridge's remarks were ex-
ceedingly proper with regard to the etiology of hemor-
rhage in certain cases, but it had not been his purpose to
enter upon the subject of the etiology of uterine hemor-
rhages, which were of a more chronic character. He
wished to speak chiefly of the acute cases. The subject
of protracted lochial oozing he thought had not been
sufficiently elaborated. He believed that, the condition
was exceedingly common, and that a great deal could
be done in the way of its prevention and cure. With
regard to the use of the tampon, he did not wish to be
understood as recommending its introduction after de-
livery of a full-grown child. It certainly was a risky
practice, but in his case he preferred to take the risk
rather than to allow tlie patient to lose another drop of
blood. J5ut it should be insisted upon that it be very
carefully watched. He did not believe that it was always
necessary to use ergot after delivery, but at the same time
he thought tlie woman was a little more safe with than
without it, and he did not believe that it did any harm.
Dr. Por.K remarked that he did not mean to criticise
the application of the binder and compress, but simply
v^ished to speak of the custom of continuing it for a week
or ten days after labor.
Dr. E. p.. Bron.son then read a paper on
ECZEMA: THE PATHOLOGY AND THE PRINCIPLES OF ITS
TREATMENT.
He believed that the epidermis played a part in the
pathology no less essential than the vascular stratum be-
neath it, and that it was primarily involved. He also
maintained that there was an independent action on the
part of the epidermal cells in the inflammatory condi-
tion of eczema. The adjacent vascular tissues, however,
soon sympathized. Dr. Bronson then spoke of the con-
ditions which favored the view advanced, and mentioned
the fact, recently demonstrated, that the epidermis as
well as the papillary layer is sup|)lied with nerves. Ec-
zema manifests itself in sensory disturbances and in
trophic changes in the epidermis. The trophic change
is under the influence of the epidermic nerves, and the
itching was probably due to their disorder. Of the pa-
thological anatomy of the epidermic nerves in eczema,
but little was known. Dr. Bronson then presented at
some length the reasons which had led him to the adop-
tion of this new theory concerning the pathology and
etiology of eczema.
The therapeutic indications were, to allay irritation and
assist repair. Measures of rest and measures of stimula-
tion comprised the whole method of treatment of eczema.
The local agents were embraced under mechanical,
chemical, and dynamical. The highest grades of eczema
were usually treated best by wet applications. Lotions
might hold in suspension powders or certain chemical
materials, such as moderate astringents or alkalies.
Sometimes it was of advantage to use a certain propor-
tion of glycerine in the lotion. Undiluted glycerine acted
as an irritant. Wet applications to be most effectual
must be continuous and copious. A little later emul-
sions might be used, and a little later still the jieriod for
the use of ointments had arrived. Of the ointments the
zinc was the best that could be employed where a pro-
tective ointment was indicated. The use of ointments
was contra-indicated in the early stages, and there were
other circumstances under which they were contra-indi-
cated, such, for example, as the existence of more or less
erosion with copious discharge, when the use of absorbent
cotton or an absorbent lotion was more serviceable.
The next class of agents considered was those which
modified vital action, and chief among these were the
alkalies, which produced a sedative influence over the
sensory nerves. They were most effective when the
nervous layer of the epidermis was exposed. In old
cases of eczema the stronger potash soaps were indicated,
but in the milder cases the milder soaps acted most
favorably. In squamous eczema the soap treatment was
the most eflectual which could be emjjloyed. It was sel-
dom that a stronger alkali than soft soap was recjuired.
Hot water for the relief of the pruritus of eczema was
very serviceable. It should be used to the extent of
substituting a sense of smarting for that of itching which
would be succeeded by a sedative eftect. To insure a
continuous eftect of hot water, it should not be stopped
too soon. Dr. Bronson then spoke of the indications
for the use of carbolic acid, preparations of tar, etc. In
the stage of active exudation the use of tar was contra-
indicated. Among the remedies belonging to this class
was the benzoated oxide of zinc ointment. Mercurials
were indicated chiefly in the later stage, when the skin
was no longer in a state of active inflammation, but was
suffering in nutrition from the accumulation of the pro-
ducts of inllanunation. In these cases mercury was most
efficient.
When is it necessary to resort to internal medication ?
Dr. Bronson considered this question at some length,
and believed that internal medication might be of some
service in diminishing reflex irritation, in restoring the
general tone of the system, and in aiding local remedies.
He thought it (juite possible that eczema resulted most
frequently from the combined etfects of an irritation
January 27, 1883.]
THE MEDICAL RECORD.
105
from within and another from without. After presenting
the views entertained by the l''rench School of Dermatol-
ogists, Dr. Bronson reached the conclusion that whatever
the predisposing causes might be, eczema in the main was
essentially a local disease, and the most rational treat-
ment that could be adopted was directed to the skin it-
self Internal remedies were subordinate to local meas-
ures. The use of narcotics should be mentioned only
to be condemned. In the n;ajority of cases the local
treatment was able to cope with the disease.
Dr. R. W. Taylor, being invited to open the discus-
sion, said that he had listened with great interest to the
paper read by Dr. Bronson, although it had a theoretical
flavor which jierhaps was not so sound as its practical
character. Wkh reference to the pathology of the affec-
tion, he thought Dr. Bronson had been rather too super-
ficial, believing that the disease has its beginning above
the rete mucosum. Eczema being a chronic disease,
and involving the entire skin. Dr. Taylor thought that if
Dr. Bronson had included the deeper invasion of the dis-
ease in his description, it would have added much to the
completeness of his paper. That the disease commenced
in the vascular layer of the skin and extended above and
below, he thoaglit would be conceded by all those who
saw much of eczema.
With reference to treatment, it could be fornuilated
something as follows : In the erythematous stages sooth-
ing applications, either in the form of powders or lotions,
such as lead and opium, were most serviceable. /\.s the
disease increased in age, stimulation should be added.
He believed that stimulation was one of the cardinal
points in the treatment of eczema, keeping the surface
well protected, and then going on gradually with the use
of stmnilating applications. The application of the zinc
ointment alone would not eflect a cure, unless sometliing
was added, and then the use of tar came in most admir-
ably. Dr. Taylor believed that in most cases, treatment
with the use of alkalies could be extended further than
had been mentioned by Dr. Bronson, and that strong
solutions of potash might be usetl with advantage. Soaps
would fail in some cases where solutions of potash would
relieve, even of the strength of a drachm of the caustic
potash to the ounce of water. The action of this strong
solution must be controlled so as to get the effect of
strong stimulation and at the same time prevent it from
producing inflammation. With regard to the nature of
the disease, he was glad to hear that Dr. Bronson discar-
ded the rheumic and dartrous diatheses which were so
completely visionary. There was one fact to which he
wished to direct especial attention, and which had not
been dwelt upon by the author of the paper. A patient
has eczema, and has had it for a long time. If you go
back into the history of the case, you generally find that
he has had a local eczema more or less severe ; in other
words, while young he suflered from attacks of inflanuna-
tion of the skin, whicii has rendered it more vulnerable
all through life than it otherwise would have been. The
more frequent the occurrence of these attacks of inflam-
mation of the skin in early life, the more the patient is
predisposed in later life to eczema, simply from the bad
habit which the skin has taken on in former days. Dr.
Taylor also thought that arsenic had not been sufficiently
recommended. He believed that it would assist the ex-
ternal treatment very much. The golden rule in the
treatment of eczema was to use local measures, but in
many cases the internal use of arsenic would be found
very beneficial.
Dr. Bulkley regarded Dr. Bronson's paper as one of
the best exposes of the idea of eczema which had ever
been presented. With regard to the conditions, the
stages and the treatment for each, if what had been said
could be properly studied, it would help all in the man-
agement of the affection. The subject of the alterations
in the cellular layers of the skin were necessarily impor-
tant, and had not received the attention which they
should have done in years gone by. That the skin
should take on this particular action, and the patient be-
come the subject of such a tendency wiiich might last
through a life-time, was undoubted. The bearing of the
nervous system in the disease he thought was important
to be borne in mind, and was an important factor in
studying the etiology of the affection. Dr. Bulkley, how-
ever, held that in the vast majority of instances the skin
would not take on the eczematous action when the indi-
vidual was in perfect health. A person who suffered
from eczema in any degree, and in whom the process has
lasted for any considerable time, was not in perfect health.
There was no specific for eczema, and yet he had report-
ed several cases in which he had given nothing except
Fowler's solution internally, and the cases were relieved
at once. He believed that in nine out of ten cases of
eczema arsenic should be administered internally at some
time in the course of the disease.
Dr. T.wi.or asked Dr. Bulkley what he meant by the
term, " is not in perfect health ; " in other words, whether
or not he believed there was a herpetic or dartrous, or
?ome other diathesis which produced the disease ?
Dr. Bulklev replied that he did not believe in a her-
petic or dartrous diathesis, nor did he believe in an
exzematous diathesis, but referred to the debilitated
condition of the patients, and to the fact that some other
organ besides the skin is in an abnormal condition.
Dr. Taylor asked, how explain the cases of eczema
which occur in patients in whom there cannot be found
any deviation from health ?
The Academy then adjourned.
SECTION IN PRACTICE.
Stated ATeetiiig, January 16, 1S83.
E. G. Janeway, M.D., Chairman.
ABSCESS OF THE LIVER ABSENCE OF HYPOCHONDRIASIS.
The Chairman reported a case of abscess of the liver
in which there was no evidence of hypochondriasis. In
a number of cases of hepatic abscess he had noticed the
absence of hypochondriasis, and had come to regard its
presence as exceptional instead of the rule.
EYE TROUBLES ERRONEOUSLY ATTRIBUTED TO LESION OF
THE BRAIN AND NERVOUS SYSTEM.
Dr. H. D. Noyes read a paper on the above subject
in which he directed attention first to a class of cases in
which the objective observations might be faulty ; and
second, to a consider.able class of cases in which func-
tional disturbances were sometimes regarded as significant
of trouble in the nervous system, whereas in truth they
originated in the eye.
What he had to say was not by any means to be in-
terpreted as disparaging to the ophthalmoscope, but rather
to encourage a more general use of the instrument than
had heretofore obtained in both hospital and private
practice.
The connection between diseases of the eye and the
nervous system especially had come to be very thoroughly
appreciated, and the more so since the ophthalmoscope
had proved itself an instrument capable of giving so
much valuable information bearing upon the latter class
of affections.
There were, however, certain objective facts observed
in the eye by the aid of the ophthalmoscope that were
capable of misinterpretation. First, the optic nerve va-
ried, to a degree not properly appreciated, in the color
which it presented on ophthalmoscopic e.xamination. It
varied so much that an inference drawn from its undue
vascularity with reference to the possibility of trouble
with the circulation in the brain was liable to lead to
erroneous conclusions. Acute affections of the brain
rarely exhibited themselves in hyperemia of the optic
nerve. When they did the disease was at the base of
the brain, and was meningitis, disturbances associated
with fracture, abscess, etc. Acute inflammation of cere-
io6
THE MEDICAL RECORD.
[January 27, 188^
bral tissue rarely exhibited itself in lesions which could be
seen in the optic nerve. Most of the brain affections,
evidences of which manifest themselves in the optic nerve,
were chronic in character, such as interstitial changes,
new growths, etc.
An intensely reddened optic nerve must be accompanied
by other symptoms before assuming that it was associated
witli lesion of the brain. It was more frequently the
result of strain or irritation of the eye or of congenital
defect than of disease of remote tissues.
Choked disk had an important bearing upon the diag-
nosis of tumor of the brain, and yet there liiight e.xist
swelling and infiltration of the optic nerve without any
evidence whatever of brain lesion, nor could it be as-
sumed that the case was one of latent tumor of the brain.
These cases were not of common occurence, but had
occasionally been observed. The appearance of the
retina varied considerably in different persons. In young
subjects It was frequently seen as a glistening somewhat
opaque reflection and especially noticeable were long
blood-vessels. This condition, due to the brilliant reflec-
tion of the light, in no respect indicated that the retina
was the seat of inflammatory infiltration, and should not
be mistaken for evidence of an inflammatory process.
The general illumination of the fundus of the eye
varied greatly in different subjects, according to the size
and complexion of the person, etc. Besides, there was
frequently seen along the edge of the optic nerve a
bright, opaque, striated surface, running out from the
nerve itself and swelling its edge, that might be mistaken
for exudation. It was a bundle of unperfectly devel-
oped nerve fibres ; was a congenital condition, and had
no influence, either local or general. On the other
hand, the optic nerve was sometimes very pale, and the
blood-vessels small ; but pallor and reduction in size
of the blood-vessels did not necessarily indicate atrophy.
It was sometimes evidence of general poverty of the
circulation, but existed entirely distinct from any altera-
tion of the nerve fibres proper.
Dr. Noyes then referred to a case in which an ex-
perienced foreign oculist saw an appearance in the
eye which he regarded as evidence of inflammation,
and from this and other symptoms he was led to the
conclusion that there was intra-cranial disease. The
real condition, as subsequently proved beyond doubt,
was a notable error of refraction in one eye, which
had not been used until disease in the opposite eye ren-
dered its use necessary. The subjective phenomena liable
to be mistaken for evidence of disease of the brain
were chiefly due to errors of refraction, as hyperme-
tropia, astigmatism, spasm of accommodation, and
trouble with the extrinsic muscles of the eye. This was
by no means a new subject. It was Weir Mitchell, of
Philadelphia, who, perhaps, had attached most import-
ance to it as a field in which causes of peculiar nervous
symptoms could be found. The class of cases which
Dr. Noyes mentioned were those in which the patients
made comparatively little or no complaint whatever with
reference to the eve.
The first and chief symptom which develops in these
cases was headache ; and it could be of any possible
variety, as frontal, occipital, pain in the temples, vertex,
etc. Jt might occur upon one side only, although such
cases were comparatively rare.
This headache might or might not be associated wuh
special use of the eyes. Sometimes it appeared on first
waking in the morning. It might be increased by any
mental labor. It was not infreeiuentiy attended by nau-
sea. The headache was liable to be exceedingly persist-
ent. In a case, in which headache is the chief symptom
complained of, an examination of the eye might reveal
deep congestion of one optic nerve, a degree of conges-
tion, associated with marked opacity, in the other ; and
the observer might be easily led, ])erhaps, to think that
it was a case of some chronic meningeal trouble. Yet
all this might be due to hypermetropia, and the same
symptoms might also make their appearance without
refractive error.
Dr. Noyes then referred to a case in which a large
part of apparent mental and cerebral disturbances was
due to intense spasm of accommodation. The patient
appeared to be near-sighted and required concave
glasses. No. 12 ; but examination determined entire ab-
sence of refractive error, and that the condition was ap-
parent and not real. Atropia was freely and vigorously
used, and although marked relief had been obtained the
spasm had not entirely relaxed. The cause of the spasm
was probably in concussion of the spine, but the prin-
cipal symptom had taken possession of the patient, and
the conclusion had been reached that the trouble was in
the eye alone.
The speaker then gave the history of a case of disor-
dered condition of the muscular apparatus of the eye.
A young woman was near-sighted and also had divergent
strabismus. A great variety of nervous phenomena
attended the case. She had been advised not to have
an operation performed for the squint. From repeated
exanrinations. Dr. Noyes became convinced that the
symptoms were due to the condition of the eye, and
recommended an operation for the relief of the divergent
strabismus, and the result was extremely satisfactory ; not
only was the pain relieved, but the general health of the
patient materially improved.
The subject of irritation produced by disturbances of
the ocular muscles was one which had been agitated
considerably among ophthalmic surgeons, and concerning
it there was not an unanimity of opinion. There was a
variety of opinions with regard to the possibility of
nervous disturbances being developed by disorders of
the ocular muscles, but the differences were rather based
upon the degree of influence which these disorders exert ;
and while there were exaggerated views which altogether
failed of being confirmed by experience, he was persuaded
that these ocular disturbances exerted a far greater
influence, not only upon the functions of the eye, but
upon the general health of the patient,' than was, for the
most part, allowed to them.
-As an illustration of how certain svmptoms, dependent
upon this condition, were expressed by patients, he gave
the history of a case in which the patient, a girl fourteen
years of age, described the symptoms from which she
suffered. In this case there was only extreme debility
of the internal recti muscles. The patient had suffered
from headache for three years, worse latterl}', people
seemed to be moving away from her when she looked at
them, she was unable to look fixedly upon objects,
inability to ride in the cars, etc.
How are the cases to be differentiated and some of
the errors avoided ? To properly study the objective
phenomena requires sufficient knowledge to enable the
observer to say what was normal and what abnormal.
In using the ophthalmoscope, the direct method was the
most valuable, that mode in which the instrument was
supplied with glasses to correct optical errors, as by it
the observer was able to determine whether he was
dealing with a normal or abnormal eye, so far as refrac-
tion was concerned. In addition, the quality of vision
must be examined with test-types and correcting glasses.
Finally, under suitable circumstances, resort might be
had to atropia. If this drug was used, it was well to
notify the patient that no ultimate detrimental inliuence
would follow. It was not necessary to use atropia where
there was reason to believe that serious brain trouble
existed, but where the nervous manifestations were sub-
jective in character, such as headache, nausea, inability
to fix the eyes upon any object, and no well-defined
evidence of brain trouble, atropia might not only clear
up the diagnosis, but might relieve the symptoms. It
frequently removed headache, although temporarily,
])ermanent relief coming from wearing glasses. The
difticuft refractive cases were those in which there was
also astigmatism.
January 2;, 1SS3.J
THE MEDICAL RECORD.
107
The severity of the symptoms in these cases depended
very much upon the temperament of the patient ; some
suffering severely, others only slightly, from the same
condition of the eyes. Those who suffered from uterine
troubles were especially liable to suffer from various
reflex irritations, and disturbances of the eyes were not
exceptional.
P'or muscular errors the trfa/iuenl consists in rest, the
use of suitable prismatic glasses, sometimes tenotomy,
and proper attention to all general causes and remote
lesions which might have an influence in producing such
disorders. Muscular and refractive errors were some-
times combined, and sometimes so combined as to make
the prescribing for glasses exceedingly complicated.
Dr. Webster thought that Dr. Noyes had not made
a single statement to which any member of the New
York Ophthalmological Society would take any particu-
lar exception, thus presenting a striking contrast with
the neurologists.
Dr. Putnam-Jacobi referred to certain anatomical
considerations which might aid in explaining functional
disturbances of the eye from ]5reri|)heral irritations ; and
also to the influence in producing muscular troubles ex-
erted by the lack of stability, uncertainty, and impaired
equilibrium both on the part of the patients and of any-
thing by which they are surrounded.
Dr. Beard asked Dr. Noyes, first, if he had watched
the cases described sufficiently long to enable him to de-
termine whether or not permanent relief had been af-
forded by the means mentioned, not only for the ocidar
trouble, but for the general nervous system ; and, second,
how he could tell whether these conditions of the eye
were mainly the result or the cause of the disease.
These were suggestions which he had been trying to
answer for several years, but had found it impossible to
answer them completely in any case. He believed that
the subject was a general one ; that the whole body was
a bundle of reflexes ; that the same principles api>lied
just as well to the stomach, the uterus, the (n'ostatic ure-
thra, etc., as to the eyes, and the same problems came up
in each instance.
In some cases disease of the womb, the itrostatic ure-
thra, the stomach, or of the eye was the very exciting
cause of the disturbances of the nervous system, but so
far as he had observed the number of cases was very
limited. However, if one out of a thousand could be
cured by proper attention to the eyes it was a fact of
importance, and was sufficient to make us study all our
cases in this special direction.
He had not seen cases of nervous disease, functional
or organic, where important and permanent results had
been obtained by circumcision or operations for stric-
ture. Yet he believed upon authority that such cases
existed.
His conclusions were that it was well, in all cases, to
find out all we can about the eyes, even if they have al-
ready been studied by oculists, perhaps carefully ; that
the condition of the eyes was simply a help, an occasion
in treatment and not the main thing ; that, upon author-
ity purely, he believed there are cases where all that is
necessary is to treat the eyes, but he had not seen them ;
that the condition of the eyes was an important one, and
he had been interested in determining which was result
and which was cause.
There was one important point brought out by Dr.
Noyes, and it was that there is a great difterence in the
capacity of dift'erent jiersons with reference to tolerating
hyperajmias and irritations.
Dr. Leale referred to a case in which the patient,
fourteen years ago, suffered from nearly all the sym[)toms
mentioned by Dr. Noyes. They were believed to be
produced by the condition of the eyes, and glasses eighteen
and fourteen were prescribed. Since that time the patient
had not suffered from any cerebral disturbances.
Dr. Putzel thought that, in these cases of muscular
troubles referred to, there was a continuous outflow of
nerve-force which must act as a constant strain upon
the nervous system, and finally resolve the difficulty into
neurasthenia.
Dr. Birdsali. referred to a case in which there was
intense headache shortly after reading, and finally ma-
niacal attacks developed. A hypermetropic condition
of the eyes was discovered, and for it glasses were worn.
The result was marked improvement for a time, but then
the headache returned and the maniacal attacks subse-
quently. The glasses were changed and with partial re-
lief, but recovery did not take place until the boy was
removed from school and put upon a farm. The error
of refraction was probably the immediate exciting cause
of the headache and mania, but it seemed to him that in
all such cases a multiplicity of influences were at work,
and that the ultimate reference must be to the nervous
system. He had seen several cases in which headache
had been relieved by correction of errors of refraction
with glasses, but believed that the headache and other
symptoms would not develop in such cases were the ner-
vous system in a normal condition.
The Chairman said that Dr. Beard had alluded to
some cases which all would recognize as those m which
probably all methods of treatment were hopeless, because
of the presence of errors of development of the nervous
system beyond the reach of medicine or other curative
means.
Dr. Putnam-Jacobi said that in addition to imper-
fect development of the nervous system we had to con-
sider that the length of time the nervous centres have
suffered from peripheral irritation has permitted consid-
erable change to take i^lace in them, and also that the
periodical pain and other disturbances is apt to remain
after the peripheral source of irritation has been re-
moved.
Dr. Webster had seen many cases of headache in
which the patients had been permanently relieved by the
use of glasses.
Dr. Noyes, in closing the discussion, said that he had
endeavored not to attach undue importance to the ocular
side of the question, and was able to state that he had
a very long list of cases in which the patients had been
permanently, positively, and absolutely cured of all their
troubles by properly treating the eyes. He could also
bring another class of cases in which only partial relief had
been obtained. Again, he had another class of cases in
which he had been unable to afford the patients any relief
whatever by such measures. That the constant pain pro-
duced nerve e.xhaustion he regarded as an important
consideration. The habit of pain, also, in some people,
seemed to be unconquerable. A good general condi-
tion acted favorably upon local conditions, but there
were local conditions from which, if not corrected, the
patient would always suften and, if corrected, the patient
would be comfortable.
The Section then adjourned.
MEDICAL SOCIETY OF THE COUNTY OP"
NEW YORK.
Stated Jifeeting, January 22, 18S3.
David Webster, M.D. , President, in the Chair.
Dr. a. D. Rockwell read a paper on
the differential indications for the use of dynamic
and FRANK.LINIC OR STATIC ELECTRICITY.
When a distinguished professor can say to a large class
of students that a simple Faradic aiiparatus will practically
answer every purpose in medical electricity, it is in order
to discuss this subject. To state that electricity has been
used conveys but little meaning unless the kind of elec-
tricity is mentioned, and, still further, the method of its
application. It is not, however, to be supposed that one
form of electricity is adapted to one line of disease, a
second to another, and a third to still another. But
io8
THE MEDICAL RECORD.
[January 27, 188^
there are certain pathological conditions which always
call for a certafn kind of electricity, and if benefit is to
follow it must be through this special form, all others
being useless, or worse than useless. For example, in
hemiplegia, where there exists, as is often the case, an
exalted electro-muscular contractility, electricity, if used
at all, should be in the form of Faradization, and with an
exceedingly mild, rapidly interrupted current. Even
when muscular contractions are somewhat less readily
called out than in the normal condition, the same current
is, as a rule, preferable. On the contrary, when there is
very great diminution of electro-muscular contractiUty,
the galvanic current is always indicated, the Faradic com-
ing into play only when the muscles give evidence of
positive reaction to its influence.
In most cases of paraplegia, complete or jiroximate
loss of F'arado-nniscular contractility exists, at least for a
short time. The galvanic current alone is ap]">licable in
these cases, and for the purpose of restoring nerve-exci-
tability. The Faradic current may be useful in attempt-
ing to improve the impaired nutrition of the paralyzed
members. When we wish to directly affect the central
nervous system, the constant current alone is applicable.
In the majority of diseases where electricity is indicated,
each one of its forms, Galvanism, Faradism, or Franklin-
ism, may at one time or another possess a positive value
over the others. Tills is illustrated in the treatment of
neuralgia. The well-known power of the galvanic cur-
rent to relieve many forms of pain has been repeatedly
emphasized, and the inference has been that F^aradism is
of but little value for this purpose. The truth is that
F'aradism is not only invaluable in many forms of pains,
but in certain conditions relieves, where Galvanism is
not only useless, but may even aggravate the symptoms.
The effects of pressure in the various forms of neuralgia,
are exceedingly useful, as giving symptoms indicating
the proper current. In the great majority of cases of
neuralgia, where firm pressure over the affected nerves
aggravates the pain, the galvanic current is indicated,
whereas, where pressure does not cause an increase of
pain, the F'aradic current has the greater power of re-
lieving pain. For hysterical hyperresthesia, the Faradic
current is infinitely superior to the Galvanic. Special
characteristics of the cases regulate the measure of benefit
to be derived from one form or another of electricity, and
yet it is impossible to point to many diseases where one
current is to be used to the absolute exclusion of the
other ; but it is possible to name a variety of conilitions
where, as a rule, one method of treatment and one form
of current is superior to another. In the class of cases
commonly spoken of as general debility the Faradic cur-
rent is indicated. It is selected for its tonic effects.
Very much, however, depends upon the method of its
use. General Faradization is of the first importance.
With regard to individual conditions that seem to demand
the F'aradic current alone there is not much to be said.
There are but few distinct organic or functional dis-
eases that in every phase of their manifestation demand
alone and always a special form of electricity. Asthe-
nopia, accompanied by Iniierssthesia of the retina and
ciliary nerves, is one of the few distinct conditions which
seems to demand the F'aradic current alone. Accordiiio-
to his experience. Galvanism is practically excluded in
these cases. The paralysis following diphtheria is an-
other condition for which Galvanism is of but little service.
The author then related the history of several cases.
For special irritation or special neuralgia so-called, Gal-
vanism is almost exclusively indicated. Galvanism is
specially serviceable in certain sequeke of cerebro-spinal
meningitis, sucli as severe pain, sometimes beginning in
the eyes and extending over the head to the neck and
lower cervical vertebraj, associated with a stiftness of the
muscles of the neck, etc. Exophthalmic goitre requires
(ialvanism. For the restoration of the senses of taste and
smell. Galvanism succeeds where Faradism fails, (lalvan-
ism is superior to F'aradism in the treatment of skin affec-
tions. F"or the relief of the pain of herpes zoster Galvan-
ism is eminently efficacious. Galvanism, according to
his experience, was preferable in the treatment of extra-
uterine pregnancy. F"or chorea, if the appetite is good
and nutrition unimpaired, and the strength vigorous,
central Galvanism was almost invariably indicated ; on
the contrary, if the patient is weak, anremic, and nutri-
tion impaired, general Faradization is indicated.
In amenorrhcea the same principle holds good. In
dysmenorrhoea both currents, either alone or in alterna-
tion, have proven efficacious, although the Galvanic is
most frequently indicated. With regard to Franklinic
electricity, he should say that while its constitutional
tonic ett'ects are unequal to those which follow general
Faradization, where this method is carried out properly
and with due attention to details, yet as an adjuvant or
supplement it was invaluable. Occasional cases of nerv-
ous exhaustion, as well as other forms of disease, after
improving to a certain point under the influence of Gal-
vanism or F'aradism, cease to im|)rov'e, but a new start
can frequently be given by then resorting to F'ranklinism.
Pain is sometimes relieved by Franklinism after both
Galvanism and F'aradism have failed, but it is not the rule.
The pain of muscular rheumatism, however, is relieved
by this method sooner and more effectually than by the
others. For this purpose the treatment by the roller is
sujierior to treatment by sparks. In the various forms
of true neuralgia Franklinism is not comparable in power
to Galvanism. The pain so siTccessively relieved by Gal-
vanism is generally of a chronic character confined to no
special nerve-trunks, dull aching, and with no tenderness
on pressure. In these instances Faradism is superior to
galvanism, and recent experience had convinced him
that F'ranklinism was superior to either. In the enlarged
joints of sub-acute and chronic rheumatism, and to facili-
tate absorption in chronic synovitis, Franklinism (sparks)
is frequently more efficacious than either F'aradism or
Galvanism. In old contractures and in cutaneous anes-
thesia Franklinism is frequently superior to either of the
other forms of electricity. In electro-diagnosis, Frank-
linism is of but limited value.
\'aluable as is F'ranklinic electricity it has a more
limited range of usefulness than dynamic, and the more
strongly this fact is impressed on the professional mind
the better. He who begins with Franklinism to study
and practise medical electricity begins at the wrong end.
The paper being before the Society, Dr. J^cobi was in-
vited to open the discussion, and he remarked that he
could add little or nothing to Dr. Rockwell's concise
paper, but he would mention one class of cases which
would terminate fatally unless the patients were treated
energetically and promptly — namely, that in which the
patients suffered from paralysis of the respirating mus-
cles in diphtheria. Sometimes this occurs in the course
of other paralyses. But unless it was treated success-
fully the patients died of apncea, and a strong F'aradic
current should be applied and frequently repeated.
Electricity used in the usual manner in such cases was
of no avail.
Dr. L. a. S.-\vre said that his daily experience corro-
borated all that Dr. Rockwell had said.
Dr. J. P. Garrish thought that electricity should not
be used in the acute stage of any disease.
Dr. Rockw'ell remarked that it should not be used
in the acute diseases as a rule.
Dr. Jacobi made the broad statement that Galvanism
mainly, perhaps exclusively, is used in all aftections of the
vaso-motor and trophic nerves, and asked Dr. Rockwell
if such statement was in accord with his views.
Dr. Rockwell replied that as a general law it was
true, but he doubted the propriety of making it absolute.
F'or instance, facial paralysis due to cold, rheumatismal
in character, could hardly be called an aft'ection of the
vaso-motor nerves, and yet the Galvanic current was the
one best atlapted to its treatment. He thought, how-
ever, that the law was almost complete.
January 27, 1883.]
THE MEDICAL RECORD.
109
Dr. Jacoei thought that perhaps the exception made
by Dr. Rockwell might come under the general law, in-
asmuch as the rheumatismal character, so-called, of the
paralysis might also be the result of disturbances of the
circulation.
Dr. Rockwell thought that to some extent, probably,
the paralysis was due to disorder of the circulation ; yet
his view was that in these cases of facial ]iaralysis the
inter-muscular nerves are afTected. The (lalvanic cur-
rent acts upon the inter-muscular fibres altogether. The
Faradic current produces contractions through these
nerves, and these being affected by the rheumatic poison
it has no further effect.
Dr. Jacoki remarked that these are mild cases ; that
is, get well speedily, and that that could not be the fact
if the nerve substance itself was affected, but it was con-
sistent with the existence of disorder of the circulation.
Dr. Lewis had never seen electricity applied during the
acute stage of diphtheria, and thought that mart specific
directions concerning its application would be bene-
ficial.
Dr. Mittendorf remarked that, according to his ex-
perience, paralysis of accommodation following diphthe-
ria had been benefited much more by the use of the
Faradic current than by the Galvanic. He had also ob-
served that the pain so frequently suffered from with
weak internal recti muscles had been greatly relieved by
the use of the Faradic current. He had found, on the
other hand, that for amblyopia, due to tobacco or loss of
blood, most benefit had been derived from the use of the
Clalvanic current, probably from the beneficial effect pro-
duced upon the blood-vessels, and consequently upon
nutrition.
The President had nothing very favorable to report
concerning the use of electricity in ophthalmic practice.
Dr. VV. INl. Chamberlain had used Faradism in the
treatment of facial paralysis with the idea that it was a
paralysis which was due to peripheral causes, and that a
corresponding action was a legitimate method of retrac-
ing the line of causation.
Dr. G. W. Jacoby had been governed by the state of
nerve degeneration in the use of Galvanism and Fara-
dism. If there was nerve degeneration, according to
Erb's rules he used (lalvanism ; if none, he employed
Faradism.
The Society then adjourned.
Dr. Tanner's Vagaries. — Dr. Tanner, who has
been several times reported dead or missing, now turns
up again, this time as a victim of connubial revolt. Dr.
Tanner has always been addicted to peculiar fancies.
Some time since, says the British Medical Journal, he
thought that he had found out that the human character
becomes modified according to the food taken by the in-
dividual, and especially in relation to the vegetables con-
sumed. Carrots, he avers, make people fidgety and sly ;
turnips produce extreme amiability, while a prolonged
diet of French beans induces great irritability of temper.
The carrying out of this theory has brought great trouble
into Dr. Tanner's home. He made a heavy wager on
the question with some friends, and experimented on
Mrs. Tanner with French beans, giving her to eat about
three jiounds of this vegetable daily. It is not altogether
to be wondered at if, alter such a regimen, Mrs. Tanner
became rather more irritable than was perhaps contem-
plated, and threw a jug at Dr. Tanner's head. The doc-
tor, however, gained his bet ; and, more thoroughly con-
vinced than ever of the truth of his theory, put his wife
on the turnip diet, so as to make her as amiable as she was
before the French bean regimen. This time, however,
the result was not so strictly in accordance with the the-
ory. Mrs. Tanner objected to be any longer a subject
for these vegetarian experiments ; sued for a divorce and,
what is more singular, obtained it.
©orrcspcrncTcwce.
OUR PARIS LF.TTER.
(From our Special Correspondent.)
FACTS CONCERNING THE LAST ILLNESS OF GAMBETTA —
THE NATURE OF THE INJURY TO THE HAND PERI-
TYPHLITIS WITH DEEP SUPPURATION EVENTUATING IN
SEPTICEMIA — AN ACCOUNT OF THE AUTOPSY.
Paris, Januar>' 5, 1883.
M. Gambetta, the news of whose premature death has
already spread far and wide, was, about six weeks ago,
at his country house, a little out of Paris, wounded in
the right hand by a pistol shot, whether accidentally or
not, does not concern us as medical men. The bullet
entered the palm of the hand, passed along under the
skin, and made its exit above the middle of the forearm.
There was scarcely any hemorrhage, and the patient did
not complain much of pain in the wounded limb. Dr.
Lannelongue, as surgeon, and Dr. Siredey, as physician,
who were personal friends of the deceased statesman,
were summoned from Paris, and were in immediate at-
tendance. The wounds in the limb healed kindly, and
no untoward symptom manifested itself until about a
fortnight later, when the illustrious patient was seized
with intestinal pains, which did not seem to cause much
anxiety in the minds of his medical attendants, as it was
considered merely a passing or accidental indisposition
The pains, however, which were at first more general,
became concentrated ami limited to the right iliac region,
and there were other evident symptoms of the com-
mencement of perityphlitis, whereupon Drs. Lannelongue
and Siredey desired a consultation, and Drs. Verneuil
and Trelat (surgeons), and Drs. Charcot and Fienzal
(physicians), were called to give their opinion on the
case. These gentlemen confirmed the diagnosis of the
medical attendants, but no active measures seem to have
been taken to subdue the progress of the disease. Symp-
toms of suppuration soon set in, and then it became a
question whether an opening should be made to give
vent to the matter ; but, for some reason or other, op-
erative measures were considered inexpedient, and even
dangerous, owing to the obese, and otherwise unhealthy,
condition of the patient, who had been for some time
suffering from diabetes. The patient gradually grew
worse ; but whether the medical attendants formed a
correct prognosis or not, the bulletins issued were thor-
oughly misleading ; for, within only a few hours of the
fatal termination, the public were led to infer that hopes
were entertained of his recovery.
The illustrious patient himself was fed with hopes that
he would soon recover. Symptoms, however, of a grave
nature having set in, he began to feel alarmed, and find-
ing indecision and hesitation written on the faces of his
medical attendants, courageously suggested that if an
operation were considered advisable, he was ready to
submit to it, or to anything that may be necessary for his
recovery. This conversation took place on Sunday
morning (the day of his death). He was seen again in
the atternoon, when his medical attendants still seemed
to be Ignorant of his real condition. At ten o'clock,
however, of the same night, symptoms of the approach
of the fatal end became evident, and he expired within
five minutes of midnight, from, as was afterward stated,
purulent infection.
In this, as in similar cases, the public must conclude,
either that the medical men were mistaken or were igno-
rant of the prognosis, or that they were guilty of wilful
deceit. Such a proceeding is inexplicable, and should
be altogether condemned. The announcement of M.
Gambetta's death, which took place on the night of New
Year's eve, was as unexpected as it was appalling, and
there was but one sentiment felt, that of universal grief —
a sentiment expressed even by his greatest political ene-
mies.
no
THE MEDICAL RECORD.
[January 27, 1883.
Owing to the unsatisfactory demeanor of the medical
attendants in this melancholy affair, and owing also to
the sinister reports that were in circulation as to the real
cause of death of this eminent statesman, the public de-
manded that an autopsy should be made and published
officially. Accordingly, under the orders of the judicial
authorities, the following gentlemen proceeded to the
country residence of M. Gambetta : Drs. Charcot, Lanne-
longue, Cornil, Fienzal, Siredey, Trelat, Brouardel, and
Mathias Duval. The necropsy was undertaken by Pro-
fessor Brouardel, medical legist, who was assisted by
Professor Cornil, and Dr. Lannelongue drew up the re-
port according as it was dictated by Professor Brouar-
del, and in presence of the medical men named, and
other political and personal friends of the deceased.
The following is an extract copy of the report :
" ViLLE d'Avray, January 2, 1883. (11 a.m.)
" I. Traces of old intlammation, causing stricture of
the junction of the small intestines and the ileo-c^ecal
valve.
" 2. Extensive and deep extravasation of pus behind
the colon and in the abdoiuinal parietes.
" 3. A slight degree of peritonitis generalized, which
was produced only a very short time before death. The
other organs presented no lesion whatever. The wound
in the hand was completely healed.''
The report concludes with the assertion that death
was caused by perityphHtis and suppurative pericolitis,
and that surgical interference was not only unadvisable
but dangerous. The latter could have had no other re-
sult than shorten the life of the patient. This report
was signed by Professors Paul Bert, Brouardel, Charcot,
Cornil, Trelat, Verneuil. Drs. Lannelongue, Siredey,
Fienzal, Liouville, Mathias Duval, Laborde, Guenlat,
Gille, and M. Paul Gibier, Interne in attendance. It
should be mentioned that to Professor Mathias Duval,
so well known for his researches on the anatomy of the
brain, was confided the examination of that important
organ. The brain in this case weighed 1,100 grammes.'
Nothing else was particularly noticed in that organ. In
fact, a more detailed report will be ultimately published.
The next day the body of the illustrious defunct states-
man \Vas removed to the Bourbon Palace in Paris (the
official residence of the Minister of Foreign Affairs),
where it now lies in state until to-morrow, when the fu-
neral will take place, with all the honors paid to the
Chief of the State, which, had his life been spared, lie
would sooner or later have become.
COURTESY IN MEDICAL DISCUSSIONS.
To THE Editor of The Medical Rf-Cord.
Sir: The object of this letter is peace. The results of
partisanship in this country are sometimes of a character
not to be desired. This we all know. The medical
profession in the State of New York at the present time
cannot be regarded as " a house divided against itself."
We are only sharply at variance on one minor and al-
most incidental point. In everything that appertains
to the main work — the grand aim of the profession — we
are united by bonds that cannot be Ijroken.
But this minor question is bringing us into a disturbed
and unpleasant condition, and, without a change in tac-
tics, it is difficult to see an innnediate good result in the
near future. I do not propose in this paper to go over
the whole ground of our ethical differences, but only to
touch upon a inv! salient points.
The Medical Record, in its editorial for December
9, 1882, seems to imply that the medical profession in
the County of Kings has lately been engaged in un-
worthy methods, and that a prominent and honored e.x-
president of the Medical Society of the State of New
York has, in some way, transcended his proper sphere
* This report, it is to be hoped, will put an end to the idle reports in circulation.
or influence. Still, these facts seem to remain. .A ma-
jority of the members in attendance at the said meeting
of the Kings County Medical Society, with deliberation,
expressed themselves against the new Code, and the
man alluded to is the one wiio, heretofore, has done
more, and is now doing more, than any fellow-worker in
the LTnited States, to maintain a distinct line between
those medicines which have good and genuine merits,
and those which are spurious and unreliable. These
facts are significant, and they must have weight with all
thinking and upright medical inen.
The question of instructions to delegates comes con-
spicuously to the surface. Does a delegate, indeed, lose
his maniiood if he, in a measure, forgets his own opin-
ions in honoring the opinions of those who send him as
their representative ? I think not.
It has been said, and, in substance, repeated, in The
Medical Record during the past year, that the oppo-
nents of tiie new Code have not offered a single sensible
argument against it. This may be, in part, true, for it
must be confessed that irony and sarcasm, instead of
argument, on both sides, have been the main weapons in
this warfare. But, if The Record will allow, I will now
undertake to offer what appears to me to be a sensible
argument, and it is to place the two codes side by side,
in their prominent features, believing that the contrast
will be in favor of the old rule.
A.MERic.\N Code. '
1. Medical education essential in
a physician.
2. Moral character essential.
3. Irregulars not to be received
in consultation.
4. Consultant not to impair con-
fidence in attending physi-
cian.
5. Should guai'd against all fu-
ture unsolicited attendance.
6. Where two disagree, an um-
pire to be called.
Code of 1SS2.
Silence.
Silence.
Legally qualified the only re-
quirement.
Silence.
Should continue his visits as
long as he deems necessary.
Where two disagree, the case
to be argued before the pa-
tient or family.
Silence.
7. Should not .take charge of I 7,
another physician's patient.
8. The relations of physician to S. Silence.
patient confidential.
A word of comment on each of these points. The
whole medical profession believes in medical education,
the more extensive the better. Our Code, which is our
platform, ought to express this fact. The same may be
said of all those traits which, combined, constitute moral
character. Practitioners without these two qualifica-
tions ought to be classed as irregulars and unfit per-
sons to be taken into partnership in assuming the
weighty responsibility of treating human sickness. The
.\merican Code so expresses it. The new Code does
not. Legal qualifications are only an outward badge.
They may or they may not be genuine. Taken alone
they are not a sufficient test. The experience of the
medical profession, under the American Code, tends to
confirm our belief that an observance of the injunction
specified in my fourth point leads to the best interests
of the sick, and also of the profession. As to the fifth
point, there may be some good arguments on both
sides. I think the position of the American Code the
safer. I have no doubt of the superior wisdom of the
American Code in respect to the sixth and tlie seventh
points. If there are any diflerences of opinion in re-
spect to the doctrine expressed in the eighth and last
point, they must be very few and unimportant. Inci-
dentally, in the discussions u|ion this subject, consider-
able has been said about " the leaders," the "legitimate
leaders," " the would-be leaders " in the profession. It
seems to me we ought to keep silent in this respect.
Every man in the medical profession is expected to be
governed by his own opinions on these questions, and
every man has a right to make his opinions known,
and to comment upon the opinions of his neighbor.
January 27, 1883.]
THE MEDICAL RECORD.
Ill
always, of course, in accordance with the dictates of
courtesy and the rules of debate.
Having now reviewed the matter as it appears from
my standpoint, I will express my thanks to you for your
kinilness in giving me this audience, and will refrain from
taking any more of tiie space of your valuable journal.
T. H. Squire.
Elmira, N. v.
[We take great pleasure in giving place to the forego-
ing, inasmuch as it is a well-written and courteous ex-
position of one side of the controversy, which is inter-
esting to many in this and other States, and we avail our-
selves of the opportunity to more fully explain some of
the points at issue. As regards the course of the "jiromi-
nent and honored ex-president" referred to, we unhesi-
tatingly believe that he " transcended his proper sphere"
when he undertook to dictate to practising physicians the
manner in which they should conduct their own affairs.
As regards the general question as to the propriety
and desirability of instructing delegates, we have already
given a de'cided opinion. It places the delegate himself
in the possible position of committing an act which
neither his judgment nor conscience approves. The safer
and better plan is for societies to elect as delegates
men whose sentiments are known to be in harmony with
the prevalent opinion of their section, and then trust to
their honesty and judgment to vote or act for the best.
If they have delegates whose honesty and judgment
they cannot trust, they have no one to blame but them-
selves.
In reference to Dr. Squire's interesting comparison of
some of the points in the old and new Codes, we can
make the general statement that we believe it was the
intention of the framers of the new Code to omit matters
that were already provided for by the laws of the land
and by the general moral laws that all persons are sup-
posed to be amenable to. The points nunrbered by Dr.
Squire are all of minor importance except the one refer-
ring to the non-restrictive clause in the new Code. This
clause confers upon every medical man the right to think
for himself and to govern his actions strictly in accord-
ance with the dictates of his own conscience. It is this
feature alone of the new Code which is the main issue,
and which we have tried to defend. Regarding all the
other points, we believe that concessions can easily be
obtained.— Ed.]
THE NEW YORK CODE OF MEDICAL ETHICS
AND FREEDOM IN CONSULTATION.
A Presentment of the Case for the Non-restrict-
ive Clause in the New Code, by One of Its
Advocates.
rules governing consultations.
" Members of the Medical Society of the State of New
York, and of the medical societies in atliliation there-
with, may meet in consultation legally qualified practi-
tioners of medicine. Emergencies may occur in which
all restrictions should, in the judgment of the practi-
tioner, yield to the demands of humanity " (Code of
Ethics of New York State Medical Society).
The section in question simply permits consultation
with legally qualified practitioners, whatever their thera-
peutic methods.
" But no one can be considered as a regular practi-
tioner or a fit associate in consultation whose practice is
based on an exclusive dogma, to the rejection of the
accumulated experience of the profession and of the aids
actually furnished by physiology, pathology, and organic
chemistry" (Code of Ethics of American Association).
The restrictive Section in the old Code forbade con-
sultation with any but regular physicians, defining " regu-
lar " as above.
The question at issue is not primarily the utilit)-, or
otherwise, of consulting with any but those who call
themselves "regular," but concerning the advisability
and justice of the individual being allowed to do so if
the welfare of the patient or of the community seems to
demand it ; but concerning the advisability and justice
of allowing every physician to decide for himself whether
he will or will not do so.
REASONS FOR THE CHANGE OBJECTIONS TO THE OLD
RESTRICTION.
1. It was i}wperative. For many years the number
of cases of discipline for violation of this restriction has
been extremely few. Although we have positive knowl-
edge that consultations with so-called '' irregular practi-
tioners" quite often occur, we have been able to find no
instance, occurring within recent years, when such cases
have been subjected in New York State to investigation
and discipline.
2. It failed to lessen quackery. We can find no evi-
dence that the old restriction, while placing a formal bar-
rier about regular medicine, has lessened the number of
quacks, or injured their prosperity.
3. It was opposed to the general jndgmefit of the pub-
lic, who never have understood, and never can be made
to understand, the technicality on which the old restric-
tion was based. It therefore injured the standing of
the profession before the world.
The people and lay press throughout the country
unanimously approve the action of the State Society in
removing the restriction. Such a complete unanimity of
opinion among all classes upon a question of morals
should not be disregarded.
4. It affronted and made enemies of all medical men
declared to be irregular. It was a form of persecution
which was just weak enough to act as a stimulus and
help to the persecuted.
5. It infringed oti individual rights. Our chartered
medical societies have a right to say what shall be the
moral qualifications of their members, judging them by
the ordinary moral standards ; but they have no right
(morally) to impose a sjjecial line of conduct upon indi-
viduals and say arbitrarily that such rule of action alone
is right. This establishes a technical morality which is
not only unjust, but is unphilosophical and at variance
with the principles of modern ethics. Good and bad are
only relative terms. A certain line of conduct pursued
by a hundred persons may be good in ninety cases, bad
in ten. The motive is the main issue. A consultation
with a " regular " physician may be dishonest and mer-
cenary. Medical societies and codes may urge hon-
esty of action and right conduct generally, but to pre-
scribe specific things and say that they alone are always
right is unwise and unjust.
6. The definition of an irregular physician given
by the old Code does not describe all in tlais State who
are classed as irregular. If literally interpreted it would
really permit consultation with many of this class.
Whatever may have been the condition of medical edu-
cation and morals at the time when the " American
Code" was adopted, the number of those styled "regu-
lar " does not now embrace all who are educated, hon-
est, and trustworthy practitioners. This is demonstrable
in the experience of nearly every physician who has
been for even a few years in practice in this State. The
attitude of the defendants of the old Code is therefore
inconsistent.
7. A legal wrong 7C'as done by the old Code, in the
opinion of eminent lawyers. The State Medical Society
is a chartered institution with certain powers by which
it profits. Yet it used these powers to exclude from
professional recognition and to injure persons whose
legal status was exactly like that of its own members.
8. // was a hindrance to securing medical legisla-
tion for the general elevation of the profession. This
has been illustrated in Massachusetts and other States,
as well as in New York.
I 12
THE MEDICAL RECORD.
[January 27, 1883.
ADVAN'T.AGES CF THE NEW SECTION.
Its advantages are summed up in this : that it does
away with the objections, just enumerated, to the old,
restrictive Code.
It is in harmon}' with general ethical principles which
urge the discharge of our duty toward ourselves and our
brother rather than the assumption of a special attitude
toward a class prejudged and condenmed.
It places the profession beside that of France and Ger-
many, where the ])olicy of ignoring rather than of actively
opposing homceopathy and other dogmas is successfully
pursued.
It gives opportunities for showing that the surest way
to vindicate the superiority of scientific medicine is to
let it come in contact and comparison with charlatanry.
SPECIAL CHARGES AND OBJECTIONS MADE TO THE NEW
SECTION.
1. That it was the work of specialists who wished to
increase their consultation practice. — This charge has
been laboriously, persistently, and insultingly made.
While it has nothing to do with the absolute merits of the
(luestion, it is, we believe, entirely false.
The Code was drawn up by a committee of five, three
of whom were general practitioners ; and three, also, were
e.\-presidents of the Society, widely known and entirely
trusted.
2. That the Code was rushed through the Society
hastily, by a small vote. — The new Code was fully dis-
cussed, at great length, in two meetings, and was adopted
by a vote of fifty-two to eighteen. Some who voted
against it voted for the Roosa resolution, so that the ma-
jority for a merely non-restrictive clause would really
have been larger. The meeting itself was one of the
largest that the Society ever held.
3. That the neiv section is an entire surrender to dog-
matic medicine, i.e., an acknowledgment of the truth of
homoeopathy, Thonisonianism, etc., and that it implies the
confession of having previously held a false position. —
The new clause simply means that we believe it unwise
and unjust to forbid consultations with legally qualified
practitioners. It advises nothing and admits nothing be-
yond the principle that there may be occasions when the
rights of humanity should be considered paramount to
the demands of trade-unionism.
The questions of "surrendering" or "admitting,"
however, we repeat, have no bearing upon the absolute
right or wrong of the thing done. If the previous posi-
tion was really wrong, it should be only fair to admit it.
It should be remembered, moreover, that society pro-
gresses and requires new adjustments.
4. That the lioimvopathist or other medical dogmatist can
have nothing in common until the scientific practitioner,
and that consultation between the two must, a priori, be
absurd, futile, orez'eji injurious. — The Code admits, does
not advise, such consultations. It urges honesty, and if
a doctor be honest and believe the above, he need not
consult with dogmatic or dishonest phj'sicians. But even
admitting the above proposition so far as relates to
therapeutics, it does not necessarily cover matters of
diagnosis or general management. Furthermore, in this
State, many so-called irregulars are not followers of dog-
matic medicine.
5. That it 'will loiuer the tone of the profession. — ■
It is claimed that the removal of the restriction will
lower the tone of the profession and lead to moral de-
cline and decay.
It is impossible to prove such a charge, and only de-
clamatory statements have so far been brought forward
in evidence. Experience so far shows that individual
morals are not appreciably affected by Society codes.
Doctors become good or bad as other persons do. The
superiority of scientific medicine nnist be proved by its
works. Societies can elevate medicine most by scientific
work and criticism — which is their legitimate function.
As regards ethics they can only urge general right con-
dtict. The present Code continues to urge and demand
this of its members ; if they obey it they cannot be made
worse by having the privilege of consulting as con-
science dictates. On the other hand, submission to a code
of ethics, which is believed to be unjust, oppressive, and
opposed to the demands of conscience and the sense of
humanity, is certainly not calculated to elevate the moral
tone or inculcate honestv of iirinciples.
^XcdicaX sterns.
Contagious Diseases — Weekly Statement. — Com-
parative statement of cases of contagious diseases re-
ported to the Sanitary Bureau, Health Department, for
the two weeks ending January 20, 18S3 :
Week Ending
• u
1 ^
tn
a
>>
V
0
>
0
c/3
Cerebro - spinal
Meningitis.
s
S
Diphtheria.
.Small-pox.
<u
January 13, 1883
January 20, 1883
5 9 75
o 10 62
64 54
55 43
o o
2 o
A Prosperous Charity. — The New York Society for
Relief of Widows and Orphans of Medical Men (organ-
ized 1842), held its annual meeting in December. Whole
number of members, 142 ; benefactors, 22. During 1882
the society has e.xtended aid to thirteen widows and four
children of deceased members. Total disbursements
1882, $4,372.68: total assets, $141,243.49. Jared
Linsly, M.D., President, 1882 ; Isaac P. Taylor, M.D.,
1883. We very much question whether any charitable
organization in this or any other country, with so com-
paratively few members, can show a better record.
A Place in Want of a Doctor. — From a tabular
list of practitioners of the different counties in Nebraska
we learn the astonishing fact that there are two entire
counties in which, notwithstanding a thorough search, not
a single medical practitioner, be he quack or regular, could
be discovered.
An .\eortio.nist's Estaklish.ment Broken Up. — A
remarkably prosperous abortionist establishment in Chi- ,
cago, to which one Dr. George Kellogg was medical ad-
viser, was recently broken up by the police. Such insti-
tutions are numerous in this city, but it is found extremely
difficult to secure evidence enough to convict in any
special cases.
Cholera .\t Panama. — For several weeks cholera has
prevailed at Salina Cruz, and Tehuantepec. Late reports
state that the deaths at the latter place number twenty-
five daily. The railway laborers have deserted and the
work is at a standstill. A cordon has been established
between the two towns and Oa.vaca. The disease has
been caused probably by the scarcity and impurity of the
water.
Propag.mion of Small-pox by the Sparrow. — Dr.
Hewson, of London, says that the sparrow may have
small-pox and propagate the disease.
A Prolific P.vrext. — A well-to-do farmer, of seventy
years of age, in Delaware, who has just married his third
wife, has twenty-eight children, si.\ by tlie first wife, and
twenty-two by the second. For economical reasons he
establislied a school for his children and his new bride is
the teacher. Further improvements upon his scheme are
possible.
A New Hospital is to be erected in Liverpool in
place of the Royal Infirmary. It is to cost $500,000.
The Medical Record
A Weekly yoiLrnal of Medicine and Sitrgei^y
Vol. 23, No. 5
New York, February 3, 1883
Whole No. 639
®tu0iual %xXxt\ts.
BISMUTH AS A SPECIFIC FOR CANCRUM
ORIS.'
By CONSTANTINE J. MACGUIRE, M.D., L.K. C.S.I. ,
NEW YORK.
The medical profession, very wisely and wiUi good judg-
Jiient, receives with caution claims to the discover)' of
new drugs possessing marvellous properties ; and the
l)rofession is very slow to accept the statements of suc-
cessful results in the treatment of diseases hitherto un-
controllable.
This IS well, and as it should be. Within the memory
of the present medical generation a cure for diphtheria
has been found by men eminent in the profession, that
is, the eminent men reported one or two cases of malig-
nant diphtheria as recovering under their siJecial line of
treatment ; but, when the same line of treatment was
applied in two or three other cases of like malignancy,
the same happy results were not obtained. Naturally
the body of sceptics in anything new or true in medi-
cine increased.
Again, men of repute came out in learned articles on
jirophylactics to scarlatina and small-pox, and, whether
they themselves believed or not, the lay public had faith
till they found the undertaker and his ice-box at the
door. Every day we either hear or read of the discovery
of a specific ; but the claims of the author are found to
be based on the cure of one, or perhaps two cases which
might have recovered without any treatment at all ; and,
when the specific is applied by other hands to other
cases, its vaunted efficacy is found wanting.
In presenting the histories of the following cases of
cancrum oris, I should have some diffidence — consider-
ing the simplicity of the treatment, and my not giving
any line of argument or reasoning in support of that
treatment — -had 1 not the good fortune to have invited a
very considerable number of my medical brethren to see
the cases during every stage of their progress.
If I be allowed to make an " Irish bull," curing a dis-
ease that does not exist, is not a matter of nnich diffi-
culty ; thus, the cure of a common tonsillitis or a])h-
thous ulceration is often, through a mistake of diagnosis,
called a cure of diphtheria. The description and his-
tory of each of the twenty-four cases I am about to re-
late, will unmistakably stamp them as being true cases
of cancrum oris, or stomatite gangreneuse. The fatality
of the first four cases, the fetor, the destruction of
hard and soft tissues, the peculiar appearances of the
children, starved and scrofulous, and the aftection in
most part following measles, complete the picture of the
disease as described by the writers on the subject in this
and the last centuries.
The epidemic, if I may so call it, came under mj'
notice in the Institution of the Sisters of St. Dominick,
situated at Sixty-third Street and Second Avenue, and
the disease appeared first among nineteen children that
had been admitted from a kind of "Shepherd's P'old,"
which had been condemned by the city health authori-
ties. These children were represented, on admission,
as being some weeks convalescent from measles, and
when first seen by me at the institution, presented a
* Read before the Vorkville Medical Association.
most pitiable and wretched condition. They were
markedly attenuated, bloated, pale and sallow, and suf-
fering from diarrhcea and cough. The unfortunate crea-
tures, it seems, became, from the neglect and starvation
they had suffered in the " Fold," so debased and de-
"•raded that they ate their own excretions. I had them
placed in a w-ard of the institution isolated from the
other inmates, and ordered them a generous diet.
January 21, 1882. — Measles showed itself; four or five
children were affected, and at the same time the Sisters
reported that three of the most starved and debilitated,
viz., Joseph M , Mary F , and Annie S ,
had " sore mouths.'' Joseph M , the first child e.x-
amined, I found to have a grayish black ulcer, about the
size of a silver dime, on the oral mucous membrane,
three-quarters of an inch from ■ the angle of the mouth,
on the right side of the face. The upper lip was swol-
len, the teeth decayed, the gums red, spongy, and
covered at the edges, with a dirty, grayish, puUaceous
deposit. The gums in the rear of the teeth were not
then affected. Pulse, no; temperature, 101° F. ; fetor
tVom mouth very offensive ; child suffered intense thirst
and drank any fiuid w-ith avidity ; saliva flowing con-
stantly.
Treatment. — Mouth washed out every two hours with
sohition of carbolic acid, ulcerated surface touched with
nitrate of silver, four grains of chlorate of potash with
cinchona every three hours ; beef-tea, milk punch, and
milk ad libitum.
January 22d. — Passed restless night; thirst insatiable ;
the child, if left a moment alone, gets out of bed and
roams over the ward in quest of drink ; upper lip much
more swollen, and two incisor teeth loose, which were
removed. Ulceration has already eaten from anterior to
posterior aspect of gums ; and ulcer on inside of cheek
increased to the size of a twenty-five cent piece without
any defined edge, but filled up with a disintegrated,
grayish-black, broken-down tissue. Fetor very much
mcreased, in fact, so bad that, notwithstanding the use
of Condy's solution and Piatt's chlorides, the ward is in-
sufterable. Patient takes nourishment freely. Treat-
ment continued.
January 23d. — Gangrene increased ; the sore on buc-
cal surface and that on upper lip now continuous, and
presenting a most foul and loathsome appearance ; fetor
simply intolerable. Clipped off with scissors the broken-
down, pulpy mass over the sore, and cauterized with
nitric acid. Otherwise continued treatment as before.
January 24th. — Small dark spot showed itself at right
ala nasi, and half an inch directly outward on cheek
another. Fetor unbearable. Ordered a solution of per-
manganate of potash for cleaning mouth ; removed three
more teeth.
January 25th. — Gangrene increasing rapidly. Quinine
substituted for chlorate of potash.
January 26th. — Whole upper lip one dark mass of gan-
grene ; tongue black ; cheek much more swollen ; fetor,
if possible, much more abominable ; temperature, 101°
F. ; pulse, 116. Still takes nourishment with avidity.
January 27th. — Gangrenous erosion spreading; right
ala nasi and adjacent parts of cheek one black slough ;
thirst seemingly the only cause of suffering. Except in
the matter of increase in the extent of gangrenous ulcera-
tion and gradual exhaustion, there was no alteration in
patient's condition up to February ist, when he died.
Annie S ■ (aged two years and six months) on
114
THE MEDICAL RECORD.
[February 3, 1883.
January 19th had, on left side of mouth, an ulcer about
the size of a ten- cent silver piece. Flow of saliva copious ;
fetor of breath offensive, general appearance wretched ;
skin loose, flaccid, and giving one the impression of its
being the only covering of the bones. Debihty and
wasting so marked that there seemed to be a complete
absence of muscular tissue. Tongue moist ; temperature,
99° !■• ; pulse, 104. Coughs considerable ; soft bronchial
rales over chest.
Treatment. — Sedative expectorant mixture; ulcer
touched with solid stick of nitrate of silver ; lotion of
chlorate of potash [fifteen grains to ounce], to be used
as mouth-wash every three hours ; syrup, ferri iodidi,
internally ; full diet, milk punch, and milk ad libitum.
January 20th. — Sloughing very much extended ; cheek
swollen and glassy ; eye nearly closed ; bright red spot
in the centre of swollen cheek ; and, though slough on
inside of cheek would give the idea of abscess, no fluc-
tuation could be found. Mouth tlioroughly washed out
with solution of carbolic acid, and gangrenous ulcerated
surface, which now extended over half the oral surface of
cheek, well covered with iodoform. No dressing could
be well applied to the ulcerated surface, as the broken-
down, disintegrated tissue stood boldly "out.
January 21st. — Swelling of cheek much increased,
appearance glazed or oily ; lower eyelid puffed and
cedematous ; gum on upper jaw of aftected side red, soft,
and pulpy ; teeth somewhat loose ; fetor horribly offen-
sive. Removed broken-down tissue and loose teeth, and
covered ulcerated surface with iodoform. Otherwise
treatment as before.
January 22d. — Bright red spot on centre of cheek has
become darkish green and is about the size of a bean ;
gangrene occupies whole of inside of cheek ; three teeth
so loose that I removed them with my fingers ; shreds of
broken-down tissue hanging in strings from side of cheek.
Child tears and actually swallows them. Tliirst insatiable ;
raves and is very restless. Ordered a little morphia ;
treatment otherwise as before.
January 23d. — Black spot on cheek now the size of a
quarter of a dollar ; surrounding tissue from its edge to the
angle of mouth showing unmistakable signs of becoming
one gangrenous mass ; temperature, 101° F. ; pulse, 106.
Tongue dark brown, mouth constantly open ; cough not
increased, soft mucous rales over chest, no pneumonia ;
bowels tending to diarrhoea, and abdomen somewhat
tympanitic. Except in cleansing the mouth with dis-
infectants to lessen the horrible fetor, and giving stnnu-
lants, all treatment was abandoned.
January 24th. — Lower eyelid and cheek to angle of
mouth, one black, rotten, loathsome, gangrenous mass.
Child still takes drink. Pulse very feeble, 114 ; tempera-
ture, ioi-|° F. Stench in the ward, notwithstanding the use
of carbolic acid and Condy's solution, simply intolerable ;
nurse in charge of ward sick and vomiting.
January 25th. — Child died; bronchial effusion taking
place six hours before death.
February 20th. — Mary F , aged two and a half
years ; a wasted, shrivelled little child, with shrill voice
and i)recocious manner, was examined. Gum on outer
aspect of molar teeth found to be soft, pulpy and detached,
grayish in color, smelling foully, in fact gangrenous.
Touching parts with probe and making examination did
not seem to give pain. At the angle of moutli, small
grayish ulcer ; tongue on same side ulcerated ; fetor of
breath ; discharge of saliva very copious, and most of-
fensive ; ulcers at angle of mouth and side of tongue are
indurated; no perceptible swelling of clieek. Temp.,
99° F. ; pulse, 100.
Treatment. — Mouth well cleansed with carbolic acid ;
ulcers touched with nitrate of silver ; pulv. cret. c. o])ii
and bismuth subnitrate internally, arrowroot and milk-
punch.
F'ebruary 21st. — Ulcer on tongue looks better; tiiose
on gum and inside of cheek larger, ami seem to be dig-
ging into the tissues; teeth are becoming loose; diar-
rhoea checked ; pulse fuller, temperature normal. Re-
moved three diseased and loose teeth. Syrup, ferri iodidi
internally, otherwise treatment as before.
F'ebruary 22d. — Gum, whence teeth were removed, one
dark grayish mass of gangrenous tissue, which stands out
loose and free from the alveolar process ; pieces come
away easily with dressing-forceps without giving any pain ;
ulcer on side of tongue healing ; that on cheek enlarged
and extending well under upper li]). Treatment : dead
tissue cut away, parts touched with hydrochloric acid, and
application of chloride of lime made.
February 23d. — Ulcers increasing rapidly ; cheek and
upper lip on affected side much more swollen. Mouth
well cleaned out ; broken down tissue removed with scis-
sors ; child chloroformed, and nitric acid apjilied ; other-
wise treatment as before.
February 24th. — Sloughing of cheek seems checked,
though. )5arts are very much swollen ; sides and base of
ulcer have taken on a somewhat healthy look ; alveolar
process bare. Tempeiature, 100° F. ; pulse, 100. Treat-
ment continued.
February 25th. — Cheek quite hard and tense ; no new
grayish pulpy matter in sore ; but on the outside, at a
point corresponding to middle of ulcer on inside, a small
grayish black spot appeared. Eye on affected side
closed ; tongue has again become affected, and evidently
exfoliation of alveolar process is taking place. Ap-
plication of sul|)hate of copi)er with cinchona ; other-
wise treatment as before.
February 26th. — Black spot on cheek as large as a
twenty-five cent piece ; inside of mouth seems one loath-
some mass of gangrene, emitting such a foul, sickening
odor, that no disinfectant seems capable of lessening it.
From this date to February ist, when the child died,
gangrene simply ate its way, increasing steadily, till the
whole side of the face looked as though it had been cut
out and the part filled up with lamp-black.
Before proceeding to the relation of the fourth and last
fatal case, I wish to give a very short and succinct epit-
ome of the views of the authors I consulted on the dis-
ease and the treatment recommended and followed by
them. As a rule, I found that most of the writers on
diseases incidental to childhood, even those held highest
in professional esteem, either partially ignored, slurred
over, or devoted a quarter of a column to the disease, or
boldly stated that therapeutics could not control, check,
or cure it.
Dr. Elliotson, in the " London Hospital Reports for
1833-34," gives the history of a case, the exact counter-
part of those related by me, traced from day to day, re-
cording the same ruthless destruction of tissue, and the
same impotency of medicine to stay its course. Dr. El-
liotson in his lecture introduces the disease " Cancruni
Oris," or, "Stomatite Gangreneuse" to his hearers as
one fortunately seldom met with. He says : " It is a
disease, 1 am sorry to say, which I have never seen
cured, though cases are related where patients have re-
covered from it." He goes on then to relate the case of
a child seventeen months old, recovering from scarlet
fever, attacked with a small ulcer on the oral mucous
membrane, and ulceration extending along the alveolar
process of upper jaw, teeth falling out, exfoliation taking
place, gangrenous erosion extending over the whole cheek
and lower eyelid, death ensuing liiirteen days from in-
ception of disease, notwithstanding that what is desig-
nated as active and heroic treatment was promptly and
persistently brought into requisition. Elliotson refers to
Dr. Cummings, of Dublin, as being then the most cor-
rect and lucid writer on the disease. Dr. Cummings
holds that the disease is only met with in children be-
tween twenty months and seven years of age, who have
lived in an impure and ]iolhued atmosphere, and on poor
and insufficient diet, and even then it is only met with as
a sequence to measles or scarlatina. Dr. Cummings seems
to have been anticipated by Huxham, who, in a report
made in 1 745, observed : " I have more than once during
I'cbruary 3, 1883.]
THE MEDICAL RECORD.
115
this month witnessed a mortification of the mouth and
fauces, besides caries of the cheek and os vomeris, which
occasioned a very painful death, and that, too, after
measles.
Dr. \Villan, who writes about the same period, says :
" In one infant, about the eleventh month, a considera-
ble erysipelatous swelling affected the left cheek, and
within three days produced a deep gangrenous eschar
and death."
Dr. Cummings describes three varieties of the disease ;
one in which the gums are first affected 'and become
]nirplish and spongy, and, with proper treatment, a fair
percentage of such cases recover. What the proper
treatment is he does not state. The second variety cor-
res|)onds to the cases I have been describing, and the
third is where the pudendum is involved. Just here I
wish to have this last point borne in mind, because, in
one of the cases I will present, such a complication en-
■ sued. All the writers who mention the disease concur
in stating that an active local treatment has proved the
most efficacious, together with the administering of
tonics, pushing them, as EUiotson says, to their fullest
extent, and placing the patient on generous, strengthen-
ing diet — beef-tea, port wine, etc. Taupin claims
good results from a very heroic treatment of caustic ap-
plications : but Tourdes, writing after him, having met
with a great many cases, says, that notwithstanding Tau-
pin the ravages of the disease have not been one whit
less. Tourdes himself recommends simply mouth washes,
caustic applications, tonics, and strengthening diet. Nie-
meyer, West, I'anner, and Bohn, all give a similar line of
treatment. Statistics of the results obtained by some of
the best known authors I will give later on.
Dennis G , aged three, was admitted to the infir-
mary April 12th, suffering from measles. Child was tat,
stout, and in general good condition. Rubeola was
mild and ran its usual course, the child being up and
around the ward on the i8th, eating well, and, to all ap-
pearances, convalescent.
April 20th. — Refused food ; skin hot ; temperature,
10 1" F.; pulse, loS ; tongue moist ; right cheek swollen,
inflamed, and small ulcer on inside showing a grayish
white deposit. Ulcer touched with solution of nitrate of
silver (40 grs. to i oz.) ; chlorate of potash wash ; qui-
nine and iron, internally. Temperature, 100° F.; pulse,
104 ; slight diarrhcea.
April 2ist. — Ulcer on inside of cheek about the size
of a dime. Takes nourishment freely — beef-tea, wine,
etc. Gums of superior ma.xilla in region of molar teeth,
soft, pulpy, swollen, and grayish in color ; fetor most
offensive. Mouth well washed out with tepid water, and
afterward with weak solution of permanganate of potash.
April 2 2d. — Cheek not so hard ; swelling somewhat
less ; ulcer oii inside of cheek not increased ; gums soft,
free of hard parts, and bleed on pressure. Treatment as
before.
April 23d. — Condition of cheek unchanged ; gums of
superior ma.xilla gangrenous ; molar teeth loose ; loose
teeth extracted ; gangrenous tissue clipped off with scis-
sors and touched with chloride of zinc. Otherwise treat-
ment as before. ,
.■Vpril 24th. — No particular change, except that ulcer
on inside of cheek has a healthier appearance ; grayish
slough cleared away, and induration not so marked.
Sleeps better.
April 27th. — Necrosis of superior maxilla; a piece, an
inch and one-half, removed ; more dead tissue cut away ;
parts touched with nitrate of silver. Otherwise no change
in treatment.
April 29th. — Swelling and induration of cheek much
less ; ulcer on buccal surface healing ; gangrenous ul-
ceration of gums looking much better ; temperature,
99° F.; pulse, 100 ; taking food well. Treatment con-
tinued.
April 30th. — Patient doing well, and continued so to
May 7th, when he contracted a slight bronchitis.
May 8th. — Cheek again swollen and hard ; eye partly
closed ; loathsome, oftensive odor returned in greater
intensity ; on inside of cheek a grayish, black spot, size
of a twenty-five-cent piece ; gums, that before seemed
healing, rapidly taking on gangrenous look. Treatment
as in the early stage, except a solution of copper with
cinchona substituted for the nitrate of silver a|)plication.
JVfav loth. — Gangrene rapidly spreading ; child restless
and suffering from great thirst. At the suggestion of my
colleague. Dr. Ripley, put on five minims of phenic acid
every two hours. Otherwise no change in treatment.
From this date to May i6th, when the child died, the
gangrene continued to spread till the whole side of the
cheek, lower eyelid, right side of the nose, and upper
lip were one black mass. On the 15th a black spot, not
larger than a dime, appeared on the chin, and, on the
following day, when the child died, it was fully as large
as a fifty-cent piece.
During the i)rogress of the last case, I had two others
equally unpromising, whose histories from April 17th to
May loth were identical with those of Dennis G
and the other fatal cases 1 had in January. There was
the same grayish slough on the inside of the cheek, the
same gangrenous condition of the gums, the same hard
glassy swelling of the cheek, and the insatiable thirst, the
same fact of its being the sequence of measles, and the
children presenting, if possible, a more wretched, scrofu-
lous, and miserable physique. These two were Arthur
W , aged four years, and Nellie H , aged three
years and four months. They occupied beds in the same
ward with Dennis G , and were subjected to nearly
the same treatment as he was. The general treatment
of support, tonics, and stimulants was exactly the same ;
while the local applications — disinfecting washes and es-
charotics — varied somewhat, without producing any ap-
preciable difference, better or worse. Indeed, so disas-
trous had been our results in the face of our having
zealously carried out the system of treatment recom-
mended by standard authors, and of my having availed my-
self of the kind and able counsel of my medical brethren
who saw the cases that I commenced to look upon any
child attacked as an inevitable victim.
On May nth I was informed upon my entrance to the
ward that still another child was, in the words of the sis-
ter, " getting the frightful disease in the mouth." This
child, Katie H , aged seven years, I examined and
found she had a small ulcer on the inside of the left
cheek, with all the characteristics described in the early
stages of the other cases. I confess 1 was in despair.
On consideration, I came to the conclusion that follow-
ing in the old rut of treatment was almost useless, if not
quite so. By a process of reasoning, or by accident if
you will, I conceived the idea of applying locally the
subnitrate of bismuth. After thoroughly cleansing the
mouth with a disinfectant lotion, I covered the ulcerated
surface with this drug, and the next day. May 12th, the
grayish slough had partly cleared away, and the fetor,
which had been most disagreeable, was sensibly lessened.
The hardness of the cheek, if not less, had not increased,
and the child was not so thirsty. Temperature, 99° F. ;
pulse, 90. Gum on upper jaw reddish purple, soft and
tender. Mouth washed out with solution of carbolic
acid ; bismuth applied every three hours, syr. ferri iodid.,
cod-liver oil, and generous diet.
May 13th. — Fetor markedly less.
May 14th. — Much better, sleeps well, ulcerated parts
getting a healthy appearance. From this date to the ist
of June, when she was discharged, thoroughly cured, the
patient did well.
On May 12th, after witnessing the happy change
effected by the bismuth in the case of Katie H ,
I determined to try its efficacy on Arthur W and
Nellie H- , both of whose cases we looked upon as
hopeless.
On May loth I had removed some teeth together with
a large piece of the superior ma.xilla from Arthur W .
Ii6
THE MEDICAL RECORD.
[February 3, 1883.
His cheek was then swollen tense, a large black gangren-
ous ulcer was on its inside surface, and his eye was
nearly closed. The stench from him was intolerable.
Usual disinfecting and supporting treatment continued.
May nth. — No change.
May 1 2th. — Filled up cavity in cheek with bismuth,
first cleansing it out well with disinfectant wash, and re-
peated every three horns.
May 13th. — -No marked change, except odor a little
lessened.
May 14th. — No increase of gangrenous erosion ! Treat-
ment continued. .Separation of a large mass of grayish
black slough from ulcer on cheek and cavity whence ex-
foliated bone was removed. Parts looking healthier,
fetor less.
Afay i8;h. — Fetor nearly disappeared in toto ! Takes
food freely ; sleeps better ; ulcer assuming a very healthy
aijpearance ; swelhng and hardness of the tissues of the
cheek rapitlh' subsiding.
May 25th. — Ulcer on inside of cheek quite filled out
and granulating kindly. Removed small piece of dead
bone from superior maxilla. Otherwise doing well. Treat-
ment continued. ]'"rom this date to July ist, when dis-
charged cured, the patient did excellently well. Since
then he has been taking cod-liver oil, and is now in per-
fect health.
Nellie H ran the same course up to May 12th, as
the two preceding. Her condition at that time was iden-
tically the same — black gangrenous slough on buccal
mucous membrane, swelled cheek, etc. Applied treat-
ment as in the last case.
May 13th. — Clipped away with scissors a considerable
amount of disintegrated tissue, then packed parts with
bismuth. Contniued treatment to 17th, when I removed
a lai'ge piece of exfoliated bone and several teeth from
inferior maxilla. From this date to June 15th, she
slowly but steadily improved, the bismuth being regu-
larly applied, and the mouth thoroughly syringed. Iron,
cod-liver oil, and generous stimulating diet administered.
She is now one of the healthiest children in the institu-
tion, though showing the loss of hard and soft tissue, but
noi showing the horrible deformity which formerly cases
that had advanced to this stage and recovered presented.
The next case is of interest, because it goes a long
way to prove that the disease is contagious, and that it
does occur in children beyond the age of seven years.
Mamie C , aged thirteen, a strong healthy girl, who
assisted in taking charge of the children suffering from
gangrenous sore mouth, was reported sick, June 5lh. She
stated she had been feeling unwell for a few days, that
her mouth was sore and constantly running water, that
she felt constant thirst, and could not sleep. On exam-
ination found inside of cheek ulcerated ; tongue brown-
ish, ulcerated and indurated ; gums soft, swollen, and
pulpy. Fetor excessively offensive, could hardly open
mouth, cheek swollen. Temperature, 103° F. ; pulse,
120 ; slight diarrhcea. Bismuth packed into ulcerated sur-
faces, mouth washed out with solution of permanganate
of potash. Pulv. cretas aromal. cum opii, internallv.
June 6th.' — Spent very bad night, restless and raving ;
so painful to open mouth that she has to be forced to al-
low it dressed. Ulceration of tongue and cheek spread-
ing ; mouth forcibly opened and syringed out ; ulcers
dressed with bismuth.
June 7th. — Fetor less. Can open mouth with less
l)am. Still raves at night. Has an immense flow of
saliva. Cheeks and tongue on both sides indurated and
trenched by a long serpiginous ulcer. Dressing of ulcers
forcibly made every three hours.
June 8th. — Fetor in great part disappeared, general
condition much better. The tongue and cheek on right
side pretty well one mass of ulceration ; but losing the
appearance of a gangrene, and taking on a liealthy look.
Pulse weak, 120; temperature, io2''F. Takes nourish-
ment with great difficulty, sleeps without sedative. Bis-
muth continued. Bark and ammonia in efl'ervescence
every three hours. F"rom this date she slowly improved ;
the ulcers healing kindly, leaving very little trace. The
teeth remained intact, though the gums were badly af-
fected. While suffering in her worst stage, I had her
examined by several of my medical friends, who all
agreed in the diagnosis of genuine cancrum oris. She is
now in perfect health.
Josephine C , aged eleven, in June had a very
mild attack of measles, and after the usual course was
discharge<l cured to the body of the house July 3d, she
was sent to the infirmary, complaining of sore mouth.
On examination, lower lip was found indurated and
swollen, with a blackish ulcer, the size of a dime, on its
inside surface. Specks of red granulation stood up at
points, and a thin sero-sanguineous discharge flowed
down the chin. The gum, in front of the two incisor
teeth, was slightly broken down and pulpy ; teeth were
not loose. Tongue coated ; slight diarrhcea ; pulse and
temperature normal ; fetor very offensive. Mouth well
washed out with solution of permanganate of potash,
and gangrenous ulcer dressed with bismuth every three
hours. Syrup, ferri iodidi and cod-liver oil, internally.
July 4th. — E.^icept that fetor was markedly less, there
was no alteration.
July 5th.— Very feverish ; temperature, 102° F. ; pulse,
120. Tongue coated and badly ulcerated on right side ;
bases of ulcers hard ; under lip looks exactly like epi-
thelioma. In trymg to find cause for heightened pulse and
temperature, discovered that the child was concealing
a phlegmonoid inflammation of pudendum. Labia
swollen to size of an orange on either side, and the con-
tiguous surfaces covered with what looked like a diph-
theritic membrane. Parts felt elastic, but no fluctuation
could be discovered. Lint smeared with vaseline intro-
duced between labia, and hot poultices applied.
July 6th. — Condition unchanged.
July 7th. — Consultation with my colleague. Dr. Rip-
ley, as to lancing labia. Determined on expectant
treatment, continuing poultices and dusting labia with
bismuth.
July Sth. — Swelling and tenderness of labia percep-
tibly lessened, ulcer on lip unchanged.
July 1 2th. — Inflammation of vulva nearly well ; ulcer
on lower lip increased ; small sore about the middle of
buccal mucous membrane ; no fetor. Treatment con-
tinued.
July 15th. — Child allowed out with parents for twenty-
four hours.
July 1 6th — Ulcer on lower lip extended to that or»
cheek and now reaching angle of jaw ; gums on same
side a whitish-gray ulcerous mass. Parts well washed
with permanganate of potash, and then dressed with bis-
muth ; which treatment was continued up to
August 4th. — A large sore appeared on hard palate
filled with grayish pulpy disintegrated tissue. Clipped
away broken-down tissue and dressed with bismuth ;
continued application every three hours. The parts are
now healed, showing, on hard palate, a loss of soft tissue
about the size of a dmie, and, on cheek and lip, cica-
trices.' There is no deformity, the disease being abso-
lutely controlled before osseous tissues were aftected.
This is a case that. I believe, demonstrates beyond cavil,
that bismiitli is a disinfectant, a deodorizer, and, unques-
tionably, an agent that cannot only check, but abso-
lutely annihilate the progress of a rodent ulcer. The
child now shows the cicatrices on lip and cheek, and a
healed cavity on the hard palate.
That this paper may not, by repetition, be prolonged
to a tediousness beyond toleration, I am compelled now
to give simply names, ages, location of disease, and re-
sults. Most of the cases thus summarily disposed of,
have been seen by a large number of practitioners and
were under the joint care of Dr. Ripley, Dr. Gleises, and
myself
Katie L , aged seven years, was admitted to the
infirmary June 20th with the same small sore on buccal
February 3, 1883.]
THE MEDICAL RECORD.
117
surface common to the other cases ; the gums were badly
affected. Treatment : Generous diet, cod-hver oil, syrup,
ferri iodidi internally, and application of bismuth, the
mouth being washed with solution of carbolic acid. Dis-
charged July nth, cured. There was /;<) loss of hard,
and very little of soft tissue; simply the bluish cicatrix
showing along the inside of cheek. Her gums were
badly affected, yet she lost no teeth !
Mary M , aged six years, admitted June 29th.
Vicious-looking ulcer on, inside and about the centre of
cheek ; inferior maxilla in the region of the molars also
affected. All the characteristics of the disease were
present. Treatment same as above, and the patient was
discharged thoroughly cured July 7th, just eight days
from the commencement of the attack.
Afary R , aged four years, admitted June 20th.
Small sore on inside of left cheek ; gums to some extent
affected ; fetor very offensive. Treatment same as above.
On the third day the fetor was almost imperceptible ;
the parts had assumed a healthy appearance, and she
continued to improve gradually up to about July 3d,
when she was discharged cured.
Gertrude F , aged two years and six months, ad-
mitted June 29th. All symptoms of the disease present.
Gums of inferior maxilla, in the region of the incisors,
badly affected. Continued the treatment we had adopted.
Mouth well washed with solution of permanganate of
potash. Bismuth applied to ulcerated parts every three
hours. Cod-liver oil and syrup, ferri iodidi internally.
Cured in three weeks. No loss of hard or soft tissue.
Maggie W , aged about three }'ears, admitted July
2d, suffering from sore on buccal surface. Cheek swollen ;
fetor as usual. Treatment as above. Discharged cured
about July 22d.
Sarah K , Robert B , Lillie E , and Edward
D were all admitted about the same period. Ex-
aminations showed the same grayish slough on inside of
cheek, 'the gums in gangrenous condition, the patients
exhibiting all the characteristics I have before fully de-
scribed. The disease yielded promptiv to the "bismuth
treatment " and the ulcers were all thoroughly healed in
from two to four weeks. Concerning the remaining six
cases, it is only necessary to say that they all occurred
during the month of July and August, and that the bis-
muth treatment effectualy controlled the disease. In all
the foregoing, I have confined myself to bare facts, daily
notes, simple and uncolored, of successful and unsuccess-
ful cases. I do not claim to be able to submit a theory
which can scientifically account for the marvellously
fortunate results of the line of treatment I adopted ; nor
do I know to which of the component parts of the drug,
used with such happy effect, is due the credit.
My colleague. Dr. Ripley, in the experiments made
by him on different solutions containing bacteria, found
that bismuth did not exhibit the properties of a germi-
cide, but rather exercised a temporary inhibitory action.
But I do maintain that, on comparing the results ob-
tained in the large number of cases treated by me with
those recorded by the ]irincipal writers on the subject in
this and the past medical generation, a percentage of
recoveries is found hitherto not met with. The statistics
of the disease are necessarily meagre. In private prac-
tice cancrum oris is rare, and it seldom happens that
even those having large hospital experience meet with
more than two or three isolated cases in a long career.
The only authority whom I found to claim any measure
of success was Dr. Hunt, mentioned in Valleix's "Guide
du Medecin Practicien," who states that twenty to sixty
grains of chlorate of potash given in the twenty-four
hours controls the disease. In the early cases under my
care I so administered chlorate of j^otash, but the result
was fatal. West records ten cases, with eight deaths.
Squares, out of three cases lost two. Ripley reported a
successful case in The Record of 1875, p. 266. Elliot-
son unreservedly stales that he never saw a true case of
'cancrum oris cured ; but that he heard of cases being
cured. Valleix sums up the prognosis of stomatite gan-
greneuse as follows: "Un resullat numerique qui pent
donner une juste idee d'e la gravite de la maladie, est celui
qu'a obtenu M. J. Tourdes, en rassemblant des observa-
tions empruntees a un grand nombre d'auteurs. Sur 239
cas, la mort a eu lieu 176 fois, et la guerison seulement
63 fois."
I have had under my personal care twenty-four cases,
and of those lost four ; lost those four ])revious to the
bismuth treatment. How those four fatal cases were
treated I have already related fully. Of the twenty suc-
cessful cases, those showing most clearly the traces and
characteristics of true cancrum oris, are still in the insti-
tution.
The appended microscopic report of examination of
the gangrenous tissue taken from one of the fatal cases
was made by ni)- colleague, Dr. J. H. Ripley.
The specimens examined were transverse sections
from the central portion of the diseased part, and included
the entire thickness of the cheek. All the tissues were
seen to be infiltrated with bacteria, the infiltration be-
coming more dense towards the internal surface. In the
deeper tissues large colonies of these organisms were ob-
served, occupying nearly circular or irregular angular
spaces. Here, too, the tissues began to show evidences
of inflammatory and ulcerative processes ; they were
partly broken down, and filled with granular debris, in-
flammatory corpuscles, and fat globules. In the deepest
parts there was complete disintegration of the muscular
structures, large detached masses lying floating in a pul-
taceous fluid.
CONVALLARIA AfAIALIS.
The Results of Clinical Experiments at the Roose-
velt Hospital, New York..
By henry ling TAYLOR, M.D.,
LATG HOUSE PHYSICIAN, ROOS'^VEI.T HOSPITAL.
(Continued from p. 89.}
Case VHI. — Mitral regurgitation. — Sarah G , fifty
years of age ; Ireland ; widow ; laundress. Admitted Sep-
tember 29, 1882. Palpitation last five months. Expec-
toration of frothy material, oedema of feet and legs, and
diminution in amount of urine for last three months.
Shortness of breath and orthopncea for a month past.
Has also had attacks of dizziness and vomiting. Had
rheumatism thirty years ago, and many times since.
Present condition. — Orthopncea ; lower limbs very
cedematous ; i)ulse very weak and irregular, 84 to the
minute; respiration, 24 ; temperature, 97.9°, a.m. Urine,
1,010; neutral; trace of albumen. Physical examina-
tion : Heart action rapid, diffuse, very irregular. One
radial pulse-beat to two or three heart-beats. Systolic
murmur at apex. A few fine rales at bases of both
lung?.
Treatment. — Rest in bed. Convallaria, V\ xv. q. 4 h.
October 2d. — Heart much quieter and cedema less.
October 5th. — Much better ; can sleep lying down.
October 7th. — Convallaria stopped.
October nth— Patient up and about, feeling pretty
well. Pulse bad. Convallaria, TH, x. q. 4 h., ordered.
October 13th. — Patient not feeling so well; not
affected by the convallaria ; ordered it stopped for
twenty-four hours.
October 14th, p.m. — Convallaria, TTi x. q. 4 h.
October 15th. — Patient has great trouble with breath-
ing ; cannot lie down. Ordered conv.allaria, TT], xx. q. 4 h.
October 17th. — Patient in great distress ; vomits.
October i8th. — Sits up all night; sleeps only by
snatches. Feet and legs very cedematous.
October 19th. — Put on nitro-glycerine lU j- of the one
per cent, alcoholic solution (diluted with water), t.i.d.
Convallaria stopped.
October 23d. — Nitro-glycerine increased to V\]. four
times a day.
ii8
THE MEDICAL RECORD.
[February 3, 188;;
October 25th. — No effect. Nitro-glyceiine stopped.
Ordered tincture of digitalis, TTl x. t.i.d.
October 27th. — Patient lias been in a fearful condition
for the last ten days. General anasarca below waist.
Skin of legs tense and shiny from pressure. Has not
left her chair. Pulse and breathing very bad. Her
death has been expected from hour to hour. Ordered
tincture of digitalis increased to TILxx. q. 4 h.
October 28th. — Legs punctured with needle.
October 30th. — Afuch serum lias drained away. Pulse
very much better.
November 3d. — Able to lie down yesterday, and slept
last night. Feels entirely comfortable. Pulse good.
November nth. — Pulse regular and slow. No cedema
of legs.
December 4th. — Urine, 1,022 ; acid; albumen, trace.
Up and about for some time past.
December 7th. — Remains perfectly comfortable. Dis-
charged improved.
Patient passed a fair amount of urine up to October
8th ; after that seldom over twenty ounces, often less,
till November 4th ; since then forty to fifty ounces
daily. Pulse record of little interest, as the pulse was
so weak and irregular, until the patient came under the
infl lence of the digitalis, that it could not be accurately
cou ited.
This was a most extraordinary case. I have seen very
few patients so sick as this one recover. Convallaria
seemed to do good at first ; it afterwards failed in the
doses given ; while digitalis (and puncturing the legs)
succeeded brilliantly. For the converse, see Case XI.,
which was equally desperate.
Case IX. — Mitral obstruction. — James \V , aged
twenty-nine ; United States ; single ; block-cutter! Ad-
mitted October 28, 1882. Rheumatism in right ankle, last-
ing two or three days, one year ago ; since then palpita-
tion. Fair health till three weeks ago ; since then cough,
frothy expectoration, cedema of legs, nausea, etc. No
change in amount of urine noticed.
Present condition. — Face and hands dusky. Great
dysimcea. Pulse weak. CEdema of legs. Pulse, 112 ;
respiration, 30 ; temperature, 98.4°, p.m. Urine, 1,022 ;
alkaline ; albumen trace ; a few granular casts. Physical
examination : Heart enlarged and beating too rapidly.
Systolic murmur between apex and sternum (tricuspid
regurgitation). P'orce of heart-action very great com-
pared with strength of pulse. Subcrepitant rules bases
of both lungs.
Treatment. — Rest in bed. Milk diet. Convallaria,
TTlv. q. 4 h.
October 30th. — No improvement in pulse or breath-
ing. Orthopncea. Sputa bloody. Convallaria, TTl, x.
q.^4 h.
October 31st. — Convallaria, TTL xx. q. 4 h.
November ist. — Continuous cough; bloody expecto-
ration. Orthopncea. No sleep for two nights. Pulse
stronger. Dr. Delafield diagnoses nearly complete mit-
ral stenosis. Convallaria stopped ; put on iodide of
potassium, gr. v. t.i.d.
November 5 th. — Patient became more and more cedem-
atous ; dyspnoea and pulse grew worse till death, at
8 P.M.
Pulse ran from 104 to 136, respirations from 20 to 40.
Urine was to a considerable extent passed in bed ; ten
to twenty ounces daily were measured.
Aiitopsyhy Dr. Delafield. — Right ventricle dilated and
hypertrophied : tricuspid opening very large ; left ven-
tricle small. Mitral valve thickened and stenosed, nearly
closed. Double hydrothorax. Chronic congestion of
kidneys. General anasarca.
CaseX. — Aortic stenosis {?) — Prci^nancy. — .AnnaR — ,
aged forty-one, admitted October 2, 1882. Said to be
six months ])regnant. Well up to four months ago,
when she had a sharp pain in left hip, which kept her
from walking and confined her to her chair or bed. Joint
was not hot, red, or swollen. This pain left her after
two months. Three months ago patient's feet began to
swell, the left preceding the right by three weeks. Denies
dyspnoea and palpitation. Has not left her chair for
three months. For a time passed less urine than normal ;
now passes more than she did.
Present condition. — Great oedema of lower extremi-
ties. Pressure sore on left heel of nearly three months'
standing. Pulse, regular. Temperature, 99.3°, a.m.
Urine, 1,011 ; neutral ; no albumen. Physical examina-
tion : Systolic murmur at base and down left side of
sternum.
Treatment. — Rest in bed. Convallaria. TU x. q. 4 h.
October 6tli. — Convallaria stopped. Gidema very
much less.
October 15th. — CEdema almost entirely gone.
November 23d. — No cedema for over a month.
Patient entirely comfortable. Discharged cured (?).
Date.
October 2d, A. M 120
October 2d, P. M 120
October 3d, A. M too
October 3d, P.M. . 108
October 4th, A. M 108
October 4tli, r.M u6
October 5th. A.M ' 96
October 5tli, p. M 96
October 6th, a.m 92
October 6th, r.M 100
October 7th, A.M 100
October 7th, p. m 96
October 8th, a.m ico
Octolier Sth, p.M 96
October 9th, A.M loo
October 9th. P.M 96
October loth, .^. M [ 80
October loth, p.m j 96
Respi-
rations.
20
16
28
22
22
18
32
26
28
26
22
22
24
28
22
28
25
28
Urine, ?
ounces.
52'
52*
64
62
46
54
^o
Case XI. — Aortic stenosis. — John S , aged fifty-two ;
United States ; married ; watchman. Admitted September
5, 18S2. Never had rheumatism. Has had palpitation and
dyspncea off and on for many years. Feet swelled last
spring.
Present condition. — Short of breath. Radial pulse
very small and irregular. Pulse, 56 ; respiration, 28 ;
temperature, 96.9°, p.m. : Urine, 1,029 ; acid ; albumen, 8
percent. ; no casts found. Physical examination : Heart
apex in fifth sjiace five inches from median line ; heart
beats violently and irregularly. Radial pulse less fre-
quent than heart-beats. No murmurs.
Treatment. — Rest in bed. Whiskey, 3 ss. q. 2 h. and
I^ . .Morpli. sulph g'"- f
Pot. citrat ; ij.
Am. carb gr- xk
Aqua; ad 3 ij.
Sig. — I ij. t.i.d.
September lotli. — Heart very weak. Urgent dyspnoea ;
cannot lie down.
September nth.- — Infusion of digitalis, 3 ij. q. 3 h.
September 12th. — Constant hiccoughing last two
days.
September T4th. — Pulse a little better.
September 15th. — Patient has not been expected to
live more than a few hours for several days past. Ra-
dial pulse could not be counted most of the time.
Medicine, except whiskey, stopped ; i)ut on convallaria,
m, X. q. 4 h.
Se|)tember iCth. — Pidse already much better. Whis-
key, 3ss. q. 3'i-
September i8th. — Pulse very slow and regular. Con-
vallaria reduced to TTl x. t.i.d. Hiccough stopped to-
day.
September 21st. — Convallaria, TTl, x. night and morn-
ing.
September 22d. — Pulse good: patient feels ipiite
comfortable.
February 3, 1883.]
THE MEDICAL RECORD.
119
October 5th. — Patient has continued to do well.
Convallaria stopped.
October Sth. — Patient up and about ; whiskey stopped.
October i6th. — Heart again beats rapidly and irregu-
larly. Pulse much slower than heart.
October 20th. — Feels some palpitation. Feet swell
during the day. Patient put to bed.
October 22d. — Very short of breath ; pulse weak and
irregular. Ordered convallaria, TTl x. t.i.d.
October 24th. — Breathes more easily and feels a little
better to-day.
November 7th. — Convallaria, tri x. four times a day.
November Sth. — Convallaria, TT], x. q. 4 h.
November 13th. — Pulse very poor ; dyspncea. Con-
vallaria, Tt], XX. t.i.d.
November 14th. — Pulse poor ; orthopnffia. Conval-
laria, TTL X. ([. h. at 10, II and 12 p.m., then q. 2 h.
November isth. — Vomiting.
November 18th. — General condition about the same.
Convallaria, 3 j. t.i.d.
November 2 2d. — Now quite comfortable. Pulse and
breathing better.
December 12th. — Up and about; very comfortable.
Pulse slow and tolerably regular. Breathing easy. \Vants
to go home. Still gets convallaria, 3j. t.i.d.
December 14th. — Discharged improved.
The urine was measured from September 21st to Oc-
tober 13th. It was always passed in fair amount, usually
thirty to forty ounces a day.
September 5th, p. M
September 6tli, A.M
Septemlier 15th, A.M. (Convallaria, HI ,■<. q. 4 hrs.)..
September I5tli, P. M
September i6th, .\.M
September i6th, p.m
September I7tli, a.m
September 17th, p.m
September iSth, a.m. (Convallaria, Tl), x. t.i.d.). . . .
September iSth, p.m
September 19th, a.m ,
September igtli, P. m
September 20th, a.m
September 20th, p.m
September 2 1 st, A. M
September 21st, P.M ,
The pulse continued at this rate till the 27th; from
then till October gth it was 50-60 ; and froiri October
9th to 14th it was 56-68 usually. After that it was not
taken.
Case XII. — Lobar pneumonia. — Ellen O'D , aged
fifty-five; Ireland; widow; domestic. Admitted Sep-
tember 24, 1882. Exposed to wet September 23d. Had
not felt well for two davs previously. Diarrhoea and
pain in back and in right iliac region for last day or two.
Present condition. — Tongue coated and slightly dry.
Pulse cannot be counted at wrist ; weak and irregular,
'^.ppetite jioor. Pulse, — ; respiration, 32 ; temperature,
102.5°, A.M. Urine, 1,015; acid; trace of albumen.
Physical examination : Dulness, absent breathing, fric-
tion rdles below inferior angle of scapula right side ; ex-
aggerated breathing left lung. Sibillant breathing upper
part of both lungs.
Treatment. — Milk diet. Rest in bed. ^Vhiskey, 3 ss.
q. 4 hours.
September 25th. — Convallaria, lU xv. four times a day.
Bronchial breathing and voice now heard over region of
dulness.
September 26th. — Patient verj' sick ; cheeks dusky
red ; eyes bright, though sunken ; chest full of coarse
rattles ; does not raise much : sputa yellowish. Whiske)-,
I ss. q. 2 hours.
September 27th. — Pulse rapid and weak; at 4 a.m.
flickering. Sputa rusty.
September 28th. — Convallaria, V\ xv. q. 4 hours.
Pulse.
Respira-
tions.
56
68
28
26
88
18
88
18
52
48
18
18
40
28
44
4S
56
30
24
24
40
48
22
22
40
36
20
18
44
20
40
-4
September 29th. — Delirious last night, got out of bed.
September 30th. — Again delirious during the night.
Tongue pasty. Quiet this morning. Pulse a little stronger.
October ist. — Pulse slower and stronger.
October 5th. — Temperature normal since September
29th. Convallaria stopped.
September 6th. — Whiskey, 5 ss. four times a day.
September 22d.^Patient allowed to sit up. Crepitant
friction rales over right base, found by Dr. Delafield yes-
terday. Physical signs otherwise normal.
November 2d. — Discharged cured.
Urine could be only imperfectly determined, as patient
passed much of it involuntarily, but the convallaria did
not seem to increase the amount.
Date.
September 24tli, A.M
September 24tli, p. M
September 25th, a.m. (Convallaria, TT^ xv.
four times daily)
September 25th, P.M
September 26th, A.M
September 26th, P.M
September 27tli, a.m
September 27th, p.m
September 2Sth, A. M
September 28th, p. M
September 29tli, a.m. (Convallaria, TT[ xv. q.
4 hrs.)
September 2gtli, P.M
September 30th, a.m
September 30tli, r, .M
Pulse
Respira-
Tempe-
tions.
rature.
32
I02.S»
1 48
32
101.8°
120
28
102. s»
',^,6
28
101.5°
132
30
I02.9'>
152
29
102.5°
148
32
102.3°
148
30
100.3°
140
30
101.8°
116
3'
I02.2»
132
7.6
101.2°
118
22
97- 5°
132
30
99.1°
136
28
99.6°
After this temperature never reached 100°. Pulse re-
mains over 100° as long as taken, i.e., till October 13th.
Case XIII. — Lobar pneumonia. — A woman, aged sixty-
five, was brought into the hospital November 13th, liaving
been sick two days. Patient hardly able to speak ; rattles
in throat. There was dulness and bronchial breathing at
right apex ; back of chest not examined on account of
weakness of patient. Put on whiskey, ? ss. q. h.; conval-
laria, TI|, iij. q. h. Pulse was stronger November 13th p.m.
but weaker again the next morning. Patient died No-
vember 14th, 3.20 P.M.
Autopsy, November 15th, showed complete consolida-
tion of right lung in gray stage.
Pulse.
November I3tli, a.m 144
November 13th. P.M 120
November I4tli, A.M 144 (?)
Respira-
tions.
34
38
40
Tempe-
rature.
101.6°
102.8°
ior.8°
Cases XIV.-XVIII. — Typhoid fever. — In five cases of
heart failure from typhoid fever, convallaria (with whiskey)
was tried. It was usually run up to y\ iv. q. h. or TH ij.
q. \ h. It was sometimes thought that the pulse im-
proved somewhat after the administration of the drug.
The patients all died in one to three days, except the first,
where the heart failure was due to intestinal hemorrhage.
She recovered.
Case XIX. — Emphysema and chronic bronchitis. —
Convallaria (TTl x. q. 4 h.) was given to a man with em-
physema and bronchitis, increased in a week to TTl, xx. q.
4 h. Urine was quite constantly about thirty ounces
daily, and was not increased by the convallaria. The
pidse was not slowed. General condition rather im-
proved.
Case XX. — Emphysema, chronic bronchitis, asth-
ma.— In a case of spasmodic asthma with emphysema,
where nearly everytiiing had been tried without avail
to diminish the frequency of the attacks, convallaria,
TTL x. q. 4 h. and afterward the one per cent, solution ot
nitro-glycerine, TT|, j. t.i.d., if anything, aggravated the
attacks.
Giving a short summary of the foregoing results I
I20
THE MEDICAL RECORD.
[February 3, 188^
should say that of the six cases of renal disease treated
with convallaria, three (I., II., IV.) improved decidedly
while taking the drug, and in three (III., V., VI.) little
benefit could be observed. Case III. developed uremic
convulsions while on the drug. Case V., complicated
with phthisis, was not affected, and Case ^'l. was very
desperate from the start.
Of the five cases of cardiac disease four improved,
one (XI.) very markedly (after digitalis had failed). Case
VIII. improved at first but afterward got very much
worse and recovered on digitalis. Case IX. was hopeless.
Case XII., of lobar pneumonia in an old woman, where
the prognosis seemed very bad, did well. Case XIII. was
nearly moribund on entrance and died.
Of the five cases of typhoid fevet four died, and it is
hard to say whether the convallaria had any good effect
or not on them or in the one (XIV.) that recoxered.
In the two cases of bronchitis and emphysema the re-
sults were doubtful.
If it be urged that this showing is not very favorable
numericall}', let it be remembered that the tests were
very severe ones and in not a few of the cases convallaria
was tried only as a last resort in cases hopeless from the
start. Nearly all the cases were very serious, much more
so than private practice would afford in such proportion.
I feel certain that the results were at least as good as
they are with digitalis in similar cases. Case XL was as
brilliant an example of the benefit to be derived from
drugs in certain instances as I saw during my hospital
experience. Cases I., II., IV., and XII. were very satis-
factory, though it is very hard to distinguish the post from
the propter. I feel sure that the rest in bed and proper
diet afforded by the hospital will slow the pulse, increase
the urine, and effect a remarkable change for the better
in the patient's general condition in certain cases of
cardiac and renal trouble, especially with dropsy, without
the use of any drug whatever. I have seen such cases.
I think the benefit m Case X., and perhaps in others, may
be mainly attributed to rest and diet.
The pulse was markedly slowed in Cases I., VII., X. (?),
and XI. ; in the latter it could scarcely have been due to
any cause other than the influence of the drug. The
urine was markedly increased in Cases I., II.. and IV., and
iir the last case we may fairly, I think, give the drug the
credit.
The discovery of another heart tonic, which shall be on
the whole as satisfactory as digitalis, and shall succeed in
some instances, where digitalis fails, would be a great
boon to the profession and to a most distressing class of
suft'erers. I think I have shown that we possess in con-
vallaria such a drus;. At least it merits further trial.
Germ.an Medical Statlstics. — The recent issue of
the German Reichs Medicinal Kalender, contains some
interesting statistical data. In the whole German Em-
pire there are 17,623 regular practising physicians. Of
this number Prussia has 8,634 ; Saxony, 1,017 ; Bavaria,
3,860; Wurteniberg, 1,053; Haden, 576 ; the remainder
being distributed among the smaller provinces. The
city of Berlin has but 1,048 i)iiysicians, which figures rep-
re.sent a proportion of 9.33 to 10,000 inhabitants. For
the wliole empire this proportion amounts to only 3.87,
showing a tendency of the profession to flock to the cen-
tres of civilization.
Germany has 4,030 licensed pharmacies, of which
number, 2,396 belong to Prussia. There are 238 county
societies, and 68 purely scientific associations. 153
medical publications are issued from German presses, in
addition to which there are 95 periodicals published by
various medical societies.
Prevention of Hydrophobia. — Pasteur claims to
have four dogs which cannot be inoculated with rabies by
any method. These dogs have been ])rotected by pre-
vious mild attacks of rabies, from which they recovered
IN PERITONE.M. TRANSFU-
SION.'
EXPERIMENTS
By JOSEPH W. HOWE, M.D.,
PROFESSOR OF CLINICAL SURGERY IN BELLEVUE HOSPITAL MEDICAL COLLEGE,*
NEW YORK.
The injection of blood into the peritoneal cavity was
first recommended by Ponfick as a substitute for intra-
venous transfusion. He advised it in all cases of im-
pending death from hemorrhage, or disease. Subse-
quently Bezzozero, Kachozorowski, and Golgi a Raggi
published the results of their experiments. These were
confirmatory of the success of the operation, and it was
again recommended in cases of " pernicious anajmia, and
to stimulate or encourage blood-making in all low states
of the system." A brief resume of these cases, in addition
to my own experiments on dogs, will be of assistance in
determining the status of peritoneal transfusion as com-
pared with the injection of blood into its natural chan-
nels, the blood-vessels.
In making his experiments on animals Ponfick injected
from one to two hundred grammes of blood, defibrinated
and undefibrinated. At the end of twenty-four hours he
found that the injected blood had been absorbed, and
only a reddish film remained on the ]5eritoneal covering
of the intestines to show that peritoneal transfusion had
been performed.
His first operation on the human adult was performed
on a woman, thirty-one years of age, with phlegmonous
inflammation of the upper extremity, accompanied with
great anaemia. A slight rise in the temperature followed
the operation, but no signs of peritoneal inflammation
were discernible. She recovered in a short period after
the injection. There seems to be nothing in the history
of this case to show that transfusion of blood was indi-
cated, or that ordinary means of medication, with nutri-
tious diet, would not have accomplished the desired re-
sult.
The second case was one of chronic anasmia with paral-
ysis. The patient survived the operation eighteen months.
A post-mortem examination showed nothing abnormal in
the abdominal cavity.
Kachozorowski reiiorted five successful cases. His first
case was one denominated " Puerperal-Venous Septice-
mia." The patient had a miscarriage at the end of three
months, followed by albuminuria, pleuro-pneumonia,
and Septic poisoning. From the combined eftect of these
diseases she became excessively exhausted, and her tem-
perature went up to 103° F. (not much of a temperature
for such a combination of serious disorders). Four
weeks subsequently five hundred grammes of defibrinated
blood were injected into the peritoneal cavity. The
temperature went down one degree after the operation,
and the general condition was improved. The injection
was repeated in a few days, and was followed by much
pain and redness at the seat of puncture. No other un-
pleasant symptoms followed the operation. The patient
was discharged cured ten weeks from the day of her de-
livery.
The second case was one of chronic anaemia and hys-
teria, from masturbation. Four hundred and fifty grammes
of defibrinated blood were injected. No inflammatorv
symptoms followed. Tonics were administered after the
transfusion. Five weeks afterward the jjatient was dis-
charged cured. This also seems to have been a case in
which no operation was necessary.
The third case, a female patient in the third stage
of phthisis, suffering from night-sweats and distressing
cough, was treated by an injection of two hundred
grammes of blood. On the third day following the ope-
ration the cough diminished, the appetite imiiroved, and
she became much stronger. Death took place at the
end of three months.
The fourth case a sutTerer from fungous degenera-
tion of the cervix, capillary bronchitis, and exhaustion.
^ Abstract of paper read beforcSthe New York Surgical Society.
February 3, 1883.]
THE MEDICAL RECORD.
121
He received an injection of six hundred grammes of blood.
Nausea, vomiting, and local pain and tenderness followed
the operation. At the end of the week the patient was
able to leave her bed, and in three months was entirely
cured.
The fifth case, a female suffering from typhus fever,
had five hundred grammes of blood injected. A rapid
amelioration of all the symptoms followed, and she was
discharged cured soon after.
Golgi a Raggi also reports a successful case of peri-
toneal transfusion. The patient was an anremic lunatic.
He injected three hundred and ten cubic centimetres of
blood defibrinated. The insanity and anremia both dis-
appeared, and a complete cure resulted. An examina-
tion of the blood of the patient by means of the " cito-
meter," fourteen days after the operation, showed that
the hemaglobine had increased from 35.8 to 57.9.
My experiments upon dogs were made with the_ pur-
pose of ascertaining : i, whether,] the peritoneum was
capable of absorbing sufficient blood, in a period of time,
that would benefit a patient at the point of death from
great loss of blood or chronic anajmia, without exciting
peritonitis. The question of time involved in absorption
is of the utmost imiiortance in determining the utility of
the operation. Ponfick did not settle that question by
his experiments, because he allowed the animals to live
twenty-four hours before ascertaining what had become
of the injected blood. If the animals had been killed
within three or four hours after the operation, that point
might have been settled ; 2, I wished to determine
whether other restorative liquids, such as milk, beef-tea,
etc., would be tolerated and absorbed by the peritoneum
as well as blood.
No. I. — A dog weighing tiiirty-five pounds, well nour-
ished and active, was etherized until all active movements
had ceased. The cylinder of Dieulafoy's aspirator was
charged with eight ounces of warm milk at 96° ¥. The
hollow needle attached to the tube of exit was passed
through the abdominal walls below and to the left of the
umbilicus, then by turning the handle of the aspirator
slowly the milk was injected. The operation was suc-
ceeded by a series of clonic spasms, very violent in
character, which lasted about half a minute. Six hours
later the dog was killed, and a post-mortem examination
made by Dr. Collyer, house-surgeon of Charity Hos-
pital. The abdominal cavity contained ten ounces of
liquid, consisting of the milk previously injected, and a
bloody serum, which gave the whole liquid a reddish
tinge. The peritoneum was injected in patches near the
seat of puncture. The other organs were normal.
No. 2. — ."X. larger ■ dog than the preceding, but not so
well nourished, was etherized, and five ounces of warm
milk were injected into the peritoneal cavity, by means
of the aspirator. No unfavorable symptoms developed
during or after the operation. The animal was kept un-
der observation for four weeks, without exhibiting any
signs of inflammation. So far as I know, the animal may
yet be alive.
No. 3. — -A large powerful slut in an advanced state of
pregnancy was ana3sthetized,and eightouncesof nutritious
liquid, consisting of equal parts of warm milk and bouil-
lon, were injected in the same manner as before. At
the end of five hours the dog was killed. Sixteen ounces
of liquid, containing milk, beef-tea, and bloody serum,
were found in the abdomen. The peritoneum was con-
gested throughout.
No. 4. — This animal was operated upon at the same
time. Seven ounces of warm water were injected into
the peritoneum. Six hours afterward the animal was
killed, and six ounces of a reddish brown liquid found in
the cavity. The peritoneum was much more congested
than in any of the ineceding cases. The kidneys were
congested, and a few ecchymotic spots were found under-
neath the capsule.
No. 5. — A large muscular dog was etherized, and two
loose ligatures placed around the femoral artery. The
vessel was then cut between the ligatures, and allowed
to bleed freely. When thirty ounces of blood had been
collected, the ligatures were tightened, and the artery
closed. A two-ounce solution of carbonate of ammonia,
containing ten grains to the ounce, was added to seven
ounces of the blood, and eight ounces of the mixture in-
jected into as before. Two hours subsequently, the lig-
ature slipped from the artery, and the dog bled to death.
Eighteen hours afterward, a post-mortem examination
was made by Dr. Collyer. Three ounces of bloody ser-
um were found in the cavity. A thin reddish film cov-
ered a portion of the peritoneum. No lesions except
those due to decomposition were found in other organs.
No. 6. — The femoral vein of this animal was ligated,
and opened. Eight ounces of blood were collected and
mixed as before with a solution of carbonate of ammonia.
Seven ounces of the mixture were injected. Eight hours
afterward, the dog was killed. Two ounces of liquid
blood were found in the cavity. A reddish film covered
the intestines as in the previous case.
No. 7. — Eight ounces of warm water were injected in-
to the peritoneal cavity of this animal. When she had
recovered from the ether, she gave evidences of pain by
rolling around the floor and whining. In half an hour
these symptoms subsided, and the dog remained compar-
atively quiet. Twenty hours after the operation a post-
mortem was made. Fourteen ounces of a dusky colored
liquid were found in the abdominal cavity. The periton-
eum was injected throughout its whole extent. Small
patches of lymph were also found, studding the mem-
brane. There was no difterence between the peritoneum
at the point of injection and other parts.
No. 8. — Twelve ounces of blood were taken from the
femoral vein, and the fibrin removed by whipping the
blood with a glass rod, and afterward straining it through
a piece of muslin. Five ounces were injected into the
peritoneal cavity. Twenty-two hours later the dog was
killed. No liquid was found, but the peritoneum was
covered with a thick reddish coating, consisting probably
of globular elements and coloring matter of the blood.
No. 9.. — Eight ounces of defibrinated bullock's blood
were injected into the abdomen of a very large and
powerful dog. The animal seemed to be in great pain
after the operation, and it ditl not seem to rally from the
effects of the injection, as the other animals did. Eight
hours subsequently a post-mortem was made, and four
ounces of blood collected from the cavity. The same
reddish coating of the intestines as in the preceding cases.
The foregoing experiments prove that the peritoneum
will absorb blood, and consequently must assist in sus-
taining the functions of life ; that the operation of peri-
toneal transfusion is liable to excite a limited amount of
peritoneal inflammation-; and if the blood of an animal
of a different species from the one operated upon be
used, there will be a likelihood of establishing general pe-
ritonitis. Kven in intra-venous transfusion, much harm
is likely to result from its use.
The injection of milk into the peritoneal cavity is of
about as little benefit as when employed in intra-venous
transfusion. A good result can rarely result from it.
Whenever I have employed it in the human adult alarm-
ing symptoms were invariably produced by it, without
any compensating improvement afterward, in the con-
dition of the patient. The injection of the milk and
bouillon, as well of milk alone, excited more or less
peritonitis. The injection of plain water seems to have
been followed by more irritation than any of the other
liquids used. The explanation of this, I am unable to
give. The fact, however, may throw some light on fatal
cases of peritonitis, following operations in the abdomen
where water was used freely for cleansing.
Granting the advocates of peritoneal transfusion
that the peritoneum will absorb blood, and that the vital
forces of the patient are sustained by it, I yet cannot
see the utility of the operation. It is reasonable to
suppose that organs such as the stomach and intestines.
122
THEl MEDICAL RECORD.
[February 3, 188^
specially designed by nature for purposes of absorption
and nutrition, would take up nutritious liquid as fast, if
not faster than the ])eritoneuni, which, so far as we know,
was not designed for such a use. It seems to me also,
that any condition of the system which would prevent
absorption by the stomach and intestines, would also
prevent absorption by the peritoneum, or any other
organ capable of performing that function. Indeed,
there appears to be no valid reason for ignoring the
stomach and intestines, imless these organs are the seat
of serious disease. In such cases as those reported by
Ponfick, Bezzozero, Kachzorowski, and others, the blood
might as well liav-e been injected into some portion of
the intestinal tract as into the cavity of the peritoneum.
In only one of these cases was any kind of transfusion
indicated.
Whenever a i)atient is in danger of sudden 'death
from great loss of blood, every moment lost diminishes
the chances of recovery. Hence, it is not advisable to
wait for either peritoneal or intestinal absorption. An
immediate stimulation is necessary, and that can only be
obtained b}' the injection into the veins of fresh blood
from a healthy adult. Intra-venous transfusion is as
easily perforjned as any other operation in surgery that
I know of, and with a proper apparatus, and attention to
the rules that I have frequently spoken of, there is little
or no danger attending its performance.
TWO CASES OF ACUTE DIFFUSE MYELITIS,
WITH AUTOPSIES."
Bv GEORGE L. PEABODY, M.D.,
VISITING PHYSICIAN TO BELLEVUE HOSPITAL ; PATHOLOGIST TO THE NEW YORK
HOSPITAL.
The cases whose symptoms and lesions I am about to
describe occurred under my care in the New York Hos-
pital during the summer of 1881. I otter them, as being
of interest by reason of the acuteness of the disease
— one of the patients having lived seven days, the other
only four, from the beginning of the attack — and because
one of them jiresented certain unusual symptoms, which
it is difficult to account for in view of the lesions in the
cord, as I shall demonstrate them to you under the nn-
croscope.
Both of the patients were young, healthy, well-devel-
oped men, in whom no cause could be assigned for the
disease, and in both it originated in the mid-dorsal region.
In one of them it spread upward, involving all the
elements of the cord as high as the third cervical nerve,
where, by interference with the function of the phrenic
nerve, it caused death from apncea. In the other the
tracheal plexus was very markedly interfered with, as
well as the hypoglossal nerve, its nucleus in the medulla
being, however, intact.
Case I. — Albert Kuanner, twenty-one years of age,
from Germany, single, musician; admitted to the New
York Hospital September 5, 1881, at 10 p.m. His
family history is negative. He is a moderate drinker,
chiefly of beer. Gives no traumatic history, and denies
all venereal history, as well as all exposure to cold and
wet. On getting up, three days and a half ago, at his
usual hour in tlie morning, he first noticed a peculiar
weakness in the legs, so i)ronounced that he could scarcely
stand ; also, that he could not fully extend the legs. His
knees were tremulous, knocking together when he en-
deavored to stand, and he had severe frontal and occi-
pital headache, and some vomiting. There was no chill
and no vertigo, but he felt very feverish. The weakness
in liis legs grew steadily worse, and at night he was un-
able to stand at all. This was accompanied by a slight
numbness, but no pain or formication was present either
in his trunk or extremities. His apijetite left him and
his bowels became constipated, his sphincters remaining
normal, and his bladder being under the control of his
* Read before the New York Practitioners' Society, January 5, 1S83.
will. A day or two later he began to experience similar
weakness in his hands, especially the right, but had no
dysesthesia or para;sthesia in them.
On admission, at lo p.m., his pulse was loS, his respi-
ration 32, and his temperature 101.6°. He is large and
well nourished, though slightly obese. There is no
oedema. He is utterly unable to stand. He was given
on the night of his admission ten grains of quinine and
some citrate of magnesia.
That night he slept fairly. The next morning, Sep-
tember 6th, he was unable for the first time to pass
water, and he was relieved by a catheter. There was no
variation of importance in his pulse, respiration, or tem-
perature. I first saw him at noon on this day. He was
then perfectly intelligent, and complained only of head-
ache and weakness in his legs. He lay upon his back,
and was wholly unable to turn himself to his side or to
sit up. He held his head somewhat drawn back, but
said he was able to flex it without pain. There was no
conjunctival injection ; his pupils were equal and normal
in all respects. His tongue was moist, flabby, and
slightly coated. He was able to protrude it in the me-
dian line without difficulty. He lay with his legs par-
tially flexed ; and, on being asked to raise his feet from
the bed, he made strong but ineflectual efforts to do so,
partly flexing his thighs, and thus dragging his heels along
the bed, but not raising them. He was able to move his
toes freely and to rotate his legs, also very feebly to ab-
duct and adduct them. He was then entirely unable to
raise either hand to his head, but he was able feebly to
flex his forearms and throw them over his chest by a mo-
tion from his shoulder. His fingers were flexed, and' he
was unable to extend them. The dynamometer showed
great loss of power in both hands, as follows : Right
hand, first trial, 15 ; second trial, 12. Left hand, first
trial, 20 ; second trial, 30.
These measurements were on the large scale of the in-
strument. Tactile sensation was everywhere normal
as tested by touching with hand, pin points, etc., and
rubbing with hand, cloth, etc. The electro-muscular
contractility remained good in the muscles of all his
extremities in response both to the continuous and in-
terrupted currents.
Direct palpation over the spinal column developed a
point of tenderness between the scapulte in the upper
dorsal region. He also complained of a slight sense of
pain in this situation when hot sponges were passed along
the spinal column, but not upon similar application of
cold sponges. I examined his abdominal and thoracic
viscera with negative \esults. He was then put upon
biniodide of mercur)-, gr. j'^, with potass, iodid., gr. x.,
t.i.d., and wet cups were applied along his spine suffi-
cient to withdraw blood to the extent of ten ounces. His
temperature rose steadily during the day, being at 6 p.m.
103.4°. No further symptoms developed on this the
fifth day of his illness.
September 7th, 9.25 a.m.— Pulse, 104 ; respiration, 30;
temperature, 102.2°. He slept poorly last night until
midnight, at which time he received a dose of hydrate
of chloral and bromide of potassium. A stimulating
enema was followed by a free movement from the bowels,
during which, as alwa)s before, the patient had no diffi-
culty in controlling his sphincter. Urine is still drawn by
catheter, and is normal in amount and in all other re-
spects. His general condition, objective and subjective.
Has not materially changed. His loss of power is just as
marked as yesterday, but apparently not more so. He
still complains of severe frontal headache. There are no
ocular symptoms. There is noticed, however, a slight
dirticulty in speech (which he is sure he never had be-
fore), consisting in a hesitation in pronouncing certain
words, and an inability to pronounce tiiem distinctly
until he has repeated them indistinctly several times, his
voice at times failing him and sinking to a whisper.
Movements of the lips are unimpaired. During the day
he had a normal, voluntary movement of the bowels, with
February 3, 1S83.]
THE MEDICAL RECORD.
12;
normal control of his sphincter. His urine still has to be
drawn. Various tests of sensation, power, etc., show the
same results as yesterday, power being very defective,
and sensory and tactile sensations being everywhere per-
fect. The point of tenderness over the spine is less dis-
tinct than it was. His temperature varied between
102.2° and 103. 1° during the day. His pulse and res-
piration were a little quickened.
September 8th. — This morning there were no important
changes in pulse, temperature, or respiration. Notwith-
standing the administration of chloral again, with bromide
of potassium, last evening, he passed a poor night. He
is now able to pass water without the assistance of the
catlieter, and he controls his sphincters normally. This
morning mercury and iodide of potassium are stopped,
and he is given drachm doses of fluid extract of ergot.
Mnscular power in his extremities is unchanged since
yesterday. Sensory and tactile perceptions are still nor-
mal. There are no ocular symptoms. Difficulty of
speech has plainly increased. Enunciation is very labored
and speech is thick. This is especially evident when he
attempts to pronounce the linguals, he being unable to
pronounce the letter "1" after many trials. Motion of
his lips is perfect. He can whistle, etc. His mental
condition is apparently good. Passed his urine voluntarily
throughout the day, and retained control over his sphinc-
ters. His pulse, respiration, and temperature did not
vary from their condition of yesteiday. Early in the
evening he fell asleep and slept quietly all night. At 5.25
A.M., on September 9th he was found dead.
Time from conunencement of attack until death,
exactly seven days.
As might be expected from this history, the lesions
were localized chiefly in the anterior horns of the spinal
cord. The autopsy was made six hours after death. All
the organs except the cord were substantially normal.
To the naked eye the only change noticeable in this
was that the line of division between the white and
gray matter was not as sharply drawn as it usually is in
normal cords. I hardened it in MUUer's fluid, and sub-
sequently in alcohol, and have since examined sections
from various parts of it. Throughout the entire cord
there is a change in the blood-vessels which is very
marked. They are everywhere full of blood, and sur-
rounded by a coating of young cells, as by a sheath,
these cells being disposed in several la3'ers. This change
is most marked in the gray matter of the dorsal and
lumbar regions ; but e.xists, also, as I have said above, in
a modified way throughout the cord, except in the
smallest vessels. The ganglion cells of the anterior
horns are destroyed throughout the entire cord, and their
places occupied by dense aggregations of young cells.
Besides this, throughout the anterior horns there is a
marked increase in the number of connective-tissue cells
and free nuclei.
In the posterior horns the ganglion cells are well
preserved ; notably so in Clarke's columns. There is a
sHght increase in the number of connective-tissue cells
and free nuclei in these horns, and the perivasculitis, as
above described, is distinct in them. The white matter
throughout is substantially normal, excepting the lesion
of the blood-vessels.
In the medulla oblongata there are a few aggrega-
tions of young cells, but no such dense masses of them
as were seen elsewhere. The olivary nucleus is normal
in appearance, as is also the nucleus of the hypoglossus.
The lesion of the blood-vessels is present, but is less
well marked than it is below.
It is interesting, though not obscure, that there should
have been interference with the function of the hypo-
glossal nerve so well marked, without any lesion of its
nucleus, for here not even the lesion of the blood-ves-
sels is present, though the capillaries are unduly filled
with blood. It is somewhat surprising that the patient
retained control of his sphincter ani. In concluding this
case I beg to ask your attention to these diagrams illus-
trating the appearance of the gray matter of the anterior
horns as compared with that of a normal cord, and also
to the sections of the cord in various places, which are
stained with carmine, and which I will place under the
microscope for your inspection. I think you will agree
with me that this case is one in which the chief lesions
and symptoms are those of acute poliomyelitis anterior,
notwithstanding the fact that death from that disease is
said not to occur.
The second case was more acute, and the lesions more
diffused. It is as follows:
Case II. — J. W , aged twenty ; United States ;
single ; clerk. Admitted to the New York Hospital July
31, 1881. Family history is negative. He is a moder-
ate drinker, and gives no specific history. He has had
gonorrhoea once, but denies sexual excesses. One year
ago he contracted malaria in New Jersey. He had
measles last spring. He was in good health up to the
beginning of this illness, which occurred two days ago.
He has received no injury, and has not strained himself,
or in any way exposed himself to cold or dampness.
Two days ago he awoke with intense frontal headache. ,
Soon after his left knee felt weak, and by night the entire'
lower limb on that side was powerless. He had no chill
or pain. There were no other subjective symptoms at
first. He had no parojsthesia or dysassthesia, excepting
a feeling of numbness over the left buttock and outer
side of the left thigh. There was no girdle sensation or
formication. On the following day the patient rapidly
lost all power in the right leg, and was entirely unable
to move either lower limb or his toes. He retained,
however, perfect sensation in thighs, legs, and feet.
Yesterday, the second day of illness, he vomited for the
first time. His bowels were constipated from the begin-
ning of the attack, and yesterday he was unable to void
his urine. His sphincter ani has acted without impair-
ment. On admission, 4.30 p.m., his temperature was
103.2°. The patient is intelligent, and gives a clear
account of himself He is well nourished, and com-'
plains chiefly of intense frontal headache, which has pre-
vented him from sleeping ever since the attack began.
Heart and lungs are normal. Spleen and liver are nor-
mal in size. By percussion a distended bladder is detected,
and thirty-five and a half ounces of urine are drawn by
catheter. Both lower extremities are entirely paralyzed.
The patient is utterly unable to move them. Sensation
seems perfectly normal over both lower limbs, but all
reflex action is gone. No tendon reflex at the knee.
Patient readily distinguishes hot and cold objects applied
to his lower extremities. There is no dysesthesia or
parresthesia. There is no point of tenderness in the
spine, either to pressure or to the application of hot and
cold sponges alternately. Pupils are normal. There is
no paralysis of tongue; no impediment of speech; no
sense of constriction ; no priapism.
Both legs are cool below the knee. Femoral and
dorsalis pedic arteries on both sides can be felt.
The conjunctiv.'e are suffused. Respiration is quiet
and natural.
August ist. — Sixty-two ounces of urine were drawn by
catheter at intervals during the night. Two enemata
were given during the night without effect.
Yesterday, at 9.15 p.m., his temperature was 104.4''.
This morning it is 103° ; respiration being 35, and pulse
84. His breath is foul. He has aphthous stomatitis.
The cervical glands on the left side are somewhat
enlarged. Pupils are normal, and there is slight inter-
nal strabismus of both eyes. The paralytic symptoms
described yesterday are still present in the lower extrem-
ities, and are now rapidly appearing in the upper extrem-
ities. The patient has no motion in either arm, and
very little in the fingers — the left side retaining more
power than the right. Four hours after the above note
(1.30 P.M.), the fingers were found to be completely
paralyzed. The patient's sensorium is becoming dull ;
he gives contradictory answers to questions. His sen-
124
THE MEDICAL RECORD.
[February 3, 1883.
sation is still perfect, apparently ; always (with closed
eyes) he describes accurately any cutaneous irritation
applied to arms, legs, or spine, such as heat, cold, pull-
ing out hairs, inching and pricking — all which are care-
fully and repeatedly tried. On placing the poles of the
galvanic battery (thirty-four cells) along the spine, and
over the flexors and extensors of his arms and legs, no
muscular contraction was obtained at any point (except-
ing over the flexors of the right hand) with either the con-
tinuous or the interrupted current. The application gave
the patient the sensation as of a brush being passed over
the skin, together with the sensation caused by the wet
sponges.
At midnight the paralysis of all his limbs was com-
plete, and his hands and feet were cold.
August 2d. — At 5.4s A.M. thoracic respiration ceased ;
the patient lies with his head thrown back, eyes
staring and blood-shot, face extremely cyanotic, fingers
cold and blue. There is internal strabismus of both
eyes ; the ate nasi work forcibly ; the tongue moves up
and down with respiration, which is wholly diaphragm-
atic.
At 6.10 A.M. respiration ceased altogether, the heart
beating several seconds longer.
His treatment was much the same as in the other
case.
Time from commencement of attack until death, ex-
actly four days.
I place under the microscope sections from the cord
of this subject, taken at various heights. His other or-
gans were substantially normal.
In this case the same vascular lesions exist as in the
other, and are quite as general. The inflammatory
lesions, including the destruction of ganglion cells, e.xist
in the anterior horns, as in the other case throughout
the cord, but are not confined to this situation. There
is, moreover, a similar inflammatory destruction of the
elements of the cord in the posterior horns. The
ganglion cells of Clarke's columns are everywhere de-
stroyed, and the posterior nerve-roots, as well as the rest
of the gray matter, contain an increased number of young
cells and free nuclei. Besides these changes there are
lesions in the white matter in this case. Very generally
the medullary sheaths and axis cylinders are broken
down, forming together in some places granular, in
others homogeneous masses. Near the periphery of the
cord, especially in the posterior columns, but also else-
where, may be seen many intact axis cylinders and nerve-
fibres.
It is certainly worthy of note in this case that the
sphincter ani was controlled, and that sensation was not
abolished throughout his illjiess. I am aware that such
cases are recorded, but I have not seen satisfactory ex-
planation of them.
AN IMPROVEMENT IN THE ARRANGEMENT
OF SNELLEN'S TEST-TYPES.
By A. SCHAPRINGER, M.D.,
ASSISTANT TO THE CHAIR OF OPHTHALMOLOGY AT THE NEW YORK POLYCLINIC.
In order to save time in the examination of eye-
patients with Snellen's test-types, I have devised the
following simple and inexpensive arrangement, which
several of my colleagues have found to be serviceable.
It consists of a screen made of a stout piece of paper or
cardboard, a few inches wider than the sheet on which
the test-types are printed, and twice as long, having an
aperture in the middle just large enough to permit a
single row of the types to be perceived through it. A
cord is fastened to the upper and another to the lower end
of the type-sheet. This is easily and effectually done by
means of staples and suspension hooks, which can be had
at any stationer's. The screen is tacked to the wall and
the sheet placed behind it. Screw-eyes are introduced
at suitable intervals into the wall, and the cords carried
through them to the place opposite the test-types, where
the examining physician and the patient are placed. Two
wooden handles attached to the ends of the cords afford
a convenient means of grasping. When one handle is
pulled down the other goes up, and one row of test-types
after the other will appear in the aperture of the screen.
The last screw-eyes through which the cords pass are
arranged so that the handles will strike against them when
the highest and lowest rows of type appear in the aper-
ture, thus preventing the sheet from being pulled too far
either way.
The height of the aperture in the screen is about three
inches, and its width corresponds to that of the type-
sheet. The type marked CC has been cut off" and pasted
in front of the screen, as it is too large to be seen entire
through the openmg. This, of course, need not be done
when we have a sheet on which there is sufficient space
between the rows so that the opening in the screen can be
made larger.
Instead of cutting a piece from the middle of the paper
screen, it will be found a little more practicable to make
only two horizontal slits, about three mches apart and
long enough to allow the type-sheet to be passed through
them in such a way that the strip between the slits will,
as it were, ride on the back of the sheet.
A screen like the one described can be seen in working
order at the New York Polyclinic, where I put it up my-
self at the expense of a few cents only.
248 East Sixty-first Street, January lo, 1883.
gvoflvcss of l^lcrtical .Science.
Puncture of the Gr.'Vvid Uterus during Ovario-
tomy.— At a recent meeting of the New Y'ork Obstetrical
Society, Dr. C. C. Lee related the following case. (J\^c7a
York Medical Jotintal, January 27, 1883). A patient,
twenty-eight years of age, was sent to the Woman's
Hospital by Dr. Hanks, for the removal of an ovarian
cyst situated on the right side. The presence of
the cyst was supposed to have been the cause of
several miscarriages, and, as the patient was then three
months pregnant, it was thought likely to prove so again.
After making the usual incision for ovariotomy, the e.xact
relation of the tumor to the uterus was ascertained. In
turning the patient on her side, preparatory to punctur-
ing the cyst, the latter was let go, and, unknown to Dr.
Lee, the uterus took its place, rolling up into the ab-
dominal incision, and was punctured instead. A large
trocar penetrated the body of the womb to a depth of
about two inches, entering at a point about two inches
below the fundus. No fluid escaped when the trocar
was withdrawn. The uterine wound was sewed up with
carbolized silk, the long pedicle of the ovarian cyst was
then ligated, the cyst was removed, and the abdominal
wound was closed. Abortion had not occurred, and the
patient was doing well. There had been vomiting, which
was probably due to the influence of the anx'stlietic. It
was a noteworthy fact that the pedicle in this case was so
long that the tumor, which was developed from the left
ovary, lay upon the oppo.site side, in the region of the
right ovary. Dr. Lee thought the silk-worm suture which
was used to close tiie abdominal wound possessed no
advantages over the carbolized-silk ligature. It was much
more liable to break, and was less easy to handle.
Fistula of the Pancreas. — The following case is re-
ported by Dr. D. Kulenkampfif, in the Berliner Klin.
Wochenschrift, No. 7, 1882, as an instance of pancreatic
fistula. A laborer, thirty-nine years of age, received a
severe injury, being iiit on the abdomen. After the
grave inflammatory symptoms had apparently subsided,
he felt comparatively well, but still complained of
gastric distress. Gradually a tumor developed in the
epigastric region, and grew to about the size of a
February 3, 1883.]
THE MEDICAL RECORD.
125
child's head. As he was uncertain in regard to the
diagnosis, Dr. Kulenkanipff cut carefully through the
abdominal wall, in the linea alba. Then he punctured
the swelling and drew off about a wine-bottleful of
clear fluid containing a large quantity of albumen.
Later the peritoneum was attached to the abdominal
walls, the tumor opened, and a quart of tlie same fluid
taken out. He then established drainage, and daily
several jiints of this fluid were discharged. The wound
closed, but a small fistula remained, and notwithstanding
all endeavors, the skin surrounding it continued sore.
This fact caused the suspicion that he had to do here
with a pancreatic fistula, and the chemical analysis, which
was made by the chemist, Dr. Hausmann, confirmed
this. Nevertheless the fistula at length became i)ernia-
nently closed.
The Advantages of a Dry Local Treatment in
Otorrhceal Diseases. — One of the greatest hindrances
to cure in an ear disease accompanied by otorrhcea,
whether the disease be due to inflammation in the audi-
tory canal or middle ear, is the presence of granulations
and polypoid growths. Yet one of the oldest forms of
treatment of otorrhceal disease has been by copious
syringing and instillation of various fluid medicines.
Hence, in such treatment of this class of aural diseases,
moisture has been repeatedly applied to, and kept in the
ear, a naturally heated locality. Now, as heat and
moisture tend to promote granulations and keep up a
discharge, it is very apparent that a moist treatment of
otorrhosa in many instances has a tendency to keep up
rather than to check the morbid discharge froin-the ear.
On these grounds, therefore. Dr. Chas. H. Burnett, in
a paper with the above title, in the American Journal of
the Medical Sciences for January, 1883, holds that the
syringe and all forms of drops should be omitted from
the home treatment by the jiatient in cases of otorrhcea.
The most the patient should be directed to do is to dry
his ear according to its need, by running into the canal
and down to the fundus a twisted pencil of absorbent
cotton. The surgeon is to use the syringe only when it
is absolutely necessary to remove by it the matter from
the ear, and thus prepare the organ for the application
of medication by his hand. This latter part of the
treatment should consist in the blowing of powders into
the ear. Of these, Dr. Burnett recommends one pre-
pared by triturating equal parts of tincture of Calendula
officinalis with boracic acid (gr. to minim), allowing
evaporation, then rubbing one part of the thus calendu-
lated boracic acid with one or two parts of pure boracic
acid. Alum should not be used, on account of its ten-
dency to produce furuncles. Comparative tables are
given, which show that by the dry method of treatment
the average duration of treatment may be shortened from
212 days under the old plan, to 34 days by the dry method.
The Antiseptic and Physiological Action of
Resorcin. — From some exjieriments made by Dr. W.
B. Piatt {American Journal of the Medical Sciences,
January, 1883), it appears, taking the minimum time in
each series, that bacteria developed in 20 c.c. of urine
exposed to favorable conditions, and that 0.050 gniL of
resorcin has no appreciable influence, bacteria develop-
ing within eighteen hours.
Twice that quantity (0.103) kept urine free from bac-
teria twenty-four hours, six hours longer; while 0.150
deterred their development to four days, urine without
any addition showing bacteria within eighteen hours.
If urine be boiled, organisms are found usually con-
siderably later, forty-six to sixty-five hours.
0.050 gramme of carbolic acid hinders development
of other living organisms (large enough to be detected
by a power of 550 diameters) in boiled urine at least
twelve days, bacteria eighteen days, the usual bacillus
not developing at all. While 0.150 of resorcin (about
two and a half grains) hinders development of bacteria
four days, one-third that amount of carbolic acid pre-
serves a similar amount of urine free from organic life,
under similar conditions, three times as long.
Experiments made to determine the physiological
action of resorcin, showed that in several warm-blooded
animals it caused — i. Restlessness and trembling. 2.
Rapid respiration very early in rabbits. Early and very
marked after a lethal dose in one dog, later after a lesser,
but fatal dose, in another. Not marked after non-lethal
doses. 3. Staggering, unsteady gait, loss of co-ordina-
tion, especially in hind limbs, present early in all the ani-
mals excepting one rabbit where a small dose was exhi-
bited. 4. Twitching of muscles, especially of hind limbs,
constant in all. 5. Clonic contraction of nearly all flexors
and extensors of body, more especially of those attached
to the pelvis and shoulder. 6. In the animals that died,
the imitation of the natural running or hopping move-
ments before death, as the animal lay upon its side, was
striking.
Blenorrhagic Pleurisy. — Several years ago Dr. See
observed a case of gonorrhoeal rheumatism, complicated
by pleurisy. To his mind the pleurisy was evidently due
to the venereal disease, since the two inflammations,
arthritic and pleuritic, commenced at the same time and
without any previous exposure on the part of the patient.
Quite recently he saw another instance of this rare com-
plication of gonorrhoea (Journal de Afedecine, December,
1882). This was the case of a young man twenty-five
years of age, who had contracted a gonorrhoea some
three months previously. He was suddenly taken with
chills, followed by pains in his side, fever and dyspnoea.
Pressure upon the sides of the thorax induced the most
acute pain. Upon his admission into the hospital, he
showed evident signs of pleuritic effusion with extreme
dyspncea. He was not benefited by hypodermics of
morphia. A hypodermic of nitiate of pilocarpine, how-
ever, gave an excellent result. Dr. See insists that the
thoracic ))ain and the general instead of the local disor-
der is suflficient to establish a diagnosis of true gonor-
rhoeal pleurisy.
St.^tistics of Symphysiotomy, — Dr. Robert P. Har-
ris publishes in the American Journal of the Medical
Sciences for January, 1883, a careful analysis of the stat-
istics of symphysiotomy, with comparative tables of the
early and later cases, showing that the operation has
been more frequently performed in Italy in the last
seventeen years than in the previous eighty. In his first
table, extending up to 1858, out of 70 cases there was a
maternal, mortality of 70 per cent., and a fcetal mortality
of 67 per cent. The second table begins with the re-
suscitation of this operation in Naples, in 1866, and as
far as he has been able to learn, there have been 53
operations in that city, saving 43 women and 42 children.
From a report of Prof. Morisani, by whom most of these
operations were performed, we leain that — i. All of the
fifty operations (in table 2) were performed upon rachitic
subjects, whose pelves were generally flattened antero-
posteriorly. In four or five instances the pelves were
simply dwarfed in dimensions. There was no case of
rostrate pelvis, as malacosteon is very rarely met with in
Naples. 2. Version was not resorted to except in the
transverse positions. The forceps were applied in about
one-fourth of the cases. 3. The separation at the pubes
amounted to about 2 inches (50 nun.), which was ob-
tained without any effort, and without producing any
lesion of the sacro-iliac synchondroses. 4. The im-
movable dressing secured the firm union of the symphysis
pubis in all the cases that recovered. 5. The women had
good health after the operation. 6. There were no
malformed infants. Nearly all of the children were sent
to the Foundling Hospital lo be taken care of 7.
Phlegmasia alba dolens did not occur in any of the
women. 8. There were no pelvic lesions left, as a sequel
of the operation, with the exception of one case of iliac
phlegmon. 9. Vesico-vaginal fistula occurred in but one
case, and this was easily cured by an operation.
126
THE MEDICAL RECORD.
[February 3, 1883.
The Medical Record
A Weekly yoiirnal of Medicine and Surgery.
GEORGE F. SHRADY, A.M., M.D., Editor.
Published by
WM. WOOD & Co., Nos. 56 and 58 LafayeUe Place.
New York, February 3, 1883.
WATER-SUPPLY OF NEW YORK CITY.
Our editorial suggestions of the 20th ultimo, tending to
arouse the citizens of New York City to make a search-
ing inquiry into the true cause of the insufficiency of
the water-supply, appears to have had the effect we
aimed at. We pointed out that the trouble was not due
to a defect in the quantity of water, but, on the contrary,
to primitive and bad methods of distribution, which re-
sulted in a waste of a large portion of the daily supply.
It is gratifying that our suggestions have been so ably
handled by those who have interested themselves in this
subject, and we find that the strongest evidence has
been placed before the mayor's committee in support
of our views. We stated that probably one-fourth of
the water-supply of our city was wasted, but one witness
observed that on some occasions fully half the supply of
water to New York City was diverted from its legitimate
use. Indeed, Mr. Henry J. Newton, of tlie Taxpayers'
Central Committee, who has made a critical examina-
tion of the water-course, asserted that he found evidence
that the water was run to waste systematically by the au-
thorities in charge, who even retarded the flow in the
aqueduct by artificial means, for the purpose of creating
a pretended scarcity, and thus demonstrating an appa-
rent necessity for another reservoir.
Commissioner Thompson denies this imputation, but
appears to leave unanswered the facts produced by Mr.
Newton, who states that he found a difference of depth
of water between One Hundred and Thirty-fourth Street
and Ninety-second Street, which could be explained only
on the supposition that a waste of water existed between
these points. We do not for a moment suppose that the
escape-valves are fraudulently opened, but jjrobably ex-
tensive leakages are permitted to exist, which have the
same effect. Those who have allowed this systematic
waste are the adherents of the political jjarty which de-
mands at this moment an expenditure of over fourteen
million dollars for a new aqueduct. We apprehend that
the most innocent of taxpayers will not fail to perceive
the raison d'etre of such behavior.
In regard to the individual waste of water by con-
sumers, to which we directed si)ecial attention and sug-
gested a remedy, Commissioner Thompson states that
the introduction of meters into private houses would
meet with " widespread opposition." In reply, we would
observe that among a cert.ain class the same " opposi-
Mon," if likely to be successful, would be raised against
gas-meters, and possibly the inventor has too often re-
ceived the anathema of the consumer when the monthly
account was rendered.
The wasteful and prodigal consumers object to all
methods of reckoning which fastens upon them the just
payment for their extravagance ; but the system of
charging pro rata according to the amount used of any-
thing, must certainly be based on a just and equitable
principle, and be acceptable to all who have honest in-
tentions.
The London system, however, to which we directed
attention, does not provide for the use of meters in all
private houses, but is merely optional to large consum-
ers, such as hotels, manufactories, etc. We quite agree
with Mr. Thompson that the universal use of meters
would entail a troublesome and expensive system of in-
spection. The English plan of charging according to
the number and size of cisterns in a house, has no such
objection, as one assessment only is required, all future
payments being the same, until additional cisterns are
added.
As we stated, such a system appears to give satisfac-
tion in England to consumers, and when combined with
high pressure, insures a limitless supply to every part of
the house.
It is admitted on all hands that the present amount of
water at the command of New York City is sufficient for
all purposes, provided the distribution is made by a sys-
tem which insures against waste and extravagance. We
have shown that the problem is not a difficult one, and
have suggested a solution, which has at least the merit
of being no novelty, as it is in practical operation in
the largest city in the world. There it works with
success, and meets the requirements of over three mil-
lions of people.
RESTORING THE POWERS OF THE N.'\TIONAL BOARD
OF HEALTH.
The Senate "Select Committee to Investigate and Re-
port the Best Means of Preventing the Introduction and
Spread of Epidemic Diseases," to which was referred
Senate Bill No. 2259, made its report on January 26,
1883, and the report has been ordered to be printed.
This bill (S. 2259) repeals the limiting clause of the
act of June 2, 1879, entitled " An Act to Prevent the
Introduction of Contagious or Infectious Diseases into
the United States,'-' better known as the " Quarantine
Act," which expires by limitation on the 2d of June
next. It also makes available the unexpended balance,
previously appropriated, "of $124,000, or so much
thereof as may be necessary for carrying out the pro-
visions of the several acts creating tlie board and de-
fining its powers." It also makes available the appro-
priations heretotbre made to enable the board " to aid
State and local boards of health and local (juarantine
stations, to be used only in case of epidemic, the sum of
$100,000."
The report of the committee, recommending the pas-
sage of the bill, enters largely into tlic merits of the
board, and claims that under its rules and regulations
the yellow fever epidemic of 1879 " was actually stamped
out in New Orleans and confined to the limits of Mem-
phis."
February 3, 1883.]
THE MEDICAL RECORD.
127
The politico-legal aspect of the subject, " the power
of Congress to regulate commerce in respect to the im-
portation of contagion," is summed up in these words:
" The powers of a State in respect to this question are
based upon and limited by the law of self-preservation,
and can go no farther than the protection of the people
within its boundaries, while the power of Congress to
regulate commerce is absolute, supreme, and exclusive."
The report also says, " Our statute-books furnish a large
number of precedents wherein Congress has, within the
last fifty years, regulated commerce with no otlier object
or purpose than to give greater security to the health
and lives of that portion of our people who chance to be
afloat upon our waters."
The report concludes with an appeal, a portion of
which is here given : "When the memories of the fearful
ravages of the epidemic of 187S were fresh, both houses
of Congress were ready to appropriate, and did appro-
priate all that the Committee asked for the purpose of
endeavoring to find, if possible, a means of preventing the
recurrence of this terrible scourge ; but as the memories
of the one hundred thousand sufferers, and the twenty
thousand new-made graves of that period are fading from
our minds, the Committee has experienced more or less
difficulty in obtaining the appropriations necessary to
enable the Board to perform the important duties which
devolve upon it," etc.
Without entering upon the subject of the merits of the
bill, we find that the report of the committee, where it
treats of the politico-legal aspect of the subject of na-
tional quarantine is curiously at variance with the pub-
lished opinion of the President of the National Board of
Health. Thus the President in an exhaustive review of
this whole subject, says : " To recapitulate, I hold that
any attempt to supersede State authority in matters of
quarantine, or for the general Government to exercise
concurrent jurisdiction with the States in regard to quar-
antine, would be inexpedient for the following among
other reasons :
" I. The decisions of the Supreme Court make it
doubtful, to say the least, whether such powers are within
the competence of the general Government.
" 2. If the power be admitted, the exercise of it would
be impolitic in view of the embittered opposition of the
great commercial emporiums of the country.
" 3. Such a system would almost necessarily lead to
the establishment of an enormously expensive bureau,
with no better means, probably, in respect to the protec-
tion of the public health, than can be realized, as expe-
rience has shown, by the system of co-operation with
State and local boards."
In speaking of the Quarantine Act of 1878 (the Ma-
rine Hospital Service Act), the President of the National
Board of Health says, in the review above spoken of:
" The passage of the Quarantine Act in question was
the single exception in the entire history of the Govern-
ment to its otherwise consistent traditional policy, and
this single exception seems to have been immediately
repented of, for the very body in which the bill originated
failed to make any provision for its execution."
From this it seems that there is a considerable differ-
ence of opinion as to the constitutionality of national
quarantine even among its friends.
PERILS OF MEDICAL PRACTICE.
The life of a physician is one of peril, as he encoun-
ters danger at every step of his existence. The portals
of the contagious chamber which none dare enter are
passed by him without a moment's hesitation ; and for-
tunate is he who goes through life without disease di-
rectly incurred in his line of duty.
What is the reward ? It is true that in some cases a
well-earned competence is secured, but too often there is
a weary struggle to secure the bare means of existence.
There is, however, one danger which is ever present in
the life o( a physician which scarcely any prudence on
his part can absolutely avert, bringing with it a train of
horrors, to escape which death itself may be welcomed
by a man of honor.
This peril is the accusation of female patients that at-
tempts have been made on their chastity, when no cause
for such a charge exists. The tragic conclusion to the
most recent case of this description may well be remem-
bered when future charges of this character are made
against physicians bearing a spotless reputation.
Dr. William Whitfield Edwardes, of Hounslow, Eng-
land, was the last victim to this system of blackmail.
The unfortunate man naturally consulted his partner, a
Dr. Whitmarsh, who, instead of trying to defend him as
a friend, took the opportunity which offered of dissolving
their business relations.
Finding himself assailed both from within and with-
out, and possibly believing that he could not convince
others of his innocence, when his own partner was ready
to brand him as guilty, the wretched man " broke down,"
and by the aid of a bottle of prussic acid put an impass-
able barrier between himself and his persecutors.
Before death, poor Dr. Edwardes, so soon to stand
before his Maker, solemnly and emphatically denied the
charge brought against him, which he attributed to the
" morbid imagination of a licentious-minded, hysterical
woman," and " with a prayer for a blessing on his wife,
his little boys, and his mother," concluded the document.
It is but little satisfaction for the loss of such a man
to learn that the woman, struck with remorse, made a
written retraction of the charge, with every expression
of regret. All, however, that could be done for the
bereaved relatives was performed, and a general expres-
sion of sympathy was displayed ; the deceased was
buried with military honors, the stores in the line of
route to the tomb were closed, and crowds of sympa-
thizing spectators lined the way.
It is said by our London correspondent that Dr.
Whitmarsh's house was stoned by the mob, and the man
would probably have been lynched if a body of forty
mounted and other constables had not kept watch over
the house for three days.
Dr. Edwardes is described as having been a hard-
working physician, and distinguished in his profession ;
and although only resident in the district for twelve
months, he had gained the esteem of all with whom he
was brought in contact, by his devotion to his profes-
sional duties and attention to the poor.
Thus a valued life has been forfeited to the caprice
of a woman, and we would ask how many more martyrs
must be sacrificed before the medical man is protected
in the discharge of his duties. The remedy is easily sug-
128
THE MEDICAL RECORD,
[February 3, 1883.
gested. Physicians should in all cases decline to make
ph3'sical examinations of women except in the presence
of a witness. This is not only a safe rule, but one easy
to carry out even among the poorer classes. Any female
who pretends to have too much modesty to allow the
presence of a friendly attendant, should be looked upon
with becoming suspicion.
CARDIAC SURGERY.
One of the latest developments of surgery relates to an
organ which has for a long tune been regarded as a noli
me iaiigere by the operating surgeon. But now, a new
era is beginning to dawn upon us, and the heart is to be
duly admitted to the fraternity of organs that may be
cut, sliced, and stitched with more or less impunit)- —
more to the surgeon and generally somewhat less to the
patient.
Punctures of the heart when conceived in moments of
calmness, and executed with care and precision, are com-
paratively harmless. For, in 1872, Roger thrust a needle
into the right ventricle of a child, and withdrew about
six ounces of blood. There was no permanent mischief,
and tiie patient died five months later from clnonic heart
disease. So also in Hulke's case ("Trans. Clin. Soc,"
London, vol. viii.), a draciim of venous blood was taken
from the heart, and the patient survived the withdrawal
four weeks. Dr. John B. Roberts, of Philadelphia, is the
fearless American apostle of the innocuousness of car-
diac punctures. He also believes that cardiotomy, or at
least cardicentesis, is preferable to phlebotomy in many
threatening cases of distention of the heart.
Dr. C, L. Dana, however, in a letter printed in the
present issue of The Medical Record, comes to a
directly opposite conclusion.
Cloquet, Bouchut, Legros, and Onimus have also
observed the apparent innocuousness of wounds of the
heart made by capillary trocars. Steiner found, ten
years or more ago, that electro-puncture needles could
be quite safely introduced into either ventricle, provided
they were at once withdrawn {Aled. Times and Gazette,
May, 1873).
It has been considered less safe to puncture the au-
ricles ; but the interesting paper of Dr. Benj. F. West-
brook, published in The Medical Record for Decem-
ber 23, 1882, would seem to show that our fears are as
unfounded as were those of our predecessors in regard to
ventricular puncture.
Dr. Westbrook's narrative has stimulated Dr. Roberts
to further thought regarding cardiac surgery. He points
out that if a few drachms of blood drawn directly from
the heart give the relief that could only be afforded by
taking a similar number of ounces from the veins of the
arm, it seems proper to adopt the former measure. The
subsecjuent circulatory depression from anajmia would
undoubtedly be less than after the latter operation.
It is manifestly necessary, however, to determine that
cardicentesis is innocuous before it can take the place of
venesection. In Dr. Roberts' opinion the above-men-
tioned cases and Dr. Westbrook's experience tend to
show that such is the fact.
Further experimentation in heart-puncture for the re-
lief of cardiac distention and pulmonary engorgement
seems, however, requisite. But Dr. Roberts thinks that
it will soon become a well-recognized surgical procedure
in selected cases. IJe asserts that pericardicentesis has
already taken that position, and there is no reason to be-
lieve that cardiac surgery will stop its inarch with the
demonstration that the pericardium can be treated as
the pleura.
Closely scrutinized, the results of cardiac operations
have not hitherto been the most encouraging. There
has been too nnich unanimity as regards the final fate of
these cases. True, a similar unanimity of death has also
been manifested by patients with excised or resected
stomachs. But in extenuation it might be said that can-
cer kills painfull}-, often slowly, always surely. On the
other hand, the gravest cardiac lesions may occasionally
become fully compensated, and lead to conqsaratively
comfortable existence. And again, death from heart
disease is often quick and painless.
Far be it from us to deprecate the boldly progressive
spirit of modern surgery. We owe too much to that ten-
dency. But it does seem as if there were a limit some-
where, to proceed beyond which would be reckless and
unjustifiable. Man is as yet incompletely evolved.
Perfection still awaits him. In his present development
the heart is emphatically a vital organ. And too nnich
chirurgical handling of that viscus seems as yet tolerably
sure to be resented by the system.
QUAIL- EATING.
Some men are born great and some attain greatness.
Among these latter is the gentleman w-ho is at date of
writing attempting the interesting feat of eating sixty
quails in thirty days. No doubt many medical men have
been called upon to express professional opinion on the
matter, and have properly beclouded the understandings
of their listeners with glittering physiological generalities.
It is needless to moralize upon the foolishness of the
performance or the silliness of the public in becoming
excited over it. New York expends its brain-force in
making money, and wants for its anmsement things which
make the slightest possible drain on mental tissues.
Quail-eating has become one of the excitements of the
day, and it is jiroper enough for the doctor to say a word,
since the matter involves a question of physiology. A
brace of quails weighs, when dressed, rarely over three-
fourths of a pound. In a normal diet it is permissible to
eat even more than this amount of nitrogenous food. It
is not a question of overfeeding, therefore, in the present
instance, but of lack of variety in diet. The flesh of the
quail is composed of solid muscular tissue, having no fat
between the fibres as in the case of mammals. It is del-
icate and tender, and easily digestible, the process not
taking over three hours. It is not strong-flavored, a
quality which makes one soon tire of particular foods.
There is no reason, therefore, why two quails a day can-
not be eaten for a long time.
The highly scientific experiment now going on illus-
trates one interesting physiological fact. It is that after
die system has assimilated a certain kind of food contin-
uously for some time, the power of building tissue from
it becomes weakened or lost. There is an analogy to
this in other functions of the body. Thus in the case of
the eye, particular rays of light, after continuously beat-
February 3, 1883,
]
THE MEDICAL RECORD.
129
ing against the retinal expansion of the optic nerve, blunt
the sensibility of the part which they excite. So the gus-
tatory and olfactory senses soon fail to be consciously
excited after uninterrupted irritations of the same kind.
We have heard even that some of our city specialists can
no longer smell iodoform.
MICROCOCCUS PUERPERALIS.
Recently pathological investigation lias pointed very
strongly toward the conclusion that a micro-organism is
the cause of puerperal septicaemia. We are quite pre-
pared, therefore, for the announcement that M. Chau-
veau has isolated this organism, cultivated it, attenuated
it, and used the attenuation as a vaccine.
M. Chauveau experimented with rabbits, and states
that he produced in them the lesions and symptoms of
puerperal fever. His experiments as to the protective
power of attenuated virus are not yet completed. But
he states that those rabbits which survive the first inocu-
lations are not susceptible to any subsequent attacks,
even when virulent virus is injdcted.
The profession will wait with much interest for the
conclusion of Chauveau's ex|ieriments.
SCHOOL HYGIENE IN OHIO.
A BILL has been introduced into the Legislature of the
State of Ohio containing the following very excellent pro-
vision :
" The Board of Health [of corporate cities and townsj
may take measures and supply agents, and afford induce-
ments and facilities for gratuitous vaccination and disin-
fection, may afford medical relief to and among the poor
of the corporation as, in its opinion, the protection of the
public health may require ; and during the prevalence of
any epidemic may [jrovide temporary hospitals for such
purposes (and the said board is hereby required to in-
spect semi-annually, and oftener if in the judgment of the
board it shall be deemed necessary, the sanitary con-
dition of all schools and school buildings within the
limits of the corporation)."
The section goes as nearly as possible to compulsory
vaccination without absolutely adopting it. It seems to
us eminently wise and in accordance with what modern
sanitary science demands. Such a provision, or a similar
one, ought certainly to be adopted not only in Ohio but
in other States.
PSYCHIATRICAL REFORM AND PSYCHIATRIC.-\L TEACH-
ING.
We have regarded the agitation which has been made
during the past few years over lunacy matters as one of
the most important of recent scientific and humanitarian
movements. This has been our excuse for so frequently
urging the subject upon our readers. We take pleasure
now in recording the marked success of the last meeting
of the National Association for the Protection of the
Insane, since this Society represents the movement in
question. There seems little doubt now that the Asso-
ciation is placed upon a secure basis. Its membership
has become large, the interest taken in its doings is
widely extended, while the number and character of the
men associated with it insures continued stability and
usefulness. It only remains for it to use wisely the posi-
tion it has obtained. If this is done, continued improve-
ment in lunacy matters in this comitry may fairly be ex-
pected.
Among the matters discussed at the recent annual
meeting, the one of most immediate and general interest
was that of teaching clinical [isychiatry in our medical
colleges. Without doubt this matter has been greatly
neglected. Surely no one will deny that a medical stu-
dent ought to see, at least, a few insane men, and know
something about insanity before he graduates. Yet
practically this subject is almost entirely ignored, and
the young physician may be called upon to treat or com-
mit the first lunatic he has ever professionally seen. We
submit that such a state of affairs deserves some attention
from our medical colleges.
mcxuB of titc Wicch.
Registration of Plumbers. — A bill providing for
the registration of plumbers and supervision of plumb-
ing work in Cincinnati has been introduced in the Ohio
Legislature, at the instance of the Master Plumber As-
sociation of that city.
Hospital Sund.w in Baltimore. — The collections
of the Hospital Sunday, at Baltimore, amounted to
about $2,000.
Dr. Joseph T. Smith has resigned the Chair of Anat-
omy in the Baltimore Medical College. Dr. Thomas
Dougherty has been appointed Lecturer on Physiology
in the same institution, 7'ict: Dr. B. F.Leonard, resigned.
The Baltimore Medical Students number in the
aggregate five hundred and ninety.
The Health Officer of Philadelphia, recently
appointed, is Gen. James L. Selfridge. His chief
qualification seems to be that he has been clerk in the
State Assembly. -
The Baltimore Medical Association, the oldest
medical society of that city, recently held its seventeenth
annual meeting, and elected Dr. J. S. Conrad, Presi-
dent.
Riotous Medical Students in Montreal. — About
three hundred medical students from the various univer-
sities in Montreal created considerable disturbance in
that city, on the occasion of the recent trial of one of
their number for body-snatching. Several of the rioters
were arrested and bound over to keep the peace.
Small-pox in Baltimore is decreasing. At last
accounts only twenty new cases were reported as occur-
ring in a day.
Duly on Quinine. — The Philadelphia Drug Exchange
recommends the restoration of sulphate of quinine to the
dutiable list.
The Death of Mrs. Beard. — Mrs. Elizabeth A.
Beard, wife of the late Dr. George M. Beard, died of
pneumonia at the Grand Hotel, New York, January 31st.
Only last week her husband died of the same disease.
I. ^o
THE MEDICAL RECORD.
[February 3, 1883.
The Lettsomian Lectures are being delivered this
year by Dr. A. Ernest Sansoiii. The subject is " Endo-
carditis."
Navy News. — Surgeon J. R. Tryon and Surgeon
Robert Whiting, detained from the Alaska and ordered
home. Assistant-Surgeon C. VV. Rush, ordered to the
Naval Hospital, New York, vice P. A. Surgeon A. C. H.
Russell, detached and ordered to the Navy Yard, Wash-
ington, D. C.
PlumbinXt Law for Boston. — The bill now before the
Massachusetts Legislature in regard to the regulation and
inspection of plumbing in the city of Boston, is a most
excellent measure. Its provisions are very similar to
those in force in this city. The supervision is to be in
the hands of the Inspector of Buildings, and all work
must be approved by him under penalty of heavy fines.
C70VERNOR Butler's Promises. — The recent action
of Governor Butler, of Massachusetts, m omitting Dr.
Folsom's name from the list of those reappointed to the
State Board of Health, Lunacy, and Charity, of which he
has been a most useful member, and the only e.xpert on
insanity in the board, is not all that might be desired.
No action has yet been taken on the matter by the Gov-
ernor's Council. Several other appointments directly af-
fecting the medical profession are to be made by Gov-
ernor Butler. Among these are four State Trustees of
the Massachusetts General Hospital.
How Gameetta Lost His Eye. — The following
is the true history of the case, as given by our corre-
spondent : When about eight years of age, he met with
an accident in the right 6ye which wounded the cornea
and which was followed by glaucomatous irido-choroiditis
with protrusion of the eye. The eye remained for some
time in this state, but the patient having been seized
with intense pains in that organ. Dr. Fiensal, his personal
fiiend and physician, fearing that the left eye would be-
come aftected by sympathy, consulted Dr. de Wecker,
the well-known oculist, who removed the diseased eye in
order to save the other. This happened in 1867, and
the operation succeeded so well that none but those who
were acquainted with the circumstance could imagine
that the great French republican leader had lost an eye,
as the false one he wore looked so natural in color, size,
etc., and even the very movements in it were so normal
that it was almost impossible to distinguish it from the
healthy one.
The Authorities of Trinity College, Ontario,
state that no offer was made to the seceding students of
the Kingston Medical School, to take without e.xtra fees
such as had paid their dues ; nor was any promise made
to the remainder of said students to receive them for
half-price. A statement to this effect is published in the
last number of the Canada Lancet.
Surgeon-General OF Maine. — Dr. Augustus C. Ham-
lin, of Bangor, who has lately been appointed Surgeon-
General of Maine, on the Staff of Governor Robie, is one
of the most distinguished medical ollicers in New Eng-
land. He served in the army during the entire war.
He was entrusted with important commands in the Army
of the Potomac, as Medical Director, and in the .-\rmy
of West Virginia. He was afterward promoted to one
of the highest positions, that of Medical Inspector, in
the Staff of the Regular Army ; and served with distinc-
tion in the Army of the South, during the famous siege
of Fort Wagner, and was afterward assigned to the
Armies of the Southwest, under the command of Major-
General Thomas. Dr. Hamlin is a man of high scien-
tific attainments, and is a member of numerous scientific
societies, both at home and abroad. The militia of
Maine are to be congratulated upon having so eminent
an officer at the head of their Medical Staff.
Small-po.x. in Atlanta. — Dr. James B. Baird, Sec-
retary of the Board of Health, of Atlanta, states that
every possible care is taken to discover and quarantine
cases of small-po-x in that city. Vaccination is largely
practised, and the transfer of small-po.x cases to the pest-
house is made with the utmost precautions against the
spread of the disease.
Instruction to Delegates. — At the last meeting of
the Putnam County Medical Society, a resolution to in-
struct the delegates to the State Society was lost by a
tie vote.
Professor Hermann Helmholtz. — The Emperor
of Germany has raised Dr. Hermann Helmholtz, the
eminent German physiologist, to the rank of a noble.
No New Cases of Typhus occurred in the city dur-
ing the past week.
New York Academy of Medicine. — Dr. Fordyce
Barker, the president of the Academy, after the transac-
tion of the routine business of the meeting of February
ist, delivered an eloquent inaugural address. It con-'
tained fitting references to the past, and was ripe with
suggestions concerning the future work of the .Academy,
over whose deliberations he has presided with such un-
animous acceptance during the last two terms. At the
close of the address, which was listened to with marked
attention by a large and appreciative audience, the Fellows
and guests were invited to attend a reception given by
the president and vice-president, to Mr. F. Seymour
Haden, of London, and to join in "the Loving Cup."
Progress of Diploma Manufacture in Massa-
chusetts.— Since the Bellevue Medical College of Mas-
sachusetts was exposed — and proved to be legal — the
"American University of Boston," president Dr. Buch-
anan (famihai; name in this connection), and the " First
Medical College of the American Health Society," located
at Boston, have been incorporated, and Dr. Alfred Booth,
the first president and one of the incorporators of the
" Boston Bellevue," has given notice of his intention to
start the " E.xcelsior Medical College."
Doctors Charged with Conspiracy. — Dr. S. B.
McDowell and Dr. Henry Beates, of Philadelphia, have
been sued on a charge of conspiracy, to obtain from
an aged and helpless invalid a conveyance or assign-
ment of all her possessions, without any other consider-
ation than the possible claim that McDowell might have
set up for medical services rendered on two occasions.
The physicians were held for trial at court.
February 3, 1883.]
THE MEDICAL RECORD.
IM
^CPLVVti5 JOf J>l3CictiC5.
NEW YORK PATHOLOGICAL SOCIETY.
Anniversary Meeting, January lo, 1S83.
(tEorge L. Peabody, M.D., Vice-President, in the
Chair,
ligature of the common carotid artery, and re-
moval of a sarcoma of the lower jaw.
Dr. Joseph W. Howe presented a specimen with the
following history : " Fanny S , forty-nine years of age,
and a domestic, stated that she had enjoyed excellent
health up to within two years ago. She then noticed a
small tumor on the gnm of the left side lower jaw. It
was firm and inelastic, and for some time gave her little
or no pain. Dr. Howe saw her first in May, 1882, when
the tumor was about the size of a hen's egg, and occupied
a portion of the ramus as well as the body of the jaw.
The larger part of the mass was external and below the
jaw. A portion of the floor of the mouth was also
involved. She was advised to have it removed without
delay, but she refused and returned to her home in the
country. She returned during the latter part of Sep-
tember last, and was admitted to St. Francis' Hospital.
The tumor had increased very much in every direction.
It extended up to the roof of the pharynx, and laterally
and posteriorly as far as the mastoid i)rocess of the
temporal bone. It also involved the salivary glands
in the floor of the mouth, and some of the muscles of the
tongue. She was in constant pain, and could only obtain
sleep by the use of large doses of morphia. After con-
sultation with his colleagues, Drs. George F. Shrady and
Joseph D. Bryant, it was determined to attempt the
removal of the tumor.
On October 7th, assisted by Drs. Shrady and Bryant,
the operation was performed. As a preliminary step in
the procedure, the common carotid artery was ligated.
This was done for two reasons, viz. : to diminish the
growth of the tumor in case it was found impossible to
remove the mass, and also to prevent severe hemorrhage
during the dissection of the tumor. As the growth
extended beyond the median line, the jaw was cut
through about half an inch to the right of the symphysis,
and severed from its attachments at the floor of the
mouth. The tumor was then dissected from its attach-
ments as far back as the pillars of the fauces, ami
removed, leaving a piece, including the condyle of the
lower jaw, attached above. This was also removed. It
was then seen that there were prolongations of the growth
along the base of the skull, at the roof of the pharynx,
and under the tongue as far as the opposite side of that
organ, which it would not be advisable to remove. The
patient rallied well from the operation. She was given
fifteen minims of Magendie's solution of morphine, and
passed a comparatively comfortable night. She partook
of liquid food on Sunday, with little difficulty; her tem-
perature was only ioi°- F., and her pulse ilo. There
was no sign of distress or special weakness. She wrote
upon a slate for all she wanted. Shortly after dinner on
Sunday she suddenly became hemiplegic on the right
side. The pulse ran up to 135, but her temperature re-
mained about as it was before the attack. The day fol-
lowing, the paralysis became more marked and the coma
complete. The breathing was markedly stertorous, and
her bowels were moved involuntarily. On October nth
these symptoms were intensified, without any increase in
the temperature. She died comatose on the evening of
the nth. Her death was evidently due to the ligature
of the carotid, and consequent anajmia of the brain."
REMOVAL OF RIGHT HALF OF INFERIOR MA.XILLA THROUGH
THE MOUTH FORMATION OF NEW JAW IN TWO PIECES.
Dr. Howe also presented a lower jawbone, accom-
panied by the following history : " August B , thirty-
eight years of age ; occupation, tailor ; was admitted to
St. Francis' Hospital, August 5, 1882. Family history
good. He never had syphilis or any other form of
venereal disease. Twelve months ago he had diphtheria,
which left him rather weak. Ten weeks previous to
admission he was upset from a row-boat, and afterward
suffered from severe pain in the jaw on the left side.
This was accompanied by swelling all along the whole
body of the jaw. On admission, extensive necrosis was
found to exist as far back as the ramus. On Se|)tember
loth. Dr. J. D. Bryant, who was on duty at the time,
separated a large portion of the periosteum from the
necrosed bone. The mouth was washed daily afterward
with carbolized water, until October nth, when Dr. Howe
completed the separation of the periosteum, and removed
the bone through the mouth, while the patient was under
ether. A new ramus and a new body had by this time
formed, but the two were not joined. This division of
the new jaw caused the patient considerable trouble on
account of the anterior fragment overlapping the pos-
terior, and preventing the teeth of the lower jaw from
approximating with the others during mastication. An
external splint was applied to remedy this defect. It did
little good, however, and he sent the patient to Dr.
Goodwillie, who made an intra-oral splint, which he
thought would remove the difficulty. 1 have not seen the
patient since."
Dr. Goodwillie, on invitation, remarked that three
things were necessary to the proper reproduction of bone
in the lower jaw : first, perfect rest, and in order to secure
that it was necessary to apply an intra-oral splint which
would hold the lower jaw in contact with the upper one.
Second, there should be an extra-oral splint to support
the new jaw in its place. Third, there should be care-
ful dressing, and it was well to make a drainage opening
through the extra-oral splint, so that all the secretions,
even the mucus, could be thoroughly washed out.
Thorough cleansing, rest, and support, both external and
internal, were essential in the treatment of these cases.
He thought the non-union in the specimen presented by
Dr. Howe was explained by the fact that the muscles of
the left side pulled the jaw around and allowed the pe-
riosteum to contract and heal without keeping the form
of the jaw. It also seemed to him that the pterygoid
muscles became contracted, as did all muscles when
they were not in use, and in that way non-union was
favored.
Dr. Howe remarked that in the specimen presented
the fragments of bone were in contact, that the peri-
osteum was stripped up to a distance for three or four
inches before he operated ; that he then stripped off the
remaining portion of the periosteum, and he could not
understand why the two pieces should not have united.
Dr. (jOODwillie thought the non-union was due in
this instance to movement, and that if there had been
perfect immobility union probably would have taken
place.
Dr. Howe suggested that the destruction of periosteum
upon the outside and inside perhaps prevented union.
Dr. Guodwillie was of opinion that sufticient peri-
osteum existed to permit union, but that movements of
the fragments prevented it from taking place.
NEURO-FIBROMA.
Dr. Ripley presented a specimen accompanied by
the following history :
"Last July he saw, with Dr. George Schlereth, Mrs.
B , a vigorous woman, twenty-nine years old, who had
been married eleven years. She was the mother of three
children, the eldest of whom was ten years of age, and she
was then in the third month of pregnancy with her fourth
child. Nine years ago she began to suffer from intermit-
tent pains, which radiated from the internal portion of her
left leg just below the knee. On examination, she dis-
covered a small, painful nodule at the point from which
the pain proceeded. These pains, often excruciating, were
much increased in severity by mental excitement at her
THE MEDICAL RECORD.
[February 3, 188;:
menstrual periods and during pregnancy. They were
also worse at night. From year to year, too, they had
been gradually becoming more continuous. Daring the
three weeks preceding the time that Dr. Ripley saw her
she had had little relief, night or day, and said the affected
part felt as though it were being pierced with a hot iron.
This was the history of her case, and on examination he
found a hard, painful subcutaneous tumor, ai)parently
about the size of a peanut kernel, situated three inches
below the head of the left tibia, on the inner aspect of
the leg. It was surrounded by a small area of thickened
integument, to which it was attached, and the whole mass
was slightly movable.
Dr. Schlereth had already expressed the opinion that
the growth was what is generally known as a neuro-
fibroma and that it should be removed ; an opinion in
which Dr. Ripley fully concurred. A few days later, at
the doctor's request and with his assistance, he extir-
pated the tumor, removing also the thickened integument
with it. The wound healed rapidly and without suppura-
tion, and from that time to the present there has been
no return of the pain. On secdon, in gross appearance,
the tumor was found to be a solid, nearly globular body,
about the size of a large pea, of a yellowish color in its
periphery, but near'y white in the centre. Under the
microscope, after hardening in alcohol and staining with
osmic acid, it appeared to be made up for the most part
of bundles of fibrous tissues crossing one another in dif-
ferent directions. A few non-medullated nerves were
seen, and here and there, a blood-vessel with thickened
wall. Drs. Heitzman and Wendt have both examined
specimens from the tumor, and the former thinks that
they contain a few smooth muscle fibres.
Remarks. — The clinical history of this case seemed to
me to be of interest in showing how a small and struc-
turally unimportant morbid growth, encroaching upon no
vital or sensitive organ, may give rise to years of the
most intense suffering. The marked effect which devia-
tions from a normal condition of mind or body had in
increasing the severity of the pain, was also an instructive
feature in the case. In 1812 WiUiam Wood published in
the Edinburgh Medical and Surgical Journal two articles
on these little tumors, in which he gave a detailed history
of a number of cases, several of them occurring in his
own practice. The symptomatology of one of them,
quoted from Pearson, is quite like mine. He states that
they occur more frequently in females, and also are more
common in the extremities. Of the five cases seen by
me, three were \\\ the female breast, one in the male
breast, and the other in the extremity. In the male
referred to, the tumor was situated in the left breast, and
the disease simulated angina pectoris, for which it was for
a long time mistaken. The paro.xysms of pain were very
severe, resulting during one seizure in syncope and com-
plete loss of consciousness.
In neither of those seen by him was the skin aftected,
differing in that respect from mine. Although these
tumors have been so long recognized, authors differ as
to their structure. Lockhart Clarke says they have a
fibrous or fibro-cartilaginous structure. Paget thinks the
]>ain depends on neither their locality nor their structure,
for in some situations he has found fibrocartilaginous
and fatty tumors similarly jjainfiil, also mammary glandular
tumors, but we believe they are most frequeutly subcu-
taneous and fibrous, or fibro-cellular. Cornil and Ranvier
class them with neuromata, and say that they probabR'
contain nerves which are compressed by the new con-
nective tissue."
URETHRAL CALCULI.
Dr. VVveth presented several specimens of urethral
calculi, which he had removed from a man forty-five
years of age, who came under his observation at the
polyclinic. The man had one stricture five inches from
the meatus, and one below this, through which a small
French bougie — eight or ten — passed quite readily anil
struck the calculi. ■ After some ineffectual efforts to
remove them by means of forceps, he introduced Bank's
instrument and performed internal urethrotomy, dividing
both strictures, after which he was able to remove the
four small calculi. Behind all of them was a fifth one,
for the removal of which he performed urethral lithotrity
by means of strong forceps.
Dr. Wyeth also presented a microscopical section,
which illustrated the lesions of
SYPHILITIC ENDARTERITIS.
The proliferation had taken place between the differ-
ent layers of normal intima. The specimen was removed
from the body of a patient who had had tertiary symp-
toms for many years. She had been hemiplegic for
fifteen years, and died two or three weeks ago suddenly.
At the autopsy this condition of the walls of the basilar
artery was found near its bifurcation. There was also a
gummatous tumor in the medulla oblongata. The chief
point of interest in the specimen was that, six or seven
years ago, he attended, with Dr. Weber, a patient who
had tertiary syphilis, and who died quite suddenly, the
manner of death being about the same as in the case
from which the specimen presented was taken. In Dr.
Weber's case there was also complete occlusion of the
basilar artery, and the conclusion was reached that the
patient died in consequence of an.-emia of the medulla,
induced by the obstructed condition of the blood-vessel.
In the present case he predicted that obliterating en-
darteritis of the basilar artery would be found, and the
microscopical specimen showed the pathological condi-
tion.
Dr. Wyeth also presented a microscopical section
which illustrated
TRAU.MATIC ENDARTERITIS.
It \vas taken from the carotid of a horse which he had
tied with the sciatic nerve of the calf. On examining the
artery he found a slight bulging inward of the intima, but
there was no true i)rbliferation of the internal coat, and
no other change had taken place in the arterial walls.
The morbid changes present were those which indicated
the existence of endarteritis, and in this case it was of
traumatic origin.
Dr. Peabodv remarked that it had occurred to him in
quite a number of instances to find this form of arteritis
obliterans, but he had in the majority of instances found
it in subjects who were not syphilitic. The lesion had
always been attended by the same microscopical appear-
ances which had been described by Dr. Wyeth. It had
first been described by Heubner as syphilitic arteritis of
the brain, but it had been found to exist in other parts of
the body. Dr. Peabody had found it in the kidneys, with
chronic Bright's disease, and in chronic disease of the
lungs. In two cases he had found it with malignant
tumor of the tongue and antrum.
Dr. Ripley said that at the Medical and Surgical
Society Dr. Delafield recently reported a case and made
the positive statement that the lesion was not necessarily
of syphilitic origin.
Dr. Wyeth further remarked that the condition had
been described at length by Greenfield, (rowers. Buzzard,
and many other London pathologists, in volume twenty-
eight of the " Transactions of the London Pathological
Society," and in all those cases the syphilitic lesions had
figured more or less completelv.
Dr. Wyeth, however, was of the opinion that any disease
which involved the peri-vascular space might give rise to
a condition which would cause endarteritis, no matter
whether it was syphilitic or tuberculous in character.
Dr. Birdsall had become convinced that the view-
expressed by the Vice-President, that it was not always
easy to distinguish between the syphilitic and other cases,
was gradually gaining ground.
Dr. Wyeth believed the second microscopical section
which he presented proved that an endarteritis sufficient
February 3, 1883,
]
THE MEDICAL RECORD.
T -> 'J
1 JO
to occlude the vessel could be caused by simply bringing
ihe surface of the intinia closely iu contact.
Dr. Howe remarked that he had already presented a
patient to the Society upon whom he had operated for
popliteal aneurism, who illustrated the point referred
to by Dr. Wyeth. Only sufficient pressure was made
with the ligature to bring the inner walls of the artery into
close coaptation and the operation was successful.
The Society then went into executive session.
THE PRACTITIONERS' SOCIETY OF NEW
YORK.
Stated Meeting, January 5, 1SS3.
James B. Hunter, M.D., President, in the Chair.
The paper of the evening was read by Dr. George L.
Peabody, and was entitled,
cases of acute diffuse myelitis.
[The paper is printed in full on page 122.]
Dr. Beverley Robinson presented a case of
asthma dependent upon vesicular emphysema, re-
lieved in a remarkable degree by the internal
use of the fluid extract of the root of conval-
laria maialis.
The history was as follows ; J. H , aged sixty three,
German, came to the Out-Door De|)artnient of the New
York Hospital, October 4, 1882. He complained of con-
stant dyspnoea and sleepless nights. He was poorly nour-
ished, and his nose and lips were cyanosed. His health
was tolerably good until eleven years ago, when he be-
gan to suffer from shortness of breath on exertion. At
present, even the slight effort of putting on his shirt ex-
hausts him.
His mother and two of his brothers were affected in
the same manner. His voice is short and jerky, and
he occasionally spits a small quantity of thick, gluey
sputum, preceded by a cough of moderate intensity.
The expectoration of this substance relieves his dysp-
noea somewhat, for a time. His appetite is poor, his
bowels obstinately constipated. He is compelled at
night to assume a semi-recumbent posture in order to
obtain any sleep at all.
Physical examination of the lungs reveals great ema-
ciation of the chest-walls ; shoulders high ; back much
bent over; thorax dilated at the base; sterno-mastoid,
scaleni, and trapezius muscles are prominent during in-
spiration ; chest moves as a whole in a vertical direction
during the respiratory acts ; third and lower intercostal
spaces are sucked in visibly with each effort to breathe.
Alje of nose are markedly distended ; expiration is sterto-
rous. Superhcial veins of arms and forearms are much
dilated. There is considerable pulsation of the brachial
arteries at the elbows. On percussion hyper-resonance
covering a wide area is discovered, which is especially
pronounced on the left side of the thorax. Ausculta-
tion anteriorly gives rough inspiration with numerous
sonorous rhonchi on both sides ; expiratory sounds are
feeble. Posteriorly, inspiratory vesicular murmur is very
feeble ; expiratory sounds are loud, and accompanied
with disseminated dry rales.
Physical examination of heart shows apex-beat in
fifth intercostal space to left of nipple ; epigastric pulsa-
tion diffused ; cardiac beats are but feebly felt ; arthero-
matous changes in arteries are at an advanced stage.
There is a faint blowing murmur synchronous with the
systole, and heard with greatest intensity outside and
somewhat below the left nipple.
Patient's symptoms always become more accentuated
toward evening. Atmospheric changes have no obvious
influence upon their character or degree. Country air
in past time has apparently given him relief from his con-
tinued oppression. Several years ago, while in Rock-
land County, he felt much better than usual. At present
he is prevented from leaving the city on account of his
narrow means. Latterly he has taken medicine sparing-
Iv ; in former years he took large quantities of different
kinds of n)edicine. Spirit of camphor, in 20 gtt. doses,
formerly gave him great temporary relief. He is now
very nnich annoyed by a condition of cutaneous irritation,
which has occasioned prurigo to an excessive degree.
October 4, 1882. — .At 3.50 p.m. fl. extr. convallaria
TTl, XV. were given by the mouth. Twenty minutes later
patient states that he breathes with much greater ease,
notwithstanding a rapid walk of several minutes' duration
through the waiting-room of the hospital.
5. El. extr. convallariK TH, iv.
Syrupi tolutani TTl viij.
Aquam q. s. ad. 3 j.
M. — S. To be taken by the mouth every three hours.
October. — Fl. extr. convallaria; gtt. v.
S. Take every three hours.
October i6tli. — Medicine seems to benefit him, inas-
much as he continues to breathe with greater comfort to
himself.
October 20th. — Statu quo — continue treatment.
October 27th. — Repeat treatment
November 8th. — Repeat treatment.
Patient states when dyspncea becomes more intense,
as it sometimes does, in a paroxysmal manner, he in-
creases the usual dose by several drops.
November 20th. — Repeat recipe.
December ist. — Increase dose of convallaria to gtt. x.-
every three hours.
When patient is at home and in repose his breathing
is much freer than formerly. While taking moderate ex-
ercise it is still very short and shallow, but if he rests for
a short time afterward, his respiration again becomes
relatively quiet, and is decidedly improved over what it
was under like circumstances, before he began to take
convallaria.
December 22d. — Patient rests quietly at night. He
can sleep now lying down, but is as yet unable to work
on account of debility. His appetite is poor.
During the past seventeen years he has taken a great
many drugs, prescribed by various physicians, but affirms
positively that he never got much relief from any medi-
cine until the present time. Since convallaria was first
taken his breathing has continued steadily to improve.
The quantity of urine passed has always been abundant,
and has not appreciably increased under the new treat-
ment. Repeat medicine.
December 29th. — Feels abo\it the same. Amount of
urine passed in twenty-four hours measures one quart.
Estimation was made on two occasions. Recijie as above.
Formerly, when able to work, the man had been em-
ployed in a sugar factory, and afterward in a tobacco
factory.
Dr. W.m. jM. Polk reported a case of
vagus neurosis — extremely rapid action of the
heart relieved by convallaria maialis.
The patient was a young man, aged twenty. Upon
examining the heart to find some cause for the trouble,
nothing whatever could be discovered. His other organs
were normal, and their functions naturally performed.
The family history was good, except that the mother
had asthma, which was probably reflex from the stomach.
The patient himself was a ruddy, stout boy.
He went about a year with no trouble ; then, in con-
sequence of dancing one evening, another attack was
brought on which was worse than the former. He re-
covered from it, the heart continuing in rapid action for
several hours.
He then went for a period of about two and one-half
years with no trouble, and was in excellent health.
Last summer, during one of the heated terms, he was
exposed a little more than usual. In consequence an
134
THE MEDICAL RECORD.
[February 3, 188;;
attack of ra|)id heart-action came on. It lasted for three
da\-s. During the first twenty hours the heart beat at the
rate of 240 a minute for most of the time. He was seen
during this attack by Dr. Peabody.
He got over this and was in good health until about
a month ago.
On Friday evening he had a headache when he came
up from his work down down. He was subject to these,
however. He took some cathartic pills. Ne.xt morning
he eat a light breakfast and went down to his work. In
the middle of the day he walked some distance to Del-
nionico's and eat his lunch. He came up at si.x o'clock,
making no extra exertion. He was then seized with one
of his attacks. His heart went at the rate of 240 beats
per minute. When seen half an hour later his e.xtremi-
ties were cold ; moist rales were present in the lungs, and
he had the appearance of a person with acute general
pulmonary congestion. He had already taken ten drops
of digitalis.
I gave him ten minims of fluid e.xtract of convallaria
niaialis hypodermically, and one-half hour later repeated
the dose. Five or ten minutes after this the pulse dropped
to 120. It did not come down gradually, but at once.
The bad symptoms all disappeared in two hours. This
was about half-past eight in the evening. At 4 p.m. in
the morning the symptoms began to return. The dose
of convallaria was repeated, and directions were left to
have the drug taken every two hours in fifteen-drop doses
until seen again. This dose was kept up until 5.30 p.m.
It was then decreased to ten drops every three hours.
Durijig the ensumg night he had no return of the cardiac
difficulty. Ne,\t morning the heart beat at the rate of
about 90 per minute. The interval of dosage was in-
creased to four hours. Next day it was discontinued,
and the patient has since then been very well.
The man's habits were very good. He does not in-
dulge in tea, coflFee, tobacco, or alcohol.
The patient had been examined by Drs. Austin Flint,
Metcalfe, and Learning, and nothing wrong was found in
the action of the heart in the intervals. Dr. Flint had
seen a few such cases, and one of these had proved fatal.
During the attack in question there seemed to be a
suspension of urine. For twenty-four hours no urine was
passed, and, so far as could be told by percussion, there
was little in the bladder.
Dr. a. a. Smith said that he had been very much in-
terested in the action of convallaria. He had used it in
larger doses than had been suggested, beginning with fif-
teen minims and increasing up to thirty, and getting some
effects if possibl'e.
He liad never used it in anv case like that of Dr.
Polk's.
In the case of a physician who used tobacco to excess,
and who had occasionally a pulse of 190, it had occurred
to Dr. .Smith, while Dr. Polk had been relating the his-
tory of his case, it might be of service.
Dr. Smith was inclined to think that it produced its effect
on the heart by acting on the nervous system. In that
case it might have a wider use than had heretofore been
stijiposed possible. It seemed to act upon the pneumo-
gastric nerve. It was also, possibly, a respiratory stimu-
lant. He had used it in two cases of sympatiietic palpi-
tation, both cases of gastric or intestinal disturbance. In
one there was marked benefit ; in the other, very little or
no result.
In one patient, upon whom he tried it with success,
there were no signs of heart disease, but
GREAT IRREGUI..ARITV OF HE.^RT-.XCTION
as well as abnormal rapidity. The patient could feel his
heart beating irregularly, and liad a sense of suft"ocation.
The convallaria was given in doses of fifteen drops every
three hours, and then thirty drops every six hours, be-
cause it was thought that it was not rapidly eliminated.
Dr. Polk, asked if he thought that convallaria was
contra-indicated in fatty heart, as digitalis is thought to be.
Dr. Smith did not think it contra-indicated in that
condition.
Dr. GnsNEY presented a patient upon whom he had
performed
ADAMS' OPER.\TION' FOR DUPUYTREN's FINGER CONTRAC-
TION
six days before, with an excellent result. The deformity,
as described by Dr. Gibney, and as shown by photo-
grai^hs, had been as follows :
Contraction of the middle finger, right hand, at the
metacarpo-phalangeal articulation to an angle of 135°,
and of the ring finger, same hand, to an angle of 160° ;
a hard ridge of indurated palmar aponeurosis extend-
ing from the proximal end of the first phalanx to the
middle of the palm, covered by the thickened skin, thrown
into small ruga: ; a smaller ridge for the aponeurosis con-
necting the ring finger with the palm. This disease had
begun eight years ago ; the patient, a porter in a liquor
store, first observing a small nodule in the line of the
transverse palmar fissure ; a few years later a second one
appeared, and during the past three years the deformity
of the finger had been progressing. He was fifty-five
years of age, a large, well-built man, and referred to Dr.
Gibney by Dr. Charles W. Packard. He called attention
himself, on presenting for treatment, to the extreme de-
gree of nervousness into which he had fallen within the
past year or two ; had pains up the arm and in the back,
and was easily frightened. This was very similar to the
condition of a patient operated on by Dr. Abbe, recently
reported to the Clinical Society, and also to one reported
by him in the second number of J^<jx's Illustrated Quar-
terly. Whether the nervous symptoms in this case were
reflex, or due to a central nerve-lesion, as suggested by
Dr. Abbe in his own two cases, was an open question.
There was no rheumatism or gout in the man's history,
and no cause could be found otlier than the traumatism
continuously acting.
The details of the operation were described, viz. : Five
small punctures with the Adams' fascia knife, and division
of the bow-like chords of the fascia from without inwards,
the assistant making traction on the finger meanwhile.
The blade being so small, was easily introduced between
the skin and bands, and the cutting was discontinued as
soon as the yielding came on. Posterior splints were
ap|>lied, and the deformity immediately overcome. The
adhesive straps were removed four days later, and a
simple steel splint, well padded, applied along palm and
palmar aspect of finger. There was no inflammatory re-
action whatever, and the nodular bodies disappeared
immediately after the sections. Interesting, too, to relate,
all his nervous symptoms had disap|)eared.
In the left hand the same disease existed, involving the
fascia in connection with the ring finger. There was
very little deformity as yet, but another operation was
soon to be performed.
In the discussion on Dr. Gibney 's case.
Dr. Hunter asked if the present result was not much
more favorable than is usually the case. He had had to
do with several such cases, and treatment had been nuich
more prolonged and unsatisfactory.
Dr. Gibney thought the result was not nuich more fa-
vorable than those usually reported.
In response to an inquiry, he said that he considered
the nervous disturbances reflex.
The Society then adjourned.
Tetanus in Typhoid Fever.— Dr. .Morris I-'ussell,
writing in The Philadelphia Medical Times, refers to Dr.
Simoneau's case of tetanus in typhoid fever reported in
The Record. Dr. Fussell reports two cases of a simi-
lar nature. One was that of a young woman in the third
week of typhoid fever, and convalescing. The jiatient
died. In the second case, that of a farmer, aged twenty-
two, recovery took place.
February 3, 1883. J
THE MEDICAL RECORD.
135
NATIONAI, ASSOCIATION FOR THE PROTEC-
TION OF THE INSANE AND PREVENTION
OF INSANITY.
Third Annual Meeting, held at Philadelphia, Pa., Jan-
uary 25 and 26, 1883.
JosKPH Parrish, M.D., Burlington, N. ]., in the
Chair.
[Special report for The Medical Record.]
The Third Annual Meeting of this Association was more
largely attended than any preceding. The papers read
in full and in part were numerous and covered a wide
range of topics. There were present many prominent
Philadelphians, and representatives from New York and
Boston. A number of asylum superintendents were
also in attendance.
At the pfternoon session an
ADDRESS OF WELCOME
was delivered by Dr. Samuel D. Gross. He said :
" The object for which we are assembled here to-day
involves some of the liighest principles of philanthrojiy,
and is, therefore, well calculated to arouse and enlist the
sympathies of every intelligent human being. The in-
terest which this meeting has evoked throughout the
country can only be appreciated when it is remem-
bered that the call for it was signed by the Governor
of the State, and by nearly one hundred and fifty of its
most prominent and distinguished citizens, embracing
two venerable bishops, learned divines, judges of our
Supreme and local Courts, eminent lawyers, physicians,
and laymen, all anxious to lend their influence in order
to insure its success."
I-etters were read from President Arthur, Governor
Pattison, of Pennsylvania, ex-Governors Claflin and
Rice, and Senator Hoar, of Massachusetts, and others,
expressive of sym[)athy with the object of the meeting.
The first of the regular papers was read by Professor
Traill Green, of Easton, Pa., and was entitled
THE FUNCTIONS OF A MEDICAL STAFF OF AN INSANE
HOSPITAL.
He referred to the need of more skilled medical at-
tendants in insane hospitals.
In the discussion. Dr. M. Putnam-Jacobi, of New
York, said that on one occasion the Superintendent and
assistants of the Insane Asylum at Poughkeepsie, N. ¥.,
were all away, and the whole institution was left in
charge, temporarily, of an ex-assistant.
Dr. Samuel D. Gross offered the following resolu-
tion :
Whereas, Numerous facts have recently been brought
to light tending to show that insanity in women, in many
of its worst and most embarrassing forms, is caused by
several diseases often of a curable nature ; therefore,
Resolved, That it is the deliberate opinion of this As-
sociation that there should be upon the professional
staff of every insane asylum, a thoroughly trained gyne-
cologist, one competent to make all necessary examina-
tions of, and to perform all necessary operations upon,
women laboring under sexual maladies.
After some opposition, the resolution was amended by
inserting "female practitioners preferred," before the
word gynecologist.
Dr. Joseph Parrish read a short paiier entitled
how to protect the insane.
Some of his final conclusions were as follows :
First. — We want in every State of this Union an in-
telligent and faithful lunacy commission, that shall have
power, under the seal of the Commonwealth, to open
every door behind which a lunatic sits, examine every
case, hear every complaint, and act in harmony with
medical superintendents and officers of such asylums, so
far as it may be possible, to secure the largest freedom
compatible with safety, and the highest intelligence in
the management of the insane.
Second. — We want intermediate homes, where ner-
vous and disordered persons, who are drifting toward
insanity, may place themselves, and thus many be
saved the alternative of a life in an asylum, and where
convalescents who are inmates of asylums may go before
resuming the duties of life and home, thus gradually en-
tering again upon their normal life, without the shock
that so frequently is a factor of relapse.
Third. — We want the people to comprehend the fact
that, if they would escape insanity for themselves, thiey
should be familiar with its causes and the manner of its
approach, and, therefore need a popular journal devoted
to the subject of lunacy reform and the discussion of
preventive measures.
Dr. Charles K. Mills, of Philadelphia, read a very
interesting and important paper entitled :
THE DUTY OF MEDICAL COLLEGES AND THE GENERAL
practitioners TOWARD MENTAL AND NERVOUS DIS-
EASES.
He stated that psychological medicine stood to-day in
this country where many now prominent specialties stood
ten or fifteen years ago. He referred to the need of a
more general knowledge and study of it. The lack of
clinical lectures on mental diseases in our different col-
leges was especially deplored. With the exception of
the University of Pennsylvania, there was no medical
college in the United States where systematic clinical in-
struction in insanity was carried on to any extent.
At the close of the paper a resolution was adopted, re-
questing medical colleges to attempt the instruction of
medical students in psychiatry as much as possible.
Resolutions were adopted expressing regret and sorrow
at the
DEATH OF DR. GEORGE M. BEARD,
who had been one of the founders and ofticers of the As-
sociation, and whose talents and scientific attainments
had done much toward securing its success.
At the evening session a paper was read by Rev. He-
BER Newton, of New York, entitled :
the OBLIGATIONS OF THE SANE TOWARD THE INSANE.
It was an eloiiuent but somewhat sentimental plea for
greater care and watchfulness toward the insane. He
also urged the special training of nurses destined to have
charge of insane cases.
Dr. C. K. Mills criticised the paper severely, saying
that it gave an entirely wrong impression of the present
condition of the insane, at least in Pennsylvania. In
that State there was no danger of the wrongful incar-
ceration of insane persons, nor were the insane brutally
treated.
He was followed in the same strain by Mr. Frank.
Wells, formerlv of the State Board of Charities.
Dr. H. Marion Sims, of New York, read a paper
entitled :
prevention OF insanity in CERTAIN CASES OF NER-
VOUS AND HYSTERICAL WOMEN.
He thought that a careful diagnosis and treatment of
any diseases of sexual organs in these cases would often
prevent insanity. He also asserted that there was en-
tirely insuflicient arrangements for the gynecological
treatment in most insane asylums.
Mr. Clark Bell, of New York, read a paper con-
taining much valuable matter, entitled :
THE LEGAL RIGHTS OF THE INSANE, AND THEIR ENFORCE-
MENT.
Mr. Bell went over the whole range of English law
upon the subject, and stated the ameliorative results ob-
tained by the Parliamentary commission to inquire into
the condition of the insane. He urged that there was
room for improvement in the laws of his own State, and
136
THE MEDICAL RECORD.
[February 3, 188:
that a general law should be passed giving Commissioners
of Lunac_v the right to visit and examine patients quar-
terly, or at least twice a year ; to effect the discharge of
any one who may be improperly detained ; to punish for
cruel treatment of patients ; to' extirpate mechanical re-
straints and seclusion, and, most important of all, to pro-
vide for the supervision of superintendents.
By unanimous vote
ST.\NDING COMMITTEES.
were appointed on the following subjects :
To prepare a proper system of laws for the commit-
ment and general supervision of the insane.
To collate statistics regarding insanity in the United
States.
To urge a more general teaching of psychiatry in med-
ical colleges.
Communications were received during the session
from P. Piper, Prussia ; Drs. Richardson, H. B. Lomas,
Halthouse, D. H. Tuke, Peddie, Cloaston, J. Critchiow,
Bowie, and Maudsley, of Great Britain, and Dr. Maynon,
of Paris.
ELECTION OF OFFICERS.
The following officers were elected :
President, Dr. Joseph Parrish, of Burlington, N. J.
Vice-Fresidents, J. S. Jewell, M.D., Chicago; "C. C.
Yeamans, M.D., Detroit ; E. C. Seguin, M.D., New
York; Mary Putnam-Jacobi, M.D., New York; C. L.
Dana, M.D., New York ; J. C. Shaw, iM.D., Brooklyn ;
Hon. M. D. Follitt, Marietta. O. ; Hiram Corson, M.'D.,
Conshohocken, Pa. ; Hon. R. A. Lamberton, Bethlehem,
Pa. ; Dr. J. P. Barcroft, Concord, N. H. ; J. C. Hall,
M.D., Monroe, Wis.; Hon. Joseph Perkins, Cleveland,
O. ; Dr. W. J. Morton, New York ; Dr. Walter Chan-
ning, Boston ; Garrett S. Cannon, New Jersey.
Secretary and Treasurer, Miss A. A. Chevallier, Bos-
ton.
Executive Committee, Dr. Parrish, Dr. W. B. Atkinson,
Clark Bell, Esq., New York, and Dr. C. K. Mills, Phila-
delijhia.
Dr. Wm. Hunt, of Philadelphia, showed to the .As-
sociation a number of beautiful macroscopic sections
of the brain, prepared by Dr. H. D. Schmidt, of New
Orleans.
Owing to the large number of papers remaining un-
read, It was voted to have an extra session Friday, at
Second D.w — Friday, Janl-.-^rv 26th.
An adjourned session was held on Friday afternoon,
in order to allow the reading of papers.
Dr. T. D Crothers, of H^tford, Conn., read an
able and original paper entitled
THE prevention OF INSANITY BY THE RATIONAL TREAT-
.MENT OF INEBRIETY.
The speaker estimated that from twenty to tiftv per
cent, of insanity was caused by inebriety. Inebriety
was a physical disease, but one that should be placed
near the border-land between sanity and insanity. There
were about three hundred thousand inebriates in the
United States, with a yearly mortality of lifty thousand.
From inebriety come from sixty to eighty per cent,
of all paupers, and from seventy to ninety per cent, of
criminals.
Dr. Crothers argued that the inebriate should be rec-
ognized legally as diseased, and should be cared for by
the State. Workhouse hospitals might be built from the
tax on li(iuor traffic.
The rational treatment of inebriates is to isolate them
in hospitals.
Dr. Carl Seiler, of Philadelphia, read a paper on
" The Connection Between Alcoiiolism and Insanity, or,
the Relation of Inebriety as a Cause of Insanity," pre-
pared by Dr. .A. Baer, of Berlin. A paper on "Intem-
perance and Insanity," prepared by Dr. Norman Kerr,
of London, was read by Mr. E. P. Allison, of Philadelphia.
Dr. Charles H. Thomas read a paper prepared by Dr. J.
Milner Fothergill, of London, on " Do Perversions of
Assimilation Play any Part in the Introduction of Insan-
ity ? " A paper on the " Systematic Education of the
Insane as a Means of Cure," [irepared by Dr. James
Lalor, Superintendent of die District Asylum, Dublin, was
read by Dr. Ulrich, of Chester, Pa. A paper on " Some of
the Conditions of Life which Influence the Production
of Insanity," written by Dr. Charles Mercier, London,
Assistant Superintendent of the Lunatic Asylum of Lon-
don, was read by the Hon. Richard Yaux, of Philadelphia.
The following, offered by Judge Peirce, of Philadelphia,
was adopted :
Resolved, That the Association recommends to the
careful consideration of physicians and superintendents
connected with the institutions for the treatment of men-
tal diseases, the value of regular and pleasant employ-
ment of their patients as a remedial agency in the treat-
ment of mental disorders.
The following was also ado|)ted :
Resolved, That the Association recommend to the Leg-
islatures of the several States the adoption of a similar
law as one jiassed in this State imposing penalties for is-
suing false certificates of insanity.
A Committee to consult about changing the name of
the Association was appointed, to report ATarch i, 1883.
The Society then adjourned.
MEDICAL SOCIETY OF THE COUNTY OF
NEW YORK.
Special Meeting, January 29, 1883.
David Webster, M.D., President, in the Chair.
THE new YORK CODE OF ETHICS ITS ENDORSEMENT
BY THE SOCIETY.
The meeting was called to order by the President, Dr.
Webster, after which the Secretary, Dr. W. M. Carpen-
ter, read the special call for the meeting signed by Drs.
N. Bozeman, L. A. Sayre, T. G Thomas, F. N. Otis,
W. M. Polk, and others.
Dr. D. B. St. John Roosa offered the following :
Resolved, That the Medical Society of the County of
New York approves of the amendment of the by-laws of
the Medical Society of the State of New York, adopted
at the annual meeting of February, 1882, and that we
endorse the system of medical ethics therein substituted
for the former one, especially because it leaves the mat-
ter of consultations to the discretion, the honesty, and
the humanity of the individual practitioner ; and although
we decline to instruct our delegates to the State Society,
we respectfully recommend to our representatives that
they labor for the simplification of the system of medi-
cal ethics until it shall not contain specific rules for the
regulation of professional etitpiette, but only authorize
procedure against conduct plainly unworthy a physician
and a gentleman.
Dr. H. G. Piffard offered the following as a substi-
tute :
Resolved, That the Society reposes confidence in the
intelligence and integrity of the delegates recently
elected by it, and that it trusts them to act in such a man-
ner as shall best conduce to the interests of the medical
profession of this citj', State, and county.
-After discussion, participated in by Drs. Garrish,
Jacobi, A. H. Smith, and others, Dr. Roosa struck out
the last clause of his resolution, when Dr. Piffard with-
drew his substitute.
Dr. Dwyer next offered the following substitute to the
original resolution :
Resolved, That the code of ethics recently adopted by
the New York State .Medical Society should be rescinded.
This was in turn discussed by Drs. .Austin Flint, C. R.
February 3, 1883.]
THE MEDICAL RECORD.
137
Agnevv, Fordyce Barker, O. D. Ponieroy, F. A. Burrall,
S. O. Vanderpoel and others. The previous question
was then ordered on the substitute, viz. : that the code of
ethics recently adopted by the New York Stale Medical
Society be rescinded, and the ayes and nays were de-
manded. The long roll was then called by the Secretary,
with the following results : Ayes, 60 ; Nays, 147.
A motion to adjourn was put and lost. Then a stand-
ing vote was had on Dr. Roosa's motion endorsing the
new code, with the result of 135 affirmative to 43 nega-
tive, and the meeting adjourned.
(CorvciipancUnKC.
OUR LONDON LETTER.
(From our .Special Correspondent.)
THE TRAGEDY AT HOUNSLOW THE PERILS OF THE DOC-
TOR FROM BLACKMAIL THE COMMUNICABILITY OF
PHTHISIS HIGH RATE OF MORTALITY ON OCEAN
STEAMERS — TYPHOID FEVER IN LONDON SPONGE-
GRAFTING — REOPENING OF MUSEUM OF COLLEGE OF
SURGEONS.
London, January 13, 1883.
Your readers have, no doubt, heard that a medical man
at Hounslow has committed suiciile under tragic circum-
stances. It can scarcely be possible, though, for them
to realize the excitement the sad event has caused here,
not only locally, but throughout the comniunili|'. The
facts are briefly these : Dr. W. W. Edwardes, a young
medical man of thirty-two, went to Hounslow about
fourteen months ago as partner in the practice of Dr.
Whitmarsh. The latter had been twenty years in Houn-
slow, and represented that he had a general practice of
about two thousand pounds a year. Dr. Edwardes paid
eighteen hundred pounds for a half share. He soon be-
came dissatisfied, and he and his partner were evidently
lately on bad terms. Mrs. Edwardes asserts that the
amount of actual cash received by her husband during
the first twelve months was only ;!£'i8o, of which sum
p£^i6o were absorbed in keeping his carriage. The day
before Christmas day Dr. Edwardes received a letter
from a laborer's wife, whom he had been attending for
some nervous and uterine trouble, charging him with
having behaved improperly to her on the previous day
and threatening proceedings. The deceased at once
communicated the fact to his partner, his wife, and his
father-in-law, and asserted the falsity of the charge. The
woman, in fact, afterward retracted it, and, together with
her husband, signed a written retraction and apology,
which was also signed by Dr. Whitmarsh as a witness.
She seems to have subsequently renewed the charge, say-
ing that although she had consented to withdraw it, it
was virtually true. Dr. Edwardes then determined to
prosecute her for libel.
In the meantime, however. Dr. Whitmarsh endeav-
ored to induce Dr. Edwardes to withdraw from the
practice and dissolve the [lartnership for the small
sum of live hundred pounds. It appears that on the
night of the death of Dr. Edwardes the solicitor
of the woman in question met Dr. Edwardes at Dr.
\Vhitmarsh's house and threatened the former to obtain
a warrant for his immediate apprehension. Dr. Whit-
marsh, it appears, took occasion to renew his efforts to
dissolve the partnership on very unfavorable terms to
Dr. Edwardes. The latter appears to have gone home
in great distress and to have committed suicide with
prussic acid almost immediately. The whole of the facts
are not yet before the public, as the inquest is still pro-
ceeding.
The public feeling at Hounslow has been so strong that
the surviving partner has been compelled to leave the town
for a time, and his house has been attacked by a mob of
several thousand persons. The woman who made the
charge has not yet been examined before the coroner,
but from what has been already elicited respecting her
character, her evidence does not seem likelv to be worthy
of much credence.
Dr. Edwardes was an industrious student, very ])opular
at his hospital when resident obstetric officer, and appears
to have gained the esteem of his fellow townsmen, al-
though he had been but a short time at Hounslow. He
was, however, a singularly nervous, sensitive, reserved,
and in some respects, eccentric man. I can quite cor-
roborate the evidence given on this head from my per-
sonal knowledge of him. When a student at St. Mary's
Hospital, he refused to compete on one occasion in a
class e.\amination for which he had been working hard
many months, sim|)ly because a fellow-student would not
exchange numbers with him and let him go in first for
the viva voce.
The Collective Investigation Committee of the British
Medical Association have issued a circular on the " Com-
municability of Phthisis." The general consensus of
opinion amongst the profession at present would seem to
be that it may be communicated under some circum-
stances, but that such communication does not often
occur. The British Aledicai Journal, in a recent article,
enumerates some instances apparently showing the trans-
missibility of phthisis from patients to persons brought
into close relation with them. The writer does not
mention, however, one possible explanation of such cases,
viz., that, as Dr. Henry MacCormac, of Belfast, has sug-
gested, the disease may be induced in healthy persons by
breathing and re-breathing their own pulmonary exhala-
tions when confined either alone or with invalids in a
badly ventilated chamber.
Attention has lately been called to the high rate of
mortality among passengers on steamers crossing the
Atlantic. It has been stated that the sanitary arrange-
ments on these vessels may be partly to blame. Another
explanation is the unsatisfactory position of ship surgeons.
They are badly paid, worse lodged, and their recom-
mendations on sanitary matters often treated with con-
tempt. In any case, they have no authority to enforce
their recommendations.
Typhoid fever is still prevalent both in London and
in Paris. In spite of the progress made in sanitary mat-
ters and the improved systems of drainage, I cannot help
thinking from my own personal experience of both cities
that much still remains to be done and that the present
state of affairs is accountable for much of the typhoid
now prevalent. In London, if not in Paris, the main
drainage system is now complete and mostly in good
order, but the drainage of individual houses is often de-
fective. I have been in many West-end houses in which
the water-closets were placed in the centre of the house
and ventilated only on to the staircase. I noticed this
arrangement in the town house of the late Earl of Beacons-
field in which he died.
Several cases of successful sponge-grafting have lately
been reported.
Professor Owen's friends are very anxious about his
health.
The President of the College of Surgeons, Mr. Spencer
Wells, held a reception at the College of Surgeons, this
afternoon, on the occasion of the re-opening of the
Museum after extensive repairs. Most of the leading
men were present. The improvements in the Museum
met with general approval.
Bubo may be a Bird. — The Boston Medical and Sur-
gical Journal, Noveiiiber 2, 1882, contains the following
warning : " Lest any of our readers may misunderstand
a statement in the daily press that a specimen of Bubo
Virginiana was lately seen in Pemberton Square, we
take occasion to explain that this is merely the expres-
sion of the scientific reporter for the great horned owl
which lately appeared in that locality."
138
THE MEDICAL RECORD.
[February 3, 1883.
THE CARE OF THE CHRONIC INSANE.
To THE Editor of The Medical Record.
Sir : I have always been opposed to the distinction
between hospitals for the acute and chronic insane, and
am not in any way responsible for any regulation or
usage by which the Hudson River State Hospital has
obtained the distinction of being for the acute insane
alone. The allusions made by Dr. Chapin, in his letter to
your journal of January 20th, to myself, have therefore no
pertinency whatever to the question as to the " scien-
tific." "humane," and "economic" care of the insane in
our State.
Every person of ordinary intelligence in our State
knows that the chronic insane are better treated in the
asylums for the chronic insane than they are, or ever can
be, in the county poor-houses. Everyone at all familiar
with the Willard Asylum, which is under the care of Dr. J.
B. Chapin, your correspondent, knows how admirable it
is in many of its provisions. What I object to is the
absence in our State of any broad plan for the " scientific,"
" humane," and " economic " care of the insane as a great
class, including acute and chronic cases. At present
there is no such |)lan. County officials naturally send
county insane where they can be treated the cheapest.
At this time they are sending all portable cases across
the State to Willard and Binghamton, because in those
places the rate of board per week is lower than it is
possible to make it at the State Hos[)ital at Poughkeepsie,
or in any other State or private asylum, on the basis of
present number of inmates. When the State Hospital
was first opened at Poughkeepsie it cost nearly thirteen
dollars a week to keep a patient, because the population
of the hospital was small and every item of e.xpense in
attendance and maintenance was divided among a few
only. An establishment had to be maintained on the
basis of a few patients which would have been adequate
for three times their number. As the population in the
hospital increased, the expense per head went down to
less than half the original cost ; but it has been impossible
to make the cost, on the basis of two hundred and fifty or
three hundred patients, the present population, as low as
Dr. Chapin can make it on a basis of fifteen hundred or
two thousand patients. Through the favor of the State
Board of Cliarities, and through opinions favorable to the
western part of the State, and legislation procured to
maintain asylums for the chronic insane, we now see the
remarkable process going on of draftnig the insane from
the eastern counties of our State to fill and compel the
enlargement of Willard and Binghamton. Of course
this depletes the State Hospital at Poughkeepsie, advances
the cost of board in that institution, and makes it there-
fore more and more unpopular with county supervisors
and superintendents of the poor. New York and Kings
County, and some others, are out of the calculation,
because in those counties they undertake to provide for
their insane, and having large numbers to provide for,
keep down the per capita cost to a very low figure —
much lower, let us say, than the immediate interests of
the insane justify, or the remote interests even of the tax-
payer make desirable.
Now let me say in a word what I think should be
done. Stop sending the chronic insane from Hudson
River or eastern counties to Willard or Binghamton after
those institutions are full, and use the three hundred
acres owned by the State at Poughkeepsie, in connection
with the State Hospital, for such cheap model lodging-
houses and worksho])S as would aflord sanitaria and
schools not only for such cases as become chronic in the
halls for the treatment of the acute there, but to relieve
the overcrowding at the hospitals in New York and
Kings Counties.
The cost of the care of the acute insane will always be
four or five-fold greater than that of tlie chronic insane.
Sixty or seventy per cent, at least of the chronic insane
are available for such industries as would provide, meas-
urably, not only for their own support, but to lessen the
cost to the State of the care of the acute insane. A hos-
pital for the care of the acute insane should be allowed
to retain within its precincts a sufficient population to
secure a "scientific," "humane," and "economic" care
of all classes of its beneficiaries. I am in full accord with
Dr. Chapin regarding the cruelty of taking insane persons
to common county houses. It should be forbidden by
law. I urge, and I trust with his approval, that every
existing State hospital be not only allowed but compelled
to provide for its chronic insane, so far as possible, with-
in its own precincts.
I do not propose, by carrying one thousand or fifteen
hundred patients from New York and Kings County to
Poughkeepsie, to make that institution another chronic
asylum, as he alleges I do, but only to make it an eco-
nomic success, and to relieve the crowded institutions of
New York and Kings Counties, and prevent the present
expensive and objectionable method of transporting
chronic patients from eastern counties to keep Willard
overfull, and apparently justify the objectionable propo-
sition to enlarge the Chronic .'Asylum at Binghamton.
If New York County and Kings choose to get farms
of their own on which to colonize their chronic insane, I
shall not object ; but it does seem to me that the State
property at Poughkeepsie should be turned to better ac-
count than it now is. That institution must be enlarged
for the accommodation of the chronic insane in its vicin-
age, or else shut up.
Yours faithfully,
C. R. Agnew.
"MEDICAL L.\TIN."
To THE Editor of X^e Medical Record.
Sir : This being my earliest opportunity, may I claim
the privilege of a few words as to Dr. Rice's "rejoinder "
to the article of mine entitled " Medical Latin," which
appeared in The Medical Record of November 18th?
The Doctor alleges that "the paper contains some in-
correct and misleading statements, which, if left uncon-
tradicted, might " have a certain mischievous effect.
Brietiy, the statements are that such nouns as carbo-
nas, etc., are rightly classed as feminine and of tlie third
declension, and that rhus, the fruit, is neuter.
Dr. Rice holds, on the contrary, that such words as
carbonas are not substantives, but adjectives in concord
with sub intelligible substantives of the masculine gen-
der, and that rhiis is feminine, whether tree or fruit.
I do not propose to contradict Dr. Rice's assumptions;
but honestly believing them to be erroneous, shall en-
deavor to show why I so believe.
The Doctor, in his " rejoinder," presents no argu-
ments, but dwells on the fact that, in certain discussions
regarding pharmacopoeial nomenclature, "it has been
shown that there is no analogy whatever in Latin for the
feminine gender in the case of these nouns, it being alto-
gether wrong to bring them into one category with the
large class of Latin feminines ending in -tas (as astas,pie-
tas, brcvilas, etc.)." He then refers us to certain argu-
ments in N'ew Remedies, 1882, p. 58, and adds : " It may
be considered as finally settled that these terms should
only be used as masculines." Longe aliter ceiiseo.
Having read the article, I think I am prepared to
prove tiiat it refutes itself Let us see (second para-
gra])h) :
"When the cliemical terms sulphate, nitrate, car-
bonate, sulphite, etc., were first introduced and tians-
latcd into I^atin for pharmaceutical use, about the begin-
ning of the present century, the different translators used
them in various genders, according to their judgment,"
etc.
Which being so, the question arises, What, grammati-
cally, are the terms sulphate, carbonate, etc. ? Substan-
tives or adjectives? That they are not adjectives is
proved by the fact that they will not unite in grammati-
February 3, 1883.]
THE MEDICAL RECORD.
139
cal concord with any substantive, except in apposition.
W'liat say the dictionaries ? The dictionaries decide
unanimously that they are substantives, each representing
abstractly a chemical combination.
How, then, should they have ceased to be substantives
by being ira?islatcd word for word into Latin? The
writer admits, in effect, that by changing -«/^ into -aj- and
-He into -is, they are " translated into Latin," but insists,
this having been done, that they are no longer substan-
tives, but adjectives agreeing with j'a/ understood.
But, if a single noun cannot be translated from one
language into another by a single word, we are always
obliged to resort to periphrasis, and every supplementary
word necessary to the sense must be expressed, or we
have imperfect sense or stark staring nonsense. Adjec-
tives like Capenas will not supply the place of nouns like
carbonate ; adjectives like Capenas, found without a sub-
stantive expressed, invariably refer to persons, not to
things.
Having assumed that such nouns as carbonas are ad-
jectives, the writer is at pains to prove it by trying to
show that they cannot be substantives. Hence he would
have it that they do not belong to the large number of
feminine nouns in -tas, making the genitive in -dtis, be-
cause their nominatives do not end in -tas ; they cannot
be classed with Greek feminines in -as, because their
genitives do not end in -adis or -antis ; nor with Greek
neuters in -as, -dtis,'' the a in the genitive of carbonas,
etc., being long. He admits, however, that the termina-
tion as [-atis), " which is the same as that in our modern
terms sulphas, etc., docs occur in Latin," and enumerates
among instances "some technical and fanciful terms, like
anas, andtis, old womanhood," but adds : "This noun is
feminine, but really belongs to § 5 above " (nouns in
-tas), "as it is contracted from anitas (aiiitdtis)!'
The termination -tas in the nominative is of no mo-
ment, as I shall presently show. That which in these
pharmaceutical nouns demands the classification, which
is claimed for them in "Medical Latin," is the genitive
in -dtis. The genitive being in -dtis (not -dtis), they fall
within the category of nouns so forming the genitive, no
matter what the nominative may be. Did they make the
genitive in -ddis, -antis, or -dtis, we would as promptly
refer them to the class thereby plainly indicated.
On the writer's own argument we might insist that
acetas is a noun in -tas as much as astas. But wrongly,
for it cannot be said that the / in acetas belongs to the
termination, for it is part of the root in acet-iim ; and in
this particular the right oi acetas diwA its analogues to this
classification is approved by the admission of cestas, which
is in precisely the same predicament, the t (which oc-
curs also in its primitive, astuo) being part of the root,
not of the suffix.
But were we disposed to maintain the claim of all our
pharmaceutical nouns in -as to this classification, we
would be sustained by the writer's own admission that the
feminine a/ias, andtis, is contracted from anitas, anitdtis.
The " translators," desirous of names as homophonous
as possible to the original substantives, had warrant, most
assuredly, in the examples oi anas for anitas, and satias
for satietas, in writing acetas instead of acetitas, etc.
As regards sulphis, etc., the writer insists that there is
only one true Latin noun in -is, -itis, namely Us,'' the
lawsuit, which is feminine, but that there are a number
of geographical and patronymic adjectives in -is, -itis, to
which sulphis, etc., belong.
But sulphis, etc., being substantives translated, like
sulphas, etc., are substantives themselves, and can follow
only the analogy oi lis in making the genitive in -ttis and
taking the feminine gender.
With regard to the Latin rhiis, authorities differ.
1 Among examples in -as, dtis, he mentions as a true Latin word anas, a duck.
No philologist would so characterize it. It is a metathesis of i^atra ; theme, veui,
whence Latni jw, to swim. , I In the same way the German ross becomes the Eng-
lish horsf.
"^ Dis, Dttis, the god, is a very good Latin noun substantive ; dis, ditis, rich,
a good noun adjective of all genders. Neither of them is patronymic or geograph-
ical, or signifies descent.
Ainsworth gives rhus, -i. m. and f., the tree ; rhus, -i. n.,
the seed or berry, quoting for the latter Pliny and Cel-
sus, without reference to edition. Andrews gives rhus,
rhois, and the accusatives, rhun and rhum. According
to the reading preferred by Dr. Rice, Celsus made the
tree masculine ; and, inasmuch as the Latin of Celsus is
unimpeachable, it is unfortunate for his argument in
favor of rhus glabra. But the Doctor admits that, " in
later writers, rhus occurs as neuter." Yes; and why?
Because it is agreeable to the idiom of the language.
Though Dr. Rice calls the rule for neuter fruit names
"an alleged rule,"r it is a rule which is acknowledged by
all scholars.
The Doctor says that rhus is not of the second de-
clension ; that " in Latin, it belongs to the third declen-
sion, and has the genitive' usually rhois."
He errs. Jihus (Greek pov%), in Latin, forms its geni-
tive singular usually according to the third declension,
rhois ; and its accusative, according to the Greek sec-
ond declension, 7-hun ; and, according to the regular
second declension, rhum.
Referring to the genitive, he says, in a note : " In
Greek, the corresponding noun may take the termina-
tions" (termination?) " of either the second or third de-
clension— pov or povs."
It has a mucli larger variety of inflection. It may
make the nominative singular according to the second
declension, "poos, or according to second or third, in the
contracted form, poCs ; the genitive, according to the
second "poou or pov, and according to the third, pooi; or
povi, the accusative singular according to the second,
pool' or povv [rhun), and in the third declension, poa.''
The Doctor declares with emphasis : " The form,
rhum, is the accusative singular of the third declension" !
Such it is not ; and it is still for Dr. Rice to produce
the first recorded instance of an accusative of the third
declension, Cireek or Latin, ending in um.
U rhus, like other Latinized Greek nouns, had an ac-
cusative of the third declension, it would be rlwa, as in
Greek.
The (ireek diphthong ov was pronounced like long (7.
The Romans, in spelling Greek words with Roman let-
ters, substituted v for this diphthong. Thus we have
rhus for pov<;, chirurgus for -)(^Lpi)vpyo<;, CEdipfis for
OiSiTToSs ; rhun for poiv, contracted from poov, the regu-
lar Greek accusative singular of the second declension.
One objection of Dr. Rice to rhus glabrum, is that
rhus here being supposed to mean the fruit, glabrum,
which has especial reference to the tree, cannot be
predicated of it. With equal reason, he might object
to the English name, sweet chestnut, applied to the tree,
though the adjective serves to show that the tree meant
is not the one which bears the horse-chestnuts, but a dif-
ferent one. Rhus glabrum does not mean the glabrous
fruit of the rhus, but the fruit of the glabrous rhus.
The Doctor refers, in a note, to one Palladius Mar-
tialis. Who was he ? There was a Palladius Rutilius
Taurus, usually quoted as Palladius, who wrote on rural
affairs and called the divisions of his principal work after
the months; one of them being yl/a^/i/zj / but I nowhere
find mention of Palladius Martialis.
Dr. Rice charged me with having made "some incor-
rect and misleading statements," which he proposed
should not go " uncontradicted." He has accordingly
contradicted much, without, in my opinion, disproving
anything. Very res|)ectfully,
John A. Armstong.
Brooklyn, E. D., January ig, 1S83.
London Smoke. — London has only about 74 per cent,
of sunny days, while towns near by liave, on an average,
12 per cent. more.
^ Gcnitivus is formed from genittiin, supine of ^igno. Tlic Greek name is
yel'iitTj-TTTio-is.
'^'Poa ^rj^avdeyra Kai KOwivTa. — Calen.
140
THE MEDICAL RECORD.
[February 3, 1883.
TWO CASES OF CARDIAC ASPIRATION.
To THE Editor of The Medical Record.
The interest excited by Dr. Westbrook's very suggestive
article on abstraction of blood from the right heart leads
me to refer to two cases which came under ni}- notice
several years ago.
A young woman, aged about twenty-five, was suffering
from acute nephritis. She was admitted to Bellevue Hos-
pital and was under the care of the House Physician, Dr.
P. M. Chadwick, in the fall of 1877. One afternoon, while
sitting up in bed, and being apparently in fair condition,
she suddenly fell over and ceased breathing. Heart
action soon ceased. All possible means of restoration
were used, but without success, by Dr. Chadwick and
myself. Finally, Dr. E. G. Janeway, in whose service
the case was, suggested the aspiration of the right ven-
tricle. A veterinary hypodermic needle was inserted
between the fourth and fifth ribs, a little to the left of the
sternum, and half an ounce of blood drawn off. No result
followed.
I have only meagre notes of this case and cannot recall
the results of autopsy.
The second case, which occurred in my service in April,
1878, was that of an Irishman, a hard drinker, aged thuty-
eight, slightly built and anremic, who was suffering from
acute lobar pneumonia in left lower lobe.
The disease did not progress very favorably. On the
eleventh day he still had consolidation ; temperature,
102° ; pulse, soft ; general condition, weak ; slight signs
of cedema of lungs. Large doses of whiskey and am-
monia were given, also digitalis. In the afternoon the
patient was suddenly attacked with tonic and clonic con-
vulsions. Respiration and convulsions soon ceased ; the
heart continued to beat, however ; artificial respiration,
injections of ammonia, ether, inhalations of nitrite of amyl
were applied in vain.
I then, at the suggestion of Dr. Janeway, inserted the
hypodermic needle into the right ventricle and drew off
an ounce of fluid blood. It produced no effect.
Post-mortem showed the trace of the needle through
the heart-tissue and the right ventricle was empty.
I do not consider puncture of the right ventricle a
difficult or even very dangerous operation. In experi-
menting upon dogs and cats I have often stabbed and
pricked the heart substance, with the result sometimes of
stimulatmg, never of checking its action. I would not
advise aspiration of the right auricle, however, under
any circumstances. Not because it is necessarily danger-
ous, but physiologists are agreed that the auricle is
chiefly a regulator and reservoir, not a propelling muscle.
The unloading it could have little effect on the work of
the heart.
Cardiac aspiration may be indicated in cases of sudden
heart paralysis, when the ventricle is presumably over-
distended. The needle may possibly relieve over-disten-
tion, and by its irritation set ihe heart to work again. It is
decidedly a last resort and was not tried in the two cases
reported until every other measure was exhausted. In
cases of laboring heart I should vastly prefer venesection,
whose polencv is unquestionable.
C. L. Dana, M.D.
^viuy Ulcuis.
Official List of Changes of Slations and Duties of Officers
of the Medical Department, United States Army, from
January 20, 1883, to January 27, 1883.
Waters, William E., Major and Surgeon. Detailed as
member of Army Retiring Hoard, to convene at Fort
Porter, Buffalo, N. Y., February 2, 1883. S. O. 21, par.
I, A. G. O., January 25, 1883.
Heizman, Chas. L., Captain and Assistant Surgeon.
Will be relieved from duly in the Department of the
Columbia, and ordered to report to the Commanding
General Department of the South for assignment to duty.
S. O. 20, par. 10, A. G. O., January 24, 1883.
KiLBOURNE, H. S., Captain and .Assistant Surgeon.
Leave of absence for one month, with permission to
ap|)ly for an extension of two months, is granted. S. O.
218, Department of Dakota, December 21, 1882.
Price, Curtis E., Captain and Assistant Surgeon.
Detailed as member of.^rmy Retiring Board, to convene
at Fort Porter, Buffalo, N. Y., February 2, 1883. S. O.
21, par. I, A. G. O., January 25, 1883.
Skinner, John O., Captain and .Assistant Surgeon.
Will rejiort in person, at the expiration of his present
leave of absence, to the Surgeon-General for duty in his
office. S. O. 20, par. 10, A. G. O., January 24, 18S3.
■ Spencer, Wm. G., Captain and Assistant Surgeon.
The leave of absence on Surgeon's certificate of dis-
ability, granted Sejitember 20, 1882, is extended three
months on Surgeon's certificate of disability. S. O. 16,
par. 4, .A. G. O., January ig, 1883.
Taylor, Marcus E., Captain and Assistant Surgeon.
Will report in person, at the expiration of his present
leave of absence, to the Commanding General Depart-
ment of the East, for assignment to duty. S. O. 20, par.
10, A. G. O., January 24, 1883.
Wood, Marshall W., Captain and Assistant Surgeon.
Will be relieved from duty in the Department of the
East, at the expiration of his present leave of absence,
and will report in person to the Commanding General
Department of the Columbia, for assignment to duty.
S. O. 20, par. 10, A. G. O., January 24, 1883.
Wood, Marshall W., Captain and .Assistant Surgeon.
.At expiration of present leave of absence, relieved from
duty in the Department of the East. S. O. 15, par. i.
Department of the East, January 26, 1883.
Wveth, M. C, First Lieutenant and .Assistant Sur-
geon. Is relieved from duty at Fort Snelling, and will
proceed to Fort Stevenson, Dakota Territory, and re-
port to the Commanding Officer of that post for duty.
S. O. 15, par. I, Department of Dakota, January 18,
1883.
i^lccUcal Items.
Contagious Diseases — Weekly St.^tement. — Com-
parative statement of cases of contagious diseases re-
ported to the Sanitary Bureau, Health Department, for
the two weeks ending January 27, 1S83 :
Week Ending
OJ
0
>
\^
c .
3
£
T3
>
0 c
0!
0
0
^J2 '
X
j::
"J
&,
c-
rt
CJ
a
January 20, 1883 o 10 62 9 55 43 , 2
January 27, 1883 ' o 10 59 ! 3 : 80 [ 44 | o
New Books. — One hundred and nineteen new books,
and fifty-eight new editions, upon medical and surgical
subjects were published in Great Britain in 1882.
A Ho.mieopathic physician in Switzerland advertises
that he performs " surgical operations milder than any
physician of the other school." .\t last we know what a
honKi;o[)athic surgeon is.
International Medical Congress for 1884. — It is
announced by the Secretary-General of the International
Medical Congress that the eighth session of that body
will be held in Copenhagen during the days from the
loth to the i6th of .\ugusl, 1884.
The Medical Record
A Weekly youmal of Medicine and Sicrgery
Vol. 23, No. 6
New York, February 10, 1883
Whole No. 640
(Dviaiual Articles.
THE ETIOI-OGY AND TREATAFENT OF CER-
TAIN FORMS OF iNON-PUERPERAL UTERINE
HEMORRHAGE.
By PAUL F. MUNUfi, M.D.,
rnOFESSOR OF GVNECOLOGV AND OBSTETRICS AT THE NEW YORK POLYCLINfC ; PRO-
FESSOR OF GYNECOLOGY AT DAKTMOL' IH COLLEGE; (iYNECOLOGlST TO MOUNT
SINAI HOSPITAL, ETC.
I DO not propose to discuss all the pathological con-
ditions which may give rise to uterine hemorrhage in the
non-puerperal state. While doubtless something new
might still be said on the menorrhagia and metrorrhagia
produced by carcinoma of the cervix and body of the
ulerus, by intra-uterine villosities, by fibroid tumors, by
dis|)lacements and the therefrom resulting hyperemia, by
chronic ovarian congestion and inflammation ; and while
there may still be points of interest and doubt both as to
the jiathology and treatment of these conditions, I in-
tend to limit my remarks to several etiological factors in
the production of hemorrhage from the non-puerperal
uterus, which seem to me rather less common and less
recognized than those above referred to. In discussing
this subject I beg to be understood as speaking of either
profuse menstrual flow, or of a bloody discharge in the
iiittr-mcnstrual period, when using the term "hemor-
rhage." The jiredominating variety will be specified at
the proper place.
I. Non-puerperal erosion of the eervix uteri. — That
blood may and does ooze from an abraded surface either
of skin or mucous membrane, even though the abrasion
be merely that of e|)idermis or epithelium, is an old
story ; and that this may take place on the cervi.x uteri, is
also well known; but I do not think it is sufficiently
recognized that, in certain instances, a more or less
marked increase of the menstrual flow, or an inter-men-
strual sanguineous discharge, or a constant bloody oozing,
may be due to nothing but an apparently trifling super-
ficial erosion of the vaginal portion of the cervix uteri.
Such patients may have been treated by ergot, acids, and
other hemostatics, by astringent injections, by rest and
ice, with but temi)orary arrest of the oozing, until finally
a specular examination is made, and the bleeding found
to proceed, not from the uterine cavity, but from the
eroded cervix. Only by a speculum can this diagnosis
be made, for the finger can but suspect it if the surface
of the cervix is felt to be particularly soft and velvety ;
and this suspicion may become almost a certainty if blood
is found on the finger when it is withdrawn.
On exposing the cervix with a speculum, the whole or
a portion of it is seen to be of a bright red color, with a
rough surface, which bleeds readily on being wi|)ed with
cotton. This erosion may be situated on both the anterior
and posterior lip, or on one only ; in anteversions on the
anterior, in retroversions on the posterior lip. The cause
of this situation of the erosion depends on the cause of
the lesion itself, namely, on the almost invariably present
cervical catarrh. According as the profuse acrid dis-
charge flows chiefly over the anterior or the posterior
lip, is the erosion found on the respective lip.
In ajipearance the erosion resembles the well-known
fruits, the tomato, the raspberry, and the strawberry, if
the epithelium is merely abraded the surface looks raw,
deep red and shiny, with dilated blood-vessels crossing
the field, not unlike the surface of a full-ripe tomato ; if
the papillre also are enlarged, we see numerous bright-
red elevations, like the tomato with its skin removed,
or like the ridges on a raspberry ; and if, in addition
to these, the cervical glands are distended and filled with
white or yellow opaque mucus, we have between the red
papillaj yellowish white dots, similar to the seeds of a
ripe strawl)erry. This description may seem, and, of
course, is somewhat fanciful ; still, it conveys fairly well
the appearance of and difference between these three
stages and forms of cervical erosion.
This lesion is found in virgins as well as married wo-
men, both nullipane and parous. I have seen young
girls with intact hymen, who consulted me for profuse
glairy, yellow discharge, menorrhagia, and "spotting"
in the interval, the cause of which was such a cervical
erosion ; and married women who had had no children,
or had not been pregnant for many ye^rs, in whom the
cervical epithelium became abraded for some mysterious
reason.
As a rule, the causes of this lesion are twofold : i,
catarrhal discharge from the cavity of the cervix, and, 2,
friction of the cervix against the posterior vaginal wall.
The fact should not be overlooked that in poorly nour-
ished, debilitated women, such an abrasion of epithelium
is much more liable to take place than in strong, healthy
females.
The form of erosion to which I now refer is not that
produced by and found combined with eversion of a
lacerated cervix. The simple erosion is situated on the
outer surface of an otherwise entirely sound cervix.
The chief symptom produced by this simple erosion is
the profuse, greenish-yellow or sanious discharge, which
annoys, and, in course of time, debilitates the patient.
If a young girl, she is distressed by the soiled linen which
the laundress naturally criticises, and by the constant
moisture of the vulva ; if a married woman, she fears
possible injury to her husband, and consequent unjust
suspicion of herself. But not this alone. In addition to
the discharge, the menstrual period is more profuse or
prolonged, and bloody spotting of the linen is observed
in the interval. This loss of blood is usually not serious,
but its recurrence and continuance not only mentally
but ]")hysically depresses the patient, until she consults
her family physician, who, especially if she be an unmar-
ried girl, naturally feels averse to making an examination,
and prescribes mild astringent injections, and possibly
tonics, if auKmia is present. The latter medication event-
ually does good ; the former is at the best palliative, and
sooner or later the patient consults a specialist, who
makes the necessary examination, and discovers in the
described erosion the cause of all the trouble. i\ mere
cleansing of the eroded surface with cotton on the for-
ceps is followed by the oozing of blood from every
enlarged and uncovered papilla, and from the external os
hangs a plug of thick green mucus.
The diagnosis of this condition is much easier than its
cure. I have found the following treatment effectual in
all the cases which have remained under my care for a
sufticient length of time to achieve a cure. The cervix
is exposed either through a Sims or cylindrical speculum
(the latter answers as well or better), carefully wiped
dry with absorbent cotton, and the tenacious mucous
plug is sucked out of the cervical canal by a long uterine
syringe, or by dry cotton, or a small sponge on a dressing-
forceps. This accomplished, a solution of nitrate of sil-
n-
THE MEDICAL RECORD.
[February lo, i88^
ver, 3 j. to 3 j. is applied on a cotton-wrapped stick ivithin
the cervical canal and thoroughly over the eroded spot. A
thin dust of finely powdered iodoform is then blown on the
cervix through an insufflator, a tam])on soaked in glycerite
of tannin, equal parts, placed against it, a dry i-iledget over
this, and the speculum is withdrawn. These tamjions
are to be worn for thirty-six to forty-eight hours, and an
injection of tepid water, with one to two drachms of sulpho-
carbolated zinc or plain sulphate of zinc should be used
twice a day for three days, when the patient should again
present herself for local treatment. The same applica-
tion will probably be repeated every three days, until the
erosion shows signs of healing, when a milder solution of
nitrate of silver ( 3 ss. or gr. xx. per ounce) should be used :
or the absence of improvement calls for a change of treat-
ment. In very obstniate cases, with chronic cervical ca-
tarrh, it is essential to cure the latter (the cause of the
erosion) first, and this is a difficuit matter. The removal of
the hypertrophied endo-cervical glands and mucous mem-
brane by the sharp curette and cauterization of the base
with strong nitric acid or the actual cautery, is usually an
indispensable preliminary to a successful treatment of the
catarrh. Occasionally I have found it necessary to apply
nitric acid, or pure chromic or pyroligneous acid to the
erosion, before a change for the better allowed me to
return to the milder astringents and iodoform. In every
case it is well to notify the patient that the cure is cer-
tain, but that she.must persevere for several months, at
least, or she will not recover.
In a few intractable cases I have found the negative
pole of a galvanic battery, applied by means of a round
button to the erosion, the positive sponge being placed
over the abdomen, to produce a marked tendency to
cicatrization. In one such case, the last resort of graft-
ing healthy mucous membrane on the erosion, as prac-
tised once by Dr. R. W. Anndon, occurred to me, but the
galvanic current finallv produced a cure. Had neither
of these methods succeeded, an unfailing remedy would
have been the paring of the erosion with scissors (as in
Emmet's operation for laceration) and the union of the
raw surfaces by sutures. This method was already pro-
posed by me in my paper on the " Indications for Hys-
tei'o-Trachelorrhaphy," published in X\\^ Journal of Ob-
stetrics for January, 1879. While the usual symptom of
these erosions is the profuse mucous discharge, the
menorrhagia and inter-menstrual oozing produced bv
them is by no means unconnnon. That this latter symp-
tom is not usually attributed to so simple a lesion as a
superficial erosion of the cervix, is my impression, and
the reason why I have thought the subject a proper one
for discussion. ,\ typical case, which occurred in my
practice some time since, may serve as an illustration
of my remarks, and of the failure of the ordinary meas-
ures to arrest the hemorrhage, so long as its real cause
was unrecognized and untreated.
Case I. — Mrs. , aged forty-two, mother of one
child, now in his twentieth year, had alwa)'s been in fair
health, although not very strong, until some two \ears
ago, when she began to menstruate more profusely than
ever before, but without pain or special inconvenience.
Gradually, however, she began to experience pain in
the left ovarian region, and in the fall of 1881 the men-
orrhagia became so profuse as to confine her to het bed
for more than one month. Her physician, a gentleman
very eminent in another specialty, treated her by ergot
by the mouth, by rest, and on two occasions by tam-
pons introduced through a cylindrical speculum. The
hemorrhage was arrested by this latter remedy, and the
lady was assured by her physician, that no doidjt the
next menstrual period would be normal, if she would only
remain ([uiet until it had passed. She therefore re-
mained in bed, but, to her disappointment, the period
appeared as profusely as before, with acute pain in the
left ovarian region. When it had continued a week, the
lady decided to consult a specialist, and discharging her
former physician, who had not visited her for several
weeks, sent for me. 1 found a nervous, anajmic woman,
who plainly showed the efl'ects of suffering and loss of
blood. After obtaining the above history, I suspected
that the menorrhagia was due to ovarian congestion, and
as the lady was bleeding quite profusely, decided first
to try the effects of ergot by the rectum and a blister
over the left ovary, with dilute aromatic sulphuric acid,
before making a vaginal examination. I accordingly or-
dered suppositories, each containing five grains of
Squibb's aqueous extract of ergot, three times daily, and,
as required, other suppositories with two grains extract
hyoscyanuis and one-fourth grain extract belladonna to
relieve the ovarian pain (the lady asserted that she could
positively not take opium). I assured her that the hem-
orrhage would probably cease in a day or two, and that
then I would make a vaginal examination and endeavor
to ascertain the cause of the bleeding. But, to my sur-
prise, a week passed and still the oozing continued, and
the patient began to be alarmed, as her menstrual period
had now lasted two weeks. I accordingly determined
to make an examination at once, and found the uterus
anteverted, the vaginal pouch rather narrow (as though
contracted by senile atrophy), and the left ovary decid-
edly enlarged and tender. The cervix had a peculiar
soft, velvety feel, which induced me to make a specular
examination, which I did through a Sims, and on wiping
the cervix clean I at once discovered the source of the
hemorrhage in a fiat, sujierficial erosion of the size of a
twenty-five cent piece on the anterior lip. I could posi-
tively determine that no blood issued from the os, and
could see it oozing in drops from the erosion when I
wiped it with cotton. I informed the lady of this fact,
discontinued the ergot suppositories and the sulphuric
acid, and at once brushed the cervix over with tincture
of iodine (this being the only agent I had with me), and
in^erted a tampon with glycerite of tannin.
Two days later I painted the erosion with a solution of
nitrate of silver ( 3 j- to 3 j.), and reapplied the tampons,
and this treatment was continued for about six weeks,
fifteen applications being made in all, six at her residence,
the remainder in my oftice. After the first two treatments
the hemorrhage ceased entirely, and with it the ovarian
pain ; in less than two weeks tlie patient was able to
come to my office, and in two weeks more the erosion was
healed, the subsequent applications being chiefly of iodo-
form and tannin (equal parts), blown on the cervix in
order to toughen it still more. The menstrual period,
which came on about one month after I began treatment,
was perfectly normal in quantity and duration, and pain-,
less, and has so continued up to the present time, and
the lady has gained more in strength and flesh than
during many years past.
\.\\ this case I think the erosion was due to the friction
of the cervix against the contracted vaginal pouch ; there
certainly was no cervical catarrli or vaginal leucorrhoea.
A very similar case was reported by Dr. Fallen, at the
meeting of the New York Obstetrical .Society held May 3,
1881, at which I was not present, and the first notice of
which I had while correcting proof of the proceedings of
that meeting for the January( 1882) supplement of X\\^Jour-
nal of Obstetrics, at which time I was already treating the
case just related. Dr. Pallen's case was that of a girl of fif-
teen, who had become greatly prostrated by menorrhagia.
Other means having failed to check the hemorrhage, a
specular examination was made, and a condition of the
cervix discovered " which resembled very closely the
catarrlial condition of the vaso- pharyngeal nuicous mem-
brane, and from its surface, which was denuded of epi-
thelium, there oozed forth blood in great drops." A simi-
lar treatment to that described by me, together with
tonics, etc., cured the case.
I wish it distinctly understood tliat the bleeding surface
may be merely the most superficial erosion, and that the
so-called "granular degeneration of the cervix" is by no
means necessary to (iroduce menorrhagia. That the latter
more aggravated form of cervical disease jiroduces that
P'ebruary lo, 1883.]
THE MEDICAL RECORD.
143
result is well known. The chief point to be made from
the preceding remarks is that a profuse menstrual flow
may often de|)end on a lesion of the cervix, which is dis-
coverable only by the speculum, and curable only by
local api)lications ; and that in severe cases it may be
advisable to make such an examination, and use such
treatment even during the menstrual period itself.
2. Laceration of the cervix unhealed or temporarily
healed. — One of the most frequent sources of hemorrhage
is undoubtedly a cervical laceration. Not only does the
blood flow freely at irregular intervals from the eroded
surface of the hypenemic and hyperplastic everted lining
membrane of the cervical canal, but also does the subin-
volution and engorgement of the whole uterus maintained
by the lesion entail menorrhagia. It is not of the large
lacerations that I wish to speak, but of the minor de-
grees, in which the larger part of the everted surface has
healed spontaneously, or been glazed over by astringents,
frequently, however, leaving a small patch of hyper-
plastic papill;\3 or granulations just within the cervical
canal. These granulations bleed readily on touch du-
ring coition, and often from friction during walking.
This can be felt by the examining finger, and easily re-
cognized throLigh the speculum. The hemorrhage pro-
duced by these granulations is usually not sufficiently
profuse to be serious ; it is chiefly the annoyance of more
or less constant oozing, and of frequently soiled linen,
which induces such patients to consult a physician. The
treatment is very simple, and consists in exposing the
cervix thoroughly through any speculum of sufficient
size, and with fine curved scissors snipping oft" these
exuberant papillas, or scraping them away with a sharp
curette ; their base is then seared with strong nitric acid,
and the usual astringent after-treatment pursued until the
surface is completely healed. So long as the cervical canal
gaps, a return of these granulations is not improbable ;
a permanent cure therefore is to be found only in restor-
ing the integrity of the cervix by trachelorrhaphy.
Those lacerations which have been apparently perfectly
healed by caustics and astringents, or in which Nature
has repaired the rent so far as she could by glazing over
the raw everted surfaces with a delicate cicatrix, not
unfrequently disappoint patients and physicians by caus-
ing the same annoying bloody oozing described above,
as springing from eroded granulations. Here the surface
is perfectly smooth, the os small, and no cervical catarrh
present ; but scattered over the pale, dull pink surface of
the everted lips are seen several small dots or patches
of a bright red color, which bleed on being touched or
wiped with cotton. These are merely spots of cicatricial
tissue which liave broken down, as such tissue is liable to
do if exposed to friction or bruising. That the epitheli-
um has disappeared from these patches is shown by their
turning white when a solution of nitrate of silver is ap-
plied to them, while the neighboring sound surface re-
mains unchanged.
These are the cases which have been "cured" by
those physicians who do not believe in the operation for
laceration of the cervix. In my paper, already referred
to, on "The Indications for Hystero-Trachelorrhaphy," I
refer to the merely temporary character of this form of
" cure," and give a colored plate illustrating the breaking
down of a cicatrized laceration, which was taken from a
case of spontaneous healing. Recently I have met with
two typical cases of this occurrence in patients who had
been treated in the non-operative manner by prominent
opponents of the operation.
Case II. — A lady consulted me during the past
autumn for a prolonged menstrual flow, saying that four
years previously she was delivered of her only child, and
from that time on had been under treatment. In the
first place, the bloody lochia continued unusually long
and were very profuse ; then she suffered a great deal
from leucorrhosa, and her menstrual period was prolonged
from four and five to ten and twelve day-;. At irregular
intervals she would flow very profusely ; but generally
about a week before the expected return of the period
she would begin to ooze moderately, merely sufficient to
soil her clothes and annoy her, until the regular flow
came on. She was under the treatment of a prominent
gynecologist of this city for three years, who, she says,
cauterized the " ulcerated womb " fretiuently, giving her
a great deal of pain, and after a few months of treatment
she would improve, the menorrhagia and premenstrual
oozing would cease, and treatment would be discon-
tinued. But in a few months the same oozing would
return, again to yield to treatment, and this rotation con-
tinued for about three years, when the lady decided to
try a trip to Europe. There she consulted a prominent
German gynecologist of the old school, who told her she
had an ulceration, treated her by caustics, and discharged
her cured. She returned to this country last September,
apparently well, but in November the old bloody dis-
charge again preceded the expected menstrual flow, and
the lady consulted me. I expected to find an erosion,
but my finger detected a double laceration, and the
speculum showed me two everted lips glazed over, with
six lo ten raw, readily bleeding sjJOts in them, varying in
size from a pin's head to a pea. A sound passed into
the uterus produced no bleeding. There we had the
source of the stillicidium, and the explanation of the
failure of either of the two prominent gynecologists to
effect a permanent cure. Neither of them had told the
lady that her cervix was ulcerated. Of course it is not
to be supposed that they failed to recognize the rent ; but
the New York gentleman, while a skilful and bold opera-
tor, has chosen to deny the necessity for the operation of
traclielorrhaphy, and the German, I presume, has re-
tained the conservative ideas of his youth. My opinion
was verified a week later, when the lady reappeared, the
usual oozing having just begun. Exposing the cervix at
once without touching it with the finger, the blood was
seen oozing in drops from the eroded patches ; none, as
yet, came from the uterine canal. The remedy was
obvious, viz., to heal the erosions (as had so often been
done before), and then keep them healed by turning i\v
everted cervical mucosa back within the cervical canai,
and retaining it there by the operation of trachelor-
rhaphy.
Case III. — A dispensary patient, a nmltipara, was
told by me several years ago that the menorrhagia and
leucorrhcea of which she com))lained could be cured only
by the repair of her lacerated cervix. She dreaded the
operation, and I lost sight of her until a few weeks ago,
when she called at the Polyclinic, complaining of the
same symptoms. She stated that she had been under the
care of a prominent gynecologist, who took her into his
service in a celebrated New York hospital, and treated
her by astringents and tampons for two months, with tlie
result of improving her condition, but finally admitted
that to cure her completely without an operation would
require a long time, and discharged her. It should be
mentioned that this gentleman is also an adversary of
Emmet's operation, and that, before consulting him,
the woman sought the advice of the same gynecologist
referred to in the previous case, who told her that no
operation was necessary. I found the cervix in its oM
state of laceration of the third degree, with complete
eversion ; the eroded surface much smaller, it is true,
but still sufficiently large and raw to bleed on digital
examination.
Here we have two instances of long-rejieated, persis-
tent efforts to heal over permanently the eroded surfaces
of a torn cervix, with the result of but temporary im-
provement in each case. The cases are both instructive
as to the origin of the bleeding and its permanent cure,
I am sure both cases could have been cured years ago
if the proper treatment by trachelorrhaphy had been
adopted. I have chosen these two cases from many
similar ones, because they illustrate so well the useless-
ness of palliative treatment for hemorrhage depending
on cervical laceration.
144
THE MEDICAL RECORD.
[February lo, 1883.
3. Chronic subiin'olution of the uterus is a ver)" common
result of abortions, of long, tedious, and instrumental
labors, and of lacerations of the cervix. One of the
prominent symptoms of this condition, besides pelvic
pain and weight, bearing down and backache, is profuse
menstruation. In such cases the uterus is enlarged,
soft, pulpy, and the blood appears to ooze from it as
water does from a wet sjjonge when it is squeezed. I have
frequently searched the cavity of such uteri with the dull
curette, expecting to find granulations or remnants of
placental vilH, and have been disappointed at not remov-
ing anything but a few shreds or streaks of bloody pulp.
Such women often bleed very profusely at their periods,
and require all the inter-menstrual time to recover from
the loss. In course of time this recoverv grows less and
less complete, and the patient becomes thoroughly
anajmic. I have found constitutional treatment alone to
give but slight benefit in these cases. Ergot, diluted
sulphuric acid, viscum album, etc., have tem))orarily
checked the flow, especiall}' if rest and ice were likewise
employed. But in several such cases only the tight
tamponade of the vagina, repeated day after day, suc-
ceeded in finally arresting the hemorrhage. My method
of treating these cases is to make applications of Churchill's
tincture of iodine to the endometrium twice a week during
the inter-menstrual period, taking care to make the appli-
cation thorough by repeating it at the same sitting until
any oozing of blood, which may possibly occur, ceases.
The usual hot water injections are taken twice daily.
These iodine api)lications should be conlmued up to the
ver}' inception of the flow. I have seldom failed to keep
the hemorrhage within bounds bv this treatment, which
I have always practised at my office. I also give a pill
of ergot, gr. j. ; sulph. iron, gr. ij., and strychnine, gr. ^L,
three times daily.
If the flow should still be too profuse, I put the pa-
tient to bed, and after four or five days do not hesitate
to check it by the iodine application and firm tamponade,
repeated daily until effectual. At the same time I give
rectal suppositories of ergot, three to five grains each,
three times daily. In a few cases the fluid extract of vis-
cum albmn, in teaspoonful doses every two or three hours,
has kept the flow in bounds.
Patient and physician should remember that usually
several months of the above treatment will be required
to insure a permanent benefit or a certain cure. If
proper precautions are observed, as to rest for the re-
mainder of the day after an application has been made
and as to avoidance of exposure to cold, this treatment
can usually be considered safe and harmless. The ap-
plications are made by cotton-wrapped hard rubber
applicators, if the uterine canal is patulous (as it gen-
erally is in subinvolution and menorrhagia), or by the
syringe-applicator (the syringe being first filled with tinc-
ture of iodine, the nozzle wrajsped with cotton, and the
fluid gently expressed into the cotton after the nozzle has
been passed to the fundus) if the canal is of moderate
calibre. ']"he usual protective tampons are inserted for
twenty-four hours. If the effect is to be a very decided
one (as during the flow), I make the application by the
sirde-applicator, slipping the saturated cotton oft and
leaving it in the uterus, to be removed by a twine attached
to it with the vaginal tampons. When the uterine cavity
is tamponed in this way, absolutely no hemorrhage can
take place. It is in this variety of uterine hemorrhage
that I find intra-uterine medication (of whatever char-
acter) the most beneficial.
4. Hemorrhage from chronic hyper cemia of the uterus.
— In a certain number of women, a profuse menstrual
How seems to depend on nothing but a chronic congestion
of the uterus ; at least the examining finger can detect
no enlargement or other cause for the excessive flow, and
the sound elicits more or less hemorrhage. 1 dare say an
excessive friability of the vessels of llie uterine nnicous
membrane may also be the cause of this hemorrhage. I
have found this variety chiefiy in young unmarried or in
married but nuiliparous women. Ergot seemed to exert
but little influence over it, but the iodine applications
above described were invariably eflectual. I have never
had to practise them in this form at other than the inter-
menstrual tune, and a few months of treatment have
always cured the case. Of course, we should remember
that in some women profuse menstrual flow is physio-
logical, and that then it should not be interfered with ;
but when the flow entails anaemia and debility, it needs
active treatment for its control.
5. Proton i;c J menstrual flow from retention of blood
by flexion or pinhole external os. — As a rule, when the
normal menstrual flow has reached its termination, a
period variable in every woman, the discharge of blood
ceases, and merely a slight sero-nnicous oozing continues
for a few davs. Until the next regular epoch the healthy
woman has no discharge whatever from her genitals ;
but in a few instances I have been consulted for a return
of the bloody discharge, from several days to a week
after the apparent cessation of the flow, this discharge
continuing for several days, and alarming and annoying
the patient. In one case this recurrence of bloody dis-
charge took place at irregular intervals during the month.
In no case was the amount of blood lost sufticient to
debilitate the patient, nor was this the reason for alarm,
or for her seeking jjrofessional advice. The cases were
all in unmarried or young married women, who had never
been pregnant, and all ladies of refinement, who were
particularly careful about their persons and whom this
oozing annoyed. The color of the blood was always
spoken of as being dark, and mention was made that it
seemed to issue in gushes, small clots, preceded by pain
of an expidsive character.
An examination in these cases would show one of two
conditions : first, and most commonly, asmall, " pinhole "
external os, with dilated cervical canal, and, second, a re-
troflexion, with normal uterine canal. The explanation of
the secondary menstrual hemorrhage complained of in
these cases seemed perfectly simple. In the case of the
narrow external os, the menstrual blood, which toward
the close of the period exudes less rapidly, is prevented
by the narrow orifice from escajiing freely, coagulates in
the cervical cavity, and is gradually expelled in gushes
or coagula, several days after the supposed complete
cessation of the menses. This is, of course, not properly
a profuse menstrual flow, but merely a prolongation of
the natural period.
The treatment of this case is perfectly simple. Re-
move the obstacle to the free discharge of the blood,
make the whole uterine canal of equal width, and the'
menstrual blood will escape from the external os as it
is poured out into the uterine cavity, and all discharge
will cease as soon as no more blood is exuded. This is
best done by making a so-called crucial incision of the
external os, dividing the mucous membrane covering the
cervix to the Length of about one-fourth of an inch, and
then trimming oH" each little flap with fine curved scissors,
so as to make the external os funnel-shaped. Then, by
stretching the uterine canal with divergent dilators, and,
if thought advisable, swabbing it with tincture of iodine,
this little operation is completed. Dilatation once a week
for several weeks, or even several months, is essential to
prevent the orifice from contracting again, and .the iodine
application may be repeated once or twice, if there be a
hemorrhagic tendency in the endometriimi.
This treatment resembles very much that necessary for
chronic cervical catarrh, only that the latter needs much
more active caustic treatment and is more intractable.
In the case of retroflexion, it is evident that the last
blood exuded at the close of the period is not sufticient
to force its way up and through the angle of flexion, for
the very simple reason that blood, no more than water,
will flow up hill. Finally, when the uterine cavity is full
the overflow takes ))lace, or the uterine body reacts on
the foreign contents and expels them by contraction.
Hence the paiu complained of. By elevating the fundus
February lo, 1883.]
THE MEDICAL RECORD.
145
uteri by'a well-fitting pessary, and in addition straighten-
ing the canal by dilatation, this retention of blood will
evidently be renderetl impossible, and any chronic hyper-
emia of the endometrium, wliich may exist besides, is
easily remedied by repeated applications of tincture of
iodine.
Both these conditions are readily susceptible of cure
by the methods above described.
There is one other form of uterine hemorrhage which
I had intended to 'speak of, namely, that caused by the
pelvic congestion induced by a large celluHtic exudation.
But this article has already surpassed the bounds origin-
ally set for it, although I have purposely avoided citing nu-
merous cases in illustration of my remarks, and I shall be
compelled to defer a further consideration of this subject
to another occasion.
\Vliile the uterine hemorrhage treated of in tliis paper
rarely, if ever, assumes alarming proportions, still its
persistence and frequent recurrence renders it a subject
of alarm and annoyance to the patient, and therefore of
etiological and therapeutical interest to the practitioner.
ON THK TNTUDICTOUS USE OF THE SUE
PHATE OF QUININE.
By D. B. St. JOHN ROOSA, M.D., LL.D.,
NKW YORK.
In a paper read before the New York Neurological So-
ciety in 1874,' the writer of this article called the atten-
tion of the profession to the possible dangers to the
organ of hearing from the administration of quinine.
Some discussion arose upon this suggestion, for the re-
marks involved scarcely more than a suggestion at that
time. This discussion led to a series of experiments
conducted on the living human subject by myself, and
upon annuals by Dr. \Vm. A. Hammond. Tlie outcome
of these experiments showed that the administration of
the sulphate of quinine, in doses of from ten to fifteen
grains, appeared to cause vascular injection of the auricle,
auditory canal, tlie tlrumhead, the conjunctiva, and pos-
sibly of the optic papilla, although the latter point was
not so strongly insisted upon, the evidence of support
being based upon one case.
Besides these objective symptoms, which were well
marked in four of the five subjects experimented upon,
there was decided tinnitus aurium and exhilaration,
the latter being apparently like that from a glass or two
of champagne. A case of otitis, which was apparently
caused by the use of quinine, and which has elsewhere
been reported in full, turned my attention to this sub-
ject as early as 1870.'^ I have also reported ' a case where
impairment of hearing already existing was greatly in-
creased on the use of quinine, even in moderate doses.
That the use of the drug does this in many cases I have
been able to verify from frequent experience. It is par-
ticularly harmful to ears that are already in a state of
hyperemia or congestion.
Subsequent clinical investigation have jjlaced the fact
beyond doubt that it is not entirely uncommon to see
inflammation of the retina or its blood-vessels and also
of the middle and internal ear following the administra-
tion of large doses of this drug. The cases to illus-
trate this point are too numerous to be explained away,
and I believe that argument has ceased against the
credibility of the belief that the primary effect of moder-
ately large doses of sulphate of quinine is a congestion
of some parts of the ear and of the retina. There re-
main a few who deny that the effects of quinine are any-
thing but evanescent, but the cases published first by
myself,* and subsequently by Voorhies, De Wecker,
Gruening, Buller, Knapp, and others have finally set-
' American Journal of the Medical Sciences, vol. Ixviii,, p. 388.
-'I're.'Uise on the Kar, third edition, page 155.
^ The Medical Rkcohh.
^ Archives of Ophthalmology, vol. viii., p. 392 ; vol. ix., p. 41.
tied the point that in rare instances deafness and blindness
may be caused by large doses of cpiinine. Dr. Baldwin,
of Alabama, has also published a pamphlet, not at this
moment accessible to me, in which lie has shown the ilire
results that have sometimes occurred from the injudicious
administration of quinine, especially in our Southern
States.
I am far from saying, that in some of these cases,
where the quinine was administered, for serious disease,
it may not have been necessary to take the chances of
ruining the sight or hearing. I simply wish to call the
attention of the profession to the fact, that such a peril
may be incurred. I believe, however, that this drug is
sometimes administered in diseases where its effects are
harmful, and only iiarmful. Such a disease is, I think,
pyiBmia. Dr. Edward T. Ely ' and myself treated a severe
case of this disease, without the use of quinine or of any
other drug, and recovery ensued.
I believe that in similar affections in which cpiinine is
generally administered it may be unnecessary, injudici-
ous, and possibly dangerous.
I have taken great pains to avoid any undue exag-
geration in the language which I use, for I know very
well that the use of the sulpliate of (juinine in reducing
temperature, in diseases where increase of temperature
is a symptom, and the breaking-up of catarrhs, is firmly
fixed in the minds of many practitioners as the one
means of treatment to be at once seized upon. So
strongly has the conviction of the almost panaceal prop-
erties of quinine come to the minds of the profession
that there are hundreds of families in New York City, in
which large doses, that is to say, ten to fifteen grains, of
the sulphate of quinine are taken with no more provoca-
tion than the apparent coming on of a serious cold in the
head. Now, I believe that quinine, given under no ad-
vice except that of the family of the patient, is a danger-
ous drug. I am behind no one in my apjireciation of
its value in appropriate cases, and I should certainly re-
gard unmistakable malarial fever as an appropriate case,
or intermittent neuralgia, and all diseases with a well-
marked malarial type. That there is some abuse of the
term malarial, however, perhaps all of us are ready to
admit.
I am sometimes called to see cases of diseases of
the ear, occurring in the course of the exanthemata,
during convalescence usually, or at least during the
middle stages, and I so often find that the symptoms
are aggravated, in my opinion, by the administration,
even to young persons, of ten to fifteen grains daily
of the drug, that I have felt it my duty to go over this
subject and bring to the mind of the profession these
apparently forgotten facts concerning the eftects of qui-
nine, facts which I claim to have been largely instru-
mental in bringing to the mind of the profession. The
effects of the sulphate of quinine in pyaemia, for example,
are quite contrary to what we desire in the cure of that
disease, if cure can be accomplished. If its cure is to be
by elimination of the poison through the bowels, through
the skin, and through the kidneys, quinine has for one of
its chief actions the shutting up of these emunctories, and
is therefore in the opinion of some, of whom I am
one, just the drug which is absolutely unfitted for the
conditions. For the throwing oft' of the poison constitut-
ing pyemia, the skin, kidneys, and bowels should be un-
clogged sluice-ways. This they cannot be in a patient
fully under the infiuence of quinine. It seems as if a
rapid reduction of temperature is considered the one
thing desired by some practitioners in all cases of fever.
None of us will say that this reduction by the use of a
drug should always be sought for. How many patients
die all the same, although the quinine "brought the tem-
perature down ! " There may be a natural reduction
even of a temperature of 104°. and this may be in some
cases at least more desirable than one induced by medi-
' Archives of Otology, vol. x., page 42.
146
THE MEDICAL RECORD.
[February 10, 1883.
cine. Certainly I recall one case where the sudden
reduction of the temperature only hastened the fatal
collapse. It is no light matter to bring down the tem-
perature with such rapidity as large doses of quinine w'ill
sometinies do. Again, a cold in the head and congestion
of the nasal cavities and of the frontal sinuses, I believe,
are aggravated b}" doses of quinine sufficient to cause
any appreciable effect.
I well remember a case, which I saw about a year ago,
occurring in the family of one of my relatives, where a
delicate woman had been seized with a severe naso-pharyn-
geal catarrh just after a long railway journey. She suf-
fered excessively from the neuralgia arising from the
congested frontal sinus, and naso-pharyngeal tract. In-
stead of what I regard as appropriate and anodyne treat-
ment, in a warm room, to which she should have been con-
fined, she was kept about the house, and drugged by her
family with quinine until the iiiiniins merium, the fulness
of the head, the nervous irritability often caused by it,
added to the symptoms of the catarrh, made the patient a
pitiable object of suffering. When the quinine w-as
stopped, and warm fomentations applied over tiie frontal
sinuses, the throat kept clean by the use of the chlorate
of ])otash, the symptoms began to be at once ameliorated.
The very day that 1 was engaged in looking over this
paper for revision, a gentleman w-ho occasionally con-
sults me in regard to a chronic inflanmiation of one of
his ears, came to ask ni)' advice about a cold in the head,
and tinnitus aurium. His first remark was, " I took
ten grains of quinine when I found this thing coming on,
but it has made my ears ring so that I feel much worse.''
This practice of takiiig quinine to abate colds has good
authority to back it, but in the face of such authority I
interpose my objection that in all colds affecting the mu-
cous membrane of the nares. Eustachian tubes, and tym-
panic cavities it aggravates the condition, and is there-
fore a bad remedy.
In diseases of the ear it becomes positively harmful
by increasing the congestion which already exists. I
have seen cases of subacute disease and acute disease of
the ear which immediately began to recover as soon as
the use of quinine was stop|3ed.
Whenever a drug, as powerful and dangerous as quinine,
becomes the property of the laity, we may expect to see
abuses from its use. There never yet was a popular
error with regard to medical subjects which cannot be
traced, in my opinion, to indiscreet ])ractice on the part
of ourselves. It is very dangerous practice to allow the
public to prescribe for themselves. I ask the profession
to review this subject of the administration of quinine in
cases not malarial in character. 1 believe that they will
then determine that its value in any other than such cases
is doubtful. In diseases of the ear it is especially harm-
ful, as it may be in those of the eye, especially in large
doses. As used for the elimination of poisons, I believe
it to be dangerous and harmful. For the so-called
simple maladies, such as colds in tlie head, its use is
generally attended by aggravation of the symptoms, and
may cause them to extend to the ear. Its efficacy in
malarial affections remains, however, indisputable. In
severe cases of fever with this tyi)e, I suppose we are
justified in taking th'e slight risk to the organs of sight
and hearing which its use in large doses may involve.
.\n Ingenious Dkvice for Supporting a Hospital.
— Mr. Arthur Keugh, of London, has hit upon an in-
genious plan for getting funds foi' the Dental Hospital.
He has started a " cigar thrift fund." He places boxes in
cigar shojis, clubs, smoking-rooms, etc., in which the ends
of cigars can be placed. They are valuable enough, if
the system is sufficiently widespread, to bring in a consid
arable sum of money annually. There is also a small cigar-
cutter for the waistcoat pocket which preserves the tips,
and these gentlemen themselves can save and forward.
SOME QUESTIONS RELATING TO TONSIL-
LOTOMY.
By W. H. DALY, M.D.,
FELLOW OF THE AMERICAN LAKYNGOLOGICAL ASSOCIATION J PHYSIOAN FOR DIS-
EASES OF THE THROAT AND LUNGS TO THE PITTSBL'RG FREE DISPENSARY,
PITTSBURG, PA. : SE.NIOR PHYSICIAN TO THE WESTERN PE.NNSYLVANIA HOSPI-
TAL, PITTSBURG, PA. ; EX-PRESIDENT OF THE ALLEGHANY COUNTY MEDICAL
SOCIETY. ETC.
A BRIEF discussion of some of the questions involved in
the operations for the removal of the tonsils, from a
practical standpoint, will be the aim of what we have to
say to you, and in order to arrive at some rational con-
clusions, we will give some of the views, based upon a
personal experience with a large number of cases, as well
as some of those arising from consultation, with authori-
ties, who by their observation and experience are calcu-
lated to give intelligent opinions upon the questions as
follows :
I. The question of the operation itself
II. The question of hemorrhage after tonsillotomy.
III. The question of the operation affecting' the phy-
sical growth.
IV. The question of virility being affected by tonsil-
lotomy.
- V. The question of the voice as affected by the oper-
ation.
VI. That of faucial utility.
VII. The question of sleep.
VIII. The question of the tonsils becoming again
hypertrophied after their removal.
I. Without entering into the anatomical details as to
the structure of these glands, we will deal more particu-
larly with those phases of the first question "which most
concern the utility and propriety of the operation itself.
As regards its antiquity, there is none more honored than
tonsillotomy,' and as to the methods there is scarcely an
operation spoken of in the annals of surgery that has ex-
cited more human ingenuity with a view of increasing
the practicability of its performance," and hence there are
a diversity of plans. However, the busy practitioner or
specialist is most concerned with what is the best mode
of operation, the indications for its performance, and a
knowledge of some of the dangers to be avoided. Of
one thousand cases collated at the London Hospital for
Diseases of the Throat all but thirty-one were observed
and operated upon in persons under forty years of age,
and the period between ten and twenty years is the one
in which more than one-third of the cases ' were seen
and operated upon.
In patients sufi'ering from enlarged tonsils the bodily
powers are often feeble, some of them congenitally so.
Others have derived cachectic constitutions from scarla-
tina, with throat complications, or from repeated attacks
of quinsv, or have inherited a tendency to scrofula or
tuberculosis.
It has also been thought by modern observers that
patients with enlarged tonsils are not altogether free
from the rheumatic diathesis. Be the causes whatsoever
they may, we cannot but assert that the child which pre-
sents the peculiar stupid countenance, with the open
mouth, drooping eyelids, dull expression, thick voice,
and the profound impress of constitutional impairment,
as well as intellectual dulness and morbidity of disposi-
tion, so generally seen in those suffering from hyper-
trophied tonsils — be the differences of professional opin-
ion ever so varied as to the several questions noted, at
least there is an urgent demand for operative interfer-
ence, in order that the life of the patient, both waking
and sleeping, may be more comfortable, and that the
organs of deglutition, respiration, and vocalization may
do their work unimpeded, and that the vitality of the
growing child may assert itself, as it is sure to do after
being freed from the constantly impending danger and
distress of follicular tonsillitis and congestive pharyn-
* Mackenzie : Diseases of the Larynx, Pharynx, and Trachea, p. 53.
' Op. cit., p. S3- ' Op. ciL, p. 46.
February lo, 1883.]
THE MEDICAL RECORD.
147
gitis, with all the other attendant obstructive discomforts,
which are so apt to follow the slightest exposure to at-
mospheric changes.
The presence of enlarged tonsils ought to be sufficient
reason to demand their removal, but there are other
considerations that increase the need for interference
with tlieni.
The breathing is often obstructed to such a degree as
to become noisy during waking hours, and Httle children
so afflicted snore during sleep like strong grown men,
owing to the posterior nares and pharyngeal cavity being
blocked up by the mass of tonsillar tissue on either side.
Interference with the sense of hearing is a rather com-
mon result of enlarged tonsils, but is not so much due to
mechanical obstruction of the Eustachian orifice by the
tonsillar growths, as to a general thickened condition of
the pharyngeal mucous membrane, the result of inflam-
matory hyperplasia. Michel ' has shown that this form
of deafness is often due to the pressure of Luschka's
tonsil upon the posterior lip of the Eustachian orifice.
The obstruction to free nasal respiration from enlarged
tonsils exposes the patient to all the influences which
tend to bring on inflammation of the air-passages.
In 182S Dupuytren calletl attention to the frequency
with which deformity of the chest was associated with
enlarged tonsils, and the so-called jiigeon-breast is often
associated with the same condition.
Chassaignac" well observed, "that although increased
efforts of the diaphragm to a certain extent neutralizes the
impediment to respiration from enlarged tonsils, there are
frequent intervals when the powers of the muscles be-
come temporarily exhausted, and the oxygenation of the
blood is very incompletely performed. The vital forces
are in consequence very much lowered and the patient
lives in a state of permanent ill-health and easily suc-
cumbs to any acute attack of disease particularly affect-
ing the respiratory organs." This writer also mentions
several cases to illustrate the evil effects of the disease
on the bram, the digestive organs, and on the senses of
sight, taste, and smell. He thinks tlie pressure of the
enlarged glands obstructs the flow of blood to the brain,
and impedes its return, whilst the digestive organs suffer
when there is difficulty of swallowing.
Mackenzie" has often observed that the senses of
smell and taste are defective in the subjects of enlarged
tonsils if the disease has existed for any length of time.
This I have also observed in a few well-marked cases.
As this paper is not intended to treat of the medical
applications recommended for enlarged tonsils, though
there are many used, but in my own hands most of them
have proved very tedious and unsatisfactory, we will,
therefore, speak of some of the most approved operative
procedures, and among these ought to be mentioned
the various caustics, viz., the nitrate ot silver, chromic
acid, nitric acid, the ac!Td nitrate of mercury, and the
galvano-cauterv. Most of these are regarded in some
respects as safe remedies, but some of the caustics are
liable to do unlooked-for mischief by dropping into the
larynx, or they may do injury to the eyes of the operator,
as I have once known to occur from the patient cough-
ing some of the caustic application into the operator's
eyes. The galvano-cautery has lately been used to de-
stroy the enlarged tonsils, and few specialists there are
who are familiar with the use of this battery who have
not used it to a greater or lesser extent for this purpose.
Dr. Cohen, of Philadelphia, has used this method of
removing them, and seems to be favorable to its em-
ployment in certain cases. The advantages regarding
its use, are safety from hemorrhage, but the disadvan-
tages attending it are several. The inflammation fol-
lowing its employment is often severe. The slough is
never just what is expected. It is either more or less
than desired, and during the operation there is the dis-
* Krankheicen der Nasenhblile. Berlin, 1876.
* ]?ullelin G^n^rale de 'I herapie Medicale, 184J
^Op. cit., p. 49.
agreeable odor of biitning flesh that few patients will
tolerate more than once, and still fewer will permit
longer than a few moments. The stumj) left after this
method is often unsightly, and loo often hard and of the
nature of the cicatrices of burns.
This plan, as well as that by means of electrolysis will
scarcely ever become po]iular with practitioners, and the
same methods are destined to be decidedly unpopular with
patients, at least this view is in accordance with my own
experience. Hence I have a very decided jireference for
the cutting operation ; and to perform it with ease, one
assistant should always be ])resent, and if he has had ex-
perience all the better. One of the best I have ever had
was a colored groom, who not only seemed to have an
aptitude for assisting in this operation, but a fondness
for witnessing the flow of blood.
The patient being placed in a good light, either arti-
ficial, which I prefer, or the sunlight, which is quite as ,
good, if not better, the assistant should support the
head of the patient against his breast or stomach, and
with the ends of the fingers make compression steadily
and carefully beneath the angle of the jaws on each side
to steady the head of the patient, and press the tonsils
into the throat. The operator takes his place in front of
the i)atient.
The guillotine is the best instrument for the operation
if the growths are not too large to enter the fenestrum.
The one I prefer is that of Professor Physick, of Phila-
delphia, as modified by Morell Mackenzie, of London
(Fig. i). W'hh this instrument, a firm grasp can be had
Fig. I
upon its handle, with which to hold it in place while
operating.
The guillotine of Dr. Win. 1!. Fahnestock, of Lancas-
ter, Pa., is perhaps better known throughout the world,
and more modifications have been made upon its original
pattern than any other guillotine.
Guersant, Velpeau, Chassaignac, and Maisonneuve
all made important modifications of it, and it is probably
the instrument most used by surgeons everywhere.
The Physick guillotine being ready for use, the hilt is
grasped in the left hand, and with the index finger of
the right hand, the right tonsil of the patient is sought,
and surrounded by the fenestrum. Some jjressure is
made by the guillotine as well as b)- the assistant, that
the growtli may be encircled well to its base. Then the
knife is with the thumb of either hand pushed quickly
home. The tonsil is usually brought away in the instru-
ment, having caught by some shreds in the sulcus or
slit which receives the knife.
I prefer to operate with the left hand first, as in case
of any unruly behavior on the part of the patient, the
dexter hand remains to do the operation on the other
tonsil quickly. The^ entire operation can be done
quickly and is usually painless.
When the growths are either too large to be easily re-
moved by the guillotine, or when they are like a narrow
flap projecting into the throat, I then use these laterally
curved knives with long handles, which were devised by
myself (Fig. 2), and I have found them efficient, the part
1 48
THE MEDICAL RECORD.
[February lo, i88j
to be removed, being seized by these viilsellum forceiis
(Fig- 3) or this tenaculum (Fig. 4), and any other nodular
growths about the tonsils can as readily be removed with
them.
With reference to these laterally curved-bladed knives,
Fig- 3-
which have probe points, as you see, and long slender
handles, I may say that they are probably only a nioditi-
■cation of knives used before by others ; but in my search
.after something to suit my purpose in these operations, 1
was unable to find anythmg in the many illustrated cata-
logues of instruments that met my own ideas of what I
desired. These I have found to answer the purpose
Fig- 4-
admirably. I can safely assure any one who desires to
use them, that they will do tlie work neatly and satisfac-
torily. They were made for me by Otto Helmold, in-
strument maker, Pittsburg, as modifications of one I had
made by Tiemann, of New York, which is, as you see,
rather large for the purpose for which it was designed.
My friend. Dr. Pollock, of Pittsburg, years ago used a
curved-bladed knife in these operations, such as I show
you, and while either instrument will do the work there
is yet a vast difference in the construction of the two
knives.
II. The question of hemorrhage after the tonsillotomy
is one that every operator should be fully prepared to
meet at once. 'I am lately in the liabit of having beside
me a pair of torsion forceps (Fig. 5), such as these, to
Fig- s-
twist any artery that may emit too much blood. I also
like to have a galvano-cautery battery ready for use, with
a pharyngeal knife attached to the handle, in order to
arrest hemorrhage, which may be copious and persistent
from blood-vessels too minute to be seen with tlie naked
eye. Indeed, the most alarming case of hemorrhage I have
ever seen after this operation was in such a case ; the
patient became so weak from the loss of blood that he
was neither able to stand nor sit.
It is true, a simple gargle of alum-water or tannin will
most generally suffice, and either iced or very hot water
as a gargle is quite equal to control most of the cases of
hemorrhage that will occur, but to be prepared for emer-
gencies is to only be guided by good judgment.
A case of hemorrhage after tonsillotomy was related
to me by a medical man that contains such a valuable
lesson that it is worthy of repeating here. He iiad an
appointment to remove the enlarged tonsils of a flirnier's
boy, but when he punctually arrived, ready to operate,
the boy had reconsidered the matter, and thought it wise
to be away after the cows. The doctor, not to be out-
witted by the boy, drove after him, and at length found
him with the cows some distance from the house, on an
out-of-the-way roadside. Afler son)e persuasion the boy
finally assented to the operation being done on the spot.
One of the tonsils was seized and removed by the guillo-
tine, but the hemorrhage which immediately followed was
so copious and alarming as to compel the medical man
to keep his fingers on the stump of the gland for several
hours before any one happened along, in order to get
assistance and save the patient's life. This operation
was not performed soon again by that medical man, and
when he did so, he secured a more auspicious occasion
and surroundings for the work.
Dr. Morell Mackenzie says he has " only known of
one case when hemorrhage actually seemed to endanger
life out of the one thousand cases reported." Velpeau
reported four cases of laying open the internal carotid
artery in operations for the removal of tonsils.
I once had a case of serious tonsillar hemorrhage re-
curring two days after the operation, from the patient
having attempted to eat solids, contrary to instructions.
• III. The question of the operation for the removal of
enlarged tonsils affecting the physical growth of children,
may be briefly stated in my own experience to have
aljvays been most positive and flattering in the highest
degree ; so much so, that I have no hesitation in assur-
ing the friends of the patient that they may look for im-
provement in the physical status of the child, and I have
never yet been disappointed, especially so if proper treat-
ment is carried out with reference to the cure of con-
comitant catarrlial disease of the naso-pharynx.
IV. Now as to the fourth question, viz., that of the
virility of the individual being affected by tonsillotomy,'
I have a very firmly fixed opinion that there is no more
intimate or special relationsliip existing between the
tonsils and the testicles and their functions, than there is
between tlie hair on the scal|i of the patient or the teeth
and the testicle.
The recent revival of this question is chiefly due to a
lecture delivered some months ago by Professor R.
A. F. Penrose, of the University of Pennsylvania, in
which his words, as quoted, were somewhat in this
wise : " I some time ago asked a professional friend of
mine, who was in my office," said the professor, "if his
experience and observation would lead him to believe
that the excision of tonsils had the eftect of destroying
the virile power in the male? He assured me it had
no such eftect. 'Why!' said he, 'I had my own ton-
sils excised when I was young.' Now, gentlemen,"
said Professor Penrose to his audience, "that man's wife
had no children." Will you not allow me to mildly
indulge in sophistry by saying that a man may have lost
a toe, or a finger, or a nose, and his wife have also failed
to bear him any children ; it does not follow, however,
that had some other woman been his wife that he
would have been similarly childless, neither is this illo-,
gical assertion proof that the medical friend of Dr. Pen-
rose was childless, although his wife bore him none.
In answer to a communication to Dr. Penrose, a few
days ago, I received a reply which contained the fol-
lowing: "The lecture (meaning the one above referred
to) was published unknown fB me in some obscure
New York journal. Since then I have received several
communications from medical men of cases where re-
moval of the tonsils did not prevent procreation."
It is to be inferred from this that Dr. Penrose is not
altogether prepared to say his position has been strength-
ened by the testimony of the profession, and as the most
striking example cited by the doctor was the one case
of his medical friend, it is scarcely necessary to pursue
this side of the question further ; but as to the opposite
view, I will state that Dr. G. T. McC , of Pitts-
burg, informs me that he had tonsillotomy performed
when a child. He is now the father of two healthful
children, and he, as well as his wife, are still young.
Dr. Wm. Wallace, of Pittsburg, informs me of a friend
of his, G. W. H , who was ojieraled upon for enlarged
tonsils when a child, who is now the father of three
children.
Dr. John Dickson, of Pittsburg, whose name as an
able and experienced surgeon was a household word in
1 British and Foreign Mctlico-Chirurgical Review for i86o.
February lo, 1883.]
THE MEDICAL RECORD.
149
Western Pennsylvania even before many of us were born,
expressed to nie his opinion that the excision of the ton-
sils had as little to do with the power of jirocreation as
the excision of the toe-nails, and he cited the instance of
A. B , now of Alleghany City, whose tonsils he excised
many years ago when the present man was a child, and
who is now the father of a large family of healthful chil-
dren. He also spoke of the wife of Dr. Wm. M , of
Beaver, upon whom he operated, and who has since been
the mother of several children, as also one of the present
daughters-in-law of the doctor, whose tonsils he excised
when she was a child, but twelve years old, who has since
been the mother of three children.
Mackenzie, one of the closest and most careful ob-
servers, as well as one who has had probably greater
opportunities for observation than any other man who
has practised as a specialist of throat diseases in any
period of time, says only this, "The disease not unfre-
quently becomes developed for the first time about the
age of puberty, owing, as somr suppose, to a sympathetic
connection between the sexual organs and the tonsils," '
and he says further, " Probably many of the cases in the
earliest period were either congenital, or made their a]i-
pearance soon after birth." l\\ a conversation some
time ago on this subject with the accomplished laryngoli-
gist. Dr. Elsberg, he expressed to me the opinion that
there was no relation whatever between the operation of
tonsillotomy and any subsequent loss of will-power.
V. The question of the voice being affected by the
operation. It cannot* be denied that the muffled or
thick voice disappears sooner or later after the parts
have healed.
VI. The faucial utility is much enhanced as the sense
of the presence of a foreign body is no longer a source
of annoyance, and the act of deglutition is performed with
ease and comfort.
VII. The question of sleep. That repose is no longer
disturbed by obstructive suft'ocation which patients com-
plain of, is a matter of fact, and refreshing natural sleep,
unaccompanied by noise or snoring, is productive of rest
and recuperation.
VIII. As to the question of their liability to grow
again, the answer can be included in the remark, " that
with every badly treated or neglected cold affecting the
throat, there will be some tendency for them to increase
in size again, but the tendency is not marked by any
means, and may be prevented altogether with ordinary
care and proper treatment by local applications.
It is a matter of observation that enlarged tonsils have
a tendency to subside after the age of forty years has
been attained.
Women Doctors in Spain. — La Tr'tbuna, of Madrid,
has a long account of the granting by the medical faculty
of that city of a Degree of Medicine on Senorita Martina
Casella Bellaspi. She is the first Spanish woman who
has studied medicine and taken her degree. The paper
speaks in warm terms of her as a lady who, in spite of
much opposition and national prejudice, has won high
honors. Another Spanish lady is following in Senorita
Bellaspi's footsteps. Finding that the Valencian School of
Medicine had closed its doors against her, she is now
studying in Madrid, where she has met with a more
friendly reception.
The Right Name. — The title of the new journal, The
Undertaker' s Assistant, may be objected to on the
ground that it is ambiguous. The Toy Pistol is suggested
as a substitute by Harper' s Weekly. Perhaps The Laiieet
or Neiv Remedies would do.
Urethritis Caused by Frogs. — Dr. Bonarny, in a
recent thesis {Rev. de Therapeut., No. 19), describes two
epidemics of urethritis among soldiers in Africa, caused
by eating frogs which had fed upon cantharides.
' Crisp and Headland. Dublin Med. Press, vol. xx., p. 229, 1849.
lU^ports jot S'ocicttcs.
%'
MEDICAL SOCIETY OF THE STATE OF NEW
YORK.
Severity-seventh Annual Meeting, held in Albany, Feb-
ruary 6, 7, and 8, 1883.
Tuesday, February 6th — First Day — Morning
Session.
The Society met in Geological Hall, and was called to
order at 10 a.m. by the President, Dk. Harvey Jewf.tt,
of Canandaigua.
Prayer was offered by Rev. Albert Foster.
The inaugural address was delivered by the President
and referred to a special cpmmittee, to be appointed by
the Chair.
THE president's INAUGURAL ADDRESS.
With pleasure and great cordiality the President
greeted the Society on the return of its Seventy-seventh
Anniversary Meeting, for the discussion of scientific sub-
jects and strengthening the social and fraternal ties of
the i)rofession. He made his grateful acknowledgment
for the high compliment of a.n unanimous election to
the presidency of the largest medical society in the
United States. Brief reference was then made to the
]5rogress in every deiiartment of literature and science
which characterizes the present age. Speaking of the
medical profession, he said :
"The result of all legislative enactments in this, and
I believe in other States, for the last forty years, _ to
regulate the practice and elevate the standard of medical
education, has done little or nothing to abate quackery
or increase the interest in the medical literature in this
State. Whatever is done in regard to this subject must
be done by the profession through their individual organ-
izations. The profession is competent, through their
representatives in the State and County societies, to
establish what shall be the standard of attainments of
those who are to be received into their ranks. .\ more
complete and thorough preliminary education of young
men who desire to enter upon the study of medicine is
the first step in advancing the cause of medical science.
A much higher standard of medical qualifications before
the granting of a diploma is universally conceded and
acted upon by the leading medical colleges in this
country. These requirements, if carried out, will in the
future tend to bring about the desired result. We have,
as a nation, reached a stage of progress and development
when our leading medical schools can carry the standard
of professional education to a much higher plane than
in years that are past."
Dr. Jewett then urged that the law of 1872 should be
made mandatory, and that a State Board of Examiners,
appointed by the Regents of the University and the
Medical Society of the State, entirely disconnected from
the schools, and whose certificate alone shall be a pass-
port for graduation, would remove all imputation of par-
tiality or favoritism from any source.
"All medical schools that fail to come up to the re-
quired standard of instruction " will go down for want of
l)atronage, and we shall see illustrated the doctrine of
evolution in the '■ survival of the fittest."
The recommendations of his predecessor in relation to
the establishment of se|)arate hospitals in our large cities
for the isolation and care of those who are suffering from
contagious diseases, such as scarlet fever and diphtheria,
as well as the humane supervision of factory children, he
regarded as eminently i)hilanthropic and demanded con-
siderate attention at the hands of this Society.
The subject of the adulteration of food and drugs re-
ceived reference.
The President also respectfully suggested that the an-
nual address of the President be delivered in the hall
I50
THE MEDICAL RECORD.
[February lo. 1883.
where the daily sessions were held. He also directed
the attention of tliis Society to the efficient and pliilan-
thropic labors of our State and National Boards of Health,
and hoped that the Society would not only endorse
the action and services of the National Board, but give
an emphatic expression of their views in regard to with-
holding congressional appropriations to carry forwanl this
eminently benevolent work.
With reference to the action of the Society, at its last
annual meeting, or its system of medical etiiics, the Presi-
dent said :
"At the annual meeting in February, iSSi, this Society
appointed a committee of five, from among the most dis-
tinguished medical gentlemen of the State, to consider
and revise the old code of medical ethics which had
governed our action for nearly forty years. In conform-
ity with the instructions given this committee, they pre-
sented their report at the annual meeting in 1882. . . .
"The report of the committee, as well as a substitute,
was printed and placed in the hands of every member of
the Society who desired a copy, that they might examine
and vote deliberately and understandmgly upon the
changes reported for their consideration and adoption.
After a general discussion, in which all jiresent had an
opportunity to express their views, the report of the com-
mittee was adopted by a large majority. The new code
has not been received by the profession, or tlie medical
liress, in this and in other States, with cordiality or favor,
but, on the contrary, by the most outspoken and emphatic
opi:>osition
" A year's consideration, a calm and dispassionate dis-
cussion of the matter, has greatly modified the views of
the profession in reference to the objectionable measure,
and I trust a more conservative sentiment exists to-day
than at the time of its adoption."
Reference was then made to the action of the Amer-
ican Medical Association, at the annual meetmg at St.
Paul, in June, 1882, refusing admission to the delegates
from the Medical Society of the State of New York, be-
cause they had taken the liberty to accept what was
deemed a more jsrogressive and liberal spirit in reference
to established rational medicine, as it exists at the present
time, and to adopt permission of consultation with any
legally qualified practitioner of medicine, as not deroga-
tory to the interest and dignity of the prolession.
The advocates of the new code asserted that this is
merely permissive, that no one is under obligation, ex-
pressed or inn)lied, to meet an irregular )3ractitioner in
consultation, unless he prefers to do so; but in certain
cases it would be illiberal, inhuman, and contrary to the
spirit of the age, to withhold professional aid, because of
"difference of opinion in creed or belief." The atten-
tion of the Society at this meeting was directed to a con-
sideration of the merits of this subject, to confirm, modify,
or abolish the new code, as in their wisdom and judg-
ment they might deem most conducive to the welfare,
dignity, and interests of the medical profession of tlie
State of New York.
Death has entered our ranks during the past year and
removed those who stood high in the esteem of our pro-
fession ; Prof. James R. Wood, of the city of New York,
Dr. George Burr, of Binghamton, and J. Foster Jenkms,
of Vonkers.
The following Committees were then announced :
Business Committee. — Drs. Alex, llutchins, of Kings ;
C. C. Gay, of Erie, and D. 1-. Hovey, of Monroe.
Committee on Credentials. — Drs. ¥.. V. Stoddard, of
Monroe ; L. E. Felton, of St. Lawrence, and T. H.
Squires, of Cheniimg.
A recess of ten minutes was then taken for ))urposes
of registration.
COMMUNICATIONS FROM COUNTY SOCIKTI KS.
Communications were read from Westchester, Monroe
andliroomeCounties,declaring opposition to the new code.
It was moved that they be placed on file. Carried.
EXPERIMENTAL MEDICINE.
Dr. J. G. Curtis presented the report of the Com-
mittee on Expernnental Medicine. It was stated that
the bill presented by Mr. Henry Bergh to the Legislature
was defeated.
Reference was made to the British Society for Scien-
tific Research. The committee had placed themselves in
correspondence with this body, and had obtained numer-
ous valuable documents thereby.
The §100 appropriated for the committee's expenses
was not expended and was returned into the treasury.
The following resolution was offered :
Resolved, That this Society wish to declare anew its
often-expressed conviction of the supreme importance to
the Art of Medicine of scientific experiments upon living
animals.
The report was adopted.
REPORT OF THE COMMITTEE ON BY-LAWS
Dr. W. C. Wey, Chairman of the Committee, reported
that they had examined the by-laws of the County of
Warren, and recommended their amendments be adopt-
ed as in accordance with the by-laws of the State Society.
The report was accepted and the resolution adopted.
Dr. W^y also reported concerning a communication
from Otsego County — with reference to dropping the
names of permanent members from the roll for non-pay-
ment of dues, that it was not expedient to rescind or mo-
dify section 5 of article 6 of the by-laws of this Society.
The report was accepted and the recommendation] of
the committee adopted.
Dr. Wey also directed attention to the fact that only
seven of the counties in the State had responded to the
request of the Society made at its last annual meeting,
to forward their by-laws for inspection as lo whether or
not they accorded with the by-laws of this Society, and
offered a resolution requesting that, before the next an-
nual meeting, the several counties be requested to sub-
mit their by-laws to this Society, for the purpose of ascer-
taining whether or not they are in accord with the by-laws
of this Society ; and that the Secretary be directed, by cir-
cular or otherwise, to call the attention of the County so-
cieties to the present and preceding resolutions.
The communication was received and the recommen
dation of the committee adopted.
The following
itlemen were made
MEMBERS BY INVITATION.
Drs. R. B. Granger, of New York ; W. W. Potter, of
Buft'alo ; A. H. Riley, of Clinton County ; K. H. Moore»
of Niagara County ; C. E. Willard, of Catskill ; T. A.
Foster, of Maine : H. R. Starkweather, of Albany ; H.
C. Cooper, of New York ; T. Z. Gibbs, of F'ort Ann ;
E. Clark, of Sandy Hill ; E. H. Squibb, of Brooklyn ;
M. J. Leroi, of Albany ; T. W. Goff, of Cazenovia ; R.
C. McEwen, of Saratoga ; H. S. Case, of Oneonta ; G. D.
Dunham, ofPlattsburg ; G. P. Clark, of Syracuse ; D. F.
Dayton, of Potsdam. ; Herman Bendell. of .\lbany ; C. C.
Bartholomew, of Ogdensburg ; A. W. Phel|)s, of Chateau-
gay.
The report of the Business Committee referred to the
resolution adopted at the meeting of 1882, limiting the
duration of the reading of papers to twenty minutes.
Dr. E. R. SguiBB moved that the resolutions of last
year be made to apply to this meeting, with the reserva-
tion that the Business Committee be allowed to extend
the time in such cases as lliey deem |)roper. Carried.
REGARDING THE REPEAL OF ACTION OF LAST YEAR.
Dr. E. R. Squibb offered tlie following resolution :
Whereas, The Special Committee on the Code of
Ethics, in its report at the last annual meeting, recom-
mended a change in one part of the Code which was
more in the nature of a revolution than of a revision,
and therefore may be more radical than was expected or
desired by the constituency of this society ; and
Whereas, That rei)ort was adopted at a session where-
February lo, 1883.]
THE MEDICAL RECORD.
151
ill only fifty-two members voted in the affirmative, and
thus legislated for the entire i)rofession of the State on a
subject of vital importance in a direction which may not
have been anticipated or desired by the profession at
arge ; therefore,
Be it Resolved, 'V\\a.t all the action taken at the annual
meeting of iSSi, in regard to changing the Code of
Ethics, be repealed, leaving the Code to stand as it was
before such action was taken.
Resolved, That a new Special Committee of five be
nominated by the Nominating Committee of the Society,
and be appointed by the Society to review the Code of
Ethics, and to report at the annual meeting of 1884 any
changes in the Code that may be deemed advisable.
Resolved, That the report of this Committee be dis-
cussed at the meeting of 1884, and be then laid over for
final action at the meeting of 1S85.
It was voted that it be the special order for an even-
ing session, at 7.30 o'clock.
Dr. H. S. Piffard then read a paper on
'the etiology and tre.«'Ment of acne.
The author used the term acne in the restricted sense
of infiammatory affections of the sebaceous glands, pre-
senting a variety of grades.
Extensive quotations concerning the etiology of the
disease were made from Wilson, Tilbury Fox, Duhring,
and others, and finally his own belief was expressed that
in the majority of instances acne is not a primary condi-
tion, but one which depends upon irritation and disease
of other organs reflected upon the skin, especially those
connected with the sexual and digestive systems. Four
causes of acne had been recognised : i, local irritation ;
2, gastro-intestinal derangements ; 3, masturbation ; and
4, uterine derangements.
With regard to external causes, Dr. Piffard believed
that they had little if anything to do with producing the
disease. Gastro-intestinal disturbances exercised a
marked influence in its production. F'rom his own ob-
servation, he regarded it as exceedingly difficult to arrive
at the truth concerning the actual eft'ect produced in the
etiology of acne by the third and fourth causes.
Papers by Dr. \V. W. Potter, of Buffalo, on " Puer-
peral Eclampsia," and by Dr. C. R. Agnew, of New
York, on "Notes on the Dangers of Specialists in Medi-
cine," were read by title and referred to the Committee
on Publication.
'- Dr. Samuel Sexton, of New York, then read a paper
ON removal of foreign bodies from the ear.
The removal of foreign bodies from the ear was rarely
necessary in adults.
The speaker stated that living insects and vermin were
generally removed without trouble by the use of water.
The various articles found in the ears were briefly re-
ferred to. One was sometimes called upon to remove the
small shells and sand that get into the ears of surf bathers.
In these cases the special forceps which he had devised
were very usefiU.
In removing foreign bodies it was important to be sure
that there was a body present. It was best to have the
child lie supinely on a low couch, the operator standing
above. The speaker showed a specially devised forceps
and also a curette. A very large number of instruments
that had been devised for removing foreign bodies was
shown.
Dr. Roosa, of New York, believed that none but a
surgeon should attempt to remove a foreign body from
the lower part of the auditory canal, or from the other
side of the membrana tym]iani. But when seen, as they
generally were seen at first by the general practitioner, in
the auditory canal, where the bean, etc., has been placed
by the child or some of its playmates, there was oppor-
tunity for the safe, easy treatment by the use of the syr-
inge and warm water, and he believed that failure would
scarcely ever occur if the case was in its inception. It
it was a case which had been manipulated, he preferred
to use the hook or curette rather than the forceps, and
of the hooks and curettes, that invented by Prof. Gross,
or some of its modifications, answered the best purpose.
Dr. Knapp, of New York, agreed with nearly all that
had been said by Dr. Sexton, and also by Dr. Roosa.
From experiments and a good deal of experience in the
use of forceps for removal of foreign bodies from the eye,
he had been prejudiced against their use in the ear ; but
latterly he had used Dr. Sexton's forceps and found it to
serve an excellent purpose — for managing such bodies
as can be impressed, especially when located in the strait
of the canal. Beyond that point foreign bodies could be
removed only with very great difficulty.
Dr. Knapp exhibited a forceps with dividing branches,
which seemed to be admirably adapted for this purpose.
For removal of bodies which had been pushed beyond
the strait, syringing would bring them to view, perhaps,
and then hooks could be used for their extirjjation. For
subduing the inflammation and stopping the otorrhoea, he
recommended alcohol and powdered boracic acid.
Dr. E. Gruening, of New York, thought too much
stress had been laid upon the use of instruments, and he
believed that by proper syringing the foreign body could
always be dislodged.
Dr. -4. H. Smith, of New York, directed attention to
a suggestion by the late Dr. T. B. Smith, of Nyack —
namely, to carry down to the foreign body a string laden
with some adhesive substance which would dry readily
and firmly attach it to the foreign body. A solution of
gum shellac in alcohol was recommended.
The President, Dr. Jewett, said that while it was
almost always possible to remove foreign bodies with the
syringe soon after they were impacted, later it was not
possible. He related the case of a boy deaf in one ear
for several months from an impacted bug. He removed
this by etherizing the patient and using a bent silver
probe.
Dr. David Webster said that the most important
thing was to be sure and see the object clearly first.
Any one who did this would be very sure to act intelli-
gently afterward.
Dr. Matthewson said that there was rarely need of
great haste in these cases, and that proper deliberation
should always be taken.
Dr. Sexton said that his paper was prepared on the
assumption that the members knew how themselves to
make a choice of the proper means for extracting foreign
bodies. As regards removal of the auricle, he did not
believe that that was a possible operation for the removal
of small bodies, but was apjilicable for the removal of
bullets from the bone parts adjacent.
Dr. Sexton thought that both instruments and sponging
were dangerous in unskilful hands.
Dr. W. B. Chase, of Brooklyn, read a paper on
hot water as a h.-e.mostatic.
The speaker thought that although this topic was old,
it was a subject not yet fully understood or appreciated.
The modus operandi of hot water as ah;i;mostatic was not
yet thoroughly understood. Its special advantages are :
First. — That it exerts no dangerous influence upon
the tissues and does not affect the rapidity of union.
Second. — Its effect is more prolonged than that of cold
water.
Sponging the parts with hot water, during an operation,
was thought not only to check capillary oozing, but to
remove coagula and allow a better chance for union by
first intention.
The water should be at a temperature of 115' to 125°
or 130° F. The good effects in post-partuni and in other
uterine hemorrhages were illustrated by cases.
Dr. C. R. Agnew read his report as delegate to the
.\merican Medical Association. He stated that his cre-
dentials were refused, and that he was not admitted as
a delegate. He received, however, many congratula-
152
THE MEDICAL RECORD.
[February lo, i88
J"
tions from nieiiibers ui)on the stand taken by the New
York State Medical Society.
Some discussion upon the report arose, and it was
voted that the matter be referred to the evening session.
The Society then adjourned to meet at 3 p.m.
Tuesday — First Day — Afternoon Session.
The Society was called to order at 3 p.m. by the Presi-
dent.
MEMBERS BY INVITATION.
Drs. S. S. Cartwright, of Roxbury ; VV. W. Seymour,
of Troy ; H. Wiggins, of Elbridge,: H. H. Dean, of \Va-
tertown ; B. Burr, of New York ; L. E. Holt, of New
York ; C. W. Green, of Albany ; J. W. VVhitbeck, of
Rochester ; J. E. Burdick, of Johnstown.
TREAT-MENT OF CHRONIC URTICARIA.
Dr. J. H. Fox read a paper on the above subject, in
which he spoke first of the disease as commonly due to
functional disturbance of the abdominal viscera, com-
bined with an abnormal condition of the sympathetic
nervous system. To effect a cure we must always de-
pend upon internal medication. An important class are
tliose remedies which tend to eliminate from the blood
imperfectly oxygenated material. Bicarbonate of soda,
3 ss., in carbonic acid water, half an hour before each
nleal. Colchicum is also a valuable agent, at the same
time abstaining from meat.
Another important class of remedies are those which
allay irritation of the gastro-intestinal tract, such as rhu-
barb, with occasional resort to mineral water. Bismuth,
in some cases of gastric irritation, has proved exceed-
ingly beneficial. Sulphurous acid, in drachm doses, three
times a day in sweetened water, has proved especially
efficacious.
A third class of remedies are those which act mainly
upon the nervous system, such as quinia, arsenic, etc.
Special reference was made to salicylic acid, balsam of
copaiba, ergot, nettle-tea, etc.
The conclusion was that the treatment is largely em-
pirical and highlv unsatisfactory. The apparent value
of drugs has been based partly upon careless observa-
tions, and partly upon the fact that the eruption often
disappears suddenly without any treatment whatever.
The successful treatment must de|)end upon a knowl-
edge of its etiology, and a diligent study of the causes of
the disease will produce results more conducive to its
cure than blind experimentation with remedies.
The paper was discussed by Dr. Rochester, of Buffalo,
who spoke of an emetic of ipecac as especially service-
able in the treatment of acute urticaria, and also of some
chronic cases of the affection.
REPORT OF CO.MMITTEE ON PRIZE ESSAYS.
Dr. Rochester reported that but one essay had been
submitted, entitled " Pathological study of epithelioma of
the lip." It was well written and showed much research,
but the committee regretted that its author had debarred
himself from receiving the prize because he had revealed
his personal identity in the manuscript. A paper present-
ed last year was rejected for the same reason, and strangely
it was from the same writer.
Signed, T. F. Rochester,
VV. S. Ely,
W. W. POITEK.
' The report was received and ordered to be entered
upon the minutes.
Dr. Rochester also offered a resolution that prize essays
subsequently submitted to the Society must be prmted
either by type-writer or other means. Adopted.
COMMITTEE ON THE PRESIDENT'S ADDRESS.
The President appointed as the special committee on
the inaugural address, Drs. J. C. Hutchison, of Kings ;
T. D. Strong, of Chautauqua, and \V. S. Ely, of .Monroe.
COM.MITTEE ON NOMINATIONS.
J^rom tJu Society at Large : — Dr. S. O. \'ander Poel, of
New York. J^ro/zi Sc-aatorial Districts : First — F. A.
Castle, New York. Second — P. R. H. Sawyer, West-
chester County. Third — Maurice Perkins, Schenectady.
Fourth — Conant Sawyer, Essex County. Fifth — J. D.
Spencer, Waterfown. Sixth — George Douglas, Chenango
County. Se'cY/ith — H. D. Didama, Syracuse. Eighth — ■
F. F. Hoyer, Erie County.
Dr. J. O. Roe, of Rochester, then read a paper en-
titled
THE PATHOLOGY AND RADICAL CURE OF HAY FEVER.
Hay fever was universally acknowledged to be a very
obscure disease. This was thought to be due to the fact
that investigators had not studied the character of the
tissue of the nasal passages. The author's belief was
that the disease was due to a peculiar susceptibility of
this tissue. The three prominent theories heretofore
held regarding hay fever are i, the pollen theory, which
is the oldest, and has been most widely received ; 2,
the vibrio theory, suggested by Helniholtz in 1868 ; 3,
the neurotic theory, propounded by the late Dr. Beard.
The writer discussed these theories, and contended
that they were insufficient to explain all the (ihenomena
of the disease. He then took up the subject of the
sympathetic relations between different parts, by which
irritations in one region cause disturbances in another.
In the nasal passages, along the turbinated bones,
there is a large amount of very vascular or erectile tis-
sue, which has been called the corpora cavernosa of the
turbinated bones. This tissue is under the control of
the vaso-motor system, and is very easily affected by
irritants. In hay-fever patients the tissue is very suscep-
tible to certain irritants, like pollen, dust, etc.
The reader reported five cases of hay-fever patients
from whom this tissue had been removed. The patients
were all cured. .'Knother physician had treated three
cases in the same way with like results.
Dr. Roe's
CONCLUSIONS
were :
First. — Hay fever is an affection not confined to any
age or sex, and is not caused by the pollen of flowers or
grasses, or by dust or irritating substances alone.
Second. — In some persons the nasal mucous membrane
is very susceptible to certain floating irritants, while in
others it is not.
Third. — This peculiar hyperiesthesia is caused by a .
diseased condition of the erectile tissue in the nasal pa.s-
Fourth. — The systemic effects in hay fever, viz., the
lung, laryngeal, and other troubles, are all reflex in char-
acter, and are due to the local disturbance in the nose.
Fifth. — Treatment during an attack can only be pal-
liative. The patient had best go where the floating irri-
rating particles do not e.\ist.
Sixth. — Curative measures should be attempted during
the intervals of the attack. These curative measures
consist in the entire removal of the diseased tissue.
The paper was discussed by Drs.-Wey, of Elmira (who
took exceptions to Dr. Roe's views) ; Sabin, of West
Troy ; Prout, of Brooklyn ; Greene, of Homer, and
Pomeroy, of New York.
OBITUARY NOTICE.
An obituary notice of Dr. Devillo White, of Sherburne,
was presented by Dr. George Douglas, of Oxford, which
was referred to the Committee on Publication.
Dr. W. F. MiiTENDORF, of New York, then read a
paper
ON A NEW METHOD OF APPLYING RE.MEDIES TO THE EYE.
The method consisted in the use of impalpable pow-
ders, made of gum arabic, with a very small quantity of
sugar of milk, and containing the alkaloid to be used.
February lo, 1883.]
THE MEDICAL RECORD.
153
The advantages claimed were that the preparations kept
for an indefinite time unimpaired, and the quantity put
into the eye could be regulated precisely. The disad-
vantages attending the use of acpieous solutions, such as
formative fungi, wiiich changed the strength of the solu-
tion ; of vaseline, wluch in many instances simply sus-
pended, and did not dissolve the agent used, etc. The
powder is to be applied after the ordinary manner of ap-
plying calomel, from a camel's hair-brush.
Dr. Mittendorf also exhibited a new
EYE SPECULUM
involving the same principle used by Dr. Jarvis in his
nasal speculum, namely, the sliding ring.
The communications were discussed by Drs. Pooley, of
New York ; Roosa, of New York ; Squibb, of Brooklyn,
and Gruening, of New York.
MEMBERS BY INVITATION.
The Committee of Arrangements announced the fol-
lowing : Drs. Wm. Hailes, of Albany ; G. S. Munson, of
Albany ; John Edwards, of Gloversville ; D. H. Cook, of
Albany; J. B. Stonehouse, H. Lilienthal, J. C. B. Grave-
line, G. L. UUman and S. E. Ullman, of Albany; S. G.
De Le Matyr, of Duanesburg ; C. B. Herrick, of Trov ;
R. H. Sabin and W. B. Sabin, of West Troy ; E. B. Tefft,
S. O. Vander Poel, Jr., and Frank Townsend, of Albany.
DELEGATES FROM OTHER STATE MEDICAL SOCIETIES.
Drs. Wm. Ingals and H. W. Williams, of Boston, del-
egates from the Massachusetts State Medical Society ;
E. F. Upham, of Vermont State Medical Society, were
introduced to the Society and responded in appropriate
words.
Two communications received from Clark Bell, Esq.,
New York, were referred to the Committee on Legislation,
to be reported upon at the next meeting.
Dr. David Webster then read a paper on
SYPHILITIC disease OF THE LABYRINTH.
Two cases illustrating this trouble were related. They
were characterized by deafness, tinnitus, and occasionallv
vertigo. In one case only one ear was affected. One
case was cured ; the other decidedly relieved.
Dr. Orin D. Pomeroy read a paper entitled
SYPHILITIC disease OF THE MIDDLE EAR, LABYRINTH,
AND ACOUSTIC NERVE.
The writer discussed the subject of the inflammation
of these parts together, because their differentiation
clinically was not often possible. The symptoms were
enumerated, and consisted of deafness, vertigo, tinnitus,
often facial paralysis, etc. Various accompanying
troubles were mentioned. As to the pathology, it was
thought that the middle ear was oftenest involved. The
points in diagnosis and treatment were given.
Dr. Pomeroy's paper gave rise to discussion, partici-
pated in by Drs. Roosa, Howe, of Utica, and Sexton,
of New York.
Dr. Gruening then read a paper
ON THE INFUSION OF LICORICE BEAN ( ABRUS "PRECATOR-
lUS) IN THE TREATMENT OF INVETERATE PANNUS.
The treatment of pannus by inoculation was discussed,
and the very serious obstacles to its use. Recently, De
Wecker, of Paris, had experimented with licorice, and
had found it to secure all the good results of inoculation
without any dangers.
Dr. Gruening tried this method, but at first with no
result, owing to the beans not being fresh. He then ob-
tained a new supply, and used the infusion upon two
cases of inveterate pannus, which had been before
treated by various methods. The results were so bril-
liantly successful that the patients could be discharged
cured in ten days.
The formula for making the infusion was as follows :
Take 36 beans, pulverized, place in 500 granniies cold
water for twenty-four liours, then add 500 grammes of
hot water, and filter immediately after cooling. Brush it
three times a day upon the surface of the lids. It pro-
duces in a few days a decided croupous or purulent in-
flammation.
Dr. Louis Ei.sberg read a paper entitled
A NEW tongue spatula AND THE PROPER METHOD OF
USING IT.
He referred to a paper presented to the Society just
nineteen years ago. At that time he stated tliat the or-
dinary tongue siiatulje were not much better than a
spoon-handle. The various points required for a jierfect
spatula were enumerated, and some of the changes which
he had found necessary to perfect the spatula then pres-
ented.
Dr. David Little, of Rochester, read a paper en-
titled
A SINGLE CASE OF OVARIOTOMY.
The case was a successful one, although no Listerism
was used. The speaker thought that scrupulous cleanli-
ness was sufficient without antisepsis.
Dr. Gruening's paper was discussed by Dr. Pomeroy,
of New York, after which the Society adjourned to meet
at 7.30 P.M.
Tuesday — First Day— Evening Session,
sustaining the new york code.
The Society being called to order, the resolution for
the special order of the evening was read. The Society
went into Committee of the Whole, Dr. Hutchins, of
Brooklyn, taking the chair.
Dr. E. R. Squibb presented his resolution and read an
argument to prove that the present Code of Ethics was
illegally adopted, because it was not presented to the
County Societies first.
A jjrolonged debate followed. Drs. Roosa, Piffard,
Hopkins, Seymour, Didama, Rochester, Gouley, Agnew,
and others taking part.
The Committee of the Whole then rose and reported
progress to the Society. The Society in Session then
voted upon Dr. Squibb's resolutions, which failed to pass
by a vote of 99 to 105, the yeas and nays being called.
Dr. Roosa then presented the declaratory resolution
which he had presented at the meeting of 1882. It was
voted to postpone its consideration for twelve months.
Dr. J. G. Adams read a protest against the action of
the Society regarding the Code of Ethics.
Wednesday, February 7th — Second Day — Morning
Session.
The 'Society was called to order at 10 a.m. by the
President.
Prayer was offered by Rev. Dr. McGee.
MEMBERS BY INVITATION.
W. R, Pierson, of Schenectady ; T. A. Foster, of Port-
land, Me. ; H. M. Eddy, of Geneva ; G. H. Newcomb,
C. L. Merrill, and W. H. Munson, of Albany ; I. G. John-
son, of Greenfield : A. B. Husted, of Albany ; H. M.
Eddy, of Ontario County ; J. C. Carson, of Willard ; I. de
Zouche, of Gloversville ; D. G. Tucker, of Albany ; D.
M. Wilcox, of Lee, Mass., and Thomas Riley, of Adains,
Mass.
Dr. F. E. Beckwith, of New Haven, was introduced
as delegate from the Connecticut Medical Society.
treasurer's REPORT.
Dr. Charles H. Porter, of Albany, Treasurer, read
his report, which showed a balance in the treasury of
$1,264.21. It was referred to an Auditing Committee
consisting of Drs. M. Perkins, W. S. Ely, and Hopkins,
of Buffalo, which subsequently reported that the accounts
of the treasurer had been found correct. The report of
the Committee was adopted.
154
THE MEDICAL RECORD.
[February lo, 1883"
Report on the Merritt H. Carl fund showed $149.26
available for purposes of prize essays.
Dr. ¥. R. Sturgis reported for the
COMMITTEE ON LEGISLATION.
Several points were involved in the report, and a re-
solution was offered asking for an appropriation of $500,
to be used by the Committee on Legislation in defraying
necessary expenses incident to looking after medical
legislation and the interests of the medical profession in
the jjassage and obstructing the passage of medical laws.
With regard to the two bills forwarded by Mr. Clark
Bell, the Committee recommended that they lie over and
be transferred to the next Committee on Legislation.
Dr. Van De ^\"ARKER offered certain amendments,
which he subsequently withdrew.
A connnunication from the Chancellor of the Univer-
sity of the State of New York concerning
BOARDS OF EXAMINERS, FOR THE EXAMINATION OF
CANDIDATES FOR LICENSES TO PRACTISE PHVSIC AND
SURGERY,
■was read by Dr. Hutchins, on behalf of Dr. ^'ander
Poel, in which the desire was expressed to have the co-
operation of the State Medical Society in the appoint-
ment of persons to fill vacancies now existing in the
present Board.
Dr. Hutchins moved that a Couuuittee of tliree be
appointed to confer witli the Regents of the University
in the matter referred to. Drs. S. O. Vander Poel, E.
M. Moore, and A. Jacobi, were appointed as the Com-
mittee.
REPORT ON THE PRESIDENT'S INAUGURAL ADDRESS.
Dr. J. C. Hutchison, Chairman, reported that, in the
opinion of the Connnittee, further legislative enactment
is unnecessary ; that the study of medicine by those
deficient in preliminary education should be discouraged ;
that those medical schools should be recommended
■which furnish the most thorough course of instruction ;
that a State Board of Examiners cannot be made so free
from political influence as to entitle it to recommenda-
tion ; that State Boards of Health should be supported ;
that tliere should at present be no change with regard to
the place where the annual address is delivered ; but that
it would he well hereafter not to require an annual ad-
dress, as all matters pertaining to the Society and the
profession could be incorporated in the inaugural ad-
dress.
The report was accepted and placed en file.
Dr. a. Jac(jbi made a report of tiie Committee on the
President's Address in 1S82. The report concerned the
establishment of
HOSPITALS FOR SCARLET FEVER.
The history of the successful attempt to provide for
such a hospital in New York City was given.
The report was accepted.
Dr. W. S. P^lv reported as
CENSOR TO THE MEDICAL DEPARTMENT OF THE UNIVER-
SITY OF .SYRACUSE.
The report was favorable to the qualifications of the
candidates for examination.
Dr. Munde then read a paper on
NON-PUERPERAL UTERINE HEMORRHAGE.
The paper is published in full in the jiresent niunber.
It was discussed by Dr. \'an uk Wakkek, of Syra-
cuse, who regarded it as a most valuable and practical
communication. It was also discussed by Dr. B. V.
Sherman, of Ogdensburg.
Dk. K. a. Castle, of New York, reported a resolu-
. tion to the effect that a complete list of
KEGISTERED PRACTITIONERS
in the Stale be made and appended to the volume of
Society Transactions. After considerable discussion the
resolution was laid on the table, on the ground that such
a work belonged more properly to the State.
Dr. Didama, of Syracuse, presented the following reso-
lution as an
AMENDMENT TO THE BY-LAWS.
" That all action taken at the annual meeting of 1882
in regard to changing the Code of Ethics, be repealed,
leaving the code to stand as it was before such action
was taken."
It was received and recorded to be acted upon at the
meeting of 1SS4.
Laid over under the rule.
An obituary of S. M. Van Alstyn, of Richmondville,
prepared by Dr. A. Vandeveer, of Albany, was read by
title and referred to the Committee on Publication.
Dr. Louis Ei.sberg read a paper on a
FORCEPS ECRASEUR FOR REMOVING NASAL POLYPI.
A number of instruments were shown, and the special
advantages of the speaker's were described.
It simply replaced the transfixing needle, as in Jarvis's
snare, with a forceps.
Dr. Roe showed a long serrated clamp which he had
used to seize the tissue, crush it, and then cut it off.
Dr. H. Knapp, of New York, read a report on the
eighth series of
ONE HUNDRED CATARACT OPERATIONS.
The results were that among one hundred cases there
were ninety good results, seven moderate results, two fail-
ures, and one case not recorded, as the patient died of
hematuria. The method of operating was Graefe's
modified linear. The speaker thought that he could ob-
tain no better results, as there must always be a certain
number of failures, owing to the unrullness of jiatients
and other causes. Dr. Knapp said that in cataract
operations there must be more than antise|5sis — there
must be effort to secure primary union. To secure this
there must be absolute cleanliness in every detail and
perfectly smooth incisions. The speaker had used strict
antisepsis (Listerism) in every other case, but got no
better results than when these measures were not em-
ployed. He made a clean incision into the capsule
instead of tearing it. After the contents were removed,
healing by primary union took place. The capsule was
then removed two weeks later in many cases, by opera-
tion with a scalpel needle.
The Societv then adjourned to meet at 3 p.m.
Wednesday — Second D.\v — -Afternoon Session.
The Society was called to order at 3 p.m. by the Chair-
man of the Business Committee, and Dr. W. C. Wey,
of B^lmira, was elected President /;v tern.
Dr. Roosa, of New York, then read a paper on
the injudicious use of THE SULPH.4TE OF QUININE.
It appears in the present number of The Record. It
was discussed by Dr. T. R. Pooley, of New York, who
cited cases confirmatory of Dr. Roosa's statements ; by
Dr. Jacobi, who thought sufficient distinction had not
been made between py;emia and seiiticcmia ; in pyemia
it had been established that quinine counteracted the
migration of white blood-corpuscles, and so was benefi-
cial in pyremia ; while in se])ticKuiia but slight benefit
follows its administration.
Dr. W. Manlius Smith spoke of some observations
made with reference to the different effects jjroduced
upon himself by cinciionine, cinchonidia, and quinia ; as
that cinchonine afl"ected his vision more than did qui-
nine, and it also diminished the urinarv secretion, etc.
Du. Roosa did not believe tliere was any such dis-
tinction between pyrcmia and septicemia as had been
made by many authorities.
The paper was also discussed by Dr. Ingai.s, of
Boston. '
February lo, 1883.]
THE MEDICAL RECORD.
155
Dr. H. W. Williams, of Boston, tlien made some re-
marks on
ERYSIPELAS EXTENDING INTO THE ORBIT.
He had seen four cases of orbital cellulitis resulting from
facial erysipelas, and had never met with a case of this
kind until two years ago, nor had any been brought to his
notice in literature until after he had seen his tirst case.
The sym])toms were pain, projection of the eyeball di-
rectly forward rather than to one side, pale condition of
the fundus, sensation of fulness, great engorgement of the
tissues, swollen lids, chemosis of the eyeball. The treat-
ment recommended was early evacuation of the pus, and
this he did in all his cases by means of deep punctures.
In the discussion of Dr. Williams's paper, Dr. T. R.
PooLEV, of New York, referred to a marked case of acute
protrusion of the eyeball, which he had treated by in-
cision, and with success. He thought that a single large
incision was the preferable method of treatment. He
thought the loss of sight which sometimes occurred was
due to pressure on the optic nerve. The disease had
been described by Von Graefe under tlie name of retro-
bulbar neuritis.
Dr. Daniel Lewis, of New York, presented a paper
on "The Development of Cancer from Non-Malignant
Disease," which was read by title.
Dr. Robert Newman read a paper entitled,
the use of suppositories of gelatine for local
medication.
The speaker had usetl cocoa butter and various other
substances, but with no good result. Two years ago, he
began to use bougies of gelatine and with great success.
The speaker showed sujipositories of this material for the
urethra, rectum, nose, vagina, sinuses, etc.
Especial attention was called to the urethral bougies.
Their advantages lay in being neat in appearance, soft,
elastic, fle.xible, not easily broken, and slowly dissolved.
They contained the medicines equally dissolved and dis-
tributed. They are not injured by time or temperature.
The best time to introduce them was at night and not
in the daytime. They had better be moistened Willi
water. In order to keep them in, apply a small piece of
cotton at the urethral orifice, and over the latter a bit of
adhesive plaster. They are to be used only when the
urethra is acutely inflamed and will not tolerate anything.
A number of cases were reported, in prostatitis great
care must be used ; ten to twelve bougies will generally
be sulficient.
Dr. Poolev, of New York, read a paper on
RUPTURE OF THE CHOROID.
A number of cases were related illustrating this trouble.
The jiatient's history, with distorted or more or less loss
of vision and the ophthalmoscopic appearances of a cres-
centic white patch with concavity toward the optic disk,
revealed the disease.
Dr. Williams, of Boston, and Dr. Pooley discussed
the paper.
Dr. Frederick Hyde, of Cortland, read a paper
entitled,
WHEN SHALL THE TREPHINE BE USED IN FRACTURE OF
THE SKULL ?
The general tenor of the paper was in favor of a non-
conservative treatment of cranial fractures. The writer
especially urged the use of the trephine in cases of frac-
ture, even w-hen symptoms of pressure were not present.
Dr. T. H. Squire, of Elmira, read a paper on
SOME POINTS IN RESPECT TO OVARIOTOMY.
The first was with regard to the pro|)er form of trocar.
The speaker thought that a plain tube with a slot half an
inch from the e.xtremity would be an improvement on
that generally used. The inner canula might often be
dispensed with.
The second point was as lo the time when ovariotomy
should be performed. There used to be a belief that the
operation should be delayed. The speaker thought that
the tendency now was to perform it as early as possible.
A course of preparatory treatment would always be
needed.
Dr. Squire also gave tlie history of a case of
VESICAL CALCULUS
occurring in a girl seventeen years of age. It was re-
moved through the urethra, which liad been fully dilated.
The nucleus of the stone was some foreign body, like a
pin or needle, which liad been left in the bladder.
The Committee of Arrangements announced the follow-
ing as
MEMBERS BY INVITATION :
Drs. Lew-is Granger, of Tioga County, Pa. ; L. A. Tourtel-
lot, of Lllica ; A. James Browne, of Newport ; and C.
W. Hamlin, of Middleville ; J. D. Lomax, of Rensselaer
County ; C. F.. Lyon, of West Troy ; W. C. Cooper, of
Troy ; Wm. Stevens, of New York ; and D. H. Cooks, of
Albany.
Dr. L. E. Felton, of Potsdam, then read a paper on
the use of
LACTIC ACID IN DIABETES.
Eight cases were reported in which favorable results had
been obtained with this drug. The patients presented the
ordinary symptoms of those suffering from glycosuria,
passed large (luantilies of urine with high specific gravity,
and containing sugar. Lactic acid was given, a drachm
and a half dail)-, diluted in a quart of water, and an exclu-
sively meat diet was adopted. i\[eat, sour milk, and lactic
acid constituted the chief factors in the treatment, the
drug being given in smaller quantities than recommended
by Cantanni.
Dr. Wey, of Elmira, referred lo a case in which the
patient had lost thirty, or more, pounds in weight, and
was passing six gallons of saccharine urine daily. The
ergot treatment recommended by Dr. DaCosta was
adopted, and in a very short time the daily ([uantity of
urine was reduced eighty ounces, the skin became moist,
the specific gravity of the urine fell, the sugar materially
changed in quantity, and there seemed to be fair pros-
pect of recovery.
Dr. French, of Montgomery County, thought that
strict attention to diet could do more in these cases than
could medicine.
Dr. Jacobi regarded restriction of the diet as the
principal factor in the treatment of diabetes, as a rule.
At the same time it was well known that the treatment
of diabetes nowadays is much more successful than it was
thirty years ago, when it was supposed that every case
of the disease would invariably terminate fatally. He
then referred to the fact that sugar occurs in the urine
temporarily not very infrequently ; and also mentioned
three cases in which sugar had promptly disappeared
from the urine under the internal use of eight grains of
iodoform daily, together with restricted diet. He be-
lieved that if the urine was tested for sugar as frequently
as it is for albumen, that sugar would be found to be
present in a much larger ]iroportion of cases than is gen-
erally supposed.
Dr. W. Gillis, of Fort Covington, then read a paper
entitled,
REPORT OF A CASE OF PUNCTURED WOUND OF THE SKULL
THROUGH THE ORBIT WITH COMPLETE AMNESIC APHASIA.
The iiatient, a boy, was struck in the eye with the
lirong of a dung fork,' wliich penetrated the skull through
the orbit for a distance of three or four inches. The
child was unconscious, and remained so for three days.
Facial paralysis and hemiplegia of the right side ap-
peared and lasted for about three days, gradually disap-
pearing. Eight months later the child was entirely
recovered, excei^t that from the beginning it had been
unable to articulate. Hearing, vision, and all the special
senses were ])erfect. Intelligence was unimpaired.
156
THE MEDICAL RECORD.
[February lo, 1883.
The paper was discussed by Drs. W. S. Ely, of
Rochester, H. R. Hopkins, of Buffalo, B. F. Sherman,
of Ogdensburg, and F. Hyde, of Cortland.
The Society then adjourned to meet in the Assembly
Chamber at the new Capitol, at 8 p.m., to listen to the
President's annual address.
Wednesday — Second Day- — Evening Session.
annual address of the president some of the
perils to life from the preventable diseases.
" Life and health may be regarded as the sum of all
good to the human race." The health, happiness, and
prosperity of mankind nuist be intimately and inseparably
connected with and dependent upon its sanitary con-
dition. The people are slow to comprehend the dangers
that arise from trivial causes, and from habits of life in
which they have indulged for years, because they are un-
able to trace any direct connection between obscure and
indirect causes and positive results. They are also un-
willing to accept the fact that disease and death may re-
sult from their own carelessness and uncleanly practices.
The excessive civilization of modern times, the lestheti-
cism of the age has blinded our eyes and perverted our
judgments, and led us to stray from the habits of primi-
tive times that gave our ancestors more vigorous constitu-
tions and more stalwart I'rames than we of this generation
can boast.
There are some conditions which greatly affect the
health of the community over which sanitary work has
little or no control ; as, for example, the temperature
and moisture of the air, variations in which greatly in-
fluence the health of the people. But these are not the
agents with which we are to deal in endeavoring to check
the progress of diseases, so much as it is certain combi-
nations of heat, moisture, and animal or vegetable de-
composition, occurring either in the course of nature or,
more often, as the sequence of man's careless and slov-
enly habits. To these we are to look for predisposing
conditions, even though we may not always see the ac-
tual cause of disease. Attention was then directed to
preventive medicine and to the work of the general prac-
titioner in relation to it. National boards of health
must be backed by local boards, and local boards must
be sustained by individual practising physicians.
At this point special attention was directed to the in-
ability of the majority of practising physicians to properly
advise their jjatients and patrons in sanitary matters,
owing to their deficiency in knowledge of the first princi-
ples of sanitary science, which involve a study of defects
in drainage, the best means of furnishing and protecting
water supply, securing ventilation, etc. A knowledge
of chemistry, natural philosophy, and the natural sciences
generally, should be had, and here the President passed
to a consideration of the demand for more thoroughly
educated men before entering upon the study of medicine.
The advantages to be derived from the observation of
contagious and epidemic disease in rural districts, where
it is isolated as it were from special prejudicial influences,
were then presented. Brief reference was then made to
the part which germs are sui)i)osed to play in the produc-
tion of disease, and a conservative conclusion was reached.
Attention was then directed to the influence of defec-
tive drainage and sewerage upon the health of the people,
and the President believed it to be safe to give patients
the benefit of the doubt whether it be est.ablished or not
that diphtheria, scarlet fever, or other diseases are pro-
duced by sewer-gas or micro-organisms. The influence
of wet soil, cesspools, ground water in building sites,
and of contaminated water, was then referred to. The
profession needs gentlemen in every district, who, in
general information and culture, shall be leaders among
the people in every good enterprise, and give the dignity
to and respect for the profession of medicine which it
does not fully possess to-day. Under the present system
of medical education, the President failed to see the pros-
pect for the achievement of this desirable result. VV'hen
such a result shall have been obtained, and when pre-
ventive medicine shall have attained its destined emi-
nence we shall hold a prouder position and be more than
ever the benefactors of the race.
Thursday, February Sth — Third Day — Morning
Session.
The Society was called to order at 9 a.m. by the Presi-
dent. Prayer was offered by Rev. Dr. Reese.
Dr. Smith, from the Committee on Publication, re-
ported that the delay caused in issuing the last volume
of the " Transactions " was due to failure on the part of
authors to return proof-sheets.
Dr. Howe, of Buffalo, introduced the following as an
amendment to the By-laws : " That the Code of Ethics
of the American Medical .Association be substituted for
the one adopted by this Society in 1882, and having thus
gained the unquestioned right to representation that our
delegates be instructed to advocate such modification of
that Code as shall be in accordance with a spirit of greater
liberality, or if advisable to urge its entire abolition."
Dr. Porter, of Albany, offered a resolution that a
committee be appointed to confer with the Capitol com-
missioners concerning appropriating a room in the new
building fortlie use of the State Medical Society. Adopted,
and Drs. Porter, Bailey, and Mosher, of Alban}', were
appointed.
Dr. Porter also ottered a resolution that a committee
be appointed to consider the propriety of publishing, and
to publish, if deemed desirable, the "Transactions,"
from 1837. Adopted, and Drs. W. M. Smith, C. H. Por-
ter, and F. S. Curtis were appointed.
officers for ensuing year.
The Committee on Nominations submitted the fol-
lowing report, which was adopted :
For President — Alexander Hutchins, of Brooklyn.
For Vice-President — H. G. P. Spencer, of Water-
town.
For Secretary — \\'iiliam Manlius Smith, of Syracuse.
For Treasurer — Charles H. Porter, of Albany.
For Censors — Southern District : J. W. S. Gouley,
Austin Flint, F. A. Castle, of New York. Eastern Dis-
trict : C. E. Nichols, M. H. Burton, W. S. Cooper, of
Troy. Middle District : Alonzo Churchill, S. G. Wal-
cott, J. K. Chamberlayne, of Utica. Western District :
C. C. Wyckoft", Thomas F. Rochester, F. F. Hoyer, of
Buff"alo.
Committee of Arrangements — S. B. Ward, J. S.
Mosher, of .Albany ; W. .S. Ely, of Rochester.
Committee on By-Laws — W. C. VV'^ey, of Elmira ; H.
G. Piff'ard, of New' York; Wm. Manlius Smith, of Syra-
cuse.
Committee on Hygiene — E. V. Stoddard, of Rochester;
Stephen Smith, of New York ; Jacob S. Mosher, of Al-
bany ; P. R. H. Sawyer, of Bedford ; Caleb Groen, of
Homer; Edwin Hutchinson, of Utica ; Theodore Dimon,
of .\uburn.
Committee on Legislation — Jacob S. Mosher. .Albert
Vanderveer, of Albany ; F. R. Sturgis, of New York.
Committee on Medical Ethics — C. R. Agnew, of New
York ; E. M. Moore, of Rochester ; S. O. Vander Poel,
of New York.
Committee on Prize Essays — Thomas F. Rochester,
of liuffalo ; \\'m. S. Ely, of Rochester ; W. W. Porter
of Buffalo.
Committee on Publication — Wm. Manlius Smith, of
Syracuse ; Charles H. Porter, of Albany ; George J.
Fisher, of Sing Sing.
Curator for the College of Medicine, Syracuse Univer-
sity— C. S. Starr, of Rochester.
For Permanent Members — First District : F. P. Fos-
ter, Laurence Jolinson, Alfred C. Post, David Webster,
of New York ; John Byrne, of Brooklyn. Second Dis.
February lo, 1883.]
THE MEDICAL RECORD.
157
trict : J. J. Ijinsen, of Tanytown ; E. F. Quinlan, of
iMonticello. Third District : S. B. Ward, of Albany ;
C. E. WiUard, of Catskill. Four.h District: A. J.
Browne, of Herkimer ; A. M. Phelps, of Chateaugay.
Fifth District : J. N. Goff, of Cazenovia ; J- D. Spencer,
of Watertown. Sixth District : L. D. Witherill, of Union ;
D. W. Huge, of Peach Orchard. Seventh District : J. ]i.
Chapin, of Willard ; Alfred Mercer, of Syracuse. Eighth
District : W. W. Potter, of Buffalo ; J. W. Whitbeck, of
Rochester.
J^or Honorary Members. — T. J. Turner, of the United
States Navy and National Board of Health ; William
Goodell, of Philadelphia ; Lockhart Robinson, of Edin-
burgh, Scotland.
Elii^ible to Honorary Membership — W. B. Robinson,
of Edinburgh, Scotland ; W. Bronson, of New Canaan,
Conn. ; Professor J. Cabell, of the University of Vir-
ginia ; Professor J. G. Richardson, of the University of
Pennsylvania ; Professor J. T. Whitaker, of Cincinnati,
Ohio ; W. Hingston, of Alontreal, Canada.
JDclegates to State Aledieal Societies — Massachusetts :
Geo. C. Smith, of Rondout ; E. N. Brush, ofUtica; P.
V. S. Pruyn, of Kinderhook ; George G. Hopkins, of
Brooklyn. New Hampshire : Wm. M. Chamberlain, of
New York. New Jersey : J. C. Hutcliison, of Brooklyn ;
Robert Newman, of New York. Ohio : Thomas R.
Pooley, of New York. Pennsylvania: H. C. May, of
Corning ; Sol. Van Etten, of Port Jervis ; T. D. Strong,
of VV'esttield. Vermont : D. Eyon, of Plattsburg ; A. G.
Long, of Whitehall; C. C. F. Gay, of Buffalo. Con-
necticut : P. R. H. Sawyer, of Bedford ; E. V. Stoddard,
of Rochester ; George Douglass, of Oxford.
Delegates to the Canadian Medical Association — B.
!•'. Sherman, of Ogdensburg ; H. G. P. Spencer, of
Watertovvn ; E. E. Felton, of Potsdam ; J. C. Hutchi-
son, of Brooklyn ; R. J. Robb, of Amsterdam.
Censor for the College of Medicine, Syracuse Uni-
versity— C. S. Starr, of Rochester.
Respecting the American Medical Association, the
Committee reported that it deemed it inexpedient at
present to name any delegaton to that body.
A vote of thanks was extended to the President for
the impartial manner in which he presided, and the Busi-
ness Committee recommended that the Society adjourn
to meet on the fust Tuesday in February, 18S4.
ATassachusetts Health Statistics.— The annual re-
port of the Massachusetts Board of Health, Charity, and
l,unacy, for 1SS1-2, has recently been submitted to the
Eegislature.
Under the head of public health, it is stated that Mas-
sachusetts is more exposed to sniall-pox than any other
State, and in 188 1-2 it appeared in about thirty cities,
but no extensive mischief resulted. The deaths from
this disease in the State in 1882 were less than the small-
jiox deaths in Chicago in one week. The presence here
of small-i)Ox is due to immigration at our ports, paper,
rags, and the Canadian immigration by land. The year
1882 was one of average health, and no disease can be
said to have prevailed excessively.
Malaiial fever has not appeared in so many towns east
of the Connecticut as in the previous years, but in the
western part of the State it seems to have been more
prevalent than ever. In connection with the National
Board of Health and the State Boards of New York,
Connecticut, and Rhode Island, this board took steps for
a combined investigation of the subject of malarial lever.
A mass of valuable information has been secureti, but
the laboratory work, by reason of the failure of the Na-
tional Boai'd to obtain the usual ai)propriation, was sus-
[lended in July.
The aggregate number of the insane in the State is at
least 5,100, a net increase of about 200. The latest in-
vestigations prove that not more than 50, probably not
more than 30 per cent, of the insane permanently re-
cover. Only about two-fifths of the insane are Americans.
The Medical Record:
A Weekly yoiiriial of Medicine a7td Surgery.
GEORGE F. SHRADY, A.M' M.D., Editor.
Published by
WM. WOOD &. Co., Nos. 56 and 58 Lafayette Place.
New York, February 10, 1883.
THE MEETING OF THE STATE SOCIETY.
The meeting of the Medical Society of the State of New
York was, as will be seen by our full report, one of not-
able interest. The attendance was unusually large,
every county society being duly represented. There was
one feature in connection with the papers presented
which calls for special comment. The lack of variety
of the subjects discussed by them was strikingly apparent.
If a stranger had dropped in at any time during the
sessions he could very justly conclude that the Medical
Society of the State of New York was specially interest-
ed in one of two things — either the study of diseases of
the eye and ear, or the merits of the question of freedom
in consultations. There was altogether too much of both
of these subjects to develop a proper scientific interest
on the part of the general practitioner in the proceedings.
It was i^erfectly |5ro|)er to make the discussion of the
merits of the new Code a special order of business for
one evening, but that was enough. As to quantity of
material, so might it be said of papers by our good friends
who have taught us so much concerning diseases of the
eye and ear.
Although each of these papers had been carefully pre-
pared, and presented the latest views on their subjects,
they in the main lacked practical application to the wants
of the general practitioner. While there was an embanass-
raent of riches in one direction there was a notable fall-
ing off in another. This should hardly be the case in
a society composed, as this is, largely of men who, in the
broadest sense of the term, are general practitioners, and
whose real interest consists in the freest opportunities
for exchanging news and comparing experiences in the
treatment and diagnosis of the conunoner diseases. Per-
haps the fault is as much to be laid at the door of the
average member, who is disinclined as a rule to read
papers, as to the specialist, who is more of a worker in
that direction and who occupies time which otherwise
might be entirely unap|noi)riated to bcientific purposes.
Hence the complaint that the specialists are generally to
the front should react upon the very members who have
it in their power to divide the honors by contributing
their own proportion of work. The example of New
York in respect to scientific zeal should be imitated by
the rural brethren, whose fields of observation are large
enough to afford them every opportunity for the contri-
bution of most valuable experience, and who really have
i=;8
THE MEDICAL RECORD.
[February lo, 18S3.
no excuse for not adding to the scientific interest of the
meeting accordingly.
A great deal of the interest of the meeting centred, as
might have been anticipated, upon the discussion of the
new Code. This discussion took place before the largest
meeting the society ever held. The freest interchange
of opinion was invited and the conclusions arrived at were
deliberate and pt'onounced. It is a matter for congratu-
lation, that, with few exceptions, a becomingly charitable
spirit characterized the debate and that all the arguments
pro and con that were collected from so many sources
during the past year were quite exhaustively presented.
The vote against Dr. Squibb's resolutions to restore the
American Code, was unexpectedly large, considering the
amount of extra-State and extra-professional pressure that
had been brought to bear upon County Societies. The
matter can now be safely left where it is.
We may be permitted to say, however, in the greatest
courtesy, that the present action of the Society conclu-
sively shows that Xew York State is determined to take
care of its own ethical affairs and resents meddlesome in-
terference from outside influences.
As a result of the meeting, we believe it to be settled
beyond all cavil and question that the majority of the
physicians in the State are in favor of the non-restrictive
Code. Equally strenuous efforts were made by both
parties to have all their forces represented at the recent
meeting. The vote was fairly taken, and plainly showed
the sentiments of the delegates and members. We need
hear no more now about the arts of " Xew York special-
ists," since, out of the 105 votes, hardly a dozen were
cast by these gentlemen.
As a further confirmation of the fact that the vote ex-
pressed the sentiment of New York State, we would state
that Dr. Manlius Smith, the secretary of the Society, re-
ceived nearly seven hundred answers to queries from
practitioners throughout the State to his card, asking
their opinion of the Code. Of these, a very consider-
able majority favored the present Code. Yet a large
part of the answers came from the country, while it has
been claimed that the cities represent the real strength
of non-restrictive principles.
.ABDOMINAL SECTION.
Dr. J. EwiiXG Mears, of Philadelphia, presented to the
College of Physicians of Philadelphia a resume of
twenty-five cases of abdominal section, in which some
interesting and instructive facts are considered. Twenty-
two of these operations were performed for the removal
of tumors of the ovary. In none of the twelve cases in
which aspiration or tapping was performed did any seri-
ous results occur, nor w'ere there evidences in the opera-
tions which followed of complications due to the previ-
ous aspiration or tapping. . The incisions were closed
by metallic sutures, the needle being carried so as to
include the peritoneum. In all cases but one the jied-
, icle was secured by the application of the clamj) ; in
the case excepted a carbolized catgut ligature was ap-
plied and the pedicle was returned to the abdominal
cavity. In one instance of an extremely short pedicle,
where, in fact, the wall of the cyst was separated not
more than half an inch from the uterus, a double animal
ligature was applied, which failed to control the hemor-
rhage. The clamp was then applied over the ligature,
bringing the uterus well up between the edges of the in-
cision. Although the patient had a tedious convales-
cence, the hgature and clamp came away in good time
and the abdominal incision healed kindly. Beneath the
cicatrix the uterus could be distinctly outlined, and after
the return of the patient to her usual duties no complaint
was made of pain caused by traction upon the organ.
In one case only was there noticed a slight tendency to
the occurrence of ventral hernia. The healing of the
abdominal incision was not materially delayed by the ap-
plication of the clamp. In three cases menstruation
took place by the pedicle, but did not produce any seri-
ous inconvenience. In one of the three fatal cases
which occurred, the ligature was applied and the pedicle
returned to the abdominal cavity ; death resulted on the
third day from septicemia. In this case the cyst was
adherent in every part to the parietes and viscera. In
fourteen cases the antiseptic methods were employed,
the spray, however, being omitted. One of these cases
proved fatal. The constitutional effect of the carbolic
acid has been observed in two or three cases in the con-
dition of the urine, other than this no symptoms were
noted. Thirty to sixty grains of quinine, in divided
doses, were given in the twenty-tour hours preceding the
operation, with a view to obviate shock, and in this re-
spect its use has been attended with success.
THE CIVILIZED .\.\D UNCIVILIZED \VOM.\N IX L.\BOR.
Thk remark of Carlyle that science originated from a
belief of man "that there was something wrong " has
certainly received confirmation in the literature of the
science of obstetrics.
The blessings of civilization with its attending comforts
and advantages, so much coveted by mankind, has its
reverse side of horrors, the worst aspect of which is seen
in the present [ihysical condition of women.
It is fortunate tor the peace of mind of the stronger
sex that a veil is drawn before the portals of a room in
which woman fulfils her duties of maternity. Could the
experience of the gynecologist and the accoucheur be
known to the general public, lew would face the conse-
quences of married life.
The agony endured by women during natural labor is
sufficient to account for the biblical belief that such tor-
ments are the result of a special curse of God. But what
are these human pains to those involved when complica-
tions exist, beginning with the forceps and ending in the
classic Cajsarean operation, as now performed in Germany
without anaesthetics ?
Turning from the richly furnished room of the fashion-
able mother, in which all the resources of civilization
have been gathered to ward off the effects of lu.xury and
ease, resulting often in the necessity of making an ab-
dominal section and thus releasing the child ; let us
turn to barbaric life and observe how perfectly and pain-
lessly the act of the reproduction of the species is per-
formed. Lieutenant Bove, speaking of his experiences
among the Jagan tribe of Terra del Fuego, says, " When
the great moment arrives the future mother leaves her
wigwam, accompanied by a few female friends, and seeks
February lo, 1883.]
THE MEDICAL RECORD.
159
a secure retreat in the woods. The very next day the
young mother is often seen fishing in a canoe, or gath-
ering shell-tish along the coast." These women marry
young and are very proUlic ; seven, and even eight, being
the average number of children.
I^ieutenant Bove states that the Fuegian women lead
a hard life, and are treated as slaves ; but hard work, a
scant diet, and plenty of fresh air seems to result in the
production of very small new-born children, hence the
ease of childbirth. On the contrary, luxury, ease, glut-
tony, and other evils of fashionable life, appears to effect
an over-development of the ftetus ; this combined wilh a
weak and debilitated body may help to explain those
com[)lications in child bearing which are so often wit.
nessed amontr civilized women.
AN .AUTHENTIC CASE OF TYPHOID FEVER IN A MAN
AGED SIXTY-EIGHT.
Dr. W. G. England, of Cedartown, Ga., writes to us
regarding an alleged case of typhoid fever in a person
aged seventy-two, and adds that he has undoubtedly
treated a case of this disease in a patient of sixty-eight
years. Dr. England sends us the notes of his case, from
which there apiiears to be no question as to the correct-
ness of the diagnosis. The patient had at first a gradu-
ally rising temperature, tympanitis, and iliac tenderness,
the rose rash, and the cerebral symptoms of typhoid.
Convalescence began in tlie fourth week. The fever
rose as high as 105^° at one time. Dr. England con-
cludes : '-When first called to this case I looked upon
it as being a malarial continued fever, as we were then
having an epidemic of malarial manifestations ; but the
evidence became so convincing that I was forced to
abandon my first opinion. I determined to give quinine
a fair chance to control the disease, if it would do so, as
is asserted by various authorities, but soon saw that it
vt^as not meeting my expectations, therefore I abandoned
it. In the past eighteen months or two years, I have
treated several cases of what I considered typhoid fever,
and in all of them I have given quinine a fair and ini-
jiartial test, but in none has it met my expectations, and
I therefore stopped its use ; possibly I did not continue
it long enough."
Dr. England gave quinine in three grain doses, which
is not enough to secure the antipyretic eflect.
THE DOCTOR AND CULTURE.
Dr. J. MiLNEK FoTHERGiLL says (^Philadelphia Medical
Tiines), alluding to the atlainments of Sir Thomas Watson,
Sir Henry Thompson, Seymour Haden, and Dr. Richard-
son, in other fields besides those of medicine or surgery :
" There has long existed an impression that if a medical
man knew anything out of his profession he could know
little of it, or at least have little acquaintance with the
latter practically — an impression most unjust to many.
Because a man is without other culture, therefore his in-
tellect is completely devoted to his profession, was a
view which it was convenient for a good many medical
men to do their best to keep up and disseminate. But
the tendency is setting the other way. If a medical
man manifests good sense and acumen in other matters
of which the public can judge, they are now inclined to
give him credit for like qualities in his profession — an
act of justice which the public is readier to render than
the medical man's professional brethren, it is to be
feared. "
This is eminently true, and we are not lacking in simi-
lar examples in our own country.
SCARLET FEVER IN THE NEWLY BORN.
Dr. a. M. Owen, Surgeon U.S.N., stationed at I^en-
sacola, Fla., writes that scarlatina anginosa has been rife
among the children in that locality. The disease as-
sumed a mild form, and has been followed in but few
cases by unpleasant seqnelaj. He mentions an instance,
however, in which the affection attacked the newly-born,
an occurrence rarely observed. A younger sister of the
lady about to be confined, and who occupied the same
bed with her, was taken ill a few days previous to the
accouchement, with what proved to be scarlet fever.
The invalid was removed from the lying-in room on the
day that the labor took place. Five days after delivery
the baby had fever, sore throat, scarlet efflorescence,
and the strawberry tongue, followed by partial desqua-
mation of the cuticle. Before the end of the week the
child resumed nursing and made a rapid recovery. The
mother had a severe sore throat, as did also the nurse.
LUCIUS 0f tlxc 'GSlcdi.
Regulating Medical Practice in Pennsylvania. —
A bill has been prepared to amend the existing law re-
garding registration in Pennsylvania. It provides for the
creation of a State Board of Health who shall have the
supervision of registration, instead of the various col-
leges, as is now the case.
An Act to Regulate the Sale of Poisons in New
Jersey. — A bill has been introduced into the New Jersey
Legislature making it imperative to suitably label all
drugs usually denominated poisons, placing upon each
box or package the name of the articles and the word
poison, together with the name and place of business of
the seller.
The Price of Quinine has declined 10 cents, and is
quoted at $i.So to $1.95 per ounce.
The Tragedy at Bellevue Hospital. — Michael
Kelleher, an inmate of the alcoholic ward in Bellevue
Hospital, was killed on Sunday last by Geo. E. Mahan,
another patient, who was suffering from delirium tremens.
The Effect of Inhalations of Ether upon the
Action of the Kidney. — Mr. Lawson Tait, in a recent
communication to the Lancet, makes the important ob-
servation that in several cases noted by him, the excre-
tion of urine from the kidneys was entirely suspended
during the administration of ether. He observed this in
a case of fistula between the ureter and cervix of bladder.
Also in several cases of vesico-vaginal fistula, the same
thing was noted. The observation, if true, is important.
It is known, however, that ether increases the gastro-
intestinal secretions, and there is no a priori reason for
believing that it always aftects the kidneys as described.
i6o
THE MEDICAL RECORD.
[February lo, 1883.
The Brain of Gambetta. — The brain of Gambetta
weighed only 1,160 grammes, or about 36 ounces. This
is extraordinarily small, since the average weight of a
Frenchman's brain is 48 ounces, the range being from 45
to 56. Decided microcephaly is usually considered as
beginning at about 37 ounces, and Gambetta must, there-
fore, if report is correct, be pronounced microcephalic.
The range of brain weight in idiots is between ten and
thirty-five ounces, and the distinguished French states-
man touched very closely upon the anatomical basis of
idiocy. The convolutional development was rich and
clearly marked.
It is something almost unique and incredible that a
man of such brilliant intellectual attainments should
have had so small a brain. It is well known, however,
that inferences as to mental development cannot usually
be drawn from a study of individual brain weights. The
size of the brains of a race do furnish an indication of
development. Highly civilized races are capable occa-
sionally of producing what may be called physiological
megalo-cephaly. The lower races cannot do this to
the same extent. Such at least is the most plausible of
the present views regarding the significance of brain
weight.
German Medico-Chirurgical Societv. — At the
annual meeting of the German Medico-Chirurgical So-
ciety of New York City and vicinity, the following officers
were elected for the current year : President, Felix Nor-
demann, M.D. ; Vice-President, Charles Heitzman,
M.D. ; Secretary, Ludwig Weiss, M.D. ; Corresponding
Secretary, H. J. Boldt, M.D. ; Treasurer, Joseph Glaser,
M.D. ; Librarian, Samuel Kohn, M.D.
Immigrant Inspection Service. — The final report of
Superintendent John H. Ranch shows that a total of
1 15,057 immigrants were inspected in the District be-
tween June I and December 31, 1882. Of this number,
57,302 were found to have been satisfactorily vaccinated
before sailing or during the voyage, and 3,127 were found
to have had small-po.x — making about 53 per cent, of
the total number protected. There were 28,408 of the
remainder vaccinated or revaccinated after arrival and
before reaching this District ; and 21,618 similarly treated
by the Western inspectors, leaving 4,602 unaccounted
for, including those whom it was deemed unadvisable to
vaccinate.
Another Cardiac Stlmulaxt. — In Russia the adonis
vernalis is a popular remedy in cases of dropsy and
heart disease. Exact experiments have recently been
made with it by Dr. liubnow, of St. Petersburg. It
stimulates the motor and inhibitory ganglia of the heart,
acting very much like convallaria and digitalis. Unlike
digitalis, it is^ not cumulative in its action. A glucoside
" adonidini " has been isolated by Cervello ; it contains
the active principles of the drug.
Cholera in Southern Mexico. — .\ recent letter
froui Chiapas, one of the southern States of Mexico,
gives a pitiable account of the havoc being wrought there
by cholera. The writer says : "The town of Tuxlla had
eight lliousand inhabitants — six hundred of wliom are
dead. Of the six thousand in Tonala, upward of one
thousand are dead. This town suffered most severely,
twenty to thirty persons dying daily. This horrible epi-
demic broke out in July, 1882, on a farm bordering on
the River Chiapas. Then it extended to San Bartolo,
where it worked havoc for a month, and then moved on-
ward, visiting Chiapas and Tuxtla, almost on the same
day. It remained in those towns about twelve or four-
teen days, and then went toward Tehuantepec. Then
it penetrated to the Atlantic, and caused many deaths in
Tabasco and other places. It is certain that it is a dis-
ease that only affects the hottest regions, as not a case
occurred in San Cristobal Las Casas."
Tobacco-s.moking among American Boys. — The head
master of the Latin School at Boston, Mass., states that
tobacco is used by half the boys in the upper classes in
his establishment, while the Principal of Harvard Gram-
mar School, in Charlestown, avers that out of 300 boys,
about 40 per cent, use tobacco habitually.
Dr. Chew Kin Fong. — It is darkly hinted that New
York physicians may yet be ruined by Chinese cheap
labor. A Chinese physician, Dr. Chew Kin Fong, who
enjoys a large practice among his fellow-countrymen
here, has recently applied to the Board of Health for
recognition. He could talk no English, but showed a
certificate issued by the Harbor Department, Hong
Kong, and aflirming his qualifications as surgeon of a
Chinese emigrant ship. The certificate was not recog-
nized, and Dr. Fong will have to be examined. Assum-
ing that he passes, the serious question arises whether it
would be proper to consult with a person who practises,
it is said, on strictly oriental principles.
Bacillus of Tubercle in the Bre.vi-h. — Dr. Arthur
Ransome has recently announced before the Royal
Society that he has been able to discover the bacillus
tuberculosis in the condensed aqueous vapor of persons
afflicted with phthisis. This is a new source of alarm, if
Koch's malignant bacillus can be puffed in our faces by
all our phthisical cases.
A New Hospital at Dayton, O., has recently been
completed and opened. It cost $75,000, and has a
capacity of 200 beds.
The Paris F.acultv of Medicine. — The Faculty of
Medicine now comprises four separate departments : the
ancient Faculty, the Practical School (which is tempo-
rarily lodged in the buildings of the former College Rol-
lin), the Botanical Garden of the Rue Cuvier, and the
Clinical Hospitals. The number of students who followed
the course of lectures for the last year (October i6th,
1882 to 1883) was 4,209, this being exclusive of fifty
foreigners and thirty-nine women, the latter being thirteen
fewer than last year. The number of examinations at
the Faculty of Medicine was 6.076, nearly a third of
whom were " plucked."
A New Prize. — The French Government has recently
resolved by decree to found a prize, to be called the Prix
Volta, and of the value of 50,000 francs, which shall be
awarded for the most successful application of electricity,
either in the production of heat, light, chemical force, or
mechanical power, or in the transmission of messages, or
in the treatment of disease. Competitors may be natives
of any country, and claims to the reward must be lodged
by June 30, 1SS7.
February lo, 1883. J
THE MEDICAL RECORD.
161
gi*O0Vcss of l^iXcdical J-cicnce.
The Histogenesis of Carcinoma. — Dr. Carl Hem-
Ijel Reed, in the Philadelpliia Medical Times, reports
the results of some studies in the Pathological Labora-
tory of the University of Pennsylvania, upon the histo-
genesis of carcinoma. He concludes that cancers have
an exclusively epithelial origin, and summarizes the es-
sential points in favor of this view as follows: i. Pri-
mary true cancers are found only in locations wliere
there is pre-e.xisting epithelium. 2. No cancer has been
proved beyond doubt to have originated heterotopically.
3. The cicatrization of cancers explains the young con-
nective-tissue infiltration. 4. Young connective-tissue
cells or white blood corpuscles never being seen inside
the alveoli. 5. The independence of the e|)itiielial can-
cer-cylinders from the connective tissue. 6. The intact-
ness of endothelial ensheathments of connective-tissue
trabecule forming the alveoli. 7. The mode of devel-
opment and concentric growth of secondary cancers. 8.
The proliferating power of epithelium normally is greater
than that of any other tissue. 9. The results of my ex-
periments showing that the epithelial covering in the
healing of ulcers is exclusively derived from the epithe-
lium of the border, a most conclusive proof of this being
the gradual advancement of the i)ignient from the borders
of the healing ulcer ; this fact, by analogy, forming a
strong testimony in favor of the epithelial origin of can-
cer. 10. The transformation of connective-tissue cells
into epithelial cells, in extra-uterine life, does not occur,
either physiologically or pathologically.
Mercurial Glvcerite. — Dr. Vigier states {Gazei/e
Hebdomadairc de Mldecine) that medicinal agents, incor-
porated with fatty substances, are absorbed to only a lim-
ited extent. Mercurial ointment, however, forms a note-
worthy exception to this general rule. Drugs incorporated
with glycerine are, according to Vigier, not at all ab-
sorbed. He considers that this [iroperty of glycerine is
due to its not wetting the skin. Experiments on himself
and his pupils have proven that the active substance thus
incorjiorated never produces its constitutional effects.
It is for this reason that lie recommends glycerine instead
of lard in mercurial preparations for scabies, pediculi,
etc., as such a mixture has an antiparasitic effect without
being absorbed. The following glycerite, notwithstanding
the caustic nature of its principal ingredient, he says, may
be used without danger :
IJ. Hydrarg. bichlorid 3 iss.
Glycerine 3 iij-
M.
The SIndermatic Use of Quinine in Malarial
Pneumonia of Children. — Dr. L. Galanti, of Rome,
applies an ointment of sulphate of quinine to the raw
surface produced by blistering, in the malarial pneumo-
nia of children. By this means he avoids the difficulties
often encountered in the internal administration of this
drug. — Gazzeita medica di Roma, No. 19, 18S2.
Washing Oct the Stomach with Chloroform Wa-
ter.— Dr. Aurelio liianchi, reports three cases in which
he employed chloroform water, in the proportion of one
drachm of chloroform to a quart of water for washing out
the stomach. The first case was one of supposed can-
cer of the pylorus, and is claimed to have been much
benefited by this procedure. The two others were in-
stances of chronic dyspepsia, and are said to have been
cured. — Lo Sperimentale, No. 10, 1882.
Lymphadenitis of the Conjunctivae. — Dr. W. Gold-
zieher, of Buda-Pesth, Hungary, recently removed from
the conjunctival cul-de-sac of a fourteen-year-old boy a
hard, painless tumor the size of a filbert. On the sur-
face of this growth were to be seen yellowish, cheesy-
looking plaques, which apparently penetrated into the
depth of the tumor ; whilst in other places small, round,
grayish nodules could be made out through the translu-
cent mucous lining. There was a family history of
scrofula. Dr. G. first thought that it was a case of tu-
berculosis of the conjunctiva, but the microscopic ex-
amination of the specimen showed that it was an enlarged
lymphatic gland. The existence of lymph-follicles in
the normal conjunctiva, though vouched for by some
microscopists, has been strenuously denied by others.
The present case would seem to afford corroborative
evidence of the real presence of these conjunctival fol-
licles.— Centralhlatt fiir Praktische Augcnheilkiuide,
November, 1882.
Hydrotherapy in the Treatment of Syphilis. —
Dr. Pascal advocates the employment of cold water,
conjoined with the internal administration of specific
remedies, in the treatment of syphilis. He states that it
is of great service in the early stages, by virtue of its
tonic effects, in overcoming syphilitic ana;inia. In the
later stages it is employed with advantage in the various
cerebral accidents of specific origin. He condemns the
thermal baths, however, as tending to cause the very
cerebral complications for which the cure is sought. The
cold bath alone is of little utility, but should always be
regarded as an adjuvant to internal medication. — Jour-
nal de Mc'deeine de Paris, No. 15, 1882.
Diabetic Coma. — Drs. Foster and Saundby record a
carefully studied case of diabetic coma in the Birming-
ham Medical Review, ^zxmaxy, 1S83. They have sum-
marized their conclusions as follows : i. Diabetic coma
is especially liable to supervene in acute cases in young
persons. 2. Diabetic patients and their friends should
be warned of the danger of constipation, muscular exer-
tion, nervous excitement, and cold, as probably predis-
posing causes of death by coma. 3. The discovery of the
ferric chloride reaction in the urine should be taken as a
warning to look out for the premonitory symptoms of
coma. 4. Deep respiration, rapid pulse, and abdominal
pain are the earliest premonitory signs of this condition.
5. Cyanosis may be absent in spite of the dyspnoea, and
may appear only just before death. 6. Convulsive seiz-
ures are not an uncommon occurrence just before death.
7. Diabetic coma, with all its classical symptoms, occurs
independently of any excess of fat in the blood, and the
pathological value of lipiemia, when present, is yet un-
determined. 8. The toxemic theory, or poisoning by
acetone or some nearly allied substance or substances,
affords the best explanation of this remarkable group of
symi)toms. *
Strangulated Hernia, Complicated f.v Disease of
THE Spermatic Cord. — Dr. John L. Atlee reports in
the American Journal of the Medical Sciences for Janu-
ary, 1883, a case of strangulated hernia, in which the
scrotum was enormously enlarged ; at the bottom it was
twelve inches in circumference, and came down nearly
hilf way to the left knee. The surface of the scrotum
was marked by numerous large and very dark veins.
The bulging at the external ring was as thick as the
wrist, and no impression was made by the taxis. When
the sac was opened the first thing that presented was a
large mass of omentum running down to near the bottom
of the scrotum. This was raised up, and a knuckle of
intestine, ilium, about five inches in length, firmly
strangulated and of a dark mahogany color, but with no
ash-colored sjjots. After the reduction of the hernia
from the ring proceeded a cord as thick as a lead pencil
for about three inches. It then became much thicker
and highly vascular, resembling the omentum, which he
had already removed. There was a large mass lying in
the very bottom of the scrotum, in some places nearly as
thick as a bantam egg, with many smaller lumps extend-
ing down the mass, and fringed with highly vascular
membranes ; when drawn out it measured eighteen inches
iri length, and weighed twelve ounces. As it approached
the testicle it became as small as at its origin in the
l62
THE MEDICAL RECORD.
[February lo, 1883.
ring. He found the testicle wasted and very soft and
firmly attached to the bottom of the cavity. The con-
clusion was drawn that it was an immense hypertrophy
of the cord and epididymis, and it was concluded to re-
move it, which he did after tying at the ring above and
at the testicle below. After jilugging up the ring with
the stump of the omentum and cleansing the empty sac,
he closed the external wound and applied a bandage.
The patient bore the operation well.
Cancer of the Testicle Following Orchitis. —
At the recent meeting of the Rhode Island Medical So-
ciety, Dr. Fuller narrated a case of carcinoma following
orchitis. Tlie patient, aged thirty-four, had chronic
orchitis for twent}'-two 3'ears caused by a blow on the
testis wlien a lad of twelve years. Four months before
removal the tumor became ijainful and rapidly increased
in size, adding one-third to its bulk in four months.
E.xcellent recovery from the operation, and immediate
recurrence in the abdominal cavity, forming a tumor the
size of a man's head, and causing death in two months.
The upper two-thirds of the tumor was fibrous, and
contained cysts and enchondromatous masses. The
lower third was encephaloid. The abdominal tumor was
also encephaloid.
Large Doses of Alcohol in Scarlatina. — At the
last meeting of the Academy of .Medicine of Cincinnati, O.,
Dr. Giles Mitchell reported forty-tlnee consecutive cases
of scarlatina treated with large doses of alcohol, without
a single death. The quantity of alcohol given in some
cases was enormous. To a patient two years old a half-
ounce of whiskey was given every hour for a number of
days, without having any other than a favorable efiect,
and without producing any symptoms of alcoholic into.x-
ication. The doctor claimed that when this treatment
was instituted, the disease had always pursued a more fa-
vorable course, hyperpyre.xia being neither so frequent
nor so prolonged, nor were renal complications so likely
to ensue. In case the kidneys became affected, the
alcohol was still pushed, and the complication fully re-
lieved. If the temperature was high before the admin-
istration of the remedy, it would rapidly fall below the
danger-line after the treatment was instituted. The re-
port of Dr. Mitchell called forth a lengthy discussion
from the members of the Academy. Prof. Whittaker
thought that the favorable influence exerted by the rem-
edy was due to its antimycotic properties. He had no
doubt that the brilliant results obtained were due to the
antiseptic an^ parasiticidal properties of alcohol, as man-
ifested in these cases by the destruction of the germ of
scarlatina. Prof. Reamy was a firm believer in the effi-
cacy of large doses of alcohol. He attributed its good
effects rather to its influence in preventing tissue-meta-
morphosis, to its value as a food, and to its antipyretic
action r,t-i_i,.,- ,r ?■ , ^- -r^
1882.
-Philadt-lphia Medical Times, December 30,
Renal Surgery. — In its annual retrospect of the
advances made in medicine during the past year, The
Medical Press, December 27, 1882, makes the following
comments on this subject: Several operations for re-
moval of renal calculi, and for relief of symptoms set up
by presence of pus in the organ, have been recorded,
the majority eventuating successfully. Nephro-lithotomy,
as performed by Mr. Morris, has been repeated by mV.
Beck, who points out that favorable subjects for the
operation should not be too fat, and that when pus in the
urine aft'ords indication that the stone in the kidney is
setting up irritation, then the time for operative interfer-
ence has arrived. Mr. Beck rei)eats what Mr. Morris
pointed out in respect to the bleeding from the incised
kidney. Though seemingly very [irofuse for a moment
it is at once and permanently controlled by the pressure
of a sponge, and docs not subsequently seem to cause
embarrassment.
From the numerous cases reported before societies and
in journals, in which grave operations on the kidney have
been attended with success, it is evident that an increas-
ing feeling of hope as to the consequences of such inter-
ference is growing up among surgeons, who will now
proceed to cut into or remove a kidney Nvith much less
hesitation than would have been shown a few years ago.
The most hopeless cases of this kind that are met with
now are those extreme examples of degeneration in which
the kidney is little more tlian a sac containing pus, and
which yield the least likely of all probabilities of success-
ful removal of the mass. A very considerable number
of cases in which operative treatment for removal or
evacuation of diseased kidneys has succeeded have been
reported during the year, and it is a justifiable conclu-
sion, from consideration of these proceedings, that a much
more evident willingness to attempt to give relief to
patients by such measures is exhibited now than formerl)-.
In fact, this may be said of surgical operations generally.
Many which are now by no means uncommon would have
been promptly rejected not verj- long .igo, as involving
an amount of risk not justified by the probabilities of suc-
cess or even of relief to distressing symptoms.
Superinvoi.ution of the Uterus. — Dr. Sinclair, at a
meeting of the Boston Obstetrical Society [Boston Med- '
ical and Surgical Journal, December 21, 1S82), reported a
case of what he regarded as uterine superinvolution. The
woman was twenty-six years old, and, after the third
child-birth, she ceased to menstruate. Although jilump
and well, she was very nervous. There had been no
menstruation for a year when she consulted Dr. Sinclair,
who found an extremely small, infantile uterus. This
would not admit a small uterine sound, but a probe could
be ]wssed up two and a half inches. She is now thirty-
six years old. A year ago the husband had called to say
that his wife was in charge of a physician who said that
the trouble was due to a ruptured perineum and lacer-
ated cervix. Dr. Sinclair claimed an examination in his
own defence, and found no laceration whatever.
A New Operation for Spina Bifida. — At a recent
meeting of the Leeds xVIedico-Chirurgical Society [Brit-
ish Aledical Journal, December 30, 1882), Mr. Robson
showed a child six weeks old, upon whom, when six days
old, he'had performed a new operation for spina bifida.
The redundant parts removed by the operation were also
shown. After the removal of these parts and after stitch-
ing up the arachnoid over the spinal canal, periosteum
from a rabbit was inserted between the meninges and
the skin so as to cover the gap in the bones. The wound
had perfectly healed ; the skin over the lumbar' region
was quite level ; there seemed to be no tenderness on
pressure ; the child looked strong and healthy. The sac
was found to be of the size and shape of half a swan's egg;
the wall consisting of true skin and subcutaneous tissue
lined by serous membrane. At one point the sac was
very thin and transparent, appearing to consist only of
the serous membrane covered by a thin layer of epider-
mis, when fresh minute blood-vessels could be seen to
ramify over it. Mr. Robson drew attention to the follow-
ing points: i, the operation was performed with full an-
tiseptic precautions, eucalyptus air being used instead of
carbolic spray ; 2, the meninges were closed by uniting
the serous surfaces, as in peritoneal surgery ; 3, the trans-
plantation of living periosteum and its continued vitality ; d
it iiad not yet, however, formed new bone, but already ||
the covering of the canal had a greater than mere skin-
firnmess ; 4, the entire absence of bad symptoms in the
child, operated upon at so early an age, was noticed.
I'Ithvl Bro.mide internally for Spasmodic Cough.
— Dr. Squire recommends a solution of bromic ether in
water (i to 200) for administration in whooping-cough,
as well as for angina pectoris and spasmodic pain. It
may be given in the same manner as the aqua chloro-
formi of the British Pharmacopceia.
February lo, 1883.]
THE MEDICAL RECORD.
163
OIo vvcsp CI n (I cu c c.
THE TREATMENT OF ASTHMA.
To THE Editor of The Medical Record.
Dkar Sir : By practising in strict accord witli acce])ted
pathological data, pure spasmodic asthma may be radi-
cally cured. In the treatment of this commonly intrac-
table disorder I have met with such success that I now
assume charge of asthmatics with a feeling of pleasure,
confident of the relief so sure to come.
In The Medical Record, over two years ago, I
pointed out the striking fact, that counter-irritation ap-
plied ever the pneumogastric nerves, from the upper part
of the thyroid cartilage to near the ujiper borders of the
clavicles, stopped paroxysms of asthma. I detailed the
case of a lady, aged fifty years, afflicted with that disease
nearly all her life, and whom I had attended at times for
over three years, and to whom I was last called on April
1, iSSo. On that day commenced the most violent attack
of asthma she ever had. Until May loth she had never
left her room — scarcely the chair in which she sat. Mor-
jihine alone quieted her continued' dyspnoea, and to
diminish the quantity was only to increase the dyspnosa.
At last, but semi-conscious, extremely weak, with face
and limbs greatly swollen, and the head fallen forward on
her chest, I feared dissolution.
Her case was one of pure 'nervous or spasmodic
asthma, a disease in which I recognize two pathological
elements : i, nervous spasm of the bronchial tul)es ;
2, hyperainia, approaching or amounting to inflamma-
tion. Difficult breathing involves all the physical signs.
The rales have a double character ; id est, they occur
both in inspiration and in expiration. This I recognize
with Professor Alonzo Clark as a sure sign of spasmodic
asthma.
In this affection I have relied on morphine most of
all ; then nauseants and antispasmodics ad infinitum.
But nothing longer benefited my patient. I was per-
plexed, when at last the idea arose in my mind, and with
Churchill's tincture of iodine I applied counter-irritation
over the course of the pneumogastric nerves. Relief
followed so rapidly and absolutely as to make me doubt
that it was due to my application. Benefited in less
than twenty-four hours, freedom from asthma was ab-
solute in less than forty-eight. I determined to paint
again so soon as the paro.\ysm returned. It never re-
turned.
In June I applied the same treatment to two more
cases, witli the same happy result. And u]) to that time
all I had observed was relief of the paroxysm, and only
of the first, because no patient had any return of them
after the one api^lication of iodine. Those three cases
were placed upon iodide of potash internally for a
short time. Not one of them, to m\- knowledge, has
ever had a return of the paroxysms.
Apropos of my report in The Record, my friend, Dr.
J. M. Lee, of Pittsburg, mentioned tome a case in his
service at the Mercy Hospital, of uncomplicated spas-
modic asthma so severe that he had become alarmed for
his patient's safety, when Dr. T. C. Christy called his
attention to my article in The Record, which he had
that evening received, and suggested " that Faulkner's
l^lan be tried." Dr. Christy's suggestion was acted upon,
and Dr. Lee reports the effect to have been "brilliant ;"
relief came rapidly and completely. The man uncere-
moniously left the hospital next day, remarking that "he
was well and there was no use in remaining longer."
Again, in February, iSSi, mv friend Dr. James B.
Murdoch was pleased to draw my attention to an article
in The British Medical Journal, by Dr. Robert Saundby,
in which, having adopted my plan and terming it " the
iodine treatment of asthma," wrote as follows: " H. H.
had suft'ered for the last six or seven years from attacks
of dyspnoea, coming on at three o'clock a.m., which for-
merly occurred only in June or July, but latterly through-
out the year. I painted the lines of both pneumogastrics
with a mixture of equal parts of the liniment and tincture
of iodine and ordered him to repeat it every night. The
next time I saw him he told me that he ' had not had
such a good night's sleep for twelve months.' He slept
all night, and was so surprised upon waking in the
morning that he got out of bed to look at his watch be-
fore he would believe it. He discontinued the iodine
after a few applications, as the skin became sore, but he
has had no return of the attacks."
Since my first successes in the treatment of this
malady, I have studied with interest and quite peculiar
favor the disease in its several bearings upon thirty-seven
cases: ist, regarding constitutional differences in asth-
matics; 2d, regarding treatment of occasional compli-
cations ; 3d, regarding climate and change in residence.
Close observation has led me lo think that one great
source of failure in treatment is to be found in insufii-
cient consideration of constitutional variations. The
treatment of a name, in lieu of pathological condition,
has never been more impotent than in asthma. Little
meditation is required to show that tall, thin, an<emic
patients need different management from short, fat, full-
blooded. Obesity must be reduced by hygienic means,
by diet, laxatives, exercise. Slender and emaciated pa-
tients must be strengthened by wholesome food, by
tonics, such as iron, strychnine, digitalis, cod-liver oil,
phosphorus, exercise.
In common torpidity of the bowels, regularity in func-
tion is often insured by a pill at bedtime, containing
one grain each of blue mass, rhubarb, inirified aloes, and
extract of hyoscyamus. In many asthmatics there is de-
preciation of the nervous system. And then my reliance «
is upon cod-liver oil. Useful, too, are iron, arsenic,
phosphorus. Sti-ychnia seems especially beneficial in
giving fillip to the muscular fibre of the bronchial tubes,
aiding expectoration. F'its of sneezing and eruptions
upon the skin give assurance for the administration of
arsenic. Bronchial congestion requires iodide of potash.
The skin of most asthmatics is so impressionable to at-
mospheric changes as to require particular attention.
To strengthen the skin, I consider a cardinal jjoint in
the treatment of asthma. And for this purpose I admin-
ister salt-water baths, by seating the patient upon a
cane-bottomed chair, and throwmg over him a blanket,
fastened around his neck and covering the chair, under-
neath which is placed an jrdinary or Bumstead evapo-
rating pan with spirit-lamp, the pan containing about
three ounces of water and a heaping teaspoonful of salt.
As soon as the sweat has freely broken, the patient is
rapidly shampooed, rinsed with pure, cold water, carefully
dried, and then rubbed until the skin glows. I some-
times find it weeks before I can make it glow. But I
persevere. The bath I order repeated twice a day,
daily, or every alternate day. Its advantages can scarcely
be told.
Another cardinal point in treatment is inflation of the
lungs: 1, to increase or restore the natural breathing
capacity ; 2, to cleanse the bronchial tubes and air-cells
of secretion. This I do not attempt with the extravagant
apparatus of Waldenburg, but with a simple and inexpen-
sive Politzer's inflator. It an.swers admirably. Asth-
matics are short of bieath because of spasm, and partly
because of diminished breath space. Now air forced
into the lungs expands the tubes, dilates the vesicles,
and is followed by free expectoration and comfort. The
patient is directed to take as long an inspiration as pos-
sible ; then the nozzle of an inflated Politzer bag is in-
serted between the closed lips, the nostrils held, and
the bag compressed. Thus do I force into the lungs at
every inspiration from one to three bagfuls of air, and
continue this process for ten minutes, and repeat it
morning and evening. Professor J. C. Dalton says that
"the average amount of air inhaled at each inspiration is
twenty cubic inches, and that representing from ten to
164
THE MEDICAL RECORD.
[February 10, 1883.
thirteen per cent, of the entire quantity of air in tlie
kings, it will therefore require troni eight to ten respira-
tions to change the whole quantity of air in the cavity of
the chest." An ordinary-sized Politzer's bag will iiold
about ten to eleven cubic inches of air. Remembering
these facts, we know the quantity of air which can with
safety be forced into the lungs, and also have a gauge
whereby to tell the amount of improvement made in the
dilatation of the air-vesicles and small tubes, or in other
words, of the increase in " vital capacity of the lungs."
To a change in the residence of asthmatics I object,
because the benefit so derived is generally only tempor-
ary, the malady soon returning in the new residence.
And it is reasonable to suppose, not even considering
the expense of travel that patients can be managed
better at home by men, to whom, as Jacobi philosophically
remarked, " the science of medicine is no longer mere
formula, and its art no routine," than by charlatans, so
numerous at all '' resorts."
It has been insisted upon by great authorities that an
urban residence is best for asthmatics, and more es-
pecially that portion of a city in which the atmosphere is
heaviest and smokiest. That I cannot believe. Smoke
and heaviness are synonyms for fog and dampness. I
dissent, because here in Pittsburg, where the atmosphere
is the smokiest, heaviest, and as such, of largest area on
the continent, we have, I dare say, more native asthma,
and from it a death-rate, great, if not greater than that of
fairer cities, in which there is a pure atmosphere, dry,
warm, and of nearly equable temperature. No one ever
visited Pittsburg without complaining, almost within an
hour of their arrival, of the " dirt" in their throat and the
blackness of tlieir nostrils. There is a faucitis peculiar
to Pittsburgers. The sulphur-charged atmosphere is
irritating to the delicate mucous membrane of the eye,
nose, throat, and bronchi, and produces a chronic con-
gestion, the secretion of which catches and holds to view
the carbonaceous material of the atmosphere. The in-
spection of the oral cavity of every resident reveals its
secretion charged with black, carbonaceous material.
This carbon, drawn in with every inspiration, affects alike
the mouth, throat, and chest, as 1 have seen upon post-
mortem examination. The inhalation of the smoke of
Pittsburg is not conducive to health.
True, there are some asthmas benefited by Pittsburg
residence, but only, I believe in accordance with the fact
that travel and change will bring relief — the centres of
relief being, however, elsewh^e as well as here.
On the whole, I judge the opinion of preference for
city over country residence to be mainly traditionary, and
due to failure in differentiation of the forms of asthma.
Yours, etc.,
RiCH.ARD 13. Faulkner, M.D.
PiTTSBL-RG, Pa.
mcxu i;,nstvutucnts.
DisiNFiiCTiON' BY HoT .ViR. — Koch and Wolfliiigcl, in
experiments made to determine the disinfecting poxver
of hot air, have been led to the following conclusion :
1. Bacteria are destroyed by being exposed to a tem-
perature of a little over loo^ C. for an hour and a half.
2. Spores of brewers would require for their destruction
an exposure for the same time at iio°-ii5° C. 3.
Bacilli are killed only by three hours' exposure at 140'
C. 4. The heat of hot air penetrates articles so slowly
that in three or four hours' heating, at 140° C, of small
objects, such as a bundle of clothes, etc., disinfection
was not secured. 5. Five hours' heating at 140° C,
necessary to certain disinfection, does serious injury to
most articles.
On the announcement in Russia that the course of
medical instruction for women would be closed, a great
meeting was held to protest against the measure, and a
Moscow merchant offered to s|>end 200,000 roubles if
the St. Petersburg authorities would undertake the man-
agement of the lectures.
IMPROVED GENERAL EXTENSION SPLINT
FOR LOWER EXTREMITY.
By A. CLENDINEN, M.D.,
FORT LEE, N. V.
The splint may be said to be composed of three sec-
tions. First, the main section, constituted by extension
and counter-extension rods Nos. 5 and 6, with their reverse
tractors No. 8 ; tractive lines through ringlets, over brass
rollers; of centre brace No. io to cross bar No. 11, with
fi.xation or check line No. 9, and suspension line No. it.
Second, the pelvic section or aftachments Nos. i,
2, 3, and 4 with ischio-pubic and abdomino-lumbar bands
attached to ringlets, as seen in cut. The ringlet in No.
3, for the attachment of ischio-pubic band, is within three
inches of point of attachment to main section, while the
ringlet at and in No. 4 is six inches from point of attach-
ment to main splint where shown by the nut of bolt in
plate. This difference is necessary to conform band to the
pelvic Imes and obtain easy bearing and even fulcrum.
Third, is the foot section 7, with attachment, as seen
by the bolt nuts opposite ankle, which is the point of
its attachment, and wliere by the temporary withdrawal of
one of the bolts, hinge motion can be had for the pre-
vention of ancliylosis, when feared. Centre ringlet is
in the end of foot-i)iece, for attachment of plasters troin
foot and at each corner, for guy lines. Tliis splint is
made of unannealed wire, is simple, cheap, and easily
portable.
The patient is su\)posed to lie upon a A-rv/ surface,
with the exception of pillow for head. On upper section
of bed lay an extra two inch thick mattress, reaching
to the buttock. In suspension of limb use as little ele-
vation as possible, viz., have the limb's heel within four
inches of the level bed surface of the first mattress. By
so arranging, the limb is in about natural line with body,
February lo, 1883.]
THE MEDICAL RECORD.
16:
and yet we have obtained room for use of bed-pan and
removed any chance of fouling the (hessings. The splint
which has been suspended is now held over the limb in
order to open or close the tractors 8, so as to maintain
proper width just to clear diameter of limb, and at the
same time the foot-piece is bent to the same width, so
that the side lines will be parallel, in avoidance of fric-
tion. Piece No. 3 should now be bent to suit the rise
over mons veneris and abdomen, and the same must be
done with pieces i and 2. which are coupled, for the pur-
pose of enabling them to be used in ai'plication to either
side and to avoid much bending. Whichever of the ring-
lets of No. 2 piece reaches No. 4 is now coupled with bolt.
The fixation line 9 is so tightened that the tractors 8 can-
not displace the extensor and Qounter-extensor rods, which
remain their entire length side and side, the ringlet hook
at either end being in juxtaiJosition to the bolt nuts seen
in plate where the pelvic and foot attachments are con-
nected. After felting or other dressing has been applied
to abdomen, etc., the splint, to off side of which the
bands and plasters have been fastened, is lowered, and
the surgeon draws under limb the plasters to the near
side, and by pins adjusts the same to the projjer rod,
viz., those plasters applying to the upper fragment will
be fastened to the counter-extension rod, and those of
the lower fragment to extension rod. By so doing we
avoid friction and get the benefit of full weight of limb
for the extension of its lower fragment. The plasters
are now adjusted to foot, etc., and attached to the foot-
piece ; the ischio-pubic and the abdomino-lumbar bands
are made taut, and the suspension cord is drawn to the
proper elevation of limb. Measurement is made, shorten-
ing estimated, and the fixation cord 9 is slacked to allow
the tractors 8 to effect the extension, while digital and
eye attention to the line of fracture will decide surgeon
when to order the tightening of No. 9 cord. His judg-
ment must be confirmed by comparative measurement
and allowance for articular separation, and to overcome
excessive muscular spasm extra traction may be judged
temporarily necessary, and can be held by fastening the
tension lines at 10. Measurements sliould be made and
remade during the first fourteen days, and at the dift'erent
periods not only spasmodic tension but muscular relaxa-
tion and atrophy judiciously accredited. Extra antago-
nistic bandages can be used in oblique and other frac-
tures.
The Health of Brooklyn. — The report just pub-
lished of Health Commissioner Raymond, of Brook-
lyn, comprises a record of eleven months ending
November 4, 1882. During that period there have
been 15,092 deaths, or 559 in excess of the actual
mortality in the year 1881. No cases of small-pox were
reported since the first week in September, due to the
fact that house to house vaccination has been systemati-
cally enforced. Dr. Raymond very earnestly and very
projierly urges the establishment of a hospital in that city
for the reception and treatment of persons suffering from
contagious diseases.
Removal of a Large Bronchocele. — Dr. Cheever,
of Boston, removed, quite recently, a large bronchocele
at the Boston City Hospital. The tumor weighed ten
ounces. The right and left lobes were dissected in
turn from their beds by the usual incisions, and the thy-
roid and other arteries tied before they were severed.
The amount of blood lost was inconsiderable, scarcely
equalling eight ounces. The patient subsequently died
of shock at the end of twenty-four hours.
PKRFOR.4TION OF Nasal Septum. — Dr. John B. Rob-
erts, of Philadelphia, has invented a punch for cut-
ting out a disk of cartilage in cases of nasal obstruction
due to deviated septum. He does not consider the
prevalent notion that the partition between the nostrils
must not be perforated in efforts to render the occluded
nostril patulous as well founded.
§lewiems mxd |1[0tices.
On the Nature and Treatment of Gout. By Dr.
VV. Ebstein, Professor of Internal Nfedirine, and Di-
rector of the Medical Clinique in the University of
Gottingen ; with atlas containing five quarto chromo-
lithographic plates. Wiesbaden, 18S2.
This work is dedicated to Prof. Henle, in commemo-
ration of the "Jubilaum'' held in honor of the fiftieth
year of his doctorate ; and forms, as the author of this
really thorough book modestly says, "an attempt to
give a history of the physiological changes in gout, which
will furnish an explanation of the clinical features of the
disease."
The particular aim of the writer is, however, to show
that the gouty symptoms are a necessary effect of the
presence of uric acid in the blood. The discovery of
uric acid by Scheele in 1776, and the proofs furnished
by Wollaston in 1787, that the gouty concretions con-
tain uric acid, did not place the |)roper significance upon
the relation which this acid bears to gout; even Henle
regarded it as an accidental product, and Garrod, in
1848, was the first indisputably to prove the presence of
urate of soda in the blood of gouty patients; from his
time on could we speak of a uratic arthritis.
Our author attempts to solve the many still open ques-
tions by means of experiment and anatomical investiga-
tions, and finally reaches the conclusion that in gout
the disturbances of nutrition in the tissues are primarily
caused by the fluid neutral urates circulating in the
blood ; the crystallization of these salts as acid salts,
and their deposit in the tissues, being a secondary effect.
The free acid necessary for this transformation is formed
in the necrosed tissues, and consequently is an effect of
the necrosis, which, in its turn, has been produced by
the ffuid neutral urates circulating in the blood.
A piece of blue litmus paper, placed between the cut
ends of a necrosed cartilage, turned red. W'hilst ])art of
the uric acid is deposited in various localities (kidney,
cartilage, tendon), but is particularly formed, according
to the author, in the muscle and bone marrow of the
affected extremities, another part passes into the blood
and causes in the different tissues and organs manifold
disturbances (visceral, retrograde, vague gout). Thera-
peutically the author recounnends diet regulation ; fat
accumulation to be avoided ; meat and a certain quan-
tity of fat are jiermissible, while hydrocarbons and alco-
holics should be reduced to a minimum. Mineral waters
are occasionally to be advised.
The excellent matter contained in this work is made
the more comprehensible by the chronio-lithographic
plates, which also artistically deserve the highest praise.
The investigations are original, the results new, and
divergent from the doctrines now held on this subject ;
the book is therefore to be highly commended to the
general practitioner as offering new and original views
in regard to the protean manifestations of this disease.
Anatomical Technology as Applied to the Domes-
tic Cat; An Introduction to Human, \'eterinary, and
Comparative Anatomy. With Illustrations. By Burt G.
Wilder, B.S., M.D., and Simon H. Gage, B.S. New
York and Chicago : A. S. Barnes & Company. 18S2.
This work is intended as a manual for the instruction of
persons studying, or intending to study medicine, com-
parative anatomy or ])hysiology.
Its peculiar features are, that it assumes no previous
knowledge of anatomy ; its descriptions are based upon
the domestic cat; these descri|)tions are very direct,
simple, minute and practical. Directions for dissection,
jjreservation of material experimentation, and proper
instruments are given, and a new system of anatomical
nomenclature is introduced, which makes the work very
technical in character.
1 66
THE MEDICAL RECORD.
[February lo, li
The book is chiefly designed for beginners, yet it con-
tains many references and suggestions of great vakie to
teachers.
The descriptions are for the most part of macroscopic
structure.
The book bears the mark of much conscientious labor
and thorough faniiliarit)- with its subject. AVe can most
cordially commend it as filling a place in text-books
hitherto unoccupied.
The only feature of the work which calls for special
criticism, is the nomenclature adopted. To this sub-
ject Dr. Wilder has given great attention, and his views
are already quite gener.ally known. His object is so to
change our anatomical names that they will equally ap-
ply to all vertebrates and be equally intelligible in all na-
tions. He therefore substitutes Latin or Greek names
for some organs at present badly named, and uses words
of a more general application in his descriptions. Some
of the changes may be indicated. Thus, as regards names
indicative of relative position, we have cephalic, for up-
per or anterior end ; caudal, for lower; dorsal, for back
or posterior ; ventral, for front or anterior ; sinistral, for
left ; dextral, for right ; mesal, for median ; ectal, for
e.xternal ; ental, for internal.
The suftix '-ad" is used to turn the above adjectives
into adverbs. Thus one surface is entad, or placed inter-
nally as regards another.
The change in the nomenclature of certain parts of
the body is very great. Thus for the upper arm the
name is brachium ; for the arm, ante-brachium ; for
wrist, carpus ; then metacarpus, polle.K, inde.^:, niedius,
annularis, and minimus.
Dr. Wilder speaks of holding a frog between the pol-
le.K, inde.x and annularis, then " dorsiventing '' it.
There are some things which are good in themselves,
but whose value we must question simply because they
are impracticable.
Dr. Wilder's nomenclature, or at least the view on
which it is based, is correct, and we believe would be a
help to comparative anatomists. But there will long
remain obstacles very nearly insuperable toward apply-
ing it to the human body. Human anatomy is a practi-
cal, and almost a popular science, in the sense that its
termmology is part of our literature, and a knowledge of
it part of a general education.
We must make one more criticism, and it is this : Dr.
Wilder has undertaken to do what should have been
done by some national or international bod)-. The
nomenclature of one individual will never be universally
accepted. Although \V'ilder's is probably the best so far
offered, the human mind is peculiar, and we doubt if a
single comparative anatomist will accept it in ioto. It
is a good step, however, in unifying the present gro-
tesque and fortuitous system of naming and description
of the animal body.
The book is well printed, and is copiously illustrated
with e.xcellent cuts.
Chromatoptometric.\l Table. By Dr. Ole B. Bull.
Christiania : P. T. Mailings Boghandel. New York :
Wm. Wood & Co.
The methods which have hitherto been offered to the
profession for the examination of the (jualitative and
quantitative perception of color have been so laborious
and complicated that they have not come into general
use, even among specialists. The chart constructed by
Dr. Bull is intended to afford a convenient means of test-
ing and recording the color sense (C) of eye patients bv
a practical and expeditious, though not over-scientific
method. It shows ten rows of small colored s(iuare.s,
each row representing a different degree of saturation as
expressed by i)rinted figures. These figures enable one
to record the power of quantitative distinction of color
in a similar way as V is recorded afier being tested by
Snellen's test types.
Dr. Bull's chart, though scarcely adapted to work out
the difficult problems presented ^y cases of congenital
color-blindness, will be very useful to the busy eye sur-
geon in tracing the progress of the different diseases of
the retina and optic nerve.
Second Annual Report of the State Board of
Health of New York. Albany, N. Y.
This report is a work of great value and interest. It is,
we believe, by far the best that any State Board has yet
produced. The amount of scientific work which its con-
tents represent, is indeed too great for any adequate no-
tice here. It is but due to the Board and our readers,
however, that we jioint out the chief features.
The reports made regarding tlie prevalence of disease,
and upon sanitary organization, relate to the year 1881,
and much of what is said is now old, and has been already
noticed. It is sufficient to say, that the organization of
local health boards, and the registration of vital statis-
tics, has progressed in a most satisfactory manner. We
note, also, that the sanitary arrangements for school-
houses have been investigated and improvements exten-
sivel)' made. Also, that during the past three years
there have been built in New York City, tenement and
apartment houses sufficient to accommodate one hun-
dred thousand persons, all upon plans previously sub-
mitted to the local health authorities.
Over one hundred pages of the present volume are
devoted to the report of the standing committee on
school buildings and the hygiene of public schools, to-
gether with special reports by Dr. D. F. Lincoln and
Dr. C. R. .\gnew. These documents constitute a valu-
able source of information upon all matters relating to
this branch of sanitar}- science.
The report upon quarantine is of more public impor-
tance than of direct interest to the medical reader.
Dr. E. H. Janes contributes a report on the outbreak
of typhus fever wliich occurred in New York City in
1S80-S1.
The Report of the Committee on Drainage, Sewage,
and Topographv, with sup|.ilementary reports on Methods
of Sewage for Large Cities and Villages, and on Efflu-
vium Nuisances, occupy one hundred and more pages.
They include a study of the various malarial regions of
the State, and a history of tlie Hunter's Point nuisances.
The best and simplest methods of disposing of sewage
in small town.s, are also described.
The most interesting portion of this volume to the
medical man, is the part containing the reports of the
Sanitary Committee, of which Professor Chandler is
Chairman. These reports relate to the purity of drink-
ing waters, the testing of inflammable oils, and the adul-
terations of food and drugs.
Dr. Elwyn Waller gives the results of the analyses of
about forty specimens of drinking water taken from dif-
ferent parts of the State. Of these, 24 were pronounced
bad, and 10 unsatisfactory. It is admitted, however,
that there are no absolute criteria for drinking-water,
and probably at the present day, the nose and eye are as
good tests in most cases as the reagents of the chemist.
\Vith regard to inflammable oils. Dr. Arthur H. Elliott
states that in New York City in 1880, there were 103
fires out of a total of 1,783, due to kerosene oil ; 54
of these were due to explosions, and none need have
occurred if the oils were of proper quality, i.e., had a
higli flashing and burning point. We find from the re-
port that the testers ordinarily used are quite variable in
value, but the per cent, of actually dangerous oils in the
market is not given.
The report upon butter and milk, by Drs. Chandler
and Munsell, shows that among 40 samples of butter,
over' 16 were adulterated. Of 28 samples of lard, 10
had from i to 7.5 per cent, of water, and were more or
less bad in quality.
Of 16 samples of olive oil, 9 were considered adulter-
ated.
As regards milk, the old story of skimming and water-
February lo, 1883.]
THE MEDICAL RECORD.
167
ing is repeated. Among 73 so-called " creameries," 63
send skimmed milk to New York City, which is sold as
pure milk. The condensed milk sold to New York cus-
tomers was found to be unobjectionable, except that in a
few instances the milk had been skimmed.
Professor Caldwell analyzed 29 samples of quinine
pills, and found that in every case the quinine sulphate
was below the amount claimed.
Professor A. H. Chester presents the analyses of nine
samples of popular meat extracts. A few contained
gelatine, but there was no other adulteration. Even in
a peptone preparation, however, there was no soluble
albumen, and in general the claims (or the extracts are
considered very much exaggerated.
In a report upon baker's chemicals. Dr. Love takes
up the "alum ([uestion,'' and considers that at the pres-
ent time there is not sufficient evidence of the injurious
action of alum upon the animal system to warrant its
prohibition.
Professor Labimore shows that out of 180 samples of
spices, 112 were adulterated.
In a report upon drugs. Dr. Frederick Hoffman states
that among 232 samples of crude vegetable drugs, 85
were adulterated or below the proper standard. Nearly
one-half of the povvtlered drugs were not of the required
purity or strength, and powdered drugs are considered
to be of questionable reliability.
.\ Dictionary of Medicine, Including General
Pathologv, General Therapeutics, Hygiene,
and Diseases Peculiar to Women and Children.
By various writers. Edited by Richard Quain,
AI.D., F.R.S. Fellow and late Senior Censor of the
Royal College of Physicians ; Member of the Senate
of the University of London, etc. 8vo, pp. 1,816.
New York : D. Appleton & Co. 1883.
In this large, double-colunmed, closely printed octavo
volume, we have alphabetically arranged the various
subjects connected with practical medicine, clearly,
fully, and concisely discussed by a large corps of dis-
tinguished writers. Each contributor was invited to
write upon such topics only as he was familiar with.
The description of each subject includes an account of
its etiology and anatomical characters ; its symptoms,
course, duration, and terminations ; its diagnosis, prog-
nosis, and lastly, its treatment. General pathology
comprehends articles on the origin, characters, and nature
of disease. General therapeutics includes articles on
the several classes of remedies, their modes of action
aiid methods of use. The articles on hygiene treat of
the causes of disease and their prevention, also the
agencies and laws atiecting public health. The diseases
peculiar to women and children receive the fullest prac-
tical consideration both in aggregate and detail. Not only
is the work a Dictionary of Medicine in its fullest
sense ; but it is so encyclopajdic in its scope that it
may be considered a condensed review of the entire field
of practical medicine. Each subject is marked up to
date and contains in a nutshell the accumulated exper-
ience of the leading medical men of the day. As a
volume for ready reference and careful study, it will be
found of immense value to the general practitioner and
student.
A System of Human Anatomy, Including Its Med-
ical AND Surgical Relations. By Harrison Al-
len, M.D., Professor of Physiology in the University
of Pennsylvania. Section III., Muscles and Fascia.
Philadelphia : Henry C. Lea's Son & Co. 18S3.
The third section of this admirable work, treating of the
muscles and lascia;, contains nearly two hundred quarto
pages, with seveial page plates, besides illustrations in
the text. The general design is consistently carried out
by a description of the organs from a strictly anatomical
standpoint, with such discussion of their relations and
functions as are considered of practical interest. The
author succeeds in infusing an individuality in his work
which gives it the highest value. As remarked in a pre-
vious review, he studies anatomy in a new way, by apply-
ing it in a striking and direct method to the actual wants of
the student and practitioner. In perusing page after
page, the reader cannot fiiil to be impressed with the
profound knowledge of the subject possessed by the au-
thor. He succeeds in making each topic interesting by
the manner in which he applies the facts presented ;
facts which, except for this application, might not be suf-
ficiently impressed upon the mind. So much for the
text. \Ve regret to say that the illustrations, although
much improved in character, will hardly realize reasona-
ble expectations. With few exceptions, they partake of a
coarseness of execution which does neither the author or
artist much credit. In a work of this kind such a criti-
cism should by no means obtain. Some of the drawings
are lackiilg in accuracy, while others fail, in consequence
of their heavy and sketchy shading, to bring out the due
proportions of different parts. For instance, the latter
point obtains more particularly in Plate XLV., repre-
senting the muscles of the neck. In Fig. i the larynx
and trachea are much too large, as are also the first rib
and clavicle. The first rib and clavicle in Plate XIV.
are also nearly twice the size they should be. In Fig. 2,
on Plate XLV., the constrictor muscles of the pharynx do
not represent the requisite degrees of rotundity, and have
curiously distorted relations witii each other. The muscles
of the forearm and hand, as well as those of the abdomen,
are well drawn, as are also those representing the muscles
on the inside of the jaw on Plate XLIV. It is to be re-
gretted that the artist has such a predilection toward heavy
shading, which appears to render necessary such coarse
printing of the names of the muscles on their surfaces.
If the outlines only of the muscles were shaded, the
drawings would have a more artistic appearance and
finer finish, the different layers would be more satisfac-
torily brought out, while at the same time the names of
the organs could be clearly represented in finer and bet-
ter type.
^niiB Rictus.
Official List of Changes of Stations and Duties of Officers
of the Medical Dcpartme7it, United States Army, from
January 27, 1883, to Febuary 3, 1883.
KiLBOuRKE, Henry S., Captain and Assistant Sur-
geon. The leave of absence granted December 21,
1882, Department of Dakota, is extended two months.
S. O. 24, par. 3, A. G, O., January 29, 1883.
Paulding, H. O., Captain and Assistant Surgeon,
(■ranted leave of absence for one month, to take effect
on or about February ist. S. O. 11, par. i. Department
of the Platte, January 27, 1883.
iUccUcal itcma.
Contagious Diseases — Weekly Statement. — Com-
parative statement of cases of contagious diseases re-
ported to the Sanitary Bureau, Health Department, for
the two weeks ending February 3, 1883 :
^
Week Ending
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January 27, 1883
0
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February 3, 18S3
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i68
THE MEDICAL RECORD.
[February lo, 1883.
The Philadelphia Policlinic and College for
Graduates. — New York has been visited by so many
Philadelphia physicians, anxious to see the workinsi; of
our Post-graduate Medical College and our Policlinic, that
it is evident that a policlinic endemic is imminent in the
Quaker City. In a recent issue we mentioned the in-
auguration of such a movement. The departments have
been assigned as follows: Operative Surgery and Clinical
Surgery, R. J. Levis, Surgeon to the Pennsylvania Hospi-
tal ; Diseases of the Throat and Xose, J. Solis Cohen, Pro-
fessor of Laryngology in the Jefterson Medical College ;
Diseases of tlie ^[ind and Nervous System, Charles K.
Mills, Lecturer on Nervous Diseases in the University of
Pennsylvania ; Orthopredic and General Surgery, Thos.
G. Morton, Surgeon to the Orthopajdic and to the Penn-
sylvania Hospitals; Diseases of the Eye, Geo. C. Har-
lan, Professor of Ophthalmology in the Jefterson Medi-
cal College ; Diseases of the Ear, Charles H. Burnett,
Aural Surgeon to the Presbyterian Hospital ; Diseases
of Women and Children, Edward L. Duer, Obstetrician
to llie Philadelphia Hospital ; Pathology and Micro-
sco|n-, E. O. Shakespeare, Pathologist to the Philadel-
phia Hospital ; Applied Anatomy and Practical Surgery,
John B. Roberts ; Diseases of the Chest and General
Medicine ; James C. Wilson, Physician to the Philadel-
phia Hospital ; Clinical Chejiiistry and Hygiene, Henry
LetTmann, Demonstrator of Chemistry in tlie Pennsyl-
vania College of Dental Surgery ; Diseases of the Skin,
Arthur Von Harlingen, Consulting Physician to the
Philadelphia Dispensary for Skin Diseases.
The Secretary is Dr. J. B. Roberts, who is known to
New York physicians, in connection with the Philadelphia
School of Anatomy, and as editor of the last Americam
edition of Bryant's "Surgery." Reference to the "Medical
Register " of Philadelphia, show's that seven of the twelve
professors are graduates of the University of Pennsyl-
vania. The alumni of this time-honored institution,
thus again prove themselves active promoters of ad-
vanced medical education. The fact of the two great
Philadelphia Schools being almost equally represented in
the new enterprise, is an auspicious omen for the future.
With one or two exceptions, all these men are known
in medical literature. Good writers, however, do not
always make good teachers. Some of theju are among
the younger members of the profession ; but vouth is
not objectionable if united with energy and intellect. It
will be interesting to watch the further development of
this medical embryo of mixed parentage.
Milk, and Typhoid Fever. — An interesting case of
the probable spread of typhoid fever, by milk contami-
nated by the use of impure well water for dairy pur[)oses,
is related in a report quoted in the Lancet. Twenty-one
persons in si.xteen households in Clapham, England, were
aflected. The houses were of the superior class and
widely separated. Investigation exhibited no one sani-
tary condition as a cause common to the households
affected, but suspicion attached to the supply of one milk
dealer who obtained a part of his milk from two dairy
farms at Musbury, near .\xminster. His customers were
divided into those who took "nursery" milk alone,
nursery and ordinary milk, and ordinary milk alone. The
enteric fever was found to be entirely limited to the con-
sumers of the ordinary milk, one in seven of every house
so supplied being affected. Several of the large houses
taking large supplies were affected with the disease. The
ordinary milk was su|)plied from the two farms referred
to, and these were at once inspected. Neither of them
exhibited the .sanitary conditions which should exist on a
dairy farm. At one the water was derived from a well
sunk in a gravelly soil, and was shown on analysis by
Dr. Dui)re to be largely polluted by sewage or surface
drainage, being entirely unfit for drinking or culinary
pur|)oses.
About eight yards from the dairy and twelve yards
from the su|)posed position of the well belonging to it is
a brook which higher up flows through a rough stone
sewer. Last winter six cases of enteric fever occurred
in Musbury, the last one being still ill during the month
of March ; and it is known tliat the infectious excreta
from this case were thrown into a privy with a vault of
primitive construction, from which, when full, the con-
tents are got rid of by ]iouring down water, and washing
them awav through a rough drain into the sewer. The
persons affected with enteric fever w-ere not specially
exposed to any known local conditions likely to have
brought about the disease ; they were not in any close
personal relation with each other, but they had a milk
supjaly in common, and that this supply came from the
dairy farm in question at Musbury, where there had been
at no remote date enteric fever, with the possibility of
access of the specific poison to the dairy farm well by
percolation from the sewage-polluted brook through a
porous, gravelly soil. These facts render it highly prob-
able, if not practically certain, that the infection was dis-
tributed through the medium of the* milk. — -Sanitary
Engineer, November 23, 1SS2.
Concerning the Dose of .\coxite i.n" the British
Phar.\iacopu£IA. — Dr. W. M. Bracken, of Thompson,
Conn., writes : " In .your issue of January 13th, ]i. 56,
Dr. Murrell is re|)orted to have said, ' The dose of tinc-
ture of aconite recommended in the British Pharmaco-
poiia — from five to fifteen minims — is absurdly large, and
no one with any regard for his patient's safety or his own
reputation would ever think of giving it.' The .same
statement will applv to the dose — one to five minims —
generally recommended by American authors. A com-
parison gives the following : The B. P. formula has one
part powdered root in eight parts of the tincture. The
U. S. P. formula has one part powdered root in two and
a /la// parts of the tincture. Dose, B. P., five to fifteen
minims ; dose, U. S. authorities, one to five minims — ■
equal to three and a half, to sixteen and a half minims
of the B. P. tincture. The U. S. minimum dose is
less, but the maximum dose greater, therefore, than
that which Dr. Murrell condemns. It is further recom-
mended ' to put half a drachm of the tincture in a four-
ounce bottle of water, and to tell the patient to take a
teaspoonful of this every ten minutes for the first hour,
and after this hourly for some hours.' This, of course,
refers to the B. P. tincture. The U. S. P. equivalent
would be eig/it and a half minims.
" The case of poisoning also reported in the same issue
(p. 42, ' Directions Regarding Administration of IVfedi-
cines') seems worthy of note. A physician directs two
teaspoonfuls of chlorate of potash ' to be dissolved in a
tumbler of water' (about six drachms by weight of the
potash in six ounces of water), two teaspoonfuls of this
solution to be used at intervals as a gargle. The patient,
a girl aged fourteen, bv mistake takes the two teaspoon-
fuls of the solution internall)' four times daily and devel-
ops symptoms of poisoning in less than thirty-six hours,
death following. Supposing all the chlorate of potash to
have been dissolved, the patient was taking fifteen
grains four times a day. This would hardly be consid-
ered poisonous, the ordinary dose for an adult being
from five to twenty grains. But it is not at all probable
that the chlorate of potash was entirely dissolved, for
this would have given one part in eight of the solution,
while only one part of the chlorate is soluble in sixteen
parts of cold water. A cold saturated solution, there-
fore, would have given but seven and a half grain-doses.
We are glad to learn that the 'jury exonerated the phy-
sician ! ! ' "
The Medical Students of Switzerland. — There
are in the four Universities of Switzerland — Basle, Berne,
Geneva, and Zurich — a total of 543 medical students, of
whom 51 are women. The largest class is at Ziirich,
where the number is 180. At Berne the number is 164.
There are women medical students at all the universities
except Basle. At Berne there are 26, at Zurich 17, and
at Geneva 8.
The Medical Record
A Weekly Journal of Medicine and Surgery
Vol. 23, No. 7
New York, February 17, 1883
^A/hole No. 641
©vioinal ^vticlcs.
ON THE SUCCESSFUL TREATMENT OF
EXTRA-UTERINE PREGN.ANCY."
By a. D. ROCKWELL, A.M., M.D.,
NEW Yoi;k*.
ELECTRO THERAPEUTIST TO THE NEW YUKK STATE WOMAN'S HOSPITAL, ETC.
In the first case of extra-uterine pregnancy which it was
my fortune to treat, I was asked by Dr. T. G. Thomas,
one of the consulting physicians, whether it was possible
to readily destroy the life of the fcetus by the electric cur-
rent. I replied that it could undoubtedly be done, but the
important question, it seemed to me, was, whether it
could be accomplished without injury to the mother.
This question was answered in the affirmative by the re-
sults that followed. The case was one of tubo-intersti-
tial pregnancy, at the third month, and terminated favor-
ably by the expulsion of the fcetus and placenta through
the uterus. The history of this interesting and remark-
able case was carefully written out by the attending phy-
sician, Dr. Charles McBurney, and published in the iVfrt'
York Medical Journal, vol. xxii., No. 3. At the same time
Dr. Thomas wrote out an interesting description of the
case accompanied by illustrative drawings, which he
kindly placed at my disposal, and which can be found in
my third edition of " Beard and Rockwell's Medical and
Surgical Electricity," p. 606.
The second case upon which I operated was in the
practice of Dr. C. E. Billington, the accuracy of whose
diagnosis was again confirmed by Dr. Thomas. The re-
sult in this case was entirely successful.
The third case I treated for Dr. Bache Emmet, who
had in consultation both Dr. T. Addis Emmet and Dr.
T. G. Thomas. Dr. Emmet's account of the case, with
its favorable termination, ma)- be found in the Neii< York
Medical Journal.
In the fourth case I operated for Dr. Everett Herrick,
the diagnosis being doubly confirmed by Drs. Thomas
and Emmet. In this case again the fcetus was effectu-
ally destroyed, followed by the prompt recovery of the
mother.
At the last meeting of the American Gynecological
Society of Boston, Dr. T. G. Thomas read an exhaustive
paper upon the subject, giving the histories of some
twenty cases of extra-uterine pregnancy that had fallen
under his observation, together with an account of most
of the cases to which 1 have just alluded, and in which
electricity was so successfully used. In addition to
these I have more recently seen and operated upon
three other cases of like character that have never been
rejiorted, and which, if possible, even more strongly con-
firm the incalculable value of the treatment in these dan-
gerous but somewhat rare abnormalities of pregnancy.
The fifth case, which I saw with Dr. N. S. VVestcott,
was of a most interesting and unusual character, from
the fact that with a normal uterine pregnancy was as-
sociated what we have every reason to believe was a
tubal or e.xtra-uterine pregnancy. Dr. Westcott had
previously called Dr. Thomas in consultation, and it was
at his suggestion that electricity was used. The patient,
a lady, aged about thirty, last menstruated August 6,
1882. Subsequently she complained of more or less
^ . ^ Read before the Harlem Medical Associauon, February 8, 1883.
discomfort and pain, with tenderness in the region of
both ovaries, but especially marked on the left side.
On September i8th an internal examination was made,
and by conjoined manipulation a small tumor was
discovered, about the size of a pullet's egg. It was
situated some two inches to the left of the median line,
nearly on a level w'ith the brim of the pelvis, and could
be moved from Douglas' cul-de-sac toward the margin
of the ribs. The tumor gradually increased until it was
larger than a billiard-ball. There seemed to be no rea-
sonable doubt as to its character, and on October 24th,
the treatment by electricity was attempted.
The constant current was used, with one pole intro-
duced to the mass through the vagina, and the other
over the tumor externally and with rapid interruptions.
The maximum of current strength employed was eigh-
teen cells, or, to speak more accurately, as different ap-
paratus vary much in electro-motive force, a power of
twenty-four volts.
This operation was repeated on October 25th, 28th,
and 30th, causing the tumor not only to perceptibly de-
crease in size, but to change its seat by an inch or so as
well. Since the last treatment it has gradually grown
smaller, until at the present date it can barely be de-
tected. At the same time there is now developing in
the uterus a six months' fcetus.
The sixth case occurred in the person of a young un-
married woman, residing outside the city limits, and by
special request, and for sufficient reasons, the name of
the attending physician will not be mentioned. From
him I obtained the following history : Two weeks pre-
viously he first saw the case professionally, and found
that sire was suftering much pain in the right side, to-
gether with irregular discharges of blood. The patient
had confessed to the possibility of pregnancy, and
examination elicited many of the objective and subjec-
tive signs of this condition. Nausea occurred every
morning, .and changes had taken place in the areola.
Digital examination revealed the fact that the os uteri
was little, if any, changed from its normal condition. By
pressure over the right side it was possible to feel a cer-
tain hardness not present on the other side, but by con-
joined manipulation, with one finger in the vagina, a
distinct rounded mass could be felt.
Examination per rectum revealed its presence even
more distinctly. If pregnancy existed — and of this there
seemed to be no reasonable doubt — it had advanced
nearly to the fourth month, and as the tumor was large,
much larger than in the case just related, there was evi-
dently no time to lose. I had brought with me a suita-
ble apparatus, and immediately operated by introducing
one pole into the rectum, and placing the other exter-
nally. On account of the great distention of the Fallo-
pian tube, and the danger of rupture, we felt the
necessity of exercising the utmost care, and consequently
made use of the interruptions, with a current strength of
but twelve cells, or about sixteen volts. The current
would then be quickly increased without interruption
and allowed for a moment to pass in a continuous
stream. The treatment was concluded by a second ap-
plication on the following day. Visiting the patient
some two weeks subsecjuently, I found that the tumor
had decreased in size at least one-half, and at this time,
after the lapse of several months, it maybe said, so far as
any external evidence of it is concernecl, to have entirely
disappeared.
I70
THE MEDICAL RECORD.
[February 17, 1883.
The last case is as follows: On December 14, 1882, I
was informed by Dr. H. Marion Sims, that Mrs. A ,
a patient of his, was suffering from extra-uterine preg-
nancy, and was by him requested to undertake the
destruction of the foetus by electricity.
Although married a number of years, she had never
before been pregnant. Dr. Sims, on first discovering
the possibilities of this condition, called in consultation
Dr. T. Addis Emmet, who positively confirmed the diag-
nosis. The pregnancy had advanced to the third
month, and the tumor, which was about the size of a
child's fist, was movable and could be distinctly felt both
from without and within.
The size of the enlargement was such that the opera-
tion was urged immediately. For fear that the cyst might
be in danger of rupture through uncontrollable move-
ments of the patient, Dr. Emmet advised the administra-
tion of an anesthetic.
Ether having been given by Dr. M. H. Nash, Dr. Sims
placed the uterine electrode, and shocks from a galvanic
current of but sixteen volts in strength were passed
through the fcetal mass.
The mildness of the treatment was necessitated be-
cause of the unusual nerve-irritability, and the violence
of the muscular contractions.
Although it was probable that the destruction of the
fcetal life had been effected at the first seance, the opera-
tion was repeated on the i8th, 24th, and 27th of Decem-
ber, for the purpose, first, of absolute certainty, and
second, to accelerate the absorptive process. The con-
tour and seat of the tumor were not only changed after
the first application, but it rapidly decreased in size.
The patient experienced no unpleasant effects, and within
a short time was able to start for Europe.
In the treatment of extra-uterine pregnancy, it is an
important point to be decided, as to the best form of
electricity to be used. Not only has galvanism and elec-
tro-magnetism been successfully employed, but it is said
that the common magneto-electric battery has also proved
sufficient, but from both a physical and physiological
point of view, and as well through the teachings of ex-
perience, I cannot, for my part, doubt that galvanism
is preferable to the other forms. It is more certain in
its effects. It has a greater power of overcoming resist-
ance, and consequently its influence is felt deeper than
the other forms. Four important effects attend the pas-
sage of the electric current through the living body, and
all these undoubtedly enter as factors, either in destroy-
ing the life of the fcetus, or in the subsequent process of
absorption.
These effects may be designated as mechanical, phy-
sical, chemical, and physiological.
The mechanical effects of the interrupted galvanic
current are equal to those of the faradic current, while
the physical effects, manifested by heat, and the modifi-
cation of endosmose and exosmose are in the main the
results of galvanic action.
By the passage of the galvanic current, the endosmotic
phenomena may be both stimulated and reversed. The
faradic current from the secondary coil produces no such
effect. The current from the inner coil, produces these
effects, but in a much less degree. Chemical or electro-
lytic effects, again, are almost wholly the result of gal-
vanic action, and it should be remembered that the elec-
trolysis of organic substances starts a process that
continues long after the current ceases to ffow. The
physiological effects of electricity are those which take
])lace by virtue of the vital properties of the body, and
unlike the other effects, are only observed in living sub-
stances. Physiological effects are manifested on the
circulation, on secretion and excretion, but only as ab-
sorinion is effected does it interest us here, and it is
quite evident tiiat the absorptive powers of the second-
ary current are quite limited.
In any case of tubal pregnancy, and especially in
those advanced conditions where the tube is greatly dis-
tended, and there is danger of spontaneous rupture, the
possibility of hastening this catastrophe in the attempt
to destroy the life of the fcetus should never be lost sight
of The tubes themselves are but slightly supplied with
muscular fibre, and the danger would more especially
arise from the powerful compression that is liable to be
exerted by the abdominal muscles, and the effort should
be so to diffuse the current proceeding from the external
pole, as to produce the least mechanical effect possible.
In regard to the diagnosis of extia-uterine pregnancy, it
must be confessed that it is not always an easy matter,
and in the cases just related the question may arise as
to its accuracy. The eminence of the gentlemen associ-
ated in the cases should perhaps be a sufficiently strong
argument for the correctness of the diagnosis, but con-
clusive evidence lies also in the effects of the treatment
itself. The results of the electrolysis are well known, but
in no other form of tumor, cystic or otherwise, is it possible
for the galvanic current, used as described, to produce
similarly prompt and effective results. In regard to the
effects of electricity on normal pregnancy, suggested by
the case of double pregnancy that I have related, a word
may be said. It is a mistake to suppose that abortions
are readily produced by electricity. Without the elec-
trode is introduced directly into the uterus, which would
of course be sufficient without the passage of any current,
the strongest treatment that it is prudent to give may
prove insufficient. Of this I have had evidence in several
justifiable attempts to bring on a miscarriage. In the
case just alluded to the current was strong, applied by
shocks, and in close proximity to the uterus, affecting it
not only reflexly, but in some measure directly, yet the
normal pregnancy was in no ways disturbed ; and, so far
as concerns general applications for the production of
constitutional tonic effects, I have in many instances ad-
ministered them with impunity through the whole course
of gestation, and with the most happy results.
THE NEGATIVE PULSE OF THE VEINS.
Bv S. E. POST, M.D.,
NF.VV YORK.
Trace No. i was obtained fortuitously during the early
part of my experiments with the faradic brush.'
It was obtained from a young woman, formerly active
in habit, but who, without organic disease, had developed
inability for physical work. She appeared incapable of
effort, and would frequently remain all day in bed.
She had become somewhat emaciated, but her appe-
tite remained remarkably good, her digestion was per-
fect, and she slept well. She was always pale, and upon
walking a short distance her lips would become almost
white, yet she never experienced dyspnoea, her heart
and her lungs were healthy, and her blood-corpuscles
approached the normal in number and size. She com-
plained of constant fatigue, and of a sensation of heat
in her extremities, which was especially present at night.
Upon one of these occasions the temperature of her
hands was found to be 99° F., that of the mouth and of
the hands being the same. The veins of the hands were
prominent, and usually gorged with blood. This pa-
tient felt better in cold weather, and she derived benefit
from sea-baths.
In the observation referred to, Pond's sphygmograph
was used. It was supposed to liave been adjusted over
the radial artery at the wrist.
The usual reactions of my experiment were an in-
creased arterial blood-pressure, then a diminished arterial
* Cutaneous Irritation and the Pulse : New Vork MtlDlCAL Record, September
3«, 18S3.
February 17, 1883.]
THE MEDICAL RECORD.
171
blood-pressure and a slowed pulse, following the stimula-
tion of the cutaneous nerves. The pulse of this patient was
sometimes accelerated. In no other way was it affected
by the irritation employed. The observations were
therefore discontinued, and for several months the sub-
ject was dismissed from my mind.
Later, however, similar tracings were obtained from
other cases, in which also the pulse was unaffected by
tlie irritation. I therefore grew to associate their contrary
character with a peculiar obstinacy toward tlie reactions
named.
By closer observation in Case I., at the side of and ex-
ternal to the artery, a vein was discovered, which some-
times could be rolled under the finger, and frequently
distinctly felt. The instrument was applied over this
vein, and a tracing, which in every essential character-
istic resembled Trace No. i, was obtained.
In other cases, where the vein could not be felt, hav-
ing recognized the arterial pulse, the instrument was
moved slightly toward the external side of the arm.
This manreuvre produced with many subjects an abso-
lutely negative result. From a number, however, tra-
cings similar to Trace No. i were obtained. In each of
these instances the corresponding arterial trace regis-
tered a tension which was abnormally low. The heart
was normal in each case.
W'ith good arterial tension, by tlie readjustment of the
instrument a line which resembled a line of respiratory
variation was sometimes produced. This line did, in fact,
correspond witli the movements of the patient's chest, its
convexity was formed during expiration, and its concavity
during inspiration. This line was more frequently met than
was that of pulsation. In one patient both were present,
the base of the pulsation following the curve of tlie res-
piratory line.
The vessels of the forearm alone were subjected to
observation. In Case I., however, a similar pulse was
obtained also in a vein of the foot. Traces 3 to 6 were
methodically taken from this case.
Case I. — Arterial relaxation — heart normal.
No. 6. — Pressure 4 ;'^dorsalis pedis vein.
Trace 3 from the radial artery. Trace 4 from its exter-
nal vein, Trace 5 from the dorsalis pedis artery, and Trace
6 from its internal vein. I suppose one of the venae co-
niites always to have been employed.
I never obtained peripheral pulsation in a superficial
vein. From this circumstance a transmitted arterial im-
pulse was suggested to me.
Very early, therefore, in the course of my investigation.
with the finger upon the artery and the instrument upon
the vein, their points of coincidence were marked. In
each instance, as shown in Trace 2, the impact of the
artery occupied in the tracing of the vein the time of its
line of descent. The pulsation of the vein, therefore, did
not depend upon the relative position of the arterial wall.
The remainder of these tracings were obtained from two
patients, whose symptoms referred to the heart. Case II.
possessed stenosis of the aortic valve, without altered
area of the apex beat.
Case II. — Stenosis of the aortie valves.
Pressure 6 ; radial vein.
Traces 7 to 1 1 represent the pulse of the carotid artery,
of the internal jugular vein, of the external jugular vein,
of the radial artery, and of the radial vein in this patient.
Case III. presented no lesion of the valves. Dr. A. L.
Loomis kindly examined each of these patients. Tricus-
pid difiiculty was eliminated in both. Trace 12 repre-
sents the pulse of the radial artery, and Trace 13 the
pulse of the external jugular vein in Case III.
Case III. — Irregularity and /eeble?iess of the heart —
no valvular disease.
No.'i3. — Pressiiie.4 ; external jugiiKir vein.
I did not obtain a tracing from the radial vein of this
patient, neither did I obtain one from the jugular vein,
excepting when the contractions of the heart were more
than usually strong. In the veins of the neck, pulsation
was sometimes apparent to the eye. Visually its most
marked characteristic was its descent. As Case III. once
172
THE MEDICAL RECORD.
[February 17, 188^
said, its beat was inward, or toward the vertebral column.
In these cases, also, the descent of the vein occupied the
time of the arterial percussion stroke.
We have therefore presented in this brief report a
pulse which falls while that of the artery rises, and which
rises while that of the artery falls, which has been found
in veins of the neck, of the forearm, and of the foot, and
which has been associated with arterial relaxation, with
stenosis of the aortic valves, and of irregularity with fee-
bleness in the action of the heart.
The occurrence of venous pulsation is not infrequent.
Reports of such occurrence have been made, nota-
bly by Marey,- of pulsation in a vein of the leg with a
systolic regurgitant murmur in the heart ; by Boyer,'
of pulsation in superficial veins ; by Friedereich,' of pul-
sation in the veins of the neck, in the thyroid, and in
an external thoracic vein with stenosis of the mitral
and of the tricuspid valves; by Parrot,' of |)ulsation
in superficial veins ; of pulsation in the veins of the ex-
tremities by Ward,' by Davis,' and by Groves ;' by Ben-
son," of pulsation in both upper extremities in a patient
having mitral stenosis and tricuspid insufficiency with
dilatation of the right heart ; by Seidel," of pulsation in
the jugular and in superficial veins; by Bamberger," and
by Geigel,'" also a venous pulse with insufficiency of the
tricuspid valve ; by CoUis and Groves," of venous pulsa-
tion in pneumonia ; by Quincke," of pulsation in the
veins of the forearm and hand in a case of cholelithiasis,
also in a case of paraplegia from fracture of the spinal
column at the level of the fourth cervical vertebra, and
more recently by Dimer,'* of pulsation in the pulmonary
veins and in the inferior vena cava after the opennig of
the thorax ; by Gottwalt," of pulsation in the vena; cavre,
in the veins of the neck, and in a brachial vein, and by
Mosso," by Riegel," and by Franck,'" of pulsation in the
veins of the neck.
Three varieties of venous pulsation have been recog-
nized. The first variety consists of a regurgitant wave.
It is due to insufficiency of the valves of the veins and
of the auriculo-ventricular valve of the right side of the
heart. By means of this insufficiency the ventricular
systole causes not only a forward impulse to the blood
in the pulmonary artery, but also a backward impulse
to the blood in the auricle, the vena; cav.is, the jugulars,
and even in more peripheral veins. This variety was
the earliest known. Formerly any venous pulsation
was considered pathognomonic of regurgitation through
the tricuspid valve. Friedereich"" says: "It is un-
questionable that without valvular insufficiency a venous
pulse cannot exist."
In agreement with this opinion were Roncati,"
Thomm,'^ Rosenstein,"^ Eichhorst,"' Oppolzer,''" Bam-
berger,"' Geigel,^' and Seidel."'
The .second variety of venous pulsation is due to re-
laxation of the minute arteries. It consists of a projec-
tion of the arterial wave.
2 Marey : Phys. de la Circ. du Sang, p. 529. 1863.
3 Koyer : Jour. Compt. des Sc. Med., .\.vi., p. 330.
* Friedereich : Deutsches Archives f. kUn. Med., Bd. I., S. 241.
* Parrot ; Histoire de I'Acad. Roy. des Sc, p. 159. 1704.
* Ward : London Med. Gaz., June, 1832,
" Davis : Dublin Hosp. Reports, vol. iv.
^ Groves ; Dublin Jour. Med. and Chem.. vol. vi., p. 54.
* Benson : 1 >ublin' Jour. Med. and Chem., vol.'viii., p. 324. 1836.
10 Seidel ; Deutsches Klinik, 1836.
*' Bamberger : Wiirt^burger Med. 2lschr.. IV., S. 232. 1863.
'^Geigel: WUrtzburger Med. Zlschr.. IV., S. 332. 1863.
^^ Collis and Groves : Legons de Clinique M^d., trad. p. Jacoud, t. ii., p. 63.
1863.
'< Quincke : Berl. klin. Wochenschr., XXXIV. 1S68.
1^ Dimer : Ueber die Pulsationen der Vena Cava inferior. Bonn, 1876.
•« Gottwall : Pfliiger's Archives, May 14, 1881.
*T Mosso : Archives p. la Scien. Med., ii., p. 401. 1878: Die Diagnosiik des
Pulses. Leipzig. 1879.
'f* Riegel : Hcrl. klin. Wochenschr., May 2, 1881 ; Deutsches Archives f. klin.
Med., May 30. 1882.
'» Franck : Gaz. Heb. de Med. et de Chir. Opr., 1882.
'■"^ Friedereich ; Boc. cit.
*' Roncati ; Diagnosi d. Med. d. Petto, d. Ventre c.d. Sist. Ncrv. Napoli, 1868.
'^^Thomm : Berl. klin. Wochenschr., No, 13, '1S69.
^^ Roscnstcin : v. 2iemssen's Hdb. der Sp. Path., VI., 2 Aufl., S. 42.
2* Eichhorst : Lehrbuch der Phys. Untersuchungs Merhodcn, etc. 1881.
^* OppoUcr : Vorlcsungcn redigirt Von StofTella. 1S67.
^* Bamberger ; Loc. cit.
^' Geigel : Loc. cit.
3^ Seidel : Loc. cit.
In Bernard's experiment upon the submaxillary gland'^"
by stimulation of the chorda tympani, or of the lingual
below the emergence of that nerve, it is obser\'ed that
the arterioles become dilated, pulsation appears in the
capillaries, and the blood issues in jets from the veins.
This occurrence is recognized by all physiologists. Flint"
has called it the true venous pulse. Marey" considers
every peripheral venous pulse to be so produced.
Quincke'" in particular was assured of the centripetal
character of his wave. He observed that the finger-tips
paled and reddened with the contractions of the heart ;
also, that by compression of the brachial artery the pul-
sation could be made to cease, while with compres-
sion of the vein it ceased only on the proximal side.
Low arterial tension was a prominent cliaracteristic of
Quincke's cases. Of the first he mentions that the pulse
fell away quickly from the fingers, and of the second a
paralysis of the vaso-motor nerves.
Pulsatory movement of the blood in the veins may
occur, therefore, both from a centrifugal and from a cen-
tripetal impulse. In the latter instance the pulse is
most marked at the periphery, in the former it is most
marked near the heart. Both, however, are positively
systolic. In both the wall of the vein rises at the same
time as does the arterial wall.
The third variety of venous pulsation has been called
the negative pulse of the vein." It consists of an abrupt
fall of pressure, which is S}nchronous with the contrac-
tion of the ventricle, and which is due to a periodic
acceleration of the flow of blood into the heart. Mod-
ern interest in this pulse dates from the observations of
Mosso.
Widemeyer," however, in 1S2S, with one end of a glass
tube immersed in water and the other end inserted into
the jugular of a horse, noted pulsatory oscillations of the
fluid in the tube.
Weyrich,'* in 1845, repeated the experiment upon
dogs. He found the fluid to rise during the systole and
to fall during the diastole of the heart. The phenome-
non was obtained, however, only in the vena cava and in
the innominate vein. According to RoUett," Weyrich
attributed the ascent of the fluid to the aspiratory influ-
ence of the auricle at the moment of its relaxation.
This theory is referred to also by Ludwig" and by Bon-
ders.'* Mosso," however, considered the negative pulse
due to periodic acceleration of the venous flow from the
increased thoracic aspiration which accompanies the
systole of the heart.
That the heart occupies less space during its systole
than during its diastole has been demonstrated by
Marey," by Mosso and Pagliani," and by Francois
F"ranck."
The yet contracting amphibian heart was placed in
water, having access to a tube through which its oscilla-
tions were measured. The fluid was found to rise during
the systole and to fall during the diastole.
Francois Franck and Stefani" corroborated this result
upon the living animal by means of a canula inserted
into the pericardial sac.
.•Mso Voit" obtained a similar result with an instru-
ruent for measuring aspiratory force. With the tube in
the mouth during suspension of respiration, he observed
the fluid to rise during the systole and to fall during the
diastole of the heart.
3' Foster's Physiology*, p. 240. 1879,
'" Flint : Te.\t-book of Human Physiology-, p. 99. 1881.
*• Marey : La Circulation du Sang. 1S81.
2^ Quincke ; Loc. cit.
23 Foster's Physiology, p. 166. 1870.
'* Widcmeycr : Untcrsuchungen ueoer den Kreislauf des Blutes. 1828.
'* Weyrich : De Coudis Asperimcntc e.\pcrinieilta. 1S53,
'^ Roliett : Hermann's Hdb. der Phys., lid. IV., Th. I., S. 331.
3" Ludwig : Lehrbuch der Physiologic, Hd. II.. .S. 141.
'* Dondcrs ; Phy-siol. d. Menschcn, 2 .Aufl., I., 153.
3** Mosso ; Loc. cit.
*" Marey : Trav. du I.ab., p. 51. 1875.
** Mosso u. Pagliani ; Gion. dclla R. Acad, di Med. di Torino. 1876, N. 10,
II, u. 12.
*'^ Francois Franck : Trav. du I„-ib. de Marey, p. 187. 1877.
*' Stcfani : Arch, per le Scienze Med,, III. 1S79.
** Voit ; Ztschr. liir Biologie, L, S. 390. 1S65.
February 17, 1883.]
THE MEDICAL RECORD.
173
Mosso's observations have attracted considerable re-
mark, though physiologists have been, as a rule, con-
servative regarding the acceptance of his views.
Rollett," however, credits Mosso with the recognition
of a normal venous pulse.
Franz Riegel {Berl.klin. Wochcnschrift, May 2, 18S1)
states that he has observed in dogs a venous pulse which
alternated in time with that of the arteries. Also that
in many healthy men he had obtained a pulse which
did not differ from that which he had obtained in dogs. He
sums up by saying there exists a normal venous pulse.
This pulse falls during the heart's (ventricle's) systole
and rises during its diastole. It is explained by the fact
that during the systole of the heart (ventricle) the flow of
blood from the vems is accelerated, while during the
diastole of the heart it is retarded.
May 14, 1881, an article appeared by (lottwalt entitled
"The Normal Venous Pulse" {Fjiiigfr' s Archives) Gott-
walt's observations were upon dogs. His apparatus was
somewhat unique. The vein was dissected from its siu'-
roundings. Under it was placed a concave tambour and
above it a closely fitting metal plate. The conducting
and registering apparatus were of the usual kind. Clott-
walt's curve consisted of one large wave followed by two
smaller ones. So nearly as he could judge, the second
sound of the heart corresponded in time with the apex
of the first smaller wave.
The efforts of this author, however, were principally
directed toward determining the extent of the pulse. For
this purpose other methods were more satisfactory than
the use of the tambour. A small mirror was placed ujion
the \'essel, and its reflection was noted upon the wall. Also
the handle of a scalpel was placed under the vein, suffi-
cient upward pressure being usetl to obliterate its lumen.
If the pulse were present upon the proximal side of
the scalpel, the blood might be seen to advance and to re-
cede like waves upon the level shore of a summer sea.
By this means he traced it in the inferior vena cava to
the renal vein, in the internal jugular to the head, in the
external jugular to the middle of the neck, and once in
a vein of the arm.
Gottwalt says the respiratory undulations extend far-
ther than do the pulsations. He detected respiratory
movement in the femoral when pulsation was confined to
the vena cava above the renal vein. He opposes Mos-
so's theory of causation, finding the pulse equally marked
after the opening of the thorax.
In 1882 anarticle appeared by Riegel upon " The Nor-
mal and Pathological Venous Pulse " (Deiitschcs Archives
f. klin. Aled., May 30, 1882), with simultaneous traces
from the carotid artery and from the jugular vein. The
normal pulse was found upon patients as follows :
Case I. — Woman, thirty years of age ; joint-affection ;
four months pregnant ; thin, but has no disease of inter-
nal organs, nor of the circulatory apparatus.
Case II. — Girl, eleven years of age ; pale ; has a large
ovarian cyst ; no lesion of the heart.
Case III. — Young man ; chronic nephritis ; heart nor-
mal.
Case IV. — Man, fit"ly-five years of age ; somewhat en-
feebled ; having the appearance of conniiencing multiple
sclerosis.
Case V. — Man, thirty-five years of age ; hKuiatemesis ;
high grade of anremia.
C.\SE VI. — Boy, eleven years of age ; convalescing
from croupous pneumonia.
Case ViI. — Man, twenty-five years of age ; conva-
lescing from pneumonia.
Case VIII. — Man, thirty-three years of age; chronic
nephritis.
Case IX. — Shoemaker ; poorly nourished ; signs of
phtliisis.
Case X. — Girl, sixteen years of age ; convalescing
from pleurisy.
" RoUett : Hermann's Hdb. der Phys., IV., i, i83.
In the tracings obtained the time of the ascent from
the artery occupied the time of the descent from the
vein. The ascent was prolonged and dicrotic, while the
descent was monocrotic and quick.
Riegel also gives simultaneous venous and arterial
traces in stenosis of the mitral and insufficiency of the
tricuspid valve. These traces did not differ in character
from those obtained with the normal heart, but the per-
cussion-wave from the artery here occupied the time of
the second and greater wave from the vein.
Riegel concludes :
First. — In dogs there is a normal pulsatory movement
in the jugular vein.
Second. — In many healthy men there can be found
likewise a pulse in the jugular vein. It is probable that
such a pulse always exists.
Third. — This pulse is not dependent upon a backward
wave, but upon the alternate retardation and accelera-
tion of the flow of blood into the heart.
Fourth. — The normal venous pulse falls syncluonously
with the heart's (ventricle's) systole, and rises with its
diastole.
Fifth. — The normal venous pulse does not require any
insufficiency in the valves of the veins.
Si.xth. — Besides the normal venous pulse there is a
systolic venous pulse observed in men, and principally in
the jugular vein and in the liver.
Seventh. — This backward venous pulse can occur only
from insufficiency of the tricuspid valve.
Eighth. — This pulse does not differ from the normal
venous pulse in form, but in time, being systolic, while
the other rises during the diastole of the heart.
Still more definite observations upon this subject were
reported in April, 1882, by Francjois Franck {Gaz. Hehd.
de Med. ct de Chir.), who gives tracings taken simultane-
ously from the jugular vein and from the heart.
The tracing from the vein is ^similar in form to that
given by Riegel. Following the sequence of the cardio-
gram, however, it is supposed to consist of, i, a sud-
den rise and descent at the commencement of the total
curve ; 2, a second rise and descent ; 3, a gradual ascent,
and then again a sudden rise, indicating the conmience-
ment of a new series. The sudden rise and descent were
synchronous with the contraction and relaxation of the
auricle, and occurred with equal prom|)titude when the
contractions of the ventricle were arrested by stimula-
tion of the pneumogastric nerve. The second rise ac-
companied the ventricular systole.
His explanation is as follows : The sudden rise is due
to increased pressure from obstructed flow at the instant
of the contraction of the auricle and the sudden fall to
rapidity of the current at the commencement of the
diastole when the blood precipitates itself into the relax-
ing auricle. The second rise is due to retardation of the
current from the loss of the aspiratory influence of the
auricle and the second fall to a new acceleration from
relaxation of the ventricle, while the gradual ascent is
due to retardation from the gradual repletion of the
whole ri^ht heart.
According to Franck's schematic representation his
curve commences at a point midway between its apex and
the base line. Riegel, on the other hand, considers his curve
to extend between the points where it reaches that line
independently of the cardiac cycle of events. Riegel,
however, agrees with Franck, in finding his abrupt line
of descent synchronous with the contraction of the ven-
tricle, and therefore of commencing auricular diastole.
Gottwalt, also, by placing the second sound of the
heart at the apex of the first smaller wave has determined
the apex of his largest wave to exactly the same period
in time as the other two. Because each has similarly
located his abrupt line of descent, not different, but the
same phenomenon is supposed to have been under the
observation of all, their peculiarities of description being
due to the varying point at which the curve was sup-
posed to have commenced.
1/4
THE MEDICAL RECORD.
[Februarj 17, 1883.
My own tracings, also, on account of their systolic de-
scent, must be considered as records of the same pulse
which has been described by Mosso, by Gottwalt, by
Riegel, and by Franck.
From the history of the subject it is apparent that I
have first recognized this pulse in the forearm and in the
foot. The observations of Mosso, of Riegel, and of
F'ranck were limited to the veins of the neck, while Gott-
walt, who investigated the extent of the wave, found it
only once beyond the jugular veins, and then in a vein
of the arm. All of these observations were conducted
under conditions which the observers have called normal.
My tracings were obtained only with the circumstance
of arterial relaxation or of insufficiency in the heart.
Venous pulsation with effusion into the pericardial sac
has been noted by Stokes, by Knoll," and by Cohn-
heim."
Riegel, upon animals injected the pericardium, and with
one monometer in the carotid of one side and a second
in the jugular of the other, noted the changes which oc-
curred. In the commencement of the experiment the
pulse of the carotid was high and possessing arterial
character, and the pulse of the jugular was low and small.
As the injection proceeded that of the carotid fell, until
it could no longer be perceived. At the same time the
pulse of the jugular up to a certain point gradually in-
creased in size, when it, too, commenced to fall, and
finally ceased to exist. ,♦
Riegel's tracings of this venous pulse did not ditt'er in
character or time from those obtained with the normal
heart. Franck" has determined that with pericardial
compression the arterial pressure sinks, while that of the
veins is increased. By arterial relaxation the same con-
dition may be attained through increased swiftness of the
arterial current, for while this swiftness is directly as
the vigor of the heart, it is inversely as the peripheral re-
sistance, which resistance is determined by the arterial
tone."
The low arterial tension and the fulness of the veins
in Case I. have been noted. The veins were prominent
also in Case II.
This case presented aortic obstruction and regurgita-
tion without alteration of the ajjex-beat. Niemeyer ''°
notices that venous engorgement must result from a non-
compensated valvular disease. In Case III. cyanosis
was frequently marked. This case, however, only pre-
sented the venous pulse when the action of Jier heart was
more than usually strong. Riegel's picture of the pulse
of pericardial effusion is typical of my entire experience.
With venous engorgement the negative pulse of the
veins increases in size and extent until the advent of a
pronounced failure in the heart, when it, too, tends to
disappear with the disappearance of the arterial pulse.
To recapitulate :
First. — The negative pulse of the veins — called the
diastolic venous pulse, called also the normal venous
pulse — may occur in the forearm and foot.
Scconti. — This pulse contrasts with the arterial pulse
not only in its negative character, in the slow ascent and
(juick descent of its curve, but also in the fact that its
amplitude is increased with the increased fulness of the
vessels in which it is found.
Third. — That it is therefore extended and accented by
any cause which increases venous engorgement, whether
it be arterial relaxation, obstruction in the lungs, insuffi-
ciency in the heart, or effusion into the i)ericardial sac.
The recognition of this pulse is iinportant, because it
may be of sufficient amplitude to mark the trace of the
arterial pulse ; because it must be eliminated in the diag-
nosis of the pulse of regurgitation through the tricuspid
valve ; and because it probably possesses a diagnostic
importance of its own. With the Pond sphygmograph
*^ Knoll : Uctjcr die Kolgen dcr Hcrz-Comprcssion.
*' Calinhcim : Vorlcsungcn ucbcr Allg. Pall.ologic, Ijd. I., S. 37.
*" Friuick ; 'I'rav. du Lab. dc Marcy. 1877.
*' Kollill : Hermann's Hdb. dcr I'hys., Bd. IV., Th. i. S. 3C0.
*^Nicincycr: Prac. Medicine, vol. il., p. 178. iSSo.
its recognition in the forearm is not difficult. Having
obtained the radial artery at the wrist, move the instru-
ment i to I cm. toward the external side of the arm,
remit one-half the pressure which had previously been
employed, and if the pulse be present its tracing will
appear.
113 East Thjktv-first Street,
January 23, 1SS3.
HINTS ON CASE-TAKING.
By J. WEST ROOSEVELT, M.D.,
NEW YORK.
This paper is intended to give an outline of the symp-
toms and signs to be sought for and recorded in medical
cases. The importance of accuracy in recording cases
is self-evident. The scheme here given may seem long
and complicated, but in serious cases the facts sought
may be all of importance. It will be seen that many of /
the questions refer to the possible existence of chronic/^
disease of certain viscera. Information is sought in re- ]
gard to such disease for various reasons, among which
are the following : Prognosis in a given acute case may
be gravely influenced by complicating chronic disease ;
differential diagnosis may be assisted by knowledge of
such disease ; an acute case may be followed by an out-
break of sym]3toms due to pre-existing chronic disease,
which had heretofore remained in a comparatively quies-
cent condition, in which case knowledge that symptoms
of such disease have previously existed is of interest and
value. Moreover, autopsy frequently shows diseased
conditions of certain organs which were never susj^ected
during life. It is a matter of importance to know
whether symptoms of such disease were ever manifest
during life, or whether the conditions never gave any
symptoms. It is often as necessary to state that symp-
toms do not exist as that they do.
The order in which the facts are recorded is, of course,
not that in which they are obtained. It is suggested
merely, because, if followed, it makes a connected history,
with facts of a general nature as a sort of introduction.
If the history of the case be covered by one of heads
suggested in the scheme, it seems better so to change
the order that such history fall just before the heading,
" Present Condition." Common-sense must dictate how
far the scheme shall be followed in each case.
In taking a history, the first points to be ascertained
are the symptoms which trouble the patient most. He
should, as far as possible, be made to tell his own story.-
Direct questions should be avoided until the physician is
convinced that no more information can be obtained
without them. The history should cover every point ;
but be as short as possible. Notes should be taken at
the bedside, if practicable, in the form in which they are
to be recorded, as this saves writing, and does away
with the temptation to alter the record so as to fit the
case, should it pursue an unexpected course. The phy-
sician should have no preconceived idea of how the case
should run, but simply aim to record facts as they come
to notice. Every sense should be trained, so that noth-
ing escapes notice, and nothing is imagined to exist
which does not exist. The previous history of a patient
should be verified by judicious cross-examination. A
history, when first recorded, had better be too long than
too short. It may be shortened afterward, though the
information contained in it should not be altered unless
shown to be false.
GENERAL PLAN FOR THE RECORD.
Name of patient, age, civil condition, occupation, birth-
place, race, residence.
These facts should head the history. The importance
of recording the age of a patient is obvious. Hy civil
condition is meant whether married, single, widow, or
widower, facts which may or may not be imiiortant.
Occupation, because of its bearing upon certain diseases
February 17, 1883.]
THE MEDICAL RECORD.
175
. should be noted. It is customary to note the birthplace,
1 because information may thus be obtained leading to
suspicion of diseases, endemic in certain localities, which
may influence diagnosis. In tliis country, where so
many races come under observation, information upon
this point is interesting, because of the alleged different
courses of various diseases in different races. Residence
should be noted, because of its importance in infectious
diseases, and in general hygienic conditions, favorable or
unfavorable to disease.
F.^MILV HISTORY.
Information should be obtained in regard to the exist-
ence or non-existence of the following diseases among
near relatives (parents, grandparents, uncles, aunts,
brothers, sisters, children) :
Phthisis should be looked for. In connection with
phthisis or tuberculosis, struma should be borne in mind.
Syphilis. — Unless the parents themselves can be ob-
served, a history of syphilis in a family can rarely be ob-
tained. When found, it is often of great value. Of
course, this disease is of importance among relatives in a
direct line with the |)atient, hardly so among collateral
branches.
Gout, rheumatism, cardiac or renal disease, existing
among relatives, may be of much interest and value.
Especially in the case of patients suffering from disease
of tiie nervous system, similar disease among relatives
should be noted.
Intemperance in many members of a patient's family
should be recorded.
Tumors among relatives of patients, themselves suffer-
ing from tumor, is important.
HcBmophilia among relatives deserves investigation.
When any of the above diseases are shown with rea-
sonable certainty to exist, it is sufficient to note the fiict.
When their existence seems only probable, the reasons
for supposing them to exist should be stated.
The early history of the patient himself should now be
recorded.
PREVIOtJS HISTORY.
Use of stimulants.- — Note if the patient drinks, how
much, and what kind of li(iuor he uses. Cross-examina-
tion on this point is necessary. Before forming a judg-
ment as to the temperance or intemperance of a patient,
the number of glasses drunk daily should be ascertained.
Also inquire whether the patient gets drunk, and if so,
how frequently. Men who are not habitual drunkards
rarely drink before breakfast, and the habit of drinking at
this time almost necessarily shows that the patient drinks
to excess. Information on this point may be valuable.
There are patients who are evidently suffering from al-
coholism who deny the use of liquor. Such must be
judged upon their own merits. This subject is enlarged
upon because of mankind's tendency to deceive in regard
to the matter. Excessive use of tobacco may be noted.
Syphilis may, be a factor in any case, no matter what
the social or moral standing of the patient. Here, again,
deliberate deception is not uncommon. Sometimes pa-
tients, especially women, do not seem to have noticed the
primary sore. It will not do merely to ascertain the exist-
ence or non-existence of a chancre ; the following symp-
toms should be looked for : If a sore be acknowledged, it
should be ascertained how soon it appeared after a sus-
picious connection. Whether a sore be acknowledged or
not, symptoms of constitutional infection may be discov-
ered. Eruptions, falling off of the hair, sore throat, sore
eyes, nocturnal headache, or other pains, tenderness of
tibis, sternum, clavicles, enlarged glands, gummy tumors,
staining of the skin, ulcers — these are symptoms individu-
ally of more or less value, a liistory of which may be ob-
tained from patients who deny all primary infection.
The diagnosis of syphilis may be safely made if a number
of them be admitted. The nature of the primary sore
should be inquired into, and whether it was followed by
a suppurating or non-suppurating bubo. In infants the
special symptoms of inherited syphilis nnist be looked for.
Rheumatism. — Attacks of acute inflammatory rheuma-
tism, because of their relation to cardiac disease, and of
the predisposition of patients having had one attack to
others, must be noted. If a patient suffer from chronic
arthritis, whether due apparently to rheumatism or not. it
is as well fo record the fact. So-called muscular rheuma-
tism may be noted. Chorea should be noted for the
same reason as rheumatism.
Scarlatina, being frequently followed by rheumatism,
should be inquired into. The rheumatic attack in very
young children may show itself only by tenderness of the
joints without swelling or redness. The child seems to
suffer pain and is restless, but only upon touching one
of the affected joints can the cause of these symptoms be
appreciated. It is very easy, therefore, to overlook the
disease if the patient be too young to speak. Yet a
rheumatic attack of this obscure nature may induce seri-
ous cardiac lesions.
Gout. — This disease should be differentiated fron?
rheumatism, with which it is frequently confounded by
the laity. The train of evils which gouty poisoning is-
stated by various authorities, with more or less show of
reason, to induce, make an investigation of the subject
necessary. It is stated to be an etiological factor in
forms of renal and cardiac disease, skin diseases, dyspep-
sia, diabetes mellitus, asthma, bronchitis, neuralgia, es-
pecially of the fit"th pair of nerves and sciatics, renal
colic, and various affections of the central nervous sys-
tem, besides a number of other diseases. Whether these
statements are correct or not, should be determined, at
least so far as certain diseases are concerned, by farther
study.
The pains of syphilis or neuralgia may be mistaken by
a patient for attacks of rheumatism or gout.
Malarial fevers. — In this country, where diseases of
this type are so common, attacks of intermittent or other
true malarial fevers should be noted. Poisoning from
these diseases seems sometimes to leave its mark upon
the constitution for a long time. It is to be remem-
bered that typhoid and other continued fevers may be
spoken of by the patient as " malarial. " Hectic from
any cause may be mistaken for intermittent. In cases
where the patient states that he has had " chills and
fever," he must be made to describe the disease.
Severe attacks of any acute diseases should be noted,
and any injury which the patient may have received
should be described.
Pulmonary disease, chronic in its nature, should be
looked for. Cough and its character, expectoration and
its nature, shortness of breath, fever, night-sweats, pro-
gressive loss of flesh and strength, hemoptysis, any
such symptoms are important, even if they have ceased
to exist for some time before the patient conies under
observation.
Cardiac disease, renal disease, dyspepsia. — These three
classes of diseases are grouped together because some
of their symptoms are so similar that it is impossible to
separate them for purposes of general investigation.
Palpitation of the heart, attacks of dyspnoea, and the
effect of exertion upon those conditions ; prajcordial
pain and anxiety, angenoid attacks, or true angina pec-
toris ; dimness of vision, seeing of floating spots (mus-
C£e volitantes) ; headache, local or general, sense of
discomfort in head, mental depression, confusion of
mind ; lumbar pains ; cedema of face or extremities, or
any form of dropsy ; changes in color or amount of
urine (frequency of micturition may be mistaken for in-
creased amount of urine) ; nausea and vomiting, ab-
dominal pain or discomfort, flatulence, eructations,
bitter or sour in taste, and the relation of these symp-
toms to the kind of food and the time it is taken ; varia-
tions in the appetite, constipation or diarrhcea ; these
are the principal symptoms to be sought for in ordinary
cases. Attacks of Jaundice should be noted. The
176
THE MEDICAL RECORD.
[February 17, i!
presence oi hanwrrhoids, or \!n^ passage of blood zx stool,
may serve to direct attention to obstructed portal circu-
lation.
Symptoms of disease of the nei-Tous sysie?n, epilepti-
form seizures, par^esthesiaj, paralysis, neuralgia, and
other pains, whether apparently of central origin or
not, mental symptoms, hysterical symptoms, etc., are
frequently important.
In men sexual habits should be investigated.
In women the history of the menstrual life should be
taken. The time of the establishment of the function,
irregularity of menstruation, menorrhagia, metrorriiagia,
suppression of discharge, painful menstruation, leucor-
rhcea, pain in the back, headache, should be noted.
Pregnancies, and their results in miscarriage or labor
may be important. There are a certain number of cases
in which sexual habits should be looked into. Hysteria
in men or women must be remembered.
The place of residence of the patient, its sanitary con-
dition as regards light, ventilation, cleanliness, warmth,
drainage, and number of residents, is highly important in
many cases. In infectious disease every ])ossible source
of contagion by fomites or otherwise should be sought.
After these facts should follow a clear account of the
attack for which the patient seeks advice. The exact
time when the attack commenced should, if possible, be
ascertained ; its mode of invasion, the order of devel-
opment of symptoms, the possible causes (exposure to
cold or infection, extraordinary exertion, a spree, any-
thing which may be a factor in the case) should be care-
fully noted. Every detail which the patient is able to
give in regard to his case should be recorded.
PRESENT CONDITION'.
Under this heading it is intended to record the condi-
tion of a patient when he first comes under observation.
- The ge?ieral muscular development of a patient and
the quantity of adipose enveloped and his condition as
to strength or weakness, being general notes, form prop-
erly the first observations to be recorded. The points
ne.xt to be noted are the expression of the face, decubi-
tus if the patient be in bed, peculiarities of gait or atti-
tude if he be up. The color of hair, eyes, etc., may
or may not be important. Is is important to observe
whether the face is pale, flushed, or normal in color. If
pale, the skin may be translucent or opaque, very white,
or yellowish or dirty white, or greenish ; the lips and mu-
cous membranes mav be pallid, or bluish, or normal, or
too red, and an\' of these conditions may be moderately
or extremely marked — facts which should be recorded.
If flushed, the redness may be bright or dusk)', dittiise or
localized, with the rest of the face pale or natural in
color. The surface may be cyanozed. The color of the
sclera may be white and natural, or yellowish or quite
yellow, or bluish. It may appear oiiaque or translucent.
The conjunctiva; may be injected or not. There may
be lachrymation, or discharge of muco-pus from the eyes.
There may be strabismus — a symptom of little value
unless its existence or non-existence before the attack
for which the patient seeks relief be ascertained. There
may be nystagmus. The condition of the pupils, their
size and reaction should be noted. They may be im-
equal or equal, both may react badly or well, or not at
all, they may be dilated or contracted, one may react
and the other not. One pupil may be irregular in out-
line, and this may be due to an old iritis, \)ossibly, in its
turn, due to past syphilitic or rheumatic outbreaks. In
testing the pupils it is necessary to observe all the pre-
cautions usually advised. The eyes may be protuber-
ant or sunken. The ala; of the nose may both dilate
extremely with inspiration, or one may do so, or tiieir
movements may be hardly noticeable, or one or both
may have a tendency to fall in with inspiration. The
lips may be tremulous, pale, or red, or bluish, or pur-
])lish, dry or moist, cracked, or coated with sordes. The
facial muscles may be almost immovable, giving the face
a vacant expression, or they may twitch, or they may be
contracted, producing any variety of expression. The
muscles upon one side of the face may be paralyzed,
and on the other not ; in muscular twitchings of the
face any muscle or group of muscles may be affected.
The tongue, its size, color, and coat, if present, must be
described. The condition of the pharynx, tonsils, and
interior of buccal cavity should be observed. Visible
small veins should be noted when they occur in the face.
They may be generally distributed over the face, or lo-
cahzed, as on the nose. The condition of the larger
veins of the head and neck, as to fulness or emptiness,
is important.
When possible, the entire body of a patient should be
examined. The color of the skin, its temperature as ap-
preciated by the hand, its moisture, its reaction to irrita-
tion, as shown by the redness which follows friction, the
presence of the idche cerebrale, the condition of the cir-
culation as shown by the rapidity of the return of a nor-
mal color after pressure has whitened it, are points to
be noted. Scars or ulcers should be described and their
causes sought. Eruptions should be described in detail,
and not merely mentioned by name. The condition of
the extremities, in regard to warmth o'r coldness, and the
condition of the circulation in them, clubbing of the fin-
gers, whether the clubbing seems due to an increase of
the size of the finger-end, or to wasting of tissue in this
part, and consequent curving of the finger-nails, should
be recorded. Qidema must be looked for. Enlarged
cervical, epitrochlear, inguinal, or other lymphatic
glands must be observed. When a gland is enlarged it
should be stated whether it is hard or soft to the touch,
painful or not.
The frequency of the pulse should be noted, and its
character described. Some confusion has arisen in de-
scriptions of the pulse owing to the loose way in which
terms are used. Walshe, in his work on " Diseases of
the Heart," gives the following classification of terms :
"Each individual beat may be: i, quick or slow; 2,
short or long ; 3, soft or hard, compressible or incom-
pressible : 4, loose or tense ; 5, empty or full ; 6, nar-
row or broad, small or large ; 7, single, double, treble,
or multiple ; 8, with or without special character, vibrat-
ing, jerking, bounding, undulating, wiry, filiform. In a
series of beats the movements may be, 9, frequent or infre-
quent; 10, equal or unequal in force ; 11, rhythmically
regular or irregular." These terms are perfectly easy to
comprehend, and as accuracy is important it is better to
use them in the sense in which they were originally in-
tended. The terms " quick " and " slow" must not be
confounded with "frequent" and "infrequent," and due
weight should be given to the terms describing the special
character of the pulse. The sphygmograph, in the hands
of one accustomed to its use, is a valuable means of re-
cording certain conditions ; but the tracings to be of value
must be taken by one familiar with the instrument and
its applications. The condition of the superficial arteries
must be observed. They may be tortuous ; their walls
may be thickened ; calcareous plates may be discovered
in the wall ; they may visibly pulsate. Pulsation in a
vein will, of course, be noted. Influence of posture on
the pulse is sometimes important.
The respiration should be observed, and its frequency
and special character, if peculiar, noted. It may be shal-
low or deep, almost entirely abdominal or thoracic,
labored or quiet. The rhythm may be regular or irregular,
or of that peculiar type the " Cheyne-Stokes." When
the respiration is labored it should be noted whether the
intercostal spaces and suisra-sternal notch, and supra and
infra-clavicular regions collapse in a marked degree with
the inspiratory cft'ort, and also to what degree the acces-
sory muscles of respiration are thrown into play. It is
needless to say that thoracic respiration is the character-
istic type with the female after i)uberty, and abdominal
with tlie male and in children, and that a departure from
this rule is abnormal. The respiration may be obstructed
February 17, 1883.]
THE MEDICAL RECORD.
177
by some abnormal condition in the larynx, in which case
it may lie accompanied by noises prodnced in this organ.
There may be obstruction in the pharynx or nares, or
buccal cavity. There may be stertor, due to paralysis
from some cause of the velum pendulum palati ; there
may be dysjincEa, subjective, that is ajipreciated by the
jiatient, or objective, that is appreciable to the observer.
The effect of posture and exertion upon this dyspncea are
im]iortant points.
The temperature should in all cases be taken and re-
corded for a sufficient length of time to exclude fever.
The frequency of the observation must vary in different
cases. In continued fever of any type observations
should be taken at least twice daily of the temperature,
the frequency of the pulse and respiration being recorded
at the same time. In severe cases the record should be
made as frequently as may seem needful. The thermo-
meter may be placed in the axilla, rectum, vagina, or
mouth. The difference in heat between the axilla and
the rectum or vagina is generally stated to be about one
degree. It varies, however, in different cases. When-
ever temperature records are made the situation in which
the thermometer is placed should be noted.
The condition of the borcels and the appearance of
the stools are important. Notes should also be made of
the appetite, and any abnormalities of it.
The uritie should be e.xamined in every case. Albu-
men and sugar are the most important substances usu-
ally sought, and bile or bile-pigment. The reaction,
specific gravity, and presence or absence of abnormal
constituents should always be noted. It is better, in
every case, as a matter of routine, to examine the urine
by Fehling's test for sugar, no matter how low the speci-
fic gravity, for low specific gravity does not exclude
this substance. In looking for albumen, the nitric acid
test, applied according to the directions of Roberts,
seems the best. The test-tube containing the urine is
held at an angle of about 45° with the horizon, and a
small amount of concentrated pure nitric acid allowed
to trickle down the side. Being heavier than urine, it
sinks to the bottom, and if albumen is jsresent, even in
very small amount, a cloud will form just over the sur-
face of the acid. If this cloud disappears on heating
the fluid, it is a precipitate of urates, if not, it is albu-
men. The quantity of acid used should not exceed one-
tenth of the bulk of the urine. Heat should always be
applied, as a proof that the cloud is albumen and not
urates. It is well to boil some of the urine, and if a
cloud forms to add a little acetic or nitric acid, when, if
the cloud dissolves, it is composed of the phosphates ; if
not, it is albumen. The nitric acid test, as applied above,
is, for clinical purposes, the most delicate yet proi)osed.
A rough estimate of the amount of albumen present
may be made by acidulating the urine, boiling, setting
aside in a cool place, and after some hours estimating
the pro[)ortion of the precipitate to the whole amount of
fluid in the tube. The amount may be expressed in
fractions. In collecting urine for examination, only per-
fectly clean vessels should be used, and it should be
kept in a cool place, otherwise fermentation takes place
rapidly. When observations are made upon the specific
. gravity, a specimen should be taken from the mixed
urine passed in twenty-four hours, in order to obtain an
average. It would be well, if possible, to estimate the
amount of urea present in the urine. As far as I can
discover there is no way of accurately ascertaining the
amount of urea present, which is safe for any one but a
chemist to use. The margin of error in every method
which I have yet tried is, in the hands of one unaccus-
tomed to chemical manipulations, very great. In all
cases in which albumen is present, and in all cases
where, from suspicion of renal disease or other reasons,
it seems advisable, a microscopic examination should be
made. The frequency of the chemical and microscopic
examinations must vary in different cases. Once a week,
in cases of albuminuria or glycosuria, seems the mini-
mum. As cases increase in severity the examination
may be made more frequently. Some cases require a
daily record of the amount of urine passed.
VVhen necessary, the reflexes of skin and tendons
should be examined, and areas of anesthesia and hy-
perajsthesia, or other peculiarities of sensation sought for
and described.
After these facts have been noted in every case, there
should follow, as nearly as possible, in his own words,
the symptoms of which the patient complains at the
time he comes under observation. This is highly im-
portant. It gives clearness to the record, and brings
into prominence symptoms which annoy the patient
most. Every symptom should be described in detail.
Physical examination. — Although many of the signs
to be recorded under the former heading are noted in a
physical examination in its broader sense, yet it seems
well to record in a separate paragraph the results of
physical examination of the thorax and abdomen, and
of any tumors which may be found. There is little to be
said upon this subject, except that physical signs should
be recorded in detail. Murmurs should be located ac-
curately, their time, and areas of transmission, and in-
tensity described. Abnormal signs in the lungs or
pleurse should also be located. The size of the livar
and spleen should be ascertained as far as possible. The
condition of the abdomen as to distention from gas or
fluid, the presence of pain or gurgling on pressure, and
the location of such pain or gurgling must be noted.
FURTHER RECORD OF THE CASE.
The subsequent history of the case and its treatment
must be noted as frequently as may seem advisable. All
subsequent physical examinations should be recorded
when made. It is better to have too many notes than
too few.
A few more suggestions may be of value. It is impor-
tant that a more detailed description of certain pheno-
mena of disease be given than is usually the case. If a
patient have a convulsive seizure, it should be noted
whether he lose consciousness, whether the convulsion is
local or general, tonic or clonic, or one form alternating
with the other ; whether the tongue is bitten ; whether
there is frothing at the mouth, flushing or pallor of the
face, how the respiration and pulse are affected ; whether
there is a flow of urine soon after the fit, how severe the
seizure is, what the condition of the pupils and eyes, the
expression of the face. If there is an aura, it should be
described. Any circumstance which may seem to have
determined the seizure should be recorded.
Cases of unconsciousness call for most careful observa-
tion. Such information as may be derived from friends
will be recorded. The age should be noted when it can
be ascertained. When accurate information cannot be
obtained, some conclusion in regard to age must be
drawn from the patient's appearance. The muscular de-
velopment and adipose envelope should be observed. It
should be noted whether the insensibility is complete, or
whether the patient can be roused in any way. The odor
of the body and breath, condition of the mouth and
tongue, frequency and character of the pulse and respira-
tion, temperature, presence or absence of vomited mat-
ter, and character, if present ; presence or absence of
fajces or urine upon clothing are matters of importance.
CEdema must be looked for. The color of the face and
body, condition of circulation in extremities. Condition
of the walls of the arteries as evidenced by touch. Con-
dition of heart as evidenced by physical examination.
Examination of lungs should be made. Condition of
abdomen should be noted. If the coma be not so deep
as to mask them, signs of paralysis may be found.
Wounds or bruises must be described. The condition of
the pupils and position of the eyes should be observed.
Signs of tenderness in any part of the body are imi^or-
tant. The urine should be drawn and examined, and its
amount noted.
178
THE MEDICAL RECORD.
[February 17, i88t
If many of the suggestions in this article are trite, it
must be remembered that nothing original is claimed.
J f it arouses i)ublic attention to the necessity of more
accuracy in the record of medical cases, it will have
served its purpose. If it is dogmatic in style, it is be-
cause of the amount of compression necessary to con-
dense the facts within the limits of a journal article.
THE importancp: of a knowledge of
THE RADICAL DIVERSITIES IN THE HU-
MAN RACE TO THE PHYSICIAN AND SUR-
GEON.
By HARVEY L. BYRD, M.D.,
PRESIDENT, AND I'ROFESSOR OF OBSTETRICS AND DISEASES OF WOMEN AND CHIL-
DREN IN BALTIMORE MEDICAL COLLEGE, BALTIMORE, MD.
Were the science of ethnography more generally culti-
vated by practitioners of medicine than it is, and the
great importance of race distinction and peculiarities bet-
ter understood by physicians m their relations as cause
and effect in certain epidemics and individual diseases
also than at present, far less difficulty would be experi-
enced in arriving at important information concerning
the etiology and the theraiieusis of many cases occurring
in connnunities composed of diverse races, and of the
hybrids frequently resulting from the intermingling or in-
terbreeding of such races. While age, sex, idiosyncrasy,
hereditary tendency, occupation, and habits of life, etc.,
are pretty generally discussed by professors in medical
colleges and in the text-books in their relations to dis-
eases, very little notice is taken, if any at all, of the great
and radical distinctions and peculiarities which exist
between the primordial types of mankind in their im-
pressions upon, and in not a few instances their marked
and unmistakable effects in the development and influ-
ence in diseases. These facts are well known to many
intelligent practitioners in the Southern States of this
country, whose experience extends back to ante bellum
times, and they ahvays recognize their existence as factors
of the greatest value in the treatment of their patients.
Their importance can indeed hardly be overestimated
by the judicious physician in many communities in
which considerable numbers of the Caucasian and negro
races exist. When they have been thoroughly studied
and their value duly appreciated, I have no hesitancy in
saying that they will be carefully regarded ever afterward,
and their mandates promptly obeyed in the treatment of
cases by all such practitioners as are at all ambitious of
attaining a high standard of excellence and success in
their profession. It is hardly necessary to mention the
fact, in this connection, that there are anatomical and
physiological differences and distinctions, of a conspicu-
ous and permanent character, existing now between the
three more prominent varieties of mankind, viz.: the
Caucasian, Mongol, and Negro races, and there is every
necessary reason for believing that they were stamped
thus ab initio by the fiat of the Creative Will. The
anatomical chalracteristics have not been lost in the os-
teological framework, at all events during the geological,
monumental, and historic periods, and if certain Hebrew
words or expressions admit of the interpretation that will
be given to them further on in this paper, there can be
no doubt of a diversity of creation and thus plurality of
origin of the races of men ; and hence those anatomical
distinctions have continued commensurate with the being
of the races upon the earth.
Parity in the general form and features is not greater
among the races than are some of the symptoms in the
diseases to which they are subject in common ; but there
are certain other symptoms that are more widely separa-
ted than even the color, and other anatomical peculiari-
ties of face and form, in the three primordial types allu-
ded to above. It does not appear necessary to introduce
them here in support of our position, nor to present
irrefutable evidence of the non-liabiiity of some of those
races to certain diseases, cateris paribus, to which the
others are exposed, in order to show that nature has
stamjjed in permanent living characters, in the pheno-
mena to be seen at the bedside, laws that were ordained
when they came into being for their governance through-
out the ages. And thus we see the reason why the
primordial races may be easily differentiated etiologically
as well as ethnologically. Such being the case, it will
be clearly obvious to those accustomed to inteipret nat-
ural phenomena and law, that the highest degree of skill
and success in the practice of our profession will not be
attained by physicians generally until the professors
and writers in all the practical departments of our
science shall give due and proper weight and consider-
ation to the laws ordained " in the beginning " for the
control of those races, and that of the amalgamations
that so often occur when they are intimately associated
or brought into juxtaposition for any considerable pe-
riod of time. And probably nowhere else in the vast
expanse of the created universe, as far as we are permit-
ted to know anything at present, can the operation of
fundamental law be more clearly seen and easily appre-
ciated by the thinking mind than in the structure, func-
tions, and pathological characteristics that so conspicu-
ously mark and distinguish the hybrid offspring of the
Caucasian and Negro races when it is found breeding
intense.
Properly directed and intelligent investigation and
study of the mulatto in his individuality as a hybrid, and
in his relations to the races from whom he sprang, at the
present time, would render important service to the theo-
logist as well as the physician, and also to the educated
portion of mankind generally. It must be evident to
the careful observer of events, that the enthusiasm which
amounted to a furor almost on the advent of the Dar-
winian hypothesis, a few years ago, and which so vio-
lently assailed some of the old systems of theology as to
shake them to their very foundations, and to threaten
the overthrow, if not the utter annihilation of the less
stable ones, is now gradually yielding to the pressure of
new and important facts and to a better system of in-
ductive reasoning, and no '• missing links "' are found
necessary to show that the races of men are now what
they were when they came into being under the fiat of
the Creative Will. It appears, indeed, that, if a few He-
brew words are correctly translated, theology and eth-
nology (the written and the scientific teaching on the
origin of the races constituting the genus homo), are in
full and perfect harmony with each other, and establishes
the further fact that all knowledge and " all (science) are
but parts of one stupendous whole."
The axiom that like produces like is too universally
known and admitted as a fundamental law to require an)--
thing much further than mere mention of it here ; so that
any subversion of its operations now by merely human or
other agencies, if such were possible, would soon convert
the harmonious relations of the existing order of things
into utter chaos or complete annihilation. Accprding to
this law of propagation and descent, the primordial types
of mankind have certainly undergone no marked or es-
sential changes in their physical characteristics since their
original creation. Caucasian men do not beget negro
children, and vice versa. It were therefore a physiologi-
cal absurdity to suppose that the testes and ovaries of a
single pair of either of those primordial races contained,
al> initio, the germs of their own future progeny and those
of the descendants the two other races at one and the
same time, to say nothing of the physiological impossi-
bility of any race having been born and perpetuated from
two individuals only. Hence, according to the doctrine
of " like," such tlieories or assertions do not rise to the
level of absurdity even when philosophically contem-
plated for a single moment ; and I would therefore re-
spectfully invite the attention of tlie reader to some state-
ments made by Prof. Josepli C. Richardson at a late
meeting of tlie Philadelpliia County Medical Society, as
February 17, 1883.]
THE MEDICAL RECORD.
179
published in the Medical Times, page 166, December 2,
1882, in confirmation of my assertion. They are as fol-
lows, viz.: Dr. Richardson said " If you took the spermato-
zoids of an African, a Malay, an Indian, and a Caucasian
— notwithstanding they were exactly alike morphological-
ly, chemically, and in their reaction with staining fluids —
and introduce them into suitable culture apparatus, you
would find them, after a suitable number of months, so
developed that they diftered from one another as much
as black does from white." This is the teaching of sci-
ence, and not conjecture or hypothesis ! Was it not al-
ways true ? Hence I feel sure that few subjects of deeper
interest or greater importance could well be brought be-
fore the thinkers in our profession, whether they should
be of the Christian faith or Jewish belief, or of those in-
clined to the hypothesis of evolution, than this brief eft'ort
to prove from the Hebrew text that both the Kible and
science teach the penal or diverse origin of the primordial
types of the human race. And I therefore take the lib-
erty to introduce a few Hebrew words and certain trans-
lations from the Sacred Volume to confirm what has been
said above, so that the theologian as well as the physi-
cian, be he Christian or Jew, may readily join the rapidly
advancing hosts of science, without the slightest appre-
hension that the truths of Revelation will sustain the
smallest injury from the discoveries that are being almost
daily made in the material world.
The Hebrew words alluded to above are ?iaphesh chai-
yah, which may and seemingly should be rendered "in-
tellectual creatures with immortal souls," when we have
only the words " living creatures," as in Genesis i., 24.
If the word naphesh qualifies and invests chaiyah, the
"living creatures," with "immortality and intellectu-
ality," as it is thought to do, though it has not been trans-
lated in our present version of the Bible, it prepares the
way for a clear and perfect understanding of what occurs
in the twenty-sixth verse, where it is stated Elohim cxe-
a.ted ha-Ai/am, or "the Adamite." It appears that it
was Adam that the Deity created in his image rather than
" man," as rendered in the text. Adam and ish seem
not to be convertible terms that may be translated alike,
as the latter is always used, so we are informed by He-
brew scholars, when speaking of man and mankind
generally. Thus : " And the Lord said, My spirit shall
not always strive with the Adamite (ha-Adam), for he also
is flesh." Not ish, or " man," as the former is translated
in our present version of the Bible. It will be seen that
the definite article is prefixed in the Hebrew. " And it
repented the Lord that he had made the Adamite "
(ha-Adam), not ish, or "man." "And the Lord said, I
will destroy the Adamite^' etc. " The sons of God" (evi-
dently the sons of Adam, or the Adamite) (red men)
and the fair "daughters of men " were manifestly of
different races, and their intermarriage v^^as a physio-
logical necessity for the perpetuation of the Adamite
race, as may be seen in Genesis vi., 2. And the giants
alluded to in Genesis vi., 4, when speaking of the com-
ing of "the sons of God" into " the daughters of men,"
were presumably, at least, of another and entirely dis-
tinct race from either of the other two just then spoken
of
It has been thought proper to introduce the foregoing
testimony from the Bible for several reasons, but chiefly
so for the following, viz.: ist. As science and revelation
are both of God, they must harmonize in the very nature
of things ; and, 2d, to establish as conclusively as facts
are capable of doing, when applied by human intelli-
gence and reason, the immutability of the laws of the
Great Jehovah in their operation upon the human race ;
and, finally, to clear away, as far as may be, the mythical
errors and hypothetical speculations which have so long
environed the origin and subsequent intermingling of the
types of the genus homo, so that perspicuous conceptions
may be had concerning the physical, mental, and psycho-
logical character and characteristics of the races, in order
ihat their mutual relations and their present dependence
upon one another may be better known and appreciated,
both in health and in disease.
The paucity of our practical professional literature on
this very important subject is such as scarcely to attract at-
tention, and yet if we have succeeded in making our treat-
ment of it at all well understood, even in its leading feat-
ures, it will be seen that iMoportion, adaptation, and
symmetry are the relations of the great facts we have been
attempting to present, and that neither accident, nor
chance, nor " natural selection " could have had any
agency or control whatever in their original develop-
ment. On a subsequent occasion some important facts
in regard to the general effects of disease upon the
varieties of mankind, and upon the human hybrids in
particular, may claim attention in a brief journal article.
I would venture to state, in concluding the present
pa]3er, that I believe I can assert, without the fear of
contradiction, or of satisfactory refutation at the least,
that the Hebrew Bible positively and indubitably
teaches that there were certainly two if not more sepa-
rate and distinct creations of the human race, and that
certain statements and logical influences, in particular
narratives and allusions on many occasions, admit of a
fair deduction that there were several if not many races
or tribes that were contemporaneous with the Adamite
race at its origin, and at other times, that were generally
inimical to it and usually avoided consanguineous affilia-
tions with it. All these facts will be readily elicited
from our E^nglish version of the Bible by any one whose
mind is free from early prejudice or training in regard
to the teaching of the Sacred Volume. True science
unquestionably declares a diversity of origin of the human
race to the intelligent anatomist, physiologist, and
physician. And thus the Bible and science are found to
harmonize completely and perfectly in all that relates
to the duty and obligation of the physician to his fellow-
man in his moral, intellectual, and physical nature.
127 N. Arlington Avenl-e.
Addison's Disease. — Semmola {London Medical Rec-
ord, January 15, 1883), by new studies, confirms the
opinion that Addison's disease must be considered an
affection of the central nervous ganglia, and that the
anatomical alterations of the suprarenal capsules are not
the point of departure of the disease ; but where they
exist, they represent trophic disorders produced by the
nervous filaments which preside over the nutrition of
these organs, and this he demonstrated at the Interna-
tional Congress in London, with drawings which showed
the microscopical alterations of some points of the cen-
tral ganglia and of the dorsal section of the spinal cord,
the alterations being a myxomatous transformation of the
stroma of the cojliac axis, and leucocytic infiltration of
the spinal medulla around the central canal.
He concludes that Addison's disease is a profound dis-
order of the renal nutrition, determined by the successive
alteration of the functions of the sympathetic and of the
different nervous centres of organic life (cceliac axis, etc.).
And with the help of the physio-pathology of the central
nervous ganglia, he explains all the successive symptoms
of the malady, such as the disorders of digestion, the ca-
chexia, the lowering of the temperature, etc. The dis-
coloration of the skin, when no lesion of the suprarenal
capsules can be found, may be attributed to the influence
of the sympathetic and central nervous ganglia, which
are certainly concerned in the formation of pigment.
Not a few cases of melanodermy have occurred a few
days after violent moral emotion.
Semmola confirms his assertion by quoting a case of
Addison's disease, accompanied by syncope, in which the
electrical current, passed from the neck to the epigas-
trium, did good. In other cases, with the same treat-
ment, there were restoration of strength, increase of the
temperature to the normal, improvement in digestion,
and, above all, gradual disappearance of pigmentation.
i8o
THE MEDICAL RECORD.
[February 17, 1883.
^fooiTss of |1rtcclicat J>cicnct.
GoLTZ ON THE CoRTEx CEREBRI. — Professor Goltz,
of Strasburg, has published a new series of experiments
on the cerebral hemispheres of the dog, in which, instead
of following his old method of destroying the cortex with
a stream of water, he established the lesions by means of
a White's boring machine. The general conclusions he
arrives at are : — i. The hypothesis of circumscribed cen-
tres for special functions in the cerebral cortex is unten-
able. 2. There is no area of the cortex exclusively con-
cerned with sight, hearing, smell, taste, or touch. 3. It
is impossible by any circumscribed lesion of the cortex to
produce permanent paralysis of any muscle, or remove it
from the influence of the will. 4. The vital manifesta-
tions which we regard as indicative of intelligence, feel-
ing, emotion, instinct, are not dependent on functionally
differentiated cortical regions. 5. Destructive lesions of
the frontal regions of the hemispheres cause defects which
differ in certain respects from those caused by lesions of
the occipital regions. These differences depend probably
on simultaneous lesion of the conducting tracts which lead
to the crura. So far as yet made out, the difference
amounts only to this — that while removal of the anterior
regions shows itself in clumsier movements and reduced
tactile sensibility, removal of the hinder lobes more dis-
tinctly affects sight and other specialized senses. This
concession to the localization hypothesis is guarded by a
suggestion that the ground of the difference is to be sought
for, not in the cortex itself, but in the underlying white
tracts. The general intelligence is also somewhat more
affected in destruction of the hinder lobes. — Amc-riian
Journal of Insanity.
Antagonism between Veratri.\ and Potassium
Salts. — In some previous experiments Dr. Sidney Rin-
ger found that circulating simple saline solution through
the ventricle causes it after each contraction to dilate very
slowly. In fact the trace is just like the trace of a ven-
tricle poisoned by veratria. He showed also that a small
dose of any potassium salt, i in 10,000 to i in 15,000
parts, will obviate this prolonged dilatation, making the
ventricular dilatation normal. From numerous experi-
ments more recently undertaken. Dr. Ringer concludes
that a small dose of potassium chloride will completely
obviate the effect of veratria, and restore normal cardiac
contractions. — TJie Practitioner, January, 1883.
The Treatment of Intussusception. — A prolonged
and practical discussion on this subject was had at a
recent meeting of the London Clinical Society {British
Medical Journal, December 16, 1882).
The whole field of treatment was thoroughly gone
over. And the points that should especially claim our
attention throughout the course of such cases were
brought out clearly and distinctly. There was a pleasant
unanimity of opinion, more particularly as regarded sur-
gical interference.
The general consensus of opinion pointed to the early
treatment of all cases by inflation and operation. But it
was also shown that a great distinction must be drawn
between cases of simple intussusception, which may last
for weeks when the bo\^l is not strangulated, and those
of strangulated intussusception, in which any delay in
operating is to be deprecated, since peritonitis is almost
certain soon to ensue. The former cases are those most
likely to be benefited by inflation and injection of li(iuid
per anum, possibly the two combined, while the patient's
abtlomen is kept relaxed by the use of an anxsthetic.
But if the strangulation has lasted for some time, and the
symptoms are severe, so that there is reason to fear that
adhesions may have formed, or the wall of the bowel have
become softened by the inflammatory process, inflation or
forcible enemata should scarcely then be attemi)ted.
Should the case be one of severity, and inflation be found
valueless, the surgeon should at once have recourse to
abdominal section ; just as in hernia, when taxis has
failed, he directly proceeds to herniotomy.
The median line of the abdomen is to be chosen for
incision, and the operation should be done with antisep-
tic precautions. The invaginated bowel may be either
withdrawn by gentle traction from the encircling portion,
or its withdrawal assisted by pushing up from below.
Many speakers remarked upon the extreme difficulty they
had sometimes experienced in returning the distended
bowels into the peritoneal cavity after the operation, a
difficulty which may be necessary to overcome by
puncture of the intestine with a trocar and cannula, for
the withdrawal of gas and liquid. But in cases in which
the intussuscepted bowel cannot be withdrawn, what is
to be done ? As Dr. Buzzard pointed out, the portion
of intestine inclosed goes on to slough and separation,
and this is nature's method of cure in the very few cases
which struggle on to recovery through the various dan-
gers which beset the patient. Surgeons reconnnended
that nature's nietliod should be imitated, as nearly as may
be, by a bold excision of all the implicated portion of
bowel, and a stitching together of the two cut ends. Mr.
Howse had already done this in two cases, though as
yet without success. To avoid risk of the passage of
any fecal material into the peritoneal cavity, he rec-
ommended that a thin sheet of gutta-percha material,
with a slit in its centre, should be spread before the ab-
domen, and all the bowel to be operated upon drawn
forward through the slit. It might then be treated with-
out fear of fxcal contamination of the peritoneum. It re-
mains to be seen whether this bold procedure of excision
will in future result in more success than has hitherto
attended it. In certain cases, in which the bowel pro-
trudes through the anus, Mr. Howse would also remove
it bodily from that situation by amputation, securing the
cut end by pins. An Italian surgeon has already done
this by inadvertence, not knowing what he was taking
away, and the patient recovered.
Neglected Measles. — Dr. Danford Thomas, in his
capacity as coroner, has directed public attention to the
mortality which follows the neglect of measles. It is a
common opinion among the poor that a child must have
the measles, and that when it gets the disease it requires
no treatment and but little care. This is a mistake. In
the records of vital statistics it may be seen that it often
proves more fatal in the large tdw'ns than any other
zymotic disease, more even than scarlatina. With medi-
cal and parental care the disease generally does well.
But without this it is liable to serious complications, and'
apt to leave disagreeable consequences. — London Lancet,
December 23, 1882.
Hebephrenia. — Dr. Fric, of Wiirzburg, considers that
hebephrenia occupies in cerebromental pathology as le-
gitimate a place as general paralysis. Its symptoma-
tology is clear and well defined, and the prognosis can be
established with certainty from the outset. This affection
is tributary to ps)chic degeneration, by which is under-
stood an early arrest of development of the brain, in vir-
tue of which the intelligence does not attain its proper
development, and at the period of puberty undergoes a
regressive evolution. The truth of this statement can be
deduced from the proteiform character of the delusions
which occur, and from the incoherence of the ideas and
acts, which are impulsive and instinctive — depression
alternating with exaltation, and complete remissions un-
expectedly supervening, followed by rapid relapses.
Hebephrenia — and this has not escaped the notice of
Morel — is a psychosis of degeneration, a congenital defect
which remains latent during childhood and the early peri-
od of puberty, showing itself when the subjects are aft'ected
by the inexorable exigencies of life, or are called upon to
make intellectual ertbrts of which they are incapable.
Moral insanity cannot be mistaken for hebephrenia be-
yond its characteristic symptomatology ; it remains sta-
tionary for a long series of years, while in hebephrenia
February 17, 1883.]
THE MEDICAL RECORD.
181
the intellectual loss is precocious. In hebephrenia the
delusions are absurd and unreasonable, like those in gen-
eral paralysis, and this character, which is an attribute of
dementia, serves to distinguish them from systematized
delusions. It is possible to confound hebephrenia with
folie circulaire, such as has been described by Falret, but
it is to be remarked that in folie circulaire the courses
of mania and melancholia do not exclude a certain degree
of lucidity which never occurs in hebephrenia, on account
of the dementia ; and the complete remissions observed
in the latter never occur in the former. From the point
of view of frequency, it can be affirmed — a neuropathic or
psychopathic predisposition being admitted — tliat hebe-
phrenia is that form of cerebro-niental disease which most
frequently makes its appearance during adolescence.
This fact is, however, only verified as regards men.
Among females hysterical insanity is its equivalent. Kat-
atonia and hebephrenia have so many points in com-
mon that it is often difficult, if not impossible, to distin-
guish them, for the spasmodic or cataleptic condition met
with in the former is also often present in the latter, and
one form may succeed another. In katatonia, however,
recoveiy often ensues ; liebephrenia, on the contrary, is
absolutely incurable. — Dublin Journal of Medical Science,
January, 1883.
The Treatment of Delirium Tremens. — In spite
of ail that has been written on this subject. Dr. .\tkinson
[Practitioner, January, 1883) thinks that sufficient atten-
tion is not given to the necessity of sui)plying the system
with adequate nourishment. Certainly in the second stage,
when the appetite is bad, the blood corpuscles deficient
in quantity and shrivelled, and the brain anaemic and
starved, it is useless to e,\pect relief from sedatives unless
the brain is at the same time supplied with the nourish-
ment it requires. Death, no doubt, in delirium tremens
arises from want of sleep, but then it must be remembered
that the want of sleep is caused by want of nourishment.
The most important part ot the treatment then, is to im-
prove the quality of the blood as quickly as possible by
throwing into the system frequent supplies of light,
nourishing, and easily digestible food. The best way of
accomplishing this end is by cutting off all stimulants and
ordering half a tin of Brand's liquid essence of beef, and
half a pint of milk to be taken alternately every two
hours. As regards medicine, twenty-five grains of chloral
with thirty minims of compound tincture of cardamoms
in an ounce of water taken every four hours, after the
beef-tea, will be found most useful. Very little effect,
though, is produced by the first dose of the chloral, inas-
much as the braui is without the nourishment it requires,
but after the second dose the food begins to tell — some
sleep, generally speaking, results, and this goes on in-
creasing in proportion as the support is maintained. If
nourishment is withheld, sleep disappears, and the old
delirium returns.
By this treatment the patient is generally free from all
delusions in about thirty-six hours, but good strong liquid
food must still be taken for some days, thougli not quite
so frequently. When there have been from ten to twelve
hours more or less continuous sleep, then it is advisable
to give up the chloral, and give thirty minims of the com-
pound tincture of gentian with five minims of the tinc-
ture of nux vomica three times a day for about three
days. This restores the tone of the nervous system and
stomach, and creates an appetite. A little tincture of
euonymin may next be substituted for the nux vouu'ca,
and some Carlsbad salt may be given in the morning
when required. By this treatment the duration of the
delirium and the after-eff"ects of the alcohol are very much
lessened.
Reseciton of the Lung. — A medical man, practising
in Dantzic, recently undertook the resection of the lung
of a young female patient, with the consent of her parents.
Through the denunciation of two colleagues, the case,
which ended fatally, will be made the subject of judicial
inquiry. All parties, however, appear to admit that the
attempt of the surgeon was made in ]ierfect good faith,
and in the full belief that it gave the patient a chance of
recovery from an otherwise incuraljle disease. Was the
surgeon's conduct simply foolhardy and entirely repre-
hensible, or was he, on the other hand, before his time?
It is by no means impossible, judging from analogies that
abound in scientific literature and biography, that works
may appear, one century hence, treating of resection
of the entire lung as a recognized operation, and
recording how, in the nineteenth century, the first
pneumotomist got into trouble. Some, though not the
majority of innovators, live to see their views and their
practices established. — British Afedical Journal, Decem-
ber 30, 1882.
Poisoning from Swallowing Chloroform. — Oliver
relates the case of a weakly man who swallowed over
three ounces of chloroform. He. was brought to the hos-
pital at 1 1 P.M. The respiration was almost imperceptible,
pulse very slow (twenty to the minute), feeble, and
scarcely to be felt, skin cold and pale, face livid, pupils
widely dilated, ]3atient sleepy and auKsthetic. The breath
smelt slightly of chloroform. Artificial respiration was at
once begun. One i)ole of an induction-coil was placed
over the heart, the other on the nape of the neck. Ene-
mata of beef-tea with brandy, and subcutaneous injections
of ether over the cardiac area were given. At 2 a.m.
the skin was still cold, and showed no trace of sensibility.
Five drops of nitrite of amyl were then given by inhala-
tion, and at once the respiration began to improve. At
3 A.M. half a drop of nitrite of amyl dissolved in alcohol
was injected beneath the skin, without any perceptible
effect. At 5 o'clock, after six hours of artificial respira-
tion, sensibility of the conjunctiva began to return, and
the natural respiration became deeper. Gradually the
skin grew warmer, and consciousness returned. In a
few days the patient was well, complaining only of pain
in the epigastrium, and of some pimples under the tongue.
The urine contained neither albumen nor sugar. The
absence of vomiting was notable ; it was doubtless due to
the local anaesthesia of the stomach and oesophagus.
When the general anesthesia was most profound the
pupils were contracted ; they dilated when the respiration
had almost ceased. They contracted again on the ap-
plication of the battery. Dr. Oliver was led to give nitrite
of amyl by observing the general capillary spasm of the
skin. — T/te Practitioner, January, 1883.
The Chemistry of Acute Yellow Atrophy of the
Liver. — In a case of this disease Salkowski estimated
the quantity of peptone and hemi-albumose in the liver,
spleen, and kidneys. In normal conditions these sub-
stances are either absent altogether or only present in
traces in the organs named. In this case the amount of
peptone and hemi-albumose in the liver were respectively
3.57 and 0.71 per cent. ; in the spleen 3.40 and 0.95 ; in
the kidneys 2.56 and 0.39. The great resemblance be-
tween the decomposition of albumen in the organs in
this disease and digestion with trypsin led him to search
for tryptic ferment in the liver. By extracting with gly-
cerine, however, he got no definite result ; the glycerine
extract dissolving fibrine but onlv after several hours
and incompletely. In regard to the hemi-albumose, he
found that Kuhne was right in his statement that this
body is insoluble in water. His own previous statement
that it is soluble in water he now finds to be due to a
slight error ; the S])eciinen he used having contained a
small quantity of acetic acid. — The Practitioner, ^z.mxzxy,
Deaths of English Physicians. — The past year
brought death to the doors of no fewer than twenty-two
prominent English medical men, and all were far ad-
vanced in age, the ages varying from seventy-eight to
ninety-two.
l82
THE MEDICAL RECORD.
[February 17, 188;
The Medical Record:
A Weekly yotir^ial of MediciJie and Surgery.
GEORGE F. SHRADY, A.M., M.D., Editor.
Published by
WM. WOOD & Co., Nos. 56 and 58 Lafayette Place.
New York, February 17, 1883.
THE ANATOMY OF THE SCROFULOUS.
Not long ago we gave a brief account of the anatomical
anomalies found by Beneke in the scrofulous. These
were, speaking generally, a disproportionately small size
of the viscera, the lungs being e.\cepted.
A contribution to the same subject has recently been
made by Dr. H. F. Formad, and is published in the
Philadelphia Medical Times. Dr. Formad makes no
reference to Beneke' s laborious researches, and is appa-
rently not aware of them. His own views, however, are
the result of much e.xperimental investigation, and have
a special interest, since they are quite opposed to any in-
fection theory of tuberculosis.
Scrofulous persons, he states, have an anatomical char-
acteristic, lymph-spaces which are abnormally narrow, or
partially obliterated by cellular elements. This charac-
teristic is found also in certain animals wjiich are known
to be scrofulous, such as the rabbit and guinea-pig. An
examination of the connective tissue from similar regions
in the cat, which is non-scrofulous, and the rabbit, will
show a noticeable difference in the appearance of the
lymph-spaces and the amount of cellular infiltration.
Scrofulous animals have proportionately, also, larger
blood-making glands and more red bone-marrow. Non-
scrofulous animals can be made scrofulous by impover-
ished diet and confinement. The same can be done with
individuals who are naturally not scrofulous.
The evidence brought forward by Dr. P'ormad to prove
a coincident change in the blood-glands and lymph-spaces
appears to us to be insufficient. The views propounded
regarding the blood-making glands in scrofulous human
beings are, we believe, contradicted by Beneke.
The scrofulous individual is not necessarily tubercu-
lous, nor is it his certain fate to become so. There is
needed for this an inflammation. In normally consti-
tuted connective tissue, the lymi)h-spaces are large
enough to carry off inflammatory products, or if this does
not happen, there is tissue destruction and suppuration.
In the scrofulous, however, these alternatives are not
presented — the lymph-spaces are blocked up, there is
lymphoid infiltration, caseation, and tubercular tissue
formation. Scrofulous beings can have no other than a
tuberculous inflammation, although that may remain local
and harmless. Per contra, inflammation (tuberculous)
is the only means by wliich the scrofulous (or non-scrofu-
lous) can get tuberculosis. '• W'iliiout intlainmation, no
tuberculosis," is Dr. Formad's dictum, in which we may
perhaps detect something of the bias toward inflamma-
tion as a pathogenetic factor which that investigator has
previously shown.
It is admitted that non-scrofulous persons or animals
do sometimes become tubercular, even with normal con-
nective tissue. In these cases, it is contended that the
injuries or inoculations must be made, and so far have
been found to be, in the serous membranes. In these
membranes there is easily produced a blocking up of the
lymph-spaces, so that the anatomical characteristics of
scrofulous tissue are artiticially obtained. The sequence
of tuberculosis after croupous pneumonia is explained on
the ground that the lining epithelium of the lungs resem-
bles very closely a serous membrane. The reasoning
here, however, is weak, and we cannot concede that the
clinical phenomena of the etiology of tuberculosis are
satisfactorily explained. Yet the statement that tubercu-
losis can only be inoculated artificially by bringing the
virus into contact with serous membranes is important.
VVe are informed that Koch, in inoculating his bacilli
into scrofulous animals, injected it into any part of the
body with successful results. But when inoculating non-
scrofulous animals, he always deposited the parasites in
the anterior chamber of the eye or in the peritoneum.
Dr. Formad's conclusion is that there is no specific
virus of tuberculosis, but that there is a specific constitu-
tion. Inflammatory processes in the latter, however
produced, lead to tuberculosis.
MEDICAL INSTRUCTION IN EUROPE.
The Allgemeine Medicinische Ceritral-Zeilung, No. 76,
1882, gives some statistics concerning the medical
schools in the difterent countries of Europe, from which
the following account is taken : In Holland there are
four universities with medical schools attached. The
course of study is for six years, with an examination be-
fore a royal commission at the end of the fourth and
sixth years. Spain has eight universities which grant a
license to practise, though the University of Madrid
alone has the privilege of conferring the degree of Doc-
tor. Only doctors are allowed to teach medicine, and
any one who desires to give medical instruction must
first pass a year in study at Madrid. Portugal has one
university and two medical schools. The course of study
is for five years, with an examination at the end of each
year. All examinations are conducted by the faculty of
the university. In Italy there are nine universities, with
a six-years' course of study. Attendance at the lectures
is for the most part obligatory. Switzerland has four
universities which confer the degree of Doctor. This,
however, is not a license to practise, for which a further
examination on natural philosophy and the medical
branches is required. The course of study is six years,
and two examinations must be passed. Austro-Hun-
gary possesses eight universities of equal rank in the
conferring of degrees. Three examinations occur in the
course of five years' studies. In Russia six of the eight
universities possess medical faculties. At St. Petersburg
there is, besides, a medico-chirurgical academy for the
education of military surgeons. .\\. the end of a five-
years' course of well-arranged and obligatory studies the
February 17, 1883.]
THE MEDICAL RECORD.
183
candidate may pass to a degree of physician or doctor.
The former grants a hcense to practise only, the latter
authorizes the holder to teach medicine. For army and
navy surgeons a further examination is necessary. Swe-
den has three medical schools, which grant a license to
liractise only after /en years' study and three examina-
tions. Norway possesses but one medical school for
theoretical instruction. Clinical experience is gained
in the hospital in Christiania. The candidate for a medi-
cal degree is required to pass four examinations. In
Denmark from six to seven years must be passed in study
in the University of Copenhagen. Instruction itself is
free, but an examination fee is required. The license to
practise medicine is given to natives of Denmark only.
In France there are three " medical faculties" besides
two " ecoles de plein exercice " and fifteen " ecoles pre-
paratoires." The degree of " docteur en medecine,"
which permits the holder to practise anywhere in the
country, is granted only by the three faculties. Gradu-
ates of the other schools are called " officiers de sante"
and may practise only in the department in which they
have studied. Doctors who aspire to professorships
must present themselves, after a further study of three
years, to one of the medical faculties for examination.
They then receive the title of " professeur agrege,"
which corresponds to the iirivatdocent of the German
universities.
SOME RECENT RESEARCHES ON THE PHYSIOLOGY .^ND
PATHOLOGY OF THE STOMACH.
In order to decide at what precise time an excess of free
hydrochloric acid appears in the stomach, Dr. Edinger
has recently undertaken a large series of observations.
He experimented upon his own person and that of many
others. It appears from his investigations (which are
recorded in the Deutsches Archiv. fiir Klinisclie Aledi-
zin, vol. xxix.) that from three to four hours after a meal
is the usual time for an excess of acid to be present in
the gastric juice. Vomited matter from a typhoid fever
patient was examined, and found to contain a large
amount of frte acid, and that, too, at a time when the
fever was at its highest. This observation affords con-
tradictory evidence of statements made by others, who
assert that in febrile conditions an appreciable diminu-
tion of gastric hydrochloric acid is an invariable occur-
rence.
Edinger has also studied amyloid degeneration in con-
nection with the stomach. He found that the vessels of
the gastric walls were commonly implicated in the pro-
cess of degeneration, but in addition the nuiscular coat
was also frequently involved, and in not a few instances
the connective-tissue structures of the stomach, and its
glandular elements likewise participated in the amyloid
change.
The author holds that an amyloitl stomach easily be-
comes a dilated one ; for in this change, provided tlie
gastric muscle suffers, mechanical distention is not op-
posed by healthy contraction on the part of the walls ol
the stomach.
When ulceration supervenes in amyloid stomachs, it is
the otherwise healthy portions that are primarily attacked,
the amyloid matter seemingly resisting the destructive
tendencies of the gastric juice. There is also noticed in
amyloid stomachs a want of free hydrochloric acid at the
proper time, showing that the gastric function is mate-
rially impaired by this degenerative process. Frerichs was
the first to point out a vital sign that should arouse the
suspicion of amyloid infiltration of the stomach, in cases
where other organs are known to be affected in a similar
manner. This symptom is the loss of appetite, with oc-
casional vomiting, while the tongue shows no coating.
But Edinger very justly contends that these symptoms
are quite vague and unreliable, for they may occur in
a variety of other disorders. On the contrary, he has
found that patients with amyloid stomachs have a natural
appetite. He says, however, that the absence of epigas-
tric pain, vomiting with a healthy-looking tongue, asso-
ciated with amyloid changes in other organs, may justify a
positive diagnosis.
One practical point may evidently be learned from
these interesting observations. If muriatic acid is to be
prescribed, with a view to aid digestion, the best time to
give it would be some hours after eating, and not, as is
often done, immediately after a meal.
DEATH IN NEW YORK CITY.
It is sometimes charged, that the physician can ex-
tract morsels of comfort in contemplating the unusual
prevalence of disease. If so, a study of New York City's
vital statistics for 1882 will have much attraction for
him.
There died in this city last year 37>95i persons, which
is at the rate of 29. -|- per thousand. This is, we believe, a
higher ratio than exists in any other Northern or Western
city. The death-rate, as shown in the accompanying
table, was very large at the beginning of the year. It
slowly fell, reaching almost its lowest point in June.
1882.
January 3>498
February 3)298 ;
March 3i4Si
.^pril 3.395 !
May 3.353
June 2,871
July 4,482 j
August 3.329 I
September 2,579
October 2,588 |
November ' 2,461
December 1 2,522
Deaths. Births.
2,278
2,092
2,506
2,042
2,150
2,065
2,060
2,469
2,365
2,471
2,292
2,531
Still-
births.
200
218
199
221
240
200
208
213
226
230
245
246
Total 137,857 127,321 2,646
It then suddenly rose, and in July there were 4,482
deaths, making the enormous ratio of 41 4- per thou-
sand inhabitants. This wave of mortality gradually sank,
and during November reached its lowest point, when
only 2,461 deaths occurred. For the whole year the
deaths have been 673 less than they were last year, de-
spite increased pojjulation. This decrease has been al-
most entirely in zymotic diseases. The number of
deaths from these diseases in 18S1 was 13,493, against
12,522 during the year just past. As the accompany-
ing tables show, there was a decrease in all the conta-
gious diseases during 1882 except measles.
1 84
THE MEDICAL RECORD.
[February 17, 1883.
C.4SES OF CONTAGIOUS DISE.ASE.
Year.
Typhus
fever.
Typh'd
fever.
Scarlet
fever.
Measles.
Diph-
theria
Small-
pox.
1880 ..
1881 ..
1S82 ..
2
568
207
508
965
684
3.048
7,338
6,594
3,891
3,116
4,733
3,307
5,272
3,842
67
1,342
708
DEATHS FROM CONTAGIOUS DISEASES.
Diseases.
Small-pox
Measles
Scarlet fever. . . .
Diphtheria
Croup
Whooping-cough
Erysipelas
Typhus fever. . . .
Typhoid fever . . .
Malarial fever. . .
Yellow fever . . . .
18S2.
269
912
2,070
1,521
73°
655
151
66
363
533
1881. I 1880.
451
31
429
479
1,964
618
2,249
1,390
1,03s
910
286
277
192
171
160
3
446
241
605
470
Twenty-five persons died from accidental poisoning ;
and the special records concerning these are instructive :
One died from rat-poison, one from soothing-syrup, one
from acetic acid, four from opium, seven from lead poi-
soning, two from laudanum, one from chlorate of potash,
two from iodine, one from carbolic acid, one from whis-
key, one from bromide of potassium, one from morphine,
one from hydrate of chloral, and one from arsenic.
The whole number of suicides recorded was 199,
against 166 in 1881, and 152 in 1880. Of these, 165
were men, and 34 were women; 71 were Germans, 50
Americans, and 20 Irish.
PHYSICIANS AND THE CRIME OF SUICIDE.
In a paper recently read before the New York Medico-
Legal Society, by its President, Mr. Clark Bell, some of
the facts regarding suicide were summarized, and the
question of its criminality discussed. The works of
Forbes Winslow, Morrelli, and O'Dca have furnished to
the public a great mass of statistics regarding suicide.
These have shown that suicide is an integral part of
human society, and is governed by certain laws, which
are quite beyond the immediate reach of individual voli-
tion. They show, for example, that suicides are most
numerous between the ages of twenty-five and fiftv-five ;
that they increase projjortionately until e.xtreme old age ;
that men commit suicide oftener than women, in the pro-
portion of two or three to one ; that men kill themselves
later in life than women; that sorrow, reverses of fortune,
physical suffering, domestic trouble, iiindered passion, and
insanity are the more prominent causes ; that suicide and
insanity are both increasing, but with no definite ratio
between them ; that the diftusion of education increases
suicide ; that the number of suicides varies greatly with
the race, from seven per million in Portugal, twenty-six
in Italy, forty in the United States, sixty-eight in Eng-
land, one hundred and ten in France, one hundred and
twenty-three in Prussia, to two lumdred and eighty-eight
in Denmark ; that the proportion in tlie United States is
largest in California and Nevada ; and finally, that in the
civili/.ed world suicide is steadily increasing.
The question of what shall be done is partly a legal,
partly a moral and medical one. The advisability of en-
acting laws which will make suicide a crime is discussed
by Mr. Bell, who is somewhat inclined to favor such a
measure. To oppose successfully this increasing prac-
tice of suicide, however, something much more powerful
than legal measures will be required. And the more one
studies social problems, the greater appear the duties and
functions of the physician toward them. Healthy minds
in healthy bodies are very nearly safe from suicide. The
securing for his young patients a well-balanced and vig-
orous constitution is the work which the physician has to
do in helping to relieve civilization of the vice of self-
destruction.
CH.^RCOAL-FUMES .^ND COAL-GAS.
It is universally conceded that the growing complexities
of modern civifization are correspondingly fraught with
danger to- life and health. The increasing number of
deaths from the effects of various noxious gases furnish
but a single, though quite apt illustration of this dictum.
Poisoning by charcoal-fumes or coal-gas is doubtless of
daily occurrence. And medico-chemical interest in
such agents is a natural consequence of accidents of this
knid. Accordingly, Drs. Biefel and Poleck have reinves-
tigated the toxicology of the agents in question. (Zeit-
schrift fi'ir Biologic, vol. xvi., 1882.) In charcoal-fumes
they found carbonic oxide and carbonic acid in the rela-
tive proportions of one to twenty. The former was
chiefly responsible for the poisonous properties of these
fumes. Their experiments were conducted by placing
animals in an atmosphere gradually contaminated with
the noxious charcoal-fumes. When the oxide introduced
had reached 0.44 per cent., severe symptoms of poison-
ing arose. Death occurretl when the gas had risen to
0.62 per cent.
Coal-gas behaved in a somewhat dift'erent way. It
required from 1.5 to r.94 per cent, of carbonic oxide to
produce fatal effects. In coal-gas the absence of car-
bonic acid, formed at the expense of the oxygen, ap-
peared to materially modify the poisonous^effects of the
carbonic oxide. The effects of the latter, as compared
with carbonic acid, are contrasted by the authors as
follows :
Carbonic acid produced varying degrees of coma.
Dyspnoea resulted, which gradually passed into asphyxia.
Violent tetanic convulsions or general tremors were but
rarely observed. Respiration appeared to become slow-
ly paralyzed. Post-mortem examinations revealed dark
red blood, congested, (edematous, and dilated lungs,
moderately hypera;mic brain, and the right side of the
heart distended with dark blood.
Carbonic oxitle, on the other liand, never led to coma ;
but it i^roduced muscular weakness and transitory paresis
of the extremities. Dyspnoea was not observed; but
there were convulsive expiratory efforts, and general
convulsions. .'Vutopsical inspection showed hyperaamia
of the brain and its coverings, together with altered red
blood in the latter. No pulmonary oedema, but vesicu-
lar emphysema. The heart was filled with liquid blood.
Tiiis fluid also frequently contained bubbles of air.
Finally the occurrence of subcutaneous empliysema was
noted.
February 17, 1883.]
THE MEDICAL RECORD.
185
THE POVERTY OF MEDICAL MEN.
Dr. B. E. Cotting, in ail address before the Massachu-
setts Benevolent Society {Boston Medical and Surgical
Journal) took a somewhat gloomy view of the pecuniary
status of medical men. He said that an eminent clergy-
man once investigated the incomes of physicians in one
of the larger cities of another State, and found that, after
deducting e.\penses necessary to the practice of the pro-
fession, they did not annually receive, on an average,
more than workingmen in the same city.
He related the following anecdote :
" Rouse up," said the members of the family to one of
the first physicians of France, then on his couch, sinking
under most painful and wasting malignant disease —
" rouse up — a patient is waiting. Go earn a few francs
— there is not any bread in the house ! "
We might instance the case of a distinguished surgeon
of this city, widely known and justly celebrated for his
skill. He died a year ago after twenty years of practice
and now subscriptions for his widow are being made.
This is an extreme case, it is true, but helps to explain
why even the best qualified medical men cannot always
succeec?. There is not only a plentiful supply of first-
class practitioners in all our large cities, but the profes-
sion is year by year becoming more and more crowded.
Hence competition is fiercer and the chances of bril-
liant success are proportionately fewer.
THE BACILLUS OF WHOOPING-COUGH.
An interesting paper, pertaining to the pathology of
whooping-cough, was lately read before the Medical
Society of London, by Mr. Dolan, F.R.S., in which
views were advocated which were put forth by Poulet, in
1867; by Letzerich, in 1873; and still later by Tsclia-
mer. Mr. Dolan has repeated the experiments of these
former investigators, and with successful results.
Poulet, in 1S67, found certain bacteria of a peculiar
kind in the sputa of patients aft'ected with pertussis ;
Letzerich commenced a series of investigations a few
years later. The latter found constantly present in the
sputum of pertussoid patients a bacterium belonging to
the genus Ustiligo, Tul.; with this micrococcus he inocu-
lated the tracheal mucous membrane of tracheotomized
rabbits and noted the results. He invariably produced
a spasmodic catarrhal affection resembling whooping-
cough, and he observed that the bacteria do not pene-
trate the epithelium, but live on the surface of the mu-
cous membrane, to the detriment of the latter.
Tschamer, of Gratz, working in the same department
of micro-pathology, has lately found, in the e.xi)ectorft-
tion of pertussis, a microphyte, which he identifies
with a black mould which develops on orange-peel.
This he thinks that he has proved by different cultures.
Satisfied of the identity, he took some of the black pow-
der which constitutes the mould of orange-peel and
experimented with it on himself, inhaling the powder as
deeply as he could. At first no effect was observed,
but after eight days he began to have convulsive fits of
coughing, and expectorated the fungus in abundance.
He explains the phenomena of whooping-cough in
this way. After an incubation of seven days, these mi-
crophytes determine an irritation of the bronchi which
induces catarrh and spasmodic cough ; then, as the irri-
tation increases, the expectoration becomes more abun-
dant and eliminates the fungoid organisms.
Dolan, in repeated experiments, found that by inocu-
lating rabbits with the sputa of whooping-cough patients,
he not only induced a catarrhal spasmodic affection,
but the death of the animal generally ensued. Inocula-
tion with the blood of such patients was without effect.
This certainly seems to confirm the conclusions of
Letzerich, that the matcries morbi — be it a bacillus, or
be it what it may — lives on the surface of the epithelium,
and does not get into the blood.
Dolan does not claim to have arrived at certain knowl-
edge respecting the special bacteroid for which causes
pertussis.
The theory, then, is a simple one, that whooping-cough,
like other contagious diseases, is the product of germs,
which, given off in the breath of pertussoid patients, are
inhaled by persons of proper susceptibility, and set up
irritation of the respiratory epithelium ; the result is the
vascular and nervous disturbances, and other pheno-
mena which characterize whooping-cough. The severe
constitutional disturbance which sometimes attends the
disease is a secondary effect.
Mr. Dolan suggests nothing new with regard to the
treatment of this affection (which must be largely di-
rected to the palliation of symptoms) ; but adds that if
the dependence of pertussis upon a specific virus, be the
true explanation of its pathogeny, the lines on which its
rational treatment and prophylaxis are to be pursued
become clearer and more hopeful.
SANITARY PROTECTIVE .'\SSOCI.\TIONS.
Sanitary Protective Associations seem to be the rage
in Great Britain. A third has recently been founded in
Liverpool, called " The Northern Sanitary Association,"
of which the Earl of Derby is president. This would
indicate that the London and the Edinburgh associa-
tions, which have been in existence for some time al-
ready, are in a flourishing condition. The services of
these associations are most valuable to vendors, pur-
chasers, and intending tenants of house property, since
they provide good practical advice on sanitary matters
at a moderate cost. They advise, inspect, and super-
intend, but do not undertake the execution of work,
thereby avoiding interference with builders and contrac-
tors. -Associations of this kind would find a very wide
field in the United States, and we hope that some will
be in running order before the summer exodus to the
seaside and the country takes place.
THE PRACTICE OF MEDICINE IN NEBRASKA.
The law regulating the practice of medicine in the State
of Nebraska is, as might have been expected under the
circumstances, reported to be virtually a failure, so far,
at least, as affording protection to the people from the
impositions of quacks. There is no provision for any
tribunal by which may be determined the genuineness of
a diploma, or license. It is, therefore, wisely recom-
mended to establish a State Board of Health, with au-
thority to refuse its certificate to any person not properly
iS6
THE MEDICAL RECORD.
[February 17, 1883.
qualified to practise medicine, and also to order before
them for examination any one practising medicine, be he
a graduate or not.
The total number of graduates of all schools practis-
ing in the State is 567, practising under the ten years
provision of the law, 206 ; " first course students," 38 ;
of less than ten years' practice, and in open violation of
the law, 27 ; number practising that are not registered,
40; number of fraudulent diplomas detected, 87.
ITlcius of the ac*lccU.
An Asylum Superintendent sues for Damages.
— Dr. Wylie, of the Di.xmont Insane Asylum, has begun
a libel suit against the Erie (Penn.) Herald for $40,000
damages for publishing an interview charging cruelty and
injustice to the inmates of the institution.
Fees of the Health Officer of the Port of New
York. — The following resolution has been introduced
into the New York Assembly :
Resolved (if the Senate concur). That the Congress of
the United States be and is hereby requested to estab-
lish by law such just and uniform quarantine fees for the
port of New York, and for all ports of entry in the United
States, as a conference of the representatives of the State
Boards of Health of the maritime States may recommend,
or as Congress in its wisdom may direct after full knowl-
edge of the irregular quarantine fees now imposed by
law, the object of this resolution being to establish eco-
nomical and efficient commercial and health service in
the principal quarantine ports of the country.
Wholesale Body Snatching. — It is stated that one
hundred and fifty bodies have been stolen from grave-
yards in the vicinity of Montreal during this winter, one- '
half of which were sent to medical schools in the United
States.
A Lady Doctor for the London Post Office. —
Mr. Fawcett is said to intend appointing a lady doctor
for the lady employees in the London Post Oflice. The
Lancet is stirred up to protest against such action.
Dr. Andrew Clark has recently been elected Presi-
dent of the London Clinical Society. Dr. Clark is the
medical attendant of Mr. Gladstone, and Punch pub-
lishes his caricature with the following lines ;
" There was a sharp doctor, and what do you think ?
His simple prescription was ' Wittles and Drink."
Wittles and Drink — most important is diet —
.^nd mind, Grand Old Man, you must keep yourself quiet."
Mixing its Anatomy. — Our esteemed contemporary,
the British Aledical Journal, has been advertising a work
entitled " Diseases of the Prostate in Both Sexes," by
David Jones, M.D.
Syphilis Spread by a Midwife. — Much excitement
was caused recently in Sheffield, England, by the trial of
a midwife on the ground that she had communicated
syphilis to about thirty married women, and to two in-
fants, while in the discharge o{ her professional duties.
A New Italian Journal especially devoted to chil-
dren's diseases, and called Archivio di Fatalogia Infan-
tile, has just been started by Prof. Luigi Somma, of Na.
pies. It is to be published bi-monthly, and includes on
its editorial staff as many as twenty-five professors and
practitioners.
The Lancet and New York Physicians. — The
three leading articles in a recent issue of The Lancet,
were contributed by New York physicians.
Medical Relief in Paris. — The Municipal Council
of Paris recently voted the sum of $600,000, of which
$400,000 is to be spent in the improvement of existing
hospitals, while $200,000 will be devoted to erecting
new establishments for the relief of the city's sick poor.
The Brooklyn Hospital Saturday and Sunday
Collection for 1S82-83 amounted to $3,925.37, to be
divided among seven hospitals. This was the first year,
and is an excellent beginning.
Facts from the Census, — A few copies of the ad-
vance sheets of the " Compendium of the Tenth Census "
have been distributed. Some of the facts therein con-
tained we publish here prior to a more extended consid-
eration of the complete volume.
The defective classes, which include the insane, idi-
otic, blind and deaf-mutes, numbered in 1870, 58,484 ;
in 1880 the number was 251,698. The increase of pop-
ulation was only thirty per cent., that of the defective
classes apparently one hundred and fifty-five per cent.
The ratio of this class to the whole population was in
18S0 as 5,018 to each million. This startling increase,
however, is only apparent, as it is admitted that previous
census reports were very inaccurate.
The total number of the insane is given as 91,997, of
whom only forty-four per cent, were in hospitals. These
are nearly the same estimates as those made by Dr.
Dana in a paper read before the National Association
for the Prevention of Insanity, a. year ago. Among 76,-
895 idiots, three per cent, were in training schools for
the feeble-minded ; of 48,928 blind persons, less than
four and one-half per cent, were in schools and indus-
trial homes for the blind ; and of 33,878 mutes, nearly
sixteen per cent, were in schools established for them.
It appears from the report that insanity in the United.
States attacks women more frequently than it does men,
but men on the other hand are more liable to be idiotic,
blind, or deaf The negro population is much more
liable to idiocy than insanity. Both the negro and the
foreign population are singularly more liable to blindness
than to deafness. The tendency of the foreign popula-
tion to insanity is especially worthy of attention. " It
is startling to know," says Mr. Wines, " that of 50,000,-
000 of inhabitants over 400,000 are either insane, idiots,
deaf-mutes, or blind, or are inmates of prisons, reforma-
tories, or poor-houses. If to these we add the out-door
poor and the inmates of private charitable institutions,
the number will swell to nearly or quite 500,000, or one
per cent, of the total population.
The death-rate of the United States, as established by
the number of deaths recorded, was 15.1 to tiie thousand,
a rate decidedly higher than those given in the censuses
of i860 and 18 ;o. This does not indicate, however,
any actual increase in the rate, but shows that the re-
turns in 1880 were more complete. Adding estimates
of deficiencies, the agent in charge estimates the actual
death-rate at somewhere between seventeen and nine-
February 17, 1883.]
THE MEDICAL RECORD.
187
teen per thousand. The rate in England in the same
year was twenty and one-half. Of the total number of
deaths reported, which was 756,893, the cause in 91,551
cases was consumption ; diphtheria caused 38,398 deaths ;
enteric fever, 22,905 ; malarial fever, 20,261 ; and acci-
dents or injuries, 35,932. The death-rate of the colored
race is much greater than that of the white.
Final Report upon the Hospital Collections. —
The detailed report regarding the "hospital Saturday and
Sunday collections has been published, and is as follows :
Episcopal churches $1 1,898 55
Presbyterian churches 3i3^9 19
Baptist churches 392 69
Reformed (Dutch) churches .. 394 69
Lutheran cluirches 241 40
Methodist churches 203 46
Unitarian churches 221 68
Swedenborgian churches 147 00
Reformed Episcopal churches. 50 00
Congregational churches 25 00
Synagogues 1,556 17
Total for churches $18,459 V^
Trade collections 8,635 40
Hebrew lodges 235 00
Bo.K collections 857 71
Individual donations 2,141 97
Balance from last collection ... 237 16
Total $30,567 02
In addition to this are sums from other sources, making
the total amount $33,862.72, against $42,535.45 in
1881, $44,371.97 in 1880, and $26,455.07 in 1879.
The falling off in receipts is thought to be due to ex-
ceptional causes which will not be present ne.\t year. It
appears that while there was a very liberal advertisement
and a great display of yellow boxes, there were few suc-
cessful attempts to secure the co-operation of any but
Episcopal churches. The collection was essentially an
Episcopal one, so far as the churches are concerned. It
will probably remain so until a thoroughly representative
Board of Managers takes the matter in charge. A prom-
ising feature in the present year's statistics is the increase
of the trade collections.
Investigating a Hospital. — The Marine Hosi)ital at
Cleveland is being investigated by Dr. Geo. Parviance,
one of the surgeons of the service. The charge is that a
contractor who had the lease of the hospital from the
Government and formed a Hospital Association to man-
age the institution, ostensibly for charity, used it to make
money by neglecting the patients, failing to give them
proper medical treatment, and depriving them of nour-
ishing or wholesome food.
New York City Vital Statlstics. — There were 2,818
deaths reported during the month of January. The deaths
from contagious diseases were as follows : measles, 64 ;
scarlet fever, 75 ; diphtheria, 108 ; croujj, 73 ; whooping-
cough, 27 ; typhoid fever, 17 ; cerebro-spinal meningitis,
23 ; and malarial fevers, 23.
Pasteur and Koch. — Dr. Koch has published his re-
ply to Pasteur, as he announced that he would do at the
session of the Geneva Congress. Koch takes the ground
that " it is not yet proved that all infectious diseases are
parasitic in character, but that the parasitic character
must be proved in each case separately." As a model of
how such proving should be done, he modestly cites his
own experiments with the tubercle bacillus. He criticises
the methods adopted by Pasteur in studying rabies and
glanders, and denies that that experimenter's conclusions
regarding them have been established. Koch also claims
priority in regard to the discovery of the cause of anthrax
and denies Pasteur's statements regarding the mode of
\)ropagation of that disease (i.e., by the agency of earth-
worms). Regarding preventive inoculations, Koch states
that while some bacterial diseases may be so prevented,
there are others, like gonorrhoea and erysipelas (?), against
which one cannot be protected. Koch considers that
Pasteur's claims for the value of preventive inoculations
are exaggerated, and that his methods are cumbersome
and defective. It remains now for Pasteur to say a word.
A Conscientious Druggist. — Some weeks ago a drug-
gist in Burslem, England, had carelessly served a cus-
tomer with poison instead of magnesia. He summoned
the bellman as soon as the mistake was discovered and
sent him about the streets warning the unknown pur-
chaser not to use the deadly drug. This is a rather novel
way of neutralizing personal error, as it may be called,
but it was successful.
A Cincinnati Physician has been sent to the Work-
house for thirty days for cruelty to his family.
Five Students of the College of Physicians and Sur-
geons, and two of the University of Maryland, have been
attacked by small-pox during the present winter. Two
of the former have died of the disease. The others are
progressing well toward recovery.
Grant on Homceopathy. — U. S. Grant, when asked
to sign the petition in favor of making all physicians
equal before the law in the Government service, said he
would " give homceopaths no encouragement directly or
indirectly ! "
The Cartwright Lectures of the Alumni Asso-
ciation OF THE College of Physicians and Sur-
geons for the present year will be delivered at the Hall
of the Young Men's Christian Association, corner of
Fourth Avenue and Twenty-third Street, by Dr. VV. T.
Belfield, of Chicago, on the evenings of February 19th,
21st, 24th, and 27th, at eight o'clock. Subject: "The
Relations of Micro-organisms to Disease."
Cigar-Making in Tenement Houses. — At the meet-
ing of the Board of Health last week, the Commissioners
condemned Assembly bill No. 173, to prevent cigar-mak-
ing in tenements, which bill was reported to have their
support. They declared that such work was not detri-
mental to the health of the tenement house population,
and directed that resolutions to this effect be sent to the
Governor, the President of the State Senate, and the
Speaker of the Assembly.
The Danger of Administering Ether in Diseases
OF THE Kidney. — Mr. Lawson Tait's observations re-
garding this point, mentioned in a previous number of
The Record, merely corroborate those originally made by
our distinguished townsman. Dr. Thomas Addis Emmet,
as long ago as 1872.
1 88
THE MEDICAL RECORD.
[February 17, 1883.
glcpovts of .Societies.
MATERIA MEDICA SOCIETY.
F. P. Foster, M.D., President, is the Chair.
VIBURNUM OPULUS IN DYSMENORRHEA.
The paper of the evening, on "Viburnum Opulus,"
was read by its author, Dr. A. E. M. Purdv. The genus
viburnum of the natural order caprifoHaceii; furnishes
two plants used in medicine, viz., viburnum prunifolium
and viburnum opulus. The first has been quite exten-
sively used, is described by numerous observers, and has
obtained a place in the forthcoming revision of the United
States Pharmacopoeia. The second, however, has received
but little professional notice, and its literature is meagre
and unsatisfactory. Believing the viburnum opulus to
be more certain in its action than its companion of the
same group, the author proposed to present some points
in its history and some of the clinical results of its use
in dysmenorrhoea. After speaking of its botany and
history, he took up its pharmacy and chemistry. For
medicinal purposes is employed the bark of the root,
shrub, and its limbs (fresh bark being preferable). From
this a tincture is made with alcohol of 75 or 80 per cent.
(Hale). The tincture should have a dark red color and
a peculiar acid odor not unlike that of valerian. Refer-
ring to its therapeutic properties and uses, the author
quoted Hale, who recommends high cranberry as a power-
ful anti-spasmodic. In virtue of this property, says this
writer, it is known among .American practitioners as
cramp-bark. It is very effective in relaxing cramps and
spasms of all kinds, as asthma, hysteria, cramps of the
limbs and other parts in females, expecially during preg-
nancy. It is said to be highly beneficial to those who are
subject to convulsions during pregnancy or at the time
of parturition, preventing the attacks entirely if used
daily for the last months of gestation. In the treatment
of spasmodic dysmenorrhoea, for which variety this rem-
edy is especially indicated. Hale prescribes of the
tincture, a few drops a day for a week previous to the
expected period. When the pains begin, he gives it every
half hour, or every quarter if they be severe. He has
found it equally useful for the severe false pains preced-
ing normal labor and often rendering the woman's life a
torture for weeks. In after-pains it is of great value, and
should be given after each pain. Cramps in the abdo-
men and legs of pregnant women he was able to quickly
control by its use. He claims that it will prevent mis-
carriage if given before the membranes are injured and
when the pains are spasmodic and threatening. The use
of the viburnum opulus for the relief of dysmenorrhoea,
said Dr. Purdy, does not seem to have originated from
professional sources. It has been in domestic use for a
very long period as a remedy in the painful affections
of women. Hale first gained his knowledge of the plant
from its domestic employment. In neuralgic and spas-
modic dysmenorrhoea he has yet to meet with a single
case in which it has failed to cure, and states : " So con-
fident have I been of its almost marvellous powers, that
I have taken pains to look up some old cases that I had
dismissed years ago as incurable, in order to .test the
remedy on them. In every instance so far it has cured
these obstinate cases. Its sphere of action seems to
cover about the same grounds as galvanism." In spas-
modic affections of other organs, the same writer predicts
its usefulness. The question is whether it acts througli
the motor nerves or directly upon the muscular tissues.
It may prove to be a spinal remedy. Dr. Meyer, of
Wilkesbarre, Pa., in his pamphlet on "Specific Medica-
tion," states that viburnum opulus, or high cranberry, and
viburnum prunifolium or black haw, seems to be anti-
spasmodic, and to have a specific action upon the uterus.
He has only used the first named. Its employment has
convinced him that it is a uterine sedative, and often a
remedy for neuralgic dysmenorrhoea and for the com-
monly associated spinal irritation. He gave it in doses of
five to ten minims of the concentrated tincture for these
conditions, and also as a preventive of threatening
abortion. He believes that in the majority of cases it
has accomplished the object for which it was given. Dr.
Charles E. Hall (Philadelphia Medical and Surgical Re~
porter kr June 22, 1878), a number of whose cases the
author abstracted, states in conclusion that many more
instances could be given to show the positive effects of the
drug, and predicts a cure when the pain is spasmodic and
neuralgic, palliation when it is congestive or pseudo-
membranous. He also used it in menorrhagia with
intense crampy pain, and obtained speedy relief in cases
of uterine colic. The only other allusion in literature
the author could find was a brief statement on page 13
of " Piffard's Materia Medica and Therapeutics of the
Skin." Here it is stated that dysmenorrhoea is sometimes
promptly relieved by Pulsatilla and viburnum opulus.
Dr. Purdy then narrated a number of cases of his
own, which led him to conclude that viburnum opulus is
a powerful uterine sedative. He is satisfied that, if prep-
arations of the fresh drug be used, many cases beyond
the reach of any therapeutic aid, except opium, might
be relieved, and more positive results obtained from its
use than from the employment of viburnum prunifolium.
He had been using a preparation similar to the abstract
of the new Pharmacopoeia. One grain equals in strength
two minims of the tincture. The latter is made from
one part of the fresh drug to two parts of alcohol.
Dr. Farnham had had no experience in the use of
this species of viburnum, but had obtained good results
from the viburnum prunifolium. He haol employed it in
doses of a tluidrachm of the extract three times a day.
Dr. Purdv stated that he had used the viburnum opu-
lus abstract in five-grain doses.
Dr. Farnham related the case of a lady who had
aborted six times, and had been subjected to a variety of
treatment. The accident always occurred before the
third month. Being put upon viburnum prunifolium, she
went on until the sixth month. Then, at a time corre-
sponding to a menstrual epoch, death in her family
caused her to be hurried out one stormy night and taken
quite a distance in a carriage. Premature delivery took
place, the child being born alive and living twelve hours.
In the next pregnancy no other remedy was used, and
no local treatment employed. She was told to rest four
days every month at the periods corresponding to men-
strual epochs, and to attend to ordinary hygiene. She
went on to full term, and gave birth to a child weighing
twelve pounds. Having had excellent results with
viburnum prunifolium, he had used that to the exclusion
of the viburnum opulus.
Dr. Castle had used viburnum prunifolium, and had
found considerable difference in the activity of the fluid
extracts generally used. A good fluid extract gave piretty
good results in doses of half a drachm repeated at inter-
vals of three hours for dysmenorrhoea. He had only
used it twice for the purpose of arresting threatened
miscarriage. In one case it seemed to have secured a
good result ; in the other, small doses of ergot were also
employed, so that no definite conclusions as to its efficacy
were possible. While speaking of olysmenorrhoea, an
observation had occurred to him bearing upon the medi-
cal treatment of many cases of this afiection. He had
seen what might account for the reputed efficacy of any
drug tried for a limited period. In many cases he had
noticed that women would suffer much from dysmenor-
rhoea one month, while the next they would be free from
pain. On the following period they would again be
much distressed, to be again comfortable on the subse-
quent epoch, and so on. After one attack of dysmen-
orrhoea they would take medicine, and the next period
would be painless, the relief afforded being attributed to
the remedy. It would then be abandoned, directions of
the physician would not be followed out, and the follow-
February 17, 1 883. J
THE MEDICAL RECORD.
189
ing month the old difficulty would arise. Then their ex-
perience would lead them to again resort to the remedy,
with tlie result apparently of once more procuring a
quiet time.
Dr. Purdy stated that he administered as much of the
abstract to a dose as could be put on a five-cent piece
(i.e., about five grains).
Dr. Castle -remarked that each grain of the abstract
rejjresented two minims of a fluid extract, each minim of
which corresponded to one grain of the crude drug ; the
abstract was accordingly twice the strength of the crude
drug.
Dr. Johnson had not had much experience with vi-
burnum opulus, but had used the viburnum prunifolium
to some extent. In dysmenorrhcea, however, although
cases showed a decided eftect from the drug, his experi-
ence with this trouble had been of such a nature as to
render him ratlier suspicious in regard to the virtues of
the remedy. There seemed to be cases of dysmenor-
rhcea in which the pain appeared to be diminijhed on the
production of a strong impression upon the mind of the
sufferer. He had given minute doses of j^ulsatilla in a
case where he could not make himself believe that this
drug had really exhibited any of its therapeutical action,
yet the woman had painless periods. One young lady,
hysterical and broken down, suffering from pain so se-
verely every month that she was prostrated, was ordered
to take small doses of Pulsatilla, being assured at the same
time that this would relieve her. It did, and relief was com-
plete. In those cases in which viburnum had been given
for months with gradual diminution of pain, the remedy
certainly did seem to possess therapeutical value.
Dr. Furdv again drew attention to one of the cases
mentioned in liis ]3aper. The patient was a seamstress
who had had a hiematocele for six or eight months. Pain,
aggravated at the menstrual jjeriods, had been controlled
by opium. Viburnum opulus aftbrded relief without
opium.
Dr. Johnson asked whether rest had been insisted
upon.
Dr. Purdy stated that the patient sewed and em-
broidered for a living, and endeavored to do nothing else
during the employment of the remedy.
Dr. Johnson inquired whether the diminution of pain
might not have depended upon diminution in size of the
exudation.
Dr. Purdv had noticed no such diminution in a num-
ber of examinations made.
Dr. Johnson thought that if the decrease in the
amount of pain was not due to a diminution in size of
the hajmatocele, it perhaps depended upon the fact that
the woma.n had become accustomed to its presence.
Dr. Purdy agreed with Dr. Johnson that such an ex-
planation might with reason be urged. He referred to the
astonishingly long list of remedies brought forward in the
" National Catalogue" for the cure of dysmenorrhcea.
Dr. Johnson did not wish to be thought a doubter,
but it seemed to him that it was exceedingly difficult to
prove the efficacy of any drug in dysmenorrhcea.
Dr. Purdy had been using the viburnum prunifolium.
When Dr. Piftard suggested the viburnum opidus, he
took u|5 the latter and employed it. He had found that
it gave him better results.
Dr. Webster inquired for the situation of the hemato-
cele.
Dr. Purdy stated that it was well down in the pelvis,
pressing upon the rectum — a pelvic hsematocele.
Dr. Webster stated that he had no experience in the
use of the drug at all, but asked whether it might be
made use of in ophthalmological practice in treating
spasm of the orbicularis muscle.
Dr. Purdy replied that Hale spoke very enthusias-
tically of it in all forms of spasm.
Dr. Farnham had found that books attributed to it a
selective action on the uterus.
Dr. Purdy had Hale's authority for its efficacy in
heart cramp. Viburnum opulus was not an unsafe
medicine, it acted as a tonic, had no nauseating taste,
was non-irritating, and could be conveniently given in
the form of a powder. In judging of its value, one def-
inite preparation should be used.
Dr. Castle regretted that the abstract unfortunately
was a new preparation. There were different abstracts
in the market. • He could not find in the literature what
dose to use.
Dr. Johnson suggested that it would be better to use
a tincture of the remedy.
Dr. Foster was very happy to have presented posi-
tive and well-arranged testimony to the value of vibur-
num opulus in dysmenorrhcea. He had not used the
remedv himself, for lack of opportunity, and perhaps for
the reason he was under the iini^ression that viburnum
was not expected to do good in dysmenorrhcea, except
in that form which is accompanied by profuse menstrua-
tion. He had not had a case of that kind for the last
few months. He had used viburnum prunifolium a
good deal, and always as Dr. Castle prescribed it —
in the form of a fluid extract in doses of half a drachm
three times a day. Lately he had not employed it to
any extent. He was pretty well convinced that it pos-
sessed some efficacy. He administered it in cases of
dysmenorrhcea accompanied by excessive menstruation.
Quite recently he came to the conclusion that it had no
effect whatever, and as it was a very nauseous drug, he had
almost concluded to discard it. In looking over his
notes, however, he found one case in which it produced
good results, that was all, he thought. He was, and had
been for some time, thoroughly imbued with the idea, so
well expressed by Dr. Johnson, that dysmenorrhcea was
in very many cases relieved by mental impressions. He
had seen illustrations of this over and over again. He
had frequently noticed that patients would feel com-
fortable for one or two periods, then nothing would give
relief He had seldom observed the alternations men-
tioned by Dr. Castle. These had been referred to the
alternating action of the ovaries, one acting one month,
the other the next. If the dysmenorrhcea was ovarian
in pathology, and but one organ affected, these alterna-
tions of pain and absence of suffering were to be easily
explained in accordance with this doctrine. It might
have been possible that he had not obtained a good
sample of viburnum. He had never, however, desig-
nated any particular preparation in his prescriptions,
and as these had been init up in various parts of the city,
he ought to have procured a good specimen occasion-
ally. His patients objected to viburnum prunifolium
as vile to the taste, most of them refusing to take it tor
any length of time. As to viburnum opulus, he hoi)ed
it might prove to be superior to its congener. He
should specially investigate it, using the abstract, which
was a good preparation for those wishing to dispense
the drug themselves. In the matter of the case of ha;ma-
tocele, of which Dr. Purdy spoke, he could not see how
a drug which had no hypnotic or anodyne effect, shoald
be efficacious, how a remedy that had no action upon
the hasmatocele should relieve the pain caused by it.
Dr. Purdy referred to a case mentioned by Hale, in
which opium had been used, and then viburnum opulus,
as a substitute. He had administered the remedy at a
venture in this case.
The Society then went into executive session.
Nasal Physiological Conditions. — The nasal pro-
tuberances of the citizens of St. Louis must present some
striking physiological peculiarities, to judge from the fol-
lowing remarks of one of their local savants : " In China
they always vaccinate people on the tip of the nose, and
when there is danger of an epidemic the whole city gets
vaccinated at once. It is said that after the things be-
gin to 'take' it is impossible for an American traveller
to realize that he is not in St. Louis."
IQO
THE MEDICAL RECORD.
[February 17, 188;;
NEW YORK: ACADE.\[Y OF MEDICINE.
SECTION IN OBSTETRICS AND DISEASES OF WOMEN.
Stated Meeting, December 28, 1882.
Henry E. Cramptox, M.D., Chairman-.
Dr. a. S. Hunter was elected Chairman and Dr. H.
Griswold Secretary for the ensuing year.
DEFOR.MITY OF THE PELVIS — INDUCTION OF PRE.M.\TURE
LABOR.
Dr. Griswold reported a case as follows : In the
spring of 1880 he was called to assist two of his pro-
fessional brethren in a case of difficult labor. The
patient was an Irish woman, twenty-five years of age,
muscular and vvell-proportioned, who had been married
four years. She had a still-birth at seven months, and a
second still-biith at full term. She had been in active
labor three days, the membranes having ruptured early.
The pains had been hard but were then very feeble. The
breech presented with the back in the hollow of the sa-
crum. The parts were clammy, and oil or lard failed to
remove the rubbing sensation as the fingers were passed
into the vagina. Under chloroform the fcetus was de-
livered. Its surface was macerated, and the epidermis
peeled ofi" under pressure of the fingers. The vagino-
rectal wall was torn for three and a half inches. The
parts were cleaned, placed in apposition, and silver-wire
sutures were introduced. The bladder was evacuated
with the catheter and frequent carbolized vaginal injec-
tions were prescribed.
On the second day following delivery the nates were
found excoriated and the right labia presented a blis-
tered appearance. On the fourth day erysipelas was
ushered in with a chill. Around each suture a slough
was forming and they were removed. The woman re-
covered in about two weeks with the loss of a portion of
the vagino-rectal wall. The cause of the difficult labor
was found to be in the narrowing of the diameter between
the rami and an api)roximation of the ischial tuberosities,
forming what is usually called the masculine pelvis. It
is a modification of the infantile, and according to Dr.
Barnes, of the Royal Maternity Hospital, England, "is
accomiianied by development of unusual muscularity,
corresponding to the laborious employment of the in-
dividual." This delivery occurred in April. In De-
cember following she was operated upon for restoration
of the integrity of the rectum. The edges of the rent
all around for a full quarter of an inch were vivified, and
the needles carried through so as to just avoid the edges
of mucous membrane of the rectum. Incisions along
the lateral walls were necessary in order to remove the
tension upon the sutures, and the surfaces thus made
were left to granulate. Union took place throughout, save
at the superior portion of the perineal body, about an inch
and a half above the anus. Here on the eighth day a
fecal fistula was established. Hardened faces, making
fre*e use of the finger necessary, caused much annoyance
until the expedient was tried of administering a teaspoon-
ful of compound licorice powder in half a glass of water
at bedtime, followed by an enema of flaxseed tea and
sweet oil in the morning, when no further trouble was
experienced. ' It is now his habit to use this method in
all cases of operation about the perineum. The daily
action of the bowels did not seem to retard the healing
of the fistula, although fecal matter frequently passed
into the vagina. The occasional application of nitrate
of silver was all the treatment that seemed necessary to
complete the union. At the end of the month tlie fistula
had entirely closed, and the patient rapidly gained in
strength and flesh. Fifteen months later she again be-
came pregnant, and about the first of the present month
we decided to induce labor at seven and a half months
of pregnancy, with a view of preserving the integrity of
the parts gained in the last ojjeration and also, if jiossible,
obtaining a living child. At the suggestion of Dr. .\. S.
Hunter, three or four small sponge-tents were introduced
into the os, side by side, which in six hours was dilated
sufficiently to admit the smallest Barnes 'dilator. This
was filled by a Davidson syringe and the two larger sizes
soon followed. The internal os, almost its entire length,
was dilated by these me&.ns to easily admit three fingers.
A bag of waters presented and pains in the back com-
menced. Mechanical means were then discontinued, in
the expectation that nature would complete the labor,
but the pains gradually subsided, and in twenty-four hours
all was quiet. A No. 3 Barnes dilator was then intro-
duced into the uterus, inflated, and left overnight. Uter-
ine contractions expelled the bag and labor ceased. A
No. 9 bougie was then introduced for five inches be-
tween the meuibranes and the uterus. It remained over-
night without producing any effect. As the os was then
dilatable, and all previous efforts had failed, rupture of
the membranes was practised. Twelve hours later labor
came on and the pains were uniform and progressive.
The nates presented. The progress was arrested by
strong cicatricial bands in the regions that had been left
to granulate in the operation. These bands were divided
with a blunt bistoury ; no hemorrhage followed, and the
delivery of a dead fietus was eftected twenty-four hours
after labor had commenced. Its presenting parts were
much excoriated by friction. The mother made a rapid
recoverv and suffered no inconvenience from the incisions
that were made. The after-treatment consisted in a
complete washing out of the uterus, after the expulsion
of the placenta, with a two i)er cent, solution of Calvert's
carbolic acid. Her diet was sustaining and lactation
was restrained by the application of stramonium ointment
and powdered camphor to the mamma;.
It was possible that had labor been resorted to two
weeks sooner a living child might have been saved. One
interesting question suggested by the case was, How
can labor certainly be induced? For a week beforehand
she had resorted to the hot douche, and then the hot and
cold alternately, with no avail. Besides, the various re-
cognized methods already mentioned were adopted, but
nothing was effected until the membranes were ruptured,
and this only after twelve hours of delay.
Dr. Isaac E. Taylor thought the cases in which there
was simply narrowing of the antero-posterior diameter of
the pelvis differed from those in which the pelvis was
equally or generally contracted, or, as he preferred to call
it, "naturally faulty." He then referred to a case in
which the antero-posterior diameter was two inches and
a half, the pelvis being substantialh" what is known as.
the male pelvis. The description given by Dr. Griswold
led him to the conclusion that there was narrowing of the
inferior strait in the case, and that it was probably re-
duced to two inches and a half or three inches in diameter.
He thought that these differences should be kept clearly
in mind, and made distinct when considering Ciesarean
section, laparo-elytrotom)-, craniotomy, and cephalotripsy.
If the antero-posterior diameter was only an inch and
three-fourths, or two inches, and the head of the child
was transverse, it would probably be better to perform
craniotomy and cephalotripsy rather than resort to Cajsa-
rean section. There might, however, be exceptional cases.
The reason was that as the head was transverse in the
pelvis it was in a favorable position, so that after crani-
otomy the base of the head could be crushed with the
cephalotribe. He very much ([uestioned as to whether
delivery could be completed by means of the cephalotribe
unless the base of the skull was crushed several times.
He doubted also wliether in one out of twenty cases the
base of the skull was crushed with that instrument, but
he believed that the head could be easily delivered
by a slight manipulation, namely, by tilting the base of
the head, and in iliat manner the operator was able to
bring it down readily. He then referred to a case in
which, after craniotomy was performed, he introduced
tlie blunt hook, tilted the head, and the labor was com-
pleted very pronqitly. k\ the next labor the same patient
February 17, 1883.]
THE MEDICAL RECORD.
191
preferred Ca;sarean section. Porro's oiJeration, however,
was performed, and the uterus and ovaries were removed,
and the patient passed on verv well until the twenty-eighth
day' when phlegmasia dolens developed. From this she
recovered, but disobeying orders, she got up, and suddenly
died of cardiac thrombosis.
The generally contracted pelvis, the naturally faulty,
the equally contracted pelvis, ranging from three and a
half to three and three-fourths inches in diameter, re-
c|uired Ca;sarean section when earlv performed ; or if the
labor had existed for some time, laparo-elytrotomy might
be preferable to Cesarean section. In Dr. Griswold's
case, where the diameter of the inferior strait was so
narrow, the child already being dead, there was no proper
way by which delivery could be completed, e.xcept by
breaking up the base of the skull or tilting the head.
With regard to methods of producing premature la-
bor there were none which he had not employed. He
thought sponge-tents were objectionable because of the
length of time required. If the uterus could be pushed
down, he would tirst introduce the finger, as it was the
best dilator which could be used. After this a small
Barnes dilator might be used, which might be succeeded
by others of larger size. He was unable to recall a case
in which this method had failed. As a rule, labor could
be established from thirty-five to forty minutes after the
first Barnes dilator was introduced.
His conclusions were, that the generally contracted, the
naturally faulty pelvis demands Cesarean section if per-
formed early ; or laparo-elytrotomy might be preferred if
labor had existed for some time.
The infantile and male pelvis probably would require
in some cases laparo-elytrotomy if the labor was far
advanced. In the pelvis in which the antero-posterior di-
ameter at the superior strait was two or two and a half
inches, he would perform craniotomy and cephalotripsy.
METHOD OF ME.ASURING THE DIAMETERS OF THE PELVIS.
Dr. Taylor then spoke of the method to which he had
frequently resorted for measuring the diameters of the
pelvis. Introduce the hand, and for measuring the trans-
verse diameter turn the thumb toward the right or toward
the left, and then estimate the difterence between the
diameter of the pelvis and the width of the hand, which
could be done with the thumb. To measure the antero-
posterior diameter, turn the hand, the thumb toward the
pubis and make the estimate in a similar manner. He
believed that when the hand could be introduced, the
operator could get a more correct view with regard to
the antero-posterior as well as the transverse diameter
than by any other method which could be employed. If
after introducing the hand into the pelvis it could not be
rotated freely, it was safe to assume that the pelvis was
generally contracted. He believed that the so-called
justo-minor pelvis, or what he denominated the naturally
faulty pelvis, occurred much more frequently than had
been supposed.
Dr. C. Jewett, of Brooklyn, referred to a case as fol-
lows : An Irish woman, thirty-five years of age, a primi-
para, had been in labor several days. The physician in
charge had been in attendance from time to time, and
had given ergot during the last twenty-four hours, sup-
posing that delay was due to inertia of the uterus. When
Dr. Jewett was called, he found the abdomen tympanitic
and the uterus firmly investing the fcetus. The occiput
was presenting antero-posteriorly, and the head was ar-
rested at the outlet of the pelvis on account of the nar-
rowness of the inferior strait. The actual measurement
of the transverse diameter at the outlet was three and
one-sixteenth inches, the pubic arch measured fifty-eight
degrees. These were the measurements made upon the
pelvis after it had been removed, cleaned, and dried.
The physician in attendance had attempted to deliver^
with the forceps, but had been unable to do so. Dr.
Jewett subsequently, however, attempted to apply the
forceps, but the space was not sufficient to admit the
instrument and permit it to be locked. He subsequently
attempted to apply Dr. Lusk's cephalotribe, but failed.
The woman was delivered by craniotomy and died six-
teen hours afterward. In this case also the head of the
child was unusually large and firm. He believed that
had he seen the case before the head had engaged and
become so firmly impacted, he should have performed
laparo-elytrotomy.
With regard to the induction of premature labor, the
method which he had usually employed was to introduce
a flexible bougie into the uterus and leave it in position
overnight. In the subsetjuent treatment he had some-
times resorted to Barnes' and sometimes to Molesworth's
dilators. He had not had any difficulty in inducing la-
bor in that manner. Manual dilatation was certainly a
most excellent method, but he had quite uniformly suc-
ceeded in the manner indicated.
Dr. a. S. Hunter remarked that he had used sponge-
tents for the induction of premature labor in a few in-
stances, and had had reason to be satisfied with the
results. He thought that if the os was filled completely
with them the results desired could be obtained very
readily, and, if there was sufficient time, he would not
hesitate to resort to that method. For example, in Dr.
Griswold's case, where there was nothing to indicate
special haste, he advised the use of sponge-tents. In
cases in which results must be obtained more sjieedily it
might be necessary to resort to other measures.
He certainly would perform laiiaro-elytrotomy rather
than craniotomy and cephalotripsy if the child was living
and if the life of the child would necessarily be sacrificed
by attempting to deliver it through the pelvic canal.
Dr. Warner, of Boston, remarked with regard to the
induction of premature labor, that he had never resorted
to any means except manual dilatation, and had always
succeeded. He thought that method was much the safest,
and in his experience it had always acted prom|3tly.
After introducing one finger another might be made to
follow, never changing position until he had taken hold
of the child's feet and completed the labor. The ad-
vantage of manual dilatation was that the operator could
know exactly what he was doing, could feel just how
much force he was using, could determine how much the
womb vvas yielding, and could estimate very precisely
the amount of pressure which was being made.
Dr. Griswold remarked that the objection which he
had to introducing the hand in his case was the condition
of the tissues in the vagina. Moreover, the uterus was
so high up that it was only with a great deal of pressure
that he was able to reach the os. Under the circum-
stances where almost all the perineum was composed of
cicatricial tissue, some of it was very thin, it seemed to
him to be best to induce uterine contractions and allow
labor to progress slowly so that the parts might dilate
gradually.
Dr. VVarner further remarked that where the uterus
was high up it could be pushed down into the pelvis by
the hands of the assistant, and held there firmly while
gradual pressure with the finger was made against the os
externum.
cancer of the neck, of the uterus.
Dr. Taylor narrated a case as follows : In Decem-
ber, 1881, he saw a patient, twenty-eight years of age.
Upon examination it was with very great difficulty that
he could introduce the finger on account of the resist-
ance offered by the hymen. Finally, he reached a firm,
smooth body, and afterward found that the entire pos-
terior portion of the cervix was gone. He diagnosticated
cancer of the uterus, and decided that the best thing to
do was to excise the anterior portion of the cervix, which
was exceedingly hard to the touch. No hemorrhage had
occurred during the patient's illness, nor was any hemor-
rhage induced by the examination. Upon making further
examination, with reference to operative interference, he
discovered that the anterior part of the cervix was e.x
192
THE MEDICAL RECORD.
[February 17, 1883.
ceedingly vascular, and he decided at once to let it
alone, and to await fiirtlier developments. No hemor-
rhage occurred, nor discharge, and he did not deem it
necessary to make any examination. In the course of a
month it became evident that gas escaped from the va-
gina. There had occurred perforation of the rectum.
On account of pain the patient had been obliged to
resort to the use of opium, which was gradually increased
in quantity until finally she took the equivalent of si.\ or
seven hundred drops of laudanum daily ; besides, she
took a bottle and a half of brandy daily. During all
this time the patient's weight and strength rather in-
creased. She died almost instantly from the sudden
occurrence of hemorrhage, probably three pints of blood
escaping at one gush. At the autopsy the body of the
uterus was found to be almost one complete mass of
cancerous disease, and the neck was entirely gone. The
actual source of the hemorrhage could not be found ;
that is, no open vessel was discovered. The interest in
the case was that it was one of cancer, without hemor-
rhage or discharge during its progress, and death oc-
curred suddenly m the manner indicated. Dr. Taylor be-
lieved that in very many cases of cancer of the uterus it
was better to allow the patients to go along under the
use of opium and perhaps stimulants rather than resort
to operative interference, such as the curette, cauteriz-
ing, etc.
Dr. Warner remarked that the only question with
regard to the treatment of carcinoma of the uterus was
not whether we should curette or resort to any other
operative interference, but what benefit is to come to the
patient ? Does it cure, or prolong life, or lessen suffer-
ing.? From his own e.xperience in the treatment of car-
cinoma of the uterus he believed that, as a rule, the plan
of interfering surgically rather hastened than retarded
the progress of the disease.
Dr. Taylor believed that in some cases amputation
might be followed by beneficial results. He then referred
to cases which had been under his observation, and in
which the disease had occurred early in life, as early as at
the age of from nine to fifteen years, notwithstanding the
opinion which had been expressed that carcinoma of the
uterus never occurred in virgins.
Dr. Griswold referred to a case in which the patient
had been operated upon by Dr. Munde, who removed
the entire cervix. He saw the woman two months after-
ward, and there had been complete rei^roduction of the
growth, and involvement of the vaginal wall. The cu-
rette was used, also the scoop, and chloride of zinc was
applied, etc., but there was another reproduction of the
growth within four weeks. After this nothing was done
in the way of operative interference, but the patient was
made as comfortable as possible, and she lived for nearly
two years. The operation, however, seemed to lelieve
her from the severe burnnig pain from which she had
suflered.
Dr. Warner asked if it was not a fact that large quan-
tities of alcohol and opium prevented disintegration of
tissue. It had seemed to him so in these cases. He
doubted very much whether curetting ever arrested the
progress of the affection.
extra-uterine pregnancy.
Dr. a. S. Hunter narrated a case or extra-uterine
pregnancy in which the pregnancy had existed appar-
ently not more than three weeks. There was evidence
of ru])ture of the sac, but the patient recovered. He
gave the details of the history of the case, which he pro-
posed to make the basis of a paper upon that subject.
Dr. Warner referred to a case in which there was a
small tumor in Douglas' cul-de-sac. The woman was
forty or fifty years of age, and had never been pregnant.
The tumor was somewhat soft, doughy to the feel, and
he thought it was a hx'matocele. The uterine sound
could be introduced to the depth of five inches. Aspira-
tion removed two ounces of blood, whicli coagulated im-
mediately. The blood was examined microscopically,
and nothing was found which indicated that it came
from an old htematocele. On the following day another
physician was called, who aspirated the tumor as a
h.-ematocele and drew off twenty-four ounces of blood,
which coagulated promptly. The woman died, and the
case was reported as one of hasmatocele. The specimen
was presented to Dr. Cutler for preservation, and on fur-
ther examination he found in the cul-de-sac a little fcetus.
This fcetus had probably been there for three or four
months.
Dr. T.wlor referred to a specimen of tubal preg-
nancy which he obtained, and which could be seen in
the Wood museum at Bellevue Hospital. The woman
had advanced to a little more than eight months in preg-
nancy when she suddenly fell into collapse and died. It
seemed evident that death had been caused by internal
hemorrhage, and at the autopsy it was found that the sac
was filled with blood, but it had not ruptured.
Dr. Griswold referred to a case as follows : About a
year ago he was called to see a woman who was be-
lieved to be sufi'ering from cholera-morbus. She was not
aware that she was pregnant, although she had passed over
one menstrual period. She had pain, vomited severely,
and had diarrhoea. The patient fell into collapse and
died with evidences of internal hemorrhage, and he re-
ported the case as one of internal hemorrhage, ])robably
from rupture of an aneurism. It was made a coroner's
case, and upon examination the abdomen was foiuid filled
with blood, and closer inspection revealed the presence of
a fcetus, which indicated that the woman was advanced
about eight weeks in pregnancy. The uterus contained
a well -marked decidua. The fcetus was not found in the
Fallopian tube, but the tube when examined gave evi-
dence of the existence of a cyst which had ruptured, and
hemorrhage had taken place from the edges of the open-
ing. No distinct blood-vessel could be found which had
ruptured.
Dr. Hunter referred to a case of extra-uterine preg-
nancy which, three years subsequently, was followed by
normal pregnancy and delivery of a living child. Not
long after the completion of the normal pregnancy the
remains of the extra-uterine pregnancy were discharged
by the rectum. This was attended by symptoms which
indicated purulent infection, and the woman died. In
this case, as also in the case which he had already re-
lated, the woman when sufi'ering from extra-uterine preg-
nancy had severe pains, which were remittent in charac-
ter, and not intermittent. He thought this was charac-
teristic of the pains of extra-uterine pregnancy not
infrequently, if not always ; particularly in those cases
in which rupture of the sac occurred.
The Section then adjourned.
With and Without Antisepsis. — The statistics of
the Surgical Clinic at Basle, in the ten years before and
after the introduction of antisepsis, are in interesting
contrast.
Thus, of traumatic amputations and exarticulations :
1861-70, 36 cases; mortality, 41.6 per cent.
1871-So, 46 cases ; mortality, 15.2 per cent.
Pathological amputations and exarticulations :
1S61-70, 28 cases ; mortality, 44.4 per cent.
1871-80, 93 cases ; mortality, 9.6 per cent.
Internal lierniotomies :
1861-70, 36 cases; mortality, 52.7 per cent.
1871-80, 80 cases, mortality, lo.o per cent.
Complicated fractures of the long bones with primary
amputations :
1S61-70, 38 cases; mortality, 50.0 per cent.
1S71-80, 85 cases; mortality, 12.9 i)er cent.
Complicated fractures, treated conservatively:
1861-70, 36 cases ; mortality, 52.7 per cent.
1S71-S0, So cases; mortality, 10.0 per cent.
February 17, 1883.]
THE MEDICAL RECORD.
193
(I'll vvcsp 0 n (1 en c c.
OUR LONDON LETTER.
(From our Special Correspondent.)
THE PICRIC ACID COXTROVERSV — THE TESTS FOR ALBU-
MEN—COLLECTIVE INVESTIGATION OF DISEASE AN-
TISEPTIC MIDWIFERV.
London, Januar>' 27, 18S3.
An amusiiii; controversy has now been going on for some
weeks among prominent medical men, on the subject of
urinary tests. The ball -was set rolling by Dr. (ieorgc
Johnson who attemi^ted to show that a saturated solution
of picric acid was a convenient and reliable test for albu-
men in urine. Dr. Pavy replied and combated Dr.
Johnson's views, recommending, in preference, a satu-
rated solution of potassium ferrocyanide, the urine being
freely acidulated by citric acid. Dr. Johnson then re-
turned to the charge, reinforced by his son, an able
young chemist, who is a demonstrator of chemistry at
King's College. The controversy has latelv become
somewhat personal. The contemptuous tone assumed
by Dr. Pavy toward Mr. G. S. Johnson is scarcely credit-
able and is not likely to promote good feeling, as Dr.
Johnson is not generally believed to be one of the best-
tempered men in the profession.
The discussion has had one good result — that of bring-
ing to light several new or modified tests for albumen.
Dr. Wni. Roberts recommends a solution of acidulated
brine. ISfr. Stephen modifies Tauret's test with a stand-
ard solution of potassio-mercuric iodide by strongly acidi-
fying the urine with citric instead of acetic acid. Dr.
George Oliver has just published a connnunication in
which he recommends the use as reagents of pieces of
filtering paper saturated with various test-litjuors, then
dried, and, when required, dipped in the urine to be
tested, which is then boiled. He describes the method
as trustworthy, and says that by graduating the papers
with standard solutions he has been enabled to make
quantitative determinations. I should say that besides
employing picric acid as a test for albumen. Dr. Johnson
has also employed it as one for sugar.
The event of last week was the large meeting of tlie
Metropolitan Counties Branch of the British Medical .As-
sociation, convened at the Royal School of Mines to con-
sider the subject of the " Collective Investigation of Dis-
ease." Addresses were delivered by Sir William Gull
and Sir James Paget. The powerful advocacy of two
such distinguished men can scarcely fail to stimulate a
movement which has already attained some not incon-
siderable success. The replies already received would
seem to indicate that not only the hospital starts of Lon-
don and the large towns but many general practitioners
throughout the country are disposed to assist in advanc-
ing the scientific study of disease. Organized by a cen-
tral committee and working on definite lines the profes-
sion may reasonably expect great results from their united
labors.
Antiseptic midwifery is receiving a fair trial at the
British Lying-in Hospital. A little information as to the
methods in use, derived from personal visits to the hospi-
tal, may interest your readers.
Antiseptics are now employed in every case. Previous
to fresh patients being received into a ward it is washed
out with a solution of carbolic acid, disinfected by burn-
ing sulphur in it, and then left with the windows open for
several days. A long-spouted kettle containing an aqueous
solution of carbolic acid (one in twenty) stands on a table
in the centre of every ward. This is heated by a small
jet of gas and, being always kept going, the atmosphere
of the wards is kept constantly impregnated with carbol-
ized spray. Carbolized oil is used by the niidwives and
nurses to anoint the fingers before making digital examina-
tions. The patients are delivered under a cloud of car-
bolic spray (one in twenty solution), which is kept playing
on the vulva during labour. A steam spray is usually
employed, but a hand-ball spray with three jets is always
kept in readiness besides, for use when the steam spray
is not ready, so that the spray is never omitted in any
case. Dr. Fancourt Barnes thinks that this prevents the
entrance of any germs into the uterus at the moment
when the vagina is dilated by the passage of the child.
He gives a quinine, opium, and ergot mixture for the
first few days after delivery to keep the uterus contracted
and thus prevent any germs from entering. The vagina
is syringed out daily for the first ten days after delivery
with a (one in sixty) solution of carbolic acid. All wash-
ings of the genitals are performed with carbolic solution
(one in eighty). These antiseptic measures have been
used at the British Lying-in Hospital for about two years,
and since they have been in vogue no deaths from puer-
peral fever have occurred, and during the past two years
(1881 and 1882) only two deaths from any cause what-
ever among three hundred and thirty-two women deliv-
ered. Febrile temperatures after delivery, which were
formerly common, are now quite the exception. It should
be noted that in addition to these antiseptic procedures,
so called, i/ii: strictest cleariHtiess is observed. The tables
and chairs, etc., in the wards are painted all over, and
when washed are thoroughly washed all over, so that no
hiding-place for dirt is left anywhere. .-Ample provision
for ventilation is made by means of open fireplaces, cross
windows, inlet ojienings on Tobin's plan with wire screens
(which can be washed out periodically) under the win-
dows, and outlets in the ceiling, which communicate with
an exhaust shaft. Each ward only contains four beds,
and is large and lofty. There is a separate labour ward.
The mattresses are disinfected from time to time by being
baked in a hot oven.. During the month of August in
every year the hospital is closed and thoroughly cleaned
throughout, and the walls limewashed afresh.
CONVALLARIA MAIALIS— A POWERFUL POI-
SON TO ANIMALS.
To THE Editor of Thk Medical Record.
Sir : I have read with the greatest interest the clinical
experience of Dr. Henry Ling Taylor with the new car-
diac tonic — convallaria maialis. One caution only
seems necessary. FVoni experiments on animals, it is
proved that convallaria is a powerful toxic agent, not in-
ferior to digitalis in its power to cause speedy death.
Therefore, in its clinical application to human patients
it is well to be a little careful about the dose prescribed.
I am surprised at the largeness of the dose given in some
of Dr. Taylor's cases, i.e., one ounce of Parke, Davis &
Co.'s fluid extract. It would never do to give this as a
commencing dose.
I have made some experiments on animals to determine
the poisonous effects of convallaria. The preparation used
— the only reliable preparation now in the market — was
Parke, Davis & Co.'s fluid extract. I shall not burden
you with the details of all these experiments. I am a
very crude experimenter, and my experiments all lack
precision. 1 shall therefore copy from my note book
memoranda of only three or four :
September i6, 1882. — Poisoned a four weeks kitten
with fluid extract convallaria ; ten drops Parke & Davis's
fluid extract under skin of back. Tremblings ; hurried
respiration ; staggering. These convulsions and death
in fifteen minutes from the reception of the poison. Ne-
cropsy showed heart arrested in systole, both ventricles
empty and firmly contracted.
October 3d. — .\ four months kitten, plump and
healthy. Fifteen minims convallaria under skin of back.
Kitten lay stupefied fourteen minutes, rapid respiration
and circulation, then went into convulsions, first clonic,
then tonic, and died with screams. Heart ventricles
empty and firmly contracted.
Other experiments on kittens are so similar that a de-
tailed account is not necessary.
194
THE MEDICAL RECORD.
[February 17, 1883.
Five minims under the skin of a frog's back arrested
the heart's action in less than twenty minutes. Professor
-See says : " The phenomena are identical in the same
-conditions in cold-blooded animals, but the heart of the
frog and turtle resist longer the action of the drug."
Convallaria, then, is a cardiac poison which arrests the
heart in systole like digitalis. In several experiments on
Ivittens which I have poisoned with digitalis, and in which
I injected under the skin from ten to fifteen minims of
the tincture, death took place in about a quarter of an
hour, but wiihoiit convulsions, complete stupefaction and
paralysis of all tiie vital functions being the marked phe-
nomena.
In some of Professor See's recorded experiments with
•convallaria, he >found /<;///- drops of a fluid extract cause
the death of medium-sized dogs in ten minutes. From a
private letter from Dr. H. L. Taylor, dated February 3d,
1 quote the following sentence, which shall be my justi-
iication for citing these few imperfect experiments —
especially imperfect because I did not ascertain the
minimum dose which would cause death, as well as the
weight of the animals experimented on : " I am afraid
that incautious men mav do damage to their patients and
to the reputation of the drug bv beginning with large
•doses in susceptible persons unless the toxic power of
the drug is known. My article failed to bring this out. '
E. P. HuRD, M.D.
Newburvport, Mass.
TRANSPLANTATION OF THE CONJUNCTIVA
OF A RABBIT.
To THE Editor of The Medical Record.
.Sir: On page 42 of The Medical Record of Janu-
ary 13th ult., a brief editorial transcribes an interesting
case in the Jefferson Medical College Hospital, Phila-
delphia, where, for the relief of cicatrization of the lids
to the eyeball, a rabbit's conjunctiva had been grafted
in lieu of the one destroyed. The case seems to have
.been unusually severe, as the right eye was entirely de-
stroyed, and the left, as stated, was ankylosed to both
tlids. This operation of transplantation of the major part
•of a rabbit's conjunctiva has been rarely performed,
probably on account of its tediousness and indifterent
success. It is not as recent a procedure as miglit be
supposed. Wolfe, of Glasgow, an authority in plastic
■operations within and without the lids, claims to have
jnade the first transplantation in 1872, again in 1873,
and has been followed by Wecker, Becker, Cohn, Schoe-
ler, and others. Wolfe's description in "Diseases and
Injuries of the Eye," 1882, details the questions of nar-
•cosis of the rabbit and patient, one or both, the method
of transfer of the llap, and his own success. He mentions
■one of the elements of failure, viz., the facility with which
the edges and corners of the delicate flap roll forward.
He omits to mention the difficulty of keeping the flap in
the inferior cul-de-sac, wiiich may be overcome by stitch-
.ing it at intervals down through the whole lower lid.
In the spring of 1876 tne writer assisted Schoeler ami
.Sellerbeck, at the eye clinic of the former in Berlin, in
several transplantations from the rabbit where the loss
of human conjunctiva had been large. The success of
these operations was mediocre. It is interesting to note
that in gynecology the mucous membranes of the rabbit
have been successfully transplanted. In this connection,
attention might be called to the ingenious operation de-
vised for improvement of sight in eyes with dense opacity
•of the cornea, almost total blindness, and a consignment
■of the patient to a life of lielplessness. Schoeler practised
it early in 1S76 with large success in several cases. In
brief, the conjunctiva of the patient was dissected in two
parallel lines from the inner canthus to the periijhery of
.the cornea, was reflected over the latter so liiat tl'.e ex-
ternal surfaces of both tissues were enfacc, and the tail of
the rhomboid flap was stitched to the outer conjunctiva.
'The gap at the iimer canthus was then tilled witii rabbit's
conjunctiva. The two epithelial surfaces united, while
the remainder of the reflected conjunctiva sloughed away.
Finally, the cornea has been transplanted in section with
success, an operation attempted nearly fifty years ago,
and which, in 1S39, attracted the attention of the Uni-
versity of Munich.
Edward S. Peck, M.D.
New York.
^vmij 4\cius.
Official List of Choiarcs of Stations and Duties of Officers
of the Medical Department, United States Army, from
February 3, 1883, to February 10, 1883.
De Loffre. Augustus A., Captain and Assistant
Surgeon. Will be relieved from duty in the Department
of the Missouri and report in person to the Command-
ing General, Deiiartment of the East, for assignment to
duty. S. O. 26, par. 3, A. G. O., January 31, 1883.
Elbrev, Frederick W., Captain and Assistant Sur-
geon. The leave of absence on Surgeon's certificate of
disability, granted July 21, '1882, is extended six months.
S. O. 26, par. 5, A. G. O., January 31, 1883.
Taylor, B. D., Captain and Assistant Surgeon.
Granted leave of absence for one month, on Surgeon's
certificate of disability. S. O. 13, par. 2, Department of
Texas, February i, 1883.
Taylor, Marcus E., Captain and Assistant Surgeon.
So much of S. O. 20, A^. G. O., January 24, 1883, as di-
rects him to report in person to the Commanding Gen-
eral, Department of the East, is amended to direct him
to report in person to the Commanding Officer, David's
Island, New York Harbor, for duty at that station.
S. O. },i, par. 2, .\. G. O., February 8, 1883.
31fXctlicaX Items.
Contagious Diseases — Weekly Statement. — Com-
parative statement of cases of contagious diseases re-
ported to tlie Sanitary Bureau, Health Department, for
the two weeks ending February 10, 18S3 :
^
"rt
Week Ending
>
3
>
■a
'0
>
u
M ■ ~
1 U
o.S
S
•fi
0
a
>
a
c
Pi
ss
«
a
F
«
H
y;
u
^
U
m
>
February 3, 1883
2
10
59
.
92
•w
0
0
February 10, 18S3
0
4
69
6
11
41
0
°
A Sanitary Conventio-V was held at Pontiac, Mich.,
January 31st and February 1st, under the auspices of
the State Board of Health.
The Ontario LEGiSL.vruRE will probably contain
three doctors, and the Dominion Senate two.
Inocul.\tion of Monkeys with Syphilis. — Dr. Mar-
tineau, of the Lourcine Hospital, claims to have at last
inoculated a male monkey with syphilis. A typical
chancre is said to have appeared on the penis twenty-
eight days after liie inoculation. The virus is being
tested upon other monkeys.
The Dublin Hospital Sunday Fund. — The last col-
lection amounted to about twenty thousand dollars.
Black Soap. — Several of our correspondents ask wliat
is the composition oi I'lacl; soap mentioned in connection
with Kern's cataplasuiata for the treatment of malignant
lympho-sarcoma. Will any of our readers answer ?
February 17, 1883.]
THE MEDICAL RECORD.
195
At an Anti-Vaccination Meeting recently held in
I'",diiil)uigh, it was claimed that thirty thousand names
hatl been obtained to a petition against vaccination, and
that Edinburgh University had lost $60,000 in conse-
quence of Dr. Rutherford's experiments. There is prob-
ably some exaggeration iu the statements.
The Gelatine Urethral Bougies. — Dr. Robert
Newman, of this city, calls our attention to an error in
the report of his remarks made before the State Society
concerning the use of the gelatine urethral bougies. He
wishes it to be understood that these bougies should
never be used when their introduction causes \)ain, the
latter being the case when the canal is in a high grade of
inflammation. Under all other circumstances they can
be employed with impunity.
Diphtheria from Infected Milk. — Drs. Cameron
and Morell Mackenzie have recently traced a severe and
sudden epidemic of diphtheria to infected milk. Fifteen
persons were attacked in the same day. The milk ven-
dor was found to have washed his cans in a brook pol-
hiteti with sewage.
Hyo.scyamin and Hyoscvamine. — Hyoscyamia or hy-
oscyamine, of which the dose is one-sixtieth of a grain,
is the true alkaloid of hyoscyamus, being analogous to
atropia or atropine, which is the alkaloid of belladonna.
But for years there has been in the market a prepara-
tion of variable strength, stronger than the extract, but
much weaker than the true alkaloid ; and this prepara-
tion is called hyoscyamin. Of this preparation one-eighth
to one grain may be given. The only distinction between
these two names, when properly written, is in the final
letter " e " being added to the name of the true alkaloid ;
but what shall we say when, on turning to the United
States Dispensatory for 1878, we find the terms used sy-
nonymously ? The cautious physician who is acquainted
with tliese facts will beware how he prescribes hyoscy-
amin, unless he has thorough confidence in his druggist.
— Dr. C. F. Clark, Therapeutic Gazette, January, 1883.
The Influence of Sulphurous Acid in Arresting
Phthisis. — Herr Kircher, a pupil of Liebig, has been,
during forty-four years, director of an ultramarine factory,
in which a special process of manufacture is employed
which involves the formation of sulphurous acid by tlie
burning of sulphur. He maintains (according to the Ge-
sundheit) that none of his work-people have ever suffered
from consumption, typhus, cholera, or any disorder, which
is produced by bacteria. He recommends the following
treatment in the case of tuberculous patients. They
should be brought into a room in which small quantities
of sulphur (one to two drachms) are burnt every hour
over a spirit-lamp or on a stove. At first coughing of a
more or less aggravated character takes place, and after
eight or twelve days the bacteria gradually disappear and
cease to irritate the lung-tissue. To complete the cure,
the patients should be brought into rooms which contain
some aromatic vapors.— 77ii? Lancet.
The An.i^sthetic Action of Styrone. — ^Dr. S. A.
Fopoff has made experiments with styrone, a substance
first described by Dr. Beach {Bostoti Medical a?id Surgi-
cal Journai, July, 18S0), and obtained from storax and
balsam of Peru. Aside from its powerful antiseptic prop-
erties, he found the following in experimenting upon
frogs and dogs. i. Hypodermic injections of one milli-
gramme in frogs caused complete anaesthesia dependent
on paralysis of sensory nerves. 2. A large dose caused
convulsions followed by motor paralysis. 3. The intra-
venous injection of five to eight centigrammes per kilo-
gramme of weight in dogs caused also anesthesia. The
drug was found to depress the respiratory centre and at
times the temperature. — Mcdiz. Obozr., February, 1882.
The Sedative Action of Stigmata of Maize. — M.
Ducasse has recently experimented largely with the ex-
tract of this drug, and finds it to have a specially sedative
action on the genito-urinary tract. In the dose of twenty-
two grains he finds that the extract has a calming influ-
ence on the jjain of chronic cystitis, gravel, and nephritic
colic, at the same time aiding in the expulsion of gravel.
This anesthetic action is very marked, especially in
nephritic colic, where it calms the pain when morphine
injections have proven ineftectual ; its action is followed
by micturition, the urine carrying away with it a large
proportion of gravel. If the medicament be continued
for a time, the accidents rarely return. It is, in fine, he
claims, the best preventive of gravel and of nephritic
colic. — Philadelphia A/edical and Surgical Reporter,
January 20, 1883.
Ichthyol in the Treatment of Articular and
Muscular Rheumatism. — Dr. Rudolf Schroter, of Ham-
burg, has discovered a peculiar oily compound, which he
calls ichthyol. It is obtained from a bituminous substance
found in certain fossiliferous rocks. This is distilled and
treated with sulphuric acid. Dr. P. G. Unna states that
its action in acute and chronic articular and muscular
rheumatism is astonishing. Several of his colleagues re-
port similar results. Ichthyol has been used chiefly in
skin diseases, psoriasis, etc. — Monatshefte f. Praktische
Dermat., December, 1882.
The Successful Quack. — In the Therapeutic Gazette,
December, 1882, Dr. Neiller, of Kansas, draws an amus-
ing picture, apparently from nature, of a successful
quack :
This individual changed teams, and even conveyances,
three or four times daily, driving into town with break-
neck speed one moment, with a match of grays and a
buck-board wagon, and going out the next with a bay
and a black and a top carriage. He never came nor
went by the same avenue twice the same day, but always
selected different portions of the town to pass through,
so all could see him, and those who had forgotten him
one day would not be left in oblivion of him the next.
His horses and carriage were always found waiting for
him at his office, down town, every Sunday morning about
10 o'clock, so that people going to church, especially
country people, would not miss this opportunity of being
reminded of him once again. They were found there
on Saturdays, off and on, all day long ; they were there
upon all public occasions when there was the least or
the greatest chance of displaying them. Although always
before the public eye, either in whirling around town or
in scouring the country over, he never missed a call to
my knowledge, and could always readily be found when
wanted. He never walked a step, being driven even in
his visits about town, an ordinary country town, though
the distance was but the half of a block. He subscribed
to all charities, public and private ; he belonged to all
the orders, associations, societies, fellowships and leagues
in the town and county ; his mail was an immense one,
nightly, of medical journals, newspapers, pamphlets,
letters, books and circulars, which he never read, but
which were conspicuously displayed, by the armful ; he
supported the widow and the destitute, having the dona-
tions conveyed by the broadest avenues ; his house was
ever open to the lame, the blind, and the halt, simulating,
in a manner, a hospital, on a small scale, and he who
once entered his portals never departed therefrom but
with an exalted opinion of its owner. This was not only
the case in regard to the stranger, but was also a studied
point with the neighbors, friends and patrons, with all
those who had any occasion to enter his doors, where
they were taken in charge by the "better half" and
given a thorough course of training. To enter but once
was certain oblivion to all other gods but the little god
brought forward for display, and all the cunning of a
singularly crafty nature was brought to bear upon this
one point.
His fees were always less than the ordinary fees for the
services rendered, from an inherent feeling of justice ;
they were never collected but by routes entirely foreign
196
THE MEDICAL RECORD.
[February 17, 1883.
and circuitous ; the}' were " charmed " from his patrons
in a manner not well understood themselves. He had a
well paid clique constantly surrounding him, who were
ever filling the community with the records of his skill
and good deeds ; he felt so mucli at peace with his own
dear little self and all the world that he could not help
but show it in his face, in his arms and in his swagger ;
his office was a perfect little curiosity shop of instru-
ments, appliances, devices, chromos, crayons (by his wife),
oil paintings (also by his wife), and medical anomalies.
Five years of this kind of quackery had built him up
such an extensive practice and had woven such a web of
popular fanaticism about him that it were next to impos-
sible to break down.
The Corsican Brothers and Mind-rf:adint.. — The
powerful melodrama of t!ie " Corsican Brothers," recently
played in this city, originated from a supposed case of
mind-reading. The story, as told in " Men of the Time,"
is as follows : " As Louis Blanc was returning home one
evening in October, 1839, he was suddenly assailed from
behind by some ruffian, who inflicted a violent blow with
a stick on his right eye. The author of this cowardly
attempt — which was made the day after ^f. Louis Blanc
had published a review of Louis " Bonaparte's work,
' Les Idees Napoleoniennes' — was never discovered. At.
Louis Blanc had a brother one year younger than him-
self, who was at that time at Rodez, in the department
of I'Aveyron, and who entertained so strong a conviction
that his brother was being assaulted at the precise moment
when it really occurred that he was induced to write at
once for information to Paris. This incident was the
origin of M. Dumas' ' Corsican Brothers,' the main sub-
ject of which is the preternatural sympathy between two
brothers." It may be mentioned that the death of Louis
Blanc followed that of his brother with very little interval.
Quackery in London. — ^Apropos of the remarks in
the Medical Press and Circular, characterizing New
York and the " States " generally as terribly quack-ridden,
we quote the following from \.\\^ Journal of Science. It
shows that things occur in London which would not be
possible in many parts of America : " .A quack who has
liis headquarters near Westminster Bridge has an ingeni-
ous method of beguiling the public. He tells his hearers
that if a person affected with incipient consumption blows
through a glass tube into water it will at once turn milky,
and invites them to make the trial. As the liquid which
he otters is lime-water, the result follows as a matter of
course. He then adds a few drops of his medicine (con-
taining some acid) to the water, when the cloudiness at
once disappears. This he argues is a proof that the
same remedy will eradicate consumption from the human
system. Multitudes of those present believe him, and
buy his secret remedy."
A Sound in the CEsophagus for Three Hundred
AND Five Days. — Krishaber reports a case of malignant
disease of the oesophagus with stricture. In order to
keep the passage open, an oesophageal tube was intro-
duced and allowed to remain. The outer end was car-
ried through the nose and attached to the forehead.
After a time tolerance was obtained and the instrument
was kept in until death occurred. — Deutsch Med. Woch.
The Salts of Nickel are claimed to be excellent
and powerful disinfectants. Dr. Hugo Schulz, who has
studied their action, uses the chloride, and finds that even
one-tenth of one per cent, solutions will kill b.icteria
termo.
A New Hypnotic and Depresso-Motor. — Herr
SchifTer, of Berlin, has recently been studying the action
of guachamaca, a Venezuelan plant. It acts very much
like curare, in allaying spasm, and in large doses causing
a general paresis. The juice taken from the plant in the
rainy season makes the most powerful preparation. If ten
milligrammes of the extract are given to a frog, an interval
of fifteen to eighteen minutes passes before any effect is
noticed. After this period, however, the action is rapid.
The animal becomes stupid, allows the head to fall, per-
mits itself to be laid on its back, and does not draw back
the leg if extended, etc. So far its action is exactly
similar to that of curare ; but now comes the difference.
The respiration continues, the circulation and cardiac
activity are undisturbed. Its effect was tried on a young
man in Frerich's clinic who was suffering from cramjjs.
Ten milligrammes of the extract were injected, but for
three-quarters of an hour no effect was observed. The
patient then, in broad dayhght, suddenly fell into a rather
deep sleep, which lasted for nearly three hours ; respira-
tion and circulation were undisturbed. Schift'er believes
that in guachamaca we have an agent capable of combat-
ing disorder of the motory apparatus, as well as a useful
hypnotic.
Marwood's Drops. — Mr. Marwood, the London hang-
man, being asked by a neighbor what was a good remedy
for a troublesome cough, is reported to have replied that
his " Marwood's Drops " had never yet been known to
fail.
Suicides in Philadelphia. — -There were 89 suicides
in Philadelphia last year. This is more than in 1880,
when the number was 68. New York as usual is far
ahead of her neighbor: in 1880, 152 persons killed them-
selves, making a ratio of 12.59 P^"" 100,000, while Phila-
delphia liad a ratio of 8.03 per 100,000. Boston has a
ratio of 11.03 and San Francisco of 37.65 per 100,000.
A Prior Claimant to Galvani's Discovery. — ^Pro-
fessor S. Thompson points out the little-known fact that
Swammerdam anticipated the famous initial experiment
of Galvani by more than a hundred years. Being on a
visit in Tuscany, in 1678, the illustrious Dutch naturalist
showed to the Grand Duke that when a portion of muscle
of a frog's leg, hanging by a thread of nerve bound with
silver wire, was held over a copper support so that both
nerve and wire touched the copper, the muscle immedi-
ately contracted.
The Immigrant and Small-pox. — Dr. P. H. B., of
Washington, D. C, writes: "Referring to an excellent
article in The Record of January 6, 1883, entitled 'The
Immigrant and Small-pox,' I am of opinion that the
efforts of the Health Officer of your port, Dr. W. M.
Smith, are being made in the right direction. He stated
in my hearing that he had long ago instituted a measure
which, if properly carried out at other ports, would
obviate all necessity for an ' Immigrant Inspectio'n
Service ' within the interior of the L^nited States. His
plan had been to require the inspection and vaccination
of immigrants to take place on the other side of the
water, or in case that was not done, to be completed on
shipboard within three days from the time of the vessel
leaving a foreign port. He stated that he had issued
many circulars and cards to this effect, explaining thereon
that by such inspection and vaccination, immigrants
would be saved from detention upon their arrival at
quarantine in New York. He thought that similar
measures adopted at other ports with a penalty or fine
for non-compliance would result in immediate benefit,
and that ultimately steamship companies would find it to
their advantage to transport no immigrant who was likely
to get them in trouble either by delaying them in quaran-
tine or causing them other expense.
" I would suiiplement these suggestions of Dr. Smith
by adding that if ships were made liable for all expenses
incurred in the care and treatment of all immigrants in-
fected with small-pox or other contagious disease landed
by them, or who are taken sick with any contagious dis-
ease within ten days after landing such immigrant, the
necessity for inspection by the United States Government
would not only be obviated, but the importation of
disease would be greatly decreas d and local quarantine
establishments less cumbersome and expensive."
The Medical Record
A Weekly younial of Medicine and Surgery
Vol. 23, No. 8
New York, February 24, 1883
Whole No. 642
©rigitxal %tt\uxt&.
ON THE
RELATIONS OF MICRO-ORGANISMS TO DIS-
EASE.
The Cartwright Lectures, delivered before the
Alumni Association of the College of Physi-
cians AND Surgeons, New York.
By WILLIAM T. BELFIELD, M.D.,
LECTURER ON PATHOLOGY, AND ON OENITO-URINARV DISEASES (POST-GRADOATE
course), rush medical COLLEGE, CHICAGO.
Lecture I.'
Mr. President and Gentlemen : In accepting your flat-
tering invitation to deliver the Cartwright lectures, I
have, in compliance with your request, selected my
present subject — almost the only one indeed which I
would venture to discuss in your presence — not simply
because of its intrinsic importance and interest, but also
because there exists in the medical public of our land a
diversity of opinion concerning it, which is not, in my
estimation, warranted by the facts. For since trust-
worthy original investigations in this direction, demand-
ing continuous devotion of the observer to the subject
and the renunciation of other pursuits ; demanding spe-
cial training and experience ; requiring laboratory and
other expensive facilities ; since such investigations,
possible therefore in general only through State or cor-
porate assistance, have been, and under existing cir-
cumstances must be made almost exclusively in other
lands than ours ; since, further, important results at-
tained within recent years and published in foreign
tongues have been as yet but partially incorporated in
our standard literature ; since the tendency of the prac-
tising physician — to which category we all, with rare ex-
ceptions, of necessity belong — is ever toward the culti-
vation of the art rather than the science of medicine ;
since, finally, there is a prevalent disposition to ignore
the entire subject as trivial or fanciful ; for these, and
perhaps other reasons, there prevail, as it appears to me,
some misconceptions as to the present state of knowl-
edge on this subject. It shall be, accordingly, my effort
to present in these lectures no original investigations, no
theories nor views, but simply the facts already estab-
lished, and the deductions incident thereto — an effort
which I am encouraged to undertake by some familiarity
with pertinent literature, and by some little practical
knowledge of the methods and manipulations involved.
In order to discuss intelligibly the more recent and
familiar subjects, such as the role of the bacillus tuber-
culosis, we must bear in mind certain facts, less sensa-
tional and perhaps less widely known, concerning the
life-history of microscopic parasites.
Although even the early microscopists, beginning with
Leeuwenhoeck (1675), observed and studied bacteria;
although these minute bodies were observed in animals
dead of septic infection by Fuchs, in 1848, and in the
blood of sheep dead of anthrax by Brauell and Davaine,
in 1849 and 1850, no effort appears to have been made
to establish a genetic relation between the plants and the
disease until the publication of Pasteur's work on fer-
mentations, in 1861. Then the bacteria which had been
the unenvied monopoly of biologists suddenly acquired
deep interest .""or pathologists. The experimental work
on septic infection, by Mayerhofer, Coze and Feltz, Rind-
fleisch, Waldeyer, and Recklinghausen, in 1865, 1866,
and 1867, drew tlie attention of the medical public to the
subject. Meanwhile Lister, imi)ressed with the results
of Pasteur's work, and desperate (as I was informed by
a Glasgow neighbor of his) at the death from pyxmia
of several cases in rapid succession, anticipating the te-
dious progress of experimental science, submitted the
question to empiric arbitration on the operating table.
His clinical results revolutionized surgical methods on
the one hand and infused new vigor into experimental
pathologists on the other ; the number of workers and
of works so rapidly increased that to-day simple mention
of the literature of this subject would be the work of
hours. I deem it, therefore, inexpedient to attempt, in
the limited time at my disposal, a historical sketch of the
development of the question, and shall endeavor to pre-
sent merely the present knowledge of the subject, with
a review of the evidence upon which it rests.
Many of the elongated bacteria have been demon-
strated to possess also a thread-like projection from the
extremity, a flagellum or cilium ; these, as well as some
other varieties not yet proven to possess flagella, are
capable of independent, often rapid locomotion in liquids ;
others are devoid of flagella, and incapable of motion ;
hence it is highly probable that the power of locomotion
is associated svith the possession of cilia. Beyond this
bacteria seem to possess no differentiation of structure
nor localization of function ; nutrition and assimilation are
processes of osmosis. This simplicity of structure and
function has given rise to discussion as to whether they
should be regarded as animals or vegetables ; the question
is, of course, merely a technical one of classification ;
since the features which distinguish the higher animals
from the higher i)lants disappear as we descend the scale
of organic life until few or none remain ; yet because
almost all of the simplest organisms hitherto called ani-
mals, the flagellata, possess a rudimentary mouth and are
capable of absorbing solid food, while the simplest plants
are not so characterized, the bacteria have been assigned
to the vegetable kingdom. Whether they should be called
alg» or fungi is a question for botanists to decide ; the
power of independent motion exhibited by some varieties
suggests affinity with the algre ; but the absence of chlo-
rophyll is generally considered to require their classifica-
tion among the fungi.
The necessities of their existence are as simple as those
of the mould fungi ; indeed, so nearly identical as to re-
quire no discussion. As to tlie chemical reactions inci-
dent to their vital activity, our present knowledge is very
scanty ; one variety is known to induce the transformation
of grape and milk sugar into lactic acid ; another the de-
composition of glucose or lactic acid with formation of
butyric acid ; another the change of urea into carbonate
of ammonia ; some produce pigments, blue, red, yellow ;
of many we know only that they transform a solid sub-
stance— gelatine, for example— into a liquid; but one of
the most important facts in regard to them is the proof
that putrefaction of albuminous substances is a phenom-
enon incident to the vital activity of certain varieties —
the bacterium termo and ))robably others — as must be
admitted by every one familiar with the work of Pasteur,
Tyndall, and their pupils. Until the chemistry of their
vital processes is ascertained, it will be impossible to as-
198
THE MEDICAL RECORD.
[February 24, 1883.
sert how Ihey can be injurious to a living tissue, whether
by simple mechanical irritation, by the appropriation of
oxygen and other nutritious elements, by the excretion
of substances injurious to animal cells, or in several of
these ways combined. The formation of substances in-
compatible with tlie life of the animal cells seems to play
a prominent role in the production of injurious effects by
at least some varieties.
The sim])licity of organization and vital requirements
explains their extensive distribution in nature : every
moist substance of organic origin and all water contain-
ing even a trace of organic matter is favorable soil for
one or more varieties ; the upper layers of the earth,
containing these essential nigredients, and remaining
comparatively warm, constitute a continual breeding-
place for these organisms. The minuteness and light-
ness of bacteria explain their presence in the atmos-
phere ; they are swept by currents of air from dry or
moist surfaces ; they float in clouds of dust ; they are
carried by insects ; the persistence of their vitality, the
rapidity of their propagation, result in practical ubiquity.
Direct microscopic observation of atmospheric dust, and
the experiments of Tyndall with the electric beam in a
dark chamber, have shown tliat wherever we find dust, at
moderate temperature and altitude, we may expect to
find bacteria. Yet the atmospheric bacteria are proba-
bly not so numerous as has been pictured. The observa-
tions of Miipiel and of Koch show that even in a labora-
tory many litres of air contain no organisms. Whether or
not bacteria are swept from surfaces of liquids ; whether
after once drying upon a given surface tliey can be re-
moved by air-currents, are as yet undecided questions
which may have practical bearings in the future. At pres-
ent we know no laws of atmospheric distribution wherein
bacteria exhibit other behavior than particles of dust in
general.
The champions of spontaneous generation, compelled
to surrender their maggots in decaying meat to the sim-
ple demonstration that covering the meat with fine gauze,
which prevented the access of flies, prevented also the
development of maggots ; forced to abandon intestinal
worms by the successive demonstrations of numerous
observers that each worm proceeded, though often by
devious ways, from a similar pre-existing organism, found
a tower of strength in the bacteria, a position fortified
by a series of careful, conscientious, and delicate ex-
periments by Bastian and Pouchet. The result of that
contest IS known to all. The errors in manipulation
and interpretation upon which the proof of sponta-
neous generation rested were detected, and a series of
hitherto unassailable experiments by Pasteur, Tyndall,
Traube, and Brefeld compelled the admission that bac-
teria, like the intestinal worms and the maggots, and
all other living things, illustrate the dogma, '• omne vi-
vum ex ovo." Yet this phantasy of spontaneous gene-
ration seems a spook which can never be exorcised from
man's imagination. Quite recently Arudt has deduced
from experiments, to which I shall presently refer, a con-
clusion which may be regarded as modified spontaneous
generation ; namely, that certain elements of animal-
cells can, under fav'oring conditions, continue to exist
and develop into bacteria after the death of the cells of
which they were previously constituent molecules. Yet
the evidence adduced does not as yet warrant any hesi-
tation in accepting the current doctrine that bacteria,
like all other organisms, proceed from pre-existent simi-
lar beings.
In order to discuss intelligibly the individual bac-
teria, we must agree upon a classification. The nomen-
clature has given rise to much discussion and more
confusion. At first each investigator christened, after his
own fancy, every new variety. The French school, first
in the field by virtue of Pasteur's work on fermentation,
employed, very loosely, the terms vibrios, monads, toru-
lacea3, etc. Natural selection has proven Cohn's classi-
fication the fittest to survive, which is quite natural,
since the greater part of our exact knowledge of this sub-
ject is due to this distinguished botanist and his pupils.
Cohn's original classification permits and will doubtless
need amendments ; in fact, he has already proposed
some essential modifications based chiefly upon the form
and mode of association of the individual cells. I shall
adhere to that nomenclature in general use by the Ger-
man mvcologists.
g^g
w'
1"' *
}
Fig. 1. — Various bactenal forms. i. MicroccKCus septicus ; a, scattered :
6, in chains — torula. 2. Same in zobglosa form. 3. Bacterium termo. 4. Same —
zooglcea. 5. Bact, lineola. 6. Uacilliis subtilis. 7. rtacillus anthracis and blood-
corpuscles. S. KaciUus (from mouth) with cilium. 9. Bacillus leprae. 10. Ba-
cilli with spores. 11. Bacillus malarise. 12. Vibrio serpens. 13. Spirochaete
Obermeieri. 14. Spirillum volutans. 15. Sarcina. X .soo. (Copied from Zieg-
ler's path. Anatomic, Jena, 1882.)
Bacteria are distinguished in this system according to
form simply into (i) micrococci, or sphajrobacteria ; (2)
microbacteria, or simply bacteria ; (3) bacilli, or rod bac-
teria ; (4) spirilla, or spiral bacteria. A disadvantage in
this nomenclature is the employment of the word bacte-
ria to designate two different conceptions — the entire
tribe including all four classes, a general name, and the
second class, microbacteria, in distinction from the others
— a double signification which has led to some confusion.
The micrococci are the smallest, and, hence, individually
least perfectly known ; so small, indeed, often less than
one micromillimetre in diameter, that nothing definite
as to structure and contents has, as yet, been ascertained.
They seem to exhibit in general no independent motion ;
they occur either isolated, in pairs, in chains (strepto-
coccus or torula), or, when multiplying rapidly, in large
numbers imbedded in a gelatinous material produced by
the organism — the whole mass being termed zooglcea.
Some are colorless, others pigmented.
Of the bacilli, Cohn makes two genera — bacillus and
vibrio ; others add more varieties. The members of
the genus bacillus are cylindrical rods ; they multiply
by fission, and some certainly exhibit a second mode
of reproduction — the formation within their sheath of
minute globular or ovoid bodies, sjjores, which subse-
quently escape by ru])ture of the sheath, and are capable,
under proper conditions, of growing again into the rod
form. These sjiores exhibit a tenacity of life not pos-
sessed by the mature bacilli, nor indeed bv other varie-
ties of bacteria, since their vital activity is sometimes
unimpaired by prolonged boiling, or by immersion for
months in absolute alcohol, either of which procedures
destroys mature forms. The spores seein under ordi-
nary conditions the impersonations of immortality : time
seems powerless to weaken them.
In order to study the phenomena accompanying the
presence of bacteria in animal tissues, one must naturally
first identify the bacteria. Now this is a more serious
undertaking than the current literature on the subject in
our language would imply. A bacterium is a mass of
matter which possesses a definite size and shape, may or
may not exhibit motion, has a certain chemical composi-
tion, and is capable of growth and reproduction — is, in
short, a living organism ; and no mass of matter can be
justly called a bacterium until proven to possess these
several characteristics ; for one or more of these several
properties may be exhibited by bodies found in the
animal tissues which are not bacteria.
February 24, 1883.]
THE MEDICAL RECORD.
199
An unfoitunatel)' large number of publications on this
subject exhibit by negative inference or positive demon-
stration, a faihire to appreciate this self-evident fact.
Si/,e, shape, and, above all, movement, are considered
conclusive evidence of bacterial nature. Size, shape,
and presence or absence of motion may be determined
by direct observation under the microscope ; distinctive
chemical traits may be detected by behavior toward cer-
tain reagents ; the various aniline colois distinguish at
once the protoplasm of bacteria from cell-bodies, fibrin
threads, fat-granules, crystals ; for every known bac-
terium absorbs one or more of the aniline dyes in wa-
tery or alcoholic solution. Yet size, shape, motion,
and absorption of aniline dyes do not conclusively prove
the bacterial nature of the body under examination,
since the same phenomena may be exhibited by material
forms which are not bacteria. Micrococci cannot thus
be individually distinguished from the granules found in
the nuclei of many cells, in leucocytes, and floating free
in the blood ; rod bacteria are sometimes closely simu-
lated in size and shape by fibrin threads and organic
crystals, (iroups of bacteria, especially of the micrococ-
cus tribe, are simulated by nuclear detritus floating in
the blood, as pointed out by Riess ; by large granular
cells, the " Mastzellen " of Ehrlich, which are found in
large numbers in various inflamed tissues, in diphtheria,
typhoid fever, elephantiasis Grajcorum, for example ;
by cross-sections of fibrin threads in blood-vessels ; by
globular masses usually considered to be leucine, which
may occur, apparently, in any tissue, in normal as well as
in certain pathological states. It is true that experience
teaches one to distinguisli these bodies from bacteria, in
some cases, by their appearance and reaction to staining
agents. Yet absolute certainty can usually be secured,
even by the experienced mycologist, only by cultivation
outside of the body. In the independent exhibition of
reproductive power, by fission or spore formation, or both,
lies, therefore, the only positive proof that a particle under
examination, exhibiting the size, shape, and reaction to
staining agents characteristic of a bacterium, is actually
one of these lowly organisms, and not an unorganized
niass of similar appearance.
The theoretical considerations end here, but the prac-
tical difficulties begin ; for, in order to be sure that an or-
ganism which grows in a liquid outside of the body is
the same as the particle previously observed within the
tissue, we must be assured that no other organism can
have obtained access to the culture fluid ; for the micro-
scopic dimensions of the particle prevent continuous ob-
servation during the transfer, and the morphological
similarity of different varieties, especially among the
micrococci, render nidividual recognition impossible.
Every object which can come into contact with the liquid
■or the particle under examination — the skin of the ani-
mal from which the tissue is transferred, the instruments,
the vessel or slide containing the nutrient material, the
material itself, the surrounding air, so far as possible —
nuist be sterilized, liberated from all contained and adhe-
.rent organisms ; and even then there remains an ele-
ment of uncertainty, since it is impossible (by the ordi-
;nary methods of cultivation) to demonstrate that these
.precautions have been eflicient. These difficulties of
sterilization cannot be fully appreciated without actual
experience, which soon demonstrates that the greatest
care and attention is often impotent to secure the isola-
tion of a given species from other bacteria ; Bastian's
•famous experiments in support of spontaneous genera-
tion may serve as an illustration.
In his earlier work, though carefully and conscien-
itiously performed, the apparently spontaneous appear-
ance of bacteria in various animal and vegetable infu-
sions was easily explained by his failure to previously
heat the glass vessels in which the infusions were kept ;
for the observance of this now elementary precaution
prevented the appearance of organisms in the liquids,
liut later experiments seemed indeed unassailable ; he
found that thoroughly boiled urine remained, in a pre-
viously heated and well-stoppered flask, perfectly free
from organisms ; when, however, the urine was made al-
kaline by the addition of a caustic potash solution, also
previously boiled, the conditions remaining otherwise
unchanged, bacteria were soon developed in immense
numbers. Bastian explained by the hypothesis that al-
kaline was more favorable than acid urine to the genera-
tion of these organisms. Pasteur, skeptical as to the
accuracy of Bastian's manipulations, repeated the ex-
periment and secured the same result — bacteria were
developed, even with the greatest possible attention to
details of execution. He found, however, that if the
caustic potash were added to the urine, not in watery
solution but in the pure state after heating to redness,
no organisms were developed ; fiirther, that if Bastian's
solution of caustic potash and urine were heated to iio°
C, no develo[)ment of life occurred. The error was
therefore the assumption that all organisms in the potash
solution, as well as in the urine, were destroyed by boil-
ing— an assumption now known to be at variance with
the fact. Tyndall also narrates an instance which would
have been in less careful hands misinterpreted. He re-
moved from a clear, sterilized infusion a drop of liipiid,
and to his astonishment found it, under the microsc()|)e,
swarming with bacteria ; examination of a second drop
showed none. The mystery was soon explained ; he
had cleansed his pipette before taking the first drop with
distilled water, a drop of which had remained in the tube,
and which contained, as examination of the water in the
bottle revealed, numerous bacteria. In these days pi-
pettes are cleansed, not with distilled water, but by a
Hunsen flame ; knives, needles, test-tubes, flasks, etc.,
are considered sterilized after heating for five minutes to
150° C; and fingers are allowed under no circumstances
to touch anything which could possibly come into subse-
quent contact with the culture.
A consideration of the difficulties thus briefly sketched
in the way of even the accurate recognition of bacteria,
discloses the value to be attached to many publications
concerning these organisms — which exhibit but too often
the author's neglect to comply with, sometimes even his
ignorance of, the elementary requirements of principles
and practice. As illustrations I shall select from the
mass of literature of this description a few which, from
the eminence of their respective writers in other depart-
ments of medicine, have attracteil considerable attention
without as well as within our jMofessional ranks. Some
four years ago a most genial and accomplished gentle-
man, an eminent practitioner of New England, made a
tour of our large cities with the benevolent object of in-
structing his professional brethren as to the etiology of
tuberculosis and of syphilis. He asserted the discovery
in the blood of such patients of "germs" not found in
other blood ; he exhibited a series of transparencies in
which granules — the germs — were shown in the blood ;
he showed a loaf of bread which had been fermented by
organisms from the defection of tuberculous and syphilitic
patients. The good work was not limited to the medical
profession; a noted Boston clergyman delivered a Mon-
day lecture upon this subject, in which the doctor's
blood-granules, projected upon a screen, posed before
the conscience-smitten audience as the avengers through
whose dread agency the way of the amorous transgressor
sometimes becomes hard. Only two links were lacking
in the chain of evidence ; first, there was not the slightest
proof, nor attempt at proof, that the blood-granules were
germs; second, it was unfortunately demonstrated that
identical granules were usually found in healthy indi-
viduals.
A few weeks ago the startling discovery was announced
that the famous bacillus tuberculosis was a fat crystal.
A distinguished pathologist, failing to detect the ba-
cilli in tuberculQus tissues, treated his sections with a
thirty per cent, solution of caustic potash, whereupon
crystals of fat of course appeared. These crystals are al-
200
THE MEDICAL RECORD.
[February 24, 1S83.
leged to be identical witli the bacilli tuberculosis ; there-
fore these organisms exist only in the imagination of be-
nighted individuals who blindly follow Koch.
Now what proof is adduced that the crystals and the
alleged bacilli are identical ? Merely that' they have the
same size and shape. When we remember that the dis-
coverer of the crystals had never seen the bacteria in
question, we can admit that the former have the same
size and shape as the bacilli of Dr. Schmidt's imagina-
tion, but not necessarily as the actual organisms. .A
comparison of the two demonstrates, as Dr. Schmidt
has recently learned by personal observation, that they
are widely different, even in appearance. But, assum-
ing that in size and contour Schmidt's crystal and Koch's
bacillus were similar, would that justify the assertion of
their identity? Evidently not to an individual whose
conception of a bacterium comprises something more
than size and shape. The crystal cannot be made to
absorb and retain aniline dyes, as Dr. Schmidt e.xiaressly
states ; the bacillus, like other bacteria, is readily stained
by any one of several aniline colors. The crystal, we
may assume, does not grow nor reproduce ; the bacillus
-'longates, divides, and produces in its substance two or
more globular bodies, which in turn grow into rods.
Dr. Schmidt fails to appreciate these vital differences ;
ignores the absorbent and reproductive powers of the
true bacilli, attested by a score of competent observers.
For him size and shape are enough, and upon this fan-
cied resemblance of his crystals, in outline, to bodies
that he has never seen, he assumes their identity. I
shall consider Schmidt's paper in the discussion of tuber-
culosis, and make this allusion here because it illustrates
admirably the fact that even in these latter days publica-
tions about bacteria, by men of e.vperience in other de-
partments of medicine, even in jjathology, evince a fail-
ure to appreciate the first principles of mycological inves-
tigation.
To ascertain the relation to a disease of bodies whose
bacterial nature is thus recognized, and which are found
in the blood or tissues of a diseased animal, it is evident
that the first ste[) nuist consist in the perfect isolation of
the bacteria from the enclosing tissue ; since otherwise
the possible effect of inoculation may not be ascribed
to the bacteria rather than to the accompanying unor-
ganized substances.
The isolation of bacteria from the blood and tissues of
an animal has been attempted chiefly in tv^'o ways : by
simple filtration through paper, clay, or other porous sub-
stance, and by artificial cultivation. Filtration is evidently
a very unsatisfactory attempt at isolation ; the separation
of the smaller bacteria, especially micrococci, is practi-
cally impossible; and since other ingredients of blood or
tissue are or may be retained on and in the filter, the
proof of isolation is not convincing. In artificial culti-
vation advantage is taken of the fact that the bacteria re-
produce indefinitely, while the animal tissues of course do
not. A drop of blood or pus, or a particle of tissue con-
taining the bacteria, is placed in an appropriate nutrient
medium in a flask, tube, or other receptacle. In a few
hours or days the organisms have become diffused, by
virtue of their rapid multiplication, throughout the entire
liquid. A drop, or fraction of a drop, of this fluid con-
taining bacteria, is then transferred to a second vessel
similarly prepared ; after the growth of the organisms in
this, a minute (juantity is transferred to a third flask, and
so on indefinitely at the will of the operator. In this
way the bacteria can be practically isolated from the ani-
mal tissues introduced with them into the first culture
vessel ; and the effect of inoculation from the tenth,
twentieth, or thirtieth successive culture cannot be reason-
ably ascribed to the unorganized constituents therein
contained. But it is evident that in order to attribute
the effect of such inoculation to that particular bacterial
species contained in the diseased annual, one must be
absolutely certain that no other variety has obtained a
foothold in the cultures — that the original bacteria are
isolated not only from the animal tissues — a compara-
tively simple matter — but also from all the other varie-
ties of bacteria — which seem omnipresent, .^iid just
here is the difficulty which has been until recently almost
insuperable ; here is the possible source of error which
weakens materially some brilliant deductions from ex-
perimental work ; and this possibility of error is the basis
of the general criticism wliich Koch urges against Pas-
teur's work — a criticism which, as is evident from a com-
parison of methods, is not without foundation. Although
numerous modifications of culture methods have been
employed, all may be grouped in three general classes.
The first, the earliest, and by far the worst, is cultiva-
tion in flasks, tubes, or other vessels containing the
nutrient liquid, usually in large quantities — one or more
ounces. This method, thanks to its adoption and re-
tention by Pasteur, as well as to the facility of its mani-
pulation, has secured an unfortunately extensive and per-
sistent employment. The defects become apparent when
we consider the vital properties of bacteria. Different
species require different pabulum and various tempera-
tures for their successful cultivation. The bacillus sub-
tilis (Cohn), for example, grows luxuriantly in a simple
infusion of hay, which is ordinarily slightly acid in reac-
tion ; the bacillus anthracis, which is morphologically
similar, indeed almost identical with the former, grows
very slowly or not at all in the same infusion ; the. addi-
tion of a little magnesia or other base, sufficient to render
the liquid somewhat alkaline, reverses the relative repro-
ductive activity of the two. The hay bacillus (b. subtilis),
again, can reproduce at a temperature incompatible with
the reproduction of the b. anthracis. If, then, the two be
sown in the same sterilized hay infusion, the crop will be
determined largely by the reaction and by the tempera-
ture of the liquid. Another feature to be remembered is
the variable rapidity with which different species multiply,
even under tlie most favorable surroundings ; for as
Nageli has shown, if two bacterial vaiieties, A and B, be
present in a litjuid adapted to each, A dividing its ceil
into two in twenty-five minutes, B in forty minutes, the
latter, even if present at first in r, 800,000 times the
number of the former, will in eighty hours have been
stifled by A. In a mixed cultivation — in other word.s —
the quickest to propagate will, ca/eris paribjts, in a
few hours or days remain alone — :a principle with whose
applicability to higher organisms we are of course famil-
iar. It is evident, then, that the best method of iso-
lation is that which affords (first) the greatest security
against the intrusion of other organisms than that under _
cultivation, and since such intrusion cannot by any
method at present employed be with certainty prevented
(second), the greatest probability of the detection of such
invasion by other bacteria. The isolation cultures in
flasks sufter the same dangers of adulteration as other
methods, aggravated somewhat by the increased difficulty
of sterilizing large quantities of the nutrient material.
These dangers recur with the institution of every new
culture ; for in order to secure isolation of the organisms
from the blood or tissue which accompanied them into
the first flask, many transplantations must be made.
Successful induction of infection by inoculation from the
first culture is, of course, met by the objection that the
liquid contains solid or fluid unorganized ingredients
from the animal diftused through it, and that the effect
cannot be attributed to the contained bacteria alone.
With every transfer to fresh culture fluid the possibili-
ties of adulteration by intrusion of other organisms con-
tained in tlie liipiid, the flask, the air, etc., are encoun-
tered ; moreover, the last culture, however long the
series may be, is theoretically, at least, a dilution of the
animal juices present in the first flask, although by many
successive generations the dilution becomes homceoiiathic
and may be practically disregarded. That this danger
of the intrusion by other bacteria during transfer, how-
ever carefully done, is not trivial, is known to every ex-
perienced observer. Mr. Cheyne (" .\ntiseptic Surgery,"
February 24, 1883.]
THE MEDICAL RECORD.
201
page 261) says: "In the room in which I work I have
never been able, without tlie aid of the spray, to transfer
micrococci from one flask to another. For in tlie latter
41ask bacteria" (in the generic sense) " ahiiost invaria-
bly developed."
The chief objection to flask- or tube-cultivations, how-
ever, one which renders them utterly unsatisfactory as at-
tempts at isolation, is the impossibility of detecting with
certainty the |)resence of foreign organisms. .Some va-
rieties, it is true, indicate their presence macroscopic-
ally, but the absence of them does not prove the absence
of others. One is compelled to remove the cotton, with-
draw a drop of the liquid, and submit it to microscopic
examination — a proceeding perilous to the jnuity of the
culture. But even in this way no certainty can be as-
sured, for the one drop may be free from intruding or-
ganisms, which may nevertheless be jsresent in the flask.
More than that ; since many varieties, at least many
bacteria growing under difterent circumstances, are mor- .
phologically indistinguishable, one is not always certain
that the organisms found are really the offspring of those
planted rather than morphologically identical intruders.
Suppose, for example, we are attempting to isolate the
micrococci found in the blood of a py;\;mic patient ; on
examining a drop from our tenth generation, our tenth
successive flask, we find only micrococci identical
in appearance with those planted. Are we warranted
in asserting that tliese are the descendants of the
organisms seen in the blood ? To answer the question
aftirniatively we must assume first that the micrococci
contained in the blood were the only ones which gained
access to the first flask ; then that our ten flasks, ten
liquids, ten stoppers were rendered and remained sterile ;
that our pipettes, forceps, etc., have been always free from
organisms, and that during the nine transfers, and perhaps
numerous test examinations, no micrococci have gained
access to our cultures from the air — an assumption not
warranted by experience. By such assumptions Bastian
demonstrated spontaneous generation.
A source of possible error in these methods, not al-
ways recognized, is the necessary assumption that ap-
parent community of form among bacteria proves identity
of function. The fallacy of such assumption is a priori
evident, and has been repeatedly demonstrated. A Cy-
clops whose exaggerated retina might fail to distinguish
objects less than three feet in diameter, could perceive
no morphological characteristics wherein a wolf differs
from a sheep, and could have no conception of the per-
versity which distinguishes a mosquito or a wasp from
the house-fly. In 1875 even Cohn pronounced the harm-
less bacillus subtilis of hay infusion morphologically iden-
tical with the bacillus anthracis ; to-day we can, thanks
to improvements in technique, distinguish the latter not
only from the hay bacillus, but also from two other impor-
tant varieties which are morphologically extremely similar,
though ])hysiologically quite distinct. Further research
may possibly reveal differences of form even among the
minute bacteria. Pint granting that two micrococcus varie-
ties are actually, as well as apparently, identical in form,
that alone proves identity of function as conclusively as
the morphological identity of two sugar-coated pills, con-
taining arsenic and bread respectively, establishes the
unity of their effects.
I have considered this subject at such length because
It will be necessary, in the course of these lectures, to
criticize certain experiments, and reject as not proven
certain conclusions, because attained by this method of
cultivation in liquids. The solution of many problems
would be, in my judgment, materially hastened, and
much conflict and confusion avoided by the substitution
for this still popular method of one demonstrably far
more accurate, to be i^resently described. Flask- and
tube-cultures are certainly convenient for cultivation en
masse, but evidently imperfect for investigations as to the
role of bacteria in disease.
The fact that bacteria growing under different condi-
tions, and apparently functionally different, are morpho-
logically identical and all so widely distributed and
ubiquitous, renders it evident that one condition must be
fulfilled in order to demonstrate conclusively and finally
that the organisms present in a culture at a given moment
are the progeny of those previously planted by the ex-
l)erimenter ; the former must be observed to proceed by
continuity of structure, from the original bacteria. In
this way, and thus only, can all doubt and objection be
silenced ; all possibility of misinterpretation be elimin-
ated. The first requisite for the execution of this method
is evidently continuous observation of the growing bacte-
ria through the microscope ; a method long used. A
drop of nutrient liquid is placed on a cover-glass, the
bacteria sown therein, and the cover inverted over a
hollow slide or a cell of glass cemented to the slide ; the
edge of the cover is then or previously smeared with oil,
for the double purpose of limiting evaporation from the
droplet and of preventing the intrusion of foreign sub-
stances or organisms.
If foreign organisms capable of growing in the liquid
obtain, by any error of manipulation or other means,
access to the droplet, they may become in a few hours
diffused throughout its extent; if perceptibly different in
size or shape from the variety sown, the intrusion may
be detected and the culture abandoned ; if morphologi-
cally indistinguishable, the intrusion cannot be detected,
the culture is considered pure, and lamentable errors of
interpretation may result. Even in Koch's skilful hands
nearly one-half such cultures were found to contain foreign
organisms.
Such, then, were the methods of attenijited isolation in
general use until three years ago, and unfortimately still
extensively employed ; methods which, even in skilful
hands gave conflicting results, and in inexperienced hands
have demonstrated incredible things. By these methods
spontaneous generation is easily proven ; the metamor-
phosis of a pathogenic into an innocent bacterium, and
conversely, is established with great facility ; in fact
almost any plausible hypothesis can, with a reasonable
amount of ingenuity and inexperience, be clearly demon-
strated. It is difficult to conceive, indeed, a shorter road
to scientific notoriety than by the cultivation of bacteria
in flasks — an opportunity already amply improved. One
need only extend his series of successive cultures long
enough, make transfers and i)ipette examinations often
enough, permit the tem]ierature of his oven to vary a
little, perhaps spice his work with a touch of the fashion-
able evolution hypothesis by varying the composition of
his culture-fluids so as to invite the growth of various or-
ganisms, and, presto ! there appears a conclusion whose
adoption would revolutionize mycology, medicine, and
perhaps modern society. A bacillus may be made to
grow out of a bacterium, this out of a micrococcus, or any
of them out of nothing. A bacillus anthracis can, in the
course of fifteen hundred transfers, be robbed of its terrors
— the leojjartl can change its spots, the lion can become
a lamb.
Three years ago there was introduced — thanks to the
ingenuity of Koch — a method which avoids, theoreti-
cally and practically, the difficulties inseparable from
previous attempts at isolation of a given bacterial spe-
cies found in an animal, both from other varieties and
frotn the accompanying animal juices. The essential
feature of this method consists simply in the substitution
of a solid — transparent when possible — for the liquid
material adapted to the nutrition of the organism.
The general plan is as follows : a solution of gelatine,
beef-extract, pepton ; or blood-serum, the relative propor-
tions of the various ingredients varying with the species
to be cultivated is sterilized by repeated heating and then
spread as a thin layer upon a disinfected slide and allowed
to dry or coagulated by heat. A previously heated needle
or scalpel is then dipped into the material containing the
bacteria — septic mouse-blood, for example — and drawn
lightly over the surface of the culture substance on the
202
THE MEDICAL RECORD.
[Februarj 24, 188,;
slide, or a series of punctures are made with the point.
Thus a number of shallow furrows may be made, in
and on the edges of which the bacteria are deposited.
The slides so prepared are then transferred to the
incubator or jjlaced under a bell jar ; or, if they are
to be long preserved, in a thorouglily disinfected vessel
/•rl'^' =■— Anthrax bacilli gnvAin- In.ni r.iL,ln'i l,»er, on blood serum. X 40.
(Inisand succeeding cuts are copied from original photomicrographs.)
closed with cotton. A disadvantage of this method,
like that with liquid media, is the uncertainty of steriliz-
ing the nourishing medium ; further, the occasional
settlement and growth of foreign organisms in the
vicinity of those planted. Yet these accidents are in this
method, in distinction from others, detected with ease
and certainty. For there is no diffusion through this
solid medium of growing bacteria ; each organism, whether
intentionally planted or not, remains in one spot, any
admi.xture must occur bv continuitv of growtii.
tig- 3- — Anthrax bacilli, pure (isolation,^ culture on blood serum. X 140.
Hy this method, then, there is ocular demonstration that
the organisms of the successive cultures jiroceed as con-
tinuities of structure from those of the first ; we may see
the bacteria in the leucocytes of septic blood freslily de-
posited on the first slitle, watch them multiply until they
break out of the containing cell and e.vtcnd over tile ge-
latine, transfer these to a second slide, observe their
continued multiplication, and so on indefinitely. By this
method, and by no other at present employed, we have
ocular demonstration that the organisms injected into a%
animal from the tenth, fiftieth, hundredth culture are
structural continuities of the organisms present in the
first animal ; by this method we know that the tenth
culture, for example, contains absolutely nothing of the
original tissue except that incorporated into the living
organisms ; by this, and by no other method with which
I am acquainted, it may be unhesitatingly affirmed that
the eff'ect induced in a healthy animal by inoculation
with the tenth, twentieth, or fiftieth culture nmst be
ascribed not only to bacteria, but to the direct descend-
ants of those bacteria contained in the animal from
which the first cultures were made. And permit me to
add that after such demonstration has been furnished in
scores of repetitions with identical results, by indepen-
dent competent observers, by every one indeed, w'ho has
attempted it, it is unwise and unreasonable, to put it
mildly, for any of us to deny, oppose, ignore, scoff^ at, or
equivocate about a fact established far more firmly than^
are the majority of accepted facts, so called, in the science
and art of medicine.
A consideration of importance in estimating the value
of observations upon bacteria, is the microscopical tech-
nique eni])loyed by the observer. That good objectives-
should be used is well understood ; but it is now essen-
tial also, in delicate investigations, to employ a condenser
made after the pattern of Abbe's illuminator. The
feature which makes this apparatus invaluable in the
detection of bacteria is the possibility of obliterating,
through the large aperture of the lenses, the picture of
the object due to refraction, thus practically eliminating.
Fig. 4.— Anthrax bacilli— showing spore formation. X 300.
from the field of vision everything which is not colored.
]5acteria not only absorb coloring matter — aniline dyes,
for instance— but retain these iiigments in the presence
of reagents which decolorize the animal tissues, generally
speaking. To detect a minute organism, the bacilUi's
tuberculosis, for example, amid the cells, fibres, and gran-
ules of lung-tissue is, with ordinary illumination, ex-
tremely difficult or impossible ; but after decolorizing the
tissue and tiien, by means of the illuminator, obliterating
refraction outlines, the bacilli appear almost alone, by
virtue of their retained color, in a luminous field — distinct
and easily recognizable. When, therefore, an obscrver
asserts the absence of all bacteria from a tissue — tuber-
culous or leprous, for example — usually supposed to con-
tain them, it is in order to inquire first whether he knows
February 24, 1883.]
THE MEDICAL RECORD.
203
how to use the aniline dyes, aud second, whether
he has the optical means, an Abbe's or similar illumina-
tor, necessary to enable him to utilize these staining
methods in the detection of bacteria ; if he lack either
he is but ill-equipped for public entrance into the arena
of original investigations on this subject ; for both are
essential to the develo|.)ment of the histologist into the
medical mycologist.
ff'^'
Fig. 5. — Anthrax cul
aded by other bacteria. X 300,
I have thus endeavored, Mr. President, to sketch the
principles involved in the study of bacteria, in order that
we may on subsequent occasions form a somewhat ac-
curate and intelligent estimate of the evidence alread\'
adduced as to the relations of these minute beings to
various morbid conditions of the human subject. If the
effort to convey the facts has been successful, you will
asree that an original contribution to this evidence de-
mands serious consideration only when it evinces, on the
part of its author, not simply skill and e.xperience as a
microscopist and histologist, but also a practical ac-
quaintance with and emplovment of the special methods
and manipulations necessary for the recognition and cul-
tivation of bacteria. Medical mycology has become a
special department of investigation, comprising most del-
icate and easily vitiated technical methods, to be ac-
quired by- special study and experience ; the time has
passed when the ability to focus a ([uarter-inch objective
entitled a man to an opinion upon the subject. Medi-
cal mycology may not be compared in age or attainments
with chemistry ; yet the necessary technique is as deli-
cate in the one as in the other ; and there exists there-
fore the same necessity for the recognition of individual
knowledge, and by consequence of general ignorance of
the one subject as of the other. I am led to indulge in
these rather commonplace remarks by the observation that
there is a more or less prevalent lack of appreciation of
the evident facts in the case ; witness the recent discov-
ery of the pseudo-bacillus tuberculosis and the comments
thereupon in current literature and society meetings.
Not a few medical journals announced the complete an-
nihilation of the bacillus tuberculosis in particular and
bacteria in general, a dictum pronounced by a witty rural
editor, equally familiar with mycology and Latin syntax,
in the words — " Sic transit bacteria." f>en a leading
New York journal remarked that " the case against
the bacilli is very strong." If it should be announced
by Dr. A. that pyremia is not characterized by an
excess of carbolic acid in the urine, as asserted by
Brieger, we practising physicians would not undertake to
decide ; we know too much about chemistry. There are
at present perhaps a score of men who have given abun-
dant evidence of competence in bacterial investigations ;
to them and to such as they, not to dermatologists, sur-
geons, or pathologists, we must look for facts upon this
subject, and for experimental criticisms of one another's
assertions.
Before discussing the relations of bacteria to the body
in disease, it is well to consider their relations to the ani-
mal in health and after death. It is a much dis|)uted
question whether any varieties of bacteria may exist in
the blood or tissues of a healthy animal. In former
years the affirmative was maintained by many, notably
Billroth ; with improvement of methods and differentia-
tion between organized and unorganized particles the
number of such affirmations decreased ; and the three
most noted observers of the present day — Koch, Pas-
teur, and Ehrlich — affirm that they have never detected
bacteria in a healthy animal. Numerous attempts have
been made to decide the question experimentally — by
the history of healthy tissues, transferred under precau-
tions against contamination, from the living or dying
body to conditions of perfect isolation from bacteria.
Such experiments demonstrate that some healthy tissues,
at least, contain no organisms capable of inducing putre-
faction ; as the majority of bacteria are, however, incap-
able of effecting this |)rocess, the failure to putrefy does
not necessarily prove the absence of all bacteria. Ob-
servation and experiment on the living body would
also prove the absence of bacteria from healthy animals.
The familiar fact that a dead human fcetus may remain in
the mother's body for months or years without putrefac-
tion, as in extra-uterine pregnancy, supports the same con-
clusion. Indeed, it has been repeatedly demonstrated
that certain bacterial species, even when injected in con-
siderable numbers directly into the blood or tissues of
the living animal, cannot be found after the lapse of
some hours ; they appear to suffer the same fate as un-
organized particles. Hiller even injected into his own
skin some bacteria obtained from putrid flesh, and ob-
served only a slight, transient, local cedema.
This failure of putrefactive and other bacteria to re-
produce in healthy tissue seems to indicate their inability
to maintain the struggle for existence against the animal
cells indigenous to the soil. For seventy years a man
may eat, drink, and breathe the ordinary bacteria, and
carry a vast and varied assortment of them in his alimen-
tary canal, without suffering putrefaction ; yet so soon as
his component cells are destroyed, generally, as in the
death of the animal, or locally, as in the gangrene of a
toe, the tissues swarm with these minute organisms.
While some bacteria seem capable of development in
tissues only after the death of their competitors, the
animal cells, others exhibit this power in the presence
of these cells when the tide is turned against the latter
by the impairment of their nutrition, or by the presence
in the blood of material favoring the invaders. The
exudate on the cardiac valves frequently contains, not
only in ulcerous, but also in simple "rheumatic" endocar-
ditis, colonies of growing micrococci, a fact first observed
by Klebs and confirmed by Eberth, Ehrlich, and Osier.
In some cases it is demonstrable that the appearance
of the bacteria upon these vegetations was subsequent
to the inflammatory process. Abnormal blood compo-
sition seems to favor the develo|>ment of some bacteria
which may gain access to the tissues. The presence of
glucose and incr^eased metamorphosis of albuminous
blood-constituents in diabetes are usually considered
responsible for the proneness of diabetics to abscesses,
carbuncles, cataracts, gangrene of wounds, sloughing of
stumps even under most careful antiseptic dressings. These
spontaneous abscesses and carbuncles contain, when
freshly opened, micrococci in a high state of activity, as
shown by Kraske, Eberth, and Pasteur. A clinical ob-
servation in the history of diabetics, their susceptibility
to consumption, acquires peculiar significance in this
connection, since the presence of the bacillus tuberculosus
is now certainly a recognized anatomical characteristic,
whatever may be said of its etiological relation. Cheyne
204
THE MEDICAL RECORD.
[February 24, 1883.
refers to a weak, cachectic jiatient who had an abscess
wherever he received a bruise, and whose abscesses
always contain micrococci. Another question, formerly
much disputed, is the possibility of invasion of animal
tissues by bacteria without previous solution of continuity.
The only possibility for discussion now remaining is as to
what shall be considered a solution of continuity ; for itis
definitely demonstrated (hat these organisms gain access
to the body without the existence of any wound or abrasion
discoverable upon the closest scrutiny. Trichina force
their way from the intestine into the muscles: jmrticles of
coal are conveyed, i)robably through the agency of white
corpuscles, into the parenchyma of the lungs, bronchial
glands, and even the liver ; it would seem a priori certain
that many bacteria, much smaller than these particles,
could also be received into the tissues. Ogston, using
the most approved technique, found micrococci in every
one of seventy previously unopened acute abscesses.
Cheyne reports a similar experience. Micrococci have
been repeatedly observed in the blood in spontaneous
pyaemia, osteomyelitis, etc., and Obermeier's spirilla in
recurrent fever patients, in cases where no lesion of the
integuments was discoverable. But the question seems
to have been finally decided by experimental demonstra-
tion. Buchner has induced anthrax in animals by the
inhalation of jiowdered material containing the spores of
the bacilli. When we remember the endothelial nature
of the cells lining the pulmonary alveoli, we readily a))-
preciate the facility with which particles, large or small,
organized or unorganized, gain access to the circulation
through the lungs.
Bacteria, then, which, by virtue of their ubiquity,
are in constant and frequently recurring contact with
the animal body, are, like other minute bodies, organ-
ized and unorganized, frequently introduced into the
body through solutions of continuity of the integuments,
or through intact skin and mucous membranes, particu-
larly by way of the lungs.
The burning question in [lathology to-day is. In what
degree are the various species of bacteria, present in
human tissues during certain morbid conditions, to be re-
garded as the cause of the morbid processes with which
they are respectively associated ? Having already re-
viewed the conditions of eligibility for witnesses and of
authenticity for evidence, we are prepared to consider
in detail the present state of the question as to the indi-
vidual diseases.
Before admitting tlie causal relation of a bacterium to
the disease, we must be convinced not only that all ob-
served jihenomena can be easily reconciled with such
assumption, but also that they can be as plausibly ex-
plained by no other assumption. The evidence of such
casual relation must establish, therefore, the competence
of the observer and the accuracy of the observation : the
presence of a constant bacterial form in every case of the
disease, and in numbers sufficient to explain the morbid
phenomena; the demonstrable isolation of the bacteria
by successive cultures ; the induction of the disease in
numerous healthy animals by inoculation with the isolated
organisms ; the reproducti_on of the .same bacterial form
in the inoculated annual. Gauged by this standard, the
evidence already adduced warrants the following unsci-
entific but convenient classification :
First. — Disease, the demonstration. of whose bacterial
origin has been completed, through inoculation with iso-
lated bacteria, by several competent observers — anthrax.
Second. — Disease whose bacterial origin has been af-
firmed, after inoculation with isolated bacteria, by one
competent observer — tuberculosis.
Third. — Diseases which are uniformly characterized,
intra vitam, by the presence of bacteria in the tissues;
but which have not as yet been induced by inoculation
with the isolated bacteria — recurrent fever, py;emia,
diphtheria, erysipelas, leprosy, rhinoscleroma, gonor-
rhoea (urethr;e et conjunctiva;), and some forms of septi-
caimia. Puerperal fever, osteomyelitis, and ulcerous
endocarditis are considered to belong etiologically with
pyajmia, septicemia, erysipelas, and diphtheria.
Fourth. — Diseases after death from which (in some
cases also during life) bacteria have been observed in the
tissues: variola, scarlatina, typhoid fever, croupous pneu-
monia.
Fifth. — Diseases in which the presence of bacteria,
ante or post mortem, has been asserted : syphilis, inter-
mittent fever, yellow fever, typhus, measles, lupus, rabies,
tetanus, ei al.
The investigation of the diseases included in the
fourth and fifth classes is as yet quite imperfect and in-
accurate, partly at least because they are with few excep-
tions peculiar to man.
The evidence as to the relations of bacteria to disease
rests largely uiion experimental observations upon the
lower animals. The impossibility of thorough examina-
tion of human tissues, not only during life, but also for
hours or days post-mortem, restricts materially the field
of clinical observation on this subject : for a few days,
even liours, suffice to people a dead body with bacteria.
We may simply ignore such contributions as that of
Zander ( l^irch. Arch., Bd. LIX.), in which he announced
the i)robable discovery of the bacterial origin of acute
yellow atrophy of the liver. In one fatal case of the
disease he found bacteria in the liver, the section hav-
ing been made fifty-four hours after death. He antici-
liates the possible objection that the bacterial develop-
ment was jierhajis jjost-mortal, and refutes it with the con-
vincing statement that " the body did not, so to speak,
exhibit any marked symptoms of putrefaction." Indeed,
while defective methods may be chiefly employed by the
practically inexperienced, most egregious misinterpreta-
tion is unfortunately not monopolized by them. Several
pioneers in this subject, notably Pasteur and Klebs, have,
by the publication of hasty and, as subsequently appeared,
erroneous conclusions, forfeited much of the prestige ac-
quired by their earlier classical works on fermentation
and gunshot wounds respectively. These two observers
have ignored successive improvements in technique ;
have a|)parently assumed that all infectious diseases are
of bacterial origin ; that therefore the discovery of a
bacterium in a diseased animal is ample proof of its pa-
thogenetic influence. Years ago, Klebs announced the
discovery of the bacterium of tuberculosis, and even
declared that the disease could be cured by an agent,
benzoate of sodium, which destroys the parasite. With
equal facility he discovered the bacterial origin of syphi-
lis, typhoid fever, etc.
Pasteur seems to have a fondness for micrococci,'
especially in the figure of 8 form, to which he ascribed
puerperal fever, rabies, his " nouvelle maladie," as well
as chicken cholera, and typhoid fever. His famous
publications about the inoculation of chickens with an-
thrax, and about the role of earthworms in trans])orting
anthrax spores, further illustrate the inability of his
judgment to cope with his imagination.
Education and Cri.me in France. — In a report on
the connection between education and crime the records
of tlie courts of France show the following result, which
is directly opposite to the records for the United States :
I. That 25,000 persons of the class wholly illiterate fur-
nish five criminals. 2. That 25,000 of the class able to
read and write furnish six criminals. 3. That 25,000 of
the class of superior instruction furnish more than fifteen
criminals. 4. That the degree of perversity in crime is
in direct ratio with the amount of instruction received.
5. That in the departments in which instruction is most
disseminated crime is greatly more jjrevalent — in other
words, that morality is in inverse ratio with instruction.
6. That relapse into crime is much greater among the
instructed than tlie non-instructed portion of the com-
munity.
February 24, 1883.]
THE MEDICAL RECORD.
205
(Dvioiual ;2\vticlcs.
SUCCESSFUL CASE OF LAPAROTOMY FOR
ACUTE INTESTLVAL OBSTRUCTION, DUE
TO STRANGULATION ; WITH REMARKS.
By professor l£ON LE FORT,
SURGEON TO HOTSL DIEU ; PROFESSOR OF OPERATIVE MEDICINE TO THE FAC-
ULTV : MEMBER OF THE ACADEMY OF MEDICINE, PARIS, FRANCE.
Intestinal obstruction by volvulus, by invagination, by
constricting bands, imposes on the surgeon a problem
whose solution is often difficult. If he decides on inter-
vention by a capital operation, he must choose between
enterotomy and laparotomy. Enterotomy is limited to
an incision of trifling extent through the abdominal walls
into the peritoneal cavity, where a loop of intestine is
sought above the obstruction, of whose site and whose
nature the operator is generally ignorant. A small open-
ing is made in the intestine, and exit given to gas and
fecal matters.
In laparotomy the abdomen is freely opened by a
large incision, which enables the surgeon to hunt for the
obstacle without any hindrance, and, having found it, to
overcome it, whether it be an invaginated intestine, the
twists or knots of a volvulus, or strangulating bands.
Laparotomy, practised in France by Dupuytren, by
Malgaigne, and in 1859 by Depaul, performed a little
oftener in England since 1847, did not win favor with
French surgeons, and under the inHuence, more espe-
cially of Nelaton and his followers, enterotomy, in spite
of the want of success which almost always attended it,
was for a long time the only operation employed. How-
ever, the past twelve years, since ovariotomy has been in
fashion and has demonstrated that the danger of free in-
cisions into the abdomen has been greatly exaggerated,
there iias been a reaction in France in favor of laparot-
omy, which to-day tends to take the place of enterotomy.
I do not intend to discuss the relative value of the
two operations ; I limit myself to mentioning the prin-
cipal reason which leads me to prefer laiiarotomy to en-
terotomy. In 1865, that is seventeen years ago, I
pointed out the danger of purgatives in hernial strangu-
lation, advising the substitution of opium. I sought to
show what at this epoch had not been clearly stated,
that the dangers from strangulation do not depend on
retention of fecal matters in the intestinal tube, but on
the reaction occasioned throughout the entire gangli-
onic nervous system by irritation of the splanchnic
nerves included in the portion of intestine strangulated.
In fact, in peritonitis, in strangulated omental hernia, m
the orchitis of a testicle retained in the spermatic canal,
we have the principal phenomena of strangulation :
vomiting, absence of stools, smallness of the pulse, cold-
ness, alteration of the features, and at the same time
there is no material obstacle to the evacuation of the in-
testines. On the other hand, after operating for strangu-
lated femoral hernia, I have known the bowels to be
confined for five, six, and even nine days after the opera-
tion, by reason of the administration of opium ; and yet
all the dangerous symptoms began to disappear as soon
as the strangulation was remedied. In short, who, con-
versant with the facts of speedy death from traumatic
peritonitis, or peritonitis from perforation, can suppose
that a few drachms of effused liquid of an irritating kind
in the peritoneum may so quickly give rise to fatal symp-
toms ; or who, believing this, can explain by what mechan-
ism death takes place ?
The theory, then, that I have maintained and taught
for many years, is that the unfavorable symptoms in all
these cases of peritonitis and strangulated hernia, whether
of the intestines or omentum, are due to irritation of
the splanchnic nerves (of the intestine or omentum) by the
band constricting the gut, and in some measure by the
over-distention of the bowel ; an irritation, moreover,
which is reflected on the great abdominal sympathetic,
and through it on the heart.
Without doubt the excessive distention of the intestine
by gas and fecal matters accumulated above the point of
obstruction adds another source of mischief, but the
primary irritation, the constricting band, is infinitely more
crrave in its consequences, and will almost inevitably le-
sult in death to the patient, even when by enterotomy
the intestine above the obstruction has been opened, and
the contents of the bowels evacuated by a false anus.
It is because laparotomy gives us hope of being able
to aiwive at the original cause of the evil, and thus re-
move it, that I prefer laparotomy to enterotomy.
I am obliged to admit, however, that errors in diagnosis
are not at all rare in these circumstances. I shall never
forget my first operation for laparotomy, in 1870, when,
with the aid and concurrence of my friend and colleague,
M. J. Bucquoi, of the Hopital Cochin, I operated on a
patient in his service. The opening of the abdomen dis-
closed, not a strangulation by organized lymph, or by
volvulus, as we supposed, but a cancer of the sigmoid
flexure of the colon, causing complete obstruction of the
bowel.
It is easy to understand why, in these conditions of
uncertainty, the surgeon should hesitate to freely open
the abdomen, and prefer an operation less terrifying to the
patient and his family. Enterotomy having (wrongly)
the reputation of being little dangerous in itself, it seems
to the surgeon less painful, in the event of want of suc-
cess, to discover at the autopsy an error in diagnosis
than to discover this error at the moment when, by a
large incision, he has exposed to view the viscera of the
abdominal cavity of his patient.
However, facts only can carry conviction, and for
several years laparotomy, which counts many cases of
success,'mingled, it is true, with failures, has been grow-
ing in favor with the profession.
In the following observation, where the operation of
laparotomy was performed under very disadvantageous
circumstances, I do not believe that enterotomy would
have saved the life of the patient. Merely giving issue
to the gases and liquids of the intestine would have been
a sorry relief, when a constricting band was suffered to
remain, provoking irritation and inflammation by com-
pression of the intestine, engendering, in fact, a perito-
nitis, which would in all probability have been fatal had
not laparotomy come to the rescue of the patient. I
have copied the report from the memoir presented to the
Academy, believing that it would interest the readers of
the New York Medical Record.
Observation. — The first day of last June (1882) I was
called to Colombes by Dr. Tachard, to see a young man
of eighteen years of age, suffering since the 25th of May,
that is to say one week, from internal strangulation. My
confrere gave me the following history of the case :
During the evening of the 25th of May, the patient
experienced some pain in the abdomen, which about
midnight took on the character of violent colic. Dr.
Tachard called in the night-time, ordered a laudanum
injection, inunctions of belladonna to the abdomen, and
hot poultices. The next day the pains were on the in-
crease, the belly was sensitive to the least pressure, some-
what distended, and since the morning of the day before
there had been no passage from the bowels. A dose of
castor-oil was given, which was immediately vomited ;
then a copious enema was administered, which came
back without bringing away any fecal matters. As the
patient had a small inguinal hernia on the left side, at-
tention was directed to that, but as the hernia vyas found
to descend and to return with all ease, it was evident that
the cause of the trouble was elsewhere.
The complete absence of evacuations, the persistence
of the vomiting which soon became incessant, the ab-
sence of fever, the alteration of the features, the small-
ness of the pulse, seemed to justify the diagnosis of in-
ternal strangulation. This diagnosis was rendered still
2o6
THE MEDICAL RECORD.
[February 24, 1883.
more probable by the fact that in 1879 the patient had
had an attack of subacute peritonitis, which would have
been likely to leave troublesome sequels in the form of
bands of organized lymph and adhesions.
The condition of the patient becoming alarmingly
worse, the family asked for a consultation, and the 29th
of May, that is to say the fourth day, a confrere from
Paris, who in 1S79 had attended the patient, was sum-
moned. He counselled purgatives, which had no favor-
able result. It was then that Dr. Tachard, seeing the
patient growing worse all the time, declared to the
family that, in his opinion, nothing but a surgical opera-
tion could save the patient. The family inflexibly op-
posed any operation, and it was not till three days after
(June ist), the seventh day of the strangulation, when
death seemed imminent, that it was decided to summon
me in consultation.
When I saw this young man in the evening of the day
above mentioned, I found myself in the presence of an
apparently moribund patient. His countenance bore a
])inched expression, his body was covered with a cold
sweat, his extremities were cyanosed, and icy cold. The
pulse was small and rapid, and the least movement
brought on fecal vomiting. The abdomen was tym-
panitic ; the markings of the intestinal convolutions
could be seen on the abdominal walls.
There was, however, no exaggerated sensitiveness to
pressure, no dulness or obscurity of sound in the lateral
and inferior portions, nothing which could lead me seri-
ously to suspect the existence of peritonitis. I repre-
sented to the family that the chance was a forlorn one,
but without surgical intervention the case was hopeless.
I was willing to attempt what could be done by gas-
trotomy, though the patient might die in the operation.
The family having left all responsibility in the matter to
me, I proceeded to operate, with the assistance of Drs.
Tachard and Ducor.
The patient having been partially anesthetized with
chloroform (which was charily administered on account
of the prostration), I made an incision, fifteen centi-
metres in length, in the linea alba, from the umbilicus to
the pubes, and with the usual precautions. As soon as
the abdomen was opened, coils of the distended intestines
protruded. We took pains, with our outspread hands, to
keep back all but a few coils, which I returned as soon
as I had examined them, drawing out carefully, little by
little, other portions of the intestinal mass, and scrutiniz-
ing them closely before putting them back ; we thus drew
out through the opening in the abdominal wall, in suc-
cessive portions, the larger part of the small intestines
before the seat of the obstruction presented itself to our
view. One of the coils resisted my attempt to bring it
out by the incision ; I felt that I was near the obstruc-
tion. Then, following with my hand into the abdominal
cavity the resisting loop of intestine, which was consider-
ably distended, I found, near the right iliac fossa, a little
tumor, formed by hardening and agglomeration of the
intestine, and I discovered that the intestinal loop which
I was following with my finger, engaged itself in a tight
circular aperture, which seemed as if formed by a firm
membranous cord. Hooking the extremity of my index
finger into this constricting ring, I drew carefully to the
surface, on a level with the abdominal opening, a coil of
congested coarcted intestine, and we had under our eyes
a band, a sort of fibrous ring, very resisting and very
thick, formed by organized adhesions, and which encircled
the small intestine five centimetres (or thereabouts) from
its termination in the caecum. I cut the band, which
was about five millimetres I'n width, with a few clips of
my scissors, and thus released the intestine.
The small intestine was congested throughout almost
its entire extent, but there was no fluid in the peritoneal
cavity ; peritonitis had not as yet set in, and at the site
of the stricture, des|)ite the long duration of the malady,
the vitality of the intestine did not seem to be compro-
mised, the stenosis not kaving been absolute.
The intestine was returned, and the wound in the ab-
domen closed by seven deep silver-wire sutures, passed
separately through and fastened to a bougie. I then put
in a dozen superficial sutures in the ordinary manner.
In the night-time the patient had a large stool, very
fetid, and for several days following copious alvine evac-
uations. The patient, though very weak, was restless
and intractable, not comprehending the necessity of ab-
solute repose. The seventh day after the operation he
rose suddenly in bed, in a state of agitation, and the
superficial sutures gave way, letting the wound gape open.
Fortunately, union of the deeper parts was eftected, so
that the abdomen was not opened. Being summoned to
the patient, I applied several new sutures, using the
quilled suture, and three days after. Dr. Tachard ap-
plied an abdominal belt, with pads nicely adjusted to the
sides of the wound, to secure exact approximation.
Cicatrization was effected in a few days.
Convalescence went on favorably, and by July ist the
patient was able to go abroad.
It is now seven months since the operation, and a
curious and most gratifying change has been effected in
the condition of this young gentleman, who previously
was thin and in delicate health. The difficulties of
digestion, the obscure abdominal pains from which he
had suffered from the time of his attack of peritonitis
in 1879 down to the date of the operation have all
disappeared, and his health is now excellent. He has
become stout and fleshy, so as hardly to be recognized
by those who knew him a year or so ago. There is
now no trace of the old inguinal hernia which he had be-
fore the operation.
The past few years the reports of most of the success-
ful surgical operations have ended with these words :
the operation was performed unth the usual antiseptic
precautions. 1 shall have to finish this report by adding
that the antiseptic method was not employed. But if 1
do not believe \n ferment germs, I do believe, and have
for the past seventeen years believed, in contagion germs.
Drs. Tachard, Ducor, and myself took precaution, not
only to cleanse our hands before the operation, but to
wash them thoroughly in camphorated alcohol. The
dressings consisted simply in the application of com-
presses soaked in camphorated alcohol and water, cov-
ered with a piece of sticking-plaster and supported by a
body bandage. ■ - . •
A Curious Bill. — Rev. Dr. Robinson, of Paterson,
N. J., has sent to the city Clerk the following modest
bill for services rendered :
To breaking up the ravages of diphtheria, by
showing that it consists of a few ounces of for-
eign matter in the blood which can only es-
cape through the i)ores $1,500
To lowering the death-rate of the city to the ex-
tent of 538 lives in two years, by means of cir-
culars, etc., showing what fever consists of. . . 2,000
To stopping the ravages of small-pox, by show-
ing that 100 cases of it can be expelled from
the blood, in two or three hours, by the vigor-
ous action of the pores produced by hot tea. . 1,500
Total $5,000
He adds: "I can prove in any court of justice that I
have been the instrument of saving 1,000 fives in this
' city, without including the thousands whom these dis-
coveries will save in the present generation." It will
be seen that the dominie rates the life of the avei'age
Patersonian at only five dollars. " Dominie" Robinson
is a well-known clerical physician or medical clergyman
in Paterson, and although peculiar in some respects, is
generally esteemed.
February 24, 1883.]
THE MEDICAL RECORD.
207
A CASE OF
STENOSIS OF THE RIGHT AURICO-VENTRI-
CULAR OPENING IN CONSEQUENCE OF
FCETAI, ENDOCARDITIS.
A TRANSVERSE CHORDA TENDINEA IN THE LEFT AURICO-
VENTRICULAR OPENING.
By JOSEF KUCHER, M.D.,
NEW VORK.
Although cases of foetal endocarditis are not uncom-
mon, stenosis of the right aurico-ventricular opening is
-^very rare. Rauchfuss (Entwickhingsfehler am ostium
atrio-ventriculare, Gerhardt, " Handbuch der Kinder-
krankheiten," p. 103) found only two similar cases on rec-
ord, one by Peacock and one by Romberg. In both the
aorta and pulmonary artery were normal. In Rom-
berg's case (boy four years of age) the aurico-ventricular
opening was very narrow ; the tricuspid valves had dis-
appeared. There was no defect in the inter-ventricular
septum. In Peacock's case (girl of seven liionths) the
stenosis was not considerable, and was apparently due to
synechia of the thickened valves, with inflammatory de-
posits on their outer walls. There were two defects in
the inter-ventricular septum.
The present specimen is taken from a child who died
twenty-four hours after labor. The mother, a primipara,
strong, healthy, was quite well throughout her entire
pregnancy. No history of rheumatism. Labor at the
normal term. I had to apply the forceps, when the head
was already visible in the vulva, because the pains had
almost completely stopped. When the child was born,
the chord did not pulsate and was flaccid, and as the
child did not cry at once, I was afraid that the applica-
tion of forceps had been delayed too long. But after
having shaken the child a little, it cried lustily and
breathed freely. It was a boy, weighing about nine
pounds, well formed, except the thorax, which was arched,
corresponding to the sternum as in cases of rachitis ; but
there were no other signs of rachitis. Such an arching
(voussure) has been observed in several cases of foetal
endocarditis, but it corresponded to the heart-region on
the left side of the sternum. The ne.« morning I was
told that the child had cried all the night. When I saw
it, the face was bluish, the respiration weak, but not
superficial as in cases of partially atelectatic lungs ; the
muscles were flabby, with no tonus in them. I shook it
a little, then it began to cry and breathe regularly. Vesi-
cular respiration was distinct all over the lungs. I paid
no attention to the heart-sounds. In the evening I was
called because the child became cold. On my arrival it
was dead. The nurse had seen that the heart of the child
palpitated very much before death occurred. From this
history, and especially that vesicular respiration was dis-
tinct all over the lungs. Dr. L. Conrad and I concluded
that atelectasia pulmonum could not have been the cause
of death, and that most likely there must be some con-
genital defect of the heart.
On post-mortem we found the lungs dark-colored,
hyperiemic, everywhere well inflated with air, under the
pulmonary pleura several bloody extravasations. The cut
face of the congested lungs discharged reddish serum with
bubbles of air. No vernix caseosa or other ingredients
of liquor amnii were found in the lungs. The heart vvas
of normal proportions, except the right auricle, which was
larger than the left. On opening it, we found the aorta
and pulmonary artery witli their valves normal, the right
aurico-ventricular oi-iening funnel-shaped, with two open-
ings permeable for a Simpson sound at the bottom of
the funnel. This change had been brought about by the
coalescence of the three curtains of the tricuspid valve,
which had been changed into a sclerotic thickened mem-
brane with the two mentioned openings. No inflam-
matory deposits or other changes were noticeable on the
walls of the auricle or ventricle. The inter-ventricular
septum was normal. The endocarditis was limited to
the curtains of the tricuspid valve, all other valves being
normal. In the left aurico-ventricular opening we found
a transverse chorda tendinea. The diagnosis of such a
chorda was once made by Schroetter on the living sub-
ject by its peculiar musical tone, and the diagnosis was
confirmed by the post-mortem.
Prehistoric Surgery. — The interesting pamphlet of
Dr. Paul Broca describing the trepanned skulls which
have been discovered in the caves of France, belonging
to the earlier periods of the new stone age, places the
date of the first operation of this nature far back in the
prehistoric times.
The fact is certain that a great number of these skulls
were trepanned during lifetime, probably in infancy and
early youth, and that they healed up again, the subject
of the operation surviving it for many years. M. Broca
supposes this trepanning to liave constituted a sacred
rite of some sort. For we find that the skulls of these
very persons who had undergone the operation in their
lifetime were after death subjected again to the same op-
eration. A number of small disks were cut from them
in such a way that each disk contained a portion of the
cicatrized edge made by the original trepanning. These
disks were used as amulets by living persons. But the
skull thus treated was in its turn provided with one of
these talismanic disks in place of those which had been
cut from itself.
It is clear, from M. Paul Broca's descriiJtions, that this
early form of trepanning was performed as an act of
mutilation in relation to certain primitive beliefs.
208
THE MEDICAL RECORD.
[February 24, 1883.
^voQvcss of l^ctlical Mcxmcc.
Acute Endocarditis Limited to the Right Side
OF the Heart. — Colomiatti (^London Medical Rec-
ord, January 15, 1S83) describes five cases of acute
endocarditis of the tricuspid valve. Having shown that
these are not so rare as is supposed, he points out that
the aflection may fall on the tricuspid or on the pulmo-
nary sigmoid valves only, or on both at the same time ;
that it may be perforating in one orifice, whilst it is as a
vegetation in the other ; that it has nothing to do with
sex or age, being found in infants, and in youth and old
age in both sexes. From a sixth case he infers that
endocarditis may affect only the right parietal endocar-
dium, and from their first origin the vegetations may be
limited to the right auricular appendage. In all the
cases the microscopical examination of the vegetations
showed that they consisted of embryonic connective tissue,
the elements of which were for the most part in a state
of fatty degeneration. The vegetations were very easily
torn, and frequently gave origin to pulmonary emboli.
The Active Principles of Officinal Podophvllin.
— Continuing his important researches on podophyllin,
Dr. V. Podvysotzky, of Dorpat, states that both the root
of the Podophyllum peltatum and podophyllin (that is,
the alcoholic extract of the root) contain a resinous,
amorphous, bitter, and very active substance, which the
author named podophyllotoxin. This is a mixture of
two distinct chemical compounds, called by Dr. Podvy-
sotzky, " picropodophyllin " and " picropodophyllinic
acid." As experiments on animals show, both emetic
and drastic properties of podophyllin and podophyllo-
toxin depend exclusively upon their containing picropo-
dophyllin, large doses of which produce vomiting, small
ones only purgation. In view of the high price of the
preparation of picropodophyllin (which represents the
essential active principle of Podophyllum pcltaium), the
author recommends to use podophyllotoxin, best of all
in form of an alcoholic solution. While prescribing, it
is necessary to take into consideration that this substance
is precipitated by an excess of water and by alkalies.
When used internally, the remedy begins to act at the
end of four hours, or still later ; hypodermically, after
about two hours. The careful study of clinical results
of his own and of other observers, and the experiments
ma'de on animals, lead the author to the conclusion that
podo\)hyllotoxin is a very useful remedy for constipation,
is very comfortably borne by patients, and does not
interfere with digestion even when used for a long
period. It is indicated especially in chronic consti-
pation in consequence of intestinal atony and sluggish-
ness, in catarrhal icterus, and similar cases. The doses
are given as follows : for an adult, from one-fourth
to one-third of a grain at a time, from one-half to two-
thirds of a grain daily ; for a child, from one-one-hundred-
and-twentieth to one-twentieth of a grain in each dose ;
the second dose is to follow not sooner than eight to ten
hours after the first. The best preparation for an adult
is made by dissolving two grains of podophyllotoxin in
two hundred grains of rectified spirit. The dose is thirty
drops in a small glass of wine. Alkalies should be
avoided during the treatment. — London Medical Record,
January 15, 1883.
Treatment of Erysipelas by Subcutaneous Injec-
tion of Resorcin. — Dr. T. F. Bogusch reports {London
Medical Record, January 15, 1883) four cases of erysip-
elas which he successfully treated by hypodermic injec-
tions of a five per cent, solution of resorcin. Having
marked the margins of redness with ink, he made a num-
ber of injections around the whole inflamed region, along
the line running outside of the mark, at a distance of
about li ctm. He used for each injection 0.25 cub.c. of
the solution, always directing the needle toward the cen-
tre of the diseased part. As many as sixty-seven, twenty-
nine, thirty-six, and seventy injections (at points nearly
equally distant) were required in various cases to com-
plete an elevated ring around the affected region, result-
ing from the blending of individual swellings produced
by injections. In all cases the injections completely cut
short the further spreading of the intianmiatory process,
the temperature rapidly falling to the normal level.
No untoward symptoms were caused by this treatment,
and no other treatment was used.
Pathogenesis of Varicose Ulcers. — It is evident
enough that varicose ulcers are caused by the presence
of varicose veins. But that something further is neces-
sary for their production is shown by the fact that ulcers
are not formed in every case, even of marked varicose
veins. This second necessary condition has been sup-
posed, by several observers, to be a neuritis in the af-
fected limb. That this supposition is correct, M. Quinn
believes to have demonstrated by examination of the
nerves of the member. He states that he has always
found a neuritis. This could not have been caused by
extension of the inflammation from the neighboring tis-
sues, as the portions of nerve examined were taken at a
considerable distance from the ulcer. It could not have
been an ascending neuritis, as then the sclerosis would
have attacked onl}' those nerves whose distribution cor-
responded to the seat of the ulceration, which he states
was not the case. M. Quinn thinks the neuritis is occa-
sioned by varicose dilatation of the veinules passing from
the nerve-trunks. This dilatation is accompanied by
phlebitis, and the inflammation is quickly propagated to
the nerve-sheaths.— _/(»«/'«d:/ de Medecine de Paris, De-
cember 22, 1SS2.
Cardiac Hypertrophy Consecutive to Neuralgia
OF the Arm. — Dr. Potain relates several cases in which
neuralgia of the left arm, due to traumatism, was followed
by hypertrophy of the heart. He exjilains the occurrence
by the nervous connections existing between the cardiac
plexus and the brachial plexus, and remarks upon the
reverse conditions which obtain in cases of angina pec-
toris.— Archives Medicales Beiges, December, 1882.
Pleurisy with Intercurrent Anasarca. — Dr. Ros-
signol relates the case of a cavalryman, twenty-one years
of age, who was admitted to hospital, suftering from a
slight attack of bronchitis of the larger tubes. He had
never had any severe illness. Eight days after admission
he was seized with repeated chills, fever, sweating, and
pain in the chest. Pleurisy with effusion was developed
on the left side. The disease ran its usual course, though
somewhat slowly, during a period of five weeks. At that
time slight ojdema of the feet was noticed, but was at-
tributed to the ana5mic condition of the patient, and to
slight obstruction to the circulation. On the following
day, however, there was another chill with fever and
sweating, and on the day succeeding that there was
marked general anasarca. The heart was perfectly nor-
mal, and there was not the slightest trace of albumen in
the urine. The fluid in the chest re-accumulated when
the anasarca set in. The oedema gradually disappeared
under appropriate treatment, and at the time the report
was made (two months later) the patient was nearly well.
Dr. Rossignol offers no satisfactory explanation of this
curious occurrence. — Archives Medicales Beiges, De-
cember, 1882.
Subcutaneous Injections of Carbolic Acid in
Muscular Rheumatism. — The results of some investi-
gations recently undertaken by Binz would seem to show
that the action of carbolic acid and other so-called anti-
septics in i)reventing suppurative inflammation is due, in
great measure at least, to the influence exerted by these
substances u|ion the white blood-corpuscles. In certain
experiments upon the mesentery of a frog, this observer
ascertained that the migration of the white corpuscles
was almost entirely prevented by applications of a very
February 24, 1883.]
THE MEDICAL RECORD.
209
dilute solution (i in 1600) of carbolic acid. Led by a
consideration of these results Dr. Edgar Kurz, of Flo-
rence, instituted some experiments in the treatment of
muscular rheumatism by subcutaneous injections of car-
bolic acid. He reasoned that in this disease we have to
do not merely with hypenemia and serous exudation, but
witli plastic infiltration of the perimysium and migration
of the white corpuscles of the blood. In jiroof of this
assertion he instances the formation of rheumatic nodes
in severe cases. This method of treatment was tried in
three cases only, but in each the success was stated to
have been remarkable. In one case of deltoid rheuma-
tism, marked relief of pain followed within an hour after
ten injections of a two per cent, solution. After six injec-
tions on the following day the patient was cured. The
second case was one of lumbago. The patient had had
several previous attacks in which relief was obtained only
by morphine. Twelve injections were made in the pain-
ful region in the morning. In the afternoon the patient
appeared in the doctor's office, complaining only of a
slight inconvenience in free movements. The third case
was one of rheumatism of the right lower extremity with
sciatica. The patient had previously suffered for an
entire winter. The present attack was of eight days
duration. The patient could with difficulty take a few
steps, and suffered severely also at night. The treat-
ment consisted in injections of a two per cent, solution
of carbolic acid. At first twelve insertions were made
each day, and the number was gradually increased to
forty every day or every second day. After the second
day the patient was able to stand upright and to walk
with tolerable ease. The nights were restful. Fourteen
series of injections were made and the patient was en-
tirely relieved of pain. No symptoms of carbolic acid
poisoning were observed even when forty insertions were
made at one sitting, amounting to 12 minims of carbolic
acid. Dr. Kurz states that the injections should be made
into the muscle itself, and not innnediately beneath the
integument. In parts wliere there is considerable over-
lying adipose tissue, as in the thigh, he plunges the needle
perpendicularly into the limb as far as it will go. No
pain is caused by a two per cent, solution, or at most
only a very slight burning sensation. Each injection
consists of fifteen drops of the solution, containing three-
tenths of a minim of carbolic acid. — Memorabilieti, De-
cember 30, 1882.
Local Employment of Boracic Acid. — Dr. King
relates several cases {Memorabi/ien, December 30, 1882)
of the successful employment of boracic acid in affec-
tions of the mucous membranes. Four cases of vagin-
itis of long standing in little girls were promptly relieved
by the local application of the remedy. In quite a large
number of cases of leucorrhcea. due to cervical catarrh,
a cure was effected by tampons of boroglycerine or by
boracic acid in powder. In a case of ozoena of forty
years' duration considerable relief was obtained by boro-
glycerine (2 parts in 10) applied on cotton. In several
instances of pharyngitis with posterior nasal catarrh the
troublesome symptoms rajiidly disappeared under treat-
ment by boracic acid in powder.
CONVALLARIA MaIAI.IS IN HeART DISEASE. Dr.
Berthold Stiller has met with very indifferent success in
the treatment of heart disease with convallaria. He re-
ports upon twenty-one cases of various forms of disease,
in patients aged from eleven to seventy years. The
drug was administered in infusion ( 3 \-i to the pint) in
tablespoonful doses every two hours. In seventeen of
the cases absolutely no results were obtained. In two
there was a slight increase in the amount of urine, but
no improvement in the other symptoms, and no dinunu-
tion in the anasarca. Indeed, in one case, the oedema
actually increased during the administration of the rem-
edy. In one case of weak heart with general anasarca,
a slight improvement was noticed after the convallaria
had been taken for twelve days. The pulse was dimin-
ished in frequency and strengthened ; the oedema of the
scrotum, though not of other parts, subsided, and the
patient expressed himself as feeling better. In another
case of mitral and aortic insufficiency with gen-eral ana-
sarca, digitalis had been taken for some time, during
which the symptoms became worse. Convallaria was
now given with apparently good result. The dyspnoea
was lessened and the excretion of urine increased, but
there was no improvement in the irregular action of the
heart or in the dropsy. The reporter raises the ques-
tion, however, whether even this slight amelioration may
not have been due to a cumulative action of the digi-
talis previously administered. From these experiments
Dr. Stiller concludes that convallaria, so far from being
an efiicient substitute for digitalis, is not worthy of even
ranking as an adjuvant to this remedy in cardiac disease.
He admits, however, that the specimens of convallaria
used by him may have been of quality inferior to that
employed by other observers, who have reported such
brilliant results. — IViener Med. Wochenschr., November
II and 18, 1882.
Histological Changes in the Skin in Measles
AND Scarlet Fever. — Neumann states that the prin-
cipal changes in the skin in these diseases are met with
in the glands and blood-vessels. The latter are dilated
and surrounded by a round cell proliferation which even
accompanies the capillary loops in the papilla. Similar
changes are observed in the sweat-glands, although the
surrounding cutaneous tissues are free from the infiltra-
tion. About the sebaceous glands the new growth is
deposited chiefly at the under part. It never is found
within the walls of the glands. The arrector pili muscle
is always infiltrated. In scarlet fever the cutis and epi-
dermis also participate in the inflammatory process.
Clinically, it is important to remember that this round
cell exudation extends even into the horny layer of the
epithelium. The epidermis presents numerous cracks
and fissures which seem to be filled with round cells and
blood-corpuscles. In like manner the cuticular fibres
are compressed by the new growth, and in places are
dislodged by aneurismal dilatations of the blood-vessels.
The contagious properties of the epithelial scales are
due, the author believes, to the above-mentioned changes
in the epidermis. — Wiener Med. Wochenschr., Novem-
ber 18, 1882.
Double Existence. — Dr. Verriest relates the case of
a woman who passes her life in two entirely distinct and
alternating states. In one of them she can talk, but
cannot swallow liquids ; in the other she is able to swal-
low, but is deprived of all power of speech. While in
one state she remembers perfectly all that has happened
previously in that same state, but is totally oblivious of
everything that occurred in the alternating existence.
Lately, a third state has developed, the external charac-
teristic of which is a total paralysis of the right leg.
All remembrance of this contlition is also lost when
once the patient has emerged from it.
A similar case has been recorded by Jessen. A young
woman fell suddenly into a deep sleep, and upon awaken-
ing had lost all memory of past events. She was obliged
to relearn to read and write, and to make the acquaintance
again of persons with whom she had formerly associated.
After a few months she returned to her former condi-
tion. Thus she continued to alternate between the
two states of existence, the change being always pre-
ceded by a deep slumber. Memory was retained only
for events happening in the like states, and was lost
for the alternating periods. Two other cases of like na-
ture have been reported by Schroeder v. d. Kolk and
Kza.\\\.— Deutsche Mcdizinal- Zeitung, November 23,
1882.
Mustard and Molasses. — Dr. Tyson, of Philadel-
phia, reconnnends the addition of molasses to mustard in
making plasters. This furnishes a mild persistent coun-
ter-irritant which can be worn for hours.
2IO
THE MEDICAL RECORD.
[February 24, 1883.
The Medical Record-.
A Weekly Journal of Medicine and Surgery.
GEORGE F. SHRADY, A.M., M.D., Editor.
Published by
WM. WOOD & Co., Nos. 56 and 58 Lafayette Place.
New York, February 24, 1883.
CEREBRAL LOCALIZATION AND THE PSY-
CHICAL FUNCTIONS.
With regard to the general physiology of the cerebral
hemispheres there is little doubt or dispute.
If Hippocrates really taught (what is by no means
certain) that the brain is a cold inert gland, of no use
but to secrete phlegm and cool the blood, the school
founded by him soon promulgated a different doctrine,
and one celebrated treatise ("on epilepsy"), attributed
by some critics to Hippocrates, but probably of a later
date, defines the functions of the cerebrum in a manner
which could hardly be improved by any modern, except
in the way of amplification and precision. Galen, in the
second century of the Christian era, first gave authorita-
tive statement to the doctrine of cerebral physiology
which henceforth prevailed for more than fourteen cen-
turies, and which, with some slight modifications of
phraseology still holds. Galen had observed cases of
paralysis from brain disease, the perturbations of intellect
which arise from cerebral inflammations, the abolition of
consciousness and volition which follows an apoplectic
stroke, and the partial losses in the psychical sphere
(amnesia, aphasia, etc.), which commonly attend a return
to consciousness after apople.xy.
It can hardly be said that much was added to the sum
of knowledge of cerebral physiology taught by Galen, till
the modern era of experimentation on animals com-
menced— an era almost dating with the beginning of this
century.
If the physician of the olden tiuies obtained important
scientific data respecting brain-function from clinical ob-
servation, aided now and then by the autopsy, the
phenomena of dementia and mental alienation being also
of great suggestive value, his modern successor is able to
utilize all these facts, and to greater advantage, since the
means of precision have been multiplied, and cerebral
jihysiology has received a powerful reinforcement from
comparative neurology.
In accordance with what logicians call the " method
of concomitant variations," the physiologist studies the
gradations of the brain and nervous system throughout
the animal series, and observes like gradations in the
powers of mind. The effects of toxic agents and stimuli
in altering cerebral function are also noted. By the
"method of difference," i.e., removal of parts or the
whole of the hemispheres, more important results still
are gained. Of course it is assumed, as the basis of these
investigations, that throughout the entire animal kingdom
homology of structure implies homology of function, and
that inferences fairly deduced from carefully conducted
experimentations, are legitimate inferences.
The only animals that have survived the entire remo-
val of the cerebral hemispheres, so as to be subjects of
experiment, are birds and cold-blooded animals. The
general characteristics of animals so mutilated are alike
in all. Though excito-motor and sensori-motor action
(terms for which we are indebted to Dr. Carpenter) re-
main, ideo- motor and voluntary action are lost. " How
admirable!" says Flourens, who must be credited with
the first experiment of this kind, "all the organs of sense
remain, and all the perceptions are lost."
With the loss of perception, volition, desire, judgment,
and memory are lost. Automaticity is at its highest in
these animals, the control of whose limbs is little de-
pendent on voluntary acquisition, all the faculties and
functions except the most psychical being fully developed
in them at birth, and co-ordinated in the sensori-motor
and spinal centres ; consequently destruction of the
cortical centres does not cause that paralysis of move-
ment which is noticed (more or less permanently) in all
animals higher in the scale of development. Such, at
least, is Ferrier's explanation of that retention of motri-
city which succeeds the mutilation.
If it were possible in a human being to remove the
cerebral hemispheres, and not produce such a shock as
to cause immediate death ; if the individual could sur-
vive such an operation as does the pigeon, we should un-
doubtedly witness a man reduced to the state of an
automaton, without desire, without emotion, without per-
ception, without volition. Nature does, in fact, produce
the experiment for us, although the lesions are far more
complex than those above described. There is a form
of melancholia called by Baillarger, Ball, Etoc-Demazy,
and others, stupor, whose material lesions produce sus-
pension (by pressure) of the functions of the cortex, and
whose psychological accompaniment is absence more or
less complete, as the lesion is more or less general, of all
mental manifestation. In pronounced cases the subject
is listless, emotionless, and unconscious — remains fixed
to one spot (like Flourens's bird), and seems as if de-
prived of his special senses. The characteristic lesion of
this form of mental alienation, according to Etoc-Demazy,
is oedema of the convolutions. In marked cases of gen-
eral paralysis of the insane, intelligence and general
motility are extinguished, anesthesia and analgesia are
complete ; a dementia of the most absolute and hopeless
kind exists. The autopsy always reveals, as the essential
lesion, atrophy of the cortical layers of the hemispheres.
The living protoplasmic elements are choked out and
perish by reason of excessive development and thick-
ening of the meninges and neuroglia. Dementia is ac-
quired idiocy, and is always due to destructive lesions of
the cortex ; idiocy is due to congenital arrest of develop-
ment of the cortex.
Hence we see that grave lesions of the encephalon,
whether morbid or artificial (the result of experiment),
are attended with enfeeblement or disappearance of the
most noble psychical qualities, and that motricity also
suffers in a marked degree. Whether there be distinct
February 24, 1883.]
THE MEDICAL RECORD.
21 1
psychical centres (as the phrenologists taught), or whether
those jiortions of the cortex which are peculiarly the seat
of mind act as a unit, so that all participate in feeling, vo-
lition, perception, etc., as Flourens believed, is not abso-
lutely determined. The supposition that the brain " acts
as a whole " (so far as the purely psychical operations are
concerned), is quite in harmony with the results obtained
by a gr.adual slicing away of the cerebral lobes, as per-
formed by Flourens, Vulpian, and others, on pigeons. It
also agrees with the results of lesions, as gunshot wounds,
abscesses, etc., in the frontal regions in man, as well as
with that integrity of consciousness which often attends
complete hemiplegia when one hemisphere is extensively
damaged. Goltz, who denies cerebral localizations al-
together, believes that every portion of the cortex (those
supposed to pertain to motricity, as well as others) is
in relation with every function exercised by the hemi-
spheres. His views are thus in harmony with those of
Flourens and those of Brown-Sequard.
SIR WILLIAM THOMPSON ON THE SIXTH SENSE.
It is announced that the distinguished physicist, Sir
William Thompson, ascribes to man six senses, namely,
those oi force, heat, sound, light, taste, and smell.
We apprehend that this announcement comes rather
late in the day, as .'\merican text-books have for some time
past taught this doctrine. As an instance we may men-
tion " The Human Body," by Dr. H. Newell Martin, of
the Johns Hopkins University, published in i8Si. In
this work Dr. Martin states, " We commonly distinguish
five senses, those of sight, sound, touch, taste, and smell,"
and he then suggests that " temperature " should be
added.
It will be noticed that both authors claim for man the
possession of six senses. Sir William Thompson substitut-
ing "force" as a sense, for "touch."
Physiologists are indebted to the science of physics
for an explanation of many facts which would otherwise
baffle research, but we fear that the present excursion of
Sir William Thompson into the domain of physiology
will not prove a success.
A physicist describes ^'- force" as being any action be-
tween two bodies, which changes or tends to ciiange their
relative condition, as to rest or motion, or, more generally,
which changes or tends to change any physical relation
between them. Our readers must not confound '■'■force'"
with " power," the latter word having relation only to the
work to be done.
It is difficult to read this definition of "force" and at
the same time class it as a human sense, or to discover
the sense organ involved. Our sense organs have a
special relation to some one form of ^^ force " or energy,
but that "force " is external to the body, and acts merely
as an irritant to excite our sensory nerves, and some
organ is necessary for generating this nervous impulse.
Where, may we ask, is the organ of force ?
Unless Sir William Thompson considers that "force"
is synonymous with " touch" it is incomprehensible how
he can omit "touch" from the list of our senses. The
organs of ^' touch" or the nerve-end organs in or imme-
diately beneath the skin, have been described often enough,
and, from an evolution point of view, touch is the first
distinctly differentiated sensation, and this primary posi-
tion it still largely holds in our mental life ; a man who
could see but had no touch sense, would conceive solid
objects very differently from the rest of mankind.
The delicacy of the tactile sense shows it to be one of
the most valuable of our senses. For instance, we be-
lieve that a weight of .03 grain pressing on an area of
.0139 square inch can be distinctly felt in the back of the
fore-arm, and that on the front of the fore-arm .036 grain
can be similarly felt.
Doubtless, muscular sensations are often combined with
proper tactile sense, and moreover, temperature sensa-
tions are also involved, thus pure tactile feeling is rare.
Tactile and temperature feelings are ordinarily so very
different, that we can no more compare them than lumi-
nous and auditory sensations, but we are aware that some
persons maintain that they are identical. In favor, how-
ever, of the view that touch and temperature are sensa-
tions of distinct modality, with different end organs, nerve-
fibres and brain-centres, several weighty facts can be
produced. The regions of most acute discrimination for
each sensation are different, and cases of disease are re-
corded in which persons have been extremely sensitive
to variations in temperature, while their tactile sensibility
was unaltered ; and conversely, cases in which the patient
could feel that he had been touched, but was unable to
say whether with a hot or cold object.
It is impossible to do justice to this subject in the
space at our command, but perhaps sufficient evidence
has been given to show the necessity of withholding as-
sent to Sir William Thompson's assertion, that "force"
which is a form of motion, should be classed as a human
sense.
THE PROTECTION OF COLLEGE STUDENTS FROM
VENEREAL DISEASES.
Physicians living in college towns or in provincial cities
near institutions of learning, not infrequently find them-
selves invaded by bands of students who are suffering
from various forms of venereal disease. The history
of the case generally is that these young men go off on
a " frolic " to some neighboring place, get to drinking,
and end their exuberance in some cheap brothel. Few
escape becoming infected with venereal disease in some
shape. This they are apt to neglect, or, at least, they
fail to secure the best treatment, and serious results thus
ensue.
There are certain reasons why especial attention de-
serves to be paid to the facts above stated. The young
men or boys who enter college have as yet neither habits
formed nor character matured. The social life fosters the
natural exuberance of spirits, and opportunities to work
them oft' are gladly seized. There is often considerable
pride felt by these amateur men in being a little bad.
It is very easy to go from one step to another, and end
a sportive night with a dispenser of syphilis.
This thing is done with little knowledge of the physi-
cal— to say nothing of the moral — dangers which are en-
countered. With a class, therefore, peculiarly exposed
aqd peculiarly susceptible to temptation, it is but right
that some special care should be taken.
We urge it upon college faculties, therefore, to con-
sider these special dangers to which their students are
212
THE MEDICAL RECORD.
[February 24, 1883.
intrusted. Let them inculcate directly, and not in spirit-
ual generalities, the fact that the truer manliness lies in
self-restraint and continence. If such appeals have no
force, the real dangers should be portrayed ; finally, it is
but right that the erring but more or less noble victims
of indulgence should be able to reach competent medi-
cal men. In some places this is not possible.
THE SUCCESSFUL TREATMENT OF EXTRA-UTERINE
PREGNANCY.
The interesting and important article in our last issue
entitled "The Successful Treatment of Extra-Uterine
Pregnancy," by Dr. A. D. Rockwell, has called forth
numerous inquiries, and we take this method of answer-
ing them in a general way. Formerly, as is well known,
these cases resulted either in immediate death through
rupture of the distended tube, or in protracted suffer-
ing, with frequently a fatal ending, through the efforts
of nature, to rid itself of the fcetal mass. The only
other alternative was the knife, with its attendant dangers.
The method described by Dr. Rockwell, on the con-
trary, and used with such uniform success, cannot but
commend itself to the profession everywhere, and espe-
cially, as it is simple in its details, certain in its results,
and attended with but comparatively little sutfering or
danger to the mother. We observe in this communica-
tion, however, one word of caution in the performance
of the operation, which may well be emphasized, and
this is, the possible danger, in cases well advanced, of
rupturing the sac by too powerful, or injudicious applica-
tions. We can readily believe that this is a possible
complication, but the total of cases reported is as yet
too few for ultimate conclusions. Up to the second
month there can be but little, if any danger, but, unfor-
tunately, the pregnancy often advances considerably be-
yond this period, before its seat is discovered. Nature
is not always a "kind mother," but in these cases there
can be no question of her generous aid. It would seem
that she supplemented the efforts of art by first encysting
and then gradually absorbing the offending material.
THE IMPRESSIONIST SYSTEM IN MEDICINE.
We have received, from an esteemed contributor in Ohio,
the following letter :
" Dear Sir : For the last three years I have been giv-
ing to my typhoid fever patients muriatic acid, with ex-
cellent results. The symptoms of meteorism and diar-
rhoea have appeared to be much less prominent. There
have been fewer pulmonary complications also, and I
believe that the mortality has been lighter, and that the
l^atients have passed through the disease with fewer bad
symptoms generally. My impression is, also, that the
duration of the fever has been shortened. I have not
notes of all my cases, but I am so convinced of tiie
value of this acid that I venture to call the attention of
your many readers to an old but somewhat neglected
remedy. Yours, etc."
We publish this letter, for it illustrates so well the
faulty and valueless system of reaching conclusions used
by so many American jihysicians. Medicine is not an
exact science, but so much the more is it necessary to
«se every possible means to make it such. We consider
the observations of our correspondent as of no use what-
ever. His conclusions are only impressions ; the numer-
ous factors which enter into the etiology and pathology
of typhoid fever are not considered. The number of
cases is not given, nor the age, or se.x, or character of
epidemic, if there was any.
Many a doctor, in treating disease, gives a certain rem-
edy with apparently excellent result. Immediately he
feels confident in his new drug ; his views of subsequent
cases are colored by his enthusiasm over a single suc-
cess. His therapeutic method for years, in particular
diseases, turns upon the happy ending of the first few
cases. He is the victim of a rose-colored " impression."
This constitutes what we choose to call "the impres-
sionist system in medicine." It is now and always has
been the bane of therapeutical science. We have fash-
ions in medicine, because fancy, more than e.xact method,
so often determines what drug we shall use.
It would be well if some one could define for medi-
cal men the sources of error in reaching therapeutic
truths, the minimum test which a drug must undergo in
order to take rank as a remedy. This has been done in
a certain indefinite way for some diseases, but we need
more careful and extended determinations.
The impressionist method is very well in art, which
interprets nature from an emotional standpoint, but only
exact observation and careful deduction are allowable in
medicine, which at least strives to be a science.
THE THIRD CORPUSCLE OF THE BLOOD.
Dr. Norris, of London, in his book on "The Physi-
ology and Pathology of the Blood,'' claims to have dis-
covered a third or invisible corpuscle of the blood, which
he regards as identical with the haaniatoblasts of Hayem
and the small blood-plates of Bizzozero. The sound-
ness of his theory rests entirely on the demonstration of
the presence of the invisible corpuscle as a normal ele-
ment of the blood. He claims that he has made this
satisfactorily, and gives in evidence a large series of
photographs which illustrate his views.
A "criticism and refutation " of Dr. Norris's theories
regarding this body has been published by Mrs. Ernest
Hart, of London, in which the writer claims that Dr.
Norris's conclusions are based upon " illusions engen-
dered by his peculiar methods of working," and reviews
the successive steps in his processes with a keenness
which is both searching and interesting.
Evidently Dr. Norris's critic is not a novice, for every-
where a familiarity with the action of reagents and the
influence of mechanical conditions is shown that speaks
of practical manipulation and study, and therefore the
physiologist and the histologist must give her work care-
ful scientific attention. The pamphlet also tells us that
this is not the first time its author has criticised Dr. Nor-
ris's work, and in order that the reader may understand
exactly upon what the controversy centres it will now be
necessary to state briefly the view held by that author.
He describes what he calls the "advanced lymph-disk,"
somewhat smaller than the red disk, colorless, trans-
parent, and homogeneous, and states that it is found in
the lymph-glands, is present in larger numbers in the
thoracic duct, and is incapable of being seen in the
February 24, 1883.]
THE MEDICAL RECORD.
213
blood because it has the same refractive index as the
liquor sanguinis, and has not become colored by endo-
genous secretion of htemoglobin. These bodies, says
Norris, are the nuclei of the uninucleated corpuscles
seen in such abundance in the lymph and blood-forming
organs, which, either while remaining in the gland or
during their passage through the thoracic duct, siied
their close-fitting, granular cell-wall. When colored they
are visible, and are then seen as red blood-corpuscles.
Certainly this is an ingenious theory, and we share in
the "genuine regret" expressed by the writer of the
criticism, that any one should feel forced to conclude
that it is based upon error in observation. We also
share in the belief that only the most diligent investiga-
tion, conducted by the most conservative methods can
place such a theory upon a solid basis, " so delicate and
unstable are the blood-corpuscles, so careful and ex-
act must be the conditions under which they are exam-
ined after quitting the vessels, and so guarded and cau-
tious must be the deductions drawn from appearances
presented under the microscope." All these conditions
seem to have been fully appreciated, and their influence
carefully estimated by Mrs. Hart. The effect produced
upon the corpuscles by pressure between two glass sur-
faces bound firmly together, the question whether all
red corpuscles lose their haemoglobin in an equal ratio,
whether there is any difference in the quality of these
bodies, the effect produced by solutions having a differ-
ent refractive index, points bearing directly on the ques-
tion at issue, have been considered closely, and the sources
of error eliminated so carefully, the reader is led to the
conclusion that Dr. Norris's theory has been shivered to
a degree which will render it difficult to collect the frag-
ments.
IICIUB of mC '<mCCl\.
Tenement-House Cigars. — The bill before the State
Senate to prevent the manufacture of cigars in tenement-
houses, or in apartments occupied as dwellings, has been
ordered to a third reading without opposition. Mr. Covert
made a statement that several authentic cases had oc-
curred of serious diseases having been communicated to
smokers of tenement-house made cigars, and the cigar-
smoking Senators, who comprise a large majority of the
thirty-two, immediately gave their adhesion to the bill, in
spite of the certificate of the Board of Health that there
was nothing dangerous or detrimental to health in the
business of tenement-house cigar manufacturing.
A Mutual Autopsy Society. — Our esteemed con-
temporary, the Philadelphia Medical and Surgical Re-
porter, refers to the fact that Gambetta belonged to the
Societe d' Autopsy Mutuelle, and urges the formation of
similar societies in this country. Such an organization
has existed for some time in New York City.
A Chair of Laryngology has been established in the
Royal University of Rome, and Dr. Zawerthal has been
appointed to fill it.
An Epidemic resembling Cholera has been prevail-
ing in Waterbury, Conn. It has affected hundreds of
people. The cause is not yet known.
The Louisville Medical News comes to us with-
out its brown cover and enlarged to sixteen pages.
The Chicago Medical Review has become The
Weekly Medical Review, and is published simultaneously
at Chicago and St. Louis.
The Physician and the Druggist — A Medico-Le-
gal Decision. — About a year ago Martin Mclntyre, a
Fonda, N. Y., druggist, put up a prescription for John
Cook, written by a Dr. Parsons, of Fultonville. The
medicine nearly killed Cook. The physician claimed
that the prescription had been altered, and commenced an
action against the druggist for damages. The prescrip-
tion called for one drachm of podophyllin. Dr. Parsons
claimed he had wrilten it one grain, and that it had been
altered by the druggist to cover up his mistake. The
case was tried recently. On the trial Mclntyre swore
the prescription had not been altered and Dr. Parsons
swore it had. Two experts testified that no alteration
had been made. Another question in the case was
whether or not the druggist was justified in putting up a
prescription in which he noticed a dangerous excess of
any ingredient. Judge Landen ruled that if the prescrip-
tion of a regular practising physician is put up as written,
the druggist is not responsible. The jury decided that
the prescription had not been altered, and therefore no
cause for action.
Regulating Medical Practice in Michigan. — The
Michigan State Board of Health, at its recent meeting,
passed the following resolution : That an examination
should be required of all who are to practise medicine
in this State, as to their qualifications. That such ex-
aminations should be restricted to questions in demonstra-
ble knowledge as distinguished from questions of mere
opinion.
American Public Health Association. — -A meet-
ing of the Executive Committee of the American Public
Health Association was held in Washington, D. C, on Fri-
day, the 1 6th inst. The business before the Committee
was the arrangement of the programme for the next annu-
al meeting of the Association to be held in Detroit next
fall — October or November, as the Committee decides.
The committee is composed of Drs. E. M. Hunt,
President of the Association ; Albert L. Gihon, James E.
Reeves, J. Berrian Lindsley, Azel Ames, John S. Billings,
G. P. Conn, Thomas J. Turner, J. J. Speed, Thomas L.
Neal, H. D. Fraser.
The Library of the Late Dr. Geo. M. Beard. —
We learn that the library of the late Dr. Geo. M. Beard
is being catalogued, with a view to disposal by auction.
More about Broken Thermometers. — The subject,
" broken thermometers," has developed into an impor-
tant branch of the general department of fractures, and
will soon have a literature of its own. We continue to
receive communications upon the subject.
Dr. G. M. Kells, of Cincinnati, O., says that a better
plan than any yet recommended to save thermometers
is the following : " Take any ordinary thermometer case
(the wooden ones are the best for the purpose), throw
around it a piece of wire just below the junction of the
top and body of the case, and twist it tight, leaving an
eye on the end of the wire. To this eye attach a chain
214':
THE MEDICAL RECORD.
[February 24, 1883.
about four inches long and secure to the vest with a
small pin, the thermometer to be carried in the upper
vest pocket."
Dr. Z. T. Dellenbaugh, of Cleveland, O., suggests a
plan which must certainly be very effective. He writes :
" Having a metal case with enough loose wool in each
end to hold the thermometer rather firm ; and having
procured a rather heavy piece of corrugated, preferably,
or plain white rubber tubing one inch longer than the
case, It is cut in two pieces at a point corresponding to
the screw-joint of the case, so that each piece is one-half
inch longer than the part of the case it is designed to
cover. Wet the tubing and slip the case in, noting that
the rubber projects one-half inch beyond each end of the
case. This rarely ever falls out of the vest pocket ;
should it, the protection the rubber affords is almost cer-
tain to save the instrument."
Dr. C. Irving Fisher, of Holbrook, Afass., writes that
he has always been lucky with thermometers, and ascribes
it to the fact that he buys short ones with metallic cases.
Over each end of the case he slips a si.\-sided rubber tip,
such as are used on lead pencils. This prevents slip-
ping from the pocket.
Removal of a Bean Piecemeal from the Ear. — Dr.
T. Y. Sutphen, of Newark, N. J., sends us an account of
a case illustrating the difficulties and accidents in remov-
ing foreign bodies from the e.xternal auditory meatus. A
boy, eight years old, was brought to Dr. S. with a com-
mon white bean in his ear, wliich he had placed there
two weeks before. Attempts had been made by others
to remove the body by the use of the syringe and instru-
ments. These had only resulted in injuring the canal,
which was swollen so as to hide the bean from sight.
There was a muco-purulent discharge from the ear. The
boy was etherized, and an attempt was made to remove
the body with a syringe, but it failed. Tlie ear was
then syringed with warm water, for four days, which
reduced the swelling somewhat. The bean could be
seen, and was immovably impacted. With a lance-shaped
paracentesis needle, the bean was broken up, with the
help of a bent probe, and removed.
The Medical Library of the Late Dr. J. Foster
Jenkin.s, of Yonkers, N. Y., was sold at auction last
week. There were one thousand eight hundred lots and
about four thousand volumes, not including miscellane-
ous pamphlets. The library was particularly rich in the
literature of obstetric medicine and surgery, from the
end of the fifteenth century to the present day. All the
specialties were represented, even to atlases and biblio-
graphy. A large number of works in black letter, rubric,
and some MSS. brought high prices, while some books
out of print were sold astonishingly low. Aside from
the large purchases of dealdts, several imiblic libraries of
Boston, Washington, and New York secured handsome
additions. Some private libraries in this city will be en-
riched chiefly from the special departments of medical
literature. The collection is said to have cost its late
owner $12,000. The proceeds of sale were about $4,000.
An Army Medical Exa.mining Board to meet
IN New York. — An Army Medical Board has been or-
dered to assemble at the Army Building, corner of
Houston and Greene Streets, New York City, March i,
1883, for the examination of such persons as may be
properly invited to present themselves before it as can-
didates for appointment in the Medical Corps of the
Army, and will probably continue in session about three
months.
.\ll candidates for appointment in the Medical Corps
must apply to the Secretary of War for an invitation to
appear for examination. The application must be in
the handwriting of the applicant, must state date and
place of his birth, and place and State of which he is a
permanent resident, and must be accompanied by certi-
ficates based on personal acquaintance from at least two
persons of repute as to citizenship, character, and moral
habits ; testimonials as to professional standing from
Professors of the Medical College at which they gradu-
ated, should also accompany the application, if they can
be obtained. The candidate must be between twenty-
one and twenty-eight years of age (without any excep-
tions), and a graduate of a Regular Medical College,
evidence of which, his Diploma, must be submitted to
the Board.
Further information regarding these examinations, and
the nature thereof, can be obtained by addressing the
Surgeon-General of the L^nited States Army, Washing-
ton, D. C.
Poisoning fro.m the Prescription of a Clergy-
man.— Clergymen are very fond of dabbling in physic.
This sometimes leads to serious consequences. The
Rev. Mr. Timins, of \\'est Mailing, England, has just
been coumiitted for trial on a charge of manslaughter.
The reverend gentleman appears to have been in the
habit of prescribing gratuitously for the members of his
flock on the strength of a short period of medical study
nearly half a century ago. On the present occasion he
administered a spoonful of the essential oil of bitter al-
monds to a young girl for some supposed complaint, and
she died in his arms in a few minutes. His intentions
were doubtless good, and it is pitiable to see a clergy-
man of hitherto unblemished character, and sixty-nine
years of age, in such a position. Still zeal, untempered
by knowledge, is not of much avail in the practice of
medicine. Clerical minds have been too apt to busy
themselves with the mysteries of medicine, and let us
hope that the unfortunate position in wliich Mr. Timins
now finds himself, may serve as a warning to others of
his profession.
S.mall-pox and the Immigrants. — The Health Offi-
cer of the Port of New York reports that among the
300,000 immigrants landed in Castle Garden during the
last eight months, not a single case of small-po.x has
been discovered.
Governor Butler and the Massachusetts Board
of Health, Lunacy, and Charity. — Governor Butler
is credited with the intention to recommend to the Leg-
islature of Massachusetts the abolition of the State
Board of Health, Lunacy, and Charity, on the ground of
expense, mismanagement, and practical inefficiency.
WcnEN Pharmacists. — A systematic attempt to edu-
cate women as pharmacists has been initiated in Louis-
ville, Ky. The .\cademy of Pharmacy opens on March
ist with a class of women students. The .Academy has
received the gift of a laboratory and a botanic garden.
February 24, 1883.]
THE MEDICAL RECORD.
215
l-lcpovts of Societies.
NEW YORK PATHOLOGICAL SOCIETY.
Stated Meeting, January 24, 1883.
Geo. F. Shradv, M.D., President, in the Chair.
PRIMARY CARCINOMA OF THE LUNG.
Dr. E. G. Janeway presented a specimen removed from
the body of a man tifty-six years of age. The clinical his-
tory was peculiar in the fact that patient's mother was the
only relative who had had cancer, and that was an epithe-
lial cancer which had been removed from the lip a number
of years previous to her death, and the disease did not
return. The patient began to complain, about one year
before death, of not feeling well, but no marked complaint
was made until about six months previous to death. His
history was that of progressive failure of strength and flesh,
a very slight febrile movement toward the latter part of
his life particularly, ioo° F. being the highest, pain in the
right side from the beginning, and afterward some short-
ness of breath upon exertion. Dr. Janeway saw him
about seven iveeks before his death, and learned that of
late the pain in the side had increased in severity. He
found flatness over one-half of the right lung, a distinct
friction sound over the upper part, with breathing some-
what bronchial and vocal fremitus impaired, and enfee-
bled and absent respiratory murmur over the lower part.
The line of flatness was nearly horizontal. A hypoder-
mic syringe was introduced, and only a very small cpian-
tity of bloody serum could be withdrawn. His presuma-
ble diagnosis, leaving it for demonstration at another
visit, was cancer of the lung, and besides he thought it
possible that a malignant process back of it involved the
pleura. At his second visit he found no marked change
in the physical signs. Exhaustion was increasing, there
was no marked febrile movement, no renal trouble, and,
by exclusion, he reached the diagnosis of cancer of the
lung, perhaps of primary origin. .\t that time the patient
complained of some disgust for food, but there was no
special difficulty in swallowing, although he preferred
liquids. He expectorated a slight quantity of mucus,
which apparently came entirely from the throat. There
was no bloody expectoration. The patient suffered
markedly from dys|incea on very slight exertion, and
finally died from exhaustion.
The left side of the chest was normal, excepting a
slight bronchitis, and this was the only abnormal condi-
tion found at the autopsy.
The specimen presented consisted of two parts : first,
the right lung, in which the new growth involved the
middle and lower lobes ; and second, a mediastinal
growth. There was no enlargement of glands above the
clavicles. In the lung the neoplasm showed itself in the
form of an infiltrated cancer, with nodular outgrowths
taking up the pulmonary tissue entirely, especially at the
peripheral part. The lung was separated from the dia-
]3hragm by a layer of fluid one inch and a half in depth,
but the diaphragm was normal except where it was cov-
ered by a very slight fibrinous deposit. The mediastinal
tumor consisted of a mass of enlarged glands at the root
of the trachea. In this apparently uniform tumor the
new growth had undergone considerable fatty degenera-
tion. In the lung the new growth encircled the bronchi,
and crowded their walls from without inward, so that
they were apparently filled. There was a pin-head new
growth in the lower part of the right lobe of the liver.
All the other parts of the body, including the oesophagus,
were normal.
From the history of the case and the appearance of
the specimen. Dr. Janeway believed that the primary
growth was in the lung, and that the mediastinal tumor
was secondary. Mieroscopical examination showed al-
veoli of medium and large size, containing small polygo-
nal epitkelial mono- and bi-nucleated cells.
This was the fourth specimen of primary cancer of the
lung which he had seen. In one case he made the
diagnosis of carcinoma of the lung ten months before
death, and at that time there was no other trace of the
disease in the body, but at two months before death car-
cinoma began in the left breast, and at the time of death
the latter growth had reached considerable size. In that
case there was no mediastinal tumor, but there were sec-
ondary nodules in the liver and right lung. The patient's
father died of carcinoma of the stomach, and a cousin
had lympho-sarcoma of the pleura.
In the third case it had-been supposed that the patient
had pleurisy, but the autopsy revealed primary colloid
carcinoma of the entire lung. The lung and the liver
were the only organs involved.
DISSECTING METRITIS.
Dr. H. J. Garrigues presented three specimens, all
obtained at the Maternity Hospital. About three months
ago he exhibited a specimen to the society, illustrating
this pathological lesion, and then stated that he regarded
it as a rare disease. Since that time he had been able to
find the records of two cases. Even in special works
on the pathology of the female sexual organs no refer-
ence whatever has been made to such cases. Besides,
he had asked a large number of physicians, whom he had
met, if they had observed loose bodies in the womb after
confinement, but all of them had answered in the nega-
tive. Nevertheless, he began to surmise that the disease
was not so rare as might be inferred from the literature
of the subject.
The first specimen presented was derived from a primi-
parous woman, eighteen years of age. There had been a
low forceps operation, very simple in character. She did
not seem to be seriously ill at any time ; her highest tem-
perature was only 102° F. At no time was there any
fetid discharge, and no uterine treatment was instituted.
On the thirteenth day after delivery she expelled a cylin-
drical body which was six centimetres in length by two
and a half in width.
The second specimen was also removed from a prinii-
parous woman, eighteen years of age, and in this case
there were extensive diphtheritic patches on the vaginal
wall and cervix. Her highest temperature was 102.5°
F., and that only once. On the eighteenth day after de-
livery, when she was apparently entirely recovered from
her labor, she expelled from the vagina a body six centi-
metres in length and three and a half in width, and one
and three-tenths centimetres in thickness.
The third specimen was from a patient twenty-nine
years of age, in whom there was retention of placenta.
The placenta was removed, artificially, one hour and
three-fourths after delivery, and was composed of two
parts joined by membrane. This patient had a high tem-
perature, 103.5° F-i and, besides, the lochial discharge
was fetid and almost constant. The uterus was washed
out with a two per cent, solution of carbolic acid two or
three times a day. She was comparatively well, although
there was constantly some indication of slight septicasniic
condition until, on the seventeenth day after deliver)-, she
expelled from the vagina a body which was twenty centi-
metres long and thirteen wide, and of variable thickness.
The house physician stated that it was one inch thick in
some places when first expelled.
Dr. Garrigues remarked that some little time ago a
specimen was presented to the society for a candidate,
which he had always believed was of the same character.
These, together with two cases reported by Russian phy-
sicians, made seven in all. He believed that they were
diphtheritic in character. In two out of his four cases,
there was pronounced diphtheritic inflammation. In the
others there was not sufficient disturbance to lead to a
vaginal examination. How these large bodies are thrown
off he had been able to understand by the study of
another condition, in which the change was simply diph-
theritic. In that case there was pronounced metritis, the
2l6
THE MEDICAL RECORD.
[February 24, iS8^
wall of the uterus measured from one to two inches in
thickness, and there was diphtheritic membrane on the
cervical mucous membrane, and in the interior of the body
of the womb, around the opening of one of the Faf-
lopian tubes. On the other side there was a patch of
diphtheritic membrane of the size of a three-cent piece,
and from this small patch he was able to follow a similar
yellowish formation coming out of the external part of
the uterus so as to form a layer just below the perineum.
Associating the thickening of the uterine wall and this
yellow mass extending in two directions, he was able to
understand how it was possible that such pieces can be
thrown off from the uterus. He did not regard the jiro-
cess as especially unfavorable. There is this danger,
however, that if the person again becomes pregnant, there
is likelihood that rupture of the uterus may occur during
labor.
Dr. J. C. Peters remarked, that in the last volume of
the "Transactions of the Edinburgh Obstetrical Society,"
a series of such cases were reported, and were spoken of as
positive sloughs. So far as he recollected, however, al-
most all the patients recovered. He thought it probable
that they belonged to the same class of cases described by
Dr. Garrigues.
Dr. G.'iRRiGUES thought that his cases could not be
regarded as those in which sloughing had occurred, be-
cause there was not the least fetid odor to the discharge,
except in the last one.
The President said, that in the specimen presented
for a candidate, and referred to by Dr. Garrigues, the
body expelled was several inches in length, about an inch
in width, and contained smooth muscular fibre in its sub-
stance. There being some question as to the structure
of the mass, it was examined by a distinguished gynecolo-
gist, who presented it at a meeting of the New York
Obstetrical Society, and asserted that it was composed
mostly of striated muscular fibre, with the conclusion
that it might possibly be the muscular fibre of the heart
of a monster, the heart bemg the only portion remaining
within the uterus.
Dr. Janew.av said that small polypi might exist in the
pregnant uterus, become detached during the progress of
labor, and appear subsequently in the discharges. He
thought that a true dissecting metritis was a serious
process. In several instances, at post-mortem examina-
tions, he had found evidence that a septic fluid from an
inflamed uterine mucous membrane had found its way
into the blood-vessels, and led to the formation of a
thrombus in the vena cava, and he had been led to be-
lieve that it was not a i)rocess which terminated in re-
covery in very many cases.
Dr. Boze.man thought the explanation given by Dr.
Janeway was very satisfactory, concerning the formation
of some of these growths, and referred to a specunen, al-
ready presented to the society, of a myo-fibroma expelled
from the cavity of the uterus. A miscarriage took place,
and six weeks subsequently a body of considerable size
was thrown ofl".
Dr. Garrigues thought that the explanation offered
by Dr. Janeway was very ingenious, and perhaps would
apply to two of the specimens which he had presented.
He thought, however, that it would not apply to the
third case because the shape and size of the mass was
unlike that of a polypus. Neither did he think it would
apply to the specimen presented by the president in be-
half of a candidate, because in that instance the sub-
stance expelled was a sheet-like piece of membrane,
several inches in length, and only of slight thickness and
considerable width. In reply to a question. Dr. Gar-
rigues said that he was able to prove the existence of
diphtheritic infection in two of his cases, and inferred
that it existed in the others.
Dr. Jaxewav remarked that he had seen two cases in
which there was complete exfoliation of the mucous
nien)brane of the bladder. In one instance it was dis-
charged before death, giving rise to a condition closely
resembling labor, and in the other he found a cast of the
bladder at the autopsy. The lesion was regarded as a
croupous inflammation of the bladder.
Dr. PE.-iBODv had seen one such specimen in the blad-
der of the horse.
Dr. Garrigues believed that it could be proved that
his specimens were not mucous membrane, because
there was no trace whatever of glandular structure. He
had seen only one case of shedding of the mucous mem-
brane of the uterus, and that was in the practice of Dr.
Jacobi.
Dr. Boze.man had seen a case of what he termed
ulceration of the bladder, in which nearly the entire
mucous membrane was thrown off. In that case there
was very great hypertrophy of the muscular coat of the
bladder, the wall of the organ being three-fourths of an
inch in thickness. He made an opening into the vesico-
vaginal septum about the size of a half-dollar, and the
patient was reUeved of the tenesnuis and other symptoms,
and went on very well for two or three weeks when the
opening closed, and he w.as obliged to make another and
increase it nearly to the size of a silver dollar. After the
second opening was made he was able to explore the blad-
der completely with the finger, and was also able, placing
the patient in the knee-elbow position, to see, by the aid
of reflected light, the entire inner surface of the bladder
and found that it was denuded of its nmcous mem-
brane. The progress of the case after the second
operation was satisfactory, the muscular coat gradually
became thinner and softer, and after si.x or eight months
he performed an operation for closure of the fistulous
opening, but it was subsequently demonstrated that the
cure had not been complete. The former symptoms
again developed, the bladder was again opened, and the
patient was allowed to go six or eight months longer.
In the meantime her general health improved. Subse-
quently an operation was performed for closure of the
fistulous opening, and the cure was complete with a per-
fect reproduction of the mucous membrane. He thought
the condition resulted from an ordinary attack of cystitis,
and believed that it was the only one of a similar char-
acter on record.
Dr. G. L. Peabody presented a specimen of
sarcoma of the right optic nerve.
The patient was in the New York Hospital about two
weeks, and complained of general malaise, loss of ap-
petite, inability to work and sleep. He went on into a
condition of apathy, which lasted for ten days, and then
symptoms of cerebral disturbance became well pro-
nounced. He died with a diagnosis of meningitis, based
upon the clinical history. .4t the autopsy, there was
found meningitis and intense congestion, and there were
two small deposits of pus, neither of which was large
enough to make him sure of their existence from examina-
tion with the naked eye. Besides, he found a small
tumor upon the right optic nerve about half the size of a
small French pea. The tumefaction upon the optic
nerve was largely fibrous in character, but between the
fibres of the optic nerve itself was a dense layer of small
round cells, and ascending between them in this stroma
were large blood-vessels filled with blood. The inter-
pretation which he gave to the case was that the sar-
comatous tumor developed on the optic nerve and caused
meningitis. It probably had existed for some time, but
was too small to produce physical evidence of its pres-
ence.
Dr. Janeway said that he had seen a little larger
tumor than this produce similar trouble in a case brought
to him by Dr. Maxwell. An oculist had operated
upon the patient for internal strabismus. Shortly after-
ward the patient died of general paralysis. At the
autopsy there was found a small sarcoma, not larger than
half a split pea, which pressed upon the sixth nerve and
led to softening of the pons, and in that way caused
death. The paralysis of the ocular muscle was due to
February 24, 1883. J
THE MEDICAL RECORD.
217
the pressure, but death occurred from acute softening of
the pons. He had also had another case, in which a
small tumor pressed upon the cervical dura and gave
rise to symptoms of acute meningitis. Of course, in men-
ingitis it was necessary to think of the various sources
of possible origin. In one case lately, he had found
well-marked otitis media purulentia without symptoms
during life, and it had doubtless given rise to meningitis.
In a second case, one of ordinary tyjjical cercbro-siii-
nal meningitis, there was well-marked otitis media ])uru-
lentia.
Dr. Peabody said he had observed the same thing,
and had found in acute cerebro-spinal meningitis, otitis
media purulentia where there was no suspicion during
life of ear trouble.
Dr. J. L. Smith remarked that it was a well-estab-
lished fact that in cerebro-spinal meningitis, if the disease
continued for some time, inflammation of the middle ear
is liable to be developed.
Dr. T. E. Satterthwaite presented specimens as fol-
lows :
ABSCESS OF THE LEFT SUPERIOR MAXII.I.A — OPERATION
— EMBOLIC PNEUMONIA AND HEPATITIS.
Post-mortem examination of Dr. (leorge M. Heard,
January 24, 1883, at 3.15 p.m., death having occurred on
the previous day at 10.30 a.m.
Present at the e.xamination, Drs. J. L. Little, J. R.
Leaming, T. H. Kellogg, G. H. Mitchell, D. H. Good-
willie, VV. H. Porter, J. A. Hegeman, Charles I.. Dana,
J. Messenger, and T. E. Satterthwaite.
The following account of his illness was furnished by
the physicians who had him under cliarge.
On Thursday, January 18, 1883, about 10 a.m., Dr.
Beard called at the office of Dr. D. H. Goodwillie. He
was then suffering from an infra-orbital neuralgia of the
left side ; his face was swollen, and his left eye congested ;
both pupils were nuich contracted ; there was also steno-
sis of the left nostril, pus and mucus passing down from
the left posterior nares into tlie pharynx. The root of
the left second superior bicuspid had an amalgam feel-
ing in it, and at its apex was a maxillary abscess having
no comnnmication with the mouth. Under an anajsthetic
the bicuspid root was extracted, and the abscess tre-
phined through the external alveolus. A good deal of
pus escaped. It was now found that the maxillary ab-
scess communicated with the left nostril. Dr. IJeard was
again seen at liis rooms about 3.15 p.m., by Dr. Good-
willie. Dr. T. H. Kellogg was found in attendance,
having been sunniioned by Dr. Beard, and visited him at
2.30 p.m. Dr. 15eard was then recovering from a prolonged
chill. Dr. Kellogg had found the patient sitting dressed
on the sofa, but in evident distress. Antipyretics and stim-
ulants were immediately ordered, and this treatment re-
ceiving tlie approval of Dr. Goodwillie, was continued
on his arrival. At 4 p.m. the temperature was 104° F. ;
pulse, 95. At 8 p.m., the patient was again seen by Drs.
Goodwillie and Kellogg. Marked constitutional de-
pression existed. Temperature, 102° F. ; pulse, 90.
Dr. Kellogg then expressed his belief, in which Dr.
Goodwillie concurred, that Dr. Beard was suffering from
septicemia. The patient was again seen by Dr. Good-
willie at 10 P.M. Temperature, 102° F. ; pulse, 85. Face
not painful. At 9 a.m. the next morning Dr. Good-
willie cleansed the abscess. There was now no pain
and little swelling of the face. The chest was examined
with negative results. A consultation was then arranged
for 8 P.M. Drs. J. R. Teaming, J. I,. Little, and T. H.
Kellogg in attendance. Temperature was found to be
102° F. ; pulse, 108. Little or no swelling of the face.
No cough, but some pain in the right side, referred to
the region of the liver. Mind clear. By general con-
sent Dr. Little assumed the management of the case,
with Dr. J. R. Leaming in consultation. On Saturday
morning Dr. Goodwillie again saw the patient, and found
that the symptoms were rather more unfavorable. The
niaht had been passed in restlessness. Temperature,
io°3° F. ; pulse, 105. When seen by Dr. Little on this
same morning the temjierature was 104° F. ; pulse, 100.
A cathartic was administered. On Saturday evening
the temperature had fallen to 102° F. The cathartic
had acted briskly.
On Sunday morning tlie temperature had risen to
103° F. Tliere was dulness on the right side, bronchial
breathing and crepitations. On Sunday evening Dr.
Leaming saw the patient and found jjleuro-pneumo-
nia, as had previously been diagnosticated by Dr.
Little, and in addition he detected adhesive pleurisy of
the left side (plastic exudation). Temperature, 102° F.,
pulse, 104-8. On Monday morning the temperature
had fallen to 101° F. Dr. Leaming then stated that the
affection of the right side had progressed rapidly ; in
the left likewise. Face flushed ; pulse rapid and vari-
able. Monday evening : Temperature, 99° F.; patient cy-
anotic ; great difficulty in breathing. Death occurred at
10.30 A.M., Tuesday, January 23, 1883. There was no
sweating throughout the attack, and the cough had been
slight, though the rusty expectoration of resolving pneu-
monia was observed during the last twenty-four hours of
life.
Posi-moriem examimition by Drs. T. E. Satterthwaite,
and W. H. Porter : Body well nourished. Rigor mortis
only slightly marked.
Thoracic cavity. — The costal cartilages contained an
unusual amount of calcific material, considering the age
of the deceased.
Pericardium and heart. — There was a slight excess of
serum, which was clear, in the jiericardial sac. Amount
about one and a half ounce. The heart was found in its nor-
mal ]50sition, and neither its substance nor valves affected.
The pulmonary artery contained a firm wliite clot, that
was adherent to the wall of the vessels, and extended
through the pulmonary valve into the riglit auricle.
Right litng. — This organ was not attached to the chest-
wall at any point, but had ap|)arently been attached re-
cently, and then separated by the moderate pleuritic ef-
fusion that was found in the right pleural cavity. There
was pneumonia of all three lobes. The lower lobe was
in a condition of gray hepatization throughout ; the
middle lobe was solid at its outer extremity only, and
was the seat of a large reddish gray, wedge-shaped in-
farction, the outlines of wliich were sharply defined by a
narrow zone of vascular tissue ; the upper lobe was so-
lidified in its posterior and external portions. One inch
below the right apex anteriorly there was a small nodule,
which was taken to indicate the site of an old pleuritic
adhesion. Along the anterior and lateral surfaces of
the lower lobe, and in the interlobular fissures, there was
a thick, yellowish white plastic exudation, easily detached,
and evidently of recent formation. On pressure the
right bronchus exuded a reddish and frotliy mucus. On
examining the left huig it was found to be attached to
the chest anteriorly, by quite old fibrous adhesions situ-
ated in the mammillary line, and corresponding with the
cartilages of the third, fourth, and fifth ribs. The apex
was also attached posteriorly by old adhesions. The
diaphragm was free. The lower lobe of tiie left lung
was solid throughout.
Tlie upper lobe was free. The secretion from the left
bronchus was similar to that in the right. Along the
posterior and axillary border of the lower lobe, the vis-
ceral pleura was rough, and exhibited traces of recent
pleurisy. At the apex there was jnickering of the lung
substance, and on the anterior surface of the lobe there
were depressed cicatrices. The substance of the lower
lobe was deep red in color, soft, and almost pultaceous,
especially near the line of the ])leural exudation. It
contained also in spots small areas of a grayish yellow
appearance, corresponding to the distribution of the ves-
sels, and having the appearance of small infarctions.
The spleen was enlarged, pale, and soft.
The kidneys were enlarged, soft and fatty. The capsules
2l8
THE MEDICAL RECORD.
[February 24, 1883.
were in the main non-adherent, and there was no ocular
appearance of any considerable interstitial deposit.
Liver. — The right lobe was enlarged. Its substance
also was extremely soft. On the surface of the right
lobe there were numerous small superficial yellowish in-
farctions. The gall-bladder was normal in size and con-
tents.
'i1ie stomach was dilated, and its mucous surface coated
witli a somewhat abnormal amount of mucus.
The other organs were not examined.
Dr. Peabody asked, Why is not the right lung a speci-
men of ordinary croupous pneumonia, clinically and path-
ologically ?
Dr. Janeway thought the appearance was that of or-
dinary gray hepatization in lobar pneumonia.
Dr. S.viTERTHWAiTE said that so far as the lower lobe
of the right lung was concerned it presented the ordinary
appearance seen in the gray hepatization of lobar jineu-
monia ; but in the upper portion of the middle lobe there
was-a large wedge-shaped mass, entirely different in ap-
pearance from the rest of the lobe ; it was dryer than
the other portions of the lung. This condition, together
with the peculiar condition of the left lung, and the
clinical history, he believed justified the conclusion that
the case was one of embolic pneumonia.
(To be continued. )
NEW YORK ACADEMY OF MEDICINE.
Stated Meeting, February 15, 18S3.
FoRDYCE Barker, M.D., LL.D., President, in the
Chair.
Dr. William H. Draper read a paper on
diet i.v the tre.it.ment of the goutv dyscrasia.
The relations of food and normal nutrition, and the
evolution of vital energy to the etiology and treatment
of disease, constitutes some of the most interesting and
important problems in the experience of the practical
physician. It is one of the encouraging signs of the
progress of scientific medicine that these problems are
attracting wider and closer attention. The physician is
nowadays expected to prescribe the diet as well as the
drugs. It is only necessary to refer to the part which
judicious feeding now plays in overcoming the consequen-
ces of malnutrition, originating either in inherited or ac-
quired disease, to illustrate the change which has taken
place in the medical mind with reference to the impor-
tance of the question of diet in its manifold relations to
health and disease.
Before entering upon the immediate consideration of
the subject of the paper, Dr. Draper made a few pre-
liminary statements with regard to the accepted jxithol-
ogy of gout. Gout, as a disease, in the traditionary ac-
ceptation of the term, is a specific arthritis characterized
by the deposit of uric-acid salts in the affected articula-
tions. Gout, as a diathesis, is an accumulation of uric-
acid salts consequent upon either increased formation or
defective secretion of the products of proteid metamor-
phosis. Recent investigations seem to indicate that the
liver is chiefly concerned, not only in the metamorphosis
of the carbo-hydrates, but also in the arrest and the for-
mation of urea, (ilycosuria and lithremia in the same
l)atient, and the frequent alternation of gouty and sac-
charine diabetes, are significant facts in the support of
the common origin of these diseases.
The purely chemical theory of gout and its allied dis-
orders, that it is a disease of suboxidation, has much to
commend it, but it must be acknowledged that it is im-
possible to reduce the theory of defective oxidization to
the simplicity of a chemical equation. Dr. Draper then
presented some objections against this theory, such as
the modification of the metabolism of the food in its
chemical process by natural forces, hereditary complica-
tions, etc., and the fact that the uric-acid salts are pres-
ent in other conditions which are not necessarily accom-
panied by gout. Another fact worthy of notice in the
consideration that excess of uric acid is an epiphenome-
non in the disease and not the exciting cause, is that the
power of digestion of farinaceous and saccharine foods
in gout is markedly diminished. The conclusion was
that the chemical pathology of this dyscrasia is still in-
volved in considerable obscurity.
It is recognized by many that gout is a neurosis. The
great variety of nervous manifestations arrest the atten-
tion in the history of the gouty person, and nervous ex-
haustion is well recognized as a frequent precursor of
gouty disease. Again, the influence of certain diseases
of the nervous centres furnish another striking analogical
argument on the possibility of the nervous origin of the
affection. But such considerations do not invalidate the
humoral theory of the aflection. The conclusion reached
by the writer was that neither the chemical nor the neu-
rotic theory is justified completely by the results of
clinical experience. Whether gout is primarily a neuro-
sis and determined by some chemical process, or whether
it is primarily a chemical process and determined by some
neurosis, were questions which at the present time it was
impossible to answer.
The treatment of gout, based upon the theory that it
is a neurosis, is chiefly successful in the acute arthro-
pathic lesions of gouty origin. The treatment of the
constitutional vice is more successfully managed upon
the theory that it is due to suboxidation of foods. The
treatment of the gouty dyscrasia involves primarily com-
plete combustion of food, whether carbonaceous or nitro-
genous, and has to be brought about partly by dietetic
rules, partly by hygienic, and partly by medicinal treat-
ment. The hygienic treatment embraces an abundant
supply of oxygen, and the medicinal treatment the use of
such drugs as facilitate oxidation, etc. The dietetic
means involves the consideration of the quantity and the
quality of the food best adapted to maintain health and
nutrition. It is impossible to arrive at anything more
than a proximate estimate with regard to the quantity of
food. It is variable, and must be proportioned accord-
ing to the age of the individual and his surroundings,
and the amount of work he is to perform, etc. In in-
fants the amount of food required in proportion to the
weight of the body is from three to five times that re-
quired for an average ordinary working adult. In the
adult regard must be constantly paid to the protection
to be secured against heat and cold, and to the oc-
cupation of the individual. Excess of food may be posi-
tive or relative ; that is, it may be either more than can be'
assimilated, or more than is required. The relation of
the qualities of food in the production of the gouty dia-
thesis may be very striking, and deserve investigation,
although they are less important probably than the quan-
tity. The farinaceous, the oleaginous, and the sacchar-
ine foods are especially indicated for the production of
heat. .\ nitrogenous diet is best constituted to maintain
the health and nutrition of persons who do not require
a large amount of animal heat, and whose occupations
are mental rather than physical.
Leaving the consideration of the principles which
should regulate the diet. Dr. Draper remarked that the
almost unifprm counsel with reference to treatment of
the gouty dyscrasia is, that albuminous foods should enter
sparingly into the diet of gouty patients, and that the
non-nitrogenous foods, especially the farinaceous, should
constitute the principal aliment. His own observation
had led him to the conviction that the uric-acid theory
of the gouty diathesis is not supported by the results of
clinical experience, and he was persuaded that restric-
tion of diet concerning the non-nitrogenous rather than
the nitrogenous foods is essential. If there is one clini-
cal fact more obvious than another in this class of pa-
tients, it is the limited capacity they possess for assimi-
lating the carbo-hydrates, the sugars and the starches.
These substances are the most common source of
February 24, 1883.]
THE MEDICAL RECORD.
219
dyspeptic trouble^. The clinical fact was well estab-
lished that the conversion of the nitrogenous fooils is
rencieied more complete when they contain a niinnnum
ajnoimt of carbohydrates rather than by allowing the
minimum amount of nitrogenous food.
The order of restriction in diet which he recommended
was first with reference to sugars, especially in the state
of fermentation, or ready to pass into that condition ;
second, farinaceous foods, and, third, fats.
Abstinence from all fermented preparations of alcohol
was, perhaps, the most necessary in the order of restric-
tion. There could be no question concerning the
etifects of malt liquors in the production of the gouty
diathesis, especially of the stronger P-nglish and Scotch
ales. The directions, therefore, with regard to fermented
l)reiiarations of alcohol should be very strict. The ab-
solute prohibition of beer should be insisted upon, and
the less wine allowed the better. Sherry, madeira, and
port should be especially excluded. If alcoholics were
indicated, the safest preparation which could be employed
was very dilute spirit taken with food, and never upon
the empty stomach. Saccharine food should be re-
stricted. The common experience of the gouty individ-
ual confirms this statement.
The amylaceous elements were the next in order to
be restricted, and pure starchy foods, such as i>otatoes,
corn, and rice, and even wheat and barley, provoke indi-
gestion. According to his experience the fats were
easily digested by most gouty dys[)eptics. The value of
milk in cases of persistent rebellious lithnsmia was well
known, and constituted a precious resource. Salads,
cauliflower, cabbage, indeed almost all vegetables except
those which are nearly all starch, may be used with
safety. A person pursuing intellectual labor and lead-
ing an indoor life should take only a limited supply of
food which requires oxidation, and had not better try
iniddings and the like, or endeavor to quench his thirst
with beer or wine.
The paper being before the Academy, the President in-
vited Dr. a. Hadoen to open the discussion, who re-
marked that Dr. Draper had recommended a line of treat-
ment very much like that which he had pursued during the
last four or five years in the treatment of gouty patients.
However much it might be against the practice which
had obtained very many years, the clinical facts, as he
had already taken occasion to state elsewhere, were well
established. The use of nitrogenous food, fully allowed,
had counteracted the influence of the gouty dyscrasia,
and especially so in subacute and chronic cases. The
urates in the blood and also in the urine had been dimin-
ished by this plan of treatment, and cutting off as far
as possible the use of saccharine and starchy foods. Dr.
Hadden then spoke at some length concerning observa-
tions which had been made with reference to the pres-
ence of uric-acid salts in birds in captivity, such as the
parrot, pigeon, and domestic fowl, and its absence in
the wild birds, such as the eagle and the vulture, etc.,
and also spoke of similar observations made upon do-
mestic animals. It was quite conclusive in his mind
that the line of treatment advocated would solve the
per|)lexing problem of the gouty diathesis.
Dr. Putna.m-Jacobi remarked that the (juestion of
suboxidation was certainly most interesting, and seemed
to her unquestionably true as brought forward by Dr.
Draper ; but simply to state that certain substances did
not pass through their normal term of oxidation was not
oftering any explanation of the fact, certainly did not
bring into any single expression the effects of heredity
upon various manifestations of gout and the nervous phe-
nomena which exist, either as a cause or as a consequence
of it. She referred to the experiments of Pettenkofer
and Vogt on the respiration, who had developed one fact
of special interest in connection with this subject, namely,
that the amount of oxygen taken up in the blood is in
proportion to the amount of albumen stored up in the
tissues of the animal experimented upon. It was well
known that, contrary to previous expectation, it was ex-
tremely difficult to increase the amount of oxidation by
increasing the amount of oxygen. By increasing the
quantity of oxygen presented to the lung the increase of
oxygen which entered into the blood was very trifling ;
but in proportion to the increase of the albumen in the
food, there is a measurable increase in the quantity of
oxygen taken in, and esjiecially that which remains stored
up in the tissues. This was the result of the experiments
of P. and V. Further, it was determined that the oxida-
tion of the circulating albumen is not carried on by means
of oxygen absorbed at the time, but by means of oxygen
which is stored up in the tissues from previous respiration.
Thus, the difference between the amount of oxidation
which goes on in the day and the night is considerable ;
more oxygen is taken in through the day, and more oxi-
dation goes on during the night.'
The last terms in the long and complicated process-
of proteid metabolism arc probably defective in gouty
persons, and the extraordinary nervous manifestations,
such as pertain to the heart, mental dei)ression, etc., are
especially associated with the deficient evolution offeree
resulting from this. It was very certain that the source
of the uric acid is by no means always the result of in-
complete development of urea. There is no constant re-
lation between the excess of uric acid and deficiency in
urea. It is also certain that a person in whom the gouty
constitution exists may sometimes have a most profound
liypochondriasis and be almost upon the verge of insanity,
and yet no lithates nor quantitative excess of uric acid be
found in the urine. She had had one such patient under
observation, who was cured by an exclusively milk diet.
She added her testimony to that of Dr. Hadden with re-
gard to the utility of jnirely meat diet in irregular lithiasis,
and had a great many cases which would prove it, as
shown by quantitative analysis of urine giving a fall of
uric acid under its use. She would like to ask Dr. Draper
what he did to enable the patients to tolerate the meat
diet when any difficulty was experienced in taking it.
Dr. H. G. Piffard remarked that, some seven or
eight years ago, he read a paper in which he advocated
precisely the same views presented by Dr. Draper, and
also referred to a paper read by Dr. Draper at about the
same time, and of the same intent, namely, that gout was
due in a great measure to failure of complete oxidation
of the peptones, and that a hesitancy in the oxidation
process led to the formation of certain acids. He
thought that that view was combated by Dr. Hadden' s
theory and also by his facts. However, stepping aside
from theories, the practical fact remained, that if we
wished to be good livers we must have good livers, else
we shall suffer from over-indulgence. He thought it would
liave been well if Dr. Draper had called attention to the
fact that the effects of these various articles of diet is
more apparent now than twelve or fifteen years ago, and
he believed it to be due largely to the use of glucose in
the manufacture of beer and wine, es|)ecially American
wine. Many of the German wines, particularly Rhine
wine, also contained considerable glucose.
Dr. F. p. Kinnicutt corroborated the clinical ex-
perience referred to by Dr. Draper, and also spoke of the
intimate relation existing between diabetes and lithie-
mia.
Dr. Janewav remarked that when milk diet was spoken
of as purely nitrogenous, it must be admitted that a con-
siderable quantity of sugar was taken, and also sugar
which admitted of acid fermentation.
It seemed to him, from what he had seen of gout, that
the main thing should be, so far as possible, to avoid
dyspeptic occurrences. This, perhaps, may be accom-
plished sometimes by the use of nitrogenous food, and
at other times we are obliged to resort to the reverse.
Again, with regard to the pathology, if the neural
' It was this influence of stored albumen on the ingestion of oxygen that might
probably explain whv an excess of albuminous food will provide for its own oxida-
tion and uric acid will diminish.
2 20
THE MEDICAL RECORD.
[February 24, 1883.
pathology is to be accepted, he thought we ought to see
among the immense number of nervous jiatients gouty
deposits more frequently than they are met with. Ac-
cording to his observation, gout was not of so frequent
occurrence among nervous patients. There are other
manifestations in tiie joints, but not gouty in cliaracter.
Again, there came in the fact that gout might be deter-
mined by anajmia, and sometimes it is determined by
some nervous affection, but when it did appear after some
nervous phenomena, it was, perhaps, more hkely due
to the nervous action setting up a dyspeptic condition
than acting primarily. He was inclined to accept the
humoral jiathology, so called, rather than the neural ex-
planation of the atTection.
The President said it had seemed to him that every
case of gout was a problem by itself, depending not only
upon hereditary tendencies, but also upon the habits and
surroundings of the patient, and also certain idiosyncra-
sies which make it impossible to settle upon any special
plan of treatment for all. There are gouty persons in
whom a single strawberry will bring on an attack ; others
in whom a single slice of watermelon will develop a par-
oxysm ; still others who can eat strawberries and water-
melons with the utmost freedom, and yet are unable to
take the slightest quantity of roast beef. Other patients
are unable to take wines or malt liquors, and at the same
time may take whiskey. There are gouty patients w'ho
cannot take any alkalies without an explosion of the dis-
ease, but at the same time they are able to take strong
acid wines with benefit. Several cases were related illus-
trating these points. The point which he wished to draw
out from the author of the paper was this : It seemed to
him that it was extremely difficult to lay down any sys-
tem or plan of treatment or diet which will api)ly to all.
Consequently the danger lies in our attempting to gen-
eralize and reduce any general law applicable to all
cases.
Dr. Flint remarked that, concerning a comparatively
nitrogenous diet, he was not prepared to offer any opin-
ion at present. He remarked, however, that he believed
we must go to clinical observations to settle many of
these questions ; that a sufficient number of cases treated
according to this plan or that plan should be secured,
from which to draw conclusions. He should feel doubt-
ful about accepting any views concerning the pathology of
the aftection based either upon neurology or chemistry.
He thought it desirable to collect a considerable number
of cases, as nearly analogous as possible, with reference
to determining, by a clinical study, whicli of all these
forms of diet would accomplish most.
Another reflection was the consideration of the influ-
ence of heredity upon the gouty dyscrasia. Perhaps
there is no disease, or but kw at least, in which dyscrasia
plays so strong a part as in gout. There are but few dis-
eases in which heredity is more distinctly manifest. Then
again, it is developed at a certain period of life, as a
rule. Exactly in what some of these influences consisted
cannot be said, but the fact should not be overlooked,
and in our investigations we should make a large allow-
ance for the existence of these elements and the difter-
ences in different persons.
Dr. Draper, in closing the discussion, s.iid that he
had not had nnich difficulty in getting his i)atients to carry
out the kind of diet recommended because he liad rarely
found it necessary to keep them upon a strictly and ab-
solutely nitrogenous diet, such as Dr. Jacobi seems to
have done. Occasionally he had been obliged to restrict
patients absolutely from the use of sugar and to a very
modeiate amount of wheaten bread. He believed, how-
ever, that ])ersons, as a rule, who were confined to a diet
of this kind were very rebellious, and after a time it be-
came necessary to grant them some indulgence. He had
never found any difficulty in adding to the diet certain
varieties of green succulent vegetables, and they certainly
contributed a great deal to tlie comfort of the patient.
With regard to Dr. Janeway's remark concerning milk,
he admitted its truth. Milk contains a considerable
quantity of sugar, and its administra'tion is antagonistic
to the theory that gouty patients do not digest sugar, but
he believed that in the use of milk it is always necessary
to give patients more or less of an alkali, and that when
soda is given with the milk it is commonly very well
borne.
He entirely concurred with Dr. Flint in his reflection
that these questions must be settled by clinical observa-
tion, and in the review of the pathology of the affection
which he gave, he endeavored to say clearly that the diet
reconnnended could not be explained, nor justified, by
either of the theories given. It was well known, and this
point was worthy of special attention, that the diet which
has been prescribed in gout forms a part of that which
has been based upon the chemical pathology of the dis-
ease. He did not think that anybody could explain why
a diet of animal food was the one which agreed with the
majority of gouty ])ersons. And yet he believed that
from his own experience it was absolutely true that it did
agree with them, and that it was the best means of pro-
tecting these patients against the subjective and objective
symptoms of the disease.
With regard to Dr. Barker's observation, he presumed
that the experience of every physician could furnish a
great variety of apparently contradictory facts, such as
he had mentioned. So far as he was concerned, he was
unable to explain them. Why an attack is determined
by a single strawberry or a single slice of water-melon,
or indulgence in grapes, he was unable to explain, unless
it was upon the basis of the neural pathology, and that
there was something in the nervous system of the
person having the gouty dyscrasia which rendered him
particularly susceptible to the irritations which are con-
veyed in certain articles of diet. Dr. Janeway had stated
that he believed the majority of nervous patients, women
for example, are very seldom gouty. Dr. Draper ad-
mitted that a great many of them were not, but he
was quite sure that a great many of them were,
although they have not had arthritic lesions, and he
thought we were often led to wrong conclusions in sup-
posing that gout did not exist on account of the absence
of the arthritic aflection. Other manifestations of this
dyscrasia may be present, such as the dyspepsia provoked
by fermented liquors, or the cutaneous irritations, or the
inflammatory manifestations, or the hypochondriasis, and
hysterical disturbance so connnon among men and women
in the later periods of adult life.
Dr. Hadden stated that in his cases milk was not
well borne, and he thought the fact was explained prob-
ably by the presence of the sugar in the milk. As a
substitute for the gluten bread he had used wheaten bread
thoroughly toasted.
The Academy then adjourned.
The Licence-tax on Physicians in Virginia. — At
the last session of the Virginia Legislature, the State li-
cence-tax on physicians residing in cities and towns of
5,000 inhabitants or upward, was raised from fifteen to
twenty-five dollars ; and throughout the State tlie dis-
crimination was made between city and country doctors
to the extent of makiiig city physicians pay U/i dollars
more than the country physician tor the same thing. The
Southern Clinic i)rotests strongly both against the dis-
crimination and the tax. The State, we are told, makes
no provision for her sick poor, but expects the doctors
to look at'ter them gratis.
An Alleged Case ok Leprosy in Delaware. —
Some excitement was caused at Lewes, Del., recently,
by the landing of a stranger from an English vessel, who
confessed to being a victim of leprosy. The man was
of P'nglish birth, but had contracted the disease in Mada-
gascar about ten years before.
I February 24, 1883.]
THE MEDICAL RECORD.
221
OPo vvcsp 0 u tic ucc.
SECONDARY PUERPERAL HEMORRHAGE
COMPLICATING SEPTIC ENDOMETRITIS.
To THE Editor of The Medical Record.
Sir : Tlie interest awakened in tlie subject of secondary
puerperal heniorriiage by the reading of a paper with
that title, at the Academy of Medicine, on January i8th,
by Dr. Paul F. Munde, prompts me to publish the fol-
lowing somewhat detailed history of a case, in a number
of respects like the one reported in that paper.
The patient was Mary C , a native of Ireland,
aged twenty-one. She was a primipara, and was seen
by nie two weeks iirevious to her confinement.
Prei-ioHS Iiistory. — Although never robust, the patient
had enjoyed fairly good health uij to one year prior to
the present pregnancy, at which time she contracted an
initial lesion, which was followed by prolonged second-
ary manifestations. When I saw her, all that indicated
the constitutional disease was a profound condition of
anaemia.
Parturient history. — She was taken in labor at lo a.m.
on Wednesday ; I saw her three hours later. On exam-
ination per vaginum I found a roomy vagina and pelvis
of normal dimensions. The cervix was high ui), soft,
and distensible, and through the os, which was dilated to
the diameter of a silver quarter of a dollar, the intact
membranes were protruding. Passing the finger through
the OS, I made out the vertex presenting with the occiput
to the right and anteriorly. Further examination proved
that the head was hydrocephalic and somewhat enlarged.
The fcetal heat was 152^. The pains were slight, but
together with her excitement, enough to keep her awake
and uncomfortable. I therefore had administered chloral
hydrate, 15 gr. per rectum, under the influence of which
she soon fell asleep and slumberetl until the membranes
_ ruptured, which occurred about one hour before the os
was fully dilated. The first stage lasted ten hours.
Seven hours later the head had descended to the in-
ferior strait, but ceased to advance. After waiting half
an hour, I had chloroform administered, and delivered
with the forceps a living hydrocephalic male child. The
second stage was of eight hours' duration.
After gentle massage at the fundus uteri there were de-
livered in eight minutes the placenta and membranes in-
tact. Five minutes later the woman had come up from
under the influence of the anaesthetic enough to be able to
swallow one drachm of Squibb's fluid extract of ergot,
which I invariably administer after the delivery of the
placenta. A second drachm dose was given as soon as
she was perfectly restored to consciousness. I held my
hand at the fundus uteri for one hour after delivery, being
occasionally relieved by the nurse, and when I left the
patient's bedside the uterus was firmly contracted, the
pulse was 100, and she had fallen into a quiet sleep.
The cervix and perineum were uninjured.
Puerperal history.~Ti\nma the following eleven days
her average temperature was over 100° F., the highest
thermometric point reached being 103° F. ; this occurred
on the third day, and followed a well-marked rigor.
During all this period her pulsq was over 100 and very
small. The uterus underwent involution somewhat
slowly, and was slightly tentler when moderately com-
pressed between the hands during conjoined mani]nila-
tion. The os was widely gaping, and the finger through
it felt the lining membrane of the uterus soft and boggy.
The lochia were suppressed for twenty-four hours after
the chill, and when they returned were scanty at first,
but later became very profuse, and varied from time to
time from a grumous to a serous fluid. The odor was at
all times offensive, and occasionally markedly fold.
I diagnosed the condition as being puerperal septic en-
dometritis. The treatment consisted of intra-uterine and
vaginal injections of hot dilute solutions of carbolic acid.
On the twelfth day the temperature went up to loa-J**
l"., while the pidse ranged from 120 to 130. I attributed
the rise of temperatiu'e to the separation of the slough at
the placental site, by which a solution of continuity was
caused, and this, by opening u|) mouths capable of think-
ing in from the septic matters present in abundance in
the cavity of the uterus, allowed of a sudden although
slight general septic intoxication.
After washing out the uterus the temi)erature steadily
fell, until at 8 a.iM. of the following day it was normal, and
she was feeling better than at any time since her delivery.
This was the morning of the thirteenth day ; about 10
A.M. I was smnmoned to her by the message that she
was dangerously flooding. I arrived twenty minutes
after the bleeding began, and found her extremely ex-
sanguinated. The bed, bedding, and clothing were
saturated with blood, while a large mass of clots lay in
the bed between her thighs. The vagina contained a
number of soft clots ; these I gently removed, and was
much relieved to discover that the bleeding had ceased.
The pulse ranged from 150 to 160, the liiis were abso-
lutely without color, and the countenance was blanched
and anxious. The patient's intellect was clouded and she
had slight hallucinations. The uterus had not been dis-
tended by the blood, as it was not perceptibly increased in
size, so far as I could make out by gentle abdominal pal-
pation. I gave her hypodermically ten grains of ergotine,
and had her partake freely of alcoholic stimulants and
iced milk. She was allowed to lie upon the bloody
sheets, and nothing was in any way disturbed about her.
The bleeding recurred again twice or three times during
the day, but the amounts of blood lost were so trifling
that I was not sent for. Twelve hours after the bleed-
ing occurred, I had dry linen placed under her, and after
having a second hypodermic of ergotine, she was left un-
disturbed for the night.
For eighteen days alter the hemorrhage the tempera-
ture remained above normal, and it was over six weeks
before her general health began to show marked signs of
improvement. Her uterus remained in a state of subin-
volution. I would say in conclusion :
First. — I believe that puerperal septic endometritis
occurs separate and distinct from metritis more fre-
quently than is generally supposed. The slight symp-
toms it gives rise to are usually attributed to light gen-
eral septic poisoning.
Seeond. — The above condition may undoubtedly cause
secondary puerperal hemorrhage. This is probably
brought on by the separation of an unhealthy slough
tiom abnormal tissue at the placental implantation, and
this, by opening up the mouths of the uterine sinuses, al-
lows of free, or.it may be even fatal bleeding.
T. T. Gaunt, M.D.
132 West Twentv-third Street, New York.
I^riny |Tlc\us.
Official List of Changes of Stations and Duties of Officers
of the Medical Department, United States Army, from
February 10, 1883, to February 17, 1883.
Brown, Jos. B., Lieutenant-Colonel and Surgeon. De-
tailed as member of Board for Examination of Assistant-
Surgeons for Promotion, and Candidates for Admission
into the Medical Corps, United States Army, to convene
at New York City on March i, 1883. S. O. 35, par. i,
A. G. O., February 10, 1883.
Clements, Bennett A., Afajorand Surgeon. Detailed
as member of Board for Examination of Assistant-Sur-
geons for Promotion and Candidates for Admission into
the Medical Corps, United States Army, to convene at
New York City on March i, 1883. S. 6. 35, par. i, A.
G. O., February 10, 1883.
Janewav, John H., Major and Surgeon. Detailed as
222
THE MEDICAL RECORD.
[February 24, 1883.
member of Board for Kxamination of Assistant-Surgeons
for Promotion and Candidates for Admission into the
Medical Corps, United States Army, to convene at New
York City on March i, 1S83. S. O. 35, par. i, A. G. O.,
February 10, 1883.
Town, Francis L., Major and Surgeon. Is reUeved
from duty at Fort Walla Walla, and ivill report to Com-
manding Officer, Vancouver Barracks, for duty as Post
Surgeon. S. O. 7, Department of the Columbia, January
27, 1883.
Woodward, J. J., Major and Surgeon. The extension
of leave of absence, on account of sickness, granted
October 6, 1882, is further extended six months, on ac-
count of sickness. S. O. 34, par. 9, A. G. O., February
9. 1883.
De Loffre, Augustus A., Captain and Assistant-Sur-
geon. Relieved from further duty in this Department. S.
O. 28, Department of the Missouri, February 5, 1883.
Newton, R. C, First Lieutenant and Assistant-Sur-
geon. Is relieved from duty at Fort Cummings, N. M.,
and will proceed to Fort Sill, I. T., and report to the
Commanding Officer for duty. S. O. 28, Department of
the Missouri, February 5, 1883.
medical Items.
Contagious Diseases — Weekly Statement. — Com-
parative statement of cases of contagious diseases re-
ported to the Sanitary Bureau, Health Department, for
the two weeks ending P'ebruary 17, 1883 :
Week Ending
V
>
3
>
•o
■3
u
u
>
V
■li
V
1
X
0
a
>
a
0.
2s
s
•a
5=
_o
H
H
crt •
u
^
u
(n
>
February lo, 1883
0
4
69
6
73
41
0
0
February 17, 1S83
0
2
85
7
75
5'
0
0
The Tariff on Skeletons. — In the present agita-
tion over the questions of tariff" and free trade, the needs
of our Western anatomists should not be forgotten. The
Chicago correspondent of T/ie British Trade Jouriuil,
in enumerating the principal articles of import into that
city, such as human hair, wigs, lace, nets, etc., says :
" Curiously enough, foreign skeletons of the genus homo
are largely imported into Chicago, and are sold at less
■cost than they can be scra|)ed, dressed, and mounted
here. Tliis, notwithstanding that we have no lack of
pauper subjects, buried at the expense of the county of
Cook, and on which our medical colleges largely depend
for their cadavers. Still, will it be believed, these for-
eign skeletons are loaded down by a tariff of thirty-five
per cent ? This, too, is in face of the fact that the laws
against ' resurrectionists ' are extremely stringent in this
and other Western States.''
Young America. — At the close of Dr. Morell Mac-
kenzie's lecture at the Bellevue Medical College, New
York, one of the students from " out West " remarked
to his neighbor, " That feller talks our language \ery
well for a foreigner." — Lancet.
The MASSACHUSErrs General Hospital. — Gover-
nor Butler has nominated Dr. Henry G. Clark as a State
trustee of the Massachusetts General Hospital, in place
of Mr. William Endicott, Jr. This hospital is to begin
in March the erection of a large addition to the present
quarters of the Out-patient Departmeijt. There were
treated last year in this department over sixteen thou-
sand five hundred patients ; and the present accommoda-
tions are too limited. There are male and female medi-
cal, surgical, nervous, eye, throat, and skin departments,
as well as the dental clinic of the Dental School.
The new Thayer building for nurses is to be open by
April I St. This is a substantial brick structure, and will
accommodate fift3'-four nurses, giving each a separate
room ; and it contains a large parlor, and suite of rooms
for the Superintendent of the Training School.
A most successful department of the hospital is the
Convalescent Home at Waverly, beautifully situated on
high land, convenient to the railroad station, and but a
few miles from the city. It has now been open ten
months, and has fulfilled everything hoped for by its pro-
jectors. The average number of patients has been ten.
The medical officer in immediate charge is one of the
surgical externes of the hospital. Those cases, so famil-
iar to every hospital surgeon, that after operation ad-
vance to a certain point, and then remain stationary or
begin to sink, are here found to recover rapidly, and
many lives are saved that would be lost in the air of a
city hospital.
The Medical Library Association, of Boston, has
added to its library a new circulating department, which
is intended to furnish the latest works to members at a
low rate per day.
Small-pox in Boston. — One case of small-pox re-
cently arrived in Boston from Baltimore, by steamer.
The Board of Health ordered vessels from that port to
be quarantined accordingly.
An Unpleasant Aural Intruder. — Apropos of the
late discussion in The Medical Record, on the Removal
of Foreign Bodies from the Ear, Dr. J. M. W. Kitchen
offers the following bit of experience : " On the 9th inst.,
during my service at the MetroiJolitan Throat Hospital,
a German woman appeared and complained of trouble
in her ear. She said that at twelve o'clock at night
(eighteen hours previous), slie had experienced ' a crawl-
ing in her cheek, and now she had it in her ear and knew
it was there.' This was somewhat indefinite, but inspec-
tion showed that a brown shining body, resembling dried
cerumen, covered the drum-head. Cautious touch with
a probe disclosed the fact that the body was alive, and
that the patient felt ' him scratching her head out.'
Considering the insect's formidable claws, it must have
created an unpleasant sensation, to say the least, to have
it clawing at the sensitive membrane. The insect filled
up the lumen of the canal completely, and was in close,
contact with the drum-head. The patient had prodded
it in with a hair-pin. It could not turn around, and it
could or would not back out ; but it sciuirmed and
twisted away from forceps and hooks in a marvellous
manner, its horny shell being very slippery. It at last
became evident that the bug must die, and finally, oil
not being at hand, I succeedeil in piercing its abdomen
with Dr. W.agner's sharp-pointed cotton holder, and then
poured a weak solution of carbolic acid into the canal.
This iirocedure reduced the creature's vitality to the
desired point ; and then an improvised square flat hook
being pressed between the insect and the wall of the
canal, and a quarter turn being made, the hook engaged
with some part of his anatomy, and he was dragged ig-
nominiously into the outer world, much to the patient's
relief, and putting an end to the discussion that was
arising in my mind as to whether I should call with the
jjatient upon Dr. Sexton or Dr. Knapp, for the help
that their several instrumental aural armaments might
afford. The insect looked like a young cockroach, and
was one-half inch in length."
What the Doctor is Expected to Do for
Nothing. —A correspondent from Pennsylvania writes :
" In your issue of January 20, 1883, you compare the fees
paid the medical attendants of the late President and
those of the lawyers in the Star Route cases, also call at-
February 24, 1883.]
THE MEDICAL RECORD.
223
tention to the pay of surgeons on ocean steamers. Bear-
ing on the same subject, is it not time for the profession
to consider iiow generally their services are underrated, or
rather, how niucii more gratuitous service is expected
from them than any other class? Is a hospital es-
tablished, other expenses may be liberally met, but
|>hysicians must be fatisfied with honor alone, in return
for a liberal daily expenditure of time and the best
skill the city affords, and the resident physicians must
give all time and not leave the premises without permis-
sion, and yet pay their board in advance ; at least this
was the custom in the City (Blockley) Hospital in Phila-
delphia, twenty years ago, and 1 suppose is now. This
general idea aiiplies to all the dealings of the public with
the profession. No matter how liberally other expenses
are compensated, physicians must serve the jiublic for
honor. Can you mention any other profession, trade,
or business where liberal pay is not expected for all ser-
vices ? Apprentices, clerks, lawyers, students, get paid
for their services while learning the business, and crimi-
nals who claim to be unable to employ counsel, either
have a lawyer furnished by the State or go without. My
personal experience bears this out, living here among the
miners. Let one be injured, liberal collections are often
made to pay his grocer, etc., but never a cent for the doc-
tor ; on the contrary, he is generally expected, while giv-
ing constant daily attention, perhaps for months, to con-
tribute more than his fair proportion for other expenses.
Several years ago a wealthy corporation called upon
jiie to attend one of their men, who was terribly injured
by an explosion. It recjuired constant attention for sev-
eral months, at a distance of six miles from my home.
They paid the [patient's board, furnislied him a nurse and
all other necessary expenses, but when the man finally
^ot well, told me that they were incorporated to mine
coal, not pay doctors. All are under the universal idea
tliat the profession is under special obligation to work
for the poor gratuitously. Where else will not the same
amount of skill and education command better remunera-
tion than in the medical profession, when public services
are to be performed, and where else is the same amount
•of gratuitous services required?"
An Anti-Quack. Wrapper. — Dr. F. H. Darby, of
Morrow, Ohio, has published a four-paged and double-
•coluumed sheet wrapper, filled with useful information
for the sick ; designed for druggists and physicians who
dispense their own medicine. It can be torn into halves,
quarters, eighths or sixteenths, without marring the
printed matter. The paragraphs comprise abbreviations
of that portion of the Code of Ethics relating to "The
duties of patients to their Physicians," useful receipts,
etc. Dr. Darby says that these wrappers can be sup-
plied at a very nominal cost.
Dissolving CoAGULA in the Bladder.- — Dr. W. Titus,
of Newark, N. J., reports a case of hemorrhage into the
bladder in wliich the resulting clots were satisfactorily
dissolved by the injection of a solution of pepsin.
Hysterical Hair-Curling. — A very curious and
unique case, which is denominated as above by Mr.
Le Page, of Durham, England, hysterical hair-curling, is
reported in the Lancet. The history is suspicious, but the
facts are well vouched for, as will be seen. The patient,
aged seventeen, with a history of irregular menstruation,
had felt ill with vari(_>us neurotic symi)tonis, and a feeling of
" pins and needles" over the scalp and general numbness
■of sensation. In the evening she washed her head in tepid
water. After partially drying her hair with a towel (she
did not approach a small fire which was in the room), and
while so engaged in the presence of her parents, nearly
the whole of the hair on the right side of her head drew
up into a hard lump, and felt as if it would pull the roots
out. Her father and mother were engaged until nearly
two o'clock the next morning in the endeavor to un-
tangle and straighten the almost solid mass, with but little
success. The few ends combed out were spread on a
pillow she then slept on ; on awaking they found them
drawn up as before. The hair on the left side of the head
was quite smooth, very lightly waved, and not in the
least tangled or drawn up. Viewed with the microscope,
it was evident all the hairs which are contracted are flat,
while those hairs which remain comparatively straight or
looped and festooned are round. This disposed of a
shadow of suspicion which naturally accompanies any
unexijlained phenomenon in a "hysterical" female.
Viewed without the microscope, it was at once evident
that no dexterity could have produced the condition of
the hair. Mr. Le Page's hypothesis in explanation of the
case is that excessive nerve-tension found vent in the
pigmentary portion of the hair — viz., that some change
analogous to electrolysis took place in the medullary
portion, leading to chemical change, decrease of bulk,
and contraction. Sir Erasmus Wilson regarded the con-
dition as very interesting and extraordinary, and, as
never seen by himself, had desired and received permis-
sion to deposit Mr. Le Page's specimen in the dermato-
logical department of the museum of the Royal College
of Surgeons of England.
The Removal of a Foreign Body from the Ex-
ternal Meatus. — Dr. E. L. Holmes, of Chicago,
writes: "The jierusal of quite recent articles on this
subject in The Record leads me to relate an experience
in removing, some years since, a pebble firmly imijacted
in the external meatus of a boy six years of age.
" Inspection showed that no form of forceps could
grasp the stone, as it had been pressed with consider-
able force deep into the external meatus, in malicious
sport, by an older companion.
" A protracted use of the syringe failed to dislodge
the foreign body.
"As I had but one ordinary steel hook, it occurred to
me to employ with it an old and unusually large cysti-
tome used in cataract operations.
" After the administration of ether, the hook and then
the cystitome were each in turn pressed between the
stone and walls of the meatus, with little injury of the
integument. The handles of the instruments, parallel
and near each other, were then so turned that the points
of the hooks were directed to the axis of the meatus.
The instruments, held firmly together, were withdrawn
with considerable difficulty, bringing with them the stone.
"A special instrument with two hooks could be con-
structed, with suitable handles and a simple ' lock.'
Properly introduced and 'locked,' they would constitute
in fact a double hook.
" I have never met, in a long exi)erience, with another
case in which a hard foreign body in the ear was not
renv3ved bv syringing.
"A very hard substance, equal in size to the diameter
of the meatus, and crowded against the membrana tym-
pani presents to the aurist a serious problem. Such a
contingency is rare, and does not fall within the purpose
of this communication."
On the Meaning ok the Words Nyctalopia and
Hemeralopia. — Mr. Tweedy communicates to the
"Royal London Oiihthalnuc Hospital Reports " a long
and learned article, discussing, in all its bearings, this
much-vexed question, and arrives at the conclusion, now
generally accepted, that the true meaning of nyctalopia
is night-blindness (6 rr/s vmkxo% dAads), and, consequently,
that the true meaning of hemeralopia is day-blindness.
Goats and Homceopathy. — It is a pleasure to learn
that the goat is an animal which responds well to homoeo-
pathic remedies. In Surrey, Englantl, there is a goat
farm where Guilielmus capricornis is raised and milked
for the alleged benefit of the babies of London. A vis-
itor says: "The goats, young and old, appear clean
and perfectly healthy ; their bright, hairy coats are sub-
jected to curry-combing ; no troublesome foot disease
224
THE MEDICAL RECORD.
[February 24, 1883.
demands attention as in the case of sheep, and any in-
ternal aihnents are promptly and successfully dealt with
by homoeopathic medicines, of whicli the manager, Mr.
Farrer, speaks with the greatest confidence and satis-
faction." We should like very much to have Mr. F. re-
port tons sojue cases. No doubt intinitesimal doses will
affect a credulous man, but not a sensible goat. — Jour-
nal of Comparative Medicine.
Donation to Veterinary College. — A subscrip-
tion of $10,000 from Mr. J. B. Lippincott, for the estab-
lishment of a veterinary college in connection with the
University of Pennsylvania, was received by the trustees
of that institution, recently.
The Action of Pilocarpin upon Horses. — After a
subcutaneous injection of pilocarpin (gr. j.) the saliva
begins to flow and continues for about an hour. The
injection of a large dose (gr. iij.) will cause the secretion
of one or two ipiarts of saliva in a short time. There is
also a considerable discharge from the conjunctival and
nasal mucous membranes. Tlie temperature rises froui
two-fifths to one degree F. The heart beats faster by
five to ten pulsations. General perspiration does not
often occur. Frequent urination will be noticed, .^fter
several days' use of pilocarpin the fsces become softer.
The horse does not seem to be weakened or made less
active by the drug. It has been found somewhat useful
in diminishing dropsy from kidney or heart disease, also
in lessening the amount of pleura; effusion (in dogs). Its
action on the heart is weakening — a fact to be remem-
bered.— Journal of Comparative Afedicine.
The Reign of Absinthe is Dr,\wing to a Close. — .A.
rival has invaded its dominions and is makins: most rapid
progress. The new beverage is called Amer-Picon—
that is, Picon Bitters. It is said to be tonic, to assist
digestion, to be an aperient and a febrifuge, and withal
an agreeable stimulant. 'J'he Amer-Picon is pre|)ared
from -Algerian plants, and it is more than thirty years
since i\I. Gaetan Picon began to make it in that col-
ony.
The Sti.mulating Properties of 0.\ts. — We have
heard much lately about the remarkable thera[)eutical
powers of avena saliva, which powers have been generally
discredited. M. Bouley recently presented to the .Vcad-
emie des Sciences the results of investigations by M. X.
Sanson) upon the subject. Experiments were carried on
at the Ecole de Grignon. With the aid of Du Bois Rey-
mond's apparatus, the neuro-muscular excitability in
horses was tested before and after the ingestion of oats.
Numerous and repeated experiments have established,
says M. Sansom, the following facts :
1. The pericarp of the oat contains a substance, solu-
ble in alcohol, which has the property of stimulating flie
motor cells of the nervous system.
2. This substance is nitrogenous, and probably belongs
to the group of the alkaloids. It is uncrystallizable,
brownish, finely granular. Its formula (subject to verifi-
cation) is C^j,Hj,NO,j. It is called avenine.
3. -Ml varieties of oats contain some of this alkaloid,
but not to an equal e.\tent. The ditTerences depend
upon soil as well as variety. The varicte noire generally
contains the most.
4. If the amount of avenine is below 0.9 per cent, of
dried oats, it is insufficient to cause excitation.
No facts are given regarding the effect of the avenine
upon the human organism.
./■ Union by First Inte.ntion in Scalp Wounds. — Dr.
Robert T. Morris, of Bellevue Hospital, N. Y., gives the
following directions for securing primary union in scalp
wounds :
Let us take for example a typical case.
A man in good health is struck upon the head by a
falling beam, and receives a lacerated and moderately
contused wound. The wound is a couple of inches long.
extending entirely through the skin, and gaping perhaps
to the extent of a quarter of an inch. The bleeding is
so profuse that the patient comes to you promptly,
thereby giving you a great advantage.
Of course the first thing to be done is to make suffi-
cient pressure to control the hemorrhage, and then the
hair is carefully trimmed away from the edges and vicin-
ity of the wound. A patient who is bald here finds for
the first time a redeeming feature to his condition.
After sufficient hair has been removed a thorough syr-
inging of the wound with carbolized water (1-30) should
follow, and then a most thorough search must be made
for any foreign body, a single hair left in the cut being
sufficient to prevent union bv first intention in its vicin-
Twist together two or three horse hairs which have
been kept in carbolized oil and lay them in the wound,
allowing the ends to project from either extremity, and
then, with a medium-sized curved needle, put in enough
silk sutures to bring the edges of the skin closely in ap-
position, taking care that the needle penetrates the en-
tire thickness of the skin each time that it is inserted.
.A-fter all of the sutures have been tied, the horse-hairs
should be pulled back and forth a little by means of their
projecting ends, in order that the canal for deep drainage
may be free.
Superficial drainage is next to be looked after, and
this end may be gained very nicely by wringing out six
or seven thicknesses of cheese cloth in carbolized water
(1-30), and applying as a compress on the wound, first
rubbing a little iodoform well into the portion which is to
come next the skin. Gutta-percha tissue, or any other
waterproof material, should then be placed over the
cheese cloth, and the edges allowed to project far enough
over so that everything beneath will remain moist and
warm. -A bandage applied not too tightly completes the
dressing.
In twenty-four hours the horse hair may be removed,
and the dressings replaced. In forty-eight hours or later,
the stitches should be removed, and a warm and dry
dressing placed over the site of the wound. If the pa-
tient is asked to return for examination in a day or two,
the wound will almost always be found to have united
beautifully by first intention, and a long period of sup-
puration, with numerous complications, to have been
avoided.
When failure occurs in a case like the one described,
the causes are usually due to lack of care in the applica-
tion of the deep or superficial drainage.
The sutures may have been tied more tightly than
necessary, or some foreign material may have been Irft
in the wound.
Heart Scanning, or the Metrical Treatment of
the Pulse. — Dr. Samuel W. Francis, of Newport, R. I.,
says that the normal " beat " of a healthy heart is iambic,
--'— ; and that when it is trochaic — —-, pyrrhic — -, or
like a spondee — — , it should be regarded as a signal,
to the physician, that there is something wrong, which
calls for a thorough investigation by auscultation and per-
cussion.
Dr. Francis also reports a case where the pulse was
only 29 to the minute; and the beat dactylic — -:
the long and two short being well marked. The patient
was a lady, sixty years of age, who recovered under dif-
fusible stimulants and counter-irritation.
Inebriety and the Teeth. — The pastor of a large
mission chapel in this city is in the habit of using moral
compulsion with his people to have them keep their
teeth in good condition. If any one has bad teeth he is
sent to a dentist, who fills or extracts them, as may be
needed. A dentist is supi)lied who does the work for
nothing, if the patient cannot afford to pay. The clergy-
man in question states that he has had much less trouble
from drunkenness since he adoptcil this plan. We com-
mend it to the attention of our inebriate specialists.
The Medical Record
A Weekly yournal of Medicine and Surgery
Vol. 23, No. 9
New York, March 3, 1883
Whole No. 643
(OviQinal ^^cctuvcs.
ON THE
RELATIONS OF MICRO-ORGANISMS TO DIS-
EASE.
The Cartwright Lectures, delivered before the
Alumni Association of the College of Physi-
cians AND Surgeons, New York.
By WILLIAM T. BELFIELD, M.D.,
LECTURER ON PATHOLOGY, AND ON GRNITO-UklNARY DISEASES (POST-GRADUATE
course), rush MEDICAL COLLEGE, CHICAGO.
Lecture II.
sepsis and antiseptic surgery.
The infectious diseases usually consequent upon wounds,
and therefore falling within the province of the sur-
geon, merit somewhat extended discussion. Such dis-
eases were known to the earliest medical writers, and,
we may assume, antedate man himself by so much time
as the existence of highly organized life preceded him.
Clinical experience had, long before the advent of ex-
perimental research, identified infectious septic material
with the products of that complicated process whereby
lifeless organic substances are de- and re-composed into
chemically less complex matters — putrefaction; and
early experimental investigation was directed to the elu-
cidation of that jirocess and its relations to disease.
Gaspard first proved experimentally that the injection of
putretying substances of animal or vegetable origin —
blood, pus, bile — was followed by the clinical features of
sepsis. Panum demonstrated that the putrid infectious
substance is not gaseous ; that it is not destroyed by eleven
hours' boiling and complete desiccation ; that it is insol-
uble in alcohol, but present in the watery extract of pu-
trid materials, even when dried ; that the albuminous
matters in putrid fluids are not per se septic, but con-
dense the infectious matter upon their surfaces ; for the
filtrate, containing no solid particles, preserves the septic
properties unimpaired. Panum concluded that the pu-
trid agent must be a definite chemical compound like
curare and the alkaloids, and named this hyjiothetical
substance sepsin. Billroth, Weber, Hemmer, and Schwen-
inger repeated and confirmed these expeiiments. The
last-named observer concluded from the fact that difterent
results followed the administration of the same quantity
of the same putrid liquid at difterent stages of putrefac-
tion, that not one only, but various putrid products, aris-
ing at different periods of the process, possess septic
properties. Bergmann and Schmiedeberg obtained from
putrefying beer-yeast a crystalline substance, melting on
contact with air and charring under heat, which induced
in dogs the clinical and anatomical appearances of sep-
sis. This they termed sulphate of sepsin. Zuelzer and
Sonnenschein isolated a similar compound. Hiller and
Mikulicz demonstrated that the septic agent of putrid
materials could be extracted and retained by glycerine,
and in so far was analogous to the active ingredient of
vaccine lymph, to pepsin, ptyalin, etc.
It was thus established, and so remains, that the clini-
cal and anatomical features of septicemia could be in-
duced by unorganized substances obtained from the
products of putrefaction. Yet in these cases two char-
acteristics, frequently observed in the septic infection of
human subjects were often conspicuously absent — the
stage of incubation and the infectiousness of the septic
blood and tissues. Panum noted particularly that the
influence of his boiled putrid materials became manifest
in fifteen miiiutes to two hours, and attained its acme
in four to eight hours. Meanwhile a new i^ath of inves-
tigation had been opened by Pasteur's demonstration
that the putrefaction of animal tissues is a phenomenon
incident to the vital activity of certain bacteria — facts
established incontestably by the researches of Pasteur,
Tyndall, Traube, Brefeld, and their pupils. The deter-
mination of the relation between the bacteria and the
diseases caused by the putrid products of their vital
action soon became the object of most patient and
careful investigation. Coze and Feltz found vibrios
intra vitam in the blood of animals infected with putrid
fluids ; and similar organisms post-mortem in the blood
of a patient dead of putrid infection. With this blood
they inoculated a rabbit, which then exhibited septic
symptoms, and whose blood was found to contain similar
vibrios. Rindfleisch found colonies of bacteria in the
heart-muscle from a case of pyaemia ; Recklinghausen
and Waldeyer followed with similar discoveries. The
work of Klebson "(ninshot Wounds" (1872) opened the
new epoch in pathological investigation. The examina-
tion of numerous gunshot wounds, both before and after
death, showed that the organs and tissues exhibiting
morbid changes due to such wounds were populated by-
bacteria ; serous surfaces, both those opened by the
bullet and those which, though still intact, lay adjacent
to an abscess or to the track of the missile ; the walls
of blood-vessels, not only those which had been the seat
of secondary hemorrhage, but also those which, while
not ruptured, showed beginning thrombus formation ;
metastatic abscesses in liver and lung ; leucocytes in
and near the track of the bullet — all contained colonies
of bacteria. A series of experiments upon animals
showed that while the injection of putrid liquids, con-
taining naturally myriads of bacteria, was followed by
continuous fever and metastatic abscesses — i.e., pye-
mia— the injection of the same liquids after filtering
through clay and thus deprived of solid particles, in-
cluding the organisms, was followed by fever just as in-
tense, though transient, but never by metastatic ab-
scesses— i.e., septicemia.
The work of Klebs, which proved that there must be
some intimate relation between the pathological processes
and the bacteria,' was soon followed by a series of accu-
rate experimental observations by Samuel, from which he
concluded that the varying effects of putrid fluids upon
the living animal were due to various substances therein
contained ; that the specific septic (toxic) influence is the
effect of certain volatile matters, probably combinations
of sulphur and of ammonia ; to the bacteria he ascribed
the influence whereby the infection is localized progress-
ively in various organs remote from the original wound.
Billroth concluded, as the result of much careful
clinical and experimental observation, that the presence
of bacteria was the result and not the cause of certain
changes in secretions and tissues. He assumed the for-
mation, during inflammation and putrefaction, of a
" zymoid " substance whose presence (i) conferred
upon pus and exudate their infectious character and (2)
converted wound secretions into favorable soil for organ-
isms. He believed, however, that bacteria might be the
226
THE MEDICAL RECORD.
[March 3, 1883.
means for transporting and multiplying his hypothetical
zymoid, and in this capacity might be, probal)ly are, the
carriers and originators of specific pathological processes.
Since the publication of this work (1S74), Billroth has
materially modified certain of his conclusions.
From these investigations it was generally concluded that
septic infection was due to an unorganized though per-
haps organic substance ; that the presence of bacteria
■was an epiphenomenon — a sequence, not a cause ; that
their deleterious agency, if any, consisted simply in the
transfer of unorganized infectious matters from one part
of the body to other portions, perhaps from one individ-
ual to another.
But there soon appeared from various sources, notablv
Koch and Pasteur, investigations more or less incom-
patible with these views. Pasteur found that in the ser-
ous sacs, muscles, liver, and spleen of a septically infected
animal there are always present microscopic organisms
{microbe septuple), although the blood may be until
death free from them. Inoculation with a drop of peri-
toneal serum, or a piece of muscle from an animal dead
of sepsis, induces, in a second animal, all the appearances,
ante- and post-mortem, of the original disease ; while a
drop of blood from the heart-cavity (proven microscopic-
ally to contain no septic vibrios) is, on the contrary,
innocuous. Pasteur cultivated his vibrio septique in
various fluids, such as solution of beef extract, in the
manner already described : and found that a drop of
Huid from the last fiask, containing presumably none of
the original unorganized septic matters, but crowded
with the vibrios, jiroduced the original septic disease.
In the tissues of infected animals Pasteur was unable to
find any unorganized substance capable of inducing sep-
sis, as had been aflirmed by Panum, but he found that a
putrid fluid, a few drops of which induced sepsis and
■death, lost its poisonous properties entirely in a few hours,
when exposed in a thin layer to the air. Now, since the
vibrios likewise lose their vitality in a few hours in the
presence of free oxygen, Pasteur insists that the loss of
vinilence in the fluid is due solely to the enforced inac-
tivity of the contained vibrios. Vet he is inclined to
the belief that just as the alcoholic fermentation of grape
. sugar is a vital phenomenon manifested by any one of
several species of fungi, so the production of septic sub-
stances may accompany the vital activity of any one of
several different bacteria.
Pasteur further reports that among the organisms usu-
ally present in ordinary water is one identical morpho-
logically with the bacteria ternio, but physiologically
distinguished by the fact that its injection from an iso-
lated cultivation under the skin of a rabbit is followed
by abscess formation at the site of puncture. Injec-
tion of the same organisms directly into the circulation,
or in several places subcutaneously, is followed by the
formation of abscesses in lungs and liver ; by fever and
death — in short, by pyasmia. .\ piece of the liver or
lung develops in a culture liquid, the same micrococcus
in great numbers. Such liquid, if previously boiled,
however, so as ta destroy the organisms therein contained,
causes, upon subcutaneous injection, abscesses as before,
but without general infection of the animal. He rejects,
therefore, for pyasmia as for septictemia, the agency of an
unorganized, soluble septic agent, and considers the bac-
teria alone responsible for septic infection.
Markedly different was the reception accorded to a
monograph published in 1878, by a then almost un-
known young German physician, Robert Koch. He sur-
mounted, by improvements in technique, some of the
hitherto insuperable difficulties in the recognition and in-
vestigation of bacteria — improvements wiiich confer such
evident and extreme advantages that they have become
absolute necessities for original research in this field ; in-
deed so many errors of coumiission, as well as of omission,
have been thereby detected in other methods, that one is
dispo.sed to regard as uncertain any researches in which
these measures most essential to accuracy of observation
are neglected. Having demonstrated the life history of
the bacillus anthracis, which the French school, working
with Pasteur's clumsy method, had for sixteen years failed
to discover, Koch turned his attention to the etiology of
surgical infectious diseases. He found that the subcu-
taneous injection into a mouse of five drops of putrid
blood was followed by immediate prostration, and in four
to eight hours by the death of the animal. Tiiere oc-
curred in these cases no local reaction, the internal or-
gans were apparentlv normal, no bacteria were detected in
the blood or tissues, inoculation of other animals with the
blood from the heart caused no perceptible efi'ect. Koch
considers this disease, therefore, as septic;"emia, etymo-
logically as well as clinically — the introduction into the
blood of a poisonous substance, soluble, not reprodu-
cing itself, analogous, in fact, with the efi'ect of certain
vegetable alkaloids and of ptomain, the substance iso-
lated by Selmi from human corpses, which so closely re-
sembles atropine in its physiological eft'ects. This is
also the efi'ect obtained from the injection of boiled pu-
trid materials by Panum, Bergmann, and Schmiedeberg,
and others. Koch found, however, that the injection of
a smaller quantity, one-half to one drop of the same pu-
trid blood, was followed by entirely dift'erent effects. In
some cases the mouse was apparently unaft'ected ; in
others brief, transient depression was observed ; in per-
haps one-third of the cases there ensued, twenty-four
hours later, progressive weakness, retardation of respira-
tion, drowsiness, and, in forty to sixty hours, death. Sec-
tion revealed no other pathological changes than local
oedema at site of inoculation and decided enlargement
of the spleen : but after inoculation of a second mouse
with a minute quantity (one-tenth to one-half drop) of
liquid from this cedema, or of blood from the heart, the
latter animal presented, in forty to sixty hours, precisely
the same clinical and pathological picture as the first ;
from the second, a third was successfully inoculated, and
so on ad libitum ; indeed, the mere contact with a fresh
wound of a scalpel-point previously dipped in the septic
blood sufficed. Here, then, was something entirely dif-
ferent from the intoxication following injection of a larger
quantity (five to ten drops) — dift'ering in the existence
of a marked stage of incubation, of local reaction, and in
certain and uniform infectiousness. The blood of such an
animal evidently contained something not present in
that of the former mouse- — a something requiring time for
the manifestation of its influence, and finally distributing
itself throughout the entire blood-mass, so that each drop
thereof possessed the septic possibilities of the original,
putrid drop. Such mode of action implies reproduction,
and reproduction is a characteristic of organized matter.
It was to be expected a priori, therefore, that the blood
contained organisms ; Koch found, in fact, invariably,
that the blood serum, white blood-corpuscles, and various
tissues of such animals swarmed with minute rods, which
stained readily with aniline colors, and when removed
from the body into similar artificial conditions multi-
plied by transverse fission. Since the blood of the in-
fected and infecting mouse dift'ers evidently from that
of the intoxicated and non-infecting mouse only in the
presence of these bacteria, Koch ascribes the infectious-
ness to these organisms. It is interesting to note that
all attempts to inoculate rabbitj and field-mice with
the septic blood were fruitless. The animals remained
unaft'ected ; no bacilli were found in their blood, al-
though the mouse-blood used for inoculation was full
of them. Further, that although the putrid fluids in-
jected contained organisms of numerous varieties — micro-
cocci, bacteria, bacilli — all of which were subsequently
found in the local cedematous liquid, yet only one spe-
cies, the minute bacillus, was found distributed through-
out the blood and tissues. The living mouse seemed to
be a culture-medium for isolating these from the other va-
rieties, to whose growth the animal's tissues were less
perfectly adapted. In the second or third mouse suc-
cessively inoculated only the specific bacilli were found.
March 3, 18S3.]
THE MEDICAL RECORD.
227
By i»ethods essentially similar, Koch demonstrated
the association of a form of septic infection of mice,
which he denominates malignant oedema, with a micro-
coccus species ; of septicemia in rabbits with a bacte-
rium ; and of pyajmia (with metastatic abscesses) in the
latter animal with a micrococcus variety. Yet, although
the fact of association was amply demonstrated, there
still remained tlie possibility of objection that the essen-
tial agent in the infection was a soluble, unorganized sub-
stance contained in the putrid liquids and the infectious
tissues used for inoculation, the bacteria being the result
and not the cause. The final demonstration to the contrary,
t!ie proof that these different effects could be induced by
inoculation with the respective bacterial varieties after
complete isolation from accompanying animal tissues by
cultivation upon solids, was not furnished at tlie time of
this publication by Koch, but has been subsecpiently com-
pletely established by Koch, Gaftky, and Loftier in the
laboratory of the German Health Bureau, for the bacilli
of mouse- and the bacteria of rabbit-septicfemia. The
extreme accuracy and critical supervision of manipula-
tions, the logical sequence of methods, and withal the
unpartisan candor and earnest desire for truth evident
throughout this work of Koch's, inspired at once a confi-
dence which has not as yet been diminislied or betrayetl.
It is worthy of note that the infectious disease of mice de-
scribed by Koch as malignant oedema is identical in clin-
ical and pathological appearances with that which Pas-
teur ascribes to his " vibrio septique ; " while the py;i3mia
of rabbits corresponds accurately with the purulent infec-
tion whicli, according to Pasteur, follows the injection of
his microbe of pus. These results, obtained quite inde-
pendently by two observers, using different methods, hive
been confirmed not only by Gaft'ky and Loftier, but also
by Rosenberger in Wurzburg, in a series of carefully per-
formed experiments.
^A review of the evidence already considered shows,
then, that infectious diseases, identical in clinical and
anatomical appearances with the various forms denom-
inated septicaimia in man, have been induced in the
mouse and rabbit by inoculation with animal tissues in
various stages of putrefaction ; that tlie resulting infection
is just as certain if the putrid substances be previously
boiled and thereby deprived of living organisms (Panum,
Bergmann, Rosenberger). On the other hand, it is cer-
tain that per se innocuous culture fiuids — infusions of
beef, etc. — acquire, after inoculation with minute quan-
tities of infected blood or tissue, the same septic proper-
ties, provided such blood or tissue contain living bac-
teria; it is further certain that this multiplication of the
sei)tic substance in such liquid is a concomitant of the
vital action of the organisms therein contained (Pasteur,
Koch, Rosenberger) ; it is further demonstrated that
these organisms can. and do, not alone multiply the sep-
tic material, but when isolated by successive cultures
from all the accompanying animal tissues, induce, inde-
pendently, fatal infectious disease (Pasteur, Koch, Lijf-
fler, Gatfky, Rosenberger).
The same principle — vital activity of bacteria — per-
vades all these phenomena ; for the artificial induction of
septic diseases has been, in all these exi)eriments, origin-
ally accomplished by the incorporation into the animal
o[ putrid tissues, with or without bacteria. Now, since
putrefaction must be regarded, in the present state of our
knowledge, as impossible witliout the presence of these
organisms, it is evident that sepsis, putrid infection, was
in every case due, directly or indirectly, to the action of
bacteria ; since even the boiled substances used by
Panum and Rosenberger, and the sepsin obtained tVom
rotten yeast by Bergmann and Schmiedeberg, had ac-
quired their septic properties through putrefaction, i.e.,
through the action of bacteria. Hence we are logically
driven, by all this work, to the belief that septic;i;mia im-
plies the introduction into the animal either of living bac-
teria, or of a substance which has acquired noxious prop-
erties through previous vital activity of these organisms.
More recent experiments have demonstrated, however,
that the etiology of the group of clinical and anatomical
appearances known as septicaemia is by no means re-
stricted to putrid infection. In the researches as to the
nature of blood coagulation, instituted by Schmidt, of
Dorpat, and his pupils, it was noticed incidentally that
the introduction or ijroduction in the blood of fibrin-fer-
ment in considerable quantity produces eftects identical
with those of putrid infection — septicemia. In this case
the result is of course attributable to coagulation of the
blood. Similar phenomena were observed by Kohler,
Angerer, Naunyn, and Francken, to follow intra-venous
injection of fresh blood-serum (containing therefore both
fibrinoplastin and ferment) , of hemoglobin solution
(which is known to favor the formation of fibrin-ferment
in the blood) ; of sulphuric ether (which sets free hemo-
globin and hence indirectly fibrin-ferment). Injected in
large quantities, these substances caused immediate death
by instant coagulation of the blood in the heart and large
arteries ; after smaller quantities the animals survived
hours or days, and exhibited the usual symptoms of septi-
cemia ; their blood contained free fibrin-ferment, while
that of healthy animals does not. Finally, Edelberg,
working under Schmidt's direction, established clearly
that the injection of fibrin-ferment alone, isolated from
other ingredients of blood, can induce the same phe-
nomena.
In a series of experiments communicated to the Con-
gress of German Surgeons, in 18S2, Bergmann observed
the clinical and anatomical features of septicemia — fever,
swelling of spleen and lymph-glands, gastro-intestinal
inflammation, cardiac weakness, ecchymoses in mucous
and serous membranes — after the injection of the physi-
ological ferments, pepsin and trypsin, in small doses ;
large quantities induced, like fibrin-ferment, immediate
death by coagulation of blood in the larger vessels.
Raynaud and Lannelongue inoculated rabbits with
saliva from a child dead of rabies, and induced thereby an
infectious disease, terminating fatally in forty-eight hours
or less. Pasteur found in the blood of these animals a
bacterium which he regarded as the cause of the disease.
Inoculation of rabbits with saliva from children dead of
broncho-pneumonia caused the same result, and pro-
duced the same figure-of-S bacterium. The same or-
ganism was found in the saliva of a healthy adult. Stern-
berg found that injection of fresh saliva from certain
healthy individuals caused a similar fatal infectious dis-
ease, which he calls septicemia, in rabbits, characterized
by the presence of a micrococcus apparently identical
with Pasteur's ; and asserts that this organism, isolated
by flask cultures, induced the disease again upon subcu-
taneous inoculation. Neucki and Gautier isolated from
saliva a substance capable also of producing fatal infec-
tion of certain animals. Saliva, then, can also induce
septicemia, not only after death of the subject, but even
fresh from the living individual. ^Vhether the effect shall
be ascribed to a contained bacterium or not is immaterial
to our present purpose, which is to emphasize the fact
that the group of phenomena called in general septi-
cemia may follow other causes than putrid infection ;
may be induced on the one hand by the vital action of
isolated bacteria, and on the other by unorganized sub-
stances— the boiled septic materials of Panum and Rosen-
berg, the sepsin of Bergmann, the fibrin-ferment of Edel-
berg, pepsin and trypsin of Bergmann, hemoglobin, etc.
The mode of action common to several, at least, ap-
pears to be the liberation of fibrin ferment ; for the blood
of septicemic animals is characterized by the presence
of free ferment, which is not found, unless perhaps as
traces, in normal blood. This ferment seems to arise,
according to the researches of Schmidt, in the disinte-
gration of white blood-corijuscles ; and these are known
to be invaded and apparently disintegrated by bacteria,
in the septicemia of mice and rabbits, at least. It would
appear, although not for all cases demonstrated, that the
clinical and anatomical features common to the various
22S
THE MEDICAL RECORD.
[March 3. 1883.
forms of septicasmia are attributable to the rapid libera-
tion of fibrin ferment in the blood ; and that any agent
— organized or unorganized, putrid or fresh — capable
of effecting such liberation ma_\- induce the disease.
This conception, at any rate, enables us to understand
much that is otherwise perplexing. Various have been
the attempts, for example, to explain the so-called asep-
tic wound fever, which occurs in the majority of severer
wounds, even under the most perfect Lister dressing.
Kiister and Sonnenburg ascribed it to absorption of car-
bolic acid ; but extensive experiments upon man, as well
as the lower animals, have proven that the acid does /wt
cause fever ; but induces, on the contrary, after slight,
brief, and by no means constant elevation, a decided
depression of temperature. Others have referred the
phenomenon to absorption of chloroform— a hypothesis
incompatible with the fact that wound fever follows op-
erations performed wdthout anaesthesia (as is so often
done in Ciermany and .Austria) as usually as those done
under chloroform. The more general opinion, that
aseptic wound fever differs from sepsis, — i.e., putrid infec-
tion— in degree rather than in kind, meets a serious ob-
jection, as Gussenbauer remarks, in the fact that the
former occurs within a few hours after the infliction of
the wound, before decomposition and consequent sepsis
can be reasonably presumed to have occurred.
The clinical facts — (i) that a large minority of wounds,
severe as well as slight, are followed by no fever under
the Lister dressing, as was the case in over three hun-
dred of a thousand reported by Volkmann and Genz-
mer, and in nine of twenty-four most carefully observed
by Edelberg ; (2) that the course of subcutaneous frac-
tures without extravasation of blood is usually afebrile,
while similar fractures with extensive blood extravasa-
tion often induce fever ; (3) that the application of a
tight bandage to a wound or fracture, which must cause
some extravasation of blood, is often followed by fever
in a patient previously afebrile (Edelberg) ; (4) that the
blood of patients during simple surgical fever sometimes
contains free fibrin ferment in appreciable quantities —
such facts indicate that a septic wound fever is caused
by absorption from extravasated blood, especially since
it has been demonstrated, as already remarked, that
blood, fluid or coagulated, h.Tsmoglobin, or even isolated
fibrin ferment can experimentally induce the same phe-
nomena. It is further conceivable, though not demon-
strated, that the products of a local intianmiation, or the
modification of cell-activity through fatigue or emotion,
may also be directly responsible, through destruction of
leucocytes and liberation of fibrin ferment, for some of
those cases of spontaneous septicemia which we ordi-
narily ascribe to unperceived entrance of bacteria or
putrid products into the body.
Septica;mia is, then, a collective name for processes
more or less similar, but etiologically distinct — at least,
in certain lower animals ; any one of several unorgan-
ized substances, any one of several bacteria (at least,
three in the case of the mouse) may induce characteristic
symptoiiis. It has been proposed to adopt the term
saprcBtnia for putrid infection without bacteria, retaining
the usual name to indicate the effect of organized agents;
yet the clinical distinction is probably rarely possible.
The clinical experience of all ages has unanimously
ascribed the second type of septic infection — character-
ized by chills, a remittent or intermittent fever and the
formation of multiple abscesses — to absorption from pus;
and it has always been designated by a name — pyremia,
purulent infection — indicative of this supposed origin.
The discussion of the relations of bacteria to py:>;mia
begins, therefore, naturally with the consideration of their
relations to suppuration. That these organisms sliould
exist in pus exposed to the air, as in other albuminous
liquids under like conditions, was a priori [irobable and
long ago demonstrated ; that they exist also in the pus
of abscesses which have never been opened, has been
conclusively demonstrated by Klebs, Nepveu, Rind-
fleisch, Waldeyer, Cheyne, Ehrlich, and especially by
Ogston, who found micrococci in every one of seventy
previously unopened acute abscesses, though rarely in
chronic, cold abscesses.
The mere fact of association does not, of course, ne-
cessarily prove a causal relation of the organisms to the
suppurative process ; but the observation that a zoogloea
mass of micrococci is often the centre of an abscess ;
that indeed abscess-formation in all stages, from a simple
accumulation of straggling leucocytes to the fully devel-
oped destructive infiltration of tissue, has been observed
around a nucleus consisting of a minute embolus com-
posed entirely of micrococci ; that the progressive puru-
lent infiltration of the surrounding tissue is preceded by
an invasion of the same by micrococci — can be impar-
tially and satisfactorily explained, in the present state of
knowledge, by no other hypothesis than that the micro-
cocci cause the suppuration. Experimentally there is
direct evidence to the same effect.
Pasteur saw, after cultivation of a micrococcus found
in ordinary water, that the injection of a few drops of
the previously harmless culture-fluid, now containing
myriads of micrococci, was invariably followed, in the
rabbit, by suppuration around the point of injection, the
pus and tissues containing numbers of the same organ-
isms. The intra-jugular injection of the same fluid caused
multiple abscesses in the internal organs. He found
the same micrococcus in pus from cases of puerperal fever.
Klebs, Zahn, and Tiegel found that while the injection
of pus from a pyemic abscess or putrid fluid w-as followed
by local suppuration and multiple abscess foriuation in
the infected animal, the same pus or liquid, after filtra-
tion through clay cylinders — whereby the bacteria were
separated from the hquid — caused intense general infec-
tion, but no suppuration, even at the point of injection.
Koch observed also the constant association of a charac-
teristic micrococcus with infectious suppuration in the
rabbit after putrid inoculation.
It appears, therefore, impossible to evade the conclu-
sion that suppuration can be and is induced by micro-
cocci. That this eftect is induced by one or more specific
varieties of these organisms seems probable from these
researches of Klebs, Koch, and Pasteur ; that it is not
induced by all species i? apparent from the fact that
colonies of micrococci are frequently ])resent in the
human and other animals during various morbid pro-
cesses in which suppuration does not occur — as in
/
A. ■.,.;&■
Fig. 6. — .Actinomyces bovis, tongue of ox. X 140.
erysipelas. As to the mode in which this influence is ex-
erted, there is no definite knowledge : the assmnption
that the deleterious effect results from changes in the
chemical constitution of the containing medium, as an
essential feature of the vital activity of these organisms,
is supported by analogy with the processes of fermenta-
tion and putrefaction, by the phenomena known to at-
tend the life of other bacteria, and by the direct observa-
tions of Koch and Pasteur.
Yet the induction of suppuration is not a monopoly of
March 3, 18S3.]
THE MEDICAL RECORD.
229
micrococci : the growth of the actinomyces bovis in the
tissues is accompanied by the formation of abscesses ;
upon microscopic section the fungus is found constitut-
ing the nucleus of a miUary abscess ; and inoculation
with the isolated actinomycetes proves that the fungus
itself, and not a hypothetical soluble substance accom-
panying it, is "responsible for the suppuration. Experi-
mental researches upon suppurative keratitis by Leber,
of Gottingen, make it highly probable that another bac-
terium, the leptothri.K of the mouth, and a mould fungus,
aspergillus glaucus, can also induce suppuration. On
Fig. 7. — .\ctiii':>myt^s bovis, and pus corpuscles. X 260.
the other hand, several bacterial varieties are known to
inhabit at times human and other animals without caus-
ing suppuration — the bacillus anthracis, for example.
The school of pathologists of which Weigert is a
prominent exponent, has been inclined to regard micro-
organisms not merely as a cause, but as the sole cause
of acute suppuration. This view was certainly incom-
patible with many clinical observations, and has been
recently quite dissipated b)' experimental research.
Uskotif, under Pontick's direction, has shown that the
subcutaneous injection into rabbits of turpentine oil, is
followed by the formation of pus in which no bacteria
can be detected ; an assertion which has since been cor-
roborated by others. The most accurate and conclusive
exiieriments in this direction were recently made by ]3r.
\Vm. T. Councilman, of Baltimore, in the laboratory and
under the direction of Cohnheim. Councilman made a
number of glass capsules, heated them to redness, poured
into each, while still hot, a boiling mixture of croton and
olive oil, and sealed the open end in the flame. Four-
teen of these were inserted, with antiseptic precautions,
under the skin, at various places, in different rabbits. In
no instance was suppuration or even adhesive intlamina-
tion observed — the cajisules remained freely movable in
the subcutaneous tissue. After intervals varying from
two to fourteen days, when the incision wound was firmly
healed, the capsules were broken subcntaneously, by
force applied to the skin ; in every instance suppuration
followed in a few hours. An examination of the pus and
abscess walls revealed nothing that could be recogni/ed
as bacteria.
Chronic or cold abscesses may have a different etiol-
ogy— their clinical history and appearances, and the fact
that they seldom cause pyaemia, would point to that con-
clusion. It is significant that of eighteen chronic ab-
scesses, Ogston — employing the most approved tech-
nique— could detect bacteria in but four, which were
consequent, moreover, upon erysipelas, t3'phoid fever,
pharyngitis, and pulmonary consumption, respectively ;
ill the remaining fourteen, both microscope and attem[)ts
at cultivation gave only negative results. Their absence
at the time of examination does not exclude the possi-
bility of their presence at an earlier period of the pro-
cess ; that they may have lost their vitality, and with it
their power to absorb the coloring agents.
Suppuration must be regarded, then, as indicating the
presence of an element foreign to the living animal cells ;
which may be introduced directly, like the croton oil in
Councilman's experiment, or indirectly as an incident in
the life of various fungi. That a derangement of cell-
nutrition, local gangrene, may by mechanical or chem-
ical irritation, without the presence of other organisms,
effect the same result, seems probable in view of clinical
experience, but is not yet experimentally proven. Prac-
tically, we may regard acute suppuration as proof of the
access of external irritant matter, organised or unorgan-
ized ; and clinically, we nnist agree with Cohnheim, that
suppuration not due to bacteria or other fungi is e.x-
tieniely rare. The comparative rarity of pus-formation
under the Lister dressing — although this is, at best, an
uncertain means of excluding organisms — is highly sig-
nificant of the relations between the two.
That form of septic infection known as pysemia is dis-
tinguished by abscess formation in external organs — from
which fact alone it is evident that bacteria must play an
essential part in the disease. Yet there is abundant
direct evidence to the same effect : these metastatic
abscesses always contain bacteria ; these organisms exist
not simply in the jnis and in the inflamed tissue constitu-
ting the abscess wall, but also in a zone external to the
territory already involved in inflammation ; the invasion
by organisms may therefore apparently precede the in-
flammatory re-action ; further, incipient inflammation
and suppuration are observed around minute emboli
consisting of micrococci ; and finally, although throm-
bosis and embolism occur in various pathological condi-
tions, no suppuration occurs in such fibrinous masses, nor
in the adjacent tissues, unless bacteria also be present.
These anatomical facts are quite in accord with the inde-
pendent evidence of experimental research. Panum
found that the injection into the jugular vein of minute
balls of wax or mercury caused the formation of emboli
in the lungs, but that no suppuration occurred around
them ; he then combined embolic formation with putrid
infection by the injection of putrid fluids just before or
just after the formation of emboli, through the incorpora-
tion of wax, mercurv fibrin or cheese particles ; and varied
the experiment by the artificial induction of superficial
phlegmonous inflammation, in the course of which the
formation of emboli was secured by injections as before.
The result was always the production of simple, non-sup-
purating embolic masses ; the substitution of fresh blood-
clots for the wax, mercury, etc., whereby a closer approxi-
mation to. the natural embolic process was secured, gave
the same results. Emboli caused by intra-venous injec-
tion of particles of putrid flesh, however, were promptly
followed by suppuration. Other experimental researches
into the formation of embolic (metastatic) abscesses —
by Virchow, Billroth, Weber, Waldeyer, Cohnheim —
confirmed these results of Panum ; putrid emboli always
softened and excited suppuration ; others rarely ; it was
farther established (Waldeyer) that puriform softening of
a thrombus can be caused by contact of pus or putrid
matters with the external surface of the containing vessel,
as well as by admission to its lumen. Since suppuration
in the iinmediate vicinity of a vein may cause inflamma-
tion and thrombus formation in the vessel, it is apparent
that phlebitis, puriform softening of thrombi — in short,
pyemia — may occur without any artificial solution of
continuity in the vascular walls. Experiment has always
shown that fluids (pus and jnitrid matter) capable of in-
ducing py:i;mia, lose by boiling (Panum, Bergmann, Pas-
teur) or by filtration (Klebs, Zahn, Tiegel) this power to
cause metastatic sui>]Juration — pyremia — though still able
to induce rapid antl fatal infection — septicKinia. Since
by these measures — boiling and filtration — the contained
2^0
THE MEDICAL RECORD.
[March 3, 1883.
organisms are destroyed or eliminated, experimenters are
unanimous in ascribing the induction of metastatic ab-
scesses to bacteria.
Tiie clinical evidence is almost as strona: ; for, accord-
mg to the unanimous assertions of eminent surgeons —
Nussbaum, Volkmann, Esmarch, Thiersch, Verneuil,
Schede, Gussenbauer, for example — py.'emia is jjractic-
ally unknown after wounds which have been treated from
their inception by the Lister method, the avowed object
and essential feature of which is the attempt to exclude
organisms.
Perhaps the strongest clinical evidence of the septic
influence of bacteria is afforded by the cases of so-called
spontaneous pyemia, where no suppuration nor solu-
tion of continuity is detected. In many of these a closer
search would doubtless reveal a |.)Ossible source of puru-
lent infection. Weichselbaum has recently called attention
to fatal cases of this kind in which the focus of infection
was found as suppuration in the nose and antrum. Yet
there still remain numerous cases in which ])y£emia ap-
pears to proceed from deeply situated abscesses, which can
have had no direct communication with the external world
— after subcutaneous fractures, for example ; and still
another class in which a general infection without local
suppuration during the first few days occurs without ex-
citing cause, unless perhaps exposure to cold ; and until
the appearance of pus in the joints, etc., cannot be dis-
tinguished from acute rheumatism or from other infec-
tious diseases. To this category belong cases of acute
osteomyelitis and ulcerous endocarditis. The blood and
metastatic abscesses contain in these cases also the
usual micrococci ; the history presents, in fact, nothing
unusual except the obscurity of the infection. In some
of these — as in one of osteomyelitis reported by Gussen-
bauer— the bacteria were observed in the blood and in
the bone-marrow before suppuration had occurred ; the
general infection preceded the local affection. Such
cases must incline us decidedly to the view that the mi-
crococci caused not only the local suppuration, but also
the primary general infection. It is noteworthy that
such cases of primarv pyajmia often follow exposure to
cold ; iierhajis we should regard the retention of certain
material in the blood, this interference in excretion, as a
predisposing moment which has favored the develop-
ment of organisms; diabetic patients certainly are espe-
cially prone to local gangrene and septic infection after
a wound, and it is equally well known that a minute in-
cision, even needle-puncture of the dropsical skin in
amyloid degeneration of the kidney, exposes the patient
to erysipelas and pya;mia. Yet in some cases the bacteria
essential to pyaemia can and do exhibit their vital activ-
ity in the human body without the pre-existence of any
recognizable deviation from the usual health, and with-
out any discoverable solution of continuity in the integu-
ments.
In this discussion I have assumed the etiological iden-
tity of the septicajmia and py.-emia of man with that of
processes marked by the same clinical and anatomical
features in animals. To such assumption objection may
be made, based on the known differences in the effects
produced on man and other animals by the same toxic
agent ; rabbits, for instance, live and fatten on a diet of
belladonna leaves, and carnivorous animals are but
slightly susceptible to anthrax. But when we consider
that the septic processes of man are objectively identical
with those of other animals, that they result in various
animals alike from putrid and purulent infection, and
furthermore, that they have been induced in animals by
direct inoculation from the human subject, we must jus-
tify the application to man of the principles ascertained
from the study of these septic diseases in other animals.
Although our present knowledge of the etiology of
septic infection is thus incomplete, our ability to pre-
vent such infection is fortunately more satisfactory. For
we may practically classify all such cases into two cat-
egories— those in which a possible source of infection
is previously apparent, and those in which no such
source is discoverable. The treatment of the former
class, the large majority, comprising all wounds, I may
be permitted to discuss in so far as the principles of such
treatment are based upon a recognition of the agency of
bacteria in the morbid processes. Septic infection from
a wound means the absorption through that wound of
one or more constituents of the putrefactive process.
Now, putrefaction is impossible without bacteria ; hence
septic infection implies the vital activity of bacteria, past
or present. The actual presence of bacteria in the
wound is, as has been shown by Panum, Bergmann, and
others, unnecessar\- — septicajmia may be induced by
putrid liquids deprived of bacteria ; but these liquids are
putrid — they embody the products of bacterial life. Pre-
caution against the introduction into a wound of already
formed poisons — by disinfection of hands, instruments,
sponges, etc., on the side of the surgeon, and by similar
cleanliness as to the body of the patient, is evidently the
first measure against sepsis — a measure quite overlooked
occasionally by surgeons who intend to use all so-called
antiseptic precautions. I once saw a laparotomy made
by a rigid ai)Ostle of I.isterism ; the carbolic spray was
used; hands, instruments, ligatures, etc., thoroughly car-
bolized ; but the patients' skin was not even washed ;
several coils of intestine were in course of the operation
laid upon the skin, and cajue in contact with the pubic
hair. The operation itself was not serious, but the wo-
man died of purulent peritonitis.
If no infectious matter be thus carelessly introduced
from without, the occurrence of sepsis from a wound
necessarily implies decomposition in the wound itself.
For the accomplishment of such decomposition it is evi-
dent that three factors must concur : i, the presence of
animal tissues deprived of vitalitv, and hence capable
of putrefaction ; 2, the presence of organisms capable of
inducing initrefaction ; 3, the prevalence of conditions
which permit the vital activity of these organisms. The
absence of any one of these conditions renders putrid
infection impossible. We are familiar with analogous
phenomena outside of the body. Urine or blood in free
contact with ordinary air putrefies ; if access of bacteria
be prevented by closing the mouth of the test-tube with
cotton, etc., putrefaction does not occur ; the process
can be prevented with equal certainty by changing the
environment — addition of alcohol for example — whereby
the vital activity of bacteria is arrested. We have abun-
dant evidence, as has been already stated, that the same
principles prevail within as well as without the living,
animal. That the bacteria ordinarily present in the air
are powerless to destroy living tissues is proven by the
fact that unfiltered ordinary air has been passed for hours
through the peritoneal cavity of rabbits without inducing
pathological changes — indeed, the entire subcutaneous
tissue of animals has been inflated with air with like re-
sult ; by the harmlessness of surgical emphysema ; by
Hiller's injection of such bacteria into his own body, etc.
That the presence of putrefiable substances, if excluded
from these same bacteria, gives rise to no putrefaction
nor sepsis is shown in the cases of intra- and extra-uterine
pregnancy, where a dead foetus is carried for months or
years.
The prevention of decomposition and consequent
septic infection from a wound can therefore be accom-
plished theoretically in any one of three ways : i, the
exclusion of putrefiable materials. /.f., cleanliness; 2, the
exclusion of bacteria ; 3, the addition of a substance in
whose presence putrefactive bacteria are inert.
It is evident that the accomplishment of any one of
these three ends is antiseptic, or, if you prefer on ety-
mological grounds, aseptic surgery. There is a preva-
lent inclination to consider Listerism and antiseptic
surgery as-synonymous terms ; and to regard the success
in avoiding sepsis w-hich is secured by other methods —
the open air and simple water dressing, for example —
as proof not only that the Listerian details are unneces-
March 3, 1883.]
THE MEDICAL RECORD.
231
sary, but also that the agency of bacteria in the induction
of sepsis — an agency which the Lister method was de-
vised to defeat — is a myth, a mere craze, a fashion. It
is manifest, however, that antiseptic surgery is far more
comprehensive than Listerism. Listerism aims chiefly at
but one of the three possible ways for the prevention
of sepsis — the exclusion of ferments ; the very methods
whose success has been considered proof of the fallacy
of antiseptic surgery demonstrate practically what is
self-evident theoretically, that putrefaction aijd putrid
infection from a wound can be prevented by the removal
of putrefiable materials, just as certainly as by the ex-
clusion of organisms. The aseptic success of Savory
and Lawson Tait — rivalling that of Volkmann, Esmarch,
and Lister, was secured by the most scrupulous care
in avoiding the retention or accumulation of any dis-
charge in the wound. The result is asejjsis, the means
a ep ic.
That this method of jjreventing sepsis affords the same
certamty of success and possesses the same range of ap-
plicability as the Listerian, I would not maintain ; in-
deed, my own limited experience, including some obser-
vation of surgery in St. Bartholomew's Hospital, inclines
me to the contrary belief. I would merely protest
against the not infrequent assertion that Savory's and
Tait's success in avoiding putrid infection is an argument
against the demonstrated agency of bacteria in the in-
duction of sepsis.
There still remain a considerable number of cases,
notably wounds of mucous membranes, in which ana-
tomical relations prevent the execution of either of these
aseptic methods : bacteria cannot be excluded, nor per-
fect cleanliness of the wound secured. In such cases
asepsis can be theoretically obtained very simply by the
presence of some substance in the wound which renders
vital activity of bacteria impossible. There is a great
variety of such agents — alcohol, carbolic acid, etc. — but
for these cases all such are, from their volatility or
solubility, practically useless ; and it was reluctantly ad-
mitted on all sides that operation wounds involving nui-
cous membranes could not, generally speaking, be ren-
dered aseptic with certainty. Between i860 and 18S0
Billroth performed the amputation or extirpation of the
tongue one hundred and nineteen times on one hundred
different individuals ; and notwithstanding the most care-
ful attention, including frequent syringing with solutions
of potassium permanganate, carbolic acid, or other anti-
septic, twenty-six of these patients died, nearly all from
septic infection, either directly from the wound or in-
directly through the inhalation of septic products —
" schluckpneumonie." With the introduction of iodo-
form into surgery the long-sought substance was found
— comparatively insoluble and non-volatile — in who^e
presence the ordinary bacteria do not multiply. Under
the proper use of iodoform wounds of nnicous membranes
are as secure from decomposition and septic infection as
an amputated stump under a Lister dressing. This is
admitted even by the fiercest opponents of iodoform —
those who, like Kocher of Berne, having ignorantly poi-
soned their patients with it, would transfer to the agent
the odium which evidently belongs to themselves. In
1880-81 Billroth made eighteen tongue extirpations,
packing the wound with iodoform gauze which was al-
lowed to remain undisturbed five to seven days, then
sometimes renewed. Not a single septic infection oc-
curred ; recovery followed in every instance.
An operation which, though not per se formidable,
had, even in Billroth's skilful hands, been followed by a
greater mortality than that attending ovariotomy, was de-
prived of its septic terrors. I would particularly recom-
mend this to the consideration of those who ignore all
experimental work, who admit as worthy of considera-
tion only clinical results, and who regard the success of
Savory and Tait as the overthrow of aseptic surgery in
particular, and of bacteria in general. Here is aseptic
surgery par excellence, though the spray, protective
mackintosh, and attendant paraphernalia are absent ;
here is the prevention of septic infection by measures
which do not exclude bacteria from the woimd, but sim-
ply restrain their development. The method of Lister,
conceived and devised upon a hypothesis, before the as-
sumptions of that hypothesis had been verified, con-
tained, as subsequent developments demonstrated, some
errors of conception and execution. The spray, for
example, that sign-manual of Listerism in the pro-
fessional mind, seems less essential since we have
learned that bacteria are less numerous in the atmos-
phere than was formerly supposed ; and when we con-
sider the researches published by the (ierman Health
Bureau, it seems somewhat doubtful whether the carbolic
acid spray ever killed a single healthy bacterium ; the
vitality of certain spores is certainly not thereby affected.
Koch found that the spores of anthrax bacilli, for exam-
ple, retained their power of development after innnersion
for seven days in a two per cent., and after twenty-four
hours in a five per cent, solution of carbolic acid ; yet
the bacilli lost their vitality after two minutes' contact
with even a one per cent, solution. The clinical results
also support the assertion that irrigation of the wound
accomplishes quite as effectually the object for which the
spray was designed. Yet it must be admitted that ex-
cept in those cases, such as abdominal sections, where
the spray causes positive and decided injury, there is a
possibility of benefit from its use.
For application to the wound, many substitutes have
been proposed for the objectionable carbolic acid :
Fischer employs naphthalin ; Schede and others report
excellent results from corrosive sublimate ; Langenbeck
and Billroth regard iodoform as satisfactory.
To secure cleanliness — freedom of the wound from all
putrefiable materials — surgeons now more generally ap-
preciate the importance of ligating or twisting every ves-
sel, however small, which could bleed when, with the
discontmuance of the anesthetic, the heart's impulse be-
comes stronger. The application of a firm, even, elastic
bandage over the lips of the wound is often used, also,
to accomplish the same object. For absorption of pu-
trefiable materials Esmarch has used with great satisfac-
tion turf enclosed in gauze bags ; Schede is pleased with
sand, previously heated and soaked in corrosive subli-
mate solution, which is poured directly into the wound.
Perhaps one of the most important of antiseptic measures
is the deep closure of the wound ; whenever the lips of
the wound are thick — as in abdominal sections and thigh
amputations — the use of silver wire and lead plates for
approximation of the deeper surfaces is essential to pre-
vent the accumulation of blood in the pockets otherwise
present, and the consequent danger of sepsis.
Antiseptic surgery, then, is not comprised in the spray
and carbolic acid ; it is not simply a question as to the
relative anti-bacterial properties of this, that, and the
other so-called antiseptic agents. It is an attempt to
prevent the entrance into, as well as the formation
within, a wound of all substances, organized and unor-
ganized, which can interfere with cell-nutrition. It com-
prises, first, the exclusion or removal of all putrefiable
materials — blood, pus, necrosed tissue (a point to which
the Listerian school seems inclined to ascribe a subordi-
nate place; witness Cheyne's " Antiseptic Surgery ");
second, the exclusion of all ferments, bacterial or other ;
and, since neither of these can always be accomplished,
since even under the most perfect I-ister or other dress-
ing, both putrefiable materials and bacteria may be
present ; third, the establishment of conditions incompat-
ible with bacterial development. The niost complete
antisepsis is evidently not that which sees in bacteria the
sum and substance of all surgical evil, but that which rec-
ognizes and endeavors to avoid all possible sources of
infection. The most perfect realization of this ideal
which it has been my fortune to witness, is seen, not
in King's College Hospital, but in Billroth's clinic.
Sponges are prepared by the abstraction of fat and sand,
232
THE MEDICAL RECORD.
[March 3, 1883.
and by at least fourteen days' immersion in five per cent,
carbolic acid solution, in which they remain until used ;
for the operation they are put in two per cent, solution ;
ligatures (Billroth generally uses silk) are also kept in a
similar solution. The skin at and around the location of
the proposed incision is shaven, scrubbed with a flesh-
brush and soap, and washed with carbolized water ;
hands and instruments are most scrupulously cleansed ;
operator and assistants wear clean linen dusters ; no
spray is used. Every bleeding point, however small, is
caught temporarily in a clamp forceps, and at the close
of the operation, ligated at the end of the severed vessel,
to diminish the amount of necrotic tissue ; the surface is
thoroughly irrigated with three per cent, carbolic solu-
tion ; a little powdered iodoform is often dusted into the
wound — not, however, if immediate union be expected.
If the soft parts severed be thick, the lips of the wound
are approximated deeply by silver wires, and superficially
by closely set silk sutures. The Esmarch bandage is re-
moved from the limb — in amputations — as late as possi-
ble, since absorption does not occur so long as the ban-
dage remains, but begins very actively so soon as the
circulation is restored. A strip of iodoform gauze, usu-
ally also some powdered iodoform, is applied to the
seam ; then several layers of iodoformed or carbolized
gauze ; finally a very firm roller, starched organdine, or
even elastic bandage is tightly applied over the lips of
the wound. The first dressing remains unmolested as
long as possible, the time varying, of course, with the
case.
©riQimtl l^rticlcs.
TWO .-VTTACKS OF SC'^lRLET FEVER IN THE
S.\ME IND1VIDU.\L WITHIN A PERIOD OF
EIGHT MONTHS.'
By FR.\NCIS p. KINNICUTT, M.D.,
PHYSICIAN TO ST. LL'KE'S HOSPITAL, AND TO THE OUT-PATIE.NT DEPARTMENT, NEW
YORK HOSPITAL.
On .April 15. 1882, ]\[. W-
died of scarlet fever. On
the 19th her brother, aged five years, was taken ill with
the same disease. There was severe angina ; the exan-
them was very profuse, involving the entire body. There
was marked delirium with the maximum development of
the eruption. The temperature maintained a high range
throughout the first week, varying between 104° and
105° ¥. (axilla). The subsequent desquamation was very
extensive, and of the characteristic lamellar type. Um-
kiteral inflammation of the middle ear, with perforation
of the membrane, occurred, and moderate albuminuria
was developed in the second week, which disappeared
two months later. The patient was confined to his room
for seven w'eeks. He was in good health during the
summer and autunni.
On the 31st of the following December the patient
suddenly became indisposed, and an examination a few
hours later showed a slight congestion of the fauces and
a swollen submaxillary gland ; the temperature was 102°
(axilla), and there was vomiting. 'J'he diagnosis of scar-
let fever was not entertained at this time. Thirty-six
hours later, however, an abundant and typical scarlet
fever exanthem appeared about the neck, which rapidly
spread, and in a few hours involved the entire body. The
eruption reached its maximum development on the fourth
day, with a temperature of 104° (axilla), and, if possible,
was more profuse than on the former occasion. Phe
manner of fading was characteristic, and a most abundant
lamellar desquamation followed in the second week.
Tlie affected gland suppurated and was opened ; slight
albuuunuria appeared at the beginning of the third week,
which still persists. The patient has since sufiered from
a copious eiuption of boils on various parts of the body.
^ The patient was under my personal observation throughout both attacks.
On the 14th of January the grandmother of the patient,
who had been in constant attendance in the sick room,
was taken violently ill with facial erysipelas, which defer-
vesced on the seventh day.
Remarks. — Recurring attacks of slight angina, with or
without a somewhat rudimentary exanthem, in individuals
exposed to scarlet fever contagion, who have previously
suffered from a characteristic attack, are of compara-
tively frequent occurrence. True relapses, in which the
characteristic eruption has reappeared during or at the
close of desquamation and has again run its course with
renewed fever, have been reported by stiveral observers.
A second infection of scarlet fever, occurring within the
short period of eight months, in 7i']iich all ilie clmracieristic
syTnp/o?iis are juaiiifesiedwilh as ?/!!ieh prominence as in the
primarv attack, is sufficiently rare to be worthy of record. I
have only been able to find similar cases recorded by West
and Hillier (one case after thirty-six days), I.audeutte (two
months). Hoist and Wetzler (three months), Salzmann (five
months), Easton and Trojanowsky (six and nine months).
In the case reported above, the two attacks were of quite
similar intensity, and were in all respects very typical.
The apparent slight susceptibility of other members of
the family to the poison (the remaining children, three
and nine vears of age respectively, without previous in-
fection, did not contract the disease, although fully ex-
posed on both occasions), and the development of a
facial erysipelas in an attendant upon the patient, are
additional points of interest in the case.
TR.-\NSPLANT.\TION OF PORTIONS OF THE
CONJUNCT] V.\ FROM THE R.\BBIT TO THE
HUM.\N EYE— ALLOPLASTY.
Bv HENRY D. NOYES, M.D.,
NEW YORK.
The above proceeding has recently attracted attention,
and I beg leave to report my experience with it. \ will
premise by stating that the operation was originated by
Mr. Wolfe, of Glasgow.in 1872, andhe gives a full account
of it in his recent book on " Diseases and Injuries of the
Eye," page 58, 1882. Many European surgeons have
done the operation, but in this country it has, so far as
my information goes, not been extensively imitated.
Soon after it was announced, I made trial of it, and Dr.
W. S. Little, whose case has recently been published,
when he was my assistant in the New York Eye and Ear
Infirmary during 1873-4, aided me on more than one oc- .
casion. I do not find a record of my earliest operations,
but since 1878 there have been seven operations done at
the Infirmary, of which one was performed by Dr. Cal-
lan and six were performed by myself. In the majority
the lesion was symblepharon caused by burns of the eye,
but about four years ago I emplo3-ed the method to in-
crease the size of the conjunctival sac, that a patient
might be enabled to wear an artificial eye. I shall not
attempt to relate the cases in detail, but shall state what
experience has taught me in certain particulars.
The necessary dissection is first performed to remove
all adhesions or deformity, and in the case of symble-
pharon to give the eyeball and the lids their proper free-
dom. F"or preparation of the conjunctival sac to make
room for an artificial eye, incisions must be made as the
peculiarity of the case may require. I have found that
black rabbits are to be preferred to white, because in
them the conjunctiva is firmer and can therefore be more
easily handled.
The animal can be best controlled by having him in a
pasteboard box, out of which his head luotrudes through
a closely fitting aperture. He should be etherized, but
the anaesthetic need not be freely given. To dissect oft'
the conjunctiva, I have in my last two cases begun by
splitting the inner canthus, turning back the angles thus
formed and stitching tliem temporarily to the adjacent
skin. Ai the edge thus cut the dissection is begun, and
March 3, 1883.]
THE MEDICAL RECORD.
233
in taking up tlie conjunctiva the semilunar fold or third
eyelid with its contained cartilage is lifted, I do not
attempt to cut out the cartilage ; I simply trim it as
needful when the whole has been taken u)). The dissec-
tion may include the conjunctiva of both lids and should
be conducted from the circumference toward the cornea.
It will not usually be needful to take jnore than half the
membrane. I have found a pointed pair of scissors,
curved on the flat, to be the best instrument. As the
membrane is lifted, two threads of fine black silk with
needles attached to them, should be put into one end of
the piece and by these, when fully separated, it will be
carried. The utmost care must be exercised to avoid snip-
jihig holes through it, and it becomes impossible to give
form to the piece until later. It rolls into a mass, and the
epithelial side cannot be distinguished from the opposite
side except by the threads. When it has been separated
I put it into a saucer of tepid water and fasten it on a
submerged piece of cork by the points of threaded
needles. I now trim it to proper shape. Next I carry
it on the cork to the eye and run two of the threads from
the piece into their places in the patient's eye. Then
taking out the needles from the cork, draw their tlireads
through the piece and pull it into its place and lay it
out smoothly. I apply it to the eyeball and cover as
much of the lid and globe as possible. To make the
cul-de-sac, the stitches are brought through the eyelid and
tied over a bit of stick on its outer surface. As many as
ten stitches or more may be required to hold the piece
in place. Bv operating in this way, a piece of con-
junctiva three-fourths of an inch long andalmost half an inch
wide can be managed. Mr. Wolfe proceeds in a different
way, which he describes as follows : " I put the patient
and two rabbits under chloroform, one being kept in
reserve in case of accident. I then separate the ad-
hesions so that the eyeball can move in every direction.
Next I mark the boundary of the portion of the con-
junctiva of the rabbit which I wish to transplant, by in-
serting four black silk ligatures which 1 secure with a
knot, leaving the needles attached. These black liga-
tures indicate also the epithelial surface, which would be
very difficult to distinguish after separation. The liga-
tures being put on the stretch, I separate the conjunctiva
to be removed with scissors, and transfer it quickly to re-
place the lost conjunctiva palpebrse of the patient, secur-
ing it in its place by means of the same needles and
adding other two stitches or more if requisite."
I have found that to put the piece upon a cork under
water was an easier mode of transfer than to do it
directly by the threads from the eye of the rabbit. Mr.
Wolfe lays the piece on the palpebral surface. I have
a])plied it to both the ocular and palpebral surfaces.
VVhether any advantage can be claimed for one situation
above the other, I do not know. My remarks apply, of
course, to symblepharon, and usually the lower lid is at
fault. In no instance have I met with entire failure
while the degree of benefit has been various.
When done to make a cavity in which an artificial eye
can be worn, I have caused the patient, after the parts
were healed, to wear a small piece of porcelain, shaped
like an artificial eye, to stretch the tissues, and have in-
troduced larger ones as the increase in the size of the
cavity would permit. In one case of a boy, twelve years
of age, the result was satisfactorily accomplished in about
four months. In some cases where the patients had
long worn an artificial eye and the conjunctiva had
grown thick and fleshy and ribbed, I have not had suc-
cess in this endeavor ; but if the tissue has not too greatly
degenerated the case is hopeful. A condition of true
xeroma, where the membrane has lost all secretory proper-
ties, is not favorable, because extreme shrinkage will
occur.
The boy above mentioned had lost one eye from in-
flammation during infancy, and not only had the globe
shrunken to a very small nodule, but the conjuncti-
val sac had become practically obliterated. The boy
was extremely sensitive to his disfigurement, and was un-
willing to go to school, because his companions made
fun of him. As above stated, I succeeded in enabling
hitn to wear an artificial eye, which, although rather
small, removed the conspicuous deformity and relieved
him from persecution. Unless a piece of new material
had been introduced, it would have been impossible to
enlarge the conjunctival cavity.
The transplantation of mucous membrane would a
priori be regarded as more likely to succeed than would
the similar treatment of large and isolated pieces of
skin — an operation which Mr. Wolfe also was the first to
propose. In both cases the cells of the transported tis-
sue must for a time maintain their vitality without gain-
ing any nutriment directly from the circulation. The
more directly they can come into relations with the living
tissues on which they are laid, the easier it will be for
them to get a supply of fresh nutriment. At any rate,
this seems a plausible supposition, and to be in favor of
the better viability of mucous membrane as compared to
skin. In the case of the latter, it is known to be neces-
sary, as Mr. Wolfe pointed out, to reduce the skin to the
utmost thinness. When this is done, it is found that
the epidermoid layer perishes and is cast off, while only
the deeper parts of the skin enter into real union with sub-
jacent structures. In a recent case in which I have done
transplantation of skin without any pedicle — to which, I
think, the name of alloplasiy may suitably be applied —
the surface layers of the skin were not cast off; they
seemed to undergo a kind of dry gangrene and became
hard, black, and leathery. Nothing was exfoliated until
six weeks after the operation. Then the dry scab dropped
off, and underneath was found a well-formed cicatrix,
which served the desired purpose, and removed the de-
formity of the eyelid, for which the operation was under-
taken. It was evident that the deep layers of the in-
serted piece formed an attachment to the locality, and
gave rise to the formation of material duly covered by epi-
dermis. With mucous membrane no sensible separation
of a living from a dead part can be recognized ; yet the
piece appears to undergo sloughing, which subsequent
observation proves is either not a total death, or that a
special activity is awakened in the surface covered by the
piece which issues in the formation of a new covering
material.
CONSIDERATIONS ON
ANTERIOR UTERINE DISPLACEMENTS AND
A NEW METHOD OF TREATMENT FOR
THE S.AME.
By C. a. Von RAMDOHR, M.D.,
ASSOCIATE PROFESSOR OF GYNECOLOGY AND OPERATIVE MIDWIFERY. NEW YORK
POST-GRADUATE MEDICAL SCHOOL.
In the consideration of displacements of the uterus it is
necessary to understand the term " normal position." I
think I cannot do better than quote the view of Richer,
" Traite clinique Martineau " :
1. In the fcetus, the newborn, and the child, up to ten
or twelve years of age, the uterus has neither a fixed
nor a determined direction or position ; it is elongated,
soft, flexible, not situated in the pelvis, but in the abdo-
men, unprovided with true ligaments, and is easily moved
by any force whatever.
2. In adult women the uterus lies though it is lightly
enough fastened by its very incomplete ligaments, sub-
ject to frequent displacements backward, forward, and
to the sides, mostly in one direction, which may be called
normal ; this is more or less regularly flexed forward, its
axis seeming to follow the direction of the pelvic canal.
Therefore, as the pelvis describes an arc, with its con-
cavity forward, the axis of the uterine cavity is inclined
the same way.
Schultze and Fritsch have enabled us to discard those
234
THE MEDICAL RECORD.
[March 3, 188;
abominable representations of pelvic sections, still scat-
tered through most of our gynecological and obstet-
ric works, and which are totally inadequate to render a
correct representation of what may be called the nortnal
position, and they have shown that dissections of dead
or frozen bodies are by no means to be relied upon
to give us the absolute position occupied by the
uterus during life. Hach (Dissert., Dorpat, 1877) also has
demonstrated that in two cases, where a displacement
of the uterus was diagnosed twenty-four hours before
death, the exact counterpart appeared in the autopsy. The
abdominal and the blood pressure, two factors in keeping
the uterus in position, discontinue after death, and con-
sequently the representations obtained by the use of
frozen bodies, etc., are frequently mcorrect.
The uterus is sustained, more or less, by the so-called
ligaments, the vagina, and perineum below, and the ex-
cessive quantity of erectile tissue and blood-vessels sur-
rounding it, the vagina, and ovaries.
The round ligaments come into play as supports only
when the uterus is in retroversion ; shortened by disease
they form a grave factor for displacement.
Professor Fallen, however, has for many years denied
these functions of the round ligaments, and claims that
they are but the analogues of the cremaster in the male,
functioning only during erotic excitement, and then for
the purpose of dragging the uterine body toward the pel-
vic arch.
The broad ligaments, though admitting of a good deal
of mobility of the fundus, before being stretched by preg-
nancy, contribute much to keep the organ from lateral
displacement.
Posteriorly the utero-sacral (utero-Iumbar) ligaments,
made up of the folds of peritoneum forming Douglas'
cul-de-sac, strengthened by strong bundles of the pelvic
fascia, and musculo-cellular prolongations from the va-
gina, and from the cortex uteri itself (Luschka's nniscle),
are, after embracing the rectum, inserted into the lower
lumbar vertebra. These are the ligaments, par excel-
lence, a shortening or relaxing of which will produce va-
rious displacements. Continuing forward from the cer-
vico-corporeal junction, they embrace the bladder, and
are inserted in the pubes. Besides, about two centimetres
of the cervix are attached to the bladder by cellular tissue.
The firmness with which the base of this organ is fixed
(by ureters, cellular tissue, etc.), and its intimate connec-
tion with the vagina and uterus, make the vesico-vaginal
septum a strong factor in the circle of uterine support,
especially when it is considered that prolapse witliout
cystocele is rare or almost impossible.
This line of support, extending from the subpubic lig-
ament to the attachment of the sacro-uterine ligament
above, forms what is described by Savage as the pelvic
roof. It is this pelvic roof which, intersecting the
Uterus at its cervo-corporeal junction, allows of a free
tilting mobility forward and backward, but not so much
upward or downward. However, the cervix is, with-
out doubt (Savage notwithstanding) prevented from
sinking downward and backward by the posterior wall
of the vagina. This, again, derives its support from the
prolongations of the vaginal tube to the pelvic fascia,
from its own inherent rigidity, and last, but not least,
from the perineum. It is obvious, then, that it is not
the perineum directly, which gives support to the uterus,
but indirectly, in so far as it sup|)orts the posterior vag-
inal wall ; besides which, the posterior wall, being rather
below than behind the anterior wall, also supports the
latter, and with it furnishes additional safety against cys-
tocele.
The abdominal pressure materially influences the
organ. The various plexuses of erectile tissue surround-
ing, as they do, vagina and uterus, and being filled in
life with an amount of blood sufficient to give them a
certain stability, •will do much to restrain the apparently
sujjcrabundant mobility of the uterus (Pallen).
Normal variations in its position occur every day ; the
filling of the bladder lifts the fundus, and throws it back-
ward ; an abnormally distended rectum throws the
organ in toto forward (and only exceptionally the fun-
dus). The act of respiration draws the organ up, or de-
presses it, any exertion or compression of the abdominal
muscles depresses the uterus ; besides, congenital mal-
formations, such as short vagina, or one short vaginal
wall, an abnormally short ligament, ma3% in a given case,
though deviating from the more frequently found position,
represent the normal one here. It is only in those mal-
positions where free mobility is impeded, where the lig-
aments are shortened or rela.xed by disease, where the
blood-vessels are stretched or impinged upon, and an ob-
struction to the return circulation takes place, concomit-
ant with congestion or inflammation, and where, even
without any of these conditions, symptoms are produced
which cannot be ex[)lained except by such displacement,
that we are called upon for their rectification. Kiwisch,
Simpson, and V'elpeau indeed imagined, and fought for
the theory that displacements under all circumstances
ought to be corrected ; but it is only exceptionally that
we meet with a case where the displacement is not the
result of some other trouble, though certainly it will
aggravate this state, and usually will call for treatment.
As my ultimate purpose is to explain my pessary, let
us omit displacements backward, upward, and laterally,
and we find that e.xciting causes for prolapse and ante-
version (with so much concomitant flexion as not to
make this an extra factor requiring treatment) are :
1. Increased zveight of uterus, a. Tumors, subin-
volution of the otgan, or inflammation in prolapse, b.
Increased weight of fundus, subinvolution of placental
site, or fibroids of the anterior wall in anteversion.
2. Interference with uterine supports, a. Rupture of
the perineum, prolapse of the vagina, relaxed ligaments,
or flabby abdominal walls in prolapse. /'. Prolapse of
anterior vaginal wall and cystocele, relaxation of the
utero-vesical ligament, shortening of lower part of pos-
terior ligaments, shortening of round ligament in ante-
version.
3. Pressure from above, a. Tumors in the abdomen,
tight lacing, violent efforts, ascites, and even, as de-
scribed by Breisky, the entrance of intestines into the
otherwise patent Douglas' cul-de-sac.
To recognize in each given case the cause of the dis-
placement will be our first duty, the treatment will
suggest itself.
A ruptured perineum ought to be united.
An inflamed or subinvoluted uterus or vagina ought,
by rest and hot water, etc., to be decreased in size;'
false membranes ought to be stretched or ruptured ;
fibroids in the uterus removed if possible ; tight clothing
discarded ; tone given to an anaemic person or lax
ligaments by out-door exercise and administi'ation of
iron and nourishment. La.x or obese abdominal walls
are to be kept in place by a bandage, thereby distribut-
ing the pressure of the intestines equally over the pelvic
roof. But in all these cases replacement of the or-
gan and a well-adapted pessary, lifting the organ to its
normal plane so as to relieve the pressure and stretching
of blood-vessels, will always prove a valuable factor,
with which I, for one, would not dispense. Of course,
where abdominal tumors are the cause of the displace-
ments, or where the uterus is so firmly glued down in its
abnormal position that it is impossible to stretch the
adhesions, these latter means will be of no avail. •
The replacement will be always easiest performed in
the knee-elbow position. The aid of giavity is thus
brought into force. Elevating the perineum will admit
the air into the vagina, which will rectify the cystocele,
prolapse, or anteversion in many cases by itself.
Slight adiiesions should be stretched, and the reposi-
tion completed by the finger, or a cotton ball held by a
forceps. Whenever we cannot replace by these means, it
is dangerous to use the sound or elevator, the application
of which, even in the other cases, is always dangerous.
March 3, 1883.]
THE MEDICAL RECORD.
235
We now come to those means which we have to main-
tain a replaced anteversion or a cystocele with prolapse
in position.
I do not wish to enumerate all those appliances which
take their support from outside of the vagina, from an
abdominal belt and perineal band. Nothing more un-
physiological could be imagined ; excluding the disagree-
able sensation of the band, each jar and every different
posture reflects violence on the uterus, giving rise to con-
stant irritation. The number, however, of vaginal ante-
version, or prolapse pessaries devised, and daily being de-
vised, indicate that we have not yet found our beau ideal.
All such pessaries aim at the elevation of the vesico-
vaginal septum, and thereby of the bladder and uterus,
exceiJt rings, which stretch the sacro-uterine ligaments,
and thus sling the uterus up from behind.
They take their support from either the posterior vagi-
nal wall and perineum, or from the bony parts, the sym-
physis, or the planes of the ischium. Those taking their
support from the soft parts, produce less irritation be-
cause they do not receive so much counter-pressure, and
they allow more latitude to the instrument and uterus ;
besides, the smaller the pessary, the less irritation it will
produce, and the more chance will the relaxed tissues
have of regaining their tonicity. Therefore, all those rings,
elastic or inelastic, and those appliances which act merely
by their bulk, and which, to mamtain their efficacy, have
to be constantly increased in size performing their woik
by stretching the whole vagina, ought to be rejected.
Thomas', Fallen's, and Graily Hewitt's pessaries are
excellent for some cases ; but one of the grave objec-
tions to them is, that they cannot ordinarily be removed
and reintroduced by the patient herself, a defect also of
that otherwise most excellent pessary of Gehrung's.
This pessary — the double horseshoe — lies, in his dia-
grams at least, with the lower bow below the tjubic
arch, while the other one supports the vesico-vaginal
septum. In reality both bows work themselves behind
the symphysis (a position illustrated by a diagram by
Munde) and stretch the base of the bladder, giving rise
to vesical irritations or peri-uterine inflammation. To
obviate these defects I have devised a pessary, a small
size of which, while supporting the anteversion or cysto-
cele completely, is easy of introduction and withdrawal,
as it takes its support ordinarily from the soft parts, and
is even applicable in cases where the perineum is rup-
tured, and cannot be operated on.
Fiql.
It has the form of a Smith's modification of Hodges'
pessary. The upper and lower parts consist of hard rub-
ber, and are joined on either side by a spring, coated
with soft rubber. The pessary is broad for those cases
where the perineum is partly wanting, while it is nar-
rower where the latter is intact.
After the anteversion or prolapsus are replaced, the
pessary is introduced like an ordinary Smith's, but the
upper bar is left in front of the cervix, instead of being
placed behind it, as in a retroversion. The weight and
the tendency for the malposition to reoccur are neutral-
ized by the springs, which will only give way to a cer-
tain extent ; while their elasticity makes it particularly
adapted for such cases where tenderness would preclude
the use of any other pessary.
In a case where the uterus is heavy the springs have
to be strong ; where the organ is light and easily mova-
ble they have to be more yielding.
CaseI.— Mrs. VV-
, aged thirty ; married three years ;
one full-term pregnancy two years ago, easy labor ;
menstruated three months after confinement ; has always
been well up to that time ; menstruation regular as to
time and quantity. Complains of pains in back and left
side, which are increased before menstruation, and upon
exercise ; frequent micturition, less when recumbent ;
constipated. Physical examination reveals a uterus which
measures three and one-eighth inches, and is in a high
degree anteverted ; severing of the perineum proper,
though skin surface intact.
Thomas' and Gehrung's pessaries produced only very
transient relief, the former after a while produced irrita-
tion, a small size of the latter she lost in walking ; wear-
ing a larger size was attended with discomfort.
For this case I devised my jiessary. The relief it
gave her was immediate ; she wore it for three months,
and is now pregnant for the second time.
Case II.- — Mrs. H , aged sixty-five ; widow ; mother
of four children, the last of which was born twenty-six years
ago after instjumental labor. Since that time patient has
been troubled with dragging pain in pelvis. A few years
ago a tumor appeared outside of the vulva, which she
has carried since then by a diajier. This has incapaci-
tated her for any exertion, though she is otherwise hearty
for her age. Physical examination revealed complete
prolapse, the uterus slightly anteverted, and a lax, partly
lacerated, perineum.
Reduction was easy ; a broad size of my pessary kept
the uterus well in place (the [latient would not consent to
an operation). She has worn the instrument for the last,
three months without any discomfort ; she is able to do her
housework, and only in straining at stool does she stand in
danger of losing it. By applying the tip of the finger to
the lower arc she can easily obviate this difficulty.
Case III. — Mrs. S , aged thirty-two ; married seven
years, three children, the youngest of which is two years
old, complains of menorrhagia, dragging pain, and frequent
micturition. Physical examination showed enlarged ante-
verted uterus, deep unilaterally lacerated cervix, and slight
perineal rent. The cervix was united by four sutures and
healed promptly, leaving the uterus decreased in size, and
the patient free from her accustomed flooding. The pain
and anteversion were not modified. The uterus was now
replaced, and one of my pessaries introduced. The re-
lief was immediate ; she did not return for ten weeks, and
then she gave me the following history : Shortly after the
introduction of my ring she had removed to Brooklyn ;
she had not felt any pain until after that event. Her
idea was, that the ring, which she had not until then
removed, was out of place ; she consequently with-
, drew the instrument and reintroduced it, at once al-
leviating her sufferings ; but in a few hours, after
straining, she felt the pains return. Being disinclined
to come over to New York, she consulted two gen-
^i tlemen in Brooklyn, both of whom tried various in-
^^ struments, none of which did her any good. On ex-
amination I found her uterus heavier and lower down
than before, and upon introducing my pessary [the same
which she had worn before] the uterus pressed it down
instead of being su[)portt:d by it. An instrument with
stronger springs at once set matters right. For several
months she has now felt perfectly well.
This strength of the spring must not be overlooked,
because in another case I have, against my will, turned an
anteversion into a retroversion, by a spring too strong for
that individual case. Unfortunately this case has passed
away from my observation, and I cannot tell how it ter-
minated. In four more cases my pessary has given com-
plete satisfaction to my patients and to myself, and I feel
warranted in presenting it to the profession, only hoping
that it will be given a fair trial. The instrument is manu-
factured for me by Messrs. George Tiemann & Co., of
New York, who have managed to make the movable
part of the pessary perfectly smooth and hard enough not
to become imbued with the secretions of the vagina.
105 Seventh Street, New York.
236
THE MEDICAL RECORD.
[March 3, 1883.
REVIVIFICATION.
By S. waterman, M.D.,
NEW YORK.
The following two cases are selected to show the ne-
cessity of making persistent efforts at revivification in
cases of sudden death, especially from heart disease, as
well as in cases of still-born children.
There is no doubt in my mind that in many cases of
sudden death, especially from heart disease, prompt and
persistent efforts to reanimate the apparently dead person
may result in restoring life. It is probable that in many
instances the heart's action may fail from transient
causes ; a dangerous syncope ina}' supervene, and unless
timely etfortsare made, and proper measures are promptly
resorted to, the person may pass from a state of suspen-
sion of vitality into the silent and lasting embrace of
death.
A case in point happened to rue in the month of Feb-
ruary, 1880. Mr. B , a gentleman c>f sound con-
stitution, about six feet in height, springing from a
healthy ancestry, aged eighty-four years, had an attack
of senile gangrene in the inguinal region, two inches and
a half in length, and one inch wide. The slough was in
time thrown off, and healthy granulation filled the wound.
A second attack subsequently, not quite so severe, de-
stroyed a part of the integument in the umbilical region.
Its cause and final cure was similar to the first attack.
The third attack was in the great toe of the left foot.
The entire toe perished, but a line of demarcation
formed, the destructive process went no farther, healthy
granulation formed, and the healing iirocess progressed
in the most healthy and satisfactory manner. Mr. B ■
suffered in addition from valvular disease of the heart,
and likewise from Bright's disease (granular degenera-
tion), i^robably in consequence of retarded circulation
and diminished blood-pressure. One morning while I
was sitting at his bedside, and in friendly conversation
with him, he being to all appearance in a very happy
mood of mind, he suddenly fell back, his eyes became
fixed and glassy, a deadly pallor crept over his counte-
nance, respiration and the heart's action ceased simul-
taneously, and death seemed to have carried him off sud-
denly and unexpectedly.
It was this suddenness of the event that impelled me
to make efforts at revivification. Two nephews of Mr.
B , who were fortunately in the house, were brought
under requisition, and under my direction systematic arti-
ficial movements were carried on for nearly thirty min-
utes. Then, to my unspeakable satisfaction one deep
inspiratory effort was made by the patient himself. Thus
encouraged, we redoubled our efforts for ten minutes
more ; other inspiratory efforts followed in quicker
succession, the heart began to respond, hardly audible
at first, it required force and momentum ; it could
now be felt at the wrist ; the deadly pallor passed
awa)', the eyes lost their glassy, fixed aspect, sighs and
groans could be heard, twitchmgs of muscles of arm and
fingers could be distinctly felt, and the rigidity of death
made way for reanimated conditions.
He Lay unconscious for more than ten hours, respira-
tion being hurried, and breathing stertorous, the heart's
action wild and irregular. During the night he was de-
lirious and restless. Toward morning all untoward symp-
toms subsided, and a quiet sleep followed the extreme
restlessness.
When I saw him next morning he sat up in his bed
and partook of a good breakfast. Consciousness had
returned, and all the life functions were in full operation.
He died six weeks afterward under symptoms of ur;\:mic
toxication. During these six weeks, up to the hour of his
death, he had several other attacks — one very prolonged
and almost fatal — during which my son, M. VV. Water-
man, attended. Artificial respiration was resorted to
with the same success.
Case II. — Mr. E called upon nie during the winter
of 18 — , to obtain a death-certificate for a still-born child of
seven months' gestation. I expressed a desire to see the
child, and promised to visit him during the day. A mid-
wife had assisted during the delivery. It was a cold
stormy day and i p.m. before I arrived at Mr. E -'s
house. He lived in a low basement. Mr. E was a
Hebrew, and according to Hebrew rites, the child had
been laid upon a little straw upon the ground, and cov-
ered with a light black shawl. It had thus been l)'ing
since 5 a.m. As I was examining the child, I could
detect some slight twitching movement over the region
of the heart. I watched attentively, and I observed the
movement again. I had the child removed from the
ground and placed upon a pillow on the table. The
child w-as as cold as ice but not rigid. 1 could detect no
heart' s-sound, nor any respiratory murmur, but the mus-
cular twitchings were very evident. I immersed the child
in a hot bath, and initiated artificial respiration. Twenty
minutes passed in this seemingl)' hopeless work. Then
the child opened its eyes. A little more work and respi-
ration began, laborious and interrupted at first, more
normal by degrees. The heart's action came up in good
style, and a human life was saved ! The child thus saved
is now one of the most accomplished violinists in this city.
The preceding cases are well calculated to rouse our
most serious attention. How often has it been within
reach of the physician thus to save life if but strict and
critical performance of duty had been attended to ! How
often are certificates of death written out without first
scrutinizing the body, and ascertaining, by all means at
our command, whether death has really claimed his vic-
tim irrevocably ! Mr. B 's case, especially, offers
much encouragement to try revivification in sudden
deaths, especially in heart disease. One case thus given
back to life and light forms a recollection bright and
pleasant upon the thorny path of a physician's life.
103 West Forty-ninth Street.
Permanganate of Potash in the Treatment of
Amenorrhcea. — Drs. Ringer and Murrell have for some
time made extensive trial of permanganate of potash as
an emmenagogue in those cases of amenorrhoea resulting
from some trivial cause, such as getting wet or catching
cold. In their experimental observations they gave the
one drug only. The most striking results were in young
w'omen between the ages of eighteen and twenty-five,
who had missed two or three periods. The administra-
tion of one or two grains of permanganate of potash in
pill, three or four times a day for a few days before the
time of the expected period, will bring on the flow almost
to a certainty. As a rule, the medicine must be taken
three or four days successively to call out the catamenia.
In this connection a letter to the Lancet, January 13,
1883, may be of interest. jMr. Martindale writes : " Hav-
ing during the last few days heard of cases of spontaneous
combustion of these pills, which it is very probable will
occur if the common excipient containing glycerine, now
generally used by dispensers, be used to mass them, I
wish to point out that any readily oxidized excipient
should not be used. Having prepared a quantity of the
pills, I found tlie following basis to answer best : Vase-
line, two iJarts, paraffin wax, one part ; melt, stir till
cold, and add kaolin, three parts ; mix well. This binds
the powdered permanganate together, and with a little
dexterity the pills may be rolled out without much dif-
ficulty, and dusted over with kaolin. They may be
coated with sandarach dissolved in absolute alcohol, and
rendered tasteless. Cocoa butter may be used as an
excipient, but it in time reduces the permanganate, and
it is troublesome to manipulate. In solution a dose of
permanganate of potash is very nauseous : in a tasteless
pill, whicli dissolves slowly and yet can be easily disin-
tegrated, it is, besides, more agreeable to the stomach
than in solution."
March 3, 1883.]
THE MEDICAL RECORD.
237
Icpoi'ts of hospitals.
THE ANTISEPTIC METHOD IN THE LONDON
HOSPITALS.
(As reported by our London Correspondent.)
London, J.inuary 22, 1SS3.
Mr. Li.ster's work has now been so thoroughlv can-
vassed before the face of the whole medical world, that
it is not nnfit at the present time to enquire how far his
views and practice have jirevailed to influence the hos-
pital surgeons of London in modifying their treatment
of wounds, whether the resiUt of accident or caused by
operation.
Mr. Lister has for some years been in London, where,
at King's College Hospital, he shows almost daily to
any that care to take the trouble to follow him round the
wards, or to watch him in the theatre, the methods which
he advocates, and which are the results of his labors for
a very considerable time, as the best for combating the
bugbear of " sepsis " which he first and foremost has the
credit of showing in its true light, as the cause of those
many diseases which formerly wrought such havoc in
surgical wounds. To say that he has been successful in
demonstrating the value of his theory, conveys but a
small idea of the great steps which have been made,
owing to the entire or partial acceptance by the surgical
world of his views. London is on the whole well pro-
vided with hospitals, although their distribution is far
from satisfactory, and the appeals for subscriptions wliich
appear every morning in the daily papers show the diffi-
culty which must e.\ist in maintaining, by public benevo-
lence, the funds of all but the happy few which are blessed
■with rich endowments. Still, as a rule, expense is never
■spared in rendering all the surroundings of their inmates
as favorable to recovery as science can suggest. For
this reason, it may be, hospital surgeons in London were
well contented with the existing state of things, and were
■unwilling to allow that any change for the better could
be possible from the routine which tradition or their own
experience sanctioned. And, no doubt, until Lister's
work and its results became known and discussed, they
had very fair reasons to be satisfied. Their statistics,
when tliey could be compared with those of other towns,
and especiallv with those of foreign hospitals, were more
than creditable. The statistics of the results of operations
in some foreign hospitals, at the time when Lister's prac-
tice became known and his reasoning appreciated, were
truly alarming. It is not to be wondered at, therefore,
that foreign surgeons welcomed any method which
offered' prospects of obtaining better results under the
■same hygienic conditions ; and we need only to look at
the results obtained by Volkmann of Halle, under a
lack of hygienic precautions which is almost incredible,
to understand the enthusiasm with which all the work of
Lister has been received abroad.
It will, then, be a matter of no little surprise to your
readers to know that it is rare to find among the visitors
to Mr. Lister's wards and the followers of his practice,
many of the surgeons to London hospitals. Before leav-
ing Edinburgh, statistics were jiublished which contrasted
the results obtained by Mr. Spence with those of Mr.
Lister under the same roof, and, therefore, the same
conditions. These were decidedly in favor of the lat-
ter's practice, and should have induced all who had the
opportunity to see for themselves by what means such
results were brought about. For it is not by reading or
by listening to his description of others that a fair idea of
the method can be obtained. The details are so care-
fully carried out, and their importance is so essential to
the principle, that it can only be by continuous and care-
ful study that any imitation can be attempted.
So much has already been spoken and written on the
subject that it would be out of ])lace in the present arti-
cle to discuss the many objections to some of these de-
tails, but It may be well just to advert for a moment to
the course which is followed with all wounds in Mr. Lis-
ter's wards. F'or example, let us take a simple opera-
tion, such as an amiiutation of the breast. So soon as
the patient is under the influence of chloroform — which
IS still, used in preference to ether at King's College Hos-
pital— the ]iarts around are sponged over with a weak
solution of carbolic acid, i to 40 parts of water. So,
too, are the surgeon's and assistants' hands, and the
sponges to be used in the operation are dipped in the
same solution. When all is ready the spray ap|3aratus,
placed at a convenient distance, is brought to play over
the part, the patient's face being protected by a towel,
and the management of the spray being the sole duty of
an assistant. The instruments to be used are all inunersed
in a solution of i in 20 of carbolic acid, and are imme-
diately replaced in it when not in use, the solution being
contained in a large flat tray which stands on a small table
within reach of the operator, and a towel soaked in the
solution is spread just below the breast of the patient,
upon which they may temporarily lie in the full atmos-
phere of the spray. When the diseased part has been
removed, the vessels are tied with carbolized catgut, and
all bleeding having ceased, a drainage-tube which has
been carefully cleansed and washed inside and out with
the stronger solution is inserted at the most dependent
part, a separate opening in the skin being made, if ne-
cessary, to obtain that object. The edges of the wound
are then brought together by sutures either of wire or of
carboli/ed silk, and if there be much tendency in the
wound to gape, or if the tension be great, the deeper
parts are drawn into apposition by two or three stout
silver-wire sutures made fast at each end to flat pieces of
lead, the edges of which are turned up in such a manner
that the wire can be easily secured by a turn or two
around them.
On this accurate approximation of the deeper parts of
all such wounds great stress is laid, and it is considered
essential to secure rapid union of all such cases. The
wound is then dressed, a narrow piece of " protective "
being laid along the whole of its length, and one or two
layers of gauze wrung out in carbolic solution being laid
over and freely overlapping it. Above this the gauze
dressing is carefully laid, and consists of seven or eight
layers of dry gauze, with a piece of mackintosh beneath
the outermost layer, and this is secured by a bandage of
the same material. In order to ensure the accurate fit-
ting of this dressing, which is sufficiently extensive to
cover a wide area around the neighborhood of the
wound and to pass up into the axilla of the affected
side, an elastic bandage is adjusted so as to bind down
the edges in all directions and obviate any chance of the
ingress of air or the disturbance of the dressings by the
movements of the patient. As soon as all this is com-
pleted the spray is withdrawn ; but should any accident
occur to the spray apparatus during the progress of an
operation, a piece of linen soaked in carbolic lotion is
always at hand to protect the whole of the wound.
The case is generally dressed on the following day
with the same antiseptic precautions, and these are used
until the wound is entirely superficial, when they are dis-
carded, and ointments containing boracic acid are sub-
stituted. Such is a rough sketch of the method followed
by Mr. Lister and those who adopt his treatment in its
entirety. But it must not be supposed that any descrip-
tion can give an adequate idea of the precautions which
are taken by all concerned in an operation such as that
above described to thoroughly guard against the possi-
bility of sepsis. Nothing but careful watching of the au-
thor's work can give the full estimate of its thoroughness.
Mr. Lister himself attends to the dressing of all his cases
whenever it is possible ; but he has so thoroughly imbued
his house-surgeons and dressers with the details of his
system that he can well aftbrd to trust them. So it is
that all recent wounds are treated on this principle,
whether they be the merest trifles or whether they are
238
THE MEDICAL RECORD.
[March 3, 1883.
complicated with a fractured bone or an injured joint.
In all cases the wound is thoroughly cleansed by syring-
ing into its innermost interstices a solution of carbolic
acid, and then dressed in the same way as a wound
caused by operation.
It is, perhaps, in the surgery of the joints that the con-
trast between past and present methods of treatment' is
most strongly marked. Any one who recollects the
gravity with which an accidental wound of the knee-joint
was regarded fifteen years ago — and with very good reason,
for the tables of our hospitals show how fatal was such
an injury — and contrasts with these tables those which
have been published in connection with such injuries
under the care of Mr. Lister, will be forced to confess,
nolens vo/etis, that some great secret has been unravelled
which has divested this injury of most if not all of its dire
fatality. But that is not all. The immunity which attends
accidental injuries of joints has increased the number
and magnified the nature of the operations which can be
performed upon them with an almost entire freedom from
those sad and frequent consequences which formerly
made surgeons hesitate long before they proposed to the
patient an operation, such as the removal of a loise car-
tilage, which incapacitated him from following any use-
ful pursuit. Contrast with former exjierience the fact
that since 1S71 Mr. Lister has treated forty cases of in-
juries to healthy joints without a death, that these cases
were in hospital wards, and that in only one, where the
wound was made by the surgeon, did suppuration occur,
and we need hardly search for further proof of the ad-
vance in surgery which has taken place in consequence
of the method which has been so carefully and earnestly
established.
As has been said, the number and the nature of oper-
ations upon healthy joints has been increased, and we
need only look at the list of those which occur in the
table to wonder at the boldness or e.\tol the enterprise
of a surgeon who dares to unite, by wire, the ends of a
fractured patella, and to drain the knee-joint for relief of
the eftiision consequent, and who obtains after this, as a
result, a united patella and a joint in no wise impaired
as to its mobilit)-.
It is not our purpose to detail the many operations
which can now be performed with comparative safety, but
we have thought it worth while to instance a few, in order
to show the difiiculty which some of the older surgeons
must feel in reconciling such bold measures with all the
teaching and experience of their earlier days. To this must
be attributed, in some measure, the hesitation which in
many cases has been shown to welcome or adopt any new
method. Still it has been forced upon them to make a
very great and thorough change in the treatment of their
cases, and it has transpired that although many sur-
geons would deny that they are followers of Lister in
all the details which he considers as vitally necessary to
the complete and thorough carrying out of his views, yet
they would indignantly repudiate the assertion that they
were not " antiseptic " in their treatment of all their cases.
Thus it has come about that to distinguish his own practice
from that of others who are antiseptic but not Listerian,
the author of this change of circumstances speaks of his
own work as "aseptic," meaning by this distinction of
terms that in his own case a distinct principle is followed
which attains the ideal of results, vi/.. : a complete ab-
sence of putrefaction — an asepsis, while under the longer
word are comjirised " those methods by which the occur-
rence of putrefaction is more or less interfered with, but
all acting on a more or less imperfect principle."
(To be continued. )
Iodide of B.irium. — This substance, which, by the
way, is actively poisonous, has been used in France as
an application to enlarged lymphatic glands, and more
especially as a local application in chronic eczema. For
this purpose it can be mi.xed with a pctrolate.
The Treatment of Lobar Pneumonia. — In a clini-
cal lecture on pneumonia recently published in the Lancet,
Dr. Francis Delafield speaks as follows regarding treat-
ment : The treatment of lobar pneumonia calls for the
exercise of much knowledge and judgment on the part of
the physician. It is necessary to be practically acquainted
with the course of the disease, and to appreciate fully the
exact condition of each patient. There is no routine
treatment for pneumonia ; each case must be managed on
its own merits. If we see a patient during the first twelve
hours of a pneumonia, the question presents itself as to
whether we shall try to abort the disease. This may be
done in two ways : by general bloodletting, or by large
doses of calomel. The latter plan is the one more fre-
quently employed in New York. From twelve to twenty
grains of calomel are placed on the patient's tongue, and
this dose may be repeated in six hours. In favorable
cases either the bloodletting or the calomel may cause
defervescence to take place within a few hours. But
both these plans fail in more cases than they succeed.
Ordinarily no such attempt is made to abort the disease.
Our first care is to put the patient into a condition of
absolute rest. He is to be kept in bed, fed on fluid
food, and given opiuju in small doses. Everything which
can annoy or irritate the patient is to be strictly avoided.
If the temperature runs between ioo° and 104° it re-
quires no treatment. If it rises higher than this we may-
sponge the skin with alcohol and water, give diaphore-
tics, and aconite or veratrum viride in small doses.
Large doses of quinine, cold baths, and cold affusions
not only make no permanent reduction in the tempera-
ture, but they are positively dangerous. The pulse
should regularly be between 100 and 120. If it is above
120 and feeble, we should endeavor to render the heart's
action slower and stronger. The most efficient agent for
this purpose is alcohol. Either wines, whiskey, or brandy
can be prescribed. The amount of alcohol used is to be
regulateil by its effect on the pulse. It is often well to
combine with it either opium or the liquid extract of
convallaria. This seems to be the only indication for
the use of alcohol in lobar jmeumonia. Unless it is re-
quired as a cardiac stimulant, the patient is better with-
out it. If the breathing is not only rapid but oppressed
at the onset of the disease, the patient may often be re-
lieved by the use of wet cups, dry cups, warm fomenta-
tions, or mustard plasters over the whole of the chest.
If such oppression continues through the disease, it may
be mitigated by the use of calomel and opium in small
doses, by aconite and veratrum viride, and by diaphore-
tics. For the pain in the side, the restlessness, and the
sleeplessness, the most efficient remedy is opium, select-
ing the preparation and the dose to suit each patient.
From what has been said, you will infer that many
cases of pneumonia reciuire no treatment but rest and
opium ; and it is true. If the disease is running a mild
and regular course, you are not likely to improve mat-
ters by interference. The only indications for treatment
are to relieve an abnormal development of any of the
symptoms which may threaten to disturb the patient.
ALBU.MINURIA AND Anasarca from Contusion of
THE Kidneys. — M. Boissard, in La France Mcdicale,
reports a case of anasarca occurring after contusion of
the loins. There was no hasmaturia, the urine was
abundant, but contained a large amount of albumen.
The anasarca disappeared in eight days, but the albumi-
nuria persisted for a month.
Changes of the Solar and Hypogastric Plexus
IN Peritonitis and TYi'm)iD Fever. — Dr. Kalantarianz.
has examined microscopically the condition of the solar
and hypogastric plexus in eight cases of peritonitis and
five of enteric fever, and found that both in the latter
March 3, 1883.]
THE MEDICAL RECORD.
'■39
and in acute cases of the former disease there are con-
stantly present morbid changes in the ganglia, which
point to the development of an acute interstitial iii-
danimatory process, with subsequent opaque swelling of
the parenchyma of the nerve-cells and their ultinjate fatty
degeneration, brown pigmentation, and atrophy. In the
chronic forms of peritonitis the alterations consisted
chiefly (i) in sinqjle and degenerative atrophy of the gan-
glionic cells, which very often were found entirely disin-
tegrated and transformed into mere accumulations of an
amorphous pigmentary matter, and (2) in increase and
sclerosis of the ganglionic connective tissue. — London
Medical Record, January 15, 1883.
The Medical Treatment of Orstinate Neural-
gia.— M. Verneuil, in a communication to the Surgical
Society of Paris {Le Prog. Med., No. 49, 1882), refer-
ring to the surgical treatment of obstinate neuralgia, said
that all therapeutic resources should be exhausted before
surgical interference was undertaken. He recalled a case
which was cured by hyoscyamin, after resection of all the
ends of nerves and even am|iutation had failed to give
relief.
Parturition in Primipar* of Advanced Years. —
Mangiagalh has advanced the opinion that the difficult
labors usually observed in primipara: of advanced years
are due to some physical defect independent of the age
of the patient. The women are deformed, and on this
account marry late in life ; but had they married earlier
the same difficulties in parturition would have been en-
countered. In order to test this theory Dr. Rumpe has
examined the records of one hundred primii)ara3, over
thirty years of age, at the Marburg Clinic. His investi-
gations lead him to reject AFangiagalli's views. He con-
cludes that the difficult child-birth in such cases is due to
two causes — sluggish pains and rigidity of the soft parts.
Another cause he finds in the relative frequency of male
births in these cases. Out of the 100 mothers 8 died.
The mortality among the children was also greater than
in the lirst labors of younger women. — Archiv.fiir Gynd-
kologie, vol. xx., 1882.
Hvdatidiform Disease of the Chorion. — Dr. Ste-
phens writes to the British Medical Journal, January 27,
1SS3, as follows : '• On September 7th, I was sent for by
a midwife to attend Mrs. C , who was flooding. On
my arrival, the hemorrhage had stopped. On making an
examination, the uterine sheath was not sufficiently dilated
to be able to ascertain its contents. On jiassing my hand
over the abdomen, I remarked to the midwife how un-
usually circular it was. On the following afternoon, I
was again hastily summoned, and found the woman had
lost much blood. On making an examination, I found
that, by a little manosuvring, I could insert my hand into
the uterus ; and I vividly remember how astonished the
midwife and Mrs. C looked, when 1 informed them
that it contained no child. In fact, the patient stoutly de-
clared that she had felt the child many times ; and that,
being the mother of thirteen children, all living, she ought
not to have been mistaken. After administering a full dose
of ergot, some sharp uterine pains followed, soon expel-
ling a mass, which, when collected, tilled three ordinary
sized chamber-utensils. After this jelly-like mass had
been expelled, she made an uninterrupted recover}'. "
The Treatment of Dysentery. — In the British
Medical Journal, January 27, 18S3, Dr. Rawle describes
a plan of treatment of this malady, which has proved very
successful in his hands. Having placed the patient be-
tween warm blankets, a pint antl a half of warm water,
at a temperature of 90° F. is injected. This is seldom re-
tained longer than a few minutes, but is pronounced very
grateful to the patient. When the water has soothed
the mucous membrane of the colon and rectum, and
brought away any effete matter, two ounces, by measure,
of the following enema is administered with a gum-elastic
bottle. IJ. Quinine sulphate, ten grains; compound
tincture of camphor, four drachms ; decoctum aniyli to
two ounces. Mix, and when about milk-warm, inject,
which is generally retained ; but, if ejected, it may be
repeated after an hour or two. This has been found of
great service, and very grateful to the patient. The effect
fs like magic. If griping pains be felt over the region of
the epigas'trium, half-drachm doses of chlorodyne, in some
aroiiiatic water — mint, caraway, or aniseed — should be
given. The diet, of course, should be of the most sooth-
fng kind: jelHes, isinglass, linseed, toast- and barley-water
ad libitum. Ipecacuanha appears of little service, and
Mr. Rawle has discarded it from his treatment. Warm
turpentine stupes on warm flannels, over the hypogas-
triuni prove very beneficial.
Rupture of the Aorta during Parturition. ^Dr.
Heinricius relates the following case : A woman, thirty-
eight years of age, of apparently good health, vyas first
seen after labor had begun. The os was dilating, the
pains were regular, and everything seemed to be pro-
gressing favorably. Half an hour later she was suddenly
seized with convulsions and died in collapse. A living
child was delivered with the forceps. At the autopsy a
rupture of the aorta was discovered, situated about three-
fifths of an inch above the semilunar valves. The visceral
layer of the pericardium was torn, and the pericardial
sack was distended with blood. — Centralblatt fiir Gyna-
kologie, December 16, 1882.
Sir William Gull on Scientific Medicine in Gen-
eral Practice. — In the course of an address delivered
on January 17th, before the Metropolitan Counties
Branch of the British Medical Association, on the sub-
ject of the " Collective Investigation of Disease," Sir W.
Gull, observed : " It will be admitted that, had we leisure,
proper means at our disposal, and from previous training
a fitness for exact observation, we should find in general
practice one of the most valuable fields of pathology, as
here and here only we have before us the earliest signs
of departure from health, and the only opportunities for
tracing the course of a disease from its beginning to its
end. Having passed many years in hospital and private
practice, 1 have come to see that experience gained in
tlie latter is necessary for the correction of that acquired
in the former, especially as helping toward a truer path-
ology. It will perhaps, and naturally, be objected, that
it is almost impossible to organize for any useful purpose
the labors of men already overburdened by the cares and
fatigue of practice ; and that there is neither time nor
fitness for delicate inquiries on their part. Admitting
that this objection is valid, it may be urged m reply, that
it need not be insuperable. It cannot be denied that
when we see the meaning of the apparent trifles which
in practice would otherwise oppress aiKl worry us, our
burden is thereby nuich lightened, and that nothing could
encourage us more than to feel that even one daily ob-
servation recorded was adding to our general store of
knowledge, and making the path of practice more easy.
There is no tonic to the mind greater than the sense of
work done ; and our journey is likely to be made shorter,
as it certainly will be easier, if the way is illuminated. We,
indeed, owe it to those members of our profession, who
are admittedly overwhelmed by the apparently senseless
details of their work, to promote a movement like collec-
tive investigation, the object of which is to establish order
out of chaos, and to help them to stamp a scientific value
upon facts hitherto only burdensome. If we compare
the unflagging interest of any pursuit where the aim is
high and clear with the tediousness and wearisonieness
felt when working in the dark, we shall readily admit that
we are actually lightening the burdens of practice by thu&
adding to them, and by giving some portion of them a
sense and meaning. It is the spirit of a man which en-
ables him to do his work lightly and cheerfully, and he
will certainly be helped in this by a combination with
fellow-workers on the same subject." — British Medical
Journal, January 27, 1883.
240
THE MEDICAL RECORD.
[March 3, iS8^
The Medical Record
A Weekly yoiinial of JMcdicijie and Surgery.
GEORGE F. SHRADY, A.M., M.D., Editor.
Pl'BLISHED by
WM. WOOD & Co., Nos. 56 and 58 Lafayette Place.
New York, March 3, 1883.
REGIONAL PHYSIOLOGY OF THE BRAIN.
When we come to the matter of regional physiolog\-,
we find ourselves in the midst of problems which still
await complete solution, bat the painstaking researches,
the past eleven years, first of Fritsch and Hitzig, later of
Munk, Ferrier, and others have done much toward clear-
ing away the difficulties. The connection of aphasia with
■definite lesion in the posterior part of the third frontal
convolution of the left hemispliere had been determined
by Broca, as a result of some hundreds of observations,
•confirmed by the necropsy ; but this first and capital fact
in cerebral localizations was little understood and bore
little fruit, till Ferrier confirmed conclusions, established
by the French physiologist more than forty years be-
fore, co-ordinating these conclusions with his own valu-
able discoveries. That Broca's convolution is, in right
handed individuals at least, the cortical centre for word
ideation and word execution, seems to be a legitimate in-
ference from some thousands of observations now on
record. Ferrier's explanation of the occurrence of the
speech-centre on the left side — that is, in the early history
of the race, communication was by manual signs and
gestures before language was invented, and the articulat-
ing centres were educated and became the organic seat
of volitional acquisitions on the same side as the manual
gesticulating centres, and as most people are right-
handed, the education of these centres takes place in the
left hemisphere-.-seems both possible and probable.
Lesions of the s])eech-centre which extend consider-
ably into the antero-frontal lobes have been found to be
attended not only with aphasia, but with amnesia — loss
of the memory of ideas, as well as loss of words, and ver-
bal expression. Multitudes of well-attested cases on
hospital files and in medical journals substantiate this.
Other considerations, such as the eftect of destruc-
tion of these " incxcitable" lobes, go to show that tiieir
main function is psychical. If any motor infiuence
■emanates from them— and very many of the anterior
fibres of the corona radiata certainly terminate in this
part of the cortex — such influence would seem to be of
an inhibitory character, i.e., restraining, rather than in-
citing.' Ferrier's experiments, and a great number of
subsequent experiments by Yeo and others, which con-
firm this, and the results of lesions of these lobes in
' Wi. ;....^ ...i;;.ir instances of motor neiirility which is inhibitor^*, in the
<:ardiac branches of the par vagum, in the depressor nerve of Cyon, and other
vaso-diiator nerves.
man, seem certainly to give striking support to the
ancient and prevalent view (for which phrenology is
probably largelv answerable), that the frontal lobes
have more to do with intellect than any other part of the
brain.
It must be confessed that when first the proposition
was formally announced that the parietal lobes were prin-
cipally concerned with motor and not psychical func-
tion, it took almost the whole medical world by surprise.
A priori it seemed quite improbable that " such valu-
able material as we must needs suppose the gray matter
of the convolutions to be, should be taken up in such,
so to speak, menial work as bending or straightening a
limb" (M. Foster). It must be remembered, however,
tliat the larger part of the lives of the greater portion of
the animal kingdom, man not excluded, is taken up with
motor performances of a very menial kind, which cer-
tainly require but very little intellect for their direction,
no more in fact than the antero-frontal region might be
supposed capable of supplying, and that a priori there
can be no improbability in the supposition that a man's
limbs and muscular groups have their representative cen-
tres in the cerebrum. The jihenomenon of descending
degeneration of the medullary strands between Ferrier's
cortical centres and the basal ganglia, in the case of lesions
of the motor area, and the coincidence of this degenera-
tion with similar degradation of the motor columns of the
spinal cord, has been noted by Charcot and Flechsig, and
seems to point to direct anatomical connection between
the anterior and crossed pyramidal columns of the spinal
cord and those cortical regions. Moreover, Franck and
Pitres have shown, by the results of section of those me-
dullary fibres which terminate in the gray matter bounding
the fissure of Rolando, that secondary degenerations occur
precisely similar to those which occur in motor spinal
nerves after their separation from their trophic centres in
the spinal cord, and they reason from this (and it seems
to us justly) "that the medullary fibres between the cor-
tical centres and the lower motor nuclei, bear the same
relation to the nerve-cells of the corte.x as the spinal
motor nerves to the multipolar cells of the anterior'
cornua."
If electrical stimulation of certain areas of gray matter
bounding the fissure of Rolando in the monkey (the cru-
cial sulcus in the dog), have produced definite motor
results, so that what will occur under similar circum-
stances can no«- be predicted witli certainty, destruction
of these areas, whether by caustic in the animal or dis-
ease in man, produces motor results no less constant
and definite. Experimenters working in the same line
with Ferrier (Carville and Buret, Luciani and Tam-
bourini, notably Yeo) have, in numerous instances,
added confirmation to Ferrier's experiments, and hun-
dreds of careful clinical and post-mortem observations
have demonstrated the concomitance of general or lim-
ited paralyses with lesions more or less circumscribed of
those portions of the parietal lobes now known as Fer-
rier's motor centres.
Among tile important contributions which have from
time to time appeared in these colunms, and which tiirow
light on certain aspects of tliis subject, we may signal the
))apers of Seguin and Dalton, in The Record for 1881.
Segiiin has found liie " New Phrenology '' (as a popular
March 3, 1883.]
•THE MEDICAL RECORD.
241
scientific journal terms the modern doctrine of localiza-
tions) a valuable aid to diagnosis, and says with regard to
Ferrier's statement of these localizations, " these are not
theoretical guides, they are valuable life laws, and there
has not a year passed the last five years that I have not
seen cases illustrative of them, and verified them by post-
mortem examination." He cites cases, occurring in his
experience, where the diagnosis was made with great ac-
curacy. In other instances, recorded by other observers,
as Wernicke and Hahn, cortical abscesses have been di-
agnosticated by these rules (motor and sensory [limbs]
paralysis occurring in members on the opposite side), the
skull has been trephined, the abscess evacuated, and
amelioration has followed the operation. In other cases,
light has been thrown on certain obscure forms of epi-
lepsy, which have been found to be due to irritative or
"discharging lesions" of the motor cortical regions
("Jacksonian epilepsy"). It is worthy of note that Dr.
Huglnlings Jackson, reasoning from clinical and pathol-
ogical observations of unilateral and localized epileptiform
convulsions, formulated in advance of any experiments of
Fritsch and Hitzig views of the etiology of those convul-
sions, which — at the time considered fanciful — are now
found to be in striking accordance with Ferrier's observa-
tions, and those of his Clerman predecessors.
The experiments of Dalton (recorded in the paper al-
luded to) corroborate the position of Ferrier that the
angular gyrus is the seat of visual perception. In two
cases in which he excised the angular convolution in
dogs, blindness of the opposite eye followed. These re-
sults coincide with those of Ferrier on monkeys and
McKendiick on pigeons, but await confirmation by a suf-
ficient number of pathological observations in man.
With regard to the other sensory centres, there is
still great uncertainty ; Munk, Luciani, and Tamboiirini
agree with Ferrier in admitting the existence of such
centres (as of hearing, smell, taste, tactile sensibility),
but dift'er as to the precise location. Ogle, however, and
Hughlings Jackson relate cases confirmatory of the loca-
tion of smell and taste in the lower part of the temporo-
sphenoidal lobe.
Whether or no the occipital lobes (which like the an-
tero-frontal are inexcitable) have any loftier function than
that of ministering to the visceral sensations, being the
cerebral centre of the appetite for food, or whether they
have even this humble function, is still undetermined.
Considering the great account which, in man as well as
in other animals, is made of the gratification of the
alimentary propensities, it would seem d priori prob-
able that the stomach has its representative in the cere-
brum.
We propose at a future time to take up other aspects
of the subject of localizations.
TRACING CONTAGION.,
The folfcwing analytical observations of Professor J.
Leidy may assist the practitioner to trace the cause of
anthrax or splenic fever, when other causes of contagion
are not apparent.
A number of cases in the same herd, owned by a
farmer at Salem, N. J., having died very suddenly, the
veterinary surgeon submitted a specimen of the blood
from the last victim to Professor I.eidy for microscopical
examination.
The animal was apparently well on one evening,
and was milked as usual ; it died the next morning.
The cause was not clear, but was suspected to be the
result of anthrax or splenic fever. A post-mortem ex-
amination was made the following day ; and the abdomi-
nal viscera were found much congested, especially the
spleen, which was gorged with blood. The specimen of
blood from the spleen was examined and found to be
teeming with bacteria of the form known as Bacillus
anthrax, which is now viewed by most competent authori-
ties as the cause of anthrax. The bacilli were actually
more numerous than the blood-corpuscles, which appeared
unchanged.
This case shows that milk is forwarded to market
drawn from cows which are within a few hours of their
death from splenic fever. Such milk can hardly be whole-
some, and doubtless contains the bacilli capable of
giving contagion.
Let us hope that the fat from the carcass of such
animals is not sent to the nearest oleomargarine manu-
factory, as this substance is rendered only at a tempera-
ture under 120°, by the patent which is now supreme'.
We need not state that the thermal death-point of bacilli
is far above such a temperature, and we leave our read-
ers to draw their own conclusions respecting the results
when such uncooked animal produce is used as an article
of diet.
ESTHETICS .'VND DRUG-TAKING.
It is a matter of some practical interest to the physician
that he take account of the results of the impact of the
a;slhetic wave upon the medical profession. It has long
been observed that, with developing civilization, the peo-
ple have become more intellectual, and the doctor has
had in consequence to become more wide-awake. The
education of the aesthetic sense in this country has been
more recent, but it too is now a thrifty and vigorous
cultus. Our modern society, in fact, has become much
more sensitive to what is disagreeable and much more
responsive to what is agreeable than was formerly the
case. The beautiful is ardently adnured and the ugly
as warmly detested. ^'Esthetics even supplants morals
with many, especially of the fairer sex, vulgarity being
often thought worse than wickedness, and good manners
quite an atonement for bad morals.
Now, if any one doubts the bearing of all this upon
medicine, let him prescribe nauseous draughts and ill-
smelling mixtures among his upper-class patients for
a while. He will soon find that it does not answer. The
young physician of to-day has an additional lesson to
learn. He must not only give the right thing therapeu-
tically, but must give it agreeably.
The pharmacist has become well aware of this new
demand of the public — the tradesman being always most
plastic to developmental readjustments or fashion's
changes. Note the history of cod-liver oil. No scien-
tific problem has received more attention or diverted
more cerebral force than has that of making oleum mor-
rhuee palatable. Even though it has proved a kind of
North Pole of pharmaceutical ambition, the struggle is
not yet given up. The demand for agreeable medicines
242
THE MEDICAL RECORD. •
[March 3, 1883.
shows itself also in the remarkable growth of the pil]
trade. The bolus is now hardly known, and we give in
small and slippery pellets what our grandfathers con-
quered asphyxia in attempting to swallow. The pill, to
be sure, is tasteless, and its aesthetic value is chiefly neg-
ative, yet it accomplishes the object of attacking the
disease without afflicting the senses. There are also
popular practitioners in our city who are not content with
this merely negative position of the pill, but require their
druggist to put upon it a seductive coating of gold or
silver foil. The mental effect of taking these expensive-
looking globules is not to be ignored.
The manufacture of elixirs, syrups, and various aro-
matic compounds has also vastly increased under this
demand for the non-oflensive in medicine. To make
something which "children will cry for" is the honest
ambition of many a druggist who appreciates the signs
of the times. Since medicine-taking with Americans often
becomes as much a pastime as a serious business, the
syrup and elixir trade flourishes, greatly to the delecta-
tion of childhood and the content of the adult.
The moral to be drawn from the state of things thus
portrayed is most apparent and important. The practi-
tioner must regard not only the disease but the palate of
his patient. Not that we would always recommend the
prescription of pleasant-flavored mixtures. There are
some persons who measure the value of their medicine
by the strangulating eftects which accompany its taking.
But the wise physician will study the whole case, and in
prescribing for the disease not forget the individual.
MEDICAL EX.'\MINATIONS IN EXGLAXD.
The English Government, as previously noted, proposes
to introduce a measure, during the present session of
Parliament, for the purpose of amending the law relating
to the licensing of medical practitioners. The recommen-
dations of the late Royal Commission will probably be
adopted, and a single board will doubtless be constituted
before which the medical student will be sure of obtain-
ing a fair examination in every branch of his art. We
believe also that a second and higher board will be con-
stituted, with power to confer degrees and higher titles.
The Lancet states that the present condition of the
licensing system admits of no other course, and that
students, the profession, and the public demand such a
change. This state of things hardly accords with the
generally received opinion that the English system of ad-
mitting medical students to practice is in advance of our
method. Our medical brethren on the other side appear
to consider that their system is far from perfection. We
shall watch with interest this attempt to form an inde-
pendent and competent board of examiners for medical
students in England, and trust that the reform may pro-
duce a system which may be accepted as a model for
some improvement in the same direction here. Medical
opinion in this country is being gradually educated to
the point of considering that State examinations for the
degree of Doctor of Medicine are the main means of es-
tablishing an absolute, consistent, and trustworthy stand-
ard of medical requirements. In fact, all measures for
reforms in medical education must necessarily centre
around this point.
LIMITING THE POWER TO CONFER MEDICAL DEGREES
IN MASSACHUSETTS.
A Massachusetts Judge recently decided that the
Bellevue Medical College of Massachusetts was legally
incorporated, and could legally confer degrees in medi-
cine, even upon persons who had not studied medicine
the proper length of time. Thereupon several new
institutions started up, and the business of diploma-
making in Massachusetts on the Buchanan plan seemed
to be in a most prosperous condition. The legal profes-
sion has, however, stepped in, and on February 24th the
Attorney-General of the State rendered an opinion, in
which he held that institutions of learning or science
created under the general law do not possess the power
of conferring degrees.
This takes away the i)owers of the medical diploma
mills, theoretically. It remains to be seen whether they
will actually be stopped in their operations.
In this connection we W'Ould refer to the fact that
somebody calling himself a " student " has asked the
Kansas City (Mo.) Times : " Is there any State in the
Union where I can practise medicine without a diploma ?
I have attended one course of lectures." To which the
Times replied : "Yes — in Massachusetts."
JOURNAL OF THE AMERICAN MEDICAL ASSOCL^iTION.
The Board of Trustees appointed by the American
Medical Association to decide upon the plan of a weekly
medical journal has issued a circular requesting medical
periodicals to inform the profession that sufficient en-
couragement has been received from different quarters
to warrant a report to the next meeting of the Associa-
tion in favor of the establishment of said journal. We
think the committee is in error in issuing a circular of
this kind, which does not give the figures upon which
such conclusions have been based.
As we understand it, this proposition involves very
considerable financial responsibility somewhere, with no
slight possibility of greater or less deficiency, to be made
good, we suppose, by the Association. If this be so, it
is right that the members should have the same data as
that possessed by journal committees, that each member
may exercise his own judgment before voting upon so
important a matter. Let the committee give a S3'nopsis
of the pledges it has received from the forty thousand
copies of the programme it has sent out. Let it state
the estimates of the cost of publishing the journal re-
ceived from four principal cities, etc. To give these
figures only at the time of the meeting in June next will
not afford the members of the Association a fair oppor-
tunity for considering them. Let us have light now.
THE POLLUTED WATER-SUPPLY OF BOSTON.
The subject of water-supply in Boston is one that at
present interests the inhabitants of that city very much.
For the past two or three years, ever since the new
basins connected with the Sudbury River have been used
as a source of supply, the water has been bad — very
bad. Experts pronounce it the worst water, with per-
haps one exception, furnished to any city in the country.
Those of the citizens that can afford to buy spring water
at the rate of ten cents a gallon — as much as the farmers
March 3, 1883.]
THE MEDICAL RECORD.
243
in the centre of the State get for their milk — do so,
and grumble at the expense added to the high water-
rates. Dr. Bowditch echoed public sentiment when he
said that the Boston water was not fit to drink, and was
sometimes too dirty to bathe in.
For some time past the Water Board has endeavored
to protest against the public voice in this matter, and
has insisted that the water was good, though perliaps a
little discolored. At last comes an official report from
the commission appointed by the City Council, in which
the public complaints are acknowledged to have a good
foundation, and remedies for the existing evils are sug-
gested.
The chief causes of pollution are, first, the sewage of
the town of Natick, which flows directly into Lake Cochit-
uate, and, second, the state of the Sudbury River basins.
These basins are nothing more nor less than meadow and
swamp lands which have been overflowed without having
been at all cleaned, and in many places the water is very
shallow, the bottom being made up of the above-men-
tioned nnid and swamp which was lately covered with
vegetation, now decaying and being furnished to water-
takers in the form of a weak decoction. In such water
algae flourish, and by their decay add more organic mat-
ter and the very disagreeable fishy taste so much com-
plained of. The remedies suggested are, first, stopping
the flow of sewage into the lake, and, second, the re-
moval of the mud and loam from the basins, especially in
their more shallow portions. It is hoped that these im-
provements will take place soon, as the health of the city
is seriously threatened as long as the present condition
of things exists.
ITlans of the 'Scflcdi.
The Ohio Flood and Typhoid Fever. — Typhoid
fever has appeared in the inundated districts of the Ohio
Valley.
Poisoning of Lunatic Asylum Inmates. — Eight in-
mates of the Western Lunatic Asylum at Staunton, Va.,
were poisoned last week, presumably by some crank hav-
ing the freedom of the house. Six of the victims have
died and two have recovered. The poison, the nature of
■which is as yet unknown, is supposed to have been
mixed with medicines on their way from the dispensary
to the wards.
Emergency Lectures to L.\dies. — .\ series of
"emergency lectures" to ladies is being given by various
members of the profession in Boston, the proceeds to be
used in aid of the Training School for Nurses. The sub-
jects to be treated of are dressing of wounds, hemor-
rhage, care of the sick, etc.
A Cincinnati Sanitary Commission. — The citizens
of Cincinnati are urging the passage of a bill appointing
a street and sanitary commission for two years, with
$1,000,000 to spend.
Victims of Trichinosis. — Five members of a family
in Port Jervis, N. Y., recently became affected with tri-
chinosis, through eating raw pork. One of the persons,
a child, died.
Further Bequests to our City Hospitals. — The
late E. D. Morgan left $50,000-10 the Presbyterian Hos-
pital, and a similar sum to the Hospital for Ruptured
and Crippled. The Manhattan Eye, Ear and Throat
Hospital was also liberally remembered.
Small-pox in Colorado.— Notwithstanding the stren-
uous efforts to throttle it, the small-pox appears to be
getting the upper hand of the authorities. The Leadville
public schools have been closed. A new pest-house is
being built there. The alarm is becoming general and is
reaching out into the surrounding towns, some of which
are estabhshing a quarantine.
Dr. M. T. Councilman has been appointed the pathol-
ogist to the Baltimore Academy of Medicine.
A Naval Medical Society.— We are glad to learn
that the medical staft' of the Navy has organized a Society
called "The Naval Medical Society," in order to estab-
lish more intimate social and friendly relations among its
members, to furnish occasions for the interchange of pro-
fessional experiences, and to assist each other in scientific
inquiry and research. Every officer of the medical corps
has the right of membership upon notifying the Secretary
that such is his desire.
The Society is to have regular meetings on the first
Thursday of every month, in the city of Washington, and
at such other times as the business committee may con-
sider advisable, or when five other members may so re-
quest.
Lively Medical Work. — The investigation recently
undertaken regarding the condition of Sing Sing Prison,
reveals a bad state of affairs. The prison physician
testified that there was really no wholesome air in the
prison when occupied, and that the cells were all badly
ventilated.
The same physician testified that he had 30,000 visits
from convicts in the year 1881, .and 29,000 m 1882. His
daily visits amounted to from So to 100, and all of these
were disposed of in about two hours. This really appears
like the application of the lightning calculus to medicine.
In our city dispensaries, where no time is wasted on in-
dividual patients, it is rare for more than 20 or 30 pa-
tients, at the utmost, to be disposed of in two hours.
The doctor makes a most reasonable request when he
asks for two assistants.
Notwithstanding the defects above alluded to, we are
told that the mortality rate is less than at any other
prison in the country except one in Wisconsin.
The Next Meeting of the American Public
Health Associ.\tion.— At the meeting of the Execu-
tive Committee of the American Public Health Associ-
ation, held in Washington on the i6th ult., the date of
the next meeting of the Association was fixed for Novem-
ber 13th to i6th, inclusive, at Detroit, Mich. The meet-
ing was not so fully attended as was expected, Drs.
Lindsley, Conn, Speed, and Frazier being absent.
An informal discussion of the programme was had,
but its scope was not definitely settled upon, the details
being left with Dr. Ezra M. Hunt, President of the Asso-
ciation. The subjects : Vital Statistics and Modes of
Registration; Adulteration of Food and Legislation
Thereon ; Etiology of Malaria ; the Physics of Hygiene ;
2 44
THE MEDICAL RECORD.
[March 3, 1883.
House Drainage, and kindred topics, were the more im-
portant matters discussed.
It is understood that the next voUuiie of the " Transac-
tions " (vol. viii.) will be ready for delivery within six
months, and that it is to be published on much more fa-
vorable terms than any former volume, thus greatly re-
ducing the price.
The Appropriation for the Library of the Sur-
geon-General's Office, U. S. A., including the Museum,
has not yet passed the Senate. When it came up in the
House Committee it was reduced from $10,000 to 85,-
000, but the original amount was restored when the Leg-
islative bill was put upon its passage. The Senate Coiii-
mittee having it in charge has cut it down again one-half,
but its friends anticipate no trouble in getting the full
amount restored in the Senate.
An appropriation covering the fifth volume of the In-
dex Catalogue of the Librar.y of the Surgeon-General's
Oftice will go through without opposition. The fourth
volume is about one-half completed, finishing the letter
" E," and running through " Fevers."
There is no bill before Congress this session looking
to the transfer of the Surgeon-General's Library to Con-
gress ; in fact, Congress has no building suitable for its
own Library as yet, the bill for the same having failed to
get a two- thirds vote under suspension of the rules on
Monday last.
The N.ational Board of Health's Bill has failed
to come up in the House, and the $10,000 recommended
by the sub-committee for " pay of members " was struck
out of the Sundry Civil Appropriation bill, thus leaving
the Board witli no appropriation whatever. The only
health legislation proposed by this Congress is the follow-
ing, taken from the Sundry Civil bill :
" The President of the United States is hereby author-
ized, in case of a threatened or actual epidemic, to use
a sum, not exceeding $100,000, out of any money in the
Treasury not otherwise appropriated, in aid of State and
local boards, or otherwise, in his discretion, in prevent-
ing and suppressing the spread of the same and main-
taining quarantine at points of danger."
It also appropriates $50,000 in aid of State and nnmi-
cipal authorities and corporations engaged in transporta-
tion of neat cattle, in establishing regulations for the safe
conveyance of such cattle and shipment thereof, so as to
prevent their exposure to pleuro-pneumonia, to pre-
vent the spread of said disease and to establish quaran-
tine stations ; and to provide proper shelter for neat
cattle imported.
A Directory for Trained Nurses. — The process
of searching for a nurse has hitherto been a tedious one,
and full of annoying delays. Hours of valuable time are
spent in going from house to house with a selected list
of names, finding again and again that nurses have
moved, or are with cases, or are not at home. A sys-
tematic registry of nurSes avoids all this delay and
trouble, and we are glad to learn that the managers
of the Bellevue Training School have recently estab-
lished such a registry of the graduates of that institution
at their ofiice. No. 426 East Twenty-sixth Street. Here
the addresses of the nurses are kept and their engage-
ments known, and the superintendent can also answer all
questions as to the special qualifications of each nurse.
In this way all necessary information can be obtained at
once by simply applying at the Training School, and a
nurse engaged without waste of time.
The Black Soap in Kern's Cataplasmata. — Nu-
merous correspondents who have answered the query in
a previous issue agree in saying that the black soap used
in connection with Kern's cataplasmata is but another
synonym of the ordinary sapo viridis of our Pharmaco-
pceia.
Hospital Sunday Distribution. — The Hospital Sat-
urday and Sunday Fund Committee have agreed upon
the ratio of distribution of the sums collected through the
various channels employed by the association. The re-
port of the committee shows that the total amount of
designated and undesignated funds collected was %'ii'>,i-
762.72, and this amount, minus $3,935.56, was dis-
tributed among the following institutions :
St. Luke's Hospital $7,674 04
Hospital for Ruptured and Crippled 405 00
Mount Sinai Hospital 4)2oo 00
German Hospital 3,2 55 00
Presbyterian Hospital 4,191 03
St. Mary's Hospital 2,052 01
House of Rest for Consumptives 1,420 00
House of Holy Comforter 1,228 75
Home for Incurables 956 71
New York Eye and Ear Infirmary 21760
New York Infirmary for Women and Chil-
dren 561 CO-
New York Ophthalmic Hospital 570 00
Hahnemann Hospital 946 02
French Hospital 595 00
Orthopedic Hospital 570 oo-
Ophthalmic and Aural Institute 550 00
Manhattan Eye and Ear Hospital 475 00
Total $29,827 16
Senseless Objection to Transfusion. — Mr. Henry
Bergh, in a recent issue of the Evening Post, comments
savagely upon an article by Dr. Joseph W. Howe, which
appeared in The Record of February 3d. The letter
of Mr. Bergh is intemperate and full of misstatements.
So far as it implies that the transfusion of blood is not a
useful practice, and one which has already saved many
lives, it should receive a prompt answer and refutation.
For the rest, Mr. Bergh's [jassions and prejudices are too
apparent to mislead any but the very ignorant.
Leading Off. — The Annual Commencement exer-
cises of the Buft'alo Medical College were held February
27th. Diplomas were conferred on fifty-six graduates.
Providing for Immigrants. — The bill introduced
by Senator Miller, of New York, to amend the Act of
August 3, 18S2, regulating immigration, has not yet found
its way to the surface, though it was read twice and re-
ferred to the Committee on Commerce in January last.
It provides for a tax on all immigrants of fifty cents a
head, creating a funtl for the purpose of defraying the
expense of regulating immigration, etc.
The National Medical College of the Columbian
University held its Annual Commencement exercises on
March 2d.
March 3, 1883. J
THE MEDICAL RECORD.
245
^cpuu'ts of Societies.
NEW YORK PATHOLOGICAL SOCIETY.
Stated Meeting, January 24, 1S83.
Geo. F. Shradv, M.D., President, in the Chair.
(Continued from p. 218.)
Dr. Lkwis Smith presented specimens of
ACUTE tuberculosis IN THE LUNGS OF CHILDREN.
Dr. Beverley Robinson presented a specimen of
aneurism of the AORTA,
accompanied by the following history, furnished by Dr.
Devlin, senior physician to St. Luke's Hospital : Mary
E , thirty-two years of a^e, married, and a native of the
Lfnited States, had an attack of rheumatism eighteen
years ago, which involved the ankles, and continued in a
chronic form for about two years ; a certain amount of
synovitis remained permanently. . The patient stated
that for a number of years she had had oedema of the
feet at intervals of one or two months and following
slight exposure to cold. She had suffered from slight
dyspnoja for several years, but there had been neither
palpitation nor cough. Drine normal. About three
years ago, after exposure, she had a chill, followed by
fever and pain in the left mammary region. Sputum
scanty, but color not noticed. The fever and dyspnoea
increased, and the patient had two distinct chills, each
accompanied by an increase of pain in the left side of the
chest. During the last four days dyspnoea has been very
marked. Cough incessant, and the patient has become
very weak. Temperature, ioi° F.; pulse, 140. The spe-
cific gravity of the urine was 1.018 ; otherwise normal.
No cardiac murmur was detected ; the heart action was
very rapid and weak. There was diminished respiratory
murmur over the left lung anteriorly and posteriorly.
Subcrepitant rales were heard over both lungs. There
was mai'ked stridor and tracheal rales. A few hours af-
terward the breathing became very labored and the pa-
tient became cyanotic. An emetic of ipecac gave con-
siderable relief. Harsh sonorous ronchi were heard over
the whole chest posteriorly. Laryngoscopic examina-
tion was negative. On the following day her breathing
was very labored, an emetic was administered, and the
patient was cupped over the chest with marked relief.
On the following day the patient became comatose and
died.
At the autopsy the left ventricle of the heart was found
iiypertrophied, and the valves normal. The muscular
tissue was pale, yellowish, and contained considerable fat.
The aorta was slightly atheromatous throughout.
There was an aneurism two and one-half inches in di-
ameter opposite the second and third dorsal vertebra; which
were slightly eroded. The sac was lined with laminated
fibrin and communicated with the aorta by an iriegularly
circular, smooth-edged opening, half an inch in diameter,
situated at the junction of the descending portion of the
arch with the thoracic aorta. The kidneys were small and
granular, the cortex was thin, the markings were obscure,
but the capsule was not adherent. The lungs were con-
gested and cedematous, and in the lower lobe of the left
were small areas of recent consolidation.
Dr. Robinson also presented a specimen of
RETRO-PERITONEAL SARCOMA,
accompanied by the following history, furnished by Dr.
Devlin, Senior Physician to St. Luke's Hospital : Chris-
topher L. H , thirty-eight years of age ; native of the
United States ; single ; clerk by occupation ; was ad-
mitted to the hospital November 19, 1882. His family
and personal history were negative. Six weeks ago,
while quietly walking across the room, he was suddenl)'
seized with violent pain in the left hypochondrium. It
was so severe as to cause faintness and profuse perspira-
tion, lasted about half an hour, and then subsided to
some extent, but had been constant ever since, although
there had been no paroxysmal attacks. The pain did
not radiate into the pelvis. There was no pain or diffi-
culty in micturition, and there was no change in the ap-
pearance or quantity of the urine. During the last two
weeks the patient had had several attacks of vomiting,
but no hematemesis. Fifteen days ago for the first, and
on several occasions since, the patient had found in the
urine blood-clots about half an inch in diameter, and
varying in length up to two inches. Two weeks ago,
and also one week ago, he had an attack of severe pre-
cordial pain and dyspnoea. P)Owels have been consti-
pated throughout the entire sickness. The urine has
gradually become high-colored, but remains clear. There
has been marked loss in flesh and strength. Examination
of the urine reveals specific gravity of 1.030, acid, no
albumen, and on microscopical examination blood-cor-
puscles, but neither renal epithelium nor casts. Liver
and spleen not enlarged. There is a tumor in the epi-
gastric region extending one and a half inches below the
umbilicus, three inches to the left, and only slightly to
the right. Its free border is separated by a slight sulc is
from the left lobe of the liver. The tumor has a convex
margin directed toward the left side, and a depression
resembling the hilus of the kidney toward the median line.
November 24th. — Left epididymus enlarged and con-
tained nodules. The patient has never noticed the en-
largement before, but has had a slight dragging sensation
in that region for a few days.
November 25th. — The patient was examined by Drs.
Alonzo Clark, Packard, A. H. Smith, Leaming, Whee-
lock, and Ball. No positive diagnosis was reached. Dr.
Clark believed that the tumor did not involve the kidney,
but probably was malignant. Dr. A. H. Smith believed
that it was a displaced kidney, and was the seat of tuber-
cles or cancerous infiltration.
November 26th. — The patient passed a blood-clot one-
twelfth of an inch in diameter and three-fourths of an
inch in length.
December 3d. — The patient vomited matter contain-
ing clots of blood. Examination by the house surgeon
per rectum and with the sound introduced into the blad-
der determine(i that the prostate was normal. He also
examined the lungs and found no evidence of pulmonary
disease.
On December 7th the tumor was aspirated by Dr. Ball,
and a small quantity of bloody serum was obtained,
which, on microscopical examination, showed only red
blood-corpuscles and granular matter. The patient was
examined by Dr. Weir, who diagnosticated post-peritoneal
neoplasm, and the diagnosis was concurred in bv Dr. W.
T. Bull.
December 8th. — The patient vomited blood copiously
during the night. The fteces had a tarry appearance.
Rectal alimentation.
December 9th. — Vomiting of blood continues at in-
tervals. Distressing hiccough has developed, which is
relieved only by chloroform.
December nth. — The patient begins to retain food
by the mouth.
December 13th. — Hiccough severe and vomiting fre-
quent.
December 15th. — Patient ate a hearty breakfast of
eggs, fish, and bread, and it was retained. Begins to
complain of painful micturition, and passes about forty
ounces of urine daily. Slight cough with hemoptysis has
appeared.
December 27th. — No change in the physical signs in
the chest. There has been occasional hajmoptysis.
Patient died on December 28th with the ordinary symp-
toms of oedema pulmonalis and heart failure.
At the autopsy two ounces of dark fluid blood were
found in the pelvic cavity. A round mass of the size of
a cocoanut was firmly attached to the vertebral column
246
THE MEDICAL RECORD.
[March 3, 1883.
posteriorly, occupied the left lumbar region, and to it
the adjoining loops of intestine and other organs were
firmly adherent. It was situated in front of the descend-
ing colon.
The spleen was large and soft, and contained no sec-
ondary deposits.
The liver contained about ten secondary nodules, most
of which projected somewhat above the surface, and
varied in size from a cherry-pit to a hen's egg. On cross
section these nodules presented a mottled appearance,
due to e.xcessive vascularity and recent hemorrhage.
They were quite soft and friable, were not surrounded
by a well-marked capsule, but there was neither diffuse
infiltration nor inflammatory zone. The other portions
of the liver were pale and apparently fatty.
The left kidney was united by loose adhesions to the
principal tumor and its ureter was, for several inches,
firmly attached to the growtli. The pelvis was dilated
considerably. The right kidney contained one secondary
deposit about the size of a pin's head. A nodule of the
new growth, about the size of a bean, was found in the
small intestine. Both lungs were studded with nodules
of various sizes, the largest being of the size of an Eng-
lish walnut. There were bronchitis and cedema. There
was a nodule of new growth in the left testicle. All the
other organs were essentially normal.
Cross sections of the tumor presented the ordinary
gross appearance of a very vascular sarcoma. At several
points hemorrhage had occurred within the neoplasm.
Microscopical examination. — The tumor and the sec-
ondary deposits in tlie lungs and the liver are the same
in their microscopical structure. The tumor is chietiy
composed of cells and blood-channels which vary in size
and shape. Some cells are large and irregular in their
outline, some are spindle-shaped, and many of them are
ovoidal. They are all furnished with one or more nuclei.
These cells are closely bound together by a minimum
amount of inter-cellular substance, and arranged to form
cavities, which are irregular in shape and differ in size,
and contain blood and fibrin. The blood in these cavities
is in contact with the cells already described. Every-
where throughout the tumor there are large areas of
fibrm surrounding blood-channels, which in places com-
municate with each other. There are a few cells in the
meshes of the fibrin which are large and spindle-shaped.
The tumor is not surrounded by a capsule. Diagnosis —
Sarcoma.
Dr. Janew.av had seen two cases of lympho-sarcoma
near the kidney. In one the growth occupied the posi-
tion of the kidney exactly, and the kidney, completely
normal, was situated within its capsule.
REPORT OF THE CO.MMITTEE ON MICROSCOPY.
Dr. Bird.sall presented the following :
The Microscopical Committee beg leave to report that
the tumor of the uterus of a seal presented by Dr. Liau-
tard, at the second meeting in December, was found to
be a myo-fibroma, in which the muscular elements largely
jiredominated, and w^ere bound together with the connec-
tive tissue forming irregularly concentric layers and whorl-
hke arrangements, constituting a tumor of very firm con-
sistency. A very scanty vascular supply existed. In the
centre of the growth a spot, 2 to 3 ctm. in diameter, was
found, in which a fatty and granular degeneration had
commenced.
The Society then went into executive session.
SoiA"BLE S.'iLTS OF C.^FFEINE. — The double Salts,
salicylate of sodium and caffeine and bcnzoate of
sodium and caffeine, are very soluble and can be used for
hypodermic injections. Citric acid does not form a def-
inite salt with caffeine, but simply augments its very
slight solubility in water. The citrate so commonly
used, therefore, is really quite insoluble. — Neiu Remedies,
February, 1883.
MEDICAL SOCIETY OF THE COUXTY OF NEW
YORK.
Stated Meeting, February 26, 1883.
D.-wiD Webster, ^f.D., President, in. the Chair.
Dr. Charles Heitzman read a paper entitled
THE INTIM.\TE nature OF TUBERCULOSIS ; ITS TR.4NSMIS-
SIBILITV AND ITS P.4RASITIC ORIGIN.
When in 1873, the author of the paper first announced
the reticular structure of so-called " protoplasm,' he
stood alone ; since that time, however, a large number
of good observers have corroborated the fact, and E.
Klein, in 1878, enumerated over a dozen who, with more
or less variations, and slight differences in their views,
agree that " protoplasm" is really possessed of a reticular
structure. Some of these have seen the structure in
living and moving elements ; some have claimed priority
for its discovery in different tissues and parts of the body ;
e.g., for liver-epithelia, although the reader distinctly
stated in 1873 that all epithelia have the reticular struc-
ture. In 1880, S. Strieker described the reticular, or
trabecular structure in saliva-corpuscles, and he saw the
trabecule in motion so long as the corpuscle itself re-
mained alive. Thus the last doubt was removed that
the trabecute themselves are the living matter proper.
In the same year, S. Strieker stated that the basis-sub-
stance of the cornea may, under favorable conditions,
under our very eyes, be transformed into "protoplasm."
Quite recently, end of 1S82, he asserted, in a public col-
lege lecture, that he is now' thoroughly convinced of the
correctness of the reader's statement, made in 1873, that
the basis-substance is endowed with properties of life,
the same as the cornea-corpuscles themselves, and added
that it took him six years' labor to convince himself
of this fact, which abolishes the theory : " Omnis cellula,
ex cellula." Thus the speaker, at present, finds his two
main assertions corroborated by the best microscopist
abroad, and may, with some right, expect that also the
third assertion, as to constitutional differences in the
amount of living matter present in different elements of
the same individual will, in time not far distant, meet
■ with the approval of good observers.
On the ground of the new views, the process of in-
flammation becomes easily understood, for nothing is
required, but a liquefaction of the basis-substance in
any variety of connective tissue, in order to set free the
living matter previously buried therein, with the result
of the reappearance of the medullary elements which in
the earlier stages of development share in the forma-
tion of the basis-substance. From any portion of the
living matter of these newly developed corpuscles, may
the new formation of elements ensue, leading to what is
known by the term "inflammatory infiltration." So
long as these corpuscles remain inter-connected, the in-
flammation remains plastic or formative, leading eventu-
ally to hyperplasia of the invaded tissue. As soon,
however, as the newly formed elements are torn asunder,
the inflammation assumes the character of destruction or
suppuration.
In every inflammator}' process a number of capillary
blood-vessels are destroyed by being directly transformed
into inflammatory corpuscles. Should the inflammation
remain formative, new blood-vessels originate in the
newly formed tissue ; while in suppuration the blood-
vessels are destroyed permanently. .\ny individual of
good constitution, i.e., supplied with a sufficient amount
of living matter will, in the process of plastic inflamma-
tion, reform the lost blood-vessels ; while in persons of
a poor constitution, i.e., those who have comparatively
little living matter in their bodies, in any inflammatory
process the reformation of the lost blood-vessels may be
wanting, the product of inflammation in such persons
must, by lack of nutrition, shrivel, dry out, as it were,
and thus a product results known as tubercle. Tubercle,
March 3, 1883.]
THE MEDICAL RECORD.
247
therefore, is a product of inflammation destitute of blood-
vessels ; it makei no dift'erence whether the process runs
a slow course in the form known as chronic tuberculosis
or phthisis, or an acute course, such as in miliary tuber-
culosis. Scrofnlosis and tuberculosis from this point of
view are pathologically identical, though clinically differ-
ent, manifestations of a general, constitutional trouble,
namely, want of living matter in the organism.
Several years ago the reader drew attention to the fact
that the amount of living matter may directly be ob-
served under the microscope in single pus or colorless
blood-corpuscles. In persons of an excellent constitu-
tion these corpuscles look nearly homogeneous, viz., are
richly supplied with living matter, and do not exhibit a
reticular structure. The coarser the reticulum, respec-
tively, its points of intersection, the surer it is that the
corpuscles come from an indixidual with good constitu-
tion; the finer, on the contrary, the reticulum, the more
delicate its points of intersection, the more are w-e en-
titled to define the constitution of the person, wiio fur-
nished the corpuscles, as a poor or tuberculous one.
Thus we are enabled to determine the constitution of
any person by simply e.xamining his pus or colorless
blood-corpuscles. All products of tuberculosis and scro-
fnlosis are known to be composed of elements scantily
supplied with living matter, therefore finely granular,
and here again is a proof of the fact that tuberculosis
and scrofulosis are strictly constitutional diseases.
As to the transmissibility of tuberculosis, neither the
observations of the physicians, nor the e.xperiments of
the pathologists since Villemin, have yielded positive re-
sults. Herbivorous animals, especially rabbits and guinea-
pigs, may be rendered tuberculous by almost any injury.
Much rarer is this the case with carnivorous animals.
Not only the sputa of tuberculous persons, but almost
anything brought under the skin of animals, for instance,
pieces of gutta-percha, paper-scraps, etc., nay, injected
granular aniline colors will produce tuberculosis in rab-
bits, especially in guinea-pigs, if these animals are kei)t
imprisoned in cellars and poorly fed. A few days' so-
journ in cellars is sufficient to produce diarrhoea in these
animals, and a rapid sinking of their constitution, which,
by itself, is poor. No rabbit, on the contrary, can be
rendered tuberculous by any injury, or contamination
with sputa of tuberculous persons, or anv other material,
if kept in yards, in freedom, and allowed to have plenty
of fresh air and proper food. .\11 experiments have, so far,
proved that the infection of animals is successful only if
the constitution be a jioor or ''tuberculous" one, and
impaired by improper sanitary conditions. The experi-
ments made on rabbits by transferring the so-called
" tuberculous virus " into the anterior chamber of the eye-
ball, with subsequent tuberculous " deposits " in the iris,
were the apparently most striking ones. Recently, how-
ever, the secretions of syphilitic ulcers or vegetations
were transferred into the anterior chamber of the named
animals, and the result was identical with that of experi-
ments made with the " tuberculous virus," viz., tubercu-
lous iritis.
Koch deserves great credit for his brilliant discovery
of the bacillus in tubercle-matter and in the sputa of
tuberculous persons. As to the presence of this low or-
ganism in the sputa there can be no doubt ; it is plainly
seen in specimens treated with certain aniline dyes (mainly
gentianin and fuchsin). Recent researches made in
Berlin and Vienna scarcely leave a doubt as to the diag-
nostic and prognostic value of this bacillus ; for it is
found only in persons invaded by tuberculosis, and the
greater its number the more rapid is the course taken by
the disease/ But the proof that this bacillus causes the
disease, stands, so far, only on the experiments of Koch
himself, known to be an accurate and conscientious
worker. If, by inoculation of the bacillus, gained by
pure culture, tuberculosis can be brought about in rab-
bits, guinea-pigs, and rats, will this prove anything in the
face of the fact that these animals, under the above-named
conditions, have been rendered tuberculous by inocula-
tion of a great many other substances, jiarlly or entirely
neutral ? The bacillus, whose germs may circulate in the
liquids of any persons, may find a favorable soil for de-
velopment in products of inflammation, deprived of their
blood-vessels, in so-called cheesy masses, in the same'
manner as bacteria develop in the depth of the tissues
for instance, in the medulla of bone in osteo-myelitis-
without being in a direct causal connection with the pri-
mary inflammatory disease.
The paper being before the Society, the President in-
vited Dr. W. T. Belfield to open the discussion, wha
thought that Dr. Heitzman laid too much stress upon the
fact that tuberculosis can be produced by simply intro-
ducing a mechanical irritant under the skin, etc. He
then reviewed some of the points connected with this
part of the subject, as already presented in a lecture de-
livered before the Alumni Association [the lecture
will ap])ear in a subseiiuent number of this journal], and
again expressed the opinion that tuberculosis is infec-
tious, as pyfemia is infectious. The real question, how-
ever, is not whether tuberculosis is infectious, but, What
is the agent in that infection ?
Dr. a. Jacobi doubted, from a clinical standpoint, the
absolute accuracy of some of the claims which Dr. Heitz-
man regarded as established facts. That the microscopical
appearances of miliary tubercle and tubercular infiltra-
tion were identical, particularly when their centres were
examined, had been well known for some time. But the
origin of the two conditions which seemed so much
alike must be different. Else, why does the miliary tu-
bercle develop most commonly in very young infants,
while the tuberculous infiltration is seen by far the most
frequently — many cases occurring to be sure between
the ages of five and ten years — between the ages of fif-
teen and twenty-five years ? There must be some reason
for this clinical fact. Concerning the peculiar condition
found by microscopical examination of the white blood-
corpuscles, Dr. Jacobi thought that the view had a cer-
tain amount of support in the irregular appearances pre-
sented by the milk globules, and yet he believed that the
conclusions reached from such examinations must be re-
stricted to the present condition of the individual, and
not be applied to the general constitution. Dr. Jacobi
believed that tuberculosis can be transmitted, and also
that diseases regarded as the least transmissible can be
transmitted, as, for example, eczema. Eczema may be
transmitted from the head to a lower extremity by means
of the finger nails, and the diseased particles produce
the disease on the part to which they are so transmitted
because the tissues of the person are in such a condition
that an inflammation of this kind is readily produced.
To say that the disease under these circumstances is of
constitutional origin, does not explain the phenomenon.
Thus he believed that phthisis was probably transmiss-
ible ; transmissible when there e.xists either a congenital
predisposition or a lowered state of the system already
referred to.
Dr. HeitZiMan was very much surprised to hear Dr.
Belfield speak of pyaemia as an infectious disease, and
thought that he must undoubtedly have used the word for
septicemia. Pycemia certainly is a non-infectious dis-
ease, while septicemia, as is well known, is infectious.
With reference to the transmissibility of eczema, men-
tioned by Dr. Jacobi, he thought the argument did not
prove very much. The fact that an eczema existed
under the knee, and the next day upon the face, did not
prove that the affection is contagious. The fact could
be best explained on the ground that the skin is a con-
tinuous organ, and when diseased in one part of the
body, it may, by reflex action, become affected in other
parts of the body.
The Society then adjourned.
A HoMCEOPATHic Hospital is to be es*^ablished in
Minneapolis, Minn.
248
THE MEDICAL RECORD.
[March 3, 1883-
NEW YORK ACADEMY OF SCIENCES.
Stated JMecting, JaJiuary 22, 1SS3.
Professor Newberry, President, ix the Chair.
Mr. Edward Pavsox Thwing, of Brooklyn, read a
pai)er entitled
TRAN'CE IX ITS RELATION' TO SEA-SICKNESS.
The histories of nine cases were given in which, by
artificially inducing the hypnotic or trance condition, sea-
sickness was allayed.
Case I. — An English lady, aged fifty, of spare habit
yet naturally vigorous constitutidn. She came on board
an Atlantic steamer in ill-health, and sea-sickness began
soon after. When first seen, two days out of port, she
was unable to keep anything on the stomach and had not
been able to retain any food since coming on board.
Taking his position behind her, as she was extended in a
steamer-chair, the speaker simply used gentle but firm
pressure on either side of the head, following this with
quiet and slow movements of the hands across the eves
and along the course of the orbicular muscle of either
eyelid, uttering assuring words meanwhile. Little, if any
somnolence followed, but, within a moment, the patient
exclaimed "What a heaven it is to be relieved from pain ! "
An hour later she ate a dinner of her own selection, of
which roast mutton and caper sauce made the central
figure.
Cases II. and III. — Two professional men on the
same ship, similarly affected and similarly treated. With
one of them drowsiness at once was induced and en-
couraged. No complaint of sea-sickness was afterward
heard from them during the voyage.
Case IV. — Two weeks later, between Stavanger and
Trondhjem, on the west coast of Norway, a hearty, stal-
wart English sportsman complained of nausea, vertigo, and
the other sensations of sea-sickness. He became drowsy
a.s soon as manipulations about the head began. The
slumber was made so profound that a shari) puncture of
the hand caused no wincing. When the words " All right ! "
were spoken he waked and found his illness gone. He
■complained no more.
C.^SES V. and W. — A German governess and her
pupil were crossing with me from Dover to Calais. The
younger was vomiting violently and the teacher was on
the point of following her example. Both were relieved
by being thrown into the trance state.
Case VII., like No. ^'., was that of lucid trance, with-
out slumber. The vomiting was arrested and quietude
was so suddenly established that an attendant suspected
chloroform, and asked with earnestness, "What did you
put on your hand ? '
Case IX.^ — Here hysteria, neuralgia, and sea-sickness
made a joint assault on the patient, a middle-aged lady,
in mid-ocean. A steady gaze full in the eye secured a
concentration of thought and expectation, which the
voice is sometimes sufficient to secure. The trance was
almost inmiediate, and became so profound that some
little force, thrice repeated, was needed to rouse. The
sensation was described as that of delicious excitation at
the beginning, which was followed by dreamless repose,
of which no recollection was had.
Other cases had occurred in the speaker's experience,
but did not materially differ in character or treatment.
Mr. Thwing's conclusions were :
First. — That the trance state, so called, will, in many
cases, arrest sea-sickness by restoring the nervous equi-
librium. Not every one responds, i.e., believes, expects.
Not every operator is able to excite expectancy in a
willing mind, still less in a reluctant, incredulous mind.
Failures are often our best teachers. Those wliom I
have failed to benefit are generally those who, by attend-
ing to or joining in conversation, or by some other di-
verting circumstances failed to fix their thought on the
subject, and those querulous, despairing creatures who
seem determined not to get better, but "enjoy" poor
health at home and abroad. Furthermore, failures at the
first or second interviews I have found to be by no
means decisive or final, as recent experiments with sur-
gical patients have proved. When sequestration and
silence can be secured success is sooner gained.
Second. — In transiforni states, where control is incom-
plete and unconsciousness is partial, great relief is often
had.
Third. — The sense of subjugation and helplessness felt
in sea-sickness is an important accessory to the process.
It is analogous to that consenting attitude which the
lower animals instinctively take when under the hand of
the tamer or trainer, and something like the trance of
fear, called panic.
Fourth. — The feeling of certainty on the part of the
operator is helpful, if not absolutely essential, in awaken-
ing expectancy on the part of the patient. This assurance
is not shown by bluster, but by gentleness ; by undemon-
strative rather than by pretentious and dramatic action ;
by low tones of voice that betray neither hesitance nor
doubt ; and by the general air of one who speaks a per-
sonal, private, and authoritative command. Fossunt quia
posse videntur. Hardly anything is more contagious than
confidence or more masterful in power.
a case of TRANCE AN.ESTHESIA.
Dr. William C. Jarvis presented to the Academy a
patient from whose right nostril he had removed the tur-
binated tissue and re-established respiration after a year's
closure, the operation, on January 20th, being performed
while the patient was made as perfectly insensible, by
Mr. Thwing, as if under chloroform. Other cases were
mentioned by him, notably one where the terrified pa-
tient had required three attendants to hold her on a pre-
vious occasion, but who, under trance-anajsthesia, allowed
the introduction and use of the ecraseur in the removal
of a glandular tumor .behind the palate, contiguous to the
base of the brain.
Prof. Newberry, of Columbia College, remarked that
this was a wholesome influence and worthy the attention
paid to it. He had seen it utilized in surgery twenty-five
years ago. Not all respond, yet in many cases it proves
to be a beneficent power. Taken out of the hands of
charlatans, it is now being used by those conqietent to
investigate its phenomena.
Expulsion of F"our Hundred and Forty-one Lum-
BRicoiD Worms within Thirty-four D.\ys. — Dr. A. C.
Pole, of Baltimore, reports [Medical Chronicle) the case
of a girl aged seven, who had been complaining for
months of nausea and colickv pains in the abdomen.
The skin was icteric, appetite variable, bowels costive.
She was treated for worms and was given santonin, cheno-
podium, etc. Within thirty-four days four hundred and
forty-one lunibricoid worms were passed, in "lots" vary-
ing from one to thirty-five. Dr. Pole says : " Larger
numbers than these have been reported, but such a num-
ber in so short a space of time I believe to be infrequent.
Ransom, in his article on intestinal worms, says that
cases are recorded in which various numbers, from one
hundred to twenty-five hundred, have been expelled from
one person within a few months. Cruveilhier cites a case
of an idiot in wliose intestines one thousand were found.
Dr. Condie has known as manv as a hundred and twenty
to be voided in a single day by a child five years old.
Dr. Meigs says : ' I have never myself known more than
six, eight, or ten to be expelled within a few -days' time,
and very generally there have not been more than three,
four, or five.' Henoch states that he remembers a case
in which whole vesselsful of round worms were passed for
a number of days in succession. Bariholow says there
may be one, two, or three worms, or they may reach five
hundred or a thousand."
March 3, 18S3.]
THE MEDICAL RECORD.
249
Covvcsponcleucc.
OUR PARIS LETTER.
(From our Special Correstioude it.)
THE TYPHOID EPIDEMIC IN PARIS DISCUSSION' ON THE
TREATMENT OF TYPHOID FEVER BEFORE THE ACADEMY
- OF MEDICINE — THE COLD BATH NOT IN MUCH FAVOR —
QUININE AS AN ANTI-PYRETIC — THE BEST MANNER OF
USING THE DRUG TO OBTAIN ITS PERMANENT EFFECTS —
ALCOHOL AS AN ARRESTER OF TISSUE METAMORPHOSIS
UR. HENRI NACHTEL ON THE PREVENTION OF STREET
ACCIDlENTS.
* Paris, France, F"ebruary 9, 1SS3.
The medical journals in and out of France have been
so full of the typhoid epidemic in Paris, and the subject
has been so ably treated of in your editorial of January
6th, that it would seem unnecessary to say anything
more about it ; but the importance of the subject having
been revived by a remarkable communication made by
Professor Germain See, at the Academy of Medicine,
last week on the therapeutics of this dire affection, will
be ni)' apology for reverting to it here.
In reviewing the most recent methods of treatment
employed, Professor See divided them into three classes,
with the view of facilitating discussion. The first, which
used to be termed s:m])le expectation, is now decorated
with the affix " armed," or, as Dr. I-)ujardin Beaumetz
would have it, "expectation armee." The second has
the pretention to be a specific method, that is to say, it
has the power of destroying the germ which is the cause
of the malady. The third comprises those agents, medi-
cinal or otherwise, which simply reduce the temperature
of the body ("antithermiques ") and those which attack
the fever itself ("antipyretiques"), or perhaps the learned
Professor would mean to say, the source or cause of the
fever or heat in the body. Professor See is not in favor
of the expectant method, which he says consists in leaving
the cure of the malady to the efforts of nature (natura
medicatrix), as he had tried this method armed or un-
armed, at the commencement of the present epidemic,
and the results were anything but encouraging. He has
also shown that the so-called antiseptic methods have up
till now given no result, in short, they cannot do so in
the proper sense of the term, as none of them can reach
the seat where the microbe is evolved, even should there
be such a thing as a specific microbe.
Before referring to the methods of treatment which
he preferred, Professor See made a few remarks on the
treatment ot typhoid fever by cold baths, which he con-
demned not only as being useless, but absolutely danger-
ous in this affection, as cases have been recorded of severe
and even fatal results having followed the use of the cold
bath. The method of the cold bath is, like the other
methods, founded on preconceived theories. In the
present case the cold bath is employed ostensibly with
the view of reducing the temperature of the body, but
M. See proves that the cold bath has the opposite effect,
and he has found that the internal heat is increased, and
so IS also the process of combustion, hence the neces-
sity for feeding the patients who are submitted to this
treatment co|)iously ; but .M. See has calculated that to
repair the enormous waste of the tissues it would be ne-
cessary to give the patient at least thirty-five hundred
grammes (a little over three pounds) of beefsteak a day,
or its equivalent in another form, and it is well known
that the digestion of typhoid patients is nil, or nearly so.
From Professor See's own experience he has come to
the conclusion that the refrigerating property of cold
baths is only apparent, or at any rate its effects are not
permanent, nor does it shorten the duration of the dis-
ease, and if it does not reduce the rate of mortality, the
Professor pertinently asks what utility there would be in
subjecting typhoid patients to such a barbarous treat-
ment. To fulfil the indications for which cold baths are
employed. Professor See prefers the use of quinine sul-
phate and alcohol, which he administers separately or
combined, according to circumstances. The former he
looks upon as the type of an antipyretic remedy. It
prevents the too rapid oxidation of the tissues of the
body, and acts on the heart and blood-vessels in the
most favorable manner. The sulphate of quinine is also
eminently " antithermic." It possesses this property in
a much higher degree when given to patients who are
suffering from fever than to healthy individuals. The
lowering of the temperature of the body is jirojiortional
to its previous rise ; in some cases, it has even been ob-
served to exceed one degree. The quantity he admin-
isters is 2 grammes 20 centigrammes, or about 34
grains per diem, half of which is given in the morning
and the other half in the evening, which he never ex-
ceeds, as it then becomes toxic. Moreover, he prefers
this mode of administering the medicine to small divided
doses in the twenty-four hours, as when thus adminis-
tered it is rapidly eliminated from the system, and its
effects are lost. Alcohol is another remedy Professor
See considers most useful in the treatment of typhoid
fever. Far from increasing the temperature of the body,
as has been supposed, it does not burn, it prevents denu-
trition, and thus lowers the general temperature of the
patient. In fine, alcohol is a substance that retards the
waste of the tissues and prevents emaciation, hence
termed "un medicament d'epargne." When one drinks
spirits one is led to suppose that the temperature of the
body is increased, as it produces a sensation of heat, but
this phenomenon is merely temporary and coincides with
a real diminution of the heat of die body. This effect,
however, is less marked than in the administration of
quinine. The Professor deems that the combination of
the two substances named would be found most useful
in the treatment of typhoid fever, or in any other condi-
tion where their effects are indicated. In any case.
Professor See considers them absolutely inoftensive, pro-
vided they are employed in the proper therapeutic doses.
Professor Jaccoud, another eminent physician, follow-
ing in the same wake, made a very interesting communi-
cation at the last meeting of the Academy on the same
subject. He advocated, with slight modificadon, the treat-
ment adopted by Professor See in typhoid fever, and, like
the latter, condemned the cold baths as employed for
some time in Germany and now adopted in a general
way in Lyons, observing that he has obtained the neces-
sary degree of refrigeration by sponging the body fre-
quently with aromatic vinegar and water, which is attended
with much less inconvenience and danger to the patient.
He also severely criticised the growing tendency in the
profession to adopt the germ theory of disease, and con-
cluded his remarks by the following practical advice :
'■ Whatever may be the fate reserved to microbes it must
not be forgotten that we cannot reach or affect them in
any way but through the medium of the patient infested
with them, and that the power of resistance in the subject
should always be kept in view."
Dr. Henri Nachtel, so well known in connection with
the Night Medical Service, established in New York,
and his efforts to introduce the American system of am-
bulance in Paris, is now occupied in endeavoring to in-
troduce the system of " street-helps " as it exists in Lon-
don, New York, and St. Petersburg, where tlie policemen
have strict orders to afford every help in their power to
enable foot-passengers to cross the streets by stopping
the carriages which follow in such rapid succession, par-
ticularly at certain hours of the day, and where the traffic
is so great that crossing over from one side of the street
to the other is simply impossible without being run over
or knocked down. Dr. Nachtel has had a personal in-
terview with the Prefect of Police on the subject, who has
promised to make the necessary arrangements for the
carrying out of such a desirable and philanthropic ob-
ject.
250
THE MEDICAL RECORD.
[March 3, 1883.
OUR LONDON LETTER.
(From our Special Correspondent.)
MEDICAL ADVERTISING- — TYPHOID FEVER THE COLD
BATH, AND OTHER TREATMENTS AT THE LONDON,
NORTH EASTERN, VICTORIA, ST. MARV'S, AND UNIVER-
SITY COLLEGE HOSPITALS.
London, February 13, 18S3.
Medical advertising continues to call forth anathemas
from the powers that be. The London College of Phy-
sicians has on several occasions, by the votes of its fel-
lows, publicly protested against the custom of advertising
medical works in lay journals. By an unfortunate coin-
cidence, however, many of the fellows who attend and
vote at these meetings at which the resolutions condem-
natory of advertising in the lay press are carried neiii. con.
are themselves actually guilty of the ofience they con-
demn in others. In some cases, no doubt, they would
say the advertisements are inserted by their publishers.
Still the fact remains. A great deal of the agitation has
arisen simply from professional jealousy. Those who
have attained success and are reaping its rewards would
gladly keep them to themselves. The medical journals
decry the lay press, because they want to get the adver-
tisements for their own columns. Not many years ago,
though, when The Lancet was animadverting on this sub-
ject, and denouncing some physicians by name, it was
pointed out by its contemporaries that The Lancet had
its contents advertised weekly in The Times, large bills
of contents exhibited at the Metropolitan Railway stations,
and was itself exposed for sale on the railway bookstalls.
Typhoid fever is still prevalent. The cold-bath treat-
ment has made considerable progress in England of late
years. Still it cannot be said that we can show results
as favorable as those of Liebernieister and other German
physicians.
At the London Hospital the cold-water treatment is
in use by several of the physicians. In some cases the
immersion bath is employed at a temperature of about 60°
F. {i.e., ordinary tap water), the patient being placed in this
for five or ten minutes. Cold sponging is, however, more
frequently resorted to on account of the much less trouble
it involves. The patient is directed to be sponged with
cold water (or spirit and water sometimes) whenever the
temperature is very high. The eftect has been tried of
placing patients in a batl' and pouring over them water
from a watering-pot with a hose attached. Drs. Fenwick
and Sansom have tried the eftect of placing a bed-cradle
over the patient so as to raise the bedclothes from off
him and within the hollow space thus formed, placing a
piece of ice in a saucer so as to cool the atmosphere im-
mediately surrounding the patient. Last year Dr. San-
som employed Rothe's method of treatment in some
cases, the notes of which appeared in The Medical
Record.
At the North Eastern Hospital Dr. Sansom, the se-
nior physician, employs the cold bath treatment exten-
sively. Whenever patients are hyperpyretic they are im-
mersed for a few minutes in a bath containing cold water
as drawn from the cistern, and therefore at about the
temperature of the air. This is repeated as often as
necessary, i.e., whenever the temperature rises again. In
severe cases Dr. Sansom has repeated them at intervals
of two hours. Dr. Sansom states that he gave quinine
an extensive trial some years ago and is not convinced
of its efficacy, although he has made use of large doses,
i.e., as much as five grains or more to a child of two
years. He has also frequently employed the sulphocar-
bolates in cases of typhoid fever. His present treatment,
in addition to the use of the cold baths, is mainly dietetic
and expectant. .A refrigerant mixture containing liquor
ammonia acetatis is usually given.
At the Victoria Hosi)ital for Sick Children typhoid
fever cases are not admitted. Those originating among
patients already in the hospital are placed, on a diet of
milk and lime-water. Complications are treated as they
arise. For hemorrhage from the bowels Dr. Venu ad-
ministers an injection of gallic, and opium is occasionally
given.
At St. Mary's Hospital the treatment is mainly expec-
tant and dietetic. Patients are fed chiefly on meat broth
and milk. Diarrhoea, if excessive, is treated by sulphuric
acid and opium. A bed, the upper half of which can be
raised or lowered by means of a lever, so as to place the
patient at any angle without fatigue to himself, is usually
reserved for typhoid cases. The cold bath treatment
has not been employed to any extent, but has occasion-
ally been used in hyperpyretic cases.
At L'niversity College Hospital the antipyretic treat-
ment is employed both by Dr. Wilson Fox and by Dr.
Ringer with good results in nianv cases. •
THE LATE DR. GEORGE M. BEARD.
To THE Editor of The Medic.^ll Record.
Sir : Will you allow me to say a word in justice to the
memory of the late Dr. Beard ? I have looked through
numerous medical journals and have failed to find any-
where a just recognition of his work and character.
Furthermore, I have not been able to find that a single
medical society has paid even the conventional tribute
of resolutions to his memory. In many prominent
medical journals half a dozen lines have been deemed a
sufficient obituary. To those who knew Dr. Beard's
many contributions to science, his active, keen, and
original mind, his tireless industry, and his charming
personal character, this seems a shameful neglect.
Dr. Beard, in connection with Dr. Rockwell, was one
of the pioneers in electro-therapeutics in this country.
Together they gave to the profession general electrization,
a therapeutic measure whose value is everywhere ac-
knowledged. Dr. Beard first gave to the profession also
definite views and facts regarding neurasthenia ; he was
the first to study and show clearly and positively that
Americans possess a peculiar and peculiarly great ner-
vousness— a fact which, when recently commented upon
by Mr. Spencer, in nearly Dr. Beard's language, was re-
ceived as something wonderful, novel, and true.
Dr. Beard first explained the phenomena of mind-
reading ; he made original researches in trance and its
allied conditions. In the same connection he formulated
the sources of error in experimentation and in weighing
human evidence. He was a friend of higher education in
medicine, and an early promoter of the success of the
American Academy of .Medicine. He was identified with
the reform movement in psychiatry now going on in this
country, .\side from these and numerous minor contri-
butions to medicine and psychology, he was a man of at-
tractive character, incapable of double-dealing, true to
his friends, helpful to younger men, generous, and of an
unvarying good humor under the worst attacks of his
critics or his enemies. With the faults only of a too prolific
writer, but with the merits of an original thinker, a bril-
hant worker, and a persistently active scientific investiga-
tor, it seems that, so far, but scant justice has been done
to his memory.
^'ery respectfully yours,
Succinate of Iron in Biliary Colic. — Dr. Jas. .\.
Stewart, of 15altimore, revives the claim that the hy-
drated succinate of the peroxide of iron is efficient in
the treatment of gall-stones. He reports one case in
which a patient, a lady of forty, who had suffered for
three months and was greatly emaciated, recovered
health rapidly under drachm doses of the succinate.
There had been no trouble for two years. Dr. Stewart's
case, as reported in the Alaryland Medical Journal, is
not very convincing, as the trouble had only lasted a com-
paratively short time, and no gall-stones were actually
found.
March 3, 1883.]
THE MEDICAL RECORD.
251
icvo Instvuincnts.
A NEW INSTRUMENT FOR TESTING THE
FIELD OF VISION.
By J. B. EMERSON, M.D.,
INSTKUCTOR IN THE NEW YORK POST-GRADUATE MEDICAL SCHOOL : ASSISTANT SLK-
C.KON TO THE MANHATTAN EVE AND EAR HOSPITAL.
The principles on which this perimeter is constructed
are chiefly the same as those of others now in use.
The arc is a semicircle of five inches radius, perforated
at the middle, and divided on its convex surface into
eighteen equal parts, and numbered from the middle to
the extremities. On each arm of the arc is a perforated
slide, so made that small pieces of paper can represent
the objective point ; and in testing the color zones, col-
ored paper can be used. This slide is held in any posi-
tion by means of a spring. The support of this arc is a
rectangular rod, surmounted by a quadrant. This rod
moves vertically in a sheath, so as to be i^levated or de-
pressed at will. The perforated axis of the semicircular
arc is attached to the upper end of the quadrant, so as
to revolve about a horizontal axis. The scale on which
the angle of revolution is measured is fixed to the quad-
rant, and a pointer on the revolving arc indicates the
meridian tested. The chin-rest is double, the right for
the left eye and vice versa. The movement of the chin-
rest is also vertical, parallel to that of the aperture and
at a horizontal distance six inches in front of it. The
base is loaded. The minimum height is twenty inches,
with an extension of four inches. It is made of polished
brass, and its weight is about six pounds. The eye of the
person tested should be five inches from the aperture,
and on the same level with it. This can readily be eftected
by observing the eye of the person tested through the
aperture. In other respects the working of the instru-
ment is similar to that of other perimeters. The advan-
tages claimed for the instrument are :
First. — By means of tlie aperture the eye of the
person tested can be watched, and any deviation im-
mediately detected.
Sei-cmi. — The double chin-rest brings the eye of the
person tested directly in front of the aperture.
Third. — The bearings of the instrument are principally
rectangular, so that it cannot "wobble."
Fourth. — The centre of gravity of the chin-rest is di-
rectly over the base, while that of the arc is nearly so,
thus rendering the instrument little liable to accident.
Fifth. — It is light, portable, and an ornament to the
office, rather than a nuisance.
Sixth. — It can be easily and quickly used.
J^rmvJ %tvis.
Official List of Changes of Stations and Duties of Ofjicers
of the Medical Department, United States Army, from
February 17, 1S83, to February 24, 1883.
Ci.EARV, Peter J. A., Captain and Assistant Surgeon.
(Granted leave of absence for four months on account of
sickness, to take effect January 3, 1883, in extension of
his authorized absence on certificates of disability. S.
O. No. 40, par. 6, A. G. O., February 16, 1S83.
Heizmann, Chas. L., Captain and Assistant Surgeon.
To be relieved from duty in the Department of the Co-
lumbia. S. O. 12, Department of Columbia, February
8, 18S3.
Te.sson, Louis S., Captain and Assistant Surgeon. To
be relieved from duty at Fort Clark, Texas, and assigned
to duty at Fort Ringgold, Texas, as Port Surgeon. S. O.
20, par. 5, Department of Texas, February 21, 1883.
7HccUcal items.
Contagious Diseases — Weekly Statement. — Com-
parative statement of cases of contagious diseases re-
;)orted to the Sanitary Bureau, Health Department, for
ihe two weeks ending February 24, 1883 :
OJ
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Week Ending
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February 17, 1883
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75
51
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February 24, 18S3
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0
Some Clinical Indications for Convali.aria Maia-
Lis. — Dr. E. L. Trudeau, of Saranac Lake, N. Y., writes:
" From what has already been published in regard to con-
vallaria,it seems that, as the study of this drug is in its in-
fancy, little is known as yet in regard to the class of patients
to whom it is most serviceable. It has been noted that in
some cases of cardiac difficulty it acts most energetically,
while in others it is of little value. Some broad indica-
tions to guide us in its use are, therefore, most desirable.
From a year's experience in prescribing this drug, it has
seemed to me that such an indication may, perhaps, be
found in the fact that it is most successful in all cases
where, to restore the balance of the circulation, stimula-
tion of the RIGHT heart is imperative, while it is much less
active where increased energy on the part of the left ven-
tricle is called for. Its striking power in controlling
dyspnoea in cases of emphysema, fibrous, and chronic
phthisis (cases in which digitalis frequently fails), in re-
lieving the orthopncea of mitral disease, increasing at the
same time the flow of urine, and its failure to mitigate
the symptoms of aortic mischief or to increase the flow
of urine in such cases, are clinical facts which tend to
confirm this suggestion. It is in relieving dyspncea that
convallaria attains its most brilliant results, while it has
only an uncertain and trifling power over oedema and
dropsy, and it succeeds often in precisely the cases in
which digitalis fails. Another indication for its use not
hitherto dwelt upon, is in controlling the symptoms of
purely functional heart disorder. Its efficacy in such cases
confirms Dr. Beverley Robinson's opinion that it acts
through the nervous system. Paroxysmal palpitation and
dyspncea due to nervous causes, rapid and irregular
heart-action dependent upon debility, are symptoms
almost always benefited by it, and which often entirely
2.^2
THE MEDICAL RECORD.
[March 3, 1883.
disappear during its exhibition. Convallaria is a drug
which oilers a most promising field to physiological re-
search, and it is to be hoped that extensive experiments
upon animals will, before long, clear up many doubtfid
points in regard to the proper indications for its use."
The Dose of Convallari.\. — Dr. H. L. Taylor wishes
us to state that the largest dose of convallaria used by
him was one drachm, and not one ounce, as stated by
one of our corresjiondents in a recent issue of The
Record.
Dr. Harvey L. Kvrd's Article. — Dr. Byrd writes :
" Please have the following corrections made in my
article of February 17th in the ne.xt issue of The Record,
viz.: in line 26, on page 178, second column, read,
' Caucasian and negro races when // is found breeding
i?iier se,' instead of ' intense.' In the tenth line from the
bottom, same page and column, insert of after the word
descendant. The woxd. peiial, in line 18, first column,
page 179, should xq3.(\ plural."
The Treatment of Pneumonia. — We are indebted
to Dr. \V. Thornton Parker, Acting Assistant-Surgeon,
United States Army, Fort Elliot, Te.xas, tor the follow-
ing item, communicated to him in a private letter by
Professor Baumler, of the University of Freiburg, Baden :
" Our treatment in cases of pneumonia in the Freiburg
Hospital is chiefly directed toward sustaining the strength
of the patient until in the natural course of the disease
the pyrexia leaves him. As the pyrexia is one of the
chief causes of the e.xhaustion which in severe cases
gradually sets in, we try to keep down the body-heat by
means of cool baths or wet packing, as well as by qui-
nine (fifteen to twenty grains in one dose in the evening)
or salicylate of soda (sixty to eighty grains within an
hour in the middle of the night). The patient must be
sufficiently fed by broths, beef-tea, and milk, and in
every case we give from one-half to one pint of light
wine, to which the populace is accustomed, in the
twenty-four hours. Afi iee-bag is applied to the chest
7C'hen there arc pleuritic pains. Dover's powder or
morphia is only given when there is restlessness or great
pain, or diarrhcea. \V\t\\ very sharp pains in the side we
apply the morphine hyiiodermicallv. If there be much
bronchial catarrh accompanying the pneumonia, we give
ipecacuanhre in infusion with or without opiates. Sweet
spirits of nitre I have never employed in pneumonia.
Altogether, it is but very seldom used in Germany.''
Menstruating at the Age of Seventv-six. — Dr.
W. S. Higgins, of Perfield, 111., sends us the history of
the following singular case: "Mrs. Eliza McG , born
in Harrison County, Ky., September 28, 1806 ; worked
on a farm, doing a great deal of out-door work ; began to
mature at the age of fourteen, but did not menstruate un-
til at the age of eighteen ; from fourteen to eighteen suf-
fered more or less with wandering pains, supposed that
washing clothes in the river was the cause of the sup-
pression. Married at the age of twenty, first child born
at the age of twenty-one. Enjoyed usual good health.
Had twelve children, last one born at the age of forty-six.
For seven years after the last child was born menstrua-
tion irregular and very copious. Since then very regular
(with good health) until the present time, at the age of
seventy-six, and always preceded with same kind of bad
feeling that ushered in the flow when young."
The History of Quarantine .\t Pensacola. — In
1853 yellow fever was brought to the navy yard by the
St. Vixen from the West Indies and spread to the mili-
tary post at Barancas, between which places there was
unrestricted intercourse. In 1863 it was introduced into
the navy yard by the United States sujiply vessel Night-
ingale, and although there were three thousand troops at
Barancas, not a case occurred there, owing to a " strict
quarantine of cavalry pickets '' which was placed around
the military camp. In 1867 it was brought to Pensacola
by ship and spread thence to the navy yard through con-
stant intercourse between the two places. A picket
line established against both these places prevented its
reaching Barancas a second time. In 1874 it was again
brought by ship to Pensacola and thence through inter-
course to the navy yard ; Barancas again quarantined
against the two places and escaped the third time. In
1875 it was brought to Barancas by the Von Moltke ;
Pensacola and the navy yard quarantined against Baran-
cas and both escaped. The past year the navy yard
and the towns of Milton and Millview established rigid
quarantine against Pensacola and all escaped, while
other towns and hamlets which did not quarantine were
attacked by the disease and suftered severely.
The Children of Wo.men Suffragists. — In a list
recently given of the children of twelve leading woman
suffragists, it was shown that there was a remarkable pre-
ponderance of daughters. Among the forty-three children
thirtv-two were girls.
Carbonate of Potash in Diphtheria. — Dr. S. S.
Cartwright, of Roxbury, N. Y., sends us the history of
two cases of diphtheria with croup occurring in the
same family. The first patient, a boy of three years,
died after a brief illness. About two weeks later, the
second case, that of a boy four years old, developed.
The disease went on rapidly and unfavorably, showing
much the same bad symptoms as at first. Emetics were
used, and chlorate of potassium given. Some improve-
ment took place on the fourth day, but severe and ap-
parently fatal relapse occurred five days after. Two
grains of potass, carbonat. were then administered every
hour, when im])rovement soon appeared, and the child
recovered. Dr. Clrtwright ascribes much virtue to the
potass, carb., which, he writes, is recommended by Vogel.
Our correspondent appears to have ignored local treat-
ment, the use of alcohol, and of muriate of iron.
Primary Cancer of the Pancreas. — Dr. Chas. G.
Partridge, of Bellows' Falls, Vt., sends us some facts re-
garding a case of primary cancer of the pancreas involv-
ing that organ alone. The case occurred in the practice
of Dr. E. S. Albee. The patient was a woman only twenty
years old. She had been ill "from an unknown cause
for about seven years." The diagnosis of the disease
was made from a microscopic examination of the tumor
by Dr. White. The case is somewhat unique, and
pathologists will be apt to doubt the diagnosis until the
facts are more fully presented.
The Medical Registration Law in Pennsylvania.
— Dr. F.. Griswold, of Sharon, Mercer County, Pa., re-
lates, in the Medical and Surgical Reporter, cases illus-
trating the successful action of the registration law in his
county.
New York Medical Journals. — Nine general and
seven special medical journals are published in this city.
There are four weeklies, seven quarterlies, four monthlies,
and one bi-monthly.
The Second (Jerman Congress for Internal
Medicine meets at Wiesbaden, April 17 to 20, 1883.
The Treatment of Chilblain. — N'e'iu Remedies pub-
lishes a list of thirty-seven difterent remedies for chil-
blain, taken in part from ihe Chemist and Druggist. The
list includes all kinds of liniments and ointments, also
hot water, electricity, balsams, acids, and that odorifer-
ous panacea, iodoform. Yet we are unable to say which
is the specific.
Syrup Iodo-Phenujue (Declat). — The composition
of this preparation is as follows, according to jVe7i' Reme-
dies : Iodine, five one-thousandths to one part ; phenic, or
carbolic acid, one to five parts ; water, or other suitable
solvent — say a solution of iodide of potassium containing
one-tenth to two parts of the salt — enough to make one
hundred parts.
The Medical Record
A Weekly yournal of Medicine and Surgery
Vol. 23, No. 10
New York, March 10, 1883
Whole No, 644
(Dvi0inat ^cctuvcs.
ON THE
RELATIONS OF MICRO-ORGANISMS TO DIS-
EASE.
The Cartwkight Lectures, delivered before the
Alumni Association of the College of Physi-
cians AND Surgeons, New York.
By WILLIAM T. BELFIELD, M.D.,
LECTURER ON PATHOLOGV, AND ON CKNITO-URINARV DISEASES (PQST-GRADUATE
course), rush MEDICAL COLLEGE, CHICAGO.
Lecture III.
In 1879 Neisser made the assertion, based upon nu-
merous examinations, that there is present in the
purulent discharge of gonorrhcea, whether from urethra,
vagina, or conjunctiva, a micrococcus not found in other
jnis, distinguished by its size, shape, and mode of repro-
duction. Neisser's previous work entitled this assertion
to respectful consideration, and it was at once subjected
to extensive tests. The reports have been, with one ex-
ception, unanimous in corroborating Neisser's assertion
in all its details. I may mention especially Ehrlich, a
most expert and experienced, yet conservative and trust-
worthy observer ; Gaffky, a pupil and present assistant
of Koch ; Aufrecht, of Magdeburg ; Loffler, Leistikovv,
Bockhart, Krause ; and among the ophthalmologists,
Leber, Sattler, and Hirschberg. The only dissenter, so
far as I know, is Dr. Sternberg, who asserts that this
micrococcus form is widely distributed, and is, in fact,
the same as that which Pasteur has shown to cause fer-
mentation of urea.
Several attempts have been made to inoculate human
subjects — since animals are not susceptible to the con-
tagion— -with the isolated micrococci. Kokai, in Pesth,
asserts the induction of urethral gonorrhcea in three out
of six students so inoculated ; but as he neglected to
keep them in solitary confinement during the trial, the
experiment is not so convincing as it might be. Bock-
hart, having cultivated the organisms on gelatine, in-
oculated with the fourth culture a paralvtic hospital pa-
tient, and observed a typical gonorrhcea on the sixth day.
Sternberg cultivated micrococci from gonorrhceal pus in
flasks, and observed only negative results in each of five
patients inoculated therewith. Thus far, therefore, it is
not decisively established that the bacterium associated
with gonorrhcea is the cause of the disease. Dr. Stern-
berg's present experiments, like all his previous work,
evince great care, skill, and a sincere desire for truth
that cannot be too much admired ; yet his deductions
would be far more convincing if he would substitute a
solid for the liquid culture medium.
Sattler has recently found micrococci, apparently iden-
tical with those of gonorrhcea, in the conjunctival granu-
lations, and affirms that inoculation with the organisms,
isolated by cultivation, induced the disease in a human
subject.
Micrococci, then, exist in the human body, locally and
generally ; yet excepting gonorrhoea there is no decisive
evidence that a specific micrococcus is associated ex-
clusively with any one specific morbid process in the
human subject. But I would again remind you that many
of these organisms are individually so minute that absolute,
and hence comparative, measurements cannot be as yet
accurately made ; further, that micrococci morphologically
identical may be physiologically distinct. Hence it can-
not be asserted at present that the same species is present
in septicaemia, pyaemia, etc., although the contrary is not
yet established beyond doubt.
Turning to the other tribes of bacteria, however, we
find more definite information ; for in size, shape, mode
of propagation, often of locomotion also, they present
such differences that a distinction into species is often
possible.
The disease variously designated anthrax, splenic
fever, malignant pustule, woolsorter's disease, charbon,
and by the Germans Milzbrand, is proven to be not only
associated with, but also caused by, a bacillus. About
this all controversy has ceased ; inoculation with the
bacilli, isolated by filtration, flask cultures, by cultures
upon solids, by scores of observers, have always and in-
variably given the same result ; Koch has even induced
the disease by inoculation with the one hundred and fif-
teenth successive culture upon solids. Further experi-
mentation is as unnecessary as further proof that a dog
can be poisoned with strychnine. Anthrax is as yet
the only disease proven to be due to a bacterium, by
demonstrations so clear and uneciuivocal as to convince
skepticism and silence sophistry. It is, therefore, the rock
of ages on which the bacteriologists seek refuge from the
waves of ridicule ; the cross to which they cling amid the
storms of adverse criticism ; the strong castle from which
they repel the impotent assaults of their enemies. The
knowledge of certain facts as to the occurrence of this
disease has extreme value for those of us who, having no
prejudices nor views to protect, belonging to no camp
nor sect in pathology, are actuated by a desire, not to
demolish every one whose views do not accord with ours,
but to ascertain and interpret intelligently all facts bear-
ing upon the relations of bacteria to disease.
Anthrax is endemic in some parts of Europe, particu-
larly of Russia, Germany, and France, and exists also in
the United States. A conception of its extent may be
derived from the fact that in one Russian district alone
there perished in 1867-70 fifty-six thousand domestic
animals — horses, cows, and sheep — and five hundred and
twenty-eight human beings. In 1770 there occurred an
epidemic in the West Indies, in which, within six weeks,
fifteen thousand men died from eating beef infected with
this parasite (Law). Sheep appear to be the natural
host of the bacillus, since they are affected during the
entire year, while other animals exhibit the disease only
sporadically. Anthrax is both contagious and infectious ;
is acquired by cattle in grazing in certain localities, par-
ticularly after inundations, and in spots where animals
similarly infected have grazed ; may be probably acquired
through the agency of files. By man the disease is con-
tracted through contact with infected animals, flesh,
hides, wool ; by eating infected meat.
These clinical facts were established long before the
discovery of the bacillus ; and have become intelligible
and coherent only since the life-history of the parasite
has been studied — for it is demonstrated that this plant
produces spores, which, when placed under favorable
conditions, grow into the mature form ; but which, mean-
while, may remain in this embryonic state for an in-
definite number of years, unaftected by extremes of
temperature, by many chemical agents, even absolute al-
cohol. The mysterious and inexplicable sporadic ap-
pearance of the disease is at once explained. These
254:
THE MEDICAL RECORD.
[March lo, 1883.
spores may be transported in the hide, the wool, and the
flesh of the animal, either of which may, therefore, cause
an outbreak of the disease in a distant part of the world,
and after the lapse of years. It is reported that anthrax
once apiieared among the workmen in an upholsterer's
shop, limited to those who were engaged in repairing
certain chairs, imported from a distance, which were
stuffed with horse-hair. Some time ago a whole family
in Scotland acquired the disease after eating soup made
from beef by several hours' boiling. A local epidemic
occurred in Paris among the workmen who had handled
a cargo of hides from South America.
>tfi*' "liiaii^'''
y ./^ -^ ^ i^ V r- __ r ^
[I 6
Fi^. 8. — Kidney of rabbit ; anthrax bacilli in the inter-tubular capillaries, x 700.
(Copied, by special permission, from a photogram by Dr. Koch. )
The natural habitat of the anthrax bacillus has not yet
been discovered, though the plant is evidently indigenous
only in certain limited districts. Koch's researches, as
well as clinical observations, make it extremely probable
that the bacillus is not properly a parasite of animals ;
that it, like many other fungi, grows upon living or dead
vegetable matter, and its entrance into the cow or sheep
is merely incidental to the consumption of its host as
food by the animal — an accidental excursion from its
usual life history — just as the presence of the trichina
spiralis in the human subject is incidental to the con-
sumption of uncooked pork.
When we reflect upon the close clinical resemblance
between anthrax and certain other infectious diseases ;
their occurrence sporadically and epidemically ; their
usual limitation lo certain conditions of climate and of
soil ; their especial prevalence during certain seasons of
the year; the predisposing influence of heat and moisture ;
the stage of incubation ; the contagiousness ; the self-
limitation of the disease, etc., it becomes evident to every
one whose cerebral functions are normally performed
that there may be, in this matter of bacteria, vastly more
than the optical delusions of a microscopist, the im-
practical fancies of a pathologist ; more than fat-crystals
and fibrin threads. Yet it is understood that there may
be no conclusions by analogy. Anthrax and septicemia
?/iay be very similar clinically and anatomically, yet the
demonstrated parasitic origin of the one does not prove
the same for the other ; arguments of that sort have no
place in e.xact science. The matter must be investigated
in the case of each disease independently, precisely as it
has been in anthrax — a fact which is insisted upon by no
one more persistently and emphatically than by Koch —
to whom, by the way, we are indebted for most of what
we now know about the life-history of the bacillus an-
thracis. And just here is another of those vital differ-
ences which distinguish Koch's work from that of Klebs
and of Pasteur. The latter seem to assume the parasitic
origin of the infectious diseases, and their deductions are
but too often fJartially based upon such assumption.
Koch assumes nothing, furnishes ocular demonstration
of his assertions and uses all his influence, by precept
and example, to raise this subject of bacterial investiga-
tion from the mire of uncertainty, doubt, skepticism, and
contempt to the firm basis of exact science. For our
patience has been so sorely tried, our confidence so often
abused, that we have acquired a certain indifference to
bacterial discoveries ; we often fail to discriminate ac-
cording to the evidence furnished, and regard all alike as
essentially uncertain and obscure.
In this failure to discriminate between evidence and
evidence, between assertions and assertions ; in this fail-
ure to distinguish between a deduction and a demonstra-
tion, is to be found, in part at least, the explanation of
the remarkable attitude, or rather variety of attitudes,
maintained by the medical public of our land, and of our
land only, on the question to be next discussed — tuber-
culosis. All pathologists worthy of the name, and I be-
lieve all others also, are agreed that the miliary tuber-
culosis of man is anatomically identical with the disease
caused by the same name in rabbits, guinea-pigs, dogs,
and cats ; and that pulmonary consumption results from
the aggregation and degeneration of miliary tubercles.
From the earliest times there seems to have been a
suspicion among medical men that tuberculosis is a com-
municable disease ; now and then an instance was ob-
served in which a previously healthy individual, of non-
consumptive stock, became tuberculous after assuming
an intimate relation — as of husband or wife — to a con-
sumptive individual ; and domestic animals, even those
not particularly susceptible to the disease, such as dogs,
became m some instances consumptive after close attend-
ance upon a human subject previously so afflicted. Yet
the evidence of such cases, however suggestive, was not
decisive ; so difficult is the proof of inoculation, so insid-
ious and gradual the inception and manifestation of the
disease, so numerous and diverse the other influences to
which the individual is exposed, so impracticable the re-
striction of personal liberty necessary for accurate ob-
servation, that the exclusion of other possible causes for
the disease has not been, and probably cannot be, con-
clusively demonstrated in the human subject. Clinical
observations have therefore never been decisive, either
affirmatively or negatively. With experiments upon ani-
mals it is evidently otherwise ; and this question was,
early in the history of experimental pathology, submitted
to experimental investigation. In 1865 Villemin de-
monstrated that the subcutaneous introduction of tuber-
culous human tissues was followed by local and general
tuberculosis in rabbits and guinea-pigs. His results
were in succeeding years corroborated by Klebs, Lebert,
Waldenburg, Cohnheim, Frankel, Tappeiner, Orth, Bol-
linger— in short by all who made the experiment ; yet
not every inoculation was successful : the animals most
frequently subject to spontaneous tuberculosis — es-
pecially the rabbit and guinea-pig — were found also
most susceptible to inoculation ; those which rarely
exhibit the disease spontaneously — the dog and cat, for
example — often resisted attempts at artificial induction
of the disease ; this was to be expected, and was con-
sidered, indeed, as clinical confirmation of the ana-
tomical evidence as to the identity of the spontaneous
and the induced disease. Tuberculosis can, there-
fore, according to the unanimous testimony of ob-
servers, be induced by inoculation with tuberculous
tissue. But it soon became doubtful whether this un-
questioned fact could be interpreted as proof that there
is anything specific about the tubercle ; for it is evident
that if all the effects jiroduced by inoculation with tubercle
can be just as certainly induced by non-tuberculous
materials, no assumption of specific nature is necessary.
It was demonstrated by Burdon-Sanderson, Wilson Fox,
Martin, Waldenburg, Cohnlieim, Friinke!, that after the
introduction of mechanical or chemical irritants — a piece
of wood or paper, a linen thread, a cork, glass, pepper,
March lo, 1883.]
THE MEDICAL RECORD.
!55
cantharides — in short, after the induction of irritation and
inrtanmiation in the subcutaneous tissue or peritoneum,
an eru|)tion of miliary tubercles, indistinguishable his-
tologically from those following inoculation with tubercu-
lous matter, often occurred. It is a little strange, by the
way, that Dr. H. F. Formad, in a recent paper, called
"The Bacillus Tuberculosis," in which he relates the re-
petition of these experiments by himself and by one of his
own pupils, makes no allusion, direct or indirect, to this
work to which I have just referred. This is doubtless an
unintentional oversight ; yet in consequence of this over-
sight, the casual reader derives the impression that a fact
demonstrated by a score of observers in the last fifteen
years was discovered two years ago in Philadelphia.
And then arose the school, represented among patholo-
gists by Buhl and Cohnheiin, and among clinicians by
Niemeyer, who were inclined to deny altogether the spe-
cific nature of tuberculosis, who saw in the etiology of this
disease only the caseous degeneration of an inflammatory
product, a conception tersely expressed in the phrase — no
cheesy product, no tuberculosis. Dr. Formad, after re-
peating these experiments, has recently arrived at the
same conclusion ; but, by a repetition of the singular over-
sight already mentioned, he conveys the impression, by
his failure to mention Niemeyer, Buhl, and the rest
(though citing one of his own pupils) that this doctrine
is new.
Experimental investigation, however, revealed certain
facts that demolished the Cohnheim-Niemeyer theory
entirely, as admitted by Cohnheini himself.
It had long been observed that wild animals, which in
their native state are not known to sufter from tubercu-
losis, are prone to the disease when kept in confinement ;
and that some tame animals, when closely confined, as is
usually the case in physiological laboratories, exhibit an
excessive mortalit}- from this disease. Klebs suggested that
the successful induction of tuberculosis after the insertion
of glass, wood, etc., might after all be simply infection from
contact with animals already tuberculous, or from tuber-
culous materials left in laboratories by previous subjects
of the disease. Cohnheini repeated his experiments on
rabbits and guinea-pigs, isolated both from other animals
and from the stalls in which animals had been previously
confined. The subcutaneous or intraperitoneal intro-
duction of mechanical and chemical irritants was under
these circumstances followed by tuberculosis — in 7iot a
single instance. Friinkel, who had performed with
Cohnheini the original successful experiments in the
Berlin Pathological Institute, repeated them in his pri-
vate dwelling, with absolutely negative results. Cohn-
heini, with the moral courage born of true scientific spirit,
published this fact, and acknowledged the justice of
Klebs' suggestion.
Chauveau, Aufrecht, Bollinger, and others proved
that tuberculosis can be induced in rabbits and other
animals by simply mixing with their food tuberculous
material, and that this tuberculosis begins not in the
lungs, nor in some caseous inflammatory product, but
directly in the intestinal wall. Giboux placed healthy
rabbits in cages in each of two rooms ; into one room
was passed, for several hours a day, the breath expired by
phthisical patients ; into the other room the same, after
filtering through carbolized tow ; in a few months the
rabbits in the first room were dead of tuberculosis ; in
the second apartment there was no sign of death nor of
tuberculosis. Tappeiner, and after him Bertheau, de-
monstrated that the inhalation of sputum from phthisical
patients in minute quantity is followed by pulmonary,
and then general tuberculosis, not only in rabbits, which
are so susceptible to the disease, but even in dogs ; and
that the inhalation of other sputum did not produce this
effect. On the other hand, Schottelius observed among
the inflammatory products following the inhalation of
irritant particles, such as malodorous cheese, certain
nodules histologically identical with spontaneous tuber-
cle ; and that similar nodules sometimes followed the
prolonged inhalation of non-phthisical sputum in large
quantity. (Schottelius, by the way, has since acquiesced
in the infectiousness of tuberculosis.) Weichselbaum
found a few similar nodules in the lungs of one of three
dogs treated in this way, but no tuberculosis. He found
further, that the inhalation, even when brief, of phthisi-
cal sputum induced general tuberculosis ; but after boil-
ing, or after treatment with corrosive sublimate, the same
sputum produced no tuberculosis, and rarely, if ever,
nodules.
These inhalation experiments — of Tappeiner, Bertheau,
Schottelius, and Weichselbaum — illustrate admirably from
the experimental side what had been for years acknowl-
edged from the histological standpoint : that there is
notliing characteristic in the indivitlual nodule. The
same histological structure, including the giant-cell, may
be found in the nodules of syphilis or lupus, as well as
of tuberculosis ; the same local anatomical change may
follow the inhalation of large particles of Limburger
cheese, as the inspiration of atomized phthisical sputum.
For decades the pathologists from Virchow down, their
eyes full of caseous matter and giant-cells, wrestled with
one another over the question, what is true tubercle?
Their hair-splitting disputes remind us of the bitter con-
troversies of the medieval philosophers as to how many
spirits could stand on the point of a needle. Finally it
dawned upon them — they were confounding anatomy with
etiology ; they were regarding as characteristic of one
morbid process a histological structure common to sev-
eral ; they were ascribing to a single cause the common
effect of many ; they ii'ere confounding tubercle with tu-
berculosis. As Cohnheini said years ago: "Struggle
against this as we may, there is no help for it — the ana-
tomical definition suffices no longer for the tubercle and
tuberculosis." Even Schottelius, the last of the German
pathologists to deny the infectiousness of tuberculosis,
has finally recorded his conviction that tuberculosis is
certainly infectious, though not all individual tubercles
belong to tuberculosis.
And what shall be considered a tuberculous tubercle ?
^V■herein may we distinguish a " true " tubercle from a
nodule exhibiting an identical structure ? The question
is answered instantly when we consider what constitutes
pyajmic pus. Pus is a definite anatomical entity, vary-
ing, like tubercle, within certain limits. The pus from
a pyemic joint, may be indistinguishable by the micro-
scope from the pus of a simple abscess ; yet there is
none the less a vital, or rather a fatal difference. Fresh
pus from a simple non-specific abscess does not cause
pyajmia, as Virchow long ago proved ; a minute quan-
tity of pyaemic (lus is fatal through pyemia, as the death
of many a physician has testified. The tubercle from
Limburger cheese does not cause tuberculosis, as Schot-
telius himself admitted ; the tubercle from tuberculosis
never fails to do so, as all observers testify. Pyajmic
pus, however similar histologically to that from croton-
oil or turpentine, is unerringly distinguished by its infec-
tiousness ; tubercles from tuberculosis, though anatomic-
ally identical with those from mechanical irritation or
from syphilis, contain a something sure to propagate it-
self in the proper soil. The non-specific pus of a simple
wound or abscess may acquire pyaiiiiic properties, with-
out the intentional or even conscious introduction of
pyremic matter ; the non-specific cheesy products of a
simple inflammation may acquire infectiousness without
the intentional introduction of a specific agent. This
acquisition of pya;mic infectiousness never occurs, as
has long been known, without bacteria ; and the day has
come when we can say that the infectious tubercle — of
tuberculosis — is also characterized by a bacterium.
Perhaps the clearest proof — because a demonstration — ■
of the infectiousness of tuberculosis is furnished by com-
parative observations upon the eye made by Baum-
garten, Cohnheini, Salomonsen, Deutschmann, and
others. When the piece used for infection is fresh,
Cohnheini says " the irritation at the commencement
256
THE MEDICAL RECORD.
[March 10, 1883.
usually soon subsides, the particle becomes gradually
smaller, and can indeed entirely disappear, and for some
time the eye then appears entirely clear and intact, until
there suddenly appears in the iris a greater or less num-
ber of very minute gray tubercles which, precisely like
the human tubercles, grow to a certain size, then become
caseous, etc. In rabbits Salomonsen and I observed
the eruption of the tubercles usually about the twenty-
first day after the inoculation, in guinea-pigs a week
earlier as a rule.'' " Yet these observations have first
acquired their full significance from the fact that the
tuberculosis is generated by the inoculation of tubercu-
lous matter only and of nothing else." These are the
words of a man who, some years ago, was inclined to
the belief, from the fact that the disease may follow sub-
cutaneous or intraperitoneal mechanical irritation, that
tuberculosis was not an etiologically specific disease. In
his " Allgemeine Pathologie," in discussing the same
subject, Cohnheim says, "After a few days the cornea
is quite clear, the iris thoroughly clean and in perfectly
normal condition ; in the aqueous humor there is also no
exudate to be seen, so that one can see the piece intro-
duced sharply and clearly defined against the lens cap-
sule ; and thus it remains unchanged for weeks, except
perhaps that the particle becomes somewhat smaller.
All at once, in our cases between the twentieth and thir-
tieth day, the scene changes ; there arises in the iris
tissue a considerable number of small transparent gray-
ish tubercles." " Yet the most interesting feature is that
in numerous instances, though not always, a more or
less extensive tuberculosis of lungs, lymph-glands, spleen,
and other organs, occurs. From these experiments it
cannot be doubted, first, that the tuberculosis by inocu-
lation can develop without the medium of a coagulated
exudate, and, second, that it has a stage of incubation."
He says further, " Where experiments so positive and so
easy of repetition are adduced, it would seem impossible
to discuss any longer the question of infectiousness."
Until, therefore, we can otherwise explain the fact
that general tuberculosis can be induced by mixing small
quantities of tuberculous matter (but not by mixing any
other tissue) with food ; by suiiple inhalation of phthisical
sputum, but by no other sputum, nor even by this after
boiling or treatment with corrosive sublimate or filtration
through carbolized tow ; that general tuberculosis with-
out caseous exudate follows the introduction of a minute
tuberculous particle, but of nothing else, into the eye ;
until it shall be possible to offer another explanation, we
must admit that there is a something peculiar to tubercu-
losis and not common to all tubercles. To assert with
Niemeyer that the disease originates de novo in a cheesy
mass, is to assume that because there is no inte^itional
or conscious introduction of an infectious agent therefore
none occurs. Surely no surgeon ever intentionally or
consciously introduced pyasmic matter into a wound ;
yet infectious pyasmia was formerly the scourge of hos-
pitals. Septica5mia, erysipelas, diphtheria, and pyemia
are none the less infectious because there is — especially
in the so-called spontaneous cases of each — no discover-
able possibility of contact with previous subjects of the
same disease. Infection, in other words, does not neces-
sarily imply contagion. No man becomes syphilitic un-
less there be incorporated into his body material from an
individual previously syphilitic ; no man acquires scabies
without contact with a sufferer from itch ; but pyajmia,
erysipelas, diphtheria, anthrax, and tuberculosis are ac-
quired not only by transfer from subjects of the respec-
tive diseases, but also without such transfer. The puru-
lent secretions of a wound are doubtless favorable soil
for the retention and propagation of pya;mic or erysipe-
latous virus; the catarrhal products in the throat for the
origin of diphtheritic iiifection ; the cheesy i)roducts of a
bronchitis or of mechanical irritation for the location and
projiagation of the tuberculous infective agent ; but none
of these are necessary. Py;v;mia, erysipelas, diphtheria,
anthrax, tuberculosis occur not only by demonstrable con-
tagion, not only alter a simple wound without demon-
strable contagion, but also without either demonstrable
contagion or even a simple wound — i.e., spontaneously.
Yet in the face of this perfect analogy with other in-
fectious diseases, in the face of the experimental proof
as above related, there are doubtless many practising
physicians who cannot believe that tuberculosis is com-
municable. Why ? First, because clinical proof to that
effect IS unsatisfactory ; a surgeon pricks his finger in
dressing a pyemic patient, and in twenty-four hours has
a chill and local symptoms pointing unmistakably to
the source of infection ; a physician inspires the breath
of a struggling diphtheritic patient, and in three or four
days gives evidence that the disease w-as communicated.
Had tuberculosis ever been observed to occur in animals
so soon or so violently, were the introduction of tuber-
culous as well as of py;\;mic and erysipelatous virus ac-
companied by chill, fever, and severe acute local inflam-
mation (it does seem to be so accompanied in gen-
eral acute miliary tuberculosis), there might be reason in
the objection that no absolute clinical proof has been
furnished. But even when the freshest of tuberculous
material is introduced into the most favorable soil, the
eye of a susceptible rabbit, two to four weeks elapse be-
fore the first local manifestation of infection, and further
weeks or months before the evidences of general tuber-
culosis are api)arent ; there is, indeed, nothing in the
animal's history to indicate infection, the proof of which
consists merely in the conscious act of inoculation. An
observer who was not aware of this act, might honestly
believe that the infection which manifests itself weeks or
months later is spontaneous — even autochthonous ; and
some physicians, because they see no transfer of tuber-
culous material (though opportunities enough for such
transfer are certainly given), because they see no strik-
ing symptoms to mark the hour or the day of infection,
insist that no infection has occurred.
A man may be shot in the presence of witnesses ; but
if we find a body with a bullet in the heart, we are none
the less certain that this body, alive or dead, has been
shot, though no revolver nor human agent may be dis-
coverable. A man may be killed by the lightning which
dazzles all eyes ; but he is none the less killed if the
electricity be the invisible current of a powerful battery.
If a man exhibits secondary syphilis, nothing can shake
our conviction that he has, whether consciously or not,
come into contact, mediate or immediate, \viih a syphil-
itic person, although the sufterer himself may be honestly
unable to point out the moment or the mode of possible
infection. In many cases of pyemia and diphtheria the'
course of the infection is as plain as the track of the
lightning ; the effect as pronounced and almost as sud-
den as that of the murderer's bullet. In other cases,
however, of pysemia, diphtheria, as w-ell as of anthrax,
syphilis, and tuberculosis, there are absolutely no phe-
nomena observable in the individual which attract atten-
tion to a given moment as the time at which an infec-
tion, subsequently manifested, may have occurred. A
piece of tuberculous matter introduced into a rabbit's
eye may entirely disappear ; and for weeks the animal
presents absolutely no signs, local or general, of tuber-
culous infection.
The opportunities for the usual mode of infection by
syphilis are only occasional ; and the attendant circum-
stances are such as to impress such occasions upon the
mind and conscience ; when, therefore, the first evidence
of infection appears, perhaps weeks subsequently, upon
that part of the anatwmy peculiarly exposed upon such
an occasion, it is but natural that the mind should asso-
ciate the two phenomena as cause and effect. Were
syphilis communicated not in the way at present in
vogue, but by inhalation ; were the initial evidence of
infection not upon the integuments and therefore visible,
but in the lungs and hence inaccessible to the eye, there
might be the same clinical grounds for doubting the in-
fectiousness of syphilis as of tuberculosis. The occurrence
March lo, 1883.]
THE MEDICAL RECORD.
257
of infection in tuberculosis is usually as unobserved clin-
ically as in the exceptional cases of syphilis, in which
a primary lesion was neither suspected nor discoverable.
Another argument often heard against the infectious-
ness of tuberculosis, recently uttered and printed by
a Philadeli^hia surgeon, is the fact that we do not all
die of this disease. Yet the same argument is valid
against the infectiousness of cholera, yellow fever, diph-
theria, scarlatina, etc. Indeed, since the death-roll of
tuberculosis is greater, year after year, than that of any
one or perhaps all of these diseases combined, the argu-
ment, if it had any sense at all, would tend to prove the
excessive infectiousness of tuberculosis. Such an argu-
ment ignores the unquestioned and familiar fact that we
are not all equally susceptible to any one of the infec-
tious diseases ; even the most malignant cholera or yel-
low fever attacks only a portion — usually a decided
minority — of the community. Explain it as we may,
there is a something which we may call predisposition,
by virtue of which only certain individuals yield to in-
fection by cholera or by tuberculosis ; and the fact is,
that the number susceptible to tuberculosis seems smaller
than to any one of several other infections. Compara-
tively few of us attain maturity without having had
measles, scarlet fever, and whooping-cough at least ; yet
six-sevenths of us complete our pilgrimage without ex-
hibiting evidences of tuberculosis. That this is not mere
accident is shown by experiment : guinea-pigs and rab-
bits rarely, dogs and cats usually fail to respond with
general tuberculosis to inoculation with tuberculous ma-
terial. Even the deadly anthrax usually fails to destroy
carnivorous animals, although the most virulent material
be introduced ; and it was long ago pointed out by
Chauveau, and often confirmed, that although sheep are
very susceptible to this disease, yet some sheep resist all
experimental attempts at inoculation, even when large
quantities of fresh anthrax material are injected into the
animal. Dogs enjoy in general imnumity against infec-
tion by anthrax ; yet young dogs are often successfully
inoculated. Infection implies, therefore, not simply a
virus capable of propagation in an animal, but also an
animal capable of permitting such propagation. All vari-
ations of this relative adaptability may be exhibited be-
tween animals of the same si)ecies and a given virus. To
affirm, then, that a disease — anthrax or tuberculosis, for
example — is infectious is to assert that it can be com-
municated by the diseased to a healthy animal, not to
all healthy animals, even of the same species'. Herein
lies evidently our security against tuberculosis, as well as
against many other infectious diseases. The general
principle — the survival of the fittest — seems to have been
for generations at work in eradicating this disease from
the human family, by removing those members of it sus-
ceptible to tuberculosis ; the great majority of us now
living are as safe from tuberculosis as most dogs are from
anthrax.
Another, perhaps the most profound, argument against
the infectiousness of tuberculosis should be considered
here, namely, that the fact must cause us to relapse into
barbarism. " Some of the most noble and tender traits of
humanity threaten to be undermined. The consumptive
who has been heretofore lavishly loved and cared tor,"
etc., "is to be isolated and shunned as a leper, if such
doctrines prevail " {Philadelphia Medical Neii'S, January
27th, ]). 94). Therefore tuberculosis is not infectious.
Incredible as it may appear, the author of these lines is
not a clergyman nor a poet, but a distinguished surgeon
who does not shun infectious pyasmia, septicemia, and
erysipelas ; and who, we may assume, does not love his
child less lavishly, nor care for his patient less faithfully
because that child or patient may sufl'er from infectious
diphtheria or scarlatina.
Were the susceptibility to tuberculosis as general as to
diphtheria, scarlatina, and measles, there might be grounds,
not for shunning the consumptive "as a leper," but for
ihe observance of proper precautions for the protection
of the healthy many, even at the inconvenience of the
diseased few. But since the experience of generations
has shown that only about one-seventh of us acquire
tuberculosis even with unrestrained intercourse with con-
sumptives, it may be questionable whether any other
protection than a knowledge of its infectiousness for some
individuals be necessary ; we do not invoke the law to
brand syphilitic individuals, though to this infection not
one-seventh but, probably, all of us are susceptible. But,
however that may be settled, let us not confound a fact
with a possible deduction which may be unpleasant.
These more or less prevalent arguments against the in-
fectiousness of tuberculosis have been considered not
because they have any bearing upon the question, but
because there are those who will not or do not take into
consideration the demonstrations attained by accurate ex-
perimental methods, and whose opinions rest upon dis-
torted deductions from necessarily inaccurate clinical
observations. Yet while those who are pleased to regard
pathology as something extrinsic to practical medicine
are still discussing the clinical proofs of the infectiousness
of tuberculosis, it is quite otherwise with pathologists and
clinicians whose opinions are founded upon knowledge
without prejudice. One after another the German and
French pathologists (who are not infrequently clinical
teachers as well), honest in their previous conviction
that the communicability of tuberculosis was not proven,
honestly recorded their convictions as succeeding proofs
were furnished, that the case was reversed ; so that three
years agoCohnheim said, "To-day there scarcely exists
a pathologist who would deny that tuberculosis is a com-
municable disease." '
Cohnheim himself, extending and repeating more care-
fully his observations, saw and acknow-ledged the error
of his former deduction. True, a would-be pathologist
has occasionally reminded us that he was not yet con-
vinced ; yet even Schottelius, the last of them, has finally
yielded the point. There have been in all ages, and on
all questions, similar psychological curiosities ; twenty-
five years ago it was maintained on the floor of the
French Academy of Sciences that intestinal worms origi-
nate de novo in a peculiar influence pervading the system
— the vermicular diathesis. There is a gentleman in this
State who recently reminded us that bacteria, so-called,
are in his opinion fibrin threads and the like ; and there
is said to be a man in \'irginia who still insists that the
earth is flat.
You may have noticed that in this discussion the name
of Koch has not been mentioned — a fact to which I call
attention, because a jjopular impression, not entirely con-
fined to the laity, saddles upon Koch the paternity not
only of the bacillus, but also of the infectiousness of tuber-
culosis. Dr. Formad, for example, says (p. 3) : " An
analysis of Koch's experiments shows that he has not
proved the parasitic nature of tuberculosis, so that the in-
fectiousness of tubercular disease is still sub judice." It is
apparent from the facts which I have endeavored to sum-
marize that the communicability of tuberculosis was estab-
lished years before the well-known publication of Koch's
discovery. Dr. Formad says (p. 10): "The supreme
question before the medical world is now, whether the
disease under consideration is really infectious." This
statement may represent faithfully that portion of the
world bounded by the city limits of Philadelphia ; the
supreme question before that portion of the medical
world including Virchow, Cohnheim, Billroth, Bamberger,
Weigert, Villemin, and the other German, French, and
Austrian pathologists and clinical teachers is, not
whether tuberculosis is infectious, but whether the bacil-
lus of Koch is the infective agent. For them the two
questions are quite independent — the former established,
the latter awaiting confirmation.
(To be continued.}
' In the Medical News, January 27, 1883. p. 94, Dr. \Vm. Hunt leads us to
infer that " most recent path.ilogists" agree in regarduig tuberculosis as the result
of a simple inflammation. Will he kindly name one pathologist who now holds this
opinion, and mention the pertinent publication?
258
THE MEDICAL RECORD.
[March lo, 1883.
(Dvioiuul Articles.
CONDENSING OSTITIS OF THE MASTOID
PROCESS.'
By albert H BUCK, 1\I.D.,
NEW YORK.
Hyperostosis or sclerosis of the mastoid process of the
temporal bone has, until quite recently, been considered
rather as a pathological condition, which is occasionally
encountered in operations upon that bone, or at the post-
mortem examination, than as an active morbid process
possessing a sufficiently definite train of symptoms to jus-
tify us in assuming its existence in particular cases. Many
a surgeon has undoubtedly bored into the mastoid process
of a patient who presented almost every symptom of an
incipient or well-advanced caries of that bone, and has
been astonished to find its cells wholly or in part oblit-
erated, its substance almost as hard as ivory, and no pus
discoverable at any point. He is afterward pleased to
find that the operation has relieved the patient of pain,
and that the evidences of active inflammation have all
gradually disappeared ; but he has undoubtedly been not
a little puzzled to find a satisfactory explanation for the
sequence of well-marked pathological phenomena of
which he has been a witness. A few experiences of this
kind led me years ago to maintain that in the great ma-
jority of cases which seemed to call for the operation of
boring into the mastoid process, we should not be able to
say beforehand whether we should find the bone in a
carious condition or simply congested. When I have
least expected it, my drill has plunged into a well-defined
collection of pus and fragments of carious bone ; while
still more often, not a trace of pus has been discovered
in the progress of the operation. In cases belonging to
the latter class I have assumed, in my desire to find some
reasonable explanation of the severity of the pain and of
the pronounced character of the outward signs of deep-
seated inflammation, that the operation was performed
at a time when the bone was still m the first stage of an
inflammation which, without operative interference, would
be certain to eventuate in caries. It was difficult to real-
ize that such severe pain and such well-marked periostitis
might be simply the outcome of a subacute proliferative
inflammation of all those soft parts which supply nourish-
ment to the mastoid bone — and such indeed is undoubt-
edly the nature of the processes which take place in cases
of hyperostosis of this part of the temporal bone.
So far as I can learn. Dr. C. R. Agnew, of this city,
was the first person to suggest the idea that inflammation
of the mastoid cells need not necessarily tend toward
caries of its bony structures. He says that he is con-
vinced that " caries is not the invariable and immediate
result of mastoid cell disease, but that sometimes there
may be, instead, an ostitis, w'ith hyperplasia of the bone,
filling a few or all of the cells." ^ Three years later
(1873), in a paper which I published on the subject of
mastoid diseases, I made the following statement with
regard to sclerosis or hyperostosis of the mastoid process :
" While this form constitutes a distinct pathological con-
dition, we are not yet in possession of sutficient clinical
facts to guide us to a positive diagnosis. Sclerosis or
hyperostosis of the mastoid process is associated with
either chronic catarrhal or chronic purulent inflammation
of the middle ear. Its progress is so insidious and so
rarely accompanied by any marked symptoms that it is
only at the post-mortem e.xamination, or when called
upon to trephine the bone, that we discover the existence
of this condition. As the very delicate membrane which
lines the mastoid cells serves the double function of mu-
cous membrane and periosteum to the intercellular bony
septa, It will be readily understood how a chronic con-
* Hyperostosis, sclerosis, or osteo-sclcrosis of Ihc mastoid process.
3 Report of Llie American Utologicat boctcty, 1870.
gestion of the membrane may result, on the one hand, in
thickening of its substance, and, on the other, in hyper-
trophy of the bone which it nourishes. In place, then,
of air-containing cavities separated by thin septa of bone,
we find a tolerably dense bony mass, whose substance is
studded throughout with small collections of slightly vas-
cular connective tissue." It was not, however, until at
a still later date that any attempt was made to hazard a
diagnosis of this condition. In 1876, and again still
more recently. Dr. J. Orne Green, of Boston, Mass.,
published reports of cases in which he had made, and
verified by operation, the diagnosis of hyperostosis of the
mastoid process.' Finally, in 1879, Arthur Hartmann,
of Berlin, Prussia, published a paper from which it ap-
pears that he also had arrived at the conclusion that scle-
rosis can appear as an idiopathic disease of the mastoid
process, after cessation of inflammation of the middle ear,
and cause the most violent pains.''
The preceding brief statement furnishes, I believe, a
correct account of the progress of our knowledge with
regard to this pathological process. It is also a fact
that, even at the present time, this knowledge is still
available only in a vague and disconnected form. It is
my purpose to see how far I can succeed in bringing
these fragments together into a logical whole, in the hope
of thus reducing to order some of the confusion which
now exists. The blame for a part of this confusion, as
I can now see, may justly be laid at my own door, for in
the paper which I published in 1873, on the subject of
mastoid diseases, I endeavored to establish different
forms of disease for what were in reality simply phases
of one and the same pathological process. Another
part of the confusion is to be attributed to the fact that
very few of the cases reported as illustrations of hyper-
ostosis of the mastoid process are sufficiently free from
complications to render them useful as types. The pic-
tures drawn are undoubtedly true to nature, and the ex-
pert assents at once to the correctness of the diagnosis,
but the student, or the physician who sees such cases
onlv at long intervals, would perhaps fail to appi'eciate
what are the particular features which distinguish hyper-
ostosis from ulcerative or carious disease of the mastoid
bone. Finally, I am disposed to attribute some of the
confusion to the terms which w'e commonly employ in
speaking of the disease, viz., hyperostosis, sclerosis, and
osteo-sclerosis of the mastoid process. The idea of ac-
tive inflammatory changes is not embodied in any of
these terms ; but rather that of a pathological change
which has reached completion, and has therefore ceased ■
to be active. I much prefer the expression ostitis (as
used by Dr. .Agnew in the paper referred to above),
which implies an activity of the inflammatory or hyper-
plastic processes ; and, in order to convey at the same
time the idea tliat the inflammation tends toward solidi-
fication, rather than toward destruction of the bone, I
should be disposed lo add the qualifying term condensing.
While I have ventured to put this expression — condens-
ing ostitis of the mastoid jirocess — at the head of this
paper, I have made no attempt to employ the term ex-
clusively, through fear that 1 might create further confu-
sion in the minds of those readers who are familiar only
with the expressions commonly used.
Among a number of cases which have from time to
time come under my observation, I have seen but two
in which the two things required to render them suita-
ble as types — viz., a maximum degree of hyperplasia
of the mastoid process, and a minimum degree of activity
of all disturbing complications — coexisted. One " of
these cases is still under observation, and conse(iuently
my history of it must necessarily be incomplete. The
other, though seen more than ten years ago, and reported
at the time, has always been more or less of a puzzle to
> Report of the International Otological Society, 1876 ; Transactions of the Amcr-
i:an Otological Society, iSSc,
'J Archives of Otology, 1879.
March lo, 1883.]
THE MEDICAL RECORD.
259
nie, until I came to reflect upon it while reading Dr.
Green's papers. The histories of these two cases are as
follows :
Case I. — The patient, a lady, about thirty-five years
of age, consulted nie on March 30, 1880, on account of
a discharge from the right ear, and frequent attacks of
pain throughout the right side of the head. I was not
able to obtain a very full account of her previous his-
tory, so far, at least, as it related to the affected ear ; but
as the result of my cross-questioning, I ascertained that
the disease had begun in early childhood, as an acute
purulent inflanunation of the middle ear ; that it had
then run an irregular course, lighting up at long intervals
into an acute exacerbation, and then subsiding again into
a comparatively quiet state ; that there had always been
some discharge from the ear, at one time very scanty, at
another quite copious; and that the disease had finally,
during a period of ten or twelve months, immediately
preceding the time when I first saw her, settled down
into a steady discharge from the ear, associated with fre-
quent and sometimes quite severe attacks of pain in-
volving the right side of the head. The affected ear
still possessed a useful degree of hearing. An examina-
tion with the speculum and reflected light revealed the
existence of a thick laminated mass of epithelium, pus,
and cheesy matter, occupying the deeper part of the ex-
ternal auditory canal. Fresh pus was oozing out from
beneath the mass. By aid of the curette, a slender silver
probe, and a mop of cotton wound around the end of a
cotton-holder, I was able to clear away all these old and
foul-smelling products of inflanunation, and to obtain a
clear view of the diseased region. About two-thirds of
the membrana tympani still remained, and the greater
part of the discharge evidently came from the mastoid
antrum, the tympanic mouth of which was partly blocked
by a small polypoid growth. I removed this growth
with the wire loop and Blake's snare, and advised the
patient to use regularly, for a short time, the douche
with lukewarm water. My scant notes say nothing about
the condition of the mastoid process ; and from this I
infer that I must have overlooked certain conditions
which very probably existed at that time, but which I did
not discover until later.
On March 8, 1S82, or nearly two years later, the patient
again consulted me. During this long interval the ear
proper had given her very little trouble, and there had
only been an occasional slight discharge, but she had still
continued to be subject to periods of pain involving the
right side of the head, and occasional attacks of flushed
face. During the previous week, however, the pain had
been quite severe and had localized itself more particu-
larly in the ear. She had also experienced considerable
dizziness at times. I examined the ear and found that
the desquamative process had a second time produced a
tough plug that filled the deeper end of the meatus. I
also found, by aid of a bent probe, that the upper part
of the tympanic cavity, posteriorly, was filled with a
tough white mass of laminated epithelium. It was only
after prolonged efforts, made partly with the bent probe
and partly with a douche provided with a slender glass
end-piece, bent at a right angle, that I finally succeeded
in completely freeing the cavity from the offending masses.
A sharp inflammation followed this prolonged opera-
tive interference. It spread along the cutaneous lining
of the external auditory canal, and caused it to become
greatly swollen ; it extended along the Eustachian tube,
and rendered the act of swallowing painful ; and, finally,
it involved the cellular tissues behind, above, and in front
of the ear. Throughout all these outer regions tender-
ness on pressure, redness of the surface, and decided
cedematous swelling were noticeable already on March
loth. The body-temperature was 102° F. The aiiisli-
cation of hot poultices having failed to afford nnich re-
lief from the pain, I made a Wilde's incision and divided
the mastoid periosteum freely. I also prescribed the
frequent application of hot flax-seed meal poultices.
On the following day I found the patient in a more
comfortable condition, but there was still a great deal of
inflammation all around the ear. Three leeches were
applied behind the ear, and the continuance of hot appli-
cations was advised.
On March 12th I found more decided evidences of the
subsidence of the inflanunation.
On the 13th the body-temperature was 99° F., and the
patient expressed herself as feeling fairly well again. A
small amount of pus constantly escaped from the audi-
tory canal, and its walls were still so much swollen that
I could not obtain a satisfactory view of the deeper parts.
The tenderness, however, had almost entirely disap-
peared, except innnediately over the mastoid region.
About the middle of April I removed another poly-
poid mass of granulations from the tym]janic orifice of
the antrum, and from that time forward the discharge
ceased altogether.
On May loth-I made a careful examination of the
ear, and found that all those parts of the middle ear
which could be seen, were pale, dry, and perfectly free
from the slightest trace of congestion. So far as I could
ascertain by means of the bent probe, the antrum and
the posterior upper portion of the tympanum were
empty. The cutaneous walls of the auditory canal were
also perfectly free from either redness or swelling. Be-
hind the ear, however, the skin was noticeably red, and
firm pressure with the finger, at almost every point over
the mastoid process, caused some pain. These parts
were at the same time slightly cedematous. On com-
paring this region with the corresponding one on the
other side of the head, I discovered, for the first time,
that the right mastoid process was appreciably larger
than the left. On simple mspection it seemed to be
markedly larger, but on palpation, and after making due
allowance for the cedematous condition of the integu-
ments, I became satisfied that the difference in size was
only moderate in degree, though yet unmistakable. As
the patient was still subject to almost constant pain in
the region behind the ear, and in fact throughout the
entire right side of the head, I applied -three leeches
directly over the right mastoid process, and allowed the
after-bleeding to go on unchecked for a considerable
time.
On October 6th I again had an opportunity of exam-
ining the patient's condition. She reported that the
local blood letting referred to in the preceding para-
graph, had aflbrded her decided relief from pain for a
period of several days. The pain had then returned, and
all through the summer she had experienced more or
less of it, not constantly, but yet very frequently. Blis-
ters had also occasionally been applied over the mastoid
region, but without any beneficial effect. Notwithstand-
ing the persistence of the pain, she had had the best of
health in all other respects. On examination, I found
the deeper parts of the ear in a perfectly quiet state, and
free from even the slightest evidence of inflanunation.
On the outside, however, the previously described con-
dition of redness, tenderness, and slight osdema still per-
sisted. In fact, the tenderness extended as far back as
the occipital protuberance. As the pain had been more
acute than usual, during the previous three or four days,
I advised a repetition of the local blood-letting. (The
patient has since moved away from the city.)
Case II. — A physician, a resident of South Carolina,
fifty-six years of age, and of a strong constitution, con-
sulted me on October 6, 1872, for a jjainful affection
of the ear. He gave the following history : In 1835
he contracted an acute inflammation of the left middle
ear from the violent concussion of the air caused by
the bursting of a gun. The severe symptoms soon
passed away, but the purulent discharge from the ear
continued for some time afterward. Then, for a period
of many years, he exiierienced no trouble beyond a
moderate degree of deafness and some tinnitus. The
perforation in the drum-membrane remained unclosed
26o
THE MEDICAL RECORD.
[March lo, 1883.
through all these years. About twelve weeks before the
time when I first saw the patient, he noticed that there
was a slight watery discharge from the left ear, which
was at the same time somewhat painful. The pain be-
came gradually more severe and was associated with
headache and fever. The doctor bled himself to the ex-
tent of about sixteen ounces ; six hours later he took
from the arm an additional quantity of about eight
ounces. A profuse suppuration from the ear soon took
place, and the pain then became less severe. For a month
no marked change occurred in the condition of the ear.
The discharge continued, thougli at times it would al-
most cease. On August 23d he had a rigor, which was
followed by a return of all the acute symptoms. The
pain was referred to the base of the brain, the mastoid
process, and the articulation of the jaw, and was very
severe. Bleeding to the amount of twelve or fifteen
ounces afforded some relief, and the discharge again be-
came abundant. For a week the paiil remained moder-
ate. On August 31st he had another rigor, followed by
intense pain, referred to the mastoid process, whence it
extended backward toward the occiput and occipito-
vertebral articulation ; in fiict, the w-hole side of the
head was painful. There was tenderness over the mas-
toid process, and the auricle was pushed out somewhat
from the head. On September i8th, no material im-
provement having taken place in his condition, the doc-
tor started for New York, in the hope of obtaining relief
there. The sea-voyage from Charleston benetited him
very decidedly. The severe symptoms abated, and, for
some time after reaching this city, he enjoyed, at least
during the day, comparative comfort ; toward night,
however, the old trouble returned with greater or less
severity. During the few days preceding his visit to me,
he suffered acutely from pain in the region of the ear.
On examination I found the meatus in a normal con-
dition, the membrana tympani perforated anteriorly, the
Eustachian tube freely open, and only a trace of pus in
the middle ear. The mastoid integuments were cedema-
tous and tender on pressure. The tenderness also ex-
tended back" toward the occiput. General condition
fair ; pulse a little accelerated ; no heat of skin. At
a consultation held by Dr. James R. Wood, Dr. Her-
mann Knapp, and myself, it was deemed best to per-
forate the mastoid process. At the patient's own request
the operation was performed without the aid of an an-
esthetic. The appearance of the bone, after the peri-
osteum had been divided and lifted to one side, was
entirely normal. The drill was applied on a level with
the upper wall of the meatus, and was made to penetrate
to a depth of three-fifths of an inch without encounter-
ing the characteristic cells. At this depth, however, a
tolerablv firm pad of connective tissue was felt. It was
supposed at the time that this mass filled the antrum,
but on subsequent ins[)ection I became persuaded that,
owing to the thickness of the swollen integuments and
the recumbent position of the patient, I had erred some-
what in the direction which I gave to the drill, pointing
it too far backward. The pad of connective tissue was
undoubtedly the outer wall of the lateral sinus.
October 13th. — Patient passed a comfortable night.
Pain much less than before the operation. Ordered
quinine, gr. vj. daily.
October 14th. — Pain again severe. Consultatioh with
Dr. Robert F. Weir and Dr. Hermann Knapp. A sec-
ond perforation was made with the drill, this time nearer
to the meatus and on a somewhat lower level than the
first. The mastoid cells encountered were small and con-
gested, but no pus was found. Tent inserted ; poultices.
October i5tii. — Slight improvement.
October i6th. — Pain diminishing. Temjierature, 97°
F. Free discharge from wound.
October 17th. — .Marked improvement in every re-
spect. Api)lication of poultices to be discontinued.
October 23d. — Tenderness over mastoid process almost
gone.
November 14th. — Patient is quite well again. There
is no discharge from the meatus, and the wound behind
the ear has healed except at two points, corresponding
to the two perforations in the bone.
A few weeks later I heard from the patient, who had
returned to his home, that he had remained free from
pain, and that his general health was quite good again.
To these two cases I wish to add one reported by Dr.
J. Orne Green. While it is comparatively free from
disturbing complications, and therefore admirably adapted
to serve as a type for purposes of study, I cannot help
believing that this patient, at some earlier period of his
life — perhaps many years before the occurrence of the
acute attack which, according to the history given, ap-
parently afforded the exciting cause of the mastoid hy-
perostosis— must liave had a prolonged infiammation of
the middle ear. The history of this case is as follows :
C.-\SE HI. — "Another case in which osteo-sclerosis
existed, and was proven by operation, was that of a man
seen in 1878. He was about thirty-five years of age,
previously healthy ; one week before he began to have
pain in the left ear, followed by discharge two days after,
and severe vertigo with vomiting and great weakness ;
there were also subjective noises as of hissing. Examin-
ation showed purulent inflammation of the tympanum
with a minute perforation, which was enlarged with a
paracentesis needle so as to give free evacuation. A
few days after there was a slight paralysis of the left
facial nerve. The inflammation of the tympanum sub-
sided under treatment, the perforation healed, the paraly-
sis disappeared, and at the end of two months the ear
was apparently well, but the deafness was absolute on
that side. Pain in the mastoid and over the side of the
head continued, however, with slight tenderness of the
mastoid on deep pressure, but without any swelling of
the soft tissues ; no enlargement of the bone was per-
ceptible. Other means failing to relieve the pain, the
bone was perforated under ether with a triangular borer
to the depth of half an inch ; no pneumatic cells
were reached, the bone throughout being dense and
ivorv-like. The relief from the operation was gradual,
but decided, and the patient made a good recovery. In
this case also there was no reason to suspect syphilis."
In the first of these cases the pathological events suc-
ceeded each other in the following order : purulent in-
flammation of the middle ear occurred in childhood,
with destruction of a part of the membrana tympani ;
the inflammation did not entirely subside, but continued
for years afterward, in a chronic subacute form, with oc-
casional exacerbations. From the antrum, as the centre
of its greatest activity, the inflammation spread to the
pneumatic and diploetic portions of the mastoid process
and caused an active hyperplasia of this bone. During
the continuance of this ostitis the patient suffered from
pain in the mastoid region and vicinity. At first the
paroxysms of pain were of comparatively short duration
and the intervals of freedom from pain lasted weeks or
even months. Later, however, these painful attacks
lasted for days, and finally even for weeks, and they re-
curred more frequently. In addition to the pain, in this
later stage of the disease, certain external manifestations
showed themselves, viz., redness, swelling, and tender-
ness of the mastoid integuments, and even an appre-
ciable degree of enlargement of the bone itself. Fur-
thermore, while at first the mastoid ostitis required an
exciting cause, in the shape of a more or less active in-
flammation of the middle ear proper and antrum, to
keep it alive, in the later stage of its existence no such
stimulus seems to have been required, inasmuch as the
com])lete arrest of the inflammation of the middle ear
and antrum by treatment, failed to restrain, in appar-
ently the slightest degree, the diffuse mastoid ostitis,
which had already gone so far as to cause visible enlarge-
ment of the bone.
A similar synopsis of the second case shows much the
March lo, 1883.]
THE MEDICAL RECORD.
261
same sequence of jiathological events. In early man-
hood a violent concussion of the air seriously damaged
the middle ear, leaving it for a long time the seat of a
l)urulent inflammation. Probably during this period a
certain degree of subacute mastoid ostitis was associated
with tiie affection of the middle ear. For a period of
many years all these parts remained quiet and free from
all diseased action. Then, under some provocation
which does not clearly appear in our history of the case,
the middle ear again became the seat of a violent in-
flanuiiation lasting several days, and afterward lighting
up once or twice into exacerbations of marked severity.
A fresh ostitis was thus started in a mastoid process
whose cells were probably already much reduced in size
by the previous attack. For a period of several weeks
it was kept in a state of activity by the continuance of
the acute inflammation in the middle ear. Finally, when
the latter subsided, the ostitis still persisted, having in
the meantime acquired sufficient momentum of its own.
An artificial opening in the bone revealed the true na-
ture of the disease, but the condition was not clearly
appreciated at the time.
In the third case we find again essentially the same
order of pathological events, but with some noteworthy
variations. In the first place, the original inflammation
of the middle ear spread, not only to the mastoid struc-
tures, but also apparently to the labyrinth, causing a
total loss of the hearing of that side. Then, after the
lapse of a period of less than three months, during which
time the inflammation of the middle ear gradually dis-
appeared altogether, a very decided degree of hyperos-
tosis was found when an opening was made in the mas-
toid bone. In this case also the latter operation afforded
decided relief from the persistent pain.
In these cases we have, as I believe, remarkably jnire
types of condensing ostitis of the mastoid process. Many
of the accidental symptoms, which are so apt to be
present in these cases, and which complicate greatly the
problem in diagnosis, are lacking. I refer to decided
evidences of inflammation in the middle ear or external
auditory canal, to fistul;B, to facial paralysis, to convul-
sions, to i3y;i5mic symptoms, etc. When such conditions
are present, the possibility of making a correct diagnosis
will depend entirely upon the observer's ability to weigh
nicely the significance of each of the phenomena ])re-
sented, and to correctly estimate their relations to each
other. This sort of work belongs to the expert, and no
fornudae that I am able to lay down will materiall)' aid an
inexperienced person in arriving at the truth. I can only
hope to point out those peculiar relations of symptoms
to each other, which, in cases like those which I have
narrated, may enable the general practitioner to arrive at
a correct diagnosis. I will enumerate these distinguish-
ing marks in the order of their importance :
First. — The persistence of decided pain in and around
the mastoid region, despite the existence of an adequate
outlet in the drum membrane for the pus secreted in the
middle ear ; despite the absence of anything like acute
inflammation of the middle ear or external auditory canal ;
or, finally, despite the employment of such therapeutic
measures as would be likely to allay any ordinary inflam-
mation of these parts or a mere passing congestion of the
mastoid structures.
Second. — The presence of such external signs as red-
ness, swelling, and tenderness of the outer mastoid in-
teguments, under the conditions just enumerated, furnishes
strong corroborative evidence of condensing mastoid os-
titis. Actual enlargement of the bone itself may be consid-
ered as furnishing almost positive proof of the disease.
Tliird. — The history of previous chronic purulent in-
flammation of the middle ear justifies the assumi)tion that
the mastoid cells have already been greatly reduced in
size, if not obliterated, by earlier attacks of subacute
ostitis of these parts.'
^ In 1880 I published the sLitement that the existence of a sclerosed condition of
the mastoid process may be assumed in the great^niajority of cases of chronic puru-
Dr. Green expresses the opinion that as time goes on
we shall find that cases of hyperostosis of the mastoid
process become more numerous. I fully agree with him
in this belief; and, inasmuch as experience seems to
teach that simple non-purulent ostitis is rather therule
than the exception, I would suggest that we emancipate
ourselves hereafter from the idea that a purulent or
carious focus is the lesion to be looked for in these pain-
ful afl^ections of the mastoid process, and adopt rather
the state of mind which will lead us to assume the exist-
ence of a sinijjle condensing ostitis. The prognosis is
far less grave than in the other condition, and the indica-
tions for treatment are clear and simjile. Leeches, hot
poultices, and even Wilde's incision will probably fail to
give more than temporary relief, and if such prove to be
the case, we should not hesita:te to perforate the bone
with a drill or other suitable instrument. In the great
majority of cases it will not be necessary to make any
eff"ort to reach the antrum. The desired relief will be
equally well attained by the simpler operation of pen-
etrating the bone, in one or, at the most, two places, to
a depth of say half an inch. The relief seems to depend,
not upon the establishment of an outlet for pent-up pro-
ducts of inflanunation, but rather upon something which
may be described as counter-irritation. I once tested
this point in an obstinate case which presented every ap-
pearance of being one of simple mastoid ostitis, and
which had failed to improve under the action of blisters,
local blood-letting by leeches, jjoultices, and, finally,
Wilde's incision. I repeated the latter operation, and,
as soon as the bleeding had ceased, I freely applied the
stick of nitrate of silver to the raw surfaces, down to the
very bottom of the wound. The vigorous inflammation
thus set up effected a perfect cure of this painful affec-
tion, and satisfied me that the beneficial effects of the
decidedly less barbarous method of boring into the
mastoid bone, may in large measure be attributed to
counter-irritation.
THE DANGER ATTENDING THE USE
ETHER AS AN ANAESTHETIC IN CASES
BRIGHT'S DISEASE.'
By R. VAN SANTVOORD, M.D.,
OF
OF
NEW YORK.
The fact that the employment of the comparatively safe
anesthetic, sulphuric ether, is not entirely free from dan-
ger has been attested by the record of a number of fatal
accidents occurring from its use. In some of these cases
death has taken place during anesthesia, in some cases
the action of the heart, in others respiration, first ceasing.
In others consciousness has been restored but the patients
have passed into collapse some hours after its adminis-
tration. In these cases there has usuall)- been no distinct
organic affection on which could be laid the blame of the
accident. Fright during the commencement of the in-
halation, as is known to be the case with other anes-
thetics, may account for some of them. It is possible
that the shock of the operation during imperfect anes-
thesia, as Mr. Lister claims to have observed under
chloroform (" Holmes' Surgery"), may have caused deaths
which were attributed to ether, but which would in reality
have been prevented by the ether had the anesthesia
been more profound. Death occurred in some cases in
lent inflammation of the middle ear. From a study of fifty of Schwartze s cases
(published at different times in the Archiv fur Ohrenheilkunde) of perforation of
the mastoid process, with drills or with gouges, 1 found that in twenty-three a
chronic purulent inflammation of the middle ear. of not less than five years dura-
tion, preceded the acute symptoms which induced Dr. Schw.irtze to perform the
operation of perforating the mastoid process ; and in thirteen of this number— or
fifty-si.\ and one-half per cent.— well-marked sclerosis of the middle and upper
portions of the process was found. Of the remaining ten cases, there are four in
which no mention whatever is made of the condition of the bone, and six in regard
to which it 15 distinctly stated that there was no sclerosis. I found, furthermore,
that out of five cases of my own, which were similar to SchwarUe's twenty-three
cases, there were four— or eighty per cent.— in which more or less pronounced
sclerosis ol the mastoid process was discovered at the time of the operation or on
post-mortem examination. 'I'his evidence, it appears to me, corroborates the truth
of the formula which I have given.
' Read before the Harlem Medical Association, New York.
.'J»
262
THE MEDICAL RECORD.
[March lo, 1883.
which the patients, though presenting no gross lesions of
heart, Kings, or nervous system, yet were very much de-
bilitated, as for example in two cases narrated bv Kap-
peller {Deutsche Chiriirgic), of strangulated hernia, in
several others by malignant disease. Others again have
been caused indirectly by the ether, as we all know, by
inhalation of vomited matters, usually during partial un-
consciousness while recovering from the anajsthetic or
from the filling up of the trachea by blood during opera-
tions about the mouth and fauces. To this list of acci-
dents I might add that certain French observers ' claim to
have seen death caused by suffocative bronchitis induced
by the inhalation in some cases of chloroform, in some,
and more frequently, of ether.
There is one source of danger from the use of ether
which has not yet, I believe, been generally recognized
by the profession. I refer to the danger of congestion
of the kidneys, and consequent suppression of urine in
patients already subjects of chronic Bright's disease. The
elaborate monographs of Turnbiill, written in 1879, Dnret
(" Des Contraindications I'Anitsthesie '), 1S80, and Kap-
peller in the Deutsche Chirurgie, 1881, make no mention
of disease of the kidneys as a contra-indication to the use
of sulphuric ether. Lyman, writing in 1881, says that
" even sulphuric ether may prove fatal if the kidneys are
seriously damaged, but does not go into the subject be-
yond this slight allusion.
Isolated cases, however, of death resulting, in the
opinion of their reporters, from the irritant effects of
ether on diseased kidneys have been recorded. It is my
purpose in the present paper to present to the Society
what information I have been able to obtain from the
literature of the subject, and to endeavor to form some
estimate of its importance.
'J'he power of ether to cause temporary suppression of
urine is illustrated very markedly in a case reported by
Mr. Lawson Tait, in the British Medical Journal oi 1880
(vol. ii.,. p. 845), in which a fistula existed between the
cervix uteri and one of the ureters. .\ constant dribbling
of urine occurred from the opening. On two trials the
urine ceased to flow as soon as the woman was etherized.
As the stream of urine was essential as a guide in the
performance of the operation, it had to be performed
without an anajsthetic. There is no record of any urinary
examination."
The first to call attention to the danger of suppression
of urine and death, resulting from the use of ether in
cases of chronic Bright's disease, was Dr. F. .•\. Emmet,
who, about sixteen years ago, made an opening into the
bladder of a [>atient suftering from chronic cystitis, under
ether. No water was passed after its use, and the patient
died of urajmia three days afterward. Marked chronic
lesions of the kidneys was found post-mortem. The case
was published at the time in one of the Southern journals,
and an abstract of it can be found in his work on gyne-
cology. Since that time he says, in the same work, that
he has seen " at least five cases, in (lublic and private
practice," of death occurring under similar circumstances.
So strongly has Dr. Emmet been impressed by his ex-
perience that he considers albuminuria the contra-indi-
cation par excellence against the use of ether, and in such
cases operates with the patient under the influence of
opium and without an;«sthesia. Dr. Emmet, in a per-
sonal communication, informed me that he had reported
each case as it occurred at the meetings of the Obstetri-
cal Society of this city, but I have been able to find only
one of them in print. In that case pyelitis and advanced
chronic interstitial nei)hritis existed.
Dr. William Hunt, in the Philadelphia Medical Times
of January 9, 1875, reports a case of death occurring two
weeks after an amputation of the thigh, in a patient whose
pulse dropped dangerously at the time of the operation,
* Richct : Gazette des Hopitaux, July 12, 1879. Kcvillout : Gazette des Hopi.
taux, No. lii., pp. 633, 63s, 1879.
^ Since the above was written Mr. 'I'ait, in the Lancet for Jannary 6. 1883, p. 39,
states that in every case of vcsico-vaginal ft>lnla in which he has operated since
the above recorded operation he has "observed the same thing."
after a few whiffs of ether had been taken. The patient had
fever, which was not pyemic, but never had any ur;-emic
symptoms. Dr. Hunt asks the question, " Had the
kidneys anything to do with it ?"
Dr. Sims, in his article on a death from bromide of
ethyl, in The .Medical Record, vol. xvii., casually re-
ferred to two deaths from suppression of urine in cases
similar to Dr. Emmet's.
Dr. Hutchinson, in the BritisK Medical Journal for
March, 1879, reports the death of a feeble old man,
eighty-four years of age, who was operated on for carci-
noma of the lymphatics of the neck, who never became
completely conscious after ether narcosis, became com-
pletely comatose in eight, and died in forty hours after
cessation of administration of the anaesthetic. There
had been no great loss of blood. The right arm seemed
paralyzed. Tremor, passing into convulsions of the
right side of the face occurred, and, later, tremor of the
right arm. Contracted kidneys and an old cyst, dating
back, jirobably, to an apople.xy ten years previous, were
found post-mortem. Thorax not examined. No allusion
to the possible connection of the kidneys with the result
is made by the reporter. The prolonged coma and the
convulsive seizure, however, suggest such a connection.
Dr. W. F. Norris, in a paper read before the Ameri-
can Ophthalmological Society in 1881, gives the history
of two of his patients, whose death he attributes to the
irritant effect of ether on the already diseased kidneys.
The first was a child five months old, probably syph-
ilitic, who was operated on by discission for cataract.
Four hours after the ailministration of ether the child had
convulsions, became comatose, and died. The kidneys
were found to be fatty and intensely congested. The
second case was that of a woman sixty-eight years of
age, apparently in good health. Operation was the ex-
traction of a cataract, .\fter the operation there was
some fever, thirst, and disturbance of digestion. She be-
came delirious on the sixteenth, and died on the eighteenth
day. The kidneys were found to be congested. There
was increase of their fibrous tissue and fatty degenera-
tion of the renal epithelium. Numerous casts were ob-
served in situ.
These cases constitute all that I have been able to find
in the literature of the subject. In reviewing them, the
question suggests itself — Was the ether really the cause
of the fatal exacerbation of the kidney diseases which
killed the patients ? The cases of Drs. Sims and Emmet
were all operations on the female genito-urinary organs.
It is a well-known fact that surgical interference with
these organs may give rise to suppression of urine by
reflex influence upon the kidneys, though it is my im-
pression that such a result is more apt to occur in the
male than in the female. The answer that may be .given
to this objection is, that both the reporters are men of
large experience in gynecological operations, and that
Dr. Emmet's statements on the subject imply — although
he does not make any direct statement to that effect —
that he has not met with any corresponding accidents
when he has operated without ether. His strong con-
viction on the subject is certainly entitled to great weight.
Dr. Hutchinson's case, again, occurring in an old, much-
exhausted man, might well be attributed to the general
depressing effect of the ether on a broken-down consti-
tution. The convulsive seizure, however, strengthens
the supposition that un^mia iiad something to do with
the result. This case suggests a way in which ether
might prove indirectly fatal in cases particularly of the
form of disease, i.e., contracted kidney, from wliich this
patient suffered. It is well known that the high ar-
terial tension which accompanies this disease calls upon
the heart for extra exertion, which results in the hyper-
trophy of that organ. .Vs long as the heart can respond
to the demands upon it, the high pressure in the kidneys
enables them to perforin their I'unctions satisfactorily, even
when very much diseased. If, now, the ether depresses the
heart's action, a corresponding diminution of the exertion
March lo, 1883.]
THE MEDICAL RECORD.
263
from the kidneys must result, independent of the direct
irritant effect of the agent on these organs themselves.
The case of Dr. Norris' child, in which death followed
four hours after the use of ether, with symptoms distinctly
pointing to urremia and after a comparatively trivial op-
eration, seems to me to be the most conclusive of the
series, though the child must be supposed to have been
on the brink of a spontaneous outbreak for the fatal
event to have followed in so short a time. Another mat-
ter must be considered in this connection, and tliat is
the recognized fact that the mere shock of the opera-
lion is apt to prove a grave matter for people suffering
from Hright's disease. In reference to tliis subject Sir
James Paget says, in his "Clinical Lectures and Essays : '
" I do not know by how many times the risks of a given
operation are increased in any jjatient who has albumi-
nuria, but I do know that you will find it safe never to
])ertbrm any operation without an acquaintance with the
manner ni which the iiatient's kidneys discharge their
function, and never to [lerform one, except under some-
thing like compulsion on a patient whose urine is con-
stantly albuminous. I do not say that you should never
operate on such a patient, for the exigencies of the local
disease ma)' justify you, as they inay justify you in oper-
ating in advanced phthisis; but be clear that you operate
against heavy odds ; for even if the patient do not die
with erysipelas or pya;mia, or some other form of diseased
blood, he will be apt to linger with a wound half healeil,
till at last he dies of his renal disease, just as if you had
done nothing for him.'' The suggestion conveyed in this
<luotation is applicable especially to the cases re|)orted
by Drs. Hunt and Norris, in the former of which death
occurred in si.xteen, in the latter in eighteen days after
the opeAtion. The depressing effect of an operation, it
must be remembered, depends not a little on the morale
of the ]3atient. A cataract operation in a nervous female
might be quite as serious as a much graver operation in
a phlegmatic male. Dr. Norris recognizes this objection
to the second case and reports one almost similar, in
which death followed a cataract operation, with the im-
portant exception, that no anesthetic was used. On the
other hand, the reflection suggests itself that some of the
cases on which Sir James Paget bases his estimate of the
unfavorable influence ofBright's disease on the results
of operations, may have been cases in which the a/urs-
///(■//(■ was to blame and not the operation. The suppres-
sion of urine in the only two cases of Dr. Emmet's, of
which I have been able to find any detail, resulted fatally
in one case thirty-two hours, in the other three days after
the operation. It is certainly possible that many such
cases may have occurred and the operator may have
failed to recognize any causal connection between the
ether and the fatal result.
That ether has been employed frequently in cases of
Bright's disease Jt'/Mf?/// bad results is certain. Dr. Nor-
ris in his paper mentions two cases, one of which had
been anajsthetized twice, and the other three times by
ether without obvious ill effect. Dr. T. G. Morton, in
discussnig Dr. Hunt's case in connection with a death
from ether in his own practice {American Journal of
the Medical Sciences, October, 1876), states that he has
frequently given ether in cases of albuminuria without
accident. The same is probably true of eveiy surgeon of
large e.xperience. It is not to be denied that the recorded
experience which I have been able to find on the subject
is not entirely conclusive. Nevertheless, I think that the
evidence renders it highly probable that structural disease
of the kidneys furnishes a grave contra-indication to the
administration of ether. Further experience is necessary
before any api)roximate estimate of itsgravity can be made.
The frequent immunity from accident may justify the em-
ployment of ether in such cases under certam circumstan-
ces, but the surgeon certainly ought to be aware of the
risk to which he is subjecting his patient, and ought to
be sure that the advantages to be gained by the use ot
the anaesthetic more than counterbalance its dangers.
REMARKS ON CARDIAC ASPIRATION.
By F. M. CORWIN, M.D.,
NKW YORK.
The subject of canliac aspiration having recently at-
tracted some attention and conuiient in The .Medical
Record, perhaps the following account of a case which
came under my observation may be of interest to some
of your readers :
The patient, a man aged forty, a native of Turkey, was
admitted to Hellevue Hospital, November 2, 1881, in
the service of Dr. Janeway, Dr. VV. C. Stone being
House Physician. Owing to his limited knowledge of
English no history was obtainable. He had a very badly
deformed chest, due to right lateral curvature of the
spine. On admission he was much cyanosed, the face, lips,
and hands being very blue. His res])irations w'ere in-
creased in frequency and labored in character.
His pulse was about 120 a minute, of fair strength but
irregular. There was considerable uidema of the lower
extremities.
Physical examination of the chest gave no evidences of
consolidation of lung. There were numerous subcre-
pitant rales and pleuritic crepitations all over both lungs.
Voice-sounds not sensibly altered.
The heart was pushed upward, the apex-beat being an
inch or more above the left nipple, and the impulse dif-
fused. There was thought to be considerable enlarge-
ment of the heart, but owing to the misshapen chest and
displacement of viscera, that point could hardly be de-
termined with accuracy. The heart-sounds were distinct,
and there was no murnuu'.
He was ordered whiskey and digitalis every two hours
with milk diet. He got some sleep through the night ;
but on November 3d he was still much cyanosed, and if
anything changed, he was weaker than on admission. His
urine was found to be scanty, specific gravity 1015,
reaction acid, and to contain about ten per cent, albu-
men, with large and small fatty and hyaline casts. In-
fusion of digitalis was substituted for the tincture.
About 3 P.M. of this day he was seen by Dr. Janeway,
and the question of hydropericardium being raised, the
needle of a veterinary hypodermic syringe was intro-
duced at a point where there was dulness on percussion,
and but little or no motion apparent on palpation. On
withdrawing the piston, the barrel of the syringe, which
held nearly an ounce, was immediately filled with dark
venous blood, and as the needle had been moved slightly
while in the chest, it was thought the heart had been
penetrated.
There was no change in the condition of the patient
at the time, nor did he afterward develop any symptoms
or physical signs which could be referred to the aspiration.
After this a considerable diaphoresis was brought on
by surrounding the patient in bed with hot bottles
wrapped in clothes wrung out of hot water, aided by
spirits of mindererus and nitre. The cyanosis remained
the same.
On November 4th, it was apparent that he was grad-
ually growing weaker, otherwise there was no change.
Stimulants were increased during the day, but he contin-
ued to fail, and died quietly about 8 p.m., death appar-
ently being due to exhaustion.
Autopsy, November 5th, 3 p.m. — Heart weighed four-
teen ounces, the increase in weight being chiefly due to
hypertrophy of walls of right ventricle, the cavity of which
was much dilated. About an inch from the apex of the
right ventricle was a small ecchymosis, evidently where
the needle had entered. There was no evidence of in-
flammation around it, or in the heart muscle, the ecchy-
mosis being subserous only and not traceable into the
muscle. The valves were normal. The pericardium con-
tained some reddish serum, as did the peritoneum, and
both pleura;. There were no coagula in the pericardium,
and no appreciable difterence between the fluid there and
that in the other serous cavities.
264
THE MEDICAL RECORD.
[March lo, 1883.
The lungs were very small, the lower portions es-
pecially being compressed and in a condition of atelecta-
sis. The remaining portions were cedematous, and the
small bronchi contained some mucus. There were numer-
ous and strong pleural adhesions. Kidneys were much con-
gested and the seat of considerable parenchymatous
change. Capsules were adherent. All the other viscera
were markedly congested, and cellular tissue of depend-
ent portions of body was edematous. On examining the
interior of the thorax after removing viscera, the right
side was found to be much infringed upon, the left side
being much the more capacious. Owing to nearness of
sternal ends of right ribs to spinal column, the liver was
displaced upward and to the left, the left lobe pushing
the Iieart well u[>. The right side dilatation and hyjier-
troph}- of heart was thought to have been due to ob-
structed pulmonic circulation brought about bv the con-
dition of the lungs.
It was the opuiion of those present at the autopsy that
the aspiration had not crippled or injured the heart in
any way.
During my house-service I saw and performed cardiac
aspiration a number of times, where the patient was mori-
bund or the heart had ceased to beat, but I never saw
any benefit resulting from it. 1 have narrated the above
case somewhat in detail, as I believe it shows right ven-
tricular aspiration to be practicable, in some circum-
stances at least, if anything is to be gained by it.
Reports of Itospitals.
THE AXTISEPTIC METHOD IX THE LONDON
HOSPITALS.
(Continued from p. 23S.)
(.\s reported by our London Correspondent.)
London. Januarj- 22, 1SS5.
It is to the antiseptic methods as practised in the hos-
pitals of London 'that we now address ourselves, and
in order to do so it is necessary to revert to what has al-
ready been said, that few London surgeons have taken
the trouble to follow even once or twice the practice of
Mr. Lister in his own wards. As a consequence, there
are many now practising and even teaching surgery in
London who in all good faith profess to treat their pa-
tients " a la Lister." That such persons have every de-
sire to do justice to their patients and to the system is
not to be doubted, but from lack of confident belief in
or knowledge of the minor details, these are neglected,
and the result is disappointing. For example : we have
seen a surgeon in a well-known hospital stand in the way
of the spray for several minutes together, call for an in-
strument from the cupboard, and, without washing it in
lotion, plunge it into the wound and use it for the re-
mainder of the operation. Such a detail seems trivial in
itself, and may jjossibly lead to no bad result, because
the antiseptic material in the wound may be sufficient to
destro\' anything convej'ed on the unclean instrument ;
but the point to be noticed is that this system must not
be hastily blamed if carried out in an ignorant and in-
competent manner. Again, there are others in London
at the i^resent moment who show a sort of unwilling al-
legiance to the system by treating certain classes of in-
juries and operations by all the complete details, while
in other cases they will follow a nondescript antiseptic
treatment, in some cases using one form of dressing and
in some another, but always allowing the necessity of its
being antiseptic. It is certainly a noticeable feature in
Mr. Lister's career that neither argument nor obloquy
has turned him aside from the strict observation of liis
own results, and though he has and still does occasionally
make slight changes and modifications of the details of
his method, yet this is done in strict accordance with
the principle maintained, and one detail is only discarded
because another, which seems to promise better results,
can be substituted in its stead. Of all the details of his
method, the one which he is most ready to discard as not
absolutely essential is the use of the spray ; for it may
be safely said that the danger of organisms entering by
the air is the least of all those which are likely to arise
in an operation, and if they do obtain access, they can
be destroyed by washing the wound with an antiseptic
lotion ; and it must be remembered that for many years
Mr. Lister worked without the spray and obtained good
results, and the results which have been published by the
late Mr. Callender, at St. Bartholomew's Hospital in
London, and by Wendlenberg in Germany, show that
the spray is not the most vitally essential element in the
svstem ; but, on the other hand, there is the fact that
tile author of the system is unwilling to relinquish its
use, and this doubtless from the fact that he expects less
immunity from danger by any other plan.
To answer the question, therefore, as to what have
been the results of the antiseptic system on the surgery
practised in London hospitals, two facts must be re-
garded. First, the question of general results, and, sec-
ondly, that of new operations which have been rendered
justifiable by reason of the greater immunity which at-
tends them. The first is really the smaller question, and
is most easily and satisfactorily answered. There can be
no doubt that the mortality from operations and from in-
juries has become, in a very considerable degree, dimin-
ished. Pyremia, erysipelas, difluse cellulitis, which a few
years ago were only too rife in all our hospitals, are rare,
and daily are becoming more scarce. Speaking of one
of the largest, most wealthy, and best conducted hospi-
tals in the metropolis, situated in the most ooen and
healthy part of London, we can remember that fifteen
or even less years ago pyasmia and erysipelas were rarely
absent from the wards, while at the present time they
are so seldom seen that their occurrence is a matter of
surprise and consternation among the authorities. Not
that in this institution the practice of aseptic surgery is
by any one individual strictly carried out, but the teach-
ing of Mr. Ivister's principles has had such an effect in
causing attention to be paid to details and to the neces-
sity of some antiseptic precautions being taken in regard
to ever\' wound that the cases of septic poisoning are re-
duced to a very small number — a number which is ca-
pable of still further diminution.
With regard to the second, it must be remembered that
many operations have of late years been introduced into
practice which before antiseptic surgery was carried out
would have been condemned as unjustifiable. Such, for
instance, are the operations for the correction of deform-
ities of the long bones of the limbs, or the many expedi-
ents which have been resorted to for remedying the de-
fects in germ valgum, not to mention the very numerous
procedures in which the abdominal cavity has during the
last few years been opened. In all these operations the
spray and antiseptic treatment are almost generally used
by London surgeons with a very few exceptions, and
this fact is a silent but impiortant tribute to the extra
amount of safety which it is considered is given by this
method. In the operation for curved tibia;, for example,
a large number of cases have been treated during the
last few years, with only one fatality, at the Children's
Hospital, while as a contrast between the jiresent and
the past it is curious and interesting to reflect that the
operation had been occasionally performed in former
years by one of the surgeons, but had been desisted from
on account of the risk and danger to the patient.
Again, in abdominal surgery, the Master of Ovariotomy,
Mr. Spencer Wells, has given the strongest testimony in
favor of the aseptic treatment, and has shown that since
adopting it his results have eclipsed all that preceded.
His successor, Mr. Thornton, at the Samaritan Hospital,
was a pupil of Mr. Lister's in Edinburgh, and is naturally
a firm believer in his doctrines, though it nuist in justice
be stated .that his colleague, Dr. Bantoch, has obtained
I
March lo, 1883.]
THE MEDICAL RECORD.
^65
very satisfactory results by a course which discards the
s|.iray and the form of dressing recommended by Mr.
Lister.
Mr. Savory, of St. Bartholomew's Hospital, is no con-
vert to the aseptic treatment, and his views were ably
and eloquently expressed in the meeting of the British
Medical Association held at Cork three years ago. He
endeavored to show that by cleanliness alone the re-
sults obtained at the hospital to which he is the senior
surgeon were as good as could be claimed by the ad-
vocates of the antiseptic theory. Among the deaths,
however, which took place according to the report pub-
lished by the Surgical Registrar for the year following
this address — namely, iSSo — there were 45 deaths occur-
ring after 619 operations, large and small (74 were for
phimosis and 25 were tenotomies). Of these 9 were
caused by pyajmia and 4 from erysipelas, and this in a
hospital with the most favorable surroundings which can
be given by a liberal administration with an almost
boundless fund at its disposal.
The practice of the other surgeons at this the largest
of our metropolitan hospitals and schools varies some-
what according to the circumstances of the case. While
some are careful and thorough followers of the system
under discussion, others use it only in the more severe
and perilous cases. Mr. Atornas Smith is one of the lat-
ter category, using it in all operations on the abdomen
or upon joints, while he has of late used all the other many
antiseptics which have been advocated in the treatment
of ordinary cases and wounds of minor danger and im-
portance. The principal of these are eucalyptus oil,
carbolized wool, iodoform, and wool saturated with this
material, boroglyceride, and many others. This latter
agent has been used for some time at St. Bartholomew's,
and was advocated during the past year by a surgeon
to another hospital in one of his medical papers, on the
strength of some half dozen cases which had done well
under its use. We have, however, seen at least one fatal
case of erysipelas occurring when this form of dressing
was used after amputation of the breast, and are dis-
posed to think less well of it than of many other materials
which are in use for the same purpose.
St. George's Hospital, the school of Brodie and Hun-
ter, is perhaps the most conservative of all as regards its
treatment of surgical cases, but that an improvement is
callable of being eft'ected in the results of au)putations is
shown by statistics published by Mr. Holmes in 1874,
which analyzed the last live hundred cases of amputation
•and showed a mortality of 158, or 31 per cent. The last
•two hundred amputations which were performed between
the years 1866 and 1874 — the years during which Mr.
Lister's treatment was under discussion — 75, or 37.6
per cent., ended fatally. With the exception of Mr.
Holmes, who has discarded the general use of the
aseptic system except in operations upon joints and
others involving serious risk, no one at this hospital
follows systematically the treatment under discussion.
On the other hand, some attempts have here been
made to improve upon the materials used, and wuh
this object sulphurous acid spray was tried, but the
results were not encouraging. Speaking generally of the
treatment followed here, it may be said that antiseptic
lotions are freely used, principally carbolic, and wounds
are dressed either with gauze and protective or with car-
bolized wool, but as the surgical reports have not been
published, no conclusion can be arrived at as to any im-
5)roveinent in results obtained.
One proniment London surgeon, Mr. Jonathan Hutch-
dnson, of the London Hospital, has continued a line of
treatment of his own, and has not been carried awa)' into
any deviation from it by the many more recently advo-
'Cated. The wound, after hemorrhage has been arrested,
is washed out with pure spirit ; drainage-tubes are then
arranged at the most dependent part and the wound is
stitched iii|i. Thin compresses, soaked in a lotion coni-
juofifid of sbc parts of absolute alcohol, a half part of liquor
plumbi, and sixteen parts of distilled water, are then ap-
plied, and are kept moist by ah irrigator. Thus by using
per drainage he follows the principle of Mr. Lister, but
differs from him in abolishing the use of the spray and in
substituting a different lotion, which is, by virtue of the
alcohol, a distinct and satisfactory antiseptic.
It is difficult and indeed almost impossible at the pres-
ent moment, when the opinions of surgeons are so greatly
at variance, and are undergoing so great a reaction from
those held and taught but a few years ago, to describe
and individualize the treatment followed by different ])er-
sons at the more prominent institutions in London, but
it is not invidious to state that what may be seen in
London hospitals is a fair interpretation of the general
views of surgeons throughout this country, and a sketch
has already been given of the extent to which the exact
acceptance of the antiseptic treatment of wounds has
been received. At every hospital there are one or
more who have given it every chance which faithful
observance and careful following can require, and the
fact that their seniors and colleagues are willing to
follow it in those critical and severe operations on parts
in which septic poisoning is most to be anticipated does
not weigh against it, but inclines, on the contrary, to
show an unwilling acceptance of its value. The dangers
and inconveniences attending the use of carbolic acid as
a lotion have been shown to be due to a want of prop-
erly appreciating the way in which it should be applied ;
for it must be carefully remembered that the use of the
protective is solely to avoid the contact of carbolic acid
with the wound, and that where any antiseptic is used
upon an open surface some other material which is
proved innocuous has to be employed, such, for instance,
as salicylic acid, boracic acid, etc. Among other mate-
rials which have not been already mentioned in the pres-
ent article as having had their fair trial are eucalyptus
oil, which has been used as spray as well as for a dress-
ing, salicylic wool and jute, thymol, and many others.
What, then, we may well ask, are the results of this new
doctrine as aftecting the treatment now pursued in Lon-
don, when compared with that followed by surgeons be-
fore its introduction some twelve or fifteen years ago ?
Firstly, the answer comes, a very greatly improved rate
of mortality in all severer cases of operative and acci-
dental wounds, and secondly a very widely extended
field, which is daily on the increase, of operative meas-
ures, since they can now be undertaken with so much
greater an immunity from disaster. The surgical records
of our hospitals, the medical press, and the transactions
of the various societies tell daily of recoveries from acci-
dents and injuries which we were taught to regard in
former years as inevitably fatal, and record operations of
which our predecessors never dreamt of even proposing,
but which are now performed with a percentage of mor-
tality which is truly astonishing.
One collateral reason for this imprcjvement is, no doubt,
the better understanding of and the stricter attention to
the hygienic surroundings of our patients, and another is
the very great improvement in the class and education of
our nurses. But, these apart, the details of surgical
treatment are the main factors in the advance of the sci-
ence, and of these none is of greater importance and none
has done more to improve results than the appreciation
and use of drainage. Whatever be the means resorted to
of dressing wounds, almost every surgeon now looks to
the careful drainage of all cases in which there is a possi-
bility for the collection of any fluids, whether he uses india-
rubber tubing, horse-hair, catgut, or decalcified bone. A
stricter attention to cleanliness is also universally practised,
both in the cleansing of the wound itself, usually by some
antiseptic, and of all that comes in contact with it,
such as the hands, the sponges, and the instruments.
Then, too, in some form or other, antiseptic dressings are
almost invariably applied, and this, with the use of drain-
age, necessitates a less fretjuent disturbance of the wound,
which alone is of powerful influence in promoting its
266
THE MEDICAL RECORD.
[March lo, 1883.
speedy union. These means permit also of tlie more close
approximation of the surfaces, and by securing their ab-
solute rest and freedom from disturbance, allow nature
more opportunity for performing her share of the work.
It will be seen, then, that we have in the above en-
deavored to show some of the influences which are at
work in London, and in England generally, to improve
the results of surgery. The jirogress in the last few years
has been of marvellous rapidity, and it still continues to
advance, but this is not an unfitting time to review the
past with the [iresent, and some ideas on the subject are,
it is confidently hoped, set forth in the pages of this
article.
^voovcss of l^accUail J>cicncc.
The Uselessness of Styptics. — In a paper read be-
fore the Philadelphia County Medical Society, Dr. J. B.
Roberts {Pliiladdphia Medical Times, January 27, 1883)
argues with nuich force against the use of styptics in
general surgical practice. He states his objections to
their employment in the following propositions : i.
Their reputation as hajmostatic agents leads practi-
tioners to resort to them when more trustworthy methods
are needed. Thus valuable time is lost, for, after tem-
porary arrest, the hemorrhage recurs in the already anremic
patient, and is perhaps followed by disastrous results. 2.
If they fail to control the bleeding — which they generally
do if the hemorrhage is important — it is often so diffi-
cult lo rid the surface of the pasty clots that subsequent
ligation of the vessels is well-nigh impracticable. 3. Many
styptics prevent union by first intention, because they irri-
tate the raw surface, lead to inflammation, or induce
suppuration.
He says, further, that Monsel's salt — the subsulphate of
iron — has jirobably more reputation than any other
styptic, yet it is the most objectionable of all. It covers
the wound with black, sticky clots, which obscure fur-
ther examination of the surface, prevent primary union,
and may even allow bleeding to occur beneath them. I
have seen such leathery masses of coagulum raised up
into vesicles by the subjacent hemorrhage.
There are but two scientitic and satisfactory ways of
arresting hemorrhage as usually observed in the practice
of general surgery : i. The first is occlusion of each
individual vessel by ligation, torsion, or acupressure, and
is generally not required for arteries smaller than the
facial, nor for veins, except those of the largest calibre.
2. The second method is direct pressure by compresses
and bandages, which, if properly applied, will always he
effectual when the first method is not demanded. It is
to be adopted when there is oozing from small arteries
and capillaries.
In all cases of traumatic hemorrhage, it should be re-
collected that a man can lose many fluidounces of blood
without serious injury, and also that no artery or vein
can bleed if it is compressed by the fingers. These
facts assure the surgeon that there are always time and
means to control the bleeding, at least temporarily.
Many arteries that spurt freely when first divided soon
spontaneously stop bleeding. Therefore it is foolish to
interrupt the steps of an operation by ligating every
little vessel that throws out a jet of blood. Let the
surgeon proceed, even if the arteries are quite large, and
when he has finished his incisions he will find, to his
suri)rise, very few points requiring ligatures. He should
ligate these, and, after washing away the loose clots,
make moderate and equable pressure. There will then
be no part for styittics to play. It is possil)Ie, perhaps,
that there may be occasional instances of oozing where
jiressure cannot be efiectually ajiplied ; but these are
certainly so rare that they do not materially affect the
truth of the proposition that styptics are useless.
The Use of the Mullein Plant in the Treat-
ment OF Pulmonary Consumption. — Dr. Quinlan, of
Dublin, observes that from time immemorial the verbas-
cum thapsus, or great mullein, has been a trusted popu-
lar remedy in Ireland for the treatment of phthisis. After
relating some cases where it proved of benefit, he con-
cludes : "These cases although too few to justify any
general conclusion, ajipear to establish some useful facts.
The mullein plant boiled in milk is liked by the patients ;
in watery infusion it is disagreeable, and the succus is still
more so. The hot milk decoction causes a comfortable
sensation, and when once patients take it they experience
a physiological want, and when the supply was once or
twice interrupted, complained much in consequence.
That it eases phthisical cough there can be no doubt ; in
fact, some of the ]xatients scarcely took their cough-mix-
tures at all — an unmixed boon to phthisical sufferers with
delicate stomachs. Its power of checking phthisical
looseness of the bowels was very marked, and experiment
proved that this was not merely due to the well-known
astringent properties of boiled milk. It also gave great
relief to the dyspncea. For phthisical night-sweats it is
utterly useless ; but these can be completely checked by
the hypodermic use of from the one-eightieth to one-
fiftieth of a grain of the atropia sulphate ; the smaller
dose, if it w'ill answer, being preferable, as the larger
causes dryness of the pharynx, and interferes with ocular
accommodation.
"In advanced cases it does not prevent loss of weight,
nor am I aware of anything that will, except koumiss..
Dr. Carrick, in his interesting work on the koumiss treat-
ment of Southern Russia (page 213) says : ' I have seen
a consumptive invalid gain largely in weight, while the
disease was making rapid progress in her lungs, and the
evening temperature rarely fell below loi" Fahr. Until
then I considered that an increase of weight in phthisis
pulmonalis was a proof of the arrest of the malady.' If
koumiss possesses this power, mullein clearly does not ;
but unfortunately, as real koumiss can be made from the
milk of the mare only, and as it does not bear travelling,
the consumptive invalid must go at least to Samara or
Southern Russia. In pretubercular and early cases of
pulmonary consumption, mullein apiiears to have a dis-
tinct weight-increasing power. In early cases, the mullein
milk appears to act very much in the same manner as-
cod-liver oil ; and when we consider that it is at once-
cheap and palatable, it is certainly worth a trial." — Brit-
ish Medical Journal, January 27, 1883.
Intercurrent Pleurisy in Heart Disease. — Dr.
Bucquoy has observed a number of cases of pleurisy oc-
curring in the course of heart disease. He states that
notwithstanding the weakened condition of the patients
consequent upon the prolonged cardiac trouble frequently
associated with albuminuria, the inflammation presents
all the characteristics of subacute idiopathic pleurisy,,
and is entirely distinct from hydrothorax. It usually
pursues a favorable course, ending after a variable dura-
tion in a cure with resorption of the eftusion. The treat-
ment should be that followed in ordinary ])leurisy. It is,
however, desirable that a cure be obtained as speedily as
possible, because of the embarrassment of the already
enfeebled heart by the pleuritic eftusion. Consequently
the author advises an early thoracentesis in all cases in
which the absorption of the fluid is delayed. Especially
should this be done if dyspncea or other urgent cardiac
symptoms be present. — La France Midicale, November
30, 1882.
Uterine Movements. — In formulating the results of
a large number of experiments made upon rabbits. Dr.
Frommel states that the uterus undergoes regular rhyth-
mical contractions. These contractions occur in all
stages of uterine development, though they are more
regular in pregnant animals or in those which have pre-
viously borne young. The movements are slowed by a
low tem[)erature, and quickened by a slightly increased
i
March lo, 1883.]
THE MEDICAL RECORD.
267
one; but a high temperature (103° F. or more) abolishes
them. Circulatory disturbances exert a marked influ-
ence upon the contractions. Compression of the aorta
causes them to cease within a very short time ; that of
the vena cava produces the same eflect after a longer
period (fifteen to thirty minutes). The author states that
the uterine contractions are independent of any nervous
centre situated witiiout the organ itself, though, of
course, they may be modified by impulses received from
the cerebro-spinal centres. — Centralhlatt fiir Gyniiko-
logie, November 25, 1882.
Extirpation of the Gall-Bladder. — Ur. Carl l,an-
genbuch reports the following case in the Berliner
KHnische Wochenschrift of November 27, 1882 : A man.
forty-three years of age, had been suffering for six years
with repeated attacks of bilious colic. They recurred
with increasing frequency until, at the time of the patient
coming under observation, they came on usually twice
a day. The pain was intense, and increasing doses of
morpiiine were taken to relieve it. The jiatient was
emaciated and weak, had no appetite, and suft'ered from
constipation and constant nausea. It was determined to
remove the gall-bladder. A T-shaped incision was made
at the outer border of the rectus muscle, and the cystic
duct was first ligated. The bile was then withdrawn by as-
jiiration, and the gall-bladder removed. On the morning
following the operation the patient was found sitting up
in bed smoking a cigar. He went on steadily to recovery,
complaining of nothing but a ravenous hunger, and in
twelve days left his bed. In six weeks the patient gained
thirty pounds in weight. Four months later he reported
himself entirely free from pain, in excellent general
health, and completely cured of the morphine habit
which liad been acquired during the last year of his suf-
ferings.
Influence of Continuous Cold upon the Deeper
Tissues. — Dr. Bayer formulates the following conclu-
sions from an elaborate series of experiments made upon
dogs : I. Local abstraction of heat causes a cooling ot
the neighboring and underlying organs and tissues. 2.
The lowering of the temperature of a part is less marked
the more distant it is from the cooled surface. 3. The
heat-losing property of a given tissue is in inverse \>xo-
portion to its vascularit)'. 4. The local cooling an-
nounces itself by a more speedy fall of the general tem-
perature. As a practical application of his researches,
he states that ice-water should not be used as a hemo-
static, since the contraction of the vessels depends u])on
a continuous api^lication of a moderate degree of cold
rather than upon that of a very low degree. He does
not, however, deny the efficacy of ice applications in
bruises and subcutaneous injuries ; but he states that in
these cases the deeper tissues do not attain the same de-
gree of cold as when ice is applied directly to the bleeding
vessels. They receive only the proper degree of con-
tinuous cold to insure the contraction of the blood-vessels.
The value of local cold applications in inflammations is
thus explained : The direct cooling of the tissues de-
presses their activity. The vessels being contracted, the
migration of white corpuscles is restricted, the general
temperature is lowered, and the heat centre is depressed
by reflex influence. — Zeitschrift fl'ir Heilkuiide, Novem-
ber 15, 1882.
Parasites in American Pork.. — From an investiga-
tion into the parasites in the pork-supply of Montreal,
Dr. Osier concludes : i. That the hogs slaughtered for
our markets present parasites in numbers sufficient to
necessitate a more thorough inspection than is at present
earned out. 2. As regards trichina spiralis, which was
found in the proportion of i to 250, he is of opinion that,
considering the extreme rarity of cases of trichinosis, and
the difficulties attendant upon a s)steniatic inspection, a
compulsory microscopic examination of the flesh of every
hog killed is not at present called for. 3. In the case of
"measles," the liver should be carefully examined, and
if present in it, the flesh of the animal should receive the
special attention of the inspector ; if only in the liver,
the entire carcass need not be confiscated. 4. Echino-
coccus cysts in the liver render that organ unfit for food,
but in other parts, unless very numerous and disorganiz-
ing, they may be cut out, and the carcass remain market-
able. 5. The iniblic should be made aware of the pos-
sible dangers of eating, in any form, raw or ])artially
cooked meat. The best safeguard against parasitic affec-
tions is not so much inspection of the flesh, unless, in-
deed, this is minutely carried out, as careful attention to
culinary details. 6. To reduce the number of infected
hofs, greater attention should be paid to their hygienic
surroundings, particularly in tlie matter of feeding. The
danger is not during the period when the animals are
penned and fed on grain, etc., but when they are allowed
to roam at large and feed indiscriminately.
Treatment of Buro. — Dr. Hermann Kiimmell em-
ploys a dressing of bichloride of mercury after the extir-
pation of an inguinal bubo. He removes the whole
group of glands, and not merely those that are affected.
After the extirpation of the glands the wound is thor-
oughly dried with siwnges, drainage-tubes being inserted
into the deeper pockets, if necessary. The edges of the
wound are then approximated by sutures, except for a
short space at the lower edge, which is left open for
drainage. The surface over the wound cavity is now
covered with pads of gauze soaked in a bichloride solu-
tion, or with little ash bags, one or two larger bags being
placed over all. P'irm jiressure is then made with a
roller bandage. After eight or ten days the dressing is
removed and a second one applied, if necessary. Dis-
turbance of the wound by flexion of the thigh is prevented
by a short splint extending from the anterior su[)erior
spine of the ilium to the middle third of the thigh. Where
an ulcer lias already formed, the infiltrated parts are re-
moved by the scissors and the sharp spoon, and the ca-
vity is filled with sand wet with a solution of the bichlo-
ride, and covered with a few layers of gauze. Should the
discharge be sufficient to saturate the outside dressing,
this is removed and fresh gauze applied. The sand, how-
ever, is not removed, but is wet again with the solution.
Dr. Kiiiumell claims excellent results in the treatment of
bubo by this method. In cases where the skin is still
sound, he says that union by first intention is usually ob-
tained, and where ulceration has occurred, the wound
heals rapidly by granulation with a very moderate amount
of suppuration. — Centralblait fur Chirurgie, December
30, 1882.
HVPERIDROSIS OF THE .\XILLA IN THE NuDE SUCJECT.
— Dr. Aubert reaches the following conclusions {Annales
lie Dermatologie et de Syphili graphic, December 25,
1882), from a study of this phenomenon in a large num-
ber of individuals : I. Axillary hyperidrosis is almost al-
ways present in nude subjects. 2. This is so great in
many instances that streams of perspiration may be ob-
served running down the body and inner side of the arm.
3. The chief cause of this phenomenon seems to lie in
the anatomical disposition of this region permitting of a
local elevation of temperature, while that of the general
surface is lowered by the surrounding atmosphere. 4.
This local elevation in a number of instances amounted
to nearly 1° F. 5. Various facts lead to the supposition
that this elevation of temperature finds in the glands of
Robin an organ favorably disposed, by its innervation and
structure, to the reception of thermic influences. 6. The
mental effect produced by nudity and examination may
aid in causing an increased secretion, but it plays a very
subordinate role in the production of this phenomenon.
The Legal Relation between Doctor and Pa-
tient.— No binding agreement can be made between-
the patient and the doctor in Paris, as the patient is not.
regarded legally as a free agent. — Detroit Laneet.
^68
THE MEDICAL RECORD.
[March lo, i88c
The Medical Record
-A Weekly yonr)ial of Medicine and Surge)y.
GEORGE F. SHRADY, A.M., M.D., Editor.
Published by
'WM. WOOD & Co., Nos. 56 and 58 Lafayette Place.
New York, March lo, 1883.
THE INFLUENCE OF THE THEATRE UPON
THE PUliLIC HE.-VLTH.
As long ago as 1856 an elaborate essay upon the re-
lations of the theatre to tlie public health was written by
M. Bonnaire of Paris. The author was at the time justly
criticised for his extravagant denunciations of play-houses,
which, e.xcepting the opera, he considered to be little
better than pest-houses in their influence upon the human
body. Since Bonnaire' s day occasional comments have
been made upon the subject, but it has hardly received
the consideration which it deserves. Artistic and moral
■questions are those which the drama chiefly excites.
Our attention has been called to the subject now, how-
ever, by a number of instances communicated to us, which
show, if that were needed, that the theatre bears a relation
of no inconsiderable importance to preventive medicine.
It is not the question of protection against tire, which
especially concerns the sanitarian. Even the results of
sitting for two or three hours in over-heated and ill-ven-
tilated halls, or of passing from these, while thinly clad,
into the open air, are of a minor importance and do not
-concern us now.
The influence of theatre-going upon the young and im-
mature of our cities is a matter, however, which does claim
thoughtful attention. We venture to state most positively
that this influence is bad. With a nervous system still
■unformed and unstable, the excitement of the melodrama
-or tragedy, the late hours, the precocious ideas, the dis-
torted and often false notions of life arid character pre-
sented, all tend to act injuriously both upon mind and
i)ody. In the larger cities there is always among the bet-
ter classes a great number of silly stage-struck girls, whose
■nervous system, already unstable, is made more so by a
iXondness for theatre-going, or a secretly nursed ambition
•to become actresses themselves. Occasionally these city
aiiaidens become affected with a passion for a particular
artist, which develops into an epidemic. Witness the pop-
ularity of an actor, not long deceased, of only moderate
abilities, but of more than ordinarily pleasing appearance.
"The abnormal devotion which he excited was strictly
K;omparable, though less grotesquely accentuated, to the
•dancing epidemics of the middle ages. That such per-
versions and exaggerations of youthful emotion may excite
hysteria, chorea, and a varied train of morbid nervous
symptoms was the claim of M. Bonnaire, and may be in
part allowed.
Among the humbler classes who attend the spectacular
and nuirderous melodramas, or the licentious variety
shows which make up the programmes in cheaper resorts,
similar pernicious effects follow. We do not speak of
the moral side, but only of the physical. The premature
excitement of the sexual passion, the unhealthy stimulus
given to the emotions and the imagination react upon the
body.
It is quite universally agreed that stimulants injure the
young and immature in a special degree. Remembering
that the drama is a psychical stimulant and often one of
great intensity by very poor quality, parents and perhaps
even the State should be called upon to be careful how
indulgence in it is allowed.
THE CAUSE OF TISSUE-METAMORPHOSIS.
There are a good many pathological theories which
have a certain intellectual value quite apart from any
more solid merits. The ingenuity of argument and elab-
orate collation of facts often shown stimulate the atten-
tion, at least, and furnish, perhaps, a little useful mental
discipline.
Professor Schmiedeberg has given to the medical world
an ingenious hypothesis, regarding which the foregoing
remarks are pertinent. This gentleman has been for
some time industriously studying the nature of tissue me-
tamorphosis, or, in the learned nosology of modern
science, metabolism.
The process by which the changes of formed tissue
{e.g., muscle, gland, nerve, etc.) into excrementitious pro-
ducts takes place has long been the object of scientific
inquiry. Professor Schmiedeberg claims to furnish us
with a part of the solution. He shows first of all that
when certain aromatic bodies, like benzol, are mixed
with alkaline fluids or blood, only a slight amount of
oxygenation takes place. When, however, these sub-
stances mixed with blood are sent through an isolated
gland like the kidney or the lung, oxygenation takes
place nearly a thousandfold more actively. From this
and other facts he concludes that the tissues have a special
action on oxidizable substances, rendering them able to
take u]) that element actively from the blood. It is right,
therefore, to expect that certain substances can unite
with o.xv'gen in the blood very actively by virtue of the
tissue action about them — which action may be attributed
to a ferment.
The exact significance and luminousness of this dis-
covery are not so very apparent. A further series of ex-
periments, however, with nitrogenous substances resulted
in a discovery which, if corroborated, has a much more
practical bearing. The decompositions of nitrogenous
bodies in the system are due, says our investigator, to
the presence of an unformed or soluble ferment, which
he calls " histozyme." This ferment he has separated
from a glycerine extract of pig's kidney by precipitation
with alcohol. It is assisted in its decomposing actions
by the presence of the oxygen in the blood. As an ex-
ample of its effect a solution of benzylamine in blood,
passed through the kidney of a dog produced benzoic
acid. Without the histozyme, this effect cannot be pro-
duced. The chemical change is thought to be as fol-
lows : the benzylamine is turned by the ferment into
benzyl alcohol and ammonia, then the o.\ygen of the bloocl
March lo, 1883.]
THE MEDICAL RECORD.
,269
unites with the former to make benzoic acid, while the
carbonic acid unites with the ammonia to form urea.
The practical side of this supposed discovery lies in
the relation of the histozyme to the production of fever.
\\'hen a solution of it is injected in large cpiantities into
a dog, it causes malaise and rise of temperature. Pro-
fessor Schmiedeberg thinks that some febrile conditions
are caused by an excess of the ferment in the body.
The relation of the ferment to such diseases as gout
and rheumatism is naturally suggested.
Further experiments in substantiation of the claims for
the histozyme are being made, and they are, we confess,
much needed.
FORENSIC MEDICINE.
Is an inaugural address recently delivered liy Clark
Bell, Esq., before the Medico-I.egal Society, some in-
teresting facts are given regarding the condition of
medico-legal science in P'.urope and America. There
are, we are told, only two scientific bodies in the world
devoted entirely to the study and discussion of medico-
legal topics. These are the Medico-Legal Society of
France and that of New York. A tliird society is, how-
ever, soon to be organized in Italy, and a fourth has
recently been organized in this city.
As to the general condition of forensic medicine, it
appears that the existence or not of definite organiza-
tions is not a strict measure of scientific work in difl'er-
ent countries. Great Tiritain, for example, although
without a society or a journal, has had some eminent
writers on forensic medicine, prominent among these
being Woodman, Tidy, Guy, Taylor, Husband, and
Winslow. Germany, also, as regards actual work, leads
all other civilized countries, and indeed contributes as
much as all others combined. Of a series of works on
poisons, numbering 152, 100 were written by Germans,
33 by French, and 19 by English speaking authors.
Among 498 other contributions to the science in (jues-
tion, 319 were by Germans. Of late years, however, the
number of articles by French, English, and American
authors has very greatly increased.
The importance of medico-legal knowledge is recog-
nized much more fully in many European countries
than it is in America. Chairs for its teaching exist in
many, if not all of the medical colleges, and in some of the
legal schools in Europe. France appears to be at present
most active in discussing the science, and disseminating
a knowledge of it by means of official bulletins, journals,
volumes of transactions, and society discussions.
America has shown an increasing interest in medico-
legal subjects. The Medico-Legal Society of Massachu-
setts, organized not long ago, consists chiefly of medical
examiners appointed by the Governor under the new
law abolishing coroners. This body, though it has not
published officially any scientific contributions, is likely
to give an impulse to forensic medicine.
There is, undoubtedly, all over the country a growing
interest taken in questions relating to insanity and the
commitment and care of the insane than ever before.
The New York Medico-Legal Society has had an addi-
tion of nearly one hundred members during the past
year. Its library has also been increased by the addi-
tion of 564 pamphlets and 376 volumes. The continued
growth of this society and the organization of others-
seems inevitable. For every doctor, whether specialist
or not, is liable to be called upon the witness stand, and
thus be forced into an active interest in some branch of
forensic medicine.
The New York Society proposes several undertakings
which are likely to prove of great value. One of these is
the securing translation and [lublication of foreign medico-
legal works ; another is the inviting of all superintend-
ents of hospitals, asylums, prisons, charitable institu-
tions, nuuiicipal boards, judges, district-attorneys, and
others to communicate to this Society cases involving
medico-legal questions. This plan has been adopted,
with success in France. Lastly, it is proposed to publish
a medico-legal journal, which shall be the organ of the
Society and contain its papers and proceedings. As-
there is no journal devoted entirely to medico-legal
science in the world, it is thought that such a publica-
tion would meet wide support in both the legal and
medical profession.
THE PANCREAS IN FEVER.
It is well known that disturbances of the digestive secre-
tions take place in fevers, and these changes, so far as the
stomach and salivary glands are concerned, are tolerably
well known. Dr. S. Stolnikow has recently made a series
of investigations into the condition of the pancreas in
fever, and his observations form a noteworthy contribu-
tion to the pathology of febrile conditions.
His experiments were made upon dogs with permanent
artificial pancreatic fistulre. It was first found that these
animals, in normal condition, secreted from 27 to 30 c.
ctm. of pancreatic juice in the first two hours after a meal ;.
and that then the secretion fell to about i to 2 c.ctm. per
hour. Artificial fever was then produced in nine dogs by
injection of septic fluids, and in two cases by inclosing
the animals in hot boxes. It w^as observed that regularly
after the injection there was an enormous increase in the
pancreatic secretion for about two hours, the amount
being from 70 to 79 c.ctm. (about 3 iiss.) per hour; then.
a change took place. The secretion rapidly diminished,
and finally comiiletely ceased. It was found, therefore,,
that in fevers there is at first a short increase, then a
complete stoppage of the secretion of the pancreatic
gland. This stoppage was not influenced by the taking
in of food. We are not told how long the fever and its-
attendant pancreatic disturbance was kept up. It is not
likely, however, that, in a prolonged fever of many days,
the pancreas continues entirely inactive, but only that
the general effect of the febrile condition is to lessen very
materially the activity of this gland, just as it does that
of the parotid and those of the stomach.
Stolnikow made some experiments in order to deter-
mine the nervous mechanism of the phenomena in ques-
tion. His conclusion was that the septic poison (and
probably also the heat) acted first as a stimulant to the local
nervous ganglia which excite secretion, and that it then
paralyzed them. In this latter action it resembled atropine.
Our investigator found that the ferments of the pancreas
were present in the gland during fever, although they
were not carried off in the secreted fluid. He also found
that they were present in quite varying amounts, and
270
THE MEDICAL RECORD.
[March 10, 1883.
concludes from this that the manufacture of each of the
three ferments is under a difterent nervous control.
The practical suggestion which he offers is that possibly
pilocarpin may be given with benefit in fevers, on account
of its stimulating properties upon the pancreas.
BEER .JiXD INEBRIETY.
In the January issue of the Journal of Inebriety is an
editorial article which strongly protests against a preval-
ent view that beer and light wines may be safely substi-
tuted for the stronger alcohols. Many persons who be-
lieve in temperance, but not in teetotalism, have held the
opinion that, in this country, the introduction of malt
liquors and table wines would satisfy the demand for al-
cohol without causing a serious amount of disease and
vice. This theory, we are now told, is without support
in facts. In Germany, for example, the consumption of
brandy and whiskey has been steadily increasing since
1S37, and in 1881 it was double the amount per capita
to that in England or the United States. There has
been also an increased demand for strong drinks in
France. In this country the use of beer has increased
far beyond that of distilled liquors. We are not allowed
to draw comfort from this fact, however, bat are told
that inebriety is increasing at a greater rate than the
population, thus showing that beer has no apparent
beneficence.
The statements of our contemporary deserve much at-
tention. The facts given, however, are far too few to
establish the point claimed. The increased demand for
stronger alcohols is often due to the stress of modern life.
Certainly, a community that drinks malt liquors is safer
than one which depends on whiskey for its stimulus. It
would be better without either, but humanity is frail, and
we must study it as it is.
QUACKS IN NEW YORK .^ND LONDON.
The Medical Press and Circular a short time ago made
some comments upon our editorial regarding " Quackery
in Missouri.' Our contemporary first iiemoaned the sad
state of affairs in Missouri, then transferred its melan-
choly and disapprobation to the whole United States, in-
cluding especially New York. The logical process in
the sympathetic and cosmopolitan mind of our esteemed
contem|>orary was as follows : Missouri is a quack-ridden
State, therefore New York and all the United States are
the victims of a pestilent and utterly utter charlatanry.
Now, we trust that it is not merely a narrow and local
prejudice which makes us protest against these conclu-
sions on the part of the Press and Circular. We think
it should really be known, for instance, that Missouri is
half a continent from New York geographically, is gov-
erned by different medical laws, and is under somewhat
different social conditions. We make no unfair insinua-
tions against Missouri, which is a robust commonwealth,
and one that contains many eminent and rei)resentative
physicians. But it really is a very difterent place from
New York and many other States, so far as quackery is
concerned. The New York law compels every practis-
ing physician to have a diploma, whicii diploma is always
an evidence of some medical education at least. We
cannot boast that our Slate has been so purified of char-
latanry as Illinois, or that there are not other States
whose medical status is as good or better. But we are
quite sure that London has as many quacks as New
York, where the registration law is sharply enforced, and
that the wholesale charge that the United States is piti-
fully quack-ridden is quite untrue.
THE TENTH CENSUS .A.ND THE PROFESSIONS.
The "Compendium of the Tenth Census" furnishes
some facts regarding the professions of our country.
The total number of physicians and surgeons in the
United States in 1880 was 85,671, of whom 2,432 were
women. The number of lawyers was 64,137, of whom
75 were women, and the number of clergymen was
64,698, of whom 165 were women.
The following table shows that of foreign countries
Germany contributes most to our profession, England
and then Ireland following. The clergy are mostly sup-
plied from foreign sources, while medicine ranks next.
Profession.
United
States.
Ireland.
Germany.
Great
Brit.' in.
77,092
60,342
51.967
1
1,021 2,640
i,ooS 791
2,516 4.301
1,748
94S
2.589
Lawyers
Clergymen
As Germany contributes about one-seventeenth of all
gainful occupations, the number of German physicians
is not disproportionately large. The same may be said
of Ireland and Great Britain.
The facts for a study of the duration of working life in
the difterent professions are given.
Under sixty Over sixty
years of age. years of age.
Physicians 77,274 8,397
Clerg)'men 55-779 8,919
Lawyers 60.241 3,896
Dentists ii.SSo 434
Musicians ■ 29,450 S37
Artists 8,699 ' 36S
Authors, etc 1,006 \ 124
Commercial 1,726,020 54'^"
Agriculture 6,324,053 625,711
From the above table it will be seen that more clergy-
men survive their si.xtieth year than any other profes-
sional men. Physicians rank next, and lawyers last, with
quite a gap between them. The agricultural classes
have nearly as good a life as physicians, while of those
engaged in trade and transportation a very small propor-
tion continues in activity after the sixtieth year. Artists
of all kinds have a short working-life, a fact which is in
harmony with the i;eneral law that those who subsist by
cultivating imiiressions and emotions die earlier than 1
i-eal brain-workers.
SURGERY FOR ENGINEERS.
The trustees of the University of Pennsylvania have en-
gaged a lecturer on operative surgery, who is to give a
course of lectures on operative surgery to the senior sci-
entific class of the collegiate department of the Univer-
sity. The object is to give them sufficient surgical
knowledge to enable them to deal with the accidents and
emergencies which are frecincnt in the li\es of civil and
March lo, 1883.]
THE MEDICAL RECORD.
271
mining engineers. It is an api>Iication of the methods
adopted by the First Aid to the Injured societies. The
■class selected for instruction, however, is presumably an
intelligent and educated one. It is, therefore, quite
likely that some instruction in anatomy, physiology, and
minor surgery will be very useful. We take no roseate
■views of the great advantages resulting from elementary
surgical instruction to the laity. No one, so well as the
practising physician, knows how rapidly a little technical
knowledge is forgotten unless continually applied. I'.ut
the project adopted by the Pennsylvania University is a
simple one, and while doing no harm, may occasionally
be productive of good.
^cxtTS Of tttc imccTi.
A Public School Medical Servick. — It is proposed
in Paris that a medical service be formed for the purpose
of ascertaining what chronic or constitutional diseases
affect the teeth, eyes, or ears of the pupils in the public
schools, and of devising suitable remedies for the ail-
ments.
Prohibition of Patent Medicines in Italy. — By a
law which has just come into operation in Italy, the sale
of patent medicines tliroughout the kingdom is prohibited
unless the precise composition of the medicine is stated.
The promulgation of this important decree has been
made by the Minister of the Interior, the Customs, and
the sanitary authorities. One well-known chemist in
Rome has at the present moment nearly five hundred
dollars worth of patent medicines lying at the Dogana,
and likely to have to remain there or to be sent back to
England undelivered. F"or the future, travellers will
have to smuggle their favorite drugs into Italy.
Fire in Bellevue Hospital. — A temporary excite-
ment was caused in Bellevue Hospital last week by the
breaking out of a fire in Ward 7. A considerable part
of the tloor was burned, but the flames were soon ex-
tinguished without assistance from the Fire Department.
The Manufacture of Drugs and Chemicals in
THE United States involves a capital of $28,598,458.
Products to the value of twenty-eight millions are annu-
ally made.
In contrast to this legitimate work, the manufacture
of patent medicine involves a capital of ten and a half
millions, and produces mixtures valued at fourteen and
a half millions annually.
The nmnber of manufacturing establishments is five
hundred and sixty-three.
The Miami Medical College held its annual Com-
mencement on March i, 1883.
The Ohio Medical College held its Commence-
ment March 8, 1883.
The Cincinnati Medical College held its annual
Commencement on February 27th.
Defeating Medical Reform. — The Legislature of
Indiana recently defeated the Bowers bill to regulate the
practice of medicine in that State by a vote of (in the
House) 46 to 41.
The Bill to Prevent the Importation of Adul-
terated Teas was passed by Congress.
The Medical Department of the Arkansas In-
dustrial Uniyersitv held its annual Commencement
on February 28th, graduating a class of four, to whom
there were distributed six prizes.
A French Society of Ophthalmologists has just
been organized in Paris. M. Chilret was elected Presi-
dent pro tem. The meetings are to be held annually in
January. M. Gayet, of Lyons, opened the scientific
work with a paper upon a rare form of cyst of the iris.
A Memorial to the Late Professor Buhl is to
be erected in the Pathological Institute at Munich.
Philadelphi.\"s Streets. — New York does not suffer
alone from filthy streets. The grand jury in Philadel-
phia calls attention to the very dirty and unhealthy con-
dition of the streets of the city at the present time, and
to the evil effects of not providing some other and easier
outlets for the sewer-gas than the dwelling-houses of
the citizens.
The Medical College of Indiana held its annual
commencement on March ist, at English's Opera House,
Indianapolis, graduating a class of fifty-three. Two
prizes were given.
A Medical Journal Suppressed. — 77;^ Wiener
Medlcuiische Blatter has had the honor of being confis-
cated by the Austrian authorities on account of an arti-
cle which appeared in it criticising the sanitary arrange-
ments of the army.
La Vox de Hippocrates is the ingenious title of a
new medical journal recently started in Mexico. The
voice of Hippocrates has been sounding down the ages
but we hardly thought it would bring up in Mexico.
A Protest Agai.nst the Indiscriminate use of
Potassium Chlor.\te. — -The Medical College of Ham-
burg has issued a protest against the too frequent use,
without medical advice, among the laity of chlorate of
potash.
The Widow of Pirogoff has given the University of
Moscow 12,000 rouble?, the interest of which is to be
applied to the endowment of two lectureships in the
name of Pirogoft".
The Immigration of German Physicians is a thing
which is yearly increasing, and which deserves some
attention from the profession in America. They now
number over two thousand, and they generally succeed
abundantly. Such, at least, seems to be the opinion en-
tertained among themselves. A German (or Russian)
physician, practising in Chicago, has sent a letter to the
St. Petersbunr Alcdicinische Wochenschrift, in which he
answers, as he says, a large number of inquiries that he
is constantly receiving, as to the prosi)ect which Euro-
pean physicians have, if they come over here. He says:
" With the ordinarily slight practical education which
American physicians possess, it is not so very difficult for
European physicians to obtain a very good practice here."
It is only necessary, he continues (i) that the European
in question have some knowledge of English ; (2) that
he have some money to start with ; (3) that he select the
right location. The letter concludes with some more
272
THE MEDICAL RECORD.
[March 10, 188:
detailed advice. It has already been copied and widely
circulated by German medical journals. There is no
doubt some truth in the fact that German physicians
coming over here, thoroughly equipped medically, easily
keep, at least, the practice among their countrymen.
It may be seriously questioned if they will not do much
more if our colleges continue at their present low stand-
ard.
A Woman- Phvsici.ax President of a Medical So-
ciety.— Dr. Jennie McCowan was elected President of
the Scott County Medical Society, Iowa, on February
iSth. This is, we believe, the first instance on record
in which a woman has been elected to preside over a
body of medical men.
The American Veterinary College held its Eighth
Annual Commencement last week, and degrees were
conferred upon twenty-eight graduates. Rev. Henry
Ward Beecher delivered the address.
An International Quinine Quarrel. — During the
recent typhoid epidemic in Paris, a German firm in Milan
supplied a Paris house with considerable quantities of
sulphate of quinine for the hosijitals. It was suddenly
perceived that this sulphate, which cost 450 francs a
kilogranmie, was adulterated with a substance costing
only 150 francs. The adulterated article was refused, and
the French newspapers denounced German and Italian
manufacturers as fraudulent. This caused a great sensa-
tion in Italy and Germany. The manager of the Milan-
ese factory hastened to Paris, and it was discovered that
it was the Paris house that had substituted the spurious
substance for the real sulphate of quinine — a fact which
the head of the Paris house himself admitted in a letter
to the manager of the Lombard factory. The latter has
now commenced an action against the Paris house ; but,
though the French papers, especially the Temps, have
acknowledged their mistake, the papers of German)- and
Italy continue to manifest great irritation at an accusa-
tion which might have thrown discredit on their respec-
tive chemical products.
Congress and the National Board of Health.' —
Congress has adjourned and the National Board of
Health has only been remembered to the amount of $io,-
000 for " compensation and personal expenses of its
members."
The most earnest friends of the Board look upon this
action by Congress as indicative of a desire to discon-
tinue the Board as at present organized. What will be
the outcome it is difficult to surmise, but some prominent
medical men think that Congress will eventually clothe
the various services already in existence with ample
power to manage epidemic diseases, without the inter-
vention of an outside organization. Others think that
as quarantine matters are of the same nature as police
matters, they should be left with the States or municipal-
ities interested, and that the General Government has no
more jurisdiction in the one case than in the other. This
opinion is held by President Cabell, of the National
Board of Health, who says : " I hold that any attempt to
supersede State authority, in matters of quarantine, or
for the General Government to exercise concurrent juris-
diction with the States in regard to quarantine would be
inexpedient."
The whole profession will regret the loss of a national
scientific organization, and we trust that one will again
be established on a satisfactory basis. Meanwhile a
Board which has $10,000 a year should be able to do
some profitable work.
Ivcincms and 3^oticcs.
The Hospital Treatment of Diseases of the Heart
and Ll'ngs, with over Three Hundred and Fifty For-
muL-e and Prescriptions, as Exemplified in the Hospi-
tals of New York City : Bellevue, Roosevelt, St.
Luke's, New York, Presbvterian, German, Charity,
St. Francis, Mt. Sinai, in the services of Drs. Alonzo
Clark, Austin Flint, Alfred L. Loomis, E. G. Janeway,
W. H. Draper, F. Delafield, W. H. Thomson, A. Jacobi,
J. R. Leaming, A. H. Smith, Beverley Robinson, J
Lewis Smith, G. G. Wheelock, J. H. Ripley, F. H.
Bos worth, A. C. Post, A. A. Smith, etc. By Charles
H. Goodwin, M.D. New York : C. H. Goodwin,
M.D., 245 West Fifty-third Street. 1883.
This unpretentious little volume will prove of great ser-
vice to those numerous practitioners who come to this
city for the purpose of refreshing and enlarging their
knowledge of disease and its treatment. Its possession
will save them much valuable time which, they otherwise
would have to spend in taking and copying notes on
treatment and prescriptions, and which they will employ
to greater advantage by the observation and examination
of cases. This book will also be found to be of value
to the young graduates just entering upon their duties as
internes in the various hospitals of this city, as well as any-
where else. It reproduces, with photographic fidelity, the
features of treatment, as actually carried out, and has
the advantage over bulkier books on therapeutics that it
does not enumerate long arrays of remedies from which
it is difficult to make a choice.
In a work like this careful proof-reading is very impor-
tant, and we are glad to state that though we have
searched for errors with an unsparing eye, we could not
detect any of importance, except on page 8i, where one
ounce of the syrup of senega is put down as an expecto-
rant dose, and on page 153, where fifteen grains of chlo-
ral hydrate is stated to be the quantity given to " chil-
dren " as a sedative, without any specification as to age.
If we have any fault to find with this book, it is that
there is not enough of it ; but we hope that the inevitable
success of this volume will encourage the author to com-
pile similar handy volumes on the treatment of the other
organs of the human body.
Proceedings of the American Society of Micro-
scopisTS. Fifth Annual Meeting, held at Elniira, N.
Y., August 15-18, 1882. Buftalo : Bigelow Brothers.
This volume contains a large number of papers, most of
which represent original work, which is most creditable
to the Society.
Therapeutic Use of the Faradic and Galvanic Cur-
rents IN the Electro-Thermal Bath, with History
of Cases. By Justine Hayes, M.D. Chicago: Jan-
sen, McClurg & Co. 1S77.
This is a small work, written three years ago. The au-
thor claims so much that we are left as doubtful about
electro-thermal baths as ever.
Quiz Compends ; A Compend of Human Physiology.
Especially adapted for the Use of .Medical Students.
By .\lbertP. Bruhaker, Af.D. Philadeliihia : P.
Blakiston & Co.
This little volume of 133 pages is necessarily incomplete,
and is not minutely accurate, but for the pur|)ose of
cramming students it will no doubt answer. We are
inclined to think that for New York students it says too
little about the nervous mechanisms.
March lo, 1883. J
THE MEDICAL RECORD.
273
Reports of Siocieties.
NEW YORK ACADEMY OF MEDICINE.
Stilted Melting, March i, 1883.
FoRDYCE Barker, M.D., LL.D., President, in the
Chair.
intra-uterine injections.
Dr. Laurence Johnson related the history of a case
which iUustrated the possible dangers of intra-uterine in-
jections with Chamberlain's tube. He had jiractised the
injections for about one week without any accident what-
ever, and the next time, introducing the tube with the
utmost care, and throwing the current of water in with
as near as possible the same force as had been previ-
ously used, he found, when the injection had been fin-
ished, that the water was tinged with blood, and some
blood followed withdrawal of the tube. A severe chill
occurred within half an hour, the temperature rose to
107" F., the pulse to i6o, and this condition continued
for two or three hours and then subsided, and the patient
had since progressed very favorably.
The President remarked that within the past few
years he had had occasion to frequently use intra-uterine
injections, and to e.xpress a word of caution to those
wiiom he had met in consultation in regard to continu-
ing the use of intra-uterine injections in the treatment of
seiJticfemia and puerperal fever beyond a certain fixed
point of time. It was well known that the uterine si-
nuses were closed ordinarily within three or four days
after labor. It had occurred to him to see cases where
the evidence had been conclusive to his mind that the
introduction of the Chamberlain tube, a most e.xcellent
instrument to be used when ihtra-uterine injections are
indicated, has been continued too long, and that after
the sinuses have been blocked up by the formation of
coagula or the contraction of the uterine tissues, some
of the channels have apparently been opened, and the
absorption of septic material has followed, as proven by
serious reinfection. Furthermore, it has been noticed
that after using intra-uterine injections for one or two
days, when the tube is withdrawn it has been found to
be covered more or less with little points of blood, and
in some cases slight hemorrhage has followed, and in
others profuse hemorrhage has occurred. Consequently
he had frequently spoken concerning this possible dan-
ger in continuing the use of the tube for such a length of
time that it becomes a source of traumatic injury tc the
internal surface of the uterus, and thus of infection.
Dr. Isaac E. Taylor then read a paper on
the naturally faulty or CONTRACTED PELVIS ; WITH
THE HISTORY OF A CASE OF LABOR, THE NON-DELIV-
ERY OF THE CHILD, AND THE DEATH OF THE MOTHER,
AFTER CRANIOTOMY AND CEPHALOTRIPSY.
The faulty pelves referred to embraced the equally
contracted or the justo-minor, the infantile or the im-
mature, and the male or the funnel-shaped. The patient,
whose history was given, was twenty-nine years of age,
healthy, whom he first saw in consultation with Drs.
Wharton, E. A. Judson, Waterman, and others, on July
28th. Ki that time the pains were short and recurred at
intervals of ten minutes ; the os was dilated to about the
size of a half dollar, and the head occujjied the left oc-
cipito-anterior position. Ergot produced only a very
slight increase of pain. A third of a grain of morphine
was then administered hypodermically, and the patient
got some rest. On July 2gth the os was found widely
dilated, the head occupying the same position as before
and resting at the brim. Forceps were applied, but no
change could be effected in the position. Version was
then attempted, but was unsuccessful. Craniotomy was
then performed, and at that time the position of the
head was transverse, and at the superior strait with the
brow presenting, and perforation was made on the right
side. The cephalotribe was applied, the handles brought
into position, and the brain more freely evacuated, and
then traction was made for fifteen or twenty minutes
without causing any advance. The instrument was then
removed, and on examination it was found that the cra-
nium had regained the same form as before its applica-
tion, and this Dr. Taylor believed to be not unusual.
He then applied his long narrow-bladed forceps, and
brought the head more securely into the pelvis. A right-
ano-led blunt hook was inserted into the mouth of the
child, and .Meigs' long embryotomy forceps were applied,
and the head brought into the inferior strait, and finally
delivered after three hours' trial. The shoulders then
offered an obstruction, and on examination he became
convinced that the pelvis was naturally faulty, or equally
contracted, and there was not sufficient space to permit
any further manipulation by the hand. A right-angled
blunt hook was introduced, and firm traction made, but
no change in the position of the shoulders could be ef-
fected. During all this time the patient's general condi-
tion grew worse and worse, despite hypodermic injections
of brandy and other measures, and she died undelivered
after three and a half hour's faithful trial.
This form of pelvis, the equally contracted, he believed,
was much more frequently met with than is generally ad-
mitted, and that it should receive as much consideration
as those forms which depend upon certain general con-
ditions, such as rachitis, malacosteon, etc. The infantile
or immature ]ielvis is explained by an arrest of growth due
to some important impairment of the constitution. For
the equally contracted and the male jielvis no such ex-
planation could be received. In the male pelvis, or the
funnel-shaped, or the Irish pelvis sometimes called, a
condition of advanced ossification exists, and indicates a
healthy constitution. Barnes regards the equally con-
tracted pelvis as due to the fact that the person is small,
but Dr. Taylor believed that it did not necessarily follow
that a female of small stature should have a small pelvis.
With the exception of some German writers, the subject
of equallv contracted pelvis had scarcely been mentioned.
Velpeau'had once said that he had yet to learn that such
pelves ever offered an obstacle to successful parturition,
but he soon afterward had an opportunity to become
convinced to the contrary. The equally contracted pel-
vis sustains a normal relation to the size of the body, and
the woman having it has the same general structure, and
does not differ from health, either in stature or general
condition. No positive information can be obtained in
regard to the existence of this pelvis until labor has some-
what advanced. The position of the head may assist
somewhat. It may be oblique at the superior strait ; the
occiput may dip at the commencement of labor, and it
should do so, for flexion is absolutely and positively ne-
cessary. Should complete flexion not take place, a brow
presentation, or a face isresentation, will usually occur.
After delivery is completed some notion of the condition
of the pelvis may be formed by the condition of the head,
and the specimen presented gave an excellent illustration
of this point. There was marked overlapping of the
parietal bones, compression of the frontal bones, and a
ball-like appearance of the cranium. Another means for
determining whether or not this pelvis is present is pel-
vimetry. Dr. Taylor did not place much confidence in
the various methods of measuring the diameters of the
pelvis, and believed that internal pelvimetry could be
best accomplished by the introduction of the whole hand.
If the hand moves freely in the cavity of the pelvis, the
diameter must be more than three and three-fourth
inches. In measuring the outlet of the pelvis Breisky's
method was most valuable.
With reference to treatment, the use of the forceps was
almost totally impracticable. Should craniotomy have
been performed, version might succeed. Should the
child's head rest in the cavity of the pelvis and the case
be seen earl)', he would perform C;tsarian section ; but if
2 74
THE MEDICAL RECORD.
[March lo, 1883.
not, he would resort to either laparotomy or symphysiot-
omy, and he was inclined to regard symphysiotomy as
the more acceptable operation.
Dr. E. a. Judson gave a resume of the clinical history
of the case reported by Dr. Taylor, described the suc-
cessive steps of the craniotomy and the difficulty experi-
enced in attempting to turn the child. A great danger
in these cases, he thought, was liability to rupture of the
uterus. The most interesting question, perhaps, was
with reference to diagnosis ; that is, whether there are
any certain means upon which we may rely. He was
inclined to think that internal pelvimetry might furnish
something in this direction, and then referred to a method
recommended by Carl Schroeder for obtaining the diag-
onally conjugate diameter, as he had called it. It con-
sisted in introducing two lingers, allowing the tip of the
middle finger to rest upon the promontory of the sacrum,
and then note upon the index finger the point at which
it came in contact with the inner edge of the arch of the
pubis. This diameter being obtained, it bears a certain
relation to the other diameters, and perhaps in this way
a pro.ximate estimate might be formed with reference to
the condition of the pelvis. With reference to external
pelvimetry it did not seem to be of much service. He
thought that some information might be obtained by re-
sorting to abdominal palpation early.
Dr. E. L. P.4RTRIDGE, from a clinical standpoint, sug-
gested that possibly the early appearance of menstruation
might lead to the early ossification of the bones of the
pelvis, and therefore might be of some assistance in form-
ing an opinion with reference to its general condition.
Again, it should be borne in mind, in endeavoring to ar-
rive at an opinion as to whether a difficult first labor is
likely to be succeeded by labors equally difficult and per-
haps dangerous, that the first labor is frequently severe,
perhaps necessitates craniotomy, and yet subsequent;
labors are comparatively easy. This can be explained
by the fact that ossification of the child's heacl''femore
complete in prinnparas than in multipara;, and there-
fore the head less yielding. Practically he had found
that the cephalotribe applied to the delivered head had
facilitated delivery of the shoulders. He believed that
the equally contracted pelvis should receive more con-
sideration and study than simple cases of deformed pel-
vis from disease, because it probably occurred far more
frequently, and it was very probable that craniotomy and
cephalotripsy were performed more frequently in this
class of cases than in any other.
Dr. H. J. Garrigues thought there was no doubt
that diagnosis could be made during pregnancy. Of
the external methods to be employed, he thought Bau-
delocque's instrument ottered the most advantages. In-
ternal pelvimetry was difficult to practise, but it might
be assumed that if the finger could touch the promontory
of the sacrum the i)elvis was contracted. In cases in
which ojierative interference was necessary lie thought
the following should be considered in the order men-
tioned : first, gastro-elytrotomy ; second, Ctesarian sec-
tion, not according to the old method but according to
the methods recently described in monographs ; third,
Porro's operation ; fourth, total extirpation of the uterus.
The President directed attention to one important
practical point on which we are all liable to be con-
sulted. It had already been alluded to by the author of
the paper, namely, that external conformation, form and
figure and size of the patient otTered but slight indication
of the condition of the pelvis. This is a jjoint which
should be constantly borne in mind. He had repeatedly
had patients under five feet two inches in heiglit, who had
a perfectly normal pelvis, and had given birth to fine,
healthy, and often large children. -Again, those patients
who have had antero-posterior and lateral curvature of
the spine, i)erhaps also hip-joint disease, have experienced
no difficulty whatever in the process of parturition. In
some cases he had been able to form a pretty accurate
estimate of the probable diameters of the pelvis, but not
always, and oftentimes it was found quite impossible.
He then referred to a case in which the woman had suf-
fered from double curvature of the spine and also hip-
joint disease in early life, and in whom he was unable to
discover any deformity of the pelvis whatever, and she
gave birth to a child weighing ten pounds and a half be-
fore her attending physician could reach her. The Presi-
dent also referred to a case of an exactly opposite cha-.
racter, in which a large, well-developed woman had so
small a pelvis that it was with the utmost difficulty that
she could be delivered of a child not very far advanced
in development. Notwithstanding the proximate estimate
which we might be able to make in certain cases con-
cerning the diameters of the pelvis, he regarded it im-
portant to be extremely cautious with regard to promis-
ing favorable results during parturition even after having
made a most careful and thorough examination.
In closing the discussion. Dr. Taylor briefly alluded to
the equally contracted pelvis from a gynecological stand-
point, and expressed the opinion that very many cases of
uterine displacements were due to this peculiar condition
of the pelvis rather than to disease of the uterus itself.
The .\cademy then adjourned.
NEW YORK P.VrHOLOGICAL SOCIETY.
Stated Meeting, February 14, 1883.
George F. Shrady, M.D., President, in the Chair.
Dr. a. G. Gerster presented, in behalf of a candidate,
a specimen of
SARCOMA OF THE J.iW.
Dr. B. a. Watson presented a specimen of
STENOSIS AND atresia OF THE PULMONARY .\RTERY, WITH
k AN OPENING IN THE VENTRICULAR SEPTU.M.
Alexander X , aged thirteen ; born in Scotland ;
came to America in June, 18S1 ; admitted to Christ
Hospital May 2, 1882. According to patient's account,
the cyanosis which later became a very marked symptom,
was first noticed when he was four years of age, and ap-
peared at the tips of the fingers, slowly extending over
the hands and along the arms, later involving the lower
extremities and finally the face and entire body. At the
time of admission he was in a very exhausted condition,
brought on by the fatigue and excitement of travelling
the previous day and night from Birmingham, Conn., to
Jersey City. Immediately after being p)ut in bed, he be-
came semi-comatose, in which condition he remained
several days. On the fourth day (unable to take nourish-
ment the three preceding days), and from that time till
the end of the attack, he could be aroused sufficiently to
take liquids, but would relapse into the former condition
directly afterward. During the attack the cyanosis was «
extreme, being much more marked than at any other
time, the pupils were widely dilated and insensible to
light, the respiration slow and sighing, the pulse rapid
and feeble (120 to 150), the temperature at first somewhat
elevated (100° to 102° F.), but later slightly below the
normal and the extremities cold and covered with a slight
perspiration.
The patient gave no history of similar attacks prior to
admission to the hospital, but had them at varying inter-
vals subsequently. The later attacks were of less in-
tensity and shorter duration, and were generally produced
by slight fatigue or exposure to the heat of the sun.
They were always preceded, for several hours, by severe
headache and a general feeling of illness.
On the evening of the day before he died he com-
plained of the usual symptoms of an impending attack,
complicated by a severe pain in the pnecordial region,
of which he had never before complained. He gradually
became worse until he died, September 15th, at 10 a.m.
Physical examination. — Heart : Precordial area of
dulness not increased and ape.x-beat in normal position,
but on auscultation two murmurs were heard at the apex,
March lo, 1883.]
THE MEDICAL RECORD.
275
supposed to be mitral direct and regurgitant, and two at
the base, supposed to be aortic direct and regurgitant.
Tlie lungs, when the patient was not in the semi-comatose
and deeply cyanosed condition, were normal, but during
the bad spells subcrepitant rales were lieard over the
entire chest.
Post-mortem examination. — Heart : Abnormally large
(weight not known), left auricle one-half the capacity
of the right, tricuspid and mitral valves perfect, and
aortic valves atheromatous, covered with vegetations,
two of them being joined together by a material of carti-
lage-like firmness. There was also found to be marked
stenosis and atresia of the pulmonary artery, with an
opening in the ventricular septum, which permitted the
little finger to be easily passed into it. The left common
carotid artery arises from the innominate and the left
subclavian nearer the median line than in a normal body.
Remarks. — The principal interest connected with this
specimen centres in the stenosis and atresia of the pul-
monary artery, inasmuch as the interventricular opening
and valvular lesions are probably dependent on the
arterial obstructions.
The symptoms observed and fatal termination are in
harmony with our published records ; but, these cases
are not of such frequent occurrence as to be therefore
uninteresting.
Dr. Watson also presented specimens with the follow-
ing history :
COMPOUND FRACTURE OF THE LEFT TIBIA — NON-UNION — ■
SUBSEQUENT AMPUTATION OF THE LEG.
August M ; born in Germany ; aged twenty-six ; la-
borer, admitted August 26, 1882. This injury had been
produced by indirect force, and examination showed an
oblique fracture in the middle of the tibia, the lower seg-
ment of which had been driven through the integument
covering the anterior surface of the bone.
The patient was fully anc^sthetized and reduction at-
tempted, but it was not accomplished ; the soft parts were
then thoroughly divided, and another thorough but un-
successful attempt made at reduction, after which, both
the lower and upper segments were exposed and sawn
smoothly off. There was removed by this operation
about three-fourths of an inch of bone, but nevertheless
after the reduction it was found that the sawn surfaces
remained in actual contact. A drainage-tube was intro-
duced and the wound neatly closed with iron-wire sutures.
The entire operative procedure was performed under
strict antiseptic precautions.
August 27th, the patient was comfortable, but the ]nilse
and temperature w'ere above the normal. The temiiera-
ture reached on the third day 104° F., although the
patient was still comfortable ; but from this date the tem-
perature gradually declined, and before the end of the
month his condition was normal in every respect. August
31st, the sutures were removed and the wound was found
to be completely healed externally, except at the points
where the drainage-tube made its exit. During the
month of August the wound-fluids discharged, althougli
not profuse, were sufficient to soil the dressings and make
a daily change necessaiy. 'J'he removal and reajiplica-
tion of these dressings were made under strict antiseptic
precautions until September i, 1882, when all Listerism
was immediately discontinued.
There is a complete break in the history of this patient
during the next four months, with the exception that he
was transferred to the Jersey City Charity Hospital,
November 2d, at which time his condition was designated
in the books of St. Francis by the word "unimproved."
The amputation was performed in the Charity Hos-
pital, January 5, 1S83, after which the patient made a
good recovery.
The pathological specimen exhibits at the point of the
fracture a progressive necrosis which involves a |)ortion
of both fragments. There is also observed to the out-
side of the upper fragment a new bony formation which
is one and one-fourth inch in width, one-fourth thick,
and one and three-fourths long, which jjasses down and
overlaps the lower fragment one-fourth of an inch. This
new bony formation has evidently been fractured near its
attachment to the lower fragment, since its fractured sur-
faces were covered with a layer of firm fibrous material.
This fracture, it is thought, occurred soon after the new
material had attained its present dimensions. The origi-
nal fragments are separated elsewhere by an irregular
cavity surrounded by diseased bone. This separation at
no point exceeds half an inch, and is shown to be due to-
the erosion of the diseased bone, while at other points still
in actual or almost actual contact. There were several
ligamentous bands which connected the original frag-
ments together, but these have disappeared during the
process of cleaning.
Dr. \\'atson remarked concerning the second speci-
men that the necrosis was due unquestionably to tlie
accumulation and decomposition of pus, and that if he
had been able to avoid this, union would probably have
taken place. The question therefore arose, what should
be done under such circumstances ? Would it have been
better to have exsected the diseased portions of tibia,
leaving as much of the periosteum as possible ? or, would
it have been better to have exsected not only the diseased
portion of the tibia, but the corresponding portion of the
fibula ? or, would it have been better to have removed
the necrosed portion of the bone, and afterward attempted
bone-grafting, an operation which he had never adopted
and in which he had never had any experience ?
Dr. Putnam-Jacobi said that Dr. Watson's second
case was also interesting because it illustrated the exist-
ence of the antiseptic traumatic fever to which attentiork
had been called in an elaborate monograph recently
published in Volkmann's series. The writer had col-
lected a number of cases in which operations had been
performed under strict antiseptic precautions, and after-
ward the patients had a very high temperature ; but
without any conscious disturbance of their well-being.
Dr. Jacobi reniarked that Dr. Watson's first specimen
illustrated the statement which had been made, that as a
clinical fact malformations of the heart can be almost
entirely summed up in stenosis of the pulmonary artery;
as this alone, or with its consequence — patency of the
inter-ventncular septum, is almost certain to occasion
clinical symptoms. It did not appear, however, in the
history of Dr. Watson's case, that the openings in the
septum had given rise to any symptoms, and so far sus-
tained a very elaborate article written to prove that the
opening in the auricular septum may persist without giv-
ing rise to physical signs or rational symptoms of cardiac
disturbance.
Dr. Watson remarked that he was unable to obtaiii
any history of preceding inflammatory attacks or any-
special cardiac disturbance.
CHRONIC osteomyelitis OF THE LOWER PART OF THE.
FEMUR.
Dr. a. G. Gerster presented a specimen removed
from a female child, ten years of age, who became seri-
ously ill during the course of last August, with symptoms
which led the family physician to make the diagnosis of
cerebro-spinal meningitis. The child was in a comatose
condition, had strabismus and convulsions, and in the
course of the second week very high fever developed,
and he noticed marked swelling of the lower third of one
thigh. Dr. Gerster saw the child in consultation, and at
once recognized that he had to deal with acute osteo-
myelitis of the fennir. At that time also distinct fluctu-
ation was present, and other evidences of a deep-seated
abscess were obtained. The tissues situated above the
bone, and not distended by pus, were very much thick-
ened as usual by oedema. He advised immediate in-
cision, and as soon as it was made an enormous quantity
of pus was evacuated, and the general condition of the
child improved very considerably. At that time he had
276
THE MEDICAL RECORD.
[March 10, 1883.
not noticed any contraction of the joint, but from that
date contraction of the knee-joint commenced to take
place, and finally within two months and a half an angle
of twenty to twenty-five degrees was attained. The
slightest attempt at passive motion caused pain. An
effusion into the joint could not be detected, and he sus-
pected that the contraction on the knee was caused by
the presence of a cheesy focus in the lower epiphysis, or
by necrosis of a portion of the cancellous tissue. In
the month of November he performed necrotomy of the
femur. After making suitable incisions he endeavored
to expose the diseased part, and tried to penetrate the
central portion of the condyles in order to determine the
exact state of aft'airs in that locality. The specimen ex-
hibited a femur covered with a thick layer of newly
formed bone which had disappeared from the posterior
surface at the part corresponding to the linea aspera. It
was at that place where he endeavored to reach the cen-
tral portion of the bone by the use of chisel and mallet.
He succeeded in doing so, and scooping away a large
quantity of diseased bone, mostly fragments of small
size, one, however, being three-fourths of an inch in
length. No improvement followed the operation. The
bone continued to increase in size, suppuration continued,
contraction of the knee-joint persisted, the child's gen-
eral state of health began to suffer more severely, the
liver began to increase in size, albumen appeared in the
urine, and he decided to amputate the limb and jier-
formed the operation two weeks ago. After having re-
moved the limb he sawed the bone through longi-
tudinally, and found the following condition of aft'airs.
The knee-joint did not contain any effusion whatever,
nor present any signs of acute inflammation, although
one portion freely communicated with the cheesy focus
situated in the condyle. He mentioned this fact for
the reason that the question was raised as to whether it
would not have been well to have treated the limb by
brissement force. The condition of things, revealed on
examination of the bone, explained why such an under-
taking might have been followed by serious consequences.
The cavity of the joint was intact, yet the disease
was so close to it that if the limb had been forcibly
stretched, undoubtedly the contents of this cavity would
have been emptied into the joint and innnediately estab-
lished purulent infection. As it was, the anterior wall of
the capsule being put on the stretch, was drawn snugly
over the opening of the cheesy focus, thus preventing an
escape of its contents into the joint-cavity as long as ex-
treme flexion was maintained. The external condyle
was the original seat of the disease where the acute
osteomyelitis had taken place. There was a thick layer
of new osseous tissue enclosing the original bone. He
had therefore to deal with chronic osteomyelitis in the
epiphysis and of the lower end of the shaft of the femur,
chronic periostitis of the entire shaft of the bone, pro-
ducing periosteal new formation of the bone throughout
the entire length of the femur. The specimen was
especially interesting on account of the fact that al-
though the necrosis was only circumscribed and confined
to the epiphysis, yet there was an enormous new forma-
tion of bony matter throughout the entire length of the
shaft, such as is characteristic of extensive central
necrosis.
VENEREAL WARTS.
Dr. Gerster presented specimens of venereal warts,
accompanied by the following history : They were re-
moved from a patient thirty-two years of age, who had
no history of either hereditary or actjuired syphilis.
When he first saw the jiatient he found about the anal
opening numerous masses of villous growths covering an
area of about six square inches, which he recognized as
venereal vegetations or jiapillomata that had accjuired a
very large size. Their origin was doubtful. One pe-
culiarity of the growths was that they occujiied two semi-
lunar spaces about the anal opening, leaving the median
line of the perineum along the raphe entirely intact, a
fact which he had never before observed. Four or five
years ago he saw a mass of similar growths removed from
the skin surrounding the anal opening in a patient under
the care of Dr. D. M. Stimson, during his service at the
Mt. Sinai Hospital, and Dr. Gerster recollected that in
that case the mass was removed very thoroughly by
means of the galvano-cautery. Yet it relapsed three or
four times, finally involved the anal mucous membrane,
and necessitated a very severe cutting operation, in which
a portion of the mucous membrane of the rectum had to
be removed. Bearing in mind that fact, he did not lose
any time in attemiJts at cauteri^ation, but exsected the
growths, together with their bases, and he hoped to secure
non-recurrence of the disease. Microscopically the tu-
mors were simply warts. The incisions healed by granu-
lation in six weeks.
Dr. Gerster, in reply to a question, said that he did
not attenqit to secure union by first intention in his first
case, and that the child at the present time is doing very
well. There had not been any notable elevation of the
temperature. In several cases of osteomyelitis, especially
central, he had known of the diagnosis of typhoid fever
having been made, and in this case the diagnosis of an-
other severe systemic disease was made.
Dr. J. Lewis Smith asked if there was much swelling
of the limb in the early stage.
Dr. Gerster replied that there was not, and that the
swelling developed in the course of two w'eeks.
Dr. Putnaii-Jacobi referred to a case lately seen in
dispensary practice, a child four years of age, suffering
from osteomyelitis of the upper extremity of the femur,
accompanied by complete separation of the epiphysis.
There was considerable swelling of the thigh and buttock,
and the swelling extended into the groin and to a con-
siderable extent upward upon the abdomen, so much so
that the question was raised as to whether osteitis of the
pelvic bones did not also exist. The necessity for open-
ing the abscess was certainly apparent, but, owing to the
delays incidental to dispensary practice, this operation
was unfortunately not performed on the occasion of the
child's visit. The subsequent history of the case was,
that the child had a violent attack of pain in the abdomen,
and the swelling of the thigh and buttocks collapsed.
Simultaneously the child passed into colla]ise and died
two hours afterward from what, so far as could be inferred
from this report, was shock due to bursting of the abscess
into the peritoneum. Probably if the physician who saw
the child previous to the time it came under her observa-
tion, or if she herself had acted promptly, the child's life
would have been saved.
Dr. Ferguson presented a specimen of
dissecting aneurism of the arch of the aorta.
A man, aged fifty-six, native of England, and a news-
dealer by occupation, on P'ebruary 9, 1SS3, at 9 p.m.,
suddenly felt faint and became unconscious. He was
imniediateh' transferred bv ambulance to the New
York Hospital, k. friend said that ten years ago the pa-
tient had a similar attack, followed by unconsciousness
which lasted for two days, and that he was sick for six
weeks, but that since that time he had been quite well.
On admission he was semi-comatose, was fairly nourished,
and there was no cedema. He could be aroused, seemed
to understand, but could not answer. His heart action
was slow and feeble. The apex-beat was in the sixth in-
terspace on nipple line. The radial arteries were stiff-
ened ; the right radial artery was tortuous. The radial
pulse was from fifty-eight to sixty-four per minute. The
day after admission he was completely unconscious,
his breathing became stertorous, and his pulse ran up to
ninety per minute. His right impil was slightly dilated,
and there was slight paresis of the right side of the face,
with slight left lieniiplegia. He continued in this condi-
tion until the time of his death, three days after admission.
His heart action was imperceptible for two hours before
March lo, 1883.]
THE MEDICAL RECORD.
277
he died. Urinary examination showed a small amount
of albumen, hyaline and granular casts. His tempera-
ture was 102.6' F., respiration 30, and pulse varied from
fifty-eight to ninety per minute. Me was given carbonate
of ammonia, digitalis, and whiskey. The autopsy re-
vealed intense oedema and congestion of the lungs,
chronic diffuse nephritis, and atheroma of the vessels at
the base of the brain. The brain and membranes were
otherwise normal. The liver was congested. The stom-
ach and intestines were normal.
Heart. — The pericardium contained 680 c.c. of fluid
and coagulated blood. The left ventricle was dilated,
the left ventricular wall hypertrophied, and the muscular
fibres of the heart contained a great deal of fat. The
valves were competent ; the anterior segment of the
mitral was atheromatous.
Aorta. — 'I'he arch of the aorta, especially its ascend-
ing portion, was markedly dilated. There was a rent
in the wall of the ascending portion, through the
intima and media, commencing just above the aortic
valve and extending directly upward an inch and a half.
The middle and outer coats of the artery were separated
almost throughout the entire extent of the vessel. The
blood passing downward into the pericardium, upward to
a considerable distance around the vessels given off from
the arch and separating the middle and outer coats of
the thoracic and abdominal aorta, down to the iliac ves-
sels. l"he aorta throughout was atheromatous.
(To be continued. )
CCorrcspoutlcncc.
THE PROTECTION OF COLLEGE STUDENTS
FROM VENEREAL DISEASES.
To THE Editor of The Medical Record.
Sir : Referring to the editorial in The .Medical Record
of February 24th, on "The Protection of College
Students from Venereal Diseases," it may be proper
to state that the suggestion therein made as to the incul-
cation of continence, " directly, and not by spiritual gen-
eralities," has been anticipated at Cornell University.
In following to its legitimate conclusion the urgent and
often-e.xpressed wish of President White for " practical
instruction in the laws of health,'' I have for several years
supplemented the regular courses in physiology and hy-
giene by one or two lectures to the Freshmen upon the
advantages of continence and self-restraint, and the dan-
gers, physical and mental, as well as moral, of sexual
transgression. In addition, when requested by a majority
of the class, I have given to the Seniors, just before
graduation, advice with regard to the hygiene of the mar-
riage relation, especially the tendencies to excess, and to
a lack of consideration for the wife. While far from
satisfied with either the extent or the character of this
instruction, I have reason to believe that it has diminished
the amount of undergraduate immorality, and contrib-
uted to the welfare of married alumni. Similar instruc-
tion is, I think, given at Amherst College, and I trust the
time may come when college faculties will generally feel
ill some degree responsible for such errors of their stu-
dents as might have been arrested by the impartation of
adequate information and sound advice.
Burt G. Wilder, M.D.
Ithac\, N. Y., February 26, 1SS3.
%tw ^iistfttmctxts.
The Cause OF Diabetes. — Among 600 cases of diabetes
treated by Dr. Richard Schmitz ^British Medical Jour-
nal), 248 were in families in which diabetes had already
disappeared, g6 were in neuropathic or psychopathic fam-
ilies, and in 183 cases the exciting cause of the disease
was attributed to some acute disturbance of the nervous
centres. In 153 cases the disease was attributed to an
excessive indulgence in sugar.
GRUNOW'S NEW CAMERA LUCIDA.
Mr. J. Grunow, of this city, has constructed a new
camera lucida, which deserves the attention of microscop-
ists. It was described by the editor of The American
Monthly Microscopical Journal, at a recent meeting of
the New York Adcroscopical Society.
The instrument consists of three rectangular, equilat-
eral prisms, so arranged that, when placed over the eye-
piece with the microscope inclined, which is the most
convenient position, a portion of the surface of the work-
table of the size of about twelve by fifteen inches is pro-
jected into the field of view, so as to be distinctly and
clearly seen together with the object on the stage.
The two prisms e, f, g, and h, f, g, are cemented
together so as to form a cube, the sides h, g, and /, e,
being parallel. The hypothenuse /, g, of the prism
h, /, g, is silvered, to do away with the blue halo other-
wise peculiar to this form of prism, which would greatly
obscure the reflected image. The silver is removed at
the centre of the coating, at the point o, so as to leave a
clear space about half the diameter of the pupil of the
eye. The other prism l,j, k, is placed with the side/, k,
inclined to the cube h, g, /, e, at such an angle as may
be most desirable.
In viewing tlie object under observation in the direc-
tion of N, M, through the aperture at 0, we see the whole
field of view, while at the same time the drawing-board
and pencil are reflected from the side l,j, of the prism
l,j, k, to the silvered surface/, g, and then reflected to
the eye in the direction of F, N. Both the pencil point
and the object are very clearly seen without any strain
upon the eye.
It is in this respect that the maker claims for this cam-
era lucida superiority to any other form. It can be im-
mediately applied, while the microscope is in an inclined
or vertical position, without any change of conditions or
loss of time. The camera is simply sli[)ped over the eye-
piece, the paper placed on the table, and the drawing
proceeded with.
The Wanderings of a Swallowed Needle. — Dr.
W. P. Beach, House-Surgeon of Randall's Island Hos-
pital, N. Y., sends us an account of the following case :
The patient, a woman forty years of age, four years ago
swallowed an ordinary cambric needle about one and
one-half inch long, from which she experienced no trouble
until two weeks ago, when she felt a slight soreness just
over the middle of the sternum. Later a small sore ap-
peared in that situation, and on probing it I felt a rough
substance. Enlarging it I found about two inches from
the surface a needle which was considerably oxidized and
very blunt. The canal had the appearance of an old sinus,
and was about four inches long.
zjd,
THE MEDICAL RECORD.
[March lo, 1883.
^rmy gXcvns.
Official List of Changes of Stations and Duties of Officers
of the Medical Department, Utiited States Army, from
February 24, 1883, to March 3, 1883.
Burton, Henry G., Captain and Assistant Surgeon.
The leave of absence granted October 2, 1882, is ex-
tended two months. S. O. 49, par. 2, A. G. O., Febru-
ary 28, 18S3.
ItXccUcal Jtcms.
Contagious Diseases — Weekly Statement. — Com-
parative statement of cases of contagious diseases re-
ported to the Sanitary Bureau, Health Department, for
the two weeks ending IMarch 3, 18S3 :
Week Ending
>
>
•0
'0
t
c ■
■§•:!
. M
O.S
II-
'«3
OJ
1
1-^
fa
>.
a
11
a
B
H
H
M
U
^
U
(/:
>■
February 24, 1SS3
0
II
86
4
81
44
I
0
March 3, 1883
0
8
69
6
lOQ
49
3
0
Some Delusions Regarding the Digestion of
Oysters. — Some experiments with oysters by Dr. Chas.
L. Dana (Med. and Surg. Reporter) dispel certain de-
lusions concerning that bivalve. He finds that it does
not possess the power of digesting itself, as has been as-
serted by some ; that raw oysters are not always more
digestible than cooked ones, but that when roasted the}'
are digested very nearly as rapidly as when eaten raw ;
that fermented liquors do not have an}' special power in
dissolving them (as claimed by Professor Haughton) or in
assisting their digestion.
The Antisepsis of Tuberculosis. — M. Vulpian, as
the result of numerous experiments with tuberculous
virus, recommends sulphurous acid as the most power-
ful destroyer of its specific properties.
The French Medical Political Leader. — Dr.
Georges Clemenceau, the present leader of the Left in
the French Assembly, is the descendant of a line of
physicians. He began his medical studies in Nantes,
and subsequently studied in Paris under Robin, now a
Senator. He was admitted to the degree of Doctor of
Medicine in 1865, on the strength of a remarkable thesis
on the generation of anatomic elements, a thesis in which
he expounded and formulated the theories which Dr.
Robin had scattered confusedly in a score of diffuse
volumes. M. Clemenceau's thesis remains up to this
day one of the best expositions of the theories in ques-
tion. The theory itself, however, is no longer entertained
by physiologists. AL Clemenceau practised medicine
until 1875. He then definitely abandoned his profession
for politics, being elected Radical Deputy for the arron-
dissement of Montmartre. He represents extreme re-
publican and materialistic opinions.
Small Doses Frequently Repeated. — In urticaria
Dr. .\. ,\. Smith recommends (yVcji:/ York Medical Jour-
nal) two grains salicylate of soda every hoiu' or half-hour.
In spasmodic croup, one one-hundredth of a grain of
atropia in a goblet of water, a teaspoonful every hour or
half-hour. In the nervous disturbances and excitements
of children, the bromides in one or two-grain doses every
ten or fifteen minutes. Teaspoonful doses of a solution
of tartar emetic, one grain in a quart of water, given fre-
quently, will relieve the wheezing and cough of a slight
bronchitis in children. \\\ orchitis and epididymitis, and
also in dysmenorrhoea, two-minim doses of tincture of
Pulsatilla every hour are most efficient. Hemorrhages
from the uterus and htemorrhoids will generally be
stopped by two minims of the tincture of haniamelis
every half-hour.
More about Cephalh.ematomata. — Dr. P. L. Myers,
of Fostoria, O., writes: "Dr. H. M. Battershall's case
of 'subpericranial cephalhrematoma,' reported in The
Record of January 27th, appears to have been pecu-
liarly formidable. The doctor's action in early remov-
ing the ' oma' is certainly commendable ; as death,
in time, would have undoubt-dly resulted — from the first
effort of the child to utter the name of its difficulty.
Last May I attended a multipara in confinement. Labor
easy. The following day the nurse noticed a swelling
over the sagittal suture. It was one and one-half inch
in diameter, soft, fluctuating, and irreducible. As it
caused no pain or uneasiness (to the child) I let it alone.
After two days it was found considerably enlarged. I
aspirated with a hypodermic needle. The dark blood
not escaping freely, I made a small opening with a bis-
toury. After two more days there remained no trace of
the tumor. The parents seemed sufficiently awed when
I explained it to them as a ' blood-blister.' "
[Our correspondent could hardly claim his case to be
a "subpericranial" hematoma, since these are very rare,
and occur over bones, not sutures. Dr. Battershall also
cannot be said to have proved his case positively to be
subpericranial, although it seemed probable that it was
such, and hence its interest. — Ed.]
Dr. G. Frank Lydston, of Chicago, 111., also sends us
the history of a case of ordinary cephalhajmatoma, re-
sembling that of Dr. Myers'.
-A Case of Uremic Coma Hastened by a Dose of
Morphine. — Dr. E. T. Hubbard, of Madison, N. H.,
sends the history of a patient, a farmer, aged sixty, who
had been suffering for fifteen years with attacks of renal
colic. In the last six months cedema of the legs had ap-
peared, with scanty urine. Dr. Hubbard was called to see
him while suffering from the colic, and he gave half a
grain of morphine in the course of an hour. He was re-
lieved, but after a time fell into a coma, from which he
was but partially aroused by most energetic treatment
during the next three days. At the end of that time he
died. Our correspondent thinks that "probably the
uremic condition existed in the system, and all it wanted
was the morphia to fire the train."
Warts may be removed by the continuous applica-
tion of mercurial ointment containing five per cent, of
arsenic. Prof. Unna recommends this, or a plaster con-
taining in each 0.2 square meter (eight square inches)
ten grammes (154 grains) of arsenic and half that quantity
of mercury.
The Last Night of the House. — .A ^Vashington
correspondent w-rites that during the last night of the
House, some of the members began to relieve themselves
from the strain of their assiduous statesmanship by
throwing paper wads at drowsy members. One big wad
struck the face of Dr. McLean, of Missouri, a manu-
facturer of patent medicines, who writes his name, " Hon.
Dr. McLean, M.C." The member in question called a
page and sent his assailant a bottle of his last patent
mixture.
Ante-Partu.m Hour-Glass Contraction of the
Uterus. — Dr. H. W. Dorman, of Ashtabula, Ohio, re-
lates the history of a case which seems to have been one
of ante-parlum hour-glass contraction. The patient was
a young and healthy Swede in her third labor. The head
was in the first position, and the pains strong, but al-
though the neck dilated well, the child made no prog-
ress. Dr. Dorman then passed his hand into the
uterus and felt a constriction near the child's neck which
nearly baffled all his strength to dilate. He succeeded,
March lo, 1883.]
THE MEDICAL RECORD.
279
however. The membranes were then ruptured and the
progress of the ciiild thereby favored. DeUvery was at
last successfully accomplished. The whole duration of
the labor was eighteen hours. A constriction was found
around the placenta.
Further Facts from the Tenth Censvs. — The
Coffin Industry of the United States employs 3,762 hands
and manufactiu-es goods to the value of eight millions
annually.
The ' Nund'cr of Midunves in the United States is
2,118. The number of nurses is 13,483, of whom 1,189
are male and 12,294 are female.
Surgical Instruments are manufactured in the United
States yearly to the value of nearly a million of dollars.
The number of establishments is seventy-one.
The Number of Veterinary Surgeons in the Country,
according to the last Census, is 2, 130. Of these 1 ,45 7 are
natives of the United States, 104 of Ireland, 156 of Ger-
many, 252 of Great Britain, and 171 of other countries.
According to a register prepared with much care by
the Journal of Comparative Medicine, only about one-
half of these have degrees.
Anecdotes of the Late Sir Thomas Watso.v. —
The following are a few of the many anecdotes told by
the late Sir Thomas Watson {British Medical Journal) :
When attending Lawrence, the great surgeon, when he
had hemiplegia with aphasia, it was thought desirable to
give to the patient some sedative. Lawrence, knowing
this, and wishing to indicate what remedy he desired, was
unable to find the word he wanted, and became greatly
agitated in consequence. Sir Thomas Watson got i)en,
paper, and ink, and asked him to write the word. This
he could not do, but, taking the pen full of ink, made a
large splash on the paper, and offering it to those at his
side. Sir Thomas Watson at once perceived the drift of
this, and saw that his patient wished for the " black drop,"
a discovery which greatly delighted and satisfied Law-,
rence. Once, when dining at a large dinner party wherj^,
Lawrence and Brodie were, the former remarked that
Abernethy was the only genius in surgery he had ever
seen.
Sir Thomas, in relating some of his professional ex-
periences, used to mention the extensive amount of
venesection which he had witnessed, relating an instance
in which a man in Edinburgh was bled to seventy ounces
by a clinical clerk, and with benefit, having been told to
let blood until a sensible alteration was produced on the
pulse.
He remembered the following as having happened :
When at the Middlesex Hospital, he once saw a chimney-
pot fall to the ground, and out of it jumped a sweep-
boy, who immediately ran away, unhurt, for fear of being
beaten.
He used to relate that, after a letter of his in the
Times on the cattle-plague, some one wrote to him from
Norwich to ask him to come down and vaccinate his
cattle. Watson replied " he did not know how."
Once, when dining in company with Mr. Richmond,
and the conversation turning upon sporting, the latter
said, " Well, he had never put a gun to his shoulder, and
supposed that by not shooting he missed a good deal."
Watson replied that, " if he did shoot he probably would
miss a good deal more."
He told the story of some c;ne at a medical dinner
party asking another, " Well, what's the news ? " " Oh,"
said his friend next to him, " Dr. Jones has refused a fee.
Dr. Smith has taken one, and Dr. Smithson has had one
offered to him."
Some Rare Forms of Dislocation of the Arm. —
Dr. Leopold Meyer, of Copenhagen, Denmark, reports
three unusual cases of dislocation of the arm. The first
two were cases of luxatio humeri erecta, so termed by
Middeldorpf in 1859. The patients presented all the
characteristic signs of subglenoidal dislocation, but with
exaggerated abduction, the arm being elevated nearly to
a vertical position and the hand resting on the head.
The third case was that of a woman who had fallen
backward while carrying a pail of water in each hand.
She had a subcoracoid dislocation on both sides. In all
these cases reduction was easily effected. — Nordiskt
Medicinskt Arkiv, vol. xiv.. No. 23, 1882.
Hot Water as a Tipple. — .\n English physician
writes, in The World of Science, some very interesting
things regarding what to drink. " The habit of drinking
strong tea, or black coffee, directly after dinner, is espe-
cially bad, and certainly interferes with digestion. At
breakfast time a healthy man has all his sleep in him,
and surely it is then unscientific for him to inflict upon
his system strong tea or coffee. .At ' tea-time ' tea or
coffee may well be indulged in moderately ; the bulk of
the day's work is done ; the body not only wants rinsing
out, but fatigue is felt which may well be counteracted by
the use of a mild stimulant, such as tea ; and bedtime is
not yet so near that sleep is thereby interfered with. Most
nations that drink coffee largely get a sallow skin ; and
I am inclined to think that the carbonaceous matter of
the roasted coffee, when so largely and frequently taken,
may perhaps have something to do with this. For hard-
working people, who are not corpulent, I should suggest
the thick flake-cocoa as the healthiest and most nutri-
tious breakfast beverage. For those who do not want
fattening drinks, and who often cannot digest cocoa, I
should say drink hot water at breakfast. Those who
dine late, and make their dinner their main meal, need
a diluent drink an hour or two afterward, and if they
drink tea it keeps them awake or makes them irritable
and nervous. I find for myself that dining solidly, as I
am obliged to do when I have done my work (7-3° P-M-)>
and often needing to work from 9 to u, a tumbler of
hot water brought into my study or laboratory is the
best and wholesomest drink, and, after a few evenings,
it will be as much relished as the usual draught of tea.
The hot water assists to complete the digestion of resid-
ual food, it acts upon the kidneys, and rinses out the
effete matters, and thus will be found to wake one up
sufliciently, and neither to injure the stomach nor to
keep the brain awake after bedtime. In cold weather
warm water is by far the best drink at dinner time, and
in hot weather a draught of warm water is far whole-
somer and more cooling than cold or iced water."
Most Artful. — The Western Medical Reporter says :
" For patients who have to use iodoform for certain pur-
poses it is advised to spread some of the ointment on
muslin and bandage a finger with it. Thus the purpose
for which the agent is used can be concealed." Such
a pleasing and (at meal times) appetizing arrangement
may deceive the children of Light who populate the
great West ; but we fear that the children of Darkness,
as generally met with nearer the Atlantic coast, would
look with scorn upon so transparent a subterfuge.
Dr. Oliver Wendell Holmes, on retiring from his
professorship at Harvard, received the following pleas-
ant greeting from London Punch :
"Your health, dear ' .\utocrat !' All England owns
Your instrument's the lyre, and not ' the bones.'
Yet hear our wishes — trust us they're not cold ones! —
That though you give up bones, you may make old ones."
Ipecac during Labor. — Dr. N. P. Reeves, of Grand
Cane, La., referring to Dr. Pitkin's article in The Re-
cord on the above subject, reports two successful cases
(iVeti> Orleans Medical and Surgical Journal) in his own
practice. He says in conclusion : " I, like Dr. P., never
thought that ipecac increased the muscular power of the
uterus ; indeed I have inclined to the opinion that it les-
sened it, to some extent ; yet, by its relaxing powers and
co-ordinating influences it lessens the danger and greatly
facilitates the desired end."
Salicin in half-drachm doses every two hours will re-
lieve acute coryza.
2 So
THE MEDICAL RECORD.
[March lo, 1883.
Sleep-Drunkenness. — A gentleman living in this
city recently suffered from a very severe attack of night-
mare. He imagined himself assaulted by highwaymen,
and in his struggles he severely injured his affectionate
and unconscious spouse. A surgeon had to be sum-
moned, and the case was thought of sufficient interest to
be put in the hands of reporters. These enterprising
gentlemen consulted a number of medical luminaries from
whom much valuable information was obtained.
It appeared that the case in question was not a simple
one of nightmare from a late supper or an extra piece of
Christmas pudding. It belonged to a well-understood
and defined derangement of sleep known as somnolentia
or sleep-drunkenness. It is a condition, said an emi-
nent neurologist, in which some of the mental faculties
and senses are fully awakened, others but imrtially so,
while still others remain in the quietness of sleep. It is
generally brought about by the sudden awakening of a
person from a sound sleep. In children such derange-
ments occur quite frequently ; while a few persons are
subject to them all their lives. Serious injuries have
been inflicted by these sleep-drunken individuals, and
works of medical jurisprudence discuss the questions of
responsibility thus raised.
A Complicated Monstrosity. — Dr. S. C. Franks, of
Bentonsport, Iowa, sends us an account of a monstrosity
delivered by him from a healthy primipara at full term.
The monster, which was born dead, presented the follow-
ing peculiarities : The brain protruded from posterior
fontanelle with placenta adherent. Left eye much smaller
than right. Double hare-lip. An opening reaching from
the third rib to os pubis from which protruded heart,
liver, stomach, and intestines. The forearms were fle.xed
at right angles with arm and ankylosed. Right knee
fle.\ed and ankylosed so that the heel rested against the
nates, and lastly double talipes varus. Both parents
were healthy and of the laboring class. Our correspon-
dent gives no details of prenatal history.
Utero-ovarian Disease in Insane Women. — Dr.
Margaret A. Cleaves, Physician to the Female Depart-
ment of the State Lunatic Asylum, Harrisburg, Pa.,
writes in her annual rejiort : " Briefly formulated, my con-
clusions, then, are as follows : that a large proportion of
women in insane hospitals have some form or another
of utero-ovarian disease ; that many of those under treat-
ment make marked mental and physical improvement
cbmcidently with the improved local condition, that in a
majority of cases, however, this improvement, owing
doubtless to the long standing of the combmed physical
and mental disorder, only reaches a certain point, beyond
which it seems impossible to make further gain."
Calx Sulphurata. — Dr. H. G. Piffard {Journal of
Cutaneous ami Venereal Diseases) says that calx sulphu-
rata (commonly misnamed sulphide of calcium) is a mix-
ture of the sulphide and sulphate of calcium, but con-
tains not less than thirty-six ))er cent. (U. S. Pharm.)
of the former substance. He adds : " My own experi-
ences, extending over a series of years, lead me to the
inference that the drug is an aplastic or resolvent of
great energy ; that its tendency, when given in sufficient
doses, is to break down and dissolve, rather than build
up and restore. This theory of its action is in jierfect
harmony with the observed effects of its administration ;
and if it be the correct explanation, it will lead us to a mul-
titude of useful applications of the drug. In other words,
it appears to me probable that calx sulphurata will be
found capable of fulfilling the role that was assigned to
mercury thirty and forty years ago, that of a general re-
solvent in inflammatory exudations, chronic infiltrations,
'and possibly also in some forms of neoplasm."
Triturations. — Of late years the ado|nion of finely
pulverized combinations of sugar of milk with medicinal
substances has so largely increased that it has become
practically impossible to supply the demand, witho\it
making use of some other than manual .power. The in-
troduction of " triturations " and "abstracts" into the
new Pharmacopoeia is very likely to increase still more
the demand for this class of preparations. Triturating
machines that go by steam have, therefore, been intro-
duced by some pharmacists.
The " Hammond Prize" of the American Neuro-
logical Association. — The American Neurological
Association offers a prize of five hundred dollars, to be
known as the "William A. Hammond Prize,'' and to be
awarded at the meeting in June, 1884, to the author of
the best essay on the " Functions of the Thalamus in
Man." The conditions under which this prize is to be
awarded are as follows : — The prize is open to competi-
tors of all nationalities. The essays are to be based upon
original observations and experiments on man and the
lower animals. The competing essays must be written
in the English, French, or German languages : if in the
last, the manuscript is to be in the Italian handwriting.
Essays are to be sent (postage prepaid) to the Secretary
of the Prize Committee, Dr. E. C. Seguin, 41 West
Twentieth Street, New York City, on or before February
I, 1884 ; each essay to be marked by a distinctive device
or motto, and accompanied by a sealed envelope bear-
ing the same device or motto, and containing the author's
visiting card. The successful essay will be the property
of the -Association, which will assume the care of its pub-
lication. Any intimation tending to reveal the author-
ship of any of the essays submitted, whether directly or
indirectly conveyed to the Committee or to any mem-
ber thereof, shall exclude the essay from competition.
The award of the prize will be announced by the under-
signed Committee ; and will be publicly declared by the
President of the Association at the meeting in June, 1884.
The amount of the prize will be given to the successful
competitor in gold coin of the United States, or, if he
prefer it, in the shape of a gold medal bearing a suitable
device and inscription. Signed, F. T. Miles, M.D.,
Baltimore; J. S. Jewell, M.D., Chicago; E. C. Seguin,
M.D., New York.
Iodide of Lithium. — Iodide of lithium is said, by a
writer in the British Medical Journal, to be the most
useful of the lithium salts in the treatment of gout. Not
only is it serviceable in well-developed cases, but also in
the varieties of eczema and dyspepsia which are of gouty
origin.
Dr. Richard Meade, who became so famous in the
seventeenth century, made himself remarkable among
other things as the doctor who fought a duel. It was .
with Woodward, who had not only attacked him in his
writings but had insulted him in public. Matters came
to a climax one day when they were leaving Gresham
College, and Meade's patience gave way. He drew and
called upon Woodward to defend himself It is related
that Meade succeeded in disarming Woodward and telling
him to beg for his life. " Never, till I am your patient,"
was the reply.
A Famous Prescription for Epilepsy in the eight-
eenth century was made from the corvus epilepticus or
anti-epileptick crow. It is given by Ashton in " Social
Life in the Time of Queen Anne," as follows :
I^. Of raven's flesh in powder 3 i'j-
Viper powder 3 J-
Native cinnamc^n 3 j-
Mix and make a subtile powder for two doses, to be
given at night on going to bed.
Longevity of Medical Men. — \ London paper
notes that tluring the year 1S82 twenty English medical
men died at an age varying between seventy-eight and
ninety-six.
Dr. W. W. D. Parsons, of Fultonville, N. Y., writes to
say that he is not the gentleman to whom reference was
made in the paragraph published in the issue of February
24th, on page 213.
The Medical Record
A Weekly yoiLi-nal of Medicine and Surgery
Vol. 23, No. II
New York, March 17, 1883
Whole No. 64s
©trigitial %tzXviXz&,
ON THE
RELATIONS OF MICRO-ORGANISMS TO DIS-
EASE.
The Cartwright Lectures, delivered before the
Alumni Association of the College of Physi-
cians AND Surgeons, New York.
By WILLIAM T. BELFIELD, M.D.,
LECTUKER ON PATHOLOGY, AND ON GKNITO-URINARV DISEASES (POST-GRADUATH
course), rush MEDICAL COLLEGE, CHICAGO.
Lecture III. — (Continued).
The numerous examinations of tuberculous tissues re-
vealed occasionally bacteria, which the discoverers were
but too willing to consider the cause of the disease ;
Klebs, Schiiller, and Aufrecht severally announced but
failed to demonstrate that the infective agent had been
found and that it was a bacterium. The lack of evidence
in support of their statements, as well as the reserve
with which such assertions in general were received,
combined to reduce to a minimum the attention bestowed
upon them. Such was the state of affairs when Koch
read before the Physiological Society of Berlin a paper
whose contents were in forty-eight hours telegraphed
over the world. Koch's statements are so familiar to all,
that detailed repetition would be superfluous ; they may
be summarized in the assertion that the active agent in
the induction and propagation of tuberculosis is a distinct
species of bacterium, a bacillus ; that tuberculosis does
not occur without the presence of this organism ; that
conversely all those anatomical changes and only those
should be called tuberculosis whose point of departure
from the normal condition is the- presence and vital ac-
tivity of this bacillus ; hence, general and local miliary
tuberculosis, cheesy pneumonia and bronchitis certainly,
fungus-joint granulations, scrofulous inflammation of
lymph-glands probably, and the pearl disease of cattle,
are etiologically identical. The point of chief interest is of
course the assertion that tuberculosis and cheesy pneumo-
nia, pulmonary consumption, are caused by the bacillus.
The evidence in its favor is first the experimental work
of Koch himself, and then the unanimous confirmation
of those of his statements which have been already tested.
His experience with and knowledge of bacteria found
in the animal body is by general consent admitted to be
excelled by that of no other observer ; his caution and
conservatism and the accuracy of his methods are such
that, although he has for eight years been constantly
working and frequently wiiting on this subject, he has
never as yet been detected in a single error of observa-
tion ; his facilities and opportunities in the Imperial Ger-
man Health Bureau are unexcelled. The confidence
and good will of government and people alike — for
Koch's is an official position, you know — would be de-
stroyed by any ill-executed observations, or by any in-
judicious and untenable assertions in this, the most im-
portant and widely circulated of all his works. That
Koch appreciated the situation 'is shown by his course in
the matter : having discovered the bacilli in tuberculous
tissue, he did not send an announcement to the Academy
of Sciences nor blazon it through the medical press ; he
kept it to himself, satisfied himself that this was a con-
stant, not an occasional or accidental association ; that
the same bacteria were present in the spontaneous tuber-
culosis of animals— the hog, chicken, ape, guinea-pig,
and rabbit ; then he devised, by experimentation, a proper
medium, solid of course, for cultivating the organisms
outside of the animal body under constant microscopic
supervision, comparing them with fresh bacilli from tu-
berculous tissues ; satisfied himself again by personal
experiment of the inoculability of tuberculosis ; found
that while vaccination of the rabbit or guinea-pig with
fresh tuberculous matter induced the disease, inocula-
tion with such material after lying in alcohol for a
month or dry for two months, was impotent to cause the
disease, and contained no living bacilli / found that the
bacteria were often, not always, present in the sputum of
tuberculous patients, but never, so far as examined, in
that of others. Having thus made a preliminary investi-
gation, Koch proceeded to the experimentum crucis with
bacilli which had grown from the tuberculous tissue under
his eyes ; which were therefore proved to be the progeny
of the original ones, not by the theory of probabilities,
not simply by their identical size, shape, and chemical
reaction, but by the fact that he had seen them proceed
from the first as continuities of structure ; which were
seen under the microscope to be quite free from any
foreign solid matter, bacterial or other; which were
proven to be equally free from any foreign matter in
solution because growing in successive cultures upon
solid soil ; which had been carried from the first to the
eighth generation ; which had been thus isolated from
the original animal tissues three, four, five, even six
months. With these isolated descendants of the bacilli
found in tuberculous tissues, Koch inoculated numerous
animals— using over two hundred altogether— not only
the susceptible rabbits and guinea-pigs, but also cats, a
dog, white rats which had resisted inoculation by injec-
tion and by feeding with tuberculous materials, and field
mice. Inoculation was made in the skin, the abdomen,
the eye. In every case tuberculosis and tubercle bacilli
were found in the infected animal.
Having spent iivo years in the completion of this work,
amid all the facilities of the imperial laboratory ; having
meanwhile permitted himself no public intimation of the
same, Koch quietly announced his results at a regular
meeting of a medical society, with as little ostentation as
if he had merely appropriated a chapter from Ziemssen.
One whose knowledge of bacteria and of disease is not
such as to permit a technical appreciation of Koch's
work, cannot help seeing in the unobtrusive, systematic,
and undeviating work of two years, and in the modest
announcement of the result, that Koch's work is not to
be classed with that of Klebs, or Letzerich, or even Pas-
teur. I would call your attention to the fact that Koch's
assertion embodies not a theory, but simply an ocular
demonstration. If a man is seen to plunge a knife into
the heart of another the killing is a fact, not a theory ;
if Koch saw tuberculosis invariably follow the introduc-
tion of isolated bacilli, the relation of cause and effect is a
fact, not a theory. There is only one possible escape (I
use this word intentionally out of regard for the prejudices
of many friends) from the conclusion that the bacillus
causes tuberculosis ; and this forlorn hope is the possi-
bility that Koch did not see what he says he saw— that
he made some vital error of observation. This is of
course possible, though if true it will be the first error
282
THE MEDICAL RECORD.
[March 17, 1883.
that the most searching scrutiny could ever detect in his
observations ; that it is improbable is evident.
If we accept Koch's observations as accurate, there is
only one conclusion — that these bacilli cause tubercu-
losis. For here the conclusion and the observation are
identical ; this is not a deduction, but a demonstration.
And how shall it be decided that this work is or is not
free from errors of observation ? Certainly not by say-
ing that it cannot be so ; not by exhuming Niemeyer's
buried argument that tuberculosis is not infectious ; but
simply and solely through the repetition, by competent
observers, of the same work. Until such repetition shall
detect serious errors of observation, Koch's work stands
unchallenged — more accurate and complete investigation
can scarcely be conceived. On the other hand, until
such repetition shall confirm Koch's observations, we
may justly decline to accept them unreservedly, on the
ground that he may have made his first error in this
his greatest eftbrt.
While, however, Koch's main assertion, that the bacilli
cause tuberculosis, can be competently criticised only
by the few men who like himself have the time, facilities,
and skill necessary to conduct sucli tedious and delicate
experimental observations, yet some of the preliminary
assertions fall within the range of a larger circle of critics,
and have been already subjected to extensive investiga-
tion. The results are as yet unanimous in confirming
the original assertions of Koch that the bacilli are to be
found in the sputum from most though not all cases of
pulmonary tuberculosis, and, what is quite as significant,
have never been found in any other sputum.
Ehrlich, Balmer and Frantzel, Guttmann, d'Espine,
Lichtheim, Frankel, Ziehl, Heron, Gibbes, Green, West,
Yeo, Whipham, Councilman, have already recorded their
unanimous experience that while the bacilli are found in
the sputum in at least a large majority of cases of pulmo-
nary consumption and tuberculosis, they are not found
in any other disease. Balmer and Frantzel found them
always in their one hundred and twenty cases, but never
in bronchitis. Ziehl recognized them in nearly all of
seventy-three cases, but never in thirty-four other cases,
including acute and chronic bronchitis, acute fibrous
pneumonia, gangrene of the lungs — indeed all pulmonary
diseases that he had opportunity to examine. It should
be remembered that Koch failed to find them in the s|hi-
tum from a certain number of cases. In the tubercles
of tuberculosis and in the cheesy matter of consumptive
lungs the bacilli are usually present — not always, as
Koch himself discovered. Whether their absence from
certain tubercles is to be explained, as Koch suggests,
by the death of the organisms and their consequent fail-
ure to absorb aniline colors, or whether some of these
tubercles arise from other causes than the presence of
these, may be perhaps an open question. Gibbes' ex-
perience— that the bacilli are present in only one reticu-
lar nodule out of ten, but in nearly all non-reticular
tubercles — might, perhaps, support another explanation.
Certainly the absence of the organisms from tuberculous
tissue is the exception. On the other hand, the bacillus
is never found in the body except m tuberculosis ; the
only suggestion to the contrary is the recent assertion of
Koranyi that he found similar organisms in a case which
he believed to be pulmonary syphilis, and not consumi)-
tion.
Such, then, is the state of the case to-day : Koch's
assertion of the association of the bacillus with tubercu-
losis— its presence in every case of the disease, its ab-
sence in all other morbid conditions — confirmed by all
who have investigated ; his assertion of the causal relation
of the parasite to the process — based upon a demonstra-
tion unexcelled in the history of experimental science for
accuracy, clearness, and completeness — as yet unchal-
lenged.
The subject might be properly left here ; but I deem it
advisable to consider briefly two recent publications, not
because they demand consideration by one familiar with
the facts, but because they may have influenced some
who derive their information chiefly from American liter-
ature.
A few months ago there was heard a scream of exul-
tation from a Western journal, soon echoed on many
sides. The attention of press and public alike was at-
tracted to the jubilant cry that Koch, bacillus, and bac-
teria were to be annihilated ; that the " bacillary craze "
of German pathologists ; the absurd fancy that a small
organism could harm a large one ; the comical idea that
an experienced mvcologist should know more about bac-
teria than a practising physician ; the barbarous doctrine
that our loved ones could be subject to infectious dis-
eases ; all these and similar absurdities which pseudo-
scientists had vainly attempted to foist upon our superior
intelligence would be forever buried. The American
eagle, that implacable devourer of microscopic poultry,
would consent to leave for a brief time its favorite swamp
at the "delta of the Mississippi," and by a single act of
deglutition would teach our terrified friends, " the micro-
pathologists," to " take their eyes from their mounted
specimens," and engage in less disreputable pursuits. So
ran the widely advertised programme. After weeks of
joyous anticipation the appointed day arrived ; a distin-
guished microscopist, whose skill in mycology had been
amply indicated by his failure to detect the bacilli always
present in leprous tissue, appeared in the arena armed
with the startling discovery that if caustic potash solution
be added to fattily degenerated tissue, crystals of fatty
acid appear ! The announcement was greeted by the
audience of assembled experts with rounds of applause —
"Sic transit bacteria," etc. .\gain has free America re-
pelled the assaults of eftete Europe.
I had intended to ofler some remarks upon this matter,
suggested by the evident fact that Koch's bacillus and
Schmidt's crystal were different objects ; but criticism is
no longer necessary. Dr. Whittaker has stated the case
very clearly ; Dr. Hunt has shown that the crystal polar-
izes light, while the bacillus does not ; and I have re-
ceived from Dr. Schmidt a letter which disarms criticism.
After reading his article, I sent him a slide of sputum
containing the bacilli ; in his reply he says, "From what
I understand now the minute crystalline rods which I dis-
covered are not identical with Koch's bacilli ; " and
later, " the failure with which I met in my attempts of
staining the bacillus tuberculosis, appears to have been
due to the worthless aniline oil which 1 have used." I
interpret these sentences -as a candid admission that the
crystal and the bacillus are not identical, and shall there-
fore refrain from further remark. Such admission, by
proving sincerity of purpose, transfers to his friends of
the antibacterial "camp" the obloquy and chagrin con-
sequent upon the blare of trumpets with which this pub-
lication was heralded ; the mouse may be per se a highly
respectable and by no means ridiculous animal, though
its advent as the result of herculean eftbrts at parturition
is said to be very absurd. This entire matter can hardly
fail to teach far more eft'ectually than lectures, that trust-
worthy investigations on this subject demand not only
skill and ex|)erience in pathology, which Dr. Schmidt
undoubtedly possesses, but also acquaintance with the
special methods involved.
A paper called " The Bacillus Tuberculosis," by Dr.
H. F. Formad, of Philadelphia (^Philadelphia Medical
Times, November i8, 1882, reprint), opens witli the an-
nouncement that the author " will bring forward some
points from researches of my own, which will check the
acceptance of the doctrine of the parasitic origin of tuber-
culosis ; " " my anatomical researches will also surely
throw grave doubts upon the correctness of Koch's views
on the etiology of tuberculosis " (p. 2). The author fails
to discriminate between the bacillus and the infectious-
ness of tuberculosis, which is in this article, however, a
matter of little consetpience, except as an index to the
general accuracy of the publication.
The original researches which are to destroy the
March 17, 1883.]
THE MEDICAL RECORD.
283
" parasitic theory" consist, curiously enough, in the time-
honored demonstration that tuberculosis often occurs in
certain animals (notably the rabbit and guinea-pig) after
simple wounds, the irritation caused by glass, etc. ;
especially if the animals be carefully confined in a patho-
logical laboratory where many others have died of this
disease. As Dr. Formad has seen " more than one hun-
dred rabbits, out of five or six hundred operated upon,"
die of tuberculosis, we may infer that in his laboratory
there was no lack of tuberculous material for infection.
There is, however, one original feature in this work as
reported by Ur. Formad. Actuated doubtless by a com-
mendable high-tariff sjiirit of [jrotection for American
industry, while quoting copiously his own students, he
resolutely ignores the work of Burdon-Sanderson, Cohn-
heim, and a dozen others who have, during the last
fifteen years, performed the original experiments of
whicli his own are repetitions ; and neglects to state that
Cohnheim and Frankel found that while these ex[)eri-
ments succeeded admirably in the Berlin laboratory where
many animals had long been confined, no tuberculosis
occurred in a subsequent repetition in a private dwell-
ing. On the same princi|)le, perhaps, he neglects to
state that for such reasons as these, such experiments as
his own were years ago abandoned to amateur.s, while the
battle for infectiousness was fought and won in the eye,
the lung, and the intestine, as above stated. Perhaps Dr.
F'ormad will kindly explain how he came to deny the in-
fectiousness of tuberculosis merely on the strengtii of
these long since abandoned experiments, without a sol-
itary experiment, or even reference to an experiment, on
the eye, etc.
Because in his experiments no tubercular matter was
"intentionally or knowingly" introduced, he maintains
that nothing could have entered ; that the disease is there-
fore not specific nor infectious. Surgeons, then, intention-
ally and consciously inoculate their patients with py^emic,
diphtheritic, and erysipelatous material. It will not help
Dr. Formad to deny, as a New York microscopist in the
same dilemma has curiously done (Medical Record,
March 3, p. 247), that pyajmia is infectious. For in the
National Board of Healtli Bulletin, Sup. No. 17, Formad
asserts and attemi^ts to jirove the infectiousness of di|)h-
theria, and says (p. 18) : "A case may begin as one of
sthenic pseudo-membranous croup, and end as one of
adynamic dijjhtheria with blood-poisoning ; and in cases
of this character, not infrequently, no exposure to conta-
gion is discoverable." ' Perhaps he will explain why the
absence of intentional or conscious inoculation, even of
discoverable exposure to contagion, is perfectly com-
patible with the infectiousness of diphtheria, and yet
proves the non-infectiousness of tuberculosis. Formad
says (p. 2) : "I can positively prove that true tubercu-
losis may be produced without the bacillus in question."
The only proof adduced for this important statement is
the experiment with glass, etc., in which the disease oc-
curs without any " conscious or intentional " introduction
of the bacillus, and the assumption that the organisms
were therefore absent ; if, however, the parasites be never-
theless present in such cases, this assertion is evidently
unwarranted. We are not informed on this point in the
paper, although we may infer their presence from the fol-
lowing statement (p. 11): "Koch has discovered that
tubercle-tissue is ahvays infested by bacilli, and this is
correct." " To secure definite infonnation, I addressed
to Dr. Formad, some months ago, three several letters,
enclosing stamps, requesting him to state, for incorporation
in these lectures, whether he had examined these cases of
tuberculosis following wounds, mechanical irritation, etc.,
to ascertain the presence or absence of the bacilli, and if
so, with what result. To these letters I have received no
reply.'
1 It.ilics mine.
2 Koch, by the way, does not make this statement, which is, moreover, ttot cor-
rect, since Koch, Gibbes. Ziehl, Guttmann and others failed to detect the bacilli in a
certain number of tubercles.
3 If Dr. Formad shall reply to these queries- and for many reasons I sincerely
As to the association of the bacilli with tuberculosis,
Formad's limited observations seem to agree with Koch's
statements.'
The one novelty — which I am charitably disposed to
think explains the existence as well as the peculiar char-
acter of this paper — is a theory that the susceptibility to
tuberculosis is inversely proportional to the width of lymph-
spaces ; whence (by a process of reasoning peculiar to
the author) he makes the deduction that no etiological
influence other than inflammation and narrow lymph-
spaces is necessary to induce tuberculosis. It is useless
to remind Dr. Formad of the induction of tuberculosis in
the eye, lung, and intestine, since he ignores pathological
work which does not emanate trom himself or his pupils.
But since by a singular coincidence the rabbit and guinea-
pig — the animals exhibiting typical narrow lymph-spaces
— are peculiarly susce|)tible, the dog and cat insusceptible
to anthrax as well as to tuberculosis, I would suggest the
possibility that the etiology of anthrax also may be found,
not in a bacillus as the Europeans suppose, but in nar-
row lymph-spaces."
Dr. Formad promulgates the dogma (p. 3) "Scrofulous
beings " {i.e., those with narrow lymph-spaces) " can have
no other than a tuberculous inflammation, although it
may remain local and harmless." Are scrofulous beings,
then, assured against syphilitic, erysipelatous, diphtheritic
inflammations, or are these merely varieties of the tuber-
culous?
As yet the presence of the bacillus in sputum has pos-
sessed a confirmative rather than a diagnostic value, for
in the cases in which it has been detected the diagnosis
has been usually already assured by the physical signs.
Whether or not the bacillus may be present in cases
called chronic bronchitis, etc., where the symptoms and
the family history beget a suspicion not yet suijported
by physical exploration, must be decided in the future.
In this connection it may be proper to mention an in-
stance which has fallen under my own observation.'
A young gentleman of my acquaintance, in whose
family history there is no record of consumption, but who
had for months suflered from a persistent and annoying
cough, requested me one day to examine a microscopic
slide which he had prepared. The diagnosis was easy,
tubercle bacilli in sputum. He then informed me that
the sputum was his own. Physical exploration by one of
our most experienced physicians revealed subsequently
a circumscribed area of consolidation in the right lung.
Frankel has always found the bacilli in laryngeal ulcers
of tuberculous patients, but never in those of syphilitic
or other individuals. Barrow found them in the urine
from tuberculous kidneys in one case.
Not only the clinical, but also the anatomical investi-
gation already reported, confirm Koch's statement that
tuberculous tissue, whether occurring in miliary nodules
or as cheesy masses, whether in lung, or liver, or spleen,
peritoneum, or meninges, contain tubercle bacilli, and
that no other tissue harbors them. Some, it is true, find
a larger proportion than did Koch, of individual miliary
tubercles, in which no bacilli can be detected ; this is
particularly true of Ziehl's examinations. Gibbes found
the bacilli in reticular tubercle in only one nodule out of
ten, in the non-reticular they were usually present. Koch
was inclined to the belief that his failure to detect them
was due to the fact that the organisms had lost their vi-
tality, and hence their power of absorbing aniline dyes ;
and demonstrated instances in which a very imperfect
staining of individual bacilli was visible. This explana-
tion is certainly plausible, yet it is possible that tubercu-
losis, like individual tubercles, may be produced by any
hope that he may— he will perhaps state whether those letters were received : if so,
whether he answercil them ; if he did not, why not.
^ Paradox ; "Tubercle tissue is always infested by bacilli," yet "true tuber-
culosis may be produced without" them.
^ Dr. Formad will enlighten us, ni subsequent '* Pathological Studies," as to
what he will permit us to call '* true" tubercle, and annoimces that a student of his
is incubating a cognate topic. Possibly we may yet learn what constitutes '* true"
pus : and how many spirits can stand on a needle-point.
^ I have recently learned from my friend Professor VV. H. Welch, of New York,
that two essentially similar cases are known to him.
284
THE MEDICAL RECORD.
[March 17, 1883.
one of several causes. The clinical picture exhibits
many variations ; the histological structure is not peculiar
to tubercle. We have learned to distinguish trichinosis
from typhoid fever ; charbon symptomatique from char-
bon ; actinomycosis from pyiijmia and pulmonary con-
sumption ; indeed, Pfiug observed in the lungs of a cow
a miliary tuberculosis, and upon microscopic examination
was surprised to find that the individual tubercles con-
tained, not Koch's bacillus but the aciinoinyces bovis ;
this as yet solitary observation strengthens the suspicion
that among the numerous agents whose presence excites
the inflammation which results in tubercle formation,
there may be other parasites than the bacillus of Koch ;
that there may be several diseases etiologically distinct,
but anatomically so similar as to be included under the
common name tuberculosis ; the one characterized by
the famous bacillus, others, possibly, by organisms yet to
be discovered. In one instance, certainly, an analogv to
this supposition has become a demonstrated fact. For
thirty years it has been known that the disease called
anthrax or charbon is characterized by the presence of a
large bacillus ; yet in some cases the site of inoculation
was indicated not by a malignant pustule or carbuncle,
but by a local necrosis with subcutaneous formation of
gas. These cases were designated charbon symptoma-
tique. Kve years ago Bollinger discovered that the ba-
cillus found in the so-called charbon symptomatique is
another variety than the bacillus anthracis which charac-
terizes the malignant pustule — distinguished by both
morphological and physiological features. And now the
two diseases are recognized as etiologically distinct,
though anatomically and clinically almost identical.
To-day we can say with Schottelius, that one infectious
disease, one infectious tuberculosis, is characterized by
the presence of Koch's bacillus, though there may be
others, clinically and anatomically entitled to the same
name, which future research may distinguish etiologi-
cally from this tuberculosis, just as charbon sympto-
matique has been distinguished from charbon. Indeed,
some observers have already expressed the suspicion,
based on their own investigations, that there is more
than one bacillus tuberculosis.
The association of Koch's bacillus with tuberculous
tissues, and its absence from other structures, is there-
fore demonstrated and acknowledged ; and this fact,
taken in connection with Koch's own demonstrations,
constitutes an array of evidence which has induced nu-
merous German, Austrian, and English pathologists to
accept as a fact the vital activity of the bacillus as the
starting-point of the disease. Among these is Billroth,
whose acquiescence is notable not merely because of his
eminence as pathologist and surgeon, but because his own
elaborate researches upon bacteria, published in 1874 and
still widely quoted, led him to the conclusion that these
organisms appeared in human tissues as the result, and
not as the cause of morbid processes. Billroth, like the
German pathologists generally, is open to conviction.
Yet while we may have, probably have, found in this
bacillus the object whose presence is followed by tuber-
culosis, we may not forget that the appearance of the
disease implies not only the presence of this organism,
but also the existence of animal tissues which permit
the bacillus to exercise its vital functions. Many ani-
mals, even some rabbits, resist inoculation with the
freshest tuberculous material. There is, in other words,
a predispcjsition of the animal — an adaptation of his tis-
sues favorable to the growth of this organism. The palm-
tree cannot grow in Greenland ; the oak does not flour-
ish in the desert ; the bacillus anthracis and the bacillus
tuberculosis rarely grow in the body of a dog. And
it may not be forgotten in the excitement over Kocli's
discovery, that there remains much to be done in deter-
mining tile nature of this predisposition of the animal
soil to the growth of the tuberculous plant. Thus far we
are utterly in the dark. Dr. Formad thinks he discovers
a ray of light issuing- from certain narrow lymph-spaces.
If he will prove what he asserts, he will have made a
valuable anatomical contribution ; yet when we remem-
ber tliat rabbits and guinea-pigs are peculiarly susceptible
not only to tuberculosis but also to anthrax, and that cats
and dogs are as markedly insusceptible to the one disease
as to the other, it becomes evident that there nuist be some
factor in the common predisposition to both diseases alike,
which is not visible in the field of the microscope.
Indeed, with all due iionor to Koch, and admiration for
the most brilliant of experimental researches, we must ad-
mit that the discovery of the bacillus has chiefly an ana-
tomical value : it localizes in this organism the infectious
principle which had long been known to exist; it enables us
to distinguish — ante- and post-mortem — infectious tuber-
culosis from inflammation, tubercular or other, due to
other causes ; but it does not as yet explain the hereditary
predisi)osition, nor why this infection occurs in one man
and not in another exposed to the same influences.
A dozen questions should be considered in this con-
nection— the etiological identity of scrofula, tuberculosis,
and fungus joint granulations ; the possible infection of
the infant by the mother's breath and breast, by the ap-
plication of a handkerchief to the child's nostrils, etc.
Yet time permits a reference, and that but brief, to
one of the most important — the possibility of infection
from tuberculous meat and milk. For the so-called pearl
disease of cattle, while presenting certain histological
differences — an excess of calcareous salts, ascribable to
their vegetable food — from tuberculosis in man and other
animals, would seem to have an identical etiology ; since
inoculation with, minute pieces into the anterior chamber
of the rabbit's eye gives precisely the same result — local
and general tubeiculosis — as is induced by the same
quantity of human tuberculous tissue and by nothing else.
The effects of introducing the two into the circulation are
also identical. Indeed there now remain but few who
are not satisfied of the etiological identity of the two pro-
cesses, especially since Koch's bacillus is found to in-
habit both tissues. Yet etiological identity does not
prove the possibility of infecting the human subject
with tuberculous meat and milk. For it is a principle
that must be borne in mind — a principle which Pas-
teur, in his ideas of preventive vaccination seems to
have forgotten, by the way — that a material which
can infect a given animal when placed in the eye, may
fail when introduced into the alimentary canal or even
under the skin. Koch found, five years ago, that al-
though a mouse is so susceptible to anthrax as to be a
reliable reagent in testing the strength of anthrax material
when introduced subcutaneously, yet all attempts to in-
duce the disease in mice, as well as in rabbits, by feeding
them with anthrax tissues or spores, were quite unsuc-
cessful. Since anthrax bacilli grow best in a somewhat al-
kaline liquid, and not at all in one markedly acid, the
explanation may lie in the general acidity of the gastric
and intestinal secretions in the carnivora. But whatever
the explanation tlie fact remains.
Many experiments have been made to determine the
possibility of infecting animals by feeding them with tis-
sues and milk from tuberculous cattle. Gerlach, Orth,
Bollinger, Klebs, and Chauveau were almost invariably
successful with herbivorous animals ; but Colin, Giin-
ther, and MuUer saw only negative results. Virchow,
experimenting with pigs, achieved somewhat indecisive
eflects; and while not inclined to deny the identity of
the two diseases, he thinks it not yet experimentally
proven that tuberculosis can be induced in animals by
feeding them with such meat and milk. While we may
quite agree in this, yet when we consider Xhn probability
on anatomical and experimental evidence ; when we re-
member the peculiar frequency of intestinal tuberculosis
in infants, especially in those artificiallv nourished ; when
we think that thirty per cent, of certain herds of cattle
are, according to Professor Law, demonstrably tubercu-
lous ; we may be inclined to dispense with further direct
experimental evidence, and avoid such meat and milk.
March 17, 1883.]
THE MEDICAL RECORD.
285
(Dinoinal Avticlcs.
ROTHELN.
By D. N, kinsman, A.M., M.D.,
PROFESSOR OF I'KACTICE OF MEDICINE, COLUMBUS MEDICAL COLLEGE, OHIO.
In November, 1882, there was an outbreak of rotheln,
or " German measles," in the Ohio Institution for the
Deaf and Dumb. In this institution there are four hun-
dred and fifty inmates. The sexes are about equally
divided, and their ages range from six to eighteen years.
The pupils occupy four dormitories, two on each side of
the main building. In each of these dormitories there are
ninety beds, and one hundred sleepers. Two large halls are
used in addition for the temporary accommodation of those
for whom there is no place in the regular sleeping-rooms,
when the institution is crowded as at present.
These conditions are obviously most favorable for the
rapid spread of any infectious disease. During the win-
ter of 1873 and 1874, so far as I know, rotheln made its
first appearance in Central Ohio, when it was generally
prevalent in this region.
It is also quite clear that it was not generally recog-
nized as a new disease by the physicians, for during the
last nine years I have frequently met persons, laboring
under an attack of true measles, who asserted that about
that time they had measles, and they were then suft'ering
from a second attack. Occasional!)', since 1874, I have
met small groups of cases of rotheln.
The source of the infection which acted upon the in-
mates of the institution is unknown. I know of no cases
being reported in the city before this outbreak.
The school had been in session since September 15th,
much too long a period for the incubation of the disease
in any pupil who could have been infected during the
summer vacation. Therefore I am led to believe the
disease was brought to the institution by some one of
the many visitors, from all parts of the State, who are
daily seen there. The first case was sent to the hospital
on the afternoon of November 19th. The patient was a
girl of seventeen. She had an irregularly outlined papu-
lar eruption, resembling the exanthem of measles, except
that it was of lighter hue and in larger patches. Her
eyes were red and watery and quite sensitive to light.
She had some difficulty in swallowing. The throat was
red and the uvula and half arches covered with red
puncta. There was a hacking cough, and she complained
of tightness in the chest. Pulse, 100; temperature, 98.6°.
The eruption extended over the whole body and the ex-
tremities, being most marked on the back.
She said she had suftered from frontal headache and
nausea the day before.
Believing the case to be one of measles I gave orders
for her isolation, although I could not understand why
a case of measles with so extensive an exanthem should
show so little constitutional disturbance.
On the morning of the 20th the temperature was 98.6° ;
pulse, 90. The eruption had subsided on face and neck
so as to be barely perceptible, while it was yet distinct
on the portions of the body covered with clothing. The
congestion of the eyes and cough had subsided, and the
patient declared herself well.
The nature of the case was now evident, and the prog-
ress of the epidemic was from this time carefully ob-
served. Cases reported at the hospital as follows :
Girls. Hoys.
November 1 9th i o
" 20th I 12
" 2ISt I 4
" 22d 2 15
23d 5 7
" 24th 6 2
" 25th 2 2
" 26th 2 4
" . 29th I o
From the last mentioned date there was a subsidence
of the epidemic until December gth, when it again ap-
peared among the girls, and during the following five
days 27 had the disease, and on the 15 th i boy, mak-
ing a total of 48 girls and 47 boys, or 95 cases in all
among the mutes.
In addition, the assistant matron, a lady near fifty
years ; an officer, male, aged thirty ; two children of the
superintendent, and the daughter of the matron, were
attacked, so that the institution furnished just one hun-
dred cases.
All of the patients but five being mutes, it was diffi-
cult to secure as complete a history of the prodromes as
I could desire, and still more, to increase this difficulty,
many of the pupils who were attacked had entered the
school at the beginning of the term, and hence had a
limited knowledge of sign language. From the fact that
many were seized in the schoolroom and the eruption
was the first symptom noticed, I conclude in quite a
proportion of cases there were no prodromes whatever.
In some cases there was frontal headache, nausea, and
vomiting, with vertigo. The assistant matron suffered
much from headache and vertigo for twenty-four hours
previous to the eruption.
In all cases there was suffusion of the eyes and in some
abundant lachryniation, so that the tears ran over the
cheeks. There was also a hacking cough, but by no
means as severe as in measles. In one case I observed
an extensive eruption of urticaria, with headache and
nausea on one day. This was succeeded by an eruption
of rotheln on the following day, with a complete sub-
sidence of urticaria. In some other cases I observed a
general congestion and swelling of the skin of the face
and neck for several hours before the appearance of the
typical eru|)tion.
The duration of the protlromic stage was in most cases
twenty-four hours. The exanthem appeared first on the
face and neck, and in from two to six hours would de-
velop over the whole body. Sometimes the eruption
was slightly or not at all marked on the body and ex-
tremities, being hmited to the face and neck. In other
respects the eruption was subject to great variations. In
one group of cases the exanthem was fine and there was
a general blush of the integument, as in scarlatina ; indeed,
the resemblance to that disease was so close that in the
absence of other characteristic cases of rotheln I should
have been obliged to regard them cases of mild scarlet
fever.
In another group of cases the exanthem consisted of
discrete |)apules, from one-eighth to one-half an inch irr
diameter, closely resembling measles. Again, these pa|ndes
would coalesce in large irregular patches an inch in diam-
eter. This was especially the case upon the face of a
boy who had acne, and in two girls who had pustules
upon their faces. It was curious to observe the rapid
changes the skin would undergo.
A boy came into the hospital while I was making my
morning visit, his eyes were suftused and his tace was
covered with an erythematous blush. During the hour
I was e.xamining the other patients, the characteristic
exanthem appeared, and the congestion had marked itself
off into circumscribed territories around the papules.
In the evening the papules alone were visible, the inter-
vening skin having assumed its natural appearance. A
boy, aged seventeen, on the first day 01 the eruption,
had the ordinary papules ; on the second day, each
papule was surmounted by a vesicle. Some of these vesi-
cles were globose and the size of a small shot ; on the
third day the drying of the vesicles was advanced, and on
the fourth day complete. In this case the eruption was
confined to the face and neck, and the exposed surfaces
of the hands and wrists. There was no eruption on the
palmar surfaces. The eruption was in all cases elevated
and rough to the finger, and exfoliated in small branny
scales. The patients all complained of the itching. On
the decline of the eruiition I observed in three cases a
286
THE MEDICAL RECORD.
[March 17, 1883.
puffy condition of the integument of the forehead, and in
two cases cedema of the ankles. The urine was ex-
amined for casts and albumen with negative result.
The throat symptoms in all my cases were mild, in no
case did I observe false membranes or ulcerations. There
was a little swelling of the glands of the neck in a
few cases, and in the cases where this occurred it was
confined to the glands around tiie angle of the jaws. The
mucous membrane of the soft palate was, with the uvula
and tonsils, slightly swollen and dotted over with a mul-
titude of prominent points like "goose-flesh " of the skin.
In some of tne throats I noticed dark mottling of the
swollen membranes, which appeared to be due to minute
extravasations of blood. These spots remained after the
decline of the other symptoms, and were observed as late
as the fourth day.
The tongue was usually covered with a thin wliite fur
through which the papilh"e projected as red points. As
a usual thing, the appetite was good after the second
day, and was in no way iiupaired in the patients who
had no nausea. The bowels were not disturbed. Head-
ache was not severe in most cases, and the pain seemed
to be confined to the frontal region. There were six
cases in which the pain might be called severe, and was
associated with vomiting. A careful examination of the
cases in which the cough was worse failed to show any
thing wrong with the bronchial tubes. There was no ex-
pectoration attending the cough. The temperature in
one case reached 103°. Six cases registered 101.5°. ^
find ten recorded at 99.5°, while many reached 99°, but
the largest number showed 98.6°. Chilly sensations were
complained of frequently, and were especially noticed
in all the patients who could speak. The pulse was in
one case 110; most of the cases ranged from 85 to
90, while many never exceeded 80. I recognized no
special odor among these patients such as is described
by some writers. The duration of the eruption was usu-
ally three days. There was not a case in which 1 could
recognize it as late as the sixth day, even on the pro-
tected surfaces. There were no critical discharges. I
saw no decided complications. One boy who had the
exanthem on the 24th, on the 27th had a decided chill
followed by a croupous pneumonia. All of the patients
who could speak said their muscles were sore and pain-
ful on movement for some days after the decline of the
eruption. In four cases the fingers and wrists remained
swollen and painful for several days.
One child was confined to bed for a week after the
disappearance of the exanthem. In her case, in addi-
tion to the above-mentioned joint aftection, there was
general muscular soreness, which caused extreme suffer-
ing when she moved or when pressure was made upon
the muscles. The soreness was the greatest over the
extensor surfaces.
The disease is unquestionably contagious. The con-
tagion is not so active as tiiat of measles. The num-
ber of pupils attacked was twenty-one per cent, of the
whole. Only three adults suffered from the disease out
of about fifty who were employed in the institution,
sliowing thus a diminution of susceptibility with increas-
ing years. Of the mutes who suffered, twenty traced
their deafness to scarlatina. Many of them had had
measles, but as this was not lecorded as the cause of
their deafness in any of these patients I could not obtain
definite uiformation on this point. All these patients
recovered, which would seem to justif)' an absolutely fa-
vorable prognosis.
Evidently from what has been written on this disease
by British authors it is not always the mild affection
which has been observed in America.
J. Lewis .Smith says "it resembles varicella in general
mildness of symptoms, in the absence of dangerous com-
plications or sequeke, and in the imiformly favorable
prognosis, while its symptoms and history show its close
alliance with measles and scarlet fever."
Palmer says : " As the disease is so slight and devoid
of serious consequences no particular medicinal treat-
ment is required."
Hartshorne, in " Reynolds' System of Medicine," in-
dicates "an absence of any fatal cases.''
Aitken, however, in his " Science and Practice of
Medicine," gives an account of the lesions seen in fatal
cases, and describes a much more active and intense
form of morbid action than has ever been reported by
any American author. He says the prognosis requires
to be as guarded as in scarlatina, for, like scarlatina, ru-
beola is often an extremely rapid and fatal disorder."
Indeed, the account he has given, as to the duration and
gravity of the disease, would lead one to think he had in
mind some anomalous forms of measles and scarlatina,
or a true hybrid instead of rotheln, as we have ob-
served it.
Furtherjiiore, by comparing the accounts given by
Smith and Hartshorne with my observations, variations
in local epidemics can be observed.
CYSTO-ABDOMINALRAPHY.
By ALEX. W. STEIN, M.D.,
SimGEON TO CHARITY HOSPITAL, NEW YORK.
SuRGEON.s are not in accord regarding the best method
of dealing with a supra-pubic incision of the bladder.
With some tlie open method is invariably adopted, oth-
ers as uniformly suture the vesical wound, and drop the
viscus into the pelvic cavity to take care of itself While
both methods have shown good results, they are far from
being as satisfactory as could be desired. This will
probably be admitted by the most ardent advocate of
either procedure. The choice of a third and, as it would
seem, a very safe oi>eration, comes to us in the sugges-
tion to bring the bladder-wound in apposition and in
union with the abdominal wound. This jiroposition
dates back as far as 1716, Joh. Jacob Hoyt {" Unterricht
von den todtlichen wunden des ganzen menschlichen
Leibes "), but so far as I know has never been practically
carried out until recently by Dr. T. G. Thomas, of this
city, who, in the course of a laparotomy, found it neces-
sary to open the bladder in order to determine the upper
limit of the viscus which was adherent to the tumor.
After the removal of the cyst, the lips of the vesical inci-
sion were drawn up and clamped between those of the
abdominal wound by means of silver sutures. A Sims
sigmoid catheter was kept in the bladder. The sutures
were removed on the tenth day, and at the end of three
months the patient went home entirely well. As a sin-
gle instance of success can never establish the safety or
feasibility of an operation for general adoption, I sought
further evidence in tlie following experiments, the results
of which, I think, tend strongly to confirm our confidence
in the practicability of what may be called " cysto-ab-
dominalraphy. " The first three experiments were made
last winter at the American Veterinary College, the latter
five by my former assistant. Dr. R. H. Harrison, of Low-
ell, Mass., to whom, also, I am indebted for the notes :
Experiment I. — Brown dog. partly setter; weight
about 60 pounds ; three years old. Etherized ; supra-
pubic incision of abdomen. Bladder opened on the end
of a catheter, introduced through a previously made per-
ineal incision to the extent of an inch, and the vesical
lips brought together with the abdominal wound by
means of silk sutures. Lister's dressing ; catheter tied
in the bladder through perineal incision. Next day,
temperature, 104'^ F. ; pulse, 120; respiration, 18. No
aijpetite ; considerable depression. Catheter removed
thirty-six hours after operation. On the second day,
temperature, 102° F. ; pulse, no; respiration, 18;
drinks a little milk. l''rom this time dog rapidly im-
l)rovetl ; sutures remained five days, but urine escaped
through the abdominal wound. Granulations touched
with nitrate of silver. On the fifteenth day, wound en-
tirely closed ; urine passes /^r viam naluralum ; appetite
March 17, 1883.]
THE MEDICAL RECORD.
287
and spirits good. On the twenty-first day animal was
killed, and the bladder was found to be firmly adherent
to the anterior abdominal wall.
Experiment II. — Black Newfoundland bitch ; weight,
50 pounds ; aged four years. Operation same as in E.\-
periment I. Dressings of oakum applied over abdomen.
For six days temperature ranged from 102° to 106° F. ;
pulse, 100 to 14s; respiration, 18 to 24. A subcutane-
ous e.xtravasation of urine occurred, extending to the left
mamma, wliich afterward sloughed, leaving a large granu-
lating surface. The wounds, however, all healed, and
on the thirty-second day the animal was killed, and the
bladder was found adherent to the anterior wall of the
abdomen.
ExPERl.MENT III. — Poodle bitch ; weight 20 pounds ;
two years old. Operation same as before. Sutures held
for three days, after which healing by granulation. Dog
seemed in good health and spirits throughout. Fistula
closed completely in ten days. Killed on the twenty-
first day ; bladder found attached to the anterior abdom-
inal wall.
Experiment IV. — A cross-bred setter bitch ; four
years old, and weighing 40 pounds ; in poor condition at
the time of operation. Was fasted for twenty-four hours,
and operated upon under the carbolic spray. The op-
eration was performed as in the previous cases. Four
interrupted sutures of carbolized silk were used, and no
dressing of any description applied ; a harness was im-
mediately put on, so that she could not bite the part, or
tear the stitches away. Was then put in a dark place
and left alone for twenty-four hours. When visited was
somewhat stupid from the effects of the anresthetic, and
seemed unwilling to eat or drink. The pulse and tem-
perature were normal, and the respiration a little below
normal. The w'ound looked healtiiy ; there was some
inflanunatory swelling, but no discharge of urine through
the incision. As far as could be seen no urine had been
passed ; a catheter was carefully introduced, and about
one and a half ounces of high-colored urine was with-
drawn. Nothing was done to the wound except to spray
it for a few minutes with carbolic solution. On the third
day she drank a little beef soup, appeared quite in her
usual spirits, and passed her urine at two different times.
On the fifth day the stitches were removed, and she was
given her freedom and a generous diet, together with
gentle exercise. The wound has entirely healed by first
intention, and there has been no escape of urine through
the incision. Was allowed to run about the infirmary
for a week, and was then destroyed. Autopsy showed
firm adhesions between the bladder and the abdominal
walls. The bladder was healthy, and showed slight thick-
ening at the point of incision.
Experiment V. — A white bull bitch ; six months old,
and weighing 20 pounds ; in good condition. She was pre-
pared and operated upon as in the first case, and placed
under the same conditions of quiet and fasting. The wound
healed by first intention in the anterior two-thirds, the
remaining third by granulation. The reason of this ]iar-
tial failure was due, most likely, to the suture being tied
too tightly. There was no escape of urine from the
wound at any time, the animal voiding her urine naturally.
She was kept ten days after healing had taken place,
and then destroyed. The autopsy showed firm adhesion
of the viscus to the abdominal walls. The bladder itself
was hypertrophied, enlarged, and flabby, but otherwise
healthy.
Experiment VI. — .A. black and white cur dog; two years
old ; weiglit, 49 pounds ; in good condition. Before open-
ing the bladder a perineal incision was made to facilitate
the introduction of a catheter, which was afterward re-
tained in place by stitches taken in the surrounding skin.
The abdominal incision healed by first intention. The
perineal wound was nearly four weeks in closing, the urine
constantly dribbling away, until healing took place. On
post-mortem examination the bladder was found to be
firmly united to the line of the abdominal incision. The
urethra was constricted to about one-half its natural size
where it had been opened.
Experiment VII. — A hound ; liver and white ; seven
or eight yeai s old ; weight, 49 pounds. The operation in
this case was a repetition of the previous one, except no
catheter was allowed to remain. Healing with first in-
tention took place in the abdominal incision in four days.
The perineal incision healed by granulation, and the
urine, after the third day, escaped by its natural outlet.
Adhesions were well established in this case and the
bladder and urethra were healthy.
Experlment VIII. — A partly bred Gordon setter bitch;
nine months old, and weighing 53 pounds; plethoric.
This patient required an unusual amount of ether to effect
anesthesia, and during the operation artificial respiration
had to be jierformed. The following day the tempera-
ture was elevated to 105° F. ; pulse, 120 ; respiration,
60. There was much inflammatory swelling about the
wound, with a slight discharge of urine. A catheter was
introduced, but it gave rise to so much irritation that it
was not allowed to remain. For more than a week the
temperature was from 105° to 101°, the animal having
no desire to eat, but showing intense thirst. .A. fistulous
opening was present, through which the urine escaped
continually. This remained until she was destroyed,
twenty-five days after the operation. Autopsy showed
adhesions more marked than in any of the other cases,
and a fistulous tract, large enough to admit a silver probe,
leading from the bladder to the surface.
The bladder in the dog is covered on all sides by
peritoneum, hence our operations were intra-perito-
neal. In Experiments I., II., and III. we did not suc-
ceed in getting union by first intention. After three or
four days the sutures gave way, and healing went on by
granulation, with escape of urine from the abdominal
wound. Nevertheless, it was gratifying to note that ad-
hesions preventing the escape of urine into the peritoneal
cavity had already occurred thus early, and rapid closure
of the fistulous tracts ensued. In Experiment V. two-
thirds of the incision healed by first intention. In Ex-
periments IV., VI., and VII. healing occurred through-
out by first intention. In Experiment VIII. a fistulous
tract remained, sufficient to admit a silver probe, and it
is to be regretted that no attempt was made to close the
same, which undoubtedly could have been effected with-
out difficulty by the ai^plication of a suture. It may
therefore be said that our experiments have been uni-
formly successful. In all the cases firm adhesions be-
tween bladder and anterior abdominal wall were found to
exist. In the first two cases the dressings applied were
practically useless, and in the subsequent experiments
no dressings were used, the wound in each being oc-
casionally irrigated with carbolized water. A catheter
could be retained in only two of the dogs, and that with
difficulty for but a short period. We observed that in
nearly all the cases some hypertrophy of the bladder-walls
was manifest, induced, no doubt, by the abnormal at-
tachments of the viscus.
It is true that the peritoneum in the dog is very tol-
erant of injury, but not much more so than that of man,
as abdominal surgery has long since demonstrated that
the danger to life from injury to the peritoneum, so long
as no decomposable or septic fluid escapes and remains
in its cavity, is very slight indeed.
It is obvious also that the conditions of position, mode
of life, etc., of the animals experimented upon are such as
would militate against, rather than favor the success of
such an operation, while in man, quiet, recumbent pos-
ture, constant drainage of bladder by catheter, Listerism,
etc., are available factors which will contribute no little
to the safe and rapid union and healing of a cysto-ab-
dominalraphy.
A Boy describes the method of extracting a tooth in
this way : " The doctor hitched fast to me, pulled his
best, and just before it killed me the tooth cauie out."
288
THE MEDICAL RECORD.
[March 17, 1883.
INFUSION OF THE LICORICE BEAN (JEQUIR-
ITY, ABRUS PRECATORIUS) IN THE'TREAT-
MENT OF INVETERATE PANNUS.'
By EMIL GRUENING, M.D.,
PROFESSOR OF OPHTHALMOLOGY NEW ^■ORK POLYCLINIC.
There are conditions of vascularity and inliltration of
the cornea which resist every mode of treatment, reme-
dial as well as operative. As a last resort in these
desperate cases of trachomatous pannus, inoculation of
the eye with blennorrhoic or gonorrhoeic pus has been
])roposed, and in a number of cases successfully prac-
tised. The purulent inflammation of the conjunctiva
following this mode of inoculation often destroys the
granulations of tlie lids and clears the opaque cornea.
In spite of such favorable results, the treatment of pan-
nus by inoculation has not been generally adopted.
]\Iany surgeons are strongly opposed to it, and base
their objections upon the following arguments: i, the
introduction of pus, especially gonorrhoic pus, into the
eye of man, is in itself a revolting procedure ; 2, the en-
suing ophthalmia often gives rise to diphtheritic inliltra-
tion, which may destroy the eye; 3, the patient maybe-
come infected with syphilitic virus from urethral chancre ;
or, 4, may become affected with gonorrhoic arthritis.
This array of facts and possibilities is sufficiently po-
tent to deter both the physician and the patient.
Quite recently de Wecker, of Paris, published an ac-
count of a new method of rapidly causing purulent, or
rather croupous, ophthalmia in cases of inveterate pannus.
This method is said to possess all the advantages of inoc-
ulation, but none of its repugnant and perilous features.
De Wecker experimented with an infusion of jequirity,
or licorice bean, the seed of abrus precatorius, a shrub
belonging to the order of Leguminosas.
The infusion was jirepared in accordance with a for-
mula extensively used among the natives of Brazil. The
formula reads as follows : Pulverize thirty-two beans,
macerate them in five hundred grammes of cold water
during twenty-four hours, then add five hundred grammes
of hot water and filter imtnediately after cooling. Brushed
upon the inner surface of the lids, instilled into the eye,
or applied on linen compresses to the outer surface of
the lids, this infusion produces, within a few days, a
most decided croupous or purulent conjunctivitis, which,
after the discontinuance of the irritating agent, rapidly sub-
sides, leaving a previously trachomatous lid without any
trace of granulation, and a previously opaque cornea
without a vestige of infiltration and vascularity.
The gratifying results obtained bv de Wecker in his
cases of chronic granulation and corneal opacity induced
nie to employ the infusion in a few cases of inveterate
pannus. Several years ago a friend had sent me from
the West Indies a small quantity of the very pretty coral-
like licorice bean, and as I was still in possession of the
seeds, I ordered an infusion to be prepared according to
the Brazilian formula given above. This infusion proved
to be perfectly inert. My results were negative and are
recorded as such in the Transactions of the New York
Ophthalmological Society.
Inasmuch as these negative results might have been
due to the age of the bean employed, I procured an in-
fusion prepared of fresher seeds, and admitted, for the
])urpose of experimental study, two cases of granular lids
and inveterate pannus into the eye wards of the Mount
Sinai and the German Hospitals.
The first case was that of a little girl, ten years of age,
who had suft'ered from trachomatous pannus ibr a number
of years, without being benefited either by the perennial
application of sulphate of copper or the operations of
canthoplasty and peritomy.
The second case was that of a man, fifty-five years of
age, who had been treated eight months with sulphate of
copper in substance and the mitigated stick. His pannus
was very dense, and he suftered greatly from photophobia.
' Read before the New York State Medical Society, Albany, February 6, 1883.
The patients were treated in the following way : The
infusion of licorice bean was freely applied by means of
a camel's-hair brush upon the inner surface of the upper
and lower lids three times daily. The application is
painless. Compresses moistened with the infusion were
placed over the eyes and kept in position day and night.
This treatment was continued five days, during which
time the man suftered from frontal headache, loss of ap-
petite and sleep, while the child remained perfectly well,
and neither of the patients exhibited any rise of temper-
ature. With regard to the local changes observed in the
course of the treatment, I may mention that during the
first twenty-four hours no alteration was perceptible, but
that on the third day the lids were found to be much
swollen and their conjunctival surface covered with a
yellowish-white membrane, which adhered firmly in the
upper and but slightly in the lower lids. The cornea had
become much more opaque through an increase of vas-
cularity and infiltration. On the fifth day, when the treat-
ment was discontinued, all the changes had become still
more pronounced. I then ordered cold applications and
instillation of a saturated solution of boracic acid, and, to
my intense gratification, found that the improvement in
the condition of the eyes, following the jequirity treat-
ment, was so rapid and satisfactory that both patients
could be discharged ten days later. The inner surface
of their lids had become smooth and shining and the vas-
cularization and infiltration of the cornea had completely
disappeared.
These two cases fully corroborate the glowing account
given by De Wecker of the action of jequirity upon in-
veterate pannus. The limited experience thus gained is
most encouraging, and it seems probable that in this
infusion of the licorice bean a specific has been found
for a class of cases that hitherto resisted every mode of
treatment. More experience, however, is needed. Gen-
tlemen who have pertinent cases and wish to experi-
ment with jequirity can jM'ocure the fresh bean or the
infusion from Mr. Fingerhut, druggist, corner Twenty-
eighth Street and Fourth Avenue, New York City.
ENCEPHALOID SIMUL.ATING SLTBCLAVIAN
ANEURISM — LIGATURE OF RIGHT SUB-
CL.AVIAN IN SECOND PART OF COURSE.
By henry E. JONES, M.D.,
PORTLAND, OREGON.
(Reported by F. B. Eaton, M.D.)
Surgical literature, and especially periodic literature,
has chronicled a few narratives illustrating the unusual
difficulties involved in the difterential diagnosis of aneu-
rism when the existence of a tumor is suspected. No
form of tumor presents so many diagnostic difficulties as
encephaloid, and perhaps in no part of the body are
these difficulties so great as in the posterior triangles of
the neck.
The following history and operation will attest these
statements, as well as the unreliability of the history it-
self, so much depended upon as a means of diagnosis.
Moreover, it wall serve to emphasize the warnings so
often repeated in the text-books, while it proves their
limitations in i)ractice :
K , aged forty, an .American backwoods farmer,
consulted me October 15, 1882. He had been a hard
worker, for the i)ast five years, at wood chopping. A
year ago he first felt jiain in the right shoulder, and sup-
posed it to be rheumatic. Two months ago he first no-
ticed a luni]) had formed over the right collar-bone and
attributed its appearance to lifting. It throbbed when
first noticed, this throbbing being increased by fast walk-
ing and work. Four weeks ago he consulted two jjhy-
sicians, who said they heard a "bruit" and saw the lump
jiulsate, which inilsation was apjiarent to himself also.
The last time it [lulsated was three weeks ago, when,
while fixing a fence, he suddenly felt something give
March 17, 1883.]
THE MEDICAL RECORD.
289
way in the region of the tumor, and experienced such
severe pain that he could not rest. Heat and rubbing
allaj'ed the pain somewhat. Family all healthy except-
ing an older sister, who, however, had no trouble of this
nature.
The patient was a iiealthy, robust-looking subject, with
a fine color and complexion, the very oi)posite of cachec-
tic, the expression of the face being, however, a little
drawn and anxious. The right clavicle was displaced
upward, and behind and above it was a somewhat firm
swelling, extending about two inches posteriorly to the
clavicle. Below the clavicle, and occupying nearly the
whole pectoral region of that side, was a round swelling,
plainly continuous with that above the clavicle, measur-
ing seven inches in diameter and extending from the
inner border of the deltoid nearly to the sternum.
In the cut the timior is too heavily shaded, and the
risht clavicle not elevated as it should be.
....
One or two subcutaneous vems were famtly seen over
the centre of the convexity. It was soft and elastic to
the touch, having a cystic feel, but there was no fluctua-
tion, neither was there discoloration of the integument
or enlargement of glands. The appearance of the
swelling and venous injection gave me, at the first
glance, the impression that here was an encej^haloid,
but learning that a bruit had been heard, and in con-
sideration of the history, I advised perfect rest, in order
that the diagnosis might more readily be ascertained.
Accordingly he was put to bed and quiet maintained.
The pain now increased, aiiparently as a result of the
confinement. After ten days there was no marked
change to be noticed in the tumor, only a slight enlarge-
ment and some flattening. Deep pressure over the sec-
ond portion of the subclavian controlled the pulse, but
caused no perceptible difference in the tumor.
The question of diagnosis now lay between a diffuse
aneurism and a tumor ; the presumption being, from the
sudden disappearance of pulsation during exertion, that
it was the former.
An operation was decided upon as the only course
now open.
On the day of its performance the temperature was
101°. My purpose was to expose the subclavian in the
second part of its course, and, throwing a ligature around
it at a sufficient distance from the tumor to fulfil the
Hunterian principle (leaving it untied), to explore the
swelling by incision. My assistants, however, arrived so
late and the operation proved so difficult from the cla-
vicular displacement that the winter twilight of this north-
ern latitude was upon us by the time the ligature was
around the artery. It was decided, therefore, to tie the
artery, which was done directly behind the outer edge of
the scalenus aniicus. The ligature controlleil the pulse
))erfectly, and the wound was closed by sutures and
dressed antiseptically.
The tumor was then explored by plunging a hypoder-
mic needle and syringe into the aj^ex of the tumor and a
small amount of half-clotted blood was withdrawn. The
patient reacted well and collateral circulation was evi-
dently soon established, as the arm remained warm. The
temperature for three days remained uniformly at ioi°,
the only symptom of note being pain of some severity in
the right side of the neck above the wound.
On the morning of the fourth day the temperature
rose suddenly to 104°, and heavy sweating ensued. The
case ])resented now all the symptoms of septicasmia,
though the wound had been kejn carefully cleansed, and
the )iatient died on the night following the sixth day with
a tem|)erature of 107^°.
Autopsy. — Twelve hours after death. — Several of the
sutures had cut through and pus had formed in the wound,
burrowing a short distance \.\\) the side of the neck.
An incision was made over the most prominent portion
of the swelling, exposing the pectoralis major, which was
cut and reflected. The pectoralis minor was found
much stretched by the underlying prominence, but on
dividing and reflecting it, it was found to have no con-
nection with It. The tumor as now exposed was found
to be a large encephaloid, lying freely within, and filling
nearly the whole pectoral region, as well as a portion of
the axilla, extending as far back as the anterior edge of
the latissimus dorsi. Upward it extended under and
above the clavicle, which was considerabl)' displaced.
Its upper and inner extremity touched the scalenus ami-
cus, about one-third of its bulk being above the clavicu-
lar boundary line. In the vicinity of the wound the
tumor had, as a result of the operation, sloughed con-
siderably. The artery was found to be plastically oc-
cluded ; the ligation correct and complete.
The tumor was dissected out completely, and on pass-
ing a catheter through the axillary end of the artery, the
latter was found to pass through the substance of the
tumor, while dissection proved the vessel not to be in-
cluded in the morbid process. The most prominent
portion of the mass which had been aspirated was found
softened and full of black blood. The pleura and pul-
monary tissue were normal.
Remarks. — A due consideration of the patient's history
and symptoms, and of the position and attachments of
the tumor will make it apparent that diagnostically this
case is instructive as well as interesting.
To illustrate one remarkable simulation of aneurism
which this tumor aftbrds, it may be cited that in pla-
cing the ligature and clearing a space with the fingers
for the aneurismal needle, the i)ortion of the tumor
touched had a " feel '' precisely similar to that of a sac
containing blood. But more particularly the case serves
to demonstrate the unreliability of the so-called " scien-
tific tests" of aneurism, as well as the tendency of the
patient's own history to mislead. This patient was of
unimpeachable honesty and intelligence. The tumor
was in the course of a large artery when it fiist appeared.
Two physicians, one known to myself as thoroughly com-
petent, hear a " bruit," and see the ))ulsation ; the latter
ceases suddenly with the exact symptoms attending the
formation of a diffuse aneurism. In addition there was
neither cachexia nor glandular infection. My first opinion,
partly intuitive, proved correct, while the careful appli-
cation of systematic methods of diagnosis by myself, and
by several very competent surgeons in consultation, only
served to mislead. The negative result of as]:)iration by
a fine needle hardly coincides with Gross' assertion of its
value in such cases. He says (vol. i., p. 717, fifth ed.) :
" When no satisfactory decision can be arrived at, the
290
THE MEDICAL RECORD.
[March 17, 1883.
only resource is the insertion of a delicate exploring
needle, which, while it can do no harm, if it be properly
employed, will at once determine the diagnosis." Here
the half-clotted blood withdrawn only obscured correct
diagnosis.
Where the diagnosis remains doubtful it certainly seems
wise to expose the artery, adjust the ligature untied, and
then make an exploratory incision of the tumor.
Reports of Itospitals.
ST. FRANCIS HOSPITAL, NEW YORK.
Service of C. LELLMAN, M.D.,
.Reported by William D. Dietz, M.D., House Physician.)
CASESOF TYPHOID FEVER.
Since October ist, the commencement of the writer's
term as House Physician at St. Francis Hospital, there
have been treated in the service of Dr. Lellman, thirty-
one cases of abdominal typhus. A short epitome of the
histories of some of these may prove of interest as illus-
trative of various manifestations of the malady. In six
instances the disease terminated fatally ; one patient
being brought in moribund, and dying in short time.
Case I. — Typhoid fever — Pulmonary infarction —
Pneumonia — Pulmonary abscess — Pyopneumothorax —
Femoral embolism. — Anton H , aged nineteen, wig-
maker. Initial chill, September 22d ; admitted Septem-
ber 25th. The symptoms were of moderate intensity,
and under expectant treatment the patient soon improved.
On October ist, the morning and evening temperatures
were 99° ; the diarrhrea had ceased, the bronchitis disap-
peared, and the patient complained merely of weakness.
On the 7th, however, the morning temperature was 104°,
and signs of an incipient pneumonia, involving posteriorly
the lower portion of the left upper lobe, were present.
The inflammatory process was regarded as of embolic
origin, and embolism of other parts of the body was an-
ticipated. On the 8th, a pulmonary hemorrhage took
place, which recurred with less intensity on several subse-
quent days. A week later, sudden pain was experienced
in the right inguinal region, extending from there along
the course of the femoral artery ; the limbs felt cold and
numb, and the vessel imparted the sensation of a hard
cord in Scarpa's triangle. An occasional feeble pulsation
could be detected at Poupart's ligamijnt, but below this
point none. jMeanwhile, the pneumofiic process had ex-
tended, and had gone on to the formation of an abscess.
The pleura was perforated, and pyo-pneumothorax es-
tablished, to which cthe patient succumbed October lo,
1S82.
Case II. — Typhoid fever — Catarrhal pneumonia —
Femoral embolism. — Max W , aged twenty-six, mil-
ler. Initial chill, October 20th ; admitted October 26th.
The disease at first ran the course of an ordinary typhoid
attack, exhibiting intermittent tiiermometric fluctuations
in the fourth week. On November iSth, the morning
temperature was 99°. Later in the day the patient com-
plained of great pain in the right side, and [jresented
signs of a beginning inflammatory process of tiie base of
the right lung. On November 19th, the temperature was
103° in the morning, and 105° in the evening. The
pneumonia extended until it involved the right lung below
the middle of the fourth rib anteriorly, and the eighth pos-
teriorly. In the course of this complication tiie i)atient
complained of jjain in the left groin and region of the fem-
oral artery (December loth). Pulsations in the vessels
were found to be feeble and diminished in number at Pou-
part's ligament, and absent in Scarpa's triangle, in which
situation the artery was rigid to the touch. The limb
felt numb, and its temperature was lower than that of the
other side. By December 24th, all pulmonary symptoms
had disappeared, but collateral circulation had not yet
been perfectly established through the right lower ex-
tremity. January 24th : The patient has entirely recov-
ered with the exception of a certain amount of swelling
of the left lower extremity.
Case III. — Tvphoid fever — Double catarrhal pneumo-
nia— Otitis media. — .\nnie H , aged fifteen, domestic.
Initial chill, November 27th. Eruption on the tenth
day. The attack was a very severe one, and utterly
prostrated the patient, an ana;mic girl, in a short time.
For quite a period she lay at the point of death, in a
condition of stupor, low, muttering delirium, and ex-
treme subsultus. December 2ist : Temperature, 8. 30 a.m.,
98° ; 7 P.M., 101° ; 9 P.M., 105°. About 9 p.m. she had
several marked chills, the first indications of a pneumo-
nia which was to involve both lungs posteriorly from
apex to base. By January 5th the right lung, and by
January 17th, the left, had returned to their normal con-
dition. An otitis media developed itself on January ist,
but yielded to treatment in a few days. February ist.
The patient has entirely recovered.
Case IV^. — Typhoid fever — Intestinal hemorrhages —
Paralytic dysphagia — Fpistaxis — Otitis media. — George
E , aged twenty, tailor. Initial chill, September i8th ;
admitted October 2d. \ few days after admission the
patient had several profuse intestinal hemorrhages, which
jeopardized his life and served to increase an already
existing an»mia. Six weeks later, after the subsidence
of the typhoid symptoms proper, a paralytic dysphagia
manifested itself, the patient speaking in a thick unintel-
ligible, nasal voice, and complaining that he could not
swallow unless lying down, and that ingested fluids oc-
casionally passed out through the nostrils, or into the
larynx. At the same time he suffered from epistaxis to
such a degree as to necessitate the adoption of active
measures for its prevention. As a result, possibly, of
the entrance of ingesta into the unguarded Eustachian
tube, an otitis media developed (December 14th), which
gave rise to great pain and tenderness, hemicrania,
profuse purulent discharge, and considerable elevation
of temperature. On January nth, deglutition was
easier, speech more distinct, and the otitis had disap-
peared. The patient thereafter gained rapidly in weight,
and by January i6th was without fever, and could talk
and swallow as well as ever. He is now, February i,
1883, entirely cured.
Case \.— Typhoid fever— Parotitis.— W. V. G ,
aged seventeen, clerk. Initial chill, October nth ; admit-
ted October 23d. The course of the disease was quite a
severe one. The intermittent stage was reached on
November 6th. Two days later, however, the morning
temperature was 105°: the patient experienced a chill of
extraordinary severity, complained of pain and tender-
ness in the parotid region, and soon became delirious.
Well marked swelling of the gland occurred, and in the
evening the temperature rose to io6|-°. On November
9th, the temperature in the morning was 104!^°, and in
the evening 106°. On November loth, it was 104^°
and 106° respectively. The patient succumbed from
exhaustion, at 10 p.m., November loth.
Case VI. — Pneumotyphus. — Ludwig J , aged fif-
teen. The initial chill occurred on November 14th, and
the characteristic eru|)tion appeared on the fifth day. The
evening temperature of the last six days of the first week
was uniformly 105°. Throughout the course of the dis-
ease there was no diarrhoea, the bowels being rather in-
clined to constipation. The bronchial manifestations,
on the other hand, were exceptionally severe, bronchitis
occurring early, and soon associating itself with pulmo-
nary collapse and intense hypostasis. By December ist,
all bronchial symptoms had subsided, and by the middle
of the month the patient had entirely recovered.
Case V^II. — Abortive typhoid. — George O , aged
twenty-eight. Initial chill October 30th; admitted No-
vember 4th. The eruption and the early manifestations
were those of the " normal " typhoid of Niemeyer ; but
the highest temperature observed, on the seventh day,
March 17, 1883.]
THE MEDICAL RECORD.
291
was 1031°. In the second week theCe was but a slight
bronchitis, and the abdominal symptoms had entirely
subsided; the highest temperature attained was 104°.
In the beginning of the third week convalescence was
established, and the patient went on to his final recov-
ery without untoward accident. He left the hospital
December 18th.
Case VIII. — Typhoid fever — Croupous pliaryng^o-
tonsillitis. — Robert B , aged thirty-four, singer. Was
taken sick on November 30th, and admitted December
1 6th. At the time of admission, the abdominal and
bronchial symptoms had ceased, but the patient was ut-
terly prostrated. A croupous exudation involved the
pharynx, tonsils, the hard and the soft palate. In spite
of energetic stimulation, the heart gradually gave out,
and the patient died nine days after admission. The
autopsy showed recent typhoid intestinal ulcerations.
I^vogvcss of I^Mical Sckwcc.
The Mortality Referable to Alcohol. — At the
end of a long and carefully prepared report recently
drawn up by a committee of the Harveian Society, it is
concluded that there is, upon the whole, reason to
think that, in the metropolis, the mortality among any
considerable group of intemperate persons will differ
from that generally prevailing among adults in the fol-
lowing important particulars, viz. : a fourfold increase
in the deaths from diseases of the liver and chylopoietic
viscera ; a twofold increase in the deaths from disease
of the kidney, a decrease of half as much again in those
from heart disease, a marked increase in those from
pneumonia and pleurisy, a considerable increase and an
earlier occurrence of those from disease of the central
nervous system ; a marked decrease in those from bron-
chitis, asthma, emphysema, and congestion of the lungs,
a decrease nearly as great in those from phthisis, and a
later occurrence, or at least termination, of the disease ;
a very large decrease of those from old age, with an in-
crease of those referred to atrophy, debility, etc., and
the addition of a considerable group referred in general
terms to alcoholism or chronic alcoholism, or resulting
from accidents. — British Medical Journal, February 3,
1883.
Nocturnal Eneuresis, Treated by Voltaic Al-
ternatives.— Dr. Althaus writes, British Medical Jour-
nal, February 3, 1883 : " In June, 18S2, I was consulted
in the case of a boy, aged fifteen, who had suffered from
incontinence of urine during sleep, ever since he was
nine years of age. He had been treated with belladonna
and other medicines without relief; and as he was about
to enter a public school, where a continuance of this
trouble might have been particularly annoying, the par-
ents were very anxious that something more should be
done. The boy's general health was good, but he was
considered a nervous child, and highly sensitive. There
were no ascarides, but he had a very long prepuce which
could only with difficulty be retracted. There was, how-
ever, no suspicion of masturbation. Treatment by elec-
tricity having been recommended, I applied the middle-
sized circular cathode over the region of the blatlder,
and the large oblong anode (five inches by two) to the
lumbar portion of the spine. The current-strength 2.50
inilli-amperes for five minutes at a time. As after a few
such applications no material benefit appeared to have
been gained, I then added fifty voltaic alternatives pro-
duced in the metallic circuit. The night after this was
free froiu the usual annoyance, and the boy has made an
apparently uninterrupted recovery." Dr. Althaus prefers
this method of treatment to injections of nitrate of silver,
as recommended by Sir Henry Thompson. He believes
that belladonna is of value when eneuresis is distinctly
caused by undue excitability of the bladder.
Compound Fracture of the Femur, Erysipelas,
Py.«mia — Amputation of the Thigh — Subsequent
Exarticulation at the Hip — Complete Recovery. —
Barker describes a case under this title at great length.
The patient was a rivetter, aged twenty-nine, who fell
from a roof and fractured his femur. The case illustrates,
in the first place, what is, however, unfortunately rare in
experience, namely, the possibility of recovery from
pyaemia, even in a patient weakened by a most severe
injury, prolonged suppuration, and an attack of erysip-
elas. Secondly, it illustrates the feasibility in some cases
of amputating with the best results through the thigh for
compound fracture, leaving a second compound fracture
in the neighborhood of the hip-joint to be treated other-
wise later on, when the first amputation wound is healed.
Thirdly, it shows that, in such a case, it is possible to
exarticulate the whole of the remaining bone up to the
hip-joint, without re-amputation through the soft parts,
but through a moderate opening in the outer side of the
stump. — British Medical Journal, February 3, 1883.
Salicylate of Soda in Acute Orchitis. — Dr. Hen-
derson, of Shanghai, reports (Lancet, December 16,
1882) three cases of gonorrhoea! epididymitis in which
the symptoms were rapidly relieved by salicylate of soda.
In using it. Dr. Henderson advises that only acute cases,
i.e., those in which there is distinct rise of temperature,
be selected. The dose should not be less than twenty
grains, repeated every hour until at least three doses
have been taken. Afterward the drug is to be given at
longer intervals.
A New Treatment for Gonorrh(F,a. — A correspond-
ent writes to the Lancet concerning what he considers a
rational treatment of this comiuon affection. He gives
regularly five-grain doses of iodide of potassium, and full
doses of cubebs in powder, every three hours. The
cubebs in drachm doses he finds rarely fails to cut off
the ailment rapidly, and the iodide, besides its solvent
influence on the essential element of the powder, has
a well recognized action on the various mucous surfaces.
Electricity in Intermittent Fevers. — The treat-
ment of intermittent fever by electricity in the Medical
Clinic of Genoa, directed by Professor de Renzi, has
given very good results {Annali Univer. di Med.). Elec-
tricity was first tried in the treatment of intermittents by
Frank and Borsieri, afterward by Aldini, Cavallo, and
Puccinotti, and lately, after having been neglected for a
long time, by Bossi, of Rome, Sini, of Leghorn, and by
Shipulski, Deparquet, etc. In De Renzi's hands it gave
immediate and decisive results. He says that in the
majority of cases intermittent fever can be cut short
more promptly than by quinine. In nine cases he had
five complete cures, one marked improvement, one
slight, and two unsuccessful cases. He uses the con-
stant and the faradic currents ; the constant applied for
five to fifteen minutes in ascending direction along the
spinal column, the rheophores being placed over the two
extremities of the medulla ; the faradic of medium in-
tensity for half an hour, the patient holding a rheophore
in each hand. The faradic was more efticacious than
the constant current.
Frequent Tapping in Ascites. — Mr. Paterson, in
the Lancet, December, 1S82, mentions a case of cirrho-
sis of the liver in a woman, aged forty-two, in which he
tapped the abdomen with a small canula thirty-nine
times in eight months, drawing off altogether one hun-
dred and ten gallons of fluid. The treatment, however,
was only palliative.
The Therapeutic Use of Clay. — Dr. Saveljeff, of
Vladimir, confirms the results published by Drs. D. T. So-
koloff {London Med. Record, April, 1S82) and A. Masalit-
inoff [Lbid., November, p. 452). Having followed the
advice of Professor Botkin, he has since 1878 employed
clay-cakes in about one hundred cases of cardiac organic
292
THE MEDICAL RECORD.
[March 17, i!
diseases, cardiac neuroses, and palpitations, of every
kind, and invariably met with most remarkable success.
He takes common red clay (instead of SokoloiT's sculp-
tor's clay, or Masalitinoft"'s plaster of Paris), moistens it
with water until a thick paste is formed, makes a cake
of a palm's size and of a finger's thickness, and then ap-
])lies k to the cardiac region. Pain disappears within
eight to ten minutes, palpitation within ten to fifteen. A
cake dries in feverish patients in two to three hours, oth-
erwise in five, and then is to be changed. In conclusion
the author states that the Vladimir peasants from time
immemorial have employed red clay-cakes (all over the
body) as a cooling remedy in febrile cases of every de-
scription.
The Salicylates and Hemorrhages in Typhoid
Fever. — In the Briiish Medical Journal Dr. Fergusson
calls attention to the increased frequency of hemorrhages,
which he observed in typhoid fever patients treated by
tiie salicylates. He raises the question whether these
salts could favor the production of that accident. Dr.
Fergusson's successor at an infirmary noticed similar re-
sults, following the use of the salicylate of soda. The
latter gave ten to fifteen grains of the drug frequently,
while Dr. Fergusson exhibited the salt in half-drachm or
drachm doses at longer intervals. The question raised
by Dr. Fergusson still remains an open one.
Displacement of the Heart and Syncope in Pleu-
risy.— Dr. Tchirkofif has undertaken a series of experi-
ments on dogs in order to elucidate two points : first,
the causes and mechanism of cardiac displacements ; and
second, the causes of syncope in patients suffering from
exudative pleuritis. He has arrived at the following con-
clusions : I. In all cases of pleuritic effusion, the first
change in the position of the heart consists in a rotatory
movement round the long axis from right to left, the apex
invariably turning to the right. 2. This rotation depends
upon the increased filling of the right side of the organ,
in consequence of narrowing of the blood-current in the
l)ulmonary artery. 3. With increase of the exudation
and diminution of negative pressure within the corre-
sponding pleura, the difference in pressure between the
affected and healthy iileurK finds its expression in a dis-
placement of the heart toward the healthy side ; the
displacement to the right (i.e., in cases of left-sided effu-
sion) always being greater and developing more rapidly
than that to the left. 4. The apex and the base are dis-
])laced simultaneously, but the former in a greater degree
than the latter. 5. Positive pressure of an exudation
acts only on the distended pericardmm and mediastinum,
but not at all on the heart itself. 6. Therefore, any ex-
tensive displacement of the heart, under the influence of
sudden or forcible movements of a patient, cannot take
place, for the force of pressure is not excited on the
heart, but on various other very elastic structures. 7. In
cases of very considerable pleuritic eft'usions, no rotation
of the heart (from right to left) is usually observed ; the
organ may even appear rotated from left to right under
the positive jiressure produced by the exudation on the
right side of the heart. 8. The sudden death of jjleuritic
patients cannot be caused by displacement of the heart
and sudden compression of the inferior vena cava (as
liartels teaches) ; for neither experimental cardiac dis-
placements nor a few minutes' compression of the vein
in dogs could bring about any attack of syncope ; besides,
as it IS already stated above, any extensive displacement
of the heart in a pleuritic patient is ijnpossible. 9. As
the author's experiments show, a heart whicli is exhausted
from accommodative work in a case of the pleuritic effu-
sion may be easily and irrecoverably stopi)ed by irritation
of one of the vagus nerves ; from this experimental fact
^ he concludes that pleural inflanuriation spreading over
the mediastinum may exhaust the heart through directly
acting on the cardiac nerves, and so may produce an at-
tack of syncope. According to the author, syncope may
occur even in cases of scanty effusion, or after the oper-
ative removal of tiie fluid and after cessation of the com-
pensating work of the heart. .\s one of the causes lead-
ing to exhaustion of the heart, the author points out an
excessive quantity of carbonic oxide present in the blood
of pleuritic patients. In conclusion. Dr. Tchirkoff recom-
mends, while operating in empyema, to keep in view that
an exhausted heart may be easily stopped in a reflex way,
^.^i,'., in consequence of pain caused to the patient. —
London Medical Record, February 15, 1883.
Hypodermic Use of Iodide of Potassium. — Dr.
Gilles de la Tourette {Le Pr ogres Medicale, January,
1883) draws attention to the hypodermic use of iodide
of potassium. He found tliat it was possible to intro-
duce a syringeful of a solution containing 7.5 grains of
iodide of potassium, carefully neutralized, without caus-
ing any irritation. In twenty injections, only one caused
a slight slough. Some burning jiain was com])lained of,
which was usually readily allayed by gentle friction with
the palm of the hand. The drug was readilv absorbed,
and could be detected in the urine on the following day.
He thinks the method may be of value where there is
intolerance of the drug by the mouth, or in cerebral
syphilis with coma and inability to swallow medicines.
Chamo.mile Tea in Infantile Diarrhcea. — Dr. El-
liot advocates the use of chamomile tea in the diarrhoea
of young children (Practitioner, December, 1882). The
dose, for infants under one year, is one-half to one
drachm, and double that quantity for older children,
given two or three times a day, or oftener. The ra-
tionale of the action is the power the drug possesses of
subduing reflex excitability. This power belongs es-
])ecially to the volatile oil contained in the flowers. A
decapitated frog, previously fortified by a dose of chamo-
mile oil, was not susceptible to the influence of strychnia,
according to Grisan. He also calmed tetanic convul-
sions, due to strychnia, by the same oil.
Aneurism of the Brachio-cephalic Trunk cured
by Injections of Ergotin. — The subject was one Ra-
phael Beretti. A brother, fifty-four years of age, died
of aneurism of the thoracic aorta, diagnosed thirty-four
years before death ; it gave him no trouble until the last
few months of his life. Another brother died of chronic
heart disease. In the subject of this history there was
developed slowly and unnoticed a diffused true aneurism
of the arch of the aorta, of the brachio-cephalic trunk, of
the subclavian and right carotid : to this succeeded a
false sacciform aneurism of the brachio-cephalic trunk.
The cure appeared hopeless, but Dr. Angelini deter-
mined to try injections of ergotin, repeated twice a day
for a week, then every two days, every three, every five,
and so on for about three months. After four months,
the aneurism was reduced to half its former size, being
hard and firm, and the patient was able to resume work.
Dr. Angelini comes to these conclusions : i. Certain
aneurisms, even of arteries of large calibre, of slow growth,
can exist unobserved by the patient for many years. 2.
Chronic diseases of the arteries, of the cardiac valves, and
of the endocardium, have an hereditary predisposition, and
are not always due to the abuse of stimulants. 3. His case
encourages us to try hypodermic injections of ergotin in
ail such cases, as well as in aneurisms of small arteries.
— London Medical Pecord,¥e.hmSiry 15, 1883.
Inhal.ation of the Si'r.w of Iodoform and Tur-
pentine.— De Renzi and Rummo (Gazz. Medica Ital.)
claim good results in jihtliisis and other diseases of the
respiratory organs from inhalations of iodoform dissolved
in turpentine. The patients were made to inhale twice
a day for two hours, in a small room, the spray of iodo-
form and turpentine. The eftects wxre more satisfactory
than witii any other mode of treatment. There was al-
ways jirompt and considerable diminution of cough and
expectoration ; in bronchiectasis the fetid expectoration
was comi)letely deodorized. Physical signs diminish,
,he temperature falls, pulse and respiration are less fre-
March 17, 1883.]
THE MEDICAL RECORD.
293
quent. The secretion of urea is lessened in jiroportion
to the fall of temperature. Iodoform given by inhalation
is much more prompt in action than when taken by the
stomach ; it is an anaesthetic to the pulmonary vagus,
and has an alterative and drying local action, which is
aided by the turpentine. Its antiseptic action must also
be taken into account.
SuRc.iCAi, Dilatation of the Pylorus. — In an indi-
vidual suffering from pyloric stenosis from a cicatrix,
Professor Loreta, of P.ologna, after having made an in-
cision in the epigastrium, and opening the stomach, me-
chanically dilated the pylorus. The result was most
successful, since, on the seventh day, the phenomena
caused by the stenosis had disappeared, and the patient
was going on well in every way. — London Medical Re-
co?-d, February 15, 1883.
Some Points in the Treatment of Cardiac Disease.
— From a number of carefully studied cases of heart dis-
ease, Dr. Finny {Dublin fonrnal of Medical Science,
February, 1883) draws the following conclusions : i. That
too much dependence is not to be placed on the presence
of the physical signs of mitral regurgitation as evidence
of organic disease. 2. That such signs may be due to
purely functional derangement and weakness of the
heart, or to an altered condition of the blood. 3. That
blood-murmurs ))roduced in the heart and large vessels
may be louder than tlie murmurs due to valvular lesions.
4. That the danger of valvular diseases is enormously in-
creased by, if not directly due to, weakness of the
cardiac walls. 5. That increased action and force of the
ventricular contraction in the presence of valvular dis-
ease is not to be considered a disease, but rather a symp-
tom of disease, and is directly proportionate to the
amount of regurgitation or obstruction. 6. That mitral
regurgitation is not to be considered in the light of a
" safety-valve function " in cases of aortic obstruction,
but as an element of increased danger to life. 7. That
lowering treatment of the heart's force is rarely, if ever,
required in disease of the organ. 8. That indications for
treatment in diseases of the heart should be sought from
the evidence of the condition of the muscle of the heart,
and not that of the valves.
Two Hundred and Eight Consecutive Cases of
Abdominal Section. — Mr. Lawson Tait gives the follow-
ing analysis of his last series of operations occurring in
the period from March i to December 31, 1881 : Ex-
ploratory incisions, 13 cases with no deaths; incomplete
operations, 8 cases, with 4 deaths. Operations for
cystoma : one ovary, 36 cases ; both ovaries, 28 ; par-
ovarian cysts, 12; hydrosalpinx, 16; pyosalpinx, 20, or
112 cases, 3 deaths. Removal of uterine appendages:
for myoma, 26 cases ; for chronic ovaritis, 12 ; for men-
strual epilepsy, i, or 39 cases, 5 deaths. Hepatotomy for
h\ datids, 2 cases ; hydatids of peritoneum, 2 ; cholecyst-
otomy for gall-stone, 2 ; radical of hernia, i ; nephrotomy
for hydatids, i ; nephrectomy, i ; intestinal obstruction, i ;
solid tumors of ovary, 3 ; hysterectomy for myoma, 10 ;
cysts of unknown origin, i ; tumors of omentum, i ; pelvic
abscess opened and drained, 7 ; chronic peritonitis, 4, or
3S cases, 4 deaths. Total, 208 cases with 16 deaths.
These operations were not performed under carbolic
spray. ■ — British Medical Journal.
Cardiac Gummata. — An instance of this rare occur-
rence is reported in the Lancet. The patient was brought
moribund to the hospital. He had seemed well until a
fortnight previously, when he began to complain of faint-
ness and pain in the precordial region. On his way to
his work he suddenly staggered and fell, and was uncon-
scious till death. At the autopsy, the heart weighed
thirteen and one-half ounces. The pericardium over
the left ventricle was studded with pale yellowish-white
elevations ; there were also one or two over the right
ventricle. The endocardium of the anterior wall of the
left ventricle was studded with similar nodules. In the
septum was a mass of fibroid tissue extending into
the muscular substance, which was permeated by tissue
with gummatous characters. The smaller vessels were
narrowed by thickenijig of the intima. The liver had a
depressed fibroid scar in the right lobe. The spleen was
congested, firm, and adherent to the parietes. The
other organs were healthy.
Milk-diet in Grave.s' Disease. — Dr. Schnaubert
speaks very favorably of the value of exclusive milk-diet
in cases of exophtlialmic goitre. In one of his patients,
three weeks' treatment by milk restored digestion and
general health, and so greatly improved all symptoms,
that some weeks later the patient left the hospital re-
latively sound, and remained so nearly two years. At this
time she returned witli highly developed signs of the dis-
ease, and though the milk treatment again greatly re-
lieved the patient's condition, she soon died. The
necropsy showed hyiierplasia in the cervical sympathetic
ganglia, pigmentation of roots of the cervical nerves, and
cerebro-spinal hyperemia. — London Medical Record,
February 15, 1883.
The Significance of Changes in the Pulmonary
Epithelium. — Dr. Veraguth recently completed an in-
vestigation concerning the existence and pathological
changes of the epithelium lining the pulmonary alveoli.
Hy injecting weak solutions of nitrate of silver into the
lung-tissue of iiealthy rabbits he was able to demonstrate
the epithelial lining of the air-cells. This he found to
vary in difl'erent parts of the lobules. In the terminal
alveoli it was made up of small nucleated cells, of a
rounded or polygonal shape, while in those air cells
which branch from the sides of the bronchi similar cor-
puscles were collected into little groups surrounded by
irregular surfaces of flat, structureless, and unnucleated
cells. The composite membrane thus formed was joined
directly to the lining of the bronchus.
Veraguth also injected the trachea; of living rabbits
with solutions of nitrate of silver (one-half to four per
cent.) and killed the animals after intervals of from six
to sixty hours. From observation of the various stages
of pneumonia thus artificially produced, he concludes
that the origin of fibrin in the croupous exudation is in
the destruction of the flat epithelial cells just mentioned.
From this he thinks it is fair to assume that in pneumo-
nia of the human subject, the morbific agent, whether
infectious or not, produces the same fibrinous degenera-
tion of the unnucleated flat cells. — Correspondenzblatt
fiir Schweizer Aertze.
Unusual Modes of Discharge of Pus in Empy-
€MA. — Dr. Bouveret relates a number of cases of empy-
ema in which the discharge of pus took place through
unusual channels. He divides these rare cases into two
classes. In the first category, the pus works its way
into some of the neighboring organs. It may be dis-
charged through the oesophagus, the stomach, the intes-
tines, or the pelvis of the kidney. Or it may force itself
into the cavity of the peritoneum or of the pericardium.
Such occurrences are so extremely rare that they are
seldom diagnosticated during life. In the second class,
the pus perforates the posterior cul-de-sac of the pleura
and appears in the posterior wall of the abdomen. In
such cases the abscess may point in the groin, the lum-
bar region, the buttocks, or even in the thigh. The
prognosis does not appear to be more grave than when
spontaneous evacuation occurs through the chest-wall.
In case serious general symptoms continue after the
discharge of a migratory abscess, the author recommends ■
that the pleural cavity be opened and washed out as in
simple empyema. — Journal de Medecine de Paris, De-
cember 16, 1882.
Quain's Dictionary — A Warning. — On page 1181,
article phthisis, the dose of picrotoxine is given as grain
\ when it should be grain -g-'j.
294
THE MEDICAL RECORD.
[March 17, 1883.
The Medical Record
A Weekly yournal 0/ Afedici'ne and Surgery.
GEORGE F. SHRADY, A.M., M.D., Editor.
Published by
WM. WOOD & Co., Nos. 56 and 58 Lafayette Place.
New York, March 17, 1883.
THE CARDIAC MECHANISM AND THE DRUGS
WHICH ACT UPON IT.
The number of nervous centres in or connected with the
cardiac muscles has been much multiplied of late years,
and is now sufficiently confusing to the ordinary student.
These centres have, however, for the mammalian heart
in large part only a physiological existence, the exact an-
atomy not being determined.
The centres whose action is more generally brought
out in practical therapeutics are, ist, two sets of motor
ganglia in the heart-muscle, (a) one of which (corre-
sponding to Ludwig's ganglion) inhibits, [h) while the
other (corresponding to Bidder's, to Remak's, and to
Lowett's ganglia) excites contractions. In addition, we
have the heart-muscle itself, which some drugs seem to
act upon directly, either exciting or paralyzing it.
2d. These cardiac centres are connected with three
regulating centres, placed in the medulla and upper part
of the spinal cord : {a) The first of these is the cardio-
inhibitory centre, situated in the medulla, communicating
with the heart 7na the pneumogastric, and exercising a
continually repressive influence upon the rapidity of the
heart's beat. (1^) The second centre is in the upper part of
the spinal cord, and it sends weak accelerating impulses
to the heart via the sympathetic, {c) The third is the
vaso-motor centre, and it regulates the cardiac action
only indirectly. Nerve-tibres pass from the heart to
this centre (depressor fibres) which convey impulses de-
pressing it ; the blood-vessels dilate and the heart-beat
is slowed.
The nervous mechanism of the heart is made up of
a fusion of sympathetic and cerebro-spinal fibres and
cells, a fact which complicates its study. It should
be remembered, however, that the heart beats auto-
matically, and gets most of its motive impulses from
local stimuli.
Cardiac tonics, therefore, must act chiefly upon the
intrinsic mechanism, stimulating this or that motor-
centre according to the morbid conditions. In some
cases, however, a medicine may apparently be a car-
diac tonic when it really only affects the extrinsic
mechanism.
M. Germain See has recently written a chapter on
cardiac therapeutics in which he gives the following table
showing the special action of ditlcrent drugs on the
heart.
Stimulation. Paralysis.
Cardiac muscle. Digitalin. The same in the second
period of action. J
Iodine in small Emetin.
doses.
Camphor. Salts of copper, barium
and potash.
Caffeine. Chloral in large doses.
Scillaine.
Intra-cardiac muscular
motor centres.
Intra-cardiac inhibit- Muscarin.
ory centres.
Intra-cardiac ramifica- Nicotin.
tions of the inhibit- Pilocarpin.
ory filaments of the Calabar bean.
vagus nerve.
Trunk of the vagus Aconitin.
nerve. Nepalin.
Saponine in its last
period of action.
Iodine in large doses.
Atropin.
Fabarm.
Spartine in large doses.
Pilocarpin, second
phase of action.
Spartin.
Nepalin, second phase
of action.
Accelerator filaments Apomorphin. Spartin.
of the great sympa-
thetic.
Medullary cardio-in- Digitalin. Chloral,
hibitory centres.
Vasomotor centres. Bromide of potas- Croton-chloral.
slum. Hydrocyanic acid.
This list is by no means complete. Thus, to the stim-
ulants of the cardiac muscle we must add one or more
of the active principles of convallaria, and atropin should
be included as a paralyzer of the entire inhibitory
mechanism.
M. See's table, however, will show that the term "car-
diac tonic " is a vague one, and it suggests one important
consideration, which is, that in order to study scientifically
and carefully the action of drugs on the heart, it is ne-
cessary to use the isolated active principles singly at first,
and not crude preparations which contain a number of
them.
THE SICK IN C.'^SES OF FIRE IN .\PARTMENT HO USES
The recent burning of the Cambridge Flats, in this city,
with its attendant loss of life, has called out many com-
ments. One point, however, has been quite overlooked.
Of the four persons who occupied the fourth story of the
flats in question, the two who failed to escape were sick.
The young lady had been suffering from peritonitis and
had not yet been allowed to get up from her bed. The
mother was a hemiplegic with late rigidity and hardly
able to walk. It was owing to these facts more than
any others that their lives were not saved.
If one would draw a moral, therefore, it should be that
the so-called fire-proof flats should be provided with
means for the escape of the sick. A paralytic cannot
go down an ordinary fire-escape, and an exhausted fever
patient in the upper story of some of our city flats would
be almost at the mercy of any accidental conflagration.
The precaution of having extra watchmen and extra help
during sickness should at least be taken.
We would refer here also to another phase of the mat-
ter. It is well-known that many lives are lost simply
through the panic occasioned by the fire. This panic
could be averted in many cases if persons would only
habituate and train their minds to associate the emer-
gency of a fire with a certain definite plan of action.
This, of course, would involve a knowledge of all the
different modes of egress from the apartments and the
house.
March 17, 1883.]
THE MEDICAL RECORD.
295
THE TREATMENT OF ACUTE RHEUMATISM.
\
From the results furnished by an analysis of a large
number of cases of acute rheumatism, met in the primary
attack, and treated in St. George's Hospital London,
during 1877 and 1878, by Isanibard Owen, M.D., as
Medical Registrar, much valuable information is elicited
as to the merits of the salicylate treatment. These cases,
210 in number, were all recorded under the personal su-
pervision of Dr. Owen, and include all that occurred in
the hospital during the years named with the exception
of a few which were admitted in the Registrar's absence.
The methods of treatment adopted, embraced {a) the
salicylate of soda or ammonia in variable doses, alone
and in combination with full doses of alkali ; {d) the al-
kalies, or the same in combination with quinine ; (c)
iodide of potassium, alone or with alkali, bark, guaiacum,
or sarsaparilla ; and (<^) varying treatment. Of those
treated by the salicylate, in 85 cases the administration
of the drug was commenced in doses amounting to 3 iij.
or more in the twenty-four hours ; in 52 cases, 3 ij-> and
in 19 cases, 3 iss. were given during the twenty-four
hours. From several tabulated statistics, carefully pre-
pared from these results, it is noticed that a tolerable uni-
formity exists as regards the average duration of pain and
of pyrexia after the conunencement of treatment (by
salicylate), and that this duration is always independent
of the character of the case and of its previous duration.
A similar uniformity likewise prevails in the results of all
modes of salicylate treatment, showing that the duration
of the primary attack was unaffected by the amount of
the initial doses of salicylate, or by the combination of
full doses of alkali with the drug. A marked excess over
these is, however, noted in those cases treated by full
doses of alkali alone (or with quinine), the duration of the
primary attack being twice as long as under the salicylate.
Furthermore, a marked feature of the cases treated by
salicylate, especially when administered in large initial
doses, is the rapid subsidence of pain and fever, as com-
pared with the more regular decline of these symptoms
under other methods of treatment. Therefore, on the
average, a duration of a certain number of days under
salicylate involves much smaller amount of suffering than
the same number of days under alkali.
With the different modes of salicylate treatment, also,
the average residence in the hospital (including conva-
lescence) is found to vary, being shorter in cases of low
temperature. This total duration is further shown to be
independent of the character of the case and of the pre-
vious duration, but is favorably influenced by the combi-
nation of full doses of alkali with salicylate, more par-
ticularly where the latter drug is given in medium dosage ;
large initial doses tending to prolong convalescence, and
small doses showing hardly any greater advantage. And
although the primary attack is shortened by the use of
salicylate alone, yet the entire period of illness is not
lessened by this means. If combined with alkali, how-
ever, the advantage gained at the onset is sustained
throughout, and most markedly so when, under this plan,
the salicylate is given in doses amounting to about 3 ')•
in the twenty-four hours.
Regarding relapses, it appears that the tenc'ency is
practically the same under either salicylate or alkali, but
that the average duration of a relapse is twice as long,
or more, under the former treatment. The combina-
tion of alkaline with salicylate treatment apparently ex-
hibited no more effect in preventing a relapse than the
salicylate alone. In these cases, however, the admin-
istration of salicylate was stopped shortly after the disap-
pearance of pain and fever, hence this conclusion is ques-
tionable. Moreover, where salicylate alone was used,
pyrexial attacks without pain occurred during convales-
cence in all cases treated with large initial doses.
The information which these cases offer in regard to the
influence of salicylate on cardiac complications is of lit-
tle or no value. As to the benefit derived from quinine
in combination with this drug, the effect is found to be
nil.
Regarding the use of iodide of potassium and alkali
nothing of especial importance is developed. In a few
instances this treatment proved efficacious after the total
failure of salicylate, and z'iire vfrsa.
From the above, therefore, it will be seen that of these '
several plans, that which offers the greatest aggregate of
advantages is the combination of alkaline and salicylate
treatment, the salicylate being given in doses equivalent,
at the commencement, to 3 ij- in the twenty-four hours,
and reduced as occasion requires.
STATE BOARDS OF MEDICAL EXAMINERS.
We have always held that State Boards of Medical Ex-
aminers are the necessary means to the end of elevating
professional standards and nullifying the pernicious effects
of our present educational systems. There are, of course,
objections to such an idea. These come principally from
the smaller colleges, whose standards are low and the
chances for whose students in passing an impartial board
are comparatively few.
But opposition is not entirely confined to these schools.
Many of the larger colleges, or at least such as graduate
the largest classes, find it extremely difficult to settle
upon any plan that will be practical, and therefore satis-
factory to all concerned. There is a good reason for
this. It is quite natural for the colleges, great and small,
to guard jealously the power they possess to grant li-
cences to practise, without the intervention of State
authority. If any college corporation can consider itself
the beginning and ending of the law in the matter of li-
censing, there is not much more for it to desire either in
the way of educational influences or business prospects.
We can hardly expect that any school, under the cir-
cumstances, will be anxious for any change that may
curtail such privileges. When the change comes, it will
be the result of compulsion rather than choice. In the
meantime general professional sentiment over the coun-
try is leaning strongly toward the necessity of the estab-
lishment of State Boards of Examiners.
The latest testimony in favor of reform in college ex-
aminations comes to us in the scholarly address of Dr.
Thomas F. Wood, President of the Medical Society of
North CaroHna.' This gentleman informs us that North
Carolina has had a board of medical examiners in suc-
cessful operation for over twenty years, and as the result
'Trans. Med. Society North Carolina. Concord, N. C, 1882.
296
THE MEDICAL RECORD.
[March 17, 1883.
of its workings the character of the profession has been
elevated more than by any other means. Public opinion
is so much in favor of a law that guarantees proper qual-
ifications according to a fi.xed standard, that a young
physician no sooner settles in any part of that State than
the people begin to inquire if he has passed the board of
medical examiners. The license of this board is the es-
sential pre-requisite to holding any official medical posi-
tion for county or State, or indeed to maintaining any
professional standing whatever. During the jiast four
years we are informed that candidates have been exam-
ined from twenty-three different schools. No preferences
are given, no partiality shown. North Carolina has no
medical college within its limits, and fortunately is en-
tirely free to protect herself. The results have been
evervthing that could be desired.
A WAN'T MUCH FELT!
A Western medical journal, whose editors are also pro-
fessors in a local medical college, claims very emphati-
cally that our country has not medical colleges enough;
" and, // needs more" says our contemporary, italicizing
its disinterestedness and philosophy.
The same journal congratulates the profession upon
the organization and success of a new college at Omaha,
and of the probable establishment of another new college
at Toledo.
We can add to the pleasure of onr contemporary by
informing it of a report that two new colleges have also
been organized in Boston very recently, under the act
incorporating manufacturing companies.
It cannot be expected that the great body of the pro-
fession feels the need of new medical schools quite so
keenly as do those professors who are attached to them.
Still the majority is not always in the right, and it may
be that new medical colleges are just the things which
our beloved country most needs, in order the better to
round oft' its prosperity and accenttiate its greatness.
For our part, however, if we could be convinced that
legislative codes of ethics had efficacy, we should advo-
cate one that made it not only an ethical offence but a
medical crime, to establisli cheap two-term schools, os-
tensibly for the convenience of the community, but really
for the aggrandizement of local physicians. We shall
gladly welcome and support any new medical college,
Western or Eastern, which honestly undertakes the
higher medical education. Such colleges are indeed
needed ; but to say any part of our country wants more
of the ordinary kind of Cheap-John educational diploma-
factories is a monstrous excursion from the limits of the
actual.
THE SIGNTFICAN'CE OF THE BACILLUS TUBERCULOSIS.
Ix the present expectant condition of the profession re-
garding the significance of the bacillus of tubercle, some
experiments by Dr. Franz Ziehl, recently reported at the
Heidelberg Medical Clinic, will be of interest.
This gentleman examined the sputa in seventy-three
cases of phthisis, and found the bacillus in all instances
but one. In some other cases, where a diagnosis of
phthisis from physical signs was doubtful, the bacillus
was also found. Dr. Ziehl's final conclusions are : First,
that as a rule, the bacillus will be found in the sputa of
persons sufiering from pulmonary phthisis, but that to
this rule there are some exceptions. Second, that the
presence of the tubercle bacillus can sometimes be of
help in making a diagnosis in early and doubtful cases.
Third, that the absence of the bacillus in the s[Hita will
not permit one to exclude phthisis. Fourth, that the
number and developmental condition of the bacillus do
not furnish (as has been claimed) a basis for prognosis.
There is now considerable evidence, from various
sources that the bacillus is less often found in tubercle
tissue than in phthisical sputa. Especially is it difficult
to find these parasites in the nodules of acute miliary
tuberculosis.
A PHILANTHROPIST'S OPINION OF THE MEDIC.-^L
F.\CULTY.
In the annual report of the American Society for the
Prevention of Cruelty to .\nimals, for 1883, Mr. Bergh
gives his views on vivisection, the New York Legisla-
ture, and the medical faculty, as follows: "That sum
of all physiological villany, vivisection, which I again
recommended to the consideration of that sapient State
Congress which was characterized by a portion of the
press as 'a mob.' has been remorselessly, and, at the bid-
ding of a heartless and opinionated medical faculty, dis-
respectfully slaughtered as before ! " Mr. Bergh may
have some kindness of heart, at least for those who agree
with him, but he is certainly deficient in common sense
to claim that he is the only man on the jury entitled to
an opinion. Hence the medical faculty still persist in being
stubborn, and of course sentimental humanity sutlers.
PRESERVING THE BODIES OF THE DEAD.
Much attention is being devoted just now to the best
method of preserving the bodies of the dead. The novelty
of cremation has somewhat worn away, and though the
practice is increasing, it does not seem likely to become
popular in the present generation.
The subject of embalming has been most energetically
studied by various individuals, largely, we fear, because
there is thought to be money in it. Injections and washes
containing arsenic or chloride of zinc, form the basis of
most of the more conmion preservative solutions. It has
been recently stated that if organic substances are first
steeped in an alcoholic solution of nitrate of silver, wiped
dry, exposed to the action of hydrogen, sulphide, or
phosphide, and then immersed in the ordinary galvano-
plastic bath, they will keep for an indefinite length of
time.
A novel method of i)reserving dead bodies so that they
will not injure the living, has been proposed by Dr. A.
Mayer. He advises the use of glass cases, which, after
the introduction of the corpse, are sealed and thus made
perfectly air-tight. There arc two holes in the case.
Through one of them carbonic acid gas is forced until
all the atmospheric air is driven out. Both holes are then
closed. In this way bodies will remain preserved for
a considerable time, while their final decomposition can
do no harm by polluting the soil. It is not stated
whether these coffins can be manufactured cheaply, or
whether they would not be liable to become broken and
thus valueless.
March 17, 1883.]
THE MEDICAL RECORD.
297
THE DEATH-CURRENT.
The current of the Brush-Swan electric h'ght has an
electro-motive force of about two thousand volts. It is
nearly such a current as would be produced by a battery
of two thousand Daniell's cells. Its fatal effects have
been shown in several instances already. Tliis current
has heretofore been used chieHy in out-door lighting,
where the dangerous conductors are beyond reach. It
is now proposed, however, to utilize tlie current in
domestic lighting by means of storage-batteries. These
batteries, which are contained in large bo.xes, will be
[ilaced in the various houses ; they will then be regu-
larly charged by the two thousand volt current, after
which they will give off a harmless forty volt current to
the house. By this process it is claimed that the terrific
and deadly conductors of the principal circuit will be
made harmless. It is quite evident, however, that during
the time, each day, when the storage batteries are being
fed the wires leading to them cannot be touched without
dangerous or fatal consequences. It behooves those
who have the care of public health, therefore, to watch
the introduction of this storage system of lighting, and
see that it is done under proper precautions.
In tlie Edison system of domestic lighting a current is
employed of, it is claimed, one-twentieth the " intensity"
of the Brush current, and of "lower pressure." The de-
scription is somewhat vague, but probably means that the
current has a low potential. But assuming it is a cur-
rent of one hundred volts only, it would still be a disa-
greeable thing to pass through a fellow-citizen, and it
might be dangerous to children. In the introduction of
domestic illumination by electricity, the dangers of fire,
the danger to the eyes, and the danger to the person or
even to life are to be borne in mind.
THE KENTUCKY STATE BOARD OF HEALTH.
The attention of both the public and the profession has
recently been directed to this organization by the secular
and medical press of Louisville The Board was by no
means prepared by virtue of past services, efficiency, or
judicious management of its afiairs to stand criticii^m or
comment, and hence has suffered. Indeed, to those
members of the profession cultivating a laudable pride
in professional work in behalf of the public, it may be
said of the Board, as was said of tiie defendant in the
celebrated Bardell-Pickwick lawsuit, "the subject pre-
sents but few attractions." It has been discovered that
one member of the Board has never attended a meeting
since the organization of the Board. Another member
has not attended for a year or more, and the quarterly
meetings of the Board failed for want of a quorum two
or three times during the past year. The annual report
of last year came out bristhng with errors concerning the
ordinary lessons of vital statistics, as well as in other
matters relating to the public health. The major por-
tion of the appropriation entrusted to the Board goes to
the salary and office-rent of the secretary, which official
has recently delivered two popular lectures on public
health in the State. With this e.xception the Board has
done nothing in the interests of the public health or sani-
tary science. Very naturally, a bill to increase the ap-
propriation and powers of the Board failed at the last ses-
sion of the (ieneral Assembly. In consequence of recent
comments and criticisms upon the inefficiency of this or-
ganization, a convention of county and local boards was
called by the State Board to meet in Louisville on the
7th inst. This convention proved an utter failure. Only
ten or fifteen persons were jiresent, and not more than
four or five of the one hundred and thirteen counties in
the State were represented. The lack of co-operation
and confidence thus evidenced by the profession of the
State is much to be regretted. It is to be hoped that
the Board may by earnest work demonstrate its efficiency,
and thereby elevate the cause of sanitary science in the
public esteem.
MoRTALiTV FROM .\bortion.— A member of the N.
E. Divorce Reform League, Mr. S. R. Dyke, states that
over six thousand women die yearly in the United States
from attempts to destroy unborn children.
A Cremation Society in Chicago. — A cremation
society, with a capital of $100,000, is to be formed in
Chicago.
Three Deaths fro.m Chloroform have occurred in
Baltimore since October, 18S2.
Death in the Dentist's Chair. — The wife of a
prominent physician of Portsmouth, Va.,died March 9th
from the effects of chloroform administered previous to
the extraction of some of her teeth.
Pasteur's Reply to Koch is a long one and some-
what discursive. He answers Koch's charge that he
(Pasteur) presented nothing new to science at the
Geneva Congress last summer, by citing his communica-
tion regarding the mode of attenuating virus and his dis-
covery regarding the special septic effect of hydrophobic
saliva.
He says that while in 1877 he (Pasteur) had acknowl-
edged Koch's work ujion anthrax, yet Koch himself
had never referred to Pasteur's earlier studies in the
organisms of fermentation, the diseases of the silkworm,
etc. It was he (Pasteur) who made the first discoveries
regarding the life histories of these minute organisms. To
Koch's charge that pure cultures could not be obtained
by the flask method, he states that all the important dis-
coveries and cultivations of minute organisms had been
made by this method until recently. He refers to some
of Koch's statements as exhibiting " the impertinence of
error," and said that " before Koch was born to science "
pure cultures had been made and special disease organ-
isms found by numerous experimenters to whom Koch
himself was a debtor.
Koch's statements that the anthrax-vaccine is of doubt-
ful value Pasteur characterizes as another impertinent
error, and cites some recent statistics from the department
of Eure-et-Loire to prove it.
Medical Department University of Louisville.
— The Commencement exercises of the Medical De-
partment of the University of Louisville were held last
week at Macauley's theatre. The class during the past
session was a large one, though tiie number of graduates
298
THE MEDICAL RECORD.
[March 17, 1883.
was numerically smaller than that of last year, number-
ing only about seventy-five. The regular course at this
institution now covers a period of six months, and the
facilities for instruction, together with the clinical advan-
tages, are in accordance with the advancing standard of
medical education in this country. The address in be-
half of the faculty this year was delivered by Professor
Theophilus Parvin, and was thoroughly scholarly and in-
structive. This address we learn will be published in
pamphlet form.
Both the Kentucky School of Medicine and the Hos-
pital College of Medicine now hold their sessions in the
spring and summer months, instead of in the winter as
heretofore. The faculties of both these institutions in-
clude gentlemen of superior abilities as teachers of medi-
cine, and their duties are discharged with energy and
efficiency.
The Bill to Establish a Board of Health in
Pennsylvania is said to have been killed for this ses-
sion. The bill provided for a mixed board, with homeo-
paths and eclectics upon it. Opposition was met witli,
therefore, on the part of the regular profession. We fear
that an " unmixed " board cannot be established as long
as the atmosphere of Pennsylvania politics continues to
be purified and invigorated by that homceopathic states-
man, Don Cameron.
The Pseudo-Bacilli of Tuberculosis. — Dr. Schmidt
acknowledges, in the February number of the Chicago
Medical Journal, that the fat-crystals discovered by him-
self are not the bacilli of Koch. He thinks, however, that,
like the true bacillus tuberculosis, the pseudo-bacillus, to-
gether with the fattily degenerated cells, with or without
pigment, when found in the expectoration of the patient,
may prove valuable in the diagnosis of the case ; as their
presence must certainly indicate grave lesions in the
lungs. The particular quantity of fat found in the ex-
pectoration of the patient, which may be determined by
treating it with the solution of caustic potassa, also may
be of service, he thinks, in the diagnosis, as it will indicate
the grade of fatty degeneration.
The Twelfth Congress of German Surgeons
meets in Berlin on April 4th, 5th, 6th, and 7th. The
President, Baron von Langenbeck, will attend and pre-
side.
The Second German Congress of Internal Med-
icine meets at Wiesbaden April 17th to 20th. There
will be a debate upon the tubercle bacillus opened by
Ruhle and Lichtheim ; also a debate upon diphtheria,
and one upon the abortive treatment ot infectious diseases.
The Ter-Centenary of the University of Edin-
burgh will be celebrated in April next. Those ac-
quainted with Edinburgh medical politics state that the
glory of Edinburgh medicine and surgery has come from
the extra-mural school and not from the University.
The former school is said also to be two hundred years
older than the latter.
English and American .Medical Students. — The
total number of first year's students in England, in 1882,
was 6.^5. There were 371 of these in the eleven London
schools and 264 in the eight provincial schools. Thus
England, from a population of 26,000,000, furnishes 635
students yearly, while the United States, from a popula-
tion of 50,000,000, supplies about 3.500 or 4,000 students
annually, or between five and six times as much. Among
the four millions of people in the United States between
the ages of sixteen and twenty, one in every 1,200 wants
to be a doctor.
Modern Theories and Treatment of Phthisis
was the title of the Croonian Lectures recently delivered
in London by Dr. J. E. Pollock.
The Boston Water Board has been discharged as
incompetent to deal with the existing state of affairs.
The Commencement of the Albany Medical Col-
lege was held at Albany, March 7th. The graduating
class numbered fifty-two. Rev. E. N. Potter, D.D., de-
livered the address to the graduates, and Dr. W. D. Has-
brouck the valedictory.
The Alumni Association of the Albany Medical
College held its tenth annual meeting at Albany,
March 7 th.
A Fasting Doctor. — We are informed that a certain
Dr. F. T. Cook, of Taylor, Texas, has been outdoing
Tanner in the fasting line. On March 3d he had fasted
for fifty-five days " with the exception of a pound of soda
crackers, a small piece of Graham bread, and an occa-
sional glass of sweet milk " — which are important excep-
tions certainly. It seems to be a disputed question
whether the cause of the fast is a diseased stomach or an
affection of the heart. A local paper states that "while
the Doctor frankly admits being desperately in love
with a certain little lady, still he holds that a man can
love on an empty stomach quite as well as he can with
one filled with all the luxuries of life."
In the Case of the Hotel Bellevue, at Seabright,
N. J., recently tried, the jury failed to agree. The main
question was whether the sanitary arrangements of the
hotel were not so bad that typhoid fever was caused
thereby. Most of the expert testimony given was to the
effect that the fever had its origin in the hotel. The
case will be tried again. It is a most interesting and
important one.
Sir Erasmus Wilson has accepted the position of
President of the Egyptian Exploration Fund, and headed
the subscription list with a donation of $2,500.
The Annual Commencement of the Medical School
of the University of Maryland was held in Baltimore on
March 15th.
The Councillors of the Massachusetts Medi-
cal Society have voted that Columbus Medical College
be dropped from the list of medical colleges whose dip-
lomas are recognized.
Dental Service in Public Schools. — The Municipal
Council of Paris has arranged to have a periodical in-
spection of the teeth (as well as of the eyes and ears)
of the pupils in the public schools.
The Physiological Prize of the Acade.mie des
Sciences has been awarded to M. Dastres.
The Association of French Physicians meets in
Paris on April ist and 2d. The association is a political
one and will do no scientific work.
March 17, 1883.]
THE MEDICAL RECORD.
299
Louisiana State Medical Society. — The next meet-
ing of the Louisiana State Medical Society will be held
at Shreveport, La., April 4, 1883.
An "Exposition Gastronomique Internationale "
is soon to be organized in Paris.
PoRRo's Operation in Italy. — In a recent letter to
the Lancet, Dr. C. Godson says that Porro's operation has
been performed forty times in Italy, from May, 1876, to
February, 1S83. Fifteen women recovered, twenty-five
died, and thirty-one children were saved.
Commencement of Bellevue Hospital Medical
College. — The annual Commencement of the Bellevue
Hospital Medical College took place on the evening of
March li^'Cn, at Chickering Hall, and 166 students, com-
prising the graduating class, received their medical dip-
lomas. The Rev. Dr. Samuel Burchard opened the
exercises with a brief prayer. Professor Isaac E. Taylor,
M.D., president of the faculty, conferred the degrees.
Professor Samuel D. Gross, M.D., of Philadelphia, ad-
dressed the graduating class with words of good advice,
and Dr. E. A. Morgan, of the graduating class, gave the
valedictory.
Dr. W. T. Belfield, of Chicago, during his visit to
this city, has been the recipient of many marked atten-
tions from our leading practitioners, who have been in-
terested and edified by his admirable demonstrations of
the different bacilli. VVe are pleased to announce tliat his
course of lectures, now being published in The Record,
has given entire satisfaction to his audiences and has
realized the best expectations of all who are interested
in his line of study. We understand that during the
coming week he proposes to accept an invitation to visit
Philadelphia and exhibit his microscopic specimens and
the difterent methods of preparing the same. We be-
speak for him a cordial reception.
The Inoculation of Scarl.^tinal Virus as a Pro-
phylactic Against Scarlet Fever. — Dr. Stickler, of
Orange, N. J., is making some investigations in the use
of equine scarlatinal virus, to test its value as a prophy-
lactic against human scarlet fever. The results will soon
be published.
Asylum Poisoning. — Professor Mallet, of the Univer-
sity of Virginia, has testified that the poison used with
such fatal result in the Staunton Lunatic Asylum was
aconitine. It is believed that the latter was dropped in
the mediciue-cups by one of the patients, but the whole
affair is still involved in mystery.
Another Asylum Tragedy. — On March loth, at
Columbia, S. C. a lunatic in the asylum cut the straps
which bound his hands and then attacked a fellow pa-
tient, striking him on the head with a heavy piece of
wood, inflicting injuries which caused death.
Tenement House Cigars. — Governor Cleveland has
signed the bill prohibiting the manufacture of cigars in
tenement houses.
Commencement of University Medical College.
— The forty-second annual commencement of the Med-
ical Department of the University of the City of New
York was held at the Academy of Music on Tuesday
evening, March 13th. Professor Martin opened with
prayer. Ernest R. Birkins, M.D., of the graduating
class, delivered a well-written valedictory, and was gen-
erously applauded for his eftbrt. Rev. Dr. John Hall in
his address to the graduates bade them bring to their
life-work rules of honest, conscientious endeavor, to do
their best at all times and treat their fellow men fairly,
and they would meet with professional and pecuniary
success. The prizes were awarded as follows : Gold
medal to Robert George Bindrim ; silver medal to A. J.
Meuer ; bronze medal to Frank S. Halsey. Henry P.
Loomis, A.B., was awarded a prize of $500 for the high-
est standing in the class, and Leroy W. Mubbard gained
a prize of $300 for having passed the best competitive
examination in the seven general departments. The
honor men are : H. P. Loomis, L. W. Hubbard, W. M.
H. McEnroe, M. O. Bunn, F. D. Gray, E. Z. Brievo-
gelle, R. E. Bell, E. Le Fevre, G. D. Gregor, O. C. Lud-
low. The graduating class numbered one hundred and
sixty-four.
^Uuicius and 2]lotices.
A Guide to the Practical Examination of Urine.
By James Tyson, M.D., Professor of General Pathol-
ogy and Morbid Anatomy in the University of Penn-
sylvania, etc. Fourth Edition. Philadelphia : P.
Blakiston, Son & Co. 1883.
The fourth edition of this popular guide-book deserves
in all respects the favor which has already been be-
stowed upon the previous issues of the work. While
completeness is not one of the aims of the author, his
special object is fully accomplished, viz., to furnish short
and precise directions for carrying out urinary analysis
in such a way as to satisfy the needs of the practitioner.
The Functions and Disorders of the Reproductive
Organs in Childhood, Youth, Adult Age, and Ad-
vanced Life, considered in their Physiological, Social,
and Moral Relations. By William Acton, M.R.C.S.,
Late Surgeon to the Islington Dispensary, and for-
merly Externe to the Venereal Hospital, Paris, etc.
Sixth Edition. 8vo, pp. 267. Philadelphia : P. Blakis-
ton, Son & Co. 1883.
This little work, which has for so many years been the
leading one of its kind on the subject, has just been is-
sued by the Messrs. Blakiston as a sixth edition. The
entire field of sexual hygiene and sexual diseases is
thoroughly discussed in a calm and philosophic spirit.
The general practitioner will find in this interesting vol-
ume a safe guide for the treatment of all the affections
which belong directly or indirectly to the abuse of the
sexual functions.
Early Aid in Injuries and Accidents. By Dr.
Friedrich Es.march, Professor of Surgery at the
University of Kiel, etc. Translated from the German
by H. R. H. Princess Christian. Philadelphia : H. C.
Lea's Son & Co. 1S83.
In five short and clear lectures Esmarch shows how
non-medical persons may occasionally render great ser-
vice, perhaps even save a life, in those accidents which
are likely to happen at any moment. Popular explana-
tions of medical matters often leave the mind of the lay
reader beclouded with doubts and misgivings, or worse
than this, may foster the illusive liope that a physician's
counsel is needless. No such tendency is attributable to
the present collection of essays, and hence the advice
found in Esmarch's lectures, if properly heeded, can do
no harm, while it may often lead to much good. Of
course the physician is expected to be thoroughly fa-
500
THE MEDICAL RECORD.
[March 17, 1883.
miliar with all this little volume contains, and yet even he
may here and there derive a practical hint from a perusal
of its pages. Altogether, it is a creditable production,
and has lost none of its usefulness in the work of trans-
lation.
Proceedings of the Nebr.\sk.\ Sx.iXE AIedic.^l So-
ciety. Thirteenth and Fourteenth Annual Sessions,
1881-82. Omaha, Neb.
Besides the usual report of Society proceedings, the
views of many of our Western brethren in the different
departments of medicine and surgery are recorded in de-
tail, together with some interesting remarks relative to
Nebraska, on climate and its relation to disease, and to
physical and mental culture.
Quiz Compends — A Compend of Obstetrics. By
Henry G. Landis, A.M., M.D. With illustrations.
Philadelphia : P. Blakiston, Son & Co.
In this little book the author has furnished a series of
quiz lessons in obstetrics on the system of question and
answer. Throughout, while presenting the latest views,
etc., he has endeavored to maintain a strict neutrality-
unbiased by the teachings of various authors. Students
will no doubt find this a valuable aid.
A Man'u.-m. of Histology. Edited and prepared by
Thomas E. Satterthwaite, M.D., of New York,
Professor of Histological and Pathological Anatomy
in the New York Post-Graduate Medical College, etc.,
in association with Drs. T. Dwight, J. Collins War-
ren, W. F. Whitney, C. J. Blake, and C. H. Wil-
LiA.MS, of Boston ; Dr. J. Henry Sims, of Philadel-
phia ; Dr. Benj. F. Westbrook, of Brooklyn : and
Drs. Ed.mund C. Wendt, Abraham Mayer, R. W.
Amidon, a. R. Robinson, \V. R. Birdsall, D. B.
Delavan, C. L. Dana, and W. H. Porter, of New
York City. Second edition, enlarged and revised,
containing two hundred and two Illustrations, with an
Appendix. New York : W. AVood & Co. 1882.
A second edition of Satterthwaite's manual has quickly
followed the first issue. Indeed, the editor informs us
that so little time elapsed between the publication of the
first and the publishers' call for a second issue, that raili-
cal changes have not been introduced in the text. Never-
theless, certain essential alterations have been made, and
tW'O appendices have been added to the volume. The
first of these is by Dr. W. R. Birdsall, and embodies re-
cent discoveries made concerning the lymphatic system.
Dr. E. C. Wendt is the author of the second appendix,
which deals with the histology of the salivary glands.
His views on several points connected with the subject
are at variance wdth those of many observers. Thus he
does not admit the correctness of Boll's statements with
regard to the structure of the membrana propria. Boll
and others, it will be remembered, describe it as com-
posed of branching cells. Wendt holds that it is merely
a nucleated connective-tissue membrane, with superim-
posed or underlying branching corpuscles, the latter
never forming true constituent elements of the membrane
in (piestion. He also disputes the presence of cai)illary
secreting ducts between the gland-cells ; and further, he
is of opinion that the latter are never normally destroyed
in the process of secretion.
On the whole it may be said that Satterthwaite's man-
ual worthily represents the histological knowledge of to-
day, and it may be safely used as a guide-book by stu-
dents and practitioners.
The Illustrated Joirnal of Medicine and Sur-
gery. Edited by Geo. Henry Fo.x and Frederick.
Sturgis. New York : E. B. Treat & Co. 1883.
The first number of the second volume of this admirable
quarterly, is more than ordinarily filled with good things.
It contains excellent articles, beautifully illustrated as
follows : Dental Development, by Dr. William Hailes,
Jr. ; Case of Palato-|)haryngeal Sarcoma, by Dr. Johnson
Eliot ; Excision of the Shoulder-joint, by Randolph Wins.
low ; Cases of Compound Complicated Hare-lip, by Dr.
J. L. Little ; Cysto-adenoma of the Thyroid Gland, by
Dr. Charles Buckley ; Secondary Myeloid Disease of the
Pleura and I.iing, by Dr. William Osier ; Congenital
Union of the Fingers, by Dr. J. H. Pooley ; .-V Terato-
logical Contribution, by Dr. George J. Engelmann, and
an .Apparatus for treating Fracture of the Patella, by Dr.
J. S. Wight.
Nerve Vibration and Excit.ation as Agents in the
Treatment of Functional Disorder and Organic Dis-
ease. By J. Mortimer Granville, M.D. London :
J. & A. Churchill, .New Burlington Street. 18S3.
The use of mechanical vibration in the treatment of
various nervous disorders has been placed before the pro-
fession for several years. Dr. Granville, now for the first
time, however, presents the subject in a complete form,
stating the principles and results of the method. We are
much impressed with the evident honesty and conscien-
tiousness with which the author of this method puts forth
its claims. He has been studying and experimenting
with it now for nearly ten years, and he finally submits
the facts and hypotheses to the judgment and trial of the
medical profession.
Dr. Granville's theory is that the nerve-cell and nerve-
fibre, when functioning, are in a state of vibration, the
one in its matrix, the other in its partite sheath. In dis-
ease, the vibrations are disturbed, weakened, or destroyed.
In a beginning sclerosis, for example, the nerve-cell has
been prevented from normally vibrating, it atrophies
from lack of exercise ; in neuralgia, the vibrations pass-
ing along the nerve are abnormal in number or rhythm.
The object of treatment by mechanical vibrators is to
exercise the cell, or supplant morbid vibrations with others
that are either normal or harmonic with the normal.
To secure this, Dr. Granville has, after much experi-
mentation, devised a clock-percuteur, and also a per-
cuteur which goes by electricity, the latter giving much
the better results. With these he has a large number of
instruments for varying the character of the blow, e.g.,
discs, brushes, hammers, etc.
The author reports success with the use of his instru-
ment in a large variety of nervous diseases : neuralgias,
spinal sclerosis, neurasthenia, vaso-motor disturbances,
constipation, etc. In some cases of idiocy the applica-
tion of the percuteur has remarkabh' developed the in-
telligence.
Dr. Granville writes, on the whole, quite temperately
as regards the new therapeutical method which he has
fathered, yet he fails at times to conceal entirely the pro-
found faith which he feels in the great results it will
produce.
He applies his vibration theory very widely, and would
make it enter very largely into the pathology of all func-
tional nervous diseases.
It appears to us, and we believe it will to every reader,
that too much is made of vibrations in jjhysiology or
pathology. It is supposed that these vibrations are of
cells or their vital and organized elements, not of mole-
cules. This is a difficult hyjiothesis to admit, yet it is
not, of coarse, impossible. .\ point which is neglected,
however, is that of the chemical or nutritive activities of
the cells. These, in functional disease, are undoubtedly
altered, and there must be more important and funda-
mental factors in disease than mere vibrations, which
must, if they exist, depend upon them.
As for the practical part, there is no question that
good results can be obtained by mechanical vibrations.
The method has been employed in Paris by Boulet, and
also in New York, with as yet no definite results.
Castor Oil and Glycerine. — Dr. William Soper
claims that glycerine increases the purgative power of
castor oil when given with it. h preparation combining,
but not mixing these two, is active in teaspoonful doses.
— Lancet.
I
1
March 17, 1883.]
THE MEDICAL RECORD.
301
^U'-povts of fiocictics.
NEW YORK PATHOLOGICAL SOCIETY.
Stated Meeting, February 14, 1S83.
George F. Shradv, M.D., President, in the Chair.
(Continued from p. 277.)
CARDIAC DISEASE — THORACENTESIS — DEATH.
Dr. Van Santvoord piesented specimens accompa-
iiied by the following history : They were removed from
the body of a man forty years of age, who died in his
wards in the Randalls Island Hos|jital on February 8th.
He had obtained from the house-physician the following
rather scanty history : The man served in the United
States army up to 1876, and considered himself perfectly
healthy. There was no history of syphilis or rheumatism.
At that time, in consequence of a strain, as he believed,
a swelling developed in the region of the left testicle,
which has since remained without material change. Why
he was discharged from the army was not known. His
history since then could not be ascertained except that
the disease from which he died had existed for some
time. He was admitted into the hospital during the
month of December, when there existed general ana-
sarca except the face. There was evident hypertrophy
of the heart, and the first soinid was prolonged. There
was fluid in both pleural cavities. The patient suffered
from shortness of breath, and there was also found an
oblong swelling over the left testicle. He remained in
the hospital for some time and improved under rest and
the use of digitalis. His liver was also enlarged, and it
was said to have extended at one time as far down as
the crest of the ilium. Dr. Van Santvoord saw him for
the first time in January, and from that time u)) to
February 7th no special change took place in his condi
tion. Physical examination revealed hypertrophy of the
heart, the apex beating in the sixth intercostal space
and two inches outside of the nipple, reduplication of the
first sound at the apex, and also a reduplication less
marked of the second sound, heard at the apex but not
at the base. There was, besides, marked pulsation in
the epigastrium. There was also evidence of fluid in
both pleural cavities, over which, on both sides, there
was distinct bronchial breathing, although rather distant,
bronchial whisper and diminished vocal resonance. A
slight systolic murmur was heard over the apex, but it was
not transmitted. The liver iirojected into the abdomen
about two inches below the free border of the ribs.
CEdema still existed. Dr. Van Santvoord aspirated the
left side of the chest, and removed twenty-three ounces
of fluid which was clear serum. The bronchial breath-
ing disappeared. The normal respiratory murmur re-
turned with a certain amount of friction sound. The
patient bore the operation well, and he jiroceeded to as-
pirate the right side. After having drawn out thirteen
ounces of fluid an accident occurred to the apparatus by
which air entered the chest. Very soon the patient be-
came distressed, the distress became urgent, and within
ten minutes he was expectorating frothy material. There
was tympanitic resonance over that side of the chest, and
evidently considerable air had entered. An attempt was
made to withdraw some of the air from the pleural
cavity, but it was unsuccessful. The patient died of ex-
haustion at the end of twenty-four hours. At the au-
topsy the only thing noticed concerning the brain was
that it was slightly firmer than usual. On puncturing
the diaphragm through the abdomen air escaped from
the thoracic, cavity. The right lung was found collapsed
and carnified, but no sign of an external opening into
the lung was found. In the left lung there was com-
mencing pneumonia in the lower lobe. The heart was
markedly hypertrophied and dilated. The pericardium
was markedly thickened, and seemed to be undergoing
atheromatous change, especially along the line of the
coronary arteries, which were themselves apparently nor-
mal. A similar degeneration was found throughout the
endocardium, especially on the right side. The valves
were normal. The aorta was extensively atheromatous,
with a certain amount of cheesy degeneration in the ex-
ternal coat. There was no aneurismal dilatation. The
liver was enlarged and showed marked congestion of
the central portion of the lobules. The kidneys were
embedded in a mass of fibrous tissue one-third of an inch
in thickness and perfectly symmetrical, and separated by
a pultaceous cheesy layer. The kidneys were entirely
normal. The tiuiior of the testicle was a cyst containing
bloody fluid, the testis itself being not more than one-
third the size of the opposite one. Microscopic exam-
ination of the muscular fibre of the heart showed no de-
generation upon the left side, but exhibited a marked
tendency to longitudinal splitting of the muscular fibres.
On the right side the muscular fibres were in a condition
of not very far advanced fatty degeneration. Why heart-
failure sliould have developed was something not par-
ticularly explicable from the external examination.
the entrance of AIR INTO THE PLEURAL CAVITY,
AND ITS SIGNIFICANCE.
Dr. Gerster asked what the immediate symptoms
were after the entrance of air into the pleural cavity.
Dr. Van Santvoord said the patient complained
within two or three minutes of great dyspnoea; his respi-
ration became panting, and he passed into a state of
semi-collapse with cold sweat, and within ten minutes
began to cough, and ex|iectorated a frothy, bloody serum.
Dr. Gerster said he asked the question because he
thought the simple fact of air entering the pleural cavity
in a healthy individual would not be sufficient to produce
death. Doubtless, with the patient's bad general condi-
tion and his embarrassed circulation and respiration, this
accident was the last straw that crushed the camel. Pro-
fessor Kiinig recently removed an extensive tumor with
the entire sternum, and in performing the operation
opened both pleural cavities, and also opened the peri-
cardium, and air entered each of these cavities. The pa-
tient suffered no marked inconvenience, and survived the
operation, and made a good recovery.
Dr. Watson referred to a case in which air entered
the pleural cavity after an operation for necrosis of the
rib, and the patient died within forty-eight hours.
Dr. Gerster referred to the fact that of late years
when the pleural cavity becomes filled with pus, an open-
ing is frequently made for the purpose of evacuating it,
and immediate bad consequences following the entrance
of air rarely take islace.
Dr. Van Santvoord remarked that in these cases
very frequently the empyema is encapsulated.
Dr. Putnam-Jacobi suggested that the explanation
might be in the fact that the lung, in old cases of empyema,
has been compressed for a considerable time, and that
the shock, which is liable to occur when a comparatively
healthy lung is involved by the entrance of air, is avoided.
Dr. Van Santvoord thought that the condition of
the heart probably explained why death occurred so
rapidly from collapse of one lung.
Dr. J. Lewis Smith remarked that if the pleura is
healthy, the admission of a moderate quantity of air did
no special harm. In a number of cases in which he had
performed jiaraceiitesis in children he had known air to
enter the [ileural cavity, but he had not known that it
had produced any ill-effect ; but, in one instance, a sharp-
pointed needle was used, and the lung was penetrated in
three places, and he had reason to think that air escaped
from the lung into the pleural cavity.
endocarditis EMBOLIC PNEUMONIA.
Dr. Putnam-Jacobi presented specimens removed
from the body of a child thirteen years of age, who was
seen in the out-door practice of the New York Infirmary.
She saw it only once during life, and that on the twentieth
?02
THE MEDICAL RECORD.
[March 17, 1883.
day of its sickness. The iiistory was that it had had a
febrile attack, which for the first five or six days was
markedly intermittent in character, but during the last
ten days had been continuous. It was, however, diffi-
cult to decide whether the intermittent temperature,
varying from 105.5° F- '" even sub-normal, 97.5° F., was
due to the type of the disease or to the antipyretic doses
of quinine which were administered, and this circum-
stance contributed to embarrass the diagnosis. The
child had had diarrhoea ; there was some tympanites, and
a moderate amount of hyperesthesia over the entire ab-
domen. On the first day it was found that the heart was
somewhat hypertrophied. A friction-sound had been
heard during twenty-four hours over the left part of the
pericardium, but not over the base. On the sixteenth
day of the child's sickness a friction-sound was heard
over the base of the left lung, which' was followed by a
certain amount of bronchial breathing in the same region.
There was pain over the pericardium, and wandering
pains through the limbs, which were readily relieved by
the application of chloroform liniment. The tempera-
ture was 102° F., the pulse 120, and the respiration 40.
There was flapping of the nostrils, and when the patient
sat up in bed she was extremely pale, although there was
no lividity. There was no effusion into the pericardium
on that day, the friction-sound had entirely disappeared,
and only a systolic murmur at the apex could be recog-
nized. There was no positive evidence of fluid in the
pleural cavity. At the base of the left hnig bronchial
breathing could he heard mingled with some rales, and
accompanied by dulness, but there was no broncho])hony,
and vocal resonance was not diminished. Examination
of the right lung gave negative results ; the abdominal
hyper;tsthesia continued, and also the diarrhcea. The
pains in the limbs had subsided. The child had had an
attack of rheumatism one year previous to present ill-
ness. The diagnosis was placed between a continued
fever complicated with pneumonia, or a visceral rheu-
matism ; i.e., a rheumatism with very slight articular
manifestations, but with acute endocarditis and pleuro-
pneumonia. The diagnosis between these two conditions
was rendered the more difficult by the enlargement of
the liver and spleen. Twelve to fifteen hours after the
examination the respiration rose to sixty, remaining so
three days, but the condition of the child otherwise was
not ajiparently changed until the end of the third dav,
when she sank into a comatose condition, and died a few-
hours later.
At the autopsy the pericardium was found to contain
considerable citron-colored fiuid. There was also fluid
in both pleural cavities. Whether the fluid had been
present in the left pleura at the time Dr. Putnam-Jacobi
saw the patient, she was unable, for reasons stated, to
decide. It certainly was not in the right. Notwithstand-
ing the effusion into the pericardium, its internal surface
presented no fibrinous exudation, was perfectly smootli,
though somewhat injected. The external surface of the
pericardium was covered with fibrinous material, in some
places very thick. It adhered to the left pleura. At
the base of the left lung, and at the extreme tip of the
right lung, recent plastic exudation was found. The left
lung was much compressed. In addition, over the lower
third of the left lung, were found nodules of lobular pneu-
monia, which in places projected above the surface, were
distinctly circumscribed, and were surrounded by zones
of congestion. The right lung, with the exception of the
extreme tip referred to, was healthy. The heart showed
evidence of endocarditis in both ventricles, but it was
difficult to distinguish how far it might be recent, and
how far it might date from the rheumatic attack which
had occurred the year previously. The mitral valves
were very much thickened, and were insufficient, as
shown by the water test. The tricuspid valves showed
patches of recent injection, were very nnich thickened,
and were covered with apparently recent de|)osits of
fibrin. The liver was very nuich increased in size, but
otherwise a])peared normal. The spleen was very large
and soft, and looked very much like the spleen of typhoid
fever. The intestines were examined carefully and with
negative results. The kidneys were very large, the cor-
tical substance was ralher pale, but they had not been
examined microscopically. The examination of the urine,
during life, had been negative as to albumen. The march
of the disease seemed to have been as follows : from
either a fresh or from an old attack of endocarditis, parti-
cles of fibrin had been separated from the tricuspid valve,
and passed into the lungs and set up an embolic pneu-
monia, which had been followed by secondary pleurisy.
The external pericarditis was secondary to the pleurisy,
and not, therefore, the direct manifestation of the rheu-
matic attack. The question why the liver and spleen
should be so enlarged was not explained. The fact sug-
gested a septic endocarditis, rather than rheumatic.
Dr. Van S.\ntvoord remarked that the transmission
of vocal fremitus through fluid in adults was not very ex-
ceptional, and therefore its presence could not be abso-
lutely relied on to exclude pleurisy.
Dr. Putnam-Jacobi remarked that this occurred much
more frequently in children.
Dr. J. Lewis Smith asked if it was not rare to find
the lesions of endocarditis in the right ventricle.
Dr. Jacobi replied that in this case lesions certainly
did exist on the tricuspid valve, as well as on the mitral.
She further remarked that if it had been positively de-
cided in such a case that the endocarditis was due to
rheumatism, it would be interesting to know whether
treatment by salicylic acid would be likely to have exer-
cised any special ettect in [preventing the efiusion into
the pericardium by means of its supposed action on the
rheumatic materies morbi in the blood. Sibson, in " Rey-
nolds' System of Medicine," attributed efficacy to the use
of salicylic acid in the treatment of rheumatic heart dis-
ease. The patient in question was treated by stimu-
lants internally and poultices over the pericardium.
tubercular laryngitis THE VALUE OF TRACHEOTOMY.
Dr. Beverley Robinson ])resented a specimen ac-
companied by the following history, furnished by Dr.
Devlin, Senior .Assistant at St. Luke's Hospital : Rachel
B , forty-seven years of age, married, and a native of
the Lhiited States, was admitted October 25, 1882.
There was no specific history, nor distinct evidence of
hereditary tendency to phthisis. The patient began to
lose flesh and strength about five years ago, but definite
symptoms did not appear until three years ago when she
had an attack of acute laryngitis accompanied by severe
dyspncea. Since then she has been subject to frequent
attacks of laryngeal obstruction brought on by slight ex-
posures to cold. Two years ago she became completely
and permanently aphonic. There was no history of
cough previous to the laryngeal symptoms. During the
last six months paroxysms of dvspncea have been frequent
and very severe. Two months ago it was noticed that
the dyspncea was constant. There was no pain nor dys-
phagia. On admission she was weak, emaciated, had a
cough with marked dvspncea and laryngeal stridor, and
was completely aphonic. The urine had a specific grav-
ity of 1.022, and acid; otherwise negative. Physical
examination of the chest revealed consolidation at both
apices, particularly the left. Wheezing sounds were
heard all over the chest.
November ist. — Dr. Robinson examined the larynx,
and found the epiglottis normal, the arytenoids and com-
missure thickened. In attempts at phonation an oval
chink remained. There was marked inspiratory stridor,
also heard during expiration slightly. 'l"he ventricular
bands were very much thickened. 'Phe vocal cords were
not satisfactorily abducted. The conclusion was reached
that it was not a case of phthisical laryngitis. There
was circumscribed dulness under the left clavicle, no dul-
ness under the right, outside of this there was hyper-
resonance. There was prolonged inspiration and ex])ira-
March 17, 1883.]
THE MEDICAL RECORD.
3^3
tion on both sides. The heart-sounds were feeble but
normal. Diagnosis, chronic bronchitis and emphysema,
chronic laryngitis.
On November 2d the patient was examined by Dr. A.
H. Smith, who diagnosticated tubercular laryngitis.
On November loth the patient was examined by Dr.
McBurney, who diagnosticated tubercular laryngitis.
On November 13th it was recorded that the patient
had had several severe paroxysms of dyspnoea during die
night.
On November 17th the dyspnrea had become quite
urgent, and the patient's consent to tracheotomy was ob-
tained. The operation was performed by the house
physician, Dr. Charles Remsen, in the ])resence of Dr.
Robinson, and the patient made a good recovery. For
several days she was nourished by nutritive enemata.
The patient breathed freely through the tracheal tube,
the lower angle of the wound failed to unite, and ulti-
mately, despite careful iodoform dressing, it burrowed
downward to the sternal notch. During the entire time
the patient was in the hospital there had been an even-
ing rise of temperature varying from one to three degrees
above the morning temperature, which was always above
the normal. No change in the temperature curve was
produced by the operation.
On November 25th the patient was examined by Dr.
Leaming, who diagnosed fibroid phthisis with thickened
pleura, especially over the U|)per lobes of both lungs.
On December 12th laryngeal examination showed the
arytenoids not so inflamed as formerly, normal epiglottis,
papillary condition of the inter-arytenoid commissure,
and that the vocal cords did not separate well. Diar-
rhoea developed, which was diminished but not checked
by medication. Dr. Lefferts examined the patient, and
diagnosed tubercular laryngitis.
On January 10, 1883, the patient died quietly.
At the autopsy, made by Dr. Ferguson, the right lung
was found bound down to the thoracic wall by adhesions
over the upper lobe in the axillary line and posteriorly.
The upper lobe was honeycombed with cavities, varying
in size from that of a pin's head to a horse-chestnut.
These cavities were surrounded by bands of connective
tissue containing tubercles. The lower and middle lobes
were congested and cedematous. Along the free border
the lung was emphysematous. The left huig was
firmly bound to the chest-wall by adhesions. In the
upper lobe there were two large cavities, one as large as
an English walnut, the other the size of a hen's egg, which
communicated with each other, and contained cheesy
pus. In the lower lobe were many miliary tubercles
and circumscribed masses, yellowish in color and cheesy
in character. Many of the bronchial tubes were thickened,
and all the cavities communicated with bronchi. The
small mtestines contained ulcers which involved the
mucous membrane, and in the peritoneum opposite
were a large number of miliary tubercles. There was
extensive ulceration in the caecum and the ascending
colon. The right ovary was the seat of cystic degenera-
tion, the left ovary was atrophied. The other organs
presented no noticeable gross appearances.
Larynx : There is an oval opening in the anterior
wall of the trachea, median line, dividing the cricoid
cartilage, the first ring of the trachea, and the intervening
tissues. This opening admits a cylinder j\ inch, in di-
ameter. There are two small, irregular, superficial ulcers,
one on either side of the median line, just external to
the projections caused by the cartilages of Wrisburg and
Santorini. The tissues in the neighborhood of these
ulcers are cedematous. There is extensive and deep
ulceration of the tissues covering the vocal cords. The
arytenoid cartilages are exposed, their only point of at-
tachment being that of the anterior processes to the true
vocal cords. The left arytenoid cartilage is much smaller
than the right. Examination with the microscope of sec-
tions from the neighborhood of the ulceration over the left
false vocal cord, shows miliary tubercles, at the periphery
of which are large numbers of small round cells, small
spindle-cells, and many giant-cells; their centres are granu-
lar. Sections from the lungs sliow large numbers of miliary
tubercles with giant-cells at their periphery and in the
tissues of the lung between the tubercles. There is in-
crease in the fibrous tissue in their neighborhood, and
similar round- and spindle-shaped cells to those described
in the examination of larynx.
There is slight increase in the connective tissue of the
kidney. The vessels are slightly thickened. The epi-
thelium lining the straight tubules in places is pig-
mented.
There is dilatation of the radicals of the hepatic vein,
and atrophy and pigment of the he[)atic cells surrounding,
them, there is some fat in the periphery of the ascini.
There are a few miliary tubercles in the liver.
Dr. Robinson remarked that he believed tubercular
disease occurred relatively less frequently in this coun-
try than abroad ; certainly in children. Further, it had
been stated that laryngeal phthisis had been cured, but
he believed that if any cases of so-called laryngeal
])hthisis had been cured, they were not true laryngeal
phthisis. He thought that a positive opinion could not
be formed safely concerning the nature of the disease
affecting the larynx previous to post-mortem examina-
tion. 'These facts he thought should encourage the per-
sistent use of local applications, for it is probable that
the disease may be cured. Too much importance must
not be attributed to mere ocular inspection with the
laryngoscope. Concerning tracheotomy he regarded it
as erroneous to state that the operation is objectionable,
because patients suft'er from the presence of the tube ;, .
for, in the great majority of cases the patients are bene-
fited by the operation, and certainly it is an advantage
rather than a disadvantage from the point of view of in-
dividual comfort. He also believed that the introduc-
tion of the tube was positively beneficial, because rest is
thus afforded to the larynx, one of the most important
means for eftecting a cure, and that tracheotomy should
be performed, if done at all, at a less advanced period
than it is usually adopted.
GENERAL TUBERCULOSIS IN A CHILD.
Dr. H. D. Chapin presented specimens of tubercu-
losis occurring in a child thirteen months old. It came
into his service' at the Out-door Department of Bellevue
Hospital, November 4th, when the mother stated that
the child had suffered since November ist from vomit-
ing and fever, and had had a slight cough for a week.
The temperature was 103° F., and the pulse 150. The
pupils were normal. He made a careful physical exam-
ination, and was unable to find any evidence of disease of
the respiratory organs. The child lay in a kind of stupor.
He e.xamined it from time to time, suspecting broncho-
pneumonia, but it was impossible to diagnosticate it from
physical signs. The temperature varied from 100° to
103° F. The child, under the use of cod-liver oil and
iron, improved. It was then taken with inflammation
and suppuration of the cervical glands, but the child re-
covered from this, and by December seemed to have
made a complete recover)-. It continued to improve until
February i, 1S83, when the mother returned with it,
saying that the child had been taken with vomiting and
great restlessness, uttered sharp cries, and bored its head
into the pillow. The pupils were normal, and also the
temperature. Dr. Chapin again examined the lungs and
found nothing. On February 9th the child was seized
with convulsions of the left side of the body. There was
internal strabismus of the right eye. The patient went
on from day to day, and finally died in a convulsion.
At the autopsy there were found tubercles in the lungs,
in the spleen, and in the bronchial glands, which were
also large and cheesy. There was a large cheesy nodule
of the size of a walnut at the base of the lower lobe of
the right lung. The brain was soft, and the ventricles
were enormously distended with serum. Very minute
o04
THE MEDICAL RECORD.
[March 17, 1883.
tubercles were found along the fissure of S)'lvius. The
other organs were normal.
Ur. J. Lewis Smith had seen si.x cases in which cere-
bral symptoms had been produced by enlarged bronchial
glands pressing upon the large veins, and thus interfering
with the cerebral circulation to the extent of giving rise
to serous transudation into the ventricles, and in which
the brain was otherwise normal.
The Society then went into executive session.
NEW YORK ACADEMY OF MEDICINE.
SECTION IN OBSTETRICS AND DISEASES OF WOMEN
AND CHILDREN.
Staii'd Meeting, February 22, 1SS3.
Alexander S. Hunter, M.D., Chairm.an.
Dr. F. a. Burrall read a paper entitled
A disease in children sometimes mistaken for
malari.a.
Children from one to two years old, sometimes older,
suddenly or gradually, from their usual health, become
indisposed, pale, perhaps faintly yellowish, have a dry
and somewhat warmer skin than natural, irritable stomach,
constipation, or scanty light-colored stools. This is the
milder form which, if not arrested, tends to further de-
velopment when the skin becomes decidedly yellow and
dry, the pulse frequent, and the tem]3erature elevated,
with headache more or less severe, grating of the teeth,
and perhaps delirium. The appetite is sometimes vo-
racious, sometimes lost. The irritability of the stomach
varies from nausea to i)ersistent and sometimes ap-
. patently uncontrollable vomiting. Repeated chills usually
occur. The urine contains abundance of urates. In
some cases'sore throat is present.
Among the causes assigned were, improper diet, check
of perspiration, undue excitement of the nervous svstem,
such as nervous excitement from over-playing, studying
in poorly ventilated school-rooms, etc.
The essential nature of the condition was regarded as
'■ acute blood-poisoning due to defective hepatic secre-
tion." The indication was to promote excretion by the
natural channels. Clinical experience had shown that
this could be done by giving mercurials. In such cases,
therefoie, he recouniiended calomel, one-sixth to one-
tourth of a grain every hour, placed on the tongue dry, un-
til four or five doses have been taken or the bowels begin
to act.
Dr. J. C. Peters said that he had seen many cases of
the class mentioned by Dr. Burrall, and was aware of the
good effects produced in them by mercurv. Other
remedies, however, might answer an equallv good, per-
haps better purpose, according to the experience, and a
favorite combination with him was four parts of the tincture
of aloes. United States Pharmacopceia, and one part fluid
extract of licorice, and of this give one-fourth or one-
half or one drachm according to circumstance, .\nother
remedy is the phosphate of soda.
He believed there was a class of mixed cases which
did not always yield prom|)tly to quinine, but by a com-
bination with one of the remedies mentioned, the quinia
acted more favorably than when given without an ad-
juvant.
Dr. Joel Foster had been familiar with the class of
cases alluded to by Dr. Burrall and could corroborate
the statement made concerning the good eti'ects produced
by calomel.
Dr. a. C. Po.st said that much was heard concerning
the frequency of malarial diseases in New York. He,
however, had practised in this city for more than fit'ty
years and did not remember that he had ever seen a case
of typical fever and ague that had not been traced to ex-
posure beyond the portion of the cit\' where the paving
and sewerage had been completed, or else in the country.
Dr. Hubbard referred to cases in which patients, who
had never been out of the city, had suffered from true
intermittent fever. There were two localities, namely, at
the corner of Bedford and Carmine Streets and at the
corner of Canal and Hudson Streets, in which such cases
occurred not infrequently.
Dr. Sell said that mercurials produced only temporary
benefit, according to his ex|)erience in such cases, but when
he had treated them with irosin, euonymin, and bicar-
bonate of soda combined and triturated into an impalpa-
ble powder, the good results obtained had been per-
manent.
Dr. J. Lewis S.mith mentioned several diseases liable
to be mistaken for malarial fever in children, such as
meningitis, tuberculosis in the upper part of the lung,
typhoid fever, etc., etc.
Dr. Beverlev Livingston then read a paper
ON the value of bismuth in the TRE.VrMENT OF
ulcerative .stomatitis -AND NOMA.
The communicatijn was essentially a review of the
subject, suggested by the pai)er recently published in The
Medical Record by Dr. C. J. Macguire, and was based
on the use of the remedy in the Nursery and Child's
Hospital by Dr. E. L. Partridge in 1881 and 1882, and
his own experience as Visiting Physician in the same in-
stitution. Concerning the diagnosis he thought the term
noma should be reserved for those cases which end in
perforating gangrene of the cheek, and that the difter-
ential diagnosis between it and ulcerative stomatitis
could be made from the facts: i. That the ulceration
in one (noma) begins upon the cheek and upon the gums
in the other ; 2, that there is greater induration in noma
than in ulcerative stomatitis, and the gangrene is very
much more rapid in the progress, etc. Thirty-one cases
had occurred in the hospital ; twenty-three before bis-
muth was recommended and eia'ht afterward. In all the
o . . .
cases in which bismuth was used, iron, quinine, and
whiskey were given according to indications. Tlie parts
w-ere cleansed with carbolic acid solution, cauterized with
the solid stick of nitrate of silver and packed with bis-
muth. Three deaths occurred among the twenty-three
patients treated before bismuth was used, and two in the
eight cases which occurred afterward. In one case, bis-
muth failed and alum cured. One case jirogressed to
true noma under the use of bismuth. According to his
experience and from the history of the bismuth treatment
in this hospital, he had more confidence in the thorough
use of the solid stick of nitrate of silver followed by the
application of alum, or probably better, alum combined
with bismuth, than in bismuth alone, and was forced to
the conclusion that bismuth is no more a specific for
ulcerative stomatitis and noma than is pilocarpin for
diphtlieria.
Dr. Macguire remarked concerning diagnosis, that
many of his cases were seen by other physicians, all of
whom corroborated the diagnosis of cancrum oris, and
that the cases were published some months after they oc-
curred. The object in publishing them was to elicit a
fair test of the remedy. His method of treatment was to
clip away all the gangrenous tissue, thoroughly cleanse
the tissue with permanganate of potash— 3 j. to 3 iv. —
once a day, and then pack the ulcer with bismuth, which
was applied every three hours. In all his cases there was
no loss of teeth, no exfoliation of bone, and no further
destruction of soft parts. The general treatment was the
same as that used in Dr. Livingston's cases.
The Section then adjourned.
A Child Born with Teeth. — Dr. Kochman of Stras-
burg relates the history of a primipara who gave birth at
full term to a healthy child with the two lower internal
incisors just beginning to protrude. These were out and
well grown at the end of a week. — Allgetneine Medicin
Central Zettunkr.
March 17, 1883.]
THE MEDICAL RECORD.
305
(£io wcspo mUnic c.
OUR PARIS LETTER.
(From our Special Correspondent.)
A STRIKING ILLUSTRATION OF THE INFLUENCE OF HER-
EDITV IN THE TRANSMISSION OF INSANITY THE
MOTHER OF THE EXECUTED MURDERER MENESCLOU
THE NEW SCHOOL OF MEDICINE THE FRENCH
OPHTHALMOLOGICAL SOCIETY AN INTERNATIONAL EX-
CHANGE OF COLLEGE THESES — THE DISCUSSIONS OF
KOCH AND PASTEUR — THE NOMINATION OF DR. RAN-
VIER.
Paris. February 23, 1SS3.
A VERY Striking illiistrarion of the influence of heredity
in the transmission of disease, and particularly that of in-
sanity, has just been witnessed in Paris in the following
case. It may be remembered that about two years ago
a young lad by the name of Menesclou was guillotined
for the murder of a little girl whom he had cut to pieces
after having committed rape on her. Doubts were
raised as to his sanity, but the experts who had exam-
ined him came to the conclusion that although the young
culprit was evidently of weak intellect, yet he was intel-
ligent enough to understand the enormity of his crime
and that he was consequently responsible for what he
had done. The counsel for the defence, however, insisted
on the tmsoundness of his mind, and during his confine-
ment in prison he was closely watched, but be)'ond a
little eccentricity of manner and occasional outbursts of
passion nothing abnormal was observed in him. At the
necropsy several important lesions were found in the
brain, which the medical men who examined the body
considered sufficient to cause great derangement of his
intellectual faculties, and that, therefore, he was not cog-
nizant of what he had done. It was, unfortunately, too
late to have made the discovery, and it is no wonder
that whenever cases of the kind occur a general outcry
is raised against the profession and it is set forth as a
good excuse by those who persistently [ilead for the abo-
lition of capital punishment. I must say that the experts
did not come out very brilliantly in this case, and what
would tend to disprove their diagnosis is the fact that
the mother of Menesclou, who is forty-five years of age,
has just been sent to a lunatic asylum, and it has been
ascertained that the father of the latter died a lunatic
and a brother of hers committed suicide. She is the
subject of monomania, and of that form which the French
alienists designate " delire de persecution."
The new School of Medicine, or rather the new addi-
tion to the old building, wiiich was commenced about
three years ago, seems to be making some advance,
though very slowly, toward completion. A good deal of
the scaffolding has been removed, and the front of the
building presents a nioninnental aspect, the principal en-
trance of which is decorated with two allegorical figures
— the one representing medicine and the other surgery.
To make room for the additional building, several dwell-
ing-houses had to be pulled down. Among them was one
which bore the number 30, and which w;is occupied by
the notorious Marat when he was stabbed by Charlotte
Corday.
It has been proposed to establish a new school of
Military Medicine in one of the larger cities of France,
not including Paris, to replace that which the French
lost by the annexation of Strasburg to Germany in the
last vvar. The faculties of Montpellier, Bordeaux, and
Lyons claimed the favor, but the Minister of War has
decided for the last named city as being the most cen-
tral, and possessing other advantages over the cities
named.
A bust of the late Professor Bouillaud has been placed
in the hall of the Academy of Sciences. It is now pro-
posed to erect a statue by subscription to his memory,
for which purpose a list for subscriptions is open at the
.'Vcaderay of Medicine, and under the auspices of the
President of the Medical Association of the Charente,
the birth-place of this illustrious jihysician.
The Academy of Sciences has awarded the " prix
Montyon " to Dr. Maillot for his interesting works on the
continued forms of fever as they occur in tropical cli-
mates.
A new society, under the name of " Society F"ran(;aise
d'Ophthalmologie," has just been formed in Paris, meet-
ings of which are to be held annually, and the society is
open to all those who speak the P'rench language. It
counts already a goodly number of members, among
whom are to be found for the present, Belgians, Swiss,
and Spaniards.
According to an agreement entered into between the
French faculties and thirty foreign universities a regular
exchange of theses and dissertations will be officially
effected. The first exchange took place in December
last.
You are aware of the discussion that has been carried
on for some time between Professor Koch, of Berlin, and
M. Pasteur, the eminent French biologist. The various
communications made by the latter to the dift'erent
learned bodies on the subject of microbes and the dift'er-
ent kinds of virus, are to be put up in a condensed form
for early publication.
Dr. Ranvier. the eminent histologist and professor at
the College of France, has been nominated correspond-
ing member of the Academy of Sciences of St. Peters-
burg.
MEDICAL LATIN.
To THE Editor of The Medical Record.
Sir : May I ask the privilege of an additional brief space
in your valuable journal, for the purpose of replying to
the communication of Mr. John A. Armstrong (Medical
Record, February 3, 1S83), containing a crii;icism of my
"rejoinder" {Ibid., December 2, 1882) to his paper on
"Medical Latin " (//'/</., November 25, 1882). I am
aware that the subject is one almost foreign to the pur-
poses of this journal, and therefore do not intend to en-
cumber your pages with any further communications on
this subject.
Leaving aside, for the present, the minor points on
which Mr. Armstrong and I differ, I will at once revert
to the two main points at issue, namely :
First. — \Vhether such terms as Carbotias, Sulphas, etc.,
should be regarded as masculines or as feminines.
Second. — Whether Jihus glabrum or Rhus glabra is the
correct pharmacopceial title to denote the fruit of the
smooth sumach.
Concerning the first point, the reasons which con-
vinced me that those nouns should be masculines — and
which convinced, so far as I knew before Mr. Arm-
strong's communication, all others who had occasion to
give an opinion on the subject — were pretty fully pub-
lished in Ne-w Remedies (1882, p. 58). They were not
quoted here, as I wished to save space, and they will be
merely outlined even now, since it may be ].>resumed
that those who are' sufficiently interested in the argument
will consult the article quoted.
Mr. Armstrong, having read the paper, states "that it
refutes itself," and " that it presents no arguments," etc.
I fail to see, however, how he arrives at this conclusion.
My argument is, \\\ brief, the following : Such modern
Latin terms as Carbonas, etc., should follow the analogy
of true Latin nouns of snnilar termination, so far as the
genius of the language permits.
Now, we find two classes of such nouns (having -diis
in the genetive '), namely: first, the large group of nouns
1 Mr. Armstrong adds a note, on page 139, second column, in which^he informs
us that " Genitivus is formed from genitttm, supine of gigno. The Greeli name
is Yevixjj-TTTwo-is " {sic). This is probably meant as a criticism of my spelling
"genetive" in my last paper (where it is unce printed "' genitive " by oversight).
Kut the form "genetivus" is now preferred by the best authorities (Neue, Kriiger,
Halm, Keil, etc.), as being authenticated by the best manuscripts, notwithstanding
the supine ^^«zV«w and the Greek yiivi.ia\ tttujo-is.
3o6
THE MEDICAL RECORD.
[March 17, 1883.
in -tas. -tdiis, which denote a quality or property, that is,
an abstract idea. These nouns are feminines, without
exception, in Latin as well as in the cognate or deriva-
tive languages. Since the technical terms Carbonas,
etc., evidently do not belong to this class, neither having
the characteristic secondary noun-suttix {-to), nor denot-
ing any abstract idea, we must look elsewhere for an
analogy. '
The second group of nouns in -as, -dtis, are those
which were originally adjectives (patronymic, geograph-
ical, etc.), and which have a gender corresponding to the
idea or noun understood.
Mr. Armstrong does not accept the view that Caibonas,
etc., should be classed here, because he thinks that these
modern terms are pure nouns which have never been
used as adjectives, and which do not require a supple-
mentary noun in order to be understood.
Now, 1 never meant to assert that fir, who use these
terms constantly, are compelled mentally to supply a
noun, such as sal (salt), in order to understand them.
In fact, I consider them to be good substantives, just as
Mr. Armstrong does. But the case was different with
those who invented the terms and introduced them into
literature. Chemists had previously been in the habit of
denominating salts (among other methods) by such terms
as sal phosphoreus magnesia, sal acetosus argenti, etc.^
The reformers of nomenclature substituted a single term
for the sal phosphoreus, namely, pliosp/tas, and acetas for
sal aceiosum, etc. And they used these new terms as
masculines, simply because the idea of sal still floated
before their minds. Other writers even used those terms
as neuters, since they may have been accustomed to use
the Latin noun sal as neuter.'
While such a process of mental supplementation was
quite natural to those who first used these terms, who
had been long accustomed to use the older method, this
process is not at all necessary nor likely to take place in
the minds of those who learn chemical terms in our day.
We regard the latter now as true nouns, denoting con-
crete things, and we require no mental supplement to
understand them. This, however, does not invalidate
the history of the origin of the terms, nor their claim to
be regarded as masculines, since we know precisely how
they came to be formed, and since we can readily follow
the train of thought of those who designed them.
Mr. Armstrong writes : "The ' translators,' desirous of
names as homophonous as possible to the original sub-
stantives, had warrant, most assuredly, in the examples
of anas for anttas, and sa/ias for satie/as, in writing acetas
or acetitas." ■"
Now, I venture to say that the "translators" (of the
London Pharmacopceia, 1809) never thought of those
two solitary words, but that they merely followed the
usual routine of grammars, or that they struck, for them-
selves, a mental balance of the Latin nouns in -as, -dtis
^ The circumstance that the term Acetas apparently belongs to this class does
not interfere with the argument, since the / {as Mr. Armstrong himself acknowl-
edges) does not belong to the termination.
On the other hand, the noun aestas, wliich Mr. Armstrong draws to the second
group in -as, -dCis (since he regards the t as belonging to the root), really belongs
to the first class. The root is acs- (belont;ing to Sanskrit iiidh, Greek IB- {aldui
aid-rjp, etc.), Lat., acti- {ueii-es, aes-tns {ior ait/-id) etc.), and the termination is
-tas, -talis. Compare Vanicek, (Jriechisch-Lateinisches Ktymologisches W'orter-
buch (Leipzig, 1877), I., 85, and the authorities quoted on p. 86.
^ Also sat phosphoreum, sal acetosuiit, etc.
3 .!)'^/ occurs both as masculine and as neuter. See Neue, Kormenlehre d. Lat.
Sprache, L, 697-698.
* In my paper, m New Remedies, I slated that anas, andtis ("old woman-
hood ") formed an apparent exception, inasmuch as it wasay^w/z^/w^not ending in
-tas. \\y explanation, that it was contracted from a word ni -/lutjust like j«//rtj,
quoted by Mr. Armstrong), is, in my opinion, sufficient to bar its use as an arstu-
ment against me. I also mentioned, as ** the only true Latin lunin in -as, -dtis,^^
the word anas {afidtts). the duck. Mr. Armstrong remarks to this : " No philol-
ogist would so characterize it. It is a metathesis of i-jjuatt ; tlieme rew. whence
Latin w<j, to swim, etc." In reply to this 1 can only say that I tru^l there is no
philologist who would assert that the Romans coined the word anas after the
Greek vi)tnxa, or that they derived the word (and idea) for swiuiniirig from tlie
Greeks. There are thousands of good Latin and good (Jreck words which are
derived from a common form in the mother-language. There are others again
which can be shown to have been borrowed or been transplanted by commercial,
military, or migratory expeditions and the like. I consider the etymological con-
nection between anas, vriaaa. vtta, ntt (old high German anut, Anglo-Saxon eneil,
Lith. rt«/w, etc.) as well established, but 1 also consider the duck (with Hehn.
Kulturpflanzen und Hausthierc, ate Anil., Hcrlin, 1877, p. 323) to be .a native of
.Italy as well as of Greece.
(irrespective whether a / precedes this termination or
not), and having, as they thought, found an over-
whelming majority on the feminine side, selected this
gender.
.■\nd I further venture to assert that aeetas does not
stand for acetitas any more than sulphas stands for sul-
phitas, or nitras for nitritas. Acetitas, etc., can only
mean " the condition of being an acetate," "the acetate-
ship," an abstract idea ; its employment to mean a con-
crete substance would be utterly foreign to the genius of
the language.
That the similar terms in -is, -itis, must follow the
analogy of the terms in -as, -dtis, requires no argument,
because the implied idea in both cases is the saine, and
there are ample analogies for their use as masculines in
Latin.' •
An additional support for my view (and that of others)
of the gender of these technical terms is offered by
several modern languages which have adopted them, and
in which they are either masculines or neuters, according
to the gender of the word meaning "salt." So in Ger-
man, where Salz is neuter, we say : " Das Sulfat," " Das
Nitrat.'' In French and Italian, where the words for
" salt " are masculine, we have : " le sulfate," and " il
solfato." "
With regard to Jihus, I have nothing to add to my
argument that the botanical name of the plant should
denote the /<;;■/ of the plant understood in the Pharma-
cojioeia.
So far as relates to the gender of rhus, Mr. Armstrong
truly says that the authorities differ. There are examples
for rhus (as tree), both masculine and feminine. Con-
cerning the passage from Celsus, Mr. Armstrong implies
that I prefer the reading which makes it masculine. But
I do not need to prefer any, since the manuscripts and
editions, so far as I know, offer no other, and neither
the differing genders of rhus (as tree), nor the fact that
rhus (as seed) does occur as neuter (besides feminine),
can disprove my argument in favor of Jihus glabra as
pharmacopoeial title. Mr. .-Vrmstrong wants Rhusglabrum,
and he wants this translated, not "the glabrous fruit of
Rhus," but "the fruit of the glabrous Rhus." If this
translation is admissible, then malum aurei/m might with
equal right be translated " the fruit of the golden apple-
tree."
.\s to the declension of rhus, I am aware that many
forms occur in different authors, and the list given by
myself and by Mr. .\rmstrong could possibly be still
further increased.^
It is conceded, as I already stated m my last paper,
that the Greek poO? may be declined either in the second
or the third declination. In Latin, however, rhus is re-
stricted to the third declension. The accusative is either
rhun, rhoa, or rhum (occurs only once). Rhun is the
Romanized Greek form povv (though it might also be the
contracted form of the accusative of the second (attic)
Greek declension). Mr. Armstrong finds it singular that
I should regard rhum as an accusative of the third de-
clension. I have done so and do so still, first, because
the other forms of the regular Latin second declension
(gen. rhi, dat. rho) are missing, and secontl, because I
regard rhum as a Latinized accusative, contracted from
rhu-em, just as we find the genetive form rhiis (see note
to my last paper), which is contracted from rhu-is (for
rho-is).*
1 In my paper, in New Remedies, I quoted tis. titis, as the only true Latin
noun in -is, -itis. Mr. .Amrstrong quotes another Dis, Dltis, which 1 omitted, as
it is a contracted form. The adjective tCts ;for dives) has no bearing on the argu-
ment.
3 In Spanish, we have " cl sulfato" as masculine, although sat is feminine.
But the Spanish chemical nomenclature is based on the Kreiich.
^ I believe to be correct in assuming that the misplaced or missing accents in
some of the Greek forms quoted in .\Ir. Armstrong's paper, are merely oversights
of the proof-reader. Hut to the same category belongs the Pattadius .\farttatis
(in my copy it was Mart.), in the note to my last paper, which Mr. Armstrong
draws special attention to. 1 have handled my own copy of I'alladius often
enough to be aware of his name. The mistake arose from a tr.Hiisposcd correction
made in the preceding line, where the name Catgittits .}/artiatis appears.
* 1 do not regard rhus as the Greek contracted gcnclivc pod?, because the con-
traction in this case is regarded generally as inadmissible. See Kiihner, Ausfiihr-
lichc Grainm. d. Gricch. Sprache, 1., 349, Anm. a.
March 17, 1883.]
THE MEDICAL RECORD.
307
There is, of course, no objection to regard rhiim as
the accusative singular of the second declension. Yet I
l)rcfer tlie former view and think I have sufficient author-
ity for doing so.'
Charles Rice, Ph.D.
New York, February 25, 1883.
^mnij ^cius.
Official List of Clianges of Stations and Duties of Officers
of the Medical Department , United States Army, from
March 3, 1883, to March lo, 1883.
Brown, Harvey E., Major and Surgeon. To be
temporarily assigned to duty at Mount Vernon Barracks,
Ala., during the absence on leave of Captam T. A.
Cunningham, .Assistant Surgeon. S. O. 17, par. 2, De-
partment of the South, March 6, 18S3.
Caldwell, D. G., Captain and .'Assistant Surgeon.
To be relieved from duty at Fort Fred. Steele, VVyo.,
and will report in person to the Commanding Officer at
Fort Laramie, VVyo., for assignment to duty at that j^ost.
S. O. 23, Department of the Platte, February 27, 18S3.
Hopkins, Wm. E., First Lieutenant and Assistant Sur-
geon. The leave of absence granted December 28,
1882, is extended two months. S. O. 56, par. 5, A. G.
O., March 9, 1883.
Paulding, H. O., Captain and Assistant Surgeon.
The leave of absence granted in S. O. 11, Department
of the Platte, January 27, 1883, is extended twenty
days. S. O. 23, Military Division of the Missouri, March
2, 1883.
^UctUcal ^^tcms.
Contagious Diseases — Weekly Statement. — Com-
parative statement of cases of contagious diseases re-
ported to the Sanitary Bureau, Health Department, for
the two weeks ending March 10, 1883 :
Week Ending
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March 10, 1SS3
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A Dinner to Oliver Wendell Holmes. — As an
expression of apiireciation of the honor Dr. Oliver
Wendell Holmes has won for American medical and
general literature during the past forty years, a compli-
mentary dinner is to be given to him at Delmonico's,
April 1 2th, by the medical profession of this city.
Dr. T. Gaillard Thomas is chairman of a committee
of thirty representative men of all the different interests
and sections of "the profession, which insures a perfect
success, not only as to numbers, but as regards the en-
tertainment in all respects, as the gentlemen who are to
respond to the toasts are the most distinguished in their
respective professions for their eloquence and wit on
such public occasions. The tickets for the dinner are to
* There are analogies for the above, for instance, among Greek words in j'-r,
such as Itys (gen. Ifyns], which h.Ts in the ace. either It_yK {the regular Greek
form, Verg. Aen., 9, 574 ; Ovid. Metam., 6, 652) or Ityfn (Frop. 4 (3), 10, 10).
Halyn (Cic. de divin. 2, 56, 115 ; Liv., 38, 16, 13). or Halym (Verg. Aen., 9, 765).
The forms rhu-m, Ity-ui, Haly-m, etc.. might also be supposed to be formed
without the binding vowel c, and subsequent contraction ; I think, however, tliat
acontraction took place, for I find the open form hnity-enz (Plin. hist, nat., 6, 7, 7).
" Rhuni^^ being the only instance occurring where an accusative in utK was pos-
sible, of course no further examples of this^form can be quoted.
be ten dollars, and those wishing to secure them should
apply to either of the following gentlemen : Drs. E. G.
Loring, F. R. Sturgis, John G. Curtis, George G. Whee-
lock, Paul F. Munde, the committee who have this in
charge. Tickets cannot be obtained after Ajiril ist,
and to prevent disappointment it is absolutely necessary
to apply as early as possible, as the number who wish to
be at the dinner is likely to exceed the capacity of the
dining-hall.
New Portable Tests for Albumen. — Dr. Pavy has
devised some ferrocyanic pellets, which are portable
and keep well, and which furnish, it is claimed, a very
delicate test for albumen.
Dr. G. Oliver has preiiared test-papers saturated with
various reagents, more sensitive than heat or nitric acid
to albumen, extremely portable, but little liable to de-
terioration from exposure to the air, and quite devoid of
the corrosiveness which interferes with the portability of
nitric acid. The papers were saturated with potassio-
mercuric iodide, potassium ferrocyanide, potassic-mer-
curio-iodo-cyanide, sodium tungstate, and picric acid ;
and all gave sensitive reactions with slightly albuminous
urine.
The above preparations seem to be useful, but we
fear that heat and nitric acid will still remain popular,
because these latter furnish some idea of quantitative
change.
Death of Professor Sigmund. — Professor Sigmund,
of Padua, recently died at the age of seventy-three.
For twenty-four years he conducted the clinic for syph-
ilis at Vienna, being associated with Hebra. He is best
remembered, perhaps, on account of his having asso-
ciated a particular gland in the arm (known as Sig-
niund's gland) vi^ith the diagnosis of syphilis.
Grand Trunk Railroad Schedule of Surgical
Charges. — Our Canadian brethren are justly exercised
over the schedule of charges drawn up by the Grand
Trunk Railroad for its surgeons. The fees for a day visit
are $i ; night visit, $2 ; office consultation, 50 cents ;
surgical dressing, $1 ; amputation of foot, $20; leg,
$25 ; thigh, 850. It seems a good deal like robbery
when a rich corporation refuses to pay a poor doctor but
$20 for, we will say, a Syme's operation with subsequent
treatment.
The St. Joseph Medical Herald is a new medical
monthly. It is unusuall)'' well edited.
The Late Dr. Alexander Ming Fisher. — At a
meeting of the Medical Staff of the Northern Dispensary,
held February 26, 18S3, the following action was taken :
Whereas, We have with deep feelings of regret learned
of the death of Dr. Alexander Ming Fisher, in Cologne,
Germany, on the 12th inst. ; therefore.
Resolved, That in the death of Dr. F'isher we feel that
the dispensary has lost an efficient physician, the mem-
bers of the staff a valued friend and courteous co-
worker, and the connnunity an esteemed and worthy
gentleman.
Resolved, That these resolutions be published in The
Medical Record, and that a copy of them be transmit-
ted to the family of the deceased.
Lsaiah F. Pr.av, Chairman.
Nelson H. Henry, Secretary.
Suit against a Medical College. — An important
decision was rendered recently against the United States
Medical College, a so-called eclectic institution of this
city. In April last the Attorney-General began a suit in
the Supreme Court to set aside its incorporation. The
officers of the college demurred to the complaint, but
before argument could be heard the Legislature amended
the general act of 1848 by providing that scientific and
literary colleges and universities that had reported their
organizations to the Regents of the State University
within two years prior to the passage of the amendment
?oS
THE MEDICAL RECORD.
[March 17, 1883.
should be declared legally incorporated. The demurrer
was then withdrawn and an answer was put in asserting
that the United States Medical College had been legal-
ized. Judge Van Vorst decided on March 7th, in Su-
preme Court, Special Term, that the amendment did not
legalize the college, for the reason that it had been de-
cided by a Cieneral Term of the Supreme Court that
words in an amendment passed in 1870 to the act of
1848, similar to those in the amendment of 1882, which
define the institutions to be legalized by it, do not include
medical colleges in their meaning.
The New York Microscopical Society held its an-
nual meeting in this city on March 8th. The President,
Mr. Benjamin Braham, delivered an address. An exhi-
bition of microscopical objects was given by the mem-
bers, fifty or sixty microscopes being used. The cir-
culation m fish and frogs was shown and the bacillus
tuberculosis. The e.xhibition was highly creditable to
the Society.
The Office of State CommissioMer in Lunacv
was abolished in the Appropriation Bill as passed by the
New York State Legislature. It was stated that the
State Board of Charities could do the work as well. We
never had great confidence in the utility of a single lu-
nacy commissioner, but to abolish the oftice without sub-
stituting something in its place is' a step backward.
Another Cremation. — The late Mr. Henry Seybert,
of Philadelphia, was cremated at Washington, Pa., on
March 7th. This is the seventeenth cremation at this
place. Mr. Seybert left $60,000 to the University of
Pennsylvania. It is stipulated that an impartial investi-
gation of modern spiritualism be made. The sum of
$1,000 or $s,ooo was given to nearly every charitable or
educational institution in the city.
Appropriations for State Medical Charities. —
The Supply Bill was reported to the New York Legisla-
ture on March 7th. It includes the following items :
New York Idiot Asylum, $10,000; Binghamton Asy-
lum, $36,230 ; Auburn Insane Asylum, $6,500; Sea-
men's Retreat, $1,244.35; Willard Asylum, $3,000;
Buffalo Insane Asylum, $18,300 ; State Homceopathic
Asylum,, $12,200 ; Commissioners in Lunacy, $300 ;
Disbursing State school tax, $25,000 ; American Mu-
seum of Natural History, New York, for departmental in-
struction to school-teachers, $12,000; Quarantine Com-
missioners, $1,500; State Board of Health to prevent
adulteration and sale of food and drugs, $10,000 ; State
Board of Health to enforce law regulating sale of illu-
minating oils, $3,500; State Board of Audit, $18,777.71.
Alcohol and the Stomach Digestion. — Man is a
carnivorous animal, according to Lewin, and should eat
flesh as much as possible. He should not drink alcohol,
since that hinders flesh digestion. Dujardin-Beaumetz,
however, takes the opposite view, and thinks that wine
may be taken with meat, since, as Richet shows, it in-
creases the acidity of the gastric .juice. Vulpian and
Mourrut found that alcohol in excess hindered digestion.
Levin and Petit de Semerie found the same as a result
of experiments on dogs. Three dogs were fed with 200
grammes of flesh : dogs i and 2 received also 25 grammes
of brandy ; dog 3 received 75 grammes of the same.
In No. 3 there was no digestion ; in No. 1 and 2 it was
unimpaired. Fleischer has obtained similar results.
The Treatment ok Scalp Wounds. — Dr. W. S.
Parker, of Piqua, Ohio, writes : " .'\n article on scalp
wounds in the last number (February 24th) of The
Record, prompts me to connnunicate a simple device I
have used for the last twenty years in such cases. After
cleansing the wound thoroughly, all hemorrhage being
suppressed, bathe the parts freely with balsam Peru, a time-
honored, but none the less valuable antiseptic. Then,
presupposing its existence, comb \\\t along the edges of
the wound, and exactly opposite, for the space of say half
an inch, the hair, which twist into a thread and tie with a
single turn, drawing the edges of the wound gently but
firmly together. Having previously laid a well waxed
ligature beneath the hair and parallel with the wound,
tie with the thread the single loop of hair, employing a
surgeon's knot. Repeat the process, i.e., another single
loop and surgeon's knot, and you have a fixed dressing.
The coaptation of the flaps is necessarily perfect. I
have not hesitated to use sutures when necessary, owing
to the absence of hair or its being too short, or from loss
of tissue, and in my entire experience have had but one
case of erysipelas following their use, which seems to
bear out Professor Gross' teaching of the harmlessness
of sutures in the scalp."
Chloral Hydrate and Bromide of Potassium in
Delirium Tremens. — Dr. W. Washburn, of this city,
mentions a plan of administration by which these reme-
dies have proven effectual, when other means as well as
large doses of chloral had signallv failed. He advises,
first, that the bowels be thoroughly moved with croton
oil, following which, from a solution of chloral hydrate,
gr. ij., 3j-i and potassium bromide, gr. v., 3 j-, he admin-
isters four drachms as the first dose. At the expiration
of twenty minutes or half an hour, a second dose of one
drachm is given, and repeated every fifteen minutes
until sleep is produced. From this method of adminis-
tration it is claimed that a quiet and refreshing sleep is
induced usually after the second dose, and, in his expe-
rience, nothing has given such speedy and excellent
results in the treatment of these cases.
The Tongue under the Microscope. — Dr. G. P.
Hachenberg, of Austin, Texas, has been making a series
of microscopical examinations of the tongue, with a
view to establishing the diagnostic value of its appear-
ance, not only in disease of the liver and alimentary
canal, but also in lesions of the respiratory organs, in
the cachexia;, etc. To this end he invites the attention
and co-operation of the profession, and proposes to
utilize the material received in a treatise on this subject.
All reports will be duly accredited by him.
Anatomical Technology. — In the review of this
work, iniblished in The Record of February loth, the
word "dorsiventing" is quoted when the text says " ven-
triducting," and the author writes us that it should be
" dorsiverting."
Iodine and Blisters in Tabes Mesenterica. — In
tabes mesenterica. Dr. Bouchut, of the Children's Hos-
pital, recommends the application of blisters, or the tinc-
ture of iodine, upon the abdomen. If ascites be present,
tapping should be employed without hesitation. The
regime to be followed should be very severe — beef-tea,
eggs, raw milk, and claret. If diarrhoea be present,
enemas of borax, one drachm each time, should be given,
and three or four teaspoonfuls of glycerine in the day, by
the mouth. Bismuth, or phosphate of lime, would be
very useful. Your correspondent tried this treatment in
an apparently hopeless case, and a rapid recovery ensued.
The disease was far advanced, and the child was aban-
doned by its ordinary medical attendant. — Medical Press
and Circular.
The Minnesota College Hospital held its Annual
Commencement in Minneapolis March i, 1883.
A Bill to Regulate the Practice of Medicine in
Minnesota has been introduced into the State Legislature.
The Norih^vestern Lancet approves the bill in the main,
and urges its passage.
The Medical Depart.ment of the University of
Nashville held its annual Commencement last week,
graduating a class of 125.
Bequests to London Hospitals. — Seven London
hospitals have recently received bequests of $25,000 each
from Mr. George Tierney, recently deceased.
The Medical Record
A Weekly yournal of Medicine and Surgery
Vol. 23, No. 12
New York, March 24, 1883
Whole No. 646
©viginat ^cctuvcs.
ON THE
RELATIONS OF MICRO-ORGANISMS TO DIS-
EASE.
The Cartwkight Lectures, delivered before the
Alumni Association of the College -of Physi-
cians AND Surgeons, New York.
By WILLIAM T. BELFIELD, M.D.,
LECTURER ON PATHOLOGY, AND ON GKNITO-URINARY DISEASES (POST-GRADUATE
course}, rush medical college, CHICAGO.
Lecture IV.
In this discussion I i:ave referred to various bacteria as
distinguished into species by essential differences of form
and function. In these latter days it has become fash-
ionable to speak of these minute organisms as transient
modifications, due to incidents of their environment, of
one and the same organism. Niigeli, indeed, would in-
clude not only bacteria, but also some of the higher
fungi in this hypothesis. As this seems as yet a specu-
lation, based not so much upon direct demonstration, as
upon deductions, it will not require discussion here.
An essential element of this theory, however, the so-
called accommodative cultivation of bacteria, seems to
be supported by certain experimental evidence. This
assumes that the physiological characteristics may be
modified by contact with unusual influences — by a change
of environment, in other words — as to render the de-
scendants of a given bacterium which is capable of
successful contest with the living animal tissues impo-
tent to maintain such combat ; and conversely to confer
upon a previously harmless bacterial species the power
to invade and destroy a living animal. This hypothesis
is so fascinating, the solution of many difficult problems
is rendered thereby so simple, the reconciliation of con-
flicting observations and opinions becomes so eas)', that
every man becomes at once his own bacteriologist.
Diphtheria, on this hypothesis, is not due to a specific
bacterium, but to some of those usually guileless organ-
isms which ordinarily inhabit the healthy throat, incapa-
ble of harm ; but which, excited into unusual and per-
verse activity by unknown influences of atmosphere, etc.,
invade the body with disastrous results. The application
of this assumed principle is evidently limited only by the
fancy and ingenuity of the individual ; we have been al-
ready amply entertained by theories ascribing typhoid
fever to the hypothetical tonic influence of sewer-gas
upon the bacteria inhabiting the alimentary canal, etc.
The evidence in support of this hypothesis consists of
deductions by analogy and of experimental observations.
Since the life of an organism is the resultant of many
forces, it is d priori evident that a modification of one or
more of these forces may be followed by a change of the
resultant life. In the higher plants and animals we have
abundant evidence to this effect ; the domestic pigeon
and the dahlia are examples rendered familiar to us by
Darwin. Such modifications, it is true, require time ;
but in biology time is measured by generations, not by
years ; and since from one bacterium a second may be
produced in thirty to sixty minutes, it is evident tliat a
day may induce in these organisms the effects of a thou-
sand years in man. The evidence by analogy with higher
organisms supports then the theory in question.
This same principle — modification of function by
changes of environment — which flrawitz and Buchner
had vainly attempted to demonstrate, seems to have
been demonstrated by Pasteur in his studies upon i)ro-
tective vaccination. He asserts that the microbes which
he regards as the morbid agents in chicken-cholera can
be deprived of their virulence by successive cultures in
contact with air ; so that a given quantity of such culture
fluid causes eftects far less severe than the same quantity
before such modification. Pasteur subsequently applied
the same principle to the mitigation of anthrax virus ;
indeed the list has been still further extended by himself
and others. Since in all these cases the same general
principle is illustrated, it will suffice for our present pur-
pose to consider the mitigation of anthrax virus for the
preventive vaccination of sheep.
Pasteur's theory is this : the anthrax rods, as found in
the blood of an animal dead of the disease, when placed
in a suitable liquid maintained at a temperature of 42-43°
C. grow as usual into threads, but do not produce si)ores.
After a certain time their vitality is lost ; when transferred
to another flask, kept under the same conditions, they do
not grow nor reproduce. But at any time previous to
this final extinction of vitality, the bacilli still exhibit life,
though their ability to invade a living animal, i.e., their
malignancy, is diminished. There occurs, indeed, a grad-
ual diminuendo of malignancy, their morbid effect upon
an animal decreasing with the prolongation of their ex-
posure to these conditions, high temperature and exclu-
sion of oxygen, until finally both life and malignancy are
extinguished. Pasteur found that after eight days the
bacilli had lost their fatal jwwer to destroy rabbits, guinea-
])igs, and sheep, though these animals are peculiarly sus-
ceptible to this virus. He claims that he has thus miti-
gated the virulence of these bacteria, has induced a.
modification of function.
As to the accuracy of Pasteur's obsei-vation in this case
there can be no doubt ; the vaccination of thousands of
animals has already proven that the mortality induced by
such anthrax cultures is much less than that following the
usual inoculations with fresh virus. But his explanation,
that the decrease of malignancy is due to modification of
physiological function, is a by no means necessary con-
clusion, since precisely the same results can be and have
been secured, under circumstances which preclude the
possibility of -a transmissible physiological modification.
First among these methods is simple dilution. It has
been long since and often demonstrated that the effect
induced by the incorporation of these virulent organisms
into an animal depends, cctteris paribus, upon the number
introduced. Chauveau found that sheep which had sur-
vived injections of fifty to six hundred anthrax bacilli
died after subsequent injections of one thousand bacilli
each. Oemler had previously made analogous observa-
tions upon horses ; Loffler upon rats ; it is mdeed an ac-
cepted principle that the effect of inoculation increases
with the number of injected bacilli. The somewhat
general impression that quantity exerts no influence upon
the result, except as to time, maybe true when the effect
is manifested upon an inert, unorganized mass, but not
in the case of a living animal.
Diminution of malignancy can be secured in other
ways also, which seem to accomplish practically the same
result, dilution of the virus. Nocard and Mollereau found
;io
THE MEDICAL RECORD.
[March 24, 1883.
that anthrax virus is attenuated by simply mixing it with
twice its volume of oxygenated water under pressure.
Four hours' contact produces Pasteur's premier vaccin
(for the guinea-pig), ninety minutes' exposure the second.
Chauveau makes the premier vaccin by exposing anthrax
blood to a temperature of 56° C. for fifteen minutes ; and
the second vaccin by the same exposure for nine to ten
minutes. Since oxygen under pressure, as well as a high
tem|ierature, destroys the anthrax bacilli, it would seem
that these methods accomplished merely a dilution of the
virus by killing a certain number of the contained organ-
isms ; for in the brief time required in these experiments
a physiological modification seems scarcelj- possible.
According to a communication presented by Bouley
to the F'rench Academy of ATedicine, Peuch discovered
that the effects of tag-sore virus (variola in sheep) de-
creased by simple dilution with distilled water.
' In the case of chicken cholera also, the characteristic
organisms of which have been " modified " by Pasteur
through a long and interesting process, there is reason to
supi>ose that this modification may be simply a dilution.
For vaccination against the disease has been successfully
practised by simply introducing into the animal a piece
of blotting-paper on which the blood of an infected ani-
mal has dried. The bacteria in dried anthrax blood die
in a few weeks, but those still living at a given moment
exhibit their original functions if transferred to a proper
soil, and it seems probable that the diminished virulence
of dried chicken cholera blood is due to the death of
some of the contained organisms rather than to a physio-
logical modification. This belief is strengthened by a
letter recently received from Dr. D. E. Salmon, of Ash-
ville, N. C, in which he says : " I have vaccinated fowls
experimentally, both by Pasteur's method and by a
method of my own. My method is simply inoculation
with a very diluted virus ; when sufficiently diluted it
produces only a very circumscribed, local irritation that
•does not affect the general health in the least. One or
a dozen germs of this fatal disease may be introduced in
the tissues and are unable to produce any effect what-
ever. Twenty, fifty, or a hundred, according to the sus-
ceptibility of the fowl, will produce a slight local irrita-
tion. Pasteur's method requires five to nine months to
attenuate the virus ; by mine it is accomplished in as
many minutes."
The effect can be secured, therefore, by simple dilution
of anthrax or chicken cholera virus, as well as by Pas-
teur's cultures, and there are other reasons for suspect-
ing that his mysterious method for the mitigation of bac-
terial virulence is practically a dilution of the culture, or
rather, of the contained bacteria. If Pasteur would
demonstrate that his tamed bacilli transmit their tame-
ness to subsequent generations, the question would be
finally settled ; he asserts, indeed, that he has observed
such transmission "in a few cultures," but gives no par-
ticulars, while the extensive vaccinations already per-
formed on sheep prove that even his first (weak) vaccin
sometimes kills an animal. It is but just to state that
Koch has recently expressed his conviction that a gen-
uine physiological modification does occur in Pasteur's
cultures ; whether this conviction is based upon personal
observation or not does not appear.'
.\lthough proper functional activity may doubtless de-
crease susceptibility to infectious diseases, whether of
bacterial or of still unelucidated origin, it is evident in
our daily observation that such activity does not neces-
sarily confer immunity. At present but two avenues to
such acquisition are known, a natural attack, and the
artificial induction of the disease in mitigated form. The
immunity secured by one attack of variola, scarlatina,
measles, whooping-cough, etc., and by artificial inocula-
tion with variola, as was formerly extensively practised,
prompted experimentation in regard to other diseases. In-
* I have not succeeded in procuring Koch's monograph : the above statement is
taken from reviews of it in French and German journals, the Deutsche Med.
IVochenschyi/t, and the Revue Scieniijigue, especially.
oculation of cattle with material from animals dead of in-
fectious pleuro-pneumonia — lung plague — was begun in
Holland in 1852, and soon extended to Germany and Rus-
sia. In Saxony the mortality, previously twenty-five to
thirty per cent, of the herds, became ten, six, two, even one
per cent. At the Cape of Good Hope, where seventy to
eighty per cent, of the cattle died of this infection, the
disease almost vanished after inoculation was extensively
practised. The tag-sore of sheep was always robbed of
many victims by artificial inoculation. But of the diseases
of whose parasitic origin we have conclusive or strong pre-
sumptive evidence, every one may occur more than once
in the same subject. It is evident therefore, first, that im-
munity against an infectious disease, in the ordinary
sense of the term, implies not necessarily the absence,
but merely a relatively slight degree of susceptibility ;
second, that the question must be studied as to each dis-
ease independently of all others.
Although the ([uestion of protective vaccination has
been experimentally studied as to anthrax, charbon symp-
tomatique, chicken cholera, septicemia, by Chauveau,
Toussaint, Semmer, Colin, and Rosenberger, yet the re-
sults are so closely associated with Pasteur's name and
with anthrax that I shall omit extended reference to the
pioneer workers and works, and consider as the most
favorable example, the well-known experimentation in
protecting sheep against anthrax by inoculation with the
cultivated bacilli. This method of Pasteur, I might say,
is the first one which has afforded results at all satis-
factory ; and the principle differs from that employed in
lung-plague, tag-sore, etc., in that the artificially cultivated
organisms isolated from the accompanying animal tis-
sues are employed — a new departure therefore.
In considering this subject, with which Koch's name
is almost as closely associated as Pasteur's, it is advisable
again to remember that this is a question of facts and
not of individuals ; that to us Gaul and Teuton are alike
friends, as we fortunately keep no watch on the Rhine ,
that neither Pasteur's brilliant work on fermentation, nor
Koch's services on anthrax and tuberculosis ; neither the
unreasoning enthusiasm of the French for Pasteur, nor
the intelligent confidence of the Germans in Koch ;
neither the grandiose egotism and artful dodging of the
former, nor the apparent personal rancor of the latter;
none of these may obscure our vision in estimating the
value of present evidence.
Pasteur's theory may be briefly stated as follows :
Since anthrax does not recur in the same individual, im-
munity against it as against other infectious diseases may.
be secured by one attack ; the same effect may be ob-
tained as in the variola of the human subject, by a harm-
less inoculation with the specific virus after exi)Osure to
unusual influences whereby its eflfect upon the animal is
diminished.
To this theory Koch remarks that although some of
the infectious diseases occur in the same animal but
once, as a rule, yet no immunity is secured from others
by the first attack ; and adduces erysipelas, the septic dis-
eases, gonorrhoea, intermittent feVer. and recurrent fever,
as examples familiar to all ; the last-named is especially
interesting, because it is invariably associated with a
specific bacterial form — the spirochaete of Obermeier —
though final proof of the causa! relation of the parasite
has not yet been furnished. But more than that : Koch
points out, by the records of Prussian veterinary surgeons,
that anthrax itself not infrecjuently occurs twice in the
same individual : instances Oemler, who experimented
on about one hundred animals years before Pasteur be-
gan to work upon the subject ; and who saw horses, for
instance, exhibit all the symptoms of anthrax once, twice,
even eight times — at intervals of weeks or months, after
inoculation with anthrax material ; (luotesjarnowsky, who
saw the disease occur among fifty human patients, twice
m one at an interval of two years; three times in another
at intervals of two and three years. Loffler found that
of 52 rats which were inoculated at intervals of some
March 24, 1883.]
THE MEDICAL RECORD.
;ii
days or weeks, with the fresh virus, 30 survived the
first, 23 the second, 13 the third, 3 the fourth, and i the
fifth and sixth inoculation. Koch reminds Pasteur, tliere-
fore, that even though an animal survive a virulent in-
oculation he is not tliereby secure against subsequent
infection with anthrax. Further, Koch calls attention to
the fact — proven by himself and others — that immunity
against subcutaneous inoculation is not necessarily syn-
onymous with immunity against infection through mucous
membranes, especially of the alimentary canal ; although
Koch admits that as the fact had been jsroven only for
horses, dogs, mice, rats, and rabbits, it might be other-
wise with regard to sheei), with which he had not at that
time experimented.
Such were the considerations advanced on either side.
Pasteur's theory was soon extensively tested — in Prus-
sia and Hungary the experiment was superintended by
an ofiicial commission of medical officers of the govern-
ment. The proceeding has been usually the same. Pas-
teur vaccmates first with a weak virus, two weeks later
with a stronger one, and after two further weeks, the
animal is considered protectetl ; and those thus protected,
as well as others not vaccinated, are inoculated with ma-
terial fresh from an animal dead of anthrax. At the end
of the experiment in Hungary, fourteen per cent, of the
protected animals were dead — mostly in consequence of
the second protective vaccination ; ninety-four per cent, of
the non-vaccinated died. In Prussia the result was more
favorable : 3 out of 25 sheep (twelve per cent.) died after
the second protective vaccination. After the final in-
oculation with fresli blood, all of the non-vaccinated, but
not one of the vaccinated, died. Pasteur thus demon-
strated that sheep at least may acquire increased power
of resistance to subcutaneous inoculation with anthrax ;
but he demonstrated at the same time that his protective
vaccination tlestroyed almost as large a jjer cent, of
animals as usually die from spontaneous infection in the
[lasture. Since that time Pasteur seems to have em-
ployed less virulent material, for according to accounts
in French journals the mortality from the protective vac-
cination has been often only three, two, one, or even less
|)er cent. But as Koch very properly observes, the
ability of an animal to withstand a mild inoculation is not
the question at issue, for that has been long known ;
their subsequent power to resist virulent material is the
mooted point. The eft'ect of Pasteur's own virus seems
by no means uniform, since Duclaux, his assistant, who
[irobably had virus of the proper attenuation, lost 20 out
of 80 sheep in one tiock during the two weeks after pro-
tective vaccination, and 1 1 out of 60 in another ; yet in
a third flock of the same race he lost only i out of 50.
In the session of the Paris Veterinary Society, June 8,
1882, it was announced by Weber that 23 out of 993
sheei) (2.3 per cent.) had succumbed to the preventive
inoculation ; at a later session Mathieu reported 29
deaths among 896 vaccinations (3.2 per cent.). At Salz-
dahlum 2 of 82 sheep died of anthrax after the second
vaccination ; in Kapuwar 5 of 50, and in Packisch (as
already stated) 3 out of 25. Oemler lost 26 among 703
(3.7 per cent.). Dr. Klein recently called the attention
of the British Government to the fact that Pasteur's vac-
cine virus was on sale in England ; that he (Klein) had
found that even the first and weaker virus could kill
animals, having himself lost two sheep by such vaccina-
tion. Pasteur re|)lies that Klein must have allowed
other bacteria to invade the anthrax liquid.
From these accounts it would appear that Pasteur's
preventive inoculation is a somewhat perilous perform-
ance, since even when performed by his own assistants
it has killed 10, 12, even 25 per cent, of the vaccinated
animals. Yet Pasteur recently stated that of nearly eighty
thousand siieep vaccinated in France during the i)ast
year or two, none had died of the preventive inoculation.
And now for the second cjuestion : Does Pasteur's
vaccination protect the sheep which survive it against
airthrax ? Against subcutaneous inoculation it certainly
does for some weeks, as demonstrated in Prussia and
Hungary ; how long this jjrotection endures and — more
important still economically — whether it protects against
infection through the mouth and alimentary canal, the
usual mode of infection in the spontaneous anthrax of
the pastures — these questions are not yet decisively
answered. Yet we have already some data, collected
largely by Pasteur on the one side, and by Koch on the
other. Boutet reports that in the department Eure-et-
Loire (where anthrax is especially prevalent, according to
Pasteur) the general mortality last year was three per cent. ;
while of 79,392 vaccinated animals only .7 per cent, died ;
one herd of 2,308 vaccinated sheep lost only 8, less than
.4 per cent.; another of 1.659 unvaccinated animals ex-
posed to the same conditions lost 60 (3.6 per cent.).
Nocard vaccinated in August, 18S1, 380 sheep, reserving
140 for comparison ; during the following five months
4 of the former and 15 of the latter died of si)ontaneous
anthrax. According to these reports, therefore, the mor-
tality of the vaccinated is only about one-tenth that of the
unvaccinated animals, though it must be remembered
that this does not include the mortality from the vaccina-
tion itself
Other results are decidedly less favorable. Of 266 sheep
vaccinated in Packiscli last spring by Pasteur's assist-
ant, Thuillier, there died between May and November,
of spontaneous anthrax, 4 ; of 243 unvaccinated kept for
comparison, 8. Cagny reported to the Paris Veterinary
Society the following observation : In 1881, 20 sheep
were vaccinated d la Pasteur ; in February, 1882, 10
more. They belonged to a herd of 250, 2 of which died
of spontaneous anthrax in May and June, 1882 ; it was
therefore deemed advisable to revaccinate, which was
done in July with Pasteur's stronger virus. Of the 20
animals vaccinated in 1881, none died of this inoculation ;
but of the 10 vaccinated only five months previously,
nine died ; of 4 non-vaccinated animals inoculated for
comparison at the same time, 3 died. Koch vaccinated
8 sheei) after Pasteur's method, and then inoculated them
with virulent material ; one died. The remaining 7 had
therefore been inoculated with anthrax three times.
Twelve days later material containing anthrax spores
was mixed with their food ; 2 of the 7 died of anthrax.
A review of the evidence already adduced indicates
that although Pasteur's theory has been demolished be-
yond repair, yet he has established the fact that the sus-
ceptibility of sheep to anthrax can be diminished by
vaccination with the cultivated bacilli. From the eco-
nomic standpoint the value of this measure is still de-
batable, though the aspect of the question has certainly
improved since iSSi, when the Hungarian medical com-
mission, after inspecting Pasteur's experiment, advised
tiieir government not only to withhold its official sanction,
but also to forbid all private experimentation. Nocard
and MoUereau claim to have secured immunity of guinea-
pigs by their method with oxygenated water ; Chauveau
with heated anthrax blood. If these claims be substan-
tiated we may hope that simple dilution may furnish a
virus which shall protect against other diseases as well as
against anthrax. At any rate, Pasteur has established a
principle, and it is to be hoped will be merely stimulated
by the present unsatisfactory results to future and more
successful efforts for its application.
Having thus sketched the present state of knowledge
as to the agency of micro-organisms in the induction
of disease, I may be permitted to consider briefly certain
deductions therefrom, collectively known as the germ
theory, l would emphasize the remark that the facts
already summarized are not to be confounded with the
speculations in which it may please one or another of us
to indulge. Ocular demonstration removes a chain of
events from the realm of speculation to the domain of
fact ; hence the germ theory has no longer jurisdiction
over anthrax at least. A possible future demonstration
that small-pox, syphilis, etc., are not caused by micro-
organisms would be disastrous to the germ theory, but
312
THE MEDICAL RECORD.
[March 24, 1883.
could not change the facts already established as to the
morbid agency of the bacillus anthracis.
The germ theory supposes, if I understand it aright,
that all infectious diseases are caused by the vital activity
of parasitic organisms. In support of this theory there
is certainly strong presumptive evidence : the stage of
incubation ; the unlimited reproductive power of the
virus; the cyclical course and self-limitation of the dis-
ease. The stage of incubation can be explained by the
assumption of no unorganized virus ; all mere chemical
compounds with which we are acquainted, even the fer-
ments ptyalin and pepsin, begin to manifest the charac-
teristic effects as soon as absorption has occurred.
Panum found that even boiled putrid materials, i.e.,
the products of bacterial activit}-, though inducing the
other features of septicaemia, failed to exhibit this charac-
teristic incubation. Bv assuming an organism as the in-
fectmg agent this phenomenon becomes intelligible : the
stage of incubation is then the period during which the
i.idiicted organisms are multiiilying. In this way, too,
the various durations of the incubative stage character-
istic of the different diseases become intelligible. W'e
cannot conceive that one chemical poison should require
two to four days for the manifestation of its constitu-
tional effects, as in scarlet fever, another forty days, as in
syphilis ; but we know that different micro-organisms
multiply with different degrees of rapidity. A micro-
coccus may produce a second in thirty mmutes ; the ba-
cillus anthracis may accomplish its entire vital cycle in
twenty-four hours; the bacillus tuberculosis seems to
require days. The unlimited reproductive power of the
virus, characteristic of many infections diseases, cannot
be attributed to an unorganized poison or even organic
ferment. A drop of blood from an animal poisoned with
oiuum or strychnine exhibits only the power of the di-
luted poison. A drop of vaccine lymph, of variolous or
gonorrhoeal pus induces, in successive generations, un-
limited quantities of identical materials. This effect
cannot be justly ascribed even to any physiological unor-
ganized ferment — a favorite refuge of those who are
determined to deny to bacteria any influence whatever.
Ptyalin can, it is true, convert into grape-sugar many
times its bulk of starch, and ihe ptyalin is not thereby
diminished in quantity ; but it is not increased. No more
perfect illustration of this principle can be furnished than
an experiment of Rosenberger, which has especial value
because this observer would assign to bacteria a subordi-
nate role in morbid processes. He found that the boiled
blood and tissues of septic animals — proven to contain no
living bacteria — induced septicaemia as certainly as the
same blood unboiled. He then placed in one of two
flasks containing identical culture-liquids a few drops of
the boiled blood, and in the other the same quantity of
unboiled blood. Two days later every drop out of the
latter flask conveyed septic infection, while large quanti-
ties from the former induced no reaction ; every drop of
the septic fluid was swarming with bacteria ; in the other
flask there were no organisms.
The virus of an infectious disease must then be some-
thing capable of reproduction, and this power is the pe-
culiar characteristic of an organism. No unorganized
poison, acid, salt, alkaloid, ferment is at ))resent known
which is capable of manifesting the phenomena shown
by the virus of syphilis, variola, scarlatina, etc.
Turning to diseases whose jiarasitic origin is already
demonstrated, we find all the characteristics of the in-
fectious diseases exquisitely exemplified. Anthrax is
marked by a stage of incubation — twelve to seventy
hours — during which the bacilli multiply and effect ac-
cess to the blood ; the onset of constitutional disturbance
is marked by the presence of numerous bacteria ; with
the death and disappearance of these, convalescence be-
gins ; the disease is eminently communicable by contact
and yet may occur also sporadically and epidemically.
And this leads me to mention a fact often urged as an
objection to the parasite theory : that many infectious
diseases are intimately associated with climate, soil, and
topographical features, indeed indigenous to certain dis-
tricts. This is, in fact, strongly favorable to the germ
theory. Many plants and animals of larger growth have
decidedly limited habitats ; botanists and zoologists have
long since informed us that this same principle applies
to microscopic organisms, including fungi; shall bacteria
then, a family of fungi, be exceptions to the general
rule ? As to anthrax, the case is answered ; the disease is
endemic in certain districts, that is, the bacilli grow out-
side of the animal body only in these districts. Koch has
recently endeavored to elucidate the reasons for this.
He ascertained that the growth of the anthrax bacilli re-
quires moisture and a temperature of 15° C. It is evi-
dent, therefore, why anthrax is not endemic in districts
whose surface temperature fails to reach this point.
Koch further ascertained, from the official reports of
Prussian veterinary surgeons, that after the overflow
of rivers and lakes an outbreak of anthrax had been
frequently observed in cattle pasturing at certain points
along the banks. He found by experiment that the
bacilli flourish in infusions of various grasses, grains,
and vegetables. Hay infusion is usually a poor soil, be-
cause of acid reaction ; when rendered neutral or slightly
alkaline, the bacilli grow in it luxuriantly ; but it had
been long before stated by German and French observ-
ers that the anthrax districts usually had a calcareous
soil. Hence he conjectures that in such districts the
alkalinity due to the lime may render even hay a soil
favorable to the anthrax parasite ; that it may usually
grow on decaying plants in such districts. That anthrax
is especially prevalent in autumn seems to result in part
at least from the fact that these bacilli, like many other
fungi, grow only on dead plants. It might be interesting
to review for comparison with anthrax the facts which
establish the association of various infectious diseases —
cholera, yellow fever, the malarial fevers, for example
— with local influences of soil and temperature ; the ori-
gin of typhoid fever in particular wells and sj^rings, as
has been conclusively established by observations upon
the German and .\ustrian soldiery. Yet such discussion
would transcend my time and my jirovince, since I have
attempted to portray what has been, not what remains
to be accomplished.
Certain popular arguments against the morbid agency
of bacteria are worthy of consideration perhaps, though
not because of their intrinsic weight. To some it is in-
credible that bacteria should harm us, since we live in
health though surrounded by them — eating, drinking,'
and breathing them. If it be remembered, however,
that the name bacteria is merely a convenience for
designating organisms of widely different functions,
this argument seems less formidable. On the same
principle it might be asserted that all mammalia are
liarmless because we come into daily contact with
sheep, cattle, horses without injury. The diversity in
function, food, etc., among the microscopic beings is
not less marked than among the larger organisms :
there are bacteria, and bacteria. It is surprising that
Mr. Cheyne, in his admirable work on antiseptic sur-
gery, falls into a similar error. He admits that bac-
teria are not infrequentlv found under Mr. Lister's
own dressings ; that sometimes the course of the wound
appears thereby unaftected, while at other times he
thinks he has observed that the wounds heal less kindly.
He consoles himself, however, with the reflection that
these are " only micrococci " He seems to forget that
several species of micrococci are distinguishable in form,
size, color, and function from one another and from all
others. The fact that certain micrococci found during
different diseases are morphologically indistinguishable
from others found under Mr. Lister's dressings, does not
justify the assumption that all are functionally identical.
If Mr. Cheyne were requested to swallow some pills, he
would probably inquire as to their contents before com-
plying, and would not be satisfied with the assurance
March 24, 1883.]
THE MEDICAL RECORD.
3^3
that they were " only pills." Yet we have every reason
for asserting tliat the minute globules known collectively
as micrococci present differences as great as the larger
globules designated, for convenience, pills. When we
reflect that the active agents in the induction of pyajmia
are micrococci ; that the organisms found in malignant
diphtheria are micrococci, we must protest against Mr.
Cheyne's promiscuous ascription of benign qualities to
any tribe of bacteria, even if "only micrococci." There
are micrococci and micrococci.
Again, it is said, how is it possible for recovery to oc-
cur from a disease caused by bacteria ? What stops
their growth ? So far as I am aware, this question has
not been decisively answered. Several facts suggest that
the products of their own vital activity arrest further de-
velopment. Analogous facts have been demonstrated :
the mucor racemosus ceases to grow in a liquid when
the alcohol produced by its own vital action exceeds a
certain percentage, though there may still remain fer-
mentable sugar in abundance. During putrefaction
there are produced numerous compounds, of which one
at least, carbolic acid, arrests, even in small quantities,
further development of putrefactive bacteria. Brieger
has recently shown that the infectious diseases proven
clinically and experimentally to be caused by putrid in-
fection — pyajniia, diphtheria, erysipelas — are distin-
guished by the excretion in the urine of excessive quan-
tities of carbolic acid ; while in other diseases exhibiting
equally intense fever and constitutional disturbance —
acute rheumatism and variola, for example — the amount
of this acid in the urine is normal or subnormal. Hence
the conjecture that the bacteria are both bane and anti-
dote. Yet a failure to explain the phenomena satisfac-
torily does not, of course, impair the stability of the fact.
The bacilli of anthrax are observed to become, in the
living animal, pale, of uneven outline, incapable of ab-
sorbing staining fluids ; in short, they are dead. With
their death the convalescence of the host begins, as a
rule.
It should be remembered that other parasites than bac-
teria may cause disease, some of them, perhaps, over-
looked in the universal hunt after bacteria. Koch calls
attention to Woronin's discovery that a disease of cab-
bages is caused by an amojboid parasite, which enters the
root of the plant and becomes almost indistinguishable
from the proper vegetable cells ; and suggests the possi-
bility that some of the amoeboid bodies known as white
blood-corpuscles in animals may be intruding organisms,
especially since Ehrlich has shown that different leuco-
cytes exhibit various reactions to staining agents. Five
years ago it was discovered that a mould-fungus, the ac-
tinomyces, induces fatal disease of man and other ani-
mals ; Wittich found organisms, which he calls spirilla, in
the blood of apparently healthy gophers ; Koch found
numerous organisms (monads) in the blood of five
gophers that had died without other discoverable cause.
A new filaria has been recently discovered in the human
subject by Bastian, and similar discoveries are reported
in the camel and the hog.
There is probably no one among us who doubts that
the trichina spiralis can and does induce in the human
subject a serious, even fatal disease ; yet the evidence as
yet adduced is merely the association of the worm with
the morbid condition, for no one, so far as I am aware,
has ever induced the disease by introduction of the iso-
lated worms. Yet the same men who assert the patho-
genetic influence of the trichina, contemptuously reject
the idea that leprosy, tuberculosis, recurrent fever, and
py;emia are caused by bacteria, although the evidence —
constant association of the parasite with the morbid con-
dition, applies to all cases. Indeed, the weight of evi-
dence is decidedly in favor of the bacteria ; for the tri-
china is found not only in the subjects of trichinosis,
but also in many individuals who have never been sus-
pected of harboring the worm. It is not extremely sel-
dom that trichina are found in the bodies of patients who
have died of acute disease, wounds, accidents, etc.; in-
deed, an examinaticyi of several thousand consecutive
cadavers in German hospitals, some years ago, revealed
trichina; in over two per cent., without regard to the
cause of death. It might, therefore be argued that the
presence of the worm is a mere accident — an epiphenom-
enon, observed in healthy as well as in diseased con-
ditions. The bacilli of leprosy, on the other hand, are
found o>!/y in patients suffering from this disease. I
would not express any doubt, by this comparison, of the
morbid agency of the trichina, but would merely call atten-
tion to the fact that for this belief we have really no more
conclusive evidence than we have for accepting the path-
ogenetic influence of bacteria in leprosy and in several
other diseases. Yet it will doubtless be years before
some of us realize the fact that in this unreasoning and
prejudiced opposition to demonstrated facts, we are play-
ing the unenviable role of the cow to the locomotive of
advancing science. George Stephenson's prophecy —
that the result of such collision would be "bad for the
cou"— has been often fulfilled; neither horned cattle
nor pseudo-bacilli have materially retarded the progress
of science. The improvement of means and methods
for minute investigation has ever been and must still be
followed by further advance into the realm of the minute,
whose boundaries doubtless stretch far beyond the pres-
ent means of optical exploration. After centuries of
controversy the intestinal worms banished the " ver-
micular diathesis ;" the acarus scabiei conquered the
" itch cachexia ;" the step from the acarus to the bacil-
lus tuberculosis is not quantitatively greater than from
the tape-worm to the acarus ; each is merely the measure
of successive improvements in means for minute obser-
vation. Yet the same spirit which nurses the vermicu-
lar and itch diatheses, will doubdess for years see in
bacteria only fibrin threads and fat crystals ; and will
cling with heroic devotion to the tubercular diathesis,
to " micronecrosis," and to narrow lymph-spaces.
When we glance over the progress of the last few
years ; when we consider the life-saving revolution in
surgical methods ; when we regard the enhancement, in-
deed the very salvation of enormous economic interests
by the eradication of the bacterial disease of silkworms,
without mentioning preventive vaccination against anthrax
and chicken-cholera, we may search in vain the records
of other departments of science during the same period
for discoveries which have secured direct personal and
pecuniary advantages comparable to those derived from
our present incomplete knowledge of the relations of mi-
cro-organisms to disease. And when we consider the
problems already half solved, the questions to whose so-
lution the way appears open through the same methods
already successfully applied to anthrax and tuberculosis,
we may hope for results to which present knowledge
shall seem a mere introduction. But these results can
be secured only by earnest, skilful, continuous experi-
mental investigation, which is practically impossible with-
out pecuniary support. In France and Germany such
support is liberally supplied by the government ; in the
United States, where human life is certainly as valuable
as there ; where live-stock interests are already greater
than in these countries combined, and must multiply
many fold in the immediate future ; where a single infec-
tious disease of cattle has caused the loss of $20,000,000
in one year, and a single disease of hogs the destruction
of $30,000,000 in the same time ; where infectious dis-
eases are so prevalent among live stock that the fear of
infection has closed European markets against American
meat and cattle— the government of this great common-
wealth, which advances enormous sums for local river
and harbor itiiprovements ; which sends expensive com-
missions over the world to observe the transit of Venus
or of the moon ; to find an open Polar sea ; and engages
in other undertakings of purely scientific interest, has not
yet made one judicious, systematic, liberally supported
inquiry into the possibility of acquiring protection.
314
THE MEDICAL RECORD.
[March 24, 188
o*
against pleuro-pneunionia, hog-cholera, and other de-
vourers of the national wealth. A glance at the Im-
perial German Health Bureau and its work during the
last four years, and a mental comparison of the pecu-
niary resources of Germany with those of the United
States, ins]3ire the hope that we shall not always lag so
far behind in matters which appeal to the tenderest spot
of the American anatoni)' — the pocket.
In concluding these lectures, Mr. President and gen-
tlemen, I shall offer no apology for their fragmentary
character, since I would not call attention to defects al-
ready amply apparent. Yet I venture to hope that one
merit may be accorded them — that they constitute an
impartial and unpartisan attempt to portray the present
status of this vexed question. And tliis I hope, not on
personal grounds, but because a suspicion of insincerity
in the portrayal would retard acquiescence in what I
must and do regard as truth.
If these lectures shall serve as a vehicle for conveying
to the busy practitioner facts which he has not time to
seek amid the mass of current literature ; shall contri-
bute, however little, to the more general discrimination
between theories and facts, between observations and
deductions, between assertions and demonstrations ;
shall tend to confirm the belief that much may be hoped
for, though perhaps but little is already completed in this
direction — their object will be accomplished, and your
lecturer will hope that he was not inexcusably presump-
tuous in consenting to a|)pear upon a platform which
has been honored by a Bartholow and by a Dalton.
APPENDIX.
The following cuts are copied from some of the twenty-
eight photomicrographs exhibited at the lectures. It has
been deemed advisable to print them here with the brief-
est possible summary of the remarks which accompanied
their exhibition.
In erysipelas the l)niph-spaces just at and in front of
Fig. 9. — Skin excised, intra vitatit, from a case ot en-sipelas : micrococci in
lymph-vcsscI, x 700. (Koch.)
the advancing edge of the inflamed area contain micro-
cocci. These organisms have been isolated by cultiva-
tion on solid media (Koch's method) by Felileisen. He
reports the successful induction of erysipelas by inocu-
lation with the micrococci thus isolated, in eight rabbits
and in one human patient.
Recurrent or relajising fever is characterized by the
presence of Obermeier's spirillum in the blood.
As yet no successful inoculation with the isolated spi-
rilla has been reported.
A short, thick bacillus is found post-mortem in the
liver, kidney, spleen, and lymph-glands in the majority
of cases of typhoid fever (Eberth, Koch, Friedlander) ;
and larger bacilli in the vicinity of the intestinal ulcers
(Klebs). Maragliano asserts the presence of both vari-
eties in blood drawn by a hypodermic syringe from the
spleen in fifteen cases {intra vitaiii). It would seem,
f
\
\
#
Kig. ID. — Spirochaete of Obcrmcier and human blood-corpuscles, ^ 700. (Koch.)
however, that he protests too much ; for even post-mor-
tem only Eberth's, never Klebs' bacilli, are found in the
spleen.
In croupous pneumonia small bacteria have been
found at the edge of the advancing inflammation (like
the micrococci in erysipelas); also in some internal or-
gans. The same bacteria have been found in the^lung
immediately post-mortein, and even intra vitani.
5 of bacilli in interuibul.ar capillaries,
Fig. II. — Kidney, typhoid fever; masses
K 100, (Koch.)
Endocarditis ulcerosa seems to be one of the forms of
pyajmia, sometimes of spontaneous {i.e., undiscovered)
origin.
The internal organs as well as the cutaneous tubercles
of patients afflicted with leprosy contain a distinct bac-
terium— the bacillus lopra\ Attempts to induce the
disease in the lower animals by inoculation with the iso-
lated bacilli as well as with leprous tissue, have not as
yet been successful.
Frisch, of Vienna, has found a characteristic short,
thick bacillus in every case of rhinoscleroma (twelve in
March 24, 1883.]
THE MEDICAL RECORD.
315
number) which he has had opportunity to examine.
Pieces were excised from the nose or mouth intra vitam ;
the bacilli occur, like those of leprosy, in the large cells
characteristic of the tissue. Frisch cultivated these or-
ganisms on solid media, after Koch ; but was unsuc-
cessful in attempts to induce the disease in rabbits. It
must be remembered that man is the only animal known
to suft'er from rhinoscleroma and fmni h-prosy.
Fig. 12. — Kdge of bacterial colony in the liver from typhoiil fever ; the indi-
vidual bacilli are seen, X 700. (Koch. J
Klebs and Crudeii assert the induction of malarial fe-
ver in rabbits through the agency of a bacterium — the
bacillus malari;^. Dr. Sternberg, U. S. A., has made a
critical and experimental review of this work, from which
he concludes : " The evidence upon which Klebs and
Criideli have based the claim of the discovery of a ba-
cillus malaria: cannot be accepted as sufficient," and
" their conclusions are shown not to be well-founded."
Fig. 13. — Intertubular capillary of kidney containing bacteria; from a case of
croupous pneumonia, x 700. (Koch.)
Such is the general opinion, so far as I have been able
to ascertain, among those familiar with this department
of investigation. Bacteria said to be identical with these
have been found in the blood of patients suffering from
malarial fever, and by Ziehl in one individual who had
no symptoms nor history of intermittent fever, but was
suffering from diabetes. In three ofZiehl's four cases,
the bacilli disajjpeared from the blood after the adminis-
tration of quinine for several days.
Bacteria of various kinds have been seen in syphilitic
tissues, post-mortem, by different observers. Quite re-
cently Birch-Hirschfekl announced the discovery of
micrococci in twelve gummata, post-mortem ; in three
condylomata, one chancre, and one cutaneous papule
excised during life. Morison, using aniline staining and
Abbe illuminator, found bacilli in chancres and other
syphilitic tissues — the same variety being jTresent in all.
pig. 14 — Incipient abscess furnnliuii ai.iuiij .*
cus colony. Heart-muscle, endocarditis ulcerosa.
(Koch.)
iilcd by a micrococ-
The contents of variolous [nistules, like other pus often
contains micrococci. No trustworthy observation of the
presence of bacteria in the blood during this disease has
been recorded. Ehrlich has sought them in vain even
in hemorrhagic small-pox. Post-mortem they are some-
times found in the tissues.
In diphtheria micrococci are often found not only in
the local necrotic tissue, but also in internal organs and
in the blood. In scarlatina no reliable affirmative ob-
servations have been made, so far as I am avvare. But
Fig. 15. — Micrococci in renal capillar}', sniall-po.\, x 700, (Koch.)
since diphtheria, scarlatina, and erysipelas must be classed
according to clinical, experimental, and chemical (Brieger)
evidence with the putrid diseases, the evidence in favor
of the bacterial origin of septicremia and pyajinia suggests
analogous etiological influences for these diseases also.
Schiitz and LOffler have recently reported the induc-
tion of glanders in rabbits and in two horses by inocula-
tion with bacilli isolated by cultivation from animals suf-
fering from this disease.
;i6
THE MEDICAL RECORD.
[March 24, i!
Cuts-; of the' trichina spiralis and of the filaria san-
guinis are added as an illustration of the fact that
morphological similarity does not prove physiological
identity. These two nematode worms are, of course,
easily distinguishable by the difference in size ; yet
structurally they are, in the larval state as here repre-
Fig.
(Oliver.)
sented, quite similar. Yet the one is found coiled in the
voluntary muscles, its migration from the intestine often
causing symptoms simulating typhoid fever ; the filaria,
on the other hand, circulates with the blood (by night
•only, as a rule), and is associated with one of several
2 •»•
^oV*®"® "e"® °e©
F'g- ^7- — Filaria sanguinis hominis in human Ijlood, >^ 280. (In this case
from twenty-five to one hundred worms were found in every drop of blood between
-six I'.M., and five A..M.]
morbid states — chyluria, lymph-scrotum, sometimes end-
ing in py;i;mia (as in the case which I was fortunate
•enough to observe in the London Hospital). In some
cases its presence seems to cause no abnormal symp-
toms.
Fig. 18. — Filaria, dried and stained to show the sheath (compare Fig. 16).
One of the most interesting of recent observations is
that of Brieger and Ehrlich (^Berliner Klin. Wochens-
<hrift, 44, 1882), in which they report two cases of
Koch's " malignant cedema" in human subjects suffering
from typhoid fever. The bacillus characteristic of this
affection is widely distributed, being often fountl in or-
dinary garden earth, and frequently appearing in animal
bodies a few hours after death ; in these two cases the
organisms seem to have been introduced by subcutaneous
injections of musk. Koch and Pasteur have induced
the disease in mice and rabbits by inoculation with earth
and with the isolated bacilli ; and the morbid condition
which often appears spontaneously in cattle, termed
charbon symptomatique, or Rauschbrand, seems to be
the same disease : but this is, I believe, the first instance
in which the bacterium has been demonstrated in the
human subject of the disease.
©I'iriinaX Articles.
EQUINE SCARLATIN.\L VIRUS AS A PROPHY-
LACTIC AGAINST HUMAN SCARLATINA.
By J. W. STICKLER, M.D.,
ORANGE, N. J.
In the endeavor to discover in the lower animals an
agent possessed of a power to so aftect the human tissues
when implanted in them as to render them insusceptible
of certain contagious diseases, it is necessary to deter-
mine that such an agent represent in a more or less modi-
fied form a morbid principle giving rise to a disease in
man similar to the one of which this modified microzyme
is the exciting cause in the lower order of animal life. The
investigations of Cheveau' have proven that the contagium
particles of small-pox have their counterpart in the active
contagious poison of cow-jio.x, and that the two diseases,
although dift'erent in degree of intensity, are identical as
regards their nature. To prove their identity he inocu-
lated a cow with some variolous matter. There resulted
a papule at the point of puncture, unaccompanied with
any marked constitutional disturbance, from which he
collected some lymph. With this he inoculated a child,
getting as a result a vesicle in every respect similar to
the vesicle of cow-pox, and this was followed by a gen-
eral eruption similar to, but milder than what follows a
direct inoculation with human small-pox virus. He also
failed to produce variolous papules on cows which had
already been vaccinated. On the contrary, cows which
had neither been vaccinated nor had cow-pox were
readily variolated, subsequent vaccination having no ef-
fect, proving that immunity had been secured.
Jenner believed in the identity of these two diseases,
and that they originated in the "grease" of the horse. If,'
then, these two diseases, so different in intensity, are due
to the same morbid poison, it seems highly probable that
the conditions of the tissues, in the case of the cow, ex-
erted constantly a modifying effect upon the poison,
while in man the fertility of the disease was not lessened.
The fact stands, then, that variola passes through a very
modified course in the cow, and probably if the variola
were passed from one cow to another for several genera-
tions, the modification produced would be still greater.
This is rendered more probable by some of the modifi-
cations produced on races by crossing. "Lord Orford,"
says Mr. Darwin, "crossed his famous stud of grey-
hounds once with the bulldog," which breed was chosen
from being deficient in scenting power and from having
what was wanted, courage and perseverance. In the
course of six or seven generations all traces of the ex-
ternal form of the bulldog were eliminated, but courage
and perseverance remained. In this instance the most
marked eflect was produced in the first cross ; but from
repeated breeding with the greyhound, one character
after another was lost, and only one or two remained
permanent. Similarly with regard to the variola, it is
probable that the greatest ettect would be produced by
the first inoculation, and that by subsequent inoculations
from cow to cow some characteristics would be lost until
' Twelfth Report of the Medical Officer of Privj- Council ; Dr. Sanderson's
Essay, p. 337.
March 24, 1883.]
THE MEDICAL RECORD.
2>'^7
finally a modified pox would be produced which would
become natural to the cow."
But it has not been necessary to institute a series of
ex|5eriments to produce a form of variola of the de-
sired type, this result iiaving been reached without any
effort on the part of science, and suddenly brought to
light by comparatively recent discovery. It remains to
ascertain if the same result has not obtained in the case
of scarlatina. Thomas '^ states that it is believed that
animals may be aftected with a disease corresponding to
scarlatina in man. Zurn says that Spinola has observed
it in the horse. Williams ^ believes in the existence of
such a disease in the horse, and gives the following de-
scription of its most common forms : First, scarlatina sim-
plex. On the third or fourth d.ay, or even as late as the
sixth, after the commencement of epizootic catarrh, the
animal is seen to be covered with blotches upon the face,
neck, body, and extremities. The blotches elevate the
hair, but in many places there is scarcely any elevation of
the skin, for if the hand be passed lightly over the apparent
swellings, the skin is felt to be but little altered. In other
parts of the body, particularly upon the inner aspect of the
thighs, actual elevations of the skin in the form of rounded
pimples can be seen and felt. The nasal membrane will
be covered with scarlet spots of variable size, and there
will be a discharge from the nostril of at first a thin se-
rous mucus, which afterward becomes yellow or yellowish
brown. The limbs are generally swollen, and the animal
stitf in consequence. In some instances no eruption is
present, and the only evidence of scarlatina is found in
the Schneiderian membrane, and, perhaps, the mem-
brane of onl)' one nostril will be covered with minute
scarlet spots.
Soreness of the throat is almost a constant symptom,
and if it has preceded the rash, it will in all probability
be more or less increased ; but it by no means follows
that soreness of the throat will appear concomitant with
the rash. In a few days the rash and scarlet spots begin
to disappear, and on the rash declining, some desquama-
tion of the cuticle takes place, the skin becoming scurfy
and the coat remaining dirty for some time. In scarla-
tina angiosa he states that, in addition to the symptoms
already given, there are the following : swellings upon the
body and face, petechial spots of a purple hue upon the
nasal mucous membrane more intense, severe sore throat,
enlargement of lymphatics about the neck, elevation of
temperature, acceleration of pulse, rapid breathing, scanty
urine, constipated bowels, but no renal dropsy or albu-
miniiria as in the human being.
If, then, this be a true scarlatina and identical with
human scarlatina, may it not manifest itself in a modi-
fied form when grafted onto the human tissues ? To
determine, if possible, whether this be true or not. I
performed the following experiments : The " nasal mu-
cus" kindly sent me by Professor Williams, of Edinburgh,
with which I made the inoculations, I examined micro-
scopically and discovered that it presented the appear-
ance shown in Fig. i. The large polygonal cells were
quite abundant, and scattered about the field were many
minute glistening granules, yellow in color, strongly re-
fracting tlie light. Besides these granules there were
larger spherical bodies, about one-third the size of pus
corpuscles, and slightly granular. Larger corpuscles,
granular, and about as large as pus corpuscles, were
quite numerous. Of this fluid I injected with the hyjjo-
dermic syringe into the subcutaneous tissue of four rab-
bits and one dog, about six minims, getting as a result
within forty-eight hours a confluent eruption, scarlet in
color, which existed about four days. After its disap-
pearance there was slight furfuraceous exfoliation. The
temperature during the time the eruption was out, ranged
between 100° F. and 102° F. Appetite was poor and
the animals were disposed to keep very quiet. On the
^ Ross ; The Graft Theory of Disease, p. 121.
' Ziemssen, vol. ii., p. 166.
* Williami : Principles and Practice of Veterinary Medicine, p. 376. ]
third and fourth days the dog had a thin mucous dis-
charge from the nostrils while the rabbits had merely a
slight redness of the mucous membrane of the nose.
There was an enlargement of the lymphatics nearest the
point of puncture. A complete return to the normal
condition was reached by the eighth day. Microscopic
examination of the blood from day to day showed an in-
crease in the number of leucocytes, and on thejthird
day small round granules could be seen, bright in ap-
pearance, of a pale red color, and adhejent to the cir-
cumference of the white corpuscles as seen in Fig. 2.
On the sixth day these granules could not be found. I
next injected under the skin of these animals several
drops of human scarlatinal blood taken from the arm of
a boy who had at the time a bright confluent eruption
Fig. 2.
over both arms, chest, and neck. There was not sub-
sequently any local or general disturbance.
To determine the worth of such experiments, it must be
ascertained if the scarlatinal poison resides in the blood.
The investigations of Coze and Feltz throw light on this
point. They introduced a small quantity of blood under
the skin of sixty-six rabbits ; of these sixty-two died in the
course of from eighteen hours to fourteen days, having
had high temperature, then diarrhcea and emaciation, and
THE MEDICAL RECORD.
[March 24. 1883.
the remaining four only recovered after an intense fever.
Reiss injected a few drops of blood taken from tlie arm of
a patient dying of scarlatina under the skin of the back of
a rabbit, causing its death in twenty-four hours. Further
inoculations with this rabbit's blood gave rise to identi-
cal results. It seems probable, therefore, that the blood
does contain the contagium particles of this disease, and
that it is capable of producing a specitic etTect when im-
planted on foreign soil.
I next vaccinated twelve patients who had never had
scarlatina, with the following results :
Case I. — Leopold W , aged seven. Patient of Dr.
Carl Biittner, of Orange, who submitted him for vacci-
nation. ^^accinated in right thigh with equine virus.
Twenty-four hours later there appeared a punctate red-
ness about the point of puncture. Lymphatics in rigiit
groin enlarged. Temperature, 99" F. No general dis-
turbance. By the third day eruption had extended so as
to cover a space about as large as palm of hand. On
drawing a pair of blunt-pointed scissors across the skin
a distinct white line was left, which remained about one
minute. The red punctate appearance had disappeared
by the sixth day and was immediately followed by des-
quamation of the epidermis, the period of exfoliation
lasting about one week. Slight induration at point of
puncture after desquamation. 1 then injected into the left
thigh a few drops of scarlatinal blood, having microscoiJ-
ically such an appearance as is seen in Fig. 3. This
Case IV. — Edward F-
aged six. Vaccinated with
blood was kindly furnished by Dr. J. \V. Andrews, of
Newark, N. J. The blood-globules were crowded together
in such a manner as to make some of their number ap-
pear oblong, while to their surface there were many
small round or oval red globules attached. Besides
these there were a few masses of matter without definite
outline, looking something like mucin. A specimen of
human scarlatinal blood given me by Dr. George Bayles,
of Orange, had the same characteristic appearance. The
injection of this blood had no eftect locally or constitu-
tionally.
Case II. — Barney F , aged eleven. \'accinated
with equine virus in right arm. Same local changes as
in preceding case. No constitutional disturbance. In-
jection of human scarlatinal blood into opposite arm
produced no effect.
Case III. — Kate F , aged eight. Vaccinated with
equine virus in right arm. Punctate redness not very
extensive, but well marked. White tracings distinct on
second day. Desquamation beginning on tilth day. Sub-
sequent inoculation with human scarlatinal blood without
effect, j
equine virus in right arm. Twenty-four hours later, there
appeared an intense redness with bright red spots scat-
tered here and there. On drawing the finger-nail across
the skin, a white line was left. Duration of eruption
about four days. Desquamation complete. No effect
produced subsequently by injection into opposite arm of
human scarlatina! blood.
Case V. — Michael F , aged twelve. Vaccinated
in right arm w-ith equine virus. Area of eruption greater
than in any preceding case. Lymphatics more de-
cidedly enlarged. Slight pyrexia. Cuticle exfoliated in
quite large tlakes. Inoculation in left arm with human
blood had no effect.
Case VI. — Kate C , aged thirteen. Vaccinated
with equine virus in right arm. Eruption not very de-
cided, although apparent, and on the second day the
white tracings were easily made. Furfuraceous desqua-
mation. No effect produced afterward by inoculation
with human blood.
C.4SE VII. — Daniel C , aged ten. Vaccinated in
right arm with equine virus. Confluent redness, dotted
at irregular intervals with fine bright red points. Second
day white tracings, and after disappearance of eruption,
the epidermis desquamated. No symptoms produced sub-
sequently by injection of human scarlatinal blood into
left arm.
Case VIII. — James C , aged seven. Vaccinated
right arm with equine virus. Same local changes as men-
tioned in preceding case. Inoculation with human scar-
latinal blood without effect.
Case IX. — Jolin C , aged seventeen. Vaccinated
in right arm with equine virus. Area of eruption about
as large as hand. Small bright red points quite numer-
ous. White tracings very marked. Inoculation afterward
with human scarlatinal Islood had no effect.
Case X. — Wm. H , aged five. Vaccinated in right
arm with equine virus. Eruption, white tracings and des-
quamation all well marked. No effect followed injection
of human scarlatinal blood.
Case XL — Martin H
right arm with equine virus.
aged eight. Vaccinated in
The eruption during the
second and third days was quite intense, with enlarge-
ment of axillary lymphatics. Redness disappeared mo-
mentarily on pressure. Desquamation in small scales.
Inoculation with human scarlatinal blood without effect.
Case XII. — Catherine D , aged twenty-five. Vac-
cinated in right arm with equine virus. Redness developed
in about twenty-four hours, was intense and punctate.
White tracings distinct. Furfuraceous exfoliation be-
ginning on the seventh day. No effect produced by in-
jection into opposite arm of human scarlatinal blood.
An examination of the blood during the time the eruption
was out showed the red globules to be larger than those
seen in normal specimens, crowded together edgewise,
and occasionally having attached to their borders small,
round, shining bodies as seen in Fig. 4.
The points of interest elicited in these twelve cases
are :
First. — The safety in using siibcutaneously the virus ob-
tained directly from the horse.
Second. — That when this virus is implanted in the
human tissues, there follows a local eruption similar to
that seen in mild cases of scarlatina.
Third. — The system appears to be protected against
the action of the human scarlatinal poison after vaccina-
tion with the equine virus.
May it not be possible, then, that the scarlatinal poison
has undergone such modification in the tissues of the
horse as to have reached a degree of fertility which ren-
ders it, when grafted onto the human tissues, prophylac-
tic against the more malignant form of scarlatina as de-
veloped spontaneously in man ? Ross makes the following
statement : "The disease (scarlatina) may be grafted
upon some of the lower animals and by transmission
tlirough the same species for a few generations a modi-
March 24, 1883.]
THE MEDICAL RECORD.
;i9
fied form may be obtained, which, when grafted upon
man will produce a disease so mild as to be entirely in-
nocuous, and yet afford a sufficient protection against
the natural variety." But may not equine scarlatina be
to human scarlatina, because of modifications already
wrought, what cow pox is to small-pox, in consequence
of some change in its fertility brought about long ago ?
Whether this be true or not, the investigations wliich I
have thus far made seem to possess some points of special
interest, and I therefore submit them to the consideration
of the profession, and from time to time, as I am en-
abled to continue these experiments I shall report the re-
sults in the hope that they will contirm those already
given.
A CASE OF DALTONISA[ AFFECTING ONE
EYE.
By R. W. SHUFELDT,
CAPTAIN MEDICAL DEPARTMKNT, U.S.A. ^
Jackson Barracks, New Orleans, at the present writing,
is garrisoned by two batteries of U. S. Artillery. From
time to time it becomes necessary to recruit this force
from such material as presents itself, and my duty as
one of the attending surgeons stationed here is to con-
duct the physical examination of these men.
In the case of each subject the examination of the
eyes is invariably completed by submitting him to the
test for color-blindness, using for this piu'pose the Berlin
worsteds, and following the method as prescribed by
Professor Holmgren.
Since the middle of last October some thirty recruits
have been examined. Of this number three were com-
pletely color-blind, one momentarily red-blind, exhibiting
like symptoms with such cases as described by Dr. Jef-
fries, and the subject of this article.
On December 12th last, W. S (white) was physi-
cally examined by me as prescribed by the regulations of
the service. He was twenty-one years of age ; born in
England of healthy parents. No history of syphilis or
other disease ; had never received any bodily injury, and,
in fact, his general examination was satisfactory. He
was next required to read the number of spots on the
test-cards at twenty feet. This he promptly did with
both eyes open, and equally well with his right eye, but
upon closing this the left one was discovered to be
markedly myopic. This defect disqualified him as a re-
cruit. Still, never allowing an opportunity slip to ex-
amine into a candidate's sense of color-perception, I
directed him to step up to the table where the worsteds
were spread out. With both eyes open he, without
trouble or hesitation, picked out series of purples and
greens to match the test-shade, but exhibited a good deal
of uncertainty when called upon to do the same for the
reds, the test-color being a bright red-lead shade. The
worsteds being again mixed up, he successfully chose the
purple and green shades with either eye, one or the other
being closed, and the reds with his right eye, the left one
being closed. Mixing up the worsteds once more, and
firmly shutting his right eye, he was asked to pick out
the red shades. This he essayed to do by first selecting
a pale shade of brown, placing it one side, and, with con-
siderable hesitation of manner, he proceeded in the same
way until he had laid aside a full series of brown shades
from dark to a light ochre. It was amusing to see his
confusion when I suddenly released his right eye, as
the lids were kept together by my finger, and quickly
closing his left, allowed him to see what he had done.
The experiment was tried several times, the worsteds
being thoroughly mixed up each time, before he was
completely convinced that he had some defective color-
sense in one eye that he could demonstrate himself with
the opposite and sound one. Not having the opportunity
then, I exacted a promise from him to return next day,
upon which occasion I proposed to make a complete
recortl of his case, but he never returned, and this is all
I can ever be able to offer illustrating this singular and
interesting condition.
TWO CASES OF INJURY TO THE CARDIAC
VALVES FROM SUDDEN VIOLENCE.
By WM. L. AXFORD, M.D.,
CHICAGO, nx.
Injuries to the valves of the heart are of so rare occur-
rence that the two cases which have come under my
observation during the past two years seem well worthy
of report.
The literature of the subject is extremely meagre, and,
in the limited amount to which I have access, I have been
able to find very little more than a mere mention of the
fact that such accidents do occur. Dr. C. Hilton Fagge
('■ Diseases of the Valves of the Heart," in "Reynolds'
System of Medicine ") briefly discusses this subject.
Corvisart was the first to point out that this injury was
possible and that it could be caused by muscular effort.
Dr. Peacock in 1865 had collected seventeen cases, four
coining under his own observation. These were all
cases where the previous condition of the patient had
been good, with no history of rheumatism or suspicion of
previous cardiac disease. The valves injured were as
follows : aortic valves, ten times ; mitral, four times ; tri-
cuspid, three times.
The two cases which I wish to report seem to be
worthy of classification with those of Dr. Peacock, since
both patients were young, both had previously enjoyed
good health, both were able to perform severe manual
labor before the accident.
To Dr. C. A. Babcock, of Detroit, in whose practice
the first case occurred, I am indebted for the particulars
as well as for permission to report it.
Case I. — J. G , aged sixteen, well developed.
While carrying a heavy weight made a sudden and severe
muscular effort. Soon complained of considerable pain
in the centre of the sternum, also of an uncomfortable
feeling in the left arm. Expectorated some blood, short
dry cough. Before coming under Dr. Babcock's care he
had been treated for dys[)epsia. His condition then was
as follows: Pulse, 100; temperature, 97^^; respiration,
26 ; irregular. Skin had peculiar brown hue. Com-
plained of a dull rumbling sound in his ears. Urine
loaded with urates. Auscultation revealed an aortic re-
gurgitant murmur, partially obscuring and following the
second sound of the heart. After treatment for some
time the subjective symptoms disappeared but the mur-
!20
THE MEDICAL RECORD.
[March 24, 1883.
mur was still to be heard. He was seen by Professor
Palmer, of the University of Michigan, who contirmed
Dr. Babcock's diagnosis of rupture of an aortic valve.
Here it was my good fortune to see the case. At the
present time the boy is able to earn his living as a book-
keeper, but is unable to do manual labor.
The second case was presented by Dr. Robert John-
ston, of Milford, Mich., before a local society with the
following history :
Case H. — A. M , aged fifteen. Previous history
good. No rheumatism before his present trouble oc-
curred. Was cultivating when his horses became sud-
denly frightened. To regain control of his team he was
obliged to make a violent muscular eflfort. His feet
sank deeply into the soft ground and one was so injured
that an abscess formed in the plantar surface. He was
ver)' much fatigued by his exertions, he immediately felt
pain in the region of the heart, and says he could not
get his breath for several days. On several occasions
when he became e.xcited or attempted any muscular ef-
fort dangerous symptoms followed, syncope and a sense
of impending suffocation. He was treated by various
local i)hvsicians, and at some time during this period was
said to have had " subacute rheumatism affecting the
large joints, the back, and many of the lesser joints."
Exactly what the nature of this complaint was 1 am un-
able to determine. He finally fell into the hands of Dr.
Johnston, who first recognized the true nature of his
trouble, and by the use of digitalis was able to relieve
his symptoms to a considerable extent.
He is able to be about but cannot make any physical
exertion beyond what is absolutely necessary, and is
obliged to be very careful in his habits.
All were agreed that the physical signs were those of
mitral regurgitation, buf the question of etiology elicited
considerable discussion. With the previous case fresh
in my memory, taking into consideration the history of
the present case, I had no hesitation in pronouncing it
a case of rupture of a mitral valve. Some present were
inclined to the theory that the obscure rheumatic trouble
was the important etiological factor, but the patient says
that all his subjective symptoms dated from the moment
of the accident.
That a careful physical examination was not immedi-
atel)' made is to be regretted, nevertheless it seems to
me clear enough that this case can be safely classed with
the one first mentioned as an example of injuries to the
cardiac valves from violent nuiscular etforts.
MONSTROSITY OF A HAND.
By DAVIS HALDERMAN, M.D.,
PROFESSOR OF SURGERY, STARLING MEDICAL COLLEGE, COLUMBUS, OHIO.
The subject of this strange anomaly was a male, forty-
three years of age, a native of Bavaria, in Germany.
The account he gave of his deformity, as gathered
from his parents, was to the effect of his having been
born with his right ring finger as "big (?) as a man's ;"
and that, because of its unsightly character, it was am-
putated by a surgeon when he was but nineteen weeks
old ; whereupon the middle and little fingers, together
with their part of the carpus and metacarpus, which, up
to this time, were all of natural size, now took to grow-
ing mucli faster than the rest of the hand, and this
growth, he further states, was kept up until his thirtieth
year, when said parts had attained their present magni-
tudes, which were as follows : The little finger was 4|
inches long, and 5^ inches in circumference at its first,
and 4f at its second phalanx, and nearly the same at its
last. It was completely anchylosed in a straight position
at its phalangeal articulations, and allowed but a moder-
ate degree of passive motion at its metacarpal junction,
from which latter it stood off at right angles with the axis
of the hand in a ghastly and repulsive manner. Its encum-
brance, to say nothing of its uselessness, may be judged
of from the fact that the distance from its tip to the end
of the thumb, when the hand lay at rest upon its palm,
was 11^ inches. The same linger of the opposite side
was only 3^- inches long, and otherwise of normal pro-
portions, as were also the rest of the digits of this hand.
The malformed middle finger measured si inches in
length by 5^ in its greater, and 4^ in its lesser circum-
ference ; but it was considerably constricted at its base.
It occupied a uniformly lateral curved position, and was
semiflexed ; the former, which was considerable, and
toward the radial side, was due, evidently, to the pre-
ponderance of the morbid growth on its ulnar aspect,
thus forcing the finger round upon itself in the opposite
direction, similar to what takes place in the distortion
^^
outward (hallux valgus), sometimes, of the great toe,
from hypertrophy of the bony factor of its metatarso-
phalangeal joint on the inner side alone. Save at its
metacarpal junction, this digit, too, was completely an-
chylosed, and looked more like a vast claw thanj a
human finger. It, also, was worthless, except a sort of
hook-like purpose that it served.
The metacarpal region of this hand, exclusive of the
thumb part, measured eleven inches round ; but its pre-
ternatural size was confined to the three inner ranges.
It was made up of bone and soft parts in their relative
proportions ; the latter, which seemed to consist largely
of adipose tissue, formed a vast, cushion-like eminence
at this place, in striking contrast with the thenal side,
whose group of muscles was almost completely atro-
phied, leaving quite a pit, instead of the prominence
that normally characterizes it. This, it was stated, took
place along between the nineteenth and twentieth years,
and it, of course, left the thumb in a greatly enfeebled
condition. No exciting cause could be assigned for it.
March 24, 1883.]
THE MEDICAL RECORD.
321
A similar measurement of the opposite metacarpus
gave only eight and one-half inches.
The cicatrix left from the removal of said ring finger
was of linear shape, extended in an antero-posterior di-
rection, and was two and one-half inches long, showing,
therefore, that it must have grown pari passu with the
growth of the malformation, verifying thus the old adage,
that a scar in childhood, as long as the little finger, will
be so still in adult life ; and moreover, that it holds as
well in morbid as in natural growths.
A no less interesting feature of this case was the dis-
crepancy that existed in the lengths and magnitudes of
the upper extremities above the wrists, as the following
comparative measurement will show :
Table of Ccmparative Measurements of Upper Extremi-
ties.
Acromion process to head of ulna
Acromion process to external epicondyle of
humerus
External epicondyle of humerus to head of
ulna
Circumference of forearm at smallest part
near wrist
Circumference of forearm at muscular part
near elliow
Circumference of upper arm
3
£3
§•1
c
C/} «
<
Inches.
Inches.
20
2li
Hi
I2i
8^
9i
Si
7
11^
Qf
91
91
Inches."
:i
'I'his preponderance in the size of the forearm was
confined to its inner side, and was made up of bone and
muscle in their relative proportion, the latter being finely
developed, and free from adipose. The ulna, as com-
pared with its fellow upon the opposite side, and with its
associate radius, was truly massive. The prominence of
its subcutaneous portion, especially its head, as viewed
from behind, was so striking as at first sight to be
strongly suggestive of luxation of this end of the bone
backward upon the radius. Its olecranon process, too,
was preternaturally salient, and gave to the elbow a dis-
torted contour.
The man declared this forearm to be the stronger,
which, judging from the above, was doubtless true,
des])ite the crippled condition of the hand.
From the foregoing it will be seen (t) that the
anomalous growth above the wrist was of thickness
only, not of length; (2) that the latter, on the contrary,
fell even below the normal, (3) but that it was more than
made up in the hand, taking the elongated little finger
as a guide, to say nothing about the inner carpal and
metacarpal ranges, which, it might have been observed,
were also somewhat lengthened ; (4) that this growth
in thickness took its rise in the olecranon process, (5)
and in travelling down kept to its ulnar side, until the
hand was reached, (6) when it overstepped the bounds
recognized in the correlation of the different parts of the
latter and the forearm, the middle finger, belonging as it
does to the radial side, being included in the enlarge-
ment, though not to the same degree on both sides ;
and again, {7) that the digital distortions followed the
lines of abduction until the hand became spread out like
a vast paw, or, as remarked by one, " like the foot of a
large ostrich."
The man was otherwise sound. He was of medium
size, well built, and of average intellectual endowment.
Notwithstanding crippled as it was in its individual
members, except the index finger, which alone was
sound, the hand as a whole was of considerable use,
the man being enabled, as a common laborer, to gain a
livelihood for himself and family ; and it is worthy of note
that he has six children, normal in all their parts. Nor
could any irregularity be tniced in his genealogy or
maternal impressions during his gestation.
The occasion of his coming to our notice was a slight
frost-bite of the monster small finger, on account of
which, and of its being useless anyhow, he desired it
amputated, which was accordingly done, drawings, casts,
etc., of it having been previously secured.
Many queries naturally arise in connection with this
case. It would be interesting to know (i) what, pri-
marily, determined the nutritive activity that was evi-
dently at the bottom of it ; (2) why, in the forearm, it was
confined to the ulnar side, but at the same time was
exercised in one direction only, and fell short in the
other ; (3) while in the hand, it extended abnormally in
all, (4) why the process shoidd have been maintained
for so many years, and meantime been deficient in
another part of the same hand, and (5) what, if any,
influence the removal of said ring finger had on the sub-
sequent growth, etc.
The circumstance that the area of hypertrophy corre-
sponded with the distribution of the ulnar nerve, points
to it as an agency in the trophic action. Still, it does
not answer the question as to the fans et oris^o of this
queer development, and of its eccentric course ; its
falling short of the normal here, and going beyond it
there ; and finally, that in the same part it should be in
excess in one direction, and deficient in the other.
As showing the nutritive activity even at this age, it
may be observed that the hemorrhage from the digital
artery of the enlarged little finger, at its amputation,
was as free as ordinarily takes place from the dorsalis
pedis.
It may be further mentioned that the fatty tissue here,
too, was in excess ; the bones, also, were very large ;
but the muscular element was poorly represented, as
might be expected, from its non use.
^voQVCss of ^Icdical Science.
The Bacillus Tuberculosis in the Urine. — Dr.
Victor Babes, of Buda-Pesth, Hungary, found the bacillus
of Koch in the pus-corpuscles of the urine of two per-
sons during life, where post-mortem examinations re-
vealed tubercular disease of the kidneys and bladder.
In a third case, where no abnormality could be made out
in the lungs, but where Professor Verneuil, of Paris, nev-
ertheless suspected tubercular disease of the urinary ap-
paratus. Dr. Babes examined the urine and found the
bacillus. No autopsy has as yet been made in the last
case. — Orvosi Hctilap, February 18, 1883.
Mucous Polypus of Bladder in a Child. — At
a meeting of the London Pathological Society Dr.
Shattuck exhibited a growth which came from the blad-
der of a girl, and exactly resembled a nasal mucous
polypus in its histological characters. A long process
occupied the urethra. The pelves of the kidneys were
dilated, but the renal substance was healthy. The case
was a fit one for surgical treatment, but unfortunately
the patient died from exiiaustion before an operation
could be performed. — British Medical Journal.
CvsTiNURiA. — Dr. Madcr relates the case of a woman,
thirty-two years of age, who was seized with a chill,
vomiting, and pain in the right hypochondrium after ex-
posure to cold. Nine days later the urine contained a
quantity of pus streaked with blood, and gave forth the
odor of sulphuretted hydrogen. Microscopical examina-
tion revealed the presence of a few beautifully formed
crystals of cystine. No calculi were jjassed at any time,
except on one day when a small mass of cystine the size of
a poppy-seed was discovered. The pus and the cystine
gradually disappeared, and the patient was cured in about
six weeks. Dr. Mader supposes that the case was one
of renal abscess, possibly caused by the little mass of
cystine crystals subsequently discovered in the urine. —
Ber. Rudolph-Stift., Wu-n, 1882.
122
THE MEDICAL RECORD.
[March 24, 188:
Trephining for Intracranial Abscess. — Dr. Kil-
gariff exhibited a patient before the Academy of Medi-
cine of Ireland on whom he had performed trephining,
on account of an abscess resulting from a fall in the hunt-
ing field. The patient was unconscious for two hours
after the accident. At the end of a fortnight he was re-
moved to Dublin, suffering much from pain over the
upper part of the occipital bone on the right side, and
also much gastric irritability and general debility. Any
motion, such as driving, intensified the pain, and caused
nausea. On examination, a shallow depression of the
size of a florin, bounded by a ■well-defined margin, was
found at the situation where he complained of the pain.
The diagnosis of fracture, with the subsequent formation
of an abscess within the cranium at the seat of the lesion,
was made. An exploratory incision was made down to
the bone, and a small purulent collection was opened.
On exploring the bone, a small circular opening through
the skull, about two lines in diameter, was discovered.
Through this opening, situated on the upper part of the
occipital bone, some purulent matter oozed. A circular
jiiece of bone was removed with the trephine, to provide
free exit for the pus. An abscess-cavity, from which al-
most half an ounce of pus welled up, was opened. The
inner surface of the piece of bone removed was deeply
eroded. The cavity of the abscess was washed out with
a weak solution of carbolic acid. Subsequently, the pa-
tient experienced an attack of erysipelas of the head and
neck, from which, however, he recovered ; and nothing
further occurred to interrupt the progress of complete
recovery. — British jMedical Jour?ial.
Lymphosarcoma Invading the Duodenum. — Dr.
Norman Moore, at a meeting of the London Patholog-
ical Society, showed a lymphosarcomatous growth origi-
nating in the lumbar glands. They were greatly en-
larged, and the mesenteric glands to a less degree. The
duodenal wall was greatly thickened, and the mucous
surface ulcerated. There were no other infiltrations.
The specimen was from a woman, aged forty-one. During
life an irregular ovoid tumor was felt in the epigastric
region. The greater part of it was dull on ]5ercussion ;
a lesser part was slightly resonant. The dull part was
where the duodenum was most thickened by infiltration.
The resonant part was where it was dilated. There was
no intestine in front of the tumor. The duration of
illness was eight months. A pulsation in the abdomen
was first noticed, then vomiting after food, and the ab-
dominal tumor. — British Medical Journal.
Nervous Dysphagia. — .A man, thirty years of age,
had suffered from childhood with extreme nervousness.
He stated that he had always had more or less difficulty
in swallowing. But six years ago, in attempting to swallow
a piece of meal, he was seized with a severe attack of
suffocation. This was repeated a few years later, upon
eating a soft-boiled egg. The patient was very excitable,
becoming greatly agitated from slight causes. He com-
I'lainetl also of a feeling of weakness. The act of deglu-
tition, besides the expression of anxiety, was seen to be
accompanied by a general trembling of the entire body.
At times there were hypochondriacal delusions. Bro-
mide of potassium, galvanization, the cold douche, and
other remedies were tried unsuccessfully. If the patient
could be engaged in conversation while eating, the act of
swallowing became much more easy. Attempts to intro-
duce a stomach pump, were followed by very great ex-
citement and distress. 'l"he |)atient was finally discharged
unimproved. — Ber. Rudolph-Stift., Wien, 1882.
The Causation of Pain in the Lefi- Side. — At a
recent meeting of the Academy of Medicine, in Ireland,
Dr. Beatty read a paper on this subject, drawing special
attention to a form not sufficiently recognized, which was
due to fecal accumulation, and removed by getting rid
of the accumulation. The pain was felt over the lower
few ribs on the left side, was associated with extreme
tenderness on pressure uinvard of the tenth or eleventh
rib, scarcely any pain being felt on pressure of these ribs
downward, and was relieved when the side was pressed
inward with the flat of the hand. He explained its oc-
currence by the drag of a loaded colon on the pleuro-
colic ligament, this constant drag setting up a state of
extreme irritability in the nerves of that ligament, so that
a painful impression was carried upward along the left
lesser splanchnic nerve to the spinal cord, and was trans-
ferred, by the law of irradiation of sensations, to the
tenth and eleventh intercostal nerves. In the discussion
which followed. Dr. Smith said the pleuro-colic fold had
not received the attention it deserved. It certainly was
of considerable importance in the investigation of ab-
dominal disease. Dr. Beatty's arguments were valid as
exi)laining certain kinds of left-side pain, but did not ex-
plain all kinds. Dr. Beatty replied that he did not wish
it to be understood that he considered left-side pain was
caused in every instance by fecal accumulation, but only
in cases presenting the symptoms he had mentioned. —
British Medical Jouriial.
Tuberculous Nodule in the Lumbar Enlarge-
ment of the Cord. — A coachman, thirty-nine years
of age, was admitted to hospital suffering from advanced
pulmonary tuberculosis. Eight weeks before admission
he had experienced considerable pain in the feet, radiat-
ing into the toes and up each side of the leg. There was
no ataxia. The spinal symptoms continued to increase.
There were retention of urine and involuntary passage of
ffeces, progressive anasthesia and analgesia, and finally
complete paraplegia. The tendon and skin reflexes were
abolished. There was a painless effusion into both knees
and ankles. Death finally ensued upon symptoms of
peritonitis. At the autopsy there was found to be pul-
monary, laryngeal, and intestinal tuberculosis with per-
foration of the bowel. In the lumbar enlargement of the
spinal cord, a little to the left of the centre, was found a
caseous nodule the size of a bean, surrounded by an area
of softening in the medulla. — Ber. Rudolph-Stift., JVien,
18S2.
Hydatid of the Brain. — -Dr. Hawkins, in the Aus-
tralasia/! Medical Gazette, reports a case of hydatid of
the brain. The patient was a youth, eighteen years of
age. He had an epileptic fit on March 25th, but was
soon well again. Dr. Hawkins first saw the patient on
April nth. He was then sitting up, complaining of severe
pain at the back of the head, a fulness about the throat,
and he had a very marked squint — no fever, no vomiting.
He said he felt as if another fit were coming on. He was
ordered a purge and large doses of bromide, and was to
be seen the following day. The doctor, however, re-
ceived a message to the effect that the boy was much
better, would not trouble him to call, but would come
and see him himself. He did not appear as promised, but
two days later a message came to say he was dead. It
appeared that, feeling so much better on the day before
— the pain and the squint having both left him — he went
out to spend the evening with some friends. He was ob-
served to be in excellent spirits, and thoroughly enjoyed
himself, but it was said he did not touch any stinuilant.
The next morning he was about to get u[) as usual, but
not feeling very well, determined to lie in bed. He com-
plained of a slight return of the pain in the head, but was
able to converse until noon, when he quietly turned
round in his bed and died, having asked for a drink five
minutes before. Prior to the date first mentioned (March
25th) he had never had an epileptic seizure, but on two
occasions, at intervals of a year or more, had complained
of fainting attacks. He also suffered occasionally from
what he considered to be bilious headaches. He was a
hard-working lad, engaged in a butcher's establishment,
not deficient in intelligence, could draw, play the
harmonium, and had a good memory. He had been
brought up in .Sidney since the age of two years, but his
early infancy was passed in Queensland, where the drink-
March 24, 1883.]
THE MEDICAL RECORD.
ing water used by the family was obtained from an open
creek through which, at certain seasons of the year, there
was considerable traffic of shee]) and dogs. The follow-
ing was noted at the autopsy : skull larger on right side
than on left. Calvaria very thin — almost transparent in
places — showing plainly marks of convolutions on the
right side. Dura mater normal, subarachnoid fluid absent,
from the convolutions being so closely pressed together.
At the back of the right posterior lobe the nerve-tissue
had given way, and from it was seen protruding a trans-
parent bladder distended with fluid. The brain was care-
fully removed, and the hydatid cyst (for such it proved
to be) was found embedded in the substance of the brain
tissue, without occupying the lateral ventricle.
Anatomical Changes in Bright's Disease. — From
a series of articles in the Archives Gaicrales de Mt'decine
Dr. Brault feels justified in formulating the following
propositions : i. The group of symptoms understood by
the name of Bright's disease corresponds with a variety of
renal changes, acute, subacute, and chronic, which may
be either inflammatory or degenerative. 2. These various
renal changes mav be due to several causes, or one cause
may give rise to different forms of the disease. 3. The
first cause of the lesions is probably a chemical alteration
in the blood, the nature of which is to be determined in
each case. 4. To find expression in clinical signs, the
anatomical lesions nuist be situated in the glomeruli and
the lining of the convoluted tubules. 5. The only clinical
expression of the renal lesions is albuminuria. This
point, however, is still questioned by some writeis. 6.
The other lesions of the kidney (increase or diminution
or contraction of the connective tissue, disseminated fatty
degeneration, etc.) which determine the [ihysiognomy or
gross appearance of the gland, find no clinical expression.
7. The symptoms, other than albuminuria, of thedifterent
forms of nephritis depend upon the retention of excre-
mentitious matters in the blood. 8. This retention is due
to an anatomical change, producing a disturbance of
function in the secreting portion of the kidney. The
anatomical changes upon which this functional trouble
depends are numerous, such as acute or chronic fatty de-
generation, transformation of columnar into flat epithe-
lium, and finally atrophy and progressive disappearance
of this epithelium. The latter is seen in interstitial
nephritis of vascular origin.
Gouty Tumor of Penis. — .\t a recent meeting of
the Glasgow Medico-Chirurgical Society {Glasgow Medi-
cal Joicrnal), Dr. H. C. Cameron related a case in which
there was a hard little tumor of gouty origin situated be-
tween the dorsal and right lateral aspects of the penis,
about an inch from the pubes. It caused no pain except
during erection, when there was always severe pain in the
part, and the penis became distorted and bent at a sharp
angle. He had seen one other similar case.
Exploration of the Bladder by Perineal Sec-
tion OF the Urethra. — Sir Henry Thompson, at a
meeting of the Royal Medical and Chirurgical Society,
read a paper on an operation for exploring the bladder
by perineal section of the urethra, and for removing
vesical tumor, impacted calculus, etc. The author con-
sidered this a new method of investigating obscure dis-
eases of the bladder, which promised to be valuable in
certain conditions, occasionally met with. Every one
sometimes met with a case in which the symptoms of
vesical disease were severe and obstinate, and although
very careful examination had been made, he was unable
to arrive at a rational diagnosis. The occurrence was
doubtless not a common one ; in the great majority of
cases carefully made observations demonstrated the na-
ture and seat of the disease. But for the exceptional
instances, always important — cases generally marked by
frequent or persisting ha;maturia of some standing, mani-
festly not renal, and without local sign of cancerous tu-
mor— he proposed to take decided action, and to submit,
further, that such action should not be unduly jjostponed.
The essential ste|i in the method proposed was to exam-
ine the entire internal surface of the bladder with the
finger, by which means we could recognize the presence
of any tumor, large or small, the existence of encysted
calculus, etc. The method of doing this was illustrated,
and shown to be a proceeding simple and easy of per-
formance, and at the same time one which involved little
if any danger to life. It consisted in making a small
opening from the raphe of the i)erineum to the membra-
nous urethra, which was opened on a grooved staff just
enough to admit the left index-finger to enter the canal
and to be pushed on to the neck of the bladder. Pro-
vided the anaesthesia of the patient was so complete that
the abdominal nuiscles were perfectly relaxed, every por-
tion of the internal surface of the bladder might be
brought consecutively by supra-pubic pressure into close
contact with the tip of the finger, and any deviation from
the natural condition, however slight, could be noted.
The operation was an external urethrotomy only, and
involved neither the prostate nor the bladder. The ap-
plication of the proceeding not only to diagnosis but sub-
sequently to treatment was then discussed. It was
shown to offer facility for the removal of tumor, impacted
calculus, etc. Seven or eight cases in which the opera-
tion had been performed were cited, and several speci-
mens of tumor were exhibited which had been removed
by the author. These latter were exam])Ies of a disease
which is inevitably fatal unless removed by operation.
Great care was necessary in examining the state of the
patients before having recourse to operation. The two
conditions, the absence of which were so important to
be assured of before interfering, were renal disease and
cancer. Hasmaturia from either of these sources of
course absolutelv contra-indicated an operation. — Lancet,
January 27, 1883.
Venesection to Prevent Premature Birth. — Dr.
Mayo writes to the Australasian Medical Gazette to the
effect that he has found phlebotomy an efficient prevent-
ive of premature births. He recommends that from three
to four ounces of blood be abstracted soon after the first
indication of quickening. For fifty years he has resorted
to this practice with good success. And he adds that he
bleeds indiscriminately both robust and delicate women.
Traumatic Pneumonia. — Dr. Mader relates the case
of a laborer, fifty-eight years of age, who fell from quite
a height, striking upon the chest. Ten days after the ac-
cident he entered the hosjiital suffering from severe pain
in the epigastrium and right hypochondrium. The liver
was enlarged and exceedingly tender. There were also
marked signs of imeumonia of the right lung, dulness on
percussion, bronchial respiration, and bloody sputa. The
disease ran the ordinary course of an idiopathic pneu-
monia, resulting in complete recovery. — Ber. Rudolph-
Sti/t., Wien, 18^82.
Antagonism between Syphilis and Vaccinia. — Dr.
Polin inclines to the belief [A>inales de Dermatologie ct de
Syphiligraphie) that there is an antagonism between the
vaccine virus and that of syphilis. He was led to this
view by the results of some vaccinations performed by
him in Algeria. Of 471 children the vaccination was
successful in 410, all of whom were free from any syphil-
itic taint. Of the 61 children in whom the inoculation
did not succeed, 48 presented indubitable evidences of
syphilis.
Acute Inflammation of the Internal Ear. — Dr.
Voltolini calls attention, in a monograph published in
Breslau, 1882, to the frequency of acute inflammation of
the labyrinth {otitis lahyrinthica s. intima) in young chil-
dren. He states that it is usually mistaken for epidemic
cerebro-spinal meningitis, but that it differs from that
disease in its origin, sj'inptoms, and sequela;. He pro-
poses to give it a place among the diseases of childhood,
and argues at length against Politzer and others who
deny its existence.
324
THE MEDICAL RECORD.
[March 24, i!
The Medical Record
A Weekly younial of Medici >ie and Sjirgery.
GEORGE F. SHRADY, A.M., M.D., Editor.
Published by
WM. WOOD & Co., Nos. 56 and 58 Lafayette Place.
New York, March 24, 1883.
CHANGES IN THE RENAL GANGLIA AND
BRIGHT'S DISEASE.
Dr. S.iUNDBY, in the British Medical Journal. January
13, 1883, confirms the observations made by Drs. Da Costa
and Longstreth, concerning the altered state of the renal
ganglia in Bright's disease. But whereas the latter are
disposed to regard the neural change as the primary and
causative one, Dr. Saundby asserts that the ganglionic
nerve-cells are only secondarily affected. Moreover,
while the nature of the nerve-change was described by Da
Costa and Longstreth as identical with fatty degeneration,
Dr. Saundby affirms the process to be one of pigmen-
tary metamorphosis merely. Thus, although admitting
the accuracy of their observations, he dissents from the
conclusions which they have arrived at. Indeed, he is
certainly right in asking why they regard the ganglionic
changes as causative factors, more especially in the pro-
duction of the contracting kidney, since similar nerve
alterations are found as well in all the other types of
Bright's disease. To quote Saundby's own words, he
says :
" I think we cannot escape from the conclusion that
the ganglionic lesions stand in the same relation to all
the forms of Bright's disease. There is nothing to sug-
gest that they are more likely to be primary in one
form than in another ; so that, if we hesitate to regard
acute Briglit's disease as primarily a disease of the re-
nal ganglia, any objections which weigh with us in this
case should hold good in all. It may be thought that
the insidious mode of origin of the contracting kidney
makes it a fairer field for speculation than the other
forms of Bright's disease; but I would earnestly protest
against the assumption that the obscurity of a problem
justifies the introduction of crude hypotheses resting on
ambitious facts and doubtful analogies. A moment's re-
flection, moreover, will assure us that we really know no
«iore of the actual mode in which the kidney is affected
by, for example, the poison of scarlatina, than we do of
that of gout."
But the cjuestion of most moment i.s whether the nerve-
changes, about the actual occurrence of which there
appears to be no longer any doubt, are primary or second-
ary. And the answer to this question has not yet been
a satisfactory one. Here, as elsewhere, we should remem-
ber that the association of pathological processes does
not prove the existence of a causal relationship between
them. Dr. Saundby very aptly calls to mind that (piite
similar nerve-changes have been described in other more
or less obscure diseases. Thus Marcacci has found them
in diffuse eczema; Brigidi has described them in pseudo-
hypertrophic muscular paralysis and pernicious anemia ;
Morselli has noted their occurrence in glio-sarcoma of
the brain ; Ponicare in general paralysis of the insane ;
Pio Foa in cholera. They have also been seen in con-
nection with diabetes niellitus. Moreover, Giovanni, as
long ago as 1876, had found cellular infiltration of the
sympathetic ganglia in a great variety of visceral and
general diseases. The evident inference is that struc-
tural changes of organs are commonly accompanied with
demonstrable signs of irritation in the ganglia.
Reasoning from analog)', we may therefore assume
that the ganglionic lesions of Bright's disease are the re-
sults or concomitants of the renal alterations. At any
rate, our present knowledge does not justify the assiunp-
tion that they are in any sense the forerunners of that
malady.
This, statement is by no means intended to discourage
a new line of research. On the contrary, it should stimu-
late us to further labor in a promising field of pathologi-
cal inquiry.
DISE.aiSES OF THE F.\LLOPI.-VN TUBES.
Dr. Thomas Savage directs attention in the Birming-
ham Aledical Review, January, 1883, to the comparative
frequency of pyosalpinx as a cause of recurrent attacks of
pelvic inflammation. He believes that many cases of
supposed pelvic cellulitis hitherto regarded as incurable
really come under the head of inflammation of the Fallo-
pian tubes. Such cases he holds to be often curable by
operation. Among other causes, he thinks that gonorrhoea
may play an important part in the production of Fallo-
pian tube diseases, and in this respect he agrees fully
with Dr. Noeggerath, of whose previous publications he
seems, however, quite ignorant. Tlie first effect of in-
flammation seems to be to seal up both ends of the ovi-
duct, giving rise subsequently to an accumulation of
serum or pus. In cases of hydrosalpinx the fluid may.
be absorbed, but this result, Savage thinks, is seldom, if
ever, obtained when pus is present. Now, in all such
cases temporizing is not only useless, but positively
harmful.
The diagnosis of disease of the Fallopian tube is, to
some extent, presumptive. There will be found a small
tumor in the position of the tube on one or both sides of
the uterus, or, if larger, it may be felt almost wholly in
Douglas' space. In the acute forms the parts around
the uterus may be felt to be boggy, with more or less fi.x-
ation of that organ. In the more chronic forms, the
uterus may be quite free and mobile. In some cases
there is nothing to be felt in the pelvis, and the diagno-
.sis is based upon the presence of more or less constant
pain and recurring attacks of inflammation. In perform-
ing abdominal section for the removal of these tumors,
the author recommends that the incision be about two
inches in length, or just large enough to admit two fin-
gers. If the tumor be too large to permit of its extrac-
tion through this short opening, it is a good plan to as-
pirate it. If any fluid escajie into the abdominal cavity,
it is not necessary to wash out the pelvis, but dry spong-
ing should be tlioroughly practised. If no pus or blood
March 24, 1883.]
THE MEDICAL RECORD.
o o C
have escaped into the peritoneal cavity, the wound should
be closed completely, otherwise a glass drainage-tube is
ito be inserted. Both Fallopian tubes should be removed,
even though one be apparently healthy, as the proba-
bility is that the normal one would sooner or later become
affected in the same way as its fellow. Dr. Savage for-
merly insisted strongly upon the use of the spray in all
abdominal operations. But he has now discontinued its
use, believing that increased operative experience and
extreme cleanliness are the two main factors which con-
I tribute to successful practice.
THE HYGIENIC TREATMENT OF ALBUMINURIA.
The treatment of chronic Bright's disease by medicines
alone has not hitherto been very satisfactory. Witness, for
instance, the long list of drugs that have all had their day
of popularity, only sooner or later to be consigned to ob-
livion. Ever since the publication of his well-known
treatise, Senator's name is prominently coupled with
modern notions concerning albuminuria, which must ever
remain one of the most significant symptoms of renal
disease. His monograph on this subject is still one of
the most elaborate and carefully prepared essays extant.
At a recent meeting of the Berliner Med. Gesellschaft,
he again took up the subject of albuminuria, more
especially as regards the hygienic management of pa-
tients suffering from the various forms of Bright's disease.
He urged upon his hearers the great necessity of at-
■ tention to the details of diet and hygiene in the manage-
ment of this affection. In this connection he also called
attention to the improvements in the condition of subjects
of Bright's disease so often seen to follow their admission
to hospital. Senator had noticed this amelioration even
in cases in which the medical treatment remained pre-
cisely the same as that previously followed without effect.
And he attributed the improvement solely to the more
favorable hygienic surroundmgs of such patients follow-
ing their admission to a hospital.
We all know that transient albuminuria is frequently
seen even in healthy individuals during the digestion of
a full meal. Now, in view of this fact, Senator advises
that patients with Bright's disease should never eat hear-
tily at any one time, but should rather take nourishment
in smaller quantities at more frequent intervals. In re-
gard to the quality of food taken, he recommends that it
be, as far as possible, non-albuminous. Eggs should
under no circumstances be allowed. Of meats, those
should be given the preference which contain the smallest
proportion of albumen, such as veal and poultry. Fish
should also enter largely into the dietary. A liberal use
of vegetables, with the exception of the leguminous ones,
is advised. The popular milk diet is likewise recom-
mended as exhibiting a minimum of albumen. But as
milk is also deficient in the carbo-hydrates. Senator allows
with it a small quantity of bread, meal, or wheaten grits.
The functions of the skin should be most carefully at-
tended to. A moderate perspiration is to be almost
constantly maintained, and to effect this with the least
danger to the patient, the speaker advised a more or less
prolonged confinement to the bed. This was also re-
commended on the ground of restraining muscular move-
ments. It was stated that an increase in the amount of
albumen excreted always followed upon muscular exer-
tion. Consequently all active exercise should be for-
bidden. And if fresh air were deemed necessary it
should be taken in a carriage, the patient being well
wrapped up to guard against the danger of catching cold.
Senator does not claim tliat chronic albuminuria car»
be cured in this way, but he states that he has brought
about a marked amelioration of the symptoms through
strict attention to the minutire of the hygienic and die-
tetic treatment, here briefly outlined. It is questionable,
however, how far the subjects of nephritis in the earlier
stages would carry out the strict and to them tiresome
details of treatment as laid down by the speaker in his
interesting address. Such patients are sick, to be sure,
but they are not always sufferers. Pain is, after all, the
most persuasive reminder of the physician's injunctions.
When this is absent or insignificant, his advice is too
often neglected, even by the otherwise prudent and in-
telligent.
As regards the more advanced cases, a cure is, of
course, out of the question. Nevertheless, Senator's
method may prove of great value in prolonging life, and
ensuring a more comfortable existence. Results cer-
tainly that the profession will never belittle or despise.
CEPHALIC AUSCULTATION IN MENTAL DISEASE.
Dr. Adriani ( /ournal de Med. et de Chir. Pratiques,
February, 1883) has been conducting a series of investi-
gations upon the transmissibility of the voice to the occi-
put, with a view to determine its value as a sign of men-
tal disease. The patient should speak in a low tone
while the ear of the auscultator is applied to the occi-
put. He found that in a number of cases of mental dis-
ease the voice-sounds were exaggerated or weakened, am-
phoric, indistinct, or absent. In healthy individuals they
were seldom exaggerated or weakened, and never am-
phoric or indistinct. He thinks that the sound of the
voice is transmitted by the cranial bones and not by
the brain substance. The latter, however, influences the
sound, and it is probably to the difference in its density
that the various modifications of the voice-sounds are
due. According to Crichton Browne the density of the
brain varies in the different forms of mental disease, and
hence Adriani sees ground to hope that cephalic auscul-
tation may become of value in the diagnosis of these
diseases.
THE CURABILITY OF TYPHOID FEVER IN THE PRODRO-
MAL STAGE.
At a recent meeting of the Academy of Medicine of
Paris {Bulletin de F Acadc'mie, January 14, 1S83) Dr.
Jules Guerin maintained the existence of mild and
abortive forms of typhoid fever. The modified typhoid
presents symptoms similar to those of the prodromal
stage of the disease as usually described, yet is not to be
confounded with the prodromal stage. In each case the
symptoms observed are the first manifestations of the
specific poison. The difference, however, lies in this,
that in the one the disease is arrested at this stage owing
to an insufficient dose of the virus, in the other the
symptoms are due to the first weak efforts of a large
dose, and will increase in severity unless the virus be
destroyed.
326
THE MEDICAL RECORD.
[March 24, 188;
The author thought that the action of the fever-poison
might be compared to the action of such a poison, c'.g., as
arsenic. When a dose of arsenic was taken it produced
first, by virtue of its presence in the stomach, a certain
local action ; but presently, if it was not expelled or neu-
tralized, it became absorbed and gave rise to a general
action. So the poison of typhoid fever, when it entered
the body, produced a primary local action, and then,
becoming absorbed, gave rise to the characteristic train
of general symptoms. The poison might be introduced
primarily into the lungs through the respiratory passages,
into the nervous system by absorption through the skin,
or directly into the intestinal tract ; and before it became
absorbed into the general system it produced in these
organs a certain local action, giving rise to symptoms
which were truly prodromal. The prodromal symptoms
would thus indicate the local action of the fever-poison
before its absorption. Guerin farther claimed that it was
possible in this prodromal stage to eliminate the poison
and thus cut short the disease. His plan of treatment
was based upon this belief, and consisted in the adminis-
tration of purgatives or emetics, according as the in-
testinal or gastric symptoms predominated, at the very
earliest possible moment. He then gave charcoal, and
continued the administration of evacuants and disinfec-
tants on alternate days, until the patient was cured. Dr.
Guerin made the rather broad assertion that, during sev-
eral years in which he had pursued this plan, he had
never had a case terminate fatally.
The author's reasonings seem plausible enough ; nev-
ertheless when he asserts the invariable curability of
typhoid in its prodromal stage there is room for doubt-
ing the accuracy of his diagnostic powers. We have
elsewhere heard the question put whether quinine might
not avert impending typhoid. But in that instance
also, although there seemed .abundant evidence to justify
an affirmative answer, the question was rightly consid-
ered to be still an open one. And so while Gueriu's
claims certainly deserve to be noticed, we do not feel
disposed to accept them as the unquestionable proof of
the curability of typhoid fever in the prodromal stage.
THE NEW .AQUEDUCT BILL.
Now that a new aqueduct is considered necessary by
the politicians at Albany, it is quite important that the
e.xpenses for the same should be reduced to a consistent
minimum. It will be quite difficult, it is true, to take
the huge job entirely from the hands of some of the in-
terested workers. Ever)- movement in that direction,
however, deserves the support of ta.\-payers and the
public at large. The new water bill from the anti-Ring
association of ta.x-payers of the city has some very
commendable features in it, looking toward the reduc-
tion of e.xpenses and the checking of political jobbery.
Although the provision for a commission of seven
citizens, to be appointed by the Mayor, representing the
different senatorial districts of the city, is a wise one in
itself, it does not by any means prevent the appointment
of incompetent, but influential politicians to such an
office. Still, such appointment must necessarily be trusted
to His Honor the Mayor. The best safeguard against
incompetency on the part of members of the proposed
commission will be guaranteed by their fitness to con-
tinue investigations concerning the water supply, and
within a given period to present a report, which shall be
open to public criticism for a reasonable period. This
at least insures, to a certain extent, fair play to all such
as are interested in seeing that the work is done prop-
erly.
THE NATIO.\.\L BO.A.RD OF HE.^LTH [
The lack of support given to this organization by tlie
last Congress is still a matter of warm discussion among
our sanitary confreres. Much that was said against the
Board in Congress was rhetorical drivel, of which the
country should be ashamed. It is very evident, how-
ever, that Congress and the commercial interests of the
country have not yet been brought to see that prevent-
ive medicine as carried out by a national body will be
useful and economical. Such being the case, the medi-
cal profession is not called upon to start a propaganda
in the matter. Another epidemic will be more potent
in this direction than tomes of arguments. We believe
that a sentiment in favor of a national health organiza-
tion will again be developed, and that it is only a ques-
tion of time.
TRICHIN.A. SPIRALIS .-WD GERM.ANY.
The trichina spiralis seems likely to be the cause of
international difficulties. The German Government
has [irohibited the introduction of American pork on the
ground that it is infested with trichina; and therefore
dangerous to health. There has not been sufficient ex-
amination as yet to determine the exact relative merits
of German and .(American pork, as regards freedom from
trichina;. It seems, however, that the American article
is affected to a slightly larger extent than that of Europe.
On the other hand, there has as yet been no well authen-
ticated case in which trichinosis in Germany was pro-
duced from eating pork imported from America. The
prohibition is, we believe, a political rather than a sani-
tary measure. It is understood that Secretary Freling-
huysen has taken the matter in hand, and if he fails to
secure a repeal of the prohibition, will lay the matter be-
fore Congress.
THE NEW HOSPIT.-VLS FOR CONT.\GIOUS DISEASES.
The hospital for contagious diseases on North Brothers'
Island, has been completed and delivered to the sanitary
authorities. It has cost $66,900. A submarine cable of
three wires to cost $900 will soon belaid to Port Morris,
when there will be direct telegraph communication be-
tween the island and Sanitary Headquarters. In the
summer a strong steamboat, to cost $30,000, will be built
to transport patients and employes to and from the hos-
pital. .\ contract will be awarded to fill in a marsh on
the island and build a sea-wall, this will cost $5,000.
Specifications and plans are preparing and bids will be
advertised for an administration building to cost $15,000;
a boiler-house and laundry to cost $15,000; a kitchen
building to cost $8,000 ; steam-heating apparatus to cost
$10,000, and corridors to connect all the buildings with
the hospital to cost $3,000. The sanitary authorities
will also soon advertise for proposals to build, at a cost
of $50,000, the hospital for children sick with contagious
diseases at the foot of East Sixteenth Street.
March 24, 1883.]
THE MEDICAL RECORD.
327
^eius of U\c WXcc}\.
Death of Baron Jules Cloquet. — ^Baron Cloquet,
.one of the oldest medical men in France, died on Feb-
ruary 23d at the age of ninety-four. He was the author
of several works on anatomy and surgery. F"or thirty
years his anatomy was a standard work.
A Micro-Organism for Yellow F'ever. — Perono-
spera Lutea is the title of the micro-organism which Dr.
Carmona del Valle believes to be characteristic of yellow
fever. The germs of this cryptogerm are always to be
found in the e.Kcretions and in the fluids and secretions.
Animals inoculated with it show febrile symptoms. After
recovery they are not affected by a second inoculation.
The Graduating Class at the Miami Medical Col-
lege numbered forty-one.
The Micrococcus of Cerebro-Spinal Meningitis. —
At a meeting of the Berlin Society for Internal Medicine,
February loth. Professor Leydeii demonstrated the pres-
ence of micrococci in cerebro-spinal meningitis. He re-
ferred to the fact that these organisms had been discov-
ered in this disease by Klebs and Ebert. Leyden found
them in traumatic meningitis also. He distinguished
them from decomposition organisms by their less rapid
movement and their shape. He thought that with the
present evidence there was no doubt that cerebro-spinal
meningitis was a parasitic disease.
Is IT Science, or Snobbery, or only Gossip ? — Our
British journalists write that " the auspicious result of the
accouchement of H. R. H. the Duchess of Albany, is a
source of great pleasure and congratulation
Prior to the happy event there had been some natural
anxiety among the many friends of etc., etc." This all
sounds very strange in American ears, but American phy-
sicians do not have to act as medical valets to a particu-
lar class.
The Detroit Medical College held its annual com-
mencement on F'ebruary 28th, and graduated thirteen
students.
The Michigan College of Medicine held its annual
commencement on March 5th, graduating a class of
twenty-eight.
The Columbia Veterinary College and School
OF Comparative Medicine, holds its annual Commence-
ment on March 29th.
The Buffalo Medical College at its last Com-
mencement graduated fifty-seven students. The Faculty
has accepted the resignation of Prof. Charles A. Doremus
as Professor of Chemistry and To.xicology. Dr. R. A.
Witthaus was elected to the vacant chair.
More Commencements. — The seventy-sixth Com-
mencement of the Medical Department of the Univer-
sity of Maryland took place, March 15th, at Baltimore.
Eighty-seven graduates received diplomas as doctors of
medicine and thirty-four as dental surgeons. The annual
Commencement of the Woman's Medical College of
Pennsylvania was held March 15th. The degree of M.D.
was conferred upon thirty-five women.
Retirement of Professor Mulheron. — Professor J.
J. Mulheron, who has held the Chair of Medicine in the
Michigan College of Medicine, recently retired. At the
close of his last session the students of the college pre-
sented him with a handsomely engrossed address, express-
ing warm sentiments of regret at the retirement of their
teacher, and of acknowledgment of his work. We con-
gratulate the able editor of the Medical Age on the fact
that he is appreciated.
The next Meeting of the Sanitary Council of
the Mississippi Valley will be held at Jackson, Miss.,
beginning on Tuesday, April 3d, iiroximo. In view of
recent action, legislative and judicial, aftecting the sani.
tary interests of territory not embraced in the Council,
in common with the Valley proper, invitations are ex-
tended to prominent sanitarians and health officials in
the South Atlantic and Gulf States. John H. Raugh,
M.D., the Secretary (Springfield, 111.), should be promptly
advised by all accepting invitation.
Death of a Leprous Patient at Salem, Massa-
chusetts.— Charles D. Erby, a leprous patient at the
Salem (Mass.) Almshouse, who contracted the disease in
the Sandwich Islands, and whose case has excited much
ai)prehension, died there March 19th.
First Report under the New Rule for Rail-
ROADS.^The Railroad Commissioners of the State of
New York have adopted a requirement to the effect that
whenever an accident of any kind occurs on any railroad
in the State, the particulars shall be at once telegraphed
to them. The first report of the kind was transmitted
March 19th, by the New York Central & Hudson River
Railroad authorities. Their fast train, which left New
York at iialf-past ten that morning, struck a man south of
Yonkers, who was walking on the track. He was found
by the side of the track with his right arm and side badly
injured, but no bones were broken.
A New Water Bill. — A meeting of representatives
from various reform and anti-ring associations was held
at the headquarters of the Central Taxpayers' Association
on the evening of March 19th. The organizations repre-
sented were the New York County Anti-Monopoly
League, the Council of Reform, the West Side Associa-
tion, and the Taxpayers' Central Association. The object
of the meeting was to consider the new Water bill, which
has been prepared in accordance with the rei)ort of the
Water Conuiiittee. Its principal features are to have the
work on the new aqueduct done under the direction of a
commission of seven members, one from each Senatorial
district, to be appointed by the Mayor, to limit the total
cost of increasing the water supply to $20,000,000, which
sum is to include the entire expense of getting land for
"right of way," etc. Other provisions of the bill are that
there shall be further investigation of the water problem
by the conniiissioners when appointed ; that they shall
make their report within three months and exhibit the
said report for public inspection for one month, and
shall also give the citizens a hearing in regard to it, make
any necessary modifications and complete the report with-
in one month. The bill will also contain the usual pro-
visions for securing the necessary land by agreement in-
stead of by process of law, arbitration, condemnation, etc
328
THE MEDICAL RECORD.
[March 24, i!
Professor Arlt has been given the cross of the order
of Francis Joseph in recognition of his long services as a
teacher and worker in tlie Vienna Medical Faculty.
A Training School for Nurses has been organized
in connection with the Cincinnati College of Medicine
and Surgery. The first term begins on March 26th.
Candid Criticism on the New Code. — In the midst
of the flood of vituperation, the charges of dishonesty,
greed, avarice, and trickery which have been made against
the profession of New York in the name of the Code, it
is due that there be an acknowledgment of the candor
and fairness shown by the Weekly Medical Review and
the Medical Age. These journals have taken the pains
to let their readers see that there are at least two sides
to the question.
The Kentucky State Medical Society meets at
Louisville on April 4th. Dr. L. S. McMurtry, Secre-
tar)'.
The Bill to Create a State Board of Examiners.
— As widespread as has been the interest e.xcited by the
State Society on the position it assumed a year ago on
the subject of Medical Ethics, in our opinion, says the
Buffalo Medical and Surgical Journal, the most \ital
question presented for the consideration of the society
was the recommendation of a bill for the creation of a
State Board of Examiners. The proposed bill came be-
fore the society in the report of the committee on legis-
lation, and was evidently prepared with great care. It
sets forth : i, what it means to be a practising physician
in this State ; 2, that after some future time (December,
1883) a person shall not have the right to practise medi-
cine in this State unless licensed by the State Board of
Examiners ; 3, that candidates for license to practise
medicine may select to be examined in any of the schools
of practice represented by the incorporated State medi-
cal societies ; 4, that the records of the examinations
upon which licenses are granted shall remain a part of
the archives of the University of the State ; 5, it repeals
all acts or parts of acts authorizing medical colleges or
other corporations to grant degrees which shall beliceiTses
to practise medicine.
The Morphine Fiend. — Our readers in the city are
warned against a certain woman who is at present visit-
ing physicians' offices and asking for a hypodermic injec-
tion of morphine. Her plan is generally to appear to be
suffering intensely from neuralgia and to be in a state of
pitiable weakness and depression therefrom. She claims
to have been sent by some one who has highly recom-
mended the jiarticular medical victim on whom she is
calling. After securing a hypodermic injection, she in-
(juires for the toilet room, and having disembarrassed
her bladder, she waits a while and then demands another
injection. If this is denied her, she sits down refusing to
leave, and refusing to pay, claiming that she has not
been treated properly. In one case she declared she
would stay all night, greatly to the horror of her modest
bachelor attendant. The woman in question is about
thirty-five years old, and is tolerably well dressed, though
rather dirty. She claims to be a little deaf Quite a
number of physicians have already been annoyed and
imposed upon by her.
The New York College of Pharmacy Alumni. —
The twelfth annual meeting of the College of Pharmacy
Alumni Association was held March i6th, in the college.
The following officers were chosen for the ensuing year :
Fresidenl, George Inness ; Vice-Presidents, Charles F.
Hubner, \. G. Cook, and Frank Hay ; Secretary, Fred-
erick Hohenthal ; Treasurer, L. M. Royce, and Regis-
trar, John Oehler. An exhibition was given in honor of
the graduating class of 'S3.
A School of Sanitary Engineering is to be estab-
lished in connection with Columbia College.
Traffic in Pauper Bodies in Massachusetts. —
Governor Butler has charged that a traffic in pauper
bodies has been going on in Massachusetts for many
years. It has been recently stated that of 2,800 deaths
in ten years 580 bodies were delivered to the medical
colleges, according to law. There is no record of the
disposition of the remainder. They are supposed to be
buried in Potter's field, but it is alleged that some of the
graves contain no bodies. Charges have been made that
bodies were preserved in a pickling fluid and sent to dis-
tant points in kerosene barrels. Country medical col-
leges, it is well known, are generally supplied from the
cities in this way. These colleges need the "material"
in question, and under proper restrictions should be al-
lowed to have it.
The late Premier Gortschakoff. — An examina-
tion of the intestines of the late Premier Gortschakoff
has shown the presence of phosphorus in them. It is
suspected that he was poisoned.
Death of Dr. C. Henry King. — Dr. C. Henry
King, School Commissioner of Richmond County and
Physician-in-Chief of Sailors' Snug Harbor, died at Quar-
antine Station, Staten Island, March 18th, of pneumonia.
Dr. King was for a long time Physician-in-Chief of the
Seamen's Retreat Hospital. He was well known for his
energetic advocacy of the physical examination of sea-
men before shipment.
The Bodies of Murderers and the Prevention
of Public Funerals. — The Connecticut Legislature
recently passed a bill directing sheriffs to cause the body
of any executed criminal to be quietly and decently
buried at an expense to the State not exceeding twenty
dollars. The sheritT may deliver the body to relatives,
still retaining exclusive direction of the funeral, or he
may at his discretion refuse to deliver it where there is
a prospect of an extravagant and disgraceful e.xhibition.
There is a prospect that some legislation upon this mat-
ter will be undertaken by the New York Legislature.
Well-water Supply of Brooklyn.— The health au-
thorities of Brooklyn have condemned a large number of
wells as containing water unfit to drink.
The Will of Sir Thomas Watson.— Our London
correspondent writes that Sir Thomas Watson's will has
been proved. The personalty alone amounts to more than
^164,000. With the exception of a few legacies, this
sum is divided between his son and his daughter. Large
fortunes — whether acquired by practice or inheritance —
are not common amongst medical men in Great Britain.
The above amount is certainly large, even for a court phy-
sician with an extensive practice and world-wide reputation.
March 24, 1883. J
THE MEDICAL RECORD.
329
Reports 0f J'ocicties.
NEW YORK ACADEMY OF MEDICINE.
Stated Meetijig, March 15, 1883.
FoRDvcE Barker, M.D., LL.D., President, in the
Chair.
the regulation and repression of prostitution.
Dr. F. R. Sturgis read a paper on the above subject, in
which he made the preliminary statement that although
the problem had for a long time been under discussion
in difterent countries, it was yet far from solution. He
then discussed the question under three Iieads : first, the
causes of prostitution ; second, the necessity of regulat-
ing the evil ; and third, the results obtained by legislative
action in this direction.
With regard to the causes, he had derived his informa-
tion from three sources — French, English, and American
— and after reviewing at some length the works of Sanger,
Acton, and others, it was found that all these writers had
reached the practical conclusion that man is the aggres-
sive party and is primarily responsible for the existence
of the evil.
The next most prominent cause is the desire which
women have for dress and luxury, not only for them-
selves, but for the purpose of attracting and pleasing the
opposite sex. The desire for luxury exerts a more po-
tent influence in the higher than in the lower classes. In
this country, except among the foreign born, the use of
intoxicating drinks enters much less frequently as an as-
signable cause than in any other country except England.
Another cause to which special attention was directed
was the promiscuous herding of people in tenement-
houses and the absence of home intluence.
The necessity for regulating the evil became especially
apparent when its consequences, as shown by conniiuni-
cation and propagation of venereal diseases were studied.
It was estimated from a calculation based upon Parisian
statistics tliat in the present population of the city of
New York there are in round numbers eleven thousand
prostitutes ; that annually there appear for treatment of
venereal diseases in the various public institutions of the
city about twelve thousand patients ; that in both public
and private practice there are probably sixt)-' thousand
persons who are being treated for venereal diseases, and
that of this number there are probably forty-five or fil'ty
thousand who are syphilitic. When the additional fact
is taken into consideration that probably from a third to
a half of the syphilitics are really capable of conveying
the disease, the necessity for regulating the evil at once
became apparent. The women who are most dangerous,
so far as syphilis is concerned, are not the old prosti-
tutes who have plied their vocation for years, but the
young girls who come upon the town and fall to the
lot of the so-called better classes rather than the work-
ing-men or the class even lower than those, and this
fact, in great part at least, accounts for the larger pro-
portion of cases in which the initial lesion of sy|)hilis, or
the chancre, is met with in private practice. It is im-
portant that this fact should be recognized among phy-
sicians, for the initial sore of syphilis is frequently so
slight as not to attract any attention, and the malady
goes on unchecked until syphilis is carried into families.
The old prostitute has passed beyond the condition most
favorable for the propagation of syphilis, while the young
woman, who is most attractive, has the disease in its
stages most favorable for contamination. The real dan-
ger, then, is not so much for the persons who receive
the syphilis, because, if then recognized, it is very amen-
able to treatment, but the penalty falls in full force upon
those to whom the disease is transmitted.
Dr. Sturgis then discussed at some length the obsta-
cles met with in all attempts to restrict the evil, such as
the natural repugnance of the question, the tender re-
gard for the rights of the subject, and the somewhat
prevalent belief tliat the evil is one which should not be
interfered with, but that those who contract the diseases
incident thereto should be allowed to suffer, etc.
With reference to results obtained by legislative ac-
tion in this direction, special reference was made to the
decided benefit which had followed the enactment of the
English regulations. At the same time it must not be
overlooked that if the disease could be confined to house
prostitutes, there would be much greater hope of restric-
tion than at present exists. The great difficulty, how-
ever, existed in the inability to restrain or check clan-
destine prostitution. In Paris it is estimated that there
is only one inscribed woman to six illegal prostitutes ;
that is, that the number of those engaged in clandestine
prostitution is nearly six times as great as of those who
follow it as a business, register, and submit to examina-
tion. The French writers on this subject, while admit-
ting the value which is obtained by regulating it, at the
same time confess the danger of driving inscribed women •
into clandestine prostitution, or at least increasing the
number of clandestine prostitutes.
The conclusions reached by the speaker were that
among the better classes it was impossible to repress
prostitution ; that at the present time the only hope ex-
isted in the ability to regulate it among the lower classes
who were found diseased, by sending such persons to
hospitals, where they could be compelled to remain un-
til they were either absolutely cured or rendered the
least possible innocuous. Any attempt, however, to
check the evil must be done without sentiment. If the
question became one of mere repression or control, all
attempts at repression would be absolute failures ; but if
an elTort were merely made to regulate it, he believed
that its regulation could be as easily accomplished in
the city of New York as it has been in London and in
some other large cities, where most of the women were
well known to the police, whether in or out of houses.
Dr. Sturgis then presented an interesting question,
namely, the effect which inscription has toward depopu-
lating a country, a fact to which a French writer had
directed especial attention. No such result, however,
need be feared in this country.
In conclusion he directed attention to the rules laid
down at the International Statistical Congress held at St.
Petersburg with reference to investigations concerning
the existence of syphilis.
The President remarked that no laws were of effect
which were in advance of public opinion or were not sus-
tained by public opinion, and that it frequently occurred
that laws which had been enacted that were not sustained
by public opinion had produced most disastrous results.
That there was a moral, social, and political aspect of
the question under consideration was apparent. That
there was also a legal aspect was equally apparent, and
in order that it might be properly presented he had in-
vited Judge John R. Brady, of the Supreme Court, to
be present and participate in the discussion, and he then
introduced the honored guest to the Academy, who first
referred to the study of this subject as presented by cer-
tain English writers, and in all of their articles one re-
markable feature was noticeable, viz., that none of them
had reached any conclusion. The Judge, from his gen-
eral consideration of the subject, thought that the better
opinion of the community at large seemed to be in favor
of legislative enactment, yet he doubted very much indeed
whether such enactments could be secured at the present
time. The judiciary had always been arrayed against
prostitution in any form, and just here he took issue with
Dr. Sturgis, and said that a woman has not control over
her own body ; that, according to the law of the State of
New York, she can be arrested as a vagrant and sent to
the penitentiary if it can be proven that she is without
other support than that derived from prostitution. The
difficulty, however, in enforcing all existing laws with
reference to prostitution was the migratory character of
330
THE MEDICAL RECORD.
[March 24, 1883.
the persons engaged ; that is, when routed from one
street they would migrate to another, and so move on
to dift'erent points, and thus manage to evade the law.
With reference to clandestine prostitution, it seemed
impossible to reach it in any way. His conclusion was
that no reform can ever be accomplished except through
the instrumentality of the medical profession ; that if
the efforts of medical men were sufficiently persistent
to give rise to the proper sentiment in the commu-
nity, all the social and intellectual objections which
had heretofore been raised against interference with
this evil might be waived, and the people might say
we will abide by your opinions concerning this known
evil, and will unite with you in all reasonable efforts for
either its regulation or its repression. Until such a sen-
timent can be created all etforts at securing legislative
enactment would very probably be unavailing.
Dr. Sturgis then read a letter received from Dr. A.
P. Gihon, of the United States Navy, ex]iressing his great
regret at being unable, on account of extreme sickness
in his family, to be present and participate in the discus-
sion, and also exjiressing the view that the question un-
der consideration was one which must be met by physi-
cians and looked squarely in the face, and that whatever
relief should come to the community must come very
largely through the united efforts of the medical profes-
sion.
Dr. L. Weber remarked that three modes of dealing
with the question of prostitution had been put into aii-
plication in various countries. First, to do nothing con-
cerning the evil ; second, to adojjt the policy of repres-
sion, which had been applied in Rome, Spain, Bavaria,
and Austria ; and, third, to recognize the evil and attempt
forcible regulation. All of these methods had proved
failures. He believed that the evils of prostitution
could be best restricted by turning attention directly
toward the means best adapted to diminish the propaga-
tion of syphilis. First, syphilis must be recognized ;
second, it must be treated with energy ; third, greater
hospital facilities than now exist should be afforded for
the treatment of syphilitic persons.
Dr. R. W'. Taylor believed that so far as legislation
is concerned no benefit would be derived in that direc-
tion from efforts to restrict the evil or its consequences.
Reform, if any, must come from two sources : First, in
a manufactured sentiment, which had already been
alluded to by Judge Brady, and which must come largely
through the medical profession ; second, in the better
education of the profession itself concerning venereal
disease in all its phases. The profession should to a
man be educated up to a point of being able to recog-
nize syphilis under whatever phase it might appear.
Gonorrhoea and chancroid are of such common occur-
rence that they might be said to be endemic, even in
polite society, and the difficulties in the way of their
recognition were manifestly less than concerning syphilis.
He believed if the fact was thoroughly understood that
syphilis is eminently a curable disease, and if every med-
ical man was able to recognize the disease m all its
phases, that the evil consequences attending its existence
and its propagation might be very largely restricted, and,
so far, one of the necessities of restricting prostitution
could be met.
The discussion was closed by Dr. Sturgis, who re-
ferred to the great difficulty in educating the people up
to the point of regulation or repression of the evil.
The Secretary then read a letter from Dr. Willard
Parker, gratefully acknowledging the kind expression of
sympathy extended to him by the President of the Acad-
emy in his inaugural address, and conveyed by the Com-
mittee, consisting of Drs. Detmold, Adams, and Hubbard.
The Academy then adjourned.
The Use of the Ophthalmoscope. — Nothnagel
says that no physician should be allowed to practice who
does not know how to use the oiihthalmoscoiie.
NEW YORK PATHOLOGICAL SOCIETY.
Stated Meeting, February 28, 1S83.
George F. Shrady, M.D., President, in the Ch.air.
Dr. Beverley Livingston presented specimens with the
following history :
double hydronephrosis due to abnormal bending-
OF the ureters — suppur.ative disease of the knee-
joint — abscess of the liver.
"Thomas M was delivered by forceps in the Nur-
sery and Child's Hospital September 29, 1S82, of a
healthy mother, and the mother and child did well,
nothing being noticed until November ist, when the
nurse reported that the child's left knee was swollen, red,
and painful, and that she thought the mother had turned
over on the child in her sleep and so injured it, but the
mother claimed the knee had been swollen since birth.
On examination the knee-joint presented the signs of an
acute inflammation, being red, swollen, and painful on
pressure, and the femur seemed to be dislocated inward,
also the lower end of the femur and the upper end of the
tibia seemed enlarged. Fluctuation was very apparent,
and this tumor evidently communicated with one in the
lower and outer part of the thigh. An opening was
made, a quantity of pus let out, and a drainage-tube in-
serted. Dead bone was found at the bottom of the cav-
ity. The limb was dressed once a day. The tempera-
ture was normal before the operation, but it went up to
102° to 103° F. afterward, with a rapid pulse, and in
five days (November 6th) the child died, having had
vomiting and diarrhcea for the last two days of its life.
" The autopsy was made November 7, 1882. The body
was emaciated, there was an opening on the under and
outer surface of the left thigh just above the knee-joint;
the knee was enlarged and the femur seemed to be dis-
located inward. On dissection the abscess was found to
extend upward on the under and outer part of the thigh
more than half the length of the femur, and in it a piece
of drainage-tube was found. This abscess communi-
cated with the knee-joint. The external condyle was
necrosed and thus allowed the femur to slip inward. On
section the shaft of the fenuir was found to consist of
two layers of bone, the outer being of a different struc-
ture from the inner, denser and showing striations in the
opposite direction, and was evidently due to the inflam-
mation of the periosteum. .Also there seemed to be a
line between the normal shaft of the bone and this outer
layer. The lines of ossification at the end of the femur
were normal and the ossification of the other bones was
also normal. The lungs showed catarrhal pneumonia in
the posterior part of both. The heart was normal. The
liver contained two abscesses in the middle of the right
lobe, about three-fourths of an inch in diameter. The spleen
was normal. Kidneys : They were both removed before
they were examined. The right one was opened and the
pelvis found to be considerablv dilated, with atro))hy of the
pyramids, only the cortex remaining. The left was in
the same condition. The pelvis of both kidneys con-
tained a small ([uantity of urine, no renal calculi could
be found. The part of the ureters that had been left in
the body was normal in size and entered the bladder
naturally, and the bladder was normal as well as the
urethra. The cause of the hvdronephrosis seemed to be
the bending of the ureters twice on themselves. On the
left side there was also constriction at the second curve."
Dr. Robert New.man presented a specimen of
carcino.ma of the rectu.m,
accompanied by the following history : Mrs. S. D-
aged fifty-six ; widow ; three miscarriages ; no living
children ; menstruated at fifteen ; regular throughout
until menopause.
Family history. — Father died at age of seventy-eight —
cause, dio|)sy ; mother diet! at age of seventy-two — cause.
March 24, 1883.]
THE MEDICAL RECORD.
33"^
senile asthenia. Had four brothers and four sisters, of
which one brother and one sister died in childliood (seven
and nine years of age). The rest are living and well.
Persoiialhistory. — The patient had most of the dis-
eases of childhood. At twenty years of age she had a
severe attack of dysentery, which came on after a mis-
carriage and lasted nine weeks. Since that time she
was troubled with more or less dysentery every summer.
Three years ago she was attacked by erysipelas of
the face and head which lasted two months. One year
ago she had an attack of spasmodic asthma, from
which she suffered for about two months. The present
complaint showed itself about two years ago, with
pain in lower part of abdomen, and occasional bloody
stools and the passage of " Hesh-like " matter from the
bowel, which had a very bad odor, her underclothing
also was continually stained by matter. This lasted
about one year. In August last she first noticed a lump
at the anus, of about the size of a chestnut, which rapidly
enlarged, was exquisitely painful, especially during the
act of defecation, and a larger amount of bloody, bad-
smelling matter was continually discharging from the
bowel. One night in bed she felt the sensation at the
anus as if a pin concealed in the bed-clothing had pierced
her. On feeling with her hand, she discovered what she
thought to be the point of a needle protruding partially
at the side of the anus ; ]nilling it out, however, and
looking at it, she discovered the offending article to be
a sharply pointed fish-bone, about one inch in length.
She thinks it was a part of the backbone of a cod. This
happened on New Year's day last.
January 8th. — Patient first presented herself at the
Northwestern Dispensary, complaining of piles, with
passage of blood and a continuous discharge of matter,
constipation, etc. An examination was refused by the
patient at the time, but a promise was given to retmn
and allow it. Was given a powder to do away with her
constipation.
January loth. — Patient presented herself for examina-
tion, though she thought the powder had given her some
relief Examination revealed a timior protruding from
the bowel of about half the size of a hen's egg, which had
at a superficial glance, somewhat the look of a bunch of
protruding hemorrhoids, beginning superficially to ulcer-
ate. To the touch, however, the tumor had a peculiarly
hard feel, and digital examination revealed that for about
three inches (in fact as high as the finger could reach)
the rectum was constricted and band-like rugre, hard as
cicatricial tissue, were felt in every direction. This
peculiar hardness and ready bleeding of the protruded
mass (which also involved quite a considerable portion
of the ring of the anus) coupled with the age of the pa-
tient and peculiar haggard and distressed look, led to
the diagnosis of carcinoma of the rectum. As the woman
was perfectly willing to midergo an operation for the re-
lief of her distressing symptoms, and the facilities of the
dispensary did not allow of the oi:ieration being performed
at the latter place, arrangements were made to operate
at her own residence with the galvano-cautery.
Operation. January 27, 18S3, by galvano-cautery knife,
assisted by Drs. G. Meier and Bassett.
The operation was performed for two reasons : first,
to give relief to the patient because the growth had oc-
cluded the rectum ; and, second, to determine the nature
of the disease. The operation was performed with the
galvano-cautery, the growth being pierced with a double
thread, which placed it under the control of the oper-
ator. Dr. Newman preferred this method to seizing the
tumor with the forceps or other instruments, for the reason
that in this way hemorrhage was avoided, as these growths
are sometimes very brittle and very vascular. The re-
sult of the operation had been that the outside appear-
ance was very much improved, but that the growths
above in the rectum had become aggravated. The
specimen was referred to the Committee on Micros-
copy.
CARCINOM,\ OF THE BREAST.
Dr. Newman also presented a specimen with the fol-
lowing history : On P"ebruary 18, 1882, he presented to
the Society, in behalf of Dr. Rodenstein, a specimen
which he supposed was one of carcinoma of the breast.
It was referred to the Committee on Microscopy, which
reported in April, 1882, that the specimen consisted
simjjly of inflammatory tissue, that it contained no true
glandular tissue, and exhibited nothing which suggested
the existence of malignant disease. In less than a year,
however, the disease returned. The original tumor was
in the left breast, involving the gland itself The nodule
which reappeared was not in the cicatricial tissue, but
closely above it and a little toward the axilla. It was
removed on January 16, 1883, by Dr. Rodenstein, Dr.
Newman assisting. The specimen was referred to the
Committee on Microscopy.
Dr. Wveth asked Dr. Newman what relation he sup-
posed the fish-bone had to the carcinoma of the rectum
in his first case.
Dr. Newman believed that it was the exciting cause,
and further, that most carcinomatous growths could be
referred to actual injury of some kind. He did not ac-
cept, to very much extent, the theory of inheritance, and
believed that cancer was in most instances caused by
some local irritation or injury.
WAXV degenkration of the placenta.
Dr. TAUSZK.V presented a specimen with the following
history : A priniiparous woman, twenty-one years of age,
had a miscarriage on May 22, 1882. She again became
pregnant, and under his care exercised all possible pre-
cautions to prevent a second abortion or miscarriage,
but despite all means employed, premature labor came
on at the end of the eighth month, and after a few hours
the woman gave birth to a child which, although very
feeble, was still living. Dr. Tauszky was unable to find
any cause for the premature labor, unless it existed in
the condition of the placenta, in which he found certain
changes. There were nodules of different sizes, yellow-
ish and grayish in appearance on the decidual surface,
but none upon the amniotic surface. These nodules
varied in size, from that of a pea to a walnut, and were
very numerous. The placenta presented the gross ap-
pearances of what is ordinarily known as fatty degenera-
tion. He remembered that Dr. Green, in Dr. Heitzman's
laboratory, had examined several of these specimens, and
reached the conclusion that they were the seat of waxy
instead of fatty degeneration, and he presented the speci-
men on that account. He was unable to find any dis-
ease whatever which could explain the occurrence of
the change in the placenta, or the premature birth. -An-
other point of interest was the fact, that on July 8th,
after the occurrence of the miscarriage in May, the
woman thought that she conceived, and she had not men-
struated after the occurrence of the miscarriage. Dr.
Tauszky believed that this case was evidence in support
of the opinion which he had long entertained, that men-
struation and ovulation are independent of each other
entirely. The specimen was referred to the Coniinittee
on Microscop)'.
medullary cancer of the stomach — PATIENT WITH
GOOD APPETITE.
Dr. Heineman presented a specimen accompanied
by the following history. An interesting feature in the
clinical history of the case was the fact that the jiatient
continued to have so good an appetite up to one or two
days previous to his death.
" Vogel B , sixty-three years of age ; Austrian ; sin-
gle, and without occupation, was admitted to Mount Sinai
Hospital, January 21, 1883. His family history was
negative. There was no history of alcohol, rheumatism,
or syphilis. The patient was well up to two years ago,
when he began to have epigastric pain, increased after
eating. The isain has increased in severity, and referred
to the vertebral column for a time, and has been severe
332
THE MEDICAL RECORD.
[March 24, 1883.
•enough to keep him from sleeping. He has never vom-
ited and his appetite has remained good.
For six months he has passed a large quantity of urine.
Upon admission, patient was poorly nourished, and
jaundiced. His appetite was good, but he took very little
food because of the pain it caused. The bowels were
■constipated. On examination a hard resisting mass was
felt in the epigastric region, reaching in the median line
■down to within a half inch of the umbilicus, and extend-
ing on the left side to the free border of the ribs. The
urine had a specific gravity of 1.022, was acid, contained
thirty-three per cent, of albumen, and the quantity passed
was thirty-eight ounces in twenty-four hours.
After admission the pain increased, but was subdued
with morphine, and without vomiting the patient rapidly
lost strength and died February 16, 1883.
Autopsy. — The brain was not examined. The heart
■contained post-mortem clots. The mitral valves were
thickened. The lungs were congested and cedematous.
The stomach : The mucous membrane throughout the
posterior and lower half of the anterior walls of the
greater and lesser curvatures from the cardiac to the
pyloric extremities, was replaced by irregular, flattened,
projecting (cauliflower) cancerous masses, which in-
volved the entire thickness of the stomach, had ulcerated
through the peritoneal coat in numerous places, project-
ing beyond, and at these situations had constructed
adhesions with the surrounding viscera, thus preventing
extravasation of stomach contents. The pancreas was
also involved to a considerable extent by continuity of
growth. The liver contained a few very small secondary
nodules in the right lobe ; the left lobe being invaded by
•continuity of the cancerous growth from the stomach.
Tlie kidneys presented the lesions of chronic diffuse
nephritis, being increased in size and containing numer-
■ous small cysts. The spleen was considerably increased in
size.
Dr. Wendt referred to a similar case which came un-
■der his observation, in which almost the entire cavity
of the stomach was occupied by the cancerous growth,
and in that instance the singular feature was that the pa-
tient had a good appetite up to within two weeks of his
death, and was able to take a very large amount of food,
a fact difficult to be explained by the size of the cavity
found at the autopsy. Vomiting occurred for only about
■one week before the patient's death, and yet the cancer
was present probably a year previously.
(To be continued.)
ASAFtETlD.'i IN THE TREATMENT OF ABORTION. In
\\\^ Journal de Medecine de Paris of December 16, 1882,
are collected the results obtained by several observers
in the prevention of abortion and premature labor by
asafcetida. Dr. Laferla, acting upon the theory that
the death of the fcetus was owing to an asthenic condi-
tion of the uterus, administered the drug in a number of
instances. In nearly ninety per cent, of the cases so
treated, the patients (who had aborted from two to five
times in former pregnancies) went on to full term. Drs.
<;iordano and Carzani announce equally favorable re-
sults, though the number of their cases was smaller.
The latter prescribes the drug in pill form in doses of
one and a half grain twice a day, gradually increased to
twelve grains per diem. Dr. Gourgnes recommends the
administration of asafcetida, in emulsion with the yelk
■of an egg, by t+ie rectum.
The Bro.mide of Arsenic in Diabetes. — Dr. Bekai,
of Buda-Pesth, reports two cases of diabetes in which
Clemens' licjuor arsenici bromati was used. In the first
case, after eleven days' use of the drug, together with an
animal diet, the sugar disappeared from the urine. Upon
leaving off the treatment, one per cent, of sugar ap-
peared again, but disappeared upon renewal of treat-
ment. In the second case the results were not quite
so good. — Wietier M(d. Blatter.
QJoiTCspoiulcncc.
OUR LONDON LETTER.
(From our Special Correspondent.)
THE LONDON COLLEGE OF PHYSICIANS AND MEDICAL
advertising THE LONDON HOSPITAL AND MEDICAL
COLLEGE — PAPERS ON SCURVY AT THE MEDICO -CHI-
RURGICAL SOCIETY.
London, March 3, 1883.
In my last letter I referred to the position taken up by
the London College of Physicians toward professional
advertising in the lay press. The question has now as-
sumed a somewhat different phase. The college has
condemned one of its fellows for advertising a lunatic
asylum — not in lay journals, but in strictly professional
media. With a lamb-like docility the fellow in question
has submitted and engaged to desist from such objec-
tionable practices in future. The college will doubtless
next require its fellows and members to desist from the
use of door-plates and to have their names removed from
the " Medical Directory.'' Publicity even of the most
respectable kind is apparently objectionable to the sages
of Pall Mall. That is, of course, as regards other peo-
ple, for the officials have no objection whatever to being
advertised themselves.
Dr. Mathews Duncan's lectures on "The Sterility of
Women " have been recently advertised in a prominent
place in The Times. What useful purpose can this
serve ? Only medical men are admitted to hear the lec-
tures at the College of Physicians. This immodest pro-
ceeding may perhaps bring a few patients to Dr. Duncan,
especially when bulletins signed by him and faithfully
chronicling the progress of the Duchess of .Albany's ac-
couchement are being simultaneously published in the
daily papers. This, however, is venial — nay, even com-
mendable— compared to the advertising of a lunatic
asylum in a medical journal !
Such is the stand made by the London College of
Physicians. It is scarcely conceivable that a public
body, of which Sir William Jenner is the head, should be
so unreasonable and inconsistent. The college, how-
ever, has never studied the interests of the profession at
large. Many of its members have been excluded from
the fellowship, not because they are not worthy of it, but
for private and personal prejudices. On the contrary,
many have been elected who have little or nothing to
recommend them except large fortunes or perhaps friends
on the council.
The college is, in fact, a club, and that of a very close
kind. A letter has lately appeared in The Lancet, sug-
gesting that it should be turned into 3, bona Jide club and
refreshments served. No doubt the Mrs. Grundies of
Pall Mall have been holding up their hands in pious
horror at this proposal. Yet, if not, why not ?
The London Hospital is about to erect a building to
serve as a residential college for its students. When
erected, this will doubtless iirove a considerable attrac-
tion to many intending students, as the neighborhood of
the hospital is not a nice one wherein to live in lodgings.
It is a strange fact that although we have eleven Schools
of .Medicine in London, only two of them, viz., Kings
College and St. Bartholomew's Hospitals, have, I be-
lieve, any residential chambers in connection with them.
At the last meeting of the .\Iedico-Chirurgical Society
two interesting papers were read by Mr. \V. H. Neale
and Dr. Hale White, respectively, on scurvy. Mr. Neale
(surgeon to the late Eira .\rctic expedition) contended
that lime-juice may be dispensed with if fresh meat can
be obtained. He reconmiended that the crews in Arctic
expeditions should pass the winter in huts on shore rather
than on board ship. I'"or food a good deal of fresh flesh
meat was desirable. This should be stewed and the
blood of the animals should be added to the stew, {'re-
served vegetables should be nii.ved with every meal —
March 24, 1883.]
THE MEDICAL RECORD.
333i
not because they i)ossessed any special antiscorbutic
properties, but to assist the digestion of tiie meat.
Dr. ^Vhile read the notes of a case of scurvy with re-
tinal hemorrhages and dilatation of the heart Dr. White
said there was no previous record of such a condition of
the heart in scurvy. The patient had previously suffered
from dysentery, which Dr. White considered aggravated
the scurvy, the severity of the latter being evidenced by
the marked blood-changes.
An interesting discussion followed, in which several
veteran naval surgeons with Arctic experience took. part.
Many of these corroborated Mr. Neale in his statements
as to the value of fresh meat.
INEBRIETY AND THE TEETH.
To THE Editor of The Medical Record.
Sir : In a paragraph with this heading you refer to the
experience of a clergyman, who thinks he has seen less
drunkenness in cases where the teeth have been treated
and properly cared for.
This is the recognition of a fact which appears very
often in the history of cases of inebriety, namely, the
presence of distinct physical causes which are both e.x-
citing and predisposing in every case. As, for instance, a
man of eminence will invariably drink to intoxication, after
a hearty dinner at midnight. Avoiding this, he is absti-
nent and can fully control himself. A business man never
uses spirits to excess, except when he sits up all night
or travels by rail. After this exposure he is powerless to
stop short of profound intoxication. With proper rest
every night he can be a thorough temperance man. A
broker was forced to retire from business because of ex-
cessive use of spirits. He was able to fully abstain as a
manufacturer in a quiet town. Every time he went back
to Wall Street, even for a few hours, he drank, although
not tempted in any way more than others.
In the Journal of Inebriety, vol. ii. , Dr. Harman, of
Ohio, reports a case of a pronounced inebriate who re-
covered, and remained a sober man ever after, dating from
the expulsion of a tape-worm. An officer in tiie late war,
who was considered a chronic inebriate, dating from a
wound of the tibia, recovered immediately after the removal
of some dead bone and the healing of the wound. He had
tried repeatedly before to abstain, but failed. The re-
covery after the operation was in circumstances more
adverse than ever before. The late Dr. March, of Albany,
trephined the skull of a man who had drank to great
excess, from the time of an injury by a fall on the head.
The man recovered and never used spirits after, for a
period of eight years, up to his death.
In an article in the Cliicago Medical Journal for
November, 18S1, I have staled many of these singular
cases, where injury and irritation of any part of the body
may react by some unknown law and develop inebriety.
In many of the cases which come under my care there is
often apparently very insignificant states of the body,
which are found to be prominent in the causation —
sources of irritation and exhaustion, neuralgias, nutrient
disturbances, and local derangements of almost every
description, the removal of which is followed by a rapid
cessation of the desire for drink, and the cure of inebriety.
The teeth may very naturally be sources of irritation,
which, if it does not cause inebriety, will most naturally
keep up the irritation which provokes a continuance of
this disorder.
In the majority of these cases a special diathesis may
be the favoring soil, which will develop inebriety from
the slightest causes. A neurasthenic state and general
nerve instability, for which alcohol is a most seductive
sedative, and inebriety follows with great certainty.
It is only a rational expectation to find that decayed
teeth was an exciting cause, and inebriety would be more
manageable when this source of irritation was removed.
Recovery cannot be expected until all sources of irrita-
tion can be more or less removed. The clergyman whck
insisted on the care and treatment of the teeth in in-
ebriety as a i>art of the treatment, was following the
teachings of the most advanced science of to-day. If, in
addition, nutrition, surroundings, and the removal of all
exciting causes was made a part of the treatment, re-
covery would be the rule and failure the exception. In~
ebriety is always the result of physical conditions, whether
understood or not. The sooner this is recognized and
practical treatment based on it, the whole subject will
be raised from the realm of superstition and quackery.
The curability of inebriety by physical means and
remedies is as practical and real as that of any other dis-
order. What is wanted is a thorough study of the subject
from the standpoint of science, above all theories and
dogmas of to-day.
T. O. Crothers, M.D.
Hartford, Conn.
Hlcwr Just vum cuts.
A NEW
ADJUSTABLE UNIVERSAL JOINT OR COM-
POUND RACKET,
AND ITS RELATIONS TO SURGICAL MECHANICS.
By CHARLES F, STILLMAN, M.I>.,
adiunct frofessor of orthopcedic surgery i^n the new vork polyclinic.
In surgical mechanics we have often been at a loss for
acomjiact joint-racket which would admit of movement in
several directions at the same time, or movement in one
or two directions and fixation in the others, or an ad-
justable fixation in all. The racket which is depicted in
Fig. A, 1, 2, and 3, is the result of my study to supply
this want. It is simple and compact, and will admit of
motion or fixation at any angle. In its niodifications it
alTords us a means for controlling every twist and de-
formity to which the human frame is subject, so far as
they can be overcome by mechanical methods. This
may seem a broad ground to assume, but a few moments'
attention to the matter will afford proof of the assertion.
Is there any position of a limb or joint which a ball
and socket-joint cannot be made to assume? It is a
universal joint, and of course is movable and, if provided
with a clamp, adjustable in any direction. A universal
movement, so tar as its relation to the mechanism of the
human frame is concerned, consists of abduction and ad-
duction, flexion or extension and rotation (or, in other
words, eversion and inversion).
These comi)rise the sum total of directions in the
movement, and are attainable by the ball and socket-
joint.
But suppose we desire to allow motion in any two of
these directions and prevent it in the third. This the
ball and socket-joint does not allow us to do, its action
is either to prevent all or allow all.
It is then of paramount importance to possess a
racket or regulating clamp, which will allow one move-
ment to be prevented and the other two allowed, or
two prevented and one allowed, or all three prevented
or all three allowed, in other words, to possess complete
control of movement in all directions.
By placing the racket, just shown, in three difierent di-
rections, we obtain this complete control, and by pla-
cing them opposite a joint, we obtain mechanical control
■> ^ 1
THE MEDICAL RECORD.
[March 24, 1883.
of tlie joint ; by placing them along the course of a limb
we obtain control of the twists and bends of the limb (if
controllable) ; and placed along the trunk or any other
part of the body, gives us control of the part, provided,
of course, that the attachments of the splint in which the
rackets are introduced conform to the proper mechanical
laws oroverning such attachments.
Fig. B.
Fig. B shows how these movements may be applied to
a splint for tlie knee, so far as indicating the relative direc-
tions in which the rackets are placed to produce the uni-
versal joint ; A indicating the position in which the racket
is placed to produce movable or immovable abduction or
adduction ; B, indicating the racket for flexion, and C for
rotation. The rackets are operated by a simple wrench
which either tightens or loosens them as desired, and
they can be readily and inexpensively inserted into any
form of apparatus, and the elaboration of this racket into
its various applications, which will be fully explained in
the future, constitutes in part the ground- work of an im-
proved system of treatment for deformities and diseases
of joints.
Ventral Hernia. — Dr. Jordan reports {Birmingham
Medical Review, February, 1S83) a somewhat remark-
able case of true and strangulated ventral hernia. The
patient was a lady, of previously good health, who, when
first seen by Dr. Jordan, had had symptoms of intestinal
obstruction for forty-eight hours. All the ordinary sites
of hernia were in a natural state. Nothing like hernia
was anywhere visible or to be felt, but when the abdom-
inal surface was examined, the lady complained of a
tender spot between the umbilicus and the groin — well
removed from the inguinal canal. On closer examin-
ation a certain fulness was found, not visible to the eye,
but clearly ditiferent from the. corresponding spot on the
other side of the middle line. It was decided that he
should operate, and there was found a very flat liernial
sac containing some eight inches of bowel, the neck of
the sac ajjparently passing through the lower part of the
linea semi-lunaris below and to the right of the navel.
The lady made a favorable recovery. Tlie dressing at
first was a soft new sponge kept constantly moist with a
solution of carbolic acid in water and glycerine.
^vmij ^Icius.
Official List of Changes of Stations and Duties of Officers
of the Medical Department, United States Army, from
March 10, 1883, to March 17, 1883.
Brown, Harvey E., Major and Surgeon. Temporarily
assigned to duty at Mount Vernon Barracks, Alabama,
during the absence on leave of Captain T. A. Cunning-
ham. S. O. 17, par. 2, Department of the South, March
6, 1883.
Williams, J. W., Major and Surgeon. Upon being
relieved from duty at Fort Cosur d'Alene, Idaho, will pro-
ceed to Fort Walla Walla, Washington Territory, and
report for duty as medical officer of that post. S. O. 24,
par. 5, Department of the Columbia, March i, 18S3.
CuNiNGHAM, T. A., Captain and Surgeon. Granted
leave of absence for twenty days, to take effect from the
2ist instant. S. O. 17, par. i. Department of the South,
March 6, 18S3.
Heizmann, Chas. L., Captain and Surgeon. To be
relieved from duty in the Department of the South, and
assigned to duty at Columbus Barracks, Ohio. S. O. 58,
par. S, A. G. O., March 12, 1883.
Taylor, B. D., Captain and Assistant Surgeon. To
be relieved from duty at Fort Ringgold, Texas, and will
so soon as able report to the Commanding Officer, Fort
Clark, Texas, for duty. S. O. 25, par. 6, Department
of Te.xas, March 9, 1883.
Wood, Marshall, Captain and Surgeon. Is assigned
to duty at Fort Cceur d'Alene, Idaho. S. O. 24, par. 5,
Department of the Columbia, March i, 1883.
Brechemin, Louis, First Lieutenant and Assistant
Surgeon. To proceed to Fort Brady, Michigan, and re-
port to the Commanding Officer for duty at that post.
S. O. 41, par. I, Department of the South, March 14,
1883.
iUccUcal Items.
Contagious Diseases — Weekly State.ment. — Com-
parative statement of cases of contagious diseases re-
ported to the Sanitary Bureau, Health Department, for
the two weeks ending March i 7, 18S3 :
>
CJ
>
1-
>
u
in .-
A
x"
>
Week Ending
3
■a
'0
>^
r-
0
7;
II
u
V
u
s
t
(5
i
(A
0
1
March lo, 1883
0
13
loS
4
109
40
0
0
March 17, 1S83
0
1 1
1 1 1
4
96
50
2
0
The Recognition of Micrococci. — We have re-
ceived from Dr. RoUin R. Gregg, of Buffalo, a lengthy
article on this subject, in answer to the last one by
Dr. Geo. A. Sternberg, in which it is reasserted with
emphasis that the bacterists never have made proper al-
lowance for the granules anti fibrils of fibrin in and about
diphtheritic exudations ; and in which it is claimed that
besides said forms of fibrin there are thousands upon
thousands of the granules of decolorized and broken
blood-corpuscles, mingled in said exudation, which are
also very similar in appearance to micrococci ; but which
have never before received the slightest recognition.
This subject, however, has not that general interest of
more practical questions, and because of this and the
crowded state of our coluiuns, we cannot spare the space
to Dr. Gregg's communication.
March 24, 1883.]
THE MEDICAL RECORD.
o -^ c
000
More about Boro-Glyceride. — Additional experi-
ments, as communicated to the French Academy of
Sciences, apjjear to show the effective value of M. Le
Bon's new antiseptics, tlie glyceroborates of calcium and
sodium. Both of these compounds prove to possess the
important advantages of being very soluble, destitute of
odor and free from all toxic action ; when exposed to the
air they both deliquesce with great rapidity, absorbing
from the air an equivalent weight of moisture. Both al-
cohol and water dissolve twice their own weight of the
solution. The most effective, in a therapeutic point of
view, appears to be the calcic salt ; it is said to be abso-
lutely innocuous, and can be applied in strong solution
to so delicate an organ as the eye without bad results. In
a hygienic sense, both can be employed with advantage
as disinfectants, and it is believed that both of the salts
will also prove very useful as antiseptics in dressing
wounds.
Medical Missionaries. — The Rev. Dr. J. M. Scud-
der, of Vellore, India, wishes that every missionary in
that land were a medical man, and urges the home so-
cieties not to send out any workers who iiave not, at
least, a slight knowledge of medicine. He visited two
towns for several years in succession without gaining the
least hold, apparently, upon the people, when a slight
surgical service on his part opened both their hearts and
homes. It also opened his eyes to the value of medical
knowledge.
The Dangers of Convallaria Maiat.is. — Dr. F. B.
Robinson, of Grand Rapids, Wis., reports to us tiie results
of some experiments with the fluid extract of convallaria
upon two five-months kittens. Hyi^odermic injections
of fifteen drops in one case and eight drops in the other
caused death. Dr. Robinson argues that therefore the
drug is dangerous to man — which is hardly a logical in-
ference.
A Moth in the Ear. — Dr. Howard Jones, of Cir-
cleville, Ohio, relates the following somewhat dramatic
case, a propos of foreign bodies in the auditory meatus :
"Two gentlemen were walking leisurely down the street a
quiet evening in July, after the street lamps had been
lighted, one of them wearing a white straw hat. As they
came near a gas-post, an insect flying rapidly, struck the
straw hat of No. i, and carromed directly into the right
■external meatus of No. 2. The gentleman clapped his
hand to his ear and screamed with pain. He entered
the nearest dwelling, where I found him a few moments
later, greatly excited and suftering intensely. The lady
of the house had attempted to pour milk into the ear,
but could not succeed. Upon examination I discovered
the external canal completely plugged with a dirty gray
body, which when touched, the patient said, scratched
terribly. The blades of a pair of small forceps were at
■once carefullv inserted upon either side and then closed
upon the object. By careful pulling, it was gradually
withdrawn, and proved to be a gray-and-white moth,
something over an inch in length, and so large in diam-
eter that it fitted tightly into the canal."
Death of Dr. John H. Saunders. — Dr. Saunders,
of Belfast, Me., died at his home on February 24th, at
the age of sixty-two. He was a graduate of the New
York University Medical College. He had attained a
wide reputation as a physician, and was highly esteemed
by every one.
Anato.mical and Physiological Study in Europe
AND America. — A writer in the Journal of Comparative
Medicine, says : " Among somewhat over three hundred
■contributions to anatomy and physiology made during
the past year, I find the authors distributed as follows :
Germans, 160; French, 70; British, 26; Italian, 24;
American, 14 ; Scandinavian, 13 ; Russian, 6. Among
the contributors to physiology. America ranks as one of
the last. It will be seen that over half of all the work
has been done in Germany.
How to Purify the Air of the Sick-Room. — An
article on the above subject contained in the Sanitarian,
March i, 188 j, concludes as follows : " i. To purify the
air in the sick-room, place in the bed a small basket or
other porous article, containing wood charcoal, for the
purpose of absorbing the foul air which, if diffused
throughout the surrounding atmosphere, would be con-
stantly returned to the lungs and cause the patient to die
of auto-infection. 2. In a sick-room in which infants are
sleeping, it is necessary to put a box or basket contain-
\wo a piece of quick-lime and some wood charcoal, for
the purpose of fixing the carbonic acid exhaled from the
lungs, and of absorbing all the foul air generated in the
system, and given off by exhalation from the skin or
otherwise."
A Busy Doctor sent in a certificate of death, the other
day, and accidentally signed his name in the space for
"cause of death." The registrar says he wishes the
profession would be as accurate generally.
Physicians' Prescriptions. — In France it has re-
cently been decided that pharmacists who furnish poison-
ous medicines on physicians' prescriptions must register
the prescription, and also the name of the person to whom
the medicine is dispensed. Against this latter regulation
serious objection is made, as persons suffering from
venereal diseases sometimes do not desire to have such
semi-publicity given to their troubles.
Monthly P^ngagement Cards, which may be made
useful to the physician, are published by George B. Hurd
& Co., of this city. These cards are printed on both
sides ; the one spaced for recording engagements for
three weeks, and the other, one week, and a summary for
the month, and are contained in neat Russia, plush, and
calf frames.
The Struggle for a Living. — We quote the follow-
ing from a presidential address to the Maine Medical As-
sociation by the late William Warren Greene, M.D. :
" Witness the large number of doctors in every city
struggling for a mere existence, and see how few out of
the whole number really do the work. See how in almost
every country village a full practice for one or two good
men is piece-mealed by sharp and often acrimonious com-
petition to the detriment of all.
" It would seem that in a calling so high, so noble, so
sacred, men fit for such ministry should be sought for ;
but the great question of the young graduate is not ' Who
wants me ? ' but ' Who will employ me ? ' not ' Who needs
me ? ' but ' Where can I get a living ? ' In the case of
four physicians dying, each in a country village, during
the last year, I am credibly informed that in one instance
two, in another three, in the third five, and in the fourth
case seven new men came to look the field over within
ten days after the doctors' death, sometimes before the
burial. In one case two attended the funeral, and in
another the widow had three letters from aspirants for the
vacant place while the dead body of her husband still lay
in the house.
" It is a hackneyed saying, with which too many ears
are tickled, that ' there is always room for good men.'
Applied to the present condition of our profession it is
false. Were only good men and the best men admitted
it would undoubtedly be true. But all over the land, in
city and country, are well-educated, cultured gentlemen,
honest and loyal, striving in vain to secure a competence
— yes, a bare living even — and too often is disappoint-
ment mingled with shame and mortification at the suc-
cess of ignorant and unprincipled rivals. I have said that
the evil results of this excess in numbers are manifold.
It leads to over-practice and to bad practice. The man
who is hard pushed, who has few patients and needs more,
is tempted to make much of little ; to magnify the im-
portance of his cases, both in his own mind and to his
patrons : to make uncalled-for visits, and to give too
33^
THE MEDICAL RECORD.
[March 24, 1883.
much medicine; and unnecessary medication soon ceases
to be rational. Patients are injured in mind and body.
Tiie community is injured by teaching the people to at-
tach undue importance to trivial diseases, and to over-
estimate the value of treatment therein. I.egitimate,
honest practice suffers in reputation ; money is obtained
under false pretences."
Medical Students in England. — The number of
medical students officially registered in Great Britain
during the year 1882 was, we find, 1,862; of these,
1,064 were registered in England, 585 in Scotland, and
424 in Ireland. These numbers are considerably less
than those registered as in course of study during either
of the three preceding years, the falling oft' being exclu-
sively in England and Ireland. Two hundred and four-
teen fewer students were registered this year in England
than last, and one hundred and si.xteen fewer students in
Ireland. There was no falling off in Scotland.
The Effect of Working in Tobacco Factories
UPON Menstruation, Pregnancy, and LACT.'iTioN. —
Since it has been observed that tobacco, and especially
nicotine, increases the peristaltic movements of the in-
testines, some have supposed that it would have a similar
effect in stimulating the muscular fibres of the uterus.
So much has been said on this subject that the' French
Minister of Finance requested certain physicians to report
as to the health of women employed in various tobacco
manufactiuing houses. These reports have now been
received, and the writers are unanimous in concluding
that no evil effects upon the se.xual organs can be as-
cribed to the tobacco. The abortions recorded, the
deaths of infants registered, and the anomalies of men-
struation noticed amongst women employed in tobacco
works could be accounted for by causes outside of their
employment. — Lancet.
HoMCEOPATHV IN ENGLAND. — .\ homceopathic direc-
tory has recently been published in Great Britain. Ac-
cording to its pages there are 260 practitioners of this
class in Great Britain and Ireland, four only being in the
latter country. As there are 19,947 regular physicians,
the ratio of honiceopaths to regulars is for England and
Wales I to 64 ; for Scotland, i to 1 70 ; and for Ireland,
1 to 609. Most of the honiceopaths are in large towns ;
thus London has 85, and Liverpool 11. The contrast
between the condition of things, as shown above, in
England and in this country appears to be considerable.
It is claimed that there are about 6,000 homojopaths, so
called, in the United States, giving a ratio to regular
practitioners of about i to 10.
A Modest Friend to Hu.manity and the Medi-
cal Society of New York. — A letter has strayed into
our hands addressed " To the Medical Society of New
York." The author writes : " Sirs i adress to inform you
after all the artful eft'orts of our smartest men ihave se-
lected 9 ingrediences of tlie vegitations of the Earth to
Cure all Manner of Blood Deseases scrofula it never fails
in no form or stage privat Deseases of all kinds olde sores
or Cifulis and Catarrh of the head or any Desease Caused
by impurity of the Blood it also renovates the Stoniac
bowels and liver Beyornt anything ever got up and Can
be established as the greatest Medicen nowe in the world.
Now a reasonable salery will make this great
matter known to the Society
" addres Dr. ,
" Henry Co. Ky."
The Hunterian Oration was delivered on February
14th by Mr. Spencer Wells. The orator began with the
following interesting account of the origin and purpose
of the endowment : " Just seventy years ago, Matthew
Baillie and Everard Home, being, to use their own words,
' desirous of showing a lasting mark of respect to the mem-
ory of the late Mr. John Hunter, which shall at the same
time express the very high sense they entertain of the very
liberal conduct of the Royal College of Surgeons, in sup-
porting and preserving the Hunterian Collection,' agreed
with Sir William Bli/.ard and Mr. Cline to endow an ' an-
nual oration, to be called the Hunterian Oration, which shall
be read or delivered in the theatre of the said college on the
fourteenth day of February in each and every year (being
the birthday of John Hunter).' They devised that such
oration ' shall be expressive of the merits in compara-
tive anatomy, physiology, and surgery, not only of the
said Mr. Hunter, but also of all such persons as are or
shall be from time to time deceased, whose labors have
contributed to the improvement or extension of chirur-
gical science.' After the first oration in 1814, one was
delivered every year until 1849. Since that year it has
been biennial." .Mr. Spencer Wells passed in review the
history and work of various deceased members of the
Royal College of Surgeons, including Gulliver, Critchett,
Soelberg Wells, Clover, and others.
A Pleasant Mineral Water. — The French have a
seductive way of putting things. Twenty-six years ago the
late Dr. Amedee Latour, writing of a still popular French
mineral water, said : " It is the good God who created
the waters of Saint-Galmier, but it was an intelligent
man, M. Badoit, who discovered them, and two wide-
awake physicians who made their fortunes out of them.
The water of Saint-Galmier," continues Latonr,
" is the amiable companion of the student, the useful
ally of the enteralgic, the intimate friend of every lady
afflicted with ' vapors ' or threatened with corpulence,
and the inestimable benefactor of the gourmet and dys-
peptic."
The Climate of S.\nta Barbara as Compared with
that of the Mediterranean Coast. — The following
careful and impartial account of the climate of Santa
Barbara, written by a correspondent of The Tribune, may
be of service to our readers, since such contradictory
opinions are given regarding this health resort : "The
good days at Santa Barbara are among the most delight-
ful in the world ; and there are few days here in winter
when the most delicate invalid may not stay out of doors
as long as he has the strength to walk or to ride. The or-
dinary temperature is from five to ten degrees higher
than that of Mentone ; the air is soft and genial ; the
dampness of the ocean is hardly perceptible in the upper
part of the town, and I know of no seaside place, except
on the Riviera which is U]5on the whole so dry. Santa
Barbara, moreover, is free from serious drawbacks which
impair the value of all the Mediterranean health resorts
— such as the bad company, the bad smells, and the vio-
lent contrasts of temperature between sun and shade, the
open country and the narrow streets.
■' On the other hand the California town has its faults.
A raw wind, loaded with chilly moisture, does sometimes
blow in from the sea. Fogs are not uncommon. Sud-
den changes of temperature are frequent and vexatious.
Rain occurs only between .\pril and December. Occa-
sionally there are cold and blustering days, like those of
March in the East."
Syphilitic Synovitis. — Dr. Mracek states that this
rare aftection is observed among the secondary pheno-
mena of the syphilitic infection. It may attack one or
several joints, the knee and the ankle being most fre-
quently invaded. If the patient has already suffered
from an arthritis, the same joint will be aflected by the
specific disease. A recent synovitis of this kind is readily
amenable to anti-s\philitic treatment, but later its cure
is more ilitf'icult, and joint-motion is usually compromised.
Relapses are fre<iuent. Local treatment consists in im-
mobilization of the joint with massage, when the affec-
tion has become chronic. The author also reconuiiends
painting with iodine, compression, and in some cases ap-
plication of ice to the articulation. — Annates de Derma-
iologie et de Syphili};raphie, December 25, 1882.
The Medical Record
A Weekly yournal of Medicine and Sn7^gery
Vol. 23, No. 13
New York, March 31, 1883
Whole No. 647
(Oviginal ;Ai*ticlcs.
ON VARIOLA.
Its Definition, History, Cause, Varieties, Prog-
nosis, AND Treatment.
By J. N. McCHESNEY, M.D.,
LATE ONE OF THE ATTENDING PHYSICIANS TO THE HOSPITAL FOR CONTACH >l rs
DISEASES OF THE CITY OF NEW YOKK.
Dejiniiioii and Jfisfory. —Variola., or small-pox, is a
febrile, eruptive, infectious, and contagious, disease, de-
pending upon a specific, morbid poison, the symptoms
of which, after a period of incubation of from twelve to
fourteen days, result in an eruption on the surface of
the body, which passes through the regular stages of
macule, papule, vesicle, pustule, and desiccation, termi-
nating with desquamation.
An exhaustive review of the history of variola would
far exceed both the pur|)ose and limit of this article.
Although much time and careful research have been
expended in trying to discover the origin of the disease,
all efforts have thus far been without definite success.
According to the most authentic account, the disease
originated, about a.d. 544, in Egypt, whence it spread
to Constantinople. In 569 it made its appearance in
the Abyssinian army, then besieging Mecca, with such
virulence as to compel the abandonment of the siege.
During the latter part of the sixth and the whole of
the seventh centuries it raged in Egypt and spread into
Asia and Africa. It was introduced into Europe by the
Saracens upon their invasions of Spain, Sicily, Italy, and
France, and gradually extended northward, reaching
Saxony, Switzerland, and E.ngland in the latter ])art of
the ninth or first of the tenth century. The Spaniards
transported the infection to St. Domingo and Cuba
about 1520. It was carried to Mexico in 1527, where
it raged witli great virulence, destroying millions of the
inhabitants. Thence the disease rapidly extended over
the whole of the Western hemisphere.
Etiology. — Variola spreads by contagion, and cases of
supposed spontaneous origin can always, with proper
care, be traced to a person who has suffered from a re-
cent attack, or to infected articles.
The morbid principle is contained both in the pustules
and in the emanations from the body of a patient sufter-
ing from the disease. It is contagious from the begin-
ning of the stage of invasion until the last trace of the
desquamative process has passed away.
The infection is contained in the breath, which has
been known to convey the disease before the eruption
had made its appearance, and it has been communicated
both by the virus and the emanations of a dead body.
A case' has been recorded in which the contagion was
communicated from a dead body, though death had
taken place before the development of the eruption.
"The patient, a medical student, died suddenly in this
city, the chief symptoms being gastric with great ex-
haustion. At the autopsy a few petechia; were ob-
served on the body. The coffin was taken home to a
New England village for burial, and at the funeral some
of the relatives opened it to look at the face. Eight of
the number present were attacked with small-pox. No
* Dickson, in American Journal of the Medical Sciences, July, 1862.
Other persons in the neighborhood contracted the dis-
ease." In a Western medical college, a year or more
ago, a number of students contracted it from a body
which was being dissected. A very slight exposure is
often sufficient for acquiring the disease. We have met
with one or two cases in which there was every reason
to believe that the contagion was acquired while riding
in the street cars. Many patients are unable to give
any history of exposure. The disease is communicable
in all of its stages, but the pustular and desquamative
stages are most dangerous. Exposure to the same case
may give rise in one instance to a mild, and in another
to a severe form of the disease ; and exposure to the
mildest form of sniall-pox (commonly known as vario-
loid) may give rise to the worst variety.
No age is exempt from it ; we have met with it in a
child of three weeks, and in a patient of seventy-nine
years. In some instances the disease has been contracted
before birth and nearly the whole period of incubation
passed in utero, the eruption making its appearance on
the child when it was four or five days old. The child
may be born with the eruption on its body, or i>resenting
evidences of having passed through an attack in utero.
Authentic cases are on record in which the disease has
been communicated to the fcetus without the mother pass-
ing through a regular attack ; these cases may be ex-
plained by the fact that the mother had that form of the
disease in which there is no eruption — variola sine va-
riolis. As a rule, every individual is more or less sus-
ceptible to the contagion of variola. Rare instances are
met with in whicli persons, unprotected by either inocu-
lation or vaccination, though constantly exposed, escape
the disease. A physician friend of the writer, who has
never been successfully vaccinated, though repeated at-
tempts have been made, has escaped, notwithstanding
constant exposure to every variety of the disease under
almost every circumstance ; and though he has made
autopsies on the worst cases which bad died in the sup-
purative stage, and has even received wounds of the
finger while thus engaged, no symptoms beyond a little
septic trouble have ever been manifested. This can only
be ascribed to a peculiar idiosyncrasy as yet unexplained.
Though uterine lite does not exclude the danger of in-
fection, the fcetus is less liable than the child under two
years of age.
The existence of chronic diseases affords no protection
against the contagion of variola, though patients, while
in the active stages of the other eruptive fevers, appear
to escape infection.
The dark-skinned races are regarded as peculiarly sus--
ceptible, and the mortality among the negro and the
Indian races is very great. In 1881, in the New York
Hospital for contagious diseases, the mortality among
the negroes was ten per cent, greater than among whites.
The general opinion is that small-pox prevails to a
greater degree in winter than in any other season of the
year. Cold weather, by keeping a larger number of jjeople
within doors and the avenues to ventilation closed, doubt-
less does contribute to the spread of the disease, but the
records of small-pox hospitals show that a larger number
of patients are admitted in May than in any other month
of the year. When the disease has begun to prevail it
continues throughout the year uninfluenced by winter or
summer.
As a rule, one attack renders an individual insuscep-
tible for the remainder of his life. To this rule, however.
338
THE MEDICAL RECORD.
[March 31, 1883.
there are occasional exceptions. We have met with two
cases in which there was a second attack.
Inoculation does not always give perfect immunity ; we
have seen one case that gave a history and presented the
scars of inoculation. The form of small-po.x was very mild.
The poison is readily conveyed by clothing and other
articles worn and used by a patient, and the contagion
may be retained in them for an indefinite period. U'e
recall an instance where the disease was conveyed to
a shoemaker who repaired the soles of a pair of shoes
whicii had been worn by an attendant about a room oc-
cupied by a patient desquamating from small-po.x. In-
fected clothing which has been buried (a popular method
in country districts of disposing of the clothing and bed-
ding of persons who have suffered from variola) has been
resurrected and become the starting-point of epidemics.
Healthy persons wiio have been sutliciently exposed may
carry the contagion in their clothing and infect others,
though they themselves escape.
Varieiies. — Six varieties of variola are generally de-
scribed : I, Variola discreta, when the pocks stand dis-
tinct and separate from each other ; 2, variola senii-conflu-
ens, when there is partial coalescence of the eruption ; 3,
variola confiuens, when the pustules run into each other;
4, variola hemorrhagica, nigra, or black small-pox, when
the vesicles are filled with red blood-corpuscles ; 5, va-
riola corymbosa, when the eruption is arranged in bunches
or clusters ; 6, variola anomahe, when it occurs compli-
cated with other diseases, or presenting unusual symp-
toms.
A mild form of the disease occurring in persons pre-
viously vaccinated is commonly described under the
term of varioloid. The name is one which should be
discarded. Its use has been the source of much confu-
sion and great injury on account of the popular opinion
that varioloid is not dangerous. This is probably true
in respect to the patient himself, but fiitally false in re-
gard to the community in which he is permitted to go at
large. We remember hearing a physician of considerable
practice in this city say that he met with many cases of
varioloid but did not consider them of sufficient impor-
tance to report to the health authorities, and that, too,
when small-pox was epidemic. That the laity should
consider varioloid harmless is not to be wondered at
when we hear such expressions from members of the pro-
fession. Mild cases of variola, without regard to previ-
ous vaccination, should be classed as discrete small-pox.
In mild forms, while there is little or no danger to the
patient himselt", he is more dangerous to the community
in which he lives than a patient confined to his bed with
the worst form of the disease, since, as frequently hap-
pens, no significance is attached to the mild symptoms
that occasionally precede the eruption, or the eruption
itself may be so scant as to fail to attract his attention,
or the notice of those about him. This is often the
source of the unexplained appearance of the disease
in isolated localities. The epidemic through which this
city has just passed w-as introduced in the person of an
engineer who came from a neighboring city where small-
pox was prevailing, during the incubative stage of the
disease. His attack was so mild thai he did not leave
his engine-room or quit his work, yet, as a result of this,
several cases appeared among his fellow-workmen and
among the servants of his boarding-house, two of whom
absconded to the lower j^art of the city, whence the dis-
ease began to spread.
Stages. — -The course of variola is divided into four
stages: i, Incubation ; lasting from the date of the re-
ception of the poison till the initiatory chill, fever, and
other symptoms, generally twelve to fourteen days ;
2, invasion, or primary fever, lasting from the first gene-
ral disturbance to tlie appearance of the eruption, about
two to four days ; 3, eruptive, or stage of maturation,
lasting about nine days ; 4, suppurative stage, secondary
fever, desiccation, and desquamation, which is of vari-
able duration.
These stages maybe shorter or more prolonged under
certain circumstances, notably shortened and modified
after vaccination.
Incubation. — During the period of incubation there
are no manifestations of the approach of the disease ;
the patient is as well as usual and able to attend to his
work. In some exceptional instances tiiere may be a
certain feeling of uneasiness or foreboding of the ap-
proach of sickness.
Invasion. — The stage of invasion is generally ushered
in by a well-pronounced chill, or there may be a series
of chills, followed by high temperature, 103-104°,
which may, before the eruption appears, reach 106° F.
The pulse is full and hard, varying from no to 120;
respiration is usually increased in frequency ; there is
great prostration, and the patient staggers if he attempts
to walk ; the skin may be hot and dry, or bathed in pro-
fuse perspiration, which continues throughout the stage.
There is great thirst ; the lips are parched, the tongue
coated with heavy, yellowish white fur, and the breath is
fetid ; complete anorexia exists ; nausea and vomiting
are often the most distressing and persistent symptoms.
The bowels are in most cases constipated, though di-
arrhcea is present now and then — most frequently in
children. Intense headache is a constant symptom, and
continues throughout the stage with more or less severity ;
the pain is referred to the whole of the head, or may be
limited to the frontal region. Intense pain in the lum-
bar and sacral regions is one of the most striking symp-
toms. This, in conjunction with nausea and vomiting,
is almost invariably present in the initial stage. It is so
severe in character that patients almost a'lways complain
of it ; It appears at the beginning of the stage and con-
tinues with unabated severity until the eruption is estab-
lished. Patients are frequently very restless and are
often unable to sleep. Delirium is sometimes present.
Convulsions are of frequent occurrence in children.
Coma is said to occur, but we have not seen it. Red-
ness and swelling of the pharynx, with pain on deglu-
tition occur in some cases ; injection of the conjunc-
tiva, with lachrymation, is sometimes present ; slight
cough, with little or no expectoration, is occasionally
met with.
Not unfrequently a general erytliematous condition of
the skin, lasting twenty-four or forty-eight hours, precedes
the appearance of the eruption and may be so intense as
to lead to mistaking the disease for scarlatina. This, it
is generally thought, is followed by a mild eruption, but
such has not been our experience. In a number of cases
we have seen this condition followed by the hemorrhagic
type.
As a rule, if the symptoms of this stage be mild and
protracted beyond the usual duration, the eruption will
be scant ; if, on the contrary, thev be of great intensity,
a severe type of the disease may be expected. Occasion-
ally the mildest attacks are preceded by prodroma of
great intensity, and we have met with cases in which this
stage was marked by symptoms of unusual severity, pro-
tracted for four days, which have ended without the ap-
pearance of the eruption.
The most significant symptoms of the initial stage are
the acute pain in the small of the back, the obstinate
nausea and vomiting ; and when it is known that there
has been exposure to contagion, 'these go far to prove
that the person is about to be the subject of an attack of
variola.
Stage of eruption. — The eruption of variola makes its
appearance on the third day — or after forty-eight hours,
and is first noticed about the ahe of the nose, corners of
the mouth, and the chin. It appears about the same
time on the fronts of the wrists ; next on the trunk and
arms, and last on the legs and feet. It is first seen as
small red spots or macules, which rapidly become ele-
vated and hard, forming papules ; these are small, rounded,
and have a peculiar hardened feeling, likened to a shot
under the skin. On the face the eruption is usually much
<
March 31, 1883.]
THE MEDICAL RECORD.
339
more abundant that on the body, frequently being conflu-
ent there while it is discrete on the body. If it be con-
fluent there will be a general redness and granular-looking
swelling of the face, particularly of the forehead. A
tendency to arrangement in groups of threes and fives
is sometimes observed, best seen on the arms and back
of the trunk.
The eruption makes its appearance sooner and in greater
abundance, in the neighborhood of recent woimds, or
where there has been any irritation of the skin. One
patient that we remember had received a recent abrasion
extending from above the elbow to the wrist ; the eruption
was first noticed extending along both sides of this, and in
greater abundance than elsewhere. We have seen several
instances in which the application of kerosene oil around
the neck for the sore throat had brought out the papules
in great abundance ; the ai)plication of mustard poultices
produces the same effect. We recall one case, in a wo-
man recently confineil, on whom the eruption made its
appearance in great profusion over that portion of the
body covered by the bhider, several hours before it was
seen elsewhere.
About the same time the eruption appears on tlie skin
it may be observed on the soft palate, pharynx, inside
of the lips and cheeks, and on the tongue. Here it
appears as small, round, opaque spots, which do not
form vesicles and pustules. Points of eruption also occur
on the conjunctiva. When the eruption is abundant in
the mouth it increases the flow of saliva ; in the fauces it
causes difficulty in swallowing ; in the air-passages it
occasions cough and hoarseness ; on the conjunctiva
it increases the secretion of tears, and gives rise to con-
junctivitis and to photophobia.
Vesicular stage. — Twenty four hours after the first
appearance of the eruption a clear fluid makes its appear-
ance in the papules, which now become vesicles. These
enlarge until they attain the size of a small pea. Just
before the vesicles become fully distended there is a
cup-shaped depression in their centre, which is known
as unibilication and constitutes a sign of diagnostic im-
portance. Umbilication does not appear in every vesicle ;
it is not found in those of the palms of the hands and
soles of the feet. This appearance has been attributed
to the presence of bands, passing from the centre of the
roof to the floor of the vesicle, which hold down the
centre while tne sides of the vesicle are distended by
the accumulation of serum.
When the eruption is well established, there is an
amelioration or subsidence of all the distressing symp-
toms of the initiatory stage. The temperature falls to
near the normal, a sign of great diagnostic value ; the
nausea and vomiting cease ; the lumbar pains disappear ;
the appetite returns ; the patient gets up, says he feels
well and often expresses a desire to go about his daily
avocation. In the severer types of the disease these
changes are less marked, and the discomfort may be
only slightly, if at all, modified.
From the fifth to the seventh day the vesicles become
fully distended ; they lose their unibilicated appearance ;
there is an opaque ring at the circumference, inside this
a!, clear rmg with an opaque spot in the centre ; theu'
contents gradually change, first becoming opalescent,
then turbid, and finally purulent. These changes occupy
abgut two days, and the suppurative stage is thus estab-
lished at about the eighth or ninth day of the disease,
and the sixth of the eruption.
'J"he changes which take place in the eruption occur in
the order in which it makes its appearance, so that it may
be seen in one stage on the face and arms, and in another
and earlier stage on the less and feet.
The skin surrounding the bases of the pustules is red
and swollen, forming what is termed the areola. The
tissues of the head and face become greatly swollen ;
the oedema of the eyelids is often so great as to close
the eyes ; the features are obliterated, and the pa-
tient becomes wholly unrecognizable. The presence of
pustules on the scalp causes considerable swelling, so
that pressure upon that part occasions severe pain. The
swelling of the jjocks in the palms of the hands, especially
on the finger-tips and in the soles of the feet gives rise to
agonizing pain, not unlike that of paronychia. This jiain
is due to the resistance which the toughened and thick-
ened skin of those parts oft'ers to distention, and to the
pressure upon the terminal nerves.
With the stage of suppuration the fever returns and
reaches 103° to 104°, and may continue for four or five
days in cases of ordinary severity. This elevation is
called the suppurative or secondary fever. The pulse be-
comes frequent, and there is a return of the general dis-
comfort of the initial stage. Delirium is frequent and,
though it may be passive, is sometimes so active as to
necessitate restraint. The throat symi)toms are intensi-
fied ; swallowing becomes painful and difiicult ; the nose
becomes stopped ; there is a hoarse cough, and the voice
is frequently inaudible. Diarrhoea is occasionally present
and is always to be considered an unfavorable symptom.
Desiccation. — Desiccation begins usually about the
twelfth day. Some of the pustules rupture from over
distention ; their contents escape and dry into yellow
crusts. Others dry up and form brownish scabs. In the
palms of the hands and soles of the feet, where the
cuticle is thicker, the pustules dry down into hard, brown-
ish spots, which are the last to disappear and frequently
retain some of their contents after desquamation is well
advanced on all other parts of the body. We have fre-
quently found persons going about with these hard
brown s]jots in their palms and soles, and contagion is
undoubtedly spread by them.
The scabs fall oft", leaving darkly pigmented cicatrices,
the number being in proportion to the amount and
severity of the eruption. The whole body may be
covered with these stained spots, but the face generally
suffers most. This staining gradually fades out and, if the
destruction of tissue has not been very great, the scars
become less and less noticeable. Where there has been
much ulceration, as is common on the face, the pitting
is deep and permanent. Six to ten days is the usual
duration of the stage of desquamation.
In some cases when the ulceration about the cheeks
and alfe of the nose has been deep the scabs show a ten-
dency to adhere longer than in other situations, and by
confining the pus increase the ulceration. When they are
removed the surface presents a worm-eaten api>earance
which continues for some time after recovery, but finally
disappears almost entirely.
As desiccation and desquamation proceed the fever
becomes less and other symptoms disappear ; appetite
returns, the patient begins to improve and goes on to
convalescence.
Complications, particularly erysipelas and furuncles,
are most apt to occur during the stage of desiccation.
These prolong convalescence, and not unfrequently
bring about a fatal termination when all danger from the
small-pox is passed.
The symptoms above described are those that occur
in natural or unmodified variola, and usually extend over
a period of seventeen to twenty-one days.
In modified small-pox, commonly called varioloid, the
symptoms and course of the different stages are very
irregular, and the duration of the stages, as a rule, is very
much shortened. The appearance of the eruption is oc-
casionally delayed to the fourth day. It is not unusual
to see the eruption abort in the various stages. A few
of the vari are arrested in the papular and vesicular
stages, others develop and reach maturation in a shorter
time than usual, desiccation takes place early, desqua-
mation is rapid, and the scabs fall off, leaving little or no
pitting. The stage of invasion in some cases of modified
small-pox is attended with the severest symptoms, yet the
eruption that follows is slight and of short duration. In
these cases there is little or no suppuration, consequently
there is no secondary or suppurative fever.
340
THE MEDICAL RECORD.
[r»Iarch 31, 1883.
Variola seiniconfluens. — In semiconfluent small-pox
there are patches of coalescing pustules on different parts
of the body. The symptoms and course are those de-
scribed in the natural variety, perhaps a little more in-
tense. It is the ne.\t simplest form to the discrete variety
and is generally not attended with any great danger to
life, except in children, or from some complication, as
erysipelas, pneumonia, pleurisy, etc.
Variola conjluens. — This is the form of the disease in
which the pustules coalesce over the whole surface of
the body. The symptoms preceding the eruption are
greatly intensified, and their severity indicates that the
attack is to be of the worst nature. Beginning with a
pronounced chill, or there may be several chills, the tem-
perature is high, 104° to '106°; the pulse is rapid ; the
headache and lumbar pains are of unusual intensity ;
the nausea and vomiting are distressing and persistent ; the
patient is wakeful and intensely restless ; there is tremu-
lousness of the hands and lips ; dehriumis almost always
present, and is active, violent, and often maniacal in
character. _ The patient cannot be kept in bed, but is con-
stantly trying to escape from some imaginary pursuer,
who he fancies is trying to injure him. Under these
delusions we have known patients to jump from windows
and receive fatal injuries. Occasionally tliere is a ten-
dency to do themselves injury, and patients have com-
mitted suicide while in this state. Such cases require
close, unremitting watchfulness, and often it is necessary
to use the straight-jacket or to strap them to their bed's
to prevent accident.
In this variety the eruption makes its appearance
soinetimes as early as the second day, and develops far
more rapidly than in ordinary cases. The papules are
so numerous and close together as to cause a general
redness and granular swelling of the forehead, face, and
arms ; they spread rapidly over the wliole body. The
swelling about the head and face is very great, closing the
eyes and often disfiguring the patient beyond recognition.
There is general coalescence of the pustules, so that the
eruption is one mass ; the cuticle on the forehead, backs
of the forearms, wrists and hands is completely raised
from the subjacent tissues, forming large bullce ; fre-
quently these burst or are broken, leaving large raw sur-
faces which exude bloody serum. The eruption is equally
abundant on the nmcous membrane of the nose, mouth,
pharynx, cesophagus and larynx, and extends into the
trachea. The tongue becomes inflamed and greatly
swollen, so much so in three cases under our care as to
fill the mouth and render asphyxia inniiinent. A viscid,
sticky secretion is formed in the mouth and throat, which
is expelled with great difficulty, and occasions the patient
much annoyance. He complains of sore throat and
great difficulty of swallowing ; cough is excited bv at-
tempts to take food, and fluids often regurgitate through
the nose. There is a hoarse cough ; the voice is a harsh
whisper, or becomes entirely inaudible. The swelling of
the air-passages, together with the accunuilation of this
viscid secretion, frequently renders respiration exceed-
ingly difficult, and at times impossible. The proper
aeration of the blood is thus interfered with ; the surface
becomes livid ; the eruption turns a dull purplish hue •
there is great prostration ; the delirium changes to the
low muttering kind, and death usually ensues.
In some cases of confluent small-pox the pustules do
not till out but remain flat, and present a dirty white,
pasty appearance. Cases with this flat confluent erup-
tion almost invariably terminate in death.
Confluent variola causes tiie greatest number of deaths
among the unvaccinated — death being due to the exten-
sive suppuration.
Variola corymbosa. — The eruption in this variety of
small-pox is arranged in bunches or clusters, and takes
its name from the fancied resemblance to a cluster of ivy-
berries. It is a rare and usually very fatal form of the
disease. There were only two or three cases admitted
to the Riverside Hospital during the years i88i and 1882,
all of whom died. In the London Hospital, in a period
of thirty years, there were 104 cases of this variety ; 29
were unvaccinated, 13 of whom died, or forty-four per
cent.; 74 had been vaccinated, 32 of whom died ; i had
been inoculated and died ; 2 died of complications ; which
gives a mortality of forty-one per cent, in the vaccinated.
Variola hemorrhagica, commonly known as the
"black pock," is that variety in which the vesicles be-
come filled with red blood-corpuscles. From the be-
ginning the symptoms are very intense ; the patient fre-
quently succumbs from the intensity of blood poisoning
before the true nature of the disease is determined, or
even suspected. Many cases of this nature occur in in-
land towns, and, being unrecognized, are the cause of
serious epidemics. In the fall of 1881, in a village of an
adjoining State, a peculiar fever occurred in the person
of a lady resident of that place. The diagnosis of typho-
nialarial fever was made. The disease proved very ma-
lignant, and death occurred in five days from the begin-
ning of her illness. A public funeral was held which was
largely attended. In due time a brother of the deceased,
who had nursed her, was similarly attacked and the same
diagnosis made. This case was seen before its termina-
tion by an eminent physician of this city and the diagno-
sis of hemorrhagic small-pox made. Death occurred at
the end of a week. From these a number of cases of
small-pox, of different varieties, developed, and the dis-
ease assumed epidemic proportions.
Of this form of variola there are two types. In one,
the hemorrhages take place into the pocks after the vesi-
cles are developed; in the other, the eruption is petechial
from the start.
In petechial hemorrhagic small-pox the stage of inva-
sion is of great intensity, and the eruption not unfre-
quently makes its appearance on the second day, but is
slowly developed. From the soft nature of the spots
and their bright red color they are often mistaken for
measles. Unlike the eruption in the other varieties of
the disease, the macules do not change to papules.
There may be a slight elevation above the surrounding
surface, but there is an absence of that hard, shotty feel-
ing so characteristic of the papules in other forms. The
spots are first seen about the lips and chin. Frequently
they appear earlier and are better defined about the
axillary folds, on the fronts of the elbows, the sides of
the abdomen, and the inner face of the thighs where the
skin is whiter and thinner. They vary in size from that
of a millet-seed to two or three lines in breadth. At first
they are a bright-red, clarety color, then become purplish,
and subsequently a deep blue. They are slightly raised
above the surface, and (iressure does not efface them,
even momentarily. This type of hemorrhagic variola
usually terminates fatally in less than a week.
In the other type of hemorrhagic small-pox the vesicle
is filled with bloody serum. Umbilication is present, but
requires closer observation to detect than in the ordinary
vesicle. Bulls of different sizes filled with bloody serum
are frequently observed at various places. The blood in
the vesicles undergoes further change, becoming darker,
almost black; hence the name "black small-pox."
Simultaneously with the appearance and development
of the eruption hemorrhages occur from all of the mu-
cous surfaces. Epistaxis, which is frequently difficult to
control, is one of the earlier symptoms. The gums
bleed ; there are hemorrhagic spots on the soft palate ;
the expectoration is abundant and tinged with blood, or
occasionally composed of jnire blood. There may be
vomiting of blood. The conjunctiv;^ are intensely con-
gested, and often the effusion of blood beneath the con-
junctiva is so great as to raise it above the cornea. Blood
is also found in the urine and in the discharges from the
bowels. In the female the menstrual flow is brought on,
and is very profuse. If jiregnancy exist, abortion takes
place early, and the child is usually dead. Prostration
is marked ; the pulse rapid and weak ; respiration shal-
low and imperfectly performed ; the temperature is only
March 31,
1883.]
THE MEDICAL RECORD.
341
moderately high, and, if the hemorrhages have been pro-
longed, may fall below normal before death.
The mind is often clear to the end ; the patient hope-
ful and unconscious of the nearness of death. In one
case we recall telling the patient that if he had any
messages for his family, or any requests to make, he
had better attend to them at once. He seemed surprised,
and said, " Vou don't think I will die, do you, doctor?"
and it was with difficulty that he was convinced of the
short time he had to live. This was about 2 p.m. Death
occurred at five o'clock.
Delirium, if it occur, is of the low muttering kind ;
there is twitching of the fingers and picking of the bed-
clothing ; the lips are cracked ; the teeth and gums
covered with dark-brown sordes ; the tongue dries into a
blackened mass with deep fissures, and cannot be pro-
truded ; deglutition becomes impossible. Death com-
monly occurs a'Dout the fifth day of the eruption.
This description applies to the confluent variety of
hemorrhagic small-po.K. The eruption may be discrete,
under which circumstance recovery not infrequently takes
place. The semi-confluent eruption increases the danger.
Blood is often seen in the pustules on the feet and
legs in those patients who leave their beds or keep their
feet dependent. This is due to mechanical rather than
other causes, and does not constitute any form of hemor-
rhagic variola. The following are illustrative cases :
Case I. — Confluent hemorrhagic small-pox. — Henry
W- ■ ; aged fifty ; Germany ; orderly at this hospital.
July 5th complained of a tired feeling ; arms and legs
felt heavy. In the evening had a chill lasting a few mo-
ments ; appetite much impaired, but no nausea.
July 6th. — The symptoms of yesterday more intense ;
appetite entirely lost ; pains in head, small of back, and
extremities ; sleep fair.
July 7th, A.M. — More chills ; pains continue ; sense of
weight in epigastrium ; some fever ; no nausea, no epis-
taxis ; constipated, p.m. — A macular eruption in scanty
amount on various parts of body ; macuku small ; gives
history of imperfect vaccination.
July Sth, 10 A.M. — Pulse, io8 ; temperature, 103" ;
respiration, 38. Eruption becoming papular. 5 p.m. —
Pulse, 112 ; temperature, 104.2° ; respiration, 38. 6 p.m.
— Pulse, 100 ; temperature, 104"^ ; respiration, 28.
July 9th, 8.30 A.M. — Pulse, 92; temperature, 101.3°;
respiration, 22. 5 p.m. — Pulse, 104; temperature, 104.2'' ;
respiration, 26. Appetite better, sleep better ; head-
ache not constant, and not nearly so intense ; general
feeling much more comfortable. The eruption increased
somewhat in amount. A very few vesicles may be seen.
July loth, 9.30 A.M. — Pulse, 90 ; temperature, 102.3°;
respiration, 26. Eruption slowly increasing ; number of
vesicles greater, but they are still few, with here and
there one which is umbilicated. Constipation relieved
with salines. 5 p.m. — Pulse, 88; temperature, 102°;
respiration, 26.
July nth, II A.M. — Temperature, 99°.
July i2th, 9 A.M. — Pulse, 80; temperature, 100°;
respiration, 20. A marked increase in the amount of the
eruption during the last thirty-six hours, so that now it is
very abundant. The color of the areolae of the spots
much deeper. The eruption more generally vesicular ;
on the face it is pustular, and there and on portions of
the body elsewhere it is becoming confluent. The cheeks
and lower lids, the nose and the upper lip are swollen con-
siderably ; complains of a throbbing, band-like feeling
across the nose ; skin sensitive generally ; a number of
vesicles on mucous membrane of mouth ; no difficulty
in deglutition or respiration, except a feeling of slight
constriction around the chest ; a slight coryza. No vesi-
cles noticed on conjunctiva:, but there is some conges-
tion and photophobia. Appetite good ; sleep broken.
5 p.m. — Pulse, 92 ; temperature, 100.3° J respiration, 24.
July 13th, 9 A.M. — Pulse, no; temperature, 100.3°;
respiration, 20. 5 p..m. — Pulse, 108; temperature, 101°;
respiration, 21.
July 14th, 9 A.M. — Pulse, 115; temperature, 100.3°;
respiration, 22. 5 p.m. — Pulse, 127; temperature, 102°;
respiration, 29.
July isth, 9 A.M. — Pulse, 120; temperature, 101.2°;
respiration, 24. 5.30 p.m. — Pulse, 128; temperature,
103° ; respiration, 24. Suppuration progressing over the
whole surface ; hemorrhages have occurred into a number
of pustules, especially on hands and forearms and legs;
no large hemorrhagic spots. Appetite continues fair ;
sleep poor. Is a little delirious at night.
July i6th, 9 A.M. — Pulse, ii8; temperature, 102.1°;
respiration, 24. 5 P.M. — Pulse, 124; temperature, 104.3°;
respiration, 28.
July 17th, 8.30 A.M. — Pulse, 112 ; temperature, ioif°;
respiration, 24. 7.15 p.m. — Pulse, 120; temperature,
104.2°; respiration, 28.
July iSth, 8.30 A.M. — Pulse, 112 ; temperature, 103.1° ;
respiration, 24. 6.15 p.m. — Pulse, 112: temperature,
102.3° ; respiration, 24.
July 19th, 9 A.M. — Pulse, 107 ; temperature, 100.3° '■>
respiration, 24. Has diarrhcea. Desiccating. 5 p.m.
— Pulse, 112 ; temperature, io2|^° ; respiration, 29.
July 20th, 9.30 A.M. — Pulse, 104; temiierature, 101.3° \
respiration, 24. 7 p..m. — Pulse, 112 ; temperature, 102.3°;
respiration, 28. Diarrhcea checked ; cedematous swell-
ing of feet and legs ; large bulhe of sanguinolent fluid on
feet and legs, aisd smaller ones on arms. Urine of nor-
mal quantity and free from albumen. Larvae up to a
third of an inch in length in ears and under scabs on
face.
July 2ist, 9.30 A.M. — Pulse, 104 ; temperature, 101.1° ;
respiration, 25. 5.15 p.m. — Pulse, 108; temperature,
101.3°; respiration, 28.
July 22d, II A.M. — Pulse, loS ; temperature, 99-1°;
respiration, 24. 5.30 p.m. — Pulse, 118; temperature,
103° ; respiration, 27. Desiccation far advanced every-
where, except on face, where suppuration is still active.
July 23d, 9.30 A.M. — Pulse, 104 ; temperature, 98^-° :
respiration, 24. 5.30 p.m. — Pulse, 114; temperature,
102° ; respiration, 28.
July 24th, 9 A.M. — Pulse, 104; temperature, 100°;
respiration, 24. 5 p.m. — Pulse, 100 ; temperature, 100.3° J
respiration, 24. Suppuration ceased on face.
July 25th, 10 A.M. — Pulse, 104 ; temperature, 99.1° ;
respiration, 22. 5.30 p.m. — Pulse, 112 ; temperature,
ior^° ; respiration, 24. The oedema of lower extremi-
ties somewhat diminished. Is improving rapidly.
July 26th, 9 A.M. — Pulse, 100; temperature, 99.2°;
respiration, 24. 5 p.m. — Pulse, 100; temperature, ioo|-°;
respiration, 24.
July 27th, 10 A.M. — Pulse, 106 ; temperature, ioii° ;
respiration, 26. 5.30 VM. — Pulse, 100 ; temperature,
\o\\° ; respiration, 26.
July 28th, 8.30 P.M. — Pulse, 92 ; temperature, 99 ; res-
piration, 20.
July 29th, 9.30 P.M. — Pulse, 100 ; temperature, 98!° ;
respiration, 20.
August. — An abscess in the site of an old wound
in the back between the shoulders, opened and several
. drachms of pus evacuated.
.August 2oth. — Desiccation progressing very slowly in
face, elsewhere desquamation is about completed.
October 6th. — Desquamation now completed. The
pitting is very extensive on the face ; on other parts
there is none at all. Discharged cured.
Case II. — Confluent hemorrhagic small-pox. —
John P. R ; aged twenty-seven ; United States ;
butcher ; arrived at New York, July 23d, per S. S. De
Ruyter from Antwerp. Admitted 7.30 a.m., July 24th.
No history of sickness previous to admission obtained
from patient.
July 24th, 8 A.M. — Pulse, 96 ; temperature, 99.2° ; res-
piration, 17. Everywhere on the surface of the patient's
body, is a very abundant vesicular eruption, which for
the most part is discrete, though upon the face, backs of
hands, and in spots elsewhere it is confluent. That on
THE MEDICAL RECORD.
[March 31, 1883.
the face and dorsal surface of the hands has the appear-
ance of a superficial blister, and is but slightly raised.
Where the eruption is discrete the vesicles are small
and the inflammation around their bases shows onl}- a
pale pink color. Many of the vesicles are umbilicated.
The tongue and buccal mucous membrane also show a
similar discrete eruption. Pulse is quick, thready, and
strikes with considerable force. Patient is stupid and
not able to give an intelligent account of his illness.
5 P.M. — Pulse, 100 ; temperature, 100.3°; respiration, 22.
July 25th, 8 A.M. — Pulse, 104; temperature, 101°;
respiration, 22. In a stupor day and night, and at times
attempts to leave the bed. Offers no objection to the
administration of his food. Pulse weaker and still
thready. 5 p.m. — Pulse, 124 ; temperature, 104.2° ; res-
piration, 30.
July 26th, 8 A.M. — Pulse, 120; temperature, 103°;
res|)iration, 25. 5 p.m. — Pulse, 136 ; temperature,
106.2° ; respiration, 35. The eruption, especially on the
legs and forearms, now has a purplish look. On the
fingers are a few hemorrhagic spots of small areas.
Sponged with cold water. 7.30 p..m. — Temperature,
106.2°. Placed patient on Kibbee cot, and two pailfuls
of cold water used. After the bath the record of the
pulse, temperature, and respiration was, S p.m. — Pulse,
96 ; temperature, 98.2° ; respiration, 20. Mind clear.
Pulse strong, and no longer thready. Skin warm, but
p>atient feels chilly. Has been constipated since admis-
sion, relieved by enema. 10 p.m. — Pulse, 107 ; tem-
perature, 100°.
July 27th, 8 A.M. — Pulse, loS ; temperature, 102^" ;
respiration, 20. 3 p.m. — Pulse, 128; temperature, 105°;
respiration, 36. Pulse feeble and thready. Kibbee cot.
After bath: yiulse, 100; temperature, 99'. 5 p.m. — Pulse,
104; temperature, 101.1°; respiration, 27. 7 P.M. —
Pulse, 120; temperature, 103.3°; respiration, 30. Kib-
bee cot ; after bath, pulse, 100 ; temperature, 99.3°.
July 28th, 8 A.M. — Pulse, 108; temperature, 101.1°;
respiration, 23. 5 p.m. — Pulse, 108 ; temperature,
101.2° ; respiration, 31.
July 29th, 8 A..M. — Pulse, 108 ; temperature, 99.3° ;
respiration, 29. 2.30 p.m. — Pulse, 120 ; temperature,
101° ; respiration, 39. 5 p.m. — Pulse, 120 ; tempera-
ture, 101.3' ; respiration, 43. Died about 7 p..m., July
29th.
■" ' (To be continued.)
Great Men a.vd Small Heads. — "It is usually sup-
posed,'' says the Atheiiceuyn, "that men of great intellec-
tual powers have large and massive heads. But this
theory, which Dr. Gilbert, physician to Queen Elizabeth,
was the first to suggest, is not borne out by facts. An ex-
amination of busts, pictures, medallions, intaglios, etc.,
of the world's famous celebrities almost tends the other
way. In the earlier paintings, it is true, men are dis-
tinguished by their large heads, but this is attributable
to the painters, who agreed with the general opinion,
and wished to flatter their sitters. .4 receding forehead is
mostly condemned. Nevertheless, this feature is found
in .\le.\ander the Great, and, to a lesser degree in Julius
CKsar. The head of Frederick the Great receded dread-
fully. Other great men have had positively small heads.
Lord Byron's was 'remarkably small,' as were those of
Lord Bacon and Cosmo di Medici. Men of genius of
ancient times have only what may be called an ordinary
or every-day forehead, and Herodotus, .\lcibiades, Plato,
Aristotle, and Epicurus, among many others, are men-
tioned as instances. Some are even low-browed, as
Burton, the author of ' The .\natomy of Melancholy ;'
Sir Thomas Browne, and Diirer. The average forehead
of the Greek sculptures in the frieze from the Parthenon
is, we are told, 'lower, if anything, than what is seen in
modern foreheads.' The gods themselves are repre-
sented with ' ordinary, if not low, brows.' Thus it ap-
pears that the popular notion on the matter is erroneous,
and that there may be great men without big heads."
GLIO-SARCOMA OF THE CEREBELLUM OC-
CURRING IN A CHILD FOUR AND ONE-
HALF YEARS OF AGE.
By L. EMMETT HOLT, A.M., M.D.,
>'EW VuRK.
Lizzie B-
- came under observation at the Northwesterr>
Dispensary, December 11, 1S82. She was carried in by
her mother ; she having been unable to walk alone for one
month. It was stated that the child had not been well
since the summer, the first thing noticed being a listless-
ness and an indisposition to any exertion. Later, fever
came on, at first regularly every other day, but without
any noticeable chill or sweating. She vomited frequently.
Severe neuralgic i)ains in the forehead, the epigastrium,
and the extremities were often complained of There
was complete anorexia, and after a little the bowels be-
came obstinately constipated. Occasional rigidity of the
muscles of the back of the neck had been seen, which
had been accompanied by pain in this region. The gait
was first noticed to be peculiar about three months be-
fore she came to the dispensary. She had difficulty in
going up and down stairs at first, and was seen to stagger
as she walked. This gradually became more pronounced
and the mother said "she walked like one drunk." Thus
she became at last almost helpless. There had been a
general and steady decline in strength and flesh. Of late,
the pains at the ei-'igastrium and the extremities had some-
what abated and she complained only of severe occipital
pains and of a soreness about the neck or throat. There
had been lately no tendency to periodicity in the S)mp-
toms. She had had measles and scarlatina about two
years before, and though diphtheria was carefully sought
no history of this could be obtained.
On examination the patient was found very pale and
ansmic, with a heavily furred tongue and a fetid breath.
She was unable to stand without considerable assistance.
When supjjorted on either side, she walked with great
difficulty, constantly crying for fear of falling. The body
was balanced awkwardly, rocking to and fro. As she
sat upon the mother's lap she was found to be able to
execute all the usual movements with the lower and the
upper extremities well, though it seemed with a little di-
minished power, exactly how much it was difficult to
say from the age of the patient. The muscles were all
rather flabby to the feel, but no comparative atrophy was
present. Reflex sensibility of the soles was normal.
There was no ex.iggeration of the patellar reflexes.
Handling of the muscles produced so much pain she
cried out. No facial or ocular paralysis. The pupils
were normal and responded to light well. The tongue
was protruded without difficulty. The mind was unaf-
fected. Nothing abnormal was found on examination of
the throat, heart, or lungs. The spleen was much en-
larged, its vertical dulness measuring four and one-half
inches in the posterior axillary line. The head was drawn
backward, and the muscles of the neck showed a little
rigidity, this could, however, be readily overcome.
There seemed to be no doubt regarding the existence
of chronic malarial poisoning ; but whether all the symp-
toms could be referred to that source was the question.
This view was taken as a working hypothesis from the
following grounds : 1, the history of a fever which at the
outset came on periodically ; 2, the marked splenic en-
largement ; 3, the great muscular soreness ; 4, the in-
complete character of the paralysis.
Quinine sulph. was ordered, gr. xx. per diem.
On December 16th, my friends Drs. V. P. Gibney
and L. Putzel saw the case with me, and a more thor-
ough examination was made than hitherto, demonstrating
the fact to the satisfaction of all, of the existence of a
very marked degree of ataxia in both upper and lower
extremities. In putting out the hand to grasp anything,
a slow oscillatory movement from side to side took place
before the object was seized. A similar thing was no-
ticed when she raised the foot to touch anything. Iru
March 31,
1883.]
THE MEDICAL RECORD.
343
walking, when supported a little, she lifted the feet well
from the floor, but put them down in an uncertain way.
When she stood, the body swayed from side to side witli-
out any especial tendency to fall in any direction. She
could button and unbutton the clothes, though with some
difficulty. There was nothing spasmodic about the
movements, and closing the eyes did not appear to
make any difference in them. Her general condition had
improved very perceptibly under the quinine, and she
seemed to have a little more power in the limbs. In
fact, grave doubts were expressed as to whether there
was any actual paralysis present, the ataxia being con-
sidered a sufficient explanation of the inability to walk
alone. The different muscular groups were examined
electrically, and good responses obtained to a mild fara-
dic current. The disease was still regarded as a malarial
neurosis, and it was decided to continue quinine, espe-
cially as the child was improving under its use.
The improvement continued for about a week, and
then, despite the use of the drug, she grew steadily worse.
The bowels, which had yielded to mild laxatives before,
again became obstinately constipated ; she vomited four
or five times a day ; she took no food to speak of ; once,
for twenty-four hours, retention of urine took place. She
complained much of severe occipital pains, and some-
times for days together the head would be drawn back
into the pillow. Pain about the front of the neck or
throat — it could not be determined which — troubled her
much, and nothing to explain it could be found. She
became very irritable in disposition, though not drowsy.
She could move the hands and feet freely, but when laid
upon the sofa was unable to change her position.
The temperature had never been above ioo-J° (rectal),
and reached that point only once. The diagnosis of
malaria was now given up, and it was thought to be most
likely basilar meningitis. The quinine was now discon-
tinued, and the treatment was mainly symptomatic.
There was no irregularity of pulse or respiration noticed
at any time. A few days before my last examination,
which was on January 3, 1S83, she was said to have had
at times difficulty in "getting out what she wanted to
say" — as the mother expressed it. VVHien I saw her
she seemed bright, responded intelligently to questions,
though the speech seemed to be a little thick. The
tongue was protruded normally. No paralysis of face or
eye muscles. The pupils were normal and responded to
light. The head was drawn in marked opisthotonos,
though the muscles of the neck were not rigid. Deglu-
tition had seemed a little interfered with lately. The
special senses were not critically tested, though they
seemed normal. The ataxia was still present. The di-
agnosis of tumor was now made quite positively. The
child seemed in no immediate danger, but about noon
the following day she called for water, drank with avidity,
became cyanotic and died quite suddenly, never having
had any convulsive movements at any time. The wiiole
duration of the disease, reckoning from the first disturb-
ances in locomotion noticed, was a little less than four
months.
Autopsy, made twenty hours after death. Rigor mortis
well marked. Nothing abnormal was found in the tho-
racic organs. Spleen was normal in size but rather firmer
than natural. Liver was slightly congested. Right kid-
ney about twice the size of the left, though neither gave
any gross evidences of disease.
On removing the calvarium, the dura was seen to be
tense and bulging. No evidence of pachymeningitis. -As
the brain was being removed quite a quantity of clear
serum escaped, estimated to be about three ounces. This
seemed to come from the ventricles, through the aque-
duct of Sylvius ])rincipally. The meninges were much
congested, but showed no evidence of inflammation or
extravasations. On the inferior surface of the cerebel-
lum was a new growth about the size of a hen's egg. It
measured two and a half inches antero-posteriorly and
one and a half transversely. It occupied nearly the me-
dian line of the cerebellum, projecting posteriorly a little
beyond that structure.'
The specimen was examined by Prof. \Vm. H. Welch,
who kindly furnished me with the following report : " The
tumor occupies the situation of the inferior vermiform
process of the cerebellum. It is soft in consistency and
bears a considerable resemblance to the normal brain
substance, but is redder in color. The shape of the new
xig. I. — Inferior surface of the cerebellum ; A is the tumor ma^s.
growth is much like that of the inferior vermiform pro-
cess, but it is about two or three times larger in size.
It has encroached somewhat upon the lateral lobes of
the cerebellum, wiiich in the rest of their extent appear
normal, as does likewise the superior vermiform process.
The ventricles of the brain, particularly the fourth ven-
tricle, are considerably dilated, manifestly by the en-
croachment.of the tumor upon the fourth ventricle.
Superior surface of the cereljellum : A is the projecting tumor.
" Microscopically, the tumor is a glio-sarcoma. It is
composed of a mass of cells, predominantly round cells,
in a finely granular and finely fibrillated matrix. The
growth is rich in blood-vessels."
Remarks. — The study of cerebellar disease has, within
the past few years, received a valuable contribution from
Nothnagel." The view which he takes seems to me to
be able to reconcile many of the hitherto contradictory
facts relating to this subject. As my own case corrobo-
rates them fully, I will briefly state his conclusions :
First. — Lesions confined to the lateral lobes of the
cerebellum are not at present diagnosticable.
Second. — Destructive lesions involving the central lobe,
or the vermiform process, are accompanied by muscular
' The drawings of the tumor were made by my friend Dr. Frank W. Olds.
^'I'opische Diagnostik der Gehirnkrankhciten — Art. Cerebellum.
344
THE MEDICAL RECORD.
[March 31, 188;
inco-ordination ; but this is the only symptom which is
diagnostic.
Third. — The inco-ordination from a lesion of the ver-
miform process is sufficiently characteristic to be distin-
guished in most, if not all cases, from that of posterior
spinal sclerosis. Its peculiarities are a swaying move-
ment of the body in walking, the legs widely separated,
the feet raised but slightly, a staggering, a rocking to and
fro, and finally falling in any direction. Closing the
eyes may or may not increase the difficulty. The spas-
modic character of the movements is usually wanting.
The group of symptoms so closely simulates those of
alcoholic intoxication, that one of Nothnagel's patients
was several times locked up by the police for drunken-
ness.
Fojirth. — Vertigo is often an early symptom, and may
be the first noticed, but is of no diagnostic importance
unless associated with inco-ordination.
Fifth. — The optic is more frequently involved than
the other nerves of special sense.
Sixth. — Vomiting is wanting in the stationary and de-
generative lesions, but is a common symptom in abscess,
hemorrhage, and tumor.
Seventh. — In many cases, especially of tumor, we have
occipital neuralgia as a prominent symptom.
The following are occasionally seen, but are acci-
dental, and are to be considered as rather against, than
in favor of cerebellar disease : Paraplegia or hemiplegia ;
paralysis of one-half of the tongue, though disturbances
of speech are more frequent ; dysphagia, epileptiform at-
tacks, and disturbances of the other special senses.
One point of practical value which this case teaches,
is that we should not be too ready to attribute obscure
nervous symptoms to malarial poisoning, even in patients
in whom indubitable evidences of such poisoning exists ;
and that a failure of full doses of quinine to aftect the
symptoms should lead to a careful examination for or-
ganic disease of the nerve-centres.
200 West Fiftv-second Street.
LUNATICS AT LARGE I'S. SANE PERSONS IN
LUNATIC ASYLUMS.
By N. ROE BRAD.XER, A.M., M.D.,
LATE OF THE PENNSYLVANIA HOSPITAL FOR THE LNSANE, PHILADELPHLA.
In a weekly journal I read, recently, an article entitled
" Lunatics at Large," which, although intended as iniblic
gossip or general information, contains so much that is
of real importance and especially interesting to the pro-
fession that I feel prompted to take up the cue, and beg
for a few moments the indulgence of the readers of The
Medical Record.
It begins as follows : " The number of embryo lunatics
at large in this city (New York) is appalling, and con-
tinual outbreaks of insanity that we are treated to, such
as the mad Frenchman who recently stabbed a dozen
helpless women on Fourteenth Street has not resulted in
any attempt by the authorities to suppress the lunatics at
large." Proceeding it declares with lamentable truth
that " people seem to think that an insane person is not
dangerous until he or she commits some deed of actual
violence ; " and if the writer can disabuse his readers of
this erroneous and dangerous belief, he will feel that he
has accomplished quite as much good as can be expected
to result from any one magazine article.
The writer in the journal referred to relates how a lady,
who had taken an aversion to pie, screamed with violent
excitement when her eye fell upon the oftendiiig dish
which her son had ordered for the family table, and seiz-
ing a carving-knife she chased the young man witli great
energy and desperation. " But the family say she is not
crazy, only eccentric." And of her mother it is related
that slie is an old lady of three score and ten, and eccen-
tric too, having been discovered one winter's night, on a
public street, a considerable distance from home, " shiv-
ering in her night-dress." Again we read : " Only a day
or two ago a man came into my office who, if not a rag-
ing lunatic, was so near being one that I did not enjoy
his visit at all. His hair was half a foot longer than
Oscar Wilde's, and hung in beautiful chestnut ringlets
down his back ; his beard and moustache were long and
gray mixed, and he wore a pair of large round spectacles
with heavy rims. On his head he wore a black sombrero,
and under his arm carried a portfolio." He was further
described as a man whose looks would decide a jury of
physicians against his sanity, and as follows : " I see this
man constantly on the street and expect nothing else
than to find some of these days he will become violent
and treat us to a massacre in true lunatic style."
Let us now for a moment look at the converse, and
each one for himself recount the number of graphic re-
ports of sane persons having been incarcerated in lunatic
asylums we have read in the daily i^apers within the last
month. Indeed, the public press almost without excep-
tion seems to seize with the fondest avidity, and magnify-
ing to the greatest exaggeration, every case of alleged
illegal or improper hospital commitment that is made
public by means of the writ of habeas corpus. It is,
therefore, not surprising that the numerous discharges that
have been recently so effected from insane asylums, es-
pecially in New York, have produced much sensation
among those who believe all they see in the papers ; indeed
the profound thinker may well be startled when one day
he reads that the community is thronged by dangerous
lunatics at large, only awaiting a hazard impulse and axe
to brain whoever happens to run counter to him, and is
the next day informed through the same medium that
another, and numerous other sane persons have been
discovered incarcerated in lunatic asylums, where are
depicted dungeons and horrors that nearly make his hair
stand on end ; attended by a little hint or history of how
they had been kidnapped from homes they alone could
make happy. Otherwise how their personal fortune had
prompted and conspiracy effected their capture and im-
prisonment— the conspirators being heartless relatives,
unprincipled piiysicians, and a straw judiciary. It is not
my intention to assert on the one hand that sane men
may not be unjustly declared insane, and thus deprived
of their liberty ; nor yet deny that insane and dangerously
insane persons do mingle in society that does not yet even
dream of the imminent tragedy that may so quickly throw
it in consternation. It is true that a great smoke indi-
cates some fire, but I have been intimately acquainted
with all the circumstances of some of the lunacy cases
that have become sensational and am well aware that
they have been made so chiefly by reason of the color
given by the reporter who wished to interest his readers.
But while the public has been startled, the friends of the
patient alarmed, and the hospital authorities annoyed by
these sensational newspaper articles, it is not therein that
exists the greater evil to which, in this article, I can but
briefly, but will pointedly and plainly call your attention.
The arrogant presumption of ignorance, if not intemper-
ance, whom chance or political cunning may have ele-
vated to the woolsack — when he ignores philosophy and
experience — commanding the doors of asylums to be
opened, and those sent abroad who are declared insane
by those who are most experienced in insanity, and
whose unrestrained liberty may be dangerous to human
life, is truly appalling. We have no respect for him who
would look down from that exalted position to insult
Dr. Kirkbride — if not indeed the whole medical pro-
fession— with the strong hint that if he were only
clothed with a little greater authority the tables would
be turned and the whole crowd of us consigned to the
lunatic asylum.
Some months ago a female (latient in the Pennsylvania
Hospital for the Insane applied to the Court of Common
Pleas, througli writ of habeas corpus, for her discharge.
She had been regularly committed by forms and process
as provided by existing law of the State of Pennsylvania,
March 31. 1883.]
THE MEDICAL RECORD.
345
including the sworn statement of Dis. D. F. Woods and
Tiiomas G. Morton that the girl was insane and a
proper subject for the hospital. Dr. Kirkbride, the
Physician-in-Chief, and who has been so since the foun-
dation of this branch of the hospital, over forty years ago,
testified that she had in some measure recovered, and
suggested that she might, with propriety, leave the hos-
pital, if she could go where she could be pleasantly and
properl)' surrounded, which he knew would not be the
case if she was returned to her father's house, where ex-
isted domestic infelicity that he knew would be detri-
mental to her peace of mind. At this point the August
looked down and sneeringly asked the doctor, who had
given his exclusive attention to the subject of insaiiltv
since before that judge was born, if that was why she was
sent to the asylum.
The doctor mildly replied that she was sent to the
asylum because she was insane. But what are we to ex-
pect toward reform, whether of sane persons in asylums,
or lunatics at large, at a tribunal where one of the best.
if not, indeed, the best .'American authority concerning a
certain disease, is thus publicly insulted at the bar of jus-
tice, and by him of the robes. Bijcause, forsooth, in the
goodness of his heart he suggests that a convalescent
patient should not be yet exposed to the noxious atmo-
sphere that caused her disease. In another case, where
one of our most excellent judges sat to hear the evitlence
of insanity of a patient who demanded his discharge from
the restraint his physicians advised, his Honor con-
sented to take that resjionsibility — a step, I will venture
to say, he has ever regretted, for the patient being de-
jirived of the protection the restraint of the hospital af-
forded him, immediately destroyed himself.' I would
convey the idea, then, that to discriminate between
sanity and insanity, or those who should or should not
be therefore deprived of their liberty, requires not only
a sober desire to be just, but peculiar skill that can only
be acquired by experience.
I may be permitted to illustrate more forcibly by two
cases within the scope of my own practice : Colonel
S , aged fifty, a Philadelphia gentleman, who had,
until within a few months, enjoyed good health, and was
known as the life of his large circle of friends, became,
by degrees, dyspeptic, melancholy, and suicidal. His
friends placed him in close confinement, and when he,
by my order, was closely watched by day and night, that
he might not destroy himself, he refused all food until
he was in a starving condition.
He seemed to have formed some attachment to me,
and I discovered that he valued the principle of truth
more highly than happiness or life. Acting upon this in-
formation, I made the following bold agreement with him,
to which he became a party after much hesitation and
pressure : i, He was to go with me directly and partake
of dinner ; 2, he was, thereafter, to eat his meals regu-
larly : 3, his meals were to be served in his room ; 4,
his attendants were to cease to watch him, and he was
to be at full liberty, except that he was not to go beyond
certain specified limits ; 5, this contract was to con-
tinue for three weeks and then terminate.
He was a splendid specimen of mankind ; of handsome
face and form, six feet two inches in height, and in health
weighed full two hundred pounds, but at the time of this
agreement his weight had been reduced by at least fifty
pounds, and by his long fasting he was too weak to walk,
except by the help of a cane which he borrowed of me.
This singular contract was kept in toto, religiously and
faithfully. It is now, indeed, to me interesting in the
extreme to remember that first meal he ate at my table.
He soon after became cheerful — happy, indeed ; he was
abroad each morning by five o'clock, and was at all times
at his liberty.
During the three weeks so spent he regained his
strength and a considerable part of the flesh he had lost
during his fast, and the pleasure of his daily visits to me
is never to be forgotten.
The day previous to that terminating our contract, he
came and reminded me of the fact, but circumstances
over which neither he nor I had control prevented its
renewal. Returning to me on the following day to re-
turn my cane and bid me good-bye, he presented the
picture of health, and there can be no doubt that any
judge deciding such a question on the result of his own
jiersonal examination, without the opinion of a physician,
and one indeed well experienced in mental diseases,
would have pronounced it a shocking outrage to restrain
such a man of his liberty. He left our care and we saw
him no more forever! His poor lifeless body was after-
ward found suspended by the neck.
The second case to which i referred is related as fol-
lows : A few years ago I was sitting in the private office
of a chemist of this city, and although I could not see
what was transpiring in the front office, I could distinctly
hear. Presently some person entered and began con-
versation with the clerk, and inadvertently, almost un-
consciously, I became interested. The voice forsooth
was that of one of my friends and near neighbors, whose
sanity had never been questioned, while its statements
and arguments were those of a madman. Within one
minute, and without seeing this man, I discovered him
to be insane, with delusions of the most dangerous char-
acter. He had brought several articles of food and a
fly, that he said he had taken from his tea, all of which
he wished the chemist to analyze, confidently expressing
his conviction that his friends were all down on him and
wished to destroy his life by means of poison. I knew
the physician of the family and immediately informed
him of my apprehension. Within a day or two I was
consulted as to treatment, and becoming familiar with
the circumstances and history, advised his immediate re-
straint, and he was accordingly placed in a hospital for
the insane, where his disease never abated but progressed
so rapidly that he died a maniac within a month.
This case, I think, furnishes a forcible illustration of
the importance and necessity of experience in determin-
ing as to the sanity or insanity of any individual. This
gentleman was in the early stage of a form of mental
disease most dangerous to the lives of those around him,
while the external manifestations were not such as to be
recognized, excei)t by those who had previously become
acquainted with its symptoms and course.
Between him and the long-haired eccentric described
in the early part of this paper, at least ten to one, ex-
cepting medical experts, would judge the former to be
the more dangerous, while, as I have already said, I con-
sider the latter gentleman was one of the most dangerous
of all men to be at large. And now my task would be
more than half undone if I did not impress upon the
reader and make clear the truth and reason of this which
is so simply done.
Self-preservation is the first law of man, and any one
is justifiable in causing the death of another, if this be
the only means of preventing his own murder. When
reason then is dethroned, displaced by delusion, the lu-
natic believing another, or a score of others, even his
nearest friends, are endeavoring and conspiring to kill
him, his impulse is to anticipate their attack and slay
those, always the most innocent persons, whom his ob-
scure disease leads him to suspect.
2038 Race Street.
Hyperidrosis of the Hands and Feet. — Naphthol
has been reconmiended {Druggist) as an effective rem-
edy against excessive sweating of the palms, foot-soles,
and axillar. These places should be moistened once or
twice daily with a mixture of naphthol 5 parts, glycerine
10 parts, and alcohol 100 parts, and afterward dusted,
either with pure starch or with a mixture of naphthol 2
parts, starch 100 parts. In case of sweating feet, small
pellets of antiseptic cotton should be dipped in the pow-
der and placed between the toes.
346
THE MEDICAL RECORD.
[March 31, 1883.
THE TREATMENT OF OVARITIS.
By HORATIO R. BIGELOW, M.D.,
WASHINGTON, D. C.
1 KNOW of no pathological condition involving the female
sexual apparatus which is so unsatisfactory in its treat-
ment, so discouraging to the physician, and so hopeless
to the patient, as is ovaritis. Were absolute rest of
ovaries and Fallopian tubes possible, and were it equally
possible to reach interstitial and peri-oophoritis by deep
massage, we might expect much from expectant treat-
ment. But participating directly or indirectly, as they
do, in every functional change, being subjectively and
objectively factors in all mental operations, the ovaries
cease to be active only with the cessation of life itself.
Equally energetic are the tubes, suffering from trans-
mitted influence, from intrinsic disease, or engaged in
the retrogressive metamorphosis and healing process of
menstruation. There is no period of physiological rest.
The tubes, until the menopause, are either preparing for
the catamenia, or are engaged in recovering from the
shock. Whether menstruation be a mere expression of
ovulation, or whether it depend upon " the exfoliation
of the outermost layers of the proliferated mucous mem-
brane of the uterus," or whether it be an especial pre-
rogative of the Fallopian tubes, the direct eftect and the
transmitted influence are felt along the entire uterine
track. The congested ovary, the hemorrhagic tube, in
active operation itself and participating by contiguity of
structure with the ovary, and the utricular glands of the
uterus, are all sympathizing in a physiological event,
which may easily be rendered pathological by a want of
integrity in the faithful functioning of any part engaged.
A past history of constant suffering, of neuralgic aches,
painful defecation, a tearing sensation in the ovary, dys-
menorrhoea, pains in the back and loins and down the
thigh, despondency, dyspepsia and melancholia, a pres-
ent history of a life miserable and bedridden, and a
future which does not bear contemplation, these are
common incidents written in the pages of the life history
of those who address themselves to the gynecologist for
the relief of an oophoritis. Any chance that offers the
slightest hope of respite is eagerly seized. Abdominal
section and the removal of the uterine appendages is
stripped of terror, and the patient joyously submits to
anylliing that will bring future sunshine. Uteri re-
troverted or in any way misplaced are supported by pes-
saries, lacerations are sewed up, vegetations of the endo-
metrium are removed with the curette, cervices are
depleted, tonics are administered, but the patient finds
no surcease from her suffering. The recurrent peri-
tonitis, or the pains simulating a peritonitis, due to a
salpingitis with pus formation in the tube, or to an in-
flammation or degeneration of the ovary, come around
with discouraging regularity and persistency. With as
constantly recurring a disregard of the ovary, the seat of
the disorder is again relegated to the uterus, the endo-
metrium is again and again medicated, another pessary is
applied, the recurrent abdominal inflammation is vari-
ously attributed to an old pelvic inflammation, to sym-
pathy, or to a pathological condition within the uterus,
and thus and so the woman fades away, carrying along
with her the reputation of the [ihysician and the silent
evidences of his lack of discrimination.
I do not believe that the cause of this long and varying
train of symptoms is ever to be found within the uterus,
liowever misplaced it may be, or in however great a de-
gree its mucous membrane has degenerated. Displaced
uteri, lacerations of the cervix, endometritis, endo-cervi-
citis, and metritis, have a symptomatology in which, while
many symptoms are common to each, other and charac-
teristic ones are sure guides in the location of the diffi-
culty. Neither do I believe that any good results can
possibly obtain if the secondary conditions are allowed to
obscure the primary. The intercurrent dysmenorrhcea
accompanying an oophoritis, being a mere expression of
deranged ovarian function, will not yield to uterine
medication, neither will the dysmenorrhcea, associated
with a dislocated uterus, yield to the replacement of that
organ, provided there be inflammation or degeneration
of the ovary. Misplaced uteri are never accompanied
by the same alarming series of symptoms. The incon-
veniences thus occasioned, in uncomplicated cases, yield
readily to pessaries, or to medicated tampons. But it so
happens, that oophoritis is most frequently found in con-
nection with some derangement of the uterus, sufficiently
well marked to lead up to the belief that this, of itself, is
ihe/ous et origo of the patient's illness.
The groin pain, the melancholia and dyspepsia are
attributable to the retroverted uterus, and will yield, so
it is hoped, to the properly adjusted pessary. The great
mischief of the pessary is found in the ease with which it
is applied, and in the marvellous and oftentimes imagina-
tive good which it is alleged will follow upon its intro-
duction. Pessaries are only exceptionally beneficial.
The majority of cases do better without them, and get
well faster and with a greater assurance of permanency
with medicated tampons. The indiscriminate use of the
pessary, and its not infrequent mal-adjustment, are the
exciting causes of serioiis disease. He is a wise man in
his generation who, recognizing an oophoritis, will allow
the uterus, no matter however greatly misplaced it may
be, to remain just as he happens to find it, and will ad-
dress himself to the ovary alone ; who will assure his pa-
tient by a cheerful manner, and will explain to her what
he hopes to achieve in the administration of certain reme-
dies. He will much more surely attain his end and the
confidence of the woman, by declining to interfere need-
lessly, by vaginal examination, or by constant attempts
to replace the uterus, which only shock her nervous sys-
tem, and exaggerate the mental disturbmce always pres-
ent. Relieve your patient first of her intolerable suffer-
ing and despondency, thus winning her sincere regard,
and there will be time enough left to rectify the other
matters.
But how shall we relieve the suffering ? I protest
that I have carried this matter about with me, as a
burden, of which I have been unable to disembarrass
myself by night or day. .\ case in my own family, so
hydra-headed in its ever-changing symptoms, so irrespon-
sive to treatment, so painful to witness, has invested me
with a deep sense of a physician's responsibility in such
instances, and with a very painful conviction of my osvn
ignorance. The intense desire to relieve, with complete
inability to do so, is a species of punishment about as
painful as any that one can undergo. This case has
made a more enduring impression because of its associa-
tion with a retroverted uterus, with a subacute pelvic
inflammation, and with the recurring abdominal pain
and nausea, i have already so fully described it that I
may merely add, that the pain in the right ovary is con-
stant, and sometimes conveys the impression of dragging ;
the ovary is enlarged and tender, menstruation is insuffi-
cient in quantity and attended with much distress, and
there is a general condition of great malaise. No local
treatment of the uterus, whether of replacement or of
internal medication, has given the slightest reliet. Ab-
solute rest, electricity, massage, and full feeding, have
accomplished something, but the least departure from so
strict a regimen sets up the old train of symptoms. Er-
got with bromide of potassium, chloride of gold and so-
dium, the alter.Uive treatment with mercury, and coun-
ter-irritation have all been equally unavailing, though a
fair and honest trial was given to each. The fact seems
to me to be clearly demonstrated that the uterine dis-
placement has nothing to do with the distressing symp-
toms ; that the retroversion and oophoritis are entirely
distinct maladies, each characterized by peculiar phe-
nomena and each calling for separate treatment. While
it may be an error to postpone. an operation for the re-
moval of the uterine appendages until the patient is worn
out with her sufferings, it is a very natural timidity to
March 31, 1883.]
THE MEDICAL RECORD.
347
shrink from assuming so grave a responsibility, especially
in the case of those within the home circle.
At the suggestion of Dr. P. J. Mur|)hy, of this city, I
have been induced to make a trial of rectal suppositories
of one-quarter of a grain of iodoform, combined witli a
small quantity of the alcoliolic extract of bt'Iladoiitta, one
of these to be used three times a day. In three instances
under my own observation, including the case referred
to, these suppositories have given me more satisfying re-
sults and better grounded hopes of future alleviation
than anything else that I know of. Absence from the
marital embrace, with proper hygienic and dietetic rules,
must be enforceil rigidly. Tlie alleviative and sedative
properties of iodoform are well known, and in no other
disease are its properties brought. out so clearly.
BORO-CITRATE OF MAGNESIA FOR PHOh'-
PHATIC INCRUSTATION OF URETHRA
AFTER LITHOTOMY.
By S. S. KAHN, M.D.,
SAN FRANCISCO, CAL.
Patrick R , aged four years and six months, became
a patient of mine on May 8th last. The symptoms of
his affection, as described by his mother, were severe
pain on n)icturition, with occasional stoppage of the
stream, when his agony would be intense When he was
but nine months old the symptoms first began, and had
continued uninterruptedly ever since. A number of phy-
sicians had at diti'erent times been consulted, none of
whom seemed to recognize the true nature of the dis-
ease. At no time had any vesical examination ever
been made.
In appearance the child was pale and somewhat ema-
ciated. The prepuce was long from constant rubbing.
A small-sized silver catheter introduced into the bladder
almost immediately detected the stone. It lay to the
left of the median line, was not movable, and seemed
approximately to be about an inch in diameter.
Careful imjuiry into the history of the case presented
no ascribable cause. The father of the child was of very
dissipated habits. The mother was stout and robust.
They had had in all eight children, of whom but tiuee
were living. The eldest of these was of a stnnnous ten-
dency, I having removed, a week or two previous, two
lymphatic tumors from the neck. Those of the children
who died showed the same tendency.
On May i2lh I performed a median lithotom\', with-
out any accitlent, and with but little trouble dilating the
urethra and neck of the bladder. My linger in the bhul-
der detected the stone, which was rough and knobbed,
adherent to the vesical wall ; the separation was easy.
After some delay I succeeded in engaging it in the grasp
of the forceps, and extracting it through the perineal
opening. Hemorrhage during the operation was slight.
After the extraction of the calculus the bladder was care-
fully searched, but no other stone or fragment discov-
ered. Before leaving the patient the bladder was thor-
oughly washed with a weak solution of carbolic acid.
The stone had the knobbed appearance of a mulberry
calculus, but on examination it was found to be phos-
phatic in character, with a small lithic acid nucleus. It
was of an irregular cylindrical shape, about one inch in
length and five-eighths of an inch in diameter. Its weight
was one hundred grains.
Reaction after the operation was excellent. There
was very little fever, and within two days it began to re-
gain control over the bladder. On the third day some
few drops of urine emerged from the meatus. On the
fifth day fully half passed through the urethra, and it
could retain water for two or three hours at a time.
During all this time the perineal wound was repeatedly
irrigated with a two per cent, solution of carbolic acid.
Sixteen days after the operation the patient was up
and about, the wound in the perineum had entirely
healed, and urine passed through the urethra freely and
without pain.
F'our days later the boy was brought to my office in
terrible agony, suffering from complete retention of
urine. I innnediately administered chloroform, for the
child struggled too violently to admit of a carefid exami-
nation otherwise. The penis was erect and much swol-
len. All along the track of the urethra could be felt
little hard nodules. The endeavor to introduce a silver
catheter into the bladder was unsuccessful. Even an
elastic catheter could not penetrate beyond the begin-
ning of the scrotal portion of the canal, where the largest
concretion was located. The wall of the urethra was
unevenly coated with this gritty deposit up to within
three-fourths of an inch from the meatus. It was firmly
adherent and could only with difficulty be scraped off.
Examining the perineal wound, I found that there was
still a very small fistula left, through which I introduced
a probe, which finally passed into the bladder. By mov-
ing this about the size of the fistula was enlarged, and
when the probe was withdrawn, there was a copious flow
of urine. During the passage of the probe through the
prostatic urethra, the same gritty sensations were de-
tected as before described. A hard-rubber catheter was
then introduced into the bladder, tied in, and the patient
sent home to return the next morning, when I proposed
taking measures to relieve the obstruction.
The following day the child was again chloroformed.
During the previous night the catheter had slipped out
of the perineal opening, but it was easy to reinsert it.
This I did, and injected through the catheter about two
ounces of a one per cent, solution of the boro-citrate of
magnesia. This I also injected into the meatus, but it
did not penetrate far. I removed the catheter, as the
fistula was sufficiently patent to allow of a free escape
of the urine. I ordered the internal administration of a
teaspoonful of this solution every hour. About eight
hours after this procedure the child, in attempting to
pass water, after a great effort accompanied with intense
pain, passed through the urethra a quantity of this cal-
culous material, about the size and double the thickness
of a five -cent piece. Its consistency was like putty.
Immediately after this the flow of urine was compara-
tively easy, although still attended with pain. His con-
dition, however, was much relieved, and he slept soundly
and well.
At the next visit the introduction of a silver catheter
into the bladder was an easy task. Deep in the urethra
there were still gritty points to be felt, but the pendulous
urethra seemed clear, the perineal opening had again
closed up. The bladder was once more injected through
the silver catheter, and the internal administration of the
drug continued. Tiiat night he passed a piece about the
size and shape of a small bean. Subsequent examination
revealed the fact that the canal was now free throughout
its entire extent ; the urine was clear, passed freely, and
without the slightest pain. After this there was no
further trouble, the child continued to take the medicine
internally, but there were no fiirther evidences of [ihos-
phatic deposit. It is now fully eight months since this
complication occurred, but there has been no relapse
and the patient has gained both health and strength.
It was not for the purpose of presenting the operation
itself that this article was written, but to point out the
oddity and the rarity of the complication that resulted.
A careful search through the literature of the subject
presents the most meagre details. The surgical authori-
ties in common practical use make absolutely no men-
tion of it. One German work refers to the possibility of
the occurrence of incrustation of the urethra after opera-
tions for stone, but that it is very rare ; and then dis-
misses the subject without one word as to prognosis or
treatment.
Sir Henry Thompson speaks of an incrustation of the
perineal wound, and this when slight to be treated with
348
THE MEDICAL RECORD.
[March 31, 1883.
hip baths or washing with a waim acidulated solution.
Once or twice he has found it so thickly deposited that
he was compelled to remove it with the forceps. In one
case only it coated the whole track of the wound from
the perineum to the neck of the bladder itself, and was
crushed by him before the end of the fourth week. The
wound was four months in healing. In my case, with the
solvent or softening agent employed, the urethral tract
was cleared in two days, the perineal wound closed up
again the following day, and no further trouble ensued.
A comparison of the two cases, methods of treatment,
and results, is both interesting and instructive.
The possibility of dissolving urinary concretions within
the living passages is a question of practical interest,
especially as to the possibility of affecting renal calculi.
Upon this subject many investigations have been made
and varying opinions expressed by Mevet, Civiale, Rees,
Roberts, and many others. In an exhaustive review of
the subject, published in the " .Medico-Chirurgical Trans-
actions " of London, vol. .\iii., 1865, Roberts enun-
ciates the princi|)les upon which the solvent treatment of
stone should be carried out, declaring that while no new
solvent agent had been discovered, they had arrived at a
better application of treatment which had long been
known in princii^le, but which had forfeited the confi-
dence of the profession by the faulty manner in which it
had been carried out, and its employment in cases where
it was sure to fail. In the lithic acid diathesis, the alka-
line treatment is emphatically recommended, particularly
in limiting the size of the stone when once formed.
Dr. Koehler, in the Berliner Klinische Wochcnschrijt,
No. 44, 1879, recommended the boro-citrate of magnesia,
and asserted it to be ver\- effective in the dissolution of
stone in the bladder and kidneys, as well as in the treat-
ment of catarrh of the bladder. He states that he has left
a piece of uric acid calculus in the solution of the boro-
citrate of magnesia, and found it broken up at the end of
eight days. Reference is made to its use, in 1868, by
Bacher, whose formula for the preparation of this salt is
given in Hager's " Handbuch der Pharmaceutischen
Pra.xis '' as follows : Calcined magnesia, 30 grms.; bora-
cic acid, 100 grms.; distilled water, 10 grms. To this
mixture is to be added 30 grms. of hydrochloric acid,
C. P., and then sufficient alcohol to make it into a fluid
paste, and to this add 60 grms. of citric acid. After the
alcohol evaporates, this is to be pulverized. For use a
one per cent, solution is to be prescribed and freely ad-
ministered.
EXTIRPATION OF CANCER OF THE FACE,
Involving Inferior Maxillary Bone, Floor of the
Mouth (Right Side), Submaxillary and Parotid
Glands.
By G. WACKERHAGEN, M.D.,
BROOKLV.N, N. Y.
Patrick S , fifty-five years of age ; farmer ; born in
Ireland, consulted me on the 6th of December last in ref-
erence to a tumor situated over the middle of the right
lower jaw. He was suffering great pain from the growth,
but otherwise seemed to be in good health, exceining
that he had a very feeble pulse. He aiipeared to be an-
xious tliat some operation should be performed, as the
tumor was rapidly increasing in size, and he found great
difficulty in taking nourishment.
Upon examination 1 found the most prominent portion
of the growth circular in shaiie, and about one and a half
inch in diameter, with ulcerated surface. The remaiii-
cler involved the inferior maxillary bone, riglu floor of
the mouth, and the submaxillary and parotid glands.
After explaining to him the danger attending so formid-
able an operation, and the probability of its return, I
told him that I would consult with his piiysician, Dr.
Alex. J. Rooney, which I did on tiie following day.
Dr. Rooney informed me that he had known the patient
several years, and that his general health had always been
good. Three years ago he had attended him in an attack
of double pneumonia ; and two years ago he had removed
an epithelial growth from his lower lip, when the wound
healed readily. Last April Mr. Smith consulted him
about a small tumor situated in the soft parts over the
right lower jaw, which was well defined and movable.
Upon examining the jaw, he discovered a decayed tooth,
which he directed should be removed, and the tumor
painted with tincture of iodine. Under this treatment
the tumor disaijpeared, and did not return until about
two months prior to his consulting me, when it com-
menced to grow rapidly, involving the surrounding tissues
in all directions.
On December 7th I visited the patient at his home in
New Utrecht, and finding him still anxious for relief, de-
termined to operate on the following day. The gentle-
men present and assisting at the operation were Drs.
Spier, N. Ford, Rooney, and Silberman. Careful exam-
ination of the heart detected no organic trouble, though
the pulse was remarkably feeble, but it improved during
the administration of ether.
After placmg a ligature upon the common carotid ar-
tery and internal jugular vein, I extended the incision
upward around the lower portion of the tumor to the
lower border of the inferior maxilla, following the lower
border of this bone to its symphysis, and dividing the
lower lip by a vertical incision. Commencing again at a
point anterior to the tumor, the incision was carried above
and around the upper and posterior portion, to the lower
border of the jaw ; thence around the angle and posterior
border of the ramus, half-way to the condyle. The in-
cision was then continued around the posterior and lower
border of the tumor, to the point where I first started.
The tumor was then detached fron) the inferior maxillary
bone, which was found to be extensively involved.
The hemorrhage being quite profuse, in spite of the
previous ligation, it was considered advisable at this
point to perform tracheotomy, and continue the anaes-
thetic through a tampon. The instrument devised by Dr.
A. Gerster was used for this purpose, and it worked ad-
mirably and proved a great convenience. It would seem
impossible to improve upon this instrument, and for the
information of those who may' not have seen it, the ac-
companying illustration is introduced.
The diseased portion of the lower jaw was now removed
by sawing and cutting through near the symphysis and at
the angle. Following this the floor of the mouth (right
side) including the submaxillary glands, and finally the
parotid gland, with all connecting tliseased tissue, were
thoroughly removed. After the application of carbolic
acid solution to the wound, the skin was drawn over and
united, with only slight tension.
The patient speedily rallied from the operation, and on
the third day was able to sit up. There were no un-
pleasant symptoms trom the ligation of the vessels. The
temperature did not reach above 101°, but the pulse was
very feeble, anil about 100. The nourishment consistetl
of beeftea, brandy, milk and eggs. On the fourth day
he refused the quinine and stimulants, and the attendants
stated that it was with great difficulty he could be pre-
vailed U|)on to take any nourishment. By the ninth day
he refused all food, and I passed a tube into the stomach
and injected some beef-tea and brandy. The i)atient
resisted so much that it became necessary to have him
March 31, 1883.]
THE MEDICAL RECORD.
349
held by the attendants. After this he took nourishment
wilhngly, and in considerable quantity, until the twentieth
day, when hemorrhage took place from the wound, the
|)atient losing about a pint of blood before it was dis-
covered. Styptic cotton was applied by one of the attend-
ants, and a compress placed over the wound. Upon re-
moving the compress next morning, I could not discover
the origin of the hemorrliage. After my departure the
patient again refused nourishment.
About a week after the operation, the integument
covermg the wound commenced to slough,' so that the
wound was entirely uncovered. The tracheal incision
also refused to heal. During the entire period, there
seemed to be scarcely any disposition toward granulation
or heahng ; and the patient becoming more and more
exhausted, died on January ist, twenty-five days after
the operation. The dressings consisted of carbolized oil,
iodine, iodoform, and nitric acid solution, but they seemed
to have little eftect in promoting the healing process.
Friends would not permit post mortem examination.
1S8 State Street, Hrooklvn, Febnuiry 7, 1883.
ON DR. SQUIBB'S RKSOLUTIONS TO ABOLISH
THE CODP: of ethics of the MEDICAL
SOCIETY OF THE STATE OF NEW YORK.'
Bv C. R. AGNEW, M.D.,'
NEW YORK.
If I understand the ciuestion before us, it is whether we
will report for or against Dr. Squibb's resolutions, a
question substantially |)resented, also, in the resolution
of Dr. Gouley, -'That when the Committee rises it shall
re|)ort in favor of repealing the new code enacteil by this
Society in 1882."
I rise to oppose these resolutions and all similar ones,
and to urge that when the Committee of the Whole rises
to report to the Society, its report shall be against the
repeal of the existing code.
A year ago, after mature deliberation and a free dis-
cussion, this Society, by more than a two-thirds vote, and
in the e.xercise of its indisputable right, amended its by-
laws so as to make them consistent with the laws of the
State and public policy. It is true that various attempts
have been made to promulgate the error that said action
was hasty, imperfectly considered, and that a few "am-
bitious," "mercenary," and, not to say, unscrupulous
members of the Society had brought it about ; that
''specialists" had been accomplishing their nefarious
purposes through the force of ill-timed and badly directed
energ)'. Such gratuitous allegations, however, have not
stood for a moment the crucial tests of legitimate criti-
cism or investigation, and may therefore be dismissed
as unworthy of even this brief animadversion, much less
the serious consideration of the medical profession of the
country. In view of them one has only to recall a little
history, and to draw comfort from its evidences of the
triumph, even though it be sometimes slow, of liberty of
conscience over prejudice, misrepresentation, and intol-
erance. Revisers, all down the pages of history, have
had to endure hardship, and the only way for those who
are called upon to do the work of revising is to live above
the low level of the fear of their fellow-men, and not to
be confused, diverted, or intimidated, even though the
torch of persecution be brandished in their faces by those
who assume to be the moral lights of the world, and the
appointed guardians of its best interests.
"Zeal to promote the common good, whether it be by
devising anything ourselves, or revising that which hath
been labored by others, deserveth certainly much re-
spect and esteem, but yet findeth but cold entertainment
in the world. It is welcomed with suspicion instead of
love, and with emulation instead of thanks, and if there
be any hole left for cavil to enter (and cavil, if it do not
^ Remarks made before the Medical .Society of the State of New York, in Con
mittee of the Whole, at its Annual Meeting, February 7, 1S83.
find a hole, will make it), it is sure to be misconstrued
and in danger to become condemned. This will easily
be granted by as many as know history, or have any ex-
perience. For, was there ever anything projected that
savored in any way of newness or renewing, but the same
endured many a storm of gainsaying and opposition ? "
The revisers who unanimously reported the by-law, or
code of 1882, framed it to be consistent with the Statutes
of the State, especially the law of 1880. This Society
adopted the Code by a very large vote without even a
verbal amendment, after hours of animated discussion.
Under this code or by-law, the medical profession of the
State has prospered for a year, and might have gone on
doing so for years to come, if it had not been for
an agitation fomented by parties living outside of the
limits of the State, largely aided, and no doubt on
conscientious grounds, by the mover of the resolutions
published and widely circulated in the " Ephemeris."
The legitimate course would have been to have moved
either to give up the charter of the Society, or to amend
the State Statute of 1880.
It may be well for us to consider for a moment our po-
sition as a Society in relation to the State.
Whence do we get the right to be here in session ?
Indisputably through our charter from the State. No
one but a legally qualified medical man has a right to be
a member of this Society. It is nothing to the point to
say that the diploma, or certified right to practise, comes
from a medical school, and not directly from the State.,
In this State the law undertakes to regulate, by charter
or otherwise, the powers which confer the right to prac-
tise, and the method is easy by which you may hold all
who attempt to practise within the limits of the State to
a strict legal accountability. It is true that this statute
of 1880 regulating the piactice of medicine is not all that
it should be. It is not perfect, nor are the men who ac-
quire rights under it. But it will be amended just as
soon as the members of the medical profession cease to
legislate for themselves in proscriptive codes, and join
other public spirited citizens in inducing legislators to
protect the people, as far as practicable, against medical
incompetency. Whence do we, as a society, get the
right to make medical codes and other by-laws ? From
the State through our charter. The New York State
Statute of 1880 says, "Section 5. The degree of Doctor
of Medicine lawfully conferred by any incorporated Medi-
cal College or University in this State shall be a license
to practise physic and surgery within the State after the
person to whom it is granted shall have complied with
Section 2 of this act." Section 2 referred to, provides
for registry in the County Clerk's office before commenc-
ing to practise, etc. Section 4 i)rovides for the indorsing
of the diplomas of persons coming to the State to practise,
from without the State, by an incorporated university,
medical college, or medical school, etc.
The revised Statutes of New York especially provide
that every corporation, as such, has power "to make by-
laws not inconsistent with any existing law for the manage-
ment of its property, the regulation of its affairs, etc."
And in accordance with this provision of the Statutes, the
Medical Society of the State of New York has the right
to make by-laws not inconsistent with the laws of the
State. Kent says, " These corporate powers of legisla-
tion must be exercised reasonably, and in sound discre-
tion, and strictly within the limits of the charter, and in
perfect subordination to the constitution and general
laws of the land and the rights dependent thereon." If
you look at your charter you will find that whatever
quality your by-laws, or codes, may have, they must, to
be legal, and to have binding force upon your members,
and punitive power, be " not inconsistent with the laws
of the State."
Now, Mr. President, I put it to this society, are we
prepared, even under the leadership of the eminent mem-
bers, I do not call them conspirators, who have been
sowing seeds of discord all through the year in the profes-
oo^
THE MEDICAL RECORD.
[March 31, i88:
sion and in this meeting, to array ourselves against the
letter of the law and the policy of the State ? Or, are
we pre])ared to adopt the resolution to rise and report to
the society to repeal the new code ? Report to repeal
the new code if you please. There is not much in the
new code that 1 strongly desire to see retained. I am
quite ready to abolish all but one or two clauses of it. I
do wish, however, especially to see the clause retained
which binds us all to acknowledge the public necessity for
a "legally qualified practitioner." "Members of the
Medical Society of the State of New York and of medi-
cal societies in affiliation therewith, may meet in consul-
tation legally qualified practitioners of medicme." ]t is
permissive, not mandatory. I wish to see the profession
united to contend for that and to secure a higher and
better standard of legal qualification.
Having a safe basis, and one on which legislators and
the public are willing to aid us, we may as speedily as
possible raise the standard of medical education, and
express in amendments to the laws regulating the practice
of medicine, a higher and higher ideal, and force schools
and legislators to api)ly higTier standards of fitness for
practice. What I am opposed to here is the declared or
implied purpose of the movers of both resolutions,
namely : to re-enact the old code, and to throw on the
profession, powerless to do the work, what belongs to
medical schools and legislators.
One great defect in that old code was that it had
come, in the jirocess of time and growth of legislation, to
be inconsistent with iniblic policy in our State, and with
its statutes. Would it not be grossly opposed to public
policy and the letter of the law of the State to attempt,
by any code or by-law of our making, to strip a fellow-
citizen of a right which the State had conferred upon
him : a right identical with that in the exercise of which
we are authorized to be here to-night as duly qualified
nudical men ? '
The man whom the State has enfranchised this society
cannot disfranchise. The medical man whom the State
has pronounced to be a legally qualified practitioner,
this chartered State Society cannot disfranchise, how-
ever much we may despise him or refrain from social
communion or fellowship with him. We cannot dis-
cipline a member of our society if his conduct is in
conformity with the law of the State.
Pass Dr. Squibb's or Ur. Gouley's resolutions, attempt
by your vote to re-enact the old code, and you take ac-
tion which will certainly be decided to be against jniblic
policy, and your action in making the by-law proposed
inconsistent with the laws of the State. I here quote
from a paper by Prof D. R. Jaques, Professor of Muni-
cipal Law, University of New York :
" What is the Code of Ethics ? What is the power of
tlie State Society to enact one, or to legislate on any
subject ? What are the relations of the County Society
to the State Society ?
" The State Society and each county society are dis-
tinct corporations, each with power to acquire and hold
property; each with an organization of its own. 'J'he
State Society is composed of certain jjermanent mem-
bers, whom it selects in a certain proportion to the other
members, and of members elected periodically. The act
of 1S13 speaks of them as members, not dclcf^ates. The
State Society is not so much a representative body as a
distinct and cori)orate board of control. The suggestion
that the members elected by the county societies must
vote as instructed by them is untenable. A doubtful
jirinciple in any case, it would convert the State Society
into a/iv/i-ra/ organization, and would, in effect, reciuire
the members to vote by counties. In this way rules might
be adopted which wc\c disapproved by a large majority
of the practitioners of the whole State belonging to the
county societies. Moreover, who, it may be asked, are
to instruct xhs permanent members?
* See case of The State and relator Cjray against Medical Society of the County
of Kric, 24 Barbour.
"Instruction makes the delegate a mere messenger to
carry the conclusions of the County to the State Society ;
but the members of the State Society are corporators of
a distinct body, and go to its meetings to form, receive,
and adopt conclusions as the result of views gathered
from all sections.
" But the Statutes are conclusive on this point. They
require that, in all cases, the rules and regulations of the
county medical societies shall receive the sanction of the
State jnedical societies, and the act of 1866 (chap. 445)
applies this restriction to the homoeopathic county so-
cieties as well. Now, if the county societies may instruct
the members they send to the State Society, a majority
of the counties could alwa)'S control the State Society,
which would be its mere creature and mouthpiece ; where-
as the act of 1813. in terms declares that the 'by-laws,
rules and regulations ' of the county societies shall not
be 'repugnant' to those of the State Society.
" The rules of the Code of Ethics are by laios. Their
force and effect are the force and effect they have as by-
laws. The autliority to adopt the old rule and the new
rule of consultations must be found in the power given
by statute to adopt by-laws and rules. The act of
1813 aiid the act of 1866 are explicit in requiring that
the by-laws, rules and regulations of the State Society
shall not be ' inconsistent ' with the huus of the State.
There may be an ' inconsistency ' which is not a direct vio-
lation of the law ; but it is believed that the old rule is
contrary to both the spirit and letter of the law, as it is
contrary to tiie dictates of a broad and true humanity
and the interests of medical science.
" It is not consistent with the tetter of the Statutes
which prescribe the qualifications of practitioners. It
says, in effect, that the employment of physicians whom
the law has sent into the connnunity and pronounced
qualified, thereby inducing the ignorant and the unwary
to entrust them with their lives, shall be punished by
deprivation of all benefit from the counsels of enlightened
physicians. Will the law allow jiatients to he punished
for em]iloying those the law pronounces qualified ?
" But there is another consideration equally serious :
The rule in question is the action of an organized body
of men. It is the act of combination. The men tlnis
combining are considered by many — and consider them-
selves— the most competent practitioners, the only fully
qualified practitioners of the State. By adopting this
rule, they condnne to deprive the community of the best
advice to be had in cases of sickness. Such a combina-
tion is against common law, and the jirovisions of the
statute as well (Penal Code, Section 168). It is a con-
spiracy against the public health."
What are we to do then, Afr. President? For the
present keep the code as it is. After we .shall have de-
feated the attempts in this Society to lead us to rebel
against iniblic policy and the law of the State by re-
enacting the old code, it will be time enough to say what
we may do to amend the existing code. We shall be
ready for that question in due season. We have not
lowered our Hag to any " ism," nor do we propose to.
"There is probably no one thing which man, con-
sidered collectively, grants less willingly to his fellow-man
than liberty. Nine-tenths of all the wars which have
desolated the earth, and no small part of all the ills that
have afflicted humanity since the race began, have been
due to a denial on the one hand, and an attempt to gain
possession on the other, of those attributes of freedom
which modern thought is coming to regard as among the
inborn, iniierent. and inalienable rights of every indi-
vidual. .'\nd still the struggle goes on. Liberty of the
person, liberty of belief and worship, liberty of sjieech
and press, and liberty to have a voice in the choice of
rulers and forms of government." I would also add lib-
erty of medical consultations, "are still privileges denied
to no small ))art of mankind ; and any extension of
liberty in these respects, in the future as in the past, will
probably be conditioned upon long-continued, desperate
March 31, 1883.]
THE MEDICAL RECORD.
35 1'
efforts and upon the payment in bloo.l. treasure, and suf-
fering of large price. I^- A. Wei.i.s."
Charles O'Conor, the great jurist, in a recent letter to
your speaker says, the "general doctruie of enianci|Kition
from every unnecessary restraint upon individual liberty
in action or pursuit which forms the basis of the argument "
(referring to the speaker's " Limits of Medical Ethics "),
" has long had me for a disciple."
After we shall have defeated the attempts to re-enact
the old code, let us return to our counties determined to
carry into effect the laws we have against illegal practi-
tioners, and to make the laws better. How many coun-
ties, represented here, have done their duty in this matter ?
New York County has endeavored strenuously to do its
duty. Twenty-seven illegal practitioners have been ar-
raigned in New York City during the past year, and
twenty-tive of the number have been convicted and ])un-
ished. And at this moment charges are being pressed
against a medical college there with good prosjject of
convicting its managers of illegal methods of granting
diplomas.
But the question is i)ertinent, What are we doing indi-
vidually for higher medical education ? How many
public-spirited men have we attempted to enlist in the
cause of medical education in our respective counties ?
How much have we done to advance the interests of our
Medical Alma Mater to give it the means to make its
diplomas more valuable ? How much have we done in-
dividually to change the character of proprietary medical
schools, and to secure for them adequate funds and a
more thorough and severe curriculum ?
When we shall have begun even to consider honestly
these and kindred questions, we will soon see the standard
of medical education and of tlie legally qualified doctor
rise, and the petty questions of schools and '' isms" will,
like other ephemeral issues, vanish or become despicable.
As regards error in medicine, what Thomas Jefterson
said in another field is indisputably true here also.
"Error of opinion ceases to be dangerous w^hen reason
is left to combat it." Leave members of a liberal pro-
fession free to go as advocates of the truth wherever
called, and only restrained by the rules of common de-
cency, legality, and prudence, and error will be less ar-
rogant and dominant, and the dupes of error less numer-
ous and more quickly rescued.
The Treatment of Pelvic Abscess. — Dr. Tait treats
this troublesome affection in the following way : He
makes an abdominal incision, ojiens and empties the ab-
scess, stitches the two wounds together, and secures
drainage of the abscess cavity. The result has been
most satisfactory, as twenty-two of his twenty-four cases
were completely cured, and another is neaily well and
improving, while in only one did the wound fail to heal,
and the jjatient died of jjhthisis inilmonum, which was
sus|)ected when the ojieration was jierformed. Under
the old methods of treatment, he says that more than
one-half the cases were not cured, but either died or led
an invalid life by reason of suppurating sinuses. — British
Medical Journal, February 17, 1883.
Transfusion of Pure Water. — Dr. Coates {London
Lancet) reports a case of transfusion of pure water,
warmed to the proper degree. The patient was a |)rimi-
para, twenty-seven years of age. The cause of collapse
was an alarming hemorrhage on the ninth day after child
birth. Some twenty-two ounces of water were allowed
to enter the median cephalic vein through a Jennings
si|)hon. The result was striking, and convalescence
speedy.
Congenital Sarcoma of the Lower Jaw. — Dr. Ar-
kovy narrates the case of an infant, which was born with
a tumor of the lower jaw. The growth was about the-
size of a walnut, and on microscopical examination
proved to be a large-celled sarcoma. Congenital neo-
plasms of this kind are known to be exceedingly rare..
Thus Holmes's " Surgical Diseases of Children " mentions-
only two similar cases. — Orvosi LLctilap, February 4,.
1883.
Impregnation before the Menstrual Epoch. —
Mrs. P. J , born March to, 1842, married December 24,
1854, making her age at marriage twelve years, nine
months, and fourteen days. Was fully developed, but
breasts were small and she had never menstruated. On
the 9th of September following she was delivered of a
well-developed child; time of gestation eight months and'
fifteen days. One month after delivery she menstruated
for \.\\i^ first time, which lasted seven days.
Menstrual function was absent from this time untili
after the birth of the second child, which was born Octo-
ber 16, 1856, one year, one month, and seven days after
that of the first.
From this date menstruation has been regular until
about fifteen months ago, when it suddenly ceased and
has not since returned. Her general health has been
good. She was married three times and had five children.
In 1862 had a miscarriage. At no time was the men-
strual flow profuse.— -fV O. Med. and Surg. Jour.
Multiple Lvmphadenoma of the Conjunctiva. —
Dr. Goldzieher, of Buda-Pesth, Hungar)-, who sometime
ago described a case of lymphadenoma of the conjunctiva
(see Medical Record, February 10, 1883), at a recent
meeting of the Medical Society of Huda-Pesth, showed
a patient, aged tvventy-si.\, from whose left eye he had.
removed a portion of the ocular conjunctiva, including,
several miliary nodules. Some of these were yellow,
others grayish and translucent. Under the microscope-
they exhibited the structure of lymph-follicles with giant
cells, but did not show Koch's bacilli. The wound,
healed kindly, but soon afterward a recurrence of the
disease took i)lace. Goldzieher is inclined to think that
those cases which have been recortied as tuberculosis of
the conjunctiva with caseous degeneration, were, like the
present one, cases of lymphadenoma. — Or7'ost Hetilap,-
February 4, 1883.
Gastro-Enterostomv. — Dr. Fischer, of Strasburg,.
describes, in the Deutsche Zeitschri/t fiir Cliirurgie, a
remarkable abdominal operation. In 1881 Freund le-
moved a fibroid uterus from a woman, aged thirt)-. Last
May this unfortunate patient, who ap|iears to have been
predestined to be a victim to abdoiuinal disease, was
found, by Dr. Fischer, to be suffering, according to his
diagnosis, from carcinoma of the jivlorus. Lucke deter-
mined to attempt resection of that part of the alimentary
canal. From May 1-3. 1882, to May 25, the stomach was
washed out every' day, and on the 25th, after an enema
had also been administered, the operation was lom-
menced, without spray. The parts were exposed by a
free incision, but resection was found to be im|nactica-
ble, owing to extensive adhesions between the p)-lorus-
and the neighboring structures, es|)ecially the pancreas.
The pylorus was tiierefore laid oi^en and the aperture
united to the abdominal wound, as in gastrostomy. The.-
opening left in the wound was dressed with iodoform, and
covered in with thymol-gau/.e. After the oiieration the
patient did well ; the temperature rose but little above,
normal, and she was discharged in thirty-seven days.
Since then she has enjoyed very fair health, being free
from attacks of vomiting, and can easily digest liglu, nu-
tiitious food. — British Medical Journal.
The Clinical Society of London has appointed a
committee for the purpose of inquiring into tlie results
of the treatment of spina bifida by injection. Circulars
have been printed and sent to all the registered members,
of the profession in the British Islands.
352
THE MEDICAL RECORD.
[March 31, r88^
The Medical Record
A Weekly Journal of Medicine and Surgery.
GEORGE F. SHRADY, A.M., M.D., Editor.
Published by
WM, WOOD & Co., Nos. 56 and 58 Lafayette Place.
New York, March 31, 1883.
STATE EXAMINATIONS IN GREAT BRIi'AIN.
The chief subject of medical interest in Great Britain is
the proposed new Medical Act, which is expected to
come before Parliament for a second reading in the
course of the next few days.
The pretty general opinion in London seems to be
that the act is a good one. How the different licensing
bodies of the United Kingdom will receive it is another
matter.
Practically, the new bill, if it should pass and become
law, will supersede most of the nineteen examining bodies
now in existence. It is proposed to hold a State exami-
nation in each of the three divisions of the United King-
dom, and to admit no one to the register until he has
passed this examination. By this means all students
will be compelled to pass an examination in surgery, ob-
stetrics, and medicine before being admitted to practice.
Until a few years ago, the College of Surgeons did not
examine in obstetrics for its membership examination,
but only required a certificate of attendance on ten cases
of labor. Their examinations have lately been extended,
but even now there is no clinical examination in medi-
cine, and no examinations at all in forensic medicine or
chemistry, although courses of lectures must have been
attended in these subjects.
Similarly, the Society of .\pothecaries holds no exami-
nation in surgery, thougii lately the examiners in medicine
have wandered somewhat into the region of surgery in
their questions. The examination in anatomy is chiefly
confined to regional anatomy, and does not comprise
examinations on dissections. These anomalies will, it is
to be expected, soon disappear.
All the British examining bodies retiuire four years to
be spent in study, of which period at least three winter
sessions (of six months each), and two summer sessions
(of three months each), nuist be passed at a medical
school.
The examinations for the M.R.C.S. and L.S..\. are
both of them sufficiently stringent so far as they go. The
defect has consisted in granting a diploma which practi-
cally allows practice in all branches without examining
in all.
The new act will also create a reformed Medical Coun-
cil to which will be handed over the funds accumulated
by the present one. It is to be hoped that the new
council will do more useful work for the profession than
the present one has done. Most of its income has been
devoted to salarying the members, who hold an annual
sitting which begins and ends in — talk ! The?present
council has little power, and has made itself the laughing-
stock of our professional cousins.
PNEUMONIA IN NEW YORK .\ND ITS TREATMENT.
CON.SIDERABLE has been said of late regarding an alleged
unusual prevalence of pneumonia in New York, and
some attempts have been made to create a sensation
over the matter. As will be seen by the accompanying
table the mortality from pneumonia during the past few
months has been somewhat greater than it was a year
ago. For example : in the month of March, 18S2, the
weekly mortality from this cause varied between 97 and
III ; in the corresponding month of the present year it
has ranged between no and 128. For the two pre-
ceding months of 1883 the weekly mortality has also
been greater. We must infer, therefore, that there is
either more pneumonia at present than usual or it is of
a more malignant type. At the same time the number
of cases cannot be very excessive — certainly not enough
so to cause alarm. K somewhat vague estimate of the
number of cases occurring weekly might be made, based
upon the ])robable per cent, of deaths from pneumonia.
This per cent, varies between 2 and 33, but perhaps a
mortality ratio of 15 per 100 would not be far out of the
way. This would make the weekly number of cases at
present about eight hundred.
Wkek Ending —
Mortality from—
Pneumonia.
Bronchitis.
Phthisis.
March 24, 18S3
17, "
128
iiS
III
no
94
99
71
85
72
74
92
78
75
84
80
82
69
40-50
36-51
3S
35
40
45
36
29
25
40
31
37
33
3^8
30
29
35
31
121
127
112
92
February 24, 1SS3
" 17, ••
118
119
119
" 10, **
it, -. [.
S7
III
102
** II *'
120
'■ 6; •' .:..:;:::.:..
89
December 30, 18X2
103
92
106
16, '*
'' 0. *'
11 ^ ti
For the month of November
** '* '* October
Whek Endisg-
MOBTALITY FROM —
Pneumonia. Phthisis.
March 25. 1SS2. . .
" 18, •• ...
'• II, " . . .
" 4. " ...
February 25, 1882.
iS, '• .
" II, " .
" 4. " •
January 2S. " .
21, " .
14, " .
7, " .
December 31, i8Si
lOI
93
107
98
84
•03
92
8t
82
92
93
82
104
97
104
109
III
100
120
"7
96
102
III
99
94
107
March 31, 1883.]
THE MEDICAL RECORD.
353
Along with the increase in mortality from pneumonia
there has been a slight increase in the mortality from
phthisis, while that from bronchitis is not greater than it
was a year ago. Despite the slight increase shown above,
the mortality rate of the city is considerably lower tlian it
was in the winter of 1881-82. It now ranges between
25 and 30 per 1,000, the nnmber of deaths for tiie week
ending March 25th being 763. During the month of
March, 1882, the mortality reached as liigh as 814 per
week, the increase being due to an excessive prevalence
of zymotic diseases.
In the management of pneumonia, New York physi-
cians, in accordance with the prevalent American teach-
ings, adopt the principle that there is no special treat-
ment for the disease. In most cases, rest, pure air,
careful attention to nourishment, and, toward the close,
some stimulants, are generally all that is resorted to. A
little mor|)hine, or a hypnotic, and some external aiipli-
cations are often used. Cold water applications are, we
believe, very universally condemned — as they should be.
Tartar emetic, iodide of potash, bleeding, and even qui-
nine, are special drugs whose regular use is now gener-
ally abandoned. Some physicians give aconite or veratruin
at the beginning of the attack. The administration of
sedative doses of calomel, toward the close of the fever's
course, is a practice that is creeping into fashion. The
results are sometimes brilliant, but not rarely are disap-
pointing. Cardiac stimulants, cupping, bleeding, inhala-
tions of oxygen, etc., are measures that have to be em-
ployed to relieve the dyspnoea, exhaustion, and threatened
heart-failure in serious cases.
THE PHYSICIAN AND HIS PROFESSIONAL SECRETS.
A SUIT involving the old question whether information
obtained by a physician from a patient, orally or by ob-
servation, must be disclosed on the witness stand, has
recently been tried before the Supreme Court of Mis-
souri. The law in that State declares that a physician
" shall be incompetent to testify concerning any infor-
mation acquired by him from any patient whom lie may
be attendmg in a professional character, and which in-
formation was necessary to enable him to prescribe as a
physician or operate as a surgeon." The court held in the
case in question that it will not do, while the mouth of a
physician is closed as to the talk of his patient, to open it as
to knowledge acquired from his own diagnosis of the case.
It thus sustained the lasv and the principle underlying
it, and the decision is an important one.
The law in the State of New York is very much like that
in Missouri. In England, however, the highest legal au-
thorities have decided that medical men enjoy no special
privilege with regard to secrets of a professional nature.
Although this view may have a great weight of legal
argument in its favor, it is not the one which the medi-
cal profession or the leading medical jurists advocate,
and we are gratified to find that the medical, and as we
believe, higher position, is gaining strength.
The single weak point in the laws of Missouri and
of some other States, regarding this position, is that they
do not sufficiently insure to citizens a high status for
these medical men who are thus privileged to keep back
evidence.
FALLING FROM GREAT HEIGHTS.
It has been asserted that a man falling from a great
height dies before he reaches the ground, and we re-
cently noticed this question discussed in a public journal.
The experience of an aeronautical party in the balloon
Owl, which made a very rapid descent, during the fall of
last year, at Dunmow, Essex, England, throws some
light on this disjjuted subject.
The voyage being limited to time by the conditions of
the contest in whicli the party in the car were engaged,
a rapid descent became necessary. The valve was twice
opened, and volumes of gas rushed out. The balloon
fell plumb 1,300 feet in one minute and a quarter. They
came to the ground with a thud which sent one of the oc-
cupants of the car limping for six weeks afterward, but
none of his other three companions suffered from the
severe bone-shaking. It is interesting to know that
their breathing was not in the slightest degree affected
by this rapid falling through the air. All appeared to be
perfectly conscious, and as calm as men might be who
had reason to fear that their next second might have
been an eternal one.
We understand it is on record that one aeronaut fell
from a car, a distance of sixty feet into a ploughed field,
without loss of consciousness.
A WORD TO OUR STATE MEDICAL SOCIETIES.
We have before us a large number of the "Transactions"
of State Medical Societies. They are most suggestive
volumes, like all thmgs which are truly American. But
perhaps the thing most strongly presented, after turning
some of the pages, is the query whether or not our State
Societies have any function as scientific medical bodies.
It has been, we know, the fashion to decry State medical
work, but unfortunately this fashion has had a solid basis,
and criticism is still sadly needed. And as this work tor
the present year will soon begin, we may very properly
assume the task of gentle criticism now.
One of the great needs of the societies in question has
been efficient and experienced officers who understand
what to do in order to get work out of a medical organ-
ization. All societies should have a practically, perma-
nent executive officer, who should generally be the secre-
tary. This officer, if supplied with a little money and a
good deal of intelligent energy, could arrange definite
programmes of scientific work, could solicit papers from
men who know how to write, and could pre-arrange dis-
cussions. For experience has as yet failed to teach our
brethren who attend State societies that the medical work
is not actually done at the annual meetings, nor is it ex-
pected to be done. This work is to be finished before
the sessions and simply reported on at the time of meet-
ing. Experience has also failed to teach society man-
agers that even debates are rarely satisfactory and useful
unless some previous thought has been specially given
to the subject in hand. All these things a good officer
could and should attend to.
The practice has been growing in some societies of
having special reports upon various branches of medi-
cine. These reports are merely summaries, taken from
medical journals, and contain no originality. They are
a form of literary work which should not be presented at
.354
THE MEDICAL RECORD.
[March 31, 1883.
imeetings of medical societies. Tiie same reports and
tetter ones are found in a dozen medical periodicals, and
tit is first-hand work wliich such large bodies, as our State
medical organizations are, should call out.
With a competent executive to arrange for real work,
a society may, witli a clear conscience, indulge in social
irelaxations. We believe iu the usefulness of this feature,
promoting, as it does, mutual acquaintance and good-
fellowship. Happily our societies are already quite be-
yond the need of criticism or advice in their provisions
ifor this part of the proceedings.
We trust thai tlie presidents of our State societies,
■who will now so soon be delivering their " inaugurals "
and "annuals," will temper their eloquence with some
practical suggestions. We have heard quite enough, for
■example, in annual addresses of the scope and benefi-
cence of "preventive medicine." We respectfully re-
■quest that this topic, which has been the mainstay of
.presidential elociuence for several years, be allowed a
'temporary repose. Let the presidents urge the adoption
•of systematic methods of work, the securing more and
(better papers, the encouragement of critical discussion.
In this way there may in lime be some good work done
■ and good volumes published. At present the majority
•of State Medical "Transactions" are worth little more
.tlian the paper on which they are printed.
THE .ABSTRACTS.
'This class of powdered drugs introduced in the new
:Pharmacopaia, claims some attention from physicians.
It is introduced, we are tukl, in order "to supply a de-
mand lor dry-powdered extracts. ' These abstracts are
just twice the strength of the crude drug, or about twice
the strength of the fluid extracts.
The chief objection to them is, according to Ephemeris,
■that they require a troublesome, expensive, and hurtful
.process to effect a little in the way of concentration, con-
■densation, and convenience.
In order to have them of uniform strength, many are
made much weaker than they might have been, and
• are consequently bulky and inconvenient.
A list of eleven drugs is given of which abstracts are
made. For the information of our readers we a|)pcnd
the list : Valerian, podophyllin, nux vomica, jalap, ignatia,
.hyoscyannis, digitalis, belladonna, aconite, senega, conii.
In an analysis and description of these drugs given by
the authority above quoted, we are told that there are
•only two of them, conium and senega, which have any
■especial advantage over the crude drug or extracts.
UTERINE DYSPEPSIA.
In an article upon this subject in the Prager Afciiicinische
Wocheuschrift, December 20, 1S82, Dr. E. H. Kisch re-
niarks upon the relationship existing in health between
the stomach and the uterus. He states that while nor-
mally the reaction of the stomach becomes neutral in
five to seven hours after a meal, during menstru.ition it
remains constantly acid. Not all affections of the female
sexual organs give rise to dyspepsia, but only those of
the uterus itself, and of these may be excluded all
superficial erosions and affections of the mucous mem-
brane, thus leaving as causes only the structural changes
of the organ, versions, flexions, subinvolution, deep fol-
licular and cancerous ulcerations, and similar conditions.
The most frequent cause of digestive disturbance he
finds to be retroflexion. The symptoms vary much
in intensity, sometimes, however, they assume a most
threatening severity. The appetite is capricious, the
tongue is but slightly coated. There is often pain in the
epigastrium, with sour eructations and heartburn. Some-
times there is vomiting after each meal, together with
constipation and flatulence.
Sympathetic disturbances are common, such as palpi-
tation of the heart, neuralgia, melancholia,, etc. The
affection is to be distinguished from gastric catarrh, ulcer
of the stomach, and simple nervous dyspepsia. This is
to be determined by attention to the symptoms peculiar
to each of these conditions, but especially, and some-
times only, by the results of treatment. \Vith the im-
provement in the affection of the uterus the dys'peptic
symptojns subside. Hence all curative efforts are to be
directed especially against the abnormal condition of
the uterus. Certain mineral waters are often of great
value, especially those containing sulphate of sodium.
The author concludes by urging the necessity of a uterine
examination in all cases of obstinate dyspepsia occurring
in females.
A ST.ATE CHEMIST.
Following the example of some European countries, it
has been recommended to the Medico-Legal Society that
the State of New York create the office of a State chem-
ist. The person holding this office is to have charge of
a laboratory suitably furnished. His duties should be to
make proper and careful analyses in all cases of poisoning,
etc., where such analyses are needed. In this way the
State and the accused would be sure of having examina-
tions made by experts who were non-partisan and com-
petent.
The idea at once arises that, under our present politi-
cal system, the officer thus appointed might very likely
be more of a " statesman" than a chemist. If we are to
have a Slate chemist also, why not a State expert in in-
sanity and other branches ? The scheme appears to have
no inherent objections, but it would be difficult to carry
it out satisfactorily.
THE ELECTION OF .NEW YORK COUNTY DELEG.\TES.
Three new delegates were elected at the meeting of the
County Medical Society, March 26th. The occasion
was taken to bring up again the question of codes. The
three delegates, elected by a vole of 94 to 71, represent
the old code element. This result was saluted as a great
victory. We trust that those who so announce it will
have the fairness to add some of the accompanying facts.
The vote was obtained by means of systematic canvas-
sing and a preliminary caucus. Printed ballots were sup-
plied ami all the machinery for securing the desired end
was put in action. The other side, which has already
polled twice the number of votes cast at the last meeting,
was taken by surprise and made little (jreparation for so
vigorous a campaign.
The lesult will have the effect of silencing those who
March 31, 1883.]
THE MEDICAL RECORD.
355
have been charging the new code and no-code party with
using political methods and of packing meetings.
So far as this election goes, the vote of the State Medi-
cal Society remains substantially unchanged, being made
by it 102 to 106.
It is a noticeable fact that out of the 2,500 physicians
in the city, and 900 in the County Society, only about 200
can be wrought up to enough interest in the code to vote
upon it.
We are glad to observe that the battle in the city here
is still in the main a good-natured one and it should be
kept so. We have plenty of mud thrown in from outside.
SPINA'S ATTACK ON KOCH.
Dr. Arnold Spina, of Vienna, one of Professor Striek-
er's assistants, has published a brochure in which he
strongly attacks some of the claims made by Koch. Dr.
E. E. Saltier [Cincinnati Lancet and Clinic) gives the
following summary of the points wliich are made :
First. — Dr. Spina denies the statements of Koch and
Ehrlich, that solutions of the aniline dyes nuist react
alkaline in order to stain the so-called bacillus tuber-
culosis, and also that acids and aqueous solutions of
vesusin do not enter the bacilli.
Second.- — He denies that bacteria, which stand in no
causal relations to tuberculosis, react in a different way
with coloring matter from the bacilli found by Koch.
Third. — He denies the statement of Koch that the
bacilli of tuberculosis occur constantly in the tuberculous
organs of man. He found that this statement was too
far reaching, and in many cases examined he never found
any bacilli. .\s regards the bacilli in sputa, jiis results
agree essentially with those of Koch.
Fourth. — He was never able to find bacilli in the tu-
bercles which stood in no connection with the open air —
the serous membranes of the body. He says " I have
examined about one hundred and fifty mesenteric and
omental tubercles, in the most various stages of their de-
velopment, according to Koch's and Ehrlich's method,
and found bacilli in not one case."
Fifth. — He also criticises the insulation experiments
made by Koch with purified bacilli, and says that the
specific character of tuberculosis has not been proved by
them. He calls attention to the history of inoculation
experiments ; the conflicting results, the negative and
positive results of inoculations with tuberculous matter
and indifferent substances, and also gives the results he
obtained by inoculations with purified bacilli.
Sixth. — He concludes by saying that the bacilli of tu-
berculosis are the result, not the cause of the disease.
Dr. Spina's paper is critical and aggressive rather than
judicial. His view that the infection of animals by tu-
bercle has not yet been proved ; in other words, that
tuberculosis is not an infectious disease, is contrary to the
general tendency of pathological opinion at present.
A Swiss Hospital in New York. — It is proposed to
erect a Swiss Hospital and Home in this city. The
enterprise is under the management of the Swiss Benevo-
lent Society, which already has five thousand dollars for
the object. The Swiss in New York number between
twelve and fiifteen thousand.
mciUB of tlxc "QcEecTi.
A Law to Legalize Dissection in Colorado has re-
cently passed the Legislature.
An Epidemic of Small-pox in New Orleans. —
Small-pox continues to increase in New Orleans. Dur-
ing the week ending March 24th the number of deaths
from the disease was sixty-five, out of a total of one hun-
dred and seventy-nine deaths.
New Delegates of Medical Societv of the County
of New York.- — At the stated meeting held the 26th
inst., Drs. Charles Hitchcock, Charles A. Leale, and
Charles S. Ward were elected delegates to fill the vacan-
cies caused by the resignation of Drs. Laurence John-
son, David Webster, and Frank P. Foster, who were
elected permanent members at the last meeting of the
Medical Society of the State. The newly elected mem-
bers are in favor of retaining the Code of the .\nierican
Medical Association.
A Generous Act. — The Louisville Medical News
publishes a list of the New York physicians who were
active in sustaining the present code of ethics, and now
impliedly recommends that the physicians of the South
and West send no patients to these gentlemen, on the
ground that they are dishonest, mercenary, and desirous
of affiliating with and encouraging quackery.
An Annual Alumni Prize of one hundred dollars
has been offered by the Alumni Association of the Col-
lege of Physicians and Surgeons of Baltimore.
A Coroner's Verdict upon a Doctor and Apothe-
cary.— The coroner's jury at Titusville, Pa., recently
found that Leander Smith, of that place, came to his
death by a dose of cyanide of potassium, which had been
obtained for him by a physician, at a drug store tempo-
rarily in charge of an inexperienced clerk. They found
the doctor guilty of criminal ignorance in ordering so
poisonous a drug and directing its use in the manner he
did, and they found the proprietors of the drug store
culpably ignorant and guilty of keeping and selling drugs
the nature of which they know nothing about, and guilty
of employing an inexperienced druggist.
No School of Phar.macy for Women has been es-
tablished at Louisville, Ky., as has been very generally
reported.
Testimonial to Professor Erichsen. — A bust of
Professor Erichsen and a sum of money were presented
to him a few weeks ago by a number of his pupils and
admirers. The bust is deposited in the University Col-
lege. Mr. Erichsen will use the money to found a prize
for skill in operative surgery.
The State Pharmaceutical Associations of the
country meet this year as follows (Pharmaceutical Record):
April 2d, Louisiana, at New Orleans; May ist, Iowa, at
Davenport; May 8th, Alabama, at Selma ; May isth,
Virginia, at Norfolk ; May i6th, Massachusetts, at
Springfield; May i6th. New Jersey, at Orange; May
i6th, Ohio, at Cleveland ; May i6th, Kentucky, at Emi-
nence ; June i2th. New York, at Ithaca; June 12th,
Pennsylvania, at Harrisbuig.
356
THE MEDICAL RECORD.
[March 31, 1883.
Statue to Pinel. — Subscriptions are being made in
Paris to erect a statue to Pinel. The sum of five tiiou-
sand dollars has already been raised.
The New York Skin and Cancer Hospital. — The
Medical Herald^ of Louisville, Ky., says that voluntary
contributions for the establishuient of this hospital " are
being solicited openly all over the country by a printed
circular.'' The promoters are criticised for thus going
abroad to beg.
Sanitary Inspector of Schools. — Dr. ^V. E. Grif-
fiths has been appointed by Health Commissioner Ray-
mond, of Brooklyn, Sanitary Inspector of Schools.
A New Medical Poet. — Dr. S. Weir Mitchell has re-
cently had published a volume of poems entitled, "The
Hill of the Stones, and other Poems." The work is highly
spoken of. We welcome another medical man into the
ranks of poesy ; Esculapius was the son of Apollo.
Proposed State Examinations in Great Britain. —
There are in the United Kingdom nineteen examinmg
bodies, no two of which agree e.xactly in the standard of
their examinations. Some of them are very severe — nota-
bly those of the Universities of London and Cambridge ;
some are quite the reverse. Nevertheless, all boards now
require four years study, and examine in medicine, sur-
gery, and in midwifery before granting a diploma. The
Enghsh College of Surgeons has recently extended its
examinations, and even the Society of Apothecaries now
gives some surgery ni their final examination. All this,
we learn, is to be changed, and a state examination of
uniform standard instituted in each of the three divisions
of the United Kingdom.
The New Hospital for Small-pox on North Broth-
er's Island in this city is nearly completed. The old
Riverside Hospital on Blackwell's Island will be used
probably for other contagious diseases.
The New York Infant Asvlu.m. — A medical board
has recently been appointed for this institution, consist-
.ing of the following gentlemen : For the Sixty-first Street
branch, Drs. J. Lewis Smith, George B. Fowler, Diseases
of Children ; Drs. C. L. Dana, Graeme M. Hammond,
Mental and Nervous Diseases ; Drs. Paul F. Munde,
William M. Polk, J. Clarke Thomas, Obstetrics ; Dr. O.
D. Pomeroy, Ophthalmic and Aural Diseases; Dr.
George M. Lefterts, Diseases of the Throat. For the
Mount Vernon branch, Drs. George S. Conant, J. H.
Ripley, Diseases 0/ Children ; Drs. W. R. Biidsall, W.
J. Morton, Mental and Nervous Diseases ; Dr. William
F. Mittendorf, Ophthalmic and Aural Diseases ; Dr. T.
H. Bosworth, Diseases of the Throat.
For both branches : Dr. H. G. Piftard, Dermatologist ;
Dr. L. H. Sayre, Orthopadist ; Dr. Cyrus Kdson, Sur-
geon ; Dr. A. N. Bell, .Sanitarian ; Drs. T. E. Satter-
thwaite, and William H. Welch, Curators and Patho-
logists.
Rejected Medical Colleges. — The following medi-
cal colleges are not recognized by the Illinois Board of
Health : American Eclectic Medical College, Cincin-
nati, Ohio ; American Health College, Cincinnati, Ohio ;
American University, Philadelphia, Pa. ; College of
Physicians and Surgeons, Buffalo, N. Y. ; College of
Physicians and Surgeons, Joplin, Mo. ; Edinburgh Uni-
versity, Chicago, St. Louis, and elsewhere ; Hygeo-
Therapeutic College, Bergen Heights, N. J. ; Eclectic
Medical College of Pennsylvania (late issues) ; Joplin
Medical College, Joplin, Mo. ; Livingston University,
Haddonfield, N. J. ; New England University of Arts
and Sciences, Boston, Mass., and Manchester, N. H. ;
Northwestern Medical College, St. Joseph, Mo. ; Penn
Medical University, Philadelphia, Pa. ; Philadelphia
University of Medicine and Surgery, Philadelphia, Pa. ;
Physio-Eclectic Medical College, Cincinnati, Ohio ;
Physio-Medical College, Cincinnati, Ohio (late issues) ;
St. Louis Eclectic Medical College, St. Louis, Mo. ;
St. Louis Homoeopathic Medical College, St. Louis,
Mo. The list embraces eighteen names, and is short
enough.
The Duval Prize of the Paris Society of Surgery has
been awarded to Dr. Desnos for an essay on " Litholrity
in Prolonged Sittings."
The Fothergili. Gold Medal for 18S3 has been
presented to Mr. Norman Perritt, L.R.C.P.,for an essay
on " The Operative Treatment of Intrathoracic Effu-
sion."
The New York College of Pharmacy held its
annual banquet at Delmonico's March 27th. Dr. D. H.
J. Menninger presided. Speeches were made by Rev. J.
P. Newman, Hon. R. P. Flower, Dr. Walter De F.
Day, Mr. D. C. Robbins, Professor Ewen Mclntyre,
and others. The ices were served in white pastry skulls.
The Medical Association of Georgia meets at
Athens on the third Wednesday in April.
An .\bortionist Arrested. — One of the many creat-
ures in this city who unblushingly traffic in fcetal life
was recently arrested and is likely to be punished. The
cases in which sufficient evidence to convict is obtained,
like the present, are unfortunately rare.
Free Lectures on Materia Medica. — Dr. D. W.
Prentiss is giving a course of free lectures on Materia
Medica at the National Museum, Washington, D. C.
An Anti-Vivisection Society is to be organized in
Philadelphia.
Typhoid Fever from Milk. — In a group of fifteen
typhoid fever cases recently occurring in the northwestern
part of the city, it has been found that all the patients
used the milk from one herd of cows, one of which suffered
from a herpetic eruption. This cow is watched and the
use of its milk is prohibited. The sanitary condition of
the houses inhabited by the persons who contracted the
disease is excellent.
Medical Hospitality. — An entertainment fund has
recently been endowed in the Philadelphia College of
Physicians by Dr. S. Weir Mitchell. The income is to
be used, under the direction of a standing committee, to
defray the expenses of occasional receptions, at which
refreshments suited to the dignified character of the So-
ciety are to be provided. It is proposed to issue invita-
tions not only to members of the College and other
physicians, but also to laymen who may be identified
with the intellectual welfare of the city. In this city the
New York Academy of Medicine forjiierly dispensed
doughnuts, coffee, and sandwiches after the scientific
labors were over. The practice has now, we believe,
been given up.
March 31, 1883.J
THE MEDICAL RECORD.
)57
^cpo\*ts jof J'ocictics.
NEW YORK PATHOLOGICAL SOCIETY.
Stated Meeting, February 28, 1883.
George F. Shradv, M.D., President, in the Chair.
(Continued from p. 332.)
' SPINA-BIFIDA COMPLICVIED WITH HYDROCEPHALUS.
Dr. Putnam-Jacobi presented a specimen accom-
panied by the following history : The child was first
seen at the dispensary at Mt. Sinai Hospital about a
month after its birth, and then presented a tumor which
occupied the entire region of the lumbar vertebrse, the
posterior arches of whicli were evidently absent. The
tumor was not covered by skin, but only by a semi-
transparent membrane which was ulcerated at the time
that she first saw the patient, and during the entire year
which followed it continued in an ulcerated condition
despite all the care given to it. The tumor was entirely
incompressible, but pressure gave rise to no pain, and to
no perceptible phenomena. The child was completely
paralyzed in its lower extremities, and also had double
talipes calcaneus. It exhibited no cerebral symptoms.
The treatment was entirely expectant, consisting chiefly
in etnoliient dressings and protection. At the time the
child was seven months old its head began to enlarge,
and the eyes showed the characteristic appearances of
hydrocephalus. They were not protruded at all, but it
was noticeable that rolling down of the eyeballs occurred
simultaneously with enlargement of the head, thus show-
ing that [Mominence of the eyeballs cannot be due to
mechanical protrusion of the eyeballs from fluid in the
orbit, but rather to paralysis of the superior rectus
muscle, as suggested by Henoch. Emaciation began fiom
this date. The child remained under observation five or
six months, had occasional attacks of apparently cere-
bral hyperemia, apparently suffered from headache, and
finally died comatose in one of these attacks. The
child had no convulsions. It seemed quite probable, on
account of the paraplegia and the double talipes, that
there might exist communication between the sac of the
spina-bifida and the cerebral ventricles, accompanied
with dilatation of the central canal of the spinal cord. At
the autopsy, however, there was no trace of any such dila-
tation. A considerable quantity of fluid was found in
the arachnoid cavity of the cord which communicated
below with the cavity of the sac, and above, through the
transverse fissure, with the subarachnoid cavity of the
brain, but there was no dilatation of the central canal,
and the sac did not communicate with it or with the cord
at all. The sac lav against the posterior surface of the
bodies of the lumbar vertebra;, from which the posterior
arches were absent. The termination of the cauda
equina was spread out on the lamina of the sac, which
divided its cavity into several loculi. The brain exhib-
ited an extensive dilatation of the lateral ventricles, the
latter being filled with serum. There was no roughen-
ing of the ependyma, such as exists when ventricular ef-
fusion is due to leptomeningitis. The eft'usion, how-
ever, within the ventricle was not sufficient to compress
the cerebral convolutions from within. There was no
softening of the brain. Death seemed to have been due
to gradual pressure within the ventricle without sec-
ondary encephalitis or softening. The intelligence of
the child was perfectly preserved as far as could be ascer-
tained, but at the time of its death the body was no
larger than that of a child five or six months old.
Dr. Heineman referred to a case of spina-bifida in
which the sac was nearly as large as an orange. In that
instance there was double equino-varus with decided
spastic contracture. The tumor was situated over the
legion of the cauda equina.
Dr. Wveth referred to a case which came under his
observation at the Policlinic, in which there was a
very great variety of deformities — cleft palate, hare-lip,
and with the others a double talipes varus on one side
and valgus on the other. His belief was that in these
cases the deformities were due to lack of development.
Dr. Putnam-Jacobi remarked that the association of
club foot with spina-bifida had been often noted, and it
was remarkable that it was due in some instances to
compression of the spinal cord.
Dr. L. Emmett Hoi.t presented a specimen of
glio-sarcoma of the cerebellum (see page 342).
Dr. Wveth asked if any examination was made of the
semicircular canals or the petrous portion of the tem-
poral bone.
Dr. Holt replied that there was not.
Dr. Wveth thought it important that such an exami-
nation should have been made, as the same symptoms
present in Dr. Holfs case might be produced by the af-
fection known as Meniere's disease, which had been es-
tablished to be due to disease of the semicircular canals,
and that interference with the function of the semicircu-
lar canals is accompanied by lack of co-ordination.
Dr. Holt remarked that' Nothnagel had made a very
careful resiane o{ the literature of tumors of the cerebel-
lum, and had reached the following conclusions :
First. — That they were unable to make any diagnosis
positive of a lesion which affects the lateral lobes of the
cerebellum.
Second. — That the main symptom is ataxia, and this is
only present when there is destructive lesion affecting
the vermiform process ; that the ataxia symptomatic of
cerebellar lesion is not like that of locomotor ataxia, but
resembles that which exists in alcoholic poisoning.
In his specimen the lesion was limited almost entirely
to the vermiform process and to the anterior lobes ; the
lateral lobes were healthy.
Dr. Putnam-Jacobi remarked that if a tumor press
upon the pons, convulsions might occur and complicate
the case. She had seen one case of this kind which was
rather an interesting combination of lesion and diagnosis.
In a large number of cases of tumor of the cerebellum
mentioned by Nothnagel, amaurosis was present.
Dr. Holt remarked that another symptom mentioned
by Nothnagel is vertigo, but the presence of this symp-
tom it was difficult to determine in so young a child as
was the patient in the case reported.
Dr. Birdsall remarked that the peculiar description
of the ataxia given by Dr. Holt was typical of cerebellar
disease, and that the case was extremely interesting with
reference to location of the tumor in that region. With
regard to disease of the semicircular canals producing
certain symptoms, he believed it to be well established
that the symptoms of Meniere's disease might depend
upon disease of any part of the auditory tract, or disease
from that ])ortion back to the centres of the medulla ob-
longata, and possibly certain parts of the cerebellum from
the same cause. The view which at one time held sway
that only lesions of the labyrinth caused Meniere's dis-
ease he believed had been so modified that it was now
generally admitted that disease in any part of the audi-
tory tract might give rise to the symptoms present in
that aft'ection.
Dr. W. T. Belfield was made member by invitation,
and demonstrated to the society
THE bacillus of leprosy and the practical use of
abbe's illuminator.
The two points which he regarded as of sjiecial im-
portance in order to demonstrate the presence of bacteria
were, first, the use of aniline staining, and, second, the use
of Abbe's illuminating apparatus. The peculiarity of the
bacteria was that they retained aniline colors under con-
ditions which deprived every other substance of the
color. The effect of the illuminator was to obliterate re-
fraction outlines, leaving the bacilli in the luminous field
o:5
58
THE MEDICAL RECORD.
[March 31, iSS-
where, by virtue of their retained color, they are dis-
tinctly and easily recognizable.
Dr. Wendt was pleased to hear Ur. Belfield admit
that in the present state of our knowledge concerning
most of the bacteria, we could speak only of their associa-
tion or coexistence with certain pathological conditions.
Perhaps a relation of cause and effect would sooner or
later become established. But at present evidence of
this kind was still forthcoming. For this reason he
thought that when Dr. Kelfield had cited trichinosis as a
similar exam|)le, he had not done justice to the fuller
knowledge which we possessed of that subject. Dr.
Wendt did not consider trichinosis analogous to the so-
called bacterial diseases. For the natural history of the
trichina spiralis was fully known, and its causal relation-
ship to attacks of trichinosis did not admit of the slight-
est doubt. Not so with the bacteria, hoH-e\-er, as "Dr.
Belfield himself had freely admitted.
Dr. Belfield dissented entirely from the statement
made by Dr. Wendt that a relation of cause and effect
had been demonstrated between trichina and the clinical
history of the disease known by the- name of trichinosis,
as we did not know much more with reference to the
natural history of the parasite than was at the present
time known concerning the natural history of the various
forms of bacteria. It was known and established that a
parasite occurred in the intestines and in various parts of
the body, but where it came from originally we were in
just the same doubt as in regard to the different varieties
ot bacillus, and that there was any demonstrative relation
of cause and effect he was not willing to admit.
After some further discussion the Society went into
executive session.
NEW YORK ACADEMY OF MEDICINE.
SECTION I-\' PRACTICE OF MEDICINE.
Stated Meeting, March 20, 1883.
Edward G. Janewav, M. D., Chairman.
Dr. V. P. Gibney reported
cases of polio-mvelitis anterior. ,
Case I. — Affecting left leg and foot when fourteen
months of age ; right similarly, though not symmetrically
affected five months later.
Louis S , aged sixteen months, was seen first on
November i8, 1882, with an infantile paralysis of left
leg. It was reported to be of two months' standing, but
no further information concerning the attack was re-
corded.
There was no faradic response in the muscles of the
leg, nor was there any to galvanism except in the ex-
tensor long, digitorum, where Ca. C. C. > An. C. C.
(both weak).
An apparatus was applied, and he was temiiorarily
discharged to report again when he had recovered from
pertussis.
January 27, 1883. — He reports to-day for the tirst time
since last note. No response to either current in the
affected limb.
February i6th. — For a week or more a response to
galvanic current has been obtained in both anterior and
posterior tibial groups, A. C. C. > C. C. C, but it re-
quires a fairly strong current. For the electrical notes
recorded every few days, I am indebted to Dr. S. iM.
Taylor, of our hospital staff.
February 23d. — On Monday last ( 19th inst.), the patient
refused to stand on right [affected] limb. He fell fre-
quently, the limb having ajiparently lost all strength.
This was mentioned by the mother on her previous vis-
its, but no notice was taken of it. There was uniiucs-
tionable degenerative reaction in anterior tibial group,
where there was apparent loss of power on the 21st inst.
To-day the degenerative reaction — well marked — was
obtained in all muscles below gluteal region, except pos-
terior tibial group.
February 28th. — Measurements. Right thigh, gf — 8f
inches; left, 9 — 74-; right calf, 6^-, left, 5^^ inches.
March 5th. — .-Ml the muscles of right limb react to a
moderate faradic current, except anterior tibial group ;
also quadriceps extensor and the peronei are question-
able. Degenerative reaction in anterior tibial (muscle).
Response in quadriceps either normal or C. C. C.^A.
C. C. The posterior tibial and posterior thigh group
do not respond to the current which gives a response
in above mentioned muscles.
March 7th. — Mother reports that yesterday the child
would frequently cry out while at play with pain in the
limbs. He often complained of the left as the right. He
moves the right limb very freely under the stimulus of the
current to-day. Can ilex the foot and use the toes, using
the anterior tibial group where there remains a A. C. C.
> C. C. C. No response from nerve. Response to
galvanic //// in other muscles, all of which react normally
to faradism. Electrical treatment suspended for a week.
March 14th. — Is beginning to use the limb a little in
standing. No electrical examination to-day.
March 20th. — Examined by Dr. Birdsall to-day with
the following result : Right limb. Faradism. Peroneal
(nerve) weakened. Primary reaction in anterior tibial
group. .Muscles. Slight primary in anterior and posterior
tibial groups. Left limb. Peroneal. No reaction in
either muscles or nerves.
A moderately strong galvanic current, over the pero-
neal nerve, right side, gives the normal reaction in the
anterior tibial group.
Stimulation of the anterior and posterior tibial groups
of muscles, right side, gives the normal response.
Typical degeneration reaction in the posterior group
of muscles, and no response whatever in anterior tibial
group to a strong current.
Case II. — Thomas G , aged five. Came to the
Outdoor Department of the Hospital for Ruptured and
Crippled on March 16, 1S83, for the treatment of paraly-
tic talipes.
The mother gave a history of an illness of three weeks
dating from Thanksgiving Day of last year. He had
considerable fever, and very marked hyperesthesia of
both limbs during this time. The pain in the limbs was
the most prominent symptom. The loss of power was
noticed in the beginning of his illness.
In a few weeks he began to use the limbs and was
soon on his feet. The right limb has entirely recovered.
There is one inch atrophy of left calf, one-half inch of
instep. Marked coldness of surface and anassthesia.
There is a degenerative reaction in anterior and posterior
tibial groups to the galvanic current. Peroneal group
shows normal formula but exalted contractility. Peroneal
nerve gives resiionse also. No faradic response in any
of the muscles of left leg. Thigh muscles and muscles
of other limb respond to faradic current.
The question in the first case was whether there was
really a recurrence of the infantile paralysis. If we rely
upon hypeiKsfhesia alone it will sometimes mislead, and
therefore Dr. Gibney believed that the only really reliable
way to test the electrical reaction was to put the patient
under the influence of an anesthetic and proceed with
exceeding care. It was a question, however, as to
whether hyperesthesia existed in the paralytic limbs
during the first stage, or whether there was general myeli-
tis at the time of the invasion sufficient to give rise to
the various sensory disturbances. If it was allowed that
hyi)enesthesia did so occur, the view would be well main-
tained in the case presented if it was really one of polio-
myelitis on the right side.
Dr. Putzei. remarked, concerning hyperesthesia, that
he had one hospital case under observation in w'hich the
disease began suddenly by severe pain in the upper part
of the sacrum. On the next day severe pain extended!
along the course of the sciatic nerve, and continued three
March 31,
1SS3.]
THE MEDICAL RECORD.
359
(lays, and the patient also had a feeling as if pins and
needles were in the liglit foot. At the end of that time
the right limb was entirely paralyzed, and wiien he came
under observation there was great atrophy of the whole
limb, with absence of all electrical reaction except in the
sartoriiis and one other muscle. The limb was also cold.
Autojjsy showed distinct polio-myelitis anterior in the
right horn of the lumbar enlargement. He thought Dr.
Ciibney's case was especially interesting on account of
the relapse. He had never seen an instance of this
kind, arid had not seen in literature any reference to its
occurrence. He thought that the occurrence of the de-
generation reaction would e.\clude the diagnosis of tem-
])orarv paralysis merely, and make it really one of polio-
myelitis.
'i'lie Chairman saw no reason why we should be dis-
suaded from the opinion that there was a recurrence of
the disease simply because it was the inverse of what
usually takes place. At the beginning of all cases of in-
fantile paralysis we usually have a much greater area of
manifestation than remains permanently paralyzed. That
is, the child at the time of the invasion may have all the
limbs paralyzed or paretic, and afterward the paralysis
disappear entirely except from a single limb or portion
of the limb. In Dr. Gilpney's case there was the same
order of events, and some time after distinct paralysis
appeared, which did not spread ; there was a later oc-
currence of paralysis affecting the oiiposite leg.
With regard to hyperesthesia, any one who has exam-
ined many cases nuist have been struck with the fact
that the typical outline given in the books does not cor-
respond altogether with the facts as they exist in actual
cases, for we find quite a number of children who bear
the faradic current out of all proportion, which would
imply a certain degree of annesthesia. Of course, this
might be explained to a certain extent by lack of sensi-
bility in the nerves, but beyond that there is a certain
degree of anaesthesia manifest to the faradic current.
He had seen patients, adults, who had complamed of
numbness, tingling, a slight grade of anaesthesia, and
after a time these cases had run a typical course of
anterior polio-myelitis. It is sometimes very difficult to
determine whether the case is one which will develop
into the more marked diffuse myelitis or remain limited
to myelitis of the anterior horn.
Dr. Gibnev asked the Chairman if degeneration reac-
tion was apt to occur within the first week after the in-
vasion.
The Chairman replied that it was occasionally seen
at the end of six days.
DIFFERENTIAL DIAGNOSIS BETWEEN DELIRIUM AND IN-
SANITY.
The Chairman reported certain cases which illustrated
the difficulty and the importance of deciding whether a
patient was suffering from delirium or insanity. He had
seen a number of such cases in the last year. Of course,
delirium, if continued and associated with hallucinations,
constitutes one grade of insanity, but if it is possible to
do so we should all prefer to call any given case one of
delirium rather than one of insanity, l)oth for the sake of
the friends and for the sake of the patient. He had
been struck by seeing cases which illustrated how closely
these two conditions were allied, and how well some
cases terminated in which there was delirium accom-
panied with delusions ; for example, delirium in pneu-
monia, bronchitis, fever, or bronchial pneumonia, had
continued for six weeks, and been the leading symptom.
(To be continued.
The Midland Medical Miscellany and Provin-
cial Medical Journal is an English monthly of a new
and somewhat novel character. It aims to represent
provincial medical work and seems very successful in
doing so.
MEDICAL SOCIETY OF THE COUNTY OF NEW
YORK.
Stated Meeting, March 26, 1883.
David Webster, M.D., President, in the Chair.
RESOLUTIONS ON THE DEATH OF DR. GEORGE M. BEARDv
Dr. a. D. Rockwell offered the following resolutions :
Resolved, That in the death of Dr. George M. Beard
this Society and the profession at large have lost one of
their most brilliant, active, and earnest members. As
an investigator he was original and conscientious. As a
friend he was generous and steadfast. Exposed by his
restless activity to many peculiar attacks, he ever mani-
fested the utmost charity and good humor. Of his worst
enemies, he seldom spoke a harsh, and never a vindictive
word.
Resolved, That to his child, orphaned in one short
week, by the added affliction of a mother's death, to his
mother, brothers, and sister, we tender our heartfelt sym-
l)athy.
Resolved, That these resolutions be published in the
medical journals of this city.
In presenting these resolutions, Mr. President, I
would simply add, that having been associated for many-
years with Dr. Beard in a peculiarly close intimacy, it
was my fortune to know him perhaps better than most
others. His self poise was remarkable. As a foil, so to
speak, to the many attacks that followed his original in-
vestigations and his ]iositive and independent methods of
expression, he seemed almost to live and move and have
his being in humor. His powers were of the most versa-
tile character. His readiness and originality as a scien-
tific writer are well known, but it is not so well under-
stood that he had a genius for an entirely different sort
of literary work. While a very young man, serving dur-
ing the late war in the Gulf Squadron, and merely tO'
give vent to his ever restless mind, he penned a work of
fiction, which gave evidence of no mean talent in that
direction, and since his death an autobiographical sketch
has come to light, which, for its quaint humor, its keen
estimate of character, and its philoso|)hic insight is un-
surpassed. I could say much in regard to this individu-
ality, through which ran so rich a vein, and which in many
respects was as unique and remarkable as any I have
ever known or read of; but I forbear and content myself
with the brief but just tribute embodied in the resolutions.
Dr. D. B. St. John Roosa — Mr. President : Before
these resolutions are put I would like to say a few words
in memory of my dejjarted friend. It was my privilege
to know Dr. Beard at the time when he and I entered
the profession, and it continued to be my privilege to know
him up to the time of his death. I think all of us must
have been, during the last winter, particularly admonished
of the frailty of the existence of even the strongest. When
we recall the names of Draper, and White, and De Luna,
and Beard, all men in the prime of life who have passed
away, I think we must say that " the battle is not to the
swift nor the victory to the strong." Dr. Beard possessed
qualities which a physical infirmity did not allow of com-
plete illustration. That physical infirmity in one instance
at least had an untoward eft'ect in prejudicing a large
number of our transatlantic brethren against him. In an
announcement that he made a certain experiment and
laid his paper before the New York Academy of Medi-
cine, a claim which he never made, he was not only mis-
represented but was unable, in consequence of that phy-
sical infirmity, deafness, to appreciate the statement, and
therefore did not have the opportunity to show that he
had no intention of claiming any such thing. Thar
statement was made one of the groundworks of a charge
against him, and those of us who knew him best, what-
ever we may have thought of his scientific opinions, know
that it was utterly mistaken. So in many other instances-
Dr. Beard was unable to enter fully into debates which
his views originated, and therefore he was very much.
;6o
THE MEDICAL RECORD.
[March 31, 1883.
handicapped. I simply allude to this in doing justice to
his noble character, as we all know that in no instance had
he ever departed from that which he believed to be en-
tirely and completely true. He was a man, as has been
said by the gentleman with whom he was so intimately
associated for years, extremely tolerant of the opinions
of others. He was a man who never retaliated upon
those who seemed to make personal those matters which
he regarded as merely differences of opinion on scientific
or other subjects. He was a man far ahead of his age
in many respects, and I believe that future generations
will do more justice to some of Dr. Beard's statements
than was done them during his lifetime. I have more
charity, perhaps, than some with reference to his opinions
regarding the mental condition of the man who assas-
sinated the President. I believe that his views regard-
ing the mental power of man after the age of forty years
will be more and more accepted, and also that his views
concerning responsibility at certain periods in life will
be more and more respected. I think his idea that the
golden period in man's life, however much we may smile
upon it now, is the middle period of life, will finally
be accepted in all quarters of the world. I had the
pleasure of being associated with him in making e.\ami-
nations with regard to the lesions which give rise to deaf
mutism. This was early in his career, and these obser-
vations, and others I believe have taken a place in the
literature of a certain department of medicine.
Dr. Roosa then spoke of his great work on electricity,
written in association with Dr. Rockwell, a recognized
standard te.xt-book on that subject in all countries. He
also referred to the remarkable fact that at one time Dr.
Beard wished to read Tobold's writings in the original
and to accomplish this he began the study of German,
and so perfected his acquaintance with the language that
in si.x weeks he was not only able to read the book but
to present an acceptable translation to the medical pro-
fession. These were mentioned as illustrations of the
versatility of his talent.
I am, Mr. President, in conclusion, very much re-
minded of the remark with which we are all familiar,
made by Edmund Burke on the hustings at Bristol, de-
ploring the loss of an antagonist who had been engaged
in the same contest. " The worthy gentleman who has
been snatched from us at the moment of the election and
in the middle of the contest, while his desires were as
warm and his hopes as eager as ours, has feelingly told
us of the shadows we are and of the shadows we pursue."
I cannot accept the notion that we pursue shadows,
fully as I admit that we are shadows ourselves passing
along the galleries of time. . I conceive with you, Mr.
President, and others, that we are not pursuing shadows
but realities in investigations for truth, and it is a hope
we fondly cherish that Dr. Beard, to use the language of
his own death-bed, " higher, higher," is pursuing the in-
vestigation, of what is never a shadow, truth in another
sphere.
Dr. \V. M. Carpenter — Mr. President : It was about
the year 1873 that I made Dr. Beard's acquaintance,
and that acquaintance, as it gradually increased, matured
and ripened into a friendship which was both true and
faithful. 1 had not heard of his sickness, and when the
startling announcement of his death fell upon my ears 1
felt that 1 had lost a brother, and it is to the memory of
that departed brother that I wish this evening to pay my
humble tribute of respect. It has justly been said, Mr.
President, that Dr. Beard possessed an active mind. In-
deed, it may have been said of him that he was an enthu-
siast, if in the interpretation of that word we mean de-
voted, to the study of whatever subject he had under
consideration. But I believe there was something more
in his work than this. I think I can see, as I trace it
from year to year, how he gradually stepped out of routine
courses, and finally we find him engaging with those prob-
lems which gather along the border line between the seen
and the unseen, between the knovvable and the unknowa-
ble. It was in that field that his faculties found their
greatest freedom. But in whatever department he
worked, he wrought well, for he made a worthy fame,
carved an enduring name and won a niche in the scien-
tific temple of the last half of the nineteenth century.
He indeed was enthusiastic, but he was not precipitate.
He was bold in the e.'cpression of his opinions, but he
was not bigoted. It has been said that he was erratic
and visionary. The same, however, was said of men
who lived before our generation, and who to-day are
accredited with having possessed the brightest intellects
of their times. In this great human caravan, keeping
pace to the march of time, there are three classes of
workers : first, and by far the largest in number, those
who merely plod, and follow in routine courses or walk
in circles ; second, those who strive to make these routine
courses and these circles easier and straighter by chip-
ping oft" a little here and filling a little there, lessening
the grade at this point and increasing the momentum at
that ; and, third, embracing only a very small fraction of
this great multitude, those who are the advance work-
ers, who do what is sometimes called " original work,"
who live bej'ond their time. It was in this field that Dr.
Beard was laboring when the summons came. There-
fore it was that any man who had the pleasure of his con-
versation could always carry away something that fur-
nished food for thought. He worked because he loved
to work ; not as a slave, but as a child filled with and
prompted by filial devotion, and in the very hour of his
dissolution he expressed the hope that some one would
take up his 7Uork at the point he left it and carry it for-
ward, and he whispered the wish that he might be per-
mitted, as a contribution to his work, to place upon record
the thoughts of a dying man.
But his labor has ceased. In the prime of life, in the
midst of greatest activity, in the mid-day of gathering
usefulness his sun went down. But do we not see on
the blue vault a golden radiance which marks the place
where it sank beneath the horizon ?
The resolutions were unanimously adopted.
The Society then adjourned.
Inosuria. — Dr. Cochot concludes a thesis on this sub-
ject as follows : I. Inosite (muscle sugar) is fiever met
with in normal urine. 2. Urine containing inosite may
also contain albumen or ordinary glucose. In some
cases, however, the glucose disappears entirely, and is
replaced for a time by inosite, or vice versa. 3. Thus
inosuria is not a separate disease, but is a symptom which
may be met with in Bright's disease or diabetes. 4.
Whenever we find inosite in the urine we have to do
with diabetes or albuminuria. The patient is exposed to
the same dangers, and the effects of injuries are equally
grave. 5. Since inosuria may supervene upon glycosuria
it adds another difficulty to the diagnosis of the latter.
For inosite does not turn the plane of polarization,
neither does it give the characteristic chemical reactions
of glucose. 6. Inosuria is to be suspected when the
urine, boiled with Fehling's solution, throws down a floc-
culent precipitate of a greenish color. But certainty is
only obtained by a thorough qualitative analysis. 7. It
is of great imiiortance to remember that a patient with
inosuria is really the subject of Bright's disease or dia-
betes, in view of the gravity of operations or of wounds
in general in such patients. — Journal de Mcdecine de
Paris, January 13, 18S3.
CoFFKE IN TvpiioiD Fever. — The value of coflfee as
a heart and brain stimulant in adynamic conditions is
perhaps not fully recognized. Recently Dr. CUiillassee,
of the French Navy, has given coffee in the early stages
of typhoid fever with marked success. Three teaspoon-
fuls were given adults every two hours, alternating with
one or two teaspoonfuls of claret or Burgundy wine. A
beneficial result was immediately apparent.
March 31, 1883.]
THE MEDICAL RECORD.
361
®Mtnttvvi.
WII-LIAM HOLMK VAN ]5URKN, M.I)., T.L.D.,
NEW YORK.
Profes.sor \Vm. H. Van Buren, M.D., LL.D. (Y.alen),
died in this city on the morning of March 25, 1883, within
twelve days of the completion of his si.xty-fourth year.
In his death a pillar of the profession has fallen, and a
career has terminated the memory of which will long
remain to serve as an example of honest dignity in
professional life, an example which, in the commercial
hurry of the present day, it would be well for the young
physician to recognize and to emulate.
Born April 5, 1819, of a line of medical ancestors, in
a family of refinement antl education but devoid of wealth,
Dr. Van Buren reached a [losition in the i)rofession of
the highest distinction, and dies reasonably mellow in
years and ripe with honors.
His flexibility of person, his graciousness of manner,
his dignified dexterity as an operator, his wide command
of language as a lecturer, his elegance of diction as an
author, the magic of his presence in the sick-room, will
be long and pleasantly remembered by those who came
into contact with him ; while the keenness of his scorn
and the pungency of his satire were only fully understood
by those who ventured, in the heat of controversy, to im-
pugn his motives or to attack the honest purity of his
princiijles.
He entered Yale with the class of '38, but did not grad-
uate ; yet the college, in recognition of his literary attain-
ments and distinguished position, decorated him with the
honorary degree A.M. in 1866, and later, in 1878, con-
ferred u]5on him the highest title in her gift, LL.D.
The University of Pennsylvania, in 1840, graduated
him in medicine after his return from a tour in the Paris
hospitals. He then served in the army until 1845, in
which year he came to New York to assist the late Val-
entine Mott in the work of his clinique in the medical
department of the University of New York.
During thirty-eight years he labored in the rich surgi-
cal fields furnished by this great metropolis, reaching early
and distinguished honors which accumulated upon him as
he advanced in life.
Among these may be mentioned the professorship of
anatomy in the University, and of the science and art of
surgery as well as of genito-urinary surgery and syphilis
in the liellevue Hospital Medical College. He did
creditable work as an active surgeon to the Bellevue, the
New York, and St. Vincent's Hospitals, and has been con-
sulting surgeon to St. Vincent's, New York, Bellevue,
Charity, the State Woman's, and the Presbyterian Hos-
pitals. He was for many years active in medical society
work, being vice-president of the New York Academy of
Medicine and President of the Pathological Society. He
figured also largely as a prominent name upon the con-
sulting boards of many of the dispensaries and other
medical institutions of the city. He was a corresponding
member of the Society of Surgery of Paris, and his name
was nearly as well known abroad as at home.
His first literary efibrts were translations of French
works, but soon able essays upon matters of personal
exi^erience appeared from his pen in the various medical
magazines — essays marked by the honesty of the obser-
vations reported as well as their graceful elegance of ex-
pression. His " Contributions to Practical Surgery " ap-
peared in 1865, his "Lectures on Diseases of the
Rectum" in 1870, and again, in much better form, as a
second edition in 1882. In 1874 he appeared as joint
author with his junior partner in a text-book on " Genito-
urinary Surgery," and finally, his latest and perhaps
ablest jjroduction on "Inflammation," came out in
" Ashhurst's Encyclopaedia of Surgery" only a short time
before his death.
His work in the Sanitary Commission is a matter of
public as well as of medical interest. To the great detri-
ment of his private revenue, he served his country faith-
fidly upon this commission, and added largely to the
efficiency of the medical and sanitary conduct of the war.
The credit of being the author of the tunnelling of
urethral instruments attaches to his name. This im-
provement is perhaps second to none in modern urethral
surgery.
He leaves a wife — a daughter of the late Valentine Mott
— and two married daughters to deplore his loss.
His friends loved him devotedly, and he reciprocated,
their attachment with a fervor which could be counted
upon in any emergency. When at the summit of his.
success, in the full rush of practice, he was particularly
zealous in sustaining and assisting many younger mem-
bers of the profession, most of whom hold his past favors,
in grateful remembrance.
His deatli was due, indirectly, to apoplexy, which oc-
curred in the spring of 1882, directly, to degenerative
changes about the injured cerebral focus, changes which,
set in with the beginning of the present year. He a[)-
preciated the approach of death, and wished for it. In
communion with the mother church, and solaced by its.
sacraments, in the brightness of the Easter morning he
ceased to be of earth.
Hcxir ^nst nun cuts.
A COMBINED INSUFFLATOR AND VAPOR--
IZER.
By C. J. CLEBORNE, M.D,,
MEDIC.\L INSl'ECTOK U. S. NAVV.
The woodcut belovi' represents an improved powder
blower or insufflator, combined with a vaporizer for
chloroform, rhigolene or other volatile substance.
A, insufflator ; E, air-bulb ; C, Ihioat-tube : D, vaporiser ; E, (elastic) uterine or
urethral tube ; F, ear tube (elastic).
The insufflator A is furnished with valves between A
and B, in order to prevent fouling of the air-bulb B, which,
is to be used for both instruments. The insufflator (with.
or without the throat-tube C, or the uterine, urethral, or
ear-tubes E and F) will be found useful in applying bis-
muth, calomel, iodoform, or other powder in the " dry
treatment of mucous membranes." The vaporizer D is
filled with sponge or cotton-wool, and is charged by
dropping the chloroform or other volatile liquid upoix
the filling ; then screwing the vaporizer (with its ap-.
propriate attachment) to the air-bulb B ; by compressing
the latter the vapor may be forced into any cavity of the
body. In a form of neuralgic headache, described by
the patient as " a pain far behind the ej'es," or " on the
floor of the brain," immediate and generally permanent
relief may be obtained by inserting in the external ear its.
ajipropriate tube attached to the vaporizer, and then
blowing with the mouth or air-bulb the vapor of chloro-
form into the ear. In a large number of cases of head-
ache and earache of a neuralgic character, and in func-
tional nervous deafness, relief has followed this proceedure
without any injurious result. The instrument is manu-.
factured by Messrs. George I'iemann & Co., of New.
York.
;62
THE MEDICAL RECORD.
[March 31, 1883.
A NOVEL TAPE-WORM TRAP.
To THE EUITOR OF ThE MeDICAI. ReCORD.
SrR : While recently looking through
the records of the United States Patent
Office for another purpose, I came upon
a most remarkable invention by Alpheus
iMyers, M.D., of Eogansport, Ind. The
invention, numbered 11,942, was pat-
ented November 14, 1854, and purports
to be a tape-worm trap. It is described
as follows :
" This trap is made of gold, and is
shown set at Fig. i, the length being
less than an inch, and the diameter
one-fourth of an inch. The separate
parts, Fig. 2, are united by inserting
spring ^"^ into cup a, and following the
former by cup d and by cup b, which is
held upon cup a by a bayonet fasten-
ing. In setting the trap stud /catches
upon the top of cup d. Bait being
placed in cup b, the trap is set and
swallowed, after the patient has fasted
several days, an end of cord h being
returned from the mouth. The worm,
in reaching the bait through opening c,
pushes cup d from study, when spring
g forces upward cup d, whose teeth
seize the worm, when both the trap
and worm may be withdrawn together.
In this manner the inventor asserts
that he has operated successfully.
Claim. — A trap for the removal of
tape-worms from the stomach and intestines, constructed
and operating substantially as herein described.'' C.
New York, March 3, 18S3.
%xmxs ijliMUS.
The Thirteenth Cranial Nerve. — In 1881, Dr.
SapoHni, of Milan, published a monograph bearing the
above title. Dr. Burnett {Medical Times, February 24,
1883) gives the following resume of the subject : Sapolini
came to the conclusion that the so-called intermediary
nerve of Wrisburg, lying between the seventh and eighth
nerves at their origin, is the proximal portion of the
chorda tympani, which really originates in the floor of
the fourth ventricle and terminates in the lingual mus-
cles. He followed this nerve up to the ganglion geni-
culatum in the facial canal ; he then traced the chorda
tympani backward to the same point and found that they
were really one and the same nerve. To follow this
down through the tympanic cavity and the canal of Hu-
guier to its junction with the lingual branch of tlie fifth
is an easy matter. His careful dissections show further
that the two nerves now form a plexus in the muscles of
the tongue, which he calls the plexus tympano-linguili;^.
He thinks that from its origin, both in the corpora resti-
formia and the lateral bodies, it must possess both sensory
and motor fibres.
If now all this be true, this nerve must have special
function, and to it Sapolini assigns that of governing
speech. No articulate souiid can he made without a
motion of the tongue, and the slow progress in articula-
tion made by children he explains by the late ajjpear-
ance of white matter in the Hoor of the fourth ventricle.
Speech belongs to man, but with patience a parrot cati
be taught to speak. Two talking parrots, whose chordce
tympani he cut suddenly, ceased to speak. To the chorda
tympani alone then would he ascribe speech, while he
holds that the lingualis of the fifth and the glosso-pharyn-
geal give the tongue touch and taste, and the hypo-glos-
sal and lingualis of the seventh govern its movements in
deglutition.
UJfficial List of Changes of Stations and Duties of Officers
of the Medical Department, United States Army, from
March 17, 1883, to March 24, 1883.
Murray, Robert, Colonel and Assistant Surgeon-
General. Detailed as member of .\rmy Retiring Board
to convene at the call of the President thereof, at Gov-
ernor's Island, New York Harbor, for the examination
of such officers as may be ordered before it. Par. 2,
S. O. 62, A. G. O., March 16, 1S83.
Summers, John E., Lieutenant-Colonel and Surgeon.
Detailed as member of Army Retiring Board to convene
at the call of the President thereof, at Omaha, Neb.,
for the examination of such officers as may be ordered
before it. Par. 9, S. O. 62, A. G. O., March 16, 1883.
Bill, Joseph H., Major and Surgeon. Detailed as
member of .Army Retiring Board to convene at the call
of the President thereof, at Omaha, Neb., for the exam-
ination of such officers as may be ordered before it.
Par. 9, S. O. 62, A. G. O., March 16, 1883.
Irwin, B. J. D., Major and Surgeon. Detailed as
member of General Court Martial to meet at Whipple
Barracks, Prescott, .'\rizona Territory, April 23, 1883,
for trial of Captain J. P. VValker, 3d Cavalry. Par. i,
S. O. 62, A. G. O., March 16, 1883.
Janeway, John H., JVIajor and Surgeon. Detailed as
member of Army Retiring Board, to convene at Gov-
ernor's Island, New York Harbor, for the examination
of such officers as may be ordered before it. Par. 2,
S. O. 62, A. G. O., March 16, 1S83.
Burton, Henry G., Captain and Assistant Surgeon.
To be relieved from duty in the Department of the East,
and will report in person to the commanding general
Department of Dakota, for assignment to duty. Par. r,
S. O. 67, A. G. O., March 22, 1883.
GiRARD, Joseph B., Captain and Assistant Surgeon.
Detailed as member of General Court Martial to meet
at Whipple Barracks, Prescott, Arizona Territory, April
23, 1833, for trial of Captain J. P. Walker, 3d Cavalry.
Par. I, S. O. 62, A. G. O., March 16, 1883.
Porter, Joseph Y., Captain and Assistant Surgeon.
To be relieved from duty in the Department of the South,
and will report in person to the commanding general
Department of Texas, for assignment to duty. Par. i,
S. O. 67, A. G. O., March 22, 1S83.
WiNNE, Charles K., Captain and Assistant Surgeon.
Granted leave of absence for three months from i\Iarch
31, 1883, and will be relieved from duty in the Depart-
ment of the East, and upon the expiration of his leave of
absence will report in person to the commanding gen-
eral Department of California, for assignment to duty.
S. O. 61, A. G. O., March 15, 18S3.
Cauteriz.vtion of the Clitoris in the Treat.ment
of Hysteria. — Dr. N. F"nedreich ( Virchow's Archiv,
Vol. XC.) believes, with Baker Brown, that many cases
of hysteria are caused by masturbation. Further, he is
of opinion that in neuropathic females an over-sensitive-
ness of the sexual organs may exist, which acts upon the
spinal and cerebral centres, causing hysterical symptoms,
without there being actual, voluntary masturbation. He
treats these cases by cauterizing the clitoris. The opera-
tion is most painful, but the results are so remarkable
and agreeable that the iiatients, says Dr. F., never object
to a repetition. Eight cases are reported, and all were
ultimately cured. In two cases there were relapses, and
the cauterization was repeated. In three other cases the
cauterization had to be repeated. The disease was in
all instances very marked, there being paralyses, general
convulsions, hystero-epilepsy, etc. — Journal of Nervous
and iVental Disease.
March 31, 18S3.]
THE MEDICAL RECORD.
3^3
^ctlicat Itctits.
Contagious Diseases — Weekly Statement. — Com-
parative statement of cases of contagious diseases re-
ported to the Sanitary Bureau, Healtii Department, for
tile two weelvs ending Afarcli 24, 1883 :
Week Ending
u
C .
T3
>
o.S
./i
rf
0
U
j:
J2
•^
>>
I-.
•a
h
H
C/3
u
c
— 5 jT s
March 17, 1883 o 13 1 11 4 , 96 , 50 1 2
March 24, 1883 o 10 1113! 6 |I02| 52 1 4
A Grave-Yard Insurance Company. — Dr. J. F.
Jeni<ins, of Tecumseh, Mich., writes that his town has a
Grave- Yard Insurance Company, composed of an under-
taker as president, a homceopathic physician as secretary,
and another of the same persuasion as e.xamining [jhy-
sician. It is on the co-operation plan, and the chief
feature of it is an " old people's " class, consisting of per-
sons ranging from the age of si.Kty up to eighty-five years.
Thev take policies on aged and infirm individuals, and
sell these policies at the rate of five dollars apiece to
any one whom their agents can find gullible entyigh to
purchase them. The laws of the State of Michigan ilo
not appear to reach this species of rascality.
Blue-Gum Stea.m in the Tre.'itmeSt of Diphtheria
AND other Infectious Diseases. — Dr. G. Murray
Gibbes, Taranaki, New Zealand, describes (Lancet) the
result of his use of blue-gum (eucalyptus globulus) in the
treatment of diphtheria. He takes the leaves and steams
them, keeping the patient in an atmosphere of the steam.
He has had thirty-seven cases in which this method was
successfully used. Dr. Gibbes thinks it would be valua-
ble in other infectious diseases, including phthisis.
Slaughtering Mercifully. — A well-known electrical
engineer of London, Mr. George Lam Fox has devised
an apparatus for the painless destruction of incurable and
worn-out animals, especially horses. The animal to be
killed, first has the top of its head and its feet and its legs
wetted with salt water. It is then led into a stall anil
made to stand upon an iron plate connected with the
negative pole of a condenser of a capacity of about one
hundred microfarads. The operator then touches the
animal's head with the positive pole, and it falls dead.
The death is believed to be painless, because physiolo-
gists have demonstrated that a nervous vibration cannot
be communicated to the brain in less than a tenth of a
second, and another tenth of a second must elapse before
a sensation can result from the vibration thus communi-
cated. One-fifth of a second must, therefore, necessarily
intervene between the actual infiiction of an injury and
the experience of pain from it. But the flash from such
an apparatus, as has been described, presumably para-
lyzes every fragment of a nerve in man or beast in some-
thing like a hundred-thousandth part of a second. The
difference between this swift and certain death and the
horrible practice of the knacker's yard is sufficiently ap-
parent to incline every humane person to fervently wish
that this scientific mode of slaughtering may speedily be
adopted. The idea, of course, is not new ; but the ap-
plication of the condenser to this business renders the
process more certain antl manageable than it was a few
years ago. It is said for about two thousand five iuin-
dred dollars such an electrical apparatus as is here al-
luded to may be fitted up in any stable or outhouse, that
It will kill as rapidly as animals can be placed in position
and taken away again. We commend the matter to Mr.
Bergh.
Comments on the Code. — Dr. Alexander J. Stone,
Vice-President of the American Medical Association and
late President of the Minnesota State Medical Society,
said in his presidential address :
" The code, since its final adoption, has apparently
been laid upon the shelf by the side of the family Bible,
to be treated with almost as much reverence, to be read
quite as seldom, and to be ([noted only when its provisions
enable one to discipline a rival, or to exclude him from
the benefits of professional affiliation. A judicial considera-
tion of the code forces a conclusion that much which it
contains is gratuitous insult to the profession, and more,
is rather calculated to amuse than to impress with respect
the mind of the la)'man. There is not a clause or sentence
in the first two articles which is not absolutely true ;
but, should the self-evident truths contained in Article
I. be held constantly befoie the physician, as if by nature
he was a brute who is to be taught the ordinary law-s of
humanity ; a fool who must be taught a wisdom in the
management of his patients which instinct alone would
inculcate ; a knave who must be withheld from empiri-
cism ; or a man without the instincts of a gentleman ?
Granted that men enter the ranks of the profession to
whom the epithets of ' fool,' ' knave,' or ' clown,' apply,
of wliat value are the platitudes concerning brotherly
love, or to what good is a formulated code defining the
relations of medical men to the public or to each other ?
Among gentlemen such a code is unnecessary ; among
pirates it only serves to foster a cathauling hostility ; as
between a gentleman and a pirate, any difficulty which
may arise is not to be satisfactorily settled by a reference
to any code, because the stand|>oints from which each
look at matters differ too widely — nor are the [lenalties
which the code imposes such as to deter a real rascal,
nor is that unsovereign body, the medical profession, able
to enforce its laws rigorously."
The Increase of Insanity in Nev/ York. — The
American Journal of Insanity, by a very elaborate and
apparently careful analysis of statistics, tries to prove that
the increase of acute insanity or of new cases in this
State is not greater than the increase in the population.
The total increase of insanity in 1882 was 633 cases, or
06.28 per cent, of all the insane in the State. The in-
crease in acute cases, however, is estimated to be 01.4 per
cent, while that of the population was 01.5 per cent.
This estimate does not take into account the fact that
many new cases are not put at once in asylums.
The St. Mary Hospital of Brooklyn, of which one
wing was recently completed, has been very severely
criticised by the Sanitarian on account of its defective
sanitary arrangements. We are told that it has cess-
pool drainage, pan water-closets, and no ventilation
worthy of the name. Our contemporary concludes:
"No new demonstration is necessary to show the crim-
inality of all hospitals constructed without regard to
an abundant supply of pure air, and the danger of such
plumbing as that which has been put into this institution.
Unless these glaring defects are speedily remedied the
structure is calculated to bring disgrace on the faculty
and destroy all the promised utility of the institution."
Medical Co-education. — The Chicago Homceopathic
Medical College has given up the plan of educating wo-
men. This is the second medical college which has
abandoned medical co-education this winter.
The Code in Canad-a. — The Canadian Practitioner
comments on the Code as follows : " In T'oronto, we
manage these things more quietly. One or two surgeons
consult repeatedly with homceopaths, and, although they
are members of both the Ontario and Canada Medical
Associations yet, these societies meet in this city and —
to their shame be it spoken — take no notice of the fact.
We wonder if there be a latent fear that a discussion of
the matter might reveal the existence of a general ad-
vanced liberality such as the State to the south of us has
not blushed to proclaim."
564
THE MEDICAL RECORD.
[March 31, 1883.
A Dental College and Infirmary has been or-
ganized in Chicago under the auspices of Drs. N. S.
Davis, William B3'ford, A. R. Jackson, and others.
Rooms have been secured and the' chairs filled. .Students
entering the infirmary must have matriculated in some
medical colleges of good standing. After attending two
courses of clinical instruction and found qu.^lified, they
will receive diplomas providing the degree of M.D. has
been conferred.
Another new departure in medical teaching, says the
Chicago Medical Journal, was inaugurated in the medical
colleges last fall. Full chairs on dental pathology and
surgery were added to several of the colleges, and in-
struction on dental and oral diseases was given in the
regular winter course. These chairs were filled by grad-
uates of medicine who are practising dentistry in Chicago.
Almost a Specific, for Snake-bites. — Professor Binz
in seventeen cases found that filtered solutions of chloride
of lime injected into the place where the virus entered,
prevented any poisonous symptoms appearing. The
suggestion is made that in cases of the bites from hy-
drophobic dogs, the same- plan may be pursued.
Prevention of Blindness. — The fifth International
Congress of Hygiene, which will meet at the Hague,
Holland, in 1884, will award the prize of two thousand
francs ($400), offered by the London Society for
the Prevention of Blindness, to the author of the best
essay written in English, French, German, or Italian, on
"The Causes of Blindness and the Practical Means for
Preventing It." Besides this prize the International Soci-
ety for the Improvement of the Condition of the Blind
reserves to itself the right to award a second prize of
one thousand francs ($200), or two prizes of five
hundred francs ($ioo) each, and a silver gilt medal
with a diploma, should it see fit, to such of the essays
as should, in the opinion of the international jury
for the ])rincipal prize, be deserving of it ; the last-
mentioned prizes will be distributed at the centenary
festival of the first blind institution founded by Haiiy,
which will take place in Paris in 1884. The fourth
International Congress of Hygiene, which met at (ieneva,
in September, 1882, adopted for this competition the
following programme, as prepared by the London Soci-
ety for the Prevention of Blindness : I. The study of
the causes of blindness — a. Hereditary causes : Diseases
of parents ; consanguineous intermarriages, b. Infantile
eye diseases : Various inflammations of the eyes. c.
School period and time of aijprenticeship : Progressive
shortsightedness, etc. d. General diseases : Diatheses ;
various fevers ; chronic poisoning, etc. e. Trade influ-
ences : Wounds and accidents, etc.; sympathetic op!i-
thalmia. /. Social and climatic influences : Conta-
gious ophthalmias; unhealthy habitations; defective
lighting, etc. g. Neglect of treatment and bad treat-
ment of eye affections. II. The study of practical pre-
vetitive means — a. Legislative means, b. Hygienic and
professional means, c. Educational means, d. Medi-
cal and philanthropic means.
The international jury elected by the Geneva Con-
gress for the purpose of judging the essays, consists of —
Holland : Dr. Snellen, Professor of Ophthalmology,
Utrecht ; Germany : Dr. Varrentrapp, Frankfort ; Dr.
H. Cohn, Professor of Ophthalmology, Breslau ; France :
Dr. Fieuzal, Physician to the Hospice desQuinze-Vingts,
Paris ; Dr. Layet, Professor of Hygiene, Bordeaux ;
Italy : Dr. Reymond, Professor of Ophthalmology, Turin ;
Dr. Sormani, Professor of Hygiene, Pavia ; England :
Mr. Streatfteld, Professor of Ophthalmology, University
College, London ; Dr. Roth, Honorary Secretary and
Treasurer {pro tcm.) of the Society for the Prevention of
Blindness, London; Switzerland: Dr. Dufour, of the
Ophthalmic Hospital, Lausanne ; Dr. Appia, Geneva ;
Dr. Haltenhoflf, Lecturer on Ophthalmology, Geneva, and
secretary to the jury. Dr. A\)pia and Dr. Varrentrapp
having resigned, the jury completed its number by elect-
ing Dr. Coursserant, oculist, Paris, and Dr. Berlin, Pro-
fessor of Ophthalmology, Stuttgart.
Those essays to which ]irizes have been awarded will
become the property of the Society for the Prevention
of Blindness and of the International Society for the
Amelioration of the Condition of the Blind, who will be
at liberty to publish them, in whole or in part, in several
languages, in order to make them useful in the %vay they
consider best.
The inedited manuscripts for competition are to be
sent to Dr. Haltenhoff, secretary to the jury, not later
than March 31, 1884. Every manuscript has to be
distinguished by a motto, which is also to be written
on a sealed envelope containing the name. Christian
name, titles, and address of the author. The envelopes
will not be opened until after the award of the jury.
Lunacy in Spain. — In 1879 ''''s number of lunatic
asylums in Spain was 26, with a population of 3,790,
which gives a ratio of one to 2,250 of the whole popula-
tion. About eight per cent, are discharged cured every
year.
Darwin's Religion. — -Karl Blind, in the Vienna Neue
Freie Pressc, notes the curious fact that the recent reve-
lations regarding Darwin's religious opinions were only
noticed by three or four of the English periodicals, and
that even A'^ature sujjpressed Darwin's letter to a Jena
student, which Haeckel had sent to the editor as part of
one of his lectures. In this letter, it will be remembered,
Darwin had stated verbatim : " For myself, 1 do not be-
lieve tljtit there ever has been any revelation ;" and in a
conversation witli Dr. Ludwig Biichner, he said he was
with him in thought, but preferred the word agnostic to
atheist, and that 1* had given up Christianity because
"it is not supported by evidence." Karl Blind adds to
this testimony another item, in the form of a letter writ-
ten by Darwin in 1873, io a Dutch gentleman (N. D.
Doedes) of which we give the following translation from
the German, as given in the Fresse : "I find it impossi-
ble to give a brief answer to your question. I do not
know if I should be able to answer it if I should write a
great deal about it. Thus much I can say, that the im-
possibility of understanding how this great and wonderful
universe, besides our own consciousness, could have come
into existence, through chance, seems to me to be our
princi]jal argument for the existence of a God ; but
whether this argument is of any value I have never been
able to decide ; for I know that, if we accept a highest
cause, the mind again strives to know whence it came
and how it arose. Moreover, I cannot pass over the
difficulty which, on this assumption, arises from the vast
amount of suffering prevalent in the world. I am, in-
deed, bid to attach a certain amount of weight to the
judgment of the large number of intelligent men who
have implicitly believed in God ; but here, again, I see
what an insufficient kind of proof this is. The safest con-
clusion seems to be that the whole subject lies beyond
the range of human understanding ; nevertheless, a man
may do his duty." — GaillarcTs Weekly.
The Increase of the Jews. — The Lyon Medical
states that in general throughout Europe the increase
among Catholics, Protestants, and Jews is as i, 2, 3. In
France and .Austria the increase of the Jews is seven and
four times that of the Catholic population. At the same
time, the actual birth-rate of the Jews is as a rule lower
than that of Catholics and Protestants ; but illegitimate
births are very rare among Jews, and the infiint mortality
is very much less. In general, among the Christian
population, the number of girls and boys is nearly equal,
the boys being slightly more numerous, the figures being
105 to 100 ; but among the Jews of Russia, Prussia,
Austria, Hungary, and Verona, the proportion rises from
110 to 120 and 130 boys for 100 girls. This predomin-
ance is believed by Dr. Lagneau to be the consequence
of the early marriages of the Jews.
The Medical Record
A Weekly yoitrnal of Medicine and Surgery
Vol. 23, No. 14
New York, April 7, 1883
Whole No. 648
(Ovininal Articles.
ON VARIOLA.
Its Definition, History, Cause, Varieties, Proo-
Nosis, AND Treatment.
By J. N. McCHESNEY, M.D.,
LATE ONE OF THE ATTENDING PHYSICIANS TO THE HOSPITAL FOR CONTAGIOLrs
DISEASES OF THE CITY OF NEW YORK.
(Continued from page 342.)
Variola AnomaliB. — Siiiall-pox occurring with other dis-
eases, or presenting unusual features, is called anom-
alous. We have seen scarlatina, diphtheria, and variola
in the same person. The patient, while sick with a
mild attack of discrete small-pox, slept in a bed which
had been occupied by a scarlatina patient. The scarla-
tinal eruption developed regularly, and all of the syiup-
toins were very severe. The diphtheritic deposit was
abundant. Desquamation ni both diseases took place
at the same time, and the patient made a good recovery.
In another case variola developed in a female patient
who was desquamating from scarlatina. The attack was
mild, and she recovered after a slow convalescence.
A rare complication occurred in a case of variola at
the Riverside Hospital in the spring of 1881. .A patient
was admitted with discrete small-pox, and in a few days
desiccation began. About this time the temperature went
up to 104° or 105°, the patient became delirious, and
in a few days a jjetechial eruption made its appearance
on the trunk and upper extremities. The sym|)ton)s and
eruption were those of typhus fever. The man was a
tramp, admitted from one of the lodging-houses of the
city which were making daily contributions to the typhus
wards of the hospital, and the chances of exposure were
many. Later in the case, cerebro-spinal meningitis was
developed and the case terminated in death. .An autopsy
confirmed the correctness of the diagnosis.
Pregnancy is a complication which is of serious con-
sequence ; abortion generally follows with fatal results to
both mother and child.
.Another anomalous condition is the birth of a child
with the eruption on its body. It is obvious in this case
that the disease must have been conveyed to the fcetns
and the stages of incubation, invasion, and partly of
eruption passed in utero.
We have met with a number of cases of variola com-
plicated by pregnancy. In most of them abortion oc-
curred, though in one or two recovery took place and
the child was born at full term. In only one instance
have we seen the foetus born with the eruption. The
history of the case is as follows ;
Mrs. F -, aged thirty; native of this city; vacci-
nated in childhood ; fair cicatrix. First seen on Febru-
ary II, 1882, and found to be sick with discrete variola
in the vesicular stage. The initial stage had been mod-
erately severe ; the eruption was abundant on the face
and extremities, scant on the trunk. At this time she
was about two and a half months pregnant. The disease
ran a modified course, and on March nth, a little more
than one month after the beginning of the attack, quar-
antine was raised and she soon resumed her household
duties. Quickening occurred in the first week of .^pril.
On the 23d of that month she ceased to feel any fetal
movements, and three weeks passed without any signs
of life in the fcetus ; two careful examinations, made at
different times, failed to discover any evidence of life,
which, taken with the fact that the abdominal tumor had
diminished in size, rendered it quite probable that death
had occurred. On June 6th she was delivered of a dead
female child. There was little or no decomposition.
F'orty or more distinct pustules Were counted on the
body. They were most abundant and better developed
on the trunk and about the folds of the axilhe and groin,
where they were grouped in twos and threes ; they were
also present in the palms of the hands and soles of the
feet. The pocks varied in size from the head of a pin to
a pea, the largest being on the posterior aspect of the
trunk. There was no evidence of umbilication.
Many questions of interest are present in this case,
the discussion of which would, however, exceed the limits
of this paper.
Several cases of small-pox in females recently deliv-
ered were admitted to the hospital. The eruption made
its appearance on the children when they were only a
few days old, showing that the contagion had been con-
veyed to them, and nearly the whole period of incuba-
tion passed, in utero. In several of the pregnant cases
the children were born at full term, apparently strong
and vigorous, without any evidence of having suffered
from the disease before birth. These children were vac-
cinated at the age of three months. In one case three
attempts were made before vaccination was successful.
One case, seven months pregnant, had discrete hem-
orrhagic variola, with a moderately abundant eruption.
.\bortion was threatened, but the course of the disease
was modified. She passed safely through the attack and
was delivered of a living child with no traces of the dis-
ease on its body. It was puny and delicate, however,
and died of infantile diarrhuia a short time afterward.
Variola sine exanthemata, or small-pox without the
eruption, is an anomalous form which now and then oc-
curs during the prevalence of an epidemic. Early in
1881, while attending the wards of the small-pox hos-
pital, at a time when there was a number of unusually
malignant cases, the writer was seized with rigors,
headache, obstinate nausea and vomiting, intense pain
in the lumbar region, rapid pulse, temperature went up
to 106° F. ; the tongue was heavily coated with thick
yellowish white fur, and complete anorexia existed. The
fauces were inflamed and swollen. The temperature re-
mained high, in spite of heroic doses of quinine and cold
sponging, until the fourth day, when it fell to the normal
and all other symptoms disa|)peared. Careful examina-
tion was made, but not the slightest trace of eruption
could be discovered. Vaccination had been successfully
performed only a month or two previous and doubtless
prevented the appearance of the eruption. The following
case, related by a writer on this subject, is interesting as
illustrating this form of the disease as well as the occur-
rence of variola in the ftetus;
" During a severe epidemic of small-pox, a midwife,
forty years of age, in the eighth month of pregnancy, fell
sick with rigors, followed by violent fever, headache, pain
in the back, etc., apparently the initial stage of small-
pox. On the fourth day, however, she was free from
fever, and in spite of the most careful examination, ex-
hibited no trace of the expected eruption. Ten days
after the commencement of the disease, feeling perfectly
well, she gave birth to a child covered with a small-pox
eruption, evidently just appearing, which developed still
366
THE MEDICAL RECORD.
[April 7, 1 88:
further, and in three days terniinated in death during the
stage of suppuration." '
A variety of anomalous sniall-pox called variola verru-
cosa (from verruca, a wart), in which the disease as-
sumes a mild form, is occasionally seen. The initial
stage may be as severe as in the worst types of the dis-
ease, but the severe symptoms subside early in the erup-
tion, which assumes a modified form. Some of the pus-
tules shrivel up, while others mature ; desiccation is
early ; there is no secondary fever ; the scabs fall otil'and
leave little or no pitting.
Complications.- — The complications and sequela: oc-
curring with, and subsequent to, small-pox are numerous
and varied, often leading to a fatal termmation when the
disease itself is not necessarily so. The number and
variety of complications and sequehi; differ verv much in
difterent epidemics, and at different times of the same
epidemic. Erysipelas, abscesses, etc., abound in some
epidemics and are comparatively rare in others. Among
the patients admitted to the hospital in i88i the com-
plications were numerous — erysipelas, crops of boils,
large, diffuse abscesses, two or three cases of gangrene,
ulcerations of the cornea, with destruction of one and,
in one instance, of both eyes, several cases of pvKmia,
and nearly every other complication. The frequency of
erysipelas may be accounted for by the fact that during
the wuiter of iS8o, and the spring following, that dis-
ease prevailed to an unusual extent in this city.
During the stage of secondary fever, in the more severe
forms of the disease, when desiccation is taking place,
crops of boi-ls appear, difliise abscesses occur in difterent
parts of the body, the pus burrows underneath the skin
and between the muscles, forming sinuses and not un-
frequently causing extensive destniction of tissue. These
are apt to Occur in the neighborhood of old wounds and
recent bruises. Glandular swellings occur now and then,
and frequently result in suppuration.
Large bed-sores are formed on those parts where there
is any pressure. In one case, that of a negro man, the
whole sacrum was uncovered and both trochanters were
exposed ; he recovered from his attack of small-pox, but
succumbed to the exhaustion consequent upon this ulcer-
ation. The hair falls out in some cases, leaving the pa-
tient completely bald. Fortunately, however, unless
there has been great ulceration, or erysipelas of the scalp,
it is generally reproduced. The nails fall oft' occasionally.
VV^e have met with one case of well-marked |)y<-emia in a
boy who had a semiconfluent eruption. There were fre-
quent rigors, high temperature, nausea, numerous small
boils and ulcerations, with collections of pus in all of the
large joints. Death occurred in a few days.
Gangrene, fortunately, is of rare occurrence. We have
seen three cases : one of the right forearm, in a man with
confluent hemorrhagic small-pox, and the other two of
the scrotum. One of the latter had discrete variola,
which was complicated with gonorrhtea. Nearly the
whole of the scrotum sloughed away, leaving the testicles
bare. The ragged edges were trimmed, the testicles
pushed up into the abdominal rmgs, and aided by the
elasticity of the tissues the edges were easily approxi-
mated and united in a central raphe. Union was speedy
and complete, giving him a short but useful scrotum.
He will probably never suft'er from varicocele, or be un-
der the necessity of wearing a suspensory bandage.
Of the internal organs the pleura is the most disposed
to take on inflammatory action. Pleuritis is one of the
most painful and fatal complications ; it supervenes sud-
denly, and runs a rapid course. One of the cases which
occurred in the hospital was in an adult negress. The
attack was not of a very acute nature ; the eft'usion in
the right chest was very large — became purulent, per-
forated an intercostal space, and formed a large abscess
in the axillary region ; this was oijened and fully three
pints of offensive purulent fluid withdrawn. The case
^ Churschmann in Ziemsscn
terminated in death, and autopsy showed the whole right
chest filled with fluid of the same kind ; the pleura of
the left side was also involved.
Pneumonia of the congestive variety frequently occurs.
Inflammation of and purulent discharges from the ear
are of occasional occurrence. Conjunctivitis, of more
or less severity, is a frequent complication ; it is due to
the presence of the pustules on the margins of the eye-
lids, and on the palpebral and sclerotic conjunctiva;.
A complication of tolerable frequency, which generally
results in serious mischief to the patient, is ulceration
and perforation of the cornea. We have seen several
patients lose one eye, and one case became completely
blind from this cause. The trouble first shows itself as
a small wiiitish speck at the margin of the cornea, gener-
ally on the inner side. It may disappear, or give rise to
an opacity of such size as to interfere with vision, or else
destructive ulceration may ensue, resulting in perforation
of the cornea, escape of the aqueous, and loss of sight.
In one case of perforating ulceration we had the start-
ling accident occur of having the lens pop out into our
hand while attempting to seyjarate the lids to examine
the progress of the ulceration.
The nervous system is now and then implicated. Two
brothers, Canadians, were admitted to the hospital about
the same time ; in the suppurative stage both had hemi-
plegia, and one, the elder, aphasia ; both died. In two
cases we have seen insanity ; one patient made a com-
plete recovery, the other committed suicide after recov-
ering from small-pox.
A sequel which occurred in five cases, all of them ex-
cept one being negroes, was cedeina of the left foot and
ankle. The swelling extended from the instep to several
inches above the ankle, was painless and unattended by
heat ; the urine was examined for albumen and casts, but
the result was negative. The cause of the swelling was
doubtless due to some obstruction of the venous circula-
tion. It passed away without any further trouble.
As a rule, one attack of small-pox renders the person
insusceptible to the disease for the remainder of his life.
Exceptions do occur, but are of less frequency' than the
statements of i)atients might lead one to suppose. We
have seen but two cases of recurrent small-pox ; the
first was in a young man aged twenty-two, who was ad-
mitted with a discrete form of the disease, which ran its
course in about two weeks. On the night \)revious to
the day on which he was to have been discharged from
the hospital, he was seized with rigors, headache, pain in
the back, and the other initial symptoms of variola,
which so closely resembled the symptoms that ushered
in his first attack that he remarked, "I believe I am go-
ing to have a second attack of the disease." The erup-
tion appeared on the third day, and ran a course similar
in every respect to the first attack. The second case
was that of an Italian child, not vaccinated ; the variety
was discrete from which it recovered and was discharged
from the hospital. In less than a month it was again
sent to the hospital with the disease, which proved to be
of the confluent variety, and ended in death.
Several patients were admitted who exhibited the pits
of a former attack. Two or three who had mild discrete
small-pox claimed and exliibited cicatrices resulting from
inoculation, done years before in the " old country."
Diagnosis. — It is always of the greatest importance to
decide upon the nature of febrile eruptive diseases at the
very earliest moment, in order that isolation of the pa-
tient and other precautionary measures may be taken
for the protection of those who may have been exposed.
While we recognize the importance of early diag-
nosis, we should be exceedingly careful not to declare
an eruptive trouble only measles and harmless, or, on
the other hand, to decide it to be small-pox, and have
the patient removed to a small-pox hospital, where, if he
has not the disease, his chances for contracting it are
greatly increased, before the evidence in the case war-
rants our giving a decided opinion. When small-pox is
April 7, 1883.]
THE MEDICAL RECORD.
Z^7
prevalent, mistakes in diagnosis frequently occur, grow-
ing out of undue haste and want of careful examination
of the patient. In every case wliere doubt exists the
patient should be isolated and closely watched.
In natural or unmodified variola, after the eruption is
well out, there is little or no difficulty in making a diag-
nosis. No one symptom, or series of symptoms, before
the appearance of the eruption, is sufficient to justify a
positive opinion. All of the symptoms, taken in con-
junction with the character of the eruption, should be
carefully considered before deciding whether we have
small-pox, or one of the less dangerous eruptive fevers,
to deal with. It will be of great assistance to find out
whether there has been any exposure to small-pox, also
whether the patient has been recently vaccinated or re-
vaccinated. In regard to vaccination, the statements of
the patient or of his friends is not alone to be relied
upon, but the arm should invariably be examined for a
vaccine cicatrix.
The diseases which in the early stages are most apt to
occasion difficulty in diagnosis are measles, varicella,
scarlatina, febrile lichen, and some of the skin diseases.
Many of the symptoms of the initial stage of variola — as
chilis, fever, headache, aching of the limbs, nausea with
vomiting, and anorexia, are common to the other erup-
tive fevers, but the intense lumbar pain which accom-
panies these symptoms in small-pox is rarely found in
the other diseases. In some cases of small-jiox the pain
in the back is not so pronounced, and its absence does
not exclude the possibility of that disease.
The duration of the initial stage is a point for consid-
eration ; in small-pox it is from two to four days ; in
measles, four to five ; in scarlatina, one day ; in febrile
lichen the eruption appears on the second day ; varicella
can scarcely be said to have any prodroma.
The presence of catarrhal symptoms — redness of the
conjunctivc-e, burning, smarting pain in the eyes, sneez-
ing and coughing, and known exposure are in favor of
measles ; the temperature of the initial stage of measles
is not so high as in variola — is seldom above 102° to
104° F.
The early appearance of throat symptoms, the straw-
berry tongue, and a diffuse eruption showing itself on
the second day, favors scarlatina.
In the initial stage, the symptoms of greatest diag-
nostic significance in favor of small-pox are obstinate
nausea and vomiting, the intense pain in the lumbar and
sacral regions, and a temperature of 104° to 106° F. These,
with the other symptoms and a known exposure to con-
tagion, should put us on our guard. A positive opinion,
however, is not to be given until the characteristic erup-
tion is established.
The eruption of variola appears on the third day, con-
sists of small red spots or macules, seen first about the
mouth, nose, and chin, and at the same time on the
fronts of the wrists and forearms. In twelve to twenty-
four hours papules are formed ; these change to vesi-
cles, in which the central depression or unibilication is
seen.
In measles the eruption is first seen on the forehead
and about the temples, extends rapidly over the face,
neck, and trunk, but more slowly over the lower ex-
tremities. The confounding of small-pox with measles
usually occurs in the papular stage of the eruption ; the
papules of variola are smaller and have a hard, shot-like
feel ; those of measles are larger and softer.
Vesicles are to be carefully sought for, and if found
with nmbilication, decide the question. They are often
found first about the axillary folds, inner face of the
arms and thighs, where the skin is thinnest. The mouth
and throat should be examined for the eruption. In
measles it appears as a mottled redness; in variola the
s))ots are round, whitish or ashy.
The eruption of scarlatina appears on the second day
about the neck and chest, is diffuse, and extends rapidly
over the whole body. The general erythematous con-
dition of the skin accompanied by redness of the fauces,
which sometimes precedes the eruption of variola, may
lead to the diagnosis of scarlatina. We have known this
to occur in one or two instances. This erythematous
redness is of a brighter scarlet tint than the eruption of
scarlatina, which is more dusky in hue ; it is not so gen-
erally diffused over the whole surface ; the faucial symp-
toms are more pronounced in scarlatina. Crops of miliary
vesicles are now and then met with in scarlatina, and may
orive rise to doubts. These occur chiefly about the sides
of the neck and upper part of the chest, are small in
size, do not umbilicate, dry up in a day or two and des-
quamate.
The eruption of febrile lichen appears on the second
day as small papules on the trunk and face at the same
time, and does not vesiculate. The duration and char-
acter of the (irodromata and the difference in the erup-
tion, will decide between this affection and variola.
The fall of temperature and disappearance of the
symptoms of the initial stage after the eruption is estab-
lished, is a strong diagnostic point in favor of small-pox.
It does not occur in any of the other eruptive fevers.
The diagnosis of modified small-pox or varioloid from
varicella is not always an easy matter, and the more
modified the small-pox, the greater the difficulty. They
are frequently confounded, and such errors have led to
incalculable mischief To mistake varicella for varioloid
and send the i^atient to a small-pox hospital, where in
all probability he would contract small-pox, would be a
great injury to him ; but to mistake a mild case of variola
(varioloid) for varicella, would lead to far more serious
consequences, from the lack of the necessary precautions
to prevent the spread of the disease. We recall a case
which occurred in the person of an only soil in a family,
living in this city, which illustrates the serious conse-
quences of the latter error. After a mild stage of inva-
sion an eruption made its appearance. There was a
difference of opinion among the physicians who %a.\\ him
as to the nature of the disease ; the diagnosis of varicella
prevailed, and the case was treated accordingly. The
patient only remained away from business for a day or
two. It was deemed advisable to vaccinate the mem-
bers of the family, and this was done except in the case
of the mother, who was excepted because she had had
an attack of small-pox when young. In due time the
was attacked with confluent hemorrhagic variola, of
which she died.
Varicella usually, though not invariably, occurs in
children. There is scarcely any appreciable systemic
disturbance, though exceptionally there may be a mild
stage of invasion, lasting twenty-four hours. The erup-
tion is vesicular almost from the beginning, appears first
on the body as small spots which can be felt, but there
is no hardness as in small-pox. The vesicles are present
on the face and scalp, but are most abundant on the
trunk, and are largest about the shoulders and between
the shoulder-blades. They may attain the size of a split
pea, though frequently are no larger than the head of
a pin. They are very superficial, and look as if caused
by a shower of boiling water. The contents of the
vesicles become turbid, but not purulent, unless they are
irritated. As a rule the vesicles are not found in the
palms and soles, and, when found there, are along the
radial and ulnar borders of the hand, and the inner and
outer sides of the foot — not in the centre. Unibilica-
tion is now and then observed, but is not so universal as
in varioloid. It may be due to the presence of a hair-
folhcle, or the depression resulting from the escape of a
portion of the contents of the vesicle. However this
may be, its presence may lead to error, and alone it
should not be taken as a decided point in favor of vari-
oloid. The vesicles of varicella are less often fouBd
on the mucous membranes than in varioloid.
The presence of a characteristic cicatrix, due to a
recent vaccination, is strongly, if not positively, against
varioloid. Supposed varicella, occurring in adults, is
568
THE MEDICAL RECORD.
[April 7, 1 88
J-
always suspicious and should be very carefully looked
into. In many cases it will prove to be varioloid.
Some dermatologists, among them Hebra, consider
varicella and varioloid to be identical, but a careful com-
parison of the two diseases will demonstrate the error of
these views. The following history of a series of cases
that occurred in the e.xperience of the writer will serve
to controvert the above opinion :
Case I. — Maud H , five and one-half years of age ;
vaccinated when four years old, good cicatrix. On Jan-
uary Sth, after little or no general disturbance, a vesicu-
lar eruption made its appearance, most abundant on the
trunk, and ran its whole course in about one week.
Diagnosis varicella.
Case II. — Margaret H , two years of age, sister
of Maud ; vaccinated when nine months old, excellent
cicatrix; was taken sick (January 21st) one week after
the recovery of her sister ; after a slight indisposition,
had an eruption identical in every particular with that in
her sister's case.
Case III. — Jennie \V , eight years of age ; never
v.u:i:inated ; lived on the first floor of the same house
and was a playmate of the H s. Was sick first on
February 5th ; her symptoms, the appearance and dura-
tion of the eruption, were the same as in the other cases.
In February an uncle of the H s came to visit
them. On the 15th was sick with the following history :
H •, twenty years of age; e.xhibited cicatrix of a
vaccination done in infancy; began to be sick on the
afternoon of February 15th, with chills, headache, pain
in the back, fever, anorexia, etc. On the 17th "pim-
ples ' were noticed on his face and wrists, which changed
to vesicles, and later some of them became pustular ;
the eruption was present in the palms of the hands. The
initiatory symptoms abated as soon as tiie eruption ap-
peared and the patient was not confined to his room
after the aytii, though the spots of the eruption and pig-
mentation were plainly seen after convalescence. 'Fhe
occurrence of this case, after the illness of the children
from varicella, and the similarity of the attack, led to
the conclusion that this case also was one of varicella,
" only a little more severe," and no physician was called.
On February 27th, J. H , a brother of the young
man, began to be sick and had all the symptoms of the
initial stage of variola. No eruption appeared, but on
the fourth day the fever subsided and all of the symp-
toms disappeared. This was in all probability variola
sine variolis.
On March 2d, H. \V , forty-six years of age, father
of Jennie \V , had the first symptoms of small-pox.
The eru])tion appeared on the 5th. He was removed to
the hospital ; the disease assumed the confluent form,
and death ensued on .March 14th.
Jennie W , eight years of age, never vaccinated,
recently recovered from varicella, taken sick with the
first symptoms of variola on March 4th; the eruption ap-
))eared on the 7th. She was removed to hospital with
her father. The form was discrete small-pox. She re-
covered and was discharged from hospital on the 24th of
the month.
These cases illustrate not only the many points of di-
agnostic difference between varicella and varioloid, but
also the fatal consequences of mistaking one for the
other ; and further, that an attack of varicella does not
prevent the occurrence of variola, since Jennie W •
had scarcely recovered from the former when she was
attacked by the latter. .A.II of the cases of varicella were
in children — two vaccinated and one unvaccinated —
which illustrates the fact that vaccination does not act as
a preventive against varicella. T.ie siqiposed case of vari-
cella in the adult was undoubtedly modified small-pox
(varioloid), he having been vaccinated in infancy, as the
occurrence of the three cases of variola in the same
house are clearly traceable to him. The benefit, of vac-
cination is illustrated by the fact that the two nieces of
H , both having tlie protection of comparatively re-
cent vaccination, escaped, notwithstanding constant ex-
posure in the same rooms. Jennie W , though not
so constantly exposed, being unprotected by vaccination,
contracted small-pox.
Of the diseases of the skin, those most likely to be
mistaken for small-pox are pustular acne, papular eczema,
ecthyma, and some forms of the secondary syphilitic erup-
tions. By strict attention to the stage of invasion, care-
ful observation of the characteristic points of the eruption,
and noting the regular development of, and the changes
in the form of the eruption of variola, there will be little
difficulty in making the distinction.
The question of diagnosis between typhus fever and
the petechial type of hemorrhagic variola occasionally
presents itself Reliance is to be placed in the differences
in the symptoms and duration of the initial stage, and
upon close observation of the appearance of the eruption
and the changes which occur in variola. Vesicles should
be carefully sought for, and if present will decide the point.
The temperature of variola abates on the development
of the eruption, in typhus it does not.
Purpura hemorrhagica has been mistaken for petechial
small-pox, and, during the prevalence of variola, deaths
are now and then reported as caused by the former, when
investigation proves them to be due to the latter.
Hemorrhagic spots are occasionally seen in acute
rheumatism, which may lead to a diagnosis of petechial
variola. The writer has met with one such case.
Sudaniina, and miliaria occurring in fevers and diseases
in which there is jjrofuse acrid perspiration, notably
rheumatism and scarlatina, have been diagnosed variola.
With a little care this need not occur. The vesicles are
consequent upon profuse acrid perspiration, are minute
in size, contents very clear, generally found at the root
of the neck, around the shoulders and sides of the thorax ;
there is no redness at their base ; they attain full develop-
ment in a few hours, remain so for about a day, and
either burst or dry up. AV'e have met with one case in
which a profuse crop of sudaminous vesicles appearing
in a patient subject to rheumatism led to the diagnosis
of variola. In this instance they were even noticed be-
neath the hardened cuticle of the palms.
Now and then cases are encountered in which the
eruption of small-pox is found coexisting with the eruption
of syphilis, and the detection of variola on first examina-
tion is extremely difficult. The symptoms and appear-
ance of the eruption must be carefully considered ; an
attempt to make a diagnosis on the appearance of the
eruption alone may lead to discomfiture. We have seen
one case of this kind, occurring in a Cuban negro. The
presence of a pustular syphilide was recognized, but a
few days of fever, with the other symptoms of the initial
stage of variola, with new points of eruption appearing,
and small-pox being prevalent, gave good grounds for
the suspicion of the coexistence of the two diseases. He
was isolated, and, after a few days watching, variola was
excluded.
Prognosis. — In predicting what will be the jirobable
termination in any particular case of small-pox, we should
be guided by the following points : the character and
quantity of the eruption ; the age of the patient ; the ex-
tent of the implication of the mucous membrane of the
larynx and trachea ; the previous habits and condition of
the patient ; whether vaccinated, and if so, how recently ;
the complications, their nature, etc.
Discrete variola when uncomplicated is attended with
but little danger. Of 657 cases admitted to the Riverside
Hospital for 1882, 409 were of this variety, and but 25
of these died — a mortality of 6.1 1 per cent. The danger
to life is not from the disease pi-r se, but if death occur
it is usually from some complication. A semiconfluent
eruption greatly increases the danger to life.
The prognosis of confluent small-pox snould always be
guarded, and cannot be given with safety in the early
stages of tiie disease. Confluency about the face is un-
favorable, as these patients frequently die, although the
April 7, 1883.]
THE MEDICAL RECORD.
369
eruption may be discrete on the other parts of the body.
VVhen the pustules do not fill out, but remain flat, and
the eruption has a dirty whitish, pasty appearance, re-
covery almost never takes place. A deep, clarety-col-
ored areola; surrounding the pustules, is to be regarded
as unfavorable. In the year 1882, of the 657 cases of
small-pox admitted to the hospital, thirty-one were of
the confluent variety, of which number only four re-
covered.
Recovery from the petechial type of hemorrhagic
small-pox is so rare that it may be said never to occur.
Death very frequently occurs from the intensity of the
poison before the eruption is established. From conflu-
ent-hemorrhagic small pox recovery rarely, if ever, takes
place. There were thirty-seven cases of this form in tiie
hospital in 1882, all of which died.
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Age occupies an important place in prognosis, the
mortality being greatest among young children and the
aged. The least mortality takes place from ten to twenty
years of age.
TABLE II.
Showing the Total N'umbi-r of Cases admitted to the Riverside Hospital,
for the Years l88o, 1881, 1882, arranged according to Ages, with
the Ratio of Mortality for each Period.
Aces.
o-S
5-10
' ' 1 ^ ':?
10-20:20-30 30-40 40-50 50-60 00-70
70-80
Total
Adniissiuns
456
247
159! 281 637; 311 1121 46I 9
37 53 135' 68 32I 16! A
3
3
2,014
23.27
Mortality per cent. .
54.16
18.8621.1921.8628 5734.7844.44
1 1 1 1 1
100.00
29-54
Although the mortality is greater among young unvac-
cinated ciuldren, it is to be remembered that mild, discrete
sniall-pox does occasionally occur and recovery take place.
In the year 1881, of 1,259 cases of small-pox admitted
to the hospital, 138 were in unvaccinated children of two
years and under. Recovery took place in 41 of these.
The patient's having been vaccinated will make an im-
portant difference in prognosis. The recency and thor-
oughness of the operation is of more importance than any
number of cicatrices resulting from the same operation.
The stage of invasion of small-pox in those who have
been vaccinated may be of the severest nature, yet the
eruption is usually discrete and runs a modified course
unattended by any great danger.
The symptoms which justify a grave or unfavorable
l)rognosis are : great prostration ; rapid and feeble pulse ;
low muttering delirium, or intense restlessness ; diarrhoea ;
general confluence of the eruption ; the formation of
large blebs or bulLx ; a flat, white, pasty appearance of
the eruption ; the appearance of a dark spot in the cen-
tre of the pustule during maturation ; a livid, purple
color of the vesicles and surrounding surface ; hemor-
rhages into the vesicles and from the mucous surfaces ;
abundance of the eruption in the throat and larynx.
Pregnancy is a most dangerous complication and rer-
ders prognosis unfavorable.
During the stage of desquamation the occurrence of
pleurisy, pneumonia, erysipelas, gangrene, numerous ab-
scesses and sinuses, and prolonged exhaustive suppura-
tion render the prognosis unfavorable.
(To be continued.)
Interesting Sanitary Experiment. — An interesting
debate took place in the Italian Parliament recently on
the emplovment of convicts in agricultural operations,
which has been going on for some years at the Abbey of
the Tre Fontane in the Roman Campagna, under the
direction of the Trap]-iists. The object with which these
works were started was to ascertain if the cultivation of
the soil would result in purifying the air of the Cam-
pagna, the general opinion being that the malaria is
caused by atmospheric influences unsusceptible of modi-
fication. The results so far have been most satisfactory.
At first the monks were obliged to live within the city
w^alls during the bad season, but since the ground has
come under cultivation, and, above all, since the Euca-
lyi^tus globulus has been planted on a large scale in the
neighborhood, the Abbey has been inhabited all the year
round, and the fevers from which its inmates still some-
times suffer are of a mild character, and rarely fatal ;
whereas at the outset something like a fourth of the lit-
tle conununity succumbed every year. The debate
proved that the health of the two hundred and eighty
convicts employed on the works was satisfactory, the
average annual deaths from malaria not exceeding three.
The government has lately made a very large grant of
land in perpetuity to the Trappists, who have already
planted on it no fewer than one hundred thousand euca-
lyptus trees, which are all doing well.
o/"-
THE MEDICAL RECORD.
[April 7, 1883.
ON THE
PRODUCTION OF IMMUNITY FROM CONTA-
GIOUS FEVERS BY INOCULATION WITH
DILUTED VIRUS.
By D. E. salmon, D.V.M.,
ASHEVILLE, N. C.
A FEW years ago, a considerable number of extremely
ingenious and instructive experiments were made by M.
Chauveau, which demonstrated beyond the possibility of
doubt that the active principle of virulent liquids con-
sisted of solid particles held in suspension and not of
soluble chemical substances. These experiments were
modelled after those of Spallanzani with the spermatic
fluid, by which he proved so conclusively that the
fecundating agent was not the aura sfminis of the older
philosophers, but existed as suspended and insoluble
particles.
The idea of one series of experiments was to obtain
the results of inoculations with diluted virus. If, after
the dilution was carried to a certain extent, the inocula-
tions in some cases produced the disease and in others
did not aflect the animals, he reasoned that this must be
due to the fact of the solid particles being too few to
exist in every drop of the diluted liquids, and that the dis-
ease was only caused by those drops which contained
one or more of the virulent particles. If the virus was a
soluble poison, it should exist equally in every drop, even
of the greatest dilutions.
Practically he found that virus diluted to the same
degree sometimes produced the symptoms of the malady
with all their intensity, while sometimes it had no etTect
whatever. Vaccine virus diluted to one-fiftieth nearly
always failed, and this was accepted as a proof of the
theory that the active agent consisted of solid particles
too few to be inserted in every inoculation puncture.
Similar experiments were made by way of contirniation
with the virus of small-pox, sheep-pox, and glanders.
From that time until the present, no one, as I am
aware, with the single exception of Chauveau himself,
has ever expressed a doubt in regard to the ability of a
single disease-germ, once introduced into the tissue of
the body, to produce the disease with all its characters.
On the other hand, our best scientific authorities have
felt confident in assuming that because disease-germs
evidently have the power of multiplying themselves in-
definitely, when the conditions are favorable, a single one
of these would produce the disease as certainly as a
larger number, though it would probably require a longer
period of incubation.
Strange and inexplicable as it may appear to us, this
assumption is not in accordance with the truth, and if
the conclusions from all of M. Chauveau's experiments
had been as defective as with this series, which happily
they were not, we might well have doubted the power of
man to solve a problem so complicated and mysterious.
If we examine a drop of fresh vaccine lympli, with
suitable jirecautions, we will have no difficulty in decid-
ing that it contains many more than fifty germs, and
that, consequently, if Chauveau's reasoning was correct
there should have been no failures with dilutions of one
to fifty.' Again, Chauveau's experiments with diluted
virus, like those of every other investigator who has at-
tempted the same line of research, are unreliable and
defective, because, first, lymph, blood, or other licjuids
taken from the animal body contain cells, organic debris
and coagula to which the germs adhere and which pre-
vent their regular diffusion in the diluting licjuid ;
secondly, because the number of germs in a drop of
lymph from difterent pustules, or in a drop of blood from
different animals, varies to an extraordinary degree ; and,
thirdly, because different animals have a different degree
of susceptibility in regard to the germs of the same dis-
' I hope that the opponents of the germ theory will forgive me for assuming that
the organisms seen in virulent liquids are disease-germs, for it would be manifestly
impossible for me to enter into a discussion of this question in the present article.
ease. In other words, just as there is a vis medicalrix
natures which enables a certain number of tlie individuals
in which disease-germs have multiplied to overcome such
germs and to recover from contagious diseases, so there
is a vis conservatrix natura, by which not only a certain
number of individuals resist the germs of any given dis-
ease, but which enables every individual to resist a certain
number of these germs.
When, in the summer of 18S0, I commenced my in-
vestigations of the effect of inoculations with diluted
virus, I soon became convinced that, to obtain definite
and comparable results, it was necessary to obtain a virus
of a standard strength, and one free from coagula and
other foreign particles which prevent the even diffusion
of the virulent granules. In these experiments, fowl-
cholera was the disease selected, not only because it is an
excellent type of the non-recurrent contagious fevers ;
but also because the virus is easily cultivated outside of
the body, the subjects are cheap and easily obtained, and
the Department of Agriculture, with which I am con-
nected, was anxious for an investigation in the interests
of our agricultural population.
The production of a virus which should contain a
practically constant number of disease-germs in every
drop, which could be obtained at will and in any desired
quantity, which should be free from foreign particles,
certainly seemed, at the time I am referring to, a most
difficult question to resolve. But, fortunately, the ob-
stacles to our success, as so frequently happens, did not
prove so insurmountable when we came to grapple with
them as they had appeared when contemplated from a
greater distance. The germs of this disease were easily
cultivated in a broth made from the flesh of fowls, which
was carefully filtered until perfectly limpid and sterilized
by heat. A few germs placed in a flask of this liquid,
multiplied for a certain time and then became inactive.
Pasteur demonstrated that this cessation of activity was
due to the exhaustion of the available nutriment. What,
then, would be easier than to make a broth of a definite
strength by extracting the soluble parts of a given weight
of flesh with a given quantity of distilled water? If we
cultivate our germs in such a broth, at a favorable tem-
perature, we should always obtain, at the moment when
the nutriment is exhausted, a virus of practically identical
strength. This reasoning, I may add, has been fully
justified by the many experiments which I have made
with a standard virus prepared in this way.
The number of germs in a drop of such standard virus,
I have never accurately determined, but I assured my-
self at an early stage of these researches that there were
over one million six hundred thousand.
It was not until the 13th of May, iSSi, that my
methods of investigation were sufficiently perfected to
allow the inauguration of a series of experiments by in-
oculating with dilutions of a standard virus. The inocu-
lations always consisted of a single lancet puncture, and
as much of the virulent liquid as would adhere to the
grooved lancet was inserted between the skin and the
muscles beneath the wing.
It will be necessary for me to refer here to some
symptoms of this disease, in order that the reader may
better appreciate the results of these experiments. Ow-
ing to some anatomical and physiological peculiarities
of birds, the secretions of the kidneys are added in the
cloaca to the freces. The kidney secretion of birds is of
a semi-solid consistency, it is in health perfectly white
and is seldom intimately mixed with the bowel contents.
This white secretion of the kidneys, which for conven-
ience I call the urates, is easily seen and examined in
the droppings. The very first symptom which is seen
after inoculation with strong fowl cholera virus is a
slight yellowish coloration of the urates, due very prob-
ably to disturbance of the liver, as this organ is the one
most constantly and most intensely affected in the dis-
ease under consideration. \ day or two later, the drop-
pings arc more fretpient and consist almost entirely of
April 7, 1883.]
THE MEDICAL RECORD.
2>7^
the yellowish urates mixed with an increased proportion
of liquid. The fleshy parts about the head now become
pale and bloodless, the temperature rises four or five
degrees, the appetite is lost, the bird becomes dull,
stu|)id, sleepy, and finally dies within two or three days
from the first symptoms.
Miy 13, i88i, I inoculated four fowls with diluted
virus ; for one the dilution was i to 50 ; for the second,
I to 500; for the third, i to 2,500 ; and for the fourtli,
I to 5,000.' With the first one the urates were slightly
tinged for a day or two ; with the second the urates
were deeply colored, and there was loss of ai)i)etite for a
few days ; with the remaining two the urates showed no
signs of coloration, nor was there any ajiparent change
in the perfect health of these birds. The most impor-
tant result of the inoculations was a slight circumscribed
inflammation, which was noticed in each case at the
point of inoculation the seventh day after the operation.
This local lesion is very ai^parent from the increased
size of the blood-vessels, and a noticeable swelling from
one-fourth to three-fourths of an inch in diameter.
At the time of these experiments, I underestimated
the importance of the lesion just described, for, while I
thought it possible that a slight degree of immunity
might be obtained by means of it, I could not conceive
that a complete insusceptibility would result without the
yellow urates and other symptoms of a constitutional
affection. That is, it was naturally expected that a
mild attack of the fever was necessary to protect against
the subsequent recurrence of the disease.
Being desirous of producing the general fever of as
mild a type as possible, I now inoculated four fowls with
the same virus diluted as i to 1,000. What was my sur-
prise to see each one of these birds succumb to the
disease in its most virulent and fatal form ! I was now
brought face to face with the great obstacle which has
always jjrevented the physiological investigator from de-
veloping an exact science, and which had proved an in-
surmountable difficulty to those who had previously at-
tempted this line of investigation — that is, the individual
peculiarities of living animals.
It was not to be supposed that the birds in the first
experiments escaped because no germs were introduced
with the diluted virus, since in a dilution of i to 2,500
there would be more than 600 germs to every drop, and
in the dilution of i to 50 these would be increased to
more than 30,000 ; besides there was the local inflam-
mation which developed after the punctures had healed,
and with two of the birds a sufficient coloration of the
urates to denote constitutional disturbance.
My experiments have demonstrated, conclusively,
that susceptibility and insusceptibility are only relative
and never absolute conditions. A certain proportion of
fowls will resist inoculation with a drop of strong virus,
but if we increase the dose to ten, twenty, thirty, or sixty
drops, even these may be made to contract the disease.
As we decrease the dose to one-fiftieth, one-five-hun-
dredth, one-thousandth of a drop, we find that the pro-
portion of fowls which contract the aflection becomes
continually smaller and smaller. Measuring the suscept-
ibility of fowls by means of this diluted virus, we find
that it varies to an enormous extent with dift'erent indi-
viduals. In one case a bird died from inoculation with
one-forty-thousandth of a drop, while another resisted
the enormous dose of one drachm, or about two and
one-half million times the former amount.
We will now return to our experiments in the produc-
tion of immunity. The 2d of June, 1881, the two birds
which had been inoculated with dilutions of i to 50 and
I to 500 and recovered, received an inoculation witn
pure standard virus, while the two which had been inocu-
lated with dilutions of i to 2,500 and i to 5,000, were
tested with a dilution of i to 500. Not one of these inoc-
ulations produced the least effect ; the punctures healed
' llet.iils of these experiments will be found in the Report of the Department of
Agriculture for i8Si and 1882, p. 285.
and remained free from irritation as though no virus had
been inserted, and the general health was not in the
least disturbed.
On November 7, 1881, I inoculated two fowls with a
dilution of i to 2,500, two others with a dilution of i to
5,000, two others with a dilution of i to 10,000, and two
others with the undiluted virus. The last two died, as
did one from each of the first two lots. The remaining
four birds had a well-marked local lesion, but no consti-
tutional disturbance, and remained in the best health.
December 6th, all were inoculated with a dilution of i
to 500. This producing no effect, either general or
local, they were reinoculated December 13th with un-
diluted standard virus. Two now showed more or less
coloration of the urates, but no other signs of ill health ;
the appetite and general appearance were perfect
throughout the experiment.
Ten fowls were inoculated November 28th with a
dilution of 1 to 10,000. Of these, three died, two had
mild attacks and recovered, while five had the local
lesion with no general symptoms. December 21st, the
seven birds which recovered from these inoculations
were inoculated with the strongest virus. This was fol-
lowed in one or two cases with yellow urates, but there
was no loss of appetite or dulness, and all remained in
excellent health.
Up to this time more than eighty birds have been in-
oculated with diluted virus, though, as the remaining ex-
periments have only recently been communicated to the
Department of Agriculture, it would be premature for
me to publish details at present. I may say, however,
that with dilutions beyond i to 100,000, I have had no
results, and it appears that inoculations with dilutions of
I to 80,000 would give the local lesion and immunity to
the most susceptible birds, and that the remainder could
then be safely inoculated with a dilution of i to 10,000,
which would 'grant immunity to all or nearly all. ■ The
experiments are still too few, however, to enable us to
be perfectly certain in regard to the strength of virus to
use with the greatest safety. The birds protected in
this way have not only been tested with strong virus, but
they have been placed in infected runs with sick birds,
and in no case has there been a failure to resist the con-
tagion.
From these experiments a number of exceedingly im-
portant conclusions may be safely drawn :
jPirst.—A single disease-germ cannot produce this ex-
tremely virulent disease ; it cannot even nmltiply suf-
ficiently to produce the local irritation at the i)oint of
inoculation. When a quantity of virus was introduced
into the tissues, which should have contained at least
twelve germs, there was no effect, either general or local,
but by increasing this one-third with the same birds, the
local irritation appeared.
Sei-ond. — It is apparent that the local resistance to the
germs fails, while the aonstitutional resistance may still
be perfect, and that in this case there may be a local
multiplication of the organisms for two or three weeks
without any disturbance of the general health.
7y„>^._That this local multiplication of the virus is
sufficient to grant a very complete immunity from the
effects of such virus in the future.
From these conclusions it follows that the most viru-
lent virus may be diluted to such an extent as to become
practically a vaccine, and that in this condition it may
be used safely for producing insusceptibility.
These facts are not exactly what we should have ex-
pected from theoretical considerations, but unless I am
greatly mistaken, they are on this account, even, destined
to modify our ideas' very materially as to the general
principles underlying the contagia and the contagious
fevers. At present I can do no more than refer to this
aspect of the question, leaving the practical applications
to suggest themselves, as I believe they will, to every
one who ponders over the many mysteries connected
with the phenomena of this class of diseases.
0/-
THE MEDICAL RECORD.
[April 7, 1883.
Interesting and important as the results I have detailed
evidently are to the veterinarian and the agriculturist,
they would he more or less out of place in this journal,
were it not for the probability that the germs of the con-
tagious fevers in men and animals are very closely re-
lated organisms, that the mysterious condition of the
animal body, which we call insusceptibility, is compar-
able from all points with the insusceptibility of mankind,
and that the methods by which we can grant immunity
to animals are equally applicable to the human subject.
From this standpoint it at once becomes a matter of im-
liortance to learn if the diluted virus of other contagious
fevers of animals produces either a milder affection or a
harmless local irritation also ending in immunity ; in
other words, is our method of vaccination, with a small
number of very virulent germs, generally a|iplicable to
the various diseases of this class?
In April, 18S1. M. Chauveau ' announced the result of
experiments made with charbon virus, by diluting viru-
lent blood until each cubic centimetre contained from
fifty to one thousand rods of the Bacillus anlltracis, and
injecting this dose directly within the jugular vein. He
did not state how the number of the germs was estimated,
and one would suppose that this would be rather a diffi-
cult matter to accomplish with any degree of certainty,
unless, indeed, an apparatus similar to that used for
counting blood-corpuscles was at hand. M. Chauveau
believed that by introducing the germs directly into the
blood-stream there would be less danger of a fatal result
— a supposition which may be contested from the results
of my e.\))eriments. In his first experiment four sheep re-
ceived a dose of one thousand bacilli each. AW died of
charbon. In the second experiment, two sheep received
about six hundred bacilli each. One died of charbon ;
the other did not show the least symptom of disease. In
the third experiment, one animal received fifty and the
other one hundred bacilli. To the liquid containing the
larger number one per cent, of carbolic acid was added.
No effect was produced by the carbolized virus ; the other
animal had a very slight fever of short duration.
The animals remaining from the second and third ex-
periments, and two others, mall five sheep, received, seven
days after the third experiment, a dose containing about
one thousand bacilli. All died of charbon ; but the one
which had showed slight symptoms of fever in the third
experiment did not die until the seventh day. The death
ot this animal was due to abacterial meningo-encephalitis
— being the usual result of inoculating partially insus-
ceptible sheep with large quantities of virus. It seemed,
then, that this one animal had acquiretl a certain degree
of immunitv'.
In the fifth experiment, five sheep received about two
hundred and fifty bacilli each. All recovered after jire-
senting slight and transient symptoms of fever. Re-
inoculated, six weeks later, with strong virus, four re-
sisted perfectly, while a singlff one died. In this
experiment, the first virus used was taken from a rabbit
which had been dead several days, though perfectly (ire-
served because of the cold weather. We know, however,
from Pasteur's experiments, that when the bacilli are
preserved, either at so high or so low a temperature that
tliey cannot form spores they rapidly lose their virulence,
and, as in this case the strength of the undiluted virus
was not tested, there is some reason to doubt if the dilu-
tion should receive the entire credit of the results.
In the same communication, M. Chauveau records an
observation with the virus of charbon sxtuptomatique,
which corresponds to the black quarter of this country,
and is entirely distinct from charbon. This virus, though
one of the most active known, may be injected into the
veins in considerable quantity w-ithout causing death ; but
a very much smaller dose in the connective tissue infal-
libly destroys cattle and sheep. In December, 1880,
ten sheep had been collected, which, from many preven-
' Coinptcs Rcndus, xcii., 1881, p. 844.
tive inoculations with charbon virus, had obtained a very
complete degree of immunity from this disease. Before
receiving their final test, they were to have a last pre-
ventive inoculation with one cubic centimetre of liquid
extremely rich in bacilli. By mistake, this liquid was
filtered through a cloth that had served in preparing the
virus of charbon syynptomatique. This cloth had been
washed, but a sufficient quantity of virus remained in it
to produce the disease in each of the ten sheep. The
virulent liquid was drawn with the syringe from a high
and narrow vessel, so that for each animal it came from a
different depth. The results were in proportion to this
depth, being mildest with the first and most severe with
the last. The first four recovered, while the remaining
six died. A month later, an inoculation was made in
the other thigh, of those which had recovered, with a
considerable quantity of black quarter virus. The result-
ing symptoms were very mild, but not equal with all.
Those which sutTered the least by the former inoculation
were more intensely affected by the latter.
The observations of .\[. Chauveau are undoubtedly ver\'
important if we look upon them as confirming the doc-
trine of attenuation by dilution, but of themselves they
are plainly insuflicient to establish this doctrine with
either of the diseases with which they are connected.
With charbon all the indications must be drawn from the
last experiment, and this was made with virus of doubtful
activity. The observation with black quarter virus was
not a premeditated experiment, there was no intention
to inoculate with this virus, and, consequently, it cannot
carry the weight of a genuine experiment. At the same
time, viewed in the light of my results with fowl cholera,
these experiments with charbon and the observation with
black quarter are sufficient to show that these viruses are
subject to the general law which my experiments were
first to demonstrate.
Still more recently, M. Peuch,' Professor at the Tou-
louse Veterinary School, has made experiments in the
same direction with the disease known as sheep-pox.
This is a form of variola peculiar to sheep and extremely
fatal to these animals. It has been combated in the
north of France by inoculation, but in the southern de-
partments the losses from this operation were so nearly
equal to those caused by the spontaneous disease that
the ]iractice has been about abandoned. .-\s the danger
in this disease is principallv due to the eruption, and as
M. Chauveau in his experiments with vaccine had
granted immunity to cattle bv hvpodermic injection of
virus without producing any specific eruption, M. Peuch
conceived the idea that bv reducing the number of germs
by dilution, and injecting the liquid beneath the skin a
similar result might be obtained with sheep-pox. His
recorded experiments have been made with seventeen
sheep. Eight were inoculated with a dilution of i to 20,
four with a dilution of 1 to 30, and five with a dilution of
I to 50. The inoculations with the strongest virus (i to
20) produced a general eruption, which followed the
regular course. But with the weakest virus, injected in
half the quantity, the eft'ects were less marked. With
five sheep inoculated with eight centigrannnes of this
dilution a single one presented a very mild secondary
eruption, three had a jnistule .at the point of inoculation,
the fifth had only a slight swelling at this point. All
acquired innnunity.
These experiments, like Chauveau's, are not sufficiently
numerous to demonstrate a great principle, but they are
one more and a very iniiiortant contribution to this end.
In the methods of both of these gentlemen, there is much
to be desired before they could be applied in practice,
especially to such virulent diseases as fowl cholera, with
which a single drop of a dilution of i to 40,000 some-
times causes death. The strong virus which they use
varies greatly in strength, it contains coagula and animal
debris which prevents its even diffusion ; it is in many
' Rccucil de M^dccine Wliirin.iirc, 1882, p. 977.
April 7, 1883.]
THE MEDICAL RECORD.
Z7i
cases difficult to obtain when desired. By my method
tlie virus is obtained of a definite strength ; it may l)e
preserved for an indefinite lengtli of time in cuhivation
tubes, and in a short time can be increased to any de-
sired quantity. These are points which, especially in
endeavors to control the diseases of mankind, must be
considered of the greatest importance.
In presenting a new method for attenuating the active
viruses of contagious diseases, it is, of course, desirable
to know how it compares practically with the method of
M. Pasteur which has recently received so much atten-
tion, and which, in spite of adverse criticism, must be
accepted as a remarkable advance in medical science.
It has not been unusual for men who stand quite high
in scientific circles to speak of Pasteur's method as
though the mitigation in this case was produced bv dilu-
tion ; others of equal eminence have told us that it
consisted in passing the virus through a large number of
cultivations. In reality, it is neither the one nor the
other. Pasteur's first attenuation was made with fowl
cholera virus, and his method with the later ones has only
been changed to suit the peculiarities of the virus of
other diseases. With fowl cholera a cultivation of the
virus was made in sterilized broth, the flask being ar-
ranged to admit filtered air. This was set aside for an
indefinite period, varying from five to eight months, dur-
ing which time the attenuation occurred. A second cul-
tivation, made from this first one after this indefinite
period, was the vaccinal virus. During this time the ac-
tivity of the germs is gradually lessened, but the same
degree of attenuation does not always occur in the same
length of time ; and when jireparing fresh vaccine the
degree of attenuation must be determined by inoculation
experiments.
When the vaccine is once obtained it may be preserved
for a considerable time by frequently renewing the cul-
tivations of it, but this cannot be done indefinitely, as
Pasteur at first announced. This vaccine gradually loses
its strength, no matter what precautions are observed ;
consequently, it must from time to time be renewed, the
setting aside for from five to eight months, and the test-
ing of the activity, which involves much trouble and
expense, to say nothing of the skill required, all nuist
be gone over again as at first. What makes this still
worse, there must be two vaccines, one stronger than the
other, because the weaker vaccine is too inactive to grant
complete immunitv.
With charbon virus, the attenuation occurs more rap-
idly, being complete in less than eight davs for the weaker
vaccme ; but here there is also an obstacle to its prepa-
ration. The virus must be kept at a constant tempera-
ture of 42° to 43° C. to prevent the formation of spores.
If spores are formed, there is no attenuation and the
vaccine obtained will produce fatal effects. Koch and
Klein have each attempted to show that virus could not
be attenuated in this way ; but they undoubtedly failed
by allowing spores to form either by variation of tiie tem-
perature, by the liquids being too shallow, or from neg-
lecting to supply some other required conditions. These
experiments, while they cannot overthrow Pasteur's gen-
eral conclusions, are sufiicient to demonstrate the difficul-
ties and the uncertainties of the method when attempted
by others less skilful than the originator.
With the method of attenuation by dilution, as I have
developed it, most of these difficulties are avoided.
The preparation of the standard virus and its dilution
can be accomplished, with fowl cholera at least, within
twenty-four hours from the time the particle of blood
which originates it is taken from the affected animal.
Xhe stronger the virus, the longer will it retain its full
activity, and, hence, the unmitigated virus is in far the
best condition for preservation, and the dilution can at
any time be made in a few minutes.
Again, the method of Pasteur cannot well be applied
to human diseases, because it requires too many experi-
ments to learn the degree of attenuation. In some
cases, the attenuation does not occur until a few hours
before the death of the virus, while in other cases it may
be weeks or months before. So that, in applying it to
a new disease, there are no indications except those fur-
nished by inoculation experiments. On the other hand,
if we dilute we know that we attenuate. If we introduce
but ten or twenty germs of almost any disease the prob-
abilities are that the effect would be very slight ; if such an
inoculation were unsuccessful, the number could be grad-
ually increased. Surely when many people are exposed
to a deadly plague, it would not be impossible to pursue
this class of investigations. Of course, 1 only mean the
above remarks to apply to those non-recurrent fevers
from which unnmnity may be acquired within a few days
or weeks.
Whether I am right or wrong in considering that this
method of ]ireventive inoculation may, under certain
circumstances, be used advantageously in controlling the
plagues of mankind, it seems to me that the method by
dilution has some incontestable advantages over the
method of Pasteur. I may summarize these as follows :
I. The virus is obtained hy a definite strength. 2. It
may be preserved in the condition in which it retains its
activity the longest time. 3. The attenuation requires
but minutes instead of weeks or months. 4. The ex-
periments to learn the proper degree of attenuation are
less dangerous to the individuals operated upon. 5.
These experiments once made, it is not necessary to
repeat them with every fresh lot ot virus. 6. One virus
and one successful vaccination are all that is required.
7. The amount of virus needed is many times less than
with other methods. Certain disadvantages will doubt-
less be revealed by the exi>eriments of the future, but
their importance cannot be foretold.
I should not be surprised if greater advances are made
by the investigations of the future, for the prevention of
contagious diseases, than have been accomplished in the
past, possibly vaccination in all forms may be discarded,
but at present the question is fairly before the medical
profession — Shall we vaccinate with a large number of
comparatively inactive germs, or with a small number of
those which retain their greatest virulence ?
The solution of such a question can hardly be made
from theoretical considerations, it may even require in-
vestigations which include a large number of individuals,
scattered over a considerable territory and embracing a
variety of diseases ; but, with the principles upon which
these methods depend for their success once understood
by our scientists, it cannot be long before we have the
elements for a complete and satisfactory conclusion. At
the same time, it is not to be forgotten that the method
by dilution, because of the little time required to pre-
pare the virus, might often be resorted to when the other
would be impossible.
In conclusion, I would call attention to the following
points of this communication, which are believed to be
original :
First. — The method of producing a virus of standard
strength.
Second.— 'n-\e fact that germs which usually multiply
throughout the whole body may be compelled to limit
their reproduction to the point of inoculation by redu-
cing the number inserted.
i/;//-,/._That this local multiplication grants an im-
munity from the disease in the future.
Fourth.— T^at a very small number of germs may be
introduced into the tissues with impunity, and are not
able to produce the least efi"ect, either general or local.
Granulated Milk is made by subjecting milk to a
temperature of 130° until the watery part has been evap-
orated. It is then granulated and sugar is added, when
it looks like corn meal. The evaporated milk is not as
solid as condensed milk, and when water is added it can-
not be distinguished from natural milk.
c/'
THE MEDICAL RECORD.
[April 7. 1883
THE INFLUENCE OF EXTREME LATERAL
CURV^^TURE OF THE SPINE UPON THE
COURSE OF LABOR."
By W. M. POLK, M.D.,
n PROFESSOR OF OBSTETRICS, MEDICAL DEPARTMENT UNIVERSITY OF NEW YORK.
The following case is one so interesting to nie that I
cannot forbear presenting it to you to-night. In June
last a lady seeking my services as an attendant in her
first confinement, asked that I make an examination of
her pelvis, that she might know whether any difficulty in
labor was to be apprehended. She was moved to this
by the fact that she was the victim of decided lateral cur-
vature of the spine, a state of things which had existed
for some years.
I made a very careful examination of the pelvis, and
finding it of normal dimensions expressed myself as sat-
isfied that all would go well in the coming labor.
She then told me that before marriage she had sought
the same opinion from one of the most distinguished and
careful obstetricians in our city, and he, after a careful
examination, had expressed himself precisely as I had
done. Thus reassured she went forward to confinement
with all confidence. The sequel showed, however, that
matters were not to end so smoothly as all had expected.
On Friday evening, in the latter part of December, she
sent for me, as labor had commenced. I found her in
excellent condition, mentally and physically. A vaginal
examination proved that labor had just set in. The
cervix was rather higher than is usual even in a first labor,
and the os was somewhat nearer the left pelvic wall than
to the right, showing right lateral obliquity of the uterus.
This, to some extent, being almost a normal condition.
I attached but little imi)ortance to it. The patient now
called my attention to the position of the fundus. An
examination of the exact position of the uterus was now
made, and it was seen that the obliquity was somewhat ex-
cessive. An attempt to push it toward the median line
revealed the fact that it could not be placed and held in
normal position without causing more pain than the
patient was willing to bear. The resistance came from
the left side of the abdominal wall and the left free
border of the ribs. Inquiry showed that for three
months the uterus had gradually been pressing more and
more toward the right, and for some weeks past had
caused a decided bulging of that side. As she expressed
it, she had been carrying the child on the right side.
Thinking position would correct the defect, she was ad-
vised when resting to lie on the left side.
Friday night, Saturday, Saturday night, Sunday, and
Sunday night were passed, and still the patient was not
delivered.
Until Sunday night at twelve, her condition was excel-
lent, the pains though regular were feeble, lender the
influence of morphia she had sleep Saturday night and
Sunday. The condition that existed was " tedious labor "
to an aggravated degree. An observation taken at i
A.M., Sunday night, showed the membranes intact, the
OS about the size of a trade dollar, soft and dilatable,
still out of the median position. Uterine contractions
were regular, but short and inefficient, the organ seemed
to be acting at a disadvantage. A catheter was introduced
into its cavity, and allowed to remain half an hour, the
result was to strengthen its action, but still no progress
was effected.
The condition of the child was excellent, but the
mother began to show signs of exhaustion. The pulse
stood steadily at no, and tlie temperature had reached
ioo|°. It was evident that the woman could not deliver
herself, that dangerous symptoms were appearing, and
that the pathological condition present was tedious labor,
due to inefficient uterine action. The cause of the faulty
action was evidently right lateral obliquity of the uterus,
and this in turn was directly due to the lateral curvature
of the spine and its accompanying pelvic deflection.
^ * Read at a meetins of the Practitioners' Society of New York, Febi-uary a, 1883
This conclusion was reached only after a careful con-
sideration of all that was before us. Tedious labor was
certainly present, no othtr cause of such a labor save lat-
eral obliquity was pt escnt. The inclination of the uterus
was such that the plane of the os looked toward the mid-
dle of the left pelvic waB, while nearly the entire fundus
lay to the right of the median line, so that a rough esti-
mate of the uterine axis, made at the time, found it to
correspond to a line running from the centre of the left
ischium to a point about three inches to the right of the
umbilicus. The organ was freely movable, and no other
tumor was to be found in either the pelvis or abdomen.
All attempts to place it squarely over the pelvic inlet
were prevented by the position of the free border of the
ribs on the left side, aided by the tension of the muscles
attached thereto. The spine was curved laterally to an
extreme degree, the dorsal convexity looking to the right,
the lumbar to the left, the left leg was half an inch shorter
than the right, and the pelvis was displaced so as to meet,
and as far as possible correct the deformity. The right
side was thrown up and forward, consequently the left
was lowered and thrown back, making the axis of the
superior strait strike the abdominal wall to the left of
the umbilicus. The distance from the free border of
the ribs to the iliac crest was one and one-half inch
shorter on the left side than on the right. In other
words, the deformity present was an extreme form of the
more common variety of lateral curvature of the spine.
By looking at the diagram it will be seen at what great
disadvantage the uterus was placed, the position of the
ribs on the left side had evi-
dently thrown it over to the
right, while the centre line of
the pelvic inlet had been dis-
placed to the left, the two
conditions not only intensi-
fying, but tending to maintain
the uterine obliquity. The
observations upon the spine,
thorax, pelvis, and leg were
carefully verified after con-
finement, both upon the pa-
tient and by reference to the
Case Book of Professor Lewis
A. Sayre, who kmdly granted
me access to it, the lady hav-
ing formerly been under his
care.
From all this I was able to
verify the opinion formed at
the time of labor as to the
nature of the difficulty and its course. It was a case of
tedious labor, due to uterine obliquity, which in turn was
due to lateral curvature of the spine. The obliquity
could not be easily corrected because of the position of
the free border of the ribs on the left side.
As said above, the woman could not deliver herself,
making it necessary to apply the forceps. The os was
dilated so as to apply the instrument within the uterine
cavity. Some little traction was needed to get the head
well into the canal. After a while this was accomplished,
and all seemed going well. By the time the head reached
the floor of the pelvis the uterus had shifted its jiosition
over to the left of the median line. Suddenly violent
contractions set in, and, though the patient was com-
pletely under the influence of chloroform, the head was
driven out so rapidly I could not remove the forceps, a
ruptured perineum being the result. This was repaired,
and for a few hours it looked as if we would have a favor-
able termination of the i)ucrperal period, but the persist-
ent elevation of temperature dispelled the hope. Yoi
three weeks we battled with a stubborn attack of puer-
peral fever, finally carrying the patient to a comi)Iete
recovery. Such is the record of this case. That all
questions as to the possibility of some deformity of the
pelvis being present may be met, I will say that in addi-
Explanations — S, spinal column :
A, B. plane of pelvic inlet ; C, D,
axis of pelvic inlet ; E, F, axis of
uterus — down.
April 7, 1883.]
THE MEDICAL RECORD.
375
tion to the examinations made before and after labor, I
took advantage of the anaesthesia to explore the canal
with the hand in the vagina. This, together with care-
ful external measurements, showed that the pelvis in it-
self was normal.
Uterine obliquity as a cause of tedious labor is men-
tioned in every work on obstetrics ; but the variety
mentioned is that in which, owing to relaxation of the
abdominal muscles, the uterine axis is not held in coin-
cidence with the axis of the pelvic inlet. Such a con-
dition is one remedied easily by external pressure and
position. Neither of these sufficed here, owing to the
causes mentioned making the case one of great dan-
ger, calling for the introduction of the forceps through
an incompletely dilated cervix, and the delivery of the
head from above the superior strait, the high force|)s
operation. It would seem, then, that extreme lateral
curvature of the spine, even with a normal pelvis, is a
condition likely to seriously affect delivery.
I am at a loss to account for the fact that such cases
have not been observed and reported frequently, for the
reason that lateral curvature is so common. I can only
imagine that such extreme cases as this, complicating
pregnancy, are not counnon, else our works on obstet-
rics would not be so free from all allusion to them as
now appears.
The condition of contracted pelvis with lateral cur-
vature is known and dwelt upon, but lateral curvature is
not recognized. One always feels nesitation in report-
ing a case which may appear to suggest that his obser-
vation may have been more acute than that of others ;
therefore I do not ask you to accept my conclusions ; I
only ask you to consider them for what they may be
worth.
EXHAUSTION OF BRAIN-ENERGY.
By J. LEONARD CORNING, M.D.,
NEW YORK,
Intimately associated with, and often the direct out-
growth of insomnia is a condition which manifests itself
by a greater or less degree of impairment of cerebral
energy, more particularly in the domain of the psychical
functions. Those who sufifer from this disorder com-
plain that they are quite unable to perform the usual
amount of mental work ; that they are easily fatigued by
a continuation of the same employment for any length of
time ; that the memory for remote as well as recent events
has become unreliable ; that society has become dis-
tasteful to them ; that ambition has deserted them ; that
they are frequently and even profoundly depressed.
Sometimes they complain of fatigue upon even the
slightest bodily exertion, but very often there is no im-
pairment of the motor functions whatever, and the dis-
turbances are purely psychical in nature. Sometimes
those afflicted by this disorder are the victims of various
forms of morbid fear. This fear may be directed toward
extraneous sources or may confine itself to the individual
economy. In the tirst instance it may manifest itself in
a vague dread of being left alone, in a dread of society,
in a fear of open or exposed places or of circumscribed
localities. Again, there may be an ever-present fear of
pecuniary calamity or a dread of a possible loss of social
status, etc.
Where the attention of the sufferer is directed toward
himself, the symptoms often assume the form of hypo-
chondria. The individual imagines that his liver or some
other organ is diseased, that he is about to become in-
sane, that he is about to suffer from a stroke of paral-
ysis, or that he has entered upon some form of insidious
malady, which is sure to result in death.
It is very necessary, however, that the physician should
use the utmost caution before ascribing importance to
apprehensions of these persons. Usually these fears
have only a. subjective significance, and are purely
the outgrowth of a morbid condition of the mind mech-
anism.
Otherwise to be considered are those symptoms which
point directly toward those organs enclosed within the
cranial cavity. Those symptoms are: (i) Great weari-
ness upon the slightest mental exertion, and often total
inability to work at all ; (2) jiain in the region of the
vortex following even slight mental work ; (3) sometimes
frontal headache ; (4) tenderness of the scalp ; (5) a
feeling of constant weariness ; (6) disorders of memory ;
(7) impairment of will power ; (8) sometimes occipital
pain, which not infrequently disappears after a few ap-
plications of the faradic current ; (9) morbid excitability,
which often assumes the form of violent anger upon
slight provocation ; (10) very great depression, particu-
larly during the early morning hours; (11) disorders of
the cerebral circulation, which may sometimes assume the
form of congestion, sometimes of ana;niia, or sometimes
the two conditions may alternate with each other. In
any event the vascular derangements, although, doubt-
less, of s- condary origin, deserve especial attention on
accou-.t of the baneful effects which they in their turn
exercise upon the already demoralized condition of the
central ganglia.
In brain-exhaustion we have to do with a condition of
the ganglia in which the processes of disintegration have
outstripi)ed those of integration, a condition in which the
ganglia are no longer able to hoard up the usual and
requisite amount of explosive energy. Exhaustion of
brain-energy is, therefore, the outgrowth of defective nu-
trition, primarily inaugurated by an illegitimate demand
upon available brain resources. It is the state engen-
dered by an excess of demand over supply.
Treatment of exhausted brain-energy by prolonging the
duration of brain-rest. — If, then, brain-exhaustion be that
condition of the organ in which the mechanism of supply
has become more or less defective, the problem presented
for therapeutical solution is how best to bring the supply
of brain-energy up to the normal standard. I know of
but one method of accomplishing this end, namely, by de-
creasing for a time the expenditure of cerebral energy to
a minimum, and increasing the amount of available
cerebral force. By prolonged sleep it is possible for the
ganglia to hoard up, in spite of the defective mechanism
of supply, an amount of energy proportionate to the com-
parably reduced output of brain-force. Thus, by slow
degrees, the proper co-relation between integration and
disintegration may be re-established. But it is utterly
'useless to hope for such a result at once, as, when the
perverted nutritive conditions have once become estab-
lished, nothing short of prolonged brain-rest can by any
possibility result in the re-establishment of the normal
nutritive processes of the cell economy. In many in-
stances of brain-exhaustion there is present a condition
of anremia, which calls for a tonic treatment. Sometimes,
however, the general bodily' condition is excellent, and
there is no organic or even functional trouble discover-
able e.xcepting the morbid cerebral manifestations described
above. In these, and in fact in a large number of cases
of impaired brain-energy, general faradization and cen-
tral galvanization often aid materially in treatment.
Where there are marked derangements of the function of
sleep, and where the insonmia is not attributable to gas-
tric or other visceral disturbances, sedatives may be em-
ployed with good results in combination with the Turkish
or hot bath. The reaction from these baths is, however,
often too great to be borne by very sensitive patients.
In such cases recourse may be had to tepid baths. The
best soporific effects from baths are obtained shortly be-
fore retiring, and they should be prescribed at this time,
do circumstances admit of it. Exercise is another im-
portant element in treatment, but should never be car-
ried to excess. The effects on sleep induced by horse-
back riding or a brisk walk are often quite remarkable.
In the treatment of those cases of cerebral erethism, in
which a morbid degree of irritability is present during
Z1^
THE MEDICAL RECORD.
[April 7, 1883.
the day, the bromides play a conspicuous part. The
dose will depend somewhat on individual idiosyncrasy,
but five or ten grain doses will often be found to answer.
Where there is a marked determination of blood to the
head, cold baths should not, as a rule, be resorted to.
On the other hand, a warm bath to the body and ice-bag
to the head, will often be found to render the greatest
service.
A change of climate is often very beneficial in these
cases, more particularly from the seaboard to an ele-
vated and dry atmosphere.
Sometimes benefit is experienced from the adminis-
tration of ergot in large doses, but the effects of this
drug are not constant. Where gastric derangements are
present, these cases are very materially complicated, and
nothing very permanent can be hoped for until the stom-
achic conditions have been sufficiently improved to ren-
der an amelioration in nutrition possible.
In a more extended consideration of this and allied
subjects (''Brain-Rest," Putnam's Sons) I have devoted
considerable space to the discussion of the various thera-
peutical questions connected with sleeplessness, on ac-
count of the intimate relationship which subsists between
tlisturbances of sleep, insanity, and functional brain-
trouble.
flcpovts of gEoBpituls.
BELLEVUE HOSPITAL, NEW YORK.
{Reported by Robert T, Morris, M.D. )
A CASE OF DISLOCATION OF THE SCAPHOID AND OS
MAGNUM.
On January 20, 1SS3, Frank M came to Bellevue
Hospital as an " office case," to be treated for an in-
jury which he had received seven days ])reviously ; he
having caught his right hand between a heavy brush and
roller, which are used in polishing paper, and having
forcibly extricated it.
On making an examination I found the hand strongly
adducted and rotated inward, with an unnatural pro-
jection at the carpus anteriorly. At the fourth meta-
carpo-phalangeal articulation there was also a marked de-
formity. In addition to the above the whole radial side
of the thumb was denuded of cuticle. On account of
the tension exerted by the muscles of the forearm, which
the patient kept firmly contracted, it was difficult to
made a diagnosis, and he was j^laced under ether, the
nature of the injury thus becoming apparent. The
scaphoid and os magnum were dislocated anteriorly and
the semilunar, altiiough not out of place, was freely
movable. The fourth proximal phalanx was also dislo-
cated anteriorly from its metacarpal bone. The disloca-
tions at the carpus were easily reduced after pressing
the semilunar forward slightly, and there was no difficulty
in rejilacing the phalanx.
On allowing the patient to come partially out from
under the influence of the ether, the dislocations at the
carpus were immediately reproduced, so that it was
necessary to readminister the anaesthetic. This having
been done, and the bones again put in place, anterior
and posterior splints were applied, and the hand band-
aged in sucli a way that the tendency to adduction would
be overcome.
Passive motion to all of the fingers except the fourth
was begun in a few days, and continued until the splints
were removed, nearly four weeks later. Passive motion
at the wrist and to tlie fourth finger was then proceeded
with, and at the present lime (March 12th) the patient
has a fair amount of voluntary movement at the carpus,
as well as at his injured finger-joint.
The mechanism of the injury to the wrist would seem
to be as follows : The patient throwing himself violently
backward in order to extricate his hand from the ma-
chinery, probably ruptured the external lateral ligament,
and portions of the anterior and posterior ligaments of
the carpus, the dislocation of the bones occurring sec-
ondarily. The ligaments connecting the dislocated bones
together and to adjacent bones were probably ruptured
also, as the scaphoid, os magnum, and semilunar were
individually freely movable. (There was no fracture of
the radius.) Whether the dislocation of the phalanx
took place secondarily to rupture of its ligaments, or
whether the bone in being forced out of place ruptured
its ligaments, it would be hard to say.
^vogvcss of |TEXcdicat J>cieiicc.
Intestinal Movements. — Nothnagel, in a recent lec-
ture (Catiada Medical and Surgical Journal, March,
1883), gave a detailed account of some valuable experi-
ments which he has performed in connection with this
subject. His method of investigation was to keep chlo-
roformed animals, with their abdomens opened, immersed
in a bath (100° F. ) of a half per cent, solution of com
mon salt. He has demonstrated by this method that,
in animals at least, no peristaltic actions occur in unin-
jured intestines. The effect of injections into the rec-
tum was examined, colored fluid being used. It was
found that a small quantity of water had no effect on the
peristalsis. A considerable quantity distended the rec-
tum without exciting any action. Iced water caused ac-
tion sufficient to move the fluid from 15 to 20 ctm. up
the bowel. Olive oil had a similar action. A strong
solution of common salt, forced up by a syringe a dis-
tance of 10 ctm., was carried up, together with a mass of
fcBces, by the antiperistalsis to the caecum. Similar results
were obtained by using concentrated solutions of nitrate
of potash and bromide of potassium. The common salt
injections always caused contractions, which passed both
ways, in a case of ileus in the human subject, an injec-
tion of colored salt solution, which was used during life,
was found, after death, to have reached the ca;cum. The
conclusions to be derived from these experiments are
that, in intestines in a healthy condition, or containing
only unirritating contents, peristalsis only occurs from
above downward, and if there are any irritating substances
in the bowel, antiperistalsis occurs also. To explain the
occurrence of fecal vomiting in intestinal obstruction,
ligature of the small intestines was resorted to. It was
found that, unless irritating substances were introduced
into the bowel, no ascending contractions occurred.
When the intestine is ligatured, the part above becomes
filled and the part below empty. Descending contrac-
tions are generally seen conuiiencing at the stomach and
terminating at the distended portion, and as the disten-
tion ascends higher and higher, the waves of descending
contraction travel less and less, until finally they are lim-
ited to a narrow segment near the pylorus. There is no
such thing noticed as antiperistalsis sufficient to bring
about fecal vomiting. Its true cause is due to the action
of the diaphragm and abdominal muscles. The paralyz-
ing effect of distention of the bowel above the ligature
proves clearly the well-known injurious effect induced
by the use of purgatives in intestinal obstruction. By
increasing the peristaltic contractions, they carry the
contents of the intestines more rapidly and violently to
the seat of obstruction, and in this way the paralysis
vvhicli follows distention is more quickly brought about.
Nothnagel had many opportunities of noticing the
occurrence of intussusception during the course of his
experiments. The invagination always occurred from
above downward, a part that was contracting strongly
slipping into a ])ortion that was at rest. He was often
able to remove these invaginations by injections of salt,
which set up an antiperistaltic movement. Morphia, in
doses of from one-sixth to two-thirds of a grain, has the
power of preventing the antiperistalsis induced by salt
J
April 7, 1883.]
THE MEDICAL RECORD.
zn
injections, but if larger doses are given, from a grain and
upward, then not only does the antiperistalsis appear,
but in an aggravated degree. This anomalous eflfect
Nothnagel ascribes to the small doses stimulating and
the large ones paralyzing an inhibitory mechanism which
is antagonistic to the nervous mechanism stimulated by
a salt solution. This action is comparable to that of
digitalis on the innervation of the heart, small doses
stimulating and large ones paralyzing the inhibitory fibres
of the vagus. The constipation produced by morphia is
thought to be owing to a stimulation of a nervous me-
chanism which other experiments have located in the
splanchnic nerves.
On the Treatment of Infantile Paralysis. — Dr.
Robert J. Lee calls attention to the very marked value
of artificial heat in the treatment of infantile paralysis.
This he illustrates by the case of a girl suffering from this
disease in a severe form, who received no other treat-
ment than hot sponging night and morning, and artificial
heat to the affected limb, after going to bed. This limb
was equal in size to the sound one eight years after the
attack came on, although still paralyzed below the knee.
Dr. Wm. H. Barlow refers to the fact that artificial
heat is an old therapeutic method in the disease in ques-
tion. He considers it always necessary to protect care-
fully the paralyzed limbs, but believes that electro-therapy
and voluntary and passive movements are much superior
remedies to heat. — Journal 0/ Nervous and Menial Dis-
ease, January, 1883.
Micrococci in Cerebro-Si'inal Meningitis. — At a
meeting of a German medical society Dr. Leyden exhib-
ited germs taken from a case of fatal inflammation of the
membranes of the brain and cord. According to him,
there is little doubt that meningitis is due to germs.
Both Klebs and Eberth have observed meningitis after
pneumonia, where micrococci were present in the spu-
tum ; indeed, Eberth detected the same germs in the fluid
exuded from the inflamed meninges as he found in the
pneumonic exudation ; the same authority found micro-
cocci in the pus, from a case of pyocephalus. In puru-
lent fluid, found under the meninges of a school-boy,
aged sixteen, Klebs discovered bacteria in active motion.
Ebert claims to have observed, in the pus from trau-
matic cases of meningitis, germs of a different kind to
those which he had found in septic cases of the same lo-
cal affection. The question remains as to whether idio-
pathic meningitis, independent of wounds, pneumonia,
or pyaemia, be a parasitic disease. Dr. Leyden believes
that it is essentially due to micro-organisms. He bases
his observations on a case under his own observation.
A woman, aged thirty-five, was seized with violent vom-
iting in a railway carriage, on December 22, 1882. As
she was stepping out of the carriage at the Berlin ter-
minus, she was seized with a giddiness, and fell on the
platform. Her face was bruised, and the membrana
tympani of one ear ruptured, some fluid escaping. A few
days later she was admitted into the Charite Hospital,
with inflamed ear, violent headache, and constant sick-
ness. After the other tympanic membrane had become
perforated, and appropriate treatment adopted, the pa-
tient apparently recovered. At the end of last January
all the symptoms recurred, with the more special symp-
toms of cerebro-spinal meningitis, rapidly proving fatal.
At the necropsy, the exudation over the pia mater of
the brain and cord was found to be very abundant, the
otitis had disappeared, and the perforation in each mem-
brane had closed. In the fluid, hosts of micrococci of a
perfectly oval form were found, oscillating freely, and
rather larger than pneumonic micrococci. Some were
solitary, some in pairs, some in chains.
In the discussion that followed Dr. Leyden's demon-
stration. Dr. Baginsky observed that, in children who
had apparently recovered from cerebral symptoms after
the rupture of one membrana tympani as the result of
suppurative otitis, fatal pneumonia sometimes appeared
very suddenly in a few days, and this complication was
probably due to micro-organisms. In Dr. Leyden's case
there were symptoms of intracranial disease before the
patient fell out of the railway-carriage ; but then rupture
of one membrana tympani occurred, discharge escaped,
and thus clear evidence of otitis was proved by the acci-
dent. The distinction between uncomplicated otitis and
mild meningitis is not always easy, and the first disease
alone might have existed before the fall. The rupture of
the membrane admitted air into a suppurating cavity ;
and the suspicion that the subsequent cerebro-spinal dis-
ease might have been a purely secondary affection is
very strong. Dr. Leyden, however, believes that the
micrococci of meningeal pus, as seen in this case, are
more oval, but oscillate less actively than those of pus
simply jjutrefied by exposure to air : in other words, he
endeavors to prove that the meningitis was primary, and
that the micrococci existed within the patient's body
before the injury. — British Medical Journal, March 10,
1883.
Mercury in Intestinal Obstruction. — From an
examination of a large number of cases, Bettelheim has
come to the conclusion that the use of mercury in bulk
(about seven ounces as a dose) is by no means a worth-
less remedy. On the contrary it sometimes saves life in
cases of obstruction of the intestine, not yielding to other
means, which are due to fecal accumulation, ascarides,
twisting or intussusception. No injury, and especially
no perforation of the intestine is caused by it. He
therefore recommends that after the use of the ordmary
means, such as moderate doses of laxatives, opiates,
irrigation of the intestine, changes in the position of the
patient, electricity, and massage, mercury in bulk should
certainly be had recourse to without fear.— The Practi-
tioner, March, 1883.
Inversion of the Sexual Sense. — Under this title
Charcot and Magnan {Archives de Neurologic, Novem-
ber 3, 1882) report six cases of imperative conceptions
respecting sexual matters, which they consider allied to
the sexual perversion of the Germans. The first case
was that of a masturbator, a physician, who felt drawn
to the anal region of females and clothed children for
sexual gratification ; the naked bodies were repugnant
to him. He was disgusted with the idea of paederasty
and sexual intercourse ; there was strong heredity in the
case. In the second case there was also strong heredity,
and the patient felt sexually attracted by the nails of
women's shoes, concerning which he constructed elabor-
ate romances and masturbated while gloating over these.
The third case also had hereditary defect, and felt sex-
ually attracted by white table-cloths, several of which he
stole and was punished for so doing. The fourth patient,
also a victim of hereditary defect, was unable to copulate
with a woman unless her hair was dressed in a certain
way, and she had a night-cap on. The other cases were
victims of nymphomaniacal impulses. There is, it will
be obvious, very little in common between these cases
and sexual perversion as described by Gock, Servaes,
Krijg, Krafft-Ebing, Ulrichs, and others. Dr. Hammond
("Diseases of the Nervous System ") has described a
case where shoes were the attraction, and Van Buren
and Keyes ("Venereal Diseases") a case where a man
was impotent except with women dressed in a peculiar
style. As might be expected, impulses of this character
are very frequent among hebephreniacs. — Journal of
Nervous and Menial Disease, ]sin\xa.xY, 1883.
Sir Erasmus Wilson, although now in his seventy-
fourth year, is not yet past work, his present studies be-
ing F:gyptological. He is the President of the Biblical
Archaeological Society, and Treasurer of the Society for
the Exploration of the Buried Cities of Egypt. He is
also one of the Court of Assistants and late Master of
the Curriers' Company.
3/8
THE ^MEDICAL RECORD.
[April 7, 1883.
The Medical Record
A Weekly journal of Medicine a7id Surgery.
GEORGE F. SHRADY, A.M., M.D., Editor.
Published by
WM. WOOD & Co., Nos. 56 and 58 Lafayette Place.
New York, April 7, 1883.
PROPOSED CHARTER AMENDMENTS AND
THE HEALTH BOARD.
It is well known to many, if not to a majority of our
readers, that there is now pending before our State Legis-
lature a bill containing some radical amendments to our
city charter, and which, if it becomes a law, will have the
effect to reorganize our city government. Ever since
the overwhelming Democratic victory achieved at the
last election demands and promises have alike been made
for such " reform " in the several departments as will
both lighten the burden of the taxpayers, and at the
same time secure a faithful and judicious administration of
the functions of various departments sufficient to meet
the public wants and merit the public confidence. With
this motive in view Mayor Edson, several weeks ago,
sent to the Legislature a bill providing for such amend-
ments to the charter as would in his view meet the best
interests of the city. It certainly had the merit of de-
priving politicians of their power to dictate or to inter-
fere with the Mayor's appointments, and of placing the
responsibility of the city's government where it properly
belongs, in its chief magistrate. This feature not suiting
the politicians, a substitute has been prepared in which
the present power of the Board of Aldermen to confirm
or reject the Mayor's appointments is retained, and
which is openly declared to be for the benefit of a politi-
cal party.
Now we do not propose to discuss in the columns of
The Medical Record any political question whatever ;
but there are a few points in these proposed amendments
to which we desire to call the attention of our readers.
A prominent feature of the bill is the provision for one
headed commissioners in the city departments, with the
exception of those of Charities and Corrections, of Police,
and of Taxes and Assessment. This will remove our
Health Department from its present efficient manage-
ment, and place it directly under the control of political
influence, to which we most seriously object. \\'hatever
may be the result as it regards other branches of the
city government, it nmst be acknowledged that the func-
tions of the Health Department are too manifold and
important to be intrusted to one man, and that man ap-
pointed for political purposes. The Board of Health is
not only executive in its functions, but legislative and
judiciary ; that is to say it has the power of making or-
dinances, sitting in judgment upon nuisances and en-
forcing the sanitary laws. Questions often arise involv-
ing large property as well as sanitary interests, which
need careful consideration and full discussion before be-
ing finally decided. Emergencies are not infrequent
where cool judgment is required, and heavy responsi-
bilities assumed, and where interchange of opinion is
important to intelligent action. These matters are all
of too grave a nature to be exposed to the corrupting
influences of jiolitical manipulations.
We verv well remember when, some twenty years ago,
the New York Academy of Medicine instituted a move-
ment looking toward the rescuing of our public health
matters from the hands of the crafty politician who then
controlled them. We have not forgotten the health
warden who defined hygiene as an offensive gas which
rises from stagnant water. We remember how eminent
physicians and sanitarians labored in this cause of sani-
tary reform until the legislation of 1866 was secured,
which established the present system of health govern-
ment, the efliciency of which was in a few months demon-
strated by the masterly manner in which the outbreak of
cholera during that sumnier was controlled, saving to
the city hundreds of lives and hundreds of thousands of
dollars. The same system is now in operation with such
amendments as have from time to time been suggested by
experience and advance in sanitary knowledge.
The Board of Health has to deal with an almost un-
limited variety of nuisances. It is charged with the reg-
ulation of offensive trades, which involve large amounts
of capital and industry. In settling the question of
manure disposal and cattle driving, it was almost con-
stantly at war with moneyed interests and political in-
fluence, while it is often obliged to call upon the courts
to sustain its actions. It is charged with the care and
treatment of contagious diseases, requiring ambulance
and hospital service, disinfection, and gratuitous vacci-
nation. It has undertaken to see that our citizens are
supplied with pure milk by the arrest and punishment of
persons offering for sale an impure article ; it is also
charged with the duty of supervising the plans for all
tenement and apartment houses, the registration of
plumbers, the establishing of rules for, and the inspec-
tion -of all new plumbing work, a duty second to none
other in importance.
The President of our Board of Health is a gentleman
well known as a man of science and ability, who is just
completing his second term of an office which he has
filled to the eminent satisfaction of the public. His col-
leagues are the President of the Police Department and
two physicians of eminence, one of whom is Health
Officer of the Port. For efficiency and intelligence our
Board has received repeated acknowledgments from
sanitarians at home and abroad ; and as specimens of
its good work we can jioiiit with pride to its control of
small \)0X, and to its more recent success in arresting a
threatened epidemic of typiius fever in the spring of
1881, and again in the following year. Its coimsels are
often sought by health authorities of other cities, who
have copied the general features of its organization and
work with success.
The duty of caring for the iniblic health is too im-
portant and responsible to be influenced by any political
considerations. We cannot afl'ord to take any backward
steps. Such will certainly be the case if the proposed
charter jiasses as it stands.
April 7, 1883.]
THE MEDICAL RECORD.
379
GOVERNOR .BUTLER AND THE CHARGES OF MISMAN-
AGEMENT OF THE TEWKSBURY ASYLUM.
On Tuesday last the Committee on Charitable Institutions
began its investigations into the charges of mismanage-
ment of the Tewksbury Almshouse, made by Governor
Butler in his inaugural message. The Governor has con-
ducted the investigation personally in his well-known
style. The investigation is interesting to the public, not
only from the fact that the whole subject of the care of
the sick and insane poor and of foundlings is brought
forward, but also grave charges are made against the
management in relation to the disposal of the pauper
dead. This latter point is the one on which Governor
Butler lays the greatest stress, and on which the wit-
nesses e.xamined have been most closely questioned.
The principal witness on this subject was a physician,
a graduate of the Harvard Medical School in 1873, who
swore that he dissected at least fifty or sixty babies a
year, besides adults. At that time there were two hun-
dred or three hundred students in the scliool. It may
be that the witness was a more zealous anatomist than
others in the school, and that he was able to obtain more
babies for dissection than others, though he states that
several of his classmates obtained an equal number.
Now, it has been shown that the average number of
deaths of infants under one year of age in this almshouse
during the years 1870-73 was forty-seven. Yet he says
that he was " told " that the babies all came from Tewks-
bury.
The examination of other witnesses brought out the
fact that bodies were removed from Tewksbury at night
in a covered wagon, a very proper method of proceed-
ing, one would think, and up to the present time it has
not been shown that any of these bodies were removed
and sent to the medical schools contrary to the provi-
sions of the Anatomy Act.
Other charges are made against the managers of the
institution, such as neglect of sick and insane inmates,
misappropriation of supplies, etc. Whatever the exam-
ination may show later, up to this time it has only jsroved
the desire of the Governor to make political capital at
the expense of dragging the secrets of the dissecting-
room before the public, which is to the last degree inde-
cent and unnecessary.
KOCH'S REPLY TO HIS CRITICS.
In a recent communication to the Deutsche Medicine
Wochenschrift, Dr. Robert Koch has published an elabo-
rate review of the various criticisms made against his ex-
periments and conclusions regarding the tubercle bacillus.
He premises by saying that investigators have some-
what lost sight of the chief point which he made, viz. :
that tuberculosis must be a parasitic infection because he
caused it by inoculating the isolated parasites. He re-
fers to the fact that in nearly all instances the bacilli
have been found in phthisical patients and in no others.
The few failures he attributes to lack of diligence in ex-
amination, the bacilli being sometimes few in number,
or to want of skill in microscopic technique.
He then takes up the various criticisms and answers
them in detail. We observe that it is only among
Americans and Germans that he finds persons who have
ventured to oppose his views.
Dr. Ephraim Cutter's opinion that Koch's discovery
is not new, and that his bacilli are only the "babies" of
Salisbury's mycoderma aceii is stated without comment.
Dr. RoUin R. Gregg " appears to have considered,"
says Koch, "that microscopical investigations would be
superfluous for the establishment of his views."
Schmidt is commended for his honest desire to find the
bacillus, but is advised that it would have been better if
he had had the patience to wait till he had obtained
good colors and learnt how to use them, before an-
nouncing fat-crystals as bacilli.
Dr. Forniad, of Philadelphia, is complimented as a
more skilful microscopist. Still he has not, Koch
thinks, yet learned to distinguish the bacilli of tubercu-
losis. He is further accused of being a prejudiced ob-
server, having certain preconceived views regarding the
lymphatic system of scrofulous animals. Finally, Koch
states that Dr. Formad cannot give authoritative evidence
upon the subject of tuberculosis until he has learnt to
find the bacilli with certainty, and until he has made
himself familiar with the literature of tuberculous inocula-
tions, especially of those of Cohnheim and Salonionsen,
Hansen, Schuchardt, Baumgarten, and Damsch, and un-
til he has become sufficiently expert in experimental
technique not to let his animals inoculated with wood,
glass, and metal, die of tuberculosis.
Turning then to his German critics, Koch says: "If
one thinks that German medicine cannot bring forth such
blossoms of tubercle-bacilli literature as America, he is
mistaken."
Beneke, who discovered, as he thought, bacilli in the
ethereal extracts of the blood of healthy men, really
found, says Koch, fat-crystals, like Schmidt's.
Cramer announced that by using Ehrlich's coloring
method he had found bacilli in the stools of twenty
healthy persons. Koch cites contrary results obtained
by Gaffky and states that Cramer's bacilli were not
identified with those of tuberculosis.
Balogh found in the Berlin mud, after a rain, bacilli
like those of tuberculosis. Koch, from examinations of
his own, contradicts Balogh, and denies any value to the
inoculation experiments made by that investigator.
Schottelius produced anatomical tuberculosis in dogs
by causing them to inhale masses of finely pulverized
non-tuberculous matter. Koch states that the anatomi-
cal appearance is not the criterion of what is tubercu-
lous matter, and that Schottelius' experiments are com-
pletely contradicted by those of Bertheau and Wigart.
Koch also argues against the view of Schottelius that
bovine and human tuberculosis are not identical.
Dettweiler has tried to show that the bacilli of tuber-
culosis are accompaniments, not causes of phthisis, be-
cause their inoculation is always followed by acute mil-
iary tuberculosis, not by the pulmonary phthisis seen in
man. Koch thinks he would change this view if he had
a better knowledge of the pathology of tuberculosis.
Koch finally reviews Spina's recently published criti-
cism, which has excited much attention, because this critic
alone had repeated Koch's cultivations and inoculations.
Koch says that " Spina's microscopic technique is al-
most entirely difterent from that employed to-day in the
study of bacteria." He speaks of Spina's " mistreat-
ment of the bacilli with coloring methods," compares his
;8o
THE MEDICAL RECORD.
[April 7, 1883.
work with that of Schmidt, and believes that all the new
conclusions of Spina as regards staining are valueless.
Spina's cultivation and inoculation experiments are also
characterized as imperfect and ill-conducted, and as be-
ing but " characatures '' of Koch.
Koch's reply shows how exacting and careful all ex-
perimenters must be in order to test fairly the problem
he has claimed to solve. It shows also Koch's great
confidence in the fact that he alone so far has carefully,
accurately, and impartially studied and settled the ques-
tion.
MORTALITY IN THE UNITED STATES.
The statistics published in the Compendium of the
Tenth Census show a total mortality, during the census
year, of 756,893 deaths. This gives the low ratio of
15.1 per thousand. Allowing for deficient returns, how-
ever, the actual mortality rate is estimated to be about
eighteen per thousand. This is a better showing than can
be given by any other civilized country, so far as is known.
Thus the death-rate for the whole of England, in iSSo,
was 20.5 per thousand ; for Scotland, in 1878, it was 21.3
per thousand. In other European countries the death-
rate is about as follows :
Denmark 20.2 per 1,000
France 24.2 per 1,000
Pru.ssia 27.1 per 1,000
Austria 32.2 per 1,000
Italy 30.2 per 1,000
The death-rate is found to be considerably higher
among the colored race than among the whites. Thus
in the Southern States it is over 17.28 for the former, and
about 14.04 for the latter. This excess of mortality is
attributed to the great number of deaths among the in-
fants of the colored population. As we showed some
time ago, however, the negro race is so prolific that its
actual increase in numbers has been greater, proportion-
ately, than that of the whites, and this despite the fact
that their numbers receive no accessions from outside.
While the males in the United States number nearly
nine hundred thousand (872,857) more than the females,
the death-rate is 15.35 P^r thousand for the former, and
14.81 for the latter. This corresponds with the law that
more male infants are born and more die than females.
The relation of age to mortality is shown in the fol-
lowing table :
Male. Female.
Total number of deaths 390,644 363,874
Ratio of deaths under i year to total deaths. . . . 24.803 21.S3S
Ratio of deaths under 5 years to total deaths. . . 41.951 38.185
Male and
female.
Ratio of deaths between 5 and 15 years to total deaths 8.757
Ratio of deaths between 15 and 60 years to total deaths. . . . 29.966
Ratio of deaths over 60 years 17.24
These figures, if they represent the truth, show a very
marked excess of infant mortality, and one which has not,
we believe, so far been alluded to in the numerous com-
ments upon the census. One-fourth of all the male deaths
occur among children under one year of age. This is a
higher rate than exists even in the city of London, where,
in 1871, it was only 20.8 per cent, for both sexes. In
1862 Dr. Lethcby found that this same death-rate (20 per
cent.) existed, and commented upon it as being very high.
The death-rate among children under five years of age is
also about the same as that for London twenty years ago,
and is certainly a high one. It must be admitted, there-
fore, that our infant mortality-rate is proportionately very
high indeed.
The causes of death could be obtained in only 733,840
cases. They are classified as follows :
Per cent.J
Measles 8,772 ....
Scarlet fever 16,416 ....
Diphtheria 38.398 5-23
Whooping-cough 12,202 ....
Enteric fever 22,902 3- 121
Diarrhceal diseases 65,565 ....
Consumption 9ii55i 12.475
Diseases of nervous system 83,670 ....
Diseases of respiratory system 107,904 ....
Diseases of digestive system 34,094 ....
Malarial diseases 20.261 2.761
Accidents and injuries 35-932 • • • •
Diphtheria, enteric fever, and malarial fever are all
found to be more prevalent in small towns and rural
districts than in large cities. P'or diphtheria and typhoid
the difference in favor of the cities is between five and
ten per thousand on all deaths reported. Consumption
also is less prevalent in the large cities of the North At-
lantic and lake regions than in the rural districts. We
note in this connection, that Colorado, with a population
of 194,327, has a mortality from phthisis of 420, and from
other respiratory diseases of 1,012, the total number of
deaths from all causes being 4,094.
In Florida, on the other hand, with a population of
269,493, the deaths from phthisis were 263, and from
other respiratory diseases 346, the total deaths from all
causes being 3,150. This apparently gives a much more
favorable showing for Florida as a health resort.
Pensacola's Board of Health. — It appears from
the following presentment of the grand jury that the
Board of Health of Pensacola, Fla., is held responsible
for the yellow fever epidemic which occurred there in
September and October last : " We find the Board of
Health of this county have been grossly negligent of
their duties, in that they did not take proper sanitary
precautions previous to the introduction of yellow fever
into Pensacola in 1882, and in the fact of their having
employed an inexperienced and inefticient physician at
the quarantine station, and in that after the yellow fever
had made its appearance here they failed to take the
proper measures for stamping it out, and that they sup-
pressed the information, misleading, not only the people
of our city and county, but of neighboring cities and
States, causing distrust for the future ; and from these
causes we consider them responsible for the loss of many
valuable lives, and of incalculable injury to the business
interests of the city. We, therefore, recommend to the
Governor that he shall appoint a new Board of Health,
and we would suggest such a revision of the
quarantine laws as that it may be made absolutely effi-
cient, either by land or water." The members of the
Board have since resigned.
April 7, 1883.]
THE MEDICAL RECORD.
381
leans of tTtc 'SSJccTi.
The New York Neurological Society held its an-
nual meeting April 3d. The following officers were
elected: Dr. VVni. J. Morton, PresideJit ; Ur. L. Weber,
First Vice-President ; Dr. Fariington, Second Vice-Presi-
dent; Dr. M. J. Roberts, Secretary ; Dr. M. Piitnam-
Jacobi, Corresponding Secretary ; Dr. E. C. Harwood,
Treasurer.
Gift for a Vermont Hospital. — Mr. Chauncey War-
ner has given some property for the establishment of a
free hospital in St. Albans, Vt. An organization for the
building and managing of the institution has been ef-
fected.
A Grave Robbery at Camili.us, N. Y. — A body was
recently stolen from the cemetery at Camillus, N. Y., and
taken to Syracuse, where it was left in the dissecting-room
of the Syracuse Medical College. The officers found it
in this place. It had not been [lurchased by the College,
as the vender was unknown.
NEwppRT AS A Resort for Consumptives. — A con-
troversy is going on in the Boston Medical and Surgical
Journal between Dr. J. H. Tyndale and Dr. H. R. Storer,
regarding the climate of Newport. The former gentle-
man denies the claims of Dr. Storer that Newport is
a favorable climate for consumptives.
Births and Deaths in New Jersey. — According to
the statistical report of the State Board of Health there
were 25,942 deaths in New Jersey in 1882, an increase
of 5,000 over the previous year. There were 8,837 mar-
riages and 23,108 births.
Syphilis in the Monkey. — M. Martineau reports
progress as regards the syphilitic lesions in the monkey
inoculated by him. On the fifteenth day mucous patches
appeared, and the monkey showed signs of constitutional
disturbance. The question whether lower animals can
be affected with syphilis, which seems likely to be
settled by M. Martineau, is not one of scientific interest
alone. The pathology and treatment of the disease can
be greatly helped by a study of it upon such animals.
The Medical Department of the State Univer-
sity OF lowA will insist in future that all applicants for
admission must pass a preliminary examination in the
English branches.
Science. — This is the title of a new journal published
weekly at Cambridge, Mass., by Moses King, and edited
by S. H. Scudder. It is intended to occupy such a posi-
tion as is held by Nature in England. The first num-
bers have been excellent, and the journal promises to be
a help and credit to American science.
We venture to criticise, however, the plan cf intro-
ducing pictures and biographies of living American
scientists. This is a catch-penny practice not counte-
nanced or desired by earnest scientific workers.
Hospital .\buses. — "The Hospital Abuses of Lon-
don" is the subject of a very elaborate and caustic paper
by Mr. Henry C. Burdett, in the current number of the
Nineteenth Century.
Mr. Burdett complains of the very large number of
small, semi-private, special hospitals. These are gene-
rally run in the interests of a single doctor, who superin-
tends it and whom it advertises. Benevolent people are
imposed upon ; the jjrofession and the larger and legiti-
mate hospitals are injured.
The same abuses are appearing in the large cities of
this country. It behooves the profession and the public
to be on the watch against these semi-private, special
hospitals.
The Treatment OF Heart-Complications in Rheu-
matism.— Dr. Sansom's lectures on heart diseases before
the -Medical Society of London have aroused renewed
discussion as to the therapeusis of cardiac complications
in acute rheumatism. Dr. Maclagan has again brought
forward his views as to the value of the salicyl com-
pounds, and especially salicin. He urges that small
doses are ineffectual, but that we should employ large
doses and at frequent intervals, say twenty to forty grains
every hour for si.K hours, or until relief from pain is ex-
perienced. Dr. Maclagan thinks we may, by the early
and free use of salicin, prevent valvular inflammation.
Dr. Sanson), while endorsing much that Dr. Maclagan
says, is not so sanguine as to the preventive action of
salicin.
Sanitary Inspection of Schools in Ohio. — An im-
portant bill for the sanitary inspection of all schools in
Ohio has recently passed the Legislature of that State.
The following are some of its main provisions :
The board of health may take measures and supply
agents, and afford inducements and facilities for gratui-
tous vaccination and disinfection, may afford medical re-
lief to and among the poor of the corporation, as in its
opinion the protection of the public health may require ;
and during the prevalence of any epidemic, may provide
temporary hospitals for such purposes; and the said
board is hereby required to inspect semi-annually, and
oftener, if in the judgment of the board it shall be deemed
necessary, the sanitary condition of all schools and
school buildings within the limits of the corporation.
A New Clinical Journal, the Zeitschriftfiir Klinische
Medicine, is to be edited by lour prominent German
professors, representing the Berlin and Vienna Schools.
These are Frerichs and Leyden, Bamberger and Noth-
nagel. The journal is to be devoted to the cultivation
of internal medicine.
The Alleged Potency of Iodoform in Laryngeal
Ulcers is being questioned by some eminent Vienna
specialists. Professor Schiotter, who claims to have seen
" many thousands of cases of tuberculous ulceration of
the larynx," states that he never saw iodoform do any
good. The Vienna Medical Society has appointed a
committee to report upon the subject.
The Chateauvillard Prize of the Paris Faculty of
Medicine has been divided between Dr. Giraud Teulon
for a work entitled " Vision and its Anomalies," and Dr.
Cadial, for a "Treatise on General Anatomy."
Prolonging the Course of Medical Study in Ba-
varia.'— The Munich Medical Society has presented a
petition to the Bavarian Government asking that the
course of medical studies be prolonged from four years to
five. The petition is widely signed and appears to be
favorably received.
THE MEDICAL RECORD.
[April 7, 1883.
The Alkaline Tannates, e.g., the tannate of sodium,
is said by Prof. Pribram to be a very efficient diuretic,
and useful in dropsies from nepliritis.
Pop-corn as a Remedy for the Vomiting of Preg-
nancy is recommended by Dr. T. C. Wallace, of Cam-
bridge, N. Y. The writer states {Philadelphia Medical
and Surgical Reporter) that for the past four years he
had always found it beneficial, and generally a sufficient
remedy.
The Story of a Stolen Diploma. — A student in
the Medical School of Maine a year ago was jilucked at
his final examination. His diploma, however, had been
made out and he managed to get possession of it. The
party then came to New York and put out his sign. It
was discovered that things were not as they should be,
and a requisition for the young doctor was served on the
Governor of New York. It was not successful, however,
and he continued to practise. A short time ago he re-
turned to Bowdoin, thinking that matters were settled.
He was arrested on the charge of larceny and placed
under $100 bonds (which raises the query whether this is
the legal market value of a diploma). He declined to
contend and was ordered to appear later and receive
sentence.
Dr. William Salisbury Headley died at his resi-
dence, in this city, on March 31st. Dr. Headley was born
at Walton, N. Y. He was educated at Union College,
and was a graduate of the College of Physicians and Sur-
geons of this city. He practised medicine in Syracuse
for a time, but impaired health compelled him to give up
his profession. For the past thirteen years he had been
Assistant Appraiser in the Department of Drugs in the
Public Stores in this city.
Death of Dr. M. A. Wilcox. — Tlie death of Dr. M.
A. Wilco.x, of Halifax County, N. C, one of the oldest
physicians in the State, is announced.
Scarlet Fever and Cerebro-Spinal Meningitis in
Horses. — A writer in The New York Times comments
on the claim of Dr. J. W. Stickler to have discovered a
preventive of scarlet fever in the equine virus. He adds :
" I have long known that scarlet fever exists among
horses, and that it has been recognized, especially by
French veterinary surgeons, but could obtain no infor-
mation about it in New York, although I was well satis-
fied that it lurked among one of the forms of so-called
' pink-eye,' and I have several years ago called atten-
tion to this fact. It is well known, also, that the great
epidemic of cerebro-spinal meningitis among horses, in
187 1, was followed by the greatest outbreak of that dis-
ease among our citizens in 1872. There is some well-
established connection between tlie two. I have long
thought that scarlet fever and cerebro-spinal meningitis
were carried by grooms and hostlers to their own homes,
and perhaps to those of their masters and [latrons, but
could not positively prove the facts, because so much
concealment and prevarication is always covered
around such matters, arising from ignorance and sur-
prise at such notions, more perhaps than from deceit."
Swimming Schools and Public Baths are to bo es-
tablished in Paris. A nominal charge for their use will
be made.
Conviction for the Sale of Adulterated Sul-
phur.— A druggist in this city was lately convicted and
fined $10, at the suit of the State Board of Health, for
selling as precipitated sulphur a mixture of sulphur with
thirty per cent, of plaster-of-Paris.
The Astley Cooper Prize. — The next triennial prize,
founded by the late Sir Astley Cooper, will be awarded
for the best essay or treatise " On Diseases and Injuries
of the Nerves and their Surgical Treatment ; together
with the Operations Performed upon Nerve-Trunks in
the Treatment of Various Diseases, and Descriptions of
the Changes which Ensue in the Structures as well as in
the Nerves Themselves from the Operations." The
money value of the prize is ;^3oo. It is open to the
whole world. Essays must be sent to Guy's Hospital be-
fore January I, 1S86.
The Cultivation of Tubercular Bacilli. — It is
somewhat noteworthy that although a year has passed
since Koch announced his discovery of the bacilli of tu-
berculosis no one has yet repeated his experiments. The
explanation is, no doubt, due to the fact that the experi-
ments are difficult and require a large outlay of time and
money, besides much technical skill. We learn now,
however, that Professor Feltz, of Nancy, has been at-
tempting to cultivate the bacilli, following strictly Koch's
descriptions. He announced recently that all these at-
tempts had i)roved utter failures, although he exactly
followed the directions given by Dr. Koch for this pur-
pose in his original paper. "In presence of my failures,"
he says, " I could not be sufficiently thankful if I were fur-
nished with the necessary information to enable me to
avoid this kind of misadventure : for I would not cast a
doubt, from the facts only which I have just mentioned,
upon those which Dr. Koch has so positively affirmed."
Small-Pox in Nashville has become very prevalent.
About forty-eight cases were reported in two weeks.
Dr. R. S. Huidekoper has been elected Professor of
Veterinary Anatomy and Pathology in the proposed
Veterinary Department of the University of Pennsyl-
vania.
The New Yi)rk Infant Asylum — A Correction. —
In The Record of last week Drs. Gragme M. Ham-
mond, William M. Polk, Cyrus Edson, Lewis H. Sayre,
and T. E. Satterthwaite are reported as members of the
Medical Board of this asylum. We are informed by
these gentlemen that this is an error, as they hold no
medical positions in this institution.
Experimental Investigations into the Nature of
Contagious Diseases in Animals. — We are glad to
announce that the Government has at last undertaken to
make some experimental investigations into the nature
of infectious diseases in animals and the value of pro-
tective vaccinations. The Department of Agriculture
has leased a piece of ground in the suburbs of Washing-
ton to be used as an experimental farm and hospital.
The grounds are being put in order and buildings erected
thereon. Dr. D. E. Salmon, who has for several years
been employed by the Department in the investigation
of diseases of cattle, swine, and poultry, will arrive in
Washington about May ist to take charge of tlie work.
Dr. Salmon will brinj; with him a number of cattle and
April 7, 1883.]
THE MEDICAL RECORD.
3^3
sheep, and the experiments will begin soon after his ar-
rival. The Pasteur system of inoculation will be adopted.
The investigations now to be made will be on a much
larger scale than any heretofore attempted by the de-
partment, and will be conducted with the view of ascer-
taining the origin, causes, and nature of the Texas cattle
fever, pleuro-pneumonia, and hog and chicken cholera,
together with means of preventing and curing these dis-
eases.
Quarantine at New Orleans. — Governor McEnery
has issued a proclamation establishing a quarantine of not
less than ten days against vessels, crews, passengers, and
cargoes from the Mexican ports of Matamoros, Tampico,
Tuxpan, Vera Cruz, and Minatitlan ; Porto Rico and
Jamaica, and the Brazilian ports of Rio de Janeiro, Bahia,
and Pernambuco ; other West India Islands and ports
along the isthmus and the coast of South America to
Brazil ; the Islands of Barbadoes, St. Thomas, Martinique,
Guadaloupe, and Trinidad, and the ports of Colon, Car-
tagena, Savanilla, Baraiiquilla, Laguayra, Georgetown,
and Cayenne. The quarantine will go into effect May i.
It is unusually severe, and practically prevents intercourse
with the specified points.
Dr. Nathaniel Low died at Dover, N. H., April 3d,
aged ninety. He was graduated at Dartmouth in 1S69,
and held numerous offices of trust in New Hampshire
and Maine.
Dr. Joseph H. Bailey, United States Army, died at
his residence, at Kent Cliff, N. Y., April ist, in his
eightieth year. Dr. Bailey entered the United States
Army in 1834, as Assistant Surgeon. He was promoted
to the rank of Captain in 1839. In 1862 he was retired
from the service through a disability obtained in the
line of duty.
Professor Las^que, the eminent 'alienist, died re-
cently, in the sixty-seventh year of his age, after a long
illness, deeply regretted by all who knew him. He took
his degree in 1S46, and became successively " Chef de
Clinique," Hospital Physician, Agrege, and Professor of
the Faculty, and it was only in 1876 he was elected mem-
ber of the Academy of Medicine. He was nominated
Chevalier of the Legion of Honor in 1850, for his zeal
during the cholera epidemic of 1849, ^^'^ ^^^^ promoted
to officer in 1871, in recognition of his distinguished ser-
vices during the siege of Paris. But it was as a medical
jurist in mental cases that he particularly distinguished
himself. Dr. Laseque's literary productions were con-
fined principally to medico-psychological subjects, in
which he emmently excelled, though his contributions to
the " Archives Generales de M^decine," of which he was
the principal editor, bore testimony to the profoundness
of his knowledge of general medicine. He was for some
years clinical professor at the Hopital la Pitie, where his
lectures were well attended, and he displayed great
skill in diagnosis. He also proved himself a therapeutist
of a high order, in which branch he equalled, if not sur-
passed, his former master and friend, the nmch-lamented
Trousseau.
Exhibition of Insects in Paris. — An exhibition of
great interest to the agricultural and industrial world is
to be held in Paris in July next. The exhibition will
comprise different sections of useful and destructive in-
sects, showing their products in a raw state, the appa-
ratus and instruments employed in their transformation
for the various purposes of arts and manufactures, as
well as the means adapted for the destruction of injuri-
ous insects. During the exhibition an insectological and
an agricultural congress will also be held. The insecto-
logical congress will treat of the nature and importance
of the injury caused by insects, the means employed for
their destruction, and those proposed to favor the de-
velopment of birds and reptiles which contribute to their
destruction. The phylloxera and its habits will be par-
ticularly treated of, and sericulture will form a very
important section of the exhibition. The agricultural
congress will study the creation of artificial hives and
the most practical means for increasing the production
of honey. The exhibition, which is to be organized under
the patronage of the Minister of Agriculture, will take
place at the Palais de ITndustrie.
Gay-Lussac, the distinguished chemist and son of the
illustrious '' savant " of the same name, died recently in
Paris at the age of sixty-three years. His works on
chemistry are well known, but those on metallurgy were
particularly appreciated.
A New Dolmen has just been discovered at St. Pierre
Quiberon in Brittany. The dolmen contained four skele-
tons in a perfect state of preservation, and in one corner
was found some twelve or fifteen skulls. Among the
bones were also found two hatchets in silex, a long pin
in bronze, and some fragments of pottery. M. Gail-
lard, of Plouharnel, who was charged with the restoration
and the preservation of Celtic monuments, immediately
resorted to the locality and had a photograph of the dol-
men and the skeletons taken. Judging from the position
in which the latter were found, one would conclude that
they were thrown there anyhow. This discovery is con-
sidered very interesting, and M. Gaillard states that it
will throw some new light on the question of Celtic mon-
uments. Up till now skeletons or loose bones had not
been found near dolmens or menhirs. The skeletons of
Quiberon would therefore appear to justify the hypothesis
that the stones there found formed part of the monu-
ments indicating the places of sepulture.
The Annual Commencement of the Columbia
Veterinary College and School of Comparative
Medicine was held at Chickering Hall, March 29th.
Twenty-five students were graduated, this being one of
the largest classes ever graduated in the city. The vale-
dictory was delivered by Dr. Henry C. Slee,of Brooklyn.
The degrees were conferred by Dr. Alexander Had-
den. President of the College. Junior certificates were
awarded by the Dean, Dr. E. S. Bates, to a large class.
The prizes, which were numerous, were awarded by Pro-
fessor Hubbard W. Mitchell. Judge Rufus B. Cowing
delivered the address to the graduates. Hon. Andrew
L. Soulard, delivered the concluding address. The audi-
ence was a very large one.
The New Medical School in Boston and " Sar-
cognomy." — On Monday last, the College of Thera-
peutics, being the " medical department of the Ameri-
can University," was formally opened. The medical
department of this great institution, by the way, is the
584
THE MEDICAL RECORD.
[April 7, 1883.
only department to be opened at present. The princi-
pal address was made by Dr. J. R. Buchanan, the pres-
ident. He states that "the college will have the
scientific basis of Sarcognomy, a revelation of the
philosophy of the human constitution, explaining the
relations of soul, brain, and body." It is, perhaps, un-
necessary to remark that the " University " hopes to issue
diplomas, for a consideration, to a large number of
graduates.
Suicide of a Physici.'^n. — Dr. John W. Ferguson,
of Charleston, S. C, was found dead near Savannah,
April ist. He is supposed to have committed suicide.
%Umcxo5 imd Notices.
Manual of Gynecology. By D. Berry Hart, M.D.,
F.R.C.P.E., Lecturer on Midwifery and Diseases of
Women, School of Medicine, Edinburgh, etc., and .\.
H. Barbour. M.A., M.B., etc. Vols. I. and II. With
Plates and Woodcuts. New York : Wm. Wood & Co.
1883.
It was a wise choice on the part of the publishers to se-
lect Hart and Barbour's •'Gynecology" for the opening
volumes of their Library for 1883. The treatise before
us is different from all other works on diseases of women
with which we are acquainted, and for the general prac-
titioner, if not for the specialist, this new manual is in
some respects superior to them. In the first place, it
does not reflect the bias of a single mind, nor does it
represent the system of an exclusive school. It is not a
distinctively Englisli, .-American, French, or German
gynecology, and yet it is somewhat of all of these. It
might be supposed from the international character just
alluded to that it was confusing on account of the multi-
plicity of counsel offered ; but the judicious eclecticism
of the authors has enabled them, in most instances, to
steer clear of such a fault.
We cannot attempt to analyze seriatim the different
sections of the work, but we may give some idea of the
scope of the manual by a cursory examination of the plan
of arrangement of the subject matter. The entire trea-
tise is divided into two parts, the first dealing with anat-
omy, physiology, and methods of gynecological examina-
tion, the second being reserved for the detailed description
of diseases of the pelvic organs. We liave no hesitation
in stating our preference for the first part. Here Dr.
Hart's personal studies have enabled him to present a
well-worn subject in an original and attractive shape.
The style, however, is ofter marred by poor diction, the
result, in many instances, of forced briefness, while yet
the desire to be explicit, is evident throughout. In a
second edition these faults will doubtless be largely
remedied.
Part Second, forming the main bulk of the manual,
may be called a well-iliustrated and lucid epitome of
modern gynecology. The different diseases of women
are one by one discussed, generally in a satisfactory man-
ner. AV'e are pleased to note the absence of excessive
enthusiasm about favorite methods of treatment or the
broad enunciation of pet theories of etiology. The au-
thors are fond of giving facts, and it is to be hoped that
this fondness may prove contagious. All the subjects
are not evenly dealt with; but perhaps that is excusable,
being an inherent difficulty of first editions. There is no
doubt in our mind tliat Hart and Barbour's "Gynecology "
will soon be one of our most popular manuals. The
mechanical execution of tlie volumes is excellent. What
with good i>aper, large, bold type, clear woodcuts, and
some really satisfactory plates, the publishers may be
complimented upon having turned out a valuable work
in a proper and becoming dress.
A Practical Treatise on Diseases of the Skin. By
James Nevins Hyde, .A..M.. M.D., Professor of Skin
and Venereal Diseases, Rush Medical College, Chi-
cago, etc. Philadelphia: H. C. Lea's Son & Co.
1883.
In this treatise of 560 pages Dr. Hyde has presented
us with the main features of dermatology as they appear
to-day. No claim as regards completeness can be made
for the present manual, but in a clear, concise, and
practical way the different diseases of the skin are pre-
sented in their various aspects of etiology, symptoma-
tology, diagnosis, prognosis, and treatment. For the
student and practitioner the book might have been made
more valuable still by discarding altogether the more or
less artificial and arbitrary subdivisions and varieties of
the commoner dermatos-es. The dermatologist proper,
on the other hand, will probably be inclined to take the
author to task for too much condensation and simplifica-
tion ; but as the book was written for the former class,
their needs alone should be consulted. On the whole,
the work is a commendable one, and will not fail to win
the appreciation that it well deserv'es.
A Text-Book of Pathological Anato.my and Patho-
genesis. By Ernst Ziegler, Professor of Pathologi-
cal .\natomy in the University of Tubingen. Trans-
lated and edited for English Students by Donald
M.\cAlister, M.A., M.B., .M.R.C.P. Part I. Gen-
eral Pathological Anatomy. London : Macmillan &
Co. 1883.
Dr. Ziegler's treatise on patjiology has quickly achieved
a merited popularity in Germany. It is now made ac-
cessible to the English student, and will, without doubt,
be found by him a welcome guide-book in this depart-
ment of medicine. The great merit of the present work
lies in its elementary simplicity, in its clearness, and in
its positiveness. In many existing manuals the reader
is confronted by the simple narration of the conflicting
views of difterent observers. And thus the task of
gleaning the author's personal convictions often becomes
a sorely perplexing one. Not so with Ziegler's manual.
He has carefully filtered contending views through the
media of a critical mind and extensive personal investi-
gation. And he presents the result as a clear solution
of existing knowledge on pathology. That there needs
must be a tinge of individuality about a work thus pre-
pared goes without saying. But we have no reason to
regret this. It rather makes the book a more even and
pleasant one to read, and in no way detracts from its use-
fulness.
The work is divided into seven sections, and we
must content ourselves with simply mentioning the sub-
jects described, as space forbids our examining each one
in detail. Section one deals with the malformations,
and though short is satisfactory. The second section is
devoted to a consideration of anomalies in the distribu-
tion of the blood and of the lymph. Retrogressive dis-
turbance of nutrition are next discussed in a very com-
plete way. Then the progressive or formative disturb-
ances of nutrition are examined. The fifth section is an
interesting and important essay on inflammation and
inflammatory growths. Section six is devoted to an ex-
cellent expose of the intricate subject of tumors. The
seventh and last section deals with parasites, and we
may conclude by saying that we know of no student's
text-book which presents tiiis branch of pathology in so
perfect and yet elementary a manner.
We must also congratulate the translator and editor
on the good judgment which he has shown in making
some needful alterations and additions. We hope soon
to see the work completed.
Fluid Extract of Coca is said to cause anaesthesia
of the pharynx when brushed upon the mucous mem-
brane.
April 7, 1 883. J
THE MEDICAL RECORD.
585
^%epox*ts of .Societies.
%'
THE PRACTITIONERS' SOCIETY' OF NEW
YORK.
Stated Meeting, February 2, 1883.
James B. Hunter, M.D., President, in the Chair.
Dr. Robert F. Weir related the liistory of a case of
HIP-JOINT AMPUTATION, IN WHICH DAVV's RECTAL ROD
WAS SUCCESSFULLY USED.
The patient, a boy seven years of age, had received, in
the autumn of 1881, a severe fall, striking upon the right
knee. One month later a swelHng appeared in this re-
gion, which continued to grow, with some pain and some
depreciation of general health. Nearly a year later the
boy was admitted to the New York Hospital. At that
time the tumor had grown so as to involve the thigh-
bone, and to reach from the knee to within an inch of the
trochanter. Amputation at the hi|i-joint was decided
ripon, but the pathological conditions made it necessary
to give up the idea of attem])ting the most rapid method
of operating, i.e., by anterior and posterior flaps. In-
stead of this the slower procedure of making a circular
division of the muscles a little lower down, then gradu-
ally working up to the joint, was determined upon.
The control of the hemorrhage in such cases could be
made in three ways : either by an abdominal tourniquet,
bv the use of Trendelenberg's transfixing rod (wiiich is
passed for the anterior incision in front of the bone, am!
then a rubber tube is wound half round the limb and
caught in a figure of 8 turned over the jjrojecting ends of
the rod, in this way compressing the vessels, after which
the flap is made, vessels secured, and the same procedme
resorted to for the formation of a posterior Hap), or by
tlie employment of a rectal rod. This latter method was
suggested by ISIr. Richard Davy in 1878, and has since
been resorted to some twenty-two times, and with very
good results. The rod, about two feet long and the si/e
of one's finger, is passed up the rectum about eight
inches, until it reaches the common iliac artery, which it
presses against the subjacent structures. In this case
the rod (a syringeful of oil having been first thrown into
the bowel) was very readily passed up the rectum on the
right side, and rested nearly parallel to the spine ; the
outer end was then tilted up and the artery easily con-
trolled. There was a little slip once during the oiieration,
and a spurt of blood, but this was promptly stopped.
The vessels were secured by bull-dog forceps and liga-
tured. The total amount of blood lost was only two ami
a half ounces. The wound was dressed \yith bichloride
of mercury dressing, and left open in its lower half The
patient recovered very satisfactorily and was shown to
the Society. The tumor was a round-celled sarcoma of a
very juicy nature and likely to return. It had its origin
in the bone, however, and some authorities think that 111
such cases a return is less probable.
There is one point in relation to the use of the rod
which is of interest in other than a surgical point of view.
In the region compressed by this rod the
URETER
is also found, which tube we sometimes wish to compress
in order to determine the comparative condition of the
two kidneys. Dr. Sands suggested some time ago, in
trying to acquire a knowledge of the condition of a single
kidney, the jjassage of the hand into the rectum and
compression of the ureter thereby. The speaker thought
that, by the use of the rectal rod, this might be better
done, and for the accomplishment of this idea one end
of the rod had been broadened and flattened.
In seven of the cases in which the rectal rod had been
used for the control of hemorrhage in hip-joint amputa-
tions, there had been only a total of seven ounces of
blood lost. One accident only had taken place in its
use, which occurred in the experience of Mr. Davy him-
self In this case, narrated in the Medical Netvs of July 8,
1881, twenty-four hours after amiiutation at the hip-joint,
peritonitis set in, due to perforation by the rod, and the
patient died. In this case, hovyever, Mr. Davy ' had been
experimenting with a little different instrument. What-
ever risk, and it is jirobably slight, is connected with its
employment is confined to the control of the right iliac
artery.
With reference to the amputations at the hip-joint in
general, by common consent surgeons use the circular
method adopted by the speaker, if it is practicable, since
the risk is less. It is even suggested by F. Jourdan that
one should cut low down, and dissect the bone out of its
bed where possible, so as to leave a greater length of soft
parts. The mortality is thus diminishetl, and the stump
furnished is a good one.
In the discussion which ensued Dr. George F.
Shrady said that he had seen the ojieration in question,
and was much pleased at the readiness with which
hemorrhage was controlled. Dr. Shrady remarked that
in Davy's fatal case the right iliac artery was compressed.
It seemed to him that there was an anatomical reason
why the rectum, which was situated to the left, should
suffer from injury under such circumstances.
Dr. a. H. S.mith said that when a student, and at-
tending one of Dr. Carnochan's clinics, the idea sug-
gested by Dr. Weir had occurred to him, viz., that it
would be better to make the section lower down and dis-
sect out the bone from its bed.
Dr. Weir said, in response to a question, that there
was no difficulty in his case in finding the artery and
compressing it. The compression did not increase arte-
rial tension, since it cut off only the circulation of one
limb. The rod had this advantage over the abdominal
tourniquet, that it did not compress the viscera, and
thus, perhaps, interfere with respiration.
Dr. Polk asked how long the ureter would have to
be compressed in order to collect sufficient urine from
the other kidney.
Dr. Weir said that in one Case which Dr. Sands
tried, the ureter was compressed for fifteen or twenty
minutes. During this time he collected about half an
ounce of urine. He did not think that pressure for that
length of time would do any harm.
Dr. Polk had been making some experiments in this
direction. He had found that by taking an ordinary
sound and giving it a double curve, then introducing it
into the female bladder and pressing the urethral curve
against the wall of the pelvis, the other part of the sound
comes square across the track of the ureter. Then by
introducing a finger into the rectum and pressing against
the sound, the ureter can be occluded completely. In
order to test this, the speaker had made the following
experiments on the cadaver.
He opened the ureter just below the kidney. Then
having introduced the sound in the manner described
and occluded the ureter, he injected water into its upper
open end by means of a syringe. Not a drop of water
flowed through the ureter, although he had dilated it to
the point almost of bursting. He was unable to detect
any special erosion of the mucous membrane in conse-
quence of the ])ressure made. The experiments were
performed on two women and one man. The question
was whether the bladder in the living subject would
stand this sort of treatment.
Dr. Weir said that the sound left in the bladder for
some time does not cause any serious trouble. He was
much pleased with Dr. Polk's idea, and did not see why
it would not prove jiracticable.
^ Mr. Davy, in the Lancet of February 17, 1883, speaking of his accident, says
that his rod has now been used over forty times, twenty of which were on the right
side. Under its use there was 65 per cent, of recoveries after amputation at the
hip-joint. In seven deaths the rectum had been carefully e.\amined. and in only
one (the abuve) was there any injury to the intestine found.
r,86
THE MEDICAL RECORD.
[April 7, 1883.
Dr. Sexton asked if it would not be possible to ca-
theterize the ureter with a suitable instrument.
Dr. Hunter said that he had seen Dr. Emmet do
this once in a female.
Dr. Polk thought it quite impracticable ordinarily,
even in the female. Schroeder had done it once.
Dr. Dan,\ said that the pressure of the urinary secre-
tion was quite exactly known, at least in the higher
mammals. The rate of How of urine normally was about
an inch a second. It was influenced by the administra-
tion of ether, however. Emmet had asserted that
THE FLOW OF URLN'E OFTEN CEASES IN ETHER NARCOSIS.
Dr. Hunter said that on the other hand it w-as some-
times increased in tliat condition. In one case the
urine was ejected almost in a spurt.
Dr. Polk read the paper of the evening (see p. 374),
which was entitled
THE INFLUENCE OF EXTREME LATERAL CURVATURE OF
THE SPINE UPON THE COURSE OF LABOR.
In the discussion Dr. Polk, in response to inquiry, said
that the patient had been under treatment for two or three
years, but he did not think that any of the trunk-muscles
had been weakened thereby.
Dr. V. P. GiBNEV said that he thought Dr. Polk's
view was correct, and that the observation made was a
new and important one. Such cases would be apt to
escape the attention of orthopcedists, because they are
rarely seen by them after twenty years of age. It was
a common thing in such cases of curvature to have the
abdominal organs compressed down into the pelvic cavity,
thus, perhaps, affecting the uterus. Ladies who had had
Pott's disease had frequently asked him whether they
could get married, and he had generally discouraged
them.
The exaggerated form of curvature which Dr. Polk
described was not very common. A great many persons
have a slight deformity ; they get treated for a time, the
curvature ceases to increase, and tiiey give up treatment.
They go through life with a slight deformitv which is not
noticed.
Dr. Hunter had attended one case of labor in which
the lady was the subject of Pott's disease. The patient
had suffered from this trouble for two years, and married
while still uncurcd. She had a normal labor, but the
child was very small, weighing only three pounds. The
disease was low down at about the fourth lumbar vertebra
where there was a very decided prouiinence. There was
no contraction of the pelvic outlet.
Dr. Gibney thought it important to know when the
Pott's disease developed. In cases where the disease
came on early, even if it was slight, it often affecteti the
growth, the stature was small, the pelvis also might be
small. It was further worthy of note that a jsatient mav
have Pott's disease, and often does have it, the symptoms
being so slight that years may elapse before the Aict is
recognized. Then some one is examining for the cause
of certain pains considered neuralgic and finds the ky-
phosis (long since- solid), and perhaps an old residual
abscess just now coming to the surface.
Dr. Weir said that it seemed a fair inference, since so
many women had lateral curvature, that Dr. Polk's case
was a very exceptional one. He could recall two cases
in which there was very great lateral curvature, and in
which there had never been any trouble during labor.
Dr. F. p. KiNNicuiT read a short paper entitled :
A REPORT OF A CASE SHOWING UNUSUAL SUSCEPTIBIL-
ITY TO THE SCARLET-FEVER POISON.
In the discussion Dr. C. L. Dana related the case of
a medical friend, who before the age of twenty-one had
suffered from five attacks of scarlet fever. In each case
the symptoms had been well marked. Desquamation took
place, and m most of the attacks albuminuria was present.
The Society then adjourned.
NEW YORK PATHOLOGICAL SOCIETY.
Stated Meetiiii^, March 14, 1883.
George F. Shrady, M.D., President, in the Chair.
Dr. T. E. Satterthwaite, from the Committee on Mi-
croscopy, made the following report ; (i) That the tumor
of the rectum presented by Dr. Robert Newman at the
stated meeting held February 28, 1883, was a cylin-
drical epithelioma; (2) that the placenta presented by
Dr. Tanszky at the same meeting was the seat of waxy
degeneration ; (3) that the specimens oi metritis desiccans
presented by Dr. Garrigues at the stated meeting held
January 24, 1883, contained smooth muscular tissue.
Dr. Satterthwaite also presented specimens removed
from the body of a dwarf upon whom Dr. Richardson,
of Philadelphia, a few years ago, performed
porro-muller's operation.
The patient died of acute Bright's disease. There was
a ventral hernia, one of the results of the operation, but
it had been so easily supported by a truss that it had not
given the woman marked discomfort. The vagina, the
cervix uteri, and surrounding tissues were presented and
showed the cervical canal intact and containing mucus.
The complete history of the case has already been pub-
lished by Dr. Richardson in the American Journal of
the Medical Sciences.
Dr. W. p. Northrup presented a specimen of
congenital cvst of the kidney — absence of the
ureter.
" k male child, aged four months and one week, died
in the New York Foundling .Asyhun with gastro-intes-
tinal catarrh and broncho-pneumonia. There was also
cranio-tabes.
The riglit kidnev was about twice the normal size. It
seemed normal ; the ureter and bladder were in normal
condition. The left kidney was a monolocular cyst.
There was entire absence of the ureter. The pelvis
seemed to be a part of the common cyst.
" Remarks. — Virchow has written an elaborate article
on cysts of the kidnev. ' In all but two cases both kid-
neys were affected.' In cases of cystic kidney malfor-
mation of the pelvis or ureter or bladder were generally
found. The theory he gives is of intra-uterine inflam-
mation from impaction of uric acid in the straight tubes,
obstruction, dilatation of tubules, Malpighian capsules,
until the whole kidney is involved."
Dr. Northrup also presented a specimen of
calculous pvelo-nephritis.
" A female child, aged thirteen months ; foundling.
First appears on the books of the New York Foundling
Asylum, ' Aged one day ; condition miserable.' Four
days after entrance was put into the care of a wet-
nurse out in the city and brought to the Outdoor De-
partment from time to time. Three months later is an
entry, ' Condition poor ; vomiting, purging ; sprue.'
Nine months later, 'Pale, thin ; bowels regular.' One
month later, and one month before death, was returned
to the hospital very much emaciated. Over both lungs
were well-marked signs of consolidation. A week later
diarrhoea set in again. From this time the child wasted rap-
idly, developing no new symptoms and showing none at
any time referable to the urinary tract. It died Febru-
ary 6, 1883.
"Autopsy. — Body: Emaciated; excoriations about
buttocks; moluscum sebaceum on the face. Lungs:
Broncho-pneumonia of both in posterior portion of up-
per and lower lobes. Heart: About two drachms clear
serum in pericardium ; heart itself normal. Spleen :
Normal. Stomach : Moderate congestion and increase
of mucus. Small intestine: Inflated, little solid material;
mucous membrane tiiin, pale; mesenteric glands enlarged.
Large intestine : Membrane dusky red in linear patches,
and increase of mucus ; intestine em)ity. Liver : Closely
April 7, 1883.]
THE MEDICAL RECORD.
387
adherent to the diaphragm, the abdominal walls, and to
the tissues covering tiie right kidney; hepatic sub-
stance shows no gross change. Left kidney : Somewiiat
enlarged ; in its pelvis is a calculus moulded to its cavity
and filling it ; pelvis not dilated, ureter normal. Right
kidney : Enlarged to twice the size of its fellow, tightly
adherent to the surrounding tissues, capsule thickened
and adherent. On section the whole of the spongy
fluctuating mass found perforated with cavities radiating
from the pelvis to the periphery, and these cavities are
filled with grayish, ropy pus. In the pelvis are three or
more calculi, varying in size from a pea to a filbert.
Ureter is dilated and filled with ropy pus ; its mucous
membrane is thickened, granular, and red ; its orifice at
the bladder is shghtly larger than that of the left ; no
obstruction. Bladder contains pus from the right ure-
ter, but its mucous membrane looks normal.
"On examination the calculi are found to be uric acid.
The left kidney shows well-marked parenchymatous in-
flammation, degenerated epithelium, engorged capilla-
ries, hyaline casts. Right shows all gradations from
moderate parenchymatous degeneration, engorgement of
capillaries to interstitial hemorrhage, inflammatory infil-
tration, necrosis, abscess detritus. To summarize, the
left kidney shows parenchymatous nephritis with calculus ;
the right shows calculous pyelonephritis or suppurative
nephritis ; right ureter shows dilatation and inflamma-
tion.
"The inflammation obviously arose from the irritation
of the calculi. In the right the pyelitis became purulent
and e.vtended along the straight tubules until nearly the
whole kidney was involved. It also extended down the
ureter to the bladder, but did not set u|) inflanuuation
there.
" Hemarks. — Civiale, in 5,900 cases, found 45 per cent,
of calculi in children. Neussauer gives the following
table of frequency of calculi : From three to twelve
months, 1.55 ; from twelve to twenty-four months, 1.55 ;
from two to four years, 27.6; from four to five years,
12.5; from five to seven years, 22.4; from seven to
twelve years, 17.7; from twelve to sixteen years, 3.63.
The most common calculi are the uric acid, and occur
more often in males than females (Gerhardt)."
Dr. Northrop also presented a specimen of
ENLARGED BRONCHIAL GLANDS AND FALSE CROUP.
"Male; aged eleven months; New York P"oundling
Asylum. In November, 1882, the child had broncho-
pneumonia. From the urgent symptoms the patient re-
covered after about three weeks. The emaciation and
cough remained persistent. Child very white and pinched.
The character of the cough simulated very closely whoop-
ing-cough — periodic, spasmodic, severe. Rales heard
over both sides of chest.
"Two months later there were diarrhoea and vomiting.
Cough continues ; child pale and thin. Three months
later, a week before death, it was taken again with acute
broncho-pneumonia. On the following evening laryn-
geal dyspnoja developed and the symptoms very urgent
and severe. On the following day the dyspnoea became
less, and did not again become severe. Breathing con-
tinued more or less strid\ilous until death.
"Autopsy. — Body emaciated; both sterno-costal re-
gions depressed ; brain normal ; larynx normal. Right
lung : Adherent by tough, slender, scattered filaments
over anterior and lateral surfaces ; posterior surface cov-
ered with recent fibrin ; extensive consolidation of the
lower and posterior portion of upper lobes. Left lung:
Consolidation of about two-thirds of lower and posterior
portion of the upper lobe ; recent fibrin over the lower
lobe. Bronchial glands all enlarged, soft, dusky, ap-
parently the seat of recent change ; one large, cheesy
gland, about one inch and three-fourths by one inch, was
tightly wedged up into bifurcation of the trachea, com-
pressing both bronchi ; the gland rides up behind trachea,
IS firm, exerts pressure forward upon the trachea, and
upward and forward upon the bronchi, diminishing the
calibre of both. Heart normal ; liver large and fatty ;
spleen anemic, reddish, size normal ; kidneys normal.
Stomach : Increase of mucus, red in linear jiatches ;
empty. Intestines : Mesenteric glands enlarged, dusky ;
solitary follicles swollen ; Peyer's patches not changed ;
crease of mucus. Large intestine appears normal ; con-
tents yellow and tenacious."
Dr. Northrup remarked that the case was interesting,
because it illustrated the irritation which may arise from
pressure of an enlarged gland upon the bronchi or the
vagus nerve. There was a spasmodic cough and a
nightly attack of what appeared like false croup.
"Dr. B. Livingston said that he had had a similar case,
in which there was no history of cough. The enlarged
gland was an inch and a half in its vertical and three-
fourths of an inch in its antero-posterior diameter, and it
seemed to press ujjon both bronchi and also upon the
oesophagus, but there was no difiiculty of swallowing.
There was no croupy cough, but there was broncho-
pneumonia, as seen in Dr. Northrup's specimen.
Dr. E. L. Partridge presented specimens illlustrating
PURPURA hemorrhagica,
removed from the body of a child four months old.
The history of the case was furnished by Dr. Remsen, of
the resident stafT at the Nursery and Child's Hospital.
"The child was born in the hospital, and had always ap-
peared to be healthy. No evidence could be obtained
of hereditary tendency to the affection. Early in March
the mother directed attention to the child, and on ex-
amination small ecchymoses were observed quite thickly
scattered over the face, arms, legs, and feet, varying in
size from a mere dot to a pin's head. Otherwise the
child seemed well. It nursed, and the temperature was
98° F. During the night of March 4th it vomited blood
and had epistaxis. Wine of iron and cod-liver oil were
ordered.
" March 7th. — Patient growing stupid ; does not nurse
well ; very pale ; vomiting has ceased ; had a bloody
stool. t
" March i ith. — The child refuses the breast. No vom-
iting ; has attacks of epistaxis; temperature normal;
large hemorrhagic spot upon the hard palate, and many
smaller ones upon the tongue. Passes urine in small
quantities, and only when wrapped in hot blankets. Last
night an ecchymosis appeared on the cutaneous surface
of the nasal septum, which broke and gave rise to con-
siderable hemorrhage. Continuous oozing of blood from
the mouth. The gums appeared normal. The patient
died of exhaustion March 12th.
" The autopsy was made by Dr. Beverley Livingston.
The body was well nourished, and here and there were
remains of purpura hemorrhagica. The heart showed
some very small ecchymotic spots on the pericardium.
The cavities contained no clots and the valves were nor-
mal. The liver was extremely fatty. Spleen normal.
Blood fluid. The stomach showed some submucous
hemorrhages, but there was no fluid-like blood in either the
stomach or intestines. The right kidney was very pale
and the pelvis contained a number of small calculi. The
left kidney showed several small hemorrhages under the
capsule and also scattered in the substance of the organ.
There was some bloody fluid in the supra-renal capsules.
'I'here were no calculi in the bladder, and the urine it
contained was clear. Dr. Livingston exhibited micro-
scopic slides of the blood, taken post-mortem, which
showed chain bacteria in abundance. They had taken
the methyl-violet staining, and their presence he re-
garded as difticult to explain. He did not regard the
micro-organisms as the result of decomposition. I'he
number of white blood-corpuscles was materially in-
creased."
Dr. Northrup referred to a case of purpura hemor-
rhagica, occurring in a child, in which, soon after death,
the skin became intensely yellow.
3^8
THE MEDICAL RECORD.
[April 7, 1883.
Dr. Van Gieson thought that absence of bloody
urine was a point worthy of note.
Dr. G.arrish remarked that the affection usually oc-
curred in the poorly nourished. In all the cases he had
seen bloody urine had been passed and hemorrhage
fiom the gums had occurred. In one case, that of a man
ninet3'-t\vo years of age, blood oozed from every part of
the body. In two cases occurring in children, si.\ and
ten years of age, he had given the fluid extract of ergot,
and both patients recovered.
SUBPERIOSTEAL REMOVAL OF THK RADIUS — REPRODUC-
TION OF THE ENTIRE BONE.
Dr. J. A. WvETH presented a radius removed from
*e left arm of a boy ten years old, who si.x weeks before
the operation received an injury to the wrist-joint that
caused separation of the epiphysis, followed by necrosis.
The operation, performed in November, 1SS2, was a
subperiosteal one, and since that time the radius has re-
produced itself entirely, and there is free motion at the
wrist-joint and about 15° motion, with pronation and
supination at the elbow.
FRACTURE OF THE NECK OF THE FEMUR.
Dr. Wyeth also presented the upper part of the femur
of a woman who died at the age of sixty-seven years,
and who suffered at the age of sixty-two from what was
supposed to be fracture of the neck of the thigh-bone.
She was under the care of Dr. William Selden, of Nor-
folk, Va., who gave the history that the patient fell upon
a carpeted tioor, was unable to rise, was carried home,
and when the doctor arrived, he found the characteristic
deformity of fracture of the femur high up. Careful
measurement showed that there was from three-fourths
to one inch shortening. He regarded the case as one of
fracture of the neck of the femur, probably within the
capsule. He put the patient into bed, kept her quiet,
and no other treatment was adopted. The patient so
recovered that she was able to walk without a crutch and
showed no signs of lameness for several years, although
y: took a year to recover from the injury.
Dr. Wyeth also presented two
CARTILAGES FROM THE KNEE-JOINT,
removed post-mortem. They were found in the syno-
vial bursa, connected with the knee-joint, lying over the
most external tendinous insertion of the semi-membran-
ous muscle. They were found at the bottom of this
pouch, close to the side of the bone, but not adherent
to it. Dr. Wyeth believed that they developed in the
bursa.
Dr. Wyeth also presented the contents of an
OMENTAL FEMORAL HERNIA
removed from the same body, and the specimen was in-
teresting because it demonstrated the fact that an omen-
tal hernia can cure itself. The mass had come partly
through the femoral canal, had become incarcerated
without being strangulated, and had become adherent.
It was the third specimen of omental femoral hernia that
he had seen.
Dr. Wyeth also presented the fragments of an
ENGLISH GUM CATHETER REMOVED FROM THE BLADDER.
The patient had suffered from a severe accident which
involved the spinal cord, but his locomotion was good.
He was obliged to use a catheter, and lost the instru-
ment in the urethra, from which locality Dr. Wyeth at-
tempted with several different instruments to extract it,
but it slipped on into the bladder before he succeeded.
He then removed it by the aid of a lithotrite. There
was almost complete anesthesia of the urinary tract,
the patient feeling the lithotrite only when quite vio-or-
ous pressure was made with the instrument on the floor
of the bladder.
Dr. Wyeth also presented several
PHOSPHATIC CALCULI
which he had removed from the bladder by means of
Thompson's evacuator, although no stone could be de-
tected by sounding. The patient had marked cystitis.
Dr. Wyeth thought it well to resort to this method in
similar cases, with the view to determining whethar or
not calculi were present which could not be touched
with the sound.
The President referred to a case in which he per-
formed the sub-periosteal operation for acute necrosis of
the humerus, and the result was reproduction of the entire
shaft of the humerus. The results in these cases showed
how much the periosteum had to do with production of
bone as compared with the epiphyseal cartilages.
Dr. Ferguson presented a specimen of
ANEURISM of THE ARCH OF THE AORTA.
"The specimen was from a male, aged forty-five, a native
of the United States, and a news-dealer by occupation.
He was admitted into the New York Hospital on March
4, 1883. He had been temperate in his habits. Some
of his remote relatives had phthisis. He had had a
chancre, but secondary and tertiary syphilitic symptoms
were not well marked. He gave a history of sun-
stroke, rheumatism, and malarial fever, the latter during
the months of June and July of last year. The attack
was attended by cough, elevation of temperature, and
sweating, but no chills. Following this his health was
good until last November, when his cough returned, ac-
companied by pains in his chest. A month later he
noticed his voice failing, and he suffered from moderate
dyspncea. Three weeks previous to his admission into
the hospital, he began to be troubled with spasmodic
attacks of dyspncea, coming on without any apparent
cause, and not accompanied by cough. During that
time he had six of these attacks, each more severe than
the preceding one, and the last so severe as to occasion
fears of a fatal issue. The last occurred immediately
after eating, and for the first time he noticed difficulty
in swallowing. During the intervals he was almost en-
tirely free from dyspncea. He gave no history of vio-
lence, cardiac, or renal disease.
"On admission, patient was noticed to be indifferently
nourished. The face was slightly cyanotic ; there was no
oedema. His respiration was much embarrassed, inspira-
tion high-pitched and forcible, and expiration prolonged,
blowing, and cogwheel in character. The accessory mus-
cles of inspiration acted strongly. The cardiac action
was rapid and forcible ; the arterial tension was high.
The cardiac sounds were obscure. There was no bruit
detected. On the day of admission patient had three at-
tacks of dyspncea, each of which lasted from five to twelve
minutes, and during which the resi>iration was very greatly
embanassed and the face was very cyanotic. These at-
tacks were at first relieved by bromide of ammonia and
chloroform vapor, but later they were not influenced
favorably by these drugs. Examination of the urine
showed a trace of albumen, granular casts, and blood. His
temperature was normal. F'irst night in the hospital he
had several slight attacks of dyspncea (none of them
severe), and on the morning of March 5th, his tempera-
ture was 98.1° F., his respiration 18 per minute, and his
pulse 76. The left radial |)ulse was markedly less forcible
than the right. The piqiils were equal, and tiiere were
no symptoms of paralysis. In the afternoon he had a
severe and prolonged attack of dyspncea, during which
respiration was suspended for a time.
" Laryngotomy was performed and a tube was inserted
through an opening made in tlie cricothyroid membrane,
but this gave no relief. A stiff catheter, No. 12, English,
was then inserted through this opening, into the trachea
to the distance of five and a half inches, and by this means
respiration was established. A note on the 5th de-
scribes a tumor above the clavicle on the risjlit side. On
April 7, 1883.]
THE MEDICAL RECORD.
389
cleep palpation there is pulsation, and over its site a
distinct systolic murmur is heard, which is audible in the
cervical vessels. During the night, temperature rose to
104.6°; respiration, 25; and pulse, 128 per minute. During
the 6th he suffered for lack of oxygen and an unsuccess-
ful effort was made to introduce a larger catheter. The
smaller one then was reinserted. He became more and
more cyanotic, gradually sank, pulmonary cedema de-
veloped, he became moribund, and died on March 7,
1883, at 2.40 A.M.
"The highest temperature was 105.2°, his respiration
34, and pulse 160 per minute.
" He was treated with whiskey and digitalis.
'' Aictopsy on March 7th, at 2 p.m.— The body was well
nourished. There was an incised wound in the median
line of the neck, one and a half inch in length, dividing
the crico-thyroid membrane. There was a small amount
of serum in both pleural cavities. The lower lobe of the
right lung and a part of the lower lobe of the left lung
were in the condition of red hepatization, and the pleura
covering the hepatized parts was covered by recent lymph ;
lungs elsewhere were intensely congested. The spleen,
kidneys, stomach, and intestines were normal. The liver
was pigmented, but otherwise normal. Heart and aorta :
The heart is normal in size ; its cavities contain recent
clots. The cusps of the aortic valve are thickened and
retracted, other valves are normal. The aorta through-
out is atheromatous. There is a circular opening in the
arch of the aorta, three-fourths of an inch in diameter, be-
tween the innominate artery and the left connnon carotid.
This openmg communicates with an aneurismal sac rising
above the upper wall of the aortic arch two inches, the
transverse diameter is two and one-half inches. It con-
tains laminated fibrin and recent clots. The innominate
artery communicates with the sac, partially arising from
the lower right side of it. The left subclavian artery ad-
mits a cylinder one-fourth of an inch in diameter, while the
corresponding artery on the right side admits a cylinder
nearly one-half inch in diameter. There is a growth in the
wall of the left subclavian artery, just above its origin,
one-eighth of an inch in thickness, which is situated be-
tween the intima and media. This growth is lenticular in
shape, its long diameter, parallel with the long axis of the
artery, is one-half an inch, and its short diameter is one-
fourth of an inch. It is made up of white fibrous tissue,
small, round, and spindle cells.
The Society then went into executive session.
Ligature of the Bile-duct. — Beloussow has studied
this subject under the direction of Cohnheim and Weigert.
He ex\)erimented upon rabbits, guinea-i)igs, and dogs.
The longest time that any animal survived was eighteen
days. The liver was jaundiced and slightly enlarged. In
its substance were seen yellowish gray spots, varymg from
the size of a pin's head to a pea. These were most nu-
merous from the first to the sixth day. The microscopic
examination showed them to represent a partial necrosis
of the liver substance caused by the pressure of the bile.
Around these nodules appeared a zone of reactive inflam-
mation with the formation of young connective tissue
in which were newly formed bile-ducts. This new tissue
gradually replaced the necrotic portions entirely. In this
way is to be explained the cirrhosis of the liver observed
by earlier experimenters (VVickham, Legg, Charcot, Gom-
bault, and others) after the ligature of the ductus chole-
dochus. This occurred in entirely aseptic cases, and was
in no way to be connected with any inflannnation starting
from the point of ligature and following up the course ol
the bile-ducts. Kelsch {Rev. de Med., 1881) records
two cases where the retention of bile was followed by
cirrhosis — one following closure of the duct by chole-
lithiasis and cancer of the gall-bladder, the other in which
a dilatation of the bile-ducts was found without any for-
mation of concretions. — The Practitioner, March, 1883.
lew Itistrtimetxts.
A NEW HYPODERMATIC SYRINGE.
By frank SARGENT GRANT, M.D.,
NEW VOKK.
Description. — The illustration shows the size, in and
out of the case. The syringe is of glass, \yith hard rub-
ber fittings, and holds ten minims of fluid when fully
charged. The piston is of
the dumb-bell kind, and works
smoothly in a uniform bore.
The piston-rod is made larger
than usual, in order to insure
an easy and steady action. The
steel needle drops into the top
of the piston-rod when not in
use. A little vaseline placed in
the rod will effectually prevent
rusting of the needle. The
syringe screws on to a glass vial
with a capacity of a little over
ten minims, and should be al-
ways filled when not in use, as
by this means the leather pack-
ing on the rod is constantly kept
moist and in working order.
Both syringe and vial screw in-
to a hard rubber case, and thus
can be carried in the vest
pocket. At the bottom of the
case is a receptacle for holding
the various hypodermatic prep-
arations now in the market.
Directions. — Unscrew vial
from syringe at A ; fill almost
futt with solution or water, leav-
ing only an air-bubble to act
as an air-chainber, and rescrew
on to syringe firmly. Now in-
vert instrument and draw solution into syringe ; unscrew
vial at B, attach needle, and the instrument is ready for
use.
If desirable, the physician can have the instrument
ready for an injection at a moment's notice, by pre-
viously dropping into the vial a powder or globule of
given strength. For such a purpose I have found the
hypodermic ''globules," as manufactured by \Vm. R.
Warner & Co., most reliable and quickly soluble.
The hypodermatic syringe is made bv |ohn Revnders
& Co.
n West Foktv-fifth Stref.t.
KEY RING ARTERY
Bv BREWER M.\TTOCKS,
CLAMP.
M.D.,
F.\RIBAULr, MI.NN.
In the routine practice of surgery — especially in the
country, where one rarely has experienced assistance — ■
delay, annoyance, and chagrin invariably attends the
ligature of arteries ; and even in
town, where one may avail himself
of experienced surgical friends,
sooner or later the exclamation is
breathed, " good surgeon but poor
assistant." If this be true of oper-
ations involving a surgical staff,
how much more trying is the ligature of arteries where
one has no assistance whatever, as frequently happens
in the office, or in cases of emergency.
Ten years ago, after working alone with my patient
over a small artery for a long time, it occurred to me, " If
I could but put a split ring on an artery ? " I could not,
however, until recently.
This cut explains the instrument I have devised, and
390
THE MEDICAL RECORD.
[April 7, 1883.
suggests its application perfectly. With a set of these
clamps — they should be had in sets of six or more — -one
may apply them to the arteries in a capital operation
himself, and ligate at leisure ; or one may be applied
to a single artery till bleeding has been controlled, or
until one may turn to his table for a ligature, without
fear of its weight pulling it loose ; or one may fish for
a wounded artery with the clamp, and the artery having
been secured it may be left in position for several days if
thought best. It is nickel plated. To sum up its ad-
vantages :
First. — It is self-holding, and its lightness will not
cause it to tear loose, and its shape is perfectly adapted
to slipping the ligature to its (ilace.
Second. — With the clamp one is enabled to operate
with no assistance when necessary.
Third. — In cases of emergency one may be attached
blindly, and left in position.
Fourth. — If a pair be placed upon a physician's key-
rnig he will always have a convenient and ready means
of controlling hemorrhage from a wounded artery.
Fifth. — While it would be idle to claim that this clamp
will supersede the use of the forceps, I may claim that
a set of them will multiply the uses of his forceps tenfold.
Sixth. — May I make the claim that a surgical instru-
ment may be constructed so simply that any one may
understand its application, and so cheaply that its cost
will not be a bar to its use ?
A NEW N.\SAL SPECULUM.
By WM. C. JARVIS, M.D.,
NEW VORK.
A CAREFUL and satisfactory trial has induced me to pre-
sent to the medical profession a new nasal speculum.
Its simplicity in principle and construction as shown
in the figure, drawn
nation unnecessary.
full size, makes an extended expla-
It is represented as half-opened.
The arms of the speculum, piv-
oted in the centre, are encircled
by a small ring.
The instrument is readily intro-
duced into the nostril when the
blades are closed. Gentle pres-
sure upon the handles separates
the blades and at the same time
permits the ring to drop and keep
them open. The tension of the
speculum can be very nicely reg-
ulated by this arrangement, and
a very light pressure is sufficient
to retain them in the nostril.
It does not irritate the nose
even when used at short intervals
on the same person. Indeed, |)atients sometimes forget
the presence of the instrument in the nostril.
This is an important advantage in view of the severe
excoriation and fissure which has followed the frequent
use of most self-retaining nasal specula.
Mr. W. F. P'ord has constructed the instrument in sev-
eral shapes with skill and at little expense. He informs
me that he can furnish eye, vaginal, and anal specula
working on the same ring-drop principle.
1 take this opportunity to comuninicate with the many
correspondents who have encoiu'aged me by their success
in the practice of my operations, and believe they will
find that this little instrument facilitates the use of the
ecraseur in the anterior nares.
123 East Twkntv fifth Street.
Cannabin Tannicum as a Hypnotic. — Hiller con-
firms the statements of Froumiiller that the tannate of
cannabin is a good hypnotic in the milder forms of in-
somnia. The dose is 0.3 to 0.5 gramme.
©tiituatnj.
PHILIP HARVEY, M.D.,
PORTLAND, ORE.
Dr. Philip Harvev, Professor of Diseases of Women
and Children, Willamette University, died in Portland,
Oregon, March 23d, in the seventy-ninth year of his
age. He was born in England, pursued the study of
medicine, and graduated in that country. He traced his
descent to the family of William Harvey, the discoverer
of the circulation of the blood.
During early manhood he came to the United States
and commenced practice in Brooklyn, N. Y. , where
he became one of the physicians to the Brooklyn Dis-
pensary. Believing that a larger field was open to him
in the West, he moved thither and practised for some
years in Cincinnati. During that period he published a
treatise on " Food and Climate," a work of much learn-
ing, originality, and research. Afterward he was in-
duced to remove to Iowa, where he edited, with marked
ability, the Burlington Gazette, making it a model news-
paper, and greath' increasing its circulation. He was
appointed and reappointed Surveyor of the Port, and not-
withstanding the absorption of much of his time by the
duties of those positions, he wrote considerably, made
investigations on scientific subjects, and carried on a
large practice. Soon afterward he accepted the chair
of Theory and Practice in the University of Iowa, which
he held at the outbreak of the rebellion. Politically he
subscribed to the doctrines of the Jeffersonian Democ-
racy, but throughout the entire war was a staunch Union-
ist. He received early in the struggle the commission
of surgeon of an Iowa regiment, and was continuously
on duty at the front or in hospital from that time till
the cessation of hostilities, when he retired as Lieutenant-
Colonel and Surgeon of Volunteers.
.^bout eight years ago he went to Oregon in search of
relief from asthma. I'here he at once became identified
with the medical school, as teacher and consultant, lec-
turing and writing much upon medical and scientific sub-
jects.
He was a profound scientist and Shakesperean scholar.
His memory was remarkable ; he could repeat word
for word, whole pages after one perusal. He was a man
of extremely abstemious and simple habits, of high moral
rectitude and general impulses. Sympathetic and con-
scientious in his professional life, he was at all times
ready to sacrifice his personal ease, health, or prospect
of gain at the call of duty. He knew several languages
well, and had some acquaintance with many, was an ex-
cellent nuisician, and possessed considerable artistic
ability.
His widow survives him at the age of sixty-nine. Also
two sons, Cleorge Harvey, an artist, and Dr. Philip F.
Harvey, U. S. .\., and one daughter, Mrs. E. P. Rogers,
of Portland, Maine.
Another Device for Preventing the Breaking
OF Thermo.meters. — Dr. James Bordley, of Centreville,
Ohio, writes regarding this much-agitated matter : "The
device is nothing more nor less than an old style pencil-
holder, with pin for attaching. Secure it by its pin just
within the upper pocket of the vest, and I am sure there
will be no further complaint, for it is satisfactory in every
respect, answering tlie purpose much better and at less
cost and trouble than anything I have tried or seen
offered.
" I would suggest that some instrument-maker (or some
one else) manufacture them especially for the purpose,
making them a little stronger than they are usually made
for pencils, with such other slight modifications as might
more perfectly adapt thejii for tliis vicarious function."
April 7, 1883.]
THE MEDICAL RECORD.
391
^vmij '^cvos.
Official List of Changes of Stations and Duties of Officers
of ike Medical Department, United States Army, from
March 24, 18S3, to March 31, 1883.
Harnf.tt, Richards, Captain and Assistant Surgeon.
To proceed to Fort Adams, R. I., and report to the
commanding officer for duty at that post. S. O. 51, par.
I, Department of the East, March 28, 1883.
Cronkhite, Henry M., Captain and Assistant Sur-
geon. Relieved from duty at Fort McKinney, Wyo.
Ter., and assigned to duty as Post Surgeon at Fort Fred
Steele, Wyo. Ter. S. O. 31, Department of the Platte,
March 22, 1883.
De Loffre, Augustus .\., Captain and Assistant
Surgeon. Granted leave of absence for three months.
S. O. 71, par. 3, A. G. O., March 27, 1883.
LoRiNG, L. Y., Captain and .Assistant Surgeon. To
IMOceed without delay to Fort Schuyler, N. Y. H., and
report to the commanding officer for duty as Post Sur-
geon. S. O. 51, par. 2, Department of the East, March
28, 1883.
MosEi.EV, Edward B., Captain and Assistant Sur-
geon. To report in person to the President of the Army
Medical Examining Board in New York City for e.xaui-
ination for promotion, and upon completion to return to
proper station. S. O. 70, par. 3, A. G. O., March 26,
1883.
Paulding, H. O., Captain and Assistant Surgeon.
Relieved from duty at Fort Laramie. Wyo. Ter., and
assigned to duty at Fort Sidney, Neb. S. O. 31, De-
partment of the Platte, March 22, 1883.
Skinner, John O., Captain and Assistant Surgeon.
To report in person to the President of the Army Medi-
cal Examining Board in New York City for examination
for promotion, and upon completion to return to proper
station. S. O. 70, par. 3, A. G. O., March 26, 1883.
Taylor, Marcus E., Captain and Assistant Surgeon.
To report in person to the President of the .'\rmy Medi-
cal Examining Board in New York City for examination
for promotion, and upon completion to return to proper
station. S. O. 70, par. 3, A. G. O., March 26, 1883.
Turrill, Henry S., Captain and Assistant Surgeon.
Relieved from duty at Fort Fred Steele, Wyo. Ter., and
assigned to duty as Post Surgeon at Fort McKinney,
Wyo. Ter. S. O. 31, Department of the Platte, March
22, 18S3.
I^itcclical Items.
Contagious Diseases — Weekly Statement. — Com-
parative statement of cases of contagious diseases re-
ported to the Sanitary Bureau, Health Department, for
the two weeks ending April 3, 1883 :
Week Ending
_j
cd
«
u^
P
II
■n
u<
0
0.
1)
h
J^
U
March 24, 1883
March 31, 1883
March 31st to April 3d.
0
10
113
6
102
52
4
0
9
125
7
96
52
2
0
4
53
6
29
16
0
o
o
o
Deaths from contagious diseases from March 31st to
April 3d, inclusive, are scarlatina, 8 ; diphtheria, 8 ;
typhoid fever (emigrants), 2 ; cerebro-spinal meningitis,
5 ; measles, 7.
The Vote of the New York State Medical So-
ciety —That the vote of the Society fairly represents the
sentiment of the entire State at the present time seems,
further, to be pretty certain. During the summer the
secretary of the society .addressed a card to members of
the county societies asking for the vote of individuals
upon the 'question. To this he received about seven
hundred replies, of which three hundred and sixty were
in favor of the new code, a small number were non-com-
mittal, and the rest were opposed to it. This vote,
which in its way fairly represents the prevailing feeling,
tallies quite closely with that of the assembled representa-
tives of the county societies and permanent members.
More than half the counties, moreover, were directly
represented by instructed delegates, many of whom were
compelled to vote against their individual convictions.
It is altogether probable that a free vote to-morrow would
result in^a larger m.ajority, and that each passing day
would add to it. — Medical Annals.
Beef-Tea.— Dr. Ridges gives the following directions
for preparing an article which really is what it purports
to be, and far superior to any of the so-called ex-
tracts of meat : I. Take one pound of lean gravy beef
and cut it into pieces as small as possible. A sausage-
machine will accomplish this most thoroughly, and thus
save half the time of step No. 5, while it will enable you
to extract all the goodness of the meat more thoroughly.
2. Place the meat in a preserve jar with one salt-spoonful
of salt, and put the jar in a saucepan sufficiently large to
allow tlie lid to be placed on when the jar is in it. 3.
Mix in a large jug equal quantities (carefully measured)
of boiling water and cold water. 4. Put half a pint of
this mixed water into the jar which contains the meat,
and pour sufficient of the remainder into the saucepan
outside the jar to reach as high as the water inside the
jar. then put the lid on the saucepan and place it on the
hearth, not on the fire or on the hob. It will do no harm
to cover the saucepan with a cloth or anything which
will keep in the heat. 5. The meat must remain in the
jar from three-fourths of an hour to two hours, according
to the fineness to which it has been chopped, being stirred
every quarter of an hour. If cut into pieces a little
smaller than dice, one hour and a half will be sufficient.
At the end of this time take out of the jar and strain
through a hair sieve, or through muslin, with gentle pres-
sure. 6. Place the red meat-juice thus obtained in a
small saucepan, and heat it to boiling while you stir. It
will turn brown and curdle. Strain off the solid flakes
and rub these thoroughly with a small teaspoonful of
arrowroot or corn flour, then boil these again five min-
utes with the liquor which was strained oft", and set it on
one side for the present. 7. Now take the meat which
was left in the sieve at the end of step No. 5, and put it
into a saucepan with a quart of boiling water, cover, and
let it simmer over a slow fire for three hours ; then allow
it to boil and strain immediately. 8. Now boil this
strained liquor down to. half a pint. 9. Then mix this
half pint with the half pint left at the end of step No. 6,
and you will have one pint of strong beef-tea containing
all the soluble portion of the meat.
" How Many Doctors are There," says Montaigne,
"who disdain medicine in their own persons, following a
free sort of life very different from what they recommend to
others ? What is all this but abusing shamefully our simplic-
ity ? For their life and health are as dear to them as they
are to us, and they would accommodate their proceedings
to their doctrines if they did not know their falseness."
Gambetta's Brain again.— It is claimed by Prof.
W. Krause of Gottingen, that the true weight of Gam-
betta's brain was not 1,160 grammes as reported. Soon
after death the arteries were injected with a zinc chloride
solution. This solution extracted the water from the
brain and lessened its weight according to Prof. K.
He estimates its true weight, at 1,320 grammes. There
may be some truth in this view, but not much.
392
THE MEDICAL RECORD.
[April 7, 1883.
The Late Professor Poxd was once demolishing
Darwin and his theories — a task which he frecjuently en-
gaged in — when he triumphantly wound up with the ques-
tion : " If we are monkeys, where are our tails ? " The
professor, who had been speaking for two hours at a
stretch before asking this poser, was startled to hear a
tired auditor answer audibly : " We have sat on them so
long that they are worn off."
A New Remedv in the Treatjient of Syphu.is is
described by Dr. J. Marion Sims in The British Medical
Journal. It consists of fluid extracts of smilax sarsa-
par ilia, stillingia sylvatiea, lappa minor, ph \tolacca decan-
dra, and a tincture of Xanthoxylum caroHnanum. The
s. sylvatiea (queen's delight) is thought to be the active
drug. It has long been used in the .South against syphi-
lis by the Indians and negroes. It has also been intro-
duced and used by Drs. McDade and Rush Jones. Some
remarkable instances of its eflicacy are given by Dr.
Sims.
The iNDic.vnoNS for the Use of Digitalis in heart
troubles are empty arteries, full veins (Fothergill). The
bulk of urine is the index of arterial fulness, and tells
whether digitalis is acting (Traube). Digitalis fills the
arteries and empties the veins (Rosenstein).
A Prospect of Cholera in the Southwest this
Summer. — Dr. Ludeking, clerk of the Board of Health
of St. Louis, has found that cholera ravaged that city in
1S49 and in 1866, and was each time preceded by very
high water in the Mississippi. As another seventeen
years has passed, and the premonitory high water is at
hand, he will not be astonished if the disease becomes
epidemic again next summer. It must be added, he
says, that before the cholera made its appearance in the
West, it each time visited Asia, and thus far Asia is un-
commonly free from it. The latter statement, sad to
say, is not true, judging from recent accounts.
A Class Quiz on .\natomv — New Positions for
the Aorta and New Relations for the Pancreas. —
A correspondent from Chicago writes : " Frequently
short articles have appeared in The Record and
other medical journals alluding to and praising the ex-
cellent laws which regulate medical practice in Illinois.
Perhaps the operation of these laws does not exclude ig-
norant quacks from the State as well as distant observers
mav suppose. Allow me to speak of a visit I made one
of the recognized medical colleges of Chicago a short
time before the end of its term. The subject of tlie
hour happened to be a quiz on anatomy by the regu-
lar lecturer. As soon as the throwing of orange-peels
had ceased and the embryo male and female doctors had
become somewhat (juiet, the lecturer began to ask about
the abdominal aorta. Although there was a diagram of
the vessel in front of the class, and many of the students
had Gray's open before them, yet much difficulty was
experienced in determining tbe location of the artery.
Of the half of the company who answered at all, some
held that the vessel was behind the sternum, one said
it su])plied the heart, and one man carefully affirmed that
it was located one inch to the left of the left nipple.
Like resuUs were obtained wlien the quiz on the
branches was reached. Perhaps a climax of ignorance
occurred when one man said that the gland on the tip
of the coccyx was the pancreas. These answers f^iirly
represent tour-fifths of those given during the hour.
This is one of the recognized colleges whose diploma is
gladly given to any one who has taken two five months'
courses of lectures. Between four and five hundred di-
plomas are granted each year in this city, and very few
of the graduates have taken more than two short courses
of study. Kntrance examinations are unknown. These
conditions do not tend to make an Illinois student
especially proud of his chosen profession. Likewise
there seems little possibility of improving the condition
as long as diplomas are recognized as licenses."
Professor Rilev on Mind in Plants. — .\t a re-
cent weekly lecture at the National Museum, under the
joint auspices of the Biological and .Anthropological
Societies, delivered by Professor C. V. Riley, the sub-
ject was, " Do Plants have Mind.'' He first spoke of
insectivorous jilants which derive nourisliment from
the animal mould, and his ideas as to the allurement of
insects by plants in order to secure cross-fertilization
were elucidated by numerous illustrations of both plants
and insects. He described the movements of many
plants as voluntary and the actions of many insects as
rational. In concluding, the Professor said : " One thing
is certain and profoundly significant, viz., that the lowest
organisms and the first existant on our planet possessed
at some state of development the power of independ-
ent motion — activity. It matters little whether we call
them animals or plants ; they were, and their present
representatives yet are, perhaps, combinations of both.
They represented the potentiality which has developed
on the one side the most complex animal intelligence,
and on the other the highest vegetative organization.
The Incomes of London PhysicL'\ns. — Our London
correspondent writes : "Few London physicians can earn
more than _;^r,2oo a year, even by the most unremitting
labor. The number of London practitioners who make
more than ^'10,000 a year in practice is probably less
than a dozen. In the pre-railway days, however, when
large fees were paid for long distances, physicians did
occasionally receive very large fees. It is stated that
the late Dr. Jeai^reson, of Leamington, earned consider-
ably over _;^i 0.000 a year for many years, and that one
year he actually realized in practice the large sum of
_j{|'20,000."
The Associ.4tion of .\merican Medical Editors.
— The next annual meeting of the Association of .■\meri-
can Medical Editors will be held in the city of Cleve-
land, Ohio, simultaneously with that of the -American
Medical .Association, on June 5 and 6, 1883. An ad-
dress will be delivered by the President, Dr. N. S. Davis,
Chicago, on ''The Present Status and Tendencies of the
Medical Profession and Medical Journalism." A free
discussion upon this important subject is invited, which
will be open, not only to members, but to all physicians
present. Dr. Marcy will also present the subject of
" Journalism Devoted to the Protection and Concentra-
tion of Medical and Surgical Science in S|)ecial Depart-
ments " Special papers by Dr. John .\. Octerlony, of
Louisville, Ky., and Dr. Alexander J. Stone, of St. Paul,
Minn., are also promised.
The Results of Resections of the Pylorus for
Cancer, as given by Rydygier, are as follows : Sixteen
surgeons have operated upon twenty-three cases, all but
two of which have been examples of cancer. Of these
last two operations one was performed by Rydygier in
a case of stenosis, caused by round ulcer, which termin-
ated successfully ; and the other by Lauenstein in a case
of supposed cancerous tumor, which at the autopsy
proved to be one of gangrene of the transverse colon.
Of the twenty-three cases nineteen proved fatal, viz.,
fifteen some hours after operation, three on the seventh
or eighth day, and one (Billroth's) four months after from
relapse. Of the four recoveries, one belongs to Billroth
(no relapse liaving occurred in six months), one to Wolf-
ler (the patient seeming well at the end of a year),
one to Czerny (seven months without a relapse), and one
to Rydygier. — Medical Times and Gazelle.
Mountain Fever, so called, is tliought by Dr. B. P.
Anderson (Denver Medical Times) to be due not to ma-
larial infection or influence, but probably to accunuilated
secretions from the liver, kidneys, and skin. He believes
that a dose of calomel or blue pill taken every two or
three months, with the practice of frequent bathing,
would so thoroughly prevent this disease that physicians
would seldom be called upon to treat it.
The Medical Record
. A Weekly yoiLnial of Medicine and Surgery
Vol. 23, No. 15
New York, April 14, 1883
Whole No. 649
O)rioiual Articles.
ON VARIOLA.
It's Definition, History, Cause, Varieties, Prog-
Nosis, AND Treatment.
By J. N. McCHESNEY, M.D..
LATE ONE OF THE ATTENDING PHYSICIANS TO THE HOSPITAL FOR CONTAGIOUS
DISEASES OF THE CITY OF NEW YORK.
(Continued from page 369.)
Treatment. — The treatment in small-pox is of two kinds:
prophylactic or preventive, and measures, local and gen-
eral, addressed to the symptoms as they occur, in other
words, the expectant method. Small-pox once contracted
can neither be cut short nor the course of the eruption
modified by any plan of treatment that we know of. In
mild, discrete cases little or no treatment except or-
dinary hygienic measures will be needed. Patients are
often not ill enougli to keep their bed, and, if they can be
kept away from others, are benefited by exercise in the
open air. This, of course, is only permissible when they
are so situated that out-door exercise will not bring them
in contact with other persons.
For the first few days, during the initial stage, we can-
not be certain what febrile disease is approaching, since
the symptoms of this stage are similar in )nany respects
to those of other acute eruptive troubles, and the same
general measures are to be adopted. For the fever,
cooling acidulated drinks ; if the bowels be constipated,
they should be opened. Active cathartics are to be
avoided, and enemas, or the milder laxatives preferred.
The effervescing salines, such as the citrate of magnesia,
seidlitz powders, Rochelle salts, or some one of the ape-
rient waters, will act sufficiently and prove agreeable, as
well as have a tendency to allay the nausea and vomiting
attendant upon this stage. Sponging of the body with
cool or tepid water reduces the temperature, and renders
the patient comfortable. Quinine to allay fever is of but
little use in this stage ; it is rarely retained and generally
increases the irritability of the stomach.
Headache may be relieved by cold cloths— occasionally
cloths wrung out of water as hot as can be borne prove
more acceptable. The bromides, combined with chloral
in an aromatic vehicle, are useful if there is restlessness
and delirium ; if they prove inefficient a small amount
of morphia may be added. If diarrhcea be present — as it
occasionally is, more especially in children — the ordinary
mistura creta, alone or with some one of the vegetable
astringent tinctures in combination, is frequently suffi-
cient to check it. We .have had much satisfaction from
the use of the fluid extract of coto bark, alone or with an
aromatic syrup, giving twenty minims every half hour till
three doses have been taken ; this quantity is usually
sufficient. If these remedies do not suffice some of the
more powerful astringents may be resorted to ; the min-
eral astringents combined with opium in pill, or given per
enema, should be tried.
■ The nausea and vomiting, which is one of the most
persistent and disagreeable symptoms of this stage, is
very difficult to relieve. Small lumps of ice, swallowed
whole, relieve the thirst and allay nausea; lime water,
carbonic water, taken in small doses, is frequently re-
tained. One-eighth to one-sixth grain morphine, hypo-
dermically, in the epigastric region, is frequently success-
ful. Mustard applied to the stomach is useful, but it is
to be remembered that counter-irritation brings out the
eruption, and vesication takes place very easily. The
numerous remedies for this condition may all be tried —
the simplest will often prove the most efficacious.
.Another obstinate and distressing symptom is the in-
tense pain in the lumbar and sacral regions. The patient
will often complain of this and beg to be relieved. The
sponging and bathing which reduces the temperature
often aft'ords'some temporary relief K sponge wrung out
of water as hot as can be borne and placed on the back
gives ease. It should be changed as often as it becomes
cool. Mustard poultices may be used, but are open to
the objection above mentioned. Dry cupping is worthy
of trial. Morphia hypodermically may be necessary.
The diet during this stage should be light and easily
assimilable, consisting of milk, rice, corn-starch, and like
articles.
After the appearance of the eruption all of these
symptoms, as a general rule, are either greatly ameli-
orated or disappear entirely ; the patient feels so well
that for a few days little or no treatment is required.
As soon as the nature of the disease is determined — if
the case occur in a town or city — the health authorities
should be notified, and if the most perfect isolation and
quarantine is not ]iossible at the patient's home, he should
be removed at once to the small-pox hospital, or to some
isolated building set apart for the purpose.
The isolation of patients at their homes is always a
questionable measure, and keeping a case in houses
where there are more than two small families should never
be permitted. If small-pox be prevalent or a history of
exposure can be obtained, or there are any other grounds
to justify suspicion of variola, even in the stage of inva-
sion, strict isolation should be enforced from the begin-
ning.
When the diagnosis has been established, the first stei)s
to be taken, after the isolation or removal of the patient,
are to protect all those who may have been exjiosed in
the slightest degree. This is to be accomplished by
thorough vaccination and revaccination of every person
in the house where the case occurs, and all of those living
in the vicinity. The persons living in the house and
neighborhood should be visited every second day, and
kept under the closest surveillance for two or three weeks
after the removal or recovery of the case.
If the patient is to be treated at his home, a large,
well-ventilated room, at the top of the house, with an
open fire-place, should be selected. The carpets, and all
unnecessary furniture, should be removed ; the bed should
be firm, a hair mattress is preferable ; a suflicient supply
of linen for frequent changes, both for the patient and
his bed, and all other articles for his use should be set
aside and kept apart. Old pieces of muslin for handker-
chiefs will be useful for cleansing the mouth and nostrils
of the patient ; they can be burned after using. An ad-
joining room, opening into that occupied by the patient,
should be prepared for the use of the attendants, whose
isolation must be almost as strict as that of the patient.
We do not mean that they should not be allowed exercise
and fresh air, but the promiscuous mingling with the
family or others, even for the shortest time, without proper
disinfection and change of their infected clothing, should
be enjoined. The attending physician should be equally
careful as to his person ; he should provide an old suit of
clothing and a calico wrapper, or linen duster, to go over
394
THE MEDICAL RECORD.
[April 14, 1883.
all ; these should be kept in the adjoining room, to replace
his own clothing when he makes his visits. A rubber
coat and shoes are frequently used, but these are cumber-
some and impede the movements more than lighter gar-
ments. Disinfectant materials and solutions should be
kept in saucers around tlie rooms, and in the vessel into
which the discharges from the patient are passed. The
best for this purpose are Labarraque's solution, crude
carbolic (crysilic) acid, and a solution of suli)hate of iron
(copperas), one pound and a half to the gallon of water.
For washing the hands and bathing purposes, we prefer
tar to carbolic soap.
If the attack proves to be of a mild form, with a discrete
eruption, little or no treatment will be necessary except
that of a hygienic kind ; but if it prove to be one of the
more severe forms of the disease with an abundant erup-
tion, there will be many distressing symptoms throughout
its course which may be alleviated.
The symptoms which occasion the most discomfort in
the stage of eruption, are those caused by file presence
of the eruption on the mucous membranes of the throat
and larynx, the cedema of the face, especially of the
eyelids ; and the smarting pain of the whole surface.
The cedema of the eyelids and face is soonest relieved
by the constant applications of compresses, wrung out of
hot water. They shoidd be frequently changed, and
never allowed to become cool. For the smarting of the
surface, vaseline or cosmoline applied cold is preferable
to any of the various cold creams, ointments or salves.
The former are perfectly bland and do not become rancid.
The throat symptoms give most trouble and are most
complained of. It is necessary to explain to the patient
that the presence of the eruption on these parts is the
cause of the distress, and that we are unable to check its
development. For this, the various gargles of flax-seed
tea, solutions of the chlorate of potassa, alum, or borax,
may be tried. We have used ahnost every form of gargle,
and have had more satisfaction from bromo-chloralum
than anything else ; it gives relief quickly and for a longer
time. Small kunps of ice, allowed to dissolve in the
mouth, are usually very grateful to the throat. Hot
moist applications externally around the throat some-
times give comtort. The inhalation of steam, and the
use of astringent solutions, applied by means of a spray,
will often prove useful.
For the conjunctivitis, cold compresses and astringent
collyria have been recommended to allay the inflamma-
tion and lessen the liability to development of the
eruption on the conjunctiva. We have found weak solu-
tions of alum useful for the conjunctivitis, and have also
used solutions of atropia (ij.-iv. grs. to r j.) with good
effect when there is pain and photophobia. As to pre-
venting the development of the eruption on the con-
junctiva, we have not been able to accomplish so much,
but think that prompt treatment will prevent ulceration
and perforation of the cornea.
The intense pain caused by the distention of the vesi-
cles in the palms, on the finger-tips, and in the soles of
the feet is relieved by soaking the hands and feet in hot
water for fifteen or twenty minutes at a time, and then
puncturing the vesicles and allowing their contents to
escape. The large blebs or bullae so often seen in the
confluent eruption frequently burst, or become broken,
leaving large raw exuding surfaces ; these should be
dusted with some fine dry powder — bismuth and oxide
of zinc is best for this purpose ; lycopodium may also be
used.
The great restlessness and prostration, which often comes
on early in the severe forms of the disease, must be met
with stimulants and anodynes, in conjunction with nutri-
tious and easily assimilable food. When the eruption is
abundant, and the suppuration likely to be extensive and
protracted, su])|)ortive measures sliould be resorted to
early in the treatment of the case. The use of stimulants
sliould be commenced early and administered regularly
throughout the suppurative stage, and continued until
convalescence is establised ; the form and amount should
be governed by the indications furnished by the pulse.
In the stage of secondary fever, should the temperature
rise very high, say 103° F., the patient will become very
uncomfortable, restless, and delirious, and be'continually
trying to get out of his bed. If the temperature be re-
duced he becomes more comfortable, and frequently falls
asleep. We have tried large and frequent doses of qui-
nine under these circumstances, and had such poor satis-
faction from its use that we ceased to give it, preferring
to rely upon the use of cold sponging, the wet sheet, or
the use of the Kibbee cot.
The latter measure we have found both agreeable and
effective in reducing the temperature and allaying restless-
ness and delirium. If the patient be a child, or a person
of delicate constitution, sponging, or the pack, is to be
preferred to the cot. We should always begin with the
water barely tepid, and continue its use till the tempera-
ture falls to about normal. The addition of alcohol to
the water for feeble subjects is of advantage. In per-
sistent high temperature, after sponging and the wet
sheet have been tried, the use of the Kibbee cot will often
prove etiectual. It may be necessary to resort to the use
of anodynes and sedatives to insure quiet and sleep.
The bromides, chloral and morphia, will prove useful.
Care should be exercised in the administration of ano-
dynes to those cases where there is copious formation and
expectoration of viscid mucus ; if the patient should fall
asleep, the accumulation may go on in the air-passages
to such an extent as to interfere with respiration, and may
produce asphyxia.
The diet throughout this stage should be as nutritious
and easily digested as possible, it may consist of milk,
beef-tea and other meat-broths, eggs, gruel, etc. Stimu-
lants may be given alone, or in the form of eggnog or
milk-punch.
When the pustules break and their contents escape
over the surface, there is burning and itching of the skin,
which is very annoying to the patient. This is generally
allayed by frequent use of carbolized baths, after which
the skin may be freely anointed with vaseline. The
odor at this stage of the disease is peculiar and very of-
fensive ; for this we have found Labarraque's solution,
solutions of the permanganate of potassa, and bromo-
chloralum much preferable to carbolic acid.
In the hot months care must be exercised to prevent
the large green flies from depositing their eggs in the
pustules ; these, once deposited, are in the most favora-
ble condition for development into larva;, which, when
developed, burrow into the pustules and ulcers, make
their way into the nose and ears, and thus occasion much
annoyance. A strong solution of permanganate of po-
tassa, liberally applied, is the best method of exterminat-
ing them and of preventing their return.
When desquamation is established and the temperature
subsides, if suppuration has been extensive, and the
patient in an asthenic condition, tonics, such as iron and
quinia, with the bitters, should be given, with a nutri-
tious diet, and the use of stimulants. During convales-
cence wine, ale, beer, and porter are useful. All of the
hygienic surroundings of a patient suffering from small-
pox should be the very best possible ; free ventilation is
especially important, but care should be taken not to ex-
pose the patient to currents of air and thus incur the risk
of getting up a pleurisy or pneumonia.
During the stage of desquamation frequent warm baths
give comfort to the patient and promote the falling oft' of
the crusts. The ulceration on the face, about the cheeks
and wings of the nose, is frequently prolonged ; the scabs
are unusually adherent, confining the pus beneath them,
which has a tendency to increase the ulceration. The
crusts should be soaked with hot water, or softened by
vasehne, and removed, and applications made directly
to the bottom of the ulcers. The best application that
we have used in this condition is iodoform and balsam
of Peru, thirty grains to one ounce. Patients, especially
April 14, 1S83.]
THE MEDICAL RECORD.
395
females, and their friends are always anxious about
the pitting and danger of disfiguring of the face, and they
will beg of you to do every thing to prevent it. Numer-
ous remedies have been used to prevent pitting, with va-
ried success claimed for each by its advocate. The fol-
lowing list is given by Professor Flint :
1. "The caretul evacuation of the vesicles by means
of a fine needle." This calls for much patience, both on
the part of the patient and the physician, and may be
useful when the eruption is scant — under which circum-
stance there would be little or no pittmg anyway. Where
the eruption is confluent the undertaking would be an
endless one, far exceeding the patience of the operator
or the endurance of the jiatient, and the amount of bene-
fit not at all commensurate with the time expended.
2. "Evacuation of the vesicles, and cauterization by
means of a fine-|)ointed stick of nitrate of silver." This
too is a tedious process and open to the above objections.
In mild cases this method may possibly shorten the time
of quarantine, and may be resorted to for that purpose.
3. " The application of the tincture of iodine, once or
twice daily, by means of a brush, while the eruption is
papiUar." This has been claimed to diminish the size
of the vesicle and lessen pitting. We have given this
plan a trial in a number of cases, and the results were
not at all satisfactory. It causes severe smarting, and
occasionally produces considerable swelling.
4. " The exclusion of light and air. This is done by
covering the face with a plaster of some kind." We have
not found that this lessens the amount of eruption, or
sufficiently diminishes suppuration to alter the result.
5. "The application of a mild, mercurial ointment,
spread on cloth, or of compresses dipped in a solution of
corrosive sublimate (gr. ij. to iv., to water 3 vj.)." The
risk of producing the constitutional eftects of mercury is
an objection sufficient to condemn this plan.
6. " The application of subnitrate of bismuth and pre-
pared chalk in equal ])arts, twice daily, after smearing the
surface with sweet-oil."
7. "The application of poultices over the face, begin-
ning at the earliest period and continuing to the ad-
vanced stage of the disease."
8. "Solutions of collodion or of gutta-percha, painted
on the surface twice daily by means of a brush. This
should be done in the papular or early vesicular stage."
Our experience with these remedies has been the re-
verse of satisfactory. The contraction produced by the
drying of the solutions is much complained of by the pa-
tient. If they be kept up in the later stages of the disease
they confine the discharge, produce a very offensive con-
dition of the patient, and increase ulceration.
9. "Carbolic acid, liquefied by alcohol, and applied
by means of a camel's-hair brush as soon as the con-
tents of the vesicles appear puriform." This is recom-
mended by Lister to lessen the amount of suppuration.
He also advises the following paste : Carbolic acid,
four to ten parts ; olive-oil, forty parts ; prepared chalk,
sixty parts.
10. "Compresses, wet with cold water, are applied
by many and regarded as useful."
In deference to the wishes of patients and their friends,
it is always well to make a trial of some of these methods,
but it will be prudent not to encourage them to expect
too much in the way of results. After a faithful trial of
nearly all of the methods enumerated above, we have come
to the conclusion that the amount of pitting in each case
will be in proportion to the amount of eruption and de-
struction of true skin. If the pustules are superficial the
scars will be slight ; if the true skin is involved, pitting
will occur in spite of all the preventive measures that
may be used.
The brown staining of the skin from the eruption,
which at first is so plain, soon fades, but the pitting be-
comes more perceptible some time after the patient has
recovered.
Pneumonia, pleurisy, and bronchitis, are to be treated
according to the indications for the management of these
affections occurring primarily, bearing in mind always
that the tendency to asthenia is greatly enhanced by the
presence of small-pox. Erysipelas we have best met by
the internal exhibition of large doses of the tincture of
the chloride of iron with quinine, and a generous nutri-
tious diet ; locally, by the application of the tincture of
iron over the whole of the surface involved, and painting
with the tincture of iodine a broad margin around the
inflamed skin to prevent its extending. If there is a
tendency to suppuration, hot poultices should be con-
tinuously applied, and as soon as evidence of fluctuation
is detected free incision should be made.
For the corneal ulceration we have tried the various
local api^ilications, including the use of the solid "stick,"
and have not had sufficiently satisfactory results from any
one to give it preference. The use of tonics, a generous
diet and stimulants are especially indicated in these cases.
Gangrene and pyajmia call for the remedies applicable
to these conditions occurring under other circumstances.
Abscesses of the cellular tissue and suppurating glands
should be freely opened, and are best healed from the
bottom ; occasionally we have succeeded in healing large
abscesses by hyperdistention, afterward introducing a
tent of oakum and applying firm compression. Sinuses
should be laid open, otherwise they do not readily close.
Balsam of Peru, in our experience, has proven more gen-
erally useful as a dressing than any other application.
We have made use of the sulphide of calcium in a
number of cases selected with a view to try its •efficacy in
preventing the crops of boils and abscesses which so
frequently follow small-pox. In no one of the cases was
there any appreciable benefit from its use.
Convalescence from the severe forms of variola, and
also from the milder forms, when there have been com-
plications, is often very protracted.
Patients should not be discharged from quarantine
until the whole surface is completely free from scabs and
every part of the body, including the scalp, has been
thoroughly and repeatedly washed. Desquamation is
very slow about the elbows, knees, backs of the arms and
thighs, in the palms of the hands and soles of the feet.
The pustules in the hands and feet require to be opened
and disinfected.
All of the clothing worn by the patient during the dis-
ease should be left at the hospital, or in cases in private
practice destroyed. The bedding and other articles
should be burned, not buried. No amount of washing,
disinfecting, or fumigation can render them safe against
infecting others.
The apartments occupied by the patient during his ill-
ness should be thoroughly fumigated with chlorine or sul-
phurous acid gas. The latter is preferable, because it is
more easily generated. The method adopted is as follows :
Close all of the windows and doors ; stop all the cracks
with cotton, or by pasting strips of paper over them ;
place a vessel containing water several inches deep in
the centre of the room. In this may be floated the tin
or iron vessel containing the finely broken sulphur.
Moisten it with a little alcohol, which will make it burn
quicker. One pound and a half of sulphur to the thou-
sand cubic feet of space will be sufficient. The better
plan is to burn a sufficient quantity to exhaust the oxy-
gen of the room, which should be kept closed for not less
than twelve hours. The windows and doors may then be
opened and free ventilation permitted. After this the floors
and all woodwork, including furniture, should be thor-
oughly scrubbed with soft-soap and hot water, to which
carbolic acid has been added (one pint of cresylic or crude
acid to three or four gallons of water). The walls should be
scraped and freshly whitewashed or painted. The apart-
ments from which patients suffering from small-pox have
been removed to hospital should be thoroughly fumi-
gated and disinfected. If the disease has reached the
latter stages, su|)purative or desquamative, all clothing and
bedding used by the patient should be taken with him.
396
THE MEDICAL RECORD.
[April 14, 1883.
In country places or small towns, in times of epi-
demics of small-pox, cheaply constructed buildings are
generally erected to be used as hospitals. When the dis-
ease has disappeared these should be burned and not
allowed to remain standing, deserted, to afford shelter to
some 'tramp, who, after sleeping in the infected rooms,
will, in all probability, carry contagion away with him
and spread it abroad.
Prophylaxis, or the preventive treatment of small-pox,
is to the general public of more importance than the
treatment of one or more isolated cases. The only sure
method of prevention is by vaccination and revaccina-
tion at the proper intervals. Unfortunately, the conclu-
sions first reached and published to the world by Jenner,
" that one successful vaccination afforded protection to
the individual for the remainder of his life," has not been
entirely eradicated from the minds of many of those who
submit to vaccination in the first instance, and fail to
recognize the fact that, after the lapse of time, a new
susceptibility to the poison is acquired. Even in this
late day we freciuently meet with persons who retain
these views, and only submit to a second operation after
much persuasion. In the country, nothing but the ap-
pearance of the dread disease in their midst is sufficient
to awaken the people to the necessity of v'accination
and re vaccination. This disregard of so vital a matter
furnishes the grounds for the strongest argument in the
hands of the few anti-vaccinationists which they possess
against vaccination, namely, that in spite of the practice
of vaccination and the boasted immunity afforded by it,
every three to five years witnesses epidemics of small-
pox sweeping over the whole inhabited world.
That this does occur we cannot deny ; but the explana-
tion is easily given. An epidemic of small-pox only
ceases when the material upon which it feeds is exhausted
by systematic vaccination and revaccination. As soon
as many communities are rid of the scourge they cease
to avail themselves of the protection so easily obtained.
Children are being continually born, and those who have
heretofore been protected have by the lapse of time ac-
quired a new susceptibility, and the material awaits but
the importation of the contagious principle to renew the
experience of former years.
Non-vaccinated children of five years and under con-
tributed over forty per cent, of the deaths trom small-pox
at the hospital during the epidemic of the last two years.
And while a vaccination performed in childhood may
and generally does modify an attack of variola occurring
in after life, so that there is little or no danger to life, it
does not prevent the person infected from being the
source of contagion, and increasing the number of cases,
and thus indirectly the death-rate. When the day arrives
at which every man shall consider it his moral duty to his
children, to himself, and to the community in which he
lives to pay strict attention to this great preventive
measure, we shall see the world rid of this scourge and
small-pox numbered among the plagues of the past.
Much discredit is brought upon vaccination by the im-
proper performance of the operation, which is often con-
sidered too insignificant to be worthy of much care or
time. The simple scarification and application of the
quill is to the observer unattended with any special re-
quirements of skill, but it is far otherwise. Nothing but
strict attention to the niinutiai of the operation, and close
observation of the changes which occur at the spot where
the virus has been introduced, and an ac<iuaintance with
the appearance of a characteristic vaccine sore will justify
any one in pronouncing that the individual is thoroughly
protected against small-pox. Too many of the laity are
impressed with the belief that they are not only capable
of performing so trivial an operation as well as the phy-
sician himself, but also that they know what a sore arm
is ; and this, even though they go to the doctor to be vac-
cinated, leads them to neglect to return at the proper
time to see whether the operation is successful or not.
The careful, conscientious physician should not only
see that the operation is properly done in every respect,
but what tlie result has been, and not rely upon the state-
ment of the parent or any other incompetent observer as
to the success. We have often been told by patients
"that their vaccination had taken,'' when an examination
showed an irritated, slightly intlamed spot, or the rasp-
berry-looking growth which frequently occurs but is of a
fungous nature, not in the least protective.
It is always advisable to procure virus, either bovine
quills, or crusts one remove from some creditable source,
rather than to trust to any of the patent cones, etc.,
guaranteed never to fail. If the quill slips can be pro-
cured fresh, they are preferable, as being most convenient,
and not open to that popular prejudice of conveying dis-
ease which is held against humanized virus.
The proper age for vaccination is when the child is two
or three months of age ; it will then have sufficient time
to recover from the effects of the operation before den-
tition begins. If the child be suffering from any of the
acute exanthema, the operation should not be undertaken,
for in all probability it will be unsuccessful. If small-pox
be prevalent there can be no reasons why the operation
should not be performed.
The best instrument for the operation is the ordinary
thumb lancet ; it is convenient, easily kept clean, and
occasions less pain than any of the patent devices. The
best method of performing the operation is to make a
number of parallel scratches and cross these till a spot
about the size of a ten-cent piece, over the insertion of
the left deltoid muscle, is obtained ; they should be barely
deep enough to cause the transudation of serum, or the
smallest possible amount of blood ; the convex surface
of the square cut end of the quill should then be rubbed
on this surface for the space of half a minute to a minute.
It is unnecessary to moisten the quill. The arm should
be kept uncovered until it is perfectly dry. It is not
necessary to apply adhesive plaster, or tie anything
around the arm. In remote towns or country places it
is often impossible to procure fresh reliable bovine virus,
and it is necessary to use crusts of humanized virus in-
stead. A portion of the crust, sufficient for the number
of vaccinations to be performed, should be rubbed up on
a glass slide, with sufficient water or, better, glycerine,
to make a paste, which is then to be applied to the scari-
fied surface.
On the third day after vaccination papules make their
appearance at the point where the virus was inserted ;
these develop and by the fifth day become vesicles, which
umbilicate and contain clear lymph. On the eighth day
the vesicles are fully distended, and a faint blush makes
its appearance around the circumference ; on the ninth
the areola is fully established, and is generally from the
size of a trade dollar to three or four inches in diameter.
There is usually some febrile action, with headache,
pains in the back, perhaps nausea, and considerable itch-
ing of the arm. In this stage the vesicles should be
protected by some lightly applied dressing, as vaseline
applied cold on a soft old handkerchief tied loosely about
the arm. Woollen or tight sleeves should be avoided.
The contents of the vesicles become purulent on the
ninth or tenth day ; desiccation and desquamation follow,
and at the end of about three weeks the whole course is
complete.
Now and then we have seen patients, generally chil-
dren, admitted to the hospital with small-pox, who pre-
sented a vaccination advanced to the vesicular stage and
there arrested by the development of small-pox. Such
cases usually pursue a modified course and recover.
Vaccination to be protective must have reached the
areolar stage before the first symptoms of small-pox
appear, and it does no good whatever to vaccinate per-
sons after the symptoms of the stage of invasion have
made their appearance. Since the exact time at which
the contagion of variola is received cannot be positively
known, as long as persons who have been exposed are
well it is right to vaccinate and revaccinate them. As
April 14, 1883.]
THE MEDICAL RECORD.
397'
has been stated, after the poison of small-pox lias been
taken into the system, there is a period of twelve dajs
before any syini)toms of illness are manifested. Tiie
areola of vaccination (the sign of protection), is not fully
developed until the ninth or tenth day, in those who have
never been vaccinated before, so that unless there is suf-
ficient time for the formation of the areola before the
first symptoms of small-pox are manifest there will be no
benefit from vaccination. If a i)erson receive the poison
of small-pox on Monday and be vaccinated two days
later it will be in time to prevent the development of
that disease ; if vaccination be done on the third day
small -pox will appear but will be modified ; if the vac-
cination be postponed beyond the third day no benefit will
be received, since there will not be time enough for the
development of the areola before the first symptoms of
small-pox appear. In secondary, or revaccination, the
areola appears on the seventh or eighth day, therefore
vaccination will be protective if done two days later.
ON THE
OCCURRENCE OF THE BACILLUS TUBERCU-
LOSIS IN TUBERCULOUS LESIONS.
By T. MITCHELL PRUDDEN, M.D.,
NEW YORK.
DIRECTOR OF THE PHYSIOLOGICAL AND PATHOLOGICAL LABORATORY OF THE
ALl'MNI ASSOCIATION OF THE COLLEGE OF FHYSICL^NS AND SURGEONS, N. Y. ;
LECTURER ON NORMAL HISTOLOGY IN THE YALE MEDICAL COLLFGE.
A CAREFUL and impartial study of Dr. Koch's papers on
the bacillus tuberculosis, and the more or less valuable
communications upon the same subject which iiave fol-
lowed in great niunbers, would seem to lead to the con-
clusion that an important discovery has been made ;
although how important, and in exactly what direction
its value lies it is yet too early to say. The inconii)ara-
ble mortality of tuberculosis, the almost boundless pos-
sibilities in prophylaxis and therapeutics which the estab-
lishment of the new hypothesis suggests, and the generous
hospitality which is to-day so freely accorded both by
lay and ]5rofessional writers to all so-called germs, have
combined to give to this bacillus an importance which
only a much more extended series of careful observations
can fully justify. In the prevailing furor it is important
to remember that even if all that is claimed for the new-
bacillus should be proven true, still the morphological
basis upon whicli the jjresent knowledge of tuberculosis
rests has not been in the least disturbed, and that even
the proof that this bacterium causes all the lesions of
tuberculosis, would not explain either the peculiar re-
action of the living organism against the parasite or the
varied phenomena of the distribution of tubercle, he-
redity, variations in mode of attack, etc. While, however,
a too ready accejnance of the new belief is to be de-
plored, it should not be forgotten that such a carefully
conducted series of experiments as that by which Dr.
Koch was led to his conclusions, is not to be met or
shaken either by general scepticism or by reasoning
based on analogy or more or less remote clinical data. It
is only by actual experiments and observations, as minute,
extended, and logical as his own, that Dr. Koch's conclu-
sions are to be confirmed or disproved.
The proof of the parasitic character of any infectious
disease involves, first, the demonstration of tlie constant
association of the parasite with the disease — this may be
called the morphological part of the problem, and is
often mistakenly regarded as the most imjjortant ; sec-
ond, the complete isolation of the parasite by cultiva-
tion ; third, the production of the disease in a healthy
animal by inoculation ; fourth, and lastly — and this factor
is, unfortunately, too generally ignored — it is necessary, in
order to make the results of animal inoculation applica-
ble to man, to prove that his organism will react in
approximately the same way in the presence of the para-
site as the animals experimented on.
The present paper, which has almost exclusively to do
with the first or morphological part of the problem, pre-
sents the record of the examination of a series of cases
of tuberculosis with a vi?w of determining to what ex-
tent, and in what way the tubercle bacillus was associ-
ated with the lesions in the material at the writer's dis-
posal. The results seem worthy of record, not because
of any novelty either in method or result, but simply
because they serve to increase the data available for
arriving at just conclusions upon the important subject
of the etiology of tuberculosis. The simple purpose of
this paper and the contemporaneous character of the
publications on the subject, will justify tlie absence here
of specific reference to the work of other observers.
It requires but a short jiractical experience in the
staining and study of phthisical sputum and tuberculous
lesions to become convinced that they are more or less
constantly associated with a well-defined bacterium, hav-
ing the characters described by Dr. Koch. It is highly
impoitant, however, to determine at the outset very
definitely the exact distribution of the bacillus in tuber-
culous organs, and whether they are present in every
growth of tubercle tissue, for simply to say that the
parasite may be found in the s|Hitum, or in the organs of
all cases of tuberculosis examined, means little unless the
number of cases is recorded and the seat of the parasite
described. P"or, as has already been shown, and as will be
seen farther on, they have a marked jiredilection for cer-
tain parts of the body or organs, and for certain varieties of
the lesion ; all of which has an important beating upon
the significance which we must ascribe to their presence.
It has been the writer's endeavor, in the present series
of examinations, to hold himself strictly to the morpho-
logical phase of the problem, and not to permit the ob-
servations to be in the least prejudiced by the cultivation
and inoculation experiments thus far done and recorded
by others.
Technicjue. — The method of staining employed was
Ehrlich's, which, in the writer's experience, gives uniform
and satisfactory results. The staining fluid was warmed
to about 50° C. when the specimens were immersed, and
the staining prolonged to twelve hours. The most scru-
pulous attention was given to cleanliness of instruments
and apparatus, in order to avoid contamination of speci-
mens from previous examinations. Here, as everywhere
in delicate technical procedures, and here perhaps to an
unusual degree, a certain amount of experience is requi-
site in arriving at precision of result ; and accordingly a
long series of the earlier examinations are not included
in the present record, except those upon material capable
of re-examination. The Abbe condenser was made use
of, and greatly facilitates the examination, although in
many objects — sputum, for example — it is not absolutely
indispensable.
Sputum was prepared in the usual way, and, after
staining and decolorizing, the specimens were mounted
in glycerine, in which the bacilli api)ear with perfect
distinctness, and retain the color for several weeks ; the
recorded examinations were, however, made immediately
after the staining. In the examination of tissues the
method varies, depending upon the exact purpose of the
study — whether for the simple determination of the pres-
ence or absence of the bacilli, or for their e.xact location
in the tissue. If for the former purpose, a fragment, a
miliary tubercle, for example, may be picked out, moist-
ened with a minimum quantity of distilled water, and
ground to a pulp in a small mortar, and the pulp applied
to the cover-glass and treated as in the manipulation of
sputum. This method is valuable, because it enables
the observer to obtain an apiiroximately accurate analy-
sis of the contents of an entire miliary tubercle or other
small nodule ; but it is especially applicable to fresh
tissue, and is obviously less exact for the purpose of lo-
calization than the examination of thin sections. Sec-
tions may be cut from the fresh tissue by the freezing
microtome, but in the present studies they were cut by
398
THE MEDICAL RECORD.
[April 14, 1883.
the ordinary microtome from tissues hardened in strong
alcohol. Thoma's microtome was used, and the sections
were cut of a nearly uniform thickness of .01 mm. After
staining and decolorizing, the sections were mounted and
studied in oil of cloves, in which the color is perfectly
preserved for several weeks, and often much longer. It
is important that tissues be hardened in alcohol, and only
sjiecimens thus preserved were used. Organs whose
blood-vessels are injected with acidified coloring material
are not available, since the bacilli under these conditions
do not uniformlv stain. Organs which have become par-
tially rotten before the preservative and hardening agents
are used are also useless, for the same reason.
The material examined was all from man, and may be
classified as follows : i, acute miliary tuberculosis of
lung, nine cases; 2, sputum in acute and chronic phthisis,
fifty-eight cases ; 3, sputum in chronic bronchitis and lo-
bar and lobular pneumonia, nine cases ; 4, lung lesions
in acute pneumonic phthisis, six cases; 5, lung lesions in
chronic phthisis, thirteen cases ; 6, miliary tubercles in
liver, three cases ; in kidney, two cases ; in spleen, three
cases ; in pia mater cerebralis, four cases ; ependyma of
lateral ventricles, two cases; 7, localized primary tuber-
cular pleuritis, two cases ; 8, tubercular ulcers of small
intestine, eight cases; of larynx, one case; 9, typhoid
and dysenteric ulcers of intestine, six cases; 10, ]jrimary
tubercular inflamtnation of bladder, ureter, and kidney,
one case. The importance, for purposes of control, of
the examination of non-phthisical sputum and non-tuber-
cular ulcers is obvious.
Acute miliary tuberculom of lungs. — Nine cases. Kout
of the cases were uncomplicated acute general miliary
tuberculosis, with miliary tubercles in lungs, liver, spleen,
kidney, and pia mater cerebralis. In the remaining five
cabes from young children the tubercles were confined
to the lungs and were associated with chronic peri-bron-
chitis, chronic interstitial pneumonia, and bronchiectasis,
but the tubercles were the predominant lesions and were
presumably the cause of death. These cases were studied
by 520 sections of miliary tubercles from dift'erent parts
of the lungs, and by 105 entire tubercles which were ground
to a pulp and stained in the manner above described. The
tubercles, control sections from which were examined
after staining in hiematoxylon and eosin, presented the
usual structural variation ; some being of the traditional
giant-celled type, others of the pneumonic form, some
dense, others cheesy and disintegrating at the centre. The
bacilli were found in eight of the cases, in about seventy-
five per cent, of the individual tubercles examined. They
were entirely absent from all of the tubercles examined in
one case (180 sections and 15 entire tubercles). In the
cases in whicli they were present, the number of the bacilli
varied greatly. In some of the sections there would be
twenty or thirty, in others only one or two. As a rule they
were most abundant in the vicinity of the cheesy centres
which were undergoing disintegration, but they were not
infrequently scattered in small numbers in the intact tuber-
cle tissue near the periphery of the nodules ;. more rarely
in tubercles which presented no cheesy degeneration or
breaking down. They were present occasionally in the
giant-cells, but seemed to have no predilection for this
situation ; the record of examination of giant-cells show-
ing the presence of bacilli in about one in sixty. A large
number of large and small bronchi and their contents and
blood-vessels, were examined but no bacilH were found
in them. The case in which no bacilli were discovered
was from a young child with acute general miliary tuber-
culosis with tubercles in lungs, liver, s[)leen, pia, and
ependyma, the tubercles in the lungs were few in number,
in the other organs moderately abundant. In a large pro-
portion of them there was cheesy degeneration but very
little breaking down. They were mostly loose in texture,
containing the usual proportion of giant-cells and pre-
sented the usual variation in character in the different
organs which is found in acute general miliary tubercu-
losis. They did not appear to differ morphologically in
any respect from the tubercles in the other cases in which
an abundance of bacilli were found. As will be seen
below, the bacilli were absent in this case not only from
the tubercles in the lung, but also from those in the spleen
liver, kidney, pia, and ependyma of the lateral ventricles.
Sputum in acute and chronic phthisis.^- — The material
was taken from cases in which the diagnosis had been
carefully made by competent observers, and in ten cases
confirmed by autopsy. The sputum was collected in
carefully cleansed wide-mouth bottles, which were used
for spit-cups, and in most cases embraced all that was
expectorated during the night and early morning hours.
This was carefully mixed in the bottles by prolonged
shaking, and in all cases several examinations were made
to insure accuracy. In some of the cases giving negative
results, the examinations were repeated at intervals of
days and weeks. The number of cases of phthisis from
which sputum was examined was 58. In these the
bacilli were present in 46 cases, absent in 12. Of the
46 cases in whose sputum the bacilli were found, physical
examination revealed cavities in 41. Of the 12 cases
whose sputum was without bacilli only 4 had cavities ; 5
of these 12 cases passed from under observation before
re-e.\aminalion was made, 2 died before re-examination,
and no autopsy was made. At the autopsy of one of the
negative cases which died shortly after the examination of
the sputum, no cavities were found, but myriads of bacilli
were found embedded in dense cheesy nodules in the
lungs. The remaining negative cases presented on
physical examination a moderate amount of consolida-
tion, but no cavities.
In some cases, notably in those presenting large
cavities, the bacilli were present in the sputum in enor-
mous numbers, in others they were not very abundant.
To this general rule, however, there were occasional ex-
ceptions, for in some cases with numerous and extensive
cavities the number of bacilli was small and remained so
up to the time of death.
The presence of spores within the bacilli was observed
with varying frequency in nearly all cases, and the abun-
dance of these forms appeared to bear no definite relation
to the size of the cavities or the gravity of the disease.
They were as often found in the sputum of patients with
small cavities, who were not apparently very sick, as in
that of those in the last stages of the disease.
Sputum in chronic bronchitis and lobar and lobular
pneumonia. — The examination of sputum from six cases
of chronic bronchitis, two cases of lobar pneumonia, and
one case of lobular pneumonia gave negative results, no
bacilli were found.
Acute pneumonic phthisis. — The number of cases ex-
amined was six, and the bacilli were found in all. In all
but one of these cases there were several cavities, some
large and some small, and in the contents and in the
inner disintegrated portions of the walls of all of the cavi-
ties there were large numbers of bacilli. In cases in
which there was a distinct w-all to the cavity, the bacilli
were absent in the outer portion of the wall adjoining
the lung-tissue. In the consolidated areas of the lungs —
one hundred and forty-nine sections from various parts
— the bacilli were present in great numbers, in a large
proportion of instances where the cheesy portions were
breaking down, and in a few instances they were present
in the cheesy masses which were still dense and solid.
In one case they were scattered in and among the cells
in air-vesicles lying in the periphery of tuberculous nod-
ules, which contained otherwise only the exudations of
simple pneumonia. In nodules composed of tubercle
tissue which was not cheesy, the bacilli were present in
many but not all cases, but always in small numbers.
Chronic phthisis. — Number of cases, thirteen. In nine
of these cases there were larger and smaller cavities. In
'Thewriler wishes to express his sincere th:inl<s to Dr. H. Kogilik, Resident
Physici.in to Hellevue Hospital ; to Dr. W. T. Van Vrcdenburg, Resident Physi-
cian 10 Roosevelt Hospital ; to Dr. W. S. Gottheil, Resident Physician to Charity
Hospital, and to Dr. C. S. Mack. First Assistant Resident Physician to Mount
Sinai Hospital, for their courtesy in securing the cotlectionof material for tliis part
of the investigation.
April 14, 1883.]
THE MEDICAL RECORD.
399
the lungs, in which, without or in addition to cavities,
there were larger and smaller consolidated areas, these
presented the usual variation in structure, which it is not
necessary to describe in detail. In all of these cases of
chronic phthisis, the bacilli were found, usually in large
numbers. In four of the cases they were met with only
in the walls and contents of cavities and in the contents
of the bronchi. Eighteen cavities were exanimed, and in
all the bacilli were found in enormous numbers, many
of the yellowish masses clinging to the walls consisting
almost entirely of them. In cases in which the cavities
were limited by a distinct wall, the bacilli were usually
found in the inner jiortion only. In the consolidated
tuberculous areas, of various forms — four hundred and
sixty sections from different parts of the lungs — the ba-
cilli were found in a small proportion only, and in these,
with few e.xceptions, only in and immediately around
cheesy areas which were disintegrating. In a few in-
stances they were found in large numbers in dense
cheesy areas, and, in a few instances, in the intact diffuse
tubercle-tissue in the periphery of the cheesy nodules.
In one lung they were found in considerable numbers in
the air-vesicles near tuberculous nodules, which contained
otherwise only the ordinary products of simple inflamma-
tion. They were never found in areas of simple intra-
alveolar and interstitial pneumonia, e.vcept when these
were closely associated with tubercle tissue. They were
found in considerable numbers, in large and small bron-
chi, in cases with cavities ; in others they were invariably
absent. The inner walls and contents of a large number
of blood-vessels were examined, but no bacilli were
found. It will thus be seen that in the cases of chronic
phthisis examined the bacilli were found in all, but
chiefly in the walls and contents of cavities and in and
about cheesy areas ; most frequently in such as were dis-
integrating, but occasionally in those which were not.
Their occurrence in diffuse tubercle tissue not cheesy
was comparatively infrequent, and in the dense so-called
fibrous tubercles they were never found. Their pres-
ence in the giant-cells of all forms of the tuberculous
lesions in chronic phthisis was infrequent.
Miliary tubercles. — In kidney, two cases ; spleen, three
cases ; liver, three cases ; pia mater cerebralis, four cases ;
ependyma of lateral ventricles, two cases. These organs
were all from cases dying with acute general miliary
tuberculosis. In the tubercles of one of each of the
different organs-— those from the above-described case,
in which no bacilli were found in the lung tubercles —
no bacilli could be detected, although about one hun-
dred and fifty sections from different tubercles were ex-
amined, and a large number examined entire after grind-
ing to a pulp. In all of the remaining cases bacilli
were found. When present, they were very few in num-
ber, and were as often present in tubercles without as
in those with cheesy degeneration. Very rarely were
more than two or three seen in a single section of .01
mm. in thickness, and never the large clustered masses
so frequent in the lungs.
Localized primary tubercular pleuritis. — Two cases.
The tubercles in these cases were of the loose-textured,
traditional giant-celled form (" Schiippel's tubercles"),
with and without cheesy degeneration. The bacilli
were found in both cases in a large proportion of the
miliary tubercles, but always m small numbers.
Tubercular ulcers of intestine. — Nine cases. Larynx,
one case. These were all from cases of chronic phthisis.
In eight of the cases with intestinal ulcers, the bacilli
were present in all of the ulcers examined, but in com-
paratively small numbers. They were scattered in and
among the shreds of necrotic tissue at the bottom and
sides of the ulcers and in the tubercle tissue in the vicin-
ity. In one case they could not be found. In this case
thirty sections from six different ulcers and scraijings from
portions of these and from two others were examined with
the greatest care. As shown by the examination of sec-
tions stained in the usual way, the ulcers in this case
were typically tubercular in character. The lung in this
case had not been saved, so that it is not known whether
the bacilli were present in it or not. In the ulcer from
the larynx, which was shallow, they were present in
small numbers in all of the sections.
Tvphoid ulcers, two cases : dysenteric ulcers, four cases.
The examination of these ulcers for jiurjioses of control
gave entirelv negative results, no tubercle bacilli being
found.
Friiiiarx tubercular injlamiiiatiou of bladder, ureter,
and kiditcv. — One case. The lesions in this case were
seen both macroscopi'cally and by the study of sections
stained with hrematoxylon and eosin to be of most unmis-
takable tubercular character, and yet the examination of
a large number of sections from different typical parts
and of a number of scrapings, and of the fresh purulent
fluid abundant in the calices of the kidneys, failed to re-
veal a single tubercle bacillus.
In reviewing the above recorded studies, it will be seen
that in 100 cases of tuberculosis of various forms, in none
of which the diagnosis was doubtful, and in 51 confirmed
by autopsy and thorough subsequent microscopical study,
the examination for the presence of bacilli in nearly 1700
preparations revealed their presence in 46 out of the 58
cases of simple sputum examinations and in all but 3 of
the 42 cases whose tissues were examined after death.'
In one of the three exceptional cases, however, the ex-
amination was only partial, being limited to ulcers of the
small intestine in a case of chronic phthisis. Again, in a
large proportion of the cases in which they were pres-
ent they seemed to have a decided predilection for
tubercle tissue in a degenerated and disintegrating con-
dition, either cavities in the lungs, cheesy and breaking
down areas or tubercular ulcers, although present with
great frequency in small numbers in well-formed intact
tubercle tissue. In the present series of cases it is worthy
of remark that the bacilli were present in far greater
abundance in the respiratory organs and intestinal tract
than in other ])artsof the body less directly in communica-
tion with the external world.
It is further evident that in nearly every case there arc
many miliary tubercles of all forms, and in many cases
much diffuse tubercle tissue, from which the bacilli aj)-
pear to be entirely absent.
The examination of the present series of sputum of
phthisis throws but little light upon the value of such
study for diagnostic purposes, since in most of the cases
the diagnosis was certain enough without recourse to this
factor. While undoubtedly the detection of bacilli in
sputum in doubtful cases may be of great value in form-
ing a diagnosis, it should be remembered that their ab-
sence does not exclude the possibility of the existence of
phthisis. This is shown in one of the above cases, in
which careful examinations of sputum failed to reveal
bacilli, and yet on the death of the patient both lungs
were extensively involved and large numbers of bacilli
were found embedded in cheesy nodules ; but there 7vas
little breaking doivn if tubercles and no cavities. The
abundance of bacilli and the presence of siiores within
them does not seem to the writer to have the importance
in the formation of a prognosis which has been ascribed
by some recent writers to them, since the presence of
large numbers of the spored forms was observed in all
classes of cases, and in many of the gravest cases the
bacilli were present for long periods in comparatively
small numbers.
In regard to the miliary tubercles and other forms of
tuberculous tissue in which no bacilli could be detected,
although they were found in other parts of the body, and
also to those cases in which, although distinctly tubercu-
lous, no bacilli were found in any part of the body, the
simplest conclusion would be that they were not there.
But to the unqualified adoption of this conclusion two
' The apparent discrepancy between the figures in lliis summary and those in a
preceding portion of the paper are due to the fact tliat in the former arrangement
of the material by organs several of the specimens belonged to one case.
400
THE MEDICAL RECORD.
[April 14, 1883.
objections may be justly urged. In the fust jilace, it
should be remembered that our main reliance for the de-
tection of the bacilli is upon their staining, but, as recog-
nized by Dr. Koch in his first article upon this subject,
they ma\', when life in them is becoming or has become
e.xtinct, fail to stain and hence escape detection. Dr.
Koch furthermore recognizes the fact that they may be
entirely absent from some forms of tubercle tissue, but
assumes that this is the case only when the tuberculous
process has come to a standstill. It does not, however,
seem to the writer that we are sufficiently familiar with
the process of development of all forms of tubercle tis-
sue to enable us to say in many cases positively, or even
with great jirobability, which tubercles are in an early
and active stage of development and which are not ;
hence it is very difficult to forjn a definite concejition on
morphological grounds of the ])art which the bacilli i>lay,
if any, in producing tubercle tissue. This difficulty of de-
termining tlie exact significance of the ])resence of small
numbers of or of single bacilli in or near tuberculous lesions
is enhanced by the possibility that they, like pigment
or other small granules, ma)' be carried about passively
to a certain extent through the lung tissue by amoeboid
cells or lymi^h currents. The failure of the bacilli to stain
under certain conditions has been repeatedly observed
by the writer in the walls and contents of cavities and
sputum, which when fresh showed an abundance of easily
stained bacilli, but in which after being allowed to re-
main in a warm, moist atmosphere until a considerable
degree of decomposition had occurred, tlie bacilli could
be detected only with tlie greatest difficulty, being in a
few cases but very slightly and in most not at all stained.
.\gain, the results obtained bv the above methods, sec-
tions and grinding of entire tubercles, do not admit of
absolute accuracy, since the bacilli are very small, and
it is obviously imjiossible to examine completely all of
the tuberculous lesions in any given case, the degree of
approximation to absolute accuracy depending entirely
upon the thoroughness of the work. The objection, that
in all this morphological work on the distribution and
occurrence of the bacilli in tuberculous lesions there is
a certain lack of precision, seems to the writer to be a
perfectly sound and legitimate one. The lack of abso-
luteness in the data upon which conclusions rest is one
of the evils inherent in every incompletely develoiJed
science, and particularly in the medical dejjartment of
the science of biology, and the frank recognition of this
inherent difficulty in many of our ])roblems would leave
our conclusions quite as available for future use if jjroven
true, and nuicli less difficult to get rid of if false, than if
we ignore it. Nevertheless the limitations in the present
case are so clearly defined that the acknowledged lack
of absolute precision would seem to be of no vital im-
portance in the ])resent jihase of the inquiry.
It should not be forgotten that it is a form of inflam-
mation with which we are dealing in tuberculosis, the
characters of which are by no means embraced by tlie
traditional descriptions of miliary tubercles, descriptions
whose very precision and exclusiveness have unfortu-
nately come to be stumbling-blocks in the way of prog-
ress toward a broader comprehension of tiie entire pro-
cess. It does not appear at present that there is such
imity in the lesions of tuberculosis as to render improba-
ble a duality of causation.
The writer is perfectly aware that the discussion of the
causation of tubercular inflannnation from the morpho-
logical standpoint alone can never be aught but an im-
])erfect and partial one ; but tile demonstration, with
tlie above limitations, of the fact that tubercular lesions
can exist without the jjresence of the tubercle bacillus in
them, while not in the least tending to discredit the jjos-
sibility, or even the demonstration by Dr. Koch of the
bacterial origin of many or most forms of tuberculous
lesions, would seem to make the doubt of its universality
perfectly legitimate. It should be remembered, finally,
that Dr. Koch's experiments have not been done on man,
but on the lower animals, and that the proof that the
human organism reacts toward the bacilli in the same
manner as that of other species has not yet been fur-
nished, and in the absence of this link, the facts recently
furnished by Schottelius' in regard to the harnilessness of
the ingestion of presumably tuberculous meat by man,
and what is still more important, the large amount of
clinical exjierience which at present seems distinctly not
in harmony with the new hypothesis, should receive care-
ful consideration.
TRIAL BY jury;'
As A Means of Ascertaining the Mental State
OF Alleged Lunatics, and as a Pre-requisite
TO THE Seclusion of I^unatics.
By RALPH L. PARSONS, M.D.,
GREENMO.NT-ON-THE-HUDSON, N. Y.
A BILL has recently been introduced in the New York
Legislature, or is about to be introduced, iiroviding that
hereafter no person shall be dei)rived of his liberty in
this State, as a lunatic, unless such person shall have
been dulv tried on the charge before a jury of his peers,
and shall by them have been adjudged insane. The ob-
jections to such a law are so grave that the probabilities
of the measure being approved by this or any other legis-
lature would seem to be slight. Yet its advocates are
earnest and undoubtedly sincere in the belief that such
a law is required ; and it must be remembered that ear-
nest, sincere men often accomplish their ends against
truth and justice and against the feeble efforts of indif-
ferent opponents. In fact, this has already taken place
in the State of Illinois, where a similar law has been in
existence for some years past. Hence the subject is of
sufficient imijortance to entitle it to general attention
and especially to the attention of physicians.
The following are the most important of the consid-
erations urged in favor of the ]iroposed law.
In the first jilace the general plea is urged that it is
both unconstitutional and is a dangerous invasion on the
rights and liberties of the citizen to incarcerate him with-
out aftbrding the opportunity of making a defence in ac-
cordance with the usual legal forms. Every citizen is
entitled to the rights and benefits of a trial by jury before
he can justly be deprived of his liberty under any pre-
tence or charge whatever, and a violation of this right
involves possible danger to every citizen. It does not
follow even that every man who is of unsound mind is
dangerous to the community and ought to be jjlaced in
prison. But ivhysicians are educated to look upon all
lunatics as subjects of a dangerous disease and to think
that the only proper course to take with them is to shut
them up. As the law and the practice now stand, the
doctor is, to all intents and jnirposes, both judge and
jury in the case. .An ordinary jury is quite as comijetent
to judge of the weight of evidence in a case of alleged
lunacy as in any other brought before them for judgment,
and is more likely to decide without bias than medical
men are.
It is further urged that through defects in the present
methods of adjudging men to be insane many are actu-
tually incarcerated as lunatics who are of perfectly sound
mind ; and that if a trial by jury were required in all
such cases this danger would 'be for the most i)art if not
altogether avoided.
Some of these reasons and arguments are plausible
but it is believed that none of them will bear the test of
a candid examination. A man's house may be ]:)ulled
down or his jirojierty destroyed without process of law
if by reason of a conflagration or of any great public
danger it becomes a jjublic menace. Or a person sick
of a dangerous, contagious disease may be removed from
a hotel or jiublic building on the simple judgment and
* Virchow's .\rchiv, Hd. 91, Heft, i, S. 129.
April 14, 18S3.]
THE MEDICAL RECORD.
401
authority of one or two men who are assumed to know
the nature of the disease. And sometimes mistakes are
made in both these instances. But the pubhc have
rights as well as the individual. So in tlie case of luna-
tics, they may justly be restrained without any process
of law, if the public safety or even if the safety of the in-
sane person demands. Further than this due process of
law is and always has been requiied. l!ut the assump-
tion that a jury would make a better judgment regarding
the question of sanity in a given case than is now made
by the methods in ordinary use, either in this country or
abroad, is altogether gratuitous and improbable. The
main weight of the evidence that would be brought be-
fore a jury would be the opinioii of the physicians who
had made a study of the case, and if such opinions did
not prevail with them as determining facts the presump-
tion would certainly be against the jury and in favor of
the scientific decision of the physicians.
It is quite true that from time to time mistakes are
made in the diagnosis of insanit)', and that sane men are
deprived of their liberty under such a mistaken diagnosis.
Indeed, it would be strange if mistakes were not some-
times made in this as well as in other matters upon which
men form candid deliberate judgments. But it should
be remembered that there may be vast differences in the
character of the mistakes that are made. For instance,
a mistaken diagnosis of insanity might be founded on
eccentricities of conduct that were an expression of the
natural characteristics of the individual and were harm-
less in character; or, a mistaken diagnosis might be
founded upon such appearances, actions, and language
as are usually found to be the expression of a state of
lunacy. In the former case, a more careful investiga-
tion would have served to establish the true nature of
the case. As a matter of fact, this sort of mistake is of
very rare occurrence. In the latter case, or rather class
of cases, for the manifestations are very diverse, the
person suffers no serious harm on account of having
been judged in accordance with his actions. At all
events, it is in the highest degree improbable that a jury
would have made a more correct, or even a difterent
judgment. Almost without exception the improper sub-
jects who have come under my,own observation, have
been of this category. They have been cases of delirium,
of cerebral congestion, of concussion, of alcoholism, of
drug-poisoning, or of pure folly, or malignity of disposi-
tion that has been brought to the surface by some pe-
culiar train of circumstances. The following example
will serve to illustrate the last-mentioned type : A mar-
ried man with a family of grown-up daughters, is ob-
served by his family physician to conduct himself in a
strange excited way, to run excitedly about the street, hat-
less, with dishevelled hair and disordered garments, to talk
in an excited way, to neglect his business, and to disturb
the quietude of his household. He mentions the sub-
ject to the family and is informed that the husband and
father watches about the house in corners and by-places
as though he suspected some conspiracy, and that he is
at times so violent in language and conduct that the fam-
ily fear lest he may do some of them bodily harm ; in
fact, that one day he actually did seize one of the smaller
children in a violent manner and hold it over the heated
range. The physician made the diagnosis of insanity,
and advised commitment to a lunatic asylum as a meas-
ure of safety. It afterward transpired that the alleged
lunatic had an ungoverned and ungovernable temper,
that during the whole twenty years of his married life he
had been subject to outbreaks of blind passion when-
ever his wishes were opposed, and that latterly the
malignity of his disposition had been brought out with
especial virulence by a series of family events, among
which were a growing indisposition on the part of his
daughters to submit to his abusive language and treat-
ment, and the advent of a lover to one of the daughters
he did not approve. He was found not to be insane,
and collected damages of the family physician for false
imprisonment. The physician was, without doubt, en-
tirely honest in his diagnosis. The members of the
family were quite willing to accept his view as a plausi-
ble explanation of the father's conduct, and as a means
of relieving them of such a terror, and so were not anx-
ious to change the doctor's opinion. Few will be likely
to think, however, on a careful consideration of the cir-
cumstances, that the doctor ought to have been fined on
account of his mistaken diagnosis, or that the father did
not deserve to be considered a lunatic and treated like
one, since his conduct had fairly entitled him to that
distinction. In the other cases to which reference was
maile there was a state of actual mental obscuration, al-
though the condition was not one of technical insanity.
The patients — for such they should be considered —
needed treatment somewhere, and might possibly have
done worse than become inmates of a lunatic asylum.
The impression, which would seem to have gained
some credence, to the effect that large numbers of sane
persons are shut up in lunatic asylums, is strengthened
by the various suits at law which are brought under this
pretence or belief. Yet it will undoubtedly be found
that very few persons of this class who have been de-
clared of sound mind by an intelligent jury, in opposi-
tion to the opinion of well-educated physicians, really
conducted themselves so rationally as to inspire univer-
sal confidence in their sanity.
The statement that sane persons are often shut up as
insane through interested motives is rarely made. The
supposed instances are not numerous enough nor clear
enough for that. The claim is rather that sane persons
may be put in asylums through such motives. Certainly
every sort of injustice is possible, but the obstacles to
the perpetration of this sort of injustice are too great
to render the attempt attractive. Too many i>ersons of
responsible position would require to be in guilty collu-
sion in the first instance ; and the dangers of detection
by numerous other persons would be too imminent.
The fact is that the ratio of indisputably sane men
who are incarcerated in asylums as insane is so small
that the Lunacy law should be constructed with especial
reference to the welfare and interests of our unfortunate
fellow-citizens who are really insane. While the legal
methods should be such as to prevent mistakes as far as
possible, they should be so ordered that the insane may
enjoy every needed facility to get that early efficient
care and treatment which their malady requires.
A trial by jury would be very decidedly prejudicial to
the interests and welfare of many, if not of a majority
of the insane. The whole process of being arraigned
and tried before a court on any charge is repugnant to
most men. The charge of being insane is particularly
offensive, especially when made in public, and no less
so to many of the insane than to those who are of sound
mind. Not only would such a trial be offensive to many
of the insane, but it would also be repugnant to all of
their devoted friends. The inevitable result would be
that friends would hesitate and delay in taking the neces-
sary steps for early and efficient management and treat-
ment. It is a well-established fact that the likelihood of
recovery depends very much on the promptitude with
which the patient is removed from perturbing influences,
placed in favorable surroundings, and properly treated
and managed. Although the hesitancy of friends to sub-
ject the unfortunate patient and themselves to the repul-
sive ordeal of a trial would probably be the most im-
portant cause of delay, there must be added to this the
various causes of delay that would of necessity be inci-
dent to the trial itself.
The following quotation from the Annual Report for
1882, of Dr. H. F. Carriil, Medical Superintendent of
the Asylum for the Insane, at Jacksonville, 111., will
show that the above-mentioned objections are not merely
hypothetical, but are supported by actual experience,
viz. : " It is probably in the experience of every super-
intendent in this State (Illinois), as it certainly has been
402
THE MEDICAL RECORD.
[April 14, 1883.
in mine, to notice how many have been deterred from
making apjilication for their friends' admission to a
hospital on account of the laws of this State requiring a
public trial, a judge, jury, and lawyers, just as in a crim-
inal proceeding. I say many are kept out of the hospi-
tal in the early stage of the disease on account of the
repugnance and dislike in the minds of friends to this
public trial. Many such cases have come under my
personal notice."
Again, the immediate effect of a jury trial, or of any
proceeding analogous to a jury trial, would be highly
prejudicial to many of the insane. It may be admitted
that cases often occur that might not be seriously in-
jured by a trial, as those which are apathetic or de-
mented ; but these are not the cases for which the
formalities of a trial would be invoked. The process
would of necessity be a serious cause of disturbance and
injury to all insane patients who were able to compre-
hend the nature of the proceedings and of the evidence.
In addition to the disturbing influence of the proceed-
ings themselves, they would be disturbed, annoyed, and
injured by the evidence adduced in proof of their in-
sanity. They either deny the truth of such evidence or
do not admit the inferences that are drawn. In either
case they naturally feel that they are objects of mis-
representation and injustice.
A consideration of the actual facts and circumstances
attending cases of insanity will show more clearly than
any merely theoretical discussion how annoying and
harmful a jury trial would be.
For instance : a young girl sufters an attack of melan-
cholia attended by morbid fears and suspicions, or from
an accession of hysterical mania with nymphomaniacal
propensities. In the former case she shrinks from
strangers with terror, and in the latter she behaves in an
unbecoming manner in their presence. Or the mother
sufters from an acute attack of puerperal mania attended
at the same time with great mental disturbance and
great physical depression. Her immediate safety requires
that she be carefully protected from all disturbing mflu-
ences and promptly placed under the conditions most
favorable for efficient care and treatment. Or the
father suddenly manifests symptoms of mental aberra-
tion, which it is hoped will be only temporary in charac-
ter, but whose case requires prompt and careful manage-
ment. It may safely be assumed that even the most
strenuous theoretical advocate of the jury trial would
hesitate a long time before subjecting a dear relative or
friend who was suffering as in the cases instanced above,
or in a multitude of similar ways, to the coarse, repul-
sive ordeal of such a trial. They would be restrained by
their own better feelings; by a humane wish to protect
the sufferer from unnecessary annoyance, pain, and dan-
ger, and by a desire as much as possible to avoid a pub-
licity which might seriously prejudice the social or busi-
ness interests of the patient after recovery had taken
place, and the remembrance of which would certainly be
a painful one. Harmful delay in taking the measures
most conducive to the welfare of the patient would be
the probable result.
Even in the case of a patient suffering under a mild
form of mental aberration without serious physical dis-
turbance, and who is anxious for the trial, such a pro-
cedure is by no means certain to be harmless to the
patient. He will certainly not be convinced of his in-
sanity if a dozen juries were to pronounce him insane.
It is not unlikely that he will be irritated by tiie apiiear-
ance against him of those whom he supposed to be his
friends, and that he will be annoyed by evidence which
appears to him irrelevant or untrue, or distorted, and
that diminished prospects of recovery will be the result.
The influence upon such a patient will be more espe-
cially bad when, as is often likely to hapjien, there is
conflicting evidence and conflicting opinions are ex-
pressed. Being of an argumentative dis])osition of mind,
he will afterward urge the evidence and opinions in fa-
vor of his sanity as true and correct, and thus establish
himself in his insane delusions, although the decision
may have been adverse to his sanity.
The conclusion is that men who manifest no symptoms
indicative of insanity need have little fear of being shut
up in lunatic asylums as insane; that if possibly mistakes
are sometimes made in the case of some who appear and
act in a greater or less degree as though they were in-
sane, the results are not likely to be very serious in char-
acter, and that the injury of a jury trial to the insane as
a test of their sanity would immensely counterbalance
any possible advantages that might accrue to the sane.
The insane are the weaker jiarties, and need the full pro-
tection of the laws, in this instance by being protected
from legal annoyances. If a few sane men and women
are in danger of being declared lunatics, means certainly
can be devised for their protection that will not be preju-
dicial to the multitudes of the insane.
If additional means not prejudicial to the insane can
be devised to prevent such mistakes as are liable to oc-
cur, and it is altogether probable that the methods of
investigation and procedure can be improved, there will
certainlv be universal and unqualified acquiesence in
such improved methods.
THE ANALOGY BETWEEN UNION IN SCION-
GRAFTING AND THE HEALING PROCESS
OF WOUNDS.
By H. I. RAYMOND, M.D.,
ASSISTANT SURGRON U. S. ARMY.
The surgeon is satisfied to consider a wound aseptic
that fulfils these two conditions, viz., emits a sweet,
healthful, non-putrefactive odor, and reveals to the mi-
croscope no micro-organisms upon the wound-surface.
When antiseptic surgery was first introduced to the pro-
fession, surgeons observed that under the use of certain
so-called antiseptics, a wound would run an aseptic
course, but not apprehending clearly the rationale of
such action of an antiseptic, experiments were set on
foot by investigators to determine the same.
One of the most recent and plausible explanations of
how an "antiseptic" provides for the two conditions
mentioned above, as essential to an aseptic course, is
that set forth by Boillet in his exiierlments with zinc
chloride and carbolic acid. Although his experiments
are familiar to the medical world, I desire to recite them
in brief in this paper, in order that the theory which
Boillet advances as to why zinc chloride or carbolic acid
secure good healing in flesh wounds may be compared
with a theory — its prototype — on scion-grafting, pub-
lished before 1S55, and appearing in an article on " Fruit-
garden'" in "Chambers's Information for the People."
First, then, for Boillet's theory of the action of zinc
chloride or carbolic acid upon the prevention of the de-
velopment of micro-organisms upon a wounded surface.
The assertion that these substances acted detrimental
to bacteria, or at least arrested their growth, was shown
by Koch's experiments to be incorrect. He placed cer-
tain species of micro-organisms for a longer or shorter
period in one of the antiseptic media under question,
and then brought them into a favorable culture medium
and found that their function of development had not
decreased. But although the afore-mentioned antisep-
tics exert no direct fatal effect upon bacteria, they do
act ])reventive to the development of bacteria in wounds.
Now, Boillet explams tiiat this ]irevention dejiends
upon their power to form insoluble compounds with al-
bumen. Thus chloride of zinc added to a solution of
albumen, gives an insoluble albumenate of zinc ; in a
similar manner an albumenate of mercury may be formed
with the corrosive chloride, and even carbolic acid was
found to produce a precipitate in albumenous solution.
A part of a solution of the albumenates of zinc, copper,
and mercury in water was placed in the open air, and
April 14, 1883.]
THE MEDICAL RECORD.
403
another portion of the solution was supplied with the
germs of bacteria. These solutions of tiie metal albu-
menates proved to be unfavorable culture media for bac-
terial germs. In the solution exposed to the air, bacteria
did not appear until after four weeks, and after six weeks
only could a decided decomposition be recognized.
In preparations of pure albumen exposed to the air,
bacteria appeared very shortly after twenty-four hours.
Now, according to the opinion of Boillet, these inetal-
albumenates would prevent the development of bacteria
for an indefinite period, if they were not decomposed by
the oxygen of the air and the water.
Now follows Rennie's theory of the treatment of scion-
grafting, published nearly three decades ago. Mv at-
tention was called to it in a letter from Dr. Adler of the
army.
The practice advocated is that of bandaging the grafted
pieces by a strip of mat, lightly applied, so as not to ob-
struct the circulation, and over this bandage is plastered
around a handful or two of a soft adhesive material — a
conglomeration of clay, cow-dung, and chopped straw.
This will form a hardened coating over the junction of
the coapted surfaces, and may be allowed to remain until
midsummer, when, union having been perfected, the
plaster case may be removed.
The principle upon which the external plaster was
applied over the junction of the raw surfaces was that of
excluding the atmosphere from the wound, and is thus
scientifically explained by Rennie.
" It is to prevent the oxygen of the air from getting to
the fluid pulp at the joining, where it would unite with
the carbon and form carbonic acid gas, and thereby rob
the pulp of its solidity. The exclusion of light is neces-
sary on the same account ; for, as in the case of a finger
cut, the oxygen would unite with the carbon and prevent
the thickening of the blood. On the same account,
moisture by supplying oxygen would be injurious, and
dryness might act both by exhausting the pulp, and by
causing the edges of the bark to shrivel and to gape,
which would facilitate the entrance of the air with its
oxygen. It must be obvious that the occlusive covering
of plaster conferred a benefit by its virtue of excluding
the atmosphere, for the principle (never, so far as I am
aware of, before stated in reference to scion-grafting)
that no composition, whatever may be said of its peculiar
power of healing, can act in any other way than this,
any more than the farrago of plasters and salves for heal-
ing flesh wounds and cuts, which are only good in so far
as they keep the lips of the wound together and exclude
oxygen and light."
Rennie wrote this in 1855. Is not his theory of scion-
grafting a prototype — in analogy — of the recent theory
of Boillet that explains the reason why flesh womids heal
favorably nnder an impermeable albimrenate formed by
the union of a metal with the albumen of the tissues !
Urea a.s an Antiperiodic— Urea, which is used by
homceopathics for diabetes is now recommended ( IVeekty
Med. Review) by Dr. lielvousolT as an efficient substi-
tute for quinine. He asserts {Journal d' Hygiene) that
carbamide has a specific action in intermittent fever ;
that it can be employed in many other complaints as an
antipyretic ; that it is an efticient germicide, killing bac-
teria and vibriones instantly. It is tasteless, and does
not depress the nervous system, and is nuich cheaper
than quinine. In Southern Russia and Montenegro the
use of urme as a cure for intermittent fever is common
among the peasants. Several years ago the attention of
the profession was called to the value of a double salt
of urea and quinine for use by hypodermic injection in-
stead of the other salts of quinine, the claim tor it being
that it was less irritant, and equally, if not more efficient.
The facts just cited, as to the therapeutic qualities of
the urea, will explain and guarantee these claims.
^vo0vcss 0f |]bXcdical J^cicnce.
<*
Fever a Neurosis. — Dr. W. Innkler {FJltiger's
Archiv, vol. xxix.) has made an elaborate study of the
phenomena of fever experimentally produced in animals.
Since Tcheschicin first announced that there was a cen-
tre inhibiting the production of heat, there have been no
very exact methods carried on to prove the fact. Fink-
ler, however, has selected a very accurate method to
settle the question ; that is, a quantitative estimate of
the oxygen absorbed and of the carbonic acid given off.
In Pfliiger's school at Bonn, it has been found that in
guinea-pigs cold increases in a very regular manner the
generation of carbonic acid and the consumption of
oxygen. In this school it has also been shown that in
poisoning with curare the production of carbonic acid
and the absorption of oxygen fall greatly, showing that
the nervous system is a tactor in the tissue metamor-
phoses. It was also further established that section of
the medulla oblongata ' was followed by similar results,
there being here a partial elimination of nervous action.
Finkler measured the oxygen consumed and the car-
bonic acid given off", and compared these with a time
unit and the weight of the animal. From his experi-
ments the law is deduced that the consumption of oxygen
is greater during the fever-elevation of temjierature than
during the non-febrile state, under like conditions of food
and surrounding temperature. He also thinks that in
fever an increased amount of carbonic acid is given
off, due to increased heat-production. When the oxida-
tion passes through the three phases of increase, con-
tinuance at a height, and decrease, it corresponds only
in a general way to elevation, continuance at a height,
and decrease of temperature. Finally the author con-
cludes that fever is mainly an affection of that portion
of the nervous system which regulates temperature.
Insanity in the United States. — The ratio of in-
sanity to the population is lower in the United States
than in any other civilized country, and would be still
lower if estimates could be limited to .American born in-
habitants. At least so says Dr. Everts, of the Cincinnati
Sanitarium, in his annual report. One fact which swells
the number of insane reported is that " almost all adults
of the feeble-minded class are enumerated as insane."
This is no less true in other States than in Illinois, where
it was noted specially by Dr. Wilbur, of the Asylum for
Feeble-Minded Children of that State. Dr. Everts ex-
presses a truth which we all recognize when formulated,
in saying : " With us it is more reputable to be mad
than to be weak, and our public provision for those who
have lost their reason is much more pretentious, if not
more generous, than for those who never had much, if
any, to lose." He thinks there is no ground for believ-
ing that insanity as a disease is increasing in this coun-
try. The causes of insanity are such that in the opinion
of Dr. Everts, the American people may be assumed to
have a comparative exemption from the disease. Life
insurance records and the army statistics show that the
organic heritage of the American people is superior to
that of European natives, while it is unquestionable that
ours is the best fed people in the world. Again, the dis-
ease drunkenness is less common among Americans of
the present day than among their immediate or remote
ancestors, and less common, too, than among the pres-
ent inhabitants of Northern Europe, to whom they are
so intimately related. — Weekly Medical Review.
New Methods of Reduction of Dislocations of
the Thigh. — In cases where reduction of the femur by
manipulation in the usual way, with the aid of anaesthetics,
has failed, or is inapplicable, and as a substitute, in many
cases, for anesthesia, assistants, and mechanical power,
Dr. Kelly proposes the following methods :
For posterior dislocations. — The patient is laid pros-
trate upon the floor. Three strong screw-hooks are in-
404
THE MEDICAL RECORD.
[April 14, 1883.
serted into the flooring close to the perineum and each
iHuni of the jiatient, and to these hooks he is secured by
strong bandages or rope. The injured thigh is flexed at
right angles to the patient's body ; the foot and lower ex-
tremity of the tibia are placed against the perineum of
the surgeon, who, bending forward, with the knees slightly
flexed, passes his forearms behind the patient's knee and
grasps his own elbows. Reduction is now accomplished
by drawing the femur upward. But circumduction may
also be practised ; the surgeon stepping backward, then
extends the limb, and lays it by the side of its fellow. In
sciatic dislocations in order to liberate the head of the
bone from the foramen a bandage may be passed around
the thigh, close to the trochanter, by which an assistant
may make traction.
For anterior dislocations. — The patient is placed upon
a table of such elevation as to have his pelvis nearly as
high as the trochanter of the surgeon. A bandage around
the [lelvis, and secured to the side of the table farthest
from the dislocation affords counter-extension. The sur-
geon, with his fiice directed toward the dislocated joint,
and standing on its inner side, with his trochanter pressed
against the femur, now bends the leg behind his back,
and grasps the ankle with the corresponding hand. Re-
duction is effected by rotating or turning his body par-
tially away from the patient, thus making traction on the
femur in the most favorable direction, and at the same
time jjressing his head toward the acetabulum with the
disengaged hand. — The Fractitioner, March, 1883.
Is Craniotomy Justifiable. — From an analytical
study of the subject, Dr. Montgomery (^Philadelphia
Medical Times, ]\Iarch 10, 1883) is inclined to answer
the above question in the negative. He terminates his
studies by stating the following proposition : Craniot-
omy is unjustifiable, as, ist, it considers only the life of
the mother, and destroys that of the child, while it is our
duty to endeavor to save both. 2d. In pelves with a
conjugate diameter greater than 2\ inches we have other
alternatives equally safe for the mother, which afford the
child a chance for life. These alternativiJs we would sug-
gest in the following order : Where the conjugate meas-
ures 3.25 inches or over, the forceps ; 2. 75 inches or over,
version ; sf inches or over, symphyseotomy, followed if
necessary by the forceps. In all subsequent pregnancies,
and in the first when distortion is discovered sufficiently
early, premature labor should be induced. 3d. In pelves
measuring less than 2^- inches, Ca;sarean section affords
better results for the mother, and should be done whether
the child be living or dead.
In a limited number of cases (where the os is dilated)
laparo-elytrotomy may be preferred to Cajsarean section.
\\\ all cases requiring it, operative interference should be
early. The obstetrician should control events, not be
controlled by them.
Picric Acid as a Test for Albumen in the
Urine. — For the detection of albumen. Dr. Johnson
(^British Aledical Journal) recommends that this acid
should be used in the form of a saturated at[ueous solu-
tion, or in the form of powder or crystals. The atjueous
solution is most suitable for home use, while the powder
or crystals may conveniently be carried in a urinary pocket
test-case \ saturated aqueous solution may be quickly
made by adding about fifty times tlie bulk of boiling dis-
tilled or rain water to the powder or crystals, a portion
of the acid will crystallize out on cooling, leaving a trans-
parent yellow supernatant liquid. This solution being
added to an equal volume of albuminous urine in a test-
tube, immediately coagulates the albLimen. The coagu-
lated picrate of albumen is soluble in alkalies ; if, there-
fore, the urine be highly alkaline, it must be acidulated
by a vegetable or a mineral acid before adding the picric
acid solution. In numerous testings for albumen with
picric acid, the author has not once found it necessary to
acidulate the urine. The picric acid solution is itself
sufficiently acid to dissolve the phosphalic sediment which
results from boiling a neutral or alkaline specimen of
urine. To detect a very minute quantity of albumen,
the following method is the best. Into a test-tube about
six inches long the urine is poured to within two inches
of the top : then, the tube being held in a slanting jiosi-
tion, about an inch of the picrid acid solution is gently
poured on the surface of the urine, where, in consequence
of its low specific gravity (1.003), '^ only partly mixes
with the upper layer of the urinp ; and, as far as the )el-
low color of the picric solution extends there will be
more or less turbidity from coagulated albumen, contrast-
ing with the pellucid unstained urine below. If, then,
the tube be placed in a stand, the coagulated albumen
will gradually subside, and form a delicate horizontal film
at the junction of the colored and the unstained stratum
of urine, the yellow liquid above and the uncolored urine
below being quite free from turbidity. If the urine should
be turbid with urates, it must be cleared by heat before
the addition of the picric acid solution.
As a result of numerous observations. Dr. Johnson has
arrived at the conclusion that picric acid applied in this
way is a more delicate, and therefore more trustworthy,
test for albumen than nitric acid in cold urine, whether
the latter be employed by the method of dropping the
acid into the cold urine or by pouring the urine on the
acid previously placed in the tube. The simplest and
most satisfactory mode of comparing the two tests as re-
gards their relative delicacy, is to dilute a specimen of
albuminous urine until one or the other test fails to act ;
and it will be found that the picric acid solution sliows
the presence of albumen in a specimen diluted consider-
ably beyond the point at which the nitric acid fails to
give any indication. The picric acid, too, often causes an
immediate albuminous opalescence in specimens in which
nitric acid only slowly, and after an interval of some
minutes, gives a similar, but sometimes a doubtful, indi-
cation.
Ergotine Injections for Hydrocele. — Dr. Walker,
says {British Medical Journal) that, owing to an acci-
dental substitution, he injected two drachms of liquor
ergots, instead of the same quantity of tincture of iodine
into the sac of a hydrocele. The result was very gratify-
ing, there being a radical cure without the slightest re-
action. He has since repeated this method with perfect
success, and prefers it to other plans of treatment.
Priapism in Leucemia. — Dr. Carl Ketli, at a recent
meeting of the Medical Society of Budapest, Hungary,
exhibited a patient who had been suffering from painful
priapism for two weeks and had not been benefited by the
use of bromide of potassium, lupuline, and various other
measures undertaken for his relief. Spinal disease was
not present, but the patient showed all the characteristic
symptoms of splenic or medullar)- leucajmia. Similar
cases have been described heretofore by Longuet {Frogris
Medical, 1875, No. 32), and Salzer (Berliner Klinische
Wochenschrift, 1S79, No. 11). — Orvosi Hetilap, March
4, 1883.
Sassafras in Rhus Poisonino. — Dr. R. L. Hinton
claims that sassafras tea is almost a specific for the rash
produced by poison oak. This is an infusion of the bark
of the red sassafras. The diseased parts are covered with
compresses soaked in the cold infusion, while internally
there is administered the infusion warmed, sugared, and
with milk, according to the taste.
Primary Tuberculosis of the Intestines. — The
existence of tuberculosis of the intestines as a primary
affection has been denied by several writers. Dr. Kor-
czynski, however, affirms its occurrence and cites a case
in proof. A previously healthy man, forty-seven years
of age, began to suffer from pain in the abdomen after
having lifted a heavy beer-keg. He lost appetite and
strength, and general anasarca sui)ervened. The stools
were frequent, thin, and slimy, .'\fter a time he began
to coiiiiilain of constant i)ain to the right of the umbili-
April 14, 1883.]
THE MEDICAL RECORD.
405
cus, and upon palpation a tumor the size of an ap|)Ic,
soft, elastic, and very tender, could be felt. This tumor
disappeared from time to time and rea|)peared with bor-
borygmus and inclination to stool. The diagnosis was
made of tuberculosis of the small intestine with conse-
quent circumscribed peritonitis and constriction of tlie
gut. At this tiine there were no signs of disease in the
lungs. Later, the lungs gave evidence of being affected.
After death the autopsy confirmed the diagnosis. There
was a tuberculous tumor m the ilium with secondary
peritonitis. There was a recent disseminated tubercular
infiltration in the lungs without any cheesy collections.
The author thinks that the injury received in lifting the
heavy weight caused a sligiit inflammation of the ileum,
which inflammation determined the localization of the
previously latent tuberculosis. — Centialbhitt fur Klin.
Med., February 3, 18S3.
Diabetic and Nephritic Neuralgias. — Dr. Berger
has analyzed a number of cases of neuralgia depending
ujion diabetes or nephritis. He states that these neural-
gias affect usually the sciatic nerve, and more particularly
single branches of this nerve, such as the plantar or aural.
They show a tendency to aftect both sides symmetricallv,
are often associated with vasomotor symptoms, and are
exceedingly obstinate to treatment other than that di-
rected against the primary disease. The severity of the
neuralgia bears a direct ratio usually to that of the causal
disease, although in the cases under consideration it was
by means of the former that the organic trouble was dis-
covered. The author is inclined to regard these neural-
gias as having a central origin. — Centralblatt fur Klin.
Med., February 10, 1S83.
Phosphorus in the Treatment of Osteomalacia.
— Dr. W. Busch reports two cases of osteomalacia treated
by phosphorus. The first patient was a fairly healthy-
looking woman, thirty years of age, in whom the disease
appeared a few weeks after childbirth. The objective
signs were confined to the bones of the pelvis. This
presented the appearance of having been pressed to-
gether from the sides. The symiihysis projected forward
like a beak, while the horizontal rami of the pubes were
sharply bent. Walking was impossible, the patient being
able only with the greatest difiiculty to move from the
bed to a chair. Absolute rest in tlie horizontal [losition
was ordered to be maintained for three months, and
Wegner's phosphorus pills were prescribed. After five
months' treatment the patient was able to go up antl
down stairs without difficulty. At this time she changed
her residence and passed from under observation. The
second case was that of a woman, fifty years of age, who
complained of intense pain in the right arm near the in-
sertion of the deltoid nuiscle. A diagnosis of osteitis
was made and the ordinary measures were prescribed.
No improvement was noticed, and after several weeks
the patient abandoned the treatment. In about nine
months she again came under observation. She was
then reduced almost to a skeleton, was absolutely unable
to walk, and was greatly deformed. The dorsal spine
was kyphosed, while the cervical spine was so strongly
lordosed that the head seemed to rest between the shoul-
■ders. The thorax was distorted, the femora were bowed,
and the pelvis presented the characteristic deformity of
•osteomalacia. The patient was confined to the bed for
seven months, and took Wegner's pills for a year and a
■half. At the end of this time the bones were firm, and
she could go about without complain!*. The deformity
was not decreased. The following is the formula for
Wegner's pills: Vp. Phosphori, 0.025 ; syr. simpL, 7.5;
M. bene et adde pulv. glycyrrh. rad., lo.o ; pulv. gummi
arab., 5.0; gummi tragacanth., 2.5; ft. pil. No. 250.
Each pill contains about -j^^ grain of phosphorus. The
•dose is one pill twice a day, to be gradually increased.
Busch does not consider the drug to be of any value in
rickets or caries. — Centralblatt fiir Klin. Med., February
ao, 1883.
Pf;RiTONiTis Neonatorum. — Dr. Oscar Silbermann
recognizes two varieties of peritonitis in the new-born.
The non-septic or chronic form is developed usually in
the first third of ftetal life, and is generally syphilitic in
origin. If the peritoneum covering the intestines be in-
volved, as well as that over the liver and spleen, various
forms of intestinal obstruction may result. Most fre-
quently we find occlusion of the anus, less often stenosis
or complete occlusion of the small intestine. Of a num-
ber of cases of congenital occlusion of the intestine, col-
lected by the author, all ended fatally, only one living
beyond twelve days. The second, acute or septic, form
of ]3eritonitis in the new-born the author divides into two
varieties, according as the peritonitis is only a part of the
general infection or is the sole manifestation of the sep-
tic poison. In either case the point of entrance of the
poison is always at the navel wound. The symptoms,
which need not all be present in a given case, are vomit-
ing, watery stools, meteorism, ascites, abdominal tender-
ness, icterus, etc. The pulse, temperature and respira-
tion may vary in degree in the different cases. A cure
of the septic form is possible ; therefore, the treatment
should be carefully considered. The navel wound must
be cleansed, and the child is to be isolated from its
mother. To control the fever quinine may be given.
The Priessnitz sheet is of value. Vomiting may be
checked by chloral (one-half to one grain in water). The
strength should, of course, be maintained by stimulants
if necessary. — Schmidt's Jahrbilcher, January 17, 18S3.
Food Makes the Man. — Speaking roughly, says the
London Lancet, about three-fourths, by weight, of the
body of man is constituted by the fluid he consumes, and
the remaining fourth by the solid material he appropriates.
It is therefore no figure of speech to say that food makes
the man. We might even put the case in a stronger light
and affirm that man is his food. It is strictly and literally
true, that " a man who drinks beer thinks beer." We
make this concession to the teetotalers, and will add that
good sound beer is by no means a bad thought factor,
whatever may be the intellectual value of the commodity
commonly sold and consumed under that name! It
cannot obviously be a matter of indifference what a man
eats and drinks. He is, in fact, choosing his animal and
moral character when he selects his food. It is impos-
sible for him to change his inherited nature, simply be-
cause modifications of development occupy more than an
individual life, but he can help to make the particular
stock to which he belongs more or less beery, or fleshly,
or watery, and so on, by the way he feeds. We know
the etifect the feeding of animals has on their temper and
very natures ; how the dog fed on raw meat and chained
up so that he cannot work off" the superfluous nitrogenized
material by exercise, becomes a savage beast, while the
same creature fed on bread and milk would be tame as a
lamb. The same law of results is applicable to man, and
every living organism is propagated "in its kind" with a
physical and mental likeness. This is the underlying prin-
ciple of development. Happily the truth is beginning,
though slowly and imperfectly, to find a recognition it has
long been denied. It is possible that in the natural desire
to secure the best and purest su]iplies of food and drink for
man we are pushing matters a little to extremes and be-
coming ridiculous. Utopia is a long way off, and " Hy-
geia" has not yet been built. It is, however, desirable
that we should aim high and make the teachings of physi-
ological science the precepts of our daily life and conduct.
We may not be able to reach our ideal, but progress will
be advanced by striving to make its attainment an object.
"What to eat, drink, and avoid" is a rational proposi-
tion ; and if some of us are becoming a little unreasonable
in the attempt to solve it, at least we are on the right
road, and ought to be encouraged rather than abashed
by the, not unkindly, criticism our endeavors are calling
forth.
4o6
THE MEDICAL RECORD.
[April 14, 1883.
The Medical Record>
A Weekly yournal of JMcdicine and Suj-gery.
GEORGE F. SHRADY, A.M., M.D., Editor.
Published by
WM. WOOD &. Co., Nos. 56 and 58 Lafayette Place.
New York, April 14, 1883.
SEWER GAS, AND ITS ALLEGED CAUSATION
OF TYPHOID FEVER.
In a paper recently presented before the College of Phy-
sicians of Philadelphia, by Dr. George Hamilton, some
very e.xcellent arguments are brought forward relating to
the causation of typhoid fever, as opposed to the opinion
that sewer gas is the principal agent in the production of
this disease, and more than equal, singly, to all other
causes combined. While admitting the importance of
the vehicle sewer gas as one element in this direction,
numerous instances are cited, supported by facts founded
upon personal observation and inquiry, and upon statis-
tics, in which sewer gas played no part whatever, and
showing that the larger number of cases of typhoid fever
occur altogether independently of this influence. In-
deed, the weekly reports of the health boards of Phila-
delphia and New York City, and, in contradistinction, the
practical experience and investigation of eminent author-
ities, show that typhoid fever has always been far more
prevalent in the suburbs and surrounding country than
in the cities subjected to the contamination of sewer gas.
That sewer gas is, however, a prominent factor in the
causation is not denied ; but upon this foundation enthu-
siasts have built until the credulity of public opinion has
accepted the mountain, while other agents, the little
mole-hills, which possess not only an equally important,
but even a greater, influence in this respect, are almost
totally ignored.
Regarding tlie declaration that there is in country
houses, or the surroundings, something ecpiivalent to
sewer gas, personal experience has shown that the young
men at work in the fields were more frequently attacked
than the females, who were generally engaged in domes-
tic duties in or about the house. The same results are
also exhibited of diphtheria and scarlatina, as to the cau-
sation of these maladies by this agent, the most fatal at-
tacks occurring in tiie country where sewer gas is want-
ing. Furthermore, ex[Jerience justifies the assertion that
in not more than one house out of five has any evidence
of sewer gas been detected, either before or during an
attack of typhoid fever. If, also, the opinions of some
eminent authorities are correct that the plumbing appa-
ratus, as at present constnicted, is incapable of excluding
the gas, and that the dwellings of New York City and
Pliiladelphia are so thoroughly infected, the self-evident
conclusion is that the mortality would be something
frightful. Again, instances are recorded where individu-
als returning from the country to their city homes have
been taken with typhoid fever in a very few days, and be-
fore the incubative period could have passed. And
others where the disease has appeared among the wealthier
residents of the country, where the surroundings, the
farm, the agriculture, domestic and general economy have
been exceptionally good. Yet all this has often occurred
without the influence of sewer gas or, to all appearances,
of any of the other agents which are usually held respon-
sible. And the experience of extensive practitioners,
both in town and country, almost invariably serves to
show that typhoid fever, when it appears in the country,
is far more general and more fatal than in the city, and
that it is, as a rule, impossible to trace its origin.
Attention is also directed to the habit, by professed
sanitarians, of expatiating on the unnecessary prevalence
of the so-called "filth diseases" — typhoid fever, scarlet
fever, and diphtheria — in large cities, while, at the same
time, they seem unmindful of the great excess in the
ravages of these same diseases in the country, both in
proportionate number of cases, in violence, and in fatal-
ity. In connection with this it is further shown that ia
the central portions of Philadelphia, where sewers and
water-closets most abound, there is, as a rule, less typhoid
than in the adjacent country ; and just in proportion as:
the city encroaches upon the rural sections, constructing^
streets, houses, and sewers, a diminution in the fever has
invariablv followed. The condition of the streets of one
or two of the most populous cities of Africa are also men-
tioned, wliere every species of filth abounds, and yet
typhoid fever prevails only to a very slight extent.
In regard to the contamination of drinking water act-
ing as a cause, while this is unquestioned, yet it is reminded
that the quality of the water remains essentially the same
from year to year, whether typhoid prevails extensively
or is absent. In this connection, however, should not
individual susceptibility also receive consideration ? And,
moreover, is not the fact of the streets of Africa, etc.,.
reeking with filth and stench, while the statistics of that
region show a comparative immunity from the disease,
but a blow at every generally accepted cause of typhoid
fever, since nothing would seem to be wanting among-
such surroundings but the appearance of even one single-
case ?
Admitting the various factors, then, can the prepon-
derant one be selected by exclusion. Possibly water-
pollution may claim the foremost rank, but is this simply
because the use of water is universal and its infection so-
easy a matter? Ma\' it not be fair to assume that, at
least in the primary exhibition of the disease, the peculiar
state of the constitution holds an important part. The
acarus scabiei cannot thrive in every soil. May not also-
the typhoid germs (presupposing their existence) often
fail to set up their specific condition, particularly when
taken into a healtliy and robust constitution ; and may
not the drinking water be essentially the same from year
to year — be infected — and yet the germ fail to excite its.
disease, until the particular individual or the special state
offers? While, therefore, the numerous elements brought
forward in this direction are important in their several
bearings, yet it must finally be admitted that the intimate
and primary cause of typhoid fever is, at present, one of
the most obscure i)roblems of medical science.
April 14, 1883.]
THE MEDICAL RECORD.
407
THE WHOLESALE PREPARATION OF DRUGS AND MIX-
TURES.
Neiv Remedies publishes the following letter, fioin a
correspondent, concerning what is termed " a growing
evil."
" The leading pharmacists of this city have had several
meetings recently to consult in regard to the prescrib-
ing by physicians of special preparations emanating from
the large manufacturing establishments. This practice is
working to the injury of both the physician and ])har-
macist. The pharmacist, in order to hold his trade, is
obliged to keep in stock a full line of similar preparations
from perhaps half a dozen different makers, and the
physician often loses his fees, from the patient finding out
that he can purchase the remedy prescribed in original
packages, and at reduced rates, from the fancy goods
dealer or the wholesale druggist, and will continue the
use of the niedicme, and if benefited, reconnnend it to a
friend, without giving his doctor the credit by sending
him other patients. It is now proposed, and an able
committee has been appointed, to get up a uniform set of
formulas for the preparation of the different eli.xirs, syrups,
and other products of elegant pharmacy, so called, for
the use of the pharmacists and physicians of New York
and Brooklyn, so that after the adoption and publication
of these formula; the physician may send his patient to
any respectable pharmacy, confident that his prescri])tion
will be filled with a uniform and reliable preparation,
which cannot be obtained by the patient in any other way
than by his order."
The preparation of a set of formulx such as is suggest-
ed will no doubt be useful. The whole matter, however,
appears to be one of greater interest to the pharmacist
and the public, than to the physician. The manufacture
and extensive advertisement of special mixtures contain-
ing numerous vegetable drugs in unknown proportions
"so combined as to produce peculiarly valuable efiects"
has become very popular of late. This practice tends to
demoralize legitimate therapeutics and is not to be com-
mended. The manufacture, however, of officinal drugs,
singly or in various combinations, and the putting them
upon the market in attractive form, has much to be said
for it, and we do not share the fears of the corres|iondent
quoted above, that such action of itself injures the phy-
sician's practice or diminishes his income.
THE CLINICAL TEACHING OF MENTAL DISEASES IN
AMERICAN COLLEGES.
The National Association for the Protection of the In-
sane and the Prevention of Insanity has issued a circular
addressed to the various medical colleges of the country,
and asking that the didactic and clinical teaching of in-
sanity be introduced. The circular is signed by Dr. E.
C. Seguin, Dr. M. Putnam-Jacobi, and Dr. Margaret
Cleaves.
With the increased prominence now being given to
clinical teaching, it is most proper that mental diseases
should receive their share of attention also. Every medi-
cal student ought certainly to see some of the various
types of insanity before graduating, and be able to recog-
nize their salient features. We have often insisted upon
the need of a better knowledge of insanity on the part of
medical men, believing that such a knowledge would be
a powerful factor in preventing and lessening the disease.
The recommendations of the National Association will
appeal to every one as wise and sensible.
We understand that there are already nearly a dozen
colleges which have lectureships on mental disease, but
that verv few of these attempt any clinical instruction,
it IS thib latter alone which will give value to the teaching.
THE NOURISHMENT OF CHILDREN AFFLICTED WITH
HEREDITARY SYPHILIS.
The question of the nourishment of children afflicted with
hereditary syphilis is one upon which there is considerable
diversity of opinion. Most authors agree that the lives
of this unfortunate class of beings can only be preserved
by a strict diet of human milk. I!ut writers are less unan-
imous in their views as to the best means of obtaining
this nourishment. Zeissl advises {Centralblattfiir Gyndk.,
February 3, 1883), in case the child of a syphilitic mother
shows no signs of hereditary syphilis, that a nurse be
procured. He argues that, even if the milk cannot
convey the poison, it is yet unhealthy and unfit for the
nourishment of the child. In the other case of a syphil-
itic child born of a healthy mother, Zeissl thinks it safe,
as a rule, to let the mother suckle her infant. Yet
CoUes' law*, that a child cannot infect its mother in nurs-
ing, is not without exceptions. Two of these have al-
ready been recorded, and the author cites a third case
related to him by Dr. Luth. If a nurse be employed she
should be warned of the possibility of infection. Eisen-
schitz (Ceniralblati fur Klin. Med., February 3, 1883)
agrees with Fournier and F"urth that the infection of the
nurse is certain to occur, and, therefore, insists that the
mother herself should suckle the child. A nurse should
be procured only when the mother is absolutely unable
to nourish the infant, and when the prognosis for the
latter is favorable. And she should, of course, be warned
of the danger to which she is exposed."
THE ACTION OF CALABAR BEAN UPON THE INTESTINE.
A NUMBER of authorities have conunended the use of cala-
bar bean on account of its peculiar power of stimulating
intestinal peristalsis. Subbotin and Schaefer, of Bonn,
have especially called attention to its value, but we find
mention and commendation of it in nearly all the modern
therapeutical works. At the Berlin Veterinary School,
and at the Columbia Veterinary College and School of
Comparative Medicine in New York, eserine, the active
principle of physostigma, has been used with remarkable
results in the obstinate constiiiation and colic of horses.
Grain doses of the drug injected into the jugular vein, or
subcutaneously, will, it is said, cause movements when
everything else has failed. Subbotin has reported a
similar experience in cases of obstinate constipation in
man.
The attention that has been called to the value of
calabar bean as a tonic and stimulant to the intestinal
musculature gives a special interest to a recent communi-
cation by Dr. A. Hiller, of Berlin, detailing his experi-
ence. He employed a fluid extract of calabar bean, one
part in three hundred of glycerine, and gave ten drops
three or four times daily. He confirms the statements
of Subbotin that calabar bean is a rapidly acting remedy
4o8
THE MEDICAL RECORD.
[April 14, i!
in atonic conditions of the intestinal tract, and is useful
in the flatulence and oppression which accompany this
atony. He adds, however, that in his experience the
drug has a temporary action ; that after a few days the
intestine seems to become less responsive, and that then
the fluid extract must be given in doses which are likely
to produce toxic symptoms. Furthermore, Dr. Hiller
states that he has never known the physostigma alone, in
safe doses, to produce an evacuation. It must be given
with aloes, castor oil, or some other purgative. The
writer concludes that if one wishes to use physostigma as
a tonic to the intestinal wall, he can safely give the drug
for only two or, at most, three days, using doses of 1.5 to
3 milligrammes three or four times daily. An early
evidence of toxic action is found in the narrowing of the
pupil.
Calabar bean, when given in large doses to rabbits,
was found by Hiller, as has been done by others, to pro-
duce at first increased peristalsis, but finally a tetanus of
the intestinal wall accompanied by great anieinia. Hiller
suggests that possibly the drug, in large doses, may be
useful in cholera, since it produces the opposite condi-
tion to that of the disease in question. Some years ago
this idea was broached by Mapother and by Munro. The
drug was, we believe, tried, but the results were not very
satisfactory.
AIR-BATHS.
Dr. Franklin is credited by the Boston Journal of Clum-
istry, March, 1883, with the discovery of a sanitary or
curative agent called the air-bath. It is certainly a mat-
ter of conniion experience that the application of cold or
warm water is not equally well borne by all. Indeed,
some invalids, convalescents, or enfeebled persons have
experienced deleterious effects from bathing as ordinarily
used. In certain conditions of the body, sponging,
douching, the wet-sheet, and especially the popular Turk-
ish and Roman baths, or similar ordeals, may be readily
conceived to be measures of doubtful hygienic value.
Yet attention to efficient cutaneous action is never out
of place. Now, it is for the benefit of persons who do
not bear well any kind of "water-cure," that it is pro-
posed to substitute- the air-bath as a means of, or, at
least, an aid to recuperation.
We are told by the author that the morning is the best
time for the air-bath, and all that is required is a hair-
cloth mitten and a moderately cool room. Here are the
directions for this new kind of batliing : Let the invalid
step from the bed to the Hoor, seize the hair glove or
mitten, and without removing the night-clothes proceed
to rub gently all parts of the body, at the same lime
walking about in the room until a feeling of fatigue is ex-
perienced. Then drop the glove, and gently pass the
hand over all parts of the body before resuming the cloth-
ing. Unless the nude body is extremely sensitive to
cold, a portion may be exposed to the air for a few
moments while in motion, even on the first morning.
The next morning jump out of bed in a moderately cool
room, and go over the same process as before, remain-
ing a little longer exposed to the air after the rubbing.
The third morning repeat this treatment ; and on the
fourth, or at the end of a week, take off all the night-
clothing, and briskly apply the hair glove, first with the
right hand and then with the left, all the time walking
about. Follow up this as the degree of strength permits,
niornmg after morning, until the blood is so attracted to
the surface, that the cool air is felt to be a luxury. Let
the body be entirely nude. Al first, or after the first
week, perhaps, the exposure to the pure cool air may be
three or four minutes. Soon this may be increased, un-
til, after a month or two, the air-bath may continue for
twenty minutes or half an hour. It is essential to walk
about during the first month, using the hands in polishing
the skin. Later on the patient may sit in the air of the
room part of the time. But constant, gentle exercise is
best.
Now, according to the author, another most important
curative agent connected with the air-bath is sunlight.
In summer, this is easily accessible, but in winter only the
late risers can secure its benefits. Exposure to sunlight
during the air-bath apparently enhances its hygienic
value. It is thought that the direct actinic rays of the
sun may have some very beneficial properties. We are
not aware that air-bathing has already become universally
recognized as an important aid in re-establishing normal
vitality in enfeebled constitutions. Judged a priori the
method appears to commend itself in certain selected in-
stances. Yet it will scarcely sup[)lant the popular
aqueous ablutions, as a healthful, delightful, and time-
honored practice.
CURE OF SQUINT WITHOUT OPER.ATIOX.
In the early stages of convergent strabismus, before the
internal rectus muscle is permanently contracted, Dr.
Boucheron {Sc-hmidt's Jahrbiicher, January 17, 1883)
claims that a cure is possible without operation. He
states that as convergence is caused by efforts of accom-
modation for near objects, if we take away the power of
accommodation squint will not occur. He maintains a
constant mydriasis by the instillation of atropine night
and morning. A cure is usually obtained in two or three
weeks. If atropine is not well borne, other m3driatics,
such as duboisia, may be used. In nine cases of inter-
mittent strabismus the author obtained eight cures by
this method.
THE METHOD OF BRANDT.
During the late epidemic of typhoid fever in Paris,
upward of six thousand persons were attacked with the
disease, and the mortality was nearly thirty-seven per
cent. In three months the number of deaths was 1,358.
These facts maybe some excuse for the interminable dis-
cussion regarding typhoid fever which has been going on
in the Academic de Medicine since last Fall.
One of the features of this discussion was the appear-
ance of a Lyons physician, Dr. Frantz Cdenard, who
came up to Paris as a representative of the Faculty of
his city, and as an apostle of the method of Brandt in
the treatment of typhoid fever. Glenard has long been
known as an enthusiastic advocate of hydrotherapy in
this disease. His first and second monograjihs on the
subject have been ([uite widely circulated. A third mono-
graph, published two years ago, contrasted the use of cold
baths with that of phenic acid, very favorably to the
former.
April 14, 1883.]
THE MEDICAL RECORD.
409
In Glenard's later writings he states that, while the
mortality from typhoid fever without cold baths was 22
per cent, in 33,293 jiatients, with cold baths, as directed
by Brandt, the mortality has fallen to 7.4 per cent, in
8,141 cases. The rejiort of M. Strube, Medical Director
to tile Prussian Minister of War, is quoted, in which it is
stated that in several army corps where the lirandt
method was tried, the mortality fell fiom thirty to three
or four per cent. Glenard claims that tiie hospital phvsi-
cians of Lyons, almost without exception, have adopted
the method of Brandt.
There is a certain lack of definiteness and authority
about Dr. Glenard's statistics, and we cannot find that
he now brings forward very much new evidence for his
hobby. He firmly believes, however, that the method of
Brandt strictly carried out will reduce the mortality from
ty|ihoid fever to three per cent. We hope he is right,
but in America, at least, there have been no clinical re-
sults which in the least sui)port this pleasing view.
THE STATE MEDICAL SOCIETY AND A TURN IN THE
TIDE.
It is gratifying to observe the change which is taking
place in the attitude of the American medical press and
profession toward the New York State Medical Society.
One year ago The Medical Record and the A''t;7a York
Medical Journal were almost alone in defending the po-
sition assumed by this Society.
Now' matters are nuich changed. The Buffalo Medi-
cal and Surgical Journal accepts the action taken last
February; the Medical Annals ably defends it. 'I'he
Medical Age, one of the best edited and most repre-
sentative journals in the West, sides with those who be-
lieve that the position of the profession will be elevated
by not attempting to antagonize homoeopathy, or to en-
force a petty and ineffective discipline. The H'eckly
Medical Review, perhaps the most wide-awake and pro-
gressive of meilical journals west of the Alleghanies,
takes an impartial position, and admits arguments on
both sides. 'I he Indiana Medical Monthly shows in a
recent editorial how foolish, exaggerated, and unjust have
been the criticisms against New York's action. It is
quite willing to wait and learn from this State's e.xperi-
ence. The Southern Clinical dieview and, we believe,
the Northivestern Lancet side with the position taken by
our State Society. The Virginia Medical Monthly com-
ments with great fairness upon this position ; so also
does the Maryland Medical Journal and the New Or-
leans Medical and Surgical Journal. The Independent
Practitioner is non-committal.
To all this we should add the weighty effect of the
doctorate address delivered by Professor Moses Gunn
and published in the Chicago Medical Journal and Ex-
atnitier, as also that of the Presidential address by Dr.
Alexander Stone, Vice-President of the American Medi-
cal .Association.
It is no longer possible, therefore, to say that the
medical profession universally disapproves of allowing
freedom in consultations.
Under the influence of maturer thought, kindly and
sensible feelings have developed. The eflicacy of fa-
natical and abusive declamation has spent its force. The
question is reaching the right basis for fair discussion.
THOMSEN'S DISEASE.
Professor Westphal recently showed to the Berlin
Medical Society two patients suffering from a very
unique affection which he christened at the time, and
very approjjriately, with the name of " Thonisen's Dis-
ease." Dr. Thomsen, a general practitioner in Schles-
wig, first described the trouble in 1876, having himselt
been a victim to it all his lite. .Since his description was
published only eigiit snnilar cases have been reported,
and so far the disease appears not to have been observed
in France, England, or .'\nierica.
The prominent symptom is the following : When the
patient under certain circumstances attempts voluntary
movements, the nuiscles undergo tonic contraction, and
the movement is stopped or hindered. Thus, after long
sitting or standing, if the person tries to move, he finds
his muscles so stiff that it is at first impossible to stir.
The same thing follows after rapid and powerful muscu-
lar movements. The unfortunate patient, in trying to
run or dance, is suddenly overcome with muscular stiff-
ness. If he throws a stone, the extended arm remains
rigid. Sudden irritations, either physical or mental, also
bring on the spasm. If, while walking along, the foot
strikes a stone, the leg becomes rigid and the patient
may fall down. In some of the cases simply concentrat-
ing the m'ind upon the trouble would bring on some evi-
dences of it.
The spinal nerves are most aftected, but the innerva-
tion of the face, and even of the ocular muscles, is par-
tially interfered w-ith. The smooth muscles are not dis-
turbed. The muscles undergo an increase in volume,
though not in proportionate strength. Their electrical
reactions are unaftected. Microscopic examination of
the fibres shows nothing abnormaL The reflexes are
normal. Sensibility is undisturbed and the contractions
and stiffness do not cause pain.
The cause of the disease is not known, but it has a
curious hereditary tendency. In fact most of the cases
have occurred in Dr. Thonisen's family, where it has
been traced through four generations. Dr. Thomsen
was inclined to think that the trouble had a psychical
basis, but Westphal believes it to be an anomaly of the
muscular tonus. Treatment accomplishes little or noth-
ing. The disease is a pathological curiosity and a highly
interesting; one.
THE PROPOSED JOURNAL OF THE AMERICAN MEDICAL
ASSOCI.\TION.
We had occasion recently to refer to the statements of
the committee on the proposed journal of the American
Medical Association, and suggested that the estimates of
the yearly cost of the scheme, and a definite statement
of the encouragement received be published at once.
We have neither heard nor seen anything in response to
this practical and common-sense advice.
Surely the members, w'ho are individually to become
liable for any deficit in the annual accounts, and in our
judgment a deficit is more than probable, should have the
fullest opportunity to consider the prospective debit and
credit sides of this account.
If the committee have the figures, as they say they
have, let the items be published now ; if they are favor-
4IO
THE MEDICAL RECORD.
[April 14, 1883.
able to the plan, it can do no harm ; if they do not
satisfy all, the Association will, at least, have the satisfac-
tion— if it concludes to start the journal — of knowing that
it went into it with its eyes open. To withhold the
figures, upon which alone an intelligent judgment can be
made, until the time of the meeting is quite unfair and
unjust to the members generally. Shall we ha\'e light ?
n
^cxus of the ^IccU.
The North Caroi.ixa Bo.^rd of Health has failed
to receive an appropriation from the Legislature.
The New York PosT-GRADU.vrE School and the
New York Policlinic. — We are glad to learn that both
the above institutions have prospered beyond expectation
during the past season. The present courses are larger
than ever. They will continue open during the sjning
and summer, a fact which will be much appreciated by
many i)hysicians who cannot easily come to New York
in the winter season. The advantages which these ])0st-
graduate schools possess is the ability to offer direct and
personal instruction in technique and in symptomatology.
Sir William Jenner has been re-elected President of
the Royal College of Physicians, London.
De.'\th of Professor von Bruns. — The death is re-
ported of Professor von Bruns, one of the highest surgic.1l
authorities in Germany. The deceased, who was born in
1812, in Brunswick, was the author of several surgical
treatises and handbooks, and made a special study of dis-
eases of the larynx, for the treatment of which he in-
vented a new and effective throat-mirror. His work on
laryngoscopic surgery gained for him the grand prize of
20,000 marks offered by the Academy of Turin.
The Kentucky St.^te Medical Society held its
twenty-eighth annual session on April 4th, at Louisville.
A large number of members were present. The address
of welcome was delivered by Dr. Coleman Rogers, who
referred to the fact that, in accordance with a previous
resolution, no special entertainments would be offered the
Society, which was expected to devote itself to scientific
work alone.
A letter was read from Dr. S. D. Gross, in which he
said : " Forty-two years have elapsed since my then col-
league, the lamented Drake, and I were deputed by the
Medical Faculty of the University of Louisville as dele-
gates to attend a convention at Frankfort, called at the
instance of Dr. George Sutton, of Georgetown, to as-
sist in the formation of a State medical society, of which
the present Society is the offspring. The attempt was a
-signal failure, and it was not until the following year, if
indeed so soon, that Dr. Sutton's efforts were crowned
with success.
" Since the date of my visit vast changes ha\e taken
place in and outside the profession. .Medical education
has been greatly improved, and the practice of medicine
has assumed many new features, while many of its
branches have been completely revolutionized. .Ml my
■ old colleagues, with the exception of two, of the I'niver-
.sity of Louisville, are dead, and most of my old personal
friends of Louisville are moldering in their graves. My
own davs are numbered ; time has made me an old man,
and 1 cannot expect to attend many more public meet-
ings of any kind. All that I can do is to send you
and all the rest my love and my best wishes for your
and their prosperity and happiness. Always truly your
friend."
The annual address was delivered by Dr. A. D. Price,
and was sensible and practical in character. He touched
upon the subjects of medical education, trained nurses,
legalizing prostitution, and specialism in medicine.
Action of the Illinois State Board of Health
IN Relation to the Columbus Medical College. —
The following action of the Illinois State Board of Health
was had at its meeting, January 12, 1883 :
" Ordered, after a careful investigation of all the essen-
tial facts in the case of the Columbus Medical College,
two members of the Faculty of said College being present,
and the facts elicited being confirmed by documentary evi-
dence, that, while said College committed an irregularity
in granting a diploma to A. M. Dent, that irregularity
does not seem to warrant this Board in refusing to recog-
nize other diplomas of said College. "
We are asked to add, in regard to the " Dent "' case
that the F'aculty " presented to said Board evidence of a
previous full course of lectures at a regular college,
eight years of reputable practice, a copy of his written
examination by the Faculty of Columbus Medical. Col-
lege, a thesis in his own handwriting, and the recommen-
dation of two medical gentlemen of West Virginia of high
standing and character, etc., and after careful review of
the case, they said there was no doubt as to his (Dent's)
qualification and fitness for degree ; that there was
simply a technical ' irregularity,' in this, that the Board
now required two full courses of lectures. In regard to
the charges of graduating ' short time men.' these were
without foundation, in the opinion of the Board."
A College of Midwifery has been established in
this city. The object of the institution is to give instruc-
tion to all desirous of learning the art of midwifery.
There are, we are told, only two others of similar design
in America.
The announcement says : " France and (iermany have
their schools and maternity hospitals, and no one can
practise midwifery without a thorough course of training,
passing a strict examination, and receiving a certificate
or license. The opportunities for practical instruction
in midwifery in this country are so limited that many of
the graduates of the medical colleges begin practice
without seeing a single case of obstetrics, and are sadly
deficient in the details of this important branch."
The course of study lasts tliree months. Four even-
ing lectures a week are given on anatomy, physiology,
midwifery, puerperal diseases, and management of in-
fants.
Quebec An.vto.mv .'\ct. — The Quebec Government
has recently brought in important amendments to the
.Anatomy Act, which will, it is hoped, put an end to body-
snatching in the Dominion. Insijectors are to be ap-
pointed whose duly it will be to see that all unclaimed
bodies in institutions receiving government aid are
handed over to the schools, who shall pay ten dollars for
April 14, 1883.]
THE MEDICAL RECORD.
411
each body. The institutions are to notify the inspectors
within twenty-four hours after the death of any friendless
persons, and claimants must show relationship within the
third degree.
Health Statistics in Canada. — The Dominion Gov-
ernment has increased the appropriation for the purpose
of collecting and utilizing health statistics, the sum of
$20,000, instead of $10,000 as last year, having been
placed in the estimates just brought before the House.
The Sanitary Council of the Mississippi Valley.
— .^t a meeting of this Council, April 4th, the following
resolutions were passed :
First. — That a committee be appointed by the Presi-
dent of the Council to petition the President of the
United States to place the $100,000 epidemic fund in
the hands of the National Board of Health for disburse-
ment, in case its use is demanded.
Second. — That in case the National Board of Health
is deprived of the power of making inspections of [ier-
sons and freight, when demanded by the local doctors,
health certificates issued under the supervision of repre-
sentatives of the Sanitary Council of the Mississippi
Valley shall be accepted as valid by the Boards of Health
of the Mississippi Valley, provided that said inspections
be carried on under the rules and regulations heretofore
prescribed by the National Board of Health.
A Judgment against the United States Medical
College. — New York Supreme Court. Special Term.
The People of the State of New York, plaintiffs, against
Robert A. Gunn, Benjamin J. Stow, Paul \V. Allen, Al-
exander Wilder, Thomas \. Granger, Mark Nivison, and
Dennis E. Smith, defendants. Judgment, April 4, 1SS3.
This action having been brought to trial upon the issue
of law raised by the plaintiffs' demurrer to the defendants'
second defence contained in their answer herein, and be-
ginning with the words, " Second, And for a further and
separate defence," and ending at the demand for judg-
ment ; and the said demurrer having been, by order of
February 5, 1883 (settled and filed March 12, 1SS3),
sustained, with leave to defendants to answer over on
payment of costs ; and the costs having been taxed at
$108.13 ; 3.nd the order having provided further that un-
less the defendants pay said costs and amend their an-
swer within twenty days, plaintiffs should have judgment
absolute against defendants as for want of an answer ;
and the defendants having failed to ])ay said costs, or
amend said answer, within the time aforesaid.
Now, on motion of Leslie \V. Russell, Attorney-Gen-
eral, attorney for the plantiffs, it is
Adjudged : That the said defendants are not and have
not been incorporated as a medical college, with the
franchises or powers of a medical college ; and that the
said United States Medical College, mentioned in the
complaint, is not and never has been incorporated as a
medical or surgical college, and does not possess the
powers or franchises of a medical college,
Aftd it is further adjudged : That the defendants,
and each of them, and all persons acting with or under
them or any of them, be and they hereby are enjoined
and restrained from acting, or assuming to act, as an in-
corporated medical or surgical college, and from usurp-
ing or exercising the power, functions, or franchises of
an incorporated medical or surgical college ; and from
maintaining or assuming to maintain, for gain or other-
wise, a medical or surgical college ; and from granting
diplomas or certificates of graduation to medical students
or practitioners, purporting to be granted by a medical
or surgical college ; and that the plaintiffs, the People
of the State of New York, recover of the defendants,
Robert A. Gunn, Benjamin J. Stow, Paul \V. Allen, Al-
exander Wilder, Thomas A. Granger, Mark Nivison, and
Dennis E. Smith, the sum of one hundred and eight dol-
lars, and thirteen cents costs and disbursements taxed as
aforesaid ; and that plaintiffs have execution therefor.
(Endorsed, Filed April 4, 1883.) (A copy.)
Dr. Nagle, Deputy Register of Vital Statistics, has in-
structed the clerks in the Bureau of Vital Statistics to re-
ject all death certificates signed by graduates of that col-
lege.
Disciplining a Doctor for Producing Abortion. —
The New Haven Medical Association has taken steps to
expel Dr. E. L. R. Thomson on account of his connec-
tion with a case in the city court, in which he is charged
with procuring an abortion. The statements made by his
counsel. Col. Dexter R. \\'right, claiming that there was
not a father in New Haven who would not be willing
that an abortion should be i)erformed on his daughter to
save her from shame and trouble, and that he would have
no difficulty in finding physicians to perform the opera-
tion were strongly resented. The Prudential Committee
claim that if Dr. Thomson is allowed to remain in the
society it would be a tacit support of him.
Distribution of the Excise Money to the Med-
ical Charities. — The sum of $35,430 from the Excise
Fund has been assigned to the different charities of the
city. The hospitals get between one and five thousand
dollars each.
Nurses' Training School of the New York Hos-
pital.— The Commencement exercises of the graduating
class of the Training School for Nurses attached to the
New York Hosjiital were given .\\)n\ 5th in the lecture-
room of the institution. This was the first Commencement
of the school, which has been in successful operation since
1877, and the exercises were attended by a number of
the friends of the pupils and of the hospital. The school
numbers twenty-six pupils, of whom nine were graduated.
A Bill to Establish a Department of Eclectic
Medicine in the University of .Michigan has been intro-
duced in the Legislature. Should it pass, that most
catholic university will have a triple set of therapeutical
professors.
Attempt to Rob a Physician. — Dr. Patrick H.
Flood, one of the oldest and wealthiest physicians of
Elraira, N. Y., was knocked on the head in front of his
own gate last Tuesday night, and would have been
robbed but for his pluck and vitality, even under the
stupefying effects of the blows. The robbers escaped,
and there is no clue to their identity.
Dr. Havremann, a young physician residing in Ros-
tock, has been appointed special physician to the Queen
of Madagascar.
The Utica Insane Asylum is being investigated
again by a committee from the State Assembly.
412
THE MEDICAL RECORD.
[April 14, i88.
Death of Dr. John Davis. — Dr. John Davis, one of
the oldest physicians of the city, died recently in his
eighty-second year. Dr. Davis graduated from the Col-
lege of Physicians and Surgeons in 1823. He had
practised m this city and Brooklyn for fifty-five years.
Mme. Scalchi is staying while in New York with Dr.
Louis Elsberg and his family, who are old friends of the
great contralto.
Chicago Medical Society. — The following officers
were elected for the ensuing year : President, Dr. D. W.
Graham ; First Vice-President, Dr. R. G. Bogue ; Second
Vice-President, Dr. R. Park ; Secretary, Dr. L. H.
Afontgomery ; Treasurer, Dr. E. F. Ingals.
Professor Charcot has been elected an honorary
member of the Royal Irish Academy on account of his
important researches in pathology and physiology.
Ca.mbridge Uxiversitv. — England is gradually de-
veloping a medical school. Funds have been supplied
for the Physiological Chair, occupied by Dr. Michael
Foster. Dr. Humphrey has accepted the Chair of Sur-
gery without stipend, leaving vacant an endowed Chair
of Anatomy, which will soon be filled.
The Orkney Islands are at present suffering from a
wide-spread and unwonted epidemic of measles.
^>cincui5 and ^Uiticcs.
A Manual of the Practice of Medicine. Designed
for the Use of Students and the General Practitioner.
By Henry C. Moir, M.D. Second Edition. i2mo,
pp. 455. New York : James H. Belding.
The second edition of this admirable little work has
been very carefully revised, and several portions of it
have been entirely rewritten. We take occasion to re-
peat our good opinion of the work, considering it, as we
do, one of the best condensations of the theory and
practice of medicine that has been published. The more
it is known the better will it be appreciated.
Pocket Therapeutics and Dose-Book. By Morse
Stewart, M.D. Third Edition. Revised and en-
larged, pp. 240. Detroit : Geo. D. Stewart .S: Co.
This little work, now in its third edition, hardly needs
any special comment. We believe it will be founil use-
ful, and can recommend it, both to the student and prac-
titioner.
A Practical Treatise on the Diseases of the
Uterus, Ovaries, and Fallopian Tubes. By A.
CouRTY, Professor of Clinical Surgery, Montpellier,
France. Translated by Agnes M'L.-\ren, M. D.,M.
K.Q.C.P.I. With a preface by J. Mathews Dun-
can, M.D. Philadelphia: P. Blakiston, Son & Co.
1883.
Courty's gynecology has been long familiar to the
French as one of the ablest exponents of that branch of
medicine. It is now made accessible to the English
reading portion of the profession. The present is a
good translation of the third edition of Courty's treatise,
and may be said to compare favorably with the works of
Barnes, Thomas, Emmet, and others. It can scarcely
hope, however, to replace the volumes just mentioned,
being more valuable to the specialist desirous of becom-
ing familiar with (Gallic methods, than the general prac-
titioner in want of precise directions for daily use.
The introductory chapter of the work contains a good
account of the anatomy, physiology, and teratology of
the female generative organs. The remaining chapters
are divided into two parts — the first dealing with uterine
diseases in general, and the second being devoted to their
special and detailed consideration. We regret to find
no description of that frequent class of diseases affect-
ing the external organs of generation and the vagina.
A work already extending to 802 pages might be profit-
ably made complete by devoting some space to a discus-
sion of the diseases of the external parts.
Laceration of the cervix does not appear to have en-
gaged Court)-' s attention, a fact which the American
reader will be sure to deplore. In general, the author's
views on pathology are sound, and his therapeutical re-
commendations are practical and rational. We are
pleased to find him ([uite emphatic about the great value
of constitutional measures, while he does not under-
estimate the importance of local treatment. The trans-
lator is to be congratulated on the fidelity with which
her part of the work has been accomplished. In con-
clusion we may repeat that no specialist should be
without this work ; but the student and general practi-
tioner will scarcely need it.
Legal Medicine. By Charles Meymott Tidy, M.B.,
F.C.S. Vol.1. Philadelphia: Henry C. Lea's Son &
Co. 1882. Also, in two volumes, Wood's Medical
Library. New York : Wm. Wood & Co. 1882.
This work is intended to be a comprehensive treatise
on the branches of legal medicine. The present volume
takes up the following subjects : Evidence, the Signs of
Death, the Post-Mortem, Sex, Monstrosities, Hermaphro-
ditism, Expectation of Life, Presumption of Death and
Survivorship, Heat and Cold, Burns, Lightning, Explo-
sives. Starvation.
To treat all these matters properly requires no small
degree of research, knowledge, and judgment. The writer
must not only be familiar with their physiology, pathology,
and chemistrv, but also have a good degree of legal knowl-
edge. Dr. Tidy has shown that he is competent for the
task so far, however, and has produced a volume which in
scope and accuracy has no equal in the English language.
The plan of the work is excellent. The author has col-
lected a very large number of illustrative cases, but has
placed them at the end of the chapters instead of inter-
polating, as is the custom, in the text. This lightens the
labor of reading and makes it easier to grasp the subject.
There are many subdivisions and tables, which add to the
intelligibility and clearness of the discussions.
The author shows an acquaintance with foreign litera-
ture, but he quotes less extensively from German works
than could be desired, seeing that Germany has done the
most scientific work in this particular field.
The book really deserves an extended analysis, but our
space forbids this. An enumeration of the subheads in
the chapter on "The Signs of and the .-\ppearances Pro-
duced by Death " will show, however, how elaborately
each topic has been studied. This chapter begins with a
definition of death, somatic and molecular, then follow
the titles Premature Burial, and The Circumstances under
which the Medical Jurist may be called upon to Certify
as to the Reality of Death. Under heading of " Signs of
Death " we find the following : i. The entire and contin-
uous cessation of the heart's action, and 2, of respiration ;
3, insensibility and loss of power to move ; 4, certain
minor signs of death ; 5, changes in and about the eye ; 6,
changes in the temperature of the body ; 7, changes in the
muscles and in the general condition of the body after
death.
The subjects of cadaveric ecchymoses, putrefaction,
formation of adipocere, and mummification of bodies
conclude the chapter, to which are appended many illus-
trative cases.
Dr. Tidy's work shows the very wide range of matters
upon which legal medicine touches. It will bo espe-
cially acceptable to medical practitioners at the present
time, when interest in forensic medicine is increasing.
April 14, 1 883. J
THE MEDICAL RECORD.
413
Reports of J>ocictics.
• NEW YORK ACADEMY OF MEDICINE.
Suited AJcf/i?ig, April s, 1S83.
FoRDVCE IUrker, M.D., LL. D., President, in the
Chair.
The Corresponding Secretary, Dr. J. G. Adams, an-
nounced the death of Brigadier-General Joseph E.
Barnes, recently Surgeon-General of the United States,
and Baron Jules Cloqnet, of Paris, France.
The Statistical Secretary, Dr. F. V. White, announced
the death of William H. Van Buren, M.D., LL.D.
Dr. E. L. Keves then read
A MEMOIR OF W. H. VAN EUREN, M.D., I.I..D.,
in which he i)aid an eloquent and just tribute of respect
to the dignified bearing, the gentlemanly deportment, the
scholarly acquirements, the professional skill, and ])ro-
found judgment of his grand okl master and enduring
friend.
Dr. Austin Flint, Jr., in behalf of Dr. Austin Flint,
unavoidably detained from being present, offered resolu-
tions expressing admiration of his character as a teacher,
a writer, and a gentleman, and of heartfelt sympathy for
the family of the deceased.
Dr. Lewis A. Savre, ])revented by sickness from the
privilege of seconding the resolution, sent a letter, which
contained a touching reference to the sterling worth of
his departetl colleague.
Dr. Alfred C. Post, associated for many years with.
Professor Van Buren in the Medical Department of the
University of the City of New York, took great pleasure
in seconding the resolutions offered by Dr. Flint, and fully
endorsed the eminently appropriate remarks made by Dr.
Keyes. As a gentleman, a scholar, a teacher, and an
operator, the deceased had left a name so distinguished
that no one could be looked upon as his superior, and
but few could be regarded as his equal.
The President remarked that, having listened to the
beautiful eulogy which had been read, the resolutions of-
fered, and the remarks made by the gentlemen who had
seconded them, he felt incompetent to add anything e.x-
cept to express the feeling that all must be heartily in
accord with what had been said with regard to our de-
parted Fellow.
The resolutions were unanimously adopted.
Dr. Beverley Robinson then read a paper entitled
A CLINICAL STUDY OF CAFFEINE AND CONVALI.ARIA .ALil-
ALIS AS CARDIAC TONICS.
The author of the paper gave a resume of the litera-
ture of the subject, the views held concerning the physio-
logical action of the drug, and added an e.\tensive clinical
contribution. The clinical histories of several cases, with
post-mortem conditions, were referred to as having al-
ready appeared in the jjroceedings of the New York
Pathological Society, published in The Medical Re-
cord.
The President related the histories of two cases, and
raised the question whether the eftect produced by this
remedy is entirely due to its jiower as a cardiac tonic, or
whether it might not have another property, which is jjer-
haps as useful, but which, so far as he had observed, had
not been mentioned by any writer.
Case I. — Five weeks ago he was called to see a gen-
tleman who was in a very feeble condition, but the only
evidence of disease which he was able to detect was a
general failure of nerve-power and loss of appetite and
strength. Any exercise caused shortness of breath, and
at tinies he suffered from a sense of suffocation, with pal-
pitation and a feeling of terror. When an exacerbation
came on the patient was ashy white, very restless,
anxious, and alarmed, and there was coldness of the ex-
tremities. Careful examination, made not only by him-
self but by several eminent physicians in cities through
which the jiatieiit had been travelling, failed to discover
either cardiac, pulmonary, or renal disease. The pa-
tient had profound mental depression on account of a
family affliction. It was noticeable, however, that dur-
ing the periods of his greatest distress there was no
marked feebleness of the pulse. Six drops of convallaria
were prescribed to be taken every three hours. On the
evening of the same day, six or eight hours having
elai^sed, the patient expressed himself as feeling very
much better, and on the following day as being in the most
comfortable condition he had been in for two months.
Case II. — A widow had an attack of bronchitis accom-
panied by very violent and persistent cough. Nervous
prostration was very great, attended by apprehension, in-
ability to get her breath, palpitation, etc., but there 7Lias
710 marked iveakiu-ss of the eardiae impulse. Convallaria
was prescribed and the benefit which followed was even
more marked than that shown in the first case.
The question was. Is it not a vasomotor stimulant ?
Dr. F. p. Kinnicutt remarked that his observations,
also, made largely in St. Luke's Hospital, corroborated
essentially those reported by Dr. Robinson. The diu-
retic effect of the drug, however, he had not noticed as
being so marked as stated by the author of the paper.
He thought that further experiments were necessary to
determine the exact modus operandi o{ the remedy. He
also regarded as still an unsettled question whether pal-
pitation depends on exhaustion of the vagi or of the
cardio-inhibitory apparatus.
Dr. a. a. Smith's experience concerning the diuretic
power of the drug accorded with that expressed by
Dr. Robinson.
It had seemed to him that when cardiac hypertrophy
was present the remedy was not indicated. In chronic
renal disease, with cardiac hypertrophy, according to
his observations, it aggravates the symptoms. In cases
of enlargement of the heart in which dilatation predomi-
nates, it serves a very good purpose. He was not, how-
ever, prepared at present to give up digitalis and sub-
stitute convallaria. Nor was he quite sure the experi-
ments of Ott had not demonstrated that it does not act
through the pneumogastrics.
Dr. Smith then referred to four well-marked cases of
pulmonary ledema complicating pneumonia,
occurring in his service at Bellevue Hospital, and which
illustrated the good results that possibly might follow the
administration of convallaria. Three patients received a
hypodermic injection, containing ten minims of the fluid
extract of the root of convallaria with one two-hundredth
of a grain of sulphate of atropia, repeated every half hour,
and all recovered. The fourth case was one of pulmonary
cedema complicating pneumonia, occurring in a patient
suffering from Bright's disease, and it terminated fatally.
He had seen better results follow the use of hypodermics
of one two-hundredth of a grain of sulphate of atropia
than by the adoption of any other plan of treatment, and
therefore was unable to say exactly how much the re-
covery in the three cases reported depended upon the
effect produced by the convallaria ; the combination,
however, was a happy one.
Dr. Smith did not think that the drug acted as a direct
res])iratory stimulant, as does belladonna and strychnia,
but that it probably acts through the circulatory system.
However, on account of the difficulty of obtaining prep-
arations of uniform strength, and for other reasons, he
regarded it as important to be exceedingly careful con-
cerning accepting conclusions with reference to the way
in which the drug produces its effects, and precisely what
those effects are.
Dr. Robinson, in closing the discussion, said that he
had not had cases which made him feel that possibly in
convallaria we possessed a special stimulant to the vaso-
motor system.
414
THE MEDICAL RECORD.
[April 14, 1883.
On motion by Dr. J. C. Peters, the President was
empowered to appoint a committee of five to make in-
vestigations concerning scarlet fever in horses.
The Academy then adjourned.
SECTION IN PR.\CTICE OF MEDICINE.
Stated Meeting, Mareh 20, 1SS3.
Edward G. Janeway, M.D., Chairman.
(Continued from p. 359.)
DELIRIUM WITH EMPYEMA.
A CASE had lately come under his observation which pre-
sented some interesting and ratlier remarkable features.
It was orie of a series of cases of empyema. The patient
was admitted to Bellevue Hospital and assigned to the
insane pavilion as a case of acute mania. His wife said
that he was apparently perfectly well until the night be-
fore admission, when she found him against the door with
his head in his arms and screaming out, "father,"
"mother," "God," etc., and saying "they are going to
kill me." Previous to that time he had been able to
work and was in his usual health. The history seemed
to be a rather straightforward one of mental aberration,
and perhaps independent of any definite cause. The
point of interest was that his left side was one-half an
inch larger than the right, the apex-beat of the heart was
two inches to the right of the median line, and there
were well-marked evidences of effusion into the left
pleural cavity. The hypodermic needle was introduced
and pus was obtained. The patient, therefore, was suf-
fering from empyema, and he had been taken suddenly
with acute mania and without fever. Under the influence
of hyoscyamin and morphine he quieted down somewhat
and had some sleep, and then Dr. Janeway attempted
aspiration. His plan of treatment in such cases is, first,
to aspirate the chest, and afterward, if necessary, to make
a free incision. This led to the remark that he made it
an absolute rule not to give anesthetics for making an
incision into the chest, as he believed it to be a most
dangerous practice. In this case he experienced con-
siderable difficulty in introducing the needle, and ob-
tained only about twelve ounces of pus, for the reason
that the fluid was so thick that it did not flow through the
canula. On examining it microscopically its thickness
was easily explained, and was due to two things : First,
the large number of pus-cells; and, second, to the pres-
ence of little lumps of fibrin, equivalent in size to about
six or eight pus-corpuscles. On the next day after the
aspiration hydroi)neumo-thorax developed, and then fol-
lowed rapidly a septic process. Five days after the oper-
ation Dr. Janeway made a free incision into the chest,
and after washing out the cavity with a weak carbolized
solution the patient's temperature fell to normal. So far,
however, his mental condition had not markedly iminoved.
The time at which his mental condition seemed to be the
best was shortly after the occurrence of the i)neumo-
thorax.
Another interesting point in this case was the inability
to say from the history when this process began. It was
found, after considerable inquiry, that five vears ago he
was sick for about nine months, first in the hospital,
where he was treated without benefit, and that he was
short of breath, etc., and that he was then taken home
and soon after spat up very large quantities of matter
which gave him a great deal of relief. Dr. Janeway re-
garded it as possible that that process might have con-
tinued up to the present time, and perhaps was the ori-
ginal source of the eniin'ema. One circimistance which
pointed somewhat in that direction was the fact that the
chest did not sink in after the free incision, the heart still
remained displaced, and at no time hati the pulse been
very rapid, nor had the respiration been very hmried.
In one case of emi)yema, nnich more marked than the
one just related, the disease had existed i)robablv for a
year and a half before it came under observation, and the
heart was displaced to the left. In that case for days
there was no elevation of temperature, and yet he re-
moved two hundred and six ounces of pus at three sittings.
A little further inquiry made it somewhat apparent that
the disease dated as far back as three years. In that in-
stance it was decided to diminish, if possible, the size of
the pleural cavity, and he made a free incision. The
patient has had no fever except on two occasions during
the entire period, and the chest is now on the right side
one and a half inch smaller than it was, although it is
still about two inches larger than on the left side. There
has been no accumulation of pus. In this case there
was absence of those phenomena which are supposed to
indicate the development of purulent pleurisy, but the
symptoms throughout had been rather those of serous
effusion. There had been an entire absence of elevation
of temperature and sweating.
EXPLORATORY PUNCTURE WITH THE HYPODERMIC NEEDLE.
Dr. Janeway remarked that, recently. German writers
had brought forward the use of the hypodermic needle as
a new means of making the exploratory puncture in cases
of pleuritic eflusion. This practice, however, he had
followed during the last ten or twelve years, and it had
also been freely adopted by others in this country. He
believed that there was no danger in using the hypoder-
mic needle if it was properly cleansed, and his rule was
always to wash it thoroughly with warm water, and then
with a strong carbolic solution, before introducing it into
the chest.
Dr. Gibney asked the Chairman if he attributed the
delirium to the presence of pus in the pleural cavity.
The Chairman replied that the empyema had its in-
fluence in producing a deterioration of health, and in
that way might be regarded as the cause of the delirium,
the same as diseases of organs constitute causes of in-
sanity.
Dr. Gibney asked if delirium was not more likely to
be an accompaniment of acute processes than of chronic.
The Chairman replied that it occurred very frequently
in chronic afl'ections with more or less an.-emia.
Dr. Post remarked that delirium is a common symp-
tom in thoracic affections, especially in young children.
The Chairman remarked that, of course, cerebral abs-
cess, embolism, and meningitis were to be excluded in
making up an opinion concerning any given case.
Dr. Putzel asked the Chairman if he had had any
pathological experience with regard to the lesions of the
mild chronic mania of Bright's disease.
The Chairman replied that there were lesions in these
cases, such as peri-arterial thickening, cedema of the
brain, and, as a result of the mixed process, there might
be more or less anaemia of the brain. These conditions
would in part account for the delirium.
Dr. Putzel remarked that he had one case in which
there was chronic mania lasting several months, and at
the autopsy nothing whatever could be found to explain it.
Dr. Pcst remarked, with reference to cleansing the
hypodermic needle, that the method reconunended by
Dr. S(iuibb was a most efficient one, namely, to pass it
through the flame of a spirit lamp or Punsen burner.
A CASE FOR DIAGNOSIS.
Dr. Putzki. read the history of a case and submitted
it for diagnosis. Joseph J , fifty-nine years of age, a
laborer, with unimportant previous or family history, had
rheumatism (?) three years ago affecting the ankles and
lasting three days. Twenty-five years ago he fell down
stairs, and as the result of the injury received he was in
bed ten weeks, was out of his n)ind for three months, and
since that time has been easily excited, especially easily
aftected by drink, has had poor memory, but no head-
ache or other synqitonis, except more or less pain in the
cervical spine.
In March, 1882, he went to bed all right, but his wife
found him in a convulsion in the middle of the night, his
body and legs twitching, but the arms being quiet. He
April 14, 1883.]
THE MEDICAL RECORD.
415
frothed at the nioutli, and remained unconscious for an
hour, with the mouth closed and moaning continuously.
About fifteen minutes afterward he vomited and purged
once. As soon as he regained consciousness he com-
plained of pain in the shoulders and arms, and cried out
with pain whenever he attempted to move the upper
limbs. There was no pain in the lower limbs, which be-
came very much swollen six weeks later. The upper
limbs swelled at once from the shoulders to the wrists,
and about two weeks afterward the arms turned black
and remained so nearly two months. The pain which
he had suffered in the cervical spine was relieved. There
was no bladder trouble.
November 22, 1882. — Opacity of the right cornea due
to injury. Eyesight normal in the left eye. Hearing
approximately normal. Motion and sensation in the
face normal. The left deltoid muscle is a little less full
than the right. When the limb is directed forward he
can raise it to a horizontal, but when it is directed out-
ward, only to an angle of about thirty-five degrees. Tlie
head of the left humerus is very much enlarged, especially
posteriorly. There are no sensory disturbances, and
only very slight paresis of the other muscles of this limb.
The right deltoid is apparently normal ; shoulder move-
ments freer than in the other limb. Anteriorly the limb
can be raised a little above the horizontal, and outwardly
above forty-five degrees. Enlargement of the head of
the humerus very marked, especially posteriorly, where it
simulates dislocation. Sensation normal. Other move-
ments of the arm very good, although not quite so strong
as before the attack. A sensation of coarse grating is
obtained on motion in each shoulder-joint.
Six weeks ago there was considerable atrophy of the
deltoids, and the other movements of the arms were con-
siderably weaker than at present. The faradic excita-
bility of the deltoids was slightly diminished (probably
from the atrophy).
EPILEPSY FOLLOWING CEREBRAL CONCUSSION.
The Ch.-mrm.4N directed attention to the fact that in-
juries of the character of that received in Dr. Putzel's
case are not infrequently followed, after the lapse of a
considerable period of time, by some cerebral disturb-
ance. During the last year he had seen cases in which
epilepsy had developed three months, six months, three
years, and six years after the receipt of an injury which
was probably the cause of the convulsive affection, no
other cause being ascertained. He had been especially
struck, with reference to such cases, by the fact that rail-
road companies desire a certificate from the person in-
jured and with whom they settle, that the person so in-
jured is absolutely well, and so worded that it looks
forward to the cutting off of any compensation for pos-
sible future disturbance. He thought that medical men
in giving certificates should, for their own interests,
if for nothing else, be guarded in expressing an opinion
beyond the fact that "such person, so far as present
appearances go, is well, but that the future must be un-
certain for at least one year — perhajis much longer."
Dr. Post thought it might be diflicult to make the evi-
dence strong enough to convince a jury that such remote
consequences were the result of the injury. It might be
regarded as probable, but not proved. If, however, there
had been even slight disturbance, such as headache or
other nervous manifestations, occurring at short inter-
vals and referable to the injury, he thought we might
fairly attribute the more grave phenomena to the same
cause.
THE USE OF A BIVALVE ANAL SPECULUiM TO FACILITATE
CATHETERISM.
Dr. Post was requested by Dr. Gouverneur M. Smith
to see in his service at the Presbyterian Hospital a man
who was in the advanced stage of Bright's disease, and
was unable to pass his water freely on account of the
enormous oedematous distention of the prepuce. Nu-
merous punctures were made to evacuate the fluid from
the cellular tissue, but he was unable to find the urethra.
He then resorted to the expedient of introducing a small
bivalve anal specidum into the preputial opening and
carrying it down and dilating the tissues sufficiently to
permit the introduction of a catheter.
The Section then adjourned.
THE PRACTITIONERS' SOCIETY OF NEW
YORK.
Stated Meeting, March 2, 1883.
James B. Hunter, M.D., President, in the Chair.
CASE OF MASTOID DISEASE ILLUSTRATIVE OF TREATMENT
AND CURE WITHOUT RESORT TO TREPHINE.
Dr. Sexton, in presenting this case, hoped that this
Society, so largely composed of practitioners who saw
much of disease in general, would find it not without
interest, inasmuch as it was a case in which the treat-
ment adopted differed very widely from that generally in
vogue. He thought that the mastoid was much too fre-
quently trephined in these cases, and were one to esti-
mate the value of the oi)eration by the current literature
of the subject he feared that we must conclude that fatal
results had not been lessened by such treatment, and in
some instances it even appeared that aggravation had re-
sulted. In a large number of such cases occurring in his
own practice he had not found the operation necessary.
The case had been referred to him by Dr. Weisse, on
October 3, 1882. The patient came to this country from
Ireland two years before the attack, and ever since her ar-
rival had been subject to menstrual irregularities. She
was found by Dr. Sexton to be suffering from an attack
of purulent inflammation of the left middle ear and of the
pneumatic cells of the mastoid process, consequent upon
a severe cold in the head, contracted in March, 1882.
She is a tall brunette, twenty-four years of age, and
weighs one hundred and forty pounds. Her mother
probably died of consumption, but her own health has
been pretty good until of late. Her condition was, when
first seen, one of extreme depression, her complexion
was sallow, the eyes were heavy, and the tongue coated.
Her appetite was not good, and owing to the painfulness
of mastication she was limited to soft or fluid foods.
The patient for a considerable time had been subject
to naso-pharyngeal catarrh of the dry variety, with a ten-
dency to ozena — dark greenish crusts forming in the
upper pharynx, which were removed by persistent hawk-
ing every few days.
Altogether she presented the appearance of a very sick
person, too weak, indeed, to ascend a flight of stairs
without resting. Were it not for the aid given by her
sister she could not keep up with her work as waitress,
and she now fears she will have to give it up altogether.
She had been seen by several physicians, the treatment
consisting for the most part in the usual routine of
syringing the ear and the introduction of powders into
the external auditory canal. During the time she was so
great a sufferer the ear discharged " off and on " — the
secretions which accumulated in the tympanum every few
days giving rise to pamful distention.
That the patient had been long subject to aural catarrh
was shown by the lustreless, porcelain-looking membrana
tympani of the right ear. The left external auditory
canal was found to be somewhat narrowed at the iniier
end from periosteal inflanuiiation, which also affected the
tempero-maxillary articulation, thus giving rise to the pain-
fulness experienced in mastication. The left membrana
tympani was inflamed and fleshy in appearance, and there
were three perforations, one in front of, and one poste-
rior to the short process (both in the membrana flaccidi)
and one in the lower segment of the membrane. From
each one of these perforations sprung a polypoid growth
4i6
THE MEDICAL RECORD.
[April 14, 1883.
the size of a very small jjea. A slight, greenish colored,
thick, purulent discharge existed.
Hearing was not greatly affected in the right ear, but
she could hear a loud voice only in the left. At no time
was tinnitus auriuin a marked feature, although the voice
was autophanous.
For the past two months there had been pain referred
by the i)atient to the left side of the neck, and she was
observed to hold the head very rigidly, inclining it to
that side, motion being i)ainful.
The integument over the mastoid was of a dark-red
color ; the tissues were considerably swollen, the promi-
nence of the ape.\, owing to the extension of the.swelling
down the neck, being lost. During the past few days
there had been pain in the neck just below the occiput,
and higher up, toward the vertex, pressure could not be
well borne.
The jjains in the mastoid had been steady from the
first, but during the past month they had much increased,
and a dull, heavy pain is now constantly experienced. It
is worthy of note that during the exacerbations of (lain
experienced in the ear, from retained secretions, the left
cheek became flushed and moving the head extremely
painful. There was a decidedly bad odor about the pa-
tient's ear, such as is sometimes experienced when cari-
ous bone is present.
The treatment adopted was the sulphurated lime, in
small doses, in the form of hepar sulphur, and the tinct-
ure of aconite. The former was given every two or three
hours at first, and the latter in teaspoonful doses of a
solution consisting of a few drops of the tincture in four
ounces of water. Locally, powdered boracic acid was
lightly applied.
On the next day, October 4th, the patient reported
that she had not rested so well for the past three months.
She had experienced no pain excepting in the region
down along the sterno-mastoid muscle. The three polypi
were removed at this visit, one at a time, with my
own snare. They were very soft, and the pedicles were
slender. After their removal the membrane i)resented a
smooth surface. During the first week the improvement
of the patient was very marked ; the purulent discharge
became thinner and the polypi showed no disposition to
return, although there was slight pouting. The appetite
improved, mastication was easy, and the patient was
more comfortable. Local ap|)lications of tincture of cal-
endula were now made to the drumhead daily. Swell-
ing, tenderness, and jnirplish redness of the skin over the
mastoid remained. During the first month's treatment,
improvement continued, although the discharge was vari-
able. Fluctuation, limited to a small area over the mas-
toid was now found to be jjresent, and an incision less
than half an inch long was made down to the bone on a
level with the external auditory canal. In a day or two
a slight purulent discharge was established, and the run-
ning from the canal of the ear became less. The wound
was carefully probed on this and subsequent occasions,
and although some roughness of the bone was seemingly
felt, no sinus leading through the cortex of the mastoid
and giving exit to the discharge which evidently came
from the mastoid cells, was ever found. The wound was
soon filled with redundant granulation-tissue, which was
for a longtime elevated slightly above the surface. At one
time the hepar sulphur was withheld for a few days, but
the patient did not continue to im])rove until it was
again renewed, and subsequently calcium suli)hide was
substituted in somewhat larger doses.
During the month of November the case slowly im-
proved. The membrana tympani began to clear up, the
nipples upon its surface becoming daily smaller. The
discharge from the mastoid, at no time free, was less and
irregular, sometimes ceasing entirely for a day or two.
The discharge from the external auditory canal was
almost absent.
During the month of December the treatment was
continued, but the doses of the calcium sulphide were
given less frequentlv. Discharge from the external au-
ditory canal ceased entirely about December 20th. At
this time, when the perforations had closed and the in-
tratympanic structures were clearing u]i, the flexible Eus-
tachian catheter was daily emiiloyed to inflate the tympa-
num. There was only a little oozing of bloody serum now
from the wound behind the auricle, and the incision had
a tendency to close if let alone. There was great im-
provement in general health, the ]iatient looking brighter.
The hepar sulphur was again resumed, but was given in
smaller doses. The membrane was almost entirely clear.
During January the ])atient was feeling as well as ever,
but early in February the mastoid incision, being occasion-
ally the seat of irritation, was deepened with a knife. This
was followed in a few days by a more free discharge, and
on February 12th the wound closed altogether, and the
patient was discharged cured.
Dr. Sexton drew the following conclusions from this
case : Otitis media purulenta., occurring in subjects of
ozena, is liable to assume a grave form, and extension to
the mastoiii ceils is conmion. Such cases are also char-
acterized by their chronicit}'. Carious teeth and eollec-
iions of tartar, which give rise so often to irritation of the
dental filaments of the fifth pair of nerves, were present
in this case ; in consequence of their reflex influence on
the ear, such conditions should always be regarded as im-
portant etiological factors. Uterifie functional disturbance
was ]3robably also a factor in this case, and had been in
other cases also frequently observed by Dr. Sexton to re-
act most unfavorably ujion aural disease. Hygienic treat-
ment had not been omitted, and was considered important
in all cases. This patient had been required to take daily
out-door exercise, although the weather during the time
she was under observation was usually very inclement.
The patient at no time entirely failed to attend to her
work. The dry method which Dr. Sexton had adopted
some eight years ago was ijractised in this case through-
out. The few drops of tincture of calendula employed in
the ear were not allowed to remain long in the canal,
but were carefully removed by means of cotton-wool.
The employment of calcium sulphide in the case les-
sened pain, as it frequently does, and is by no means to
be regarded as an inactive or "let alone" method, when
its controlling influence over inflammatory processes
about the ear is considered. The avoidance of ano-
dynes, which, if given in large and repeated doses, de-
range the system, was considered advantageous.
Not the least interesting feature of the case was the
behavior of the crusts, which eventually closed the per-
forations in the membrana tympani. They were ob-
served to travel slowly toward the periphery of the mem-
brane. The one in the anterior superior quadrant
reached the walls of the canal within the first eight
weeks ; the one in the |)osterior superior quadrant was
considerably slower, while the one on the lower segment
did not disappear from the membrane until in the fifth
month after the removal of the polypoid growths. Hear-
ing in the aft'ected ear was almost normal, and the auto-
phonous voice had long since ceased to be experienced.
No symptoms of ozena remained.
Dr. George F. Shradv remarked that the result was
a very satisfactory one and served to prove the value of
conservative treatment. He was not an otologist, but
during the past four years, and since his intimate i)er-
sonal relations witli a case that had attracted the atten-
tion of many of the leading specialists'of the city, he had
been much interested in the surgical management of the
mastoid complications of otitis media. The patient, who
was in a position to command the best talent wliich tlie
city could aft"ord, was the subject of a severe attack of
inflammation of the middle ear. The disease ran its
usual orthodox course, until finally symptoms of mastoid
trouble manifested themselves, and trephining was pro-
posed by one of the consultants as the only means of
saving life. To this measure Dr. Shrady ottered objec-
tions which were happily sustained by Dr. Roosa, the
April 14, 1883.]
THE MEDICAL RECORD.
417
gentleman having direct charge of the case, as well as by
a majority of the other distinguished otologists and gen-
eral surgeons subsequently atlded to the consultation.
The patient finally recovered without tlie operation or
the formation of an abscess external!)-, and in spite of
the appearance of a formidable swelling of the neighbor-
ing soft [larts. The good result in that case had made
such an impression upon Dr. Shrady that he had become
a convert to the conservative method of treatment.
Since that time, through the kindness of Dr. Se.xton and
others, he had seen several cases of mastoid complica-
tion, some in which pus had already found its way exter-
nally, but in none had he felt called upon to advise the
use of the trephine, or do more than increase the open-
ing in the soft parts. In all of these there had been a
perfect recovery. He did not presume to say that tre-
phining of the mastoid was not a perfectly justifiable op-
eration in very many instances, but that there was possi-
bly not enough credit given by many surgeons to the
wonderfully conservative power of nature in such as were
generally looked upon as desperate cases.
Dr. KiNNicuiT was much interested in the good re-
sults claimed by the use of aconite in acute ear diseases
in children. He also alluded to the promjjt manner in
which pain was relieved by the puncture of the drum-
head.
©bituanv
JOSEPH K. KARNES, M.D., SURGEON-CIENERAL
U. S. ARMY (RETIRED).
General Joseph K. Barnes, recently Surgeon-General
of the United States Army, died in Washington April 5th,
of Bright's disease. He was born in Philadelphia on
July 21, 1817, and was in his sixty-sixth year. He studied
medicine in the office of Dr. Thomas Harris, a celebrated
physician of his generation, and attended lectures at the
Medical Department of the University of Pennsylvania,
where he was graduated with honor in the spring of 1838.
The first year of his practice was spent as resident phy-
sician at the Blockley Hospital, where he laid the foun-
dation for the distinction he afterward gained in the or-
ganization and management of the hospital system of the
United States Army. His second year of professional
work was devoted to the medical care of the jjoor in one
of the northern districts of Philadelphia. On June 15,
1840, he was appointed an Assistant Surgeon in the army,
and one month later was assigned to duty at the Military
Academy at West Point. In November of the same year
he was transferred to Florida, where he saw his first field
service in Gen. Harney's famous expedition to the Ever-
glades in the war against the Seminole Indians. He re-
mained with Gen. Harney's command in Florida two
years, and in 1842 was transferred to Fort Jessup, an
old-time military station in Louisiana, where he served
until its abandonment, four years later. At the breaking
out of the Mexican war, in 1846, the young surgeon, then
only twenty-nine years of age, was appointed chief medi-
cal officer of the cavalry brigade, and in that capacity he
participated in every action of the war in either Gen.
Taylor's or Gen. Scott's lines, excepting that at Buena
Vista, and at the close of the hostilities was placed in
charge of the general army hospital at Baton Rouge, Ea.
For the next few years he rendered valuable service to
the Government in organizing medical posts at various
stations in Texas and throughout the West, acting for a
short period as Medical Director of the Department of
Oregon. He was assigned to duty at West Point again
in 1854, and served there several years. In 1S56 he re-
ceived his commission as a Surgeon.
At the outbreak of the war of the rebellion Surgeon
Barnes was stationed in Oregon, and was among the first
officers to be called to Washington. In 1S61 he was
assigned to special duty in the office of the Surgeon-
General at Washington, where his experience in field and
hospital service was of great value to the Government.
Two years later he was promoted to be a Medical In-
spector with the rank of Lieutenant-Colonel, and a few
months afterward he was appointed Medical Inspector-
General with the rank of Colonel. In September, 1863,
he was made acting Surgeon-General, was promoted to
fill the vacancy, with the rank of Brigadier-General.
He served during the war with great honor, and in 1865
received the brevet rank of Major-General. He was
the first physician called to the bedside of President Lin-
coln when he was assassinated, April 15, 1865, and had
charge of the case until its fatal termination. On July
2, 1 88 1, when the late President Ciarfield was shot, he
was among the first physicians to be summoned to the
White House, and served on the consulting board of
physicians until the death of the President, giving the
case his closest attention. He was placed on the re-
tired list last year by the operation of the compulsory
retirement law, and has since then been living (juietly
at his residence in Washington.
The General had a fine, erect military bearing. He
was agreeable in his manners, and socially was a most
attractive person. In his profession he stood deservedly
high, and was universally res[)ected by all who knew him.
3ivnii]i ami Zlaxm Jllcius.
Official List of Chanties of Stations and Duties of Officers
of the Medical Department, United States Arinjy, from
March 31, 1883, to April j, 1883.
Ham.mond, John F., Colonel and Surgeon. Granted
leave of absence for six months on Surgeon's certificate
of disability, with permission to go beyond sea. S. O.
75, par. 6, A. G. O., April 2, 1883.
Hammond, John F., Colonel and Surgeon. To be re-
lieved from duty in the Department of the East, and to
report by letter to the Surgeon-General United States
Army. S. O. 75, par. 7, A. G. O., .'\pril 2, 1883.
Official List of Changes of Stations and Duties of Medical
Officers 'of the United States Marine Hospital Service,
from January i, 1S83, to March 31, 1883.
Bailhache, p. H., Surgeon. Detailed as member of
Board for the Examination of Officers of the Revenue
Marine Service. March 27, 1883.
Murray, R. D., Surgeon. To proceed to Vicksburg,
Miss., as Inspector. March 24, 1S83.
Purviance, George, Surgeon. To proceed to Cleve-
land, O., to investigate management of hospital. Jan-
uary 22, 1883. Granted leave of absence for seven
days. February 8, 1883.
At;sTiN, H. W., Surgeon. To proceed to Gallipolis,
O., as Inspector. January 9, 1883.
Flsher, J. C, Passed Assistant Surgeon- Detailed as
member of Board for the Examination of Officers of the
Revenue Marine Service. March 27, 1883.
Carter, H. R., Passed Assistant Surgeon. To proceed
to New Orleans, La., for temporary duty, thence to San
Francisco, Cal., for duty. February 7, 1883.
Porter, F. D., Passed Assistant Surgeon. Granted
leave of absence for thirty days. February 10, 1883.
GUITERA.S, John, Assistant Surgeon. Granted leave of
absence for thirty days. January 19, 18S3.
Wheeler, W. A., Assistant Surgeon. To proceed to
Chicago, III, for duty. January 27, 1883.
Ar.mstrong, S. T., Assistant Surgeon. To proceed to
Key West, Fla., for temporary duty. February i, 1883.
Bennett, P. H., Assistant Surgeon. To proceed to
Charleston, S. C, for temporary duty. February 19,
1S83.
'Resignation.
Porter, F. D., Passed Assistant Surgeon. Resignation
accepted, to take effect March 31, 1883. February 10,
1883.
4i8
THE MEDICAL RECORD.
[April 14, 1 883.
^ctlical
3tcms.
Contagious Diseases — Weekly Statement. — Re-
port of cases and deaths from contagious diseases re-
ported to the Sanitary Bureau, Health Department, for
the two weeks ending April 10, 1883 :
Week Ending
u
£
in
3
V
•a
■3
V
>
c .
'H
o.S
1
In
i
X
0
>
0
a.
0.
ci
SiS
V
a
f=
H
H
tn
u
^
(J
y:
>■
CcZSt-S.
April 3, 1SS3
0
"
128
12
97
54
2
0
April 10, 1883
0
6
■3°
6
i2ij 55
I
0
Dfjt/ts.
I
6
29
15
12
25
t6
21
4
I
0
April 10, 18S3
0
5
6
23
0
Whole number of deaths for the week ending Satur-
day, April 7th, 746 ; of which 132 were from pneumonia.
The Results of Section of the Vagus upon Sheep.
— Ellenberger has made some very interesting experi-
ments to determine the effect of section of the pneumo-
gastncs upon sheep. He found that after cutting the
pneumogastric on one side only, no disturbance of lieart,
lungs, or stomach was observed. The general matter
was not impaired. Ten weeks after the section the ani-
mals were killed. There appeared to be soma thinning
and atrophy of the muscular wall of the third and fourth
stomach in the animal whose right vagus was cut, and a
similar change in the first and second stomach of the
animal whose left vagus was cut. When both vagi were
cut the animals died in from twelve to twenty-si.x hours,
except in one case, when life was prolonged for si.xteen
days. Death resulted in all cases from suffocation by
stopping of air-passages. There was constantly observed :
complete paralysis of the oesophagus, partial paralysis of
the first and second stomachs, increased heart-beat up to
160 per minute, labored irregular and at first slower (12
to 16 per minute) respiration, and inability to regurgitate
and chew the cud. It apjiears that the vagus sends
motor nerve-fibres to the first and second stomachs, but
that the third and fourth stomachs are enervated inde-
pendently. The constant development oi tympanitis as
a result of paralysis of the vagus may have some practical
significance. — -Journal of Coin. Mfd.
The Seat of the " Music of the Hemispheres " in
the Dog. — H. Munk thinks that he has located the cen-
tre of hearing in the cerebral cortex of the dog. And
not only this, but he believes that different parts are de-
voted to the i)erception of different notes. This centre
for sound-sensations is in the convolution near the apex
of the post-sylvian fissure. The posterior parts appre-
ciate the low notes, while the more anterior portions
appreciate the higher notes. — Journal 0/ Co inp. Med.
Congenital Absence of One Kidney. — Another
recent case of this kind has been reported by Dr. Turbin,
of Tiflis [Deutsche Med. Zeit.). He has collected eight
similar cases from literature. That this may especially
concern the surgeon is shown by a recent case from
Czerny's clinic. That surgeon found it advisable to ex-
tirpate a kidney for disease, the operation being per-
formed with his customary dexterity and skill. On the
death of the patient some thirty-si.K hours later, it was
first made known that the patient had had but one kid-
ney, and that it had been removed. A similar case oc-
curred in New York some time ago.
A Curious Experiment. — The ease witli which i)er-
sons fall under hallucinations of special sense is illus-
trated by M. Yung, in a recent communication to the
Helvetic Society of Sciences. The operator places eight
cards on a table, in positions corrcs])onding to foreliead.
eyes, ears, nose, mouth, and chin : he pretends to " mag-
netize " them and also some person in the company, and
then goes out, while the magnetized person is required
to touch any one card. The operator, having returned,
notes the action of a confederate, who scratches a \)art
of his head corresponding to the card touched. Then
he commences an innocent comedy, passing his hand
carefully over the cards, and on reaching the touched
card seeming to experience a strong shock. The ob-
servers are surprised, of course. One of them is then
asked to go out and repeat the experiment. It is as-
sumed that a certain card has been touched. Passing his
hand over the cards, he indicates, in nine cases out of
ten, a particular card as giving him a shock ; and if the
company be instructed to support his idea of that being
the " correct card," he is confirmed in his illusion, which
may be successfully repeated. Of 85 persons tried, M.
Yung found only 9 who refused to indicate a card, not
having experienced any sensation ; 53 said they had ex-
actly the sensation announced, and 23 described some
different sensation.
The Everlasting Pill. — The " everlasting pill,"
once a part of our ancestors' armamentarium, was com-
posed of metallic antimony, and it was believed to have
the property of purging as often as it was swallowed. This
was economy in right earnest, for a single pill would serve
a whole family during their lives, and might be transmitted
as an heirloom to their posterity. We have heard of a
lady, who having swallowed one of these pills, became
seriously alarmed at its not passing. " Madame," said
the physician, "fear not; it has already passed through
a hundred patients without any difliculty."
The Question of Nationality has at last found its
way into medicine. The French doctors in Nice are up in
arms against their English and other foreign brethren es-
tablished in that favoied health resort. A general meet-
ing of the former body has been held, at which protests
were entered against the manner in which alien practi-
tioners monopolize the most lucrative practice. Amongst
other points which were urged, it was stated that many of
the intruders are not qualified French physicians, and con-
sequently have no right to practise anywhere in France.
Credit to whom Credit is Due. — Philip Doddridge
(1702-1751) spoke of nerve-stretching, and recommended
it as a religious stimulant in his zeal and vigor in the
Christian race.
" Awake my soul : stretch f.'cry ner-je.
And press with vigor on."
Medical Professor to Raw Student: "Where is
the glottis } " '• 1 don't know, sir. I think you put it on
the shell in the dissecting-room with the rest of your sur-
gical instruments."
Blessed is the College, and especially the medical
school, says the Boston Medical and Surgical Journal,
which is so munificently endowed that it can fix its stan-
d.ard of scholarship independently of the necessity to
make a living for itself; in fact, which can from the first
adopt the position of the sought and not the seeker.
The Water-Closet's Doo.m. — An ingenious German
has invented a plan for the manufacture of gas from
human tajces. These are decomposed in a retort by
heat, the chief products being a light-yielding gas, car-
bonic acid, tar, oil, and ammonia. As in ordinary gas-
works, the tar and oil are sei)arated, and the liglit-yielding
gas purified for use. There remain in the retorts the ash-
constituents with a portion of carbon, which the inventor
designates coke. The autliority for this description, Der
Techniker, inforuis its readers also that a Breslau hotel
has already been successfully lighted by means of this
novel and presumably economical gas.
Jonathan Hutchinson's Advice to Medical Stu-
dents.— " If now I were to sum \\\t in one sentence
what I have been enforcing, it is this : The secret of all
noble life lies in belief, and the characteristic of all noble
minds in the vigor with which thev believe that «'hich is
April 14, 1883.]
THE MEDICAL RECORD.
419
true. Try to attain belief in the reality of all things ; so
shall you never want for motives ; so shall you be able to
live and work without hurry and without sloth. Finally,
permit me to cunimend you this formula : Prize strength,
love the beautiful, practise self denial, and be patient."
A Candid Criticism on the Action of the New York.
St.ate Medical Society.- — We do not share in the opin-
ions of those who see in this action (the vote of the New
York State Medical Society) nothing but disaster to the
profession. We do not believe that the teachings of the
code of ethics are infallible, that its provisions should be
accepted with unquestioned faith, and that any amend-
ments thereto, or an abrogation of one or all of its pro-
visions, would encourage quackery, disorganize the pro-
fession, and place it on a common level with all the isms
and pathies of the age. We have more taith in the
honesty and probity of the great body of men who com-
pose the profession of this country, as exhibited from
time immemorial in the performance of those imperfect
obligations which the code does not reach and cannot
enforce, than to believe for a moment that, if the entire
code should be abolished, the old professional ship would
lose her bearings and be dashed to pieces on the inhos-
pitable shores of quackery. Therefore we are perfectly
willing that our New York brethren shall try the merits
of the new code, and if, as they believe, it will result in
good to the profession and to humanity, the whole pro-
fession will ere long follow their example ; and if, on the
other hand, it shall result, as has been predicted, in
lowering the tone and dignity of the profession and the
encouragement of quackery, we do not doubt but they
will soon see their folly, repudiate the new code, and
return to their first love, wiser if not better for their ex-
perience.— Indiana Medical Journal.
Diphtheria in Fowls. — Dr. L. Roth, of Kitzingen,
observed an epidemic of diphtheria in a flock of hens.
It was caused by the slops from a room in which two
children had been sick with diphtheria, being thrown
upon the dung heap in the yard where the fowls were
kept.
Some Lessons from the Small-Pox Epidemic at
LocKPORT, N. Y. — Dr. Walter J. Ransom, of Lockport,
N. Y., sends us an account of the epidemic of small-pox
at Lockport, N. Y., with some suggestive points relating
thereto. The epidemic lasted from October, 18S1, to
January, 1882. It originated and was stopped in the
following manner : " During the early part of October a
woman was taken suddenly ill and died in a few days ;
her sickness was pi'onounced ' gangrenous erysipelas
complicated by acute eczema.' During her illness she
was visited by numerous friends and acquaintances. A
public funeral was had. Within different periods of time
corresponding to the incubating stage of small-pox twelve
of fifteen persons who had visited the patient came down
with small-pox, and the result was that we had our hands
full of just so many centres of contagion. We quaran-
tined our cases according to the rules prescribed by the
State Board of Health, and began the fight. In all we
had about fifty-three cases. I suggested general vaccina-
tion as the remedy to prevent the spread of the disease,
and submitted my plan to our local board, which was
adopted, and they nobly sustained me in carrying it out.
The plan was this : Our population is about fifteen thou-
sand; city divided into four wards ; two physicians to be
appointed to each ward, they to be supplied with virus
procured from the vaccine bureau of New York City,
they to go from house to house, factory to factory, store
to store, and office to office, and offer free vaccination to
all. This was done, and not another case of small-pox
did we have. Our vaccinating corps quilled about four
thousand. The rule was to vaccinate all previously un-
protected individuals, and all others who would consent
to a re-vaccination who had not been vaccinated within
seven or eight years."
One of the points of interest observed was the follow-
ing: "In one family, consisting of the parents and four
children, two children too young to attend school, and
never vaccinated, had confluent small-pox. The other
children, vaccinated successfully during the summer term
of school, escaped entirely. Parents, vaccinated years
before, had varioloid. Another family, two adults, three
children. Mother pregnant, six months advanced, pro-
tected by a previous vaccination, escaped entirely, and
was subsequently delivered at full time of a healthy
child. Her brother, boarding, unprotected, had conflu-
ent small-pox. In my experience the so-called partial
working characterized by a red papule or macule was no
protection. In many instances I saw the marked power
of vaccine to protect, exemplified by the escape of all
in the family who were vaccinated within three days of
first exposure and in whose cases the vaccination worked.
In my own case I escaped, and I was exposed, as far as
man could be, without direct inoculation, for I delivered
a woman who was prematurely confined and was dying
with the disease at the period of secondary fever; had
retained placenta, which I removed.
" I say, palsied be the tongue that opposes vaccina-
tion."
Slow Pulse. — Dr. W. T. Harris, of Brantford, On-
tario, Canada, writes : " In one of the numbers of The
Record last summer, I observed a reference to a re-
markably slow pulse, thirty-six per minute. Last Octo-
ber, I saw a gentleman in perfect health with a pulse of
thirty-one per minute, and the same case I saw again
last week, and found his pulse thirty-three per minute
in the sitting posture. This man is sixty-eight years of
age, and has always been perfectly healthy. He is a
farmer residing in the vicinity of this city."
A List of Health Officers of the Port of New
York from 17S4T0 1S84. Dr. Stephen Smith of this city
writes: "While engaged in the preparation of a Report
to the National Board of Health on the ' Origin and
Growth of the Quarantine Systems of the United States,'
I obtained from Mr. Ferno, the learned custodian of the
colonial archives of the State of New York, a corrected
list of the names and dates of appointment of all the
Health Officers of the Port of New York. As the first
appointment was made in 1784, and as the present
Health Officer's term continues until 1S74, the list com-
prises a century of Health Officers of this Port. At the
same time, Mr. Ferno prepared lists of the Commission-
ers of Health, of Resident Physicians, and of the Health
Officers of Albany and Hudson. I am not aware that
these lists have ever been published."
Health OJieers of the Fort of New York : Charles
McKnight, appointed Afay 12, 1784; Malachi Treat,
January 10, 1792; William Pitt Smith, September 29,
1795; Richard Bailey, February 19, 1796; Isaac Led-
yard, August 22, 1801 ; John R. B. Rodgers, October 5,
1803; Joseph Bailey, March 15, 1810; John R. B.
Rodgers, February 19, 181 1 ; Joseph Bailey, March 5,
1813 ; Benjamin De Witt, March 6, 1815 ; Joseph Bailey,
February 4, 1820 ; John T. Harrison, April 24, 1S23 ;
John S. Westervelt, February 25, 1829 ; William Rock-
well, February 10, 1836 ; A. Sidney Doan, February 14,
1S40 ; Henry Van Hovenburgh, February 8, 1843;
Alex. B. Whiting, January 28, 1848 ; A. Sidney Doan,
April 4, 1S50 ; Richard L. Morris, April 10, 1852 ;
Henry E. Bartlett, April 21, 1S54 ; Richard H. Thomp-
son, April 21, 1855; Alex N. Gann, April 6, 1859;
John Swinburne, March 19, 1864; John M. Carnochan,
January 27, 1870 ; S. O. Vanderijoel, February 28, 1872 ;
William M. Smith, ]\[arch 24, 1880.
Commissioners of Health under the Act of April i,
1796 ; Robert Bowne, Francis Childs, John Campbell,
John B. Coles, William Robinson, Henry Will, John
Murraysen, appointed April 9, 1796; William De Pey-
ster, appointed September 30, 1796.
Act of February 10, 1797; John Oothoudt, Jacob
Abramse, Ezekiel Robins, appointed February 25, 1797;
420
THE MEDICAL RECORD.
[April 14, 1883.
Gabriel Furman, March 12, 1799, reai>pointed April 9,
1800; Edward Miller, appointed August 22, 1801 ;
Gardner Jones, October 5, 1803 ; John H. Douglas,
April 6, 1807 ; Gardner Jones, February 8, 1808 ; John
H. Douglas, April 3, i8ro ; Gardner Jones, February
19, 1811 ; John Onderdonck, March 5, 1S13 ; Samuel
Torbert, March 6, 1S15 ; NicoU H. Dering, April 24,
1818 ; Peter S. Townsend, June 6, 1820; Jacob Dyck-
man, February 13, 182 1 ; Richard L. Walker, April 11,
1S23 ; Smith Cutter, April 22, 1828 ; James H. Hart,
March 14, 1838; William Turner, March 14, 1840;
Stephen R. Harris, February 8, 1843 ; Richard L. Mor-
ris, April 4, 1850.
Resident Physicians of the Port of Neiv York (Act of
February 25, 1799): James Tillary, appointed March
12, 1799 ; John B. R. Rodgers, March 27, 1802 ; Edward
Millen, October 5, 1803; Joshua E. R. Birch, April 3,
1810; Edward Millen, February 19, 181 1; J. E. R.
Birch, March 5, 1813 ; Nicholas I. Quackenbos, March
6, 1815 ; David Hosack, June 6, 1820; N. I. Quacken-
bos, February 13, 1821; reappointed, April 24, 1823;
Joseph Bailey, appointed February 4, 1826 ; James R.
Manley, April 11, 1828; William James McNevan,
April 9, 1S40 ; John W. Francis, July 6, 1841 ; Alex-
ander F. Vache, August 16, 1843 ; Seth Geer, January
21, 184S ; Grid P. Wells, Tannarv 25, 1850.
Health Officers of Albany, N. Y. : Charles D. Cooper,
appointed Afarch 27, 1794; Christopher C. Yates, April
II, 1803; Peter Wendell, April 11, 1S22 ; Barent P.
Staats, July 3, 1832 ; John F. Townsend, March 10,
1840; Richard H.Thompson, January 15, 1849; John
Swinburne, May 28, 1855.
Health Officers of Hudson, y. Y. : Joseph Hamilton,
appointed October 3, 1S03 ; Moses Younglove, Febru-
ary 9, 1809; Robert G. Frary (Tracy?), June 21, 1832.
A Rapidly Successful TREAXiMENX of Erysipelas
is, according to Dr. Richard Barnwell {Lancet), the paint-
ing the part with white-lead paint. He reports five cases
of traumatic erysipelas so treated, and one cas,e of idio-
pathic erysipelas.
Doctors' Dinners and Doctors' Wines. — A writer
in the London World discourses upon the ditiference be-
tween the preaching and the practice of London medical
men : "As an M.D., yEsculapius cannot hear the name
of wine or spirits mentioned without a shudder ; but as
Ampiiitryon, it is quite another thing. He is the most
lavish of hosts, keeps an excellent cellar, and gives his
guests of the best which it contains without stint. Doc-
tors were surely never so nobly fond of seeing their
friends at dinner as at the present moment. It is Hip-
pocrates, Podalirius, Machaon, and others who make up
the comijany of veritable Amphitryons. Politicians,
diplomatists, poets, novelists, journalists, and even roy-
alty meet round his pleasant and profuse board. A little
of that Roman punch, you are surprised to hear, is in-
dispensable after the clear turtle. A couple of glasses
of Johannisberg is the minimum which it is safe to take
with your fish. Then comes the question which cham-
pagne you will have, Pommery Greno or Perrier-Jouet —
brut or only sec. Your astonishment increases as the
banquet proceeds. Champagne — you can scarcely be-
lieve your ears as the sentiment is uttered — is the true
drink of the statesman and the author ; and champagne
is not a wine whicli, if it is to be appreciated, can be
sipiied. If you had any superstitious idea that it was
unwise to touch claret after dinner, you are entreated to
emancipate yourself from it as soon as possible.
"Doctors' dinners have deservedly achieved a iiigh place
in the scale of London entertainments. .-Vnd, indeed, so
hospitable are the doctors, that it would really seem as
if they did not wish their friends and patients to dine
with any one e.xcept themselves. If you hap[)en to feel
a little out of sorts, and, on consulting your physician,
mention that you have latterly been dining out a good
deal, he shakes his head ; and, while commencing with
the general proposition that alcohol is, under all circum-
stances, abominable — that for wine in any shape you
should substitute cocoa, and milk, and beef-tea, and
other slops — concedes you the indulgence of a couple of
glasses of a remarkably thin hock at dinner. This wine
is only to be purchased at one establishment in London ;
and of this ^-Esculapius gives you the address : your onl)'
chance of physical salvation lies in being constant to it.
If you attend a dinner-jjarty, a bottle of it must be your
vade mecum. It looks somewhat odd to see a gentleman
produce from his coat-pocket a flask of a fifth-rate Rhine
vintage. You do not quite like the idea ; but you are
sternly informed that it must be done. You must obey
the special mandate of your physician ; and if you have
not the courage to do this you had better decline the
hospitality of your friends."
The Protective Function for Animals of the
Semicircular Canals of the Ear. — Necessity compels
most of the higher animals, but especially wild animals,
to be constantly on the alert, and the sense of hearing is
of especial value in self-protection. Dr. P. McBride
endeavors to prove the theory (which is not entirely new)
that the semi-circular canals have an important function
in this matter. Sudden sounds conveyed to the internal
ear e.xcite the nerve-fibres. These refle,\ly cause a sud-
den turning of the head in the direction of the noise.
This action is seen when a deer is suddenly startled by a
whistle. The other function of the semicircular canals
relates probably to the sense of space. Stefin has re-
cently asserted that the cells of Purkinje in the cerebel-
lum were in cIos<4 relation with the semicircular canals,
so that when the latter are destro\'ed the former elements
atrophy. — Journ. of Comp. Aled.
Se.\t of "Good Nature'' and Intelligence in
Dogs. — Goltz, by e.xperiments upon dogs, shows that ex-
tensive and profound destruction of both vertex convolu-
tions causes not only diminished intelligence, but also a
remarkable change in their disposition. Harmless and
good-natured dogs, after this operation become surly,
quarrelsome, and violent. If the occipital lobes are
damaged, the animals preserve their good-tempered
character, but the intelligence is more seriously impaired.
A Case for Thermometers. — Dr. A. L. Cory, of
Chicago, writes : " I desire to add ni)' mite to the methods
of preventing broken thermometers. Some years since
I carried my thermometer-case loose in my pocket, and
averaged a broken thermometer at least once in two
weeks. Three years since I had constructed a case which
contained a tongue depressor, an hyppdermic syringe, with
space for morphine powders, and a small bottle with the
compressed hypodermic tablets. It takes little room,
being only two inches wide, five and a half inches long,
and three-fourths of an inch thick. I have carried it in
my pocket now three years, and during that time have
broken only one thermometer, and that I let slip from
my fingers when shaking down the register. The case
was made for me by E. H. Sargent & Co. of this city."
The New York Physicians' Mutual Aid Associa-
tion.— The fourteenth annual report of this association
shows a continued prosperity. The additions to the
membership in the past year have been twenty-six, the
deaths ten. The association has been able to give $425
to the families of deceased members. In future it will
be able to do more, for its permanent fund now amounts
to over ten thousand dollars, and the interest upon it will
hereafter be used.
We are glad to observe the success of this association,
and would urge its claims upon the physicians of the
city and neighborhood. .\ny member of the regular
medical profession of the counties of New York, Kings,
Queens, Richmond, and Westchester, in good health, and
under seventy years of age, may be admitted.
A Pure Alkaloid ok Gei.se.minum has been obtained
recently, and for the first time, by Mr. .\. W. Gerrard,
of the London Pharmaceutical Society.
The Medical Record
A Weekly Journal of Medicine and Stirgery
Vol. 23, No. 16
New York, April 21, 1883
^A^hole No. 650
CDvioiual Articles.
CATARRHAL
HEADACHES AND
FECTIONS.'
ALLIED AF
By RICHARD C. BRANDEIS, M.D.,
PROFESSOR OF LARVNGOLOGY, RHINOLOGY, AND OTOLOGY, NEW YORK POLYCLINIC.
There is no class of disease which presents more varied
types and greater difficuhies in the dififerential diagnosis
and treatment than that which is grouped under the gen-
eric name of headache. It is met with not only in ner-
vous affections, but in almost every other form of disease,
as in fever, in disturbances of the digestive organs, and
in the most diverse inflammations of the head and adja-
cent parts.
As the caption of this paper shows, it is not my inten-
tion to enter into a consideration of all the various types
of headache, but I wish to call your attention to those
forms which, in my opinion, are due to the diflerent dis-
eases affecting the nasal and adjacent cavities.
If we bear in mind the fact that the nose has to per-
form a threefold function, we cann«t but agree that a
consideration of the relations which it bears to the sys
tern at large must be of great im|)ortance. The special
function of the nose is to preside over the sense of smell ;
it plays a leading part in the process of respiration, since
in health all tiie air taken into and e.xpelled from the
lungs, is intended to make its way through the nasal
cavity. The voice is also dependent, in a great measure,
upon the co-operation of the nasal cavity, inasmuch as
it acts the part of a resonant chamber.
Nature has recognized tiie important role which the
nasal cavity has to play in the general economy by plac-
ing it in the middle of the head and bringing it into direct
communication with almost all tlie bones which enter
into its construction. It is, as I hope to show you, in
immediate relations with the cavities of the superior
ma.xillary, the frontal, ethmoidal, and sphenoidal bones.
The nose consists, grossly, of two parts : first, the an-
terior prominent part, which is composed of bone and
cartilage, with small muscles which slightly move the
latter, and two orifices, the anterior nares, opening down-
ward ; and, secondly, of the two nasal foss;e. As the
former part does not participate in the affections which
we propose to consider, it is hardly necessary to enter
into its anatomical details, as it contributes but little to
the physiology or pathology of the parts under discussion.
The nasal fossx are two cavities, placed one at each
side of the median line, separated by the flat, vertical
septum, part bony and part cartilaginous. The depth
of the fossa from the upper to the lower wall is consider-
able, as is also the e.\tent from before backward, or be-
tween the anterior and posterior nares. But the breadth
from the outer to the inner wall is very limited, and is
less at the upper than toward the lower part of the fossa,
and in the middle than at the anterior or posterior open-
ings. The roof of the nasal fossa is flat at its middle
part, and sloped before and behind ; it is formed in front
by the inner surface of the nasal bones ; behind by the
body of the sphenoid, and in the middle by the horizontal
or cribriform lamella of the ethmoid bone. The floor — ■
smooth, concave from side to side, and formed by the
palatal plates of the superior maxillary and palate bones —
■ Ke.-id before the County Medical Society, March 26, 1883.
extends backward and a little downward from the nares
to the pharynx.
The internal wall, or septum narium, which extends
from the roof to the floor of the cavity, is flat, almost ver-
tical— although often deviating toward the left side— and
composed of the perpendicular |)late of the ethmoid bone,
the vomer, and the nasal cartilage.
The outer wall of the cavity is formed by the ethmoid,
superior ma.xillary, lachrymal, inferior turbinated, and
palate bones. The posterior and inferior parts of this
surface are marked by a number of inequalities, whilst
the superior and anterior are comparatively even. In the
latter situation may be observed, first, the smooth surface
just mentioned, and secondly, passing downward and
backward, three, and sometimes four-arched and con-
voluted bones, beneath which are grooves (meatus) lead-
ing from before backward. The superior turbinated, or
spongy bone, is much shorter than the others, arises from
the lateral plate of the ethmoid ; beneath it is the superior
meatus. The middle spongy bone, also arising from the
ethmoid bone, overhangs the middle meatus. The in-
ferior turbinated bone appears as if api)ended to the side
of the superior maxillary and palate bones. Between
it and the floor of the nasal cavity we have the inferior
meatus.
To illustrate the relations which the nasal fossa; and the
pneumatic cavities in the adjacent bones, which form
their framework, bear to one another, I beg to show you
a number of anatomical sections of the head, which I
made a few years ago, according to Schalle's' method.
In specimen No. i I have cut away the external nose,
the frontal bone, all of the superior ma.xilla of the right
side, and on the left side have only left that part which
forms the e.xternal wall of the corresponding nasal cavity.
In order to show the position of the turbinated bones on
the left side, I have removed the e.xternal nasal wall on
the right, as well as the se[)tum narium, e.xcepting the nasal
plate of the ethmoid.
If we look at the specimen in front, we see, above, the
left frontal sinus, with a bristle passing downward through
the infundibulum into the middle meatus. Looking
downward, and near the roof of the cavity, on either side
of the vomer, we see two foramina, which, leading up-
ward and backward, pass into the sinuses situated in
the body of the sphenoid bone. Looking at the left ex-
ternal wall of the cavity from the right, the short superior
and the middle and inferior turbinated bones are brought
into view. At the same time, farther back, the pharyn-
geal orifice of the left Eustachian tube can be seen.
In the second si)ecimen, I have removed the frontal
bone, the external nose, and the outer half of both of the
superior maxilla;. I have, however, left the nasal fossEe
and their component parts, as nearly as possible, intact.
On the left side, we see the inner wall of the antrum of
Highmore. We see this also on the right side, but find,
near the upper and posterior border of the cavity, the
foramen which connects it with the right nasal fossa, and
which passes in through the middle meatus near the lower
surface of the middle turbinated bone. In front, we see,
above, the right frontal sinus, a bristle passed through the
foramen which connects this cavity with the nose, and
which enters the middle meatus just above and in front
of the foramen which leads into the antrum of Highmore.
Further down we see the right and left nasal fossa;, sep-
arated one from the other by the vertical septum,
1 Virchow's Archive, 1877,
422
THE MEDICAL RECORD.
[April 2 1, 1883.
which, however, in this instance, deviates somewhat
to the right side. On either side of the septum we see,
above, the middle turbinated, and below, the inferior tur-
binated bones. We can also see the inferior, middle, and
superior meatuses of both sides. In this specimen the
three cavities of the nose are very large ; but I must call
your attention to the fact that in the living subject they
never attain this size, owing to the extreme vascularity
of the mucous membrane lining the septum and the tur-
binated bones. This mucous membrane attains its great-
est bulk on the inferior turbinated bone, where, according
to Kohlrausch' and later observers, it forms a truly caver-
nous network, which in health attains a thickness of at
least four millimetres between the periosteum and the
lining membrane. This erectile tissue is sufficient to ex-
plain the transitory obstruction to nasal respiration which
a sudden turgescence sometimes gives rise to, as well as
the profuse mucous secretions which are common to
acute and some chronic catarrhal conditions.
In the third dissection I have removed all the parts
not directly connected with the nasal fossa. On the
right side we again see the inner wall of the antrum of
Highmore and the foramen which leads into the nasal
fossa. It will be noted, however, that this foramen is
not situated in the upper and jwsterior angle of the inner
wall, but is seen near the anterior superior angle of the
cavity. On the left side there is no salient point.
Viewed from the front, the specimen shows, above, the
two frontal sinuses, with bristles passing downward and
backward through the infundibuli into the middle meatus
on either side. Lower we see the septum naiium and
the two pairs of turbinated bones. In order to show the
cavities of the nose, as well as those of the ethmoid and
sphenoid bones, I have made two vertical sections
through that part of the base of the skull formed by the
frontal, ethmoid, and sphenoid bone, on either side of the
median line. These sections pass downward into the
nasal fossa on either side of the septum narium, and when
the parts are held asunder we see the nasal cavities in
their entirety. On the right side we see, above, two of
the sphenoidal cells, below these the middle and inferior
turbinated bones and the three longitudinal canals. We
next see the septum narium and its component parts :
the nasal plate of the ethmoid, the vomer, and the carti-
lage. On the outer wall of the left half of the specimen
we have an excellent view of the cells contained in the
ethmoid bone in front, and of the sphenoid bone behind.
We can here see how the cavities of these two bones are
connected, and in what manner they bear relation to the
nasal cavity. Below we again see the turbinated bones,
with their respective meatuses, and behind the inferior
turbinated bone we have a fair view of the orifice of the
Eustachian tube. We learn from this dissection that in
the superior meatus there is a small orifice which leads
into the posterior ethmoidal cells, and through them into
the sphenoidal sinus.
In acute coryza we have, besides the lassitude, general
malaise, and alternate chilliness and heat, more or less
weight and pressure about the head, especially in the
frontal region. On ocular inspection we find the nasal
mucous membrane highly congested, and sometimes so
swollen as to produce occlusion of the fossa;. The
greater the obstruction the greater will be the sense of
uneasiness about the forehead, which in some cases may
reach such a degree as to cause the patient and sur-
roundings considerable anxiety. 1 liave seen instances
where the agony was so great that fears were entertained
that there might ensue a loss of reason.
This condition, however, generally endures only dur-
ing the first stage or dryness of the nasal mucous mem-
brane. As soon as the mucous discharges have fairly set
in, a gradual amelioration of the symptom is usually
observed.
The connection between the nasal cavity and the
frontal sinus is very free by means of the anterior eth-
' MUUcr's Archiv far Anal. Physiologic, etc., p. 149, 1853. j
moidal cells and infundibulum. The sinuses in the
frontal bone vary greatly in size, and in proportion with
it will be the distress occasioned by any inflammatory
condition which may be propagated to them from the
nose. The membranous lining of these cavities is sim-
ilar to that of the nasal fosss. But, as Luschka' says,
it is subject to certain modifications, which consist of a
diminished thickness and a far less number of secreting
glands than is found in tlie pituitary membrane. As long
as the nasal mucous membrane is in an active state of
inflammation, which is attended with a greater or less
degree of swelling, the connimnication with the frontal
sinus must be occluded. As soon as secretion sets in
there must be an accumulation of fluid, which presses
upon the anterior and posterior tables of bone forming the
boundaries of the cavities, and as the pressure increases
so will there be an increase of the pain. This may cease
almost spontaneously as soon as the imprisoned fluid
finds an exit through its natural passage, and if the in-
flammation subsides entirely no further discomfort need
be felt.
In order to illustrate the causal connection between
acute coryza and frontal pain, I will give a brief history
of a case which was recently under my care :
Mr. Charles P , aged twenty seven, traveller, has
been subjected to repeated violent attacks of colds,
which manifested themselves chiefly b)' marked obstruc-
tion of the nasal passages and intense pain in the fore-
head, extending to botli temples. This pain has, during
recent attacks, been so severe that the patient was com-
pletely prostrated and unable to sleep in spite of the ad-
ministration of the most powerful hypnotics. I found,
on examination, that he had an unusually prominent
brow and very protuberant superciliary ridges. On in-
spection, the mucous membrane covering the inferior
turbinated bones was found to be so much swollen that
the latter were in absolute contact with the septum na-
rium on both sides. The entire surface of the forehead
was painful to the touch, but the notches, through which
the supraorbital nerves pass, were not more markedly
tender. The entire mucous surface was dry and harsh,
and touching it lightly with a probe caused considerable
pain.
In order to stimulate the secretions, and thereby di-
minish the bulk of the mucous membrane, and restore the
patency of the foramen leading to the frontal sinuses,
I prescribed a small quantity of Hegar's fluid, with in-
structions that a few drops should be inhaled every
hour until profuse secretion had set in. This fluid is
composed as follows :
]J. Acidi carbol. cryst 5 j-
Alcohol fort 3 iij-
Liq. ammoniie fort 3 j-
Aqu.T; destillat 3 ij-
M.
This the patient employed five or six times, when a
profuse mucous discharge appeared, accompanied by a
gradual disappearance of the headache. The next
morning he again visited me, and at that tune, aside
from a feeling of weariness, all discomfort had disap-
peared. The entire nasal cavity was lined with a layer
of tenacious mucus, which I removed by means of a
spray of alkaline water, and found that the turgescence
of the mucous membrane had diminished so much that
the patency of the canals was normal. There was not
the slightest tenderness over the forehead, and all the
sense of constriction had passed away.
Since this time Mr. P has had repeated manifesta-
tions of coryza, with the usual accompaniment of frontal
headache, but this always disappears as soon as he has
made several inhalations of the fluid.
Chronic catarrhal rhinitis, when accompanied with
hypertrophy of the mucous membrane, is also often at-
tended with more or less pain in the frontal region.
* Die Anatomic dcs mcnschlichcn.Kopfcs, p. 359. Tubingen, 1867.
April 21, 1883.]
THE MEDICAL RECORD.
423
When we consider the fact that the frontal sinus and the
nasal cavity are in such direct coniniunication, we can
hardly be surprised that disease of one cavity is fre-
quently attended with a similar condition of the other.
According to Zuckerkandl ' there is one opening lead-
ing into the ostium frontale in the anterior portion of
the infundibulum, and another between the insertion of
the anterior extremity of the middle turbinated bone
and the processus uncinatus, or one of the anterior eth-
moidal cells.
This predisposes to consecutive inflammations of the
frontal cavities, and, in fact, they are more frequently
affected than any other of the pneumatic adnex;e, ex-
cepting the antrum of Highmore. The favorable |)osi-
tion ot these cavities, and the form of the foramen
renders a restoration to a healthy condition more |irob-
able than in the other pneumatic spaces, as the fluids
and secretions contained m them can readily be drained
off. In a healthy condition, the mucous membrane lin-
ing this sinus does not secrete, but when it is diseased
its discharges are similar to, but less in quantity than,
those thrown off by the pituitary membrane. As the in-
fundibulum may be occluded either by a swelling of its
lining membrane or by pressure from a thickened tur-
binated bone, the secretion must increase in bulk until
it either finds a natural outlet or forces its way through
the roof of the sinus into the dura mater. Fortunately
this latter is but a dernier rcssort, which is but rarely en-
countered. I have known several cases of severe, per-
sistent headaches, which have had all the changes of
treatment rung upon them, and have only disappeared
when the nasal cavity was restored to its norjnal condi-
tion.
Mrs. C. R , aged twenty-four years, recently mar-
ried, has, since her fourteenth year, suffered from con-
tinuous distressing headaches, which have been most
intense in the frontal region. She informed me that
during these ten years she cannot recall a single day
during which she was free from pain. On close ques-
tioning I found that her paroxysms were always increased
during wet weather; but she could not recall the fact
that the season of the year exerted any special influence
on her affection.
At one time or another Mrs. R has been under
the care of almost every authority in New York, in hopes
of finding relief ; but, in spite of the most varied forms of
treatment, she has derived no lasting benefit. For some
time past, however, she has noticed a considerable ob-
struction in both nasal fosss, which interfered with res-
piration, and for the relief of this condition she came to
me.
On examining the nasal cavities I found a diffuse
thickening of the entire pituitary membrane, with de-
cided hypertrophy of the anterior extremities of both the
inferior and middle turbinated bones. The bulk of the
former was so much increased that it completely closed
the inferior meatus, and its inner surface was in immedi-
ate contact with the septum narium. Posterior rhinos-
copy showed but slight thickening of the posterior ends
of the bones; but 1 found the entire surface covered by
a thin layer of nnicopus.
On applying pressure over the frontal sinuses the |:>a-
tient complained of some pain, but stated that she often
did the same, as it seemed to afford some relief for her
headache.
As a result of my examination I advised a removal ot
the hypertrophied tissue of the turbinated bones, hoping
in this manner to relieve the nasal obstruction. The pa-
tient absolutely refused to consent to any operative
measures whatever, but begged me to apply any other
<orni of treatment which might afford her some relief. I
thereupon cleansed the nasal cavity thoroughly by means
of a coarse spray of Dobell's solution, and gave the pa-
tient a quantity of Hegar's fluid, in the hope that by irri-
tating the mucous membrane and gustatory nerves 1
' Normaleund pathologische Anatomic der Nasenhohle, etc. Wien, 1882.
might stimulate an active secretion. Two days later the
patient returned, stating that the cleansing of the cavity
had somewhat relieved the nasal obstruction, but the
headache had not diminished. I again douched her
thoroughly, and after a careful cleansing of the cavity, I
insufflated a quantity of German sternutatory powder,
called Schneeberger's sneezing powder, composed princi-
pally of finely powdered white hellebore (which can be
procured at any (ierman pharmacy), into the middle
meatus, on both sides. I endeavored to drive the pow-
der as nearly as possible to the orifice of the infundi-
bulum. The patient soon began to sneeze violently, and
continued to do so between forty and fifty times. This
sneezing was not attended with any pain, and was soon
followed by a profuse discharge of mucus from the nose.
Before leaving me the patient expressed herself as al-
ready much relieved. During her absence the discharges
increased in quantity, and when I again saw her, after
an interval of three days, I observed a very decided
diminution of the thickening of the pituitary membrane.
On the evening after the last treatment the headache
had been greatly relieved, and for the two days following
the pain was nuich less. I repeated the above applica-
tions six or seven times, at intervals of three days, with
increasing benefit to the nasal stenosis and headache,
and then gave the patient a quantity of the powder and
a Davidson syringe, for nasal irrigation, with instructions
to use both daily. I last saw her on January 26th, when
she suspended further visits and treatment, owing to an
imminent confinement. A few days ago, however, I
learned that Mrs. R had been entirely free from
headache for nearly two months, and the nasal obstruc-
tion had almost disappeared.
We find that in this case an undoubted catarrh of the
frontal sinuses was relieved, and, perhaps, cured simply
by stimulating the mucous membrane to active secretion,
thereby diminishing the congestion and consequent in-
crease of bulk which caused an obstruction of the efterent
passages. There are, however, many cases in which the
nnicous membrane and the turbinated bones are so hy-
pertrophied that operative procedures alone will suffice
to remove the obstruction.
Hartmann' has recently reported two cases of obstinate
supraorbital neuralgia, due to empyema of the accessory
cavities of the nose, in consequence of obstruction to a
free discharge through the middle meatus.
Two years ago I had under treatment a case which
strikingly illustrated this state of affairs. Mr. H. K ,
aged twenty-seven, had suftered for many years from
chronic conjunctivitis with nasal catarrh. He had been
subject to many attacks of coryza, and in the winter of
i88o-iSSi contracted a violent cold, which was compli-
cated with intense pain in the forehead, which remained
even after the disappearance of the original trouble.
The pain was so continuous, and the photophobia so in-
tense, that he was compelled to absent himself from his
business, and after the lapse of several weeks he consulted
me for the relief of the nasal obstruction.
On examining the nose I found the mucous membrane
hyper^mic and slightly swollen throughout. The nasal
septum was deviated below to the right side, and above
to the left, thus diminishing the size of both the middle and
inferior meatus. The turbinated bones were greatly hy-
pertrophied on both sides, so that but little air could enter
on either side. There was a total absence of the sense of
smell, and the voice was characteristic of an obstruction of
the passages. In attempting to gain a better view of the
cavities, 1 pushed the turbinated bones aside, and found
them covered with a thick layer of creamy pus. Posterior
rhinoscopy merely showed a swelling of the mucous mem-
brane on both sides of the septum.
Pressure on the supraorbital notches caused intense
neuralgic pain, which extended over the entire frontal
region, but was not comparable to the paroxysms which
set in every afternoon and lasted throughout the greater
1 Berlin, klin. Woclienschrift, No. 48, 1882.
424
THE MEDICAL RECORD.
[April 2 1, 1883.
part of the night. At these times there was generally a
profuse discharge of fetid pus from both nasal fossK.
I had but little doubt that the pain -was due to the
nasal affection, and to satisfy myself on this point I in-
flated the nasal cavity by means of Politzer's method, as
suggested by Hartinann.' After this I cleansed the pas-
sages thoroughly with an alkaline solution. This done,
the patient felt himself much relieved, the pain and the
fulness of the head being greatly lessened.
In order to enable the pent-up secretions to discharge
freely, and to restore the nasal fossas to their normal po-
tency, I removed the hypertrophied tissues of the turbi-
nated bones by means of the galvano-caustic snare. This
was done in three sittings, and was followed by a marked
improvement in the condition of the patient, although
there was some pain in the suiiraorbital region for a few
days after the last operation.
Before I undertook the treatment of the case, the jia-
tient had been under the care of one of the most eminent
physicians in this city, who emiiloyed everv remedy at
his command for the relief of the neuralgia, but without
avail. As soon as I cleansed the nasal cavity and al-
lowed some of the pent-up secretions to escape, a decided
improvement was noticeable, and when the connection
betw-een the nasal and frontal cavities was restored all
trouble disappeared. I do not think that there can be
any doubt but that the neuralgia and the obstructed con-
dition of the nasal fossa; stood in the relation of effect
and cause.
For nearly two years the jiatient has been able to
breathe freely through the nose, and since that time,
without any further treatment, the chronic aficction of
the conjunctiva has disappeared spontaneouslv.
1 am somewhat at a loss to explain the manner in
which the neuralgia was superinduced, whether it was
due to a direct pressure upon the trunk of the supra-
orbital nerve or caused by a reflected irritation of some
of the many branches of the trigeminal nerve. Hack"
has reported a number of cases of nasal affections com-
bined with reflex neuroses, and found that the latter in-
variably disai^peared as soon as the cause was removed
or the irritability of the diseased surface w-as diminished.
.\ftections of the deeper parts of the nasal cavity and
the ethmoid and sphenoidal sinuses may give rise to such
grave conditions that disease of the brain or its meninges
may be suspected. -Schwalbe, A.\el, Key, and Retzius '
have demonstrated the fact that not only can the lym-
phatics of the nasal mucous membrane be injected from
the subdural and subarachnoidal spaces, but if force be
used the fluid will pass through the lymphatic canals to
the surface of the nasal mucous membrane. W'e thus see
that there must be a direct communication between the
nasal and the cerebro-spinal cavities. It is therefore fair
to conclude that if these channels are obstructed there
may ensue an increased pressure on the cerebro-spinal
fluid. It occurs to me here, that the cases of exudation
of fluids from the nose, reported a few years ago by Sir
James Paget and Dr. Althaus, may be attributed to an
unusual patency of these communicating canals, which
favored an egress of the cerebro-spinal fluid.
In December, 1882, Mr. Henry B , of Ciiicago,
came to me to learn whether or no he had any nasal polypi.
Tiie patient had for several years been suflering from
continuous headaches, referable to the base of the brain
and the occiput, was greatly emaciated, suftered from
insomnia and loss of appetite, and from difficulty of
respiration. During the greater |)art of the time he had
been under the care of Dr. Jewell, of Chicago, who, how-
ever, finding that he could not afford him any relief, and
suspecting the true cause of the trouble, advised Mr.
B to consult a specialist for diseases of the nose and
throat. My patient did apply to several physicians, who
failed to give him any satisfactory information, and he,
^ Dcutschcs Archiv fUr klin. Mcdicin, BamI xx., 1S77.
^ Berliner klin. Wochenschrift, No. 25, 1882.
^^ Hack : loc. ciL
therefore, determined to come to New York. On e.x-
amination, I found that the posterior nasal space, on both
sides, was absolutely filled with polypoid growths, which
I determined to remove. Owing to the prostrated con-
dition of the patient I was compelled to proceed very
slowly, but in the course of several weeks I removed a
sufficient number of polypi to completely fill an ounce
vial. I operated at first with a Wilde's snare, and later
by means of the galvano-caustic loop, hoping thereby to
serve the double purpose of removing the growths and
destroying their attachments.
The patient began to improve perceptibly after the
removal of the most prominent polypi, which enabled
him to breathe somewhat through the nose. As the
patency of this passage was restored his headaches dis-
appeared, his appetite returned, he was able to sleep
without the aid of narcotics, and, in short, when he left-
me for the South, about five weeks ago, he was, to all
intents and purposes, a well man.
Zuckerkandl ' says, " that polypi arise in the majority
of cases from ethmoidal turbinated bones and the tissues
of the middle meatus. They are frequently found near
the orifices of the ethmoidal foramina, and therebj' con-
tribute, by their gradual growth, to an obstruction and
inflammatory condition of the cellular cavities contained
in the ethmoid and sphenoid bones." This condition
must naturallv have an influence in causing more or less
marked congestion of the base of the brain, producing
headaches which may be irremediable, owing to the great
difliculty of arriving at a satisfactory ex|3lanation of the
cause of trouble. It is almost impossible to effect a
radical cure, owing to the inaccessibility of the polypoid
growths, as the}' are generallv situated in a part of the
nasal cavity which cannot well be reached by any surgical
apparatus.
Of all the cavities which are connected with the nose,
the antrum of Highmore is most liable to disease, owing
not only to its intimate relations with the nasal fossa, but
to irritation and inflammation caused by the development
of the teeth. Diseases affecting the nasal cavity are
readily propagated to the cavity of the ma.xilla, but ownng
to the peculiar situation of the communicating canal are
not so easily relieved. It will be remembered that the
foramen is situated in the upper portion of the inner wall
of the antrum, and that it connects with the nasal fossa
just below the middle turbinated bone. While in a
healthy condition the lining membrane of the antrum
does not secrete more fluid than can be absorbed by the
lymphatics. But in disease these secretions are increased,
the absorbents cannot carry them off', and they will accu-
mulate until they reach almost the roof of the cavity,,
when they may force their way through the foramen into
the nose. In the meantime, however, the patient may
suffer from great pain in and about the upper jaw, owing
not only to the inflammatory process but from the weight
of the column of fluid contained in the cavity. This.
pressure and the propagation of the diseased condition
to the teeth give rise to neuralgias, and even the teeth
may become seriously affected.
In many cases it becomes necessary to perforate the'
antrum in order to procure a discharge of its contents
and to allow the application of topical remedies. The
most common mode of procedure, and the one which I
have re|)eatetily em|)loyed, is to extract the second upper
molar tooth on the affected side, and then to perforate
the alveolus so that a direct comnninication between the
cavity and the external air is established. Zuckerkandl,"
however, suggests that it is more feasible to perforate
the outer wall of the nasal cavity just behind and below
the infundibulum, where the sinus is only separated
from the nasal fossa by soft parts.
Mr. J. P , of Newark, was fre(iuently subjected to
acute attacks of nasal catarrh, which were generally at-
tended with more or less tenderness of the right upper
jaw, and shooting pains into the corresponding eye and
' Op. cit., p. 79.
'Op. cit., p. 143.
April 21, 1883.]
THE MEDICAL RECORD.
425
ear. At these times he was always affected with tooth-
ache, which led him to consult his dentist, who gave him
the assurance that his teeth were iJerfectly sound. In
November, 1882, Mr. P was again aft'ected with a
severe cold, which, however, disappeared after the lapse
of a few weeks. The pain in the upper jaw remained,
however, and the patient observed, from time to time,
a faint fetid odor in his nose, and whenever he lay on
tlie left side he could distinctly taste some putrid fluid.
Fearing thai he might be affected with nasal catarrh he
came to me for advice. '
On examination I found a general hyper;emia of the
nasal mucous membrane, with some hypertrophy of the
inferior turbinated bones, especially so on the right sitle.
There was a thin deposit of creamy pus in the middle and
inferior meatus which emitted a very offensive odor.
The right cheek was rather puffy, and pressure over the
antrum gave rise to considerable pain, which was most
marked near the infra-orbital notch, the place of e.xit of
the superior ma.xillary branch of the trifacial nerve.
After thoroughly cleansing the nasal cavity I bade
Mr. P to bend his head strongly toward the left side,
and dilating the nares and illuminating the cavity I could
see the jnis exuding from the orifice of the maxillary
foramen. I now felt certain that I had to deal with a
clironic i)urulent catarrh of the antrum of Highniore, and
determining to attack the disease boldly, 1 took the
patient to a dentist, who unwillingly extracted an appar-
ently healthy second upper molar tooth. On the next
day I perforated the alveolus with a small trocar, and was
pleased to have this followed by a copious How of bloody
pus through the canula. The quantity of fluid evacuated
was more than three drachms. 1 now introduced a small
drainage-tube, such as is used in trepanation of the
mastoid cavity, and injected a one per cent, solution of
carbolic acid into the cavity. After an interval of a few
minutes I allowed this fluid to drain ofl", and ordered the
patient to return on the following day. I then injected
a fluid drachm of a two and one-half per cent, solution of
chloride of zinc, which I retained in the cavity a few min-
utes by letting the patient lie down and turn his head
toward the left side. When he again resumed the eiect
posture this solution escaped through the drainage-tube.
I made fifteen injections, at intervals of from three days to
a week. At this time the tenderness had disappeared, and
I discharged the patient with instructions to return within
a month. During all this time the drainage-tube remained
in situ, and when Mr. P returned he informed me that
at first he noticed an occasional exudation of fluid from
the opening, but none had escaped for nearly three weeks.
On examination I found no evidence of disease, and there-
fore removed the canula, intending to allow the fistula
to close up. More than two months have now elapsed,
and, in spite of several attacks of acute cory/.a. Mi.
P has had no further trouble in the antrum.
I might continue to multiply instances indefinitely of
the causal relations between diseases of the nasal and ac-
cessory cavities. But 1 hope that I have succeeded in
calling attention to the necessity of making a careful ex-
amination of these parts in all cases where symptoms of
headache, neuralgia, and other pains exist, which cannot
be traced to other sources by the usual methods of ex-
amination.
Dead Drunk. — "Dead drunk" is described by savants
of the Paris Biological .Society to be a condition in which
there is a pro|iortion of one part of alcohol to one hun-
dred and ninety-five parts of blood in the circulation.
Should the proportion ever come to be one part of alco-
hol to one hundred of -blood, death would ensue. Tliis
might happen, and in fact has happened repeatedly,
where a very large quantity of alcoholic liquor is swal-
lowed at one time and quickly. In ordinary drinking
consciousness is lost, and with it the power to drink
more, before the proportion of alcohol in the circulation
becomes fatal. — Medical and Surgical Reporter.
THE HOT-WATER RETROJECTION IN THE
TREATMENT OF GONORRHCEA.
By H. HOLBROOK CURTIS, M.D.,
NEW YORK.
During the past twenty years in no disease has there
been less advance made theraiseutically than in the treat-
ment of simple gonorrhoea. Of late there have appeared
in the London Lancet many articles upon this subject,
but no especial claim has been advanced for any method
that will eflectually abridge the orthodo.x three weeks'
limitation of this troublesome difficulty. I propose, with-
out entering upon the discussion as to the probable bac-
terian origin of the malady, to exjjlain a course of treat-
ment that I have employed for two years with very
excellent results.
Endoscopic examination reveals that a current of
hot water passed continuously through the urethra pri-
marily congests and secondarily renders anaemic the mu-
cous membrane, in the same way that a hot bath affects
the fingers. It is observed also that the urethra, after
being acted on for some time, will endure water of a
temperature that cannot be tolerated by the hand. Tak-
ing advantage of this fact, I have arranged an apparatus
by means of which one is enabled to pass several quarts
of hot water through the urethral canal from the prostatic
portion outward, increasing all the time the temperature
of the water until the thermometer ofttimes indicates
180° to 190° F. I have rejieatedly passed ten ijuarts of
water from behind forward in this manner, continuing
the retrojection for some time after the point of tolera-
tion has been reached. This varies much in different
persons. It remains then to pass a mild astringent solu-
tion through the same catheter that has been employed
for the retrojection. Preferably I use a suspension of
iodoform in a glycero-tannin solution in the following
proportions :
Yy,. Acidi tannici,
lodoformi aa 3 ij.
Glycerine 3 j.
Aqua; 3 iij.
Sig. — Heat, shake, and inject.
After the injection the catheter is withdrawn and the
patient is directed to return in twelve or twenty-four
hours, as the case may warrant.
As I intend shortly to publish the histories of some
twenty cases ofgonorrhcea and gleet that have been
treated in this way, I will here but briefly outline the
method and results.
In twelve cases of undoubted acute gonorrhoea the
discharge has been entirely checked in three days. In
two cases I have succeeded in aborting the disease by
one prolonged (ten quarts) thermoretrojection. In six
cases the disease lasted six to ten days, while a case of
chronic gleet that had made the round of the profession
for nine months succumbed in seven days to dilatation
and retrojection.
It has been noticed that cases that have been treated
for some time with strong mineral injections do not re-
spond nearly as quickly to the hot-water method. I have
yet to see, however, a " fresh case " of gonorrhoea, in
which no previous injection has been employed that will
not recover within a fortnight if the retrojection is prop-
erly administered.
From a careful study of more than forty cases I claim
for hot retrojection :
First. — The course of the disease is shortened by, at
least, two-thirds, making the average limit of the case —
viz., stoppage of the discharge — nearer one week than
three.
Second. — The discharge immediately changes from a
purulent to that of the nature of gleet, and is reduced to
a very small quantity.
Third. — There is absence of chordee and pain in
passing urine.
1
426
THE MEDICAL RECORD.
[April 2 1, 1883.
Fourth. — Stricture as a sequel is improbable.
Fifth. — The usual inconveniences of the disease are
done away with.
A brief description of the apparatus employed is as
follows : An ordinary wooden armchair is half-mooned in
the front of the seat to admit a tall cuspidor. A pulley
is rigged on the ceiling by means of which a tin pail wilii
a lamp beneath is elevated. A rubber tube, provided
with a stopcock and connection, leads from the pail and
at any time may be fitted to an ordinary No. 8 English
flexible catheter. The necessity of having a catheter
with a bulbous end to prevent water passing into the
bladder is purely imaginary. I would also state that an
ordinary Davidson's syringe may be used, the patient
giving himself the retrojection from the pail on a chair
beside him ; this is not as convenient, however, as the
gravity apparatus. When the water is of the proper
temperature, say 120° F., the catheter is vaselined and
introduced to within an inch of the prostate, connected
with the rubber tubing and the pail elevated to such a
height that the flow is brisk. The lamp under the pail
will keep the temperature of the water slowly increasing.
The patient holds the catheter in position and may read
the morning paper until the water becomes uncomfortably
hot. The lamp is then extinguished and the retrojection
proceeds at the point of toleration. After this has gone
on for a sufticient time, a syringeful of the injection for-
mulated above is thrown in and the catheter withdrawn.
If the patient is unable to come back at once give him
the same prescription for urethral injection or slightly
modified to suit the particular case, with directions to
use it twice a day, until he can return. As an adjunct
to this the only internal treatment I employ is bicarbo-
nate of soda in five-grain compressed tablets, to take ten
daily. Heretofore my cases have been confined to
private practice, but recently, at the kind invitation of
Professor Sturgis, I had an opportunity to demonstrate
this method at the Charity Hospital, where I am told the
results have been so gratifying that Dr. Sturgis has
promised to compile the statistics in regard to this mode
of procedure, which seems so rational that it will un-
doubtedly supersede the ordinary injection treatment.
Several writers have advocated warm water "irrigation "
of the urethra in gonorrhcea and have claimed more or
less success for their methods, but no one, to my knowl-
edge, has shown any statistics that can compare with
those obtained by prolonged i^rogresso-thermal retrojec-
tion. More than a brief outline of the subject would be
too lengthy for an article of this kind, but there is such a
field for experiment atforded in this direction, I take this
opportunity of placing some fragmentary data before the
profession.
A SINGLE CASE OF OVARIOTOMY .\ND WHAT
MAY COME OF SIMPLE CLEANLINESS.'
By D.WID little, M.D.,
ROCflESTEK, N. Y.
Three years ago this Society was entertained and in-
structed by Dr. J. Marion Sims in a graphic portrayal of
Thomas Keith and his ovariotomies. It must dwell fresh
in the memory of each one who heard the recital. Quot-
ing a single paragraph will suffice as a text for what I
have to offer :
Said Sims : " If Keith cured from 86 to 90 percent, be-
fore antisepsis, while others were curing 70 or even 80, and
if he now cures 97 per cent, with it, while others cannot
get even 88 or 90 with it, then I thought there nnist be
something besides antisepsis to account for this differ-
ence. With this feeling I went to Edinburgh, and I
think I have learned the secret of his great success."
This secret (if I heard rightly and remember correctly)
might be summarized in the one word — cleanliness.
Cleanliness that is next to godliness ; cleanliness tliat is
godliness ; for to do good is to be godly, and as a bene
^ Read before the State Medical Society, Albany, N. V., February 6, 1883.
factor in surgical operations cleanliness stands pre-emi-
nent.
Almost three years later came the wonderful record of
Lawson Tait — one hundred consecutive ovariotomies
with but three deaths ! and one of these due to " imme-
diate suftbcation," so as in no wise to be attributable to
septic poison. " and in no case zvas any detail of Lister-
ism used."
In homely phrase, " ]5ut this and that together," and
is it not apparent that Listerism played but an insignifi-
cant part in the success of Keith reported to us in t88o.'*'
So Keitli and Tait can "cry quits." Ninety-seven per
cent, of recoveries tallied to each ! One with his germi-
cides and germ-shields, and the other germ defying ; but
both doubtless worshipping at the shrine of cleanliness.
Without further preface, let me introduce my single
case of ovariotomy, nor let those with " their flocks and
herds " who count their operations by the liundreds,
smile at my lone " ewe lamb.'' Bear in mind the Scotch
proverb, " Every mickle makes a muckle." Every little
unit helps to swell the sum of experience.
Regina E (resident of Wheatland, Monroe Co.,-
N. Y., of German nativity, aged forty-six, married and the
mother of three children) first noticed a lump in her left
side (iliac region) about June i, 1881, which grew rapid-
ly, invaliding her, so that with her illness and poverty
she was forced to become an inmate of the Count)' Alms-
house, on February 28, 1882. Dr. Backus, the attend-
ing physician, made a diagnosis of ovarian tumor, and
asked me to see her, in the latter part of March follow-
ing.
We found a fluctuating tumor occupying the abdom-
inal cavity and extending from pubes to near the ensi-
form cartilage, and lying largely to the right of the
median line. It was slightly movable, and we thought
we could trace its attacliment and pedicle down into the
right iliac fossa, though the woman insisted that the
growth began in her left side.
Examination jier vaginam showed the uterus to be
tilted with its fundus to the right side.
The patient was bedridden and in constant pain, for
which she had for months been taking hourly doses of
morphia.
The operation was done on April 2 2d, in a room
25x18x11 feet in dimensions, thus having an air capacity
of 4,950 cubic feet. This room was in the southeast
corner of the third story, and was furnished with five
windows and a door with a transom.
It had been thoroughly cleansed, painted, and white-
washed a few days before. As soon as the woman, in-
cased in flannel, was covered in bed, each of the five
windows was opened, top and bottom, and so left as long;
as the patient occupied the room. The transom and
door were kept closed, because of the existence of ten
suspicious cases of post-partum fever lying in a room
across the hall.
The instruments used (Thomas' case) were new.
Sponges new and acid-cleansed. Anassthetic, Squibbs""
sulphuric ether.
Present and assisting, Drs. Backus and Montgomery
of Rochester, Dr. Richmond of Livonia, Dr. Rosebooni
of Utica, and Messrs. Moore and Fulton, internes.
With hands prepared only by soap and water with a-
nail-brush, we were ready to begin. Temperature of
room about 90° Fahrenheit.
The cut in the abdomen was four inches long. Be-
fore opening the peritoneum, all oozing of blood was-
stopped. Adhesions were found to abdominal wall and
to omentum. Pedicle of tumor was traced to left side ;.
tumor a monocyst ; pedicle was .twisted (which perhaps-
explained Iier pain). After emptying and drawing out
the sack, the pedicle was tied in two halves by a strong,
double silken ligature.
The (ledicle was severed three-fourths of an inch above
this, and its raw end smeared with licjuid persulphate of
iron. Two fine silken ligatures only were needed to se-
April 21, 1883.]
THE MEDICAL RECORD.
427
cure bleeding vessels. All these intraperitoneal ligatures
were cut short and left in situ.
Sponges were freely used in the bottom of pelvic cav-
ity, until thev came forth clean and stainless as they en-
tered. Then the cut was closed with interrupted sutures
of silk. Operation was completed and the patient in bed
in three-quarters of an hour.
And now I have to confess that (unlike Tail's cases)
in this one were used two details of I.isterism, so incom-
plete, however, that they should be admitted as inconse-
quential. For Lister and his imitators insist that, with a
missing link in its details, the whole system falls to the
ground, and fails in etfecting its object of excluding the
no.xious germs.
For form sake, and to appease the fears of assisting
surgeons, the water used was carbolized, but only to the
e.\tent of a drachm to the pint, i. e., less than one part to
one hundred and twenty ! What part this inundated
carbolic played in the destruction of disease-germs, if
such there be, I know not, my care being that the
vaunted germicide should not in this (as in many authen-
ticated cases) prove to be a homicide.
Again, after the wound was closed, a piece of lint
soaked in the thyinol (i part to 1,000) was laid on it,
and over this was pinned the customary tiannel binder.
•• Only this and nothing more." I should have mentioned,
while describing the operation, that no one was asked to
thrust a hand into the opened abdomen for any jiurpose.
The gentlemen were polite enough to take my word for
it that bladder, uterus, and remaining ovary were healthy,
and the last sponges coming spotless from the pelvic
floor satisfied them that we had, at least, made ch'an
work of it.
The size of the tumor had to be estimated, owing to an
accident. When the trocar was withdrawn, the rubber
tubing attached to the canula was forced off, and most of
the fluid escaped onto the floor; fortunately, none of it
leaked into the peritoneal cavitv. It was judged that
about three gallons flowed from the cyst. The liquid
was of a dark straw-color, and was albuminous.
And now as to results. The poor woman with her
tumor lost her pain, lost her appetite for opium, and, in
due time, lost her worn and haggard look and regained
complete health. Only three-fourths of a grain of mor-
phia in all was given to her after the operation. Her
pulse never exceeded 116 per minute, and her tempera-
ture reached its highest point at ioo|-° ! Both dropped
to normal standard on the third day, and thereafter so
remained.
On June 20th the woman walked away from the alms-
house to the house of a friend a mile and a half distant.
She called at my office last August and expressed herself
as "perfectly well and able to do as hard a day's washing
as any Dutch woman going."
In giving this history, for brevity's sake I have re-
frained from entering into the manv little details which
are known to be so essential to the proper performance
of the operation. Suffice it to say I ke]it steadily in mind
the lesson learned from Dr. Sims — Cleanliness, clean-
liness, above all things cleanliness. To the surgeon's
motto " tuto, cito, jucunde," might well be added " et
munditer. "
To this scrupulous cleanliness before, during, and after
the operation, together with the free admission of air and
sunlight throughout the management of the case, in my
opinion, belongs the credit of its successful issue.
You remember what dear, soft-hearted old Uncle Toby
said, as he bore unhurt the troublesome fly (which he
vainly fought, but finally caught) to the open casement :
" Go! Surely the world is wide enough for both thee and
me." So said we to the bacteria, only (because we had
been told they vastly outnumber the fly) they were given
vent through five windows instead of one.
Vaccine virus needs but the slightest abrasion to effect
its entrance into the system ; if the unrecognized, or at
any rate unconvicted micro-organisms are so numerous.
omnipresent, and dangerous, why don't they enter on
their errand of destruction through like small gateways ?
" Ay, ay, a scratch, a scratch ; marry 'tis enough. . . .
No, 'tis not so deep as a well, nor so wide as a church
door, but 'tis enough, 't will serve." And whv do not the
daily accidents of prick or scratch make us constant vic-
tims of septicemia?
Common experience teaches that such trivial wounds
are best left alone exjjosed to the air, and only covered,
in nature's own time and way, with her plaster of dried
blood and lymph. This common experience is but the
outcome of an instinct. The dog licks his wound, the
child sucks his ; so the wound is cleansed.
Years ago, a certain " quack," wiser than his day and
generation, or it mav be building better than he knew,
proclaimed to the wounded knight that he could heal
his hurt by anointing the offending weapon, if only the
sick knight would meanwhile keep his wound clean. His
marvellous success soon banished salves and plasters,
and there ensued open air and water-dressings. But now,
again, the fear of the ultra-microscopic fiend brings back
plaster and salve and in turn banishes air and water as
being probable vehicles of the infinitesimal vermin.
Pasteur and his co-workers are engaged in investiga-
tions of absorbing interest, from which may some day
come an "output " that shall give us an apjilied science,
working a revolution in the healing art. jMeanwhile, let
us " hasten slowly," and hesitate to fight an unseen and
l)erhaps imaginary enemy with uncertain and dangerous
weapons ; weapons that, like the boomerang, may be
more destructive to friend than foe.
A CASE OF IDIOPATHIC (?) PURULENT IN-
FLAMiMATK^N OF THE SEROUS MEMBRANES
OF ALL THE GREAT CAVITIES.
By FRANCIS P. KINNICUTT, M.D.,
PHYSICIAN TO ST. LUKe'S IIOSriTAL, THE OUT-I'ATIENT DEPARTMENT OF THE
NEW VOKK HOSPITAL, ETC.
C. F , male, aged twenty, grocer by occupation, was
admitted into my wards in St. Luke's Hospital, Febru-
ary 4th.
The patient's condition was such that a reliable history
could not be obtained from him. Doctor Robert Camp-
bell, former house physician of the hospital, under whose
care the patient had been, and by whom he was sent to
the hospital, has kindly furnished me with the following
facts. The patient had com]5lained during the previous
ten days of headache, wandering muscular pains, loss of
appetite, and general malaise ; had been free from chills,
but was feverish. There had been several attacks of
epistaxis during the same period. His bowels had been
regularly moved ; there had been no cough or sore
throat, nor any discoverable eruption. The patient was
first seen by Dr. Campbell on February 2d, and an ex-
amination at this time of the throat and chest revealed
nothing abnormal. There was no eruption ; there was
general sensitiveness over the abdomen. Temperature,
103°; pulse, 120; respiration, 24.
On the following day he was found lying in bed covered
only with a horse blanket, in a room without a fire, and
which was very cold.
The patient complained of stabbing pains in left side.
Examination revealed pleuritic crackling over the whole
of left chest, posteriorly. On the succeeding day the pa-
tient was admitted to the hospital. On admission he was
well nourished, tongue dry, face congested ; respiration,
40 ; pulse, 138 ; teinperature, 104I'' (mouth) ; complains
chiefly of pain in left side, p.m.— Patient slightly deliri-
ous ; respiration, 50 ; pulse, 140; temperature, 105!°.
Severe attack of epistaxis.
Physical examination of the chest was necessarily im-
perfect on account of patient's condition. There was
marked flatness on percussion over the lower three-
fourths of left chest, posteriorly, with distant respiratory
428
THE MEDICAL RECORD.
[April 21, 1883.
sounds and exaggerated voice over the same area ; ex-
amination of the urine showed the presence of a small
amount of albumen.
Febuary 5tli. — Respiration, 58 ; pulse, 152; tempera-
ture, lo^J-^^. Flatness over whole of left chest, anteriorly
and posteriorly, with distant respiratory sounds. Heart-
sounds hardly distinguishable ; impulse absent. Area of
cardiac dulness cannot be defined on account of general
flatness over left chest. Pericardial effusion believed to
be present in addition to i^ieural. Exploratory puncture
into left pleural cavity revealed the presence of a sero-
purulent effusion. Aspiration performed and sixteen
ounces of thin creamy pus, free from odor, withdrawn.
Immediately previous to aspiration, respiration, 50 ;
pulse, 132 ; teni]jerature, 105°. Two hours later, res-
piration, 36 ; ])ulse, 138 ; temperature, 102°.
February 6lh. — Patient passed a comfortable night ;
respiration, 44 ; pulse, 152 ; temperature, 102.5°. Flat-
ness over whole of left chest, anteriorly and posteriorly.
Aspiration again performed and sixteen ounces of sero-pus
withdrawn, but with only very temporary improvement
in patient's condition. The fluid in the pleural cavity
apparently accumulated almost as rapidly as it was with-
drawn; the physical signs remained unchanged; the
symptoms of cardiac failure gradually became more
marked, and death occurred on the 9th.
Autopsy, fourteen hours after death, by Dr. Ferguson,
pathologist to the hospital. — Body well nourished ; rigor
mortis well marked ; no cedema ; no cutaneous lesion.
Peritoneum : Visceral and parietal peritoneum congested,
especially in pelvic cavity and over coils which dip into
it ; small amount of jnis and lymph in this situation.
Thorax : Right pleural cavity contains twenty-two ounces
of sero-fibrinous fluid ; left pleural cavity, seventy-four
ounces of sero-pus. The right lung is markedly con-
gested and oedematous ; bronchi congested ; left lung
compressed against spinal column, seems totall)' de-
prived of air ; and is covered by recent lymph. Heart :
The pericardium contains about six ounces of fluid, con-
sisting of serum, pus, and fibrin ; valves normal ; muscular
tissue of heart normal in appearance, surface covered with
recent lymph. Spleen slightly increased in size, normal
in ai)pearance. Kidneys normal in appearance. Stomach,
intestines, bladder,, urethra normal. Liver apparently
contains a slight excess of fat. Laryn.x and trachea nor-
mal. Joints examined and found to be normal. Ex-
amination of the brain not |)ermitted.
Microscopic examination of the different tissues showed
only a slight degree of fatty degeneration of the cardiac
muscle and swelling, with a cloudy appearance of the
epithelial lining of the renal tubules.
Remarks. — So general an inflammation of a purulent
character of the serous membranes of the great cavities is,
in itself, an interesting observation. Such inflammations
are of occasional occurrence in simple pyajmia and in the
metastatic form. They are more rarely seen accompany-
ing the acute infective diseases and as secondary to Bright's
disease. Pericarditis, with bilateral i)leurisy, is of suffi-
ciently common occurrence in acute inflammatory rheu-
matism, but the exudation is usually of a serofibrinous
character. In the present case, a very careful investiga-
tion of the innnediate previous history of the patient
failed to reveal the existence of any of the usual causes
of py;>;mia, the presence of an acute infective disease, of
a renal affection, and finally, of any of the symptoms of
rheumatism.
A very complete post-mortem examination corrobo-
rated the clinical eviilence of the absence of any possible
source of pyaimic or septic infection ; the kidneys, more-
over (with the exception of presenting the cloudy aj)-
pearance of the e])ilheliuni of the tubules not unusual in
individuals dying of acute disease) were wholly free from
disease. The inflammation of the peritoneum was almost
wholly confined to that portion lying within the pelvis,
indicating the absence of the influence of contiguity of
structure in its production.
The very acute nature of the morbid process (the ill-
ness only extending over a period of ten days), its occur-
rence in an individual of exceptionally fine physique, the
entire absence of any of the usually recognized causes of
similar wide-spread serous membrane inflammations are
noteworthy, I hesitate to pronounce the pathological
process idiopathic in character, yet all the evidence ob-
tainable in the case would seem to justify such an opinion.
CASE OF CYANOSIS DUE TO CONGENITAL
CLOSURE OF AORTIC ORIFICE.
Child living Twenty-seven Days,
By ALFRED MEYER, M.D.,
NEW YORK,
Though cases of congenital malformation of the heart
have not infrequently been put on record, with few ex-
ceptions these have been cases of malformation of the
right side, with possible secondary changes in the left,
Moreton Stille, writing in 1844 (American Journal of the
Medical Sciences), mentions sixteen forms of congenital
heart disease giving rise to cyanosis, but does not even
allude to atresia or stenosis aort«. J. Lewis Smith
("Trans. N. Y. Ac. of Med., 1863," p. 335) publishes one
hundred and ninety-five cases of cyanosis, of which seven
were cases of disease of left side of heart, and of these
seven only one of complete closure of the aortic orifice
(Case 143). Rauchfuss (Gerhardt's "Handbuch d. Kin-
derkr.," vol. iv., pt. i, p. 123) has collected twenty-four
cases of congenital disease of the aortic orifice, in six of
which there was stenosis and in the remaining eighteen
atresia.
Of one hundred and thirty-nine cases of congenital
heart disease which I have collected from the journals of
the last fifteen years, there is not a single case which
bears the remotest resemblance to my own, nor have I
been able, after diligent search, to find a heart like mine
in any of the pathological collections of the city. Of
course, when speaking of the rarity of occlusion of the
aortic orifice, 1 exclude cases of stenosis and of atresia
aortc-e at or near the points of insertion of the ductus
arteriosus. ' Of these latter numerous instances are on
record. Thus Eppinger {Prager Viertelj., vol. cxii., p.
31), in a historical review of the subject, collected forty-
two cases of this kind up to the year 1871, to which he
added two more cases of his own; whilst Kriegk {Prager
Vier., vol. cxxxvii., 187S) collected and tabulated fifty-six
cases, beginning with one observed by Paris at the end
of the last century, and described in "Desault's Journal,'"
which is probably the first case on record. To this series
of cases 1 am able to add nine" more, omitted by Kriegk
or published since the appearance of his article. A
great many of this kind of cases live many years without
any appreciable disturbance of health. Living to fifty
and sixty years of age is not at all uncommon, and
Reynaud (quoted by Kriegk) reports the case of a man
dying at ninety-two years, in whom this malformation
was found.
My own case is not one of this more common and
favorable kind, but of the rare and fatal variety of com-
plete absence of the aortic orifice. It has already been
reported by me at the Society of German Physicians,
but will surely prove of interest to a wider circle — a jus-
tification for its publication in detail in this journal.
On the evening of June 7th last I was called in haste
to see the patient in question, a male infant, twenty-four
days old, whom I foimd in great dyspncea, with marked
cyanosis of entire body, and no radial pulse to be felt on
either side. Curiously enough the pulsations in each
* Gosling's Transl., vol. ii., p. 104.
■■' Hcrlcl ; Herl. KI. Wocllcnschr., 1871, p. 337 : Fitz : IJost. Med. & Surg. J.,
1875, p. 444 ; W.isastjcrna : I'rag. Vicrtclj., 1876, vol. c\x,vii. (2 cases) ; Green-
how : Lancet, 1876, vol. i., p. 674 ; .Moore : Am. J. Med. Sc. 1877, vol. ii,, p. 172 ;
lyiiuich : CcntralUl. f. d. m. Wiss., 1876, p. 351 ; Legg : Dublin Med, J., 1878, vol,
i., p. 260; Kucssncr; Ucil. Kl. W., 1879, p. 3.
April 21, 1883.]
THE MEDICAL RECORD.
429
dorsalis pedis artery were full and distinct enough to per-
mit of their being readily counted. At that time they
numbered one hundred and thirty-five. On examination
of the chest, to which, naturally, attention was first di-
rected, nothing abnormal could be discovered in the
lungs, but there was a distinct, loud, blowing systolic
DA
Tt A, ductus arteriosus ; A, aorta
valves ; A A, auricular appendix.
Fig. 1.
; P A, pulmonary artery ; SJV, semilunar
murmur to be heard in the neighborhood of the second
and third ribs to the right of sternum. The mother of the
boy reported that he had been short of breath from birth,
but that no discoloration of the skin was observable until
some time in the third week, and that then the midwife
pronounced the child to be sufl'ering from " severe jaun-
dice." The gradual increase of the dyspncea at nursing,
as well as the deepenmg cyanosis, finally impelled the
C L V
F O, foramen ovale ; P A, pulmonary artery ; C L V, cavity left ventricle :
A A. auricular appendix ; C. coronary vessel ; E, cndocarditic deposit : W L V,
wall of left ventricle.
mother to seek other advice. This was on June 7th,
when I found the condition as described above. The
child was found dead in bed, somewhat more than forty-
eight hours later. After a great deal of opposition, I was
finally permitted to remove the heart through a small in-
cision. The pericardium contained about three-fourths
of a drachm of clear serum. Heart-substance of a dark-
blue color. Right auricle and ventricle both greatly di-
lated ; foramen ovale pervious, pulmonary artery fully
twice the normal size ; ductus arteriosus pervious ; left
auricle about one-third the size of right one ; walls of
left ventricle about one-half inch thick, its cavity just
laro-e enough to hold a small jjea, musculi pectinati being
fused into a solid mass. Mere traces of chorda: ten-
dineae to be seen. Aortic orifice completely closed ; no
trace of semilunar fiaps. Ductus arteriosus leads into
arch of aorta, which is about one-eighth inch in diameter,
but ends as a blind sac at the base of the heart. Sep-
tum ventriculorum complete.
The circulation in this case was carried on by the
right ventricle and the two auricles, the systemic circula-
tion being supplied from the pulmonary artery via the
ductus arteriosus.
The absence of a radial pulse, at a time when pulsa-
tions were to be distinctly felt in the dorsal arteries of
the foot, seems to me accounted for by the fact that the
arch of the aorta is more nearly a direct continuation of
the ductus arteriosus than the vessels going to the upper
extremities, and that hence the blood-current mainly
took this direction.
A rather unusual feature of this case was the length of
time the child lived — twenty-seven days. The one most
nearly resembling it which I have been able to find in
print lived only two days. It is the case of a girl report-
ed by Canton in the London Pathological Society's
" Transactions," vol. ii., p. 38.' The case quoted by
J. Lewis Smith (No. 143) in the article already referred
to lived four days.
A close inspection of the heart indicated that the mal-
formation was due to an endo- and myo-carditis.
The causes of foetal endocarditis, as of many other
fcetal diseases, are obscure. Anxiety or fright are frequently
mentioned in this connection. \n my own case there
was a history of this kind. When in the seventh month
ofpregnancy the mother was frightened by the severe
scalding of one of her children, and shortly after nursed
her husband during a severe attack of pleurisy. Be this
as it may, the exciting cause of the endocarditis must
certainly have acted after the end of the second or the
beginning of the third month of pregnancy, for this is the
period of closure of the ventricular septum, and, as we
have seen, the closure was complete in this heart.
In the Transactions of the German Medical Congress,^
1882, Von Hoffman records a case of congenital heart
disease, in which the placenta was the seat of numerous
recent and old extravasations. He advances the theory
that pathological products had been introduced through
villous absorption into the fostal circulation, and had
thus given rise to endocarditis. He advises a careful
examination of the placenta, and believes much light
may be thrown on the etiology of congenital disease.
Influence of Fowler's Solution upon the H.«mo-
GLOBIN IN THE Blood. — From an investigation made to
determine the effects of the medicinal administration of
some remedies upon the proportion of hc-emoglobin in the
blood. Dr. Fenoglio, of Turin, concludes that the iron
preparations vary considerably in their effects. Fowler's
solution increases the h;«moglobin, and this becomes
more marked the longer it is given. In spite of the gen-
eral opinion to the contrary, the administration of
Fowler's solution is indicated in amumia, chlorosis, and
in general in all conditions in which there is a decrease
in the hsmoglobin, for the influence of this agent is veiy
evident in increasing the proportion of the hemoglobin.
And, furthermore, its use increases the api)etite and pro-
duces a general improvement in the bodily appearance
and condition.
1 Also included in Ranchfuss' series of cases.
2 Medical Recokd, December, 1882
430
THE MEDICAL RECORD.
[April 21. 1883.
^cpovts of liospitats.
THE TREATMENT OF FRACTURES IN BRITISH
HOSPITALS.
(From our London CorrespondenL)
There is, perhaps, no other province in the wide do-
main of Surgery, in which similar and equally satisfactory
results are so commonly brought about by a variety of
means than in the treatment of simple fractures of
the limbs. And this is the case, not because any great
diversity of opinion e.xists as to the end that is to be de-
sired, for that cannot be alleged in this particular in-
stance, but rather because the result sought for is in all
cases identical, though capable of being accomplished
by very many forms of treatment, which differ in this
detail, and allow scope for the ingenuity and dexterity of
the individual surgeon.
Fractures of the limbs are so common, that it is not a
matter of surprise that we find at each institution some
recognized method, which is sanctioned by custom and
hallowed by time, for meeting all the more common
forms of each injury, whilst any complication that may be
found needs generally but a very slight modification of
the apparatus. And this is rendered all the more neces-
sary seeing that such injuries, except when complicated
by some serious addition, such as severe injury to a joint
or rupture of an artery, are treated in the first instance
by the house surgeon, and the surgeon on his visit is rarely
called upon to do more than approve, or at most to sug-
gest some slight alteration in the apparatus.
Except there be some other injury, or on account of
the feebleness of the patient, or in the event of some
serious complication to a joint or artery, cases of fractures
of the upper extremity are usually treated as out-patients,
thus coming entirely under the care of the house surgeon
and his dressers, and this renders it necessary that a con-
venient and portable apparatus shall be applied to keep
the ends of the injured bone in good apposition. It
would be impossible to enumerate the many ways in
which fracture of the clavicle is dealt with, or the many
ingenious appliances which have been invented by sur-
geons and by instrument makers ; but speaking only of
hospital practice, the result obtained by a simple bandage
with or without a pad in the axilla, and applied so as to
throw back the shoulder upon the injured side, to raise
and keep steady the humerus, and to take off the weight
of the arm, are as satisf;ictory as could be wished for.
Sometimes a figure-of-eight bandage, with a sling for the
arm, produces the desired effect, whilst in other cases
where it is difficult to overcome the deformity, the sur-
geon must rely upon his skill in using and applying a
bandage, with a pad secured in the axilla by a strap pass-
ing over the opposite shoulder.
Fractures of the scapula do not commonly occur with-
out either severe bruising of the surrounding parts or
some other more serious complication, of which fractured
rib is by far the most frequent. When they do occur
without any serious complication, the treatment consists
only of a sling or bandage to steady the arm and take off
the weight of the limb, and this is all that can be done
if the acromion or coracoid process be broken.
Before speaking of the mode of treating the long
bones in detail, it may be well to mention some of the
materials which are in use in London at the present time
for securing the position of fractures, after the api^lica-
tion of splints has been dis|)ensed with, as these means
are not unconnnonly found available in the first instance,
and can be applied in many instances where there is no
bruising, and where only one of two bones is broken, as
happens particularly in the case of a fracture of the fibula
or radius. The principal of these are, the starch or glue
bandage, the plaster-of- Paris bandage, and one made stiff
with de.xirine,. guiii, and chalk, etc. A very useful mate-
rial for this purpose lias long been in use at St. George's
Hospital, and can be applied in the first instance in
treating fracture of the fibula without bruising, and is
almost invariably employed to put up fractures of the
thigh or leg as soon as union has taken place and the
splints can be laid aside. A piece of ordinary stout mill-
board is cut to about the size necessary to embrace the
limb ; it is then soaked in hot water, which renders it
pliant, and is shaped roughly to the limb, the edges being
torn carefully so as to form a bevelled margin. A piece
of flannel is then placed round the limb, or a simple
roller is applied, and then a bandage is neatly and firmly
carried from the toes to a distance above the joints
between which the fracture is situated, and closely em-
bracing the mill-board. This, on drying, makes a very
convenient apparatus, light and strong, and in order to
increase its strength and to keep the bandage from be-
coming unravelled, a thick coating of clarified gum is
pasted over the bandage. The starched bandage which
is in general use at University College is applied in much
the same manner, coarse pasteboard soaked in starch
being used, and the limb being surrounded by an even
layer of cotton-wool before this is applied. This being
elastic, avoids the danger of compression which might
ensue when this treatment is followed, as it often is, in
the case of recent fractures ; and the apparatus has the
advantage, when thus applied, that it can, if necessary,
be split up by a strong pair of pliers, and its width cur-
tailed, while its efficacy for support can be re-established
by the application of tapes or a fresh bandage. With one
of these forms of permanent apparatus it is almost invari-
ably the custom to treat fractures after union has taken
place, and in many instances where the displacement is
not great and the extravasation slight, recent fractures
are also treated in this way. In the case of the bones of
the leg, a junk is sometimes slung in a "Salter's swing"
and the limb placed in it for a few days, until all swelling
and bruising have disappeared. A solution of silicate of
potash is sometimes preferred to either of the above-
named materials.
To return, then, to the consideration of the fractures of
the various bones and the usual plans for their treatment.
In London hospitals the general method adopted in cases
of fracture of the shaft of the humerus is to put the arm up
in four well-padded wooden splints tied together by two
pieces of bandage which are made to encircle them, one
above and one below, and the forearm, being supported
by a sling round the neck, gives sufficient extension to
ensure a good position of the broken ends. The fingers
and forearm may be left unbandaged, unless there is a
tendency for these parts to become swollen, and this
treatment is usually continued until union has taken
place, but the plaster-of-Paris bandage can be applied as
soon as all swelling has subsided. This form of treat-
ment can be used in all cases of fracture of the shaft, ex-
cept those of the condyles or of the lower end of the
bone, for which a rectangular wooden splint is almost
always resorted to, with or without three additional flat
splints to encircle the humerus, the one arm of the right
angle being placed along the front of the forearm, and
the other along the anterior aspect of the humerus. Any
immovable apparatus is disapproved of in this locality
on account of the desirability of making early movement
in the elbow-joint, which generally is more or less in-
jured when the accident takes place, and is therefore
liable to become stiff if passive motion is not commenced
at an early stage.
The old plan of treatment of fracture of the olecranon
was to put a long straight si)lint on the anterior aspect of
the arm and thus keep it fully extended, whilst the frag-
ments were brought as nearly as possible into apposition
by a figure-of-eight bandage. But when, by the action of
the triceps, the upper portion of the ulna was drawn a
long way up the arm, this plan was not found to give
very good results, which answered, however, sufticiently
well when the fibrous covering of the bone held suffici-
ently together to prevent any great separation of the
April 21, 1883.]
THE MEDICAL RECORD.
431
parts. Accordingly, the plan which has been success-
fully carried out in the case of the patella has been tried
for the ulna, and the parts brought closely together by a
silver wire passed through holes drilled obliquely down
from the surface of each fragment. Under the antisep-
tic system this mode of proceeding has been attended
with temarkable success in the few cases which have
been reported, but it remains to be seen whether it is
capable of being more generally followed.
A coui>le of well-padded, straight, and flat wooden
splints are generally all that is required to keep the bones
of the forearm in position when fracture takes jilace in
the shaft of one or both, but many plans are in use for
correcting the deformity in the injury which goes by the
name of " Colles's fracture." Some surgeons use these
same splints, and by a turn of the bandage which keeps
them in position, passed over the hand, maintain it at an
angle downward to the side of the ulna, and obtain satis-
factory results. Another very useful apparatus, by which
the deformity is more easily corrected, is that invented
by Dr. Gordon, of Belfast, who denies that impaction of
the broken ends of the radius is of conmion occurrence,
and corrects the deformity " by traction on the hand or
pressure on the fragments, placing the hand in the prone
position, then applying to the anterior surface of the
forearm a splint to which a wooden conical or triangular
piece is so attached that the external border of the splint
projects beyond it ; and on the back of the forearm a
straight splint more thickly padded over the wrist than
over the forearm," the whole to be fixed by two straps
of webbing, and not by bandage. A more convenient
and less complicated method in common use is a pistol-
shaped splint applied to the back of the hand, with or
without a short straight splint to the front of the fore-
arm, and not extending beyond the wrist ; the two being
ke|)t in position by a bandage.
Passing to the lower limbs, and to the fractures which
occur in the femur, the plan of treatment usually followed
in London hospitals is by one of the two forms of long
splint reaching from the axilla down to the foot, and ap-
plied with or without shorter splints surrounding the
thigh. When these are applied the foot is fixed by ban-
dages to the lower end of the splint, and to an iron foot-
piece which runs out at right angles to it, the form of
splint known by the name of the French surgeon Desaulx,
and this is secured to the body by a band passing round
the waist, and runs up on the outer side of the body to
the axilla, having a fork cut in its upper extremity for
the purpose of giving a secure /<?/«/ d'appui for the |)eri-
iieal band, as it is called, by which traction is made. On
this band are threaded three short flat splints, the upper
ends of which are cut obliquely so as to fit the line of the
groin, and these, with the long splint, surround the whole
thigh, and are kept iij position by one or more pieces of
webbing. The whole having been jiroperly adjusted,
traction is made by tightening the perineal band, which,
by passing over the upper end of the long splint round
tlie groin and behind the nates, causes extension of the
whole limb, and brings the fractured surfaces into close
and accurate a[)position. The shorter splints are, how-
ever, very frequently dispensed with, and then extension
is effected by means of a weight applied with strapping
to the leg and passing over the end of the bed, where an
apparatus is fixed with a rest, over which the cord attach-
ing the weight of seven to nine pounds is passed ; and to
further the effect of extension the lower end of the bed is
slightly raised by blocks, so that the weight of the body
may act in a manner to extend from the opposite direc-
tion. A patient thus treated is usually kept in bed for
from four to seven weeks, and then one of the forms of
immovable apparatus is generally applied, plaster-of-
Paris being less frequently used in the case of the thigh
on account of the great weight whicli a splint made with
this material necessarily involves. With very young
children the best results are often obtained by using a
weight to the leg as above described, whilst to secure
the limb from movements during sleep, and to keep the
fragments in good position, a sandbag is placed on either
side of the thigh, and another laid across the seat of the
fracture ; and further to prevent the patient from slipping
down and so nullifying the influence of the weight, a
band is passed behind the back t'rom which two loops
pass over the shoulders, and this is tied beneath the bed
or secured to its upper end. One of these forms of
treatment suffices in almost all fractures of the thigh-
bone, but there are some in which the broken ends can-
not be kept in position by any such means, and this
happens particularly when the break occurs a short way
below the trochanters, and the upper fragment is drawn
upward and inward by the action of the psoas. For
these cases the most frequent aii[)aratus used is Earle's
bedstead, which allows the patient to lie flat on his back,
but the foot being secured on the injured side to a foot-
piece, the knees are bent over the raised portion of the
bed, which thus forms a double inclined plane, and trac-
tion is kept up by the weight of the body, the knee thus
becoming practically a fixed point. Many other inge-
nious modes of effecting the same results have been in-
vented and are occasionally used, but they are not in
general use, and are only required in exceptional cases ;
such, for instance, are the methods of placing the limb in
a wire support, without splints, and making extension by
a weight attached to the foot and passing over a [nilley,
which is placed at some height and distance from the end
of the bed, or the splint known by the name of " Thomas,"
which consists mainly of a couple of parallel iron rods
united at both ends, the upper being secured round the
pelvis and the lower to the foot, whilst a bandage passes
round the whole apparatus and gives support to the lower
part of the limb.
The treatment of fracture of the patella varies in detail
at almost every institution, but the main points are to
reduce the effusion into the synovial membrane of the
knee-joint, by which the primary separation of the frag-
ments is mainly produced and maintained, and then to
bring the two surfaces as nearly as possible in apposition.
The first object is attained by raising the limb to an
angle with the trunk on pillows, junks, or other appa-
ratus, and applying evaporating lotions to the joint, and
the second, by the use of bandages applied in various
fashions, strapping, to which is sometimes attached a
weight, which, passing over the foot, is intended to drag
down the upper fragment and to act counter to the re-
traction of the quadriceps extensor. Some surgeons still
use Malgaigne's hooks, but they are objectionable on ac-
count of the risk of inducing erysipelas. The operation
of wiring together the fragments has' been already al-
luded to, and has now been performed in a considerable
number of instances, but the danger, even with the utmost
aseptic precautions, is sufficient to deter surgeons from
recommending the operation, especially when the acci-
dent occurs, as it most frequently does, in persons past
the healthiest period of life, and also considering the very
useful limb which is obtained by patients who are will-
ing to submit to a prolonged course of treatment by
simple means. Where the separation of fragments has
taken place after fibrous union between the two ends of
bone, the operation has been resorted to in several cases
with more or less satisfactory results. Where splints are
used for the treatment of fractures of the bones of the
leg, those which bear the name of Cline are perhaps
most frequently had recourse to. They consist of two
pieces of light pine-wood roughly hollowed out and
shaped to embrace the outer and inner surfaces of the
calf, ankle, and foot, a round hole being cut for the
malleolus in each. These are padded with tow or cot-
ton-wool, and are fixed to the foot by pads and bandages,
whilst they are secured round the leg by two pieces of
broad webbing. Other surgeons prefer to suiiport the
back of the limb, and for this purpose use three flat deal
splints to which a foot-piece is applied, and these are
kept in position by webbing and strapping or bandages.
432
THE MEDICAL RECORD.
[April 21, 1883.
Whatever form of splint is used, tlie custom is almost in-
variable of swinging or raising the limb, either by jiuiks
or by the use of " Salter's swing," which allows the pa-
tient to exercise more movement of the body without
disturbing the injured extremity. In some cases where
tiie swelhng is not great, the limb is placed in plaster-of-
Paris, by laying strips of blanket soaked in the plaster on
either side of the leg, and bandaging with muslin into
which the dry plaster has been rubbed, cotton-wool
being used, or, as some prefer, a tiannel bandage, to
guard against the risk of subsequent swelling. For
Pott's fracture, where ecchymosis forbids its immediate
treatment by some immovable apparatus, the practice
recommended by the Dublin surgeon is usually adopted,
namely, to place a single flat wooden splint upon the
inner side, with a thick pad over the inner malleolus, and
to secure to this the foot below and the leg above by a
light bandage.
The same appaiatus suffices in the treatment of com-
pound as in simple fractures, the more so as the wound
is almost invariably treated on antiseptic principles,
more or less strictly carried out in the manner of Pro-
fessor Lister. Some surgeons, however, still adhere to
the use of '' Assalinis' fracture-box," a weighty and some-
what cumbrous machine, whilst others prefer iVlacIntvre's
splint, which has the advantage of being more easily
cleaned, and is thus less likely to become a medium tor
conveying or retaining the germs of contagious diseases.
^r0gi*ess of ^ctXicaX J^cicncc.
Aneurism in the Gall I^i.adder. — At a recent meet-
ing of the Society of German Physicians in Prague, Dr.
Chiari presented a specimen of aneurism in the gall-
bladder The patient had died of mela;na. At tiie au-
topsy the oesophagus, stomach, and intestines were found
filled with partly fluid blood. .-Vbout two fingers' breadth
below the pylorus, in the wall of the duodenum, was a fis-
tula, closed with a blood-clot, leading into the gall-blad-
der. The latter contained about a dozen calculi. .At
its lower part was seen an aneurismal dilatation in the
course of the right hepatic artery measuring one inch in
length by about half an inch in \vidth. Death had re-
-sulted from a rupture of this sac. Careful search re-
vealed a second aneurism protruding into the gall-bladder.
It was the size of a pea and arose from a branch of the
gastro-duodenal artery. There had been an inflamma-
tion of the gall-bladder with ulceration, by which the ar-
teries had been laid bare, and tiie aneurisms resulted
from the blood-pressure upon the exposed arterial walls.
— Wiener iMed. IVoeltensehrifi, February 3, 18S3.
Treatment of Vascular Tumors without Opera-
tion.— Dr. Fiorani has treated several cases of telangiec-
tasis sup cessfully by the external application of corrosive
sublimate in collodion (three parts in twenty). He ap-
plies four layers of the substance over the tumor, and a
little beyond, with a camel's hair brush. On the fourth
day the edges are a little raised, and then a second appli-
cation of four layers is made. This is repeated every
four days until the swollen edges have become depressed.
After the crust falls off, the surface is seen to be some-
what sunken and of a pinkish color, which gradually
changes to a normal hue. The procedure is entirely
painless. It is to be employed only where the angioma
is raised but a line or two above the surface. — Allgem.
Med. Central Zeitimg, January 3, 1883.
Thrombosis of the Basilar Arterv. — Professor
Leyden {Allgem. Med. Central Zeitting, January 20,
1883) relates two cases of this rare affection. The throm-
bosis results from arterial sclerosis, with consequent dila-
tation, or from embolism. In the latter case the embolus
is usually lodged in one of the vertebral arteries. The
changes in die vessels are usually due to syphilis. Ley-
den divides the symptoms into local and general. To
the former, due to changes in the pons and medulla, be-
long paralyses, difficulty of deglutition and of speech, and
a low temperature. The paralysis may be of the face
and extremities on the same side, of the face on one side
and the extremities on the other, or of the oculomotor
nerve on one side and of the facial muscles and e.xtremi-
ties on the opposite. This points to a lesion in the crura
cerebri near the pons. To the general sym)3toms belong
stupor, somnolence, delirium, and sopor. They depend
upon disturbances of the circulation, induced through
closure of the basilar artery. Choked disc is a symp-
tom sometimes present and due to the same cause.
MEDIC-A.TED Gelatine in the Treatment of Skin
Diseases. — Dr. Pick speaks highly of medicated gelatine
in the local treatment of various skin diseases. It is a
clean and convenient dressing, obviating the necessity of
bandages or plaster to retain the application. After a
bath the patient applies the gelatine, melted in a water
bath, with a brush, and after it is dry paints over it a thin
coat of glycerine. The latter prevents cracking and
chipping off of the dried gelatine, and also keeps it flexi-
ble, so that the joint movements are not interfered with.
The following is the mode of preparing the medicated
gelatine : Dissolve fifty parts of gelatine in one hundred
parts of distilled water in a water bath. Then add the
medicament in the desired proportion, stirring constantl)".
Then set the mixture aside and, when cool, wrap in oiled
paper. The patient is instructed to melt a piece of this
gelatine cake in a saucer set in hot water and, when fluid,
to apply with a camel's-hair pencil to the diseased sur-
face. When it is desired to make a fresh application,
the patient takes a warm bath and the old dressing is
washed away. — Allgem. Wiener Aled. Zeitung, February
13, 1883.
Treat.ment of Neuralgic Metrorrhagia.- — Uterine
hemorrhage, occurring in connection with lumbo-abdom-
inal neuralgia, is a condition which is pretty generally
recognized, and one for which treatment is, as a rule,
unsatisfactory. A writer in the Revue Med. Chir. des Mat.
des Fcinmes claims to have employed with success the
tincture of aconite in repeated doses. The only indica-
tion for its use is the establishment of a relation between
the neuralgic exacerbations and the return of hemorrhage.
Even in cases depending upon actual lesion of the
uterus, the writer asserts that we can always obtain a
favorable remission, if not a permanent cure. The tinc-
ture is given in drop doses, in a teaspoonful of water,
every fifteen minutes for six hours. No food is to be
taken in the meanwhile. On the following day, if the
symptoms are ameliorated, the aconite may be repeated
in the same dose. If there is no improvement the dose
is to be doubled. The maximum daily dose necessary to
arrest the hemorrhage is said never to exceed fortv-five
to fifty drops. But this is an amount of aconite that
might give rise to serious symptoms, and tiie effects of
the drug should be very carefully watched.
Antiseptic Thoracentesis. — In the Revue de Chir-
urgie for January, 18S3, Dr. Hache reviews at length the
various operations for the removal of pus from the
pleural cavity. A comparison of the results obtained in
the different modes of procedure leads him to prefer that
which is conducted in strict accordance with the rules of
Lister himself, even to the eight layers of gauze and the
mackintosh. The following are the rules by the strict
adherence to which he thinks the greatest success may
be obtained: \. The operation and the subsequent dress-
ings should be performed under the most vigorous anti-
septic precautions. 2. The incision should be large and
permit of the complete evacuation of the contents of the
pleural cavity. The operation should be undertaken as
soon as the diagnosis is made. 3. A single washing out
of the pleural sack should be made, unless in exception-
al cases. A large drainage-tube is to be inserted, and
removed only when the discharge has nearly ceased for
April 2 1, 1883.]
THE MEDICAL RECORD.
433
several days. When conducted in this way, Dr. Hache
favors the operation as leading to a more certain and
speedy cure than do the old methods. Since such scru-
pulous attention to minutia; is required to ensure the
success of the procedure, it would seem to be better to
transfer it to the domain of surgery.
TvrHO-MALARiAr, OR Continued Fever. — Dr. R. D.
Webb concludes a paper in the April number of tlie Ame-
rican Journal of the Medical Sciences as follows : " See-
ing, then, that fevers are so closely allied genericaily, and
that even when separated into species, there are striking
resemblances ; that pathological researches do not estab-
lish a constant anatomical lesion, which is pathognomonic
of any one of them ; and that ulceration of Peyer's glands
(claimed as characteristic of typhoid fever) is frequently
found in other diseases, we are justified in claiming that
a continued fever, occurring under circumstances which
point to a miasmatic origin, although it may present
many of the vital phenomena of the typhoid fever, and
occasionally its recognized anatomical lesion, is still
malarial fever. There remains, to his mind, but one
other explanation of these continued fevers, viz., that they
are to be regarded as atypical typhoid fevers, originating
de novo. But, admitting the origin, de novo, of typhoid
fever from animal miasm, and that jjossibly it may have
thus originated in the example he has given, even the
warmest advocate of this view will be unable to bring
those sporadic, isolated cases which occur again and
again in malarial, but otherwise salubrious and healthy
country localities, within the role of such instances as
are claimed as establishing this mode of origin. The
natural conclusion, taking all the facts into consideration,
is that they are malarial fevers of a typhoid form, using
the term typhoid, not in a specific sense, but as indicat-
ing a typhoid condition of the system.
Gastrostomy, OSsophagostomy, and Internal CEso-
PHAGOTOMY. — Operations on the internal organs of the
body have become much more common than they were
formerly, and in recent years the stomach has been very
frequently operated on with the view of counteracting
the effects of oesophageal obstruction. Dr. Morell Mac-
kenzie, in the American Journal of the Medical Sciences
for April, 1883, analyzes the cases of this character which
have been already published, and gives an account of
two new cases. He finds that gastrostomy has been per-
formed 81 times, and that death occurred from sliock in
27 or in 24.6 per cent.
The advantages of gastrostomy are : i, that it can be
carried out with comparative ease ; 2, that there is very
little risk in the steps of the operation itself, especially if
done in two acts separated by a proper interval of time ;
3, that there is almost entire certainty of being able to
effect the object aimed at, which is the establishment of
an alimentary fistula altogether beyond the seat of stric-
ture ; and 4, that the fistula is hidden from sight. The
only disadvantage is that gastrostomy still yields a high
percentage of deaths. Twenty-six cases of cesophagos-
tomy are analyzed ; of these 16 died within a fortnight,
and 7 died from shock.
The advantages claimed for oesophagostomy are ; i,
that it is attended with comparatively little shock ; 2,
that it facilitates subsequent dilatation of the stricture ;
while the disadvantages are that the operation is a very
difficult one, and attended with considerable danger from
its proximity to so many important structures, and there
is great uncertainty in any given case whether the open-
ii^g in the oesophagus can be made below the stricture ;
and finally a discharging fistula in the neck is a conspicu-
ous disfigurement.
Seventeen cases of internal cesophagotomy are ana-
lyzed, and the following advantages claimed for this
operation: i, that it is attended with an inconsiderable
amount of shock ; 2, that if the stricture can be thoroughly
divided, gradual dilatation can be carried out, and a cure
thereby effected ; 3, that the procedure involves no ex-
ternal wound. The disadvantages of cesophagotomy are :
I, that it can only be safely performed in cases where it
is still possible to pass a bougie ; 2, it is often difficult to
pass all the strictures ; 3, in many cases the walls of the
oesophagus are so thickened that limited longitudinal in-
cision does not relieve the obstruction ; 4, the actual
danger in the operation is far from inconsiderable.
The Use of Iodine as a Stomachic Sedative. —
The employment of iodine for the relief of the vomiting
of pregnancy has been somewhat in vogue for a number
of years. And while the success attending its use has
been pointed out with more or less enthusiasm, its exact
value has never been established. Dr. T. T. Gaunt
{American Journal of the Medical Sciences for April,
1883) has for a number of years been employing the com-
pound tincture of iodine in drop doses in nearly all forms
of emesis, and reports thirteen cases of the most varied
character, in all of which vomiting was promptly arrested
by the use of this drug.
Perinephric Abscesses. — Prof. Dr. John B. Rob-
erts {Atnerican Journal of the Medical Sciences, April,
1883) believes that purulent collections in the cellular
and adipose tissue surrounding the kidney are very
properly termed perinephric, or circumrenal, abscesses.
It has recently become somewhat customary to speak of
them as perinephritic abscesses, but Dr. Roberts believes
that perinephric is etymologically the more correct ad-
jective.
The early recognition of the existence of perinephric
abscess, and the determination of its relative position
with regard to the kidney is important, as the prompt-
ness and efficiency of operative treatment must depend
very much upon the early discovery of the exact position
of the abscess. The author arbitrarily divides the peri-
nephric cellulo-fatty tissue into six tracts. The upper,
middle, and lower anterior ; and the upper, middle, and
lower posterior tracts. There is, of course, no sharp defi-
nition between these regions, which are used to con-
veniently indicate the location of the disease.
It may be premised as an axiomatic truth that,
although there may be pains radiating in various direc-
tions, anterior inflammation will give rise to pain especi-
ally m the front or side of the abdomen, posterior lesions
to pain in the loin. Tenderness upon pressure, cedema
over the abscess and pointing will be similarly exhibited.
The swelling, the tumor-like outlines, and the feeling of
resistance to palpation will naturally be the more evi-
dent in anterior lesions because the tissues between the
disease and the surface are flaccid. Involvement of the
chain of sympathetic ganglia, situated along each side of
the spinal column, would occur in posterior lesions
only.
The following tabular statetiient of symptoms is given
to assist in the localization of perinephritis and perine-
phric abscess : —
All anterior regions. — Pain, tenderness, swelling,
oedema, and pointing in front and side of abdomen.
All posterior regions. — Pain, tenderness, swelling,
cedema, and pointing in loin. Upper tracts. — Pleuritic
friction, pleural eft'usion, empyema, expectoration of
pus ; dyspnoea ; suprarenal involvement ; solar plexus
involvement. (On right side.) Bilateral cedema of
legs ; jaundice ; fatty stools ; persistent vomithig ; rapid
emaciation ; ascites. Middle tracts. — Albuminuria and
casts ; suprapubic, scrotal, or vulvar pain or anaes-
thesia; suppression of urine ; unemia ; pus in the urine ;
cedema of scrotum or varicocele (especially on left side).
Lower tracts. — Flexion of hip ; pain or anesthesia of
front, inside or outside of thigh ; retraction of testicle ;
pain at knee ; scrotal or vulvar pain or anassthesia, with-
out accompanying albuminuria; unilateral cedema oi
legs; abscess or sinus near Poupart's ligament; consti-
pation (if left side) ; involvement of chyle receptacle (if
right side).
434
THE MEDICAL RECORD.
[April 21, 1883.
The Germicide Value of Certain Therapeutic
Agents. — Dr. George M. Sternberg, in the American
Journal of the Medical Sciences, April, 1883, has made a
long series of experimental studies as to the germicide
value of certain therapeutic agents on various forms of
bacterial organisms. In his experiments on the micro-
coccus of gonorrhcfial ])us, he found that, in general, those
reagents which destroyed the vitality of the micrococcus
from pus are destructive of other organisms of the same
class ; and their relative value as germicides is not
changed when a different micro-organism is used as the
test of this value. Moreover, the reagents which were
found to be practically valueless as germicides in the
first series of experiments, e.g., ferric sulphate, sodium
sulphite and hyposulphite, boracic acid, etc., proved to
be equally without value when the test was extended to
other micro-organisms of the same class. But the re-
agents found to possess decided germicide power have,
in some cases, a different value for different organisms.
In other words, the vital resistance of different bacterial
organisnrs to the reagents in question is not in all cases
the same. Nevertheless, the comparative germicide value
of the reagents tested is the same for the several test-
organisms, and, allowing certain limits for specitic pecu-
liarities, it is safe to generalize from the experimental
data obtained in the ]iractical use of these reagents as
disinfectants. But it must be remembered that the re-
sisting power of reproductive spores is far greater than
that of bacterial organisms in active growth (multiplica-
tion by fission), and the data obtained for the latter can-
not be extended to include the former. The antiseptic
value of the reagents tested depends upon their power to
prevent the multiplication of putrefactive bacteria, and
this is not necessarily connected with germicide potency.
Disinfection of the Stools in Typhoid Fever. —
The importance of the thorough disinfection of the stools
in typhoid fever is, to those who believe in it at all, so
great, and its practical results in the control of the ex-
tension of the disease are so manifest and direct, that any
I additional data as to the best methods of employing dis-
infection cannot fail to be of interest. On the other
hand, there are quite as many other physicians to whom
the subject appears to have no importance whatever.
These latter either do not believe in the necessity of the
disinfection of enteric fever stools, or else they regard it
as of so slight moment that it matters not practically
whether it be attended to or not, or, finally, whilst pro-
fessing to recognize its importance, they adopt in practice
imperfect or incomplete measures to accomplish it. In-
deed, it may be regarded as the exception to the rule,
rather than the rule, both in private practice and in hos-
pitals, to systematically and thoroughly disinfect every
stool, even in well-characterized cases of typhoid. Both
of these classes of physicians will be interested in a paper
on this subject published by Dr. James C. Wilson, in the
AmericaJi Journal of the Medical Sciences for April, 1883.
He shows that although the nature of the germ that gives
rise to enteric fever is unknown, many facts in its natural
history are established by abundant proof. Of these the
following have a direct bearing upon this subject : i. It
is invariably derived from a previous case of enteric fever.
2. It is eliminated with the fecal discharges. 3. It is not
capable of producing enteric fever at once in susceptible
persons exposed to it, hut must undergo changes outside
the body before it acquires this power. 4. It retains its
activity in favorable situations for a lengthened period,
the requirements to this end being decomposing animal
matter, especially fecal discharges, and moisture. 5. In
such situations it is capable of reproducing itself.
Trigemi.nal Neuralgia Relieved by Ligation of
the Co.m.mon Carotid Artery and Neurectomy. —
Dr. Ferdinand H. Gross publishes in the American
Journal of the Medical Sciences of April, 1883, a con-
densed clinical history, extending over nine years, of a
case of this disease, with an account of the various
remedial measures undertaken for its relief. The result
of the operative treatment may be summarized as fol-
lows : —
First. — The effect of the ligation of the common car-
otid artery was immediate relief in the domain of the
first and second divisions of the trigeininal nerve ; the
period of imnmnity from pain in the second division
being fully two years, while in the first division the pain
has never returned, the relief there being probably per-
manent, and can only be accredited to the carotid liga-
tion. The effect of this operation upon the third
division of the nerve was too transient to count for
anything.
It should be added that no impairment of intellect
has followed the ligation. After the lapse of nearly two
years and a half no disturbance of brain functions has
been noticed either by Dr. Gross or the patient, or by
any of those who are habitually associated with him.
Second. — The first neurectomy of the inferior dental
nerve, eight months later, resulted in a period of relief
from the neuralgia of about one year and three months —
to remain within safe limits.
Third. — The last two operations, viz., the neurectomy
of the superior maxillary and the repetition of the opera-
tion upon the inferior dental nerve, were performed
within two months of each other, September 14th and
November nth. respectively, and may be considered
together. The result thus far is entirely satisfactory, the
patient being now, three months later, completely re-
lieved of the neuralgia.
Syphilis of the Eye and its Appendages. — Dr.
Leartus Conner publishes in the American Journal of
the Medical Sciences for April, 1883, a paper bearing on
this subject, in which the following points are empha-
sized : —
First. — The study of specific ocular diseases is helpful
in the diagnosis of certain obscure cases otherwise diffi-
cult to make out satisfactorily. Thus, a specific iritis
will at once set at rest all doubts as to the origin of a
series of indefinite general symptoms which have an-
noyed the patient and puzzled the doctor.
Second. — The careful attention to these cases is the
only method by which, in many cases, the eyes can be
saved intact during the course of the disease. Surely,
when such attention can save eyesight in some cases,
it is criminal not to give it to every case.
Third. — The study of these lesions calls for the most
searching examination of the entire organism. Especi-
ally is this true of such affections as cannot be dis-
tinguished from like diseases of the eye due to far
different causes. Thus, if the early treatment of a
dacrocystitis be simply local, it is sure to fail if it be of
specific origin. Hence, the only chance to avoid failure
lies in such an examination as will reveal its specific
nature. The same remark applies with even greater
force to many other specific diseases of the eye, as will
be gathered from his brief review. From this it follows
that, in every eye case, the only safe practice is to con-
stantly entertain the possibility of specific infection.
Fourth.- — The treatment of every specific case calls for
constant watchfulness of the eyes with the ophthalmo-
scope, otherwise lesions impossible to repair may be
established before the practitioner is aware of their ex-
istence or of any danger. Perhaps in no class of
troubles is it more apparent that the general and special
knowledge of morbid phenomena need to be constantly
combined in one person. The special practitioner
needs to be a general one, and the general practitioner a
special one.
Holmes on Ricord. — "I think life has not yet done
with the vivacious Ricord, whom I remember calling the
Voltaire of pelvic literature — a skeptic as to the morality
of the race in general, who would have submitted Diana
to treatment with his mineral specifics, and ordered a
course of blue pills for the vestal virgins."
April 21, 1883.]
THE MEDICAL RECORD.
435
The Medical Record:
A Weekly yo2irnal of Medicine and Surgery.
GEORGE F. SHRADY, A.M., M.D., Editor.
Published by
WM. WOOD & Co., Nos. 56 and 58 Lafayette Place.
New York, April 21, 1883.
THE QUININE OF THE POOR.
Under this attractive title Dr. Ugo Bassi describes the
result of his experience with resorcin in the treatment of
intermittent fever. He reports twenty cases in which he
had used this remedy. Of them seventeen were en-
tirely cured ; two of the remainder were old and obsti-
nate quartan types, while the third patient was in very
unfavorable hygienic surroundings. In one case the
symptoms returned and were not removed again either
by resorcin or quinine. It required only two or three
doses of the drug to effect the cure in the successful
cases. The doses given varied between thirty and forty
grains. Larger amounts were not found to do any good.
The peculiar advantage of resorcin in Dr. Bassi's opinion
is its cheapness.
Resorcin is a drug of which much has been written
lately, especially by foreign observers. It was first ob-
tained in 1864 by Hlasiwetz and Earth from galbanum
resin bv fusing it with potassa. It is now best prepared
by fusing potassium benzol-disulphate with caustic potassa.
Resorcin is a substance closely allied chemically and in
its physiological action with phenol, its formula being
CjHjO,, while that of phenol is C^H^O. It is claimed,
however, to be much less poisonous and much more
agreeable in taste and smell.
Among the most recent contributions regarding its
therapeutical uses is an article by Dr. C. Fiirst, of Vi-
enna, upon resorcin as an antipyretic. This physician
states that resorcin was given in more than three hundred
cases of puerperal fever occurring in the service of Pro-
fessor Braun. It was administered in doses of three
grammes (forty grains) dissolved in water, repeated when
necessary. The result was almost without exception to
bring down the temperature nearly to the normal. After
a few hours there was a rise again, so that a dose given,
for example, in the evening had to be repeated in the
morning. The temperature fall was usually accompanied
with profuse perspiration.
Dr. A. Skibnevsky, of Moscow, has used injections of
resorcin in erysipelas with good results. From ten to
twenty injections of the five per cent, solution were given,
with the result of lessening very rapidly the fever and
checking the progress of the disease. In the Deutsche
Medical-Zeitutig, for 1S82, page 347, are recorded similar
favorable results obtained by Dr. Bogusch.
Dr. Justus Andeer, of Wurzburg, has experimented
with resorcin externally applied, and finds that it is not
absorbed by the sound skin. He made a fifty per cent.
vaseline ointment and used it in the treatment of some
cases of anthrax. The ointment was applied to the pus-
tules and covered with a gauze bandage. The results
were remarkably favorable, the pains disappeared and
the diseased parts speedily assumed a healthy appear-
ance. Dr. Andeer also states that the drug does not
cause haemaglobinuria like naphthol, and develops none
of the poisonous symptoms caused by its congener, car-
bolic acid.
THE INFECTIOUS NATURE OF PNEUMONIA.
At a recent meeting of the Berliner Verein fur In-
nere Medicin {Allgem. Med. Central-Zeitung, February
3, 1883), Dr. Leyden exhibited some preparations of
micrococci taken from a patient with pneumonia. They
were obtained by inserting a Pravaz syringe into the
hepatized portion of the lung, and were prepared by the
dry method and stained with methylene blue. The para-
sites were of an oval shape, usually in pairs, but sometimes
united in a chain of three or four links. The patient
died, and an autopsy was made six hours after death. As
soon as possible portions of the inflamed lung-tissue were
removed and placed under a Hartnack immersion lens,
without staining. The micrococci were readily perceived.
In stained preparations the parasites were seen to be
most numerous in the portions of red hepatization, but
much more scanty in the parts which had passed into the
condition of gray hepatization. Dr. Leyden stated that
he had withdrawn blood from the diseased portion of
lung in two other cases of pneumonia, but without re-
sult. He explained the absence of micrococci in these
cases by the fact that the disease was^in both instances
in the stage of resolution, and hence it was to be ex-
pected that th_' parasites should have been absent, or
present^ in__|very smalllfnumbers. The^speaker gave to
Klebs the credit of having first describedjhese organ-
isms in 1875. His article, however, attracted but little
attention at the time, owing perhaps to the fact that his
investigations were apparently not conducted with effi-
cient exactitude.
THE ETHICAL CRISIS.
There is little doubt that the activity displayed by those
holding diverse views regarding the question of ethics is
leading many who heretofore have given little thought to
the matter to begin a careful examination of the subject
for themselves. A series of commentaries by Dr. Austin
Flint on the Code of the American Medical Association
are in process of publication in the columns of our valued
contemporary the New York Medical Journal. In his
remarks concerning the portion of the Code that re-
lates to consultations. Dr. Flint claims that the "exclu-
sive dogma " clause of the Code was directed not so much
against the homoeopaths, as against the steam doctors,
or Thomsonians, etc. He further claims that the .-Vmeri-
can Code was not intended " to interfere with the practice
of medicine, under any circumstances, in the],cause of
humanity." He says that " the restrictions of the Code
are in nowise inconsistent with the demands of humanity
in cases of emergency." This view of the case is cer-
tainly a novel one, and one that, so far^as we are aware,
has never been taken by any of the organized bodies that
436
THE MEDICAL RECORD.
[April 2 1, 1883.
have heretofore accepted this Code. If this is the correct
view, it is greatly to be regretted that Dr. Flint had not
brought it to the notice of the profession at an earlier
date. Curiously enough he goes on to say that " a prac-
tice based on an e.xclusive dogma " is not a proper ground
on which to refuse to " meet practitioners in consulta-
tion." " Any physician has a right either to originate
or adopt an exclusive dogma, however irrational or ab-
surd it may be." Dr. Flint hopes that the American
Medical Association will adopt such modifications in the
phraseology of this section as will place restrictions on
consultations, not on the ground of doctrines or forms
of belief, but on separation from and avowed antagonism
to the medical profession." If Dr. Flint would person-
ally urge this matter on the attention of the Association
at its approaching meeting, we have little doubt that
much could be effected in the way of restoring harmony
in the profession. .\ much better and lasting solution
of the question, however, would be arrived at if the As-
sociation itself would rescind all formal codes, and sim-
ply urge the profession to establish such ethical regula-
tions as local circumstances might render most expedi-
ent. If the American Medical Association would for the
future strictly confine its deliberations to the considera-
tion of purely scientific matters, science would be the
gainer and propriety would lose nothing.
CAN A FCETUS BE POISONED WITH ALCOHOL THROUGH
THE BLOOD OF THE MOTHER?
We have received from Dr. Willianr A. McDonald, of
Lynn, Mass., some interesting testimony bearing upon
the question of the effect upon the fcetus of alcohol
taken by the mother. It appears that Dr. McDonald
was called upon to deliver a woman who had been drink-
ing for some ten hours, and who, when labor began, was
profoundly into.xicated. The child was large, weighing
about twelve pounds, and the pelvis small. Forceps had to
be resorted to. The infant lived for only three hours, and
died, it is believed by our correspondent, from alcoholic
poisoning. The use of the forceps and the death of the
child were made the pretext by a Catholic priest for
circulating stories against Dr. McDonald's professional
skill and moral character. A suit was brought. Four
local physicians testified for the defendant and all agreed,
as Dr. McDonald writes, that "There is no quantity of
alcoholic stimulants taken into the mother's system that
can in any way affect her unborn child, or affect it after
it is born. That the perineum is never lacerated by the
passage of the child's shoulders in parturition, and that
forceps, when properly applied to the child's head in de-
livery, cannot slip under any applied degree of traction,
however great."
It is regarding the first point that we are furnished
some interesting testimony. Tlie following inquiry was
sent to Drs. John C. Dalton and William B. Carpenter :
" If during the progress of labor, and at the moment of
delivery, the mother is deeply intoxicated from the ex-
cessive use of alcoholic stimulants, would the new-born
infant suffer in consequence, or show any symptoms of
alcoholic poisoning ? "
To this Dr. Dalton replied : " I would say that if the
mother were deeply intoxicated at the beginning of
labor, I should not be surprised to find the new-born in-
fant affected in consequence. As the fcetus derives its
nourishment, by absorption through the placenta, from
the blood of the mother, I see no improbability in alco-
holic substances being absorbed by the same channel, so
long as the placenta is adherent, and the placental circu-
lation going on."
Dr. W. B. Carpenter answered : " I c.innot profess to
speak with any authority upon the question you have
submitted to me, for I am not aware of any experiments
(such as have been made with other poisons) on the
passage of alcohol from the maternal to the foetal blood.
I can only say that as there can be no question of alcohol
received into the alimentary canal being taken into the
circulation by transudation through the walls of the blood-
vessels of the intestinal villi, there seems every proba-
bility of its passage from the maternal blood, through the
placental villi, into the foetal circulation. Though I can
see no reason why such passage should take place more
actively during parturition than at any other time, I can
suppose it to have a much more pernicious effect. For up
to the detachment of the placenta, the fcetus is not only
deriving nutrimtnt from the maternal blood, but is de-
pendent upon the placental circulation for the small
amount of aeration which it requires to sustam its intra-
uterine life. As soon, however, as the child comes into
the world, active muscular movement begins, and atmos-
pheric respiration is required to sustain it. The first in-
spiration, as you are doubtless well aware, is a reflex act,
performed through the instrumentality of the nervous
system. .\\\A it seems to me not only possible, but
probable, that blood-poisoning of the foetus by alcoholic
intoxication of the mother during parturition, may so
torpify the respiratory centres of the infant that the or-
dinary inspiratory movement may not be excitable, and
the child be ' still-born.' You do not say whether this was
the condition of the infant in the case to which you re-
fer. Supposing it to have been so, my opinion would be
that while there is strong ground for believing the death
of the child to have taken place through the mother's
fault, there would 7iot be an adequate basis for a criminal
charge against her."
Dr. Carpenter subsequently submitted his views to Dr.
B. W. Richardson, who corroborated them entirely.
Despite the opinions of the above eminent savants, we
must consider it, in the lack of positive facts, extremely
improbable, if not entirel)' impossible, that the foetus
should be fatally poisoned by alcohol through the blood
of the mother. Alcohol is rapidly eliminated from the
mother's system, and no great amount can exist in the
blood at a time. On the other hand the fatally poisonous
dose of alcohol is considerable. There is little doubt that
the foetus could be affected somewhat, but this needs to
be better proved. The question deserves further study.
THE PATHOLOGY OF INTESTINAL SYPHILIS.
Syphilitic lesions of the intestines are, according to
Kundrat, very seldom met with in adults, being more
commonly found among the manifestations of hereditary
syphilis. Yet even here they are comparatively rare,
Kundrat and Marzek having seen but nine instances
among two hundred cases of infantile syphilis. In all
April 21, 1883.]
THE MEDICAL RECORD.
437
of these cases S)'philis of other organs was also present.
The small intestine appears to be oftener attacked tlian
the large, in the proportion of about four to one. Two
varieties of the affection present themselves. In the
first the process is essentially localized, and is confined
usually to Peyer's patches and the solitary follicles. In
the second the disease attacks the entire circmnfereiice
of tlie canal. The nnicous membrane presents a velvety
appearance, and about Peyer's patches is of a dark red
color. Little pits are seen in the surface of tiie patches,
giving a cribriform appearance to the part. In the sec-
ond form little nodules are scattered over the inner svn-
face of the intestines, of the size of a hemp-seed, ur
smaller. The meconium is thickened and adlierent to
the wall of the intestine. The peritoneum is usually uf a
pale red color and presents numerous points of syphilitic
growth about the vessels. In more severe cases there is
a fibrinous exudation covering the peritoneum.
A diagnosis of this variety of visceral syphilis is evi-
dently a matter of some practical importance. Bat it is
not always possible to make it. As regards the treatment
of luetic affections of the alimentary canal, the same
general principles which govern all cases of congenital
syphilis are applicable to this class of .cases.
PATHOLOGICAL SLEEP.
Over a year ago, M. Gelineau described a peculiar
symptom which he called narcolepsy, and which con-
sisted in an abnormal tendency to sleep. The subject
excited some interest, and recently M. Gilbert Ballet
has contributed several cases, having the same features.
The narcolepsy of Gelineau and Ballet, however, is a
different thing from the sleeping sickness of Atrica,
which is apparently a specific and generally fatal en-
demic disease. Narcolepsy, or pathological tendency to
sleep, is a symptom of several different morbid condi-
tions. Ballet classifies them under four heads, viz.: i. In
a certain number of cases the morbid contlition is
not known. It can only be assumed that the metabolic
changes in the brain-tissues are modified, the retrograde
process being perhaps too active, or the constructive
action too feeble. 2. This condition certainly appears
to exist in diabetics, a class in. which excessive somno-
lence sometimes develops. 3. Narcolepsy is observed
in connection with various organic diseases, which dis-
eases are related in some way to the sleep-symptom.
Camusat has observed it in a patient with heart disease ;
Bouland, in a case of hepatic congestion ; Gelineau, in
a case of chronic dyspepsia. In these instances there
seemed to be a condition of cerebral congestion. 4. Cer-
tain hysterical persons will at times be aftected with
narcolepsy or attacks of spontaneous sleep. Some of
the cases reported as of this nature are rather examjiles
of trance lethargy.
The symptoms of this condition are generally simple.
The patient sleeps all night, and is awakened with diffi-
culty. During the day he is frequently overcome with
an invincible drowsiness ; he dozes at his meals, anil falls
to sleep after them ; he sleeps in the cars, or stages, or
whenever he sits down to rest. The appetite may be
good and all the bodily functions normal.
Some benefit has been done by treating any coinci-
dent disease that may be present and by hydrotherapy.
THE HOLMES DINNER.
The profession of the city can congratulate itself upon
having so happily conceived and successfully carried out
the project of tendering Dr. Holmes a complimentary
dinner. It is but once in a century that the medical
profession raises up to literature an equal to our Boston
guest. Since the days of Goldsmith, medicine has had
many singers ; Akenside has written his beautiful pas-
torals, Armstrong his robust and prophylactic epic, and
Darwin his botanic philosophy and his episodes in vege-
table loves. We would claim Keats, if it were fair to do
so. Mr. Cieorge William Curtis fitly reminded us that
New York has had a doctor-poet in Nathan Drake, of
whom we may be justly proud. We would be glad to
think, as many do, that the late Dr. Holland was some-
times touched with the divine afflatus.
But although the list of the last hundred years is not
so very short, it contains no name which can justly rank
with that of our Boston anatomist, autocrat, and poet.
It is most creditable, therefore, to the profession here
that it has shown its appreciation so handsomely and en-
thusiastically.
The guests of the evening appear to have been satis-
factorily entertained in every way. Dr. Holmes's poem
discovered the pleasant fact that he has lost none of his
old inspiration ; but that, even under the ribs of seventy
he can kindle a flame as w-arm and brilliant as in his
younger days. The poem w'as received with an applause
and enthusiasm such as is rarely disi)layed by our digni-
fied Faculty.
;iUnii5 of the ^tUccU.
Fiftieth Annual Meeting of the Tennessee State
Medical Society. — The Tennessee State Medical So-
ciety met at Nashville, April loth, nth, and 12th, the
President, Dr. W. F. Glenn, presiding. About seventy
members were present. Dr. Deering J. Roberts, Chair-
man of the Committee on Arrangements, delivered a stir-
ring address of welcome, defending the Society against
the charge that it was a decrepit institution.
The President's annual address was devoted to the sub-
ject of the " Immortality of Man," arguing eloquently for
the reality of such immortality.
Dr. J. S. Nowlin read a paper upon " Vaccination and
Small-Pox." It presented strongly the facts demonstrat-
ing the value of vaccination. He thought that special
care and skill was required for the preparation of bovine
virus. At the close of his paper the Society passed the
following resolutions :
Resolved, That this Society does recommend and ask
the State Board of Health to immediately institute such
measures as will at the earliest possible moment secure
a law requiring the vaccination of every infant born in
this jurisdiction.
The resident physicians of Nashville gave their visitors
a dinner Wednesday evening.
The following officers were elected for the ensuing
year : President — Dr. A. B. Tadlock, of Knoxville (who
said he would rather hold that office than be a Congress-
man) ; Vue-Prestdents — Dr. A. Morrison, of Nashville ;
438
THE MEDICAL RECORD.
[April 21, 1883.
Dr. W. W. Taylor, Dr. C. S. Wright ; Secretary— T)r. C.
C. File ; Treasurer — Dr. D. J. Roberts.
Papers were read by Dr. Tadlock, on " Femoral Her-
nia; "by Dr. G. W. Davis, on" Induced Abortion." Dr.
Grant opened a discussion on puerperal fever ; Dr. J.
G. Sinclair showed a case of burn of the eye ; Dr. W. D.
Haggard read by title a paper on " Ovarian Disease,"
and Dr. S. Lipscomb related some interesting historical
reminiscences.
So far as our reports inform us, the Medical Society
of the great State of Tennessee during the parturient
stress of a two days' session, gave birth to only three
written contributions to medical science.
We agree with the late President that man is probably
immortal, but we feel less confident as regards the Ten-
nessee State Medical Society. Deo volente, it will meet
next year at Chattanooga, on the second Tuesday in
April.
The Kentucky St.\te Medical Societv. — The
scientific work of the first day consisted of a report upon
" Materia Medica," by Dr. T. J. Greely, and one on " Sur-
gery," by Dr.W. M. Fuqua. During the second day, papers
were read on ''Obstetrics," by Dr. P. B. Scott, and on
" Hygiene," by Dr. Speed. Dr. J. N. McCorinack read a
report on " Local Boards of Health," which opened a very
lively discussion upon the subject of the State Board of
Health. Dr. Holland defended it ; Dr. Yandell attacked
it, and stated that in five years it had received §12,500 in
cash, without making any real return.
Tiie following officers were elected : President — Dr. J.
N. McCormack, of Bowling Green; Vice-Presidents — Drs.
J. M. Riffe and G. M. Harwood ; Secretary— T)x. S. M.
Letcher; Treasurer — Dr. H. Brown. Dr. L. S. McMurtry
tendered his resignation as Permanent Secretary.
Papers were read by Dr. Thomas F. Rumbold, on
"Chronic Naso-Pharyngeal Catarrh;" by Dr. W. O.
Roberts, on " Head Injuries ; '' by Dr. J. M. Matthews,
on " Diseases of the Rectum."
The Committee on Prize Essays reported that no essay
had been reported for them.
On the last day seven papers were read upon various
topics.
The Society adjourned to meet next year at Bowling
Green, the first Wednesday in May.
A Medical School for Women at Toronto is talked
of, co-education having failed.
The Ontario Medical Association meets in To-
ronto the first Wednesday in June. The Secretary, Dr.
White, is trying to arrange for an exhibition of patho-
logical specimens at the time.
Scarlet Fever from Oysters. — Dr. Fred. Eklund,
of Stockholm, says that in tlie juice and parenchyma of
oysters he has found two kinds of micro organisms in
great number. One of these, the plax scirideris, is, we
are informed, the determinate cause of scarlet fever.
St. Paul is to have a Hcaltii Officer, says the iVorth-
western Lancet ; and no doubt the old gentleman needs
a little attention, being now in his ninetcentli century.
An P>idemic of Influenza is prevailing at St. Paul,
Minn. It appeared about January ist and has been
steadily increasing in severity.
The (Georgia State Medical Association holds its
annual meeting at Athens, April i8th, 19th, and 20th.
The Journal of Nervous and Mental Diseases.
— The January number of this journal contains a steel
portrait of the late Dr. George M. Beard, with an appre-
ciative notice of that lamented neurologist.
The Journal of Nervous and Mental Diseases has
been ably and successfully conducted since it was re-
moved to New York and placed under the editorship of
Dr. Morton. It most creditably represents neurological
science in this country.
Physiological Investigation. — Dr. McKendrick,
Professor of Physiology in the University of Glasgow, and
Fullerian Professor of Physiology to the Royal Institution
of Great Britain, will give at the Institution a course of
ten lectures on Physiological Discovery, being a retro-
spect, historical, biographical, and critical, of the subject.
The object of the course of lectures is to trace the prog-
ress of physiological research from about the beginning
of the sixteenth century to recent times, and more espe-
cially along those lines that have led to great results.
The Missouri State Board of Health, recently es-
tablished by legislative enactment, is to be composed of
seven persons, to be appointed by the Governor and con-
firmed by the Senate. Five of the Board are to be phy-
sicians in good standing, graduates of reputable medical
schools. No special school is designated. The Board is
to exercise general supervision over the health of the
State, but not over the private practice of physicians.
Ten thousand dollars are appropriated to meet expenses.
A Law to Regulate the Practice of Medicine
in Missouri has recently been enacted. It requires every
person practising medicine and surgery to register his
diploma with the Board of Health. If the diploma is
genuine and issued by a reputable school of medicine, the
Board issues its certificate upon the payment of a fee of
one dollar ; said certificate entitles the lawful holder
thereof to practise medicine. If not a graduate, and
practising medicine in the State for a term of less than
five years, he shall submit to an examination as to his
qualifications. If his examination proves satisfactory to
the Board, upon the payment of a fee of five dollars the
said Board shall issue its ceitificate in accordance with
the facts, and such shall entitle the lawful holder to all
the rights and privileges. If a diploma is found to be
fraudulent, or not lawfully owned by the possessor, the
Board shall be entitled to charge and collect twenty dol-
lars from the applicant presenting it. It appears to us
that the law will be found a most inefficient one. It will
legalize all the five-year quacks, and it contains appar-
ently no machinery for carrying out its provisions.
An Affectionate Daughter. — It is said that Mile.
Bernard, the daughter of Claude Bernard, has been fined
at Boulogne-sur-Seine, on complaint of her neighbors,
for converting her courtyard, garden, parlor, and bed-
room, into a kennel for destitute dogs. She felt some
reparation was due the canine race for the miseries in-
flicted on it by her father's vivisections.
Dr. James B. Bairu has retired from the editorship of
the Atlanta Medical Register. He will be succeeded by
Dr. John H. Logan.
April 21, 1883.]
THE MEDICAL RECORD.
439
New Field for Women Physicians. — The Russian
journals state that General Tchernieflf is about to estab-
lish a hospital for Mussulman women at Tashkend. It is
to be presided over entirely by Russian female physicians.
The Pathogenic Micrococcus of Erysipelas. — The
existence of micrococci in erysipelas has long been
known. Dr. Fehleisen, Bergmann's assistant, now an-
nounces that they are positively the cause of the disease.
He has isolated them, cultivated them on gelatine through
fourteen generations. He then inoculated rabbits, and
also men, with the pure organisms and produced in most
cases a typical erysipelas. The inoculations were made
in seven patients who were suffering from lupus, cancer,
and sarcoma. One case of lupus was almost completely
cured, in another case the cancerous tumors disappeared,
in another of fibro-sarcoma the tumor diminished in size.
In the other four cases no especial effect on the tumors
was noticed.
Newport Medical Society. — At the Annual Meet-
ing of the Newport Medical Society, held April 3, 1883,
the following officers were elected : President — Dr. H. R.
Storer ; Vice-President — Dr. Samuel W. Francis ; Secre-
tary— Dr. W. D. McKim ; Treasurer — Dr. William C.
Rives ; Librarian — Dr. C. L. Fisher ; Curator — Dr. S.
H. Sears.
The National Academy of Sciences held its Annual
Meeting, during the present week, at Washington, D. C.
The Turn of the Tide : The Kings County
Medical Society on the side of the New Code. — ■
The Medical Society of the County of Kings held its
regular meeting April 17th. The question of action
upon the new Code of Ethics came up. The resolutions
offered by Drs. E. R. Squibb and Kretschmar were dis-
posed of by laying the whole matter on the table, by a
vote of 54 to 35. It was then moved that, in the opin-
ion of the Society, it is inexpedient to discuss this gen-
eral Code question further for the current year. This
motion was carried by a vote of about 48 to 35. The
action of the Society was a decided victory for the new
Code. The vote to refrain from further discussion of
the subject during the current year will strike all as a
very sensible act.
Columbia Veterinary College and School of
Comparative Medicine. — Dr. Alexander Hadden has
purchased a new site and buildings for the Columbia
Veterinary College and School of Comparative Medicine
at 215 and 217 East Thirty-sixth Street. A new hospital
will at once be erected and the buildings will be en-
larged and improved. The college has been growing so
rapidly that the old buildings were quite insufficient for
the proper accommodation of the students. The Cohun-
bia Veterinary College has been the centre of much
good work in comparative pathology and physiology, and
its present prosperity is amply deserved.
A Doctor Expelled. — Dr. E. L. R. Thompson,
charged with causing abortion, was expelled last Monday
from the New Haven Medical Association.
Death of Dr. William Farr. — Dr. William Farr,
F.R.S.,D.C.L., Superintendent of the Statistical Depart-
ment of the Registrar-General's Office, Somerset House,
which he organized in 1838, died April i6th. He was
born at Kenley, Shropshire, in 1807, and received his
medical education in the universities of Paris and London.
He was for a time editor of the Medical Annual and
British Annals of Medicine, and was a frequent and a
learned contributor to medical literature. He assisted in
taking the census of 1851,, 1861, and 1S71 in Great Brit-
ain, and wrote a considerable portion of the reports of
the first two years named. He wrote the annual official
reports on the public health, and among his best known
works were " The Finance of Life Assurance," " English
Life Tables, with Values of Annuities and Premiums for
Single and Joint Lives," a new " Statistical Nosology,"
and a report on the "Cholera Epidemic of 1849." ^^
was chosen a corresponding member of the French In-
stitute in May, 1872. Dr. Farr was one of the pioneers
in state medicine.
The Proceedings of the Naval Medical Society
are published in the form of a neatly printed monthly.
So far, the society has evidently done excellent work.
An International Congress of Colonial Physi-
cians will be held at Amsterdam, September 6, 7, and
8, 1883, during the International Colonial Exposition
which is to be held at that time. Professor Stockvis is
chairman of the Committee of Organization ; Dr. Van
Leent, Secretary-General. Questions of special interest
to physicians living in the colonies, and tropical climates
will be discussed.
Stricker, Spina, and the Tubercle Bacillus. —
At a recent meeting of the Medical Society of Vienna,
Professor Stricker stated that though he had not followed
Spina's work in detail, he believed in its trustworthiness.
He thought that Spina had shown that some bacteria of
putrefaction can be colored in the same way as the so-
called tubercle bacillus.
Our Dental Brethren on both sides of the water are
becoming a very pushing class. Not long ago several
Parisian dentists offered to do dental work free in the
municipal hospitals. The Municipal Council, politely
refusing this over-liberal offer, reminded the petitioners
that it was a principle of true democracy that every man
should be paid for his work. New York dentists vent
their surplus activities in other ways. A firm in this city,
for example, have a large show-window containing a wax
figure with moving jaws and a hysterical smile. Above
it is the legend : " Acher, Puller, & Filer, French
Dentists. No charge for extracting teeth. Come in and
have one drawn. Rubber sets, $1 to $5."
Drug- Store Tippling. — The Liquor League at Indian-
apolis, Ind., has inaugurated a movement looking to the
suppression of dram-drinking in drug-stores, as it has
grown to such proportions as to interfere with the reg-
ular retail business. It is said much testimony has been
taken, and an effort will be made to compel drug-stores
at which liquor is sold in less quantities than a quart to
take out a State license.
The Night Medical Service of Paris. — In 1882
there were 6,891 visits against 5,282 in 1879, and 3,613
in 1876, the year in which it was first started. The
service contains 658 physicians and 185 sages-femmes.
44°
THE MEDICAL RECORD.
[April 2 1, 1883.
Women Physicians in Austria.— iA young woman
of Prague, who had received a medical degree from the
Universit}' of Zurich, asked permission of the Minister
of PiibHc Instruction to have her diploma recognized
and to be admitted to the examinations of the Vienna
Faculty. This permission was denied, the minister al-
leging that the practice of medicine by women is not
permitted in Austria.
Sanitary Statistics wanted in Italy. — The Ital-
ian Government has asked for an interchange of vital and
sanitary statistics with the Board of Health of this city.
iUnncius and iUiticca
Transactions of the Medical Society of the State
OF -Pennsylvania at its Thirty-Third Annual Session,
held at Titusville, May 10, 11, and 12, 1882. Vol.
xiv. Philadelphia : Times Printing House. 1882.
On opening this volume, we were agreeably surprised
by the marked improvement in paper and type which it
presents over the previous annual reports of the Society.
Of the papers contained in it, the following deserve
mention : " Address *in Obstetrics,'' by R. Stansbury
Sutton, M.D., of Pittsburg, giving a good bird's-eye
view of the present state of abdominal and pelvic sur-
gery on the continent of Europe ; but not containing a
word about obstetrics ; " Reflections of Criminal Lu-
nacy, with Remarks on the Case of Guiteau,'' by C. K.
Mills, of Philadelphia; "The Oleates and Oleo-Palmi-
tates in Skin Diseases,' by John V. Shoemaker, of
Philadelphia; "A Comparative Study of the Action of
Certain Mydriatic Alkaloids," by Edward Jackson, M.D.,
of West Chester ; " On Sympathetic Irritation and
Sympathetic Ophthalmia," by W. S. Little, M.D., of
Philadelphia; "Powdered Boracic Acid in the Treat-
ment of Otorrhcea," by C. S. Turnbull, M.D., of Phila-
delphia ; " Excision of Cartilage in Nasal Obstruction
due to Deviated Septum," by John B. Roberts, of Phila-
delphia.
Injuries of the Spinal Cord, without Apparent
Mechanical Lesion and Nervous Shock, in their
Surgical AND Medico-Legal Aspects. By Herbert
•W. Page, M.A., M.C. Cantab. Philadelphia: P.
Blakiston, Son & Co. 1S83. $4.00.
Mr. Page devotes the first two chapters of his book to
the discussion of concussion of the spine. He combats
the generally received view that the spinal cord is sub-
ject to serious disturbances or suspension of function
from blows which shake it, but do not cause mechanical
injury. The spinal cord, he says, is the best protected
organ in the body, and is not affected by concussion,
as is the brain. In Mr. Page's opinion, the clinical
symptoms generally classed under this head of " con-
cussion of the spine," are due to nervous shock, united
often with sprains or other injuries of the muscles and
ligaments of the spine. Those symptoms of functional
disturbance of the cord wiiich are objective and can be
demonstrated are, he thinks, due to hemorrhages and
mechanical lesions. They are not brought on by a sim-
))le shaking of the cord. The author particularly attacks
Mr. Erichscn for his too easy acceptance of the concus-
.sion theory.
The nature and symptoms of shock are described
very well, from a surgical point of view. The author in-
sists upon the larger imijortance of this physical element
in the disturbances from railway injuries.
There is a chapter upon functional or neuro-mimetic
disorders which is interesting, although chiefly a compi-
lation from others — a too prominent feature in the book.
The chapter on malingering is more original and better
written.
A very useful appendix containing the tabulated his-
tories of two hundred and thirty-four cases is added.
The author states in his preface that although sur-
geon to a railway company, he is not biassed in his
views. Mr. Page, no doubt believes this ; but it strikes
us that the general tone of the book and the discussions
in it are decidedly favorable to railway companies, and
that it would be an excellent thing for them, from a
business point of view, to see that it is well circulated.
We say this, while believing that the author is right in
his view as to the importance of nervous shock, and the
physical element in railroad injuries. He has undoubt-
edly shown also that functional disturbance of the spinal
cord from concussion is rarer than has been supposed.
That it can, and does occur, however, we must still be-
lieve.
The book should be examined by all physicians who
have to deal with the class of cases treated of.
The Diseases of the Prostate, their P.-\thology
and Tre.atment. By Sir Henry Thompson. Fifth
London Edition. Philadelphia : P. Blakiston, Son &
Co. 18S3.
The present fifth edition of Thompson's well-known
treatise has been carefully revised, and, by many new
additions, has been brought fully up to date. It may be
consulted with profit by student and practitioner, as it em-
bodies the ample experience of a careful observer and
the mature judgment of a sound mind.
Suprapubic Lithotomy. By William Tod Helmuth,
M.D., New York. Illustrated. 4to, pp. 93. New
York : Boericke & Tafel. 18S2.
This volume is a \)lea iji behalf of the high operation
for stone or epicystotomy, on the grounds of its easy
performance and comiiarative freedom from danger.
Dr. Helnnith presents his case strongly, and his work
may be instrumental in restoring to professional favor a
method of cystotomy now but rarely resorted to in
calculous affections. With commendable diligence the
author has collected statistical data concerning the vari-
ous methods of lithotomv. From these it would appear
that the high operation is followed by the smallest mor-
tality. Helmuth's work deserves to be read and studied
by all who are interested in this department of surgery.
The mechanical execution of the volume is satisfactory,
the paper, type, and illustrations being unusually good.
Formul/E for Hypodermic Injection of Caffein.
— Dr. C. Tauret, of Paris, Laureate of the Institute of
France, etc., writes us : "I have read in The Medical
Record of January 6th, the resume of my researches on
caffein. I seize this opportunity to give you below the
exact formuhe that I use for ten hypodermic injections
of caffein. First :
]J Benzoate of soda 3 grm. 60 •
Caffein 3 " 00
Distilled w^ater, about S " 4°
or a sufficient quantity to get ten cubic cen-
timetres.
One cubic centimetre of that solution contains thirty
centigrannnes of caffein. Second :
IJ Benzoate of soda 2 grm. 95
Caffein 2 " 50
Distilled water, about 6 " 00
or a sufficient quantity to get ten cubic cen-
centimetres.
One cubic centimetre of that solution contains twenty-
five centigrammes of caffein."
Two other formuL-e are given, but the interest in them
is chieflv pharmaceutical.
April 2 1, 1883. J
THE MEDICAL RECORD.
441
^Icpovts of Societies.
NEW YORK PATHOLOGICAL SOCIETY.
Stated Meeting, March 28, 1883.
George F. Shrady, M.D., President, in the Chair.
CHRONIC HYDROCEPHALUS %VITHOUT ENLARGEMENT OF
THE SKULL.
Dr. Beverley Livingston presented a skull and brain
with the folloning histoiy:
"James 15 , born in the United States, aged two
years and seven months, was admitted to the Nursery and
Child's Hospital on February 16, 1883, with his mother,
who stated that she was twenty-three years old, had been
married three years ; that she was one of twins, the first
one, also a girl, was born dead, that she was paralyzed
on the left side after birth, but recovered, with the result
that her left leg is at present smaller and two inches
shorter than the right, so she has to walk on the toes of
her left foot. The jiatient, her first child, was born nat-
urally, nine months after marriage. The father is a healthy
man ; neither parents show any signs of syphilis. Until
three or four months old the child seemed healthy, then
he was taken sick, but how I could not discover, only
that the doctor said he had water on the brain ; his mother
says he has always been a restless child, who did not sleep
well and would have "spells of crying;" he never had
any convulsions, but was very dull ; he grew like any
other child, cut his first teeth when he was about one year
old, and he has never had any other nourishment than
his mother's milk. The mother at present is a jiale,
an;emic, poorly nourished woman, and her milk may not
have been good, but her second child, now seven months
old, born when this one was two )-ears old, has the ap-
pearance of a strong healthy baby. The mother cannot
say definitely when she first noticed that this child was
blind, but assures me that she always thought his eyes
were queer ; his hearing seems normal, his bowels have
been regular, and his urine normal.
"When admitted the child was 76.7octm. (2 feet 7 Inches)
in length, symmetrically developed. The head was only
of the average size, being 44 ctm. in circumference, 15
ctm. in the antero-posterior diameter, and 10.75 ctm. in
the biparietal ; the only abnormal point was that the
anterior fontanel was open and would admit the end of
the finger. The face was well formed and perfectly syui-
inetncal ; the expression was vacant, for the eyes were
widely open and the eyeballs wandered aimlessly here
and there, the pupils being partially contracted, but equal ;
they would not respond to light or other stimulant, there
was no strabismus or the usual rolling of the eyes down-
ward ; he was totally blind. The bridge of his nose
seemed flattened, and he was said to have suftered from the
snuffles. The mouth was regularly formed but the child
kept it half open most of the time with his tongue more
or less between the lips and in constant motion. The
teeth, particularly the four upper and the two lower
middle incisors, are notched. This change is, even in the
first dentition, attributed to syphilis by Parrot,' of Paris,
and others, but Mr. J. Hutchinson,' in his remarks to the
last International Congress in London, says they are
caused by stomatitis, either mercurial or not.
"The way in which the teeth meet is peculiar, both
molars coming in contact, while generally only the first
molars strike when the jaws are closed naturally ; during
life the teeth did not project much from the gums. The
hair was well developed. When quiet, the child's limbs
were extended, the hands and feet being flexed, but the
spasm of the muscles was only partial, for at times the
child would kick and move on the bed like one that was
healthy. The tendo-reflex was present at the knee and
1 Trans. International Congress, London, 1881, vol. iv., p. 35.
^ Loc. cit., p. 146.
in the abdominal muscles, but absent in the dartos. The
physical examination was negative, the ophthalmoscopic
was not made. When admitted the child was weaned and
put on bread and milk with 3 j. of Mardock's food t.i.d. ;
he seemed to do well until February 28th, when he had a
slio-ht dry cough. The physical examination gave nothing,
he lost his appetite, which had been very good before,
and died suddenly on March 2d. He had no convulsions
or other symptoms. He had never walked or made the
slightest effort to say anything.
"The autopsy was made on March 3d, 10 a.m., eleven
hours after death. Child fairly nourished ; well marked
rigor mortis. Lungs were congested in the posterior part
of the upper and lower lobes ; toward the central portion
were regions that were rather harder than the rest of
the lung substance, and seemed to be commencing
catarrhal pneumonia. Heart, liver, spleen, kidneys, in-
testines, normal.
" Head, as has already been said, was not enlarged, the
open fontanel being the only abnormality. When the
calvarium was opened a gush of light yellow fluid followed,
and what could be collected measured 350 grammes (11^
ounces); quite a little was lost. Before the brain was re-
moved the hemispheres were seen to collapse. The me-
ninges were congested and the convolutions flattened. On
section the brain-substance was rather pale and the gray
seemed to be normal, while the white substance was de-
creased, due to the expansion and pressure of the fluid in
the lateral ventricles. The thickness of the cortical sub-
stance varied between i to 1.50 ctm. The ventricles \vere
evenly dilated, their lining membrane very much thick-
ened ; the third ventricle was dilated and the various
canals leading in and out of it were much dilated, viz.,
the two foramina of Monro, the aqueduct of Sylvius,
and the iter ad infundibulum, and when the spinal cord
was removed the fluid was found increased.
" On examination of the base of the brain I found
the blood-vessels normal and all the cranial nerves
seemed of normal size and consistence except the optic
nerves, which were smaller and harder than normal and
when the eyes were removed the disk was found to be
I nun. in, diameter and very white, the other structures
of the eye were normal.
"The bones of the skull showed nothing of note that
has not been mentioned. The orbital plates of the
frontal bone are seen to be depressed and the opening of
the orbit is increased in the perpendicular diameter, die
base of the skull shows the basilar portion of the occipital
bone. Internally the skull shows the marks of the
convolutions and the arteries, in some places being quite
thin ; the ossification was normal here as well as in the
long bones."
enlarged THYMUS GLAND.
Dr. Livingston also presented a thymus gland which
was removed from the body of a child one year five
months and fourteen days old, that died March 26, 1883.
The mother stated that the child had had " fits " for
some time, but had always come out of them on being
patted uiion the back. The nurse said the child had
convulsions when looked at by anybody. On the day
before death slight stridor was noticed in the respiration.
The child died in one of the " fits."
At the autopsy the body was well nourished ; rigor
mortis fairly marked. The thymus gland was enlarged
equally in all directions, hard to the touch, and weighed
twenty-five grammes. (For comparison the thymus from
the body of another child, one year and six months of
age, and weighing three grammes, was presented.) The
lungs were intensely congested and there was consider-
able bronchitis. The larynx and trachea were congested,
but contained no false membrane. The heart, liver, and
spleen were normal. The kidneys were intensely con-
gested. The peritoneal cavity contained a small quan-
tity of reddish serum, probably post-mortem.
Dr. Livingston thought that death was caused by press-
442
THE MEDICAL RECORD.
[April 2 1, 1883.
ure of the enlarged thymus upon the organs within the
mediastinum.
Dr. J. C. Peters said that twenty years ago cases of
enlarged thymus gland, asthma, and sudden death were
reported very frequently. Of late years only a few cases
have been reported. Either they had been overlooked
or did not occur so frequently as formerly.
Dr. G.arrish thought that serrated edges of the teeth
occurred in scrofulous subjects, and therefore did not
necessarily indicate the presence of syphilis.
EXSECTION OF RIBS FOR EMPYEM.A — NEW FORMATION OF
BONE.
Dr. Ger.ster presented a specimen illustrating the
new formation of bone after exsection. A boy, five years
of age, came to the German Dispensary in the beginning
of June, 1882, with empyema of four weeks' duration.
The left side of the thora.x was filled with purulent fluid,
as ascertained by puncture, and was attended by the
ordinary symptoms of purulent pleurisy. An incision
was made, a drainage-tube was placed in the cavity, and,
after the ordinary methods, the cavity was washed out
with a weak solution of carbolic acid. The operation
was performed on June 24th, and the incision was made
in the sixth intercostal space. A few days afterward it
was found that the opening was not suflicient to allow of
complete drainage, and therefore retention of pus took
place, and it was necessary to resort to further measures
to secure efficient drainage. The patient then came
under Dr. Adler's care at the German Hospital, who per-
formed exsection of the sixth and seventh ribs on June
29, 1S82. The patient was dismissed cured on October
29th of the same year. In the beginning of January of
this year the boy presented himself again to Dr. Gerster
at the dispensary, and it was found that he had grown
considerably, that he looked healthy, that the lung had
expanded, and the thorax presented its normal appear-
ance. At the place of the former excision, however, a
fistulous opening had from time to time showed itself,
closed, discharged a little, then closed, then opened and
discharged again, and so on. On examination. Dr. Ger-
ster found roughening of the bone, surrounded by a cav-
ity which was filled with unhealthy granulations, which
were scraped away with a scoop and the cavity washed
out with an eight per cent, solution of chloride of zinc.
The cavity, however, did not exhibit the least tendency
to close, although it could not contain more than two or
three drachms of fluid, and did not communicate with
the pleural cavity. He concluded he had to deal with
that condition of affairs which sometimes occurs in scrof-
ulous ])atients where ulceration of the surface of the
bone takes place, from which unhealthy granulations
spring up without tendency to bone formation or cica-
trization. On March 21, 18S3, he cut down upon the
rib in that locality, and ascertained that the ribs from
which the exsection had been made had grown together,
that there was a circular opening one-third of an inch in
diameter, and corresponding to the site of the drainage-
tube, in this newly formed bone, and that behind this
there was a little cavity filled with unhealthy granula-
tions. The portion of newly formed bone was exsected,
and the wound has closed.
TUBERCULOSIS AND HVDROTHORAX IN A FE.MALli RHI-
NOCEROS.
Dr. I.iautard presented specimens with the following
history :
" ' Mongo ' a female rhinoceros, about sixteen years of
age, weighing about five thousand pounds, had been for
the last thirteen years one of the attractions of iVIr. P. T.
Barnum's show. Ever since she joined the show she had
enjoyed apparently good health, and at the time of her
arrival in New York on the morning of last Wednesday,
seemed to be as well as usual. She was on the evening
of that day fed as usual, and when on Thursday morniii"-
her cage was opened, she was found dead, lying in her
natural position, and showing that she had died without
a struggle. Her cadaver was brought to the American
Veterinary College, when a post-mortem examination
was made.
"An incision was made in the median line of the body
from the chest to the pubes, and the skin, more than an
inch thick, was dissected from the body. The abdominal
cavity being open and the contents removed, the follow-
ing principal lesions were found : Near the stomach
and between the cardiac and pyloric opening of that or-
gan, was found a large, nodulated tumor, resting upon
the small curvature of the stomach, tuberculous in char-
acter, and filling the entire space left between the two
openings of that curvature. Spleen and the liver pre-
sented several nodulated tuberculous deposits much
smaller than the first one. Near the quadrifurcation of
abdominal aorta a number of tuberculous deposits were
also found. The uterus is mammillated here and there
on the body and the horns with tuberculous masses of
the size of a walnut, situated in the cellular tissue be-
tween the muscular and mucous coat.
"All the organs of that cavity are healthy — the stom-
ach, the intestines, the kidneys, the suprarenal capsule —
with the e.xception of the small deposits already alluded to
in the liver and spleen.
"On opening the thoracic cavity it was found to
contain twenty-eight gallons of clear serous fluid, which
had crowded the lungs into the upper portion of the
chest, and the anterior lobes of both lungs were adherent
to the thoracic walls by strong fibrous bands. The
pleura presented a number of thickened spots containing
tubercular deposits. The mediastinum was filled with
tuberculous masses, varying in size from that of a pea to
that of a child's head. The lungs were dark, of a bluish
color, slightly emphysematous at their lower border,
and with their surfaces filled with miliary tubercles, very
heavy and dense. Heart has both cavities empty and
presented tuberculous granules on the tricuspid and
semilunar valves. At the base of the heart, around the
aorta and pulmonary artery, was found a large mass of
tubercles. The pericardium is adherent to the pleura
and to the lungs by fibrous bands, but is otherwise
healthy. The pericardiac and cardiac lymphatic gangli-
ons are enormously enlarged and indurated. On section
they presented a circular wall of dense fibrous tissue,
sending oft" shoots into the centre of the mass, and interla-
cing each other formed a kind of reticulum or stroma, with
a dark greenish aspect in the meshes, containing tubercu-
lar deposits of various sizes. On the superior face of the
sternum three large tubercles were found attached, and
the axillary glands of both sides were very much en-
larged, dense, of whitish color. The pectoral, jjrepecto-
ral, and lymphatic glands of the neck were also much
enlarged, indurated, and tuberculous in their character.
" Poth of these aft'ections were evidently of old stand-
ing, and readily accounted for the sudden death of the
animal."
Dr. John A. Wveth presented specimens as follows :
FRAGMENTS OF BONE REMOVED FROM THE SKULL BY
TREPHINING.
The patient, a man thirty-two years old, came to the
Polyclinic six weeks ago. He had been struck on the
head with a hammer. A portion of the frontal and pari-
etal bones were driven in. The depression was about
one-fourth of an inch. Operation one week after the
injury. A large blood-clot was found lying upon the
dura mater. A square inch of bone was entirely re-
moved. AH the dangerous symptoms disappeared and
the patient is fully recovered.
ORIGIN OF THE CALCANEAN ARTERIES.
Two specimens of arteries, showing the derivation of
the calcatKOHS branches from the external p/antar. The
necessity of a thorough knowledge of this fact was in-
sisted upon in order to obtain good results from Synie's
amimtation.
April 21, 1883.]
THE MEDICAL RECORD.
443
Professor Stephen Smith, who had made an analysis
of all amputations, had concluded that re-amputation
was more frequentl)' necessary in Syme's than in any
other, and that the sloughing was principally confmed to
the inner flap.
The incision should be made from the anterior portion
of the malleoli, directly across the sole, in the axis of the
leg wiien tlie foot was heUl at a right angle to the leg. Dr.
Wyeth demonstrated, in 1876, in an essay embodying
eighty-seven dissections of the tibio- tarsal region, that
this method of oiierating was the only one based upon a
thorough understanding of the anatomy of the parts in-
volved. Mr. Erichsen and others advise an incision well
back over the heel, on account of redundancy of flap
from an incision farther to the front. But a redundancy
is better than a re-amputation. Mr. Syme practised the
long flap. Mr. Savory, in the Lancet for February 3,
18S3, advocates the long flap, but neglects to say that
his advocacy is based upon a study of the arterial dis-
tribution from the calcaneous branches of the external
planlar (not posterior tibial) to the posterior flap.
From the standpoint of practical surgery I wish to re-
iterate what was said in the Prize Essay of the Bellevue
Alumni Association in 1876, that the line of incision,
which is carried obliquely backward over the heel,
divides the posterior tibial so near its bifurcation that
the supi-ily of blood to the heel is insufficient, while the
incision well forward (as above described) divides the
internal and external plantar arteries well beyond the bi-
furcation of the tibial and leaves the calcaneous branches
of the external plantar uninjured.
ABNORM.^LITIES OF THE CAROTIDS.
The arch of tlu aorta from a man in which the left
common carotid artery was absent, the external of that
side arising from the aorta in the usual site of the coin-
tnon trunk. The skull of this subject had no carotid
canal on the left side. It was presented to the Wood
Museum of Bellevue Hospital. It is the second one
known to me, the other being mentioned by Hyrtl. Dr.
Eugene Peugnet had reported a case of absence of the
common carotid.
AN INTERNAL CAROTID ARTERY, FROM WHICH THE AS-
CENDING PHARYNGEAL ORIGINATED, ONE INCH ABOVE
THE BIFURCATION OF THE COMMON TRUNK.
It is stated, generally, in the anatomies, that no
branches are derived from the cervical portion of the in-
ternal carotid. Dr. Wyeth found the ascending pharyn-
geal derived from this vessel in seven of one hundred and
twenty cases examined.
Twelve specimens of the common internal antl ex-
ternal carotid arteries, in which the distance from the
origin of the superior thyroid and bifurcation of the
primitive carotid to the origin of the lingual, varied
from one half to three-fourths of an inch. The average
distance betsveen these two points, he found in an analysis
of 1 2 1 cases, was yV\; of an inch.
These specimens went to prove that the application of
a ligature to the external carotid artery at this point was
a safe and justifiable operation. Nevertheless, in per-
forming this operation, it was always safer to examine if
any branch was derived within the immediate vicinity of
the ligature. If found, it should be separately secured,
as a safeguard against secondary hemorrhage.
A specimen in which the common carotid trifuicated
into the internal, external, and a single large trunk,
which afterward divided into the superior thyroid, lingual,
and facial.
This anomaly occurred twice in 121 cases examined
carefully. The cases are reported in the Prize Essays
of the American Medical Association for 1S78.
A specimen showing a common origin for the facial
and lingual arteries from the external carotid. I found
this condition to exist in 31 cases out of 121.
Three cases showing an exaggerated type of the
normal trumpet-like expansion of tlie origin of the in-
ternal carotid.
The explanation he offered for this almost constant
dilatation was, that the column of blood projected into
the common trunk divided about equally into the two
principal branches when it reached the septum of bifur-
cation. The pressure upon the external carotid was re-
lieved by reason of the large number of branches given
off by it, while the internal carotid, having no such
means of relief, expanded under the pressure.
(To be continued.)
(i^ovvcspoucicucc.
OUR LONDON LPnTER.
(From our Special Correspondent.)
THE NEW MEDICAL BILL HOSPITAL ACCOMMODATION IN
LONDON AND ITS ABUSES MEDICAL FEES.
London, March 31, 1883.
The new medical bill continues a prominent subject of
interest. It is believed that some of the corporations
will oppose it, particularly the College of Surgeons, as its
diploma of membership will probably die out in the event
of the bill becoming law. One objection justly urged
against the new bill is, that although it provides for a
uniform T*"//;?/ examination in medicine, surgery, and mid-
wifery, it offers no guarantee that the examinations in
the primary subjects of study shall be of equal and suffi-
cient security.
The subject of hospital accommodation in London is
again receiving attention. On the one hand, it appears
that some districts are insufliciently provided, notably
the north of London ; on the other hand, there is no
doubt that the existing hospital accommodation is greatly
abused. This remark applies chiefly to the out-patient
departments. There is no doubt that many — it might
almost be said most — of the out-patients could afford to
pay something for the advice and medicine received. In
many cases well-to-ilo middle class people, and even the
upper classes, do not disdain to receive gratuitous advice
and medicine. In some uistances, no doubt, the motive
is to avoid expense, but in oth'-rs such patients attend
public institutions under the belief that they will receive
better advice than from their family attendant, and they
are either unable or unwilling to pay the fee of a hospital
physician and consult him as private patients. On one
occasion a banker's wife went to an hospital to see a cele-
brated specialist, and leaving her carriage at the corner,
presented herself among the patients attired in her lady's
maid's clothes. She was, however, recognized by an-
other member of the staff who happened to be present,
and unkindly informed his colleague, so that on a subse-
quent visit the specialist refused to prescribe for a lady
of her position within the hospital walls, and gave her a
short lecture on the use and abuse of charitable institu-
tions.
I have known though of a wealthy man attending as a
hospital patient in order to "take a taste" of a physician
before consulting him privately. This gentleman betook
himself for this purpose to a large institution in London
which shall be nameless. He entered the physician's
consulting-room along with several other patients. One
of these approached the great man, and, amongst other
symptoms, mentioned his inability to keep awake, and
said he could always go to sleep at any time. He was
always falling asleep, he said. "Very well," said the
physician, " then lie down on that bench and go to
sleep." The patient lay down as bid. Several patients
were seen and dismissed. The physician then bethought
himself of the drowsy one, and, turning toward hjm,
said loudly, " Hallo there, are you asleep ? " "No, sir,"
timidly replied the patient. " Well, go to sleep at once
then," responded the doctor. In a few minutes the doc-
444
THE MEDICAL RECORD.
[April 2 1, 1883,
tor again demanded if he were asleep, and finding he was
not, said " How dare you tell me such a lie as to say you
could go to sleep any time ? " and scolded and dismissed
him. The gentleman did not consult that physician,
who, I beg emphatically to say, is not a fair specimen of
London medical behavior.
Your readers may care to know how our scale of fees
runs. General practitioners charge from half a-crown to
•seven shillings a visit, and this charge includes the lueiU-
cine supplied. Consulting practitioners, whether phy-
sicians or surgeons, charge a guinea per consultation.
For the first interview it has of late years become cus-
tomary with many to charge two guineas. For visits,
consulting practitioners charge by distance. For short
distances a guinea a mile is charged, with a mininuuri
•charge of two guineas. For long distances, one-third of
a guinea is charged per mile for the double journey ;
i.e., sixty guineas would be charged for a journey of
ninety miles and back. Though these are the accepted
■fees, it will readily be understood that they are subject
to variations. Thus many young physicians are glad to
take a guinea for two or even three consultations, and
•even established hospital physicians and surgeons will
sometimes see a patient of limited means an e.xtra time
or so without extra charge. Similarly, it is onlv the
busiest men who exact the outside charge for visits at
long distances.
ArEDJCAL EDUCATION IN CHICAGO.
To THE Editor of The Medical Rfcokd.
Sir : In your issue of April 7th is a description of a
" Class Quiz on Anatomy in a recognized Medical Col-
lege in Chicago," which I think should not pass without
notice. The article has no signature, and the name of
the medical college in which this wonderful quiz took
place is not given. If this narrative is anything but a
grotesque exaggeration, the class spoken of must have
t)een made up of the champion ignoramuses of .\merica,
and it is unjust to other colleges not to specify the one
alluded to. A reader not faniiliar with the schools and
laws of Illinois would be likely to suppose that this oc-
■curred in a school which is recognized by the profession.
Our State Board of Heakh recognizes all the schools
here ; but not n)any who read The Record do. We
have the Rush Medical College, the Chicago Medical
College, the \Voman's Medical College, and the College
of Physicians and Surgeons, which we recognize ; but
the others are Homceopathic and Eclectic, and would not
be classed with those named. The scene described could
not have been in any of those four schools. None of these
have mixed classes, and therefore no "embryo male and
female doctors to throw orange-peel before the lecturer
began to ask about the abdominal aorta." The Record
has before said, in substance, that "entrance examina-
tions are unknown in Chicago." This is an error. The
Chicago Medical College and the Woman's Medical
College established the rule of requiring a good English
education as a condition for matriculation in 1875, and
jjerhaps may claim the rank of pioneers in this move-
ment.
The College of Physicians and Surgeons adopted this
rule on its first organization in 1882. I have reason to
believe that it has been fairly applied by these institu-
tions. 1 suppose that all medical schools in the State
will feel compelled to require this in future ; if our
State Board of Health adheres to its rule, recently
adopted, of not recognizing schools that do not, I think
your correspondent is warranted in doubting that the
medical practice act of Illinois excludes ignorant cjuacks
from the State. That it does has been claimed, and the
claim has been generally admitted. It may be said for
this act that it is an effort in tlie right direction ; but if it
has driven any quacks from Illinois, I am not aware of it.
There are, and always have been plenty of them practis-
ing in Chicago. Some niay have been frightened away,
but I do not think any have been driven away. A per-
son has long practised medicine in Chicago under an
alias. The Board revoked his certificate several years
since, but he has never suspended his practice. A
doctor's sign has been on one of the principal streets of this
city many yeais. Several years since his well-advertised
name brought him a patient who lost her life in an at-
tempted abortion. An investigation revealed the melan-
choly fact that the doctor had been a good while dead,
but another had personated him, and the infamous busi-
ness went on without interruption, and the old name still
stands at the entrance to invite the unwary across the
threshold. I have long been an attentive observer of the
condition of the profession in Illinois, and I do not think
that our legislation has greatly advanced its interests.
The profession has accomplished much through its own
organizations by carefully registering its recognized
members, and by a persistent demand that medical col-
leges shall give more thorough instruction to students
and exact a higher grade of attainments for graduation.
"'T is true 't is pity, and pity 't is 't is true," that the
medical schools of Chicago confer about five hundred
diplonias annually, and that the ease with which they are
obtained nearly robs tlie parchment of its value ; yet I
doubt if our regular schools distribute their diplomas with
a more liberal hand than do those of New York.
Chicago, .^prj lo,
E. Ingals, M.D.
CATHETERIZING THE FEMALE URETER.
To the Editor of The Medical Record.
Sir : In the New York Medical Journal, February 17th,
there apjieared an interesting report of the extirpation, by
Dr. W. M. Polk, of a misplaced kidney. The patient, a
girl of nineteen, died eleven days later of -unetnia, and
the autopsy revealed the congenital absence of the other
kidney, the excised organ having therefore been the pa-
tient's only kidney. After alluding to other cases in
which the same operation has been followed by the same
result from the same singular cause. Dr. Polk discusses
the various possible means for detecting the absence or
disease of one kidney before operations upon the other.
No mention is made, however, of Pawlik's method for
catheterizing the ureter in females — an easy and generally
practicable proceeding, which involves no preparation of
nor danger to the patient.
.•^s originally demonstrated to the Versammlung deut-
scher Naturforscher, at Salzburg, in 1881, the method
was this : The patient is placed in the knee-elbow posi-
tion, the posterior vaginal wall retracted by means of a
Sims speculum ; the (losition of the trigonum vesica: is
recognized by the conformation of the vaginal wall. An
elastic bougie (or small catheter) is introduced into the
bladder and its point is directed, by inspection and pal-
pation of the vagina, into the orifice of the ureter. Dr.
Pawlik subsequently acipiired such dexterity that inspec-
tion of the vagina (and the use of the speculum) became
unnecessary ; the finger in the vagina sufficed to guide
the bougie. Pawlik has thus repeatedly introduced bou-
gies into the ureters m patients of Billroth as preparation
for the vaginal extirpation of the uterus. He informed
me last July, that he had thus sounded some thirty pa-
tients, and had failed but once, in a case of pronounced
prolapsus uteri. The writer is convinced by experience
that the proceeding is practicable on the cadaver, at least,
though demanding patience and practice.
A sketch of Pawlik's method was communicated to
the London Congress, and the doctor intended to pub-
lish it in detail with illustrative plates ; but so far as I can
learn, the article has not yet appeared.
W. T. Belfield, -M.D.
71 Dkaruokn Stkkht, Chicago, III.
April 2 1, 18S3.]
THE MEDICAL RECORD.
445.
THE HOLMES DINNER.
TiiK comi)liiiientaiy dinner to Dr. Oliver Wendell Holmes
was given, as announced, at Delmonico's, April 12th.
About two hundred and twenty-five guests were present.
Almost all of them were medical men, there being repre-
sentatives from Boston, Springfield, Utica, Albany,
Syracuse, Washington, and Philadelphia. Among the
laynien present were, Mr. Horace White, John Habber-
to'n, Noah Brooks, Bishop Clarke, Hon. Win. M. Evarts,
and Mr. George Wm. Curtis. The guests were seated
at five long tables, completely filling the hall. On a
raised dais, sat Dr. Fordyce Barker, who presided, at his
right Dr. Oliver Wendell Holmes, at his left Right Rev.
T. M. Clarke, of Rhode Island, .-^mong others seated
on the dais were Drs. Wm. Pepper and S. Weir Mitchell,
of Philadelphia, Drs. A. C. Post, J. T. Metcalfe, T. A.
Emmet, J. C. Dalton, S. O. Vanderpoel, and I. E.
Taylor.
Dr. Barker, in calling the assembly to order, made
some happy introductory remarks introducing the guest
of the evening. These were supplemented by a poem
from Dr. A. H. Smith, which was received with much
laughter and applause.
The following is the poem :
You've heard of the deacon's one-hoss shay
Which, finished in Boston the self-same day
That the City of Lisbon went to pot,
Did a century's service, and then was not.
But the record's at fauh which says that it bust
Into simply a heap of amorphous dust ;
For after the wreck of that wonderful tub.
Out of the ruins they saved a hub ;
And the hub has since stood for Boston town,
Hub of the Universe — note that down.
But an orderly hub, as all will own.
Must have something central to turn upon,
And, rubber-cushioned, and true, and bright,
"We have the axle here to-night.
Thrice welcome, then, to our festal board
The doctor poet, so doubly stored
"With science as well as with native wit ;
Poeta nascitur, you know, nonjit.
Skilled to dissect with knife or pen,
His subjects dead or living men ;
V\\\.\\ thoughts sublime on every page
To sH-ell the veins with virtuous rage.
Or with a syringe to inject them
■With sublimate to disinfect them ;
To show with demonstrator's art
The complex chambers of the heart.
Or armed with a diviner skill
To make it pulsate at his will ;
■With generous verse to celebrate
The loaves and fishes of some giver,
And then proceed to demonstrate
The lobes and fissures of the liver ;
To soothe the pulses of the brain
"With poetry's enchanting strain,
Or to describe to class uproarious
Pes hippocatnpi accessorius;
To nerve with fervor of appeal
The sluggish muscles into steel.
Or, pulling their attachment, show
■Whence they arise and where they go;
To fire the eye by wit consummate.
Or draw the aqueous humor from it ;
In times of peril give the tone
To public feeling called backbone.
Or to discuss that question solemn
The muscles of the spinal column.
And now I close my artless ditty
As per agreement with iiommittee,
And making place for those more able,
I leave the subject on the table.
Yet one word more. I've had my pride
As mt'dicui most sorely tried,
■When Englishmen, who sometimes show
Of things .American, you know.
An ignorance that is melancholy ;
As Dr. Holmes is very jolly.
Assume that he must therefore be
A Doctor of Divinity.
So to avoid all chance of wrong,
To medicine, or church, or song ;
Let Doctor Holmes discarded be
For Oliver Wendell Holmes, M. D.
And now, for I really must come to an end.
May the fate of the chaise be the fate of our friend.
May he never break down, and never wear out.
But a century old, or thereabout ;
Not feeling the weight of years as they fly,
Simply stop hving when ready to die.
Dr. H. D. Noyes was then announced as the toast-
master ; his reading of the subject of the first toast,.
" Our Guest," was the signal for a vigorous outburst of
enthusiasm, all rising to their feet and following the
quaffing of their wine by three hearty cheers.
Dr. Holmes then read his poem. He was listened to
with the most enjoyable attention. No doubt many
were surprised at the freshness and vigor of the speaker's
presence, his clear voice, and sympathetic elocution..
There was no trace of old age in manner or matter.
The poem has been so e.xtensively printed in the daily
press throughout the country that we present only a
fragment of it, but sutficient to show the power and.
pathos of its author :
Have I deserved your kindness? Nay, my friends.
While the fair banquet its illusion lends
Let me believe it, though the blood may rush
And to my cheek recall the maiden blush
That o'er it flamed with momentary blaze
When first I heard the honeyed words of praise.
Let me believe it while the roses wear
Their bloom unwithering in the heated air :
Too soon, too soon, their glowing leaves must fall,
The laughing echoes leave the silent hall,
Joy drop his garland, turn his empty cup,
And weary Labor take his burden up—
How weighs that burden they can tell alone
Whose dial marks no moment as their own.
Am I your creditor ? Too well I know-
How Friendship pays the debt it does not owe.
Shapes a poor semblance fondly to its mind.
Adds all the virtues that it fails to find.
Adorns with graces to its heart's content.
Borrows from love what nature never lent.
Till what with halo, jewels, gilding, paint,
The veriest sinner deems himself a saint.
Thus while you pay these honors as my due
I owe my value's Larger part to you.
And in the tribute of the hour I see
Not what I am, but what I ought to be.
Brothers in art. who live for others' needs
In duty's bondage, me-.cy's gracious deeds,
Of all who toil beneath the circling sun
Whose evening rest than yours more fairly won ?
Though many a cloud your struggling morn obscures,.
What sunset brings a brighter sky than yours ?
I. who your labors for a while have shared.
New tasks have sought, with new companions fared.
For Nature's servant far too often seen
A loiterer by the waves of Hippocrene ;
Yet round the earlier friendship twines the new.
My footsteps wander, but my heart is true
Nor e'er forgets the living or the dead
Who trod with me the paths where science led.
How^ can I tell you, O my loving friends.
What light, what warmth your joyous \selcome lends
To life's late hour ? -Alas ! my song is sung.
Its fading accents falter on my tongue.
Sweet friends, if shrinking in the banquet's blaze.
Your blushing guest must face the breath of praise,
Speak not too well of one w ho scarce will know
Himself transfigured in its roseate glow ;
Say kindly of him what is, chiefly, true.
Remembering always he belongs to you ;
Deal with him as a tru.ant, if you will.
But claim him, keep him, call him brother still !
As Dr. Holmes read the last line he sank back into his-
seat, and a loud cheer burst from the listeners, which
lasted for at least a minute. Several ladies had stood in the
gallery overlooking the room, and they waved their hand-
kerchiefs and applauded as heartily as the men did. Sud-
denly Mr. Evarts jumped to his feet, swinging his handker-
chief in the air, and in an instant every man in the room
was standing, shouting and cheering and waving napkins-
and handkerchiefs. It was a scene of enthusiasm seldom
witnessed even in Delmonico's, and Dr. Holmes bowed
his thanks with a face m which smiles and tears struggled,
visibly for the mastery.
The speeches that followed were exceptionally good..
Bishop Clarke, of Rhode Island, responded to the toast
" The Clergy." He said, among other things,'- When the
name of Dr. Holmes is spoken, we do not think of bones
and ligatures and lesions. It is difficult to conceive of
him as ever administering to a poor man anything that it
446
THE MEDICAL RECORD.
[April 2 1, 1883.
was hard for him to take. If he had not been great in so
many other ways we might consent to think and speak of
liim as the great doctor. How much we learn from him,
and how much we are impressed by his glowing words !
As we read we weep, and sigh by turns, but the glad song
of the bird is always heard above the sad moaning of the
sea. Whatever chord he touches, the answer comes back
from the soul, prompt and clear. But I am diverging from
my subject, which is the clergy. Now, we clergymen are
proud of Dr. Holmes, because we consider him as one
of us. If he had never had a father he would never have
been, and his father was a clergyman, so that he is really
one of our production. ^Ve are very grateful to the father
for producing such a son. Long may it be before the
sun of his life sets."
Mr. Evarts responded to the toast, "The Bar." He be-
gan by complimenting the doctors. " It is much pleas-
anter," he said, " to be asked to meet three hundred doc-
tors in this way than it is to ask one to meet you. An old
German book on medicine lays down the sweeping propo-
sition that all diseases and all accidents requiring surgical
treatment are caused in order that the skilful and learned
in the profession of medicine may be educated by means
of them. I don't know, after all, but there is a good deal
of feeling in the three learned professions that this is a
true view of human affairs. The estate, the body, and
the mind make up, do they not, all that is visible, all
that is interesting, all that is important in human affairs ?
The lawyer takes charge of the estate, the clergyman is
the curer of the souls, and the doctor is the curer of the
bodies. As the sheep are for the shepherd, so those
taken care of are for those who take care of them. You
medical men have one striking advantage over the rest
of us, for though, alas, everybody has not an estate, and
everybody has not a mind, yet everybody has a body.
We are all bound to be in at the death, and although it
is a cheerless moment, yet to us there are assuaging cir-
cumstances. In contrasting our relations I should say
that Bishop Clarke and his fellow-laborers are sent out as
sheep among wolves; you and I are sent out as wolves
among the sheep." Dr. Holmes, Mr. Evarts said, "had
the advantage of being born and livuig near to Boston,
a place that no one can live early in life without feeling
that he has a great advantage over his fellows, and no one
who first learns it later in life fails to be grateful that he
has seen it before he dies. Now fame was nothing to
Dr. Holmes in influencing him to pay us a visit. The
only curiosity that he had in the matter was to see how
a Boston fame would sound echoed from New York. I
never could understand how the Boston people were
able to put up so long with Dr. Holmes, who, while he
furnished a reputation to Boston, took also the principal
part of the reputation of Boston to himself. Now,"
said Mr. Evarts in conclusion, " as we are all professional
men here, and as the rest of the world is shut out, and
there is no possibility of anybody knowing what we say
or do here, is it not fair for us, does not our character
for truth require us, to admit that we are really the
saviors and protectors of society ? Why should we strive
to hide this even from ourselves ? Let us animate our-
selves to a more vigorous pursuit of our several interests,
as sheep and wolves ! Let us understand that the la-
borer is worthy of his hire, and that those who are un-
willing to be aided by professional skill and advice in
parting with their property and their lives are unworthv
of serious consideration."
"The Medical Profession'' was responded to by Dr.
T. (jaillard Thomas. He said that everybody knew that
nothing was so difficult for a medical practitioner as the
making of an impromptu speech. He felt embarrassed
when asked to present his speech between the speeches
of the two eloquent gentlemen who had i)receded him
and those who were to follow. But he felt that a per-
son must indeed be barren in thought and entirely bereft
of speech if he could not express in some way his appre-
ciation of the sweet and noble qualities of the honored
guest of the evening. Dr. Holmes was not only an honor
to the medical luofession, he was an honor and a bless-
ing to mankind. He concluded with an eloquent trib-
ute to the character and genius of Dr. Holmes.
George William Curtis responded to the toast of " Lit-
erature.'' He said that medicine, the church, and the
law had spoken praise of the honored guest. As the
church was supposed to dispose satisfactorily of a man's
mind, the law most summarily of his estate, and medicine
inevitabl)" of his body, what was there left for literature
to do but to claim the man in his entiretv. One profes-
sion had cried "All hail, Macbeth!" Another, "All
hail, thane of Glamis ! " A third, " All hail, thane of
Cawdor," and it remained for literature to cry, " Hail,
King that shall be ' " It was appropriate that literature
should assert its claim upon Dr. Holmes, for in literature
he had attained his greatest reputation and honors. It
was also appro|)riate that the literature of New York
should extend the hand of fellowship to the eminent lit-
erary son of Boston. The speaker referred to the liter-
ary work done by New York men, Cooper, Halleck,
Irving, and Drake. His speech was a wonderful speci-
men of finished oratory, and excited great ajjplause.
Mr. Whitelaw Reid responded to the toast "The
Press." In concluding he said : "Your honored guest,
Mr. Chairman, must have seemed to every one here the
youngest man at your table to-night. Yet we know, and
perhaps may venture to say, that save for the ever youthful
spirit, he is no longer young. The man who has written
thirty-two successive annual poems for the class of 1829
must not be surprised that all the world knows by heart
— if not his precise age — at least how long he has been
out of college. It is one of the pleasantest things con-
nected with his formal relinquishment of some of the
burdens he has been bearing that he has the right, in this
mellow Indian Sununer of his fruitful life, to know that
his fame is still a growing one. The very flash and glit-
ter of his wit have sometimes blinded men's eyes to the
rich and generous qualities that lay beneath it. Lowell
painted him as
* A Leyden-jar, always full-charged, from which flit
The electrical tingles of hit after hit."
This tribute from your jnofession, Mr. Chairman, has
served to recall to us how many more are his titles to
renown ; how wide has been the field of his work and
how rich the harvest he has gleaned. And it gives us the
welcome opportunity to show that New York prizes him
no less than Boston ; and is glad to thank him alike for
the pleasure he has for so many years given us all per-
sonally ; for the examjjle of his life, for the service he
has rendered our literature, and the honor he has done
our country."
On the conclusion of Mr. Reid's speech. Dr. Barker
referred to a number of physicians who had sent letters
of regret, and then called for a bumper to absent friends.
It was drunk standing and the company sang " Auld
Lang Syne " right heartily as a resjjonse, and then sepa-
rated.
Brains of GkE.vr Men. — General Skobelof, thchero
of Plevna, after death was subjected to a rigorous autopsy.
The circumference of his head was 57 centimetres ; of
the skull, 54 ; antero-posterior diameter, 18 centimetres ;
transverse, 14. The brain weighed 1,457 grammes. The
brain of Gambetta is deposited in the laboratory of the
School of Higher Studies, and will be described by M.
Mathias Duval of the Society of Mutual Autopsy, to which
M. Gambetta also belonged.
Thb; Health Record of Xew Oi^i.eans from 1863
to 1882, as given by the Louisiana State Board of Health,
shows a remarkable and steady improvement. In 1863
the mortality was 41.35 per 1,000 ; in 1873 it was 37.73 ;
in 1882 it was 26.45.
April 2 1, 1883.]
THE MEDICAL RECORD.
447
^vmj$ ^ems.
Official List of Change's of Stations and Duties of Officers
of the Medical Department, United States Army, from
April-], 1883, to April 14, 1883.
Alexander, Charles T., Major and Surgeon. To
be relieved from duty at the U. S. Military Academy,
West Point, New York, .4.ugust 28, 1883. S. O. 82,
liar. 6, A. G. O., April 10, 1883.
Bartholf, John H., Captain and Assistant Surgeon.
The extension of leave of abserice for twenty-three days
by S. O. 37, C. S. Department of the Columbia, further e.x-
tended one mofith. S. O. 31, par. i, Military Division
of the Pacilic, April 3, 1883.
Gibson, R. J., Captain and Assistant Surgeon. Re-
lieved from duty at cantonment on the Uncompahgre,
Colorado, and assigned to duty at Fort Hays, Kansas.
S. O. 73, par. I, Department of the Missouri, April 7,
1883.
^Icclical items.
Contagious Diseases — Weekly Statement. — Re-
]iort of cases and deaths from contagious diseases re-
ported to the Sanitary Bureau, Health Department, for
the two weeks ending April 17, 1883 :
Week Ending
3
>
"o
•a
U
V
>
u
. M
O.S
II
i
1
V
•c
Si
1
>
H
H
CO
u
'^
2
<A
>
Cases.
April 10, 1883
0
6
130
6
121
55
50
1
0
April 17, 1883
I
3
4
199
2
0
Deaths.
April 10, 1883
0
5
6
15
21
6
16 23
27 20
I
0
April 17, 1883
I
3
0
0
Pneumonia still figures largely among the causes of
death, the number for the week ending .\pril 14th being
131 out of 721, the total number of deaths reported.
A Simple and Ingenious Instrument for Remov-
ing Foreign Bodies from the Ear. — Dr. Louis B.
Couch, of Nyack, N. Y., sends us the description of a
little instrument which any jeweller can make, and which,
he says, is very useful and efficient in removing foreign
bodies from the ear. The description is as follows :
I have been interested in the late discussion going on
in your journal with reference to the best methods for the
removal of foreign bodies such as corn, beans, etc., from
the auditory canal or nares, and herewith transmit my
mite to the general fund of information.
Take a piece of eight-sided brass wire, or round wire
vith roughened surface, and drill into either end a small
hole a quarter of an inch deep. Into one end bronze or
solder a small twist drill one thirty-second of an inch in
diameter, and into the other a nice sharply cut screw
(such screws maybe obtained of any jeweller) of about
one twenty-fifth of an inch in diameter. When this is
done, you are ready for your smart boy with more beans
in his head than brains.
Suppose the bean is at the bottom of the auditory canal,
enlarged and surrounded by intlamed swollen tissues, a
small portion only being visible.
Introduce the speculum, and carefully with light press-
ure drill into the presenting portion of the corn or bean
to the depth of about one-quarter of an inch, and clear
off all dust, then reverse the instrument and insert the
screw and the bean must come.
I have by actual test inserted my samj^le instrument
into a bean, and sustained with it a weight of twenty-five
pounds, as shown by scales ; a holding power far in ex-
cess of that required for the removal of any such bodies.
Physicians will be surprised at the rapidity with which
the drill will perforate the hardest of dry beans and the
slight pressure required. Care, however, should be ex-
ercised in first enteiing the drill, that it does not slip.
I confidently reconniiend this instrument to the pro-
fession in all cases for which it is applicable.
Written and Unwritten Ethics. — \Ve venture the
statement that of the 75,000 practitioners of medicine of
this country, not ten per cent, have ever read the Code
of Ethics of the American Medical Association, and that
not five per cent, even of the ethically correct in their
deportment toward both the public and their brother
practitioners remember enough of it to be of the slight-
est possible value to them as a guide to conduct. Cer-
tain it is that as a guide to the every-day conduct of the
physician, it is as if it did not exist. The gentleman
does not require it, and he who is not a gentleman can
utilize it to cloak his rascality. One of the greatest
sticklers for the code whom we know, is notoriously un-
fair toward his brother i^ractitioners, injuring them by
innuendo and robbing them of their patients when he can.
Correct medical conduct requires more than can be for-
mulated in words. It requires that rare admixture of re-
gard for others, self-respect, charity, and magnanimity
which goes to make up the gentleman. No code can
define the constituents of this admixture, and any code
which cannot define it is useless, and in many respects
injurious. Better than such a code is the unwritten and
indefinable law which defines a gentleman. If physicians
were absolved from the obligations of gentlemen, and re-
quired only not to violate the Code of Ethics of the Amer-
ican Medical Association, the profession of medicine
would soon cease to be the honorable callmg that it is. —
Medical Age.
New Medical Colleges. — Dr. Richard C. Moore,
of Omaha, Neb., writes: "The position you have
usually taken in reference to new medical colleges being
established in cities already occupied or in towns too small
to furnish clinical material, 1 consider correct ; but in re-
ferring to the Omaha Medical College in the same article
in which mention is made of new colleges in Boston,
organized under act incorporating manufacturing com-
panies, you do an act of injustice to a flourishing and
honest institution."
Dr. Moore then describes to us, in a temperate man-
ner (barring a slight exaggeration of his city's popula-
tion), the advantages which Omaha possesses as a medi-
cal centre. There is also, we are told, no medical
college equal to that in Omaha, short of St. Louis or
Chicago, five hundred miles away. Our correspondent
is plainly a sensible and judicious gentleman. We are
anxious to do his institution justice. We cannot, how-
ever, force ourselves to believe that the lack of medical
men in the West is such as to require the establishment
of more colleges, even though, like that at Omaha, they
require "two full terms of six months each."
The Afterbirth Mistaken for Intestines and
Returned. — A correspondent from the Sandwich Isl-
ands sends us the following : " Some of the statements
about obstetrics in the Sandwich Islands made in The
Record are not quite true, but the following is what
took place here : ' An Englishman's donkey had a colt,
the first the man had ever seen born. When the after-
birth came he thought it was the bowels, and so he and
two other white men took a stick and pushed it back.
This they did three times, and at last out of pity they shot
the donkey. The man said, ' I did not like to see the
animal suffer for want of bowels.' "
44S
THE MEDICAL RECORD.
[April 2 1, 1883.
Advertising in Lay Journals. — The Irish College
of Physicians has followed in the steps of the English
College in adopting the following resolution : " That the
advertisement of medical books in other than medical
publications, and the giving by any of the licentiates,
members, and fellows of the college, whether for publi-
cation or not, of laudatory certificates of medicinal or
other preparations, or medicinal or surgical appliances,
is misleading to the public, derogatory to the dignity of
the profession, and is censurable by the college."
Healing the Sick by Faith. — The " Rev. Dr.''
Monck, " teaching and healing pastor " of the " Apostolic
Church of the Divine Gifts," conducted a public e.xhibi-
tion in the Academy of Music, Brooklyn, Sunday evening.
Curiosity, belief, and liberal advertising filled the house
with people of simple appearance and decorous behavior.
The exhibition of ''healing" the sick was preceded by a
suitable discourse. Then the process of healing began.
Little children, men, and women came forward ; the doc-
tor announced their disease, spoke his I'ormula, asked how
they felt, interpreted their answers to the peojile, and
hurried them aside.
To the above we append the following anecdote :
" Have you ever tried the faith cure ? " asked a long-haired,
sallow-faced stranger, addressing a gentleman who sat be-
hind him in a street-car. " 1 have,'' was the answer. " Do
you believe in it ? " "'I do." " May I ask, then, of what
you were cured ? " "Certainly. I was cured of my faith."
A New Remedy for an Old Disease — Hvdriodic
Acid in the Treatment of Acute Inflajlmatory
RHEUM.vnsM. — Dr. James Craig, of Jerse)- City, N. J.,
writes us: "Before using the remedy shortly to be
spoken of, I was in the habit of prescribing bicarbonate
of potassa, which, as a rule, gave relief as soon as the
urine was rendered alkaline, which required about a week
or ten days, and during that time opiates had to be given
to relieve pain and produce sleep. I have also prescribed
salicylic acid, but cannot say that I have seen any decided
benefit derived from its use. [!] Syrup of hydriodic acid,
prepared by Robert W. Gardner, of New York, is the
remedy par excellenee for this painful and troublesome
aftection. I have used it for the past two and a half
years in bronchitis and scrofula, but its effects have been
most prompt in acute inHammatory rheumatism, reliev-
ing pain in from twelve to tbrty-eight hours. I have been
called to see patients suftering from this aftection, and
found them with hisjh fever, joints swollen, and sufterintr
terribly, and on the following dav have been agreeably
surprised at their rapid improvement, finding them in a
great measure free from pail, and fever reduced. Some
other cases take a longer time, but 1 have yet to find one
that was not in a comfortable condition within forty-eight
hours. The dose I prescribe for adults is from two to
three teaspoonfuls every two ix three hours, in a wine-
glass of water, until relieved ; aAerward I reduce the dose
to one teaspoonfiil, which may be continued for five or
six days, at longer intervals. I was first led to the use
of this remedy in prescribing for a patient sufi'ering from
bronchitis complicated with rheumatism, its eli'ects being
most salutary hi the relief of both diseases. I should
state that under this mode of treatment the heart has
been free from com[)lications ; the remedy preventing
exudation and organization of plastic niateiial. 1 more
fre<iuently use it now in rheumatism than in bronchitis —
in fact, 1 use it in all cases of acute rheumatism, and
must say have always been jileased with its results. I
have also prescribed it in chronic rheumatism, but with
less effect. I hope that other physicians will give it a
fair trial, and find it as useful in their hands as it has been
in mine."
Menstruation. — In a lecture on the subject of the
comparative jihysiology of menstruation, by Dr. Alfred
\V'iltshire, of London {British Medical Journal), in which
he adduces proof of menstruation in various brutes, the
following curious statements are quoted: " Vel[)eau (TV.
Comp. de f Art des Accoiich., t. 1, p. 126) says that in
Lapland and Greenland women are not often more reg-
ular than every three months, and Gardien {Tr. d'Ac-
coiuh. et de Mai. des Femmes, t. i, p. 233) pretends that
in women in polar countries the menstrual flow takes
place only twice or thrice a year."
Powdered Rhubarb. — Mr. George W. Hayes has
made some investigations into the quality of and tests for
powdered rhubarb. New Remedies sdiyi : ''Some of the
samples examined by Mr. Hayes contained more cathar-
tic acid (the laxative principle) than the standard, and
the inference that may be drawn from his investigations
of twelve specimens, some of them obtained from thor-
oughly respectable and conscientious dealers, is that
powdered rhubarb may be of value conjmercially, but is
not to be depended on therapeutically. In other words,
we may paraphrase a famous mot by Punch as follows :
' Advice to those about to purchase commercial powdered
rhubarb. Don't I ' "
Ergot in the Tre.^tment of Congestive Head-
ache.— Dr. Charles T. Rogers, of Honolulu, Hawaiian
Islands, writes us regarding the above subject, referring
to an article by Dr. J. L. Corning in The Record of
•December 23d. Dr. Rogers thinks that the value of er-
got in this trouble is not appreciated. He gives it in
large doses ( 3 j. of fluid extract) and would not be afraid
to repeat it within an hour. He combines it generally
with a full dose of bromide of potassium (gr. xl. or more).
The combination is much more eft'ective than bromide
alone. Dr. R. says that he is not at all afraid to use
ergot in large doses. He has seen 3 ss. given for pul-
monary hemorrhage without toxic symptoms following.
Ophthalmic Aphorisms. — Dr. J.J. Chisholm, of Bal-
timore, gave the following aphorisms in a report presented
to the Marvland State Medical Society at its last session :
First Aphorism. — Do not blister. In forty-nine appli-
cations out of fifty, as I find it used by physicians at large,
it is an additional and useless torture to the eye diseases
from which the patient is already suftering.
Second Aphorism. — Do not use nitrate of silver. As
constantly iirescribed by general practitioners, it is not
beneficial in one case out of one hundred, and therefore
is a very painful infliction to the ninety-nine who would
have been so much better off without it.
Third Aphorism. — Do not prescribe sugar of lead. In
every case zinc, tannin, or alum is better, and then there
is no fear of having insoluble deposits incorporating them-
selves with the exposed surface of corneal ulcers.
Fourth Aphorism. — .^.hvays use weak solutions of the
mineral and vegetable astringents in the treatment of
eye inflammations which attack the mucous surfaces, and
restrict their application to conjunctival diseases exclu-
sively. One grain of alum, sulphate or chloride of zinc,
sulphate of copper or nitrate of silver, in an ounce of
water, will, in the majority of cases of conjunctival dis-
eases, do much more good and give much less uneasi-
ness than the very painful five and ten grain solutions
which are so often injuriously prescribed by physicians.
Fifth Aphorism. — Solution of the sulphate of atropia,
from one to four grains to the ounce of rose water, is an
essential eye-drop in the treatment of acute iritis, to
break up newly formed adhesions. One drop of atropia
solution in an inflamed eye is a most valuable means of
establishing the diagnosis whether iritic complications
exist or not, and should be used in most cases of eye
inflammation to find out whether there are any adhesions
of the pupil to the lens.
Sixth Aphorism. — Eserine.in solution of one grain to the
ounce of water, is the remeily for |)urely corneal lesions.
Seventh Aplwrism. — When physicians are in doubt as
to the character of an eye (lisease, they should seek a
consultation from specialists who are more familiar with
the eye diseases than general practitioners can possibly
be. Such timely aid ol"ten saves the patient a lifetime of
trouble.
The Medical Record
A Weekly yoitrnal of Medicine and Surgery
Vol. 23, No. 17
New York, April 28, 1883
Whole No. 651
(Dvioiii'il Articles.
SCARLATINAL NEPHRITIS AND ITS COMPLI-
CATIONS.
• By JOHN H. RIPLEY, M D.,
; PROFESSOR OF DISEASES OF CHILDREN IN THE NEW YORK POLYCLINIC.
In the following paper it is intended to consider some of
the more important points of practical interest in the
subject of scarlatinal nephritis. The views therein ex-
pressed are based on personal clinical observation.
Special reference is had to prognosis and tiie indications
for treatment. As it is believed that the great object in
the management of the disease should be to give the in-
flamed kidneys rest by having their work done vicariously,
the number of drugs recommended is correspondingly
small.
The subjoined case presents many instructive features,
and is especially illustrative of the subject under con-
sideration.
W. IVlcG , four and a half years old, had whooping-
cough when two years and a half old, and a year later an
attack of measles. From both of these diseases he made
perfect recoveries, and had had no other important ail-
ment when the present illness began, September 2, 1881,
with fever and vomiting. I was sent for, September 4th,
and found him with the earlier symptoms of scarlet fever.
There was a small area of red rash over the upper part
of the chest and another at the root of the neck behind.
The fauces were reddened, the tonsils swollen, and the
tongue presented its ordinary raspberry appearance in
that disease. The temperature was 103"; the pulse,
160. The skin was hot and tlry, and the patient quite
restless. I prescribed a tepid bath and a diaphoretic
mixture.
Sei)tember 5th. — The rash now covered most of the
body. Temperature, 102° ; pulse, 140. Patient more
comfortable.
September 6th. — About the same. Has vomited twice
since yesterday. Temperature, 102.2°. Urine exam-
ined with negative results.
September i8th.-^io a.m.: Since the last note the boy
has been doing tolerably well, but he has remained peev-
ish and feeble, and the temperature has fluctuated
between 100° and 101.5° during the interval. Desqua-
mation has been slight. The fauces have rejnained con-
gested. The urine has been repeatedly examined, but
there has been no evidence of kidney complication until
to day. Since midnight last night no urine has been
passed, the patient cannot void any now, and there ap-
pears to be none in the bladder. The boy has been
wakeful and restless since early this morning, and has
vomited several times. Pulse, 130; temperature, 101°.
Pressure on the kidneys causes some pain, but it is not
very decided. Flaxseed-meal poultices containing fox-
glove leaves are to be applied over the lumbar region, and
twenty drops of the U. S. solution of morphine are to be
given every two hours until the patient gets quiet and dozy.
September 19th. — Three consecutive doses of the
morphine were given, when the boy fell asleep and slept
for three hours. The medicine was then continued at
intervals of between three and four hours, and quiet thus
maintained. He perspired a good deal throughout the
day and night, but no urine was voided until this morn-
ing (thirty hours) at four o'clock, when he passed about
two drachms which was thick and bloody. He has taken
buttermilk, fresh milk with lime-water, beef-juice and
water, in dessertspoonful doses and has vomited only
three times. He looks very pale and has a dry tongue.
Temperature, ior°; pulse, 130. At times a little deli-
rious. No oedema. Treatment continued. 5 P.M.: After
several fruitless trials he succeeded, about an hour ago,
in passing a couple of teaspoonfuls of urine of the same
appearance as the last. His general condition remains
unchanged. Same treatment.
September 20th. — Sixteen hours after the last urine
reported above was passed, he voided about an ounce
which was of a lighter color than the former ; and again,
four hours later, two drachms. This last I carefully ex-
amined microscopically, after allowing it to stand in a
champagne-glass for half an hour. It contained all the
varieties of casts common in acute scarlatinal nephritis —
hyaline, epithelial, blood, and granular. The multiplicity
of forms of these bodies was a matter of especial interest
to me. There were large and medium-sized epithelial,
and granular, and blood casts ; small straight, and
long, narrow, curved, and colorless casts ; and a number
of small, twisted, worm-like, or i)ig-tail forms. Of the
first two forms there was a large number — a dozen or
more in a single field ( x 500). Besides casts, the urine
contained, of clinical importance, a profusion of red
and white blood-corpuscles and tubular epithelium. This
specimen was not examined for albumen.
September 2 2d. — Urine a little more free ; about four
,ounces having been passed during the last twenty-four
hours. It continues of a dark, smoky color. There is
still no droi)sy of cavities or tissues. Erysipelas appeared
at the left base of the nose last night and now involves
the lower half of the organ and a small area of the ad-
joining cheek. Temperature, 101° ; pulse, 126. Had one
severe attack of vomiting in the night, but none since.
The amount of nourishment has been increased. The
tincture of iron in five-drop doses every three hours is now
prescribed for the erysipelas.
September 23d. — The water is still dark and scanty,
only six ounces having been passed during the last twenty-
four hours. As usual, since the beginning of the kidney
trouble, the boy perspires freely, although less so now
than during the two preceding days. The erysipelas is
fading at the site of the original invasion, but now in-
volves a portion of both cheeks, and these parts are
quite red and tender. The tongue is moist at the edges,
but still dry in the centre. Emaciation has been rapid.
Only one dose of moriihine has been given since yester-
day, and only one attack of vomiting has occurred in the
interval. Pulse, 1 16 ; temperature, 99°. The urine pre-
sents the same microscopical appearances as at the last
examination. About one-third of its volume solidifies with
heat and nitric acid.
September 24th. — Patient improving. He has passed
a pint of urine since yesterday. He is hungry and retains
large quantities of food. The erysipelas is fading.
September 25th. — Still gaining.
September 27th. — The boy has a ravenous appetite.
The urine is now about normal in quantity and of a lighter
color, but contains yet a large number of casts of all
kinds ; those from the smaller tubes being the more' nu-
merous. Less red blood than at former examination, and
more leucocytes. Albumen diminished.
October 6th. — Since the last report the patient has
been gaining until yesterday, which was a poor day ; he
450
THE MEDICAL RECORD.
[April 28, 1883.
was unusually feeble, had no appetite, and his face was
veiy pallid. The urine is again dark and scanty and con-
tains an increase of blood and casts.
October 9th. — Better again. More and lighter-colored
urine.
October 1 ith. — Convalescent. The urine still contains
a few casts, some red blood globules and leucocytes.
October 13th. — Gaining rapidly in flesh. Urine slightly
albuminous and contains a little blood, but no casts.
October 31st. — Urine normal. No sequela;.
The special interest in the above case pertains to (i)
the unusual grouping of symptoms, and (2) the fact that
the child recovered notwithstanding the gravity of the
kidney lesion, which was indicated by both the anuria and
the microscopic ap]5earance of the urine.
Dropsy is one of the earliest and most constant symp-
toms of scarlatinal nephritis. So well established is this
tact that " renal dropsy " and " dropsy after scarlet
fever " have often been used by intelligent practitioners
and writers as synonymous terms with " scarlatinal ne-
phritis." Thomas' recognizes it as one of the initial symi^-
toms, and so does Roberts." Bartels^ says : " The in-
sufficient excretion of water by the kidneys leads to dropsv
— a symptom which is scarcely ever absent in the severer
cases of acute parenciiymatous nei^hritis, although very
often absent in the milder cases. The opinion expressed
by the last-named author quoted is in full accord with my
own experience, and hence I consider it noteworthy that
this boy had not an observable trace of serum-infiltration
during his entire sickness.
In this connection it may not be entirely irrelevant to
state that I have observed in a few instances, in children
suffering from acute nephritis, symptoms which could
most easily be explained by supjjosing pulmonary inter-
stitial adema to be present. Such children had not ex-
cessive anasarca, and the congested face, rapid pulse, and
frequent respirations were suggestive of pneumonia. On
examination of the lungs, however, e little dull tym])anitic
percussion would be obtained, a slight bronchial or rude
character to the respiration, and, perhaps, a few moist
rales would be heard, but nothing indicating either intra-
alveolar tedema or pneumonia. ]f any cough accom-
panied the other symptoms it was dry and short and in-
frequent. The temperature varied, but was generally
from 100° to 103°. Hertz ' recognizes an interstitial
oedema of the lungs as sometimes occurring durin" a
chronic nephritis and giving rise to the " so-called luamic
asthma." But the manifestations and physical signs of
urcemic asthma, as I have observed it, are i)recisely the
same as those of bronchial asthma produced under other
circumstances and by other causes, and besides it will
often quickly and entirely disappear after a full dose of
morphine or a hydragogue cathartic. Now, to account
for urajmic asthma by calling it an interstitial pulmonary
oedema, we must suppose the calibre of the smaller
bronchi to be reduced by the infiltration of their walls at
the same time that tlie alveolar capacity remains unin-
vaded ; for otherwise the sym|)toms and jihysical signs
would not sinuilate bronchial asthma. Such a condition
would seem very improbable. The cases of supposed
interstitial pulmonary osdema which I refer to, lasted
several days each, and, ahhough modified at times in the
severity of their symptoms, there was no complete in-
termission during the whole period of attack.
The low temperature in this case, when considered in
relation to the severity of the onset of the disease, is note-
worthy. Gee ' states that i)yrexia accompanies the onset
of renal drop.sy and is high in proportion to the severitv
of the symptoms. This accords with my own observa-
tions and is the general rule according to most authorities.
In several fatal cases of which I have record, the tem-
perature ranged between 103° and 106.5°. A low tem-
* Ziemsscn, vol. ii., pp. 249-257.
'•' Reynolds' System of Med., p. 651.
' Ziemssen, vol. xv., p. 284.
* Ibid., vol. v., p. 279.
* Reynolds' System of Medicine (H.irtshorne), vol. i., p. 92.
perature, therefore, in otherwise grave cases, may prove
to be of prognostic value.
Prolonged anuria, as one of the manifestations of scar-
latinal nephritis, justly excites the apprehension of the
experienced physician.
Bartels ' says : " Apart from the individual conditions
and complications, the prognosis may be set down as ab-
solutely bad, so far as my own experience goes, in every
case (with the exce|ition of cholera nephritis) in which
the suppression is complete. In no such case have I
ever seen recovery take place."
So, too, Thomas " considers the prognosis unfavorable
when there is "great diminution in the secretion of urine,
or complete anuria for several days with or without signs
of urremia, and with or without fever." West ° expresses
himself still more strongly, as follows : "Of all indications
furnished by the urine none is of such constantly evil
import as a marked diminution in the quantity of that
secretion, especially when such diminution takes place
suddenly ; and in whatever other respects the state of a
patient may differ, complete suppression of urine for a
period much exceeding twelve hours almost invariably-
announces the speedy approach of death." Ahhough the
cases of nephritis from scarlet fever that I have observed
have, in a large majority of cases, terminated in resolu-
tion, still this is the first instance which has fallen under
my observation of a child recovering from acute nephritis
after a total suppression of tlie urinary secretion of more
than fifteen hours. And if I have found the prolonged
suppression of urine in scarlatinal nephritis so uniformly
followed by death, anuria occurring during an attack of
diphtheritic nephritis, even of nnich shorter duration, has
in my experience been equally fatal. I cannot agree
with Jacobi (" A Treatise on Diphtheria," pp. 90-91), that
nephritis is of such rare occurrence at a very early period
in diphtheria, but I believe it is a complication of great
danger, both in that disease and in scarlet fever, when
occurring thus early.
It is very important in these cases of nephritis not to
mistake retention for suppression. Children will some-
times retain their urine in the bladder for many hours
when there is no lack of secretion. Should percussion
over the bladder leave us in doubt, a catheter can be in-
troduced and the question thus positively answ^ered.
A number of cases of jirolonged anuria from acute ne-
phritis have been jiublished, which show how, partly by
vicarious excretion and partly by special tolerance of the
system to the retained poisons, patients have been en-
abled to endure this condition for an unusual period be-
fore a fatal result ensued, and some have even recovered.
Dr. C. Lellman has referred me to a very interesting
case of scarlatinal nephritis, reported by Biermer,* in
which the suppression of urine lasted at one time five
days — fatal. Dr. L. Haupt, of this city, has kindly fur-
nished me with notes of the case of his little nephew, six
years old, who, about the beginning of the fourth week
after an attack of scarlet fever, began to sufler from ne-
phritis, which caused great anasarca, and, at one time, a
total suppression of urine for thirty-six hours. The
child ultimately recovered.' INIeigs and Pepper mention
two cases of prolonged suppression due to scarlatinal ne-
phritis. In the case of a boy between one and two years
old there was no discharge of urine for thirty-six hours.
In the other case, which occurred in a girl between three
and four years old, no urine was passed for five successive
days, and there was no accumulation in the bladder.
The patient suffered very much and i)assed nearly the
whole time in a semicomatose state, but could be roused
and then showed some intelligence and complained of
headache. Vomiting was persistent. She had no con-
vulsions and finally recovered.
I saw, with Dr. L. D. Sproat, a few months ago, a man,
thirty years old, who was taken suddenly with fever, in-
1 Log. cit., p. S91. ' Diseases of Children. Sixth edition.
* Loc. cit, p. 289. * Virchow's Archives, vol. 19.
* Diseases of Children.
April 28, 1883.]
THE MEDICAL RECORD.
451
tense headache, pain in the back, and vomiting. From
the onset of the disease until the death of the patient from
pneumonia, nine days later, only a few ounces of urine
were passed, which was bloody and became nearly solid
by boiling. At one time during his sickness he passed
no urine for three days, and at the end of that period
only about an ounce. For forty-eight hours before he
died he passed no urine. A catheter was several times
introduced, but none found. He had no convulsions,
and delirium was not marked until the last day of life,
when he gradually lapsed into deep coma. His temper-
ature was about 103° until pneumonia developed, about
the seventh day of his illness, when it became more ele-
vated. In this case, as in my own, there was no drojisy.
The theory of Harley ' that "anasarca, in fact, only
makes its appearance when not alone both, but the whole
of both kidneys are so much affected as to be unable to
e.xcrete the urinary ]5roducts," is disproved by such cases
as these. According to Ebstein,^ complete anuria from
nei)hrolithiasis may exist and go on to a fatal termination,
and yet one kidney remain healthy.''
The quantity of albumen alone furnishes no trustworthy
guide for i)rognosis. In some cases of acute nephritis, as
also during acute attacks in old cases, I have seen the
urine rendered nearly solid by coagulating its albumen,
and yet the [mtients make good recoveries, whereas some
of the very worst cases have had proportior.atelv small
amounts of albumen. I have often found it in the urine
of diphtheritic patients in considerable quantities when
casts were absent and other kidney symptoms mild, .^s
is well known, temporary albuminuria occurs in malarial
fever patients, even in cases in which the temperature is
comparatively low, but, as a rule, it disappears without
causing serious complications. I have had no experience
in those rare cases of scarlatinal nephritis associated with
various dropsies in which albuminuria is absent. Bartels
emphatically states that lie has never seen a case of acute
parenchymatous nephritis in which the urine was not al-
buminous, although, in a few cases, he has known the
dropsy to precede the albuminuria for a short time.
However,Thomas, Niemeyer, Reynolds, Frerichs, Steiner,
and others recognize such a form of acute nephritis.
Dickinson ' reports a single cure which came under his
care, with the autopsy.
Philippe, of Berlin, is said to have examined the urine
of sixty patients suffering from scarlatinal anasarca, dur-
ing a certain epidemic, without once finding albumen.
In regard to the prognosis of such cases, Niemeyer speaks
of it as " a sequel of scarlatina as free from danger as it
is inexplicable." Johnson,' however, quotes two cases
from Roberts, both of which were fatal. The autopsy on
the second case, after five months' illness, showed the
kidneys " to be good examples of the smooth white
' Bright's kidney.' "
The number and forms of casts found in the mine
are, in my opinion, of great value in determining tlie
prognosis. A small number of straight casts suggests a
mild attack. Although a large number pretty uniforndy
indicates a severe form of the disease in scarlatinal ne-
phritis, it is of still more evil import in diphtheritic nephri-
tis. This arises from the fact, I believe, that when this
marked form of ne|)hritis occurs in diphtheria, that dis-
ease is in other respects more severe, and the kidney
atfection occurring, as it often does, during the early stage
of the attack, the system has a double poison to withstand.
When all jiarts of the kidney are represented by casts,
as in this case, I believe the gravest apprehension should
be felt as to the result. My own observations are lim-
ited to five cases. One, a case of diphtheria, elsewhere
reported, died (Medical Record, 1880). The second,
1 The Urine and its Derangements.
5 Ziemssen. vol. xv., p. 712.
3 Dr. E. P. Fowler, of New York, published in i8Si an interesting and instruc-
tive monograph. Suppression of Urine, in which he tabulates and conmients
upon ninety-three cases of anuria. In many of these cases the suppression was of
almost incredible duration, lasting in one patient sixty days.
* A Treatise on Albuminuria, p. 74. Second edition. New York.
® Lectures on Uright's Disease.
a young married woman with scarlatinal nephritis, a
patient of Dr. Milne, died. The third, a girl six years
old, also scarlatinal nephritis, died. The fourth, a girl
four years old, nephritis following scarlet fever, died.
Dickinson' has reported a similar case, with a drawing
representing the ajipearance of the casts, which was also
fatal. The fifth, the boy on whose case these remarks
are based, recovered.
No very positive statements can be made from obser-
vations so limited ; but as I have found all these differ-
ent forms of casts present together only in these few cases,
and as all but one have terminated fatally, I infer (i)
that the combination is rare, and (2) that it indicates
a very grave form of the disease. Although it has been
abundantly proved by pathological examinations that casts
a.re for mt'if in the convoluted tubes, some authorities deny
that they are ever found in the urine, it being, in the
opinion of these observers, impossible for such cylinders,
on account of their large size, as inferred from the com-
parative size of the tubes in which they are formed, to
pass through the narrow loojjs of Henle. The force of
this objection is considerably weakened by the fact that
the epithelium of the convoluted tubes is much thicker
than that lining the descending loops of Henle, and thus
the disparity between the calibre of these different tubes
is greatly reduced. .\nd when the cortex of the kidney
is the seat of congestion or inflammation the epithelium
of the convoluted tubes is increased in thickness much
more proportionably than the latter.
In speaking of the anatomy of the convoluted tubes,
Charcot ' says : "The cells which form this lining, as we
know, almost coalesce ; they are voluminous and leave in
the cavity of the tube onlv a narrow lumen." Farther on
he says, " In the descending limb of Henle's loop the
epithelium suddenly undergoes a profound modification ;
we then find only, indeed, a tessellated and clear epi-
thelium, swollen only at the level of the nucleus and
entirely analogous to that presented by the blood ves-
sels." This is substantially in harmony with Flint's ° de-
scription of the minute anatomy of the kidney. If to the
above anatomical facts we add the one in regard to a
physical jiroperty of casts themselves, wherever jsro-
duced, namely, that a certain amount of shrinkage takes
place in them before they are dislodged from the site
of their formation, it seems quite possible that they may
be driven through the narrow looped tubes and subse
quently appear in the urine. Clinical testimony in sup-
port of this opinion is not wanting. Charcot ' says that
"the casts of the convoluted tubes can, indeed, jiass
through this narrow branch only with the greatest diffi-
culty, and we cannot expect to find them o/U/i in the
urine." Cornil and Ranvier assert that " it is certain
that casts formed in Henle's loops sometimes pass into
the urine, and it is probable that narrow casts formed in
the convoluted tubules of the cortical substance may
also be washed out by the secretion of urine." On the
following pages, in describing the different forms of casts,
they say '' at times they resemble a corkscrew, having
the shape of the convoluted tubules in which they are
formed." Under the head of " Casts." Dickinson ° makes
the following statements : "Casts of large diameter are
seen, containing within themselves others of smaller size.
In such cases the small cast has been formed in the
upper or convoluted part of the tube," etc.
Tyson," after mentioning the theoretical objections ad-
vanced against the escape of casts from the convoluted
tubes, and stating that it is easy for them to pass from the
iiitermediarx portion, says, " Whde there are difficulties
in the descent of a cast from the cortex of the kidney,
and while such descent is doubtless more rare, I do not
consider it impossible." Now, casts formed in the con-
• Loc. cit.
= Lectures on Bright's Disease of the Kidneys. Millard's translation.
' Human Physiology.
* Loc. cit.
^ Loc. cit., p. 14.
** Hright's Disease and Diabetes. \
452
THE MEDICAL RECORD.
[April 28, 1883.
voliited tubes would probably retain the general shape
of the mould in which they originate, as is true of casts
from other parts generally, even after passing through
the medullary portion of the kidney, and hence be [latli-
ognomonic. The small, crooked, spiral, or corkscrew-
shaped bodies which I observed in the urine of the boy
whose case I have herein detailed, as well as in that of
the other similar cases referred to, 1 believe were formed
in the convoluted tubes. They resembled those seen in
situ in the cortex of the kidney, and correspond to the
illustrations of Dickinson, Bartels, and others. If they
are not formed in the convoluted tubes it is difficult to
account for their shape. If they come from straight tubes,
and their shape is a matter of accident, they should be
seen oftener and in mild cases. Judging from my own
observations, I should say that they are rarely seen, and
that their presence is a symptom of very great gravity.
.\s bearing on this subject, the following extract of a
letter which I received from Dr. George L. Peabody,
Pathologist to the New York Hospital, more than two
months after I made the inquiries, is of interest :
" . . . I have had the usual crop of diseased kidneys
this winter, and can now answer your questions, I think,
with more certainty and definiteness than I could have
done before. In answer to your first question as to the
comparative frequency of casts in the straight and con-
voluted lubes, I may say that in my experience they are
much more common in the straight ones, and are fre-
quently confined to the straight tubes of the pyramids.
I can hardly say that it is rare to find them in some of
the tubes of the cortex (other than the straight tubes of
the medullary rays) ; but from the anatomical intricacies
of the cortex I do not think that in any given case it is
always possible to say whether the casts are actually in
the convoluted tubes or in the intercalated tubes. In
regard to your second question, I do not now recollect to
have seen casts in the convoluted tubes in any case
where they were not present in the straight tubes." In
regard to the significance of granular casts they seem to
be present at times in the urine in all forms of nepiiritis,
and in all stages and all degrees of gravity of the disease.
Certainly they are common enough in the milder grades of
acute parenchymatous nephritis. If the urine contain
a large number of blood-casts, it is a symptom of grav-
ity.
(To be conrinued.)
The Blue Man of Missouri. — Dr. Thomas F. Rum-
bold reports in the St. Louis Medical and Surgical Jour-
nal the following history of a patient known as the blue
man of Missouri : " Mr. J. S. F , aged thirty-three
years, of Columbus, Mo. At the age of about fifteen
years he took daily from five to ten drops of a solution
of nitrate of silver of the strength of grs. xx. ad 3 j. This
was continued for about five or six months ; at the end
of this time he noticed that his face and hands were get-
ting a peculiar dark color. The color increased for some
time after he discontinued taking the silver solution. The
color of the integument of his face and hands at the present
time resembles a No. 2 lead pencil mark, with a light
sky-blue in it. A stove merchant, who hapjjened to see
him in my office, thought that his face and hands had
the appearance of being colored with a light coating of
stove-polish, which is really a very good description of
his appearance, as the skin of the face, especially, has a
marked polished appearance or a shine to it. The color
is decreased during cold and dry weather, and increased
during damp and hot days. The mucous membrane lin-
ing the anterior nares, the inside of the mouth, the lips,
the under portion of the tongue, the soft palate, tonsils,
pharyngo-nasal cavity, larynx, and vocal cords were all
colored by the nitrate of silver, so were also the mem-
brana lympani and the sclerotic coat of the eyes. The
whole of his body was more or less colored, but not to so
marked a degree."
HEMIAN.^STHESIA AND HEMIOPIA IN
CEREBRAL SYPHILIS.'
Bv L. PUTZEL, M.D.,
NEW YORK.
The symptomatolog}' of cerebral syphilis is almost as
varied as that of hysteria, the most capricious of all neu-
roses. In the present paper I shall not attempt to enter
into the general bearings of the topic, but shall merely
call your attention to a complex of phenomena which is
of such exceedingly rare occurrence in this disease that
my acquaintance with the literature of the subject has
made me cognizant of but one case bearing any analogy
to it, and to which attention will be called further on.
I suspect, however, that the symptoms in question are
not so rare as the infrequency of reference to them might
lead us to believe, but that this is partially accounted for
by the fact that they are not alone usually unrecognized
by the patient but also escape the observation of the
physician unless careful search is made for them. None
of my cases proved fatal, so that post-mortem demon-
stration was impossible, but the peculiar combinations of
symptoms were so well defined that a tolerably exact lo-
calization of the lesion could be ventured upon. At all
events, there can be no doubt that the symptoms in ques-
tion were due to cerebral syphilis. The histories of the
cases are as follows :
C.4SE I. — R. S , admitted to my wards in Randall's
Island Hospital January 13, 1881, a native of this coun-
try, aged forty-seven years ; her family history is unim-
portant ; she is married and has had five children and
two miscarriages. Three of the children died ; one had
an eruption appear upon the body which lasted until
death at the age of nine months ; the other two died in
convulsions, one at the age of nine months, the other at
four months. The patient states that her husband was dis-
solute in his habits.
She has had crying spells for which she could give no
cause, and also a sensation of something in her throat
and vague pains in her head, all of which symptoms
passed off without treatment. About eight years ago she
had a sore throat with a similar condition of the tongue
and lips, and also lost a large quantity of hair from the
scalp. Five years ago she had an iritis in the right eye
together with sore throat ; vision has been impaired ever
since in this eye.
Seven 'years ago she began to suffer from muscular
twitchings in the right leg, occurring during the night.
In the spring of 1879 she first noticed loss of strength in
this limb, accomi)anied by a sensation of cold on the
outer side of the right thigh and leg. About the same
time her attention was called to a dead sensation on the
outer side of the right arm and hand, occurring during
the night ; five months later she also began to lose power
in this limb. These symptoms had been preceded by
occasional burning pains in this region. I'he power in
the arm and leg continued to diminish very gradually un-
til finally the patient was compelled to give up work.
Five months ago she began to notice a loss of general
sensibility over the entire right side of the body, and
about the same time the sense of smell was lost in the
right nostril. There has never been any disturbance of
the functions of the bladder or rectum.
Present condition. — The patient is well nourished ; has
a rather flabby look ; denies drink. There is nothing
noticeable about the face; the muscles can be moved
normally ; the tongue is protruded in a straight line.
The patient masticates better on the left side of the
mouth than on the right.
Special senses : S/g/it. — Can read ordinary newspaper
print at a distance of about twelve inches with the left
eye and at about eight inches with the right. The right
field of vision is much contracted.
^ Rcid before the Section on Practice of Medicine of the New York Academy
of ftiedicine, at a Stated Meeting held February 32, 1883.
April 28, 1883.]
THE MEDICAL RECORD.
453
Smell anil taste. — Absent on the right side, normal
on the left.
Hearing. — The ticking of a vvatcli is heard at a dis-
tance of eight inches on the left side, and very slightly
when pressed directly against the right ear.
Motion. — There is considerable loss of power in the
right arm ; the dynamometer can only be forced to fifteen
on this side, to twenty on the left. The right side of the
thorax lags somewhat during resinralion ; tenderness over
the sternum on pressure. There is considerable loss of
power in the right leg, but no muscular atrophy ; the
tibiae are tender on pressure. The patellar tendon reflex
is increased on the right side.
Sensation. — Tactile sensation is diminished on the
right side of the face, and also over the right upper limb,
the diminution being most marked in the hand and lin-
gers. Can feel nothing but large articles with this hand,
and then is unable to recognize them by the touch.
Over the right leg the patient feels only one point of the
sesthesiometer, although the instrument is separated to
its fullest extent.
Dr. D. C. Cocks, Ophthalmic Surgeon to the hos-
pital, has kindly furnished me with the following notes
of the results of three examinations of this patient's
eyes :
April 22d. — Choked disks, most marked in the right
eye; slight insufficiency of the interni; field of vision
slightly contracted.
June 14th. — V. = i-5. with — ^; the interni are weak,
also the right externus ; the patient states that she sees
double with the right eye when the object is carried to
the right and upward. Examination with the ophthalmo-
scope shows neuro-retinitis.
September 21st. — Left eye : temjjoral side of nerve
looks atroi)hic, but the upper and nasal sides are still in-
distinct. Right eye : nerve indistinct. Patient was or-
dered the anti-syphilitic remedies, and soon showed con-
siderable improvement. Smell is much improved and
she now hears a watch at a distance of six inches on the
right side. The field of vision has expanded slightly.
Taste has not improved. She can now distinguish
articles by feeling them. The muscular power of the
right side has also increased ; grip with the dynamom-
eter, right hand 28, left hand 28.
April I, 1881, the patient was discharged at her own
request, greatly improved.
Diagnosis. — The occurrence of hysterical symptoms
in this patient may, perhaps, lead to the suspicion that
she suflered from hysterical hemianajsthesia, but this view
may be discarded for the following reasons : The mildness
of the hysterical symptoms whicir were really present ;
the absence of convulsive seizures and other phenomena
occurring in grave hysteria ; the gradual and regular
onset of the sym[)toms ; their persistence ; the presence
of organic changes in the optic nerves.
There can be no doubt, indeed, that the cerebral dis-
ease was organic in its nature, and the well-marked his-
tory of syphilis, together with the marked improvement
under the antisyphilitic remedies prove the case to be
one of cerebral syphilis. As is well known, this disease
is characterized by various lesions, by giunmata growing
from the dura or pia mater, by gummatous meningitis,
endarteritis with its sequences, and the occurrence of
gummy growths in the substance of the brain. The de-
velopment of the latter within the brain-substance, i.e.,
not propagated from the periphery, is of exceedingly rare
occurrence, and has been denied by a number of authors.
I have had the good fortune, however, to observe a case
of this kind in which a gumma was found in each corpus
striatum, surrounded on all sides by brain-tissue. To
this category I believe the case under consideration
belongs, since all the symptoms can be readily explained
by the formation of a gumma in the posterior portion of
the white capsule on the left side, and, so far as 1 am
able to judge, by a lesion in no other situation. The
occurrence of softening in this region from vessel changes
is negatived by the slowly ])rogressive character of the
symptoms, their long duration, and the marked improve-
ment under treatment. The branches of the middle
cerebral artery, which supply this portion of the brain,
are terminal arteries, and vessel changes of such long
duration would inevitably have led to disorganization of
cerebral tissue, and a consequent incapacity for the res-
toration which occurred to a certain extent in this case.
The existence of choked disks is also significant in this
respect.
Case II. — Jane O'N , aged thiity-three years; do-
mestic ; admitted as prisoner from the Workhouse, Sep-
tember 19, 1S81.
Family history. — Unimportant.
Previous history. — Patient has been a hard drinker,
chiefly of alcohol diluted with water ; was married at the
age of fifteen years ; had six children, all of whom, with
one exception, died at the age of two to four years.
Denies venereal. She was always healthy until two years
ago, when diplopia developed, with turning inward of the
right eye ; about a week later the right eyelid and face
in the neighborhood of the eye began to swell, and there
were shooting pains in the ball of the eye and the head.
Since that time these parts have been more or less
swollen ; at limes the eye would be closed, then the
swelling would diminish, but it has never been entirely
absent. At the outset she noticed anesthesia of the
right side of the face, but after the lapse of six months
there was marked hyperjesthesia of the upper half of the
right side of the face and forehead and the anterior half
of the right side of the scalp. This has continued to
date, being much worse at times. She has had pain and
ringing in the right ear from the beginning ; during the
last two or three months there has been more or less
deafness in this ear.
About a year ago the legs got weak after standing for
any length of time, the right more markedly than the
left ; there have been slight cramps in the limbs at night.
About two months ago the right arm began to grow
much weaker than the left, so that the patient was com-
pelled to give up work.
Present condition. — The patient is fairly nourished.
Marked tumefaction of the right side of the face, begin-
ning at the lower border of the malar bone and extend-
ing to the upper part of the right side of the scalp and
forehead ; the right eyelid is swollen and partially closed.
There is a perceptible heaviness and dragging of the
right leg in walking.
Special senses : Hearing. — The patient hears a watch
at six inches with the right ear, and two feet with the
left.
Sight. — Left eye normal ; the right field of vision is
narrowed in all directions, markedly in a vertical direc-
tion, to a much less extent laterally. Spots are some-
times seen before the right eye, and, at times, vision is
entirely lost for a short period. Dr. Cocks states that
the right optic nerve shows evidences of neuritis.
Taste and smell are also markedly diminished on the
right side.
Motion. — Considerable diminution of jsower in the ex-
tensors of the right arm and forearm, less of the flexors ;
dynamometer : right hand, 22 ; left hand, 40. There is
slight paresis of the right lower liinb.
Sensation. — Tactile'sensation is abolished in the toes
of the right foot ; markedly diminished on the dorsal and
plantar surfaces, to a less degree on the leg ; it is abol-
ished on the last phalanges of the right hand, markedly
diminished on the front and back of the hand, less on
the arm. Slight diminution of sensibility on the right half
of the trunk except the infraclavicular region ; abolition
on the right cheek from the lower border of lower jaw to
a horizontal line drawn from the lobe of the ear. Exqui-
site hyperesthesia on the right side above this line.
Sensation to pain, heat, and cold correspond to the tac-
tile sensation ; these sensations are all slightly delayed.
Reflexes. — The cutaneous reflexes are abolished on
454
THE MEDICAL RECORD.
[April 28, 1883.
the right side, normal on the left ; all the tendon reflexes
are normal.
Electrical reactions. — The faradic reactions of the
muscles and nerves are equal on both sides ; electro-cu-
taneous sensation diminished and delayed on the right
side.
Diagnosis. — Syphilitic (?) periostitis of that [)ortion of
the cranium and face corresponding to the tumefaction ;
endarteritis of the left middle cerebral arter)', produ-
cing softening of the internal capsule. The patient was
ordered iodide of potassium gr. xv. and hydrarg. bi-
chlorid. gr. Jjt. i. d. After the lapse of two weeks there
was marked improvement in the symptoms.
October 13th. — She complains of steady burning pain
in the epigastrium with a tendency to vomit ; states that
her menses came on four days ago but stopped at once ;
has a sharp shooting pain in the left leg.
October 20th. — The shooting pains in the leg are in-
creasing ; an occasional shooting pain in the left thigh
along the sciatic nerve ; a feeling of crepitation under
the patella. Increased cutaneous reflex in sole of left
foot ; with the exception of the hip-joint, the joints of
the left leg are tender when pressed together ; pain re-
lieved on extending them. Tenderness over the trans-
verse processes- of the spine, chiefly on the left side,
from the middle of the dorsal region to the upper border
of the coccyx ; this is most marked over the last lumbar
and first sacral vertebra;. Marked hyperesthesia over
the left side of the trunk, beginning above at the middle
of the dorsal region, and also over the left lower extremity.
The right side is approximately normal.
The tumefaction on the head is rapidly disappearing.
The dose of the antisyphilitic remedies was ordered to
be doubled and the actual cautery applied, every second
day, over the transverse processes of the spine on the
left side.
Dr. W . O. Moore examined the eyes and found R. V.,
4f,- ; L. v., IJ ; R. Snellen, I.; L. Snellen, IV'. Accommo-
dation good.
November 8th. — The iodide was increased to 3 j. t. i. d.
November 12th. — The pains in the limb have disap-
peared. The patient has made a marked improvement,
with the exception of the special senses, which remain as
at time of admission.
December 2d. — Patient discharged.
The symptoms which developed late in the left leg
may be attributed to spinal pachymeningitis below the
middle of the dorsal region. .-Vlthough syphilis of the
spinal cord is a rare affection, a number of cases have
been reported in which post-nrortem examination showed
the presence of lesions in the spinal cord and its mem-
branes similar to those occurring in the brain.
In this case no direct history of syphilis could be ob-
tained, but the occurrence of periostitis without any
known cause, the irregular distribution of the cerebral
and spinal lesions, and the prompt response to anti-syph-
ilitic treatment, justifies the assumption of constitutional
syphilis.
The question arises whether the disturbance of the
special senses in this patient was peripheral or central in
its nature. I incline to the former view, for the following
reasons :
The disease began with diplopia from paralysis of the
right sixth nerve, and this symptom, when isolated, is
always perijiheral in its character. The trigeminus
and auditory nerves were the next to suffer, and the
same remark holds good with regard to these. In addi-
tion, sypliilitic jieriostitis of the cranial bones is often
combined with pachymeningitis. But perhaps the strong-
est argument in favor of the peripheral nature of the
special sense disturbance is the fact that vision was af-
fected on one side alone. Were the lesion of the optic
fibres central in its origin, it would undoubtedly have
l)roduced interference with vision in both eyes.
Case III. — Cornelius J , aged forty-seven ; jani-
tor, single; admitted December 23, 1S81.
Family history. — .\ maternal uncle became melan-
choly and committed suicide ; a brother and sister died
of phthisis.
Previous history. — .\t the age of fifteen years the
patient had ship-fever and ?mall-po.x ; when sixteen years
old had a chancre and buboes. At the age of eighteen
he states that he had a true syphilitic eruption ; also gives
a history of enlarged glands, pain in the bones, etc. Be-
gan drinking when twenty years old, and has since in-
dulged in protracted sprees from time to time, .\bout
two years ago, after he had been drinking for two weeks,
the patient rose from bed in order to go to the closet,
when he found that the left side was powerless and ap-
parently dead. On the first attempt to step he fell and
was carried to bed. Before the fall he was conscious, ap-
preciated his condition, and called for help ; after the
fall he was unconscious for a few hours. It is stated
that while in this condition he was asked by a physician
with regard to sensation on the left side, but no evidence
of sensibility could be obtained. Upon the return of
consciousness, however, the left side was again almost
normal as regards sensation and motion. A slight feel-
ing of weakness remained in the left leg and has never
disappeared, but the hand was normal. The patient
left his bed the same day, feeling no worse than prior to
the attack. For six months previously he had complained
of pains in the head, and these have continued until the
present time. .\ week later he returned to work and
no further trouble was experienced until four months ago.
At this time he went to bed one night feeling perfectly
well, and, on the following morning, awoke with complete
loss of vision, which lasted five minutes ; he was then
able to see the color of a friend's coat, but required as-
sistance in dressing himself, being unable to see small
objects, such as buttons, etc. He groped his way down
stairs into the yard ; is unable to say how well he could
see, but knows that he could not depend on his vision.
When he reached the yard, he fell upon his back and
rolled on the right side, the left being powerless, and
cried for help. He did not lose consciousness, but re-
members being carried to his room, and was soon able
to see better than when he went to the yard. After
sitting in a chair for two or three hours, he rose, un-
dressed himself, and went to bed. Eyesight was per-
fect then, and the left side caused no inconvenience to
him while undressing. Upon the following morning he
got up after a restless night, but could detect no trace of
the attack of the previous day. The pains in the head
were, perhaps, more severe than usual.
For upward of nine months he has had various at-
tacks of more or less complete momentary loss of vision
while walking in the street. At times he has walked di-
rectly against persons, and, on one occasion, fell into an
open cellar, knocking himself senseless. He found him-
self in the New York Hospital when consciousness re-
turned. .\bout a month ago the patient noticed that his
sight was very poor, and to this he attributes breaking
several articles of glassware intrusted to his care.
Present condition. — The patient is a well-nourished,
healthy looking man ; appetite fair, bowels costive.
There is a swelling in the left temporal region, and a
short incised wound on the left supraorbital ridge, the
result of running into a pillar in a dark cellar. No-
paralysis of the facial muscles ; the tongue is protruded
in a straight line and freely movable ; the movements
of the hands and feet show no perceptible loss of strength
in these parts. The left triceps is weaker than its fel-
low on the opposite side. The dynamometer registers
in the right hand 49, left hand 40. There is no differ-
ence in the power of the lower limbs, except that the
flexors of the left thigh appear to be slightly paretic.
The measurement of the limbs are the same on the two
sides. The patella tendon reflexes are well marked and
equal. 'i"he cutaneous reflexes are lost on the left side
and normal on the right.
Sensation. — There is complete anaesthesia and almost
April 28, 1883.]
THE MEDICAL RECORD.
455
complete analgesia on the left side of the body, bounded
exactly by the median line ; sensibility to heat and cold
is much diminished on this side, but not entirely lost ;
no delay of sensation. The right half is apparently nor-
mal. The patient suffers from a constant pain in the
head, principally in the frontal region ; this is the chief
source of complaint.
Special Sc-nses. — Hearing is much impaired in the left
ear ; he only hears the tick of a watch at two inches on
this side, while with the right ear it can be heard at a
distance of twenty inches ; no perforation.
Sight is impaired in both eyes, especially for near ob-
jects ; he is inclined to close the left eye when unusually
good vision is required. He states that the defect in the
left eye is due to a pustule forming in the eye during his at-
tack of small-pox ; but no remains of this can be detected
at the present time. He reads print at twenty feet with the
right eye that he can only read at ten feet with the left
eye. The pupils respond to liglit and show the reaction
of accommodation. The left half of the normal field of
vision is absent on both sides. The light half of the
field of vision of the left eye is also considerably nar-
rowed. Examination with the ophthalmoscope shows
slight neuro-retinitis of both eyes.
Smell appears to be abolished on both sides.
Taste is also impaired, but no difference can be de-
tected between the two halves of the tongue. Sweet sub-
stances are recognized, but quinine and other bitter
articles produce simply a bad taste and cannot be distin-
guished from one another. A number of seconds elapse
before any taste is appreciated. This patient was sud-
denly discharged without my knowledge, so that I am
unable to describe the further course of the disease.
The diagnosis of this case is surrounded with great
difficulties, and the localization of the lesion can only be
made with a certain degree of probability. It seems to
me most probable that the symptoms are due either to
a diffuse lesion of the cortex of the right occipital lobe,
perhaps gummatous meningitis with softening of the sub-
jacent cortex, or more probably to a lesion of the poste-
rior third of the posterior half of the internal capsule. I
am inclined strongly to the latter opinion, on account of
the very marked loss of general sensation.
Case IV. — Richard B , aged forty years ; fannly
history unimportant ; about two years ago, patient had
an attack of gonorrhoea ; last June hatl some chancres,
which were cauterized, but for which internal remedies
were administered also. Last winter he had rheuma-
tism (?) in both legs, for which he applied turpentine lo-
cally, and states that this application was followed by
the suspicious pigmented spots which are now visible
over both tibia:. At the present time has a slight en-
largement upon the upper part of the right tibia, which
is exquisitely tender on pressure. Also has two patches
of eruption (in the palm of right hand and left forearm),
which look like tubercular syphilides. About July 4,
1882, he became affected with a violent headache, which
lasted uninterruptedly until near the middle of September
(about five weeks after the beginning of his present ill-
ness).
August I, 1882, while crossing the street in order to
enter his house, the patient suddenly became dizzy and
acted as if under the influence of liquor ; he managed to
reach home, but then lost the use of the right siile antl
was carried to bed ; he says that sight was lost for three-
quarters of an hour (whether this loss of vision was real
or merely apparent, and due to the intense vertigo, I was
unable to determine positively). On the following day
the power over the right side was restored and he became
paralyzed on the left side ; he also suffered from nausea
and could retain nothing on his stomach ; the bowels,
which had been regular previously, became very much
constipated, and since the attack he has had but one
movement every eight to ten days ; for the past five
months micturition has been attended with some dif-
ficulty. Contracture and tremor of the paralyzed side
developed soon after the attack, and have been grow-
ing steadily worse ever since. About a month ago the
speech became so thick as to be almost entirely unintel-
ligible ; this condition lasted four or five days, and then
disappeared entirely.
Present condition. — The patient is a fairly nourished
man ; he presents well-marked nystagmus, which, accord-
ing to the statement of his mother, existed from birth.
The movements of the facial muscles appear to be nor-
mal ; the tongue is protruded in a straight line and can
be moved readily in all directions ; speech entirely nor-
mal. Sensation is slightly dulled on the left side in the
lower half of the face. Smell is impaired in left nostril ;
taste is also distinctly impaired upon the left half of the
tongue, both anteriorly and posteriorly. Dr. D. C.
Cocks, to whom I sent the patient for examination,
kindly furnished me with the following report :
" Dear Doctor — I have examined the eyes of Rich-
ard B , but the fundus could not be examined in detail
owing to the rapid nystagmatic movements of the eyes.
First V. = |a with— 30.
" The field of vision is somewhat contracted downward
and outward in each eye. The ophthalmoscope shows
one or two floating bodies in .the vitreous, but no marked
lesion of the fundus. Nystagnuis probably congenital,
but he has better vision than is generally found in these
cases. Yours, etc., • D. C. Cocks."
Upon testing hearing, I found that there was a slight
difference in favor of the left ear in detecting the ticking
of a watch, but that there was a very marked diftcrence
in favor of the left ear in appreciating conversation.
Memory seems to be entirely intact ; the patient ap-
pears intelligent, and states that he has detected no
mental deterioration.
The left arm is fiexed at the elbow and at the wrist
and fingers. After considerable effort on my part, the
limb can be extended completely ; but this passive ex-
tension is attended with some pain.
The limb is almost completely paralyzed, the move-
ments being extremely limited. Upon comparison with
the right side, the limb appears to have undergone general
atrophy. Measurements : right forearm, \o\ inches ; left
forearm, 9 J inches. The muscle? are somewhat softer than
those of the opposite side. There is slight anaesthesia of
the entire limb, most marked in the fingers. The tendon
reiiexes are enormously increased, particularly those of
the biceps and triceps ; the mechanical excitability of
the muscles is also increased markedl}'.
The loss of power in the 'left lower limb is much less
marked than in the upper. In walking the limb is moved
stiffly, and is not bent at the knee ; movement is often
attended by involuntary tremor. Atrophy of the lower
limb is also evident. Measurements : right calf, \t,^
inches ; left calf, 1 2 \ inches. The muscles are somewhat
flabby, and the limb feels very cold to the touch. Sensa-
tion is diminished throughout the entire lower limb and
to a more marked extent than in the upper. There is
an enormous increase of the patellar tendon reflex and
ankle clonus, the entire limb being thrown into violent
spasmodic movements upon tapping the ligamentum pa-
tella; or the tendo-Achillis. The knee phenomenon can
be produced also by tapping the tibia or the muscles of
the thigh (these reflexes are also exaggerated consider-
ably in the other limb).
In some of its features — viz., the evidences of descend-
ing degeneration of the lateral column (increased tendon
reflexes and contracture) and of secondary atrophy of the
anterior horns of the spinal cord (early muscular atrophy)
— this case resembles very closely the histoiy of a case
which I had the honor of reading before this Section a
year ago, and in which the diagnosis was confirmed upon
autopsy. With regard to the cerebral localization, I
must confess to an inability to make a diagnosis, unless
we assume the occurrence of two lesions — one which has
given rise to the loss of hearing on the right side, and
concerning whose situation I am unwilling to ofter ary_
456
THE MEDICAL RECORD.
[April 28, 1883.
opinion whatever ; the other probably in the posterior
part of the right internal capsule.
A comparison between this and the preceding case re-
veals an interesting diagnostic feature bearing on locali-
zation. Anatomical investigations, which have been
confirmed by a few pathological facts, have proven that
the anterior two-thirds of the posterior half of the inter-
nal capsule are occupied by the pyramidal (motor) tracts
and the posterior third by the tracts for general sensation
and special sense. In the preceding case, therefore, we
may assume that the lesion involved almost exclusively
the posterior third of the internal capsule, since hemi-
anassthesia and hemiopia were almost the sole symptoms,
motion being unimpaired, while in the present case the
lesion affects chiefly the anterior two-thirds of the poste-
rior half of the capsule, and extends very little into the
posterior third, since motion is affected most profoundly,
general sensation to a moderate extent, and the imjiair-
ment of sight is limited to a small part of each field of
vision.
The following case reported by Dowse (" Syphilis of
the Brain and Spinal Cord," p. 92) is the only one wliich
I have been able to find in the literature of the subject
which at all resembles those reported above :
"C. A , aged thirty-three years, contracted syphilis
when young. At the age of twenty-nine he began to
suffer from attacks of headache, vomiting, and a
sense of numbness of the entire right half of the body,
but consciousness was scarcely if at all interfered with,
neither was voluntary power. The fit commences with
dimness of sight, leading to total blindness of the right
eye, diplopia during the seizure, but immediately preced-
ing it there was hemiopia (no retinal change). There
were no formications, but the right half of the tongue be-
came numb, as well as the parts applied by the sensory
division of the nerve and pharyngeal plexus. Taste and
smell were both lost on this side, and saliva flowed freely
from the mouth. Then the tips of the fingers of the
right iiand became numb, and rapidly the whole of the
right half of the body became involved. This condition
usually lasted twenty to thirty minutes, the numbness de-
parting inversely to its arrival. Between these attacks
he says that he feels all right except that he is a little
confused in his mind. The right lialf of the body during
the fit is colder and paler than the left, and at ordinary
times there is slight impairment of tactile sensibility and
the special senses. He denied ever having had a fit,
neither had he found his tongue bitten, or his bodv
bruised when he awoke in the morning, but the pillow
was always wet with saliva. I had him watched carefully
at night, and there was no doubt whatever about his
being the subject of epilepsy during sleep, but of this he
was quite unconscious.
" The i>atient was cured by the administration of iodide
of i^otassium in two-scru|ile doses every other night, with
Donovan's solution three times a day."
The history of my first two cases illustrates a point
with regard to the prognosis of cerebral syphilis of long
standing, to which I desire to call attention, viz. : that
the current opinion with regard to the read)' curability of
this disease should be modified to a considerable extent.
According to my experience, the most we can hope for
except in cases of simple syphilitic epilepsy (which are
generally due to gunniiata of the dura mater or pia
mater) is a considerable improvement in tlie symptoms
and their maintenance at the minimum. In a certain
proportion of cases, especially those due to lesions of the
vessels, the disease terminates fatally despite all our
endeavors. I may state, however, in this connection,
that, during the last few years, I have seen much fewer
autopsies upon fatal cases of cerebral syphilis and have
observed a less number of cases in practice than in
former years. I believe that this condition of affairs
must be attributed to the greater length of lime during
which the profession now subject syphilitic patients to
appropriate treatment. At least, no other cause appears
to me to be adequate to explain such a marked change
as that to which I have referred.
A word with regard to the frequency of the disturbances
of the special senses and of general sensation occurring
in the cases reported above. The conclusion has been
forced upon me by my clinical experience during the past
year or two, that heniianaisthesia, either of the special
senses alone or of these in combination with general
sensation, is much more common in organic diseases of
the brain than is generally supposed. I have observed
these symptoms well marked in at least half a dozen
cases of the ordinarv form of hemiplegia, due either to
hemorrhage or embolism, and in none of them were the
patients aware of anv sensory disturbance. In the pres-
ent unsettled state of the question of cerebral localiza-
tion, it may be well worth our while to bear this fact in
mind, in view of the light which it may shed upon the
subject, and to examine the condition of the special
senses, as a matter of routine, in all cases of organic dis-
ease of the brain.
Since reading the above paper I have found a refer-
ence to the subject under consideration in Fournier's
book " La Sy|ihilis du Cerveau." After stating that
syphilitic hemiplegia is complicated with hemianesthesia
in very exceptional instances, he narrates the following
case :
" This woman presents a left hemiplegia of undeniably
syjihilitic origin. You will observe in her both motor
troubles of an uncommon intensity and very marked sen-
sory disorders. The entire cutaneous surface on the left
side is absolutely anaesthetic to contact, pain, and tem-
perature. The mucous membranes on this side are also
insensible. Furthermore, you will find, on the left side,
sight abolished, hearing almost extinguished, taste and
smell very much enfeebled."
In conclusion Fourni'er places the lesion in the pos-
terior third of the internal cai)sule.
In this case, however, the imperfect history does not
permit us to decide whether the sensory symptoms may
not have been of an hysterical character. It is a sus-
picious circumstance in this connection that the disturb-
ance of vision was limited to the left eye. In intra-
cerebral lesions, followed by affections of sight, both eyes
are always aftected. In the absence of any statements,
therefore, concerning the condition of vision in the right
eye, the question must be left undecided. Perhaps, as
has been shown with regard to a number of cases of
cerebral hemianassthesia reported by Charcot and his
pu])ils, hemiopia was really present but had been over-
looked.
The Efficacy of Bromide of Ethyl in Short
Operations. — Dr. Chisolm thus describes the efficacy
of the bromide of ethyl in operations on the eye:
"A little girl eight years of age, who had strabismus,
was put on the operating table, and told that the folded
towel containing a teaspoonful of bromide of ethyl
would feel choky when placed over her nose, but that
she should breathe it freely nevertheless. In perfect
confidence she commenced to breathe freely from the
towel placed over her face, and in twenty-two seconds
by the watch she was fast asleep. The operation of di-
viding the faulty muscle did not occupy nnich more than
one-halt of a minute. After two minutes of sleep she
awoke and expressed herself as not knowing what had
been done. Within three minutes from the connnence-
ment of the inhalation, the child was perfectly awake and
was ready to get from the table. AN'hen on the floor she
walked at once to the chair, and witliin four minutes from
the lime that the anitstiiesia was commenced, she was
engaged in pinning roses into the front of her dress, with
a composure whicli siiowed not only no present discom-
fort, but also a complete oblivion of the experience
through which she iiad just passed. In less than sixty
seconds by the watch, an ugly deformity had been pain-
lessly, perfectly, and permanently eradicated."
April 28, 1883.]
THE MEDICAL- RECORD.
457
CHLOROFORM NARCOSIS DURING SLEEP.
By JOHN H. GIRDNER, M.D.,
NEW YORK.
The impression is very general, both among the profes-
sion and the laity, that if chloroform be inhaled by a
person while asleep, that person may pass from a nat-
ural sleep to a chloroform narcosis without returning to
consciousness. This is sufficiently proven by the fre-
quent accounts pubHshed in the daily papers of burglars
having chloroformed their victims while asleep, and also
by the fact that from time to time medical men testify
under oath that such a thing is possible.
It is to throw light on this subject that I write this ar-
ticle. The evidence wiiich comes to us from the secular
press, tending to prove that such a thing is possible, will,
I think, appear at once to be of little value from the
standpoint of scientific inquiry, because these reports are
written by reporters who have no eye to establishing the
truth or falsity of the theory, and if they did, are never
in possession of the proper facts to enable them to sjieak
with even a moderate degree of certainty. It is gener-
ally stated that the smell of chloroform was detected in
the room the next morning after the robbery. The odor
of chloroform does not remain many hours in a room, be-
cause it IS so volatile, and if the odor is really detected
it is far from just to argue from that fact that the occu-
pants of the room had been placed under the influence
of the drug.
As to the testimony of medical experts, I may say that
I am not willing to accept their statements that a person
may be chloroformed while asleep without being awak-
ened, because the evidence on which they base this
opinion is anything but conclusive. The few e.xperi-
ments which have been made by these experts were not
reliable tests, because the parties on whom they experi-
mented were aware that at a certain hour of a certain
night the doctor would make the experiment, and a de-
sire on the part of the subjects to have the experiment
succeed may have been strong enough to tempt them to
simulate narcosis. At any rate, no experiment of this
kind can be considered as evidence one way or the other,
unless the subject on whom the experiment is made is
ignorant of it, and not a willing party to the affair.
The experiments which I here give in detail were
made by another medical man and myself, and I may
add that we had both had large experience in the ad-
ministration of anassthetics, and that every possible pre-
caution was taken that no error should creep into the
result. The V'srsons on whom we experimented were
entirely ignorant of our intention to administer chloro-
form or anything else to them while asleep, and, in fact,
we had told no one of our intentions.
It will be seen, therefore, that these experiments were
made solely with the desire of arriving at the scientific
facts, and under the best possible conditions to that end.
At twelve o'clock on the night of January 31, 1882, I
went to the hospital through a terrific snow-storm, and
together with Dr. , a house surgeon, we made tiie
following experiments :
I. — A little girl, aged twelve, was sleeping soundly,
breathing slowly and regularly. Chloroform was poured
en a folded towel and held eight inches from her face,
and slowly and carefully brought nearer. At the end of
about three minutes she coughed, awoke, and sprang
upright in bed.
II. — Man, aged thirty-two, sleeping soundly. Chloro-
form used as before. At the end of about three minutes
he awoke, coughing and striking out with his hands.
III. — Man, aged thirty-five. Chloroform given as be-
fore. At the end of three minutes he awoke, coughing
and attempting to remove the towel from near his face.
IV. — Man, aged thirty. Acted as the others : woke
at the end of about three minutes, coughing and re-
sisting.
V. — Little boy, aged eight. Awoke at end of two
minutes, coughing and struggling.
Here, then, are five experiments, made under the
most favorable circumstances, and on both children and
adults, and in each case the subject awoke at the ex-
piration of three minutes, or about the time the nervous
system was beginning to be profoundly impressed with
the drug ; all awoke suddenly, with coughing and resist-
ing, or attempting to tear the towel from near the face.
These experiments must then be taken as prima facie
evidence toward the establishment of the fact that it is
impossible to transfer an individual from a natural to a
chloroform sleep without an interval of perfect conscious-
ness, during which he would be able to appreciate his
situation, and if force were used to carry on the anaes-
thesia to unconsciousness, the person would still be able
on awaking to recall to mind the person who used the
drug.
While many will doubtless require a larger number of
experiments before giving a decision, there are some
who will see sufficient evidence in these five experiments
to satisfy their minds that every experiment of this kind,
made for whatever purpose, will have a like termination.
THE ECCENTRICITIES OF ATROPINE.
By G. sterling RYERSON, M.D.,
LECTURER ON THE EYE, EAR, AND THROAT IN TRINITY MEDICAL SCHOOL, TORONTO.
Case I. — Master M was brought to me on March
5, 1881. He is a delicate child and an only son, of
highly nervous temperament, dark hair and pale com-
plexion. He complained of pain about the eyes after
reading ; watering of the eyes, slight congestion of con-
junctiva and periodic alternating convergent squint. I
diagnosed H = i D. with ophthalmoscope, and as he re-
jected all glasses, I ordered two drops of a solution of
atrop. sulph., gr. iv., aq. dest., |j., to be dropped into
eyes twice a day and to return in two days ; this was at
10 in the morning. About 2 p.m. I received a mes-
sage to go at once and see the child, as he was very ill.
On arrival I found him covered with a rash closely re-
sembling a scarlatinal eruption. The pupils were dilated
ad max.; breathing quick, pulse huiried, throat dry and
parched, with difficulty in speaking. He also complained
of numbness of the extremities. I felt strongly inclined
to give a hypodermic injection of morphia, but thought
it prudent not to do so unless forced to it by the urgency
of the symptoms, inasmuch as the parents were already
sufficiently alarmed, and the proposal would not have
iielped to calm their fears. Upon inquiry the mother
positively assured me that she had only put in one drop
in each eye about half an hour before I was called. This
lady was most intelligent, and I have every reason to
credit her statement. The symptoms gradually s\ibsided
and in thirty-six hours the boy was playing about as
usual. The mydriatis continued for some days, and
there was partial paralysis of the accommodation for
some weeks after. The jiatient made a good recovery.
Case II. — In October, 18S2, an infant, one year and a
half old, was brought to me with congenital cataract.
Proposing to dilate the pupil prior to needling, I dropped
into the eyes two or three drops of a four-grain solution
of atropine. Within fifteen minutes the child was covered
with a scarlatinoid rash and it seemed to have difficulty
in swallowing. The ]nipils only dilated sluggishly. The
rash subsided gradually.
Case III. — When assistant to the late Mr. Soelberg
Wells at the Moorfields Hospital an elderly woman came
to the clinic with spasm of accommodation and symp-
toms of irritability of eye, due to prolonged use at her
trade as a dressmaker. I ordered atropine to be dropped
in. In a few days the symptoms yielded, but after
the atropine had been stoiiped for some time the pupil
still remained dilated and fixed. The acconnnodation
also was paralyzed. Eserine and electricity were used
458
THE MEOrCAL RECORD.
[April 28, i88;
with but little benefit, and when I saw her last, some
months later, there was but little improvement.
Case IV. — In the fall of 1880 an ex-postiiiaster, aged
seventy-eight, consulted me with regard to senile cataract,
and a week or so later I did a Moorfield's extraction in
the left eye. Ordered atropine (gr. iv. ad 3 j.) to be
dropped in, and was horrified ne.xt day to find the lid
much swollen and excoriated, and a sharp attack of con-
junctivitis. There was a little pain about the eye. I
could not make out iritis after a careful examination of the
eye. The edges of wound looked well. I immediately
stopped atropine and gave eserine sulph., gr. ij. ; aq. dest.,
I j. The symptoms subsided rapidly, and beyond a
somewhat persistent conjunctivitis I was not annoyed
by any more unpleasantness on the part of the con-
junctiva
Remarks. — I am induced to give publicity to these
cases of atropine idiosyncrasy for several reasons.
Cases I., II., III. have a medicolegal aspect. It
would not have been difficult to trump up a charge of
malpractice in these cases, and their record in a medical
journal of repute may be of assistance to the practitioner
should he be so unfortunate as to be placed in such a
predicament. It may serve also as a warning against
the too free use of atropine in refraction cases, and I
would strongly advise preliminary use of atropine in
cataract cases as a safeguard against optic accident.
Further, they serve to show how small a dose of atropine
may in certain individuals produce severe constitutional
symptoms.
MENTHOL VERSUS PAIN.
By D. M. cam MANN, M.D.,
NEW YORK.
When the temperature of the oil of peppermint is low-
ered sufficiently it deposits small, colorless, prismatic
crystals. These are called peppermint camplior, or men-
thol. Menthol is only slightly soluble in water, but dis-
solves readily in alcoliol and ether, and iii oils both fixed
and volatile. Until lately it has not been used in thera-
peutics, but strong oil of peppermint painted over tlie
part has long been a favorite mode of treatment in China
for gout and neuralgia. Menthol has antiseptic proper-
ties similar to thymol.'
In a letter to The Lancet, Mr. Macdonald, a student at
Edinburgh, records the use of menthol in a solution of
one part to sixty of rectified spirits, in cases of facial
neuralgia, and writes, " relief was had in from two to
four minutes, and within one or two minutes at most,
after this, the then existing attack was cured." He
also recommends the application of the crystals on cotton
wool in cases of toothache." In all my cases the follow-
ing formula was used :
5 . Menthol ." 3 j.
Alcohol 2 ss.
M.
It may be painted on the part several times daily with
a camel's-hair brush. No precautions are necessary in
its use, except to keep the solution from the eyes. It is
rather agreeable than otherwise, except when applied
over a large surface it may cause a feeling of chilliness.
Several of my jjatients now keep it always at hand, and
ai)ply it wlien they feel an attack coming on. One of
my cases was a boy, seventeen years of age, who had
suffered with intermittent fever. At the time of exami-
nation he had had no chills for several weeks, but since
they had ceased he suftered with severe pains over the
spleen, from which he was never entirely free. The
spleen was found to be enlarged. He was told to paint
the side with tincture of iodine. \n a few days he re-
turned saying the pains were no better. Menthol was
then prescribed. .\ few days after the pain had entirely
disappeared. Another case is of a lady who has had
facial neuralgia for several years. She has tried many
drugs, including chloral hydrate, bromide of potassium,
quinine, and chloroform liniment externally. She is al-
ways benefited by quinine. During the last attack she
used quinine, and also menthol. She recovered more
rapidly than from former attacks, the pain disappearing
in a short time. She was surprised herself at the rapid-
ity of her recovery.
In addition to the above I have used menthol in cases
of lumbago, facial neuralgia, fugitive chest pains of pul-
monary phthisis, intercostal neuralgia, pleurodynia, gas-
tralgia.' In all the cases in which internal medication
was beneficial, menthol seemed to hasten its action ; in
some cases in which both external and internal remedies
had been without avail menthol gave relief. In some
cases it has failed, but I have been surprised to see that
sometimes very obstinate cases have yielded to its influ-
ence. It has acted well where tincture of iodine, chloro-
form liniment, and other local applications have failed.
Nor in many cases is the result only temporary ; the
pain may return after the first two or three applications,
but if the treatment be persisted in for a few days a cure
may often be effected. It seems, then, that in menthol
we have a drug of considerable value in some of the less
dangerous but most troublesome ills that flesh is heir to.
*The Lancct» August 30, 1879.
' Ibid.
A NOVEL MODE OF CLEANSING THE VAULT
OF THE PHARYNX.
By G. FAIRFAX WHITNEY, M.D.,
NEW YORK.
F , a railroad conductor, aged forty-six, presented
himself at my clinic at the New York Post-Graduate
Medical School, complaining of having been afflicted dur-
ing the last four years with post-nasal catarrh. He also
stated that he was continually annoyed by hard lumps of
mucus collecting in the upper part of the pharynx, and
that the only way they could be dislodged was by being
scraped away with the tip of his tongue. Upon being
requested to perform this feat, he, much to my surprise,
depressed the base of his tongue and inserted its tip be-
tween the velum palati and the vertebral column. I
was unable to perceive by merely looking through the
mouth to what height the tip of the tongue readied, but
by making an examination through the anterior nares I
was enabled to see that the tongue approximated the
vault of the pharynx, yet could not determine positively
whether it came into actual contact ; but, judging from
the patient's statement, am of the opinion that such was
the case. The patient could readily move with his
tongue a probe inserted through the inferior meatus, pro-
vided it protruded slightly through the posterior nares.
A rhinoscopic examination revealed no collection of
mucus upon the vault of the pharynx, and the patient,
when asked whether he could detect any, replied in the
negative, adding that immediately before entering the
room he had removed with his tongue a hardened lump
which he had then expectorated ; but that though he
could not detect any mucus, he could distinctly feel a
depression with the tip of his tongue. This depression
may have been a slight concavity of the vault of the
pharynx immediately back of the pharyngeal tonsil, or
it may have been the posterior nares. The anatomical
structure of the parts was normal, with the exception of
the fntnuin Hngum, wliich was merely represented by a
lax fold of mucous membrane. The tubercle upon the
anterior arch of the atlas was unusually prominent, and
the patient could easily detect its presence with his
tongue.
Remarks. — Thougli this case is, I believe, the only one
of its kind reported, 1 do not doubt but that there are
many more existing to which attention has not been
1 My thanks are due to Dr. David Magie for the report of several cases of the
use of menthol.
April 28, 1883.]
THE MEDICAL RECORD.
459
called. It seems very probable that one whose frajnuni
lingua: has been severed in childhood can readily acquire
the power of introducing the tongue into the upper
pharynx. In the above-reported case there was no his-
tory of any such operation having been performed.
^vocjvcss of IjWctUcal Science.
Dissociation of the Auricular and Ventricular
Rhythm. — Dr. Chauveau recalls the case {Lyon Medi-
cal, February 4, 1883) previously recorded by Dr. Fi-
guier, of a man in whom the radial pulse indicated but
twenty-four cardiac pulsations per minute, while the
auricles contracted about si.\ty-five times per minute.
The ventricular rhythm was perfectly distinct from that
of the auricle, the two pulsations coinciding only occa-
sionally and without any apparent regularity. Some
cerebral symptoms were present, notably vertigo. The
writer argues that this singular dissociation of rhythm
was due to a bulbar lesion involving the roots of the
pneuniogastrics ; for experiment has shown that if the
right pneumogastric nerve be divided and the peripheral
portion be slightly irritated, the ventricular systole is
slowed, while the auricular contraction is unaffected.
Renal Inadequacy. — Under this title, Dr. Andrew
Clark {British Medical Journal, February 24, 18S3),
describes a class of cases which, in some measure, he
ventures to separate entirely from Bright's disease, in
which the kidney, without any sensible alteration of
structure that modern means of investigation will enable
us to determine, cannot produce a healthy urine. Such
kidneys produce a urine which, assuming the quantity to
be a quantity of health, is low in density, and is deficient
in solid constituents, principally the constituent of urea
and its congeners. This condition may be regarded as a
very early stage of Bright's disease, but the writer thinks
it of practical value to recognize by a distinct name a
state which may remain as it is during the whole period
of life, which is nevertheless capable of removal, and
which if unnoticed may lead to serious injury to the
patient.
Such patients are characterized by three things par-
ticularly : I. By a curious inability to properly repair
damages done to them either by accident or by disease.
2. They not only repair damages slowly, but are peculiarly
vulnerable ; they catch coULfor example, easily, and get
rid of it with difficulty. 3. One can never be sure of the
result of the performance of an ordinary surgical opera-
tion upon them ; they die from a simple operation by
hemorrhage, or have an ordinary abscess opened and be-
come pyremic.
Dr. Clark says that he knows of no symptoms in the
early stage whereby these cases can with certainty be de-
tected. In general, however, he states that " When you
get hold of a patient who is ill, suffering from dyspepsia
or nervousness, having headaches, and complaining of
malaise and weakness, who cannot sleep well, who can-
not do his work very well, examine his urine, and if you
find that the urine is low in density yO-i had better pro-
ceed a little further, and be very precise, and get the
urine of twenty-four hours, and if you find that it is under
fifty ounces in quantity, that it has not a specific gravity
of loio, and that the urea in it is deficient 'in amount —
under two per cent. — then, whether there be albumen in
the urine or not, whether there be any casts or not,
whether there be granular debris deposited or not, you
may know with certainty that the kidney is not doing its
duty."
It may not be that this defect is the cause of the pa-
tient's ill health, but if it is found in addition that an in-
crease of food makes the patient worse, and that, within
certain limits, a diminution of food makes him better,
there need be little doubt of it. As these cases of renal
inadequacy progress if they be not well managed, that
is, if the management be not adjusted to the fact that
they are chimneys being choked, and that a roaring fire
cannot be kept on, they develop exceedingly character-
istic symptoms, symptoms so like those observed in
myxcedema that they can scarcely be distinguished. Dr.
Clark cites two autopsies on patients who presented the
symptoms of renal inadequacy, one in the earlier, one in
the later, stages, in which none of the gross appearances
of renal disease were piresent.
In the way of prognosis it may be said, in regard to
these cases, that if care be taken, if compensation be made
for the defective kidney, they probably may go on in-
definitely, that is, they may reach the full term of life al-
lotted to man.
Treatment should consist in close attention to simple
physiological laws and careful adherence to such rules in
regard to diet, clothing, temperature, and exercise as are
generally laid down for chronic albuminuria.
Expulsion of a Calculus through the Vesico-
vaginal Wall. — Dr. Polaillon reported to the Soci^te
de Chirurgie de Paris {France Me'dicale, February 17,
1883) tlie following case : A woman, seventy-two years
of age, suffered greatly from pain, especially during the
act of micturition. An examination per vagina was made,
and a hard body being felt, the physician gave a diagnosis
of carcinoma. One day the patient experienced more
severe pains than usual, and passed some blood. Putting
her finger into the vagina she felt a hard body, which
she supposed to be a piece of bone, and which she man-
aged by violent efforts to expel. It proved to be a cal-
culus of oxalate of lime with a phosphatic crust. It
weighed 4f ounces, and measured xf inches in length, 2|-
inches in thickness, and 2^ inches in width. The patient
was afterward lost sight of, and it was not known whether
the vesico-vaginal fistula ever closed.
Effects of External Temperature upon the
Body Heat. — Dr. Nasarofl" has been experimenting upon
rabbits to determine the effects of sudden elevation and
lowering of temperature. The animals were first placed
in a room the temperature of which varied from 100^ to
130°. Partly grown or fasting rabbits responded more
quickly to the influence of the hot air than did full-grown
animals or those that had just eaten. The body tempera-
ture rose at first slowly, but when 110° was reached the
increase was more rapid — about 3.5° in ten minutes. If
the animal were removed quickly from the chamber when
a temperature of 1 1 1° was reached, it recovered promptly.
The only results of such an elevation were a momentary
sinking of the temperature below the normal and a tem-
porary albuminuria. In cases of death the striated mus-
cular tissue as well as the liver and kidneys were seen to
be darker than normal. There was also a stasis in the
capillaries. In experiments upon the abstraction of heat,
young and fasting animals responded more quickly.
They were placed in water of 32.5" to 53.5°, and re-
covered after a lowering of the body heal to 68°, but a
temperature of 60° was fatal After numerous repeti-
tions the animals acquired an increased heat-forming
power and were less readily affected by the surrounding
temperature. Nasaroff states that the effects upon the
internal organs of sudden change of temperature are too
insignificant to account for disease from ''catching cold."
Drs. Richet and Rondeau have also been conducting
somewhat similar investigations to determme the mode
of death by freezing. The first change was noticed in
the respiration, which became at first shallow and then
irregular. Life could be preserved longer if artificial
respiration were practised. Next the heart was affected,
the pulsations becoming markedly slowed. When the
temperature fell below 62° the nervous system became
affected. The loss of the power of voluntary movements
preceded that of reflex movements. The corneal reflex
was lost before the muscular reflexes of the lower ex-
tremities. Sensibility to pain and electrical irritability
460
THE MEDICAL RECORD.
[April 28, 1883.
were also lost. Although the animal was apparently
dead, it could often be resuscitated by warmth and arti-
ficial respiration. The pulse returns first, then reflex
movements ; respiration is next established, and last of
all to return is the power of voluntary movements. The
practical value of these experiments lies in the demon-
stration of the possibility of recovery in apparent death
from cold by means of warmth and artificial respiration.
— Centralblatt fiir Klin. Medicin, January 27, 1883.
Misleading Cardiac Murmurs and Expiratory
Auscultation of the Heart. — Dr. Hamilton Osgood
describes, in the Boston Aledical and Surgical Journal of
March 29, 18S3, a cardiac murmur occurring independ-
ently of an;Bniia or heart-lesion. The murmur was sys-
tolic in point of time, located in tlie pulmonary area,
with but little propagation, and was soft in tone, yet with a
suggestiveness of friction. The man, an applicant for life
insurance, was the picture of health, not a trace of anK-
mia, had never had rheumatism nor pleurisy, and never
experienced the slightest dyspnoea. The murmur was
discovered to be more faint during expiration. Acting
upon this suggestion. Dr. Osgood instructed the man to
make efforts at expiration and then to hold his breath.
When this was done the murmur was found to have dis-
appeared. The author thinks the murmur was due to
some slight irregularity of surface in the pericardium
near the base of the heart. During inspiration the pul-
monary pressure increased the friction created in systole,
while in expiration pressure was removed. He recom-
mends the practice of auscultation of the heart during
forced expiration, when the lung is collapsed, and the
heart rests more directly under the ear of the ausculta-
tor. True endocardial murmurs become more distinct
during exi)iration, while murmurs like the one described
disappear.
The Mechanism of Lachrv.mal Conduction. — In
a monograph entitled "Die Muskulatur der Thranemi'ege
und der Augenlider,'' published in Stuttgart, Dr. G.
Krehbiel, of New York, embodies the results of a pains-
taking anatomical study of the lachrymal apparatus. He
states that the tensor tarsi muscle arises by two roots,
the anterior and inner root from the crest of the lachry-
mal bone, the other behind and external to the first.
Immediately after their origin the fibres of the two roots
become interwoven, enclosing in their meshes the canalic-
uli and the ducts of the Meibomian glands. Thus the
tarsal portion of the orbicularis muscle is formed of inter-
mingled fibres from both roots of Homer's muscle, but
those from the inner root run mostly along the lower lid,
and the others along the upper. The author thinks that
the tensor tarsi sliould be regarded as a muscle distinct
from the orbicularis. When in action it exerts a consid-
erable comiiressing force upon the canaliculi, and in so
doing occasions the normal periodical emptying of these
tubes. It lias nothing to do, however, with the expulsion
of the contents of tlie lachrymal sac. The latter is cov-
ered on its lateral wall, for the most part, by an aponeu-
rosis from which arise fibres of the orbicularis palpebra-
rum. The contraction of these fibres causes a widening
of the lachrymal sac. Thus, at every closure of the lids,
two synchronous actions are caused. The lachrymal
sac is dilated by the fibres of the orbicularis, and the can-
aliculi are compressed by the tensor tarsi. The en)pty-
ing of the lachrymal sac is occasional by atmospheric
pressure, which exerts its influence the moment the eyes
are opened and the orbicularis is relaxed. When the
eyes are open the canaliculi act like capillary tubes to
suck in the tears. If an unirritating colored fluid be
dropped into the outer corner of tlie eye and winking be
restrained, its presence in the nasal cavity is very quickly
made manifest.
Treatment of Gouty Pains and Neuralgia by the
I'.XTERNAi. Application of Nitrate of .Silver. — Dr.
Fronmiiller advocates the external use of nitrate of sil-
ver to relieve the pain of gout and certain neuralgias.
He relates several cases in which this practice was fol-
lowed by the most gratifying results. The solid stick is
to be rubbed over the moistened surface for about thirty
seconds. When the skin is dry it is to be covered with
a compress of salicylated cotton, which should be re-
moved once or twice a day until the blister is healed.
The caustic is to be rubbed over the affected joint in
gout, and in neuralgia over the point of exit of the nerve
from the bone, when this is possible. In order to be
eftective, the irritation should be sufficient to cause an
exudation beneath the epidermis. — Alemorabilien, Janu-
ary 31, 1883.
Distention of the Stomach by Carbonic .A.cid Gas
as an Aid in Diagnosis. — The more frequent employ-
ment of this long-recognized method is advocated by Dr.
Rosenbach as a means of determining more definitely
the situation and character of tumors of the stomach and
neighboring abdominal organs. He claims that we can
by this means ascertain exactly the position of the stom-
ach, and can determine the size and location of tumors
of this organ. The borders of the liver and the gall-
bladder are rendered more distinct. Tumors of the
spleen can be more readily diagnosed and differentiated
from those of the kidney. And lastly, we can study bet-
ter the pulsating jiainful tumors met with at times in the
abdomen. The author states that such tumor is, in most
cases, the head of the pancreas pushed forward by the
dilated aorta. When the stomach is distended the tumor
disappears, showing that it lies behind this organ. — •
Scliniidts Jahrbiieher, February 27, 1883.
Temperature of the Joints. — Dr. Redard has been
conducting a long series of observations to determine
the local temperature of the joints in health and disease,
and has arrived at the following conclusions : The tem-
perature of the skin overlying the joints may fluctuate
through 1° to 10' from external causes. The local tem-
perature of the joints falls in proportion to their distance
from the body. It is always higher on the flexor than
on the extensor surfaces, ranging in the larger joints from
87° on the latter to 96° on the former. Joint motion
causes an increased temperature not onl)' of the articu-
lation but also of the whole limb. Continuous move-
ments of flexion and extension of the ankle for five
minutes will raise the temperature of the entire limb
nearly a degree. Thermometry of the joints in diseases
is of value only in the superficial articulations. In hrem-
arthros the temperature rises after the third or fourth
day and remains more or less elevated according to the
nature of the resulting inflammation. In traumatic joint
suppurations the local temperature sometimes reaches
the same height as the general, but is never seen to rise
above it. In rheumatic, gonorrhceal, and puerperal joint
inflammations there is a considerable increase of heat,
frequently of the entire limb. In joint effusions follow-
ing fracture of the long bones there is an increased
temperature after a few hours. This would uidicate that
there is a contusion of the joint with an inflammatory
tendency, and not a simple eftusion. In white swelling
the temperature of the surface over the fungous granula-
tions is raised from ■^-J' to ^° above that of the neigh-
boring parts. In caries sicca there are no character-
istic changes to note. In old anchyloses we sometimes
find an elevaUon of from one to two degrees. This shows
that the inflammatory process has not fully subsided,
and may thus furnish an indication for treatment. — Cen-
tralblatt filr Chirurgie, January 13, 1SS3.
Fatty Necrosis. — Dr. AV. Balser (Deutsche Medi-
zinal-Zeitung, February 8, 1883) states that there is
in many people a growth of fiit-cells in the neighborhood
of the pancreas. In exceptional cases, usually in very
corpulent persons, this attains to such a degree that the
greater part of the abdominal fat necroses, and death en-
sues from hemorrhage induced by this necrosis.
April 28, 1883.]
THE MEDICAL RECORD.
461
The Medical Record
A Weekly Joiirjial of Medicine and Stirgery.
GEORGE F. SHRADY, A.M., M.D., Editor.
Published by
WM. WOOD &. Co., Nos. 56 and 58 Lafayette Place.
New York, April 28, 1883.
THE MEDICAL SERVICE IN OCEAN-GOING
STEAMERS.
The act passed last year by Congress for the inspec-
tion of steamers carrying passengers to and from Ameri-
can ports does not attempt to control the arrangements
for medical treatment and sanitary supervision to be ex-
ercised by the ship's surgeon. So long as the great
majority of these vessels enter our harbors under a foreign
flag, and the sanitary police of these harbors remains en-
tirely in the hands of municipal or state governments not
directed by a central national authority, any undue inter-
ference therewith might hamper the interests of the inter-
national ocean traffic, and result in a disadvantage to the
immigrants themselves. But it is easily to be foreseen
that with the revival of American steamboat travel, the
increase of emigration from Europe in a geometrical pro-
portion after the prospective opening of the Northern
Pacific Railroad, and the accomplished connection of
the southern roads, the question of protecting our great
cities and the populations of the vast territories on this
continent, against the importation of disease and the
germs of widely spreading epidemics, will have to be
faced resolutely by the representatives of the nation in
Congress and the central executive power. An organized
system of sanitary control and disinfection on uniform prin^
ciples laid down by a federal law, and watched over by the
national executive, may be imperiously demanded sooner
than the present aspect of affairs might seem to warrant.
The late Dr. Woodworth, of the United States Marine
Hospital Service, in his paper on Quarantine, read before
the International Medical Congress of Philadelphia in
1876, has pointed out that " the endemic homes of cholera
and yellow fever are the fields which give the greatest
promise of satisfactory results to well-directed and ener-
getic sanitary measures, and to this end an international
sentiment should be awakened, so strong as to compel
the careless and offending people to employ rational
means of prevention." We fear it will be a long time
before any international measures of this kind will be
universal and efticient, whilst we insist that every national
government has the right and the duty to protect its citi-
zens by the most stringent regulations which science
suggests and self-preservation dictates. Everybody who
has read in Rapp's history of German innnigration into
the United States, how, during the seventeenth and eigh-
teenth centuries small-pox and typhus fever were rife in
the crowded vessels from Antwerp, Rotterdam, and other
ports, tossing for months on the ocean, and how these
diseases were sown broadcast among the populations of
the North American colonies, will admit that, mutatis
mutandis, the same danger exists still to some degree.
Under the present political and social straits of Euro-
pean states, with England commencing to ship her
starving Irish subjects wholesale at reduced rates " to
the Canadian fields of promise,'' with the experiences
of the New York Emigration Commissioners, as laid
down in the facts published in their yearly Reports at the
time of the Irish famines, the great epidemics of cholera
and the small-pox visitations in different European coun-
tries, the medical profession of the United States should
timely consider how to strengthen the hands of the
hygienic superintendents in passenger vessels, and of
the health officers of ports of entry, in order to prevent
and check at the outset all dangers to the public health
coming from abroad. We have but to call in mind, in
connection with the necessity of such measures the very
stringent quarantine regulations adopted by the British
self-governing colonies, especially the Australian and
African, in consequence of repeated importations of con-
tagious diseases into these young and prosperous com-
munities by half-starved immigrants.
" The supervision of ocean-travel ought to be directed
to securing good sanitary conditions for vessels at all
tiiiies, out of as well as in port " said Dr. Woodworth.
We must add that the supervision ought to begin at the
ports of embarkation before the immigrants come on
board. It was the merit of the late surgeon-general of
our national mercantile marine service, to have first in-
augurated a system of consular reports by telegraph from
those ports. The medical inspections by the government
officers of the European countries are notoriously made
in a hurry, and are something of a sham. Competent
voices have been raised for the establishment of a sort of
quarantine lasting a few days before the sailing of the
vessel in times of epidemics. This may be unfeasible, but
whilst the ship is afloat there are two conditions of guar-
antee which ought to be complied with. The ship's doctor
ought to be an experienced and an authoritative officer,
to whom full power is given to order and supervise the
inspection and disinfection of the effects and baggage of
the passengers. For the latter purpose there ought to be
on board a hot-air disinfecting compartment supplied
with steam from the engines ; there ought to be also
proper bath-rooms in all passenger vessels. Now that
the importance of the "germ theory " is fully estimated,
and its bearings acted upon in the sanitary and therapeu-
tic arrangements of surgical hospitals and infirmaries for
contagious diseases, in phthisical and lying-in wards, it
is time that the hygiene of sea-going vessels become re-
modelled on the hints long ago given by all experienced
medical officers of the naval and mercantile marine ser-
vices, but hitherto often unheeded by ignorant or head-
strong commanders, or avaricious shipowners and com-
panies greedy for dividends. The position of the doctor
in passenger ships becomes more responsible and more
important to the whole community under such circum-
stances. In the Army and Navy the importance of the
medical service has been recognized in this country and
in Europe after the teachings of great wars and their
sufferings. Nothing short of a public calamity may do
462
THE MEDICAL RECORD.
[April 28, i88j
the same in regard to the mercantile marine. It has been
contended that the nation which takes the lead in secur-
ing the lives and health of passengers at sea, will take the
first rank on the ocean, and secure the greatest com-
mercial advantages to its shipping. We believe there is
some truth in such a saying, and we claim for the ship's
doctor a share in bringing about an increase of safety to
the ocean traveller, and to the public on shore.
THE DISCUSSION OF THE NEW CODE IN THE ACADEMY,
AND WHAT CAME OF IT.
The proceedings at the Academy of Medicine on Thurs-
day evening of last week were of a character to bring the
blush to the cheek of every honorable member of the
profession, whatever opinion he may hold concerning the
Code or the question that was before the meeting.
Certain resolutions, designed to commit the Academy
to a decision in a matter concerning which its members
hold widely differing views, and which is seeking its legiti-
mate solution elsewhere, were prepared in secret, brought
without notice before a regular meeting, secretly packed
with partisan supporters, and rushed without debate to a
hasty adoption. Members who asked only for time to
discuss the question and for notice to other members of
the question to be discussed were received with hisses
and their protests with jeers.
The trick, worthy of a machine politician, carried with
the manners of a ward primary in a society one of whose
declared objects is "the advancement of the character
and honor of the profession ! "
And then, with a fatuity which, however common its
manifestations in the seconder of the motion, has not
heretofore been suspected in the mover, a motion was
made to reconsider, and then another to lay this one on
the table, this being a parliamentary device to dispose
finally of a motion. As if any final parliamentary dis-
posal of a motion could prevent reconsideration of a .f;^^-
jcct. Such a move might avail to delay where long pre-
liminary proceedings were necessary before a motion
could be brought to a vote, but in such a case as this it
would be gross flattery to call it even puerile. It served,
however, to bring out the two following remarks, as re-
ported elsewhere :
Dr. Agnew asked: "Then the object is to throttle
this Academy ? "
" Undoubtedly it is," said Dr. Flint, Jr.
• The members of the Academy may well cry "Pause,"
and hesitate to sanction such methods — to follow such
leadership. And we believe there are many, even among
those who are heartily in support of the old Code, who
will not allow their honorable reputations to be smirched
by a tacit acceptance of the acts to which we have re-
ferred.
MEDICAL EDUCATION IN CANADA AND CHURCH IN-
FLUENCES.
I'oR many years back Laval University, of Quebec City,
has been struggling against effects of the gradually in-
creasing commercial depression which has attended
that city. Its students in medicine became fewer and
fewer each year ; and, some three or four years ago, the
university conceived the idea of opening or establishing
a branch called a " Succursak," in Montreal, the largest
and most prosperous city in the Dominion. In this way
the university hoped to improve its condition by drawing
to its doors students from the Montreal district. Up to
this period this district had supported the " Montreal
School of Medicine," latterly known as " Victoria Col-
lege," which institution being refused affiliation with
Laval some years ago, had affiliated itself to the Victoria
University of Coburg, a Methodist institution. This
affiliation gave Victoria College in Montreal power to
grant degrees in medicine to its students, otherwise it
could not have done so. This relationship, however, of
Victoria College with a Protestant university, was not
pleasing to the Roman Catholic clergy ; they wished to
establish a purely Catholic institution of their own with
university powers. Laval, as before stated, taking ad-
vantage of this feeling (some three or four years ago),
opened a branch of its medical faculty in Montreal, and
induced several of the teachers in Victoria College to
give up their positions and accept similar ones in its
faculty.
Open warfare now began between Laval University of
Quebec and Victoria College of Montreal, and a suit in
law was taken by Victoria against Laval to prevent it
establishing its branch faculty of medicine in Montreal.
This suit was carried to the Privy Council in England
and decided by that tribunal in favor of Victoria College,
saying that the charter which Laval possessed gave it
power only to grant degrees in the Quebec district, and
not elsewhere ; so that all the degrees issued up to the
present time by Laval in Montreal are illegal docu-
ments. Laval University now represented the matter to
the Pope in Rome, so also did Victoria College. The
Pope, after hearing both sides, declared in favor of Laval,
reversing the former judgment of the Privy Council in
England ; and not only gave Laval full power to establish
its " Succursak " in Montreal, but caused Victoria Col-
lege to sever all relationship with the heretic institution
in Coburg, thus throwing her back to her old position of
a teaching school with power to issue a diploma only,
and not the degree of M.D. His Holiness also issued a
command to the faithful to assist Laval in every way,
and all Catholic students to avoid Protestant institutions
of any nature whatsoever. He also caused \'ictoria to
withdraw all hindrance to the prosperity of Laval. But
now comes the most extraordinary part of all : " The
College of Physicians and Surgeons of the Province of
Quebec," a lawfully incorporated examining body, before
which all men seeking a license to practise medicine and
surgery have to appear and obtain such license, simply
upon producing a college diploma or university degree
from a lawful and recognized institution — this body has
all along accepted, and does so still, this illegal docu-
ment issued by Laval Llniversity in Montreal, and grants
to its graduates a license to practise.
So nmch for the colleges; now a few words about the
part the hospitals played in the matter.
The " Hotel-Dieu," the largest charity in Montreal,
has always been the clinic of Victoria College. It is
conducted by, and belongs to, an independent ecclesias-
tic order of sisters or nuns, and they have the power to
offer or refuse teaching facilities to whatever school they
wish. Now, when those gentlemen on the staff of the
hospital who went over from Victoria to Laval openly
April 28, 1883.]
THE MEDICAL RECORD.
4^3
declared themselves in favor of Laval, the nuns informed
them that their services were no longer required, and in
fact struck their names from the hospital staff register.
These men were now in a ditRcult position, because
they had no hospital material to instruct their students
with ; so they put their shoulder to the wheel and origin-
ated the present flourishing " Notre-Dame Hospital,"
which is supported by voluntary contributions from all
good Catholics,-and has the recognition of the Pope and
Catholic clergy. While this hospital was being fitted up,
the Montreal General Hospital, in its usual liberal and
generous way, admitted the Laval students to instruction
within its walls, and issued certified tickets to attending
students by the clinical professors of Mc(iill University.
The matter now stands thus : the Victoria College stu-
dents and professors are the guests of the nuns in the
" Hotel-Dieu Hospital," and these nuns refuse to coun-
tenance in any way the professors or students of Laval,
notwithstanding the urgent request of the Pope to do so.
The " Notre-Dame Hospital " is the clinic of Laval
University students, and is maintained for their use.
How matters will be reconciled it is impossible to say.
Laval is an illegal teaching body in Montreal, and \'ic-
toria College being stripped of her affiliation to the Co-
burg University, lives in the hope that she may succeed
in becoming again afliliated to some Catholic university
— there is one in Ottawa, and one in Manitoba — and
in this way regain her power to grant university degrees,
and at the same time conform to the wishes of the Church.
A JEALOUS WATCHMAN AND A RELIGIOUS HERALD
ON QUACK REMEDIES.
AFTER-dinner speakers and commencement orators an-
nually tell us of the close and beautiful harmonies in the
work of the doctor and of the clergyman. We have
wondered why these gentlemen have not sometimes
pointed their rhetoric with journalistic illustrations, and
shown us how harmoniously medical announcements
work in with fervent piety in the columns of our religious
weeklies.
The Watchman is a Boston paper, whose motto on the
first page is : What of the Night ? The Morning Com-
eth" ; on the last, "Yours for Health."
This Watchman has written an editorial in which it states
that the careful aim of its editor is " to guard jealously
its advertising columns," especially, as it says later, as
regards " patent medicines." Our contemporary then
proceeds to argue that some patent medicines are good,
that they can be advertised properly, and ought not to
be called quack medicines ; it finds also much comfort
in a similar position taken by the Richmond Religious
Herald. These twin journalistic ornaments of religion,
and stipendiaries of Lydia Pinkham, et id. om.gen., assert
that they cannot test all the mixtures they advertise ;
they do not endorse them editorially, and there probably is
some exaggeration in their claims ; their readers should
be judicious in buying.
The reasoning adopted sounds finely, but while reason-
ing for one thing they practise another. The position
taken by The Record, which is, we believe, that of all
just and sensible men, is this : There is a large number
of diseaseSj such as consumption, cancer, Bright's disease,
certain catarrhs, surgical maladies, for which there is
generally no cure and never any specific. These things
are matters of common and accepted belief among all
educated doctors, and they should be known to journa-
lists and editors who, like our religious brethren, assume
the responsible position of advertising all sorts of medi-
cines and quacks.
Observe now the inconsistency, and, we will hope, ig-
norance, of our esteemed contem|)orary The Watchman.
^Ve are told that " it guards jealously its advertising col-
umns." In these same guarded columns, we observe
first, and with chaste rapture, that the immortal Lydia,
Goddess of the Replaced Womb, occupies a considerable
space in telling what is for the most part palpably false
and impossible. Another party announces a "surest cure
for all kidney diseases "—diseases which are not cured
by any single medicine or measure. Dr. X advertises
the "radical cure of epilepsy, even its worst cases;"
Dr. Y announces a positive cure for consumption. Cer-
tain bitters will " cure dyspepsia, indigestion, malaria, and
weakness." The C. and C. pills " really do cure sick
headache, neuralgia, paralysis," and other trifles of a like
nature. We note also a sure cure for " pimples," and
another for rheumatism, neuralgia, and gout.
Most extraordinary of all, we find in these "jealously
guarded columns " an advertisement for the cure of gon-
orrhcea I which is new, quick, and complete in four days !
Is this a religious necessity ? Do subscribers want it ?
Watchman, what of the night ? Does the morning
come with this ?
We need not say anything further about the magical
remedies for coughs, and asthma, about the " radical
cure for catarrh," or of the two hundred New England
clergymen who, says our watchful contemporary, have
spontaneously testified to the superior excellence of the
sarsaparilla troches.
The Watchman is no worse than many of its brother
journals, though few go so far as to provide for the noc-
turnal indiscretions of its readers. It does, however,
announce to its subscribers, whom suffering makes credu-
lous, that there are cures for incurable diseases, specifics
for troubles that cannot be relieved by specifics ; and
the whole tendency of its two or three columns of quack
advertisements is doubly injurious. They help bolster
up impostors, they deceive and very likely injure in purse
and body the readers.
But these advertising columns are well-paid for, hence
editorial sophistry and shame to the cause of religion.
HOW TO MAKE AN AUTOPSY.
The remarkable studies of Professor Beneke, a notice of
which appeared in The Record some time ago, have
given a new impulse and interest to the studies of the
post-mortem room. The Massachusetts Medico-Legal
Society, in a report by Dr. Bowditch, a year ago, called
attention to some of Beneke's work as furnishing a
model of what might be done by others in this direction.
We quote here the conclusions especially referred to,
since some of them are sufficiently instructive and signifi-
cant to bear repetition :
" I. Before the period of puberty the aorta is smaller
than the pulmonary artery, after this period the relation
begins to be reversed, and in advanced life the aorta is
always larger than the pulmonary artery.
464
THE MEDICAL RECORD.
[April 28, 1883.
"2. The aorta and pulmonary artery are absolutely
smaller in the female than in the male, but relatively to
the length of the body there is scarcely any difference
between the circumference of the arteries in the two
sexes, while the heart in females is absolutely as well as
relatively a little smaller than in males.
" 3. In adult males the volume of the lungs is greater
than that of the liver ; in adult females the reverse seems
to be true.
" 4. In men the volume of the two kidneys is nearly
equal to that of the heart ; in children it is greater.
" 5. Children have a relatively larger intestinal canal
than adults.
"6. A sudden increase in the size of the heart occurs
at the period of puberty.
" 7. The iliac arteries diminish in size during the first
three months of life.
" 8. The cancerous diathesis is, in the majority of
cases, associated with a large and powerful heart and
capacious arteries, but a relatively small pulmonary ar-
tery, small lungs, well-developed bones and muscles, and
tolerably abundant adipose tissue.
" 9. Pulmonary tuberculosis is often associated with an
unusually small heart.
" ID. In constitutional rachitis the heart is generally
large and well developed ; the arteries are also large."
Taking the above as a te.xt also, Surgeon-General
Crane, of the Army, has recently issued a circular of in-
formation regarding the methods of making an autopsy.
He gives a model form of record of autopsy, which is
essentially the same as that of Dr. Bowditch. To this is
appended a list of instructions, from the same source,
regarding the best methods of making careful autopsies.
Most of the hints given are familiar to those in the habit
of making post-mortems ; but many of the points dwelt
upon, even if familiar, are certainly quite ignored. The
object of the investigator is, of course, first to find and
verify the cause of death. .\nd this in most cases ends
the inquiry. Much more, however, could and should
be done. The volume measurement of organs, their
weight, the measurements of blood-vessels, of limbs, and
body height, the length and capacity of intestines ; all
these and similar points are, as a rule, left out even in
hospital record-books. Yet out of data like these some
most important conclusions may be drawn.
We are gratified to observe how quickly the new Sur-
geon-General has learned the value of systematic and
complete autopsical records. Some such model as that
furnished by Dr. Bowditch should be adopted throughout
the country in institutions where these records are kept.
PNEUMONALGIA: AN OLD NAME FOR A NEW DISEASE.
Dr. R. R. Dashiell, in a series of articles published in
the Nashville Journal of Medicine and Surgery, upon
the diseases of the Forked Deer and the Hatchie River
Valleys, describes, under the name of pneumonalgia, a
" symptom-comple.x " characterized by a kind of mala-
rial congestion of tile lungs. He says :
" Persons suffering from a protracted spell of inter-
mittent fever, or such whose constitutions have been
much broken or mucii impaired by re|)eated attacks, are
frequently the subjects of a periodical painful stricture
across the breast, or sharp shooting pain through the
chest, dyspnoea, and a shorr dry cough, though this in
some cases is moist, attended with mucous expectora-
tion in certain individuals, and sanguineo-mucous in
others. I have seen the sanguineous expectoration in
two cases amount to a haemoptysis, the hemorrhage in
one case coming on every evening, and in the other every
other morning, in both cases preceded by chills, fol-
lowed by painful stricture across the chest, accelerated,
quick, small pulse, hot skin, flushed face, difficult breath-
ing, and cough, with bloody expectoration, succeeded
by a crisis of sweat. This form of affection 1 choose
to denominate pneumonalgia, believing it to essentially
consist in a neuralgic condition of the pulmonic plexuses,
occasioning or inviting an afflux of blood to the pulmo-
nary structure."
There are several objections to Dr. Dashiell's termin-
ology and pathology. The term "'pneumonalgia" has
already been appropriated as a synonym for angina pec-
toris. Again, although the trouble may be a neurosis of
the sympathetic nerves supplying the posterior pulmo-
nary plexus, tlie essential disturbance is a vascular, not
a painful one. From a clinical point of view Dr. Dashi-
ell's contribution is interesting, and no doubt correct.
Tlcius of tlic 'SSlcdi.
Central Park as a Source of Danger to Health.
— We are told by the Park Commissioners that the ponds
in Central Park are unquestionably a source of danger
to the neighborhood. At a recent meeting of the Com-
missioners an elaborate report was made upon the sub-
ject.
"It is a fact," says the report, '-100 well recognized
and understood to be contradicted, that of late years a
considerable portion of Central Park, more especially
some of the ponds of water, have become sources of
malaria, whose unwholesome effects and influence have
extended quite beyond the limits of the Park itself, to
such an extent as to have given rise to numerous com-
plaints and earnest remonstrance from the residents in
the vicinity. There are within the Park six ponds, in-
dependent of the Croton reservoirs. These six ponds
have a total area of 43^ acres. The total area of the
reservoirs is 142 acres. Of the ponds, the one at Fifty-
ninth Street and Fifth Avenue, being the nearest to resi-
dences outside of the Park, is the one that is most com-
plained of. The area of this pond is 4^ acres. Its
height above tide-water is 26 feet, but the others out of
the six are lower in altitude. It has a drainage area
within the Park of about 160 acres. At the present time
the pond in question receives its chief supply of water
from three sources, first, the direct surface drainage of
all the area of open ground immediately contiguous to
it ; second, the water collected from the walks and roads
lying within its drainage area ; third, the water brought
to it in brick conduits or sewers that find at this point
their lowest outfall. ... So strong and active is
the organic matter in the pond that vegetation is con-
stantly forming on the surface, while the large amount
of ammonia discharged into it from the roadways creates
the most pungent and offensive odors. The low situation
April 28, 1883.]
THE MEDICAL RECORD.
465
of the pond, surrounded by high ground and dense vege-
tation on the south, excluding the sun to a large extent,
gives a dank, unwholesome aspect to its surroundings.
Furthermore, the soil saturation of the borders of the
pond where there is no rock adds largely to the possible
chances of malaria."
The .\ves and N.-^ys at the New York .\cademy
OF Medicine. — On Dr. Agnew's motion to lay upon the
table the preamble and resolutions offered by Dr. Austin
Flint, Jr. [see page 471] :
Ayes.—C. R. Agnew, W. T. Alexander, W. R. Birdsall,
C. E. Killington, R. C. Brandeis, W. M. Carpenter, W.
M. Chamberlain, W. F. Cushman, B. F. Dawson, J. H.
Emerson, T. A. Emmet, G. H. Fox, V. P. Gibney, H. J.
Garrigues, H. Griswold, H. T. Hanks, E. D. Hudson,
Jr., A. S. Hunter, W. H. Katzenbach, E. L. Partridge,
O. D. Poineroy, D. B. St. John Roosa, C. D. Scudder,
A. A. Smith, A. H. Smith, C. D. Varley, J. S. Warren,
D. Webster, R. F. Weir, W. Gill Wylie— 30.
JVays. — J. G. Adams, J. .'\nderson, J. H. Anderson,
W. B. Anderton, E. S. F. Arnold, C. C. Arnold, W. B.
Blakeman, F. H. Boswortli, F. A. Burrall, E. O. Cowles,
A. Dubois, E. Eliot, J. O. Farrington, M. J. Pleming,
A. Flint, A. Flint, Jr., J. Foster, G. Frazer, J. P. Garrish,
H. Gomez, O. A. Gorton, J. W. S. Gouley, G. Griswold,
J. H. Hinton, A. Hodgman, S. T. Hubbard, N. C. Hus-
ted, F. E. Hyde, J. E. Janvrin, E. G. Janeway, E. .\.
Judson, R. P. Lincoln, J. Linsly, W. T. Lusk, M.
McLean, A. W. McLeod, J. A. Monell, H. D. Nicoll,
£. H. Peaslee, P. B. Porter, S. S. Purple, H. F. Quack-
enbos, L B. Read, E. Saunders, L. A. Sayre, L. H.
Sayre, J. Shrady, J. L. Smith, I. E. Taylor, C. S. W^ard,
E. F. Ward, J. W. Warner, F. V. White, O. A. White,
W. T. White, L. M. Yale, Wm. Young— 57.
On the adoption of the resolutions :
Ayes. — J. G. Adams, J. Anderson, J. H. Anderson,
W. B. Anderton, E. S. F. Arnold, G. C. Arnold, W. B.
Blakeman, F. H. Bosworth, F. A. Burrall, E. O. Cowles,
A. Dubois, E. Eliot, J. O. Farrington, M. J. Fleming,
A. Flint, A. Flint, jr., J. Foster, G. Frazer, J. P. Gar-
rish, H. Gomez, O. A. Gorton, J. W. S. Gouley, G.
Griswold, J. H. Hinton, A. Hodgman, S. T. Hubbard,
N. C. Husted, F. E. Hyde, E. G, Janeway, E. A. Jud-
son, R. P. Lincoln, J. Linsly, W. T. Lusk, M. McLean,
A. W. McLeod, J. A. Monell, H. D. Nicoll, E. H.
Peaslee, P. B. Porter, S. S. Purple, H. F. Quackenbos,
L B. Read, E. Saunders, L. A. Sayre, L. H. Sayre, C.
D. Scudder, J. Shrady, A. A. Smith, J. L. Smith, L E.
Taylor, C. S. Ward, E. F. Ward, J. W. Warner, F. V.
White, W. T. White, L. M. Yale, Wm. Young— 57.
JVays.—C. R. Agnew, W. T. Alexander, VV. R. Bird-
sail, C. E. Billington, R. C. Brandeis, W. M. Carpenter,
W. M. Chamberlain, W. F. Cushman, B. F. Dawson, J.
H. Emerson, T. A. Emmet, G. H. Fox, H. J. Garrigues,
V. P. Gibney, H. Griswold, H. T. Hanks, E. D. Hud-
son, jr., A. S. Hunter, E. L. Partridge, O. D. Pomeroy,
D. B. St. John Roosa, A. H. Smith, C. D. Varley, J. S.
Warren, D. Webster, R. F. Weir, W. Gill Wylie— 27.
Office Thieves. — Two miserable-looking, dirty Irish-
men, evidently office thieves, are going about the city rep-
resenting themselves as Cincinnati physicians, sufferers
from the flood. One of them says his name is Donnelly.
Death OF Dr. J. C. Palmer. — Medical Director James
C. Palmer, on the retired list of the Navy, died in Wash-
ington, April 24th. He had seen thirty-eight years of
active duty in the Navy, and was put upon the retired
list in 1S73.
Typhus Fever in New York. — The City Sanitary
Superintendent announces that fifteen cases of typhus
fever in a very mild form have been discovered among
the children in St. Stephen's Home in East Twenty-eighth
street, near Third avenue.
Endorsing the U. S. Marine Hospital Service. —
The New Orleans Board of Health recently passed reso-
lutions unanimously requesting the President to place
the Congressional appropriation for the suppression of
epidemic contagious diseases, in case it should be re-
quired, in the hands of the Marine Hospital Service of
the Treasury Department. A telegram from New Or-
leans states that the Boards of Health of all the Gulf
ports will adopt the same course, and the National Board
of Health will not have a foothold at any trade point in
the Gulf of Mexico.
Dr. H. S. Tanner, whose abstinence from food for
forty consecutive days in 1880, in New York, caused so
much astonishment, is now a resident of Jamestown,
N. Y., where he is engaged in the practice of his profes-
sion and in manufacturing patent medicine.
'^cpavts 0f Societies.
MEDICAL AND CHIRURGICAL FACULTY OF
MARYLAND.
Eighty-fifth Ariniial Convention, held at Baltimore, April
24 and 25, 1883.
(Special Report for The Medical Recokd.)
First Day — April 24TH.
The great event of the year with Maryland physicians,
more especially those of Baltimore, is the annual spring
convention of the Medical and Chirurgical Faculty of
Maryland, an organization incorporated by the Legisla-
ture of the State in 1799, ^'^^ bearing an analogy to the
State Medical Societies elsewhere, but distinguished from
them in many respects, both in its object and present
working.
The Convention of 1883 was called to order in Hopkins
Hall, Johns Hopkins University, on Tuesday April 24th,
at 12 M., by Dr. William M. Kemp, of Baltimore, President.
Seventy-two members answered to their names on the
call of the roll.
After prayer by Rev. Charles S. Albert, and the read-
ing and adoption of the minutes of meetings held during
the last year, the President delivered his address.
president's address.
He began by congratulating the society on its present
prosperity and favorable prospects. His connection with
it, he said, extended back over more than half the years
of its existence. He then took up the subject of the im-
portance of observation as contrasted with theory in the
advancement of medical science. The most prominent
epochs in its history correspond with revivals in the la-
borious and protracted observation and classification of
facts. He illustrated this by reference to the lives and
labors of Hippocrates, who perhaps gave the first impulsq
to true medical science ; of Galen, whose influence re-
tained its impress on medicine for nearly fifteen hundred
years ; of Rhazes, the great traveller, who gave to medicine
466
THE MEDICAL RECORD.
[April 28, 1883.
the first accurate description of small-pox, and the first
treatise on the diseases of children ; of Harvey, of Syden-
ham, Bonetus, Baglivi, and others, all of whom have
secured their great renown by contributing to science
and humanity some fact or facts secured by persevering
labor and observation. Dr. Kemp had himself tested
the accuracy of the prognoses of Hippocrates, and had
been profoundly impressed with their sagacity. Locke
and Bacon contributed powerfully to the independence
of medical thought and investigation which characterizes
modern times. CuUen and Morgagni, in the eighteenth
century, the first in Scotland the second in Italy, con-
tinued with zeal and success the methods which had so
crowned the labors of their great predecessors. The ad-
dress continued at length to outline the methods and mo-
tives which should characterize the true student of nature
and of science in the pursuit of knowledge. At its con-
clusion the address was appropriately referred.
The resignation of Dr. W. W. Murray, who has re-
moved to Virginia, was read and accepted.
treasurer's report.
The report of the Treasurer was read, showing a net
gain of two members. There had been seven resigna-
tions, four deaths, and four dropped for non-payment of
dues. Sixteen active and one honorary member (Dr.
A. M. Fauntleroy, of Virginia) had been added. The
receipts had been $2,274, the disbursements $1,736,
leaving a balance in the treasury of $538. The esti-
mated increase in the value of the library was $800.
The assets amount to $9,125 (including library furni-
ture, etc., valued at $8,300). The society is free of
debt.
REPORTS OF COMMITTEES.
The Publication Committee reported the distribution,
in this country and abroad, of five hundred copies of the
last volume of Transactions. The Committee on Me-
moirs announced, with appropriate allusion, the deaths
of Drs. Wilson G. Register, the late Secretary ; Charles
Albert, Henry .Albers, and E. Cleveland Co.xe.
The Committee on the Library reported gratifying
progress in the condition of the library, constituting it
the most valuable feature of the Faculty. It now con-
tains 3,346 volumes, an increase of 277 during the year.
Among the most valuable contributions are Ziemssen's
" Cyclopaedia," Sydenham Society publications to end of
1881, and many late editions of leading text-books.
Number of books donated by members, 151 ; expenses,
$595-
One hundred and eight American and foreign journals
are regularly received ; a number of portraits of eminent
Marylanders, including that of Dr. Upton Scot, of An-
napolis, the first president of the society ; a portrait and
autograph letter from Pasteur ; a medical <ii|)loma granted
in 1769, to Dr. Josias Carvil Hall, of Maryland, by the
College of .\fedicine, of Philadelphia, and other articles
of value and antiquarian interest iiad been received. In
concluding, the report recommended the adoption of a
resolution authorizing the committee to exchange books
and pamphlets with the Surgeon-General's library, in
Washington, upon such terms as would promote the in-
terests of the society. The resolution was adopted.
These reports, and others which present no general
interest, were all accepted.
DELEGATES.
The following delegates presented their credentials
and were admitted to seats : Dr. John H. Patterson,
Baltimore Academy of Medicine ; Dr. A. A. Hanna,
Cecil County Medical Society ; Dr. Walter Wyman,
Chirurgical Society of Maryland ; Dr. J. T. King, Balti-
more Medical Association. Dr. Randolph Winslow (who
leaves for Europe in the morning) was ai)pointed a dele-
gate to the International .Medical Congress, which meets
in Copenhagen next .\ugust.
THE REPORT ON .-iBDOMINAL SURGERY.
The Chairman of the Section, Dr. O. J. Coskery an-
nounced that the subject of his report would be .\bdom-
inal Surgery exclusive of operations in gynecological
practice. He treated of gastrostomy, splenectomy, and
nephrectomy. Gastrostomy, or opening the stomach for
the removal of foreign bodies, or on account of obstruc-
tion in the oesophagus produced by simple or malignant
strictures, has been made most successful since Mr.
Howse suggested that the process should be divided into
two separate stages — the first consisting of opening the
abdominal walls and stitching the stomach to it by six or
eight sutures ; the second, opening the stomach itself
five or more days afterward.
WHEN IS GASTROSTOMY JUSTIFIABLE.
After reviewing the cases reported and the statistics of
the operation. Dr. Coskery concludes :
I. Gastrostomy is justifiable (A) in cases where a for-
eign body has been introduced into the stomach, which,
owing to size or shape, cannot pass through the pylorus,
(B), in cases where malignant contraction or diseases of
the oesophagus is progressing, (C), where the disease in
the calibre of the gullet is due to inflammatory action
following the introduction of corrosive liquids, and where
such contraction will not yield to the bougie treatment.
II. Under all circumstances the first possible oppor-
tunity for the operation should be availed of. Mr. i5ry-
ant, alluding to cases in which decrease in the size of
gullet is the occasion for the operation, says, " Do it as
soon as there is any difficulty in swallowing solid food."
III. The incision in the stomach itself should not be
longer than one-eighth inch, unless made for the removal
of foreign body, and then as small as will permit of its
extraction.
IV. The operation is most successful ultimately when
undertaken for the removal of foreign bodies or for acci-
dental stricture of the gullet.
V. When done for obstruction to the swallowing of
food, the operation should be divided into two stages, as
was suggested by Mr. Howse.
THE IXDIC.^TIONS FOR SPLEN'ECTO.MY.
In regard to splenectomy, Dr. Cosker3''s conclusions
were that the operation of splenectomy for conditions
unassociated with leucocythremia is pre-eminently the
most successful in abdominal surgery, but when the white
cells are very abundant in the blood, it probably is the
most dangerous of operations and should be abandoned.
The tendency to hemorrhage in this condition may alone
be regarded as a barrier to the operation, even in the in-
cipiency of the disease.
The following are the conclusions reached by Dr. Cos-
kery in regard to nephrectomy : The operation must be
regarded as a justifiable one ; the great difficulty lies in
making a correct diagnosis between those conditions of
the kidney requiring extirpation, simple tapping, or cut-
ting down and extracting a stone from the pelvis of the
kidney.
By the incision made in the same direction as for lum-
bar colotomy the operation should be as bloodless and
as free from danger. The ]irincipal dangers are accidental
adhesions and the shock of the operation.
SECTION ON PR.VCTICE OF iMEDICINE.
Dr. R. H. Thomas read the report of the Section.
His paper was entitled
A CONTRIBUTION ON THE INFLUENCE OF SE.VSON AND
WEATHER ON THE DEATH-RATE FROM DIPHTHERIA IN
BALTIMORE, 1861-1SS2.
The paper was freely illustrated by charts, showing the
range of temperature, moisture, wind, etc., during the
four and one-fourth years embraced by the report.
Dr. Thomas said that his study of these charts seemed
to warrant the following conclusions :
First. — While the weather alone does not regulate the
April 28, 1883.]
THE MEDICAL RECORD.
467
absolute number of deaths from diphtheria, it has a very
important bearing upon the rise and fall of the violence
of the disease, although temporary Huctuations occur in-
dependently of it.
Second. — Temporary changes in the weatlier have but
little effect ; but a continued prevalency of certain kinds
of weather does cause a rise or fall in the mortality from
diphtheria.
Third. — The conditions favorable to arise are low
barometer, low winds, especially from the East, high
temperature with high humidity and heavy or continued
rainfall.
Fourth. — The conditions favorable to a fall are high
winds, especially from the West, low humidity, with liigh
temperature, or high humidity with low temi)erature, and
"generally " a high barometer.
Second Day — April 25TH.
The session opened with a report from
THE SECTION ON MATERIA MEDICA AND THERAPUTICS
read by Dr. Barton Brune, consisting of a resume of the
contributions made in urinary chemistry during the year.
Dr. I'.rune paid especial attention to the recent lectures
by Alfred Barring Garrod, of London, on uric acid and
allied subjects, to various urinary pigments lately de-
scribed, and to new tests for albumen and sugar, particu-
larly the picric acid test of George Johnston, which he
thought was likely to supersede the test now in vogue.
The report of the Section on Anatomy and Physiology
consisted of a paper on •
the progress of physiology during the year,
by Dr. Latimer, which, owing to the author's being called
away from the city, was read by title only.
The Committee on Sanitary Science reported through
Dr.J. R. Ward, President of the Maryland State Board of
Health. The principal point in Dr. Ward's address was the
stress which he laid upon
sanitary instruction in the young.
He urged that it should be made one of the subjects
taught in the public schools. The susceptible minds of
the young men were particularly adapted to receive and re-
tain such instruction, which might then be spread broad-
cast through the masses.
The report "of the Section on Ophthalmology, Otology,
and Laryngology was presented by Drs. Friedenwald and
H. Clinton McSherry. The former took for his subject
the relations of spinal and eye diseases.
Dr. McSherry read a paper on
laryngeal stenosis,
and exhibited an instrument designed to effect dilatation
of the glottis from below after tracheotomy. It consists
of three blades, by which dilatation is effected both lat-
erally and antero-posteriorly.
Dr. McSherry reported three cases successfully treated
by himself, and exhibited one of the three, who, after be-
ing obliged to wear the tracheal tube for a year, is now
able to breathe freely without it.
The next was a volunteer paper by Dr. C. W. Chan-
cellor, Secretary of the Maryland State Board of Health,
upon
THE sewerage of CITIES BY THE PNEUMATIC PLAN.
This paper was based upon observations made in Eu-
rope by the author, who has recently been abroad study-
ing the various sewerage systems in vogue. Dr. Chan-
cellor discussed at length the relative merits of the
various methods and expressed a very decided preference
for the pneumatic system, which prevails in Holland.
He urged the special adaptability of this system to Balti-
more.
(To be continued.)
MEDICAL SOCIETY OF THE COUNTY OF
NEW YORK.
Stated Meeting, April 23, 1883.
D.4VID Webster, M.D., President, in the Chair.
Dr. D. B. St. John Roosa read an elaborate paper on
the effects of noise dpon diseased and healthy
ears.
The author first referred to the literature of the sub-
ject as found in the writings of Willis, Wilde, Kramer,
Troltsch, Ran, Ficlitz, Burnett, and E. E. Holt, who
published his paper in 1882, Politzer, and others. Willis,
a little more than two hundred years ago, gave an ac-
count of a somewhat famous woman who could only hear
the voice of her husband when a servant was beating a
drum in the same room. The facts, as stated by that old
author, have since been denied and affirmed, and differ-
ences of opinion have existed concerning the explanadon
of the phenomenon, of hearing better in a noise, when
its existence has been admitted. Dr. Roosa showed
subsequently that Wilde was in error in supposing that
the phenomenon depended upon the state of the mem-
brana tympani, and therefore could not occur when there
was a hole in the drum head. He did not agree with
Troltsch that the symptom of hearing better in a noise
was not a common one. His experience had proved
that it is a very frequent one. Holt doubts if in any
case the hearing-power is improved by noise. Polit-
zer has no doubt as to the existence of these cases, and
confirms what Dr. Roosa stated years ago, " that the
patients can understand speech during such noises much
easier and at a much greater distance than people with
normal hearing;" but he (Politzer) has observed this
symptom " almost exclusively in the incurable forms of
affections of the middle-ear." Dr. Roosa believed that
while the symptom frequently accompanied incurable
disease of the middle-ear, it is a very frequent symptom
in subacute cases, when both ears are affected. He had
never seen the symptom except in disease of the middle-
ear. He believed it never occurred except in cases
where the nerve is sound. If it be true that it never
occurs with disease of the acoustic nerve, the theory of
an extraordinary excitement of the nervous apparatus, as
a cause of the phenomenon, must be rejected. Special
reference was then made to Politzer's explanation and to
the conclusions reached in Dr. Holt's paper. Reference
was then made to illustrative cases.
But there is a class of patients who have been made
deaf by noise. They are often confounded with those
whose impairment of hearing has resulted from catarrh,
but are to be entirelv disassociated from them. Boiler-
makers, and those who become deaf from an exposure
to the continuous shock of loud sounds, suffer from a
lesion of the acoustic nerve. These patients hear better
away from the din, and have a sense of relief when in
quiet places.
The author of the paper then exjilained how, by the
publication of certain views, he assisted in creating con-
fusion in our ideas, as to hearing better in a noise and
the effects of noise upon the ear. He then explained,
by means of a diagram upon the blackboard, what is
understood by bone-conduction and aerial conduction.
This was followed by illustrative cases of boiler-makers'
deafness.
The following conclusions were reached :
First.— Thtrt is quite a large class of people suffer-
ing from impairment of hearing in ordinary places who
hear very acutely and with comfort amid a great din or
noise.
Second. — The disease causing the impairment of hear-
ing thus relieved, is situated in the middle ear. It has
been usually observed in the chronic non-suppurative
468
THE MEDICAL RECORD.
[April 28, 1883.
form of disease of the middle ear, but it may also be
found in acute and subacute catarrh of this part, as well
as in the chronic suppurative process.
Third. — The proximate cause of this phenomenon is
not as yet jjositively known. It is probably to be found
in some change in the action of morbid articulation of
the stapes bone with the fenestra ovalis.
Fourth. — The hearing-power of persons working in
such a din as that of a boiler-shop invariably becomes
impaired.
Fiflli. — The lesion caused by this occupation is one
of the labyrinth, or of the trunk of the acoustic nerve.
Sixth. — Persons thus affected do not hear better in a
noise. Their hearing-power is better in a quiet place,
and becomes better after prolonged absence from the ex-
citing cause of their impaired hearing.
Seventh. — The cases of inspissated cerumen and ca-
tarrh of the middle ear, occurring among boiler-makers,
are such as occur among those engaged in other occupa-
tions, and mask and conii'licate the fundamental primary
trouble so long known as boiler-makers' deafness.
Eighth. — In disease of the labyrinth or acoustic nerve
the tuning-fork " C " is heard louder and longer through
the air than through the bones of the head.
The President invited Dr. Knapp to open the discus-
sion, who said that the paper was so much in the direc-
tion of new experimentation, and observations which
must needs be repeated in order to discuss the subject
properly, that he had nothing to offer. So far, however,
as his observation had extended upon this question, it
agreed in the main with Dr. Roosa's, although he could
not entirely agree with him in reference to distinguishing
between internal and middle-ear disease.
Dr. Brandeis said that the experiments which he had
made had led him well toward the conclusion to which
Dr. Roosa had arrived. At the time Dr. Holt read his
paper Dr. Brandeis ventured to take issue with him, and
claim that in boiler-makers' deafness the disease was not
of the internal ear, but in a majority of cases was an
affection of the naso-pharynx which extended to the
middle ear and t3'mpanic cavity through the Eustachian
tube, and that the impairment of hearing was not due so
much to impairment of the integrity of the nerve as to
the anchylosis of the ossicles and closure of the Eusta-
chian tube. He had found very great difficulty in deter-
mining exactly the amount of impairment of hearing in
boiler-makers ; also, whether it was due to impairment of
the integrity of the auditory nerve or of the conducting
apparatus, because in every one of the cases there was
decided naso-pharyngeal and Eustachian catarrh. In
many cases he was inclined to believe that the catarrhal
condition was the principal factor in the etiology of the
deafness. Dr. Brandeis had recently observed a number
of cases of unilateral impairment of hearing, especially
among violinists. Here again he was inclined to the
opinion that the difficulty was not alone in the internal
ear, but that there was also a simultaneous affection of
the middle ear, the tympanic cavity, and the ossicles,
which he attributed to partial compression of the arte-
ries that go to supply the middle ear, thus impairing the
circulation.
Dr. Pomeroy was inclined to place considerable stress
upon the observations made bv Dr. Holt, who with others
had demonstrated beyond question that there is middle-
ear disease in a verv large number of these cases of boiler-
makers' deafness. Dr. Fonicroy believed that the appear-
ance of the membrana tympani generally sustained that
proposition. In many cases it is altogether opaque, show-
ing the signs of a considerably long-continued low grade
of inflammation, resulting in a certain amount of prolif-
eration. jMoreover, all the men who are thrown into the
category of boiler-makers are especially exposed to those
causes which are supposed to give rise to catarrh, 'i'hat
there is actually catarrh present in a very large number
of cases he thought was admitted by all observers. At
the very beginning, then, a condition was present which
served to render diagnosis ditficult. Dr. Pomeroy's
belief was that it begins as a middle-ear trouble and trav-
els into the labyrinth. With regard to the tuning-fork
furnishuig evidence of middle-ear disease, that is a ques-
tion requiring the utmost acuteness of observation. Our
knowledge on that subject is still so defective that all
statements made with reference to it must be taken with
a great deal of allowance. He was sure the statement,
that if a patient hears the tuning-fork louder and longer
by aerial-conduction than by bone-conduction he has not
middle-ear disease, but labyrinthian trouble, was true in
only a certain number of instances. With regard to hear-
ing better in noise, he believed that in a large number of
instances patients with middle-ear trouble were likely to
hear better in a noise than a person with normal hearing,
and better than when in a quiet place. But that fact he
thought was not sufficiently important to be of special
diagnostic value. A person may have middle-ear trouble
and not hear better in a noise.
Dr. Bacon believed with Dr. Roosa that the real dif-
ficulty in boiler-makers' deafness is in the internal ear.
At the same time the middle ear is, in the majority of
cases, affected with catarrhal troubles.
Dr. Andrews said that, at one time, he studied this
subject carefully for a number of years. Inasmuch as
there had been no post-mortem examinations to verify
the statements given this evening, it would be impossi-
ble, he thought, to positively locate the disease. Disease
of the middle-ear might give all the evidence of disease
of the labyrinth, and yet the labyrinth be perfectly nor-
mal. He believed that we could not yet, in these cases,
positivelv locate the. disease in the labyrinth so long as
tympanic disease cannot be eliminated as an acting cause.
Dr. Andrews thought that the absence of the drum-head,
referred to b) Dr. Roosa as disposing of Wilde's explana-
tion, did not dispose of the view entertained by Wilde, in-
asmuch as the round and oval windows were probably
intact.
Dr. Roos.'i, in reply to Dr. Andrews's question, said
he supposed the two windows were intact. But he be-
lieved that their presence did not overthrow the argu-
ment, betause Wilde held that the phenomenon depends
upon rela.xation of the drum-head ; whereas he (Roosa)
believes that it depends upon some change of the os-
sicles, a decidedly different condition.
Dr. Roosa could not agree with Dr. Andrews in the
broad statement, that because no post-mortems had been
obtained in cases of boiler makers' deafness, therefore
we cannot ever tell whether we have to deal with disease
of the middle-ear or of the internal ear. He had as-
sumed two things which he expected would be doiibted,
and they had been doubted ; but he did not think that
they had been disproved. He had the fortune of being
a pioneer in this kind of investigation, and had come to
believe that in the tuning-fork we have a means of mak-
ing a differential diagnosis between disease of the middle
and internal ear. Hearing better in a noise was an-
other means, and by employing these two aids he be-
lieved that a differential diagnosis in these cases could
be satisfactorily made. Practice in ear diseases had
gone to extremes. Only a few years ago nearly every
otologist followed Kramer, who said that the acoustic
nerve was the part most conuiionly affected ; then Wilde,
who said that disease of the middle-ear explained all the
symptoms ; later the Germans, who came with catarrh
of the middle-car and swallowed all previous theories.
Now, no matter what the ear affection may be, the or-
gan must be blowed up almost invariably, according to
some authorities, and their teaching is ])ractised by a
large number of otologists. Dr. Roosa was contending
against that view, and was trying to prove that there is
quite a large proportion of cases of deafness in every vi-
cinity, due to acoustic trouble, which are incurable, and
that it is better to let them alone than to be continually
blowing them up with an apparatus.
The Society then adjourned.
April 28, 1 883. J
THE MEDICAL RECORD.
469
NEW YORK ACADEMY OF MEDICINE.
Stated Meeting, April ig, 1883.
FoRDYCE Barker, M.D., LL.D., President, in the
Chair.
Dr. Caspar Griswold read a short paper on
CRYSTALLINE ELATERIN.
Tlie author of the paper first spoke of the excellency of
elateriuni as a hydragogue cathartic, and referred to
the uncertainty in obtaining desired results, because of
the variations in the strength of the drug sold in the
shojis. He then described the methods by which the
crystals, the active principle of the juice of the cucumber,
should be obtained in order to be reliable, and exhibited
specimens which illustrated the differences in apjjearance
between the inert substance and the white hexagonal
crystals known as elateriiL The following conclusions
were reached : First, that the crystalline elaterin of
Merck, now for sale in tiiis city, is identical with that
discovered by Morries in 183 1, and is the active princi-
])le of elateriuni ; second, that its distinct crystalline
form and freedom from impurity renders it more reliable
than any preparation of elateriuni ; third, that the proper
dose to commence with is one-tenth of a grain, and that
this may be prescribed in a solution of one grain of
elaterin to half an ounce of alcohol, or in the form of
tablet triturates, containing one-tenth of a grain. The
last are now to be had at Frazer & Co.'s pharmacy.
ANTEFLEXION OF THE UTERUS ITS ETIOLOGY AND AS-
SOCIATED PATHOLOGICAL CONDITIONS.
Dr. W. Gill Wvlie read a paper on the above sub-
ject, in which he first directed attention to the anatomy
of the position and surroiuidings of the healthy uterus.
This referred to the shape and size of the organ, its
de|)th, flexibility, etc. The average depth was given
as a little over two and one-half inches. When pres-
sure is made on the fundus or upper portion, the
organ bends, chiefly at the os internum. It does not
bend so as to form an acute angle, but with a curve
such as would be made by a rubber tube with very thick
walls and small calibre. In very rare cases the anterior
wall might be bent at a much more acute angle. A de-
scription of the supports of the uterus was then given. It
is held in position chiefly by the fascia; and connective
tissue of the p'elvis, and by the reflexions of the peri-
toneum. These form more or less distinct ligaments, in
which there is more or less muscular tissue, and are so
elastic as to permit considerable mobility of the uterus
as a whole, especially upward and downward, and back-
ward and forward.
The elastic contractility of the muscles and connective
tissue, that is, the heart and muscles of the arteries,
muscles of the ligaments and perineum and abdomen, the
connective tissue of the skin and the abdomen and peri-
neal walls, of the ligaments, fascia;, and so-called ceUular
tissue of the pelvis, unitedly exerted a pressure to which
he gave the name vital musculo-coiuiective-iissue pres-
sure.
Dr. Wylie then proceeded to the consideration of the
dynamics of the pelvic cavity, or the influence of force
in causing anteflexion. The influence of atmospheric
pressure has but little to do with keeping the pelvic or-
gans in place by opposing gravity. In order that this
force may act as a retentive power by counteracting
gravity, the vessel must be rigid and fixed above as well
as on the sides, and impermeable to air. Gravity acts
upon the contents of the pelvis as it does upon the semi-
solid, elastic, and mobile contents of a rigid cylinder with
a flexible bottom, and with a top opening into another
flexible cylinder, also filled with an elastic ever-changing
mass, falling and lifting at all times, and with more or
less force.
The writer then spoke of the influences which prevent
a normal uterus from bending forward at or above its
middle when the person stands erect, or when it is pressed
upon by the action of the diaphragm and abdominal
muscles, etc. First, the firm, elastic nature of the tissues
of the organ had a tendency to keep it in its normal
shape ; second, the forward inclination and slight ante-
rior curvature of the normal uterus placed the organ in
the best possible position to enable it to withstand both
continued and sudden waves offeree from the action of
the diaphragm and abdominal muscles. The third in-
fluence mentioned was the vital musculo-connective-tis-
sue pressure — that is, the sustaining power of the sur-
rounding flexible and elastic adjustable tissues, which
during life are filled with blood, fluids, gases, etc. So
important is this influence that it cannot be left out when
considering the dynamics of the pelvic cavity, and while
the uterus is surrounded by these elastic and adjustable
tissues in the living body, it is sustained in the same way
as a flexible sea-weed is when surrounded by water. In
other words, the tendency of the fundus to fall forward
and bend the uterus on itself is very much less than it
would be out of the pelvis.
The advocates of the mechanical iiathology of uterine
displacements had overlooked this greatly modifying influ-
ence of all indirect force acting on the pelvic organs,
and had, therefore, exaggerated the effects of sudden falls
in producing anteflexion, consequently were naturally led
to rely too much upon mechanical support for effecting
a cure. The effect of downward pressure on the healthy
uterus tends to produce general prolapsus rather than
anteflexion.
Dr. Wylie then asked the question : When a uterus is
soft what causes it to become flexed when the person is
erect, or when there is downward pressure produced by
the action of the diaphragm and abdominal muscles?
The answers were, first, the normal position of the uterus
is one of anterior curvature, and if the tissues are soft the
weight of the fundus has a tendency to increase this
curvature ; second, downward i^ressure would cause the
pouch of Douglas and the bladder to yield first, and this
yielding would make taut the utero-sacral ligaments at-
tached to the uterus just above the vaginal junction
posteriorly until these ligaments gave way. This par-
ticular part of the uterus would be held upward and
backward, while the abnormally soft cervix would be
pushed downward in the direction of the vaginal axis.
At the same time the utero-vesical ligament would be
made taut only at its higher points of attachment to the
uterus, and the upper part of the fundus would be pulled
downward on the bladder. The third answer referred
to Hart's views as to the floor of the pelvis being divided
into two segments, the author accepting some of them
with modifications. F'ourth, the loss, to a greater or less
extent, of the vital niusculo-connective-tissue pressure.
Dr. Wylie then spoke of the influence of downward press-
ure in producing backward and forward displacements
of the uterus, the latter result being the most frequent
and the most important ))athologically.
The influence of the bladder on the position of the
uterus, and the' influence of the rectum on the uterus
were then considered.
The point of greatest curvature in anteflexion was men-
tioned next, and the writer stated that the exact location
of this point is often very difficult to determine. As a
rule, it is just about the os internum. And he then gave
the reasons why it occurred at this point.
The time of making examinations to decide the exact
degree of flexion should be carefully considered ^ for,
without doubt, the amount of curvature varies at diflerent
times, for instance, just before and just after menstrua-
tion. The most favorable time is during one or two
weeks between the menstrual periods, when the uterus is
usually quiescent.
After speaking of the variability of the generative or-
gans reference was made to the frequency and degree of
anteflexion. All nuUiparous women have some degree
470
THE MEDICAL RECORD.
[April 28, 1883.
of anterior curvature of the uterus, and this may vary
considerably without denoting an abnormal condition ;
that is, while the uterus is quiescent the angle made by
the axis of the cervical canal with the axis of the
canal of the body may vary from 165° to 135° without
being abnormal. But whe'n it is most of the time found
less than 135° it may fairly be called abnormal.
ETIOLOGY.
Under this head the author considered the influences
which prevent the perfect development of the organs of
generation ; the ennervating influences of modern life ; the
general tendency to development of the intellectual
faculties at the expense of the physical health ; the ten-
dency there is in civilized communities to keep the func-
tion of these organs under restraint, enforced restraint
brought about by measures to avoid child-bearing ; the in-
fluence of deformities of the pelvis ; the influence of ex-
cessive physical labor, although not so potent as exces-
sive intellectual development, etc. The condition of
the general health has much influence on the development
and position of the uterus. Many of the cases classed as
congenital are undoubtedly merely flexions made per-
manent before maturity is reached. Of children born
of healthy parents, few reach full development in perfect
health.
In those who have an inherited or acquired rheumatic
diathesis, or a tendency to catarrhal diseases, exi)osure
to malarial poisoning or to cold may induce endometritis,
and^ finally lead to anterior displacement.
Child-bearing is usually enumerated as a predisposing
cause of anteflexion ; but Dr. Wylie preferred to say that
too frequent child-bearing, or abnormal labors or the
puerperal state, or labor in an unhealthy woman, may
result in an anteflexion. Child-bearing is as truly a
natural act as is eating. Besides these, a large number
of causes were mentioned.
PATHOLOGY.
For several years past he had given up the belief that
anteflexion very often directly caused dysmenorrhcea by
mechanically closing the canal, and thus obstructing the
menstrual flow. Where there is obstructive dysmenor-
rho3a, except in rare instances, he believed it to be due,
as a rule, to stenosis of the os uteri at some jjoint, or to
clonic spasm at the os internum, as is the case in the
majority of instances of dysmenorrhcea in anteflexion.
He believed that pain and obstruction is caused bv the
hyperaasthetic condition at or near the os internum, com-
bined with more or less stenosis at this point.
Anteflexions may be divided into two classes : first,
those usually termed congenital, that is, those in which
the curvature exists before puberty, or is acquired before
maturity is completed, and the result of interfered or im-
perfect development ; second, those in which the curva-
ture takes place after full growth. The peculiarities of
these two classes of cases were then discussed at some
length.
The President invited Dr. T. Addis Ealmet to open
the discussion, who thought the subject could be simpli-
fied by recognizing the fact that in most cases the condi-
tion under consideration is due entirely to obstruction
of the circulation outside of the uterus. As a rule, it is
due to inflammatory action caused by cold. When we
have dysmenorrhcea accompanied with that condition it is
not a mechanical attection, but it is due to faulty nutrition
and obstruction of the circulation, and is an alfection of
the general system. lie believed that it was very im-
portant to recognize this as a cause of flexure from the
simple fact that malpractice was seen to no greater de-
gree than in the treatment of such conditions by divid-
ing the cervix, dilating the canal, etc., etc., treating the
effect as if it were the cause. Inflammation in the pelvis
somewhere, in one of the ligaments, is the chief cause of
anteflexion, and tliis explains why we have so uniformly
trouble from surgical procedure for its relief. If attempts
are made to raise the uterus before the pelvic inflamma-
tion is removed, a fresh attack will be set up. This doc-
trine is applicable to the treatment of all versions, and
it is due to this fact that there is such a difference of
opinion in regard to the use of pessaries in the treatment
of uterine displacements. Whenever we treat antever-
sions and reduce inflammation to a point at which it is
regarded as safe to undertake to restore the uterus to its
normal position, whatever the mechanical appliance is
that is employed, it simply relieves the patient by raising
the organ up to where the circulation can be restored ;
sometimes we can antevert the uterus still more than it
is anteverted, and yet give entire relief The principle
is not simply to correct the position of the uterus so far
as flexion or version is concerned, but to raise the organ
up in the pelvis to a point at which circulation can go
on unimpeded.
Dr. W. T. Lusr said he had been invited to participate
in the discussion ; but inasmuch as the author of the
paper had anticijiated nearly all that he had proposed to
say, he would not further consume the time of the Acad-
emy.
Dr. W. M. Chamberlaix thought the paper covered
a range of inquiry which all would do well to prosecute.
He referred to a single illustration of one point, namely,
the propagation of force from the contraction of the dia-
phragm and connective-tissue movements in the upper
part of the abdomen. Whoever has had occasion to
watch the movements of the pelvic viscera in a patient
anajsthetized lor operation, and has noticed the result
when an attack of vomiting came on, would recognize the
fact so well brought out, that the maximum downward
pressure is not exerted into Douglas' cul-de-sac, but into
the space anterior to the uterus and upon the posterior
wall of the bladder. So far as his observation went, the
extrusion of the vaginal wall had always been much more
in the form of a cystocele than in the form of a recto-
cele.
The dynamics of uterine movement has a wide rela-
tion to education and habits as well as to the cure of
the sick, and he thought that manifestly any great de-
parture from the order of nature, as is frequently dictated
by fashion, was likely to be mischievous. For example,
the influence of affected posture, what is sometimes
called the "Boston tip," in which the body is bent for-
ward and the abdominal walls are relaxed, he believed
was prejudicial to good health. The influence of high-
heeled boots he also believed was a factor worthy of
consideration. He was especially pleased with Dr. Wy-
lie's statement concerning the influence of the vital mus-
culo-connective-tissue pressure. While Dr. Emmet had
spoken most judiciously of anteflexions depending upon
a greater or less amount of pelvic inflammation, he
thought there were anteflexions, but more especially
anteversions, which are the source of great discomfort,
which never can be cured by any mechanical appliances,
because they depend essentially upon an empty state of
the connective tissue. And he believed that in many
of those women who are bedridden, the displacement
continues because they are bedridden, and that the one
means of restoring them is to restore the normal condi-
tion of the connective-tissue system.
Dr. Wylie, in closing the discussion, said, with refer-
ence to Dr. Chamberlain's remark, concerning the etiect
of pressure of the diaphragm being chiefly expended
upon the bladder when the patient was anajsthetized and
placed in Sims' position, that Dr. C. would recollect
that in Sims' position the curve of the spine is mainly
taken out, and that the greater part of the force is di-
rected downward more in the direct line of the bladder.
In the upright position he thought that the pressure was
so equally distributed that there is a projier balance be-
tween the two, and that the uterus settles in the pelvic
cavity in accoidance with this equalized anil balanced
pressure.
April 28, 1883.]
THE MEDICAL RECORD.
471
DISCUSSION ON THE NEW CODE, AND WHAT CAME OF IT.
The Academy then proceeded to the transaction of
new business.
Dr. Austin Flint, JR-i rose and said : I have been
requested to introduce a certain preamble and resolu-
tions with reference to the election of resident Fellows.
I think, Mr. President, it is time that in this hall, the
gift of a distinguished fellow and benefactor of this Acad-
emy, in the presence of these portraits of past presidents
and distinguished fellows, and many good men who have
left us, I think it is time that resolutions should be in-
troduced deprecating the admission of any Fellow who
cannot conscientiously sign, as we have all signed, and
cannot cordially support, as we should all support, the
Code of Medical Kthics recognized by the regular pro-
fession of this city. State, and country, the Code of Ethics
which has been embodied as one of the by-laws of this
Academy. I therefore move you, Mr. President, the
adoption of the preamble and resolutions which I will
read :
JI /wrt'cTS, The New York Academy of Medicine has
adopted in its By-Laws, and as its standard of medical
ethics, the Code of Ethics of the American Medical Asso-
ciation ; and
IV/iereas, Each newly elected P'ellow of the Academy
is required to sign its Constitution and By-I.aws, be it
Resolved, That the Committee on Admissions be and
are hereby instructed to report to the Academy for elec-
tion as resident Fellow, no physician who is known by
the Committee to be in opposition to the Code of Ethics
of the Academy, and who in consequence cannot con-
scientiously sign the By-Laws of the Academy ; and
Resolved, That these instructions to the Connnittee on
Admissions continue in force until the American Medical
Association shall have modified or repealed its Code of
Ethics, and such modification or repeal shall have been
adopted by the Academy, or until the Academy shall
have modified or repealed its by-law referring to med-
ical ethics.
Dr. J. P. Garrish. — I second the resolutions.
Dr. C. R. Agnew. — Mr. President : Of course, in
common with a large number of my colleagues and P'el-
lows of this Academy, I have had no intimation of the
import of these resolutions otTered at this time. It was
only by accident, the merest accident, that, at half-past
seven o'clock this evenini:;, I heard that a certain number
of the Fellows had been secretly informed that such reso-
lutions would be introduced. It seemed to me, when in-
formed of the intention of my honored colleague to intro-
duce such resolutions — accidentally and unintentionally
informed — that I had a right to suppose, as a P'ellow of this
Academy, I should have been informed by the Secretary
of the Academy of the intention to introduce resolutions
of this kind. It has been very evident, by the rhetorical
way in which our distinguished colleague has introduced
them, that these resolutions have been well prepared, and
that persons have been informed that they were to be in-
troduced, and so a very large attendance at the Academy
has been secured of those who were known to be favor-
able in advance to the ethics of the resolutions which the
gentleman has introduced.
Now, may I ask the Secretary to read the qualifica-
tions for membership in this Academy ? These are found
in the Constitution, Article 3, Section i.
The Secretary reads : " Each candidate for Resident
Fellowship must have been a graduate or licentiate in
medicine residing in this city and county, or in either of
the counties of this State thereunto adjoining, for three
years."
Dr. Agnew. — Are there any other qualifications pro-
vided for in the Constitution, Mr. President, for admis-
sion into this Academy ?
The President.— Signing the Constitution and By-
Laws.
Dr. Agnew. — Then it seems to me that it is the in-
tention of the resolutions to embody in the Constitution
of the Academy an additional qualification for member-
ship, and that it should have been noticed by the Secre-
tary in conformity with the provision of the Constitution,
which says tliat " no part of the Constitution shall be al-
tered, excejit at a stated meeting, subsequent to one at
which a proposition to that effect shall have been made
in writing, and then only by a vote of three-fourths of the
Resident Fellows present."
Now I move that the resolutions with their preamble
be laid upon the table until that provision of the Consti-
tution shall have been complied with. It is proposed to
establish a new test for membership, and I think the
Secretary should, in conformity with the custom of the
Academy, if nothing more, give notice of their introduc-
tion. I call for the Ayes and Nays on my motion.
Ayes 32. Nays 60.
The motion to lay on the table was declared lost.
Dr. Roosa. — Mr. President, the distinguished gentle-
man upon this occasion seems to have forgotten the
scene which occurred in this Academy when his even
more distinguished father, in an address to the medical
profession, counselling harmony, distinctly slated that it
was in the County Medical Society that discussions like
this were to be carried on, and that, that was the arena
for the discussion of ethical subjects on which medical
men of all shades of opinion might differ. It is very in-
teresting to watch the indignation beginning in Brooklyn
and being continued in Philadelphia, which it has taken a
year and a half to whoop up to proper dimensions. When
the Medical Society of the State of New York, in the
right given to it by a charter as old as 1809, and given
to it by its by-laws, which have not been repealed, clid in
1S82 repeal a certain section of its by-laws, I had the
honor of conversing with many of the gentlemen who
have now become so excited lest the honor of the pro-
fession of the State should be entirely swept away, and I
failed to see then any of the indignation expressed in the
gentleman's remarks when he claims that he and his party
alone represent the regular profession, and causes the
inference that those gentlemen who do not resort to the
same expedients to obtain control of medical societies,
represent an irregular profession. This is not a spon-
taneous agitation. It is not an expression of the real
sense of the medical profession lest its time-honored rules
should be overturned. It is an exjiression created simply
by a secret society, a high organization which sends its
orders to individuals to be present on certain occasions.
This is an agitation which is all artificial, and is one of the
most decidedly political organizations which ever existed.
It was not until this evening at a very late hour that
we became aware, those of us who are standing by the
rights of the medical profession of the State of New
York [Interruptions and jeers, promptly suppressed by
the President], and of that society which will survive any
derision, and can rest secure simply upon its own history
and its own merits, it vi'as only at a late hour, I re-
peat, that we knew anything of such an occasion as
this, or we should have been better represented than-
it has been our fortune to have been. If there were
that sublime ethical feeling for which these gentlemen
are clamoring, even if any attention had been paid to
that law of ethics, higher than those of any academy or
any American medical association, to the law which
obtains among men who are waged in contest with each
other, we would have been notified that this matter
would be brought up to-night, and it would not have ap-
peared in the characteristic method in which it has been
presented. To properly characterize it would require
language not parliamentary, and from which I will re-
frain. I simply appeal to the honor of the gentlemen who
differ with us in opinion concerning ethical interpreta-
tions, and who claim to represent the purity of the ethics
of the profession, as against us who are irregular.
Dr. Goulev. — I rise to a point of order. The gen-
tleman is not speaking to the question.
472
THE MEDICAL RECORD.
[April 28, 188^
The President. — The Chair decides that the gentle-
man is speaking to the question.
Dr. Roosa. — I wish simply to say that I appeal to
the honor of the gentlemen who claim to represent the
purity of the ethics of the profession, as against us who
are irregular, that they shall forego their action this night,
and allow us to discuss this- question when the Academy
may liave a fuller representation. I trust I see men here,
no matter what their obligations upon the general ques-
tion are, who are under no obligations which would bind
them to disregard the common courtesies of any contest,
and especially this one, which thus far has mainly been
carried on in a friendly way. I hope it will be continued
m a friendly manner, and let us at least have an opportu-
nity to say what we may have to say when we are ade-
quately represented.
The President. — The Chair begs leave to state that
any one speaking on either side, will, while he is speak-
ing, be protected, and that without reference to the
opinion he may express.
Dr. Flint, Jr.— Mr. President, I would like to ex-
plain with reference to certain strictures which have been
made by the gentlemen who have spoken. All I intended
to say was in the few remarks with which I introduced
these resolutions, and they constituted all which I should
have said upon the subject, did i not feel that I must
reply to the strictures which have been init upon me and
have been put upon some others. We consulted to-
gether, and all thought it best that these resolutions
should be introduced at this time. They have no refer-
ence to .State or county medical societies. The move-
ment which many of us have gone into is to sustain the
Code of Ethics of the American Medical Association
until it shall be modified by that body.
The New York Academy of Medicine is the only
chartered medical society in the State of New York,
which is entitled, through its delegates, to recognition,
either in the American Medical Association or in any
of the State Medical Societies in the Union. I wish
that fact to stand fully before the mind of every Fellow
of the Academy. Now the question is that, being the
only body which can send delegates to the forthcoming
meeting of the American Medical Association, that being
disfranchised by an action which I shall not attempt to
characterize, that action which cannot be compared to
anything — I will not try to go on — but 1 think many of
us feel deeply that that action has been the occasion of
such action as we have taken to-night. It is true, we
invited our friends to be present, and expected that they
would be here and vote for these resolutions. But we
have not organized and given our organization a public
appearance in medical journals ; but we have a list of the
names of the men who have signified their willingness to
sustain the Code of Ethics of the .\merican Medical Asso-
ciation until it is so modified, which I will give to any one
who may ask for a copy. There is no secrecy in the mat-
ter, but the sinqile question is this. Will the Academy
take the ground which shall put it right before the country,
before the medical societies of our sister States, and right
before the American Medical Association ?
Shall we fall in with the idea that there may be a code
of ethics for New York State, another for New Jersey,
another for Connecticut, another for .Massachusetts, and
so on? Shall we do it? Or shall we sustain the code
which has governed all the States ? I contend that we
have a right to call our Committee on Admissions to ac-
count if they report for election any men who cannot
sign these By-laws. It does not follow that they must
be called upon to go and vote against good men on that
account. But that committee should know t'.ieir duty.
We are not modifying the Constitution or By-laws, we
are simply saying that it is the sense of this meeting, that
these are the By-laws which are to be signed, and that
they are to be signed without mental reservation. The
Academy may dismiss the committee, if necessary, if it
does not do its duty, by a two-thirds vote. If any one
feels that he is hampered by this action, he can resign.
I have considered the matter carefully, and I undertake
to say that there is no thought of any new qualification
or modification, or alteration of the By-laws, but it is
simply a resolution to instruct this committee to act in
accordance wirh the By-laws. I hope it will pass, and I
hope that this question regarding the Academy of Medi-
cine will be forever settled.
Dr. Agnew. — As the gentleman says there is no organi-
zation on their part, I ask if he would have any objection
to telling us the method by which he secured this attend-
ance of his associates ? [Confusion, and cries of order,
question.]
Dr. Purple. — Is that in order ? Has the gentleman a
right to call upon any member of this Academy to tell
the mode in which he attempts to support the Constitution
and By-laws of this Institution. We wish to let the pro-
fession know that this Academy has its code of ethics,
and that it is not a dead letter. There are those members
here to-night, gray in years, who have stood by this institu-
tion, stood by its Constitution and its By-laws, and they
are going to go through thick and thin to support them, and
if need be to fight for them, either by blackballing or any
other means which will support the By-laws. The gentle-
man must not consider that these are dead letters.
[Question, question.]
Dr. Weir. — If I understand Dr. Flint correctly, his
resolutions are only intended to instruct the Committee
on Admissions as to their duties ; that they are not to do
any more by passing these resolutions than is now ex-
pressed in the By-laws. Therefore I do not see why the
passage of such resolutions should be enforced. We
have no delegates to be sent to the American Medical
Association. They have already been chosen. We have
no meeting to-night in accordance with all fair working,
and I think we are entitled to this consideration from
gentlemen on the opposite side ; that due notice should
have been given, and that this matter should be postponed
until the next meeting or to a special meeting. I am
sure that is not much to ask of them.
Dr. a. H. Smith. — I should like to ask, before I vote
on this question, inasmuch as everything seems to hang
upon the intents and purposes of the candidate, how
the members of tlie committee are to know what he is
going to do, antl exactly how the committee are to go
about settling the question for his conscience — a question
which should arise in the conscience of each man. It
seems to me that it is rather ungracious, and that to
clothe the committee with any such power is extending
to it a province which does not belong to any committee.
I would like to know upon what ground the action of the
committee is to be based.
Dr. Ira B. Reid. — The object is to throw upon the
committee the work which would be otherwise thrown
upon all of us every time a name comes up. The By-
laws and Constitution are not usually presented to the
candidate to sign before his name is balloted upon, and
it is simply to permit him to say whether he can sign
them or not ; if he cannot the matter is ended with the
committee ; if he says he can the committee will present
his name for election.
Dr. E. C. Harwood read Sec. 14, Art. 5 of the By-
laws, which relates to the Code of Medical Ethics of
the Academy, and said that when he entered the Acad-
emy he signed these by-laws and constitution, and that
he proposed to stand by them, and it implied that he must
stand by the Constitution and By-laws of the American
Medical Association. At the same time he did not see
any necessity for the resolutions that had been intro-
duced, as the same ground had been entirely covered by
the By-laws. He would be glad if the subject could be
considered more fully, and what the opposite side had
claimed he regarded as no more than fair. He had al-
ways sustained the Code of the Academy, but he did not
see any necessity for the resolutions, and believed that
they were entirely out of order, and declined to vote.
April 28, 1883.]
THE MEDICAL RECORD.
473
Dr. Partridge said if the resolutions were a modifi-
cation of the By-laws, a three-fourths vote would be re-
quired. Were they intended as such, or siniply as in-
structions to the Committee on Admissions ?
Dr. Agnew. — It is an aphorism of Montesquieu that
any act of authority exercised over one man by another,
which is not absolutely necessary, is tyranny. [Oh ! Ho!|
Now these gentlemen, who hope these resolutions will be
adopted, imagine that this act will help their cause. I tell
them that it will not. The cause of liberty of conscience
[Oh! Oh!], which we represent, is a cause which is advo-
cated by a higher power than that of man. The Medical
Society of the State of New York appomted a committee
to revise its system of medical ethics, that committee
made its report — a report which was afterward adopted —
and which was in strict conformity to the Statutes of the
State of New York. The New York State Medical So-
ciety in so doing accomplished an act which cannot be
overthrown as long as the people of this State are infiu-
enced by the principles of the love of freedom which ani-
mated our forefathers. [Derisive laughter.] ("lentlemen
may jeer and scoff and laugh in derision. So it was when
Disraeli stood up in the House of Connnons ; he was
laughed at by more respectable gentlemen than those who
sneer at me, and gentlemen who represented the aristoc-
racy of their profession. I am a much smaller man than
Disraeli, but I tell my scoffing friend on my right
Dr. John G. ."Vdams. — I call the gentleman to order.
Dr. Agnew — that the time will come when this Acad-
emy will hear me. Now, Mr. President, the Revised
Statutes of the State of New York
Dr. Flint, Jr. — .\h, we have heard enough about that.
Dr. Agnew. — Very well, if this Academy does not
wish to hear me it can say so.
The President. — The gentleman is in order and will
proceed.
Dr. Agnew. — I was about to state that the Revised
Statutes of the State of New York say that any incorpo-
■ rated society shall have its by-laws strictly within the
limits of those statutes. The friends and advocates of
the Code of Ethics of the State of New York did not
come in to disturb this Academy. They had no in-
tention of bringing this question into the .Academy. I
defy any man to bring evidence of any infraction by
us of the Code of Ethics of the American Medical As-
sociation before the Medical Society of the State of
New York passed its revised Code allowing consulta-
tions with legally qualified practitioners, and brought its
by-laws to conform with the statutes of the State. ^Ve
know gentlemen, however, in this Academy who have
lived in violation of the Code of Ethics of the .American
Medical .Association, and who would have to take refuge
under the Code of Ethics of the Medical Society of the
State of New York if their cases were carried before the
Academy's Committee on Ethics. Now I had hoped that
the gentlemen would consider the full bearing of the
question before they passed these resolutions, and before
bringing in here a disturbing element. The number of
men who have voted in opposition to them, even under
these unfavorable circumstances, shows that this Acad-
emy is not united. The number is sufficiently large to
show that they cannot be disregarded and ignored. xMat-
ters of morals and matters of conscience should not be
settled by a certain number of men who, organized like
ku-klu.\, endeavor to compel others to submit to their
will. [Cries of " Order, order, order."]
Dr. Roosa. — I ask for the ruling of the Chair : Does
this measure require a majority or a two-thirds vote ?
The President. — The Chair decides that it is not a
by-law, being simply a resolution containing instructions,
and tiierefore only requires a majority to adopt.
Ayes, 56. Nays, 26.
The President declared the resolution adopted.
Dr. Flint. — I move a reconsideration.
Dr. Gouley. — I move that the reconsideration be in-
definitely postponed.
Dr. Agnew. — What is the object in postponing in-
definitely ? [Cries of " Order, order."] I simply ask the
question if it is the intention of the gentleman to put
tliis subject beyond further discussion ?
Dr. Flint. — It is.
Dr. Agnew. — Then the object is to throttle this .Acad-
emy ?
Dr. Flint. — Undoubtedly it is.
Dr. Agnew. — I call for the privilege of having this
statement recorded, that it is intended to throttle dis-
cussion in this .\cademy. [Cries of " Order, order."
"Question, question.'']
The President. — The Chair, before putting the ques-
tion, wishes to state that in his opinion no body, by any
parliamentary move, can declare that expressions of
oiiinion or action upon any question can never be
changed by that body.
The motion to indefinitely postpone was carried.
Dr. Flint. — Mr. President, I have now another resolu-
tion to introduce, and I hoi)e it will be adopted.
Resolved, That the .\cademy hereby disavows any sym-
pathy with the action of the State Medical Society which
has put the State and County Medical Societies in an at-
titude of opjiosition to the profession of the State tlirough
the State and County Societies.
Dr. Roosa. — Mr. President, it was agreed, as nnich as
it can be agreed among gentlemen, that this fight would
not be carried into this Academy, and now it has been
brought here by means which no honorable man can suc-
cessfully defend. [Cries of " Order, order."]
A motion was made to adjourn.
The President. — I wish to make a request, and I beg
the pleasure of the Academy to comply with this request.
I beg that some gentleman will make a motion, which I
believe most earnestly and most strongly should be
adopted in the best interests of the Academy, and that is,
that the by-laws be suspended, and that wheu the .Academy
adjourns, it adjourns to meet on the first Thursday in Oc-
tober. [Confusion.]
Dr. Weir. — Before that motion is made, Mr. President,
I wish to make a statement. I believe I am called upon
to choose between the law of the State and the State Med-
ical Society, and the Code of Ethics of the .American
Medical Convention, an organization of which I know
nothing. I consequently choose to abide by our State
law and the Medical Society of the State of New York
and therefore tender my resignation as Vice-President
and Fellow of this Academy. [Confusion.]
The motion asked for by the President was made and
put, and declared lost.
Dr. E. D. Hudson, Jr. — I would like to know if intimi-
dation has not been a part of the mode adopted by the
friends of this organization which has such a following.
To the best of my belief they have had their secret meet-
ings in this building, with locked doors, where measures
were discussed for packing the hall this evening to vote
for these resolutions. [Great confusion.]
Dr. William T. White. — .As Chairman of the House
Committee, I wish to say that I do not know of any such
meeting.
Dr. Agnew. — I wish simply to raise my protest once
more. It has always been the practice of this Academy
to issue notices containing memoranda of tlie work pro-
posed, and in that way every gentleman has had an op-
portunity to attend and act upon questions in which he
was either especially or generally interested. In that re-
spect the Academy has been on the side of the best kind
of parliamentary practice. Now, this secret society which
issued its instructions to its members some time or other
during the last day or two, has prepared for the action
of this Academy a resolution which contains the most
important questions which this Society has ever under-
taken to decide upon, and yet no notice of it has been
given to the Academy in general. We might have come
here simply supposing that papers were to be read, but
a sufficient number have been gathered to accomplish
474
THE MEDICAL RECORD.
[April 28, 1883.
the purposes of the mover of these resolutions — resolu-
tions duly prepared in ink and with facility of expression ;
and the direct voting which these men so assembled
have given, shows how well they are drilled, and that each
gentleman is under command. 1 simply wish to put in
my protest, and to say that such a movement will not
bring peace or honor into this Academy. One of the
principles upon which this Academy is based is, that
there should be toleration of dissent. Our profession has
reached its eminence, I know, by doing things against
precedent, but these gentlemen propose to enforce a
system of ideas from which there shall be no dissent
without incurring their displeasure. But I am not afraid
of their dis|ileasure. I see a gentleman pointing his fin-
ger at me. I defy him or any other man to bring any
charges against me. In accord with my convictions, I
defy these men who have organized this secret Society,
and who have come here to throw this Academy into
anarchy. If there is not to be freedom of discussion and
freedom of opinion in a scientific body, where is there to
be freedom ?
Dr. Gibnev. — I move that, in the interest of harmony,
the question be laid upon the table.
Lost.
The resolution was then adopted.
Dr. Flint. — I move a reconsideration.
Dr. Goulev. — I move that the reconsideration be in-
definitely postponed.
The motion to indefinitely postpone was carried.
The President. — I have asked tlie personal favor
that, in what I believe to be for the best interests of the
Academy, the Academy should adjourn to meet on the
first Thursday in October. That request, by a vote of
the Academy, had been denied. I now file my resigna-
tion.
Drs. Roosa, Agnew, and W. F. Cushman also ottered
their resignations.
Dr. Purple. — I rise to a point of order. The Acad-
emy cannot act upon any of these resignations until we
know whether or not the gentlemen have paid their dues.
[Storm of hisses.]
Dr. Bosworth. — I renew the motion that the By-laws
be suspended, and that when the Academy adjourns it
adjourn to meet on the first Tiiursday in October.
A rising vote was taken, 54 voting in the affirmative,
and 16 in the negative.
The Academy then adjourned amid confusion.
A C.\se of PliaDCTiTis resulting from Acute Me-
tritis.— Dr. E. T. Hubbard, of Madison, N. H., de-
scribes a case under the above head. Dr. H. considers
the complication quite a rare one. A married lady,
twenty-eight years of age, after a long railway journey,
aborted at the second month, since which time she has
suffered considerably from irregular menstruation, and at
times flooding quite profusely. I was called to see her
in about three months after she aborted. Found uterus
enlarged, very tender, and e.xuding a thick grumous dis-
charge. Put her on ergot with bromide i)otash. At my
next visit, in two days from that time, I found tempera-
ture 1034°, circulation 130, with dry tongue and con-
siderable abdominal tenderness with pain shooting down
the thiglis and across the lower and back part of the
pelvis, she having passed considerable tough, stringy
mucus from the rectum, attended with considerable tenes-
nuis, there being also a comjilete retention of urine. I
diagnosed it as proctitis as a comi)lication of metritis. I
think it quite a rare complication. We may have con-
siderable irritation of rectum, but no true inflammatory
action, as there evidently was in this case.
A New Word — Dvscardia.- — M. Lubanski suggests
(Z' Union Medicalc) the term dyscardia to signify ditticult
action of the heart. Tiie word, he thinks, would mean
for the heart what dyspncea means for the lungs.
CCo rvcsp 0 u (1 en c c.
OUR LONDON I^F.TTER.
(From our Special CoiTespondent.)
THE DEBATE ON DIABETES AT THE PATHOLOGICAL SO-
CIETY THE grocers' COMPANY AND THE ENDOWMENT
OF RESEARCH — COMPARATIVE PATHOLOGY — THE VIC-
TORIA UNIVERSITY — MEDICAL TITLES.
London, .'\pril 7. 1883.
Diabetes has been selected this year as the subject
of the annual debate at the Pathological Society. This
was opened on Tuesday last by Dr. Wilks. After a few
remarks, in the course of which Dr. Wilks said that he
had not himself found any changes in the fourth ventricle
in patients dying from diabetes. Dr. Ralfe rose and
brought forward his views. He distinguished two forms
of diabetic coma, to the rarer of which he considered
the term acetonremia should alone be applied. He
thought this condition was paralleled by those of acute
yellow atrophy and phosphorous poisoning He doubted
the existence of free acetone in the urine, but thought
aceto-acetic acid was probably present. If so, this
would explain the high acidity of the urine so often ob-
served in diabetes, the lactescent condition of the blood,
and the intense fatty degeneration so noticeable in cases
of acute diabetic coma. No other speakers advanced
any theories, but confined themselves to criticisms.
Several microscopic specimens were exhibited. The de-
bate will be resumed in May.
Great outcries have been from time to time raised
against the city companies and their disposal of their
funds. The Grocers' Company, though, has shown its
liberality on several occasions The new wing of the
London Hospital was built by its contributions, and now
it again comes forward with a generous proposal to
spend some thousands of pounds in the endowment of
research.
Dr. Garrod's " Lumleian Lectures on Uric Acid," now
in course of delivery at the College of Physicians, are
interesting as containing tlie results of researches carried
on by him for years, into the chemistrv of the excretions
of various animals. Dr. Garrod is, however, not alone
as an investigator in the field of comparative pathology.
The senior surgeon to one of the London hosi)itals has a
model farm a short run by rail from London, to which he
is accustomed to repair in his leisure hours. He has
stocked it by purchasing diseased stock from neighboring
farmers, and occupies himself in watching the patholog-
ical phenomena thus presented to him.
The Victoria University, Manchester, has received a
charter to grant degrees in medicine to persons of either
sex. Those who object to a multiplicity of titles now
remark that this makes a twentieth medical licensing
authority.
American physicians find it diflicult to understand how
it is that so many medical men call themselves Mr. The
fact is, only university graduates (i.e., M.D. or M.B.)
can call themselves Dr., and /// England the majoritv of
practitioners are not university graduates in medicine.
Some even who have taken a degree in arts do not take
a degree in medicine. The older English universities
require residence, and this arrangement practically ex-
cludes students at the London hospitals. This anomaly
is not seen in Scotland, where the universities draw large
classes. Consulting surgeons call themselves Mr., even
though they are graduates. Physicians are nearly all
graduates and style themselves Dr. In England most
of the general practitioners are not graduates : those
who are use the title of Dr. Tiiese anomalies are the
growtii of years, and are almost universally adhered to.
Specialists are mostly surgeons, and use the title Mr. on
tlieir door-plates, though many who have degrees use
them even when practising a surgical specialty. In
April 28, 1883.]
THE MEDICAL RECORD.
475
Edinburgh, every medical man is called " Dr." by the
IJublic, no matter what liis qualifications. In Dublin,
consulting surgeons often distinguifh their mode of prac-
tice by prefixing " Surgeon " to their names.
DO THE L.A.WS OF A STATE DEFINE THE
DUTIES OF INDIVIDUALS OR SOCIETIES
IN MATTERS OF ETHICS?
Sir : A noticeable feature of Dr. Agnevv's article on the
Code question in a recent issue {vide p. 349) is that it
does not in any way discuss the claims to recognition of
the class or classes of practitioners who are welcomed by
the new Code ; but, aside from some rhetorical reference
to liberty, jirogress, inalienable rights, etc., his remarks
are devoted entirely to the legal aspect of the question,
and the obligation which he claims is placed upon the
medical societies of the State by the various medical acts
of the State Legislature.
1 shall not discuss at present the ethical principle in-
volved by our recognizing in the new Code officially, as
it were, the right of those whom we have formerly enti-
tled irregular practitioners to exercise the duties of phy-
sicians ; I will only call attention to our relation to the
law.
Is there any one wlio will claim for a moment that the
law created the Medical Society of the State of New York,
or for that matter any other medical society. It is sim-
ply an impossibility for the law to exercise such a func-
tion. The first condition for the organization of a so-
ciety of the nature of medical societies is the coming
together or agreement of a certain number of individuals
having certain interests and ol)jects in common. Here
we have the essential idea of the society upon which the
law may confer certain corporate rights, which no doubt
may, and in fact often do, amount to privileges. It is not
necessary that there should be formal meetings and or-
ganization before the incorporating act of the I>egisla-
ture, but it is necessary that there be men ready for the
corporate work, and practically we find that these men
are the originators and promoters of the special law.
The laws of the State of New York have never defined
the duties of individuals or societies in matters of ethics,
while, on the other hand, in medical affairs these matters
have been distinctly and properly left to physicians them-
selves, by the acts incorporating the various societies
representing what we will call ditt'erences in opinions and
practice.
The Act of 1880 can in no way be construed as com-
pulsory in matters of practice, either as to the persons
we shall accept as patients or the physicians whom we
shall meet in consultation. These are matters of indi-
vidual liberty, and any restraint put upon us concerning
them by the law would be contrary alike to the spirit of
the age and the genius of our political institutions. \Ve
ai'e at liberty to respond to a call or to decline going.
We can meet another physician in consultation or refrain
from doing so, and the law cannot interfere ; we are pri-
vate citizens and not officers of the State, and I believe
the best interests of society will be served by our con-
tinuing to occupy that relation to the law.
As members of tlie State and County societies we are
at liberty to frame for our guidance such rules and regu-
lations as seem best, simply keeping ourselves in this
instance, as in otlier relations of life and in common
with other citizens, free from violation of the laws.
If the regulations adopted seem onerous or unjust to
individual members, they have the right of protest and of
eftbrtto secure action favorable to their views ; and finally
if the difference be irreconcilable, there remains tiie "in-
alienable right '' of withdrawal.
The statement that the objectionable feature of tlie
new Code in tlie matter of consultations with " legally
qualified practitioners of medicine is permissive and not
mandatory" seems to concede the question of law, but
certainly is no argument as to the question of right. This
permission might serve as an incentive to objectionable
affiliations, and the instances, now too common, of men
serving low and selfish purposes with the indorsement of
honorable associations and the livery of honest intent
would be multiplied.
' I cannot see any additional liglit as to the legal status
of the question in the opinions quoted from lawyers. It
is possible that the "Professor of Municipal Law" may
have been studying closely the various acts and projected
acts of the Legislature concerning the city of New York
during the last quarter of a century, and thus have be-
come confused when he takes up the question of our
rights and duties.
I trust our societies will continue free from any inter-
ference on the part of the Legislature comparable to
that visited upon some of our municipalities, but, failing
to maintain that freedom, it would be the part of wisdom
to forfeit our corporate privileges and become simply
voluntary associations.
Unless it can be shown tliat the law is compulsory in
this matter, it is idle to raise the question for argument.
1 listened attentively to the discussion at the recent
meeting of the State Society, and I heard no reason ad-
vanced in favor of the new Code, except that an adhe-
rence to the former Code placed us in hostility to the laws
of the State, and a certain amount of sentiment as to a
generous spirit, a ]irogressive age, efforts for a higher
standard of qualification and the like, 'these statements
are not arguments, and become nonsense unless sup-
l)orted by a plain and distinct array of facts showing
their truth.
I heard no one deny the legal right to decline a con-
sultation with any physician, regular or irregular, so that
the consultant felt tiiat he jireferred to decline, and I
have yet to hear the proof from the cliam|)ions of the
new Code that a physician can be what we have termed
an irregular practitioner and at the same time a proper
and desirable person for fellowship in our societies or to
be met in formal consultations.
In the discussion of the question that will occur till
the meeting of the State Society in February, 1884, and
at that meeting as well, it is desirable that we confine
ourselves as closely as possible to the real merits of the
case, and leave the idea of " courtesy to the Legislature,"
etc., alone ; and, above all, unless some statutory obli-
gation can be shown which will make us liable to some
penalty for a particular action in the premises, let us
hear no more of the law.
E. D. Ferguson, M.D.
Trov, N. Y.
3Vvimi ^Jlcixis.
Official List of Changes of Stations and Duties of Officers
of the Medical Department , United States Army, from
April 14, 1883, to April 21, 1883.
WoLVERTON, Wm. D., Major and Surgeon. Granted
leave of absence for four months on surgeon's certificate
of disability. S. O. 85, par. 7, A. G. O., April 13, 1883.
Shufeldt, Robert W., Captain and Assistant Sur-
geon.' To report in person to the President of the Army
Medical Examining Board in session in New York City,
for examination for promotion, on completion of which
will return to proper station. S. O. 87, par. 10, A. G.
O., April 16, 1883.
Sweets from Coal-tar. — .A new substance, remark-
able for its intense sweetness, being much sweeter than
cane-sugar, has lately been found by Dr. Fohlberg, in
the course of some investigations on coal-tar derivatives
(Journal of the Franklin Institute). He designates it
benzoic sulphonide, or anhydro-sulphamine benzoic abid.
4/6
THE MEDICAL RECORD.
[April 28, 1883.
medical litems.
«*
Contagious Diseases — Weekly Statement. — Re-
port of cases and deatlis from contagious diseases re-
ported to the Sanitary Bureau, Health Department, for
the two weeks ending April 24, 1883 :
Week Ending
3
V
1
•a
0
C .
'5.-=
•c
i
a
0.
fi
^s
u
^0.
13
H
H
03
u
^
if.
>
Cases.
I
3
6
141
4
5
199
166
50
51
->
0
April 24, 18S3
17
■T
0
Deaths.
Aoril 17, iSS^
T
6
7 I
3
3
77
20
0
0
0
T
20
26
26
I
0
Typhus fever has appeared among the children at St.
Stephen's Home ; the cases so far are very mild.
Deaths during the week ending April 21 were 676, of
which 98 were from pneumonia.
A Thermometer Holder. — Dr. J. 1'. Savage, of
Sioux City, Iowa, writes that an efficient thermometer
holder is already in the market and has been for some
time. He sayS : " Several years ago, when attending
Believue, after breaking three thermometers in one day,
by falling out of pocket while stooping to examine pa-
tients, I found a holder, made and now for sale by Cas-
well & Hazard, of this description : made of CJerman
silver, screw top, in top is a small staple to which is at-
tached a chain ; to other end of chain is attached a small
'safety pin.' The pin can be fastened in pocket out of
sight. Since using this I have not lost a thermometer."
Prescribing by Telegraph. — The Eh-ctrician pub-
lishes the following : '-.-Vn employe of the Eastern Exten-
sion Telegraph Company, stationed at Cape Bolimao,
Manila, had a narrow escape the other day, having taken
ten grains of sugar of lead in mistake for a similar quan-
tity of ammonia. He telegraphed for advice to the
Hong Kong telegraph office. Dr. Hartigan, of that city,
came down to the office and sent him advice per cable
which resulted in his recovery. The distance between
Hong Kong and Cape Bolimao is about five hundred
and fifty-five miles. Probably this is the first time that
a doctor has prescribed for a patient over five hundred
miles away from him."
To Prevent Pitting in Small- Pox. — Dr. Emil Stei-
ger, of Prairie du Chien, Wis., writes : " I have perused
with much satisfaction the article of Dr. J. N. McChesney,
on variola, but I was surprised not to see among the rem-
edies against pitting a simple preparation which, in three
epidemics during the last twelve years, has proved to me
invariably successful. The fact that the preparation has
given the utmost satisfaction in all cases where it was
•properly employed, including even those where 1 only ob-
tained charge in the vesicular stage, may justify my pre-
sumption in publishing my treatment. Take of wiiite lead
(plumbum carbonicum), ciuantum lib., mi.x with linseed-
oil q. s. to make a cream-like paste, add to the bulk about
five to si.x per cent, carbolic acid, and apply with a large
camel's-hair brush reiieatedly, so as to keep the surface
of the face, hands, etc., permanently and fully covered."
The Association for Preventing the Re-en.\ct-
MENT IN the State of New York of the Present
Code of Ethics of the American Medical .Associ.v
tion has issued the following address to the medical
profession of the State of New York : —
When very many members of a learned and liberal pro-
fession come to the conclusion that the rules by which
their relations to their colleagues and to the public have
hitherto been regulated have been injurious to themselves
and to the community, it is evidently the duty of persons
having these convictions to labor for the abolition of
such rules, and to state clearly the reasons why they
should no longer be enforced.
The Code of Ethics of the .\merican Medical Asso-
ciation which is now in force is identical with that which
was in authority in the Medical Society of the State of
New York, and which was abolished at the annual meet-
ing of that society in February, 18S2. It appears from
the proceedings which led to the abolition of the Code in
the State of New York that there had been a gradually
increasing conviction among its members that some of
the provisions of the Code were arbitrary and illiberal, and
that a larger liberty should be granted the members of
the societv in the pertbrmance of their professional duties.
.\fter a full discussion of the subject, a vote of the society
was taken, and by a constitutional two-thirds majority
the old Code was abolished and a new one was enacted
in its place. Among those who voted for the substitution
of the new Code for the old one were many who preferred
the entire abolition of the special ethical Code as unneces-
sary for the guidance of an honorable and learned pro-
fession. But the members who took this view of the
subject were willing to unite with those who were less
radical than themselves, in order to secure the abandon-
ment or the most obnoxious features of the old Code.
At the annual meeting of the society in P>bruary, 1883,
a strong effort was made by the advocates of the old Code
to undo the work of the previous year and to re-establish
in this State the Code of the .American Medical Associa-
tion. For this purpose no exertions were spared to se-
cure the election of delegates who were in favor of the
proposed retrograde movement. But the efforts which
were then made failed to secure the votes of even a ma-
jority of the members of the society.
It is well known also that a strong effort is now being
made, even by coercive measures, to secure in advance
such a representation at the meeting of the society in
1884 as will undo the work which was done in 1882 and
1883. Believing that such action would be injurious to
the honor, dignity, and usefulness of the profession, and
to the best interests of the community, we earnestly en-
treat the members of the profession to give the subject
their serious consideration, and to use all honorable and
legitimate means to prevent the re-enactment of the pres-
ent Code of the .-Vmerican Medical Association by the
Medical Society of the State of New Y'ork. It appears
to us to be particularly important to preserve to each
member of the profession perfect liberty to decide for
himself with whom he shall consult in order to secure the
best interests of the sick.
The arbitrary rules which have to so large an extent
controlled the actions of medical men, and which were
originally designed to defeat the efforts of irregular prac-
titioners to gain influence with the community, have
signally failed to accomplish the object in view. These
rules also have not commanded the respect of intelligent
men in other professions. They have been regarded as be-
longing to the same category as the rules by which the
various trades unions have infringed upon the individual
liberty of their members, subjecting those who resisted
the arbitrary action of the majority to the greatest in-
dignities, pecuniary losses, and even personal sufferings.
We call upon all fair-minded medical men to unite with
us in freeing the profession from this stigma, and in
giving all its members perfect liberty to practise their art
in accordance with the dictates of their own consciences
and with the enlightened opinion of intelligent men who
are engaged in other pursuits.
There are indications that the movement which has
begun in this State is destined to extend throughout the
Union and to end in establishing a larger liberty than we
have hitherto enjoyed, and in increasing the usefulness of
our profession, and in giving it a more honorable posi-
tion in the State and in the nation.
A. C. Post, M.D., President.
The Medical Record
A IVeekly yoitrnal of Medicine and Surgery
Vol. 23, No. 18
New York, May 5, 1883
Whole No. 652
COviiiinal ;i'ivticlcs.
SCARLATINAL NEPHRITIS AND ITS COMPLI-
CATIONS.
By JOHN H. RIPLEY, M D.,
PROFESSOR OF DISF.ASES OF CHILDREN IN THE NEW YORK roLYrUNIC.
(Continued from p. 452.)
The J>rog-;iosis in scarlatinal nephritis is generally favor-
able. A very large number of those attacked completely
recover. In addition to the symptoms already given
(anuria and multiform casts) as rendering the prognosis
unfavorable may be mentioned: 1, a severe form of fever
preceding the nephritis, especially if complicated with
true diphtheria ; 2, a complicating pleurisy or pneumonia ;
3, a late or an excessive dropsy, especially of the lungs,
pleural cavities, or pericardium. In some cases, even
where the nephritis seems not in itself severe, the child has
become so enfeebled from the effects of the fever that it
ofters only slight resistance to this new malady and slowly
dies of exhaustion. Pleurisy, so common in infancy and
early childhood as a primary disease, is a frequent com-
plication of scarlatinal nephritis. The pleura is prob-
ably the most commonly inflamed of all the serous
membranes in tliis disease, and for obvious reasons the
inflammation is more likely to be purulent than when oc-
curring primarily in a previously healthy child. It is,
therefore, a very serious complication and adds decided
gravity to the prognosis. Pneumonia is less common
than pleurisy and less dangerous, unless conii)licated
with pulmonary cedema. Judging from my own experi-
ence, limited to two cases, both of which recovered, I
should say that acute pericarditis is not as formidable a
complication as one would suppose, theoretically. Ex-
tensive pulmonary cedema and large effusions into the
pleural cavities only occur, as a rule, in consequence of a
very feeble state of the vital powers, especially cardiac
weakness, and hence are unfavorable lesions. The last
two conditions are not infrequently mistaken for pneu-
monia. In a certain proportion of cases of pulmonary
cedema, in which the air-cells over large areas are
completely filled with fluid, the physical signs are pre-
cisely those of the second stage of pneumonia ; and
when only one lung is involved to this extent, the differ-
ential diagnosis must be made more particularly from a
comparison of the vital signs with those of pneumonia.
A change in the decubitus of a child for a few hours, when
practicable, will determine the fluid to another part and
so clear up the diagnosis. Dangerous a'dema glottidis is
a complication of acute Bright's disease, which I do not
remember to have ever seen in a child.
Treatment. — The tendency of scarlatinal nephritis is,
in a majority of cases, to terminate by self-limitation in
recovery. The same general principles of treatment ap-
ply to all grades of the disease, but certain individual
symptoms and the different complications should be met
as they arise. A child suffering from a mild attack of
this form of nephritis should be put to bed as soon as the
disease is recognized, and an equable, moist, and rather
high temperature (70° to 75°) should be maintained in the
sick room. Although it is now generally conceded that the
nephritis of scarlet fever does not, as a rule, arise from the
patient's taking cold, still exposure to cold is a recognized
cause of a simflar form of nephritis, occurring as a pri-
mary lesion, and it is also known to cause exacerbations
of the disease in all its forms and stages. It is not im-
probable, therefore, that it may aggravate e.xisting inflam-
mation, or even determine it from a simple congestion
in a small percentage of cases. The bowels should be
kept rather free by means of some mild laxative, such as
a combination of magnesia, senna, and rhubarb, but hy-
dragogue cathartics are not indicated, although some phy-
sicians seem to hold the opinion that the appearance of
albumen in the urine is the signal for drastic purgations.
A simple nutritious diet, such as could be formed by al-
ternating with milk, buttermilk, milk porridge, beef-tea,
broths, and stewed tripe should be adopted. A diapho-
retic mixture, as the liquor aiivnotiia acetatis, completes
all that it is necessary to do in mild cases. In the man-
agement of grave cases we have to deal with one or more
of the following symptoms : i, Partial or complete sup-
pression of urine ; 2, dropsy ; 3, uraemia ; 4, complica-
tions with other diseases.
I. Partial or complete suppression of urine. — In those
forms of chronic Bright's disease in which we have a
feeble heart and anremic kidneys, much good may be
done by stimulating the heart and irritating the kidneys
with diuretics, thereby bringing about an increased flow
of urine by an increased blood-pressure. But in the earli-
est stage of this disease the secreting portion of the kid-
ney is already surcharged with blood, even to rupture of
its capillaries, while later the terminal capillaries are so
compressed by interstitial cell-infiltration and intratubu-
lar epithelial swelling, as to render the action of diuret-
ics worse than useless. Says Klein : ' "Portions of the
cortex are converted into pale, firm, round-celled tissue,
in which the original urinary tubes of the cortex become
gradually quashed and lost." These elements cannot be
" washed out," and this is probably the only instance in
which intelligent practitioners can be found treating an
acutely inflamed organ by trying to drive more blood into
it. Here it is done in violation of the ordinary rules of
treatment, with the vain expectation of squeezing out a
little more urine, and washing out intratubular debris. In
my observation the opposite result has generally been
produced. It is only when the disease is subsiding, either
temporarily or permanently, as can be affirmed from con-
comitant symptoms, that the apparent diuretic effect of
these active drugs is observed.
In the examination of a large number of sections of
kidneys which had been taken from the dead body of a
girl four years old, who had died of diphtheritic nephritis
lasting only four days, the disease being accompanied
with almost total suppression of urine, I observed the
following microscopical changes : The Malpighian tufts
were pretty uniformly congested and swollen, so much
so as to distend their capsules. I saw no tufts showing
compression from intracapsular exudation, and very few
instances of capillary hemorrhage. The epithelium lining
the tubes of the cortex was much swollen, coarsely granu-
lar, and the calibre of the tubes consequently greatly di-
minished. In some instances neither the nucleus nor the
inter-epithelial markings could be made out, and in longi-
tudinal sections such tubes appeared to be lined by one
continuous granular strip. Quite a number of stumps of
hyaline casts were seen in transverse sections, occupying
mostly the narrow tubules, but some were seen in the con-
voluted tubes. The intertubular vessels were more or less
engorged throughout all parts of the kidney, but there was
almost entire absence of cell-infiltration as also of detached
> London Pathological Society's Transactions, vol. xxviii.
478
THE MEDICAL RECORD.
[May 5, 1883.
epithelium in the tubes. Bartels objects to the theory that
suppression is due to swelHng of the epithehum and ob-
struction of the tubules by fibrintius casts, because " dimi-
nution or arrest of secretion is observed in the very earliest
stage of the renal affection." In two of the worst cases
which I have had under my care, mucus first appeared in
the urine and then slight traces of albumen, forty-eight
hours before the fulminant onset of the disease ; the chil-
dren meantime exhibiting no premonitory constitutional
symjnoms of illness. Considering, then, the pathological
conditions which exist in bad cases of scarlatinal nephri-
tis, the rational plan of treatment would seem to be to en-
deavor to re-establish the kidney circulation by reducing
the congestion of the proximate portions of these vessels
and thus favor absorption of the exuded material by both
lymphatics and capillaries. " Among the curative meas-
ures," says Bartels, " a sustained diaphoresis deserves,
unquestionably, the first place, not only in the sympto-
matic treatment of the dropsy, but as a measure which
favors and promotes the retrogression of the inflammatory
process in the kidneys." Theory and clinical experience
alike sustain the correctness of this opinion. It will be
observed that in the case which forms the text of this
article, there was profuse and pretty constant voluntary
sweating during the whole period of the inactivity of the
kidneys, and to this vicarious work of the skin, mainly, I
attribute the com]iarative mildness of the constitutional
symptoms.
I have observed this fact before both in the nephritis of
pregnancy and in that due to scarlet fever. One very re-
markable case of the latter I saw with Dr. \V. A. Ha'wes.
The patient, a girl about five years old, although passing
only a few drachms of urine at long intervals for several
days, had profuse sweats, suffered principally from an
irritable stomach, and ultimately recovered. Now,
whether we hold that the skin can or cannot eliminate
7trea in any considerable quantity, the clinical fact re-
mains that free perspiration will generally relieve a
patient, temporarily at least, from what we call ura3mic
poisoning. But, according to Foster,' " the toxic conse-
quences are due not to the presence in the system of the
large quantity of urea, but of other, at present undefined,
substances, which have at the same time ceased to be
excreted," and these, perhaps, may be more freely ex-
creted by the skin. Of the difterent methods of inducing
perspiration in cases in which it does not occur spon-
taneously, one of the best is the moist, warm pack.
This has the advantages of simplicity, practicability, and
efficiency. The following is the plan of preparing it :
A bed covered by woollen blankets should be made
ready. Then a sheet or sheets several folds thick,
loosely wrung out of warm water should be closely wrap-
l)ed around the child so as to completely envelop it,
except the head, and the child thus enveloped be tucked
in between the woollen blankets and allowed to remain
for at least two hours, unless the coverings become
sooner cold, when the pack can be renewed. In a bad
case it may be necessary to repeat the pack several
times during the twenty-four hours and perhaps every
day for several days. Great care should be taken in the
intervals to avoid exposing the patient to the cold air.
In case the child prove refractory, the hands and arms
may be pinioned and the coverings fastened securely by
safety-pins or by means of tapes, or a simple and often
better way is to keep the patient partially under the in-
fluence of morphine while in pack. When taken out of
the pack the body should be thoroughly rubbed with a
rough towel until the surface is dry. The warm bath,
even when facilities for its use are ample, can only
be recommended to a limited extent. Alany children
are terribly afraid of it. In some it produces speedy and
alarming syncope. In general, it lias a tendency to ex-
haust the patient if prolonged or frequently repeated.
The hoi air bath is very highly prized by (i. Harley and
others, as not only greatly in.n.ising the cutaneous but
* A Text-Book on Physiolo^', p. 44S. New York, 1880.
also the pulmonary elimination of the urinary poisons.
It may serve as a good substitute for the pack with older
children in a small proportion of cases, but it will gener-
ally be found less practicable. Dry cupping over the
kidneys appears occasionally to do good. Any one
who has seen much of cupping for cedema or active con-
gestion of the lungs must have observed how speedily
efficacious it often is in those conditions. I believe,
with Tyson,' that the cups should be removed before
stagnation and rupture of the capillaries occur. From
five to ten minutes is sufliciently long to allow them to
remain on. In delicate, nervous children it is better to
give chloroform while applying them. Large, hot
poultices of flaxseed meal placed over the same parts,
either instead of the cups or following them, have, I
think, a deserved reputation. Whether the admixture of
foxglove leaves and the meal is any more efficacious
than the latter alone, I cannot say, but I frequently use
it. Of the internal remedies, jaborandi or its alkaloid,
pilocarpine, mor|)hine, veratruni viride, and aconite are,
perhaps, the most valuable. After other means of indu-
cing perspiration have succeeded, a dose of from five to
twenty drops of jaborandi repeated every two hours,
according to the age of the child, has a tendency to keep
up a gentle moisture of the skin, and is often a more
satisfactory wav of giving the drug than to give larger
doses at longer intervals. When the disease is accom-
panied with a high temperature and a rapid, strong
pulse, small doses of the tincture of veratruni viride,
given every two hours, have a very marked beneficial
eflfect on both temperature and pulse, and secondarily
on the action of the kidneys. My friend, Dr. L. D.
Sproat, who prizes it highly in puerperal peritonitis,
thinks that the system will tolerate much larger doses if
it be combined with syrup of ginger. He certainly suc-
ceeds in giving it with a free hand. Tincture of aconite
is less certain to produce its specific effects than vera-
truni, but it is not so likely to induce vomiting and is
less dangerous when its use is prolonged. In regard to
its vaunted cures of the angina of scarlet fever, or that of
any other disease, I can only say that in my hands it
has been a complete failure. Morphine may be used to
control restlessness, and also, in conjunction with other
means, to produce diaphoresis.
2. Dropsy. — In all cases in which the effusion is mod-
erate, whether it be limited to the superficial cellular
tissue, or invade also one or more of the large serous
cavities, the treatment is substantially that recommended
above. Should great cedema of the lower extremities
exist, together with general anasarca, giving rise to
distressing symptoms, and resist the faithful efibrts to re-
move it by diaphoretics and catharsis, a few small punc-
tures made with a sharp bistoury into the cellular tissue
of the lower part of the legs will sometimes accomplish,
by mechanical drainage, what we have failed to do with
other means. Such punctures generally remain open for
several days, and often excrete a surprising amount of
the dropsical fluid. I do not remember having seen
erysipelas or sloughing follow as a consequence of these
punctures (a danger feared by some), although I have
resorted to it many times, mostly, however, in chronic
cases. Indeed, I believe the instances are rare in which
this procedure will be found necessary in acute cases.
An extensive anasarca will generally be borne with com-
paratively little discomfort if the thoracic organs are not
involved, and it will ultimately yield as the kidneys re-
cover. But so long as the dropsy exists to any great
degree, it not only endangers the life of the imtient from
exhaustion, but also especially as a bad comi)lication in
case of any acute serous inflammation. CEdenia of
the lungs is best treated, locally, by repeated dry cup-
pings and by large hot poultices covering the entire
thorax. Should hydrothorax or hydro|)ericardium seri-
ously threaten life, aspiration may be resorted to. .■As-
piration in hydrotliorax seems not to be attended with
• Op. ciL
May 5, 1883.]
THE MEDICAL RECORD.
479
the same degree of danger from purulent change in the
fluid, as in pleurisy with effusion of serum. The fluid
usually remains unchanged after repeated tappings. If
a'dema r;lottiiiis occur and give rise to dangerous obstruc-
tion, tracheotomy should be performed without delay. I
believe it is a very rare complication of this disease.
3. Uramia. — The most common manifestations of
uremic poisoning in children are, great gastric irritation,
painful and e.\hausting diarrhrea or dysentery, extreme
restlessness. Convulsions rarely occur.
The treatment of these symptoms has necessarily been
somewhat considered in the general management of the
nephritis ; for, of course, the same general principles ap-
ply throughout the course of the disease, whatever special
symptoms may arise. The indications are, first, to elim-
inate from the system, so far as we are able, the poisons
which are the cause of the symptoms and which the kid-
neys are powerless to remove, and, second, to enable the
patient to tolerate, until the kidneys assume their func-
tions, such portions of those jioisonous matters as remain
in the system in spite of our efforts to expel them. The
proper course to pursue in order to fulfil the first indication
has already been considered. There is one danger, how-
ever, to be borne in mind, both in the treatment of dropsy
and uraamia, and that is the danger arising from hyperpur-
gation. I verily believe that quite a number of cliildren
are sacrificed in every epidemic of scarlet fever by the too
heroic administration of cathartics — especially the prep-
arations of mercury. Under the e.xcessive use of cathar-
tics, the irritability of the stomach is increased, nutrition
is impaired, and the patient's strength fails, while trans-
udation through the weak and thinned walls of the capil-
laries more than keeps pace with the fluid removed by
the bowels. It is unwise, in my opinion, to carry cathar-
tics beyond the inducing of two or three liquid passages
a day.
To control gastric irritation a careful management of
the diet is of primary importance. Whatever article of
food or drink be given should be taken only in small quan-
tities. A teaspoonful given every fifteen minutes or less
will be retained when a tablespoonful every hour will be
vomited. Koumyss, buttermilk, sweet milk with lime-
water, clam broth, milk porridge, and grated smoked
beef are among the nutrients most likely to be retained.
If prostration be a prominent symptom, plain brandy with
iced water or champagne may be indicated. From five
to twenty drops of the U. S. solution of morphine given
hypodermically, or by the stomach, and repeated every
three or four hours, if need be, is almost a specific. Hy-
drate of chloral in from five- to fifteen-grain doses by the
rectum in a small quantity — half an ounce to an ounce
— of water sometimes acts most satisfactorily. A mix-
ture of a few drops of chloroform with paregoric and
syrup of acacia occasionally does well.
For the diarrhoja it is generally well to begin treatment
by giving a small purgative dose of calomel and com-
pound jalap powder, and then to hold it in check with a
mixture of opium, tannic acid, and cinnamon water. It
is not desirable, of course, to produce constipation, but
only to modify the action of the bowels.
A very eftective way of managing the dysentery is,
first to give a large enema of hot water, so as thoroughly
to wash out the rectum and relieve the congestion of the
gut, in a measure, at least, and then to follow this by an
enema of half an ounce of warm water containing a tew
drops of laudanum, according to the age of the child.
These laudanum enemata may be repeated after each
passage ; the hot-water injections twice or three times a
day. If the rectum will not retain the medicinal en-
emata, then opium in some form, either alone or com-
bined with very small quantities of calomel, can be sub-
stituted. The acetiim opii of the U. S. P. is an excellent
preparation, and not likely to be vomited. No doubt
these intestinal troubles depend on various pathological
conditions, but they have a common etiology, and the
most valuable remedy in all cases is opium. Extreme
restlessness in a certain proportion of cases is a painful
and exhausting symptom. It usually yields promptly to
hydrate of chloral, especially when this drug is combined
with small doses of morphine. I believe that propor-
tionably much larger doses of this drug may be given
with safety to children than to adults. Chloroform and
morphine increase its effect, a fact to be remembered
when prescribing maximum doses.
Convulsions. — Although convulsions are so common in
infancy and early childhood from the outset of other,
often comparatively slight diseases, urajmic poisoning,
even when profoundly affecting the nervous system,
rarely produces co^ivulsions. I have seen two instances
of probable urremic convulsions in new-born children,
where the mothers suffered from uremia both before and
during labor. One reason why convulsions do not
oftener occur in this condition is, probably, that the ac-
cumulation of the poison in the system takes place slowly,
and, as may be shown in several other instances of
diseases affecting the nerve-centres, the tolerance is
much greater when the invasion is gradual. If this com-
plication arise, and the convulsions recur in spite of ef-
forts to eliminate the poison which causes them from
the system, I am satisfied from my experience with urte-
mic convulsions in adults, that morphine given hypoder-
mically is the most effective remedy that can be used.
When, in 1870, at the New York County Medical
Society, Dr. F. D. Lenta advocated the hypodermic in-
jection of morphine in puerperal convulsions, which, as
he said, he believed nearly always depended on urtemia,
his remarks met with a cold reception. Since that time,
more especially since the publication of a paper on the
subject by Prof. Alfred L. Loomis," the remedy has been
steadily growing in favor. Now it is rare to find an
intelligent practitioner of medicine who does not advo-
cate its use in obstinate cases.
The most common complications consequential to the
nephritis are pleurisy, pneumonia, endocarditis, and
cellulitis of the neck ; less common are pericarditis and
erysipelas. Pleurisy, the most frequent of all the com-
plications, should be treated constitutionally in the first
stage with morphine, in suflicient doses to relieve the
acute pain, and, locally, by large hot poultices. If there
be no general anasarca, a small blister may be applied
over the seat of the pain before poulticing. If serous
eft'usion follow in the second stage and cause severe
dyspnoea, aspiration should be resorted to, but, unless
the quantity of fluid be large, it is better to treat the case
expectantly, for, as the kidneys resume their functions,
the fluid generally begins to diminish.
In case the exudation be purulent at the outset, which
it is very likely to be, or become purulent later, surgical
interference should be delayed until the active stage of
the nephritis subsides, unless embarrassment to circula-
tion and respiration be great or septic fever threaten the
child's life. If either of these emergencies arise, recourse
should be had to aspiration. In a small proportion of
cases, when fluid is removed in this way, the pleural cavity
will not refill ; but generally the relief is only temporary,
and subsequent radical treatment by free incision into
the pleural cavity and the insertion of a drainage-tube
becomes necessary. In uncomplicated empyemas I
prefer to open the chest at once, and, in my experience
thus far in children, the cases have uniformly terminated
in recovery. I have never found it necessary to remove
a portion of rib in any of these cases, and I believe it to
be an entirely unnecessary and unjustifiable operation.
I doubt whether any advocate of the practice would be
willing to have a child of his own deformed by this pro-
cedure.
Pneumonia should be treated substantially as under
other circumstances, namely, locally by hot poultices
enveloping the entire thorax, and by the internal ad-
ministration of diaphoretics, sedatives, and stimulants
' MitDiCAL Record, vol. viii.
480
THE MEDICAL RECORD.
[May 5. 1883.
when required. Endocarditis generally gives rise to little
pain or constitutional disturbance, and its existence is
frequently first suggested by physical examination. It the
action of the heart become irregular or tumultuous, con-
vallaria or digitalis and opium will be indicated early in the
disease, and carbonate of ammonia in small doses it there
be reason to believe obstructive exudation is taking place.
CdluUtis of the neck, which began during the proSr«s
of the fever, not infrequently lights up atresh when the
nephritis sets in, and goes on to suppuration. 1 he most
important point in the treatment of it is to make a tree
incision into the inflamed mass as soon as pus can De
recocrnized, in order to prevent the burrowing of matter
and extensive destruction of the soft parts. I have
known of one instance of death from hemorrhage due to
sloughing of the external jugular vein. ^0;^'/;;f/
should be treated on general principles, except that,
perhaps, frequent doses of the muriate tincture of iron
are especially indicated. Pericarditis is probab y more
frequently caused by scarlatinal rheumatism than by
scarlatinal nephritis, but it occasionally occurs from the
latter disease. It is sometimes secondary to a pleu-
risv, especially of the left side. Prof. J. Lewis Smith
sav^ • speaking of the complications of scarlet fever .
" Serous inflanmiation, especially that affectmg the peri-
toneum, pleura, or pericardium, is a common complica-
tion independently of the rheumatic afteclion. It occurs
during the desquamative period, etc. Are not tnese
inflanimations thus referred to often caused by an acute
""^ Aside from the general treatment of the causal disease
of pericarditis, other remedies will be indicated according
to the symptoms present. When the area of inflammation
is small and the symi^toms mild, specia drugs are not re-
quired. Cardiac weakness will call for digitalis and stimu-
lants. Pain, dyspncea, and restlessness will be relieved by
morphine or chloral and the local application o hot poul-
tices If, at a later period, a large ettusion takes place,
and die danger to life be imminent, aspiration will be de-
manded. Sudden or violent exertion is l>able to be fol-
lowed by fatal svncope, and hence quietude in bed should
be maintained throughout the entire course of the disease.
Tf ;= iicinlU' durin'' the night that the
r»ir\rf^ rpaSSUnna". J-t lb USUail) UUIlli-, Li»^- o
patleYtron waking up from his first ^^^^^^^^ ^
ble of enduring the pains of earache, S'^J^ ^^^y '°^^' .'^^
sufierin-s It were better for him, too often, to ha%e
s bn ted in silence to his tortures than to have disturbed
he kepin. household ; for it will generally be found tha
Sh more energy than skill the patienfs ear has been
made the receptacle of a most indiscriminate variety ot
s imrila;it,"no!ivne, irritant or other substances ;some^
times the visible parts wil in this "'a""^^^^^^^^^';"^^
blistered, or e^^n greater injury may have been done to
the deei'cr structures. Again, in other cases, the do
EARACHE liX CHILDREX.=
By SAMUEL SEXTON, M.D.,
NEW YORK.
It is probable that in no aftection requiring prompt
treatment for the relief of severe pains is there greater
need of both scientific and practical knowledge of the sub-
ject than in children's earache. The urgency of he
iv^nptoms in these cases, however, would seem to of en
pVevent so careful a study of their clinical history being
made as their treatment requires, and they are, therefore,
much too often regarded as exclusively local in their na-
mreand treated accordingly. Were the excruciating
pa'ns in acute inflammation of the middle ear alone con-
sklered local treatment would, indeed, seem to be im-
peratively demanded, almost to the exclusion of any
attention to the remote causes usually present. Lutue
should not be unmindful, however urgent the local symp-
oms may be, that when the causes of the disease have
been ascerta:ined we may then more surely, and very
often even more expeditiously, relieve the patient by
striking at the origin of the difficulty : thus a remedy ap-
pl ed to a carious tooth may cure an otalgia, a reversal
of the practice of the ancients, who made application to
the ear for the relief of toothache.
The occurrence of earache is well known to be most
frequent at night, although it may announce itself during
he waking hours, when it seems to be much better endured
probably owing to the fact that the nervous energies of
The patient ar^_then_mor^ active and the surroundings
> Diseases of Children, fifth edition, ?»«■: '95.
■' R«d before the Practitioners' Soe.cty of New \ ork, .4,ml 6. .SS3.
Fig. 2.
Its Ut-
steam-
mestic economy is urged to
most capacity in poulticing,
in<T douching, fomenting or otherwise
heating the ear. The methods pur-
sued in these cases too often seem to
depend on the number and individual
views of the lay consultants present,
and it is fortunate, if after any, or even
all of these measures have been tried
we do not find that the domestic treat-
ment has converted what might have
been a simple affair into a severe and
probablv protracted one.
Examination of the .rar.— When
the physician encounters a case of
this kind it will often be found neces-
sary to first bring order out of chaos
before attempting to make an exami-
nation, but a little firmness on his
part is usually quite suft^cient to ac-
complish this, and to also tranquil-
lize the patient. During the tempo-
rary lull which usually ensues, the
patient may be held in the nurse s
lap while the examiner promptly but
crently proceeds to ascertain the ex-
tent and nature of%ny local lesions which may give
rise to the earache. . ^. .
Instruments employed in "f'J.'^'ZTZt'h^^-^
head-mirror had best be employed, in orde that both
hands may be free for necessary "f "'P">f ";"^- ^^^°/, .^^
examination there will be required specula (^ "X^f 1^^^
fer those known as ('.ruber's , an effective metal or bulb
ear- vr nge, a vulcanite cotton-wool carrier, and a supply of
absorbem a.tton-wool. One should not onnt to have a
cm, of luite warm water near by, that no time may be
10 °ho lid any syringing be required. Hard rubber and
May 5, 1883.]
THE MEDICAL RECORD.
481
glass syringes should both be avoided in cleansing the
ear ; the former kind are very seldom found to work
freely, owing to their imperfect construction. The calibre
of these syringes is uneven and the vulcanized surface
seems illy adapted to the purpose, on account of its offer-
ing too much friction to the packing. The glass syringe
is of scarcely any service whatever.
Elither of the syringes shown (Fig. i, a brass syringe,
and 2, a bulb syringe) in the cuts will be found to be free
from the objections referred to above.
In these cases one must conduct the examination as
expeditiously as possible, not forgetting that the parts
to be examined are nearly always sensitive to tiie touch,
and that the patient's fortitude is usually by no means
great. If there be swelling and redness of the auricle or
antiguous parts, manipulations will be yet more painful.
Nature of discharges. — At first syringing had best
be avoided, for fear of increasing the pains and discom-
fort ; besides, any secretions lying in view should be in-
spected before removal, since the significance of their
appearance is of value in diagnosis and treatment.
Thus it is known that the cutaneous lining of the ex-
ternal auditory canal does not, under any circumstances,
secrete mucus. Purulent secretion from the canal
itself is comparatively infrequent, but a limited quan-
tity is discharged from maturating furuncles, and can
usually be seen escaping from the swollen wall of the
canal. The serous constituents of the blood exude
slightly in acute eczema and from wounds. Rut the
diagnosis in all of these conditions is not difficult. There
is one variety, however, of acute catarrhal infiammation of
the middle ear which is liable not to be so readily recog-
nized by the inexperienced observer in consequence
of a coe.xistent exudative dermatitis confined to the
inner end of the canal and the outer layer of the drum-
head ; the inflammation is generally superficial, the con-
secutive necrosis and exfoliation of the epidermis being
associated with more or less whitish and somewhat in-
spissated exudative matter, which sonietimes completely
fills the inner end of the canal. In these cases the mem-
brana tympani frequently escajies perforation.
In acute purulent intlammation of the middle ear the
discharge is generally more free than in any of the con-
ditions above alluded to ; it is at first, m most cases,
serous or sero-sanguinolent, but soon becomes muco-
purulent. The mucous flocculi, observed more readily
floating about in the water if syringing has been
done, unerringly points to the existence of a perfora-
tion in the membrana tympani. Frequently the simple
inspection of the ear, as described above, will suffice to
establish a diagnosis upon which the treatment at this
stage may be planned, since the clinical history as regards
colds, etc., may afford sufficient data to remove all doubts,
if any yet remain.
When it seems important to make a more complete
examination of the ear, the canal may be gently syringed
with quite warm water and afterward dried with cotton-
wool wound about a proper carrier ; or perhaps the latter
appliance used as a mop may be quite sufficient for our
purpose. If I may venture to recommend so unimpor-
tant an instrument as a cotton-wool carrier, I will here
suggest the advantages of employing a polished vulcanite
rod, properly shaped, for the uses to which a metal probe
is sonietimes put in cleansing the ear ; it is light and will
not injure the parts by its momentum when introduced
into the organ. No care is too insignificant to occupy
the surgeon's mind when manipulating the ear ; the touch,
the instruments, and every feature of tlie treatment should
be of the gentlest kind ; even the warming of the specula
and other instruments employed, by holding them for
a while in the closed hand or otherwise, should not be
neglected.
When the canal has been freed of secretions, etc., its
walls may then be viewed and in many cases the drum-
head can also be seen ; but when the latter is not visible,
owing to accumulations and swelling of the canal's walls.
we may often observe a pulsating bubble in the discharge
which wells up out of the middle ear. From this air-
bubble there is a light reflex and the vibrations of the
artery in the carotid canal impart the pulsations seen :
this phenomenon indicates the membrane's perforation.
Closure of the canal attended with pain may happen from
several causes, as in consequence of circumscribed or
diffuse inflanniiation, from dermatitis, or from the hard,
dry scales which sometimes form subsequently from the
exudative matter; from erysifielas or eczema; from col-
lections of cerumen, and from the presence of foreign
bodies.
Remote causes. — The above are conditions which are
recognizable to the observer under proper illumination,
but it very often happens that a patient will present him-
self where no such easily recognized cause will be found.
On the contrary, the canal and drum-membrane will ap-
l)ear to be free of any disease while the child suffers
intensely from earache. We have here to deal with a
perplexing case of neuralgic otalgia, which may be due to
ilental irritation or to a draught of cold air falling upon
the ear. I have seen cases of earache in midsummer
induced by cold sjaair blowing into the ear, and the
entrance of cold sea-water is also a well-known cause;
these agencies are likewise sufficient to induce inflamma-
tion of the canal and middle ear.
In a very large number of the earaches of childhood
the causes are to be sought elsewhere than in the hearing
organ itself, and they will be found to depend, for the
most part, on nervous sympathy ; the most prominent
are dentition, dental caries, and colds in the head. Thus
nervous impulses propagated from regions remote from
the ear may give rise to pains in the ear — neuralgic
otalgia — without perceptible hyperemia, or the intensity
of the congestion arising in a part so richly supplied
with blood-vessels may manifest itself as an acute aural
catarrh.
The eftect on the ear of taking a severe cold in the
head is by no means always dependent on an extension
of the catarrhal inflammation from the upper pharynx
along the Eustachian tubes, but it will be found that im-
mediate aural inflammation may also be a consequence
of the same influences that affect the pharynx ; in fact,
the throat, the Eustachian tubes, the middle ear, and the
mastoid antrum and pneumatic cells of the mastoid may
all be affected simultaneously from cold. During the
prevalence of influenzas the ear is frequently thus affected.
Recurrent earache is an exacerbation during the course
of chronic inflammatory processes in the middle ear,
usually occurring as a consequence of taking cold ; it is
in such cases that the ear is said to "gather and break,"
or to "run off and on."
In the e.xatithemata earache manifests itself in a more
virulent manner than usual, and while, owing to the par-
ticular dyscrasia present, the jiatient is more obnoxious
to these attacks, the etiological conditions are similar.
TJie age at 7C'hich earache occurs. — Earache may occur
in children soon after their birth, from acute or chronic
catarrh of the upper pharynx and middle ear. These
processes are not usually painful, but may become so
when the drum-head has been thickened. Painful aural
catarrhs, however, are not common before the process
of first dentition begins, and they are of exceptional oc-
currence after the second permanent molar tooth has
been cut, which event usually happens about the twelfth
year.
In some children earache is experienced from dental
caries almost as soon as the first teeth are cut. My at-
tention was drawn to the frequency of this condition
many years ago, on examining the ears of the children
of a public institution ; and subsequently I made a
more thorough study of the subject, during which the
ears and teeth of some eighty children in the parochial
school of the Church of the .\ssumption were examined.
A large number of casts of the teeth of these children
were taken, and scarcely any of them were found to be
482
THE MEDICAL RECORD.
[May 5, 1S83.
free from dental irritation. An example is ' exhibited in
Oral irritation, it goes without saying, is extremely
common throughout childhood, but sympathetic aural
pains may not be experienced unless a cold in the head
should supervene ; the habit once established, however,
the eruption of every tooth may become the signal for
pains in the ear.
Catarrhal itiflam7naiion of the middle ear, which gives
rise to most of the earaches experienced in childhood,
may conveniently be divided into two forms : (1) The first
is an affection of the mucous surface of the lining'of the
tympanum only, and is characterized by a greater or less
flow of mucus or of serum into the t) mpanic cavity ;
Fig. 3. — Casts of the teeth of a schoolgirl, tweKe \ears of age: from the
author's cabinet : the casts are represented as being held together by a hinge.
I, I, The second bicuspid teeth of the upper jaw. both of \s hich have been crowded
out of pl.-ice as they erupted by the remains of the fangs of the temporary second
moLar teeth ; these fangs, which have been too long retained in the gums, are seen
in the cut just inside the second bicuspids. The retention of the fangs, together
with the crowded and irregular condition of the permanent teeth which have just
been cut, gave rise to much irritation. This anomalous condition of the teeth is by
no means an unusual occurrence where the leetli are neglected. 2, The' left upper
si.\-year molar tooth, which is very carious. 3. 3, The two lower six-year molars,
both of which have been destroyed by caries. The little girl from whose teeth
these casts were taken sufiered from deafness and frequent attacks of pain in both
cars, and, as she herself expressed it. " the decayed teeth had ached verv much all
around."
(2) the second lorm occurs along with or is consecutive to
the first, and consists in an inflammation of the sub-
mucous connective-tissue and of the periosteal layer of
the membrane. The tympanal walls being everywhere
invested by a membrane which possesses the double
character of a nuicous and periosteal membrane, the in-
flammatory process is attended by an abundant secretion
and is characterized by its painfulness. The mucous
laver, when swollen, very nuich reduces the size of the
drum cavity, and thus also obstructs the entrance to the
Eustachian tube through which the normal drainage of
the parts takes place. In both stages, or varieties, of
the disease spontaneous rupture of the niembrana tyni-
pani may take place under the pressure of accumulated
secretions sooner or later. The pains experienced are
sometimes very slight when the membrane gives way
early, but in some constitutions the disturbance is always
attended with suftering. In a certain number of cases
the attack now speedily subsides, and, if no injudicious
interference jirevents, recovery is rapid and complete.
AVhere the onset, however, has been severe, and deeper
tissues become more jiarticularly involved, the pains are
* From the author's " Causes of Deafness among School Children," etc., Cir-
culars of Information of the Bureau of Education^No. 5 — 1881. (Government
Priming Office. Washington. i88t.
more severe and continue longer, secretions in the mean-
time remaining free or ceasing altogether.
In earache the attack is frequently preceded by a rigor,
and afterward alternations of chill and heat continue
until the local disease is fully established. " The first
thing a patient complains of, in the midst of these symp-
toms, are acute pains deep in the ear, which are described
as pricking, burning, tearing, boring, and dragging.
These pains are usually confined to one ear, and are
aggravated by every motion of surrounding parts, as in
chewing, sneezing, coughing, stooping, and the like." '
In pure neuralgic otalgia there is not the same sensitive-
ness to motion, and in proportion to the predominance
of this feature of earache will the patient manifest restless-
ness and a desire to toss about while in bed, or to walk
or be carried in the nurse's arms.
Tlie seat of pain in earache. — I have stated above that
the tissues involved in inflammation of the middle ear
consist of a membrane which performs the double duty
of mucous membrane and periosteum. The sensitiveness
of this structure is extremely great, for it is not only
richly supplied with blood-vessels, but also wonderfully
well provided with sensory nerves. These latter compose
the tympanic plexus, a diagram of which is here shown.
Fig. 4. — Diagram of the tympanic plexus (Riidinger). 1, Oculomotor nerve :
2. trigeminus nerve, with the gasserian ganglion ; 3, first branch of the tri-
geminus nerve ; 4, second branch ; 5. entrance of the same into the spheno-
palatine fossa : 6 and 7, superior maxillary nerve ; 8, spheno-ethmoidal nerve :
9. descending palatine nerve; 10. Vidian nerve: 11. large superior petrosal
nerve; 12, buccinator nerve; 13 and 14, pterygoid nerve; 15, chorda tj-mpani
nerve : 16, carotid plexus of the sympathetic : 17, petrosal ganglion of the glosso-
pharyngeal nerve ; iS, 19, and 21. vagus, accessory nerve of Willis, and hypo-
glossus : 20, facial nerve; 22, nen-ali carotico-tympanici ; 23, tympanic, or Jacob-
son's nerve ; 24, small superficial petrosal njrve : 25, nerve of the tensor tympani ;
26, tympanic ple.xus ; 27. branch for the oval window ; 28, branch for the round
window ; 29. large, deep-seated petrosal nerve ; 30, branch for the Eustachian
tube : 31. division of the Vidian nerve into its two branches ; 32, anastomosis of
fasciculus of theJVidian nerve.
This anastomosis derives supplies from sources most ex-
tensive ; thus by means of branches from the otic gan-
glion the inferior maxillary nerve is brought into intimate
relations with it, and the petrosal ganglion of the glosso-
pharyngeal nerve supplies the tympanic branch, or Ja-
cobson's nerve, which constitutes a large portion of this
anastomosis. The carotid plexus of the sympathetic
sends a branch to the glosso-pharyngeal and thus estab-
lishes a communication between the ear and the superior
cervical ganglion of the sympathetic nerve. Through
Meckel's ganglion, by means of the Vidian nerve the su-
perior maxillary of the fifth pair of nerves also is con-
nected with the tympanic system. Besides these there
are other connections which may be seen by consulting
the diagram. In describing these parts Burnett^ calls
attention to tlie importance of bearing " these relations
in mind when considering certain neuralgias in and about
the ear, which might otherwise be puzzling."
Diagfwsis. — Sufficient significance has already been
given to the local and remote causes of earache, or rather
the conditions that give rise to this symptom, to indicate
their relative importance. In neuralgic otalgia it will
often be found that there is an entire absence of local
* Dufton on Deafness, pp. 47, 48. Tendon, 1844.
- Treatise on the Ear. p. 90. I'hiladclpl'.ia. 1877.
May 5, 1883.]
THE MEDICAL RECORD.
483
inflammation, and in this as well as in all painful affec-
tions where no sufficient local influences can be found,
it is well to cast about and endeavor to discover any
sources of reflex irritation, for treatment directed to the
remote origin of the difficulty is in many instances
the most effective and often of itself sufficient to cure
the [latient.
As regards the significance of pain in and about the
ear, it is important to diflerentiate as between pain and
tinnitus aurium in all cases. The noises in the head and
the autophanous reverberations of the voice of the patient,
symptoms alike confusing and distressing, are often even
more unbearable than the pains ; and when the two coexist,
as they frequently do, they are indeed almost indescribably
tormenting. Noises in the head may constitute the entire
cause of distress in conditions where active treatment
may not be required, and one should, therefore, keep this
fact in mind when examining a case of children's earache,
since the patient is frequently unable to distinguish be-
tween subjective and physical signs. In a long experi-
ence I have nearly always found it very difficult to obtain
from patients a clear description of their sensations under
these conditions. Not the least satisfactory have been
the definitions sometimes obtained in the humbler walks
of life, and the following terse and expressive phrases
seem to most explicitly describe the feelings ; thus a
woman who once came to my clinic at the New York
Eye and Ear Infirmary, in reply to my request to de-
scribe her symptoms, said that she had '• roaring pains in
the head," and on another occasion a patient, also a
woman, desciibed somewhat similar phenomena as being
like a "noisy dizziness."
Respecting the sensations which are experienced in
the ears during attacks of aural catarrh it may be said
that, in addition to a greater or less degree of deafness,
there is nearly always a feeling of the ears being " stuft'eil
up," together with tinnitus like escaping steam, buzzing,
ringing, and whistling sounds, etc.
Meningitis, which sometimes coexists in the more
grave cases, either arising from the same conuiion cause
or consecutive to otitis media, is not always easily dis-
tinguishable from the latter affection, but fortunately in
most cases the treatment is the same in either.
Duration. — Earache may continue several days in the
acute state, always worse at night, before spontaneous
rupture takes place, when there is immediate relief ex-
perienced in most cases. When a carious tooth is the
cause of the trouble, its duration will be more indefinite.
Under treatment, the attack may be cut short in many
instances and nearly always may be ameliorated.
Treatment. — The desire to relieve pain in these cases
generally leaves prospective measures to be last consid-
ered, and, indeed, the surgeon will usually find that local
measures have been already carried to excess. It will
by no means always be easy to proceed at once to make
the necessary examination upon which a plan of rational
treatment may be founded, where there are a number of
anxious attendants who have already emptied into the
sufferer's ear everything their resources could command
before availing themselves of skilled counsel. It will
usually be expected that the means at the command of the
medical adviser will enable him to propitiate the disturb-
ing spirit by the contribution of some new libation, un-
known to common mortals ; this requirement may be met
where the condition of the canal admits of deep applica-
tions being made. A remedy that will in some instances
be found serviceable for this purpose is belladonna ; the
deeper parts may be painted over with a small quantity
of a mixture composed of equal parts of unguentum bel-
ladonna and vaseline, or four drops of a five-grain solu-
tion of the alkaloid sulphate of atropine may be instilled
into the upturned ear by the surgeon himself, who can
alone apply these remedies properly. They should be
warmed before being used, and, it is needless to say,
should not be wasted upon the outer portion of the canal.
Of course it would be useless to make these applications
when the canal was not free of secretions. In a certain
number of cases this medication will be found to be an
efficient palliative, as in periostitis of the inner extremity
of the canal, as shown by redness and swelling, and when
the membrana tympana is inflamed ; any considerable
effect on the nerves more deeply situated in the tym-
panum is, however, not to be expected, unless, as might
exceptionally happen, a few drops of the solution passed
into the middle ear through a perforation in the drum-
head.
Drv warmth, when grateful, may be apiilied, either as
heated air conducted into the ear, or by means of heated
pillows, etc. In some instances gentle fomentations or
steaming may be employed, but active syringing, douch-
ing, steaming, poulticing, or even mojiping out the canal,
are all of them to be sj^ecially avoided, as they usually do
more harm than good, and in very many instances are
positively injurious.
Myringotomy. — Sometimes there is no discharge from
the inflamed parts, and then the question of puncturing
the drum-head arises. In regard to the necessity of this
operation there has been much discussion among otolo-
gists, some authorities favoring its performance m nearly
all cases, especially when the membrana tympani is much
inflamed or is perceptibly protruded by the pressure of se-
cretions. It is a matter, I believe, where a great deal of
judgment is often re<|uired.to be exercised, more, in fact,
than is generally thought necessary. In my own ex-
perience I have found that a bulging or much-inflamed
drum-head by no means always demands this procedure
for the relief of the patient, for I have often found that
under other treatment the pains and other inflammatory
symptoms will speedily subside ; secretions will be re-
absorbed or partly escape through the Eustachian tube,
the membrane will rapidly clear up, and all the parts as-
sume a healthy appearance.
But occasionally the membrana tympani will be found
to have been much toughened by previous acute or
chronic inflammation, or the existing attack may have
occasioned thickening of its inner mucous or outer cuta-
neous coat. If now it is found that there is undue and
painful pressure of secretions whose escape is prevented
by closure of the Eustachian tube, we shall be warranted
in liberating them by means of myringotomy. But this
operation is not always unattended by considerable pain,
and, moreover, if well performed, not to be done without
skill, and we should not, I am convinced, resort to it as
a mere antiphlogistic measure, with the belief that, even if
useless, it is at all events harmless. When the parts to be
operated on are not well seen, the procedure is at best an
unskilful stab, the consequences of which are not always
favorable. When myringotomy is necessary, however, it
should be promptly done, and usually while the patient
is under the influence of an anassthetic.
The employment of leeches in my own experience has
not been satisfactory, and I have for a long time past
ceased to use them. I am aware that custom still de-
mands the use of these sanguinary worms in certain quar-
ters, but I doubt not their usefulness has been much
overestimated.
The remote abstraction of blood from the cheek in
front of the tragus or, even from the concha, will not
permanently relieve congestion of the deeper parts ; and,
moreover, it is not the stagnant blood that is withdrawn,
but the more freely circulating fluid. In a certain num-
ber of cases, the bite of the leech seems to give rise to
irritation, and what wonder that it does when we con-
sider that its mouth, according to Baird, is provided with
three jaws, and " each of these is armed on its edge
with two rows of very fine teeth, which penetrate the
skin by a motion resembling that of a semicircular saw."
Besides the irritation from the bite, their appearance is
calculated to frighten the child, and oftentimes the bleed-
ing is arrested with difficulty.
Among the more valuable drugs which are serviceable
in earache from any cause in which nervous excitability
484
THE MEDICAL RECORD.
[May 5, 1883.
is a feature, I know of none equal to aconite, gelsemiuni,
or Pulsatilla, five or ten drops being added to half a
glassful of water, and given in teaspoonful doses as re-
quired.
In my own experience the relative efficacy of these
remedies has been found to be about in the order men-
tioned above. In very young children, I give the pref-
erence to the Pulsatilla. It is im|iortant in employing
these drugs to secure a tincture made from the fresh
plant.
The sulphurated lime, which I have long emploved in
aflections of the ear, I still regard as of the greatest
service. I have scarcely ever seen a case where this
medicine produced nausea, although some persons who
have given it a trial claim to have had an experience of
this kind. I have so often described my own experience
in tiie use of this drug that I will not repeat myself here.
When the subject is too young to admit of the adminis-
tration of pills, triturations may be employed.
No plan of treatment would be entirely satisfactory
where an examination of the mouth and upper pharynx
was neglected. Oral irritation may thus be found to con-
sist in the eruption of teeth, caries of the teeth, irregulari-
ties, tartar, irritation from catarrh of the gums, periostitis
and alveolar abscesses. The frequency of the occurrence
of these conditions has been mentioned above ; they re-
quire treatment and likewise often the assistance of the
dentist. Under treatment the worst agonies of earache
may be jjrevented, and very often our remedies act like
a charm ; but it must not be forgotten that the causes
in a given case may not be so easily eradicated, and that
treatment must be ke]jt up for some time if we would
entirely prevent a return of this tormenting disease.
Catarrh and other aft'ections of the naso-pharynx and
Eustachian tubes also require like care, and sometimes
must be treated actively.
The advantages of rest in acute purulent infiammation
of the middle ear should never be lost sight of, and the pa-
tient should be kept indoors for several days. If the case
be a severe one, he will be best off" in bed for a time.
Quiet ought to be maintained in all cases, for noises
sometimes under these circumstances become exceed-
ingly distressing. The evils of active treatment in these
cases, by syringing, etc., have been alluded to, and it may
here be urged that deafness as a symptom should not be
treated ; especially should inflation be avoided ; the pa-
tient is to be cautioned even against violently blowing
the nose. Of course in the later stages syringing and
mopping may be more thoroughly practised and the cau-
tious use of the air-douche may even be advisable. The
well-known tendency of some drugs to cause or increase
existing aural hyperemia should warn us to avoid their
indiscriminate use. First among these is quinine, which
has long been suspected of causing deafness when admin-
istered in large doses in malarious diseases. The intense
tinnitus aurium following its administration establishes
the fact of an increased vascular action in and about tiie
ear. The employment of ferruginous preparations seem
to iiave a like effect, and doubtless there are manv others
whicii it were best to omit when the ear is inflamed.
During the existence of acute aural disease, the conse-
quences of its early management u]ion the subsequent
course and duration should be kept in mind, but the con-
sideration of chronic processes here would lead me be-
yond the scope of the present paper, which has, I fear,
already been unduly drawn out.
Majalis or Maialis ? — Dr. S. S. \Val!ian, of Blooming-
dale, N. Y., asks for the authority upon which the spelling
" maialis" is based. The spelling, according to Grav,
is " convallaria majalis." It is so given by ^Vebster.
The use of "i" instead of "j" has no doubt been
adopted because it is so spelled on the continent of Eu-
rope, and especially in France.
ON RAPID OR SUDDEN HEART-FAILURE IN
ACUTE INFECTIOUS DISEASE, NOTABLY IN
DIPHTHERIA AND TYPHOID FEVER.'
By BEVERLY KOBINSON, M.D.,
NEW YORK. 1
For many years this subject has been one of peculiar
interest to me. Already, when an assistant or house
physician in the medical wards of a large city hospital, I
had seen cases of this sort. They impressed me at the
time, and gave me food for thought afterward. In the
course and progress of chronic disease, too often do we
see the heart become acutely embarrassed, even when
no i)revious organic disturbance prevailed, and fre-
quently a speedy and fatal termination closes the scene.
But such instances, though painful to witness, do not
specially command our attention, nor strike us even as
remarkable. When a patient has been for a long while
suffering from some severe chronic ailment, and his
strength and vitality are evidently much impaired, that
a complication should arise within the heart and occasion
death, is what we have reason in a measure to expect,
and if it occur not to be surprised. A like feeling may,
indeed, prevail with respect to acute disease, especially
if from the beginning it assumes a serious aspect, and
proceeds surely from bad to worse. But there are nu-
merous examples, and these are specially the ones we
would dwell upon at some length, in which the disease
has at no stage from the very beginning been of more
than moderate intensity, and yet rapid or sudden death
will occur, presumably due to the changes produced in
the cardiac structure. Such cases are not new. Occa-
sional reports of them may be met with in medical peri-
odicals during many years in the past. And yet, so far
as I know, they have never been considered collectively,
nor has an entirely satisfactory exjilanation of their
pathogeny been given, nor their therapeutic indications
been made clear. To fill up in small degree this lacuna
in practical medicine is the object of this paper." Only
one month ago, when visiting daily at St. Luke's Hos-
pital, I had several cases of typhoid fever nnder my care.
Amongst them, two patients presented grave symptoms
throughout the duration of the disease. In one of these
the fever lasted only two weeks, and at the end of this
time death took place. Previous to the end there had
been high temperature, marked nervous phenomena, and
moderate diarrhcea. P'inalh-, the lungs became nnich
congested, the brain wandering, the pulse weak, rapid,
and intermittent, the heart-sounds feeble, and the patient
succumbed when she was extremely prostrated. An
autopsy was not obtained.
In my second case, that of a young girl twenty-two
years of age, a teacher, who had been under the care of
Dr. Pallen some weeks before for intrapelvic cellulitis,
there was evident malarial complication, which rendered
the convalescence long and tedious. In this example
the main cause for anxiety was referable to the heart.
The temperature, with the exception of two or three
passing exacerbations, was moderate during the continu-
ance of the fever. There w-as little or no diarrhcea after
the first week. No nervous complications arose, with the
exception of great somnolence, due to congestion of the
cerebral vessels, and the lungs remained intact, the res-
pirations being always regular and of normal frequency ;
but the cardiac (ntlsations were, during three or four
weeks from the time of entrance at St. Luke's (about
fourteenth day of disease) extremely weak. They were
clearly defined, however ; there was no muffling, no
abnormal bruits. Occasionally they were somewhat
uneven and irregular, without iierceptible intermissions.
The pulse at the wrist was quite frequent, at times run-
ning up to one hundred and ten, one hundred and twenty,
^ Read M a meeting of the Practitioners' Society, March a. 1883.
' This was my object when [ began this article fnar^ t/tan a year a^o (Decem-
ber I, 1881), but circumstances have prevented my carrying out my intentions .and
1 now pres'-nt it to the Practitioners' Society merely as a suggestive note in re-
gard to an important and interesting matter of practical medicine.
May 5, 1883.]
THE MEDICAL RECORD.
485
or even one hundred and thirty pulsations ; but wherein
it was a source of solicitude was its extreme weakness.
At times it was very depressihle, thready, or crjnipletely
disappeared under the palpation of my fingers exercising
the most gentle pressure. This patient was treated with
small and (juite frequent doses of all the cardiac tonics —
nux, belladonna, and digitalis. She had tonic doses of
fluid extract of bark, stimulant in the form of brandy, as
mucli as I considered proper to give, milk, meat extracts,
raw or lightly boiled eggs, strong black coftee in doses of
two ounces morning and afternoon, fluid extract of coca
— m fact, niv therapeutic armamentarium was exhausted
in my eftorts to raise this flickenng life, and in the end I
apparently succeeded, for my patient has now almost re-
covered and is walking about the wards. I say appar-
ently, because for more than one week I could see no
perceptible change in the patient's strength, and when
she did show manifest improvement, I confess I was un-
certain whether my medicines had occasioned it, or the
disease, having reached its climax, had waned according
to a natural law.
The third case to which I shall refer was one of which
a short abstract will be found reported by me in the
" Proceedings of the Pathological Society " for November
23, 1881. It was briefly as follows: The patient was a
man thirty years of age who died suddenly during the
progress of typhoid fever, at St. Luke's Hospital, on No-
vember 12, 18S1. Death occurred on the nineteenth
day of the disease. The patient's temperature had not
been much elevated until the second day before his
death, when it reached 103^-° F., and the pulse 120. Di-
arrhoea moderate in character. On November 9th and
loth he was delirious and weak ; on the nth semi-coma-
tose, and on the 12th his breathing became very rapid
without apparent cause ; face and extremities not cyan-
osed, and he gradually sank and died at 9.15 a.m. At
the autojjsy there was enlarged and softened spleen,
splenization of the lungs, fatty kidneys, swollen solitary
follicles, and numerous ulcers scattered along the entire
length ot the ileum. The ileo-c;i;cal valve was thickened
and extensively ulcerated. The feature of special interest
was the existence of a long, slender, fibrinous clot at-
tached to the aortic and mitral valves, and extending
ribbon-like into the aorta. There was also an ante-mor-
tem clot attached to the chordre tendine;i;. There was
quite extensive granular degeneration of the muscular
fibre of the heart.
Now then, to sum up these cases in a few words.
With respect to the evidences of cardiac failure, we
would remark, in the first case, that the other symp-
toms were such as to render the cardiac weakness only
a part of the general portrait of the disease, which in
this instance tended toward a fatal termination. In the
second example the cardiac failure was considerable
but not complete, and hence life held on, though trem-
bling more than once in the balance. In the third and
last example, although there were well-marked lesions at
the autopsy of typhoid fever at the stage during which
the patient died, yet the termination seems to me to be
connected jiarticularly with the condition of the heart.
Some years ago, when a resident physician in a large
children's hospital, I was called from my room to see a
patient in the ward, a lad about twelve years old, con-
valescent from typhoid fever, who, while seated in bed
and about to take a goblet from a shelf at the head of
his bed and drink, suddenly became pale, fell back, and,
without a struggle or any convulsive movement, inuiiedi-
ately expired. In this example no sufficient explanation
was afforded by the autopsy of the cause of death. There
was no heart-clot, no pulmonary embolism, no evident
degeneration of cardiac fibre, no alteration of the pulmo-
nary structure. In the absence of recognizable cause,
the heart was said to have been (jaralyzed and death the
result. This, as you all admit, 1 am sure, was a lame
and unsatisfactory conclusion. Such instances have in
the last few years been connected with morbid alterations
in the pneumogastric nerves, or cardiac ganglia, when
the muscular fibre has been shown under the microscope
to be healthy in appearance — without granulations or fat-
globules, and with the transverse striaa well marked.
Instances of partial or complete heart-failure are even
more frequent in diphtheria than they are in typhoid fe-
ver. In some 01 these cases where death has taken place
within a few days of the inception of the disease, and
where the extension and character of the false membranes
in the fauces, the swollen condition of the infra-maxil-
lary ganglia ; the excessive pallor, or almost waxy hue
of the integument ; the somnolence and prostration of
strength, all indicate a high degree of septic-emia — the
heart may only share in the general downward march,
and it is not noteworthy to emphasize especially the
weakness, irregularity, or frequency of its beats, but
occasionally, even with all the concomitant phenomena
of gravest import, the cardiac action is relatively strong
and but little impaired until a brief period, perhaps only
a few hours, before the fatal termination. Such a case
I attended with Dr. Morris J. Asch during the past win-
ter (1881-82). The following is taken from notes kindly
sent to me by Dr. Asch, with respect to our case :
Called to see Mrs. G • on October 15th. I found
her with a red and swollen tonsil on the right side, and
with some fever. The next day the tonsil was still in-
flamed, partially covered with a thin, gray film, and the
uvula cedematous. The patient complained of dyspha-
gia. Dr. Asch considered the case one of diphtheria. •
The next day there was swelling of the submaxillary
glands, but the diphtheritic exudation was not extensive
until a day or two later, when both tonsils, the uvula,
and the whole of the soft palate were covered with a
thick, gray membrane. At this stage I saw the patient
in consultation with Dr. Asch. Two days afterward she
died at 3.15 p.m. Dr. Asch saw her an hour and three-
quarters before her death. At that time he found her
in great distress and in a state of great weakness. "She
sat up for me, however," he writes, " to spray her throat.
VVhen I left she was bright, though very weak. Her
heart was beating feebly, and I urged the necessity pf
giving her stinnilants at once. When I returned, at a
little after three, she had just died. She had called her
mother to her and given her a kiss, and expired. She
died of asthenia. " Dr. Asch adds, "There were no laryn-
geal symptoms, nor any pulmonary ones of a nature to
have been looked on as serious. If the patient could
have been tided over another day, I think the force of
the disease would have been expended."
It will be understood from the above reading, and,
in fact, it is so stated farther on in Dr. Asch's account,
written to me at my request, that he considered this pa-
tient as having succumbed to intense asthenia. Hut
what was the organ principally and fatally affected by
the diphtheritic poison ? Was it not clearly and indu-
bitably the heart ?
Still another case in which death took place this
winter in a young married lady who had been a pa-
tient of mine, and whom I had cared for when the
diphtheritic membrane first showed itself on her ton-
sils. At that time she was jiassing a few days in New
York, and staying at one of our large city hotels. When
I saw her at the hotel, and after careful examination
of her throat, I urged her immediate removal to her home
on Staten Island, where she was afterward under the
professional care of Dr. Frederic Clarke, and also saw
Dr. Austin Flint, Sr., in consultation. The following
very interesting, graphic description of this patient was
sent to me at my request by Dr. Clarke after her death.
I take the liberty of narrating it in extenso : " I first saw
Mrs. W — — , Wednesday, November 2, 1881, and found
her with a rapid, full inilse, face flushed, and a well-
marked diphtheritic exudation on both tonsils, which rap-
idly extended in every direction. She did fairly well
for the first six days, pulse strong and regular, with no
dyspnoea or thoracic oppression. On the following
486
THE MEDICAL RECORD.
[May 5. 1883.
Wednesda)', in my jiresence, she suddenly complained of
pain in the precordial region, about over the valves of
the pulmonary artery, and her face, which all along had
been (with the exception of the tirst day) perfectly natu-
ral in expression and color, suddenly became of well-
marked leaden hue, accompanied with a very distressed
look, with some oppression ; pulse weak, regular, and
about 96, and she several times said she was choking.
These symptoms soon passed over, and she was moder-
ately comfortable until Friday last, but with a jiersist-
ently weak pulse. About 11 o'clock, Friday, a.m., she
was seized again with precisely the same syn)ptoms,
which were longer in yielding to remedies. In the
evening she was bright, expression and color of face
good, with inilse at 80 and regular, but very weak.
Passed a fair night, not restless nor inclined to throw
herself about the bed. She expired Saturday, 7.30 a.. m.,
nery suMenly, without any previous exertion, lying quietly
on her back. At no time could I detect anything ab-
normal about heart or lungs. Signed, F. E. Clarke."
I may add that I was informed later by a sister of this
lady that Dr. Austin Flint, Sr., saw her the evenmg be-
fore she died, and did not think at that time that there
was any occasion for special anxiety with respect to
the cardiac condition. Dr. Clarke, 1 am told, consid-
ered the complication which caused death directlv to
be the formation of an intra-cardiac thrombus. Xo
autopsy was made.
In regard to cases of diphtheria and typhoid fever 1
will at once direct attention to the following observa-
tions, which I have time and again corroborated and
verified in the dead house : There is a marked difter-
ence in the condition of the heart of a patient dying
of typhoid fever and of one dying of diphtheria. .Al-
though apparently similar in character, I have found the
right heart ventricle and auricle in diphtheritic patients
filled, as a rule, with a mass of fibrinous deposit, which
seemed to have been formed some days prior to death.
In several cases of death from typhoid fever, I have
found the blood in the right heart liquid, and in the left
heart coagulated fibrinous masses of small dimensions,
which did not seem, however, to be the inniiediate cause
of death.
The last case to which I would direct attention is the
following : Somewhat more than one year ago I saw, in
consultation with my friend Dr. F. H. Bosworth, a boy
about five or six years of age who was sufifering from
diphtheritic laryngitis. The dyspnoea became so intense
as to render tracheotoniy necessary. During the night
following the operation the tube became blocked up witli
blood and false membrane and threatened immediate
suffocation. A young man, in this emergency, who was
boarding in the house, applied his mouth to the tube and
attempted by forcible suction to free it of its obstruction.
A few days later this gentleman was taken ill with diph-
theritic angina. The case was one of moderate severity
and progressed favorably from day to day. The mem-
branous deposit, after several days' duration, had in great
part disappeared from both tonsils, and the patient, who
was naturally a strong, robust man of twenty-five to thirty
years, was seated in bed and svell enough to be playing
a game of cards with his nurse, so as to lessen the tedium
of his forced confinement. Suddenly, without premoni-
tory symi)toms, he complained of a distressed feehng in
the |)recordial region, became pale, his extremities cold,
scarcely perceptible pulse at the wrist, and he fell back
on his pillow in a syncopal state of very alarming char-
acter. The nurse at once used all ordinary means (fric-
tion with mustard, hot bottles to feet and trunk, exliibi-
tion of considerable amount of brandy, etc.) to restore
consciousness and vitality. .After about three-quarters
of an hour her endeavor was rewarded by seeing a mani-
fest change for the better in her patient. I arrived
shortly afterward, only to hear the detailed history of the
accident and to recogni/.e no sufficient cause in the heart
or pulse to explain the symptoms which had taken place.
The patient continued to do well when, under analo-
gous circumstances, three days later, the same occurrences
were again remarked. On this occasion Dr. Austin
Flint, Sr., was sent for at the same time as myself. Dr.
Flint saw the case with me about one hour after the ter-
mination of tlie phenomena of the second attack. At
this time auscultation of the heart revealed absolutely
nothing abnormal, and palpation of the pulse showed it
to be regular and of tolerably good volume. From this
time onward the patient continued to make a good re-
covery, without intercurrent complication of any sort.
The explanation of the sudden cardiac failure in this
and similar cases is difficult to give in a thoroughly satis-
factory manner. In some, undoubtedly, cardiac throm-
bosis is the immediate cause. But whether in these in-
stances the blood stagnates and finally forms coagula m
the right heart, owing to a relative increase of fibrin, or
because the cardiac contractile force is rapidly diminished
and thus makes a jiredisposing condition of fibrinous de-
posit, it is very difficult positively to affirm. In certain
examples where death has followed in diphtheria within
a few days of the beginning of the attack, I have noticed
a condition of granulo fatty degeneration of the muscular
fibres. But even in these instances, and with a con-
siderable knowledge of this subject, I do not recognize a
morbid change more advanced than one finds in the
majorit)' of cases of acute febrile disease which terminate
by death due to other causes. The pneumogastric trunks
and the peripheral fibres, as well as the intra-cardiac
ganglia, have been more than once examined carefully in
such examples, without leading to the discovery of a
change of structure sufficient in amount to account for
the rapid and fatal issue. I am disposed to-day, in view
of what I have been able to remark at the bedside, to
recognize the fact that at times — not infrequently, in fact
— there is a sudden and considerable dilatalion of the car-
diac cavities, and especially of the right heart.
Coagula may form under these circumstances, or, if
the hfeart be immediately and strongly stimulated, the
imminent stage may be tided over and only incomplete
failure, with dangerous but not fatal symptoms, occur.
The fact of the existence or non-existence, at the au-
topsy, of the coagulum in the right or left heart, which
may also be of larger or smaller size, and of more or less
consistence, is, doubtless, explained by the intimate
blood condition which an advanced physiological chem-
istry can alone satisfactorily elucidate. In regard to the
therapeutic indications, and as at present advised, they
are few and simple.
First. — -AH unnecessary fatigue should be absolutely
avoided during the duration of even the mild cases of
diphtheria and tyi>hoid fever. Patients should not be
permitted to raise themselves in bed, to sit up but a
very short while on any particular occasion, and then
only when convalescence is well advanced. They should
not be allowed to feed themselves or to perform any act
which causes outlay of physical energy and which can
be avoided by judicious nursing.
Second. — Cardiac tonics should be employed in very
moderate doses from a relatively early stage of the dis-
ease, and particularly if there be even slight manifesta-
tions of cardiac failure, as shown by inequality or ir-
regularity in force or rhythm of cardiac beats, or of the
radial pulse, or indeed, by attacks in any manner resem-
bling those to which I have referred.
Third. — In typhoid fever, as well as in di))htheria, I
look upon black coflee as a very valuable stimulant, and
therefore particularly urge its employment early m the
course of the disease. Besides the above recommenda-
tions, I naturally incline strongly to the use of liquid
nutriment in very concentrated forms. In regard to one
drug so largely used by the medical profession generally,
in the treatment of asthenic forms of acute disease, I am
disposed to enter here a word of warning — and it is about
the internal use of large doses of the tincture of the
chloride of iron. This tincture is one of the most power-
May 5, 1883.]
THE MEDICAL RECORD.
487
fill styptics and astringents we possess, and is presumed
to exercise these properties in tlie blood if it be absorbed.
Now, then, to what extent, 1 iiave alreaiiy asked myself
on more than one occasion, is it responsible for the
formation of intra-cardiac fibrinous coagula, particularly
in diphtheria ?
I here leave the very important subject presented in
this paper for full consideration by the members of our
society.
FOUR CASES OF OPIUM-POISONING.
Treatment by Atropia and the Faradic Current
— Recovery.
By SAMUEL S. WALLIAN, M.D.,
[|ILOOMINGDA[-E, N. V.
C. C. T-
-, A.
April 3, 1883, four men, J. W. L-
B , and S. L. P , jointly drank from a bottle
(supposed to contain whiskey and ijuinine) four ounces
of tincture of opium (Phar. of 1870). Nearly half an
hour elapsed before the nature of the mistake was fully
realiied.
By this time Dr. Rice and myself were both sum-
moned. He, being nearer, arrived some minutes first,
and very soon administered to each a very large dose of
sulph. zinc, in solution, to which was added fifteen grains
of ipecac. On my arrival he was mixing a second dose
of the same, which was promptly swallowed by three of
the unfortunates, without effect, save in the case of S.
L. P , who vomited sHghtly. Advising further efforts
at producing emesis by irritating the fauces, etc., I sent
for my buggy case, which was at some distance, and after
three of the victims had called for and swallowed a third
large dose of the zinc and ipecac, I hastily prepared a
solution of apomorphia mur. ; and, as the impending
narcosis was not yet perceptible in any one of the cases,
1 risked the injection of one-sixth grain subcutaneously
into the arms of each. My anxiety lest this drug should
also fail to procure emesis, in which case it would neces-
sarily add to the approaching narcosis, was quickly dis-
pelled. Within three minutes emesis was quite free with
two, and moderately so with the other two.
Copious draughts of warm mustard and water were
supplied, but it was soon evident that no further emetic
effects could be secured. It was now 5.30 p.m., the
poison having been swallowed not far from four o'clock.
Five grains citrate of caffea were exhibited to each of
the four, and ambulation resorted to vigorously.
Asking the druggist, from whom the drug had been —
without fault of his — procured, to give me, as nearly as
possible, the equivalent in morphia received by each
patient, which he stated to be 4J grains, I prepared a
solution of atropia, gr. j. to 3 ij-, of which I injected,
subcutaneously, lUxij. (= gr. ^^) to each patient.
In case of A. B , who vomited a little earlier and
more freely than the rest, complete narcotism did not
ensue, and ambulation was kept up without great effort.
By 7 P.M. I repeated the dose of atropia, gr. Jj^. See-
ing no apparent effect from the two doses, aggregating
^ gr. to each patient, and recalling the antagonistic
ratio existing between atropia and morphia, as stated by
Bartholow, viz., atropia, gr. ss. to morphia, gr. j., I pre-
pared a solution double the strength of the former one,
or, grs. ij. to 3 ij- Of this I exhibited TTlxxiv., hypoder-
mically (=: gr. j'j-), to each of the three most under the
influence of the narcotic. By this time — 7.30 — the pupils
of the latter were contracted to a mere dot, narcosis
was so fully established that they could not be roused
by the mbst vigorous measures, and ambulation was en-
tirely out of the question.
Respirations fell to 8 per minute ; the pulses of all
became fainter and slower until scarcely perceptible.
Having sent for my battery I now applied a strong faradic
current, one pole over the diaphragm and one at the
nape of the neck. By carefully interrupting the current
at regular intervals respiration was gradually restored,
but in each case the application had to be repeated as
often as every ten minutes. Twice in the cases of J. W.
I^ .and C. C. T resi)iration was suspended for a
space of two minutes each time, and the struggle seemed
to the assistants to have become a forlorn hope. Grad-
ually the antagonistic influence of the atropia began to
assert itself ; the pupils gradually relaxed, and by 9.30
P.M. the respirations were quite regular and loi- to 11
per minute. The three were now lying in a tranquil
sleep, from which, hovvever, they could not be roused by
any effort. By 10 p.m. S. L. P showed signs of returning
consciousness, swallowed some stimulants, and could be
momentarily aroused. Pupils of all well dilated ; respi-
rations, easy and regular, 11 to 14 per minute; pulses,
70 to 95.
We now had all removed to more comfortable quarters,
the two more fortunate subjects walking between two
assistants.
Warmth was now applied more effectually than before
— in fact, too zealously by some of the excited assistants,
as some severe hot-bottle blisters abundantly testify ! —
but with the exception of occasional sips of brandy and
ammonia, with beef-juice, no further treatment was
deemed necessary. To the two who were already con-
valescent, milk and other nourishment were freely allowed.
By 4 A.M. it was evident that all were out of danger.
The effects of the antagonist, atropia, were visible for
forty-eight hours or more, as shown by disturbance of
vision, unsteady gait, hallucinations, harmless delirium,
etc., which would seem to indicate that it was exhibited
somewhat in excess of the requirements in the several
cases.
Impossible as it was to estimate accurately just how
much of the laudanum had been ingested by each, and
how much ejected by emesis, this result was unavoidable.
I now think it would have sufficed had the third dose
been limited to ^, or even to J,, gr. ; yet Bartholow, as
stated, and other good authorities, insist that it requires
i- gr. atropia to antagonize one gr. of morphia.
If we assume, on their own and the druggist's subse-
quent statements, that the two worst cases received the
equivalent of five to six grains of morphia each, and also
assume that only one-third of this amount was ejected
by the delayed and imperfect emesis, about four grains
would require to be antagonized in each case. This, ac-
cording to the authority quoted, would require two grains
of atropia. The inference is, that not more than ^\
grain, and perhaps even ^'j- grain, of atropia is sufficient
to antagonize one grain of morphia.
No doubt the prompt use of apomorphia at a critical
moment, the after administration of caffea, and the vig-
orous application of the faradic current, contributed
something to the success of the treatment ; but it is evi-
dent that but for the timely use of atropia all other means
would have failed to save life in at least two of the four
Hot Water in Therapeutics. — Several years ago
I learned in my personal experience that no agent re-
lieves nausea and vomiting so satisfactorily and promptly
as water, as hot as can be drunk. Since then I have
used it in a large number of cases, and it has been uni-
formly reliable. The following classification may be
made of the cases in which it has been used : i. Cases
in which nausea and vomiting occurred at the outset, or
during the course of acute febrile disease ; 2, cases in
which these symptoms were caused by overloading the
stomach when its functions had been impaired by pro-
tracted disease ; 3, cases in which they were produced
by nauseous medicines (not emetics), at the time they
were taken ; 4, cases of acute gastritis, caused by the in-
gestion of irritants ; 5, cases in which these symptoms
were purely reflex ; 6, cases of chronic gastritis ; 7, cases
of colic in newly born infants ; 8, cases of flatulent dis-
tention of the stomach. — Dr. Douglas Morton.
488
THE MEDICAL RECORD.
[May 5, 1883.
|^ro0vcBs of Ittcrtical J^cicncc.
Removal of Carious Portions of the Vertebral
Bodies. — Dr. Boeckel relates the history of a case in
which he removed the carious portion of the bodies of
two dorsal vertebra, by means of the sharp spoon, with
gratif\ing results. From his experience in this case and
in operations upon the cadaver, the writer concludes that
it is not so difficult as is usuallv supposed to reach the
anterior portion of the spinal column. The resection of
an inch to an inch and a half of one rib affords room
enough for the finger to reach the bodies of the diseased
vertebr.-e. The danger of wounding any of the great ves-
sels lying in front of the spinal column is not so great as
it seems, as the pus has already formed a sinus which
serves as a guide to the diseased bone. The bodies of
the lumbar vertebrfe maj' be reached by an incision made
at the outer border of the sacro-lunibalis muscle, as for
nephrotomy. The same operation is indicated in gun-
shot wounds of the vertebral bodies. The difficulty in
such cases lies less in the operation itself than in the
uncertainty of the diagnosis respecting the location and
extent of the injury to the bone. — Schmidt' s Jahrhiicher,
March 14, 1883.
Traumatic Paralysis of the Quadriceps Muscle.
— Professor Liicke states that slight injuries sometimes
cause a loss of function with rapid atrophy of the quadri-
ceps extensor femoris. The electrical irritability is
markedly diminished but never entirely lost. A passive
effusion into the knee-joint occurs from relaxation of the
capsule. In a similar aftection of the deltoid there re-
sults, from loss of support, an apparent luxation. The
author believes that many cases of so-called congenital
dislocation of the hip are due to a like condition which
obtains in the muscles about the hip. The prognosis of
traumatic muscular atroi)hy when untreated is bad. But
treatment, if undertaken early, is very successful. It
consists in the application of a weak constant current
at first, and the induced current later. — Centralblatt fiir
Chirurgie, February 24, 1883.
Umbilical Hernia of a Part of the Stomach-
Wall. — A boy, thirteen years of age, had a tumor, about
the size of a walnut and of a bright red color, at the
navel. It was covered with mucous membrane, which
secreted, upon being handled, a viscid fluid of acid re-
action. The tumor, which was attached to the umbilical
ring by a slender pedicle, remained always of the same
size and was irreducible. No opening into the interior
could be discovered. The mother stated that the cord
had been of great thickness, and, near the navel, was
funnel-shaped. It was ligated very close to the body.
^Vhen the end came away the tumor was noticed. There
had never been any food or fecal matters discharged
from tiie navel, nor did the secreted mucus ever have a
fecal odor. The pedicle was cut through, and the wound
rapidly cicatrized. Dr. Tillmanns, wlio reported the
case \Centralblatt fur Chirurgie, March 3, 1883), be-
lieved it to be an ectropia ventriculi. He stated that
the secretion possessed the power to digest fibrin, and
further, the microscopical examination of the tumor
showed it to be composed of gastric mucous membrane
from the neighborhood of the pylorus. The portion of
prolapsed stomach was cut off with the umbilical cord,
this little piece being at the distal end. The o|)ening
into the stomach was closed probably at the time of
birth.
Tetanus Hvdrophobicus. — The following case of a
l)eculiar affection, first described by Rose, is related by
Dr. Von Wahl (Centralblatt fiir Chirurgie, Jamiai)- 6,
1883). A man, forty-one years of age, while intoxicated
fell down some steps, striking his forehead just alwve
the right orbit. Very extensive ecchymosis of the right
cheek followed. .\t the end of a week the iiatient felt
well, but on the ninth day lockjaw set in, tliere was right
facial paral)si3, and the right eye could not be closed.
The left eye, on the contrary, was spasmodically shut,
the teeth were pressed firmly together, and the muscles
of the cheek, even on the paralyzed side, were as hard
as a board. The sensibihty of the skin on the right side
of the face was somewhat diminished. The movements
of the head were at this time perfecdy free. On the
following day it was necessary to perform tracheotomy
on account of dyspncea, and on the day after that spasm
of the right trapezius muscle appeared. The pupils at
first responded slowly to light, but were now strongly
contracted. The patient died of pneumonia. At the
autopsy, the right vertebral artery was seen to be con-
siderably smaller than the left ; the right half of the pons
was also smaller than the left, while the [pyramidal and
olivarj- bodies on the right side appeared broader and
fuller than those on the left. There was no lesion (ab-
scess or tumor) of the pons. There was no fracture of
the cranial bones nor injury of the cranial nerves.
Fever Dependent upon Fecal Accumulation. —
A rise of temi)erature is often observed in women after
childbirth or ovariotomy, which subsides after a free
movement of the bowels. In addition to the fever there
are frequently symptoms of peritoneal irritation — pain
on pressure, meteorism, elevation of the diaphragm, cy-
anosis, and rapid pulse. To explain these symptoms.
Dr. Kiistner instituted a series of observations upon
women after ovariotomy {Zeiischrift fiir klin. Afedicin,
vol. v.). He found that the temperature rose when the
fecal matters had passed into and distended the rectum.
By reason of increased peristalsis and from direct press-
ure of the distended rectum, the wounded surfaces were
disturbed and a resorption of the secretions induced.
This gave rise to fever. Perhaps also the retained fajces
caused a more rapid decomposition of the secretions.
The same explanation will answer also for similar con-
ditions in the jiuerperal state, and the author asserts
that peri-uterine exudations are often due to the same
cause.
The Tubercular Nature of Diabetic Phthisis. —
Drs. Immermann and Riitimeyer report in the Centralblatt
fiir klinische Afedicin, of February 24, 1883, a case of
phthisis in a diabetic subject, in which tubercle bacilli
were found in the lung- cavities. Though convinced of
the tubercular nature of that particular case, they are
not prejtared to formulate general conclusions from one
observation. They state, however, very truly, that the
more often tubercle bacilli are found in the lungs or
sputum in similar cases, the more certainly will the etio-
logical identity of diabetic phthisis and ordinary i^ulmo-
nary phthisis be established. And further, the more cer-
tainly the tubercular nature of diabetic phthisis is proven,
just so certainly will the greater frequency of phthisis in
the subjects of diabetes demonstrate that the constitu-
tional conditions in this disease are favorable for the
reception and development of the parasite.
A Simple Method of Producing Local Anaes-
thesia.— Dr. Cheize relates (Moniteur de la PoHcli-
nique, March 25, 1883) a simple procedure adopted by
him in a case of ingrowing toe-nail, requiring immediate
operation, at a time when he had no apparatus at hand.
He saturated a little piece of lint with ether and placed
it on the toe. He then projected the air from an ordin-
ary pair of hand bellows u|)on the lint until the ether was
evaporated. This was repeated two or three times,
when anaesthesia was so complete that the nail was re-
moved without the patient's knowledge.
Influence of An.*;mia on the Electrical Irrita-
bility OF the Cerebrum. — From a series of experi-
ments upon dogs, conducted in Munk's laboratory in
Berlin, Dr. Orschansky formulates the following conclu-
sions : 1. The abstraction of less than one-seventh of
the total volume of blood of the animal does not modifv
May 5, 1883.]
THE MEDICAL RECORD.
489
the excitability of the psychomotor centres of the cere-
biuui. 2. The loss of one-seventh to one-fifth of the
entire voliinie of blood increases the irritability. 'I'he
abstraction of a greater quantity causes a gradual dim-
inution of excitability until it is finally lost completely.
At the same time there is a flattening of the convolutions
and the pulsations of the brain cease. 3. Dining the
period of increased irritability, the annnal is restless and
agitated. As the irritability is lessened he becomes
quasi-narcotized, though the power of voluntary move-
ment remains. 4. These changes are not dependent
upon the lowered blood-pressure. 5. They are caused
by the induced anxmia, which seems to act through
lowered nutrition of the brain. — Deutsche Medizinal-
Zeiiung, February 8, 1883.
Constitutional Treatment of Chronic. Uterine
Disease. — A forcible plea in behalf of constitutional
measures in the treatment of chronic womb troubles is
entered by Dr. Boisliniere in the St. Louis Cour'uT of
Medicine, April, 1SS3. He concludes his paper by the
following practical suggestions :
"The late excessive tendency to specialize has led us to
attach, in uterine affections, too great an importance to
the lesions and not enough to the general condition.
The morbid influence of the constitution on the uterus
shoidd be considered first, and the reciprocal influence
of the uterus on the organism should be considered as
secondary. The uterus does not lead an isolated life in
the organism, but it is only a link in that harmonious
chain constituted by all the organs, and if the action of
that chain be disturbed, there will be suftering in every
organ constituting the chain. There will be suffering in
the uterus, as well as in any other organ, but not more."
Operations for Cataract in the Subjects of
Chronic Disease. — Dr. Armaignac opposes the com-
monly entertained opinion that operative measures
should be avoided in cataract occurring in individuals
suffering from any cachexia. He has examined the
records of a number of operations for the cure of cata-
ract performed in his clinic, and he states that he has
yet to meet with a failure in patients suffering from
either diabetes, albuminuria, cancer, or malaria. In
every case the cure was at least as rapid as it is usually
in healthy subjects, and it occurred without inflammatory
reaction or complication of any sort. Some of the
operations were performed in the last stages of the gen-
eral affection. — Revue M'edicale, March 17, 1883.
Addison's Disease and the Suprarenal Cap-
sules.— From a study of the literature bearing upon
this subject. Dr. Carl Burger arrives at the following
conclusions : The suprarenal capsules are, from their
structure, to be classed among the blood-vascular glands,
and have no important vital function to perform. They
stand in no causal relation to the bronzing of the skin.
This dark-coloring of the skin occurs not only in
Addison's disease, but may accompany a variety of
cachexia;. Disease of the suprarenal capsules is not in-
frequent, and often runs its course without any of the
recognized symptoms of Addison's disease. The great-
est variety of lesions of the capsules may be seen in dif-
ferent cases of Addison's disease. Addison's disease
depends upon an affection of the semilunar ganglia and
of the solar plexus. This affection is usually caused by
some disease of the suprarenal capsules, most frequently
a tubercular inflammation. Disease of the sennlunar
ganglia and solar plexus may arise from lesions of other
organs than the suprarenal capsules, or may even be
idiopathic. The symptoms of Addison's disease may
thus be present without any lesion of the suprarenal
ca|.)sules. — Allgem. Med. Central-Zeitung, March 14,
1883.
Glycosuria after Removal of the Mamm.'e. — M.
Paul Bert related, at a recent meeting of the Societe de
Biologie, the effects produced by the ablation of the
mamma; of a pregnant goat. After the birth of the kid,
the urine of the goat was found to contain a very con-
siderable amount of sugar. Owing to irritation, caused
by vain attempts of the kid to suck, a large phlegmon
arose in that region. The sugar at once disappeared
from the urine. Similar experiments made about the
same time, by MM. Bert and De Sinety, upon pregnant
guinea-pigs, were attended with negative results. — Ga-
zette des Hopitaux, March 20, 1883.
Effects of the Internal Ad.ministration of
Glycerine. — Dr. Tisne speaks highly of glycerine as a
therapeutic agent internally administered. He states
[Gazette des Hopitaux, March 17, 1883) that it causes
no irritation to the nnicous membrane of the digestive
tract beyond exciting a slightly increased peristaltic
movement. It exerts a beneficial eft'ect upon nutrition,
increasing the weight and palliating many of the dis-
tressing symptoms in phthisis, such as loss of appetite,
diarrhcea, night-sweats, and insomnia. Its action upon
the liver is manifested by an increase in size of the organ
and by a more abundant flow of bile. It has a diuretic
effect and increases the excretion of urea, the chlorides,
and the phosphates. The alkalinity of the urine is di-
minished, and if any pus be present in this fluid it is
greatly lessened in amount.
Eclampsia Nutans. — Dr. Gantiez relates a case of
salaam convulsions which he witnessed in a child, seven-
teen months old. The attacks were precede'd by a
period, varying from a few seconds to a minute, during
which the child presented an absorbed air, seeming to be
a little apprehensive, but not agitated. The eyes were
raised and fixed, and there was a little pallor. Then
suddenly any toy that was in the hand was cast away, the
head was flexed upon the thorax and the trunk upon the
pelvis. At the same time the shoulders were slightly
raised and the arms thrown forward with the hands ex-
tended, as if to prevent a fall. These movements fol-
lowed each other with great rapidity, sometimes as often
as thirty times in succession, but usually only eight or
ten times. After the attack the eyes were filled with
tears, and there was an expression of astonishment upon
the child's countenance. He was easily comforted and
soon resumed his play. The attacks occurred about
eight times a day, and since they began, at the age of
nine months, had never missed a day. Bromide of
potassium had failed to exert any controlling influence
over the disease. — Revue Medicale, March 3, 18S3.
Puerperal Infection through Erosion of the Nip-
ples.— The possibility of sei)tic infection through wounds
of the nipples, as well as through wounds of the genital
apparatus, has hitherto received but scant notice. Pro-
fessor Kaltenbach regards this occurrence as probable,
arguing from the etiological relation between erosions of
the ni|)ple and mastitis, and from the beneficial effects •
claimed by Hausmann to follow the treatment of the
fissures by carbolic acid. Spiegelberg has shown the pos-
sibility of mastitis arising from infection through the nip-
ples and openings of the lacteal ducts. Kaltenbach goes
further, and regards every case of mastitis as of septic
origin. The necessity of the greatest possible cleanli-
ness of the mouth of the child, the hands of the nurse,
and the nipple itself is self-evident. — Deutsche Med.
Zeitung, March 1, 1SS3.
Influence of Erysipelas upon Syphilis. — Dr. Strack
relates several cases in which the disappearance of gummy
tumors was promoted by an intercurrent attack of ery-
sipelas. He thinks this beneficial influence is exerted in
two ways. The first effect is that which erysipelas exerts
in common with other acute fevers. The second is to be
referred to the local inflammatory processes. The in-
creased flow of blood to the diseased parts causes a
breaking down of the cell-infiltration, which becomes thus
more readily absorbed. — Centralblalt fiir Klin. Medicine,
March 3, 1S83.
490
THE MEDICAL RECORD.
[May 5, 1883.
The Medical Record
A Weekly yojirual of Alcdicinc and Surgery.
GEORGE F. SHRADY, A.M., M.D., Editor.
Published by
WM. WOOD & Co., Nos. 56 and 58 Lafayette Place.
New York, May 5, 1883.
ELIGIBILITY OF DELEGATES TO REGISTRA-
TION AT THE NEXT MEETING OF THE
AMERICAN MEDICAL ASSOCIATION.
At the last meeting of the New York Academy of Medi-
cine the following unqualified statement was made :
" The New York Academy of Medicine is the only
chartered medical society in the State of New York,
which is entitled, through its delegates, to recognition,
either in the American Medical Association or in any
of the State Medical Societies in the Union. I wish that
fact to stand fully before the mind of every Fellow of the
Academy." (See report of the proceedings in The
Medical Record for April 28, 1883, p. 472.)
There is a legal aspect of this statement which should
not be entirely overlooked.
In the plan of organization of the Association it is
stated that members shall hold their appointment either
as delegates, members by invitation, or as permanent
members. "The delegates shall receive their appoint-
ment from permanently organized State Medical Soci-
eties, and such county and district medical societies as
are recognized by representation in their respective State
Medical Societies, and from the Medical Department of
the Army and Navy of the United States, and the Marine
Hospital Service of the United States." ("Transactions
American Medical Association," vol. n, p. 618.)
Manifestly this clause means that only such county and
district medical societies are entitled to representation in
the association as are entitled to representation in their
respective State Medical Societies. It is equally evident
that the county and district medical societies stand upon
the same level ; that no iirivileges are granted to the one
which are not extended to the other ; and that the basis
of representation exists in the words " entitled to repre-
sentation in their respective State Societies."
According to this interpretation of the clause regu-
lating membership in the American Medical Association,
the societies in the State of New York, prior to 1S82,
entitled to representation in the Association, were the
Medical Society of the Slate of New York, ami the
several county societies, together with the district medical
societies whicli were entitled to representation in the
State Medical Society.
There is only one medical society in this State which
belongs to the class denominated district medical soci-
eties, and entitled to representation in the State Medical
Society, namely, the New York Academy of Medicine.
This medical society derives its right of representation, by
delegates, in the American Medical Association solely
from the fact that it is entitled to representation by dele-
gates in the Medical Society of the State of New York.
The only relation which the New York Academy of Med-
icine sustains to the .\nierican Medical Association is
that of a district medical society. It stands upon the
same level, in that respect, with the county medical soci-
eties, and in common with them obtains the right of rep-
resentation in the American Medical Association by the
fact that both are entitled to send delegates to the State
Medical Society. The statement then, that " the New
York Academy of Medicine which has no connection with
the State Society, except that it is empowered to send
delegates to that body," does not unfold the close rela-
tionship existing between these two bodies and reveal the
real dependence which the former has upon the latter with
reference to representation by delegates in the National
Association.
The question now arises, what are the conditions
which exclude re|)resentation in the American Medical
Association ? These are found in Article IX. of the
By-Laws, which reads as follows : " No State or local
medical society, or other organized institution, shall be
entitled to representation in this Association that has
not adopted its Code of Ethics ; or that has intentionally
violated or disregarded any article or clause of the
same" ("Transactions .'American Medical Association,"
volume ■^■^, page 629). In the light of the clause in the
plan of organization, already quoted, it is plain that the
following interpretation of the above by-law must be ad-
mitted. No State or local medical society, or other
organized institution — that is, no State, county, or dis-
trict medical society — shall be entitled to representation
in this Association that has not adopted its Code of
Ethics ; or, that has intentionally violated or disregarded
any article or clause of the same.
This interpretation is sustained by the decision of the
Judicial Council, at the last annual meeting of the
American Medical Association, touching the action of
the Medical Society of the State of New York in 1SS2,
which says : "Having fully examined the Code of Ethics
adopted by the New York State Medical Society at its
annual meeting in February, 18S2 [as furnished by the
Secretary of said Society], the Judicial Council find in
said Code provisions essentially different from, and in
conflict with the Code of Ethics of this Association, and
therefore, in accordance with the nintli by-law of the
American Medical Association, they unanimously decide
that said New York State Medical Society is not entitled
to representation by delegates in this Association "
("Transactions American Medical .Association," vol. Ht
page 60). Accordingly, at the annual meeting of the
Association, held at St. Paul in 1882, the delegates from
the Medical Society of the State of New York were re-
fused admission ; but the delegates from the several
county medical societies and the district medical society
(the New York .Vcademy of .Medicine) were not excluded
and were permitted to register. The legitimate infer-
ence is that they were permitted to register and become
members of the Association because there was no evi-
dence that the several societies which they represented
had not adopted the Code of Ethics of the .American
May 5, 1883.]
THE MEDICAL RECORD.
49 T
Medical Association, or had intentionally violated or
disregarded any article or clause of the same.
If this be the true inference, we may still infer that
those county societies and district medical societies which
have adopted the Code of Ethics of the American Medical
Association, and have not intentionally violated or dis-
regarded any article or clause of the same, are yet en-
titled to representation in that body.
It has been said, and the inference was allowed among
the members at the meeting at St. Paul, that the dele-
gates from the county societies and the district medical
society of the State of New York were admitted merely
as a matter of policy, believing that the action of tliis
State Medical Society would be repealed at the annua'
meeting in February, 1883. We do not believe, how-
ever, that the Judicial Council is a body that has been,
nor will be, governed in its decisions by policy when tlie
policy conflicts with the laws of the Association.
It is a matter of fact that all the county medical so-
cieties in the State adopted the Code of Ethics of the
American Medical Association, and it is also a matter
of fact, that only a very few have modified their by-laws
in this respect, so as to make them conform to the S)s-
tem of Medical Ethics of the Medical Society of the
State of New York. Indeed, a large number of the county
medical societies have done more than has been done
by the New York Academy of Medicine even, and have
shown their hostility to the new Code, as it is called, by
instructing tiieir delegates to vote for its repeal, and for
the re-enactment of the old Code. Why should not they
be entitled to representation in the American Medical
Association as well as the New York Academy of
Medicine, whose delegates have, with a single exception,
uniformly voted either for the new Code or against reso-
lutions which provided for the re-enactment of the old
Code ? What has lifted this medical society into the ele-
vated position among its peers in which some of its Fel-
lows have sought to place it ? There are, possibly,
special reasons.
If policy or expediency is to govern the decision of
the Judicial Council, certainly the delegates from the
county medical societies and the district medical society
will be received at the forthcoming meeting of the
American Medical Association, the same as they were
last year. For, the same argument, on the policy side,
holds now as it did in 1S82, namely, that the question
is not yet settled in the Medical Society of the State of
New York, because an amendment to the by-laws will
be called up for action at the Annual Meeting in 18S4,
and if adopted, will repeal the action taken iu 1882 and
sustained in 1883, and besides, the opposition to the new
Code is much more formidable and determined than it
ever has been.
From the jiolicy standpoint, therefore, we fail to see
that the New York Acadeni}' of Medicine is the only
medical society in this State entitled to representation
in the American Medical Association. But it may be
said that because the county medical societies are in
affiliation with the State Medical Society, they are bound
to make their by-laws conform with those of the State
Medical Society, and are therefore cut off from repre-
sentation. This is an argument, however, which those
who believe that the New York Academy of Medicine
is the only medical body in tjie State entitled to repre-
sentation, by delegates, in the American Medical Asso-
ciation, cannot safely employ. It proves too much. For,
if it be true that the county and district medical societies
are cut off from representation in the American Medical
Association, by reason of the action of the State Medi-
cal Society, then is the New York Academy of Medicine
cut off as certainly, because, without reference to its
disavowals, it has been, and is now, in affiliation with
the Medical Society of the State of New York. It has
sent its delegates to the State Medical Society, has taken
no action looking toward their withdrawal, depends
uiJon the State Medical Society for its right of repre-
sentation in the American Medical Association, has
failed to even attempt to instruct its delegates to vote
for the re-enactment of the old Code, and therefore its
delegates shoukl not be received if the delegates from
countv medical societies are refused admission.
A CITY OF DISPENS.\RIES.
The subject of the abuses connected with medical
charities in Philadelphia was made the subject of a
paper and discussion before the Philadelphia County
Medical Society, recently. Dr. J. W. Walk, who read
the paper, said that there were in Philadelphia thirty-two
free dispensaries, which treated in one year 161,019
cases, or about one-fifth of the entire population. Ur.
Walk was disposed to think that the dispensary system
was a pernicious one, injuring both the profession and
the public. He referred to a previous attempt to secure
reform made three years ago, and which had proved
futile. There had recently been organized a " provident
dispensary," modelled after the institutions in London.
It remained to be seen whether this would turn out a
success.
The statement of Dr. Walk's, that Philadeliihia has
thirty-two dispensaries, is a surprising one. It i)laces
Philadelphia at once at the head of all the cities in the
Union \\\ the matter of these institutions. New York
City,with a population one-third greater, has only twenty-
two, and many of these do very little work. Nine dis-
pensaries in this city treat nine-tenths of the patients.
On the other hand the actual amount of free dispensary
service is about the same for both cities. In New York,
a quarter of a million of persons are treated at the dis-
pensaries annually, which is one-fifth of our population.
There are many abuses connected with this form of
charity and we trust that Philadelphia will be able to
inaugurate some effectual measure of reform.
PAINFUL CONGESTION OF THE LIVER IN THE EARLY
STAGES OF ALCOHOLISM.
But little has been written concerning the early stages of
hepatic disease in hard drinkers. The symptoms at this
time are insignificant, or, at any rate, are not troublesome
enough to disturb the equanimity of persons that are not
habitually solicitous about their health. Dr. Mathieu was
led to examine the liver carefully in a number of patients
who already presented some of the early signs of alco-
holism. In no instance were there any subjective symp-
toms of hepatic disorder, yet there was always an in-
492
THE MEDICAL RECORD.
[May 5, 1883.
crease of liver dulness of about one inch above the
normal. There was at the same time some tenderness
on jiressure. In the majority of cases examined there
was also a slight enlargement of the spleen. The author
regards this enlargement, combined with tenderness on
pressure, as indicative of a congestion bordering on in-
flammation. It will, in time, pass into true intiammation,
which may. according to circumstances, assume the
form of general hepatitis, or of one of the varieties of
cirrhosis.
Hc-uis of the Mlcch.
THE ETIOLOGY OF PERNICIOUS AX-EMIA.
Professor Fraxkenhal'sek has made the rather start-
ling discovery that pernicious ansmia is caused by bad
teeth. He claims to have found in the blood of jsregnant
women suffering from pernicious anaemia little, round,
very active bodies, about one-tenth the diameter of a
blood-corpuscle, and furnished with a scarcely discerni-
ble tail. Besides these there were other objects, longer
than the preceding, without tails and more sluggish,
which seemed to be in a state of transition into double-
celled bodies. The smaller bodies were exceedingly
active, resembling spermatozoa in their rapid movements.
As he never found these micrococci in the blood of preg-
nant women not the subjects of pernicious anasmia, it
seemed to the author most reasonable to conclude that
there was some connection between them and the disease.
The next question to determine was in what way these
little strangers foiuid entrance into the blood. The
most promising field for investigation was now the liver,
an organ which he had for a long time regarded, on clini-
cal grounds, as the disease centre. And the in\estigator
was not disappointed, for he found in the liver-cells,
near the left lobe, in severe cases of the disease, a
great number of multicelled filaments. These, he thought
probable, had worked their way from the intestine up
through the ductus choledochus and biliary ducts into the
liver-cells. Thence they forced an entrance into the
capillaries in such numbers as to stop the circulation, or
at least to offer a very great impediment to it.
Here, we claim, they change their form and get a
tail and then pass out into the general circulation. We
see in their presence in the liver a ready explanation of
the icterus which occurs in pernicious ana;mia. As far as
the investigator's researches have yet gone they have led
him to the belief that the origin of these organisms is to
be found in a fungus growing in carious teeth. .\\l the
patients whom he examined had dental caries and a fetid
breath. Hence he concluded that the frequency of per-
nicious anjeinia in pregnant women was to be explained
by the fact that women in this condition often had bad
teeth. .\nd further, since almost the entire population of
_ Zurich is afflicted with unsound teeth, an explanation of
the unparalleled frequency of the disease under question
in that city is afforded. The dependence of fatty heart
upon the same conditions appears to Professor Franken-
hauser, to be not only possible, but even probable. If
this most promising field of investigation be cultivated
with sufficient energy and imagination, it may yet come
to pass that the dentist, with his ounce of prevention,
will take rank as the greatest benefactor of the human
race.
Testimonial to Mr. Ernest Hart. — A testimonial
to Mr. Hart, editor of the British Medical louriial, was
recently presented to Mrs. Hart at the Grosvenor House
by express permission of the Duke of Westminster. The
testimonial was a portrait of himself, and was presented to
him by Mr. Spencer \Vells, President of the Royal College
of Surgeons, and treasurer of the fund. The testimonial
was a fitting and deserved recognition of the invaluable
service rendered to the medical profession of England by
Mr. Hart.
A Fortun.^te Hospital. — St. George's Hospital,
London, is shortly to come into a legacy of $100,000.
The American- Psychological Journal. — This is a
new quarterly journal issued by the National Association
for the Protection of the Insane and the Prevention of
Insanity. It is edited by Dr. Joseph Parrish, with A. A.
Chevaillier, and Drs. \\'. U'. Godding, C. L. Dana, H.
H. Bannister, and J. C. Shaw, associates. The publish-
ers are P. I'.lakiston, Son & Co,, Philadelphia. The first
number is certainly a most promising one, containing
original articles from such well-known names as J. Mil-
ner Fothergill, Norman Kerr, \Villiani Julius Mickle,
W. W. C.odding, C. K. .Miles, \\'alter Channing, Crothers,
H. Marion Sims, and others. The publishers have done
their work excellently.
The Journal of Compar-^^tive Medicine and Sur-
Gerv. — This journal has appeared enlarged and under
charge of a new publisher. It has established itself as
the leading journal in America, on matters of compara-
tive pathology and physiology, as well as in veterinary
medicine. It contains a great deal of practical interest
to all medical men.
The New York Neurological Infirmary. — An
institution bearing this title, and having for its object
"the gratuitous treatment of the poor for all diseases of
the nervous system," has been incorporated in this city.
Dr. J. L. Corning, Dr. M. Josiah Roberts, and Messrs.
Sidney CIreen, John T. Sherman, and Benjamin Crane
have been elected trustees for the first year.
The Indiana State Medical Society meets in
Indianapolis, on May 8, 1883.
A Reciprocitv-Annuitv-Bond Associ.ation has been
organized in Chicago, with branch offices in St. Louis,
Detroit, and Pittsburg. The Indiana Medical Journal
commends it, and says it is organized by and for
physicians. It pays annuities for ten years or more.
We should advise our readers to examine the institution
very carefully before putting money in it.
Sir Erasmus Wilson appears to have gone daft in
his last effort of philanthropy. He wishes to raise funds
for the erection of a statue to John lirown, late first
waiter to Queen Victoria.
An Electric Head-Light. — MM. Paul Helot, sur-
geon to the Rouen Hospital, and Q. Trouve, have
devised an electric lamp to be worn on the forehead, in
the examination of cavities. The light is very intense,
and will last for hours.
May 5, 1883.]
THE MEDICAL RECORD.
493
A Regular Physician. — The following, says the Indi-
ana Medical JouDial, are tlie favorite prescriptions of a
so called regular ph\sician of Indianapolis, and a member
of the County A[edical Society, who practises his trade,
we will not say profession, in the northeast part of this
city :
IJ. " l.ung Remedy," which properly translated
means "Mrs. Rhorer's Lung Remedy."
IJ . "Sinniion's Liver Regulator.''
I^. "My Pills."
IJ. "My Tonic'
The Maryland Medical Journal will be published
weekly, commencing May 3d. ^Ve congratulate our
contemporary upon this evidence of its well-deserved
success.
V
The Preshyterian Rye, Ear, and Throat Char-
ity Hospital, of Baltimore, whose new building was
recently dedicated, is supported in a somewhat novel
way. Each of the Presbyterian Churches in the city in
succession takes charge of the hospital for a month, pay-
ing all expenses. When a congregation is too small to
bear the expense, two are united.
The hos|)ital has acconniiodations for twenty in-
patients.
Bill to Regulate the Dlstribution of Bodies
among Medical Colleges. — A bill to regulate the
distribution of bodies from public hospitals, prisons,
morgues, etc., auiong medical colleges has passed the
State Senate.
The West Virginia Medical Society will hold its
annual session at Grafton, May i6, 1883.
The .'American Medical Association meets at
Cleveland, O., June 5th, 6th, 7th, and 8th.
The American Laryngological Association holds
its fifth annual meeting in this city, at the Academy of
Medicine, May 21st, 22d, and 23d. The sessions begin
at ten o'clock a.m.
A C.4SE of Adipocere. — The Cincinnati Medical
News voucltes for the following : " There is on exhibition
in Cincinnati, at the present writing, the body of a
woman who died in 1859, ""^^.r Dupont, Indiana ; and,
after remainuig in the grave until last November, for a
period of twenty-three years, lier grave was opened, that
her remains might be reinterred in the Wesleyan Ceme-
tery, near Cincinnati. She was the mother of a Mr. Rob-
ert Leitch, of the printing works, 12 West Eighth Street,
Cincinnati. When the coffin was reached, in the pro-
cess of disinterring, although made of common poplar,
not a durable wood, it was found in almost perfect con-
dition, the wood seeming to be firm and solid. \\'hen
lifted from the grave the immense weight was remarked.
On reaching the depot in this city, it required six men
to lift it from the car to a wagon. A glimpse at the in-
terior showed the cause of the great weight. The bod)'
was found to present a normal form and siiape ; and,
although black, the outline was almost perfect. There
was the head, with its sunken eyes, withered nose and
chin, hair along the edge of the forehead ; the body
flattened, and somewhat spreading ; the upper part of
arms lying alongside of the body, and the lower portion
of them with the hands placed across the body. The
arms and hands, as they lie across the body, indent it.
Only the bones of the fingers are remaining. The ab-
domen is considerably flattened, the sides bulging con-
siderably. The mammary glands of the breast are easily
outlined. The thighs and legs preserve their contour,
but seem enlarged. The blackened appearance is caused
by the burial garments adhering closely to it, their fibres
being easily distinguished. The present weight of the
body, we understand, is about five hundred pounds.
The deceased, when living, weighed about two hundred,
and was seventy-three years old.
Quarantine. — On account of the reported existence
of yellow fever in Cuba and other southern islands, the
National Board of Health has decided to establish quar-
antine stations on the Southern coast earlier than usual
this year.
A Movement ag.a.inst Counter-prescribing. — A
daily paper is authority for stating that a movement has
been set on foot in this city by medical men, which has
in view the prevention of apothecaries and drug clerks
from prescribing for patients and from copying the pre-
scriptions of physicians — a practice which has become
very common in some quarters of the city. It is pro-
posed, as the most feasible mode of giving authority to
the protest and declarations of the profession, that action
shall be taken by the County Medical Society, and that
the registered members of that body shall pledge them-
selves to withdraw their patronage, and to use their in-
fluence to induce patients whom they attend to withhold
their prescriptions from stores whose proprietors are
known to be in the habit of reconnnending patent medi-
cines or of compounding potions without medical author-
ity. According to numerous observers, while most of
the larger and more important drug stores in the city
refrain from all such practices, others are managed by
men who style themselves physicians or doctors, and
spare no pains to obtain patients, even going so far as to
make criticisms on prescriptions sent to them by regular
jiractitioners, with a view to impair confidence in them
and to divert the fee for prescribing into their own
pockets.
A Boston Enterprise. — We have received a circular
which states that " To show the value of nutrition in de-
veloping life the Food Co. have established
a free hospital of seventy beds." Forty beds for diseased
and orphan infants ; thirty beds for women with chronic
disease.
The Jacksonian Prize of the Royal College of
Surgeons has been awarded to Mr. Anthony K. Bowlby,
F.R.C.S., for an " Essay on Wounds and other Injuries
of Nerves, their Symptoms, Pathology, and Treatment."
Compelled to Resign. — It is reported that Dr.
Joseph W. Howe, late Professor of Clinical Surgery at
Bellevue College, has been compelled to resign that po-
sition in consequence of the stand he has taken in favor
of the new Code of Ethics. It is said that several other
gentlemen connected with this college have recently
been obliged to change their views or keep silent regard
ing them.
494
THE MEDICAL RECORD.
[May 5, 1883.
The Baltimore Medical College, which was started
two years ago on a " Christian " and co-educational basis,
has, says the Maryland Medical Journal, abandoned
both these features, " Not that it loves Cassar less," but
it prefers substantial success to the propagation of ideals.
The Michigan State Medical Society holds its
annual meeting at Kalamazoo, May 8th, 9th, and loth.
Kentucky State Pharmaceutical Association. —
The regular annual meeting of the Kentucky Pharma-
ceutical Association will take place at Lexington, Ky.,
Tuesday, May 2 2d, at 3 p..m. As the new jiharmaceuti-
cal law conies up for discussion, a large attendance is
requested, and all members are urged to bring as many
new members as possible.
Dr. Lyon Plavfair has received the Knight Com-
niandership of the Order of the Bath.
The Brazilian Government has awarded a gratuity
of §1,750 to Dr. John Baptist Lacerda for his discovery
of the antidotal virtues of permanganate of potash in re-
lation to snake-poisoning.
Professor T. H. Huxley and Mr. J. Tomes have
been elected Honorary Fellows of the Royal College of
Surgeons.
State Idiot Asylum at Syracuse. — Dr. Henry B.
Wilbur, Superintendent, since the foundation of this
institution, died suddenly, May 1st. He was a pioneer
in the education of idiots in this country.
Dr. Richard Joseph, formerly of Marblehead, Mass.,
disbursing officer of the Department of the Interior, died
of heart disease, May ist.
College Commencement — More Doctors. — The
first Annual Commencement of the Woman's Medical
College of Baltimore was held May ist. One graduate,
a former pupil at the Woman's Medical College in New
York, received a diploma. A nucleus of this kind fre-
quently yields many fold.
Dr. Ort(jn, of Milwaukee, accused of producing an
abortion upon his intended bride, was, on April 2Sth,
discharged by the Judge of the Criminal Court.
Florida as a Health-Resort. — The Atlanta Post-
Appeal, speaking of the recuperative powers of Florida,
says that when the invalid's first week's hotel bill is
presented he usually says, "I guess I'm well enough to
start for home this afternoon."
The Pharmaceutical Exa.minations. — The follow-
ing were the successful candidates at the pharmaceutical
examinations held in Montreal, April 27th: Major
Students. — Charles E. ScartT, .Miiheus Davidson, E.
Leonard, Alex. Robert, Ernest G. Swift, A. Dugal.
Ali/ior. — A. E. Holden, I-. Flannigan, Joseph H. Noad,
R. A. Kerry, A. R. Read, F. Baker, J. L. Beaudry, W.
Punchard, M. B. Rice, and F. C. Daniel.
The Argenteuli Prizes.- — The liighest of these
(§1,200) has been awarded to Dr. H. J. Bigclow, of
Boston.
The New S.mai.i.-pox Hospital. — The Board of
Health has advertised for bids preparatory to a contract
for the building of a boiler-house adjacent to the new
small-pox hospital at North Brothers Island. Connected
with the boiler house, which is to fuinish steam for
warming the main building, will be a laundry, a kitchen,
and sleeping rooms for the "help." The hospital has
four wards, each having ample space for sixteen beds,
though, in cases of emergency, a third row of eight beds
can be added without any serious overcrowding. It is
proposed soon to erect an administration building,
where the doctors, matron, and trained nurses will live,
and also another pavilion as soon as needed. The hos-
pital cannot be occupied until the heating apparatus is
complete, and the island is supplied with Croton water,
which is about to be done by the Department of Public
Works. With a view to beautifying the surroundings, as
well as to afford future protection to the buildings from
the high winds that occasionally sweep over the island,
one hundred young elms have been planted there, to
which additions will be made at a future time. It is in-
tended to make this spot as attractive as ])ossible to
those unfortunate ones, who, by reason of a loathsome
disease, are involuntary exiles from their friends and
homes.
A Bad Lunacy Bill. — Mr. Austin Abbott calls atten-
tion in the Times to the very bad features of .-Assembly
Bill No. 636, for amending the lunacy laws, — a bill which
has a strong backing. If this bill becomes a law, we are
told that one can be taken and confined in an asylum
upon a certificate made by two qualified physicians
(made without consultation between them), and indorsed
by the approval of only a Justice of the Peace within
the county, in which the alleged insane person resides,
without judicial examination on his part other than of
the contents of the certificate. He "may" take evi-
dence, but is not required to. Upon such a certificate a
person so confined may, without further authority, and at
any time within thirty days, be removed from one asy-
lum, public or private, or home, or retreat to another,
and with no restriction against removal beyond the State.
It is easy to im.igine the task which the friends or coun-
sel of a person thus committed in exparte proceedings
would have in endeavoring to trace him from asylum to
asylum, for there is no provision for any public record
of the proceedings.
The French Associ.ation for the Advancement
of Science, of which there is a medical section, meets
this year at Rouen, August i6th to 23d.
A Medical Fraud Exposed. — The Therapeutic Ga-
zette has with great completeness exposed the fraudulent
character of ''a retired missionary, returned from South
America, whose sands of life had nearly run out ; " but
who had sufficient vitalit)- to put on the market a precious
specific for erring but noble young men. It cost, says
the Gazette, about two cents a box, and it was selling
for $3.50.
Ho.vio Nevadensis. — California scientists are serious,
says The Times, in their speculations concerning the so-
called fossil human footprints found in the sandstone of
Nevada, near the State prison quarry. Dr. Harkness,
the explorer in these footprints, is confident that he has
discovered a new species of the genus homo, and he sub-
May 5, 1883.]
THE MEDICAL RECORD.
495
niits the following description of his scientific find :
"Homo Nevadensis (Harkness) : Length of track, 18^
inches; width at ball of foot, 8 inches; width of heel, 6
inches; average length of step, 27 inches; length of
stride, 54 inches; width of trackway, 18 inches; angle
with the median line, about fifteen degrees. Each track
is modified in form by a sandal or other protection to
the foot." It has been suggested by rival persons tliat
the prehistoric and giant man was only an early emigrant
to California from St. Louis or Chicago, a foot iSi
inches long being no novelty in either of those cities,
according to their own newspapers.
Dr. George B. H.wvley, seventy-two years of age,
for many years a prominent physician of Hartford,
Conn., died April 19th.
Inspection of the Throat without Instruments.
— Dr. Samuel W. Francis, of Newport, R. I., writes that
very often it is difficult to depress the tongue of a pa-
tient who is sufiering from sore throat, diphtheria, follicu-
lar tonsillitis, or other affections of the fauces, etc., and
suggests that they be told to open their mouth, in front
of a good light, and simply, but with force, say : Arh !
Barrh ! .' Varrrst .' .' ! Life — enunciating each word
some few seconds. Dr. Francis has tried this, and not
only obtained an excellent view, but the different posi-
tions of the uvula and surrounding parts, greatly assisting
the diagnosis and treatment of the disease.
M.D. or M.B., IN Great Britain. — Dr. Parks, of
Ashton, R. I., in an interesting letter commenting on
"Our London Letter," says that the correspondent is
wrong in some particulars as to the mode in which Eng-
lish practitioners are designated. For instance, he says
" only university graduates can call themselves Dr. (M.D.
or M.B.)." This is true as regards M.D. He being
a Doctor of Medicine can call himself Doctor, while the
M.B. being only a Bachelor not a Doctor, can, in com-
mon with all other gentlemen, only call himself Mr. He
also states that physicians are not nearly all graduates,
and do not style themselves Dr. ; the vast majority of
them being licentiates of one or other of the Colleges
of Physicians of London, Dublin, or Edinburgh, and as
such are only enlitled to the designation of plain Mr.
The Nashville Medical Society. — Dr. J. L. Wat-
kins writes that the "parturient stress" is over, and that
this Society is the outgrowth of the late meeting of the
State Medical Society. Its officers are Dr. N. D. Rich-
ardson,/'/vj/Vtv// / Dr. W. J. McMurray, Vice-President ;
Dr. J. L. W'atkins, Secretary and Treasurer. The So-
ciety will meet twice a month, and has every ho|>e and
evidence of success.
Army Sanit.\tion in India. — Dr. Cunningham, in his
report concerning the health of the European army in
1881, says that, although the rate of sickness was high,
the ratio of mortality was less than in former years.
This result he attributes to improved sanitation and
greater attention to the health of the soldiers. The
largest number of deaths occurred from enteric fever ;
cholera ranks second. In Bengal the rate of mortality
from enteric fever was 2.62 ; Bombay,2.83 ; and Madras,
0.58 per thousand.
The Bacillus of Tuberculosis. — In the Central-
blatt far Klinische Medicin, .\\m\ 14, 1883, Fincklerand
Eichler express the opinion that other bacilli than the
tubercular, stain blue, and do not yield the color to
nitric-acid washing ; that the bacilli of tubercle ofi'er
greater resistance to the reagents than do other micro-
organisms ; that nitric acid may so completely remove
the color that pure water will not restore it, however pro-
longed the bathing ; and finally, that the claim that Bis-
niark brown does not aftect them is not strictly accurate.
Chloroform in Midwifery. — Dr. Fancourt Barnes,
in the British Medical Journal, expresses the opinion
that the reason why chloroform is so well borne in mid-
wifery lies in the condition of the heart during pregnancy,
namely, that of hypertrophy, developed during gestation.
Absence of the Characteristic Eruption in Ty-
phoid Fever. — Dr. Whipham, of London, related at a
late meeting of the Clinical Society two cases of
typhoid fever in which there was found, at autopsy, the
characteristic intestinal lesion, but the typhoid eruption
was not found ; on the other hand, an eruption was pres-
ent which resembled that of scarlet fever. He does not
object to the view that scarlet fever and typhoid fever
are frequently concurrent.
Corrosive Subli.m.\te as an Antiseptic in Mid-
wifery.— Dr.Tarnier reconniiends that the genital region
be washed and injected with corrosive sublimate (i to
2,000) and that the mattrasses and napkins be disinfected
by the same fluid, during the process of labor.
The Independent Practitioner.- — Dr. Leigh H.
Hunt has resigned the editorship of this journal.
Royal College of Surgeons. — At the recent pass
examination for the diploma of membership, the candi-
dates were given two hours in which to answer three out
of four questions in midwifery and diseases of women.
One of the questions was as follows, and evidently it was
sufficiently broad to occupy one-fourth of the time allot-
ted : "In what circumstances is the operation of crani-
otomy indicated, and how would you complete the deliv-
ery when the head has been perforated ? "
^U-uu-ius and Uoticcs.
Lectures on Orthopedic Surgery and Diseases of
the Joints. By Lewis A. S.a.yre, M.D. Second
Edition, pp. 569, with 324 illustrations. New York :
D. Appleton & Company.
The first edition of this work has been before the pro-
fession since 1876, and has been considered, as it pur-
ported to be, a record of the views and procedures
advocated by its author, rather than a critical review
and resume of all the ijrinciples and practices comprised
in orthopedic science. The edition just issued pos-
sesses the same general features and has been enlarged
and more fully illustrated, so that it may be considered
a compenduim of the present views and methods advo-
cated by the distinguished author. -A large number of
illustrative cases are cited, some of the chapters are re-
written and brought up to the present time, and hlty-two
new engravings have been added, so that the work may
be considered as complete. The chapters upon Spon-
dylitis and Lateral Curvature will be particularly wel-
come to the profession at the present tune, as they em-
496
THE MEDICAL RECORD.
[May 5, 1883.
body the views of the author upon the use of the Plaster
Jacket in these affections, and contain many valuable
suggestions regarding its a]3plication and practical uses,
together with a defence of its employment as a method
of treatment. The objections to the jacket are fully
considered and refuted, and the indications for its em-
ployment are laid down with the exactness of experience.
The book contains thirty-two chapters, of winch five are
devoted to the consideration of diseases of the hip-joints,
and a table of seventy-two cases of exsections of the
head of the femur, performed by the author, is added, the
table having been compiled by his son, Dr. L. H. Savre —
the latest operation recorded having taken place in De-
cember, 18S2.
Of Hutchinson's method for the hip, he states, " I
am therefore reluctantly compelled to abandon this plan
of treatment, although, when first proposed, I gave it a
most cordial endorsement before I had any practical
experience with it,'' and cites a case to illustrate the
principles involved.
An illustrated frontispiece, drawn by Dr. Heitzman,
and illustrating a section through an exsected hip joint
during the process of reproduction, is not the least of the
attractive features of the book.
Taken as a whole, the book will prove a valuable ad-
dition to the library of the general practitioner, as well
as the orthopedist, both as a work of reference and as a
guide to the princijjles and practice pertaining to this
much-neglected branch of surgery, and it should meet
with the general commendation it deserves.
A System of Hu.man Ax.m-omv, inxluding its Medi-
cal AND Surgical Relations. B\- Harrison Al-
len, M.D., Professor of Physiology in the University
of Pennsylvania. Section IV., Arteries, Veins, and
Lymphatics. 4to, pp. 45S. Philadelphia : H. C. Lea's
Son & Co. 1883.
Section 1\'. of this admirable work, treating as it does of
the vessels of the body, is of peculiar interest to the prac-
titioner. The author goes over the whole ground with
his usual thoroughness, discussing the various regions not
only from an anatomical, but from a clinical, point of
view. This latter element of the work gives it a unique
and peculiar value, as the subjects discussed are made
of equal interest to the surgeon and jjhysician. The
descri|)tive text is terse and accurate, omitting no detail
and giving due jirominence to important facts, and due
consideration for leading principles. The illustrations,
which show a great improvement over those in the previ-
ous sections, are not as numerous as they might be.
Still the excellent descriptions in the text more than make
up for the deficiency. The illustrations of the venous
circulation are particularly good, and are well colored.
The Medical and Surgical History of the \\'ar of
THE Rebellion, Part iii.. Vol. ii., Surgical History.
Prepared under the direction of Joseph K. Barnes,
Surgeon-General United States .\rmy, and D. ],.
Huntington, Surgeon United States .\rmy. First is-
sue. 4to, pp. 986. \V^ashington : Government Print-
ing Office, 1883.
The present volume completes the surgical series of the
Medical and Surgical History of the War of the Rebel-
lion. Continuing the general scheme of scries, the
treatment of regional injuries of gunshot origin is con-
tinued, leading off with those of the lower extremities.
The succeeding chapter gives an interesting account of
miscellaneous gunshot injuries, then follow facts general
and statistical relative to the nature, peculiarities, and ef-
fects of the missiles and projectiles, and the graver at-
tending complications. Under the latter heading are
considered secondary hemorrhage, erysipelas, pya}mia,
gangrene, and tetanus. The chapter on Aniusthetics in
military ])ractice is an exceedingly interesting and in-
structive one, embodying as it does a wide experience,
under all possible conditions, of surgical operations.
The historical sketch of the medical staff, and a descrip-
tion of the materia chirurgica, give a very fair statement
of the great resources on the field and in hospital which
were so efficiently utilized during the late war. The
methods of field, railway, and water transportation of the
wounded are given in necessary detail, and serve to
prove what can be done in promptly caring for the
wounded, even on the largest possible scale and in the
face of what might generally be considered as insur-
mountable obstacles. The particular value of this noble
volume to the general surgeon centres more particularly
in those portions which treat of the result of gunshot
fractures in the lower extremities. Under the respective
headings of injuries to hip, thigh, knee, leg, and foot, are
grouped a mass of facts concerning the characters of
fractures in these localities, their methods of treatment
and results, the accuracy and value of which cannot be
overestin)ated. The painstaking accuracy with which
the various facts of history are summarized, and the de-
ductions which are drawn therefrom, reflect the highest
credit upon the accomplished author of the present vol-
ume. Here come in also the discussion of amputations
in all situations and under all conditions, giving the re-
sults in a mass of statistics, the value and accuracy of
which have never before been equalled. The careful
study of these statistics will serve to settle many facts
heretofore in doubt, and will mark the value of new lines
of practice which must always redound to the credit of
American surgery. It would be useless to attempt to
fornnilate the conclusions arrived at. Such would be
impossible short of noticing each chapter by itself as an
independent volume, for such each chapter could be
consistently considered. The illustrations, i)hoto- and
chromo-lithographic, are fully up to the jjrevious stand-
ards, which is saying everything for them. The wood-cuts
are also admirably executed. I)r. D. L. Huntington, who
has prepared the present volume, has satisfactorily dis-
charged the great responsibility imposed upon him, and
has in every way shown himself the worthy successor to
the late lamented surgeon, George A. Otis, whose name
is also justly and appropriately placed upon the title-
page of this monumental volume.
Labor A.mong Pri.mitive Peoples. Showing the De-
velopment of the Obstetric Science of To-day from
the Natural and Instinctive Customs of all Races,
Civilized and Savage, Past and Present. By George
J. Engelmann, A.m., M.D., Professor of Obstetrics,
Post-Graduate School of Missouri Medical College,
St. Louis. 8vo, pp. 227. St. Louis : ]. H. Chambers
& Co. 18S3.
The second edition of this work conies to us revised, en-
larged, and rearranged. .\s we have already said, it is
one of the most interesting and instructive volumes that
can be placed in the hands of student or practitioner.
It represents an innnense amount of research, which is
utilized in the direction of making this one of the most
practical obstetrical guides ever presented to the profes-
sion. It contains a large number of illustrations, repre-
senting the natural and instructive customs of the primi-
tive races during the parturient act. The medical man
who studies nature as he finds her will gain many a use-
ful hint by the perusal of Dr. Engelmann's entertaining
history.
Hand-Book. of X'ertebrate Dissection. By H. New-
ell Martin, D. Sc, M.D., and William .-V. Moall,
M.D. Part II. How to Disseci' a Bird. Pp.
174. New York : -Macmillan & Co. 1883.
In reviewing Part I. of this series we commented upon
the object aimed at in them. The present volume is
equally good with the first, and was, i)erhaps, still more
needed. The directions are carefully given, anil the
illustrations, though not numerous, are sufficient.
May 5, 1883.J
THE MEDICAL RECORD.
497
^Icpovts of s^ocicties.
THE PRACTITIOXKRS' SOCIETY OF NEW
YORK.
Slated Meeting, April 6, 1S83.
James B. Hunter, M.D., President, in the Chair.
Dr. Beverly Robinson presented to the Society a
case of
LARYNGEAL PARALYSIS, ILLUSTRATING ALSO SYPHILIZA-
TION BY bock's METHOD.
The patient was a German, aged forty-two, and had
lived in Copenhagen. Twenty-five years before he had
contracted a chancre, which appeared about ten days
after coition. About three weeks later, an eruption on
the body appeared. He went to Professor Bock's hos-
pital, and was put under treatment. He was first inocu-
lated in three places on the chest with syphilitic virus ;
six days later the vaccination was repeated ; it was then
repeated every third day, three vaccinations each time.
They were made upon the chest, arms, and legs. Grad-
ually the inoculation effects became weaker, and finally
the virus produced nothing but a superficial scab. The
whole process lasted about three and one-half months.
During that time he was obliged to lie flat on his back ;
he suffered intensely and would not, he said, "go through
it again for a million dollars."
Since that time, however, he had been perfectly well,
and had never noticed any symptoms of having syphilis,
although he had taken no medicine. He had married,
and his wife had had several healthy children and no
miscarriages.
As regards the throat trouble, examination showed that
the fauces are intensely congested and marked by a large
number of varicose veins. The uvula large, infiltrated,
and evidently quite relaxed. The epiglottis was red ; the
posterior third of the true vocal cords had a pink colora-
tion.
In phonation, the free margin of the left vocal cord
presented a half oval excavation very appreciable to the
eye, as reflected in the small laryngeal mirror. This ex-
cavation was probably due to paralysis of the tensor mus-
cles on the same side of the larynx.
The interesting feature, said Dr. Robinson, in the case,
to be determined, beyond the fact of the patient being a
notable example of Professor Bock's plan of treatment,
is whether or no the intra-laryngeal paralysis be proof of
a syphilitic deposit, possibly of gummatous nature, in the
intrinsic muscles of the vocal organ.
In view of the limited localization of the paralysis, of
the man's general excellent physical condition, and of
his inability to recognize elsewhere any pathological
lesion capable of explaining the localized laryngeal pa-
ralysis, the speaker was of the opinion that this must be
received as the most probable explanation, and, notwith-
standing the fact that the patient had only had few and
very mild symptoms at any time, of constitutional syph-
ilis.
Dr. Samuel Sexton read a paper, entitled :
EARACHE IN CHILDREN.
[The paper is published in full on page 480.]
The paper being open for discussion, Dr. R. F. Wkir,
referring to the question of paracentesis for the relief of
pain in acute otitis media, said that, in his experience,
the external canal often became swollen and paracen-
tesis was a difficult and painful process. It was better,
as a rule, especially in children, to let the drum alone.
In adult subjects he performed the operation oftener.
For the pain he used morphine and atropine, with in-
jection of hot water, pouring the water into the ear — not
syringing it. He had abandoned the use of leeches, for
the reasons given by Dr. Sexton.
Dr. Beverly Robinson had seen relief from the ap-
plication of leeches in children, when nothing else did
any good. He had also seen a great deal of relief from
the application of the continuous douche. In some in-
stances he had seen salicylate of soda in large doses re-
lieve aural pain.
Dr. Kinnicutt said that his experience was con-
firmatory of Dr. Weir's. In the earache of children the
simple pouring of hot water into the ear would often
suffice, the child falling asleep during the process.
Dr. Abbe frequently used the old-fashioned remedy
of laudanum on cotton, and it was generally satisfactory.
If necessary, he gave an anodyne internally.
Dr. Sexton said that he very seldom had to use an-
odynes to children, but often gave them to adults to
bridge over the night. He thought that large doses of
narcotics tend to make the trouble worse sooner or later.
Warm water was often beneficial, but if poured directly
down upon the drum-head it might do harm, and hot air
(from hot salt or sand-bags) would accomplish just as
much.
Dr. Nicoll had obtained very satisfactory results
from the use of hot water in the shape of the douche.
Dr. Walker spoke of the relief sometimes obtained
with adults by shutting the mouth, holding the nose, and
making a forcible exi)iration so as to drive the air into
the middle ear. Good effects were observed also by the
reverse method, making an inspiratory movement so as
to suck the air from the tubes.
Dr. Sexton said that this latter process had often to
be done methodically by adults in order to clear up the
ear. It was often supplemented by swallowing at the
end of the inspiration.
Dr. a. a. Smith had been in the habit of using warm
douches, and the application of heat in the form of hot
salt bags. He frequently found it necessary to give in
addition a full anodyne. In one case he had blown
chloroform vapor into the ear with good result.
A discussion was opened by the Society upon the
paper read by Dr. Beverly Robinson, entitled
note on RAPID OR SUDDEN HE.^RT-FAILURE IN ACUTE
infectious disease, notably in DIPHTHERIA AND
TYPHOID FEVER.
[The paper is published in full on page 484.]
Dr. H. F. Walker had had cases similar to those de-
scribed by Dr. Robinson, especially cases of diphtheria.
His patients, however, had never been completely out
of danger. In a case of diphtheria, the patient had
reached the ninth day ; he was doing well in the morn-
ing, at night he was dead. In another case death was
still more sudden. There seemed to be heart paralysis,
but no post-mortem was made.
Dr. F. P. Kinnicutt, said that in the various acute
infectious diseases, in diseases accompanied by high
temperature, as well as in pericarditis and endocarditis,
pathological research has demonstrated the very frequent
existence of a parenchymatous myocarditis. The in-
flammatory process may be diffused or circumscribed ;
the cardiac muscle becomes swollen and pale in color ;
numerous minute granules, partly soluble in acetic acid,
make their appearance in the muscular fibre, the trans-
verse strias become indistinct and finally disappear.
This process may proceed to a condition of true fatty
degeneration.
In typhoid fever we have clinical evidence of the exist-
ence of degeneration of the heart-muscle, in the inijiair-
ment or absence of the impulse and of the first sound
of the heart; and in individuals dying of the disease a
degeneration of the kind which I have described is
found to be the rule. Have we not in this fact a rational
explanation of both the gradual heart-failure which ob-
tains so frequently in this disease and of the sudden or
acute cardiac paralysis ?
The inflammatory affection of the muscular fibre is
necessarily attended with more or less dilatation of the
498
THE MEDICAL RECORD.
[May 5, 1883.
heart ; a sudden movement or unusual exertion may well
be sufficient to produce a correspondingly rapid in-
creased dilatation with fatal syncope. In diphtheria, a
fatal heart-paralysis, it seems to me, may be ascribed, in
a certain number of cases, to a like pathological process ;
in others, to a parah'sis referable to a lesion of the
nervous system. To the latter class are especially to be
referred those cases of sudden death occurring during
apparent convalescence from the disease.
Dr. C. I.. Dana said that the French observers had
recognized the fact that in acute infectious disease the
poison sometimes especially attacks the heart. In the
descriptions of typhoid fever a " cardiac form " had been
described.
Sudden deaths from heart-failure, in persons apparently
doing well, occur also in other diseases, as in acute
nephritis and in pneumonia. The speaker had seen
instances of this kind.
Dr. Robinson said that in typhoid fever we lind
granular and fatty degeneration of the heart, but he had
not observed that this degeneration was any more
marked in persons who had all along had symptoms of
cardiac weakness than in others who did not die directly
from heart-failure.
x\EW YORK PATHOLOGICAL SOCIETY.
Stated Meeting, March 28, 1S83.
George F. Shrady, IM.D., President, in the Chair
(Continued from p. 443.)
Dr. G. L. Peabody presented on behalf of a candi-
date a specimen oi fibroma of the sciatic nerve.
He also presented specimens illustrating
THE lesions in syphilis of the brain, lungs, and
KIDNEYS.
"The patient, an Englishman, fifty-five years of age, first
consulted me in January of last year. He was a drinker
of beer and a smoker, whose general health had always
been good. Three years previously he had had a chancre
followed by a rash upon the body, soreness of the throat,
falling out of hair, pain in the crests of the tibiae and
other manifestations of syphilis. At the time of his in-
fection, and subsequently up to the present, he says he
has had no treatment for his malady, nor has he felt much
need of relief. Ten days before consulting me he had a
sudden sharp pain m the head posteriorly on the right
side. It soon left this side and went to the left occipital
region when it persisted obstinately. This was also ac-
companied by a severe sore throat. The i)ain in the
head was much aggravated by the recumbent position and
deprived him of sleep, except such as he could enjov in
the sitting posture. At this time there was also marked
loss of power on the right side, notably in the right hand,
but also, though to a less extent, in the right leg and
thigh. He complained also of a sensation of formication
in both extremities on this side. I examined the fundus
of his eyes at this time with the ophthalmoscope and
found it normal on each side. The tendon retlex was
normal on both sides.
" Under the use of iodide of potassium in increasing
doses — a drachm and a half three times a day having
been finally reached — all these distressing symptoms grad-
ually passed away and he was able to resume his work. I
cautioned him at this time never to neglect the warning
which a recurrence of any of these manifestations ought
to convey to him. Late in May he again jjresented
himself for treatment in precisely the same condition in
which he had been when he first came under observation,
except that the pain in the left occipital region was more
severe than before. My warning had not been regarded,
and his pain had returned two weeks before his coming
this time to me.
" Iodide of potassium was again faithfully tried, but
without avail, even in the same large doses as before.
After some days he was given mercury in combination with
it, and then he began again slowly to improve. Conval-
escence this time was much more tardy than before, and,
in fact, it was nearly two months from the beginning of
the second attack until he was entirely free from pain.
He did recover, however, completely, so far as his sub-
jective symptoms are concerned. His wife tells me,
however, that he became morose and sullen and con-
tinued so as long as he lived.
" I again warned him as before, not to allow any such
symptoms, should they recur, to go a day untreated ; and
he promised, as before, that my warning should not be
disregarded.
" About the end of August he was again attacked in a
similar way, and he again neglected to apply for relief
until his symptoms had existed two weeks. This time
they seemed more severe than ever before, though the
pain, however, was on the right side. It was described by
him as a sharp pain, very severe, diffused over the posterior
part of the right side of the head. Forcible palpation
and gentle percussion over the head in this situation give
him much pain. He was at this time distinctly, though
to a slight extent, hemiparetic on the left side.
"The glands in his groins were slightly enlarged and
the crests of the tibia; were slightly roughened. This
time, in my absence from town, he was treated by a col-
league by iodide of potassium, but in smaller doses than
those to which he had been accustomed. The largest
amount given in any one day was a hundred and twenty
grains divided into three doses. Opium, morphine, and
bromide of potassium were also administered at times to
relieve his pain, which was even more severe than usual.
" Having been very apathetic at first, he soon became
dull and stupid. In a few days stupor deepened into
coma ; he became unable to take his medicine ; coarse
rales were heard over his chest ; he coughed a little in
his comatose condition and his temperature began slowly
to rise. His pulse and respiration soon became rapid ;
and, nine days after he had coine under observation, he
died with a temperature of 107°, having been comatose
during the last three days of his life.
" I made the autopsy twenty hours after death. The
calvaria was observed to be unusually thin. The convo-
lutions presented the usual appearances of senile atroi)hy,
the fissures beneath them being deeper and wider than
in middle life, and there being a large amount of serum
in the meshes of the pia mater in these situations. The
arteries at the base showed a few small patches of athe-
roma. In the fissure of Sylvius on the right side was a
thin yellowish mass surrounding the middle cerebral
artery, extending about one-third of an inch along the
vessel. The thickness of this mass was nowhere as great
as the diameter of the vessel itself, but it was quite evi-
dent that the calibre of the vessel had been reduced by
the pressure thus exerted. The corpus striatum on this
side was distinctly softened, and in this situation the roof
of the ventricle was loosely adherent to its floor. I
" The microscopic examination of sections made through
the middle cerebral artery and the surrounding mass is
of considerable interest. The yellow-ish mass is found to
be partly in the adventitia of the vessel and partly ex-
ternal to it. In the adventitia it presents the appear-
ance of a densely aggregated mass of small round cells
with a small amount of fine fibrous stroma between them.
External to this the material presents a granular and
amorphous appearance.
"Within the vessels in these sections is also seen a new
growth — a somewhat cresccntic-shaped growth — of con-
nective tissue from the intima. This is a good illustra-
tration of the form of endarteritis obliterans, which was
formerly ascribed only to syphilis. It is now know-n to
occur under various other conditions. I have myself
found it in tiie cerebral arteries in subjects in whom there
was no reason to suspect syphilis, as well as in syphilitics,
though less frequently. I have also found it in the arte-
May 5, 1883.]
THE MEDICAL RECORD.
499
lies of the kidneys in chronic diffuse nephritis, and in tlie
lungs in chronic phthisis when no indication of syphiHs
existed. Recently I have found the same form of endar-
teritis in two mahgnant tumors, both epithehomata, the
one of the tongue and the other of the antrum. The
lungs of this subject presented several small syphiUtic
growths surrounded by areas of catarrhal pneumonia.
The right kidney contained on its surface a similar growth,
liotii kidneys showed the lesions of diffuse nephritis, not
f;ir advanced.
" I place under the microscope sections of the mitldle
cerebral artery surrounded by the gummy growth, and
showing in its interior the lesion of endarteritis obliterans
in two places; also a section through one of these
growths in the lungs, together vvith the zone of pneu-
monia surrounding it.
" The special interest in this case is in the coincidence
of these two cerebral lesions at the same point in the
course of an important artery. I do not think that either
one alone would have interfered with the blood-supply
sufficiently to jjroduce cerebral softening and death, but
together their influence could not be long withstood."
Dr. Van Santvoord presented
A UTERUS UNICORNIS
removed from the body of an infant seven months old.
The organ was conical in shape, and on the left side the
Fallopian tube and the ovary presented a normal ap-
pearance. On the right side the ovary was located in
the right iliac fossa, and the Fallopian tube was corre-
spondingly displaced outward, and terminated in a club-
shaped, fleshy mass, one-fourth of an inch in thickness at
its extremity, which extended toward the uterus and
gradually lost itself in the broad ligament just at the
upper end of the cervix. There was no opening in the
uterus corresponding to the Fallopian tube on the right
side, although the tube itself was pervious. The club-
shaped muscular mass represented the right horn of the
uterus. There was no septum in either the cervix or the
vagina.
SUBPERIOSTEAL HEMATOMA.
Dr. Van Santvoord also presented a dried specimen
illustrating subperiosteal hematoma occurring on the
skull of an infant, a foundling in the Randall's Island
Hospital. There was no history. Over the right parie-
tal bone an elastic fluctuating tumor was found, when the
child was first seen, with its edges hard and elevated,
and what felt like a depression beyond the borders of
the tumor. The child died of marasmus when twenty-two
days old.
Dr. Heineman presented a specimen illustrating
cerebral hemorrhage, osteo-fibrom.\ of uterus,
and pyelo-nephritis.
"The patient, aged sixty, was admitted to Mount Sinai
Hospital March 16, 18S3, in a semi-conscious condition.
At eight o'clock in the morning she was found on the
floor of her room with the right side of her body par-
alyzed. She was apparently conscious when found,
though unable to speak.
" On admission patient is inclined to sleep. She can
be roused, but is dazed and yawns. There is slight diffi-
culty in deglutition ; cannot speak, but answers intelli-
gently by a nod of the head after being thoroughly roused.
Has right hemiplegia. Slight systolic aortic murmur.
Arteries slightly thickened. On the succeeding day her
temperature rose to 101° F. There was marked anes-
thesia of right upper extremity ; fingers were flexed ;
there was slight an:esthesia of the right lower extremity.
There was retention with overflow of urine.
"The patient subsequently became more rational, but
did not regain her power of speech ; her paralysis con-
tinued ; her bowels remained constipated ; she passed
urine involuntarily at times ; her axillary temperature,
taken daily, was always slightly higher on the paralyzed
side. Two days before death she began to pass bloody
urine, and with a temperature of 99° F. she continued to
fail, and died Marcli 27th, on the twelfth day of her
attack.
" The autopsy revealed in the brain considerable exuda-
tion of serum beneath the pia matter. Effusion of recently
clotted blood was found in the left corpus striatum and
optic thalamus, the brain-tissue about the clot being soft-
ened. Heart : Slight thickening of aortic and mitral
valves. Lungs emphysematous ; were moderately oedem-
atous and congested. Liver and spleen were normal.
Kidneys: In the left kidney the mucous membrane of
the pelvis was reddened and inflamed and coated with
blood ; the kidney-tissue was atrophied, the pelvis and
ureter dilated. In the right kidney the pelvis was enor-
mously dilated and filled with fluid- blood and urine.
The mucous membrane of the pelvis was coated by re-
cent exudation of fibrin and pus : the calyces were di-
lated, the kidney-tissue atrophied. Bladder : The mucous
membrane was reddened, inflamed, and covered by exu-
dation of fibrin and pus. Uterus : The posterior wall
contained an enormous submural fibroid, which had in-
creased in size so as to completely fill the cavity of the
pelvis. It had undergone calcareous degeneration,
being converted into bony tissue. The uterine tissue
was stretched in a thin layer over its anterior surface.
The cervix was normal, and the ovaries had preserved
their normal relation to the fundus uteri, and were
normal."
Dr. Heineman, on behalf of a candidate, presented a
specimen which showed several Jieedles in the omentum.
Dr. Beverly Robinson presented a specimen, for
which he was indebted to the courtesy of Dr. DeWitt C.
Romaine, who also gave the following history and re-
marks :
placenta weighing three pounds immedi.4telv after
expulsion.
" The patient was born on an English vessel in the
Atlantic Ocean, thirty-two years ago. Her previous his-
tory presented some points of unusual interest. Dur-
ing her girlhood she had always been delicate, was
easily fatigued, suffered much from intense headaches,
pains in her back, loins, and thighs ; had a constant pro-
fuse leucorrhceal discharge, but never menstruated. Her
mother, becoming alarmed at the absence of this function,
consulted many physicians, who prescribed iron, quinine,
and various other tonics, but all to no purpose. Al-
though having never experienced a single monthly flow,
she married at the age of nineteen, and bore her first
child one year later, the weight of which was pronounced
by the attending physician to be twelve pounds. Several
months after this birth, the patient noticed that her
leucorrhojal discharge increased in amount, once monthly,
emitted an exceedingly offensive odor, and, as it issued
from the vulva, presented a rust-colored appearance.
These peculiar discharges occurred during a period of
about eight months, when she again became pregnant,
and was delivered in due time of her second child, whose
weight, she says, was fifteen pounds. A third, fourth,
fifth, sixth, and seventh birth occurred at intervals of
little more than one year, the product of each being un-
usuallv large children. Her eighth confinement took
place in November, 1881, when Dr. Romaine dehvered
her of a still-born child in an advanced state of putre-
faction, the weight of which, taken immediately after
birth, was ten pounds. Following this birth there was a
period of seven months during which the patient en-
joyed fairly good health, and the last four months of
which she had a regular monthly flow having a duration
of three davs. This, she said, was the first time in her
life that she' had her courses as other women have them.
She again became enceinte, for the ninth time, and was
delivered by Dr. Romaine of her ninth child, with the
forceps, March 23, 1883. The weight of this child was
seven pounds, while the secundines, immediately after
expulsion, weighed three pounds.
500
THE MEDICAL RECORD.
[May 5, 1883.
'■^Remarks. — The case is interesting with reference to
four points :
" First. — Postponement of menstruation until several
months after the birth of the first child.
" Second. — Menstruation occurring only twelve times in
twelve years.
" Third. — Birth of nine children during a period of
twelve years.
"Fourth. — Placenta weighing three pounds while cliild
weighed but seven pounds."
STRICTURE OF THE URETHRA CHRONIC DIFFU.SE NETH-
RITIS.
Dr. Ferguson presented specimens accompanied bv
the following history : The patient was a male, forty-four
years of age, a native of the United -States, and a book-
binder by occupation. He had a stricture of the urethra
for twenty years, for the relief of which he was operated
on, by perineal section, four years ago. The wound
never healed completely, and since that time he had re-
tention of urine several times, symptoms of cystitis, and
all the urine passed through the fistula which remained
open after the operation. He was admitted into the
St. Luke's Hospital on January 29, 18S3. One month
previous to this date he had several attacks of paroxysmal
dyspnoea which were relieved by treatment.
On admission he had marked dyspnoea and cedema of
the legs. Urine was 1.016, alkaline in reaction, and
contained ten per cent, of the column of albumen. He
was put on milk diet, acetate of potassium, and digitalis.
He improved slowly and left the hospital much bene-
fited by his treatment, passing sixty ounces of urine a
day, on February 26th. He was readmitted on March
15th. He said soon after his return home the cedema
reappeared, his urine became scanty, and he suffered
from dyspnoea, constipation, and dyspepsia.
His urine at this time was 1.014 in specific gravity,
alkaline in reaction, and contained thirty per cent, of
albumen and many pus-cells. Treatment did not relieve
his symptoms. On the iSth he showed evidence of
mental derangement. Urine continued scanty and con-
tained a large amount of albumen.
He failed gradually and died on March 27th. During
the last week he was often delirious, both during the day
and night. Toward the close pulmonary cedema devel-
oped, and he was comatose for several hours previous to
his death. His temperature was always normal, his pulse
114, and respiration 32 per minute.
Autopsy on March 28, 1883. The vessels at the base
of the brain were thickened, the brain was anaemic but
otherwise normal. There were thirty-eight ounces of
serum in the right pleural cavity, and eight ounces in the
left. The heart was moderately hypertrophied. The
lungs were congested and intensely cedematous. Kid-
neys : The right kidney was normal in size, its surface
was granular, marking indistinct, and much fat in the
convoluted tubules. The left kidney weighed only one
ounce. Its surface was granular, both cortex and pyra-
mids markedly atrophied and cystic. There is a close
stricture of the left ureter, which admits a probe
not quite one-sixteenth of an inch in diameter. The
ureter above the stricture is moderately dilated. The
right ureter is normal. The bladder is enormously
hypertrophied and distended. Tiie prostate gland is
moderately hypertrophied. There is a stricture at the
bulbo-membranous junction which does not admit the
passage of any instrument, .interior to this stricture
the mucous membrane of the urethra is rough in places,
and at certain points in the course of the tube its calibre
is slightly narrowed. .At a point one inch posterior to
the stricture there is an opening in tlie floor of the uretiira
through which a probe passes downward and forward
through the perineum. Externally this fistulous opening
is at the junction of the scrotum and perineum, and ad-
mits a probe one-sixteenth of an inch in diameter.
The Society then went into executive Session.
(CoxTCspoiuU-ncc.
OUR LONDON LETTER.
(From our Special CoiTespondent.)
THE CONTAGIOUS DISEASES ACTS AND THEIR REPEAL
DR. FARR REVlfARDS TO MEDICAL MEN MR. SPENCER
WELLS OCCLUSION OF CEREBRAL VESSELS BY OIL.
London, April 21, 1883.
A bomb-shell has fallen among the ranks of those who
support the Contagious Diseases Acts of 1866 and 1869.
Mr. Stansfeld's motion in the House of Commons last
night, to the effect that the House disapproved of the com-
pulsory enforcement of the .Acts, was carried by a majority
of 72 — the numbers being, for the motion, 182 ; against,
no. Such a large majority could scarcely have been an-
ticipated, even by the most sanguine enemies of the Acts,
but the fact of the (Govern ment being divided in opinion
amongst themselves probably gave considerable encour-
agement to the abolition party. Mr. Gladstone was not
present, but his son (Mr. Herbert Gladstone) voted with
the majority. None of the medical members spoke on
either side. .As a body, the profession is certainly in
favor of the Acts as they now stand, on the ground that
they have undoubtedly lessened disease. A few medical
men are against the .Acts, and of late public opinion has
been growing against them, chiefly on moral grounds. The
various religious organizations have done a good deal to
foment an agitation against them. Many army surgeons
and chaplains are of opinion that not only are the Acts
hygienically satisfactory, but that they have actually less-
ened imnioralitv in the districts where they are in force,
especially juvenile prostitution. The opinion of the
House of Commons as expressed last night is doubtless
the death-knell of the Acts, at any rate in their present
form. Legislation is slow in this country, so a change
in the law is iiardly to be expected this session, which is
perhaps fortunate, as it will give time to members to con-
sider the subject more carefully. It is satisfactory to find
that the Acts have, in general, been carried out carefully,
and without any of the brutalities of which the French
police have been guilty. Some of the latter, described in
this month's number of the Westminster Review, are pos-
itively sickening.
Death has again been busy amongst us. One of its
latest victims is Dr. William Farr, who has just died at
the ripe age of seventy-five. In him has passed away
one who may justly be described as the founder of our
present system of "' Returns by the Registrar-General."
The importance of this work it would be difficult to ex-
aggerate. .Almost all our present knowledge of vital
statistics is due to Dr. Farr. Our insurance companies
owe him an immense debt of gratitude, for he placed no
key upon his knowledge, but the results of his enquiries
were published for the free use of ail, and from the infor-
mation supplied in Dr. Farr's tables many of them have
constructed their scales. The head of the statistical de-
partment, he was for many years regarded as the virtual
" Registrar-General," the latter post being merely a sine-
cure, and when a few years since the post became vacant,
and Dr. Farr applied for it, loud and widespread was the
indignation amongst the profession that Dr. Farr should
be grudged his well-earned reward. The office was be-
stowed on a political puppet, and Dr. Farr retired from
the work which he had founded and successfully carried
on for so many years. The only honor lie ever received
was a paltry C.B., a dignity wliicli, wlien bestowed, sel-
dom leads to anything higher. Dr. Farr was not merelv a
government official ; lie was in early life a journalist and
contributed several papers to the literature of hygiene. .\
testimonial was got up by public subscription and presented
to him on the occasion of his retirement from public life.
Curiously enough, in the very week of his funeral a
discussion on rewards for public services has been going
on in the Houses of Parliament, the occasion being the
May 5, 1883.]
THE MEDICAL RECORD.
501
Egyptian campaign and its leaders. The profession has
always complained of imperfect recognition, and when as
now, a medical man receives some honor or reward it is
usually the case that the favored recipient is the holder
of some Court appointment, and is thus brought into
contact with those who prefer a medical attendant with a
handle to his name. Such is the case with Mr. Spencer
Weils, who has just received a baronetcy. Mr. Wells is
now President of the English College of Surgeons, and no
one will grudge him his reward for much good work in
the past. It is, however, a significant fact that he is also
Surgeon to the Queen's Household.
At the last meeting of the Pathological Society, Dr.
Handfield Jones exhibited some microscopic specimens
which e-xcited some interest, and to examine which a
special connnittee has been appointed. They seemed to
show that atheroma of the larger cerebral vessels may
lead to blocking of the smaller, by globules of oil.
OUR PARIS LETTER.
TYPHOID FEVER RESTRAINT UNDER PRETENCE OF I.\-
SANITY.
(From our Special Correspondent.)
Paris, .April 13, 1SS3.
The long and yet inexhaustible discussion on typhoid
fever at the Academy of Medicine has at last been
brought to a close, but before it was so it had merged
into a war against microbes, and in the tmlie poor M.
Pasteur was rather severely handled. Professor Peter
led the attack and contested the correctness of M. Pas-
teur's views respecting his inoculation for the mitigation
or prevention of certain diseases, as they were performed
under circumstances so different and on animals so dis-
semblable in their nature. Moreover, they could not
stand the test of clinical experience in human medicine,
whatever may be the results among the lower animals.
Even among the latter, he said, it was questionable
whether inoculations as practised by M. Pasteur were of
any real value, as, to acquire a certain amount of innnu-
nity, it was necessary that the inoculations should be
performed at short intervals, and during the whole life-
time of the subject. Besides which. Professor Peter did
not believe that the microbes were the real agents of
disease ; that is, they had no pathogenetic power uiherent
in themselves, but that they were the simple vehicles of
virulent or mfectious diseases, so that the same microbe
may transmit different diseases in passing from one or-
ganism to another. M. Bouley, the eminent Professor
of Veterinary Medicine, stood up as the champion of
Pasteur's views, and although he was most eloquent in
his response to Professor Peter, yet it cannot be said
that his arguments were sufficiently convincing, and the
Academy, weary, no doubt, of the interminable discus-
sion on typhoid fever, has appointed a commission to
formulate conclusions, which simply means they have
had enough on the subject, and I think your readers too.
In continuing their researches on the inherent proper-
ties of oxygenated water, or the peroxide of hydrogen,
on the animal organism, which has been proved to
possess antifermentative or antiseptic properties, MM.
Paul Bert and Regnard lately submitted a paper at the
Biological Society, demonstrating the action of oxygen-
ated water on albuminoid substances, and found that
when shaken together with the white of egg the latter
becomes incoagulable by heat, but retains its coagula-
bility by the other agents of coagulation. The sub-
stance thus formed constitutes a variety of albuminose,
which behaves like albumen, but only in a minor de-
gree. The same result is obtained with the albumen of
the blood. In treating fibrin with oxygenated water, the
new substance becomes incoagulable by heat or nitric
acid, but coagulable by the other agents of coagulation.
This, then, is a new modification of albuminoid sub-
stances, and the authors expressed a hope that these re-
sults will induce chemists to make further researches and
be able to explain the different properties of albuminoid
substances, which will prove of great value in the diagno-
sis and therapeutics of certain affections.
A recent "cause celebre" of illegal or unjustifiable
" sequestration " has created some sensation in this coun-
try, on account of a young lady who was removed by
force from her own home and placed in a " Maison de
Sante," or private asylum, under the pretence of insanity,
to which effect a certificate was given by an ordinary
physician. The case was brought before the police
court, and Dr. Legrand du Saulle, one of the leading
alienists of this country, was directed to re-examine the
presumed lunatic. The purport of Dr. Legrand du
SauUe's report did not quite refute the tenor of the
medical man's certificate, but he asserted that, although
the mental condition of the patient was below the nor-
mal, yet it did not necessitate her being removed to a
lunatic asylum. The young lady was in consequence set
at liberty and the charge of illegal sequestration was
brought against those who were concerned in the act.
The medical man who signed the certificate was severely
reprimanded for having acted with such levity, as the
certificate was granted only on one visit, which lasted
but a few minutes. The principal agents have been re-
manded for the Court of Assizes, as sequestration is con-
sidered not a misdemeanor but a crime, the police court
being therefore incompetent to give judgment in the
case. This unsatisfactory state of things drew the atten-
tion of the authorities to the law of 183S, which is con-
sidered very defective. .According to this law any citi-
zen, on the simple certificate of a physician, whether he
be the regular medical attendant or not, may be confined
in a mad-house. It is said that the tenor of the law
referred to gives the doctors too great latitude, as the
power thus vested in them may be abused. No doubt it
has been, as in the case under notice, and will be again,
but it is the opinion of some alienists, that however lax
that law may appear, yet it is not sufficiently rigid, as
there are a great number of lunatics at liberty whose
place would be better in an asylum. Dr. Legrand du
Saulle, a high authority on the subject, has calculated that
there are twelve hundred lunatics who go about the streets
at the present moment, and in a very interesting work by
the same author he made the startling statement that
three-fourths of those who spoke at public meetings, par-
ticularly of a political character, were not of sound mind.
For instance, a great number of the " communists "
were insane or on the border-land of insanity, as shown
by their acts, and whether insanity is contagious or not,
there can be no doubt that, judging from recent events,
there are other people besides French communists or
anarchists who are manifestly affected with the malady.
In connection with the above I may mention that Dr.
Legrand Du Saulle has been appointed principal physi-
cian to the infirmary for lunatics attached to the Prefec-
ture of Police, in the room of Dr. Lasegue deceased.
This infirmary is intended for the reception of people out
of their mind, whether they are really or only susjsected to
be so. Here they are detained for twenty-four hours, during
which time they are visited by the physician and disposed
of according to circumstances. It appears from a report
lately published that, on an average, there are three thou-
sand individuals who are annually taken to this infirmary.
An.«STHESIA FROM GALVANIZATION OF THE SUPERIOR
Laryngeal Nerve. — Brown-Sequard states that it is
sometimes possible to produce complete general anaes-
thesia by galvanization of the superior laryngeal nerve.
In the anesthesia as produced in a dog, irritation of the
brachial plexus elicited no expression of pain. Another
effect of galvanization of this nerve is an extraordinary
acceleration of the respiratory movements. .At the
moment of the irritation of the nerve, the respiration,
which was calm and slow, counting about 12 to the
minute, suddenly rose to 120 or 130 respirations ])er min-
ute.— La Tribune Me'dicaU, March 11, 1883.
502
THE MEDICAL RECORD.
[May 5, 1883.
3^vm-Q miA '^iivv^ 3tc\us.
Official List of Changes of Stations and Duties of Officers
of the Medical Department, U?iiied States Army, from
April 21, 1883, to April 2%, 1883.
Cleaky, Peter J. A., Major and Surgeon. So much
of par. 10, S. O. 273, November 23, 1S82, from this
office as directs him (then captain and assistant suigeon)
to report in person to the Commanding General, De-
partment of Dakota, is revoked, and upon the expiration
of his present sick leave of absence, to report- in person
for assignment to duty in the Department of the Missouri.
S. O. 95, A. G. O., April 25, 1883.
Hopkins, Wm. V,., First Lieutenant and .A.ssistant Sur-
geon. Now on leave of absence in New York City, to
be relieved from duty in the Department of the East, and
assigned to duty in the Department of Arizona. S. O.
95, par. 7, A. G. O., .April 25. 1883.
Official List of Changes in the Medical Corps of the Navy
for the week ending April 28, 1 883.
Parker, J. B., Surgeon, ordered to the Torpedo Sta-
tion, Newport, R. I., vice Surgeon VVm. J. Si.mon, de-
tached and waiting orders.
Simon, M.H., Passed Assistant Surgeon, detached from
the Naval Hospital, Chelsea, Mass., and ordered to the
Naval Hospital, Yokohama, Japan, vice Passed Assistant
Surgeon C. Biddle, detached and ordered to the Rich-
mond.
Austin, A. A., Passed Assistant Surgeon, from the
Richmond and ordered home.
Bryan, J- H., Assistant Surgeon, ordered to report
May 1 St for examination for promotion.
^^Icclical Items.
Contagious Diseases — Weekly Statement. — Re-
port of cases and deaths from contagious diseases re-
ported to the Sanitary Bureau, Health Department, for
the two weeks ending .May i, 1883 :
Week Ending
>
3
1
*o
c .
f ti
o.S
n
4)
A
%
>
■fe.
s %
n
7;
H
H ' en
U
s 0
m
>
Cases.
Aoril 2J., i88'?
17
13
6 141
7 ''53
5
4
166 51
167' 54
n
May I, 1S83
2
0
Deaths.
April 2\, 18S3
0
I
2
3
20
23
3
4
26 26
22 17
I
I
0
May I, 18S3
0
'
Of the few cases of small-pox occurring this year, an
unusually large proportion have been either of the con-
fluent or hemorrhagic variety, causing a proportionally
large death-rate. Twenty-one cases of typhus removed
from St. Stephens Home up to May ist.
Whole number of deaths reported for week ending
April 2ist, 630, of which 84 were from pneumonia.
Ai.uMNi Association of Bellevue Hospital Med-
ical College. — \\ the annual meeting, held at the Col-
lege on April 21st, the following officers were elected for
the enduing year : President, F. A. Castle (re-elected) ;
First Vice-President, V. P. Gibney ; Second Vice-Presi-
dent, W. T. Alexander ; Recording Secretary, R. Van
Santvoord ; Corresponding Secretary, R. Newman ;
Treasurer, W. H. Katzenbach ; Historian, V. K. Castle.
Managers to serve until 1 884 : J. D. Bryant,'F. A. Cas-
tle, W. A. Ewing, F. E. Hvde, G. R. Kent, W. T. Lusk,
R. Newman, J. R. Taylor, 'C. Terriberry, R. M. Wyckott'.
To serve until 18S5 : E. S. Bunker, L. J. Godon, G.
Griswold, E. M. Lvon, E. A. ^[axwell, J. B. Messemer,
J. J. Van Voorst, W. R. Varick, D. L. Wallace, T. Wilde.
To serve until 1886 : G. W. Bull, T. H. Burchard, V. P.
Gibnev, E. C. Harwood, .\. M. Jacobus, C. A. Leale,
A. V. B. Lockrow, L. H. Sayre. X. A. Smith, L. M. Yale.
To serve until 1887 : W. T. Alexander, F. H. Bosworth,
F. S. Dennis, W. H. Katzenbach, S. N. Leo, J. P. Munn,
L. Putzel, G. H. Sweze)-, R. Van Santvoord, W. G. Wylie.
The Hands and Muscles of Prize-Fighters. — A
trainer and sporting man discusses in the Sun the subject
of prize-fighters' hands: " I have seen, in my experience,
that the smaller the hand, if in i)roper condition, the
more execution it does as a general thing, particularly in
dealing chopping blows. A small, hard hand often cuts
like a knife, whereas powerful, big hands and huge mus-
cles behind them may knock a man down without hurt-
ing him much. And this thing of getting up very big
muscles is liable to be carried to e.xtrenies, and to do
more harm than good. The training and development of
muscle has a tendency to draw up and tighten the sinews,
and to make the muscles act more slowly. What a pugilist
needs is quick, natural muscle, and small, hard hands for
it to punish with. Heenan's hands were of quite a mod-
erate size, and would have been small but for the black-
smithing work he did in his youth. That spread them.
Yankee Sullivan had a very small hand and a small arm,
but there wasn't a wickeder fighter in the world. He
was really an eleven-stone man when in condition, though
he looked like a man of twelve stone. John Morrissey
had a good-sized hand and short arms. But he wasn't
any criterion to go by in any way. Tom Hyer did not
have a large hand in proportion to his size. He was six
feet two inches, you know, in height, one of the niost
formidable-looking men ever seen, and, for his size, his
hand was even small.
" It is a very important thing to get the hands in good
condition before a fight. To do that if they are pulpy
and soft, we sweat them as nuich as possible and rub
them, to work off the superfluous flesh and fatty tissue.
Then, about two weeks before the time for the fight, we
begin pickling the hands. This is deferred as long as
possible because it is a very disagreeable operation. It
gives a very disagreeable feeling to the hands, and if you
incautiously touch your eyes with fingers that are under-
going the pickling process, you will hurt them severely.
The pickle is composed of vinegar, alum, horseradish,
saltpetre, and tan water, all boiled together. When a
man's hands were inclined to be very fleshy, we used to
put in a little copperas also, which cuts down the flesh
very rapidly. That, however, was only in extreme cases.
When a man has come* in from his afternoon exercise,
had his bath, rub down, and supper, then for a while be-
fore he goes to bed he has to sit and soak his hands in a
pot of that pickle, rubbing them hard at the same time.
Soon they get hard and almost as rough as a nutmeg
grater. Once a day is enough. It takes some time after
the operation for the hands to get fleshy and soft again,
much longer than it does to bleach them to a decent
color again."
Bleeding Coup-sur-Coup in Pneumonia. — Not long
ago Professor Hardy, in his clinic at La Charite, pro-
tested against the unreasonable prejudice against all
venesection which has taken the i)lace of its former ex-
travagant adoption. His audience seemed almost aston-
ished at his presenting to them a case in which he had
performed bleeding for pneumonia three times in the
twenty-four hours, and that in the very theatre in which
Bouillaud formerly so warmly advocated the coup-sur-
coup practice, since almost forgotten. The subject of the
case was a man of thirty-seven years of age, of good con-
stitution, and in the enjoyment of good health until four
May 5, 1883.]
THE MEDICAL RECORD.
503
days prior to admission with well-marked signs of acute,
fibrinous, lobar pneumonia of the left side. In presence
■of this case of uncomplicated pneumonia occurring in a
man in the prime of life and of good health, and who
had no morbid antecedents except two similar attacks
some years before. Professor Hardy ordered 400 grammes
of blood to be drawn at once, 400 in the evening, and 300
next morning, so that 1,100 grammes were taken in the
twenty-four hours, and a somewhat abundant epistaxis
followed some time after the last venesection. After the
third bleeding the condition of the patient was greatly
improved. The oppression of the breathing was relieved,
and the cough and expectoration were sensibly modified,
the temperature descending first to 39° and then to 38
Cent. Next day all fever had entirely ceased, the tem-
perature being 36.8°, the pulse 80, and the respiration
18 ; the cough had disappeared, and the expectoration,
which persisted awhile, was white and fluid. The local
signs decreased in like manner, so that on the second
day there scarcely remained a slight dulness and ob-
scurity of respiratory sound at the base, respiration being
quite normal throughout the rest of the lung. This rapid
disappearance of the local signs was, in fact, one of the
mos: special and remarkable facts of the case, when we
remember how frequently such signs are found to persist
for several days after the complete disappearance of
fever and the general symptoms. In this case the disap-
pearance was almost simultaneous; and Professor Hardy
attributes this favorable result to the bleedings practised
after the method of his great predecessor. Hut while
treating the patient in this manner. Professor Hardy had
the case of a colleague under treatment, in which the con-
ditions of the patient's general state and local lesion were
quite different, and in which blistering, Todd's alcoholic
mixture, tonics and reconstituents were the means re-
quired, and were followed by complete success.— ylA'i//-
<:al Times and Gazette.
Diet and Resistances to Infection. — Professor
Feser, of Munich, has been making some examination^
on animals, with a view to establishing the connection
believed to exist between diet and the liability to infection.
In the trials he has made on rats inoculated with the
poison of cattle distemper, he demonstrated the fact tliat
the animals which had been fed upon a vegetable diet
were quickly attacked by the disease, while those which
had been fed exclusively on meat resisted the effects of
the inoculation. In recording this fact, a leading Eng-
lish journal in connection with the European leather
trade, attributes to the greater amount of vegetable diet,
in the shape of bread, beer, etc., taken by wool-sorters
between Saturday and Monday the greater frequency of
cases of outbreak and the aggravation of disease during
this period. We fear that the above theories will not
hold good when widely applied to man.
Experiences of the Naval Medical Department
WITH SOME New Remedies. — In the spring of 1882 the
Bureau of Medicine and Surgery distributed a number of
new remedies to various stations with the request that
they be tried and the results reported. The following re-
port was given regarding some of them by Dr. Hud^jn,
at a meeting of the Naval Medical Society :
Cascara Sagrada. — Dr. Dean, Naval Hospital, Phiki-
delphia, reports : " This is a reliable and unirritating
laxative and cathartic, but the tluid extract is nauseous
and objectionable ; the cordial is, however, much less
so." Dr. (iorgas. Naval Academy, says : " It is a cer-
tain cathartic, and in small doses an excellent laxative.
In a case of chronic constipation in a child of four years
this remedy afforded perfect relief" Dr. Bloodgood,
Naval Hospital, New York, observes : "It possesses un-
doubted virtues as a mild cathartic, and is not of un-
pleasant taste."
Cascara Arnarga. — Dr. Bloodgood has tried this in
several cases of consecutive syphilis, but without any
perceptible results.
Stigmata Maidis. — Dr. Dean reports that this was tried
in several cases of chronic cystitis, and, while they were
not cured, the results were favorable in mitigating the
severity of the symptoms. Dr. Gorgas was able to speak
very highly of it as a demulcent and diuretic. Dr.
Bloodgood states that in cases of acute and chronic cys-
titis its action was not remarkable.
Quebracho . — Dr. Gorgas used this remedy in several
cases of asthma, and in one onlv was there marked bene-
fit, but the relief here was immediate and complete. Dr.
Dean states that temporary relief followed in some cases,
while in others there was no result. Dr. Bloodgood
found that in cases of cardiac hypertrophy, with dyspnoea,
in which it was tried, there was no relief
Piscidia Erythrina {Jamaica Dog7t<ood). — Dr Sud-
dards, Naval Hospital, Norfolk, Va., finds this agent to
be slightly anodyne in its effects in mild cases of neu-
ralgia, and in large doses it produces sleep. Dr. Dean
tried it in three cases in full doses ; no eftect in two, and
sleep induced in the third ; it did not appear reliable as
a hypnotic. Dr. Bloodgood found only negative results.
Verba Santa. — Tried by Dr. Dean in several cases of
chronic bronchitis and asthma, with no decided benefit.
Dr. Bloodgood reports like results in cases of chronic
pneumonia and secondary syphilis.
Manaca. — Dr. Bloodgood states that this was carefully
tried in cases of chronic rheumatism. Full doses pro-
duced severe headache, diarrhoea, tenesmus, and bloody
stools, but there were no beneficial results.
Sanguis Bo7'is Exsiccata. — This was tried by Drs. Dean
and Bloodgood without benefit ; the latter reporting
nausea from it use.
Angina Pectoris Successfully Treated with
Nitro-Glycerine. — Dr. Jacob F'rank, of Buffalo, N. Y.,
relates the history of a married woman, aged thirty-one,
mother of three healthy children, who had for six years
suffered intensely from attacks of angina pectoris. Dr.
Frank does not say whether there was any organic heart
trouble. She was treated with morphine and various
other remedies, but without success. Dr. Frank at first
applied the faradic current over the pneumogastric, and got
relief During the next attack, however, this failed. The
patient was then put upon nitro-glycerine, TIlj. of the
one per cent, solution gradually increased to lUvj., t. i. d. ;
then decreased. The patient has had no further attack.
Dr. Frank writes : " During the course of this treatment
a rather curious phenomenon occurred. After she had
been taking this nitro-glycerine for about six weeks,
aphthje broke out on the tongue, mouth, and fauces.
The medicine was stopped, and these ulcers treated with
borax, etc., after which the treatment was again resumed."
Dr. Frank gives the usual explanation of the curative
action of the drug.
Louisville School of Pharmacy for Women. — Dr.
J. P. Barnum writes us that there is a school of pharmacy
for women in Louisville, and that it is well endorsed, and
has already a fair attendance. He further writes : " The
object of the school is to thoroughly educate women as
practical apothecaries, and by this means open to them
another avenue by which they may obtain a livelihood.
That woman is eminently fitted for this business the
writer can testify from personal experience, having made
the practical test in his own business. He has found
female assistants equal to those of the other sex in every-
thing except physical strength, while they are very far
superior in delicacy of manipulation, accuracy, and neat-
ness in a multitude of details, which tend to make the
prescription either attractive or unpleasant to the eye, and
agreeable or nauseous to the palate of the sick."
The Treatment of Erysipelas with White-Lead
Paint. — Dr. William W. Reese, Brooklyn, N. Y., writes :
" A note on page 420 (from The Lancet) of the last num-
ber of The Medical Record (April 14th), on the treat-
ment of erysipelas with ' white lead paint,' suggests to me
to give some of my experience also with this local ap.
504
THE MEDICAL RECORD.
[May 5, 1883.
plication during the past fifteen or eighteen years, which
may possibly induce sonie other practitioners to give the
benefit of the treatment to their patients, as well as save
themselves some solicitude at times and a good deal of
trouble.
" Reasoning as to the sedative and other properties
of the carbonate of lead and the peculiar character of the
diseased surface, I began the local application of the
article, in a case of the disease developed on the face and
head, with a patient about sixteen years old ; and have
continued to employ it in all cases since, whether idio-
jiathic or traumatic, and invariably with satisfactory re-
sults, in ages varying from that already mentioned to over
seventy years — not, of course, disregarding the indica-
tions pretty generally to be observed for the employment
of a mercurial purgative in the beginning and tonics sub-
sequently.
" The lead mentioned must be ground up very finely with
flaxseed oil only, and after the manner of house-carpen-
ters, and applied with a soft brush over and a little beyond
the affected surface of both face and head, and renewed
whenever it should get rubbed off. There need not be
any fear of injurious absorption through the diseased
skin. Unless the hair on the head be very thick, it need
not be thinned for the purpose of applying the paint. .\s
evidence that the lead will not injure the hair (a considera-
tion or fear that might create resistance with some per-
sons), one patient, who was over seventy years of age,
and iiad had a very thin crop on the top of the head, ex-
hibited, some months after getting well, a greatly increased
supply, and of his own growth."
Dr. N. O. D. Parks, of .\shton, R. I., writes: "Two
days after reading in The Lanret the article to which you
refer in your last issue from Mr. Barnwell, of Charing
Cross Hospital, London, on ' Rapid and Successful
Treatment of Erysipelas,' I was called to a child, who
about a week previously had received a burn on the back
of the right hand. When I saw him there was a sore
about the size of a silver dime, from which started a
dusky erysipelatous blush all over the hand and about two-
thirds up the back of the forearm, partially encircling it
in front with great swelling and fever and intense pain
in the affected part. Tongue very foul, temperature
101.4°; pulse, 108. I painted the entire reddened sur-
face, and about three inches beyond, with a thick coating
of white-lead paint, enveloped the limb in cotton-wool,
and prescribed tinct. ferri chlor. The next morning I
was delighted to find the child playing about, tongue
clean, temperature 97^, pulse 84, and he lias continued
well ever since.
" A writer in a subsequent number of The Lancet calls
attention to the fact that this treatment is by no means
new, at least as relates to burns and scalds, and refers to
Wood & Bache's United States Dispensatory (1858, p.
601), where will be found the following: 'It (plumbi
carbonas) is recommended for scalds and burns by Pro-
fessor Gross ; and Dr. Henry, of Iowa, bears testimony to
its efiicacy. The white lead is first brought to the con-
sistency of cream by linseed oil, as in making common
white paint, and then brushed over the inflamed surface.
Its external use, however, is viewed by many practi-
tioners as dangerous, on account of the risk of absorp-
tion, but the occurrence of bad eft'ects is rare.'
" It will be seen that I did not trust to the efiicacy of
the white-lead paint alone, but I think the rapidity of the
cure may be justly attributed to it."
The Paper .A.n'gei, Case. — The case of Miss Gannon
and the paper angels, which has lately come up in the
courts again, was described in full in The Record some
time ago. It illustrated a curious form of hysteria, com-
bined probably with the hypnotic state.
Rk.i'okt of Twenty-Nine Case.s of Typhoid Fever.
— Dr. J. T. Deenier, of Manorville, Pa., sends us the
notes regarding twenty-nine cases of typhoid fever treated
by him in private practice during the past year. All the
cases were either of severe or medium type of severity.
The mortality was three, or about ten per cent., which is a
lavorable showing. The deaths were, one from perfor-
ation of the bowels, two from exhaustion. They oc-
curred in cases above the age of twenty years.
Relapses occurred in three cases. Of the twenty-nine
cases twenty were adults.
Hemorrhages occurred in several cases. In two cases
there were seven hemorrhages, but recovery took place
under the use of ergot and turpentine.
Persistent diarrhcea was met with in two cases, of
wjiich one died. The other recovered under the use of
morphine and sulphate of copper.
Ordinarily for the diarrhoea bismuth, with a little opium
controlled, was sufficient. In both cases of bad diarrhcea,
beef-essence had to be discarded.
Tympanites was )jresent in about two-thirds of the
cases, for this turpentine emulsion was used with good
effect.
The temperature ranged in most cases from 102° F.
to 105° F. The treatment for reducing the temperature
was quinine and mineral acid, with si)onging morning
and evening. The mode of exhibition of quinine was
about two grains every second hour, combined with
either nitro-muriatic or arom. sulph. acids.
Stimulants were used in nearly every case, from four
to eight ounces of whiskey in twenty-four hours, as indi-
cated by the heart's action. Whiskey and brandy were
preferred. Wines being too bulksome. The diet con-
sisted of beef-essence, rice, water, tapioca, milk, etc.
In the most cases quinine acted most happily, in a
few cases it seemed to cause cerebral trouble.
One case was complicated with articular rheumatism.
In this case there were no cardiac symptoms of rheuma-
tism. Salycilic acid and quinine were used, and the case
recovered after a lingering illness. One case was com-
plicated with pneumonia, but the patient recovered.
Three cases were complicated with bronchitis, one of
these was one of the fatal cases before enumerated. The
local applications to the bowels used were inunctions,
with lard and turpentine, in some cases where much ten-
derness existed, light warm poultices were applied.
The causes seemed clearly traceable to bad drinking-
water, which undoubtedly was contaminated with fecal
impurities from privies in close proximity to the wells
from which the water was obtained. Two nurses con-
tracted the disease.
The above treatment has been compared side by side
with other modes of treatment in the hands of other phy-
sicians, and has been found to yield as good results as any.
A Correction. — The name of the author of the article
entitled "A Novel Mode of Cleansing the Vault of the
Pharynx," published in The Record of April 28th, was
by mistake printed Dr. G. Fairfax Whitney, instead of
Whiting, as it should be.
We have been requested to insert the following as a
special favor to the signers :
"To THE Medical Profession of the State of
New York : — l]'e, the undersigned, ex-presidents of the
New York .•'Vcademy of Medicine, desire to record our
approval of the action taken by the -Academy at the
Stated Meeting of .\pril 19, 1883, reaffirming the ethical
clause of its by-laws, and our indorsement of the
course inirsued, by request of the Council of the Central
Organization of the New York State Medical Associa-
tion as presented at this meeting by Dr. Austin Flint, Jr.
WiLi.ARD Parker, M.D., President New York Academy
of Medicine, 1856.
James Ander.son, M.D., President New York Academy
of Medicine, 1861 to 1867.
Austin Flint, M.D., President New York .\cademy of
Medicine, 1873 to '875.
Samuel S. Pbrpi.e, M.D., President New York Academy
of Medicine, 1875 to 1879.
New York, April 30, 18S3."
The Medical Record
A Weekly jfozcrnal of Medicine and Sitrgery
Vol. 23, No. 19
New York, May 12, 1883
\Vhole No. 653
©vioiual Xcctuvcs.
THE DETERMINATION, BY THE GENERAL
PRACTITIONER, OF THE NECESSITY FOR
WEARING GLASSES."
By D. B. ST. JOHN ROOSA, M.D., LL.D.,
PROFESSOR OF DISEASES OF THE EVE AND EAR IN THE NEW YORK POST-GRAD-
UATE MEDICAL SCHOOL . SURGEON TO THE MANHATTAN EYE AND EAR HOS-
PITAL ; PROFESSOR OF DISEASES OF THE EVE AND EAR IN THE UNIVERSITY
OF VERMONT. ^
Lecture I.
Gentlemen — I suppose that most of you will be general
practitioners of medicine. Even if some of you are to be-
come specialists, you will be general practitioners for some
time before you enter upon special practice. As general
practitioners you desire to know the things which are
essential to the successful filling of such a position.
Some of this knowledge I attempt to teach in the ophthal-
mological course in this college. To-day I begin a series
of three lectures on the conditions of the eye which re-
quire the use of glasses. I propose to speak only in a
way in which the average general practitioner may fully
understand. You may, therefore, dismiss from your
minds any notion that I am lecturing to men who have
already taken some instruction in ophthalmology, or who
have attended special courses of instruction in hospitals
where diseases of the eye are treated.
I presume only, that you are medical students of one or
more year's standing, that each one of you has a knowl-
edge of the anatomy of the eye, that all of you have a
general knowledge of its physiology, and that each one
of you knows something of the laws of light as at present
understood.
If you are deficient in any of these respects, these lec-
tures, whatever they may accomplish under other cir-
cumstances, will do you but little good. He who knows
nothing whatever of the theory of the manner in which
undulations of the atmosphere produce what is called
light ; who knows nothing about the bending of rays of
light when they pass from one medium into another ; who
knows nothing about the cornea, sclerotic, optic nerve
entrance, the retina, and so on, will profit but little from
what I shall have to say. It is in the attitude of a good
general student that I expect the hearer to ^and, and I
hope he will go out from these three lectures enabled to
give a correct opinion in a given case as to whether or
not the patient would probably be benefited by properly
chosen spectacles.
The necessary apparatus for the oculist embraces
quite a large variety of glasses. I have brought my
working-case here simply for the purpose of showing to
you what is used by those who make diseases of the eyes
a specialty. I do not e.xpect that you will attempt to
use one so large. Here it is, as it is in daily use. With it
we may correct every impairment of vision that is de-
pendent upon an error in refraction or accommodation
of the eye.
On this side is a set of concave glasses extending
from those of two inches focal distance to those of sixty
inches focal distance. On this side is a set of convex
lenses. Here is a series of prisms ranging from two
degrees to fourteen degrees. Here is a disk with a small
central aperture, and here is one without the central
^ Delivered at the University Medical College, Session of 1881-82.
opening. Here is a colored glass. Here is a tape meas-
ure.
There is a frame for holding a pair of glasses, and here
is one for holding two pairs of glasses, so that we are
able to make combinations, change the axis of the glasses,
and so forth. Then there is a series of the lenses not
ground from spheres, but from cylinders, cylindrical
glasses, glasses for correcting the defect of vision known
as astigmatism. With these you have, so far as glasses go,
an outfit for the man who wishes to correctly fit any con-
ditions of the eyes that may require spectacles. But we
will put this large case aside. We do not need it for
our present purpose. It will be impossible for the gen-
eral practitioner to equip himself with sphygmographs,
ophthalmoscopes, laryngoscopes, test-glasses, and all the
appliances which the knowledge of the nineteenth cen-
tury has rendered necessary for special experts. You
will, however, have no right to the name of good general
practitioners, unless you are able to say, in a given case,
whether it be one of hypermetropia, myopia, presby-
opia, or amblyopia.
Let us study the case before us and from it learn the
method by which you are to work. You will go to your
village where you are to begin the practice of medicine,
and where there is no specialist. Let us suppose that
a woman brings her child to you for some examination
with regard to its eyes. You shake your head at once as
you see that the eyes are not red, there is no opacity of
the cornea, the pupils are movable, and you say,
" Madam, I do not know anything about eyes, and I
prefer not to meddle with them."
" But, Doctor, do you think I can do anything for my
child ? What shall I do ? She cannot see as well as
the rest of the children. Do you think she is going to be
blind ? " You will find it to your advantage and it will add
to your self-respect to be able to answer these questions,
and you should be able to do so correctly, and put your
would-be patient's mind at rest.
You will have in your office a set of test-types, for you
can get these by an expenditure of twenty-five cents. I
will show you a sample. I will not attempt to tell you
the history of these test-types ; that you can find in any
of the special books on affections of the eyes. They are
known as Snellen's test-types, from the name of the dis-
tinguished Dutch oculist who provided them for the pro-
fession. You will assume from what you have heard and
what is stated in the books that this large letter " A "
should be seen at a distance of two hundred feet, by a
person whose vision is normal. The letter in the next
line should be seen at a distance of one hundred feet, and
so on until you reach the bottom line of letters, and that
should be read at a distance of twenty feet. Here, then,
you have an arrangement by means of which you can find
out whether or not there is any loss of vision. This is the
first step to be taken in the examination, no matter what
the defect in vision may actually be. Persons are often
said to be blind when they see moderately well, and are
said to see very well when they see very badly, or scarcely
at all, but with a card like this hung up across the room at
the distance of twenty feet or less, you will be able to de-"
termine accurately whether or not the vision in a given
case is deficient. You may not have a room twenty feet
long. If not, perhaps an adjoining hall may be added,
or you may apply the test at the distance of sixteen or
even twelve feet ; but these are difficulties which will
quickly be overcome if you are in earnest concerning
5o6
THE MEDICAL RECORD.
[May 12, 1883.
your investigation. The state of bewilderment some
general practitioners are in when examination of an eye
is mentioned, is only to be compared to the dismay
which comes over the mariner when he finds himself in a
dense fog, and when he fears that the next moment he
may run upon the shore. There is no need for this be-
wilderment. The means for learning these things about
the eyes are perfectly simple. All that is necessary is a
well-lighted room, a set of test-types, and a patient com-
plaining of his or her eyes, and we are ready to begin a
scientific investigation of the vision.
Our little patient's name is Maggie ; she is twelve
years of age. Let us allow her to tell her own story.
She complains of pains in her eyes, which come once in
a while through the day. They generally occur when she
is reading and studying, for she is a school-girl. With-
out doubt the same pains would occur were she writing
or sewing, or doing any similar work which engaged the
eyes steadily.
She recollects that her eyes began to pain her about two
years ago, but does not remember whether they troubled
her before that time or not. She locates the pain in what
we know as the orbicularis palpebrarum muscle. She
says that her eyes begin to pain her whenever she looks
at her book or any near object for ten or fifteen minutes.
We will first do what should always be done in every
case, namely, inspect the eyes. The eyelashes are perfectly
free from secretion. The cornea is perfectly clear. I
shut her eyelid over the eyeball, and then remove it and
allow the light to come in quickly, and I see that the
pupil moves. I evert the lids and find that they are
healthy. Her eyes, then, are apparently, to the external
view, normal, and yet she complains that she cannot use
them steadily for any length of time without suffering
pain. We have found a symptom, and only a symptom.
That symptom is pain upon any continued use of the
eyes. It has existed more or less for two years, and oc-
curs chiefly when the little patient attempts' to read. The
name of that symptom is asthenopia, or weak sight. The
definition of asthenopia is inability to read, write, sew,
etc., continually without pain or discomfort. Thus we
have gone in a circle. What is the cause of this asthen-
opia ? Can we find it out ? If so, how ? You might say :
" I cannot go any further ; it will probably require the
ophthalmoscope to ascertain the condition of the eyes.
Doubtless she has commencing atrophy of the optic
nerve ; or amaurosis ; or, forgetting that young people sel-
dom have glaucoma, you may say perhaps this is a case
of glaucoma, and you only breathe with freedom when
some specialist or some other general practitioner as-
sumes the responsibility of the case.'' But suppose vou
do not say so ; and on the contrary assume that the prob-
able cause of this asthenopia can be determined without
a knowledge of the ophthalmoscope, or the appearance of
the optic nerve or of the retina. At any rate, let us see
how far we can go without tiiese instruments of precision.
In the first place we will measure twenty feet from this
chair where Maggie will sit, and at that point the card on
which are Snellen's test-types will be held. I ask in this
instance that twenty feet be measured in order to carrv
out the form of examination with absolute correctness
and see whether this patient can read the bottom line of
letters at this distance.
But, after all, it is only approximately correct. There
are but few absolute truths in this world. There are but
few statements which are not modified by circumstances.
For example, I hold in my hand another test-tvpe in
which the letters are of the same size as in Snellen's, but
they are a little closer together, and, as a matter of ex-
I)erience, it is a little more diflScult to see them at a
distance of twenty feet ; but I will not dilate upon this
trifling fact, because it may lead to confusion in your
minds.
Can a given patient have a very serious disease of
the back part of the eye, considerable optic-nerve or re-
tinal trouble, and still be able to read the letters in the
lower line at the distance of twenty feet, or, as oculists
say, who has vision W or normal ? We may safely an-
swer this question in the negative, and say that, as a
rule, these conditions being fulfilled, there is no serious
disease of the back part of the eye, nor of the refracting
media, the cornea, or the lens, or the vitreous. Yet this,
after all, is a statement which is only appro.ximately
true. It is generally true. The exceptional cases which
you will occasionally meet with you will soon learn to
place by the side of these ordinary ones, and you will
soon come to the making of a correct diagnosis in them.
We will therefore assume, as a general rule, that a per-
son who can read fi has jierfect vision, and we may ex-
clude disease at the back part of the eye. We have
already assumed that you do not use the ophthal-
moscope, and we shall not be able to go further without
this assumption.
It is essential in this scientific experiment, as in all
others, to exclude, so far as can be done, ail possible
sources of error. It is a wise thing, therefore, not to
keep these test-types hung where the child can see them,
even for the five or ten minutes that you are conversing
with the mother or friend, for a bright child may learn
all these letters within that space of time, and when you
come to your testing, may assume to read them readily
at any distance.
It is also proper to test each eye separately, because
the eyes may not be alike. We will therefore cover
Maggie's left eye by holding a bit of pasteboard closely
in front of it, and then ask her to read. [The patient
reads.] She reads all these letters readily at the dis-
tance of twenty feet, and we can say, so far as the right
eye is concerned, that she has no serious disease at the
back part of it. The vision of the right eye is normal :
V. R. E., |J,'. [The right eye was then covered, and the
patient asked to read letters in diff'erent lines at random,
in order to avoid the possible error of having committed
them to memory.] The vision of the left eye is normal:
V. L. E., Vy.
We are now no further in our study of the case than
we were before, except that we are able to say that the
child has no very serious disease at the back part of the
eye, and she is not going to be blind from her present
trouble. These are certainly somewhat important facts.
Let us take another step. We have been told that there
is a condition of the eyeball in which it is too short from
before backward. You have already seen a diagram
by which lectures upon this condition have been illus-
trated, and here you may see it again.
You have been told that the rays of light whicii come
from objects at an infinite distance are practically paral-
lel ; that an eye of the right length does not need to ex-
ercise muscular strength in order to unite these parallel
rays so that they make an exact focus upon the layer of
rods and cones of the retina, where the image is re-
ceived.
You will also remember that there is a ciliary muscle,
represented in this diagram, which acts in a certain way
upon the capsule of the lens so as to allow it to be-
come thicker. Objects situated at a distance from the
eye of less than twenty feet emit divergent rays. These
are the two rays of light we find in nature. Those
coming from an infinite distance are practically parallel,
those from a point near at hand are divergent. The rays
of light which come from an illuminated landscape one-
fourth or one-half a mile distant or one hundred feet or
twenty feet away are practically parallel. The rays which
come from a book read at the ordinary distance at
which it is held from tlie face, or at any distance less
than twenty feet, are divergent. These are the only rays
which nature exhibits. \Ve may have convergent rays by
the aid of lenses. This ciiild has been receiving parallel
rays, which came from illuminated objects situated twenty
feet distant from her eyes, and she has been able to read
the letters in the bottom line. .Are you ready to assume,
now, because she has done that, that her eyes are of the
May 12, 1883.]
THE MEDICAL RECORD.
507
right length ? You cannot safely assume that, because
she may have been making an effort, such as the properly
shaped eye does not make, in order that vision may be
clear. In otiier words, she may have been using her
ciliary muscle in order to thicken this lens and increase
the refractive power of the eye. By that efibrt she may
have been able to see fg, and yet her eyeball may have
been too short from before backward. Yet she by mus-
cular effort may have made it practically longer.
As general practitioners we can now exclude short-
sightedness, or myopia ; and we can also exclude ambly-
opia, because her vision is |° ; she is certainly not pres-
byopic, for that is a disease of accommodation occurring
from lapse of years. What kind of defective sight has
she ? We have reached, by exclusion, the diagnosis that
she is in one of two conditions : i, that her eyeballs are
exactly of the right length, that she is emmetropic ; or 2,
that her eyeballs are too short, and by using her ciliary
muscle she has been making her lenses long enough to
enable her to focus these parallel rays. She may have
latent hypermetropia. How am I to find out which one
of these two conditions is present ? We have a test
which will enable us to answer that question with cer-
tainty. Here is a case of glasses which costs some ten
or twelve dollars. It contains glasses for answering the
question that has arisen concerning the sight of this girl.
By means of the test-types and these glasses you can an-
swer the question. Is she hypermetropic, that is, are her
eyeballs too short, and is she obliged to constantly use
her ciliary muscles in order to see clearly, even at a dis-
tance ; or is she emmetropic, that is, has normal eyes,
and does the asthenopia or weak sight de[)end upon some
general condition of the system, such as anasmia, want
of general muscular tone, or the like ?
If I put a convex glass over the eyes of a [lerson
whose vision is accurate and normal, who has never suf-
fered from weak sight, a glass which increases the refrac-
tion of the eye, it has the same effect as if the eye is entered
and the lens thickened. The eye will not then be ada[)ted
for parallel rays and a " blur " will occur, clearness of
vision will be mterfered with. We know that fact prac-
tically, and we explain it by saying that the normal eye
is in a state of rest while looking at an infinite distance,
and does not need any assistance to the ciliary muscle.
If we put a glass upon it which makes the eye slightly
too long, slightly myopic, there will be a blur, because
the image will not be accurately focussed.
Let us apply our test. I will first use this lens. No.
60, a glass of sixty inches focal distance.
It will make a difference in vision at once when placed
before the normal eye. It may or may not make a dif-
ference in the vision of our patient. [Glass aiiplied and
patient asked to read.] She says that the bottom line of
the^ test-type is clearer than without this glass. That
result might be a delusion, as perhaps she may have ob-
tained the idea from what has been said or from the mere
fact of a glass being put upon the eye, that we expect
her to see better ; but we will go on and apply a glass
that has a 48-inch focal distance.
Some authorities say that a hypermetropia of -jL is not
to be regarded. Practically I agree with that statement,
and also that if we find hypermetropia of ^^ it is not
always to be regarded, because, as has been shown by
examination of eyes under atropia by myself, and the
eyes of young children as examined by Dr. Ely, most
people are hypermetropic. Donders stated that fact a
long time ago, although he did not bring forth the special
proof. You may accept it as a tact that the larger pro-
portion of eyes are slightly hypermetropic, and there are
more eyes hypermetropic than myopic.
But when a glass of 48-inch focal distance is required
for distinct distant vision, or when it is tolerated, and the
sight is just as good with it as without, we may fairly as-
sume that the patient who thus requires or tolerates a
glass is hypermetropic, for when the ciliary muscle is init
at rest by atropia it will be found that there is a latent
hvpermetropia added to that found before this occurred.
But there are some persons, as I have shown by experi-
ment, who even when their ciliary muscles are set com-
pletely at rest by the instillation for some days of a
four-grain solution of atropia, will not tolerate any glass,
but reject every one, havnig clearer vision without it.
Now I will add this glass, having a 48-inch focal dis-
tance. She says at once that the letters are not so clear
as without the glass.
I will now have her keep looking at the test-types
while I arrange another glass, and I do that in order
that she will keep up the exercise of the ciliary muscle.
I now put upon the eyes No. 40, and she says that she
sees clearer than with either of the glasses tried. I will
not consume time by extending the examination further,
for we have demonstrated that she has hypermetropia,
her eyeballs are too short, and although she can see
IJ, she is using unnatural muscular force in order to do
it. We will therefore order for her a pair of convex
glasses with 40-inch focal distance and see what the effect
will be upon the symptoms of which she complains.
It is probable that she will soon allow her ciliary mus-
cle to give up its excessive work, and let the lens in
front of the eye serve to thicken the lens within it. This
rest to the muscle may, and probably will, relieve the
symptom of pain, fatigue, etc., caused by its undue or
excessive action.
The case is one o{ facultative hypermetropia. It is
not latent, for then the patient would have rejected
all glasses until atropia or a drug with similar efl'ect had
paralyzed the ciliary nniscle. Her vision is |-|} with and
without convex glasses. It is not manifest hypermetro-
pia. Then the patient would have seen well at a distance
only with convex glasses.
You have spent twenty-five cents for test types and
twelve dollars for a case of glasses. You have shown
that these troublesome symptoms, blurring of the sight,
watering, burning of the eyes, depend in this case not
upon straining to see through a cloudy medium (an
opaque cornea or a cataractous lens), or a vain eftort to
get a sharp image on an inflamed or hemorrhagic retina,
but upon undue exercise of an overweighted ciliary
muscle, and you have made a diagnosis in an obscure
case.
I will finish the lecture by presenting a case which
furnishes a striking contrast with the one which we have
just examined. This is a case which the general prac-
titioner could not make out, unless he had had some
special training, and I put it in contrast with the other
in order to show you where is the dividing line bet7veen
the knowledge that may be expected from a general prac-
titioner, and that demanded from one tvho gives especial
and perhaps exclusive attention to diseases of the eye.
This young man has had inffannnation of the right eye,
which has practically destroyed it so far as vision is con-
cerned. There is general staphyloma of the cornea and
only that perception of light which oculists call quanti-
tative. The left eye has not been injured, but the sight
is weak, and he is naturally anxious to know whether
it has undergone any change in consequence of sympa-
thetic irritation or inflammation. We look at it, and see
that it does not water, it is free ftom redness, the pupil
moves well, but he has the symptoms of asthenopia
enumerated in connection with the other case. He can
read next to the bottom line ; that is, his vision is ||}.
I take up my general practitioner's case of convex and
concave glasses and am not able to make him see |-{},
and I begin to be alarmed. I say that he has lessened
sight in that eye with a bad condition of the fellow eye,
and I send him off to a specialist, and that is well
enough.
Now I will put a convex cylindrical glass before his
eye, a glass of which the general practitioner is not
bound to know anything, except as a matter of general
professional information. I take one of 48-inch focal
distance — -I have already reached this by a series of
5o8
THE MEDICAL RECORD.
[May 12, 1883.
experiments with the patient — and I find that his vision
readies -|a. This is a cylindrical glass, the one used in
correcting astigmatism.
The asthenopic symptoms do not depend upon the ir-
ritation of the other eye, but upon the same cause as that
just given in the case of the little girl — undue action of
the ciliary muscle in endeavoring to focus an image.
But this eye, unlike that of the little patient, is too short
in but one meridian (hypermetropic astigmatism). Her
eye was too short in all meridians (hypertnetropia). The
latter condition is easily ascertained by a general practi-
tioner educated in the last ten years. The former may
properly be left for correction, if not for detection, to a
specialist.
We can say, in this case, that there is no sympathetic
irritation or inflammation. Sometimes people are sup-
posed to have sympathetic irritation when they are
merely affected with an error of the refraction of the eye.
The latter fact is sometimes only discovered after a dan-
gerous accident has occurred.
TUBERCULOSIS IN INFANTS.'
By J. LEWIS SMITH, M.D.,
CLINICAL PROFESSOR OF DISEASES OF CHILDREN IN THE BELLEVUE HOSPITAL
MEDICAL COLLEGE.
These specimens exhibit the lesions of acute miliary
tuberculosis occurring in a child. The history of the
case is as follows :
James , aged ten months, was taken sick January
16, 18S3. He was returned to the New York Foundling
Asylum January 20th. He was apparently well-nourished
and was wet-nursed. He had a severe cough, with dul-
ness on percussion, and large and small rales in both
lungs. The respiration was increased in frequency, and
was shallow. Diagnosis, broncho-pneumonia. The child
continued to gro\i' weaker, the dulness became more and
more marked, and he died at 4.15 a.m. January 24, 1SS3.
The autopsy was made by Dr. \V. P. Northrup, path-
ologist. The body was well nourished.
Brain. — A few tubercles were found scattered over
the surfiice in the pia mater ; otherwise normal.
The spinal cord was normal.
The lungs, both external and cut surfaces, were thickly
studded with large, well-defined tubercles. The bron-
chial glands were large and cheesy, and one contained a
thick creamy fluid. The portions of lung-tissue between
the tubercles were mostly consolidated, and presented
the appearance known as " raspberry jam.' There was
one cheesy nodule, about the size of a hickory-nut, at the
anterior edge of the right upper lobe.
The heart was normal.
The liver contained tubercles about half the size of
those seen in the lungs.
The spleen was of normal size, but contained tubercles
in abundance.
The kidneys showed five or six large tubercles in the
cut surface.
The stomach was normal.
The intestines. — The mucous membrane of the small
intestine was congested and showed occasional ulcer-
ation of the solitary follicles ; some of the solitary fol-
licles in the large intestine were also ulcerated. The
ulcers were shallow, and had thickened edges.
The mesenteric glands were enlarged and cheesy.
Besides these specimens, I have others removed from
the body of a phthisical cliild who died at the age of
seventeen months. He had the following history :
Joseph , a twin, aged seventeen months, was sent
out to board in September, i88i. He was always a
feeble child, and the record states that he suffered from
cholera infantum in December, 1S81. He returned to
the asylum January 24, 1883, and died four hours after-
ward.
1 Presented at a Stated Meeting of the New York Pathological Society, Jan-
uary 34, 1883.
The autopsy was made by Dr. W. P. Northrup, path-
ologist. Marked emaciation. The brain was normal.
There were cavities in the upper lobes of both lungs, con-
taining thick, greenish-yellow fluid. The bronchial glands
were enlarged and chees}'. A few small, transparent
tubercles were seen on the surface of the lungs. The
heart was normal. Small tubercles w-ere scattered
sparsely through the liver. The spleen, the kidneys, and
the stomach were normal. The mesenteric glands were
enlarged and cheesy. The small intestine showed ulcera-
tion of the lowest Peyer s patch, and occasionally ulcera-
tion of solitary glands. Similar ulcers were found in the
large intestine.
JRemarks. — Tuberculosis in young children is more
common among the city poor than those are probably
aware who observe diseases chiefly in the better walks of
life. Two post-mortem examinations at the same time
of tubercular children implies this frequency. In the
etiology of tuberculosis in children two important factors
occur. First, inheritance ; secondly, the occurrence of
caseous material in some part of the system. The child
of a tubercular parent, as is well known, is much more
liable to tubercles than is one of healthy parentage. The
tendency to it appears to be greater when the mother is
suffering from it than when the father is the invalid. If
the mother have advanced consumption, her child is apt
to begin to cough when a few weeks old, and sometimes
when only a few days old, although it may have been
born of full size and plump. As tuberculosis advances
the more rapidly the younger the age, the child thus af-
fected is apt to perish before the mother. Such cases
have now and then occurred in my practice.
Much attention has recently been given to the theory
of the infectiousness of tuberculosis — a theory that is
gaining ground by observations which appear to sub-
stantiate it, and by the probable discovery of the tuber-
cule bacillus by Koch. Certainly the fact that wives
who are devoted to their consumptive husbands, sleep-
ing by their sides, and perpetually inhaling their breath,
now and then contract the disease — contract it appar-
ently more frequently than those who are not so exposed
— lends support to this theory. It seems probable that
tubercular particles, to which, perhaps, bacilli are at-
tached, exhaled from tubercular lungs, and lodging in
the lungs of the exposed individual, may excite by their
irritation the cell-proliferation, which produces the tu-
bercular neoplasm. If this theory be true, as seems
probable, we would expect that infants who are held in
the laps of diseased mothers or nurses, and whose lungs
are delicate and susceptible to morbific influences, would
be especially liable to be attacked, and the journals have
recently published the case of a midwife in a European
town who had confirmed tuberculosis, and had been in
the habit of blowing into the mouths of new-born infants
under her care. A considerable number of these infants
perished with tuberculosis, while those in the practice of
another midwife who was healthy escaped.
Another, and in my opinion the common mode in
which tuberculosis arises in children, is from cheesy foci.
The child takes inflammation from some cause, perhaps
from exposure to cold, and on account of feebleness of
system or a pronounced cachexia, the inflammatory pro-
ducts do not resolve. Remaining in the system, they
undergo caseous degeneration, and caseous material fur-
nishes the conditions, as is well known, in which the
tubercular neoiilasm often originates. Detaclied caseous
particles lodged in the tissues excite tiie cell-prolifer-
ation, which produces tlie tubercle. Hence in post-
mortem examinations we so often find a cluster of
tubercles around caseous matter.
The two sets of specimens before us show the ordi-
nary anatomical characters of tuberculosis in infancy.
We know the rule in the adult, that tubercular matter
first appears at the summit of the lung and extends
downward, the amount of tubercle being greater at the
apex than elsewhere and at a more advanced stage. At
May 12, 1883.]
THE MEDICAL RECORD.
509
the apex we find softened tubercles, and sometimes
tubercular cavities, while in the central and lower part
of the lungs we find either no tubercles or tubercles dis-
seminated and recent. In the infant, on the other liand,
miliary tubercles are disseminated throughout the lungs,
nearly the same in size and appearance in every part, with
surrounding healthy lung-tissue. Hence tlie difficulty in
making a diagnosis except at an advanced stage, for we
do not obtain dulness on percussing the chest, until at a
late period, when infiammations have arisen to consoli-
date the lung at some point, and on auscultation we
only observe a rough or rude respiration. In the tuber-
cular infant, as a rule, the bronchial glands are enlarged
and cheesy, with softening of some of them in their
interior. The so-called bronchial phthisis plays an im-
portant role in many cases, producing various severe
symptoms. Hyperplastic or caseous bronchial glands
by pressure on a bronchus, cause narrowing of its lumen,
and consequently more or less obstruction to the respi-
ration ; or by ulceration and discharge of caseous and
softened gland substance into a bronchus, or into the
lower end of tlie trachea, it produces a troublesome irri-
tative cough. These glands sometimes also produce
distressing, even dangerous symptoms, by pressure on
important nerves, as the laryngeal, or im|)ortant veins,
as the innominate. In some cases which I have ob-
served, the return circulation from the brain has been so
obstructed from this cause as to produce dangerous ce-
rebral symptoms. Extreme passive congestion occurred
in the intracranial veins and sinuses from this cause.
These specimens also show another well-known fact
in reference to the tuberculosis of early life, to wit : the
tendency to generalization of the tubercles. They ap-
pear in the pia-mater, especially at the base of the brain,
where they often give rise to tubercular meningitis. In
one of the specimens before us tubercles were present in
this location, but they had ajiparently produced no
symptoms. Miliary tubercles aj^pear almost as fre-
quently in the spleen as in the lungs, and in as great
mnnber relatively to the size of the organ. They are
found less frequently upon the surface of the liver, and
less frequently still upon the surface of the kidneys. As
in the cavity of the chest, miliary tubercles often occur
in the connective tissue under the pleura, distinctly seen
through this membrane, and raising it slightly, so that they
occur under . the peritoneum in any part of its extent,
parietal, visceral, or omental, where they frequently i)ro-
duce localized peritonitis. They occur, also, not infre-
quently in the mucous membrane of the intestines,
causing ulceration and a troublesome diarrhcea. Ordi-
narily, also, the mesenteric glands undergo great enlarge-
ment and caseous degeneration like the bronchial, but
they are not so frequently softened.
The tubercles being thus widely disseminated in the
system of the infant do not ordinarily give rise to any
prominent local symptoms till they produce inflammation
around them. Hence the difficulty of making a positive
diagnosis at an early stage. We infer the presence of
tubercles from the general condition, from the wasting,
poor appetite, loss of strength, and the cough, but can-
not say positively, as in the adult, that tuberculosis is
present until the disease is pretty well advanced. The
sputum is scanty, and is swallowed, hfemoptysis does not
occur, but by and by we observe dulness on percussion
over some part of the chest, due to pneumonic solidifi-
cation, e.xcited by tubercles, and this persists, for the in-
flammation kept up by such a cause does not resolve.
Whenever the symptoms due to tubercular meningitis or
bronchial phthisis arise, the diagnosis is of course easy.
Whenever, therefore, I am called to a young child
with a chronic cough and wasting. I do not wait for a
more accurate diagnosis, but if there be no diarrhrea to
contra-indicate it, prescribe cod-liver oil with the hypo-
phosphites, frequently adding the syrup of tlie iodide of
iron, since the strumous cachexia is so apt to be present,
with probably caseous substance, in some part. Such
a case requires the utmost attention to the hygienic
management, pure air, nutritious, and easily digested diet,
into which milk enters largely, the juice of meat or meat-
broths, prepared at a temperature of 100°, so as not to
coagulate the albumen. A favorite prescription in two
of the asylums of this city for these infants with chronic
cough and wasting, whether or not tuberculosis be diag-
nosticated, is the following, to be taken between the
doses of cod-liver oil :
.aa. gr. xxiv.
... 5iij.
IJ. Amnion, carbonat.,
Ferri et amnion, citrat. . .
Syrupi simi>lici
M.
Dose, one teaspoonful every two or three hours to a
child of one year.
(i)vioinal Articles.
WHAT IS THE R.^TIOXALE OF TRACTION
AND COUNTER-TRACTION IN THE TREAT-
MENT OF HIP DISEASE?
By a. B. JUDSON, M.D.,
ORTHOPEDIC SURGEON TO THE OUT-PATIENT DEPARTMENT OF THE NEW YORK
HOSPITAL.
As suggested by Dr. E. M. Yale,' the word traction
should be used instead of extension, when reference is
made to the common method of applying mechanical
treatment in hip disease. Whatever form of apparatus
is used, the object sought is traction. This cannot be
secured, however, in any case except by the simultan-
eous development of counter-traction. If the extension
and counter-extension (tractive and counter-tractive)
apparatus is used, counter-traction is made against the
inferior surfaces of the os innominatum. If the weigh*
and pulley are used, it is found in the friction which the
body makes with the surface on which it lies, and partly
in the weight of the body if the limb is elevated. If the
patient is standing, the affected limb being pendent, and
its weight tractive, then counter-traction is found in the
pressure made by the head of the sound femur on the
floor of its acetabulum. Manually, traction may be
made on the condyles of the femur and counter-traction
on the prominences of the pelvis, and it is conceivable
that in certain cases favorable to the experiment, the
contracted muscles may be thus opposed or "counter-
acted" while passive motions of the joint are made.
The reasons which lead to a substitution of the word
traction for extension also lead to the use of the ex-
pression traction and counter-traction. This term will
therefore be employed in the present paper, which is to
be a brief inquiry into the validity of some of the ac-
cepted theories offered in explanation of the efficacy of
this form of treatment.
When we view the application of traction to a case of
hip disease, an obvious incident is the apparent drawing
away of the thigh from the trunk. The inference has
been made that the usefulness of the application depends
on the separation of the head of the femur from the floor
of the acetabulum. It is an interesting question whether
this separation can be affected in the cadaver. The
experiments of Harwell ' and Morosoft"' sustain the neg-
ative, and those of Kcenig and .\rmand ' the affirmative.
It is probable that both sides are partly right, and that
the facts have been indicated by Dr. Edward H. Brad-
' Dr. Yale writes : ** The word extension is objectionable because of its obscurity',
since it is used as the opposite of flexion." (iMEMCAL Record, Januan,- 12, 1S78, p.
27.) The point thus made had been aptly ilhistrated in the discussion which
took place in the New York Academy of Medicine (Am. Med. Times, April 27,
1861, p. 279). when nr. Bauer was credited %vith the \ery early use of extension
(traction) in hip disea>,e, although his method really consisted in the reduction of
flexion followed by fixation. (N. Y. Journal of Medicine, .September, 1853, p. 173,
the method of Bonnet and of Hilton.}
' Diseases of the Joints, pp. 336-342, London, t86i. American Edition, 18B1,
pp. 16-18.
' Quoted by Charles Monod, .'krch. Gen. de Medicine, p. 718, June, 1878.
* Jules Armand : Th^se de Paris, pp. 30, 31, 33, 34, 1878.
5IO
THE MEDICAL RECORD.
[May 12, 1 88^
ford,' whose experiments show that in some conditions
of development, and perhaps of disease, this separation
is possible with ordinary effort, while in other conditions
it cannot be effected by extraordinary force.
The question of the therapeutic value of attempting
to separate these surfaces has also given rise to varying
opinions, some writers believing that it is an important
part of mechanical treatment. Dr. L. A. Sayre is re-
ported as holding this opinion," but I do not find it ex-
pressed in any of his valuable writings on this subject, and
the weight of contemporary authority is decidedly op-
posed to such a view, if we may judge from the following
quotations : " It is not possible for the two articular sur-
faces to be directly separated by an extension so insig-
nificant " (Bauer).' " I do not believe it (the drawing out
of the head of the bone) occurs, or ought to occur, nor
do I believe it would be anything but harmful if it did
occur" (C. Fayette Taylor).* " Tliis separation is scarcely
possible under any amount of force likely to be em-
ployed by a surgepn " (Yale).'' " I do not believe it pos-
sible, by any amount of extension that can be applied, to
separate the intlamed and swollen interior surfaces of
the joint" (Hutchison)." The united opinion of these
authorities is an assurance that separation of the articular
surfaces is not an adequate explanation of the efficacy
of traction and counter-traction.
Fixing our attention still further on traction as ap-
plied to a case of hip disease, there is, in addition to an
apparent drawing away of the limb from the trunk, an
apparent antagonism bet\veen two forces, that of reflex
muscular action and that of traction. There is thus pro-
duced an apparent counteraction of the muscles sur-
rounding the joint, and the inference has been made that
u[)on this depends the efficacy of traction and counter-
traction. I believe, however, that their usefulness is en-
tirely independent of the alleged counteraction of the
muscles.' While taking this ground I retain the highest
possible appreciation of this mode of treatment, and find
a satisfactory explanation on other grounds. Leaving
to another occasion the consideration of the question
whether "a fractional degree of fixation," * such as is
secured by traction and counter-traction is not the true
explanation, it will be sufficient in this paper to critically
consider the statement that traction and counter-traction
owe their usefulness to the counteraction of the muscles.
That this opinion is widely entertained is evident
from the following quotations from writers of note,
American and foreign, who have considered this method
from a practical jioint of view. " It is obviously of im-
portance in treatment (i) to keep the surfaces at all
times from contact, and (2) to control the uniscles."
"This constant contraction of muscles jiassing over a
joint should always be counteracted." "The India-
rubber spring counteracts that force which presses the
bones too violently together." ''To overcome the in-
jurious pressure from irritated muscles is imperative.''
"The object of extension is to overcome reflex muscular
action." "The object of such appliances is merely to
* Boston Medical and Surgical Journal, p. 465, November 11, 1880,
2 Discussion in Surgical Section, New York Academy of Medicine (Medical
Record, p. 544, December 6, 1879).
3 American Medical Times, p. 345, May 25, 1861.
* Medical Record, p, 290, September i, 1S67.
* Loc. cit.
^ J. C. Hutchison : Contributions to Orthopedic Surgery, p. 9, New York, 18S0,
Mr. Howard Marsh believes that separation is impracticable (British Medical
Journal, p. 99, July 28, 1877J.
"Because reflex muscular action — ("vigilance rnusctilaire" I'frtieuiL "If
handled a little roughly, all the muscles will be upon their guard" Davis,
American Medical Monthly, p. 323, November, 1S62) — is an important clinical
feattirc and of great assist.)nce ui diagnosis, it docs not follow that it is the
chief element in the pathology and the point against which our local therapeutics
are to be directed. There arc occasions in practice when direct counteraction of
muscular fibre is feasible and important, as in the cramps of the extremities in
cholera and the nocturnal cramps of the sural muscles. In the treatment of stumps
immediately after amputation, painful twitchings may be prevented by traction
(R. K. Weir, Medical Record, p. 51, April 1, 1867). In Buck's extension for the
treatment of fractures traction is believed to be useful by directly controlling the
spasmodic twitchings of the muscles (ibid., p. 50). After exscctioi) of the hip
the muscles may doubtless be contracted by a tractive force. But all these cases
are so radically different from acute hip disease that an argument cannot be drawn
from them. After exsection or fracture the muscles .are in a position peculiarly
suggestive of the propriety of traction, because their points of origin arc abnormaliy
approximated to each other.
^ H. (). Thomas : Diseases of the Hip, Knee, and Ankle Joints, p. 10, Liver-
pool, 1875.
relieve the joint from pressure, by permanently extend-
ing the morbidly contracted muscles."
A proposition drawn from the above expressions, no
two of which are from the same authority, may be worded as
follows: Traction and counter-traction are useful in hip
disease because of their power to counteract the muscles
which are injuriously contracting around the joint. If
it can be proved that they have not this power, or if un-
due importance has been ascribed to the action of the
muscles in question, then the reason of the efficacy of
this form of treatment must be sought elsewhere. Al-
though I believe that the muscles cannot be thus counter-
acted to any practical degree, it is impossible to give a
demonstration from the nature of the case. All that can
be done will be to present certain reasons for disbelief,
leaving the question to the judgment of the reader.
There should be no obscurity in regard to the meaning
of the term " to counteract the muscles.' If the joint were
fixed the muscles would in a certain sense be counter-
acted, because they would be prevented from action.
But this is evidently not the meaning of the term. Nor
does it apply to the eflect of extension (the opposite of
flexion), which would indeed counteract the flexor mus-
cles, or to the effect of flexion, which would counteract
the extensors. The term is evidently used with reference
to all the muscles surrounding the joint, and it signifies
to make traction on them in such a way as to prevent
their contraction (or at least to obviate its pressure
effects) by the direct application of a force acting in an
opposite direction.
It is evident that a contracting muscle can be counter-
acted only when traction is made on the bone in which it
is inserted. In the case of the hip-joint it is necessaiy
to obtain a secure hold of the femur, and a little consid-
eration will show that the ordinary method of grasping
the femur by adhesive plasters applied to the skin is very
imperfect. If our adhesive plasters could be applied
directly to the bone, or if it were admissible to use a de-
vice like Malgaigne's hooks for the treatment of fracture
of the patella, we might perhaps hope to make such
traction on the bone as to counteract the muscles.
The shaft of the femur may be said to occupy the
middle of a cylinder of elastic integument, the space
around it being filled with a jelly-like mass, composed
mainly of relaxed muscular fibre and loose connective
tissue. It is not denied that a slight amount of traction
is thus exerted on the femur, but it is unreasonable to
suppose that in circumstances so extremely unfavorable
it is strong enough or steady enough to counteract the
muscles which directly move the joint.' If the great mus-
cular masses of the thigh and hip were in a state of rigid
contraction the case would perhaps be different, but
these muscles are, with few exceptions, in a relaxed con-
dition in acute disease. In the thigh the adductors are
probably the only muscles w^hich are found in sustained
contraction. The sartorius, gracilis, quadriceps exten-
sor, the three hamstring muscles, and the tensor vaginaj
femoris are found (in acute disease) relaxed and atro-
phied. The reason for this exceptional condition of the
adductors is perhaps to be found in the fact that they
alone of all the muscles thus far enumerated have their
origin in one osseous member of the joint and their in-
sertion in the other, an arrangement which may make
them more liable to reflex action, the result of ostitis near
the joint. The psoas magnus has its origin above the os
innoniinatum. The only muscles, then, which move the
joint and have their origin and insertion immediately
above and below it, besides the adductors, are the iliacus,
I Mr. Howard Marsh says : " I suppose the greatest amount to which the sur-
face of the head of the femur can be separated front that of the acetabuliun cannot
be more than about the tenth of an inch. .\nd it is very difficult to preserve effi-
cient extension and counter-extension within this range ; for the parts cannot be
acted upon as if they were parallel metal plates to be adjusted by a screw ; they
must be controlled through the agency of perineal bands and strapping fixed
upon the skin, and all these arc apt to give when they arc subjected to constant
traction : and if they yield, though it be but slightly, they soon, in the aggregate,
lose this tenth of an inch of extension which they should iiiaintain, and then tlie
articular surfaces come again into firm contact "( British Medical Journal, p. 99,
July 28, 1877).
May 12, 1883.]
THE MEDICAL RECORD.
511
pectineus, glutei, gemelli, obturators, and quadratus fe-
nioris. The glutei are, as a rule, relaxed and atrophied.
The gemelli, obturators, and quadratus femoris are sim-
ple rotators, acting only in horizontal directions. By
this process of exclusion we have left as muscles liable
to sustained contraction and proper subjects for coun-
teraction the iliacus, the pectineus, and the adductors.
Considering the secondary position of these muscles, when
compared with the immense muscular masses of this re-
gion, it does not appear that counteraction is impera-
tively demanded for the protection of the joint, even if
the mechanical difficulties above pointed out did not
exist.'
It is difficult to explain the efficacy of traction in
hip disease on these grounds, while an easy and reason-
able explanation .is found in the opinion of M. Verneuil,"
that fixation is of prime im])ortance, joined with a recog-
nition of the fact that traction and counter-traction fur-
nish the best solution of the difficult problem of the fixa-
tion of the hip-joint.
Before concluding, however, it is necessary to review
two theories which have been advanced for the purpose
of explaining more fully how the alleged counteraction
of the muscles promotes recovery.
The first was proposed by Dr. Henry G. Davis, who
believed that the muscles could be counteracted by an
apparatus which should at the same time allow the jomt
to perform its normal motions. He wrote : " I can but
consider it highly beneficial to keep up motion of the
joint, yet not allow of friction upon the diseased sur-
faces." ^ This idea has been adopted by a number of
eminent writers. One of them who declares that " mo-
tion is just as essential to a joint as light is to the eye," *
advocates a " plan by which extension could be main-
tained that would remove pressure from the acetabulum
and the head of the femur, and at the same time permit
motion of the joint." Another has devised a combina-
tion of a plaster-of-Paris jacket with a hip splint, by which
he claims that "extension and counter-extension and
mobility of the affected limb are made feasible." An-
other has devised a splint in which " the movements of
every jomt of the limb is most perfectly secured ; that at
the hip especially not being in the least interfered with
by the counter-extending force." Still another form of
apparatus secures "mobility of the joint with extension,''
and a recent most instructive writer frankly admits that
"up to the present day (1882) no effectual appliance to
secure these results (motion and avoidance of articular
pressure) had been aftorded.' The device which he ad-
vocates, although very ingenious, has not as yet perhaps
been sufficiently tested by time to prove its superiority.
The idea entertained by these authorities is that the
muscles can be counteracted by an apparatus which shall
permit the ordinary motions of the joint. There are great
mechanical difficulties in the way of the practical appli-
cation of this idea. If traction and counter-traction are
applied in the line of the thigh and the trunk, it is difficult
to conceive that the same amount of force can be main-
tained through all the variations of tiexion, extension, ad-
duction, and abduction.' The difficulty depends partly
on the irregular shape of the inferior surface of the bony
prominence made up by the body of the ischium and the
rami of the ischium and pubes. As motion of the limb
is made in difl'erent directions, different facets of this
prominence, more or less removed from the lower end
of the femur, are successively presented to the pressure of
the counter-tractive part of the apparatus. If the facet
' That the pathological facts do not call for the counteraction of the muscles in
hip disease has been shown in a preceding article. See N. V. Medical Journal,
pp. 1-17. July, 1882.
2 Verneuil teaches : i, that prolonged fixation is powerless alone to produce an-
chylosis ; 2, that the best way to prevent anchylosis is to combat inflammation : and
3, that fixation of a diseased joint is an antiphlogistic of the first importance (Bull,
et Mim. de la Soc. de Chtr. de Paris, pp. 510, 511, 1879).
3 New York Journal of Medicine, p. 420, November, 1859.
* This proposition was questioned by a distinguished opponent, who ^aid^:
*' Light is for the eye in a healthy state, but in disease light should be excluded
(American Medical Times, p. 311, May II, i86t).
6 Mr. Marsh says: "If the penneal band be adjusted when the limb is ex-
tended, it will become loose when the limb is flexed " (loc. cit.).
presented is prominent, traction will be more severe, if
depressed, less severe. And even if we imagine the bony
surface reduced to a mathematical point, presenting the
same resistance to counter-traction from whatever direc-
tion it conies, there is a further difficulty in the fact that
the point of counter-traction (ischiatic tuberosity) is on
a lower level than the point of motion (acetabulum), the
effect of which arrangement is that motion will make a
change in the distance between the point of counter-
traction and the point of traction (lower end of femur)
with, of course, a change in the degree of traction. To
prevent these variations it is necessary to make the point
of counter-traction identical with that of motion, and on
reflection it will be found that in this way alone, which is
of course impracticable, can mobility be maintained with
equable traction.
It has been supposed that the use of India rubber
would facilitate the practical development of this idea.
Dr. Davis himself, in i860, described an ingenious ap-
paratus partly constructed of this material, but this de-
vice failed to secure general adoiition, and none of its
successors has as yet proven its value."
It is, indeed, desirable to adopt some theory in accord-
ance with which traction and counter-traction may be
transferred from empirical to rational medicine, but it
surely is not necessary to adopt an explanation which is
burdened with so many mechanical impossibilities.
The other theory also owes its origin to the fertile and
ingenious mind of Dr. Davis." He formulated it in iSCio,
as follows: "When I speak of extension I do not apply
the term to confining the limb in a given position, but to
the process by which the soft parts are kept continually
upon the stretch, whether by means of a weight or some
elastic material, the result of which process upon the
muscular fibre is to weary it and thus put it at rest." '
This idea has been entertained by a number of writers,
American and foreign, from whom the following quota-
tions are made : "It (India rubber) appears, by its un-
varying, constant, and yet not unyielding power, to tire
out the muscles." "By this force (continuous extension)
the muscles are tired out and soon made to capitulate."
"We must carry extension until the muscles relax, and
then we must maintain the extension until they lose their
irritability and the inflammation in the joint has been
given time to become retrogressive." "The object of
continued extension is to paralyze the muscles." " When
the muscular contractions are completely overcome, and
the muscles are thoroughly tired out, but little extension
is needed." "The object of extension is not, as gener-
ally supposed, to separate articular surfaces, but to over-
come reflex muscular contraction, and by relaxing the
muscular rigidity to prevent undue pressure of inflamed
articular surfaces." "Forcible traction being applied in
the axis of the thigh, the muscles are fatigued and over-
come and rendered incapable of contraction." "If pro-
longed and powerful traction be a|)plied to a muscle, it
will, after resisting for a time, at length yield and fall
into relaxation." " We must overcome the contractility
of the muscles governing the joint."
The idea contained in these quotations, no two of
which are from the same writer, is that traction and
counter-traction are curative because they deprive the
muscles of their contractilitv. Muscular fibre may lose
I Dr. Davis, who employed an elastic perineal strap, described his mvention as
follows : " Quite at the top and inside of the splint is an eye, throu,gh "h.ch runs
the catgut attached to the two ends of a perineal or extending band, "n<J f°™s
part of it when the whole is applied to the patient : the catgut, passing through
this eve unconfined, allows the upper portion o the *Pl'"'.><""/=j;" .^?.=„'; f^^
forth without disturbing the perineal band. .Ml that portion of the ^Phnt that
passes above the hip-joint has a motion of which the joint ,s the centre. i'V^'^
management, allowing the catgut to traverse in the eye of the splint, the pe meal
bandTs not disturbed by any motions of the hmb, and all irntation from motion is
avoided" (American Melical Monthly, p. 204, April, iSfa). .. ,.,u„ „„„
'Referring to "artificial muscles," Dr. Davis m ,856 wrote that . "hen cot^-
tracted musde is to be overcome, it (India rubber) stealthily we.aries it until t si-
lently comes off conqueror " (Am. Med. Monthly, p. 330, May, 1856) 'n ."859 he
related a case of hip disease in which, on the application of conunued traction the
muscles became " wearied, so as to allow the head of the bone to come down upon
the inferior portion of the acetabulum " (N. V. Journal of Med., p. 418, November,
1859).
• Am. Med. Times, p. 149. September i, i860.
512
THE MEDICAL RECORD.
[May 12, 1883.
its contractility from rupture or from degeneration,
but that it surrenders this high endowment to the
appHcation of traction is, to say the very least, ex-
tremely questionable. If an elastic force be used the
muscles to which it is applied would probably increase
in size and vigor from the exercise. If an unyielding
force be used we have already seen how great are the
mechanical difficulties to be overcome. But if it were
possible to grasp tlie femur and maintain unyielding
traction, the amount of stretching is necessarily limited
by the ligaments of the joint, and furthermore is extremely
minute when compared with the elongation to which the
muscles are accustomed in the ordinary motions of the
joint. When, for instance, the thigh is extended on the
trunk the flexors are of course relaxed and lengthened,
and this normal lengthening is so great that it is unrea-
sonable to suppose that the minute degree of stretching
which traction and counter-traction produce can deter-
mine any important change in the qualities of the mus-
cular fibre.'
It thus appears that this theory also contains points of
fatal weakness.
Which of these essentially different theories shall we
adopt ? Shall we say that the hip splint secures mobility
with traction or deprives the muscles of their contractility ?
Authorities are clearly divided. The fact that there are
two current explanations calls for caution before the
adoption of either and suggests the possibility that neither
is the true one. .Vnd if this possibility were to become
a certainty, and if fixation were recognized as the key to
the efficacy of traction and counter-traction, these condi-
tions would not lessen the value of the hip-splint or ma-
terially diminish the credit of those who have illustrated
American surgeryby its invention and use.
ELECTRO LY.S I. S IN THE TREATMENT OF OR-
GANIC STRICTURE OE THE URETHRA.
By J. H. GLASS, M.D.,
UTICA, N. Y.
The desideratum in the treatment of organic stricture of
the urethra has been an operation that would effect a
radical cure, thus avoiding to the patient the disagree-
able necessity of introducing a sound at certain intervals
(perhaps for a lifetime), as is now demanded by the recog-
nized operations. .'Although my individual experience in
the treatment of these cases by electrolysis is limited, I
have uniformly obtained results so flattering that in de-
fence of the operation I take the liberty to present an
abstract of them.
The somewhat meagre literature of this subject is so un-
satisfactory and conflicting that it seems to me to be the
duty of those who may have applied this method of treat-
ment to offer in evidence their experience. Should this be
(lone, the operation would soon be accorded the position
it deserves — either that of more general recognition by
the profession (which I believe it will have) or a more
general condemnation. The great variance of opinion
on tlie value of this operation is well illustrated by two
articles, one appearing in the A'f7i< York Medical Journal
tor December, 187 1, by Professor E. L. Keyes, the other
in the Archives of Electrology and Neurology, for May,
1 874, by Dr. Robert Newman. Respectively one reports
uniform bad results from its use, and uni|ualifiedly con-
denms ; while the other reports uniform good results and
most heartily commends the operation. As the opinions
of these two distinguished men may be said to be repre-
sentative of the opinions of most others who do, or do
not favor the operation, perhaps a cursory review of
them would not be out of place. Dr. Keyes says : " I
operated upon ten cases, and from that amount of ex-
^ Traction applied to the flexors by extension, as opposed to flexion, is not of
course relied on to deprive the muscles of their contractility, because in this case
there would be the obviously absurd application of traction to one set of muscles,
the flexors, and relaxation to tbcir opposites, the extensors.
perience, cannot but condemn the operation in toto. The
operation is disagreeable, often very painful, the pain
sometimes lasting several days, and vesical symptoms
were always aggravated when they pre-existed.' In all
but one of Dr. Keyes' cases the patient is reported as
having refused further operation or disappeared before
observations were completed.
In the remaining case the treatment was abandoned.
Granting that the operation is disagreeable and painful
as conducted by him, is there not something of incon-
sistency in so summarily condemning the efficiency of
the operation when viewed from a purely curative stand-
point? To the use of potential currents, prolonged ap-
plications, and too short intervals between applications
I think Dr. Keyes' failures maybe fairly attributed. The
distinctive feature of Dr. Newman's treatment, as com-
pared with that of Dr. Keyes, is the use of very mild
galvanic currents," just perceptible to the patient." The
current is passed but from three to five minutes. No
force is used in the manipulation of the bougie and long
intervals, two to four weeks, advised between applications.
As with others, the negative pole is used for the insulated
bougie, while the positive pole is applied to the thigh
through the medium of a sponge. Dr. Newman reports
over thirty cases, all of which resulted successfully. To
the adoption in the main of his principles of tieatment I
ascribe the successful results obtained in the folio tving
cases. However, some allowance may be made for the
fact that with one exception, my cases were uncompli-
cated and of large calibre.
Case I. — C. W. D , aged twenty-six ; single. First
gonorrhoea at twenty-one ; second and last attack con-
tracted at about twenty-five, since when he has had a
constant muco-purulent discharge. Otis bougie No. 12,
American scale. (Here I may remark, to prevent repeti-
tion, that all measurements hereafter given in this report
will conform to the American scale.)
January 5, 1880. — No. 13 held lightly against the
stricture and current from ten cells passed for five min-
utes, when the sound passed on into the bladder.
January 19th. — No. 13, after one minute's application,
passed and was followed by No. 14. which also passed
easily after three to five minutes.
February loth. — No. 14 passed without grasping. No.
15 passed after five minutes' application.
March 6th. — Patient called to say that he had had no
symptoms from his trouble for the past three weeks. On
examination 1 can discover no induration, and as No. 15
passes without grasping, this number representing the
maximum calibre of his urethra, he is discharged recov-
ered.
Case II. — B. S , aged eighteen ; unmarried. Two
gonorrhoeas, the last six months since. This case, in
all essentials being a duplicate of No. I., I will not fur-
ther detail it, suffice it to say that the recovery was com-
plete.
Case III. — J. J. H , aged thirty-one ; married.
This case is of interest from the fact that the stricture
developed from a bastard gonorrhoea, and could not have
been induced by potential injections, as they were never
used. While out on a duck-shooting excursion in the
fall of 1879 was severely chilled. Took considerable
diffusible stimulants. Coition with wife on his return
(who had a leucorrhcea consequent upon an anteflexion
of the uterus) was followed by a "bastard clap," which,
as he modestly remained away from a phvsician, has
continued to grow worse, until at this examination, Feb-
ruary ist, I find him with a resilient and irritable stric-
ture which admits with considerable grasping No. 13.
No. 14 passes under the effect of electrolysis in about
six minutes, with some pain.
February 13th. — Nos. 14 and 15 pass after five minute
intervals with inconsiderable pain.
March 7th. — No discharge. No. 16 passed under mild
current from ten cells.
,\pril lotli. — No. 16 Van Buren's sound passed with-
May 12, 1S83.]
THE MEDICAL RECORD.
513
out battery,
discharged.
Case IV.— W,
Third {lonorrhcea.
No perceptible induration. Consequently
aged nineteen ; unmarried.
Cannot explore urethra, as it is a case
of congenital occlusion with hypospadias three-fourths
of an inch posterior to the fr;unuin. With a long, nar-
row, and straight bistoury, made an artificial urethra to
admit a section of a No. 12 English catheter, which is
fortified with a tin canula inside to prevent its collapse.
This is kept in situ nearly two weeks, until February
2 1 St, when I explore his urethra to find a tortuous stric-
ture, about three-fourths of an inch long, occupying tliat
portion of the urethra just anterior to the bulbo-mem-
branous junction. No. 8 ])asses with considerable iiani,
also No. 9, after about ten minutes with rather strong cur-
rent from twelve cells. Well-marked chill during the night,
but no untoward symptoms after. On the fifth day a
cast of the urethra one-half inch in length comes away.
March 5th. — No. 9 passed with some pain. Twelve
cells.
March 24th. — Passed Nos. 9, 10, and 11 within fifteen
minutes. Twelve cells. Considerable |)ain. Some fe-
brile reaction during night and next day. Another small
urethral cast comes away.
March 28th. — Some cystic irritability with conseijuent
frequency and ardor in micturition. L'nder treatment
these symptoms rapidly subside.
April isth. — Passed without pain of note Nos. 11 and
12. Ten cells.
May loth. — Passed easily Nos. 12 and 13.
June 3d.^ — Passed Nos. 13 and 14.
June 27th. — Passed Nos. 14 and 15. No pain.
July 15th. — Dolbeau's operation was performed for
cure of the hypospadias. Result successful.
July 30th. — Slight narrowing of urethral calibre at
point of last operation. Passed No. 15. Ten cells.
August 20th. — No. 15 Van Buren's sound passes easily
without the aid of battery. Patient discharged.
Case V. — P. H. M , aged thirty-five ; married.
Fell from hay-loft eight months since, striking the peri-
neum on an inch board. Examination this day, April
ist, reveals an annular stricture of the membranous ure-
thra, which will pass a No. 9 bulbous bougie, with current
from ten cells. No. 10 passes after five minutes.
April 20th. — Nos. 10 and 11 pass without trouble or
pain worthy of consideration.
May i2th. — Nos. 11 and 12 pass easily. Patient says
he can now hold his water from three to five hours, and
it conies away in a good stream. When commencing
treatment was obliged to urinate frequently, proof posi-
tive that in this case, at least, vesical irritability was not
aggravated by the treatment by electrolysis.
May 2Sth. — Pass easily Nos. 12 and 13. Patient de-
clares himself cured.
June 2oth.^Pass Nos. 13 and 14 with ease.
July i8th. — Pass No. 14 Van Buren sound without
the aid of the battery. Patient discharged.
Cases VI. and VII. — April i6th. — Two young men,
aged respectively twenty and twenty-one, both unmarried,
came to me for treatment. I humored their request and
examined and treated them together. Together I will
report them also, as one will answer equally well for the
other and some time will be saved. Both attended the
same camp-meeting in the fall of 1879, and both, as they
rather inelegantly but tersely expressed it, were •' burnt "
by the same woman. Both tried the abortive treatment for
gonorrhoea and failed. Both, as examination proved,
had a double linear stricture of the pendulous urethra,
in each of which a No. 12 bougie was admitted. Passed
with ten-cell current No. 13 on each.
May ist. — D and P came together. Passed
on each No. 14 with mild current often cells. No pain
complained of by either.
May 20th. — D and P report decided im-
provement in their symptoms. Passed on each No. 15.
Ten-cell current.
and P-
-, No. 15 Van
June 2d. — Pass on each, I>-
Buren sound without the aid of battery. No induration
discoverable in either case, and as this number represents
the normal calibre of their resjjective urethras, both are
discharged recovered.
Case VIII.— May 30th.— F. E. S , aged fifty:
mairied ; wants to be relieved of his impotence, he says ;
gives history of gonorrhcea five years since. Has muco-
ptnulent discharge, etc. Found stricture of No. 9 calibre
at bulbo-membranous junction ; passed No. 10 with mild
current from ten cells ; complains of some pain, .'\fter
operation a considerable flow of muco-pus and cheesy
matter occurred which had evidently been dammed back
in the vicinity of the orifice — Covvper's duct — by the un-
disturbed stricture ; advise abstinence from any attempt
at sexual intercourse.
June 23d. — Nos. 11 and 12 passed without considera-
ble pain within fifty minutes.
July iSth. — Patient reports a good degree of sexual
vigor returned ; pass Nos. 12 and 13 with ease.
August 6th. — Patient reports progress ; pass Nos. 13
and 14.
September ist. — Pass Nos. 14 and 15 with usual mild
ten-cell current without trouble. No. 15 being the nor-
mal calibre of his urethra, nominally discharged him,
liighly gratified with his returned health and virility. Told
him to come for final examination in course of five or
six weeks.
Case IX. — August 2 2d. — M. B , aged twenty-
eight : married. Had first gonorrhoea five months since,
which still continues to trouble him ; meatus admits No. 9,
freely cut this. Further examination reveals stricture
of No. 12 calibre tw'o inches posterior to the meatus ;
pass No. 13 with mild current from ten cells ; no untoward
symptoms.
September 19th. — Can detect very little thickening;
pass No. 14 ; current as usual.
October 2d. — No thickening; pass No. 15 and dis-
charge him.
It will be noticed that all of the above cases were dis-
charged recovered from one year to eighteen months
since. By recent communication I find that in no case
has there been any return of stricture symptoms.
This, I think, justifies me in the claim that a complete
and radical recovery was effected in each case.
In view of these results, and the fact that of the more
than fifty cases I have treated by other methods, mainly
gradual dilatation, twenty-one percent., owing to neglect
of instruction given or other cause, have returned within
six months for further advice. I deem the above nine
cases treated by electrolysis a substantial argument in
favor of more extensive employment of the operation in
question.
K Historical Case of Acquired Autom.\tism. —
The venerable pianist, Franz Liszt, says the Ti?iies, has
ceased to play in imblic on account of the stiffness of
his finger-joints. The fact recalls the method by which
he used to keep his fingers supple, a method which is
also an interesting illustration of acquired automatism.
It was his custom for more than forty years to read a
mass immediately upon rising in the morning, and when
that duty was finished to seat himself at the piano. So
seated, he placed on the rack in front of him, not a mu-
sical composition, but some new work of French or Ger-
man literature, first being careful to mark the number of
pages which he intended to read. Then for a long time,
sometimes for two or three hours, he would continue to
read his book and practice scales. On one occasion,
being asked if the reading did not interfere with the play-
ing or the playing with the reading, he replied : " Oh,
no, the playing of the scales is entirely mechanical with
me, and simply exercises the fingers ; I give all my mind
to the reading, very much as do our good ladies who
knit stockings and read at the same time."
514
THE MEDICAL RECORD.
[May 12, 1 88:
i*vo0vcss of ^tccticuT J^cicucc.
Syphilitic Reinoculation. — Dr. Scavenzio relates the
case of a woman, thirty-tive years of age, who was under
treatment by the iodides for some of the tertiary manifes-
tations. All at once she was seized with a feeling of gen-
eral malaise, and in a short time presented a diffuse
syphilitic roseola and sore throat. In seeking a cause
for these new symptoms, Scavenzio ascertained that the
woman had had an indurated ulcer at the entrance of
the vagina, four months previously, which was followed
by a non-suppurating inguinal adenitis. The iodides
were stopped and injections of calomel given sub-
cutaneously. Under this treatment the new symptoms
promptly subsided. The author does not believe in an
acquired immunity against syphilis. He is inclined to
admit the possibility of auto-inoculation, wliich. he thinks,
would explain the great irregularity in the course and
duration of the disease, and also its liability to relapses. —
Lyon Medical, March 25, 18S3.
The Reparative Process in Cartilage. — Dr. (lies
opened the knee-joint in young dogs under strict anti-
septic precautions, and excised a piece of the articular
cartilage, taking care not to wound the bone beneath.
The operation was never followed by the slightest inflam-
matory reaction. After the animals were killed the wound
in the cartilage was seen to be surrounded by an
" atrophic zone," in which the cells were degenerated or
had disappeared. Around this was a " proliferating
zone," characterized by enlargement and segmentation
of the cartilage cells and an increase in the number of
nuceli. In no instance was there the least trace of a
reparative process. Incised wounds of the cartilage, even
after five months, showed no tendency to union. Here
also, as in the case of actual loss of tissue, were seen the
atrophic and hypertrophic zones parallel to the tissure.
In a second series of experiments, the knife with which
the cartilage was incised was previously dipped in a putrid
infusion. The results now obtained were the same as
those of other experimenters who operated without anti-
septic precautions. Proliferations from the inflamed
synovial membrane filled the wound in the cartilage with
round and spindle cells. Presently cartilage cells ap-
peared in the newly formed tissue, and in three months
the wound was entirely filled with hyaline cartilage, so
that scarcely any trace of the former injury could be dis-
cerned.— Centralblatt filr Chirurgie, February 17, 1883.
Removal of Warts by Cauteriz.-vtiox. — Dr. Cellier
recommends the following treatment for warts in the
Journal de MAlecine et de Chirurgie Pratiques for March,
1883. The base of the wart is transfixed by an ordinary
pin, care being taken not to pierce the healthy tissue be-
neath. Then, the skin being protected, the head of the
pin is held in the flame of a candle. In a few minutes
the wart becomes white and fissured, and comes away on
the point of the pin. The procedure is said to be pain-
less as well as bloodless. The curious assertion is made
by Dr. Cellier that it is necessary to remove but one wart
on the hand, and all the others (sometimes even a dozen
or more) will disappear without treatment.
Arsenical Paralysis.— Dr. C. K. Mills relates a
^ case of paralysis following arsenical poisoning in a young ^
\Sr mail tweiHy-four years of age. The patient was in good
health prior to the time of eating the food which'con-
tained the poison. The first symptoms were repeated
attacks of vomiting and a sense of great prostration. The
bowels were confined. Six days after the arsenic had
been taken a sensation of aching and numbness about
the knees was comi^lained of. This extended gradually
toward the feet. 'I'hree days later the same sensations
were experienced in the hands. Paralysis of the legs
soon set in, and there was also some loss of power in the
forearms. The patient's condition now remained station-
ary for two or three weeks, when he began to suffer great
pain. The pains began in the knees and gradually in-
vaded the legs and feet. Two days later the hands were
affected in the same way. The following was his condi-
tion ten weeks after the poisoning : There was no brain
symptoms and no disturbances of sight, hearing, taste, or
smell ; emaciation was marked ; paralysis below the el-
bows was not complete, the extensors and supinators
being most aftected ; there was somewhat less power in
the right limb than in the left ; the elbows were flexed at
right angles and could not be wholly extended without
causing jiain in the flexor tendons ; both legs were com-
pletely paralyzed below the knees ; the knees were not
flexed ; the bowels were torpid, and for a few days
there was a little dribbling of urine, but this soon passed
away ; farado-contractility was abolished in all muscles
below the knees ; above the knees the faradic reaction
was greatly diminished, but not wholly absent ; the mus-
cles below the knees would not respond to weak galvanic
currents : to medium currents they responded, but
showed the reactions of degeneration. In the upper ex-
tremities farado-contractility was decreased, but not lost.
To the galvanic current the reaction of degeneration was
present, but not so decidedly as in the legs ; the patellar
reflex was abolished ; the cremaster reflex was marked ;
irritation of the right lower extremity, as far down as the
malleolus, caused retraction of the right testicle, and oc-
casionally of both. Irritation of the left thigh and leg
caused a less vigorous retraction of the left testicle, and
occasionally, a moment later, slight retraction of the right
testicle also. Irritation of one limb never caused re-
traction of the testicle on the opposite side only. The
fingers and forearms were hyperajsthetic, but there was
inability to distinguish between one and two points of
the a;sthesiometer. This condition was more marked in
the feet and legs. Dr. Mills concludes from his analysis
of this case that in arsenical paralysis we have to deal
with a diffused myelitis, decided motor, trophic, and sen-
sory bilateral phenomena being present.
iMMiJNiTY OF Animals from Syphilitic Inocula-
tion.—Professor Neumann has made a number of ^-
tempts to inoculate animals with syphilis, but without
success. The experiments were made w-ith the greatest
care, the virus being taken directly from the diseased;
person and introduced into the body of the animal. The
animals experimented upon were kept under observation
for a considerable period of time after the inoculation.
In no case did any results obtain other than those which
would naturally follow the introduction of an irritating
material into the tissues. Nothing that bore any resem-
blance to a chancrous tumor was observed. The ani-
mals employed in these experiments were three apes, '.'♦■
three rabbits, a horse, a hare, a wVite rat, a marten, and >' »»
a cat. The total number of inoculations was fifty-four. '
Neumann concludes from these experiments that we
must regard syphilis as distinctly a disease of man. —
Aled. CentralZeitung, January 24, 1883.
Oper.\tive Measures in Acute Peritonitis. — Dr.
Reibel relates the case of a child, eight years of age,
suftering from acute idiopathic peritonitis. The disease
having resisted all treatment and the child being ap-
parently about to die, it was determined to open the
abdomen with a view to removing the fluid and washing
out the peritoneal cavity with a solution of carbolic acid.
The meteorisni was intense. No fluid was found in the
abdominal cavity. In prolonging the incision, a loop of
intestine was punctured, as evidenced by the escape of
gas and intestinal fluid. The wound was washed with
carbolic acid and covered with a layer of antiseptic cot-
ton. The following day the little patient was nearly free
from pain and was able to retain a little milk. The tem-
perature had fallen from 104^ to loi^ and the tympanites
was almost entirely relieved. The loop of intestine was
adherent to the abdommal wall, and there had been no
escape of fluid into the peritoneal cavity. The patient
May 12, 1883.]
THE MEDICAL RECORD.
515
made an excellent recovery. Inspired by his success in
this instance, DK Reibel formulates the following rules
for the surgical treatment of peritonitis in cases where
life is threatened. by an extreme degree of tympanites:
I. Open the abdominal wall by an incision about an
inch in length. 2. If adhesions have formed between
the two layers of tlie peritoneum, make a little puncture
in the presenting loop of intestine. 3. If there are no
adhesions, cover the wound with a carbolized compress
and wait a few hours until adhesions form, before open-
ing the gut. 4. In the latter case, if the meteorism be
urgent, a few punctures may be made with a fine trochar
at once. The author does not regard the puncture of
the intestine through the abdominal wall, as ordinarily
practised, as of much utility. He thinks that the in-
testinal walls have lost their elasticity through over-
stretching and cannot expel the gas through a tine
canula. — Journal de Medicine de Paris, February 17,
18S3.
Lipoma of Traumatic Origin. — The following case
is related by Dr. Kolliker in the Ceiitralblatt fiir C/ii-
rurgie or Ma.rc\\ 17, 1883 : A man was struck upon the
left shoulder by a brick falling from a considerable height.
When seen a few hours later, there was a tumor of about
the size of a fist, formed of extravasated blood, over the
outer third of the clavicle. This was reabsorbed in about
six weeks. Three weeks later the patient presented him-
self again on account of a lipoma, which was growing
rapidly, in the exact location of the previous ecchymosis.
The tumor was removed shortly afterward and meas-
ured one inch in height by two and one-half inches in
width. Kolliker thinks that possibly there may have
been a small lipoma in this situation previous to the
injury, though the patient denied positively ever having
himself noticed a tumor there.
Fatal Purpura Hemorrhagica. — Dr. Rongon re-
lates the following case in Z' Union Mi'dicale, No. 1 7,
1883. A naval officer, sixty-four years of age, had suf-
fered for several years with glycosuria in a mild degree.
In the summer of 1882 he received a severe^^hock in
learning of the sudden death of his daughter. Other
troubles weighed ui>on his mind, and he became very
despondent. Soon afterward he was seized with a profuse
hematuria. This was followed by a deep hemorrhage in
the scapular region. Purpuric spots made their appearance
upon the abdomen and thighs. A few days later a sud-
den increase in volume of the right lower extremity was
observed by the medical attendant, the left limb remain-
ing of normal size. This was supposed to be due to
hemorrhage, and the supposition was confirmed the fol-
lowing day by the discoloration of the skin. Hematuria
and extravasations i^i various parts of the body continued
until the death ofl^^e patient in syncope, thirty-seven
days after the first symptoms had manifested themselves.
Cold Abscess of the Tongue. — A woman, thirty-
five years of age, presented herself with a swelling upon
the right side of the tongue. The tumor was the size of
a walnut, soft and fluctuating, and not painful on press-
ure or manipulation. It had appeared, without any
known cause, four months previously, had attained its
present size in about a month, and then remained
stationary. The patient's general health was excellent.
Dr. De Krun incised the tumor, which gave exit to a
quantity of thin pus. The sac was dissected away and
the wound closed with sutures. Union was comiilete in
a few days. — La France Mcdicale, No. 14, 1883.
Purulent Inoculation in the Treatment of
Granular Lids. — Dr. Terrier formulates the following
conclusions to an article on this subject in the Revue de
Chirurgie for February, 1883 : i. Purulent inoculation
is a good method of treatment of old conjunctival granu-
lations with pannus. 2. It is indicated where the [)annus
is thick. But corneal ulcerations and pannus tennis are
contra-indications to its employment. 3. In pannus.
granular or not, affecting one eye, the procedure is to be
practised with the greatest care lest the sound eye be in-
oculated. 4. The pus to be used is that of ophthalmia
neonatornm. When this cannot be obtained gonorrheal
pus may be employed. 5. No attempt should be made
to abort the induced ophthalmia, but it should be treated
judiciously, with a view to prevent permanent injury to
the cornea. 6. Sulphate of copper, nitrate of silver,
yellow precipitate, ointment, or calomel insufflations are
frequently indicated in order to complete the cure. 7.
In exceptional cases it will be necessary to resort to
syndectomy or iridectomy.
Spontaneous (tAngrene in a Young Subject. —
A young man, twenty-four years of age, of healthy ap-
pearance, entered the Charite Hospital, suffering from
gangrene of the lower extremity. The lower part of the
left leg for about three inches above the malleoli was of a
livid hue. The foot was of a purplish black color, and the
skin upon the dorsal surface was raised in a dark bleb.
The temperature of the foot was 72^, while that of its fel-
low was 96". Sensibility of the affected member was lost.
At the commencement of the trouble there was some
fever and anorexia. lUit this soon passed away, and
with the return of appetite the general health seemed
good. The origin of the aff'ection was obscure. There
was no history of traumatism, but the patient stated that
a few months previously he had been obliged to work
while standing on the wet ground. About six or eight
weeks before his admission to hospital he began to feel a
sensation of numbness and formication in the left leg.
Soon afterward he found that he was unable to bear his
weight' upon this limb. The patient appeared to be in
excellent general health, and no dyscrasia was discover-
able to account for his condition. Examination of the
urine gave negative results. By way of exclusion, Dr.
Berger was led to attribute the gangrene to an acute
arteritis, induced by the prolonged action of damp cold
to which the patient had been exposed. — Gazette des
Hopitaux, No. 14, 1S83.
The Spleen as a Blood-Producing Organ. — Dr.
Korn has conducted a number of experiments to deter-
mine the part played by the spleen and bone marrow in
the formation of red-blood corpuscles. He practised
repeated small blood-lettings upon pigeons. Changes in
the blood after this procedure were constant. It became
of a darker color, clotted more readily, and contained a
greater number of white corpuscles. The bone-marrow
was more red, contained less fat, but presented a very
large number of undeveloped red-blood corpuscles.
These results were the same whether the spleen had been
extirpated or not. When present, this organ was
anamic. Dr. Korn concludes from these experiments
that the spleen performs no function in the reproduction
of red-blood corpuscles in birds. And in this he is in
agreement with Neumann, who has arrived at the same
conclusions in respect to animals.- — Deutsche Medicin-
ische Wochenschrift, No. 6, 1883.
Climacteric Dyspepsia. — Mr. Prangley, in ihc British
Medical Journal, describes a form of dyspepsia which he
terms climacteric. It occurs in women between the ages
of forty and fifty. The symptoms are those of great
nervous depression, with pain on the top of the head,
noises in the ears, hot flushes and chills, with curious
sensations in the abdomen. The dyspeptic symptoms
are those of precordial distress, with palpitation, costive
bowels, coated tongue, and foul breath. The treatment
consists of the administration of bismuth, bicarbonate of
potash, and ammonia, adding valerian if the nervous
symptoms predominate, followed by quinine, strychnia,
and dilute nitro-muriatic acid.
Quarantine on Texas Border. — The health officers
of Brownsville, Texas, have arranged with the Mexican
authorities to establish a quarantine at Bagdad.
5>6
THE MEDICAL RECORD.
[May 12, 1883.
The Medical Record-.
A Weekly yoicrnal of Medicine and Sia-gcry.
GEORGE F. SHRADY, A.M., M.D., Editor.
Published by
WM. WOOD &. Co., Nos. 56 and 58 Lafayette Place.
New York, May 12, 1883.
THE CENSORSHIP OF MEDICAL COLLEGES.
The Illinois State Board of Health has established a
reputation as censors of the standing of medical colleges
and for energetic work in the matter of regulating the
practice of medicine. Despite some serious charges with
regard to its action toward the Columbus Medical Col-
lege, we believe that the Board deserves the good name
that it has obtained. Its rulings as to the status of our
country's numerous medical institutions have been pro-
ductive of considerable good. At its recent quarterly
meeting the Board resolved to recognize the Indiana
Eclectic Medical College and the Joplin Medical Col-
lege, and not to recognize the diplomas of the United
States Eclectic College of this city.
The Secretary, in commenting upon the work of the
Board in its relation to medical practice, sa\s :
"Since the last meeting many letters have been re-
ceived from colleges, both in this and in other States,
asking specific information as to whether the Board
would recognize diplomas if issued to certain students
under the circumstances as detailed. A number of
inquiries, both official and personal, have also been
answered concerning the standing of colleges in various
parts of the country, and the value of their diplomas in
this State as entitling to practice. This correspondence
marks an increasing sense of accountability in the teach-
ing or educational department, and of its responsibility
under the law. If this sense can be sufliciently quick-
ened it may correct some of the evils arising from the
want of an examining body independent of the colleges,
and there is reason to hope for such result in the prog-
ress already made."
The Secretary then refers to the fact that many
medical colleges by no means carry out even the mini-
mum requirements announced in their catalogue. Dr.
Ranch says :
" .\s a result of my own official e.xperience during the
past si.\ years, I think it entirely within bounds to say
that a strict adherence to their advertised recjuiremcnts
is the exception among colleges rather than the rule.
In fully three-fourths of those which have come under
my observation there have been irregularities of more or
less gravity."
We have every reason to believe that there is no e.^-
aggeralion in the above statements. The announce-
ments made by many medical colleges too often possess
the same literary style and moral value that we find at-
tached to patent medicines. In fact, it seems as if the
profession greatly needed a body of censors who should
inspect our colleges and compare the glittering state-
ments in their circulars with the cold actuality. College
corporations are sadly in need of some reminder that the
moral law includes them as well as the individual doctor.
In the report to which we have alluded several illustra-
tions of the difterence between the letter and the spirit
of college catalogues are given :
" An official proceeding required that Dr. , a
graduate of one of the most popular and widely known
colleges in the countr}-, detail his acquirements in phar-
macy. He was asked what experience he had had in
compounding medicines, and replied that he had had
none. ' Did you not put up prescriptions under j'our pre-
ceptor while a student?' 'No, sir; I didn't have any
preceptor.' ' Why, I supposed that medical colleges re-
quired that their graduates should have read or studied
medicine under a preceptor for three years. How did
you get through? How did you graduate?' 'Well, I
attended two courses of lectures, paid the fees and got
my.diploma.' "
The following communication from Dr. was re-
ceived by the Secretary :
. 111.
To the Secratary State boar of health Deear Sir I sent
you my dipluma early last March and have not heard
from it sine did you receive it or do you know anything
about it I am becoming quite anxious concerning its
safty My dipluma is from Medical College
dated 1882 I also sent you a
letter containing a one dollar bill to pay for the certiffi-
cate If you will give me the information I requist I shall
be greatly obliged to you
Your's verv respectfully
M. D.
In the annual announcements of the college which is-
sued this diploma, among the regular requirements for
graduation one is stated to be " such primary education
as is clearly requisite for a proper standing with the pub-
lic and the profession ; " and another that " he must have
pursued the study of medicine three years.''
Continuing his argument upon this subject, the Secre-
tary makes the following strong statement: "Aside from
its legitimate function as a medium of information to
the student concerning his studies, the annual announce-
ment, so lavishly scattered throughout the country, is
often prostituted to advertising the college and the
claims of the individual members of the faculty, in terms
and manner diftering little, if any, from those of the
ordinary advertising quack. In the course of the past
six years I have carefully examined nearly all the an-
nouncements issued in this country, and do not hesitate
to say that many of them are of such a character that if
a private iJractitioner had been guilty of publishing a
professional card making such claims and couched in
such terms, he would have been expelled from almost
any medical society for a gross violation of ethics."
It is scarcely necessary to emphasize the importance
of the foregoing. It means that the physicians who
are annually flooded with college circulars must read
many of them at least with large reservations — a fact
which is not creditable to the medical teachers of our
country.
May 12, 18S3.]
THE MEDICAL RECORD.
517
THE DIAGNOSTIC SIGNIFICANCE OF VENOUS PULSA-
TION.
The existence of pulsation in the jugular veins has usually
been regarded as of evil prognostic import. It has been
held by some authorities to indicate tricuspid regurgitation.
Others see in it a sign of insufficiency of the venous
valves alone. The former regard it as a ventricular
pulse, the latter as one caused by auricular contraction.
Nearly all, however, have been agreed in the assumption
that it is due to a backward current in the veins, .^nd
all have admitted a failure in the venous valves, fiani-
berger and others even went further, and asserted that
the real cause was to be found in a defective auriculo-
ventricular opening.
.\ very careful sphygniographic study of the phenome-
non in question has been recently made by Dr. t'ranz
Riegel {Volkinaitif s Klinische Vortrage, March 13, 1883).
As a result of his labors the author is led to oppose both
these views. He contends that a true venous pulse, not
transmitted from the neighboring artery, may and often
does exist in health. This pulsation is produced not by
a backward, but by a forward current. It is caused by
the auricular diastole. The blood being drawn in from the
distended veins by the suction force of the dilating auricle,
there is produced a partial collapse of the vessels, which
become again distended during the auricular systole. So
that this pulse, indicative of no disease, is really but the
expression of the alternately hastened and retarded How
of blood to the heart.
This normal venous pulse may be readily differentiated
from that of tricuspid regurgitation by the time of its oc-
currence. It beats alternately with the carotid pulse.
The auricular diastole occurs at the time of the ventri-
cular systole, and consequently the period of arterial
fulness corresponds with that of venous collapse. The
venous tracing of tricuspid insufficiency begins to ascend
prior to the ventricular systole, reaching its highest point
just after that of the arterial tracing has been attained.
At the ventricular systole the blood is forced backward
into the auricle, as well as forward into the pulmonary
artery, and the former being thus filled from the ventricle,
its diastole causes no venous collapse. It is only when
the ventricular diastole occurs that the pressure upon
the veins is relieved sufficiently to cause a sinking of the
sphygniographic curve. This is the pulse of tricuspid
regurgitation, as it occurs when the heart beats with lull
strength. When the cardiac contractions are weak, a
modification of the tracing is observed. In such cases
the ventricular contraction is insufficient to fill at once
the dilating auricle, and we have a momentary fall in the
venous curve. The auricle is more rapidly filled, how-
ever, than under normal conditions, and we see in con-
sequence a second rise in venous pressure, the second
fall occurring only at the ventricular diastole. The
jugular pulse of tricuspid regurgitation with a weak heart
is therefore dicrotic.
Still another venous pulse is noted by Dr. Riegel. It
is met with in cardiac and pulmonary affections which
lead to engorgement of the right side of the heart. The
tricuspid valve is here normal, and consequently the pulse
corresponds exactly in time with that occasionally seen
in healthy individuals. It is a very distinct pulsation,
and this is its characteristic. And it is only by its
creater size that it is to be distinguished from the normal
pulse. These investigations were conducted apparently
with <Jreat care, and the conclusions derived therefrom
are doubtless correct. But as to their practical value in
a diagnostic sense there is room for doubt. Very few
practising physicians, we imagine, are provided or will
provide themselves with the delicate and expensive ap-
paratus necessary for recording simultaneously the carotid
and jugular pulsations. And although the author gives
directions for making these observations by the aid of
touch and sight alone, the possibility of error in judging
of minute fractions of time is too great to render such ob-
servations of much value.
THE L.ATE STATE LEGISL.ATURE.
The State Legislature which adjourned last week was,
so far as matters of medical interest are concerned, most
remarkable for what it failed to do. There are two bills
in particular which the profession will regret to learn
failed to become laws. These were, the bill providing
for a State Board of Medical Examiners, and another
making better provisions for the conmiitment and care of
lunatics. There were three bills presented bearing upon
this latter subject, and all were lost through some delay,
or inadvertance, none of them reaching the stage when
they could fairly be beaten in legislative session. A bill
abolishing coroners' juries shared the same fate.
It is unfortunately the fact that all bills which contem-
plate some reform and improvement are most difficult to
carry, for, while many are agreed that they are admirable,
no particular individual is sufficiently interested to urge
the matter systematically. The medical profession is
greatly in need of competent representation at .Albany.
Among the three or four hundred bills which became
laws, there are none which have any medical or sanitary
matters, if we except the law which prohibits the manu-
facture of cigars in tenement houses, and that which re-
gulates the farming out of infants.
It is, perhaps, a matter of congratulation that at least
no bad bills were passed, and particularly that no charters
for cheap medical schools were given. Some credit is
due the Committee on Legislation of the State Medical
Society, that this latter was prevented.
PETER AND PASTEUR.
The opposition to Pasteur and his doctrines has hitherto
proceeded chiefly from across the Rhine. It has very
promptly been attributed, by his own disciples at least, to
national jealousy and Teutonic prejudice. But now an
attack has been made upon him from within the camp,
and he has been challenged by his own countrymen to
substantiate his claim of having materially advanced the
science of medicine. At a recent meeting of the Acade-
mie de Medecine, Dr. Peter varied the monotony of the
customary discussion of typhoid fever, by branching off
upon the germ theory of disease and the practical value
of Pasteur's researches. He did not attack the germ
theory itself ; nor would he deny that the discoveries of
this investigator had led to most useful and practical
results in both obstetrics and surgery. It was to minds
inspired by the theories of Pasteur, he said, that we
owed the conception of antiseptic surgery. A prevalence
5i8
THE MEDICAL RECORD.
[May 12, 1883.
of the same ideas had led to the adoption of certain pre-
cautions by means of which puerperal fever had become
a far less common disease than in former times. Hav-
ing said this much, however, he had said all. Further
praise would be but flattery.
He maintained that the discovery of the material ele-
ments of contagion had, thus far at least, thrown no light
upon the pathological anatomy, the evolution, the treat-
ment, or, above all, the prophylaxis of contagious diseases.
What, asked M. Peter, is the ultimate object of Pas-
teur's methods? To attenuate the virus by the action
of air and of time, and then to vaccinate with this stale and
weakened contagion. Now this is not vaccination at all,
he went on to say, but inoculation — a much more serious
matter. For the weakened virus is very uncertain in its
eftects, and is likeh' to create new centres of contagion.
It may even, notwithstanding its "attenuation,"' induce
a mortal disease. The hrst inoculation, with virus of
greatest dilution, does not confer immunity, as Pasteur
himself admits. And the second, with strong virus, often
kills the animal whose prospective safety it was intended
to insure. The admission, by Pasteur himself, that the
vaccination was protective only for a limited time, was
commented upon in a jocose strain by the speaker, and he
pictured to his auditors the woes of the future man, forced
to protect himself anew every year, by a course of vacci-
nation, against a multitudinous variety of ravenous bac-
teria. M. Peter confessed with a chuckle that he had
designedly turned the discussion in the Academy from
typhoid fever to germs, and he e.\pressed himself as con-
fident of victory in the battle which was now fairly begun.
His argument against the utility, or indeed the safety, of
Pasteur's vaccinations was a strong one, and was sup-
ported by numerous facts. But arguments may be falla-
cious, and facts are apt to be variously interpreted. Yet,
as M. Bouley announced his intention of speaking in de-
fence of this doctrine, in which he is an ardent believer,
the discussion bids fair to become an interesting one.
CAN THE MEAN DURATION OF HUMA.V LIFE BE PRO-
LONGED ?
A MOST important deduction has recently been made
regarding the possibility of extending the duration of
human life. In a paper read before the London Sta-
tistical Society, Mr. Xoel .\. Humphreys discussed the
question: Has the duration of life in England in-
creased during the last thirty years? It is now nearly
thirty years since the late Dr. Farr published his " Life
Tables," based on statistics covering a period from 1838
to 1854. His conclusions were that the mean after-life-
time of males at birth was 39.9 years, and that of females
41.9 years. According to the new tables jiresented by
Mr. Humphreys, covering the period from 1S76 to 18S0,
this life-period is now for males 41.9 years, for females
45.3 years, representing a prolongation of life of about
two years, or a five ])er cent, increase.
The statistics, when further analyzed, show also that
over two-thirds of this prolonged life is for the working
period between the ages of twenty and sixty years, thus
apparently refuting an assertion which has been widely
circulated, that the improvement effected by science
consistL " in the prolongation of the passive endurance
of life rather than an extension of the power of true
vitality, or any increase of the op|JOrtunity for good work
and for intellectual enjoyment."
These conclusions are, as is remarked by the British
Medical Journal, well calculated to encourage sani-
tarians, and to give a fresh impetus to the propagation
of the gospel of proi'liylaxis.
It would be interesting to learn, however, how much
of this increase is due to preventing zymotic diseases and
how much to an actually greater vital stamina. We
suspect that the zymotic factor is the chief one in securing
the present favorable results.
Hospital for Contagious Diseases in Brooklyn.
— Brooklyn Health Commissioner Raymond will address
a communication to the Board of Audit at the meeting of
that body, to be held on Tuesday next, recommending
the insertion in the tax budget of an amount sufficient to
erect suitable structures for the treatment of persons af-
flicted with contagious diseases, and whose means will
permit of their paying their own expenses.
The Rejection of Dr. Charles F. Chandler as
President of the Board of Health of this City. —
On Wednesday, Mayor Edson nominated Dr. Charles F.
Chandler as President of the Health Board. The nomi-
nation was rejected by the Board of .\ldermen by a vote
of 13 to 10. Mayor Edson, in common with many other
friends of sanitary reform, believes that the rejection was
due to personal enmity caused by fidelity to duty. Dr. C.
had been a faithful officer, and in the exercise of his au-
thority as such naturally gave offence to some who would
not willingly submit to sanitary regulations.
The State Board of Health at Albany on Wednes-
day elected Dr. E. M. Moore, of Rochester, president,
and Dr. Elisha Harris secretary. The president reap-
pointed all the committees of last year.
Dr. Maurk e Krishaber, well known as a laryngolo-
gist, recently died in Paris.
The University of Pennsylvania has arranged for
a voluntary fourth-year course in its medical department.
The North Carolina State Medical Society will
meet at Tarborough on Tuesday, May 15 th.
Regulating the Practice of Medicine in New
Jersey. — The New Jersey Legislature has passed a sup-
plementary act compelling the registration of all persons
practising medicine in that State. The provisions for
regulating medical practice are now very complete.
The Care of the Ins.ane in Pe.nnsylvania. — It
seems that, ever since last January, when it was announced
by a Philadelphia editor that the insane of his State were
beautifully and lovingly cared for, a succession of charges
against various insane asylums and the State lunacy laws
have aijpeared. The latest refers to the Blockley Alms-
house at Philadelphia. ' The mortality among the insane
occupants being very great, the matter was investigated by
Dr. Richardson. He reports that the sewage from
nearly one hundred persons was dumped into the cellar
May 12, 1883.]
THE MEDICAL RECORD.
519
from which the air-supply was drawn. He also found
that the buildings were not properly warmed, the reason
being that the boilers were in such a condition that the
inspector refused to permit a sufficiently high tempera-
ture to be carried to produce the necessary heat.
" VVe should be glad to know," says The Sanitary En-
gineer, " who is responsible for this disgraceful condition
of things. Have they another ' Tewksbury ' establish-
ment in Philadelphia ? "
Death of I^r. Henry B. Wilbur. — Dr. Henry B. Wil-
bur, Superintendent of the State Idiot Asylum at Syracuse
since its foundation, who died suddenly at the asylum
May ist, aged sixty-three, was a native of Weklen.
Mass., and the pioneer educator of idiots in this coun-
try. He established the first asylum in his own house
in 184S. He took charge of an experimental sta-
tion at .■\lbany in 1S51, and of the State institution in
Syracuse three years later. He was a graduate of Am-
herst College, and a physician in his early life. In late
years he had been actively concerned in lunacy reform,
and was for several years President of the National As-
sociation for the Prevention of Insanity and the Protec-
tion of the Insane.
Medical College of Virginia. — -The Court of Aj;-
peals of Virginia, in the case of a petition for mandamus
to compel the old Board of Visitors to the Medical Col-
lege of Virginia to surrender to the newly appointed
Board full possession of the buildings, property, etc.,
has rendered its opinion, which is, that Governor Cam-
eron had no authority to appoint a new board under the
charter granted the college years ago ; that he can
only fill vacancies as they occur by death, resignation,
removal from the State, etc. ; that the Legislature alone
has power in the premises to authorize the dismissal of
the old, and the appointment of a new board, etc.
This puts the management, says the Virginia Medical
Monthly, practically in the same hands that it has been
in during the past.
The Supporters of Brand. — Twenty-two physicians
of Lyons who believe in and practise the " Brand "
method of treating typhoid fever, have tendered AL Bou-
ley a banquet for his eloquent defence of this method,
and of Pasteur and experimental medicine, before the
French Academy of Medicine.
^cvovts of J»octctics.
MEDICAL SOCIETY OF PENNSYLVANIA.
Thirty-fourth Annual Session, held at Norristown, Pa.,
May 9, 10, and 11, 1883.
(By Telegraph to The Medical Record.)
The delegates had not arrived in sufficient numbers on
Wednesday morning to make the o|)ening session of the
Thirty-fourth x'\nnual Convention of the Medical Society
of Pennsylvania other than the medium for the trans-
action of routine business.
The Society was called to order at nine o'clock, in
Music Hall, the opera house of Norristown, by its Presi-
dent, Dr. William Varian, of Titusville, who made a
few appropriate remarks.
In the absence of Rev. Jos. McCaskey, who was ex-
pected to offer an opening prayer, the divine blessing was
invoked by Rev. Mr. Twedell, of Norristown.
The list of delegates was then read by the Secretary,
Dr. William B. Atkinson, of Philadelphia, about forty
responding to their names.
ADDRESS OF WELCOME.
An address of welcome was then delivered by Dr.
Hiram Corson, of Norristown, after which the Com-
mittee on Arrangements reported the programme.
reports of delegates and committees.
The report of the delegates from the Society of Penn-
sylvania to the American Medical Association at St.
Paul last year, signed by Dr. William Varian, the chair-
man of the delegation, was then read and adopted. Dr.
Marshall was introduced as a representative of the Dela-
ware State Medical Association. Dr. William B. Atkin-
son, of Philadelphia, the Committee on Publication,
then reported that the proceedings of the last meeting
of the Association at Titusville had been duly printed.
preliminary medical examinations.
The report of Dr. O. H. Ali.is on schedule of sub-
jects for preliminary medical examinations was then
read. After some debate, it was referred to a committee
of one from each county society.
The reports of the various county medical societies
were then read and referred. As an amendment to the
printed rules, it was resolved that they be so amended
as to allow a suspension of the rules by a two-thirds vote
of the members present.
endorsing the code of ethics of the American
medical association.
Under the head of New Business, Dr. H. H. Smith, of
Philadelphia, offered the following ;
Resolved, That the State Medical Society of Penn-
sylvania reafiirms its approval of and adhesion to the
Code of Ethics adopted by the American Medical As-
sociation.
Resolved, That organized opposition by a local so-
ciety and by mdividuals to the Code ajiproved by the
medical profession of the United States is rebellion
against the constituted authorities, and should be so
treated.
Resolved, That the Secretary be instructed to forward
a copy of these resolutions to the Committee of Ar-
rangements at Cleveland, O., for presentation to the As-
sociation.
Drs. W. Atlee and F. Woodbury, of Philadelphia,
and E. Fallen, of Athens, spoke on the resolutions, in
the passage of which much interest was manifested. The
resolutions were carried, after which thanks were re-
turned to Dr. Corson for his address.
Dr. Benjamin Lee, of Philadelphia, made some re-
marks upon the aftection known as
writers' cramp,
or writers' palsy. He considered that these were two dis-
tinct affections, the one a true cramp, the other a paralysis,
or rather an exhaustion of certain muscles of the arm and
hand. Both were recognized by physicians as being very
intractable, especially when they have existed for a con-
siderable length of time. A number of appliances have
been invented to enable persons suffering from them to
hold and use the pen. Dr. Lee presented two such, one a
modification of his own of the instrument devised by the
famous French surgeon, Velpeau, which he considered
as more applicable to those cases in which exhaustion or
paralysis was the prominent feature. It consisted of a
pear-shaped piece of wood, to be lield in the |)alm of the
hand, with a shank passing down to the end of the index
finger, to which are attached metallic rests for the fingers
and thumb and rings to hold the first two fingers tirmly
in the instrument ; the pen is held below the index finger
in very nearly the ordinary position. The other had been
introduced to the profession by Professor Nussbaum, of
520
THE MEDICAL RECORD.
[May 12, 1883.
Munich, during the past year, and is called by him
bracelet for writers' cramp. In Dr. Lee's experience it
was especially adapted to those cases in which a true
cramp is the prominent feature of the case. The one ex-
hibited was imitated from a pattern sent from Germany
and made under the inventor's direction. It consisted
of a ihin band of hard rubber, about an inch and a half
broad and large enough to take in the thumb and three
fingers when stretched out quite straight. On the back of
this band the pen was attached in such a way that its
•direction -to the paper and length could be regulated.
Professor Nussbanm's theory was that the e.xtensors of the
fingers were the seat of the disease and not the flexors,
as usually supposed, and he believed that this appliance
would, by compelling the extensors to act, not only
prove a means to enable the patient to write, but also
aid in curing the disease. Dr. Lee read an extract from
a letter from a patient who had been using this bracelet
for several months, in which he testified to the ease with
which he was enabled to write by its means. Specimens
of the patient's writing, both witii and without the bracelet,
were shown and fully sustained his favorable report.
At the opening of the afternoon session, Dr. William
M. Welch, of Philadelphia, read by request his volun-
tary paper on the
WEARI.>iG OUT OF VACCINE PROTECTION
and the efficacy of revaccination. Dr. James Tyson,
who was to deliver the opening address of the afternoon,
not having arrived at that hour. The substance of the ad-
dress of Dr. Welch, who is the [physician in charge of the
Municipal Small-pox Hospital, was as follows :
Jenner's belief in the identity of small-pox and cow-pox
has led to experiments by Thiele, Bodcock, Voight of
Hamburgh, and others who have successfully transformed
variola virus into vaccine in the body of the bovine
animal.
The belief in the identity of variola and vaccinia led
to the idea that they can be coinnumicated to a person
but once in a lifetime. Jenner believed that vaccination
was as complete a preventive of small-pox as one attack
of that disease was of anotiier. Learned Medical So-
cieties, in the early part of this century, emphatically
denied with Jenner the necessity of revaccination.
However, although very many physicians still believe in
the absolute efficacy of early vaccination, which leaves a
well-defined cicatrix, I am convinced of the fallacy of
this, and propose to show, first, the susceptibility to
small-pox, however thoroughly destroyed by vaccination,
may subsequently return ; second, revaccination can be
depended on to destroy this return of susceptibility to the
disease.
The first epidemic of smallpox that occurred after vac-
cination was in general use appeared in Scotland, in 181S.
This epidemic, however, did not convince the profession
of the necessit)' for revaccination, though it gave rise to
the term varioloid. In 1824, another such epidemic, at-
tacking many persons vaccinated in early life, appeared
all over Europe.
The British Government began the employment of
public vaccination in Ceylon belore 1819, but in that
year as well as in 1830, 1833, and 1836, a violent epi-
demic overspread that island, attacking many who had
been vaccinated. Between 1824 and 1835, 3,839 cases
occurred in Copenhagen, of which 3,093 occurred among
persons who had been vaccinated, altiiough the death-
rate among the latter was only 2.13 per cent.
The statistics of small-pox iiospitals show tiiat a large
proportion of cases occur among persons who have been
vaccinated in early life. In 7,326 admissions to the Lon-
don Sinall-Pox Hospital from 1855 'o '865, 78 per cent,
occurred after vaccination. In my own experience, dur-
ing the great e|)idennc of 1871-2, 2,377 cases were ad-
mitted into the Philadelphia Municipal Hospital, of which
68 per cent, occurred in persons vaccinated in early life.
In the epidemic of 1880-81-82, there were 1,659 ^i'-
niissions, of which 54 per cent, were post-vaccinated
cases, the proportion being 14 percent, less than before,
owing to the greater use of vaccination in Philadelphia at
that time.
I shall also show that this deterioration of vaccine pro-
tection is progressive, increasing up to a certain period
of life with the length of time since vaccination. Be-
tween January i, r87i, and May i, 18S3, I observed
2,507 cases of post-vaccinal small-pox. Under the age of
five years there were 10 cases and 2 deaths, from 5 to 10
years there were 46 cases and S deaths, from 10 to 15
years there were 99 cases and 8 deaths, from 20 to 25
years there were 745 cases and 96 deaths. The percent-
age of deaths in the total number of 2,507 cases was
16.89 pei" cent. It is evident, therefore, that while at
first aftbrding almost complete protection, as children
aijproach the age of puberty there is very great deterior-
ation of vaccine protection. The tables prove that the
maximum number of post-vaccinal cases occurs at the
period immediately following puberty.
I am also convinced that vaccine virus not only loses
much of its vigor through a long series of human trans-
missions, but also sufters in the dur.ability of its prophy-
lactic power.
When a i)ublic vaccinator in Philadelphia, from 1867
to 1870, I found it necessary to visit my patients, for the
purpose of collecting crusts for future use, on the four-
teenth or fifteenth day after inserting the virus. The ap-
pearance of the vaccine scar always determines, as a
general rule, the character of the vaccination a person
has received. .-^ permanent scar, distinct as if stamped
with a die, shows proper vaccination. As a general rule
there is a direct relation between vaccine cicatrices and
the prophylactic power. The protection which results
from vaccinia of short duration is not so durable as that
which results from vaccinia of a perfectly typical char-
acter. Long humanized virus produces less favorable
results than bovine lymph or that of recent humanization.
Successful revaccination modifies, of course, the result-
ing vaccinia. .\s varioloid differs from small-pox, so does
the vaccinoid resulting from revaccination differ from
true vaccinia. Every eiaidemic has proven the virtues of
revaccination, the time for which is shown by the tables
from which extracts have already been made, ^'accina-
tion is nowhere so carefully performed as in Germany,
and there the efficacy of revaccination has been proven.
In the twelve years of mv experience no one connected
with the MuniciiJal Hospital who was jiroperly revaccin-
ated had the small -pox. If vaccination be effectually
performed in infancy, and revaccination at puberty, we
would begin to realize that small-pox may be extirpated
from the earth.
Dr. R. L. Sibbett, of Carlyle, then read a voluntary
paper on " Obstetrical Notes." He was followed by Dr.
Huf.H Hamilton, of Harrisburg, who read a paper with
many charts upon artificial infant alimentation, in which
he recommended mixed healthy cow's milk neutralized
with bicarbonate of soda and with an -iddition of one or
two tablespoonfuls of good cream, according to age,
heated to 55° C. (131" F.), and sweetened with a freshly
made syrup of milk sugar.
ADDRESS ON MEDICINE.
Dr. Jamks Tyson, of Philadelphia, Professor of Pa-
thology and Morbid .Vnatomy in the University of Penn-
sylvania, was then called upon to deliver his address on
" Medicine," the substance of which was as follows :
Perhaps the most important form of hajmaturia and
hemoglobinuria resulting from general causes is that due
to malarial poisoning.
The first complete report of an undoubted instance of
this affection appears to have been published by Dressier
in 1854, although incomplete and uncertain cases were
reported prior to this date, one as early as 1832 by
Pllliotson. Two degrees of the disease are met with — a
milder form, in which other symptoms as well as the
May 12, 1883.]
THE MEDICAL RECORD.
521
hematuria are less pronounced, and of which instances
occur in the Middle States as well as the South and W'est
ot' this countrv ; and second, a more malignant form, at-
tended by great prostration, vomiting, etc.. yellowness
of the skin, along with copious discharges of bloody urine.
\Vhiie a majority of cases of malarial hjematuria are
intermittent many are continuous, and of my seven cases,
onl)' two were distinctly intermittent. One of these
cases I published in a chnical lecture in the Philadelphia
Medh-al Times as far back as Se[)tember 1, 1S71.
Tlie pathology of malarial ha^maturia consists, as yet,
chietiy of theoretical deductions. We can only conclude
that the malarial poison acts upon the blood and blood-
vessels, impairing the integrity of both. This goes so
far, occasionally, as to produce an actual destruction of
blood-disks, and always so alters the ca]iillaries that tliey
permit the transudation of blood-elements ordinarily re-
tained.
The treatment is distinctly that of malarial disease, and
I have seldom seen more brilliant and satisfactory results
than have followed the use of quinine, in a case ac-
curately determined ; although such results are not in-
variable, and I have known the disease to resist for a long
time the most thorough and judicious use of anti-malarial
remedies. Usually, however, I take hold of a case of
this kind with consitlerable confidence ; when there are
distinct remissions, my practice has been to administer
sixteen to twenty grains of sulphate of quinia, in the
usual manner of anticipation of the paroxysm in inter-
mittent fever, from three to five grains every hour un-
til the required amount is taken. The whole amount
may be taken in two doses, or even in one dose. Where
there is no distinct remission I more usually direct three
to five grains every three hours until the hemorrhage
ceases or decided cinchonism is produced.
The second more serious form of this disease, as it ap-
pears in the tropics and in the southern part of the United
States, is characterized by such increased intensity of all
the symptoms that it may be well called "malignant.''
Singularly, however, the disease has seemed to be much
more prevalent during the last fifteen years. My atten-
tion was first called to it in September, 1868, when 1 re-
ceived specimens of urine and the history of some cases
from Dr. R. D. Webb, of Livingston, Alabama, who
wrote also that it was not known in that part of his State^
at least prior to 1863 or 1864.
The treatment for the breaking of the paroxysm is pre-
eminently quinine, or quinine with mercurials, and al-
though this does not always succeed, there seems to be
no other remedy. It has been given hypodermically.
The nausea has been controlled by morphia and lime-
water, by carbolic acid and by creosote. In addition
restorative measures are necessary, including the free use
of stimulants. Turpentine has been used in large doses,
it is said, with advantage in .-Mabama.
R. H. Chase, Superintendent of the male department
of the Norristown Asylum, then read a very interesting
address on
INSANE ASYLUMS IN SOME OF THEIR RELATIONS TO THE
COMMUNITY.
He alluded to and ridiculed the sensational stories of
the confinement of sane men in insane asylums, which he
thought utterly impracticable. He mentioned the case
of Dr. Sevin, of Erie, whose story of his confinement in
Dixmont, resulted in the legislative investigation of
that institution ; and another which came under his
own observation. He said such charges reflected on
men and institutions which were an honor to the State
and deserved better diings. The sensational charges
made in such cases were contrary to common sense.
Dr. De F. Millard then read an address on
SIMPLE METHODS OF TREATMENT OF CLUBFOOT,
giving practical illustrations on a living subject of the na-
ture and use of proper mechanical appliances. The use of
gypsum as a setting and of elastic force were commended.
The utility of the forms of rubber known as " printer's,
blanket," "gum soling,'' and of gutta-percha when
moulded in hot water, as well as of sole-leather as sup-
porting bands was then shown. .\11 these papers were
referred to the Committee on Publication.
In the general discussion of the papers. Dr. Stewart,
of Erie, said that if a one-hundredth part of what was
published about Dr. Sevin were true it would cast odium
on every institution for the insane in the United States.
He would stake his professional reputation that Dr.
Sevin was insane when committed to Dixmont. He
had never made any complaint to him, Stewart, when
the latter had visited him, and was still insane to-day.
Dr. William Ulrich, of Chester, said that the only
paper which had been read at the recent meeting of the
Society for the Protection of the Insane in Pliiladelphia,
which favored the popular sentiment that sane persons
are confined in insane hospitals, was by Dr. Heber
Newton, of New York, and his paper met with such a
savage reception that he did not think Dr. Newton, who
was not a physician, would venture soon to seek noto-
riety outside of New York.
Dr. Hiram Corson, of Norristown, said there were
some cases of sane people confined in asylums, and
he knew of harmless people who might well be at home,
but who are in asylums. In some cases husbands pay
largely to have their wives confined. There should be
a home for convalescents in connection with every asy-
lum, a home which is not a hospital or an asylum.
Dr. Ulrich said that physicians did not always dis-
tinguish between insanity and drunkenness. He knew
of one man in Philadel[)hia who was committed as in-
sane (when drunk) thirteen times and discharged as
cured thirteen times.
Dr. Schultz, of the Danville .Asylum, said the laws
of Pennsylvania made it very easy for a patient to get
out of an asylum. He showed how outside parties could
get a man out of an asylum, but did not show how a
patient could get out, if unlawfully confined, without
powerful outside aid.
Dr. Corson again s|)oke of the difficulty with which
a woman could get out of an asylum. He had been
trying to get a married woman out of a Pennsylvania
asylum for a year and a half ; her sister wanted her out to
live with her ; her so doing would benefit the sister and
would be a saving of twenty dollars a week to the hus-
band, yet the husband, the power behind the trustees,
would not let this woman out, and no one could say
how she could get out, though she was mild, intelligent,
harmless, and cultivated.
An adjournment was had about 4.30 o'clock, until 7.30
o'clock.
annual presidential address.
Quite a number of the citizens of Norristown, the
visiting medical men and ladies gathered in the
Court House at 8 o'clock to hear the annual address of
the President of the Society. Dr. \'arian was intro-
duced by Dr. Addinell Hewson, of Philadelphia, First
■V'ice-President of the .Association, The substance of
Dr. 'Varian's address was as follows : The Medical
Society of the State of Pennsylvania was organized
thirty-five years ago in Lancaster. Now there is an
active living society in almost every one of the sixty-six
counties of the State, with a total membership in the
State Society of nearly eighteen hundred. The main
objects of the great Society are now to obtain efficient
Legislation in behalf of State H)-giene, the proper drain-
ing, building, and lighting of dwellings, and legislation
for hospitals for the insane, feeble, and sick.
But charlatanry, superstition, and ignorance still roam
almost unchecked throughout Pennsylvania. Its physi-
cians and jjeople need a State Board of Health. It is
time that, in regard to burial, sentiment should yield to
connnon sense. All refuse matter, whether animal
THE MEDICAL RECORD.
[May 12, 1883.
or human remains, should be cremated. Let the cre-
matory t:ake the place of the cemetery. Again, how can
the inebriate be restored to moral, mental, and physical
health, thus reducing crime sixty or so per cent. ? The
penitentiary has proved ineffective. The asylum, in its
proper development, will doubtless answer the question.
In the great question of vaccination there should be
e.xpert inspection and control of animal vaccine as a pro-
tection aganist diseases scarcely less to be dreaded than
small-pox itself.
In the matter of medical education, a Chair of State
Medicine and Hygiene should be established in every
medical school, and three full years of attendance should
be required before a diploma is granted.
The action of a medical society of a neighboring State
in throwing down the barriers which have been so long
maintained between the science of medicine and legal-
ized dogmatism, received from you at your last session
an expression of unanimous disap]3roval. The renewal
of that action demands a renewal of your disapproval.
MICHIGAN STATE MEDICAL SOCIETY.
Eighteenth Annual Aleefing, held at Kalamazoo, Michi-
gan, May 9 and 10, 1883.
(By Telegraph to The Medical Record.)
The Michigan State Medical Society began its eighteenth
annual meeting May 9th, in the Kalamazoo Academy of
Music, President Geo. Topping, M.D., of Dewitt, in
the chair.
.ADDRESS OF WELCO.ME.
After prayer by the Rev. Geo. F. Hunting, the Hon.
E. \V. Devoe, President of the Village, gave an address
of welcome, to which President Topping responded
briefly on behalf of the Society.
report of executive committee.
Dr. Foster Pratt, Chairman of the Executive Com-
mittee, gave his report. He announced that all the
medical gentlemen with their ladies were invited to a
reception tendered by the citi<;ens of Kalamazoo and
by the local medical society at the Burdick House,
on Wednesday evening. He also read an invitation to
the gentlemen from Superintendent Palmer to visit the
Michigan Insane Asylum, and another from the presi-
dent and secretary of the village to inspect the various
departments of the village.
REPORT.S of CO.M.MITTEES.
The Secretary, Dr. Cteo. T. R.\nnev, read his annual
report, and also that of the Committee on Publication.
The present number of members of the Society is two
hundred and sixteen.
Dr. S.mart, the Treasurer, reported a balance in the
treasury of $429.26.
ANEURISM BY ANASTOMOSIS.
Dr. W.m. Brodie reported a case which had recently
come under his observation. The patient, a healtliy Ger-
man woman, aged forty-seven, still menstruating, mother
of several children, slipped one day upon the sidewalk,
striking upon the back of the head. She was stunned
by the fall, but soon recovered therefrom. She had not
noticed, however, a swelling over the occiput, which
slowly increased in size. When Dr. Brodie first saw the
patient tliis swelling had reached tlie size of a goose-egg.
He discovered several smaller tumors over the scalp.
Auscultation revealed a bruit. There were no pulsa-
tions. A bistoury, iilunged into the tumor carefully,
allowed a free escape of arterial blood. The wound was
closed, erysipelas set in, and it seemed at one time im-
possible to save the i)atient's life. She recovered from
this, however. . The diagnosis ,of dilf'use aneurism was
made. For treatment, pressure was not considered ex-
pedient. Ligation of arteries was rejected on account
of the free anastomosis of the arteries involved. Elec-
trolysis was advised, but the patient did not wish to try
it at present.
Dr. Geo. Rannev read the list of applications for
membership.
In the afternoon session The President read the an-
nual address. He lauded the work of the State Board of
Health, and urged the profession to assist them in their
efforts to control disease. He called attention to
the rapid increase in the proportion of doctors to the
population, and in that connection lamented the State
support of medical schools. He remarked that the low
lecture fees was an inducement to men to enter the pro-
fession who would otherwise be content in humbler spheres.
The free hospitals in connection with the schools treated
at public expense many who were perfectly able to pay
for treatment. The portion of the president's address
relating to the University was referred to a committee to
report upon on Thursday.
Dr. C. J. LuNDV, of Detroit, read a paper upon
errors of REFR.ACTION and their RELATION TO CON-
STITUTIONAL SYMPTOMS.
He gave a series of cases in which patients complained
of headaches, such as have been generally thought to be
due to uterine disease, consisting of pain in the vertex
and at the lower occipital region. In all of the cases re-
lated, after fitting proper glasses to the eyes, the other
symptoms disappeared. He also spoke of errors of re-
fraction causing retinal congestion. He called attention
to the fact that many persons wear colored glasses for
retinal hyperajmia, which is made worse thereby, when if
the errors of refraction were corrected they would not
need the colored glasses.
Dr. Conner, in discussing the i>aper, mentioned two
cases which had come under his observation. In one
physician astigmatism had so excited the brain as to pro-
duce insanity, which disappeared after wearing glasses.
In the other, after correcting errors of refraction, epilep-
tic attacks had grown less severe and less frequent.
Dr. T. \V. Reynolds read a paper on
TI.MELV CATHARSIS.
He recommended the use of cathartics in the early stages
of lobar jmeumonia ; he had aborted an attack of rheu-
matism by free catharsis, the same result had been reached
in one case of trifacial neuralgia, and in the delirium fol-
lowing cranial injuries. He recommended three drops
of croton oil in water ; he used the same for puerperal
mania, violent hysteria, and urajmia. He did not discuss
the abuse of carthartics. For mild action he recom-
mended a glass of warm water, or a cup of cofifee in the
morning. In the discussion following, attention was
called to the fact that free catharsis did not necessarily
imply that the bowels had been emptied ; in one case
mentioned about a peck of fecal matter had been re-
moved after catharsis.
(To be continued.)
THE TWELFTH CONGRESS OF THE GERMAN
SURGICAL SOCIETY.
Held in Berlin, April 4, 5, 6, and 7, 1SS3.
Professor v. Langenbeck, President, in the Chair.
[Special report for The Medical Record.)
The President, Dr. von Langenbeck, opened the Con-
gress w-ith the report of the connnittee on the award of
the prize offered by the Empress for the best essay upon
" Experimental Investigations u|)on the Etiology of 1 )iph-
theria, and Practical Conclusions derived therefrom.''
The Committee reported that of twenty-three competing
essays, only a few were in any way worthy of considera-
May 12, 1883.]
THE MEDICAL RECORD.
523
tion; and even the essay to which the prize was
awarded was worthy of it only in its first part, and ac-
cordingly it was for this part only that the prize was
given. The author was Professsor Heubner, of the Uni-
versity of Leipzig.
On motion of Dr. Bardeleben, Professor von Lan-
genbeck was re-elected President of the association.
After the election of officers the scientific work of the
Congress was begun by Dr. Kocher, of Berne, who read
a paper entitled
extirpation of bronchocei.e and its results.
The chief difiiculties met with in the operation were
the avoidance of injury to the recurrent laryngeal nerve
and the arrest of hemorrhage. The author advised the
ligation of the veins prior to that of the arteries. Dr.
Kocher did not now perform tracheotomy, as advised by
Rose, for he considered it a harmful procedure as tend-
ing, through incision of the cartilages, to increase the
bend of the trachea caused by the lateral pressure of the
goitre. It was allowable only in case the danger from
suftbcation was imminent. He held that the total extir-
pation of the goitre was injurious to the organism, espe-
cially during the period of growth, and he thought there
was some relation between so radical a measure and cre-
tinism or idiocy. The unfavorable results of the opera-
tion were seen in a feeling of weakness and a constant
chilliness, in slowness of thought, of speech, and of move-
ment, and also in a swelling of the hands, feet, abdomen,
and especially of the face. These latter gave to the i-ia-
tient the appearance of one suffering from Bright's dis-
ease, though tliere was no albuminuria. There w'as
anjemia in a high degree, as evidenced by microscopical
examination. To this ensemble of symptoms the author
gave the name of cachexia stnunipriva, while the anaemia
following the extirpation of the spleen is but temporary
and appears immediately after the operation, this cachexia
strtimipriva is a progressive and truly pernicious amemia,
which is developed only some time after the operation.
The author concluded from this that the thyroid gland
was a blood-producing organ, or at least that it aided in
the formation of blood. He thought also that possibly
it was a regulator of the cerebral circulation. The atro-
phy of the trachea following the operation was worthy of
note. It was probably due to the ligation of the superior
and inferior thyroid arteries. In conclusion, he stated
that, as a rule, the gland should never be totally, but
only partially, removed. His conclusions were based
upon a study of one hundred and two operations.
A second paper on
extirpation of the thyroid gland
was read by Dr. Bardeleben, of Berlin. The author
confined his remarks to a short report of four cases of
goitre, recently operated upon by him, as he feared the
paper prepared by him would appear insignificant after
the one just listened to. He denied that unfavorable
results necessarily followed upon the total removal of
the tumor, as in two of his cases he had met with un-
equivocal success. On the contrary, he thought that
the very cachexia observed by Kocher would have ap-
peared had no operation been performed. He had
never had recourse to tracheotomy. He opposed the
theory that extirpation of the spleen and thyroid gland,
as being blood-forming organs, was of evil influence upon
the organism. He had removed the spleen and thyroid
gland in a dog several years before, and had observed no
unfavorable consequences.
Dr. Maas, of Freiburg, presented the third pajjer, en-
titled :
CHANCES IN THE TRACHEA INDUCED BY BRONCHOCELE.
He had never observed a connective-tissue degenera-
tion, such as is described by Rose. He had, however,
met with a bending of the trachea caused bv the tumor,
and by reason of which tracheotomy was rendered neces-
sary. He had also seen two cases of posterior dislocation
of the trachea caused by unilateral goitre. \\'henever
these patients bent the head forward, asphyxia arose.
Both were cured by-extirpation of the goitre. Dr. Maas
had never performed tracheotomy in the operation for
removal of goitre, nor had he ever performed the latter
operation except in case of urgent necessity. In 522
cases of goitre treated by him, he had excised the tumor
only 23 times. In all the other cases he had obtained
a diminution in the size of the tumor by treatment with
iodoform.
Dr. Maas also read a paper on
THE ALKALOIDS OF DECOMPOSITION.
He referred to the investigations of Thiersch, Bergmann,
and others, and stated that he also, by a process, the
principal steps of which he described, had found alka-
loids of very poisonous properties in decomposing animal
matter. These substances were found in a body as early
as twenty-four hours after death ; they were present in
great quantity. The author had found three alkaloids
of differing action. The first, in very small dose, in-
duced a most marked tetanus, and in larger doses caused
the death of the animal in thirty or forty minutes. The
action of the second resembled that of morphia, and the
third simulated strychnia in its effects. These researches
would indicate that we may have diseases following a
wound which are referable to poisoning from the alka-
loids in question.
Dr. Von Bergmann remarked that in the preceding
Congress he had noted the difference between a putrid
infection caused by the poison of decaying animal mat-
ter and septicaemia induced by the presence of micro-
organisms in the blood.
Dr. Maas stated that Brieger had obtained an alka-
loid by treatment with am}'] alcohol, whose action exactly
corresponded to that obtained by himself.
Dr. Boegehold, of Berlin, presented an article on
INJURIES OF THE THORACIC DUCT.
This was followed by a report by Dr. Bruno Schmidt,
of Leipzig, on
THE RESULTS OF HERNIOTOMY SINCE THE INTRODUCTION
OF THE ANTISEPTIC METHOD.
In 308 cases of strangulated hernia, operated upon in
various hospitals from 1875 to 1881, the mortality was
36.6 per cent. The mortality of operations undertaken
previous to the introduction of Lister's method was
45.8 per cent., showing a difterence of only 9.2 per cent.
In spite of any antiseptic precautions, he thought the
mortality would always correspond to the severity of the
operation. The field of the operation was itself a septic
one, and such precautions could reduce the proportion
of deaths no further. In view of these facts the removal
of the immediate danger of death only should be at-
tempted, and the radical operation should not be ventured
upon. In the case of gangrene an artificial anus should
be made, and only after an interval should the suture of
the gut and its reposition be attempted.
Dr. Gussenbauer, of Prague, differed very decidedly
from the author. He stated that the results of r6o
operations, collected by one of his assistants, made an
excellent showing for antisepsis. The results depended
not so much upon the nature of the operation as upon
the condition of the cases operated upon. Even a sim-
ple reposition of the intestine might eventuate fatally if
peritonitis were already present. '
Dr. Zeller, of Berlin, related
A CASE OF MELANURIA,
occurring in Von Bergmann's clinic. The patient, a man
forty-three years of age, was suflering from multiple
5^4
THE MEDICAL RECORD.
[May 12, 1883.
melanotic sarcoma of the skin, and died, six weeks after
coming under observation, with cerebral symptoms. The
urine was clear, of a dark brown color, and contained a
large amount of hydrobilirubin. He thought the color-
ing matter of the urine was to be referred to two sources.
One was the coloring matter of the blood or bile, the
other the substances formed in the digestion of albumen
in the intestine.
(To be continued.)
MEDICAL AND
CHIRURGICAL FACULTY OF
MARYLAND.
Eighty-fifth Annual Couvcntion, held at Baltimore, April
24 and 25, 18S3.
(Special Report for The Medical Record.)
(Concluded from p. 467.)
MKDIC.\L BIBLIOGR.APHV — TARNIER's FORCEPS — AXTIPV-
RETIC EFFECTS OF CARBOLIC ACID AND ASTRINGENT
INFLUENCE OF RUBUS PROCUMBENS — -ACTION OF ALCO-
HOL ON THE HEART SUBCUT.ANEOUS NERVE-STRETCH-
INC INCREASING USE OF NARCOTICS — SPONTANEOUS
COW-POX IN BALTIMORE COUNTY NASO-AURAL CA-
TARRH AND ITS TREAT.MENT — ELECTION OF OFFICERS.
Dr. John S. Billings delivered the annual oration,
choosing for his subject " Medical Hibliography." He
gave a historical review of medical bibliographical work,
and then described the library at Washington, its objects,
and the future plans regarding it.
In the Section on Obstetrics and Gynecology, Dr.
William T. Howard read a paper on Tarnier's forceps,
which he highly praised.
In the Section on Materia Medica and Therapeutics,
Dr. John S. Lynch presented a paper entitled " Obser-
\ations on the Antipyretic Eft'ects of Carbolic Acid, and
upon the Astringent Influence of Rubus Procumbens.'
Carbolic acid in large doses (gr. v., q. two to four hours),
was thought to be highly potent as an antipyretic in essen-
tial and inflammatory fevers. He combined aconite with it.
Typhoid fever rarely lasted over fourteen days, if treated
with this drug. In septicemia and in hectic phthisis it
was also recommended.
Rubus procumbens, or dewberry root, was a drug
which had never failed him in diarrliceas of all forms.
It was a specific for the summer diarrhoea of infants.
The dose for adults was a drachm of the fluid extract.
Professor H. Newell Martin read a paper entitled
the "Direct Action of Alcohol on the Heart." The
reader had experimented upon the isolated mammalian
heart, and upon a man jjreviously a total abstainer.
First, from a Marriott's flask defibnnated blood was
fed to the heart, then blood containing absolute alcohol,
and after this good blood again. The results of these
experiments demonstrate : i. Alcohol in the above
doses has no influence on the pulse. 2. As regards the
work done by the heart in a minute, blood containing
one-eighth per cent, of alcohol is without effect, at least
for five or ten minutes ; but blood containing one-fourth
yjer cent, of alcohol nearly always, and that containing
one-half per cent, always greatly diminishes the work
done. If the supply of alcoholized blood be not too
long continued, the heart can be recovered by feeding
anew with pure blood. 3. The diminution of work is
due to an alteration in the elasticity of the cardiac mus-
cle, in consetiuence of which the heart swells out so tliat
even in its systole it nearly or quite fills the pericardial
bag. Hence in diastole it cannot dilate farther to receive
a fresh supt)ly of blood. 4. If the pericardium be re-
moved, the above doses of alcohol are without effect on
the work done, at least for a considerable time ; the
heart, hou-ever, swells enormousl\- and beats in a quite
un|)hysiological manner, never obliterating its ventricular
cavities in svstole.
Dr. J. D. Arnold read a paper upon "Some Forms
of Laryngeal Paralysis."
Dr. R. B. Gundry read a paper on "The Prognosis
of Insanity," which was very well received.
Dr. J. Vv. Cha.mbert read a report upon the subject of
" Subcutaneous .Verve-stretching for Sciatica." The au-
thor concluded that in most cases the operation was
promptly efficacious.
Dr. Tiffany exhibited a girl, aged thirteen, from whom
he had excised the upper jaw from the left uicisorto the
second right molar tooth, for a sarcomatous tumor origi-
nating in the socket of an undeveloped right lateral in-
cisor.
Dr. G. Halstead Boyi.and read a paper upon the
" Increasing Use of Narcotics" — opium, chloral, bromide
of potassium, etc. — and the evils resulting therefrom, and
urged the need of legislation to regulate their sale. \i-
ter reviewing the legal status of the subject in other
States and countries, he jiroposed a law rendering it un-
lawful " to sell, give, or dispose of any poison or poison-
ous substance, except upon the order or prescriiition of
a regularly authorized practising physician, under penalty
of a fine not exceeding §25 for the first offence, nor $50
for each succeeding offence." The act not to extend to
wholesale dealers.
Dr. St. (iKORGE W. Teackle, State vaccine agent,
related the facts connected with a case of spontaneous
cow-pox in Baltimore Co., and the result of experiments
with crusts obtained therefrom. This alleged vaccinia
appeared about the middle of January last upon the
udders of a herd of Alderneys on a farm about six miles
from Baltimore. Four cows were affected. Careful
investigation excluded all possibility of inoculation.
Dr. Joh\ N. Mackenzie read a very elaborate and
valuable paper on •' Naso-Aural Catarrh and its Rational
Treatment.'' The author insisted upon the great fre-
quency of reflex cough as a symptom of disease ; in his
experience it has become so common that he has long
since ceased to regard it as a curiosity. His clinical
experience furnishes abundant proof that the cough occurs
only when from a local pathological process, or ab-extra
stimulation, irritation of the turbinated corpora cai'ernosa
of the nose exists. He has furthermore succeeded ex-
perimentally in localizing the area of reflex excitability
in the mucous membrane coveritig these erectile bodies.
Repeated experiments also show that all parts of this
sensitive area are not equally susceptible to irritation,
and that the cough is most constantly produced by arti- •
ficial stimulation of the membrane clothing the posterior
end of the inferior turbinated bone, and that of the erectile
body on the septum immediately opposite. In other words,
there exists in the nose a rellex sensitive area analogous
to that discovered in the larynx by Stterk, Vulpian, and
others. Apart from its ]ihysiological interest the prac-
tical importance of this fact in a diagnostic and thera-
peutic point of view is sufficiently obvious ; in it is found
the explanation of many obscure cases of cough which
heretofore have received no satisfactory solution, and its
recognition, therefore, is the key to their successful treat-
ment.
Dr. Mackenzie describes further on a forceps he has
invented for the removal of adenoid growths.
The following officers were elected : President, Dr.
Richard McSherr\- : Vice-Presidents, Drs. \V. Stump,
Forwood, and John S. Lynch; Recording Secretary, Dr.
(i. Lane Taneyhill ; Assistant Recording Secretary, Dr.
Robert T. Wilson ; Corresponding .Secretary, Dr. W . F.
.-\. Keni]) ; Reporting Secretary, Dr. Richard H. Thomas ;
Treasurer, Dr. Judson Gilman.
On motion of Dr. William Lke, a resolution was
adopted reaffirming allegiance to the Code of Ethics of
the American Medical .^ssociation.
After the ado]nion of a vote of thanks to the author-
ities of the Johns Hopkins University, and a complimen-
tary vote to the late President, the Faculty adjourned
sine die.
May 12, 1S83.J
THE MEDICAL RECORD.
525
NEW YORK PATHOLOGICAL SOCIETY.
Stated Meeting, April 11, 1883.
George F. Shrady, M.D., President, in the Chair.
Dr. VV. M. Carpenter presented, in behalf of a candi-
date, a specimen of ovarian cyst.
Dr. J- A. Wyeth presented a specimen which ilhis-
trated
the capability of the jugular vein for distention.
It was taken from a subject injected with plaster-of
Paris, and the vessel, just at the point where the common
carotid is crossed by the omohyoid muscle, had a circum-
ference of about three inches. The point of interest in
the specimen was that the veins become distended when
free circulation is obstructed, and thus the internal jugu-
lar may become so distended that it will overlap the ar-
teries, and hence easily be wounded in cutting down
upon the common carotid artery for purposes of ligation.
Dr. Wyeth also presented the tooth of some animal
that probably lived in one of the former geological periods.
It was sent to him by a former student from Randolph,
Tenn., who found it on a sand-bar in the Mississippi River.
Dr. Wm. p. Northrup presented a specimen of
cirrhosis of the liver in a child four and one-
fourth years of age.
The child died at the New York Foundling Asylum of
scarlatina and diphtheria. Autopsy showed hob-nailed
liver, and for this lesion the case was reported. The
history was furnished by Dr. O. M. Swift, House Physician.
January 19th. — Whooping cough.
January 30th. — Eruption of scarlatina.
February 6th. — Diphtheritic membrane in the pharynx,
profuse discharge from the nose ; later, croup and ex-
tensive sloughing of pharynx. Death occurred eighteen
days from the appearance of the scarlatina, and nine days
from the appearance of the exudation upon the walls of
the pharynx.
Autopsy eleven hours after death. — Body, well nour-
ished ; excoriations about lips, nose, and ears. Brain,
normal. Pharynx, sloughing ; naso-pharynx in like con-
dition. Larynx : Epiglottis and its folds oedematous ;
chink nearly closed when viewed from above ; diph-
theritic membrane over inner surface. Trachea : gran-
ular fibrin upon a deeply congested base. Lungs : mod-
erate general cedenia ; scattered lobules of bronchopneu-
monia ; bronchi deeply congested. Heart : about one
ounce of clear fluid in the pericardium ; heart-tissue
normal ; ventricles in diastole, filled with dark- and light-
colored clots. Liver: somewhat diminished in size,
thicker than normal, shortened in antero-posterior meas-
urement, edges rounded ; upper surface distinctly mam-
millated and tuberculated ("hob-nailed "), marked with
dilated vessels ; in the depressions the capsule has a
translucent, gelatinous appearance ; color of liver caff-
au-lait ; consistence firm and unyielding, " cries " when
cut with a knife ; cut surface shows an indistinct reticula-
tion, the spaces enclosing an area about the size of a
millet-seed ; gall-bladder moderately distended with light-
green bile. Spleen : size small ; outer surface normal :
when cut, shows dry tissue thickly studded with Mal-
pighian bodies, which appear somewhat enlarged and
white. Kidneys : congested ; firm ; size normal. Stom-
ach : uniform redness ; increase of mucus. Intestines :
mesenteric glands somewhat enlarged ; dusky. Small —
Peyer's patches congested, and in lower portion of
ileum swollen ; contents normal. Large — solitary fol-
licles enlarged ; white ; contents dark, grumous.
Microscopic examination. — A section transverse to
and including the upper surface of the liver gives a cre-
nate margin. Within the depressions of this margin the
capsule is thickened, and at the lowest point the thick-
ened capsule sweeps down into the substance of the
gland, and following the distribution of the portal system
invades the whole organ. It envelops single acini and
groups of acini, but manifesting no tendency to invade
the lobule except at the surface of the liver, where the
process seems to have been more active and of longer
standino-. There is also a moderate increase of connec-
tive tissue about the intralobular veins. The liver-cells
are everywhere in a condition of fatty infiltration, uni-
formly from periphery to centre ; nuclei are distinct ;
cell-bodies are finely granular, outlines usually well de-
fined.
In the interior of the liver the connective tissue is
well organized. Near the upper surface there is a free
sprinkling of lymphoid cells upon a background of organ-
ized connective tissue. The veins and arteries are not
obliterated, and there is no increase of bile canaliculi re-
marked by some observers. In the spleen there is a
slight increase of connective tissue. This, however, is diffi-
cult to maintain ; it is on the border-lands between a nor-
mal and pathological condition.
After the autopsy the records of the institution \vere
searched, and the following additional information gained :
The child entered the house when one day old. "Con-
dition fair." "Condition," uniformly reported, "good"
till May, 1882, when she was adopted by French parents,
with wliom she lived four or five months, and was returned
in good condition. This was about two months before
death. There is no history of syphilis, and in this case
the records are unusually satisfactory. The child's health
was always good. She was regarded a very " clean child,"
bright, active, and attractive. During her stay with the
French parents there is no reason to think she was
abused or indulged in irritating food or drink.
Remarks. — " In the ' Transactions of the Pathological
Society of London' for 1876 I find three cases of cir-
rhosis of the liver in children. Dr. T. Griffiths reports a
case. He remarks, in conclusion, ' This is an excellent
specimen of a cirrhosed liver from a child ten years of
age, without any evidence whatever, on the most careful
and satisfactory inquiry, of its having been produced by
the use of alcoholic drink or irritating food of any kind.
Neither is there a particle of evidence of hereditary
syphilis, of previous history of rickets, diseased bone, or
chronic abscess.'
" Dr. W. Cayley reports a case of a female child, six
years of age. No history of syphilis or drink. No ill-
ness since whooping-cough at nine months of age. He
found changes akin to those in the liver in brain, heart,
stomach, spleen, and kidneys.
"iMurchison reports a case in a boy nine years of age.
« After the bov's death it was ascertained that his father
kept a low public-house, and that the boy had been in
the habit of drinking a good deal of wine and water,
especially between meals. While in hospital he took
stimulants with a readiness quite unusual in ciiildren.'
" He concludes : ' So far as my experience goes, I have
never met with a typical example of hob-nailed liver (as
distinguished from other forms of contracted liver) after
death, at any age, in which there could be made out a
clear history ot moderation in the use of alcohol. In
early life it is not improbable the activity of the liver
may render it more liable to suffer from alcohol or other
irritating ingesta than adults.'
"In the above cases the children suffered from the or-
dinary symptoms of cirrhosis, and all were tapped several
times.
" Dr. J. Wickham Legg (' St. Bartholomew's Hospital
Reports,' vol. -xiii., 1877, page 148), in a very able re-
sume, reports two cases of his own — one in an infant of
seventeen months. Tlie prominent symptom during
life was purging, and just before death symptoms of
tubercular meningitis. Death was due to the latter.
He remarks : ' No symptom to suggest a special atten-
tion to the liver was present.'
" Another was a boy twelve years of age, whose symp-
toms suggested typhoid fever or tuberculosis, and yet
neither tubercle nor ulcer of Peyer's patches was found.
526
THE MEDICAL RECORD.
[May 12, 1883.
'In either case,' he adds, ' ahnost superhuman sagacit_v
would have been needed for the diagnosis to have been
made aright.' On examination, the livers were found to
be in condition of ordinary cirrhosis, very similar to
that of adults, 'bands of connective tissue about the
acini ; connective tissue studded with lymphatic cells.'
Liver-cells granular in one case, fatty in the other.
" Dr. Samuel Wilks reports a case of syphilitic cirrhosis
in a child one month old. Surface of liver was smooth,
resembling fibrous tumor ; secreting cells were unchanged.
"Dr. Frederick Taylor reports ('Transactions of the
Pathological Society of London,' 1880) a case of a child
five years of age. No evidence in life or at post-mortem
examination of syphilis ; evidence as to alcohol incom-
plete. 'On one occasion (the child) admitted he knew
the difference between brandy and gin and liked them,
and that he had often had them at night."
"In the 'Transactions of the Pathological Society of
London,' for 1 881, is reported a case of a boy nine years of
age with congenital hydrocele, and later ascites. No history
of syphilis in parents. The child was often sent to bring
the ale for father and mother, and it is said he often took
a 'sip of ale.' He says : ' The history of morning sick-
ness— the splenic engorgement, the nausea, appearance
of the liver, are in favor of alcohol being the cause.' Of
nineteen cases mentioned by Legg, ten were girls and
nine boys. Of fifteen cases the ages were between seven
and thirteen years, three between five and six years, and
one of seventeen months. He quotes F. Weber for a
case of cirrhosis in a stillborn child (no mention of syph-
ilis in this case).
" As to the causes of cirrhosis of the liver in children :
1. French and German authors agree with Murchison
that before and during the first dentition cirrhosis other
than syphilitic is rare. 2. After the first dentition the most
frequent cause is undoubtedly the use of alcohol ; irritat-
ing food may cause it (iMurchison and Niemeyer). 3. Legg
says : ' It seems to me a highly probable conclusion that
cirrhosis may arise independently of excess in alcohol.'
In his twelve-year-old case the symptoms were of a grave
general disorder, high temperature (103 to 104°) and de-
lirium. There was no jaundice, no ascites. This case
showed cirrhosis of liver, pleurisy, and parenchymatous
nephritis. Cayley's case showed changes in brain, heart,
stomach, spleen, and kidneys, of similar nature.
" Hillier reports a case of cirrhosis in which were also
pericarditis and pleurisy. He suggests that 'cirrhosis
may be the expression of some general disease of the
lymphatic tissue throughout the body.'
" Dr. Hayden, in the Uublin /our^ia/ a/ Jft':/u-i!/ Scie^ice,
reports a case of cirrliosis in a boy of fourteen years,
complicated with ' cirrhosis ' of kidneys, with pleurisy
and pericarditis.
" Dr. Thomas Olivier in the British Medical Journal,
reports a case in a female infant three months old. Parents
both temperate ; no history of syphilis. He adds ; 'Syjih-
ilis will not, however, explain all cases of cirrhosis of the
liver, even in the young.'
" One author, already quoted, says : ' The view that
cirrhosis is due solely to an intemperate use of liquors,
seems hard to sustain, when it is considered that not
only domestic animals but wild animals suffer from cir-
rhosis.'
" Briefly to summarize : i, The anatomical appearances
are in no way distinguishable from the cirrhosis of adults ;
2, from birth to two and one-half to three years in cases
of cirrhosis of the liver the presumption is in favor of
syphilitic origin ; 3, later than three years of alcoholic
origin ; 4, in many cases it seems fair to regard it as a
general disease."
Dr. J. C. Peters said the records of the Society
showed that specimens of cirrhosis of the liver had been
(iresented which were removed from the bodies of chil-
dren ten, twelve, and fourteen years of age ; the majority
of them were females, and in none was there a history of
excess in the use of alcoholic drinks.
Dr. Hei.ne.man remarked, in commenting upon the
admirable /■((!■«;«(•' of Dr. Northrup, that the explanation
suggested by some as an etiological factor in cirrhosis of
irritative articles of diet, as well as of drink (alcohol),
was perfectly rational. Intestinal dyspepsia was a com-
mon enough disease in young children and adults, and
there was no reason why repeated and long-continued ir-
ritation of the duodenum, accompanied as it was often by
functional liver derangement might not in some cases
be followed by structural lesion.
Functional disorders were, with the light of physio-
logical chemistry, beginning to be considered as mani-
festations of real cell changes, which it is true were
not always recognizable after death, just as were con-
gestion and even slight catarrhal inflammation not al-
ways to be recognized post mortem. The fact stated
by Dr. Northrup, that it is only in children over three
years of age that cirrhosis is found independent of
syphilitic or alcoholic origin, possibly helped this the-
ory, since, as was just stated, it was at and after this age
that dyspepsia became so common an affection.
Dr. J. Lewis Smith remarked that in the Revue de
Medecine for July and October last, Dr. Lancereaux de-
scribed three varieties of cirrhosis, the alcoholic, syphil-
itic, and malarial. In the syphilitic the liver is deeply
furrowed. It is not attended by ascites or icterus. In
the malarial variety the liver is firm and it presents a
slightly granular surface. In alcoholic cirrhosis the liver
is contracted, hard, and nodulated, or it is somewhat en-
larged, with smooth or granular surface, and the micro-
scopic examination shows hyperplasia of the connective
tissue, and fatty degeneration of the gland-cells.
In young children we can exclude alcoholism as a cause
of cirrhosis, and if there be no history of inherited syph-
ilis, may we not in these cases of obscure etiology regard
malaria as the cause ? Certainly in and about New
York malaria is an important and common factor in the
causation of disease. .\n abstract of Lancereaux's paper
appears in the London Medical Record for March 15th.
CONGENITAL SYPHILIS SECOND.^RV TUBERCULOSIS.
Dr. L. E. Holt presented the lungs, spleen, and por-
tion of hver and kidneys removed from a boy four and a
half years of age, who died on April 5th, at the Sixty-third
Street Institution, and for the specimens he was indebted
to the courtesy of Dr. Ripley. The boy first came under
Dr. Holt's observation on February 16th of this year,
with the following history : His family history was nega-
tive ; he was one of four children ; two were healthy, one
died early in infancy. This child, when four weeks old
had an eruption on the skin and also had snuffles, was
backward in its development, and was unable to walk
alone until it was three years old. It had suffered from
cough, had had irregular fever, no sweating at night, had
a chronic nasal catarrh, abdominal pain, and constipa-
tion. The child was feeble, its face pinched, and it had a
fetid discharge from the nostrils, which had also excori-
ated the upper \\\>. The cervical glands were consider-
ably enlarged on both sides, and there was also enlarge-
ment of the jugular veins. The upper incisors were
absent entirely ; the lower incisors were in a condition
of caries. The chest was decidely rachitic, and the ex-
tremities of the long bones were enlarged. On the right
index finger was an onychia which had existed two or
three weeks, and the left great toe was the seat of dacty-
litis. The abdomen was greatly distended, and the ab-
dominal veins were enlarged and tortuous, but there was
no fluid in the i>eritoneal cavity. The liver was consid-
erably enlarged, as also was the spleen. The temper-
ature was 103° F. No satisfactory examination of the
lungs could be obtained. The child was referred to Dr.
Ripley at the Polyclinic, who found consolidation at both
apices, general broncliitis, and on the right side behind,
evidence of a small cavity about the size of a walnut.
The patient was placed upon the mixed treatment, with
the addition of cod-liver oil, iron, and tonics, wliich were
May 12, 1883.]
THE MEDICAL RECORD.
527
kept up about one month without any improvement.
The fetiile movement continued, the temperature once
reached 103.5° -F- When Dr. Holt saw the child last, on
March 23d, all the symptoms were aggravated. There
was, however, no fluid in the abdominal cavity. Com-
mencing onychia was seen upon every linger of the left
hand, and upon the fingers of the right hand. The child
continued to have fever, the temperature ranging from
100" to 101° F. with considerable pain and tenderness
in the region of the liver. Physical signs were more
pronounced on the right side of the chest, and later the
evidence of a small cavity was found on the left side an-
teriorly. Examination of the urine was negative, except
once, when a trace of albumen was found. There were
no head symptoms at any time. Toward the termina-
tion of the case the patient had dianhcea, but had no
vomiting at any time. Death occurred by slow asthenia.
At the autopsy small cavities were found in the apices
of both lungs, with surrounding consohdation. There
were pleuritic adhesions on both sides. The heart was
normal, also the pericardium. The omentum was adhe-
rent, but it contained no tubercles, nor were tubercles
seen on the surface of the intestines. The liver was en-
larged and contained yellowish nodules, varying in size
from that of a pea to a pin's head, and situated about the
bile-ducts. Miliary tubercles could be seen sparsely
scattered over the surface of the organ. The spleen
was considerably enlarged, and firm and adherent to the
surrounding organs. Scattered through the tissue of the
organ were very numerous nodules, which resembled
those seen in the liver, very firm and hard, but there were
no tubercles seen upon the surface of the organ. The
kidneys showed nothing abnormal to the naked eye. It
was impossible to say what the nature of the nodules in
the liver apd spleen was without a microscopical examina-
tion.
The case was interesting, because it showed — first,
quite a clear history of congenital syphilis, and, second,
pretty conclusive evidence of the development of tuber-
culosis which seemed to have come on as secondary to
the syphilis.
The specimens were referred to the Committee on
Microscopy.
CARCINOMA OF THE BREAST.
Dr. L. H. Sayre presented a mammary cancer with
axillary glands, removed from a patient fifty-three years
of age. There was no history of cancer in the family.
Six weeks ago a lump appeared in the left breast, which
gradually increased in size, and two weeks ago he re-
moved it by making an elliptical incision. The opera-
tion was performed under the antiseptic spray. The
wound had entirely healed.
AMPUTATION AT THE KNEE.
Dr. Sayre also presented a leg removed from a fe-
male patient sixteen years of age, who had a fair family
history. When eighteen months old she was attacked
with disease of the knee-joint, which continued for about
three years, and resulted in complete bony anchylosis
with the usual deformity of flexion, subluxation, and ro-
tation outward. The leg was flexed at a right angle
with the thigh. The patella was completely fused, and
the articular surfaces of the tibia and femur were also
completely anchylosed. It was decided to amputate in
preference to attempt brisement force, for the reason that
the anchylosis was so firm it would probably be impos-
sible to break it up ; but if able to break it up, there
would be great danger of rupturing the jiopliteal artery.
In the event, however, of being able to avoid that acci-
dent, the limb would probably be useless for the reason
that the joint surfaces had probably become destroyed.
Amputation was preferred to Buck's operation of removing
a wedge-shaped section, for the reason that the limb was
already three and a half inches shorter than its fellow,
and the patient has not yet attained her growth. Con-
sequently exceedingly high support for the foot would
be necessary, which would give more inconvenience than
would an artificial limb. Amputation was selected, and
was performed by making a modification of Stephen
Smith's operation. In this case it was found impossible
to disarticulate the joint, and it was therefore necessary
to saw through the head of the tibia. The operation was
performed under the spray, the wound was closed with
sutures, and an antiseptic dressing applied. Three days
after the operation the dressings were removed,' the su-
tures taken out. There was no secretion of pus, the
temperature had not been elevated above 100^° F., and
the pulse had not risen above 102.
Dr. Garrish said that Dr. Valentine Mott made it a
rule never to operate for removal of a cancer until the
integument became ulcerated.
Dr. Gibney remarked that he had met with numbers
of limbless people who came to the hospital with irrita-
ble stumps and broken artificial limbs, and in many cases
it would seem that resection of some kind in adult life,
at least, would have been a better mode of procedure.
He therefore asked Dr. Sayre if he would have performed
amputation had the patient obtained her entire growth ?
Dr. Sayre replied that he thought the artificial limb
would be more advantageous to the jjatient than a high
shoe or other supjjort.
Dr. Wyeth thought that an osteotomy would have
been less dangerous than amputation, although amputa-
tion is not, as a rule under such circumstance, a danger-
ous operation. He thought that, on the whole, if an
osteotomy had been accomplished successfully, and the
limb placed in the desired position, it would have been
better, so far as utility is concerned, than an artificial
limb. ' He believed that he should have tried osteotomy,
straightened out the limb, and endeavored to utilize the
leg and foot. Again, if amputation had been necessi-
tated, he thought it was recognized as more favorable to
utilize the normal tissues which have been accustomed
to pressure, and therefore to save some of the tissue be-
low the knee to form a basis for the support of the arti-
ficial limb.
Dr. Sayre remarked that the cicatrix in this case was
entirely behind and in the popliteal region, and that its
lowest part was an inch and a half above the end of the
stump.
Dr. Gibney asked concerning the per cent, of mor-
tality in knee-joint amputation and resection.
Dr. Wyeth replied that twenty-five per cent, of the
cases of resection of the knee-joint terminate fatally ;
that the mortality after amputations in which the wounds
were sewed up was twice as great as in those cases in
which the amputation was left open. He then referred
to the fact that at one time he looked over the history of
several hundred cases in Bellevue Hospital, and found
that in every other amputation the patient died. Dr.
Dennis reported fourteen cases in which the operation
was performed by the late Prof. James R. Wood, and
all of the patients recovered. 'All the stumps were
treated openly. He knew of over one hundred cases
which were treated in the same way, and in none of
them did septicemia or pyremia cause death, and the
rate of mortality was far below that of amputations
treated by the closed method. Recently he had made
seven consecutive amputations. The wounds were
treated openly, and all the patients recovered. Ampu-
tation at the knee-joint for disease is fatal in about onem
seven cases.
embolic pneumonia — THROMBOSIS OF THE UMBILICAL
VEIN.
Dr. J. Lewis Smith presented the lungs removed
from an infant which died at the age of fifteen days.
There was nothing unusual in the condition of the child
until it was about one week old. It became feverish
and fretful, and on examining carefully for the cause of
this trouble evidence was found of inflammation at four
528
THE MEDICAL RECORD.
[May 12, 1883.
different localities under the skin, circumscribed cellu-
litis, little nodules about half an inch to an inch in di-
ameter. The child began to fail soon after, and died at
the age mentioned. At the autopsy there was found in
the lower lobe of the left lung on the posterior aspect, a
small nodule of pneumonic consolidation. On open-
ing this its interior presented a grayish appearance, of
the wedge-shape, characteristic of embolic pneumonia.
Around this wedge-shaped portion of consolidation the
lung presented a hyperajmic appearance, as is connnon
in this form of pulmonary inflammation. It was be-
lieved that there would be found somewhere in the body
a thrombus, and further examination revealed what
seemed to be the true source of the pulmonary disease
and the cellulitis, namely — a softened thrombus in the
umbilical vein. This vein contained a purulent looking
* liquid which under the microscope was found to be sim-
ply softened thrombic material to the amount of five or
si.\ drops. The question might be asked why, if this
was the source of the embolic pneumonia, do not em-
bolic inflammations occur more frequently in the new-
born. The clot in the umbilical vein evidently remains
undisturbed in situ, under ordinary circumstances, since
there is no propulsive power acting upon a thrombus in
this vein, as is the case in the systemic veins when
thrombi form. It is usually, no doubt, absorbed within
the vein, or it enters the circulation gradually and in a
different state so as to do no harm. But we can easily
understand how, by rough handling of the child, especially
b\- sadden and firm pressure on the abdomen, as in toss-
ing, a portion of the thrombus might enter the circula-
tion and produce such inflammations as were present in
this case. Some years ago he presented to the Patho-
logical Society specimens from a young infant, showing
numerous abscesses. The cause may have been the
same as in this patient, but it was not at the time sus-
pected.
Dr. John C. Peters then made a preliminary report
on scarlet fever in horses, after which the Society went
into executive session.
The Cause and Cure of Cholera Infantum. —
Dr. A. E. Walker, of Mount Liberty, O., sends us some
judicious criticisms upon "Henoch's Lecture on Cholera
Infantum," published in "^Vood's Library of Standard
Medical Authors, for 1882." Dr. Walker believes that
high temperature is not given its proper importance as
a cause of disease. "One other fault I find in his lecture
is that his cases of cholera infantum appear to have as-
sumed a chronic form (figuratively sjjeaking). He says
that when we are called to see a jiatient sufiering an at-
tack of cholera infantum on the second or third day of
the disease, we can administer such remedies as he in-
dicates. Now, in this part of the world (it may be en-
tirely different in Berlin) a i)hysician is scarcely ever
called upon the second or third day after the attack has
begun, unless it is for the mother of the babe who is suf-
fering from nervous shock caused by the sudden death of
her child. As I understand cholera infantum, it is very
sudden in its onset and the majority of cases die within
thirty-si.x hours if left to the curative efforts of nature."
Dr. W'alker thinks that Henoch's treatment would be
valueless in a vast majority of cases. He recommends,
in the place of it, the |)lan adopted by Professors D. N.
Kinsman and Pooley, of Cohnnbiis, O. These gentle-
men commend injections of ice-water, cold comjjresses
to abdomen, and in addition to this Dr. Pooley advises
the use of sub. nit. bismuth in the following doses: he
takes enough bismuth to make a tolerable thick cream,
using aqua dist. as the vehicle ; of this he gives from
one-half to one teaspoonful about every four hours until
choleriform discharges cease.
Dr. Walker writes: "This plan of treatment, I believe,
is destined to become the treatment par excellence in
cases of cholera infantum."
CCo r vcsp a lul en c c.
MEDICAL CONTROVERSY AND THE NEWS-
PAPERS.
To THE Editor of The Medical Record.
Sir : One of the evils following the effort of a part
of our jMofession to change our Code, is the tendency
of the discussion to be diverted into the newspapers. Is
it wise to yield to this tendency ? Both Codes condemn
it. The first sentence of the New Code says: "It is
derogatory to the dignity and to the interests of the pro-
fession for physicians to permit their opinions on medi-
cal questions to appear in the newspapers." If any
physician, prompted by a spirit of individual liberty,
allows himself to disregard this teaching, he ought, cer-
tainly, for the dignity and interests of the profession, to
be very careful not to overstep the bounds of truth,
while purporting to narrate simple facts. Dr. Abram
Jacobi — than whom few cultivators of medical science,
or disciples of humanity, have reached a higher emi-
nence in the profession — has, unfortunately, fallen into a
mistake of this kind, in his letter to the German phy-
sicians, published in the Netv York Tribune for May
3, 1883. He says: "The New Code was confirmed,
after long discussion, by an increased majority, at the
meeting of 1883." Of course the facts are the reverse
of this. In 1882 the vote stood fifty-two to eighteen ;
majority, iliirty-four. In 1883 the vote was one hun-
dred and five to ninety-nine ; majority, six.
Doubtless, friends of the American Code, and at the
same time friends of Dr. Jacobi, may find some other
mistakes, or perverted influence, in this letter, so con-
spicuously published. It may not be best to descend to
minor criticism in matters of this kind; but, plainly, a
friendly critic is justified in caUing attention to an error
of this magnitude and import, and in respectfully re-
questing the author to have it publicly corrected.
T. H. Squire, M.D.
Elmika. N. v.. May 5, 1883.
DOES THE RETENTION OF DEAD TEETH IN
THE JAWS EXERT AN UNFAVORABLE IN-
FLUP:NCE ON HEALTH ?
To THE Editor of The Medical Record.
Sir : The report of the proceedings of the .April meet-
ing of the Practitioners' Society in The Record of May
5th, in which the discussion of my paper on " Ear-
ache in Children " ajjiiears, omits some remarks that
were made respecting the retention of pulpless or "dead"
teeth in the jaws. I should not desire the publicity af-
forded by the columns of The Record for a special
commtmication regarding this matter, were it not to draw
greater attention to the probable bad effect on health
from keeping " dead " ])ermanent teeth indefinitely in the
mouth. Every one is naturally reluctant to part with any
of their teeth, however greatly impaired they may be, so
long as they can be made to serve a useful purpose, un-
less, indeed, toothache cannot be prevented ; and I am,
moreover, quite well aware that many practitioners are
not unmindful of their patients' interests in this regard,
and that, in the treatment of diseases seeming to be in-
fluenced by dental irritation, the management of the
teeth is very properly relegated to the more competent
care of competent dentists. But we ourselves very often
encounter dental disturbances in our patients, the harm-
fulness of which is not suspected by them, so long as
pain is absent, yet we very well know from experience
that they constitute important causative factors in cer-
tain diseases. Thus, when it is found that teeth have, in
consequence of death of the pulp, been deprived of an
important source of nutrition — the only remaining source
of nourishu)ent being through the periosteal connection —
their vitality is frequently so much impaired that their
May 12, 1883.]
THE MEDICAL RECORD.
529
entire separation from the jaw is usually only a question
of time. If it is sought to retain these defective teeth
by means of fillings, we are met by the fact that this
cannot always be effectually done, inasmucii as the death
of the parts, with greater or less speed, still goes on, and
the products of pathological processes, small though they
may be, cannot be considered as entirely free from dan-
ger to the patient when absorbed. The presence of
fillings in these cases is an eftectual barrier to the nat-
ural escape of deleterious products, unless, indeed, alve-
olar abscesses form. The " dead " tooth maybe in a
certain sense regarded as a foreign body, and the occur-
rence of periostitis, as is well known, may give rise to
greater or less irritation ; thus may either an acute or a
chronic process be set up, the former causing pain or
alveolar abscesses, or both, while the latter may continue
almost indefinitely with, for the most part, scarcely any
pain.
But these appliances are not always intended to serve
the purpose of stopping cavities only, for mechanical
skill, in a certain branch of dentistry, has made it pos-
sible for the operator to permanently attach gold or
amalgam mounts to teeth, the crowns of which have
yielded to the ravages of caries, in such a manner as to
offer very useful substitutes. These metallic substances,
some of which are very large, are not, I fear, always
harmless when continuously worn in the mouth.
Now, while I am very far from recommending that
all pulpless ("dead") teeth should be removed, yet I
believe that in many instances they cannot be retained
without injury to the patient. I am quite sure that I
have seen many recoveries in my aural practice quickly
follow the removal of a defective tooth. I shall be glad
if others who have had opportunities for observation
would contribute their experience to the literature of
this subject.
Yours sincerely,
Samuel Sexton, M.D.
New York, May 7, 1883.
Jlicm ^nstvumcuts.
A NEW INSTRUMENT FOR LIGATING THE
UTERINE ARTERY.
By CLINTON GUSHING, M.D.,
PROFESSOR OF GYNECOLOGY, COOPER MEDICAL COLLEGE, SAN FRANCISCO, CAL.
In September, 1881, I essayed the removal of the entire
uterus through the vagina on account of epithelioma of
the cervi.x. At the outset of the operation I undertook
to ligate the uterine artery upon either side of the cer-
vix, and between the cervix and the ureter, just above
the vaginal vault. I used for this purpose a strong
curved needle and a heavy needle forceps, and was en-
abled, after several failures and much difficulty, to pass
a ligature above the artery, and thus ligate it before any
incisions were made in the tissue around the cervix. The
operation was then carried out according to the original
plan, without the loss of blood, and the operation was
followed by recovery.
In looking over the literature of pelvic surgery, I was
surprised to find no mention made of any plan by which
the uterine artery might be ligated, whether for the con-
trol of hemorrhage or for ablation of the uterus.
I at once began a series of experiments upon the cada-
ver, with a view of determining some method best suited
to ligating the uterine artery from the vagina, and with-
out opening the abdomen. After making several dissec-
tions I became convinced that the only point that the
artery could be reached without endangering the ureter
was midway between the body of the uterus and the
ureter.
To imderstand clearly what I am about to say, it nuist
be remembered that the uterine artery furnishes at least
four-fifths of the blood supply to the uterus ; that it arises
from the internal iliac artery at the point of its bifurca-
tion, and passes inward along the lower edge of the
broad ligament, and reaches the uterus just above the
cervico-vaginal junction, where it sends off the circular
artery of the cervix, and then passes upward along the
side of the uterine body, sending off numerous tortuous
branches to that structure, and finally anastomosing with
the ovarian artery, an exceedingly small vessel.
The uterine artery is about the size of the radial, and
can be felt with the finger through the roof of the vagina
in thin subjects, its pulsations being clearly perceptible.
The ureter passes over the brim of the pelvis about one
inch to the side of the promontory of tlie sacrum, and
extends downward and slightly inward beneath the pelvic
peritoneum, just external to the utero-saral ligaments,
reaching the connective tissue of the broad ligaments
about three-fourths of an inch
laterally from the cervix,
where it passes behind and
in close juxtaposition to the
uterine artery. The ureter
then passes forward between
the bladder and vagina, open-
ing into the bladder about
one inch in front and below
the cervi.x uteri. In study-
ing Savage's plates, one is led
to suppose that the ureter is
nearer the cervix than is really the case,
as can be easily proven by passing a
small flexible bougie through the ureter,
from the brim of the pelvis into the blad-
der, and then studying the parts in situ.
The accompanying cut represents an
instrument that I have devised for the
purpose of passing a ligature around the
uterine artery from the vagina without
endangering the ureter.
As will be seen, each blade of the
instrument consists of a small canula,
curved at its terminal end, so that when
the blades are united and closed they
fornr a half circle, and the two canulas
\ when joined represent a closed tube from
handle to handle. The end of each ca-
/ nula is furnished with a trocar point.
\^ The method of using the instrument
is as follows : Place the patient on the
left side and introduce a large-sized Sims'
speculum ; seize the cervix with a strong
vulsellum, draw it down slightly, and
steady it ; now take one of the blades and pass it through
the roof of the vagina a third of an inch to the side of the
cervix, and a third of an inch back of the median line
running from the cervix to the side of the pelvis ; pass
the canula into the tissue of the broad ligament until the
opening a of the canula has entered one inch, keeping
the point of the trocar within a half inch of the body of
the uterus. Now introduce the other blade in front of the
cervix and to the side in a similar manner, and close and
lock the handles of the instrument, and the curved ends
of the canulas come together in the connective tissue of
the broad ligament above the uterine artery, and between
the ureter and the uterine body. Now take a piece of
steel wire. No. 23 gauge, made quite sharp at one end,
and with a loop at the other for the attachment of a liga-
ture, and pass it around through the canula and draw
the ligature into its place. The sharp end of the wire
pierces any portion of the connective tissue that may
become engaged between the ends of the canulas. The
blades are now unlocked and removed separately, and
the ligature is left in their track, and by tying it firmly
the artery is perfectly controlled, and much the larger
part of the blood supply to the uterus is cut off.
The cut represented is one-half the size of the original
instrument.
m
53°
THE MEDICAL RECORD.
[May 12, 1 88;
It has occurred to nie that b_v hgating these arteries in
cases of uterine fibroids, that their growth would be
checked and atrophy follow, and I expect at some future
time to report the results of the experiment. The ligation
of these arteries, as the first step, renders the ablation of
the entire uterus com])aratively easy to those who are
practically familiar with this branch of surgery. What-
ever the disease or operation that causes serious uteric
hemorrhage, this method of procedure may prove of ser-
vice.
^vmy and Hlnny 3\cius.
Official List of Changes of Stations and Duties of Officers
of the Medical Department, United States Army, from
April 28, 1883, to May 5, 1883.
Bailv, Joseph C, Major and Surgeon. To be relieved
from duty in the Department of California and assigned
todutvin the Department of Texas. S. O. 102, par. 12,
A. G.'O., May 3, 1883.
TiLTON, Henry R., Major and Surgeon. To be relieved
from duty in the Department of the Missouri and as-
signed to duty in the Department of the East. S. O. 102,
par. 13, A. G. O., May 3, 1SS3.
Cra.mptox, Louis \V., Captain and Assistant Surgeon,
now awaiting orders. To proceed without delay to Fort
Wayne, Mich., and report to the commanding officer for
duty at that post. S. O. 73, par. 2, Department of the
East, April 30, 1883.
Paulding, Holmes O., Captain and Assistant Sur-
geon. To be relieved from duty at Fort Sidney, Neb., and
assigned to duty at Fort Douglas, Utah. S. O. 42, par.
1, Department of the Platte, April 25, 1S83.
Perley, Harry O., Captain and Assistant Surgeon.
To be relieved from duty in the Department of the East
and assigned to duty in the Department of Dakota. S.
O. 102, par. 14, A. G. O., May 3, 1883.
Spencer, Wm. G., Captain and Assistant Surgeon,
now awaiting orders. Assigned to duty in the Department
of the East. S. O. 102, par. 12, A. G. O., May 3, 1883.
WoRTHiNGTON, James C, Captain and Assistant Sur-
geon. To be relieved from duty in the Department of
the East and assigned to duty in the Department of the
Missouri. S. O. 102, par. 14, A. G. O., May 3, 1883.
BiART, Victor, First Lieutenant and Assistant Sur-
geon. To be relieved from duty in the Department of
the Missouri and assigned to duty in the Department of
Dakota. S. O. 102, par. 13, K. G. O., May 3, 1883.
Macaulev, Caster N. B., First Lieutenant and As-
sistant Surgeon. To be relieved from duty in the Depart-
ment of the East, and assigned to duty in the Department
of Dakota. S. O. 102, par. 12, A. G. O., May 3, 1883.
Strong, Norton, First Lieutenant and Assistant Sur-
geon. Upon expiration of leave of absence, to be as-
signed to duty at Fort Thornburgh, Utah. S. O. 42, par.
2, Department of the Platte, April 25, 1883.
Byrne, Charles B., Captain and Assistant Surgeon.
To be relieved from duty in the Department of the South
and assigned to duty in the Department of the Missouri.
S. O. 102, par. 12, A. G. O., May 3, 18S3.
Official List of Changes in the Medical Corps of the Kavy
for the week ending May 5, 1SS3.
Law, H. L., Passed .Assistant Surgeon. Detached
from the Navy Yard, League Island, Pa., on loth inst.
and ordered to the Yantic.
Harvey, H. P., Passed Assistant Surgeon. Detached
from the Yantic on reporting of relief and ordered to
Naval Hospital, Chelsea, Mass.
Ordered as member of a
Senior, Wm. J., Surgeon,
board at Naval Academy.
McCi.uRG, W. .\., Passed Assistant Surgeon. De-
tached from the Naval Academy on the 15th inst. and
ordered to the Dale.
Diehl, Oliver C, Assistant Surgeon. Detached
from the Naval Academy and ordered to the Constella-
tion.
BtccticaX SStcms.
Contagious Diseases — Weekly Statement. — Re-
port of cases and deaths from contagious diseases re-
ported to the Sanitary Bureau, Health Department, for
the two weeks ending May 8, 1883 :
Week Ending
>
3
A
a
>
"0
•§.
erebro - spinal
Meningitis.
U
s
V
■i
t
1
>
H
H
fi
U
^
S
73
>
Cases.
May
May
I, 1883
13
5
7
8
153
166
4
9
Ifi-J
54
44
0
0
8, 18S3
170
I
0
Deaths.
May
I, 1SS3
I
.1
23
4
T>
17
I
0
May
8, 1883
0
5
28
9
24
25
2
0
The total mortality for the week ending May 5, 1883,
was 703, of which gi were from pneumonia.
Wounds of the Abdo.men and Abdo.minal Sur-
gery.— Dr. S. D. Seelye opened a discussion upon the
above subject before the Medical and Surgical Society
of Montgomery County, .-Via., March 3d. Dr. Seelye
described the relative fatality of wounds of the different
viscera. He said : " Wounds of the stomach give the
highest rate of mortality. Dr. George A. Otis, in the
' Medical and Surgical History of the War,' calculates,
after careful sifting of all the literature on the subject
which his great facilities could give him access to, that the
mortality from wounds from this viscus is nearer ninety-
nine per cent, than Perc)-'s estimate, which was seventy-
five per cent. Comparatively uncomplicated wounds of
the liver show a mortality of sixty-six per cent. Without
giving the percentage of mortality in wounds of the kid-
neys, it is enough to say that they are not among the
most fatal of such wounds, provided that only one is in-
jured and free drainage can be maintained. Wounds of
the bladder show a favorable result as compared with
wounds of other viscera. Wounds of the intestines, next
to those of the stomach, are the most fatal. Yet these
latter present differences according to location of wound.
Injuries to the ascending and descending colon are less
fatal than those of other portions of the bowels. This we
might ex])ect when we remember that posteriorly these
portions are, through a part of their course, uncovered
by peritoneum on their posterior surface." Dr. Seelye's
conclusions were expressed by the following : " Is it
enough that we examine the little hole made by the bul-
let, and, as Abernethy said nature does in these cases,
' Shakes her head and leaves the patient to his hope-
less fate ? ' Is not aggressive surgery the true conserva-
tism in these cases ? We doubt not the lime will soon be
when the surgeon will open up the abdomen, examine
the nature of the injuries, tie bleeding vessels, sew up
wounded gut, clean out extravasated matter, excise spleen,
if necessary, and do anything and everytliing to help na-
ture repair the injury, as we do in external wounds."
Tlie views of the speaker were concurred in by most of
those who took part in the discussion.
May 12, 1883.]
THE MEDICAL RECORD.
531
The Sale of Patent Medicines in Japan. — It is
stated in the first report of the Central Sanitary Bureau
of Japan, just issued, that the Government has estab-
Ushed a pubhc laboratory for the analysis of chemicals
and patent medicines. The proprietors of patent medi-
cines are bound to present a sample, with the names and
proportion of the ingredients, directions for its use, and
explanations of its supposed efficacy. During the year
there were no fewer than 11,904 applicants for license
to prepare and sell 148,091 patent and secret medicines.
Permission for the preparation and sale of 58,638 differ-
ent kinds was granted, 8,592 were prohibited, 9,918
were ordered to be discountenanced, and 70,943 re-
mained still to be reported on. The majority of those
which were authorized to be sold were of no eflicacy, and
but few were really remedial agents. Hut the sale of
these was not prohibited, as they were not dangerous to
the health of the people. If similar regulations were init
in force in this country, it is probable that the sale of
several patent medicines would be put a stop to.
Old Fogyism. — The profession in America labors un-
der another drawback which will hamper it for some time
to come, namely fogyism, within its circles and outside
public opinion, which is too often prone, as far as medi-
cine is concerned, to consider only one phase of the sub-
ject and that the worst. What an outcry would go up
from some of our teachers themselves and the public
generally if a patient were stripped, especially a woman,
before a class, for the purpose of studying a skin atiec-
tion ! Yet that is the way that patients are handled
here. And if they were not so e.xamined, in many in-
stances it would be impossible to make out a correct
diagnosis, as is daily exemplified here. — J'it'iina cor. of
The Quinologist.
The Ancient Operation for Circumcision amonc
THE Jews. — Dr. S. Wiltshire {Medical Press a?id Circu-
lar) thus describes this operation : " The operation is
always performed on the eighth day after birth. Two
seats are prepared in the morning with silken cushions,
one for the godfather, who holds the child, the other, as
they say, for the Prophet Elias, whom they suppose to
assist invisibly. The person who is to circumcise brings
the necessary appliances — the razor, styptics, linen fillet,
oil of roses, to which some add a shellful of sand to
catch the blood, and put the prepuce in when removed.
A Psalm is sung till the godmother brings the child, at-
tended with a crowd of women, and delivers it to the
godfather, none of them entering the door ; the godfather,
being seated, sits the child on his lap, then the Mohel,
or circumciser, taking the razor and preparing the child
for the operation, says with a loud voice : Blessed be
Thou, O Lord, who has enjoined us circumcision. And
on so saying cuts off the thick skin of the prepuce, and
with his finger-nails tears off another finer skin remain-
ing, sucking the blood by putting the penis into his
mouth for two or three seconds and then spitting out into
a glass of wine. Then he lays dragon's-blood on the
wound with powder of coral and other styptics to arrest
bleeding, and staunch any blood that might flow. Over
all he places a fillet or compress saturated in oil of roses,
and then binds up the whole ; that being done, he takes
a glass of wine, and blessing it, adds another benediction
for the child."
The Sequels of Tracheotomy. — Mr. Ross read a pa-
per on "Sequelse of Tracheotomy Occurring after Closure
of the Tracheal Wound," before the Edinburgh Medico-
Chirurgical Society recently, in which he pointed out
that some important lesions tending to cause tracheal
stenosis may occur as a result of the operation of trache-
otomy, without manifesting their presence till some time
after the tracheal wound had healed. Notes were given
of the case of a young woman, who had undergone the
operation at the age of eighteen months for the re-
moval of a hook from the larynx. She now suffered
from occasional attacks of dyspnoea. The laryngoscope
showed a catarrhal condition of the mucous membrane,
with a great want of development of the vocal cords.
At the bottom of the internal cicatrix, there was what
appeared to be a diaphragmatic membranous stricture,
which occluded more than one-half of the tracheal lumen
a condition which has been described once or twice as
occurring after cut throat, but not hitherto, so far as is
known, after the longitudinal tracheal wound. Mr. Ross
also referred to the interesting question which has been
stirrintT the minds of French surgeons recently : " VVhat
becomes of children who have successfully undergone
the operation of tracheotomy ?" Very few adults are
seen with the tracheal scar, in whom the operation has
been done in childhood. — N. E. Medical Monthly.
The Attacks against New York Physicians. — •
I do not write to defend our specialists, however, who
can, no doubt, take care of themselves ; but only for fair
treatment toward them and toward the profession of
New York. It seems to me that there is no call for so
much violent feeling and vituperative language. The
profession is not going to be destroyed or disintegrated,
as has been intimated. I do not think that we are vic-
tims of moral decay. I find it perfectly safe to mingle
freely with my neighbors. The view in this city, I think,
is, that by removing a restriction that had been a dead
letter, we have placed ourselves in a better light before
the world ; have removed an affront and a stimulus to
homoeopathic progress, and have only set aside a tech-
nical morality which infringed on the individual's rights
without elevating him in return. We believe that the true
work for professional elevation lies in securing a higher
educational standard, better trained minds, a more scien-
tific spirit, and a greater technical skill in our midst. We
believe that this work can be better done without the em-
barrassment and reproach caused by the restrictive Code.
We believe that skilled and learned physicians, obedient
to the laws of God and the dictates of common morality,
are what the profession needs. Why cannot the profes-
sion at large admit that we too in New York may, per-
haps, be honest and earnest in our views. And is it not
barely possible that the American Medical Association
has been a little hasty in cutting off from its membership
a State like New York, because of an honest disagree-
ment in by-laws ? — Cor. Chicago Medical Journal and
Examiner.
A Louisville Suit, brought by Dr. Vance of that city,
for recovery of fees for professional services, has excited
considerable interest. Some four or five medical men in
that ethical centre testified that Dr. Vance had per-
formed an improper operation. The jury found in favor
of the plaintiff.
Dr. F. W. Putnam, of Binghamton, N. Y., writes us
a letter regarding the new Code, in which he makes the
point that it forbids regular physicians to advertise,
thus tying their hands, yet places the irregulars who do
advertise on a level with the regular profession.
The homoeopaths have a code which is nearly identical
with that of the American Medical Association. It
ought to keep them from advertising.
Cottage Hospitals. — Two hundred and fifty cottage
hospitals are now in successful operation in England,
relieving about fifty thousand patients annuall), who con-
tribute to the hospital at least one-sixth the cost of their
maintenance. If this system could be generally intro-
duced into this country, a large class would be provided
with hospital accommodations who are now deprived of
their advantages, and many of whom would be willing to
pay a small sum weekly for the medical care and nursing
thus provided. A large outlay is not required, for the
necessary building need not be expensive. In England,
the average cost of cottage hospitals, having a capacity of
about eight beds, is from $4,000 to $6,000 each. In the
experience of Dr. L. W. Baker, a capacity of twenty-five
532
THE MEDICAL RECORD.
[May 12, 1883.
beds for children, $5,000 will about cover the expense
of land and building ; of course the cost of construction
will vary with the location, but there is surely no town
of ten thousand inhabitants and upward too p(5or to es-
tablish and maintain one of these small institutions.
Mortality in New York Durixg the Present
Year. — Dr. F. A. Burrall writes to correct what he, by
a misunderstanding, considers an error in our editorial
on "Pneumonia in New York" (Medical Record, March
31st). We stated that for January and February the
weekly morta.\ity from />ncuma/i!a, not the total mortality,
was greater than in 18S2. The context will show this.
The Advertisement of Quack Medicines in Reli-
gious Journals. — Dr. E. Ingalls, of Chicago, writes us,
referring to the above subject : "In happy contrast with
the course of the IVatchmaii, and many other nominally
religious papers, is that of the Christian Register, of
Boston. The Register has kept its pages clean. The
editor told me not long since that the paper might liave
received fifty thousand dollars for such advertisements
had it not declined to insert them."
The Arkansas State Medical Society holds its
Eighth .\nnual Session at Little Rock, May 30th and 31st.
Chloroform Breath in Gastric Disturbance. —
There is a symptom of gastric disturbance in children
which I have never yet seen mentioned in any text-book,
French or English, and yet it is almost invariably con-
stant and generally to be met with at the debut of the
affection, so that it ma)' be considered as a sure premoni-
tory sign, I mean that of the breath, which smells as if
the child had freely inhaled chloroform. I have always
found that this " chloroform breath " not only commenced
with the gastric disturbance, but continued during the
whole period of the malady, and that its cessation indi-
cated also a cessation in all the other general symptoms,
fever, vomiting, etc., and consequently a return to health.
I have remarked this peculiar odor in children of every
age, and once in a grown-up person ; it was then very
strongly marked. I do not jiretend to be bringing to
light anything new, but I have never heard this peculiar
symptom alluded to anywhere. — Medical Press and Cir-
cular.
The Lancet on Bicycles. — A writer in the London
World says : " I seldom read The Lancet, because when I
do I generally discover that if I do not give up something
or other I shall die before a week is over. Just now this
alarmist organ is explaining to bicyclists that they are
storing up for themselves many fearful maladies. Not
satisfied with airing this trash, The Lancet goes on to ex-
press a hope that bicycles should be taxed, in order to
prevent, so far as is legislatively possible, young men
destroying their constitutions by riding on them. This
is, indeed, protection with a vengeance. Were every-
thing which The Lancet condemns taxed, we should be in
a fair way of paying off the national debt in a lew years.
Unfortunately for The Lancet, bicyclists are so lost to all
proper sense of science as to enjoy better health than
before they took to their machines."
Treatment of Furuncles. — It is well known to-day
that the matter of furuncles is inoculable spontaneously,
and it is considered that this spontaneous inoculation is
encouraged by the softening of the epidermis from the
employment of the [joultice so often used in this aflec-
tion. The primitive boil becomes thus the point of de-
parture for secondary ones, which manifest themselves
in the neighborhood. To prevent this inconvenience M.
Labbfc had the idea of employing successively for the
dressing of furuncles a solution ofcliloral or phenic acid,
but he perceived that this dressing, which was undoubt-
edly antiseptic, did not hinder the softening of the epi-
dermis ; it was thus he had recourse to collodion, a layer
of which he placed around the furuncle. The result an-
swered to his expectations, for no secondary evil ap-
peared. M. Pasteur discovered the microbe of the
furuncle, which he found situated at the summit of the
pustule. However, it will be borne in mind that second-
ary evils do not always depend on auto-inoculation, but
often are the result of a diathesis at present not well un-
derstood.— Medical Press and Circular.
An Interesting Decision Regarding the Plea of
Insanity. — In a murder case appealed from Clarke
Count)', the Supreme Court of Indiana has made a ruling
that has attracted wide attention. The defence in the
case was the insanity of the prisoner. On the trial the
judge charged that the law presumes sanity in all cases,
and the burden of overthrowing the presumption is upon
the person who alleges insanity ; but if the evidence
given by defendant has been sufficient to raise a reason-
able doubt of his sanity, then the general question is pre-
sented to the jury whether or not the crime was com-
mitted by him while responsible for his acts. If a rea-
sonable doubt exists as to the defendant's sanity, he is
entitled to the benefit of the doubt.
The Supreme Court says : "The proposition that the
burden was upon defendant of creating by affirmative
evidence as to his sanity is erroneous. The burden was
upon the State to establish, beyond a reasonable doubt,
every material averment in the indictment. One of these
was malice. There can be no criminal intent when the
mental condition of the accused is such that he is inca-
pable of forming one, and the burden is u]ion the State
to prove that when the offence was committed the mental
condition of the defendant was capable of forming an
intent. The burden is upon the State."
The Finances of the British Medical Journal —
The Financial Statement of the British Medical Asso-
ciation for the year ending December 31, 1882, is an
interesting document as showing the earnings and ex-
penses of a great medical organization. The total ex-
penses for the journal are somewhat over $50,000. The
various expenses of the Association ran the sum up to
about $So,ooo. The receipts from subscriptions and ad-
vertisements amount to above $70,000, leaving a balance
of over $10,000 profits. The expense for the editorial
work and for contributors amounts to $13,000.
Italian Medical Men in Parliament. — Seventeen
medical men have been chosen members of the Italian
Parliament at the last general election, .\mong them
are Drs. Bacelli, Panizza, Semmola, Sperino, and Tom-
masi-Crudeli.
University of Vienna. — The number of students in
the medical faculty of the University of Vienna during
the session recently ended was 1,750, against 1,412 in
the corresponding period of last year.
Pasteur. — On the reassembling of the French Cham-
bers, the government intend submitting a bill to raise Dr.
Pasteur's yearly pension from 12,000 to 25,000 francs.
Annual Meeting of the British Medical Asso-
ciation.— The fifty-first annual meeting of this Associa-
tion will be held at Liverpool, July 31, .August i, 2 and
3, 18S3. Dr. William Strange will preside. An address
in surgery will be delivered by Mr. Reginald Harrison,
and one in i)athology by Dr. C. Creighton. The busi-
ness will be conducted in ten sections.
The Freedmen's Hospital at Washington, D. C. —
The First Comptroller of the Treasury, in examining the
accounts of Dr. Josephs, late disbursing clerk of the
Interior Department, has discovered certain irregularities
in connection with the accounts of the Freedmen's
Hospital. It is alleged that part of the appropriation for
clothing for that institution was paid out for salaries of
officers. The amount paid for salaries in excess of the
appropriations for that service is not stated.
The Medical Record
A Weekly yotcrnal of Medicine and Stcrgery
Vol, 23, No. 20
New York, May 19, 1883
Whole No. 654
©vigtiial ^cctui'cs.
THE DETERMINATION, BY THE GENERAE
PRACTITIONER, OF THE NECESSITY FOR
WEARING GLASSES.'
By D. B. ST. JOHN ROOSA, M.D., LL.D.,
PROFESSOR OF DISEASES OF THE EYE AND EAR IN THE NEW YORK POST-GRAD-
UATE MEDICAL SCHOOL ; SURGEON TO THE MANHATTAN EYE AND EAR HOS-
PITAL : PROFESSOR OF DISEASES OF THE EVE AND EAR IN THE UNIVERSITY
OF VERMONT.
Lecture II.
Gentlemen — We are again to assume that we are gen-
eral practitioners, with a fair knowledge of the anatomy
of the eye, and that we are armed with a case of glasses,
comprising lenses which run iromfive to sixly inches focal
distance, and that we have a set of test-types. With these
aids we are to determine, in a given case, whether the
condition is such as may be diagnosticated by us ; and, if
diagnosticated, treated. I begin with a case of whicli I
know as little as you do, never having examined it. This
patient is twenty-four years of age, and he consults a doc-
tor on account of his eyes. He says that he sees specks
before his eyes, that the eyelashes are falling out, and that
the inside of the lidsfeels rough when he is going to sleep.
He can see at a distance ; it does not trouble him to
read ; his eyelids look well. There is a slight blepharitis,
a little more than hyperemia. There is an excess of
secretion from the Meibomian glands, and the hair-folli-
cles are in an unhealthy condition. As general practi-
tioners we have seen it stated, on fair medical authority,
that people who do not wear glasses when the anatomical
length of the eyeball demands them, sometimes suffer
from blepharitis or conjunctival catarrh. We are therefore
on the look-out to see if any of the cases of this kind
that occur in our practice may not be due to a failure to
wear glasses to correct hypermetropia, myopia, and as-
tigmatism.
Having inspected the lids, cornea, iris, and conjunc-
tiva, our next step will be to determine, by means of the
test-types, what the vision is. We find that the vision of the
left eye {V. L E.) is f-g- — that is, he miscalls some letters
of those that should be seen at twenty feet, but he names
the most of them correctly. The vision of the right eye
(V. R. E.) is |{j-. We now know that this patient has
slightly defective vision in his left eye, but we have not
yet determined whether it is myopia or hypermetropia ;
nor do we know but that there may be added another
condition, known as astigmatism. How shall we begin
in order to find out whether it is myopia or hypermetro-
pia? If we place convex glasses before his eyes, if he
is myopic, he will reject them, because they will make
his vision worse. They make the myopia worse by in-
creasing the existing anatomical defect — that is, elonga-
tion of the diameter of the eye from before backward.
For, as I said in the preceding lecture, a convex glass
placed in front of the eye is but adding to the convex
lens inside of the eye, and increases its refractive power.
With both eyes open, the patient makes but one mis-
take in reading the bottom line at twenty feet. Now we
will put a convex glass before the eyes, and he says at
once that he is sure his vision is made worse, but not
very much so. The glass which I use is one of forty-
1 Delivered at the University Medical College, Session of 1881-82.
eight inches focal distance. I will next use a glass which
is of sixty inclies focal distance, and if he is myopic his
vision will be made worse even with this weak glass. He
does not see worse, but better. He now makes out all
the letters, he says, and therefore he is not myopic. He
is probably hypermetropic, and probably would get on
better with a pair of convex glasses. Hut his case is not
likethat of the little girl whom we prescribed for last week,
and who could see equally well with or without glasses,
and equally well with glasses of considerable power.
This is a case where the patient sees normally with a
very weak glass, and not quite normally without one,
and it differs in degree from the one seen last week. It
is a case of manifest hypermetropia, because he sees bet-
ter by the aid of the convex glass. There may be a
larger degree of hypermetropia concealed. Can we, as
general practitioners, go farther ? We now know that
he has a certain amount of hypermetropia, but it is so
small that it is not to be practicall}' considered, if there
is no more. Can we, without the ophthalmoscope, find
out if there be any more ? As general practitioners we
must know that there is an agent, the sulphate of atropia,
which, when put into the eye, will paralyze the ciliary
muscle, and if there is any concealed hypermetropia,
that it will exhibit it. Of course, we then come at once
to another kind of hypermetropia. We have already de-
monstrated a manifest hypermetropia, and a hyperme-
tropia that is called facultative, or, so to speak, voluntary.
A case of manifest hypermetropia of a very slight degree
we are now discussing. In it vision is only normal, i.e.,
VI by the aid of convex glasses. Facultative hyperme-
tropia was demonstrated last week. In this last-named
form vision is equally good with or without convex glasses.
It may be that the sulphate of atropia will reveal a
degree of hypermetropia, which is entitled to considera-
tion, and which requires glasses of 36- or 30- or 24-inch
focal distance to correct. In order to get full paralysis
of the ciliary muscle we must use a solution ol four grains
to the ounce of water, for several days in succession, not
less than two days, better still from three to five days,
dropping in a drop three times a day, and then, if the
patient sees better with, than without a convex glass, the
glass with which he sees best at a distance is the glass
measuring the hypermetropia, which has been concealed.
From what we have read as general practitioners, we
know that we have a right to suspect a certain degree of
concealed or latent hypermetropia in any case where
there is a slight manifest or even a facultative hyper-
metropia. In other words, the total hypermetropia, or
the true refraction of the eye, is not usually revealed un-
less the ciliary muscle be put completely at rest. Let us
prescribe for our patient, however, on the basis of what
we have learned to-day. If, however, the blepharitis be
not relieved by the weak glass, we may then use the
atropine to determine if there be such a concealed defect,
and that we are justified in using a stronger one.
It would be possible to measure the refraction by
using an ophthalmoscope, but this instrument is not
necessarily in the hands of the general practitioner, and
we ignore its use for our present purpose of diagnosis.
I will now test each eye separately with the finest type,
and see whether the defective vision in the left eye may
not be due to lesion in the cornea. He reads the finest
print fluently, at more than six inches from the eye, and
the proof is almost positive that his trouble is one of re-
fraction, and that his other trouble, consisting of a mod-
534
THE MEDICAL RECORD.
[May 19, 1883.
erate form of conjunctivitis, is secondary to the strain
of the ciliary nmscle. Over and over again, I have seen
such cases cured, for the time, by the aid of atropia alone.
In conjunction with treatment by glasses, you may ad-
vise him to keep his eyelashes clean by the use of a solu-
tion of bi-carbonate of soda, one drachm to eight ounces
of water, which will dissolve the dried mucus, and that is
about all he requires except the glasses.
MVOPIA.
Our next patient is a man of twenty-six years of age,
who says he cannot see at a distance ; as a student he
could not read letters upon the blackboard, but he can
see to read fine print. It suggests itself, then, if he can-
not see at a distance, cannot recognize places or faces,
cannot read letters upon a blackboard at the distance
from it that a student ordinarily sits, and still can read
fine type, that he may have manifest hypermetropia, which
would impair vision for distance, without interfering with
vision of objects a few inches from him.
We may make a test at once with fine type, for we
have physiological knowledge that will enable us, with-
out glasses, without any aid except test letters, to deter-
mine as to the probabilities in his case.
The physiological fact which we call into service, is
what is known relating to accommodation of the eye.
We know that this accommodative power is exercised by
the action of the ciliary muscle upon the crystalline lens.
We know, from our knowledge of optics, that the rays of
light coming from a near point are divergent, and the
nearer the object is to the eye, the more divergent are
the rays. We know that it will take a thicker lens to
cause divergent rays to come to a focus upon the retina
than those that are parallel ; that it will require more
muscular power to cause tlie lens to become thicker, so
that the divergent rays which pass through will focus
exactly on the perceptive layer. We also know, from
anatomical and physiological knowledge, that a short-
sighted eye is longer, from before backward, than a
hypermetropic eye ; and that it is also longer than the
normal eye.
We see, then, that if a person starts with an eye
which is too long, when he comes to read fine type,
when he comes to look at objects near at hand, he has
an advantage over the person who has eyes of the rifht
length, or who has eyes that are too short. The infer-
ence is that if this man is myopic, he will be able to read
fine type nearer to the eyes than if he is hypermetropic
or ennnetropic. because divergent rays do not trouble
him. The myopic eye, or the one that is too long, is
adapted to them, whereas the normal eye is adapted to
parallel rays, and the hypermetropic eye is adai)ted to
convergent rays.
Now we know from observation carefully made and
corroborated and laid down in tables, that the nearest
point of exact vision for fine print of an eye which is
normal, at twelve years of age, is 2| inches, and as we
increase the age the near point becomes farther oft", be-
cause the power of the ciliary muscle weakens in time,
and also because the lens itself becomes more rigid than
in youth. At twenty-five years of age, therefore, we
find that the near point is 4 inches ; at forty-five years
8 inches, and at sixty years of age the near point is at
24 inches.
In contrast with this, notice the near point for the
myopic eye. At the age of sixteen years it is 2|
inches, and at the age of forty years it is the same. The
near point does not change ; does not recede ; and this
is a great advantage for reading, sewing, and the like.
If this man, twenty-six years of age, has a near point, a
great deal nearer than a person of the same age whom
we know not to be near-sighted, we shall at once suspect
that he is myopic.
You will always have the means for testing whether or
not this be true. That is, you will test for the near point
of some person of the same age, who sees perfectly at a
distance, and then compare the result with that obtained
by testing the eyes of the person who is suspected to be
near-sighted or myopic. The man whom I now ex-
amine, who says that he has always been able to see ob-
jects clearly at a distance, reads fine type at the distance
of 4-J- inches, and you see that it corresponds pretty w-ell
with the figures given in Bonders' table. He is of the same
age as our patient whose near point for the same object
is 3^ inches. The probabilities, therefore, are that he is
myopic. In order to assure ourselves of the absence of
errors in observation, I will put a glass before the eyes
which I am quite sure will not do him any good.
Before doing this let us test his vision. [Test-tj'pes
used.] We find the vision in the left eye (V. L. E.) -^^-^ ;
and in the right eye {V . R. E.) J/^. \Ve have also seen
him read fine type fluently, and we do not believe that
he has neuro-retinitis, detachment of the retina, amauro-
sis, or cataract. He is probably myopic ; and I con-
clude he is considerably so because his lack of vision is
so great and his near point is so near. I will now put
on a 7i'eai: convex glass. He says that his vision is made
a little more indistinct. I will next put on a concave
glass of thirty inches focal distance, which practically
shortens the eyeball considerably. With this glass he
can make out " A," the first letter of the test-types. We
have raised his vision to ^-Jg-. Now 1 will make a long
leap in choice and use a glass of sixteen inches focal
distance. His vision is now raised to -|{}. I next use a
concave glass of eleven inches focal distance, and his
vision is raised from -j-J^ to f [f. Shall we stop there ?
Oh, no.
We have skipped over two or three numbers in our
trials. In myopia we give the iveakest glasses that
will fully correct the erroi-. In hypermetropia we give
the siroiigest glasses ivhich will fully correct the error.
The danger is iti giving too weal: glasses in hypermetro-
pia, and too strong glasses in myopia. Why ? Because
there is in some eyes, under strain in constant work, a
kind of accommodative myopia ; that is, the ciliary mus-
cle is not at rest in a myopic eye any more than in a
hypermetropic eye, and there may be an excessive action
or spasm of that muscle, which increases the myopia by
unduly thickening the lens, and if you are not careful
you may give too strong glasses. It is better to give
a myopic patient a glass under than over the exact
degree. The glass which will do our patient the most
good is probably number 12, a little weaker than 11,
which raised his vision to normal or ||}.
In young persons especially, accommodative myopia
is very common. It is not safe to prescribe concave
glasses for them, without first paralyzing the ciliary mus-
cle by the use of atropia.
This, then, is a case of myopia, and we have made our
diagnosis without the aid of the ophthalmoscope. Upon
the basis of this examination, I will now go on and say
to you what the general practitioner should know con-
cerning myopia.
Myopia may be a congenital condition or it may be
acquired. Its anatomical basis consists of an elongation
of the anteroposterior diameter of the eyeball. The
great problem of heredity occurs in the discussion of
myopia. If the father and mother, one or both, are my-
opic, will the children he myopic ? Some of them will ;
probably not all of theui. In some of them there will be
a return to the normal type, a tendency which, accord-
ing to Darwin, will always preserve the human race from
degeneration to any great extent. I speak of this fact
because of those w-ho are fearful that the human
race is gradually undergoing degeneration, and finally
will succumb to the assaults of civilization, and that at
last we shall all be myopic, that our grandchildren will uni-
formly have detachment of the retina and other conse-
quences which flow from myopia. No ; the laws of hered-
ity, whatever they are, may be overcome — may be shorn
of some of tiieir power by circumstances. The child
born with eyeballs too long may be encouraged in early
May 19, 1883.]
THE MEDICAL RECORD.
535
life to look only at large objects, to play with good-si/ed
toys, to always live in a well-lighted room, discouraged
from reading by twilight, encouraged to shoot, and to i)lay
games which involve looking at a distance, and so forth.
In other words, circumstances may control his hereditary
tendency to a certain degree, and may finally overcome
in the race, to a large extent, the myopic tendency which
may have been transmitted to lis. The myopic tendency
which has come upon the German people, until it is
nearly a scourge, might be modified if the Germans
■could be induced to banish their abominable type, cease
the everlasting writing upon most trivial subjects in of-
fices and bureaus everywhere, and place themselves
under conditions favorable to overcoming the tendency.
In other words, if they would imitate their Anglo-Saxon
neighbors across the channel, do a little more hunting
and driving and riding, and work less in enclosed gym-
nasia and exercise halls.
But there is an acquired myopia. Children are born
into the world with eyeballs too short, and by a reversal
of the proper conditions of life their eyeballs may become
too long. Suppose that I wish "to produce elongation of
■the eyeball, how can it be done ? I would do this : I
would allow the child to play with only the smallest toys,
train him in picking up pins, in looking out finely printed
names on a map, and I would be careful to get the most
illegibly and finely printed books for him to read ; set him
at work in the evening by the aid of a tallow dip, or by
the light of a wood-fire ; in the daytime have him sit as far
away from the light as [jossible ; see that the light used for
reading or work is shaded by the arm ; see that-(rall out-
door occupation is neglected ; discousage his playing at
ball with other boys ; see that he is fed with farinaceous
food only ; that he is washed once in four weeks, if at all ;
.has insufficient clothing in the winter and is overclad in
the summer. In other words, make his condition as
hard as possible ; place him in a position so that when he
looks upon a book he will have to strain his utmost to
get an image upon the retina ; and in a large number of
cases I think you will produce myopia. How would it be
•done? This straining to see in a poorly developed child
would fill the blood-vessels in the ciliary region, would
prevent the return of venous blood, and there would be
congestion. The next step would be the stage of soften-
ing, and then the coats of the eyeball would yield, and
elongation sufficient for our purpose will have been
accomplished. A one hundred and twentieth of an inch
as a great deal in an eyeball.
This is myopia ; this is elongation of the eyeball, either
•congenital or acquired. The old notion was that myo-
pia depended upon change in the curvature of the cornea.
That is a kind of acquired myopia which occurs in cer-
tain diseases, occurs with conical cornea, so called, and
after an inflammatory affection of the cornea; but it is
not the myopia which we are considering. It is not the
myopia to be remedied by glasses, to be diagnosticated
and prescribed for by the general practitioner. The lat-
ter, the true myopia, depends upon elongation of the en-
tire eyeball from before backward.
As general practitioners, you will be called upon to
see to the building of school-houses, to the admission of
light, and to the nutrition of the children. Prevention
of disease is to be the function of the medical man of
the future. The curing of disease will always remain his
dire alternative where it cannot be prevented. Your
greatest efforts should be directed toward the prevention
of disease. The ignorance of the conniumity, and the
insuperable insolence with which some of our officials
receive sanitary plans made for them, the political cor-
ruption of every age and time, are obstacles which will
prevent you from carrying out your purposes, even if you
were sufficiently skilled to obviate every disease. Thus
there will always be, besides accidents, plenty for you to
do in the way of treatment. Nevertheless, I say again,
your great work as practitioners in the future will be in
the prevention of disease. In the prevention of myopia
there is a great field before us. It would be very sad
for this country if we came into the condition in which
Germany exists with reference to myopia, even if there
cro with it the culture and scientific acquirements which
have made Germany so easily first in many of the great
movements in the scientific world. To become a myo-
pic nation, even with such a reward, would be paying
too great a price. A myopic eye is a diseased eye, the
hypermetropic eye is an undeveloped eye. The emme-
tropic eye is the normal eye, but it very seldom exists.
But the dangers from the myopic eye are much greater
than those from hypermetroj^ia. The chief danger to a
myopic eye is that changes in the light-perceiving portion,
the image-forming portion of the eye, the retina, may ren-
der it unable, even with the greatest muscular exertion and
under the most favorable conditions, to form an accu-
rate image. These changes will be due to the increasing
softening and elongation of the eyeball, and the constantly
acting congestion which precedes it. 'I'he elongated e\e-
ball is also in danger, from sudden exertion, of being
fatally injured, as to sight, by detachment of a portion
of the retina. We are, therefore, very anxious as sani-
tarians to diminish the amount of myopia.
Long ago Mr. Ware, who wrote on myopia first of all
'of those who have said so much on the subject, discov-
ered that it was very rare in the English Foot Guards,
and experience shows that it is very rare in England as
compared with Germany, for reasons already mentioned..
I predict that it will never become a scourge in this
country, because of the tendency among our people to
use the rod and gun, to ride upon horseback, and to
work up our boundless facilities in the way of open-air
exercise. Thus I return to the statement, that you as
sanitarians must attempt to prevent myopia by advice
to your patients.
Our patient here has a sound retina, for he has perfect
vision with glasses. Just now, it is a little troublesome
for him to wear glasses perhaps, but upon the whole it is
an advantage. He will have the advantage of those who
are emmetropic when time has made his hair gray, weak-
ened his ciliary muscle, and made his lens a little harder ;
for then his long eyeball will stand in good stead for him,
and he will read the newspaper with ease without glasses.
And this is all the advantage there is in myopia. In
myopia glasses are not needed for reading in old age.
As to the poiHilar notion that it decreases, it is utterly
incorrect. An eyeball once elongated remains of the
same length. A spasmodic myopia may exist, and that
may diminish, but not a myopia that depends upon the
pathological changes I have mentioned.
Pernicious Jaundice. — The following case is related
by Dr. Verdalle in the Journal de Medecine de Bordeaux
of April I, 1S83. A young man, nineteen years of age,
of temperate habits and of good physique, was admitted
to hospital complaining of nothing but excessive lassitude.
He had marked jaundice with clay-colored stools, but
there were no nervous symptoms and no fever. The
liver was normal in size and not tender on pressure.
Laxatives and Vichy water were prescribed, and no
further attention was paid to the case, it being supposed
to be one of simple catarrhal jaundice. Five days later
there was vomiting, which was controlled by simple
remedies. Four days after this, suddenly, during the
night, the patient became wildly delirious, in which con-
dition he remained until the morning, when coma set in.
There was absolute unconsciousness, reflex movements
were abolished, the pupils were dilated, the pulse was
sixty and regular, and the temperature was sub-normal.
Death ensued the following night. The autopsy revealed
acute interstitial hepatitis. The liver was of normal size,
and showed upon its surface and within its substance a
number of irregularly shaped spots of a bright yellow-
color. There were numerous small ecchymoses upon
the gastric mucous membrane. The brain and meninges
presented no traces of inflammation.
536
THE MEDICAL RECORD.
[May 19, 1883.
©riQinaX J^rticlcs.
SUCCESSFUL LUMBAR COLOTOMY L\ AN
INFANT OF TWO MONTHS.
By GEORGE R. FOWLER, M.D.,
Sl'RGEON TO ST. M.\R1-'S HOSPITAL; SENIOR SURGEON TO BUSHWICK .\ND E.^ST
BROOKLYN DISPENSARY.
Annie S , two months old, was brought to my office
on December 6, 1881, with the following history: The
mother, who has borne four well-formed and healthy
children, states that while pregnant with this child, and
when about five months advanced, she cared for another
child suffering from an ischio-rectal abscess, which was
opened by my assistant, Dr. Beasley, near the margin of
the anus. The patient, an otherwise well-developed "child,
at birth exhibited no subjective symptoms of any malfor-
mation ; although the parents now recall that but very
small and purely liquid fa5ces were discharged up to
within two weeks, w^hen these ceased. It was noticed
that urine was voided, up to this time, when no fffical
matter was found upon the napkin, and likewise that a
stain of f^ces occurred when no urine was voided. E.x-
amination reveals a distended abdomen, tympanitic ex-
cept over the transverse and descending colon. The
navel is protruding, and the superficial abdominal veins
are enlarged and prominent. There is no anus. No
trace of a recto-vaginal fistula can be discovered, although
such must have existed.
On December 7th, the child under chloroform, assisted
by Drs. Beasley and King, I attempted to find the open-
ing between the vagina and gut, through which the fxcal
matter had escaped. Failing in this, Idividetl the tissues
posterior to the vagina in the median line directly back
to the point of the coccyx. The dissection was then
carried carefully upward until the peritoneal cavity was
reached, above the cul-de-sac of Douglas. At a point about
midway between the ostium vagina; and the upper limit
of the vagina posteriorly a membranous septum was
found, dividing the canal into an anterior and posterior
cavity ; it was thought that this latter was the one lead-
ing to the rectum, but patient search failed to reveal any
opening. In this emergency I performed colotoniy
through the left loin as follows : The child was placed
upon its right side, and the outer border of the quadratus
lumborum muscle made out as far as practicable ; this
latter was found to be attended by some difficulty, on
account of the extreme youth of the subject. The oblique
incision, recommended by Bryant, was then made, about
one and one-half inch long, beginning at the supposed
site of the outer border of the quadratus lumborum mus-
cle and extending obliquely downward and forward.
The skin and superficial fascia, a portion of the latissimus
dorsi, the external oblique, internal oblique, and trans-
versalis muscles were divided in turn, and the transversalis
fascia exposed. Upon incising the latter, the lower
border of the kidney was brought into view, lying at the
bottom of the wound. It was found necessary to divide
the peritoneum before the colon could be reached ; this
being done the latter rose prominently into sight, and
was easily identified. Having taken the precaution to
pass a ligature through the walls of the colon and given
the same in charge of an assistant, I incised it for a distance
of about three-fourths of an inch in a direction parallel to
its long axis ; a sponge wrung out of warm carbolized
water was held over the anterior angle of the wound to
prevent fecal matter from passing into the cavity of the
peritoneum. Upon opening the intestine there escaped
a quantity of f;cces and gas. The edges of the opening
into the gut were now stitched by interrupted sutures of
silk to the incision in the integument, care being taken
to frequently wash away the fa;cal material which from
time to time oozed from the opening during this stage of
the operation. Owing to the traction made upon the
colon, the anterior angle of the incision into tlie perito-
neum slipped inside the abdominal cavity, and could not
be secured ; the posterior angle was included in the su-
tures uniting the intestine to the skin. Several times
during the operation the little patient stopped breathing,
and frequent eftbrts at resuscitation were necessary ;
these consisted of artificial respiration by Sylvester's
method, slapping the precordial region, inhalation of
nitrate of amyl, inverting the patient, and upon one
occasion the hypodermic injection of gin, the only
available stimulant ; this latter was found to be rapidly
efficacious, probably owing to the pain produced by its
irritating qualities.
A large cup-shaped sponge, wrung out of carbolized
water and held in place by a napkin, was the only
dressing employed for the wound in the loin ; the peri-
neal wound was dressed with carbolized oakum after
thorough cleansing with i to 40 carbolic solution. The
little patient was placed in its mother's arms, where it
soon rallied from the chloroform and after an hour slept
comfortably. The sponge was directed to be changed
frequently, as there issued almost continually from the
• artificial anus large dejections of a natural yellow color.
The carbolized oakum dressing over the perineal wound
was ordered to be changed, and the parts bathed with
1 to 40 carbolic solution, whenever soiled by the urine.
The following is the record of the further progress of
the case :
December 7th, evening. — Pulse, 140 ; temperature,
100° Fahr. ; child crying lustily and is quieted by nurs-
ing. Ordered two drops of deodorized tincture of opium
to be given every hour when in pain.
December 8th. — Pulse, 160 ; temperature, 102^° Fahr.
Patient is moderately under the influence of the opiate.
Size of abdomen much diminished; large quantities of
fscal matter of the consistence of putty is coming away
with gas. Perineal wound glued together by plastic exu-
dation.
December 9th. — Pulse, 120 ; temperature, 98^° Fahr.
Has rested quietly with but a single drop of the deodor-
ized tincture of opium during the last twenty-four hours.
Bowels moved through artificial anus four times during
the same period. Suckles well ; mother thinks that a
slight ffecal stain occurred upon the dressing over peri-
neal wound.
December loth. — Pulse, 120; temperature, 98^° Fahr.
Child rested well during the night ; looks bright and na-
tural this morning. Bowels have moved three times dur-
ing last twenty-four hours and has taken but one drop
of the deodorized tincture of opium during that time.
Tissues around opening slightly reddened. Good union
of the edges of the incision in the colon to the integu-
ment.
December nth. — Pulse, 120; temperature, 98^" Fahr.
Patient's condition, so far as can be determined, exclu-
sive of the opening in the loin, is perfectly normal.
Ordered carbolized cerate for the edges of the opening
in the loin. The mother showed me a stain upon the
lower napkin which is undoubtedly that of fscal matter ;
thus far, however, the napkin has been also wet with
urine.
December 12th. — Pulse, 125 ; temperature, 98^° Fahr.
Slightly uneasy ; removed sutures ; wound healthy.
Bowels move through artificial anus four or five times
in twenty-four hours. Lower wound united perfectly.
Discharged cured so far as operation is concerned.
I subsequently attempted to find the termination of
the rectum b)' passing flexible bougies through the arti-
ficial anus ; tliese were arrested at about the site of the
sigmoid flexure. Further operative jirocedurcs were
deemed inadvisable. The child is strong and healthy,
and seems to suffer no inconvenience from the artificial
anus.
Remarks. — This is one of those rare cases in which
there seems to have been a fxcal fistula terminating into
the vagina, conjoined with absence of both rectum and
anus. Cases in which a fistula opens into the v.agina
May 19, 1883.]
THE MEDICAL RECORD.
537
exits are commonly those in which the rectum is pres-
ent, and may be regarded as the cases most favorable
for operation, excepting, perhaps, those cases of the mal-
formation in which there is simply absence of the anal
opening, and in which the bulging gut can be plainly
felt and seen through the integument or occluding mem-
brane. From the fact that fascal matter had come away
early in the patient's history, when no urine stained the
napkin, and that, per contra, urine had been voided wher.
no faecal stain accompanied it, it was reasonable to sup-
pose that I had to deal with one of those cases in which
the rectum was present, the fajcal fistula opening into
the vagina, the anus only being absent. Such being the
case it would have been comparatively easy, upon locat-
ing the opening into the vagina, to have passed a
curved director into the rectum through the opening,
directing its point downward and backward, and upon
this as a guide, made the necessary opening for the pur-
pose of establishing an anus in the normal situation.
The fact that the urine and fajces were voided separately
was an almost positive indication that the case was not
to be classed among those in which the fajcal fistula
opened into the bladder or urethra. It was, therefore,
with the greatest confidence that I expected to be able
to relieve the patient by the simple operation above in-
dicated. The event proved, however, that I had to deal
with one of the most difficult, as well as rarer forms of
the deformity, and the question as to what was best to
do in such an emergency at once arose. Exploratory
operations, such as I performed, i.e., that of mcising the
tissues in the median line and following the curve of the
coccyx, and dissecting carefully upward in the hope of
finding the cul-de-sac in which the gut sometimes ends,
as frequently fails as it succeeds ; unfortunately it is
not devoid of danger as well, for diffuse inflammation of
the sub-peritoneal cellular tissue and peritoneum gener-
ally bring about a fatal issue. Again, in such an opera-
tion, there is no certainty that the rectum, even if it
exist at all, lies in the median line, and a dissection may
be carried up alongside of the gut, so as to open into
the peritoneal cavity, or a trocar may be plunged into
what appears to be the bulging cul-de-sac at the bottom
of the wound, and only a protruding fold of peritoneum
be perforated. Thus it may occur that the intestine is
near at hand, and yet be missed entirely.
Although in this case an attempt was made to find
the rectum by dissecting up the perineum, yet I believe
that such a course should not generally be followed.
The uncertainty of finding the gut, the possibility of a
atal issue resulting from traumatism mflicted upon the
peritoneum and its underlying connective tissue, and
the liability to hemorrhage from some of the branches
of the internal iliac artery, all combine to render the
procedure an exceedingly hazardous one. Taking every-
thing into consideration, therefore, I think that the ad-
vice of Holmes should be followed, and in cases in
which no guide to the actual presence and location of
the gut exists, as, for instance, a fsecal fistula through
which a probe can be passed into the rectum, the opera-
tion of colotomy should be at once performed. This
operation is not more dangerous than the exploratory
one through the perineum, and possesses the advantage
of relieving the patient's immediate wants ; it is also
comparatively easy of performance.
What I consider of the greatest importance, however,
in the immediate performance of colotomy in the class
of cases under consideration, and a point that suggested
itself to me at the time when I attempted, in this pa-
tient, to pass a flexible bougie through the artificial anus
in the hope of locating a rectal pouch, is the feasibility
of making available the opening in the colon for pur-
poses of diagnosis. A sound or guide may be passed
through the latter downward and backward, thus demon-
strating indubitably the jjresence or absence of a rectum ;
in the former case the sound will form an infallible guide
upon which to direct the incision for the establishment
of an anus in the normal location. Should such prove
successful, the opening in the colon can be closed at
once, or at a subseciuent operation. On the other hand,
should it be discovered that no rectum exists, the patient
will have been saved from the dangers attending the
uncertain exploratory operation, and the operation of
colotomy, to which it must finally submit, be already ac-
complished.
That the child in this case had attained the age of two
months before serious symptoms of intestinal obstruction
occurred is worthy of note. The ex])lanation most rea-
sonable is that, in the earlier part of its existence, the
fffices, being almost purely liquid, readily found their way
through the fistula; even then, according to the mother's
statement, the discharges were only sufficient to merely
stain the napkin in small spots. Later on, as the faecal
matter became more solid, it could not find its way
through the opening, and gradually accumulated ; in
consequence of this the track of the fjecal fistula grad-
ually contracted until it became so small as to be un-
discoverable. That the fistula, in some instances, may
be sufficient during early existence, and yet not fulfil
the requirements of later life, is shown in a case of Mr.
Lane's, at St. Mary's Hospital, London, in which the
patient lived to the age of four and a half years.' By
this time the intestine, from the insufficiency of its out-
let, had formed an immense pouch which filled the whole
pelvic, and encroached considerably upon the abdominal
cavity. Ricord relates two cases in which the opening
into the vagina was sufficiently large to answer all the
purposes of an anus ; the subjects, both females, reached
adult life and apparently suffered but little inconvenience
from the malformation. In these cases the fistula and
its opening must have been large, and a sphincter mus-
cle develojjed around the latter.
In the matter of the influence of maternal impressions
upon the arrest of development in this case I have very
little to offer, except to express my disbelief in such in-
fluences. The period at which this influence was sup-
posed by the mother to have been instrumental in affect-
ing her offspring was too late in intra uterine gestation
to have preceded the time when the anus and rectum,
separately developed, meet and coalesce to form the
complete intestinal canal.
The Temper.\ture of Sc--\rl.4TIN.i. — Drs. Kuv-
shinsky and Pastor have undertaken a large series of
observations on the course of the temperature in scarlet
fever, and have concluded therefrom as follows :
I. In a vast majority of the cases, the temperature,
after a lysis on the sixth to the tenth day, remained
normal during the next three to eighteen days (mostly
fourteen days), and then again rose to febrile figures (in
some cases to 104° F. and above). Within one to five
days it again gradually returned to the normal. In some
few cases there were observed similar tertiary elevations
of temperature, generally on the thirty-fourth to the
thirty-sixth day of the disease. 2. Simultaneously with
these secondary elevations of temperature, there were
almost invariably found some other characteristic mor-
bid phenomena, as swelling of the lymphatic glands
(mostly cervical), more or less pronounced renal aft'ec-
tion, reappearance of a diffused angina, inflammation of
the endocardium, extreme weakness of pulse, and, lastly,
in four cases, reappearance of the scarlatinal rash with
subsequent desquamation. Considering the facts stated,
Drs. Kuvshinsky and Pastor arrive at the conclusion that
re-elevations of temperature in the course of scarlet fever,
being far from accidental, are caused by the scarlatinal
infection itself The latter, therefore, in common with
some other infectious diseases, shows a disposition to
run its course with greater or lesser oscillations in the
development of various symptoms of the pathological
process.
1 British Medical Journal, p. 845. 1858.
538
THE MEDICAL RECORD.
[May 19. 188:
ON THE
IMPORTANCE OF RECOGNIZIxXG THE CON-
DITIONS KNOWN AS STHENIC AND AS-
THENIC, IN DIFFERENTIATING THE CAU-
CASIAN AND AFRICAN RACES ; AND IN
DISEASES GENERALLY.
By HARVEY L. BYRD, M.D.,
PRESIDENT AND PROFESSOR OF OBSTETRICS AND DISEASES OF WOMEN AND CHIL-
DREN IN THE BALTIMORE MEDICAL COLLEGE, BALTIMORE, MD.
There are two good old words with explicit significa-
tion, which were much and properly used for the most
part by our grandfathers in the jjrofession, that seem to
have lost their value in a great measure in the estima-
tion of some of our modern teachers and writers upon
medical subjects, which might be profitably restored to
their former prominence and importance in our profes-
sional literature of the present day. Should this brief
communication, therefore, produce no other beneficial
result than that of recalling attention to their significance
and their peculiar fitness to occupy an enduring place in
our nomenclature, and thus to keep the two widely sep-
arated and almost diametrically opposite states or con-
ditions of the human organism in health and in disease,
ahvays prominently and perspicuously before the medical
mind, a most important step will have been taken toward
wiping away some of the flimsy drapery with which cer-
tain morbid conditions have been sought to be clothed by
a few modern writers, and many of the hair-breadth dis-
tinctions between diseases, attempted to be made by
others, bridged over or annihilated altogether. The im-
port of the good old Greek, stheiws and asthenos, stands
out in bold relief before the mind of the medical philos-
opher, of much practical experience in the profession,
whenever he is called to the bedside of disease. And
like the Pillars of Hercules, they must ever mark the
entrance into the great sea of successful professional
practice, where their significance is obeyed as it should
be. It is not, therefore, claiming too much for those
words to add, that a correct knowledge of the conditions
which they represent, establishes the only true basis, or
foundation, upon which an accurate diagnosis can be
formed, and consequently a correct therapeusis insti-
tuted in the treatment of diseases. The value and im-
portance, then, for the revival and a more general use of
those terms in our discussions and treatment of the thou-
sand ills to which flesh is heir, must be obvious to the
intelligent mind upon a moment's consideration ; par-
ticularly as they may be readily observed as intimately
associated with the action of morbific agents in the de-
velopment of disease, and sometimes, if not frequently,
important factors as predisposing, and, possibly, even
the exciting causes of certain diseases in either race, and
among many conditions of mankind. But there is absolute
necessity for the use of these words, if we would appre-
ciate at their proper value certain normal or natural states
and conditions as we find them existing in the primor-
dial types of the genus homo. .-Vnd long experience has
satisfied my mind completely that professional success of
a high order is unattainable where the Caucasian and
African races are contemporaneously attended either in
hospital or private practice, without heeding the natural
tendency of disease to a sthenic state in the white and
an asthenic condition in the negro race. This state of
things is conspicuously marked in endemic and epidemic
visitations, when the two races are under the action of
the same morbific agent or influence for a certain space
of time. The natural and radically distinct differences
and peculiarities, anatomical and physiological, which
exist between the negro and the white man, have been
already sufficiently referred to in a previous article in
this journal, when speaking of the primordial races of
man ; and hence it will only be necessary to say a few
words, a little further on in this paper, on the effect of
materies morbi, and the action of therapeutic agents
upon the respective races to render the entire matter
clearly intelligible to the reader.
As both the white man and negro are exotic, and have
resided contemporaneously in this country for a suffi-
ciently long period of time under the same and similar
climatic, hygienic, and physical surroundings to be
equally well known, they are, therefore, in a suitable
condition to be studied in regard to their predisposition
to, and their ability to withstand, the influences of mor-
bific agents, when acting as chief factors in the develop-
ment of endemic and epidemical diseases. Whilst pre-
senting some leading facts in support of the foregoing
premises, I shall take occasion to introduce the action
of therapeutic agents, as being fully in harmony with the
laws which establish and control diversity in the races
to which they apply ; and thus develop the utility, not
to say imperative necessity, for carefully regarding the
sthenic and asthenic conditions as factors of the highest
value in the diseases to which the races are liable.
And, therefore, the absolute demand for a modification
of treatment in the Caucasian and African races w^hen
suffering from the same disease. To what has been
said already of the status of the two races must now be
added the distinctions of age and sex, in order that the
parallelism may be rendered as complete as possible, and
thus the dift'erentiations be perspicuously brought forth
and made of practical advantage to the profession in a
clearer presentation of the value of symptoms and signs
at the bedside. As already intimated, the white and
black races are not equally liable to impressions from
morbific agents and influences.
Thus, to Cholera. — For twenty or more years preceding
the late civil war, cholera occurred from time to time,
endemically, among the negroes on the rice plantations
of South Carolina and Georgia, assuming even epidemic
proportions as it extended to adjacent or contiguous
plantations ; and though the overseers and their subor-
dinates, and sometimes the owners or proprietors of the
estates and their families even, remained uiion the plan-
tations continuously during such visitations, they enjoyed
almost complete immunity from the disease. The ne-
groes all the while manifesting the chain of phenom-
ena so characteristic of Asiatic cholera in a malignant
form.
Second. — Yelloic Fever. — ."^sthat disease prevailed epi-
demically in the cities of the South, in ante-bellum times,,
the white, or Caucasian race, was the material upon which
it seemed pleased to feed ; and the fairer the type, all
other things being equal, the greater the fatality of the
disease ; while the African, or negro race, was nearly
exempt from its ravages. In mv own experience, in the
treatment of hundreds of yellow fever patients, I never
saw a case of black vomit in a negro.
Third. — Malaria. — Whilst he was liable to be at-
tacked with remittent and intermittent fever, the negro
was very far less exposed to the effects of malaria than
the white man, under the same circumstances.
Fourth. — Inflammatory Diseases. — The negro suffered
much less frequently from inflammation of the serous
and fibrous tissues than the white race, and much less
also from troubles of that kind in the mucous surfaces ;
and though attacked with jjueumonia to a considerable
extent, when it appeared to prevail epidemically in the
South, he did not suffer in the same ratio with the white-
man, though far more exposed to inclement weather and
atmospheric vicissitudes. The parallelism and difteren-
tiations of the diseases to which the two races are ex-
posed might be extended almost indefinitely ; but it is
thought that a sufficient number of facts have been ad-
duced to satisfy the wishes of any wlio might be pursuing
this branch of professional inquiry, and 1 will therefore
hasten on, as fast as (iracticable, to the other salient
points adverted to in the earlier portion of this paiier.
Any, and as far as I know, every disease that affects the
white and negro races, in common, assumes a lo'ii'cr grade
of action much sooner, under the same circumstances^
May 19, 1883.]
THE MEDICAL RECORD.
539
in the latter than in the former race, when that state is
not conspicuously obvious ab initio. Again, I feel quite
sure that I can state, with great accuracy and propriety
of language, that the converse of the foregoing observa-
tions is true of diseases generally in the white race —
certainly so when contrasted with morbid conditions as
found in the former race. Hence, it would seem to be
logically certain, that while a disease might exhibit a
higher or lower grade of action, in either the Caucasian
or the African, under certain circumstances, and at dif-
ferent times, the law depending upon difference in race
is, that tlie type of disease in the white race is sthenic,
and it is asthenic in the negro, under the same, or as
nearly as possible the same, circumstances. These types
will of course suffer modification or exaltation, and become
more or less sthenic or asthenic, under different or vary-
ing influences ; all of which are, however, too well
known or easily recognized by the profession generally
to require that more should be said in that connection.
But these facts do not lessen the value of the preceding
statements in any way, regarding the tendency of all dis-
eases to assume a sthenic or an asthenic type, whether
they occur in the white or negro races.
The constancy of the action of this law was strikingly
exemplified in my experience in the South during the
civil war, both in regard to the symptoms of disease and
the treatment necessary for the two races, under as
nearly the same circumstances as it is possible for them
to appear. A proper appreciation of the foregoing facts
is necessary in order that therapeutic applications may
be judiciously and properly made in the treatment of
diseases. In fact, it may be safely said that this most
important consummation cannot be certainly reached
in any other way. To illustrate its value, I will state a
few facts that have been repeatedly observed in my pro-
fessional experience. Thus, sedatives and depressents
and antiphlogistics generally, whilst often called for in
the treatment of acute and recent cases of disease, and
manifest such prompt and decisive benefit when applied
in the Caucasian, as a rule produce no good results in
the negro, unless they should be used with great caution,
and then suspended promptly upon the slightest evidence
of depression taking place ; and it may be safely said
that such remedies are often productive of positive
harm in his case. This fact is particularly and strikingly
exemplified in the effects of bloodletting and in the ac-
tion of veratrum viride — two of the most potent sedatives
and at the same time valuable agents where their action
is called for in the white race, are almost always attended
with harm in the negro, and especially so when carried
to the extent found useful and necessary in the Cau-
casian. Thus, no agents act more satisfactorily or philo-
sophically in the subduction of acute inflammatory symp-
toms in the white race, or are more urgently called for in
the scientific treatment of such cases, than bloodletting
and arterial sedatives ; and yet, if they are resorted to
for a similar purpose in the negro, the greatest caution
and circumspection are imperatively demanded in order
that harm shall not result from their use. In the rare
cases in the negro which seem to warrant active anti-
phlogistic treatment, tonics and stimulants are required
at an early period in their management. Opium and
its preparations are badly borne by the African, as a rule,
and the same is true, in an equal degree, of the entire
narcotic class of remedial agents in their action upon his
organism.
This is an exceedingly interesting branch of profes-
sional inquiry, and though the field 'is so inviting as to
tempt me to detain the reader much further in the pres-
entation of many other valuable facts gleaned in it du-
ring more than two decades of active practice upon and
near the rice plantations of South Carolina and Georgia,
where, I may add, that in ante-bellum days the material
and the opportunities for turning it to practical and val-
uable account were of the most abundant character,
yet it seems necessary that, after a few more words or
statements of closely allied facts, this hastily written ar-
ticle should be brought to a close.
The hybrid — nnilatto — is a factor of considerable im-
portance to physicians who encounter him in practice to
much extent. But wlien he is considered as partaking
of the structure and nature of his progenitors in a nearly
equal degree, it will be readily perceived that he occu-
pies a place intermediate, or between the Caucasian and
African races, in other respects also. His iumiunity and
his susceptibility to the diseases of his progenitors, and
his impressability to the action of therapeutic agents, is
also of an intermediate grade between that of|jthe races
from which he sprang.
127 N. Arlington Avenue.
INEBRIETY FROM OBSCURE PHYSICAL
CAUSES.
By T. D. CROTHERS, M.D.,
HARTFORD, CONN,
In The Medical Record of last October, I gave the
notes of a number of cases of inebriety, in which the
causes were imknown, even to the physicians familiar
with the cases. This paper attracted much attention,
and I have received a large number of letters from phy-
sicians and others relating to it. Many of these letters
were histories of similar cases, or the personal narratives
of the experience of the writers, who were victims, or of
patients or relatives ; and all are eloquent in ajipeal for
help and advice what to do, I propose to present some
of these cases, as an argument for a medical and scien-
tific study of inebriety, above the levels of the theories of
reformers and clergymen. These notes are mere outlines
of cases that are familiar to every physician, and cover
an almost unknown realm of pathology, psychology, and
therapeutics.
The following cases are evidently the histories of the
writers, and are found to be truthful from other evidence
than the authors' :
A, B , born of healthy parents, and brought up
on a farm. After several years of school teaching, al-
ternated with studies at an academy, and working on
the farm, he studied medicine and graduated with honors,
receiving a prize. Soon after he married and settled in
the country. At this time he was healthy, vigorous, and
temperate from principle. Ten years after he had be-
come a prominent, prosperous physician. He fell
through the ice of a river one cold winter night, and
was vk'ith difliculty saved from death. A severe attack
of pneumonia followed, with a long convalescence. From
this time he suft'ered from violent beating of the heart,
with every excitement and overexertion. He began to
use spirits for this nervousness, and found relief A
year later he was intoxicated and obliged to use spirits
regularly to prevent this nervous state. After this (in
!iis opinion) a series of troubles began, which came di-
rectly from his enemies, and culminated in poverty and
disgrace. His wife died, and he was a chronic inebriate,
and after a few years of great irregularities, was sent six
months to prison. He served out his time, and has resumed
practice, greatly improved in health, and is now temperate.
He writes that his inebriety began from some physical
condition, and that through the treachery of friends he
was made worse.
From other sources I ascertained that soon after
the attack of pneumonia, he drank to great excess at
intervals, associated with low people, and gambled. A
total change of character and impulse followed. Before
he was honest, frank, and generous ; now he was treach-
erous, secretive, and thoroughly unprincipled in con-
duct. He forged notes, became a tramp, and after six
months' imprisonment seems to have recovered, and be-
gan to live a temperate life.
In all probability, the pneumonia was followed by
heart-strain, or acute asystolism, for which spirits was a
540
THE MEDICAL RECORD.
[May 19, 1883.
sedative. Inebriety followed most naturally. The train
of events which culminated in inebriety was physical ; the
nature and character of this change, and the moral par-
alysis which seem to follow, were largely unknown. The
partial recovery following a period of forced abstinence
in prison is very significant of what might have been
accomplished by an early recognition and treatment of
his case. •
C. O writes me that his father died of consumption
before his birth, and no other heredity is present in the
family. He was always hale and strong, graduating
from Yale College with some prominence as an athlete.
After a long medical training he was made demonstrator
of a medical college, and six years later became a full
professor. , He was temperate in all things except smok-
ing. One day he became accidentally intoxicated in his
lecture room, and soon after was forced to resign. He
began life in a frontier city, became reckless, lost all
ambition, and drank to great excess. He was finally
taken to an insane asylum, where, after two years' treat-
ment, he was given a position on the staff, and for many
years has been constantly gaining in strength and
vigor. From his statements, confirmed by a physician
who was intimate with him, it appears that two years be-
fore he was seen intoxicated in public he drank brandy
at night for its sedative effect. He was engaged writing
a book, and after the active duties of the day were ever
he would spend most of the night in his library. He
would become so ner\'ous and restless that he could not
sleep. Various remedies were tried, but at last brandy
and ether was found most effectual. He failed in all
his efforts to give up the use of this drug at night, until
at last he appeared publicly intoxicated. He writes
that inebriety began from neurasthenia and heart e.x-
hauslion, following excess of tobacco, and general neg-
lect of healthy living.
This is no doubt correct. He inherited a defective
organisni and was an impulsive, nervous man, very
strongly impressed by the surroundings. Had his
malady been recognized in the early stages, and the
treatment been prompt and effectual, a life of great use-
fulness might have been preserved.
An eminent physician writes of his son, who is free
from any inherited defect, but who uses spirits to great
excess every two or three months, spending the intervals
in great exertions to prevent the further use. He was
educated as a clergyman. After graduating at the
seminary he was called to supply a church at a famous
watering place, and was very ambitious to make a good
impression and secure a call to a city church. He suc-
ceeded, but before he was ordained drank to intoxication
in public. From this time he has lost all ambition and
interest in the future. For a few weeks after the paroxysm
of intoxication he is very active in his desire to get well
and help others. His father is convinced that his ine-
briety is from purely physical causes. He traces it to
general neglect of e-xercise, overwork, and failure to sleep.
He thinks that he began to use spirits in the seminary
for a tonic, and used it quite freely while supplying the
pulpit, but always at night.
A physician reports this case : A gentleman of wealth,
education, and high standing in the community, will fre-
quently drink to excess and associate with the lowest
company, in the vilest places, and in a most public way.
This will last for ten days, after which he will recover
and live a most exemplary life for an indefinite time.
He is married, has a family, and attends church regularly.
No history of heredity can be traced, but a few years ago
he was defeated for Congress, much to his disappoint-
ment. He suffered soon after from an attack of asthma
and fever, with a long, slow convalescence. He used
spirits freely during his illness as a medicine. After re-
covery he was greatly irritated in the settlement of some
business, and drank to excess for the first time. He was
.emperate up to this [joint, and after the paroxysm of
drink will regret keenly his conduct, and make efforts to
regain his lost energy and reputation. The physician
writes: "Although I cannot clearly make my belief ap-
parent to others, yet I am convinced that he is suffering
from some pathological change and disease, which began,
or burst out, after his disappointment, and the fever
which followed from it. I am also sure that he is more
or less powerless to help himself, and needs positive
medication and active treatment."
In another case reported to me by a physician : .-V
strong, healthy farmer began to drink after recovery from
a severe wound of the foot, in which he had lost much
blood, and was laid up for three months. His wife died
at this time, and he became gradually a notorious ine-
briate, spending all his property, and living an aban-
doned life. The exhaustion, and probably the shock,
from the hemorrhage and death of his wife, acting by
reflex action, broke up the normal integrity of some
nerve-centres, and inebriety was only an expression of
this state.
A New York physician writes: "I have a patient
who never drinks except after sexual intercourse. If
this is prolonged he becomes very stupid from drink,
and cannot recover until he is taken to some hotel or
hospital and carefully treated for two or three weeks.
He has very little sexual desire, and after its gratifica-
tion suffers from great depression, and a nameless agony
of both body and mind, which only spirits can remove.''
The wife of a physician writes of her husband, who is
a confirmed inebriate, that his drinking dates from the
time of her illness and injury from an accident ; that for
two weeks he was greatly excited, supposing she would
not get well, and blaming himself for the accident.
Working all day and sitting up every night, neglecting
to eat or sleep regularly, and using spirits to keep up.
From this time he has used spirits, and although he de-
clares that he will and can abstain, never succeeds, or
attempts it.
A noted medical teacher describes the case of his
brother, which in substance is as follows : Insanity ex-
isted in the grandparents, and moderate drinking in the
parents. This case was a gentleman of superior educa-
tion, of correct, temperate habits, and an ambitious, proud
man ; but naturally very nervous and impulsive. He
excelled as an orator and lecturer, and for several years
occupied a iirominent place on the lecture platform.
Then suddenly he gave up this work and began to study
law. At this time he had a severe attack of scarlatina,
was disappointed in marriage, and lost most of his prop-
erty in stock speculation. After admission at the bar, he
began to practise in the police court among the lowest
cases. A change of ambition and character was noticed.
He drank regularly, and lost pride in appearance, asso-
ciated with low people, became a politician, and served
in the city boards. His character for honesty changed,
and he became low and unscrupulous in his recognition
of right and wrong. His drinking increased, and finally
he was sent to prison. The doctor writes : " I am con-
vinced that the inebriety, with change of character, am-
bition, and habits, all following a succession of physical
and mental troubles, came from disease. He was thirty-
four years old when this decline began, and the inherited
predisposition undoubtedly formed the favoring soil
which encouraged the growth of inebriety, and general
failure of all normal brain-action."
These cases might be multiplied to fill a volume, both
fiom my own observation and from correspondence. I
am satisfied they are very common, but from want of
study are passed by as poor victims of a vice which may
be controlled at will. Now and then a physician, who
becomes familiar with all the details of the history of a
case, will recognize the presence of disease ; but as this
is not sustained by the prevailing opinions of the profes-
sion and general public, he has no incentive to defend
such views. It is not moral cowardice, but simply ab-
sence of sufficient evidence and study of cases that pre-
vents many physicians from urging that inebriety is
May 19, 1883.]
THE MEDICAL RECORD.
541
always a disease. While they are personally convinced
of the truth of this fact, a public defence of it must be
from clinical study, and evidence that requires time
and effort to obtain. The frequency of these cases,
and the general ignorance of their nature and character
at present, will be a cause of great wonderment in the
future.
The blundering efforts of law and religion are most
disastrous to the inebriate and his malady. Inebriety,
and what to do with the inebriate, is a purely physical
liroblem which only physicians are capable of determin-
ing. The inebriate is a literal lunatic, flitting up and
down the border-land where the twilight and night of
mental darkness unite. Like the lunatic, the malady
from which he suffers may only affect some parts of the
brain, giving the appearance to the casual observer of
strength to control and ability to reali/.e all the relations
of life. Hence he is always under a mask, which his
disordered impulses are ever ready to maintain. Delu-
sions of capacity to stop the use of spirits any time follow
to the end of life
The inebriate is not an enemy of society or civiliza-
tion, but the victim of physical conditions — a child, a
sick man, a ward of the State, needing physical care and
treatment to be helped back to health and his natural
place in society. Tp-.day he is separated by a great
gulf from rational reqomj{ion and treatment, and physi-
cians only can cross tb,'yspace and solve the problem.
The physician should study the inebr'ate and define his
disorder, the nature and degree of his rights and respon-
sibility, as well as the means to remedy and remove his
malady. Inebriety is not a vice or crime, but a disease
to be cured by treatment. How this statement can be
made an apology for inebriety and so become a 7iight-
mare of objection to any one, is difficult to understand.
The fact that inebriety is a disease increases the respon-
sibility of the victim and both his friends and the com-
munity to use the means for recovery. To call small-
pox a disease is no apology for the victim or lessening
of responsibility to use all means for restoration. To
call a man insane gives no encouragement to insanity, or
renders him less amenable to exact, rational treatment.
In this shadowy territory clergymen and reformers lay
down theories that are accepted as truths. But the
march of science has carried this subject beyond the
realm of morals and mystic remedies. The question of
to-day is what shall we do ? What means and remedies
can we apply that will reach these cases? The physical
nature of inebriety is clearly established wherever the
subject is examined. The full acceptance of this fact
will reveal the way by which a large percentage of these
cases can be permanently restored to health and useful-
ness again.
Ovarian Cyst Cured by Injection of Wine. — Dr.
Pedrini {Gazz. Med. Ital. Lomb.) gives the details of this
case : The patient, thirty-nine years of age, was seized,
after a day's washing in cold water, with acute pain in
the abdomen. A few days afterward a small movable
lump was noticed in the left ovarian region. The lump
steadily and slowly increased for fourteen months, when
it suddenly became nuich larger, threatening to prove
fatal by asphyxia from the pressure it caused. The lungs
were congested, with diffused bronchial catarrhal sounds,
and the lower limbs were cedematous. The patient was
very emaciated. A large trocar was thrust in at the
lower third of a line drawn from the umbilicus to the an-
terior inferior iliac spine ; seventy-two litres of a serous
citrine-colored liquid were gradually withdrawn. A litre
of white wine was then injected through the canula, and
allowed to remain for an hour. There was sharp reaction
and fever, which for a week imperilled the patient's life.
She, however, made a good recovery and regained en-
tirely her former good health, with no sign of the return
of the tumor (after six years).
^vo0vc6s of ^cdical Jiciciice.
Percussion of the Colon in Diarrh'ka. — Diar-
rhcea depending ui)on fecal accumulations in the lower
bowel {diarrhan paradoxa) is a well-known condition,
the treatment of which by laxatives is of long-recognized
utility. The diagnosis, however, between this form of
diarrhcea and that other whose location is, more strictly
sneaking, in the small intestine, has often presented con-
siderable difficulty. In an article upon this subject, in
the Deutsche Medicinische Wochenschrift of February
14, 1883, Dr. Goedicke advocates the systematic practice
of abdominal percussion in all cases of diarrhoea. He
was led to adopt the practice in this wise : Several years
before, when a young army surgeon, his suspicions were
often aroused by the number of soldiers coming to him
with the complaint of diarrhcea. In order to detect the
malingerers, he made use of percussion of the colon,
reasoning that in genuine diarrhcea the descending colon
should be empty, and therefore give a tympanitic per-
cussion note. He was surprised, therefore, to find that
the contrary was usually the case. In most of the men
in whom diarrhcea actually existed, as was ascertained
from the rei)orts of the infirmary orderlies, the percussion
note of the descending colon was dull. The investi-
gations now undertaken led him to the following con-
clusions: 1. In a healthy individual, with normal
movements, if we percuss the colon, we shall find that
the left iliac fossa usually gives a flatter note than the
right. 2. In patients suftering from diarrhcea the greater
dulness may be on either side, but is usually, in other-
wise healthy persons, on the left. 3. The same condition
obtains in children. 4. Whenever there is tenderness
on pressure, it is found on the same side as the greater
dulness. 5. The term "dulness" is to be understood
as relative and not necessarily absolute, for the percus-
sion note on both sides may be actually tjnipanitic if the
colon be distended with gas. The author asserts that
by far the more common form of diarrhcea is that excited
by fecal accumulation in the large intestine. It is this
variety which is characterized by increased relative dul-
ness in the left iliac fossa, and in which opiates and
astringent remedies are contra-indicated. In the other
form of diarrhoea the trouble is in the upper bowel, and
here the percussion note upon the right side is more
dull, or less tympanitic, than that on the left. It is in
these cases that the ordinary diarrhcea medicines find
their application. Dr. Goedicke concludes by urging
the practice of abdominal percussion in every case of
diarrhoea, where possible (it is always possible in children,
and it is in children that the knowledge of the true
nature of the trouble is of the greatest importance).
And he states his conviction that the more general this
practice becomes, the less frecjuently will opium be em-
ployed in the treatment of diarrhcea.
Spasm of the Gloitis. — A very troublesome laryn-
geal spasm is sometimes provoked in sensitive subjects
by local applications of irritant substances, either as liquid
or powder. This spasm arises, according to Dr. Max
Schaeffer {Deutsche Med. Wochcnschrijt, No. 2, 1883),
by reason of a series of involuntary inspirations, so that
when the trachea can contain no more, the air is forced
into the oesophagus. He formerly attempted to over-
come this by the induced current, but discovered by
chance a much more simple and effective method. He
holds the patient's mouth and nose and prevents any fur-
ther inspirations. By this means he asserts that the
spasm is speedily overcome.
Subcutaneous Osteotomy. — Dr. Borchers has col-
lected the statistics of sixty-one osteotomies performed
upon thirty-seven patients by Dr. Von Muralt in the
Eleonorenstift at Zurich, from 1876 to 1881 (Corre-
spondetiz-Blatt fiir Schweizer Aerzte). Of this number,
542
THE MEDICAL RECORD.
[May 19, 1883.
forty-eight operations were performed for bow-legs, and
seven for knock-knees. Suppuration followed in nine
cases, the balance progressing exactly as in simple frac-
ture. There were two deaths, one from acute miliary
tuberculosis, the other from a relapse of morbus coxarius
following osteotomy for the correction of deformity at the
hip. Esmarch's bandage was applied, and the opera-
tions were performed under antiseptic precautions. A
straight incision, two-fifths of an inch in length, was
made through the soft parts directly to the bone, which
was chiselled coiiijiletely through. The wound was not
syringed out, nor was any drainage employed. The de-
formity was then corrected, a l.ister dressing applied,
and over that a plaster bandage. The limb was then
elevated and the tourniquet removed. The temperature
after the operation usually rose to 100° or ioi°. The
average length of treatment was forty days. The result
of osteotomy for rachitic curvatures was in every case
favorable. In genu valgum, tibial osteotomy was per-
formed, as the principal deformity affected that bone.
The results, as regards reduction of deformity and restora-
tion of function, were good. The author thinks the
operation is justifiable in all cases of rachitic deformity
of the lower extremities in which hardening of the bones
has taken place.
Dental Formation in the Nasai, Cavity. — Dr. Max
Schaeffer relates the following case in the Deutsclie Aled.
Wochetischrift, No. 2, 1883 : A gentleman had for some
time experienced a slight obstruction in one nostril. Ex-
amination revealed the presence of a hard, roundish,
movable body, which was attached to the floor of the nos-
tril about one inch from the anterior opening. It was
removed by the snare, and was found to be a perfectly
formed canine tooth, a little over an inch in length. The
anterior portion was covered with enamel, and its little
root presented a layer of cartilage. There was no bony
alveola. The patient had all his teeth.
' Permanent Asthma. — Professor Germain See does
not accept the generally received notion of asthma as
being always manifested by paro.xysms of short duration,
but holds that it is also met with as a disease character-
ized by permanent dyspnoea. He regards asthma,
whether paroxysmal or permanent, as a condition made
up of three elements — nervous, catarrhal, and emphyse-
matous, either one of which may predominate and give its
characteristic to the disease. It is when the latter ele-
ment, emphysema, assumes an undue degree of promi-
nence that we have the condition which the author de-
nominates permanent asthma. It corresponds to what
Waters, in his work on emphysema, characterizes (erro-
neously, according to Professor See) as primary idiojiathic
emphysema. This distinction which the author seeks
to establish between emphysema and emphysematous
asthma is, he asserts, of great importance in determining
the proper treatment. His method, for which he claims
excellent results, consists in the exhibition of full doses
(thirty to forty-five grains per diem) of iodide of potas-
sium. Under its continued use for some length of time,
the asthmatic exacerbations disappear and the perma-
nent dyspnoea is greatly lessened, if not entirely con-
trolled. It is sometimes useful to add from three-fourths
to one and one-half grain of opium to the daily dose of
the potassium salt, to prevent iodism. — Z' Union Midi-
cale, Mard 6, 1883.
The Origin ok Re.spiratorv Murmurs. — Chomia-
koff and Kotovshtchikotf having repeated the exiieri-
nients of Aufrecht and Halbertsma, and completed a
series of experimental researches of their own, conclude
as follows : i. Aufrecht's theory is incorrect ; that is,
the bronchial respiratory murmur does not in the least
depend upon the movements of (juiescent air-columns
within the lung. 2. The bronchial nnirmur originates
exclusively in the larynx ; the friction of the air against
the walls of the large bronchi does not give rise to these
sounds. 3. The vesicular respiratory murmurs are of a
compound nature. A large part of them have a laryn-
geal origin ; that is, the bronchial murmur originated in
the larynx, while passing through the normal tissues of
the lungs, changes its characters, and is heard on the
lung-surface as a vesicular murmur. The remaining
part of the vesicular sounds originates on the periphery
of the lung, but the authors are not as yet able to eluci-
date its mechanism.
A New Function of the Semicircular Canals. —
A new function of the semicircular canals has been re-
cently suggested by Dr. M 'Bride of Edinburgh (^Lancet,
February 17, 1883). The connection of these canals
with the organ of hearing has been a constant enigma to
modern physiology, which can discern in them no other
end than that of subserving the maintenance of equili-
brium and giving information as to the position and
movements of the body. This function could, it is sug-
gested, be as well performed if the canals had no relation
to the organ of hearing. Their relation to it implies that
they have some other function, and this Dr. M 'Bride be-
lieves is to produce, through the ampullar nerves, reflex
rotation of the head and eyes toward the point from
which a sound proceeds, and, further, to co-ordinate and
brace the muscles necessary for escaping from a danger
of which sound is the first indi«;^6n. The theory is,
from its anatomical basis, nece.^ rfily insusceptible of
direct proof. It is, however, known that irritation of the
canals causes movement of the head and eyes toward
the side irritated ; and in pigeons a loud sound, as a pis-
tol-shot, will cause a rotation of the head. But the effect
of the discharge of a pistol is scarcely comparable to
those sounds which are the usual stimuli to the auditory
apparatus. The reflex phenomena produced by a sound
in an uninjured animal may be equally well explained by
the hyjiothesis that the afferent impression is through the
cochlear part of the auditory nerve. At any rate, the
experiments of Ferrier seem to show that when the cere-
bral centres of hearing are destroyed, reflex movements
can only be evoked by loud sounds made close to the
animal — a fact which renders it probable that the appar-
ently reflex movements which are produced in the normal
state by slight sounds are the result of true auditory sen-
sation.
How TO Give Santonin. — Lewin finds fault with all
the usual methods of administering santonin. Accord-
ing to him it should be given in its least soluble form,
i.e., in that form in which it will be the least readily
absorbed, as the effect desired is not a general, but a
local one. .A.n oily solution of santonin undergoes, ac-
cording to his exjieriments performed on animals, not
the slightest absorption in the stomach, so that under no
circumstances is any trace found in the urine. Almost
any kind of oil may be employed, cocoa-nut oil, olive-
oil, cod-liver oil, or castor-oil. He recommends that
three grains of santonin be mixed with two ounces of
oil and given in four doses. He thinks that a useful ad-
dition to the above would be that of an oil contained in
santonica, the oleum cina; a;ther., for the reason that all
ethereal oils have been shown to act as poisons on the
lower forms of animal life.
The Cause of Hysterical Tv.mpanites. — Ebstein
regards the rapidly developed tympanites in an hysteri-
cal attack as due to incontinence of the pylorus. In this
way the air which is swallowed during tlie attack passes
directly through the stomach into the intestines. In two
cases in which this phenomenon was observed the disten-
tion of the entire abdomen was greatly increased imme-
diately upon the introduction into the stomach of an
effervescent mixture. The author regards this insuffi-
ciency as a pathological condition, although Kussmaul
asserts that a relaxed pylorus is the normal state when
the stomach is empty. — Centralblatt fUr Klinische Mtdi-
cin, March 31, 1883.
May 19. 1883.]
THE MEDICAL RECORD.
543
The Medical Record
A Weekly Journal of Medicine and Sjirgery.
GEORGE F. SHRADY, A.M., M.D., Editor.
Published ev
WM. WOOD &. Co., Nos. 56 and 58 Lafayette Place.
New York, May 19, 1883.
DELEGATES TO THE AMERICAN MEDICAL
ASSOCIATION.
We have received several inquiries concerning the num-
ber of delegates which county societies are entitled to
send to the American Medical Association. According
to the plan of orgahization (see "Transactions American
Medical Association," vol. xxxiii., p. 618) "each State,
county, and district medical society, entitled to repre-
sentation, shall have the privilege of sending to the Asso-
ciation one delegate for every ten of its regular resident
members, and one for every additional fraction of more
than half that number ; provided, however, that the num-
ber of delegates from any particular State, Territory,
county, city, or town shall not exceed the ratio of one
in ten of the resident physicians who may have signed
the Code of Ethics of this Association."
According to the by-laws of the Association all socie-
ties entitled to representation have adopted its Code of
Ethics, and therefore the members of these several socie-
ties have signed the Code of Ethics of the American
Medical Association. The number, then, is left, practi-
cally, as given in the first clause — " one delegate for
every ten of its regular resident members," etc.
The number of delegates, therefore, from the county and
district medical societies in this State, entitled to repre-
sentation, may be very large. For example, a society
which has adopted the Code of Ethics of the American
Medical Association, and can send delegates to the State
Medical Society, may send fifty delegates if it has a resi-
dent membership of live hundred. Will the delegates be
admitted ? Presumably, if there is no evidence that the
society which they represent has " intentionally violated
or disregarded any article or clause of the same" (that
is, the Code of Ethics of the American Medical Asso-
ciation). The question, however, has not yet been acted
upon by the Judicial Council.
SUDDE.N DEATH DUE TO CEREBRAL INHIBITION.
Under the name of inhibition, Dr. Brown-Sequard desig-
nates the arrest or suspension of function in a nervous
centre, muscle, or nerve — an arrest which takes place
without visible organic change, following immediately
upon irritation of some point of the nervous system
more or less distant from the part in which the effect is
observed. It is to cerebral inhibition that the author
attributes a form of sudden death, called formerly by
him death without agony, which is analogous to the sud-
den loss of intellectual activity that occurs in epilepsy.
This death is easily produced in animals by a simple
prick of the ventricle of Arantius in the floor of the
fourth ventricle. The animal falls motionless at once
with complete loss of consciousness. The heart con-
tinues to beat, but respiration is arrested. The reflex
action of the cord is increased. The cause of death is
nowhere apparent. At least, there are no visible changes
to account for it. In the absence of any other explana-
tion. Dr. Brown-Sequard arrives at the conclusion that
loss of cerebral function and activity, in certain cases,
is the pure effect of inliibition proceeding from some
more or less distant irritation.
THE END OF THE DEBATE IN THE ACADEMY OF
MEDICINE OF PARIS.
For six months the learned members of the Academy
of Medicine of Paris have been discussing the question
whether typhoid fever should be treated by cold baths,
by quinine, by salicylic acid, by carbolic acid, or should
not be treated at all. Tlie debate was brought to an
end, on April 24th, by M. Peters, who summed up, in a
somewhat pessimistic spirit, the results of the long battle
of words.
It has been shown, he said, that we possess no specific
treatment for typhoid fever, but that this disease is to be
treated symptomatically in accordance with the indica-
tions.
This appears to be a small result, truly. Almost any
intelligent American physician would have said the same
last December before the debate began. Yet the influ-
ence of the discussion may prove useful in checking the
ardor of those physicians who imagine that in cold water
or carbolic acid they have at last found something which
is really applicable to, and efficient in, all cases. In other
words, the debate has given strength to the rational
therapeutics of the disease. Nor need any one say that
because there is no specific for typhoid fever, the phy-
sician cannot do much in the way of treatment. There
are, on the contrarj', few diseases in which intelligent
watchfulness and care are so likely to prove helpful.
M. Peters, in concluding his speech, replied to Pasteur
— who was absent. The speaker reiterated his former
charges regarding the uncertainty, inutility, and danger
of animal vaccinations by the_Pasteur method. We need
not go over his arguments, however, since no new facts
of consequence were presented. The question at issue
must be settled by practical tests in the laboratory and
on the farms.
The Coming Meeting of the American Medical
Association. — Dr. X. C. Scott, of Cleveland, O., Chair-
man of the Committee of Arrangements, desires us to
make the following announcement :
The next annual meeting of the American Medical
Association will be held in Cleveland June 5th to 8th in-
clusive. All railroads west of Pittsburg, Salamanca, and
Buffalo, east of Chicago, and south of Cleveland, will
carry delegates, and members of their families, at one
full fare, and return them on certificate signed by me as
Chairman of the Committee of Arrangements (certifying
that they have been in attendance at the meeting of the
Association) at one cent per mile.
544
THE MEDICAL RECORD.
[May 19, 1883.
The Trunk Lines east of Buffalo, Salamanca, and Pitts-
burg, and lines west of Chicago, have refused to make
any reduction. The rates per diem at the hotels will be :
Kennard House, $3.00 ; Weddell House, $3.00 ; Forest
City House, $2.50 to $3.00 ; American House, $2.50;
Hawley House, $2.00; Striebinger House, $2.00; Clar-
endon House, $2.00 ; and Prospect House, $2.00.
The Fifth .Annu.^l Congress of the .American
Laryngoi.ogical .Association, which meets in this city
May 2ist, 22d, and 23d, has a very elaborate programme
laid out. On the first day seven papers will be read,
on the second day seven, and on the third day eight.
Among the i^iore novel subjects to be treated of are :
Chorea of the Larynx, Photographing the Larynx,
Smell Hygienically and Medico-Legally Consiilered,
Reflex Phenomena of Nasal Disease, Researches on
the Tension of the Vocal Cords.
The .Annual Dinner will be given at Delmonico's on
the evening of May 21st, and there will be a theatre
party and suiiper tlie next night.
§lcports at Societies.
MEDICAL SOCIETY OF WEST VIRGINIA.
Sixteeih Annual Mealing, held at Grafton, West Virginia,
May 16 and 17, 1S83.
(By Telegraph to The Medical Record.)
The sixteenth annual meeting of the Medical Society
of West Virginia convened in the court house, in CIrafton,
W. Va., at two o'clock, on Wednesday, May i6th, the
President, Dr. W. B. Allen, of Morgantown, in the
Chair.
Prayer was ofifered by the Rev. F. P. Robertson, of
the Baptist Church, in Grafton. The roll, called by Dr.
S. L. Jepson, of Wheeling, the Secretary, was answered
by twenty-seven members. The
ADDRESS of welcome
was delivered by Dr. .A. L. Grant, of Grafton, the
chairman of the Committee of Arrangements, and the
Hon. J. W. Mason welcomed the delegates on the part
of the citizens. Dr. R. B. Stover, of Richmond, \'a., and
Drs. J. F. Baldwin and H. G. Landis, of Columbus, O.,
were reccjignized by the Society as delegates from sister
societies. ' Dr. J. F. Baldwin replied to his acceptance
at some length, congratulating the Medical Society of
West Virginia on its State Board of Health.
address of the president
Dr. B. W. .Allen, of Morgantown, the President, read
an address touching on many matters, but referring par-
ticularly, and with some severity, to
THE RECENT BREAK IN THE MEDICAL PROFESSION IN
THE STATE OF NEW YORK.
He also referred to the
NEGLECT IN THE PRELIMINARY MEDICAL EDUCATIO.N OF
YOUNG PHYSICIANS,
as evinced by the prevalence of several epidemics
of small-pox throughout the State. He advocated, wiili
much ability, the creation and sustenance of a medical
department in the University of the State of West Virginia,
at Morgantown.
Dr. J. Fl. Reeves, of Wheeling, called the attention of
the Society to the fact that a ruling, at one of its early
meetings, prevents the election of a man to the State So-
ciety unless in good standing in his County Medical So-
ciety. He thought this ruling very unjust and, after
argument, moved that the former resolution be repealed.
Dr. G. Baird, of Wheeling, also spoke against the
old ruling, which was sustained in quite an animated
speech by Dr. J. M. Lazzell, of F'airmont, who moved
that Dr. Reeves' appeal be laid on the table. It was,
however, jnit to the vote and carried by the Society.
Dr. R. W. Hall, of Mannington, from the
COMMITTEE OX EPIDEMICS,
reported no severe general epidemic to have existed in
the State, but nearly all the epidemic diseases to be |5re-
sent. The paper referred to pneumonitis, naso-jiharyn-
gitis, influenza, scarlatina, rubeola, variola, varicella, per-
tussis, parotitis and typhoid fever, discussing all these
diseases, and typhoid fever at length, strongly arguing
for the contagiousness of this disease, and citing cases in
support.
The discussion on the paper was opened by Dr. J. S.
Reeves, who recommended the use of
ERGOT as a PREVENTIVE OF HEMORRHAGE,
and also as an antiphlogistic agent.
Dr. R. B. Stover, of Richmond, Va., had also noticed
a reduction of temperature following the use of one
drachm of Squibb's fluid extract of ergot, every three
hours, in both pneumonia and typhoid fever.
Dr. a. Gerstell, of Keyser, thought typhoid fever a
purely germ disease, which could only be taken from the
introduction into the system of fecal matter.
Dr. T. L. Jepson, of Wheeling, thought that the dis-
cussion propounded three questions, which, with their
answers, were as follows :
First. — May the disease arise de novo? The facts
which he had obtained from a perusal of the report of the
Massachusetts State Board of Health prove that it does.
Second. ~li it contagious? The fact that not a doc-
tor, nurse, or patient, had been known in all his hospital
practice to take disease from undoubted typhoid fever
cases, proves that it is not.
Third. — What remedies are indicated ? Statistics on
the therapeutics of typhoid fever show the uncertainty
of the action of any one reputed species. It requires a
stupendous array of confirmatory cases to establish the
success of any drug as a specific in this disease.
Dr. J. M. Lazzell instanced a case occurring in his
own practice as going to show that typhoid fever is com-
municable. He had known it to occur twice in the
same person.
Dr. J. F. Hamilton, of Columbus, O., spoke strongly
in favor of the
DE novo origin OF TYPHOID FEVER.
He treated his cases with milk and lime-water.
The Secretary read his report, which v^as accepted.
The Treasurer's report showed a balance on hand of
$115. The Board of Censors passed upon the following
list of
candidates FOR admission to the society.
C. F. Johnson, T. F. Landman, C. M. Frizell, A. P.
Nathans, J. H. Silvev, E. M. Baird, J. L. Nixon, C. V.
Henry, J. C. Lawson, and G. L. Bomberger. These
gentlemen were all elected members.
THE AR.MY medical .MUSEUM AND LIBRARY.
Dr. James S. Reeves, of Wheeling, introduced the
following preamble and resolutions, which were adopted
unanimously by the Society, viz.:
Whereas, The collections knows as the Army Medical
Museum and Library of the Surgeon-General's Office, lo-
cated in Washington, D. C, are recognized among the
most complete and valuable of their kind in the world,
and as their practical usefulness has been abundantly
demonstrated by the interest with which they are regarded
by the medical jjrofession, both at home and abroad, and :
Whereas, By reason of the insecurity and unsuitability
of the building in which they are now placed they are in
constant danger of dam,ige or destruction, from which
would ensue irreparable loss, therefore :
Resolved, That in the opinion of the Medical Society of
the State of West Virginia, the inestimable value of these
May 19, 1883.]
THE MEDICAL RECORD.
545
collections demands from Congress such fair consideration
of the merits involved as will secure an appropriation of
sufficient amount to provide a fireproof building, of an
ample size and suitable construction, for the present and
future uses of the Museum and library.
Resolved, That the Army Medical Museum and l.ibrary
of the Surgeon-General's office are inseparable in object
and interest, and only capable of the greatest usefulness
when under one control and management ; that this Soci-
ety views with regret and disfavor any attempt to separ-
ate the two ; dismemberment must result in injury to
both.
Resolved, That Congress would meet the wishes of the
medical profession of the United States by appropriating
suitable sums of money for the support, care, and in-
crease of the collections, viz. : not less than ten thousand
dollars annually for the library, and five thousand dollars
for the museum.
Resolved, That the work now in [jrogress under the
direction of the Surgeon-General of the army, entitled
" An Index Catalogue of the Library of the Surgeon-Clen-
eral's Office," is also one in which the medical profession
of the United States is greatly interested, and should re-
ceive the substantial aid and encouragement of Con-
gress with a view to its speedy and certain comjileiion.
Resolved, That a copy of these preambles and resolu-
tions be forwarded to each senator and representative of
our State, requesting his special aid and co-operation in
the matters herein specified.
The meeting then adjourned for the day. The Rev. VV.
A. Shipman, of Grafton, delivered an address at 7.30 p.m.
in the Court House, on " Materialism." At 9 p.m. a grand
ball was tendered to the visiting physicians by the citi-
zens.
A report of a case of
PERITONEAL H.EMATOCELE
was read by Dr. R. W. Hall, of Mannington, W. Va. :
Dr. G. L. Mclntire, of Grangeville, W. Va., requested
me to see in consultation with him Mrs. R , stating
that the patient was about thirty years of age, a multi-
para, and had enjoyed good health until about four
■weeks previous, when she had metrorrhagia and sent to
Dr. Mclntire for medicine. The doctor sent her the
usual remedies and she was, as she thought, well in a
few days. After a little more than two weeks elapsed,
she became very nervous, had considerable nausea and
occasional rigor. This condition continued for a little
over a week, gradually getting worse, and pain was pres-
ent in the hypogastriiun. She became very restless, the
'nausea became more marked until emesis occurred. On
rising one morning she observed for the first time
that she had a tumor about the size of a child's head in
the lower part of the abdomen. This condition caused
her considerable alarm. In a few days it became very
tender to the touch and she observed it to be increasing
rajjidly in size. She then sent for Dr. Mclntire, who,
thinking the case of a serious nature, requested consul-
tation. I saw the patient Friday evening. Upon e.x-
amination found tongue coated with a light fur ; pulse, 90 ;
respiration, 24; and temperature, ioi^°. Dr. Mclntire
informed me that the pulse had been normal as well as
the temperature up to the evening I saw the patient.
I found in the hypogastrium, to the left of the median
Ime, a round tumor about the size of a two-year old
child's head, hard and exceedingly tender to the touch.
A digital examination, per vagina, revealed the uterus
slightly prolapsed, but no other evidence of disease.
After a careful consideration of the case we diagnosed
ha^matocele, and to make the diagnosis certain, we took
a hypodermic syringe, pushed the needle into the tumor,
and drew out some of its contents, which were fluid and
had the appearance of prune-juice. Recognizing this as
blood in a partial state of decomposition, the diagnosis
was thus proved correct. Owing to the large quantity
of fluid, we could not hope that relief would come to the
patient by nature's slow process of absorption, and to
avoid the great danger feared from septicjemia, we ad-
vised the evacuation of the tumor. The patient con-
senting, on Sunday morning, two days later, we drew, by
means of the aspirator, ninety-six ounces of fluid, resem-
bling in color prune-juice, and having quite an oftensive
odor.
The patient expressed herself greatly relieved ; all the
tenderness and pain had vanished as if by magic. We
directed that an antiseptic treatment be pursued, together
with astringents, and that Dr. Mclntire see the patient
daily. The patient soon had general peritonitis. By Dr.
Mclntire's skilful management she finally recovered,
and at this writing enjoys good health.
Dr. D. p. Morgan, of Clarksburg, read a paper on
THE ABUSE OF ERGOT IN OBSTETRIC PRACTICE.
The teachings of college professors and of text-books
on obstetrics of how and when to give ergot in labor are
various and very conflicting. One will tell us to give
ergot when the pains are slow, another to give it to
overcome inertia daring the first stage of labor, and
another that it shall never be given during the first or
second stages of labor; another will tell us it is little less
than murder to give it while the child is viable, another
advises us to give it only to expel a retained jilacenta or
to control post-partum hemorrhage, while still others ad-
vise us to use it only as a prophylactic against hemor-
rhage, or to give it to prevent after pains, etc. Now this
is all confusing, more especially to the younger mem-
bers of our profession, and I shall, after noticing very
briefly its action on the uterus during labor, try and
formulate a few rules as to when it shall not be given.
Now it is desirable to ascertain, if possible, the true ef-
fects of ergot on the muscular fibres of the uterus, and
on the fcetus within the uterine cavity. It usually pro-
duces in a uterus at terin or in labor a strong tonic
conti-action, which differs from the natural rhythmical
contraction, which is followed by a period of relaxation,
in being of a continuous or tetanic nature, and if the dose
be repeated often, or a sufficient quantity given, a con-
tinuous and powerful tetanic contraction is usually pro-
duced, which is participated in by all the uterine muscu-
lar fibres, and the contents, be they fetal, placental, or
blood clot, are held as in the jaws of a vice instead of
being normally expelled, and thereby often proving fatal
to the child by compressing the cord and thus cutting off
the fetal circulation.
The so-called hour-glass contraction is evidently a
form of tetanic contraction, similar to that produced by
ergot. Again, the action of ergot is not uniform. It
may act on a part, or upon the whole organ, it may act
upon one set of the muscular fibres and not on the
others. It may produce such a powerful tetanic con-
traction as to drive a head too large into a pelvis too
small or deformed, and thus produce impaction with all
its fearful consequences. It may, and has produced all
the lacerations possible, from rupture of the uterus, with
escape of the ftetus into the abdominal cavity, to that of
the perineum, with great shock, loss of blood, etc. It
has produced pelvic cellulitis and peritonitis ; it has
produced gangrene and sloughing of all the soft tissues
in the pelvic cavity. It very frequently produces lacer-
ation of the cervix uterus ; it has produced such exten-
sive sloughing of the vagina as to result in contraction,
destroying the entire vaginal canal. The safety of the
maternal tissues and the life and health of the child de-
pend upon a regular relaxation after each siiccessive
contraction of the uterus, as well as the recession of the
presenting fcetus, and when such contraction, relaxation,
or recession are replaced by a tetanic, or continuous
contraction, injury to either mother or child, or both, is
apt to result. And yet, in the face of all the facts, very
many physicians daily use ergot without any especial
object or aim as to its results, they merely feeling the
necessity of giving something, or doing something. Now
546
THE MEDICAL RECORD.
[May 19, 1883.
I claim that in giving ergot during the tirst stage of
labor we commit malpractice. But in what does this mal-
practice consist ? It is this : Ever since Dr. Stearns, of
Saratoga County, N. Y., in 1S07, had his letter pub-
lished in the Neici York Medical Repository, and even
unto the present moment, many, very many physicians
will attend a given case of labor, the usual examina-
tion is, or is not made, perhaps the usual inquiry as to
the condition of bowels, bladder, etc., is made, how long
the lady has been in pain, frequency of pains ; how long
intervals intervene, etc. The physician perhaps finds
the OS dilated as large as a twenty-five cent coin, or
larger, with moderate pains and long intervals. He is
in a hurry, besides he feels that he must do something,
gives a teaspoonful of the liquid extract of ergot, or its
equivalent of tincture, wine, or infusion, or a hypodermic
injection of ergotine, waits twenty or thirty minutes,
gives another dose, and another, until the uterus is
thrown into a furious state of contraction, with scarcely
any relaxation. The result will probably be a dead child
with some one or more of the serious injuries above men-
tioned to the mother.
Well, when shall we give ergot in cases of labor?
First, never till the uterus is thoroughly dilated or dilat-
able and the perineum is thoroughly relaxed and the
pelvis properly shaped, and it is better not given then.
Secondly, not till the head has passed the perineum and
continued inertia exists. Thirdly, to secure contraction
in post-partum hemorrhage, and then not till the uterus
is emptied of placenta clots, etc., by other means ; and in
this case continued pressure over the fundus, after the
method of Criede for expelling the placenta, is much
better ; besides, the intra-uterine injection of very hot
water is superior to ergot and will not produce the nau-
sea, vomiting, and prostration, as is frequently done by
ergot. Hence ergot is not necessary at all during the
first stage of labor. It should only be given in the sec-
ond stage when the os uteri is dilated and the perineum
relaxed, and then only in conditions of continued atony;
and here abdominal bandages, stimulants, quinine, etc.,
will overcome this atony in almost all cases, and with
much more ease, safety, and satisfaction than ergot or
any similar remedy. Ergot is unnecessary in post-par-
tum hemorrhage, except in small tonic doses of ten to
twenty drops every half, one, two, or three hours, and
even here we possess in the hand a safe, rational, quick,
easy, ever ready remedy, to be used in the manner before
mentioned. In the Bethesda Hospital, in Dublin, the
use of ergot as an oxytocic before delivery has been pro-
hibited by the trustees. Finally, it has serious disadvan-
tages and it is very questionable whether the risks to
both mother and child do not more than counterbalance
any advantages attending its use, or, in other words, it
were probably better that it had never been given in
labor before the uterus was emptied.
The second day's session convened in the Court
House at 8.30 a.m.
ENDORSI.VG THE CODE OF THE A.MERlCA>f MEDICAL
ASSOCIATION.
Immediately after the ofifering of prayer the following
preamble and resolutions were moved by Dr. D. H.
Morgan, of Clarksburg :
Whereas, The medical profession of West Virginia
views with deep concern and regret tne confusion and
discord which have resulted in the State of New York
from the action of the State Medical Society in renewing
allegiance to tlie code of ethics of the American Medi-
cal -Association, under wiiich all State and other auxili-
ary societies have so long and harmoniously worked to-
gether for the common good ; and
Whereas, Certain medical journals and specialists,
under the specious plea of " liberality," humanity, and
advancing civilization, have used and are still using
every effort to bring about and maintain such a degree
of opposition to the National Code as shall completely
separate the said State Medical Society of New York
from affiliation with all loyal organizations in other
States, thus rendering it independent of and antag-
onistic to the American Medical Association ; therefore
Resolved, That the Medical Society of the State of
West Virginia again declares and reaffirms its willing
allegiance to the time-honored notion and code of medi-
cal ethics as the great common law, and the only safe
and proper guide for the physician in the midst of the
conflicting interests with which he is beset in daily prac-
tice and in his interests with his fellows.
Resolved, That the delegates from this society to the
American Medical Association, at its forthcoming meet-
ing, be and they are hereby instructed to resist, by their
votes and influence, all attempts which may be made to
change or modifv any of the provisions of the code, or
to in any other way compromise the dignity, standing,
and influence of the profession.
Resolved, That this Society recommends to the medi-
cal profession of VV'est Virginia, that they support, by
their subscriptions, only such medical journals as re-
commend their patients to such specialists, and direct
their students only to such medical colleges as have
shown, by their unequivocal attitude, their representation,
the demands of true humanity, their recognition of the
pure and unselfish aspirations of our calling, and their
loyalty to the high and noble interests of rational medi-
cine.
Resolved, That a copy of these preambles and resolu-
tions be forwarded to the Permanent Society of the
American Medical Association.
The resolution was unanimously adopted.
A JOURNAL FOR THE SOCIETV.
The following was then read :
IVJiereas, The Medical Society of the State of West
Virginia is growing in numbers and increasing in useful-
ness, as is evidenced by the superior quality of the
papers, so far read, and by the interest manifested on
medical subjects generally in the State, and
Whereas, Our State has a law regulating the practice
of medicine, and establishing a State Board of Health
which is not surpassed, if even equalled, by any similar
law in any of the States, and
Whereas, The Society, and the profession at large in
the State have no medium of communication on medical
and public health subjects, except the annual meeting of
the Society ;
Whereas, The State Board of Health and the Medical
Society should be in perfect harmony and be enabled to
interchange opinions and suggestions upon public health
subjects, therefore be it
Resolved, That this Society elect annually three mem-
bers, which shall constitute a Committee on Publication,
whose duty it shall be to associate with themselves an
editor, which committee and editor shall publish a quar-
terly medical journal under the auspices of this Society,
and, if practicable, in conjunction with the State Hoard
of Health, which committee and editor, in addition to
publishing through the difierent numbers of the journal
(after being approved, passed, and read before this So-
ciety), may insert original articles, reports of cases, com-
munications, selections, translations, medical and sanitary
news, etc.
Dr. J. M. Lazzelle, of Fairmont, spoke against this
plan, as did also Dr. J. Frizelle, of Wheeling. Moved
to be referred to the Committee on Publication. Car-
ried.
Mr. F. Howell, of Clarksburg, read a report of a
CASE OF CESOPHAGOTOMY FOR THE EXTRACTION OF A
silver fifty cent piece
swallowed, by recovery, with suggestions as to the con-
ditions under which the operation is justifiable.
The following conclusions were reached by the author,
First, when a foreign body has become lodged in the
May 19, 1883.]
THE MEDICAL RECORD.
547
"cervical" portion of the " cesophagus," and has re-
sisted a fair trial for its extraction or displacement, its
removal should be at once affected by incision. Second,
when a foreign body has become lodged in the " ceso-
phagus," determinable within a finger's length below the
upper end of the " sternum," and has resisted a thorougli
trial for its extraction or displacement, its extraction
should be at once attempted by incision. Third, when
a foreign body has become lodged in tlie " resophagus "
at a point beyond a finger's length below the upper end
of the '• sternum," or in extreme cases, even at the
cardiac contraction, and its position can be pretty def-
initely ascertained, and its character, size, shape, etc.,
are known or have been pretty definitely determmed
to be such that it could not, without great danger,
work its way outward, or pretty readily become dis-
lodged or loosened by ulceration and pass onward, and
it has resisted the most careful and thorough efforts for
its extraction or displacement, its extraction should
then be at once attempted by an oiieration.
Dr. John Frizelle, of Wheeling, read an intolerably
lengthy and monotonous column of manuscript, touch-
ing on
THE TERRIBLE DANGERS ATTENDING THE USE OF TOBACCO,
ALCOHOL, ETC.
About an hour was consumed in the elimination of this
humanitarian effort. Its effect upon the delegates was
disastrous.
The paper was referred to the State Board of Health,
with the request that they publish it in their proceedings.
NATIONAL BOARD OF HEALTH.
Dr. W. F. Vankirk, of Grafton, offered the following :
Whereas, The National Board of Health, by its effici-
ency and faithful discharge of official duty, has won the
confidence and endorsement of the most expert sanitari-
ans both in this country and Europe, and of the medical
profession, generally, in the United States ; and
Whereas, This society deems it of the greatest im-
portance that the strong arm of the general Government
shall be exercised to prevent the introduction of con-
tagious disease into the United States from foreign ports,
and there spread from State to State ; to co-operate with
and aid Stale and municipal boards when such domestic
authorities are unable to control or stamp out epidemic
diseases among the people ; therefore,
Resolved, That this Society requests the senators and
representatives in Congress from West Virginia to use
their influence to accomplish such legislation as will se-
cure the perpetuity and usefulness of the National
Board of Health in preventing the importation of foreign
pestilences and their spread among the people ; to co-
operate with and aid State and municipal boards -of
health, when such boards are unable to control and sup-
press pestilences which are afflicting and killing the
people ; to encourage investigations concerning the
sources and causes of disease among the people, and
clothe the central power and authority with a sufficient
appropriation of money to enable it to discharge the im-
portant trusts committed to its care in a matter credita-
ble alike to the general good of the medical profession
of the United States.
Adopted.
Dr. S. L. Johnson, of Wheeling, read a paper on
PUERPERAL FEVER, WITH SPECIAL REFERENCE TO TREAT-
MENT BY EXTRA-UTERINE ANTISEPTIC IRRIGATION.
He combated the specific theory of causation, and ad-
vocated the septic or toxajmic nature of the disease. He
suggested that when " puerperal " fever arose apparently
from erysipelas or scarlatina it was due to the fact that
an atmospheric state was produced by these diseases
predisposing to putrefaction of lochial discharges.
He recommended the following classification of grave
puerperal diseases : i, Puerperal inflammation ; 2, puer-
peral fever, septicremia, or toxjemia ; 3, zymotic dis-
eases in puerperal women ; and gave the following rules
for antiseptic irrigation of the uterus: i. What must be
done only by a physician ; 2, must be preceded by va-
ginal irrigation ; 3, must be done by gravitation and
not by injection ; 4, fluid used must be as warm as the
body temperature ; 5, a free exit from uterus must be
secured ; 6, concentrated solutions must be avoided.
A discussion ensued at this point as to the use of ergot
in labor. Dr. S. G. Landis, of Columbus, denied the
"oxytocic" properties of ergot in his experience, and
deplored its use in any of the stages of labor. He
thought it acted simply as a nauseant, nauseants being
well known to cause contraction of the womb.
Dr. R. K. Stover, of Richmond, spoke at some
length in support of Dr. I.andis's remarks. Dr. J.
Gregg, of Quet, Del., was also in the habit of conduct-
ing his cases of labor without employing ergot.
MISSOURI MEDICAI, ASSOCIATION.
Twenty-sixth Annual Meeting, held at Jefferson City,
Mo., May 15 and 16, 1883.
(By Telegraph to The Medical Record.)
address of welcome — URGING APPROPRIATION FOR
fire-proof BUILDINGS FOR NATIONAL MEDICAL LI-
BRARY DISCUSSION OF THE CODE THE USE OF THE
WORD ALLOPATH — REPORT ON GENITO-URINARY SUR-
GERY— ELA.ST1C LIGATURE IN SURGERY THE PROG-
RESS OF MEDICINE — STANDARD FOR THE EXAMINA-
TION OF STUDENTS.
The twenty-sixth annual meeting of the Missouri
Medical Association opened Tuesday afternoon, May
15th. The Address of Welcome was delivered by Gov-
ernor Crittenden. He criticised tlie Code of Ethics
and prophesied the abolition of the Code and of the
American Medical Association itself He paid a hand-
some tribute to the memory of Dr. Hodgens, late Presi-
dent of the Association.
President Gore protested against breaking down the
Code of Ethics.
Resolutions were adopted urging upon Congress ap-
propriations for a fire- proof building for the Medical
Library and publishing index catalogue.
Dr. G. M. Dewey read a paper, " Remarks with Refer-
ence to the Code," which led to an animated discussion.
Dr. Todd, of St. Louis, introduced a resolution con-
demning the use of the word allopath.
Dr. Ford, of St. Louis, presented a long report on-
"Genito-Urinary Surgery," discussing strictures, litho-
lapaxy, etc.
Dr. Trader, of Sedalia, read a brief paper on " The
Elastic IJgature in Surgery."
Dr. Allen reported from the Committee on Medical
Legislation the history of the bills passed by the last
Assembly.
On Wednesday, May 15th, Dr. Lester presented a
report on "Progress of Medicine," referring specially
to the bacillus tuberculosis, and the treatment of typhoid
fever and of rheumatism by the salicyl compounds.
This elicited an extended discussion.
Dr. J. W. Brent read a paper on " Force."
Dr. T. Pollock, of St. Louis, presented a paper on
'• Jequirity in Ophthalmia," giving personal observations.
Dr. Hollev, of Kansas City, presented an abstract of
an extended paper on " Pathology and Classification of
Tumors."
Dr. Warth's paper on "Spontaneous Evolution" was
read by title.
Dr. B. F. Wilson, of Salisbury, read a paper on
" Bacteria," denying that they can affect normal tissues.
This paper was fully discussed in the afternoon.
The President gave an address recalling some points
in the progress of medicine, but showing how far short of
548
THE MEDICAL RECORD.
[May 19, 1883.
our wishes is that progress, noting also defects of med-
ical education in practical points.
Dr. T. J. NoRRis presented a long report of the Com-
mittee on Medical Legislation, with letters from prominent
physicians in this State and elsewhere. The paper was
partly read, and referred without discussion to the Com-
mittee on Publication.
Dr. .Allen proposed a resolution containing a recom-
mendation to the Board of Health to fi.x a certain stan-
dard for the examination of students grading from medi-
cal schools, and requiring publication of questions and
answers. After some irregular discussion an adjourn-
ment was had without action on the resolution.
ILLINOIS STATE MEDICAL SOCIETY.
Thirty-third Annual Meeting, held at Peoria, III.,
May 15 and 16, 1883.
{By Telegraph to The Medical Record.)
The Thirty-third Annual Meeting of the Illinois State
Medical Society was called to order May isth, at 10
o'clock by the President, Dr. A. T. Darrah, of Bloom-
ington, who made an address of welcome on behalf of the
Committee of Arrangements and the citizens of Peoria,
which was responded to by Dr. William Hill, of
Bloomington.
After the routine of business, the arrangements for the
reports of the various committees was made, making
provision for voluntary reports in connection with the
same.
The morning session concluded with the reading of
the Annual Address of "the President.
Reports on the Practice of Medicine were offered by
Drs. N. S. Davis, of Chicago ; B. M. Griffiths, of Spring-
field, and J. F. Todd, of Chicago, which were received.
These reports were discussed bv several members, among
others Drs. S. C. Plummer, of Rock Island ; J. P. Walker,
of Mason City ; D. Prince, of Jacksonville, and B. F.
Crummer, of Warren.
The report on Necrology showed that death had not in-
vaded the members' ranks during the past year.
Dr. Booth presented the report of a special
COMMITTEE ON MEDICAL EDUCATION,
expres.sing the desirability of separating teaching and the
conferring of diplomas, criticising severely the American
system of medical education, and warmly reconmiending
the creation of an
E.XAMINING BOARD SEPAR.\TE AND DISTINCT FRO-M ANY
AND ALL MEDICAL COLLEGES.
This caused considerable discussion, the point being
generally conceded that the existence of separate exam-
ining boards is greatly to be desired.
Professor W. Hay, of Chicago, as chairman of a
special committee, submitted a report relative to the
COMMITMENT OF THE INSANE,
and submitted a brief of a bill to be recommended to
the Legislature. The report was accepted, and the
committee was continued for two years.
At the VV'ednesday morning session, reports on Surgery
were given by Drs. E. Owen, of Chicago, and J. T.
Stewart, of Peoria. The latter related a case of
EXSECTION OF THE UTERUS, OVARIES, AND GRE.ATER POR-
TION or THE POSTERIOR WALL OF THE VAGINA, WITH
RECOVERY.
Dr. Verity, of Chicago, exhibited an ingenious and
simple device for
SUSPENSION DURING THE APPI.ICATIO.V OF THE PLASTER
JACKET.
Dr. David Prince, of Jacksonville, exhibited an ap-
paratus for evacuation of the bowels, and
Dr. J. S. Whitmire showed a new spring truss for
which he claimed certain advantages of simplicity and
universality of application.
Dr. N. Holton, of Smithfield, reported a case on the
SPONTANEOUS dislocation OF A KID.NEY
to the anterior part of the abdomen, with a reduction of
the same.
The Treasurer, Dr. J. H. Hollister, having com-
pleted his twentieth year of service, tendered his report
through Dr. N. S. Davis, requesting at the same time
to be released from service.
The appointing of the Nominating Committee and the
discussion of the Reports on Surgery concluded the
morning session.
At the ^Vednesday afternoon session the following reso-
lutions were presented from the Special Committee on
Recommendations on President's Address :
Whereas, The Illinois State Medical .\ssociation take
much interest in
URGING and PRO.MOTING THE FOR.MATION OF THE STATE
BOARD OF HEALTH,
and the results of its work since its organization fully
justifies the expectation of its friends in protecting the
people from professional ignorance and imposition from
epidemic diseases and various other causes prejudicial to
life and the promotion of a higher standard of medical
education, thus placing Illinois in the front rank in this re-
spect among her sister States, this rule being largely due
to the personal sacrifices of members of the board, the
appropriations made by the State having never been
sufficient to carry out the duties imposed on the board by
law ; therefore be it
Resolved, That, in the opinion of this Society, it is
the duty of the Legislature of this State to make such ap-
propriations as will enable the board to carry out the
important duties assigned it by the acts creating the
State Board of Health and the act to regulate the prac-
tice of medicine.
Resolved, That a copy of this preamble and resolu-
tions be sent to members of the Legislature now in ses-
sion. Adopted.
Dr. Prince, of Jacksonville, and Dr. Chenoweth,
of Decatur, and Dr. E. S. Norred then read papers
on gynecology.
THE report of nominating co.mmittee
was then presented and adopted.
President — Prof Edmund Andrews, Chicago ; First
Vice-President — David Booth, Sparta ; Second Vice-
President — Geo. W. Nesbitt, Sycamore ; Treasurer —
Walter Hay, Chicago ; Members of the Jtldieial Council
(for three years) — Robert Boal, Peoria ; Herbert Judd,
Galesburg ; L. G. Thompson, Lacon ; Committee on
Practical Medicine — J. C. Frye, Peoria ; J. W. Hensley,
Yates City ; N. S. Reed, Chandlerville ; Surgery —
Roswell Park, Chicago ; D. S. Booth, Sparta ; J. D.
Whitley, Petersburg ; Obstetrics — S. R. Crawford, Mon-
mouth ; Ellen A. IngersoU, Canton ; C. Duhadway,
Jerseyville ; Gynecology— \\\ S. Caldwell, Freeport ; L.
H. Corr, Carliiiville ; A. F. Rooney. Quincy ; Ophthal-
7nology and Otology — J. P. Johnson, Peoria ; Robt. Til-
ley, Chicago ; P. H. Garretson, Macomb. Place of
meeting, Chicago, 1884.
During the afternoon session a connnunication from the
Missouri Medical Association, asking that the time of
meeting of one of the associations should be changed,
was received. The Missouri association was considerately
invited to make such change.
Reports on Drugs and Medicine were submitted by
Drs. S. J. PiTNEK, of Jacksonville, and Herbert, of
Galesburg.
.After the conclusion of the afternoon session, the dele-
gates were invited to partake of a carriage excursion in
the suburbs, and a promenade reception was given in
the evening.
May 19, 1-883.]
THE MEDICAL RECORD.
549
INDIANA STATE MEDICAL SOCIETY.
Thirty-third Annual Session, held at Indianapolis, May
8, 9, and 10, 1883.
W. H. Bell, M.D., President, in the Chair.
[Special Report for The Medical Record.)
MEDICAL PAPERS READ — THE NEW YORK CODE IN INDI-
ANA-— INSTRUCTING DELEGATES TO AMERICAN MEDICAL
ASSOCIATION — ELECTION OF OFKICERS.
'Over two hundred members of the Society were present.
The Secretary, Dr. E. S. Elder, rejjorted that the So-
ciety was larger than ever, numbering now over 1,200
members. During the past year 44 members had been
suspended, 2 e.xpelled, which shows that Indiana doc-
tors are rather uncontrollable, or that the censorship is
rigid.
. Pa]iers were read by Dr. S. E. Earp, of Indianapolis,
on "Typhoid Fever," Dr. G. F. Beasley, of Lafayette,
on ''A Case of Gunshot Wound in the Knee," Dr. J. M.
Green, of Stilesville, on "Typhoid F"ever," and by Dr.
T. B. Harvey, of Indianapolis, on " The Laceration of the
Cervix Uteri." Dr. Mary J. Thomas, of Richmond, read
a paper on " The Medical Education of Women of the
State," advocating the removal of the restrictions of sex
in the reception of students by the colleges.
The paper was really a plea for co-education in the
Indiana Medical College. Dr. T. B. Harvey, in reply,
said that co-ediication in that college was impracticable
at present.
Dr. George Sutton read a paper on " Human Para-
sites."
Dr. George Rowland, who had previously posed as
an ethical reformer by introducing resolutions condemn-
ing the New Vork Code and its originators, read a paper
on " Medical Legislation," which excited the charge of
plagiarism. Dr. Boyd, of Dublin, said that it was nearly
identical with a paper read by himself two years ago,
which paper had been lost by the Secretary.
A paper by Dr. Worrell and one by Dr. Gaddy were
read by title.
A, resolution was adopted, instructing the delegates
from Indiana to the American Medical Association to
vote against any change in the Code of Ethics, so far as
consultation with irregulars was concerned.
A resolution was adopted, allowing Dr. T. M. Stevens
to spread upon the record of the county his defence
from the charges made by the State Health Board against
him as its secretary, and on account of which he had
been deposed.
The following officers were elected for the ensuing
year : President — Dr. S. E. Munford, of Princeton ; Viee-
President~V)x. Wm. H. Shulse ; Secretary— V)r. E. S.
Elder, of Indianapolis ; Assistant Secretary — Dr. G. W.
Burton, of Mitchell ; Treasurer — Dr. G. W. H. Kemper,
of Munich.
The Society adjourned to meet in Indianapolis on the
second Tuesday in May, 18S4.
THE SOUTH CAROLINA MEDICAL ASSOCIA-
TION
Held its thirty-third annual session at YorkviUe, April 25th
and 26th, the President, Dr. F. F. Gary, in the Chair.
The annual address by the President was upon the sub-
ject of the State Board of Health, which is the State
Medical Association. Resolutions endorsing the Na-
tional Board of Health and asking for a quarantine sta-
tion at Sapelo Sound were passed.
A committee consisting of Drs. Bralton, Taylor, and
Taber, appointed to investigate the subject of anajsthesia,
reported with the following conclusions : i. That for more
than fifty years the inhalation of sulphuric ether as an
excitant has been common in some parts of Georgia,
though not practised in the colleges. 2. That Wilhite
was the first man to produce profound anesthesia, which
was done accidentally with sulphuric ether in 1841. 3.
That Long was the first man intentionally to produce
ana.-sthesia for surgical operations, and that this was done
with sulphuric ether in 1842. 4. That Long did not by
accident hit upon it, but that he reasoned it out in a
philosophic and logical manner. 5. That ^Vells, without
any knowledge of Long's labors, demonstrated, in the
same philosophic way, ana5sthesia by the use of nitrous
oxide gas in 1844. 6. That Morton, desiring to use the
gas in dentistry, asked Wells to show him how to make
it in 1846. 7. That Wells referred Morton to Jackson,
as the latter was a scientific man and an able chemist.
8. That Jackson told Morton to use sulphuric ether in-
stead of gas, as it possessed the same properties and
was as safe and easy to get. 9. Tiiat Morton, acting
upon Jackson's suggestion, used the ether successfully in
the extraction of teeth in 1846. 10. That Warren, Hay-
wood, and Bigelow jierformed important surgical opera-
tions in the Massachusetts General Hospital, October,
1846, on patients etherized by Morton, and that this in-
troduced the practice throughout the world.
Dr. A. A. Moore read a paper reporting cases to show
that chloroform tended to increase the danger from
hemorrhage during labor. Dr. T. P. Bailey read a jiaper
on hemorrhagic malarial fever, a form much resembling
yellow fever. Dr. John Forrest read a paper on boro-
glyceride, commending it as an antiseptic in surgery,
diphtheria, and ulcers. Dr. J. J. Chisolm, of Baltimore,
read a paper in which he urged the use of spectacles by
children suffering from optical troubles.
The following officers were elected : President — Dr.
R. A. Kinloch; Recording Secretary — Dr. John Forrest;
Corresponding Secretary — Dr. H. D. Frazer.
The Association adjourned to meet at Florence, April
22, 1S84.
THE MISSISSIPPI STATE MEDICAL ASSOCIA-
TION
Held its Sixteenth Annual Meeting at Meridian, April 4th,
5th, and 6th. Numerous jjapers were read, among
them one by Dr. R. S. Toombs, on a case of " Gin-Saw
Injury of the Hand, Forearm, and Elbow-Joint," in
which the arm was saved after a very extensive injury.
Dr. John Brownrigg showed an apparatus for securing
counter-extension in fracture of the fenmr, a close-fitting
jacket being substituted for the perineal band ; Dr.
Brownrigg also showed an apparatus for the treatment
of Barton's fracture. Dr. W. E. Todd read a paper on
a case of " Hysterical Convulsions in a Woman with
Anteflexion and Endocervicitis Cured by the Galvanic
Current." Dr. Mabry read a paper on "Puerperal
Convulsions," Dr. Guise a paper on " Veratrum \'iride
in Puerperal Convulsions," Dr. D. L. Pharis a report
on epidemic orchitis, vvhich had occurred during the
past year. The following officers were elected : Presi-
dent— Dr. J. M. Greene, of Aberdeen : Vice-Presidents —
Drs. S. N. Walker, and Dr. McCallum ; Recording Sec-
retary— Dr. W. E. Todd, of Clinton ; Assistant Secre-
tary— Dr. J. F. Hunter, of Jackson ; Corresponding
Secretary — Dr. M. S. Craft, of Jackson ; Treasurer — Dr.
Robert Kells. The Society adjourned to meet at West
Point the first Wednesday in April, 1884.
THE TEXAS STATE MEDICAL ASSOCIATION
Held its Fifteenth Annual Meeting at Tyler, April 24th,
25th, 26th, and 27th, over one hundred members being
present. The annual address was delivered by the Presi-
dent, Dr. S. F. Starley, of Corsicana. It was voted
that the "Transactions" be published in pamphlet form
instead of in the Galveston Medical and Surgical Record.
Among the papers of interest read was one by Dr. John-
son, who reported the case of a girl six years old, who
had menstruated ever since the first week of life. Dr.
E. J. Beall and Dr. \V^ A. Adams reported the case of
a large indolent ulcer cured by sponge-grafting. Dr. D.
M. Ray read a paper in which he described a very novel
55°
THE MEDICAL RECORD.
[May 19, 1883.
method of removing pins, etc., from the stomach. He
gave the patient, who had swallowed a pin, a mixture of
mush and cotton ; he then produced emesis and the pin
was expelled.
The following officers were elected : President — Dr.
A. P. Brown, of Jefferson ; Vice-Presidents — Drs. T. H.
Nott, J. D. Osborne, and Frank Allen ; Secretary— \ix.
W. J. Burt, of Austin ; Treasurer — Dr. J. Larendon, of
Houston. The Society adjourned to meet next year at
iBelton, on the last Tuesday in April.
THE MEDICAL SOCIETY OF THE STATE OF
CALIFORNIA
Held its Thirteenth Annual Meeting in San Francisco,
April 1 8th and 19th. The President, Professor L. C.
Lane, delivered an address, taking for his subject the
■climate and diseases of Guatemala, which country he
had just visited. He stated that the deaths from phthisis
were proportionately very small, being about eight per
cent, on the whole mortality. Goitre prevails, but with-
out cretinism. There is a small colony of lepers. Tlie
practice of medicine is carefully regulated, and hardly
any quackery jirevails. Dr. Lane says : " In passing
along the streets one is struck with the almost total ab-
sence of medical signs ; and even if one is seen, it is in
characters so small as to be illegible at a short distance."
Guatemala has a tolerably good medical college with
about one hundred students. The scientific work of the
Society was chiefly in the form of reports on the various
special branches. Thirteen of these were made, and
about the same number of original (lapers was read.
The Board of Examiners reported that eighty-eight
licenses had been given during the year. The Board of
Censors recommended the expulsion of Dr. P. D. McD.
Miller, alias Dr. Francis St. Clair Miller, on the ground
that his diploma had been fraudulently obtained. The
•recommendation was adopted.
An exhibition of the gastroscope was given by Dr. J.
O. Hirschfelder.
The Society voted to have the next annual session
cover three days.
The following ofiicers were elected : President — Dr.
Ira E. Oatman, of San Francisco ; F^our Vice-Presidents ;
Treasurer — Dr. F. \V. Hatch; Permanent Secretary — Dr.
W. A. Briggs, of Sacramento ; Assistant Secretaries —
Dr. Thomas Ross and John Wagner. .\ Board of Cen-
sors and Examiners were also elected.
THE SECOxVD GERMAN CONGRESS OF IN-
TERNAL MEDICINE.
Held at Wiesbaden, April 18, 19, 20, and 21, 1883.
Professor Frerichs. President, in the Chair.
(Special Report for The Medical Record.)
The number of physicians present upon the opening day
was over two hundred, the list including well-known
representatives from Berlin, Breslau, Bonn, Wiirzburg,
Gottingen, Tubingen, Kiel, Jena ; also from Prague,
Vienna, St. Petersburg, Copenhagen, Bern, and Zurich.
The Congress was opened on the morning of the i8th
(Wednesday) with an address by the President, Profes-
sor Frerichs. The speaker congratulated the associa-
tion upon its rapidly attained success, called attention to
the need of a renewed interest in internal medicine,
which had threatened to be overtopped by other and minor
specialties. He said that the present Congress had three
specially important questions to discuss : i. The germ
theory of tuberculosis ; 2, the nature, prevention, and
treatment of diphtheria ; 3, the abortive treatment of
infectious diseases.
At the close of the President's address, Drs. Biermer
and Liebermeister were elected Vice-Presidents.
The scientific work then began with a paper by Pro-
fessor RiJHLE, of Bonn,
UPON THE INFLUENCE OF THE DISCOVERY OF THE TU-
BERCLE BACILLUS UPON THE PATHOLOGY OF TUBERCU-
LOSIS.
The author gave a history of the various experiments
and observations which culminated in Koch's discovery
of the bacillus. He reviewed and endeavored to answer
the arguments against the view that the bacillus is the
specific cause of phthisis. Accepting it as a cause, he
urged the use of disinfection, isolation, and antiseptics in
the treatment and prevention of the disease. His con-
clusions were : I, Human tuberculosis is an infectious
disease ; 2, the bacillus discovered by Koch is its special
cause ; 3, the fact that pulmonary tuberculosis may be
transmitted from man to man by contagion is estab-
lished ; the exact method is not certainly known ; 4, tu-
berculosis in man and animals is identical ; 5, the thera-
peutics relate chiefly to prevention, but the best methods
of prophylaxis cannot yet be formulated.
Professor Riihle's remarks were received with much
applause.
He was followed by Professor Lichthei.m, of Bern,
who agreed in the main with the preceding speaker.
Dr. F'raentzel, of Berlin, related the results of the
experiments made in connection with Koch and Gaffky
with the
ANTISEPTIC method OF TREATING PHTHISIS.
They had employed inhalations of menthol camphor,
naphtalin, anilin, etc., but with negative results.
Professor Klebs, of Zurich, believed it demonstrated
that bovine tuberculosis was communicable to man. He
thought that a certain predisposition must exist in order
that contagion occur, and reaffirmed his old view that
the intestinal tract was often the place where the infec-
tive virus entered.
Professor Killer, of Berlin, iiad made injections
into the lung tissue (in cases of phthisis) of corrosive
sublimate, bromide of ethyl, and alcohol, but without
any result.
Dr. Schott, of Mannheim, recommended salicylate of
sodium and sulphurous acid as antiseptics in tuber-
culosis.
Dr. Zeigler, of Tubingen, described his views of the
way in which the tubercular virus enters the system. He
thought that the entrance occurred through three chan-
nels, viz., the blood-vessels, the lymphatics, and the
lungs. In accordance with this we may distinguish
three types of tuberculosis.
When it enters by the blood-vessels we usually have
general miliary tuberculosis, but in rare cases, especially
in children, tuberculosis foci are formed in the lungs,
making the disease resemble a localized tuberculosis.
The second form, in which the lymphatics take part,
is that which is generally produced by inhalation. A
tubercular lymphangitis is excited. The tubercular foci
thus formed enlarge, then soften, and their products
may be carried further (i) by the lymph paths, or (2)
by the blood-vessels, causing an embolic tuberculosis, or
finally (3), directly along the bronchi. In this way, or
by direct infection, we find developed the third type, or
bronchial tuberculosis.
Professor Ruhle, in concluding the discussion,
called attention to the fact that not a voice had been
raised against the view that tuberculosis was an infectious
and parasitic disease.
A debate was opened on the second day by Profes-
sor Gerhardt, of Wiirzburg, on
DIPHTHERIA : ITS PATHOLOGY, CONTAGIOUSNESS, THE-
RAPY, AND PROPHYLAXIS.
The speaker reviewed the history of diphtheria, and
showed how our knowledge of its infectious and con-
tagious character had gradually been obtained. He
May 19, 1883.]
THE MEDICAL RECORD.
551
believed in the essential identity of croup and diphtheria.
He gave an interesting account of an epidemic of diph-
theria among the hens in a village of France. Among
2,500, 1,400 died of diphtheria. One thousand chickens
hatched from their eggs died within six weeks. A diph-
theritic hen bit an hospital attendant, who soon devel-
oped a diphtheria.
Diphtheria, the speaker beheved, depended upon the
presence of micro-organisms, but these probably carried
or generated some chemical poison. They varied in
character and appearance, a fact which accounts for the
varying course of the disease. The differentiation of
various kinds of diphtheria, in accordance with the
special micro-organism, was the future problem for the
pathologist.
He discussed the question whether the membranous
exudate in scarlatinal sore-throat was truly diphtheritic,
and was inclined to think it was not.
As regards therapeutics the indications were two :
First, the loosening or removal of the membrane, by
vapors with lime-water or lactic acid, by pilocarpin or
papayotin (which latter he recommended as useful).
Second, the attack upon the cause of the disease with
antiseptics.
(To be continued.)
THE TWELFTH CONGRESS OF THE GERMAN
SURGICAL SOCIETY,
Held in Berlin, April 4, 5, 6, and 7, 1883.
Professor v. Langenbeck, President, in the Ch.^ir.
(Special Report for The Medical Record.) .
(Concluded from p. 524.)
The morning session of the second day was occupied
witli the presentation of cases.
excision of tarsus, REPRODtJCTION OF BONE.
Dr. Lauenstein, of Hamburg, presented a woman,
fifty-four years of age, from wliom he had removed the
greater part of the tarsus of the right foot, on account of
caries, nearly two years before. The under portion of
the OS calcis, as well as its neck and head, the scaphoid,
three cuneiform, cuboid, and tarsal ends of the fourth
and fifth metatarsal bones were excised. In addition,
the remaining part of the calcaneus was scooped out.
The patient could stand at the end of five months, and
could at present walk for half an hour without fatigue.
There was good reproduction of bone, and the foot was
less than half an inch shorter than its fellow.
Dr. Wolfler, of Vienna, presented a report, with
specimens, upon
RESECTION OF THE SMALL AND LARGE INTESTINES.
In a case of a woman, fifty-two years of age, the at-
tempt was made to remove a large tumor of the ab-
domen by laparotomy. Upon opening the abdomen,
however, the tumor was seen to be a fibroma of the mes-
entery. So closely attached was it to the small intestine,
that it was found necessary to cut out a strip of the lat-
ter, over three feet in length, before the tumor could be
removed. The patient died in collapse.
A second case, in which a piece of the transverse
colon, six inches in length, was removed with a cancer-
ous tumor, made a good recovery. This was the second
successful resection of the transverse colon which the
speaker had been able to find. In conclusion, Dr.
Wolfler described the steps in the operation of gastro-
enterotomy as reconimencjed by him, and detailed the
indications therefor. The operation should be attempted
in all cases of cancer or ulcer of the pylorus, in which
the patency of the opening is impaired by the new
growth.
Dr. Lauenstein stated that he had made a gastro-
intestinal fistula in a case of advanced cancerous steno-
sis of the pylorus, but there was no relief of the vomiting
or constipation.
Dr. Schonrom, of Konigsberg, related a case in which
there was
A BALL of HAIR IN THE STO.MACH IN A YOUNG GIRL.
An ansemic girl, suffering also from lateral curvature,
had complained for three years of severe gastric pains.
Examination after eighteen months revealed the presence
of a tumor in the left side of the abdomen, freely mov-
able, of an oblong, kidney shape, about the size of a
man's fist, and painful on pressure. The diagnosis lay
between a tumor of the spleen or omentum and
a floating kidney. The fact that the pain was greater
at night and when at rest argued against the latter
supposition. The removal of the tumor was determined
upon because of the constant vomiting and decreas-
ing strength of the patient. The tumor was found to
be a bundle of matted hair lying free in the stomach.
It was removed and the patient recovered. She
stated that four years previously she had been in the
habit, for about a year, of biting off the ends of her hair
and swallowing them, with the object of thereby act^uir-
ing a clear voice. The mass of hair was black in color
and of a kidney shape, or of the shape of the contracted
stomach. The patient was a blonde, and the dark color
was probably caused by the iron which had been taken.
The reporter could find but seven similar cases on rec-
ord. All of these died either from ])eritonitis or from
uncontrollable vomiting. Death in one case occurred
through hffimatemesis.
.At the afternoon session Dr. Wolfler presented an
elaborate paper on
THE EXTIRPATION OF BRONCHOCELE,
which he had been unable to read the previous day.
There was no further discussion of the subject.
Dr. Riedel, of Aix-la-Chapelle, presented a report
upon
THE RESULTS OF THE BISMUTH TREATMENT OF WOUNDS
IN THE CITY HOSPITAL AT AIX DURING THE FIRST QUAR-
TER OF 1883.
His results correspond pretty closely with those ob-
tained by Kocher. He had followed very nearly the
directions of the latter, except that he had not employed
secondary suture (Secundamaht), but rather primary
suture and drainage. The bismuth was found useful not
only in fresh wounds and operations, but also in cases
where suppuration had already occurred. The most
beneficial action of this substance seemed to reside in
its dryness and tendency to repress secretion, whereby
primary adhesion of the wounded surfaces was promoted
and septic infection avoided. The author had added to
his clinical observations numerous experiments upon ani-
mals, which all tended to show the value of this method.
He never observed any symptoms of poisoning. Al-
though bismuth was a good antiseptic, still, like the other
antiseptics, it was not absolutely unfailing. He had ob-
served erysipelas (during an epidemic) although this
method was strictly carried out. He had tried a mixture
of bismuth and corrosive sublimate, but even then had
had one case of erysipelas. Dr. Riedel desired to hear
from the members if they had found corrosive sublimate
to be protective against erysipelas. If so, bethought he
could recommend the combination with bismuth, in spite
of his want of success in one instance. The discussion
was postponed until the next session.
The scientific work of the afternoon session of the
third day began with a discussion of
THE BISMUTH TREATMENT OF WOUNDS.
Dr. Kocher thought he need only say that further ex-
perience had increased his confidence in the value of this
method in promoting union by first intention.
Dr. von Langenbeck had had but little experience in
o:)-
THE MEDICAL RECORD.
[May 19, 1883.
operative surgery since leaving Berlin, and it was difficult
to judge of the value of a procedure of this nature from the
results obtained in a small number of cases. In the in-
stances in which he had used it, however, it had served
him so well that he could only praise its action. He
also, as Dr. Riedel, departed slightly from the rules pro-
posed by Kocher. He closed the wound at once by su-
ture, inserting a drainage-tube, but removed the latter not
later than the second day. In one case especially the
result was so beyond expectation that he could attribute
It to nothing else than the bismuth. It was that of the
extirpation of a cavernous angioma situated on the inner
side of the thigh. The resulting wound was one appar-
ently most unfavorable for healing bv first intention ; it
was a large, deep hole, whose walls were formed of mus-
cles moving with every change of position of the body.
The surface was sprinkled with water holding bismuth in
suspension, a drainage-tube was inserted, the edges of
the wound were exactly approximated by suture, and
over all was applied a bismuth compress. The drainage-
tube was removed on the second day, and the wound
healed throughout by first intention, without any secre-
tion. He had never seen such a result with other anti-
septics, except when deep sutures were used. He would
never fill a cavity with bismuth for fear of toxic effects.
There was one disadvantage of bismuth as compared
with iodoform, that it was impossible with it to obtain
healing by a scab.
Dr. Israel had had a case in which he regretted his
employment of bismuth. It was one of carcinoma of the
breast. He amputated the breast, following Kocher's
rules strictly in every particular. The wound healed
beautifully in ten days, but the patient developed a gan-
grenous stomatitis, from which she suftered for eight
weeks. The same patient presented herself some weeks
later because of numerous nodules, about the size of a
cherry, w-hich she had noticed in the neighborhood of the
cicatrix, and which she feared were cancerous in nature.
An exploratory incision showed them to be composed of
little collections of bismuth. To a remark of Langen-
beck, that it was evident that he had made too free use
of the bismuth. Dr. Israel answered that he had fol-
lowed Kocher's directions implicitly.
Dr. Hahn had obtained excellent results from the em-
ployment of bismuth, and had never seen stomatitis. He
had noticed the beneficial action of the substance in stop-
ping hemorrhage.
Dr. KtJSTER, of Berlin, then read a paper upon
THE TREATMENT OF MAMMARY CARCINOMA.
The author condemned the practice of some surgeons
who amputated the entire gland for every new growth of
whatever nature. In doubtful cases he thought it better
to first make an exploratory incision. If the malignancy
of the tumor was established, the entire breast should be
removed, as well as the axillary glands, even though the
latter could not be felt to be enlarged. He had col-
lected the statistics of 132 cases, in 15 of which the
mammary gland alone had been removed. Of the latter,
13 died within a short period, from a return of the dis-
ease ; in 2. a second operation was performed. In the
remaining 117 cases the axillary glands were extirpated,
with a result of 21.5 per cent, of cures, after a lapse of
over three years, and 20.17 per cent, free from a return
at the end of two years. In every instance the axillary
glands were submitted to a microscopical examination,
and in but two cases were they found free from disease.
A somewhat heated discussion followed.
Dr. Gussenbauer said that he went further, and re-
moved the supraclavicular glands as well as those of the
axilla. As far as his observation went, there was scarcely
a surgeon who did not extirpate the axillary glands in
every operation for the removal of mammary cancer, and
therefore he could not discover that Dr. KUster's paper
contained anything new.
Dr. von Langenbeck thought it was of little use to
remove the supraclavicular glands, for when they be-
came involved the disease had usually invaded other or-
gans also.
Dr. Esmarch not only took out the axillary glands
but advised amputation of the arm in cases in which the
arteries and nerves were involved in the new growth.
He had done so in one instance, and his patient was now
in good health, free from any return.
Dr. von Langenbeck. a|iproved of this course. He
himself had cut away the diseased vessels, nerves, and
muscles in three cases. One was cured, one died of a
return of the disease, and the other from gangrene of the
arm. In future he should prefer to amputate.
Dr. Kuster, in concluding, expressed his gratification
in learning that Dr. Gussenbauer was so convinced of
the necessity of extir|wting the axillary glands ; but he
could assure him that there were many surgeons who did
not think it necessary to resort to such a radical pro-
cedure in every case ; and if his remarks were effective
in convincing them of their error, he would not regard
his labor as having been in vain.
Dr. Heuck presented some statistics concerning
the oper.ative treatment of cancer of the rectum,
in which he showed the successful results of a total extir-
pation of the tumor by the knife.
Dr. Kuster then read a second paper upon
the use of IODOFOR^r in ovariotomy.
Upon the conclusion of the operation, after the abdom-
inal cavity was thoroughly cleansed, all the presenting
portions of the intestine were wiped with a sponge which
had been dipped in iodoform, and then shaken to re-
move all excess of the powder. Thus the peritoneum
was covered with a very fine layer of iodoform, enough
to insure antisepsis, and not so much as to give rise to
toxic symptoms through absorption. An iodoform tam-
pon was also placed in the vagina. The patient made
a rapid recovery without the least inflammatory reaction.
The speaker also recommended iodoform in collodion, as
a simple and etTective antiseptic application in wounds
of the face, and of other parts on which the ordinary
dressings were retained with difficulty.
The only paper read at the last session of the Con-
gress was one by Dr. Zabludowski, of Berlin, entitled,
the physiology of mass.\ge.
The author based his conclusions upon a number of
experiments upon men, in different physical conditions,
upon rabbits, and frogs. His investigations led him to
believe that nearly all the bodily and mental functions
could be influenced by the various kinds of massage.
The weight of the body is reduced in corpulent and thin
persons, but is increased in those of medium build. Ca-
pacity for work and bodily strength is increased. The
mental processes become more active, and sleep is ren-
dered more sound and regular. The frequency of the
pulse is lowered, motility is favored, and sensibility is
blunted. These effects would serve to explain the value
of the method in affections of rheumatic and neuralgic
nature. Massage also favors resorption, and hence is
useful in many surgical diseases of the limbs and joints.
The speaker warned his hearers not to attempt to sub-
stitute massage for orthop.-edia. The former may well
precede mechanical treatment, as it renders the liga-
ments more supple and promotes the absorption of extra-
vasations and pathological exudations. In conclusion, he
said that massage should be performed by strong and
active men, to whom some knowledge of anatomy and
physiology was necessary ; without this knowledge mas-
sage might well be productive of more harm than good.
Medical men should superintend this method of treat-
ment in the individual cases, and shouki endeavor to
avoid a routine treatment for all conditions.
After the transaction of some general business the
Congress adjourned.
May 19. 1 883. J
THE MEDICAL RECORD.
553
MEDICAL SOCIETY OF PENNSYLVANIA.
Thirty-fourth Annual Session, held at Norristoiun, Pa.,
May 9, 10, and 11, 1883.
(Special Report for The Medical Record.)
(Continued from p. 522.)
Second D.ay — Morning Session.
The Society was called to order by the President, Dr.
Varian, at 9.20 o'clock.
The meeting was opened witii prayer by the Rev. H.
M. KiEFFER, of the Reformed Church of the Ascension.
The following gentlemen were named as
MEMBERS OF THE NOMINATING COMMITTEE
from their respective counties : Adams, A. Knowell ;
Allegheny, T. J. Gellever ; Armstrong, R. S. McCurdy ;
Blair, \V. R. Finley ; Bradford, E. P. Allen ; Bucks,
Joseph Foulke ; Cambria, W. B. Towman ; Carbon, .-\.
J. Donnelly ; Centre, P. S. F"isher ; Chester, E. Jack-
son ; Cleartield, S. C. Stewart ; Crawford, G. O. Moody ;
Cumberland, R. L. Sibbett ; Dauphin, Hugh Hamilton ;
Delaware, I. N. Curtin ; Erie, I. L. Stewart ; Hun-
tingdon, A. B. Brombere ; Indiana, William Ansley ;
Lancaster, J. A. E. Reed ; Lackawanna, I. W. Gibbs ;
Jefferson, W. B. Gibson ; Lycoming, J. W. Young ;
Mifflin, A. Rothecock ; Montgomery, S. N. Wiley ;
Montours, S. Shantz; Northampton, Charles Mclntyre ;
Philadelphia, W. G. Porter ; Schuylkill, J. S. Kaland ;
Snyder, J. F. Kanawald ; Venango, S. G. Snowdon ;
Warren, F. A. Shubert ; Westmoreland, J. A. Fulton ;
York, W. S. Rowland.|9
^THE ADDRESS IN [sURGERy]
was then read by Dr. A. Craig, of Columbia, who re-
viewed the progress of that science within the past few
years. He advocated the use of the knife as an expe-
dient when all other methods of treatment had failed.
He dwelt at considerable length on the treatment of the
various forms of fracture.
Dr. S. W. Gross, of Philadelphia, read a paper on
THE THOROUGH REMOVAL OF CARCINOMA OF THE BREAST.
The speaker illustrated his method, which consists in
thorough excision and the removal of all the diseased
tissues liable to produce recurrence of the malignant
growth, by offering the results of fifteen cases occurring
in his own practice, seven of which were perfect cures ;
three of the subjects operated upon by Dr. Gross were
brought upon the stage and the cicatrices pointed out to
the audience. These scars seemed to move free over
the underlying tissues, and in one of the cases, that of a
rather fleshy woman, the wound made by the operation,
which was originally as large as a dinner -plate, had
closed up perfectly.
Dr. Samuel D. Gross, of Philadelphia, and Dr. John
L. Atlee, of Lancaster, were invited to take seats on the
stage, but declined the honor.
Dr. Wm. Pepper, of Philadelphia, was next intro-
duced, amidst applause. His paper was entitled
A CONTRIBUTION TO THE CLINICAL STUDY OF TYPHLITIS
AND PERITYPHLITIS.
He said that from his observations he found that the
caecum and the ileum are the seat of very frequent dis-
ease. He is convinced that cases of
TYPHLITIS CAN SAFELY BE TREATED WITHOUT THE USE
OF LAXATIVES
for several days, and that much harm has often been
done, even by the use of mild laxatives. This class of
cases partake more of the nature of a surgical than
medical disease. The time for performing the operation
cannot be definitely stated; but if after eight or ten
days signs of inflammation become apparent, an incision
may be made into the bowels. He gave a description
of the symptoms and treatment of numerous cases which
had been under his treatment.
Dr. E. a. Wood, of Pittsburg, spoke on an
UNAVOIDABLE MALFORMATION THAT SOMETIMES ACCOM-
PANIES OUTWARD DISLOCATION OF THE FOOT.
He drew models on the blackboard to illustrate his re-
marks, which were instructive and entertaining.
Dr. J. C. Wilson, of Philadelphia, read his voluntary
paper on
THE TREATMENT OF PURULENT PLEURAL EFFUSIONS.
According to Dr. Wilson, the treatment of patients suf-
fering from collections of fluid in the pleural cavity, is
capable of exceeding favorable results which tend to
diminish human suffering and prolong life. The physical
sii^ns of such eft'usions relate, first, to the actual condition
of the lung, and, second, to the relative displacement
of that organ by pressure. These inflammatory fluid
exudations are first fibrino-serous, and second purulent.
The hypodermic needle is generally used for the explor-
atory puncture, but Dr. Wilson prefers the aspirator. In
adults after aspirating the pus rapidly reaccumulates. A
thoracic fistula should be established as soon as possible.
The dangers to life are many : the patient may perish
from exhaustion, or from heart-clot, the lung may not
expand, necrosis may occur, or gangrene of the lungs
or tuberculosis supervene. The real dangers attending
the operation are puncture of the lungs and collapse.
Ajireliminary withdrawal of a portion of the pus should
be made by aspiration. Morphia, and other stimulants
may be given prior to the operation, and salts of am-
monia should be administered internally during the
treatment. There should only be one puncture made ;
the external air need not be excluded ; a short needle,
not exceeding two inches in length, should be used for
the puncture, and the cavity should be washed out by
means of a ball syringe, and a system of soft-rubber tubing
once or twice a day. Of five cases treated in this way,
three fully recovered, one died of heart-clot, and one is
at present under treatment. Dr. Wilson introduced a
young man to show the position of the drainage-tube in
the bodv.
Dr. Charles K. Mills, of Philadelphia, read a volun-
tary paper on
THE MEDICAL SERVICE OF INSANE HOSPITALS.
The substance of his address was as follows: The
number of resident physicians in State asylums is en-
tirely too small. There should be an individual exam-
ination of every patient. Governor Hoyt's new law
makes admirable provisions, but they are impracticable
with the present force of physicians. Let steps be taken
to provide means to carry out the supervisions of Gov-
ernor Hoyt's bill. The physicians and attendants are
required to do too much routine work. Why not have
unpaid resident physicians or internes? The opportu-
nity for study, etc., would be of incalculable advantage
to young physicians in their first year after graduation.
The number of surgical operations and examinations
which such an experience offers are wonderful, as shown
by the statistical tables of the Norristown Asylum. There
should be in every large hospital or asylum a board of
consulting physicians, in deed and not only in name.
Each of the board should have a distinct task. Dr. Mills
believed that the measures of the Hoyt Committee
would do much good.
Some remarks on scarlet fever by Dr. E. O. Bard-
WELL were read by title, and ordered to be referred to
the Publishing Committee.
Under new business. Dr. C. B. Nancrede gave a his-
tory of a case of carcinoma of the breast which had
come under his charge.
Dr. Lee made some remarks with reference to ad-
dresses on surgery.
554
THE MEDICAL RECORD.
[May 19. 1883.
The Corresponding Secretary next read his report.
Dr. Hiram Corson then offered,
A COMMUNICATION FROM THE PHILADELPHIA ANTI-VIVI-
SECTION SOCIETY
protesting against vivisection, and asking that the State
Society take some action on that subject.
Dr. E. a. Wood, of Pittsburg, spoke against the
paper. He alluded to tlie poisoned sausages which the
Pittsburg policemen throw to stray dogs, causing them
to die in great agony. Why did not the society turn its
attention to that subject?
The following gentlemen were appointed a committee
to act upon the resolutions of the Anti-Vivisection So-
ciety : Eskridge, Wood, Keen, and Eittle.
The following resolution was offered bv Dr. W. W.
Keen, of Philadelphia.
Resolved, That the Medical Society of Pennsylvania, in
view of the very urgent need of
ENLARGED FACILITIES FOR VIVISECTION,
both in the medical schools of Pennsylvania and also by
physicians throughout the entire State, a privilege now
denied them, most earnestly urge upon the Legislature of
Pennsylvania the passage of
THE PENDING ANATOMY BILL.
The resolution was carried.
Dr. S. D. Gross, of Philadelphia, then offered a reso-
lution which was read by the secretary,
TOUCHING THE REMOVAL OF THE MEDICAL LIBRARY a"nd
MUSEUM OF THE SURGEON-GENERAL'S OFFICE TO A
FIRE-PROOF BUILDING,
and requesting that resolutions be passed by this As-
sociation favoring that removal. These resolutions were
adopted by the Society.
COMMITTEES ON MEDICINE, SURGERY, AND GYNECOLOGY.
Dr. John Curwen, of Harrisburg, presented the fol-
lowing resolution : That the President of this Society be
requested to appoint a committee of three members on
each of the following branches : Medicine, Surger)-,
Diseases of Women and Children, Ophthalmology and
Otology, Nervous Diseases, Insanity and Idiocy, to pre-
pare a series of questions calculated to obtain the his-
tory, symptoms, and treatment of the different forms of
disease, that when these questions are prepared they be
sent to the different members of the Society throughout
the State with the request that each member fill out in
full one specified case of disease in the list of questions
sent him and return the same to the chairman of the
committee of that branch ; so that by this means
A COLLECTIVE INVESTIGATION OF THE DIFFERENT FORMS
OF DISEASE
may be made and thus a more thorough account be
obtained of the facts bearing on the disease in all its
different stages, and when these answers have been re-
ceived the different committees shall arrange the facts
and present them to this Society, .\dopted by the Society.
Second Day, Afi-ernoon Session.
The Nominating Committee reported the following
names for officers for the ensuing year :
President — H. H. Smith, Philadelphia ; First Vice-
President — Ellis Phip|)s, New Haven ; Second Vice-
President— Y{. B. Van^^llseah, Clarefield ; Third Vice-
President — J. W. Kerr, York ; Fourth Vice-President —
S. S. Schultz, Danville ; J'ermancnt Secretary — William
B. Atkinson, Philadelphia; Recording Secretary — M. S.
French, Philadelphia ; Corresponding Secretary — [. ().
Lee, Philadelphia ; Treasurer — Benjamin Lee, Philadel-
phia ; Additional Members of the Committee of Publica-
tion— Hugh Hamilton, Harrisburg ; James Tyson, Phila-
delphia ; C. S. Turnbull, Philadelphia ; Members of
Judicial Council — .\. Rotlirock. Mc\'eytown ; G. O.
Moody, Titusville ; William Pepper, Philadelphia. The
society to meet next year in Philadelphia. John B.
Roberts, Chairman of the Committee of Arrangements ;
his associates to be selected by the Philadelphia County
Medical Society.
Resolved, That this conmiittee recommends that the
Publication Committee be instructed to have the transac-
tions of the Society printed and ready for distribution
within three months from the date of the final adjourn-
ment of the Society.
A resolution was offered by the Secretary and adopted
by the Society, providing that the President and Perma-
nent Secretary fill any vacancies occurring in the national
and various State delegations.
the ADDRESS IN OBSTETRICS
was read by Dr. G. O. Moody, of Titusville. The speaker
referred at some length to the various means for the pre-
vention of abortion. He advocated the early use of the
forceps. When greater reliance is placed upon the use of
the forceps and less upon the administration of ergot
much better results will ensue. On obstetrics, he spoke
of the uses and abuses of Tarnier's forceps ; he concluded
that this instrument was one of unquestionable value.
He then passed to a consideration of the various thera-
peutical appliances and remedies for the treatment of
puerperal convulsions, support of the |jerineum, etc.
Other papers read were "Address in Hygiene," by
Henry Leffman, of Philadelphia ; " Our Asylums and
Our Insane,'' by Sayres, of Pittsburg ; "Surgical Expe-
dients in Emergencies," by R. J. Levis, of Philadelphia ;
etc., etc.
Dr. Benjamin Lee, the Treasurer, offered the follow-
ing report of the Society's financial condition : Balance
on hand May 11, §1,965.68 ; receipts through year,
$2,269.91 — total, $4,235.59. Expenses during year,
$1,871.75. Balance on hand, $2,363.84.
The same gentleman, as chairman, also offered the
following : The committee appointed at the last meeting
of the Society to memorialize the Legislature of this State
with reference to
amending and codifying the lunacy LAWS.
now on our statute books, beg leave to report that soon
after their appointment the government of the State an-
ticipated their proper action by appointing a commission
for the very purpose contemplated in the resolution.
They therefore considered that further action was un-
necessary and beg to be discharged.
The report was adopted.
Dr. William T. Little, of Philadelphia, read a paper
upon
reflex uterine disease from irritations of the eve,
in which, after tracing the irritations of the eye from the
uterus, as described by Professor Forster, of Breslau, he
next traced the infiuence of the eye upon the nervous
system and various organs as described by S. Weir Mit-
chell, of Philadelphia. He desired to report a case where
a chain of reflex symptoms extended to the uterus im-
pairing its function, and relative sterility ensued and
lasted for twelve years. This case also presented various
nervous and physical symptoms.
The subject of
the higher medical education
was discussed at some length at the close of the day's
proceedings, by Drs. S. D. Gross, James Tyson, William
Ulrich, etc.
In the evening receptions were held at their homes by
the members of the Montgomery County Medical Society.
May 19, 1883.]
THE MEDICAL RECORD.
555
Third Day — Morning Session.
The third clay's session was called to order at 8.30 on
Frida)' morning by President Varian, and a blessing
invoked by the Rev. A. J. VVeddell, of Norristown.
The new order of business was then called for, and
Dr. E. J. Jackson, of West Chester, moved the adop-
tion of the following :
Resolved, That at each annual meeting the President
appoint one member to deliver, at the next yearly meet-
ing, an address on " Ophthalmology and its Relation to
General Medicine."
Dr. \V. S. Little, of Philadel|)hia, moved to amend
by adding the subjects Otology and Laryngology.
The resolution and amendment were both warmly dis-
cussed until Dr. W. T. Bishop, of Harrisburg, demanded
that the regular order of the day be called.
The President sustained his point and introduced Dr.
John Curwen, of Harrisburg, who delivered
THE address on MENTAL DISORDERS.
It is most assured!)' a subject demanding the most
earnest and persevering investigation by the profession
to trace out the cause of the peculiarly intractable char-
acter which mental and nervous disorders have lately
assumed, to discover, if possible, the reason why they
are so. In such investigations it is desirable and imjior-
tant to keep constantly before the mind the error into
which all are likely to fall, of confounding cause and
effect, and thus nullifying the correctness of the results
to be attained. No one doubts but that physical dis-
eases are transmitted from parent to child. That we
cannot explain the reason does not invalidate the fact,
and to endeavor to discover that reason should be our
prime motive. In certain families part of the children
will be found to have not only the physical peculiarities
of one parent, but also that parent's mental idiosyn-
crasies, while the other children will have all the physical
and mental traits of the other parent. In many cases
actual disease may be transmitted from parent to child,
and this tendency may be traced back through several
generations.
To the nidulgence in intoxicating drinks is un(iuestion-
ably due much of the moral depravity, want of true
principle, and attendant mental inability to exercise
proper self-control, or to resist certain forms of temp-
tation, which characterizes the rising generation. In
this fact of the impaired physical condition of the mother
also lies the explanation of the great difference some-
times observed in certain members of a family who seem
to be constituted diversely (mentally and morally) from
the other children. During the period of gestation the
mother should be enlivened by cheerful scenes and im-
pressions of every kind, so that the mind may be led
into bright and healtht'ul thoughts.
During infancy and early childhood the greatest care
must be given to the child's physical condition, so that it
may be strengthened for that course of discipline and
school education through which all should pass. The ne-
cessary activity of the first few years of life needs to be
regulated, not restrained. The child should not be kept at
school too closely, as this form of restraint has the double
effect of increasing the child's irritability and its dislike of
its lessons to be learned. Too close an application at an
early age is apt to strain the mental powers, and in this
way retard development. The steady, continuous influ-
ence of a good example will do more than precept upon
precept to impress upon the mind of the child the im-
portant lesson that true happiness is always to be
secured. A true and healthful education consists in such
a cultivation of each of these states that one shall not
preponderate over the other. Ample and regular nutri-
tion is essential to the proper growth and development
of the body. Next in importance to nutrition must be
ranked sleep, to recruit the exhausted powers. Those
who do the best work and the largest amount of it are
those who carefully observe these requirements. Ob-
servation has clearly shown that those who make the
greatest apparent progress in early life are not those who-
hold out to the end, while those who are more slow are
more sure to retain and better able to make use of that
knowledge. Bodily and mental habits have also a de-
cided influence on the functions of the different organs.
The following voluntary papers were then read : " Diag-
nosis, Prognosis, and Treatment of Mitral Constriction,""
by Dr. J. T. Eskridge, of Philadelphia ; " Lithasmia,"
by Dr. J. B. Walker, of Philadelphia ; " Clinical Notes
on the Use of Convallaria Majalis," by Dr. E. T. Bruen,
of Philadelphia.
The resolution offered at the opening of the morning
session by Dr. Edward T. Jackson was then adopted.
Dr. Henrv Leffman, of Philadelphia, on behalf of
the Philadelphia County Medical Society, presented an
amendment to the Constitution of the State Medical So-
ciety, the purport of which was that hereafter no paper
should be read before the Society unless it had been pre-
viously read before a county society, and by them re-
ferred to the State Society.
Action on this amendment was postponed for one year.
The resolutions of respect ado|)ted by the Montgomery
County Medical Society on the death of Dr. David:
Shrack, of Jeflersonville, were read and ordered to be
printed in the Transactions.
At eleven o'clock the Society adjourned, and were
conveyed by a special train to the State Hospital for the
Insane in the Southeastern District of Pennsylvania, sit-
uated just outside the city limits. The members were
accompanied by their wives and daughters. Arriving a
little before twelve, an hour was spent in a tour of some
of the male and female wards, the resident physicians
acting as guides. No one could fail to be impressed
with the great cleanliness everywhere apparent.
The area covered by the buildings is inunense. There
are now nine hundred and sixty inmates, male and female,
black and white, yet there is no indication of crowding.
After doing justice to a substantial and well-arranged
cold collation, in a long hall of one of the new buildings,
the Medical Society re-convened in the Asylum Chapel.
Dr. Mayne, a trustee of the Asylum, spoke briefly,
and, while hoping that the results of the inspection had
been satisfactory to the visitors, expressed, nevertheless,
the firm intention of the managers of the institution to
persevere to the end in the course which they are now
pursuing.
In some respects, he continued, the Norristown Hos-
pital for the Insane is different from, and in advance of,
the other similar institutions in the State. Its leading
physician, or superintendent, is not burdened with its
material interests, and is not forced to cater, or make
contracts for coal, wood, provisions, etc. In another
respect, also, it is generally conceded that the Norristown
Asylum is managed in a more progressive spirit — it has
an independent female physician at the head of the fe-
male department, of powers equal to, and coordinate
with those of the male physician in charge.
At the conclusion of Dr. Mayne's remarks Dr. Wm.
Thompson, of Philadelphia, was invited to occupy a seat
on the platform and jjarticipate in the proceedings.
The Secretary then read an invitation from the phy-
sicians of the Philadelphia Hospital for Skin Diseases for
the Society to visit that institution that evening.
increase of medicai- staffs in insane asylums.
Dr. B. Lee read a resolution to the effect that the
State Medical Society, after listening to the able papers
on insanity which had been read at its present session,
resolve that the popular idea that sane persons are incar-
cerated in insane asylums is an unworthy aspersion on
the medical profession, and that the State Legislature be
made to feel the necessity of making such appropriations
for these institutions as will warrant the increase of their
medical staffs.
556
THE MEDICAL RECORD.
[May 19, 1883.
The paper expected from Dr. M. Landesburg, of Phila-
delphia, on " Stretching the Optic Nerve," was not read,
owing to that gentleman's absence.
One of the most novel and, to the general profession,
most interesting papers presented during the session was
that then read by Dr. J. M. Anders, of Philadelphia,
on the
HYGIENIC MANAGEMENT OF CONSUMPTION,
in which he claimed that the eftect of plants on the
atmosphere of houses is not onl}^ beneficial, but ahiiost a
specific preventive in cases of incipient consumption.
House plants exhale a great deal of aqueous vapor, and
may so increase the humidity of the atmosphere to any
desired extent. It is now known that tlowering plants
emit ozone, and so the atmosphere of the living rooms
may be very beneficially medicated. Half of all cases
of consumption are known to be preventible, and per-
sons threatened with this disease have, in all known
cases, escaped it as long as they lived and worked
among house or hot-house plants. Thirty Philadelphia
florists, who work from ten to sixteen hours a day among
hot-house plants, had been found to confirm this theory
to a remarkable extent. In a consumptive family of a
father and two sons, tlie father and one son were healthy
until they abandoned their business as florists, but died
almost immediately afterward. The other brother, after
working all his life among growing plants, went into the
"cut-flower business," and died in less than a year.
Other striking cases were cited. Dr. Anders siioke of
the purifying influence of house plants on the air, md the
relief and amusement afforded an invalid in caring for
them. They should be kept in a living- or sleeping-room
of not less than 12 x 20 feet, with a southern exposure,
and arranged so that the sun would strike them. A tem-
perature of from 68° to 74° F. should be maintained in
the room, and soft, thin-leaved plants, with large foliage,
should be chosen, such highly scented flowers as the
tuberose being excluded.
Resolutions of thanks to the Montgomery County
Medical Society, the oflncials of the Norristown Asy-
lum, etc., were passed.
Dr. E. H. Wood, of Pittsburg, made some remarks
on insane asylums, speaking in the highest terms of
praise of the management of the Norristown Hospital.
Dr. Varian, before resigning the chair, made the fol-
lowing appointments for the annual meeting of 1884, in
Philadelphia : Address in Medicine, Dr. \V. H. Daly,
Pittsburg; .Address in Surgery, Dr. J. B. Roberts, Phila-
delphia ; Address in Obstetrics, Dr. J. Price, West Ches-
ter ; Address in Hygiene, Dr. J. G. Lee, Philadelphia ;
Address in Mental Disorders, Dr. .Alice Bennett, Nor-
ristown.
•After thanking the members for their kindness and
courtesy. Dr. Varian then yielded his place to the new
President, Dr. H. H. Smith, of Philadelphia, who ad-
journed the Society after a few words of thanks.
In the evening a reception was tendered the members
by the Philadelphia Polyclinic and School for Graduates
at its rooms at the southeast corner of Thirteenth and
Locust Streets, Philadelphia. Many ladies were present
as well as a number of invited guests.
A large delegation of tlie members also visited the
Philadelphia Hospital for Skin Diseases, No. 923 Locust
Street, and were received by Dr. J. V. Shoemaker and
his assistants. Refreshments were served in the parlor
of the hospital.
The Site of the Initial Lesion of Svphii.is. —
In 120 male patients examined by Mr. Bernard {Liver-
fool Med. C/iir. /our., January, 1883), the site of the
initial lesion was — the furrow, 53 times ; the inner pre-
puce, 57 ; the outer prepuce, 10 ; the free margin, 2 ;
the corona, 31; the glans, 10; the sheath, 18; the
meatus, 6 ; the frajnum, 6 times ; and the urethra once.
MICHIGAN SPATE MEDICAL SOCIETY.
Eighteenth Annual Meeting, held at Kalamazoo, Michi-
gan, May 9 and 10, 1883.
(Special Report for The Medical Record.)
(Continued from p. 522.)
Second Day, Morning Session.
The Michigan State Medical Society resumed its ses-
sion at Kalamazoo, Mich., at 9.30 a.m., Thursday.
THE COMMITTEE ON ADMISSIONS
reported favorably upon over fifty names.
The application of Dr. George .\. Hendricks was re-
ported on adversely. He had issued a circular letter,
which he had sent wherever he thought it safe, urging at-
tendance at this meeting, evidently for electioneering
purposes.
After a heated discussion his case was referred to the
Judicial Council.
From the first there has been an eff"ort on the part of
a few to capture the Society for Professor McLean of
Ann Arbor.
Many came up under the impression that the Univer-
sity and Professor McLean were to be attacked, but see-
ing how matters stood refused to support .McLean for the
Presidency.
Dr. Tyler presented the report of the Committee on
Nominations.
Professor Vaughn, of the University, oflfered as a
substitute a full set of nominations in the McLean in-
terest. Several of the most prominent nominees of the
substitute list refused to accept, and the committees list
was elected.
Dr. A. F. Whelan, of Hillsdale, was then unanimously
elected President. The other officers are : First Vice-
President, H. Tupper, Bay City ; Second Vice-President,
J. S. Hamilton, Tecumseh ; Third Vice-President, H.
B. Barries, Ionia ; Fourth Vice-President, Augustus Kei-
ser, Detroit. The Secretary holds over another year.
Judiciary Council, Foster Pratt, Kalamazoo ; H. B.
Sank, Lansing ; S. P. Duffield, Dearbornville.
delegates to AMERICAN MEDICAL ASSOCI.-iTION.
H. C. Wyman, J. B. Book, Win. Brodie, L. Connor, H.
O. Walker, L. Shirly, Detroit ; E. E. Dunsler, A. B.
Palmer, W. F. Breakey, Ann .Arbor ; Foster Pratt, Kala-
mazoo ; -A. R. Smart, Hudson ; J. H. Bennett, Cold-
water ; J. .Andrews. Pawpaw ; S. S. French, Battle Creek;
C. H. Lewis, Jackson ; F. H. Owen, Ypsilanti ; Y. M.
Hurd, Pontiac ; Hugh McCall, Lapierre ; A. F. Haga-
dornj Bay City ; J. H. Jerome and L. D. Bliss, Saginaw;
W. U. Smart, Grand Haven ; S. R. Shepherd and C. V.
Beebe, Manistee ; W. E. Dockery, Pentwater ; M. A.
Duckinson, East Saginaw.
The following pajjers read by title were referred to the
Committee on Publication : " Plaster-of-Paris as a Surgi-
cal Dressing," by H. O. Walker; " Water and its Rela-
tions to Health and Disease," by J. R. Post ; " Etiology
of Urethral Inflammation," by H. J. Reynolds. Dr. H.
B. Baker, of the State Board of Health, read
A PAPER ON DIPHTHERIA.
He claimed it was epidemic. The death-rate appeared
as a wave, more fatal in cold months, but not necessarily
in cold years. Did not seem to be much influenced by
known conditions of filth. Length of waves between
points of greatest mortality in city, five or six years;
country, fourteen. More fatal in children.
Dr. Prait called attention to the subject of exposure,
and Dr. Worcester related the history o{ a series of
cases which occurred in the asylum.
Dr. Brodie considered simple diphtheria non-con-
tagious, malignant, or contagious. Diphtheria was always
complicated with scarlatina. He thought placarding
houses did no good but harm, by alarming the people.
Dr. Smart reported a case in which a brass glove-
May 19, 1883.]
THE MEDICAL RECORD.
557
button had been carried in the ear of a patient for thirty
years without having been discovered, though the patient
had a purulent otorrhtea all the time.
Dr. Ward read a poetic effusion, entitled " Pro Bono
Professorium."
The committee to whom the President's address was
referred brought some questions before the society for
discussion.
Prof. P.\lmer called attention to
THE HIGH REQUIREMENTS OF THE MEDICAL DEPARTMENT
OF THE MICHIGAN UNIVERSITY.
He denied that the professors were unprofessionally
advertised, and that they took time for themselves which
belonged to the University.
After further speeches by Professor McLean and others
the matter was referred for publication.
Grand Rapids was decided upon as the place for the
next meeting.
After seating the new President, and passing the usual
resolutions of thanks, the Society adjourned.
NEW YORK PATHOLOGICAL SOCIETY.
Stated Meeting, April 25, 1883.
George F. Shrady, M.D., Preside;nt, in the Chair.
Dr. Carpenter, in behalf of a candidate, presented
microscopic sections of carcinoma of the breast.
Dr. Kucher presented what he believed to be a por-
tion of
the sac of an echinococcus,
which came from a patient whom he saw with Dr. Brad-
bury, a woman, fifty years of age, who five years ago had
what was supposed to be an ovarian cyst. She was ex-
amined by Professor Schroeder, who doubted that the
cyst was ovarian. Although it increased in size rapidly
it was not operated upon. Shortly afterward the pa-
tient had an attack of pleurisy, and during that sick-
ness she discharged from the rectum a slimy, gray fluid,
which gave her very great relief On examination the
tumor in the abdomen had disappeared, and aftervvard
she felt quite well. Six months ago she came to this
country, and one week ago she discharged from the rec-
tum the mass which Dr. Kucher presented. On the fol-
lowing day she was up and felt very well, except that
her abdomen was somewhat tender to the touch. On
examination he found the liver increased in size, and in
the lower part of the abdomen a tumor about the size of
two fists. Otherwise the patient feels quite well. The
material discharged from the rectum had been washed
and made completely clean before Dr. Kucher saw the
specimen. He had examined it microscopically, and
found it to be a structureless membrane, which led him
to the conclusion that it was a portion of the sac of the
echinococcus, although he was unable to find any hooks.
He thought there was a sac somewhere in the abdominal
cavity, that a communication with the intestines had
been established, and that a portion of the sac had been
discharged. He was unable to say whether the echino-
coccus had originated in the liver or not, although that
organ was considerably enlarged. Perhaps it was from
the omentum, as occurred in Dr. Schnetter's case, re-
ported a few years ago.
Dr. Wackerhagen presented a specimen of
carcinoma of the breast
with the following history : Mrs. C , aged sixty-two
years, widow, born in Ireland, came under his care on
March 24th. In July last she noticed a small tumor in
the right breast, but as it caused no inconvenience, she
did not consult her physician, Dr. Rooney, until Novem-
ber, when it had grown as large as a medium-sized
orange. She was then suffering some pain from the
growth, but would not consent to an operation for its re-
moval. After this time the tumor grew more rapidly,
the patient suffering severely from lancinating jiains.
The patient was anajmic and somewhat emaciated, but
had always enjoyed good health. The operation was
performed on March 27th. The longest diameter of the
tumor extended diagonally upward and outward, involv-
ing the axillary glands, and had formed attachments to
the axillary vessels and nerves. The body of the mass
extended U]nvard, involving a considerable portion of
the pectoralis uiajor. It also extended about one inch
below the lower border o: ::ie breast. The entire tumor
was firm, resisting, and surrounded by fat, which also
penetrated deeply and lay between the fibrous bands in
larf'e quantity. The weight was .lincteen ounces.
There was very little hemorrhage during the opera-
tion.
She rallied from the effects of the anesthetic, com-
plaining of severe pains in the wound ; pulse rapid and
feeble. A hypodermic injection of morphine was ad-
ministered, followed by stimulants. After resting quietly
for three or four hours, she awoke, complaining of severe
pain and difficulty in breathing. Stimulants were con-
tinued, but the patient gradually sank, and died about
eight hours after the operation.
Postmortem examination not permitted.
Dr. W. p. Northrup presented a specimen, with the
following history :
tubercular
ulcer of colon — general tubercu-
losis.
Female ; two years eight and a half months old ; New
York Foundling Asylum. The case was entered on out-
door book in the spring of 1S82, as "bronchitis and en-
teritis ; " in January, 1883, " diarrhcea." Was returned
to the house January 15, 1883, " pale, restless ; no vom-
iting, no diarrhcea, no febrile movement." Drank but
little. Sent out again to nurse. Returned three days
later, the nurse saying that the child would not take
food. Convulsions. Died 3 p.m., June i8th.
Symptoms of bronchitis and diarrhcea and "delicate"
condition extend back about one year.
Autopsy, ]■A.\^\^^.xy 19, 1883.— Body : Well nourished;
skin clear and clean. Larynx and oesophagus : Nor-
mal. Lungs : Bronchial glands cheesy and large ; left,
congested, ' scattered lobules of pneumonia, adherent
at apex by few fine adhesions ; right, slight amount con-
gestion. Liver, spleen, and kidneys : Normal. Intes-
tines : Mesenteric glands enlarged, some as large as a
hickory nut, and cheesy in centres. Small — Peyer's,
patches of lower half of ileum ulcerated ; edges raised
and rounded ; deep excavation in centre ; in upper half
the patches are congested, dusky, not raised. Large —
Large ulcer in cajcum, about J by i^ inch, extending
obliquely across axis of gut ; another similar ulcer
near the middle of the colon extends nearly vertically
across the axis of the gut : this is smaller than the
first. Of these ulcers the borders are thickened uni-
formly for some distance around, the whole intestinal
wall being involved ; the bases are coarsely granular,
sunken ; margins are extensively undermined, so that
they appear rounded and crenate or puckered. On the
peritoneal surface covering the region of the ulcers are
numerous miliary tubercles. Scattered about the mucous
membrane of the colon are numerous enlarged sohtary
follicles.
On cutting the lungs, subsequently, they were found
studded with miliary tubercles.
Microscopic examination of the ulcers of the colon
shows numerous tubercle granula with many giant-cells.
The induration about the ulcer is due to infiltration of
tubercle-tissue. The ulcers in the small intestine show
no tubercle tissue. Numerous sections from different
ulcers were examined to make this statement satisfac-
tory.
The interest in this case is mostly pathological.
Though general tuberculosis is of frequent occurrence.
558
THE MEDICAL RECORD.
[May 19, 188^
tubercular ulceration of the intestines is not frequent,
and an ulcer like the specimen was unique in his experi-
•ence.
Dr. Northrup also presented a specimen of
■CHRONIC FOLLICULAR COLITIS IN A CHILD TEN .MONTHS
OLD,
-with the following history. Male child ; ten months old;
New York Foundling Asylum. October 27, 1882, en-
tered in out-door department ; " condition ]ioor ; pap-
ular eczema; face thin, peaked; whines." "Mar-
asmus.'' Returned December 26th; "condition misera-
ble ; continues to grow worse." Remained in house
•one week; diarrhoea constant ; nothing peculiar about
stools.
Autopsy, January 6, 1883. — Body : Emaciated, otor-
rhoea ; both pinn;\a deeply ulcerated and excoriated ; ex-
coriations about buttocks : sprue on tongue in abun-
•dance, less on gums and buccal surfaces ; weight eight
pounds two ounces. Brain : Normal. I^ungs : ]!ron-
chial glands sliglitly enlarged ; left, small amount pneu-
monia in posterior portion ; old adhesions over sides
and front ; right, extensive pneumonia in lowest lobe
posteriorly ; pleura thickened ; no adhesions. Heart :
Normal ; weight, one ounce. Stomach : Normal. In-
testines : Small, normal ; mesenteric glands skirling them
normal ; large, throughout whole extent sprinkled
with clean-cut, circular, " punched-out " ulcers, involv-
ing mucous coat ; these ulcers are about like solitary
follicles in distribution, and seem to have removed the
follicles by ulcerative process ; mesenteric glands skirt-
ing the large intestine, large and hard ; contents of
colon, dark greenish, and apparently for most part made
np of curdled milk and mucus. Kidneys : Urates in
straight tubes ; the tissue appears normal. Liver :
Normal ; weight, six ounces and two drachms. Spleen :
Normal.
Microscopic examination. — The lungs show ordinary
broncho-pneumonia. Colon shows simply follicular ul-
cerative colitis ; the solitary follicle is wholly removed
by the process ; surrounding tissue not involved ; some
follicles are just breaking down, though niost are in an
advanced stage.
TEMPER.iTURE IN URAEMIA.
Dr. J. C. Peters referred to a case of chronic Bright's
■disease, in which the patient had suffered so little that
she had not seen a physician, but was suddenly seized
with difficulty of breathing, and died within three min-
utes. At the autopsy there was found evidence of well-
marked oedema of the lungs and of chronic disease of
the kidneys.
Dr. Van Gieson asked if it was not unusual to have
low temi)erature in the ura;mia of Bright's disease. Had
not the elevation of temperature in urtemic poisoning
been regarded as a guide in making a differential diag-
nosis ?
Dr. Ripley said that a few years ago attempt was
made to establish as a fact that the temperature in ure-
mic coma is elevated, while in apoplexy it is lowered,
thus furnishing a ready means of making a difterential
■diagnosis between these two conditions, .\fter a little
time, however, exceptions were noticed, and it was also
determined that the temperature in apoplexy varied con-
siderably according as it was taken immediately, quite
soon, or several hours after the stroke. On the other
hand, it was found that the temperature in ur;eniic coma
■did not always rise, tiiat sometimes it fell toward the
■close of life, and occasionally reached a very high point.
Dr. Van Gieson said that he had made a large num-
ber of ob.servations in cases of uremic coma and had
invariably found the preagonistic temperature above the
normal. In the last case, two hours before death, the
temperature reached \o(ih° F. He could imagine that
in cases of apoplexy there might be possibly some inter-
ference with the heat-centre which would give rise to
elevation or other changes in temperature, but he be-
lieved that in the majority of cases of urajmic coma the
preagonistic temperature would be found considerably
above the normal, whereas in cases of atheromatous de-
generation of the arteries the temperature is usually low.
Dr. Riplev said that with the general statement made
by Dr. Van Gieson he agreed, and only wished to say
that elevation of temperature did not invariably occur in
urajmia, and that, in his opinion, a differential diagnosis
could not be based safely upon the temperature alone.
It might be said that, as a rule, the temperature in urs-
mia is elevated.
Dr. Carpenter referred to cases, seen in hospitals,
of well-marked urfemic poisoning and coma, in which
the temperature was not elevated, and special attention
had been directed to them because of this fact, the visit-
ing physicians regarding them as evidence against the
claim that the temperature is invariably elevated in ure-
mic coma.
(To be continued.)
Covvcispciuclcucc.
OUR LONDON LETTER.
(From our Special Correspondent.)
THE JIEDICAL COUNCIL PROPOSED NEW EDITION OF THE
PHARMACOPCEIA — THE LONDON HOSPITALS AND THEIR
FINANCES THE LONDON COLLEGE OF PHYSICIANS AND
ITS FELLOWSHIP.
London, .\pril 28, 1883.
The Medical Council is now holding its general meet-
ing, having commenced its deliberations last week. One
of the most interesting items is the announcement that
the Council have appointed a committee of three phar-
macists to prepare a new edition of the British Pharma-
copoeia. It is proposed to omit three drugs and add
twenty-nine. Other changes are at the same time to
take place, with a view to increased accuracy. It is pro-
posed to assimilate it somewhat to the United States
Pharmacopoeia, by substituting the use of proportional
parts, wherever possible, for that of specific weights and
measures.
The simultaneous appeal made by two large London
hospitals — St. George's and the London — for funds, has
drawn considerable attention to the financial state of
these institutions. .A few of them, such as Guy's and
St. Bartholomew's, are so richly endowed that they have
little need to appeal to outside charity. It is far other-
wise with most of them. The London Hospital, our
largest metropolitan hospital, having nearly eight hun-
dred beds, has just made an appeal for _;^i 50,000 to en-
able its work to be carried on for five years. A few
years ago a similar appeal was made. Standing as it
does almost alone in the midst of a population of two
millions the calls upon it are indeed great. Still, it would
appear that no pains are taken to check the indiscriminate
hordes of out-patients apjjlying for relief. It has the larg-
est and the hardest worked staff in London. The out-
patient department in all our hospitals stands in need of
reform. It has been suggested that the out-patient de-
partment of hospitals should be, to a large extent, closed,
and provident dispensaries established in the vicinity to
which out-patients should be drafted, being there placed
under the care of local medical men who would receive
salaries for their services.
The London College of Physicians is rapidly losing
ground with tiie profession. It has lately jnit itself in
opposition to the medical bill in a manner that has called
down the animadversions of all the journals and many of
its own members and fellows. But it has throughout its
long history been obstructive. So this is nothing new.
Many years ago it refused its fellowship to obstetric prac-
titioners on the ground that they performed operations.
This is not now the case, but still of late years I have
May 19, 1883.]
THE MEDICAL RECORD.
559
heard much discontent at the cliquism displayed in elect-
ing to the fellowship. I should explain that there are
three orders, viz.: Licentiates, quite a new grade started
in 1869 for general practitioners; members, who are
bona fide physicians and admitted by examination only ;
fellows, who are chosen from amongst the members by
election only. Nominally, the existent fellows elect the
new ones to the number of eight or ten yearly ; really,
the council elect, for they, sitting in secret conclave, pre-
pare a list which the fellows always pass. It is believed
by many that nepotism and favoritism reign supreme. I
often hear that the only way to get promotion is to toady
some of the officials in some way. I know that relations
and proteges often get promoted while abler men are
passed over — men who despise toadyism and are left out
in the cold. As a surgeon I can look on and smile.
Last week a new list appeared of members elected to
the fellowship, and it is astonishing to peruse it. Some
are good men and none can be objected to, only that
others more distinguished are passed over in favor of
their juniors. One does not like to single men out, but
I may say that there are men who have been for years
physicians to large hospitals, teachers in our medical
schools, honored officers of medical societies, distin-
guished officers in the public services, and others with
many other claims who have been passed by. Many
names could be mentioned that are well known both on
the Continent and in the United States, and are every-
where respected, but their holders are simply members
and have been so for years. To show you how real is
the grievance, I may say that two medical men lately
picked out from the official list of members in ten minutes
no fewer than sixtv who had joined since 1859 who could
be said to be fairly deserving of the honor of the fellow-
ship— if, indeed, it be an honor. Many of them can
justly be said to be far superior to men who have been
made fellows, and comparing them with the latest list of
promotions, any ten of the sixty would make as good a
show. This was not so much to be wondered at when a
weak man like Bennett was President, but better things
were expected from Jenner, who has the credit of being
a strong man and one disposed to do what is right.
THE ANTAGONISM OF MORPHINE AND
ATROPINE.
To THE Editor of The Medical Record.
Dear Sir : In a valuable communication which ap-
peared in The Medical Record of May 5th, Dr. Wal-
lian gives the details of four cases of opium-poisoning
treated in part by the administration of atropine. In
his remarks on these cases. Dr. Wallian inadvertently
commits me to a statement which is not justified by any-
thing I have said or published. His expression is, " re-
calling the antagonistic ratio existing between atropia
and morphia, as stated by Bartholow, viz., atropia, gr. ss.
to morphia, gr. j.," etc. In another place in the same
communication he again says: "Yet Bartholow, as
stated, and other good authorities, insist that it requires
one-half grain of atropia to antagonize one grain of mor-
phia." In my " Manual of Hypodermatic Medication"
(4ch ed., p. 227), and in my "Cartwright Lectures" on
this topic, as also in my " Treatise on Materia Medica
and Therapeutics " (4th ed. See articles on opium and
on belladonna), I have very distinctly stated that the
ratio of antagonistic action is about one-twentieth or
one-twenty-fourth grain of atropine to one grain of mor-
phine.
The importance of such a mistake must be my excuse
for troubling you with this communication, and for call-
ing in question the statements of Dr. Wallian, whose
otherwise excellent paper well deserves careful examina-
tion. Before closing I must thank a former pupil. Dr.
C. W. King, now on the stafif of the Cleveland Asylum
for the Insane, for calling my attention to Dr. Wallian' s
error. As a "constant reader" of The Medical
Record. I must have seen this paper, nevertheless, in
the course of the week after its appearance. Thanking
you in advance, I am, my dear Dr. Shrady, very truly,
Roberts Bartholow.
PiilLADELrHlA, May lO, 18S3.
MEDICAL CONTROVERSY AND THE NEWS-
PAPERS.
To THE Editor of The Medical Record.
Sir : Under the heading " Medical Controversy and
the Newspapers," you publish on page 528 of your issue
of May i2th, a letter from Dr. T. H. Squire, of Elmira.
His acknowledged reputation in the profession for both
scientific attainments and superior morals render it
necessary that I should fake notice of it. Thus I ask
you to publish the following statement : I never knew,
until I was informed of it by Dr. Squire's letter, that
the Tribune of May 3d published (a translation of) my
letter addressed to a large number of German phy-
sicians of the city and State. This letter was printed
on April loth, and mailed to every individual German
physician in New York, Brooklyn, and Richmond
County, also in Albany, whom I knew, or knew to be
German. Most of the city letters were enclosed in a two
cent envelope. Many of the letters were directed and
mailed by a clerk, who may have sent a few to such
whose names (taken from the register) may have ap-
peared to him to be those of " German" physicians. A
few copies were also sent to friends in the counties, with
the request to distribute them amongst the German phy-
sicians, if any there were. A solitary copy was given
by me to a medical friend in this city, who was not a
" German," but demanded that copy from me. Thus it
follows that my letter was a personal one in every in-
stance, and not meant for the newspapers at all. Where
the Tribune obtained its specimen, or who made the
translation for it, I cannot know.
The purpose of my letter is best illustrated by its final
remarks : " It is far from me to try to prejudice you.
What I desire to impress upon you is but this, that you
may not commit and bind yourself without an accitrate
examination of the subject (viz., the Code question).
The question is not one of the relation of medical sci-
ence to medical sects, for that question no longer re-
quires an answer — but of our, your, individual relation
to the sick, of conscience, and of the personal independ-
ence guaranteed to each citizen by the usage and the
laws of the commonwealth. It is my main object to re-
quest that you may, in regard to the subject under con-
sideration and the general interests of the medical pro-
fession, grant such" attention and co-operation as any
community — professional, municipal, or State — is entitled
to expect from every educated and thinking member and
public-spirited citizen."
In view of the fact that of the large number of German
physicians but very few give the required attention to,
and co-operation in public affairs — a fact best substanti-
ated, if by nothing else, by the small number of German
names appearing in the lists of our medical societies —
I think every public -spirited man in the profession,
no matter of what code party, ought to welcome every
attempt at rousing them from their apathy and indiffer-
ence, which are the more intolerable the higher the sci-
entific accomplishments of very many amongst them.
In regard to the tone and contents of my letter, I
claim that no statement of any man who has taken a de-
cided party stand on any question, could be more quiet
or impartial.
The correction of Dr. Squire's, in regard to the "ma-
jorities," I accept. I am glad he found nothing else to
object to. After all it is a great satisfaction to be one
of the "one hundred and five."
Very respectfully yours,
A. Jacobi, M.D.
New York, May 15, 1SS3.
56o
THE MEDICAL RECORD.
[May 19, 1883.
J^rmij l^cius.
Official List of Changes of Stations and Duties of Officers
of the Medical Department , United States Army, from
May 5, 1883, /(? May 12, 1883.
Bartholf, John H., Captain and Assistant Surgeon.
The extension of leave of absence granted April 3, 1883,
further extended four months. S. O. 105, par. 8, A. G.
O., May 7, 18S3.
BiLi.iNCS, JoHX S., Major and Surgeon. By direction
of the Secretary of War, to represent the Medical De-
partment of the Army at the annual meeting of the Amer-
ican Medical Association, to be held at Cleveland, O.,
June 5, 1S83. S. O. 105, par. 10, A. G. O., May 7, 1883.
FoRWooD, W.M. H., Major and Surgeon. 15y direc-
tion of the Secretary of War, to represent the Medical
Department of the Army at the annual meeting of the
American Medical Association, to be held at Cleveland,
O., June ;, 1883. S. O. 105, par. 10, A. G. O., Mav 7,
1883.
S.MITH, Jos. R., Major and Surgeon. By direction of
the Secretary of War, to represent the Afedical Depart-
ment of the Army at the annual meeting of the .American
Medical Association, to be held at Cleveland, O.. June
5, 1883. S. O. 105, par. 10, A. G. O., May 7, 1883.
I^lcclical items.
Contagious Diseases — Weekly Statement. — Re-
port of cases and deaths from contagious diseases re-
ported to the Sanitary Bureau, Health Department, for
the two weeks ending May 15, 1883 :
Week Ending
>
>
'0
>
erebro - spinal
Meningitis.
easles.
iphtheria.
X
0
u
>
r-
H
•Jl
U
-i Q
CO
>
Case!.
May 8, 18S3
5
0
8
r66
9
4
'70,44
163 39
May 15, 1883
5
132
0
0
Deaths.
May 8, 1883
5
4
•'8
9
6
24 25
25. 19
2
May i;, i8S^
2
30
0
The total mortality for the week ending May 12, 1883,
was 668, of which 94 were from pneumonia.
The Two Doctors. — The following is told of Dr.
Channing {Medical and Surgical Reporter) : " The rev-
erend doctor and the medical doctor were both at a
party in Boston one evening, and, some one being taken
ill, the man of medicines, Dr. Walter Channing, was
summoned. The servant entered the room where the
brothers were seated, and said, ' Dr. Channing is want-
ed.' ' Which Dr. Channing ? ' said Walter, the pliysi-
cian ; ' the one who preaches, or the one who practises ?' "
Newport Medical Society and the Coroner
Question. — In behalf of the committee appointed to
consider the present system of coroners the undersigned
would respectfully report : 'I'hat the coroner system, as
usually constituted, of non-medical men, is not in accord-
ance with the advanced intelligence and needs of the
present time ; and that, even when the coroner is a med-
ical man, the antiquated encumbrances of the system
are so decided as to occasion very serious disadvantages.
Therefore the committee recommend the replacement of
the whole system of coroners by that of the medical ex-
aminer, as in the State of Massachusetts ; and as a
means toward this end that a special committee, to con-
sist of Drs. Rives, McKim, and Fisher, be requested to
prepare a draft of a law in accordance with the .Massa-
chusetts statutes, incorporating therein the slight modifi-
cations suggested by Dr. .Alfred Hosmer, President of
the Alassachusetts Medico-Legal Society. The commit-
tee further recommend that the said draft, when accepted
by this society, be presented in its behalf, by the Presi-
dent and Secretary to the State Assembl)', with the prayer
that it be made the law of Rhode Island ; and that a copy
of the draft and petition be communicated to the State
Medical Society, with the request that it at once take
concurrent action. All of whicli is respectfully submit-
ted. Samuel W. Francis, M.D., Chairman ; Francis
H. Rankin, M.D., of Committee.
-■V Quack .Arrested. — Dr. O. C. Gage, of New York,
who has extensively advertised himself as the man so cele-
brated for his wonderful cures in New Hampshire, was
arrested at Dover, N. H., May sth, at the instance of a
medical student, who charged him with practising medicine
without a license from some medical society of the State.
Good Work and Bad in Medicine. — The following
graphic sketches of two types of professional workers are
from a recent address of Dr. .Andrew Clark :
In the work of the younger members of our profession
I see, or at least I think that I see, greater care, patience,
and accuracy in observation, a more rigorous fidelity m
the record of therapeutical experiments, wiser caution in
speculation, graver deliberation in judgment, a growing
frankness in the confessions of oversights and errors, in-
creasing severity in the sifting and testing of their own
conclusions, a readier eftacement of personality in the
work, less unseemly eagerness for mere priority of publi-
cation, a deepened sense of the responsibilities of prema-
ture speech and writings, a rapidly abating bitterness in
the conflicts of opposing views, a more robust and man-
lier spirit of scientific life, and less reluctance in making
admission that there is no unconditional truth in the
results of our inquiries — no finality in our finished work —
no creed in medicine.
But, for one competent and conscientious worker there
are ten incompetent and unconscientious, and who in
divers ways hinder our progress and spoil our present
possessions. Intolerant of the patient and painful toil of
the true worker, acute in power of superficial obser-
vation, gifted with a certain showy versatility, quick at
catching hold of new ideas, ingenious in guessing, crude
in experiments, loose in therapeutic trials, hasty in
speculation, strong in dogmatic assertions, accomplished
in the transfiguration and use of other men's work, find-
ing what they want wherever they seek, unhindered by
difficulties, facile in speech, ready in wTiting, thirsting for
notice, such men. now, alas ! not uncommon in medi-
cine, beget papers so quickly that they can have na
necessary relation to time, observation, or thought, and
flood our literature with their unworthy if not unveracious
lucubrations.
The favorite hunting ground of such men is therapeu-
tics, and their favorite sport is the catching of new
remedies, the putting of them to new uses, and the set-
ting forth of their successful results. These men discern
no difficulties and have few failures ; they can illustrate
their successes by scores of cases, and explain them by
the most ingenious theories. There is scarcely any limit
to the extent or the variety of their achievements ; and,
as they flaunt along in the fulness of self-satisfaction,
they look down with pitying condescension upon those
in the strait and narrow way, who conscientiously toil
with small success in seeking after truth, but wlio, never-
theless, missing the praise of men, find strength and
solace in the sacred search.
The Number of Female Medical Students in the
University of Paris in 1880-S1 was 52, in 18S1-82 it was
39 ; of whom 10 were French, 11 English, 5 .Americans,,
and 9 Russians.
The Medical Record
A Weekly jfournal of Medicine and Surgery
Vol. 23, No. 21
New York, May 26, 1883
Whole No. 655
©viniual ^cctufcs.
THE DETERMINATION, BY THE GENERAL
PRACTITIONER. OF THE NECESSITY FOR
WEARING GLASSES.'
By D. B. ST. JOHN ROOSA, M.D., LL.D.,
PROFESSOR OF DISEASES OP THE EYE AND EAR IN THE NEW YORK POST-GRAD-
UATE MEDICAL SCHOOL; SURGEON TO THE MANHATTAN EYE AND EAR HOS-
PITAL : PROFESSOR OF DISEASES OF .THE EVE AND EAR IN THE UNIVERSITY
OF VERMONT. .
Lecture III,
Gentlemen : You will very often hear patients say that
their eyes have been overused, and that for this reason
their vision is deficient. I think experience is rather
against the likelihood that great use of tiie eyes neces-
sarily impairs the sight. The best eyes, like the best
brains, are those which are used most. The use of eyes
forms no exception to the general rule that the organs
of the body are the better for employment. They are all
the better for being used under proper conditions. The
fact that an eye has become presbyopic, does not at all
prove that that eye has been overused. Very indolent
people, who seldom overtax their eyes, sometimes have
very poor sight. In practice, I never regard it as in-
trinsic evidence that a man has been a very great student
merely because his eyes have given out. I must have
other proof than the existence of useless eyes. The
function of adapting the eye to vision at different dis-
tances is called accommodation, and the employment of
it will not necessarily injure the eyes. Therefore you
are often to encourage this ordinary action of the eyes
as a curative means. The continuous employment of
the eyes upon fine objects, without breaking the tedium
of it, is sometimes harmful. But all of you must know
men and women who, while usmg their eyes constantly
in what are called trying employments, never are troubled
with asthenopia or with inflammatory affections of the
eyes. Long ago exact observers showed that watch-
makers and others, who used one eye at a time, and
almost constantly, have- just as good eyes as mechanics
who scarcely use their eyes, or as the idle men about
town who read nothing but the newspapers, and of these
very little. Remember, if you please, as a preface to
your knowledge about the eye, that ordinary eyes are
better for being used.
I have talked to you concerning hypermetropia and
myopia, and there remains, of the forms of disturbance of
vision to be discussed in these lectures, the condition
known as presbyopia, or far sightedness.
Fortunately, I am able to show you, to-day a case
which illustrates not only hypermetropia but also pres-
byopia. Perhaps the general practitioner might ask what
is the difference between conditions which require the
same remedy?
Hypermetropia is an error in the refraction of the eye,
that is to say, the hypermetropic eye has not sufficient re-
fractive power. The myopic eye has a refractive power
that is too great. The presbyopic eye may be either
hypermetropic or presbyopic, or it may be emmetropic
or of normal refraction. Presbyopia is a failure of ac-
commodation. It is a condition that does not necessarily
have anything to do with an error of refraction. What-
I Delivered at the University Medical College, Session of 1881-82.
ever the refraction of the eye, presbyopia must occur if
more than forty years of life are passed.
If a person is hypermetropic, he has an eyeball that is
congenitally too short from before backward, and he
needs convex glasses. If a pierson has reached the age
of forty years or over, and is no longer able to read the
finest type at a convenient distance he also needs convex
glasses.
Now, you ask what is the difference between these two
conditions? Are they identical ? By no means.'
The little girl present at our first lecture has the con-
dition known as hypermetropia. She has an error of re-
fraction. The refractive power of her eye is insufficient.
In the man present at the second lecture, one of my
staff, who has myopia, the refraction is too great, the rays
of light that enter the eye are bent too much. In the
latter case the eye is too long, in the former case it is too
short. Your lecturer has passed beyond the age of youth,
he has turned the corner, which means that he is among
middle-aged men, and he has become presbyopic in the
natural course of things. But my eyes were never hyper-
metropic. I could always read the bottom line of the test-
types, since these tests have been suggested, at twenty feet,
and the weakest convex glasses before my eyes blur my
distant vision throughout. Besides, the fundus of my eyes
was examined by an expert ophthalmoscopist, and said to
be emmetropic ; that is, my eyes when at rest are adapted
to parallel rays. But the time has come when, although
I can still read the bottom line with perfect distinctness,
my accommodation is beginning to fail, and 1 cannot
read fine type at eight inches from my eyes. I will show
you the nearest point at which I can read " Jaeger No.
I," or -iiriiiiuii" type. According tj Bonders' table the
near point of a man of forty-four should be eight inches.
But I find that it is often at nine or ten inches, in an aver-
age light. When the near point has come to be farther
off than eight inches, presbyopia is reached. The near
point of your lecturer, for brilliatit type in this light at the
age of forty-four is nine and one-half inches.
This recession of the near point, from the weakness of
the ciliary muscle, and from the loss of the elasticity of
the lens, describes far-sightedness, or presbyopia.
But, on making a test in your presence, I find that in
this fair light mine is nine and one-half inches. I think
it is usually found as far off as that in an emmetropic eye
past forty-three years of age. In practice, when the near
point of vision for fine objects is beyond eight inches,
there begins to be inconvenience in reading fine print
(unless the illumination is exceedingly good), in sewing,
in detecting foreign bodies on the cornea, in short, in
any use of the eyes on near and small objects. This
change always comes as a surprise.
We are very apt to ascribe the results of failure in the
power of the ciliary muscle and senile rigidity of the lens
to other causes than the real one. When a person talks
much of the poor type they have nowadays, of bad
gas, and has at the same time reached forty or forty-five
years of age, an examination of the distance of the near
point, and the application of weak convex glasses will
often clear up the mystery of the change that has come
over the sight.
Myopia and hypermetropia are errors of refraction ;
emmetropia, the normal condition of refraction ; pres-
byopia, an error of accommodation, and it appears as
life advances. It does not depend upon flattening of the
cornea, it does not depend upon alteration in the length
562
THE MEDICAL RECORD.
[May 26, 1883.
of tlie eyeball from before backward. It depends, as I
have already intimated, upon diminished power in the
ciliary muscle. The inevitable processes of time have
begun. The ciliary muscle is no longer able to contract
as vigorously at forty as at twenty-nine years of age. In
addition, this perfectly transparent lens, with its cajjsule
and its tubular contents, has become less yielding.
These are the two factors which have rendered the
presbyope unable to thicken his lens by muscular con-
traction ; that is, to perform the act of accommodation
with the same vigor as he did when he was a younger
man. The presbyojie, for certain occupations, at least,
such as reading the finest type, etc., is doomed to the ne-
cessity of seeking artificial aid by means of glasses. But
I will now show you the case of which I spoke, which
combines an error of refraction with this error of accommo-
dation ; that is, a case in which both hypermetropia and
presbyopia exist. It is a case perfectly within your ca-
pabilities of diagnosticating with these test-types, and
with this case of glasses. Pleasant and profitable as it
may be to use the ophthalmoscope to determine an error
of refraction, it is not necessary in this case. This
woman is fifty years of age, and has worn glasses about
fifteen years. She began to wear glasses, then, at
the age of thirty-five, a period in life at which she
had no right to wear glasses as a presbyopic person.
What is technically known as presbyopia does not begin
until after forty years of age. The near point never re-
cedes in a healthy eye farther than eight inches, that is,
there is no natural change in the accommodation until
after forty years of age. We are, therefore, at once
interested in her statement that she began to wear glasses
at the age of thirty-five years. She first used them for
reading, and she does not remember having used them
before that time. We have discovered that the error in
this case is not myopia, because the patient who wears
glasses for reading at thirty-five years of age, but does not
wear them for looking at objects at a distance, is certainly
not myopic. Myopia does not necessarily require glasses
for reading, unless the myopia is of a very great degree.
We have discovered, then, that the condition of her eyes
differs from myopia. She has not worn glasses for going
about the streets or in her ordinary avocation.
Let us ne.xt test her vision by means of the test-types.
We find that V. R. E. is /Jl, and V. L. E. is the same,
^%\, and with both eyes open her vision is a little clearer
than with either one blinded.
Now we will try and find out what kind of glasses she
has been wearing. How can that be done ? Simply
passing them between the fingers does not amount to
much, but with my case of glasses and test-types I can
tell exactly. I take the glass that has been worn, shut
one of my eyes, hold it before the other several inches
away, and then look at the test-types, and I find that
everything is blurred ; the glass obscures my vision. It
may be a concave or a conve,\ glass that does this. If a
convex glass, a concave glass will certainly neutralize it.
So I will take up a concave glass of thirty inches focal dis-
tance and put it before this glass, and now I can see a glim-
mer of the letters. That shows that I am going in the right
direction, and the glass which the patient has been wealing
is undoubtedly convex. If I had added a convex glass it
would have increased the indistinctness of my vision.
I ]3ut on another concave glass, correcting the glass
worn by the patient until I can see the large letters dis-
tinctly and in their natural size.
AVith a concave glass of twelve inches focal distance, i)ut
before the glass being corrected, I see the letters larger
than they sliould be, as the glass is still more convex.
I wish to have a glass that will make these letters look
as though seen with the naked eye. By the next trial I
find that No. 11 neutralizes the i)atient's glass, and I see
the letters as though looking through a plain glass. The
glass worn by the patient is undoubtedly convex, and the
number is probably 10. The patient now tells us that
she was ordered to buy No. 10.
I have now settled, beyond question, that she is not
myopic if she can read with this convex glass. You
will please notice where she is holding the book, al-
though wearing a convex glass, in order to read fine
type ; it is at^a distance exceeding eight inches. At the
distance of sixteen inches she can pick out letters. But
the glass is too weak; it does not correct the condition
of things there. She has something more than presbyopia.
She is not myopic. Now what is she ? She must be
hypermetropic and presbyopic.
In the next place, let us correct her hypermetropia.
Let us put on a pair of glasses which makes the eyes of
the proper length for distance. If I find that she reads
with a glass having a twelve-inch focal distance, but that
this does not enable her to read from eight to twelve
inches, her glass is not strong enough for near objects.
Even a presbyope, in the beginning of his trouble, can read
at nine or nine and a half inches. The rule in fitting glasses
for presbyopia is to order a glass with which fine type.
No. I Jaeger (brilliant), can be read at eight inches from
the eye ; of course it can then also be read at a greater
distance.
I will try one eye at a time. I will put on a No. 14
convex glass with the view to correcting her hypermetro-
pia, which is of a different form from that seen in the
little girl presented at the first lecture, who could see
with or without glasses. Here is a patient who cannot
see well at a distance without glasses, and we will now
see if she can do any better with them. With her right eye
she can read, aided by a glass having fourteen inches focal
distance, the bottom line at twenty feet. This is a case
of manifest liypermetropia. Her vision is not distinct
at a distance, unless aided by a convex glass. The left
eye is very much like the right. With a convex glass
of fourteen inches focal distance her vision becomes nor-
mal ; her hypermetropia is converted into emmetropia.
Now about her reading. If you have followed me
carefully in this course of lectures, you are able to say
whether she will need a stronger glass to read with or
not. She is not particularly concerned about her dis-
tance vision, or she would have had glasses for that pur-
pose long ago. She has not worn glasses habitually.
Very comfortable and clear vision for all ordinary pur-
poses is consistent with an inability to read the bottom
line of Snellen's test-types at twenty feet, Y=|u.. If pa-
tients have never had more visual power than ffl- or ^,
they do not always appreciate ll}. One of my myopic
and astigmatic patients, a lad}', whose vision was made
normal by glasses which she began to wear for the first
time when she had reached middle life, complained that
objects appeared too distinct with them, and that "the
beautiful haze" was taken away from the scenery of the
world.
Another, however, also a lady, under the same circum-
stances, after having walked down Broadwa}', and hav-
ing looked at the shops with her new concave cylindrical
lenses, turned about and walked immediately up again,
saying that she had never enjoyed the street before.
It is an interesting fact that some patients who have
not worn glasses habitually, do not estimate them as
having much advantage, even if they do not see well
without them. Certain myopes, who can scarcely see
large objects six feet away from them, will say that
they see perfectly well, and object to using glasses, and
positively state that they do not care to see any better.
They will even deny, after their vision is increased from
say 12 to 15, that they see practically any better. The
fact is that these tests by letters at a distance, do not
furnish to all patients satisfactory subjective evidence of
visual power. That is only found out by tests with small
type near at hand, and by looking at familiar objects.
This patient has no special inconvenience in looking at
a landscape. This fraction, ^»,'j, does not express her
real vision. If she could not see to read or sew, she
would be inconvenienced. Now, does she need thicker
glasses for reading than for looking at a distance ? If so,
May 26, 1883.]
THE MEDICAL RECORD.
563
a glass of fourteen inches focal distance will not answer.
Look at this diagram, and then you will be able to tell
me. Here is illustrated an eye of the same kind we are
studying ; the eyeball is too short, and a glass has been
put in front of it to bend the rays of light so that they will
take the course indicated by these dotted lines. Now,
suppose 1 change these rays to those comuig from an
illuminated page, or from a lady's sewing — change their
direction so that they are no longer parallel but divergent,
does it take a thicker lens to focus divergent than parallel
ravs ? Certainly it does. We need more refraction ; a
greater breaking up of the rays of light. If this patient
requires a glass with a focal distance of fourteen inches
to see objects illuminated by parallel rays, she will need a
stronger glass to read objects illuminated by divergent
rays.
1 proved to you, a few minutes ago, that a glass with
ten inches focal distance was not strong enough, because
she could not read No. i test-type nearer than si.\-
teen inches, and indistinctly. I will take a glass having
six inches focal distance, I think, because I have found
that the near point recedes further than eight inches,
which is the dividing line between presbyopia and em-
melropia even with the glass. To correct the presbyopia
and bring it back to the normal, it is necessary to give a
glass with which she can read the tinest type at eight
inches. The glass that will correct her hypermetropia,
added to that ordinarily used by a presbyope of her age,
will be the one which will enable her to read fine type at
eight inches. This will be one of about seven inches
focal distance in her case. I try one of seven inches
focus.
She fancies it is rather strong ; but with that fancy we
are not to be particularly impressed, but we are to pre-
scribe that glass with which she can see No. i easily at
eight to twelve inches, which will be the one generally
needed for fine work in the evening, when the light is
not perfect. Then you can allow a little for other work,
giving a weaker glass for daylight.
I therefore prescribe it and one of fourteen inches
focal distance for going about at work, if she chooses to
wear it.
We might imitate Dr. Franklin, and have a glass made
after his suggestion, the upper part of which would be of
fourteen inches focal distance, for looking about, and the
lower part of seven inches focal distance for fine work.
This is a typical case illustrating manifest hypermetro-
pia, to which has been added presbyopia, and the gen-
eral practitioner may be perfectly competent to diagnos-
ticate this condition. When vision can be made |J with
a glass, or the person can read the finest type without a
glass, it is not necessary to have an ophthalmoscope nor
a large case of glasses in order to diagnosticate these
conditions of refraction and accommodation, and to pre-
scribe for them. I see from different neighborhoods,
wheie the general practitioner has paid no attention to
the advance made by a knowledge of the different specta-
cles required for the improvement of vision, case after case
that has been neglected, which should be treated suc-
cessfully by some of the recent graduates from the
University or Bellevue or the College of Physicians and
Surgeons. Some practitioners are so absorbed in the
diagnosis of pneumonia, which can be readily made out,
that they have had no time to attend to the little and
more obscure matters that might enable them to relieve
many persons from serious inconvenience and even
danger. I hope that, with your test-types and glasses,
you will, before dismissing them, at least see whether or
not it is within tlie bounds of your knowledge and ex
perience to correct the condition of their eyes. I have
shown you three typical cases, and you should, as general
practitioners, be competent, without any special knowl-
edge, exce]n that which 1 have indicated, to diagnosticate
and prescribe for them with correctness.
There is one interesting point in this patient's case.
Hypermetropia may remain latent for years and years.
and finally the eyes break down, and it becomes mani-
fest. This patient may have been able, as a school girl,
to read -S J ; but, as time went on, her ciliary muscle
weakened, the natural refractive condition of the eye-
ball appeared, and she was no longer able, by any extra
amount of force she possessed, to make the lens thick
enough to see parallel rays, and she then needed glasses
for a distance.
I remember the case of a judge who came to me in
great distress, saying that he was becoming blind ; that
he was no longer able to see the lawyers in front of him.
He had worn glasses for several years for reading, and
had always been able to see at a distance, and I found
that his entire blindness depended upon hypermetropia,
which had suddenly become manifest, so that he was
obliged to wear convex glasses for distance. For years,
by an extraordinary strain upon the ciliary muscle, he
has been able to see distinctly at a distance, but his ac-
commodative power suddenly gave out one day while in
court, hinc ilhz lacrymcz.
FACULTATIVE HYPERMETROPIA.
This gentleman, one of your number, complained of
asthenopia; that is, weakness of vision. The first thing
I did was to find out whether or not he could read the
bottom line at twenty feet. He was able to do so with-
out glasses. But he complained that he was unable to
continue to read ; that the eyes watered, etc. I found
that he could see just as well at a distance, that is §§, with
glasses having thirty-six inches focal distance, and I made
my diagnosis, without an ophthalmoscope, that it was a
case of facultative hypermetropia, voluntary hypermetro-
pia ; that is, he is hypermetropic or not, as he chooses. I
said to him, "Your trouble is because you are using your
ciliary muscle too much. You are using it to see objects
at a distance, and also for reading. In a natural condition
you are only required to use it in work upon near objects.
If you will put on convex glasses and relieve your ciliary
muscle from some of the strain, if my diagnosis is correct,
if no general condition exists which causes paralysis of
accommodation, you will be able to get on very comfort-
ably." He is wearing the glasses, and he says that he
can read without inconvenience. With the glass of
thirty-six inches focal distance we have relieved the cili-
ary muscle, wliich was busily engaged in thickening this
lens ; in other words, we have relieved the strain upon it,
and the asthenopia disappears. It is a case of facultative
hypermetropia relieved by the use of convex glasses for
the near point. This patient will become like the pa-
tient who has just gone out. The time will come when
he will not be able to see the bottom line at twenty
feet ; will not be able to adjust parallel rays to an exact
focus, and then he will have manifest hypermetropia, and
require convex glasses for distance as well as for objects
near him.
Chloroform Narcosis during Sleep. — Dr. S. Mu-
rill, of West Liberty, la., writes : " In your issue of
April 28, I !
I have read with interest an article on
chloroform narcosis during sleep, and I contribute my
item of experience. I was requested to remove a tooth
from a little girl, Mabel D , aged five, daughter of
Herbert and Almira D , who now reside in the vil-
lage of Potsdam, N. Y. The child was nervous and
afraid, and would not allow me to even look at the tooth.
I approached her while sleeping, put her under the in-
fluence of chloroform, and extracted the tooth, which was
a front upper one. There was very little hemorrhage.
The child showed no signs of awakening. I watched her
for some time, and she quietly slept on until morning.
Some time the next dav she noticed the tooth was gone,
but had no knowledge of when or how it had taken its
departure. I would suggest that Dr. John H. Girdner,
would try it again. It succeeded in my solitary case, and
that is the only time I have had occasion to try it."
5^4
THE MEDICAL RECORD.
[May 26, 1883.
(Dvioinal Articles.
IS THE BLOOD A LIVING FLUID ? '
By FRANCES EMILY WHITE, M.D.,
PROFESSOR OF FHYSIOLOGV IN THE WOMAN'S MKDICAL COLLEGE OF I'ENNSVLVANIA,
The question, Is the blood a living fluid ? announced as
the subject for discussion at this meeting, is, to the phy-
siologist at least, if not to the pathologist, a most inter-
esting one, since it involves some consideration of living
maker in general and the characteristics by which it is
distinguished both from matter which has never lived and
from that which has ceased to live. The so called vital
functions, common to all grades of living matter, vege-
table as well as animal, may be briefly stated to consist
in such an interchange of materials between anv organ-
ism and its environment as serves to maintain the chem-
ical and structural integrity of that organism.
The life of the various tissues of any complex organ-
ism, though in some sense distinct from that of the organ-
ism as a whole, may nevertheless be detined in identical
terms with that of the body of which they form a jiart.
Says Professor Huxley : "The preservation of the life of
the tissues from moment to moment is a physiological act
consisting in successive and simultaneous degenerations
and regenerations of parts." In other words, vital pro-
cesses are nutritive processes, nutrition and denutrition
going on to some extent simultaneously, though by no
means with always equal steps. But these two processes
— nutrition and denutrition of tissues — though mutually
dependent, stand in very different relations to the func-
tions of the organism considered as a unit. The processes
of assimilation are concerned solely with the welfare of
the tissues, as tissues. The activities of the organism,
considered as a unit, are accomplished by means of de-
nutrition, i.e., the retrograde metamorphoses of individ-
ual tissues or parts of tissues, which thus complete their
functions only in dying — the potential energy stored up
in the assimilation of materials obtained from food be-
coming kinetic in their breaking down. Thus the pro-
duction of secretions, the movements of respiration, the
activity of the heart as an organ of the circulation, the
voluntary movements, emotion, volition, and thought, are
all immediately dependent on the breaking down of cer-
tain constituents of the various tissues concerned. Work
means waste, and the measure of the activity of any liv-
ing mechanism is to be found in its excretions. Thus,
increased muscular exertion is accompanied by increased
escape of CO, in the expired air, and intellectual work
adds to the labor of the kidneys in eliminating the greater
amount of excrementitious salts thereby added to the
blood. That tissue-waste during any given jieriod is not,
however, necessarily commensurate with the matter at
the same time assimilated by any given tissue is proved
by the whole history of metabolism in the body.
It may be said, probably without fear of contradiction,
that the processes of nutrition are localized in cells —
that the cell alone is the essentially vital structure ; and
there exist biologists (notably Beale among the English)
who limit vital activity, in their belief, to certain parts of
the cell, mainly the nucleus, which they regard not only
as the chief agent in the reproduction of the cell but in
its nutrition also, the outlying portions consisting largely
of formed material in which nutritive changes have
ceased. It is, nevertheless, through changes in this
formeil material, rather tlian by the activity of the living
matter, that the function of the tissue is accomplished.
Whether or not the views of Prof. Bealc and his followers
be wiiolly accepted, it must be admitted that only certain
parts of the tissues of any complex organism arc, strictly
speaking, living. The heart of the oak is physiologically
dead, playing a purely mechanical rule in the life-history
' A Paper read before the Montgomery County Mcdicjil Society.
of the tree, whose vital processes are carried on in other
parts of its structure.
This is an extreme example of a principle which holds
good, though to a less extent, in animal organisms; and
a large part of the tissues which make up the bodies of
adult animals have, in a great measure, lost their re-
semblance to the living formative protoplasm from which
they were derived.
It is only certain portions of cartilage and bone, for
example, which have the power of reproducing new
tissue out of ])abuluni ; the other parts consist of formed
material which has no reproductive power and which
serves a purpose as purely mechanical as that of the
heart of a tree.
So in the case of the actively secreting glands, it is the
formed products of their nutritive activity which break
down to supply the characteristic organic constituents of
their respective secretions which then serve their purpose
in the body. So also the glycogenic function of the
liver is completed only when the glycogen, built up as a
part of the hepatic cells, breaks down into the sugar
necessary for maintaining the normal constitution of the
blood. To what extent these principles may be applied
to the chief active tissues — the muscular and the nervous
— it will be difticult to determine until more is known of
the modus opera?tdi of these tissues ; it may, however, at
least be doubted whether biologists are in a position to
refute the theories of Dr. Beale in denying life to every-
thing but bioplasm.
But probably the real question before this Society is
somewhat more restricted in its scope than the one just
considered, and may be stated as follows : Can the
blood be regarded as a true tissue, having a definite origin,
structure, and function ; also undergoing phases of
growth and decay, of repair arid waste, like the solid tis-
sues of the body ?
In this inquiry, the first point to be established is what
constitutes a tissue.
If we restrict our statement to the more simple forms
of nerve and muscle tissues, all tissues may be described
as alike consisting of cells and an intercellular substance
or matrix. The various kinds of cells are also marvel-
lousl)' alike — tissues differing far more in respect to their
intercellular substance than in their cells. The cartilage
cell, the bone-cell, the connective-tissue corpuscle, the
epithelial-cell, the non-striated muscle, and the nerve-
cells, may all be described in terms almost identical.
May the blood also be regarded as consisting of cells and
an intercellular substance difiering from cartilage — for
example, in having a liquid instead of a solid matrix ?
In other words, is the red-blood corpuscle (which,
for brevity's sake, I will designate as a hamacyte) a true
cell ? If it be admitted that the hremacyte is derived
from the leucocyte and represents the adult stage of the
white-blood corpuscle, the question is at once answered
in the affirmative ; for the white-blood corpuscle (first
discriminated from the red by Hewson) is well-known
as a living, amceboid cell ; it has been seen by Klein to
multiply by simple division, and its curious movements
(first observed by T. Wharton Jones in the blood of the
skate') have since been watched by many eyes ; these
are evidences of life which cannot be adduced in the
case of many cells which are nevertheless considered as
belonging to living tissues. Moreover, whether the red
bodies be recognized as arising from the w^hite, or, as
claimed by Hayem, from certain intermediate corpuscles
(designated by him as hasmatoblasts, and by Klein as
microcytes) or from some as yet undiscovered source,
they have a definite form and chemical composition
which they maintain in the midst of a [jlasma differing
materially from themselves, since they contain all the
iron of the blood, and a large proportion of the fats as
well as of the phosphates and the potassium salts, while
the chlorides and sodium salts predominate in the plasma.
* PhnosophicllTrans.ictions, 1846
May 26, 1883.]
THE MEDICAL RECORD.
565
These cells also perform a definite physiological function.
What more can be said of any cell in suiiport of its claim
to being considered as the active element of an anatomi-
cally distinct and living tissue?
The complex body of any of the higher animals may
be regarded as consisting of tissues, all of which have
not only been developed by and differentiated from the
original protoplasm of the fertilized ovum, but each of
which corresponds in its perfected function to some one
of the fundamental properties of protoplasm, to the man-
ifestation of which, in a highly developed degree, it is
especially devoted in the interests of the organism as a
whole, on the important principles first spoken of by
Milne-Edwards as the physiological tlirision of labor.
Each tissue, nevertheless, retains in its own private in-
terests, as it were, vestiges of many of the other proper-
ties belonging to their common ancestor. Thus, all the
tissues are assimilative to the extent of keeping up their
own nutrition ; all are to some degree irritable ; all are
capable of reproduction of their own kinds of cells, and
so on. To what extent can these statements be applied
to the blood ? What property of protoplasm is special-
ized in this fluid, and what comn)on protoplasmic prop-
erties does it retain ?
Pfliiger has said that " albumen lives " (that is, be-
comes protoplasm) "when it begins to take in oxygen"
— a power e.xalted to the highest degree in the hxma-
cyte, which, to this extent, not only establishes its own
claim to being regarded as a living cell, but that of the
blood to a place among the true tissues.
The fully developed, non-nucleated, red-blood cor-
puscle in its state of formed material has undoubtedly
lost the power of reproduction — a power which belongs
to all tissue-cells — but that it has this power at some stage
of its existence scarcely requires proof.
In the embryo the first red corpuscles are derived
from mesoblastic cells of the vascular area, and they in-
crease by simple division ; at a later stage of embryonic
life, hremacytes are produced by transformation of leu-
cocytes (which probably arise in the liver and spleen
and pass thence into the blood) and by transformation
of connective-tissue corpuscles; in the spleens of adults,
also, as well as in the large capillaries of the red medulla
of the bones, small nucleated red corpuscles, similar to
those seen in the embryo, have been observed (Rol-
lett). Both von Recklinghausen and Golubew have
watched the actual conversion of colorless into col-
ored cells in blood drawn from the body of a frog and
kept in suitable conditions of moisture and warmth.
The proofs of this transformation in human blood are, it
must be admitted, indirect, and dependent on analogy
and reasoning rather than upon actual observation.
Among these indirect proofs may be mentioned the fact
that although leucocytes are constantly being poured
into the blood from the lymph-ducts, appearing in excess
after any special influx (as following a full meal), their
number nevertheless maintains a remarkable uniformity
in proportion to the haimacytes. The rapid regeneration
of red blood after hemorrhage, which appears to be pro-
moted by the administration of iron in connection with a
generous diet, also admits of the same explanation, while
in the blood of leuchsmic patients nucleated red-blood
corpuscles are often found presenting the appearance of
the nucleated embryonic blood-corpuscles of mannnals
and of man (Rollett) ; and since the red corpuscle is not
known to reproduce itself in the blood of adult animals,
notwithstanding nunrerous and careful observations on
this point, we must conclude that it constitutes a later
stage in the life of some other cell which has the repro-
ductive power — and the probabilities are immensely in
favor of its derivation from the leucocyte of the lymph
and the blood.
The same conclusion may be drawn from considera-
tions of another and perhaps higher character. If it be ad-
mitted that the numerous homologies of structure existing
between man and the lower animals, taken in connection
with the significant facts of human and comparative
embryology, throw a powerful light on man's ancestral
history and on his kinships, both near and more remote,
with the lower forms of life throughout the entire animal
series, then the same must be admitted in regard to the
origin and descent of the red-blood corpuscle. The
blood of most invertebrates is colorless, its white nu-
cleated cells resembling the earliest corpuscles of hu-
man blood. The blood-cells of the lower (the oviparous)
vertebrates, though colored, are nucleated like those of
human blood in its second embryonic phase. The blood
of the young, also, of all mammalia (except the human)
has nucleated red corpuscles, the nucleus disappearing
only when the mammal has reached the adult stage, its
corpuscles being then homologous with those of human
blood in its third and last phase. It thus appears that
the corpuscles of human blood, originating from cells
of the blastoderm as colorless, nucleated, reproductive,
amceboid cells, later giving rise to colored cells which
still retain the nucleus, and finally appearing as fully dif-
ferentiated, highly colored, non-nucleated, non-repro-
ductive, and non-contractile corpuscles, pass through
various successive stages which establish their resemblance
to those of the blood of all the lower animals represented
by the invertebrate, the oviparous vertebrate, the young
mammalian, and the adult mammal types, reaching their
full perfection about the middle of fcetal life.
The leucocyte may then be regarded as the original
cell-element of the blood, the hsemacyte having been
specialized for the more successful performance of the
respiratory function.
White blood has undoubtedly the power of absorbing
a certain amount of oxygen, illustrating the general law
of absorption of gases by fluids ; and in those exceptional
cases of colored blood in invertebrates (as in certain
annelides described by Milne-Edwards in 1838, in several
molluscs reported by Harless and von Bibra in 1847,
and in various other groups especially investigated by
Dr. Ray Lankester ') the capacity of such blood for ab-
sorbing ox>gen is undoubtedly increased by its coloring
matter, since, when red, it contains ha;moglobin, and
when of other colors, substances capable of acting as
oxygen-carriers, some of which — notably the hremocyanin
(Frederique) of the blue blood of the octopus — contain
copper, which may be supposed to take the place of the
iron in hremoglobin. In most of these cases the coloring
matter is found, not in the corpuscles, which are white, as
in other invertebrates, but in the plasma, which thus adds
a special respiratory to its other general nutritive func-
tions. The fluid which circulates in the water-vascular
system of the sea-urchin, and which undoubtedly serves
the same purposes as the blood of higher animals, con-
tains richly colored nucleated amoeboid cells, the color-
ing matter of which is readily oxidizable and de-oxidizable,
and therefore well adapted for respiratory pur|ioses.
These and numerous other facts which might be cited,
did time and your forbearance ])ermit, all favor the sup-
position that blood is primarily a nutritive fluid which
may or may not possess special respiratory power ; in all
the higher animals, however (beginning with the craniate
vertebrates), the principle of the physiological division
of labor is doubly illustrated in the blood by the difteren-
tiation of the h.-emacytes for the performance of the re-
spiratory function — a specialization of its general function
of nutrition ; and how well these bodies (which consist
of almost pure hemoglobin) are adapted to their work is
shown by the fact that a given bulk of human blood is
capable of taking up from ten to thirteen times as much
oxygen as an equal bulk of water can do. That this
power belongs to the ha;macytes is thrice proved : i. By
comparison with white blood ; ?, by the fact that blood-
serum has no greater power of absorbing oxygen than has
pure water; and 3, by the fact that solutions of hremo-
globin out of the body readily combine with oxygen.
'A Conlrlbution to the Knowledge ol Hemoglobin. Proceedings of Royal
Society. 1872.
566
THE MEDICAL- RECORD.
[May 26, 1883.
The avidity of the ha^macytes for oxygen is only
equalled by the readiness with which they surrender it
when they reach the tissue capillaries under the influence
of the change in external pressure of this gas to which they
are there exposed. This delicate balance of physical
and chemical forces is a marked characteristic of living
matter ; were it not so, development and physiological
progress would be impossible. Since life consists in the
continuous reactions of organized matter in response to
the actions of the various forces of its environment, the
grade and quality of the life of any organism will depend
on the sensitiveness of the matter of which it is composed.
The more delicate the balance of its forces, the more
ready are its reactions and the more complete its adapta-
tions to the environment — the more assured, therefore,
the continuance of its life.
Thus the hcemacytes, through the facility with which
their hemoglobin is oxidized in the lungs and the chem-
ical instability of the resulting oxyhemoglobin, are not
only most admirably fitted for the performance of their
important function, but also afford a conspicuous illus-
tration of the living state of matter.
The blood differs, it is true, from other tissues in seem-
ingly performing a variety of duties — the corpuscles hav-
ing one office, the respiratory, and the plasma another,
that of conveying dissolved and liquid nutriment to all
the solid tissues, affording at the same time a means of
ready escape for their numerous gaseous and other solu-
ble waste materials ; but these various offices (of which
the latter may be regarded as merely incidental to the
liquid character of the plasma) have a single object, viz.:
the nutrition of the tissues.
A great advance was made in the principles of nutri-
tion when Liebig's classification of foods as plastic and
respiratory came to be regarded as unphysiological, and
it was shown that the tissues are the seat and immediate
source of all the energy, including heat, which is liber-
ated in the body — that food, therefore, must become a
constituent of some tissue before it can serve as a source
of energy. The same is probably also true of respiratory
oxygen, which first serves in the building up of the oxy-
hjemoglobin of the arterial blood-corpuscle ; and the sup-
position that respiratory oxygen acts solely in the tearing
down of tissues, thus becoming the agent in the liberation
of their stored-up energy, is undoubtedly a false one.
The celebrated experiments of Pettenkofer and Voit,
from which it appeared that more o.xygen was consumed
during sleep than in an equal number of waking hours,
carbon dioxide elimination being at the same time greatly
diminished, go far to prove that respiratory oxj'gen, like
nutritive material in general, is assimilated in the restora-
tion of exhausted tissues, especially the nervous.
Numerous observations have shown also that the ac-
tivity of muscle tissue is not immediately dependent on
oxidation, since excised frog's muscle will continue to
contract for a considerable time in an atmosphere free
from oxygen, when artificially stimulated. Not oxygen,
but the nerve-centres sup])ly the normal stimuli by which
the energies of all the other tissues are liberated, their
own energy being set free in automatic action (so-called),
or through the influence of the various external forces
transmitted to these centres by afferent nerve-fibres ;
and respiratory oxygen, in common with other constitu-
ents of the blood, is without doubt approi)riated in the
building up of those highly complex substances by the
explosive decomposition of which the energies of both
nerve and muscle tissues are liberated.
The blood has therefore, /^r excellence, a single func-
tion— that of supplying nutriment, gaseous as well as
liquid, to the .solid tissues ; and to what extent its life-
sustaining power depends on the h;emacytes is shown by
the rapid occurrence of asphyxia (in three to five minutes
in the dog) when their function is seriously interfered with,
as well as by the facts of transfusion, since whipped
blood containing these bodies retains all its restorative
properties, while mere serum has no immediately reviv-
ing power ; and although the importance of the plasma
in nutrition must not be overlooked, the highest place
(as in other active tissues) must be accorded to the
fully developed adult cells — the oxygen-carrying hasnia-
cytes.
We next inquire whether the activity of the blood, like
that of the other tissues, is accompanied by waste.
That the red cells die in great numbers (finding a
grave, as man)' believe, in the siileen) is a necessary cor-
ollary of the conclusion that the lymph-cells are being
constantly converted into these bodies ; otherwise, the
red cells would be disastrously increased in number. The
various pigments, also, found in the bile, the urine, etc.,
give evidence of having been derived by reti'ograde meta-
morphoses from the coloring matter of broken down cor-
puscles, which thus escapes in both the solid and fluid
excretions. That a ]iortion of the iron is retained in the
spleen in some peculiar proteid compound ' is probable,
perhaps serving for the perfecting of the new cells which
are supposed to have their birth there.
The marked chemical similarity which exists between
blood and muscle, long ago procured for the former the
soubriquet of liquid flesh. The proportions of water in
the two substances are about the same, and the same
salts abound in muscle-tissue, which have already been
mentioned as predominating in the red-blood corpuscles.
Red muscle gives the spectrum of ha;moglnbin, and
crystals of hajmin may be obtained from it by appropri-
ate means (Kuhne). But the researches of Kuhne have
disclosed other still more interesting points of resem-
blance, and the ultimate muscle-fibre is now described as
consisting of an elastic tube, the sarcolenmia, filled with
liquid or semi-liquid contents, the muscle plasma, capa-
ble (like the plasma of the blood) of spontaneous coag-
ulation at ordinary temperatures and separating into
clot and serum — the process being similarly accelerated
by contact with foreign matter, by whipping, etc. The
myosin which constitutes the clot, though not identical
with fibrin, has many properties in common with it, while
the albumen of muscle-serum (the most abundant of its
proteid constituents) is apparently identical with the se-
rum-albumen of the blood.
Liberation of heat, which takes place not only during
the contraction of living muscles but in rigor mortis (a
state of coagulation shown by Prof Hermann to be in all
likelihood an extreme condition, of which every contrac-
tion is a partial illustration), also accompanies coagulation
of the blood. There is a similar change from an acid to
an alkaline reaction during the contraction and the rigor
mortis of muscle and in the coagulation of blood.
Were it desired to carry the parallelism between these
tissues still further, the solid doubly refracting bodies
contained in the muscle-plasma — the sarcous elements,
which appear under the microscope to be especially con-
cerned in the phenomenon of contraction — might be com-
pared to the solid corpuscles of the blood floating, in like
manner, in the fluid plasma ; but perhaps too little is
known of the nature and function of the sarcous elements
to aff"ord grounds for an analogy, nor would it greatly
strengthen the resemblance. More significant, perhaps,
are the nuclei embedded in small masses of granular pro-
toplasm, which, in the frog, may be found at varying
depths in the substance of the fibre, but in matiunalian
muscles are generally situated just beneath the sarco-
lenmia.
These nucleated masses of protoplasm, taken in con-
nection with the distinctly cellular character of the more
siniple non-striated muscle-tissue, reveal the morpho-
logical unity existing between this tissue and all the other
tissues of the body.
Kuhne, in 1859, was the first to compare the amreba
and the vorticella with the muscle-fibre in respect of
their excitability and death changes ; and the unity of
the contraction exhibited by these microscopic proto.
* See Foster's Test-Book of Physiology.
May 26, 1883.]
THE MEDICAL RECORD.
567
plasniic creatures and • the highly speciah'zed muscle-
tissues of the higher animals may be regarded as estab-
lished.
Thus, through the hxmacyte of the blood in its amce-
boid contractile stage as a leucocyte, the resemblance
between these two tissues is made complete.
Before leavmg this division of the subject, however, I
beg your sufferance in calling attention to still another
point in this analogy which involves the reference to a
purely hypothetical substance — the so-called inogen sub-
stance of Prof. Hermann — the probable existence of
which, as the result of the final synthesis of the con-
tractile material, he offers as an explanation of certain
remarkable facts, viz. : the marked increase of non-nitro-
genous excretions and the equally conspicuous non-
increase of urea which accompany muscular activity.
This substance (the constituents of which in contraction
are supposed to become disassociated to the extent of
liberatmg carbon-dioxide and sarcolactic acid without
the breaking down of its proteid part, which is thus
spared to recombine with fresh supplies of non-ijroteid
materials in the construction of new inogen substance)
finds its analogue in the oxylipemoglobin of arterial
blood, which appears as reduced hemoglobin in the
venous blood, ready to reunite with more oxygen in the
lungs, the previous supply of this element having escaped
from the hsmacytes without further chemical disturbance
of the proteid compound with which it was combined —
loosely, it is true — nevertheless in a real chemical union ;
and the plausibility of Prof Hermann's theory is, to my
mind, greatly strengthened by this analogous phenomenon
of the red-blood corpuscle.
Dr. Foster, in liis valuable and charming book, for
which the student of physiology can hardly be grateful
enough, in introducing the subject of the blood, speaks
as follows : " In regarding blood as tissue, we come
upon the difficulty that it, unlike all the other tissues,
possesses no one characteristic property. The receptive
tissues pour into it the material which they have received
from without, the excreting tissues withdraw from it the
things which are no longer of any use ; and the irritable,
the contractile, and indeed all the tissues seek in it the
substances (including oxygen) which they need for the
manifestation of energy or for the storing up of differ-
entiated material, and return to it the waste products
resulting from their activity. Its real usefulness lies not
so much m any one property of either its corpuscles or
its plasma, as in its nature fitting it to serve as the great
medium of exchange between all jiarts of the body."
It has already been shown (unless I overestimate the
significance of the various facts cited and the irpportance
of the arguments employed) that the differences in these
numerous offices of the blood are more apparent than
real ; moreover, transferring our attention for a moment
from the processes of nutrition to those higher phases of
animal life known as sensation, emotion, volition, and
thought — an equally broad and comprehensive view may
be taken of the various functions of nervous tissue. Ex-
posed through the terminations of innumerable nerve-
fibres (the different varieties of which are as universally
distributed among the other tissues as are the capillaries
themselves) to an environment which may be indefinitely
extended by the microscope and the microphone on the
one hand, and by the telescope, the spectroscope, and
the telephone on the other, the central nervous organs
are played upon by all the forces of the external world.
Changes are thereby set up in these centres, of the nature
of which we know little (except that they are accom-
panied by the liberation of lieat with elimination of carbon
dioxide and other products of tissue activity), changes,
however, which are capable of modifying the action of
every other tissue in the body through the return threads
by means of which these central organs are brought into
communication with all the other organs.
Not only this, but " striking the electric chain where-
with we're darkly bound," which links all sentient beings
in a common brotherhood, vibrations from these central
organs thrill through the magnetic touch, sound from the
vocal cords, or, more subtly still, flash from the speaking
eye, and penetrate to the conscious centres of many
thousands of other similarly constituted beings. Nor
does nervous tissue forfeit its character as a true tissue in
thus serving as a meduan of exchange in comparison with
which the exchanges of the blood seem trivial.
From every point of view, then — whether of origin and
development, of structure and function, or of analogy
with other tissues — the blood must be regarded as a true
tissue; originating, in common with the other tissues,
from the cells of the blastoderm ; consisting, like other
tissues, of structural elements and an unstructured matrix ;
maintaining its chemical and structural integrity by the
processes of nutrition common to all tissues, and, like
other tissues, subserving the interests of the organism at
large through the performance of its own particular func-
tion.
A SUCCESSFUL CASE OF SPONGE-GRAFTING.
By W. G. THOMPSON, M.D.,
NEW YORK.
During a recent service in the Bloomingdale Insane
Asylum a patient suftering from acute mania came un-
der my charge. Several days before admission, his wife
had been instructed by his physician to " blister his back
with mustard." This she had done with an heroic zeal
which resulted in the removal of the deeper layers of the
integument at intervals over the greater part of the lum-
bar region ! At one point, a little above the left buttock,
a deep and extensive slough was formed which separated
in a few days, leaving a granulating ulcer with sloping
sides, i^ inch deep, 2 inches wide, and 3J inches long.
As the patient's temper was none of the best, it was im-
portant that this source of irritation should be removed
as speedily as possible, and 1 accordingly tried sponge-
grafting to hasten the granulating process. Not having
time to prepare the sponge by removing the silicates and
cretaceous salts in the manner suggested by Dr. D. J.
Hamilton, I used an ordinary fine-grained sponge, thor-
oughly washed, and soaked (or twenty-four hours in acid,
carbol., i to 20. From the periphery of this sponge were
cut a dozen pieces from one-fourth to one-third of an inch
square, which were closely applied to the floor and sides of
the ulcer. The peripheral surfaces of these pieces were
placed in contact with the ulcer, because the spicule are
larger and more branching there than in the interior, and
consequently the fragments were more likely to adhere
like burrs until the granulations should grow into them.
The wound was cleaned with acid, carbol., i to 40, and
powdered with iodoform. A compress was placed over
the grafts and a bandage applied.
Next morning the patient had torn oflf the dressing,
and only one graft remained in situ. The grafts were
replaced, and instead of a bandage, broad strips of ad-
hesive plaster were employed to secure the compress.
The wound discharged pus freely, and for the first six
days it was cleaned wi.h acid, carbol., i to 40, and the
dressing was renewed every twelve hours. After this it
was only necessary to reapply the dressing once in
twenty-four or thirty-six hours. Five of the grafts ad-
hered well after forty-eight hours, and those which came
away with the dressing (owing to the restlessness and in-
terference of the patient) were replaced, so that at the
end of a week the entire dozen were quite firmly adhe-
rent, and those which had been first applied could not be
pulled off with a forceps without giving some pain and
using considerable force. At the edges of the grafts the
granulations could be distinctly seen pushing their way
into the interstices of the sponges and forming little
bridges from the walls of the ulcer. At the end of a
fortnight the sponges had been raised to a level with the
surrounding integument, and most of them had become
568
THE MEDICAL RECORD.
[May 26, 1883.
very much smaller, while one or two seemed to have
been completely absorbed.
After three weeks the ulcer had almost entirely healed,
and the grafts which had not become absorbed or dis-
solved, perhaps in part by the pus, were gradually re-
moved with scissors as the skin grew inward to meet
them.
From the situation of the ulcer and the restlessness of
the patient, who was constantly walking about, it would
have been impossible to maintain the grafts in position
had they not early become ver}' firmly attached.
The granulations sprouted up with such vigor that one
could almost see them grow, and the healing was no
doubt completed in less than half the time that would
have been required without the support and stimulus af-
forded by the grafts ; and had the sponges been elabor-
ately prepared, the result could not have been more sat-
isfactorv.
DEATH FROM VACCIN.ATION.
By HORACE M. SIMMONS, M.D.,
BALTIMORE. MD.
In view of the universal interest which must attach to
such a subject, I avail myself of a little space in the col-
umns of your wide-spread journal in reporting a case of
death superinduced by vaccination. The extent to
which small-pox prevailed in our city during the past
winter, requiring the most prompt and energetic meas-
ures to suppress it, afforded ample opportunity for ob-
servation and experimentation in proving the efficacy of
vaccination as a prophylactic. No sooner had general
compulsory vaccination been inaugurated than the rav-
ages of the disease began to abate. During the preva-
lence of small-pox in this city in 1873 similar measures
were instituted with equally apparent results. Other
cities have had a like experience. It would seem that
such incontrovertible evidence should convince the'nipst
skeptical ; nevertheless, there are those among us;>yho
deny the efficacy of vaccination as a prophylactic, and
denounce it as a most pernicious practice, the outgrowth
of barbarism and superstition. The occurrence of so
unfortunate a case as we are about to relate only affords
the opposition element more plausible grounds for their
arguments, and makes them more bitter in their denun-
ciations.
In the discharge of my duty as a city vaccine jjhysi-
cian, I visited the house of Micliael R- , and vac-
cinated all the inmates whom I did not deem sufficiently
well protected from previous vaccinations. The date of
this occurrence was January 20th. On February 23d,
on my second visit to this locality, I repeated the opera-
tion where it had not been successful in the first in-
stance. Among the number was a white female infant
nine months old, apparently in perfect health, whose
arm bore no signs of the previous operation. Accord-
ingly I repeated it, using this time the National virus
which I had obtained from the Health Department. The
operation was performed in the usual manner, by mak-
ing the abrasion about one-sixth of an inch in diameter,
with the pointed end of the quill, without drawing blood.
(I would state liere that I did not follow these directions
in every instance, as sometimes I would make the abra-
sion nnich more extensive. But I never employed the
lancet while using either the National or Chelsea virus,
both of which were furnislied us by the Health Depart-
ment ; nor did I use the same jjoint a second time.)
Nothing unusual was noticed until the ninth day after
the operation, when the child became fretful and sliowod
signs of fever, accompanied by swelling of the Ijniphatic
glands of the neck and axilla. Siuuiltaneously, a meas-
ley eruption developed over the abdomen and extremi-
ties. The arm api)eared to be paralyzed, and was some-
what swollen, especially in the region of the axilla, while
the skin presented a rough, chafed api)earance, and was
dotted willi ccchymosis extending almost to tlie hand.
The scab had assumed a dark reddish hue, with con-
tracted margins and depressed centre, and did not pre-
sent the characteristic appearances of a genuine vesicle.
The contiguous glands, together with the parotid and
submaxillary, became involved, and showed signs of
suppuration. Convulsions supervened, with an aggrava-
tion of all the other symptoms, on the third day of the at-
tack, being the twelfth after the operation, and the child
died on the thirteenth day.
No constitutional taint could be discovered in the
parents or grandparents, all of whom are living and in
good health. The peculiar circumstances attending this
case render it difficult to account for the unfortunate re-
sult. This is the first case known in medical annals
where a child has died of vaccination in Baltimore. In
my daily rounds as vaccine physician, numerous instances
were recounted to me by the laity in which they at-
temjited to depict the horrors of vaccination. I dis-
credited these reports, believing them to be fabrications
devised by those who denv the efficacy of the Jennerian
method, or who w-ished to oppose it from some other
point of view. Upon further investigation, however, I
have derived information from authentic sources, showing
conclusively that vaccination is by no means free from
danger. I shall not encroach upon your valuable space
in relating the details of cases, but suffice it to say that
the principal abnormal deviations consisted for the most
part of erysipelas, pyjemia, gangrenous ulcers, suppura-
tions, glandular involvements, eruptive disorders, etc. ;
though, perhaps, some of these complications may have
occurred coincidentally, and not as the result of vaccina-
tion. The operation may have acted only as an exciting
agent in arousing a latent predisposition to the disease.
On the other hand, cases have occurred, no doubt,
where the disease was on the point of outbreak, and not
the result of any exciting cause. The following instance
is recorded : For some reason a proposed vaccination
was postponed ; in the interval the infant developed an
inherited syphilis. In this case, as in all other troubles
that happen to appear after vaccination, the parents
would have been only too happy to avail themselves of
a convenient scapegoat for their own infirmities.
As to what may be regarded the most formidable com-
plication following the operation of vaccination, I am
unable to say from personal experience. Apropos to the
subject, however, I shall quote briefly from a few emi-
nent authorities. In Hardaway's "Essentials of Vac-
cination," erysipelas is s[)oken of as a comparatively rare
although one of the most serious complications of vaccinia,
or rather of vaccination. Dr. Ballard makes a wise dis-
tinction between erysipelas after vaccination and erysipe-
las from vaccination. He points out that the disease
may occur as a consequence of the prevalence of general
erysipelas, or may be due to sanitary defects in the
house of the patient. Dr. J. Lewis Smith observes that
the vaccination acts often merely as an exciting cause,
not from any deleterious property in the virus itself, but
just as an equal degree of inflammation might be pro-
duced from a cut, burn, or other indiff'erent agency. On
the other hand, the virus itself may be the direct exciting
cause. A'accinal erysipelas may commence immediately
after the operation, or it may wait upon the development
of the vesicle, or be delayed until the fall of the crust.
Excluding those cases of erysipelas in which the vac-
cination has been merely an accidental factor, it is stated
that the disease is prone to occur from use of revaccina-
tion lymph, from spurious primary cases, or from lymph
taken at too late a period of the vesicle, or, finally, from
lymph which has become partially decomposetl. The
course of the vaccine vesicle is sometimes interfered with
by mechanical influences, such as scratcliing, rubbing of
the clothes, etc. The inflammation under these circum-
stances is apt to be increased, and sujipuration may oc-
cur. The scab which results is composed of large yel-
lowish crusts unfit for use in vaccination. Inflammation
and suppuration of contiguous lymphatic glands are some-
May 26, 1883.]
THE MEDICAL RECORD.
569
times an annoying, although not generally a serious,
complication. Hebra states that occasionally swelling
of the parotid and submaxillary glands occurs after vac-
cination, attended with rather abundant salivation. In
children of a vitiated constitution, when the intiauiniation
surrounding the vesicle has been intense, circumscribed
abscesses may occur. Mr. Savory reports a case of py-
aemia following about the ninth day after vaccination
which resulted in death. Dr. Day records the case of a
[jatient who had wasting of the deltoid and paralysis of
the arm, which he regarded as consequent upon vaccina-
tion.
The foregoing facts would lead us to the conclusion
that we may reasonably expect, as utiavoidable, a small
percentage of mortality, with other untoward results,
consequent upon the operation of vaccination. In view
of this fact, it behooves us, as intelligent and faithful phy-
sicians, to exert our utmost endeavors in combating and
overthrowing those wide-spread notions which are the
outgrowth of skepticism and incredulity, and which are
so prejudicial to the cause we espouse and to-the well-
being of human-kind. It is only through a more ex-
tensive dissemination of knowledge upon this subject,
derived from a careful observation of facts, that we shall
be able to refute those absurd theories which have al-
ready gained favor with the unenlightened. Such incon-
trovertible evidence is needed to restore the confidence
of the wavering, and to disabuse the jjublic mind of those
preconceived and unwarianted conclusions which have
been so universally propagated by the opponents of vac-
cination.
558 West Favette Street.
A CASE OF PARALYSIS OF THE ARM, FOL-
LOWING VACCINATION.
By J. H. POOLEY, M.U.,
PROFESSOR OF Sl'RGERV IN THE TOLEDO MEDICAL COLLEGE.
Eugene S , German, married, aged twenty-two. He
is a finely developed, athletic young man, and has al-
ways been perfectly healthy.
On August s, 1880, he was vaccinated on the left arm
at the usual situation, the insertion of the deltoid muscle,
with the so-called bovine virus. .-V large number of per-
sons—about fifty — were vaccinated at the same time,
and with the same virus, in none of whom did any unto-
ward results follow.
S had a very sore arm ; the vaccine pustule be-
came a large, deep ulcer, witii a wide-spreading areola
of dusky redness, indurated, painful, and tender.
The lymphatics in the axilla were exceedingly painful,
and enlarged to such an extent that it was thought at
one time they would inevitably su|)purate. He had also
pretty severe constitutional reaction, with high fever and
slight delirium.
About September ist, when both the local and consti-
tutional symptoms were decidedly on the decline, he got
up one morning and found his left arm completely para-
lyzed. Though he had formerly been in the habit of
sleeping with this arm thrown up under his head, he had
not, of course, done so for some weeks, owing to its
painful condition.
I first saw him on December i, 1S80 ; his condition
then was as follows : The left upper extremity was still
perfectly paralyzed. When lifted up, and then let go of,
it dropped to his side like a lifeless and inert mass ; he
had not the slightest power to move it, nor any part of
it, not even a finger. There was also complete anaesthesia
and analgesia ; he could not tell when it was touched,
or distinguish between ice and boiling water. A pin
thrust into the limb, or small incisions, were entirely un-
noticed.
This anaesthetic region extended completely up the
arm, and quite up to the top of the shoulder, also over
the pectoral region half-way to the sternum, and behind
as far as the spine of the scapula, ending quite abruptly
at these points. The limb continued to be well-nour-
ished, not even measurement showing any difference in
the size of the two arms, but I thought the muscles were
decidedly flaccid and deficient in tone.
I couUi detect no difference in the pulsation on the two
sides, and the temperature was the same in both axilla;.
The electrical excitability of the paralyzed muscles was
good. The vaccination sore had been well some time,
there was no enlargement in the axilla, and his general
health was first-rate. The palm of his left hand was con-
stantly wet with perspiration, even in the coldest weather,
while the other was quite dry ; there was some of the
well-known "glossy-skin" appearance about the fingers,
but no causalgia, or pain of any kind. A few herpetic
or eczematous vesicles were distributed about the roots
of the nails.
He had no pain of any kind, anywhere, when I saw
him, but had previously had, in addition to that caused
by his sore arm and axillary swelling, darting, lightning-
like pains the whole length of the limb, together with
tingling and pricking sensations.
I advised the hypodermic use of strychnine into the
paralyzed arm, in gradually increasing doses, till some
toxic effects were produced, together with massage, and
faradic electricity.
I saw no more of him till about a year afterward, when
I met him accidentally, and found that he was quite well,
and had been for some months ; he said that he began to
improve soon after I first saw him, and attributes his
recovery mainly to the electricity.
This is certainly a very interesting case, and perhaps
not quite easy of interpretation, though my own opinion
was, and is, that it was a neuritis of some of the nerves
of the axillary plexus, perhaps all of them, brought about
by pressure and extension of inflammation from the en-
larged lymphatics.
The entire absence of more grave general symptoms,
and the peculiar phenomena of the sweating palm, glossy
skin, and vesicles about the nails, seem to nie to establish
the diagnosis. As to the treatment, we must not forget the
element of time, and very likely he would have recovered
with this alone, but what we did was at any rate in the
right direction, and could do no harm.
Toledo, O., May i8, 18S3.
SUTURE-CLAMP COAPTATION.
A New .Method for Closing Wounds.
By J. H, CIPPERLY, M.D.,
medical ASSISTANT, M
ARSHALL INFIRMARY, TROV, N. Y.
To the means ordinarily employed in repairing a lacer-
ated or incised wound — bandages, adhesive strips, sur-
gical pins, and the various sutures— another, a new and
facile method, is obtained with what I am pleased to
call, in the want of a better term, a suture-clamp. Made
of hard silver wire, bent at acute angles at both ends,
the extremities of the arms sharpened to a point, the in-
strument is pictured thus :
V"^
One hand supports the severed parts together, while
the other introduces a clamp, penetrating one lip at a
time, and introducing a clamp at regular distances until
the coaptation is complete. Their position is retained
by the tight grasp of the skin and tissues on the arms of
the clamps, supplemented by the inclination of the arms
toward each other. A moment's consideration of the
advantages of this method : the most striking are the ease
and rapidity with which you close the wound. A single
instrument is all there is at hand ; you do away with
needle, wire, needle-forceps, scissors, and the trouble
accompanying them. In the closure of the wound there
is less constriction to the lips than results in the use of
570
THE MEDICAL RECORD.
[May 26, 1883.
sutures or pins, where the svvelHng often causes a tearing
out ; thus is aided the better work of repair. The arms
of the clamp sustain both walls, so that the deeper parts
of the wound conjoin, and there is less opportunity for
the pocketing of blood and pus, and more rapid healing.
Again, there is the minimum of pain attending their in-
troduction,and they are removed without pain, and may
be used again. Made of various sizes (usually required
but three or four), their application is general. With
short arms they may be used in scalp wounds and over
bony places. In wounds where there is contusion and
laceration and gaping, long clamps reaching across will
produce a partial union at least, otherwise not attained.
The first application was made in the case of an injury
where the toes and portions of the metatarsal bones
were removed, a buzz-saw accident leaving a single flap
from the plantar surface of the foot, and rather short to
cover the e.icposed bones. Five clamps were applied
that closed the wound, and were allowed to remain six
days, when adhesive plaster was brought into play, as the
wound was healing by granulation. In this first instance
their ready, time-saving usefulness was at once clearly
demonstrated. This occurred in March, 1882, and I
have since made use of them repeatedly, and with the
uniformity of repeated satisfaction in their success.
Suture-clamp for 7O0unds. — 1. Is a new method.
II. Is made of hard silver wire by preference.
III. Has advantages: i, Of rapidity in application;
2, of a single instrument at hand ; 3, of less constric-
tion ; 4, of better coaptation ; 5, of but little pain on
introduction and removal ; 6, that it may be used again ;
7, of partial union in gaping wounds.
IV. First used in March, 1882.
DOUBLE IDENTITY AFTER TREPANNING.
By J. N. McCORMACK, M.D.,
BOWLING GREEN, KV.,
PRESIDENT OF THE KENTUCKY STATE MEDICAL SOCIETY, AND MEMBER OF THE
STATE BOARD OF HEALTH OF KENTUCKY.
C. W , an American farmer, aged twenty-three years,
was brought to .me in March, 1881, for examination as
to his mental condition, that I might testify before
a jury, which his friends had requested, as they de-
sired to send hun to a lunatic asylum. He was brought
from the country in an open wagon by his wife and
two friends, and from them was learned the foUowino-
history : When fifteen years of age, and while engaged
as a "striker" in his father's blacksmith-shop, he was
struck on the head with a pointed hammer and felled to
the floor, was unconscious for several hours, gradually re-
covered, and after a few weeks, suffered no noticeable
inconvenience from the injury, although a marked de-
pression of the skull remained. This occurred in Allen
County. Two or three years later he came to the com-
munity in which he now resides, was married when
nineteen years of age, purchased a farm shortly after-
ward, and all this time presented no mental peculiarity
which was sufficiently marked to attract attention. Six
months before he was brought to me he began to com-
plain of pain and tenderness in the seat of the old
wound, and about the same time began to exhibit indica-
tions of mental derangement. At first he was morose
and sullen, but later became maniacal and difficult to
restrain, and for several weeks had had no lucid interval.
He had eaten but little, his sleep had been much dis-
turbed, and he had lost strength and flesh rapidly. At
the time I saw him he was emaciated and cachectic in
appearance, with furred tongue ; pulse, no; temperature,
g8°. He was very nervous and impatient of restraint,
and presented all the symptoms of acute mania. There
was a deep depression, about the size of a silver quarter,
at the junction of the sagittal with the coronal suture, and
the scalp in the vicinity of the depression was so sensitive
that it was examined with great difficulty. The man was
evidently in no condition to be sent to an asylum, and
was returned to his home a short distance in the country.
On the following day the operation of trepanning was
performed in the presence of Drs. Porter, Murray, Neale,
and Meredith. At first a section of bone was removed
with a large trephine, and as this did not include all the
internal depression, a second section was taken out
which slightly lapped into this ; still a corner remained,
which was removed with bone forceps. The membranes
were not injured, and the dura mater appeared healthy.
The wound was closed, except at the posterior part,
which was left open for drainage. The recovery was
rapid, and the relief of the mental derangement was im-
mediate and permanent. He gained strength and flesh
rapidly, and in a few weeks appeared to be in perfect
health.
Immediately following the operation were developed
those curious mental phenomena which gave special in-
terest to the case. The man seemed to be impressed
with the idea that he had just recovered from the eftects
of the blow on the head, and although he talked freely
of his history up to the time of the accident, seemed to
have no recollection of any event of his life from this time
until he was relieved by the operation. He said that he
did not know his wife, or that he had a wife ; his neigh-
bors were strangers to him, and his business transactions
in connection with the purchase of his farm could only
be understood after an examination of the deeds and
full e.xplanation. He seemed to be entirely ignorant of
his former surroundings, and had to learn the roads of
his neighborhood like any other stranger. Some of his
friends were sceptical in regard to these things, and many
tests were made of their truth. His answers were frank
and candid, and he always said that he was totally unable
to recall anything occurring in this period of his life.
When it is remembered that while a man of fair intelli-
gence, that his education was very limited, and that he
had never heard of a similar case, it is more difficult to
believe that he could manufacture and be consistent in
such a story than to believe the story itself. His friends
all concurred in saying that there had been a marked
change in his general demeanor since the operation.
While always industrious and sober, he had been rather
boisterous and turbulent in disposition, which was in
striking contrast with his quiet manners since the opera-
tion. It is to be regretted that the man was not highly
intellectual and accustomed to describing his methods of
thought, as the interest of the case would be greatly in-
creased by minute mental details.
GoNORRHCEA OF THE Rectum. — Thiry {Presse Med.
Beige) believes in the reality of gonorrhceal inflammation
of the rectum, an affection which is not recognized by
many authors. In su|)port of his opinion he relates the
following case : A woman, aged twenty-four, a clandes-
tine prostitute, was admitted into the Hopital St. Pierre,
Brussels, complaining of weight and shooting pain in the
pelvis, pain in defecation, and a constant thick discharge
from the bowel. Walking also was difficult. On exami-
nation, there was a well-marked funnel-shaped depres-
sion of the anus, the anal folds were obliterated, and the
sphincter was weak and dilated. .\ vaginal speculum of
ordinary size passed easily and without causing pain.
On washing away the abundant thick discharge, the
lower portion of the rectum was seen to be acutely in-
flamed and studded with bright red points, which bled
when wiped with wool. The follicles in the rectal folds
were enlarged and discharged pus. The patient con-
fessed that she had had relations with men who were suf-
fering from clap. .Solution of borax was used locally at
first ; afterward red cinchona bark was applied to the
mucous membrane, and, finally, an injection of oak-bark
was used. Under this treatment, combined with sitz-
baths, and the mternal administration of iron, the woman
recovered in about three weeks.
May 26, 1883.]
THE MEDICAL RECORD.
571
'^xoQVCss 0f ^jedical Science.
Peculiar Disturbance of the Capillary Circula-
tion.— At a recent meeting of the Harveian Society, Dr.
Broadbent showed a patient who was suffering from a pe-
culiar disturbance of the capillary circulation. Eight years
ago he had a sunstroke, which for a time rendered him
insensible ; previously to this, he had frequently suffered
from pain in the occipital region and vertigo, which since
that time had been much aggravated. Seven weeks ago,
while looking over a bridge, lie was seized with a sudden
and violent pain in the back of the head, and intense
giddiness, upon which supervened unconsciousness, last-
ing for fifteen minutes ; since that time he had had many
similar attacks, as many as three or four a week. He was
a man aged forty-six, somewhat deaf, and with a con-
fused manner when spoken to. The patellar tendon re-
flex was increased, especially on the left side, ankle-
clonus was absent ; there was slight loss of sensibility in
the lower extremities. On speaking to the patient a
blush appeared on the face, which extended over the
chest and back, and lasted several minutes, leaving a
mottling of the skin which somewhat resembled roseola.
The /a/r/i£ cen'brale was unusually well marked, a line of
vivid redness appearing in the track of the finger-nail
drawn over the skin ; myoidema was also present, though
not in so marked a degree as when the patient first came
under observation. Dr. Broadbent stated that this was
a condition occasionally seen when the nervous system
was broken down by overwork and strain. The tache c&r-
brale was most frequently seen in tubercular meningi-
tis, but it was often present in other acute cerebral dis-
eases, and sometimes in enteric fever ; its recurrence in
association with prostration of the nervous system with-
out fever was interesting. He was reminded of cases in
which artificial urticaria could be produced by very slight
irritation, but he had seen this in robust health, and it
appeared to be congenital. Myoidema was most com-
mon in phthisis, and in the late stage of enteric fever,
and was generally indicative of wasting under fever. In
the case before the meeting, however, there was no his-
tory of any febrile condition. It might possibly have been
due to insufficient food, which, during the siege of Paris,
had given rise to myoidema on a large scale. Dr. Broad-
bent had once seen this condition in a single muscle, the
right trapezius, in a case of aneurism of the aorta.
Are Phthisis, Bronchitis, and Pneumonia Epi-
demic Diseases ? — At the last meeting of the Epidemio-
logical Society (British Medical Journal, April 21,
1883), Dr. Longstaffe presented an interesting report
touching the above question.
The author explained that his object was to examine
the Registrar-General's returns in such a way as would
make clear their bearing on the solution of the question
propounded. As in previous papers relating to summer
diarrhcea and the diseases allied to erysipelas respect-
ively, he exhibited diagrams graphically representing the
death-rates for England and Wales from the diseases in
question, and certain others in various ways allied to
them, during a period of twenty-five years. He also
showed the same death-rates in London for thirty-three
years, compared with a curve expressing the number of
cold days in each winter. One diagram showed that the
death-rate curve of phthisis deviated very little from a
straight line, resembling in this respect those for cancer,
apoplexy, paralysis, convulsions, and fractures. The
curves of tubercular meningitis, and to a less degree
tabes mesenterica, resembled the phthisis curve. The
death-rate from phthisis had fallen twenty per cent, dur-
ing the last twenty years. The bronchitis curve exhib-
ited considerable fluctuations, but, on the average, it
had risen eighty-one per cent, during twenty years.
Pneumonia gave a curve closely resembling that of
bronchitis in many respects, but the average mortality
had fallen twenty per cent.
The total mortality from all diseases of the respira-
tory organs, together with phthisis, showed an increase
of five per cent., indicating that probably many deaths
formerly returned as due to phthisis or pneumonia were
now classed with bronchitis. Pleurisy appeared to be
more allied to rheumatism than to respiratory diseases.
From the curves relating to deaths in London, it ap-
peared that bronchitis and pneumonia coi responded with
the coldness of the winters, but not so closely as might
have been expected. Phthisis was but little affected.
Curves derived from Messrs. Buchan and Mitchell's
paper on "The Influence of Weather on Mortality,"
showing the average weekly fluctuations of the death-
rates from various causes in London during thirty years,
strongly confirmed the author's conclusions, with the
single exception of tabes mesenterica, which gives an
entirely different curve from that of phthisis. In another
diagram were exhibited the weekly fluctuations of the
deaths from bronchitis and pneumonia during the last
five winters in London, and their relation to cold; also
the same for phthisis during two of the winters. 'I'his
diagram showed clearly that the death-curve of pneu-
monia had a general corresijondence with the death-
curve of bronchitis ; but it differed in two particulars :
the fluctuations were much less, and while it rose in the
autumn as rapidly, it fell in the spring more gradually.
The author's main conclusions were these : i. The mor-
tality statistics of England and Wales did not give any
evidence in favor of the view that phthisis is com-
municable ; but they showed, on the other hand, that
weather had very little influence on the death-rate of
phthisis. 2. While bronchitis and pneumonia were both
greatly influenced by meteorological conditions, it was
difficult to explain by those conditions only all the phen-
omena. 3. Common catarrh was a comnumicable dis-
ease ; and it was probable that very many cases of
bronchitis and pneumonia might be looked upon as com-
plications of that or some similar disease of mild charac-
ter when uncomplicated. 4. The different incidence of
bronchitis and pneumonia on the two sexes pointed to
some difference in the causation of the two diseases.
5. There would appear to be some common factor in the
causation of phthisis and tubercular meningitis.
A New Sign of Pregnancy. — -Dr. Jorisenne claims
to have discovered a new and certain sign of pregnancy,
even in the first months. It consists in an unchanging
frequency of the pulse, in the three positions of standing,
sitting, and lying. I Normally, the pulse-rate varies in
these three positions, but in pregnancy, even at the first
month, this variation is not observed. The same con-
dition, he states, is observed only in cardiac hypertrophy.
Other changes in the genital apparatus, such as tumors,
are not marked by this phenomenon. An explanation of
this peculiarity is thought by the author to be either in
changes in the blood, producing disturbances of the circu-
lation, or in hypertrophy of the heart. The latter is as-
serted to be a physiological condition in pregnancy by
many authors, but denied by others. — Deutsche Medicinal-
Zeitutig, March 8, 1883.
Ergot as a Preventive of the Poisonous Effects
OF Salicylic .\cid. — Dr. Schilling recommends the ad-
ministration of ergot in conjunction with salicylic acid or
quinine, to obviate the unpleasant effects of those drugs.
He had observed, in a number of cases in which large
doses of salicylic acid were taken, a marked congestion
of the external auditory canal and membrana tympani.
He was thus led to give ergot to cause a contraction of
the vessels, and obtained in every case a cessation or
notable diminution of tinnitus and deafness. The dose
of ergot (aqueous extract) should be about one-tenth
that of the salicylic acid. The antipyretic effect of the
latter is not weakened by the ergot. Like favorable re-
sults were obtained by combining ergot with quinine. —
Allgcin. Med. Central-Zeitung, March 21, 1883.
572
THE MEDICAL RECORD.
[May 26, li
The Medical Record
A Weekly yournal of Medicine and Surgery.
GEORGE F. SHRADY, A.M., M.D., Editor.
Published by
WM. WOOD & Co., Nos. 55 and 58 Lafayette Place.
New York, May 26, 1883.
THE ACTIONS AND USES OF ATROPJA.
One of the physiological effects of atropia is diminution
or arrest of various secretions. Thus dryness of the
mucous membranes of the throat, mouth, and nares has
been noted after the ingestion of this drug. The secre-
tory function of the skin is also suspended. Therapeutics
has taken advantage ol this moderating action on secre-
tion. Thus, in the treatment of coryza, Dr. Gentil-
homme, of Geneva, taking his departure from the fact
that atropine diminishes the secretion, even causes dry-
ness of the nasal mucous membrane, prescribes pills, con-
taining each one-half milligramme of sulphate of atropine.
At the onset of the coryza one pill is taken, and in an
hour's time the sneezing will have ceased, the secretion
will have disappeared, and the respiration become free.
Sometimes a quarter of a milligramme {^-^ grain) is suf-
ficient to produce this result. In chronic bronchitis the
same favorable result has been obtained. In profuse
salivation, from mercury, pregnancy (reflex salivation),
etc., Gabler has derived benefit from atropine in minute
doses ; he prescribes powders of atropine, containing
each one-quarter of a milligramme rubbed up with white
sugar; one powder may be taken every four hours till
the physiological effects of the drug are experienced.
This same authority has prescribed atropine with suc-
cess in catarrhal diarrhoea, giving from one-fourth to one-
half a milligram every five hours till toxic manifestations
appeared. There is, perhajjs, no better remedy with
which to combat the profuse night-sweats of phthisis. As
an anhydrotic it has a high place in the practice of physi-
cians all over the world. Dr. J. Alilner Fothergill re-
commends doses varying from the seventy-fifth to the fif-
tieth of a grain. Vulpian (" Clinique Med.," j). 338) ad-
vises pills of sulphate of atropine, each containing one-
half milligramme. Of these, two pills, one hour apart,
in tlie evening. If this is not sufticient, give anotiier
about the middle of the afternoon. It is rare, he says,
that more than three pills a day are necessary.
Bartholovv, who prefers atropine to any other remedy
for night-sweats, is much in the habit of prescribing a
pill of jJo of a grain three times a day; besides acting
as an anliydrotic it facilitates respiration.
That well-known sedative action which atropine exer-
cises on the peripheral terminations of nerves, and on the
elements of tlie nerve-centres, may, irrespective of any
supposed constrictive effect on the vaso-motors — which
is an effect by no means constant — explain the use of
this medicament in aff'ections of the cerebro-spinal ner-
vous system characterized by phenomena of excita-
tion, such as pain, spasm, convulsions, epilepsy. By
this sedative action Gabler (also Trousseau and Pidoux)
account for the remedial efficacy (so often noted) of bel-
ladonna and its alkaloid in rheumatismal and other inflam-
mations of the spinal cord and its membranes. Under
the influence of this drug, the pain and numbness and
contracture of the extremities often give way rapidly.
In nocturnal incontinence of urine, atropine, by allay-
ing irritability of the muscular fibre of the bladder, or
producing stupefaction of the mucous membrane of that
viscus (eminent authorities, as Gabler, believe that both
effects are brought about as the result of the physiologi-
cal action of the drug) proves an mvaluable remedy.
One grain of sulphate of atropine may be rubbed up
with one hundred grains of white sugar and divided into
a hundred powders. Of these, one may be taken at bed-
time by a child twelve years old. Or one drop may be
given at bedtime of the solution of sulphate of atropia
of the British Ph., which consists of two grains sulphate
of atropine to half a fluid ounce of distilled water. If
this should be inefficacious, the second night two drops
of the solution may be administered, which will, with-
out doubt, give the physiological effect of the medica-
ment. The dose must gradually be increased according
to the necessity of the case.
In pertussis, one of the best remedies is sulphite of
atropia, and, given according to Bartholow's formula, it
is sure to give relief in the spasmodic stage where there
is profuse bronchial secretion. One grain of sulphate of
atropine is dissolved in an ounce of cherry-laurel water ;
of this two drops may be given three or four times a day.
We have used this remedy with advantage in whooping-
cough in the form of spray ; the liquid in the atomizing
cap of a spray-producer or steam atomizer being charged
with five drops of Bartholow's solution. Atropia has a
remarkable sedative or stupefying effect in irritable
nerve-terminations when applied locally, and the quan-
tities of the medicament that may be used with benefit
are really infinitesimal. The above solution makes a
good liniment m painful neuralgias, but must not be
rubbed about the orbit for obvious reasons.
These are some of the uses of this valuable medica-
ment. We have not referred to its use as a local ano-
dyne and mydriatic in ophthalmic practice ; probably
no drug is in higher repute with ophthalmologists.
Properly managed, there is scarcely a remedial agent
in the Materia Medicathat will be of such real service to
the physician, but it needs to be used with great care and
judgment.
TRANSFERRED IMPRESSIO.NS AND "TELEPATHY."
Almost every physician, during the course of his pro-
fessional life, hears stories regarding clairvoyance. Some
individual has had a vision or dreamed a dream which
is subsequently found to have represented, most mar-
vellously, actual objects or persons that were at the
time far away.
An organization in London has been investigating the
alleged phenomena of this class, endeavoring to apply
scientific methods to their study. The Nineteenth Cen-
tury and the Fortnightly Review have at different times
May 26, 1883.]
THE MEDICAL RECORD.
573
published some of the results of this work. Quite re-
cently the latter journal has published an article by Mr.
Edmund Gurney and Mr. Frederick W. M. Myers,
claiming very positively that the mind may at certain
times be capable of receiving impressions through other
channels than those of the various senses ; in other
words, that the so-called clairvoyance is an actual physi-
ological fact. The phenomenon is described as a trans-
ference of impression, and is somewhat different from
thought-reading, no evidence being here given tliat a
train of ideas or an intellectual process can be thus
" transferred."
The authors in question have collected a large amount
of what they consider evidence for their view, this evi-
dence consisting in stories told to them by persons whose
character they in most cases have investigated.
The number of these stories is, we are told, enor-
mous, and they all tend to prove the same thing, so that
even if singly they might be doubted, collectively their
weight as evidence is overwhelming.
In describing the phenomena certain technical terms
are adopted. The person who receives the impression
is called the percipient, the person who causes it, the
agent. Now it is found that when the transference takes
place, one or other of the persons is generally in an ab-
normal or unconscious condition ; e.g., in a state of
trance or of sleep, or at the point of death, or under the
influence of some powerful emotion. The cases are
therefore classified in accordance with the condition of
the agent or percipient, h^ an example of the class of
phenomena alleged to be real we append the following :
" One Sunday night last winter, at i a.m., I wished
strongly to communicate the idea of my presence to two
friends, who resided about three miles from the house
where I was staying. When I next saw them, a few
days afterward, I expressly refrained from mentioning
my experiment ; but in the course of conversation one
of them said, 'You would not believe what a strange
night we spent last Sunday,' and then recounted that
both the friends had believed themselves to see my figure
standing in their room. The experience was vivid
enough to wake them completely, and they both looked
at their watches, and found it to be exactly one o'clock.'
(One of these friends has supplied independent testi-
mony to this circumstance.)"
We have ventured to furnish our readers this account
of the work of these gentlemen because of the strong
endorsement that has been given to it, and because of
its important physiological and pathological significance.
If it could be proved that the mind can perceive through
other agencies than the senses, it would establish a fact
which would antagonize the present physiological theo-
ries (based upon evolution) of the development of these
senses ; for it is now believed that they were de-
veloped in order to enable the animal to adapt himself
to his environment. They were made by the environ-
ment primarily, rather than/(?r it, and in the history of
animal evolution there are absolutely no data which en-
able us to account for the development of a supersensual
perceptive power.
The evidence collected by Messrs. Gurney and Myers
is not of the kind, as so far presented, to bring positive
conviction, despite their positive claims. The stories.
many of them, are second hand ; they are for the most
part told by women, and sometimes by children. Some
of them were first narrated a hundred years ago. The
element of unconscious exaggeration appears to be
taken but little into account. Furthermore, the possi-
bility of coincidence is of itself almost enough to explain
them. Thousands upon thousands of dreams and visions,
impressions and presentiments are occurring constantly.
We hear from those which turn out to be true, but not
from the others. Despite all this, however, the inquiry
is a most interesting one, and if it finally ends in explain-
ing in any way the extremely numerous stories of thought-
reading and clairvoyance, a large element in the world's
uneasiness will have been removed.
Cews of ttxc "S^ecli.
The Annual Meeting of the Alumni Association
OF THE College of Physicians and Surgeons —
Donation of Ten Thousand Dollars. — The Cart-
wright Prize of five hundred dollars of the Alumni Asso-
ciation of the College of Physicians and Surgeons of
this city, was awarded to Dr. Walter Mendelsohn, for an
essay entitled : " Circulation in the Kidney during
Fever." The experiments upon which the essay was
based were performed at Leipzig under the direction of
Cohnheim. It was voted to advertise the Cartwright
Prize more extensively in the future, for the purpose of
securing more and better competing essays.
The president announced that Mr. James T. Swift had
given, under certain conditions, the sum of ten thousand
dollars to the association as a fund for the purchase and
care of physiological ap]:)aratus, to be used by and under
the care of the professor of physiology of the college.
The sum is given on condition that the college secure a
new building in which shall be a suitable room for the
apparatus in question. The fund is established in
memory of Mr. Swift's brother, the late Dr. Foster Swift,
formerly assistant professor of obstetrics in the college.
The Alumni Association now possess six different
funds for various objects. Three of them amount to
about ten thousand dollars, and one to nearly twenty
thousand dollars. It is, therefore, prob.ably the richest
association of the kind in the country. Effort is being
made to increase the fund for the support of the physio-
logical and pathological laboratory. Most of the work
in this laboratory is that of elementary instruction in
histology and morbid anatomy, and it is to be regretted
that it does not or cannot offer opportunity for higher
scientific labors.
The association re-elected its present officers.
The Moses Taylor Hospital.— The work on the
new Moses Taylor Hospital, which is to be built on an
eminence overlooking Scranton, Pa., on ground given
by the Lackawanna Iron and Coal Company, is to be
begun about June ist, under contracts based upon plans
made by Mr. Carl Pfeiffer of this city. A group of build-
ings in the Queen .Anne style has been planned to cost
$300,000. It is expected that Mr. Percy D. Pyne and
the heirs of the Taylor estate will add 8200,000 to the
endowment fund given by Moses Taylor, and it is ru-
574
THE MEDICAL RECORD.
[May 26, 1883.
inored that the Delaware, Lackawanna and Western
Railroad Company, and the Lackawanna Iron and Coal
Company will arrange to further increase the endowment
by $1,000,000.
Regulating the Practice of Medicine in Min-
nesota.— We have received a copy of the law which has
recently been enacted regulating the practice of medi-
cine in Minnesota. It provides that the Faculty of the
Medical Department of the Universities of Minnesota
shall organize as a Board of Examiners. All persons
who practise medicine in the State must present their
diplomas to this Board for verification, or if they have no
diploma must submit to examination in order to receive
a license.
There is nothing said regarding the character of the di-
ploma, which presumably need only be a medical diploma
from a medical college of any kind.
A Doctor without a License. — Dr. O. C. Gage, who
was arrested at Dover, N. H., for practicing medicine
without a license from a New Hampshire medical society,
has been discharged without costs. The defendant
showed that a license was refused him only because he
advertised in papers and did an itinerant business.
The inference is that the laws against charlatanry in
New Hampshire are very weak.
Quarrel Among the Johns Hopkins Trustees. —
A minority of the Trustees of the Johns Hopkins Univer-
sity, led by Mr. Garrett, have published a circular stating
that the funds and work of the University have not been
properly directed. It is claimed that the buildings should
be erected at Clifton, outside the city, also that too much
money has been spent in salarying professors. These
charges are denied.
Disease in Connecticut. — The April report of the
State Board of Connecticut shows an increase in respira-
tory and malarial diseases. Measles is quite prevalent.
One case of small-pox occurred not long ago.
The Death of Dr. Benjamin Wills Richardson, of
Dublin, is announced. Dr. Richardson was a i)hysiolo-
gist and histologist of high repute. This is not Dr. Benj.
Ward Richardson, of London, who is perhaps more
widely known.
Fire in the Harvard Medical School's New
Building. — A fire took place in the new building of the
Harvard Medical School recently, but it w-as confined
chiefly to the amphitheatre, the building being fire-proof.
The damage amounted to about $2,000, which does not
fall on the college, as the building had not been handed
over to the trustees.
New Insane Asylums. — Geneva, 111., has ap[)ropri-
ated $12,000 to erect a county insane asylum ; also Ra-
cine, Wis., is going to have an insane hospital.
Dk. W. E. Quine, one of the ablest jjrofessors of the
Chicago Medical College faculty, has resigned his chair.
Removal of the United States Marine Hospital
at Bedloe's Island. — The temporary buildings on Bod-
ice's Island, now used as a United States marine hospi-
tal, being insufficient for the jnirposes required, the hos-
pital authorities have leased the Seamen's Retreat at
Stapleton, Staten Island, from the Marine Society. A
few alterations will be necessary in the new quarters,
but in most respects the buildings at Stapleton, which
are of stone, are greatly superior to the temporary ones
on Bedloe's Island. The grounds of the Seamen's Re-
treat are very fine and extensive, and have a large water
front.
Forbidding the Sale of Tobacco to Boys. — The
New Jersey State Legislature has passed a law forbidding
any person, knowingly, to sell cigarettes or tobacco in
any form to any minor under sixteen years of age.
^U^povts of Societies.
CONNECTICUT MEDICAL SOCIETY.
Ninety-secotid Annual Convention, held at Hartford,
Conn., May 23 and 24, 1883.
(By Telegraph to The Medical Record.)
The Ninety-second Annual Convention of the Connec-
ticut Medical Society was held at the City Hall, Hart-
ford, Wednesday May 23d, commencing at three o'clock.
The President, Dr. Wm. G. Brownson, after welcom-
ing the Society and alluding to the results they should
endeavor to achieve, presented the following suggestions
for consideration.
president's address.
That a committee should be chosen to report on the
legal status, and a revision of the charter and by-laws,
the term of office of the Secretary, which should be per-
manent, and like topics. A board of councillors was ad-
vised, to be made up of all ex-presidents, who should be
a board of censors also, and jirocure suitable literary
exercises, etc. An increase of fellows was advised to
correspond with the increased membership of the Society.
He announced, with regret, that from press of other du-
ties Dr. Chamberlain could not longer serve as secre-
tary, and spoke of the prosperity of the Society dur-
ing his eight years' service ; notwithstanding the loss of
eighty-five members by death, the Society had gained
over a hundred members, and the balance in the treasury
had never been more satisfactory. All was largely due
to his labors as the chief executive officer of the Society.
The increase of new remedies was mentioned as unduly
large, and stated that the temptation to use them to the
exclusion of reliable remedies was often carried so far
as to result in detriment to the patient. He advised a
committee of four to report on new remedies. The ten-
dency to exalt specialists at the expense of the general
practitioners was deprecated. He commended, in the
highest terms, the results achieved by the State Board of
Health, particularizing many special points. The vexed
question of the code of ethics was gracefully touched
upon, with the conclusion that soon it would be abol-
ished, having outlived its usefulness, but that time was
not yet.
On motion of Dr. Wile committees were elected to
carry into effect the recommendations of the President,
and they reported appropriate measures.
The committee on the
society's charter
was, on motion of Professor Carmalt, selected by the
Fellows from each county, who each (iroposed one mem-
ber, this committee to report to a special meeting at the
call of the President.
There was a lively discussion on the need of any
charter and upon the relations of the society to the Med-
ical Institution of Yale College bv Professors -M. C.
May 26, 1883.]
THE MEDICAL RECORD.
575
Wliite, S. G. Hubbard, and Dr. C. W. Chamberlain and
others.
The Committee on Unfinished Business reiiorted a
by-law assigning duties to county censors, which was
adopted.
The Committee on Miscellaneous Business reported, in
reference to voluntary papers, that it was the duty of the
Committee on Publication to decide upon their publica-
tion or rejection, but it should be upon the merits of the
pajiers solely.
The Treasurer reported an increase of $40 in receipts
from those of last year, a decrease expense of $76, and
a balance of $638 — an increase of $200 over that of last
year very nearly.
This increase was due largely to Dr. W. S. Holmes, of
Waterbury, who had collected all the arrears in his
coimty. There was about one hundred dollars due
nearly all collectable, if not all.
OFFICERS ELECTED.
The Nominating Committee reported the following
officers who were duly elected : President — Dr. E. B. Nye,
of Middletown ; Vice-President — Dr. B. N. Comings, of
New Britain ; Treasurer — Dr. E. P. Swasey, of New
Britain ; Secretary — Dr. S. B. St. John, Hartford : Com-
mittee on Matters of Professional Interest— Tir^. W. C.
Wile, J. H. Grannis, and E. C. Kinney ; Dissertator —
Dr. N. E. Worden ; Alternate— \\ . H. Holmes.
When
THE DELEGATES TO THE NEW YORK MEDICAL SOCIETY
was reached it was moved to
LAY THEIR NOMINATIONS ON THE TABLE,
which was carried, after a short discussion or rather brief
statement of the reasons for such actign, which was, in
brief, viz., the attitude of the New York Medical Society
toward the American Medical Association.
Professor S. G. Hubbard presented the report of
the Committee on the Revision of
THE LAW RELATING TO CORONERS.
He stated that there had been no definite plan agreed
upon, but all the members had worked hard and effi-
ciently, each in their own way, and the result was one
the Society and State might well be proud of, as the need
of such action was notorious.
Dr. Chamberlain spoke of the work done by Drs.
Porter and Cleaveland, both of which had, at their own
expense, visited Boston several times to learn the details
of the working of the Massachusetts law, and thus
secured all the results of their experience. The law ajj-
parently was an improvement over that law in many
respects, while like it in most essential respects.
Dr. Porter presented copies of the law to the So-
ciety, and spoke of its peculiar points of merit.
The Committee on Honorary Members reported the
name of Dr. John I. Billings favorably, and he was elected
unanimously.
Dr. J. E. Reeves, of Wheeling, West Va., and Pro-
fessor T. A. Emmett, were proposed for honorary mem-
bership.
The following were elected members of the Commit-
tee on revision of the charter, etc. : Dr. C. W. Cham-
berlain, Professor W. H. Camall, Dr. E. N. Bramman,
Dr. G. F, Lewis, Dr. H. W. Bull, Dr. E. A. Hill, Dr.
G. W. Burke, Dr. A. R. Goodrich.
the army medical MUSEUM AND INDEX CATALOGUE
OF surgeon-general's office
were endorsed emphatically in a series of resolutions,
which the secretary was directed to send to every mem-
ber of Congress from this State. The general idea of a
medical register of New England, as proposed by the
Massachusetts Medical Society, was endorsed in general,
without entering into details.
Dr. W. C. Wile, Professor W. H. Camalt, and Dr.
Charles Gardiner, the Committee on Increase of Fellows,
and making ex-Presidents a Board of Counsellors, etc.,
repotted that the by-laws should be so changed as to ac-
complish this. That the secretary should receive yearly
fifty dollars, the treasurer twenty-five dollars, and that
the number of P'ellows should be increased by seven-
teen, so that fifty-five should be elected in place of thirty-
eight, as now. They also advised that the secretary
should be a permanent office. The report was accepted,
and the proposed amendments referred to the next Con-
vention for action.
It was voted that the annual tax should be two dollars,
payable on and after June ist ; also that seven hundred
copies of the proceedings should be published.
The Committee on Business reported favorably on the
following, which were passed.
AMENDMENT TO BY-LAWS : THAT NO VOLUNTARY PAPER
BE PUBLISHED THAT HAD NOT BEEN READ BEFORE
SOME COUNTY SOCIETY.
By rule, this lays over a year.
Resolved, That the Legislature be memorialized by the
Secretary to pass a law that
NO PROPRIETORY OR PATENT MEDICINE BE SOLD
in this State, unless there was plainly printed upon the
label the formula, with a heavy penalty if the contents
do not prove true to formula.
Resolved, That no resolution shall be received by the
Secretary unless it be plainly and legibly written.
That all persons making remarks upon any subject
should write them either before or after delivery, and
that the Secretary be directed to procure, at expense of
the Society, lap-tablets for this purpose.
The Auditing Committee reported the treasurer's re-
port correct.
It was voted that each county society elect two fel-
lows to serve on the Nominating Committee, the second
as alternate ; also that each such society elect alternates
for every fellow.
The Society then adjourned.
Wednesday evening, the Hartford Medical Society
gave a reception at the United States Hotel, which was
largely attended, and proved a pleasant occasion.
Thursday was the general meeting for literary exer-
cises, commencing at 9 a.m.
THE AMERICAN LARYNGOLOGICAL ASSOCI-
ATION.
The Fifth Annual Congress, held in Ne^v York, May
21, 22, and 23, 1883.
Monday, May 2 ist— First Day— Morning Session.
The Association met in the Hall of the New York
Academy of Medicine, and was called to order at 10
a.m. by the President, Dr. George M. Lefferts, of
New York.
The Secretary, Dr. D. Bryson Delavan, of New
York, then called the roll.
The following P'ellows were in attendance : M. J.
Asch, New York ; F. H. Bosworth, New York ; S. H.
Chapman, New Haven ; J. Solis Cohen, Philadelphia ;
W. H. Daly, Pittsburg ; T. A. De Blois, Boston ; F.
Donaldson, Baltimore ; J. H. Douglas. New York ; W.
V. Duncan, New York ; L. Elsberg, New York ; T. R.
French, Brooklyn ; W. Gleitsman, New York ; U. G.
Hitchcock, New York ; E. Holden, Newark ; F. H.
Hooper, Boston ; E. F. Ingals, Chicago ; F. L. Ives,
New York ; W. C. Jarvis, New York ; S. Johnston, Bal-
timore ; R. H. Kealhofer, St.- Louis ; F. I. Knight, Bos-
ton ; S. W. Langmaid, Boston ; R. P. Lincoln, New
York ; G. W. Major, Montreal ; E. C. Morgan, Wash-
ington ; D. N. Rankin, Alleghany ; Beverley Robinson,
New York ; J. O. Roe, Rochester ; C. Seller, Philadel-
5/6
THE MEDICAL RECORD.
[May 26, 1883
pliia: A. H. Smith, New York; and Clinton Wagner,
New York.
Tiie ex-Presidents of tiie Association were invited to
seats upon the platform.
The President then delivered
THE ADDRESS OF WELCOME,
in which he greeted his colleagues and fellow-workers
with cordiality and extended to them the right hand of
fellowship and a most hearty welcome.
With reference to an inaugural address, Dr. LetTerts
departed from a custom sanctioned by long usage, and
omitted it, believing that the time thus usually spent
could be much more profitably consumed in scientific
discussion. A few words of congratulation were then
said concerning the marked prosperity of the Associa-
tion, the fact that the constitutional limitation of mem-
bership had already been reached, urging emphatically
that the limitation should not be extended, and suggesting
that it was no more than fair that the few drones which were
in the hive should give place to those v/ho were willing to
assume the work and responsibilities of active fellowship.
After thanking the Association for the honor conferred
upon him by electing him to the high office, the Presi-
dent referred to the social influence of the organization,
bade his fellow-workers God-speed, and then proceeded
to the regular order of business, which was the reading
of papers.
A motion, limiting the time to be occupied by each
speaker participating in the discussions to five minutes,
was adopted without dissent.
Dr. George M. Lefferts then read a paper on
NEW FACTS IN laryngology.
He directed attention to the following class of cases, of
which he had seen two : A gentleman, young, strong,
free from any abnormality of the heart, lungs, or kidneys,
is sittmg at the dinner-table, and at a certain point in
the conversation, suddenly has a slight attack of spas-
modic cough, falls from his chair, is completely uncon-
scious ; almost immediately rises, and resumes the
conversation at the point where it ceased. Is there any
relation between this slight cough and so grave a result
as complete unconsciousness and a fall ? This is not the
first attack. Several had occurred during the past eight
years, and repeated partial attacks of unconsciousness,
lasting for a few seconds, but then passing away en-
tirely. There is an incomplete history of hereditary
neurosis. There is no evidence of convulsive move-
ments during the attacks. The face becomes suftused.
Examination of the larynx reveals a normal appearance ;
the pharynx is granular, and the uvula is not elongated.
A second instance of the same affection had been seen
by Dr. Lefiferts, and these were the only two cases with
which he hjd come in contact during his entire practice.
In the second case there was no history of neurosis. The
patient's sister was decidedly neurotic.
These cases had been called laryngeal vertigo by Char-
cot. In looking up the literature of the subject, he had
been able to find the records of only seven published
instances. Of the etiology Dr. Leflerts asked sjiecial
consideration. Charcot believes them to be due to irri-
tation of the centri|)etal laryngeal nerve, and that they
are somewhat analogous to the cases of vertigo of
Meniere's disease. On the other hand. Dr. L. C. (kay
questions the accuracy of this position, and believes that
the two affections alluded to by Charcot are unlike.
This autlior also substitutes for the term laryngeal vertigo,
the term laryngeal epilepsy, at the same time stating
that the atTection differs from the ordinary epilepsy in
the important fact that it is readily amenable to treat-
ment. Is the disease a form of epilepsy ? To substantiate
that Dr. Gray claims that it is necessary to |)rove that
the affection does not occur except in instances in which
there is present a decided neurotic condition. An an-
alysis of the cases already published seems to show that
it does not, but the rule is not absolutely invariable. Dr.
Lefferts thought that Charcot's views seem not to be
proved. On the other hand, is Gray correct ; is the dis-
ease a form of epilepsy ?
Dr. L. Elsberg, of New York, did not agree with
either Charcot or Gray concerning the nature of these
cases, but regarded them as cases of spasm of all the ad-
ductor muscles of the larynx, and to this completeness
was due the brief duration of each attack and the safety
of the patient.
Dr. F. I. Knight, of Boston, suggested that the
etiology might be some disturbance of the respiratory
function, as it was well known, for instance, that prolonged
and rapid inspiration sometimes results in unconscious-
ness, showing simply that it does not require a neurosis
or a neurotic tendency to produce unconsciousness.
Dr. G. W. Major, of Montreal, believed that the
disturbance in the larynx was possibly one of the aurre
involved in epilepsy.
Dr. E. F. Ingals, of Chicago, suggested that the brief
unconsciousness was very similar to the pseudo-apoplexy
of fatty degeneration of the heart, suggesting that per-
haps the cases referred to by Dr. Lefferts were in some
way associated with disturbance of the respiratory cen-
tres.
Dr. S. Johnston, of Baltimore, thought the point
made by Dr. Knight was a good one, and that possibly
the attacks of vertigo might be due to rapid respiration.
Dr. Lefferts, in closing the discussion, said that he
agreed more especially with the suggestion that the
laryngeal spasm was probably a variety of aura of epilepsy.
Dr. S. W. Langmaid, of Boston, then read a paper
entitled
A CO.MMON form of VOCAL DISABILITY RESULTING FROM
PATHOLOGICAL PROCESSES— THE PHENOMENA USED TO
DEMONSTRATE THE FALSITY OF ONE SYSTEM OF VOICE-
TRAINING.
The form of vocal disability referred to was that seen
in actors and singers, where an inability suddenly devel-
oped itself to sing above a certain note in the scale, or
there was a sudden break in the voice. The voice is
good for all notes within the conversational register.
An interesting feature in these cases is the fact that laryn-
goscopic examination enables us to say exactly at what
point in the register the voice will fail, and therefore is
of service in indicating to the singer that nmsic may be
arranged accordingly, and is also of service to actors in
the fact that they may be warned with reference to the
occurrence of the accident when their voices are raised
to a certain pitch. Dr. Langmaid believed that the
cause of the afiection is in most cases a fatigue of the
vocal organs produced by unusual efforts, with or with-
out some catarrhal inflammation of the mucous mem-
brane. Ordinarily, the best artists are the subjects of the
affection because from them are demanded the best, and
most prolonged efforts. The history of the case almost
always revealed unusual vocal effort, or, perhaps, only
ordinary use of the voice has been demanded during
physical prostration. There is slight injection of one Or
both vocal cords, or there may be none at all ; the posi-
tion of the cords is that of relaxation ; the glottis fissure
is simply elliptical or open through the entire extent ;
in other words, the ordinary laryngoscopic ajipearances
of vocal fatigue, such as have been described by Dr.
Cohen in his work on " Diseases of the Throat." Be-
sides, Dr. Langmaid had noticed in typical cases that
there was nothing unusual in the appearance of the
larynx until, as the patient is made to sing from below
upward, a certain note is reached, and then a change in
the position of the cords becomes well-marked, and in-
stead of a progressive closure of the glottis, especially
of the posterior position, a sudden relaxation takes place ;
the cords receding ; the vibrations are slight. The point
at which this occurs in soiirano and tenor voices is the
ninth in the scale, in the key of C ; that is, Ra above
May 26, 1883.]
THE MEDICAL RECORD.
577
Do, or D above C. In contralto and bass voices it oc-
curs in the seventh in the scale.
The treatment of this condition belongs in part to the
laryngologist, but mostly to the teacher. Dr. Langmaid
was not aware that this condition of rela.xation had been
spoken of as a result of a school of training. That the
strength of the voice might be restored he had reason to
know by e.xperiments. In conclusion, he stated that the
results, in as far as examination of the larynx was con-
cerned, were those of disability of the vocal cords from
straining of the voice, the same as when there is an in-
tentional form of misuse of the voice in attempting to
sing falsetto at a degree of the scale where the normal
tone is called for.
Dr. C. Seiler, of Philadelphia, assented in general to
Dr. Langmaid's paper, but he did not quite agree with
him as to the production of the paresis of the laryngeal
muscles being entirely due to the misuse of the voice.
He had found in a large number of cases a peculiar in-
ability to produce certain tones of the voice, which came
on graduall}- and not suddenly, and finally terminated in
a break in the voice. In the majority of these cases he
had found enlargement of the pharyngeal tonsil, narrow-
ing of the resonance space in the naso pharynx. In a
case which he had under treatment, the voice had ma-
terially improved after removal of the hypertrophied
pharyngeal tonsil, and the improvement had been much
more marked, he believed, than it would have been had
the case been one of simple paralysis.
Dr. W. H. Daly, of Pittsburg, referred to two cases
which had come under his notice, like those described
by Dr. Langmaid. In one there was no active disease
of the naso-pharynx, the larynx appeared normal, there
was no evidence of malformation, and certainly there
was no enlargement of the pharyngeal tonsil. He be-
lieved that the patient was suffering from fatigue of the
laryngeal muscles, especially of the adductors, and ad-
vised cessation of work. In the second case he found
slight local difficulty, the lodgment of a film of Pittsburg's
favorite soot upon one of the vocal cords. After this
was removed he found a slight injection of the mucous
membrane. The soot was removed and the hy])er:emia
reduced, but after all this had been accomplished there
was some loss of power in the vocal muscles when they
were called upon to sustain high notes. He believed that
even in robust cases something more than local treat-
ment was necessary, and was satisfied that ergot espe-
cially, nux vomica, and other active nerve-stimulants
would be sufficient to raise the vital action and assist in
restoring the power to the muscles.
Dr. G. W. Major, of Montreal, said that the last patient
referred to by Dr. Daly was under his care in his cUy, and
on examination he found a condition of the larynx very
much like that described by Dr. Langmaid, which he at-
tributed to strain in the use of the voice. He ordered
rest, together with the internal use of strychnia.
Dr. Daly remarked that he saw the patient immedi-
ately after she came from Montreal.
Dr. Lang.maid, in closing the discussion, thought that
in certain cases hypertrophy of the pharyngeal tonsil
might possibly be an efficient cause in the production of
this condition, but at the same time this fact did not
militate against the theory which he had advanced. Any-
thing which diminished the naso-pharyngeal space, of
course, would be serious to one who had always had free
space there. He had used galvanism and nux vomica
with benefit, although he had not tried ergot, which he
believed was a favorite remedy with Dr. Daly, but he
should hereafter resort to it with pleasure. Dr. Lang-
maid also stated that Dr. Elsberg, since the reading of
his paper, had directed his attention to the fact that
Mandel had described this class of cases, and had di-
rected attention to the same point alluded to by himself.
Until Dr. Elsberg directed his attention to this fact, he
was not aware that ihe special method of comparison
which he had mentioned had ever been adopted.
The President then appointed as Nominating Com-
mittee— Drs. Knight, of Boston ; Asch, of New York, and
Daly, of Pittsburg.
Auditing; Committee — Drs. Johnston, of Baltimore, and
Morgan, of Washington.
Dr. U. G. Hitchcock, of New York, was then appointed
teller, and the .Society elected as Fellows Drs. C. W.
Chamberlain, of Hartford, Conn., and John N. Mackenzie,
of Baltimore.
The President also read an invitation extended from
the Philadelphia Laryngological Society to the members
of the American Laryngological Society to attend their
regular meeting, to be held on Friday, May 25th. The
invitation was accepted with thanks.
The Association then adjourned, to meet at 3 p.m.
First Day — Afternoon Se.ssion.
The Association was called to order at 3 p.m. by the
President.
The first paper was read by Dr. Frank. Donaldson,
of Baltimore, on
THE destruction OF NASAL POLYPI BY CHROMIC ACIH.
The author remarked that the points to be aimed at in
the treatment of nasal polypi were their prompt and
rapid removal with as little pain and small a loss of
blood as possible, and in a manner to prevent their re-
currence. He then referred to the three methods ordi-
narily resorted to for this purpose, and spoke of their ad-
vantages and also of their disadvantages. The forceps,
the oldest method and most generally employed, is at-
tended with great pain, considerable loss of blood, and
often with ulceration of the adjacent structures. It is
very effective if the pedicle is removed near its inser-
tion. The sensibilitv of the mucous membrane can be
somewhat diminished by the use of the spray of ice water
containing salt, although the mucous membrane cannot
be rendered so insensitive that the use of the forceps will
be rendered painless. The advantages of this method
are, comparatively short time occupied in the operation
and the frequent non-recurrence of the growth. The
author then made mention of cutting forceps, snares, and
other mechanical apparatus for the removal of polypi,
directing special attention to Jarvis' completed instru-
ment. According to his experience, however, it is not
an easy matter to get hold of the pedicle with any snare,
and, according to his experience also, if the snare only is
resorted to, the growth almost invariably returns. After
speaking of the use of the galvano-cautery, he directed
attention to the use of caustics, and stated that they had
been abandoned very largely because they frequently in-
jured the adjacent tissue. Glacial acetic acid injected
into polypi destroys them, but when it touches the mu-
cous membrane it inflames it and causes great pain, and
destroys a part of it, although its irritant properties can
be easily neutralized by spraying the part by aqueous
solutions. The agent which he had employed most satis-
factorily and most successfully was either minute crystals
of chromic acid or a solution of one hundred grains to
the ounce. It is a powerful escharotic, does not cause
pain, its application is not followed by hemorrhage, and
when properly used its action can be perfectly controlled.
It is also an antiseptic and a disinfectant, more than all
the acids or metallic salts which had been tried. Its ac-
tion is prompt and not penetrating. His mode of appli-
cation was, first, to moisten the mucous membrane with
a lead lotion to protect it, and then taking the paste
with a glass rod, very thin and pointed, stick it into the
centre of the polypus as far as possible, and by turning
the rod wipe off all the acid in the growth itself. The
growth crumbles at once, and is removed without pain
and without hemorrhage with the forceps. Sometimes
irritation follows the local application, but the lead water,
if effectually applied, protects the adjacent structures.
578
THE MEDICAL RECORD.
[May 26, 1883.
After the application of the acid, if it is desirable, the
snare can be used with greater precision than before. It
-can be used in both varieties of gelatinous polypi. In
the treatment of fibromata it is valuable, but not to the
same degree as in the gelatinous polypus. He wished to
be distinctly understood that he did not recommend it to
the exclusion of surgical methods, but he had found it
effective as an aid to them by destroying the substance
■of the neoplasm, in making the surgical operation less
painful and less bloody, if it was subsequently to be em-
ployed, and it was also a very valuable adjuvant as a
supplementary application for destroying the insertions
of the growth and thus prevent their reformation.
Dr. W. C. Jarvis, of New York, referred to a case
of marked deviation of the septum, in which, after its re-
moval, he discovered that the mucous membrane at the
root of the nostril was covered with small polypi, which
were gelatinous in appearance. These were removed
with a very fine wire and subsequently the attached bases
were touched with chromic acid. The point which he
wished to make was that a return of polypi was to be ac-
counted for not so much on the supposition that they
returned from the roots of the stump which was left, as
from the polypoid tissue which surrounded the jiedicle,
and that the application of the cnroniic acid after the
surgical procedure was not so much for the purpose of
killing the roots of the large polypi as in preventing the
growth of the embryonic polypi, which would enlarge if
permitted to remain.
Dr. W. F. Duncan, of New York, thought that a per-
manent cure could be effected only by the removal of a
portion of the turbinated bone from which the polypi
spring ; and, according to his experience and observa-
tion, unless this was done there had been a recurrence
in as much as eighty per cent, of the cases, from one to
five years after the growth had been removed by any
other method.
Dr. C. Seiler, of Philadelphia, spoke with regard to
the pathology of nasal polypi. He had invariably found
that the gelatinoid variety was a localized hypertrophy of
the mucous membrane covering the turbinated bone,
whicli has undergone myxomatous degeneration. .\c-
cording to his experience, the escharotics had given rise
to more pain than had the use of the cold-wire snare, pro-
vided that the wire ecraseur was tightened slowly. Fur-
ther, he had found that if all the polyi)i are removed
there will be no recurrence. He does not believe that a
tumor grows from the stump, but that what appears af-
terward is a new foriiiation, with localized hyijertrojjhy
the same as in the original growth, undergoing my.xo-
matous degeneration. He had never experienced any
difficulty in adjusting the snare about the base of a
polypus. He preferred the use of the galvano-cautery
to any chemical application.
Dr. \V. H. Daly, of Pittsburg, had used chromic
acid, but not exclusively, and had devised a modification
of tiie ordinary scoop, a curette without a fenestrum,
made of different sizes, and upon the concave surface
the copper was picked up so as to make little meshes
sufficiently deep to hold fine crystals of chromic acid.
He had found this a very convenient method of ajjplying
the remedy to small growths, .\ccording to his experi-
ence, however, it mattered very little as to what caustic
was used, as he had obtained ecpially satisfactory results
with acid nitrate of mercury, and glacial acetic acid.
Dr. Donaldson, in closing the discussion, remarked
that he had used all other caustics which had been re-
commended, but he preferred the chromic acid. He did
not wish to say that the pedicle could not be removed
with the snare, but that the insertion of the growth could
be removed better and more thoroughly with tlie snare,
after chromic acid had been used.
Dr. F. I. Knight, of Boston, then read a paper on
CHOREA I.ARVNGIS,
in which he first directed attention to the close relation
e.xisting between chorea and hysteria. The object of the
paper was to call attention to the different kinds of cases
which have been reported as chorea laryngis, and to in-
vite discussion upon the same. Chorea laryngis was
probably but one of the many manifestations of a general
affection. There were three varieties which had been
described. First, that in which not only the adductors
of the larynx were involved, but the expiratory muscles
of the chest are affected, characterized by cough occur-
ring in paroxysms, accompanied with more or less vocal
sound, the barking or crowing character of the cough
sometimes occurring suddenly, sometimes at particular
periods of the day, usually aftecting patients between
eight and fourteen years of age — these were the leading
symptoms mentioned. On examination of the larynx in
these cases only structural changes were discovered. The
second class of cases were those in which the muscles of
the larynx alone had been affected, particularly the hyo-
thyroid muscle. The author of the paper then reported
one case of chorea of the adductors of the larynx with-
out any affection of the expiratory muscles, and hence
no effort at coughing. In this case there was a peculiar
ticking in the head which the patient heard and which he
could hear, and which he identified as a clicking to-
gether of the vocal cords. He believed that it was a
unique case, at least was in his experience, and, so far
as he had been able to find, in literature ; that is, a case
in which the spasm was rhythmical, and in which it con-
tinued during sleep. Third, and whicli did not, strictly
speaking, belong under the head of chorea laryngis, those
cases in which the expiratory nmscles alone were af-
fected.
Dr. Lang.maid, of Boston, spoke of the extraordinary
rhythmical movements of the vocal cords in Dr. Knight's
case.
Dr. E. C. Morg.^n, of Washington, referred to a case
occurring in a girl ten years of age, associated with cho-
rale manifestations of the expiratory nmscles. The
rhythmical movements were entirely absent during the
night in his case. The most interesting feature was the
barking, crowing cough during the daytime, occurring
nearly as often as every five or ten minutes. There
was no disturbance of articulation. .-Vfter exhausting
nearly all remedies he had obtained the best results
from the use of Fowler's solution and monobromide of
camphor.
Dr. E. F. Ingals, of Chicago, referred to a case in
which there was a peculiar rhythmical movement of the
levator palati muscle with a clicking sound with each
contraction of the muscle. This certainly did not come
from the larynx, and he had attributed the clicking noise
to the movement of the muscle which opens the Eus-
tachian tube in some way.
Dr. Langmaid then recited the history of a case in
which the crowing, barking noise was the most distressing
symptom, and after close observation it was found that
it was preceded by opening the mouth. He first en-
deavored to produce a moral effect upon the patient, and
then told her that the moment when her mouth opened
to close it, which she readily carried out and it succeeded
effectually in stopping the peculiar cough.
Dr. E. Fletcher Ingals, of Chicago, then read a
paper on
THE TRE.\T.\IENT of LARV.VGEAL PHTHISIS.
There are three prominent indications : First, to re-
lieve pain ; second, if possible to cure the disease ; and,
third, failing in either of these, to modify tire course of
the affection ami prolong the iiatient's life. He believed
that these indications could be met successfully in quite
a proportion of cases. Pam can generally be relieved
by topical applications, even though internal medication
is of but little avail. The second indication is met best
by the combined topical and internal medication. In
the third place, we may succeed in modifying or reliev-
ing pain, and enable the patient to swallow, and so pro-
May 26, 1883.]
THE MEDICAL RECORD.
579
long life. Dr. Ingals then gave the history of a few cases
which illustrated that the indications mentioned could be
satisfactorily fultiUed. He recited the history of two
cases which illustrated that laryngeal phthisis can be
cured when the pulmonary complications are improving.
One favorite local application which he had employed
was a combination of carbolic acid, morphia, and tannic
acid He had used eucalyptol with benefit in several
cases. In his hands iodoform had given but little or no
relief from pain, and had failed to produce any [jer-
ceptible curative effect. His conclusions were that we
may meet the lirst indication better by topical appli-
cations than by any other means, and that we may con-
fidently expect to give relief in a considerable proportion
of cases. Second, that a limited proportion of cases
may be cured by local and general treatment, the former
sometimes being the most important factor. Third, that
in many fatal cases life may be prolongetl by local appli-
cations which relieve the patient from the exhaustion of
the pain and irritating cough, and at the same time allow
digestion of food.
Dr. William C. Jarvis, of New York, then read a
paper entitled
THE HEALING OF ULCERS IN LARYNGEAL PHTHISIS.
He prefaced his remarks with a reference to the in-
credulity of the medical profession regarding the cure of
phthisical ulcers in the larynx. This was partly due to
the fragmentary histories of the cases reported, insufficient
evidence, and claims for cure based upon peculiar
methods of treatment. The history of one case was
given in which the phthisical ulcers had entirely healed.
The evidence of the physicians and specialist from whom
the case had been transferred and the appearances de-
scribed by the author of the paper demonstrated con-
clusively advanced laryngeal phthisis. The lungs had
been examined by experts and co-existing pulmonary
phthisis discovered. Treatment was explained in detail.
It consisted locally in the frequent use of fine alkaline
sprays. Atomized alkaline fluids were employed for
cleansing. Local sedation was practised and iodoform
freely used. Constitutional remedies were considered of
importance, to quiet cough, favor cicatrization, promote
sleep, relieve restlessness, and to nourish the enfeebled
body. Climatic change was considered necessary. By
carefully employing these mild means, a patient threat-
ened with death from extreme pain in deglutition, was
restored to health and comfort. One vocal cord has
been almost entirely eaten away, firm cicatricial tissue
forming the excavation. He showed there was analogy
between certain forms of phthisical ulcers in the larynx
and simple superficial sores in the mouth ; that these
buccal ulcers were sometimes produced by the irritant
action of perverted secretions upon slight wounds. In
these cases a pellicle of shellac varnish or simple eschar
was sufficient to protect and heal the ulcer. If the lesion
occurred on a part in frequent motion it was converted
into a painful ulcer, producing discomfort in deglutition
and a train of symptoms resembling those found in cer-
tain cases of laryngeal phthisis. He believed the incipi-
ent wound might be caused by violence, like a cough,
injuring the friable and thickened laryngeal tissue.
Constant motion and acrid pulmonary discharges com-
pleted the analogy. He considered certain forms of
phthisical ulcer, easily recognized by certain peculiarities
described by him, curable. Far advanced ulcer, involv-
ing extensively the hard structures of the larynx, in-
variably proved fatal.
A new laryngeal powder-blower, invented for treating
ulcerations of the larynx, was exhibited.
Dr. S. Johnston, of Baltimore, referred to one case
which he had observed //-<?;« the begintiing. His diagno-
sis was sustained by Morell Mackenzie during his late
visit to this country. The first appearance was that of
white puncta, which resulted in ulcers that coalesced ;
physical e.xaniination of the chest negative ; the epiglottis
presented the usual cocked-hat appearance seen in laryn-
geal phthisis. The ulcers entirely healed under internal
treatment with inhalations twice daily, from a steam
atomizer, of a solution of sulphate of zinc, one grain, and
carbolic acid, two grains, and at the end of a month there
was a well-marked cicatrix.
Dr. F. Donaldson, of Baltimore, said that great re-
lief could be afforded not only by sprays, antiseptic in-
halations, and local applications of iodoform, but he
regarded it as important to sustain the nutrition of the
patient by the use of the stomach-tube when there is dif-
ficulty of swallowing. He had repeatedly seen appar-
ently phthisical ulcers at least heal under treatment by
the local measures just mentioned.
Dr. F. H. Bosworth, of New York, spoke of the con-
fusion still existing concerning diagnosis of laryngeal
phthisis or tubercular ulcers. He thought that no ulcers
should be regarded as tubercular except those which
were attended by a peculiar boggy inflammatory swell-
ing, most frequently upon the arytenoid cartilages, ven-
tricular bands next, rarely upon the vocal cords, and in
a still less proportion of cases upon the epiglottis ; the
ulcer is covered with bright yellow spots, and never se-
cretes anything except ropy mucus. He had certainly
cured cases of laryngeal phthisis, and by the mild plan of
treatment which he recommended several years ago, and
described by Dr. Jarvis — cleansing, application of mor-
phine, and also the local use of iodoform, done every
day until the patient is absolutely comfortable.
Dr. J. SoLis Cohen, of Philadelphia, thought that re-
covery took place in some cases, but that it could not be
said beforehand which they were. " They get well in
spite of us." He regarded the absence of pus as one of
the most important diagnostic features of phthisical ul-
cers of the larynx. Tubercular ulcers in the lungs
healed, why not' in the larynx? He saw no reason why
they might not.
Dr. F. I. Knight, of Boston, referred to cases in
which the local symptoms disappeared, although there
was a steady failure in the general condition of the pa-
tients. They healed by the constant application of
cold carbolic acid spray — two grains to the ounce of
water — with frequent applications of morphia and sugar.
He thought it was the constant cleansing process that
was, after all, the essential factor in the treatment. Al-
though it was well recognized that tubercular disease of
the larynx was frequently arrested, as is also seen when
the lungs are invaded, we are unable to say in which cases
such a result is to occur, and not much encouragement
could be held out to the patient, even if it was arrested.
He wished to have the question of the influence of cli-
mate on these local conditions discussed.
Dr. M. J. AsCH, of New York, said that in all the
cases of laryngeal phthisis in which he had seen good
results follow treatment there had appeared evidence,
before the patients were dismissed, that the ulcerations
were syphilitic in character, although pulmonary disease
also existed.
Dr. R. p. Lincoln, of New York, believed that iodo-
form in the treatment of ulcers of the larynx associated
with phthisical manifestations in the lungs was chiefly
beneficial not in the early stages of the inflammation,
when there was an unbroken surface, but later. Keeping
that idea in mind, perhaps the discrepancy concerning
the effect produced by the drug might be removed. He
also believed that the beneficial influence of sprays, etc.,
was increased by the addition of a few drops of the essence
of peppermint to the solution, an agent especially cool-
ing to mucous membranes.
Dr. G. W. Major, of Montreal, thought that the best
local application was atmospheric, although under the
general plan of cleansing, etc., relief and, for the time at
least, an arrest of the process might be secured.
Dr. W. F. Duncan, of New York, spoke of the value of
the mild plan of treatment mentioned by Dr Bosworth,
and said that in the last sixteen or seventeen cases which
58o
THE MEDICAL RECORD.
[May 26, 1883.
were under the observation of Dr. Bosworth and himself,
all terminating fatally, the laryngeal symptoms disap-
peared entirely, and so far the patients were comfortable.
Dr. Knight said that according to his experience,
while patients in the incipient stage of pulmonary phthisis
were benefiled by living in a rarefied atmosphere, those
suffering from laryngeal complications were made worse
by such a change.
Dr. Ing.\ls said that in one of his cases there was none
of the boggy tumefaction referred to by Dr. Bosworth.
Yet it seemed to him to be reasonable to conclude that
when a patient has well-developed pulmonary phthisis
and laryngeal symptoms develop, they are also due to
the same cause, and that the ulcers in those cases are
tubercular. For his own part he had not found the boggy
swelling present uniformly. He regarded time as the
most important element in the treatn)ent. As suggested
by Dr. Cohen, some of these patients, so far as the
larynx is concerned, will get well if they have an oppor-
tunity. As to whether any of his cases were syphilitic or
not, he thought the pulmonary signs justified his diagno-
sis. With regard to climate, he did not send his patient
to Colorado on account of his laryngeal affection, but for
the pulmonary trouble, and believed that a dry atmo-
sphere was unfavorable for laryngeal ulcers.
Dr. Jarvis thought that no difficulty should be ex-
perienced in differentiating between syphilitic and phthisi-
cal ulcers. He was unable to see how mere inhalations
could produce any curative effect upon these ulcers.
Dr. F. H. Bosworth, of New York, then read a paper
entitled
paresis of the constrictor muscles of the pharynx
siml'i_-\ting spas.modic stricture of the cesophagus,
with report of CASES.
The histories of five cases were given, which illustrated
the myopathic affection, what we had been taught to re-
gard as myopathic paralysis, neurotic in character. Dr.
Bosworth believed that the affection was essentially mus-
cular and could be best explained by the general law that
muscles which are overworked show a tendency to break
down, and this tendency is especially marked if they are
situated just beneath a diseased mucous membrane. The
author of the paper then spoke of tlie inherent tendency
in certain muscles of the larynx to become the seat of
myopathic paresis. His cases were treated with rest,
strychnia, salt-water bathing, etc., and all the patients
except one recovered.
Dr. Cohen, of Philadelphia, regarded this class of cases
as essentially hysterical, certainly the majority of them as
they had occurred in liis practice. He had obtained the
greatest success by placing a nurse over the patient and
insisting tiiat food should be swallowed.
Dr. Langmaid, of Boston, had had the best success in
their treatment by passing bougies, beginning with a very
small one and advancing gradually to one of large size.
Dr. Knight of Boston, had had similar cases, but there
was no loss of electro-nuiscular contractility. He had felt
that in most cases the difficulty was due to hyper;esthesia
and was best overcome very much in the way mentioned
by Dr. Langmaid.
Dr. Bosworth said the question of hysteria was ex-
cluded in his cases because there was unquestionable
sluggishness of the muscles and anaesthesia when touched
with the probe.
The Association then adjourned to meet at 11 a.m. on
Tuesday, May 2 2d.
Tuesday, Mav 220 — Second Day — Morning Session.
The .Association was called to order at 11 a.m. by the
President.
Dr. Thomas R. French, of Brooklyn, read a paper
ON photographing the larynx.
The paper was illustrated with photographs and ap-
paratus. The conclusions arrived at were the following :
I, That better photographs have been taken with
stationary apparatus than last year ; 2, a camera has
been so adapted that it can be held in the hand and be
quickly placed in position ; 3, photographs are taken in-
stantaneously by a trap shutter ; 4, parts reflected in the
larynx are alone exposed ; 5, photographs can be taken
without the patient's being aware of the object of the
procedure ; 6, photographs of diseased conditions can be
taken (first time on record) ; 7, photographs of the
posterior nares have been taken (first time). Several of
the Fellows spoke in commendation of the work of Dr.
French.
A paper on
congenital tu.mors of the larynx,
by Dr. H. A. Johnson, of Chicago, was read by Dr.
Mackenzie, of Baltimore. The paper contained the re-
port of five cases.
Dr. Knight, of Boston, stated his conviction that,
from tlie natural history of papilloma in children and
from the sequences of the operation, the best mode of
procedure in such cases is to avoid thyrotomy ; simply
perform tracheotomy and let the growth alone until the
child is old enough to allow operation through the
mouth, at all events, is given ojiportunity for spontaneous
expulsion of the neoplasm. Thyrotomy is pretty sure to
injure the voice permanently. There is also a great
chance for the growth to return, and unless urgent in-
dications existetl he would avoid this operation.
Dr. Cohen, of Philadelphia, doubted whether con-
genital papilloma of the larynx occurred so frequently as
some had imagined. His own opinion was that the oc-
currence of these growths, congenitally, in the larynx,
was exceedingly rare. Papillomatous tumors are very
apt to develoi.) in the larynx after the occurrence of
measles, diphtheria, whooping-cough, etc., and even af-
ter ordinary catarrhal inflammation, all of which are dis-
eases of childhood, and may appear very early in life.
With regard to treatment, any operation in the cervical
region, whether it opened the air-passages or not, is lia-
ble to be followed by pneumonia. Perhaps the reduc-
tion of the temperature of the pneumogastric nerve
from exposure might have something to do with the re-
sult ; therefore it might be possible that better results
would be obtained by operating in a w-arm room and
taking precaution to maintain the temperature of the
parts at as near the normal as possible. He was op-
posed to the ordinary operation of thyrotomy unless
there was urgent necessity for it. The impairment of
the voice, however, he regarded as a secondary consid-
eration, if life coukl be saved by the operation. The
chief danger, in his opinion, was that if a large quantity
of cicatricial tissue existed, it would interfere with the
enlargement and proper changes in the larynx, which oc-
cur normally at about the time of puberty, and in that
way permanently impair the patient.
Dr. Major, of Montreal, reported two cases. In one
the child still wears the tracheotomy tube and is doing very
well. The operation was performed in 1880. The other
patient died without the benefit of any operation. He
believed that thyrotomy, even at the peril of injuring the
voice i^ermanently, was preferable to opening the crico-
thyroid membrane.
Dk. Duncan, of New York, gave the history of two
cases ; in one the child died of suffocation ; in the other
Dr. Fred. Lange performed tracheotomy, subsequently
thyrotomy, and the child recovered entirely, although
with a somewhat impaired voice.
A paper on
LARYNGEAL PARALYSIS FROM ANEURISM,
by Dr. William Porter, of St. Louis, was read by title.
The Association then adjourned to meet at 3 p.m.
(To be cODtinued.]
May 26, 1 883. J
THE MEDICAL RECORD.
581
NEW YORK ACADEMY OF MEDICINE.
SECTION IN OBSTETRICS.
Stated Meeting, April 26, 1883.
Alexander S. Hunter, M.D., Chairman.
Dr. R. Tauszky read a paper entitled
HOW TO SECURE THE BEST POSSIBLE PHYSICAL CONDITION
AFTER PARTURITION.
The author of the paper began with the question, Why
is it that ahiiost every woman as soon as slie becomes a
mother begins to suffer from some form of pelvic disease ?
In support of the words "almost every woman," he re-
ferred to the very large percentage of gynecological cases
in which the morbid condition present could be traced
directly to childbirth, and then asked the signiticant
question. By what means can the occurrence of these con-
ditions be prevented? To the influence of the old term
" meddlesome midwifery" he believed that a part of the
explanation could be traced, but he regarded meddlesome
midwifery scientifically applied as one of the most effec-
tual means of preventing the conditions under considera-
tion. Hygienic and antiseptic midwifery under intelli-
gent direction, even though it be subjected to the term
"meddlesome," should be practised in every case of nor-
mal labor. Although at the present time it is so prac-
tised by most surgeons it is not, unfortunately, carried
out to an equal e.xtent by obstetricians. How is this
method to be carried out in cases of normal labor ? First
of all, the accoucheur should be careful to cleanse his
hands with soap and water, remove all foreign particles
from beneath the nails, and then wash the hands in either
a three per cent, solution of carbolic acitf, or, what is
probably more available, [Hire vinegar, and afterward
oil the hands with carbolized oil of the same strength of
carbolic acid mentioned. .^U instruments and articles
used about the woman should be cleansed and disinfected
by similar means. Just prior to confinement, or early
in the tirst stage of labor, the bowels should be freely
moved by an enema, repeated if necessary. The blad-
der should be emptied, and if catheterization is necessary
the urine should be drawn with a soft Nelaton catheter
which has been thoroughly cleansed in boiling water and
afterward disinfected. The vulva should be bathed with
some antiseptic solution, such as a very weak solu-
tion of carbolic acid, perhaps with the addition of a small
quantity of glycerine, or with a solution of thymol.
The author recommended careful dilatation of the cervix
with the fingers. He also spoke of the advantage which
might accrue from gently pushing up the anterior lip of
the cervix above the symphysis. Tough membranes also
may be ruptured with great advantage. He recom-
mended the use of chloroform, especially in primiparx,
not carrying the anesthetic, however, to the production
of full unconsciousness. The forceps in very many cases,
if judiciously used, were advantageous rather than disad-
vantageous, and should be used rather than allow the
head or shoulders to press undulv, for any considerable
length of time, upon the perineum.
The cord should not be tied until the umbilical vessels
cease to beat. Dr. Tauszky regarded this as a point of
practical importance. He also recommended Crede's
method of expression of the placenta. The genital pas-
sages should be carefully examined after removal of the
placenta, and all slight lacerations or wounds should be
closed, and the same rules adopted as in the treatment
of wounds of soft parts elsewhere, and they should be
carefully covered with some antiseptic dressing, such as
the application of iodoform, etc. He recommended the
use of the abdominal binder. He claimed that the child
should be applied to the breast at the earliest moment,
believing that the material which it derived in this way
from the mother was more beneficial to it than any article
which could be administered ; and at the same time it
was beneficial to the mother in exciting or maintaining
uterine contraction. In multipara; he recommended the
administration of a drachm of ergot after the delivery of
the placenta. He believed that ergot in a normal labor
should never be given before the expulsion of the child.
According to his experience after-pains, when the case
was managed according to the plan outlined above,
scarcely ever occurred. Should they occur of course
they should be controlled by the use of anodynes.
In the management of the puerperal condition careful
disinfection should be strictly observed. The thermom-
eter should be used twice daily in the axilla. The breasts
and the nipples should receive careful attention. He re-
commended the following as an application for excoriated
nipples.
5 . Balsam Peru grm. iv.
Olei amygdal grm. vj.
Aqu.-e rosM grm. xxxv.
Mucil. acac grm. vj.
Mix, and apply after each nursing, the nipples being
carefully cleansed.
Dr. Tauszky laid special stress ui^on the occurrence
of hemorrhage after parturition, and remarked that a little
hemorrhage after parturition is very dangerous, and
should be arrested. He took the strong position that
the accoucheur should be regarded as guilty of malprac-
tice who would permit a slight quantity of blood to es-
cape from the genital organs of a woman for days after
parturition. He maintained that not a single drop of
blood should appear after the completion of the third
stage of labor ; that the napkins when removed should
be perfectly free from color ; that should they be col-
ored the physician should at once institute an examina-
tion with reference to the source from whence the blood
came, and set about arresting it.
The bowels need not be moved until the third day af-
ter labor. It is not necessary, is often dangerous, is even
fatal sometimes to use intra-uterine carbolized injections
once or twice daily up to the second day, even after nat-
ural labor. He jjelieved that such injections should be
used only when the lochia are offensive, and febrile move-
ment has developed. When the lochia are offensive and
there is some fever present he invariably syringes the
vagina several times a day wdth a disinfectant solution,
but intra-uterine injections post-partum are necessary
only in cases of internal violence, such as sometimes at-
tends the manual separation of the placenta or the use
of the forceps. When such injections are used, he pre-
ferred thymol or simple water to carbolized water, which
could be introduced either through a soft catheter or
the exceedingly convenient tube invented by Dr. Cham-
berlain. The injections might be repeated until the
fetor of the lochia was either markedly diminished or en-
tirely corrected.
Dr. Tauszky protested against the teachings of Dr.
Goodell, of Philadelphia, with reference to the parturient
woman being permitted to assume the upright position
within three days after labor. He believed that the doc-
trine was a dangerous one, and unwarranted, and main-
tained that the recumbent posture should be kept, chang-
ing occasionally from side to side, for at least eight days
after normal delivery, and especially until the uterus has
returned to the pelvic cavity. Dr. Tauszky then referred
to his experience on the frontier while in the army, and
stated that it was not only among the civilized, but also
among the savages, that women suffer from diseases pe-
culiar to their sex, and stated that gynecological affec-
tions among the squaws were not at all uncommon.
He attributed a large percentage of these conditions to
early rising after parturition. He then detailed the his-
tory of a case which terminated fatally, and, as he believed,
chiefly because of the early getting up of the patient.
For pelvic peritonitis, in case it developed, he regarded
cold applications as the best that could be employed, but
more especially in the early inflammatory stages. Both
5S:
THE MEDICAL RECORD.
[May 26. 1883.
the pain and the hyperemia were lessened by the use of
cold. At first the applications must be repeated very
frequently.
Dr. Tauszky then exhibited some of Lieter's (of Vi-
enna) devices for reducing intra-pelvic temperature,
which consisted of metallic cylinders three-fourths of
an inch to an inch and a quarter in diameter, and two
inches in length, within which were coils that termi-
nated in two extremities which projected from the ex-
tremity of the metallic bulb, and to which india-rubber
tubes could be attached that conducted the water from
a fountain above through the bulb into a basin below.
He also exhibited a small device of the same kind which
could be used for the application of cold to the cervical
or intra-uterine canal.
After fever has disappeared warm baths or sitz baths
could be resorted to, but he believed that the use of
wanu injections for peritonitis were dangerous.
Discussion on Dr. Tauszky's paper was opened by
Dr. W. M. Chamberlain-, who said he agreed entirely
with the author of the paper in the idea of observing scru-
pulous cleanliness in the management of cases of labor,
and believed there was truth and force in the idea. One
statement made by Dr. Tauszky, however, struck him as
a remarkable one, and one to which he could not sub-
scribe ; that is, that the attendant should not be content
with himself or his patient, and should not leave her so
long as there was any hemorrliagic flow from the vagina.
Certainly that conflicted with his own experience and his
ideas upon the subject. He expected always a hemor-
rhage, slight, it is true, but an intermittent flow of blood
for from twenty-four to thirty-six hours after labor, and
had not been concerned if it passed beyond that measure.
He had never recognized, when proper cleansing of the
vagina had been employed, that this slight amount of
hemorrhage had been productive of any harm. He
thought it was natural, almost necessary, and should not
be interfered with except to prevent it from becoming
excessive.
With regard to the dangers of septicemia, he had read,
as probably most had, the paper of Dr. Thomas, detailing
some striking cases of septicasmia in which remarkable
results had been obtained from washing out the jmerperal
uterus. Other writers also had related somewhat similar
cases. The idea involved in Dr. Thomas' paper seemed
to be that puerperal septicaemia means retention of mor-
bid matter or the formation of morbid matter within the
cavity of the uterus, and that that is the essential cause
of puerperal septicemia. Doubtless it is a very frequent,
probably the most frequent cause, and in such cases the
indication is to wash out the uterus if the cavity can be
ea'ily reached. But Dr. Chamberlain believed there
were other causes which should be also recognized, for
example, breach of the surface anywhere within the en-
tire length of the genital canal, occurring in labor, may
allow the entrance of septic matters into the lym|)h and
blood ; also any surgical operation in the non-parturient
patient may become like occasion of septicemia and
peritonitis. He had certainly seen many cases of puer-
peral septicemia which could properly be correctly as-
signed to lacerations of the perineum and vulva. If there
were in addition retention of the secundines and develop-
ment of morbid products in the cavity of the uterus, all
the conditions of septic infection would be present.
As to intra-uterine injections, he would show a speci-
men tube, employed by himself and many others, and
known as Chamberlain's tube. It should be, and gen-
erally liad been, made of soft or unannealed glass, which
was not easily broken. It is eighteen inches long,
seven-eighths of an inch in diameter, rounded and closed
at the entering end, and perforated on all sides by
counter-sunk holes. To the other end a syphon-tube of
india-rubber connected with a two-quart wash-bottle is
attached. A one per cent, solution of pure carbolic acid
(Scliering's is the best) was employed. The tube should
be passed without the aid of the guiding finger, and, he
believed, greatly simplified irrigation of both uterus and
vagina. Care should be taken to leave no fluid remain-
ing in the cavity of the pelvis.
Intra-uterine injections practised upon every lying-in
woman would probably be mischievous, and is an un-
warranted interference, which nothing except a septic
condition of the uterus would justify. The indications
that a septic condition is present are the fetid condition
of the lochia. The existence of septicemia is not an in-
dication for washing out the uterus, unless the cause can
be located within the uterus. It luay be an indication
for washing out the vagina, but not the uterus. He had
never attempted to introduce his tube and wash out the
uterus after the organ had undergone advanced involu-
tion. He thought the case which Dr. Johnson cited at
a recent lueeting of the New York Academy of Medicine
was one in which the uterus had ceased to be septic and
the occasion for the use of the instrument had passed
away.
With regard to intra-vaginal irrigation for anti-febrile
purposes, and the use of the cold coil to the abdomen,
he had nothing special to say. He had already presented
the subject to the .\cademy of Medicine about a year
ago, and to the Medical Journal Association about eight
years ago. It is probably not so strikingly efficient as is
Kibbee's cot, but its use is so simple and so efficient that
it can be adopted with very great and positive advantage
in all cases where Kibbee's cot could not be made avail-
able. The idea of intra-vaginal cooling also occurred to
him at the same time, but he had not practised it. He
believed, however, that it was legitimate, and possibly a
very valuable extension of the same idea. With his
preference for india-rubber over metallic substances he
should have continued to use rubber coil inasnuich as it
may be difficult at times to secure the metallic tube,
and the same idea could be accomplished with rubber
tubing in an equally satisfactory manner.
Dr. Jewett, of Brooklyn, said he endorsed the idea
already advanced by the author of the paper, and sus-
tained by Dr. Chamberlain, that the first and most im-
portant element in the care of puerperal cases was clean-
liness. To promote this end it had been his practice to
use the carbolized vaginal douche immediately after labor,
using a two and a half per cent, solution immediately
after the completion of the third stage of labor. From
this practice he had seen no evil results. He also ordered
the use of the vaginal douche every three or four hours
for the first two or three days after confinement. With
regard to intrauterine injections, if had not been his
practice to use them except where the vaginal douche
has been tried and failed. He used the vaginal douche
first, and if it did not immediately bring down the tem-
perature, if evidence of septic infection were present, the
intra-uterine douche was then in order. Dr. Jewett was
inclined to the opinion that in the majority of cases
puerperal septicemia originates in wounds of the vagina
and cervix. He thought, therefore, that the vaginal
douche was usually sufiicient. The objection to the fre-
quent use of the intra-uterine douche was the liability to
produce some traumatism, or to open some new avenue
for absorption. The results, however, obtained from
well-observed clinical cases must ultimately decide con-
cerning its use.
With regard to the matter of rest after delivery, it had
been his practice to keep the jiatient quiet in bed from
twelve to fourteen days, and although the woman might
be then allowed to assume the upright position, he
always counselled that she should remain quiet during
the third week. He was inclined to agree with the writer
of the iiaper concerning Dr. (loodell's views, and thought
that if Dr. Coodell examined his patients a year after
labor he would find more or less evidence of the evils of
the practice. Dr. Jewett believed it was iiuportant to
secure the early and complete contraction of the uterus
as soon as possible after the delivery of the child. In
his practice, therefore, the third stage of labor rarely ex-
May 26, 1883.]
THE MEDICAL RECORD.
583
ceeded five to seven minutes, while most obstetric
authorities advised that fifteen to twenty minutes, perhaps
more, be allowed to elapse before the delivery of the
plicenta and completion of the third stage of labor. He
believed it to be miportant that the third stage of labor
be completed as promptly and as thoroughly as jiossible
by stimulating at once the natural poweis of the uterus.
He would not approve of any method which favored the
formation of deep thrombi in the structure of the uterus.
He favored e,\pression of the placenta, believing that the
essence of the manipulation was compression during con-
traction ; that is, the process was merely supplementing
the natural powers instead of replacing them.
Dr. Burrali, believed it to be a general principle that
the more perfect the woman's health is, who is about to
bear a child, the greater the probabilities were that she
would accomplish her task with the greatest safety, and
therefore it seemed that the care of the puerperal
woman and the prevention of puerperal accidents should
begin during pregnancy. Treatment of the puerperal
woman prejiaratory to labor should begin several weeks
before the expected confinement, and should be of such
a character as to place the system in the best general
condition possible. He thought the internal use of anti-
septics before labor, perhaps for four, five, or six days,
was reasonable. The functions of all the organs should
be carefully examined, and such means taken as nn'ght
be indicated to put them into the best possible condition.
He also believed that the statement with regard to the
proper use of the forceps during labor made by the
author was very judicious. External pressure and the
use of ergot immediately after labor he believed to be
proper to avert hemorrhage. It had not been his prac-
tice to shorten the third stage of labor so much as had
been mentioned by Dr. Jewett. He thought that some-
times more satisfactory results could be obtained by
some delay than by the immediate completion of the
third stage. He agreed with Dr. Chamberlain concern-
ing the occurrence of a small amount of hemorrhage
after delivery, and in that respect diftered with the author
of the paper. He thought that a little more than the
usual quantity of sanguinolent discharge after labor was
not specially disadvantageous, but rather otherwise.
The use of antiseptic injections and douches he believed
to be indicated after delivery of the placenta. With
regard to the application of ice to the abdomen and
intrauterine injections, the necessity for their use usually
arose at about the same time during the puerperal state ;
that is, upon the rise of temperature, which is usually
accompanied with a fetid lochial discharge. Under
these circumstances nothing produced more satisfactory
results sometimes than the use of intrauterine injections.
Dr. Jewett referred to another point which he had
omitted to mention, that is, the examination of the
patient at the end of the third or fourth week after deliv-
ery before she is discharged, with reference to possible
lacerations of the soft parts or of the cervix, which oc-
curred during labor and had been overlooked.
Dr. Burrall emphasized the point just made by Dr.
Jewett. He also favored the use of the binder for two
or three weeks after confinement. He also said that he
could not endorse the views advocated by Dr. Goodell
concerning the upright position, more especially for those
whose pelvic organs are weak and need support.
Dr. Brown remarked concerning vaginal injections
immediately after delivery, that it did not seem to him
they were necessary in all cases. It seemed to him
that neither the vagina nor the uterus was necessarily
in ail unhealthy condition at this time, and that nature
provides for some of these conditions by the escape of
more or less blood from the genital passages. He
did not believe that such discharges necessarily im-
plied an unclean condition, and therefore that their arrest
was essential. He disliked to disturb the patient for
such a purpose ; further, he did not believe it was neces-
sary to remain by the bedside of the patient until the
hemorrhage had entirely ceased. Dr. Brown then spoke
of difficult labor possibly due to cicatricial formations
succeeding manual removal of an adherent placenta and
injury to the uterine walls.
With regard to antiseptics before labor, it did not oc-
cur to him that they should be administered, or that either
pregnancy or labor should be looked upon as necessarily
a sickness. He therefore did not see the utility of be-
ginning a course of disinfectant treatment before labor
commences.
Dr. Carpenter asked Dr. Tauszky if he wished to be
understood as saying that not a single drop of blood
should be seen in the discharges after the completion of
tlie third stage of labor.
Dr. Tauszky replied that no bleeding whatever should
take place after labor; that not one single drop of blood
should be seen.
Dr. Jacobus asked Dr. Tauszky how long he was ac-
customed to remain with the woman after labor.
Dr. Tauszky replied th>'\t sometimes not more than
ten or fifteen minutes; sometimes longer. When the
uterus was once firmly contracted it had, according to
his experience, remained in that condition and hemorrhage
did not occur.
Dr. Jacobus remarked that Dr. Tauszky's experience
differed entirely from his own, and that according to his
observation a certain amount of hemorrhage had invari-
ably taken place after the completion of the third stage
of labor ; sufficient, at least, to give the napkins a greater
or less bloodstained appearance ; further, he believed
that this occurred in all cases.
Dr. Burrai.l then exhibited specimens of the
kola nut.
The nut was introduced to the attention of the profes-
sion in England some eight years ago, and had been
said to contain a combination of several properties, as
the active principle of cocoa, coffee, and coca. It had
been said to contain two per cent of cafifein. It had also
had a good repute as an agent for overcoming the appe-
tite for alcoholic drink, and its repute as an article for
procrastinating desire for food was well known.
The Section then adjourned.
NEW YORK PATHOLOGICAL SOCIETY.
Stated Meeting, April 25, 1883.
George F. Shrady, M.D., President, in the Chair.
f Continued from p. 558.)
CHRONIC DIFFUSE NEPHRITIS — CIRRHOTIC AND FATTY
LIVER FATTY DEGENERATION OF HEART, WITH HY-
PERTROPHY AND DILATATION — CEDEMA OF LUNGS —
CALCAREOUS ARTERIES OF BRAIN — CEREBRAL SOFT-
ENING.
Dr. J. Lewis Smith presented specimens, with the fol-
lowing history : The patient was a woman, forty-five
years of age, who was admitted into Charity Hospital, in
nearly a moribund state, on April i6th, under the care of
Dr. Walter L. Carr, House Physician, who furnished the
following records : She was cyanotic at the time of ad-
mission, and her pupils, which were unequally contracted,
did not respond to light. The skin was dry and harsh ;
limbs cool and somewhat ojdematous ; pulse, 90, not
strong ; respiration, 44 ; vaginal temperature, 96° F. She
seemed to comprehend questions, but answered in a
very slow and hesitating manner ; said she had no head-
ache, had vomited some on the previous day, and that
her bowels were constipated.
The respiratory movements were increased ; no vocal
fremitus could be detected ; percussion resonance over
anterior part of chest good, except at left apex ; pos-
teriorly resonance rather dull, especially low down.
Upon left side of chest respiration blowing in character
in the entire lung, and expiration prolonged, but not
584
THE MEDICAL RECORD.
[May 26, 1883.
distinctly bronchial. Breathing on the right side similar
to that on the left, but not so loud ; no rales heard in
any part of the chest. The heart-sounds were normal
but weak. The urine, removed by the catheter, had a
specific gravity of 1.020, was dark-colored, slightly cloudy,
and contained ten per cent, of albumen. In it was a
large number of small hyaline casts and a few large
ones, with some granular matter.
The patient complained of pain on the right side of
the abdomen, a little below the ribs. On palpation the
abdomen was found resistant and hard, and the percus-
sion dulness extended downward from the normal liver
space to a line just above the umbilicus. The dulness
extended to the left over the transverse colon. No in-
dentation could be made. Abdomen not tympanitic,
nor distended. Deep percussion sound over the lower
part of the tumor resonant. 7 p.m. — Vaginal tempera-
ture, 97° F. ; respiration, 24 ; pulse, 86. 10 p.m. — Pulte,
88 ; temperature, 97° F.; respiration, 24. She was rest-
less, moaned often, and finally became more and more
somnolent till her death, about eighteen hours after ad-
mission.
• She was treated by purgative doses of elaterium, by
digitalis, hot-air baths, alcoholic stimulants, etc.
At the autopsy a small amount ot straw-colored fluid
was found in the pleural cavities ; no adhesions ; lungs
congested and cedematous ; heart dilated and hypertro-
phied, dilatation predominating ; walls of the heart more
yellow than normal, and under the endocardium on the
right side are irregular yellowish sjwts ; trabecuUie flat-
tened, and the spaces between them enlarged ; free bor-
der of mitral valve thickened ; walls of left ventricle
one-half inch thick ; tricuspid orifice largely dilated.
Kidneys : l^iminished in size ; capsules tear the surface
on stripping ; surface finely granular, and of a more yel-
low color than normal ; section shows a general atrojihy ;
in pyramids, radiating whitish stria; ; columns of the
tubules more narrow than normal, and wavy appearance
exaggerated ; intertubular spaces enlarged, and of a
reddish color, contrasting with the yellow color of the
tubules ; Malpighian bodies not recognizable.
Liver : Weight, 3!;} lbs. ; increased in breadth, and di-
minished in thickness ; old local thickening of cajisule ;
surface slightly lobulated and firm ; lobules small and ir-
regular. This organ is cirrhotic and fatty. Spleen : Slightly
enlarged and firm. Stomach and intestines: Apparently
normal. Brain : Meninges cloudy ; a large right verte-
bral artery, and very small left vertebral, so that the
basilar is formed apparently almost entirely from the right
vertebral ; arteries at base of brain, both tjie large and
small, are atheromatous. On the left side a large soft-
ened spot appcfared in the upper anterior portion of the
optic thalamus. Another similar softening a little lower
than this, slightly involving the middle third of the inter-
nal white cajjsule. Two or three similar Sjjots were
found in the white portion of the hemisphere, and one in
the pons Varolii on the left side. These spots were yel-
low.
Remarks. — "The liver, in regard to the state of which
some doubt has been expressed, has been examined mi-
croscopically by Professor Welch, with the following re-
sults : ' It is fatty and moderately cirrhotic. Tliere is
a new growth of connective tissue, which, although only
moderate in amount is unmistakable. Tliere are patches
of atrophied liver-cells. I think that the evidences of
cirrhosis are to be made out with the naked eye, there
being already a granular appearance on the surface, and
a distinct lobulation on the cut section.'
" This woman, though in middle life, had disease of a
fatal nature in nearly every important organ. There was
a group of structural changes, such as we would ex|iect
to find only in advanced age. No doubt a life of de-
bauchery, privation, and hardsliip renders men and
women of the class to which this woman belonged |)re-
niaturely old.
" The brain-softening was interesting, as it occurred on
the side in which the vertebral artery was abnormally
small, and it seemed probable that the diminished blood-
supply sustained a causative relation to it. What ap-
peared before death to be an abdominal tumor was the
right lobe of the liver, which lay unusually low and was
prominent.
" The most conspicuous symptoms, and also death, ap-
peared to be due more to the Bright's disease than to
any other of the many lesions. Dr. Smith called at-
tention to the subnormal temperature, which was con-
stantly three or four degrees below that of health, during
the time that she was under observation."
Dr. [ohn F. RiDLON presented a specimen with the
following history :
CHRONIC OSTEITIS OF THE SHOULDER- JOINT.
George G was admitted to St. Luke's Hospital,
April 3, 1883; twenty-three years old; single; a pol-
isher, and a native of the United States. Service of Dr.
Chas. McBurney.
He was indebted to Dr. Hunter, House Surgeon, for
the histor)'. Previous history good ; parents healthy ;
no one in family has had phthisis, carcinoma, or syphilis.
Patient has had gonorrhoea twice — last attack two years
ago ; never had a chancre ; never injured or strained his
arm in any way. About a year ago he first noticed stiff-
ness and weakness at the left shoulder-joint, followed by
pain on motion, but no pain while at rest. Next came
noticeable atrophy of the muscles of the shoulder and
arm. Three months ago an abscess appeared at the in-
ner and front part of the arm, at the border of axilla,
and pain became severe. Two months ago this abscess
was opened, and has been discharging copiously since.
He has lost in strength and weight ; has cough and night-
sweats ; appetite poor.
Examination showed some cedema of entire arm,
atrophy of shoulder and upper arm muscles ; two sinuses,
with edges undermined, at inner anterior surface of arm,
near border of axilla, into which a probe passes toward
the joint four inches, touching bare bone. Joint motion
in all directions limited, almost completely, by reflex
spasm.
April 2ist. — Patient etherized ; joint motion free in all
directions, producing grating sensation. The joint was
then laid open, a quantity of pus evacuated, the head of
the humerus excised, half an inch more of humerus re-
moved, glenoid cavity scraped out, cavity cleansed with
I to 20 carbolic solution and peat dressing applied.
Dr. Ridlon presented the specimen with reference to
two points : First, the futility of opening abscesses con-
nected with osteitis in a joint before the walls have become
very thin. He believed it to be best to either wait in this
way or allow the abscess to open spontaneously. In cases
which had been left to themselves, he had seen the ab-
scesses disajijiear entirely. Or when they had been left
to open themselves, and the patient received ordinary
good food and tonic medicines, the discharge began to
diminish, as a rule, in the course of six or eight weeks,
and in the course of three months was only slight.
The second point was the fact that it was very easy to
make a mistake where there is no motion at the joint in
supposing that there is anchylosis, and it is injurious to
give ether simply as a diagnostic test, because in these
cases where the head of the bone and the cavity in
which it rests are bare, and the surfaces are covered
with granulations, such a procedure cannot do otherwise
than make the joint worse.
Dr. Ripi.ey asked concerning the age of the patients
and the joints included in Dr. Ridlon's statement.
Dr. Ridi.on said he referred to cases of osteitis of the
hip, knee, ankle, wrist, and elbow, and to cases of Pott's
disease ; in other words, he would make the restrictions
quite general. In some cases, of course, the abscesses
may be pointing in unfavorable situations, and it may be
desirable to make a counter-opening to turn the dis-
charge in some other direction.
May 26, 1883.]
THE MEDICAL RECORD.
585
Dr. Ripley thought that abscesses of the different
joints, particularly of the ankle-joint, were most success-
fully treated by 0|)ening them, and establishing free drain-
age. Bryant, of London, had advocated free opening
into joints for inflammation, and had reported most re-
marl^able success, especially in young subjects. With
regard to the question of examining patients' shoulder or
other joints under ether in cases of suspected disease of
the joint, he would say that, despite the temporary light-
ing up of new inflanuiiation, it was the proper mode of
treatment to be adopted. The first thing to be secured
in surgical and medical practice w-as a correct diagnosis,
and if ether was necessary to accom])lish this, it should
be administered. He thought that the restrictions men-
tioned must be taken with considerable modification.
Dr. Ridlon remarked that Dr. Ripley's statement did
not apply to the view he had intended to express. He
did not wish to object to opening into joints, but simply
to express the opinion that with abscesses connected
with joints the patients were better off when as abscesses
the swellings were let alone than when opened.
As to the administration of ether for purposes of di-
agnosis, it certainly was justifiable if diagnosis could not
otherwise be made, but it seemed to him, however, that
in all cases where there was osteitis to any great extent,
giving rise to a condition which resembled that found in
hip-joint disease, it was unnecessary to give ether for the
purpose of making a differential diagnosis.
Dr. Riplkv remarked that so far from being correct
was the last statement made by Dr. Ridlon, that a few
years ago a child, brought from the South, was seen by
one of the most prominent surgeons of the city of New
York, now deceased, and whom all respected, who re-
fused to make a diagnosis without not only etherizing the
patient, but cutting mto the joint. He wished simply to
emphasize the point, that if the joint be manipulated
with care, the patient being under the influence of ether,
and subsequently being kept quiet, certainly no perma-
nent evil is likely to result.
The President expressed himself as being somewhat
surprised with regard to the restrictions announced by
Dr. Ridlon, inasmuch as it had been regarded as a
correct rule in surgical practice to evacuate pus wher-
ever it could be found. Of course there might be some
particular contra-indications with regard to not only these
cases, but also with reference to resorting to ana2sthetics
for the purpose of making a differential diagnosis. He
was sure, however, that he had opened joints and evacu-
ated pus in several cases with good results, and he had
also broken up adhesions around joints at difi'erent times
without any bad results.
Dr. Ridlon said, according to his experience in the
orthopoedic department at St. Luke's Hospital, that in
the cases in which the abscesses had been opened the
joint had discharged more profusely, and for a longer
time, and the patient had grown weak more rapidly than
where under similar conditions the opposite course of
treatment had been pursued. The statement which he
had made was simply the result of observation, and not
the result of any theorizing. During the last two years he
had had under observation probably between two and
three hundred cases.
Dr. Ripley asked what the ultimate result had been,
so far as the joint was concerned, when treated accord-
ing to the method suggested.
Dr. Ridlon replied that sooner or later, in the i>ia-
jority of cases, the patients recovered with anchylosis,
and the condition of the joint had never been seen ; and
in most cases which terminated fatally it had been im-
possible to obtain an autopsy.
The President remarked that even in cases of cold
abscess it had been customary to evacuate the pus and
hjper-distend them according to Callender's method,
and that good results had been obtained.
Dr. Ridlon referred to a case which came under his
observation at St. Luke's Hospital, in which an abscess
accompanying hip-joint disease was opened as soon
as it became quite prominent, pus was evacuated, the
cavity was thoroughly distended with carbolic solution,
and a Lister dressing applied in its most thorough detail
for about three months and a half; the discharge never
being allowed to be exposed to the air. This was in the
autumn of 1878, and the sinuses are still open and dis-
charging.
Considerable discussion then followed concerning the
indications and contra-indications for surgical interfer-
ence in joint affections, especially with reference to
operations when there is evidence of waxy change, in-
volving the liver and kidneys and other organs. The
prevailing sentiment was that resection and other
surgical operations were justifiable even though there
was evidence of waxy degeneration of the kidneys and
of the liver, because in quite a large number of cases
good results had followed operations performed under
these circumstances.
The Society then went into executive session.
MISSOURI MEDICAL ASSOCIATION.
Ticietity-sixtk Annual Meeting, held at Jefferson City,
Ale, May 15 a?id 16, 1883.
(Continued from p. 54S.)
Dr. E. M. Nelson read, on Wednesday evening, by
special appointment, a brief
SKETCH OF THE LIFE OF DR. JOHN T. HODGENS,
whose death occurred so shortly before the last meeting
that no opportunity was aftbrded for the preparation of
any biographical sketch. .\% a token of respect to the
subject of the sketch the vote referring the paper to the
Publication Committee was taken by standing.
Dr. Schenck, of St. Louis, read a very interesting
paper comparing
VITAL AND HEALTH STATISTICS OF THE MALE AND FE-
MALE SEX,
and showing that female lives are in reality better risks
for life insurance than are male lives.
.\ lady was here introduced and permission granted to
her to speak to the Association upon
THE SUBJECT OF TEMPERANCE,
she being a representative of the Sons of Temperance.
Dr. Allen, of the Special Committee on Conference
with Kansas and Illinois Associations, reported a motion
CHANGING THE DATE OF THE ANNUAL MEETING
from the third to the second Tuesday of May, so as to
allow delegates from this Association to attend the meet-
ings in the adjoining States, both of which meet on the
third Tuesday.
A resolution was also passed for the appointment of
delegates to those meetings.
Dr. N. W. Harris then read a paper on
GLAUCOMA,
recounting the history of his own case, the doctor's
vision having been so impaired that the paper was read
for him by Dr. Prewitt.
-Another paper on the same subject was read by Dr.
Tiffany, of Kansas City. This was illustrated by col-
ored drawings which were placed upon the wall behind
the reader.
On Thursday morning Dr. Dickenson, the Corre-
sponding Secretary, reported the receipt of copies of the
" Transactions " of North Carolina and Minnesota State
Societies. It was ordered that all papers offered by
gentlemen not present in person to read them, be read
by title and referred to the Publication Committee.
Dr. Allen then read the
paper ON ALCOHOL,
which he was directed at last meeting to present at this
time. A committee of three was ordered to be fap-
586
THE MEDICAL RECORD.
[May 26, 1883.
pointed to investigate and report at the next meeting
with reference to the relations of alcohohsm, insanity,
and crime.
The following papers were read by title : " Injuries
to the Head," by Dr. R. F. Brooks, Carthage ; " Case
of Congenital Encephalonia," by Dr. J. H. Duncan,
Columbia.
The special order of the day was then taken up, and
the following officers elected : Presideiit — Dr. E. H.
Gregory, of St. Louis; Vice-Presidents^Yir. O. A. Wil-
liams, of Morgan County , Dr. John H. Duncan, of
Boone County ; Dr. J. D. Griffith, of Jackson County ;
Dr. T. J. Norris, of Macon County ; Dr. C. H. Hughes,
of St. Louis. Recording Secretaries — Dr. .\. H. Ohmann
Dusmenil, of St. Louis ; Dr. D. V. Wales, of Jasper
County. Corresponding Secretary — Dr. N. F. Essig, of
Clinton County. Treasurer — Dr. C. A. Thompson, of
Cole County.
THE NEXT MEETING OF THE ASSOCIATION
will be at Sedalia.
A resolution was adopted approving the record of the
National Board of Health, and urging upon Congress the
appropriation of necessary funds for the efficient work of
this Board.
MISCELLANEOUS PAPERS.
Dr. N. M. Baskett read a paper entitled " Some Sug-
gestions on Sanitation."
Dr. W. a. Hardaway read a valuable paper report-
ing ten years' experience in the use of electricity in the
treatment of diseases of the skin.
Dr. T. E. Potter, of Cameron, read a paper entitled
" Therapeutics of Ergot and Ergotin in the Reduction
of Spleen and Fibroids of the Uterus."
Dr. C. -A. Todd, of St. Louis, read an abstract of a
paper on
ANTISEPTIC TRE.VTMENT OF SUPPURATIVE OTITIS BV THE
DRY METHOD.
The dry method consists in cleansing the ear with ab-
sorbent cotton, and applying an antiseptic powder. No
syringing is allowed ; no drops are instilled. This treat-
ment was first published by Dr. Todd, in a paper pre-
sented to this Association in 1880, after he had tested it
for some time, and fully demonstrated its value in his
aural clinic at the Missouri .Medical College. Dr. Todd
was the first to recommend the use of borax as an an-
tiseptic powder instead of boracic acid, and other insolu-
ble or slightly soluble powders.
Dr. W. p. King, of Sedalia, read a paper on " Vag-
inismus," detailing seven cases which he had treated.
He regarded the affection as purely local, and believed
that the excision of caruncuhe myrtiformes would be
curative in almost all cases. In the discussion upon this
))aper Dr. Schenck took the position that several of the
cases reported by Dr. King were not cases of vaginis-
mus as defined by Dr. Sims, but merely hypera;sthesia
of the vulva, dependent ^upon local inflammatory con-
ditions.
The following papers were then read by title : '• Re-
port on Malarial Diseases in Children," by J. P. Kings-
ley, ALD., St. Louis; "Intestinal Obstruction," by J.
Geiger, M.D., St. Josejjh ; "Report on Railroad In-
juries," by F. M. Johnson, i\LD., Kansas City.
The usual votes of thanks were passed to citizens. Com-
mittee of .Arrangements, the railroads, the press, and the
retiring President.
The Association then adjourned for one year.
ILLINOIS STATE MEDICAL SOCIETY.
Thirty-third Annual Meeting, held at Peoria, III., May
15 and 16, 1S83.
(Continued from p. 548.)
The report on obstetrics was read by Dr. E. L. Her-
riott, of Jacksonville, with supplementary reports by Dr.
G. W. Jones, of Danville, and Dr. E. A. Ingersol, of
Canton. The report was discussed by Drs. Holton and
Corr. The report on ophthalmology was presented by
Prof. S. J. Jones, and supplementary report by Dr.
McKinney, of Barr)'.
In the report on ophthalmology the results of exami-
nations of Chinese and Japanese showed them to be pe-
culiarly exempt from the defect of color-blindness. The
discussion on ophthalmology was participated in by Dr.
G. W. Jones, of Danville, and Drs. Crawford and Tilley.
Volunteer papers on miscellaneous subjects ; nomina-
tions, and votes of thanks constituted the closing session.
The miscellaneous papers were read by Dr. J. Murphy,
of Peoria, Dr. L. G. Thompson, of Lacon, and Dr. Reber,
of Shelbyville.
Dr. X. S. Davis expressed the feeling of dissatisfac-
tion which has always existed among those who have
had to report on the practice of medicine from the want
of reliable data from which to base conclusions, and
moved that the chairman be requested to appoint one
member from each county to obtain and furnish such
data to the Committee on the Practice of Medicine.
A special vote of thanks was tendered to Dr. J. H.
Hollister for his twenty years of faithful and efficient ser-
vice as Treasurer of the Society.
The Committee on Necrology requested the privilege
of correcting the statement that no deaths had occurred,
the corrections will appear in the "Transactions."
The retiring President, who was not relieved by the
President elect, gave a brief address in response to a vote
of thanks, and the meeting adjourned to meet in Chicago,
May, 1884.
Tasteless Medicines. — An old colored man saw a
sign in a drug store which read " Tasteless Medicines."
Looking in at the " pizenmixer," as he called him, he
said : " Dat am de bes' advice I ever got — taste less
medicines," and hurried away, just in time to_dodge a
package which was thrown after him.
A Confident Correspondent. — ^Dr. J. O. Davy, of
Springfield, O., is safe in prophesying the following : " In
one of the February numbers of the Medical Age is an
article on typhoid fever, in which the writer gave expres-
sion to the following sentiment : ' Typhoid fever is a
disease which is uncontrolled and uncontrollable, and
any one who says he can abort an attack or cut short
the disease after it has passed the forming stage is either
a knave or a fool!
" Has not the doctor placed himself in similar situ-
ation to the animal that attempted to make a sky-rocket
of a locomotive ? Well I the result was in no way com-
mendable to the animal for his judgment. It is very
true the medical profession of the world of to-day regard
the sentiment quite correct and endorse most heartily his
strong diction, but all that will not prove the truthful-
ness of his assertion any more than the maledictions
which were hurled at Galileo proved that the world was
flat. A thing may be regarded impossible to-day and
next year quite practical. Within the next five years
typhoid fever will be controlled almost as easily as re-
mittent or marsh fever of to-day. A patient can be got-
ten into a convalescent condition in from four to six days
after the following symptoms are fully developed : tem-
perature, 105° ; pulse, 100 or 120 per minute ; the ner-
vous symptoms with delirium well marked ; tongue, dry,
cracked ; articulation, quite indistinct ; bowels, tympan-
itic, tender, and gurgling ; diarrhoea of ochre-colored
stools, etc. .Ninety per cent, of such cases can be got-
ten up and about their rooms in from twelve to eighteen
days by i)roper medication. Fully ninety per cent, of
cases of typhoid fever can be aborted if medication is
properly commenced before the patients lake to tln?ir
beds. True, this sounds like the prattle of one sufter-
ing from mental hallucinations, l?ui time will tell luho
are in the fog."
May 26, 1883.]
THE MEDICAL RECORD.
587
(ilo vr cap 0 n cl cucc.
A CASE OF WANDERING NEEDLES.
To THE Editor of The Medical Record.
Sir : The following brief account may be somewhat inter-
esting as illustrating the behavior and one of the varied
courses taken by foreign bodies introduced into the gastro-
intestinal tract.
R. V , thirty-three years of age; seamstress by oc-
cui)ution ; born in Switzerland ; was first brought under
observation one year ago, at the State Emigrant Hospi-
tal, Ward's Island. When admitted to that institution
she had been suffering from acute colicky pains for the
previous three or four weeks, referred to the lower part
of the abdomen and the vagina, and in consequence was
unable to assume an erect position or walk, e.xcept with
marked increase of the pain.
Upon examination a narrow body about two inches in
length was discovered imbedded in the abdominal wall, one
inch below the umbilicus and somewhat to the left of the
median line, fairly movable among the surrounding tis-
sues and causing great pain when manipulated ; vagina
exquisitely sensitive to touch, and examination on this ac-
count not admissible.
Signs of inflammation shortly appearing, with increase
of the symptoms, the patient was etherized, antiseptic
precautions taken, and the body cut down upon and re-
moved by Dr. George M. Tuttle. It proved to be an or-
dinary sewing-needle, about one inch and a half long,
slightly rusted, black and oxidized, lying one-half inch
below the surface, in the substance of the rectus abdom-
inis muscle.
The symptoms now subsiding, appeared again shortly
afterward, the pain being referred to the left inguinal
region, from which situation two others were removed at
different times, however, but both lying parallel to, and
close to Poupart's ligament. After this nothing more was
discovered, although when discharged slight abdominal
pain still remained.
Patient was admitted to the Mount Sinai Hospital m
February, 1883, one year after the above ; one needle,
it is said, having been removed in the meantime at one
of the city dispensaries. With this exception there had
been comparatively little discomfort till within the pre-
ceding two weeks, during which time she had suffered
from constant vomiting, with severe epigastric pain, having
taken little or no nourishment.
When admitted, her general condition was very poor.
Pulse imperceptible at the wrist ; respirations hurried and
irregular ; extremities cold ; temperature normal ; general
abdominal pain complained of, and tenderness in this
region well marked. Other examination negative with the
exception of slight enlargement of the liver ; vomiting oc-
curred several times. Patient sank rapidly, and died eight
hours after admission.
Autopsy showed fatty liver to have caused death. Mov-
able kidney upon the right side was also present. This
could be displaced, anteriorly, to the median line, and be-
low as far as the crest of the ilium. Imbedded in the
great omentum, opposite the umbilical region, were found
six needles, and likewise in the omentum, opposite the
lumbar region, two were discovered. These, measuring
39 mm. in length, were blackened and corroded. The sharp
points had disappeared, and they were firmly fixed, evi-
dently surrounded by some inflammatory products, which
had served to encyst them in their new situation. One
needle had made its way through the parietal peritoneum
and lay partly imbedded in the rectus abdominis muscle.
Here the omentum was firmly adherent to the anterior
abdominal wall, showing that some adhesive inflanmiation
had accompanied its perforation of the parietal peritoneum
and omentum. In the pelvis, over the femoral ring, upon
the left side, the border of the omentum, which extended
down to this region, was thickened by old inflammation,
and firmly adherent to the peritoneum of the pelvic wall.
Two needles were here met with, which had found their
way through the peritoneum in part, and projected into
the substance of the psoas and iliacus muscle. Every-
where the needles presented the same corroded appear-
ance, and could not be disturbed from their [losition with-
out positive laceration of the surrounding tissues.
Nowhere were there any signs of recent inflammation.
As to the exact length of time the needles had been pres-
ent but little definite knowledge could be ascertained.
One, however, is known to have been swallowed about six
years ago.
Three years since, the patient was in the service of Dr,
Pastolozzi, of Zurich, during which time a needle was re-
moved by incision (one having been previously pressed
out with the fingers). Similar symptoms were presented,
and relief likewise obtained after removal. At this time
it was learned that epigastric pain and oppression had
been prominent since her nineteenth year, with also the
occurrence of frequent vomiting, the vomited matter fre-
quently containing considerable blood. Menstruation
had always been regular, and there seemed to be no con-
nection between it and the attacks of pain, the latter oc-
curring at intervals of from eight days to two weeks, and
lasting from one to two hours.
In all, therefore, it seems that six needles were re-
moved ; the first at least three years after one was known
to have been swallowed ; the last somewhat over two
years later, and these are ail described as being similar to
those found on autopsy.
John Vander Poel, M.D.,
House Physician, Mount Sinai Hospital, N. V.
^EMig ^cvos.
Official List of Changes in the Medical Corps of the Navy
for the week ending May 19, 1883.
CoRwiN, William A., Surgeon. Detached from the
Receiving Ship Colorado and granted sick-leave for three
months.
Crawford, M. H., Passed Assistant Surgeon. De-
tached from the U. S. Ship Pinta and ordered to the
Navy Yard, League Island, Pa.
^Mical ^teirxs.
Contagious Diseases — Weekly Statement. — Re-*
port of cases and deaths from contagious diseases re-
ported to the Sanitary Bureau, Health Department, for
the two weeks ending May 22, 1883 :
Week Ending
Cases.
May 15, 1883.. .
May 22, 1883.. .
■a
'5.-S
0 S
i.
0
>
ng
.2 -S
*
c/)
Meas
Diph
1.32
4
163 39
0
0
128
8
170
41
0
0
Deaths.
May 15, 18S3...
May 22, 1883...
4 3°
I 32
The total mortahty for the week ending May 19, 1883,
was 728, of which 70 were from pneumonia.
On Extracting Decayed Teeth as a Preventive,
or Curative Effect of Ill-Health. — Dr. G. W.
Brandon, of Milford, Neb., writes : " In looking over The
588
THE MEDICAL RECORD.
[May 26, 1883.
Medical Record of May 12th, I see a communication
from Samuel Sexton, M.D., of New York. In speakin-g
of the extraction of decayed teeth, or teeth that from any
cause are suffering from death of the pulp, I, too, have
noticed the bad effect produced upon the system, in
one instance that I recall, especially.
"Mrs. S. J. W , a lady about thirty-four years old,
who had always enjoyed the best of health previous to
her present trouble, was suffering almost continually
with neuralgia (facial), also dyspepsia, and, as she termed
it, sick headache and nervous prostration, loss of sleep,
irregularity of the bowels, etc., etc., so bad that she was
compelled to keep her bed for days at a time. She had
employed several physicians, but realized no benefit from
treatment, only temporary. She finally drifted into my
oliice. Upon examination, I could detect no constitu-
tional disturbance that I could attribute her trouble to.
But upon noticing her foul breath I requested an ex-
amination of her teeth, which I found in a bad condition,
several rotted down, others with the gum falling away,
and so on. I requested her to have the offending mem-
bers removed. She objected, said it would hurt, and
went to another jihysician for treatment, but eventually
returned, when upon reassuring her it would be a great
help, she consented to the operation. I extracted all
irritated or irritating teeth, when she asked me if I was
not going to prescribe for her. I informed her I was
not. I saw her some three months after, when she in-
formed me that since the operation she had enjoyed
splendid health, and had suffered less in the three months
last past than she had any one day for five years pre-
vious, said her health was never better ; at the same time
showing me another tooth that was slightly decayed,
said it did not ache, but no more bad teeth for her, and
requested me to extract it, which I did. Now, 1 do not
presume to say all cases will be as decided as the one
just mentioned, but I do believe that in a great many
cases we can relieve disease and do justice to our pa-
tients, as well as the profession, by considering these
small but none the less aggravating conditions."
ViT.\r. Statistics in Wisconsin. — The State Legis-
lature of Wisconsin has passed a law requiring the or-
ganization of health boards and appointment of local
health officers throughout the State ; also the compulsory
notification, by physicians, of contagious diseases. Ac-
tive measures are being taken by the Secretary of the
State Board to carry the law into effect.
" A Novel Mode of Cleansing the Vault of the
Pharynx." — Dr. J. O. Webster, of Augusta, Me., writes :
"A paper with the above title, in The Record of April
i 28th, leads me to report my own case. I can easily,
with the tip of my tongue, sweep the entire vault of
the pharynx, insert it for some distance into the posterior
nares, and slightly into the mouths of the Eustachian
tubes, and am in the constant habit of dislodging mucus
by its means. This power I gradually acquired when a
boy, by trying to dislodge mucus from behind the soft
palate with my tongue. This was at last accomplished,
with great difficulty, but the tongue became daily more
pliable, and can now be used as slated above. The
frasnum lingua; was never cut."
Fracture of Internal Epicondyle of Humerus. —
Dr. J. W. Pryor, of Lexington, Ky., sends us the
history of the following rare case: "October 18, 1882,
Willie S , aged twelve years, while wrestling with a
playmate fell with the right arm semiflexed behind the
body (the position in which fencers usually hold the
left arm), the internal epicondyle receiving the force of
the fall, as proved by tiie manner in which the arm was
held, according to the testimony of the lad, tlie ecchymosis
jjroving his statement. Pie could flex, extend, supinate,
and pronate the arm with perfect freedom and little or no
pain. The small knuckle of bone was freely movable,
and crepitus very distinct. I was positive the fracture
did not extend into the joint. I saw the case about an
hour after the injury ; there was no swelling at that time.
Dr. Stuck}', who saw the case, agreed with me that it was
a true fracture, and not a diastasis of the internal epi-
condylar epiphysis. We put the arm in an elbow-splint,
bandaging from the hand to a short distance above the
elbow. The boy did not return to my office until the
fourth day from the injury. I found that the mother had
removed the bandage and that the elbow was slightly
swelled and quite painful upon flexion. I directed the
mother to keep up passive motion. At the present time
(six months since fractured), the arm has perfect motion.
The internal epicondyle is slightly displaced toward the
hand and enlarged, showing there had been a large de-
posit of callus about the situation of the break.''
Medical Society of New Jersey. — The one hun-
dred and seventeenth annual meeting of the above
Society will be held in Congress Hall, Atlantic City, on
Tuesday and Wednesday, June 12th and 13th, com-
mencing on Tuesday at four o'clock p.m. — \V'illiam Pier-
son, M.D., Secretary.
Professor Roberts Bartholow, M.D., LL.D., of
Jefferson Medical College, has been elected Dean of the
College in place of Dr. Ellerslie Wallace, who has been
forced to resign on account of ill health.
Bromic Ether in WnoopiNG-CouGH.^Dr. Squire
recommends a solution of bromic ether in water (i to 200)
for administration in whooping-cough, as well as for an-
gina pectoris and spasmodic pain.
A Case of Polyorchism was observed in Bulgaria,
in a farmer eighteen years of age. There were three
testicles, two being on the right in the scrotum, one
above the other.
Why Some Subjects are Studied so Much. — Dr.
Da Costa has said : " If one has not too much to do he
writes a short paper on phthisis ; if one has little to do he
writes a long paper on phthisis ; if one has nothing to do
he writes a book on phthisis." The same writer says :
" Gynecologists, as a rule, part their hair and their names
in the middle, and never die until they have invented
pessaries and speculums innumerable."
A Medical Epigram. — It was Garrick who wrote the
epigram on Sir John Hill, viz. :
'' For physic and farces
His equal there scarce is ;
His farces are physic,
His physic a farce is."
Reading Biographies. — Dr. B. W. Richardson, in
recoiumending to students the reading of biographies,
says: "A man who will begin as a student to learn the
lives of great men of the past, and will pass from one life
to another regularly until he has made as many of the
great ones of the past his bosom friends as he can, will
at all times be miles in advance of other men who have
made no such friendships."
Chlorate of Potassium in Ulcerating Epithe-
liomata, in fine powder, is said to yield excellent re-
sults when dusted over the surface of ulcers and ulcer-
ating epitheliomata. The surface should be cleansed
and the powder dusted thickly on twice a day. This,
it is claimed, relieves pain and promotes healing.
Castor-Oii. and Glycerine. — A mixture, which is
of an agreeable flavor and in which the nauseous smell
of the oil is efficiently disguised, can be made thus :
1$ . 01. ricini . 3 j.
Glycerini 3 j.
Tr. auranlii lT],xx.
Tr. senega; Til, v.
AquK, cinnam ad. 3 ss.
This forms a beautiful emulsion, is easily taken, even
by children, and if administered at bedtime will produce
a gentle motion the following morning.
The Medical Record
A Weekly yournal of Medicine and Surgery
Vol. 23, No. 22
New York, June 2, 1883
Whole No. 656
©vioiual ^I'ticlcs.
ANGULAR ANCHYLOSIS OF FEMUR AT THE
HIP-JOINT.
Treated bv Subcutaneous Division ok the Shaft
AT THE Trochanter.
Bv STEPHEN SMITH, M.D.,
PROFESSOR CLINICAL SUKGERV, UNIVERSITY MEDICAL COLLEGE, NEW VORK.
The patient was a young lady who suffered from disease
of the hip-joint in early life, which resulted in anchylosis
at an angle of about forty-five degrees. A year or two
previous she had been under the care of the late Dr.
James R. Wood, who endeavored to straiten the limb
by force, but did not succeed. I gather from her state-
ment that he did overcome the He.\ion somewhat, but
that fact is not clearly made out. At the time when she
first applied to me there was no perceptible motion ob-
tainable at the joint, on the most careful trial.
The operation proposed was division of the femur just
at the small trochanter, and the method selected was
subcutaneous section with the fenestrated canula saw of
Dr. Cleo. Y. Shrady. This
saw has great advantages
over any other form of
bone-saw in this, that by
working in a canula, the
tissues beyond the bone
are not liable to be injured
by the point of the saw as
it is moved backward and
forward. The saw is de-
scribed as follows by Dr.
Shrady :
The instrument consists
of a trocar, fenestrated ca-
nula (Fig. i), and a staff
(Fig. 2), with handle and
blunt e.xtremity. A por-
tion of this staff at a short
distance from the extrem-
ity is flattened, one edge
(i9) being made into a
knife-blade, and the other
edge (C) being jsrovided
with saw-teeth. This staff
(Fig. 2) is intended to re-
place the trocar in the
canula after the latter is
introduced. When in po-
sition (Fig. 3j, either the saw (C) or the knife (.5)
edge of the shaft, according to the way the latter is
turned, corresponds with the opening in the canula.
The saw or knife can then be worked to and fro witliin
the canula by a piston-like movement, the canula being
steadied by grasping the flange {D) at its base. If it
be necessary to work the instrument as an ordinary
blunt-pointed sheathed saw or knife, the shaft can be
fixed m the canula and made into one piece by a thumb-
screw in the handle. The portion of the canula at
the back of the opening is made extra strong and is of
the same thickness as the blade, so that in sawing there
is no stoppage to the passage of the instrument through
any thickness of bone. The soft parts are protected
from injury, no matter whicii way the instrument may be
worked. The saw-blade is blunt at its extremity, and is
guarded on all sides except on its limited cutting surface.
The same may be said of the knife. The working of the
saw to and fro in the canula is sufficient in sweep to in-
sure the division of any bone having a diameter less than
the length of the cutting edge. Still, as this process is
much slower than when the saw is used in the ordinary
way, it is perhaps better to restrict its employment to
operations on the smaller bones, to cramped localities,
and to situations where there is special danger of wound-
ing some neighboring vessels. All that is necessary in
using this saw is to thrust the trocar and canula into the
limb, the fenestra of the canula being alongside of the
bone upon which the operation is to be [jerformed. The
trocar is then withdrawn, the staff introduced in its place
(Fig. 3) and worked as already described. The instru-
ment is made of different sizes, to suit the different pur-
poses for which it may be emjiloyed.
As one of the liabilities after the simple division of the
bone is the displacement of the lower fragment from
contact with the upper portion, so as to endanger non-
union, I decided to attempt to overcome that tendency
by making a half tenon and mortise by which the frag-
ments would lock. This was easily effected by dividing
the bone partially on the posterior and anterior surfaces,
the incisions being separated half an inch or more, and
breaking the intermediate portion. The object sought
to be accomplished is apparent from the following illus-
tration (Fig. 4). Placing these two pieces in the posi-
tion which the bone would assume after division, the
relations of the fragments are shown in Fig. 5. If this
conception of the operation is applied to the case in hand
the following illustrations (Figs. 6 and 7) will correctly
represent the procedure and the results.
The operation was as follows : The left thigh being
the affected limb, the patient was placed on her right
side, which brought the left trochanter prominently up-
ward. Selecting a point corresponding with the small
trochanter, a sharp-pointed knife was introduced to the
bone. Along the track of the knife Shrady's saw, sheathed
in the canula, was passed, flatwise, until the blade of the
saw was placed against the posterior surface of the
femur at the point where section was to be made. The
saw was then turned upon its axis so as to bring the
teeth upon the bone. I attempted at first to hold the
canula tirmly, and work the saw in it, but found so much
590
THE MEDICAL RECORD.
[June 2, 1883.
difficult)' tfiat I finally worked the whole as a common
saw. The difficulty of fixing the canula seemed to be
due to my inability to hold the canula firmly (the instru-
ment being without the extra handle, riJe Fig. S), and to
a bending of the canula in the track of the saw when
the saw was withdrawn, which interfered with its return.
It is possible that particles of soft tissue were also drawn
into the canula, which prevented the saw from returning
along the track. The saw, however, worked satisfactorily
with the canula to guard its point. After penetrating to a
depth supposed to be a little more than half the diameter of
the bone, the saw was withdrawn from the posterior surface
and passed along the anterior surface, flatwise, about half
an incli below the line of section of the posterior wall of
the femur. Turning the saw to the bone, the section was
made to a depth believed to be nearly on a line, in the
long diameter, with the greatest depth of the posterior
Fig. 6.
Fig. 7,
section. This fact was determined by inserting two
probes in the cuts. At this point I proposed to stop,
and apply the plaster dressings, and break the interven-
ing bone as the limb was brought down into the straight
position. Some of the gentlemen present did not think
that I had divided the bone sufficiently to insure fracture,
basing their opinion U))on the few movements which I
had given to the saw. The truth was that the saw had
cut the bone nnich more rapidly than they had supposed,
for, on re-entering it, and making two or three passages,
the bone separated in my hands.
The bone being divided while I held the limb, the as-
sistants applied the plaster-of-Paris dressing. During
the adjustment of the dressings, the lower fragment of
the femur twice slipped out of its interlocked position
with the upper fixed portion, but it was readily rei^laced,
and when returned remained quite firmly in the notch
prci)ared for it. The limb was brought into the straight
position while the plaster was yet moist. It soon hard-
ened, and then the dressings formed a s))lint, encasing
two-thirds of both thighs, hips, and the lower half of the
body. A fenestrum was cut out at the seat of the wound
of the thigh. The wound had been hyperdistended with
carbolized water, and then hermetically sealed.
The patient did well for two days, when menstruation
began with great nervous excitement, which induced
restlessness, sleeplessness, apprehensions of danger, and
loss of appetite. It was more than a week before these
symptoms subsided, when a superficial abscess was
found to have formed, which extended down the external
part of the thigh nearly to the knee. It discharged freely
through the original wound, and by means of compressed
sponges, accurately applied and firmly bandaged, soon
closed. It could not at any time be made out that the
abscess penetrated to the divided bone, and from the
rapidity with which it closed
there can be no doubt that
it was altogether superficial.
The union of the bone
progressed satisfactorily, and
in about the usual period
which is required for the
consolidation of a fracture at
this point, the patient was
able to get up, and begin to
use her limb. She now walks
without any support, erect
as she would with a healthy
limb, and with but a slight
halt.
The advantages of this
method of operation, if any,
are : i, The subcutaneous
nature of the wound ; 2,
the precision with which the
bone can be divided at the
desired point ; and 3, the defi-
nitely fixed position which the
fragments necessarily assume
with relation to each other
immediately on the division
of the bone.
The only embarrassment
experienced was the effort to
work the saw in the canula.
Failing in this, the saw and
canula were worked togeth-
er, and, as the saw cut a
groove sufficiently large to re-
ceive the canula, there was
no difficulty in very quickly dividing the bone. The
danger, however, of contusing the tissues on the inner
side of the bone, by the end of the canula, is necessarily
considerable, but in this case I am satisfied that the
harm done did not interfere with the union of bone, nor
the healing of the wound. Still it would be well to avoid
the risk. On explaining the operation of the saw to Dr.
Shrady, he modified the canula by making the fenestrum
so small as only to expose the teeth of the saw (Fig. 8).
As the teeth cut a groove which the canula readily fol-
lows, the canula, thus strengthened, will enable the saw
to work easily in it, and at the same time will follow the
saw in its section of the bone. This saw seems to me
now to be the perfection of its class.
Kig. 8.
A Modern Mikaci k. — The JVcmi Orleans Picayune
says that a medical man in New Orleans, who is fond cf
his little joke, called on a colored minister, and began to
catechise him : "Why is it," said he, " that you are not
able to do the miracles that the apostles did ? They
were protected against all poisons and all kinds of perils.
How is it that you are not protected now in the same
way?" The colored preacher responded promptly:
" Don't know about that, doctor. I 'spect I is. I've
taken a mighty sight ot strong medicine from you, doc-
tor, and I is alive yet."
June 2, 1883.]
THE MEDICAL RECORD.
591
CONVULSIVE AFFECTIONS IN CHILDREN
AND THEIR TREATMENT.
By S. henry DESSAU, M.D.,
l-HYSICIAN TO OUT-DOOR DEPARTMENT N. V. FOUNDLING ASYLUM, DISTRICT THV-
SICIAN TO N. V. DISPENSARY, FELLOW OF THE ACADEMY OF MEDICINE, El C.
Children, from infancy to the age of five years, are es-
pecially liable to convulsive attacks, and those beyond
that age, when of a highly nervous organization, are fre-
quently affected. This peculiar susceptibility to con-
vulsions is supposed to be owing to the highly irritable
nature of the growing cerebro-spinal system. It is more-
over largely influenced by certain inherited tendencies,
especially affecting the nervous centres, which act in tlie
nature of predisposing causes.
Convulsions in children occur as a complication and
often as a symptom of numerous diseases. They may
also be produced by local mechanical irritation. In
general terms they may be said to depend for their pri-
mary cause upon an irritation of certain nerve-centres in
the medulla, modified, perhaps, by a want of control on
the part of certain inhibitory centres, which in the young
child are not fully developed. This irritation may be
produced directly by the action of the blood under cer-
tain conditions of quantity and quality, or indirectly
through refle.x transmission of peripheral impressions.
The secondary or immediate cause may be said to be due
to the peculiar susceptibility of the medulla to disturb-
ance produced by the quality of blood flowing to it ; and
tiiis may be influenced either by chemico-vital changes
of that fluid occurring in the body at large, or by the
quantity of blood supplied, which supply is controlled by
the action of local vaso-motor meclianisms upon the
heart and upon the calibre of the blood-vessels in distant
parts. This quality consists in either an excess of car-
bonic acid or a deficiency of oxygen in the blood sup-
plying the brain.
Convulsions produced in animals by the inhalation of
carbonic acid gas are an illustration of the one, and con-
vulsions from a large and sudden loss of blood an illus-
tration of the other.
I therefore propose to arrange the convulsive affections
of children under two grand divisions, viz.: those due to
peripheral or local irritations, and those due to central
or circulatory causes.
I do not recognize the class of convulsions in children
commonly called essential, for where no assignable cause
for their origin can be discovered, they are in all likeli-
hood, especially when occurring after the third year,
epilepsy.
Convulsions in children due to the influence of mental
impressions may very properly be regarded as hysterical
in their nature. There are certain sources of the local
origin of convulsions that are of commoner occurrence
than others. The most frequent one in the experience
of every physician is irritation of the gastro-intestinal
canal. This is the first cause generally suspected, in the
absence of other well-defined and apparent causes, and
will bear close scrutiny by the medical attendant. It is
commonly due either to an improper tpiality or too great
a quantity of food. More rarely it may be owing to the
existence of entozoa, also a loaded condition of the rec-
tum from constipation. Occasionally an intestinal ca-
tarrh, arising from sudden changes of temperature, may
be the starting-point of the convulsion. Whatever com-
bination of circumstances will lead to indigestion will,
in all probability, excite a convulsive attack, the proba-
bility increasing with the acuteness of the stomachal dis-
order. This is, on account of the manner in which the
contents of the stomach in children is hastened on into
the intestines, where the undigested matter undergoes
fermentation, producing gases and distention which ex-
cite pain. Occasionally matter which has been wholly
unacted upon by the gastric secretions enters the intes-
tines, where it causes mechanical irritation. I have met
with a case of convulsions where large pieces of orange-
peel were detected in the passages from the bowels
Frequently the irritation proceeds from the stomach, be-
fore its contents have passed into the intestines. This
occurred in the case of^ a boy, eleven years of age, whom
I attended, where a quantity of sausage had been eaten,
and was removed by an emetic. Trousseau mentions a
case where the altered condition of the mother's milk,
after she had passed through a state of mental excite-
ment, was sufficient to cause convulsions in her infant,
shortly after nursing.
It should not betorgotten that the process of dentition
and the rachitic diathesis aid to a great extent as com-
plicating factors in disturbing the function of digestion.
This is beyond the part that they assume as independent
elements in the causation of convulsions in children.
Dentition may be regarded as next in order of fre-
quency as a source of local irritation causing convulsions
in children. By dentition is meant the active process
of the eruption of the teeth with the attending pain and
general nervous erethism, consequent upon the swollen
and congested state of the gum, when this exists. The
condition of the nervous system that exists during the
entire period of teething, which is dependent upon the al-
teration taking place in the various organs for a new de-
parture of nutrition, can only be considered as a predis-
posing cause. There can be little doubt that dentition,
as here implied, is a factor in the causation of convul-
sions, independently of any other element, for it has often
been demonstrated on good authority that they have
ceased as soon as the tension of the swollen gum was
relieved by lancing. It has been disputed by some au-
thorities on the diseases of children, notably Henoch, that
dentition is as common a cause of convulsions as rickets.
While I regard rickets as a prolific source of these attacks,
as will be noted further on, there is little doubt in my
own mind that, in the majority of cases of convulsions oc-
curring in children suftering from rickets, it will be found
that the active process of dentition is the exciting cause,
the diathesis acting meanwhile as the predisposing cause.
This view is rendered all the stronger from the fact that
dentition, although retarded in rachitic subjects, occurs
at the time when rickets is at the height of its morbid
action.
There are numerous minor sources of local irritation
exciting convulsions in children, amongst which can be
enumerated, burns, scalds, blisters, severe itching from
eczema or other cutaneous eruptions, hardened wax or
other foreign bodies in the external auditory canal, foreign
bodies in the nostrils, and in fact foreign bodies in any
of the animal tissues. Trousseau relates one case where
a long needle sticking in the brain and accidentally dis-
covered by the thread attached, produced a series of
convulsive paroxysms which ceased as soon as the needle
was withdrawn ; and another where convulsions had been
caused by a needle found at the autopsy penetrating the
liver. He also quotes Underwood, who records a
case where a pin piercing the anterior fontanelle was
found to be the exciting cause of convulsions, ending in
death. Such substances as long hairs or pieces of thread
found in the pharynx of young children, have been re-
ported in the journals as the exciting cause of convulsive
attacks. Dr. Buzzard in Tke Practitioner (vol. xx., p. 403)
has ably demonstrated the mechanism of facial spasms
produced by foreign bodies m the external auditory canal,
and it is reasonable to infer that a similar degree of ner-
vous disturbance from a like cause would be manifested
in the young child by a convulsion.
Under the division made of convulsions due to changes
in the quality and quantity of blood sui)plying the cere-
bral circulation, fevers occupy the first place in frequency
and importance. All fevers are due either to a specific
poison circulating in the blood, or to the process of con-
gestion and inflammation. To the first class belong the
eruptive fevers of children, such as scarlatina, measles,
variola, varicella, and erysipelas, and typhoid and malarial
fevers. Each of these mav be ushered in by a convulsion
592
THE MEDICAL RECORD.
[June 2, 1883.
corresponding to the chill in the adult. In malignant
cases, convulsions often occur some time after the fever
has begun, probably from the action of the specific i)oison.
Where this happens in the early stage of scarlatina and
the late stage of measles, an unfavorable termination may
be expected. Convulsions occurring during the latter
stage of scarlatina, it need hardly be said, are of renal
origin. Intermittent fever in children, especially in those
having a convulsive predisposition, presents a marked
illustration of the convulsion taking the place of the
chill in the adult. All doubts as to the nature of the
convulsion may be set at rest when it is found to occur
periodically, and is followed by high fever and sweating.
To the class of fevers arising from congestion and inflam-
mation belong pneumonia, bronchitis, summer diarrhoea
and its allied affection heat fever, tonsillitis, and other
catarrhal affections. Pneumonia involving the apex of
the lung is especially apt to be accompanied with con-
vulsions in children. Vogel regards convulsions in chil-
dren occurring where the disease is located in certain
parts, as due to the reflex irritation of the diseased organ
or tissue upon the nerve-centres.
It may fre^iuently be observed that there is no direct
relation between the rise of temperature and the manifesta-
tion of the convulsion, for in children of a nervous tem-
perament, who are more susceptible to tlie action of the
febrile process than others, a moderate rise of fever, as
indicated by the thermometer, is sufficient to induce an
attack. Gastro-intestinal irritation and the irritation of
dentition are frequently attended with fever. But in
such cases it seems reasonable to connect the rise of tem-
perature with the same condition of the vascular mech-
anism as that exciting the convulsive attack.
Rickets and syphilis are included under the head of
circulatory causes, producing convulsions in children, from
the fact that in both of these diseases the process of nu-
trition is seriously at fault, owing either to an increased or
imperfect metamorphosis of tissue, the blood necessarily
becoming changed in character. It has been supposed
by some writers that the frequent occurrence of convul-
sions in rickets was in consequence of the softened and
elastic cranial bones not offering a proper support to the
blood-vessels, so that an undue amount of blood reached
the brain. Perhaps it may be well to regard this view as
having a certain degree of importance in determining the
rationale of convulsions in rickets, though certainly the
condition of the blood supplying the brain cannot be
slighted. This view becomes all the more tenable when
rickets is compared with hereditary syphilis, which it
closely resembles in many clinical and pathological fea-
tures, and which is now well known to be frequently at-
tended with convulsions.
Laryngismus stridulus is the common form of convul-
sive manifestation in rickets, and may be regarded as an
integral part of the disease. It usually is the prelude to
a general attack, if not speedily controlled. The inter-
ference with the normal o.xygenation of the blood by the
frequent spasmodic closure of the glottis, presents a
marked illustration of the influence of venous stasis in
the cerebral circulation producing general convulsions.
Children suftering from rickets are immensely subject
to pulmonary and gastro-intestinal complaints. These,
as well as dentition, frequently aid as exciting causes to
produce convulsions in such children.
The influence of syphilis in producing convulsions in
children may be regarded in many respects as similar to
that of rickets. Disease of the cerebral blood-vessels,
leading to hemorrhagic extravasations, is probably an ad-
ditional factor.
In children affected with pertussis, convulsions are the
result of mechanical interference with the return of ven-
ous blood from the brain, through spasm of the muscles
of respiration. Here, as in laryngismus stridulus, the ner-
vous organization is already in a highly irritable condi-
tion, and the nerve-centres are easily liisturbed by the
repeated venous stasis which occurs. Convulsions in
children occurring toward the end of summer diarrhoeas,
are due to the anajmia caused by the excessive drain
upon the blood. Those occurring in the latter stages
of pneumonia and bronchitis are from an accumulation of
carbonic acid in the blood.
In the early stage of tubercular and simple meningitis,
cerebral hemorrhages, tumors, and other cerebro-spinal
affections incident to children, convulsions are a frequent
symptom. They are then jirobably due to changes in
the cerebral circulation, depending upon irritation of local
vasomotor mechanisms. Toward the end of these dis-
eases, however, the convulsions may justly be attributed
to changes in the quality of the blood flowing to the
brain, the result either of imperfect aeration from irregu-
lar breathing, or venous congestion from mechanical
pressures.
Every convulsion, however slight and limited, and from
whatever cause, should be regarded as dangerous, ow-
ing to the tendency to paralysis of the vital centres in
the medulla through exhaustive expenditure of nerve-
force. Certain forms of the attack mav, however, be
considered more favorable in their termination than
others. Such, for instance, are those occurring at the
onset of febrile processes, where there is no complication
with the rachitic or syphilitic diatheses nor dentition,
and the paroxysms are not repeated. Where the attacks
are general, soon over, and single, they have in my ex-
perience, proved less dangerous than where they are par-
tial and long-continued. Carpo-jiedal contractions should
always be regarded as a danger-signal for the near ap-
proach of a general convulsive attack, and deserve prompt
remedial measures. It occasionally happens that effu-
sions into the ventricles of the brain follow a prolonged
attack of convulsions, causing death from coma.
From the previously descwbed etiology of convulsions
in children, certain therapeutical indications may be de-
duced. These, in general terms, are to remove the ex-
citing cause, if possible, assist in restoring the balance of
circulation, and quiet the e.xcited nerve-centres. For
the proper operation of these measures the child should
first of all be entirely undressed, if this has not previously
been done, and held wrapped in a light blanket in the
nurse's or mother's arms, in a good light. While this
is being done questions concerning the kind of diet,
character of the passages from the bowels, previous
health, and other pertinent matters, can be rapidly asked,
.^t the same time a careful inspection of the body and
the cavities of the nose and ears for foreign bodies can
be made. The gums should be examined, also the an-
terior fontanelle and occiput. The existence of fever
and appearance of the skin, especially in the bends of
the joints, should be noted for the eruption of scarlatina,
and on the forehead and scalp for measles. Inquiry as
to any complaint of pain, its seat and character, previous
to the attack, should not be omitted. Sufficient informa-
tion can thus be hastily gathered to base a reasonable
method of procedure upon, exauiination of the lungs not
being included, as nothing definite can be discovered
thereby, owing to the accumulation of mucus in the
bronchial tubes and irregular resi)iration.
In the absence of any known exciting cause — excluding
epilepsy, which rarely occurs before three years of age,
is without fever and followed by a more or less prolonged
comatose stage — 1 have always considered it safe practice,
especially where the convulsive movements continue, to
suspect intestinal irritation ; for I have found in several
instances that it was possible for the child to have eaten
something that the nurse or mother was unaware of or
placed small imjiortance upon.
The first thing to be done, therefore, intestinal irritation
being the jiossible cause, is to administer an enema, which
should consist of a pint or more of strong soap-suds with
a teaspoonful of salt and a tablespoonful each of molasses
and castor-oil. This I usuall)' give mvself, the suction
end of the syringe, if a Davidson is used, being held by
an assistant near the surface of the mixture, so that the
June 2, 1883.]
THE MEDICAL RECORD.
593
oil, as it floats on the surface, may be first thrown into
the bowel. Where the enema does not appear to empty
the bowels satisfactorily, it is advisable to give a brisk
purgative by the mouth, such as three grains of calomel
with five of bicarbonate of soda. This should not
be given where an emetic has first been used, until the
stomach has had time to rest. Besides unloading the
intestines, the enema, by its stimulant properties, acts as
a derivative in equalizing the circulation, and the calomel
often has the effect of reducing temperature accompanying
the intestinal disturbance, when due to other than the
presence of undigested matter. If the convulsion occurs
shortly after a hearty meal or the eating of any very in-
digestible substance, an emetic is first indicated. The
syrup of ipecac or pulverized alum mixed with table syrup
can be given, if at hand, or what I generally find more
convenient and equally as efifective and rapid in action,
a draught of tepid mustard-water with salt. This can be
administered by the spoonful successfully, with the exer-
cise of a little knack and jiatience. If the physician car-
ries with him a solution of apomorphia, one-fortieth to
one-twentieth of a grain may be injected hypodermically
into the buttocks. The emetic, besides emptying the
stomach of its contents, in many instances aids, by its
revulsive effect, in checking the convulsive movements.
Frequently it happens that the convulsions continue
in a partial manner after the stomach and bowels have
been emptied, even where their contents had provoked
the attack. This may be owing to the impression that
the irritation has left upon the nervous centres. In such
a case the bath should be resorted to. And here there
appears to be some diversity of opinion among eminent
writers on the subject, as to the advisability of the warm,
hot, or cold bath. As each may be used with equal pro-
priety, where the occasion demands, it may be well to
ex|jlain their action upon the cerebral circulation.
Schiiller has demonstrated by physiological experi-
ments performed upon rabbits, that the action of a full
cold bath is to dilate the blood-vessels of the pia mater,
contraction occurring only after a long application of
the bath, and then from the blood being cooled down.
The full warm bath causes powerful contraction of the
vessels of the pia mater, often preceded by a transient
dilatation. A very hot full bath produces dilatation,
lasting longer, and only causes contraction after the bath
has been cooled down to about 86° F. As is well known,
the warm bath, of a temperature of 98° F. dilates the cu-
taneous capillaries, reddens the skin, and produces a
general relaxing effect, while the cold bath contracts the
cutaneous capillaries, and is attended with a certain
amount of shock. A certain length of time is required
for reaction to be restored after the cold bath, and even
then with the aid of friction. The cold sheet or rub-
down, as described by Winternitz in the The Practitioner
(vol. xxi., p. 104), rapidly excites dilatation of the cuta-
neous capillaries when combined w'ith friction or p:}tting,
and by pouring cold water over the sheet reduces tem-
perature.
It has been stated that convulsions have been ex-
cited again by the application of the hot bath — 98° F.
to 112° F. — where used to check them. As will be
seen by Schiiller's experiments, this might readily occur
where a congestion of the cerebral circulation already
existed, more especially if the precaution was not taken
to apply the cold douche or a compress to the head at
the time of giving the bath. I have, however, never
witnessed such an occurrence, but on the contrary have
seen a persistent attack of convulsions from gastro-intes-
tinal irritation cease, after complete immersion in a hot
bath, even where chloroform had previously failed to con-
trol it.
The practical conclusions to be drawn from the above
description of the effects upon the cerebral circulation
of the warm, hot, and cold bath, 'are that the warm bath
is indicated where there is reason to infer that a con-
gested condition of the pia mater exists, the hot or cold
bath where there is auEemia. Neither should be used
too long. In convulsions depending upon fever, where a
high degree of temperature exists, also in sunnner-diar-
rhcea, the cold bath may be used with advantage, but I
think the rub-down previously referred to, with the addi-
tion of cold water poured over the sheet, preferable.
Hot compresses to the head are, at the same time,
advisable in all cerebral aflections associated with a con-
dition of ana5mia. I have found the cold douche —
temperature 40° F. to 60° F. — applied to the spinal col-
umn, either while the patient was in the hot bath or im-
mediately after, has proved of considerable service in
checking some cases of convulsions.
It has become an established practice to administer
an an£esthetic at some time during the convulsive parox-
ysm. Chloroform is the one most commonly used, as
it acts quickly, and in children is harmless when care-
fully used. Many physicians are in the habit of using it
before all other remedies; while others prefer using it
after the measures previously mentioned have been tried.
The proper method, in my opinion, depends upon the
severity of the attack. If these are violent and pro-
longed, causing the face to become livid, and are fre-
quently repeated, it is best and safest to administer chlo-
roform in preference to using other means, providing
there is no easily perceptible local cause of irritation
originating the attack. Otherwise, I consider it better
jiractice to remove the cause first, if possible, and if the
attacks continue then to use chloroform.
Nitrite of amyl has been used by Dr. \\'illiams of Boston
{Canada Me,i. and Surg. Jour., '£,e\>ltimhex, 1882) with
much success in the treatment of laryngisnuis stridulus,
and other writers have reported its use in the general con-
vulsions of children. It has been generally regarded as
a highly successful remedy in the treatment of the attacks
in epilepsy for some years, and from its well-known phys-
iological action I regard it as being eminently appropri-
ate in the convulsions of children. From three to five
drops should be poured upon a handkerchief and held
close to the mouth until a general flush of the face and
body appears. My experience with it in convulsions
has been limited, but I am almost inclined to prefer it to
chloroform.
Sedatives may be administered during the attack, or
what is better, immediately after, in order to quiet the
excitability of the nerve-centres and so prevent a recur-
rence. Chloral hydrate, either alone in the form of an
enema of three to five grains in a half ounce of clear
starch, or by the mouth, in combination with bromide of
potassium in the proportion of one part of the former to
two of the latter, is a favorite treatment, the dose being
graduated to the age, and given every two to four hours,
according to the urgency of the case. This treatment
will be found of the highest service in convulsions de-
pending upon dentition, the rachitic diathesis, or .per-
tussis. Other sedatives, as belladonna in small and fre-
quently repeated doses, tincture of musk, and oxide of
zinc have been recommended. Sulphate of morphia,
given hypodermically in carefully regulated doses, may
also be used, and, especially in symptomatic convulsions,
will be found advantageous. Such cases in the comatose
stage may be recognized, according to Parrot ( JX/if Practi-
tioner, vol. xxix.. p. 451), by the fact that if the skin be
pinched there wUl be a momentary dilatation of the pupil
to two or three times its previous size. Ordinarily these
convulsions are limited to one side of the body.
Where malaria is the cause of the convulsions it need
hardly be said that quinia is the main remedy indicated
to prevent a return of the attack. Cod-liver oil and the
syrup of the lactophosphate of lime should be given where
evidences of rickets exist.
Convulsions occurring in the late stage of scarlatina, in
addition to the before-mentioned remedies, should be
treated with the view of relieving the renal congestion.
Dry cups to the kidneys, the hot-air bath, and the inter-
nal administration of spirits of juniper with bitartrate of
594
THE MEDICAL RECORD.
[June 2, 1883.
potash will be found useful remedies. Our knowledge
concerning convulsive affections in children and their
treatment may be formulated as follows :
All convulsions depend primarily either upon a pe-
ripheral or central irritation of vasomotor mechanisms,
and secondarily upon a change in the quantity or quality
of the blood-supply to the medulla for their causation.
Conv\ilsions, from whatever cause and of whatever
degree, involve an element of more or less danger to life,
and should be treated promptly.
Where there is any doubt as to the exciting cause of
the convulsions, it may be safely treated in the same
manner as if from gastro-intestinal irritation.
The treatment should be directed to a removal of the
exciting cause, if local, an equalizing of the general cir-
culation and quieting of the excited nerve-centres.
75 West Fiftv-fifth Street.
^'CHLOROFORNf NARCOSIS DURING SLEEP."
By DAVIS HALDERMAN, M.D.,
TKOFESSOR OF SURGERV IN STARLING MEDICAL COLLEGE. COLl'MBl'S. O.
In The Record of April 28th appeared an article by
John H. Girdner, M.D., under the above title, wherein
he takes the ground that chloroform narcosis during nat-
ural sleep is impossible ; and goes on to speak in the
following terms of how untrustworthy all previous experi-
ments and testimony in this direction are : " As to the
testimony of medical experts, I may say that I am not
willing to accept their statements that a person may be
chloroformed while asleep without being awakened, be-
cause the evidence on which they base this opinion is
anything but conclusive. The few experiments which
have been made by these experts were not reliable tests,
because the parties on whom they experimented were
aware that at a certain hour of a certain night the doctor
would make the experiment, and a desire on the part
of the subjects to have the experiment succeed may have
been strong enough to tempt them to simulate narcosis."
The doctor then, in support hereof, gives a series of five
experiments, made by himself and another physician —
all of which are minutely detailed, including the age, sex,
etc., of the individuals experimented upon. One of these
was a boy, aged eight ; another, a girl, aged twelve ; the
others were adult males, aged thirty, thirty-two, and
thirty-five, respectively. All of them were hospital in-
mates, and the experiments were performed " at twelve
o'clock on the night of January 31, 1SS2, during a ter-
rific snow-storm."
In each case, we are told, " the chloroform was poured
on a folded towel and held eight inches from the sleeper's
face," and that all awoke at the end of three minutes but
one, and this latter at the end of two minutes ; and
further, that all of them, on arousing, were more or less
frigktened, tried to tear away the towel, coughed, gasped
for breath, etc.
The doctor in effect claims for these ex|)eriments, (i)
that they were undertaken " solely with a desire of ar-
riving at scientific facts ; " (2) that they were done under
the most favorable circumstances to this end, the persons
chosen for the purpose being of both sexes, and of a
variety of ages, and withal were entirely ignorant of any-
thing whatever being intended ; (3) that he anil his con-
frere "had both had a large experience in the adminis-
tration of anaesthetics ;" and (4) that they " took every
jjossible precaution that no errors should creep into the
results ; " — reijuiaites and conditions the doctor justly
maintains to be necessary to the formation of correct
conclusions.
He finally closes his article with these words : " These
experiments must then be taken a.% prima facie evidence
toward the establishment of the fact that it is impossible
to transfer an individual from a natural to a chloroform
sleep without an interval of perfect consciousness." Here
we beg leave to take issue with the doctor, and shall give
our reasons for so doing.
Out of three attempts, some years ago, at chloroform-
ization during sleep, made by the writer, two were suc-
cessful. The subjects of them were convicts in the Ohio
State Penitentiary. The experiments were carried on at
about half-past ten o'clock at night, in the presence of a
number of medical gentlemen, and two of them in a
room that lodged about one hundred and fifty sleepers.
From this number these two were chosen, as it were, at
random — so that even ourselves were not avi-are before-
hand who they should be. The prisoners were here, of
course, under strict surveillance, and could have had no
idea whatever of our intentions, as no one had been told
of them. The utmost stillness surrounded the occasion,
save the heavy breathing of the sleepers, and their shift-
ing, now and then, upon their hard and narrow couches.
The gas-lights were turned down so as to shed a faint
glare over the scene. It was under these circumstances
that the first two tests were made, and in this wise : The
chloroform was administered from a cotton cloth about
the size of a common pocket-handkerchief, such as a
burglar would likely carry. It was well saturated with
the drug, and held, at first, as much as two feet from the
sleeper's face ; the object being to sparingly impregnate
the atmosphere for some distance around him, so as to
blunt, primarily, the air-passages, and thus avoid the lia-
bility of the reflex disturbance which must inevitably take
place if the anaesthetic be given freely at the start. This
done, the cloth was cautiously brought to the position
ordinarily held, and kept there until the narcosis was
complete. The patient was then handled and dealt with,
so as to leave no doubt as to the result.
The next experiment was made in the same way, but
failed. Both these were adult male subjects. The other
was an adult female, who slept by herself in a cell, in a
part of the prison devoted to that sex ; her surroundings,
too, were quiet. The anaesthetic was given as before,
and with complete success.
Here, then, are two cases of chloroform narcosis ef-
fected during natural sleep, and under circumstances
wherein all the conditions and requirements claimed by
Dr. Girdner as necessary to insure reliable results, were
fulfilled ; for our sole aim, also, was to get at the facts.
The opposite results in the doctor's experiments were,
doubtless, owing to his too great haste in the outset.
The eight inches spoken of, as the distance the cloth
was held from the face, was obviously too close for
safety, the reflex action it must have occasioned would
be almost sure to arouse the sleeper, unless he happened
to be of exceedingly sluggish disposition, or slept uncom-
monly sound. Then, too, '• the chloroform was poured
on a folded towel," which leads us to infer that it was
given in large quantity, so that the results, it is not too
much to say, were just what might have been expected.
But the most singular thing in the doctor's experi-
ments is that he did not somewhat vary them. Instead
of conducting them all alike, one would suppose after
failing in one way, he would be inclined to try another,
and so keep on, until every mode and means were ex-
hausted, to bring about the narcosis, before undertaking
to proclaim, in such a summary manner, the impossibility
of its accom|)lishment.
Nor are these results of ours the only ones in contra-
vention with the doctor's assertions. In an article on
the Medico-Legal Relations of Chloroform {Ohio Medi-
cal Recorder, January, 1877), Dr. R. M. Denig quotes
largely from a report of Professor D. Dolbeau (Annales
d Hygiene, 1876) made to the Medico-Legal Society of
Paris, on the question : " Can chloroform be success-
fully administered to a person during sleep ? "
In the experiments made by this gentleman, twenty-
nine in number, including both sexes, and comprehend-
ing a wide range as to age and physical conditions,
ten were completely successful, being more than one-
third.
In deciding a ([uestion of such gravity as the one under
consideration, it is hardly fair to ignore such an amount
June 2, 1883.]
THE MEDICAL RECORD.
595
of testimony — emanating, as it does, from such a compe-
tent source ; and Dr. Dolbeau very justly concludes by
saying that the expert is bound to admit, that although
difficult, it \i possible to induce chloroform narcosis dur-
ing natural sleep.
Here are three more cases. In the Pacific Medical
and Surgical Journal for January, 1874, may be found
the two following cases : The first was that of a little
girl, aged eight, under the care of Dr. Curtis for suppur-
ative inflammation of the mastoid process. The doctor
says : " Deeming it expedient to operate for the evacu-
ation of the pus, we met at nine o'clock. On our arrival
we learned that our patient had slept but little during
the night, but was then sleeping sweetly. Chloroform
was at "once administered upon a 4 x 6 piece of surgeon's
lint, held as near the child's mouth as possible without
coming in actual contact. Not the slightest effort was
made by the child to avoid the inhalation of the anes-
thetic, and in a few minutes was well under its influence
and was carried into an adjoining room, placed ui)on a
lounge, and the operation completed.
In the second case the little girl, two and a half years
of age, was brought to the hospital to have a supernu-
merary toe removed. While awaiting the arrival of Dr.
Nelson, the child fell asleep, and was placed in the oper-
ating chair. As soon as the doctor arrived, chloroform
was administered in the manner already detailed, with
equal success, and the operation completed without the
occurrence of an unfavorable circumstance.
This one is from Dr. Schauffler, of Kansas City
{Kamas City Medical Journal, 1875), wherein the an-
sesthetic was given for the purpose of removing a foreign
body from the nasal cavity, in a female child about four
years of age. After relating the history of the case, tne
doctor thus continues : " Tired out as she was, the
child soon went to sleep and was laid upon the lounge.
I then began to administer to her the chloroform upon a
handkerchief, and in the usual way. As I expected her
to wake up, I observed no special precautions. To my
great satisfaction, however, she did not awake, but passed
very quietly under the influence of the anesthetic. The
pebble was now readily removed, and proved to be three-
fourths of an inch long by half an inch wide, and one-
fourth of an inch thick. The little patient continued to
sleep for an hour or two, and then awoke feeling per-
fectly well."
Certamly no collusion, or " a desire to simulate nar-
cosis," in any of these cases, can be suspected.
It IS now felt to have been conclusively shown, first,
that chloroform narcosis during natural sleep is not only
possible but practicable : second, that the doctor's ex-
periments were anything but satisfactory ; as there was
not exercised in their management that care and versa-
tility of resource which would warrant the conclusions
he promulgates, even though there were no evidence of
a contrary character known, or on record ; and, finally,
that chloroform may be made use of for criminal purposes,
but that its success in this direction must always be con-
tingent upon the skill in its administration, and upon the
disposition of the victim, as regards the nature of his
bleep, whether it be sound or easily disturbed.
It is not to be presumed, of course, that all persons
can ever be unconsciously chloroformed any more than
that all banks can be robbed.
The Originator of the Army Medical Museum
AND OF THE MeDICAL AND SuRGICAL HiSTORV OF THE
■War. — Dr. Wm. A. Hammond has obtained from the
Adjutant-General of the .\rmy a correction of the state-
ment circulated in the general order announcing the
death of Surgeon-General Barnes, and giving the deceased
credit for originating both the museum and the library.
Dr. Hammond adduces proof that he conceived and put
into execution the plan of establishing a medical mu-
seum and of writing a medical and surgical history of the
war.
CHLOROFORM NARCOSIS DURING SLEEP."
By E. M. nelson, M.D.,
ST. LOUIS, MO.
In looking over the columns of your journal for April 28th,
my attention was attracted to an article with the above
title by Dr. John H. Girdner, of New York. He con-
cludes his article with these words: "'While many will
doubtless require a larger number of experiments before
giving a decision, there are some who will see sufficient
evidence in these five experiments to satisfy their minds
that every experiment of this kind, made for whatever
purpose, will have a like termination."
Now, while five negative cases may be a sufficient
number on which to base an argument in the absence of
any positive evidence, one well-autlienticated case in
which chloroform narcosis has been induced during sleep
completely overthrows the argument.
In the evening of October 9, 18S0, I accompanied
Dr. A. J. Steele, of this city, to the residence of Mr. ,
on Washington Avenue. A lad of about ten years of
age was in bed sleeping soundly when we arrived. Chlo-
roform was administered by pouring it upon a folded
towel, and gradually bringing this nearer to the face of
the boy. After about two minutes he became a little
restless and turned a little m bed. The towel was re-
moved a little farther, and then again gradually brought
near to the face. Complete narcosis was obtained ; the
operation of circumcision was performed, a dressing ap-
plied, and the patient was sleeping quietly when we left
the house.
I have no more faith than has Dr. Girdner in the
authenticity of the popular reports of chloroform admin-
istration by burglars, and am in doubt whether chloroform
can be as successfully administered to an adult ; but that
it can, in some cases at least, be successfully adminis-
tered to children the case related conclusively demon-
strates.
Gakkison Avenue,
HINTS ON THE TREATMENT OF SOME PAR-
ASITIC SKIN DISEASES."
By (i'^ORGE H. ROHE, M.D.,
professor of hygiene
AND surgeons, BALT
association, etc. ;
-ICAL dermatology, COLLEGE OF PHYSICIANS
..IHMBER OF THE AMERICAN DERMATOLOGICAL
John Hunter is said to have divided skin diseases into
three classes : those that sulphur will cure, those that
mercury will cure, and those the devil himself can't cure.
Most general practitioners seemingly indorse this dictum
of the great pathologist. At all events, most practition-
ers readily admit the difficulty of diagnosis, and the un-
satisfactory results of treatment of many cases of skin
diseases seeking relief at their hands.
When we reflect that ten years ago less than half a
dozen of the medical schools of the United States made
any pretence of giving instruction in dermatology beyond
one, two, or three lectures, in the didactic course on the
practice of medicine, which lectures were chiefly remark-
able for the extraordinary number of uncouth words and
unintelligible definitions hurled at the students, we can-
not wonder that so many physicians should be unfamiliar
with the diagnosis, causes, and treatment of the diseases
affecting the skin.
In this paper it is proposed to consider, briefl)', what
appears to the writer the best treatment of some of the
cutaneous diseases caused by vegetable parasites.
It is well known that the diseases known as tinea favosa,
or favus, tinea triclwphytina, or ringworm, and tinea ver-
sicolor, or "liver spots," are due to the presence upon
or in the skin of microscopic organisms of vegetable ori-
gin. It would lead too far from the practical side of the
subject to discuss here the botanical relations of these
' Read before the Clinical Society of Maryland, March i6, 1883.
596
THE MEDICAL RECORD.
[June 2, 1883.
three different parasites. For the present purpose it may
suffice to slate that cHnically the diseases are distinct
and easily differentiated, or rather, not at all likely to be
mistaken for each other.
Favus is comparatively rare in the United States. The
disease manifests itself in yellow, cup-shaped crusts,
nearly always occurring upon the scalp. The crusts are
])erforated in the centre by a hair. If one of the crusts
is removed, a cup-shaped depression remains in the skin,
which gradually fills up to the normal level unless the
crust is re-formed. The crusts of favus have a peculiar
odor, said to resemble that of mice.
If a small portion of one of these crusts be rubbed up
with a little liquor potassa, placed on a glass slide and
brought into the focus of a one-fourth inch objective un-
der a microscope, a number of transparent branched
tubes (mycelium), with small spherical or oval bodies
(spores) in their interior will be seen. Spores, singly or
in groups, will also be seen in various portions of the
field outside of the mycelial tubes. This is the fungus
upon which the disease depends — the achorion Schan-
leinii of Remak. The hairs which perforate the yellow
crust or scab will also be found filled with these spores.
The destruction of the fungus cures the disease by re-
moving its cause, hence a ])araciticide is the proper
remedy to use.
It will be found, however, that all efforts at treatment
will fall short of success unless all the crusts, and the
hairs perforating them, are first removed. Soaking the
scalp with oil or lard for twelve hours, then washing with
warm water and soap to remove the crusts, and afterward
pulling out the hairs from the diseased patches, are, there-
fore, necessary preliminaries to a successful treatment of
the anection. After the crusts and affected hairs have
been removed, the application of sulphurous acid, either
in full strength or diluted with an equal quantity of water,
or a solution of corrosive sublimate, one to three grains to
the ounce of water or alcohol, will be all that is needed.
The antiparasitic remedy must be kept constantly applied
and the case carefully watched. If a relapse is threat-
ened, prompt epilation and removal of the most primitive
crusts must be practised. When favus has lasted a long
time, baldness is likely to follow over the affected sur-
face.
The time necessary to effect a cure of favus varies,
but complete success should not be expected in less than
six weeks to two or three months. The disease can be
made to disappear in a much shorter time, but will al-
most certainl)- return if the parasiticide applications are
not continued for at least three or four weeks after any
evidences of the disease can be seen.
Ringworm presents marked differences as it affects
different regions of the body. When it occurs upon the
hairy scalp it appears in scaly patches, often having a
small-vesicular or pustular border. The hairs upon these
patches are dry, brittle, and most of them are broken off
a short distance above the skin, giving the patches the
appearance of a stubble field, over which the grass or
grain has been irregularly cut. The skin under the scales
is usually little, if at all, reddened, except at the border,
where the disease extends centrifiigally. This stubbly
appearance of the hairs is characteristic of ringworm of
the scalp. In that form of partial baldness termed alo-
pecia areata, and which is also held by may to be para-
sitic, the bald patches are perfectly smooth, white, and
shiny — altogether different in appearance from the scalv
ringworm patches.
AV'hen ringworm remains for a long time untreated, or
is improperly tieated, it may develop into kerion, a curi-
ous, obstinate, tuberculofuruncular disease of the scalp,
wliich has been very thoroughly observed and graphically
desciibed by Dr. I. E. Atkinson, of Baltimore.' In
kerion tliere is a condition simulating sycosis. The hair-
follicles are inflamed, variousI\ -1 1 tumors develop,
Archives of Dermatology, January', 1881.
from which exudes a gummy, honey-like fluid. The hairs
fall out and the spot is likely to remain permanently bald
— a result not apt to follow simple ringworm, in which
the hair is almost always reproduced.
In ringworm of the scalp, cleanliness and frictions
with carbolized oil have been almost exclusively relied
on in the practice of the writer. The strength of the
application used is one part carbolic acid to sixteen
parts of linseed or olive oil. This should be applied in
the following manner : After washing the scalp \yith
warm water and soap, and drj-ing, a little of the oil is
poured on a piece of flannel, and rubbed into the dis-
eased patch with smart friction. The friction drags out
of their follicles the loosened hairs, and has an additional
advantage in opening the mouths of the hair-follicles and
allowing the remedy to penetrate deeper, and come in
closer contact with the parasite, which gives most trouble
when it has penetrated into the hair-follicles. This pro-
cedure renders systematic epilation with the forceps un-
necessary, and so increases the comfort both of physician
and patient. When the diseased patch has thus been
well saturated with the carbolized oil, the rest of the
scalp should also be rubbed with it, to prevent extension
of the infection.
Sulphurous acid has also been used with great satisfac-
tion in the treatment of ringworm of the scalp. It is used
either in full strength, or diluted with a half, or an equal
part of water.
No other measures have been found necessary in the
treatment of simple ringworm of the scalp. Where kerion
was present, the boggy tumors were freely incised, and
carbolic acid ointment used as a constant application
with a favorable result.
Ringworm of the body — tinea circinata — usually ap-
pears in the form of variously sized scaly jiatches, with a
red papular, vesicular, or pustular border. It extends
peripherally until the spots reach the size of a silver dol-
lar, rarely getting larger without a break in the regularity
of the margin. As it extends peripherally, the normal
condition, barring perhaps a slight scaliness, is re-estab-
lished at the centre. Auto-inoculation not infrequently
takes place, and spots are found on different parts ot the
body. The microscope will differentiate it from sebor-
rhcea, or localized [patches of eczema. The best method
of treatment the writer has employed is to apply, once
or twice a day, pure sulphurous acid to the spots. No
other remedy has given so much satisfaction as this in
simple ringworm of the body.
Ringworm of the beard, in the majority of cases, does
not advance beyond the condition just described as
ringworm of the bodj'. It is usually communicated
through some of the shaving utensils used by the barber
— sponge, brush, or towel. When early discovered and
treated, the application of suliihurous acid will give gen-
eral satisfaction. .\ solution of corrosive sublimate, one
to two grains to the ounce, also leaves nothing to be de-
sired. Wlien it has lasted a long time, however, and
produced the disease known as parasitic sycosis — pus-
tules, tubercles, and abscesses of the bearded part of the
face, with involvement of the hair-follicles — treatment be-
comes more active and complicated, and must be pur-
sued with vigor and persistence, if a cure is expected or
hoped for. In cases of sycosis all pustules, tubercles, or
abscesses should be freely punctured, the face being gone
over every day, or every other day. The hairs of all in-
flamed follicles must be extracted with the epilating for-
ceps. The patient should shave daily. Or at least every
other day. An ointment of white precipitate, calomel
(or what is probably better than either), oleate of mer-
cury (five i)er cent.), should then be applied, and kei)t
in contact with tlie diseased surface constantly. In ad-
dition, the reddened jiatches of skin between the pus-
tules or nodules should be painted two or three times
a week with a solution of carbolic acid, one part to four
parts of alcohol.
Ringworm of the genito crural region — called eczema
June 2, 1883.]
THE MEDICAL RECORD.
597
marginatum by Hebra — presents peculiarities which de-
mand special consideration. In this affection the
diseased part presents all the characteristics of eczema —
intense itching, exudation, infiltration of the skin, etc. —
but unlike an ordinary case of eczema, there is present
a distinctly outlined border, and on careful microscop-
ical examination, a fungus resembling, and probably
identical with, the ringworm parasite may be discovered.
Eczema marginatum demands a somewhat different
treatment from ordinary eczema and ordinary ringworm.
We must endeavor to combat the intlaminatory con-
dition on the one hanti, and destroy the parasite on the
other. Hence the parasiticide employed must be one
that is effective, while it produces the minimum of irrita-
tion. In many cases the application of sulphurous acid,
followed by oxide of zinc or Hebra's ointment, will pro-
duce a prompt cure. In others, no good effect at all
will follow. In some cases the contiiuied application of
an ointment containing one or two drachms of ammonio-
chloride of mercury will produce the effect desired. In
cases accompanied by intense itching, and much local
inflammation, the writer has obtained the most excellent
results from the frequent application of a lotion of
benzoic acid, 3j. to one pint of water. After the itch-
ing IS controlled by this means, the eczema will usually
get well under simple dusting with starch or chalk, and
cleanliness. The benzoic acid acts as a parasiticide, and
destroys the fungus while promoting the cure of the
eczema by relievmg one of the chief factors in its con-
tinuance— the itching.
Tinea, or pityriasis versicolor, called also "liver spots"
in the vernacular, has been observed by the writer nearly
as frequently as ringworm. It occurs in the form of
brownish-yellow, slightly scaly patches and spots, limited
to the parts of the body covered by the clothing. It is
most frequently localized upon the chest, which is some-
times completely covered by a continuous sheet of the
eruption. The borders are irregular, and roundish or
irregular patches extend beyond with intervals of sound
skin between. It sometimes extends down the arm to
the wrist, and up on the neck to the collar-band of the
shirt — the soap-lme, as it may conveniently be termed.
Beyond this line the disease is rarely, if ever, seen. The
mildest parasiticide suffices to destroy the fungus which
causes the disease ; hence it is never found on parts
frequently washed with water and soap. The remedy
which, in the writer's hands, has been uniformly success-
ful in curing the disease, is a lotion of hyposulphite of
sodium in the strength of half a drachm to the ounce of
water. The patient is directed to take a bath once a
day, using soap freely, .\fter the bath the affected spots
are to be mopped with the parasiticide lotion. In a
week the discoloration has usually disappeared. The
remedy should be continued a week or two longer to
prevent relapse. No other than this suiii)le treatment is
necessary in the majority of cases of tinea versicolor.
It is surprising to what an extent cases of tinea versi-
color are treated for syphilis, hepatic derangement, or
similar supposed affections of the internal organs. Pa-
tients are sometimes compelled to take mercury or po-
tassium iodide for months, under the supposition that
they suffered from syphilis, when the only trouble was
that just described, which, when properly treated, yielded
to local remedies alone in the brief space of two weeks.
No mention has been made in this paper of the em-
ployment of tincture of iodine, chrysophanic acid, and
similar active irritants in the treatment of the cutaneous
parasitic diseases. The excuse offered for the omission,
if any be necessary, is that the writer has never had oc-
casion to use them. Patient and intelligent application
of the remedies before mentioned will, in most cases, be
followed by success. Nearly all patients will likewise be
better pleased if a colorless, non-irritant application be
used, than if an irritant remedy, staining the skin, and
not infrequently causing disagreeable complications, be
applied.
CONVERGENT SQUINT CURED BY ESERINE,
By C. a. BUCKLIN, M.D.,
NEW VORK.
The common form of convergent squint may frequently
be cured during the first feiu days of its appearance by
dropping into each eye a solution of the sulphate of
eserine, one-half grain to three drachms of water, morn-
ing and evening.
It is successful in those cases where the disturbance in
the relations between convergence and fixation are of a
slight degree or are only temporary. A free discussion
of the disputed causes of common convergent squint will
be found in The Medic.\l Record, vol. xvii.. No. 21;
vol. xviii., Nos. 4 and 16.
In the common form of convergent squint the child,
owing to a disturbance between his power to focus both
eyes for an object and his ability to fix his eyes both at
this object, is unable to see distinctly. Far-sighteii c\\\\-
dren recjuire a much stronger effort of accommodation to
see objects distinctly than children with normal or near-
sighted eyes. Consequently its use is to be followed
immediately by small doses of strychnia, and lurking
diphtheria or malaria appropriately treated.
Where this will not cure the squint, proper lenses should
be resorted to immediately, or a carefully performed
tenotomy may save the vision of the deviating eye. The
daughter of Dr. Dumond, of this city, had a convergent
squint of several weeks' standing cured by the use of con-
vex twelve lenses ; the acuteness of vision of the deviating
eye was restored, and also binocular vision, which was
lost, has since been restored. This result was obtained
after one of our best-known specialists had decided that
nothing could be done but a tenotomy later in life for
cosmetic effects.
The acuteness of vision in the deviating eye being
usually lost as a result of the squint, I urge upon all
practitioners of medicine not to allow a child to look
cross-eyed for two days without attempting to do some-
thing about it. The use of the sulphate of eserine in
the treatment of squint is original with me. It is only
applicable during the first few days of the squint.
Condition favors greatly the development of squint.
Probably ninety per cent, of squinting children see dis-
tinctly through their grandmother's glasses distant objects.
This always means that they have a marked degree of
hyperopia, which leaves but little margin of accommoda-
tive power over what is absolutely required to see objects
distinctly with both eyes. Should a child in this condi-
tion have slight pareses of accommodation, or his health
impaired from diphtheria or other causes, he must squint
or go without seeing objects distinctly. Should he, from
imitating another or in any other way, learn how to
squint, he would be surprised and delighted to find that
he was again able to see distinctly, and would not give
up the device like another child who derived no benefit
from squinting.
The use of atropine improves the squint while the eye
is completely under its influence, but always makes the
trouble worse as the effects of the drug begin to disap-
pear. Eserine makes an im[)rovement which will prob-
ably be permanent.
The Care of the Insane. — At the meeting of the
Medical Association of Central New York, held at Syra-
cuse on the isth of May, the report of the Committee on
the " Care of the Insane " was read by its Chairman, Dr.
Theodore Dimon, of Auburn, and after discussion was
unanimously adopted. The following resolution was
unanimously adopted : Resolved, In the opinion of this
Association, the lunacy laws of the State of New York
have been carefully considered and wisely framed for the
management and treatment of the insane, and it is not
so much needed that these laws should be changed as
that healthy public opinion should give its support to
their successful administration.
59S
THE MEDICAL RECORD.
[June 2, 1883.
^foijvcss of mcflical J«cicncc.
Paroxysmal Hemoglobinuria. — Dr. J. Boas regards
this as a disease sui generis, and distinct from any other
form of hemoglobinuria. He states that individual at-
tacks are always caused by the cooling of portions of the
integument, as of the hands, feet, nose, ears, etc. The
intensity of the paroxysm is in proportion to the degree
and duration of the cooling of the skin. The primary
condition is that of destruction of the red blood-globules,
and the passage of h;emoglobin into the plasma. The
general symptoms are secondary. The cause of this in-
creased destructibility of the blood-globules is difficult to
determine. In some cases it may be attributed to syi^hi-
lis, in others to intermittent fever. The destructive pro-
cess is at first local, occurring in the part exposed to the
action of cold. s-Thence it spreads into the general circu-
lation. The treatment is to be based upon the etiology,
when that can be determined.- — Deictsche Medicinal-Zei-
tiing, March 8, 1883.
Rupture of the Sciatic Nerve Mistaken for
Fracture of the Neck, of the Femur. — Dr. KUster
relates the following case in the Berliner klin. Wochen-
schrift oi March 26, 1883 : The patient, while walking,
slipped and fell backward. He e.\perienced a severe
pain in the right leg and numbness of the foot, and was
unable to rise. When seen the following day he was
suffering intense pain in the limb, which was rotated out-
ward and apparently shortened. Pain on jjressure was
most severe in the neighborhood of the hip-joint, where
there was also a slight swelling. At the first glance, the
case was apparently one of fracture of the neck of the
femur. This diagnosis had been made guardedly by two
other physicians, who had seen the patient shortly after
the accident, but had made no examination on ac-
count of the agony which he was suffering. Dr. Kiister
could, however, obtain no crepitation, and, moreover,
passive movements of the joint occasioned little or no
pain. A diagnosis was made of rupture of the sciatic
nerve, and was confirmed by the subsequent conduct of
the case.
Tre.atment of Chlorosis by Blood-Letting. — The
cause of the want of success in the ordinary treatment of
chlorosis and ansniia lies, according to Dr. Dyes
{Allgem. Med. Central-Zei/n/ig, March 24 and 28, 1883),
in a misapprehension of the nature of these affections.
Instead of the blood being thin and bright red in color,
it is, he asserts, thick and dark colored. This error has
arisen from the appearance of capillary blood as flowing
from superficial wounds of the integument or in epis-
taxis. But this is only a colored fluid which filters
through the capillaries, the general mass of the blood
being too thick and viscid to pass into the smaller ves-
sels. This viscosity is owing to the large proportion of
white corpuscles, and upon it depend the characteristic
symptoms of aniumia. The integument is pale and cold,
and by reason of the disturbance of the peripheral circu-
lation, congestions of the internal organs arise. The
author regards as erroneous the idea that the white
corpuscles are converted into red by the agency of iron,
and he condemns this remedy as not only useless but
harmful in the conditions under consideration. .\na;mia
frequently ensues upon recovery from acute alTections,
and is, according to him, due to the non-elimination of
morbid matter from the blood in those diseases. Dr.
Dyes advocates phlebotomy in acute inflammatory
troubles, especially pneumonia and rheumatism, and
laments that this practice has fallen into desuetude. The
mistake of the older physicians was not, he holds, in
blood-letting, but in the employment, in addition, of
purgatives. The two procedures are in no way allied in
their efi'ccts, but rather opposed to each other. I'or the
benefits accruing from the abstraction of blood are owing
to the removal of the excess of white corpuscles, while
the production of watery stools only increases the viscid-
ity of the blood by withdrawing its serum. He does not
think that simple loss of blood can ever produce anjemia.
He never found this condition to exist in invalided
soldiers applying for pensions, although many of them
had been severely wounded and had lost great quantities
of blood. In accordance with these views, therefore,
the author discards iron in the treatment of chlorosis and
anaemic conditions in general, and resorts to phlebotomy.
The local abstraction of blood by leeches or wet cups
does not fulfil the indications, as the capillaries only are
depleted, and these, as stated above, contain only a
colored fluid with but few white corpuscles. Within an
hour after the withdrawal of from three to five ounces of
blood from the vein, Dr. Dyes asserts that the hands and
feet become warm and the patient is bathed in a healthy
perspiration, showing that the disturbance of the cap-
illary circulation has been removed. The appetite soon
returns and the insomnia and nervous exaltation sub-
side. The diet should be conformed to the instincts
of the patients, who usually crave spicy and well-
seasoned food and have a repugnance to more solid
nutriment.
Ly.mphangiectasis and Ly.mphorrhagia. — A young
woman who presented herself at the clinic of Dr. Paul
zur Nieden gave the following history : When she was
onlv nine years old she observed a dropping on the floor
of a milky fluid, which the doctor said was leucorrhoea.
Two days later she noticed numerous little vesicles,
about the size of a pin-head, upon the labia majora, and
at the same time the external genitals became swollen.
The discharge was very profuse, but was lessened by
confinement to the bed. Soon afterward she had an
attack of ha;moptysis followed by pneumonia, and there
was no further trouble with the genitals for several years.
When her menses first appeared, however, the discharge
began again. A milky fluid was exuded from the labia
in such great quantity that at one time, she said, she col-
lected over two pints in four hours. This was again
controlled by rest in bed. When first seen by Dr. Nie-
den there was no spontaneous discharge, but the labia
were studded with little vesicles, which exuded a white
fluid on pressure. A small (liece was excised from one
labium, and for several da)s there was a flow from the
wounded surface in considerable amount — five ounces in
one night. The fluid was of alkaline reaction and con-
tained only a few lymphoid cells, but very numerous fat-
globules. Treatment consisted in the removal of por-
tions of the labia with the g dvano-cautery. — Deutsche
Medicinal-Zeiiung, No. 7, 1883.
Morphia in Strangulated Hernia. — The reduction
of strangulated hernia by the subcutaneous injection of
morphia first employed by Dr. Phillippe, of St. Maud6,
may render excellent services. Consequently many
practitioners in the country, where either the want of
proper instruments or the jirejudice or unwillingness of
the peasants to submit to an operation are serious ob-
stacles to be got over, adopt this method in almost every
case, and rightly so, as the eftects are sometimes marvel-
lous. A country surgeon has just published a report of
eight cases treated thus by him with only two failures.
The taxis and all ordinary means failed, and colotomy
seemed the only resource. Twice the reduction was im-
possible, and the patients having refused to be operated
upon would have infallibly succumbed. In one case to
which he was called everything was ready for the oper-
ation, the patient consenting, when he proposed to inject
a quarter of a grain of morphia over the strangulation.
A quarter of an hour afterward the hernia was reduced
without difficulty. Sometimes the delay is longer, but
the pain and vomiting ceases ; hence the operation can
be postponed without fear for some hours, when a new
injection is made and often succeeds.
June 2, 1883.]
THE MEDICAL RECORD.
599
Spontaneous Formation of Gas in the Bladder.
— Dr. F. P. Gaiard reports the following case in La
France Meduale of February 10 and 13, 1883. A phy-
sician seventy-seven years of age, had suffered for a
number of years from glycosuria, and also had a calculus,
for tile removal of which he had undergone the operation
of lithotrity three times and cutting once. For the past
three or four years he had noticed an escape of gas
from the urethra at the end of micturition, sometimes ac-
companied by a considerable report. The phenomenon
was not always present, but was never absent for more
tlian a few days at a time. Its occurrence was pre-
ceded by no peculiar sensations, and the patient could
never tell before urinating whether it would be present
or not. The gas was completely free from odor, and
could not be of intestinal origin. Its passage occasioned
no pain. The most thorough examination could not de-
tect the smallest vesical fistula. Three other similar
cases were discovered and carefully observed by the au-
thor. In one of them the urine, when first passed, was
in a state of effervescence, which the patient likened to
that of champagne. All of the patients were diabetic,
and all of them had had instruments passed into th&
bladder for one reason or another. The author attrib-
utes this formation of gas in the bladder to a i)rocess of
vinous fermentation in the saccharine urine. Germs had
been found in the urine in two of the cases by another
observer, but the author himself had never been able to
procure the urine at the moment of the emission of gas,
and could not state certainly that it contained the sugar
ferment. He thinks it most probable, however, that the
fermentation germs were carried on the catheters or
other instruments which had been introduced into the
urethra. He proposed to designate this condition by
the term of diabetic pneumaturia.
Cure of Abscesses of the Neck, without Cica-
trices.— Dr. Quinlan recommends the passage through
the abscess of a fine silver wire, and the ends tied out-
side, when it will act as a drain. This must be done be-
fore the pus reaches the surface, when it is, say half an
inch from the external surface. No poulticing or stuping
must be used, and when the abscess is evacuated a com-
press applied. The procedure has never failed in his
hands.
Chronic Tubercular Blepharitis. — .\t a meeting
of the Societe Medicale des Hopitaux, in February, 1882,
Dr. Gerin-Roze presented a patient suffering from pul-
monary and laryngeal tuberculosis. The patient had
also a granular ulceration of the palpebral conjunctiva,
which was pronounced by the speaker to be tubercular.
The correctness of this opinion was, however, doubted
by several of those present. At a meeting of the same
society in December following. Dr. Gerin-Roze aji-
nounced that the patient was dead, and that a micro-
scopical examination of the conjunctiva had confirmed
his diagnosis. The lesion was limited to the mucous
membrane, which was infiltrated with young cells and
amorphous granules. Several of the sections showed
very distinctly the tubercular granulations. They were
perfectly round, about the size of the head of a pin, yel-
lowish in color, and composed of granular tissue without
giant-cells. — L Union Medicale, March 4, 1883.
Veratrum Viride in Typhoid Fever. — Dr. A. VV.
Nelson publishes the results of his treatment of typhoid
fever by small repeated doses of veratrum viride {Ar-
chives of Medicine, K^x\\ 1883). He has administered
this drug in every case of the disease occurring in his
practice during the past decade, and has not lost a case.
He states that under its influence the pulse and temper-
ature are lowered and held within the limits of safety, the
danger of intestinal hemorrhage is reduced to a minimum,
and convalescence is not unfrequently established at the
end of the second week. The dose given was one or
two drops of the officinal tincture every hour.
Puerperal Diabetes. — A paper by Dr. Mathews
Duncan was read before the Obstetrical Society of Lon-
don, the author pointing out the distinction between the
slight glycosuria of pregnant and suckling women and
real diabetes, with its polyuria and large amounts of
sugar. Physicians and surgeons were well aware of the
dangers introduced into their cases by complication with
diabetes. But the subject of diabetes complicating preg-
nancy and parturition had attracted almost no attention,
and this probably arose from its rarity, which might be
accounted for by the disease frequently destroying in
women the sexual energies, as it is said to do in man.
The author had collected tv;enty-two cases in fifteen
women, and they demonstrated the great gravity of the
complication as respects both mother and child. Of the
twenty-two pregnancies (including those ending prema-
turely), four had a fatal result soon after delivery. In
seven of nineteen pregnancies in fourteen women, the
child, after reaching a viable age, died during pregnancy.
In two the child was born feeble, and died in a few
hours, making an unsuccessful issue in nine of nineteen
pregnancies. The histories showed that diabetes may
intervene on pregnancy ; that it may occur only during
pregnancy, being absent at other times ; that it may
cease with the cessation of pregnancy ; that it may come
on after parturition ; that it may not come on in a preg-
nancy occurring after its cure. They showed that preg-
nancy may occur in a diabetic woman ; that it may not
be appreciably affected in its natural ])rogress and termi-
nation by the disease ; that it is very liable to be inter-
rupted by the death of the fcetus. — London Lancet.
Treatment of Ulcers with Bismuth. — Dr. Truck-
enbrod reports a number of cases of varicos.e and other
ulcers of the leg, cured by the local a[)plication of sub-
nitrate of bismuth. The cases were seen at the Wurz-
burg Policlinic. The bismuth in fine powder was dusted
over the ulcer until a thin layer was formed, and then a
simple roller bandage was applied ; where there were va-
ricose veins a rubber bandage was employed. The ulcers
were usually healed in a few days. — Ceniralblatt fiir
Klinische Medicin, March 24, 1883.
Direct Transfusion from an Artery into the
Peritoneal Cavity. — Drs. Corona and Cocco-Pisani
report the following results of transfusion experiments
made upon animals: i. Pure blood, passed directly from a
carotid artery into the peritoneum of another animal is
entirely absorbed ; 2, in small animals three ounces of
blood had been entirely absorbed in five days ; 3, the
blood, until its disappearance, remains fluid in the peri-
toneal cavity ; 4, the increase of haemoglobin begins
after twenty-four hours and continues for a certain in-
definite time ; 5, the animal sufters no injury on the part
of the peritoneum or of any other organ. — Ceniralblatt
fiir Chirurgie, March 24, 1883.
Hysterical Rapid Breathing, simulating Car-
DiAC»OR Diabetic Dyspncea. — Dr. E. Mackey, in the
London Lancet, February, 1883, draws attention to the
little stress laid upon dyspnrea as a possibly hysterical
symptom, and gives the notes of a case of a girl, aged
seventeen, to whom he was several times called, as her
friends thought she was dying. Dr. Mackey points out
the diagnostic differences between hysterical and diabe-
tic dyspncea. In diabetic dyspnoea the attack conies on
suddenly and with violence ; the inspirations are deep ;
the air passes well into the lungs, but apparently does
not o.xygenate the blood ; the attacks may recur several
times, but finally the patient becomes unconscious. The
duration until death varies from ten hours to three days.
The respirations seldom exceed forty per minute, whilst
the pulse is small, weak, and very rapid. In hysterical
dyspncea the respirations are eighty or even one hundred
and twenty per minute, whilst the pulse is from sixty to
eighty per minute, and the previous history of the case
aids greatly in forming a correct diagnosis.
6oo
THE MEDICAL RECORD.
[June 2, 1883.
General Atrophy Following Diphtherl'^. — Dr.
A. Cahn relates the case of a boy, fourteen years of age,
who suffered from post-diphtheritic paralysis of the pharynx
and cesophagus. After this had passed off, in spite of a
nourishing diet of milk, eggs, and beefsteak, the patient
began to waste away, until finally he became so emaci-
ated as to seem on the point of death. A strict con-
finement to bed and the application of ascending and
descending currents of medium strength to the spine
brought about a cure after a considerable length of time.
— Deutsche Aledicinal-Zeitung, March 29, 1883.
Perforation of the Aorta by a Foreign Body
IN THE CEsoPHAGUS. — Dr. Desplats relates a case in
which a sharp fragment of bone was lodged in the ceso-
phagus, about half-way down. An abundant hemor-
rhage occurred at the eighth day, which was arrested
spcntaneously. Thirty-six hours later it again set in and
led to the death of the patient. The autopsy showed an
ulceration of the cesophagus with perforation of the aorta
about an inch and a half below the junction of the trans-
verse and descending portions. — Revue Medicale, March
24, 1883.
Hysterical Angina Pectoris. — Marie {/our. de
Med. et de Chir. Prat., February, 1883) reports two cases
of angina in hysterical patients. In one the pain com-
menced in the left little finger, radiating up the forearm
and breast of the same side. During the attack, which
often lasted some hours, the pulse in the left radial artery
became insensible, the lower parts and the entire left
side became cold. In the second case the attack was
often preceded by general malaise ; then suddenly a vio-
lent pain supervened in the prajcordial region, accom-
panied by e.xtreme anguish and invincible terror ; the
pain then radiated toward the neck, the left arm, the lit-
tle finger, sometimes even toward the leg ; the attack
lasted ten to twenty minutes, and the face, which was at
first tired and cold, became red and warmer. He com-
pares them to the form of angina called vaso-motor by
the Germans.
Incomplete Tabes. — The symptomatology of loco-
motor ata.xy is sufficiently characteristic to preclude the
possibility of mistakes in pronounced cases. Charcot
has, however, diagnosed this disease in a number of in-
stances where several prominent symptoms were absent.
Such cases may be termed incomplete tabes. The fol-
lowing will serve as examples : i, A patient with nys-
tagmus, absence of patellar reflex, lightning pains, and
double optic atrophy ; 2, a man with anaesthesia of the
face, slight paresis of the orbicularis oris, transitory di-
plopia, and absence of patellar reflex without lightning
pains or inco-ordination ; there was also a patch of anaes-
thesia in the area of the radial nerve, and difficulty in re-
taining his urine ; and 3, a man suffering from pains in
the right arm, which had lasted nine years, especially
severe in the axilla and thumb, with a species of shocks
or discharges ; also alternations of sensation in the fcles
of his feet, as if he walked on balls, and when seated, he
did not know on what he was sitting. Urination was
difficult, and he had no knowledge of the act of defeca-
tion. Patellar reflex was present. — Jour, de Med. et de
Chir. Prat., February, 1883.
Rupture of the Pulmonary Artery. — A man, ap-
parently in perfect health, was suddenly attacked with
severe pains in the chest, extreme anxiety, and difficulty
of respiration, which, after thirty hours, terminated in
death {Medical and Surgical Reporter). Dr. Arro, who
reports the case, found at the autopsy a rent in the pul-
monary artery, from which a large amount of blood had
escaped into the chest.
Acute Diabetes. — Dr. Jones, in the London Lancet,
February, 1883, describes the case of a police-constable
who was admitted into St. Thomas's Hospital in a very I
collapsed condition. A careful physical examination
failed to discover any reason for the symptoms. No
urine was voided for some hours, but a catheter was
passed and about four ounces drawn off. The specific
gravity was 1040, the reaction acid, and it contained a
large quantity of sugar and some albumen. If it had not
been for the obtaining of this urine the case might have
remained a mystery. The progress of this case was un-
usually rapid, but still it went through the usual course
of such cases. There is only one feature which seems
strange, and that is that the disease was only supposed
to have lasted five days. Cases have been recorded of
death within three weeks of the first recognition of the
disease, but never within a few days.
Copperhead Venom. — Dr. I. Ott [Virginia Medical
Monthly, February. 1883) conies to the following con-
clusions : " I. The venom of the copperhead is weaker
in toxic activity than that of the rattlesnake. 2. The
heart, with both kinds of venom, becomes greatly pros-
trated, and in rapid deaths is their main cause. 3. The
venom of either snake does not affect the sensory nerves.
4. The sensory centres are affected by both venoms. 5.
The muscular excitability continues to be little affected
at the time of death by the poison of the copperhead. 6.
The two venoms greatly resemble each other in physio-
logical activity. 7. The cardiac force, rhythm, and fre-
quency are lowered by both venoms. 8. The arterial ten-
sion is greatly lowered by both venoms. 9. The blood,
after copperhead-poisoning, shows no microscopic
changes of its globules, and no difference in its spectrum."
The Hypodermic Use ofGelsemiu;M. — Drs. Bourne-
ville and Bricon premise some directions as to the hypo-
dermic use of this drug by the following observations :
Gelseniium paralyzes the cerebral motor centres. It
first increases, then diminishes reflex spinal excitability
and cardiac contraction. It also produces a sense of
weight in the head, difficulty in the motion of the tongue,
trembling of the hands, uncertainty of the fingers, sensa-
tions of cold, mydriasis when instilled into the eye,
nausea and vomiting. The lethal dose of the alkaloid
for man is from nine-twentieths to nine-tenths of a grain.
The therapeutical dose of the alkaloid is one-seventh of
a grain, and of the tincture seven and a half minims.
Eulenburg gives the following formula for hypodermic
medication : Gelsemin. chlorhydrate, grs. xv. ; aquK, §
vjss. l\r. S. — TIl,i. to ij. at each injection. The chlorhy-
drate of gelsemine is about ten times stronger than the
drug itself. The hypodermic use of gelsemine has been
attended by good results in neuralgias. One part of
gelsemine is soluble in 1 16 of water. — Progres Medical,
March 10, 1883.
Salicylates in Dysmenorrhcf.a. — Dr. Cheron says
that long ago Weit and Simpson recognized the influence
of arthritis on dysmenorrhcea, and that this is very well
shown by the results of the salicylate treatment. The
salicylates most indicated in dysmenorrhcea are the qui-
nine and the sodium salicylates. The sodium salicylate
is employed with advantage in the jiainful crisis of the
onset. At the time of appearance of the pains, two ta-
blespoonfuls of the following mixture suffice : IJ. Sodium
salicylate, 3 ijss. ; rum punch, 3J. 3 vij.; aquas destill.
3 iij. 3 j- If the pain returns some hours later, the same
dose should be employed and pushed till six tablespoon-
fuls at the maximum, in twenty-four hours, have been
taken. Quinine salicylate is more particularly indicated
in arthritic dysmenorrhcea, where lumbo-abdominal neu-
ralgia is clearly defined, and shows itself some days be-
fore menstruation. It is best given in powder. When
migraine, or nniscular, or articular pains ai)iiear before
menstruation, sodium salicylate given in 15 to 30 grain
doses per diem is indicated. If in the same cases there
exists a periodical neuralgia, the administration of two-
grain doses of quinine salicylate twice daily often has
very astonishing effects. — Gaillard's Weekly.
June 2, 1883.]
THE MEDICAL RECORD.
601
Obstinate Vomiting in Pregnancy. — Dr. Brock,
after discussing the various theories as to the causation
of obstinate vomiting in pregnancy {London Medical
Record, Ajiril 15, 1883), arrives at the following conclu-
sions : I. Obstinate vomiting occurs in multipara; where
the uterine tissues are lax, and where the os is soft, easily
dilatable, and even patent enough to admit the tips of
two fingers. This causes him to reject the theoiy held
by Bretonneau and Barnes. 2. Obstinate vomiting is
absent in the majority of cases where there is a rigid
state of the os, and where one would almost expect it
invariably to be present, if the cause were that assigned
by Dr. Barnes. 3. Obstinate vomiting is often absent
in flexions and distortions of the uterus, and often ])res-
■ent where tliere are no flexions or distortions. This
would not be likely if Dr. Graily Hewitt's theory were
true. 4. Obstinate vomiting is often absent in inflam-
matory conditions of the uterus, and present when there
are no inflammatory conditions. This ought not to be the
•case if Dr. Bennett's theory were correct. 5. Because
•he believes a parallel condition is to be seen in other
affections clearly influenced by the individual's neurotic
constitution ; for instance, obstinate sea-sickness, the
occasional vomiting that occurs in pseudocyesis, the
proneness to convulsions in certain children whenever
all; or, to take a specific case, the vomiting simulating
the obstinate vomiting of jiregnancy in a non-i)regnant
•woman in whom the uterus was normal. 6. Because
there is no definite line to be drawn between the
■ordinary cases of sickness in pregnancy and the more
severe cases. He has found it associated with intermit-
tent albuminuria. He believes the obstinate vomiting
in pregnancy to depend on the idiosyncrasy of the pa-
tient.
Traumatic Diabetes Insipidus. — Dr. Statten records
(Centralbl. fi'ir die Med. JViss., February 3d) the case of
a. man who received a wound on the side of his neck and
the back of his head. Transitory unconsciousness and
•double vision occurred, and subsequently deafness on
the side of the injury, the left, with total paralysis of the
rectus externus on the same, and jiartial paresis of the
same muscle on the opposite side. On the left side hear-
ing was lost in the external meatus, but the ticking of a
watch applied to the side of the head was audible. The
urine, which amounted to twelve litres daily, was free
from albumen and sugar. The treatment, free adminis-
tration of iodide of potassium, was attended by notable
reduction in the quantity of urine. The author supposes
the injury to have consisted in destruction of the root of
the left abducens nerve, probably with hemorrhagic cyst,
and refers to cases in which this i>athogeny has been re-
corded.
The Significance of Atelectasis of the Lung.
— Tamassia (A'/r/. S/>er. di Fren. e di Med. Leg.), from
an experimental inquiry, holds that Schroeder's doctrine
is devoid of foundation ; and if we find by the hydro-
static test and by the other tests which complete it that
the lung is absolutely without air, we may with confi-
•dence assert that the infant has never breathed.
Cancer of the Pancreas, accompanied by Phleg-
masia DoLENS. — Dr. L. Cane, in the British Medical
Journal, reports the case of a clergyman, aged fifty-nine,
who consulted him for dys))eptic symptoms, and said his
friends had noticed he had not been looking well for
some months. A few days after this he complained of
pain in the right calf, and there was slight swelling of the
leg and tenderness along the inner side of the leg and
ankle. Two or three days after the right leg became
similarly affected, and it was found that the right
saphenous vein was plugged. A careful examination was
made to ascertain the cause of the phlegmasia dolens ;
cancer was suspected, but no evidence of its existence
•was detected. Three months afterward the patient grad-
ually became aphasic ; he could write, but not s[)ell cor-
rectly. A few days after this it was noticed that gradual
paralysis of the right arm and right side of the face was
coming on. It was not until six months after the patient
was first seen that any tumor was detected, but when
emaciation had become marked. Dr. Cane detected on
the left side a fiat, irregular mass, apparently adherent
to the spine. The patient rapidly grew weaker, and died
unable to make any mental eftbrt, but apparently con-
scious.
At the post-mortem examination it was found that a
large irregular mass occupied the place of the pancreas,
extending downward about four inches. A number of
cancerous glands, joined into one mass, surrounded the
aorta and vena cava. The case, says Dr. Cane, illus-
trates remarkably the statements of Trousseau on phleg-
masia alba dolens, that frequently the presence of jihleg-
masia dolens serves as a valuable aid in diagnosing the
existence of deep-seated visceral cancer, in which there
is no appreciable tumor.
Carbunculus Internus. — Under this name. Dr. Ste
panoft' describes a case of intestinal anthrax, or Buhl's
" mycosis intestinalis," which occurred in a soldier, aged
twenty-one, who, soon after eating some boiled (lork, be-
gan to^ suffer from vomiting. On admission a few hours
later, he presented the following symptoms: e.xtreme
prostration, hippocratic face, cyanosis, rapid and weak
pulse, cold extremities, moist and coated tongue, thirst,
inflation of the belly, tenderness in the epigastric, um-
bilical, and right iliac regions, labored slow respiration
interrupted with sighs and groans, and incessant sick-
ness. There was no diarrhcea, fever, headache, giddi-
ness, or loss of consciousness. The nature of his dis-
ease was recognized only after his death, which occurred
twenty hours after the first symptoms. About three feet
from the CKCum the hyperremic mucous memlirane of
the small intestine presented a dark red, roundish, flat,
cedematous swelling, two and one-half centimetres in
diameter ; at its margin was seen a black dense tubercle,
about one and one-half centimetre broad. Numerous
dark red elevated small spots were scattered along the
small intestine. Beyer's patches and the solitary folli-
cles were slightly swollen. The abdominal cavity con-
tained a considerable quantity of a sanguinolent fluid.
The spleen and liver were hypersmic, but not enlarged.
The blood was almost black, with easily friable clots.
Neither microscopic examination nor inoculation experi-
ments were made. Similar cases of internal anthrax
were published by Dr. Rosenberg in the Moscov. Med.
Gazeta, No. 4, 1876, and Dr. R. Albrecht in the St.
Petersb. Med. IVocIiensch., Nos. 43 and 44, 1878. Of
six patients of the latter, five were wool-sorters. In only
one of the cases, in which the skin was simultaneously
affected, the diagnosis was made during life. — London
Medical Record, April 15, 1883.
Iodide of Potassium in Enteric Fever. — Dr. J^-
lenski relates {^Berliner Klin. Wochenschr., March 12,
1883) a series of twenty cases in which he has adminis-
tered iodide of potassium as his chief remedy in the
treatment of enteric fever with satisfactory results, pre-
facing the record of cases with a brief historic notice. A
summary of these observations aftbrds the following con-
clusions : I. Under the use of the iodide there is a reg-
ular duration of from fourteen to sixteen days, which
the author observes cannot be claimed for any other
means. 2. The temperature and jiulse are both slo\yly
and surely lowered, not only for a short time, as with
many other antipyretics. 3. A prompt cessation of diar-
rhcea and abdominal pain. 4. The period of convales-
cence is shortened by the use of the iodide, and is not
attended by the after-effects that often follow other anti-
pyretic agents. The iodide, passing through the whole
length of'the intestine, aftects its glandular structures ;
and there exerts its antiseptic and antiparasitic proper-
ties, so that the author regards it as a specific in the
treatment of typhoid fever.
602
THE MEDICAL RECORD.
[June 2, 1883^
The Medical Record
A Weekly yoiirnal of Medicine ajid Surgery.
GEORGE F. SHRADY, A.M., M.D., Editor.
Published by
WM. WOOD & Co., Nos. 56 and 58 Lafayette Place.
New York, June 2, 1883.
PSYCHICAL EVOLUTION AND REGIONAL
PHYSIOLOGY.
The phrenological hypothesis that mind is constituted
by an assemblage of distinct faculties whose seats are
assigned to separate regions of the cerebral cortex, re-
ceives no support from the doctrine of evolution, which
is becoming the favorite study of so many students of
psychology. " Every form of intelligence," says Herbert
Spencer," "being in essence an adjustment of inner to
outer relations, it results that as in the advance of this
adjustment the outer relations increase in number, in
complexity, and heterogeneity by degrees that cannot be
marked, there can be no valid demarcations between
the successive phases of intelligence. Fundamentally
considered, intelligence lias neither distinct grades, nor
is constituted of faculties that are truly independent. Its
highest phenomena are the effects of a complication that
has arisen by insensible steps out of the simplest ele-
ments." Those to whom this view commends itself — and
it is a view based on an exhaustive study of comparative
psychology — cannot but regard the pretensions of phrenol-
ogists as absurd.
The only division of mind which has stood the test of
the ages is the threefold division of intellect, feeling,
and volition, and yet these three aspects of mind are,
as Bain says, so dependent among themselves, although
characteristic in their manifestations, that no one could
exist alone ; and feeling is the basic substance of Mind."
Intellect, though long divisible into various faculties, as
reason, memory, imagination, etc., is fundamentally separ-
able into only three factors, discrimination, or conscious-
ness of difference ; similarity, or consciousness of agree-
ment ; and retentiveness, or the power of memory, or
acquisition. The view, then, expressed in a previous ar-
ticle, respecting the special function of the prefrontal lobes
of the cerebrum, compels us to regard these lobes as
magazines of cells, which are the living substrata of past
experiences, registered here, and serving as the basis of
comparison, judgment, and imagination, as well as of
volition. The connection of tiiese cells by means of fibres
with motor regions and motor cells (the latter arc believed
to be the large pyramidal cells of the lower strata) is too
obvious to require insisting upon here.
"Will and intelligence," says Spinoza, "arc one and
* Primitive Psychology, vol. i., p. 388. Cited by Hasti.in.
2 Bain : Mind and Uody, pp. 44-83. Herbert -Spencer : Primitive Psychology,
vol. i., p.-irt 3. clmp. viii.
the same thing." While this may not be absolutely correct
— for we can conceive of intelligence without any element
of desire or volition, though practically this is seldom if
ever realized — certain it is that intelligence is the essence
of volition.
The above being premised, it seems a necessary con-
clusion that identical parts of the brain are concerned in
all the phenomena of mind.' To use a simple illustra-
tion : the complex psychical changes awakened at the
sight of an orange are the correlatives of excitation of
certain visual centres concerned in the reception of all
impressions of a like kind, there is doubtless, too, a call-
ing into action, by diftusion of the excitation, of certain
cell groupings in the frontal lobes concerned particularly
in the elaboration of impressions, and of such centre*
(presumably in the occipital lobes) as are concerned in
the revivability of gustatory and visceral sensations : the
desire and the voluntary impulse which ensue are in-
separable parts of the completed perception.
The division of the cerebral hemispheres into lobes is
artificial. There is, evervwhere, intermingling of nerve-
fibres and nerve-cells, and the closest blending by inter-
cellular processes. The arrangement for diffusion of
nerve " currents " are of the most perfect kind. Multiple
as are the neural manifestations, there is practically^,
through all, the solidarity of a single unit. The hypo^
thesis of Brown-Sequard and Goltz (advocated also by
E. Fournit;) that the sensory and motor substrata of
function are scattered over wide areas is by virtue of the
well-known multiplicity of fibre connections plausible,
although it presupiioses the occupancy, to a greater or
less extent, of a whole cerebral hemisphere by any psy-
chical operation, a supposition hardly compatible with the
phenomena of trance or dreaming, where there appears.
to be concentration of psychical and circulatory energy
on a limited portion of the cerebral cortex.
These are strong considerations which favor the views-
of localization which we have before defended.
In this seeming chaos of cells and fibres there must be
orderly arrangement. .\11 analogy leads us to believe
this. If the cerebral hemispheres be a representation of
inner relations answering to the most stable external rela-
tions of the outer cosmos, the order in the inner world
must correspond with the order without. The law of
physiological distribution of labor must apply to the cere-
brum as well as to other parts of the economy. When,
you move your hand in obedience to a voluntary impulse,
such motor excitation comes from a definite region of
the cortex. It will always, under similar circumstances,
come from the same cortical region. To claim the con-
trary introduces the element of disorder into the scene,
which all experience and all analogy forbid. The fibres
of the corona radiata which carry visual impressions to
the cortex must pursue a definite route. Other sense
impressions must follow, as it were, a beaten track tcv
some region of the gray matter near the surface where
they are for a time concentrated, to be afterward, it may
be, widely diffused and blended with fibres of different
sensory nature and motor fibres. That the visual, audi-
tory, and tactile centres occupy a wide area of the cortex
* See Rebot, Diseases of Memory, for striking illustrations. The nervous pro-
cess is the same in feeling, perception, and remembrance. Reawakened feelings
^ occupy the same pans as the original feelings.
June 2, 1883.]
THE MEDICAL RECORD.
603
seems probable, when we consider the part which they
have in building up the fabric of our mental experiences.
These opinions are in harmony with those expressed
by H. Charlton Bastian (" The Brain an Organ of
Mind"), Broadbeit ("Cerebral Mechanism of Speech
and Thought "), Croom Robertson (review of Farrier in
Mind, 1877). Bastian, who charily and reservedly ad-
mits the doctrine of localizations as applied to topo-
graphically distinct foci of sensation, while admitting the
essential facts of motor localizations, was the first formally
to propound the theory of " Peraptive Centres " in the
cortex {vide Journal of Mental Science, 1869), also to
state the view, supported of late by Exner, " that there
may be much and compound overlapping of areas, and
though the area pertaining to the impressions of any par-
ticular sense in the cerebral hemispheres may be a very
extended one (not to speak of the still further complica-
tion brought about by the communication established
between the nerve-cells of the sense area with those of
others in the same hemisphere and the opposite heuii
sphere), still it may well be that certain portions of the
surface of the cerebral hemispheres might correspond
more especially to the inaxitnum amount of nerve-cells
and fibres i)ertaining to some one or other of the various
senses."
With regard to Exner's investigations, we called atten-
tion to them about a year ago {vide Medical Record,
April IS, 1882), and need not repeat what we said then.
Exner's observations strikingly confirm the somewhat
hypothetical conclusions of Bastian and Croom Robert-
son, to which allusion has just been made. According to
Exner, the cortical centres are rather areas of functional
concentration than sharply demarcated sensory and mo-
tor foci, and the diffusion and interblending of fibres
which there occur, and the overlapping of one district by
another, afford a plausible explanation of the different
results which have been noted in lesions of these districts,
also of the recovery from functional paralysis, which in
animals so often follows such lesions. In other words,
they are "vicariating areas. "
The cortical field of vision, according to Exner, cor-
responds more exactly with the region assigned to this
sense by Muhr and Mimk than to that assigned to it by
Ferrier, viz. : the angular gyrus. This " perceptive cen-
tre " has a relatively wide area in the upper and middle
occipital lobes, extending thence into the cuneus. Here
again Bastian' s prevision is justified. According to F.x-
ner's observations, the tactile fields correspond very
closely with the motor fields for the same body regions,
and this is in striking confirmation of the studies of Betz
and Luys on the functional significance of the cells in
the stratified zones. "'As regards the physiological sig-
nificance of certain zones," says Luys,' " and the relation
of each to the phenomena of sensation and motion, we
may by the laws of analogy believe that the submeningeal
region, principally occupied by the small cells, may be
specially connected with the phenomena of sensation,
while the deeper regions occupied by groups of large
cells may be considered as the most important regions
that give rise to motor phenomena."
^The Brain and Its Functions, page 24. D. Appleton & Co. These views
were first propounded by Luys in his Recherches sur le Syst. Nerveux Cerebro-
spinal, p. 163. 1865.
In studying this question, Luys bases his conclusions
principally on data acquired from a study of the spinal
cord, which show that those regions (the posterior horns)
where small cells occur, have sensory functions., while
the regions of large cells, the anterior cornua, are motor.
Betz's special contribution to this micrographical study
is that the large, so called motor-cells (triangular cells
of Luys, pyramidal or giant-cells of Meynert), predomi-
nate in the neighborhood of the fissure of Rolando,' where
Ferrier's motor-centres abound. (And just here there is
a striking correspondence between F^errier's and Exner's
localizations as applied to both hemispheres.)
Exner's "absolute " and "relative" areas correspond
to regions of greater or less concentration and dififu^
sion of fibres. There is, for instance, an absolute cor-
tical field for the right upper extremity in the upper pari-
etal lobule, the upper two-thirds of each of the central
gyri, and the paracentral lobule of the left side. The ab-
solute motor field for the left upper extremity occupies
corresponding regions in the right hemisphere, but of
considerably more limited extent. The relative fields
for these extremities " shade off on both sides with di-
minished intensity from the absolute areas."
Exner's absolute field for the lower limbs is nearly the
same as for the upper, and he explains the phenomena
of separate paralyses of the arm and leg by stating " that
the areas for the arm are more sensitive than for the leg."
Exner's views, as to localization, will, if proved to be
sound (and future investigations are needed to confirm
or disprove them), cause physiologists somewhat to modify
the current theories of localization, based largely on the
carefully conducted experiments of Ferrier. Thus, while
teaching that there is no absolute speech centre he lo-
cates his relative speech centre just where Broca in 1861
located it, and where Ferrier locates it, i.e., in the pos-
terior part of the third frontal convolution. This being
only a " relative " centre, it will not be surprising if cases
should now and then happen wheie injury should occur
to this area without aphasia.
Exner's conclusions are based on one hundred and
sixty-nine positive observations, but as we said in a for-
mer article, in which the work of this physiologist is re-
viewed, " it must be remembered that there are a good
many possibilities of error in Exner's methods, since he
used cases of cerebral tumor to work up. Some of his
conclusions must, therefore, be accepted with consider-
able caution."
THE HYPODERMIC USE OF THE CYANIDES.
The number of substances with which cyanogen is com-
pounded has now become very considerable, largely
through the fondness of the French for this particular
poison. The United States Dispensatory gives a list which
includes the cyanides of ethyl, of gold, mercury, silver,
zinc, and potassium. These have all been more or less
used. Somewhat over a year ago Dr. Galezowski, of
Paris, made a communication to the Societe de Biologie
upon the subject of the hypodermic use of cyanide of
mercury in the treatment of syphilitic affections of the
eye, especially in choroiditis, iritis, optic neuritis, and
atrophy of the optic nerve. He then claimed that cases
' p. Betz in Centralblatt., 37 and 38, 1874.
6o4
THE MEDICAL RECORD.
[June 2, 1883.
which had not been reheved by mercury given in the or-
dinary way, were sensibly improved by the cyanide.
Dr. Galezowski has recently made a further commu-
nication upon the subject. The cyanide of mercury, he
states, could only be employed in very small doses (five
to ten milligrammes). Wishing to give the cyanogen in
larger amounts, he prepared, with the advice of M. Fremy,
solutions of cyanide of gold and potassium, of silver and
potassium, and of platinum and sodium. These he
found lie could give in doses of twenty to thirty milli-
grammes without trouble. Three cases are reported in
which the optic atrophy of tabes dorsalis was checked in
its progress under the use of these preparations. Dr.
Galezowski is inclined to believe that in these c\'anides
we have a remedy which is specially helpful in checking
the progress of atrophy of the optic nerve in syphilitic
and tabetic affections. Sometimes the cyanide of mer-
cury and sometimes tliat of other metals acts best.
A TWO-YE.'\R COURSE PREPARATORY TO THE STUDY
OF MEDICINE.
Our attention has been called to the preparatory course
for medical students offered by Cornell University.
Students are urged to take a full four years' course in
arts or in science. Should this not be possible, however,
the two years' course, which embraces branches calcu-
lated to help in the future study of medicine, is recom-
mended. This course includes French and German,
chemistry, zoology, physics, anatomy, physiologv, and
hygiene. A considerable amount of laboratorv work is
also required.
We are told that a certificate of attendance is given,
which usually exempts the student from one of the three
years of study commonly required for graduation in med-
icine. If this is so, we have certainly failed to observe
any acknowledgment of the fact in the printed announce-
ments of our medical colleges. Those desiring a genu-
inely higher education will be inclined to doubt wliether
a coui)le of courses of medical lectures are enough to
make a good doctor, even of one who has been through
a preparatory course. However, as medical education
stands now, a two years' preparatory course, with two
years of actual medical study, are much better than the
nominal three years of study which the majority of
American medical students pass through. We can com-
mend preparatory courses, therefore, provisionally, as
helpful. But while they assist in giving a technical edu-
cation, it should be borne in mind that they do not
educate the student in the broadest and best sense of
the term. The more ambitious, therefore, will not be
content with merely preparatory courses.
We should not omit to state that Yale, and, we believe,
other colleges have organized these prejiaratory courses,
some of which extend over a longer time than two years.
ALCOHOLIC INEBRIETY.
That industrious and esteemed writer, Dr. T. D. Crothers,
who may truly be said to be inebriated with inebriety,
has made the various aspects of his chosen specialty
familiar to the readers of medical periodicals. We have
learned tiiat inebriety is a disease, and^that lie is a bad,
bold man who will uphold the_contrary ; 'we have been
told that inebriety has a hundred thousand victims in this
country, that it is daily increasing, that its pathology,
though mysterious, is distinct; that its various phenomena
are woven into the social fabric, and affect all classes,
all interests, and all phases of life ; in fact, that inebriety
is a pathological entity of the profoundest significance,
scientifically, medicall)', and socially.
It may well be thought that this is taking a rather
large view of the matter ; and yet it is quite possible
that the medical profession may in time be brought over
to it. A particularly strong reason for this is the con-
stant increase in medical literature of scientific, in dis-
tinction from sentimental, contributions to inebriety.
There has recently appeared a work by Dr. Joseph
Panish, a pioneer in this field, upon the subject of alco-
holic inebriety.' It is not an elaborate treatise, but it
discusses the question in a scientific manner, yet with
candor and caution. The point which it suggests most
strongly, is that the subject of temperance and intemper-
ance is at present looked at almost entirely from the
sentimental side, and that those who are most enthusi-
astically interested in lessening drunkenness and in-
ebriety, study the moral side, only, or chiefiy. There
can be no doubt that this is a serious mistake, and that
much help could be gotten if only sociologists and medi-
cal men would unite to study the problems of intemper-
ance and inebriety philosophically. The question whether
inebriety is a disease or a vice, need cause no trouble
practically, since it is only a matter of words. A vicious
habit (like any habit), by repetition establishes in time a
definite change in nutrition, and, perhaps, structure. We
may call this change disease, or a vicious habit with an
unknown somatic basis, as we choose. It is a definite
thing at all events, and one to be treated by other than
mental therapeutics alone. This is, we believe, the gos-
pel which our modern apostles of the inebriate pathology
are proclaiming.
THE I.\CRE.\SE OF PHYSICIANS IN NEW YORK CITY.
In the list of registered physicians in the County of New
York, published by Caswell & Hazard, January i, 1881,
the total number given was about twenty-four hundred.
In a recently publisiied revised list, the record is brought
down to January r, 1883. The number now is over
2,800, showing an increase of about four hundred doc-
tors in two years. During this time the estimated in-
crease of jiopulation has been from 1,230,000, on Jan-
uary I, 1881, to 1,295,000 on January i, 1883, or about
65,000. In other words there has been a new doctor for
every 162 new inhabitants. This does not take into
account all the deaths and removals, which in the two
years amount probably to over eighty. Still, even allow-
ing for this, it shows how densely New York City is be-
coming crowded with physicians, and tliat medical men
are coming in much faster proportionately tiian the rest
of the population.
In 1881 the ratio of doctors to the population was one
to 514 ; now it is one to 463. The above figures relate
to registered or legal practitioners. Of the 2,800 now
in the city, about 1,800 are entitled to be termed regular
by virtue of their names appearing in the Medical Regis-
* Alcoholic Inebriety, from a Medical Standpoint, with Cises from Clinic;d Re-
cords. By Joseph Parrish, M.D. ; Philadelphia ;iP.',Ulakislon & Co. 1883.
June 2, 1883.]
THE MEDICAL RECORD.
605
ter. There are, therefore, a thousand irregulars among
us. Here truly are conditions which require a struggle
for existence, and the young man intending to practise
medicine may well hesitate before starting out in New
York.
THE PREVALENCE OF SMALL-POX.
Various telegraphic reports seem to indicate a some-
what e-xtensive prevalence of small-jjox at present in the
United States. During the month of April there was a
mortality from this disease of over one hundred and sixty
cases, more than half of which occurred in New Orleans.
During the last week of April the mortality was sixty-
four cases, showing that the disease was increasing. In
the month of May a number of new foci appeared. It
is reported that West Virginia has been particularly af-
flicted with the scourge. On May 26th it was also an-
nounced that twenty-six cases of small-pox had occurred
in St. Michaels, Minn. Small-pox broke out last month
in the County Prison at Lancaster, Pa. Much conster-
nation has been excited in Cincinnati, O. , by the sudden
appearance of small-pox in an institution for teaching
music in that city. In this latter case the disease is said
to have been spread through the failure of the attending
physicians to diagnose the disease. A number of cases
has been reported' in St. Louis, Philadelphia, and
Nashville. A few cases developed in this city during
the month of May.
On the whole, it seems that health authorities ought
to be specially vigilant in watching for and guarding
against this much dreaded disease.
THE ORIGIN OF THE AMERICAN MEDICAL ASSOCIATION.
In the light of the great amount of silly talk regarding
the "rebellion," •' secession," etc., of the New York State
Medical Society, it is interesting to read the account of
the origin of the national organization as [given by Dr.
Toner, of Washington.
"The first meeting (of the American Medical Associ-
ation) was held in the city of New York, May 5, 1846,
on a call of the Medical Society of the StatejDf New York
for a National Medical Convention." This action was
brought about chiefly through the activity of a (at^that
time) New York physician. Dr. N. S. Davis.
It is a historical fact, therefore, that the New York
State Medical Society called the American Medical As-
sociation into existence.
The child repudiates tiie parent before the latter has
reached the maturity of a chartered existence.
the>'medical; association _ of Georgia
Held its third annual session at Athens, April 18 and 19,
1883. The annual address was delivered by the Presiilent,
Dr. K. P. Moore. The following officers were elected :
President— T:)!. A. W. Calhoun, of .Atlanta ; Vice-Presi-
dents—Jiis. R. J. Nunn, of Savannah, and M. P. Dead-
wiler, of Elberton ; Secretary— Dr. Jas. A. Gray, of At-
lanta ; Treasurer— T>T. E. C. Goodrich. The Society
adjourned to meet at Macon, the third Wednesday of
April, 1884.
l^extTS 0f tTtc 'SgEccTi.
The Evolution of the New Code.- — The fourth ar-
ticle by Dr. Piffard on " The Status of the Medical Pro-
fession in the State of New York," published in the New
York Medical Journal of May 26th, gives an interesting
history of the present State Code, and explains the rea-
sons which led the committee to adopt the present non-
restrictive clause. The subject is admirably presented,
and the article reflects much credit on its author. It
should be read by all who candidly desire to know the
whole truth regarding New York State's ethical position.
The Independent Practitioner is to become a purely
dental journal, and will be edited by Dr. W. C. Barrett,
of Buffalo, N. Y. We trust it will continue successful.
The Massachusetts State Medical Society holds
its one hundred and second annual meeting at Boston,
June 1 2th and 13th.
President Oilman, of the Johns Hopkins Univer-
sity, will, says the Maryland Medical Journal, sail for
Europe shortly in order to study the methods of medical
education in vogue there, with a view to utilizing the
experience thus gahied in the organization and conduct
of the medical school to be established in connection
with his own university.
Medical Society of the County of New York. —
At the stated meeting, held May 28th, notice was given
of the following proposed amendment to the by-laws :
" No member of this Society shall assume any sec-
tarian designation indicating that his practice is based
on any special doctrine, or dogma, or specified method
of treatment."
The following amendments were unanimously adopt-
ed : I. "The members of this Society shall be governed
by the Code of Ethics, adopted by the Medical Society
of the State of New York, February 6, 1882." 2. "No
person shall be eligible for membership in this Society
who is a member of a county society not entitled to rep-
resentation in the Medical Society of the State of New
York."
The Epidemic Fund of one hundred thousand dol-
lars, to be used in the discretion of the President of the
United States, will be employed onlv in case of actual or
threatened epidemic, in which event the Secretary of the
Treasury is empowered by the President to disburse the
fund in aid of State and local boards of healtli to prevent
the introduction or spread of the disease.
Female Physicians for the Natives of India. —
Much success has attended the subscription now being
raised in Bombay to secure the services of female phy-
sicians for the nutive women. Miss H. Johnson, the Di-
rectress of the Medical Mission at Agra, one of the
largest cities of Northern India, gives a deplorable pic-
ture of the ravages of sickness and debility among the
native women, whom no male physician is allowed to
approach, and who, living in ill-kept rooms, and often
sitting, or even sleeping, on the bare floor, are at the
mercy of every epidemic. Even when European medi-
cines and prescriptions are within reach, they are often
rendered useless by the opposition of jealous and super-
6o6
THE MEDICAL RECORD.
[June 2, 1883.
stitious relatives. There can be no doubt that the es-
tablishment in every great Hindoo city of a native hos-
pital, officered by competent female doctors, would save
many lives every year.
Dr. Holmes not Going to England. — Dr. Holmes
has been invited to Birmingham, and the promise has been
made him that if he will go a reception by the members of
the medical profession will await him there. He was thus
invited on the supposition that he was about to visit Eng-
land, but this rumor proves to have been an error. His
letter declining the Birmingham honor is made public in a
London newspaper, and is as follows, the date of it being
April 21, 1883 : " I am very sorry to say that the story
of my intended visit to England is a pure invention. 1
should find a great deal to enjoy, I am sure, in ' our old
home,' but I hardly e.Kpect to see it again, being myself
a poor traveller, and having learned by troublesome ex-
perience that I am safest when I let my children do the
travelling for me. I thank you most cordially for your
very kind invitation to visit Birmingham. It is a source of
great pleasure to me to feel that I have many good friends
in England — friends on whose faces I have never looked,
and probably never shall, but whose warm heart-beats
reach me through the oldest of telephones — the one that
'wafts a sigh from Indus to the pole.' "
Those Toledo Schools is the title of an editorial in
the Columbus Medical Journal, in which the inner history
of the development of medical education at Toledo is
given. We are told that there are now two medical col-
leges in that city. It seems that there was a school
started in 1S78, that soon after the " outs" got a charter
and started a regular college. Now the original '' school "
has a charter also. The Columbus Medical Journal s,:s.ys :
" Six months ago, the stand taken by the Illinois Board
of Health would probably have prevented the birth of
either school ; but its recent pusillanimity has made it
the laughing stock of the country, and utterly destroyed
its usefulness." It seems a little unfair to lay it all on
the Health Board of another Stale.
A Bust of Dr. J. M. Toner, of Washington, is to
be made by Mr. J. Q. A. Ward for the Congressional
Library, in honor of the gift from him of a large and valu-
able collection of medical books.
Medical Assocl-vtion of Central New York. —
The sixteenth annual meeting of the Medical Association
of Central New York was recently held at Syracuse,
N. Y. The meeting was quite well attended and was
an unusually interesting one. Dr. C. .Mercer showed
specimens of bacillus tuberculosis.
An .\natomy Act designed to prevent body-snatching
by providing for a suitable supply of " material " for the
, colleges, has been passed by the Quebec Parliament.
A Woman on the Hospital Staff of a General
Hospital. — At the recent examination for the house staff
at Mount Sinai Hospital, Dr. Josephine Walter was a
successful candidate, and has received the appointment.
Miss Walter is a graduate of the Woman's Medical Col-
lege of the New York Infirmary, and after receiving
her diploma spent six months in further studies before
, venturing her examination.
Woman's Medical College of Philadelphia. —
Dr. W. W. Keen has been elected to the chair of sur-
gery in the Woman's Medical College of Pennsylvania.
Professor Richet was elected a member of the
Academy of Sciences, at its last meeting, in the section of
Surgery and in the room of Dr. Sedillot, deceased. The
struggle was hard between the newly elected Academi-
cian and the venerable Jules Guerin, but notwithstanding
the greater claims of the latter, the result that took place
was anticipated.
A Sanitary .\rmor. — The National Health Society,
London, has introduced a form of garment, made of
mackintosh, to be worn by those people who are com-
pelled to enter the apartments of persons suffering from
contagious diseases. Used in conjunction with a medi-
cated cotton respirator, it is s.aid to be a protection
against contagion.
Havana as a Source of Yellow Fever Infection.
— Twenty-two deaths from yellow fever occurred in
Havana during the week ending May 26th. The act of
Congress for the prevention of contagious diseases,
which requires the sanitary inspection of vessels at
Havana bound for the United States, expires on June
2d, and Congress has made no provision for a renewal of
the act. The want of sanitary inspection and informa-
tion in bills of health will prove, it is feared, injurious to
vessels and a danger to ports in the United States. It is
stated that the President has authority to act in the mat-
ter. The usefulness of a competent, responsible in-
spector, serving as heretofore in the American consulate,
is apparent. Havana, with its yellow fever, is constantly
endangering the ports of the United States.
A Successful Surgeon Painter. — Sir Henry Thom-
son's picture at the exhibition of the Royal Academy is
hung on the line.
There is an Epidemic of Scarlet Fever at present
in the town of Flatbush, L. I. There are now forty
cases being treated. Two cases have terminated fatally.
The Epidemic P^und of the Treasury Depart-
ment.— The Secretary of the Treasury has written a let-
ter to the Surgeon-General of the Marine Hospital Ser-
vice, of which the following is a copy: "The President
has directed the Secretary of the Treasury to take charge
of the expenditure of the appropriation in the Sundry
Civil Service Appropriation act of March 3, 1883, for
the prevention of the spread of epidemic diseases. This
department has determined to commit to tiie Surgeon-
General of the Marine Hospital Service the inquiry into
the need of the use of the money and the duty of apply-
ing it in cases that arise thereupon, and you are hereby
authorized to make requisition from time to time for such
sums as may be deemed necessary to carry into effect the
purpose of said appropriation, to be expended in ac-
cordance with the existing regulations of the Marine
Hospital Service."
Hudson County (N. J.) Medical Society. — At the
annual meeting the following officers were elected :
Gordon R. Dickson, M.D., President ; W. P. Watson,
M.D., Vice-President; J. A. E.\ton, M.D., Secretary;
C. F. Kyte, M.D., Treasurer.
June 2, 1883.]
THE MEDICAL RECORD.
607
Icpofts of Societies.
NEW YORK PATHOLOGICAL SOCIETY.
Stated Meeting, May (), 1883.
R. E. Van Gieson, . M.D., Vice-President, in the
Chair.
Dr. Wackerhagen presented specimens in behalf of
a candidate.
Dr. Ferguson presented a specimen, illustrating
pericarditis,
occurring in a female patient, aged fifty-four, a native of
Ireland, and a dressmaker by occujiation. She was ad-
mitted into the New York Hospital on September 11,
1882, with the following history : Three years previous
to date she was in a hospital for kidney disease, where
she improved under treatment. Up to three weeks pre-
vious to her admission she was fairly well and attending
to business. At that time her feet began to swell, and her
dyspnoea, which has been moderate since her first illness,
became worse, and on admission she was suffering from
cardiac palpitation. There were no visual or cerebral
symptoms.
While in the hospital her temperature was subnorjnal
(97.7' F.), her respiration ranged from 18 to 34 per
minute, and her pulse from 98 to 15S. She was stimu-
lated by whiskey and digitalis, and was cupped over the
region of the kidneys.
Physical examination revealed double hydrothorax, and
a loud blowing bruit over the base of the heart, on both
sides of the sternum. During the last three days of her
illness she passed only a few ounces of urine, which con-
tained a large percentage of albumen. All her symp-
toms became aggravated, and she died (comatose for
several hours previously) on September isth, three days
after admission.
Autopsy, twenty-two hours after death. — There were
500 c.c. [17 ounces] of serum in the right pleural cavity.
The lungs were congested and cedematous. The heart was
very large, and both layers of the pericardium were cov-
ered by recent lymph. The ventricular walls, especially
the left, were hypertrophied ; the left ventricle was di-
lated, the valves were competent, and the endocardium
was slightly thickened.
The kidneys were far advanced in chronic diffuse
nephritis. They were much smaller than normal, and
there was a great deal of fat in the convoluted tubes
and many casts in the straight tubules.
The liver was pigmented, the central vessels were di-
lated, and there was atrophy of the liver-cells in their
neighborhood. There was excess of fat in the liver,
also in the muscular fibres of the heart.
Dr. Ferguson also presented a specimen illustrating
pericarditis THROMBU.S OF THE ARCH OF THE AORTA,
from a male, aged seventy. He was found on the street
in an unconscious condition, and pulseless at the wrist.
He was aroused, and, by the assistance of two men,
walked into the ambulance. He was unconscious all the
time he was in the hospital, and pulseless at the wrists.
He died thirty-six hours after admission.
Autopsy, twenty-four hours after death. — The upper
lobe of the right lung was in the condition of gray he-
patization. The lower and middle lobes were in-
tensely congested and cedematous. The left lung was
congested and cedematous throughout. The bronchial
tubes, on both sides, contained mucus and pus. The
pericardium contained two ounces of purulent fluid.
Both layers of the pericardium were covered by recent
lymph. The left ventricular wall was much hypertro-
phied, and the cavity of the left ventricle was small. The
valves were competent. There were several small
patches of atheroma in the segments of the aortic and
mitral valves. The thoracic aorta was moderately di-
lated. There was a clot arising from the arch of the
aorta, between the origin of the subclavian artery on
the left side, and the common origin of the innominate
and left common carotid, one inch in length, and one-
half inch in breadth, and the same in thickness, with its
centre broken down. It was not organized ; a part of it
passed up into the left common carotid. Brain. The
left middle cerebral artery was occluded by an embolus,
which filled the artery and some of its branches, and
the regions of the brain supplied by these branches were
softened. The kidneys were atrophied, and in the con-
dition of chronic diffuse nephritis. The urethra. There
were two strictures of the uretlira, each of which ad-
mitted a sound one-eighth of an inch in diameter. One
was situated in the pendulous portion, two inches from
the meatus, the other at the bulbo-niembranous junction.
These cases resembled each other in that both patients
were advanced in years ; both had chronic diffuse ne-
phritis, hypertrophy of the lieart, thickening of the en-
docardium, and pericarditis.
The Society then went into executive session.
THE SECOND GERMAN CONGRESS OF IN-
TERNAL MEDICINE.
Held at Wiesbaden, April 18, 19, 20, andzx, 1S83.
Professor Frerichs, President, m the Chair.
(Special Report for The Medical Record.)
(Concluded from p. 551.)
DISCUSSION ON DIPHTHERIA.
Professor Klebs followed with a pa]3er in which he
agreed in the main with the preceding speaker, and
thought there were undoubtedly different forms of diph-
theria depending upon different micro-organisms. In
Prague he had seen a form of malignant diphtheria in
which there were hemorrhagic exudations in the central
nervous organs, with severe general symptoms, while the
local throat affection was confined to a spot the size of
a penny. The superficial layer of this membrane was
composed of masses of straight or bent threads mixed
with epithelial debris. Beneath this was the ordinary
fibrinous exudation, in which were numerous round
masses of very small micrococci closely packed together.
In Zurich he had found another form prevailing, in which
the affection was more local. There was no enlarge-
ment of the spleen, and slight or no changes were to be
found in the kidney. Dea"th occurred through invasion
of the respiratory tract by the false membrane, or from
pulmonary inflammation. Paralysis seemed to follow this
variety less frequently than it did that which he had met
with in Prague. In this form the micro-organisms were
bacilli, while in the less localized variety first mentioned
they were micrococci. He considered it important to
thus distinguish between these two varieties of diphtheria,
as in this vvay we might be able to remove many of the
difiiculties of prognosis, and, furthermore, obtain data upon
which to formulate the therapeutical indications. He
had had but little experience with scarlatinal diphtheria,
but believed it to be a distinct variety of the disease.
He had always found a swelling of the submaxillary
glands in such cases, and had discovered that they were
infiltrated with micrococci.
Dr. Heubner, of Leipzig, questioned whether the
local inflammatory process might not depend upon a
temporary interruption of the blood-supply to the part.
He had experimented upon rabbits by closing temporarily
the vessels supplying the base of the bladder, the circula-
tion being restored again after the lapse of a short time.
At the end of twenty-four hours there was a hemorrhagic
oedema of the mucous membrane ; an e.\udation appeared
on the second day ; and on the third day a perfect pic-
ture of commencing diphtheria was presented. A further
6o8
THE MEDICAL RECORD.
[June 2, 1883.
experiment seemed to him to explain the onset of infec-
tious symptoms. After the mucous membrane had be-
come diphtheritic, he injected anthrax poison into the
substance of the dorsal muscles. When this was done
early, the poison was found chiefly in the locally diseased
parts. The speaker concluded, therefore, that the con-
tagium of diphtheria was not the cause of the exudation,
but was deposited in it through the simultaneous occur-
rence of a local inflammation with a general infection.
In accordance with these views, he placed little reli-
ance upon local treatment, but endeavored to overcome
the diphtheritic poison by remedies internally adminis-
tered.
Dr. Jurgensen, of Tubingen, was inclined to regard
croup as a disease distinct from diphtheria, and related
a case in support of his view. As to treatment, he
thought it best to remove the membrane, as far as pos-
sible, for the sake of cleanliness, but opposed the employ-
ment of hargji or irritating substances to effect this object.
He considered a general disinfection of the entire body
as impossible.
Dr. Rossbach, of Jena, looked upon the tonsils as the
portals through which the diphtheritic poison found en-
trance to the system, and on this account advocated
their removal as a prophylactic measure. When they
were large he cut them away ; in other cases he destroyed
them with the galvano-cautery.
The discussion was prolonged to the close of the session,
a number of gentlemen taking part therein. In general, it
was agreed that the affection designated diphtheria was
not a single disease, but that there were two or more
conditions at present confounded under this one name.
At the opening of the third session Dr. Binz, of Bonn,
presented a paper upon
THE ABORTIVE TREATAIENT OF INFECTIOUS DISEASES.
Two causes were at work which tended to make in-
fectious diseases less dreaded now than they were in
former ages. These were an improved hygiene and an
improved therapeutics. Hygiene alone will not suffice
to prevent entirely the occurrence of epidemics, for the
simple reason that it can never become perfect ; and as
long as a single focus exists favorable to the growth and
development of the matter of contagion, there is danger
of its spread to other localities. Hygiene and therapeu-
tics must go hand in hand. But though we can never
hope to ijrevent absolutely the occurrence of any infec-
tious disease, the author believed that the time would
come when we could strangle the disease at its inception
and thus rob it of most of its terrors. We have already
five remedies which we can send after certain exciters of
disease to paralyze them and abort the diseases to which
they give rise. These remedies are quinine, mercury,
iodine, arsenic, and salicylic acid. The antagonism of
quinine to the malarial poison was dwelt upon ; the ex-
planation of its action being that it was a poison to the
micro-organism found in this disease. This was not
mere conjecture, but had been proven by direct experi-
ment. Although at present tliere were no remedies to
be regarded as specific antidotes to the microscopical or-
ganisms foiuul in tuberculosis and diphtheria. Dr. Binz
believed that they would some time surely be fountl.
These diseases were now in the same condition as were
rheumatism and malarial fevers before the discovery of
the antidotal effects of salicylic acid and quinine. In
concluding, the speaker predicted a glorious future for
therapeutics. '^
Dr. Rossbach, of Jena, followed with a thoughtful
article upon the same subject, agreeing with Dr. Buiz in
his hopes of vanquishing these enemies of mankind. He
advocated the establishment of a special commission to
study the action of the various drugs now in our posses-
sion, and of others yet to be discovered, to determine
their proper dose and to ascertain their poisonous effects
upon the lower as well as the higher organisms. In case
of an epidemic occurring in any locality this connnission
should recommend some particular remedy, whose action
was supposed to be inimical to the disease in question.
This remedy was then to be used by all physicians in
their treatment of the disease, and a report could be
made to the central body, upon the subsidence of the
epidemic, of the results obtained by the various ob-
servers. In this way we might hope to make rapid ad-
vances in our search for specific therapeutical agents.
The discussion which followed was without special in-
terest. The speakers agreed upon the desirability of the
establishment of some such commission, which could for-
mulate some general plan of investigation, and collate
the results obtained by individual workers.
THE AMERICAN LARYN(;OLOGICAL ASSOCI-
ATION.
The Fifth Annual Congress, held in New York, May
21, 22, and 23, 1883.
(Continued from p. 580.)
Second Day — Afternoon Session.
Dr. Louis Elsberg, of New York, read a paper en-
titled,
reflex PHENO.ME.VA due to NASAL DISEASE.
More than twenty years ago he introduced the subject
that naso-pharyngeal disease, especially with considerable
thickening and congestion of the mucous membrane, was
liable to be attended with loss of memory and mental
depression and other nervous phenomena. In 1863 a
remarkable case of chorea came under his observation,
so severe that the movements continued even during
sleep. The nervous affection seemed to depend upon
nasal disease, so much so that he directed his attention
exclusively to this difficulty, &nA pari fassu with the cure
of the disease of the nose the chorea was completely and
permanently relieved. The affections to which his at-
tention had been especially directed were melancholia,
chorea, reflex epilepsy, neuralgia, especially of the supra-
orbital nerve, gastric disturbances, especially diseased
conditions of the upper part of the digestive tract, uter-
ine disorders, atfections of the genito-urinary mem-
brane, disorders of smell and taste, also of hearing and
sight, and numerous affections of the naso-respiratory
tract, especially various alterations in the speaking and
singing voice, laryngeal cough, bronchial asthma, etc.
In explanation of the intimate connection which seemed
to exist between nasal disease and affections of the ner-
vous system, the author of the paper referred to a com-
munication made by Dr. A. Jacobi to the New York
Obstetrical Society, in which three points were made :
First, the trigeminus, with all its branches, is subject to
direct or reflex irritation from the inflamed nasal mucous
membrane ; second, that thickening of the mucous mem-
brane, or narrowing of the nasal passages in the child,
especially such as attend the presence of a polypus,
seriously interferes with respiration, and the result is an
accumulation of carbonic acid gas in the brain, which
affects the respiratory centre of the medulla oblongata ;
third, the nasal mucous membrane and the dura mater
have an intimate relation with each other, so much so
that each can be injected from the other side.
Dr. J. N. Mackenzie, of Baltimore, drew especial at-
tention to the great frequency of cough as a symi)tom of
nasal disease. He had reached this conclusion with
reference to this symptom by experiment, as well as from
clinical observation. Erom an extended study of the
subject, both clinically and experimentally, he had reached
the following conclusions, already presented in a paper
which he had read before one of the medical societies
in Baltimore : First, clinical experience and experimen-
tal observation had shown that in the nose, as well as in
the i)harynx, theie exists a definite and well-defined cir-
cumscribed area, the irritation of which, caused by either
pathological process or artificial means, is capable of
June 2, 1883. J
THE MEDICAL RECORD.
609
producing a series of reflected phenomena, but especially
cough ; second, this reflex area corresponds, in all prob-
ability, to that portion of the mucous membrane which
covers the posterior part of the corpus cavernosa ; third,
this reflex is only produced when this area is stimulated ;
fourth, all parts of this sensitive area are not equally
sensitive to irritation, the most sensitive being the pos-
terior end of the inferior turbinated bone and the erec-
tile body on the septum immediately opposite ; fifth, the
susceptibility to reflex cough varies greatly in different
patients. The reasons which he gave for thus local-
izing the sensitive area, were : First, the reflex cough
may be produced at will by artificial stimulation of this
area ; second, the reflex cough may be dissipated b_v
topical applications to this sensitive surface ; third, in
all cases of nasal polypi in which asthmatic attacks are
present they are only produced when the polypi are sit-
uated in the posterior part where they impinge upon
the sensitive area ; fifth, foreign bodies lodged in this
area will give rise to reflex cough, but when lodged
in the non-sensitive portion of the nose they do not pro-
duce such reflex phenomena.
Dr. J. O. Roe, of Rochester, made special reference
to asthma, especially that which occurs in acute attacks,
such as is seen with hay fever, as being produced by dis-
ease of the nose, particidarly posterior hypertrophy of
the mucous membrane. He thought that in nearly all
cases of hay fever it would be found that disease of the
nose was an essential cause. He related the history of
one case in which remarkably favorable results followed
removal of hypertrophied turbinated tissue.
Dr. C. Seiler, of Philadelphia, referred to cases in
which choraic symptoms were present, due to nasal
irritation, and in which the nervous manifestations dis-
appeared with the cure of the nasal disease. He also
referred to cases of extremely violent coryza, lasting but
for a short time, developing very suddenly, and attended
by a profuse watery discharge, which 'he thought might
perhaps be included under the class of cases referred to
by Dr. Elsberg. He recited the history of one remark-
able case ; but there was no evidence of hypertrophy of
the nasal mucous membrane.
Dr. F. H. Bosworth, of New York, thought it not
well to call the cases to which Dr. Seiler h.id referred
cases of coryza, for he had examined the fluid discharged
both microscopically and chemically, and found it com-
posed almost entirely of pure water. They were first
described by Sir Benjamin Brodie, subsequently by Sir
James Paget, and afterward by writers in the London
Lancet, making in all six cases, which covered the litera-
ture of the subject. He believed that they depended
entirely upon some neurotic condition of the general
system, but were not reflex in character. Dr. Bosworth
also directed attention to the occurrence of spasm of
the glottis dependent upon atrophic rhinitis, which he
thought was, quite probably, reflex in character. The
youngest patient in whom he had seen this symptom was
six years of age, and the oldest, a man fifty-five years of
age. Simple applications, such as a weak solution of
salt, keeping the nasal mucous membrane moist, relieved
comijletely the tendency to the attacks of spasm. One
point with regard to Dr. Jacobi's explanation, mentioned
by Dr. Elsberg, and that was. Dr. Bosworth did not be-
lieve that chronic thickenmg of the nasal mucous mem-
brane or nasal polypi occurred in children. The condi-
tion which was seen was glandular tissue, and not mu-
cous membrane which has become thickened.
Dr. W. C. Jarvis, of New York, referred to a case in
which relief from asthmatic attacks followed removal of
a posterior gelatinous polypus and opening up of one
nostril in a case in which both nostrils had been ob-
structed by reason of a polypus and also a deviated sep-
tum.
Dr. Elsberg, in closing the discussion, said that he
was not aware of Dr. Mackenzie's interesting contribu-
tions to our knowledge of the sensitive points about the
nose, and had been much interested in the conclusions
reached. He did not regard the case of excessive watery
discharge, referred to by Dr. Seiler, as one which be-
longed to the category included in his paper. The cases
of spasms of the glottis he had alluded to, and was
pleased to learn that Dr. Bosworth had observed so many
similar cases.
Dr. Clinton Wagner, of New York, then read a
paper entitled
SMELL HYGIENICALI.V ANI> iMEIlIC(J-LEGALLY CONSIDERED.
The author of the paper defined odors as impalpable
bodies in the form of vapor, and that the function of the
special sense of smell was to be able to recognize and
distinguish the impression of odors, one from the other,
on the terminal filaments of the olfactory nerve. Dr.
Wagner then directed attention to the great variety of
smells with which the human nose became cognizant,
and spoke of the exposure of workmen to certain
noxious vapors and apparently without deleterious re-
sults. He explained this fact on the ground that all
these workmen were engaged in active occupations, and
therefore that the influence of the poison was not felt ;
whereas when the same noxious odors, disagreeable
smells, were experienced by the feeble or delicate, who
led a less active life, the influence produced was phys-
ically detrimental. The medico-legal aspect of the ques-
tion was presented in the detriment to health and to
comfort embraced under the legal definition of a nui-
sance, which might be experienced by those who lived
in the immediate locality of bone-boiling establishments,
petroleum yards, abattoirs, etc.
Dr. Beverley Robinson, of New York, in discussing
the paper, directed attention to the distinction which
should be made between deodorizers and disinfectants,
and while he did not wish to say that it was not valuable
to be able to detect odors, yet he believed that the use
of so-called disinfectants frequently did more harm than
good. For example, when subjected to close analysis, it
had not yet been determined whether or not the real
germ of disease was destroyed by the use of the popular
agent, carbolic acid, which perhaps might be regarded
as substituting one bad smell for another, and not disin-
fection. It should not be taken for granted that merely
destroying a disagreeable odor was destroying a noxious
agent. Again, he believed that more stress had been
laid on the presence of sewer-gas than was always sus-
tained by the real facts in the case.
Dr. C. W. Chamberlain, of Hartford, stated that it
was somewhat difficult to judge just how far, in over-
crowded tenement houses, in school-houses, etc., offen-
sive gases influenced health, but, so far as the Connecti-
cut State Board of Health had been able to determine,
they had avoided any disinfecting agent which substituted
one odor for another, and had eliminated carbolic acid
from the list entirely.
Dr. S. H. Chapman, of New Haven, thought an odor
simply led us to seek the cause of some putrefaction ;
that the odor did no harm unless it was accompanied by
a germ of disease ; that with mere smells the sanitarian
had nothing special to do, but that stinks might be det-
rimental.
Dr. Wagner said that he wished to speak of odors
simply as a means for detecting sources of disease, and
believed that much could be learned by following them
to their origin. He did not wish to suggest that the
cause of noxious vapors should be treated by disinfect-
ants.
Dr. Harrison Allen, of Philadelphia, then read a
paper entitled
asymmetry of the nasal chambers without septum
deviation.
The author of the paper wished simply to direct at-
tention to this particular fact : he believed that a dif-
6io
THE MEDICAL RECORD.
[June 2, 1883.
ference in the diameter of the posterior nares would be
found to exist quite generally. He had found corre-
sponding to it an asymmetry of the parietal protuberances,
and this might perhaps be one means by which an ex-
ternal examination of the liead might lead to the infer-
ence that the nasal passages were deformed.
Dr. Delavan, of New York, believed that Dr. Allen,
in his line of study, was doing much to reach the root of
the whole discussion of all nasal difficulties ; for he be-
lieved it to be the general experience that in a large
number of cases attempt to relieve patients of certain
nasal affections was useless simply by treating the nasal
mucous membrane.
Dr. Rufus p. Lincoln, of New York, then read a
paper
ON THE RESULTS OF THE TREATMENT OF NASO-PHARYN-
GEAL FIBROMA, WITH DEMONSTRATION OF SUCCESSFL7L
CASES, TOGETHER WITH A TABLE OF SEVENTY-FOUR
OPERATIONS SV DIFFERENT SURGEONS.
The object of treatment in these cases is, first, thorough
removal of the growth and destruction of diseased tissue;
second, avoidance, as far as possible, of accidents inci-
dent to operations in this region ; third, to secure the
result with the least external disfigurement. Dr. Lincoln
disclaimed the idea of recommending the employment of
any single method of treatment, but he believed that
there was a simjiler method than that so frequently em-
ployed by the most distinguished of surgeons.
The tabulated operations included those performed
upon 58 patients, including three of his own cases. There
were 74 operations in all, and were tabulated as follows :
Of the patients, 46 were males ; 8 were females, and in 4
the sex was not stated. Age : under eight years of age,
2 ; between fourteen and twenty-three, 31 ; between
twenty-three and thirty, 4 ; between thirty-three and
forty-two, 6 ; between forty-three and fifty-two, 5 ; i pa-
tient was fifty-four years of age, another fifty-five, and
the age was not stated in 8 cases.
Of the operations involving section of the bones of the
face, there were 39 performed upon 28 patients. The
number of recurrences which took place within a year
was 14 ; the number of cases reported under observation
without recuirence, 4 ; the number of cases in which
there was no record subsequent to the operation, 13 ;
the number of deaths as a result or attributable to the
operation itself, 8 ; in 3 other cases the operation nearly
proved fatal.
Removal by knife, scissors, forceps, etc., 7 operations
performed upon 7 patients. Number of recurrences,
none ; number of cases reported under observation one
year or more subsequent to the operation without re-
currence, I ; number of cases in which there was no
record subsequent to the operation, 5.
Removal by the ecraseur, or ligature, 12 operations
performed upon 1 1 patients. Recurrence within one
year, 6 ; under observation for one year or more without
recurrence, 4 ; no record subsequent to the operation, 2.
Treatment by injections, cauterization, etc. Number
of cases treated, 2. Recurrences within one year, i ;
without records subsequent to the operation, i.
Removal by electrolysis in 3 cases. Recurrences
within one year, i ; no record after operation, 2.
Removal by the galvano-cautery ecraseur, 1 1 ; opera-
tions |)erformed upon 10 patients. Number of recur-
rences within one year, 3 ; under observation for one
year or more without recurrence, 6 ; no record subse-
quent to the operation, 2 ; fatal cases, none.
Dr. Lincoln then read the rejiort of a case in which,
in January last, he removed one of these growths with
the galvano-cautery ucraseur, and subsequently destroyed
the stump by the galvano-cautery. The operation per-
formed was the same which he described to the .'\ssocia-
tion four years ago. It consists in the introduction of a
loop of platinum wire through the nostril, passing it be-
hind the tumor, after which the patient is etherized, the
battery attached, the pedicle severed, and the tumor re-
moved through the mouth.
This patient was presented, as was also the patient
whom he operated upon in 1879, and another whom he
operated upon in 1875, in neither of whom was there any
trace of the growth remaining.
Dr. W. C. Jarvis, of New York, referred to a case of
m\'xofibroma of the naso-pharynx in which the tumor
was attached to the post-nasal arch, projected forward
into the anterior nares, extended some distance into the
right nares, and almost entirely occluded the vault of the
pharynx. He removed the growth with his Ecraseur,
using a No. 5 piano-wire, and, although the strain upon
the instrument was sufficient to bow the ecraseur, the
patient only complained of severe toothache and the te-
dium of the operation, .\lthough the instrument in po-
sition pulsated like an artery, there was no hemorrhage
following the removal of the growth. Four months af-
terward there was none of the neoplasm remaining.
Dr. Jarvis also exhibited a new nasal speculum, which
he devised to facilitate exploration of the nasal passages,
not only in these but in all other cases.
Dr. .Andrew H. Smith gave the history of a case in
which he succeeded in removing the growth by means of
Jarvis' snare. The pedicle, after removal of the neo-
plasm, grew rapidly downward but not laterally. He
again applied the wire, and resorted to the application
subsequently of the perchloride of iron. All that remains
now is a small conical projection, which simply indicates
the location of the jiedicle.
Dr. Seiler also referred to cases in which he had
found it most satisfactory to use the cold-wire ecraseur.
In one case he had removed the growth piecemeal, the
whole when it was entirely removed weighing nearly four
ounces.
Dr. Ingals, of Chicago, referred to three cases which
he had successfully removed by means of the galvano-
cautery.
Dr. Bosworth, of New York, thought the Society was
very much indebted to Dr. Lincoln for the most complete
tabulation of cases which had ever been prepared, and
he was very nmch pleased to know that the view that
these tumors can be dealt with successfully without re-
sorting to the frightful operation ofLangenbeck was fully
sustained by the statistics.
Dr. Lincoln thought that any one who had seen the,
operation of excision of the superior maxilla could not
but regard it as one of the most horrible in surgery, and
one of immediate hazard to the patient, and therefore
any method of avoiding such a formidable operation was
worthy of careful consideration and trial.
Dr. E. Holden, of Newark, then e.xhibited
A CARBON ILLU.MINATOR FOR EXAMINATION OF THE
throat and larynx.
It consisted of a spring loop of wire in which a mirror
could be easily slipped, was adapted to all purposes of
pharyngeal and lar3'ngeal illumination, and when at-
tached to two ordinary Smede's cells, the illumination
given was exceedingly satisfactory.
The Association then adjourned to meet at 10 .\.m..
May 23d.
Third Day — Wednesday, May 23D — Morning Ses-
sion.
The .\ssociation was called to order at ten o'clock by
the President.
The first paper was read by Dk. J. SoLis Cohen, of
Philadelphia, and entitled
A CASE OF THYROTOMY FOR MORBID GROWTH ; WITH
SUBSEQUENT DEVELOP.MENT OF EPITHELIOMA IN THE
CUTANEOUS CICATRIX, BUT WITHOUT INVOLVEMENT OF
THE INTERIOR OF THE LARYNX.
The patient was a man, sixty-three years of age, who
had persistent hoarseness of two years' duration. The
June 2, 1883.]
THE MEDICAL RECORD.
611
voice was a husky whisper. His general health was con-
siderably impaired. After some general treatment Dr.
Cohen removed the laryngeal growth by thyrotomy ; sub-
mitted the specimen to Dr. Seiler for microscopical ex-
amination, who reported it to be papillomatous. Two
years after the operation the patient presented himself
with a small, soft nodule in the skin, over the right wing
of the thyroid cartilage, but not attached to the cartilage.
This was removed by Dr. Agnew, of Philadelphia, and
submitted to microscopical examination by Dr. Formad,
of Philadeliihia, who declared it to be a specimen of
tubular epithelioma. Ten weeks later another nodule
appeared over the left wing of the thyroid cartilage, and
was attached to the muscle below ; this was also-removed
and found by Dr. Kormad to be epitheliomatous in char-
acter. Finally Dr. Cohen removed all of the skin in the
neighborhood which was infiltrated with epithelioma, and
filled the space by making a transplantation of flaps
from the upper part of the chest. The case subse-
quently did very well for some time, but eventually proved
fatal, the patient dying in January, 1883.
Dr. Cohen regarded it as a case of epithelioma induced
in the cicatrix by irritation of the neck-band, and that
after the first operation the case became an example of
malignant growth due to direct local irritation.
Dr. F. H. Hooper, of Boston, then read a paper en-
titled
EXPERIMENTAL RESEARCHES ON THE TENSION OF THE
VOCAL BANDS,
made in conjunction with Professor H. P. Bowditch, of
the Harvard Medical School. Two series of experiments
were performed ; First, with reference to the action of
the thy ro cricoid muscle, and it was proved conclusively
that the action of this muscle was to draw the cricoid
cartilage upward upon the thyroid cartilage. The second
series was to determine the effect of the air-blast, and
it was proved that in addition to the entire rise of the
larynx in singing high notes there is an excessive rise of
the cricoid cartilage upon the thyroid, a phenomenon
to which attention has not heretofore been called.
The paper was elaborate, technical, illustrated by dia-
grams and apparatus, and exhibited a remarkable amount
of careful research and experimental application.
Dr. Hooper believed that the following facts had been
established : First, that with high pressures the cricoid car-
tilage invariably moves more than the thyroid, and he be-
lieved it to be a correct inference that with all pressures
such was the result. Second, that with high pressures.
after section of the muscles, both cartilages moved upward
more freely, but the stretching of the vocal bands is less.
The conclusion reached concerning the effect pro-
duced by the air-blast was, that air escaping from the
lungs produced decided upward movement of the cricoid
cartilage, in addition to the general rise of the larynx,
the upward movement increasing in proportion to the
force witli which the air is expelled from the chest.
Dr. Hooper thought his researches might possibly offer
a suggestive clue in elucidating certain pathological con-
ditions. For instance, cases where the singing voice
can be relied upon while in the same individual conver-
sation is impossible, might perchance, in a measure, be
explained by this action of the air-blast as a tensor at
high pressures.
The general conclusions reached by the author of the
paper were : i, That the cricoid cartilage is the most
movable part of the laryngo-tracheal tract; 2, that the
thyro-cricoid muscle should be described as arising from
the thyroid cartilage, and inserted into, and giving mo-
tion to, the cricoid ; 3, the air-blast is a direct and im-
portant longitudinal tensor of the vocal bands.
Dr. Beverley Robinson, of New York, then read a
paper on
AURAL COMPLICATIONS OF INFLAMMATORY CONDITIONS
OF THE NOSE AND THROAT.
The author of the paper believed it was very impor-
tant for laryngologists to be familiar with the aural com-
plications incident to the diseases of the naso-pharyngeal
space, and first directed attention to aural complications
accompanying acute nasal and throat disease of inflam-
matory character ; and, second, to the aural compli-
cations accompanying chronic inflanunatory conditions
of the nose and throat. The aural complications, such
as occurred in connection with scarlet fever, diphtheria,
measles, tyjihoid fever, and other acute general diseases
and febrile affections, were discussed at considerable
length. The author believed that the complications
were due not, as a rule, to direct extension from the nose
and throat through the Eustachian tube to the ear, but to
the same cause which produced the general disease.
He believed that disease of the middle ear was much
more likely to occur as a complication in case of chronic
inflammatory affection of the throat and nose than in
those cases in which these diseases were not present.
In conclusion he urged upon laryngologists the impor-
tance of guiding their patients, especially with reference
to the hygiene of the ear.
Dr. Mackenzie, of Baltimore, directed attention to
one agency which had not been mentioned by the author
of the paper — namely, the reflex production of disturb-
ance in the ear, originating in irritation in the nasal pas-
sages. He had been able to produce artificial redness
of the drumhead by irritation of the turbinated structures
of the nose. Many of these cases belonged to the class
which went first to the aurists, and were told that there
was notiiing the matter witli the ear, and then to the
laryngologists, who told them there was nothing the
matter with the throat or nose, and he believed that they
were largely reflex in character.
Dr. Jarvis, of New York, referred to cases in which
hypertrophy of the posterior nasal mucous membrane is
accompanied by deafness, and also to the influence of
deviated septum in the production of aural disturbance,
believing that the aural complication was due not so
much to the deviation of the septum and disturbance of
jmeumatic conditions of the nasal and aural chambers as
to the fact that a certain amount of inflammatory disease
was usually present in connection with this change in the
organic structure of the nose.
Dr. Robinson believed that certain cases could be
best explained in the manner referred to by Dr. Mac-
kenzie. Within the past six months he had seen several
cases which sustained the conclusion which he had pre-
viously reached that obstruction of the nasal passages
and deviatioB of the nasal septum has not so much to do
with the aural difficulty as we had, perhaps, heretofore
been led to believe.
Dr. D. Bryson Delavan then read a paper entitled
TWO points in THE ANATOMY OF THE LACUNA TONSIL-
LARIUM.
The special points to which the author of the paper
directed attention were, first, the existence of large
single cavities in the interior of each one of the tonsils,
which includes several follicular folds and procures their
common discharge at the periphery. By this arrange-
ment the actual superficial extent of the tonsil is in-
creased. The second point was the unusual destructibil-
ity of the attenuated mucous membrane in the depth of
these large lacuna;, a point worthy of attention because
it constitutes a factor in the pathology and treatment of
the diseased condition of the gland.
The Association then adjourned to meet at 3 p.m.
Third Day — Afternoon Session.
The Association was called to order at 3 p..m. by the
President.
Dr. G. W. Major, of Montreal, read a paper on
the value of post-larvngeal papillomata as a
means of diagnosis in tubercular disease.
Of these papillomata he recognized two varieties : i,
the velvety ; 2, the filamentous, or feathery ; probably
6i:
THE MEDICAL RECORD.
[June 2, 1883.
two degrees of the same disease. Tlie histories of
several cases were given, in which by the existence of
these growths he had diagnosticated tubercular disease.
Dr. M. J. AscH, of New York, said he had fre-
quently observed this peculiar appearance in the larynx
in cases of tuberculosis, but it did not seem to him that
they should be regarded as absolutely diagnostic of that
disease, because he had seen the same velvety appear-
ance in other cases as well. For example, they were
frequently associated with asthma.
Dr. Major said he quite agreed with Dr. Ascli, that
where the velvety appearance existed there was not neces-
sarily actual pulmonary complication, but he had always
found tubercular tendency and tuberculosis in the family.
This was the more important condition to recognize be-
cause; so far as he had observed, after the tilamentous
growths had appeared recovery had not taken place.
Dr. E. C. Morgan, of Washington, then read a paper
on
PHARV.VGEAL TU.MORS,
with the report of a case of enormous tumor removed
from the glosso-epiglottic sinus, with remarks. The tu-
mor was two and one-fourth inches in its lesser, two
and three-fourths inches in its great circumference, and
had a pedicle one-fourth of an inch long, which could be
readily grasped between the tips of the middle and index
fingers, and with the fingers he twisted the tumor from
its attachment. The common opinion that purely pharyn-
geal tumors are rare, he thought was erroneous, because
he had found sixty-one reported cases, extending over a
period of seventy-one years. He included in this class
only those tumors which originated within the pharynx or
extended into the inferior pharynx. Of the sixty-one cases
fourteen were sarcomata and ten fibromata. The in-
terest in his case centred in the rarity of pedunculated
sarcomata in this region, the size of the tumor anfl the
method of removal.
The paper was discussed by Drs. De Blois, of Boston ;
Ingals, of Chicago ; Delavan, Lincoln, Asch, and Bos-
worth, of New York.
Dr. M. J. .\sCH, of New York, then reported
A CASE OF SUDDEN DEATH OCCURRING AFTER TRACHE-
OTO.MY.
There was nothing peculiar in the operation, and two
days subsequently the patient was progressing favorably.
Soon after visiting the patient with his assistants, and
finding him doing well, he was summoned to hasten
back, and on his return found that the man had fainted.
From this he rallied, but soon after went into collapse
and died within a few minutes.
At the autopsy nothing was found to account tor the
sudden death.
Dr. Asch believed that in the majority of cases in
which there is obstruction in the larynx, tracheotomy is
an exceedingly difticult operation ; and that when it is
performed for obstruction, whether acute or chronic, how-
ever easy its iierformance might be, tracheotomy should
not be viewed in any light except that of a serious sur-
gical procedure.
Dr. Andrew H. S.mith, of New York, read tlie next
l)aper, on
ADHESION OF THE VELUM TO THE WAI.I.S OF THE
PHARYNX.
This condition is one of the results of ulceration, al-
most invariably of syphilitic origin, and belonging to the
tertiary stage. Inflammation of the middle ear almost
always occurs as a complication. In cases of coniplete
adhesion the sense of smell is always absent and the
sense of taste is lost or greatly imi^aired. The treatment
is by dilatation with bougies, and this method failing, by
cutting operations. In connection with the latter, Dr.
Smith spoke of the use of monochloro-acetic acid to
prevent adhesion of the cut surfaces, the [jeculiar action
being that healing goes on perfectly under the eschar
formed by this agent.
The paper was discussed by Drs. DeBlois, of Boston,
and Ingals, of Chicago.
The Association then elected as officers for the ensuing
year : President — Dr. Frank H. Bos worth, of New York ;
First Vice-President — Dr. S. \V. Langmaid, of Boston ;
Second Vice-President — Dr. S. Johnston, of Baltimore ;
Alember of the Council — Dr. Beverley Robinson, of New
York ; Librarian, Dr. T. R. French, of Brooklyn.
The two retiring ^'ice -Presidents, Dr. C. Seller, of
Philadelphia, and Dr. E. F. Ingals, of Chicago, as a
committee, conducted the Presidentelect to the platform,
and Dr..Lefterts in a few well-chosen words retired from
the office, the duties of which he has so satisfactorily dis-
charged. The President made a few appropriate re-
marks, and then declared the Association adjourned, to
meet in New York on the third Monday in May, 1884.
CONNECTICUT MEDICAL SOCIETY.
Ninety-second Annual Convention, held at Hartford,
Conn., May 23 and 24, 1883.
(Continued from p. 575.)
Second Dav — Thursday, May 24TH.
The Society was called to order at nine o'clock by the
President.
REPORT OF SECRETARY.
Dr. Chamberlain, the Secretary, presented the report
of the year, stating that the prosperity of the Society had
been uninterrupted ; never had it included so nearly all
of the regular practitioners of the State, nor had its
financial condition been better. The death-rate had
been unusually large, the Society losing fourteen mem-
bers and one honorary member, Dr. Win. Pierson, of
Orange, N. J. Of these, many were from the oldest and
most active members, .\hnost all left an unspotted
name, and some a reputation extending beyond their
own State and land. Dr. Geo. B. Hawley, in the Hart-
ford Hospital, left an enduring monument of faithful en-
deavor, and has been an unwearying worker in humani-
tarian labors. Dr. E. P. Bennett's fame as a surgeon
was not limited by the borders of his own State.
In retiring from the office held by their favor for the
past eight years, the Secretary desired to express his
thanks for the cordial support received from the Society,
which made it possible for him to retire from service
while the Society was in such a flourishing condition.
During eight years, in spite of a loss by death of eighty-
six members, the net gain in numbers had been a little
over a hundred. The Society now numbered four hundred
and sixty, while the amount in the treasury was more
than a working balance, and would enable the Society
to allow some compensation to the Secretary and soon
to reprint the earlier Transactions.
Dr. White moved that the sincere thanks of the
Society are hereby tendered to Dr. Chamberlain for his
long, faithful, and arduous services as Secretary for the
past eiglit years.
Dr. Wile referred to ;he appreciation of the work of
the Secretary, the prompt appearance of the Transactions,
and moved that a committee be appointed to have an
appropriate series of resolutions engrossed and presented
to the Secretary, as an expression of our appreciation
for his services. The resolution was passed unanimously,
and the President appointed Drs. W. C. Wile, M. C.
Hazen, and Ceo. S. Porter on this committee.
The President then presented his
annual address
on the country doctor, which was in practical form, and
was a witty resume of the trials, labors, and rewards of
the country doctor, and elicited repeated applause by the
faithful pictures presented.
June 2, 1883.]
THE MEDICAL RECORD.
613
On motion of Dr. Porter, the thanks of the Society
were voted the President for his address. Delegates
were presented from Rhode Island and Massachusetts,
and Drs. M. Henry and G. Sawyer, of New York, were
invited to be present as guests of the Society.
Dr. Wainwric.ht presented his report on matters of
general interest, and deferred the presentation of the
cases until after the reading of essays.
Professor M. White, of New Haven, then exhibited
and described
AN IMPROVEMENT IN MICROSCOPIC MEASUREMENT
of his invention, with a brief essay on the subject, in
which the merits and defects of different instruments
were described. His invention was a method of delicate
measurement, by the introduction of a micrometer in the
microspectroscope. He placed above the instrument a
telescope of low magnifying power, the eye-piece having
a Jackson micrometer and the field-piece of eijual
power.
Dr. William C. Wile related
A CASE OF EXTIRPATION OF THE UTERUS,
unsuccessful, but performed under unfavorable circum-
stances, but demanded by the condition of the patient,
who lived five da)s. The specimen was exhibited and
the operation described and discussed.
He also related a case treated by the most eminent
specialists of New York for
MYELITIS OF THE CORD.
The man, aged forty-five, had had morbus coxarius.
with recovery. He presented all the symptoms of myelitis
paraplegia and the like after he returned from New
York. Dr. Wile discovered an
ABSCESS IN THE ILIAC REGION,
which, the patient insisted, should open itself. After dis-
charging an enormous quantity of pus he suffered great
Ijain. The doctor opened the hip and found that the
head of the femur was absorbed two inches, diseased,
and that there was a burrowing abscess reaching to the
scapula. Exsection resulted in complete cure.
He also related a recent case of
EXCISION OF THE TIBIA;
disease of bone resulted from an injury three years pre-
vious, resulting in osteitis. •
Dr. Burke related a
COMPLETELY SUCCESSFUL CASE OF EXTIRPATION OF THE
UTERUS,
up to the present time.
Dr. George S. Porter presented a specimen of
EXTRA-UTERINE PREGNANCY.
The head of the child extended out of fimbriated ex-
tremity, which increased the length of the neck to a ver\-
considerable degree. The woman died of asthenia.
Dr. White related a case where twenty-two calculi
were found in the bladder, in a cul-de-sac, behind a
greatly enlarged prostate. Outside the bladder, in the
cellular tissue, were fifteen concretions the size of a pea.
One examined was found to be composed of phosphate
and carbonate of lime.
Dr. Bkownson then moved that
Dr. M. Henry, of New York, by invitation, present
his views on the operation for varicocele.
Dr. Chamberlain related two cases where Henry's
method had been used successfully and very satisfacto-
rily by Dr. Jarvis, of Hartford.
Dr. George I>. Parmele presented an essay on
points in oral surgery, ,
of interest to physicians. He referred particularly to
THE relations OF DISEASED AND OF IMPERFECT TEETH
TO DIGESTIVE TROUBLES,
constipation, diarrhoea, and dyspepsia, and of the ner-
vous connections and reflex influences which induce dis-
ease, directly and indirectly. Such patients were often
treated years for troubles that a dentist relieved at once.
Diseased teeth induce many other troubles than neural-
gia, although the latter is the only one generally recog-
nized.
The thanks of the convention were voted to Dr.
Parmele for his essay.
Dr. G. W. Russell spoke of the unsatisfactory con-
dition of the essay records of the Society, and moved
that the Secretary be authorized to condense and print the
TRANSACTIONS OF THE FIRST TWENTY-FIVE YEARS OY
THE SOCIETY,
and offered to be responsible for one hundred dollars for
that purpose. The resolution was passed.
Dr. VV. H. Holmes read an essay on
ASPIRATION OF THE CHEST IN PLEURISY.
The pathology of the various forms of the disease was
described, and the danger of allowing effusions to re-
mdia for a long time was referred to. Under such cir-
cumstances absorption takes place, and the advantages
and results of aspiration are prevented.
Dr. F. N. Braman presented an essay on
COMPLICATIONS OF LABOR,
illustrating many unusual difficulties and the methods
used to counteract them. Hour-glass contractions, and
the fillet and pressure inversion were discussed.
The paper was discussed by Professor F. E. Beckwith.
He did not think the length of the symptoms was the cause
of death, but that peritonitis ensued only when the mater-
nal tissues were injured. Winding the fillet around the
body he regarded as a new suggestion by Dr. Braman,
but thought the fillet around the shoulders would ac-
complish the same purpose.
Dr. Braman said that the use of the fillet around the
body was to obtain complete control of the child in rota-
tion.
Dr. Ambrose Beardsley then read a paper on
THE treatment OF MALARIA.
The method advocated was a brisk purgative — aloes,
blue mass, and capsicum — an alterative and an aromatic
tonic, with some alkali. This treatment had been very
satisfactory in his hands, even when quinine in large
doses had failed.
The following resolution, off'ered by Dr. G. R. Porter,
was passed : That the Secretary be requested to commu-
nicate with the County Societies with reference to the
publication of the Transactions of the Society to 1S30,
to see if they would bear their share of the expense for
the same.
On motion of Dr. Bacon, the remaining papers were
referred to the Publication Committee antl read by title.
The report of the committee to examine students at
Yale Medical School was read and ordered published.
The Society then adjourned for the annual dinner at
the United States Hotel. The next session will be held
at New Haven. The attendance was large, all parts of
the State being represented.
The Medical Department of the Syrian Prot-
estant College in Beirut, Syria, says the Evangelist,
is in need of a Professor of Anatomy, Physiology, and
Histology. Instruction is to be given in the English
language. The applicant should be a graduate of a med-
ical college, ol high standing, and a man of earnest mis-
sionary spirit, who would enter upon the work for the
sake of promoting the spiritual welfare of his pupils,
and aiding in the advancement of the Church of Christ
in Syria. The Rev. Dr. H. H. Jessup, now of 23 Cen-
tre Street, New York, may be addressed for particulars^
6i4
THE MEDICAL RECORD.
[June 2, 1883.
OTorvcspondcncc.
OUR LONDON LETTER.
(From our Special Correspondent.)
THE DEBATE ON DIABETES AT THE PATHOLOGICAL SO-
CIETY— THE PROBABLE REPEAL OF THE CONTAGIOUS
DISEASES ACTS SCHOLARSHIPS IN MEDICINE AND THE
SOCIETY OF THE APOTHECARIES.
London, May 5. 1883.
The debate on diabetes at the Pathological Society was
concluded on Monday last. It seems to have led to no
definite conclusion as to the pathology of the disease,
but some interesting facts and opinions were brought
forward.
Dr. Seymour Taylor described some changes he had
found in cases of diabetes. They presented the usual
vascular engorgement, but in addition, the epithelium
presented a remarkable appearance. The cells were
large, brownish, their nuclei did not take the logwood
stain, and the cells had a tendency to come away en
masse, so in many parts the kidne)' presented a mere
skeleton of its former condition.
Dr. F. Taylor considered that we had no evidence of
any definite lesions. He referred to the large number
of deaths from "diabetic coma." He also mentioned
the frequency of severe abdominal pain as an early
symptom — an important fact to bear in mind, as it
might lead to error in the diagnosis.
Dr. Dickenson defended the doctrine of the associa-
tion of diabetes with cerebral lesions, and described le-
sions he had observed. He had found extravasations of
blood in seven out of fifteen brains from patients dying
with diabetes.
Dr. Pavy maintained that the blood was at fault. The
glucose in diabetic urine was, he considered, produced by
a glucose-forming ferment found in the liver. Venous
blood was antagonistic to this ferment, but arterial blood
in the liver produced it. Diabetes depended on a dila-
tation of the arteries of the chylo-poietic viscera (by vaso-
motor paralysis) which allowed the blood to pass to the
liver too little deoxygenated. Dr. Pavy described sev-
eral experiments he had made.
Since the vote on Mr. Stansfeld's motion in tiie House
of Commons, orders have been issued to the police in
the districts where the Acts are in force that they are to
cease performing their duties in relation to the .-^cts. A
discussion on the subject in the House of Commons is
expected in a few days, and a Bill to repeal the Acts will
probably be brought in.
The Society of Apothecaries has instituted two scholar-
ships in medicine, of the annual value of ^100, and each
tenable for two years. They are open to all students
of between four and five years' standing, who have ob-
tained a qualification. They are also about to add a
practical e.\amination in chemistry to the first examina-
tion for the L.S..\. These changes are no doubt in
view of coming legislation. The Apothecaries Society
no doubt wish to make out a case for their survival, and
intend to protest against their representative being
dropped from the new medical council. The general
opinion seems to be that, although the Society has done
good work in the past, it is not needed now. In the
case of the Irish Apothecaries Society, whose represent-
ative has also been dropped, it was only by an error
that a clause empowering it to grant medical diplomas
was ever inserted in the Medical Act of 1858.
CONCERNLNG THE DEGREE OF M.B.
To THK Editor ok The Mkdical Rkcokii.
Sir : In the number for May sth, which reached me to-
day, I notice some extracts from a letter by Dr. Parke
commenting upon a letter from my pen. Dr. Parke is
incorrect in stating that gentlemen who are onlv M.B.
are addressed as Mr. Although not in strict law en-
titled to term themselves Dr., as a matter of courtesy
the title is always gives them, and it may almost be said
to have grown into a right. Many London physicians
attached to important hospitals are only M.B., and every
one calls them Dr. .\s an example, I may mention
Dr. Lionel Beale (M.B., London), a name doubtless
well-known to your readers. Many of our universities
do not require any examination to pass from M.B. to
M.D., but merely the writing of a thesis, a short term of
residence, or in some cases merely the payment of a fee.
The London University holds a special examination for
its M.D. in two subjects: i, Medicine; 2, Logic and
Psychology, and is the only university which denies to its
Bachelors of Medicine the tide of Doctor. Nevertheless
they assume it and are addressed as such by others. I
am aware that some M.B.'s call themselves Mr., but then
they are surgeons. Some surgeons are M.D. and yet
call themselves Mr., ^.^1,'. the late Mr. Soelberg \V"ells.
In speaking of physicians, Dr. Parke seems to forget
that the word physician is used in a different sense in
England to what it is in America. My remarks applied
lo pure Jthysicians, i.e., practitioners who prescribe and
only practise pure medicine. I beg to repeat that in
London, at any rate, nearly all physicians are graduates
of some university. The L.R.C.P. is a physician's di-
ploma, but merely a license to practise, which was in-
stituted for general pactitioners. Its possession does not
make its holder a physician and the majority of those
who hold it are in general practice and supply drugs. It
is an entirely different thing to the M.R.C.P. which can
only be held by those who practise as pure physicians, j
I am sir, yours faithfully,
Your Special Correspondent.
LONDO.N", May 15, 1S83.
PELVIC H.EM.VrOCELE.
To THE Editor of The Medical Record.
Sir : In the excellent resume you have given in the last
number of The Record of the recent transactions of the
West Virginia Medical Society occurs a report by Dr. R.
W. Hall of a surgical interference in a case of pelvic
hajmatocele, with consequent general peritonitis, and
final recovery of the patient. In this case the tempera-
ture and pulse had been normal up to the moment of the
advent of the consulting physician, who found a round,
hard tumor ui the hypogastric region, exceedingly tender
to the touch, the contents of which were aspirated two
days afterward. It would seem there was no immediate
necessity for such an operation, if at all, as the tenderness
was due to local peritoneal inflammation usual in such
cases, and since the aspirator could not remove the
coaguL-e, the chief source of septic absorption, nothing
was gained by it.
The surgery of twenty-five years ago conscientiously
advocated the speedy evacuation of such tumors, but
experience has limited its interference to an exceedingly
small number of cases, and only where long chronic dis-
order has not resulted in absorption, and where septic
influences begin to appear.
Even Nelaton, who once popularized surgical inter-
ference, by experience was taught " to proscribe it in an
almost absolute manner. " Priestley shows that the mor-
tality in surgical operations for the relief of hiematocele
is one in four, while by the expectant method it is but one
in nine. Nonant lost but one case in fifteen, and Hewett
none out of eleven treated by the expectant plan.
Fritsch writes ; " Hematoceles treated by operative
opening have run a particularly dangerous and malignant
course. Rapid sloughing, sepsis, and death, or long-
continued, debilitating suppuration and pyaemia have
ensued."
In a very severe case of hematocele reported by me,
and published in the "Transactions of the Medical Society
of New Jersey," 1875, the tumor was of extraordinary size,
June 2, 1883.]
THE MEDICAL RECORD.
615
extending nearly to the umbilicus. Septic;\;mia was
feared, peritonitis existed, and yet after all the alarm, the
contents were suddenly evacuated per rectum in copious
discharges, while all the symptoms disappeared like magic.
One other case occurred in my practice last year
which further illustrates the wisdom of the expectant plan.
Mrs. A. T. A , of Holmdel, on June 9th, had the
hardihood to submit to uterine examination at the hands
of a homoeopathic non-expert in Brooklyn, who finding
no special lesion proceeded to make one by injecting
some corroding fluid into the uterus. Immediately Mrs.
A was seized with sharp pains about the organ, and
crying out, was hastily assisted from the table, when she
experienced a sensation as though the uterus was about
to escape bodily from the pelvis. She was carried in a
fainting condition to the house of a friend, where she re-
mained in great suffering for two days. On the 13th I
was called to see her, at her house in the country, where
she had been removed the day before, on a mattress, b)-
train and private carriage. Her countenance indicated
extreme prostration. There was pelvic pain with tym-
panites, coldness of the extremities, nausea, and suppres-
sion of the urine. The vagina was cool, but the specu-
lum showed recent erosion of the os, as did the upper
part of the vagina, and the vulva was inflamed from an
acrid discharge, the result of the maltreatment of the 9th.
Her underclothing on the evening of that day bore un-
mistakable stains of the caustic fluid. In the hypogastric
region I discovered a tumor of considerable size, which I
was assured had never been noticed until the Friday
night previous.
Not to impose ui^on you the long description of sub-
sequent symptoms and treatment, I hasten to say that,
absorption not having occurred by August 20th, I felt
called upon to evacuate the contents of the tumor, for
fear of abscess and septic poisoning, the patient continu-
ing in a low condition. Great difficulty occurred in
selecting a proper point for incision, much cellular tissue
remaining between the vagina and tumor. The opera-
tion was deferred for a few days.
August 20th a discharge of about sixteen ounces of
fetid matter escaped from the vagina. The tumor be-
came greatly reduced and gradually disappeared. The
patient shortly afterward was able to drive out, and in a
few weeks regained her usual health.
Very truly yours,
Geo. T. Welch, M.D.
Kkvport, N. J., May 21, 1885.
BARTHOLOVV VEHSUS wall IAN, AND ATRO-
• PIA VERSUS MORPHIA.
To THE Editor of The Medical Record.
Sir : You have had in your valuable journal some very
excellent pieces on " Medical Latin." Now it does seem
to be time for some one to say a word on Medical Arith-
metic. All your readers are, I suppose — I know they all
ought to be — interested in the antagonism of atropia vs.
morphia. This is a very important subject as well as a
very interesting one. Opium-poisoning is a very com-
mon cause of death, and in our civilization seems to be
getting more so. We are all deeply interested in the
antidotal powers of atropia, and in trying to fix some ap-
proximate ratio of the two poisons. With these feelings
I turned with avidity to Dr. Wallian's article in The
Record of May 5th, but was greatly disa|)pointed that so
excellent an article was so marred by mistakes in calcu-
lation. What dose did he give? He says he made a
solution of gr. j. to 3 ij., ^r\Agave "iTlxij., or ^^ gr. Now
it is plain that TTLxij. is ^„-, not -^^ gr. So, again, when he
finds it necessary to "double his dose," h& seems to
quadruple a dose already twice as large as he thought it
was. He doubled the strength of his solution, and then
doubled the quantity administered, making fV instead
of jij^. (See Medical Record, May 5, 1883, p. 487.)
This seems to be rather " mixed mathematics " His
worst cases seem to have gotten ^ gr. atropia to an-
tidote a dose of morphia estimated at not more, cer-
tainlv, than 4J gr., or about i of atropia to 8| morphia.
This^ so far from being less than Bartholow recommends,
is two and a half times as much, and is the largest relative
dose I have seen suggested. Bartholow says i to 20.
(See his admirable Cartwright Lecture, in The Medical
Record of November 27, 1880, p. 593.) Surely this sub-
ject is of enough importance to make a gentleman who
writes a piece otherwise so valuable a little more care-
ful with his fractions. Very respectfully,
Horace P. Lacy, M.D.
Smithville, Charlotte County, Va., May 22, 1883.
SUTURE CLAMP COAPTATION.
To the Editor of The Medical Record.
Sir : The note by Dr. Cipperly on " Suture Clamp
Coaptation" in to-day's Record suggests the following:
A case of instruments, made by Tiemann & Co., selected
by Dr. Keyes, and given to me Christmas, 1879, con-
tained a number of spring-clamps similar to those de-
scribed by Dr. Cipperly, and a detached handle by which
they could be easily and quickly applied.
Further, I have read, but do not remember when and
where, that in Central or South America the natives use
the nippers of large beetles for the same purpose. The
sides of the wound are held together, the beetle is made
to seize it transversely, and then the head of the insect
is cut off. The nippers retain their hold until removed.
While Dr. Cipperly must, I think, abandon the claim
to priority, he may well find satisfaction in the thought
that he has recognized a positive surgical need, and has
independently devised an efficient method of meeting it.
Very truly, L. A. S.
May 26, 1883.
^tnuij Itcius.
Official List of Changes of Stations and Ditties of Officers
of the Medical Department, United States Army, from
May 19, 18S3, to May 26, 1883.
Campbell, John, Lieutenant-Colonel and Surgeon.
Medical Director, Department of the South ; granted
leave of absence for one month, on surgeon's certificate
of disability. S. O. 50, par. 3, Department of the South,
May 21, 1883.
Burton, Henry G., Captain and Assistant Surgeon.
Now awaiting orders at St. Paul, Minn., assigned to tem-
porary duty at Fort A. Lincoln, D. T. S. O. 83, par. i.
Department of Dakota, May 15, 1883.
Porter, J. Y., Captain and Assistant Surgeon. As-
signed to duty at Fort Davis, Texas. S. O. 49, De-
partment of Texas, May 14, 1883.
Spencer, Wm. G., Captain and Assistant Surgeon.
Assigned to duty at Fort Hamilton, N. Y. H. S. O. 83,
par. 2, Department of the East, May 14, 1883.
GoRGAS, W. C, First Lieutenant and Assistant Sur-
geon. Granted leave of absence for one month. S. O.
51, par. 5, Department of Texas, May 17, 1883.
Hopkins, Wm. E., First Lieutenant and Assistant
Surgeon. Assigned to temporary duty at Whipple Bar-
racks, Arizona Territory. S. O. 44, par. 2, Depart-
ment of Arizona, May 14, 18S3.
Macauley, Carter N. B., First Lieutenant and As-
sistant Surgeon. Assigned to duty at Fort Bennett,
Dakota Territory. S. O. 83, par. 2, Department of
Dakota, May 15, 1883.
McCreery, George, First Lieutenant and Assistant
Surgeon. To report for duty to the commanding offi-
cer of troops in the field near San Bernardino Springs,
Arizona Territory. S. O. 44, par. i, Department of
.Vrizona, May 14, 1883.
6i6
THE MEDICAL RECORD.
[June 2, 1883.
Raymond, H. I., First Lieutenant and Assistant Sur-
geon. Relieved from duty with troops in tiie tield near
San Bernardino Springs, Arizona Territory, and ordered
to return to his proper station, Fort Apache, Arizona
Territory. S. O. 44, par. i. Department of Arizona,
May 14, 1883.
Wilson, George F., First Lieutenant and Assistant
Surgeon. Upon being relieved as Post Surgeon at Fort
Townsend, Washington Territory, assigned to duty at
Headquarters, Department of the Columbia. S. O. 64,
par. 2, Department of the Columbia, May 10, 1883.
Wilson, George F., First Lieutenant and Assistant
Surgeon. To report to First Lieutenant Frederick
Schwatka, Third Cavalry, for duty in connection with
explorations in the Department of the Columbia. S. O.
64, par. 3, Department of the Columbia, May 10, 1883.
hectical Stems.
Contagious Diseases — Weekly Statement. — Re-
port of cases and deaths from contagious diseases re-
ported to the Sanitary Burenu, Health Department, for
the two weeks ending May 29, 1883 :
.
^
■3
Week Ending
3
>
V
■0
0
V
>
c .
'5.-S
£■5
les.
theria.
a
>
V
Ix.
S
a
rt
Si.
a
F
0
H
H
W
U
s • a
Cfl
>
Cases.
J
May 22, 1883
4
4
128
8
170,41
0
0
May 29, 18S3
0
5
132
4
163' 39
0
0
Deatks.
May 22, 18S3
0
I
S2
7
27 14
0
0
May 29, 1883
2
4
30
6
25 , 19
°
0
The total mortality for the week ending May 19, 1883,
was 72S, of which 70 were from pneumonia.
Dr. Caroline S. Pease, a member of the Rensselaer
County Medical Society, has been appointed a member
of the staff of the Troy Hospital, Troy, N. Y., taking the
department of obstetrics and diseases of women and
children.
Following Great Names into Doubtful Things.
— The Christian Advocate of the 17th instant, in an edi-
torial under the above caption, after inveighing against
the misuse of great names in boosting up doubtful enter-
prises in stocks, manufactured goods, and speculations in
general, puts the case thus : " Take no medicine on the
testimony of the Rev. Father Open Mouth," who took
two bottles and found himself a new man, "or the mem-
ber of Congress who was extricated from the very jaws
of death." He that is looking for a leader will surely
find him. He who is willing to be deceived will not
wait Ipng. To follow saints when you doubt whether it
be right, is little better than to follow sinners when you
do not know that they are wrong. The wrecks of those
who have blindly followed great names into enterjjrises
doubtful as to their honesty, doubtful as to their financial
results, doubtful as to tlieir effect in re[)utation, are
l)robably as numerous as of those who have been swin-
dled by scoundrels, and fleeced by professional confi-
dence men.
The Nature of the Bite of the Leech has been
examined by M. Carlet. He detached the animal from
the shaved shin of a rabbit at different stages. Su|)pose
a scarifier, with three toothed and equidistant blades
withdrawing from one another while they press into the
skin, and operating several times successively in the same
place ; this gives a pretty exact idea of the mechanism.
Hygienic Value of Mirth. — But, aside from all
this, mirth has an hygienic value that can he hardly over-
rated while our social life remains what the slavery of
vices and dogmas has made it. Joy has been called the
sunshine of the heart, yet the same sun that calls forth
the flowers of a plant is also needed to expand its leaves
and ripen its fruits ; and without the stimulus of exhilar-
ating pastimes perfect bodily health is as impossible as
moral and mental vigor. .\nd, as sure as a succession
of uniform crops will exhaust the best soil, the daily repe-
tition of a monotonous occupation will wear out the best
man. Bodv and mind require an occasional change of
employment, or else a liberal supply of fertilizing recre-
ations, and this requirement is a factor whose omission
often foils the arithmetic of our political economists. To
the creatures of the wilderness affliction comes generally
in the form of impending danger — famine or persistent
persecution ; and under such circumstances the modifi-
cations of the vital process seem to operate against its
long continuance ; well-wishing nature sees her purpose
defeated, and the vital energy flags, the sap of life runs
to seed. On the same principle an existence of joyless
drudgery seems to drain the springs of health, even at an
age when they can draw upon the largest inner resources ;
hope, too, often baffled, at last withdraws her aid ; the
tongue may be attuned to canting hymns of consolation,
but the heart cannot be deceived, and with its sinking
pulse the strength of life ebbs away. Nine-tenths of our
cit)' children are literally starving for lack of recreation ;
not the means of life, but its object, civilization has de-
frauded them of; they feel a want which bread can only
aggravate, for only hunger helps them to forget the
miser}' of ennui. Their pallor is the sallow hue of a
cellar-plant ; they would be healthier if they were hap-
pier. I would undertake to cure a sickly child with fun
and rye-bread sooner than with tidbits and tedium. —
Popular Science Monthly.
The Free Clinic Mania. — A writer in the Neiu-
York MetUcal Journal "i-xyi, that in Buffalo, N. Y., there
are nine free dispensaries either under way or starting.
P'urther, he says : " Under the pretence of charity the
physicians thus seek to advertise their names to the pub-
lic, and jealousy has caused the dispensary mania to be-
come epidemic, no one wishing to be outdone by another
in the scramble for a vast acquaintance."
An Old Practice Adhered to. — .\t the recent
meeting of the Louisiana State Medical Society the fol-
lowing resolution, which needs no comment at our hands,,
was adopted. There seems to be a new and original
school of virus attenuators in that State :
" Whereas, This society is informed that it is the prac-
tice of one or more practitioners of medicine within the
limits of this State to inoculate human subjects with
lymph or pus taken from small-pox patients, previously
mixing it with milk or cream ; therefore be it
" Resolved, That the practice of inoculating small-
pox by mixing any product whatever from the body of a
small-i)ox patient with milk, cream, butter, or any fluid
obtained from the cow, is productive of no modification
beyond that of direct inoculation from one person to-
another. It does not dejirive the person thus inoculated
of that power to communicate the disease through the
atmosphere, which naturally small-pox possesses, and is.
therefore dangerous to public health.'
Left-Side Pain. — At a recent meeting of the Acad-
emy of .Medicine, in Ireland, Dr. Wallace Beatty read a
paper on this subject (Medical Press and Circular). He
considers the pain, in many instances, due to fecal accu-
mulation, and it can be removed by getting rid of the ac-
cumulation. The pain is felt over the lower few ribs on
the left side, associated with great pain on U|)ward pres-
sure of these ribs, but no pain on downward pressure.
He ascribes the pain to the dragging of a loaded colon on
the pleuro-colic ligament, setting up extreme irritability
of the nerves.
The Medical Record
A Weekly Journal of Medicine and Snrgery
Vol. 23, No. 23
New York, June 9, 1883
Whole No. 657
©rigiuaX Jtvticlcs.
FILTH DISEASES IN RURAL DISTRICTS.
By ALFRED L. CARROLL, M.D.,
NF.W bRlGHTON, N. Y.
An editorial comment in The Medical Record of April
14th, upon a paper by Dr. Hamilton, of Philadelphia,
may serve as an apology for some remarks on a subject
which ordinarily seems to possess scarcely more interest
for practising physicians than for "practical" laymen;
both being wont to lay the finger of incredulity against
the nose of scorn when they turn their deafest ears to
the voice of the sanitarian. In the present very unsettled
condition of professional opinion as to the diagnosis of
typhoid fever — passably good authorities in India, on
Western mountain peaks, and even nearer home, differ-
ing widely thereanent — I shall not attempt here to dis-
cuss its etiology, or to single out for reprobation any par-
ticular one of the several kinds of bacteria which have
been respectively described as its exclusive cause. Suf
fice it merely to hint that tiiere may be a possible source
of error in statistical arguments touching its relative fre-
quency in town or country. But, waiving this, I am not
aware that "professed sanitarians" have ascribed to
" sewer-gas " alone such pre-eminence over other vehi-
cles of filth or fungi as the article in question imputes.
On the contrary, I believe that the majority of cases of
enteric fever which have been traced accurately to their
origin have been traced to other and more tangible con-
taminations of food or water. Nevertheless there is
strong evidence, which has stood the test of much cross
e.\amination, that the so-called " filth diseases " deserve
their name in this respect : that, whatever be the spe-
cific tertium quid which determines their occurrence in
the individual, filth-poisoning (i.<'., the imbibition, through
some channel, of the products of organic decomposition)
is an essential factor in their genesis.
The first source of fallacy in the arguments referred to
lies in the misinterpretation of the term "sewer-gas,"
connecting it with sewers in particular instead of wiili
sewage in general. Thus, I find it stated that typhoid is
"more prevalent in the suburbs and surrounding countiy
than in the cities subjected to the contamination of
sewer-gas " ; that diphtheria and scarlatina occur most
fatally "in the country, where sewer-gas is wanting";
and that in Philadelphia the extension of the sewerage
system into the rural sections has diminished the sickness
from fever. Now, the facts on which most sanitarians lay
great stress are, that unsewered rural districts are more ex-
posed to danger from fermenting filth than cities ; that the
ineffable atrocities of leaching cesspools and privy-vaults
(those perversions of barbarism to which the American
rustic clings as to his most precious birthright) do infi-
nitely more to poison air, and soil, and water than all the
blunders of city engineers and plumbers combined ; and
that, granting the worst that can be said of some city
sewers which shall be nameless, even a bad sewer is
better than none at all — which is merely equivalent to
saying that it is better to carry away as much of one's
sewage as possible than to keep the whole of it on the
premises to decompose under one's nose. And the peril
from this fount and origin of evil is augmented a hundred-
fold where the mania for "modern improvements " has
invaded rural households. Long before sewers are
thought of — even before the importation of the agonizing
pianoforte — the suburban housewife insists on having a
bath-room, including that sum and substance of vileness, a
pan water-closet, on the bedchamber floor, and a kitchen
sink and " stationary tubs" down-stairs ; and these fix-
tures, conmionly constructed in the cheapest and nastiest
manner, are connected with an unventilated cesspool,
serving as so many inlets to insure the constant pollution
of the house atmosphere with the gases of decomiwsition.
Then, in an uncemented basement a " portable furnace"
is arranged to transport to the uiiper rooms, not only the
cellar-air, but the freely indrawn " ground atmosphere,"
laden with noxious vapors from the soil-soakage of
cesspools or privies. It is not saying too much to affirm
that for every one channel of filth-poisoning in a paved
and sewered city there are at least three in the average
village settlement, and if the evidence of insanitary con-
ditions be found in " not more than one house out of
five," it is because, unfortunately, very few physicians in
this country have cared to learn how to look for it— fa-
miliarity with the doses of drugs and the results of dis-
ease being regarded in most of our medical schools as
vastly more important than rerum cognoscere causas.
I am not sufficiently informed of the morbility statis-
tics of African cities to appreciate the full weight of
reasonings based upon their alleged comparative salu-
brity ; the occasional scattered returns which I have
seen from a few of them show death-rates ranging from
30 to over 40 per 1,000. But I am free to admit, on
general principles, that it is less dangerous to let organic
matter decompose fully exposed to atmospheric oxygen
than to store it in unventilated receptacles to form sul-
phuretted and carburetted compounds, or to saturate an
undrained soil with it. It is to be remembered that few,
if any, sewage substances are suspected of pathogenic
power while in their fresh solid or liquid state ; the pro-
ducts of their subsequent chemical changes are what we
have to fear ; and if these products be liberated al fresco
as fast as they are formed, they are diluted to homoeo-
pathic insignificance by the surrounding air. Of the two
evils, therefore, the Africo-Hibernian practice of throw-
ing house-refuse promiscuously upon the surface is pre-
ferable to the American village method of fostering and
festering it in cumulative concentration.
As regards the allegation that " the young men at
work in the fields were more frequently attacked (by
typhoid fever) than the females, who were generally en-
gaged in domestic duties in or about the house," it
may be observed : First, that agricultural laborers do
not spend all their time in the fields, but sleep in rooms
from which, as a class, they carefully exclude all venti-
lation ; second, that, for some unexplained reason, en-
teric fever seems to have a selective affinity for robust
young males. It is an affair of common observation
that, under apparently precisely similar conditions, fra-
gile women may resist the infection to which strong men
succumb.
Facts, however, are more forcible than words, and I
therefore subjoin a few examples of coincidences which
have very much the air of causes and consequences. I
have excluded instances where water-pollution could be
supposed to bear a part, and also those where careful
inquiry did not seem to eliminate the possibility of im-
mediate or mediate importation of contagium from a
pre-existing case. And let me, at the outset, deprecate
the Liebermeisteriaii criticism that if an adynamic fever
6i8
THE MEDICAL RECORD.
[June 9, 1883.
with peculiar temperature-curve, abdominal symptoms,
etc., be not directly traceable to a j^receding patient, it
is not true typhoid, but only something otherwise indis-
tinguishable from it; or that, without evidence of con-
tagion, a pseudo-membranous angina with grave consti-
tutional depression is not genuine diphtheria, though a
remarkably good imitation of the real article. (Irant
only that there are diseases — call them what you will —
which closely resemble the regulation nosological types,
that people sometimes die of them, and that they are in-
timately associated with the eating, drinking, or breath-
ing of filth-products, and I shall, for the present, leave
the c[uestion of diagnosis to be begged by whomsoever
cares for it.
I. Typhoid. — Large country house with numerous
"conveniences." Two " jian closets" on second floor ;
one in a small windowless hall-apartment, the other in a
bath-room adjoining a bed-chamber ; basin and bath-
wastes led into trap of water-closet ; leaden soil-pipe not
continued above the line of fixtures, communicating di-
rectly with cesspool, and badly corroded at bends of
closet-traps. Servants' pan-closet in basement with foul
and leaky " retainer " ; kitchen and laundry wastes on
same horizontal branch, constantly liable to siphonage.
Frequent illnesses of minor grade prevailed in this house-
hold until the whole plumbing system was reconstructed
on a proper plan, since when the inmates have enjoved
excellent health.
II. Typhoid. — Small house in village street. Under
the cellar runs the ill-covered channel of a former brook,
which receives the sewage of several adjoining tene-
ments. The house-refuse is discharged into this foul
trench through an open untrapped conduit in the base-
ment.
III. Typhoid. — Cottage of better class. No plumbing
fixtures except kitchen sink, which discharges untrapped
into an obstructed and very foul drain ; leaching privy-pit
on higher ground than the basement, which, with tiie
foundation walls, is uncemented, affording ingress to
ground-atmosphere.
IV. Diphtheria. — Elegant mansion, regarded by owner
and "practical plumber" as a model of sanitary con-
struction. Soil-pipe extended above roof, but without
ventilation at its foot. Materials and workmanship good.
On a lateral branch was a down-stairs water-closet into
the trap of which the kitchen waste discharged, and into
the dip of the running-trap of this horizontal soil-pipe,
in the basement, and within a few feet of the furnace,
was inserted a servants' hopper-closet without any flush-
ing fixture ; excremental matter being, of course, thus
retained in the trap a great part of the time, and its de-
composition favored by the admixture of hot water from
the kitchen. When the water from the boiler was set
running, the steam arose freely from this hopper.
V. Diphtheria. — Handsome country-seat. Plumbing
work recently overhauled and declared perfect by the
plumber. Three foul pan-closets, and numerous other
"conveniences," all leading to unventilated cesspool.
In the bedroom occupied by the patient the " safe-waste "
from a stationary basin was carried mto the soil-pipe,
constituting a direct inlet from the cesspool.
VI. Diphtheria. — Presumably " first class " residence.
Kitchen and laundry wastes carried from basement into
privy vault, which was filled to above the level of the
pipes.
VII. Typhoid 1 (two irregular cases). — Cottage in good
neighborhood. Hath and basin wastes discharging into
trap of foul pan-closet with " putty-joints." Two-inch
tin pipe inserted, with leaky slip-joint, into bend of water-
closet trap, and carried with several angles to roof; no
other ventflation of soil-pipe, which connects with leach-
ing cess-pool. Cellar riddled with rat-burrows (indicat-
ing ])robable connection with some old drain), and air-
box of furnace made of loosely jointed boards, so as to
convey the cellar-air to upper part of house.
VIII. 'Typhoid/ (continued fever). Cottage on high
groimd. Offensive pan-closet on bedroom floor. Soil-
pipe relieved by angular galvanized vent, but carried
without other ventilation or trapping to .cesspool on
lower ground. Kitchen and laundry wastes untrapped
and led to a row of buried barrels which were filled with
a most malodorous mess, the water being allowed to soak
into the soil as best it might.
IX. Diphtheria.- — House without plumbing fixtures.
Cellar loosely paved with bricks, and saturated with soak-
age from several privy-vaults on much higher ground and
close in the rear ; the fajcal-smelling semi-liquid filth
actually oozing up between the bricks when they were
stepped upon.
X. Diphtheria. — Cottage alleged by the owner, and
innocently believed by the tenant, to be " one of the
best-plumbed houses in the county." Pan-closet in a
decadent and offensive condition, with untrapped bath
waste and insufficiently trapped basin waste led into its
seal. Short vent from bend of closet-trap to outside of
wall, with orifice closed during winter " to prevent water-
pipes from freezing '' ; soil-pipe thus without ventilation
at top or bottom. Butler's pantry-sink connected by
tin pipe with earthenware drain, which was badly laid and
composed of different sized pipes. Some distance beyond
the junction of the soil-pipe and wastes, this drain was
tapped by a " ventilating " pipe carried into a chimney
flue, with an occasional down-draught. Kitchen waste
opening directly into an unventilated cesspool. All
lead pipes of poorest quality.
XI. Diphtiieria. — Country farm-house. No plumbing.
Uncemented cellar ; living-room in wing buUt directly
upon the earth. Overflowing privy-vault within twenty
feet and on higher ground, the soakage and surface-
washing from which had permeated the soil around and
under the building.
XII. Diphtheria. — Large and handsome house. Sani-
tary arrangements satisfactory to plumber. Pan-closet
with insuflicient flush. Two-inch tin vent from bend of
soil-pipe carried with various angles into cold chimnev-
flue. Running under the whole length of the basement
was an eight-inch earthenware drain, receiving the soil-
pipe and the wastes from different fixtures ; its large
calibre and slight grade precluded projier flushing, and it
was thickly coated with refuse and chilled grease. Into
its upper end was inserted the overflow from a tightly
covered cistern, so that the only ventilation of the entire
house-drainage system was through the rain-water leader,
close to a " mansard " bedroom window.
XIII. Typhoid/ — Two small houses of the poorer
class, situated on a road at the foot of a steep declivitj'.
No plumbing. Two priv)'-vaults, a pig-pen, and an in-
describably filthy cow-stable just behind and above them,
from which the washings were traceable into their cel-
lars.
I could extend the list by- scores of illustrations of
rural house-defects : soil-pipes disjointed from their out-
let drains and discharging their sewage under basement
floors; cesspools " backing-up " into kitchen sinks or
laundry tubs, or pouring a reflux tide through " over-
flow" pi|)es into drinking-water cisterns ; ingenious devices
of every sort to deprive the gases from pent-up filth of
any escape save into the dwelling, ."^nd these among
the "wealthier residents, " whose surroundings are com-
monly supposed to be above suspicion. As regards the
unplunibed poor, their chances of inhaling filth-polluted
air or imbibing filth-contaminated water are often en-
hanced by inadequate cubic space and faulty construc-
tion within doors, and ignorant neglect of the very rudi-
ments of hygiene in the environment; their cellars and
wells being sunk in soil saturated with putrescent refuse.
In the intermediate agricultural or mechanic class simi-
lar conditions frequently exist, their potency for evil
depending chiefly upon the porous or retentive character
of the soil ; precautions to exclude the ground atmo-
sphere from cellars or basements are seldom found ;
cesspools and privy-vaults are close at hand ; and it is
June 9, 1883.]
THE MEDICAL RECORD.
619
a common thing for a couple of adults and two or
three children to sleep in a " stuffy" unventilated room
with not more than 1,000 or 1,500 cubic feet among
them.
From a sanitary point of view it matters little whether
the gases from decomposing sewage escape from sodden
soil or from a foul sewer ; their nature is alike in either
case, and the aggregate dose may be even larger in the
former instance. But when, and why, and how, they, or
any of them, exert their most deleterious influences, are
questions wliich it is impossible to answer in the present
state of our knowledge. It is an indisputable fact that
people may for a long while be exposed to them without
pronounced manifestations of " filth disease," — altliough
such people, in my experience, are seldom thoroughly
well, even if not specifically ill. But sooner or later an
apparent qualitative change may take place and an acute
zymosis declare itself. I have elsewhere suggested the
part that may be borne in this complicated problem by
a " personal factor," or temporarily altered individual
susceptibility ; ' but it seems necessary also to assume
an alteration in the external conditions ; and such alter-
ation is explained by many etiologists on the hypothesis
of the importation or evolution of specific pathogenic
micro-organisms. That certain varieties of schizophytes
are associated with some of the acute infections is beyond
doubt ; that in a few, such " microdemes " are the con-
veyors," if not the causes, of the infection seems proven ;
but it nnist be remembered that in the diseases chiefly
under consideration no characteristic bacteroidal forms
have been defined. In typhoid fever, Klebs describes a
bacillus where Letzerich finds only micrococci ; accord-
ing to Wood and Formad, the micrococcus of diphtheria
is just like that of the ordinary buccal mucus ; indeed,
nearly all of the acutest infectious diseases are attributed
to these ubiquitous micrococci, indistmguishable from each
other in most instances, and divided into species solely
on the score of their assumed physiological effects. Ad-
mitting all that the most ardent advocates of the germ
theory can claim for it, there are at least three possible
ways in whicii filth and fungi may be connected :
1. Taking the view of Naegeli and others as regards
the mutability of the bacteria, it is conceivable that the
common " scavenger " microphytes may acquire patho-
genic properties by successive generations of develop-
ment amid the products of certain decomposing substan-
ces. In favor of this conception may be cited the
seemingly gradual intensification of " filth-poisoning" in
numerous instances ; sore throats of a less septic type
forerunning outbreaks of diphtheria ; diarrhceal derange-
ments preceding enteric fever ; and, farthermore, Koch
has found both bacillus-spores and micrococci in surface-
soils, the latter organisms preponderating where the
earth is subjected to excremental soakage.
2 . Or, accepting the specific classification of the schizo-
mycetes, it may be supposed that some pathogenic germs
obtain favorable intermediate conditions for their de-
velopment and multiplication in these products of
decomposition ; a supposition almost necessary if the
specific-germ theory be applied to enteric or choleraic
discharges.
3. Finally, if it be conceded that desiccated spores
may retain their specific vitality indefinitely, and be air-
wafted almost unboundedly, the predisposing action of
our filth emanations may be imagined to be cumulative,
slowly undermining the individual powers of resistance,
or rendering certain cell-groups an easier prey to the
intruding organisms in the struggle for existence.
Which of these hypotheses, if either of them, will ulti-
mately prevail, is a question only to be decided by ex-
perimental investigations which are beset by a multitude
of difficulties and sources of error.
J Trans. Am. Med. Ass'n., 1880.
2 In fcetal syphilis it is assumed that the spermatozoa may be the carriers of the
disease ; but no microscopist has yet described'a separate species of spermatozoon
for such cases.
"A NOVEL MODE OF CLEANSING THE VAULT
OF THE PHARYNX."
By JOHN O. ROP:, M.D.,
ROCHESTER. N. V.
In the issue of The Medical Record for April 28,
1883, Dr. G. Fairfax Whitney reported a case whicli
came under his observation in his clinic at the New
York Post-Graduate Medical School,, in which the i'»a-
tient employed the tip of his tongue for removing lumps
of hardened mucus from the upiier part and vault of the
pharynx.
These cases must be quite rare, or this physiological
peculiarity would have been mentioned in medical liter-
ature long before this.
Dr. Whiting remarks that his case is, he believes, the
only one of the kind reported. .As this peculiarity is a
rather interesting one, I will add the report of a similar
case, which came under my observation about thirteen
months ago.
H. W , a bookkeeper, aged twenty-five, consulted
me April 15, 1882, in regard to a nasal and throat trou-
ble which had annoyed him very much during the previ-
ous year. He had had some nasal catarrh for about
twelve years, but it was only during the last year of this
time that it had become aggravated. It was attended
by considerable mucus discharge from the anterior nares,
and in the posterior nares and vault of pharynx the
mucus became dried down in the form of crusts, which
he was in the habit of removing w^ith the tip of his
tongue. He also had considerable irritation about the
larynx, attended with cough, and a constant tendency to
clear the throat by hawking. Expectoration was slight,
consisting mainly of tenacious mucus.
He was seldom hoarse, and only when his nasal
trouble was aggravated by any cause. His general
health was poor, and he had become weak and debili-
tated.
Examination revealed a chronic rhinitis with some
thickening of the inferior turbinated tissue. There was
also some adenoid hypertrophy in vault. This he could
plainly detect with his tongue, and also several holes or
depressions in it which were plainly visible in the rhino-
scopic mirror.
As his nostrils were narrowed by thickened turbinated
tissue, I could not plainly observe through the nostrils
the tip of the tongue when in the vault of the jsharynx,
as Dr. Whiting could in his case ; but my patient would
move with his tongue a probe, if inserted through the
nostrils to their posterior opening, and if it were pushed
back further, he could throw it forward nearly out of the
nostrils. By looking into his mouth when he performed
this feat, his tongue could be seen to pass up behind the ,
palate, and to bury itself almost out of sight behind the
vail.
In this case there was nothing abnormal to be seen
about the tongue or fauces. The space between the
velum palati and the vertebral column was not unusually
large, and the fr«num lingute was well marked, though
a little longer and more lax than is usual. His tongue
was quite long and rather slender ; the only peculiarity
to be especially observed was the great voluntary muscu-
lar control which he had over its movements, being able
to place it in any conceivable position in the mouth,
fauces, and naso-pharynx.
Aborting Hordeolum. — Dr. J. P. McGee {Medical
and Surgical Reporter) claims good results from the
following in hordeolum when used within the first six
to twelve hours: I^. Ex. fl. belladonna, gtt. iij.; aqure
pluv. 3 ij. M. Sig. — .A teaspoonful every hour. At the
same time calcium sulphide should be given one-eighth
or one-tenth grain every hour, for five or six doses, then
every three. The belladonna is often sufficient alone.
620
THE MEDICAL RECORD.
[June 9. 1883.
THE ARSENITE OF BROMINE AND ITS USE
IN THE TREATMENT OF DIABETES MEL-
LITUS.'
By R. H. GILLIFORD, M.D.,
ALLEGHENY, PA.
In the early part of December, 1882, I began some ex-
periments with bromine and arsenious acid, the results
of which have, in part, been corroborated by experi-
ments performed .at my request by a practical chemist.
As I can find no account, in any works on chemistry, of
a compound or salt formed by the union of bromine and
arsenious acid, I submit my results or views with diffi-
dence, and will welcome either correction or confirma-
tion.
I find that bromine and arsenious acid will unite under
certain favoring conditions, in the proportions of two
hundred and forty parts by weight of bromine to ninety-
nine parts by weight of arsenious aqid. When they are
perfectly united, or arsenious acid completely dissolved
by the bromine, they form an oily liquid, soluble in wa-
ter and alcohol without any apparent reaction. They
unite very slowly, and sometimes seem for many days as
if no union was taking place when merely agitated in
contact with each other. When united without the addi-
tion of water they form a salt which consists of three
equivalentsof bromine and one equivalent of arsenious
acid, and would be represented by .'\sO,3Br.
When water is added before the bromine is united
completely with the arsenious acid, or when bromine
and arsenious acid are brought together in the presence
ot water, there takes place an immediate and rapid reac-
tion with the evolution of considerable heat. Evidently
the water is decom|)osed, and hydrobromic and arsenic
acids are formed, and the result is a solution of the
two acids with a little free bromine in the excess of
water.
The solution used in the appended cases was made by
the complete union of the arsenious acid and bromine
before the addition of water, and from observation I be-
lieve it to be much less irritating to the stomach than a
solution of the hydrobromic and arsenic acids.
As I have seen no account of any compound of bro-
mine and arsenious acid in any medical works or jour-
nals, I have concluded that I have been the first, in tliis
country at least, to make and prescribe arsenite of bro-
mine.
Dr. Theodore Clemens, of Frankfort, Germany, has
been using some compound of bromine and arsenic in
the treatment of diabetes, and has reported great benefit
from its use.
The medical journals have called his remedy bromide
of arsenic, but from the known properties of bromide of
arsenic it seems much more probable that the article he
uses is either arsenite of bromine, or a solution of the
hydrobromic and arsenic acids.
I have made a solution of arsenite of bromine, and
used it in a number of cases, and furnished it to several
physicians, who have prescribed it and reported to me
its ettects in the treatment of diabetes mellitus.
While the notes of some cases are incomplete in many
important points, yet its use has been followed by the
most marked benefit in every case in which it has been
prescribed so far.
Some of the cases seem to have made a com])lete re-
covery, others seem to be progressing steadily toward a
complete recovery. Dr. C. Emmerling, of Penn .Ave-
nue, Pittsburg, has treated two cases of diabetes melli-
tus with my solution.
The first case, a male, aged thirty years, was benefited
so much that in two weeks' treatment he had got rid of
all the distressing symptoms of the disease ; the specific
gravity of the urine falling from 1036 to 1029, and the
quantity of urine being decreased to less than one-half that
* Read before a meeting of the Allegheny Countj* Medical Socicr\-, at Pittsburc.
Pa., May 15, 1883. ,
passed at the beginning of the use of the remedy. The
patient being of dissipated habits, disappeared from the
doctor's observation.
Dr. Emmerling' s other patient met with the same
marked and immediate improvement following the use of
the remedy. He was forty-seven years of age, a saloon-
keeper by occupation, a very large man, and a very
heavy eater and drinker. The quantity of urine passed
was enormous. Dr. Emmerling reports that he seems
to be getting well. The specific gra\ity of the urine has
been reduced from 1036 to 1028, and the quantity of
urine passed has been reduced to from four to four and
one-half pints in twenty-four hours, after one month's
treatment.
Dr. A. D. Johnston, of Sedgwick Street, Allegheny,
furnishes the following notes of a case treated by him :
" Weston Hall, aged nineteen years, laborer in steel
works, called March 19, 1883, for treatment, and stated
as follows: About January i, 1883, he was carrying one
end of a steel axle, and the man at the other end allowed
his end to fall ; the jar or shock was so severe as to unfit
him for work for several days. Shortly after the accident
he noticed an increase in the flow of his urine. The flow
increased until, March 20th, he was passing three gallons
of urine in twenty-four hours, of acid reaction and specific
gravity of 1035. His thirst was constant. He could
not eat enough to satisfy the cravings of hunger, and is
very much emaciated and very weak. Tests for grape
sugar in the urine show not less than twenty-five grains
of sugar to the fluid ounce, estimated by the fermentation
test.
"March 22d. — A solution of arsenite of bromine was
procured from Dr. Crilliford, and two drops ordered to
be taken four times daily.
"March 25th. — Improvement marked as regards the
quantity of urine passed ; thirst not nearly so excessive ;
feels better after eating ; feels stronger ; spasms of the
calves of the legs disappearing ; specific gravity of the
urine 1030 ; can lie until nearly morning, whereas for-
merly he was compelled to rise at least three times during
the night to void urine. Dose increased to four drops
four times a day.
" March 29th. — The patient is able to lie all night with-
out rising to urinate. The improvement in strength and
general health very marked.
"April 17th. — The patient thinks himself well. His
gain in flesh is very noticeable. Urine passed in twenty-
four hours, eighty fluid ounces, specific gravity 1020, acid
reaction. Fehling's test shows no sugar in the urine.
The patient leaves for Clarion County in a few days, to
go to work, promising to write weekly and keep a record
of the amount of urine passed."
Dr. J. B. Johnston, of 25 Pennsylvania Avenue, Alle-
gheny, Pa., furnishes the following notes : " On April 16,
1883, I was called to see a boy, aged sixteen years and
five months. I found him very much emaciated, but
complaining of nothing in particular, only that his thirst
was insatiable and he was ravenously hungry, as he said.
He said his fauces and throat were very dry and parched.
I examined his tongue and found it red and fissured.
From the symptoms I concluded he had diabetes ; he
was passing from a gallon to a gallon and one-half in
twenty-four hours of limpid urine. I immediately made
the tests for saccharine urine, and found it to contain
sugar in very decided quantity. Moore's, Tromer's, and
the yeast test, all verifying each other, I put him on the
usual treatment of cutting off the non-nitrogenous sup-
plies, and fed him mostly upon meats, animal broths,
vegetable soups, fresh fish, etc., including cabbage and
turnips. The specific gravity, when I first saw him, was
1038. I found it to vary in density from 1035 to 1040.
I tried the different modes of treatment usually resorted
to, but must say I found little or no improvement in the
case. I found the best results in the first part of the
treatment from tinct. ferri mur., given in fifteen-drop
doses half an hour after meals, in a wineglassful of water.
June 9, 1883.]
JTHE MEDICAL RECORD.
621
During the times he was taking the iron the thirst was
not so distressing nor was the appetite so voracious, but
the urine was nearly if not iitiite as copious, and the
specific gravity remained high.
During tlie time the iron was being given there was
passed on April 27th, 132 ounces of urine ; April jSth,
130 ounces; April 29th, 129 ounces; April 30th, 127
ounces; May ist, 131 ounces; May 2d, 129 ounces;
May 3d, 126 ounces. During this time the specific
gravity varied a little, from 1036 to 1038. On May
4th I began giving four drops of arsenite of bro-
mine (my attention having been called to it by Dr. R.
H. Gilliford) largely diluted with water, half an hour af-
ter each meal. On the 5th the ([uantity of uruie, to my
surprise, had fallen to iio^V fluid ounces. On the 6th to
100 ounces, with specific gravity of 1034. On the 7th I
again examined the density of the urine and found it
1032, with a still decreased quantity, 98 ounces. May
8th, I did not take the specific gravity, but found 94
ounces of urine. Patient is sleeping well at night and
says he does not need to get up so often to urinate.
May 9th, specific gravity 1032, and 94 ounces of urine,
same as on the 8th, but he confessed to indiscretions in
his diet. May loth, specific gravity 103 1, with 92
ounces of urine. Thinking the dose of the arsenite
might be safely increased, I began on the 9th to give
five drops instead of four. May nth, si)ecific gravity
1030, with 89 ounces. May 12th, specific gravity 1030,
with 87 ounces. May 13th, I did not take the specific
gravity nor quantity. May 14th, examined both quantity
and quality of urine. Specific gravity has fallen to 1029,
and the quantity is 85 ounces. The symptoms of the
patient are not by any means so urgent as in the begin-
ning of the treatment. Thirst diminished, appetite less
craving, diminished quantity of urine from 132 ounces
to 85 ounces, specific gravity diminished from 1038 to
1029. There is one thing to be observed, that there has
been a constant decrease in the quantity and specific
gravity of the urine, though it has not been regular ; but
when we see that the remedy has been in use only since
May 4th (ten days), we cannot but look upon the
case with much hope. What the subsequent condition
of the patient may be cannot yet be known.
A CASE OF CENTRAL SCOTOMA WITH DE-
RAiNGEMENT OF COLOR PERCEPTION
Cured by the Hypodermic Use of Nitrate of
Strychnia.
By DAVID WEBSTER, M.D.,
PROFESSOR OF OPHTHALMOLOGY IN THE NEW YORK POLYCLINIC.
The patient, a married lady, twenty-seven years of age,
consulted Dr. C. R. Agnew and myself on March 21,
1876. She said she had had no trouble with her eyes
since childhood until suddenly, one morning about a week
previously, she discovered that she was nearly blind in
her right eye. There was no pain in or about the eye,
and she was led to test the vision of each eye separately
only by noticing some peculiarity in her vision. She im-
mediately consulted her family physician, Dr. Ely, of
Newburg, who, being at a loss to account for the defect
in sight, referred her to us for examination and advice.
Upon applying the usual tests we found that the left
eye had vision \%, and seemed to be normal. In the
right visual field was a large central scotoma, which
gradually shaded off into the periphery of the field with-
out any distinct or well-marked boundary. The patient
managed to read -^§^ with the right eye by dodging her
head about and catching the letters eccentrically. Tested
with the colored worsteds, she called blue a " dark gray,"
or "black." Green she called " black," or a " dark shade
of brown." She recognized red. She called yellow
" brown," but saw that it was yellow when placed in the
extreme nasal portion of the field.
She was confined in June, 1875, and it was remarked
that her eyes were unusually strong. She would not
have the room darkened, but abstained from reading for
a long time, at least six weeks.
On the Sunday preceding the Wednesday in the morn-
ing of which she discovered impaired vision, she was
" overcome by heat " in church, went out, and was seized
with a spasm of the throat. For years her friends have
remarked that she was in the habit of keeping her right
eye closed when out riding or walking.
Oplithalmoscopic examination showed no gross lesion,
but there was a faint opacity of the posterior capsule of
the right crystalline lens. The optic ilisk seemed a little
too pale, and the retinal arteries were apjiarently slightly
reduced in size.
She returned to Dr. Ely with a letter recommending
the daily hypodermic use of nitrate of strychnia, begin-
ning with a small dose, and cautiously increasing the
quantity day by day until the jihysiological effects of the
drug should be reached.
She made two subsequent visits to the office. On
April 5fh her sight had risen to j^ (-i-), having in-
creased more than seven hundred per centum in fifteen
days. On April 22d it was noted that the dose of nitrate
of strychnia injected had reached one-seventh of a grain
without producing any of the unpleasant constitutional
effects of the remedy.
On April 30, 1883, her husband called upon us and
concluded the history. He said that the hypodermic in-
jections of strychnia were continued for a short time
after her last visit, and resulted in perfect recovery of
vision, which remained good until her death, which oc-
curred in 1880, and which was caused by an attack of
cerebro-spinal meningitis.
OPIUM ADDICTION AMON(r MEDICAL MEN.
By J. B. MATTISON, M.D.,
BROOKLYN, N. V.
It was the writer's pleasure, some time ago, to dismiss
from his professional care, within about a week of each
other, six medical gentlemen, all recovered after addic-
tion to morphia, hypodermically, varying from eight
months to ten years.
This somewhat unusual occurrence, with the fact tiiat
the majority of his patients have been, are, and probably
will be, members of the profession, and the statement
elsewhere made that physicians form a large proportion
of opium habitues in general, and the great majority of
any professional class, make pertinent the title of ihis
paper and warrant his inviting your attention for a brief
time to a topic in which perchance some of you may
have a personal and painful interest.
A recent Austrian author writes : " Quite an incredi-
ble number of our colleagues have fallen victims to it,
and many have only just escaped. If medical men are
charged, and it is to be feared, justly, with the propaga-
tion of this disease, owing to their carelessly, or for mere
convenience sake, leaving morphia and a subcutaneous
syringe with the patient, it may be regarded as tlieir
punishment that the demon morphinism finds among
them his favorite victims."
A Prussian writer who, in 1877, gave the profession a
valuable monograph on morphia addiction, cited sixteen
cases under his care, of which medical men formed
more than one-third, and a much larger proportion com-
pared with any professional class.
The records of the Inebriates' Home, at Fort Hamilton,
although that institution is mainly devoted to the treat-
ment of alcoholic habitues, show a majority of the pro-
fession among those who have sought relief from the
ravages of opium.
We have been informed, on the asserted authority of a
resident physician, that, in a certain New England city,
containing upward of one hundred medical men, between
thirty and forty are addicted to some form of oi)ium.
622
THE MEDICAL RECORD.
[June 9, 1883.
Much surprise has often been expressed, and the rea-
son asked why so many physicians apply for, or are in
need of, rehef So far as concerns the first query, and as
having a personal reference, we have always deemed it
due to the fact that our professional efforts being di-
rected specially to this work, and a knowledge of this
coming directly to the fraternity through the medium of
the medical press, those who desired our aid availed
themselves of the proflered service.
Another reason may be that the peculiar secretive
character of this disorder, the fear of publicity, induces
the most of non-professional victims to place themselves
under the care of charlatans, who find in this especial
quality a fertile field which they make haste to till to
their profit, and, very often, their patients' loss ; while
medical men, on the contrary, not so likely to be duped
by the specious promises of these pretenders, are less
frequently beguiled by their blandishments, but extend-
ing their confidence to those whose skill and experience
warrant, secure the aid which scientific treatment can
now surely afford. As to why so many opium habitues
are recruited from the ranks of our profession, it may be
said that the physician's calling involving, as it often
does, especial inroads on his mental and physical well-
being, exposes him more than any other to the various
influences which stand as factors in the etiology of this
disease.
Then, again, addiction, hypodermically, is likely to
prevail largely in medical circles, inasmuch as the very
nature of this method requires a more or less intimate
knowledge of morphia and the hypodermic syringe, which
the average layman does not possess.
Then, too, may not this very knowledge and the fre-
quent employment of this potent agent for evil as well as
good whi(;h the modern practice of medicine involves,
disarm fear of its ill-eftects, and make easy the occasional
taking, which so easily and so soon forges the fetters of
confirmed addiction ?
Obersteiner's remark as to the retributive justice of the
morphia Nemesis to those who, as he asserts, directly
assist in enlarging the ranks of the opium devotees, sug-
gests a topic worthy of no little reflection.
In reviewing the causes of opium addiction among
medical men, we find that in them, as in others, some
form of neurotic di.sorder, involving, as has been truly
said by your coming president, " a physical necessity,"
leads the list ; and, so far as our experience goes, the
most frequent has been that " opprobrium of medical
art " — as Flint styles it— periodical headache. Any form,
however, of persistently painful disturbance involves this
risk, and, apropos of this I'oint, the opinion of a medical
gentleman — who, some years ago, was under our care,
and who afterward gave to the profession a most graphic
recital of his experience — may be of interest.. "I pro-
claim it as my sincere belief that any physician afflicted
with neurotic disease of marked severity, and who has in
his possession a hypodermic syringe and Magendie's solu-
tion, is bound to become, sooner or later, if he tampers
at all with the potent and fascinating allevialive, an
opium habitue.
" The first dose is taken, and mark the transformation !
This overmastering palliative creates such a confident,
serene, and devil-may-care assurance that one does not
for once think of the final result. The sweetness of such
harmony can never give way to monoton)'. Volition is
suspended. You may not think of it when the pain for
which it was taken subsides. But when distress sui)er-
venes, you go at once for the only balm that abounds in
Gilead, and every additional dose is but another thread,
however invisible, of which the web is made that binds
us fast as fate."
Another special factor is the peculiar power that opium
possesses to give strength, bring sleej), and relieve por-
tendings incident to the anxious hours, the weary days,
and wakeful nights, such as the experience of every busy
practitioner so often involves. Again and again has this
been told us, and, pre-eminently true is it when — once
under the opiate spell — a self-eflfort is made to escape.
Scarcely a physician presents himself for our care who
does not assert that, time after time, he has made an at-
tempt in this direction, only to fincj that the demands of
his calling proved fatal to his success.
Still another cause is the spirit of ini-|uisitive research
which occasionally permits a professional man to allow
his zeal in the pursuit of knowledge to outrun his discre-
tion.
Incidentally we may note the assertion — doubtless
true — that the glamour of De Quincey's writings has
proved fatally attractive to more than one, and Ober-
steiner relates this instance : " A young medical man
gave the following account of his own case. While he
was attending the hospital a patient was dismissed, suf-
fering from carcinoma of the stomach, and wdio had been
for a long time treated with subcutaneous injections of
morphia. Next day the patient returned in a state of
great excitement, and piteously begged for an injection,
as otherwise he must die. This occurred in 1869, at a
time when chronic morphinism and its phenomena were
less known than now. As the physician was inclined to
believe that the patient was romancing, he tried the ex-
periment on himself to ascertain what the effects were.
The result was that he formed the habit of morphinism,
and never could overcome it."
He also cites another, of a medical man, aged thirty-
two, who gave as one reason for his addiction that, " be-
ing assistant at the Physiological laboratory, he saw in
himself an interesting subject of experiment."
A somewhat similar case has fallen under our own
observation. Dr. A , aged twenty-seven, was at-
tacked with facial neuralgia so severe as to compel his
taking one-fourth of a grain of morphia hypodermically,
at bedtime, to secure ease and sleep. This amount was
increased to one-half a grain per diem during the follow-
ing month, when, the neurotic disorder having subsided,
the opiate was abandoned, with little or no inconvenience.
Some time after this, a gentleman addicted to the use of
morphia placed himself under his care. Then Dr. A ,
as he asserts, without the least desire for opium, but
solely from a wish to discover, if possible, some antidotal
drug to aid him in the cure of his patient, began experi-
menting on himself with hypodermic morphia, with the
result of falling a victim to its seductive influence ; and
yet, though he failed to make the wished-for discovery,
managed the case of his friend so well that success
crowned his effort, while he, despite every endeavor, was
unable to extricate himself from the pit into which he
had unwittingly fallen, and was compelled to seek aid
for his relief Unlike Obersteiner's patient, he made a
very gratifying recovery, and is to-day well.
The subtl}' ensnaring pow-er of opium is simply incred-
ible to one who has not had personal observation or ex-
perience. One of the finest specimens of physical man-
hood we ever saw, a physician, who survived the horrors
of Salisbury prison, when the death-rate averaged eighty
percent., fell a victim to morphia after only one month's
hypodermic using. Happily, he recovered, took the lec-
ture platform, and told of the bondage from which he
escaped.
It may seem to some of you like an alarmist's opinion,
yet we have no iiesitation in expressing our belief that
any physician using morphia, daily or oftener — especially
hypodermically — for four weeks, incurs great risk of be-
coming an habitue ; indeed, we think a still shorter usage
might, with some, prove a snare.
Having thus spoken of this peculiar peril, it might
seem fitting to suggest that which would tend to lessen
or avert it; but a proper limit to this paper precludes.
Of the gentlemen who honored us with their con-
fidence, some details may be of interest.
Dr. B , aged thirty-seven, six years' addiction.
Cause, asthma ; on admission was taking eight grains
per diem, and for several months he had also taken daily
June 9, 1883.]
THE MEDICAL RECORD.
623
ninety giams of chloral. The latter was at once vvith-
diawn, and to make amends for this sudden removal, his
daily taking of morphia was increased to twelve grains, so
that the chloral withdrawal caused no discomfort what-
ever, except slight mental depression the following day.
Sedative treatment was begun and the morphia with-
drawn in six days, with so little disturbance that the pa-
tient was up and about during the entire time, and after
the tinal habitual hypodermic of one-third of a grain, at-
tended a theatrical performance. Moderate restlessness
followed, but the reflex irritation in general was slight,
the most prominent being insomnia, which was unusually
marked and persistent, requning soporifics for several
weeks. Improvement, meantime, in other directions was
decided, and his case was dismissed, recovered, on the
forty-seventh day of his treatment, sleep having been
free from hypnotic the previous week.
A special point in the prognosis of this case, referred
to the return of his asthmatic trouble when the habitual
narcotic was abandoned. As a fact, nnich to our pleasure
and surprise, not a single paroxysm — save one of less
than half-hour duration, and so mild as to cause but lit-
tle discomfort — occurred up to the time of his leaving,
nor has there been any to date. This, to us, is an in-
teresting and important therapeutic feature, as suggest-
ing how much influence a prolonged narcotic condition
may have had in obliterating a neurotic siatus, the out-
come of which was his dyspnceic disorder.
It is known that in the treatment of obstinate sciatica,
Trousseau advocated opium in full and increasing doses
up to the point of entire relief from pain, and the main-
taining this semi-narcotized condition for weeks or
months, if required; and we have been told of a case
thus treated with success in the person of a near relative
of a well-known New York professor of thera|)eutics.
Stevenson, of I^ondon, himself.a victim of asthma, and
who has given us the latest work on the subject, asserts,
after long and varied personal experience, morphia,
hypodermically, to be the most effective agent for relief.
Of course its use entails the risk of addiction, but in
otherwise unyielding cases of this distressing disorder it
might be wise to counsel the taking that risk.
Dr. C , aged thirty-eight ; cause, chronic diarrhcea ;
duration, ten years ; amount, maximum, thirty grains per
diem ; on admission, fourteen. Special treatment and
hypodermics abandoned at end of eight days. Effects
were restlessness, insomnia, aching in lower limbs, and oc-
casional abdominal pain — none of which were severe and
all relieved by appropriate treatment. Natural sleep re-
turned in less than a week, patient's improvement was
prompt and steady, save one interruption from an attack
of indigestion, and he was dismissed on the twenty-sixth
day of his treatment.
Fuller details of this case may be found in the Nnv
England Medical Monthly for June, illustrative of a
paper on " Neurotic Pyrexia, with Especial Reference
to Opium Addiction."
Dr. D. , aged twenty-eight ; three years' addiction ;
three to five grains daily ; cause, sciatica. Special treat-
ment secured ; desired sedation and hypodermic with-
drawal in five days. The sequelae were restlessness, re-
lieved by hot baths ; aching below knees, removed by
strong faradic current ; and debility with insomnia, re-
quiring tonics and soporifics, the former throughout
treatment, the latter less than one week. Patient re-
covered rapidly, and was dismissed on the twenty-second
day of his treatment.
Dr. E , aged forty-eight ; eight months' addiction.
Morphia had been increased rapidly to sixteen grains
daily, but on admission was reduced to six. Seda-
tive regime for five days, when syringe was discarded.
Results : restlessness, debility, insomnia, and lumbar
pain. For -the first and last symptoms, hot baths, local
and general, proved promptly effective. Reflex dis-
turbance soon subsided, and patient left on the eigh-
teenth day. Sleep and appetite normal, but strength be-
low par. Decided improvement followed a southern
tour of a fortnight, and, on returning, his general condi-
tion was noted as fairly good.
Dr. E , aged forty-six ; addiction, with intervals,
three years ; extent, ten to twelve grains daily ; cause,
periodical headache. This patient's story, written by
himself, formed a narrative of so much interest and im-
portance as proving many of the i)oints m this paper,
that we secured his consent, and made it the subject of
a ijaper published in the New York Medical Journal,
1S83. His hypodermics were discontinued in five days,
with results similar to case of Dr. E , though the
insomnia was more protracted, yet he put in an ap-
pearance at every meal, and did not lose a single entire
night's sleep. He was dismissed on the twenty-eighth
day of his treatment, and, in company with Dr. D ,
sailed for Bermuda. Improvement continued. After
returning he gave himself several weeks' longer vacation,,
then resumed his profession, and is now doing well.
Dr. G , aged forty-seven ; addiction, ten years ; ex-
tent, six grains per diem ; cause, toothache. An attempt
was made to treat him at home, but, after abstaining forty-
eight hours, he became violent, smashing furniture, and
the opiate was resumed. He then came under our care,
and was allowed sufficient morphia to give him comfort,
and this continued five days, during which special treat-
ment was employed. Sedative effect desired, secured,
and the habitual opiate abandoned. The resultant irri-
tation was mild, the most so of any of the six cases.
Restlessness, depression, debility, and insomnia, but none
of these marked, and, like Drs. D and F , he was
able to do dietetic duty daily, and, each night, secure some
hours' sleep. Improvement was progressive, and he was
dismissed on the twenty-seventh day of his treatment.
To summarize : average addiction, five years ; aver-
age length of treatment, twenty-eight days.
Remedial measures involved bromide of sodium, hot
baths, electricity, both galvanic and faradic current, bel-
ladonna, strychnia, hyoscyamia, quinia, chloral, coca,
cannabis indica, Jamaica dogwood, varied _ tonics, full
feeding, and cheerful surroundings, for details of which
see paper, " Clinical Notes on Opium Addiction," Cin-
cinnati Lancet and Clinic, March 3, 1883, reprints of
which may be had on application.
All recovered. Repeated experience warrants the as-
sertion that every case of opium addiction, free from or-
ganic disease, and in which there is an earnest desire to
recover — be the extent and duration what it may — admits
of prompt and positive relief
The Superior Value of the Bromide of Sodium. —
Dr. Field {Boston Medical and Surgical Journal, May
10, 1883) believes that the superiority of the sodic bro-
mide over its potassic congener is insufticiently recog-
nized by the profession. From a physiological study of
the subject he feels justified in stating the following pro-
positions : I. The bromide of sodium, because it is a
sodic compound, should be more congenial, less disturb-
ing, to the fluids and solids of the body than its potassic
congener. 2. The sodium salt, in extended use, should
be less depressing to the heart, all potassic salts, after a
time, tending to produce cardiac depression. 3. The
sodic bromide is less offensive to the taste, much less ir-
ritating to the stomach. 4. The bromide of sodium
should have equal, if not superior, general therapeutic
power with the bromide of potassium, since while the
former has a bromine per cent, of 78, the latter has but
66. Clinical experience, moreover, has brought him to
the following conclusions ; i. The bromide of sodium
has equal therapeutic power, throughout the entire range
of medication, with that of the bromide of potassium.
2. Not only this, but the bromide of sodiiun has superior
therapeutic value, both from the greater miUlness of its
physiological impression and because of additional thera-
peutic applications which, were we confined to the po-
tassic salt, would be inconvenient, if not impossible.
624
THE MEDICAL RECORD.
' [June 9, 1883.
^voovess of 7]tac(IicaI s,cinTcc.
Treatment of Floating Kidney by Fixation. —
Dr. David Newman, of tllasgow, has recently performed
the operation of nephroraphy. The operation was done
in the following manner : The kidney was exposed by a
vertical incision in the right loin, immediately external
to the outer edge of the quadratus luinborum, and ex
tending from the lowermost rib to the crest of the ilium ;
the capsule of the kidney was opened, and stitched to
the edges of the wound ; and tvvo catgut sutures were
passed through the cortex of the kidney, the muscles,
fascia, and skin, and secured externally by buttons. The
patient suffered from severe symptoms, and was treated
for several years without success. Since the operation
the symptoms have entirely disappeared, and she has
now almost recovered from the effects of the operation,
which was performed tliree weeks ago. — British Medical
Journal, April 28, 1883.
Diphtheria and Nephritis. — We are still in want
of observations which shall throw light on the na-
ture of the renal changes associated with diphtheria.
The profession is familiar with the doctrine of the infec-
tive nature of the nephritic alteration. It is philoso|ihi-
cal to bear in mind that albuminuria, so often attendant
on cases of diphtheria, may not necessarily bo due to
actual disease of the kidneys. The manifold antece-
dents or causes of albuminuria may still come into play,
even though the body be the subject of diphtheria. Tlie
presence of one cause, however ]:)robable its action may
be, does not preclude the possibility of a less striking
factor being the real agent in any particular instance.
We are led to make the foregoing remarks, because Dr.
Furbringer has been unable to detect the micrococci
which other observers have demonstrated in the urine
and kidneys of cases of diphtheria. We are far from as-
serting a full belief in the view that diphtheritic neijhritis
is even generally a bacterial disease. On the contrary,
the notion that the primary diphtheritic disease is due to
micrococci requires more convincing evidence than has
at present been adduced. Dr. Furbringer has investi-
gated the clinical history and morbid anatomy of diph-
theritic nephritis with much industry. He comes to the
conclusion that the renal changes may conveniently be
arranged under three divisions, according to the degree
of anatomical change. The earlier stages are charac-
terized by comparatively slight changes in the epithelium
of the cortical region, not unlike "cloudy swelling;"
next the cellular degeneration becomes more decided
and more widely spread ; and there are some alterations
in the interstitial tissues, but no vascular lesions. The
final degree is comparable with that of the intensely
congested kidneys sometimes seen in connection with
nephritis after scarlet fever. — London Lancet, March 31,
1883.
Mercukiai. Decalcification. — A remarkable effect
of acute poisoning by mercury, in the form of corrosive
sublimate, was discovered by Salkowski, and has been
confirmed by Prevost and F'rutiger, of Geneva, in a very
interesting investigation. The effect is the deposition of
calcareous salts in the cortical substance of the kidnev.
The deposits of lime-salts may easily be confounded
with deposits of fat. The process commences in the
straight tubules, and afterward involves the tubuli Con-
torti, and is sometimes so great that tlie kidneys appear
as if petrified^ The effect is most marked in the rodents,
but may also be observed in the cat, and likewise, al-
though with more difficulty, in tlie dog, and it is appar-
ently of the same nature in all animals. It is very re-
markable that this change is not, as might be expected,
most marked when the poi.souing is most chronic. It is
greatest when the doses of the i)oison are such as to
cause death in three or four days, and are too small
to kill within twenty-four hours. The Swiss investiga-
tors have made a very important discovery as to the pro-
cess by which this remarkable effect is produced. They
find that the calcification of the kidneys is accompanied
by, or rather accompanies, a removal of lime-salts from
the bones which, in the case of rabbits, is sufficient to
render the epiphyses of the long bones movable on the
shafts. In order to estimate the actual amount of decal-
cification, a series of comparative analyses were made,
the tibia being the bone chosen. The loss of lime was
found to be usually from two' to four per cent., and some-
times to amount even to eight or ten per cent. The
change in the bones was always inversely proportioned
to the change in the kidney. To obtain even more pre-
cise results, the leg of one animal was amputated before
the commencement of the experiments, so that the nor-
mal proportion of lime-salts might be accurately com-
pared with that present after the action of the corrosive
sublimate. But the result of this experiment was the
demonstration of a very interesting fact in relation to
the processes of calcification and decalcification in the
system. It was found that when the animal had recov-
ered perfectly from the eft'ect of the amputation, no mer-
cury having been given, there was an increase in the
amount of lime in the opposite tibia. Even after intoxi-
cation by mercury, it was found that there was still an
excess of lime present, showing that the augmentation
due to the amputation of the other leg was more than
enough to compensate for the loss produced by the mer-
cury. The peculiar effect of the corrosive sublimate
cannot be attributed to impairment of the general nutri-
tion, since in starving animals, which had lost eight hun-
dred grannnes of body weight, the proportion of the min-
eral constituent of the bone was positively increased
instead of being diminished. The rapid decalcification
of the bone seems to aftbrd an adequate explanation of
the accumulation of lime-salts in the kidneys, arrested in
the process of elimination by these organs. — London
Lancet, April 14, 1883.
Modern Theories and Tre.atment of Phthisis. —
Under the above heading Dr. Pollock has just completed
a practical review of a subject which is at present en-
gaging universal attention, even of a non-medical char-
acter. This series constitutes the Croonian lectures for
this year. He concludes his remarks in the following
words {London Lancet, April 28, 1883) : "No parasitic
theory can lessen the importance of the use of tonics and
cod-liver oil. Supposing we possessed a local remedy of
sufficient power to ensure the destruction of such bacilli
as are met with in the secretions, their rapid reproduction
would soon overtake our treatment. I fear that in this
direction we may have much empiricism and many dis-
appointments.
" Finally, to sum up the brief review which we have
been able to make of these new doctrines, it would ap-
pear that while some facts, such as the presence of bacilli
in all cases of phthisis and their absence in other aft'ec-
tions of the lungs and air-passages, are fully proved, there
are some assertions of those who hold that such appear-
ances in the lungs and its secretions are the proximate
and invariable cause of the disease, which we must for
the present hold to be sub judice. Among these doubt-
ful theories are those which concern the production of
the parasites. Whether they be endogenous or intro-
duced from without, whether they may not find their birth
in certain blood-changes which are the outcome of py-
rexial action in the system, or whether they are the pro-
duct of a like morbid condition in other animal bodies,
and from them introduced into otlier organisms by con-
tact or infection, must remain for the investigation of
later pathology. We may safely relegate these interest-
ing questions to the ardent students who are now every-
where carrying on new observations. And for ourselves,
knowing well that all pathology is progressive, and that
we see but a portion of truth at any time, be content to
await the result."
June 9, 1883.]
THE MEDICAL RECORD.
625
The Medical Record:
A Weekly Journal of Medicine and Surgery.
GEORGE F. SHRADY, A.M., M.D., Editor.
Published by
WM. WOOD &. Co., Nos. 56 and 58 Lafayette Place.
New York, June 9, 1883.
THE MEETING OK THE AMERICAN MEDICAL
ASSOCIATION.
The agitation over the subject of medical conduct has
at least had this result : it has awakened a special inter-
est in the American Medical Association. The attend-
ance at its session just adjourned, of which we present a
full telegraphic account, was larger than ever before, if
we except the meeting in this city three years ago.
We are glad to be able to say that the quality of the
addresses and papers was, if not very high, on the vi'hole
distinctly better than has usuall) been the case. To
this commendation we must make some excejition. Pa-
pers which had been read before other associations weie
allowed to be presented to the sections as original, thus
openly violating a long-standing rule of the Association.
The vote to establish a weekly medical journal, under
the able and experienced editorship of Dr. N. S. Davis,
will be received with pleasure by the profession, and we
shall welcome another competitor in the higher ranks of
iournalisni. It appears to us, however, that in the details
pf management of the proposed enterprise there is a
serious misconception of its real pecuniary needs.
The election of Dr. Austin Flint, Sr., to the Presi-
dency will be understood as an endorsement of his posi-
tion upon the question of medical ethics. It would have
been more gratifying if the position had come, as it justly
might, as the recognition of liis character and attainments.
The action of the Judicial Council in compelling all
delegates to sign a preliminary pledge was hardly such
as became a dignified medical body. But it prevented
the chance for the expression of any opinions different
from those of the judicial council which so proudly as-
sumed the responsibility of dictating a course for the
members. The profession of the country will hardly be
satisfied to have its opinions and conduct thus fixed by a
few doctors who call themselves a " Judicial Council."
This act of the Association was telegraphed throughout
the country and everywhere received the condemnation
of the press. We do not hesitate to say that the profes-
sion of America, by reason of the policy thus adopted,
stands lower to-day in public esteem than it did be-
fore.
We have been among those who in the past have criti-
cised the American Medical Association. We have done
so because a candid judgment upon its work left no
other choice. It has been a shifting, purposeless, illy-
organized monster, with a floating membership of (speak-
ing biologically) undilTerentiated medical jirotoplasm.
The meeting just past has done much to give it more
coherence and purpose.
V.'\CCINATING IMMIGRANT BABIES.
It is not surprising that the sanitary enthusiasm of the
present day should at times exhibit some imperfections
in its practical outcome.
It appears from the evidence of several authorities
that the compulsory vaccination of infants while on board
the immigrant steamers, as at present conducted, is not
unattended with danger. Upon the steamship Leerdam,
of the Netherlands, whicli arrived here last month with
eight hundred steerage passengers, there were, it is said,
three deaths, and a number of cases of severe illness
among vaccinated infants.
A medical man connected with this line remarked that
" to vaccinate children, no matter how pure the virus may
be, is always followed by fever and inflammation, more
or less ; but there is not much danger when the child is
quietly at home and nursed by a mother who is able to
take good care of it ; but on board a steamship, packed
with hundreds of human beings, the mothers often very
sick themselves, food, air, and water altogether different
from what these children are used to, some also teething,
or being unwell from many other causes in consequence
of a sea-voyage, is certainly not the right time and place
for vaccination ; and his opinion is that this regulation
requires immediate review."
This opinion is expressed by several others. A Dutch
clergyman, Mr. .\. H. Bechthold, has particularly called
attention to the matter in a letter to the Evening Post.
It is suggested that certificates of vaccination be re-
quired by the ship's officers before the passengers are re-
ceived.
There is no doubt that something ought to be done.
We should, however, be very much inclined to investi-
gate the steamship companies first. It is very well known
that many of them are not at all particular as to the
quality of the virus bought, provided it is cheap. It is
strongly hinted also that the medical attendance is often
on a par with the virus ; and finally, the companies ought
not to carry passengers under unhygienic conditions.
With pure, fresh virus, intelligent medical skill, and
authority to discriminate as to vaccinating the sick, we
believe that few accidents, certainly no fatal ones, can
occur.
THE VALUE OF CEREBRAL THERMOMETRY IN DIS-
EASES OF THE BRAIN.
Dr. J; T. EsKRiDGE, in a very elaborate report of a case
of tubercular cerebro-spinal meningitis, read before the
Philadelphia College of Physicians, calls attention among
other things to the possible value of cerebral thermom-
etry in brain diseases. He states that the surface tem-
peratures of the head and of the upper posterior cervical
region were registered in the case reported on ninety-
seven different occasions, during which four hundred and
eleven surface temperature observations were made on
these parts. The cerebral temperatures exceeded the
axillary forty-six times ; that of the axilla was higher than
626
THE MEDICAL RECORD.
[June 9, 1883.
ihe head temperatures forty-seven times ; and the tem-
peratures of the head and axilla were equal four times.
Once the temperatures in the axilla and over the
upper cervical region were equal ; four times the tem-
perature of the latter region fell below that of the axilla,
varying from .1° to i^ ; twenty-four times the heat of the
upper cervical region exceeded that of the axilla, it hav-
ing been on one occasion as much as 3.4° above it.
The temperature in the upper cervical region was usually
greater than that of the head, it having been higher nine-
teen times out of twenty-nine.
The lowest head temperature found was 95.8 , the
axillary heat at that time being 97.8". The highest head
temperature registered was 103.5", the axillary being
104°. The lowest axillary temperature recorded was
93.8°, the cerebral temperature, at the same time, stand-
ing at 98°. The highest temperature found in the axilla,
at the time of registering the head temperatures, was
104", the surface thermometer on the head at the same
time rose to 103.5''. Once the head temperature was
4.2" greater than the axillary, but the heat of the axilla
never exceeded that of the head more than 2'.
As a result of the thermometrical studies in this and
other cases Dr. Eskridge concludes that : i. The right
or left side of the head may, in turn, be the warmest in
health. 2. When surface thermometers are used to regis-
ter the cerebral temperature in disease, the normal aver-
ages should be taken to be i' to 1.5° higher than those
ordinarily given. 3. The head temperature in disease of
the brain may equal or exceed the heat of the axilla for
a length of time. 4. In cerebral lesions the temperature
of the head is not marked by those sudden variations
manifested by the axillary temperature in these cases.
5. Variations of head temperature in diseases of the
brain take place comparatively slowly. The tendency
of the heat of the head to remain permanently above
the normal, while that of the axilla is normal or sev-
eral degrees below, is the strongest evidence of organic
disease. 6. The thermometer and the microscope in
the case reported agreed in locating the greatest inflam-
matory trouble in the upper cervical portion of the cord.
7. Brain lesions attended by congestion or intlanunation
have a higher local temperature than suppuration going
on within the cranial cavity.
Dr. Eskridge thinks that for purposes of study and
comparison we should assume that the average tempera-
ture of the anterior, middle, and posterior surfaces of the
brain is 95.36=" F., 94.1" F., and 93.56° F., respectively.
^V'e have before stated in commenting upon the sub-
ject of cerebral thermometry that the relation between
the temperature of the scalp and of the brain beneath
was, within certain very large limits, a physiological, not
a physical one. The mutual changes in temperature are
generally due to the intervention of the nervous system.
It is known that irritations of nerves of one part of the
body will affect reflcxly the temperature of other parts.
Variations in cranial temperatures, therefore, may be due
to changes in the brain beneath,' or to irritations in other
parts of the body. Hence cerebral tiiermometry ordni-
arily affords us but small help in diagnosis. W'lien, how-
ever, the brain or its membranes are organically affected
the thermometrical variations may be of value. This
seems to be tiie teaching of Dr. Eskridge's case.
THE MEETING OF THE AMERICAN SURGICAL SOCIETY.
We publish elsewhere a report of the fourth annual meet-
ing of the American Surgical Association. There were
about forty gentlemen present and about a dozen papers
were read, several of them being of the nature of case
reports.
We fear that even the utmost stretch of charity will
not allow that the meeting was a remarkable one or at
all representative of American surgery. Surgical science
has reached a high eminence in .\merica, and an associa-
tion aiming to represent it must show itself awake and
progressive. It must present original work, not clinical
records at its annual meeting.
We are glad to say, for all this, that several of the
papers showed careful labor and were extremely credit-
able to the Society.
The resolution asking the individual members if they
had consulted with homoeopaths, and if so, demanding
their resignation, concluded, we will not say fitly, the
proceedings of the session.
THE PROGRESS OF SURGERY IN THE GRE.\T NORTH-
WEST.
It is a satisfaction to feel that the art of surgery keeps
pace with the star of empire on its westward way. We
are particularly pleased to observe that the art and the
star aforesaid hover so conspicuously around Minneapolis,
Minnesota, as evidenced by the columns of the local
daily newspapers. One instance of the stupendous
strides in surgical science which, the great West is making
has been recently given to the world by the Minneapolis
Tribune of May loth : " Drs. C and K accom-
plished a nice piece of work yesterday when they straight-
ened the club feet of an eight-months-old child of Mr.
Peltier, on Eighth .\venue north. It is said to have
been the only operation in this city where badly clubbed
and distorted feet have been straightened." We are in-
formed that since the loth the child has been doing well.
The operation in question seems to be the culmina-
tion of a long series of appalling operations that have
been chronicled by the daily press. Dr. X , says
the Tribune, has with great boldness opened an immense
and painful felon on the hand of an esteemed citizen.
Dr. Y has amputated three fingers at one sitting,
this being the second time so serious and delicate a test
of surgical skill has been exhibited in the Northwest,
etc., etc.
We are informed that it is a matter of frequent occur-
rence for some physicians in the Northwest, in regular
standing, subscribers to the Code of Ethics of tlie .Amer-
ican Medical Association, to get a free advertisement by
letting their brilliant exploits in surgery be published in
the newspapers. We trust we may be permitted to in-
form them that such conduct is not becoming physicians
or gentlemen.
A Fatal Hlundf.r. — There is considerable excite-
ment in St. I.ouis over the poisoning of three persons at
the City Hospital, two of the cases being fatal. The
physician going the rounds administered to them a dose
in which the principal ingredient was supposed to be
Epsom salts, but which really was hydrate of chloral.
June 9, 1883.]'
THE MEDICAL RECORD.
627
icvos of the QQlccIi
Two Epidemics of Measles. — Dr. H. G. V. de Hart,
Health Officer of Pleasantville, Westchester County, has
declared measles to be epidemic in that town, and all
schools have been closed, including private schools and
Sunday-schools. Up to yesterday eighty-one cases iiad
been reported. Two patients have died. Nearly every
family has been visited. The town is so closely quaran-
tined that children are not allowed to leave it.
The town of Burgholtz, near Lockport, N. Y., is much
excited by an epidemic of malignant German measles
and scarlet fever. Over si.xty cases have developed
among the children of the inhabitants, who are mostly
Germans. Four schools have already been closed. Tiie
disease was brought here about si.K weeks ago by Prus-
sian emigrants. The Board of Health find their efforts
totally inadequate to stay the spread of the disease, and
are in great straits.
Dr. William J. Morton has resigned from the Chair
of Diseases of the Mind and Nervous System in the New
York Post-Graduate Medical School.
St. Lawrence County Medical Society. — The semi-
annual meeting of the St. Lawrence County Medical So-
ciety will be held at De Kalb Junction, N. Y., on Tues-
day, June 12, igSj, commencing at 12 M.
The State Medical Society of Vermont will hold its
semi-annual meeting at Rutland, June 13 and 14, 1883.
Professor William E. Quine has been elected to,
and has accepted the chair of Practice of Medicine in
the College of Physicians and Surgeons of Chicago, 111.
Death of Dr. Banks. — Dr. James Lenox Banks died
June 3d, at his residence in this city, at the age of fifty-
one years. Dr. Banks matriculated in 1854 at the Col-
lege of Physicians and Surgeons. He was graduated
from that institution in 1857. He pursued the higher
branches of his studies in foreign institutions for two
years, and in 1859 began the active practice of his pro-
fession in this city. He was a member of the American
Medical Association, the New York State Medical So-
ciety, the New York Pathological Society, the New York
County Medical Society, the New York Academy of
Medicine, and the Medico-Legal Society. He was also
consulting physician of the Presbyterian Hospital and of
the Presbyterian Home for Aged Women. He was a
member of the Boards of Trustees of the College of Phy-
sicians and Surgeons and the Lenox Library, a member
of the Board of Managers of the American Bible Society,
and was a member of the American Geographical and
New York Historical Societies.
The American Neurological Association meets in
this city on June 20th, 21st, and 22d. There will be five
sessions, the first beginning at 2.30 p.m. Papers are to
be read by Drs. Robert T. Edes, of Boston ; C. K. Mills,
of Philadeljihia; Burt G. Wilder, of Ithaca; McBride,
Morton, Amidon, and others, of New York. Dr. E. C.
Seguin has sent a communication entitled the " Insane
of Spain and their Asylums." A dinner at Delmonico's
to the President, Dr. Edes, and the members, wdl be
given by Dr. Amidon on the evening of the 21st.
The Practitioners' Society of New York, at its
annual meeting June ist, elected Dr. Robert F. Weir,
President, Dr. C. L. Dana, Secretary.
HoMtEOPATHY IN ENGLAND in the last decade has un-
mistakably lost ground. In 1853 there were 213 homoeo-
paths; in 1862, there were 21S; in 1871, 278; in 1880,
275-
^mmatit fHccUcal ^ssaciation.
Thiriy-fouiih Annual Afeeting, held at Cleveland, O.,
June 5, 6, 7, 8, 1883.
{By Telegraph to The Medical Record.)
Tuesday, June 5TH — First Day.
The Association met at Case Hall, Cleveland, O.. and
was called to order at 10.30 a.m. by Dr. J. C. Scott, of
Cleveland, chairman of the Committee of Arrangements.
Prayer was offered by the Right Rev. Richard Oilman,
Bishop of Cleveland.
The President, Dr. John L. Atlee, of Pennsylvania,
then introduced General Edward S. Meyer, of Cleveland,
who delivered the
address of welcome,
which was frequently interrupted by applause.
Ex-Presidents Gross, of Pennsylvania ; Davis, of Illi-
nois ; Richardson, of Louisiana ; Toner, of Washington,
D. C. ; and Baldwin, of Alabama, were then invited to
seats upon the platform.
Dr. Scott then announced that the Ohio State Med-
ical Society had met and adjourned to be admitted as
members of the Association during the present meeting.
He also announced the general programme for receptions
and other entertainments. In closing he directed at-
tention to
the blank which delegates and permanent mem-
bers WERE requested TO SIGN
before being permitted to register.
It was to the effect that every signer should make a
binding acknowledgment
TO SUPPORT AND DEFEND THE CONSTITUTION, BY LAWS,
AND CODE OF MEDICAL ETHICS OF THE ASSOCIATION.
The pledge was as follows ; " I will use my best ef-
forts to maintain the same, and in testimony whereof, I
hereunto affix my name."
NO MAN WHO COULD NOT SIGN THIS APPLICATION WOULD
BE PERMITTED TO REGLSTER EITHER AS DELEG.^TE OR
PERMANENT MEMBER.
Certain protests were simply announced and referred to
the Judicial Committee.
THE president's ADDRESS.
Dr. Atlee then delivered the annual address, in which
he expressed regret that the State of New York was not
represented by delegates, and hoped that their absence
would be only temporary, and that at the next annual
meeting every State in the Union would be represented
by delegates. He then directed attention to his own
specialty, namely, that of being a graduate of sixty-three
years' standing, and gave a brief sketch, simi^le and in-
teresting, of his own medical life. Special reference was
made to the University of Pennsylvania, to Caspar
Wistar, Physick, Tanner, Parrish, McClellan, Hajs, and
a galaxy of others who labored in our jtiofession during
those early years. Only slight reference was made to the
treatment of disease in that period, but mention was
made of the treatment of the insane when the patients
were confined in small cells in the basement, seldom hav-
ing access to fresh air, and often nothing for a bed e.xcept
straw. With regard to the lancet Dr. Atlee thought the
628
THE MEDICAL RECORD.
[June 9, 1883.
almost total disuse of this agent had been the cause of
the loss of many valuable lives. The President closed
with mention of the advantages which had been obtained
by the adoption of the Code of Ethics, and in conclusion
thanked the Convention for the high honor it had conferred
upon him, and said that " at the close of a long life, one
devoted to the study and the practice of medicine, not-
withstanding its uncertainty, fatigue, and anxiety, and its
bitter disapj.iointment, he was satisfied that in no other
career can man more fully accomplish his whole dut\- to
his God and to his fellow.''
On motion of Dr. Keller, of Arkansas,
A VOTE OF THANKS
was extended to the President for his mteresting and able
address, and the same was referred to the Committee on
Publication.
On motion by Dr. Haves, of Pennsylvania, the mem-
bers of the Ohio State Medical Society were invited to
seats as members of the Association during its present
meeting.
Dr. Bili.incs, of the United States Army, presented a
communication from the British Medical Association,
asking the American Medical Association
TO CO-OPERATE IN THE WORK OF .METEOROLOGICAL OB-
SERVATIONS
in their relation to the chemical history of disease. It
was referred to the Committee on Atmospheric Condi-
tions, of which Dr. N. S. Davis, of Chicago, is chairman.
An appeal from Dr. Dwight \V. Day was referred to
the Judicial Council.
Dr. Dida.ma, of Syracuse, N. Y., presented resolutions
forwarded by Dr. Tyndale, of New York. They were
CONCERNING METEOROLOGICAL CONDITIONS
and the establishment of an increased number of signal
stations for observation, and petitioning Congress for aid
in the matter. The resolutions were laid on the table, to
be called up at to-morrow's session.
The permanent Secretary, Dr. Atkinson, of Phila-
delphia, then read the register, and on motion by Dr.
Toner, of ^Vashington, the names of all such were con-
firmed, no protests being entertained.
The Association then adjourned to meet at 9.30 a.m.
^^'ednesday, June 6th.
Wedn'esday, June 6th — Second Dav.
The Association was called to order at 9.30 .^.M. by
the President, and prayer was ottered by Rev. Chase S.
Pomeroy, D.D.
The Secretary announced the following
CO.MMUTEE ON NO.MINATIONS.
\y. O. Baldwin, Ala. ; D. .-V. Linthicum, Ark. ; W.
F. IVEcNutt, Cal. ; H. K. Steele, Col. ; T. Morton
Hill, Conn. ; W. .\[arshall, Del. ; A. B. Van Velsen,
Dak. ; D. C. Paterson, D. C. ; E. Foster, CJa. ; C. T.
Parker, 111. ; H. D. Wood, Ind. ; \V. L. Robertson, la. ;
W. L. Schenck, Kan. ; L. S. McMurtry, K.y. ; J. VV.
Dupree, La. ; A. J. Fuller, Me. ; J. J. Chisholm, Md. ;
C. A. Savory, Mass.; F.R.Owen, Mich.; P. H. .Miller,
Minn. ; G. H. Gregory, Mo. ; V. H. Coftman, Neb. ;
D. A. Watson, N. J. ; E. Grissom, N. C. ; H. D. Didama,
N. Y. ; W. M. Beach, O. ; S. D. Gross, Pa. ; A. Ballon,
R. I. ; R. \. Kinloch, S. C. ; D. J. Roberts, Tenn. ; H.
C. Ghent, Tex. ; Ale.x. Harris, Va. ; J. M. Lazzell, W.
Va. ; S. C. Johnson, Wis. ; A. L. Gilson, U. S. N. ; ].
R. Smith, U. S. A. ; Truman W. Miller, U. S. .Marine
Hospital Service ; W. R. Typton, New Mex.
Dr. Foster Prait, of Michigan, called up the
amend.ment to the constitution
which he offered at the last Annual Meeting, to the
effect that the law requiring the nominations for officers
be made from those members present at annual meet-
ing, shall apply only to president, vice-presidents, chair-
_men and secretaries of sections, the assistant secretary,
the chairman of the Committee of Arrangements, and
the Judicial Council.
The proposed amendment was adopted.
Dr. S. D. Gross, of Philadelphia, presented a paper
received from Dr. Oliver Wendell Holmes, with reference
to the
MUSEU.M and library OF THE SURGEON-GENERAL'S
OFFICE,
at U'ashington, D. C. The communication directed the
attention of the Association to the jiropriety of the mem-
bers of the .\merican Medical Association explaining to
their senators and menibers of Congress the necessity for
funds to build a fire-proof building for the preservation of
the library and the museum ; stating that an annual ap-
propriation of ten thousand dollars for the library, five
thousand dollars for the museum, and an additional sum
for the index catalogue, should be promptly provided,
and that a fire-proof building should be built.
The communication was signed by Drs. S. D. Gross,
A. Flint, and O. W. Holmes.
Dr. H. A. Johnson offered a jireamble and resolu-
tions concerning this subject ; first, that the ."American
Medical Association endorse the movement of urging
upon Congress the importance of at once providing a
fire-proof building for the preservation of the library and
army medical museum : second, that the annual appro-
priation for the library should be sufficient to enable it to
obtain all medical publications, and that it regards
$10,000 as a reasonable sum for that purpose. The
third clause referred to the importance of continuing the
publication of the index catalogue, and the fourth pro-
vided for the apiiointment of a special committee of five,
of which the President should be ^.v officio member, to
present the whole matter in suitable form to Congress,
and also to call the attention of State and local societies
to the action taken by this Association.
Dr. N. S. Davis, chairman, then read a report from
the Board of Trustees
ON THE SUBJECT OF JOURNALIZING THE TRANSACTIONS.
The report contained, first, the resolutions adopted at
the last annual meeting to the eftect that the interests of
the .Association would be pi omoted by the publication of
its transactions in a weeklv medical journal under its
own control, instead of the annual volume, as heretofore,
provided it could be done without involving pecuniary
embarrassment, etc. ; second, a resolution that a Board
of Trustees be appointed by request to ])roceed as early
as possible to arrange a plan of the medical journal, to
be called
THE JOURNAL OF THE AMERICA.N .MEDICAL ASSOCI.«TON,
and that they send circulars explaining such plan and
asking pledges of support by actual subscription to the
members of the medical profession throughout the whole
country, etc.; third, that the said Board of Trustees be
and are hereby instructed to retain under all circum-
stances, in whatever plans of contracts it proposes
to adopt, control over the use of the advertising as
well as over all other pages of the journal tliat is pro-
posed to be established, and that said board report in
full at the next meeting of this .Association tlie plans upon
which it has been able to agree, together with tlie reply
of the profession to its circular asking subscriptions to
the proposed journal.
In accordance with the foregoing resolutions, adopted
by the .Association at the annual meeting in June, 1882,
nine members were appointed to constitute the Board of
Trustees. Immetiiately after the adjournment of the As-
sociation, a meeting of the board was held, at which the
majority of the members were i)resent, and Dr. N. S.
Davis was elected president, and Dr. J. H. Packard sec-
retary. The plan then originated was that the journal
should contain thirty-two double columns of reading
matter, each number to contain a department of original-
June 9, 1883.]
THE MEDICAL RECORD.
629
articles, a department containing an editorial summary
of the progress in various departments of medical science
and i)ractice, an editorial department proper, essen-
tially devoted to discussing sucli topics as would be
likely to promote the interests and the efiiciency of nied
ical organizations, both national and State, also a de-
partment of correspondence, and lastly, a deiiartment for
miscellaneous items and intelligence.
Having agreed as to the general plan of the journal it
was determined that forty thousand circular letters should
be issued, accompanied by the same number of blanks
for answer, with reference to operating the project.
The result of sending these circulars was, that about
three-fourths of the entire number were absorbed in sup-
plying fourteen States, leaving only a limited number to
supply the remaining portion of the country, and it was
estimated that had all been supplied the favorable re-
sponses would have been increased by at least twenty-
five per cent. To the circulars which were distributed
2,150 answers were returned, of these, 12 were direct ex-
pression of opjiosition to the proposed change, 30 were
equivocal, leaving 2,100 unqualified pledges to sustain
the proposed journal in addition to these, over five
hundred subscriptions were obtained from those who are
not members of the Association. It was also fair, to as-
sume that a certain pro[)ortion neglected to respond, who
would probably become subscribers to the journal, and it
was therefore safe to conclude that the aggregate sub-
scription to begin with, would be 2,500, making an income
of $12, 500 yearly. The proposed journal, without adver-
tising sheets, can issue 3,500 copies weekly at an ex-
pense of $8,000 annually, which would leave $4,500 for
editorial work and current expenses. But such a jour-
nal under reasonably fair business management would
receive from advertisements, not less than $5,000 annu-
ally. All of the editorial work is to be paid from $6,000,
which would leave a balance of $3,500 to be expended
for scientific investigation in such a manner as might be
deemed proper by the Association.
At the last meeting of the Board of Trustees, after a
careful analysis of all the returns and the estimates with
reference to the expense of printing and publication, all
the members unanimously voted to recommend to the
association that a journal be published, being satisfied
that it could be done without pecuniary embarrassment
to the Association, and also recommended the following
propositions :
First. — That the editor-in-chief take direct supervi-
sion of the entire work, and for business purposes he
might emi>loy a clerk competent to assist in all business
matters.
Second. — That for assistants in editorial work the
editor should engage one or more, specially qualified, to
select and write u\) progress made in all departments in
medical science and art, and give to each assistant of
the editorial chair a fair compensation for the work per-
formed. He should also secure reliable correspondents
from all parts of the country and from abroad. It was
also recommended that all advertisements of proprietary,
trade-mark, or patent medicines, should be excluded from
the sheets. It was also recommended that no advertise-
ment be accepted bearing names of endorsers having
title appended, believing it to be contrary to the letter
and to the spirit of the Code of Ethics.
The board also recommended that the printing be done
by the firm known as Tucker, Newall & Co., of Chicago,
and that the place of publication be Chicago, 111.
In conclusion, the Board of Trustees submitted the
following resolutions :
First. — That the report of the board, just read, be ac-
cepted, and the reconnnendation therein contained be
adopted with reference to establishing the Journal of the
American Medical Association.
Second. — That the Board of Trustees be instructed to
proceed with the publication of the Journal at as early a
day as practicable, to take the place of the annual volume
of " Transactions." The other resolutions referred to the
detailed arrangement with the treasurer, and closed with
the statement that all orders upon the treasury for the
disbursement of money must be endorsed by the presi-
dent of the Board of Trustees.
Dr. Brodie moved the adoption of the resolutions.
Dr. Wile, of Connecticut, moved as an amendment
that the secretary be instructed to have the report printed,
and that discussion be postponed until to-morrow, at ten
o'clock.
Dr. Atkinson, permanent secretary, said that he was
pleased with the report of the Board of Trustees, and
tendered his full services to the Association for the fur-
therance of the new plan of publishing the Transactions.
The amendment was lost ; the original motion by Dr.
Brodie was nearly unanimously carried.
Dr. McMurtry, of Kentucky, secretary of the Board
of Trustees, stated that he had been instructed by the
board to report to the Association that it had now selected
Dr. N. S. Davis, of Chicago, as editor-in-chief of the
Jourrial.
Dr. Davis then took the floor, and spoke at some
length with reference to the prospects of ihe Journal, the
anxiety which it had given him, and asked the forbear-
ance of the Association with reference to any shortcom-
ings which might appear, and also that the members
should not expect too much, and should not be too strict
in their comparison of \.\\e Journal with the British Medi-
cal Journal, which had so often been held up for a pat-
tern, for it must remember that the British Medical
Journal had been the work of years.
He further anounced that he expected to be able to
issue the first numbei; of the Journal early in July next.
He also resigned his position as member of the Board
of Trustees, to take charge of the department on the prog-
ress of medicine, with the understanding that he was to
have full access to the Medical Library.
Dr. Palmer, of Ann Arbor, spoke in complimentary
terms of the project of i)ublishing the Transactions in
journal form, and also of the editor-in-chief.
Dr. Cohen, of Philadelphia, moved that the Board of
Trustees be instructed, in addition to the Journal, to
print annually a thin octavo volume containing the min-
utes of the Association.
This motion gave rise to discussion, participated in by
Drs. Hibbard, of Indiana, Quimby, of New Jersey, and
Byrd, of Illinois, and, on motion of Dr. Richardson, of
Louisiana, the whole subject was referred to the Board o(
Trustees.
Dr. Busch, of Delaware, moved that the Association,
in consideration of the long services already rendereil, and
also the kindness, self-denial, and willingness to assume
the duties of editor-in-chief of the new journal, tender a
vote of thanks to Dr. N. S. Davis. Unanimously carried.
Dr. Davis said he had been directed by the Judicial
Council to state that that body assumed all responsibility
in putting the pledge to support the Code of Ethics u|>on
the blanks to be signed by delegates or prominent mem-
bers before registering.
Dr. Palmer, of Ann Arbor, asked if it was meant that,
by signing this blank, the signer was to sustain the
present provisions of the Code, or was to sustain the
Code, whatever it might be.
Dr. Davis answered that the Code as it now stands
was meant, and that if the Association made alterations,
that then the changes would be considered as binding.
Dr. Scott announced certain ethical communications,
which were referred to the Judicial Council.
address of the chairman of the section in prac-
tical medicine, etc., bv dr. j. h. hollister, of
illinois.
In the development of medical science men have been
compelled to grapple with some of the most intricate and
difficult problems which can challenge investigation. In
studying those higher relations which lie in part beyond
6p,o
THE MEDICAL RECORD.
[June 9, 1883.
the limits of finite conception, reason may properly defer
to faith, and seeking the guiding hand of revelation walk
with a wisdom other than its own. But in medicine it is
not so. Forces, mental and material, interchangeable,
interdependent, and inseparable, manifest themselves in
ways so manifold and with so many essential facts undis-
covered, that reason is compelled to thread her way with
steps slow and uncertain, sometimes in truth, ofttimes in
error, ever painfully conscious of her weakness and of
the mysteries which confront her on every side. Thus
only may we account for the seemingly meagre fruitage
which represent the labors for more than two thousand
years of some of the ablest minds the world has ever
seen.
Those great problems of iiealth and disease, of life and
of death which affect the well-being of the race have
been matters of patient investigation by many of the fore-
most men in every generation, and many of them have
wrought out work which will endure as long as literature
shall survive. ISut the essential causes of disease have
been in the main so obscure and their e.xpressions so
varied and comple.x that the best of men have been com-
pelled to conclusions largely inferential.
In the absence of positive knowledge no man can lay
the restraining hand upon the fancies and credulities of
man, and medicine has ever been the fruitful field above
all others for their e.xuberant developnienl.. Speculations
have been piled mountain high by one generation of
workers to disajipear before another as chaff before the
driving wind. But despite the winnowings there still re-
mained some golden grains of truth, and the treasure-
house has been slowly but surely enriched by these gar-
nerings of the ages.
The speaker then passed to some to[)ics which pertain
to medicine in general. First we can congratulate our-
selves that the year has been so prolific of trustworthy,
accurate, and able workers ; probably no year in the
world's history has witnessed an equal amount of legiti-
mate original investigation. The united labor of such
men is destined to achieve results which could never be
accomplished otherwise, and there is born of such work
a synipathy and an enthusiasm which is becoming world-
wide.
Second, the medical journalism of the year claims fa-
vorable comparison with any that has gone before ;
AN .ABLE LITERATURE IS GOING TO THE PRESS,
a wiser supervision is manifest, new and able con-
tributors are coming to the front, and all departments of
medical investigation are having an abler expression of
their work.
More than in any year before, the centres of intensest
study have been within the range of microscopic vision.
The microscope commands the advance today, and as-
sertions based upon its revelations can only be tested,
acce])ted, or rejected upon authority equally skilled in the
use of this instrument. In microscopy two subjects,
more than any others, conunaiid attention at this hour.
One is the composition of the blood, the other is the
agency of niicrocytes in the production of disease.
The speaker then directed attention to the difference
of opinion concerning
THE STRUCTURE OF THE RED BLOOD-CORPUSCLE,
also the discovery of the third corpuscle, and concluded
with the statement that as the case now stands Kngland,
and not Italy, Norris, not I5ozzozero, maintains priority
in the discovery of this element of the blood.
Turning to the subject of
MICROSCOPIC ORGANISMS
the most prominent man that confronts us is Dr. Robert
Koch, and this prominence is based upon his discovery
of what is known as the bacillus tuberculosis. One very
important point arises in connection with this question
— in fact a pivotal one, upon which all others must turn,
namely, the presence of specific organisms in many forms
of disease. But the main question is, Are these causa-
tive or only concomitants.
Somewhat extended reference was then made to the
labors of Koch and others, to the micro-organism of
leprosy, of gonorrhoea, of the vaccine pustule, and other
affections. The question that concerns us most is not
as to whether we can destroy bacteria but whether they
have not a greater vitality than the tissues of the human
bod)', and whether in the germicidal warfare the human
organism will not first succumb.
In materia medica numerous new remedies have been
brought forward, but none seemed sufficiently prominent
to command special attention in the year's reports.
The speaker then directed attention to the fact that
recently in Italy a law had been passed which prohibited
the
SALE OF PATENT MEDICINES
throughout the kingdom unless the precise composition
of the medicine is stated, and asked how long shall en-
lightened America fall so far behind Italy in the enact-
ment and enforcement of similar laws.
In conclusion. Dr. Hollister directed attention to the
following questions and suggestions : Is the time not
nearly at hand when the medical men of the United
States shall be prepared to institute something like the
following action ? Let the medical profession in each
State, in such a manner as seems best, satisfactorily de-
signate one of their number to constitute with a like ap-
pointed member from each of the other States a nomi-
nating board. Let it be the duty of this board to
nominate a list of men suitable for appointment by the
President as members of the Medical Bureau, to be con-
stituted with specific jiowers and duties in this bureau,
composed, perhaps, often members. Let the army and
the navy and the marine service have proper represen-
tation. Let the members of this bureau be subject to
removal only for cause, receive a salary of not less than
ten thousand dollars annually, to be paid by those who
are applicants for the degree of Doctor of Medicine.
Let the laws of the various States be so modified that
THE POWER OF CONFERRING THE .MEDICAL DEGREE
shall rest solely with this bod\'. Let students graduated by
the National Medical Bureau receive an honorary dis-
tinctive title, say, that of National Fellow of Medicine.
To such a movement the colleges could offer none other
than a selfish objection. He thought he could see in
such a plan, wisely and impartially executed, the possi-
bilities of a medical culture of the profession such as the
world has not yet seen.
ADDRESS OF THE CHAIRM.\N OF THE SECTION IN OB-
STETRICS AND DISEASES OF WOMEN, BY DR. J. K.
BARTLEIT OF WISCONSIN.
Dr. Bartlett first directed attention to some of the
topics in gynecological surgery. Two years ago his pre-
decessor. Dr. J. R. Chadwick, referring to Emmet's opera-
tion, stated " That it could hardly be said to have passed
through the stage of novelty to that of criticism ; that it
was destined to be a fertile topic for several years to
come ; when it could be assigned to its proper sphere
and cease to excite discussion."
Prolonged observation has shown that undue infiuence
was attributed to the lesion, and experience has proven that
the relief claimed to follow the operation is not uniformly
attained. A more definite understanding of the condi-
tions re(iuiring its performance, and the limits to which
it should be restricted, as well as a more just apprecia-
tion of its real merits, have been thus attained.
B.VITEV'S OPERATION.
Another operation which has been tested for some
years is that of Dr. Battey. .Most of the indications
June 9, 1883.]
THE MEDICAL RECORD.
631
which have been claimed to warrant it are now generally
ailniitted. Some doubts still exist with reference to its
ultimate results when performed to check uterine hemor-
rhage produced by niyomata. There is some diversity
of opinion concerning its efficacy for the relief of epi-
lepsy, or hystero-epilepsy, and mania seemingly depend-
ent upon or associated with ovarian troubles.
Dr. Bartlett then presented at some length the views
entertained concerning
tait's operation,
and made somewhat extended reference to the writings
of Thomas and F^Uiot, of New York, and Savage, of Bir-
mingham.
Concerning this operation, some important advances
had recently been made in
THE TREATMENT OF EXTRA-UTERINE PREGNANCY,
which appeared to offer a safer and a surer path out of
this difficulty than any previously discovered.
The method of treatment by electricity was then re-
ferred to as illustrated by cases re|)orted by Lusk, Emmet,
Thomas, Garrigues, Rockwell, and others.
WITH REFERENCE TO TRANSFUSION IN POST-PARTUM
HEMORRHAGE,
confidence in its practical efficacy in cases where death
appears imminent has very much lessened in France,
Germany, and England, and thus Dr. Lusk, one of our
latest authorities, says that althougli theoretically it is the
most rational method of treatment, practically it is un-
satisfactory.
A somewhat extended reference was then made to the
literature of the subject as presented by Garrigues,
Barnes, Schwartz, Woodman, Hickford, Coates, and
others. The next topic of the address was the
OBSTETRIC FORCEPS.
Special attention was directed to one of the latest ad-
ditions to the instrument presented by Dr. Alexander
Duke, of Dublin. It consists of tractors which are ap-
plied with the blades before they are locked. These can
be attached to a belt about the waist of the'operator, and
with toe-caps upon his shoes to prevent slipping. The
inventor claims an immense gain of power for shortening
labor. He considers that there is more chance for the
child, and less risk to the soft parts of the mother by
pulling the head forcibly through the pelvis, than if al-
lowed to remain and mold itself to the outlet. Dr.
Bartlett thought that we should probably hear of a small
electro-motor of one-horse power, so arranged as to do
the pulling, and save the operator as well as the mother
any exertion.
In referring to the views of various authors the state-
ment of Dr. Goodell was quoted, viz., " to tell you the
truth, such grave lessons to the mother, and for that mat-
ter to the child also, are so constantly brought to my
attention that I am disposed to accept Baudelocque's
dictum that, take it all for all, the forceps have been
more injurious than usual to society."
Dr. Bartlett also commented severely and justly upon
the motive for using the forceps which had been fre-
quently given, namely, to secure time for other engage-
ments, and in view of his own experience and the obser-
vations of others, he could not avoid protesting against
this fashion of the time, in the name and tor the sake of
the mothers, as well for the ultimate repute of a useful
but now much-misused instrument.
The next topic referred to was
THE USE OF ERGOT IN LABOR.
The object in introducing this subject was to suggest a
reason for the wide difference in opinion which exists
with reference to its usefulness in obstetrics. The writer
had administered this drug for many years in cases not
very frequently seen — where the second stage of labor
was retarded by insufficient contraction and no pelvic
obstacles existed. He regards it as a valuable resource
in such cases, and has never witnessed, in his own prac-
tice, the tetanic contractions attributed to it since he
learned how to employ it. For this purpose he uses an
infusion of the freshly and coarsely powdered kernels,
about thirty grains to three drachms of water, giving a
tablespoonful every thirty minutes until some effect is
apparent.
In some cases the effect is obvious after one dose, in
others two or three doses are required. In cases of
nervous exhaustion on the part of the patient a full dose
of quinine is also given. It was also added that the
writer had made no use of an anesthetic in labor save in
some exceptional case of feeble uterine contraction, but
where ergot was administered and pains became effi-
cient, the anesthetic was also used. How much modifi-
cation of the effects of the former were produced by the
latter agent he could not positively determine, but was
sure they acted well together as an anaesthetic. The
contrariety of views with regard to
THE USEFULNESS OF AN ANAESTHETIC FOR THE RELIEF
OF PAIN IN LABOR
also appeared to the writer to be explainable only upon
the supposition that it had been improperly and injudi-
ciously used by those who opposed it. He believed a
diversity of opinion might be, and probably was, the
result of faulty administration. There are three stages of
anaesthetic effects which may be produced : ist, a lessen-
ing or annulling of sensibility to pain ; 2d, by increased
dose, the abolition of intelligence ; 3d, the abolition of
mobility.
The method and object of anaesthesia in surgery and
labor diftered widely. For the latter it was rarely neces-
sary to produce much more than its first effect, and this
is produced J>ari /lassit with the pain. A little experience
will soon teach the physician how to arrest its effect at
this stage, or at least before the second stage is fully at-
tained, and to vary the amount as may be required by
different degrees of pain. There is no proof which the
writer has ever seen that, used in such a manner, anaes-
thesia produces or tends to produce post-partum hemor-
rhage.
In conclusion, if an anaesthetic ever produced post-
partum hemorrhage, injury to the child, or other than
beneficial results, exjierience tells us it must be due to the
impurity of the anaesthetic employed, or to want of that
experience, discretion, and use which is necessary not
only here, but in the use of all therapeutic measures
employed for the relief of human suftering.
With reference to the use of antiseptics in private
obstetric practice, the writer thought that none of the
prophylactic measures which had been recommended so
strongly were necessary in cases of complicated labor,
and that some of them were absolutely dangerous.
He then spoke of
DANGERS ATTENDING INTRA-UTERINE INJECTIONS.
The conclusions which the writer thought could be
legitimately drawn were that danger of poisoning after
ordinary labor in practice is not such as to demand the
precautionary measures which Dr. Barnes has suggested ;
that in many cases in which the lochia are offensive no
general disturbance follows, and that cleanliness as thor-
ough as can be attained and care as to general conditions
are only usually necessary ; that even in cases where
rises of pulse and temperature occur vaginal irritation is
frequently sufficient ; that in cases where relief has fol-
lowed the use of carbolized injections, vaginal or intra-
uterine, the advantageous results do not so much depend
upon antiseptics as upon the cleansing effects by even a
simple fluid used in such a manner and quantity as to se-
cure entire removal of any decomposing matters retauied
in the uterine or vaginal canal.
6.^2
THE MEDICAL RECORD.
[June 9, 1883.
In conclusion, Dr. Bartlett referred to the necessity
for careful constitutional treatment in pelvic disease,
stating that it had often been observed, but that it had
not received the attention which its importance demands.
Specialism, when exclusively practised, is apt to produce
narrowness of view. No one who has not received
tiiorough training in general medicine, and has not tested,
confirmed, and enlarged their natural thought attained by
many years of general practice, is fitted for a specialist.
When medical gynecology is thus studied and practised,
aided by larger general, local, therapeutic, and hygienic
resources, which such research in time will develop, the
clearer and surer will be the diagnosis which the future
will bring, and the time will come when the present bril-
liant triumphs of the surgical gynecologist will grow pale
before the achievements of his medical co-workers.
Dr. Toner, of Washington, presented his
REPORT ON NECROLOGY,
which was referred to the Publication Committee.
The Association then adjourned, to meet on Thursday,
June 7th, at g.30 a.m.
Thursday, June 7th — ^Third Day.
The Association was called to order at 9.30 a..\i. by
The President.
Prayer was offered by the Rev. N. S. Rulison, D.D.
Dr. Keller, of Arkansas, called up his proposed
amendment to the By-laws, permitting the Conunittee
on Nominations to fi.x
THE TLME AND PLACE OK HOLDING THE ANNUAL MEET-
INGS.
The amendment was adopted.
Dr. Bachelder, of Providence, R. I., introduced the
following :
Resolved, That a committee be appointed by the
President, to consist of one or more persons from each
of the States, who shall be members of this Association,
to urge upon each legislature
THE ENACT.MENT OF MORE STRINGENT L.WVS IN RELA-
TION TO ALL TOXICAL AGENTS.
The resolution was adopted.
Dr. Pratt, of Ntichigan, referred to the death of
William Farr, of England, and introduced a resolution
expressive of high appreciation of the labors of this gen-
tleman in collating vital statistics, and stating that his
works are recognized by the medical profession of the
United States as an enduring monument to his ability
and learning as a physician and a worker in that depart-
ment. The resolution was adopted.
Dr. S. D. Gross offered the following preamble and
resolution :
Whereas., Ciood nursing is of paramount importance,
and whereas the subject is one which strongly addresses
itself to the common sense of every intelligent member
of society ; therefore be it
Resolved, That this Association, fully recognizing the
importance of the subject, respectfully recommends the
establishment in every county or town of schools or so-
cieties for
THE El'KlCIKNT TRAINING OF NURSES,
male and female, by lectures and practical instruction
to be given by competent medical men, members of
county societies if possible, either gratuitously or at
such reasonable rates as not to debar the poor from
availing themselves of this benefit. The resolutions were
adopted.
Dr. Walter May, of Illinois, ottered resolutions pro-
viding for the organization of a special section to be
devoted to the subject of psychological medicine. Laid
over for one year.
Dr. N. S. Davis, of Chicago, reported from the Stand-
ing Committee upon
ATMOSPHERIC CONDITIONS AND THEIR RELATION TO THE
PREVALENCE OF DISEASE.
The report was an abstract of what had been prepared,
and was in accordance with the general plan established
under resolutions of the Association, providing for three
parallel sources of coincident observations in twelve
different localities, Boston, New York, Philadelphia,
Baltimore, etc.
The report was accompanied by e.xtensive tables illus-
trating the work done by Professor Long and others,
and it was stated, that as a result of the works of Pro-
fessor Long, the quantity of organic matter daily in the
atmosphere during the entire year had been estimated
for the first time in this country, or in any other. Special
attention was directed to one fact, namely, that not a
physician in New York City could be secured to co-oper-
ate in making clinical observations.
The abstract of the report closed with the following
proposition : That the committee be authorized to fur-
nish their report for publication as a part of the trans-
actions of the Association, and to continue the investi-
gations now in progress, with the privilege of drawing
upon the treasury for so much of the unexpended balance
of the former appropriation as might be necessary.
Second, that the thanks of the .Association are hereby
tendered to the Superintendent of the Signal Service,
General Hazen, for his uniform courtesy and favors ex-
tended, and that he be requested to continue the same
as the committee may recjuire. The report was unani-
mously adopted.
The resolutions offered by Dr. Didama in behalf of
Dr. Tyndale, of New York, at the session on Tuesday,
were then taken from the table and referred to the Com-
mittee on .Atmospheric Conditions.
Dr. Davis then requested that Dr. Didama, of New
York, be added to the Conmiittee on Atmospheric and
Ozonic Conditions. His request was granted.
Dr. Head, of Indiana, introduced a resolution of
sympathy with the wife and family of
DR. J. C. HUBBARD, OF ASHTABULA, WHO DIED SUDDENLY
ON TUESDAY, WHILE IN ATTENDANCE AT THE ASSO-
CI.VriON.
The President appointed the following
DELEGATES ABROAD :
G. J. Kngelman, St. Louis : Wm. M. Finley, Altoona,
Pa. ; Walter L. Ziegler, Pennsylvania ; M. H. Alter,
Pennsylvania ; R. B. Cole, San Francisco ; J. H. War-
ren, Boston ; C. H. Vonkleim, Hamilton, O. ; Wm. M.
Lawlor, San Francisco ; Henry Martin, Boston ; J. C.
Hutchison, Brooklyn ; A. M. Howes, Detroit ; E.
Borck, St. Louis ; T. F. Prewitt, St. Louis ; E. P. Allen,
Pennsylvania ; H. McCall, Michigan ; I. N. Quimby,
New Jersey ; S. La Gordon, Maine.
Dr. Pollak, of St. Louis, introduced resolutions pur-
porting to come from the St. Louis AFedical Society,
asking that the .Amsrican Medical Association appoint
a committee to take into consideration the
ADVISABll.IV OF REVISING THE CODE OF ETHICS,
and to report at the annual meeting in 18S4. Ihe
communication and the resolutions were laid upon the
table.
Dr. Brodie moved that all papers before being read
should secure the apjHOval of the chairman of the section
to which it was referred. The motion was laid upon the
table.
On motion by Dr. Davis, Dr. M. L. Nardyz, was re-
ceived as a member by invitation.
ADDRESS OF the CHAIRMAN OF THE SECTION IN SUR-
GERY AND ANATOMY, liV DR. W. F. PECK, OF IOWA.
In reporting u|)on the progress made in surgical science
June 9, 1883.]
THE MEDICAL RECORD.
633
during the last year, it is recognized that many theories
are announced as facts, which, when experience and
demonstration shall have thoroughly tested them, may
be eliminated, perhaps to reappear when the circle of
professional experience again completes its revolution.
The greatest progress has been made in operative
surgery, although other departments have been constantly
endeavoring to add new light and additional results to
our already extensive accumulations. It is not claimed
that large numbers of new operations have been origin-
ated and performed, but it is evident that a better under-
standing of pathological conditions has stimulated sur-
geons to establish a standard for operations hitherto
ventured upon in rare and extreme instances. In
pathology, the microscopist has been active in trying to
define and locate the germ cause of disease. Certain it
is tliat during the year there has been developed a strong
feeling in favor of Koch's views concerning bacilli
and their alleged tubercular relations, that these peculiar
niicrogerms exist there can be no longer any doubt, but
whether they are the cause of the tubercle or whether the
tubercle develops them the profession has not yet made
sufficient progress to justify sn unequivocal statement.
Dr. Peck then referred to the views entertained by
Dr. Koch, and Spina, his opponent. The surgeon is
interested in these investigations because it is thought by
many excellent men that germs play a very important
part in causing infection, inflammation, ijymmia, septi-
caemia, abscess, gangrene, etc., and if this view is sus-
tained it will be conceded that it will tend to give new
and moie efficient reasons for
THE USK OF .\NTISEPTICS IN PRACTICE.
The condition and the problem of the management of
wounds and other pathological processes, by means of
the so-called antiseptic methods, suggests the production
of greater confidence in the details of operative proced-
lu'e, and scrutinizing attention to extreme cleanliness in
the minutiie of practice. The speaker then referred to
the use of carbolic acid and other antiseptics, and to the
experience of Thornton, Spencer Wells, Lawson Tait,
Billroth, Esmarch, and others, and said that it could not
be successfully argued that a lessened mortality was alone
due to the use of antisepticism as practised by Lister. It
would be immediately asked, " How else can these alleged
great changes in practice be explained?" if everything
that is used to keep a wound clean, and to insure thorough
drainage is called antiseptic practice, then no adequate
explanation can be offered. Is not the experience of Mr.
Keith as wonderful as the tabulations of the Vienna or
Kiel surgeons? Yet it is admitted that most of the lead-
ing surgeons of England are thoroughly wedded to the
antiseptic treatment of wounds, still there are to be found a
few excellent teachers and operators who most reverently
believe that nature, with assistance from the surgeon, will
do more to save limb and life than the surgeon can do who
depends upon restricted antisepticism.
Dr. Peck had opened the abdomen, in all, forty-eight
times ; in forty-six instances for the removal of ovarian
growths ; once for an adherent ovary, and once for in-
testinal obstruction.
In the first thirteen cases there were six deaths. The
operations were made under the spray, and the wounds
were treated with carbolic-acid solution. In the remain-
ing thirty-one ovarian operations, also in oiiphorec-
tomy and in cases of laparotomy, the spray was not
employed. The two last-mentioned cases recovered,
and out of the ovariotomies there were four deaths. He
was of the opinion that many of the wonderful results
accomplished by numerous surgeons throughout the
country were secured not so much by means ot the spray
and carbolic acid, as by the extraordinary care and at-
tention which they gave their cases.
Among the new and important instruments which have
been presented, mention was made of the
UNIVERSAL OR COMPOUND RATCHKT JOINT,
which has been offered by Dr. Stillman, of New York,
which can be adjusted at pleasure and permits of univer-
sal motion. I'erhaps one of the most important steps
that have been taken is the utilization of the electric
light, both as a means of diagnosis and as an aid in mak-
ing operations in cavities, and in places where the natural
light can be used only with uncertain effect. For this
purpose Swain's lamp has been frequently used, which
in size is not larger than an ordinary bean, and with it
the interior of the bladder, the pharynx, the larynx, the
cesophagous, stomach, and ear have been illuminated.
Decided progress has been made in
LOCATING METALLIC SUBSTANCES IN THE TISSUES OF
THE BODY
by means of the induction balance by Prof. Graham
Bell. Sir Henry Thompson has offered some very valu-
able information concerning
THE DIRECT EXPLORATION OF THE BLADDER.
He makes a limited incision in the membranous portion
of the urethra and then passes the index-finger along the
back and through the neck of the bladder, where, by the
aid of supra-pubic pressure, a free and satisfactory ex-
ploration of the cavity and walls is permitted. The year
has greatly added to our previously meagre knowledge
of surgical procedure in intra-abdominal pathology. Sta-
tistics show that less hazard is encountered in attempting
to extirpate tumors, malignant growths, and removing
the causes of intestinal obstruction than was forjiierly
supposed.
THE FEASIBILITY OF GASTROTOMV
has been established by experience collected during the
past year. Up to January, 1883, there had been performed
thirty-six operations for the removal of some portion of
the stomach or duodenum for cancer, gastric ulcer, in-
flammation and destruction of the colon. Unless the
greatest discretion is shown, however, in the selection
of cases for operation, the mortality cannot be other-
wise than very high. In connection with this operation
there were two very important questions to be answered.
First, If the cancer, for which nearly all the operations
are performed, is due to a general cause, can the sur-
geon expect the patient to receive more than temporary
relief from the operation ? Second, Will the aggregate
life in those cases in which the operation is successful,
be greater than it would be in those cases in which death
occurs as the direct result of the disease ?
LAPAROTOMY
is an operation which is progressing with much favor in
America and France. Opening the abdomen to relieve
intestinal obstruction is not only inviting, but oper-
ators who have had experience in making ventral section
proceed with less hesitation to search within the abdo-
men for arrested alimentary action than they have here-
tofore done. Dr. Peck then gave the history of some
cases which illustrated the liability to the formation of
adhesions between the crecum and the surrounding parts,
and also illustrated the relief which might possibly be
obtained by operative interference. Prof Loretta, of
Bologna, had performed the operation of
STRETCHING THE CONSTRICTED PORTION FOR STENOSIS
OF THE PYLORIC ORIFICE
of the Stomach. The number of operations thus far
performed were four, with two recoveries. It will at
once be conceded that a careful study of the history in
any given case must result in unequivocal diagnosis.
Dr. Peck then directed attention to one of the causes
of death in this department of operative surgery, illus-
trated by a case. Post-mortem examination was made
nine hours after death. No foreign material of any kind
was found inside of the abdominal cavity. All of the
organs were apparently healthy, except that in the right
634
THE MEDICAL RECORD.
[June 9, 1883.
ventricle of the heart there was a large, white fibrinous
ante-mortem clot. What caused the blood-clot? It is
not enough to say that in any given case death came as a
result of fibrin collection on or around one or more of
the heart-valves. There must be a further cause which
influences the vital fluid.
Dr. David Newman, of Glasgow, has performed
THE OPERATION OF NEPHRORRAPHY
upon a woman, it being the first operation made in Eng-
land for floating kidney. The capsule of the kidney was
stitched to tlie margin of the incision, and deep button-
hole sutures were passed through the kidnev, thus fixing
the organ in its natural position. The patient recovered,
and is now well. Dr. Wni. Thomson, of Dublin, has
added another case of
LIGATURE OF THE I.VNOMINATE ARTERY,
the patient living forty-two days. Dr. Arthur E. Baker,
of London, has practised a novel and apparently
SUCCESSFUL OPER.ATIOX FOR VARICOCELE.
After washing the sci-otum thoroughly, he se])arates
the veins of the cord from the vas deferens, then passes a
needle threaded with twisted silk behind the veins, after
which the veins are permitted to drop back, when the
needle is returned in front of the veins, which are thus
secured in the loop of the ligature through the original
opening. The thread is then made tense, and the veins
are brought close to the walls of the scrotum, and the
ligature is well tied, cut close to the knot, and then al-
lowed to return with the veins to the scrotal cavity. The
results reported are such as to commend a further trial
of the operation. Reference was made to two interest-
ing and remarkable operations jjerformed upon the ster-
num and its contiguous relations by Dr. Keuster, of Berlin,
and Prof. Koenig, of Gottingen. They were performed for
malignant growdis, illustrated bold and scientific mani-
pulation, and at the same time indicated how nearly, de.x-
terously handled, a knife and finger may reach the vital or-
gans of circulation and respiration witiiout compromising
life. Whether or not the operations were necessary. Dr.
Peck did not propose to discuss. Im[)ortant additions
had been made to our surgical literature, and special refer-
ence was made to two volumes, one on surgery and one
on anatomy. That in surgery by D. L. Huntingdon,
who succeeds the late lamented surgeon Geo. A. Otis,
has been performed, and the world is now in jjossession
of the most complete record of wounds and injuries re-
sulting from war that has ever been produced. Dr. Har-
rison Allen, of Philadelphia, has produced a part of
what promises to be an excellent treatise on human
anatouiy, including medical and surgical relations.
A real and most substantial advance is being made
in surgery in connection with railway corporations.
Many of the leading lines have introduced into their
system of management surgical departments, the objects
of which are : first, to enable the company to more eco-
nomically manage its aff'airs, and secondly, to insure to
those who are unfortunate enough to receive injuries the
certainty of receiving the most complete surgical skill.
The ultimate benefit which is certain to accrue to the
profession is the accumulation of a vast amount of sta-
tistical information which will be of great service in neural
pathology, because it is a well-known fact that in many
cases the results of alleged railway accidents are not sus-
tained by the systematic expressions of injured tissues
and organs. The instances are exceedingly rare where
pathology which is the result of injury does not fail to
receive conesponding endorsement by the suigeon.
On the other hand, the smgeon often finds hiniself un-
able to satisfactorily interiJret the inharmonious desciip-
tion of symptoms fiunished by the i)erson who sees a
moneyed equivalent at the end of a well-established con-
cussion of the brain or siiinal cord.
The surgical bureaus of these corporations will, by
their collected experience and tabulations, be qualified
so as to be able to furnish much valuable information to
both the judicial and popular tribunals. Then justice to
pathology and rewards to individuals will receive fairer
and more honorable administration.
ADDRESS OF THE CHAIRMAN OF THE SECTION IN STATE
MEDICINE,
by Foster Pratt, M.D., of Michigan.
After mak'ing a few introductory remarks, the sjieaker
said that no noteworthy advance had, during the past
year, been made in either department belonging to this
Section. The Section was established in 1873, ^"'^ h^s
now completed its first decennial period.
Not quite fifteen years have passed since systematic
work in sanitary science began in the United States. As
we compare the sanitary work of the year 1883 with its
beginnings in 1873, there is room for congratulation
throughout the country that during these ten years so
much has been accomplished. What has been accom-
plished ? Sanitary organizations and machinery have been
developed and to a good degree perfected ; men have
been educated to some degree for their special work ;
books, magazines, and sjiecial articles have been indefi-
nitely nuiltiplied, and in all these directions it is clearly
indicated that the popular interest and approval of sani-
tary knowledge and work is well established, and that
the people are desirous of continued work and observa-
tion.
The work of sanitary reform has manifested itself in
the system of
LIGHTING AND VENTILATING OUR HO.MES,
our school-houses, and other public buildings ; and the
earth, and the air, and the water are being investigated
with wholesome suspicion, to clear out their unwhole-
some condition. Municipalities without number are now
supplying themselves with water from purer sources than
formerly, and their accumulated filth is being destroyed or
removed or disinfected, and their new filth is being car-
ried away by properly constructed sewers.
The superstitions of earlier days have been steadily
giving way under improved sanitary condition, and in
towns both large and small there is unmistakable evi-
dence of
THE GROWTH OF SANITARY KNOWLEDGE,
and the people are emancipating themselves from the
thraldom of old views which were but the harbingers of
epidemics and contagious diseases. They have come to
learn that by proper observation of sanitary law they may
escape, to a very great extent at least, the results which
follow these epidemics and contagious affections.
TO AVOID OR PREVENT DISEASE
has come to be recognized as the principal method of
counteracting the influence of these agencies. Prior to
1873 but two Slates in the Union had established State
boards of health, Massachusetts and California. Since
that date others have been added, so that at the present
time thirty-eight States practically proclaim that the
safely of the j)eople is the supreme law ; that public
health is public wealth, and that to promote the health
of the peoi)le is the first duty of ihe statesman.
There are yet other States which have either neg-
lected or refused to enter upon this warfare against dis-
ease. It might be true that superstition, or even the run-
ning fire of derision from jiln-sicians, or evolution, or all
conbined, might delay the end desired in sanitary reform,
but its consummation could not be ))ostponed for any
considerable length of time. Doubtless many years
would i)ass before every State in our Union would be en-
gaged in battling against the ails of humanity. When
we have a health board in every State, and National
board of health with |)roper powers and money, then we
June 9, 1883.]
THE MEDICAL RECORD.
635
may ask what will the Congress of the United States do
when we ask for bread — will the)' give us a stone ? Mis-
souri is the latest recruit to the number of States in
which health boards have been established, and Ohio
and Pennsylvania have made strenuous efforts to join
the majority.
The aid and agency of the American Public Health
Association in producing this result must be recognized,
but above all, and the most important of all agencies to
mould public opinion, is the individual doctor who has
his own personal sphere of action and influence.
He has led the way, and may still continue to demon-
strate the success of the movement, because facts and
reasons have been his ]irincipal weapons of warfare.
Facts have demonstrated that small-po.\ can be pre-
vented, also that isolation with reference to other com-
municable diseases has been a means of counteracting
contagious influences, and facts and reasons on a grand
scale are equally useful. Dr. Pratt then referred to the
work which the late William Farr, in England, began in
1837, and in which he continued to labor, in com[nling
vital statistics, and during thirty years accumulated pile
upon pile, and added demonstration to demonstration,
which finally led to the passage of the British medical
act, the crowning labor of his life. It w^s to Farr's ta-
bles and deductions and demonstrations that could be
traced the basis upon which all of our sanitary structures
in the United States were founded.
After reviewing the influence which statistics on such a
large scale can exert, the speaker said, should be assured
that the average mind is responsive to the ISaconian de-
ductive philosophy. But we shall be asked, What is it
that may be done by State boards of health which
justify their organization and power ? To answer this
question Dr. Pratt referred to the sanitary work which
had been performed in his own State of iVIichigan, and
detailed at some length the work as it appears in the
volumes of annual reports, where appear papers which
were written upon special subjects by men especially
qualified to write upon these subjects— by doctors, clergy-
men, chemists, and editors, who had seen how to utilize
the press for sanitary purposes.
The volume contained vital statistics from one thou-
sand four hundred local boards in the State, and all of
this work and much more had been performed at an ex-
pense of less than si.\ thousand dollars.
Does it pay ? He was sure of tiie answer that would be
given by his audience. But what would be the response
from the people ? • Dr. Pratt then dwelt at some length
upon the influences which should be brought to bear^
upon the people to convince them of the utility of this
work in sanitarj- reform, such as would convince men and
women of its practical value. He said "himself" or
'' herself" because it was a fact that in Massachusetts,
which was the first State to organize a State board of
health, the initial step in sanitary reform was taken by a
lady.
Continuing, the speaker presented the ettect which
sanitary reforms produced on the duration of life. And
it appeared from English statistics that there had been an
increase durmg the last seven years in the length of human
life, among males of two years and among females of three
years and a half; in other words, that male life had been
increased five per cent, m duration, female life more than
eight per cent., and the average increase in the duration
of human life was six and one-half per cent, througliout
England.
He asked the significant question, Is not this [iroof
that sanitary organization is of sufficient advantage to be
accepted and adopted by the masses ? and he hoped that
the time would soon come when it would be so generally
recognized that in newly organized States the people
would be able to prevent the evils which have existed in
the older States.
Are we doctors responsible for any of the tardy move-
ments in this direction ?
He was not about to preach a sermon or read a lecture,
but have we not crippled sanitary work by claiming for
it results that are not yet warranted ? Have we not
urged as facts in sanitary science what in truth is nothing
more than a theory, sometimes a mere theory too?
Our advanced ideas regarding germs, etc., what are
these but stumbling-blocks in the way of laymen and
intelligent legislation ? When we can prove to laymen that
a certain stream is polluted near its source, causes sick-
ness and death to many families, they will believe your
established facts. But how much will they know about
your theory concerning the precise nature and function
of the morbid agency that is being carried by the stream,
especially if it lead you to a somewhat too scientific
method of meeting the question which is of practical
moment, how to purify the stream.
In this country all sects in medicine, like all systems
and sects in religion are equal before the law.
Have some of us been somewhat too arrogant or ex-
clusive in the organization or pro|iosed organization and
management of this public affair? In private relations,
in private practice we hold to the rules of the code that
ignores as unscientific all medical systems based upon ex-
clusive dogmas, but in public when we meet all sorts of
doctors, and their patrons as well as our own, as taxpayers
and citizens to discuss and devise measures of common in-
terest, is not one man's medical theory as good as anoth-
er's ? Dr. Pratt called especial attention to the remark-
able unanimity with which the State Medical Societies,
the American Public Health Association, and the Ameri-
can Medical Association, expressed their approval of the
organization of a National Board of Health. He then
made brief reference to the bacillus and other micro-
organisms, and stated that before sanitation can avail it-
self of these discoveries much must be learned in regard
to the life and propagation of disease-germs ; atmos-
pheric, external, and other conditions must be thoroughly
studied. As medico-legal sanitarians, waiting for firmly
established truth, we must, metaphorically s[)eaking,hold
our breath.
THE TRE.^SURER'S REPORT
showed a balance in the treasury of $i;o3.93. The libra-
rian reported that the number of distinct titles in the
library is 1,817, i" S.Jij volumes, inclusive of pamphlets.
He recommended that the home and foreign journals be
continued, and that two hundred dollars be placed at the
disposal of the librarian for purposes of securing and
binding pamphlets and journals, also that the subscription
of fifty dollars be continued for the Index Medicus. The
report was accepted and the recommendations adopted.
The Committee on Publication, Dr. Fricke, chairman,
made its report, which was received and ordered entered
upon the minutes.
Dr. Eugene GRi.ssuM,of Raleigh, N. C, then read the
REPORT OF THE COMMITTEE ON NOMINATIONS.
President — Austin Flint, New York. Vice-Presidents
— R. A. Kinloch, South Carolina ; T. B. Lester, Kansas
City ; A. L. Gihon, U. S. Navy ; S. C. Gordon, Maine.
Treasurer — R. J. Dunglison, Pennsylvania. Librarian
— C. H. Kleinschmidt, District of Columbia. Chairman
Conunittee of Arrangements— \. Y. T. Garnett, AVashing-
ton, D. C. Assistant Secretary— V). W. Prentiss, Wash-
ington, D. C . Members Judicial Council— V . D Cunning-
ham, Virginia ; H. O. Marcy, Massachusetts ; W. O.
Baldwin, Alabama ; J. S. Billings. U. S. Army ; N. W.
Miller, U. S. Marine Hospital Service ; E. Grissom,
North Carolina; R. N. Todd, Indiana, to fill vacancy;
E. W. Clark, Iowa.
Committee on Necrolog\ — J. M. Toner, Washington,
D. C, Chairman ; R. F. Michel, Alabama ; Wm. Tur-
ner, Arkansas; H. M. Gibbons, Jr., Cahfornia; C.
Dennison, Colorado ; C. H. Pinney, Connecticut; J. B.
Van Velsor, Dakota ; H. F. Campbell, Georgia ; J. H.
6;, 6
THE MEDICAL RECORD.
[June 9, 1883,
Chew, Illinois ; W. Lomax, Indiana ; S. B. Chase, Iowa ;
C. V. Moltram, Kansas ; W. B. Reynolds, Kentucky ;
E. Lewis, Louisiana ; A. J. Fuller, Maine ; C. Johnson,
Maryland ; J. H. Oilman, Massachusetts : W. F. Breakey,
Michigan; F. A. Dinsmore, Minnesota: W.Johnson,
Mississippi; W. H. Mudd, Missouri; R. C." Moore,
Nebraska, H. D. Didama, New York ; (;. F. Welch, New
Jersey ; H. Haywood, North Carolina ; S. Loving, Ohio ;
F. Woodbury, Pennsylvania ; W. E. Anthonv, Rhode
Island ; J. B. Lindsley, Tennessee ; M. D. Knox, Texas ;
O. F. Fassett, Vermont: L. B. Edwards, Virginia; S. L.
Jepson, West Virginia ; E. L. Boothby, \Visconsin ; W.
S. Forwood, U.-S. Army; A. L. Gihon, U. S. Navy;
W. Wyman, V. S. Marine Hospital Service ; F. P.
Porcher, South Carolina ; W. H. Page, New :\texico :
Wni. Lee, District of Columbia : W. Marshall, Delaware ;
^V. H. Carpenter, Oregon.
OFFICERS OF SECTIONS.
^ Practice of Medici7ie — J. V. Shoemaker, Pennsylvania,
Chairman ; W. C. Wileconmi, Secretary. Surgery atid
Anatomy~Q. T. Parks, Illinois. Chairman ; H. O.
Walker, Michigan, Secretary. Obstetrics and Diseases of
Women— T. A. Reamy, Chairman, Cincinnati, O. ; J.
T. Jelks, Arkansas, Secretary. State Medicine — D. J.
Roberts, Tennessee, Chairman ; Franzoni, Washington,
Secretary ; J. Cochran, Alabama : J. J. Mc.\Tmat,
.Arkansas ; W. D. McNutt, California ; Chas. Dennison,
Colorado ; C. W. Chamberlain, Connecticut ; J. B. Van-
velser, Dakota ; J. P. Logan, Georgia ; O. C. Dewolf,
Illinois ; G. Sutton, Indiana ; W. S. Robertson, Iowa ; D.
W. Stormont ; Kansas, J. P. Thompson, Kentucky ; S. C.
Chaille, Louisiana ; S. H. Weeks, Maine ; John Norris,
Maryland; H.J. Bowditch, Massachusetts; F. K. Owen,
Michigan; C. N. Hewitt, .Vlichigan; N. M. Milligan,
New ^[exico; S. Townsend, D. C. ; M. Simmons,
South Carolina ; S. P. Bush, Delaware ; H. Carpenter,
Oregon: H. A. Gault, Mississippi; L Hall, Missouri;
L. Larsh, Nebraska ; E. M. Moore, New York ; E. M.
Hunt, New Jersey ; J. McKee, North Carolina ; T. L.
Neal, Ohio ; R. J. Dunglison, Pennsylvania ; C. H.
Fisher, Rhode Island ; C. C. Fite, Tennessee ; T. D.
Wooten, Texas ; S. W. Thayer, A'ermont : J. L. Cabell,
Virginia ; Moffit, West Virginia : J. T. Reeve, Wiscon-
sin ; J. R. Smith, United States Armv ; J. M. Brown,
United States Navy ; T. H. Bailhoche, L^nited States
ATarine Hospital Service. Ophthalmology, Otology, a?id
Laryngology — J. J. Chisnolm, Baltimore, Chairman ;
Thompson, Indianapolis, Secretary. Diseases of Chil-
dre>i—\\'m. Lee, Maryland, Chairman ; W. R. Tipton,
New Mexico, Secretary. Oral and Dental Surgery— T.
W. Brophey, Illinois, Chairman ; J. S. Marshall, Illinois,
Secretary.
Place of Meeting, 1884 — Washington, D. C, first
Tuesday in Maw
The report was also accompanied by the statement and
a letter from Dr. A. L. Gihon, that the rumor that he
was unfavorable to the Code of Ethics was without foun-
dation, and that he was unciualifiedly an adherent of the
present Code and should be governed by its require-
ments.
On motion by Dr. W. S. D.\vis, the report was received
and adopted.
Dr. Didam.a, of Syracuse, then read the following letter
from Dr. Austin Flint, addressed to him as a meniber of
the Committee on Nominations :
" Circumstances render it necessary for me to return
early to-day, June 7th, to .\ew York. ' Will you kindly
express to our brethren, the Members of the .'\merican
Medical -Association, with my sincere thanks, an assurance
that 1 thoroughly appreciate the great honor which has
been conferred on me. I accei)t the honor, feeling assured
that I may confidently expect co-operation and indul-
gence in my efforts to fulfil the duties which it involves."
The Association then adjourned, to meet at 9 a.m.
Friday.
Friday, June Sth — Fourth Dav.
Association called to order at 9.30 a.m. by the Presi-
dent. Prayer by Rev. C. T. Collins.
.Amendment providing for representation from Medical
Bureau United States Indian Service was laid upon the
table.
Dr. Toner withdrew his proposed amendment that
the office of Permanent Secretary be vacated.
The proposed amendment to allow the Chairmen and
Secretaries of Sections to add earnest workers, and that
the Librarian be made a permanent officer, was laid upon
the table.
The proposed amendment to allow permanent mem-
bers to vote gave rise to discussion, and finally the whole
subject was indefinitely postponed.
Dr. D-wis, from the Judicial Council, reported that the
petition of D. W. Day be returned, with leave to sup-
plement the ])aper with a written statement of the charac-
ter of the new evidence he proposed to introduce. Fur-
ther, that in the case of D. H. Goodwillie, of New York,
the Council decided, that his registration be cancelled,
and the annual dues be returned.
Dr. Turnbull offered a resolution that the Legisla-
ture of each State be petitioned to pass
laws requiring railroad e.mployees to be exam-
ined
regarding their hearing before taking charge of any rail-
road train. Referred to Section on Otology.
Dr. Pr.att offered a resolution, that being impressed
with the importance of the Parliamentary Bills Commit-
tee of the British Medical Association, the American
Medical .Association urge upon Congress the subject of
competent medical sanit.^rv service on bo.\rd all
transatlantic ocean vessels :
that a committee of five be appointed to report on the
subject at the next Session. Adopted.
Dr. Bell, of New York, offered a resolution that all
papers hereafter offered, except the address of the Pres-
ident and the Chairmen of Sections, shall be first re-
ferred to the Trustees of the Journal for classification
and appropriate reference. This gave rise to discussion,
and finally was tabled.
The President announced as the committee to further
Dr. Pratt's resolution, Drs. Bell, Gibson, Marcy, Quim-
by, and H. H. Smith.
Dr. Brodie moved resolutions of respect to the mem-
ory and labor of the late General J. K. Barnes. Adopted.
Dr. Keller offered a resolution that in the near fu-
ture, cremation will become a necessity in large cities,
and populous districts in the country, and asked that it
be referred to the Section on Hygiene. Carried.
The President appointed the following delegates to
the Canadian .Medical Association : Drs. W. Brodie and
H. L. Walker.
Dr. Toner moved the thanks of the Association to
the Secretary and Treasurer for the efficient and satisfac-
tory manner in which they have discharged their duties.
Adopted.
Dr. Blount, Chairman of the Section on Diseases of
Children, was granted the privilege of submitting his ad-
dress without reading.
Dr. Quimbv offered the usual resolution of thanks to
the Committee of .Arrangements and citizens of Cleve-
land for their enlertainmeiUs, which was unanimously
adopted.
The President invited the Vice-Presidents elect to
the platform, made a few remarks complimentary to the
President elect, bade the .Association an affectionate
farewell, after which Dr. Lester, of Kansas City, Sec-
ond Vice-President, took the Chair, and declared the
Association adjourned, to meet on the first Tuesday in
May, 1S84, at Washington, D. C.
June 9, 1883. J
THE MEDICAL RECORD.
637
AMERICAN SURGICAL ASSOCIATION.
Fourth Annual Session, held at Cincinnati, Ohio, May
■j,\, June I and 1, 1883.
(Special Report for The Medical Record.)
The fourth aniiiial meeting of the American Surgical
Society was convened at 10 a.m., July 31st, at College
Hall, Cincinnati.
Prof. S. D. Gross, M.D., of Jefferson College, Phila-
delphia, presided, and Dr. J. R. Weist, of Richmond, Ind.,
performed the duties of Secretary.
The President read a brief
ANNUAL address,
congratulating the Association upon its rapid growth
and present prosperity, upon the fact that there had been
no losses by death during the year, and recommending
the adoption of an amendment to the by-laws increasing
the limit of membership from one hundred to one hun-
dred and fifty, and also enlarging the Council from four
members to seven.
Dr. p. S. Conner, Chairman of the Committee on
Reception,, delivered a brief
ADDRESS OF WELCOME,
and invited the Fellows to attend the annual banquet
at the Gibson House at S.30 p.m., June ist, at the close
of the second day's session.
The President asked that the Council act at once
upon nominations for fellowship, in order that the new
members might take jsart in the meetings.
It was announced that only eleven vacancies existed.
In the absence of Dr. Cole, one of the members of the
Council, Dr. Moore, of Rochester, was appointed tem-
porarily to act in his place.
A letter was read from the venerable Prof. Willard
Parker, acknowledging the honor conferred upon him
by the Association in electing him to fellowship, which
he accepted with pleasure. From the
treasurer's report
it was shown that the Association has at present on
hand a balance of $2,270.31. Drs. Mears and Benham
were appointed auditors of this report.
HAVE WE ANY THERAPEUTIC MEANS, AS PROVEN BY EX-
PERIMENT, WHICH DIRECTLY AFFECT THE LOCAL PRO-
CESSES OF INFLAMMATION ?
C. B. Nancrede, M.D., of Philadelphia, Pa., read a
paper on the above, of which the following is an extract :
Careful study of the essential processes of various mor-
bid conditions, has often led to the theoretical employ-
ment of therapeutic measures, which by their apparent
practical use have confidently encouraged their future
employment.
If we find by experiment that our a priori therapeutics,
when experimentally apiilied in the case of animals, ac-
tually produce the precise effects which we have pre-
determined will probably prove efficacious, then we can
hardly go astray in confidently applying similar treatment
to the human subject. If we find clinical discrepancies,
it must be our aim to ascertain the exact limitation of
the remedy for good or evil, and the precise indications
for its employment, instead of thrusting it contemptuously
aside when we fail of the expected result, the failure be-
ing probably our faulty method of applying the treatment,
and not self-inherent. Upon the other hand, we must al-
ways hold before our eyes the experimental mirror of
what has been and can be effected, and not expect to do
what we have demonstrated is an impossibility.
The paper was avowedly written in advocacy of blood-
letting in general, but chiefly of the local abstraction of
blood. It referred only to the early stages of inflam-
mation. No direct effect can be exerted upon the tissue-
changes of that process when the inflamed part has re-
turned to its fcetal state, was merely embryonal tissue,
only a step farther from which was pus.
The writer enumerated the vascular changes, as de-
scribed by Burdon-Sanderson, but said that, contrary to
expectation, the circulation at the outset is accelerated
in the dilated vessels, but the rate soon became normal
and was succeeded by a slowing, then an oscillatory
movement, temporary stagnation, again a resumption of
the flow, and finally permanent stasis with the crowding
of the vessels, especially in the veins, with cell elements,
so that the previous clear space existing along the walls
of the arteries can no longer be detected. The obstruc-
tions seemed to consist solely of red cells, which were so
closely packed as to render " their individual forms
. . . scarcely distinguishable." Free diapedesis of
the white blood-cells now took place, with exudation of
liquor sanguinis, both processes having commenced when
incipient stagnation set in. In this connection he re-
lated the experimental conclusions of Ryneck and H.
Weber.
On account of the stimulating effects of the exudation
the cells of the part returned to the fuetal state and i)us
resulted. The whole process of inflammation was sum-
marized in the words of Burdon-Sanderson. The white
blood cells in the early stages of inflammation are slug-
gish and then cease to move in the absence of oxygen,
and were active in proportion to the amount of that sub-
stance present. It was also indisputable that the red
cells were the main carriers of oxygen, and that if their
numbers were relatively increased to the fluid in a given
bulk of blood, especially if, as in inflammation, both the
necessity and capability of the cells of the tissue making
use of the oxygen were removed, at once an excess of
oxygen, i.e., an increased amoeboid action of the white
cells, not only was jjossible but became a necessity.
The theoretically perfect remedy for incipient inflam-
mation must comprehend the following eftects : it must
either lessen the vis a-tergo of the heart's action so as
to prevent injury to the vascular wall by over-distention
and the consequent outpouring of liquor sanguinis ; it
must prevent such an ingress of blood into the affected
area as would produce the excess of oxygen, the migra-
tion of cells, the blocking up of the lymph-spaces, etc.,
or, what would practically amount to the same thing,
lessen the difficulty of escape on the venous side.
The Doctor then made his conclusions as referable to
treatment of traumatic inflammations.
The discussion was opened by Dr. Campbell, of
Augusta, Ga., who strongly favored blood-letting. He
taught his students the value of blood-letting, which he
placed next to morphia in the list of therapeutic agents.
He advocated its value in puerperal convulsions, and
thought that instead of there being a state of anwmia of
the brain, the woman in child-bed was full of blood, that
by blood letting we relieved congestion of the kidney on
which the convulsion depended. He always had and
always would carrv his lancet.
Dr. E. M. Moore, of Rochester, N. Y., contended
that we most needed a means of finer diagnosis, and re-
lated his experience of epidemics of pneumonia and
cerebro-spinal meningitis which occurred in his neighbor-
hood in 1848, when \ft advocated sustaining treatment
instead of blood-letting, in opposition to the general
opinions of those days.
Dr. Post, of New York City, was in favor of blood-
letting in a certain pronortion of such cases.
Dr. Gunn, of Chicago, also supported such a view, as
did also Dr. Briggs," of Nashville, Tenn., and Dr.
Gregory, of St. Louis, Mo.
Dr. Kinloch, of Charleston, S. C, believed that
fewer errors were committed on the side of supporting
treatment than on that of the depleting method.
Dr. Dawson, of Cincinnati, O., asked why, if blood-
letting was such a remedy, have we abandoned it ; why,
if we advocate a remedy so strongly, do we not use it ?
6.:;8
THE MEDICAL RECORD.
[June 9, 1883.
He asked some of the advocates how many times in a
year they bled a patient.
Dr. N.^xcrede made a few corrections of misconcep-
tions entertained by some of the members. He repeated
the essential phenomena of inflammations ; said he re-
ferred only to traumatic inflammation. He did not
claim that after tissue changes had occurred the process
could be aborted, but, on the contrary, bloodletting
after such time had an injurious effect ; but that when
stasis had occurred, or was beginning, it could be made
to disappear, as he had observed. If the heart was weak,
he would stimulate it to drive the blood through the
part. The good effects were confined wholly to in-
flamed area.
Paper ordered referred to Committee on Publication.
At Thursday's afternoon session Dr. John H. Packard,
of Philadelphia, read a paper containing a report of a
reamputatiou at the hip-joint, secondary hemorrhage with
ligation of the ]3riniitive iliac artery.
esm.-\rch's bandage as applied to traumatic aneu-
risms.
Prof. T. G. Richardson, of New Orleans, related
the following history of a case :
The patient received a pistol-shot in left thigh, Octo-
ber, 1876, in front and to the inner side, four inches
above jiatella, ranging downward, immediately across
the track of the femoral artery, emerged at the u|)per
angle of popliteal space, with no serious hemorrhage.
The wound healed in a few weeks — no lameness or
other discomfort resulted. In April, 187S, the patient
discovered a soft deep-seated tumor, which grew for four-
teen months, when it had attained the size of a goose's
egg. There was no discomfort. But after some time,
the limb below the tumor became suddenly one day
numb, swollen, and congested, and continued until eleva-
tion, frictions, and heat had been resorted to for twenty-
four hours.
He consulted his physician in May, 1879, ^^''lo discov-
ered a fusiform, pulsating soft fluid tumor, a traumatic
aneurism, and then placed the patient under Prof Rich-
ardson's care. The patient was admitted to the hospital
in New Orleans. The doctor then applied pressure by
Esinarch's bandage, fingers, and tourniquet. After seven-
teen hours, there being no signs of coagulation taking
place, and the patient being much exhausted, the treat-
ment by compression was omitted.
A month after, the patient's general condition being
favorable, ligation was determined u|)on. Months after
ligation the tumor was still fluid. Dr. Richardson then
proposed to aspirate the tumor and close the sac by some
stimulating fluid, but the patient, suffering no inconveni-
ence from the tumor, refused instrumental interference,
and returned to his usual business. The patient continued
well forsome time, until December, 1881, when suddenly
a most alarming condition arose ; the veins of the pa-
tient's foot and leg were in a condition of thrombosis,
and the skin gangrenous. Amputation was then made,
and during the operation the sac of the tumor was acci-
dentally cut, when a profuse discharge of dark bloody-
looking fluid occurred. The patient did badly, the flaps
after twenty-four hours became gangrenous, and the pa-
tient died. An autopsy was made, 'i'he tumor measured
seven to eight inches in length and four inches in breatlth ;
the artery for two inches immediately above was not
obliterated. Above that point the artery was merely a
fibrous cord.
The sac did not communicate with the artery be-
low. There projected into the tumor another smaller
tumor which communicated with the femoral vein. The
doctor then made a summary of the interesting points in
the case.
I. History. — a. Shot-wound, October, 1876. No
serious hemorrhage, b. Tumor discovered, .April, 1878,
an interval of eighteen months, c. .Mlenlion of phy.
sician first called, May, 1879, two and one-half years.
d. Esmarch's bandage unsuccessful, June, 1879. '■ ^'''
tery ligatured, July, 1879. /. Thrombosis and gangrene,
necessitating amputation, December, 1881, nearly eigh-
teen months after ligation.
ir. Pathological Anatomy.— a. E.\pansion of the artery
to form the tumor, b. Failure of ligation to aft'ect co-
agulation, c. No communication of sac with the artery
below, d. Nature of the blood in the sac. e. Intracystic
protuberance and its communication with the femoral
vein.
He then exhibited a diagram of the popliteal artery
and vein, also the pathological specimen, and asked the
assistance of the Association in determining the exact
nature of the lesions, expressing himself as in favor of an
arterio-venous aneurism.
The President asked if all the coats of the artery had
been traced into the tumor.
Dr. Richardson said he had not determined that
point.
The papers were referred to Committee on Publica-
tion, and a special committee of three were appointed to
examine the specimen and report at the next meeting.
It was ordered that all discussion of the paper be post-
poned until after the S[)ecial committee reported on the
return of the specimen.
THE USE of trephine IN TRAU.M.VnC EMPYEMA ASSO-
CIATED WITH THORACIC FISTULA.
Dr. Richardson also presented the following : Chronic
suppurating pleuritis with an imperfect fistulous outlet,
external or bronchial, is not an uncommon result of
gunshot or other penetrating wounds of the thoracic
cavity ; and it is no secret that the resources of surgery
have not heretofore ottered much encouragement to the
patients. In the majority of cases there is a contraction
or sinking in of the injured side from inflammatory
changes, a constant discharge of fetid pus, persistent
cough, fevers, and more or less rapid exhaustion of
strength, usually terminating fatall}'. Two main diffi-
culties were encountered in the treatment : first, insuffi-
cient drainage ; and second, permanent separation of the
lung from the chest wall. To those two points he de-
sired to call attention.
First. — The serious obstacle to drainage in these cases
was not the stenosis, but the approximation ot the ribs
consequent upon the sinking in of the chest wall. Owing
to the shortness and greater degree of fixedness of the
first four or six ribs, very close approach of their adja-
cent borders was seldom seen except in quite young sub-
jects.
But in other situations where greater latitude of
motion existed, more especially along the lateral planes
of the thorax below the fifth or sixth ribs, it was not rare,
in the cases under consideration, to find the adjacent
edges closely applied, and sometimes even slightly im-
bricated. It was impossible, under such circumstinces,
by any ordinary means to preserve satisfactory drainage,
however extensive it must be made in an intercostal
space. The effect of the entrance of air into undrained
pyogenic sacs was familiar to every one, and in no other
part of the body, not excepting pelvic and psoas ab-
scesses, was the deconii)osition of the contained fluid
more complete or more certain to result in the death of
the patient by the production of pyaemia, or more slowly
by consuming irritative fever.
Second. — The obstacle to the closure of the pus cavity
arising from compression of the lung by inflammatory
membrane, and the consequent inability of this organ
to expand to its original dimension, was not of itself
detrimental to the life of the patient. Pyogenic surfaces
when freely exposed to air, and at the same time
sufficiently protected to prevent desiccation, more es-
pecially if kept moist by an antiseptic fluid, seldom gave
rise to pyajmia or irritative fever.
As the great danger in these cases depended mainly
June 9, 1883.]
THE MEDICAL RECORD.
639
upon the want of suitable drainage, it was to the best
method of effecting this purpose that he desired to draw-
attention. The surgeon's only resort was the removal of a
portion of one or more ribs. This might be accomplished
by one or other of the Ordinary nietliods of bone-resec-
tion, but it may be best accomplished by the use of a
large trephine. The idea of trephining the thora.x was
not new. It was said to have been proposed by Hip-
pocrates, and in more modern times had been modified by
Reybard, and adopted by Recamier, Trousseau, and
others.
As well as Dr. R. could ascertain, this operation
originated in New Orleans, and was almost peculiar to
that city, where it had been frequently performed during
tlie past twenty years with increasing favor.
To the late Professor Warren Stone, Sr., M.D., was
undoubtedly due the credit of having first performed this
or any other method of resection of the rib for empyema.
The Association then adjourned to the amphitheatre of
the Ohio Medical College, to witness a demonstration
on the cadaver of ligating the primitive iliac artery and
the operation of lumbo-colotomv, by John H. Packard,
M.D., of Philadelphia, Pa.
Dr. B. a. Watson, of Jersey City, read a paper on
lister's system of antiseptic wound treatment
VERSUS its modifications,
in which a historic sketch of the developments of the
modern method of treating wounds, and a consideration
of the effects of the antiseptic treatment was entered
into, with a full indorsement of the Listerian method,
especially as modified by Dr. Markoe, of New York.
The details of several cases were given, showing the ad-
vantages of free drainage from wounds, accurate coap-
tation of surfaces, and the use of carbolic acid solution
in suppurating cavities, and their distention.
The discussions were opened by Dr. Packard, who,
on behalf of himself and other surgeons of Philadelphia,
repudiated Listerism, had contrived to get along without
it, and would continue to do so.
Dr. Post, of New York, said the details of Listerism
were not followed by himself nor by other surgeons of
New York.
Dr. a. Vanderveer, of Albany, N. Y., repudiated
Listerism on behalf of himself and other surgeons of
Albany, N. Y., but believed that the most important
point was thorough drainage.
Dr. Richardson, of New Orleans, also repudiated
Listerism on behalf of himself and other surgeons of New
Orleans.
Dr. McGraw, of Detroit, Mich., referred to
THE dangers of CARBOLIC ACID,
and related the history of a fatal case, the patient, a boy,
dying comatose.
Dr. Post asked as to the condition of the. pupils.
Dr. McGraw replied that the pupils were strongly
contracted. He was unable to obtain any urine, as the
boy passed his urine in bed.
Dr. Mastin, of Mobile, Ala., and Dr. Campbell,
also spoke against Listerism.
Dr. Dawson thought cleanliness and drainage were
the only things to be regarded. Listerism in all of its
details had been tried in Cincinnati, but he thought with
no better results than without.
Dr. Nancrede still favored Listerism.
Dr. Prince, of Springfield, III, thought Listerism in
its details unimportant, but that the principles of Lis-
terism were impregnable.
Dr. Kinloch, of Charleston, S. C, spoke strongly
against carbolic acid.
Dr. Watson said that he had not implied that Lister-
ism in its details was accepted by the surgeons of Ame-
rica. He was, in fact, aware that Listerism had made
but little progress in the United States, but that it had,
nevertheless, a great modifying influence on the treat.
ment of wounds, and that the opposition to Listerism
came principally from those who had never tried it or
had never seen it.
The Association was again called to order by the Presi-
dent at 10 A.M. on Friday, and went immediately into
executive session. The following new members were
elected : r /-i •
Dr. McCann, of Pittsburg, Pa. ; Dr. Fenger, of Chi-
cago ; Dr. Taylor, of California ; Dr. Peck, of Iowa ; Dr.
Dandridge, of Cincinnati.
THE VALUE OF EARLY OPER.\TIONS IN MORBID GROWTHS
was the title of a paper by S. D. Gross, M.D., LL.D.
The value of early surgical interference in morbid
growths, especially malignant, has long been recognized
by writers and teachers, but not with such a degree of
force and emphasis to which it is entitled.
The great reasons for the removal of tumors in the
early stages of their development may be thus stated :
I, the less risk of shock and of hemorrhage ; 2, the more
effectual riddance of the diseased structures ; 3, the di-
minished probability of septic;i3mia, or blood-poisoning ;
4, the avoidance of unsightly scars ; and 5, the less risk
of a recurrence of the morbid action, either at the^ seat
of the operation or in other parts of the body. These
propositions are so self-evident that any formal discus-
sion of them seems to be out of place.
The fact is now generally, if not universally, admitted
that all morbid growths, whether benign or malignant,
are of local origin. There is unquestionably occasionally
a hereditary tendency to the development of morbid
growths. We see this in a remarkable degree displayed
fn warts and sebaceous cysts. I state, as another incon-
trovertible proposition, that all morbid growths, tumors,
or neoplasms are the product of perverted nutrition, in
which the comparatively few cells native to the part are
replaced by colonies of young cells, of the latter of which
the new product is essentially composed. ^
All morbid growths are developed, directly or indi-
rectly, under the influence of intlanmiatory action, the
result of external injury, or, as is more frequently the
case, of some mechanical obstruction, causing in the first
instance congestion of the part, and this in turn inciting
action and inflammation, one of the most simple of all
tumors, the sebaceous, is formed under the irritating in-
fluence of its own natural secretion, retained by the
closure of its natural outlet. Obstruction of a lacteal
duct is, there is no doubt, a frequent starting-point of
scirrhus of the mammary gland. There are some tumors
whose distinguishing features are so well marked, even in
their earlier stages, that he who runs may read. On the
other hand, great difficulty often presents itself sufficient
to jierplex and puz,^le the wisest head.
Unfortunately few of the cases of malignant disease,
either in our rural districts or even in our larger towns,
come under our observation in time .for early surgical
interference. The mischief is effected before the time of
observation.
There are comparatively few reliable ready or trust-
worthy diagnosticians. Diagnosis is a high art, and
'the profession as a body are not sufiiciently familiar with
it to render it at all times, or even in a minority of cases,
properly available at the bedside. It is, of all the arts
in our profession, the one which demands the greatest
amount of refined culture, experience and tact ot an or-
dinary type, but of the highest possible type. The one
thing most culpable in the organization of some medical
colleges is exclusion from its studies of pathological
anatomy. Just in proportion as our knowledge of morbid
structure is positive, accurate, and comjirehensive, will
be the probability that we will become skilled diagnos-
ticians, and conversely. Knavery, dishonesty, and self-
conceit are found in all ranks of life, and among all
classes of men. There are " quacks " in every profes-
sion. A patient laboring under a serious morbid growth
640
THE MEDICAL RECORD.
[June 9, 1883.
may consider himself as peculiarly fortunate if, in the
early stage of his troubles, he fall into the hands of an
intelligent, upright, and conscientious surgeon. Such a
man will not hesitate to express his honest convictions.
If the case be beyond his experience, he will not be
ashamed to recommend his patient to some other more
experienced surgeon, and to lose no time. The knave
will do all he can to mislead his patient and lull his fears
by telling him his disease is of no importance. He is
afraid to tell the truth, lest he lose prestige and thus
damage his practice. It is men of this stamp (and their
name is legion) that do the damage ; ignorant, they allow
the case to proceed from bad to worse.
In carcinoma of the breast, the enlightened surgeon
does not wait for involvement of the axillary glands, or
serious structural disease. He urges the importance of
prompt interference. Every surgeon knows what the result
of excision of the mammary gland in ordinary cases of
cancer is ; how rarely the disease is completely removed,
and how few women live beyond eight, ten, or twelve
months after such interference. In all such cases, can-
cer cells have invaded the neighboring structures beyond
the knife and serve as foci of new neoplasms.
There is a class of patients, the subjects of neoplasms,
who, influenced by timidity or mock modesty, wilfully
deceive themselves. They are fully aware that there is
some disease going on somewhere, but they are afraid to
have the matter properly investigated — when they do ap-
ply for aid, all that can be done is of the most transient
kind. What has been said is true alike of carcinoma, of
sarcoma, or even of benign growths. The golden rule
in these operations is to perform the work as thoroughly
as possible. If this cannot be done it is better in many
cases, if not in all, not to meddle with the growth at all.
All secondary developments, as enlarged and indurated
glands, should be removed in immediate succession. All
sarcomatous neoplasms are, as a rule, dangerous forma-
tions, however early subjected to the knife, not so much
on account of any inherent tendency to recurrence after
extirpation, as from their liability to attack other parts
of the body from causes similar to those which gave rise
to the primary disease. The worst of all sarcomas is
the round-cell.
What should be the rule of action of the surgeon in
cases in which perhaps several operations have already
been performed, there is a large ulcerated surface, at-
tended with excessive pain and a large quantity of the
foulest discharge ? The only rational tiling to be done
is surely to sweep away the whole mass of the disease so
far as possible, and then treat the wound and the system
upon general principles. Such a procedure is the only
feasible one of relieving pain, moderating suppuration,
and of making the patient comparatively comfortable.
Death under such circumstances is generally hailed as a
welcome visitor. In malignant disease of an extremity
attended by such a state of things, the proper remedy
would, of course, be amputation without any ulterior
hope of a cure. What has been said respecting early
surgical interference in malignant and other morbid
growths applies with equal force to many other surgical
affections, as well as to diseases in general.
Dr. Post referred to the value of early removal of tu-
mors in preventing their degeneration into malignancy.
Dk. AIooRE said that the [uinciples in the paper ad-
mitted of no discussion.
Dr. Gregory remarked that developing cells were
more liable to be transferred than the fully developed, large
irregular cells, with dry matrix. He said that inflamma-
tions were reparative processes ; there had always been
some antecedent injury ; that tumors were the only things
to which the word idiopathic could be pro[)erly applied.
He doubted the propriety of early operations in all cases,
and said the success of abdominal surgery in this country
was not such as called for early operations. When his pa-
tients were useful and not uncomfortable, he put off
operating as long as he could. He related a case where
he had delayed the operation for a long time ; when he
operated, removed both diseased ovaries, and the patient
recovered.
Dr. Norris, of iVashington, D. C, then read a paper
on
DISLOCATION OF ASTRAGALUS,
and exhibited casts and specimens illustrating the same.
Dr. Gregory had a case of complete dislocation of
the astragalus, which was very easily reduced.
Dr. Weist had seen a case of incomplete dislocation
of astragalus, of twenty years' standing.
Dr. Moore had seen a case of dislocation, which after
persistent efforts was reduced. He had seen two cases
with fracture which could not be kept reduced.
Dr. Dawson had a case of simple dislocation, when a
young snrgeon, which he failed to reduce. He had pro-
posed to divide the tendo-Achillis, which was refused.
He thought Dr. Gregory would not meet with another
case so easy to reduce when the ligaments were torn;
the case was similar to a fracture, but when they were
not torn the bone was held firmly tixed in its new posi-
tion, and reduction is very difficult ifnot impossible with-
out a cutting operation.
Dr. (tUNN had not seen a case of simple dislocation,
but had had a case of fracture with dislocation forward.
No necrosis of the fragment ; had made excision with
fair result.
Dr. p. S. Conner, of Cincinnati, next read a jiaper
on
excision of the tarsus.
He remarked that the foot, in its proximal half at
least, was peculiarly liable to disease. By its situation
it was subject to violent jars and severe twists ; trau-
matic synovitis was of freipient occurrence. Its skeleton
being princi|5ally cancellous tissue and its periosteum
blended so intimately with the ligaments of its numerous
articulations, and was crossed by numerous tendons,
and overlain by a definite though not very thick sheet
of connective tissue, inflammations were readily ex-
tended by contiguity. In strumous subjects, slight trau-
matisms might be followed by sim[)le inflammation, or
by deposit of tubercle. Specific periostitis and gumma
might produce the same effects here as elsewhere. Ex-
ternal violence, compound fractures, might be the cause
of caries or necrosis. The disease might affect the whole
tarsus ; when extensive, rest, compression, stimulant, or
sedative applications were very likely to fail. When ab-
scesses had formed and numerous sinuses existed, surgi-
cal interference was limited to, i, opening the abscess
cavity and the informal removal of carious or necrosed
tissue with or without deep cauterizations or other local
stimulant applications ; 2, amputation, usually at or above
the ankle-joint ; and 3, the methodical excision of such
and so many of the tarsal bones as were unhealthy. The
first method in the less severe cases might be expected
to often result favorably. Amputation through the leg
or at the ankle joint had been and still was preferred by
surgeons generally to any more conservative method,
was less likely to be fatal from septic infection or exhaus-
tion, and the patient was better able, with an artifi-
cial limb, to earn a livelihood. It was claimed that
it might cause death at first, or later that the disease
would very likely recur in the i)arts unremoved, and even
if successful as respects life would leave an useless foot,
if not one that was an incumbrance.
The three questions to be considered were :
First. — Is excision a safe operation or at least at-
tended with no greater mortality than the alternative
amputation.
Second. — Is it likely to put an end to the disease or is
recurrence of the disease in the unremoved bones of the
foot to be expected ?
Third. — Will the i)atient after recovery from the oper-
ation be left with a serviceable foot ?
Of the 106 cases collected II died (10. 3S per cent.),
June 9, 1883.]
THE MEDICAL RECORD.
641
but two if not three of these died from causes unconnected
with the operation within less than a month. Out of 61
cases in which the aUernative was an ankle-joint ampu-
tation, 4 died (6.55 per cent.), and out of 45 cases in
which a middle tarsal removal might have been made 5
died (11. 1 1 per cent.). The Syme and the Pirogoft" am-
putation mortalities for caries were about six to eight per
cent., and the Choiiart, perhaps, four per cent. While
the mortality of the operation in young subjects was very
much less, it need not be confined to them alone. Of
77 cases in which the ages were given, 27 were under fif-
teen years, i died (3.7 percent.) ; 17 between fifteen and
twenty-five years, i died (5.88 per cent.) ; 33 were over
twenty five years, 6 died (18.18 per cent.). The disease
recurred in only two cases. The most important ques-
tion of the three is that in reference to the functional
value of the saved foot. Of the 106 operations 10.3S
per cent, resulted fatally. Of the 93 cases, the end re-
sults of which are known, 10.75 P^r cent, were failures,
6.45 per cent, left the subjects able to walk with a cane
or crutch. In 22.65 per cent., after complete cicatriza-
tion, there was no pain or tenderness, little or no limp,
and the individuals were able to earn a living ; and in
47.31 per cent, the result was so good that the gait was
not a bad one, the support of the body was firm, and
locomotion was so easv and perfect that the individuals
coiild, without special fatii^ue, walk long distances. All
hail a better weight-supporting and useful foot than an
artificial foot after a leg amputation could be.
At the Friday afternoon session Dr. E. M. Moore, of
Rocliester, N. Y., read a paper entitled
SOME QUESTION.S WITH REFERENCE TO INTRA-CAPSUI.AR
FRACTURE OF THE FEMIJR.
The points in the paper were put in the form of ques-
tions :
First. — Is not the cause of fracture of the neck of the
thigh-bone, whether intra- or extra-capsular, almost uni-
formly that of a blow upon the trochanter?
Second. — Is not the preservation of the periosteum of
the neck called in connection with the reflected capsule,
the cervical ligament, although only partial, the common
rule and not the exception ?
Third. — Does not this condition, if preserved, supply
abundant nutrition to the upper fragment sufficient to
entile rejiair ?
Fourth. — Is not the outer layer of what is called the
periosteum of the neck a rudimentary organ ?
Fifth. — In reputed cases of absorption of the neck
after blows upon the trochanter, said to be without frac-
ture, is it a reasonable, much less a perfect induction
to infer a similar result, when the changes of condition
are similar in one point, and dissimilar in every other to
those of inflammation without a blow ?
Sixth. — Should not the induction read thus: The
head of the femur and the acetabulum, not being altered,
the shortening of the neck could not be from the inflam-
mation resulting from the blow.
Seventh. — Finally, does not the practice of modern
surgeons produce a vastly improved result in the cases
treated by them as com|)ared with the methods of the
last generation ?
The doctor then passed some specimens which were
taken from patients within a few days after death.
It was ordered, that, as Dr. Senn, of Milwaukee, Wis.,
had a paper on the same subject, the discussion of Dr.
Moore's paper be postponed until after Dr. Senn reads
his paper.
Dr. Senn then presented his paper, illustrated by
specimens. At the conclusion of Dr. Senn's paper, the
President complimented both papers very highly, then
called for discussion.
Dr. Post said the most important principle in these
cases was to make no eftbrt by forcible movements to
clear up the diagnosis, related a case in his experience
where desire to clear the diagnosis broke up the impac-
tion. Said where at first tlie shortening was less than
an inch, and in the lapse of time becoming greater,
until it may be two or two and one-half inches, thought
this indicated interstial absorption.
Dr. Gunn then related a case that came under his
observation in consultatipn, where there was the usual
symptoms of fracture of the femur within the capsule.
The patient recovered with bony union, with some short-
ening, but was able to walk well with a cane. The limb
was measured some four or five years later, with about
two inches shortening.
Dr. Vanderveer asked Dr. Senn if he had used the
splint which he had exhibited. He also related the his-
tory of case, where, the specimen after boiling, there had
been as complete separation of the epiphysis of the head
of femur as would occur in a subject fifteen yearsof age, the
patient in this case being sixty-five yearsof age. Thought
that better results would follow from the simple treat-
ment of Dr. Moore, than from that of Dr. Senn.
Dr. F"ifield, of Boston, Mass., among other things, said
the time for splints was passed. The best results were
obtained from position, even in the cases of Colle's frac-
ture this had been demonstrated. He paid a high com-
pliment to Dr. Moore. Related a case where after
fracture, the head and neck of the femur had entirely
disappeared.
Dr. Nancrede said he had often seen cases where
the attachment of the ligament was considerably in ad-
vance of its usual attachment.
Dr. Gunn said he had seen in a cadaver, a vascular,
thick frenum extending from the posterior side of the
joint to close up to the head, so that had a fracture oc-
curred, even quite near the head, the upper fraginent
would have been richly supplied with blood.
Dr. Kinloch, while complimenting Dr. Senn, said
that practical surgeons demanded that the advance of
pathology must show practical results. He asked if Dr.
Senn had demonstrated the practicability of his new
methods of treatment upon the cadaver. He doubted if
surgeons could make a diagnosis so exact as to cut down
upon the neck of the femur and pin the fragments together,
lie said if Dr. Senn could do this he would admit his
pathology, and adoi>t his methods of treatment.
Dr. Campbeli- thought that practical surgeons ought
not to give up their old methods of treatment which they
had seen produce good results, for any new methods ; not
to make a compound out of a simple fracture.
Dr. Senn in reply, said he had not tried his modified
splint, as he had not yet had a case since making the
splint, also in reply to charge of cruelty of his splint, said
it was more cruel to treat old patients with this fracture
by the old method of confining them to bed, on account
of which so many developed disease of lung. Said with
his new splint the patients could turn in bed or even get
out of bed.
The President said that eversion of the foot and
slight shortening were not reliable symptoms of intra-
capsular fracture of the hip. That the eversion may
take place from simple contusion, and the slight shorten-
ing due to unevenness of the pelvis. He said he could
not see in the specimen which Dr. Senn presented as a
specimen of impacted fracture within the capsular any
evidence of fracture, but that the specimen exhibited only
senile changes.
The Association was called to order on Saturday
morning by the President. The special
committee on pathological specimens
then submitted the following report :
First. — That the original injury consisted of a contu-
sion of the walls of both the artery and vein, with conse-
quent adhesion at the site of injury.
Second. — That the inflammatory processes culminat-
ing in the adhesion of the two vessels resulted in such a
642
THE MEDICAL RECORD.
[June 9, 1883.
weakeniiifT of the walls, probably coupled with a limited
destruction of the external coats of the vessel by the
vulnerating body, as to render an aneurismal dilatation a
necessary consequence.
Third. — That the similar i)robable partial destruction
of, and certainly the inflammatory softening of, the ven-
ous walls at the joint of adhesion, resulted in a slight
pouching toward the lumen of the artery.
Fourth. — That the projection thus commenced, how-
ever minute, was acted upon to the utmost advantage
by the arterial current, which tended to enlarge the
growth by an actual traction and force, as it were, in the
direction of the blood-flow ; this is proven by the fact
that the small sac is elongated on the distal side of the
venous opening.
Fifth. — That the projecting venous sac must have
served to obstruct the lumen of the artery from the mo-
ment of its formation, and have acted somewhat in the way
an embolus has been known to do, as the exciting cause
of aneurism, by producing undue intra-vascular pressure
in an artery with softened walls.
Sixth. — That the obliteration of the lower extremitv of
the artery which occurred subsequent to the ligation,
while an anastomotic branch connnunicated through the
patulous lumen of the artery with the sac, is the cause of
the non-coagulation of the sac contents. The apparent
paradox that blood can enter into and emerge from a
tensely filled sac, is rendered clear when the physical
surroundings of the sac are considered. The muscles of
the region must have alternately emptied the sac by their
compression, and allowed it to refill, when they relaxed.
A familiar demonstration of this is the action of the or-
dinary rubber bulbed pipette, although the elasticity of
an aneurismal sac is not nearly so great. This deficiency
is, however, made up for by the constant pressure of the
blood in the patulous upper portion of the vessel, which
tended to rush into the aneurism whenever the relaxation
of muscleqjressure upon the sac permitted.
Your committee submit the above with some tlitfidence,
in view of the obscurities surrounding any investigation
as to the etiology of this case. They feel, however, that
while they have not perhaps explained all the facts of the
case, their hypotheses more nearly approach a satisfac-
tory solution of the questions involved than any others
which have suggested themselves.
Charles B. Nancrede, Chairman.
R. A. KiNLOCH.
ELECTION OF OFFICERS.
The Nominating Committee reported the following
officers: President — E. jVI. Moore ; First Vice-President
— W. W. Dawson, Cincinnati; Second Vice-President —
C. H. Mastin, Mobile; Secretary — J. R.Weist, Richmond,
Ind ; Treasurer — J. H. Packard ; Recorder — J. E. Mears.
THE PLACE OF NE.XT ANNUAL -MEETING
will be Washington, D. C, the Wednesday next preced-
ing the meeting of the .American Medical -Association.
CLOSURE OF THE JAWS AND ITS TRE.\T.MEXT,
with the report of a case in which complete occlusion
followed a gunshot wound of the left sui)erior maxilla,
received at two and one-half years of age, and which was
relieved eighteen years subsequently by operation ac-
cording to a new method, was the title of a paper by J.
Ewing Mears, M.D., of Philadelpliia, Pa.
Closure of the jaws was well known under two
forms — the spasmodic or temporary, and the chronic or
permanent. The former occurs with spasmodic con-
traction of tlie masseter and internal pterygoid muscles,
delayed irruption of wisdom teeth, abscesses, operations
on tiie jaws, etc. The treatment consisted in tlie re-
moval of the causes. Wiien possible, removal of the teeth.
Where tumors, necrosis, and alveolar abscesses exist as
causes, tite treatment was obvious. In permanent clos-
ure of the jaws, we had quite different conditions to deal
witii. It was due to formation of adventitious tissue,
which firmly and ijermanently locked the jaws, and in
some forms defied successful removal.
The effect of the closure was stated to be a serious
interference with mastication and articulation, and if it
occur early in life it is often followed by a stunted de-
velopment of the jaw. With regard to treatment. Prof.
Gross stated that ankylosis of the temporo-maxillary ar-
ticulation might be relieved by forcibly depressing the
lower jaw with wedges or levers. In order to prevent
reformation of the adhesions, the lever was to be used
daily for many montlis or years.
A resume of the methods of operation which had been
suggested for the relief and cure of permanent closure of
the jaws, showed that they had been as follows:
First. — Excision, more or less complete, of the cicat-
ricial bands or osseous formations, and the subsequent
employment, for a long period of time, of wedges and
levers to retain the separation of the jaws.
Second. — Division of the cicatricial tissues and the
adaptation of metal shields, not only to prevent recon-
traction, but to re-establish the sulcus of mucous mem-
brane at the seat of the alveolus.
Third. — Dieffenbach's method of simple division of
the ramus of the jaw, and the formation of a false joint
behind the point of contraction.
Fourth. — The formation of a false joint as originally
suggested by Carnochan. Esmarch's suggestion that it
be formed in front of the contraction ; that a segment of
bone be removed for this purpose by external incision.
Fifth. — The formation of a false joint in front of the
contraction, bv simple division of the bone made by for-
ceps applied within the mouth.
Closure due to anchylosis of the temporo-maxillary
articulation, the methods practised are :
First. — Division of the ramus of the jaw from within
the mouth, either by saw, forceps, or chisel, and the
formation of a false joint.
Second. — Exsection of the condyle with a portion of
the neck, the incision being external.
The reatier then related the history of several cases.
Dr. Maguire related a case cured by long-continued
daily dilatation with instruments.
A paper on REMOVAL OF MECKEL'S GANGLION FOR
THE RELIEF OF TRIFACIAL NEURALGIA, WITH REPORT
OF CASES,
was presented by Dr. \^anderveer, of Albany, N. Y.
While not claiming to present anything new or original,
yet the cases seemed worthy to go on record as illustrat-
ing the good resulting from operative surgery when medi-
cine has failed to afford the relief sought by suflfering
humanity. He then related the history of a case which
he first saw in May, 1870, where the patient had suftered
for over ten years with severe neuralgic pains about the
right side of face, along the alveolar processes, and right
side of tongue, also in the track of inferior dental nerve.
During the preceding five years had been operated upon
twice by loosening the attachment of the cheek from the
alveolar processes, affording each time a few months' re-
lief to the patient, but the pain returned with as much
severity as ever. The patient was very thoroughly
treated with iron, arsenic, Brown-S6quard neuralgic pills,
injections of chforoform, and every treatment known,
but with no especial benefit.
In March, 18 71, made a section of the infra-orbital
nerve, which resulted in affording great comfort to the
patient, who for two years remained quite free from pain.
It then returned, more especially along the course of the
inferior dental, and suggested the removal of Meckel's
ganglion, but his health was such that neither he nor his
friends thought it safe. The i)atient is still alive, and at
times surters great pain for months.
.\nother i)atient (female) with about the same history
of pain in right side of fiice, consulted first July, 1S75 ;
had sufilered more pain since the menopause, two years
before. Had but little relief since that time, unless fully
June 9, 1883.]
THE MEDICAL RECORD.
643
under the intluence of medicine. All her teeth of upper
right side had been removed, one or two at a time. For
last six months but little, if any, relief from pain, even
from large doses of the neurotic medicines. Was under
the same treatment as the other case.
She consented to an operation to remove the infra-
orbital nerve and Meckel's ganglion, which was made
September 5, 1875. The patient was immediately re-
lieved from pain, and since that time she has been in
perfect healtli and very grateful.
Anotlier case (female), aged thirty-seven, had suffered
with a blind eye on right side. At first had but four or
five spasms daily, confined at first mostly to the eye, but
there was really no rest for any length of time. She was
advised to have eye removed, but refused. After several
years she was treated with the usual remedies, but no
permanent relief resulted. The spasms became very
severe, and returned every few minutes, getting no rest
with large doses of morphia, by mouth, hypodermically,
etc.
.\ugust 2, 1 88 1, after she had had no rest for nearly
the whole of the month of July, the doctor consented to
remove Meckel's ganglion, but thinking the proper
thing to do was the removal of the eye.
For a few days after she suffered occasional spasms of
pain, but on the sixth day she was entirely free from
them, and slept for the first a quiet sleep. The pain
returned in the last week of November, 1881, along the
inferior dental nerve, the spasms being very intense, and
coming on so rapidly as to prevent any rest. The doc-
tor then tried aconitia (Merk's), but with httle, if any,
good. She could not bear more than one-eightieth gram
doses three to four times daily.
On January 2, 1882, trephined the lower jaw and re-
moved, as 1 thought thoroughly, a section of the in-
ferior dental nerve, giving almost immediate relief. The
pain returned in December, 1882, when a spasm occurred
along the lower jaw and outer portion of temporal re-
gion. After a time the pain came on as of old, when
the patient consented to have the eye removed, which
was done April 3, 1883, when the patient, after suffering
some pain for ten days, recovered, and still continues
fairly well.
TREPHINING THE STERNUM FOR REMOVING FOREIGN
BODIES FROM THE ANTERIOR ^rEDIASTINUM
was the title of a paper read by S. Marks, M.D., of
Milwaukee.
The history was given of a soldier, who was struck on
the sternum by a spent bullet (Minie ?) during one of
the battles of the Wilderness. He was knocked down
by the blow. When he recovered sufficiently, he went
to the rear, when he was examined by the field surgeon,
who assured hun that there had been penetration. He
was sent fi-om one hospital to another and examined by
various surgeons. At last he was sent to one of the hos-
pitals at Washington, which he did not recollect, where
he was repeatedly examined by the hospital surgeons,
but by others without any suspicion of a foreign body
behind the sternum. His condition at this time was such
that, fearing he would die in the hospital, he returned to
. his home in Ohio, where he was mustered out. In the
course of time he came under Dr. Marks's and partner's
care, with the determination to submit to any treatment
that they might advise. The Nelaton probe not answer-
ing their purpose, they improvised a probe of the stem
of a clay pipe, which was introduced into the wound,
passing quite a distance. On removing the probe it
showed unmistakable signs of lead. The operation of
trephining the sternum was determined upon. When
the piece of bone was removed by the trephine, the bul-
let was found to be a little below the point of operation.
Trephine again applied and the bullet, together with the
sac which surrounded it, was removed. There was a
considerable discharge of pus. The patient, after recov-
ery from the operation, still had some cough, pain, and
shortness. The patient went to work, when one day,
after jumping from some elevation, was sei^ed with vio-
lent hemorrhage from the lungs. After recovering from
the effects of this hemorrhage the patient found himself
entirely free from the symptoms before the accident.
On motion it was resolved that the Secretary ascertain
which members were opposed to the Code of Ethics of
the American Medical Association, and request their
resignation.
The Association then adjourned.
©ovvcspouclcncc.
THE TREATMENT OF OPIUM-POISONING
WITH ATROPIA— A CRITICISM.
To THE Editor of the Medical Record.
Sir: In The Record of May 5th appeared an article
entitled " Four Cases of Opium Poisoning — Treatment by
Atropia and the Faradic Current," by Dr. Wallian, of
Bloomingdale, N. Y., which contains a number of serious
blunders, either the fault of the writer or printer, but
probably the writer. He says, ''/our me7i jointly drank
from a bottle four ounces of tituture opii, Fkar., 1870."
" Asking the druggist from whom the drug had been — with-
out fault of his — procured to give me, as nearly as pos-
sible, the equivalent in morphia received by each patient,
which he stated to be 4I grs." Now, if the four men
drank four ounces of tincture of opium, they took what was
together equivalent to more tlian twenty-four grains of
morphia ; and if each drank one-fourth of it, they re-
ceived more than six grains each, according to the Phar-
macopfeia of 1870. How the druggist was enabled to
state that each man took the equivalent of 4-J grains of
morphia, while the attending physicians did not know, he
does not state. It is not probable that each took exactly
the same amount out of the bottle, for, had they been
like Western topers, the last wouldn't have enjoyed any.
Again, he says, " I prepared a solution of atropia, i
grain to 3 ij., of which I injected subcutaneously ni.xij.
(= gr. ^) to each patient." Now it is self evident that
if he gave lUxij. of this solution of atropia, he did not
give -j'jj- of a grain, but twice that amount, or ^L of a
grain. Then he says he repeated the dose of -^'^ of a
grain of the same solution ; when, again, the patient got
-j'-y of a grain instead of -jL making \ of a grain.
Next, he says, " recalling the antagonistic ratio exist-
ing between atropia and morphia — according to Bartho-
low to be atropia gr. ss. to morphia gr. j." Now this
must be an egregious blunder. Who ever heard of giving
a half grain of atropia subcutaneously to antagonize one
grain of morphia given by the same method. It is evi-
dent that Prof. Bartholow has never written or said any
such thing. If so, I have never seen it. But Bartholow,
in his work on " Hypodermic Medication," second edi-
tion, page 109, says: "I ascertained, in the case which
occurred to myself, thafone twenty-fourth (Jj) of a grain
of atropia was equal in toxic power to one (i) grain of
morphine," which is a marked difference, and might
prove, under certain circumstances, a dangerous one.
Now the writer, not seeming to be satisfied with the
two grave blunders he had already made in his two first
injections with his unfortunate patient, makes another.
He says, " I prepared a solution double the strengtli of
the former one, or grs. ij. to 3 ij. Of this I exhibited
TTLxxiv. hypodermically, = -^.-^ grain, to each of the three
most under the influence of the narcotic." Here, again,
if he gave 24 minims of this solution, he did not givetyL
of a grain, but ^ of a grain. Now this could not be an
accidental blunder, for in the second solution, which is
double the strength of the first, he not only doubles the
strength, but doubles the number of minims, first giving
xij. Tn, ; second, giving T^xxij. He does not seem to be
aware that doubling twice is equal to multiplying by
four.
644
THE MEDICAL RECORD.
[June 9, 1883.
Further on in the article he again asserts that Bar-
tholow and other good authorities say that it requires one
half-grain of atropia to antagonize one grain of mor-
phia. Now, the doctor not seeming to be satisfied with
making a blunder in his arithnwtic on each of his solu-
tions, has the audacity to criticise " Bartholow and other
good authorities," for he says: "The inference is, that
not more than ^L grain, and jierhaps ji,- of a grain, is
sufficient to antagonize one grain of morphia.'' Who the
otlier good authorities are, he does not state.
Now having scientifically treated his patients by atro-
pia, he " sends for his battery," and applied one pole
on the diaphragm, and one on the nape of the neck.
He also makes the announcement that " he carefully
interrupted the faradic current." He does not state in
what manner he interrupted the current, but judging
from the rudimentary manner in which the atropia was
given, that he probably interrupted it by leaving the
sponges on a while and taking them off a while.
The doctor should be congratulated for his heroic
courage in a time of difficulty and danger ; for few med-
ical men there are who would give atropia solutions hy-
podermically in cases of narcotic poisoning, when not
knowing their strength.
It is fortunate the cases recovered ; indeed, the doc-
tor himself seems to be surprised they did so, for in an-
nouncing the subject of his article, he says : " Treatment
by atropia and the faradic current — Recovery."
The doctor states : " The effects of the antagonist
atropia were visible for forty-eight hours or more, as
shown by disturbance of vision, unsteady gait, hallu-
cinations, harmless delirium, etc., which would seem
to indicate that it was e.^hibited somewhat in excess of
the requirements in the several cases."
This is quite likely, for he gave to each of the worst
cases -^ of a grain of atropia, while he intended to give
only ^, and ^^ and ^^ = j"^, or, in other words, he gave
three times as much as he thinks he gave, and then criti-
cizes the authorities for being mistaken on the antagon-
istic power of atropia.
This is very funny. C. H. Phelps, M.D.
EFFECT OF NOISE ON DISEASED AND
HEALTHY EARS.
To THE Editor of The Medical Record.
Sir : The paper by Dr. D. B. St. John Roosa on the effects
of noise upon diseased and healthy ears, as reported in
The Medical Record of April 28, 1883, is of special
interest to those who have it in their own power, from
personal experience and observation, to confirm the views
therein so ably laid down and defended. The eight
aphorisms (1. c, p. 467) are in my opinion invulnerable.
There can be no question that, as Dr. Roosa says, there
is a large class of people who, though deaf to a con-
siderable degree, hear better and to a remarkable degree
of acuteness amidst noises which to those with good
hearing are deafening. It appears, however, that all of
the observers who deny this fact, as well as Dr. Roosa
himself and all of the participants in the debate which
followed the reading of the paper, have overlooked an
essential fact : the vaiiety of deafness. Simply to say
that any one is deaf, is, in our days, to be far from
scientific accuracy. We should define the deafness ; state
whether the deafness is for high or low tones as registered
by Konig's rods, or even by the pianoforte or by tuning
forks. So far as we yet know, there n)ay be as much
difference in the inner ear, under these various degrees of
deafness, as there is in eyes affected with hypcrnietropia
or myopia.
The whole question as to hearing, or not hearing,
better in a noise, is at present of no really practical
value ; still, during our investigations we may stumble
upon valuable trutlis. With due deference to those who
claim that the deaf do not hear better in a noise, I would
suggest, from my experiments and investigations, a ninth
aphorism, to follow the eight as published by Dr. Roosa :
Those who are deaf to low tones invariably hear much
better in a noise.
J. A. Spalding, M.D.
595 Congress .Street, Portland, Me.
^xnny ^tcxns.
Official List of Changes of Stations and Duties of Officers
of the Medical Department , United States Army, from
May 26, 18S3, to June 2, 1883.
Brown, Paul R., Captain and Assistant Surgeon.
The extension of leave of absence on Surgeon's certifi-
cate of disability, granted November 23, 1882, further
extended six months on account of sickness. S. O. 123,
.\. G. O., par. 6, May 29, 1883.
Hegar, a.. Major and Surgeon. Assigned to tempo-
rary duty in charge of the office of Medical Director
Department of the South, during absence on sick leave
of Medical Director. S. O. 55, par. 9, DepartmentJ[of
Texas, May 24, 1883.
2^1ccUcal 3^tcms.
Contagious Diseases — Weekly Statement. — Re-
port of cases and deaths from contagious diseases re-
ported to the Sanitary Bureau, Health Department, for
the two weeks ending June 5, 1883 :
Week Ending
4)
>
in
3
A
0.
ii
>
1
■J
I
%
s
erebro - spinal
Meningitis.
1
■a
•a
1
>
1
h
H
tn
U
k.
u
w
>
Casts.
Mav 2q. IBS'?
9
7
136
120
6
rS
June 5, 1883
2
2
120 43
I
0
Deaths.
Mav 20. 188^
I
4
4
31
24
4
2
19
22
27
20
lune 1;. 188?
0
°
0
SCARLAIINAL RaSH FROM THE USE OF CoPAIVA.
Dr. C. F. Barber, of Fort Hamilton, L. I., sends us an ac-
count of the following instructive case : " Not long since
a patient came to me suffering from a scarlet rash which
completely covered the body, leaving a space hardly the
size of a pin's point free. He comiilained of intense
itching and burning sensation about the skin ; the right
hand was putted up, the left normal in size. His mouth
and throat were tender, compelling him to eat only fluid
food. Nausea, but no vomiting, headache and a languid
feeling were present. The eru])tion would disappear on
pressure, but instantly return as soon as the pressure was
removed. On close questioning the patient admitted
that about one week previous he had contracted gonor-
rhoea, and had obtained a prescription, as is so often
done by the young men of the present day, from a drug-
gist, the active princii^le of which was balsam copaiba;.
This he had used faithfiilly until he came to me ; time
being just seven days. Being a strong and healthy young
man, never having had any disease, save the present at-
tack of gonorrhoea, I could see no other cause for his
rash and at once stopped his recipe, and i)laced him
upon another course of treatment. As soon as the co-
paiba; was discontinued he began to improve and the
rash soon disappeared."
A Weekly youriial of Medicine and Surgeiy
Vol. 23, No. 24
New York, June 16, li
Whole No. 6s8
©vininal ^Articles.
ON THE OCCURRENCE OF TUBERCLES IN
WHICH THE B.\CILLUS TUBERCULOSIS IS
NOT DEMONSTRABLE BY THE ORDINARY
METHOD OF STAINING.
By T. MITCHELL PRUDDEN, M.D.,
DIRECTOR OF THE PHYSIOLOGICAL AND PATHOLOGICAL LAnoRATORY OF THE ALUM-
NI ASSOCIATION OF THK COLLEGE OF PHYSICIANS AND SURGEONS, NEW YORK ;
LECTt'BER ON NORMAL HISTOLOGY IN YALE MEDICAL COLLEGE.
Although more than a year has passed since the an-
nouncement by Dr. Koch of his hypothesis of the bac-
terial origin of tuberculosis, and the long and logical
series of experiments on which it is based, it is still in
the main in nearly the same condition as that in which
he made it known. Numerous of his confirmatory data
have indeed been found to stand the test of careful scru-
tiny by skilled observers, and have been greatly strength-
ened, while in some respects modified, by the record of
the examination of an almost incredible amount of ma-
terial. The additions and confirmations, however, be-
long almost entirely to that side of the problem which is
least essential for the establishment of the new patho-
logical doctrine, although of the utmost imjiortance from
the standpoint of diagnosis, and possibly of prophylaxis
and treatment. The more extended researches of the
past year have shown that the examination of sputum is
of much more practical importance than the original an-
nouncements gave reason to expect ; that the technique
of sputum examination for the bacillus tuberculosis must
become a part of the professional furnishing of every ex-
pert diagnostician, whether the bacilli stand in a caus-
ative relation to tuberculosis or not, and that to be re-
liable considerable skill and much patience must be
exercised ; that the color-test must be subjected to some
limitations not anticipated in the original announcements,
because some other bacilli and many other objects are
found to present the coloration originally supposed to
belong to the tubercle bacilli alone : and finally, that the
decoloration by nitric acid in Ehrlich's method of stain-
ing may result in the complete removal of color from
some of the structures which it is desired to demonstrate,
unless the greatest care be exercised, and possibly even
then, since the conditions which modify their power of
resisting the action of the acid are not yet definitely
known.
Dr. Koch, in his recent reply to his critics,' deplores
the fact that in the eager search for data of an immedi-
ately practical nature the more essential character of the
cultivation and inoculation experiments should have
been apparently lost sight of. While the whole world
stands agog to know whether the tubercle bacilli are to
be found m each particular specimen of sputum, faeces,
and urine, or on all tubercular ulcers, or in every phthisical
cavity, or miliary tubercle, or cheesy nodule, his funda-
mental hypothesis remains unconfirmed ; and he com-
plains, if a little querulously, still it must be confessed
justly, that the criticisms ot his hypothesis and his state-
ments, which have thus far been made, are not based upon
experiments executed with sufiicient care and data, gath-
ered with sufficient clearness of perception as to their
applicability to the question, to afford him much satisfac-
1 Deutsche Med. Wochenschr., No. lo. March 7, 1883.
tion in framirg a reply. This condition of affairs is,
however, not at all surprising, for, apart from the circum-
stance that the immediately practical bearing of the sub-
ject appeals to by far the greater proportion of men in
the profession, the careful working over of the ground
so elaborately covered by Dr. Koch's experiments, by
professional pathologists, would require not only abun-
dant and exceptional facilities, but a devotion to pure sci-
ence which must far exceed that of Dr. Koch himself,
since the stimulus of the pioneer would be largely want-
ing. Still, the immense amount of exhausting labor bear-
ing on the simpler mor|)hological side of the problem,
which in this short time has been done by men for the
most part busy in the practical exercise of their pro-
fession, leads to the hope that ere long some man may
appear happily enough circumstanced, and richly enough
endowed with patience ard acumen, who will either fur-
nish the needed confirmatory evidence, or show himself — •
to fall into language by which alone the present belliger-
ent attitude of some of the workers and more of the
writers in this field can be indicated — a foeman worth}'
of Dr. Koch's steel.
In the meantime the simple examination of tubercular
lesions and various excreta are leading to fairly definite
conclusions in some of the accessory fields. It is already
practically established that in the larger proportion, if not
in all cases of phthisis in which there is evidence of the
breaking down of tuberculous tissue, and in many cases in
which physical signs are entirely negative, the tubercle
bacilli may be found in the sputum, if sufficient care and
patience and skill be exercised, and that they do not
occur in non-tuberculous sputum. It is further demon-
strated that the bacilli may be found in the fasces in many
cases suffering from tubercular ulcers of the intestine,
and in the urine in some cases of tuberculosis of the
genito-urinary tract. It is furthermore proven that the
examination of material from the surface of tubercular
ulcers of accessible respiratory passages may often deter-
mine their specific character. While at present of much
practical importance, rapidly accumulating data lead to
the belief that increased definiteness in the estimate of
the value of such examinations may be confidently ex-
pected.
It is furthermore established, that in the great majority
of phthisical cavities in the lungs, the contents and walls
contain the bacilli in greater or less numbers ; that the
tuberculous areas and miliary tubercles in acute and
chronic phthisis, many of them, contain bacilli ; that in
most cases of acute miliary tuberculosis the bacilli are
present in many or most of the nodules. But it is equally
true that in many of the miliary tubercles and cheesy
areas, and in diffuse tubercle tissue in acute and chronic
phthisis, and in some of the tubercles in acute miliary
tuberculosis, the bacilli cannot be demonstrated by the
technical procedures at present at our command. It was
shown in a previous paj^er by the writer,' and confirmed
by two new examples about to be recorded, that diere
are cases in which over large tracts crowded with miliary
tubercles, both cheesy and in the earlier stages of growth,
no bacilli could be detected by the most exhaustive
search. Since the publication of the paper just alluded
to, the lungs of a considerable number of new cases of
acute and chronic phthisis have been examined, with
essentially the same result, namely, that in and about all
The Meliical Record, .April 14, 1883.
646
THE MEDICAL RECORD.
[June 16, 1883
cavities, in many of the larger areas of coagulative ne-
cro^i3, and in a considerable proiiortion of the miliary
tubercles, the bacilli are to be found in varying numbers.
But in nearly all cases some of tiie larger cheesy areas
and the tubercles, particularly those which were not
clieesy and were i}i an apparently early stage of develop-
ment, jjresented no bacilli by the same methods of stain-
ing and care in examination which revealed them in other
parts. This result is in harmony with the observations
of nearly all those who have made and studied extensive
series of sections from tuberculous organs.
Two cases, how-ever, formed such marked exceptions
to the rule that they seem worthy of a special record.
J. R , aged forty-seven, Irish, states that his health
was good up to four weeks before admission ; he then
first noticed swelling of the legs and face. He soon
began to suffer from cough and dyspnoea, with vomiting,
occasional headache, and constipation. On admission
patient had general anasarca to a moderate degree, dysp-
noea was intense, cough slight, temperature loof ', pulse
86, urine specific gravity i.oio, varying in quantity from
thirty to ninety ounces, and containing albumen and casts.
Fluid was found in left pleural cavity below angle of scapu-
la. Aspiration resulted in the removal of a few ounces of
bloody fluid. Immediately after the operation patient had
a severe chill, and developed lobar pneumonia in riglit
side. The dyspnoea continuing severe, aspiration was re-
peated, forty-eight ounces of bloody serum being) drawn
off. He grew steadily weaker, and died about four weeks
after admission.
Autopsy. — The right lung was jiartly bound to the
chest wall by old adhesions, and the entire lung was in
a condition of gray hepatization. The left pleural cavity
contained about one hundred cubic centimetres clear
yellow fluid, and the lung was partially and loosely bound
to the costal pleura by thin, partly organized adhesions.
The lateral surfaces of both lobes were covered by a
thin, delicate pellicle of organized membrane, thickly
studded with small miliary tubercles. Neither tuber-
cles nor cheesy degeneration were found in any other
part of the bod\'. The kidneys presented the lesions of
chronic diffuse nephritis. The mucous membrane of the
stomach was thickened, and the liver slightly infiltrated
with fat. The other organs were normal. Many of the
tubercles, as seen in sections, stained double with hema-
toxylin and eosin, consisted of sliarply circimiscribed col-
lections of small spheroidal cells ; most of them, how-
ever, were of the usual giant-celled and epithelioid-celled
type, with a more or less well marked reticulum. In none
of those exam'ned was there well-marked cheesy degen-
eration. Six hundred and ninety-five sections, about .01
jin'llimetre in thickness, were made from ninety-nine dif-
ferent tubercles from various parts of the tuberculous
membrane, and stained in the usual manner by Erhlich's
method in several different lots. In not one of these six
hundred and ninety-five sections could a single tubercle
bacillus be detected, although all were examined with
the most scruinilous care, and in many specimens the
examination was several times repeated.
This case, together with one of acute general miliary
tuberculosis in a child, and one of primary tubercular
inflammation of the bladder, ureter, and kidney, already
recorded, makes a series of three exceptional cases, ob-
served by the writer, in which, although judged by ana-
tomical criteria there could be no doubt of the character
of the lesion, the structme being in each case perfectly
well defined, no bacilli could be detected in the tuber-
cles HI any part of the body.
The following case presents a condition of affairs still
more noteworthy. The man was an Italian, aged fifty-
two, a ragpicker. He stated that he was perfectly well up
to two weeks before admission, when he first noticed a
swelling of the abdomen, and he soon began to experi-
ence nausea and vomiting. He suffered from consider-
able abdominal pam and dyspnoea, was unable to retain
food in the stomach, 'and rapidly lost flesh and strength.
On admission the patient was much emaciated, cachectic,
pulse feeble, dvspnoea marked, abdominal I'ain severe.
There were a few subcrepitant rales over both apices in
front and behind, considerable ascites preventing satis-
factory examination of abdominal organs. He refused
to take food, was sleepless ; the dyspnoea and abdominal
pain continued; he became weaker and delirious, refused
all attempts to relieve his ascites, and died, apparently
from exhaustion, twelve days after admission. The tem-
perature was at no time above the normal.
Autopsy. — Abdominal cavity contained a large quan-
tity of clear yellow fluid with fibrinous flocculi. Hands
and membranes of fibrin bound the abdominal wall
loosely to the intestines, and bound the intestinal coils
firmly together. Nearly the entire surfaces of the intes-
tines, liver, under surface of the diaphragm, and a large
part of the jiarietal peritoneum were thickened and very
thickly studded with white, slightly elevated nodules,
varying from one to three millimetres in diameter.
The omentum, converted into a dense nodule or cylin-
drical mass, lay along the transverse colon, and extended
down in a solid cord to the right inguinal region where it
was attached to the abdominal wall. Heart normal, left
pleural cavity contained about one litre of clear yellow
serum, which crowded the otherwise normal lung inward
and backward. The right lung was firmly bound to the
chest wall by old thick adhesions, and the costal pleura was
considerably thickened and sparsely studded with dense
white and gray nodules about two millimetres in diameter.
In the thickened pulmonary pleura, and in the lung tissue
immediately beneath it, were a few scattered, dense, some-
what stellate nodules, similar in appearance to those in
the corresponding thickened costal pleura. At the apex
of the right lung, and confined to an area of about six
centimetres in diameter, in either direction, were several
dense grayish pigmented bands of connective tissue and
larger and smaller hard branching nodules. One of
these nodules, about one centimetre in diameter, was
cheesy at the centre, and another, somewhat larger,
contained a small cavity filled with disintegrated cheesy
material. This cavity did not connnunicate with a
bronchus. The bronchial glands were enlarged, deeply
pigmented, and studded with small white nodules. The
other internal organs were normal. The mesenteric
glands were not enlarged. The anatomical diagnosis
was accordingly old chronic phthisis at apex of right lung,
with pleurisy and chronic miliary tuberculosis ; left hydro-
thorax ; tubercular peritonitis.
Microscopical examination by the ordinary hematoxy-
lin and eosin staining showed the small scattered nodules
in the surface of right lung, in the thickened costal and
pulmonary pleura, and about the consolidated areas in
the apex to have the ordinary structure of fibrous tuber-
cles, many of them much jngmented at the centre. The
larger nodules at the apex were composed in part of
dense pigmented connective tissue, in part of areas of
coagulation necrosis, with a peripheral zone of tubercle
tissue. The wall of the small cavity was formed of
shreds of necrotic tissue, of dense cheesy material, and in
the outermost layers of tubercle tissue and ordinary dense
connective tissue. The examination of a large number
of thin sections from these various forms of nodules,
stained by Ehrlich's method, showed that the tubercle
bacilli were abundant in the walls and edges of the
cavity, and in a few of the dense areas of coagulation
necrosis in its immediate vicinity. Hut in the diffuse
tubercle tissue, in the zones of simple pneumonia around
the nodules, in the scattered fibrous tubercles in the
lung and pleura, and in the well-formed tubercles in the
bronchial glands no bacilli could be found.
Microscopical examination of the nodules in the serosa
of the intestines, diaphragm, liver, and abdominal wall, as
well as those in the thickened omentum, showetl them to
be miliary tubercles presenting the usual variations in
structure ; most of them were more or less cheesy at
the centre and of the giant- and epithelioid-celled type,
June i6, 1883. J
THE MEDICAL RECORD.
647
but many were of less complex structure, consisting sim-
ply of circumscribed collections of small sjiheroidal and
epithelioid cells lying in and upon the thickened serosa.
Nine hundred and nine sections from a large number
of these peritoneal tubercles, from different parts of the
affected surfaces, stained by Ehrlich's method revealed,
under the most searching scrutiny, no tubercle bacilli.
Among the numerous tubercles chosen for examina-
tion, four, each of about one millimetre in diameter, were
completely cut into sections of about one-eightieth milli-
metre in thickness. This exhaustive examination of
single tubercles was made to reduce the possibility of
error which the examination of a few sections only from
various tubercles necessarily involves. Not a single
bacillus, however, was anywhere detected.
Here, then, is a case of chronic phthisis in which, judg-
ing from the clinical history and the anatomical appear-
ances, the morbid process was apparently for the most
part at a standstill, but in which the tubercle bacilli still
remained in a small cavity and in a few cheesy areas
in its immediate vicinity at the apex. Upon this condi-
tion of affairs in the lung the more acute tubercular
peritonitis presumably supervened. Judging from the
considerable thickening of the peritoneal serosa in and
upon which the tubei:cles lay, the process here was of
longer duration than the somewhat meagre clinical his-
tory would seem to indicate ; but the structural characters
of many of the tubercles, on the other hand, would favor
the belief that their development was actively occurring.
The general features of this case would lead to the
expectation that it would furnish a most exquisite ex-
ample of auto-inoculation, and the popular conception
of Dr. Koch's hypothesis would demand that the bacilli
should be found in the peritoneal tubercles, jiarticularlv
in those of presumably recent development. Thev could
not, however, be found in any of the forms. ]5ut the
writer is inclmed to believe that the popular conception
of Dr. Koch's hypothesis is not altogether correct. That
the presence of the bacilli in each and every miliary tu-
bercle, especially of younger form, must be demonstrable
or the hypothesis is greatly weakened, is a notion founded
in a misconception of the broad nature of his fundamen-
tal propositions. That tuberculosis is an infectious dis-
ease ; that it can be communicated by the inoculation
of the so-called bacillus tuberculosis, presumably freed
by cultivations from all contaminating substances, and
that this bacillus is the sole cause of the disease — these
are the main features of his proposition. For Dr. Koch
the criterion of a genuine tubercle lies in its nifectious
nature, and not in its anatomical character. Whether
this criterion be accepted or not is at present a matter
for individual decision, at any rate, it is a logical assump-
tion as based on the data adduced by Dr. Koch. That
the very frequent occurrence of the bacilli m the lesions
of tuberculosis, in the human subject and in the victims
of experimental inoculation, is a valuable confirmatory
fact, there is no doubt, but so far as the writer is aware
Dr. Koch nowhere states, nor does the establishment of
his hypothesis require that the bacilli should be, or should
have been bodily present in every tubercle.
The fact that in cases of phthisis and acute miliary
tuberculosis some of the tubercles do not, as judged by
our present technical procedures, seem to contam ba-
cilli, and that some apparently exceptional cases of tuber-
culosis do not reveal their presence anywhere in the
body may be explained, it should be remembered,
either, first, by the possibility that the parasites after in-
augurating the morbid process may disappear from the
seat of lesion or from the body ; or, second, by the faulty
nature of our demonstrating them ; or, third, by the possi-
bility that the bacilli may induce the growth of tubercle
tissue in distant parts of the body by some product of
their physiological activity at present entirely unknown
to us ; or finally, by the not improbable hypothesis that
the morbid process which we call tuberculosis, may be
induced by more than one agent.
It may be that it is just such a criterion as that which
Dr. Koch asserts which we need to supplement the ana-
tomical classification of tubercle-like growths with which,
with no end of bother, we have perforce made shift to be
content so long.
These apparently exceptional cases, while enigmatical,
are interesting and may be of nuich importance at a
later stage in the elucidation of the problem, but the
writer does not at all believe nor would he willingly con-
vey the impression that they are necessarily of much sig-
nificance as bearmg upon the parasitic character of the
disease. Whether such tubercles as do not seem to
contain bacilli would produce the disease if inoculated is
a question which, however difficult, it may be necessary
to answer when the limitations of their occurrence have
been more definitely established. In the meantime it is
important to avoid the error of adopting a more precise
conception of the exact way in which the bacilli exert
their influence, if they do so at all, upon cell-prolitera-
tion and the formation of tubercle tissue than our actual
knowledge of the conditions and phenomena of cell life
and the natural history and physiology of the bacillus
tuberculosis will fully justify. Into this error it seems to
the writer that Dr. Cheyne, the author of the " Report to
the Association for the Advancement of Medicine by
Research on the Relation of Micro-organisms to Tuber-
culosis," ' falls, when, after stating the indisputable fact
that the tubei-cle bacilli are very often found associated
with the epithelial cells formed in tuberculosis of the
lung, he assumes that the new epithelioid cells are
largely, if not entirely, due to the prolileration of alveo-
lar epithelium, and further, that this proliferation is due
to the direct stinndus of tlie presence of the bacillus
tuberculosis. " The bacilli," he says, " escape from the
blood-vessels or lymphatics and get into the alveolar
epithelium, where they grow and cause multiplication of
the epithelial cells till the alveolus becomes completely
filled with these cells and infiltrated leucocytes." Fur-
thermore, the whole process is detailed with the most
pleasing clearness as follows : " The tubercle bacilli,
which reach the lung by inhalation, develop in the epi-
thelial cells lining an alveolus, this alveolus becomes
filled with cells, neighboring alveoli become infected, and
the same process goes on in them. The further result
will depend on the number and rapidity of growth of the
bacilli and on whether the patient is a good soil for their
development. If they develop well we have carious
pneumonia, if they grow slowly and with difiiculty we
have fibroid phthisis."
Now this may all be true, but the expression of a per-
sonal conviction, however strong, does not do away with
the necessity for proof, and the fact that large quantities
of the same epithelioid tissue may be found in every
case of cheesy pneumonia and in many cases of chronic
phthisis unassociated with the bacillus, and that the same
mcrease in epithelioid cells is common in various forms
of pneumonia not tuberculous, suggests at least the de-
sirability of caution in explaining the cause of such re-
sults.
It is by no means easy, in the present state of our
knowledge concerning the life history of nearly all forms
of cells, to be certain as to the exact origin of new cells
produced in the body in disease ; witness the long series
of patient researches which have not yet led to such posi-
tive results as could be wished regarding the respective
roles of connective tissue and white blood-cells in ordi-
nary inflammation. And when to the inherent difficulties
of the jiroblem of the origin of new cells in general in
disease we add the complexities which the introduction
of a vegetable parasite whose natural history and physio-
logical phenomena are almost entirely unknown, it is not
by 3.ny precise conjectural rationale, however plausible
it may be, that this obscure and ditticult field of pathology
is to be illuminated.
^ Practitioner, vol. xxx., No. 4, AprD, 1883.
648
THE MEDICAL RECORD.
[June 16, 1883.
The much talked of refutation of Dr. Koch's hypothesis
by Spina' is couclied in so unscientific a spirit and rests
upon so flimsy a basis of actual experiment, that it seems
scarcely possible that it should for more than a moment
be permitted to have any influence whatever upon the
question. The admirable study by Dr. Cheyne, above
alluded to, is very valuable, so far as the experimental
data go, in confirming many of Dr. Koch's statements,
but it seems to the writer to lack independent and objec-
tive character and not to embody researches extensive
enough to give it the weight which must belong to that
series of investigations which alone can give to the new
hypothesis the position in science which it claims. So
our attitude in regard to the primary hypothesis must, it
would seem, still be one of expectation.
As the appearances and importance, from the diagnos-
tic standpoint, of the tubercle bacillus become more and
more familiar to the practising physician, as they are un-
questionably destined to do, it is very essential that it
be clearly understood that its occurrence in sputa and
other excreta in tisberculosis, however constant or prac-
tically valuable as a means of diagnosis, is not in itself a
proof of the parasitic origin of the disease, nor does the
search for it commit the observer in the least to the germ
theory. For as far as all this goes it may be merely a
harmless concomitant of tuberculosis and nothing more.
When once it is proven beyond reasonable doubt to be
one of the causes or the sole cause of tuberculosis in man
then will arise questions in prophylaxis and therapeutics
second in importance to none which can engage the at-
tention of medical men.
From the iumiediate practical standpoint, knowledge
is most urgently needed on the subject of the occurrence
of the bacilli in the sputa and other excreta in acute
miliary tuberculosis, both in adults and children, and on
their occurrence in cases of primary h.-emoptysis and in
the incipient stages of various forms of phthisis, as well
as in cases in which complete recovery has occurred or
in which the disease has become latent.
Finally, a searching examination of the reliability of
the technique of the bacillus-staining is urgently needed.
Ziehl " has shown that the nitric acid employed for de-
colorizing may, if permitted to act too long, entirely re-
move the characteristic color from the tubercle bacilli
and so permit them to escape detection, and, furthermore,
that marked differences exist among the individual bacilli
in the same specimen as to their power to resist the de-
colorizing action of the acid. He has shown, moreover,
and this has been abundantly confirmed by the researches
of others, that it is not at all necessary to employ nitric
acid for differentiating them. If after staining the speci-
men with fuchsine in the usual way it be |)laced in some
other anilin dye, i.e., methylin blue, the latter stain
will displace the red color from the animal cells and other
bacilli before it will froui the bacillus tuberculosis, and if
the operation be stopped at the right time a differentia-
tion in color may be obtained not less marked and less
liable to errors than that obtained by Ehrlich's method.
The writer made use of this method for controlling the
examination of the exceptional cases above described,
but with the same result.
Dr. Cheyne ° avoids the use of nitric acid, apparently
because of the unavoidable shrinkage vvhicli it occasions
in the tissues, by the employment of the following
method. Stain first with fuchsin ; wash in distilled water ;
put for a moment in alcohol ami then place the si)ecimen
for from one to two hours in the following solution : Dis-
tilled water, 100 com.; saturated alcoholic sol. methylin
blue, 2oc.cm.; formic acid, 10 TH,. It is then washed with
water and treated with alcohol and oil of cloves in the
usual way. Acetic acid may be used instead of the formic,
but is required in somewhat larger quantity.
* Studicn liber Tulierctjlosc. Wien, 1883.
* Zur ntrbung des Tubcrkeibacillus. Deutsche Med. Wochenschr., viii., 451,
Berlin. 1882.
•* Loc. cil., p. 258.^
SPINA BIFIDA.
A Successful Oi'er.ation after the Method of
Mr. Robson, of Leeds, England.
By ROBERT T. HAYES, M.D.,
ROCHESTER, N. V.
The Medical Record for February lo, 1S83, quoting
the British Medical Journal {ox December 30, 18S2, re-
ported a case of spina bifida operated upon successfully
after a new method, by Mr. Robson, of Leeds, England.
Following the points laid down in that report, a similar
case was treated here by the new operation on February
21st.
The patient was a female, aged nine and a half weeks ;
general condition good. The tumor, situated in the
lower dorsal region, was the size of one-third of a hen's
egg at birth, and more than twice that size at time of
operating. Pressure during the first two weeks after
birth seemed to stimulate the growth of the tumor, and
was abandoned on account of the irritative symptoms
induced. Fluctuation could be very distinctly and readily
produced with one hand over the anterior fontanelle and
the other over the tumor.
The child, ancesthetized by chloroform, was laid over
a pillow on its face : the object being to limit, by gravi-
tation, the loss of cerebro-spinal flifld. The attempt was
first made to remove a part of the fluid by means of as-
piration ; but after some five to six fluidrachms were
removed, the fluid having all the characters of pure and
normal cerebro-spinal fluid, no more could be obtained
by repeated punctures. The skin was then incised and
a layer of adipose tissue met with of about one and one-
half inch in thickness. This being dissected back on
each side, a double sac was found ; an external one, col-
lapsed, not conununicating with the spinal canal, and
from which the fluid was obtained ; and under this a true
sac, formed by protrusion of the membranes of the cord.
The aspirator needle was introduced through the thin-
nest portion of this sac. when the patient instantly col-
lapsed. During some fifteen minutes spent in efforts at
restoration, sufficient fluid oozed through the puncture
to leave the sac somewhat flaccid as the child lay. The
needle was then reintroduced, some ten fluidrachms
more removed, and the sac then freely opened. The
spinal cord appeared perfectly normal, and on either side
was seen the root-fibres of two spinal nerves, terminat-
ing abruptly at the inner surface of the base of the sac.
The superfluous iwrtion of the membranes was then
removed, and union formed by si.x interrupted catgut
sutures. While the periosteal grafts were being prepared,
the patient was accidentally brought nearly into an up-
right position, when, with a free gush of fluid she again,
and very profoundly collapsed. After partial restoration
was with much difficulty brought about, some twenty
small grafts of fresh periosteum from a rabbit were in-
troduced on the surface of the membranes and the exter-
nal flaps, fatty tissue and all, hastily trimmed and closed.
The patient w^as extremely exhausted, and only rallied
after some hours of active stimulation, and maintenance
of a low position of the head ; any approach to the
horizontal, much less upright position inducing fainting.
After rallying, recovery was rapid, kind, and perfect.
Simple cold water dressings w-ere used. Surgical fever
reached 102° I'", within six hours, and ceased entirely
within twenty hours. Union occurred throughout the
wound by first intention, at all but one point. Here a
sinus existed, through which clear serous fluid drained
very freely, certainly to the extent of several fiuidouncfes
daily, for four or five days, and then more and more
sparingly until the tenth day, when the sinus at once
closed. At no time was there any appearance of pus
about the wound.
The present condition of the child — more than eleven
weeks after operation is this : She is stronger, larger,
brighter, and more contented than any of her preceding
brothers or sisters have been at her age, and suftcrs ab-
June i6, 1883.]
THE MEDICAL RECORD.
649
solutely no obvious inconvenience, except a mechanical
one from her deformity. The tumor is about one-half
the size it was before operation, but the most careful ex^
amination fails to reveal anything more than fatty tissue
in it. Under this can be distinctly felt a covering over
the opening in the spinal canal, which is, to use Mr. Rob-
son's words in describing his result, " of much greater
than mere skin hardness." The tumor is no more sen-
sitive than other portions of the skin, and reasonable
pressiu-e fails to affect in any degree the tension of the
fontanelle.
I would add to Mr. Robson's points in operating : First,
care in removing a portion of the fluid in the tumor be-
fore free incision, as a guide to the degree of tolerance
present in each case for such a procedure ; second, the
careful maintenance throughout the operation and for
some time after, of such a jiosition of the patient as will
most favor the retention by gravitation of the largest
amount possible of cerebro-spinal fluid.
Finally, I would remark the apparent confirmation of
the successful and useful application of periosteal graft-
ing in this operation.
ENDEMIC DISEASES IN FLORIDA.
ByC. drew, Jr., M.D.,
JACKSONVILLE, FLA.
In February, 1881, I began a systematic study of the en-
demic diseases peculiar to East Florida, having had
compact blank forms printed to fit into my note-book, so
that at the bedside of each patient could be obtained
and recorded the date of attendance, sex, age, color,
■disease, residence, tinie of residence in the State, result,
etc. My object was to ascertain for each month the
per cent, of disease due to malaria, the per cent, of
cases of fever in non-residents, per cent, of cases of
phthisis occurring in residents, or any other facts which
might be brought to light ; also the mean barometer, ther-
mometer, humidity, and direction of winds for each
month. The question is often asked, " What are your most
•sickly months?" and although we well know that Sep-
tember and October are most insalubrious, it occurred
to me that it might lead to some useful results to
■study the subject more accurately, and obtain in figures
the exact percentage due to malarial influence, and at
the same time to ascertain the meteorological statistics
in order to consider their bearing upon such facts. Me-
teorological and topographical conditions undoubtedly
often act in concert to induce disease, and although
we can do nothing with the former, we may so change
the latter as to produce, under similar circumstances of
wind and weather, very much better conditions. The
figures, it must be admitted, are few in number, and a
larger record might perhaps lead to somewhat diff^erent
results, but it is perhaps a fair average of results to be
obtained under our usual climatic influences. Very ac-
curate results could be obtained, in studying disease in its
relations to meteorological changes, by making daily ob-
servations of both, ascertaining the prevalence of a cer-
tain type of disease and its relations to such changes
upon each particular day, and if any value could accrue
from such study, it would be much enhanced if such ob-
servations could be made by a number of observers,
■daily results being handed to a compiler for summarizing —
in other words, " the collective investigation of disease,"
as recently suggested by the British Medical Association.
Their method is to "draw up cards and explanatory
memoranda regarding certain diseases, such as chorea,
rheumatism, etc. These are sent to each member of the
association, with the request that he answer the inquiries
and return the cards to the secretary." A majority of cases
recorded were within the limits of the city of Jacksonville,
the semi-insular situation of which (being partly surrounded
by creeks with marshy borders) makes it a good index
of the influence of winds in wafting the germs of malarial
disease from certain quarters into the habitations of
man. During the last two years the marshy margins of
the creeks surrounding the city have been partially re-
claimed, which, I believe, has made a considerable
reduction in the amount of malarial disease prevalent in
the suburbs.
j o o f^ o J^
• M =
: n
! 2 = 3
, 3 3 n *^ '
i,n-a'2,"> o .
J -t -1 3 •-13 ■
> o o S'o g ;
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o o
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c c
3 3
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0 •
Si •
. 3 • •
• n ' •
. S) . •
. n ■ •
'. ^ '. '
. *a • .
. n-* -
. 0 • -
. a- ■
Total number of cases
recorded for month.
MtOl-lOllOMtOMMM
to 0 vO *^ tn 0\U> <>4^ (Jl VI 03
Total due to malaria for
each month.
10 tn 0\ 00 0\ 0\ OVOJ OJ M M M 1 _
UKjfi M J-. Co H. p pooj g\U\ _M i Per cent, due to mala-
M cn » -u vj oi cn 0 Ca) -vj -o i>. ' ria for month.
•-< oto M ooO) w vo 00 oou> w
WCJ 0.00' Ui 0.0\N4 4i.vJ M
Total number non-resi-
dents attended fcr the
month.
M0J0^^3■ U)0oOON-t-C-t-
Per cent, of total mor-
bility in strangers for
the month.
-p. t*3 » O^Co W IaJ (jJ OJ tn Oj m
4^ U) Ui N OOOj to v] Ln to M Uj
Total number residents
attended for the month.
VIVO coooo 000000 exjvo oovO
•p M p 00 0 COJ- OOUJ hJ 4- w
Cn O^ 0\Ui Q4»Wmlo00i-<00
OOVl (yiOOOvJ W 0-t* OOCn
Percent, total morbility
in residents for the
month.
OJt-HOJ-^: MMtO-t-4-»:
Total cases due to ma-
laria in non-residents.
Mm. m to w to 1 „
Lo t/iui vj . ov CO JO 00 0^ 00 . Per cent, due to ma-
S) 8 ^ 2 : k ^"o ^ 8i^ ■ '^"* '" non-residents.
Total number cases due
to malaria in residents.
Per cent, due to malaria
in residents.
< ?; p) w n < ^ ^ n ^ -"^ H
OUi 0^ 0\vo O^ CO » OOJ^ O O
Direclinn of wind.
Mean temperature for
the month.
o p p p p -p p -p p p O p
O O O Ln .u to O oot^ vj La »
Mean humidity for the
month.
Mean barometer for the
month.
The accompanying table exhibits the fact that the great-
est percentage of such disease existed when the winds
blew from the northeast or southwest, and as the greatest
areas of marshland lay in these directions, it is more than
probable that the germs of disease were wafted from them
into the residences of those living in the vicinity. Only
for the month of March is the wind reported as having
blown from the west, and during that month the number of
cases of disease due to malaria is very small — 15.42 per
cent. In F'ebruary but few cases are on record, as I had
just returned from the North and my practice was small.
In this month, although the temperature w^as 58°, the
percentage of fever cases was 25 while the wind blew
from the northeast, while in March, when the wind
came from the west, the percentage was only 15.42, with
a temperature of 60°. All things being equal, the
nearer we approach the freezing-point the less liable we
are to malaria. At this point it is not likely that winds
exert any modifying influence, but up to that point I
would infer that they did.
Dr. Austin Flint, in his work on "Practice," speaking
of malaria, proposition third, states : " Its evolution or
active agency is checked by a temperature of 32° ; " which
proposition is fiilly endorsed, I think, by the experience
of the profession. In proposition fourth, written in 1867,
he states : " It is most abundant and virulent as we ap-
proach the equator and sea-coast." It now becomes z.
650
THE MEDICAL RECORD.
[June 16, 1883.
question as to whether or not conditions have changed,
as severe cases of malarial disease have recently been re-
ported from New York (even in that famous health-
resort, the Catskill::), from Connecticut, and my conversa-
tions with intelligent observers from Western States lead
me to think that their malarial fevers are more intense
than those observ^ in East Florida. My experience
would lead me to infer that malaria in this section is
much less intense than it was a few years ago. I am al-
most certain that within the last decade cases of per-
nicious fever are much less common than formerly. One
case of clironic malarial cachexia is recorded in January,
1882. As an evidence of the scarcity of such cases in
East Florida may be mentioned the infrequency of en-
larged spleen. I have heard this fact conuneiited upon
by gentlemen of experience who have moved to this
section from other portions of the .State.
From the table it would appear that the percentage of
disease due to malaria is large, but to oft'set this the
secjueia; very seldom imperil life or future health, being
easily remedied by a temporary change of cHmate, or in
nearly all, cases by time and proper remedies at home.
The mortality is small, presenting a marked contrast to
diphtheria and scarlet fever of the North and West, both
ol which are very fatal, followed by troublesome sequelae,
and are said to be upon the increase. The table ex-
hibits a total of two hundred and twenty-eight cases of
malarial fever for the year, including one recorded as
tvjjho-malarial, out of which there were six deaths, or
2.64 per cent. In estimating the per cent, of cases due
fo malaria all those residing in the State under one year
are regarded as strangers.
The smallness of the percentage for December, Janu-
ary, and February, months when the city is replete with
strangers, is remarkable. In March also it is small.
The total number of cases of phthisis recorded for the
year as having developed among residents is fifteen, giv-
ing a percentage of morbility of 3.4 ; it is impossible to
offer any statistics as to the mortality from tliis disease
in so brief a period of time. There does not appear to
have been any remarkable relation between barometrical
pressure and the existence of disease. From February
to September, with the gradual rise of temperature inci-
dent to the summer months, the percentage of malarial
disease increases. Through September, October, and
November, although the temperature declines, the rate
increases, and keeps up until January, when it becomes
quite low. Mean humidity does not appear as a promi-
nent factor in the development of this class of diseases.
The lowest mean humidity is reported for March, when
the percentage of malarial fever is low, 15.93, but in
January, 1882, when the mean humidity was 78.8°, a high
degree, the percentage of fever was low, 21.42. The
meteorological observations were copied from those issued
by the signal service at this station.
Chlorosis and Fever. — The temperature of ordi-
nary cases of chlorosis met with in young women is
usually believed to be normal. This belief has been
contested by Dr. Molliere, in a paper contributed to tiie
Lyon Medical. His observations were made on eight
young women, who presented no other signs of disease
beyond the an;emia for which they were under treatment.
The temperature was taken every morning and evening
in the rectum, over a i)eriod varying from two to fifty
days, and was found to oscillate between ioi.S° and
102. 8°F. The amount of urea eliminated per diem was
estimated and found to be normal. Molliere suggests
that the increased heat may be explained by the hyiwthesis
of a combustion, the products of which are not so easily
recognized as urea. Sulphate of quinine was given as an
antipyretic, with the effect of reducing the temperature
temporarily. This effect, if constant, would, according to
Molliere, definitely establish the existence of abnormal
body heat in chlorosis.
progress of |VXccliatt Science.
The Biological Action of Picrotoxin. — Professor
Chirone, of the University of Padua, published last year
his experimental researches on the biological action of
cinchonidin. He found this alkaloid was capable of pro-
ducing a true artificial epileps)'. By means of many
vivisections he was able to demonstrate that cinchonidin
exercises its action on the cortical motor centres of the
brain ; since, when the cerebral hemispheres in pigeons
were removed, the epileptogenic action was wanting ;
when one cerebral lobe only was removed, cinchonidin
caused an epileptic convukion only on the half of the
body in relation with the psycho-motor centres not re-
moved.
Picrotoxin also is able to produce epileptic convul-
sions. Professor Chirone now publishes the results of
his experiments with picrotoxin, undertaken with the aid
of Dr. Testa, and compares the action of picrotoxin with
that of cinchonidin. He says :
I. Cinchonidin produces a less complete convulsion,
since the motor muscles of the eye, the tongue, and the
bladder are rarely affected, while these are always in-
volved with picrotoxin. 2. Tlie convulsion caused by
cinchonidin is at first clonic, afterward tonic ; while
with picrotoxin it is at first tonic, afterward tonic and
clonic. 3. By cinchonidin those muscles which are
most used in the normal life of the animal are most
affected ; while by picrotoxin the muscles of the back
and neck suffer most. 4. Cinchonidin does not cause
convulsions in rabbits, even in a poisonous dose, while
these animals are very susceptible to the action of picro-
toxin. 5. Cinchonidin has no convulsive action in.
hibernating animals (frogs, lizards, and toads), while
picrotoxin causes violent convulsions.
From these and many other facts the authors came to
the conclusion that picrotoxin has not the same seat of
action as cinchonidin, and that it provokes convulsions
by other mechanism. Picrotoxin acts on the medulla
oblongata, since it determines epileptic attacks in de-
capitated frogs and pigeons whose brains have been
removed, and these attacks are even more intense.
These are the conclusions at which they have arrived :
I. Picrotoxin may determine true epileptic attacks.
These attacks may be very complete, preceded by cry.
They commence ordinarily with tremors of the head or
contractions of the muscles of the face, and are progres-
sively difiiised through the whole organism. There is
loss of consciousness ; the animal falls ; there are abun-
dant salivation, tonic and clonic convulsions, loss of urine,,
convulsive rolling of the eyeballs, convulsion of the tongue,,
which is often bitten, arrest of the respiration and heart-
2. Convulsions from picrotoxin are independent of the
psycho-motor centres, since they are more intense when;
these are removed. 3. Picrotoxin displays its action first
on the bulb and on the parts connecting the cerebral and/
spinal centres, then on the spinal centres, by the last
action resembling quinine and differing from cinchonidin.
4. Picrotoxin brings into relief a functional antagonisni
between the psycho-motor centres and the motor centres
of the medulla oblongata and spinal cord. 5. Picro-
toxin can also give rise to convulsions after the medulla
oblongata is removed. This conclusion is deduced from
the experiments on frogs, and in this case the convulsion
is later and is tonic. 6. The convulsions of the limbs
due to picrotoxin depend on the action which is dis-
played on the medulla oblongata, and is projiagated by
the spinal cord, and, secondly, by the direct action of the
spinal centres. 7. In frogs the spinal functions are more
developed than the cerebral, and, vice versA, in dogs and
other higher mammals the cortical motor centres of
the brain are more developed than the spinal centres.
8. The convulsions due to cinchonidin are of cerebral
origin, and are not obtained when the psycho-motor
June 1 6, 1883.]
THE MEDICAL RECORD.
651
centres are removed. The convulsions due to i)icr()-
toxin are of spinal or bulbar origin, and are more intense
after the removal of the higher centres. — London Medical
Record, May 15, 1883.
Hot Water as a Gargi.e. — Dr. Ritzy has found hot
water systematically employed as a gargle of great benefit
in overcoming the sensation of rawness incident to acute
pharyngitis. He found that the use of hot water paled
the red and inflamed mucous membrane more or less
permanently. And so far as unpleasant personal sensa-
tions went, it cured the pharyngitis. He also believes
that this simple plan of treatment would prove beneficial
in diphtheria, in patients old enough to gargle intelli-
gently. In ordinary tonsillitis liot water, he thinks,
would hardly fail to act well. Tlie water should be used
as hot as can be well borne, and gargling should be prac-
ticed for several minutes at a time. — The Medical Age,
May 25, 1883. ,
The Use of An/ESthetics during Laijor. — Dr. Sa-
vill, in the Britisli Medical Journal, May 12, 18S3, indi-
cates what he believes to be the main precautions, the
observation of which would render the use of chloroform
perfectly justifiable : i. There are certain women who
have a tendency to flood at every confinement, and
others in whom there seems an already too great rela.xa-
tion of fibre — weak anxmic females in their eighth or
tenth confinement ; and to these it would be unadvisable
to give chloroform, except for necessity. Hap|)ily, it is
not these women who suffer the most pain, but ratlier
those strong healthy primipara; whose pelves and general
build approximate to the masculine type. 2. We should
not give it when labor is complicated with severe vomit-
ing, or with acute heart or lung disease, unless there be
imperative call for it. 3. It should not be given to the
full extent, except for operation, convulsions, or spasm
of the cervix ; and then it is most necessary tliat one
person should devote his entire attention to it. 4. The
inhalation should be stopped directly we find the
pulse becoming very weak, or the respiration irregular.
5. Anything which makes us suspect a fatty or enfeebled
cardiac wall should make us cautious in the use of
chloroform. Here, as in cases other than those of labor,
it is not the most extensive valvular disease (so long as
it be attended by compensating hypertrophy), but tlie
atrophied or degenerate wall that constitutes the source
of danger. Unfortunately, the signs of these conditions
are subtle and uncertain. Fatty heart may be susjjected
by an exceedingly feeble cardiac impulse, combined
with an almost inaudible first sound ; or attacks of dysp-
ncea, vertigo, and syncope, in the absence of an;eniia, or
valvular lesion ; or the copious deposit of fat in oilier
parts of the body, and the occurrence of dropsy without
adequate cause. A dilated heart may be suspected by
increased area of prascordial dulness, combined with epi-
gastric and venous pulsation, and a want of correspond-
ence between the violence of the cardiac impulse and
the strength of the pulse. Pericardial adhesions also
form a great source of danger. They may be suspected
when the heart's apex is fixed above its normal position,
and does not s'nift with respiration ; or when there is de-
pression instead of protrusion of intercostal spaces over
the position of the apex, giving a wavy character to the
cardiac impulse. 6. In all cases, we should take extra
care to prevent the occurrence of hemorrhage after
birth ; by giving a full dose of ergot when the head
reaches the perineum ; by ceasing the chloroform imme-
diately it is born ; and by rousing the patient from her
lethargy as soon as possible.
Primary Acute Miliary Carcinosis. — A sufficiently
searching scepticism is always necessary in medical sci-
ence, and it is at no time more needed than when an
attempt is made to add a new name to medical nomencla-
ture. There are no a priori reasons why carcinomatous
nodules should not crop up in various parts of the body
under the influence of mere general conditions. It is
conceivable that certain of the tissues in certain individ-
uals may as naturally become carcinomatous as those of
others fibroul, external agencies apparently having but
little influence in the matter. Modern pathology, however,
gives an important place to the doctrine of infection, and
in the presence of the actual the mind instinctively turns
from the merely conceivable. There can be no doubt
that the majority of [ihysicians would be extremely care-
ful to exhaust every source of infection before coming to
the conclusion, in any particular case of cancerous affec-
tion of the serous cavities, that they had to deal with a
primary carcinosis of those structures. MM. Raymond
and Brodeur diligently but unsuccessfully searched for
the primary disease in the case which they have reported.
The observation was made on a man aged seventy-six,
who showed during life symptoms similar to those in-
duced by ])ulmonary tuberculosis ; palpation of the
swollen abdomen, moreover, is said to have revealed the
existence of disseminated hard nodules, varying in size
from a pea to a bean, apparently separated from the
observer's hands only by the thickness of the abdominal
wall ; there were, in addition, periodic febrile attacks
simulating ague. To inspection with the naked eye,
tubercles and nodules of carcinoma are sometimes won-
derfully similar. The microscopical characters described
in the above case were those of genuine carcinoma,
growths from the pericardium, pleura, and peritoneum
having essentially the same structure. There was a tu-
mor in the liver which the authors assured themselves
was nothing more than a cavernous angioma. Charcot
has recorded two similar cases also occurring in old age,
and, like the present one, having no hereditary taint. If
the observations be true, we must recognize the existence
of the disease which is called " primary acute miliary
carcinosis."— Z(?«(^« Lancet, March 31, 1883.
Free Incision in Purulent Pericarditis. — At the
last meeting of the Royal Medical and Chirurgical So-
ciety {Lancet, \\>\\\ 28, 1883), Dr. West read a report of
the above case, which terminated in the recovery of the
patient. A boy, aged sixteen, came under treatment
with a large pericardial effusion. The symptoms became
so urgent that paracentesis was performed. Pus was ob-
tained. Three days later paracentesis was again per-
formed, and subsequently the pericardium was laid freely
open, evacuated, washed out, and a drainage-tube inserted.
The temperature never rose, and the boy recovered
completely in five weeks, the only feature of interest
being an attack of general urticaria, which came on about
a week after the operation and lasted three or four days.
In support of the diagnosis, a case was referred to in
which what was supposed to be a mediastinal cyst was
frequently punctured, but it proved to be, on post-mortem
examination, a case of chronic pericardial effusion. The
points of clinical interest discussed were : i, the ab-
sence of any special signs to indicate the nature of the
effusion ; 2, the operation and the place selected for
puncture ; 3, the amount of the fluid evacuated ; 4, a
peculiar epigastric prominence, noticed before paracente-
sis, which disappeared after operation ; 5, the attack of
urticaria ; 6, the pulsus paradoxus. A short account was
then given of the only other recorded case of incision of
the pericardium for purulent pericarditis, by Prof. Rosen-
stein, of Leyden, which also recovered. Dr. West also
read a paper on the statistics of paracentesis pericardii.
A complete list of the recorded cases up to date was
given in a tabular form, with the addition of several cases
hitherto unpublished. The history of the ojjeration was
briefly referred to. The cases were discussed under the
headings of sex, age, causes (rheumatic fever, scor-
butus, phthisis and pleurisy, miscellaneous, purulent
pericarditis), length of illness before operation, the effect
of the operation, the nature of the fluid ; the ciuan-
tity of the fluid, the number of punctures, the modes i f
operation, the place of puncture. The following coi -
652
THE MEDICAL RECORD.
[June 16, 1883.
elusions were drawn : i. Paracentesis pericardii is not
only justifiable, but an operation which may be safely
undertaken with ordinary precautions, for only one case
is recorded in which the operation was in itself fatal, and
with this exception all the patients were greatly relieved
by the removal even of small amounts of fluid, and many
recovered completely who would probably have died
had the oiseration not been performed. 2. The most
suitable place for puncture is, in ordinary cases, in the
fifth left intercostal space, one inch from the edge of the
sternum ; but if the pleura be adherent, the puncture may
be made safely much further out, and even in the sixth
space. 3. The instrument employed should be a trocar
and canula, with or without aspiration. 4. The operation
may be performed with advantage, not only in the peri-
cardial effusions of rheumatic or primary origin, but also
in those which occur in the later stages of general dropsy,
if it should appear that the fluid in the pericardium is
adding to the difficulties under which the heart is placed.
5. Purulent pericarditis is best treated on general princi-
ples, like empyema. 6. The pericardial sac may be safely
opened and drained. 7. This treatment, moreover, ap-
pears to be the only one which offers the slightest hope
of recovery. 8. The results do not seem to be as unfavor-
able as those of emp\ema, for the walls of the cavity are
better able to contract rapidly, and thus permit of the
obliteration of the cavity.
Salicylate of Zinx. — This salt is very soluble in
water, and dissolves also in alcohol and ether. The
medical properties attributed to salicylate of zinc are that
it forms a valuable antiseptic and astringent agent. In
certain kinds of cancerous ulcers it has, we are told,
given some excellent results, and has been used success-
fully in gononhcea, as an injection, in solution contain-
ing one-half to one per cent, of the salt. Messrs. Poignet
and Demarres, two P'rench |)harmacists, assert that it is
preferable to sulphate of zinc as an astringent in ophthal-
mic affections, and in other cases, since it combines with
its astringent action the antiseptic jsroperties of salicylic
acid. — The Monthly Magazine of Pharmacy.
Co.MUINED E.XTERNAL AND INTERNAL CEsOPHAGOT-
OJiv. — Among the conditions recently advanced as in-
dications for gastrotomy are the so-called impermeable
cicatricial strictures of the lower portion of the oesoph-
agus. They have been placed in this category because
of the generally entertained belief that their removal bv
operative measures was eitlier impossible or attended
with the greatest danger to life. While unwilling to deny
that gastrotomy may be called for in certain cases. Pro-
fessor Gussenbauer believes that many, if not all, oesoph-
ageal strictures of cicatricial origin, even in the thoracic
portion of the tube, or at the cardia itself, may be relieved
by an operation of much less gravity. He relates two
cases in the Ztitschri/t fiir Ilcilkundeoi March 20, 1883,
in which he performed the double operation of external
and internal cesophagotomy with success. The first
case was that of a young woman who had taken about
an ounce of sulphuric acid with suicidal intent. The
attem|)t against her life was unsuccessful, but it resulted
in the production of a double stricture of the tesophagus,
one in the cervical and the other in the thoracic por-
tion. It v.'as determined to perform external cesophagot-
omy, and accordingly an incision was made in the neck
below the level of the cricoid cartilage, when the upper
stricture was readily cut by a probe-jjointed bistoury
passed on a director. The lower stricture was very tight,
but after several attempts a filiform bougie was passed.
Using this as a guide, the operator introduced a fine
director and then incised the stricture in several direc-
tions with a hemiotome. The patient made a rapid re-
covery and was able to take solid food with ease. Owing,
iiowever, to neglect on her part in passing the bougies,
a recoiUraction took place. The same operation was
performed a second time with equally successful result.
The second case was that of a child, to whom a tea-
spoonful of a fifty per cent, solution of carbolic acid had
been given by mistake. The stricture was situated at
the cardia, or immediately above it, and was so close as
to prevent the passage of the smallest sized bougie in-
troduced through the mouth. The child could take no
nourishment, even water being regurgitated. The
oesophagus was opened as low down as possible, and the
attempt was then made to pass a sound. But it was only
after repeated trials that the operator succeeded in in-
troducing the finest filiform. The subsequent steps were
the same as in the preceding case, and the results of the
operation were equally favorable. Reasoning from his
success in these cases. Dr. Gussenbauer thinks that the
attempt to relieve cicatricial strictures of the lower por-
tion of the oesophagus by the combined method should
always be made before resorting to the much more seri-
ous operation of gastrotomy.
Inosculation between the Lymph.\tics and the
Capillary Blood-Vessels. — The ojuestion of the lym-
phatic circulation is one which is as yet by no means
settled. Mascagni and Sappey hold the opinion that
there is an anastomosis between the ultimate arterial
ramifications and those of the lymphatic system, but
most microscopists deny that such a connection e.xists.
In a recent communication, addressed to the Academic
des Sciences of Paris, Dr. Alphonse Guerin has em-
bodied the results of some experiments undertaken by
him to determine this point. He selected as the field of
his study the pulmonary pleura, a membrane admirably
adapted for such purpose, by reason of the number and
superficial location of its l3'm|)hatics. He found that if
an injection of water were thrown into the pulmonary
artery, in a few seconds the fluid would enter the lym-
phatic vessels, distending them so that they were readily
visible beneath the pleura. Were it not conceded that
there is no venous plexus upon the surface of the lung,
one would be tempted to regard the injected vessels as
venous radicles. But aside from that. Dr. Guerin de-
termined the nature of the vessels by tracing the injec-
tion into the lymphatic glands lying near the bronchi.
Before drawing any practical conclusions from these ex-
periments, the speaker endeavored to answer any objec-
tions that might be raised against his interpretation of
the facts observed. To the first objection, that it was
not possible to conceive of a direct coumnmication be-
tween the two svstems which would not permit the )ias-
sage of red blood-globules from one to the other, he
stated that he had never observed this to occur ; further,
it had been shown by Sappey that the led corpuscles
could not pass through a vessel less than 2 mm. (xTf utnr
inch) in diameter. The fluid passing first after the in-
jection of the pulmonary artery was of a red tinge ; but
this only proved that a fluid analogous to the blood-
serum, containing h.-cmaglobin in solution, could pass
through the anastomosing vessels. It might also be
urged that post-mortem epithelial changes may permit of
a conninmication between the two sets of vessels, which
did not exist during life. But this objection was disposed
of by some injections ])ractised upon rabbits at a time
when no post-mortem destruction could possibly have
commenced. Dr. Guerin thought he had found in this
anastomosis an explanation of some of the phenomena
of inflammation. If the scrum of the blood can pass
from the arterial capillaries to the lymphatics, the white
corpuscles can <lo the same. In accordance with these
views, he regarded suppuration as arising from the pas-
sage of the white corpuscles of the blood into the lym-
lihatic vessels rather than from their extrusion through
the capillary walls. The first phenomenon, tlicrefore, of
suppuration was the invasion of the lymphatic territory
by the white blood-globules, this invasion taking place
through the anastomotic connections of the two sys-
tems.
June i6, 1883.]
THE MEDICAL RECORD.
65:
The Medical Record
A Weekly yournal of Medicine and Surgery.
GEORGE F. SHRADY, A.M., M.D., Editor.
Published by
WM. WOOD & Co., Nos. 56 and 58 Lafayette Place.
New York, June 16, 1883.
THE CONVALLARIA MAIALIS— ITS ACTIONS
AND USES.
It is a matter of gratification that tiiis beautiful little
flower, whose clusters of white hanging bells greet us at
this season of the year in many a garden, on the heath,
and even by the solitary wayside, is of real therapeutic
value, worthy of a rank beside the purple foxglove.
The convallaria is one of our newest remedies, scarcely
known to the profession three years (in fact, Dr. Ralph
D. Ary's first report bears date October, 1881), yet it
has already won for itself an established place in the
treatment of adynamic heart afifections.
Dr. D. Ary learned the use of this plant while on a
tour through his native country, Russia, where it is used
as a favorite diuretic and tonic of the heart in chronic
dropsical effusions.
Drs. Bogoyavlenski and Troitsky. of St. Petersburg,
had previously experimented with the convallaria and
called the attention of the profession of Russia to its
merits. Their articles were, by Dr. Ary on his return to
this country, translated and published, chiefly in the
Therapeutic Gazette.
Early in the year that has passed, Professor Germain
See, of the Hotel Dieu, Paris, learning through Professor
Botkin, of St. Petersburg, of the usage of the lily-of-
the-valley, in Russian practice, introduced it into his
hospital service, besides submitting it to physiological
experimentation in his laboratory. The results of these
experiments with the convallaria were published in the
Bulletin Gen. de Therapeutique, July 30th, and were
communicated to the medical profession of the United
States, through the columns of The Medical Record,
in an article by Dr. Hurd, of Newburyport, bearing date
September 9, 1882.
Since The Record of the above date called atten-
tion to this new remedy, it has been very extensively
prescribed throughout this Union, and it is safe to say
that there is not a city or hamlet in the land where it
has not been tried in cases of cardiac dropsy. In fact,
it is now one of the remedies that are first thought of in
such cases.
Physiological actions. — Experiments on animals show
that convallaria has a marked tonic action on cardiac
innervation ; small doses strengthening, while slowing
the heart's pulsations, large doses speedily tetanizing that
organ. In fact, death occurs, in poisoning by this drug,
from tetanus of the heart, and the heart's cavities are
found empty. Experiments on the human subject show
that there is a marked effect on the heart and circulation,
but as yet no cases of poisoning have been observed.
It is probable that the toxic dose in the human subject
would be large.
In pathological conditions of cardiac adynamia, char-
acterized even by extreme asystolism, the efifects of the
convallaria are often most beneficial, but it must be taken
for granted that the heart muscle is in a state to respond
to excitation ; if fatty degeneration be much advanced,
it is useless to expect any considerable effect from any
remedy. The convallaria will generally do what any
medicament can do — cases that have failed to derive
benefit from digitalis are often helped by it. In func-
tional palpitations, from whatever cause, we have known
speedy relief to be derived from ten-drop doses of the
fluid extract of convallaria flowers. In the asystolism of
Corrigan's disease the heart's action has been strength-
ened, dropsical effusions in the thorax and subcutaneous
cellular tissue have been removed, and the patient made
every way more comfortable. But it is especially in the
dropsy from mitral insufficiency, where the heart's pulsa-
tions are weak, rapid, and irregular, that the most
marked benefit has been derived. We have reports of
several cases awaiting publication — where the paretic
heart has been aroused to new life and activity, where
the sluggish kidneys have gone to work in earnest to re-
move dropsical accumulations (it is not known whether
convallaria produces its diuretic effect in part by a special
action on the secretory function of the kidneys) and
where in a few weeks the patient has been restored to a
fair state of general health, with entire freedom from
dropsical eff"usions, and all under the influence of drachm
doses every four hours of the fluid extract of the lil)--of-
the-valley.
Preparations and doses. — Now is the time, while the
plant is in bloom, to save a quantity for use during the
coming year. The infusion of the entire plant is a good
form in which to give the remedy. Two drachms of the
leaves may be steeped in a pint of water and the whole
taken during the twenty-four hours. The alkaloid of
convallaria has been little given, and we have no cer-
tain data with regard to its administration. The alcoholic
tincture, made by macerating four ounces of the flowers
in a pint of alcohol, is a very reliable preparation, and
may be given in doses of from ten to forty drops every
four hours. The liquid extract of the root is a good
preparation, but must be given in larger doses than any
alcoholic preparations of the leaves and flowers. What-
ever form of the medicament may be chosen the dose
may be gradually increased without fear of evil results ;
unlike digitalis it has no cumulative action to be dreaded.
Sometimes it is well to interrupt the action of the medi-
cine, and give digitalis for a time. It is almost always
indicated when digitalis fails to act.
We have endeavored not to be unduly eulogistic of this
new cardiac tonic. Perhaps the sober second judgment
of the profession will give it a lower place in therapeutics
than has been here assigned. It must, however, always
from henceforth rank as a heart corroborant of great
utility.
654
THE MEDICAL RECORD.
[June i6, 1883.
MEDICAL INCOMES IN NEW YORK.
A DAILY paper of this city has recently published the
results of a reporter's investigations regarding the income
of some of New York's prominent physicians and surgeons.
The publication is an impertinent one, yet we cannot
but notice the very moderate amounts at which the in-
comes of even the best-known practitioners are fixed.
The largest do not exceed $25,000, and the average in
a list of about thirty names is about $15,000. We are
inclined to think that the estimates are somewhat under
the real amount in many cases. Yet there is no doubt
that the enormous sums of $60,000, $80,000, and $100,-
000 per year, which it is rumored some New York medical
men receive, are great exaggerations. We doubt if the av-
erage income of the New YorkCity physician exceeds $5,-
000, and there is a very large number, if not a majority,
who do not get even this sum. A doctor has to work hard
to make $400 a month, unless he has the better class
of patients.
With the increase in scientific knowledge and practical
skill, there has been an increase, in late years, in the
average incomes of professional men, but the maximum
of individual incomes has not been raised. No physician
or surgeon of the present day has probably ever reached
the _j£"2 1,000 a year which Sir Astley Cooper and Sir
Everard Home are reputed to have earned, nor the j£i,-
000 single fee which the former once received. Forty
years later, according to Timbs, there were not six medi-
cal men in London who received over ;^5,ooo a year,
and recently a London writer estimates that the number
is not above thirty.
Neither in New York nor in any other American city
is it possible for a physician, without some special genius,
to make a fortune. The more he earns the more he is
obliged to spend, so it happens that a leading specialist,
who had an income of $10,000 to $15,000 )-early, died
recently insolvent, and the widow of a prominent and
widely known surgeon has now to depend upon charity.
This is the darker side. Many members of the pro-
fession, perhaps the majority, earn enough to live com-
fortably, educate their families, and supply themselves
with some luxuries ; and their practice, though hard
enough, does not involve so much physical wear and
tear as that of their provincial and country brethren.
THE NEW YORK ACADEMY OF MEDICINE AND THE
STATE SOCIETY.
" TAa kettle to the pot denies
Its sordid superjicies."
Some attempts have been made to excuse the action of
the Academy of Medicine at its last meeting, by compar-
ing it with the action of the State Society in adopting
the State Code. " It [the .Academy's action] was done,"
says Dr. Squibb, " exactly as the New Code was adopted
in the New York State Medical Society," in 1882. Such a
statement illustrates, in an interesting manner, how parti-
san zeal will warp the most truth-loving mind.
The differences between the action of the Academy
and of the State Society are several. For a year every
county society knew, or should and could have known,
that the Code of Ethics was to be changed ; notice of
the exact cliange could not be given, because it would
have been forestalling a committee's report; there was
no previous pledge that the matter of ethics should not
be introduced ; there was no secret and organized at-
tempt to surprise the Society ; and there were no threats
of " throttling it" at the time.
We have never heard that the pot was thought the
more of because it called the kettle black, and the mana-
gers of the Academy fiasco will not regain respect by
crying that others are just as bad as they.
AUTOPSIES IN THE ARMY.
Not long ago we mentioned the fact that the Surgeon-
General of the Army had issued a circular directing mem-
bers of the medical corps to make autopsies whenever
practicable. It appears now that the carrying out of
this order will meet with some opposition.
A few weeks ago a soldier was accidentally killed on
the target range. The bullet struck him in the upper
lip and passed directly through his brain. He died in
less than two minutes. A post-mortem was held the
next day, all the viscera being carefully examined. .\
correspondent of the Ti?iu's, using this incident as a text,
protests against the right and legality of the Surgeon-
General to order or permit such examinations. He says :
" This enlisted man did not sell nor convey his body
to the medical corps ; there is nothing either expressed
or implied in the contract entered into between the
United States and this enlisted man which gives his body
to the post surgeon for dissection after death. W^hen
dead, killed in the line of duty, his body is entitled to and
merits decent treatment and honorable burial. His body
does not receive decent treatment if it be subjected to
the surgeon's knife without his consent previously ob-
tained."
We understand that the body of a dead soldier should
receive the same respect and consideration as that of any
other citizen — and no more. No one in private life
makes a bargain with his doctor not to hold an autopsy.
It would be foolish and impracticable to attempt getting
an expression of opinion from each recruited soldier as
to his exact post-mortem disposition, since in many
cases autopsies are absolutely demanded ; nor is autopsi-
cal examination "indecent treatment."
The rule which holds in civil life has been found satis-
factory, and it can be applied in a measure to the soldier.
Autopsies should be allowed, provided responsible friends
or relatives do not object. The Surgeon-General has
no moral right to order an autopsy in opposition to the
wishes of these. Yet it must be admitted that the com-
plications and unusual conditions of military life make
any special regulation impossible.
THE IRON CURTAIN .AT WALLACKS AS A SAFEGUARD
FROM FIRE.
Wallack's Theatre is one of the two or three theatres
in the city which have been pronounced perfectly safe
as regards fire. This security is attributed to the large
number of exits and to the fact that there is an iron cur-
tain separating the auditorium from the stage, which can
be let down in case of fire. This curtain was put in at
a time when iron curtains were thought to be the great
and indispensable feature of a fire-proof theatre.
June i6, 1883.]
THE MEDICAL RECORD.
655
Further experience seems to throw some doubt over
the vahie of this opinion. At the International Hygienic
Exhibition, now open at Berlin, the display of iron cur-
tains among the life-saving apparatus is small, and there
is a well-developed opposition to their use. A very
powerful argument has recently been furnished to this
side. The National Theatre of Berlin burned down
not long ago. Tliere was no one in it at the time, and
no lives were lost. The iron curtain was down, how-
ever, and we are informed that before the house could
possibly have been emptied this curtain came crashing
over into the parquet.
It would be well if the public could be assured that
such an accident can not happen at VVallack's or other
theatres where this partition has been, or is likely to be,
introduced.
§[aus of tlte ^mcch.
Death of Dr. No.ah C. Levings. — Dr. Noah C.
I.evings died at his residence in this city June nth, at
the age of fifty-nine years.
The Oregon State Medical Society met during
the past week at Portland.
The Pennsylvania Anatomy Bill. — The Legislature
of Pennsylvania has passed the new bill providing for a
supply of anatomical material substantially as it was
drafted.
Another Office Thief. — An office thief, who is
known under the name of " Dutch Lena," is around again.
She is about thirty-five years of age, of sickly aspect, and
claims to be sent by some neighboring, druggist to consult
the doctor on account of uterine ailment. She says that
several operations have been performed on her by promi-
nent specialists. She finds out when the doctor is absent
from home, when she calls, and, under pretence of writ-
ing a note, steals whatever she can.
The Death of Dr. William E. Kennedy, an old
and widely-known physician of New Orleans, is an-
nounced.
What Other People Think of The American
Medical Association. — Seldom have so many bitter
and contemptuous conuiients upon the medical profes-
sion been called out as by the recent action of the
American Medical Association. We print the following
specimen from the Neiu York Times :
" The labors of the American Medical Association
were crowned at its final session by the expulsion of Dr.
Goodwillie, of this city, upon the express ground that he
adhered to the Code of Ethics of the New York State
Society. In other words, a physician whose standing is
not challenged in any other respect is declared unworthy
of professional association because he reserves the right
to attend a patient in consultation with an ' irregular '
physician of the patient's own choosing, whenever, in his
judgment, any emergency requires him to do so. And
this reservation is regarded as the violation of a code of
' ethics.' The doctors who take this view would appear
to be cruel bigots if they did not present so much more
prominently the aspect of smiple geese. This is not the
spirit of a learned profession ; it is the spirit of an igno-
rant trades-union, bent upon punishing ' rats.' The men
who made it and who adhere to it must believe not so
much that it is the business of physicians to heal the sick
as that it is the business of the sick to furnish constant
and remunerative employment to a carefully limited num-
ber of 'regular ' physicians."
The above is somewhat strong. No one, of course,
questions the legality or logical necessity of the Associa-
tion's action — which was hardly a formal expulsion. But
to refuse.to consider that there is anything wrong in a set
of by-laws which excludes several thousands of reputable
and hundreds of eminent physicians, this naturally excites
criticism.
^cjjorts of Societies.
MEDICAL SOCIETY OF NEW JERSEY.
One Hundred and Seventeenth Annual Convention, held
at Atlantic City, June 12 and 13, 1883.
(.Special Report for The Mbdical Record.)
Tuesday, June i2th — First Da.y.
The Convention was called to order by Dr. John W.
Snowden, of Waterford, President, after prayer by the
Rev. Joseph Garrison, D.D., of Camden.
An "Address of Welcome" was tendered by Dr. Board-
man Rekd on behalf of the Atlantic District Medical
Society. He was followed by the Hon. Charles Max-
well, Mayor of Atlantic City, who in a very happy
manner greeted and made welcome the medical fraternity
of New Jersey.
After the reading and adoption of the minutes of the
last annual meeting, the recent action of the American
Medical Association
in regard to the code of ethics,
as supported by that body, was brought to the attention
of the meeting. A lively discussion ensued, in which
much was said both in favor of and against the position
maintained by them, hs there was some misunder-
standing with reference to the precise nature of the
Code of Ethics in question, Dr. Atkinson, Secretary of
the American Medical .Association, was asked to ex-
plain. He stated that the Code of this year, which all
delegates were required to sign, did not differ in any
particular from the original Code as formed by the Amer-
ican Medical Society. It was then urged by Dr. Price
that a Society which frames a law or laws had the right
to enforce compliance with such law or laws, so far as
delegates were concerned who wished to be connected
in any manner to it. Dr. H. H. Tichenor stated that
the State Society should assert its loyalty to the "old
Code " without modification.
Dr. Ezra M. Hunt then presented the following res-
olution :
Whereas, The American Medical Association has at
its late meeting made new requisition of delegates before
their names were allowed to be enrolled ;
Resolved, That in nominating delegates to that body
the Nominating Committee be requested to confer with
our Committee on Ethics, and if they think necessary,
with the Society, as to the propriety of this course, and
what action needs to be taken in reference thereto.
During the discussion that followed, a motion was
made to "lay the resolution on the table," and after a
very close contest the motion was carried.
Dr. Hunt stated that a code of ethics should not be
presented for unconditional acceptance, which, because
of some questionable modifications, rendered them liable
e^e
THE MEDICAL RECORD.
[June i6, 1883.
to debate, if inspection by a special committee were al-
lowed. Also that a body maintaining such a standard
of ethics should in all fairness listen to suggestions when
so much of importance is involved.
After the announcement of committees by the Presi-
dent the meeting adjourned to 7.30 p.m.
First Dav — Evening Session.
The meeting was called to order bv Dr. Stephen
WicKES, of Orange, Kirst Vice-President, after which the
President delivered his address.
president's address.
" The Advances Made in Medicine by Physical Diag-
nosis." He stated that in the early history of medicine
physical diagnosis was unknown. The first means of
this sort was introduced by Hippocrates, and styled suc-
cussion. The means of diagnosis of diseases of the chest
were then considered, the various appliances which are
used as aids being well enumerated and described. Among
the more recent additions since the time of Laennec are
the sound of pleuritic friction by Raynaud in 1829, peri-
cardial friction by Collin in 183 1, and the proper inter-
pretation of sounds heard over the vessels. Phonometry,
as described by Prass, is a new method of investigating
the condition of the thpracic and abdominal organs. It
consists in placing a vibrating tuning-fork on the surface
of the chest or abdomen and determining by the intensity
or feebleness of the tone it gives whether the subjacent
organs do or do not vibrate simultaneously, that is
whether they are permeable or not to air. The paper
was an exhaustive treatise on the subject of physical
diagnosis and contained much valuable information. At
its conclusion the address was appropriately accepted
and referred for publication in the " Transactions'' of the
State Society.
Dr. H. H. James, Chairman of Conmiittee on
WHERE AND OF WHOM RELIABLE V.\CCINE VIRUS MAV BE
OBTAINED,
then made a report, in which he stated that each physi-
cian for himself ought to investigate whether the virus he
uses is pure and reliable. Owing to the prevalence of
small-po.x for the last few years, the demand for vaccine
lymph has been great ; so that in order to meet this need
a quantity of unreliable virus has been thrust on to the
professional community by the "vaccine farms,' "vac-
cine companies," etc. Dr. Wm. M. Nelsh, Surgeon of
Afunicipal Hospital, Philadelphia, says that one propa-
gator is able to charge from eight thousand to fifteen
thousand points from one heifer. This is four or five
times the number collected by more reliable producers.
There is a so-called patent lymph advertised and sold
throughout the country. One of these specimens was
e.xamined by Dr. J. Mitchell Prudden, of New York,
and he found it to contain epithelial cell, hairs, some
broken oft", others having their roots attached. Beside
these things there were fragments of vegetable sub-
stances of various kinds. It is thus shown how impure
and unreliable nuich of the lymph is. The author of the
IJaper said that perfectly reliable virus might be obtained
from Dr. Henry A. Martin & Son, Boston, or from Dr.
Frank P. Foster, of New York. He closed his report
by saying that the propagation of animal virus is a ser-
vice requiring very exact management, and should be
committed to no hands but intelligent and conscientious
physicians.
After the reading of the paper it was discussed by Dr.
J. D. Osborne, of Nesvark, who said that physicians are
much to blame for the unpleasant results wliich so often
follow vaccination with animal virus. He considered
the humanized lymph much more reliable.
Dr. Price, of Camden, agreed with Dr. Osborne, and
further stated that after vaccinating a child with Iniman-
ized virus he had placed it in the bed with its father, who
had small-pox, without any fear of the disease being trans-
mitted from the sick to the healthy. No unfavorable re-
sult followed.
Dr. Wrightson, of Newark, then stated that in Mary-
land there was a State law regulating the usp of vaccine
lymph, physicians being provided with reliable virus
gratis. He made a motion to the eftect that such a law
be made in New Jersey, but it was not carried.
Wednesday, June 13TH — Second Day.
The meeting was called to order by the President
after which the Nominating Committee reported as fol-
lows :
President — Stephen Wickes, of Orange ; First Vice-
President — P. C. Barker; Second Vice-President —
Joseph Parnsh ; Third Vice-President — Charles J. ICipp ;
Recording Secretary — William Pierson ; Corresponding
Secretary- — Wm. Elmer, Jr. ; Treasurer — W. ^V. S. Phil-
lips.
Standing Committee — T. J. Smith, Chairman ; E. J.
Marsh ; S. S. Clark.
Delegates to American Medical Association — George
Bayles,' H. G. Cook, J. Condict, W. R. Little, E. J.
Marsh, D. A. Currie, E. L. B. Godfrey, A. Coles, B.
A. Watson, George F. Welch, L. A. D. Allen, D. B.
IngersoU, H. W. Elmer, Frank Ashhurst, J. D. Heri-
tage. •
Delegates to State Aledical Societies. — Pennsylvariia —
Theo. A. Varick, T. L. Laws, D. Berryman ; Connecti-
cut— D. C. English, — Sonnors, St. John ; Rhode Island
— Rich Page, Boardman Reed, L. J. Gordon ; Massa-
chusetts— E. North, E. M. Hunt, J. L. Bodine ; Ver-
mont— George H. Larison ; Maine — Joseph North, Jr.,
W. K. Newton, .A. C. Hunt.
Drs. T. .A. Emmett and Isaac E. Taylor were elected
honorary members.
The subject of the " Fellow's Prize Essay" for 1884,
will be " The Etiology and Pathology of Septicjemia and
Pyjeniia."
Dr. Joseph Parrish, of Burlington, read a very in-
teresting paper on
SO.ME problems IN INSANITY,
in which he stated that places of retreat should be
provided where the patients should in every instance
have the most careful attention, and where there should
not be unnecessary restrictions enforced. He likewise
asserted that many of the so-called lunatics in the New
Jersey State Asylums are not insane, and that if only the
insane were confined in the asylum, there would be nmch
more vacant room than can at present be found.
The doctor, after the paper was duly accepted and
discussed at some length, oftered the following :
Resolved, That it is the
OPINION OF THIS society TH.\T A LUNACY COMMISSION
should be appointed
by the State authorities and as a means of protecting the
pauper insane especially, and of improving the general
condition of the almsiiouses of the State.
This resolution was not ado])ted as first presented, but
was remarked upon and finally adopted as amended by
Dr. E. M. Hunt, in the following form :
Whereas, The condition of the insane poor in the sev-
eral county houses of the State is such as to warrant
investigation by this Society, it is therefore
Resolved, That the Chair appoint a committee whose
duty it shall be to inquire into the management of the
asylums and poor-houses in the several counties, as often
as may be suitable, and in a friendly and unofficial
manner acquaint themselves with the condition of the
insane, and report to this Society at its next annual
meeting.
June i6, 1883.]
THE MEDICAL RECORD.
657
Dr. Geo. Bayles, of Orange, then read a very in-
structive paper on
CAUSES OF MELANCHOLIA.
In this i)aper he showed, by deductive reasoning, what
may be regarded as the initial agencies at work in the
world to provoke a tendency to mental incompetency
through cerebral innutrition. Melancholia is.considereil
as a term of very general significance, applied very gene-
ricaily to many, if not all, conditions of mental aliena-
tion lireliminary and leading to insanity. The etiology
of melancholia includes two sets of causes, " the remote
predisposing " and the " immediate exciting." It was
the former that the essayist j^aid special attention to.
The great cosmic causes, and those of heredity, have
heretofore been considered as mainly those u])on which
the melancholic dyscrasia depends. Dr. Bayles claims
that in many periods of the world's history, and in many
communities, these special causes are not directly 0|)er-
ative. There is another cause, found within the system
of the mother, derived from the impressions made upon
the generative zone through the emotions. The influ-
ence of the emotions upon the nutrition of the ova, u|ion
the nutrition of the foetus in utero, and the post-natal
life, is fully set forth. The writer claims that a sufficient
first cause of depreciated mental and nerve force is all
that is necessary for the successful operation of the later
or secondary causes. The doctor claims the unqualified
importance of the [jre-natal e.\cellence of the germ of
future life. After pointing out what should be the true
physico-mental states accompanying conception, it is
shown how this bears upon nutrition or innutrition in
relation to the etiology of melancholia. A brain inherit-
ing normal and healtliy conditions is never susceptible to
motives of melanclnjlia, excepting under the direct influ-
ences of acute organic disease. This paper seems to be
an extension of the writer's views as presented in a paper
read before the New York Medical Journal Association,
about four years ago, entitled " The Malady of Innutri-
tion."
The committee ai^pointed at the last annual meeting
of the New Jersey State Medical Society to present a
plan for putting into effect the suggestions made by the
President
IN REGARD TO THE CURRICULUM OF MEDICAL STUDY,
reported as follows : They suggest that when possible a
regular college education be had, and that when such a
course is impossible an equivalent or near approxima-
tion to it be exacted, and that the applicant should pro-
duce a certificate of a completed course in a reputable
academy or high school, in which are taught in addition
to the English classical and mathematical branches re-
quired for admission to our more advanced colleges,
intellectual and moral philosophy, rhetoric, logic, and
the elements of physics, chemistry, and natural history,
including botany and zoiilogy.
In default of either a college diploma or academic
certificate as above defined, the applicant, before being
taken under the care of a physician for medical instruc-
tion, should be subjected to examination and approved
by a competent censorship appointed under the author-
ity of the State Medical Society. In order that the de-
sired result might be attained it was recommended that
the action of this Society be communicated to the medi-
cal societies of the several United States, to the National
Medical Association, as well as to the local medical or-
ganizations, with the request that they co-operate with
the New Jersey Medical Society.
Dr. C. J. Kipp, of Newark, then read a very practical
and interesting paper on
THE MANAGEMENT OF CASES OF IRITIS.
He stated that in the treatment of all cases of iritis, no
matter what the origin, the first indication is to secure
dilatation of the pupil, and for this purpose the most re-
liable mydriatic is the sulphate of atropine. In recent
cases five or six instillations of a few drops of a one per
cent, solution of atropine, made at intervals of five
minutes, will usually break up any adhesions which may
already have formed, and cause complete dilatation in the
course of a few hours. When, as is sometimes the case,
the atroisine does not have such an effect, six or eight
leeches should be apjilied to the temple. When leeches
cannot be used with benefit, a brisk cathartic will some-
times have a very desirable effect. In all severe cases the
patient should be put to bed, or at least kept in a dark
room till the severity of the disease is broken. Dilata-
tion of the pupil should be maintained until all irritation
has subsided. If such remedies as have been recom-
mended do not produce a larger pupil, mercurials should
be given bj- inunction or by tlie mouth. In some cases
muriate of pilocarpine will answer very well. In his re-
cent ]5ractice the doctor has been able to dispense with
mercurials in cases where there were not marked symp-
toms of secondary syphilis. To relieve the pain morphia
is to be given in large enough quantities to produce
sleep at night. Paracentesis of the anterior chamber will
give relief if the pain is due to increased tension of the
globe, a symptom not at all uncommon in the so-called
serous iritis. If after the iritis the pupil is excluded, an
iridectomy should be made as soon as practicable. It
would be profitable to report in full this paper which
deals with such an important lesion, but space and time
forbid.
Drs. Marsh and 15ai,dwin were appointed a com-
mittee to arrange for the entertainment of the Society at
the next annual meeting at Cape May, N. J.
MASSACHUSETTS MEDICAL SOCIETY.
One Hundred and Second Annual Meeting, held in Bos-
ton, Mass., June 12 and IT,, 1883.
(By Telegraph to The Mkdical Record.)
Tuesday, June i2Th— First Day.
The one hundred and second annual meeting of the
Massachusetts Medical Society was held at Huntington
Hall, Massachusetts Institute of Technology, Boston,
Mass., commencing June 12, 1883, Vice-President Dr.
John H. Macrie, of New Bedford, presiding.
concerning the tubercle bacillus.
Dr. H. C. Ernest, of Jamaica Plain, read a paper on
the "Tubercle Bacillus," giving a rrsiniicoi the views of
Koch, Pasteur, and others, concerning the same, and
presenting a large number of original experiments of
inoculation with tuberculous matter. In guinea-pigs,
operated upon there was always found a causal relation
of the inoculation with the death of the animals from
phthisis. Several cases of phthisis were also reported,
in all of which the bacilli were found in large quantities
in the sputa. The same result was obtained in the ex-
aminations of cheesy glands, lung cavities, in specimens
of miliary tuberculosis, and in one case of tubercular iri-
tis. No 'culture experiments were attempted. The writer
coincided with Koch's view to the effect that there was
a bacillus which by inoculation was capable of producing
tubercular processes, and also that the examination of
the sputum of cases of suspected phthisis was of great
diagnostic value.
In the discussion which followed, confirmatory state-
ments were made by Drs. R. H. Fitz and W. T. Whitney.
Dr. H. R. Bowditch believed that the bacillus doc-
trine gave great weight to the possibility of the conta-
giousness of tubercular disease, and alluded m passing to
the possible benefits of antiseptic respirators. He also
referred to the necessity of examining the sputum in
doubtful cases of pulmonary phthisis.
Dr. P;rnest remarked that no suitable antiseptic had
been found for the bacilli. Carbolic acid and other an-
tiseptics acted onlv very slightly on bacilli. Perhaps re-
658
THE MEDICAL RECORD.
[June i6, 1883.
peated cultivations, like those of Pasteur in connection
with hen-cholera, might prove of service in establishing
a means for prophylactic inoculation.
Drs. L. S. Wood, of Springfield, and W. A. Dunn, of
Boston, read papers on " The Uses and Abuses of Ergot,"
after which the morning session concluded.
First Day — Afternoon Session.
The meeting was called to order by President Alfred
HOSMER.
The following papers were then presented : Dr. J. W.
IVarren, of Boston, on " Glycogen ; " Dr. O. F. Wads-
worth, of Boston, on " Phlyctenular Diseases of the
Eye ; " Dr. B. H. Hartwell, on " Minor Injuries of
Spinal Cord" — reporting nme cases ; and Professor T.
A[. Clark, of the Massachusetts Institute of Technology,
on " Plumbing Appliances," illustrated by working
models of water-closets, ventilating systems, and samples
of faulty and good plumbing. He spoke of the system
adopted in the new bill regulating plumbing in Boston.
At the annual meetmg of Councillors in the evening
there was the usual discussion and vote
ON ADMISSION OF WOMEN TO THE SOCIETV.
Although the majority of the Fellows seemed in favor
of the measure in answer to private circulars, the mo-
tion to amend the by-laws so as to admit women was lost.
ELECTION OF OFFICERS.
The following named officers were chosen : Presidoit
— Alfred Hosmer ; Vice-President — Ira Russell; Treas-
urer— Frank W . Draper ; Recording Secretary — F. W.
Goss ; Corresponding Secretary — C. "W. Swan ; Libra-
rian— D. H. Hayden.
Wednesday, June 13TH — Second D.\y.
The meeting was called to order by President .\lfred
Hosmer, in the Chair.
The Secretary, Dr. Frank. W. Goss, read the record of
last year's meeting, and presented his annual report,
announcing the addition of twenty-six Fellows and the
death of twenty-seven.
The report of the Treasurer, which was accepted by
the Councillors at their meeting the jjrevious evening,
was read. The total income of the Society was, $8,595.-
79 ; expenditures, $7,056.37 ; balance on hand, §1,539.42.
On motion of Dr. H. H. Bowditch, a committee of
three was appointed to memorialize Congress in regard
to the
disposition and care of the library of the sur-
geon-general's office
and to urge upon representatives the importance of pro-
viding fire-proof buildings for its preservation, in con-
nection with the Museum, and distinct from the General
Congressional library, also of securing a liberal appropri-
ation for completion of the " Index Catalogue," and tor
the general purposes of the library. The Chair ajipointed
as members of the committee: Drs. H. P. Bowditch, H.
P. Wolcott, and O. F. Wadsworth.
The request of the President of the College of Physi-
cians and Surgeons, that diplomas granted by said college
should be recognized by the Society, was, after some dis-
cussion, laid on the table.
Dr. E.,N. ^VHITTIER read a paper on
RItCENT changes IN T)IE METHOD OF MEDICAL INSTRUC-
TION.
He briefly reviewed the old system of acquiring knowl-
edge of the science of medicine by studying with some
physician, remarking that tlie method was unsatisfactory
and that the jjractice of medical apprenticeship was,
properly enough, practically abolished. It was super-
seded by the cooiJerative system of instruction, the stu- i
dents having advantages by class instruction of differ-
ent lecturers and professors, which they could not enjoy
while studying with one physician. The rapid growth of
hospitals required a larger number of undergraduate ap-
pointments. The difficulty was not to get enough, but
to properly select from those fitted for such jjositions.
Dr. J. S. Greene, of Dorchester, read a paper on
NEURASTHENIA,
its courses and its home treatment. The disease was
not due to work, but to the competition, anxiety, hurry,
and excitement of business and society. Education was
one thing, but cramming was another. The latter al-
ways caused nervous exhaustion. He then spoke in de-
tail of the influences, more or less, resulting in nervous
exhaustion, and considered the dilTerent methods of
treatment, pajing high tribute to those who have en-
dowed hospitals for the reception and treatment of those
suffering from neurasthenia.
Dr. J. W. Spooner, of Hingham, read a paper on " Ar-
tificial Feeding of Infants."
Dr. W. B. Goldsmith, one of the examiners at the
Danvers Insane ,\sylum, read a paper on " Early Symp-
toms of General Paralysis of the Insane."
The following named delegates were then introduced
to the meeting : T. J. W. Pray and L. J. Young, of New
Hampshire ; C. E. Webster, of Maine ; E. R. Campbell
and George Dunsmore, of Vermont ; G. T. Swartz and
H. J. Miller, of Rhode Island ; G. G. Hopkins, P. V. S.
Pruin, and E. N. Brush, of New York, and Alice Ben-
nett, of Pennsylvania.
After an intermission of fifteen minutes
THE annual DISCOURSE
was delivered by Dr. Amos H. Johnson, of Salem. He
took for his text the motto of the Society " Natura Duce,"
and suggested that it should be changed to read "' Ra-
tione et Natura Ducibus." He referred to the wonder-
ful progress made in the study of astronomy and electri-
city during the last few years, and then turned to the
consideration of the progress in the science of medicine,
saying that it was chiefly the result of judgment and
critical observation. He also alluded to the danger of
allowing patients to follow Nature as a guide, declaring
that in many instances her advice proved fatal. The
indifference with which the presence of some contagious
diseases was regarded was one of the had moral influences
in the community which had to be met. The science of
preventive medicine was of recent growth, but it had made
tremendous stiides. He expressed the hojie that the
time would come when State boards of health would be
relieved from the fear of political influence, and thus at-
tain tlieir greatest usefulness.
At the conclusion of the address a vote of thanks was
tendered to Dr. Johnson. The Society then adjourned.
The annual dinner of the Society took place in the
Skating Rmk on Clarendon Street at one o'clock, Fran-
cis H. Brown, M D., of Boston, presiding. .-Vmong the
after-dinner si)eakers were President Hosmer ; President
Elliot, of Harvard University ; Dr. A. H. lohnson ; B. A.
Gould, Ph.D.; Rev. Edward k. Horton ; Dr. W. H. Hings-
ton, of Montreal; Rev. E. C. BoUes, Ph.D.; Dr. John
B. Hamilton, Surgeon-General U. S. Marine Hospital
Service ; Professor E. S. Morse, and President Francis
A. Walker, of Massachusetts Institute of Technology.
CJovernor Butler was not present. Esjiecially worthy of
note were the remarks of President Elliot on tlie relation
of the medical profession to the poorer classes. He
scouted the idea, now maliciously advanced, that the
medical profession systematically ill-treat the poorer
classes, either before or after death. On the contrary,
the poorest i)auper to-day had better care than a king's
daughter could liave had two hundred years ago. This
resulted largely from the advance in medical education,
which should therefore receive all possible support from
the peojjle and those who make and execute the laws.
June 16, 1883.]
THE MEDICAL RECORD.
659
Thirty-fourth Annual Meeting, held at Cleveland, O.,
June 5, 6, 7, and 8, 1883.
MEETINGS OF SECTIONS.
SECTION OF PRACTICAL MEDICINE, MATERIA MED-
ICA, AND PHYSIOLOGY.
Tuesday, June sth — First Day.
The Section was called to order at three o'clock p.m.
Dr. J. H. HoLLisTER, of Illinois, Chairman, and Dr. J.
G. Lee, of Philadelphia, Secretary.
The only two papers presented were those by Dr. Roht.
D. Miirra\-, of the U. S. Marine Hospital Service, on
YELLOW FEVER,
and by Dr. W. M. Beach, of Ohio, on
MILK SICKNESS.
Dr. Murray being unavoidably absent, his ])a])er was
read by Dr. F. \V. Miller, of Chicago, also of the Ma-
rine Hospital Service. The author advocated putting the
])atient at once to bed and giving a warm-water bath.
Mental tranquillity must be obtained by whatever means.
He laid emphatic stress on absolute quiet of both body and
mind. The symptoms should be treated with the usual
remedies, but very cautiously. Diet must be light, and
after a few days tonic ; to stop vomiting he employed
charcoal early and placed a little ice in the patient's
mouth.
Dr. Campbell, of Augusta, Ga., advised blood-letting
in yellow fever patients. The patient should also be thor-
oughly vomited with hot water.
The discussion which ensued was participated in by
Dr. Elliott, of Pennsylvania, who put his jjatients to
bed immediately, but did not ajjprove of bleeding them ;
Dr. Bell, of New York, who coincided with Dr. Murray's
treatment ; Dr. Franklin, of Ohio who depleted such
patients with calomel instead of the lancet ; Dr. J. B.
Hamilton, of the Marine Hospital Service, who advised
strict quarantine.
Dr. Beach's paper on " Milk Sickness" was discussed
by Dr. A. B. Palmer, of Ann Arbor, Mich., who thought
that the germ of the disease was multiplied after its en-
trance into the body.
The Section then adjourned, to meet on Wednesday
at 2.30 P.M.
Wednesday, June 6th — Second Day.
The Section was called to order by the Chairman, Dr.
HOLLISTER, at 3 P.M.
Dr. Thomas N. Reynolds, of Detroit, Mich., read a
paper on
THE alimentary CANAL IN BRONCHITIS AND PHTHISIS.
He argued that the abnormal condition of the alimen-
tary canal and portal and lacteal systems was often the
predisposing cause of both acute and clironic aftections
in all parts of the res|)iratory apparatus. Acute tracheo-
bronchitis was often caused by excess in the dietary, with
proportionately incomplete waste elimination. In view
of this fact in such cases the treatment should be prompt
evacuation of the bowels and restriction of the diet to alight
liquid form. Necessary quiet and warmtli of the surface
should be maintained, but the atmos]ihere of the room
should not be too warm. The cathartic, hot drinks and
warm surface produced a revulsion of nervous energy from
the inflamed part to the bowels, kidneys, and skin. He de-
precated the use of ordinary cough mixtures to the exclu-
sion of this more rational treatment. Morphine, quinine,
aconite, and veratruui viride were the more usually appro-
priate remedies in the first stage, but did not eipial the
treatment without drugs to which he referred. Derange-
ment of the ijrimae and secundse was still more causative
of chronic bronchitis, and treatment should have refer-
ence to this fact.
Wlien ])urulent, ciuinine was the best remedy in con-
nection with the management pertaining to ingestion
and elimination. It was not wise to press stimulants
and strong nourishment when not readily digested.
Clothing should be sufficient but not excessive. A
common mistake was wearing too much on the chest.
He had a few times seen striking improvements in ex-
pectoration in those going about irom removing two or
three extra undershirts and a chamois leather king pro-
tector. Physical exercise, involving free use of the
lungs, restored wonderfully their normal elasticity after
an attack. It dissipated thickening and adhesions just
as continued free motion dissipated the thickening and
adhesions from around a recently inflamed joint. Ca-
tarrhal fibroid ])hthises most frequently were the result of
neglected chronic bronchitis and should be treated in
much the same way, not by cod liver oil or any other
supposed specific alone, especially if they interfered with
digestion, but quinine was useful in lowering the tem-
perature and lessening the secretion of pus. The i^a-
tient should cultivate an out-door life with plenty of
physical exercise and wholesome mental occupation.
Under this regime digestion and tissue-building soon
went on projierly, cavities often healed, and recovery-
became comi)lete. Any region free from malaria or un-
wholesome emanations, with a temiierature iiermitting
constant out-door life, would answer for a resort. Tuber-
cular phthisis had sometimes seemed to be excited in
those of tubercular family history by neglected bron-
chitis ; in those of constipated habit, and with general
defective elimination, and who lived an inactive in-door
life. In dyspepsia with constipation, and septic ferinenta-
tion of the ingesta, it seemed probable that the septic pro-
duct might be carried by the portal and lacteal vessels
directly to the capillaries of the lungs, and be there some-
times auxiliary in causing bronchitis and phthisis in any
or all of their forms.
Dr. W. F. Belfield, of Illinois, followed with a paper
on
THE germ THEORY OF DISEASE, WITH MICRO-PHOTO-
GRAPHIC illustrations.
The paper was briefly discussed by Drs. Austin Flint,
Jr., of New York City, and A. B. Palmer, of Ann
Arbor, Michigan.
Dr. John V. Shoemaker, of Philadelphia, read a
very interesting paper on
MECHANICAL REMEDIES IN THE TREATMENT OF SKIN
DISEASES.
These remedies were massage, compression, blood-let-
ting, incision, excision, enucleation, scooping, scraping,
setons, and cauterization.
The use of massage in certain morbid conditions of
the integument, when properly applied, is often followed
with marked beneficial changes, and, at times, with com-
jilete restoration of the part to its natural state. Massage
not only acts in this way locally, but by its indirect effect,
when used generally, will add tone and vigor to the en-
tire system. Direct as well as indirect action of this
powerfully mechanical remedy can thus be put into e.x-
ecution, both for its local and constitutional ettect in
manv skin aff"ections. Massage, if employed in its original
sense, would simply imply kneading. It has now a wider
and more general use, and includes as well a groiip of
procedures known as friction, pinching manipulations,
rolling, and percussion of the difterent external parts of
the body. It can be done with the hand or with the
additional aid of some fatty substance, a coarse towel,
a hair mitten, or brush. It may be performed also
by means of ingenious machines that are now perfected
and arranged for doing what the most skilful manipulator
can do with his hands." The first, and perhaps the most
common form of massage used in the treatment of skin,
66o
THE MEDICAL RECORD.
[June 16, 1883.
diseases is friction. Friction can be employed u]5on the
integument either by patients themselves or bv a manipu-
lator.
In the dry form of seborrhrea, particularly of the scaly,
arid in thinning and loss of hair, frictional massage used
with moderation stimulates and augments the sluggish
circulation, furthers absorption, and imparts tone and
vigor to the scalp and hair. In indurated acne and in
glandular swellings it arouses the activity of the sluggish
and choked-up absorbent vessels, and thus relieves the
glandular congestion and the skin again becomes normal,
in being soft, sup|)le, and elastic, and free from these
lesions. It not only has a local beneticial intiuence
upon the class of affections just named, but likewise often
removes or assists in removing, when used over the trunk,
many gastric and intestinal disorders which very often
keep up the cutaneous irritation. This general effect of
frictional massage he had witnessed again and again, in
relieving and curing constipation and other functional
derangements, which were very often active factors in
keeping up acne, rosacea, hyperidrosis, seborrhoea, urti-
caria, and eczema. It was often efficacious in removing
scars, and in cases in which the i^gment of the skin was
either in excess or deficient in quantity stimulating to
renewed activity the absorbents, and assisting again in
restoring the parts to their natural state. Massage was
an invaluable agent in certain neuroses, and especially
in neuralgia and perverted sensibility.
Compression is a most important adjunct in the treat-
ment of herpes, herpes zoster, urticaria, furuncular, and
glandular affections, erythema, and eczema. In acute ec-
zema it soothed muscular irritation, toned up the dilated
capillaries, and prevented the escape of serosity into the
tissues. Again in subacute and chronic eczema it enabled
the vessels to remove i^oured-out (jroducts, protected the
denuded surface, and e.xcluded the air, which was very
stimulating to inflamed and irritable parts, and so
moderated diseased action. The doctor here showed a
new woven ginn -bandage which he has been using in
place of ordinary gum bandages, and spoke of its great
advantage over the latter for making systematic compres-
sion in eczema and other skin affections. In chronic
eczema of either the superior or inferior extremity, the
use of water or oil dressings and local medication, com-
bined with systematic pressure with the bandage, would
generally afford a most excellent result.
Referring to blood-letting, he remarked that the ab-
straction of blood either as a local or general measure was
one of the most powerful anti-phlogistic remedies that
could be resorted to in the treatment of skui diseases.
It was both a speedy and efficient means of combating
and arresting morbid changes of tiie integuments. It was
especially applicable in chronic conditions after medi-
cinal agents had been exhausted in vain attemi)ts to cure
many eruptive diseases. Blood might be abstracted either
locally from the capillaries or generally from a vein or an
artery. In the treatment of cutaneous affections by means
of blood-letting, local dei)letion should be used in the great
majority of cases, general blood-letting only being resorted
to in very rare instances. Topical blood-lettiiig might be
performed by puncturing, scarification, and leeching. The
doctor then dwelt upon the abstraction of blood in
various diseases, and exhibited his new dermatone and
other appliances. Concluding, he siJoke also of the great
value of the other mechanical means mentioned.
The meeting closed with the delivery of a papei upon
A -NEW METHOD OF PROCURING PURE PANCREATIC J LICE.
The speaker illustrated his remarks on a dog, in whose
stomach he had created an artificial fistula.
Thursday, June 7th — Third Day.
The first paper was by Dr. J. Soi.is Cohen, of Phila-
delphia, on
the ele.ment-s of prognosis and therapeutics of
laryngeal tuberculosis.
While acknowledging the truth that the prognosis is
always unfavorable in tuberculosis of the larynx, it may
be maintained that it is less so in some cases than in
others, .'\fter citing several cases, he discussed a num-
ber of acute varieties occurring in his own jiractice. "I
have reason to believe," said the speaker, " that the
course of certain forms of tuberculosis of the larynx may
be retarded to such an extent in occasional instances as
to start the patient on the road to recovery."
Dr. H. .\. Martin, of Massachusetts, spoke on
vaccination and propagation of vaccine virus.
He recommended physicians to procure virus from
young heifers, not because they are cheaper, but on ac-
count of their perfect health. The quantity of virus that
can be taken from an animal varies very much. It can
be used only once. He had introduced animal vaccina-
tion in this country, and would like to see it succeed.
He did not speak against the use of vaccine from the
arm of a patient, but thought it utterly impossible to se-
cure the desired quantity of it.
Dr. a. T. Kvte, of Ohio, read the closing paper, on the
diminution of the retardation of the pulse in
aortic insufficiency.
The Section then adjourned.
SECTION ON SURGERY AND .\NATOMY.
Tuesday, June 5th — First Day.
This Section met at half-past two o'clock. Chairman,
Dr. W. F. Peck, of Davenport, la. ; Secretary, Dr. Paul
F. Eve, of Nashville, Tenn.
The first paper read was on
THE RADICAL CURE OF HERNIA BY A NEW .METHOD,
by Dr. R. A. V^ance, of Cleveland, O.
Referring to oblique inguinal hernia, he spoke of the
peculiarity of his method as consisting in bringing to-
gether the two lips of the hernial opening by means of a
deep-seated suture passed subciitaneously with a semi-
circular needle.
In this way he converts tlie previously wide-open her-
nial canal into a closed valve, that resists all tendency
to allow of a second protrusion.
Dr. D. p. Allen, of Cleveland, followed with a paper
on
THE comparison OF ANTISEPTIC AND NON- ANTISEPTIC
.METHODS OF TREATMENT.
His conclusions were as follows :
First. — The fact that the operations in the abdominal
cavity succeeded without the spray does not influence the
employment of antiseptics with regard to other opera-
tions where there is a continued opportunity for infec-
tion.
Second. — It would appear that the spray is the least
important of all the details in antise|)tics, and that if the
other details are attended to, ])roper drainage, dressing,
and i^ressure may, by securing absolute quiet for a
wound, avert danger.
Third. — That different methods are of different appli-
cations, and that whereas the spray may be most impor-
tant when opening joints, and in the atmosphere of
hospitals with bail hygienic surroundings, flooding might
be equally efficient in certain other wounds.
Fourth. — That some prominent antiseptics, such as
iodoform, would be most serviceable when other anti-
septics are inapplicable, as in the removal of a tongue.
Fifth. — That although tliere are certain dangers in
the use of antiseptics, these are more than equalled by
the dangers attendant upon their omission, es|)ecially in
large hospitals ; and that dangers by poisoning are cer-
June i6, 1883.]
THE MEDICAL RECORD.
661
tainly decreasing as the application of antiseptics is
becoming better understood.
Sixth. — Tiiat investigation may develop a iiietiiod of
securing antiseptic results less onerous, and devoid of
the disadvantages that now surround them.
The various antiseptic methods proditte better results
than any other method.
Dr. Martin, of Massachusetts, in opening the dis-
cussion, remarked that in fifty years, he believed, I.is-
terism would only be regarded as one of the curiosities
of medical literature. By Listerisni he must be under-
stood to refer to the " destruction of bacilli," regardless
of any other co-existent uncleanliness. He believed in
GENERAL CI,EANLINES.S IN THE TREATMENT OF WOUNDS.
He further referred to Ambrose Pares' experience in
French campaigns, where the wounds of the higher offi-
cers, who had all possible care and surgical oversight,
proved far more fatal on the average than those of the
common soldiers, whose injuries remained uncared for
for days at a time, lying as they did utterly apart from
all assistance at the spot where they happened to fall on
the field of battle.
Dr. C. B. Nancrede spoke strongly in favor of Lis-
terisni and against Dr. Martin's criticisms.
The next paper, on the "Value of Early and Late
Operations in Morbid Growths, especially Malignant,"
was by Dr. S. D. Gross, of Philadelphia. (This jiaper
having been read before the American Surgical Associa-
tion, ap]iears in our report of that body. See page 639.)
The Section, after listening to a i)aper by Dr. H. A.
Martin, of Massachusetts, on the
TREATMENT OF SYNOVIAL DISEASES KY A NEW METHOD,
advocating the withdrawal of the synovial fluid by as-
))iration and the ai)iilicatii.in of the rubber bandage,
adjourned.
Wednesday, June 6th — Second Day.
The Section was called to order at 2.30 p.m. by Dr.
\V. F. Peck, of Iowa, Chairman.
Dr. Robt. Newman, of New York City, read a paper
on
the SURGICAL USE OF ELECTROLYSIS.
The results which he had obtained from its use in
stricture of the urethra had been excellent.
Dr. Jamks R. Taylor, of New York, read portions
of an elaborate paper on
FRACTURES OF THE LONG BONES,
which was profusely illustrated by well-executed draw-
ings. The doctor first spoke of fracture of the thigh-
bone, which he treats with a saddle made to fit into the
perineum, whereby he secures the most perfect comfort
possible by any apparatus used for the purpose of coun-
ter-extension. This neatly devised little saddle is held
in position by a strap running to the head-board on each
side, thus securing tiie limb in an immovable position.
By fastening strips of adhesive plaster, previously secured
to the leg, to a peculiar spring arrangement attached to
the foot of the bed, he can produce any desired degree
of extension. The chief advantage of the whole appara-
tus over all other instruments is the little saddle on which
the patient sits, as it were, with comfort, rather than
misery, as in most other methods, and the arrangement
of springs. The doctor announced himself as positively
opposed to the old method of using stones and other sus-
pensory weights to produce extension of the limbs, and
then turned his attention to '
THE TREATMENT OF FRACTURED RIBS.
He brings the broken ends into place by raising the
arms over the head, an original method, by which he
claims there is no trouble in adjustment. They are then
held in place by a band of adhesive |)laster around the
body. He gave original methods of treating broken
wrists and collar-bones, illustrating the treatment of the
latter with a living example in the person of an Irish la-
borer of this city, who was suffering from an injury of
the kind named.
A paper on the
COMPARATIVE VALUE OF ANTISEPTICS
was read by Dr. Henry O. Marcy, of Boston, Mass.,
detailing the results of a series of experiments.
Dr. L. H. Sayre, of New York, followed with a paper
on "Amputation below the Knee-joint, in Preference to
either Brisement Force or Resection, in Certain Cases of
Deformity with Anchylosis," illustrated by two cases. The
substance of this has already appeared in The Medical
Record, page 527.
Dr. E. M. Moore, of Rochester, N. Y., read a very
interesting paper on
THE treatment OF OLD CASES OF COMPOUND DISLOCA-
TION OF THE ULNA
in connection with Colles' fracture. He thinks that in
those cases of fracture of the radius known as the Colles
fracture there is also dislocation of the styloid extremity
of the ulna, which dislocation in many cases is not re-
duced, and great deformity is the result. At any time
within six months from the date of the original injury,
he rebreaks the united fracture and attempts a reduction
of the dislocation, but when cases are of so long stand-
ing as not to permit of breaking the bones, he exsects
the extremity of the ulna, thus making a useful and
movable joint. The discussion which followed was par-
ticipated in by Dr. Wile, of Connecticut ; Dr. S. M. Ross,
of Altoona, Pa.; Dr. Quimby, of Jersey City, N. J.; Dr.
Kinloch, of South Carolina; Dr. Mudd, of Arkansas, and
Dr. C. Redin, of Illinois.
Dr. V. H. CoKKMAN, of Omaha, Neb., read the last
paper of the day on
the TREATMENT OF TENDER SPINES BY SUBCUTANEOUS
INCISIONS.
He took issue with the usual method of treatment in
such cases and said the simplest but most effective
method, rest always understooil, is subcutaneous incision
over the seat of that portion of the spine wliich is
implicated. His procedure is to introduce a tenotome
at a point below the tender spot, thence passing it to a
point above, and then by pressure, as he withdraws it, he
cuts down upon the bone, and where tendinous structure
is involved he divides the slieath of the tendon or performs
longitudinal section of the tendon itself. He also incises
the aponeurosis when it is the seat of disease.
The paper gave rise to numerous inquiries and a good
deal of discussion, as the practice is a very novel one.
Dr. Coffman was recalled to re-explain his method of
making the incision, after which he was kept standing
upon the stage for some time answering questions from
various physicians relative to his paper.
The Section then adjourned, to meet on Thursday, at
2.30 P.M.
Thursday, June 7 — Third Day.
The first paper was on
EXCISION OF BOTH HIP-JOINTS,
by W. A. Bvrd, of Illinois.
The speaker said that ever since the first suggestion of
the removal of tlie head of the femur, by Charles White,
in 1769, for morbus coxarius, and the first execution of
it, by Schmalz, in 1816, as stated by Dr. Sayre, or by
Anthony White, in 1822, as claimed by Barvvell, there
had been great diversity of opinion among surgeons in
regard to its propriety, a few favoring it, but many con-
demning it as utterly useless. For, while it might save
the life of the patient, it frequently left a miserably de-
formed being, incapable of locomotion without the aid
662
THE MEDICAL RECORD.
[June i6, 1883.
of crutches or cane. The cnances of cure were no
better than if the patient were left to depend upon the
slow process of spontaneous exfoliation of the diseased
bone, a process generally anticipated by death. Opin-
ions, however, had greatly changed since the number
of excisions had become sufficient to compare with the
older methods. The Doctor then reported the case of
a girl, ten years of age, who, after enduring the opera-
tion for the removal of the head and upper portion of the
femur, was in due time able to walk without crutches,
passing up and down stairs with ease. The operation
consisted in an incision two inches above the great tro-
chanter, continued downward, curving behind the great
trochanter, and ending five inches below its origin. The
soft parts were pulled aside and detached carefully,
with the periosteum, from the bone, by means of a den-
tist's scraper. The head of the bone was brought out
through the opening, and, on account of its softened con-
dition, was divided just below the trochanter, there
appearing to be no other portion of the bone aftected.
The dressing was oakum and balsam of Peru. A photo-
graph illustration of this case was shown. He called
attention to the time intervening between the attack and
the e.xcision of the joint, showing the period to be four
months.
Dr. Byrd called attention to the splint used by him,
which was first brought to his notice by Dr. Charles T.
Parks, of Chicago ; but stated that the inventor himself.
Dr. W. T. Verity, of Chicago, was present, and called
upon him to exhibit and explain his apparatus. Dr.
Verity placed upon the platform an upright post, to which
he attached a triangular frame made of strips of wood,
fastened together by strong strap-iron hinges, and attached
to the upright by means of a clamp. From the extremity
of this triangle hung, suspended by a strong cord, the
wire framework in which the patient lies, capable of ad-
justment to fit any desired position of the limbs. The
triangular frame can also be adjusted at any angle, and
can be attached to a door-post, or any such convenient
upright. The entire apparatus is very portable, and can
be packed up for transportation in a few seconds. While
in this condition it requires no wider space than an or-
dinary violin-box. As the inventor explained point after
point, proving the superiority of the apparatus, he was
enthusiastically applauded.
Dr. I.. Hall Sayre, of New York, complimented
Dr. Verity very highly upon having the correct idea of
suspension, but claimed for his father and himself the
origination of the principle involved in the construction
of every apparatus for suspension.
Dr. Moses Gunn, of Chicago, emphasized the utility
of Dr. \'erity's apparatus.
The next paper was by Dk. H. O. Marcv, of Boston,
on
THE SURGICAL TREATMENT OF INTESTINAL OBSTRUCTION.
He stated that great triumphs had been achieved during
■ the last decade in abdominal operations, and divided in-
testinal obstructions into three classes — chronic, late
acute, and early acute — either or each of which might be
caused by fecal impaction, fibrous or cancerous stric-
ture, intussusception, injuries, etc. The first and most
important thing was a prompt and correct diagnosis. He
asserted that the aspirator could be used to relieve
gaseous distention with almost absolute safety, and that
its use is followed by relief, though only palliative and
not curative. He mentioned the reduction of gaseous
distention of the rectum, recommending, however, that
no time be lost in resorting to an operation, as the loca-
tion of the trouble cannot be accurately known. Dr.
Marcy recommended opening the abdominal cavity in
the median line, taking care to preserve the utmost
cleanliness during the operation. After the obstruction
had been removed, the edges of the wound should be
brought accurately together, esi)ecially the opposed edges
of the peritoneum, as the hemorrhage is generally grave.
In opening the discussion Dr. B. A. Watson, of New
Jersey, spoke in very commendatory terms of the
method.
Dr. Gordon, of Maine, believed the time would come
when physicians would be held criminally responsible for
the use of the embolic acid spray in abdominal surgery.
He accepted antiseptic precautions, but not the carbolic
acid spray.
Drs. Byrd, of Illinois ; Brophy, of Pittsburg ; Keller,
of Arkansas, and Moore, of New York, also took part in
the discussion.
Dr. Prewett, of Missouri, read a paper on " A New
Operation for Ranula.''
Dr. Ransohoff, of Cincinnati, then spoke on "The
Early Use of the Trephine." Drs. Gunn, of Chicago,
and Hyde, of New York, expressed their corroboration
of the writer's sentiments.
Dr. Henry J. Reynolds, of Orion, Mich., then read
a paper on
the treatment of stricture of the urethra.
He said no importance whatever should be attached
to the statement by the patient that his stream is full size.
The size of the stream may be evidence of the presence
of stricture, but not of its non-existence.
For either large or small calibred stricture he prefers
internal cutting and stretching with Otis' instrument to
all other methods. He always, however, provides the
patient with a full-sized sound, with instruction to pass it
every few days for an indefinite length of time.
If the stricture be too small for this instrument, he en-
larges sufficiently to admit it, first with Thompson's or
Maisonneuve's instrument, and then uses the Otis instru-
ment, carrying the enlargement even beyond the normal
calibre to insure the absolute and complete removal of
all obstruction, without which the cure is liable not to
be permanent ; the smallest amount of obstruction or
contraction remaining, he claims, will furnish a ground-
work for future gleet or contraction, or both
He then gave a report of several cases treated by dif-
ferent methods, showing the comparative merits of each ;
among which was a case of extreme stricture involving
external perineal urethrotomy without a guide, in which
even the prostatic portion was contracted in its anterior
part. In this case a pocket an inch deep, and large
enough to admit the finger, extended upward and back-
ward in front of the prostate, the septum between which
and the urethra he cut across.
Dr. R. B. Bontecue, of New York, made a few re-
marks on his method of treatment of cystitis by external
urethral section.
Dr. J. H. Warren, of Boston, followed with his pa-
per on " Tissue Repair, or the Pathology of Subcuta-
neous Injections in Cases of Hernia." He exhibited an
improved syringe that discharges its contents automati-
cally upon the slight pressure of a knob attached to the
instrument
A telegram was read from Dr. Dawson, of Cincinnati,
expressing regret at his inability to appear at the sessions
of the Surgical Section.
The following papers were read by title and referred
to the Committee on Publication : " Sypiiilitic Mammary
Tumors," by Dr. C. C. F. (uiy, of New York ; " A Form
of Inguinal Hernia Liable to be Overlooked," by Dr. A. H.
Wilson, of Massachusetts; "On Derrick and Imi)roved
Sus|)ensory Apparatus for .Suspension in the Application
of Plaster Casts, etc.," by Dr. W. T. Verity, of Cliicago.
The Section then adjourned.
SECTION ON OUSTETRICS AND DISE.A.SES OF WOMEN.
Tuesday, June 5TH — I-'irst Day.
This Section met at half-past two o'clock.
Dr. J. K. Bartleit, of Wisconsin, Chairman, and Dr.
G. A. Moses, of Missouri, Secretary.
June i6, 1883.]
THE MEDICAL RECORD.
66'
The first paper presented was that by Dr. W. H. By-
ford, of Chicago, on
CHRONIC INTERO-PELVIC INFLAMMATION.
The terms parametritis and perimetritis are supposed
by many to include the whole subject of intero-pelvic
inflammation.
These terms are misleading, because, as now often
used, they present to the mind the idea that all cases of
inrtammation not confined to the uterus must belong to
one or the other of them. Acute observation teaches
the important fact that perimetritis and parametritis
usually exist together and are usually complicated with
inflammation of the uterus, and not infrequently the ova-
ries and Fallopian tubes are involved. Chronic pelvic
abscess is generally the sequel of acute inflammation,
and attains chronicity from the imperfect evacuation of
the pus after acute inflammation has terminated in sup-
puration.
The remedy in such cases is found in surgery, and con-
sists in making a more direct outlet through the vagina,
large enough to at once completely evacuate the pus
and enable the surgeon to cleanse and disinfect the
cavity.
He gave the following summary: First, the sometimes
terrible effects of examinations or operations in the jielvis
do not often, if ever, take place when there is not a per-
ceptible predisposing inflammation. Second, the inflam-
mation may be so shght as to be easily overlooked.
Third, it may be an original condition, the sequence of
an acute attack long gone by, or it may be the product
of some immediately previous examination or operation,
the effects of which have not subsided. Fourth, to
.tvoid the dangers of acute inflanmiation we should, in
making the first examination for pelvic disease, conduct it
in such a way as not to give the patient much pain, and
when she complains of pain and suffering, desist at
the sacrifice of complete diagnosis. Fifth, complaints of
much tenderness to the touch or the use of instruments,
especially in parous women, is sufficiently diagnostic of
inflammation upon which to base treatment for that con-
dition. Sixth, if with such tenderness a thorough exam-
ination or an operation is imperative, it should be done
under profound anresthesia. There was no question in his
mind that much less danger of ill effects is incurred in
making examinations or operations on susceptible sub-
jects under the free use of anajsthetics. Seventh, exam-
inations or operations should not be repeated until the
effects of the fiist have entirely passed off". Eighth, as
chronic parametritis is a frequent complication of most
of the morbid conditions of the uterus, it should be al-
ways inspected and its diagnosis be carefully considered
in all cases of metritis. iVinth, when chronic parame-
tritis is present it should be the chief, if not exclusive,
object of treatment until removed. Tenth, it is not safe
to use the sound, sponge-tent, or intra-uterine stem when
there is parametritic inflammation. Eleventh, it is es-
pecially dangerous to replace a displaced uterus when it
is bound down by inflammatory adhesion, by any means
which will overcome its fixedness by force. Twelfth, all
local treatment of the uterus must be conducted with
the greatest care in all cases where the complication is
present.
The next paper was on the subject of
POST-PARTUM POLYPOID TUMORS,
by Dr. Henry G. Landis, of Columbus, O. He de-
scribed four forms : i, blood polypus ; 2, fibrinous co-
agula, with fragments of placenta and membrane ; 3,
prematurely detached strips of decidua, with or witliout
clots ; 4, hypertrophied patches of decidua.
The writer detailed two cases of the latter kind, very
few being on record.
A short discussion ensued on a paper on
THE restoration OF THE PERINEUM BY A NEW METHOD,
by Dr. H. O. Marcv, of Massachusetts. He advised th
repair of the perineum by the use of lateral support.
This he accomplished by the use of German-silver wire,
which possesses elasticity enough to make lateral ten-
sion, while the ends are so bent as to each form with the
other a sort of safety-pm support, which thus holds the
refreshened parts in position.
The last paper read was by Dr. R. S. Sutton, of Pitts-
burg, on
ENTEROTOMY as a COMPLICATION IN OVARIOTOMY OR
OOPHORECTOMY.
He related a case in which he had successfully removed
four inches ot the small intestine, and spoke of this case
as the first successful operation of the kind ever i)er-
formed in this country. Billroth of Vienna has performed
the same operation abroad.
Wednesday, June 6th — Second Day.
The Section was called to order at half-past two by
the Chairman, Dr. J. K. Bartlett, of Wisconsin.
Drs. R. Beverley Cole, of California, and J. Tabor
Johnson, of the District of Columbia, who were an-
nounced for papers, being absent, the first paper read
was by Dr. John Morris, of Maryland, on the subject :
WHAT MEANS CAN BE JUDICIOUSLY USED TO SHORTEN
THE TERM AND LESSEN THE PAINS OF LABOR ?
He described lingering labor, dividing it into three
stages : First, when the head remains high up ; second,
when it has descended into the pelvic cavity, but the parts
are tense and undilatable ; third, when the head of the child
impinges on tlie perineum. He explained the procedures
to be used in all these conditions and at what time to em-
ploy them. These procedures were, detaching the mem-
brane around the cervix with the finger in the first stages,
dilating the os with the pulpy part of the finger and
stretching it continuously during each pain ; rupturing
the membranes, forcible external compression pushing
the cervix over the occiput, administration of opium, er-
got, but never in first cases, and finally, chloroform.
These means all failing, the only alternative was the for-
ceps. The Doctor said that if the means he suggested
were employed, laceration of the os and perineum,
those i>eUs noir of modern medical literature, would
be obviated and post-partum hemorrhage, that greatest
of all complications in labor, would be prevented.
The discussion which followed was participated in by
Drs. McClurg, of Pennsylvania; Ghent, of Texas; T.
Reamy, of Ohio ; Smart, of Michigan ; Morton, of Maine ;
Martin, of Massachusetts ; Montgomery, of Pennsyl-
vania ; Landis, of Ohio; Humiston, of Ohio ; Robinson,
of Pennsylvania ; and Watkin, of Kentucky.
Dr. E. C. Dudley, of Chicago, followed with re-
marks on
THE IMMEDIATE APPLICATION OF SUTURES IN PUERPERAL
LACERATION OF THE CERVIX AND PERINEUM.
The paper was ably discussed by Drs. Walker, of
Kentucky ; E. W. Jenks, of Chicago ; John Morris, of
Baltimore ; G. M. Maughs, of St. Louis, and Wm. Ulrich,
of Chester, Pa.
Before the Section adjourned. Dr. W. A. Taylor, of
Cincinnati, offered a voluntary and very interesting re-
port of
A CASE OF LAPARO-ELYTROTOMY.
Dr.T. Reamy, of Cincinnati, said the one lesson to be
drawn was to make the operation earlier.
Dr. Mather, of Louisville, thought laparo-elytrot-
omy was better than craniotomy, which had been at-
tempted and could not be completed in the present case.
Li country districts the operation which should have been
done was Cesarean section, Porro's modification of Ca:-
sarean section, or Mueller's modification pf Porro's. The
latter showed great success in European hospitals.
Dr. Reed, of Ohio, referred to a case of labor in a
664
THE MEDICAL RECORD.
[June i6, 1883.
dwarf, with foot presentation. By the second day the
body had been extracted as far as the head by traction.
Finding it impossible to remove the head, they separated
the body and pulled it away with Hodge's long forceps.
He succeeded in getting blades round the head. The
woman got well without a bad symptom.
Dr. Williams, of Boston, claims that the high forceps
operation was more fatal than abdominal section. He
did not agree with Dr. Mathers that C.-esarean section
was an easier or sinijiler operation. There was less
danger of bleeding in Thomas' operation. Dr. Taylor's
case was the ninth reported.
Dr. Jenks, of Arkansas, was surprised that some one
had not referred to symphysiotomy. Recovery of
mothers, sixty per cent. ; children, thirty-seven per cent.
j\ot above 2|r of antero-posterior contraction of the pel-
vis was possible in cases amenable to this operation.
Drs. Morisani and Novi, of Italy, have reported many
such operations performed successfully.
Dr. Dunlap, of Springfield, O., said that the mortality
in such cases was very great. Death, however, teaches
us lessons which canaot be learned in any other way.
The cause of death was doubtless, in the case reported,
delay in performing the operation. He would not con-
demn the operation, but it should have been performed
much earlier than it was. Great care should be taken
that suppression, if present, is promptly treated. He
performed the operation upon the left side.
Dr. D.^ndridge, of Cincinnati, wished to emphasize
the ease with which the operation was performed although
all the facilities were poor — great want of light, etc. The
left side possesses very decided advantages ; the finger
of the left hand can be introduced into the vagina and so
map out the ground. He did not attach much danger to
hemorrhage from wounding the ei)igastric artery. An-
other lesson to be draw-n is that this operation does not
require any special preparation. In this case the operOr
tion was put off too long.
Dr. Robert Battey, of Rome, Ga., was announced for
a paper on " Battey's Operation — Death from Ether,"
but was not present.
Dr. p. Zenner, of Ohio, then read a paper on
VALUE OF GYNECOLOGICAL TRE.\T.\IENT IN HYSTERIA
AND ALLIED AFFECTIONS.
While he acknowledged that the cure of uterine dis-
eases was sometimes followed by relief of the nervous dis-
ease, he called attention to the injury occasionally caused
by local examination or treatment. Cases were reported,
some of which came under his own observation, some
reported by others, in which gynecological measures had
done direct injury. The manner in which harm can be
done, princijjally of mental origin, was detailed. The
author thought, for various reasons mentioned, that the
etiological relation between hysterics and uterine dis-
ease was not as close as believed by many — a predispo-
sition, often hereditary, was usually at its base. In con-
clusion, after
WARNING AGAINST THE PROMISCUOUS GYNECOLOGICAL
INTERFERENCE
in all hysterical patients, he spoke of general measures
to prevent the development of nervous diseases. If hys-
teria depended on defective nervous organization, Dr.
Zenner thought no one had a right to demand of the
gynecologist who removes a tumor that he must thereby
give his patient that which she never possessed — a healthy
nervous system.
ULCERATION OF THE OS UTERI VifAS A VERY RARE DIS-
EASE IN THE UNMARRIED, i
unless given rise to by the murderous practice of intro-
ducing the speculum into the virgin vagina two or three
times a week, and injecting caustic solutions. He wished
to state that tlie introduction of the speculum in the virgin
vagina by a woman doctor was just as unfortunate in its
result as the same examination by a man.
Dr. Gordon, of Maine, in the main endorsed Dr.
Reamy's views, which were that if the symptoms of un-
married women pointed to uterine disease they should
receive precisely the same treatment as in the case of a
multipara. There was a morbid sentiment in the other
direction. Were girls to endure uterine disease untreated
by men jihysicians because they are unmarried ? You
will not have done your duty if you do not apply local
treatment to girls with nervous symptoms pointing con-
clusively to the womb.
Dr. Catlett, of Missouri, thought that hysterical
symptoms in insane patients (female) did not direct their
thoughts to the generative organs.
Dr. IVIaughs, of St. Louis, said the great danger of
the age was the over-zealousness of gynecologists. He con-
demned the universal practice of making digital examin-
ation for all hysterical symptoms ; still very many married
women suffer after marriage because they have not been
examined before they were married, and treated for the
uterine disease which really existed.
Dr. Crawford, of Illinois, believed that in nervous
disorders due to uterine disease the removal of the local
disease was only the first step in the treatment. The
cure of the local uterine disorder did not by any means
imply the cure of the nervous symptoms.
Dr. JENK.S thought the chief value of Dr. Zenner's
paper consisted in its enforcement upon the specialist of
the necessity of general constitutional treatment.
Dr. G. M. Maughs, of St. Louis, read a paper on
" The Midwifery and Gynecology of the Ancients," after
which the Section adjourned.
SECTION I.V DISE.\SES OF CHILDREN.
Tuesday, June 5TH — First Day.
In the absence of the Chairman, Dr. Blount, of Indi-
ana, Dr. Earle, of Chicago, was elected Chairman Jrro
tern. ; and in the absence of the Secretary, Dr. Sears, of
Te.\as, Dr. Boothbv, of Wisconsin, was elected Secretary
pro tern.
The Chairman pro tern, then read a paper on
CEPHAL.tMATO.MA IN THE NEW-BORN.
The tumor spoken of is a soft, elastic, fluctuating
tumor, situated on one of the cranial bones, due to
rupture of a blood-vessel between the periosteum and the
bone. It is usually noticed upon one of the parietal
bones, and it can be detected by the fluctuation present.
In the caput succedaneum there is no fluctuation ; there
is simply a boggy feel, an ojdematous and bruised con-
dition of the tissues. There were four difficulties with
which it is liable to be confounded : first, the caput suc-
cedaneum ; second, congenital encephalocele, or hernia
cerebri ; third, erectile tumors ; fourth, craniotabes.
The treatment advocated was letting the tumor alone ;
nature in a great majority of cases cures this difticulty
without any aid from our art. There is a tendency on
the part of parents and t'riends to interfere. Formerly
it was regarded as good practice to open these tumors,
but the fact that a certain number thus opened were
followed by long-continued suppuration and exhaus-
tion, and in some cases death, should deter us from
operative interference. The special object of the paper
was to call attention to the greater frequency of the
difficulty than had heretofore been supposed ; also 10 the
four affections with which it is liable to be confounded,
and to the fact that in a few cases, where pain, swelling,
and tension become very great, it is admissible, indeed
the best practice, to open these tumors and treat them
antiseptically.
Dr. Wm. i^EE, of Baltimore, said he did not know how
craniotabes could be confounded with the above, as it was
peculiar to rickets, and had accompanying it the many
other symptoms of that trouble, wliich made it impossible
for it to be classed with any other disease.
In regard to treatment of cephalaematoma, while
June i6, 1883.]
THE MEDICAL RECORD.
665
many cases get well without any interference, there were
cases which unquestionably require surgical procedure.
Dr. Harris, of Virginia, had probably seen cases of
the kind mentioned, but his mind had not before been so
strongly impressed with the means of distinguishing be-
tween them and cases of caput succedaneum. He
thought the points made in the paper deserved careful
consideration.
Dr. Read, of Cincinnati, referred to a case of cepha-
hematonia in which, while the diagnosis was not per-
fectly clear, the let-alone i)lan of treatment was recom-
mended ; but the parents being anxious, sent for another
physician, wlio lanced the tumor. Hemorrhage followed,
and the child died.
Dr. Boothby, of Wisconsin, had seen three cases
falling under the title of the paper, the first one quite
early in his practice, which perhaps was a partial excuse
for opening the tumor. No bad consequences, however,
followed the operation, and the child lived. In the
other two cases he made no interference. He thought
it a good general rule to let the misshapen head of the
new-born alone, and nature would restore the normal
form which existed before parturition.
The paper was referred tO the Committee on Publi-
cation.
Wednesday, June 6th — Second Day.
The Section was called to order by the Chairman, Dr.
R. F. Blount, of Indiana.
Dr. Alexander Y. P. Garnet read a paper on
EPIDEMIC jaundice IN CHILDREN.
Duri]ig the sunmier of 1881, remarkable for its unpre-
cedented heat for a long period, he had under observa-
tion several cases of jaundice, the epidemic confining
itself to young children. The author of the paper then
reviewed the literature of the subject of jaundice, and
followed it with a detailed history of one of the typical
cases which came under his observation. The epidemic
•occurred in midsummer, after an unusually protracted
period of high temperature, and in all the instances the
Jaundice appeared before gastro-intestinal disturbance
became a marked feature. Dr. Garnet then rt^ferred to
the usual causes of jaundice, directing special attention
to gastro-intestinal catarrh, and expressed the opinion
that in the cases in the epidemic referred to, this ca-
tarrh was not the real factor in the etiology, because the
jaundice antedated the gastric disturbance. He believed
that the essential element in the production of the jaun-
dice was an affection of the nervous system, and quoted
various authorities at some length to sustain that posi-
tion. He then asked the question. In what manner does
the deleterious agent of heat operate upon the nerves
distributed to the liver to effect such a derangement of
its normal function ? The answer was that scientific
research and experimentation had not yet supplied us
with positive data upon which we can base a conclusive
reply to this question.
UNITY OF DIPHTHERIA AND MEMBRANOUS CROUP.
Dr. a. Harris, of Virginia, read a paper on the above
subject, in which he expressed the opinion that the dis-
eases which have received the name of dii>htheria and
membranous croup are one and essentially the same.
The paper contained extensive references to the opinions
■of various medical authorities upon this question.
Dr. Snow, of Michigan, believed that the two affections
■were essentially distinct. Diphtheria begins within a small
space, and extends from that location over the mucous
membrane. Croup never does this. It commences in
the air-passages, almost always over the mucous mem-
brane of the larynx, appearing as a very thin layer of
false membrane, which gradually thickens until the child
dies of suffocation. Diphtheria extends as erysipelas
does in a measure ; it begins and travels on, commencing
in the pharynx and going down into the larynx. Diph-
theria is a decidedly contagious disease, while croup is
not regarded as a contagious disease.
Dr. Wm. Lee, of Baltimore, said that he was a firm be-
liever that there were two diseases. He diffeied from Dr.
Snow with regard to the direction in which diphtheria had
a tendency to spread, and said that according to his ob-
servation diphtheria has a tendency to pass up into the
nose, and he regarded this as an important diagnostic
symptom. In most cases which he had seen the patients
had died from blood-poisoning, and in many instances
had died from neglect in early treatment, sufficient care
not being taken to cleanse the throat, especially behind
the uvula. A child with diphtheria might die of croup.
He believed, however, that diphtheria was essentially a
local disease at first, and constitutional secondarily. Dr.
Lee directed especial attention to the fact that albumen
is present in the urine in diphtheria and absent in croup.
The plan of treatment, according to his experience, which
had been most successful was the free use of alcoholic
stimulants and quinine. The following remedy he had
been using with marked success, and he gave the recipe,
for some of the most important items of which he was in-
debted to Dr. Read, of Savannah, Ga., in order that the
members of the Section might have an opportunity to try
it during the coming year.
5. Resorcin gr- x.
Acid, tannic 3 j-
Acid, salicylic 3 iv.
Acid, boracic 3 ij-
Sulph. pulv 3 ss.
Mix thoroughly, and put a small pinch of this powder
on the tongue every two or three hours.
The subject was discussed by Drs. Boothby, of Wiscon-
sin ; Franklin, of Ohio ; Freeman, of Indiana ; Sheehan,
of New York ; Farle, of Chicago ; Green, of Ohio, and
iririch, of Pennsylvania. There was about an equal di-
vision of opinion with reference to the unity or the dual-
ity of the diseases. Dr. Ulrich and Dr. Snow spoke very
highly of the beneficial effects produced by the adminis-
tration of calomel in large doses ; ten-grain doses every
two hours. The discussion was closed by Dr. Harris,
who reviewed his paper and argued further in support of
the opinion that the false membrane is a local expression
of the blood-poisoning.
Dr. W. H. Myer, of Indiana, then read a paper on
the SURGICAL TREATMENT OF PURULENT PLEURITIS.
He reconmiended making a free incision in purulent
pleuritis, resorting to puncture only when the effusion
was serous. A single puncture was allowable, chiefly for
purposes of diagnosis. The reasons for using the knife
after the first aspiration were the following : First, the
cavity refills after asjiiration ; second, repetition of aspi-
ration is painful, and causes more or less shock ; third,
much valuable time is lost by allowing the fluid to re-
main, and favoring the formation of firm adhesions wliich
will be followed by contraction of the chest ; fourth,
speedy relief of the lung promotes complete expansion.
The admission of air into the pleural cavity has ceased
to be an important factor in the operation.
Dr. E. Sinnott, of Ohio, and Dr. Christie, of Iowa,
referred to cases which they had treated successfully by
the free incision.
Dr. C. W. Earle, of Chicago, then read a paper en-
titled
A PLEA FOR pleasant MEDICATION FOR CHILDREN, AND
for a MORE THOROUGH STUDY OF INFANTILE THERA-
PEUTICS.
The Section then adjourned, to meet at 2 p.m. on
Thursday.
666
THE MEDICAL RECORD.
[June i6, 1885.
Thursday, June 7th — Third Day.
The Section convened at 2 p.m., and the first paper
was read by Dr. A. H. Good, of Indiana, on
DEXTITIOX.
In addition to the teeth acting as a foreign body, a retle.x
nervous irritabihty is produced. When the gums are
swollen they should be divided to relieve pressure, pain,
and inflannnatory action. Aphthous ulcers should be
treated with a solution of persulphate of iron, or some
other astringent lotion. For the functional and con-
comitant derangement of the stomach and bowels, the
result of enervation, he uses cold compresses to the ab-
domen and ice-water injections, and for the secondary
symptoms pepsm, bismuth, and carbolic acid.
PiEDIATRlC MEDICATION.
Dr. B. Cassebeer, of .\uburn, Ind., read a paper on
the above subject, in which he spoke of the judgment
necessary in administering medicine to children, and of
the necessity of giving as little as possible. He described
his experience in making the medicaments palatable. He
pointed out that the relation existing between diseases
of children and that of adults was as that of the sprout to
the full-grown tree. He conjured the |jrofession to wake
up to the realization of the fact that there is real science
in the projjer practice of medicine among the children,
where the nature, expression, and influence of disease is
read by the physical signs and rational symptoms, un-
aided by the verbal language of the patients, and that
any indifference or inclination to shift responsibility of
their treatment is only an evidence of weakness in' the
physician. The author directed especial attention to
the lack of knowledge or misconception of the true prin-
ciples of the practice of medicine as applied to children.
He maintained that diseases of children and adults are
essentially alike ; that ihey have been presented in a
way in text-books and by teachers as though they were
different conditions ; that the indications are the same
for treatment in children as in adults. Special atten-
tion was directed to the treatment of pneumonia and
pleurisy.
The general principles of the paper were discussed
by Drs. Ulrich, of Pennsylvania ; Boothby, of Wiscon-
sin ; Van Klein, of Ohio, and others.
Dr. Teal, of Indiana, then read a paper on
IN'FAXTILE or ESSENTIAL PARALYSIS.
He detailed the history of a case ; a female child,
seventeen months old. The patient was attacked sud-
denly. With the best possible treatment this paralysis
lasts for a long time, if it is not permanent.
The pa^jer was discussed by Drs. Myers, of Indiana ;
Sinnott, of Ohio ; Snow, of Michigan, and Hyatt, of
Ohio.
Dr. A'illiam Lee, of Baltimore, said, as Dr. Teal's
paper was confined to a description of what he called
paralysis coming on suddenly without any warning what-
ever, that he believed that these cases, almost as a rule,
had as an exciting cause, rheumatism or neuralgia, and
this from the fact that the patients get well in a short
time under treatment appropriate for these difficulties.
Dr. Lee said further, that sometimes the disease seemed
to be, as it were, the beginning of hip-joint disease, but
increase of heat of the parts and other symptoms re-
cognized as due to hip disease easily excluded the dis-
ease under discussion. As for the curative treatment of
infantile paralysis, he believed that at best it was ol'ien
unsuccessful, and even when successful was very tedious.
A somewhat protracted discussion on the identity or
non-identity of
CROUP AND diphtheria
was then introduced, and was i)articipated in by nearly
all the members of the Section. The symptomatology
was reviewed and various plans of treatment of di[)htheria
were discussed without developing anything with which
the profession in general is not already familiar.
The Section then adjourned.
SECTION IN OPHTII.\LMOLOGY, OTOLOGY, AND
L.VRYNGOLOGY.
Tuesday, June 5th — First D.^y.
In the absence of the Chairman, Dr. A. W. Calhoun, of
Georgia, Dr. J. Chisholm, of Baltimore, was elected
Chairman pro te?n. Dr. Carl Seller, of Philadelphia, was
Secretary.
PARALYSIS of the FACIAL NERVE IN CONNECTION WITH
DISEASES OF THE .EAR.
Dr. Taurence Turnbull, of Philadelphia, read a
paper on the above subject, in which he directed atten-
tion to the fact that acute and chronic disease of the
middle ear will give rise to temporary or permanent
paralysis, alteration in taste, touch, smell, gait, and vision.
Falls, epileptiform convulsions, hemiplegia, and insanity
are also due to reflex phenomena from irritation and
compression of the sensory and motor nerves of the ear,
the result of necrosis of the temporal or mastoid bones.
Paralysis of the parts supplied by the facial nerves occur,-
and are the result of acute inflammation of the ear fol-
lowed by accumulated secretions in the Fallopian canal,
or necrosis of the mastoid cells. Dr. Turnbull then re-
cited the history of several cases which had occurred iri
the aural department of the Jefferson Medical College
Hospital. The first was a case in which a woman, fifty
years of age, had a malignant tumor situated in the ear,,
originally caused by a polypus which gradually extended
from the interior of the ear, involving the meatus, audi-
tory canal, temporal bone, and passing out through the
auricle until it formed a large double tumor. The lesion
was situated between the petrosal branches of the fifth
nerve, involving the chorda tympani. It produced perios-
titis which gave rise to irritation and pressure that ultimate-
ly involved the brain and caused death. The second was
a case of entire paralysis of the mouth and face, due to-
exposure and occurring in a patient twenty-four years of
age. The patient died within a short time. The his-
tories of other cases were mentioned. This form of
paralysis. is generally attended by pain, and as the pain is
relieved the paralysis shows itself. The pain, however,
is not in the facial nerve, but is of a rheumatic character
generally, and from some irritation of the fifth nerve.
The anatomy of the fifth nerve and its distribution were
then given. Dr. Turnbull also referred to cases in which
temporary facial paralysis occurred, due to simple swell-
ing of the nerve. Permanent paralysis also of the same
nerve might occur in connection with suppuration in the
middle ear.
The paper gave rise to discussion, which was partici-
pated in by several members of the Section.
Dr. J. E. Harper, of Illinois, then read a paper on
hysterical amblyopia.
This was followed by a paper on
tonsilloto.my without hemorrhage,
by Dr. William C. Jarvis, of New York.
Reference was made to the wide difference in opiniorb
entertained by surgeons of acknowledged authority o\\
the question of hemorrhage following the removal of en-
larged tonsils. He named those who discouraged the
use of all sharp instruments as dangerous to life, and
their opponents in opinion who insisted upon the indis-
criminate removal of enlarged tonsils by means of the
knife. Safety lay between the two extremes. The his-
tories of two cases selected from a number were given
as furnishing the basis for his views. In the first case re-
ported, a profuse and persistent hemorrhage followedl
the removal of a hypertrophied tonsil excised with the
knife. The tonsil presented an unusual appearance, its
June i6, 1883.]
THE MEDICAL RECORD.
667
surface was rough, marked with numerous fine indenta-
tions, and darker in hue than the surrounding nuicous
membrane. It had the consistency of cartilage, giving a
harsli, gritty sensation when pressed upon.
Afterward another case came under observation where
the tonsils were identical in appearance and consistency
as the one in which the copious hemorrhage occurred.
The scissors and tonsillitome had been used by different
surgeons. Alarming and profuse hemorrhage followed
each operation. Convinced by the i)atient's unfortu-
nate history and also by his own experience in operating
upon a case of the kind that the knife was contra-indi-
cated, he used the ecraseur. ISoth tonsils were removed,
each operation occui^ying three hours. The operations
proved bloodless, causing but slight discomfort. When
the first was jserformed the patient said there was no
pain, and only complained of the procedure being tedi-
ous. Both of the tonsils, though very large, were re-
moved and normal deglutition and respiration re-
established. The hemorrhagic and non-hemorrhagic
tonsil could, in many cases, be easily differentiated. The
hard or scirrhous tonsil differs in many resjiects from the
familiar soft, or malacholic, hypertrophied gland. It
lacked the smooth surface, was not easily lobulated, and
had not the softness of the familiar glandular hypertro-
phies. The occasional occurrence of a serious hemor-
rhage after tonsillotomy not resulting from laceration of
contiguous tissues, showed the infrequency with which
the harder scirrhous tonsils were met. The two forms of
hypertrophy could be easily recognized and distinguished
by sight and touch. Preference should be given to the
tonsillitome in removing soft malacholic hypertrophies,
since like the glandular tissues of the vault of the phar-
ynx the hemorrhage was usually trifling and the pain only
momentary. The ecraseur afforded a safe, simple, and
reliable means for the removal of the scirrhous form of en-
larged tonsil, which, when excised with the knife, bled
invariably like its analogue, the nasal fibroid tumor.
Dr. Williams, of Cincinnati, preferred the bistoury to
the guillotine for excising tonsils.
Dr. J. P. Thompson, of Indianapolis, thought that
cutting off tonsils when they were inflamed was not good
practice. But in chronic enlargement he had uniformly
removed them, and no accidents or unfavorable results
had followed the operation. He did not intend to over-
estimate in the least, but believed that without exagger-
ation he had excised two bushels of tonsils, and thought
no special advantage existed in the use of the instrument
described.
Dr. Roe, of Rochester, had never met with a case of
serious hemorrhage after tonsillotomy, although persis-
tent oozing had occurred in several cases. He agreed
with Dr. Jarvis that cases should be selected when op-
erative interference was contemplated. Where there is
simple hypertrophy, no adhesion to the jialatine folds,
we are quite safe in not expecting any hemorrhage. But
where there are adhesions a small portion of the ])illar of
the fauces was very apt to be removed, and the liability
to serious hemorrhage followed. He uses a jieculiar
blunt-pointed bistoury and small, long tenaculum forceps.
The blade of the knife is about one-fourth of an inch
wide and curved. He had also used the tonsillitome.
In two or three cases the hemorrhage gave him consid-
erable annoyance. In one of these the hemorrhage was
controlled by pressure, and although at times it apparently
ceased, removal of pressure was followed by persistent
bleeding. Much blood was swallowed and vomiting
occurred. The bleeding, he believed, was stopi)ed by
the effort at vomiting, from pressure upon the tonsillar
artery. This was also recommended by an English sur-
geon. He has found port wine an excellent styptic for
oozing.
The Chairman believed that repressed cardiac action
resulting from vomiting might explain the cessation of
tonsillar hemorrhage.
Dr. Carl Seiler, of Philadelphia, had never met
with persistent oozing of blood after tonsillotomy. His
patients were given a powder of twenty grains of gallic
acid, with thirty grains of tannic acid (a mixture sug-
gested by Mackenzie of London), this to be used should
secondary hemorrhage occur. The patients invariably
return with the unused jiowder.
Dr. William Porter, of St. Louis, thought the de-
termination of the eftect of removal or non-removal of
enlarged tonsils was called for as having an important
influence upon the patient's career. In his experience
local applications had not given good results. The
Vienna paste or chromic acid when used mildly was-
inefficient ; if a]3plied as a caustic they proved pain-
ful ; when applied in stimulating quantity they were apt
to increase rather than diminish the hyi>ertrophy. He'
had used Jarvis' ecraseur in six cases. Pain was, how-
ever, caused by its manipulation in his hands. He had'
met with profuse hemorrhage in a single case where he
had excised the tonsils with a knife. The patient was-
a ])hysician's child, and the hemorrhage finally ceased
without the employment of styptics. Hemorrhage, there-
fore, may be looked for in certain cases. It was inadvis-
able to remove the entire tonsil, excision in a line with
the pillars of the fauces being sufficient. Hemorrhage
most frequently occurs as a result of incision of the fau-
cial pillars. The lessons taught in the paper were valu-
able and endorsed by him. In view of the opinion gaining
ground in favor of Jarvis' ecraseur, he would use it to
remove enlarged tonsils. He also thought that if a small
portion of the enlarged tonsil was removed it would be
sufficient in most cases, and did not believe there was
any special tendency to hemorrhage when the operation
was performed in that way.
Dr. Jarvis conuiiented upon the good fortune of some
of the speakers who had so far met with no serious
hemorrhage in removing enlarged tonsils, although it
would seem that one of the gentlemen had had a very
large experience. He was convinced that they had not
met with a scirrhous or hemorrhagic growth. His op-
portunities for observation had been afforded by one of
the largest throat clinics in the country. Out of a large
number operated upon, the case described in the paper
was the only one in which dangerous hemorrhage occur-
red. The history of hemorrhage in the other case was
obtained from the surgeon who operated. The fact that
the tonsillitome was used and only a small ])ortion of
the growth excised, showed that the hemorrhage was
not caused by laceration of the fauces. Five cases of
fatal hemorrhage following incision of the tonsil from
puncture of the internal carotid were cited as a warning
against the free use of sharp-pointed bistouries. The
palatine folds could be incised by even a blunt-iJointed
bistoury, but not by the tonsillitome. A case of death
from exhaustion following the incision of a tonsil by a
surgeon using the knife was mentioned, in which death
from exhaustion occurred after three days' bleeding.
Cases of nearly fatal hemorrhage, reported by Drs. Geo.
M. Lefierts, D. B. Delavan, and .-Andrew H. Smith, of New
York, were referred to. A remarkable tonsillar hemor-
rhage, published by a physician as occurring in himself,
aflbrded recent and reliable evidence on the subject.
Though flushed with success it was well to take timely
warning, as a fortunate record was liable to be blighted
by the e.xcision of an unnoticed scirrhous hypertro|)hy.
As regards the question of pain asked by Dr. Porter,
he called attention to the fact that the patient was per-
mitted to remove the tonsil. Patients by this means can
stop, when they feel a twinge, and permit the pain wave
to fade away. When the physician removed the tonsil
his activity was apt to cause pain.
action of nitrate of silver on the mucous mem-
brane OF THE THROAT.
Dr. Carl Seiler, of Philadelphia, read a paper on.
the above subject, in which he stated that nitrate of silver,
solid or in solution, is not a caustic ; that is, it does.
668
THE MEDICAL RECORD.
[June 16, 1883.
not destroy the epithelial covering, and that its action
varies according to the strength of the solution employed.
When applied to the surface from which the epithelium
has been removed it destroys the upper layer of cells.
From clinical observation, the solid stick, or supersatu-
rated, solution does not produce much pain on the healthy
mucous membrane, but acts as a local stimulant. Solu-
tions of from two hundred and fifty to one hundred and
fifty grains to the ounce act similarly to the solid stick ;
little or no pain is felt, and the localized inflammation is
of but short duration. Solutions of from one hundred
and twenty to one hundred and sixty grains to the ounce
produce no pain what.-vor, but, on the contrary, act as
a local anesthetic when applied to the inflamed surface ;
they produce no perceptible local mflammation, although
they stimulate the glandular secretions. These solu-
tions will also frequently cut short acute inflammations.
Solutions of less than sixty grains to the ounce produce
more pain the weaker they are, and the anaasthetic and
astringent action dimini.sh in equal ratio with the strength
of the solution, while the stimulant and irritant action in-
creases as the solution becomes weaker. The glandular
secretions are materially increased by weak solutions of
the salt. When the stimulant and irritant action is de-
sired, the nitrate of silver in fine powder, highly diluted
with starch, is preferable to the solution, since'the fine
granules of the silver salt set up points of inflammation
and increased blood-supply.
Dr. W.m. C. Jarvis, of New York, considered nitrate
of silver one of the most valuable of all local applica-
tions used in the special treatment of diseases of the
throat. The difl:erent effects jjroduced by the salt in va-
rious forms and parts should be constantly borne in
mind. It was unequalled by any other agent in con-
trolling the extension of superficial ulcers of the mouth or
pharynx, when used fused or in full strength. Its healing
quality in this respect w^as partly antiseptic in nature,
primarily a stimulant, subsequently anaesthetic, and
largely jjrotective. When shellac varnish was carefully
applied to a superficial sore in the mouth, associated with
perversion of the buccal secretions, it would rapidly heal.
The silver salt produced the same beneficial result', since
the chemical coating or eschar formed protected the
ulcer from the action of acrid secretions. This metal,
albuminate of silver nitrate, had been shown by experi-
ment to be a most powerful antiseptic. Nitrate of silver
did not exercise the same controlling influence over deep
ulcers, and was often contra-indicated in the treatment of
these lesions. Solutions of the salt were not well borne
by the nasal mucous membrane. Catarrhal troubles in
the throat and mouth were benefited by sprays contain-
ing the salt m solution. It was a valuable application in
■chronic, congestive, or inflammatory disease of tlie larynx
in the strength of from five to fifty grains to the ounce,
the best results being obtained by atomization.
Uk. Roe, of Rochester, spoke of tiie influence of ni-
trate of silver solution in arresting inflammation in its
€arliest stages. For example, in acute tonsillitis, a solu-
tion of sixty grains to the ounce applied over the surface
of the tonsil, and then followed by inhalations of steam,
was one of the most valuable methods of treatment for
arresting the inflammatory process.
Dr. Ti.RMsuLL, of Pliiladelphia, spoke of tiie local
application of the solid stick of nitrate of silver, and also
of strong solutions, and had sui)poscd that they jnoduced
an eschar ; that is, actually destroyed tissue.
Dr. CoNiVOR, of Detroit, thought that the effect pro-
duced by nitrate of silver depended very much u|)on the
length of time that the caustic was kept in contact witli
the surface to which it was applied.
Dr. Tho.mpsox, of Indianapolis, spoke of the beneficial
effects which followed the use of nitrate of silver in puru-
lent conjunctivitis.
The Chairman thought that he had more than once
caused ulceration by applying nitrate of silver about an
erysipelatou-: patch to prevent its spread.
Dr. Luxdv, of Detroit, asked Dr. Seller if he had any
method to suggest for removing the stains produced by
the use of nitrate of silver.
Dr. Seiler, in closing the discussion, said that when
nitrate of silver was applied frequently, and for a consid-
erable length of time, there would be a deposit of the
substance itself beneath and within the epithelium which
would stain the tissues. He knew of no method of re-
moving these stains, because they were produced by the
oxide of silver, which is i^ractically insoluble except in
cyanide of potassium, which could not be used locally.
With regard to nitrate of silver, either in stick or in
solution, producing ulcers and eschars, he could only say
that in those cases the local sore was not caused by de-
struction of the epithelium, but was due to the localized
inflammation produced by the fine particles of silver act-
ing as foreign bodies ; that is, the stick or the strong
solution does not produce the eschar, but the particles
of silver set up a localized irritation which produces rapid
cell death, the same as does many other substances.
He has never succeeded in removing nasal polypi with
nitrate of silver ; its application to these growths always
caused pain. Has seen microscopic specimens from
the eye of a rabbit, showing inflammatory action of the
salt upon the intra-ocular tissues. He believed with
Dr. Jarvis that location had much to do with the strength
in which the silver should be applied.
Benefit could not be derived from using a ten-grain solu-
tion of the salt in acute tonsillitis, solutions of from sixty
to one hundred and twenty grains to the ounce would
cut short the inflammation.
A paper on-" Myringitis," by Dr. Williams, of Minne-
sota, was read by title and referred.
Wednesday, June 6th — Second Day.
The Section was called to order by Dr. Chisholm.
The Chairman ap|iointed Drs. Connor, of Detroit ;
Williams, of Cincinnati ; and Seiler, of Philadelphia, as a
sub-committee, to which all papers submitted to the Sec-
tion were to be referred.
segmental feature of glauco.ma.
Dr. H. Culbertson, of Ohio, read a paper on the
above subject and reported a case. He believed that
glaucoma occasionally show-ed itself in segmental dis-
tribution. The author discussed at some length the
pathology of intra-ocular inflammation. A desultory dis-
cussion followed, in which the experience of the mem-
bers of the Section present seemed to sustain the view
advanced by the author of the paper.
tinnitus auriu.m and the deafness which accom-
panies THE DIFFERENT FORMS OF BRIGHT'S DISEASE.
Dr. Laurence Turnbull, of Philadelphia, read a
paper in which he detailed at length certain aural symp-
toms frequently accompanying Bright's disease. The
drift of the subsequent discussion was that none of these
symptoms are pathognomonic of Bright's disease.
Dr. J. L. Tho.mpson, of Indiana, then read a paper
entitled
questions on THE ETIOI.OGV OF SOME FORMS OF LEN-
TICULAR OPACITY.
He presented a collection of cases of peculiar opacity
of the lower periphery of the lens, a[>pearing suddenly,
and lasting for years without change. He could ascer-
tain no cause for this appearance, but had noticed it in
diabetic cases.
Dr. Noves, of New York, had seen similar cases as-
sociated with myopia. The sense of the discussion was
that similar opacities had been observed, due to various
causes.
Dr. |. O. Roe, of Rochester, then read a paper en-
titled
June ]6, 1883.]
THE MEDICAL RECORD.
669
NASAL DISEASE THE FREQUENT CAUSE OF ASTHMA.
The discussion seemed to affirm the author's views cou-
ceining the production of asthma by nasal irritation.
The Section then adjourned, to meet on Tinirsday,
at 2.30 p. II.
Thursdav, June 7th — Third Dav.
Dr. J. F. RuMBOLD, of St. Louis, read a paper on
THE APPEARANCE OF THE DISEASED MUCOUS ME.MHRANE
OF THE NOSE AND THROAT OF ADULT PATIENTS.
He described the characteristic appearance of the in-
flamed throat of the young adult and directed attention
to difTerential diagnosis, prognosis, and treatment. It is
unsafe to take the patient's account of symptoms. Fol-
licular inflammation does not require special treatment.
The writer had observed cases of aphonia treated suc-
cessfully by applications to the nasal mucous mem-
brane.
Dr. Seiler agreed with the author of the paper as to
the possibility of laryngeal trouble being disposed of bv
nasal treatment. He did not agree with the author of
the paper concerning the appearance of the inflamed
pharynx, and believed there were more manifest varia-
tions. He thought aphonia occurred most frequently
about the period of puberty, as did hysterical paralysis in
girls and change of voice in boys. He did not agree
with Dr. Rumbold concerning the smoker's sore throat,
and had found that the throats of cigarette-smokers
were more irritated than those of pipe-smokers, as the
former inhale the smoke more than do the latter, and
there was more surface exposed to irritation. He did
not agree as to the harmlessness of inflamed follicles, as
touching one of them sometimes produced marked symp-
toms of violent congestion.
Dr. Rumbold remarked, in closing, that probably not
ten per cent, of the vocal cords of smokers presented
their normal white, pearly appearance.
is ABSCISSION A PROPER OPERATION ?
Dr. J. J. Chisholm, of Baltimore, read a paper with
reference to the above question, in which he considered
the best mode of forming a stump for an artificial eye.
Enucleation is one of the easiest ophthalmic operations ;
abscission one of the most difficult, and liable to be fol-
lowed by fatal injury of the ciliary region.
Dr. Frothingham, of Ann Arbor, urged the aban-
donment of abscission on account of the great liability to
the occurrence of secondary inflannnation. He consid-
ered the difficulty of retaining observation of patients was
sometimes a fatal objection in abscission ; patients fre-
quently not returning till the cases were beyond hope of
successful treatment. He advised enucleation to young
practitioners, as the stump is a constant source of danger
from the interstitial deposit or morbid growths. The
preservation of the stump only for a cosmetic effect
should be abandoned.
Dr. Lundy, of Detroit, agreed as to the experience of
the author of the paper. Possibly a little better motion
of the artificial eye would be obtained by abscission, but
the risks overbalance this slight advantage. He gave an
instance in which bone had taken the place of the ciliary
body ; also gave cases in which great sympathetic irri-
tation had occurred. He remembered an unfortunate
circumstance in which abscission had been performed and
an eye worn on the stump which had eventuated in
hopeless blindness.
Dr. Thompson, of Indiana, mentioned a case of
panophthalmitis resulting from abscission ; he spoke of
care in rounding off the stump carefully, leaving no cor-
ners protruding. He mentioned a case of enucleation in
which the patient had returned to business on the second
day.
Dr. Culbertson, of Ohio, expressed approbation of
the paper because of its thoroughness, but he had not
had an unfavorable result from abscission in thirty years.
He never used any sutures after abscission ; sometimes
has taken out the choroid and retina and allowed the
eyeball to take care of itself. By this process he gets
not so large a ball, perhaps, but for practical purposes a
more useful one. In dividing the tissues well back he
cuts off the most sensitive ])arts of the ciliary nerves.
.Dr. Noves, of New York, had performed abscission
many times with no trouble, but he always informed the
patient of its great danger, and recommended enuclea-
tion first.
Dr. Cornwell, of Ohio, related a case in which he
had removed the globe with the lachrymal gland and
had stitched togelher the ciliary margins of the lids, put-
ting in drainage-thread, with a fine result.
Dr. Chisholm, of Maryland, had also abandoned ab-
scission, and laid down as an aphorism, a lost eye is a
dangerous element and should be removed.
Dr. Noves mentioned a case of injury to ciliary body.
Dr. Culbertson, of Ohio, described (having lost the
glasses)
a FORM OF spectacles TO BE USED I.N LIEU OF NOSE-
PIECES.
They consisted of the addition of a semicircular glass to
each of the spectacle glasses, attached by a peculiar
mechanism, so that the nose-piece allowed them to come
below the permanent glasses, out of the way for vision
and yet available for close downward vision, as in walk-
ing, descending stairs, etc. He gave cases of astigmatic
asthenopia and myopic astigmatism which he had relieved
by these glasses, and claimed that they were easy of pre-
scription and adjustment.
Dr. Frothingham expressed much regret that the
speaker had lost the glasses, and while approving the plan,
expressed much doubt as to its practicability and its
meeting all the indications as claimed.
Dr. Culbertson again explained the arrangement of
the glasses.
Dr. Cornwell reported four cases: i, hemianopia
without paralytic symptoms, monocular optic neuritis and
atrophy of optic nerve ; 2, paralysis of the sixth cranial
nerve from basilar meningitis ; 3, a case of choked disk
trom tuberculous tumor in cerebellum.
Dr. Seiler presented a convenient case of instruments
for use at night in emergencies.
Dr. Turnbull read a letter from a patient as to the
subject-matter of his paper on Bright's disease.
• Dr. Scoit then read a letter from Dr. Calhoun, ex-
plaining his absence on account of his wife's sickness.
The Section then adjourned.
SECTION ON DENTAL AND ORAL SURGERY.
Dr. D. H. Goodwili.ie, of New York, Chairman ;
Dr. T. W. Brophv, of Illinois, Secretary.
Dr. John S. Marshall, of Illinois, read a paper on
DENUD.4TI0N OR EROSION OF THE TEETH.
Various terms had been applied to this disease, such
as denudation, erosion, abrasion, surface wear, and atro-
phy. It consisted in a gradual wasting away of the en-
amel and dentine, generally upon the labial and buccal
surfaces, most often beginning with the incisors, but it
might involve all the teeth to the second molars. It
usually began at the gums, forming cavities or grooves,
which followed the curves of the gum lines. They were
smoothly cut and quite sensitive. The disease progressed
with variable rapidity ; in some cases it seemed to be-
come arrested. John Hunter was the first to notice the
condition, and named it " decay by denudation." The
views of Bell, Fox, Wedle, Salter, and various others,
were reviewed. An interesting case was narrated, in
which it was believed there was a syphilitic taint, and
670
THE MEDICAL RECORD.
[June i6, 1883.
the author then gave his ideas concerning the cause of
ithe affection. The tooth is invested at the root by vital
tissues which render it electro-positive ; the air surround-
ing the crown or exi>osed portion, renders that electro-
negative to the root, and forms a negative element, or,
in other words, the tooth is polarized. The only thing
needed to establish an active current is an acid fluid, and
that we have almost constantly in contact with the labial,
buccal, and pro.ximal surfaces of the teeth at just the
points where the disease manifests itself. It was argued,
therefore, that, like the copper wire, the teeth will be
acted upon the most vigorously at the junction of its two
poles, provided there is an acid medium, like the buccal
mucus, to establish and maintain the electro-chemical
action. By this action the lime salts are removed at the
line of junction and washed away.
Vital resistance, however, was strong, and must exer-
£ise a powerful influence over electro-chemical action.
The teetli generally denuded belonged to the class called
niedunn, and belonged often to patients who had inherited
a peculiar cachexia, as the scrofulous or syphilitic, which
had a depressing influence upon the developing processes,
and in lowering the vitality. He did not state, however,
;that syphilis or scrofula produced the disease, but that
.they predisposed to it.
At the close of the reading of the paper Dr. H. D.
Nicoll and Dr. J. H. Hinton, of New York, said they
,had been informed that the chairman, Dr. Goodwillie, of
New York, had not properly registered, and they there-
fore protested against his acting as chairman of the
Section.
Dr. Williams, of Boston, was called to the chair, and
Dr. C'loodwillie said that lie hatl written to the proper
authorities in the Association before he left New York,
■ Stating that if there was likely to be any objection raised
to his presiding over the Section, he would not go to the
trouble of attending the Association. As he was not in-
formed that any objection would be raised, he came and
registered, protesting, however, against certain clauses
in the qualifications.
Dr. Nicoll said that a member of the Judicial
^Council had informed thein that Dr. GoodwilHe was
allowed to register under protest of the committee, and
it was thouglu that he should not preside over the Sec-
tion until the Council had taken [jermanent action in the
case. There was some warmth in the discussion follow-
ing, the members of the Section generally coinciding
with the secretary in the statement that parties unknown
to the Section should not be allowed to interfere with
the regular proceedings of the Section without showing
authority for doing so. A member of the Judicial Coun-
cil came later to enter the protest in a formal manner,
but as Dr. Goodwillie, out of courtesy, had not resumed
the chair, no further action was taken. Dr. Williams
presiding, the Section proceeded to the discussion of Dr.
Marshall's paper.
Dr. Goodwillie thought that erosion of the teeth
might be due either to local or constitutional causes, or
to the two combined. Scarlet fever, the pustular, and
other diseases might check the development of the teeth
before maturity, which would be indicated by depressions
upon the sides of the teeth. The more compact struc-
ture nught form over these depressions if vitality was
sufficiently restored afterward, or, if not, denudation was
.likely to result in destruction of the teeth. One of the
most imi)ortant and frequent constitutional affections
which lowered the vitality, and led to the condition in
question, was syphilis.
The paper was further discussed by Drs. Buffin, Ilar-
ton, Andrews, Barnes, the Chairman, and others,
i On motion of Thk Secretary, invitation was extended
,to dentists in general to |)articipate in the discussions
throughout the remainder of the session.
Subsequently it was learned that a former Professor
,in a Honiceopathic Medical College had participated iu
^the discussion.
CCorvcsp on deuce.
THE INFLUENCE OF DEAD TEETH UPON
THE HEALTH.
To THK Editor of The Medical Record.
Dear Sir: In your issue of the 12th instant you ask a
pertinent question as a heading to the interesting letter
of Dr. Samuel Sexton upon the subject of dead teeth, to
which I beg permission to reply.
The care of such teeth has formed a very large part of
my practice for twenty-five years, and I feel competent
to speak as to the feasibility of their being rendered, in
every instance except where exostosis or malformation
is present, quite as durable and innocuous as if their vi-
tality had never become impaired.
A com|)lete misapprehension with respect to this ex-
ists among phvsicians and surgeons, due doubtless to the
fact of there being so very few oral surgeons who attend
to this branch of dental surgery, and also, I fear, to the
peculiar character of the representations made about it
by those who do not. It would be easy to have this un-
fortunate opinion quite changed if those who should be
correctly informed would make proper investigations.
Certainly the names of such men as .\mos Westcott,
Robert Arthur, Eleazer Parmley, E. J. Dunning, and
Joseph H. Foster cannot be unknown to the medical
profession, and there are probably few of the private pupils
of those eminent men, or of perhaps others, who could not
soon set this question at rest. Would you permit me to
ask whv such men are not applied to by those most in-
terested in being accurately informed ? The proprietors
or managers of dental depots could doubtless, if they con-
sidered it best to do so, give the names of those who are
qualified to fill a root.
Dr. E. J. Dunning is still living, and would give valu-
able information about it with pleasure, I am sure.
In speaking of the treatment and filling of devitalized
teeth, one is necessarily placed at the outset in a very
delicate position, since not more, I think, than one oral
surgeon in a thousand does it with uniform success, and
probably not two in a thousand at all (though I am not
referring to the claims made about it), and one does not
wish to be considered hypercritical by those who do not.
I should be happy to speak of this and, at the same
time, pay a merited tribute to the very many conscien-
tious and useful dental surgeons who find the successful
care of roots too much for them, but your space would
not admit of this.
So kindly pardon me if I reply to Dr. Sexton's letter,
not as its importance requires, but by a few plain state-
ments sinqily.
He does not exaggerate the harmfulness of dead teeth
left in the mouth with nerve-cavities unstO|3ped, and with
no vent from them for the accumulations which form in
them. He is also quite correct in his conclusion, that
artificial dentures are not always harmless when fastened
to dead roots. The public, which from time to time has
its attention directed to this practice in one way and
another, would do well not to permit its confidence to
be too readily captured. This, however, is not likely,
since those wearing such dentures would scarcely speak
of the ulceration following their insertion, or of the open
pustule too liable to exist, if the roots in question had not
been put in proper order by some competent person in
the first place.
Nerve-cavities are nests of disease solely from the cor-
ruption of the fluids which enter them. Obviously then
they are not at all so if the influx of fluids is absolutely
prevented. But to stop them in such a manner as to ef-
fectually accomplish this object, and it must invariably
be done with metal, requires a care in manii)ulation
which can be given it by extremely few mortals only. I
know of no manipulation in which human fingers have to
engage which approaches it in delicacy. Some years ago
June 1 6, 1883.]
THE MEDICAL RECORD.
671
a famous dentist practising abroad, where this is never
attempted, came to this country expressly to see a root
filled. The operator to whom he applied showed hiin
the process by fdling a root for a patient in his presence.
Upon its conclusion, and the departure of the patient, he
sadly remarked, " I have made my trip to no purpose,
for I could never, never accomplish that."
Would you permit me to say, finally and frankly, that
it seems to me to be the duty of every physician, surgeon,
oculist, and aurist, in every such city as New York, to
fieek out some oral surgeon who is competent to take
proper care of dead teeth and send his patients to him,
rather than to permit them to needlessly lose important
organs. He shoidd also hold the dentist to the most
rigid accountability in case of one single failure, and, if
exostosis or malformation does not exist, he should never
reconnnend him for that kind of o|)eration again.
Should Dr. Sexton feel interest enough in this matter
to investigate it more full)', I should be happy to have a
personal interview with him, and, should he desire it,
pray be good enough to give him my name and address.
Your obedient servant.
X.
Mny 25, iSSj.
DR. WALLIAN'S MISQUOTATION.
To THE Editor of The Medical Record.
Sir : Referring to Prof. Bartholow's disclaimer in your
issue of Mav 19th, I beg to explain that the misquotation
occurred through the hasty and fairly inexcusable inad-
vertence of rel)'ing on the statement of one of the numer-
ous handbooks, instead of referring directly to the works
of the distinguished author, all of which were within easy
reach as I wrote.
In the language of Napoleon, it was " worse than a
mistake, it was a blunder ; " and when I add the still more
humiliating statement that the guilty handbook referred
to was comi^iled (but not proof-read) by myself (!) I do
not know that I can make my apology any more [jointed.
It is another lesson to us all, since it proves that we
cannot possibly be over-careful or over-accurate in mak-
ing medical statements or in quoting those of others.
That the statement referred to by Prof. Bartholow was
a stupid misquotation occurred to me some days after I
had sent you, but too late to recall the report. Hojiing
to go and sin no more.
Yours very meekly,
Samuel S. Wai.lian.
Official List of Changes of Stations and Duties of Officers
of the Medical Department , United States Army, from
June 2, 1883, to June 9, 1883.
Alexander, Charles T., Major and Surgeon. So
much of S. O. 82, par. 6, A. G. O., April 10, 1883,
amended to direct that he be relieved from duty at the
U. S. Military Academy, West Point, N. Y., October i,
1883. S. O. 125, par. 7, A. G. O., June i, 1883.
McKee, J. C., Major and Surgeon. Assigned to duty
as Post Surgeon, Presidio of San Francisco, Cal. S. O.
56, par. 2, Department of California, May 25, 1883.
De Loffre, a. a., Captain and Assistant Surgeon.
To proceed to Madison Barracks, N. Y., and report to
the Post Conmiander for duty. S. O. 98, par. 2, Depart-
ment of the East, June 5, 1883.
An Improvement in Litmus Paper. — Dr. Squibb
has substituted for the ordinary blue and red litmus paper,
single color, vi/.., purple. This purple litmus paper
t^ctUcat Items.
Contagious Diseases — Weekly Statement. — Re-
port of cases and deaths from contagious diseases re-
ported to the Sanitary Bureau, Health Department, for
the two weeks ending June 12, 1883 :
u
"rt
Week Ending
>
>
3
'3
Si
>
V
B ■
'^"bo
o.B
0 a
i
X
0
>
Cu
&
la
IU«5
V
Q.
F
h
h
m
U
k
p
ifi
>
~~
Cases.
June 5, 1S83
2
7
120
2
120
43
I
0
Iiinp I '^ 1 88 ^. ....
0
6
104
4
107
4b
0
0
Deaths.
0
4
3
2i[
2
22
20
0
0
[line I "^ iSS^
0
23
4
'>r
18
0
0
turns red with acids, blue with alkalies.
be much more delicate and convenient.
It is claimed to
The Journal of the American Medical Asso-
ciation.— Our report last week stated that Dr. N. S.
Davis resigned as trustee to take charge of the depart-
ment of "Progress in Medicine," etc. This should have
read, " Dr. N. S. Davis resigned as trustee, and also an-
nounced that Br. William Lee, of Washington, had
been secured to take charge of the department of ' Pro-
gress in Medicine.' "
American Medical Editors. — At the annual meet-
ing of the Association, held in Cleveland, June 5th, the
foUowing were elected officers for the ensuing 3-ear :
President — Dr. E. Connor, of Detroit ; Vice-President —
Dr. Thomas Gallagher, of Pittsburg ; Secretary — Dr.
John V. Shoemaker, of Philadelphia.
The President, Dr. N. S. Davis, delivered an address
on " The Present Status and Tendencies of the Medical
Profession and Medical Journalism."
Dr. H. O. Marcy, of Boston, also read an essay on
" Journalism Devoted to the Protection and Concentra-
tion of Medical and Surgical Science in Sijecial Depart-
ments."
A Popular Therapeutical Delusion. — There is no
more common practice than that of giving spirits of ni-
trous ether as a diuretic. According to Dr. Nunneley
and to recent experiments made by Mr. Edmund A. Cook
(British Medical Journal), nitrous ether is in no sense a
diuretic by itself, or a diaphoretic.
A Case of Transposed Viscera — Autopsy. — Dr.
W. Fruitnight, of this city, sends us the report of a case
of transposed viscera. The patient, a woman aged forty,
married, and mother of thirteen children, had been a
steady drinker and was discovered to have a cirrhotic
liver, diffuse nephritis, and cardiac disease. Of this she
died. The following is the record of the autoiisy :
Lungs : The left oiie was made up of three lobes.
There were evidences of a recent pleurisy on its posterior
surface, and a small amount of fluid in the [ileural cavity.
The right was made up of two lobes. The pleural cavity
was obliterated by old general picuiitic adhesions. The
structure of both was" normal. Heart situated on the
right side. It was slightly hypertrophied. The left ven-
tricle was situated on the right side, and vice versa. The
aortic valve was quite rigid, thickened, and retracted. Peri-
cardium contained about two ounces of serous fluid. Aorta
had patches of thickening. It arched toward the right
and descended on the right side of the spinal column.
Liver weighed 24 ounces. It was situated in the left hypo-
chondriac, lumbar, and epigastric regions, extending three
inches below the free border of the ribs in the mammary
line. It touched the spleen on the right side. It was
diviiled into two lobes by a deep notch in the anterior
border. The left lobe was the largest, and contained
672
THE MEDICAL RECORD.
[June 16, 18S3.
the gall-bladder on its under surface. The surface of the
organ was nodulated, and the seat of a decidedly fatty
and cirrhotic change. Spleen was located in the right
hypochondriac region : its dimensions were 10 by 6 by
3^ inches. It weighed 59 ounces. The enlargement was
the result of passive congestion. Stomach was reversed.
The cardiac extremity was directed to the right, and the
pyloric orifice toward the left. Intestines : The caput
coli was situated in the left inguinal region, and the sigmoid
flexure occupied the corresponding position on the right
side. Kidne3-s were enlarged, weighing 15 ounces each.
They were affected by chronic diffuse intlammatory
changes. Pyelitis existed.
The Medicine Lay. — The following ingenious trick
is described as having been frequently practised in Lon-
don. It is known as the " bottle of medicine lay." A
healthy vagrant bandages his arm carefully, carries a bot-
tle of water under his coat, collides with a charitable-
looking gentleman, drops the bottle with a crash, and
attracts a crowd by bemoaning his broken-armed, medi-
cineless, miserable condition. Despite warning, several
of these enterprising persons have been carrying on a
profitable business and littering tlie streets with broken
glass for some time, until one of them recently rashly
lost his medicine twice in the presence of the same
gentleman, whose charitable aspect so far belied him
that, on the second occasion, he called in the police.
Dr. Squibb on Phenic Acid. — During the past two
years (Squibb's Ephemeris) very much has been published
by "Dr. Declat, of Paris," on the subject of carbolic
acid, or phenic acid as he calls it, for the cure of zymotic
diseases, among which he classes phthisis, and most irra-
tional statements are made by him and his advocates in
regard to its character and uses. Most of his statements
are at variance with well-established facts, and his deduc-
tions from these statements are as inaccurate as thev are
irrational. He seems to have had quite a successful pro-
fessional following, notwithstanding such absurd state-
ments as that it is impossible to transport pure carbolic
acid ; it immediately deteriorates and develops cresylic
acitl, an active poison ; it must be combined in its
nascent state, and so on. The effect of such under-
takings as this of Dr. Declat seems almost incredible.
For all the ordinary uses of carbolic acid as a disin-
fectant, the next article, or the " crude carbolic acid,"
is as good or better than the crystals, is much less costly,
and is more important because it is so much more largely
used. Dr. Squibb recommends very highly a dilute
solution of carbolic acid (^ per cent.) as an application
for burns.
Higher Medical Education. — Minnesota has sliown
a praisewortliy desire to elevate the standard of medical
education. We gladly note, therefore, further progress :
The faculty of the Medical Department of the Minnesota
State University, says the Northwestern Lancet, met re-
cently and organized. The President of the University
is Ex-officio President of the Medical Department, and
P. H. Millard was elected Secretary. This is not a
teaching faculty but purely an examining, and the ambi-
tion of the gentlemen forming it is to raise the standard
of the profession throughout the Northwest. They pur-
pose conferring two degrees, that of Bachelor of Medi-
cine and Doctor of Medicine. Parties desiring to take
either of tiiese degrees must have studied four years, at-
tended three courses of lectures, and possess a degree of
some college of letters or arts, and not possessmg the
latter, go before the general University faculty, and pass
an examination that would admit him to the Sophomore
year of said University. No party can obtain the degree
of M.D. without having passed an extra good examina-
tion, and defending a thesis before the faculty.
Premium for an Invalid Chair. — An Association
having the peculiar title of " The Humanitarian Inven-
tion Association,'' Youngstown, O., oilers a cash pre-
mium of 83,000, for the "most complete, practicable,
and patentable " invalid chair, for use in homes, hospitals,
and public conveyances.
A Novel Method of Medical Advertising is de-
scribed by the Maryland Medic-al Journal : "A few days
ago a one-dollar note came to the notice of one of the
editors of this journal, on which was stamped ' Doctor
A. B. L., Baltimore.' This gentleman is a member of
the Medical and Chirurgical Faculty of Maryland."
A Kindly Act. — The misfortune which befell Dr.
Comegys, of Cincinnati, in not diagnosing a case of
small-pox, has brought out the following kindly and in-
teresting letter :
"Cincinnati. Ohio, May 28, 1883.
" Dear Dr. Comegys : We desire to express to you
our sympathy for the painful criticism to which you have
been subjected in the daily press for having mistaken a
case of purpura variolosa for a case of purpura hemor-
rhagica, and believe that the report of an almost similar
accident which occurred in the hands of three of us, Dr.
James Graham and the subscribers, which you may use as
you see fit, will at least divide the responsibility among
a greater number.
"In this case, which happened seven years ago, the
symptoms were so vague and ill-defined, that we felt
constrained to regard it as an anomalous case of typhoid
fever, and so reported it in the death certificate. On
post-mortem examination the lesions were found more
like that rare form of disease, purpura variolosa, and we
determined to report it as such to the Academy of Med-
icine of this city. The full account of this case, with the
subsequent discussion, is detailed in the Cincinnati Clinic,
July 15, 1876. We subsequently learned that the body
had been in the meantime shipped to some town in the
interior of the State.
" We trust that you may take comfort in this evidence
of human fallibility, which we share with you in the cele-
brated aphorism of Voltaire : ' Only the charlatan is al-
ways certain.'
" J. T. WairrAKER,
" P. S. Connor."
A Surgeon's Misfortune. — Dr. Moses Gunn, of Chi-
cago, while conducting a surgical clinic, not long ago,
introduced to the class an infant, ten weeks old, who was
suftering from a naavus, situated near angle of mouth and
about the size of a fifty-cent piece. The child was im-
perfectly developed, and the growth of the vascular tumor
was rapid. The injection of a solution of chloride of
iron, a remedy used by Dr. Gunn in many other cases,
was selected as a means of relief. Immediately after the
injectioii of three drops of the solution, the child became
slightly convulsed and died within thirty minutes. Prof.
Gunn's explanation of this unfortunate termination was
that the babe died of shock. An inquest was held upon
the remains, and Professor Gunn was entirely exonerated,
as he should have been. No surgeon passes through
his professional life without a certain number of accidents
for which he is blameless.
Curious Result of Cannibalis.m in New Cale-
donia.— Mr. J. M. Creed, editor of the Australasian Medi-
cal Gazette, re|)orts and vouches for the following : In
1848 a man named Sutton, who had been adopted into
and was for some time living with the Shuarka tribe of
natives in New Caledonia, ofiended them so seriously,
by first leaving it and afterward firing on the messengers
who were sent to ask him to return, that w-atching their
opportunity they attacked his camp, situated on an island
a short distance outside the territory of the Shuarka
chief, killed him, carried off his body, and afterward
cooked and ate it, as was the custom of the New Cale-
donians. To the knowledge of my informant, Sutton had
been for some time suffering from venereal disease, and
the natives told him that every man who ate of the flesh
died shortly afterward, apparently poisoned.
The Medical Record
A Weekly yournal of Medicine and Surgery
Vol. 23, No. 25
New York, June 23, 1883
Whole No. 659
(Dvioiual Jifticlcs.
THE TREATMENT AND CURABILITY OF
CHRONIC UTERINE CATARRH.
By PAUL F. MUNDfi, M.D.,
PROFESSOR OF GYNECOLOGY AT THE NEW YORK POLYCLINIC ; GYNECOLOGIST TO
MOUNT SINAI HOSPITAL.
The extreme prevalence and the vital importance of
chronic catarrhal intlammation of the uterine cavity, as
regards the possibility of conception, as well as the ac-
knowledged difficulty experienced in curing the disease,
leads me to offer a few remarks on this subject. I am
not aware of having anything particularly new to ofier ;
my object is chiefly to insist on perseverance and on the
adoption of thorough measures as absolutely indispens-
able to success. The causation, pathology, and special
symptoms of uterine catarrh do not come within the
scope of this paper. The opinion has hitherto largely
prevailed, both among specialists and general practi-
tioners, that a really chronic endometritis or endocervi-
citis(l still use the latter familiar although hybrid term) is
practically incurable. This opinion is based partly on the
dictum of men of such eminence as Thomas and Sims,
and partly on the experience of the numerous physi-
cians who have vainly endeavored to cure this disease
by the usual routine of ai)plications, and in a measure
also, I presume, on the well-known obstinacy of all forms
of catarrhal affections of mucous membranes throughout
the human body.
Thomas, in his last edition, says of chronic cervical endo-
metritis, that " Even in the mildest case, which has lasted
for some time, from four to si.x months will jirobably
elapse before perfect cure can be accomplished, and
even after this a relapse will be very likely to occur,
unless preventive measures be adopted and strictly ad-
hered to. ... If a large amount of thick resist-
ing mucus hangs from the cervical canal, the progno-
sis, according to my experience, is very doubtful, and
sometimes hopeless, unless very radical measures be
adopted."
Of chronic corporeal endometritis he says : " The
prognosis ... is always grave with reference to
cure. . . . If it have continued for a number of
years it will often prove incurable." And he quotes ap-
provingly the following sentence from Scanzoni : " As
for ourselves, we do not remember a single case where
we have been able to cure an abundant uterine leucor-
rhoea of several years' standing."
In opening the discussion on a paper on Intra-uterine
Medications, by the late Dr. James P. White, before the
American Gynecological Society, in Baltimore, in 1879,
Dr. J. Marion Sims remarked that he thought " only a iew
men can say that they have cured half a dozen of these
cases (uterine catarrh with thick albuminous mucus). I
am sure that during the first thirty years of my practice I
was not able to boast of more than two or three."
Schroeder, of Berlin, has even gone so far, in his efforts
to cure this intractable disease, as to practise the com-
plete removal by the knife of the diseased cervical mu-
cous lining and its replacement by vaginal mucous
membrane, thereby removing entirely the mucus-secret-
ing power of the cervical cavity.
I could multiply these experiences indefinitely by
quoting from all recent authors on gynecological dis-
eases ; but I i^resume it is unnecessary to add further
evidence of the intractability of the disease under dis-
cussion.
Before jiroceeding to speak of the treatment and its
results, I wish to say a word as to the significance of the
disease and the physical conditions under which it oc-
curs.
Significance. — Whether there be a chronic corporeal
or a chronic cervical endometritis, the result as regards
conception is usually the same. That desirable event
rarely takes place. A thick, glairy, purulent plug of
nuicus filling and occluding the cervical canal usually
effectually bars the cavity proper of the uterus to the
spermatozoa. The ingenious hypothesis of Kricteller, of
Berlin, that this tenacious cervical plug served as a lad-
der on which the spermatozoa could climb into the
uterus is not borne out by experience.
If the cervical canal is comparatively healthy (and
this is rarely the case when its mucous lining has been
long exposed to the contaminating influence of the se-
cretions from the cavity above), the presence of a puru-
lent, acrid secretion in the uterine cavity is not favorable
to the vitality of the spermatozoa, and, granting that con-
ception actually takes place, the endometrium is scarcely
in a suitable condition to receive and nourish the rapidly
growing ovum ; as a result early abortion frequently
occurs.
This baneful influence of chronic uterine catarrh on
conception is not imaginary or exaggerated ; all will
agree that women suffering from this disease are sterile
while so affected ; and if conception has occasionally
taken place, it was rendered possible by the accidental
discharge of the cervical plug shortly before coition
(possibly by injection, for instance) or by recent treat-
ment. Thus I have known a sterile woman to conceive
within twenty-four hours after the removal of the uterine
secretions with a cotton-wrapped applicator, no medi-
cated application having be^n made.
Although sterility is the chief symptom of chronic en-
dometritis, the constant discharge, the subacute vaginitis
and vulvitis, frequently entailed by direct contact with
the uterine secretions, the menorrhagia not unconnnonly
produced by the uterine hyperajmia, and the ultimate
general anremia and neurasthenia, are even more dis-
tressing and annoying. While acute pain is usually not
ex)ierienced, many women complain of a sensation of
weight, fulness, heat, or burning in the suprapubic and
sacral regions, and of bearing-down during walking or
standing. One of my patients, a well-known pianist,
was unable to continue her daily practising of four to six
hours on account of the uncomfortable weight in her
pelvic region, after sitting some time on a piano stool,
and her sole disease was a profuse chronic cervical catarrh.
Another, a young unmarried lady, was nervous, " run
down," unable to walk or stand about long, with constant
dragging sensations in her pelvis, all produced by the
same disease.
That a chronic endometritis will, in course of time,
bring about and maintain a chronic hyperasmia of the
ovaries, with the distressing symptoms peculiar to that
affection, is well known to all gynecologists.
From what I have already said it is evident that the
significance of this disease varies accordingly as it occurs
in a virgin, a married nullipara, or a woman who has
borne children. In a virgin the symptoms are chiefly
those produced by the discharge (annoyance, soreness.
674
THE MEDICAL RECORD.
[June 23, 1883.
pruritus), and by the utero-pelvic hyperaemia. The ques-
tion of sterility merely looms up for future consideration.
Only impending marriage or great distress from the dis-
ease should in such cases, as a rule, call for very active
radical treatment.
In the married nullipara, however, the sterility will
probably be the leading indication for treatment, which
should not only look to curing the catarrh, but also to
removing any other possible obstacle to conception which
may chance to exist (narrow e.xternal or internal os, dis-
placement, flexion, ovaritis).
In the parous woman, finally, the question of sterility
may or may not preponderate. Indeed, as in such
women the cervical catarrh is very often (perhaps usually)
due to a gaping of the external os and exposure of the
cervical canal produced by laceration of that part during
parturition, and the corporeal catarrh frequently accom-
panies subinvolution, the sterility may be only temporary
and may, perhaps, be voluntary. Certain it is, that a
thick sanio-purulent mucous plug occluding the cervical
canal is quite as sure to entail sterility (at least so long
as that plug is not removed) in a parous woman with
torn and gaping cervix as in a nullipara. Of course the
mucus is more easily dislodged, as by syringing, and
sterility is therefore by no means absolute in such cases.
In parous women the enlarged glands and liyperplastic
mucous membrane of the cervical canal are fretjuently
exposed by the laceration of the cervix ; tlie so-called
ectropion of the endocervical mucosa is present. The
diagnosis is therefore an easy one, for the cervical mucus
clings to the examining finger, and the eye easily recog-
nizes the condition. But in nuUiparous married women
it may, at times, be difficult to understand the reason
for their sterility, since the finger merely feels a not un-
usually small external orifice, with rather pulpy borders,
and carries none but vaginal mucus with it when it is
withdrawn. Here the sound may clear up the case, for
on withdrawing it and the guiding finger the fannliar
thick cervical mucus accompanies it, and on exposing
the cervix with the speculum a plug of this same mu-
cus is seen issuing from and clinging to the os, whence
it is with difiiculty wiped away. The narrow external
OS, usually found in such cases, entails a retention of the
normal cervical discharge ; this retention gradually pro-
duces a dilatation of the cervical canal, and the accom-
panying irritation causes hypersecretion, until the cervix
assumes a bulbous shape, and its cavity is filled with
thick, viscid, discolored fiuid. When the external os is
dilated by the passage of the sound, and the cervix is com-
pressed by the examining finger, the mucus gushes out in
a thick stream. The sound easily detects the presence of
a large cavity within the narrow external os. This condi-
tion is not at all unfiequent, and is as unfailing a cause of
sterility as it is curable by prompt and proper treatment.
While the diagnosis of this disease is easy, and its per-
nicious influence on the fertility of the female sex is ob-
vious, the question of its successful treatment is by no
means so easy of solution. It is to this subject that I
particularly wish to invite attention, for cases of this kind
occur to the general practitioner probably quite as often
as to the gynecologist. I do not propose to discuss all
the methods of treatment which have been and may be
employed with more or less benefit, but to describe
briefly the plan which I have employed for several years,
and which I have found to answer fairly well in a major-
ity of my cases.
I may as well begin by saying that it is utterly useless
to expect to cure a chronic uterine catarrh by such mild
remedies as the i)lain or even compound tincture of io-
dine, the solution of nitrate of silver, even one drachm
to one ounce, or pure carbolic acid. You will certainly
fail in chronic cor|)oreal endometritis, and in the cervical
variety you will surely increase the discharge. I have
faithfully tried these milder remedies, and have never
seen the slightest benefit in the cervical, and but tempo-
rary relief in the corporeal variety.
If the patient is a virgin or a nuUiparous married
woman, it will generally be found necessary, after thor-
oughly exposing the cervix (in the virgin usually at
the expense of the hymen), to enlarge the external os.
This is essential for two reasons : first, to give free vent
to the accumulated endocervical mucus, and second, to
allow the ready application of the remedies. This little
operation is best done in the following manner ;
The cervix being exposed through a Sims (or after a
fashion through a large cylindrical or bivalve) speculum,
a Sims uterine knife, or simple bistoury, or straight
scissors, is passed about one-fourth of an inch into the
cervical canal, and the anterior lip is divided by one quick
stroke ; the instrument is then turned against the pos-
terior lip and this also is incised, and the same is done
with each lateral lip. Four incisions have thus been
made, each about one-fourth of an inch deep, com-
pletely dividing vaginal and endocervical mucous mem-
brane, and making the external os nearly or quite as
large as the calibre of the cervical cavity. In order to
insure this opening against speedy closure, it is impera-
tive that the four flaps of mucous membrane formed by
this cervical incision be removed. If this is not done,
even frequent sounding and forcible dilatation will not pre-
vent the flaps from re-uniting, and in a few weeks the
external os is as narrow as ever. I have invariably met
with this result when I left the flaps in situ, and hence
have adopted the plan of seizing each flap with a fine
tenaculum and trimming it ott with curved scissors, so
as to have a funnel-shaped external os. The raw sur-
faces of this slight wound soon cicatrize over, and the os
retains its funnel-shape.
It is not necessary to perform this operation in every
nullipara ; indeed, in many the discharge has rendered
the OS patulous, the examining finger easily enters it,
and its lips are pulpy and eroded.
I have found the same condition in virgins and married
nullipara.
After the os has been enlarged, the next step is to
destroy, as thoroughly as possible, the cervical glands
which furnish the annoying mucous secretion. To do
this eflfectively, once and for all, take a sharp curette,
with cutting edge (Sinis's or Simon's), and scrape the
whole cervical canal up to the internal os until the
creaking sound tells you that the subglandular base has
been reached. Do not be afraid to do this thoroughly,
since no harm can be done, and unless the glands are
entirely destroyed, their secreting power is liable to sur-
vive. When the whole canal feels smooth, apply, on a
cotton-wrapped applicator, or, what is better, a w^ooden
or glass rod, pure nitric acid, being careful to protect
the external surface of the cervix and the vagina by
packing cotton underneath. This application must be
so thorough as to give the cervical canal a charred, yel-
lowish-black appearance, with not even a drop of blood
issuing from it. In order to eftectually protect the cer-
vix from the acid, i frequently use the cylindrical specu-
lum after curetting. Any excess of acid should be
mopped up with cotton, and several tampons covered
with vaseline placed against the cervix.
In some instances I have merely aj)plied the iodized
phenol (equal parts), or saturated solution of chromic
acid. But I prefer the nitric, as more efticient and
scarcely more painful. If the patient is a multipara, it is
rarely necessary to enlarge the external os ; indeed, it
is generally lacerated, and more or less gaping. And
sprouting from the surface of the everted lips will be
found more or less numerous fungoid granulations, which
are partly enlarged papilla;, and partly tlistended folli-
cles. These must be removed in order to cure the
hypersecretion, and to put the cervix in proper condi-
tion for the plastic operation of Emmet. The sharp
curette is here also an excellent instrument, although
the curved scissors are often more rapid and efficient in
removing large and tough vegetations.
It is these same papillomatous growths which to the
June 23, 1883.J
THE MEDICAL RECORD.
675
comparatively uneducated touch feel like epithelioma,
and give rise to mistaken diagnoses and unfavorable prog-
noses. A mere clip of the scissors removes them, and
leaves a clean, smooth, although raw, surface, which
needs only to be attached to its opposite fellow by sut-
ures to effect a cure.
After removing these granulations, the surface should
be painted with tr. iodine, or sol. arg. nit. ( 3j. to 3 j.),
or lod. phenol ; or, if the production of a superficial
slough ap|)ears desirable, nitric acid should be applied,
and an emollient tampon inserted.
A very common condition is that of cystic hyperplasia,
the everted surfaces being dotted with numerous small
translucent, more or less prominent, spots, which are
simply occluded cervical glands (Nabothian follicles).
Every one of these nuist be punctured with a bistoury
or scarificator, and its cavity obliterated by thoror.gh
swabbing with tr. iodine, or it will be a constant source
of mucous secretion, and its presence will interfere with
union if trachelorrhaphy is performed.
The operation of crucial incision of the external os,
followed by the sharp curette and nitric acid to the cer-
vical cavity, had better be perfortned at the residence of
the patient, and the latter kept quietly in bed for a day
or two at least. It is not that it is attended by special
danger ; indeed, I have performed it many times in my
office or the dispensary, and seen no bad effects from it.
But within the past two years I have met with three in-
stances of unfavorable reaction to this treatment, which
has induced me to observe the i)recautions usually ad-
visable in all operative procedures about the uterus.
Two patients upon whom I practised this method at my
office during one wmter, disregarded my positive direc-
tions to go home at once and remain quiet during the re-
mainder of that day, but went down town shopping. It was
A cold, damp day, and, as a result, within a few days I
was called and found severe pelvic cellulitis, which con-
fined them to their beds for several weeks. During the
past winter I scraped away some fungoid granulations
from the external os of a patient at Mt. Sinai Hospital,
and ajiplied pure nitric acid ; she was at once put to bed,
but a furious cellulitis ensued whicli kept her in the hos-
pital for several months. These are the oidy cases, out
of several hundred treated in a similar manner, which
have been followed by the slightest unjjleasant conse-
•quences. I have also curetted the cavity of the uterus
proper many, doubtless several hundred, times, and in
perhaps twenty cases have swabbed it out with pure
nitric acid ; in only one instance did a cellulitis follow.
I am inclined from this experience to look upon the cer-
vical canal as rather more susceptible to infiaminatory
reaction from this operation than the uterine cavity, es-
pecially when a severe caustic, like nitric acid, is applied ;
and I believe this greater liability to be due to the inti-
mate relation of the cervix to the lymphatics which
abound in the paracervical cellular tissue. While appli-
cations above the internal os are more liable to produce
shock and peritonitis, those to the cervix are more fre-
quently followed by inflammation of the pelvic cellular
tissue.
In spite of this danger, the severe measure (sharp cur-
ette and nitric acid) is by far the most advisable, bi-
cause it is the most effectual. I have never as yet found
it necessary to substitute the actual cautery, so warmly
recommended by Sims ; but I have resolved in the very
next case which proves rebellious to the acid to use the
tiquelin long slender tip, and thoroughly sear the cer-
vical cavity up to the internal OS. The danger of thereby
•contracting the latter orifice should be borne in mind.
As for catarrh of the endometrium proper, I seldom
use the sharp curette above the internal os, except when
it is my purpose to remove vegetations or hyperplastic
mucous membrane of unusual exuberance, or where the
■dull curette has not prevented the return of the disease.
And then, also, I am tempted to follow the curette by
fumuig nitric acid, and have seen none but good results
follow this apparently heroic treatment. But, as a rule,
I find the dull curette and milder caustics (iodized phe-
nol, CO. tr. iodine, sol. arg. nit. 3j. to 3J.) sufficient to
effect an improvement.
The soluble gelatine pencils containing these ingredi-
ents (except the nit. silver), and also iodoform, sulph.
zinc and copper, have at times been beneficial in my
practice ; but the difficulty occasionally encountered in
kee|)ing them in the uterine cavity, and their tendency to
produce uterine colic, owing to their frequent insolubility,
has somewhat deterred me from using them as often as I
should have wished to do. If they are readily soluble
(and those made by Mitchell, of Philadelphia, and especi-
ally those of Heischer, of 652 East Sixth Stieet, in this
city, are imusually so), these pencils, by their long con-
tact with the diseased surface, are decidedly preferable to
fluid applications. They are retained in the uterus by
Hat tampons over the external os.
As a rule, I think that where an immediate, positive
effect is desired (styptic, astringent, caustic), fluid appli-
cations on cotton-wrapped applicators are preferable ;
where a steady, gradual alterative influence is called for,
soluble bougies are indicated.
The nitrate of silver is usually prepared in pencils by
fusing with nitrate of potash, in various proportions ; it
is particularly liable to produce uterine colic in this form,
and I have never thus employed it.
An indispensable condition to the safe and effectual
application of caustics to the endometrium, is the patu-
lousness of the uterine canal, particidarly the internal os.
Fortunately this is usually the case, the discharge soft-
ening the tissues and dilating the canal. But when nitric
acid is to be applied, it is always well to secure a canal
of suflncient width to p'ermit the easy insertion up to the
fundus of a straight rubber stick wrapped with cotton,
and a previous dilatation with a tnpelo tent for a couple
of hours will attain this end.
Whether the application be made to the whole uterine
canal, or to the cervix alone, it must be remembered that
the more powerful the caustic the longer will it be be-
fore the slough separates ; that of nitric acid usually takes
Irom five to seven days ; that of iodized phenol or pure
carbolic acid, three to four days ; that of tincture of iodine
two days. Not until the slough has separated should a
second application of a milder nature be made. I usually
employ a solution of nitrate of silver, one drachm to one
ounce ; or tincture of iodine, and continue these applica-
tions every other day, or twice a week, until the raw sur-
face is glazed over, or a return of the discharge shows that
the severe treatment has not been efiectual and requires
to be repeated wholly or in part. It should be remem-
bered, however, that so long as constant applications of
caustic are made to a raw surface, it cannot heal. Hence
it is well, after a couple of weeks of steady treatment, to
allow the patient a week's rest, in order to give nature a
chance to heal the wound; if she then fails we must be-
gin again, and perhajis a third and a fourth time.
That /lot injections should be steadily used whenever
there are no tumors in the vagina need scarcely be men-
tioned. The vaginal leucorrhoea usually present is very
effectually controlled by painting the canal through a
cylindrical speculum with a mixture of fluid extract of hy-
drastis canadensis and glycerine, etpial parts, and placing
a couple of tampons, soaked in this fluid, into the vagina,
to be removed in twenty-four hours. As an injection, a
tablespoonful of the plain fluid extract of hydrastis in a
pint of water is excellent to continue the more powerful
effect of the application ju^t mentioned. I have found
this remedy superior to any other astringent in vaginal
leucorrhoea, as it can be used undiluted without cauteriz-
ing or eroding the vagina or vulva.
Patients with chronic endometritis or endocervicitis
should be treated at least twice a week, and usually
every other day. The more chronic and aggravated the
case' the more frequent the treatment. As improvement
manifests itself, intermissions of several days, or a week
676
THE MEDICAL RECORD.
[June 23, 1883.
or two, may be made, in order to test the persistence of
the benefit.
I have not referred to the time-honored practice of
dilating the uterus with a sponge-tent, and tearing away
the hyperplastic glands and mucous membrane when
the tent is removed, because the dilatation is more safely
accomplished by the tupelo, and the removal of the dis-
eased tissues more thoroughly by the sharp curette.
But, when the uterus is unusually enlarged and a decided
drastic and alterative effect is desired, the sponge-tent
may still be employed and prove beneficial. The usual
caustics should follow its application. The forcible di-
latation of the whole uterine canal by steel divergent
dilators or graduated sounds has proved exceedingly
useful in my hands in this disease. Not only does the
dilatation allow the easy application of topical agents,
but the free exit of fluids and the steady pressure of the
dilators in themselves act beneficially on the diseased tis-
sues.
I have not discussed Schroeder's radical operation
(above referred to) in detail, because it seems to me so
complicated, and, I confess, wrong in j^rinciple, as to be
applicable only to the otherwise totally incurable cases
of endocervicitis. To slit such a cervix up to the vaginal
junction and transplant into its cavity vaginal mucous
membrane (so entirely different in character from that of
the cervical canal) seems doubtful surgery, until every
other means have failed. However, the operation is in-
genious, and in extreme cases doubtless advisable.
The prognosis as regards permanent cure \s\\i always
be a doubtful one, so long as some time has not been
allowed to elapse since the discharge of the apparently
cured patient. A temporary improvement, or even an
entire cessation of the discharge, may, in a few weeks or
months, be followed by a fresh attack of the disease.
This experience is common to chronic catarrhal affec-
tions of all mucous membranes. And only by means of
constant, unremitting, and long-protracted treatment can
a permanent improvement or a cure be obtained. My
experience certainly has furnished me with a fair propor-
tion of cases in which, after several months of the treat-
ment above described, an improvement was obtained of
such duration as to leave the patients entirely free from
uterine discharge for three and six months. Whether the
cure was really permanent afterward, I am unable to
say, as such patients who came from a distance were lost
sight of; of those living in the city, I infer a permanent
ciu'e, since it is fair to suppose that, having once been
benefited, they would have returned to me had the dis-
ease recurred.
Those cases I have found the most amenable to treat-
ment and the most favorable for a permanent cure, in
which the uterine discharge was chiefly maintained by a
narrow external or internal os, or where a laceration of
the cervix and consequent hyperplasia of the follicles
was present. The radical operations for these condi-
tions, as I have described them (removal of diseased
glands and papilla; by the curette and caustics, division
of the external and internal orifices ; and, in given cases,
closure of the laceration) usually secured a ])ermanent
cure. The most obstinate were those instances of ca-
tarrhal endometritis and endocervicitis, in which the ex-
ternal and internal orifices were anatomically normal,
and no special hyperplasia of the glands or mucous
membrane could be detected. Here all efforts to rest on
the normal secreting qualities of the mucous membrane
usually proved unavailing and permanent relief seemed
hopeless. Where there was a distinct pathological con-
dition or lesion of the orifices or tissues of the uterine
canal, the removal of that condition and the restoration
of the canal and its walls to the normal state was gener-
ally possible, and a permanent cure could with fair cer-
tainty be promised. My experience, at all events, does
not coincide with that expressed by the words of one of
our most eminent gynecologists when giving his opinion
on two cases of sterility depending on chronic uterine
catarrh (one endometritis, the other endocervicitis) which
recently consulted him, viz. : " This is an instance of
that interminable uterine catarrh, which is practically in-
curable." Both these cases came to me utterly discour-
aged, and after three months of the treatment here de-
scribed were discharged, to all appearance cured, having
been free from discharge for one month without treat-
ment. Whether they remain so is, of course, another
matter. But they were both certainly relieved long
enough to give them a chance to conceive, and if this
happy event should take place, nature alone could, during
the puerperal state, complete the cure. And if this one
attempt at relief fails, and after some months the dis-
charge returns, as all catarrhs are liable to do, better
success might attend a second course of treatment. It
certainly does not seem right to discourage all such
patients and deprive them ot all hopes of maternity
(should they chance to be nulliparae) when experience
has shown us how much good a thorough, persevering
course of local treatment will do them.
In making this statement I wish to except that class
of cases which have been made a special study by Dr.
Noeggerath, viz., latent gonorrhcea in the female, where
catarrhal infection (I would like to call it affection, for I
do not believe in the frequent venereal transmission of
this disease as warmly advocated by Dr. Noeggerath) of
the vagina and uterine canal has spread to the tubes, and
has thus planted itself beyond the reach of topical, as
well as general, medication. These cases, when once
chronic, are really incurable, and, if they recover, do so
almost in spite of, not in consequence of, treatment.
Fortunately these cases are not the majority of those
which come under our observation. For them only the
last resort of Tait's brilliant operation — the removal of
the diseased tubes, generally with the ovaries — remains.
And we look forward to the not far distant day when we
in this country can point to results as favorable after this
operation as those reported by its originator.
The intelligent specialist and the general practitioner
need scarcely be told that accompanying an;emia must
be suitably treated. The influence of iron and other
tonics is as marked in improving the tone and functional
power of the uterine mucous membrane as of any other
organ of the body. Pelvic plethora should be relieved
by saline laxatives, the general circulation stimulated and
regulated by massage and active exercise, and active
hyperaemia of the sexual organs prevented by abstinence
from sexual intercourse, during the local treatment here
described. And it certainly must be a desperate case
which resists all these measures.
Iowa State Medical Society. — The thirty-first an-
nual meeting of the Iowa State Medical Society was held
at Council Blufls, Iowa, May i6th and 17th. The at-
tendance was very good ; fiifty new members were
admitted during the session. This was the first meeting
of the Society held since the plan of dividing the work
of the Society into sections was adopted, and conse-
quently there was some friction and confusion, which will
be overcome in the future. Creditable work was done
in most of the sections.
The annual address of the President, Dr. D. Schofield,
was an interesting paper advocating, among other things,
further reforms in the organization of the Society ; higher
standard for medical education ; more extended and
better accommodations for our insane. Volume V. of
" The Transactions " of this Society has* been ,])ublished
during the year.
The following officers were elected : President — Dr. S.
R. Robinson, of West Union ; First Vice-President — Dr.
H. C. Huntsman, of Oskaloosa ; Second Vice-President
— Dr. D. W. Crouse, of \Vaterloo ; Secretary — Dr. A.
A. Deering, of Boone ; Assistant Secretary — Dr. A. C.
SimontOM, of Des Moines; Treasurer — Dr. G. R. Skin-
ner, of Cedar Rai)ids. The Society adjourned to meet
in Des Moines in May, 1884.
June 23, 1883.]
THE MEDICAL RECORD.
677
VACCINATION OBSERVATIONS AND SUGGES-
TIONS.
By E. F. brush, M.D.,
ATTENpiNG PHVSICIAN TO T«E NEW YORK INFANT ASYLUM.
Like many other questions in which the dispute has
lain between the profession and the laity, the subject of
vaccination has not been advanced by recent literature
as it deserves. Those who are capable of writing in
regard to the matter take upon themselves the task of
defending it from the attacks of that incomprehensible
class the anti-vaccinators. These latter say we propa-
gate other diseases and do not protect from small-po.\.
The burden, therefore, of recent contributions to the
journals has been simply to defend the procedure. Thus,
while devoting attention to statistics they have lost sight
of the surgical aspects.
It is supposed we all know how to vaccinate, and,
somehow or other, it has come to be considered that
there is no choice between the animal and the humanized
virus. Presumably this has come about in a business
way, by reason of the numerous vaccine farms which
are now worked. Some years ago I vaccinated a child
from the arm of another healthy child. The parents
told a friend of theirs ; this friend told his doctor, " a
legalized practitioner," who said it was against the law,
and that I ought to be arrested. This, of course, made
the parents very uncomfortable, but they had at least
one consolation, their child had not a very sore arm,
while the advocate of law and animal virus produced a
sloughing ulcer on the arm of the child which he de-
nuded of cuticle, a practice, unfortunately, very com-
mon, and advocated by some of the dealers in animal
vaccine, as every arm thus treated is sure to take, with
the loss of a good deal of substance.
Some time ago, I e.xamined the arms of 191 children ;
the result was striking. I found only 13 children with a
well-detined, round scar pitted, and only i with two scars,
well-defined, round, and pitted ; 51 had no marks at all ;
the remainder had scars of various forms, shapes, and
colors. No vaccination had been performed for three
months previous, nevertheless some of the arms were
still crusted. The majority of the older scars contained
cicatrices, long, irregular, varying in dimensions from a
quarter of an inch to one inch by two, some had purple
ridges in the centre, some red ; others had cavities, blue
or red ; some of these were pitted, in some of them on
the edge of the raised cicatrix the puckerings some-
what simulated the appearance of pitting. I took the
fifty-one that had no marks and selected si.x of the most
favorable subjects ; these I inoculated with animal virus,
procured from what was considered a reliable source.
Only one vesiculated, of the other five one had a very
sore arm, indurated on the third day, which did not follow
in any way the regular course. The other four did not
respond at all. From the good arm I vaccinated on the
eighth day thirteen children with only one failure. I con-
tinued at the end of each eighth day, to select another
good subject, and from it to vaccinate another group.
From the close observation of these fifty-one cases I began
my studies regarding the proper mode of performing vac-
cination.
I prefer humanized virus, for the simple practical reason
that one can select the subject, watch the vesicle, and
procure the virus at the right time uncontaminated. By
humanized virus I mean the bovine virus transmitted
through the human subject from arm to arm. And here
let me state that too much caution can not be exercised
in procuring the primary virus. Last summer I sent by
messenger to well-known wholesale druggists in New York
City for one dozen points of bovine virus, requesting in-
formation as to its source. They informed the messenger
that the supply was exhausted but that the points would be
sent the following day by mail. This was done, but they
neglected to state whence the virus had been derived.
The weather being warm I used the points immediately
and wrote to the firm asking for information, and received
the following reply: "The vaccine virus we sent you
was bovine, and was obtained through Mr. , of the
Dispensary."
I wrote to Mr. , of the Dispensary, asking
him whence the virus came, and received from the house
physician the following reply : " Your favor of the 5th
instant to Mr. has just been shown me. In reply
I have to inform you that this institution has never fur-
nished bovine virus, but has until the last four years
largely supplied the humanized. Notwithstanding, the
points furnished you were bovine and were obtained from
the Board of Health. They were sent you contrary to
rule and in violation of good faith, as they were obtained
for use here. This was the result of an error." The
above correspondence explains the degree of carelessness
that exists among the dealers. The twelve points pro-
cured as above related contained only three that were
successful, and these did not present a good appearance.
In one case the vesicle, on the eighth day, presented a
decided blue color, containing a dark-colored centre
crust ; another presented a bright opaque pearl-colored
vesicle, not umbilicated ; the third was a small pearl-
colored vesicle with a slight depression. I did not con-
sider it safe to use lymph from any one of these.
Next after the care in procuring the virus there ought
to be a preparatory examination of the subject to be
vaccinated. 'I'his preliminary examination should be
directed to the physical condition, especially in its rela-
tion to the state of the skin, and more particularly in the
vicinity of the place selected for the introduction of the
virus ; that is, the skin of itself must not furnish a poison
to produce irritation. Gregory, in writing on this sub-
ject and comparing vaccination with the inoculation of
the small-pox virus, says, " It requires no arguments to
prove that a process that is to free the constitution from
a poison so active and subtle as that of small-pox should
be conducted with at least as much attention as was paid
to its introduction into the system." These words,
written fifty-two years ago, are still applicable and deserve
attention. We send for the virus by mail, and rather
than lose it, use it immediately, our only care being that
there is an ordinary degree of health. I will point out
that it requires more than this when I come to make
suggestions as to proper careful vaccination.
There is a degree of watchfulness necessary during the
progress of vaccination, which is absolutely as much a
matter of security as the process itself. In the early
days of vaccination, when more attention was given to
the protective process and the vexing questions as to its
utility were not absorbing the medical mind as in these
latter days. Cross, a noted writer says that you must
watch the progress " for revaccination becomes impera-
tively necessary when the regular vaccine pock is im-
paired by rubbing or accident, when the system is pre-
occupied by any other disease, and where the scar is
feeble and not indented."
Notwithstanding the apparently well-authenticated
cases of the introduction of syphilis into the system by
the process of vaccination, I doubt whether this or any
other disease would be conveyed were proper caution
exercised. I regard tiie introduction of specific virus
into the system in the light of seed-planting. If I go into
afield of corn and carefully remove one sprouting grain of
corn, without the admixture of other seeds or matter, and
place this grain in my field, nothing but corn w^ill grow
from it. If 1 remove with it a shovelful of dirt with other
sprouting seeds, the Lord only knows what the product
will be. I know corn, wliere it grows, and where it will
grow. With the same absolute knowledge as to the vaccine
vesicle, its time of growth, and its form, there is to me
an absolute certainty that I can collect it for my planting
and nothing else with it. In the old experiments of Drs.
Woodville, Willan, and Ferguson, we learn that if small-
pox virus be mixed witli vaccine virus small-pox virus
only will grow, because after inoculation with small-pox
678
THE MEDICAL RECORD.
[June 23, 1883.
virus the |nistiile forms in three days, whereas after the
introduction of vaccine virus the vesicle forms in four
days. Again, if the vaccine virus is first introduced,
and when the vesicle is formed the small-pox virus is in-
troduced, they both grow. If they are planted near enough
to coalesce, the matter taken from the respective sides
will produce the respective diseases. Now, in the case
of syphilis, the shortest known period has been ten days
between the introduction of the poison and the appear-
ance of the papule, and in Pallazari's cases of syphilitic
inoculation twenty-five days elapsed between the opera-
tion and the appearance of the papule. Thus the true
and uninterrupted course of the vaccine vesicle can be
completed before the syphilitic poison becomes local-
ized.
In regard to the operation of vaccination, there are
several things to be borne in mind. In the first case we
must make the avenue which we open for the introduc-
tion of the virus sufficient for its purjiose, then we must
guard against the intrusion of any other poisons which
menace it, and, in 0|)ening this avenue, we nuist take
care to do it in such a manner that it may not of itself
generate poison.
\Viihout accurately understanding all these dangers, I,
at first, thought the chief danger to be guarded against was
the repeated use of the lancet. I sought to avoid this by
the use of a cambric needle, in each case throwing the
needle away when the operation was complete. I dis-
covered that this did not make the right opening, that is,
the incisons were not jierfectly healed when the vesicles
appeared, and this always interferes with their perfect
growth. A dried crust or an unhealed incision occupy-
ing the place where the vesicle arises distorts its shape,
thus precluding the possibility of knowing whether the
vesicle is pursuing a normal course, and likewise sets up
a premature inflammatory action.
On making this discovery I came back to the lancet,
and find, with rare exceptions, I can always make so
light and clean an incision that by the third day it is per-
fectlv healed, and the vesicle has a clear field in which
to form, and one can see by the fourth day the number
of punctata forming ; on the eighth day, when these have
coalesced, it can be seen whether the vesicle has the
normal round shape, imibilicated centre, and clear un-
contaminated lymph. I consider the use of the lancet
in the manner described as absolutely, unequivocally ne-
cessary for perfect vaccination. I may say that I have
relieved my mind of the dangers of contaminating the inci-
sion by the lancet in common use by having at hand, when
operating, a small bottle of alcohol and a lighted alcohol
lamp. I first dip the lancet in the alcohol and wipe it
dry with a napkin. I then again dip it in the alcohol
and Set fire to the adhering spirit. I regard this as better
than the employment of carbolic acid as the disinfectant,
which might adhere to the lancet and irritate the incision,
thus preventing perfect healing by the third day, which,
let me reiterate, is absolutely necessary to allow the per-
fect formation of a vaccine vesicle. As the latest hospi-
tal statistics teach us that four well-pitted vaccine marks
form the highest point of protection, it is advisable, there-
fore, to give the child two and let it acquire the other
two by adult revaccination.
In operating on infants or children I take a piece of
note-paper about an inch wide and three or four inches
long; in it I cut two holes one-fourth of an inch in di-
ameter and three-fourths of an inch apart. This I
stretch over the part selected to be vaccinated, wliich
throws into relief two disks of skin. By this method I
can hold the arm perfectly still, avoid making any acci-
dental cuts, and I find if the incisions bleed freely that
when the band is removed the bleeding ceases. Of
course I take care never to use the same jiiece of paper
twice. If I find on the eighth day that but one of my
disks has taken, with lymph from it I vaccinate the other
spot. In this connection it is worthy of remark that the
second vesicle on the sixteenth day from the first opera-
tion, appears as old as its parent vesicle, notwithstanding
that it conuiienced more than eight days later.
In regard to the preparatory treatment, I differ some-
what from many authors, who warn us against vaccinating
infants suffering from bronctiitis, sores behind the ears,
eczema of the scalp or nates, etc. I have found cases
suffering from eczema in locations removed from the
spot where the vaccine virus was introduced to follow a
normal course. Of course in these cases of eczema there
is more danger of the vesicle being scratched, by reason
of the itchiness existing m other locations. But if a ves-
icle happens to become ruptured by this or other acci-
dents, it must be kept perfectly dry by the application of
cotton. By this method every case under my observa-
tion followed a normal course. I would not have dared
vaccinate such subjects if my reading on the matter had
been restricted to modern writers. But I found Thomas,
in his work on " Practice," recommends the inoculation of
vaccine ichor as a remedy in obstinate ulcers on the
arms and chest and in glandular tumors. Without plac-
ing much faith in this, I nevertheless thought that if it
were safe to vaccinate where these troubles existed, it
would be safe to vaccinate in the presence of milder dis-
eases.
One other point in the successful carrying out of
proper vaccination is to keep the vesicle and the crust,
while it is forming, perfectly dry. Avoid, as you would
the introduction of pus itself, the application of oil, wa-
ter, or any substance that would tend to soften the crust.
If the vesicle happens to rupture, put on it dry cotton or a
dry rag, and allow it to stay there to come away with
the crust. I have seen very deep ulcers formed by the
casual habit of putting sweet oil or wet rags on the arm,
which softens the crust around its edge, where it is liber-
ated, and being still attached by the centre, it rotates till
it is finally loosened from the centre, which is deep down
near the bone, and presents deep, nasty-looking caverns
There are some conditions of the skin not absolutely
recognized as diseased which forbid the operation of vac-
cination. A case in point was that of a boy six years
old, whose physical condition seemed perfect but whose
skin on the arm was rough, dry, and scaly. The incisions
I made for the introduction of the vaccine virus did not
heal, but commenced festering on the second day. On
the eighth day the arm presented an erysipelatous blush
and was quite deeply indurated, but no vesicle had formed.
This arm was three weeks in healing. I afterward had
the skin rubbed twice dailv with sweet oil for some time,
and again vaccinated with normal results.
Undoubtedly due to the habit of denuding the arm of
cuticle, there exists a lack of knowledge of the normal
condition of a vesicle on the eighth day. A rather pain-
ful illustration of this fact came to my notice while ex-
hibiting some sketches which I had made of normal and
abnormal vaccination results. By way of experiment I
took a boy, four years old, with a rough, dry, goose-skin
epidermis, who was otherwise well nourished and healthy
looking. I simply scarified the arm in the same manner
as I do for vaccination, without, however, introducing
vaccine virus. The illustration I had made on the tenth
day, when the arm was reddened, swollen, and indurated
with a flat dark crust in the centre of the reddened [lor-
tion. This illustration, with some of normal vesicles, was
submitted to the inspection of a jihysician for his opinion
as to which was the best. He unhesitatingly selected the
illustration presenting the most intense action, namely,
the one where no vaccine virus had been introduced.
This is not surprising when we read the following passage
from an article on vaccination in a recent number of The
Record. "Tlie fault cannot be in the method, for I
scrape off the epidermis entirely from a square measur-
ing a (piarter of an inch or a little more and rub the
virus on for at least a minute."
It can hardly be called too fastidious to require the
arm in all cases to be washed with Castile soap and dried
with a clean towel before being vaccinated.
June 23, 1883.]
THE MEDICAL RECORD.
679
In removing lymph from a vesicle, the nicest kind of
care is required, that nothing but lymph be taken. I
may say here that since I have regarded vaccination as
the nicest and most delicate operation I am called on to
perform, I have not had one single case of enlarged
glands, erysipelas, or other bad results following the opera-
tion. I ought to add, of course, that I liave not operated
as extensively as many others. The number of cases on
which I base this claim is a little over two hundred. I
do not wonder that comiilications arise in the practice of
those who use bovine virus. My friend, Dr. Campbell,
related to me, some time ago, that he received a quill
from one of the dispensatories in the city, presided over by
a physician who sells animal virus, and this quill was
stained with blood. It was returned, with a request that
a clean one be sent in its place. He received the answer
that a little blood was not harmful, as it came from an
animal so different from the liuman. As we sow so shall
we reap. I have no doubt the wart-like excrescence that
occasionally grows on vaccinated surfaces where the bo-
vine virus is used arises from this admixture of foreign
material witli the lymph. It occurs to me that some one in
authority ought to call the attention of the animal-lymph
dealers to the necessity of perfect purity.
There is one careless habit which has done nnich to
bring the procedure of vaccination into disrepute, namely,
the careless, thoughtless way by which we account for all
eruptions, soreness of the eyes, and the like, which take
place during the process. It is also noticeable that many
physicians allow mothers to imagine that these things,
even when they occur after the vaccination is complete,
arise from the introduction of vaccine virus. If we take
pains to explain that this is not the case, we shall be do-
ing much to weaken the arguments against vaccination.
IMPERMEABLE STRICTURE OF THE URE-
THRA SUCCESSFULLY TREATED BY ELEC-
TROLYSIS.
By W. H. DIKEMAN, M.D.,
OLEAN, N. Y.
The following case of impermeable stricture successfully
treated by myself by electrolysis, after the plan of Dr.
Newman, of New York, may serve a purpose in giving
evidence of the successful treatment by such method :
Mr. F. H. S , of this city, about thirty-five years
ago contracted gonorrhoea. He was treated by strong
injections and the usual remedies. In three months, he
states, he was cured. About ten years later he com-
menced to notice irritation while micturating, and at
times a stoppage of the stream. Without consulting a
physician he purchased a bougie, and with more or less
manipulation attempted to force it into the bladder, but
failed. In the attempt he caused himself severe pain, and,
as he states, considerable bleeding. He undoubtedly rup-
tured the urethral mucous membrane. From this time his
trouble grew worse, and for the last three years he has
been unable to either retain or pass his water. He has
worn a urinal for three years, as his water dribbled away
drop by drop. The irritability of the bladder would
cause straining in an attempt to micturate, associated
with severe tenesmus, and he was obliged to resort to
the use of the stool instead of the chamber vessel. And
all these long years of suffering and with these in-
conveniences of life he has been unable to get relief, be-
cause in all this time he has been treated for disease of
the kidneys and bladder (by constitutional remedies).
On October 10, 1882, I was called to see him in com-
pany with another physician, when I obtained the above
history. I found him greatly emaciated and careworn.
I advised him as to the immediate necessity of exploring
the urethral canal. He did not like the idea, because
twenty-five years ago he caused himself so much pain by
the use of an urethral instrument. However, he soon
consented to the examination. I picked up a No. 17
French bougie and passed it about one inch into the
urethra, when it was arrested. It was withdrawn and a
No. 15 was introduced, which passed the first stricture
but became arrested about one inch and a half further
on. Smaller sizes were each used in succession until a
No. 9 was reached, which jjassed the second stricture but
was again arrested by a third at about five inches from
the meatus. Having no smaller instruments at hand he
was advised to call at the office. A No. 3 French fili-
form bougie failed to pass this third band. I then ad-
vised external urethrotomy or treatment by electrolysis.
He preferred the latter and the operation was performed
as follows : An insulated electrode bougie, with an olive
silver end. No. 9 French scale, was introduced, and
])assed the first and second strictures as on the preceding
day, but was arrested again at the third. The negative
pole of the Mcintosh galvanic battery was connected
to the electrode bougie, and the wet sponge of the
positive pole was placed on the left thigh. Six cells
of the galvanic battery were in operation, and in
eighteen minutes it passed through the stricture. But
to my surprise it passed but a very short distance when
it was arrested by a fourth obstruction. Electroly-
sis with the six cells was kept up fifteen minutes
longer, but failed to pass through the band. As the
patient felt somewhat exhausted, the electrode was with-
drawn and the patient sent home with the advice to keep
perfectly quiet and return again the next day at the same
hour.
Next day, October 12th, patient returned in due time,
said he felt no bad effects whatever from the operation,
but said the electricity made him feel much better and
wanted more of the same kind.
To satisfy myself as to whether the fourth stricture
band was impermeable or not I again tried to pass the
No. 3 F"rench filiform bougie, but failed to pass it through
the obstruction. So the treatment by electrolysis was
returned to as on preceding day. The current was
started with six cells and was gradually increased cell by
cell, until twelve cells were in operation. The patient
had such great faith in the treatment that he desired I
should continue the seance longer than on the preceding
day. But with the twelve cells in operation the electrode
passed gradually on — it appeared that the fourth band was
about one inch in length — and in nineteen minutes it
passed into the bladder.
The electrode was withdrawn, and Mr. S made a
stream of water, which he had not done for ten years.
He departed rejoicing, with the advice to again remain
perfectly quiet on his back, and should he experience
any ill effects to let me know.
Next day he returned. There were no ill effects what-
ever. There was no soreness, no pain, no hemorrhage,
no dribbling of urine. He wore no urinal, and for the
first time in all these long ten years of an uncontrollable
bladder, he had now full control, and when the call of
nature demanded he could pass a stream of water.
Each day he reported as feeling better, but as the open-
ing was small, the seance was repeated on October 18th,
with an insulated electrode bougie No. 13 French. The
bougie was arrested at the first stricture, but with twelve
cells of the galvanic battery in operation it passed all
four strictures into the bladder in seventeen minutes.
On October 21st a No. 15 French conical sound (Van
Buren's) passed easily into the bladder.
October 25th electrolysis was repeated with a No. 17
French insulated electrode bougie, and in thirteen minutes
it passed quietly into the bladder.
November ist he reports as gradually improving and
feeling better in every way. The seance was again re-
peated with a No. 21 French, which passed into the
bladder in seven minutes. As he is satisfied with the
size of the instrument that now passes into his bladder
the treatment will, for the present, be suspended. As he
is sixty-five years of age he feels contented and satisfied
68o
THE MEDICAL RECORD.
[June 23. 1883.
that his present condition will safely see him through his
remaining days.
November 6th, he again reports. His stream of urine
gradually_gets larger. A No. 22 French sound passed
by its own weight into the bladder, without giving any
pain in the least, or detecting any soreness whatever.
The patient declares himself perfectly well and is dis-
charged.
In place of the experiment given by Dr. Newman for
demonstrating decom|iosition by electrolysis I would
suggest the following simple practical test, which can be
performed by any one in a few minutes.
Take a small piece of fresh beefsteak and lay it on an
insulated surface. Then with the positive electrode
placed on the under surface of the beefsteak and the
negative electrode on its upper surface where the decom-
position can be watched, the conducting cords 'are now
connected with six cells of the galvanic battery. By
close observation in a few seconds the effects of the
electrolysis on the tissues will be seen to take place. By
continuing the experiment for a few minutes the results
will be distinctly appreciable, and we have a most correct
idea of what takes place in the treatment of stricture of
the urethra by electrolysis.
gr00ress oi ^caicnX Mcimcc.
The Healing of Wounds of the Spleen. Dr.
Dannenberg {St Petersburger Inaug. Dissertation)
wounded, in various ways, the spleen in fourteen dogs,
killed the animals in periods varying from twenty-four
hours to one hundred and eight days, and examined nu-
merous specimens microscopically. He sums up the
results of his investigations as follows : i. Incisions into
the spleen are prone to rapid union; some amount of
gaping occurs only on the surface of the organ. 2. In-
cisions into the pulp are prone to heal without suppura-
tion. 3. Suppuration of the splenic tissue, in the course
of a wound, occurs only as a rare exception. 4. Ad-
hesion of the splenic capsule to the omentum, which de-
velops very rapidly, is one of the conditions leading to
heahng of wounds of the spleen. 5. Perforating wounds
heal slowly, and always through development of granu-
lation-tissue. 6. Punctured wounds heal by the first in-
tention. 7. Amputation wounds of the spleen heal by
its adhesion to the omentum, resulting from the forma-
tion of connective-tissue between the parts. 8. In the
formation of a scar, both the proliferating elements of
the splenic pulp and the epithelioid elements of the retic-
ulum take part. 9. Hypertrophy of the subserous layer
of the capsule depends on the proliferation of cells of
connective-tissue. 10. There is proceeding an extremely
active proliferation of capsular ei)ithelioid tissue around
the edges of a wound. 11. There is proceeding a com-
plete regeneration of the epithelioid covering on the sur-
face of a cicatrix left by a wound. 12. Under certain
conditions common epithelio'd cells may undergo trans-
formation into cylindrical and cuboid ei)ithelioid ele-
ments.
DiAPHRAGiM.ATic Pleurisv. — Pleurisy of the dia-
phragm, or, more strictly speaking, of the supra-diaphrag-
matic space, is always very difficult to diagnose, physio-
logical symptoms being very incomplete, or altogether
wanting. Gucneau de Mussy has indicated some si^ns
which, however, are of good value in elucidating the
question in favor of this variety of pleurisy. He dis-
covered that the phrenic nerve is painful to pressure in
the accessible points of its course between the two origins
of the sterno-mastoid muscle. -Also pressure on a cir-
cumscribed portion of the epigastric region awakens an
acute pain. This spot is situated in a point correspond-
ing to the intersection of two lines — one coming from the
external border of the sternum, the other from the osse-
ous part of the tenth rib. Gueneau de Mussy named
this point the button of the diaphragm. Thus, whenever
a patient is found to present these symptoms, the case,
ciBteris paribus, may be safely diagnosed as diaphrag-
matic pleurisy. — Cor. A/a/. Press.
APOMORPHtA AS A SaFE, CERTAIN, AND QuiCK
Emetic. — Dr. Brown writes as follows to the British
Medical Journal, May 12, 1883 : "It has occurred to
me, in several cases, to have patients who have been ob-
noxious to ordinary emetics. The emetic has caused
nausea and depression, but no emesis. A few weeks
ago, two cases of this kind occurred in my practice. One
was a man who had been drinking and eating indigestible
food. Domestic emetics had been given, which had pro-
duced nausea and ineffectual attempts at vomiting. It
occurred to me that apomorphia, used hypodermically,
might succeed. I prepared a solution containing a grain
of chloride of apomorphia, twenty minims of rectified
spirit, and water to two drachms, of which I administered
ten minims hypodermically, which equals one-twelfth of
a grain. In seven minutes it produced free and copious
vomiting. There was no nausea, nor depression, nor
intolerance of food. The other case was a man who was
a total abstainer. Patient had loaded his stomach with
a mass of indigestible food, which had caused acute pain
in his stomach. He had tried domestic remedies with-
out success. Pain was so severe, that I was called up
at night. The other case having been so successful, I at
once administered ten minims of the solution. In two
minutes, without any previous nausea or warning, the
contents of the stomach were violently ejected on the
floor, the patient not having time to get a vessel to vomit
into. This was repeated two or three times at short
intervals, and the patient had speedy relief. In this
case there was no nausea or bad aftereffect. From
inquiries which I have made, I am convinced that the
value of apomorphia as a safe, certain, and quick emetic,
is not appreciated because not known. In cases of al-
coholic and narcotic poisoning, it is a most valuable
remedy, and, judging from my experience in one case,
the emesis is delayed a few minutes. In cases of acute
gastralgia and convulsions in children due to overloaded
stomach, apomorphia will prove a speedy cure. I have
given one-sixth of a grain of the drug to children by the
mouth without producing any effect whatever."
Treatment of Prem.\ture Baldness. — In the Ber-
liner Klin. Wochenschrift, April 16, 18S3, Dr. Lassar dis-
cusses the etiology and treatment of early baldness, or
alopecia prematura. From observation and experiment
upon animals it was found that the disease is contagious,
and occurs independently of any general affection or the
'state of health of the patient. The method of treatment
recommended is as follows : The scalp is to be washed
every day with tar soap, or soft glycerine soap, or with
soap containing sodium iodide ; the soap is to be thor-
oughly applied, and rubbed into the scalp for fifteen min-
utes. Following this is a warm douche ; then by the ap-
plication of a corrosive sublimate (two parts per one
thousand) the hair is dried, and a half percent, spirit-solu-
tion of naphthaline is rubbed into the affected portions.
Carbolic or salicylic acid may also be employed if desired.
If this treatment be adopted in the early stage, when the
hair is just beginning to fall, it has usually proved suc-
cessful, but it must be kejjt up for eight weeks or more.
The fact that this disease is due to a communicable mor-
bid principle has been brought up in order to show its
conveyance by the comb and brush of the barber.
Glycerine in Phthisis. — Recently Drs. Jaccoud and
Ferrand have been trying glycerine as a substitute for
cod-liver oil in phthisis, and with so much success that
the former orders it in every case where the oil is not
borne, and under its use the patients increases in weight,
the cougli diminishes, and the dyspnoea is in many in-
stances considerably ameliorated.
June 23, 1883.]
THE MEDICAL RECORD.
681
The Medical Record
A Weekly yoiirnal of Medicine and Stirgery.
GEORGE F. SHRADY, A.M., M.D., Editor.
Published by
WM. WOOD & Co., Nos. 56 and 58 Lafayette Place.
New York, June 23, 1883.
THE PSYCHOLOGY OF PANICS.
Ark we to have an epidemic of panics? It would almost
seem so. Three such have occurred in this city within
the year. With the memory of the Brooklyn Bridge hor-
ror still fresh there came this past week news of an al-
most similar disaster in England. The pulilic press has
described and pictured everything, and has emphasized
the details in the thrilling and affecting style of modern
journalism. People are on tiptoe for another panic as
soon as the occasion occurs.
A panic is an acute disease of the brain, it belongs to
medicine and to morbid psychology. A genuine panic
is an insanity of the mass. The activity of the higher
centres is suspended, reason is gone, the whole force of
volition is turned in one channel, the whole energy of
the emotions is translated into fear of danger and desire
for safety. The panic-struck are anaesthetic, insensible
to injury, ignorant of any sight or sound, or taste or smell,
except such as relate to their eftort for safety. Man
when in panic touches as near as ever he can to the
mental condition of a beast. A runaway horse, a fright-
ened fiock ■ of sheep, a panic-struck crowd are on the
same mental level.
There is no emotion so contagious as that of fear, and
no desire so strong, so intimately wrought into our nature
as that of self-preservation. Hence the rapidity witli
which the psychological contagion of the panic spreads
itself. The strongest and bravest man becomes tremu-
lous when in a crowd struck with fear. Panics have their
predisposing causes. The mind when wrought upon by
harrowing recitals of previous disasters, or when made
unstable from nervous weakness, or insecure by lack of
confidence, is most readily affected. For this reason it
seems probable that there is at present a widespread
predisposition to panics.
The best prophylactic for a panic is the cultivation of
a stable nervous system and of the habit of being men-
tally prepared for contingencies. Every one should
know where the fire-escapes are in the hotel in which he
sleeps, or the exits in the theatre which he attends. If
each person were to take these precautions it would
certainly make a difference in the number and extent of
panics.
No doubt the best thing for the individual to do m
case of panic is in most cases to remain still. One can
not stifle emotion but one can often restrain action,
which latter is the thing that does the harm. In incipient
panics, loud noises, a confident speech, music, or any
distracting object may still affect the mind and check the
tide of feeling before it has yet concentrated upon the
single purpose of escape.
The class of men who are least affected by and leasl
liable to panics is doctors. We speak from knowledge.
We have seen, in a demonstration before a large medical
audience, an explosion occur with a flash of flame,
burning ether running down and over the table. There
was not a cry nor a stir in the whole audience, the fire
was put out by throwing cloths over it, and the demonstra-
tion went on. We have often witnessed similar accidents
on a smaller scale — and the experience is not infrequent
— but never have we heard of a jiarty of physicians panic-
struck. The reason is easy to see, every medical man is-
continually called to meet emergencies and to allay
panics on a smaller or larger scale. A doctor who has
been called to see infants with sudden attacks of croup,
children in convulsions, women in hysterical moods, and
the various other pathological factors of domestic up-
heaval, necessarily requires very extraordinary circum-
stances for the complete disturbance of his own equi-
librium.
HOW TO CARE FOR THE POOR.
Among the many perplexing social questions of the day
there is probably none that have come to assume an as-
pect so alarming, an interest so vital, a resijonsibility so
pressing, as that of the relation between the upper and
lower classes, the old problem of labor and capital, the
Gordian knot of history, battling the wisest minds, and
yielding no solution even to the sword. We in America
have of late had the various phases of this subject im-
pressed upon our attention in ways that have served to
detract considerably from the effectiveness of that style
of eloquence known as " spread eagle," and which are
anything but conducive to complacency in the average
patriot. It is a question which certainly affects the
"life, liberty, and pursuit of happiness" of each and
every one of us ; and it is ceitainly time we should " stop
and see where we stand." What are the bottom facts in
the case ?
Our so-called lower class in America is a motley
crowd, as indeed, what class is not, in some degree ?
Other governments have only to provide for a body of
people whose disposition and temperament are perfectly
well-dehned and understood, whose standing and rela-
tions have been practically the same for centuries, and
are thoroughly known, who are distinctly identified with
the country by all the ties of heredity, and who are im-
pregnated with its social atmosphere. From the very
nature of the cas«, societv in America is a mixture of
many diverse elements. Our land is open to all. ^'ery
naturally, but none the less unfortunately, it has come to
be the Mecca of all who have become restless under re-
straint at home, and who seek freedom from it here. No
wonder the old discontent breaks out on finding new,
but no less oppressive influences against them in their
struggle for subsistence. No wonder despondency suc-
ceeds to discontent, and the foreign peasant becomes an
American pauper. Another potent factor in the pro-
682
THE MEDICAL RECORD.
[June 23, 1883.
duction of this deplorable state of affairs is found in the
growing adverseness of our own common people to en-
gage in manual labor. Unfitted for the "genteel" em-
ployments to which they aspire, they lapse into habits of
shiftlessness, which soon develop into absolute apathy
under the influence of the pitiable fallacy that " the
world owes them a living. '
We have, then, an enormous and increasing class of
people who are largely dependent on charity, and espe-
cially is this true of New York. But, on the other hand,
the means of relief are most abundant. The question to
be decided is, therefore, plainly this : Are these means of
relief insufficient or inadequate for the wants of the poor,
or do they fail to accomplish their end by expending
their energy in false directions ? Plainly the latter. For
every honest man will admit tliat, whatever the number
of our charitable institutions, and whatever the activity
of charitably disposed persons, for some reason the re-
sults are unsatisfactory, and as yet all etitbrts have failed
in securing the greatest possible good to the greatest
possible number of those in need. As a result of this
widespread feeling of something lacking, there have re-
cently been formed in this and other lajge cities charity
organization societies, and which have already been pro-
ductive of much good. It is easy to see the advantage
of a regular organization in such a tield. The ami and
scope of these societies are admirably embodied in the
" Handbook for Friendly Visitors among the Poor," is-
sued by the Charity Organization Society of New York,
and published by G. P. Putnam's Sons, New York, 1883.
Everyone who is brought into contact with the poor should
own this book. Its influence will surely tend to mate-
rially lessen that ill-advised and misapplied charity
which has proved, in so many cases, a curse rather than
a blessing. The gist of the whole subject we find upon,
the title-page, viz. : " Charity must do five things, i.
Act only upon knowledge got by thorough investigation.
2. Relieve worthy need promptly, fittingly, and tenderly.
3. Prevent unwise alms to the unworthy. 4. Raise into
independence every needy person, where this is possible.
5. Make sure that no children grow up to be paupers."
Then follow in detail the different chapters, as follows :
" (ieneral Suggestions to Visitors," -'Directions to
Visitors,'' "Quotations" (from eminent philanthropists),
" Hints on Domestic Economy," " Sanitary Sugt'estions,''
"Legal Suggestions," each subject being tersely but
clearly treated. The book gives in plain, concise form
what might be termed the "first principles " of charitv.
Now all this conies home with peculiar force to the
medical profession, for no other class of peo[)le are
brought into such constant and intimate relations with
the poor, and none are more identified with efibrts for
their relief Gratuitous services rendered a patient who
could possibly pay has certainly a demoralizing effect on
liis character. The Charity Organization Society have re-
cognized this, and act accordingly ; but what is the policy
of the profession ? Our attention was lately called to a
circular letter sent by the New York Society to the dif-
ferent hospitals, describing at length a man wlio had
come to New York for surgical treatment, one wiio was
well able to pay, but wh.o was attempting to pass him-
self off as utterly destitute. Assuredly a move in the
right direction ; but what medical man doubts of this
man being able to obtain free treatment, especially if
his case be an interesting one. The " interests of hu-
manity," which have of late been so feelingly alluded to,
would seem, in the light of such facts, to demand a radi-
cal reform in this direction.
XOX-P.\R.\SITIC PHTHISIS.
Dr. Franz Riegel, of Giessen, has made a contribution
to the pathology of phthisis which is of especial interest
in view of the present active agitation regarding the sub-
ject. Riegel has been and still is a believer in Koch's
discovery and in Koch's conclusions regarding the causa-
tion of tuberculosis. He has recently reported the
histories of two cases of phthisis occurring in diabetic
patients. He examined the sputa of both. In the one
he found the bacilli of tubercle, as has been done before
by Inimerman and Riitimeyer. In the other 710 bacilli
could be found, despite more than fifty careful examina-
tions. The patient was a man fifty-two years of age,
who had suffered from diabetes for a long time. At the
left apex of the lung there was dulness, irregular respira-
tory sounds and moist rales. The sputa was muco-puru-
lent, and at times small masses were expectorated which
were found microscopicall}- to contain fatty degenerated
portions of the lung parenchyma. There could hardly
be any mistake in the diagnosis. It is equally improb-
able that the failure to find bacilli was due to lack of
skill, since Riegel had frequently made such examina-
tions.
It was concluded, therefore, that there is a form of
plithisis in diabetics not due to the bacillus. This con-
clusion is thought to be strengthened by the opinion
which pathologists have already advanced, that there
occur in diabetes two forms of phthisis, one a tubercular,
the other an ulcerative or catarrhal process.
It will be readily seen that if the disciples of Koch
admit the existence of a catarrhal phthisis as a compli-
cation of one disease, they must admit also the possibility
of its occurring under other circumstances. In other
words, we are brought back to the old view that phthisis
may have two or even three forms : tubercular, catarrhal,
and fibroid.
THE DISGUSTED P.JiRTY.
\Ve have received from a correspondent the following
letter ;
" De.\r Sir — \\'\\\ you not allow me a word in your
valuable journal regarding the much-discussed subject of
medical ethics. .\[y sympathies have all along been
rather for the old Code. I have often read and admired
it, and I (juite disagree with those who talk so glibly
about its 'moral i>latitudes.' With all respect to your
opinions, sir, it seemed to me that we were tioing tery
well with it, and that it might have been let alone, when
this question of consultation would probably have settled
itself. I came very near joining the printed list of old
Code defenders. I am very glad I did not, however,
and since the disgracefiil trickery at the Academy of
Medicine occurred, 1 have heard of many who regretted
signing their names to the document which the leaders
in the old Code party have been circulating.
"The fact is, sir, the whole controversy has ceased to
June 23, 1883.1
THE MEDICAL RECORD.
683
be an ethical one, and has degenerated into a medico-
political warfare in which the real issue is forgotten. I
would not debase myself by acting under such a leader
as the old Code puts forward, even to re-enact the fiats
of Mount Sinai ; neither do I care to join the new Code
party, which poses too much as a martyr, and is too
much en rapport with newspaper men to accord with
my old-fashioned notions of what a doctor should do.
" I belong to the disgusted party, and I think that
there are many with me. \V'e, the disgusted, do not
like tlie flood of circulars which is being sent us by ma-
chine organizations. Their postal cards, asking our
personal views, are an impertinence, and their addresses
and 'comments' are platitudinous and tiresome. We
are practitioners of medicine. We know that what prac-
titioners want is more medical knowledge and skill ; and
that it doesn't make the difference of a pseudo-bacillus
in the doctor's actual work whether there is a long code,
a short code, or no code, provided we have the Scrip-
lures.
" Will not Thk Record use its powerfid influence to
help along this the
" Disgusted Party ? "
We have published the tbregoing, though rather long,
because it doubtless does represent, as claimed, a wide-
spread sentiment. In a large measure we agree and
symiiathize with our correspondent. The seeds of liber-
ality and justice have been sown, and have taken root.
They cannot now be destroyed. The issue can be safely
left to time.
ALUMINIUM IN THE TREATMENT OF PHTHISIS.
Dr. JuLitJS Pick, of Pribyslau, announces the successful
use of aluminium in the treatment of pulmonary tubercu-
losis. Aluminium, he states (in the Wiener Aledicinische
Wochenschrift)^ is one of the most active destroyers of
the bacillus of tuberculosis, and assuming that this bacil-
lus is the cause of the disease, the metal in question may
be rationally given as a remedy against it. When so ad-
ministered, it kills the bacillus and takes away the spe-
cific character of the disease. If, however, serious organic
changes have occurred, the drug will not remedy these ;
hence, in the later stages of phthisis, when nmch tissue
has been destro)ed, we can e.xpect no good from Dr.
Pick's treatment.
The method employed by the investigator in question
is illustrated by the history of a young man, both of
whose lungs revealed the changes of the first stage of
phthisis. He was ordered the following :
IJ. Aluminii metall i.oo gramme.
Aluminire hydr.,
Calc. carb. depur aa 5.00 gramme.
Gum tragac q. s
M. Div. in pil. No. 60. Sig. one t. i.d., two hours
after eating.
The lime was added to assist in the calcification of the
tubercle I
He was also ordered to be rubbed all over twice daily
with oil. After eight days the diarrhcea and night-sweats
had ceased, the fever had left him, and his appetite re-
turned. He was treated for nine weeks, at the end ot
which time he seemed to have nearly, if not entirely, re-
covered. The average dose of aluminium was about
o.io gramme daily.
Dr. Pick reports the above case as a sample of what
the metal will do. He does not say how many others he
has treated. It is evident that he has not proved very
much for his new remedy as yet.
THE THERAPEUTICS OF BLUFF.
He stood by the bedside counting the pulse, counting
the respirations. The patient was in advanced life, and
was suffering from broncho-pneumonia. " One hundred
and six!" was the exclamation, "respirations thirty-six.
An increase over last evening of ten pulsations and six
respirations. Some slight lividity of the extremities of
the fingers. Heart's action a little irregular." Dr. Blank
shook his head dubiously : " Mrs. Brown is not so well
to-day." A cloud passed over his countenance as he
spoke these words ; it was noticed by Jane, Thomas, and
Susan. A gloomy silence followed. The Cammann bin-
aural tube was applied to different parts of the thorax.
Subcrepitant ronchi everywhere ; small bubbling at the
bases. " There is extensive consolidation," he said ;
" this dull region is stuffed with the products of inflam-
mation. It is a hard tug for breath with the old lady."
The supreme cortical cells of Dr. Blank's cerebrum
were evolving this thought : " This patient will die ; I
shall lose prestige in consequence ; I shall lose the pat-
ronage of this family."
What shall he do about treatment ?
The digUalis does not seem to be working well ; there
is nausea. The squills, senega, and ipecac do not pro-
mote expectoration. There is pain in the head, and he
fears that it is caused by the quinine and whiskey. In
doubt and uncertainty he tells them to put these medi-
cines on one side, and writes a prescription for some
carbonate of ammonia. He directs full doses of this
medicament, and then, after starting for home, in his
hesitation comes back and advises the family to give
only half the dose prescribed. With a heavy heart, which
his countenance too plainly shows, he bids the Browns
good-morning.
What are Thomas and the Brown girls thinking about
at this time ? " This man is fairly discouraged. He has
done all he can. He has no confidence in his medicines.
He has made a complete change, and now is doubtful
about the result of the change. He evidently thinks
mother is going to die. Mother, too, is discouraged. It
is time to try somebody else."
Dr. Blank had hardly arrived home that morning when
a messenger brought a note from the Browns, stating
that they had made a change ; that Dr. Blank might
consider this note a note of dismissal ; that Dr. Bluff
would now take charge of the case.
Dr. Bluff was not in any sense a scientific irian, nor
had he any skill in the selection of his remedies. He
stole a good many useful hints from members of the fac-
ulty and young graduates, with whom he now and then
held consultations (and with whom he always agreed),
but his diagnosis was hap-hazard and his treatment was
hap-hazard. He drove fast horses, and would bluster
like an English country squire. All this gave him great
684
THE MEDICAL RECORD.
[June 23, 1883.
popularity. Individuals had been heard to say that they
would rather have Bluffs presence in a sick room, if he
did nothing more than talk slang, and tell them that they
would be able to dance a polka in a few days, than have
the most scientific college professor who would give them
nauseous medicines, and tell them that their sickness was
of a very grave nature.
Ur. Bluff was ushered into the room of the sick Mrs.
Brown. The diagnosis and the fearful prognostications
of poor Dr. Blank were turned to ridicule. There was
nothing the matter with Mrs. B., only "a little stuffing'' in
the chest. He " would clear out those pipes in less than
no time." Whiskey and milk and his white emulsion of
ammoniacum was all that was necessary. In less than
half an hour the vocabulary of banter and current slang
was exhausted. The sick woman was a " daisy," a
"blooming rose of Sharon," and a "gay old gal." She
had not " got through her sparking " yet, and " if the
present Mrs. Bluff should ever be taken off, he would
improve his opportunity," etc. As for dying — "fiddle-
sticks ! she cannot die with that pulse." He would
" have her out of that bed scrubbing the kitchen floor
before a week."
It is needless to say that the Browns were all delighted
with the assurance and the jocoseness of their new family
physician, whose encouraging words rallied them to re-
newed eflbrts to prolong their parent's existence by often-
repeated potions of whiskey and milk.
It is worthy of note, too, that the patient herself for a
while felt the invigorating stimulus of a new hope. Al-
though the final result was as Blank predicted, yet there
always was a feeling on the part of the Browns that if
Bluff had been called a little earlier the result would
have been different.
The above is no imaginary picture. Dr. Blank and
Dr. Bluff are the prototypes of many men who honor or
dishonor our noble profession. The latter will generally
be the most popular, if not the most successful.
We do not believe in bluff, but encouraging words and
smiles are often of real therapeutic value.
S^cxus of tTxc ^mccTi.
Brooklyn Doctors. — The King's County Register
(says Ephetneris) contains the names of 974 persons
who are now authorized to practise medicine here. Of
these 765 registered in 1880, the year in which the law
took effect. In 1881 the additions reached 104 names.
In 1882, 77 registered, and thus far in 1883, 28, making
an aggregate of 974, a few of whom are now doubtless
dead or removed. The "Medical Register" for 1S82-3,
which practically embraces the same area, and which
registers the names of all persons in the regular profes-
sion, contains 488 names, and the active membership
list of the County Society has somewhere about 370
names. Hence the legally authorized practitioners
number about 974, while the regular profession numbers
about 488, or just about one-half of the 974, and a por-
tion of the 488 are determined to destroy all impedi-
ments to their consultations with the 486, and this on the
ground of liberality and iiumanity.
Thk Medical Societv of Louisville is the title of
a new organization recently established in Louisville, Ky-
Annual Commencement of the Long Island Col-
lege Hospital. — The twenty-fourth annual Commence-
ment of the Long Island College Hospital, of Brook-
lyn, took place last week in the Brooklyn Academy of
Music. There was a large attendance of ladies and
gentlemen. The presentation of candidates for gradua-
tion was made by Prof Jarvis S. Wight, and the Hip-
pocratic oath was administered by Prof Samuel G. Ar-
mor, Dean of the Faculty. William H. Dudley, Pres-
ident of the Collegiate Department, conferred degrees
upon fifty graduates. Honors were bestowed upon the ten
men who passed the best examination. Mr. Andros P.
Chesley, of the graduating class, delivered the valedic-
tory, and the Rev. Dr. Charles H. Hall, of the Church of
the Holy Trinity, made an address to the graduates.
Among the graduates was a colored man, who is said to
be a man of fine education. About twenty-five per
cent, of the candidates for graduation were rejected.
Foundation of a Prize in Physiological Thera-
peutics.— The late Dr. Martin-Domourette has left to
the Academie des Sciences forty thousand francs for the
foundation of a prize in physiological therapeutics.
The Report of the Typhoid F'ever Co.mmission. —
The Commission appointed by the Academie de Medi-
cine to consider the subject of typhoid fever, particularly
of the Paris epidemic, have made their report. It is
couched in somewhat general terms and really presents
nothing novel. It refers the epidemic in question to bad
drainage and filth, and it recommends certain measures
to the municipal government. Only two members of
the Academie disagreed with the conclusions.
The Illinois Health Board and the Colleges. —
We learn that the Illinois State Board of Health is now
revising its " Directory of the Institutions Granting
Medical Diplomas or Licences in the United States and
Canada." Copies of the last issue are being sent to the
medical colleges asking for corrections and additions, at
the same time reminding the colleges that the schedule
of "minimum requirements" as to the good standing
of schools in that State is now in force.
Journalistic Change. — Dr. E. C. Dudley has re-
signed the editorship of the Chicago Medical Review.
Dr. Roswell Park has assumed the editorial chair thus
vacated.
The London University has for the first time given
its medical diplomas to women graduates
An Imposition. — ^Doubtloss our valued contempo-
rary The Alcdical and Surgical Reporter will unite with
us in holding up for reprobation one R. H. Gilliford,
who has evidently sent copies of the same article both
to the above journal and to The Record. We can
hardly suppose any contributor so dull and ignorant as
not to know that editors accept articles only on condi-
tion that no other journal has received the same.
Place aux Dames. — The remains of two New York
ladies were cremated at the Lemoyne Crematory, Wash-
ington, Pa., last week.
June 23, 1883.]
THE MEDICAL RECORD.
685
Donation to the German Dispensary. — Mr. and
Mrs. Oswald Ottendorfer will present a new site and a
new building with a free circulating library to the (ler-
man Dispensary of this city. The site is upon Second
Avenue at the corner of Eighth Street, the lot being 70
feet by 150. The sum paid for the site was $62,000,
and the building to be erected will cost $80,000 to $90,-
000, making the total amount of this most generous do-
nation about $150,000.
Officers of Maine Medical Association. — The
following officers were elected for the ensuing year :
President — Dr. O. A. Horr, Lewiston ; Vice-Presidents —
Drs. L. W. Pendleton, Portland, and D. E. Marston,
Monmouth ; Corresponding Secretary — Dr. J. O. Web-
ster, Augusta ; Board of Censors — Drs. H. N. Small,
Portland ; W. K. Oakes, Auburn ; J. IVf. Bates, Yar-
mouth ; W. B. Cobb, Standish ; and J. D. Nutting, Hal-
lowell ; Committee on Publication — Drs. C. D. Smith, C.
O. Hunt, and G. H. Cummings, Portland ; C. A. Pack-
ard, Bath ; and B. F. Sturgis, Auburn ; Business Com-
mittee— Drs. I. E. Kimball, Portland, and \V. P. Watson,
CJorhani. Dr. A. S. Thayer, of Portland, was chosen
Treasurer for five years. Dr. C. D. Smith, of Portland,
was elected Recording Secretary in 1882 for a term of
ten years.
Professor Chiari has been made Ordinary Professor
of Pathological Anatomy in the University of Prague.
The German Society for Public Medicine met in
Berlin May i6th to 19th. Virchow took part in some of
the debates.
Consultations in Germany. — Prince Bismarck is at-
tended in his present illness by Gen. Rath Frerichs, a
well-known and reputable physician, in association more
or less with a homceopath by the name of Zwingenberg.
On the occasion of a recent attempt to prosecute a
quack who was selling homceopathic medicines, Bismarck
is reported to have said that he considered the sale and
use of homceopathic medicines quite harmless.
More Veterinarians Needed. — In an address be-
fore the Kentucky Medical Society, at its recent session,
the practice of veterinary surgery was commended to
young men. The speaker estimated that the yearly loss
arising from the want of sound advice and treatment —
the horses of the country being valued at nearly eight
hundred million dollars — amounts to $15,000,000.
A Doctor Exonerated. — A jury of medical men
was convened last week to hear the evidence against
Police-Surgeon R. H. Vorhees, in a charge of malprac-
tice. A policeman had his foot crushed and died in
consequence. The jury brought in the following verdict,
which show's the nature of the case :
" We find tliat policeman Timothy Ryan came to his
death from traumatic gangrene and pyemia, and that in
view of the fact that the patient was sixty-seven years of
age and had calcification of the arteries, no blame can
be attached to any of the surgeons in charge of the case."
The Newport Natural History Society is the title
of a scientific organization recently established in New-
port, R. I. Dr. Samuel W. Francis was the origmal
promoter, and a number of medical men are among the
members.
The Floating Hospital of St. John's Guild will
make its first excursion this season on or about June
26th. It has been decided to begin the trips earlier this
year, as it has been found that cholera infantum is largely
produced during the June heated term. The Sea-side
Nursery will also be opened at the same time.
Our Cultivated Conte.mporary the Medical Press
and Circular refers appreciatingly to the Holmes ban-
quet, and says that American medicine may wtll feel
proud of the author of the " Breakfast- table Essays,"
"Elsie Venner," and the " Bigelow Papers." Perhaps
Minister Lowell will make some objection to this view.
Attending the Sick Poor. — The Sick Children's
Mission of the Children's Aid Society has begun its
summer work of providing medical attendance, medi-
cine, and nourishment, free of charge, to the sick chil-
dren of the poor in the tenement-houses. A corps of
physicians has been engaged to visit the sick children at
their homes. A number of druggists have agreed to
put up all prescriptions at a small cost to the Mission.
Anot'her Opponent of Koch. — Klebs, of Zuricli, has
come out against Koch. The Zurich pathologist claims
that Koch has not yet proved that his bacilli are organic
structures, and that the cultivation experiments are im-
perfect, since he has not separated the bacilli from the
substratum.
The Revival of the Pork Problem in the North
German Gazette, by attempts to show from statistics
that American pork is sixty times more liable to produce
trichinosis than German, may, says The Sun, give Min-
ister Sargent something more to do. A short time since
it was charged in the German newspapers that thirteen
deaths had occurred in the garrison at Tilsit from eating
American pork, and that many more of the troops were
sick. Mr. Sargent caused the nearest consular officer to
make an inquiry, and it was found that fourteen trivial
cases of trichinosis had occurred, and that every one of
the patients had recovered. The statement that Amer-
ican pork is sixty times more trichinosed than German is
about twenty times too strong. It is in fact unwarranted
by any trustworthv statistics.
The Honorary Degree of LI,.D., of Cambridge, is
to be conferred on M. Pasteur, Sir John Lubbock, and
Professor Roscoe.
Dr. Robert Druitt, of England, died recently. He
is well-known as the author of the " Surgeon's Vade
Mecum."
Homceopathy and the Michigan Asylum for In-
sane.— Petitions have been circulated freely among the
homoeopathic physicians of Michigan, asking the State
Legislature to place the medical management of the
Northern Michigan Asylum for the Insane in the hands
of the homoeopathists.
Passage of a Law Regulating the Practice of
Medicine in Wisconsin.— Dr. P. H. Millard, President
of the Wisconsin State Medical Society, sends us a copy of
a law passed at the last session of the Wisconsin Legisla-
ture, and entitled "An Act to Regulate the Practice of
Medicine in Wisconsin." Dr. Millard writes : " It is
quite similar to the Illinois law in many of its features,
686
THE MEDICAL RECORD.
[June 23, 1883.
and upon the whole, if properly and judiciously enforced,
I think a far superior law. There is a general disposition
to give the law a fair trial by the profession and much
satisfaction in obtaining any law upon this subject. The
provisions of the act will be judiciously and rigidly en-
forced by the Board of Examiners, and we trust will
merit the success that it deserves.
"The most objectionable feature of the bill is the five
years' exemption clause, but the bill could not have been
passed without this provision."
A HoMCEOPATHic Physician of Minneapolis has
been appointed "Professor of Obstetrics and Gynecol-
ogy" in the " State University Medical College,' a non-
teaching faculty appointed by the regents, and constitut-
ing, by recent enactment of the Legislature, the examin-
ing board for the State.
The College of Therapeutics is the title of a new
medical college recently incorporated in Massachusetts
under the general statutes. It is said that the institution
has been established in the face of the recent decision of
the Assistant Attorney-General that institutions thus in-
corporated could not confer diplomas.
Enforcing the Registration Law. — We are glad
to learn from the Buffalo Medical and Surgical Journal
that the Board of Censors of the Erie County Medical
Society have undertaken, with commendable earnest-
ness, a crusade against certain persons in that city and
county who are imposing upon the credulity of the pub-
lic by practising medicine without either diploma or
license, in violation of the laws of the State.
Trichinosis in Chicago. — The Secretary of the Cat-
tle Commission, J. H. Sanders, has learned that, since
his appointment (somewhat over a year), seven cases of
trichinosis are known to have occurred in Chicago, of
which three were fatal.
Alleged Presence of Pleuro-pneumonia. — The in-
vestigations of the Agricultural Department and the lo-
cal Health Board in Washington appear to show that the
outbreak of disease among cows in that city is not due
to contagious ])leuro-pneumonia, but to simple pneu-
monia, which is not contagious.
Prizes of the Royal College of Surgeons of
England. — No award of the triennial prize of the Royal
College of Surgeons having been made this year, the
subject has been withdrawn, and the following substi-
tuted for the next, to be awarded in 1886, viz., "The
Nature of Inhibitory Action in the Animal Body, to be
elucidated by Original Research.' This prize consists
of tlie John Himter Medal, executed in gold, to the value
of fifty guineas ; or, at the option of the successful author
of the dissertation, of the said medal executed in bronze,
with an honorarium of ^^50. The subject for the Jack-
sonian Prize for 1884 is, "The Surgical Trea<nicnt of
Uterine Tumors, both Innocent and Malignant." I'or
the present year, it is, "The Pathology, Diagnosis, and
Treatment of Obstruction of the Intestines in its Various
Forms in the Abdominal Cavity." The value of the
Jacksonian Prize is about $60.
Operating upon a Person in Order to Deter-
mine the Se.x. — Professor Porro leceiuly performed an
operation for no other purjtose than to determine the
sex. The individual requiring such unique interference
was pseudo-hermaphrodite, aged twenty-two, had been
brought up as a female, although all her (his) tasks
had been masculine. The face and chest were like those
of a man, although the breasts were considerably de-
veloped. The pelvis and lower limbs were like those
of a woman. The mons veneris was slightly developed.
There was a vulva, with a well-developed clitoris labia
and a short vagina ; no penis, no prostate, and no uterus.
At the summit of what corresponded with the labia
majora, near the inguinal region, two round bodies
could be felt, which on pressure gave pain. The ques-
tion was, were they ovaries or testicles. Professor Porro
cut down on the right side, and found that the body
was a testicle with epididymis and spermatic cord at-
tached. The wound was closed up, the patient pro-
nounced a man, and sent forth enchanted with his new
status in society.
The Order of the Royal Red Cross. — The Queen
of England has created a new decoration designated
"The Royal Red Cross." It is to be bestowed as a
recognition of special services in nursing or attending
the sick and wounded soldiers and sailors. It seems to
be intended chiefly for trained nurses.
The Mortality in the Capitals of Europe for
the first quarter of the year 1883 is as follows : London,
22.1 per 1,000; Berlin, 24.3; St. Petersburg, 40.6;
Brussels, 25.7; Paris, 27.3 ; Stockholm, 27.8; Vienna,
31. 1 ; Madrid, 36.4.
Some connnent might be made on the fact that in
Vienna, one of the greatest medical centres of Europe,
the mortality should be so excessive.
The Appearance of the Plague in Kil-Djivareno.
— It is reported that the plague has appeared in Kil-
Djivareno, a district of Persia, about twenty-five miles
from the Turko-Persian frontier. It is not far fiom the
district of Nonkris, where the ))lague appeared in 187S
and 18S1.
Medical Board of E.xa.miners for Illinois. — The
Chicago Medical Society has appointed a committee to
confer with the State Board of Health, as to the feasi-
bility of a statute which shall invest the exclusive right
to grant license to practise medicine in Illinois in a
Board of Examiners, independent of all medical schools.
The State Board of Health has submitted to the facul-
ties of the various medical colleges a proposition that
all individuals desirous of pursuing the study of medicine
in Illinois shall be submitted to imiform preliminary
examination by the State Board.
British Medical Association.— The Fifty-first an-
nual meeting of the British Medical Association will be
held at Liverpool, England, on Tuesday, Wednesday,
Thursday, and Friday, July 31, August i, 2, 3, 18S3.
A New Method of Destroying the Fcetus in
Cases of Extra-Uterine Pregnancy. — Dr. Koch-
mann, of Strasburg, reports a case of extra-uterine preg-
nancy, six months advanced, in which the foetus was de-
stroyed by a single application of sparks from a static
battery. The duration of the sitting was about fifteen
minutes, and sparks about one and one-half centimetres
long were drawn.
June 23. 1883.]
THE MEDICAL RECORD.
687
^ciucui5 and ^jloticcs.
The Pathologv and Treatment of Diseases of
THE Ovaries. Bv Lawson Tait, F.R.C.S., Surgeon
to the Birmingham Hospital for Women, etc. Fourth
Edition. Re-written and greatly enlarged. New York :
W. Wood & Co. 1883.
I^AWSON Tait's name is familiar to the profession as
as that of a leader in the department of surgical gyneco-
logy. His views are not alwavs in accordance with those
of many of his co-workers. Such as they are, however,
they appear to follow logically enough from his ])ersonal
experience, which is a large one. The present edition
of his treatise on the ovaries ditTers in no essential re-
spect from former ones, although the increasing number
of his operations, and a constantly growing experience
have necessitated an enlargement of the book. It forms
an interesting and readable volume.
Diagnosis of Ovarian Cysts by Means of the Ex-
amination OF their Contents. By Henry J. Gar-
rigues. A.m., M.D., Obstetric Surgeon to the Mater-
nity Hospital, etc. New York : W. Wood & Co.
18S3.
The present essay first appeared as an original contribu-
tion in the American Journal of Obstetrics, where it
doubtless became familiar to a large part of the jirofes-
sion. It is now issued in book-form, without further
changes or additions. The author presents a quite for-
midable array of conclusions, fifty-five all told, from
which it appears that the importance of examining the
fluid from cysts has been both under and over rated.
The truth would seem to be, that while the examination
of fluids affords no pathognomonic evidence, it is an im-
portant aid to diagnosis, and should not, therefore, be
neglected.
The Diseases of Women : A Manual for Students
AND Physicians. By Heinrich Eritsch, M.D.,
Professor of Gynecology at the University of Halle.
With 159 Wood Engravings. New York : W. Wood &
Co. 1883.
The treatise of Professor Eritsch has achieved a rapid
popularity in Germany. In its English dress it forms
the March volume of Wood's Library. Its great merit
lies in the conciseness of all statements, in its practical-
ness, and in the freedom from personal dogma. It is
nevertheless essentially a German book, and can hardly
aim to replace American and English text-books with us.
In its special province, that of elucidating the present
status of German advanced gynecology, it scarcely has
a rival, at least not of equally small size. The American
gynecologist will be pleased to discover that his German
confreres are not behindhand in this much evolved branch
of medicine.
An Index of the Practice of Medicine. By Wes-
ley M. Carpenter, M.D. Pp. 304. New York :
William Wood & Co. 18S3.
The author's well-known literary skill, practical knowl-
edge, and conservatism, led us to expect much of the
present work. We have not been disappointed. It is
an admirable epitome of practical medicine, giving in a
most condensed form, yet carefully stated, nearly every
point that the general practitioner would care to know
about the diseases of the body. The arrangement of
subjects is alphabetical, which allows of easy reference.
The headings: "Synonyms," "Definition," ''Etiology,''
"Symptoms," "Differential Diagnosis," "Treatment,"
are printed in thick, black letters, making the sub-
divisions prominent. Prescri|)tions are added in some
cases, a feature which we can hardly commend.
The book is interleaved, so that the physician can add
his own therapeutical or symptomatological notes. It is a
small octavo size, bound in sealskin, and wallet-shajied,
so that it can be easily carried in the pocket and referred
to as readily as the ordmary dose-books.
We believe that Dr. Carpenters work will prove a
boon to the general practitioner.
A Manual of Chemical Analysis, as applied to the
Examination of Medicinal Chemicals. By Frederick
Hoffmann, A.M., Ph.D., and Frederick B. Power,
Ph.D. Third Edition. Philadelphia: H. C. Lea's Son
& Co. 1883.
The third edition of this treatise takes due cognizance o'
general chemical progress, and more particularly of the
advances recognized by the recent new issues of the
United States and German jjharmacopceias. As a re-
liable work of reference to those who require to be kept
posted in matters pertaining to medical and forensic
chemistry, the book has no superior. The general prac-
titioner, however, need scarcely be burdened with a
knowledge of its contents.
A Manual of Auscultation and Percussion ; Em-
bracing the Physical Diagnosis of Diseases of
the Lungs and Heart, and of Thoracic An-
eurism. By Austin Flint, M.D., Professor of the
Principles and Practice of Medicine in the Bellevue
Hospital Medical College, etc. Third Edition. Re-
vised. Philadelphia : H. C. Lea's Son & Co. 1883.
This well-known little treatise requires no notice, be-
yond mention of the fact that a third edition was called
for a short time after the second had appeared. It ap-
pears, therefore, that its practical utility is duly appre-
ciated, a circumstance which reflects credit upon the pro-
fession as well as the author.
The Microscope and its Revelations. By W. B.
Carpenter, C.B., M.D., etc. Sixth Edition. With
Plates and Engravings. Vols. I. and II. New York :
W. Wood & Co. 1883.
The well-known treatise of Dr. Carpenter has reached
its sixth edition. The work has been issued in two vol-
umes, forming the April and May numbers of Wood's
Library of Standard Authors. It is hardly necessary to
repeat what is so generally recognized to be true, viz.,
that this treatise constitutes the most complete and in-
dispensable guide to the working niicroscopist published
in the English language. The manual is not specially
intended to be a medical book, but yet the physician
will not fail to derive both profit and amusement from a
perusal of its pages.
The Systematic Treatment of Nerve-Prostration
and Hysteria. By W. S. Playfair, M.D. Pp. 106.
This little work is a reprint of Dr. Playfair's previous
communications on this subject. They show the favor-
able results obtained in England by the Weir-Mitchell
method of treatment.
Experimental Phar.macology. A Hand-Book of
Methods for Studying the Physiological Actions of
Drugs. By L. Hermann. Translated, with the
Author's permission, with Notes and .\dditions, by
Robert Meade Smith, M.D. 8vo, pp. 201. Phila-
delphia: Henry C. Lea's Son & Co. 1883.
The increasing interest that American physicians are
taking in experimental physiology and physiological
therapeutics renders the present work a timely one.
The author describes the general method of pharma-
cological investigation, and claims for pharmacology the
position of a distinct science, covering the subject of
the action of drugs upon animals.
The special methods of studying the action of poisons
upon the various organs and tissues of the body are then
described. The book is a technical one forjthe assist-
ance of those who wish to do actual work. Dr. Smith
688
THE MEDICAL RECORD.
[June
■o<
188-
■has very numerous and valuable additions in the way of
notes and comments. Many illustrations also are given.
We trust that it will give a further impulse to the study
of pharmacology in America.
FoRMULAiRE DES MALADIES Urinaires. Par F. Mal-
LEZ. 8vo, pp. 292. Notes Therapeutiques et Cliniques
recueillees a la Clinique, de la rue Christine, Paris.
.■\drien Delahaye et Emile Lecrosnier, Editeurs. 1883.
This work covers the subject of the therapeutics of
genito-urinary diseases, and it contains much that is use-
ful. We especially commend the ingenious tables in the
latter part, by which the various methods of treatment
are presented in an admirably succinct manner.
Students Guide to Diseases of the Eye. By Ed-
ward Nettleship, F.R.C.S. Second .\merican, from
the Second Revised and Enlarged English Edition.
With a Chapter on Examination for Color Perception,
by William Thomson, i\l.D., Professor of Ophtlialmol-
ogy in the Jefferson Medical College. Philadelphia :
Henry C. Eea's Son & Co. 1883.
The verbosity of the chapter on " Examination for Color
Perception," added by Dr. Thomson, is in strange contrast
with the terse diction of the rest of this admirable (Tuide,
which bids fair to become the favorite text-book on
ophthalmic surgery with students and general practitioners.
It bears throughout the imprint of sound judgment com-
bined with vast experience. The illustrations are nu-
merous and well chosen. F'rom a reference on page 44
we infer that the English edition of the work contains
test-types which have accidentally been omitted in the
.A.merican edition.
On page 43 the statement is made that rays forming a
visual angle of one minute " are very nearly parallel, and
may be considered as coining from an object at an infi-
nite distance." This is erroneous and apt to sadly con-
fuse a tyro in physiological optics. On page 72 we read
that by the direct method of ophthalmoscopic examina-
tion the parts are seen in their true position " unless the eye
be myopic." This statement also needs correction. On
pages 72 and 305 the dot is wanting in front of the fig-
ure 5.
These are the only blemishes we could detect on a
cursory examination of this book, which, within the short
compass of about four hundred pages, contains a lucid
exposition of the modern aspect of ophthalmic science.
The Practitioner's Ready Reference Book. By
Richard J. Dunglison, A.M., M.D. Third Edition,
thoroughly revised and enlarged. Philadelphia : P.
Blakiston, Son & Co. 1883.
Thp; new edition contains numerous additions and illus-
trations, which the autlior believes will materially increase
the value of the book. The volume now has five hun-
dred and twenty-five pages, and medical topics as fol-
lows have been considered : Weights and measures oc-
cupy thirty-nine pages, which contain much useful as
well as •' handy " knowledge concerning weights and
measures of the United States Pharmacop(eia and of the
metric system. Nearly twenty pages are next occupied
with tables which give the solubility of medicines in w-ater,
alcohol, ether, glycerine, etc. Tlie abbreviations in com-
mon use, the companion of thermometric scales, and
the reference tables of size, weight, and specific gravity
of different parts of the body are interesting and useful ;
perhaps not so much so to the general |)ractitioner as
to pathologists and specialists.
The Hippocratic oath that follows is good reading,
especially in the light of the author's conunents, who
says that " instead of displ<iying a narrowmindcii and
exclusive selfisluiess, it inculcates a !;enerous line of
conduct, and enjoins an obsenance of the rules of pro-
priety" etc. Simple, comprehensive, and, amid the pres-
ent ethical agitation, interesting.
The pages which inmiciliately follow possess the least
intrinsic value of any in the book. If all that appears
concerning rules for the practitioner, rules of medical
etiquette, and what the practitioner must learn of the
patient, were totally expunged, it would greatly improve
the work. So much of it is puerile and so much im-
practicable that what remains is like a plant that has
grown in the shade ; it wilts when it is brought to the
sunlight.
The fifty pages which follow are devoted to doses of
medicines for children and adults, administered by mouth,
enemata, suppositories, etc. .\s a matter of course, the
basis of much that these pages contain is the United
States Pharmacopceia, but the simplification renders it
very acceptable ; so also is the material derived from
other sources.
Hints as to prescribing. — How and what to prescribe
is especially interesting when read in conjunction with
the selected prescriptions found a few pages subsequently.
Probably the eight pages of incompatibles will be as
little observed in practical prescribing as anything that
appears in the book, and as evidence that such may be
the case, the reader has only to refer to the prescriptions
selected by the author himself — and selected because they
have been employed with good results by eminent author-
ities— where can be found incompatibles in combination
in abundance, k fair sample is the following : Hajnia-
toxylon has among its incompatibles mineral acids and
opium, and one prescription reads as follows : IJ . .\cidi
sulphurici aromatici, ext. hajmatoxyli, tinct. opii cam-
phoratffi, and syrupi zingiberis.
The selections included under the head of" Hygienic
and Therapeutic .Management of Children " are very good.
They are from such men as Goodell, .-Vlbert H. Smith,
Meigs, and Pepper, of Philadelphia, h. A. Smith, of New
York, Eustace Smith, of London, and others, whose
opinions are entitled to favorable consideration.
Several pages are occupied by tables of differential
diagnosis, credited to P2theridge, of Chicago, Roberts
("Theory and Practice of Medicine "), Seller ("Diseases
of the Throat "), H. .\ugustus Wilson, of Philadelphia
(" Fractures and Dislocations of the Femur at the Hip-
joint"), and Bramwell, of London (" Cardiac Valvular
Murmurs"). These are only fairly good. Roberts' is
the best. A few words would have made each much
more complete than it is. For example, all the sym])-
toms enumerated as characteristic of typhoid, with a
single exception, may be present in other affections, and
the real peculiarity of the single symptom is not pointed
out.
The tables on " Fractures and Dislocations of the Fe-
mur at the Hip-joint" are lamentably deficient. They
were evidently abstracted from one author. The amount
of shortening given varies so much from that laid down
by the authority generally accepted in the courts, that
they are not entitled to consideration. They have been
made up without reference to either the influence of im-
paction or the situation of the fracture in the neck. No
mention has been made of Bryant's line, accepted as one
of the most reliable guides in obtaining the amount of
shortening. .Vor has attention been directed to the fact
that measurements from the anterior superior spinous
process of the ilium to the malleolus at the ankle have
been largely discarded because it has been definitely
ascertained that there is, in most persons, a difference
in the length of uninjured lower extremities. As it now
stands, the author would do well to either revise this
table or substitute another.
The rules for chemical examination of the urine were ar-
rangeil and condensed fiom f. Hughes Bennett's "Text-
book of Physiology," publislied in 1S73. These also need
revision, and we are surprised tliat the author, with his
well known habits of precision, should have allowed them
to remain without certain modifications. For example,
it is established that certain articles of diet so afi'ect the
urine that a precipitate like that yieldeil by sugar will be
formetl on ihe application of Trommer's test. Fehling's
June 23, 1883.]
THE MEDICAL RECORD.
089
solution, when fresh and properly applied, undoubtedly
gives the most certain results, although the rules leave it
to be inferred that it is otherwise. In the present state
of our knowledge it is very questionable whether the
terms fibrinous, hyaline, waxy, should be used to define
different varieties of casts. Sometimes casts can be ob-
tained much more certainly from the urine along the
sides of the glass, or in the cloud whicli forms part of the
way down, than from the sediment at the "bottom of a
conical glass."
Under the head of " Treatment of Poisoning" we find
no reference to electricity, certainly a most valuable
agent, although mention is made of various other ex-
ternal measures. This leads us to speak, in this place,
of the chapter " On the Use of the Galvanic Battery,"
condensed from a discourse by H. Tibbits, M.D., of
London, 1877. The writer uses the term "electrization,"
and says that the remarks concerning it apply equally
to Voltaisni (galvanism) and Faradisiii. We do not be-
lieve that this view is sustained by the best authorities of
the present day. " Electrolysis has been successfully
employed in several cases of a«^«;-w«/." True; but our
best surgeons would hesitate for a long time, probably
reject it in toto, before adopting the measure in aneurism
of the arch of the aorta, as suggested here.
" How to Apply Trusses," " How to Use the Clinical
Thermometer," " How to Apply Bandages," " How to
Apply Immediate Relief in Recent Accidents or Sudden
Illness,"" Suggestions for Nursing of the Sick," " Dietetic
Preparations and Precejits," and " How to Cond.uct a
Post-mortem Examination," are the titles of the more im-
portant chapters which follow. These pages contain a
goodly proportion of acceptable items. The section on
" Stained Sections of Animal Tissues and How to Pre-
pare Them " might be simplified to advantage for a book
of this kind, prepared, as it has been, for the general prac-
titioner.
The reputation already acquired by the author for care
and painstaking in detailed work has been maintained in
this edition of his book, and with slight revisions in cer-
tain parts, some of which have been suggested, this vol-
ume will form a substantial addition to the many books
of ready reference now in the hands of the profession.
A Text-Book, of the Diseases of the E.ar and Ad-
jacent Organs. By Dr. Adam Politzer. Trans-
lated from the German by James Patterson Cassells,
M.D., M.R.C.S., England. With two hundred and
fifty-seven Illustrations. Pp. 800. Philadelphia : Henry
C. Lea's Son & Co. 1S83.
Dr. Politzer has been long known as a profuse con-
tributor to the literature of otology, and through English
translations in the medical journals of the past fifteen
years most of his views have been made known. The
large volume before us is presumably a collection of the
author's views in the various departments of the subject,
and will therefore find a place in the library of every one
who wishes to keep informed in the literature of otology.
The author divides the organ of hearing, for the pur-
pose of discussion, into two principal parts, the sound-
conducting and the sound-perceiving portions, which he
regards as the only correct one from the pathological
standpoint. In the former are included — a, the external
ear (auricle and external meatus) ; and b, the middle-ear
(the tympanic cavity with membrano-tympani and ossic-
ula. Eustachian tube, and mastoid process). The latter,
the so-called internal ear, is divided into : a, the origin of
the auditory nerve in the brain ; b, the trunk of the audi-
tory nerve, and c, its expansion in the labyrinth. After
this division of the organ of hearing the author passes on
to the special description of the anatomico-physiological
relations of the human ear. There are 73 pages devoted
to this subject. To the diseases of the conducting ap-
paratus, general and special, there are given no pages.
The diseases of the middle ear, consisting of affections of
the membrana tympani, of the tympanic cavity, of the
naso-pharynx, of the adhesive and jiurulent inflammations
of the middle ear, and diseases of the mastoid process
and external ear, occupy 393 pages, while 85 pages are
given to ear disease and life assurance. The anatomy
and physiology of the internal ear, special and general
diseases of the labyrinth and auditory nerve, injuries of
the internal ear, cerebral disturbances of hearing, malfor-
mations of the ear, deaf-mutism, hearing instruments for
the deaf, and appendix of therapeutical formulary, occupy
loi pages of the book.
While this work evinces a great amount of labor, in-
cluding not only the author's own observations but also
an extensive comijilation of the researches of others in
this special department of medicine, yet its chief value is,
as a work of reference, for the specialist. The author
could have, perhaps, given the work more value had
he possessed more decided convictions concerning certain
matters discussed. For exanijile : a perusal of the whole
subject of the subjective symptoms of diseases of the ear
is confusing, and leaves the reader without a clear idea of
the'subject. Thus he says, page 192 : "Subjective noises
in the ear, which are always caused bv some irritation of
the auditory nerve, arise either from disease of the ear
itself or by reflex transmission from the cerebral and spinal
nerves to the auditory nerve." The portion of the above
sentence which we have italicised is an example of dog-
matism without evident meaning, which occurs rather fre-
quently in the work before us.
When the American practitioner comes to consult this
book for guidance in the treatment of aural disease he
will most likely be somewhat disappointed, unless he be
familiar with the German methods of medication which
are considered here — we may be permitted to say, as
somewhat excessive as regards local medication, notably
in skin aft'ections. Let us here examine what Dr. Politzer
has to say concerning the treatment of acute inflamma-
tion of the middle ear. He says, on page 253 — " The
treatment of acute inflammation of the middle ear in the
beginning of the disease, and as long as the congestion
and the active symptoms last, is palliative. The main
duty of the practitioner at this time consists in the re-
moval or alleviation of pain, and only in the subsequent
course of the disease does the indication for treatment
of the pathological process and of the functional disturb-
ance appear." In the more intense degrees of inflam-
mation, it is true, local blood-letting is recommended, but
the only internal treatment suggested is the administra-
tion at night, if the pain disturbs sleep, of small doses of
acetate of morpiiia, or if that does not agree well with
the patient, the chloral hvdrate in solution. To assist
perspiration in certain cases he employs a cup of tea, or
a decoction of lime blossoms, the action of which is in-
creased by adding a spoonful of spirit, mindereri.
The author's general treatment of acute purulent in-
flammation of the middle ear does not difter materially
from the above. Now, m the acute stage of these dis-
eases, we may in many instances do much to prevent
their progress, and the literature of the day is suggestive
of further advances even in this direction. The employ-
ment of calcium sulphide, and some of the mercurial prep-
arations have been used here with marked benefit, ac-
cording to reliable authorities. Then the practice here,
as regards local treatment, has undergone a great change.
The employment of solutions are much less resorted to
than formerly, and the dry treatment has now many advo-
cates. Politzer recommends only solutions in this affec-
tion.
Otologists are indebted to this author for a valuable
and simple means of inflating the tympanic cavity, which
method, as is well known, bears the author's name.
That inflation of the ears is greatly abused is not the
fault of the author, although one might almost wish, on
witnessing the unnecessary, nay, frequently injurious em-
ployment of the air-douche, that it had never been in-
vented. On the whole, this is a valuable contribution to
otological literature, although not well adapted to the use
690
THE MEDICAL RECORD.
[June 23, 1883.
of the general practitioner. We cannot but express re-
gret that the publishers had not, instead, given us a new
edition of their own Treatise on the Ear, inasmuch as
the author, Dr. Burnett, is well known to entertain ad-
vanced views in the treatment of aural diseases, and hence
would be able to bring his work up to the demands of the
present day.
The book under review is well printed, on e.Kcellent
paper, and, although bearing the imprint of an American
house, is evidently of English manufacture. The nu-
merous illustrations are in the main very good, and some
of them quite new. The representations of the drum-
head in various pathological conditions are notably sug-
gestive. The translator. Dr. James Patterson Cassells,
of Glasgow, deserves the thanks of all who rely upon a
translation from the German into English for access to
Dr. Politzer's views, and he seems to have merited the
approval bestowed upon this work by the author. It
may be remarked in conclusion, that the work before us
is not well bound, the sheets being too heavy for the mus-
lin covers.
On the Pathology of Bronchitis, Catarrh.\l P.mf.u-
MONiA, Tubercle, and Allied Lesions of the Hu-
man Lung. By D. J. Hamilton, M.B., K.R.C.S.E.,
F.R.S.E., Professor of Pathological Anatomy (Sir
Erasmus Wilson Chair) University of ."Aberdeen. With
Illustrations. London : .Macmillan & Co. 1883.
This work will be read chiefly by pathologists. It is
made up of a series of papers which were published in
The Practitioner in 1879 ^.nd 1880. Part I. is devoted
to bronchitis, and, pursuing a well-established method of
teaching, the author directs attention, first, to the struc-
ture of the normal bronchi. His views concerning the
morbid changes in this affection are based upon the
anatomy of the parts as he has seen it under the micro-
scope. He recognizes three varieties of cells in the
epithelial layer: i, the columnal epithelial cells (cili-
ated) ; 2, the deep germinal layer (Debove's membrane) ;
and 3, the perfectly Hat layer lying upon the homogene-
ous basement membrane. Besides, the author describes
other cells, which are regarded as of transitional shape
(beaker cells of older writers), and he traces what, to
him, seems to be a direct line of ascent from the endo-
thelial layer through the germinal layer to the fully
formed columnar (ciliated) epithelial cells.
The author also directs especial attention to the base-
ment membrane, quite hyaline, only a few granules here
and there interrupting the invariably homogeneous trans-
lucency, and this basement membrane of the mucosa, as
he calls it, is said to play an important part in the patho-
logical process of acute bronchitis. There have always
been (since instruments of precision were first invented)
differences of opinion concerning the minute anatomy of
various parts of the human body, and equally divergent
opinions still e.^cist, notwithstanding the improvement
and apparent perfection in the means for observation.
Probably such differences will continue to exist, and
in the very nature of things nnist be tolerated ; but they
are entitled to consideration when they give evidence of
careful investigation. So it is with the views pronud-
gated by this author — they are entitled to consideration.
The first change in the process of acute bronchitis,
says the author, occurs in the branches of the bronchial
artery rajuifying in the inner fibrous coat immediately
beneath the basement membrane of the mucosa. These
become engorged, and within from twenty to thirty horn's
desquamation of the columnar epithelium, with some of
the transitional forms of epithelium, takes place at the
foci of greatest congestion. The basement membrane,
in the meantime, becomes swollen and uedematous. and
it is this condition that facilitates the sliediling of the
epithelium.
This theory is excellent, and the author sustains it with
illustrations made from actual specimens. The faithful-
ness of the cuts we do not cjuestion, but it occurs to the
reviewer to suggest that the theory would be stronger
had the author demonstrated that the circulation in the
terminals of the bronchial arteries is the only vascular
supply which the nuicosa receives, and in the event of
blood supply from another source, that the condition of
the bronchial artery is the only one disturbed. For
eminent histologists have demonstrated, as they believe
beyond question, that the blood supply for the bronchial
mucous membrane is not derived solely from the bron-
chial arteries. In the first part the author also studies
the varieties of chronic bronchitis, chronic interstitial
pneumonia, vesicular emi)hysema, bronchiectasis, and
catarrhal pneumonia as complications of bronchitis.
Part II. contains a dissertation on catarrhal pneu-
monia and tubercle in the human lung. The term
" catarrhal " as applied to pneumonia is retained, although
the author says in one place, "catarrhal so-called," thus
partially indicating that another word would be more
correct, and, therefore, more acceptable. In speaking of
the microscopic appearance of tubercles, he lays great
stress on the presence of giant cells, and goes further in
this direction than almost any other observer. For ex-
ample, he says that " in tubercle of the lung and of all
other organs they (giant cells) are invariably present
whenever the nodule becomes defined." This may be
true for the University of Aberdeen, but the statement
does not hold for the United States.
The general style of the writer is pleasing, and from
the manner in which the subjects in this book have been
treated it is evident that the author is familiar with the
practical manipulations necessary to their proper study
from a pathological standpoint. A slight tendency, how-
ever, manifests itself to make statements and leave them
unsupported. This, in a work of this kind, should not
occur, as the evident intent of the author is to be quite
exhaustive with reference to the morbid changes that take
place in the diseases under consideration. The illustra-
tions are very good ; at all events they possess one char-
acteristic which is acceptable, and that is they do not
seem to be largely the work of imagination. The last
article is " On the Supposed Contagiosity [a word de-
ficient in euphony, at least] of Tuberculosis and Pul-
monary Phthisis." It contains an account of Koch's
discovery, a description of the methods by' which the
bacillus has been demonstrated, and is a brief resume of
what was known on the subiect at the time the book was
published. As a whole the book is worthy of a place
upon the shelves of those who are interested in the pa-
thology of these diseases.
Deep Breathing as a Means of Promoting the Art
OF Song, and of Curing Weaknesses and .Affec-
tions OF the Throat and Lungs, especially Con-
sumption. By Sophia, Marquise A. Ciccolina. Il-
lustrated. Translated from the German by Edgar S.
Werner. New York : M. L. Holbrook & Co. 1S83.
The authoress advocates, enthusiastically, the sys-
tematic cultivation of voluntary abdominal breathing.
She considers it an indispensable help to the art of
correct singing, and a hygienic measure of great value in
asthma, consumption, and weak lungs. We have heard
that the practice of teaching young women abdominal
breathing for the production of the voice is not entirely
devoid of danger.
Treating Dyspepsia with Sand. — Dr. G. Kerlus
argues from the facts of comparative physiology that fine
sand is a good thing for djspeptics to lake with their food.
Herbivorous animals all eat a little dirt with their regular
food, and it makes it more " porous." Fowls and birds
of all kinds also take sand with their meals. Why not,
therefcre, man, sajs Dr. Ivcrlus. Putting this brilliant
piece of inductive reasoning into practice, lie has admin-
istered finely ground sand with the food of his['i)atients,
and, of course, reports cures.
June 23, 1883.]
THE MEDICAL RECORD.
691
Reports jof ^ocicttcs.
NEW YORK ACADEMY' OK MEDICINE.
SECTION IN OUSTETRICS.
Stated Meeting, May 24, 1883.
Alexander S. Hunter, M.D., Chairman.
Dr. Paul E. Munde read a paper (see page 673) on
THE TREAT.MENT AND CURABILITV OF CHRONIC UTERINE
CATARRH.
Dr.W. (Iill Wvlie said that he agreed with the author
of the paper in many respects, while he differed with him
upon several other points. In the first place, he had not
met in his practice with quite so many cases such as had
been described by Dr. Munde and others as incurable.
There are cases of endocervicitis which undoubtedly arc
incurable unless we destroy the mucous membrane, but
he did not think they were so common as had been sup-
posed, and the same could be said of endometritis.
Although the subject of etiology did not enter into the
paper, there was one point to which he would direct at-
tention, namely, lie believed that many of the so-called
cases of incurable uterine catarrh were due to the general
condition of the system, or to a diathesis, and that al-
though the catarrh might be improved temporarily, if the
diathesis was permitted to remain uncorrected the local
condition will return. Dr. W'ylie also believed that
uterine catarrh was more frequently due to disease of the
Fallopian tubes than had heretofore been considered. He
had lately hat! two cases of this character under observa-
tion. In one the patient had been treated for several
years, but still there was a purulent discharge in the
vagina, especially when the patient was upon her back.
After treating her for a little time by the use of the
glycerine and alum tampon, which not only by pressure
but by producing an alterative change, affected the parts,
he was able to readily diagnosticate this condition of the
tubes, and after they had been removed lie could press
exactly the same kind of discharge from the tube which
he had always found in the vagina. He had seen other
cases in which the discharge was mechanical in charac-
ter, and came from the tubes.
His metiiod of treatment for uterine catarrh was not so
heroic as that which had been described by Dr. Munde.
If a patient came to him with cervicitis, with the slightest
tenderness, he commenced with simple applications of
pure glycerine upon cotton, not oftener than once in
three days. He followed this for a time with a saturated
solution of alum in glycerine, to which had been added
a very small quantity of carbolic acid, making the ap|)li-
cations once in three or four days. Then for the first
time he passed a sound, and, as a rule, especially if the
patient has not borne children, it will be found neces-
sary to dilate the cervical canal. For that purpose he
employs Sims' instrument, dilating tirst the external and
then the internal os to some extent, and then begins the
treatment of whichever cavity is diseased. If the mucous
membrane of the cervix is extensively diseased, after
trying astringents, although they did not do much good,
he generally uses the curette, particularly if the patient
complains of menorrhagia. After using Sims' curette
thoroughly he then makes an application of pure carbolic
acid, and rarely uses anything more powerful than this.
He does not like to use nitric acid because of the possible
contraction of the eschar. He was very certain that the
cervix did contract after the use of the actual cautery.
One reason why a cure is not effected was that the
curette and the local applications were, too frequently,
not thoroughly done. The same remarks applied wlien
the lesion was higher up. Applications to the uterine
cavity without dilating to some extent the internal os,
were of rio use whatever. The application should
be made ihrough the curved silver tube, so that it can be
delicately touched to every point, and if so done, seeing
that each little delicate recess was touched with the local
application, many of these cases can be cured which have
heretofore been regarded as incurable. He did not be-
lieve that there were many cases in which nitric acid was
necessary above the os internum. As a rule, in his hands
carbolic acid accomplished all that could be desired. If
the uterus is soft and large he uses iodine. If the uterus
is indurated and hard, being in the position of antever-
sion, and the patient complains of trouble about the
bladder, etc., having been about town under treatment
for years, he had found that these cases were about the
easiest ones which he had to treat, because they had been
almost universally treated without enlarging the internal
OS. But in these cases, even with the uterus enlargeil
and the cervical canal open, he always prepared the parts
by removing tenderness with the applications of glycerine
and alum, and if the cervix was not open, subsequently
dilating it with the Sims dilator, observing throughout the
strictest rules of cleanliness, wetting the instrument with
some antiseptic, as carbolic acid or iodine. Frequently
these cases will be relieved within a week, and can be
cured within six weeks by atlopiing this plan of treatment.
He really thought that it was the method of applying the
treatment rather than any special treatment of itself, as
it was in many other cases, which makes it successful.
He also thought that if the general condition of the
patient was neglected, probably the local condition would
return, and of all the diatheses which might give rise to
it he thought that the rheumatic was the most active.
Dr. L. Weber said that he was glad to hear that Dr.
Munde regarded his cases as cured, for the time being at
least. The treatment which he had adopted for several
years was that practised by Amann, of .Munich. After
dilating the internal os with the tupelo tent, with the
thorough application of the curette, Sims' in preference,
he had followed the plans of Professor Amann in using
mitigated nitrate of silver, making a thorough applica-
tion to the mucous surface. This he had usually done
with the ordinary Lallemand's porte-caustique. He had
not seen any disagreeable results from this method of
treatment. He had known of two deaths following the
use of nitric and chromic acid. Whether he had abso-
lutely cured thtse cases he was unable to say positively,
but he knew that they had received a great deal of Ijen-
efit Irom the treatment which he had adopted.
Dr. Weber also believed that there was an undoubted
connection between these intractable catarrhs and the
general condition of the patient. He should prefer to
lay stress upon the intimate connection between this
local condition and the scrofulous or tuberculous diath-
esis rather than gout or rheumatism. Again, in at -least
half the cases he had seen, such as the general |)rac-
titioner very often encounters, the disease had followed
early abortions. He related one such case, in which
acute tuberculosis developed after miscarriage, and the
patient died within two years.
Dr. Tauszky said he had found mild applications the
best to be resorted to at first. He had not used nitric
acid, but had for the most part followed the rule which
the late Dr. Peaslee recommended, namely, commence
with mild applications, and then gradually reach the
strongest solutions. In most cases there was some form
of displacement present which, of course, should first be
corrected. For many years he had used cotton tampons
after using glycerine in the preparatory treatment. If
he failed with mild applications he then resorted to
stronger ones.
The Chairman said he had never used nitric acid
within the uterine cavity or the cervical canal. It oc-
curred to him that we should consider the existing cellu-
litis, if any were present, and adopt measures to remove
it entirely before proceeding further, and then consider
the condition of the uterus. If subinvolution is present
he had been accustomed to resort to hot water injec-
tions, the local ai)plicalion of glycerine, and was fond
692
THE MEDICAL RECORD.
[June 23, 1883.
of applying a sponge-tent without curetting. The sponge-
tents he had made witli tl>e utmost care, prepared anti-
septically, and just before their introduction the sur-
face was wet and covered with soap, and then rolled in
finely powdered salicylic acid. After introducing the
tent it was allowed to remain forty-eight hours, the patient
in the meantime being confined absolutely in bed, the
bowels having previously been moved freely so that it was
not necessary during the forty-eight hours to rise for this
purpose. In many cases, after the tent had been thus
applied and removed, the catarrhal discharge had ceased
entirely, and with it the condition of subinvolution had
disappeared. In the event of failure he then resorted to
more active measures. In those cases in which the
uterus is anteverted lie used tents, and after removing
thoroughly with the curette the degenerated mucous
membrane of the uterine cavit}-, thoroughl)' wiped away
all the blood, and removed every particle of secretion,
he applied the strongest solution of carbolic acid ; and he
had been entirely satisfied with the results.
Dr. Muxd£, in closing the discussion, remarked that
luidoubtedly the scrofulous diathesis had a great deal to
do with the production, or at least the continuance, of
the disease under consideration. He was particularly
pleased with Dr. Weber's statement concerning one
point in the etiology of the affection, namely, that in the
large proportion of ihe cases it followed early abortion,
by which he supposed Dr. Weber meant subinvolution,
which usually accompanies these cases. That had also
been his experience, but, as had been remarked, the eti-
ology of the disease had not entered into the scope of
his paper. His principal object was to point out that
many of these cases, which had been intractable to treat-
ment, did not improve under mild applications, no mat-
ter how conducted, but would, in a certain proportion,
get well under heroic, active, and persevering treat-
ment ; at least get cured sufficiently long to get rid of
their sterility ; and if that was the prominent feature in
the case the great object of treatment was accomplished.
Besides, many of them were cured of the uterine catarrh.
Dr. Wylie had laid stress on the preparatory treatment.
This was perfectly correct. Dr. Munde did not speak
of preparatory treatment to any very great length, be-
cause it was his special point to discuss active treatment
for the cure of the disease. Preparatory treatment is
quite as important, and in cases where the uterus is im-
movable it may be one of the essentials ; but where the
uterus is perfectly movable, it may be as well, perhaps,
to go on with the heroic treatment at once.
For the class of cases to which Dr. Wylie had re-
ferred, Dr. Munde would not touch one of them with
the curette or with nitric acid. If there existed cellulitis
of the remotest origin he would not apply either the
curette or nitric acid until, at least, he had tried all other
methods without success. With regard to the objection
to the use of nitric acid because it was liable to be fol-
lowed by contraction of the cervical canal. Dr. Munde
admitted that this contraction does take place, but he
did not care for this because in these cases the canal is,
as a rule, already too large, and a moderate amount of
contraction is desirable. But it should be recollected
that he did not recommend the application of the nitric
acid sufficient to make a deep slough. With regard to
carbolic acid having been sufficient, he could only say
that he had occasionally succeeded in the use of this
remedy, but he had more frequently failed. He had not
used either the actual cautery or the galvano-cautery.
He thought that Dr. Hunter's use of salicylic acid was
an excellent one, but suggested that the results possibly
might be due to the effect of the acid cjuite as much as
to the effect produced by the sponge-tent.
One important point he had neglected to mention in
his paper, and wliich it might, have been well to have in-
corporated, namely, the contra-indications to the use of
any of these strong applications to the cervical and
uterine cavity.
MEDIC.\L SOCIETY OF THE COUNTY OF
NEW YORK.
Stated Meeting, May 28, 1883.
David Webster, M.D., President, in the Chair.
THE USE OF ANTISEPTICS AFTER ABORTIONS AND LABOR.
Dr. W. Gill ^VvLIE read a paper on the above sub-
ject, in which he slated that in 1870 and 1S71, while an
interne in Bellevue Hospital, he saw much of septicemia
in surgical cases and something of the same in jnierperal
cases. Under the teachings of the late Prof. James R.
Wood he became a believer in carbolic acid, and by
its free use subsequently, while serving in the lying-in
wards, he delivered thirty-six women without the occur-
rence of a case of puerperal fever, and he believed that
this result was due to the free use of carbolic acid, and
the burning of all sponges, rubber cloths, etc. All these
women had some rise of temperature, but none over 102°
F. at any time. In 1872 Dr. Wylie saw Dr. Lister at
work in his wards in the infirmary at Edinburgh, and be-
came a convert to his antiseptic methods, and had since
in private practice adopted the antiseptic plan, espe-
cially following the practices and teachings of Lister in all
cases of labor. Nearly without exception the tempera-
ture after confinement in his practice had not risen
above 100° F. There had not been even a so-called
milk fever, and the well-known odor of the lying-in woman
had been absent. The method is as follows :
First. — Examine locally every case some weeks be-
fore labor ; have a trained nurse several days before con-
finement is expected ; if lochia are present, warm vaginal
douches of carbolic solution, i to 40, are given twice a
day, and in all cases, as soon as the first symptoms of
labor begin the vagina and vulva are thoroughly washed
with the same solution.
Second. — Remove all useless and old stuffed furniture
from the room ; disinfect with the spray of carbolic acid
everything that remains in the room ; see that a large
supply of napkins and bed linen are on hand, all of which
are carbolized with the spray immediately before being
used ; change the linen every day ; also have two sets of
blankets ; air them and use them alternately ; wash the
hands and all instruments in a solution of carbolic acid,
I to 20.
Third. — When labor begins commence the production
of the carbolic spray, and after labor every napkin is
carbolized, or carbolized muslin or oakum is used to
catch the lochia, and changed according to the discharge
every hour or two, night and day.
Fourth. — Immediately after labor wash the external
parts thoroughly with the i to 30 solution of carbolic
acid, and give vaginal douches from two to four times a
day. This is kept up faithfully for six or ten days, as
may be required.
Fifth. — The test for the thoroughness of this method
is that at no time should one be able to recognize by the
smell the odor such as usually characterizes the lying-in
woman.
For cases of abortion endeavor to carry out the same
line of i)ractice. Dr. Wylie then read the history of
several cases.
He had reached the conclusion that it was best to con-
sider tlie uterus after an abortion precisely as surgeons of
to-day regard a punctured wound, and just as likely to
be jioisoned and beset with dangers when neglected or
badly treated. He proc»eded, therefore, upon the follow-
ing plan : First, that sejnic matter must be excluded
with great care, and that antisciitics are of great service
in preventing infection ; second, that perfect drainage is
just as essential as in a severe contused and punctured
wound ; that not only versions, and especially fiexions,
may cause retention of lochia, but contraction and swel-
ling of the OS internum very frequently is an active cause
in preventing a constant and free discharge ; third, that
when septiciomia has begun within a reasonable lime, say
June 23, 1883.]
THE MEDICAL RECORD.
693
within ten or twelve hours after the first chill or high tem-
perature, in almost all cases the jiatient may be saved by
perfecting the drainage and by washing out the cavity
either of the vagina or the uterus, as the case may be, by
frequent douches of a solution of carbolic acid of a
strength of from i to 40 to i to 20 ; fourth, that medication,
except so far as it keeps up the strength of the patient,
has little or no direct effect, and that the washing out
with the carbolic acid not only removes or renders inert
the organisms on the surface of the wound or cavity, but
in all probability sufficient carbolic acid is absorbed locally
into the surrounding tissues to weaken if not to sto]) the
active reproduction of the organisms or the generation of
poison associated witii them.
He was fully aware that many cases very soon reached
a stage where neither local nor any other treatment could
arrest the disease, such as those where the poison has
extended rapidly into the connective tissue, or has been
carried a distance from the surface by the lymphatics or
the veins, and started a new centre of local poisoning.
But he believed that most of these hopeless cases began
as simple ones, and if treated in time would never reach
such a dangerous stage.
He did not advise intra-uterine injections in all cases.
If the disease is confined to the vagina, apply antiseptics
to that canal, but do it often enough to keep up their in-
fluence for at least twelve consecutive hours. Usually,
if puerperal fever has lasted for several days, or if the
symptoms are dangerous, it would be better not to delay
washing out both the uterus and vagina, and do it vigor-
ously and faithfully, and do not be satisfied with the
uterine injection twice or three times a day, or even every
three hours. He favored intermittent irrigation instead
of continuous irrigation, for the following reasons : First,
it is more readily and with greater safety carried out ; sec-
ond; it gives the parts, if not the patient, a little rest ;
third, douching at short intervals, we can use stronger
solutions with less risk of poisoning with the antiseptic
than when the continuous stream is employed.
What should guide us in the use of antiseptics after
abortion ? The first symptom is usually a chill, or chilly
sensation, arrest of the lochia, and then a rapid rise of
temperature. If in such a case an extensive laceration
of the perineum, or cervix, or wound of the vagina were
found, he would wash out the vagina with a solution
of carbolic acid, i to 20 at first ; after this give
douches regularly, every fifteen minutes or half an hour,
for three or four hours, of a solution i to 40. If the
temperature then fell gradually, he would continue the
douches in the same manner every twelve hours or more ;
but if, notwithstanding these vaginal douches, the tem-
perature should continue to rise, or go up rapidly after
lessening for several hours, he would at once begin intra-
uterine douches, giving one of i to 20 ; and after
this douches every half hour of i to 40, until the tem-
perature fell to normal.
When the injection returns clear and remains so for
several injections, almost invariably the temperature is
found normal.
It is especially important, in giving the intra-uterine
douche, to be certain that the carbolic acid is pure, and
he insists upon having Calvert's No. i.
The histories of several cases were given which he had
seen in consultation. Dr. Wylie also referred to the his-
tories of nine cases which he had treated successfully in
Bellevue Hospital.
His experience with the dangers of intra-uterine injec-
tions was limited. In one case shock was produced, and
it was afterward found that the solution had entered the
peritoneal cavity through the Fallopian tube. The pa-
tient, however, recovered. In some cases shock was pro-
duced without any apparent explanation. If a large tube,
such as Chamberlain's, is used after the os internum is
well contracted, the instrument may be hugged so close-
ly that the uterine cavity will be filled with the lluid_
injected. Under these and similar circumstances, ot
course, the solution might be forced through the Fallo-
pian tube into the peritoneal cavity, or a clot might be
forced through a vein or sinus and do harm. But if a
gum-elastic catheter was used of sufficiently small size to
pass very readily, with a thread tied around it two and a
half inches from the fenestrated extremity, indicating the
distance to which it should be introduced into the uterus,
not only would the fluid escape, but very frequently
large threads of debris, clots, etc., would be brought
away. •
In those cases where the uterus was flexed, or the os
firmly contracted, and where there is imperfect drainage,
the tube can be left in the uterus, cut off close to the
vulva, and a piece of soft rubber tubmg attached when
the injection is given. When left in this way it served
as a drainage-tube, and the lochia should be caught by a
carbolized napkin or dressing at the vulva.
One special object which the author had in reading
the paper was to advocate the frequent and long-contin-
ued use of antiseptic dressings, when once begun, in
cases of puerperal septiciieniia, and to make it plain that
three or four vaginal or intra-uterine injections given in
twenty-four hours is not sufficient to do much good, and
was likely to result in the disuse of the best, and in many
cases the only, means of preventing death from septi-
cKmia ; that vaginal and intra-uterine injections of car-
bolic acid of a strength of from i to 40 to i to 20, will
save almost all cases when begun early, and that it will
often save apparently hopeless cases.
Dr. MuNDfi said that he had attained very positive
convictions upon the subject of Dr. Wylie's paper, and
that he had employed, with very satisfactory results, the
use of antiseptics after abortions and labor. He had
thought, however, where there was no offensive discharge
from the uterine cavity or vagina, that intra-uterine in-
jections were not useful. Since the introduction of Dr.
Chamberlain's tube, however, he had, in every case in
which the vaginal temperature reached 102° F., used the
intra-uterine injections, and had generally found it suffi-
cient to use them three or four times a day. He was
very firmly convinced where there is a rise of temperature
due to septic endometritis, where there are decomposing
substances within the uterus, giving rise to that condition
commonly known as puerperal septicaemia, that intra-
uterine injection, repeated as often as the temperature
may rise, and continued until the temperature comes
down and remains, is perhaps the only proper local treat-
ment to be employed. But the time arrived when such in-
jections could no longer be of use. He had used them
in cases where the temperature went up and down, and
finally discovered that the rise took place very soon after
the injection had been given, and the patient also com-
plained of some pain. He had thought that in such
cases the injections did not do any more good, but, on
the contrary, developed a traumatic influence which was
kept up, and which had better be avoided. He believed,
if the temperature was substantially unaffected after using
the injections for twenty-four or forty-eight hours, that they
would no longer do any good, and in those cases he had
given ten grains of salicylate of soda every two hours,
which had produced lasting reduction of temperature, even
after quinine, administered in large doses, had failed.
He thought there was a certain danger in the use of
intra-uterine injections, a certain amount of risk of wash-
ing away too much of the accumulation in the uterine
cavity, and there was also a possibility of laying open
some sinuses. He did not favor continuous irrigation of
the uterine cavity. If there is no offensive discharge he
did not see the utility of washing out the uterus. How-
ever, it might do some good, but he thought salicylic
acid or quinine, to prevent rise of the temperature in
these cases, would be better than injections.
Dr. Malcolm McLean had seen two cases in which
air had been introduced into the cavity of the uterus
with almost fatal consequences while intrauterine injec-
tions were given. At the same time, notwithstanding
694
THE MEDICAL RECORD.
[June 23, 1883.
this objection, he regarded the recommendations in the
paper as most excellent, and worthy of being commended.
He believed that the temperature, which in many in-
stances was the active agent in destroying the patient,
could be reduced by this plan. He objected to leaving
the catheter in the uterus during the intervals while the
injection is not being made. He thought it a dangerous
precedent to establish, because it was almost impossible
not to have some air in the tube which might subsequently
be driven into the uterine cavity. In'cases of abortion
he thought that swabbing the uterine cavity with a strong
solution of carbolic acid answered a most excellent pur-
pose. There is sufficient room for this, but scarcely
enough, in many cases, to carry out the plan of irrigating
the uterus by means of a tube. There were certain old
cases of septicemia, to which Dr. Rlunde had referred,
which had not seemed to be^ benefited by the intra-
uterine injection. He thought it well in all such cases
to be sure, if called in consultation, to find out as to
whether the uterine cavity had been injected thoroughly.
It may be reported that it has been irrigated thoroughly,
whereas it may not have been irrigated at all, but the injec-
tion has been simply vaginal. He believed that the soft,
flexible catheter was about as good an instrument as any
which can be used in giving intra-uterine injections, and
he thought it a good plan to keep one finger in close
contact with the cervix, to determine whether or not the
return flow from the uterus was actually taking place.
Dr. H. J. Garrigues thought that we should dis-
tinguish between prophylactic and curative measures. He
had been favorably impressed with the antiseptic plan as
a prophylactic measure, but less favorably impressed with
it as a curative measure in private [Practice. In hospital
practice he had not obtained the results which he had ex-
pected from it as a prophylactic measure, notwithstanding
very thorough antiseptic precautions had been observed.
As a curative measure, however, in hospital practice, it
had seemed to him to be very valuable, especially the
intra-uterine injections. These injections, according to
his experience in the New York ATaternity Hospital, had
invariably brought the temperature down, and they had
been repeated as soon as it rose again, and to the best of
his recollection they had not been required oftener than
once in three hours. He had also used a concentrated
solution of boracic acid and a solution of iodine with ex-
cellent results in the cases in which he wished to avoid
the depressing effects of carbolic acid. In gangrenous
cases he had used a ten per cent, solution of camphor,
and also iodoform with very satisfactory results. In
diphtheritic cases he had employed an eight per cent,
solution of chloride of zinc, besides the intra-uterine in-
jections of carbolized water, repeated^once a day for
seven or eight days, with excellent results. At the same
time, if the parts affected with the diphtheritic exudation
could be seen, a solution of chloride of zinc, i to i, might
be applied locally, and repeated if necessary. He agreed
entirely with the author of the paper, that intra-uterine
antiseptic injections were of the greatest value after abor-
tion and labor. He preferred to use the gum-elastic ca-
theter in their administration. He did not think that the
entrance of air did much harm, for it would be immedi-
ately carried out of the uterus by the injection.
Dr. VVylie, in closing the discussion, said that most
of the points referred to by those who had participated
in the discussion, and the objections mentioned, had
been considered and answered in the histories of cases,
which he did not read on account of lack of time.
He had not seen any trouble from the entrance of air
into the uterine cavity. He usually employed the gum-
elastic catheter No. 12.
With regard to waiting for the offensive discharge, he
thought that that was just the jioint where fatal mistakes
were made, for the reason that the uterus might become
poisoned in consequence of imperfect drainage without
the appearance of any offensive vaginal discharge. He
believed that the severe cases were those which had been
neglected too long, or those in which perhaps one injec-
tion had been given and not repeated until after the
lapse of six or eight hours. With regard to swabbing
the uterine cavity, he thought it doubtful, in very many
cases at least, that every little recess among the tissues
could be thoroughly reached by this method. He was
unable to understand why poisoned wounds of the uterus
should be considered and treated differently from any
other poisoned wounds.
The Society then adjourned, to meet on the fourth
Monday in September.
STATE MEDICAL SOCIETY OF ARKANSAS.
Eighth Annual Meeting, held at Little Rock, May 30
a7ul 31, 1883.
(Special Report for The Medical Record.)
The State Medical Society of Arkansas covened at 1 1
A.M. Wednesday, in the hall of the House of Representa-
tives, and was called to order by Dr. Claibourne Wat-
kins, Chairman of the Committee on Credentials.
Dr. Watkins introduced Dr. J. H. Southall, Presi-
dent of the Society.
Rev. a. R. Kennedy, of the Second Presbyterian
Church, offered a prayer.
Dr. C. WATK.INS, Chairman of the Committee of .\r-
rangements, delivered the address of welcome, an excel-
lent article and replete with good points.
Dr. J. H. Southall delivered the annual address,
which was listened to with the closest attention.
The Committee on Credentials, made their report,
which included forty-one delegates from nineteen so-
cieties, twenty-three permanent members, and twenty-
four applicants for membership.
The President's address was referred to a special com-
mittee of three members.
During the afternoon session invitations to visit differ-
ent institutions and places of interest, and telegrams
from absent members were read.
Papers were read and discussed as follows : "Surgery
of the Popliteal Space,' Dr. J. E. Bennett ; " Skin Graft-
ing," Dr. G. W. Hudson; "A Case of Strangulated
Inguinal Hernia in a Crypt Orchid, " Dr. J. H. Debrell, Jr.;
"Ligation of the External Iliac Artery for Traumatic
Aneurism of the Femoral," Dr. R. G. Jennings, "A
Case of Osteo-Sarcoma," Dr. C. L. Kirksely; "Radical
Cure of Hernia on the Heatonian Plan," Dr. J. E. Ben-
nett; " Notes on Cases of Placenta Previa," Dr. S. Kirby.
At the evening session Dr. E. Cross, as Chairman of
the Committee on Gynecology, read his address. It was
followed by papers on " Laceration of the Perineum,"
Dr. J. T. Jelks; •' Puerperal Convulsions," Dr. W. H.
Hawkins ; " L^se of Ergot in Treatment of Puerperal
Convulsions,'' Dr. A. N. Carrigan ; "An Interesting Ex-
perience in Gynecology," Dr. J. R. Dale; after which
the Society adjourned for the day.
The morning of the second day was consumed in
transacting the business of the Society, consisting of re-
ports of committees, officers, etc.
At the evening session the Nominating Committee re-
ported the following officers for the ensuing year : Presi-
dent— J. M. Keller, Garland County ; First Vice-Presi-
dent— G. W. Hudson, Ouachita County ; Second Vice-
President — -J. M. Carrigan, Hempstead County ; Third
Vice-President — J. F. Blackburn, Franklin County ;
Fourth Vice-President — D. S. Mills, Jefterson County ;
Secretary — L. P. Gibson, Pulaski County ; Assistant
Secretary — E. Meek, Pulaski County ; Treasurer — \.
L. Breysacher, Pulaski County ; Librarian — John Wa-
ters, Pulaski County.
The jilace of meeting next year to be the citv of Little
Rock, and the time to be the Wednesday next preceding
the meeting of the American Medical Association in
1884.
June 23, 1883.]
THE MEDICAL RECORD.
695
The following resolution was adopted unanimously :
Resolved, That the State Medical Society of Arkansas
not only heartily condemns the eft'ort of any local or
State body of medical men to break down or destroy the
Code of Ethics of the American Medical Association, but
pledges itself to encourage no medical school or college
whose professors, one or more, indorse or favor such
effort.
Dr. McGavock. spoke in encouragement of the elec-
tion to the legislature of such delegates as would sustain
a liberal medical law. He moved the President appoint
a committee of five to address the medical men of the
State to urge the importance of medical legislation.
Carried.
Papers were read and discussed as follows : " Diabetes
Mellitus, with Case," Dr. J. E. Bennett; "Some Ob-
servations on Hydrobromate of Hiematropia and on
Jequirity," Dr. T. E. Murrell ; " Modus Operandi of
Zymotic Agents," Dr. W. W. Hipolite ; "Influences of
the Mind," Dr. G. P.. Malone ; " Observations on Con-
cussion of the Spine from Blows, Falls, and Collision,"
Dr. E. Bentley, U. S. A. ; " Laceration of the Cervi.x,"
Dr. J. T. Jelks ; " Hydrophobia," Dr. J. G. Eberle, and
"Report of a Case of Ascites," C. L. Kirksely.
On motion, Drs. Orto and DuVal were appointed a
committee to conduct the President-elect to the chair.
Dr. Southall, the retiring President, with a few brief
remarks, thanking the members for their universal kind-
ness and appreciation of his efforts, recommended their
new officer to their kindest consideration.
Dr. Keller, in assuming the chair, said that owing
to the lateness of the hour he would make them no long
speech, but merely bow his thanks for this honor con-
ferred upon him — the greatest honor of his life.
On motion, the Convention then adjourned.
THE TORONTO MEDICAL SOCIETY.
(From our Canadian Correspondent.)
Regular Meeting, May 18, 1883.
I. E. Graham, M.D., President, in the Chair.
After some routine business Dr. J. Ferguson, M.A.,
read a paper on
puerperal pyrexia.
After setting aside conditions of elevated temperature
due to inflammatory processes, he went on to show that
in a strictly normal labor, followed by a strictly physio-
logical state of the system, there should be no elevation
of bodily heat. Of the causes giving rise to pyrexial
conditions he referred somewhat fully to the following :
I. Cases where there is elevation of temperature from
some derangement of the system, as constipation, urin-
ary derangements of various kinds, arrested or imperfect
action of the skin, and some abnormal state of the
breasts as regards the secretion of milk. 2. Cases of
pyrexia of a purely neurosal character. The reader of
the paper held that during pregnancy there is a period
of high tension ; and after labor a period of low tension.
To this condition of general low tension many cases of
pyrexia could be traced, as the functions of secretion
and excretion were liable to be interfered with by it, in
people of a specially anxious, irritable disposition. 3.
Cases where high temperature was due to malaria. He
thought that the influence of malaria had not received
the attention it merited in connection with the puerperal
state. He divided the cases into two groups : the acute,
where the symptoms are somewhat similar to malignant
ague, and chronic cases of malarial poisoning, where the
symptoms were more like those of low typhoid fever.
He thought that if the woman had once been affected
with ague or lived in a malarial locality, the system
might be so aftected as to give rise to chills and fever
after confinement, although not living in a malarial lo-
cality at the time of her delivery. He recorded three
striking cases of this kind. 4. Cases of pyrexia caused
by a deranged relationship between the absorption of
effete matter and its rejection from the system. This
loading of the system with effete matter might arise in
two distinct ways, or by a combination of both : first, by
an imperfect digestion or destructive oxidation of this
effete matter after it had been absorbed into the system ;
and secondly, by a retention of tliis waste matter in the
system. These toxic materials circulating in the blood
impressed both the secretory and trophic nerves, and in
this way gave rise to constitutional disturbances more or
less severe. 5. The last group of cases were the really
to.x£emic from putrid or septic conditions. This group
was divided into those of soporremia, due to the absorp-
tion from the genital tract of some dead poison ; and
those of a true septicaemia. This latter might arise from
local infection from the hands of the physician or nurse ;
or the contagion come in contact with the lacerated
tract through the atmosphere. It might also be caused
by constitutional infection through the lungs. In this
way the infection of measles or fcarlatina could enter
the system and produce septicemia ; or even a case of
measles or scarlatina as well as septicaemia, if the woman
had not had a previous protection from these diseases.
The treatment reconmiended for soporffimia was fre-
quent sponging of the body and infra-uterine washings,
with good nourishment. For septiciemia the same ]ilan
was adopted, but quinine in large doses, twenty to thirty
grains, three to four times in the twenty-four hours, if
required, to control the temperature and septic con-
ditions.
©orreBproritlctice.
A MISNOMER EXPLAINED.
To THE Editor of The Medical Record.
Sir : The meaning of hy-dro-pho-bia is a dread of water,
not a disease susceptible of connection by any absurd con-
struction from a diagnosis of the so-called disease of
canine madness, which exists only in the imagination.
All persons, as well as animals, dread water or any
drink when under the influence of excessive fear, as a
morbid inactivity of the organs of the throat prevails
which tends to quackle or choke, and this tendency in
the canine race, after they have taken cold in wounds
that produce spasms, is proverbial. What has become
of the mad dogs ? In their absence let us calmly con-
sider a few facts, and ask ourselves whether ignorance
and superstition have not something to do with increasing
their number and magnifying the dangers accompanying
their malady. Dogs are sometimes afflicted with a dis-
temper. When young they frequently have fits, running
wild, with glaring eyes and frothing mouth ; when old
they have attacks of paralysis, and are reduced to a
stupid, inactive condition, both of which have been
called rabies. It is a common superstition, that should
a dog go mad after biting a person, the latter will also
fall a victim to rabies. Dogs suftering from wounds may
take cold, and inflammation setting in, the nerves be-
come affected, spasms ensue, saliva is emitted, water is
avoided, the whole appearance of the animal suggesting
madness. The great disproportion of the sexes, oc-
casioned by the destruction of the female dogs, has a
capricious influence with various effects, including that
of amativeness and jealousy, often making them irritable
to strangers and to snap and bite them seemingly with-
out cause, or at the least trifling annoyance even from
friends. Persons taking cold in wounds have suffered in
a precisely similar manner, with all the attendant mani-
festations of so-called rabies. The effect is the same as
lockjaw, only that a wound from a rusty nail may, with
inflammation from a cold, produce a stronger affectionin
696
THE MEDICAL RECORD.
[June 23, 1883.
the region of the throat. The end of many diseases
which afflict humanity is attended with spasms, saliva,
and other symptoms of hydrophobia. A few incidents
will illustrate :
Some years ago a man in Dorchester, Mass., was bit-
ten by a cat, another in Boston by a rat, and several by
rabbits, the bites producing spasmodic symptoms in all
the victims.
Mad horses and cows have been known, their disorder
(frothing at the mouth, etc.) being doubtless caused by a
poisonous shrub eaten with hay. A father bitten by his
child, from whose throat he attempted to remove
diphtheritic formation, died from the wound. A black-
smith of Roxbury, Mass., sprained his ankle while attend-
ing to a horse ; he took cold, inflammation ensued, then
violent spasms, and paroxysms at intervals for a week
preceding death. The newspapers of 1S78 reported that
last March, in New York, Mr. J. Russell was bitten in
the hand by Thomas Kelly, while quarrelling with him ;
since then his linger, then his hand, then his arm were
successively amputated. He finally died from the effects
of the bite.
A farmer of Ohio died from the effects of a bite on the
hand from an insane son. Some members of a family
were poisoned from eating roast goose, which they
imagined was bitten by a mad dog, and were undoubtedly
under spastic delusion. Had these animals and persons
been bitten by dogs, they would undoubtedly have been
reported as victims of rabies.
A man was bitten on the hand by a dog in Kingston,
N. Y., and after three years was seized with symptoms
which were at once regarded as those accompanying
hydrophobia by all the city physicians, who watched the
case with much interest. Between the interval of spasms
the patient was rational and quiet, partook of water and
food at times, but usually the sight or sound of water
threw him into violent spasms. The man recovered, and
the physicians regarded it as hysteria with hydrophobia
simulation, which they thought was merely mental.
.A. dog-trainer, of New York, whose intelligent experi-
ence was of long standing, did not believe such a disease
as canine madness existed. He was bitten, and while
suffering from the wound his attendants called the malady
hydrophobia ; it was in reality delirium tremens. Watts,
of Boston, who has probably the greatest experience
with dogs in the New England States, never yet discov-
ered evidence of this so-called disease. It is true that
cases have been reported in the medical journals, but
generally with a protest from eminent authorities. One
instance is that of a woman, whose malady was hastily
set down by the physician as hydrophobia. He was
deceived by a chronic case of hysteric fits.
What gives something of a quietus to this obsolete
superstition is the fact of such innumerable cases of per-
sons having been bitten all over the world by dogs with
no serious consequences, which could be cited if space
would admit, wherein rabies have been pronounced as
absolutely existing in the animal and patient, without any
foundation or fact. A single instance, for the present,
gives the fancied ideal of a volume, which is from a per-
son holding office in the Society for the Prevention of
Cruelty to Children and Animals, who witnessed an ex-
treme case, called rabies, of a dog in paroxysms, frothing
and biting fences and everything in his way, and finally
biting a lady severely, aside from which she experienced no
ill effects, and lived thirty years thereafter. Last autumn,
a lawyer, of New York, was ferociously bitten by a large
dog, while entering the premises guarded by the faithful
animal at night. He took care that he took no cold in
the wound, and therefore no harm came of it. A ladv.
of Cambridge, .Vlass., bitten by a black and tan pet last
winter, took similar precaution with like result.
Hunters and sportsmen who have been bitten by their
own and other dogs rei)catedly, under various condi-
tions and circumstances, some attacks being mild, others
ferocious and of a mysterious nature, attest that no
positive evidence has yet been produced to show that
virus ever emanated from a canine's mouth.
The writer during his life has been surrounded by dif-
ferent species of dogs ; his children and friends, as well as
himself have often been bitten by them, sometimes se-
verely ; but by the exercise of every precaution against
taking cold, no ill results have followed. If a wound be
severe, first cauterize it, if possible ; however this may
be, the application of a poultice of flaxseed and slippery
elm, saturated with laudanum, will remove all irritation.
Many practitioners of Paris have for a long time doubted
the existence of hydrophobia as a disease, and those of
eminence, experience, and deep research of Europe and
America, regard it now as fallacious ; while observation,
experience, and an intelligent domiciliary view by others,
who have studied the subject-matter, see no reason why
this phantom should be a synonym of hydrophobia, with
any more sense, than to substitute hallucination for re-
ality! J. O. Cl.APP.
[Our correspondent's statements are interesting, but
they simply show that h\-drophobia is a rare disease
(which is well known), and that many bites are harmless
or only cause a non-specific tetanus. — Ed.]
POLYCLINICS, POST-GRADUATE SCHOOLS,
ETC., AND THEIR RELATION TO THE MED-
ICAL PROFESSION.
To THE Editor of The Medical Record.^
Sir : A fertile source for the inspiration of lugubrious
groans on the part of the medical profession are the
perversion of charity and the development of pauperism
among patients who are amply able to pay ; and as these
are great, if not the greatest obstacles menacing the suc-
cess of those of us who, by a discriminating Providence,
are compelled to practise among the middle and poorer
classes, it therefore justifies a moderate protest against
any institution whereby our means of gaining a livelihood
are materially, and even seriously compromised by these
unnecessary " long-felt wants."
I say they are unnecessary, advisedly, for there is no
city in the world with better clinical advantages than
New York, for the hospitals and dispensaries are numer-
ous where tlie specialties and details of treatment can be
studied.
Not only are there many clinics in the 'city where
for a small fee any specialty may be studied, but in ad-
dition to this many physicians of recognized ability
would gladly extend the courtesy of their ward and
amphitheatre to the student, without hope of fee or re-
ward.
The Polyclinic and Post-Graduate School inculcate
upon the mind of the rustic physician from the wilds of
Bushwick the principles of the various specialties, for a
decided quid pro quo, by means of patients appropriated
from us.
Gelatine-coated pills and the luxuries of the Phar-
macopoeia are not enough, but in addition, in seeking an
obstetric practice, we must contend against placards in
English and German, soliciting pregnant women to be
treated gratuitously — if too poor to pay. Thrift in this
instance assumes poverty for an evident advantage, for,
if necessary, one of the "professors" will assist the
pauper (?) if occasion requires it. Why, sir, in the pres-
ent style, Tom, Dick, and their unmentioned friends
can hire a back-room on the top floor of a tenement-
house, and proclaim themselves " professors " and
" specialists " in the New York Pauper Developing
School, and who can interfere ?
Let us hope, for the benefit of our profession, sadly
lacking in numbers, that the two institutions heading
this article will have the usual disagreement in their re-
spective faculties, and then we may have two more of
them, for we certainly need more colleges. There are,
at the lowest estimate, nine houses in New York City
[une 23, 1883.]
THE MEDICAL RECORD.
697
without a tenant in the shape of a medical man, and the
druggists are overrun with counter-prescribing. Now,
Mr. Editor, let nie declare tliat I have no feeling of
pique. I don't want to he a "professor." I don't want
to write a book. I simply want to make a living, and
let me here detail my experience of the past week :
I had a patient with a stricture, who is in an estab-
lished business, with an income enviable to an ordinary
medical man, and who paid me a good fee on every visit,
and I know too he had no cause for dissatisfaction. He
went to one of these institutions, where he found a " pro-
fessor " who advertises in fact, but not in words (as they
all do in a way), that he was a specialist and " profes-
sor " of venereal diseases. I lose my patient, the patient
receives treatment gratuitously, congratulates himself
on his business sagacity, and ever after becomes a med-
ical "deadhead " for dis[)ensary treatment.
The second case was one of pulmonary trouble, whose
circumstances were on a par with the preceding case.
The third case, a married lady, also able to pay, went
to the "professor" of — well, nails, who asked her
under whose treatment she had been. She mentioned
my name, whereupon the "professor" said : "Oh, yes;
we know him very well. He is a very good doctor — but
he don't know anything about nails."
I must ask you, Mr. Editor, to pardon the space I have
taken ; but 1 am sure that you will find there are others
who feel as I do in this matter. And now for a remedy.
Inasmuch as the success of these institutions means our
loss, it is evidently the duty of every physician whose
business is injured by them to do all in his power, con
sistent with business courtesy and gentlemanly courtesy
too, to thwart their aims, e.g., by persuading any of his
patients who may have gone to either of the schools, to
go elsewhere, etc., and in cases of interest alone, or in
which an opinion is sought, to refer the case to some one
of the dispensary physicians, specialists, or visiting phy-
sicians of the hospitals of this city, who are able men
and who may not be " professors."
In closing, I may say that in this enlightened age this
letter savors of the bigotry and intolerance of ages ago ;
but this is an era of trades-unions, etc. However, your
readers will judge as to the bigotry of Itis.
%XK(m, and ^awMi %zms.
Official List of Changes of Stations and Duties of Officers
of the Medical Department , United States Army, from
June 9, 1883, to June 16, 1883.
TiLTON, Henry R., Major and Surgeon. Granted
leave of absence for four months. S. O. 136, par. 7, A.
G. O., June 14, 1883.
Appel, Aaron H., First Lieutenant and Assistant
Surgeon. Relieved from duty in the Department of
Dakota and assigned to duty in the Department of the
East. S. O. 130, par. 3, A. G. O., June 7, 1883.
Powell, Junius L., First Lieutenant and Assistant
Surgeon. Relieved from duty in the Department of
Te.xas, and assigned to duty in the Department of the
East. S. O. 130, par. 3, A. G. O., June 7, 1883.
Richard, Charles, First Lieutenant and Assistant
Surgeon. Relieved from duty in the Department of
Dakota, and assigned to duty in the Department of the
East. S. O. 130, par. 3, A. G. O., June 7, 1S83.
Official List of Changes tn the Medical Corps of the Navy
for two weeks ending June 16, 1883.
Kershner, Edward, Surgeon. From Marine Bar-
racks, Brooklyn, to the Navy Yard, Brooklyn.
Taylor, John Y., Medical Director. From the Naval
Hospital, Washington, to the Naval Hos|)ital, Norfolk, Va.
Suddards, James, Medical Director. From the Naval
Hospital, Norfolk, Va., and waiting orders.
Turner, F. J., Medical Director. From the National
Board of Health, and waiting orders.
Martin, Charles, Medical Director. From the Navy
Yard, New York, and awaiting orders.
Spear, John C, Medical Inspector. From the Naval
Medical Board to the Navy Yard, New York.
DiEHL, Oliver, Assistant Surgeon. United States
Practice Ship Dale, to report to the Medical Board
for examination, preliminary to promotion.
Vertical 2tcm5.
Contagious Diseases — Weekly Statement. — Re-
port of cases and deaths from contagious diseases re-
ported to the Sanitary Bureau, Health Department, for
the two weeks ending June 19, 1883 :
^;
•a
Week Ending
•a
0
■Is
S
4
V
1
>
a.
"
vi
2iS
■a
u ■
t
^
H
H
!A
u
A
u
en
>
Cases.
June
12, 1883
0
6
104
4
107
46
0
0
June
iq. i88-?
0
7
74
6
91
20
0
0
Deaths.
June
June
12 1883
0
3
3
23
23
4
9
21
18
0
0
IQ 188^
0
22
16
0
0
The Choice of Clothes. — Much has lately been
said and written to show that the demands of fashion
should yield to the laws of physiology in matters of dress.
Public attention has been prominently and frequently
directed to certain well-recognized reforms in garments,
especially in those of women, which are of indisputable
importance. The proposed improvements have mainly
had reference to the shape and size of articles of apparel,
and have chiefly been designed to prevent certain bane-
ful constrictions and compressions, certain unscientific
distributions of weight, and certain impediments to
healthy movement and growth, which fashion has favored,
but which are obviously, in the truest sense, unphysio-
logical. But it must not be forgotten that, in human
dress, intelligently adapted to its essential utilities, the
materials of garments must be wisely chosen, and that
the texture and color of clothes have as important bear-
ings upon the health and happiness of their wearer as the
mere " make " of his apparel. On these points, hygienic
science has established certain definite and reliable con-
clusions. Whatever else may be said about clothes,
their primary object is to protect against hurtful varia-
tions of cold and heat. All their other uses are either
derived from, or are subsidiary to, their essential pur-
pose. If utility strictly rule, it is clear that the material,
texture, thickness, and color of clothes must be gov-
erned in accordance with their bearing upon the protect-
ing function of dress, and that these must be specialized
in conformity with experience to meet the necessities of
different climates, and the requirements of various oc-
cupations. With regard to protection against extremes
of simple cold, as distinguished from cold winds, wool is
much superior, for equal thicknesses, to either cotton or
linen. For protection against very extreme cold, besides .
wool, leather or waterproof clothing is useful. Wool is
especially adapted for underclothing ; when protection
against cold is particularly aimed at, all underclothing
should be of this material. Against cold, cotton and
linen, for equal thicknesses, are about equal in protective
power. For protection against cold winds, leather and
698
THE MEDICAL RECORD.
[June 23, 1883.
India-rubber, according to Dr. Parkes, for equal thick-
nesses, take first rank ; wool the second ; cotton and
linen taking the lowest places. For protection against
extreme of heat, in the form of direct solar rays, the tex-
ture of clothes is practically immaterial ; protection from
this danger depends chiefly, if not entirely, upon color.
White has the greatest protecting power, then gray, yel-
low, pink, blue, and black. For hot countries, white
clothing is the best ; ne.xt comes dress of a light gray or
dust-colored shade, like the Indian " khakee." In the
shade, Dr. Parkes found that the protecting effect of
color against heat is not marked. Here the thickness
and the conducting power of the material are the condi-
tions which affect protection. With regard to the ab-
sorption of perspiration, the hygroscopic properties of
woollen fabrics are well known. The water penetrates
into the woollen fibres themselves, and distends them
(hygroscopic water), and also insinuates itself between
the fibres (water of interposition). In absorbent power
for wat^y fluids, wool is greatly superior to either cotton
or linen ; it has been found that the hygroscopic ab-
sorption of woollen fabrics, as compared with tiiose of
cotton and linen, is at least double in proportion to
weight, and quadruple in proportion to surface. This
observation applies to cotton fabrics made of cotton
fibres as ordinarily prepared. Cotton fabrics made of
cotton fibres so dressed as to become "absorbent," as in
those made for surgical dressings, would probably equal,
if they did not sur[)ass, woollen materials in hygroscopic
afiinity. Amongst the subsidiary functions of clothes are
the effects of various dress materials upon the absorption
of odors, and in protection against malarial emanations.
These considerations respectively assume especial im-
portance in some occupations and in some countries.
Odors probably mark the diffusion of minute material
particles. Their absorption by articles of apparel has
been found to depend partly upon color and partly
upon texture. Stark's observations show that the power
of absorption of odors by dress fabrics, so far as color
alone is concerned, is in the following order : black,
blue, red, green, yellow, white. So far as texture is con-
cerned, the absorption of odors has been found to be in
proportion to hygroscopic absorption. Woollen ma-
terials take up odors best. With regard to the protective
influence of various dress materials against the effects of
malarial emanations, the late Dr. Parkes wrote : "It has
been supjiosed that wearing flannel next the skin lessens
the risk of malaria. As it is generally supposed that the
poison of malaria enters either by the lungs or stomacli.
It is difficult to see how protection to the skin can pre-
vent its action, except indirectly, by preventing chill in
persons who have already suffered from ague ; but the
very great authority of Andrew Combe, drawn from ex-
perience at Rome, is in favor of its having some in-
fluence ; and it has been used on the west coast of
Africa for this inirpose with apparently good results." — -
British Medical Journal, .\pril 28, 1883.
General Practice in England. — A " general i)rac-
titioner " writes to the Lancet in the following strain, and
doubtless his remarks will be re-echoed in nianv quarters
of the globe, not excepting our own country. Dr. Hick-
man, in an able and thoughtful address to the Harveian
Society, pointed out some of the practical grievances of
the general jjractitioner, arising from indiscriminate grat-
uitous medical aid supplied by hospitals and dispensaries,
from the too cheap medical attendance given by provi-
dent dispensaries, and from various modes of low prac-
tice pursued by men who live by underselling their med-
ical brethren.
Mr. Burdett, in the Nineteenth Century, advocates
various reforms in the working of hosi)itals, which at
present defraud the profession and the public ; for a
large and increasing proportion of the patients are quite
unworthy of charitable aid, and such patients defraud
the hard-worked junior members of the staff of the re-
muneration which is due to skilled work. They defraud
the general practitioner of his fees by leaving him and
getting gratuitous medical aid. They defraud the sub-
scribers who give their money to be expended solely for
the benefit of the needy, .\fter due consideration of
the various aspects of the question, Mr. Burdett thinks
that medical men should refuse to do gratuitous work.
The expenses of medical education and of living have
greatly increased during recent years, and yet medical
fees are sinking lower and lower. The very moderate fees
formerly paid cheerfully or gratefully, are now given grudg-
ingly or objected to. The public go to the cheapest medi-
cal market. Hospitals and dispensaries give them what
they want for nothing. Provident dispensaries supply them
at a price less than is paid for beer, and numerous cheap
dispensaries give for sixpence or a shilling what used to
cost from half a crown to five shillings. The effect of
all this on general practice is evident. Many medical
men hardly know how to make a living. The value of
medical attendance is lowered in the eyes of the public,
and an honored and learned profession sinks to the level
of a badly paying trade.
Mr. Burdett wisely advises medical men to cease grat-
uitous work. As regards the vexed question of provi-
dent dispensaries, greater discrimination sliould be exer-
cised regarding the admission of members, and the
remuneration to the medical officers should be increased.
Physicians' Prescriptions. — A rather curious lawsuit
lately took place before the justice of the peace at St. Ger-
main, in which a pharmacist was prosecuted for having
refused to give up a prescription that was taken to him by
a patient. The patient claimed the prescription as be-
ing his property, which the chemist contested ; but the
tribunal decided otherwise, and the prescription was re-
stored to the patient. The Societe de Mt-decine Legale,
commenting on the case, was of opinion that, although
the decision of the judge was unassailable from a legal
point of view, yet it was considered that the restitution of a
prescription was attended with great inconvenience, as
the patient may take it to other chemists successively,
and have it made up oftener than is necessary or good
for him, without any reference to the medical man who
gave him the prescription. Thus it has lately happened
that a female patient spent one thousand eight hundred
francs for the purchase of morphia for hypodermic injec-
tions, which had been only a few times prescribed for
her, but which she ultimately employed on her own ac-
count. The result was that she became insane, which
the medical experts who were required to give their
opinion attributed to the abuse of morphia. Whereupon
the husband sued the chemist, but a case of the kind not
having before been brought to the notice of the court,
the present prosecution has been remanded for legisla-
tion.
PiNUS Canadensis in Diphtheria. — Dr. D. M. Cool,
of Wamly, Iowa, sends a suggestive letter describing the
results of seven years' experience with diphtheria while
practising in Chicago. During this time he saw several
hundred cases of all grades of severity. Before adopting
the treatment which he now recommends Dr. Cool had
used sulphurous acid, chlorate of potash, iron, quinine,
alcohol, etc., with fair success. He writes : " There came
a time when my per cent, of deaths became itiuch too
large to be satisfactory. I was called quite early in the
morning to see a child of Mrs. C , three years of age.
Two doctors had just left it saying it could not live until
night. While thinking over in my mind what I should do
in the case, a thought struck me to try extract Pinus Cana-
densis fluid. .'Vcting upon this thought I wrote for Kene-
day's extract to be applied to the throat by means of a soft
swab once an hour. Internally 1 gave I.abarraque's solu-
tion chlorinated soda, five drops once in two hours. With
this I gave milk, quinine, and brandy. I called in the after-
noon and was agreeably surprised to find the patient bet-
ter. P'rom that time to this, in a large practice, I have
June 23, 1883.]
THE MEDICAL RECORD.
699
used the following : ft- Ex. Finns Can. fl. 3 j.; carbolic
acid (95fi^), gtts. x. M. Sig. Apply (by means of a
soft swab or caniel's-liair brusli) to tlie throat once
an hour. Also, internally, Labarraque's sol. chl. sotla,
3 ij.; give, according to age, three to ten drops in
water once in two hours. This, with the usual support,
has been my treatment, with only the loss of four cases."
A history of these cases is given, showing that in nearly
every case the remedy could not be satisfactorily ap-
plied. Dr. Cool concludes : " I am not a believer in
specifics, but this conies as near to one in my hands
as well as in the hands of the physician whom I have
given it to, as quinine is to a well-marked intermittent.
In order to make it successful it must be applied fre-
quently and thoroughly to the patient's throat, at least
once an hour during the day, and once in two during the
night. So far as 1 know, I am the hrst to use it in
diphtheria. I had used it in leucorrhoea with fair suc-
cess. The solution of chlorinated soda is useful through
the chlorine it contains. In addition to this I apply
salt to the throat e.vternally."
[Dr. Cool's letter suggests the query whether any good
disinfectant applied with such thoroughness will not se-
cure equally favorable results.]
A Successful Closure of a Ruptured Perineum,
WITH COMPLETE LACERATION OF THE SPHINCTER ANI,
without Constipating the Bowels or the Use of
THE Catheter. — Dr. VV. H. Johnston, of Selma, Ala.,
writes: "The patient's bowels were thoroughly evacu-
ated the day before operating, and on the morning of
the operation were again emptied by an enema of warm
water. The rents in the bowel and perineum were
closed with three deep silver sutures, and then two su-
perficial sutures of horse-hair were used, which closed
every part perfectly ; legs were tied together. Op-
eration [lerformed on April 25th. Patient directed to
have a cupful of tepid water, with a tablespoonful of
listerine in it, and to use this to wash out the vagina
every time the bladder should act. On the morning of
the 27th an enema of warm water was gently thrown
into the bowel, followed by the first action since the
operation. On the evening of the fourth day two tea-
spoonfuls of magnesia were given ; bowels acted three
times during night ; patient was directed to use an enema
of a small quantity of warm water whenever she felt that
her bowels were going to act. On the morning of May
ist, six days after the operation, the sutures were all
removed and union was perfect. This patient had been
unable to exercise any control over the tlatus, and when-
ever her bowels were loose could not retain their contents.
My only reason for reporting the case, is that heretofore
it has been generally believed necessary to use the cathe-
ter for three or four days to empty the bladder, and also
it was a rule to constipate the bowel, neither of which
procedures seem to be necessary, and the omission of
which adds greatly to the comfort of the patient."
The Practice of Medicine in the Middle Ages. —
In Mr. Fort's interesting work on "Medical Economy in
the Middle Ages," some interesting facts are given re-
garding the practice of medicine in the Two Sicilies.
Long before the healing art had been replaced on any-
thing like a rational basis in the rest of Christian Europe,
a great deal of the ground lost since Galen was re-
covered in the kingdom of the Two Sicilies. Here the
presence of a large Mohammedan population oftered
facilities for the study of .\rabian science, which had
preserved and in some directions augmented the knowl-
edge gained by the Hellenic anatomists and botanists
and by Greek empyricism generally. Some ol the
Sicilian laws relating to the practice of medicine and
to sanitary regulations attest a surprising degree of
knowledge and sagacity on the part of the legislator.
For instance, a decree of Frederick H. prohibits, under
severe penalties, the sale of diseased pork and deleterious
bread in his Sicilian and Neapolitan dominions. Another
sanitary ordinance by the same emperor orders the dead
bodies of men or animals to be buried in remote locali-
ties or carried out to sea and sunk. Another rescript of
this sovereign's prescribes minute rules for the guidance
of physicians in their practice. They were required to
give gratuitous attention to the indigent sick, and a maxi-
mum fee was fixed for their professional services to the
well-to-do. The fees of apothecaries were also specified,
and physicians were sternly admonished against secret
association with druggists to defraud patients by illegal
additions to the legal cost of compounding remedies. In
other parts of Europe, however, medical honoraria seem
to have been generally determined by special contracts,
often contingent on the recovery of the i)atients. The
sums thus pledged, in written instruments still extant, for
restoration to health seem very large, when we remem-
ber the purchasing power of money at the time. That
cures, real or supposed, were frequently accomplished,
notwithstanding the ridicule heaped upon the medical
fraternity by Petrarch and other writers, may be inferred
from the enormous fortunes accumulated by some prac-
titioners.
The Power of Drugs. — Many men doubt the effi-
cacy of drugs because their efforts have not been at-
tended by success. But this want of success is more
often not the fault of the remedies themselves, but the
fault of the piescriber, who fails, from the want of an al-
most intuitive tact, in the selection of the best drug, or
drugs, and in their proper combination and dosage.
How frequently one sees a patient, who, under the treat-
ment of one man, drags on wearily from week to week,
no better — often, indeed, going from bad to worse —
under another man's care rapidly improve, and from the
very rapidity of recovery giving proof of the efficacy of
the drugs employed. Instead of lowering the estimation
in which our materia medica is held, increased knowledge
is likely to carry it to a still more honored position, when
the powers of each drug, from accurate observation, be-
come more thoroughly defined. — Medical Press.
The New Code and the Sentiment in the West.—
Dr. W. B. M , of Washington Court House, O.,
writes : " I am moved to pen the enclosed effusion be-
cause I am convinced that the idea (which seems to ob-
tain in New York City) that the profession throughout
the country, and especially throughout the West, is
wildly opposed to the new Code, is an erroneous idea. I
am certain that the opinions expressed by the medical
press in the West against the new Code do not reflect
the sentiments of the majority of the practitioners. Here
almost all the regular physicians are in favor of the new
Code. 1 hope and feel certain that Drs. .A.gnew, Roosa,
and their allies, will succeed in the battle which seems
to be going on. It is only a question of a little time when
the whole profession will stand by them."
F.viAL Case ok Chorea. — Dr. J. A. Fordyce, of Hot
Springs, Ark., late House Physician to the Cook County
Hospital, Chicago, sends us a very complete history of a
case of chorea which ended fatally. The case occurred
in the Cook County Hospital under the service of Dr.
F. Heurotin. The patient was a Swedish girl, unmarried,
twenty-two years of age, who had had good health except
for a short attack of chorea a year before. Four weeks
before admission to the hospital the fatal attack began.
The movements were not very bad until a few days be-
fore admission. There was some swelling and pain in
the knees and ankles, and a systolic murmur at the apex
and base of the heart. The movements were very vio-
lent. The patient had a fever ; grew weaker. Salicylates
were given and enormous doses of chloral to secure
rest. Their effect was only palliative. The patient died
within eight days. No autopsy was allowed.
Extirpation of a Large Goitre. — M. Labbe, of the
Lariboisiere Hospital, recently extirpated an enormous
goitre from the neck of a middle-aged woman. The
yoo
THE MEDICAL RECORD.
[June 23, 1883.
operation was rendered imperative from the condition of
the patient, who was being gradually asphyxiated. Know-
ing that the loss of blood would be fatal to a person al-
ready so much reduced, he decided on iiractising trans-
fusion immediately after the operation. One of the
students generously furnished the blood. The tumor
was excised, transfusion practised, and the woman re-
covered. This noble act of the student was highly
praised, and the Legion of Honor will, it is said, be given
to him as a recompense.
The Hospitals of Rome. — In Rome I visited the
Hospital S. Spirito \n Sassia and the great lunatic asy-
lum (Ospedale di S. Maria). It is surprising what a large
number of hospitals Rome possesses. Thus it has among
its large hospitals one for internal diseases only, two for
surgical diseases, one for skin diseases, and one lying-
in hospital. Besides these large institutions it possesses
any number of smaller ones for convalescents, fever pa-
tients, scabies, chronic incurables, etc. Nine hospitals for
strangers (German, Spanish, Armenian, Portuguese, Egyp-
tian, etc.) swell this number. Ospedale di S. Spirito is the
largest hospital of Rome, and at one time was the largest
in the world. It was erected by Innocent III. to serve
both as a hospital and a foundling institution, probably
the first foundling hospital of which we have record
(1200). It possesses an income of one-half million francs
yearly, and receives 200,000 francs additional from the
State. It serves only as a hospital for internal diseases, has
sixteen hundred beds, and about twenty thousand patients
yearly. Malarial fevers, phthisis pulmonalis, pneumonia,
and intestinal troubles furnish the largest number of pa-
tients. Passing through the wards we are confronted by
the malarial cachexia on every side, and our guide was
kind enough to allow us to palpate some immensely en-
larged spleens. Large doses of quinine and some prepa-
ration of iron {I think the iodide is preferred) is the
treatment most generally adopted here. The Roman
Campagna furnishes this large number of patients suffer-
ing from malaria. Phthisical patients are kept entirely
separated here in special rooms. On the whole, I must
say that I was impressed rather unfavorably with its
wards, the light being very poor, and the ventilation not
of the best ; the age of the institution must, however,
not be forgotten in jjassing judgment as to its merits. —
E. E. Sadtler, in Cuicuinati Lancet and Clinic.
St. Andrea Hospital, Genoa. ^The St. Andrea is
our very ideal of what a hospital should be. Beautifully
situated on a hilly projection of the Genoese coast, look-
ing out upon the calm blue expanse of the Mediterra-
nean, it will be a very paradise for the sick. Tlie very
sight of the calm repose expressed on every, side, the
salt breezes laden witli health, will do more toward heal-
ing the sick in this place than any medicine that man
has ever had at his command. Genoa seems to be a
second Cincinnati as regards the lavish generosity of its
citizens. Here we have a woman, the Duchess of Gal-
liera, building three hospitals, one for scrofulous diseases,
one for chronic incurables, and this one in progress —
the St. .'\ndrea — the model of all models. She con-
tributed 5,000,000 francs for its construction, and
ordered neither pains nor money to be spared to make it
perfect in every respect. Six years have already been
spent working at it, and two more years will be required
to complete it. At jjresent work has been stopped for a
time for lack of funds, the private secretary of the duchess
having decamped with $100,000 of the money entrusted
to his care. — Sadtler, in Cincinnati Lancet and Clinic.
Insane fkom Fright. — There has just died at the
Charenton Asylum, near Paris, a man who, thirty years
ago, was condemned to death at the Seine .'\ssizes for
the murder of an old gentleman. The case had excited
considerable interest, and the court was crowded with
spectators. Among the persons standing immediately
behind the criminal, who was flanked by a pair of gen-
darmes, was an employe of the Presse newspapef, who
had somehow contrived to wriggle himself into that posi-
tion without attracting notice. Scarcely had the sen-
tence been pronounced, when this /Vvw^ employe, moved,
as he afterward explained, by an uncontrollable impulse,
passed the side of his hand over the prisoner's neck in
imitation of the keen blade of the guillotine, at the
same time emitting a whirring sound. The man just
convicted instantly fell forward with a shriek of terror,
and the by-standers, indignant at this heartless and
shocking act, rushed upon the Presse man and roundly
abused him, who also was subsequently condemned to
two years' imprisonment. His victim never recovered
the shock, but remained insane until his death. He was
pardoned by the emperor, and confined, first at Bicetre,
and afterward at Charenton, where he has just expired.
He had the delusion that he had been actually beheaded
in the Palais de Justice, and when relating the story was
in the habit of imitating the sound that haunted him for
thirty years. — Gail lard's Journal.
The New York. Medico Legal Societv. — At the
stated meeting of this Society, on May 3d, District At-
torney George B. CorkhiU read a paper entitled "Insan-
ity as a Defence for Crime." The reader referred to the
great extent to which insanity has been used as an
excuse for crime. Speaking of the cases in which men
who avenge the ruin of their domestic bliss by killing the
destroyer, and are acquitted on the ground of emotional
insanity, Colonel CorkhiU said: "Would it not be
more creditable to our juries and more honorable to the
administration of justice to let the jury say by their ver-
dict that the justification for the crime was in the char-
acter of the act which jjrovoked it, and not encourage
and countenance this plea of insanity by a verdict as
contrary to their oaths and the law as would be the
former? If they must a)5ologize, let it be the more
manly apology of open refusal to find a prisoner guilty
under such serious provocation, rather than to shield
themselves behind a defence in which neither they nor
the community which they represent believe."
Colonel CorkhiU did not think that insanity should
ever be allowed as a plea of defence for crime in the trial
of the prisoner under the indictment. When a prisoner
proposes to defend his crime on the ground of insanity,
a jury should be specially chosen for their fitness to try
the special plea, and if the prisoner, after trial, is found
to be insane, tiien he should be confined in an insane
prison a certain time commensurate with the character
of his crime ; if, however, the verdict of the jury declare
the prisoner to be sane, the (ilea of insanity should not
be allowed on the trial of the cause. It is not a question
whether the plea of insanity should be allowed as a
defence for crime, but whether some means cannot be
devised under the law by which its existence can be
rationally and honestly determined.
Mr. Corkhill's view that the question of insanity
should be determined by a special and expert jury is one
which has frequently been urged.
A New Discovery in the Physiology of the
Heart's Action. — Dr. Thomas J. Mayo, of London,
sends us the report of a series of experiments upon the
action of the frog's heart made by him in the Berlin
Physiological Laboratory. He has succeeded in un-
earthing a new phenomenon in the physiology of the or-
gan in question. Heretofore it was always found that
the pulse-waves of the frog's heart never varied in eleva-
tion whether excited by strong or weak electric currents,
i.e., an electric current in passing through the heart either
produced a maximal contraction or none at all. This
was held to be a characteristic mark in the behavior of
the heart, which differentiatetl it from a skeleton muscle.
Dr. Mayo has found, however, that under certain condi-
tions this differentiation entirely disappears, and that very
striking contrasts between high and low pulse-waves can
be called forth in the frog's heart by strong and weak
electric currents.
The Medical Record
A Weekly youj'ual of Medicine and Surgery
Vol. 23, No. 26
New York, June 30, 1883
Whole No. 660
(Dinginal Articles.
IMPREGNATION OI" A COMPLETELY PRO-
LAPSED UTERUS — ABORTION — EXTIRPA-
TION OF UTERUS AND OVARIES, WITH A
LARGE SECTION OF THE POSTERIOR
WALL OF THE VAGINA— RECOVERY.'
By J. T. STEWART, M.D.,
JEOKIA, ILL.
Mrs. C -, aged thirty-five, of (lernian binh, from
Peru, Hi., tiie iiiotlier of five cliildren. was admitted to
St. Francis' Hospital, May 23, 1882. She was suffering
from extreme jjrocidentia, the uterus and bladder pro-
truding half-way to the knees. Her constitution was
good, but she was in an irritable condition and very de-
spondent. I ]nit her on general treatment, to allay this
irritation and build her up, until June 12th. At this
time I operated on her for narrowing the vagina. The
operation was a partial success. It retained the nteiiis
in situ four months ; the organ then burst through. In
the earh' part of February last she returned to the hos-
pital. The procidentia was even worse than before. The
neck of the womb was enormouslv enlarged, measuring
about three inches in diameter, and the entire surface
in a state of ulceration.
As before stated, she was the mother of five children,
aged respectively fifteen, twelve, ten, and six. She had
a miscarriage four years ago at four months. Alter the
birth of the second child the womb prolapsed, protruded
outside the body, and was in this condition most of the
time until after the birth of the last child, when it came
down and remained in a state of procidentia continually.
Therefore, according to her account, she had this proci-
dentia for twelve years, and for the last six years con-
tinually. It probably resulted from a laceration of the
perineum during her second confinement. After the
trouble first began she bore three children. It is hardly
credible that she should become pregnant while the
womb was protruding continually ; but that is her state-
ment, and that she miscarried at four months.
Seeing she could be benefited by no operation, except
the removal of the entire organ, I so informed her, and
laid before her the full extent of the danger of the oper-
ation. She said she would rather die than live in the
condition she was then in, and insisted on my doing it.
I therefore prepared for it, and on February 13th per-
formed it.
Tiie operator was efficiently assisted by Drs. J. P.
Johnson, J. IVhirphy, and J. Studer, members of the hos-
pital staff.
The patient being etherized, the first step consisted in
drawmg the mass well downward and forward and mak-
ing a transverse incision on the posterior part through
the mucous membrane a little below the junction of the
cervix and the body of the womb. Then a longitudinal
incision to near the rectum. The uterus was then seized
by the fundus and drawn downward and forward through
the opening. The uterus with its appendages were
thus fully exposed. On one side a ligature was placed
just outside the ovary ; the ligament was divided inside
the ligature, and the broad ligament divided to the uterus
between the ovary and the round ligament, leaving the
y A paper read before the Illinois State Medical Society, at Peoria, May i6, 18S3.
ovary still attached to the uterus. A ligature was next
placed around the round ligament near the uterus, and
another embracing the rest of the broad ligament the
same distance from the uterus, perhaps half an inch.
These parts were then divided. The other side was
treated the same way.
The next step was to separate the bladder from the
uterus. Here was the great difficulty of the operation,
and it was very great. The whole posterior part of the
bladder had become firmly adherent, not only so but it
had lapped round and adhered to at least two-thirds of
the circumference, of the womb. A sound was intro-
duced as a guide, and the dissection began. By the exer-
cise of extreme care and "long jierseverance this was
accomplished without wounding the bladder. The uterus
was then severed from its attachments to the vagina.
The posterior wall of the vagina being thickened and pro-
lapsed was removed by the scissors. It was then found
that at the upper part, where the uterus was sej^arated
from its vaginal attachment, the peritoneum was loosened
for quite a distance. This was secured by three stitches.
The bladder was then replaced, a wad of absorbent
cotton placed over the vulva, and some cotton wadding
placed over the abdomen, which were kept in place by a
T-bandage.
This completed the operation, which occupied an hour
and ten minutes. By this time the patient was in an
extremely exhausted condition. She was put to bed,
warm blankets applied to her, plenty of fresh air ad-
mitted, and, as soon as she could swallow, stimulants
given freely. She revived in an hour or two and began
to suffer pain, when an opiate was administered. The
posterior wall of the vagina was removed for two reasons :
one was because it was greatly thickened and pro-
lapsed ; the other was to give a fresh surface for the
bladder to rest upon.
The posterior surface- of the bladder in removing it
from the womb was denuded ; the posterior surface of the
vagina was denuded. In lying on her back these two raw
surfaces fell together and adhered, thus making a firm
floor to sup|)ort the intestines, and, of course, the whole
posterior suiface of the bladder being adherent to the ])0s-
terior surface of the vagina prevented it from prolapsing.
There was no need to close the external i)arts. By
leaving them open it gave better drainage, and there could
be no possible object in closing them. The external parts
are now natural. From the outside it is about an inch
to the adhesion in the centre. On each side it is about
an inch and a half. The adhesion is perfect and com-
plete, closing the whole jjassage. No catheter was left
in the bladder, and it was not necessary. The urine was
very easily drawn oft". I instructed one of the Sisters
how to do it, and she drew it oft" four limes in twenty-four
hours for about two weeks, after which time the patient
passed it herself without difiiculty. I may say here that
the secretion of urine was copious all the time. I now
give, from notes taken at the time, an outline of the prog-
ress and treatment of the case. The operation was
done on the afternoon of February 13, 1883.
February 14th. — Fully recovered from the shock of
the operation. No fever and not much pain. Continued
cotton to abdomen. Applied absorbent cotton to vulva,
with two thicknesses of lint moistened with carbolized
water over it. The dressing secured by a T-bandage.
One-fourth grain oijiuni every four hours.
February 15th. — Patient resting well and feeling com-
702
THE MEDICAL RECORD.
[June 30, 1883.
fortable ; respiration normal. Pulse, 110; temperature,
102^. Skin moist. Continue opium, half grain every
four hours. Dressing same.
February i6th. — Pulse, 118 ; temperature, 102° ; great
thirst. Continue opium and dressing same as yesterday.
February 1 7th. — Pulse, 80, very weak ; temperature,
98^-°. Pain and tympanites ; vomited occasionally
through the night. One-grain opium pill every four
hours ; drop doses of Fowler's solution ever}' three hours.
Gave pounded ice to quench thirst, which was intense.
February i8th.— Pulse, 100, weak ; temperature, 98°.
Vomiting ceased ; diarrhcea. Continue opium ; con-
tinue ice. Gave Liebig's extract beef and brandy.
February 19th. — Pulse, 80 ; temperature, 98^-^ ; thirst
intense ; severe pain in abdomen Isy spells. Tympani-
tes continued. Ordered one grain opium every two
hours ; arnica flower poultices to abdomen. Beef ex-
tract continued. Champagne given in [ilace of brandy.
Ice continued ad libitum.
F'ebruary 20th. — Pulse, 80 ; temperature, 98^'. Great
tympanites and pain. Opium, beef extract, and cham-
pagne continued ; also the following mixture :
IJ . Fennel seed • 3 ij.
Manna 3 ss.
Magnesia carb 3 ij.
Tinct. asafcetida 3 ss.
Barley water 3 x.
■ Mix. S. — Tablespoonful every three hours.
Injection into the bowels of asafcetida mixture and
spirits turpentine.
February 21st. — Pulse, 90 ; temperature normal ; little
pain ; tympanites increased. Gave an injection of cas-
tor-oil and turpentine in soapsuds. It passed off with-
out etiect.
February 2 2d. — Had a restless night ; temperature,
normal ; pulse, 100 ; tympanites slightly reduced ; pain
increased. Gave one-fourth grain morphia hy|)oder-
niically. Continue opium pills. Applied turpentine to
abdomen, to be followed by mercurial ointment. A des-
sert-spoonful of the following mixture every three hours :
IJ . Spts. turpentine 3 ss.
01. sweet almonds 3 ivss.
01. anisi gtt. ij.
Aq. anisi r ij.
Pulv. acacia q.s. to make an emulsion.
Beef-tea and champagne given freely.
February 23d. — Pulse, 90 ; temperature, normal ;
tym|)anites still great ; some pain. Repeat hypodermic
injection of morphia ; continue emulsion. -■'^pplv tur-
pentine again, followed by mercurial ointment.
February 24th. — Decidedly better ; temperature, nor-
mal; pulse, 90 ; tympanites less ; pain less ; suppuration
healthy. I will say here that tepid carbolized water in-
jections were used daily to cleanse the wound until it
healed. Continue treatment as before.
February 25th. — Much the same as yesterda)'. The
intense thirst which has been i)ersistent from the begin-
ning now abating. For this ice lias been allowed freely,
which is still very grateful.
February 26th. — Still improving. .Stop meicurial oint-
ment and apply cotton over abdomen. Emulsion once
in four hours, opium at night.
February 27th. — Progressing favorably ; bowels regular,
as they have been most of the time. Stoj) emulsion, ten
grains quinine during the day and opium at night.
Suffice it to say that from this time on, with theexce))-
tion of three or four days in the latter part of the third
week, during wiiich she had a rather severe diarrlitea,
with an almost total cessation of tiie action of the liver,
she improved steadily and very satisfactorily. At the
end of five weeks she could sit up a little. In seven
weeks slie could easily walk across the room alone, and
in two months after the operation she was perfectly well.
A few days later she was allowed to go home. That is
about a month ago. She sa3's, in a letter she wrote a
few days since, that she is as well as she ever was in her
life. Tlie drainage-tube was not much used, for the
reason that it was not necessary.
HOW TO PROCURE THE BEST POSSIBLE
PHYSICAL COXDITIOX AFTER PARTURI-
TION.
Bv J.\MES D. M.\cG.\UGHEY, M.D.,
WALL[NGFORD, CONN.
The above title headed a paper read before the Xew
York Academy of Medicine, Section in Obstetrics. April
26, 1883, by Dr. R. Taus/.ky. Then came the impor-
tant questions, "Why is it that almost every woman, as
soon as she becomes a mother, begins to suffer from
some pelvic disease ? " referring to the very large per-
centage of gynecological cases in which the morbid con-
dition present could be traced directly to childbirth, and
then followed logically the second question, " By what
means can the occurrence of these conditions be pre-
vented?'' The author proceeds to state those things
which will secure the answer to the last question, and
in the main I agree, and would take no exceptions, only
in regard to his remarks on closing all wounds and sup-
pressing the lochia.
A rapid review of his i^aper will show where we di-
verge. In regard to absolute cleanliness on the jiart of
the accoucheur, and tiie use of carbolic solution for disin-
fecting the hand before undertaking a case, its importance
is thoroughly recognized, even by the skeptic, who, if
conscientious, washes his hands in a carbolic or other
disinfecting solution, to give the patient the benefit of
the doubt. Certainly, all instrimients and articles used
about the woman should be cleaned and disinfected.
The bowels should be propeilj' attended to prior to con-
finement. Careful dilatation of cervix facilitates the relax-
ation of the OS, and gently pushing up the anterior lip will
certainly save it from undue pressure and remove a minor
cause of dystocia. Of course, tough membranes should
be ruptured, chloroform given if necessary, and, as for
the forceps, we all know their value, and, I hope, when
and how to use them. As for waiting for the umbilical
vessels to stop beating before separating the child from
the mother, it would seem to be a foolish delay ; if the
child is breathing good, and shows active signs of life,
separate at once and let the attention be turned to the
mother. I'he writer of the paper in question forgot to
mention one important manoeuvre which would certainly
help him out in his idea of suppressing the lochia, viz.,
to keep the left hand pressing firmly down on the womb,
following it up closely as it grows smaller in expelling
the child, and directing an attendant to continue firm
pressure while the cord is being separated and the child
is receiving proper attention. This way of managing the
second stage of labor is very essential in producing the
permanent contraction of the uterus, and in causing it to
cast off the placenta. Crede's method of expression of
after-birth is good, if there is a little tension on the cord ;
at best, it is an overrated measure.
As for examining the genital passages of all puerpera
after removal of secundincs, and directing that all slight
lacerations should be promptly closed, the advice is very
good on pai)er, but very awkward and difficult and often
very unnecessary at the bedside ; besides, the " meddlesome
midwifery " of exposing all women, and of closing slight
lacerations or wounds, would involve more, much more,
danger to the patient than letting them alone.
The binder should never be dispensed with, the child
applied to breasts early, and in the jjuerperal condition
careful disinfection should be strictly observed. But
here Dr.Tauszky and the writer diverge, because his ad-
vice which follows I think fraught with danger, interfer-
ing with nature and the natural post-puer|)erium physio-
June 30, 1883.J
THE MEDICAL RECORD.
703
logical processes, and going entirely too far when he
remarks that " a little hemorrhage after parturition is a
dangerous thing and should be arrested ; " and that the
"accoucheur should be regarded as guilty of malpractice
who would permit a slight quantity of blood to escape
from the genital organs of a woman for days after par-
turition." He maintained that not z. single drop of blood
should appear after the completion of the third stage of
labor, and that napkins removed should be perfectly free
from color (italics my own) ; that should they be colored,
the physician should at once institute an examination
with reference to the. source from whence the blood came,
and set about arresting it. This point was made more
positive in the discussion which followed this extraordi-
nary statement by Dr. Carpenter asking Dr. Tauszky if
" he wished it to be understood as saying that not a single
drop of blood should be seen in the discharges after the
completion of the third stage of labor ? "
Dr. Tauszky replied tliat " no bleeding whatever should
take place after labor; that not one single drop of blood
should be seen." Surely the days of extremists are here,
for in my obstetrical reading I fail to recollect of having
seen any such statement made by any acknowledged au-
thority, either in this country or Europe.
I have always thought that it was a well-understood
fact, that no one ever questioned, that a sanguinolent
flow always follows the parturient state, and that it is
necessary. Upon a matter so well known and recognized,
it seems hardly worth while to take up space to quote
authorities, but on account of the importance of the mat-
ter, and of the necessity of fixing the attention on the
subject, I will do so briefly. Ramsbothara, American
edition, p. 165: "The sanguineous discharge does not
cease as soon as the placenta is expelled, nor ought it to
disappear suddenly ; but a continual oozing goes on
from the uterine vessels in a greater or less quantity for
some time after delivery." It is unnecessary to quote
Playfair, Meadows, Meigs, Smith, Barnes, and a host of
authorities whose combined dicta have settled the ques-
tion long ago. Here is Leishman's opinion, third .Amer-
ican edition, p. 591 : '• Efficient and rhythmical con-
traction of the uterus prevents the flow from becoming
so profuse as to be dangerous, but still a certain
amount of discharge goes on from time to time ; and, in-
deed, it is well known that the maintenance of this dis-
charge for a certain time after delivery is, to some extent,
a guarantee of the favorable progress of the case." Re-
collect, Dr. Tauszky puts his foot, figuratively speaking,
on the womb, and says " not one drop " shall you pour
forth, and, still figuratively speaking, if he keeps up the
practice will undoubtedly put his foot into it many times.
Well, to follow up Leishman, to see how his ideas coin-
cide with the shut-off method. He (Leishman) advises
on the second day after confinement, that the woman
make water on her knees. Why ? Because it (the posi-
tion) " permits escape of any portion of fluid which may
have accuniLdated in the cavity of the vagina." It seems
to me to be ridiculous — a work of supererogation — to
discuss this matter, so universally well known and settled.
But if a subject is allowed to come before the New
York Academy of Medicine and be discussed, and the
proceedings be published in a journal so extensively read
as The Record, and, moreover, as the practice was not
condemned by those present who took part in the dis-
cussion, I deem it necessary, from the intrinsic import-
ance of the subject, to call attention to the paper of Dr.
Tauszky, owing to the influence it may have upon others
who in their zeal are anxious and waiting to adopt some
new and novel manner of treating the parturient woman —
to call attention to a treatment which is the very opposite
of rational, and in the face of well-known physiological
facts, that such "meddlesome midwifery" will do just
what we don't want it to do.
Those who would wish to suppress inuiiediately the
lochia sho\dd read Cazeaux on this subject, and, recog-
nizing the increased amount of liquid in the uterus, also
its enormously increased solids, as compared with the
condition just before and just after confinement, can
easily convince themselves that the physiological func-
tion of the lochia should remain strictly undisturbed as
long as it keeps within normal limits. I believe, after all,
it is impossible, even if desirable, to suppress the lochia
after the delivery of the placenta, and the attempt to do
so is dangerous. After the third stage, although the womb
may have at the time been thoroughly contracted, yet in
most cases there will be a subsequent relaxation — impos-
sible to prevent owing to circumstances unavoidably ap-
pertaining to the woman's heredity, previous health, and
many conditions vitiating iiealth prior to labor ; the blood
will continue to collect in the uterine cavity as it has
slowly transuded from the uterine surface, and Dr. Tauszky
can't help it or prevent it, and after a rest will be ex-
pelled. This flow, commencing some little time after
completion of the third stage, continues from twelve to
fifteen hours, when it loses its consistency, " the color
becomes lighter, and after a short time is changed into a
bloody serosity," of course indicating the natural pre-
liminaries of involution and the reproduction of the de-
cidual membrane ; and a man that would interfere with
this natural process— a process which nature elaborated
and perfected in the grand scheme of restoring the puer-
peral womb to its healthy size and condition — ought to be
mulcted for malpractice. The close connection between
the secretion of milk and the effect beginning lactation
has on diminishing or suspending the lochia shows that
you might as well in healthy cases try to suppress the
milk for fear of mastitis, as to suppress the healthy lochia
for fear of some imaginary evil. .After labor the size of
the womb must be reduced. Suppressing the lochia
would be dangerous, for the reason that in uterine invo-
lution, much that is discharged per vaginam would have
to be carried by absorption through the circulation, un-
duly and unnecessarily loading the blood, and throwing
a heavy burden upon the eliminative organs of the econ-
omy. By its natural retractile power the liquids are thrown
out as well as by direct elimination. As Cazeaux re-
marks, the "uterus retracts its walls gradually, disgorg-
ing fluids they had imbibed, and these naturally run to-
ward the central cavity. So long as the large venous
canals in its (the womb's) substance are not empty, the
discharge continues of pure blood ; later it is composed of
serum, together with the detritus of the ovum and the
mucosities of the organ" — beautiful things to be shut up
in the womb and carried out through the general sys-
tem instead of a '• short cut" by the vagma !
Often unavoidable coagula will remain or form in the
uterus a day or two after labor, and intravaginal injec-
tions fail to dislodge them, and if the lochial discharge is
rudely shut otf, these clots will decay, as well as all other
suppressed discharges, the flow becomes fetid and a
cause of puerperal trouble. Then there is a condition of
the womb after confinement where the discharges are
abundant and the womb high up, called by Leroux
humoral engorgement, which he declares depends upon,
in his estimation, the fact that "the blood-vessels and
pores of the womb, from being distended with blood, do
not become empty as soon as usual, because the con-
tractility of tissue is not then active enough to expel it,
for the walls of the uterus constitute a true sponge whose
meshes are com|)osed of muscular fibres, and which must
retract forcibly, so as to express liquids contained in the
vessels and vacuities which they form." And so abun-
dant is the flow sometimes that, according to Cazeaux,
" the discharge might very readily be mistaken for flood-
ing occasioned by retention of some parts of after-birth
or coagula, the more especially as it is accompanied at
times by sharp after-pains. I5ut if a finger be passed
into the interior of the uterus and no foreign substance
found, with assistance of conjoined manipulation he will
be easily satisfied that the unusual size of the organ de-
pends on enlargement, and the bloody discharge is bene-
ficial. In such a case the absolute rule of shutting oft'
704
THE MEDICAL RECORD.
[June 30, 1883.
the post-parturient discharge would be folly. The pre-
vention of such a condition is difficult if firm, inherent
contractions are absent or impaired from some unknown
or unavoidable cause ; as some wombs, as no doubt has
been the experience of everv one, will contract and re-
main firm, while others will contract and subsequently
relax. To save prolixity, I will not undertake to give
an opinion in regard to the question, '' Wiiy is it that
almost every woman, as soon as she becomes a mother,
begins to suffer from some pelvic disease ? " but recur to
the question, " How to procure the best possible physical
condition after parturition ? " If you can, make the
woman's lioine life, social and moral surroundings as
comfortable and free from worry as possible, saving and
conserving her nervous system to the best extent attain-
able ; pleasant exercise and attention to all the diseases
pf gestation; and, if possible, empty bladder and rectum
before labor. Stay by her faithfully and attend to her
judiciously during labor, letting ergot alone unless most
positively indicated.
When the head, shoulders, and body are being born,
with the left hand steadily compress the womb, followmg
it up closely, so that when empty of child it will be firmly
contracted on placenta. In fifteen minutes ren;ove pla-
centa by combined expression and tension on cord.
Support perineum when needed, and bandage limbs in
minor laceration, and operate on larger ones at once.
Of course, it is expected of every accoucheur that hands,
instruments, and everything about him will be clean and
disinfected, as also about the patient. Apply forceps
when necessary. Leave the 7C'oman in a dry bed with a
good, intelligent nurse, with strict injunctions about diet,
changing clothes, and attending to the breasts. Use the
vaginal syringe only when indicated and not as a routine
practice. Have the labia, outside and in, bathed three
times a day with a solution of carbolic acid and water.
Have the moral and social atmosphere as pure as possi-
ble ; relieve pain. If in a malarial climate give quinine
during the two weeks subsequent to labor. I consider
this extremely important. Procure sleep, and recognize
deeply all the physiological processes luhich nature 'will
set in play. Keep her in bed fourteen days until the re-
laxed uterine ligaments gain strength and the weight of
the womb is reduced, and last, but by all means not
least, let the lochial discharge severely alone, and let no
interference be allozoed except there is evidence that the
proper i?ivolution is not taking place., and the symptoms
admonish us that there has been a laceration, and even
then surgical interference will not be necessary in more
than one-half the cases. It has become too much the
fashion to go to extremes in turning up every parturient
woman to a glaring light and taking a bird's-eye view of
her genital canal, feeling assured that there is a "nigger
in the wood-pile " that must be castigated, and in the
relaxed, contused, swollen, and bloody passage find-
ing something nature is incapable of taking care of imder
sensible and hygienic conditions, and trying to prove that
nature in child-bearing women is, and has been, making
grand mistakes every time a child has been liurn into the
world. Let common sense, tempered and pruned by
conscientious study and experience, following the guide-
boards, indications, be the dictator. Let us recollect that
no man has any right to disturb Viny physiological process 0/
nature in regard to laiwr, lest he cause a blight to fall upon
a home which will cause it to be darkened forever by the
death of one of the most sacred and important individuals
of the household — the mothar. Following out the plan
laid down, except in those cases of unavoidably bad
labors from some dystocia due to mother, child, or secun-
dines, we believe the results following will be the answer
to the question propounded at the head of this article.
The vARiou.s New York Medical Societie.s have
ceased to hold meetings until after the vacation. The
larger number will commence work during the first fort-
night in September.
TRACHEOTOMY: A REPORT OF TEN CASES,
WITH REMARKS UPON THE INDIC.ATIO.VS
FOR THE OPERATION.
Bv N.VTHAN JACOBSON, M.D.,
SYRACUSE, N. Y.
I SHALL briefly jiresent the records of my first ten trache-
otomies, and puri)ose dwelling in their consideration upon
the train of symiJtoms which necessitated the 0])eration,
and the circumstances afiecting the prognosis or influenc-
ing the termination of the case.
Case I. — During the months of June, July, and Au-
gust, 1880, A. K , a lad, ten years of age, was under
treatment for a suspicious form of laryngeal and bronchial
trouble. When first seen he had aphonia. He breathed
with difticulty, each respiration being audible, the air
producing a rattling noise as it forced itself through the
accumulated mucus. He was emaciated, had a cough
and night-sweats. No dulness upon percussion, mucous
and subcrepitant liiles could be heard over either lung.
The epiglottis was ulcerated and cedeinatous ; the upper
part of the larynx swollen and filled with mucus. Slight
glandular swellings about the neck. No fever. No
Hutchiusonian teeth. No history of syphilis could at
this time be revealed.
Upon cod-liver oil, hypophosphites and strychnia, and
local applications of iodoform to the larynx during the
succeeding months, his weight increased, his cough left
him, the breathing was more free and the night-sweats
disappeared, although the pulmonary condition had not
materially changed. But during the rainy weather of
August he took cold.
x\ugust 28th. — The pulse was rapid and feeble ; tem-
perature, 104° F. ; dyspnoea very severe, suprasternal and
epigastric depression with each inspiration. Extreme
oedema of the epiglottis and upper portion of the larynx
existed. Emetics and hot fomentations failed to relieve
the distressed breathing. On the following day, the
trouble seeming rather aggravated than improved, trache-
otomy was [jerformed. Drs. Didamaand Totman assisting.
In the after-treatment no steam was used; the tempera-
ture of the room was maintained at about So° F. The child
remained under the constant care of physicians for forty-
eight hours and then was transferred to the parents. The
temperature bv midnight of tlie day of operation fell to
99.5°. The following day it was normal, and remained
so. On the third day after operation auscultation failed
to detect any abnormal respiratory sounds. Anti-
syphilitic and tonic treatment was pursued, with the local
application of iodoform and astringents t© the larynx.
A steady improvement was noted in the after-history
of the case.
January 16th, four and one-half months after opera-
tion, the tube was removed. The wound healed nicely.
There was com])lete freedom from dyspnoea ; the lungs
were normal ; the ejiiglottis cicatrized, h. thickened
condition of the mucous membrane of the upjier part of
the larynx remained ; the voice was hoarse.
Case II. — On the evening of May 30, 1S81, I saw
Anna H , aged eight years. She was suffering from
the ordinary symptoms of croup. Pharynx healthy.
Temperature, 99.5° F. Emetics were prescribed and af-
forded great relief. On the following day she continued
to be hoarse, yet her breathing was free. .At this
time the laryngoscope detected a fine film upon either
false vocal cord, and reaching upward to the aryepi-
glottic folds. For the succeeding days the case was
closely watched. The temperature never reached above
100° F. The breathing gradually grew more distressed,
the attacks of dyspnoea more severe and frequent, and
the hoarseness developed into aphonia. Emetics, slak-
ing lime, steam, and other remedies failed to relieve her.
Doctors Pease and Plant were called in consultation to
consider the necessity of doing tracheotoni) . The op-
eration was performed. For ten days succeeding the
operation the temperature continued elevated, varying
June 30, 1883.]
THE rylEDICAL RECORD.
705
from 100° to 102°. A diphtheritic deposit appeared
upon the edges of the wound on liie fifth day after opera-
tion. An erythema existed over the entire body during
the second week. The urine was at all times free from
albumen. Lime was freely slaked for several days, but
seemed to irritate the bronchial tubes. One drop of
liquor potassa; <n an ounce of lune-water was substituted,
sprayed by the atoniii:er Over the mouth of the canula.
This would always relieve impending dyspncea due to
accumulated mucus or loose membranes. For two weeks
the child could not breathe, when the orifice of the canula
was closed by the finger. During the third week air
gradually found its way into the lung by the side of the
tube. The patient was carefully watched day and night.
On the twenty-fifth of June, twenty-two days after opera-
tion, the tube was removed.
Case III. — On January 30, 1882, at 10 a.m., I was
called to a child fourteen months old. The family lived
in the fourth story of a tenement block, in very destitute
circumstances. The child had been sick since the 28th
inst. It was very hoarse, had great difficulty in breath-
ing, and a temperature of 100" F. The tonsils were cov-
ered with a diphtheritic' deposit, the glands of the neck
badly swollen. A tent was made with a sheet and lime
slaked. During that day and night it constantly grew
worse. On the following morning, assisted by Drs.
Aberdein and Totman, I tlid tracheotomy. The trachea
was so small that, when the forceps were stretching it,
the tube had to be introduced by main force. I could
fairly feel the trachea tear under the pressure exerted.
Dr. Cowles (who has since met a sad fate at Rochester)
and myself in turn remained constantly with the child
after the operation, and persisted in freely slaking lime.
At eight in the evening dianhcea appeared, and vomiting
soon set in. The breathing remained free, the distress
was perfectly relieved. The diarrhoea and vomiting be-
came uncontrollable ; the temperature rose to 103° in
the evening, 104^ during the night, and 105° in the morn-
ing. Convulsive twitchings ai^peared. At three in the
afternoon, twenty-eight hours after operation, the child
died in a severe convulsion.
Case IV. — On the evening of July 19. 1S82," Dr. A.
C. Benedict requested me to see a child affected with
membranous croup. I found a girl, seventeen months
old, suffering from great dyspncea. The family was living
in some miserably ventilated upper rooms in a tenement
house. The child was poorly nourished ; had no pharyn-
geal patches. In an adjoining room was the mother,
bedridden with phthisis. 1 urged that a tent be made
and lime slaked. At the morning visit the father insisted
that the lime had only helloed to make the child worse.
Three or four times he had placed the child upon the
bed thinking it was dying. The condition certainly was
worse, and Drs. Benedict and Totman concurred with
me in the belief that unless tracheotomy be i-ierformed at
once the child would die in a very short tmie.
There was some little difficulty in introducing the tube,
because of the small size of the trachea. For several
days some of our medical students watched day and night
with the child, after this she was entrusted to the care of
the father or willing friends. No case could have had
more to contend with in the way of poor nursing, through-
out the greater part of its history, than this one. The
slaking of lime was discontinued and a solution of one
drop of liquor potassie to an ounce of lime-water sprayed
over the mouth of the canula. This would always re-
lieve her dyspncea. On March 14th an eflbrt to remove
the tube was made. Dyspncea returned at once and the
tube had to be replaced. On April 3d the mother died,
and, despite the inclement weather, the child was removed
in a closed carriage to St. Joseph's hospital. Each month
an attempt was made to remove the tube, but as often as
it was withdrawn, whether under ether or not, the im-
pending dyspncea forced its return. The child would talk
aloud, utter loud sounds, and apparently breathe freely
when the finger was held over the opening of the tube
yet it was never possible to remove it. The child's
general health seemed fairly good. She played about,
went out of doors, and was finally removed to Rochester,
after having been in the hosi)ital nearly four months.
Case V. — VV. A. S , aged fifty-four, a farmer resid-
ing in Otiseo, consulted me May 16, 1882. He had
aphonia and some difficulty of breathing, which he at-
tributed to a cold. There was a slight scaly eruption,
perhaps half an inch square, on the upper lip, but no other
cutaneous disease. His pharynx was healthy, but the
larynx bore the unquestionable marks of syphilis. I pre-
scribed anti-syphilitic treatment. Returning to my office
on the afternoon of June nth, I found the same person.
He was laboring fearfully for breath, was cyanotic, had
cold extremities and a very weak pulse. Dr. Munson
had seen him in the morning and, recognizing the danger
of the case, had sent him to the city to have tracheotomy
performed. He was at once removed to St. Joseph's
Hospital and etherized, .■\ssisted by Drs. Totman, A. C.
Mercer, and Stanton, I operated. Immediate relief was
given. Stimulants and sustaining food, large doses of
the iodide, a warm room but no steam, were prescribed.
After three weeks he left the hospital for home, not a
single unfavorable SNUiptom had occurred. The tube,
which might have been removed, was left in the trachea
to give the larynx proper rest, that it might heal. He
labored upon his farm, doing more work than he had in
some time. Late in the summer, I am told, he was at-
tacked with gastro-enterins and died.
Case VI. — On July 8, 1882, I saw — with Dr. Skinner,
of East Syracuse — a child sixteen months old, well-nour-
ished, slightly cyanotic, with hurried respiration and no
fever. The child had been seen to put a bean into its
mouth two days prior. It strangled, nearly suffocated,
and finall)', while the parents and friends were working
over it, the foreign body was pushed downward. Drs.
Skinner and Chase were called. It was impossible to
dislodge the bean by emetics, position, or any means
resorted to. The fact that the right lung was collapsed
and received no air whatever, while all the respiratory
sounds were exaggerated on the left side, indicated an
impacted right bronchus. Tracheotomy was done. Dr.
Skinner assisting. The dissection was very carefully and
slowly made. The veins were crowded aside, the trachea
finally exposed and opened for about half an inch. The
tracheal orifice was held open by Dr. Skinner with a two-
bladed dilator. After using half a dozen difterent for-
ceps in vain, one devised by Stoerk, of Vienna, finally
succeeded in grasping a piece of the skin of the bean.
Soon another piece of the skin, then half of the bean
and finally the remaining half. The wound was closed
with straps. On the day after the operation the tem-
perature was 103.5°, respiration 60, and [julse very rapid.
The child was very restless and could not sleep, the
straps had given way, and the child breathed through
the tiachc;al orifice. Paregoric, i[uinine, and sponging
were prescribed. The next day the temperature had
reached 104.2°, and no improvement in the other symp-
toms. The child breathed etiually well with both lungs.
On the third day the symptoms improved, and by the
fifth day all fever disappeared. Five days later the
wound had healed and the child fully recovered.
Case VII. — At noon of October g, 1882, Dr. Didania
requested me to tracheotomize a child five years old, that
he had just seen in consultation with Dr. Weaver. 1
found the child all but dead, with all the terrible symp-
toms of membranous croup. The little one was chloro-
foriued, and the operation done. It seemed as if it could
hardly live through the oiieration. Drs. Weaver, Tot-
man, and HeftVon were present. For two days the child
was most carefully watched, with either a physician or
a medical student in attendance. The laryngeal distress
was completely relievetl, but the respiration remained
hurried and superficial and at times dyspncea appeared.
The alkaline spray was used, but did not relieve the
dyspuLeic attacks as it had in previous cases. The
7o6
THE MEDICAL RECORD.
[June 30, 1883.
lungs were found to be cedematous. The heart's action
continued very feeble, and stimulants were freel)' admin-
istered. The temperature never rose above 102', but
the lungs continued to grow more and more cedematous,
the heart weaker, and finally, on the morning of the nth,
forty hours after operation, the little one died, not of suf-
focation nor in that terrible distress in which it was before
operation, but because of the condition of the lungs.
Case Vlll. — October 22, 18S2, at i p.m., I saw the
child of M. S , three years old. The dyspncea was
frightful, supra-sternal and epigastric depression marked,
cold extremities, and the child dying for want of air.
The pharynx was loaded with diphtheritic deposit, the
glands of the neck swollen, the pulse weak, and the
temperature 103° F. A physician had seen the child
at his office on the previous day, and had promised
to see the patient on the next, but failed to do so.
Tracheotomy was performed. Dr. Totman assisting.
The dyspncea was relieved. During the afternoon the
temperature gradually increased, despite everything that
was done, and at 7 P m. had reached 106' V. Tlie pulse
became so rapid that it could not be counted. The child
remained stupid during the entire afternoon, as if pros-
trated by the general infection. It died evidently of
paralysis of the heart.
Case IX. — About three o'clock on the morning of
November 14, 1882, Dr. Oberlander aroused me and
requested that I call with him upon a child, seven years
of age, suffering with diphtheria. The tonsils and pos-
terior arches of the pharynx were covered with mem-
brane. There was every symptom of extensive laryngeal
disturbance, which with the laryngoscope could be seen
to be of the same character. It seemed as if the child
must die at every moment. The parents consenting,
tracheotomy was performed, the father holding a miser-
able oil lamp, the only source of illumination. An effort
was made to chloroform the girl, but instead of relieving
the distressed breathing, as it usually does, it tended only
to aggravate it. You seemed to be between Scylla and
Charybdis, death from chloroform or asphyxia from la-
ryngeal obstruction. The tube was finally entered, the
child breathed freely for about a minute, when respiration
suddenly ceased and the child was dead.
Case X. — Dr. Thomas, of East Syracuse, telephoned
me about noon of April 2, 1883, to come to that village
to see R. A , a child two years of age, that had been
afflicted with pharyngeal diphtheria for several days.
Three days prior to my visit the larynx had become in-
volved. The dyspncea was very great. Tracheotomy
was performed at 2 p.m., Drs. Thomas, Skinner, and
Chase assisting. The cliild at once breathed easily, and
for the first twenty-eight hours everything progressed
fairly well. Twenty-four hours after operation I saw the
child again. There was no laryngeal distress, the tem-
perature had risen to 104° ; pulse, 150 ; respiration, 50.
During the afternoon of the second day a very peculiar
train of symptoms appeared. The respirations were not
very labored, but would at times be very irregular, now
rapid, and in a moment so slow that one would tiiink the
child had stopped breathing. These attacks would last
perhaps fifteen minutes, when, for a time, the respirations
would be regular. The temperature was very high ; at
2 P.M., 105° ; at 3 P.M., 1041° ; at 4 P.M., 105^° ; at 5
P.M., 104.9° ; 3.t 6 P.M., 1051° ; at 7 P.M., 104.1 ' ; at 8 p.m.,
103.5°. For the reduction of the heat, quinine, sponging,
and the cold pack were used. The temperature of the
room was kept at 80°. Vessels with steaming water
kept the atmosphere moist. The alkaline spray was
used. .\t midnight I w'as sent for. Dr. Thomas had
been in attendance the entire evening. The child had
several of the severe attacks of breathmg described. .Vt
one time it was thought to be dying of collapse, but
brandy hypodermically revived it. At midnight, pulse,
160; respiration, 48; temperature, 99. 5°, and the child
was sleeping quietly. In this condition it remained until
1.30 A.M., when the respirations suddenly increased to
70 and became very shallow. This continued about a
minute when the jaws became firmly set, the extremities
cold, and the respirations reduced to ten per minute.
The pulse gradually became slower and slower, until it
reached ninety. Stimulants were given hypodermically as
rapidly as possible. Suddenly the child ceased breathing.
The heart continued to beat for about a half minute after
the breathing had ceased.
Remarks. — The questions now arise : AVhen is tra-
cheotomy indicated ? What hope does it afford ? What
difficulties does it present? What benefit, in reality, is
derived therefrom ? In the cases here reported the op-
eration was done for immediate relief from impending
suffocation, save in the instance where the foreign body
was removed from the bronchus. In each case it was
the unanimous opinion of the physicians in attendance
that without the relief the operation would afford death
must follow, and, in many of the cases, that very soon.
In each case emetics, lime, steam, or some other favorite
mode of treatment, had been thoroughly tried, but with-
out any resulting benefit. In all the same tale is told of
increasing distress in breathing, approaching cyanosis,
more frequent attacks of dyspncea : shorter intervals of
free breathing ; labored respiration, w-ith supra-sternal
and epigastric depression with each respiration ; cold
extremities ; a pale, anxious countenance ; strength ex-
hausted, and the patient dying. Allowed to progress,
the patient grows more and more cyanotic, the heart
weaker, the lungs cedematous, the breathing more la-
bored, indeed, frightful to behold, and when death comes
it is thankfully received, for it frees the patient from ter-
rible agony. Tracheotomy opens the w-ay for supplying
the much-needed air to the lungs. The blood is again
aerated, cyanosis disappears, the breathing is easy and
tranquil, and the extremities regain their warmth. The
patient is given an opi^ortunity to outlive the disease.
The operation is only done when we feel certain that no
other course is left open from which we may expect
favorable results. But what encouragement does the
operation ofter ? Tet us study the successful cases and
see. Of the five that ended in recovery, two were done
for syphilitic laryngitis, one for the removal of a foreign
body in the bronchus, and two for membranous or diph-
theritic croup. In the first case (the child with hered-
itary syphilis) we gained not only immediate relief from
severe dyspncea but a restoration of the lungs to a
healthy state ; rest for the larynx, and finally a perma-
nent recovery from the laryngeal disease. Fully as much
was secured in the other case of syphilitic laryngitis ; al-
though when found at my office he was so nearly dead
that it did not seem possible that he could survive until
conveyed to the hospital. He was so thoroughly uncon-
cious that when he grew better be was unable to recall
anything that transpired for two hours prior to the oper-
ation.
The case of foreign body in the air-jiassages is no less
instructive. It certainly establishes the fact that an
operation of the severity of tracheotomy can be success-
fully performed, and followed by an equally severe oper-
ation of entering the bronchus and removing the foreign
substance, in a child but sixteen months old. It has
been said that tracheotomy is unsuccessful in children
under two years of age. This case, added to the other
reported in this paper, and the many others in which our
literature abounds, must disprove this view.
The two successful cases of membranous or diphther-
itic croup will, perhaps, interest us more. The first, a
girl of eight, asphyxiated because of laryngeal obstruc-
tion, made a good recovery without any complication,
e.\cept the aiipearance of the diphtheritic erythema. The
tube was removed three weeks after operation. The
woimd healed nicely.
'1 he second, as stated in the report, faced all the
difficulties a case could contend with. But seventeen
months old, a consumptive mother dying in the next
room, a miserable home with the vilest and filthiest sur-
June 30, 1883.]
THE MEDICAL RECORD.
707
roundiiigs, obliged to be cared for by the neighbors,
and being transferred during cold and raw weathi-r to
the hospital, were obstacles enough. It is but fair to
presume that if a child, under these circumstances,
could recover when at the time of operation it hardly
seemed possible that she could live through it, there must
be hope for other children.
As to the unsuccessful cases. The lirst, a child but
fourteen months old, with pharyngeal diphtheria, poorly
nourished, poverty-stricken parents, and wretched hygie-
nic surroundings, met its death through cholera infantum
with high fever and convulsions.
The second was of good age and robust, but the
operation had been too long delayetl. CEdema of the
lungs existed. The child was e.xhausted with vomiting
and the labor of breathing with the e.xisting dyspncea.
There is good reason to believe that had the operation
been done earlier the child would have recovered.
The third death was likew-ise after an operation per-
formed when the child was almost breathing its last.
But the terrible general infection and the high fever
overpowered the child. The fourth affords an oiiportu-
nity for argument. Whether chloroform occasioned the
death or some hidden cause existed I cannot say.
In the last case, the child did nicely for twenty-four
hours, but the peculiar respiration and the accom-
panying peculiarities of pulse and temperature point, in
my mind, to some central disturbance as the cause of
death.
In all cases the object for which tracheotomy was
done was thoroughly accomplished. The patient was
made to breathe freely. Now the question arises, What
is the duty of the physician in this class of cases ?
When called to a case of diphtheritic or membranous
croup, it should be his care to thoroughly enlighten the
parents as to the character of the disease and what may
develop. He should carefully watch its progress. If
accumulating mucus in the laryn.x obstruct the passage
6f air, emetics may be administered to relieve it. But
their persistent and continued use in cases where adhe-
rent membrane alone occludes the passage can only
result in debilitating the child, while affording no relief
to the dyspnuea. The use of the lime should not be con-
tinued when it fails to afford relief or hold the disease in
check. As will be observed I have had but poor results
from its use. The (physician is culpable if tracheotomy
be long delayed, and resultmg cedema of the lungs and
a weak heart develop. The operation should not be
done as a last resort at'ter the ill-spent efTects of turpeth
mineral, sulphate of copper, alum, and the host of other
emetics have e,xhausted the child. There is no reason
why a case should be watched from day to day, contin-
ually growing worse, and then operated upon under the
dim light of a miserable kerosene lamp, at an early hour
in the morning, just as the child is ready to shuffle off its
mortal coil.
We cannot even assure the parents that the child will
live through the operation ; but should it, we can safely
promise that it will breathe freely. One thing is sure,
they have nothing to lose, everything to gain by tra-
cheotomy. Moreover, they should be given to under-
stand the necessity of i>alient watching. The child must
not be allowed to sit up, for fear of syncope, to turn its
head, for fear of inducing suffocation. The tube must be
cleaned at proper intervals. The temperature of the
room must be cared for ; a moist atmosphere produced.
Weeks, jjerhaps months may pass before the tube can be
removed and the child breathe per viam naturalem.
These are the points that we must consider in asking
ourselves what can we e-xpect from, what can we prom-
ise for tracheotomy.
The Law and the Doctor. — Dr. Mcl-ean, of Ann
Arbor, Mich., has been successful in his action for libel
against the Detroit Eveiiini; News. He has recovered
damages to the amount of $20,000.
^r00vess J3f |]bteaicul JSciencje.
OxYDENDRON IN ANASARCA. — Dr. Clendenin {Ther-
apeutic Gazette, April, 1883) calls attention to a drug
which the eclectics have had good success with in the
treatment of dropsy. The drug in question is sourwood
(oxydendron), which grows abundantly throughout the
Soiithern States. The leaves and bark of the sourwood
contain the medicinal properties, being diuretic and lax-
ative. The best way to use it is to make a semi-solid
extract, which should be worked into two grain pills, to
be given in doses of two or three pills, tliree times daily,
gradually increasing the dose eacli day until twelve or
fifteen pills are given during the day, then gradually de-
creased day by day until the original dose is reached.
By this mode of treatment he claims dropsical effusions
of the worst form may be often removed.
Subacute Diffuse' Sarcoma of the Peritoneum.
— The following case is reported by Dr. E. Gaucher in
La France Aledicale of March 31, 1883 : A young man,
twenty-seven years of age, had been suftering for two
months with obstinate diarrhcea, the stools at times being
mixed with blood. He emaciated rapidly and lost
strength. About a week before admission to hospital
his abdomen began to increase rapidly in size and his
legs became cedematous. The belly was hard and tense
and very painful on pressure. There was excessive
tympanites with but moderate ascites. The latter, how-
ever, increased rapidly after a few days, and so interfered
with respiration that it became necessary to jJerform
|)aracentesis. About twenty-five ounces of sanguineous
fluid was taken away. The patient appeared to be re-
lieved by the operation, but died three hours later. At
the autopsy the peritoneum was found to be thickly
studded, throughout its whole extent, with verj' vascular
cancerous vegetations resembling raspberries. The
omentum presented a most peculiar appearance, entirely
covered, as it w'as, with these raspberry vegetations,
filled with blood and pressing closely one against the
other. There were no cancerous lesions to be found in
any of the viscera, nor was there any glandular infection.
The vegetations were seen under the microscope to be
composed of embryoplastic cells, closely pressed to-
gether, and sustained by a delicate network of fibrous
connective tissue. There was a large number of newly
formed blood-vessels.
Naphthaline as an Antiseptic. — In a monograph
entitled Die Wiuulbchandluiig mit N^aphtalin, Dr. Carl
Bonning has formulated the results of upward of fifty
cases in which naphthaline dressings were employed after
operations in the Strasbourg surgical clinic. From a study
of these cases, as also of a number of other less serious
injuries treated in the polyclinic, he feels justified in
regarding this substance as a most valuable antiseptic.
He sums up its advantages as follows : i. It is very
cheap — a consideration not to be despised, especially in
hospital practice. 2. It is convenient to handle and
easy of application : it is simply sprinkled in powder
upon the wounded surfaces and the dressings, or cavitie_s
may be filled with it. 3. It is not poisonous, and thus
may be used without fear in cases in which the employ-
ment of carbolic acid or iodoform might be attended
with untoward consequences.
In a brochure on the same subject (Naphtalin in der
Heilkunde tind in der Laiidunrthschaft), Dr. Ernst
Fischer speaks most highly of its destructive action upon
the lower forms of animal and vegetable life. He ad-
vances the same considerations in its favor as does Dr.
Bonning, viz.: its ease of application, its non-poisonous
properties, and its cheapness. Among its disadvantages
he recites : i. Its insolubility in water, whereby it is un-
suitable for the disint'ection of wounds which are to be
closed by suture, z. Its disagreeable odor. 3. The pro-
7o8
THE MEDICAL RECORD.
[June 30, 1883.
fuse secretion which naphthaline excites where it is
applied to a large extent of wounded surface. He
recommends its use also in skin diseases of parasitic
origm. The second part of the monograph is devoted to
a consideration of the valueof naphthahne in agriculture,
and especially of its destructive action upon the phyl-
loxera.
Lappa Minor in Psoriasis. — r>r. W. C. Reiter
{Squibb's Ephemcris) claims that the use of a tincture of
burdock seed has yielded excellent results in the treat-
ment of psoriasis. The tincture is made from one part
of burdock seed ground fine, and macerated with eight
parts of diluted alcohol. The dose is a teaspooniul.
Uric Acid and Renal Concretions. — In the Lum-
leian Lectures for 1883, Dr. Garrod [British Medical
Journal, March and April, 1883) took for his text the
physiologv of uric acid and its relation to renal calculi
and gravel.
Two theories, he said, as to the origin of uric acid in
the animal economy are advanced. In the first, the kid-
ney is regarded simply in the light of a strainer of the
uric acid which is formed in the blood, anti passes through
it. In the second, the kidney is held to be the actual
producer of uric acid, and the presence of this jirinciple
in the blood and tissues is explained by resorjition from
the renal cells, a process which becomes more marked in
proportion to the difficulty which the uric acid has in
finding its way to the luiniferous tubes.
The human subject excretes on an average in the
twenty-four hours about one part of uric acid for each
120,000 ])arts of his weight, whilst in birds the amount
excreted is about ^Isj part of the body-weight. Again,
the blood of the bird is as free as, and often freer than,
that of man from uric acid, so that it is hardly possible to
look at these facts and maintain the first theory that uric
acid first exists in the blood.
Another point which goes to disprove the first theory
is that in the kidney-cells uric acid exists combined with
ammonia, but when found in the blood, or de|)osited
in the tissues, either of man or the lower animals, it is
in the form of urate of sodium. If the second view is
adopted, and it is assumed that urate of ammonium is
produced in the kidneys, and that it sometimes becomes
resorbed into the blood after its formation, experiments
show that urate of ammonium is readily conveited into
urate of sodium, if added to a solution containing a large
excess of either phosphate or chloride of sodium. The
presence of urate of sodium in the urine of man and the
carnivorous mammal is explained by the fact that the
urate of ammonium meets with large quantities both of
phosphate and chloride of sodium, and thus becomes
converted. Those who consider that uric acid is formed
before it reaches the kidneys, generally fix upon the
spleen as its source ; and Dr. Michael Foster remarks in
his work on pliysiology that the increase of uric acid dur-
ing ague and during ordinary pyrexia seems to run par
allel to the turgescence, and therefore, presumably, the
activity of the spleen. As far as Dr. Garrod's experiments
go he has, however, proved that the spleen of the turkey
and common fowl is almost entirely free from uric acid,
and that of the ox contains a good tiuantity, wliereas the
urine of tile turkey or fowl contains much more uric acid
than that of the ox. One fact is mentioned as regards
the second theory, and that is — that the urine of the suck-
ing calf and the young of other herbivora contains uric
acid in notable quantities, while tliat of tlie adillt animal
is usually free from it, making it hard to reconcile the
view that uric acid is formed in tlie kidneys.
Uric acid is the chief ingredient of hinnan urine to
which attention is directed, and it is shown : i. That
uric acid exists in the urine as urate of sodium, unless
the urine is very ammoniacal ; then the uric acid, meet-
ing witli a large excess of a new base, is deposited as
urate of ammonium. 2. That uric acid is held in solu-
tion in an acid fluid solely on the tribasic character of
phosphoric acid, for with the urate of sodium is also
formed the acid phosphate of sodium, which exhibits a
full acid reaction, but does not possess the power of pre-
cipitating the uric acid. 3. That whenever any free acid
exists in the urine, the uric acid is immediately precipi-
tated. 4. That the difterent shapes which uric acid
assumes when it is precipitated from its state of solution
are, either in combination with a base, i.e., in the form
of a urate, or a free uric acid.
After demonstrating the action of carbonate of lithium
on small calculi, and on the spherules from the urine of
reptiles, Dr. Garrod draws attention to the influence of
diet on the production of renal calculi, and assumes that
vfhatever in the way of food tends to produce gout tends
to develoi) calculus also. Special stress is laid on the
eftects of saccharine food and of difterent alcoholic bev-
erages on the uric and excreting function, and an im-
portant point is noticed with regard to allowing patients
a proper amount of animal food, as it does not tend to
increase the amount of excretion of uric acid. With re-
gard to the causes of gravel and calculi. Dr. Garrod's
experience shows iiim that gouty subjects, or those who
inherit that diathesis, are more liable than others to
gravel and calculus. Portal congestion is another point
to be looked at in the prophylactic treatment of gravel
and calculus. Where there is a tendency to the rapid de-
position of uric acid from the urine, the value of water
as a therapeutic agent is shown. Speaking of the eftects
of alkaline treatment, the advantage of the lithia salts is
discussed. Hipi)uric and benzoic acids in an alkaline
solution possess the power of changing and removing
uric acid, so that these salts should become valuable in
the way of treatment, and great benefit has resulted from
the use of benzoate of sodium in cases of gout and of
gravel and calculus ; and if you wish at the same time to
increase the quantity of the urinary excretions, then give
the benzoate of potassium or of lithium.
The Origin of Articular Inflammation. — Pro-
fessor Schiiller obser\es (Deutsche Med. Wocheiischrift)
that at the present day we do not think of inflammation
exce|)t in connection with some special inflammatory
excitant. Such exciting material may be chemical or
organic, and may enter the joint in one of three ways :
I, through an external wound into the joint ; 2, by the
blood ; 3, by s|ireading from the neighboring tissues.
With respect to o[)en wounds of joints, antiseptic sur-
gery has taught us that they are not inevitably followed
by purulent inflammation, as was formerly supposed, but
onlv when some of the exciting causes of inflammation
can enter the wound and develop in the joint. Inflam-
mation in closed joints cannot be caused by contusion,
unless there be an exciting cause of inflammation in the
blood itself, or in some i)art of the body where it can
pass easily into the circulation, and so reach the joint
by means of tlie extravasation. Such a cause must be
always present when inflammation of a joint results from
a simple injury. Metastatic inflammation can take place
in the joints without injury of any kind, as in acute rheu-
matism, pyajmia, etc.; and tlie exciting material may be
micro-organisms, as in pyjemia, or a chemical substance,
as in gout. The anatomical arrangement of the tissues
of the joint probably predisposes to the deposition there.
Lastly, inflammation may result when the excitants enter
the joints from the neighboring tissues, which they may
do suddenly, as in some forms of acute osteo-myelitis,
gradually'invade the articular tissue from ])oint to point,
as in syphilitic and tuberculous inflammations, or enter
through the lymphatics, as in phlegmonous infiltration
and some forms of acute infectious osteomyelitis. Dr.
Schiiller finally points out how many of the old ideas
on inflammation of the joints are again coming to the
front, how great is the advance which we have made in
the knowledge of the subject, but how much still remains
to be done before we have a clear insight into the pro-
cesses and causes of the inflammation.
June 30, 1S83.I
THE MEDICAL RECORD.
709
The Medical Record
A Weekly yo2irnal of Medicine and Surgery.
GEORGE F. SHRADY, A.M., M.D., Editor.
Published by
WM. WOOD & Co., Nos. 56 and 58 Lafayette Place.
New York, June 30, 1883.
COLLATERAL INNERVATION.
M. RicHEi.OT has recently communicated to the Socie*e
de Chirurgie the report of a case which appears to indi-
cate the possibihties of a collateral motor innervation
developing when the normal nervous suppl)' has been cut
otil". The patient, a young man tuentv-six years old,
had at the age of seven sustained a compound fracture
of the right humerus just above the elbow. The bone
healed, but the median nerve had been injured, and its
integrity destroyed. There was, consequently, paralysis
of the flexors of the fingers, of the outer lumbricales,
and anajsthesia of the palm of the hand, ball of the
thumb, and first and second fingers. In the course of
two years sensibility was gradually restored. Movement
also returned to a considerable extent, the movements
of the fingers being feeble but free. The muscles of the
forearm and thenar eminence were considerably atro-
phied. The patient applied for relief from pains in the
arm, caused presumably by a neuroma of the median
nerve just above the elbow. The tumor was removed,
and in doing so the median nerve was entirely severed.
Curiously enough, motion and sensibility continued in
the fingers nearly as before. The hypothesis suggested
is that a collateral innervation, probably from the ulnar,
had gradually developed. The phenomena of collateral
innervation of sensory nerves has been often observed,
but that of motor nerves is certainly rare. M. Verneuil
reported a somewhat similar case, however.
BICYCLE RIDING.
It may be laid down as a rule, to which there are few
exceptions, that an out-door sport which maintains for
years a wide popularity is not essentially an injurious
one. The average man is a tolerably sensible creature,
and learns sooner or later whether a particular practice
is hurting him or not. So it is that ball-playing, tennis,
cricket, boating, all have, as a general result, the pro-
motion of health. Some individuals are injured, as some
individuals always will be, no matter what they do. But
the criticisms directed against these various pastimes ap-
ply only to an over-indulgence in them.
The question as to the healthfulness of bicycle-riding
has been much agitated of late. Some medical journals
and medical men have asserted that the practice leads to
all kinds of troubles : hernia, varicocele, sexual weak-
ness, spermatorrhoea, and so on. This is a view which
is unquestionably not true, so far as facts at present show.
There are certain individuals whom it may injure, and
there is a certain number of accidents which must inev-
itably accompany locomotion on a somewhat unsteady
vehicle. But bicycle-riding is not injurious to the mass
of those who practise it. We do not consider it a model
form of exercise. It brings into play chiefly the exten-
sors of the foot, the flexors of the leg, and the abdominal
muscles. The chest or arm-muscles are not greatly
exercised, and there is, at times, some mental tension
connected with the possibility of at any time taking a
" header."
For all this, bicycle-riding is an excellent form of ex-
ercise, as well as an exhilarating mode of locomotion
for many people. The propagation, by certain alarm-
ists, of the view that it is going to spread the disease of
the Scythians among us should he discountenanced.
THE MEDICAL VACATION SYSTI-:M.
JUST now the fancy of the city physician lightly turns to
thoughts of summer hotels and sea-side resorts. The
exodus to these places appears to be greater every year,
until in this jiarticular city, in August the inhabitants have
to depend chiefly upon the natural salubrity of the cli-
mate and counter-prescribing in their physical distresses.
doing out of the city, however, does not by any
means signify that the doctor is taking a vacation. The
custom is rapidly growing of taking up a summer practice,
and it is one which often furnishes no small addition to
the doctor's income. By a practice at a summer resort
he enlarges his acquaintance and greatly multiplies his
fees.
There are very few medical men who do not need all
the money they can earn, and to some a vacation practice
is almost a necessity. It is one that is not without
abuses, however. The physicians at summer resorts have
in too many cases developed remarkable business talents,
and have shown a capacity for capturing patients and
sending in bills which would adorn the memory of Cap-
tain Kidd or the lamented Jesse James much more than
the members of a learned profession. In fact, the
"hotel doctor" has been rendered a suspicious charac-
ter in some quarters, and we fear justly so. It is cer-
tainly very much to be regretted that medical men should
risk the dignity and honor of their profession for the sake
of earning a few more dollars.
A new phase of the summer vacation system is gradu-
ally developing, and not in this city alone. It is the cus-
tom of letting other physicians know by card where one
is to stay during the sununer. The practice is, within
proper limits, a good and useful one. It is the custou.,
in Germany every spring, when the bath season sets m,
for medical men to announce in the medical journals
where they will practise during the summer. A summer
medical directory might be a desirable thing for the city
physicians of this country.
OUR DISPENSARIES.
O.N'E of the younger men attached to a large dispensary
in this city, writes us as follows :
" Dear Sir : A patient, a ( '.erman liquor dealer, came
to my class in the dispensary, a short time ago. After
being treated a few times, he took out his pocket-book to
7io
THE MEDICAL RECORD.'
[June 30, 1883.
put in it some directions I had written. It was bulging
out with bills so that he could hardly shut it. I wanted
very nuich to exchange it with my own.
" An old lady comes to me wearing gold jewelrv and a
silk dress, and looking very much as though she had a large
income. She wore such a benignly respectable air, how-
ever, that I didn't like to ask her whether she was a fraud
or not.
" Two or three nicely dressed school-girls come to my
class. Their parents can evidently aftbrd to dress them
nicely but wish to shirk their doctor's bills. It is, I be-
lieve, a very prevalent practice, and one that is e.xtend-
ing, for the head of a family to send his wife and children
to the dispensary. For a long time I treated the wife and
child of a German engraver who earned (as I learned
later) about $So amonth. But he would not give his
family any moneywith which to pay for medical services.
" I wish that something could be done for these cases.
It makes a good deal of dispensary charity seem like a
humbug, and it seems rather hard on the doctors.
" Very truly yours, M. S."
Our correspondent has touched upon an old theme and
an old abuse. The suggestion that the paterfamilias
who holds the purse-strings is getting into the habit of
sending his family to the dispensaries deserves considera-
tion. We would call the attention of our correspondent,
as well as of all connected with dispensaries, to the
fact that a partial remedy at least for the abuse described
is at hand. The Charity Organization Society has under-
taken to investigate all suspicious cases that are reported
to them. If a little pains were taken to send to the Sec-
retary of tliis society every week or oftener, a list of
patients suspected of being able to pay, a great deal
could be done.
It would not take a long time to create the impression
that dispensaries were only for those who can not pay.
In fact, with the opportunities which we understand are
now offered, it is largely the doctor's fault if he continues
to treat gratis those who can aftbrd to pay him.
NEUROLOGY AND THE AMERICAN' NEUROLOGICAL
ASSOCL\TION.
The meeting of the American Neurological Association,
which took place in this city last week, is said to have
been one of unusual interest, scientificall\- and sociallv.
Rei^resentatives from Chicago, Philadeliiliia, Baltimore,
Boston, and other cities, were present. The President,
Dr. Hammond, in his retiring address, referred to the
continually increasing prosperity of the society, but ex-
pressed some surprise that a specialty so broad and com-
prehensive as neurology should not excite a still greater
interest than it had done. The explanation sug^estetl
was that nearly every [jractising physician felt himself
to be more or less of a neurologist. However this may
be, it is no doubt a fact that less special attention is |)aid
to nervous diseases by medical students and by practi-
tioners than to many other nuich narrower branches of
medicine. Clinics for nervous diseases are but poorly
attended unless the lecturer has some special popularity.
And even in some large colleges a general practitioner
is tliought quite capable of lecturing on neurology. This
iiulifference is to be deprecated, since a sound knowled'^e
of the nervous system in health and disease is indispens-
able to a correct and rational method of practice.
The American Neurological Association is doing some-
thing toward exciting a wider interest in its important
department.
^^cius of the Mlcch.
The Death of Dr. ATokitz Michaelis, of this city,
occurred on June 23d. Dr. Michaelis was born at Det-
inold, Germany, in iSii, and came to New York in
1S40. He was well known for his obstetrical skill, kindly
disposition, and unostentatious charities.
United States Sanitary Inspector at Havana. —
Dr. Daniel M. Burgess has been reappointed Sanitary In-
spector for the United States at Havana. Dr. Burgess
will act under the direction of the United States Marine
Hospital Service and the immediate direction of the
American Consul-General for the sanitary inspection of
vessels bound for the I'uited States.
A Rejected Candidate. — A woman physician re-
cently made application for admissioii to the Onondaga
County Medical Society, at Syracuse. She was rejected
by a vote of thirteen to six. It was stated that she had
advertised in the daily papers.
Concerning Medical Degrees in Great Britain.
• — Our London correspondent calls our attention to the
fact that not is omitted in the last sentence but two,
second colunui, page 614. It should read: "TheL.R.C.P.
is not a physician's diijloma."
The Tvphus Cases from St. Stephen's Home. — The
children attacked with typhus fever at St. Stephen's Home
and removed to Riverside Hospital, have nearly all re-
covered, a few only of the recent cases being still under
treatmenL The fever appeared in only one of the houses
belonging to the Home, and the number of cases thus
far occurring is twenty-four. With a view to thoroughly
eradicate the infection it has been determined by the
Health Department that the children exposed to the
fever be removetl to North Brothers Island for quarantine
and observation, and the house in the meantime be reno-
vated. For this purpose the old hospital building on the
island has been put in order, and early last week the
children were transferred to their new temporary quarters,
where they will enjoy a few weeks of fresh air. One of
the trained nurses at Riverside Hospital has been very
sick with typhus contracted from the children under her
care, but is now convalescent. This is the third one of
the regular niu^ses lliat has taken the fever since its
recent advent among us.
The Progress of the Tubercle War. — The acerbfly
of Koch's criticisms of his Vienna critics has stimulated
them to a remarkable activity in the study of tubercle
bacilli. -At a meeting of the Vienna Society of Physi-
cians, May nth, Professor Strieker and Dr. Spina re-
ported further results. They reaflirmed the opinion that
the tubercle bacilli, so-calleil, were not characterized by a
peculiar staining which t)ther bacilli did not take. They
asserted that this bacillus could not be considered a
special form, niorphologicatl}' or chemically, of micro-
June 30, 1883.]
THE MEDICAL RECORD.
1 1
organism, and further, they asserted that they had pro-
duced tuberculosis in perfectly healthy guinea-pigs by
injecting particles of glass and cinnabar. It is expected
that a commission will be appointed by the Society to
settle the whole question.
Uninterrupted Service. — In the surgical division of
the Roosevelt Hospital, the plan of having an uninter-
rupted service, which has been on trial during the past
year, has received the approval of the ISoard of Trustees,
who, at a recent meeting, reappointed Dr. Henry B. Sands
as the sole attending surgeon, to serve during the pleasure
of the Board. Dr. W'm. S. Halsted was reappointed in
a similar manner, as Dr. Sands' assistant, and was also
placed in charge of tlie out-door surgical department,
which, with an out-door medical department, under the
direction of Dr. J. West Roosevelt, has just been estab-
lished. The hospital contains seventy-five surgical beds.
An Internation.^l Congress for the Protection
OF Infants was opened in Paris on June 15th. It is
held under the auspices of the .Society for the Protection
of Abandoned Infants.
Iodoform as a \'ermifuge. — Dr. Schildowsky finds
that iodoform is an excellent remedy for nematoid worms.
He gives it in doses of one grain to adults.
Death of Professor Valentin. — One of the Nestors
of Physiology, Professor Valentin, of Berne, Switzerland,
died on May 25th, in the seventy-third year of his age.
Dr. John SwiNiiURNE has been elected mayor of
Albany.
The Late Dr. Wilklr's Successor. — Dr. (l. A.
Doren, of Columbus, O., has been elected Superinten-
dent of the New York State Asylum tor Idiots.
Banquet in Honor of M. Villemin. — A bampiet
was tendered on May 26th, by a number of eminent Pa-
risian medical men, to Professor Villemin, of Val-de-
Gr;ice. It was rightly considered very appropriate that
now, when the int'ectiousness of tuberculosis is so univer-
sally conceded, that M. Villemin, who first experimentally
demonstrated the fact, should be remembered. It was
on March 6, 1865, Villemin inoculated a rabbit with par-
ticles from a phthisical lung. The animal subseiiuently
died of phthisis.
Krao, the Missing Link.. — There is now on exhibition
at the Westminster .\ijuarium, London, a girl seven years
old, who presents many striking simian characters. Her
body is covered with hair, her face is very prognathous.
Her feet are prehensile, and she can pick up even small
objects from the floor. She comes from Laos, in the
interior of Indo-China, and her parents are both covered
with hair. She can speak some words of English. A
full account of her is given in the Revue d' Anthropologic.
Dr. W. H. Duke.man, of Olean, N. Y., is the author
of the article on " Impermeable Stricture of the Urethra,"
in our last issue, instead of Dr. W. H. Dikeman, as
printed.
The College of Midwifery of New York. — At
the completion of the first annual course in this institu-
tion nine candidates presented themselves for examina-
tion. Of these, seven passed very creditably and two
were rejected. The following are the names of the grad-
uates in the order of their merit : Katie E. Vanderbilt,
Marie Mount, Annetta Meyer, Kathrine Mergel, Bridget
A. Mulla<iy, Rosina Stuhlfauth, Theresa Hall. The
standard of requirements for midwives is high, the ex-
aminations are impartially made by a board of censors,
and the school is destined to be a success.
The Election of Theophilus Parvin as Professor
OF Obstetrics in Jefferson Medical College. — -The
Trustees of Jefferson Medical College, Philadelphia,
elected, at their meeting held June 25tli, Professor The-
ophilus Parvin, of Indianapolis, successor to Professor
EUerslie Wallace in the chair of Obstetrics. This is one
of the best appointments that could have been made.
We congratulate the college on securing the valuable
services of this distinguished and successful teacher, and
predict for him a brilliant future in his new career of use-
fulness.
A Poi.vci.iNiCAL Dinner. — The Faculty of the New
York Polyclinic gave a dinner at Delmonico's to the
assistant clinical staff, on June 23d.
Floating Hospitals. — The German admiralty, says
Gaillard's Medical Journal, are going to try a novel ex-
periment, as they intend to send a complete hospital
ship to accompany the Baltic squadron on its evolution-
ary cruise. A corvette has been fitted with cots, requi-
sites for the sick and wounded, instruments, and opera-
ting tables. It is intended that in any future war the
vessel shall accompany the fleet into action, carrying the
Geneva flag ; and, in order further to distinguish her,
she has been painted white with a red streak,
A Druggist Sentenced for Selling too much
Morphine. — A Parisian druggist has been sentenced to
eight davs' imprisonment and a fine of twenty-one hun-
dred francs for selling four hundred dollars' worth of mor-
phine in the space of ten months to one of his cus-
tomers.
A Ger.man-American Medical Monthly. — The
Medicinisch-Chirurgisches Correspondenz-Blatt is the
title of a new monthly intended for German-American
physicians. There are over two thousand of these in the
country, and it is thought that they need an organ. The
journal is published in Buffalo, N. Y., and edited by Dr.
M. Hartwig, of Buffalo, in conjunction with Dr. Meis-
burger, of the same city ; Dr. Jacobson, of Syracuse ; Dr.
Proegler, of Fort Wayne, Ind.; Dr. Schwartz, of Vienna ;
and Dr. Renter, of Berlin. In an editorial note, com-
menting on the Code controversy, the editor says : " The
physicians in (lermany have never felt the need of a Code,
and have never had one. The general rules for guiding
the conduct of gentlemen have been found sufticient."
It naturally appears strange to foreign eyes that Ameri-
can physicians alone are the only ones throughout the
world who seem to think that they need a written Code.
Eclecticism in Michigan. — We are informed by the
Eclectic Medical Journal, that a bill to establish a depart-
ment of eclectic medicine in the University of Michigan
has been introduced in the Legislature of that State.
Should it pass, the unique spectacle would be presented
of the three systems of medicine — regular, homceopathic,
and eclectic — being taught in one and the same insti-
tution.
712
THE MEDICAL RECORD.
[June 2,0, 1883.
^%cpovts of J'ocictics.
THE AMERICAN NEUROLOGICAL ASSOC LO-
TION.
Ninth Auniial Mictiiis;, Iteld in Xew York, June 20, 21,
22, 1883.
\Vednesdav, June 2oth — First Day — Afternoon
Session.
The American Neurological Association convened in
the hall of the New York Academy of Medicine, and was
called to order at 2.30 p.m., by Dr. William A. Ham-
mond, of New York, the retiring President, who made a
few appropriate remarks, and then introJ.uced tlie Presi-
dent-elect, Dr. R. T. Edes. of Poston.
Dr. R. W. Amidon, of New York, was elected Secre-
tary, pro tem.
THE president's ADDRESS.
Dr. Edes said that if he were called upon to select a
single word that would best express the progress made in
neurology during the last few years, that word would be
" localization." .Although we see where the blow has
struck, it is worth while to consider how important is the
knowledge which is so greatly lacking, or so merely
speculative as to its nature and origin, ar.d how essential
it is that correct views should prevail as to early symp-
toms. Two opposite views |)revail, in two classes of
minds, as to the significance of symptoms which have not
become thoroughly declared. One set of men, who may
be found especially among the therapeutists, are prone
to consider every recovery after symptoms which are
more or less allied to those that point to the serious or-
ganic diseases as cures, and such they may be in some
cases. The error consists, not in recognizing the bene-
ficial effects of treatment, but in not considering tliat
disorders which are at the beginning functional, or hardly
more tlian such, may turn toward recovery or toward or-
ganic lesions. The other error is that of the anatomist,
who looks at all diseases in the light thrown backward
from the autopsy, and who is apt to think of lesions as
e.xisting from the beginning, and regard failure in therapeu-
tics as a mistake in diagnosis. But both classes of minds
are necessary to the progress of neiiroIog\', as for other
branches of medicine, and both require for their correc-
tion that most important ]iiece of apparatus, without which
no physiological laboratory is complete, no matter how
elaborate its other furnishing is, that vulgarlv known as the
" level iiead." One of the first thoughts in all our minds
must be the losses which the msetiiig of the .Association
had sustained in the absence oi the Secretary, who had
done so much of the scientific work, and in the death of
one with whom many often differed, but wiiose laborious
investigations and suggestive writings had added so much
to our interest and instruction.
In conclusion. Dr. Edes read a letter from Dr. Seguin,
dated Zurich, Switzerland, May 30, 1883, in which he ex-
pressed the unabated interest he retained in the welfare
of the .Association, and sent a friendly greeting to the
members, from whom, without e-xception, he lecalled only
courteous and friendly acts.
The Council re])orted that they had examined the
papers presented by the following candidates, and recom-
mended that they should be elected to membership in
the Association : Drs. Leonard Weber, of New York ; G.
L. Walton of Boston ; and J. T. Eskridge, of Philadelpha.
These gentlemen were unanimously elected.
'no.min.ation of candidates.
Dr. Ralph L. I'arsons, of Sing Sing, N. Y., and Dr.
Ciiarles F. Folsom, of Boston, were nominated for
active membership.
NOMINATION OF OFFICERS.
Dr. Isaac Ott, of Easton, Pa., and Dr. Landon C.
Gray, of BrookUn, were nominated for President. Dr.
Ott was elected.
Dr. \\. R. Birdsall, of New York, and Dr. J. J.
Putnam, of Boston, were nominated for Vice-President,
and Dr. Birdsall was elected.
Dr. R. \V. Amidon. of New York, and Dr. E. C.
Seguin, were nominated for Secretary and Treasurer.
Dr. Amidon was elected.
Drs. J. J. Putnam, of Boston, V. P. Clibney, F. P.
Kinnicutt,"and W. J. Morton, of New York, were nomi-
nated for Councillors. Drs. Gibney and Morton were
elected.
Dr. Charles L. Dana, of New York, mo\ed that the
President appoint a committee of two to jirepare suitable
resolutions with regard to the death of Dr. George M.
Beard. The President appointed Dr. C. L. Dana and
Dr C. K. Mills, and suggested that the committee jire-
pare a letter to be entered upon the minutes, instead of
the usual resolutions.
Dr. AV. \. Morton, of New York then read a paper on
NEURITIS FOLLOWING DISLOCATION.
The paper constituted a contribution to traumatic
neuritis, and was illustrated by a case following disloca-
tion of the humerus. The essential features were the
following : Injury to the brachial ple.xus, motor paralysis,
sensory disturbance (exaggeration of tactile sense, hy|-ieral-
gesia, diminished temperature sense), reaction of de-
generation, cedema, glossy skin, painful joints, causalgia,
fibrous hyperplasia, neuro-muscular hyper-excitability,
extension of disturbance to opjiosite member; that is,
ascending neuritis.
The jjatient, Alexander M , sixty-five years of age,
about ten months ago slipped on the sidewalk and fell, strik-
ing on his right shoulder. His arm was rendered nearly
motionless, the shoulder painful, and soon the hand and
forearm swelled. He went to Bellevue Hospital, had his
shoulder set, and remained there two days. From the
hospital records the following note was taken : ".Admitted
September 27, 1S82 ; diagnosis, alcoholism and disloca-
tion of the humerus; discharged September 29th.'' The
record was important only as establishing the fact that
dislocation existed.
An interesting feature in the case was the fact that the
left, or opposite arm, at the end of ten months, showed
evidence of being affected by the injury originally in-
flicted upon the right axillary plexus. Electrical changes
were present, which approach to the reaction of degen-
eration so prominent in the right arm ; but more curi-
ously, neuro-muscular hyjier-excitabilily was also present,
although in a modifieil form.
Two noteworthy symptoms were noticed. First,
fibrous hy|)erplasia. Tlie usual nutritive disturbance
following neuritis is atrophy of various tissues. Dr.
Morton had found only one such case, that rei>ortcd by
AVeir-Mitchell, and his case formed a fitting com))anion
for it. As regards the hyperplasia, it ranks with
.Mitchell's as a uniijue observation.
Second, neuro-muscular hyper-excitability. If we would
find an exact |)arallel we must turn to Cliarcot's descrip-
tion of the condition discovered by him during the le-
thargic stage of hyjinotism, and designated by him neuro-
muscular hyper-excitability. After reviewing Charcot's
views and conclusions at some lengtii, concerning tliis
])henomenon, Dr. Morton concluded that neuro-muscular
hyper-excitability is not alone found in the hypnotism of
the hysterical, but that it may exist in ascending neuritis
which has reached the spinal centres.
Dr. C. K. Mills, of Philadeli)hia, said that Dr.
Morton's case called to mind several cases of brachial
neuritis which had fallen under his observation, and in
one of them the phenomena spoken of under the term
neuro-nuiscular hy[)er-excitability was present in one
arm at least.
June 30, 1S83.]
THE MEDICAL RECORD.
In one patient, also, symptoms had developed in the
other arm, as in Dr. Morton's case.
As to the question of neuro-muscular hyper-e.vcitahility,
it presented one of tlie best fields for discussion, from a
scientific standpoint.
Dr. CjIbnev, of New York, had found tliat it was in
cases of Pott's disease where the excitability of the mus-
cles was most marked the most perfect cure could be
promised ; and he ([ueried whetlier the hyper-excitability
in the class of cases under discussion might not have a
bearing on prognosis.
Dr. S. G. \Vf.I!I!ER, of lioston, had tried various
measures in the treatment of neuritis, and had found
that blisters yielded the most satisfactory results.
Dr. VV. a. Hammond, of New York, advocated that
rest of the nerve, as Air as possible, should be insured,
believing it to be one of the most essential elements in
effecting a cure. He believed that the only way in which
stretching an inflamed compound nerve could act was by
securing for it rest.
Dr. VVki!Bkr sustained Dr. Hammond's \iew concern-
ing the efficacy of rest.
Dr. Putn.^m, of Hoston, referred to the special effi-
cacy of ice. If ice is used day and night, or a great
many hours in succession, precautions being taken not
to have the cold too great (protect the skin with flannel),
it is of the greatest possible value.
Dr. C. L. D.-\.na, of New York, then read a paper en-
titled
NOTE ON HVDR013R0MIC ACID AS A SUBSTITUTE FOR THE
BROMIDES.
After making brief reference to the literature of the
subject. Dr. Dana stated that this acid had been used by
the profession chiefiy with quinine, under the belief that
it prevents or lessens cinchonism.
The only extended record of clinical observations re-
garding this acid that he had been able to find was one
. by Massini, published two years ago, w-ho used it in
thirty-one cases of various kinds without special benefit.
Dr. Dana was led to experiment with the drug, with the
hope that it would produce the beneficial efiects of the
alkaline bromides in epilepsy without causing depression
and scurvy. He had now used hydrobromic acid in the
treatment of various nervous affections for nearly two
years at the Northeastern Dispensary, and had the clini-
cal notes of over fifty cases of various kinds.
The officinal dilute acid is a ten per cent, solution, of
which the dose would be from one drachm to two drachms
and a half, well diluted. In (pilepsy some patients re-
ceived marked benefit from the use of the acid in doses
of four to five drachms a day. Dr. Dana believed, how-
ever, that in epilepsy hydrobromic acid could not be used
as a substitute tor the bromides, except in the non con-
trollable cases, and yet it undoubtedly has a controlling
influence over the disease.
In chorea he thought the acid could be used advan-
tageously as a medium for arsenic or strychnine when it
is desired to give a sedative. In alcoholinn it failed in
two cases, the patients being on the verge of delirium,
and the bromides with chloral were subsequently given
with relief
Hydrobromic acid is a good solvent of quinine, but it
does not prevent cinchonism, as has been asserted, cer-
tainly not in the small doses usually prescribed. In
most cases of ifisomnia it also acts well. He could say
positively that he could give the acid with just as much
confidence that it would produce nervous sedation as
when the alkaline bromides are prescribed. He had
never seen any sign of brojnisni or any disagreeable con-
stitutional effect other than some drowsiness. He be-
lieved that the ordinary custom of prescribing from
twenty minims to one drachm of the three percent, solu-
tion, the strength ordinarily employed, or of a ten per
cent, solution, was generally much too small a quantity.
Theoretically, in order to get the sedative action, from a
drachm and a half to two drachms and a half of the ten
per cent, solution must be prescribed. Practically he
had found that very satisfactory sedative effects could be
produced with drachm doses of the officinal dilute solu-
tion. In conclusion, the acid could be substituted for
the bromides in all the milder affections for which the
latter are used. It had appeared to him to be especially
efficient in producing vascular and nervous sedation in
the post- and pre-hemiplegic conditions, l^nless given
in very large doses, it takes several days to get its best
sedative eftects.
Dr. VV. A. Ham.mond used hydrobromic acid for seven
or eight years, and then abandoned it because he did not
see that it did any good. He had found, however, that
it does prevent the unpleasant effects of sulphate of
quinine ; but in this respect it is not so efficacious as a
corresponding dose of the alkaline bromides.
Dr. Hammond's experience concerning the power of
this acid to prevent cinchonism was corroborated by
Dr. Eskridoe, of Philadelphia, who also spoke of the
good eftects of the drug in typhoid fever.
The discussion was closed by Dr. Dana.
Dr. J. J. Putnam, of Boston, then read a pai)er en-
titled
lead-poisoning simulating other diseases — A SOURCE
OF error in the analysis of the urine for
lead.
within the last few years a number of cases had come
to his notice in which examination of tlie urine had
shown the presence of lead, while the symptoms and clin-
ical history were not such as are usually considered
characteristic of lead-poisoning; ir>fact, simulated other
types of disease. So far as he knew the first case in
which lead was supposed to have given rise to symptoms
simulating any other form of spinal disease than polio-
myelitis anterior, was one reported by Dr. F. Minot, of
Boston, and published in the Boston Medical and Sur-
gical Journal in i8Si. In that case the symptoms of so-
called lateral sclerosis were present to some degree,
lead was twice found in the urine, and the patient im-
proved materially under the use of iodide of potassium.
In none of the eight cases reported by Dr. Putnam
were the blue line upon the gums, colic, emaciation, or
discoloration of the skin, the characteristic localized
atrophic paralysis, or typical cerebral symptoms present,
and the diagnosis was established solely tlirough the ex-
amination of the urine after the administration, for a few
days, of iodide of potassium. All the chemical work of
the investigation was done by Prof E. S. Wood, in the
laboratory of the Harvard Medical School.
Under the vague term lead encephalopathy a variety
of nervous symptoms have been described, of which
delirium, mania, dementia, epilepsy, and coma are at
once the severest and the better recognized ; but the
disease is, no doubt, capable of giving rise to a variety
of less slowly marked but not less important signs.
conta.mination of water bv lead.
Apropos to the contamination of water from leaden
pipes. Dr. Putnam mentioned that while it was well
known that hot water is more apt to dissolve lead than
is cold, it is not, probably, so generally realized that this
fact makes it objectionable to run hot and cold water
pipes side by side through houses, especially when the
latter carry water for drinking purposes. He had been
assured by a reliable plumber that under such circum-
stances the cold water pipes were apt to be considerably
corroded.
The quantity of urine examined should be at least one
quart, and it should be collected during the adminis-
tration of iodide of potassium, given either for the first
time or after an interval of repose.
One source of error has recently suggested itself to
Prof. Wood, and that is that the tests hitherto used for
lead apply equally well to bismuth, a drug very fre-
714
THE MEDICAL RECORD.
[June 30, 1883.
quently prescribed. To avoid error, therefore, it was
necessary to make sure that the patient has taken no
bismuth within a considerable period before the examin-
ation for lead is made.
The paper was discussed by Dr. Webber, of Boston, wlio
had noticed disturbances of sensation in every case of lead-
poisoning, affecting the spinal cord, which he had exam-
ined. He also directed attention to an additional source
of error in examination of the urine, namely, that when de-
composition occurs, a chemical reaction takes place be-
tween the urine and glass by which lead is set free, and
responds to test for that metal. Add a small quantity of
acetic acid to the specimen to be examined, in order to
eliminate this source of error; by Dr. Mills, of Phila-
deljihia, who spoke of the protoplasmic effects produced
by lead, as suggested by Ringer. The discussion was
closed by Dr. Putnam.
Dr. Putx.'VM exhibited a urinal for use by female pa-
tients while sitting in a chair. It was a small copper
basin, a miniature bath-tub, with a metallic conducting
tube from the bottom of the outer, or broad end, to which
could be attached a piece of rubber tubing.
The Association then adjourned to meet at 8.30 p.m.
First D.w — Evening Session.
The Association was called to order bv the President.
Dr. J. T. EsKRiDGE, of Philadelphia, read a paper,
which contained the report of a case of
GENERAL NEURALGIA.
G. B-
a Clermjin ; aged twenty-nine ; married ; a
laborer in a foundry ; denied ever having had venereal dis-
ease. There was no external evidence of specific disease,
and his children, three in number, were well developed and
healthy. He enjoyed good health until the year 1873,
when he suffered from an attack of pneumonia affecting
the left side, and was conlined to his bed four weeks.
Two 3-ears ago, after sleeping one night in a damp bed,
he noticed a dull heavy pain in the dorsal and lumbar
regions of the spine. This pain continued about one
month, and was then accompanied by severe pain in the
course of the left sciatic nerve. During these two months
he managed to hobble to and from his work, a distance
of several squares, and was compelled to stand on his
feet about two hours daily. The following summer he
was able to walk quite well, although a little pain was
experienced when the left sciatic nerve was firmly pressed
upon. In October, 1881, melted iron fell into his left
shoe and burned his ankle severely. The burn was
mostly su|)erticial, but its area w^as greatest around the
internal malleolus ; on the outer aspect of the ankle the
area was small, but the wound extended to the bone.
For this burn he remained in the hospital of the Univer-
sity of Pennsylvania ten weeks, and left comjiaratively
free from pain, and returned to his work. One week
later he began to experience great pain in the left leg
and ankle. This attack lasted about one month, and
the pain was greatly relieved by jiressure over the sciatic
nerve as it emerged from the pelvis. During the next
ten weeks he suffered more or less pain, but was able to
work. In October, 1SS2, he remained five weeks in the
hospital suffering from severe pain, which extended from
the lumbar region down the posterior portion of the
thigh and leg to the left foot, most intense in tiie ankle.
He improved somewhat in the hosi)ital, but after return-
ing to his work the pain became worse than it had been
at any previous time. In January, 18S3, he was scarcely
able to walk, complained of great pain in the leg and
back, sleep was broken, a[)petite capricious, bowels con-
stipated ; temperature, 100"; pulse, 92 ; respiration, 24.
His spine was tender on j)ressure in the dorsal and lum-
bar regions. All the supert'icial nerves of the left leg and
gluteal region were the seat of neuralgic pain, and light
jiressurc over any portion of the aflected nerve greatly
increased his sulfering. Nothing, except hypodermic in-
jections of morphia and atropia, afforded any relief, and
the effect of these medicines soon diminished. Chloro-
form injections increased rather than diminished his pain.
In Februarv the internal sa|,)henous and genito-crural
nerves became neuralgic, the left side of the scrotum was
red and burned like fire, and was exceedingly sensitive to
the touch. The right side was normal. Double inter-
costal neuralgia soon became well established and nearly
constant. The only relief aftbrded the patient came from
the alternate use of hot and cold a|)plications to the spine
and painful sciatic nerve ; bladders filled with ice, and
rubber bags with hot water were alternately applied every
five minutes for an hour each day. When this was faith-
fully carried out the pains were greatly lessened, no mor-
phine was required, and the patient's appetite and general
condition improved, and finally the man could walk
slowly about the wards. Most of the large superficial
sensitive nerves were painful to pressure ; the left fifth
cranial nerve alone having escaped.
The question of diagnosis was one surrounded with
some difficulties. Has not the case been one of general
neuritis following inflammatory spinal trouble and im-
proved? In favor of general neuralgia were the follow-
ing reasons :
First. — It is a disease which has extended over a
period of more than two years, made up of pain lasting
from two to six months in a man whose condition and
general appearance to-day seemed to be as good as they
were after the first attack in the year 1881.
Second. — That several times by firm pressure over the
great sciatic nerve, as it emerges from the pelvis, he had
succeeded in relieving pain in the foot and leg.
Third. — That in inflammatory condition of the cord
of so long duration reaction of degeneration and other
trophic disorders would probablv be found, and improve-
ment would be slower if it occurred at all.
Fourth. — That the left leg and right fifth cranial nerve
were severely affected, while the left side of the face en-
tirely, and the right leg almost entirely escaped.
Fifth. — That jiain was often shooting or steady in
character, differing from the dull pain of neuritis.
Syphilis was eliminated not only by the history of the
case, but by treatment.
The paper was discussed by Dr. Webber, of Boston,
who thought the fact that electrical reactions of the mus-
cles were not disturbed militated against general neuritis
or polio-myelitis.
Dr. Leonard Weber, of New York, regarded the
case as one of spinal leptomeningitis, of which he had
seen two similar ones within the last two months.
Dr. Eskridge could not accept Dr. Weber's view of
the case until autopsies have been obtained which will
throw light upon the cases in which apparent recovery
takes place.
Dr. C. K. Mills, of Philadelphia, then read a jiaper
on
LOCOMOTOR ATAXIA TERMINATING AS GENERAL PARALYSIS
OF THE INSANE.
The author said that the relation between locomotor
ataxia and general paralysis of the insane had been a
problem of interest to neurologists and alienists since the
investigations of Westjjhal in 1863. He then related the
history of a case occurring in a man, forty-seven years of
age, of good constitution, who had been treated most of
the time for three years for ''rheumatism," when became
under Dr. Mills' observation. The patient was addicted
to venereal excesses and occasionallv abused the use of
alcohol. There was no evidence of secondary or tertiary
symptoms of syphilis, although, many years before, he
had had what was called a chancre. There were absence
of paralysis, preservation of galvanic and faradic reac-
tions, inability to walk well in the dark, swaying wher>
standing with his eyes shut or heels together, numbness
and tingling in the feet, sharp, sudden pains in the limbs,
awkwardness with his hands in dressing, sense of con-
June 30, 1883.]
THE MEDICAL RECORD.
715
strictioii in the lower part of the abdomen, diminished
sexual desire, marked loss of flesh, insomnia, mental
anxiety, but not aberration of mind, absence of delusions.
Im])rovenient temporarily under treatment. Decided
mental symptoms first developed two years after coming
under treatment, when he spent his money very freely ;
had queer and lofty ideas, but the delirium of grandeur
did not manifest itself until about one year later. Nearly
three years after the notes first made by Dr. Mills con-
cerning the spinal symptoms, and nearly six years after
the development of ataxic pains, the patient was sent
to the Insane Department of the Pennsylvania Hospital.
His symptoms increased in severity and he finally died
in the State Hospital for the Insane at Danville, Pa., five
years and four months after first coining under Dr. Mills'
care, and about eight years after he was first affected with
ataxic pains. The autopsy revealed opacity of the cere-
bral pia, particularly in the postero-frontal and parieto-
temporal regions, with congestion and adhesion at points,
marked decortication and atrophy of the convolutions.
The jiia of the cerebellum, especially over the superior
vermiform process, was deeply congested and adherent.
The pia of the cord was thickened, and the substance of
the cord presented a shrunken and irregular appearance.
Microscopical examination showed marked sclerosis
of the posterior cohmins throughout the whole extent,
with general inflammation and thickening of the pia
mater. Sclerosis was also present in the pons, crura,
optic Ihalanii, and convolutions examined, and in the
cerebellum.
In this case the spinal symptoms were the first to ap-
pear. Dr. Mills referred to the views of various authori-
ties concerning the relation of locomotor ataxia and
general paralysis of the insane. According to Westphal
and Hammond no direct relation exists between the mor-
bid process in the cord and that in the brain ; neither
disease is secondary to the other ; they simply co-exist
as the expression of an excessive proclivity to diseases
of the nervous system.
Dr. Mills also referred to cases reported by Ober-
steine, Hamilton, Plaxson, Mickle, and others.
The paper was discussed by Drs. J. C. Shaw, of
Brooklyn ; \V. R. Birdsall, of New York, who directed
attention to the possible relation which might exist be-
tween meningitis and sclerosis of the substance of the
cord ; Weber, of New York, who had had cases similar
to that reported by Dr. Mills ; Morton, of New York,
and Webber and Putnam, of Itoston.
Dr. E. C. SPITZK.A, of New York, then read a paper
entitled
REMARKS ON THE ALLEGED RELATION OF SPEECH DIS-
TURBANCE AND THE P.^TELLAR TENDON REFLEX IN
PARETIC DEMENTIA.
At the annual meeting in 1881, Dr. J- C. Shaw read
a paper on the tendon reflex in general paresis, which
contained the following conclusion: "The exaggerated
reflex is closely associated with two prominent symptoms
in this disease. Those cases in which there are marked
difficulties of speech, hesitancy, stuttering, up to com-
plete inability to speak, not aphasia proper, are the
cases in which is always found, sooner or later, exagger-
ated tendon reflex," etc.
Certainly the suggestions which seemed to open up a
prospect of establishing a physiological relation between
the speech centres and the lumbar enlargement of the
spinal cord would merit our serious attention if the pro-
position that such a relation exists were made but ten-
tatively. Unfortunately, however, Dr. Shaw had adopted
premises in drawing his pathological conclusions which
cannot but have contained a source of error, as he had
excluded from consideration the pathological condition
of the brain. It occurs that in paretic dementia there is,
as a rule, a ditTuse affection of the entire central nervous
axis. In some cases the lesions seem to be concentrated
and intensified in the cord, in others in the cortex, and,
as Dr. Spitzka had had occasion to observe in a series of
fifteen autopsies, in not a small proportion in the brain
isthmus. A speech disturbance may be due to a high
cerebral lesion, and may then be permanent ; it may, on
the other hand, be evanescent, and due to temporary
vaso-motor causes. It may not differ in its mechanism
l^articularly when associated with hemi-paretic attacks
from speech disturbance following cerebral or meningeal
hemorrhage. Speech disturbance may also frequently
depend upon lesions in the medulla oblongata. Here,
then, are a niunber of conditions which may in them-
selves be associated with changes in the tendon reflex.
The ])resumption of science is that there are few
thino-s in neurology as remote from each other as the
tendon reflex and the si)eech function. Dr. Spitzka re-
ported ■briefl\- eighteen cases from his private practice,
most of which conflicted with the view advanced by Dr.
Shaw.
Dr. Shaw said that his paper was on tendon reflex
exaggerated, normal, and absent in paretic dementia ;
that he had observed seventy cases, and in twenty-two
of these it was exaggerated ; and that he merely put it
forward as a clinicar observation at that time. Of course
he had been unable to prove it pathologically, and he
never pretended to make any such connection between
the spinal cord and the speech centres as would seem
from Dr. Sjiitzka's paper.
The paper was further discussed by Dr. Putnam, of
P.oston, and the discussion was closed by Dr. Spitzka.
The Association then adjourned, to meet at 2.30 p.m.,
on Thursday.
Thursdav, June 2 ist— Second Dav— Afternoon
Session.
The Association was called to order by Dr. W. J.
Morton, of New York, Vice-President.
Dr. Ralph L. Parsons, of Sing Sing, N. Y., was elected
a member.
The President, Dr. R. T. Edes, of Boston, then read
a paper on
the excretion of the phosphites and phosphoric
ACID as connected with mental labor.
It seemed to the writer that there is a strong popular
and scientific opinion that excretion of phosphoric acid
is perceptibly or decidedly increased by mental labor ;
the most common form in which the statement is made
being with regard to the increased elimination of phos-
phorus by clergymen on Mondays. He had not, how-
ever, been able to find the statement distinctly made by
the original authority. Dr. Holmes. Whether or not it
was based upon the statement of Golding Bird he did not
know ; but if so it does that eminent physiologist much
injustice, as he does not speak at all of the elimination of
phosphoric acid, but of the deposit of earthy phosphates,
and refers to Sunday service not as intellectual labor,
but as bodily exertion and anxiety. The technical diffi-
culties in the way of such an inquiry — if the condition be
at all a marked one— are almost none at all, since the de-
termination of the presence of the phosphates with rea-
sonable accuracy was a very simple process. But it is
not SO; easy to make a distinction between mental labor
and mental rest a very marked one. We have no accu-
rate scale for mental labor corresponding to the foot or
pound of mechanical work done, and it is very obvious
that degrees of mental exertion are utterly without cor-
respondence to the value of results obtained. The feel-
ing of fatigue or consciousness of mental eflort, is, per-
haps, the only means that we possess of estimating the
intellectual labor. This, it is evident, may as well result
from the adding up of a most meaningless column of fig-
ures as from the composition of a sonnet. A certain ad-
mixture of bodily and mental labor is also unavoidable if
anything like speaking or writing is attempted.
Dr. Edes gave the results of observations made upon
7l6
THE MEDICAL RECORD.
[June 30, 1S8;
himself. The earlier ones embraced only the times of a
lecture and a few hours afterward. But as it might be
olijected that phosphoric acid formed during the greatest
period of mental activity, and only slowly finds its way
into the blood and out of the e.xcretorv organs, he made
a few others in which the examination was made not only
for the evening but for the succeeding night. In soma
ot these the earthy phosphates weresejiarately estimated,
with the result of giving about the or(iinary proportion,
showing nothing of special interest. From his experi-
ments it was seen that phosphates were diminished rather
than increased duiing the process of mental action, as,
for instance, during a lecture. Would it be fair from
these figures to infer that no phosphorus is used up in the
process of cerebration ? Certainly not ; but they are suffi-
cient to show that the amount of phosphates derived from
the metamorphosis of bram-tissue in a condition of physi-
ological activity is so small in comparison with that from
the system generally, that it has no perceptible eff'ect
upon the total of phosphates foimd in the urine.
Dr. Jewelf,, of Chicago, being called upon, said that
while he had not made investigations such as those made
by Prof. Edes, he had studied the subject somewhat in
the light of common sense, as the question had been
very frequently asked him, and he had been unable to see
why the brain, in even a tolerably jnotracted mental
efiort, should so e.xtraordinarily increase the compounds
into which phosphorus enters as to make anv great
change in the (piantity found in the urine. It had seemed
to him to be almost absurd, and he was glad to have the
support of Dr. Edes' investigations.
Dr. F. T. Milks, of P.altimore, suggested that phos-
phorus existing in nerve structures hatl been detected
only in the white substance of Schwann, and not in the
protoplasm of the ganglionic cells.
The paper was further discussed by Dr. Ott, of Eas-
ton. Pa., and the discussion was closed b\' Dr. Edes.
Dr. S. G. Webker, of Boston, then read a paper in
which he rei)orted
CASES OF LOCO.MOTOR .ATAXIA, INTERESTING ON ACCOUNT
OF UNUSUAL SV.MPTO.MS AND ON ACCOUNT OF .MARKED
RE.MISSION IN THEIR COURSE.
Case first was one of severe gastric crises, without
other prominent symptoms. The patient was a man
fifty years of age, and the case was interesting from the
extreme violence of the gastric symptoms, to which no
words could do justice. There was, however, very little
vomiting. The disturbance showed itself in severe
attacks of flatulence attended with pain.
Case two was of interest from the restriction of res-
piration. Dr. Webber had seen this in one other patient.
The attacks recalled laryngeal spasm, but there was no
cough. The sensation was probably an unusual form of
the girdle sensation.
The third case was characterized by diabetes, and
occurred in a male patient fifty years of age. 'l"he
diabetic condition was associated with occipital pain, and
was the combination of symptoms which attracted espe-
cial attention.
The fourth case occurred in a male fifty-three years
of age. Deafness has been seen only a few times in
locomotor ataxia. Erb reports a case, and other cases
have been re[)orted. Sometimes the deafness is Bnilat-
eral, sometimes it is only partial. The following case
was one in which the deafness was such that the voice
could not be heard. Probably the lesion is similar to
that which is found in atrophy of the optic nerve. The
patient was examined by Dr. C. J. 151ake, of Boston, who
gave it as his opinion that the condition of the ears would
not account for the patient's deafness. In the remain-
ing cases, either the patellar reflex was not lost, or it
returned. .At least, temporary reappearance was ob-
tained in some. The first five cases reijorted were
chiefly of interest on account of the unusual individual
symptoms. The last three cases, making in all eight,
were of interest as regards the prospect of improvement,
whether great benefit or cure may ever be expected in
locomotor ataxia.
Case six might be regarded as virtually cured, as the
patient had remained free from symptoms for three or
four years. It is reasonable to think that when the
symptoms develop rapidly, the prognosis is more favora-
ble than in other cases.
The paper was discussed by Dr. G. L. Walton, of Bos-
ton, who had examined over forty patients suffering from
locomotor ataxia, with special reference to deafness, and
in not a single instance could the deafness which was
present be attributed to degeneration of the auditory
nerve. In none was hearing for high tones lost, and
hearing was best through bone on the side where the
deafness was most marked. The cases of deafness as
a symptom of locomotor ataxia, as Dr. Edes had said,
were extremely rare, hence the special interest of the
case rejjorted.
Dr. Jewell, of Chicago, directed special attention to
the great efficacy of absolute rest in bed for months, with
passive eiercise to keep nutrition in as good condition
as possible, as being the most important of all measures
in the treatment of locomotor ataxia. The rest must be
rigidly maintained to be of value.
The paper was further discussed by Drs. Morton and
W. A. Haimijond, of New York, and the discussion was
closed by Dr. ^Vebber.
Dr. R. W. A.midon presented a case of
TETANOID PARAPLEGIA
occurring in a child, the tetanoid sym[)toms being pre-
ceded by a train of s}niptoms indicating subacute hydro-
cephalus.
He made the query whether the central trouble could
not, by causing descending changes in the cord, account
for the tetanoid symptoms, the etiology in most cases
being obscure.
Dr. Aniidon also presented two anomalous cases of
PARKI.NSON's DISEASE,
the peculiarity consisting in entire absence of tremor,
every other symptom of paralysis agitans being present.
Dr. Gib.ney presented a patient illustrating
PROGRESSIVE MUSCULAR ATROPHY WITH .MARKED FIBRIL-
LARY TWITCHINGS.
He also presented a patient with fibrillary twitchings
following a gunshot wound.
Dr. Morton then read a paper and exhibited an ap-
paratus for the treatment of
writer's CRAMP.
Among the non-fatal diseases of the nervous system
there are none probably less curable or more disastrous
to the patient's 0('cui>ation than is writer's cramp. He
had obtained better and more lasting results by the
method of stretching the muscles aftected by the cramps
than by any foim of electricity. .After referring to WoWs
method of treatment, reference was made to the method
of treatment devised by Nussbaum, of Munich, who util-
izes the idea of bringing the extensors into plav in the
act of writing, and thus resting the flexors and abductors
of the thumb. Dr. Morton thought that the principle could
be applied in a much more simple way than by means
of Nussbaum's apparatus, and had therefore devised what
was practically a thimble-pen ; that is to say, it is a long
thimble worn on the entire index finger. To the end of
this thimble is attached a stub-pointed pen. The thimble
should be of very light elastic metal, split from end to
end, should be made for the finger and clasp it entirely.
A very slight rubber elastic band, such as is commonly
used on writing-desks, slipped over the thumb and fingers,
serves to steady ami otl'er a moderate amount of re-
sistance to extension or abduction. The patient now
writes by the usual shoulder movement of free writing,
holding the hand flat upon the jiaper and sliding it
June 30,^883.]
THE MEDICAL RECORD.
/
along. The natural tendency of the finger and thumb
IS to extend rather than contract, as in holding the or-
dinary pen, and the result is that tlie i)atient, with very
little exiierience, learns to write a good hand and witii-
out the slightest experience of cramp or spasmodic move-
ment.
The paper was discussed by Dr. Plt.va.m, of I'.oston,
who thought one objection to the theory of the apparatus
existed in the fact that we cannot say that simply divert-
ing the muscles is the essential thing. He also thought
it to be questionable whether the extensors could be
called upon to take this forced position without also suf
fering; by Dr. Dana, of New York, who thought the de-
vice an ingenious one, and suggested that it could be re-
sorted to as a prophylactic measure ; by Dr. Wehber,
of Boston, who thought that learning to write with the
opposite iiand was as practical and satisfactory as any
means that had been suggested ; by Dr. W'ai-ton, of Bos-
ton, and Dr. .Morton.
A paper by Dr. E. C. Seguin, of New York, entitled
"The Insane of S|)ain and their Asylums," was read by
title, after whicii the Association adjourned to meet Fri-
day at 2.30 p. .M.
On Thursday evening Dr. R. W". Amidon gave an
elegant but informal dinner at Delmonico's 10 the Presi-
dent, Dr. R. T. Edes, the members of the Association,
and numerous invited guests. Toasts were responded to
by Rev. Dr. CoUyer, Drs. Edes, Otis, Miles, J. C. Peters,
Putnam, R. VV. Taylor, Munde, Ridlon, and others.
Dr. W. J. Morton also gave a brilliant reception at a
later hour, at which there was a large attendance not
only of the members of the Association, but of the med-
ical profession of New York.
1-'riday, June 22D — Third Day — Afternoon Session.
The Association was called to order by the President.
Dr. J. Leonard Corning, of New York, was nominated
for membership.
The Secretary presented a large volume received from
Dr. J. J. Mason, entitled '"The Central Nervous System
of Reptiles.'' It was accepted with thanks.
Dr. CTR.i.ME M. Hammond, of New York, presented a
patient who had suffered tVom
locomotor ataxia.
The patient was a man thirty-two years of age, who
had been referred to him by Dr. James H. Anderson.
Early in the history he suffered from the characteristic
])ains of locomotor ataxia, there was absolute loss of
tendon reflex, and the ataxic gait was well marked. A
long while ago the patient had a sore upon his penis, but
no evidence of either secondary or tertiary symptoms of
syphilis could be obtained. The treatment had consisted
in the use of electricity, iodide of potassium, and general
measures, and every symptom of the disease had disap-
peared, and the tendon reflex had returned very con-
siderablv.
Dr. \V. a. Hammond corroborated the diagnosis, and
the case was discussed by Drs. Putnam, of Boston, and
Mii,ES, of Baltimore.
Dr. E. T. .Miles, of Baltimore, then reported a case
which illustrated
nutritive alteration in the hand fro.m pressure
of the head of a dislocated humerus in the
A-\ILLA.
The interesting points were the great amount of defor-
mity, with glossy skin, insensibility not only to touch but
to heat and cold, the loss of ])ower in the muscles, with
great deformity of the little and ring fingers, and all de-
veloped slowly by pressure of the head of the humerus
in the axillary space, with pain located entirely about the
shoulder.
Dr. Miles thought, if the question was thoroughly
studied it would be found that these various forms of
neuritis were capable of altering function witliont devel-
oping many subjective phenomena ; that neuritis may
iirogress without absolute pain, and produce alterations
in tissue without giving rise to many of those symjitoms
which It was generally thought should be present when a
nerve is inflamed.
Dr. Burt G. Wilder, of Ithaca, then read a brief
paper
on the brain of the cat lacking the callosum.
Although there have been recorded several cases of
more or less nearly complete absence of the great cere-
bral commissure with human beings, the specimen ex-
hibited (with photographs) seemed to be the only case
of the kind among the lower mannnalia, being the only
case occurring in the anatoinical laboratory of Cornell
University among the several hundreds of cats' brains
there examined. There was no trace of the callosum,
nor of the fornix beyond the dorsal limits of the port«
(foramina Monroi) ; the pr,-e commissure and medi com-
missure are larger than usual. I'nfortunately nothing
whatever was known of the history or habits of the cat.
Now that the uniciue sjiecimen had been submitted to
the ."Association, Prof Wilder will be more free to dis-
sect it.
Dr. Wilder read another brief paper
ON THE AI.LKGED HO.MOLOGY OF THE CARNIVORAL FIS-
SURA CRUCIATA wrFH THE PRIMATIAL FISSURA CEN-
TRALIS.
Referring to the assumption of T. Lauder J^runton
(Brain, January, 18S2), " that these fissures corres[)ond,"
Prof iVilder made the following suggestions :
First. — Writers should specify whether by cori'esjion-
dence they mean analogy or Iiomology, as a relation based
upon the position of a fissure based its location among
ex|)erimentally determined " motor areas," or a relation
iinplying identity as determined by embryology and com-
parative anatom)'.
Second. — The present disagreement of competent au-
thorities respecting the homology of these two fissures
should restrain both physiologists and zor.logists from as-
suming the correctness of any particular view ; for exam-
ple, the human centralis has been homologized with
not only the cruciate, but the superorbitalis, the coro-
nalis, and the ansata together with the coronalis (in con-
nection with the last idea was shown a fcetal human
brain, exhibiting the somewhat rare condition of an in-
terruption of the centralis) ; the cruciate has been homo-
logized wdth not only the centralis, but with the first
frontal, the calloso-marginalis, and the occipito-parietal ;
i.e., the surest method of determining the true homology
seems to be the one which is outlined in Wilder and
Gage's "Anatomical Technology," to make carefid and
extended comparison between the brains, especially
foetal specimens of man, monkeys, and the lemurs on the
oue hand, with those of cats, dogs, and seals on the other.
The lenuirs are prunates with some characters of the
carnivora, while the seals, though carnivora, have the oc-
cipital lobe and the post cornu of the proccelia (cornu
posterius of the ventriculus lateralis).
These papers were discussed briefly by Drs. Morton,
Miles, Mills, Birdsall, and Hammond.
Dr. W. J. Morton, of New York, then read a paper
"On the Treatment of .Migraine." [It will appear in
full in a subsequent number of The Record.] It was
discussed by Drs. W. .A. Hammond, J. L. Corning, J. J.
Putnam, Burt G. Wilder, E. T. Miles, C. L. Dana, C.
K. Mills, and the discussion was closed by Dr. Morton.
Dr. W. R. Birdsall, of New York, presented statis-
tics with reference to
the RELATION BETWEEN SYPHILIS AND LOCO.MOTOR
ATAXIA.
He had collected 525 cases of locomotor ataxia, of whic'-'
225 patients had syphilis, or 43 per cent. The cases
7i8
THE MEDICAL RECORD.
[June 30, 1883.
were from Rosenthal, Bernhardt, Remak, Westphal,
Pusinelli, Gowers, Fournier, Erb, together with 42 which
had come under his own observation. It was noticed
that there was a marked difterence in the percentage of
syphilis in the cases reported by different observers.
For instance, Erb, in 100 cases, reports syphilis present
in 88 per cent., while in his own cases (42) only 4 per
cent, of the patients had syphilis. Probably the ditter-
ences were due to accidental relations.
Dr. Birdsall also exhibited
AN ELECTRODE FOR .MAKING CAREFUL ELECTRICAL TESTS,
and also for therapeutical purposes. It was a hand
electrode, so arranged that the current could be inter-
rupted and reversed at the same time. The communica-
tion on syphilis was discussed by Dr. Mills, of Phila-
delphia.
The Convention then adjourned to meet at 8.30 p.m.
Third Dav — Evening Session.
• A comnuinication from Dr. H. D. Schmidt, of New
Orleans, " On the Pathological Anatomy of the Cerebro-
spinal .Axis in a Case of Chronic Myelitis of nineteen
years' standing." accompanied by photographic illustra-
tions, was read by title.
GALVANIZ.VriON OF THE BRAIN AND ITS VALUE IN THE
TRE.ATMENT of CHOREA.
Dr. C. L. Dan.\, of New York, read a paper on the
above subject, in which he said that, as regards the
phenomena which result from passing a galvanic current
through the healthy human brain, the effects may be
classified under those of subjective or those of which the
patient is conscious, and those which are objective or ap-
parent and can be noted. Then followed a classification
of the phenomena, succeeded by a classification of
therapeutical results which can be obtained in the dis-
eased brain with more or less certainty.
As a result of direct electrical irritation of the e.xjjosed
brain of animals, certain phenomena are obtained not
observable when the cranial bones are interposed. Then
followed tables containing the results of experiments.
A question of great interest is : In what way does the
galvanic current produce the i)henomena which result
when precutaneously applied to the brain ? Dr. Dana's
conclusions concerning precutaneous galvanization of the
brain were :
First. — That it is one of the most easily reached and
easily aftected of central organs.
Second. — That in ordinary galvanization, the polar
method and the polar nomenclature should be used, as it
is the pole and not the direction of the current which
produces specific effects.
Third. — That the anodal galvanization of the brain
probably lowers cerebral irritability, contracts the pial
vessels, slows the circulation and produces effects on the
nutrition of the brain.
Fourth. — That its action is chiefly a direct one, but is
supplemented by refie.x processes.
Fifth. — That possibly more powerful or special polar
effects may be produced by using widely separated elec-
trodes.
CHOREA.
Dr. Dana, having thus given the theoretical basis for
the practical use of electricity in chorea, said he believed
that ordinary chorea minor is an irritative disease of some
part of the voluntary motor tract. The irritation may be
chiefly in the spinal cord, or chiefly in the brain, as with
the ordinary chorea of children.
Chorea is not a disease which should be left to Natme.
It often, indeed generally, runs a typical course, but in
the beginning the physician can never say whether or not
it will cling to the child for months or years ; iience the best
tlierapeiitical means should be promptly applied. Dr.
Dana then reviewed the reports as to the value of electri-
city in chorea, and found that they had been most conflict-
ing. It had seemed to him, however, that the agent, so far,
had been applied irrationally. By acting upon the hypo-
thesis that anodal galvanization of the brain ought to
prove sedative in functional spasmodic troubles of cere-
bral origin, he began some time ago to use this method in
the treatment of chorea. It was not until recently that
he learned, in Erb's work, that Berger also had been
using anodal galvanization of the brain in chorea ; neither
of the authors, however, had given detailed reports of their
cases. Dr. Dana reported eight cases. The patients
all recovered. The average duration was thirty-four days ;
the average duration of treatment, twenty-five days. It
was not upon the statistics of duration, however, that he
was led to believe in the efficacy of anodal electricity.
U'hat he claimed for anodal galvanization is that it is a
most valuable adjunct in the treatment of chorea ; that
given daily for a week or ten days with arsenic, and prob-
ably without, it will materially shorten the duration of
the disease.
The method of application is as follows : A large
sponge-electrode of flexible brass. 4x2 inches, is
thoroughly moistened with salt water. The hair of the
patient is also thoroughly wetted and the electrode ap-
plied over the side of the head above the ear. In hemi-
chorea it need onl\- be applied over the side opposite
to the one affected. The other electrode is placed in
the hand of the affected side. The electrode upon the
scalp is made positive, and a current, three to six
Stohrer's, four to eight Daniell's cells, is passed for from
three to five minutes. The electricity should be applied
daily for at least ten days. If after that time there is no
improvement it may be discontinued.
Dr. Cornin'g, of New York, was convinced of the ef-
ficacy of central galvanization in the treatment of chorea,
with or without arsenic.
Dr. Mills, of Philadelphia, agreed largely with Dr.
Dana concerning the efficacy of galvanization of the
brain in chorea, but took some exceptions to the theory
advanced concerning the mode of action. There were
very many things which led him to believe that the effect,
so far as the brain was concerned, was indirect or of a
reflex character.
Dr. Wehber, of New York, thought the reflex action
svas probably the most important to consider. He had
no doubt of the refreshing effects of electricity passed
through the head, but had found that only a few cells of
a good battery were necessary to give the desired results ;
three elements for children, four to six, utmost eight, for
adults.
The paper was further discussed by Drs. Birdsall,
Corning, and Morton, and the liiscussion was closed by
Dr. Dana.
Dr. Burt G. Wilder, of Ithaca, then read a brief
paper
on the removal and I'RESERV.-iTION OF THE HU.\L\N
r.RAIN.
It referred to the removal of the calvaria, which should
never be done with a jerk, but by sawing through a
little to one side of the great longitudinal sinus, and then
removing the sides caref"uily after releasing the dura by
means of a thin-bladed flexible knife with curved point.
Tiie brain should never be allowed to support its own
weight, but should be sus|)ended in strong brine. Several
points concerning the handling of the brain were men-
tioned. The preservation was by means of alcohol, be-
ginning with fif'ty or sixty per cent, and gradually increas-
ing the strength until the ordinary ninety-five per cent,
is reached. He also passes alcohol through the vessels
of the brain in a continuous stream for some time, and,
besides, irrigates the central cavities of the brain. Whether
brains hardened in this manner were well preserved for
microscopical examination he was unable to say.
Dr. Spitzka said that the process recommended by
Dr. Wilder was absolutely worthless for the histologist
June 30, 1883.]
THE MEDICAL RECORD.
719
and pathologist, but was doubtless an excellent method
for the comparative anatomist.
The communication was discussed someuhat by Drs.
Mills, Miles, Spitzka, and Wilder.
Dr. Wilder then began a paper
ON SOME POI.VTS IN THE ANATOMV OF THE HUMAN BRAIiN,
but owing to the lateness of the hour did not complete it.
So far as he presented it the object was to show that we
need greater accuracy in our methoils of dissection than
have been followed in general.
A paper by Dr. E. C. Spitzka, entitled " Lesion of
the Stratum Intermedium," with remarks on the anatomy
and physiology of that tract, illustrated by specimens,
was read by title.
A paper was presented by Dr. G. L. W'alton, of
Boston, in whicii were reported
TWO CASES OF hysteria : I, hysterical hemian.«:s-
THESIA in a man FOLLOWING INJURY ; 2, HYSTERICAL
AN-ESTHESIA of special sense ACCOMPANYING CUTA-
NEOUS HYPER.+:STHESIA.
The first was interesting with regard to its etiology. A
strong, robust man, without a trace of nervous history,
who, following a fall upon his head and shoulder, had,
besides other symptoms, typical hysterical heniianies-
thesia.
The second case was interesting in that there was
anassthesia of the special senses, iiearing, smell, taste,
whereas the skin over these organs was hypera;sthetic,
entirely contrary to the rule.
Both cases yielded under the use of the magnet.
The Association then adjourned to meet at the call of
the Council.
^vmij and ITauy 3\cxus.
Official List of Changes of Stations and Duties of Officers
of the Medical Department , United States Army, from
June 16, 1S83, to June 23, 1S83.
GoRGAS, W. C., First Lieutenant and Assistant Sur-
geon. The leave of absence granted in S. O. 51, par. 5,
C. S., Department of Te.vas, extended one month. .S.
O. 63, Military Division of the Missouri, June 19, 1883.
Wyeth, M. C, First Lieutenant and Assistant Sur-
geon. .\ssigned to duty at Fort Maginnis, M. T. S. O.
103, par. 2, Department of Dakota, June 14, 1883.
Official List of Changes in the Medical Corps of the Navy
for the week ending June 23, 1S83.
David Kindleberger, Medical Director, and F. M.
GuNNEl.L, Medical Director. To the Naval Retiring
Board.
M. H. Crawford, Past Assistant Surgeon. From
Navy Yard, League Island, Pa., to the U. S. S. Pinta.
Jerome H. Kidder, Surgeon. Resigned, to take
effect June i8, 1884, and granted leave till that time.
Thom.'^s J. Turner, Medical Director. Orders of
June 7th modified to continue on duty as member of
the National Board of Health, till June 30, 1883.
Adulterations and Charity. — A Spanish magis-
trate, shocked and exasperated by repeated proof of the
adulteration of food in his district, has issued a procla-
mation aflame with righteous wratli, that "all articles in
the shape of wines, groceries, and provisions, which upon
examination and analysis are proved to be injurious to
health, will be confiscated forthwith and distributed to
the different charitable institutions."
^crticaX ?tcins.
Contagious Diseases — Weekly State.ment. — Re-
port of cases and deatlis from contagious diseases re-
ported to the Sanitary Bureau, Health Department, for
the two weeks ending June 26, 1883 :
Ih'
1 -3
Week Ending
>
3
'3
et Fever.
Dro - spin
ningitis.
X*
a
■S.
carl
ere
Me
"A
4J
Si
Q.
p
_o
H
ir'
tn U
^
2
m
>
Cases.
June 19, 1SS3
0
7
74 t>
91
20
0
0
June 26, 1883
0
II
61 : 4
«7
39
0
0
Deaths.
June 19, 1883
0
3
23 9
2''
16
0
0
June 26, 1883
0
9
16 4
.8
n
0
0
Heitzmann in Berlin. — Dr. Heitzmann, of this city,
described liis peculiar histological views before the Ber-
lin Medical Society, at its meeting on May 2d. These
views, it will be remembered, are that the body tissues
are not made up of cells, but rather of a reticulated net-
work enclosing living protoplasm. In the discussion
which followed \'irchow responded to the attack made
upon the cellular histology. His view, in brief, was that
the fact of a cellular network, even if proved, was of
secondary importance, and did not affect the theory that
the cell is the ph)siological and anatomical unit of the
tissue. That cells are the individual units and not jiart
of a great ramification, he still believed, and instanced a
number of facts in support of the opinion.
Dr. Frankel, who was the only other speaker, con-
tended, against the opinion of Heitzmann, that even
healthy rabbits may be made tuberculous by the inocu-
lation of non-tuberculous matter.
Poisoning fro.m Castor Beans. — Dr. M. E. .-Vlder-
son, of Russellville, Ky., writes : " It is the general im-
pression among the laity, and also with many of the
medical ptofession, simply because they have not had oc-
casion to carefully examine into the history of the plant,
that the Ricinus communis, or common castor-oil plant,
is non-poisonous and harmless. Very few of the writers
on Materia Medica ascribe to it any dangerous qualities.
Pareira, of the older authors, speaks of serious effects
from ingestion of the bean ; and Stille, of the modern,
gives a number of fatal cases of jioisoning from the same.
As a consequence of this careless notice, the plant has
gained a prominent jilace among the flowers in our gar-
dens, and as the fruit has thus become easily accessible
to children, I thought that the following cases might be
of interest, put some on their guard, and perhaps save
little innocent tasters from its terrible effects. On Sun-
day morning, April 8th, I was called to see Mattie and
Mabel W , aged respectively seven and three years.'
I was told by the messenger that they had, on the pre-
vious day, in the afternoon, eaten some castor beans,
and had been vomiting and purging incessantly all night.
Upon my arrival, about eight o'clock, I found both the
little girls completely prostrated, with cold extremities
and scarcely any radial pulse, in fact, almost in fatal col-
lapse. The symptoms were very similar to those of
cholera infantum. I inmiediately ordered mustard to
stomach and bowels, and administered, as best I could —
as the efforts to vomit came on every ten or fifteen min-
utes— a mixture of sulphuric ether. aqu;e camjih., and mu-
cil. acaciM. Under this treatment they seemed to revive
a little. By keeping up the stinuilant treatment and
combating the intense nausea and thirst with cracked ice
and small doses of bisrnuthi subnitratis and sulph. mor-
phia;, I succeeded in lengthening the intervals between
720
THE MEDICAL RECORD.
[June 30, 1S83.
the attacks of vomiting, the purging having stopped
earlv in the morning. After the thorough evacuation
of the poison, we had for five da\-s to contend with most
acute attacks of gastro-enteritis, during which the httle
sufferers again came near losing their hves. They, how-
ever, withstood the shock, and are now convalescent."
HoFPiT.'iL Stretchers. — Dr. ALorison, writing from
Plerlin, of the Hygienic E.\hibitioii. says {Maryland
Medical Jo itnial): "The best arrangement for carrying
the ill to a hospital, or anywhere, is suggested by the
e.xhibit of covered stretchers. This exhibition is made
by Vienna, where an ill person is always carried in this
way. Xo carriage or wagon can possibly be made as
comfortable, or managed with so little danger to the
l^atient. There is no e.x])osure, for the covering is com-
plete, and they are made so light that two men can
easily carry any jiatient upon them, .\mbulance3 may
carry tlie stretchers, but the stretchers should carry the
patients. Many an agonizing pain, and perhaps many a
life, would thus be saved."
To Stop Hiccol'gh. — Dr. Martin Hurke, of this city,
sends us the following item : " Perhaps the narrative of
these two cases may prove of interest. John C was
suddenly seized about a year ago with an attack of hic-
cough. The cause was unknown. All the usual reme-
dies were tried in vain. Dr. John Burke, my father, was
then called upon. Noticing the convulsive heaving of
the patient's ribs, moie jiarticularly upon the left side,
he firmly compressed the side between his two hands,
and in a short time the hiccough ceased for the first time
in da\s. The second case was that of Mr. C . a
young man of thirty. He also was attacked, first with
vomitmg and then with hiccough, most violent and con-
vulsive. Morphine suppositories would produce sleep,
but even in sleep the hiccough was distressingly severe.
As his vomiting had now ceased, almost every remedy
known was called to our aid, but it was not until we had
again, by my father's advice, compressed his heaving
ribs, that the hiccough almost mstantly ceased. It re-
turned indeed within twenty-four hours, but compression
again arrested it. The patient is now convalescing, and
as hiccough very often proves fatal, jjerhaps the record
of these two cases may prove of service.'
To Disguise the Odor of Iodoform. — Dr. J. .\.
Andrews, of Staten Island, N". Y., writes : "It may inter-
est your readers to know that cumurin will disguise the
unpleasant odor of iodoform. The Tonka bean has
been employed for this purpose. The bean being
placed in the bottle containing iodoform. This, how-
ever, is not effectual. Cumurin, itself a derivative of
the Tonka bean, is an anhydrate of cuunnic acid. It
disguises the odor of iodoform more effectually arid per-
manently than do other drugs with which we are familiar,
nor does it form, when incorporated with iodoform, lumps
of powder which are slow to dissolve, which is a real
advantage where this drug is employed in the therapeusis
of purulent inflammation of the middle ear. However,
it is not the object of my communication to urge the
claims of iodoform in the treatment of suppurative intlam-
mation of the external or middle ear, because I believe
it is of use only in certain selected cases of this affection,
often actually aggravating the condition in others. The
minimum amount of cumurin which I have found suffi-
cient to disguise the odor of iodoform, is three grains of
the former to one drachm of the latter."
Mercury .vxd ^^AL.4RI.\— He.morrhagic Malaria. —
VV'e have received a letter from Dr. Harris Fisher, of
Eastman, Ga., containing an interesting discussion of the
subject of hemorrhagic malaria, and criticizing some of
Dr. W. O'Daniel's views on the subject of malaria as the
cause of hainiaturia. The remarks upon the popular prac-
tice of giving mercury in malaria w-ili e.vcite some dispute.
"We have," he writes, "just jiassed through a most
notable epidemic of benign biliary jaundice. Every prac-
titioner in this country has seen scores of cases. Catar-
rhal duodenitis, with occlusion of the bile-duct, white
faeces, a stupid and depressed mental state, with an ab-
normally slow pulse in some instances as the extreme
toxic effect of the bile. With a reappearance of bile in
the feces a rapid clearing up of the skin. .\n inevitable
deepening of the jaundice by any untimely exhibition of
mercury. The jjathological states giving rise to this
icteric hue are entirely dissiiiiilar : but as relates to the
use of mercury, very similar, i.e.. it can hardly fail to do
harm in any case. Our own observation and experience
go far to sustain the broad assertion that the occasion for
the exhibition of mercurials in malarial fevers in general
is seldom present. From what we have seen and read
and heard related of the behavior of hemorrhagic ma-
larial fever, we tiiink it should here be used with the
greatest circumsjjection. First, at some period or other
of a malarial parox\sm the liver, as a rule, acts with un-
wonted energv. The hasty administration of a dose of
calomel only adds profusion and acridity to the secretion.
Depletion and an enhanced tendency to congestion fol-
lows as a se<|uence. The i^atient who has a chill to-day
and takes blue mass, and has another on the third day,
will vomit and pass more bile per anum than ever before.
In hemorrhagic malarial fever it is the observation of
most writers that the liver seems to act profusely ; and
certainly the catahsis of mercury is to be avoided where
the death-rate of the oxygen carriers is sinijily fearful to
contem]3late. Dr. O' Daniel says 'malarial haamaturia
is malignant bilious fever, and nothing more.' This is a
very debatable point. .A. monument should be erected
to Thomas \Vatson for impressing so profoundlv ujjon
the |5ractitioner the imi)ortance of studying the mode of
death and tendency to death in every disease. The ap-
plication of this hint to the point in question militates
strongly against Dr. O'Daniel's position. In ordinary
bilious or remittent fever, when it assumes a type worthy
of the term malignant, the cause of death is geuerall)'
breaking down under the prolonged and unrelieved con-
gestion of the mucous coat of the stomach and similar
changes in the liver and spleen. Prolonged high tem-
perature is an important factor in producing the same re-
sults. Day after day, running into weeks, the patient
may exhibit the dry, parched, almost black tongue, and
vomiting continue until the secreting structures of the
stomach begin to pass away in "coffee-ground" vomit,
and death supervenes ; and not a drop of blood be effused
into the tissues, or stomach, or bladder : on the other
hand, the patient yet on foot suft'ers in many instances
from all these things, effusions, before taking his bed.
The tendency to death is, in the latter case, eminently by
an;Bmia. It is true there is, perhaps, in all cases of
hemorrhagic malarial fever more or less splenic and he-
patic congestion, but the cause that carries ofia man or
woman in two or three days after going to bed is effusion
of broken down blood ; and the syncopal and asphyxia!
symptoms that immediately precede dissolution are in
striking contrast to those that close the scene in a death
from remittent fever. Patients suffering from severe re-
mittent fi*\'er are apt to have it from the first. Hemor-
rhagic malarial fever is almost always concurrent with
chronic intermittent. Dr. O'Daniel very correctly insists
that there is more in the prophylaxis than the cure. His
success is above the average. Whoever has chronic
chills and determines to live in daily or nightly renewal
of the contamination is liable at any moment to exhibit
the signs of the dreadful disease. The recently malaria-
bitten need not be uneasy. The causes that bring about
this sudden death of the blood operate slowly. The fol-
lowing observations aie, we think, justified by theory and
experience : A complete dil'fercntiation from any other
form of malarial fever ; the jaundice accompanying is
hremalinic ; the tendency to death is mainly by anajmia ;
the use of quinine now and then precipitates an attack ;
mercurials are but little indicated ; when periodic, the
rhythm must be broken ; the prophyla.xis or hygiene of
this disease is retreat.
INDEX.
Abdomen, rupture of walls of, S9 ; surgery
of. 530-
Abdominal section, 15S, 20S ; consecutive
cases of, 293.
Abortion, 297 ; antiseptics after, 692 ; assa-
fcetida in, 332.
Abscess, cold, of the tongue, 515 ; intracran-
ial, trephining for, 322 ; of the liver, 105 ;
of the neck, 599; pelvic, 351 ; perine-
phritic, 433.
Abscission, is it a proper operation ? 669.
Abstracts, the, 354.
Acetonuria, 10.
Acid, boracic. local application of, 209; car-
bolic, subcutaneous use of, in muscular
rheumatism, 20S ; chromic, in the treat-
ment of nasal polypi, 577; hydriodic, in
acute rheumatism, 44S ; hydrobromic, a
substitute for the bromides, 713; lactic,
in diabetes, 155 ; muriatic, in typhoid
fever, 212 ; phenic, 672 ; in typhoid
fever, 9 ; phosphoric, excretion of, 714 ;
picric, as a test for albumen in the urine,
193, 404 ; salicylic, ergot as a preventive
of poisonous elTects, 571; salicylic, in
night-sweats, 94 ; sulphurous, in phthisis,
195 ; uric, abnormal in various secre-
tions, 93 ; uric, and renal concretions,
70S.
Acne, 151.
Aconite, dose of, in the British Pharmaco-
pceia, 168 ; the proper way to give, 56.
Acton, Dr. Wni., notice of book by, 299.
Addison's disease, 179; and the suprarenal
capsules, 4S9.
Adipocere, 493.
Adonis vernaiis, a cardiac stimulant, 160.
Agnew. Dr. C R., remarks maae at State
Medical Society on the Code of Ethics,
349 ; the care of the chronic insane, 13S.
Air, entrance into the pleural cavity, 301 ;
how to]>urify, of the sick-room, 335.
Air-baths, 40S.
Albumen, picric acid as a test for, in the
urine, 193, 404 ; tests for, 307 ; in ascitic
fluid, 93.
Albuminuria, from contusion of the loins,
23S ; hygienic treatment of, 325 ; of epi-
lepsy, 67 ; the, of fevers, 95.
Alcohol, and stomach digestion, 308 ; in
scarlatina, 162; mortality referable to,
291.
Alderson, Dr. M. E., poisoning from castor-
beans, 719
Alkaloids of decomposition, 523.
Allen, Dr. Harrison, notice of book by, 167,
496,
AUoplasty, 232.
Alumni Association of College of Physicians
and Surgeons, 573.
Aluminum, in the treatment of phthisis, 683.
Amenorrhcea, permanganate of potash in,
236.
American Laryngological Assoiation, 575,
60S.
American Medical Association, 605, 625 ,
delegates to, 543 ; journal of, 242, 409 ;
report, 627 ; report of Sections, 659 ;
what other people think of it, 655,
American Medical Editors' Association, 671.
American Neurological Association, 712.
American Society of Microscopists, notice,
272.
American Surgical Association, 637.
Amputation at the hip-joint, 3S5.
Anasarca intercurrent with pleurisy, 20S ;
oxydendron in, 707.
Anatomy, class quiz on, 392 ; Quain's ele-
ments of, notice of, loi.
Anchylosis at hip-joint, 589.
Ancemia, etiology of pernicious, 492.
Auossthesia, frcjm galvanization of the supe-
rior laryngeal nerve, 501 ; hysteiical, of
special sense, 719; local, 4S8 ; trance,
248.
AnaiStlietics during labor, 651.
Aneurism, by anastomosis, 522; cured by in-
jections of ergotin, 292; dissecting of
the aorta, 276 ; of the arch of the aorta,
245. 388; of the gall-bladder, 432.
Aneurisms, traumatic, Esmarch's bandage,
638.
Angina pectoris, hysterical. 600 ; treated
with nitro-glycerine, 503.
Anthrax, 241.
Antisepsis, with and without, 192, 660.
Antiseptic, peroxide of hydrogen as an, 15 ;
naphthaline as an, 707.
Antiseptics, after abortion and labor, 692 ; in
London hospitals, 204, 237 ; new method
of using, 43.
Aorta, aneurism of, 245, 3SS; dissecting an-
eurism of, 276 ; perforation of, by a for-
eign body in the tcsophagus, 5CO ; rup-
ture of, during labor, 239.
Apom(jrphia, as an emetic, 680.
Arachnoid, hemorrhage into the cavity of
the, 6S.
Arm. paralysis of, following vaccination,
569 ; rare dislocations of, 279.
Armstrong, Dr. John A., medical Latin,
Arsenic, 58; bromide of, in diabetes. 332.
Arteries, carotid, abnormalities of, 443 ; ori-
gin of calcanean, 442.
Artery, common carotid, ligature of, and re-
moval of the lower jaw, 131 ; pulmon-
ary, rupture of. 600 ; subclavian ligature
of the right, in the second part, 2SS ;
thrombosis of the basilar, 432 ; uterine,
a new instrument for ligating tlie, 529.
Artery clamp, 389.
Ascaris lumbricoides. central phenomena pro-
duced by, 94.
Ascites, albumen in fluid of, 93 ; frequent
tapping in, 291.
Aspiration, cardiac, 140, 263.
Assaf'fctida in the treatment of abortion, 332.
Asthma, 35, 163; convallaria maialis in, 133;
euphorbia in, 99: paroxysms of, and
Charcot's crystals, 96; permanent, 542.
Astragalus, dislocation of, 640.
Asylum, the Tewksbury, and charges of mis-
management, 379.
Asylums, insane, 521, 553, 555.
Atalectasis, 601.
Ataxia, 600, 714, 716, 7'7; epileptic phe-
nomena in, 94.
Atropia, action and uses of. 572.
Atropine, eccentricities of, 457 ; and mor-
phine, 559, 615.
Auscultation, cephulic, in mental diseases,
325-
Automatism, 513.
Autojjsics in the army, 654.
Autopsy, how to make. 463.
Axford, Dr. Wm. L., injury to the cardiac
valves from sudden violence, 319.
B
Bacillus, a new, 43 ; of tubercle. 9, 17, -26,
355. 379- 3S2, 397. 495, 550, 645 ; tu-
berculosis in urine, 321 ; of tuberculosis,
significance of, 296 ; the, of whooping-
cough, 185.
Baldness, premature, 680.
Banks, Dr. James Lenox, notice of death of,
627.
Barbour, Dr. A. H. , notice of book by, 384.
Barium, iodide of, 238.
Barnes, Dr. Joseph K., obituary, 417.
Bartholow, Dr. Roberts, acute rheumatism,
I, 85 ; the antagonism of morphine and
atropine. 559
Battery. Rosebrugh's new medical, 83.
Beach, Dr. Wooster, epidemic of impetigo
contagiosa, 63.
Beard. Dr. George Milner, obituary, loi ;
the late Dr. Geo. M., 250 ; resolutions,
359.
Beef-tea, 391.
Belfield, Dr. Win. T., on the relations of
micro-organisms to disease, 197, 225,
253, 2S1, 309 ; catheterizing the female
ureter, 444.
Belladonna, poisoning from plaster of, 82 ;
in tetanus, 36.
Bellevue Hospital. 376.
Bellevue Hospital ^Iedical College Alumni
Association. 502.
Bigelow. Dr. Horatio R., ovaritis, 346 ;
some interesting cases in gynecology, 37.
Bile-duct, ligature of, 389.
Bismuth, in cancrum oiis, 113; in noma,
304; in the treatment of wounds, 551 ;
in ulcers, 599.
Bladder, aspiration of the, 21 ; exploration
of, by jierineal section of the urethra,
323 ; diphtheria of, W'lthout infection,
93; dissolving coagula in, 223; mucous
polypus of, 321 ; spontaneous formation
of gas in, 599.
Blepharitis, chronic tubercular, 599.
Blindness, prevention of, 364.
Blood, coagulation of the, 69; influence of
Fowler's solution on the ha-maglobin of,
429; is it a living fluid? 564; the, and
ozone, 27 ; the third corpuscle of the,
212.
Blood-vessels, inoculation with lymphatics,
652.
BluflT, the therapeutics of, 683.
Board of Health at Pensacola, 3S0.
Bone, reproduction of, 551.
Boro-glyceride, 335.
Boskowitz, Dr. Herman, notice of death of,
27.
Bosworth, Dr. F. H., growths in the nasal
passages, 29, 49.
Bougies, gelatine urethral, 195.
Brain, hydatid of the, 322 ; regional physi-
ology of the, 240 ; removal and preser-
vation of the human, 71S.
Brain-energy, exhaustion of, 375.
/
22
INDEX.
[June 30, 188^
Bradner, Dr. N. Roe, lunatics at large Z'S'
same persons in asylums, 344.
Brandeis, Dr. Richard C, catarrhal head-
aches and allied affections, 421.
Brandon, Dr. G. W., on decayed teeth, 587.
Brandt. Dr. W. J., tracheotomy in young
children, 54.
Breast, cancer of. 331 ; glycosuria following
removal of, 489.
Bright's disease, anatomical changes in. 322 ;
changes in the renal ganglia in, 324 ;
danger of ether in, 261.
British Medical .Association, 532.
Bromine, arsenite of, in diabetes, 620.
Bronchitis. 571.
Bronchocele, e.xtirpation of. 165, 523, 551.
Brubaker, Dr. A. P., notice of book by, 272.
Brush, Dr. E, F., oesophagitis as a disease of
infancy. 35; vaccination, 677.
Bubo, 267 ; and bird, 137.
Buck, Dr. Albert H., condensing ostitis of
the mastoid process, 25S ; removal of
foreign body from the external auditory
canal. 26.
Bucklin, Dr. C. A., convergent squint cured
by eserine, 597.
Bull, Dr. Ole B., notice of book by, 166.
Burn, pathology of death from. 94.
Byrd, I3r. Harvey L. . on the importance of
recognizing different conditions in differ-
ent races in disea^^es generally, 538; the
radical diversities inthe liuman race, 17S.
Caffein, for hypodermic use, 9 ; formuk^ for
hypodermic injection, 440; in heart dis-
ease, 94; soluble salts of. 246.
Calabar bean, action of, upon the intestine,
407.
Calcium, sulphide, 2S0.
Calculi, urethral, 132.
Calculus, vesical, expulsion through vesico-
vaginal septum. 45g.
Cal.x sulphurata, 280.
Camera lucida, Grunnow's, 277.
Cammann, Dr. D. M., menthol z.-s pain,
458-
Carcinoma, acute miliary, primary, 651;
general. 77.
Cancer, of the breast, 331, 553; of the face,
34S ; of the lung, primary, 215; of the
pancreas, primary, 252 ; of the rectum,
77. 330. 552; of the stomach, 19, 331;
of the testicle following orchitis, 162;
of the uterus, 77, 191 ; the histogenesis
of, 161 ; treatment of mammary, 552;
value of early operations in, 639.
Cancrum oris, bismuth in, 113.
Cannabin tannicum as a hypnotic. 390.
Cannibalism, 672.
Capillaries, peculiar disturbance of the circu-
lation in the, 571.
Carbunculus internus. 601.
Carotids, abnormalities of, 443.
Carpenter, Dr. Wesley M., notice of book
by, 687.
Carpenter, Dr. W. B., notice of book by,
6S7.
Carroll, Dr. Alfred L. , filth disea.ses in rural
districts, 617.
Cartilage, reparative process in, 514.
Cartwright lectures, 197, 225, 253, 281, 309.
Cascara amarga, 503.
Cascara sagrada, 503.
Case-taking, hints on, 174.
Castor-be.ans, poisoning from, 719.
Castor-oil and glycerine, 300, 588.
Cataract, eighth series of one hundred cases,
■54 ; operation for, in the subjects of
chronic disease, 489.
Catarrh, chronic uterine, 674, 691.
Catharsis, timely, 522.
Catheterism (.-icilitated by the use of a bivalve
anal speculum, 415.
Cellulitis, peri-uterine, in the abscess, 28.
Census, the tenth, 279 ; the tenth, and the
profession, 270.
Central Bark, 464.
Cephalhxmatomata, subpericranial, 278,664,
868.
Cerebellum, tumor of, 342, 357.
Cerebro-spinal meningitis, the micrococcus
of, 327-
Cerebrum, cortex of, igo; electrical irrita-
bility of, influenced by anaemia, 488.
Chamberlain's tube, 582.
Chapin, John B., the care of the chronic in-
sane, 81.
Charcoal fume=, 184.
Charcot's crystals and the asthmatic parox-
ysm, 96.
Cheesman, Dr. \Vm. T., abstraction of blood
from the right heart. So.
Chilblain, 252.
Children, convulsive affections in, 591,
Chloroform. Ijreath in gastric disturbance,
532 ; death from, 297 ; in midwifery,
495 ; narcosis from, during sleep, 457,
563, 594, 595 ; poisoning from swallow-
ing, iSi.
Chlorosis, jgS -, and fever, 650.
Cholera infantum, cause and cure of, 528.
Chorea, fatal case of, 699; galvanization of
the brain in. 718.
Chorea laryngis, 578.
Chorion, hydatidiforni. disease of, 239.
Choroid, rupture of. 155.
Churches, ventilation of, 84.
Cigars, tenement-house, 98.
Cipperly, Dr. J. H., suture-clamp coaptation,
569.
Circulation, eftect of intrabronchial pressure
upon the, 10.
Circumcision, J31.
Cirrhosis of the liver in a child four and one-
half years old, 525.
Courtesy in medical discussions, no.
Clairvoyance, 572.
Clapp, Dr. J. G , hydrophobia, 695.
Clay, the therapeutic use of, 291.
Cleborne. Dr. C. f., a combined insufflator
and vaporizer, 361.
Clendinen, Dr. .A., improved general exten-
sion ^splint for lower extremity, 164.
Clitoris, cauterization for hysteria, 362.
Clothes, 697.
Club-foot, 521.
Coal-gas, 184.
Coal-tar, sweets from, 475,
Cobweb, tincture of, in intermittent fever, 94.
Coca, fluid extract, to produce anjesthesia of
the pharynx, 3S4.
Code. 462, 471 ; address to the medical pro-
fession of the State, 476 ; in Canada,
363 ; medical, comments on, 363 ; the
new, in the West, 699.
Coffee in typlioid fever, 360.
Cold, influence of, on the deeper tissues, 267 ;
in the treatment of fevers, 12.
Colio. biliary, succinate of iron in, 250.
Colitis, follicular, 558.
Collodion in furuncles, 532.
Colon, percussion of, in diarrhcea, 541 ; tu-
bercular ulcer of, 557.
Colotomy lumbar in an infant two months
old, 536,
Coma, diabetic, 161.
Coma, ur.xnuc, 27S. ■>
Comegys, Dr., of Cincinnati, 672.
Conception, remarkable case of, 37.
Conjunctiva, lymphadenitis of. 161 ; lymph-
.adenoma of, 351 ; of the rabbit, trans-
jtlanlation of. 194 ; transplantation of,
42 ; transplantation of portions from the
ral)bit to the human eye, 232.
Connecticut Medical Society, 574, 612.
Consumption, mullein in, 266,
Contagit)n. 241.
Convallaria mailais, S7, 117, 193. 251, 335,
413, 653 ; in asthma, 1 33; in heart dis-
ease, 209 ; in vagus neurosis, 133.
Convulsions, in children, 591; puerperal, 68.
Copperhead, venom of, 600.
Cord, spinal, tidierculous nodule in, 322.
Corning, Dr. J. Leonard, exhaustion of brain-
■••"ea'y, 375- „ .
Coroners and the Newport Medical Society,
560.
Corrosive sublimate as an antiseptic in mid-
wifcry, 495.
Corwin, Dr. !•. M.. cardiac aspiration, 263.
Coryza, acute, salicin in, 279.
Couch, Dr. L. R., 447.
Cough, mixture for, 69 ; spasmodic, ethyl
bromide for, 162,
Counter-prescribing, 493.
Courty, Dr. A., notice of book by, 412.
Craniotomy, is it justifiable, 404.
Crothers, Dr. T. D. , inebriety from obscure
physical causes, 539 ; inebriety and the
birth, 333.
Croup and diphtheria, 20, 665 ; false, 3S7.
Curtis, Dr. H. Holbrood, the hot-water re-
trojection in the treatment of gonor-
rhcea, 425.
Gushing, Dr. Clinton, a new instrument for
ligating the uterine artery, 529.
Cyanides, hypodermic use of, 603.
Cyanosis from congenital closure of the aortic
orifice, 428.
Cystinuria, 321.
Cystoabdominalraphy, 2S6.
Cysts, dermoid, of the ovary, 19; of the in-
testine, 39 ; origin of renal, 24.*
D
Dana, Dr. Charles L. , the absorption of nu-
trient enemata, 6 ; two cases of cardiac
aspiration, 140.
Daltonism affecting one eye, 319.
Daly, Dr. W. H., tonsillotomy, 146.
Dandridge. Dr. N. P., myxo-lipoma of the
abdominal walls, 60.
Darwin's religion, 364.
Dead, preserving the bodies of the, 296.
Dead-drunk, 425.
Death from burning, pathology of, 94 ; in
New York City, 1S3 ; Shakespeare on,
55 ; sudden, due to cerebral inhibition,
543-
Decalcification, mercurial, 624.
Delegates, eligibility of, at the American
Medical .Association. 490 ; to the Amer-
ican Medical Association, 543.
Delirium and insanity, 359 ; with empyema,
414.
Delirium tremens, ergot in, 41, iSi ; chloral
and the bromides in, 30S.
Dessau, Dr. S. Henry, convulsive affections
in ciiildren, 591.
Diabetes, insipidus, traumatic, 6oi ; melli-
tus, 474; acute, 600; arsenite of bro-
mine in, 620 ; bromide of arsenic in,
332 ; coma in, 161 ; cause of, 277 ; lac-
tic acid in, 155 ; pneumaturia of, 51,9;
puerperal, 599 ; wounds in the course
of, 71.
Diarrhcea, infantile, chamomile tea in, 292 ;
percussion of the colon in. 541.
Dietz, Dr. Wm. D., hospital report, 290.
Digestion, delusions concerning oysters, 278.
Digitalis, indications for its use, 392.
Diphtheria, 41, 550, 607, 618; and croup,
20, 665 ; and nephritis, 624 ; blue-gum
steam in, 363 ; carbonate of potash in,
252; complicating scarlatina, 48, 51;
general atrophy following, 600; from
milk, 195 ; heart-failure in, 4S4. 497 ; in
fowls. 419; of the bladder without in-
fection. 93 ; pinus canadensis in, 698.
Disease, collective investigation of, 41.
Diseases, filth, in rural districts, 617; en-
demic in Florida, 649.
" Disgusted Party," 6S2.
Disinfection, liy hot air, 164.
Dislocations of the thigh, new methods of re-
ducing, 403.
Dispens.aries, a city of, 491.
Doctor, and druggist, 28 ; dinners and doc-
tors' wines, 420 ; fees of, 222 ; the, and
culture, 159.
Dogwood. Jamaica. 503.
Dorman, Dr. H. \V., 27S.
Doses, small, 21 ; small, and frequently re-
peated, 27S.
Double existence, 209.
Drew, Dr. C, Jr., endemic diseases in Flor-
ida, 649.
Dropsy, treatment of. f 7.
Drinjs, and mixtures, wholesale preparation
of, 407 ; the power of, 699.
Drug-taking and resthetics, 241.
June 30, 1883.]
INDEX.
723
Dukeman, Dr. W. H., urethral stricture
treated by electrolysis, 679.
Dunglison, Dr. Richard J., notice of book
by, 6S8.
Duodenum, lymphosarcoma of, 322.
Dupuytren's finger contraction, .\dams' op-
eration for, 134.
Dyscardia, 474.
Dysentery, treatment of, 239.
Dysmenorrhea, salicylates in, 600 ; vibur-
num opulus in, iSS.
Dyspepsia, climacteric, 515; treated with
sand, 690; uterine, 354.
Dysphagia, nervous, 322.
Dyspncea, simulated by rapid breatliing, 599.
Ear, acute intlammation of the internal, 323 ;
diseased and healthy, eflect of noise upon,
467, 644 ; dry treatment of otorrhceal
diseases of, 125 ; foreign body in, 222 ;
removal of bean from, 214 ; removal of
foreign bodies from, 54, 151, 223 ; semi-
circular canals, new function of, 542 ;
semicircular canals of, protective func-
tion for animals, 420; simple instrument
for removing foreign bodies from, 447 ;
syphilitic diseases of, 153.
Earache in children, 4S0, 497.
Ebstein, Dr. W., notice of book by, 165.
Echinococcu.s, 557.
Eclampsia, nutans, 4S9 ; puerperal, the hot-
pack in, 68.
Eczema, pathology and treatment of, 104.
Education and crime in France, 204 ; higher
medical, 672.
Elaterin, 469.
Electricity as a cardiac stimulant, 16; dif-
ferential indications for use of the three
forms of, 107 ; in intermittent fever, 291.
Electrolysis in the treatment of organic stric-
tures of the urethra, 512, 679.
Emerson, Dr. J. B. , a new instrument for
testing the field of vision, 251.
Empyema, 553 ; unusual modes of discharge
of the pus, 293 ; delirium with, 414 ;
exsection of ribs for, 442 ; traumatic,
use of the trephine in, 63S.
Encephaloid, simulating aneurism, 288.
Endarteritis, syphilitic and traumatic, 132.
Endocarditis, 301 ; acute, limited to the right
side, 20S ; fretal, 207.
Engelmann, Dr. Geo. J., notice of book by,
496.
Eneniata, absorption of. Si ; nutrient, ab-
sorption of, 23.
Enuresis, nocturnal, treated by voltaic alter-
natives, 291.
Epidermic medication, 70.
Epilepsy, 2S0 ; following cerebral concus-
sion, 415 ; the albuminuria of, 67.
Epileptic piienomena in ataxia, 94.
Epithelioma, potassium chlorate in, 588.
Epithelium, pulmonary, significance of
changes in, 293.
Ergot as an antidote to salicylic acid, 571 ;
in delirium tremens, 41 ; in headache,
448; in. obstetrics, 545.
Ergotin, injections of, in aneurism, 292.
Erysipelas, 420; and white lead paint, 503;
extentling to the orbit, 155 ; influence
of, upon syphilis, 4S9 ; treated by sub-
cutaneous injections of resorcin, 208.
Erythrophleum, 58.
Eserine, 597 ; in tetanus, 56.
Esmarch, Dr. Friedrich, notice of brochure
by, 299.
Ether, bromic, in whooping-cough, 588 ;
danger of, in Bright's disease. 261 ; hy-
podermics of, and imminent death from
hemorrhage, 43.
Ethics, influence of the laws of the Stat
upon, 475 ; medical, 435 ; medical, writ-
ten antl unwritten, 447 ; New York Code
of, 136.
Ethidine, dichloride of, death from, 42.
Ethyl, bromide of, efficacy of, in short opera-
tions, 456; bromide of, for spasmodic
cough, 162.
Euphorbia, in asthma, 99.
Eucalyptus in whooping-cough, 93 ; trees and
the Roman Campagna, 369.
Existence, double, 209.
Eye, enucleation of, 56; new method of ap-
plying remedies to, 152 ; relation of cer-
tain diseases of, to alTections of the fe-
male generative organs, 11 ; troubles of,
erroneously attributed to lesion of the
brain and spinal cord, 105.
Eyelids, granular, 515.
Eye-speculum, 153.
Face, cancer of, 34S.
Fallopian tubes, diseases of, 324.
Farnham, Dr. 11. P., thesulpho-carbolates, 8.
Fatness, the gospel of, 53.
Faulkner, Dr. Richard 1!., the treatment of
asthma, 163.
Femur, chronic osteomyelitis of, 275 ; com-
pound fracture ol, 291 ; fracture of the
neck of, 3S8, 56S ; fracture of the shaft
of, 661 ; intra-capsular fracture of, 641 ;
osteo-sarcoma of, 20 ; subcutaneous di-
vision of, 589.
Ferguson, Dr. E. D., do the laws of the
State define the duties of individuals or
societies in matter of ethics ? 475.
Fever, as a neurosis, 403 ; fecal, 488; hay,
152 ; intermittent, electricity in, 291 ;
intermittent, tincture of cobweb in, 94 ;
mountain, 392; of chlorosis, 650 ; per-
nicious remittent. 95; puerperal, 547;
report of twenty-nine cases of, 504 ; scar-
let, 3S6 ; scarlet, changes in the skin in,
209; scarlet, complications of, 51; scar-
let, in horses, 3S2 ; scarlet, in the newly-
born, 159; scarlet, two attacks iij same
individual, 232; the pancreas in, 269;
typhoid, 250, 290, 501, 543, 586, 618;
typhoid, absence of characteristic erup-
tion, 495 ; typhoid, alleged causation of
by sewer gas, 406; typhoid and milk,
16S ; typhoid, cardiac, 68 ; typhoid,
ch.anges in the Milar and hypogastric
plexus in, 238 ; typhoid, coffee in, 360 ;
typhoid, curability of, 325 ; typhoid,
disinfection of the stools in, 434; typ-
hoid, heart failure in, 484 ; typhoid,
iodide of potassium in, 601 ; typlioitl, in
a man sixty-eight years of age, 159 ;
typhoid, in Paris, 249 ; typhoid, muri-
atic acid in, 212 ; typhoid, organisms
of, 67 ; typhoiil, phenic acid an»,l iodine
in. 0 ; typlioid. sudden heart-failure in,
497 i typhoi<l, the salicylates and hemor-
rhages in, 292 ; typhoid, tetanus in, 134;
typlioid treatment, method of Brandt,
40S ; typhoid, veratrum in, 599; typho-
malarial, 433 ; yellow, micrococcus of,
327-
Fevers, cold in the treatment of, 12: con-
tagious, immunity from, by inoculation,
370 ; the albuminuria of, 95.
Fisher, Dr. Alexander Ming, 307.
Fisher, Dr. Harris, 720.
Fistula of the pancreas, 124.
Flint, Dr. .-Austin, notice of book by, 6S7.
Fcetus, can it be poisoned with alcohol
through the blood of the mother ? 436.
Food, adulteration of, 44; makes the man,
405.
Force, sense of, 211.
Forceps, ecraseur, for nasal polypi, 154.
F"oreign bodies, in the ear, eye, and nose, ex-
traction of. 25.
Fowler, Dr. George R., successful lumbar
colotomy in an infant two months old,
536.
ractures, treatment of, in British Hospitals,
430.
Franks, Dr. S. C, 280,
Fritsch, Dr. Heinrich, notice of manual by.
687.
F'ruit laxative, 99.
Fry, Dr. H. D., on the diagnostic value in
pregnancy of variations in the frequency
of the pulse due to changes of bodily
position, 7.
Furuncles, 532.
G
Gage, Simon H. , notice of book by, 165.
Gall-bladder, aneurism in, 432; extirpation
of, 267.
Galvani, prior claimant, 196.
Gambetta, autopsy on, 99 ; the brain of, [60.
Gangrene, spontaneous, in a young subject,
5'5-
Garrigues, Dr. H. J., notice of book by, 687.
Gas, formation of, in the bladder, 599.
Gastro-enterotomy, 351.
Gastrotomy, 433, 466.
Gaunt, Dr. T. T., secondary puerperal hem-
orrhage, 221.
Gelatine, medicated, in the treatment of skin
diseases, 432.
Gelsemium, hypodermic use of, 600.
German Congress of International Medicine,
550, 607.
German Surgical Society, 522, 551.
Germicides, 434.
Gilliford, Dr. R. H., the arsenite of bromine
in diabetes, 620.
Girdner. Dr. John H., chloroform narcosis
during sleep, 457.
Glass, Dr. J. H., electrolysis in the treat-
ment of strictures of the urethra, 512.
Glasses, necessity for wearing, 506, 533.
Glaucoma, 668 ; new form of, 669, 562.
Glio-sarcoma. of the cerebellum, 342, 357.
Glottis, spasm of, 541.
Gh ccrine, and castor oil, 300 ; internal use
of. 4S9; in [ihthisis, 6S0.
Glycosuria, after the removal of the inamniie,
'. 489-
Goitre, extirpation of, 699.
Goltz, on the cortex cereljri, iSo.
Gonorrhiea. hot-water retrojection in the
treatment of, 425 ; new treatment for,
291 ; of the rectum, 570.
Goodwin. Dr. Charles H., notice of book
by, 272.
Gout, 218; iodide of lithia in, 68, 280.
Grant, Dr. Frank Sargent, a new hypodermic
syringe, 3S9.
Ciranular lids, 515.
Granville, Dr. J. Mortimer, notice of book
by, 300.
Grave's disease, milk diet in, 293.
Graveyard insurance company, 363.
Gruening, Dr. Emil. infusion of licorice bean
in the tieatment of inveterate p.innus,
2SS.
Guacham.aca. as a hypnotic, 196.
Guiteau's brain, microscopical appearances
of, 96.
Gummata of the heart, 293.
Gunn, Dr. Moses, 672.
Gyn.ecology, cases in, 37.
H
Hrematocele, pelvic, 545.
Ha^maturia, 52c.
Haemoglobin of the blood, influence of Fow-
ler's solution upon, 429.
H^emoglobinuria, 520 ; paroxysmal, 59S.
Haemophilia, 95.
Haemoptysis, dependent upon hemorrhoids,
93-
Halderman, Dr. Davis, chloroform narcosis
during sleep, 594 ; monstrosity of a
hand, 320.
Hamilton, Dr. D. J., notice of book by, 690.
" Hammond " prize, 2S0.
Hand, monstrosity of a, 320.
Hands, gummy tumors in the palms, 39.
Hart, Dr. D. Berry, notice of book by, 384.
Harvey, Dr. Philip, obituary, 390.
Hay fever, 152.
Hayes, Dr. Robert T. .spina bifida, 64S.
Hays, Dr. Justine, notice of book by, 272.
Headache, catarrhal, 421 ; congestive, ergot
in, 448,
Health, influence of the theatre on the public,
268.
Health-Board, and the proposed charter
amendments, 378.
Health-Officers of the Port of New York,
419.
724
Heart, abstiaclion of blocd from the right.
So; aspu-alion of, 140, 263; dilatation
of, effect of stryclmine in. 94; disease of
caffein in, 94; disease of complicalions
of acute rheumatism, 85 ; disease of
convallaria in, 209 ; displacement of, in
pleurisv, 292 ; disturbance of rhythm.
459; gummata of, 293 ; hypertrophy of,
consecutive to neuralgia of the arm,
20S ; injury to valves by sudden violence,
319 ; malformation of, 274 ; mechanism
of, and the drugs which act upon it,
294 ; murmurs, misleading, 460 ; new
discovery in the physiological action ol.
700; scanning of, 224: some points in
the treatment of disease of, 293 ; sten-
osis of the right .auriculo ventricular
opening, 207 ; stenosis of the tricuspid
valve. 6S ; surgery of, 12S ; tumor of, 39.
Heart-clots, origin of, 52.
Heat, body, effect of external temperature
in, 459.
Hebephrenia, iSo.
Heitzmann. Dr. C, notice of book by, 75 :
in Berlin, 719.
Helmuth, Dr. W. T., notice of book by,
440.
Hematocele, pelvic, 614.
Hemianx^tliesia. hysterical m a man, 719 ;
in syphilis, 452.
Hemeralopia, 223.
Hemorrhage, cerebral, 499 ; central and frac-
ture, 56 ;inlo the cavity of the arachnoid,
6S ; non-puerperal uterine, 141 ; second-
ary puerperal, 102, 221 ; secondary and
their causes, 27.
Hemorrhoids, in etiology of hemoptysis, 93.
Hermann, Mr. L., notice of cook by, 687.
Hernia, morphia in, 598 ; omental femoral,
38S ; str.ingulated, complicated by dis-
ease of the spermatic cord, 161 ; stran-
uulated. reduction of without operation,
II; umbilical, of the stomach, 488;
ventral, 334.
Herniotomy, tender antiseptic precautions,
523.
Herpes Zoster, etiology, 90.
Hiccough, 720.
Hi'in^im's. Dr. V. J., rupture of abdommal
walls, i;c. , 89.
Hip-disease, rationale of traction and coun-
ter-traction in, 509.
Hip-juint, amputation at, 3S5 ; anchylosis at,
589; excision of both, 66i.
Hoffman, Dr. Frederick, notice of book by,
6S7.
Holmes. Dr. E. L., 223.
Holmes, Dr. Oliver Wendell, 307 ; dmner
to. 437. 445.
Holt, Dr. L. li., tumor of the cerebellum,
342-
Homceopathy, and goats, 223; m England,
33 '
Hordeolum, aborting, 619.
Hospital al)uses, 381.
Hospital Saturday and Sunday, 1S7 ; distri-
bution, 244.
Hospital St Andrea, Genoa, 700.
Hospitals of Rome, 700.
Hospital stretchers, 720.
Howe, Dr. J. W. , experiments in peritoneal
transfusion, 120.
Hubbard, Dr. E. T., urxmic coma, hastened
bv morphine, 278.
Hubbard, Dr. F. A., 64.
Humerus, fracture of the internal epicondyle,
588.
Hard, Dr. E. P., convallaria maialis as a
poison to animals, 193.
Hyde, Dr. James Kevins, notice of book by,
384-
Hydatid of the bram, 322.
Hydrocele, ergotine injections for, 404.
Hydrocephalus, chronic, 441 ; chronic with-
out symptoms, 78.
Hydrogen, peroxide of, as an antiseptic, 15.
Hydronephrosis, double in a child, 330.
Hydrophobia, 695; prevention of, 120.
Hvoscyamin and hyoscyamine, 195.
Hyperidrosis, in the nude subject, 267 ; of
the li.ands and feet, 345.
Hypermetropia, 533, 562; facultative, 563.
INDEX.
Hyperpyrexia, of acute rheumatism. 85.
Hypnotic, cannabin tannicum as a, 390 ;
guachamaca as a, 196.
Hypochondriasis, absence of in abscess of the
liver. 105.
Hypophosjihites, explosive, 99.
Hysteria, cauterizationof the clitoris for, 362.
Hysterical hair-curling, 223.
[Juiu
i88-
K
Ichth)ol in the treatment of rheumatism, 195.
Idiocy, prognosis of, 53.
Impetego contagiosa, epidemic of, 63.
Illinois State Medical Society, 548. 5S6.
Incomes of Loudon Physicians, 392.
Indiana State .Medical Society, 549.
Inebriety, 83, 539, 604 ; and beer, 270 ; and
Kola nuts, 84; and the teeth, 224, 333-
Infancy, cesophagitis in, .35.
Infants, tuberculosis in, 50S.
Infection, diet and resistances to, 503 ; puer-
peral, through erosion of the nipples,
429 ; diseases, abortion of, 60S.
Inflammation, 637 ; chronic intero-pelvic,
663; idiopathic purulent, 427 ; origin of
.articular, 708,
Inoals, Dr. E., medical education in Chi-
cago, 444. I
Injections, intra-utenne, 273.
Innervation, collateral, 709. |
Inoculation, purulent, in the treatment of j
granular lids. 515.
Inosuria, 360.
Insane, asylums for, 521 ; care of the, 597 ;
care of the chronic, 81,138; utero-ova-
rian disease of, 280.
Insanity and delirium, 359; from fright, 700 ;
iu' New York, 363; in the United
States. 403 ; restraint under pretence of,
501 ; some problems in, 656 ; transmis-
sion of, 305.
Insufflator and vaporizer, 361.
Intelligence, seat of, in dogs, 420.
International Medical Congress, 140.
Intestinal obstruction, 377; surgical treat-
ment of, 10.
Intestine, action of calabar bean upon, 407 ;
cysts of, 39; muscle of, effects of irri-
tants upon. 10.
Intestines, movements of, 376 : primary
tuberculosis of, 404; resection of, 551.
Intussusception, treatment of. 180.
Iodine, as a stomachic sedative, 433; in ty-
phoid fever, 9; preparations of, 57.
Iodoform, action of on the leucocytes. 95 ;
and laryngial ulcers, 3S1 ; and turpen-
tine, inhalation of spray of, 292 ; avoid-
ance of poisoning by, II ; in ovariotomy,
552 ; tinct. CO., 28 ; to disguise the odor
of, 720.
lodo-phenique (Declat), syrup composition
of. 252.
Iowa State Medical Society, 676.
Ipecac during labor, 279.
Iritis, 657.
Iron, succinate of in biliary colic, 250.
Kahn. Dr. S. S., boro-cilrate of magnesia for
phosjihatic incrustation after lithotomy,
Keni'ucky State Board of Health, 297 ; State
Medical Society, 410.
Kidney, cmigenital abscence of one, 418 ;
congenital cyst of, 3S6 ; contusion of in
etiotogy of albuminuria. 23S ; effect of
inhalations of ether upon the action of,
159; floating, treatment by fixation,
624 '; inability to produce healthy urine,
459 ; origin of cysts in, 24 ; surgery of,
162.
Kingsman. Dr. D. X., rotheln, 2S5.
Kinnicult. Dr. Francis P., a case of idopathic
purulent inflammation of the serous mem-
branes of all the great cavities, 427 ; two
attacks of scarlet fever in the same indi-
vidual within 8 months. 232.
Kn-app, Dr. H., hooks for the extraction of
foreign bodies from the eye, ear, and
nose, 25.
Knee, amputation at the, 527.
Koch, reply to his critics, 379; Spina's at-
tack on, 353.
Kola nut, 583.
Koumiss, home-made, 39.
Kucher, Dr. Josef, stenosis of the right auri-
I culo-ventricular opening, 207.
1
J
Jackson, Dr. George Thomas, etiology of
herpes zoster, 90.
Jacobi, Dr. A., medical controversies and the
newspapers. 559.
Jacobson, Dr. Nathan, Tracheotomy, 704
Jarvis, Dr. Wm. C, a new nasal speculum,
390.
Jaundice, epidemic in children, 665 ; perni-
cious, 535.
Jenkins, Dr. J. ¥., 84.
lews, increase of. 364.
Johnston, Dr. W. H., ruptured perineum,
699.
loints, temperature of, 460.
Jones, Dr. Henry !•'.., encephaloid simulat-
ing subclavian aneurism, 288.
Judson, Dr. A. B., what is the rationale of
tr.iction and counlertraction in the treat-
ment of hiivdiscase ? 509.
Labor. ana:sthetics in, 637; antiseptics after,
692; inductions of premature, 190; in-
fluence of extreme lateral curvature on
the course of, 374. 386 ; in primipara of
advanced years, 239; ipecac during, 279 ;
rupture of aorta during, 239.
Lachrymal conduction, 460.
Lacun'.-e, tonsillarum. anatomy of, 611.
Lacy, Dr. Horace P., .itropia versus mor-
phia, 615.
Landis, Dr. H. G., notice of Quiz by, 300.
Laparo-elvtrotomy, 663.
Laparotomy, for acute intestinal obstruction,
20;.
Lappa ininor, in psoriasis, 708.
Larvngitis, tubercular, 302.
Laryngology, new facts in, 576.
Larynx, congenital tumors of, 5S0 ; paraly-
sis of, 497 ; photographing of, 580 ;
stenosis of. 467.
Laxative, the tropic fruit, 99.
Lead-poisoning, 713.
Le Fort, Dr. Leon, successful case of lapar-
otomy for acute intectinal obstruction,
205.
Leech, nature of the bite of, 616.
Letters from London, 79, 137, 193- -S°'
332, 443. 474. 500- SS^- 614-
Letters from Paris, 79, 109, 249, 305, 501.
Leucajmia, and pseudo-leuca;mia, 9 ; pria-
pism in, 404.
Leucocytes, action of iodoform on, 95.
Licenses to practice in Illinois, 18.
Licorice bean in pannus, 153, 288.
Life, human, can its mean duration be pro-
longed? 5 1 8.
Lime, chloride of, for snake-bites, 364.
Lipoma, of traumatic ori.gin, 515.
Litmus, 671.
Lithia, iodide of, 68 ; iodide of, in gout,
280.
Little, Dr. David, a single case of ovari-
otomy, and what may come of simple
cleanliness, 426.
Liver, abscess of, 105; chemistry of acute
yellow atrophy of, iSi ; cirrhosis of,
525 ; painful congestion of in early
stages of alcoholism. 491.
Localization, cerebral. iSo; cerebral and
the psychical functions, 210.
Locomotor, ataxy, 94, 600, 7 14, 171 6, 717.
Lumbar colotomy, 536.
Lunacy in Spain, 364.
Lunatics at large, 344.
Lung, primary carcinoma of, 215; resection
of the. iSi.
Lungs, condition of, in pleurisy, 43.
June 30, 1883.]
INDEX.
725
Lyinpliadenitis of the conjunctiva. 161.
Lymphadenoma, of the conjunctiva, 351.
Lyinphangiectasis, 598.
Lymphatics, inosculation with blood-vessels,
652.
Lymphorrhcea, •jqS.
Lynipliosarctima, of tlie duodenum, 322 ; of
the neck, 40.
M
McCliesney, Dr. J. N., vaiiola, 337, 365,
394- '
McCormack, Dr. J. N. , double identity after
trepanning, 570.
MacMister, Dr. Donald, notice of transla-
tion by, 3S4.
MacGaugbey, Dr. J. D. , liow to secure the
best possible condition after parturition,
702.
Macguire, Dr. C. J-, bismuth as a specific
for cancrum oris, 113.
Magnesia, boro-citrate of, for pliosphatic in-
crustation, 347.
Maine Medical .■\^sociation, 6S5.
Malaria antl meicury, 720 ; or sepsis, 95.
Mallei, Dr. F., notice of book by, 688.
Man, the blue, of Missouri, 452.
Manaca, 503.
Mania, inteimittent, 93.
Massachusetts IJoard of Health, 157; Medi-
cal Society, 657.
Massage, physiology of, 552.
Masse, Dr. E., notice of book by, loi.
Mastoid, condensing ostitis of, 258 ; disease
of, 415-
Materia Medica Society, 18S.
Mattison, Dr. J. B. , opium addiction among
medical men, 621.
Mattocks, Dr. Brewei', a key ring artery-
clamp, 3S9.
Measles, 180 ; and small-po.N, 100 ; changes
in the skin in, 209.
Medical and Chirurgical Faculty of Mary-
land, 465, 524.
Medical and Surgical History of the War,
notice of, 496.
Medical Association of Georgia, 605.
Medicaments, respiratory, 57.
Medical College, the United States suit
against, 307; judgment against, 411.
Medical colleges, 296 ; censorship of, 516.
Medical degrees in Massachusetts, 242.
Medical education in Canada and church in-
fluences, 462; in Chicago, 444.
Medical ethics, iii, 349, 435, 504; written
and unwritten, 447.
Medical e.vaminations in England, 242.
Medical examiuers. State Boards of, 295.
Medical incomes in New York, 654.
Medical instruction in Europe, 182.
" Medical Latin," 13S, 305.
Medical Law in Wisconsin, 6S5.
Medical mind, the German, 84.
Medical practice, the perils of, 127.
Medical service, in ocean-going steamers,
461.
Medical Society of the County of New York,
136, 246, 354, 355, 359, 467, 692;
amendments, 605 ; of New Jersey, 655 ;
of the State of Arkansas, 694 ; of the
State of California, 550; of Pennsyl-
vania, 519, 553; of the State o( New
York, 149, 157; of West Virginia, 544.
Medical Societies, the State, 353.
Medical students, female, in Palis, 560 ; in
England, 336.
Medicine, forensic, 269 ; good and bad work
in, 560 ; practice of in the middle ages,
699 ; scientific, in general practice, 239 ;
two-year course preparatory to the study
of, 604.
Medicines, directions regarding administra-
tion of, 42 ; patent, in Japan, 531.
Melancholia, 657.
Melanuria, 523.
Men, great, and small heads, 342.
Meningitis, cerebral, 49 ; cerebro-spinal,
micrococci in, 377.
Menstruation, 44S ; at, 76, 252.
Menthol Z'S. pain, 458.
Mercury, and malaria, 720 ; glycerite of,
161 ; in intestinal obstruction, 377.
Metritis, dissecting, 215.
Metrorrhagia, neuralgic, 432.
Meyer, Dr. Alfred, case of cyanosis due to
congenital closure of the aortic orifice,
428.
Micrococcus, puerperalis, I2g.
Michigan State Medical Society, 522, 556.
Micro-organisms, 253, 281, 309, 355; in
cerebro-spinal meningitis. 377 ; relation
of, to disease, 197, 225; the recognition
of, 334-
Microsco|)es on the free list, 98.
Midwifery, chloroform in, 495.
Milk and typhoid fever, 168 ; granulated,
373-
Mirth, hygienic value of, 616.
Mind in plants. 392.
Mind-reading, 196.
Mississippi Stale Medical Association, 549.
Missouri Medical Association, 547, 5S5.
Moall, Dr. William A., notice of book by,
496.
Moffat, Dr. Henry, absorption of enemata,
81.
Moir, Dr. H. C. , notice of book by, 412.
Monstrosity, a complicated, 280; of a hand,
320.
Moore, Dr. Richard C, 447.
Morphine of atropine, 559, 615 ; hypodermic
injections, 58 ; in hernia, 598.
Mortality in the United States, 3S0.
Morris, Dr. Robert T. , hospital report, 376 ;
union by first intention in seal]! wounds,
224.
Mullein in consumption, 266.
Munde. Dr. P. F., the etiology of treat-
ment of non-puerperal uterine hemor-
rhage, 141 ; the treatment and cura-
bility of chronic uterine catarrh, 674.
Murmurs, respiratory, 542.
Muscle, quadriceps, traumatic paralysis of,
4S8.
Muscular fibres, intestinal, influence of vari-
ous irritants upon, 10.
Muscular sense, 8.
Mustard and molasses, 209.
Myelitis, acute difluse, 122 ; cretefaction of
the ganglionic cells in, 10.
Myers, Dr. P. L., 27S.
Myopia, 534.
Myringotomy, 483.
My.\olipoma of the abdominal walls, 60.
N
Naphthaline, as an antiseptic, 707.
Naphthol in skin diseases, 39.
Nasal septum, perforation of, 165.
Naso-pharynx, tumors of, 610.
National Association for the Protection of
the Insane and the Prevention of In-
sanity. 135.
National Board of Health, restoring the
]iowers of tlie, 126.
Nebraska State Medical Society, notice of
proceedings, 300.
Necrosis, fatty, 460.
Needle, wanderings of a, 277.
Needles, wandering, 587.
Nelson, Dr. E. M., chloroform narcosis du-
ring sleep, 595.
Nephritis and diphtheria, 624; scarlatinal,
4.1°, 477-
Nerve, optic, sarcoma of the, 215 ; thirteenth
cranial, 362.
Nettleship, Dr. Edward, notice of book by,
68S.
Neuralgia, general, case of, 714 ; obstinate,
medical treatment of, 239 ; trifacial,
642 ; trigeminal, relieved by ligation of
the common carotid artery and neurec-
tomy, 434
Neuralgias, diabetic and nephritic, 405.
Neurasthenia, cardiac, 82.
Neuritis following dislocation, 712; in eti-
ology of varicose ulcers, 208.
Neuro-fibroma, 131.
New York Academy of Medicine, officers
18S3, 46; and the State Society, 654;
ayes and nays, 465 ; reports, 49, I02,
130, 218, 273, 329. 413. 462, 469, 504,
581 ; Section in (Jlistelrics, 190, 304,
691 ; Section in Practice. 51, 358, 414.
New York Academy of Sciences, 248.
New York, Health Officers of the Port of,
419.
New York Infant Asylum, ollicers. 356.
New York Medico-Legal Society, 700.
New York Neurological Society, officers, 381.
New Y'ork Ophthalmological Society, officers
1 883, 46.
New York Pathological Society, 19, 47, 77,
131, 215, 245, 274, 301, 330, 357, 441,
498, 525, 557, 583, 607 ; officers 1S83,
46.
New York .Skin and Cancer Hospital, 82.
New York State Medical Society, 419.
Nickel, salts of, as disinfect.ants, 196.
Night-sweats, salicylic acid in, 94.
Nipples, puerperal infection through erosion
of, 489.
Nitro-glycerine, angina pectoris treated with,
503-
Noma, bismuth in, 304.
Nose, growths in, 29, 49 ; reflex plienomena
due to disease of, 60S ; tooth in, 542.
Noyes, Dr. Henry D., transplantation of
portions of the conjunctiva from tlie rab-
bit to the human eye, 232.
Nyctalopia, 223.
O
Oats, stimulating properties of, 224.
CEdema glottidis, 477.
(Edema, pulmonary, a complication of pneu-
monia. 413.
Qisophagitis in infancy, 35.
CEsophagostomy, 433, 546 ; combined exter-
nal and internal, 652 ; internal, 433.
Oesophagus, a sound in the, for three hun-
dred and five days, 196 ; removal of
bones from, 55.
Obstruction, intestinal, 377 ; intestinal, acute,
laparotomy for, 205 ; surgical treatment
of, 662.
Oleander, danger of the, 84.
Oleates, the, in medicine, 70.
Ophthalmic aphorisms, 448.
Opium, addiction among medical men. 621 ;
the strength of, 53.
Opium-poisoning, 4S7 ; treated with atro-
pia, 643.
Orchitis, >:alicylate of soda in, 291.
Organisms, mineral, 27.
Osteomalacia, phosphorus in, 405.
Osteotomy, subcutaneous, 541.
Osteomyelitis of the femur, 275.
Ostitis of the mastoid, 258.
Os magnum, dislocation of, 376.
Otitis, suppurative, .586.
Otorrhrea, dry treatment of, 125.
Ovaries, disease of, in the insane, 2S0.
Ovariotomy, 426 ; iodoform in, 552 ; punc-
ture of the gravid uterus during. 124;
significance of temperature after, 3, 22.
Ovaritis, 346.
Ovary, cyst of, cured by injection of wine,
541 ; cystic fibroma of, 47 ; dermoid
cysts of, 19.
Overwork among Americans, 97.
Oxydendron in ascitc*, 707.
( )ysters, the digestion of. 27S.
Ozone and the blood, 27.
Page, Dr. Herbert W. , notice of book by,
440.
Pain in the left side, 322, 616.
Pancreas, cancer of, 601 ; fistula of the,
124; primary cancer of, 252; fever in
the, 269.
Pannus, licorice bean in, 153, 2SS.
Paralysis, arsenical, 514; general pathologi-
cal anatomy of, 94 ; infantile, 377 ; la-
ryngeal, 497 ; traumatic of the quadri-
ceps muscle, 4SS ; agitans, 86, 716.
Panics, psychology of, 681.
726
INDEX.
[June 30, 1883.
Paraplegia, tetanoid, 716.
Parkinson's disease, 716.
Parotitis, 290.
Parsons, Dr. Ralpli L. , trial by jury as a
means of ascertaining the mental state
of alleged lunatics, 400.
Parturition, liow to secure the best physical
condition after, 5S1, 702 ; in primipaix
of advanced years, 239.
Pasteur and Koch, 297 ; and Peter, 517.
Peabody, Dr. George L., acute myelitis wilh
autopsies, 122.
Peck, Dr. E. S., transplantation of the con-
junctiva of a rabbit, 194.
Pelvis, deformity of, 190 ; method of meas.
uring the diameters of, igi; narrow,
frequency of and danger from, in Ger-
many, 2S ; the naturally faulty, 273.
Penis, gouty tumor of, 323.
Peptonuria, clinical significance of, 11.
Pericarditis, 607 ; free incision in purulent.
651.
Pericardium, tapping of the, 16.
Perineum, restoration by a new method,
663 ; ruptured, 699.
Peritoneum, sarcoma of, 707.
Peritonitis. 238 ; acute, operative measures
in, 514; neonatorum, 405.
Pharmacopceia. sixth decennial revision, no-
tice of, 76 ; the new, 40.
Pharmacy, school of, for women, Louisville,
Phelps, Dr, C. H., opium-poisoning treated
by atropia, 643.
Pharynx, antesthesia of, 3S4 ; metliod of
cleansing tlie vault of the, 458, 5SS,
619 ; paresis of the constrictor muscles
of the, 5S0; tumors of, 612.
Phlegmasia Dolens, 6oi.
Phosphorous in osteom.alacia, 405.
Phthisis, 23, 571, 588; aluminum in the
treatment of, 6S3 ; antiseptic treatment,
550 ; conveyed to dogs, 28 ; glycerine in,
6S0; laryngeal, 578, 579; modern the-
ories and treatment, 624 ; non-parasitic,
6S2 ; prognostic value of the bacillus, 9;
sulpliurous acid in arresting, 195 ; tuber-
cular nature of diabetic, 488.
Physician and druggist, 213.
Physician, the, aiitl his professional secrets,
' 353-
Physicians, in New York City. 605.
Physiology, regional and psychical evolution,
602.
Picroto.xin, biological action of, 650. '
Pilocarpin, action of, on horses, 224.
Pill, the everlasting, 418.
Pinuis, canadensis in diphtheria, 698.
Placenta, extreme size, 499; waxy degenera-
tion of, 331.
Playfair, Dr. W. S., notice of book by, 687.
Pleurisy, blenorrhagic, 125; condition of
luugs in. 43 ; diaphragmatic, 680; dis-
placement of the heart in, 292 ; explora-
tory puncture in. 414 ; intercurrent in
heart disease, 266 ; surgical treatment
of purulent, 665 ; with intercurrent an-
asarca, 208 ; with purulent elfusion, 553.
Pneumon.algia. 464.
Pneumonia, 571 ; bleeding coup-sur-coup,
502 ; embolic, 217, 527 ; in New York
and its tieatmeni, 352; in scarlaintal
nephritis, 477, 479 ; lobar, 238 ; pul-
monary cedeina in. 413; the infectious
nature of, 435 ; traumatic, 323 ; treat-
ment of, 252.
Pneumothorax, operative treatment of, 9.
Podophyllin, 208.
Policlinic or Polyclinic, 28, 83, 696 ; Phila-
delphia, 168.
Polio-myeluis, 358.
Pulitzer, Dr. .\dam. notice of book by, 6S9.
Polk. Dr. \V. M., the influence of extreme
lateral curvature of the spine on the
course of labor, 374.
Polyorchism, 588.
Polypus, mucous, of the bladder, 321 ; nasal,
33, 49 ; nasal, treated by chromic acid,
577-
Pooley, Dr. J. II., a case of paralysis of the
arm following vaccination, 569.
Poor, how to care for, 681.
Porro-Miiller's operation, 386.
Post, Dr. S. E., the negative pulse of the
veins, 170.
Potash, carbonate of. in diphtheria. 252.
Potassium chlorate, alleged poisoning by,
168; chlorate in epithelioma, 588;
chloride of, 67 ; iodide, hypodermic use
of, 292; iodide of, in enteric fever, 601;
permanganate of, in amenorrhcea, 236 ;
salts of, am.igonism with veratria, iSo.
Practice, general, in England. 69S.
Practitioners' Society of New York, 22, 133,
3S5, 415, 497.
Pregnancy, l>efi)ie the menstrual epoch, 351 ;
extra-uterine, treatment of, 169, 192,
212 ; extra-uterine, 6S6 ; new sign of,
571; vomiting in, 6oi ; vomiting of,
iodine for, 433; popcorn in vomiting
of, 382 ; value of variations in fre-
c|uency of pulse in diagnosis, 7.
Presbyopia. 562.
Prescriptions, jihysicians', 6gS.
Priapism, in leuc.iemia, 404. 1
Priinipar.e of advanced years, parturition in,
239-
Prizes of the Royal College of Surgeons,
England, 686.
Prize-fighters, h.ands and muscles of. 502.
Proctitis frt>m metritis, 474.
Prostitutes, c.ire of, in Cleveland, 97.
Prostitution, regulation and repression of.
Prudden, Dr. T. Mitchell, on the bacillus
tuberculosis, 397, 645.
Pryer, Dr. J. \V , fracture of the internal
epicondyle of the humerus, 58S. y 1
Psoriasis. la]ipa minor in, 708.
Psychiatry, 129.
Psychology of panics, 681.
Puildings and pies. 98.
Pulse, change in the, as a sign of pregnancy,
571; negative, of the veins, 170; slow,
419; 'v.ariations in the frequency of, in
changes of bodily position, 7.
Purpura hemorrhagica, 387, 515.
Putzel, Dr. L. , hemianesthesia and hemiopia
in cerebral syphilis, 452.
Pyelo-nephritis. calculous, 3S6.
Pylorus, results of resettions of, 392 ; surgical
dilatations of, 293.
Pyosalpinx, 324.
Pvrexia. puerperal. 695.
y^
Respiratory murmurs, 542.
Retrostalsis and the absorption of enemata,
Sr.
Revivification, 236. ^ y
Rheumatism, acute, i.''2qi; ; cardiac compli-
cations in acute, of children, 69; acute,
hydriodic in, 448; ichthyol in, 195;
treatmeiit of the complications, 85;
treatment of heart complications in, 381 ;
muscular, subcutaneous use of carbolic
acid in, 208.
Rhubarb, powdered. 448.
Rhus-poisoning. sassafras in. 404.
Ribs, fracture of, 661.
Rice, Charles, medical Latin, 305.
Ricord, Holmes on, 434.
Ripley, Dr. John H. , scarlatinal nephritis
and its complications, 450, 477.
Robertson. Dr, J. Ne>»ell, a new use for the
condom, 55.
Robinson, Dr. Beverley, on rapid or sudden
heart-failure in acute infectious disease,
4S4.
Rockwell. Dr. A. D. , on the successful
treatment of extrauterine pregnancy,
169.
Roe. Dr. J. O., a novel method of cleansing
the vault of the pharynx. 619.
Rohe, Dr. George H. , treatment of some
parasitic diseases of the skin, 595.
Roosa, Dr. D. B. St. John, the determina-
tion, by the general practitioner, of the
necessity for wearing glasses, 506, 533,
562 ; on the injudicious use of the sul-
phate of quinine. 145.
Roosevelt, Dr. J. West, hints on case-t.ak-
ing. 174.
Rotheln, 2S5.
Ryerson, Dr. G. Sterling, the .eccentricities
of a,tropine, 457.
Quack, the succe^sful, 195.
Quacks in New York and London, 270.
<,^uackery in London, 196.
Quack remedies and religious papers, 463.
Quain, Dr. Richard, notice of book by, 167.
Quain's Elements of Anatomy, notice of,
lOI.
Quail-eating, 128.
Qiiar.intine in Pensacola, 252.
Quel)racho. 57. 503.
Quinine, endermic use of, in malarila pneu-
monia of children, 161 ; injutlicious use
of the sulphate of, 145, 154; of the poor,
435-
R
Race, human, diversities in, 17S.
Races, asthenic and sthenic conditions in
Caucasian ami .\frican, 538.
R.ichel, Dr. Gccnge W., tissue metamorpho-
sis and sleep, 65.
Radius, subperiosteal, removal of, 388.
Rash, scarlatin.il. from the use of copaiba,
644.
Raymond, Dr. II. I., the analogy between
Salicin, in acute coryza, 279.
Salmon, Dr. D. E. , immunity from conta-
gious fevers by inoculation, 370.
•Sanguis bovis. exsiccata, 503.
.Sanitation, army in India, 495.
Santa Barbara, climate of, 336.
.Santonin, how to give it, 542.
Sapo viridis, 2'44.
Sarcoma, congenital, of the lower iaw, 351 ;
lympho of the neck, 40; of the cere-
bellum, 342, 357 ; of the femur, 20 ;
of the lower jaw, 131 ; of the optic
nerve, 216 ; of the peritoneum, 707 ;
re_tro-peritoneal, 245.
Sassafras in rhus poisoning, 404.
Satterthwaite, Dr. T. E., notice of book by,
300.
Saundby, Dr. Robert, origin of cysts in the
kidney, 24.
Saunders, Dr. John H. , notice of death of,
335-
Sayie, Dr. Lewis A., notice of book by, 495.
Scaphoid, dislocation of, 376.
Scarlatina, 316 ; complications and sequelae
of, ^i ; complicated by diphtheria.' 48,
51 ; in the newly-born, 159; large doses
of alcohol in, 162 ; temperature of, 537.
Scha]>ringer, D, A., an improvement in the
arr.angement of Snellen's test-types, 124.
School hygiene in (^hio, 129.
Sciatic nerve, nqjlure of, 59S.
Scotoma, central, with der.ingement of color
perception. 621.
Scrofulous, the anatomy of the, 182.
Scurvy. 332.
.Sea-sickness, trance in relation to, 248.
See, Germain. Prof., on respiratory medica-
ments, 57.
scion grafting and the healing process of Semi-circular canals, new function of, 542.
wounds, 402.
Rectum, carcinoma of, 77, 330, 552; gonor-
rhcua of, 570.
Refraction, errors of, in relation to constitu-
tional symptoms, 522.
kemedies, new, trial of, in the naval medical
department, 503.
Rc^orcin, antiseptic and physiological action
of, 125; in erysipelas, 208.
Sense, the sixth, 21 1.
Sex, operation to determine the, 686.
Sexton, Dr. Samuel, does the retention of
bad teeth exert an unfavorable influence
on health ? 52S ; earache in children,
4S0 ; on the removal of foreign bodies
from the ear, 54.
Sexual .sense, inversion of, 377.
Sewer-gas in etiology of tyi)hoid fever, 406.
June 30, 1883.]
INDEX.
727
/
Shakespeare on death, 55.
Shoultlcr-joint, cin-onic osteitis of, 584
.Shufeldt, i)i' li W., a case of Daltonism
affectini; one eye. 319.
Silica, spinal jacket of, 84.
Silver, nitrate of, action on mucous mem-
branes, 667 ; in neuralgia and gouty
pains, 460; nitrate of, staining of the
skin liy, 452.
Simmons, Dr. Horace M., death from vacci-
nation, 56S.
Skin, changes in, in measles and scarlet fever,
209; mechanical means in diseases of,
659 ; naphlhol in diseases of, 39 ; para-
sitic diseases of, 595.
Skeletons, tariff on, 222. i
Slaughtering mercifully, 363.
Sleep, and tissue metamorphosis, 65 ; chlo-
roform narcosis during, 594, 595 ; path-
ological, 437.
Sleep-drunkenness, 2S0.
Small-pox, 13, 337, 419, 605 ; and the im-
migrant, 196 ; and vaccination in Hayti,
56; propagated by the sparrow, 112;
to prevent pitting, 476.
Smell, hygenically considered, 609.
Smith, Dr. T- Lewis, tulierculosis in infants,
50S.
Smith. Dr. R. M., notice of translation by,
6S7.
Smith, Dr. Stephen, angular anchylosis of
femur at the liip-joint, 5S9.
Snake-bites, chloride of lime for. 364.
Soda, salicylate of, in acute orchitis, 291 ;
bromide of, superior value of, 623 ; tan-
nate of, in dropsy from nephritis, 3S2.
South Carolina Medical Association, 549.
Spalding, Dr. J. A., effect of noi^e on dis-
eased and healthy ears, 044.
Speculum, a nev\' nasal, 390.
Spina-bifida, 351. 357; a new operation for, 1
162 ; successful operation for, 64S. |
Spinal cord, tuberculous enlargement in, 522.
Spleen, as a blood-producing organ, 5'5;
congenital absence of, 95 ; wounds in,
6S0.
Splint, improved general extension for the
lower extremity, 164.
Sponge-grafting, 567.
Squint, convergent, cured by eserine, 597.
Squire, Dr. T. H., courtesy in medical dis-
cussions, no; medical controversy and
the newspapers, 52S.
St. Francis Hospital, 290.
State Board of Health of New York, second
annual report, 166.
State Examinations in Great Britain, 352.
State Medical Society, and a turn in the tide,
409.
Stein, Dr. Alex. W. , Cysto-abdominalraphy,
2S6.
Sternum, successful resection of, 42.
Sternum, trephining of. for removal of foreign
bodies from the mediastinum, 643.
Stewart, Dr. J.T., extirpation of uterus and
ovaries, etc., 701.
Stewart, Dr. Morse, notice of book by, 412.
Stickler, Dr. J. W. , equine scarlatinal virus
as a prophylactic against human scarla-
tina, 316.
Stigmata maidis, 503,
Stigmata of maize, the sedative action of, 195.
Stillman, Dr. Chas. F. , adjustable compound
racket, 333.
Stimson, Dr. Lewis A. , notice of book by,
100.
Stomach, ball of hair in, 551 ; cancer of,
19, 331 ; stomach-pump in diagnosis of
cancer of, 41 ; distention of, 400 ; recent
researches on the physiology and pathol-
ogy of the, 1S3; ulcer of in child, 93;
washing out with chloroform water, 161.
Stone, Dr. A. ]., comments on the code, 363.
Stomach-pump, diagnostic use of, in sus-
pected cancer, 41.
Strabismus, convergent, 597 ; cure of, with-
out oi)eration, 40S.
Stricture, urethral, 500, 512, 662, 679.
Strychnine in dilatation of the heart, 94.
Styptics, uselessness of, 266.
Styrone, anaesthetic action of, 195.
Suffocation, from a shirt-stud, 45.
Sugar of milk, as a laxative, 95.
Suicide, 1S4, 196.
Sulpho-carbolates, 8.
Suppositories of gelatine, 155.
Surgery, abdominal, 456 ; antiseptic, 225 ;
cardiac, 12S ; for engineers. 270 ; pre-
historic, 207 ; progress of in the great
northwest, 626; rural, 162.
.Surgeons, ship, p;iy of, 84.
.Sutphen, Dr. T. Y.. 214.
Suture-clamp, =^69, 615.
Symphysiotomy. 125.
Synovitis, syphilitic, 336.
Syphilis, 526; and vaccina, 323; and canni- j
bals. 672 ; cereliral. 452 ; disguised, 95; \
excision of the primary induration, 11;
hydrotherapy in the treatment of, 161 ;
immunity (jf animals from, by inocula-
tion, 514 ; influenced by erysipelas, 489 ;
in children, 67; in monkeys, 194, 3S1 ;
new remedy for, ^92 ; nourishment of
children afflicted with hereditary, 407 ;
of the brain, lungs, and kidneys, 49S ;
of the eye and its appendages, 434 ;
pathology of intestinal, 436 ; reinocula-
tion, 514; site of the initial lesion, 556.
Syringe, new hypodermic, 3S9.
Tabes, incomplete, 600; iodine and blisters
in, 30S.
Tait, Mr. Lawson, notice of book by, 6S7.
Talipes, etiologv of congenital equino-varus,
6j.
Tanner's vagaries, 109.
Tape-worm, trap for, 362.
Tarsus, excision of, 551, 640.
Taylor, Dr. Henrv Ling, convallaria maialis,
87, 117-
Tea, the adulteration of, 44.
Tears, mechanism of conduction to nose, 4O0.
Teeth, dead, influence on health e.xerted by,
52S, 670 ; decayed, removal of, 5S7 ;
denudation of. 669 ; in the new-born,
304 ; relation of to inebriety, 333.
Telepathy, 572.
Temperature, after ovariotomy, 3, 22 ; ex-
ternal, effects on body heat, 459; of
joints, 460 ; recovery after low, 64.
Testicle, cancer of following orchitis, 162.
Testimony, expert, in lunacy cases, 92. ■
Test-types, improvement in the arrangement
of Snellen's, 124.
Tetanus, eserine and lielladonna in, 56; hydro-
phobicus, 48S ; in typhoid fever, 134.
Texas State Medical .-Xssociation. 549.
Therapeutic agents, germicidal properties of
some of them, 434.
Thermometers, broken, 14, 214, 390, 420,
476.
Thermometry, cerebral. 625.
Thigh, new methods of reducing dislocations
of, 403.
Thomas, Dr. Frank W., 28.
Thompson, Sir Henry, notice of book by,
440.
Thompson, Dr. \V. U., a successful case of
sponge-grafting, 567.
Thomsen's disease, 409.
Thoracentesis, antiseptic, 432.
Throat, inspection without instruments, 495.
Thrombosis of the basilar artery, 432.
Thymus, enlarged, 442.
Thyroid, extirpation of, 523, 699.
Thyrotomy, 610.
Tibia, compound fracture of, 275.
Tidy, Dr. C. M., notice of book by, 412.
Tissue-metamorphosis, cause of, 268.
Tobacco, consumption of, 82.
Tongue, cold abscess of, 515 ; spatula, 153;
under the microscope, 30S.
TonsiUotomv, 146 ; without hemorrhage,
666.
Tonsils, hypertrophied, vertigo as a reflex
symptom in, 93.
Tooth hi the nose, 542.
Toronto Medical Society, 695.
Trachea, changes induced in, by broncho-
cele, 523 ; secretion of mucus in, 69.
Tracheotomy, in young children, 54 ; sequelae
"f^i 53' ; report of cases, 704.
Trance in relation to sea-sickness, 248.
Transactions of the Medical Society of the
State of Pennsylvania, notice of, 440.
Tansfusion, direct from an artery to the peri-
toneal cavity, 599 ; of an alkaline solu-
tion, 93; of pure water, 351 ; peritoneal,
120.
Trephine, when shall it be used in fractures
of the skull ? 155.
Trephining, double itientity after, £^70,
Trial by jui"y with reference to lunacy, 400.
Trichina spiralis in American pork, 267.
Trichinosis, 39, 685.
Trichlorophenol, 69.
Tricus|nd stenosis, 68.
Trudeau, Dr. E. L. , clinical indications for
convallaria, 251.
Tubercle, bacillus of, 26, 397 ; bacillus not
demonstrable by the ordinary method of
staining, 645 ; prognostic value of the
bacillus, 9.
Tuberculosis, antisepsis of, 27S ; secondary
to syphilis, 526 ; general in a child, 303 ;
in infants, 508; intimate nature of, 246 ;
primary of the intestines, 404 ; prophy-
laxis of, 10; the pseudo-bacillus, 298.
Tumor, canliac, 39 ; of the cerebellum, 342 ;
gummy, 39 ; of the pharynx, 612 ; path-
ogenesis of secondary, 28 ; vascular,
treated without operation, 432.
Turpentine and iodoform, inhalations of
spray of, 292.
Tympanites, cause of hysterical, 542.
Typhlitis, 553.
Tyson, Dr. James, notice of book by, 299.
U
Ulcers, bismuth in, 599 ; laryngeal, and iodo-
form, 381; of the stomach in a child,
93 ; tubercular of the colon, 557 ; vari-
cose, 208.
Ulna, fracture of, 661.
Urticaria, chronic, 152.
Uraemia, 479 ; temperature in, 55S.
Urea as an antiperiodic. 403.
Ureter, 3S5 ; catheterizing the female, 444.
Urethra, stricture of, 500, 512, 662, 679.
Urethral calculi, 132.
Urine, albumen in picric acid, test for, 193 ;
bacillus tuberculosis in, 321 ; cystine in,
321 ; effect upon the flow of by ether
narcosis, 3S6.
Uterus, ante- flexion of, 469 ; acute ante-flex-
ion of, 38 ; ante-partum hour-glass con-
struction, 278 ; carcinoma of the fundus,
77 ; cancer of the neck of, 191 ; chronic
catarrh of, 674, 691 ; constitutional
treatment of chronic disease of, 4S9 ;
disease of, in the insane, 2S0 ; displace-
ment of, 233 ; displacement of, pathol-
ogy and treatment of, 11; erosion of
the cervix, 141 ; fibro-cystic tumor of,
38; gravel, puncture of during ovariot-
omy, 124; hemorrhage from chronic
hypera;mia, 144 ; impregnation of a
prolapsed, 701 ; laceration of the cer-
vix, 143 ; movements of, 266 ; injection
of, 273 ; osteo-fibroma, 499 ; prolonged
menstrural flow from pinhole external os,
144 ; super involution of, 162 ; tolerance
of traumatic and septic influences, 9 ;
unicornis, 499.
Van Buren, William Holme, M.D., LL.D.,
obituary, 361
>Van Santvoord, Dr. R,, the danger attending
the use of ether as an anaesthetic in cases
of Bright's disease, 261.
Vander Poel, Dr. John, a case of wandering
needles, 5S7.
Vaccina and syphilis, 323.
Vaccination, 396, 616. 660, 677 ; among im-
migrant babies. 625 ; and small-pox in
Hayti, 56 ; death from, 56S ; paralysis
of the arm following, 569.
728
INDEX.
[June 30, 188^
Vaccine, reliable virus, 656 ; wearing out of
the protection of, 520.
Vagus neurosis, convallaria in, 133 ; results
of section of the, in sheep, 418.
Vaporizer and insufflator, 361.
Varicocele. 634,
Variola, 337. 365. 394.
Vein, jugular, capacity for distention, 525 ;
umbilical, thrombosis of, 527.
Veins, negative pulse of, 170; pulsation of,
diagnostic significance of 517.
Venereal warts. 276.
Venereal, protection of college students
from, 211, 277.
Venesection, to prevent premature birth,
323 ■
Veratria, antagonism between, and potas-
sium salts, 180.
Vertebr.-E, removal of carious portions of.
4SS.
Vertigo, laryngeal. 576; symptom in en-
larged tonsils, 93.
Viburnum opulus in dysmenorrhoea, 1S8.
Viscera, transposed, 671.
Vision, instrument for testing the field of,
251.
Vocal cords, tension of, 611.
Voice, disability of. 576.
Vomiting, iodine for, 433 ; of pregnancy,
60 1 ; of pregnancy, pop-corn in, 3S2 ;
paro.xysmal stercoraceous, 68.
Von Ramdohr, Dr. C. A., anterior uterine
displacements and a new method of
treatment, 233.
W
Wackerhagen, Dr. G. , cancer of the face,
34S.
Wall. Dr. O. .'\.. on the strength of opium,
S3-
Wallian. Dr. Samuel S., opium- poisoning.
4S7, 671.
Ward, Dr. Charles S., the significance of
temperature after ovariotomy. 3, 22.
Warts, 27S; removal of, by cauterization.
514 ; venereal. 276.
Water, contamination of, by lead, 713 ; hot.
as a gargle. 651 ; hot, as a hemostatic.
151 ; hot. as a tipple, 279 ; hot, in the-
rapeutics, 4S7 ; polluted supply in Bos-
ton, 242; supply of, for New York. 70,
126.
Waterman, Dr. S-, revivification, 236.
Watson, the late Sir Thomas, anecdotes of,
279.
Wel)ster, Dr. David, central scotoma with
derangement of color perception, 621.
Webster, Dr. J- O. . cleansing the vault of
the pharynx, 5S8.
Welch, Dr. George T., pelvic hematocele,
614.
Welch, Dr. W. B., 95.
White. Dr. Frances Emily, is the blood a
living fluid ? 564
Whiting, Dr. Guy F., a new mode of cleans-
ing the vault of the pliarynx, 458.
Whooping-cough, and eucalyptus, 93: bro-
mic ether in, 5S8 ; the bacillus of 185.
Wilder. Dr. Burt G., notice of book by,
165; the protection of college students
from venereal diseases, 277.
Woman, in labor, 158.
Woman's dress, 97.
Worms, expulsion of four hundred and forty-
one lumbricoid within thirty-four hours,
24S.
Wounds, bismuth in the treatment of. 55 1 ;
dressing of, 27 ; in the course of dia-
betes. 71; in the spleen, 680; new
method of closing. 569; scalp-treat-
ment of, 30S ; scalp, union by first in-
tention, 224.
Writer's cr<amp, 519, 716.
Wyman, Dr. Hal C, abstraction of blood
from the right heart, 80.
Verba santa, 503
Ziegler, Dr. Ernst, notice of book by. 3S4.
Zinc, salicylate of, 652.
THE
MEDICAL RECORD
A Weekly yotir^tal of Medicine and Surgery
EDITED BY
GEORGE F. SHRADY, A.M., M.D.
SURGEON TO THE PRESBYTERIAN AND ST. FRANCIS HOSPITALS; CONSULTING SURGEON TO THE HOSPITAL FOR RUPTURED
AND CRIPPLED, NEW YORK; AND PRESIDENT OF THE N. Y. PATHOLOGICAL SOCIETY.
JULY 7, 1883 — DECEMBER 29, 188^
NEW YORK
WILLIAM WOOD & COMPANY
i88c!
Tkow's
Printing and Bookbinding Company,
201-213 ■^'"' 12/// Street,
Nkw York.
LIST OF CONTRIBUTORS TO VOL XXIV.
Abbott, Dr. Frank, New York.
Adler, Dr. Albert S., Lordsburg,
N. M.
Alderson, Dr. M. E., Russelville,
Ky.
Amidon, Dr. R. \V., New York.
Andrews, Dr. J. A., New York.
Baker, Dr. Smith, VVhitesboro, N. Y.
Baldwin, Dr. D. A., Englewood, N. J.
Baruch, Dr. Simon, New York.
Bauer, Dr. Joseph L., Lehighton,
Pa.
Bigelow, Dr. Horatio R., Washing-
ton, D. C.
Blakeman, Dr. W. N., New York.
BoRCHEiM, Dr. L. E., Atlanta, Ga.
Bradnack, Dr. P\, New York.
Brechin, Dr. W.P., Boston, Mass.
Briddon, Dr. Chas. K., New York.
Briggs, Dr. l\r. D., Belle Plaine,
Iowa.
Brose, Dr. Louis D., Evansville, Ind.
Browne, Dr. Valentine, Yonkers,
N. Y.
Brush, Dr. E. F., Mount Vernon,
N. Y.
Buchanan, Dr. J. J., Pittsburg, Pa.
BuRCH, Dr. T. Hamilton, New
York.
Burke, Dr. Martin, New York.
Burnett, Dr. Charles H., Phila-
delphia, Pa.
Burrall, Dr. F. A., New York.
BuRRiLL, Dr. T. J., Champaign, 111.
Carpenter, Dr. James Stratton,
Philadelphia, Pa.
Carpenter, Dr. Wesley M., New
York.
Case, Dr. Meigs, Washington, D. C.
Castle, Dr. F. A., New York.
Chalmers, Dr. G. S., Alton, 111.
Chapin, Dr. Henry D., New York.
Cheesman, Dr. W. S., Auburn, N. Y.
Chew, Dr. S. C, Baltimore, Md.
Clark, Dr. D. S., Rockford, 111.
Conkey, Dr. Caroline R., Water-
town, N. Y.
CoNOVER, Dr. C. I., Charleston Four
Corners, N. Y.
Coonley, Dr. E. D., Staten Island,
N. Y.
Corning, Dr. J. Leonard, New York.
CouES, Dr. Elliott, Washington,
D. C.
Creighton, Dr. Charles, London,
England.
Crothers, Dr. T. D., Hartford, Conn.
Culbertson, Dr. H., Zanesville, O.
Dana, Dr. C. L., New York.
Darby, Dr. F. H., Morrow, O.
Davy, Dr. J. O., Springfield, O.
Dawley, Dr. L. Byron, Seneca Falls,
N. Y.
De Garmo, I?r. W. B., New York.
Delafield, Dr. Francis, New York.
DiCKERMAN, Dr. W. H., Clean, N. Y.
' DuFKiELD, Dr. J. J., New York.
Dujardin-Beaumetz, Dr., Paris,
France.
Eliot, Dr. Llewellyn, Washington,
i D. C.
! EsTES, Dr. W. L., South Bethlehem,
Pa.
Ferguson, Dr. Jtihii, Toronto, Can-
ada.
Forest, Dr. \V. ¥.., New York.
Foster, Dr. Joel, New York.
FoTHERGiLL, Dr. J. MiLNER, Lon-
don, England.
Frankl, Dr. J. W., New York.
i Freeman, Dr. Alpheus, New York.
: French, Dr. J. M., Milford, Mass.
I Fuller, Dr. Eraser C, New York.
Fuller, Dr. Frederick, Manitou,
Col.
Fuller, Dr. William, Grand Rap-
ids, Mich.
Gallatin, Dr. Hattie A., Cleve-
land, O.
Garrigues, Dr. Henry J., New
York.
Gay, Dr. Charles C. F., Buffalo,
N. Y.
Gee, Dr. W. S., Hyde Park, N. Y.
GiRDNER, Dr. John Harvey, New
York.
Godfrey, Dr. John, New Orleans',
La.
Goldmann, Dr. Edmund, Monterey,
Me.xico.
Goodridge, Dr. E. A., New York.
Goodwillie, Dr. D. H., New York,
Gottheil, Dr. W. S., New York.
Hachenberg, Dr. G. P., Austin,
Te.xas.
Hamilton, Dr. (jEORGe, Philadel-
phia, Pa.
Hamilton, Dr. J. W., Columbus, O.
Harrison, Mr. Reginald, Liverpool,
England.
Hart, Dr. B. F., Brownsville, Mo.
Haviland, Dr. Frank W., New
York.
Hawley, Dr. J. S., Brooklyn, N. Y.
Hendee, Dr. H. S., Louisville, N. Y.
Henry, Dr. Morris H., New York.
Hinsdale, Dr. Guy, Philadelphia,
Pa.
Hochheimer, Dr. E., New York.
Huntington, Dr. Geo., Le Grange-
ville, N. Y.
HuRD, Dr. E. P., Newburyport, Mass.
Ill, Dr. Edware J., Newark, N. J.
Jackson, Dr. A. W., Wurtsboro, N.Y.
Jarvis, Dr. William C, New York.
Johnson, Dr. Robert W., Baltimore,
Md.
Jones, Dr. Howard, Circleville, O.
Judson, Dr. A. B., New York.
Kearney, Dr. Thos. J., New York.
Kemper, Dr. G. W. H., Muncie, Ind.
KiNNicuTT, Dr. Francis P., New
York.
Kipp, Dr. Charles J., Newark, N. J.
Klingensmith, Dr. I. P., Derby Sta-
tion, Pa.
Knapp, Dr. Herman, New York.
Lachapelle, Dr. E. P., Montreal,
Canada.
Leonard, Dr. Alfred M., Camden,
N. Y.
Leonard, Dr. W. R., New York.
IV
CONTRIBUTORS TO VOL. XXIV.
Little, Dr. James L., New York.
Lydston, Dr. G. Frank, Chicago, 111.
MacCormac, Sir William, London,
England.
McBride, Dr. T. A., New York.
McCarroll, Dr. H. B., New York.
McNfAHON, Dr. J. B., New York.
Mann, Dr. Matthf.w D., Buffalo,
N. Y.
Martin, Dr. Franklin H., Chicago,
111.
May, Dr. H. C, Corning, N. Y.
Mearns, Dr. Edgar A.
Metcalfe, Dr. John T., New York.
Mitchell, Dr. S., Jr., Hornellsville,
N. Y.
Moffat, Dr. Henry, New York.
Morgan, Dr. \V. F., Leavenworth,
Kan.
MoRisoN, Dr. Robert B., Baltiinore,
Md.
Morris, Dr. Robert T., New York.
Newton, Dr. Richard Cole, U. S.
Army.
Nicoll, Dr. Henry D., New York.
North, Dr. Alfred, Waterbury,
Conn.
Noyes, Dr. Henry D., New York.
Oppenhei.mer, Dr. Henry S., New
York.
Osler, Dr. Wm., Montreal, Canada.
Otis, Dr. F. N., New York.
Page, Dr. R. C. M., New York.
Parker, Dr. Daniel, Calvert, Tex.
Parker, Dr. W. Thornton, Fort
Elliot, Tex.
Parks, Dr. N. V. D., Ashton, R. I.
Parsons, Dr. A. W., Brainerd, Minn.
Parsons, Dr. Stoveli. C, New York.
Pease, Dr. Caroline S., Troy, N. Y.
Peck, Dr. Edward S., New York.
Peckham, Dr. Grace, New York.
Powell, Dr. Hunter H., Cleve-
land, O.
Prettyman, Dr. J. S., Milford, Del.
Pryor, Dr. W. R., New York.
Rafter, Dr. J. A., Holton, Kan.
Ranney, Dr. .A.mbrose L., New York.
Roberts, Dr. M. Josiah, New York.
Robinson, Dr. A. R., New York.
Rockwell, Dr. A. D., New York.
Roehr, Dr. C. G., Ledyard, Wis.
RussEL, Dr. Charles P., New York.
Sattf.rthwaite, Dr. Thomas E., New
York.
ScHAPRlNGER, Dr. A., New York.
ScHiVEiGH, Dr. George ^[., New
York.
SfiE, Prof. Germain, Paris, France.
Sexton, Dr. Samuel, New York.
Shaw, Dr. W. E., Cincinnati, O.
Shephard, Dr. George R., Hart-
ford, Conn.
Shrady, Dr. George F., New York.
Shufeldt, Dr. R. W., U. S. Army.
Smith, Dr. F. W., Syracuse, N. Y.
Smith, Dr. J. Lewis, New York.
Stair, Dr. J. B., Spring Green, Wis.
Starr, Dr. M. Allen, New York.
Stelwagon, Dr. Henry W., Phila-
delphia, Pa.
Stickler, Dr. J. W., Orange, N. J.
Stillman, Dr. Chas. F., New York.
Stillwell, Dr. Joseph A., Browns-
town, Ind.
Stockard, Dr. C. C, Columbus,
Miss.
Storer, Dr. H. R., Newport, R. I.
Stuart, Dr. J. H., Minneapolis,
Afinn.
SwASEY, Dr. Edward, Limerick, Me.
Swinburne, Dr. R. E., New York.
Tauszkv, Dr. Rudolph, New York.
Taylor, Dr. James R., New York.
Taylor, Dr. R. W., New York.
Taylor, Dr. W. H., New Bedford,
Mass.
Taylor, Dr. W. U., Mooers, N. Y.
Thompson, Dr. J. S., Indianapolis,
Ind.
Thorne, Dr. H. S., Farmingdale,
L. I.
Tibbetts, Dr. L., Rockford, 111.
Tuttle, Dr. F. A., Jefferson, O.
Van Santvoord, Dr. R., New York.
Van Wyck, Dr. R. C, Hopewell
Junction, N. Y.
Varick, Dr. Theodore R., Jersey
Ciiy, N. J.
Veeder, Dr. M. A., Lyons, N. Y.
Walker, Dr. Le Roy Pope, New
York.
Wallian, Dr. Samuel S., Blooming-
dale, N. Y.
Ward, Dr. E. B., Greensboro, Ala.
Ward, Dr. J. M., Cornelia, Mo.
W.4TERS, Dr. A. T. H., Liverpool,
England.
VV^ATSON, Dr. William P., Jersey
City, N. J.
Webster, Dr. David, New York.
\ Weidenthal, Dr. N., Cleveland, O.
I Welch, Dr. Geo. T., Keyport, N. J.
: Welch, Dr. J. T., Keyport, N. J.
Wendt, Dr. E. C, New York.
Williams, Dr. W. N., Indianapolis,
Ind.
Wolff, Dr. Arthur J., Hartford,
Conn.
Worthington, Dr. J. C, U. S. A.,
Colorado.
Wright, Dr. L. W., Columbus, O.
\Vright, Dr. T. L., Bellefontaine, O.
WvETH. Dr. John A., New York.
Young, Dr. E. Ruthven, New York.
Yount, Dr. T. J., Lafayette, Ind.
Institutions and Societies from which
Reports have been received.
American Academy of Medicine.
American Dermatological Associ-
ation.
American Gynecological Society.
.\merican Ophthalmological So-
ciety.
American Otological Society.
British Medical Association.
Maine Medical Associ.'iTioN.
Medical Society of the County of
New York.
New Hampshire Medical Society.
New York Academy of Medicine.
New York Neurological Society.
New York P.\thological Society.
Northwestern Medical and Sur-
gical Society, New York.
Ontario Medical Association.
Oregon State Medical Societ\\
Practitioners' Society of New
York.
Presi'.yterian Hospital, New York.
St.\te .NFedical Society of Virginia.
St. Luke's Hospital.
Tri-State Medical Society of In-
diana, Kentucky, and Illi-
nois.
University of Pennsylvania.
Vermont .St.vfe Medical Society,
The Medical Record
A Weekly younial of Medicine and Surgery
Vol. 24, No. I
New York, July 7, 1883
Whole No. 661
@vi0iual ^vticles.
THE FIXATIVE POWER OF TRACTION IN
THE TREATMENT OF HIP DISEASE.
By a. li. JUDSON, M.D.,
OKTHOI'EDIC SUKGHON TO THE OUT-I'ATIENT UEPAUTMEM OF THK NEW VoRK MOS-
PITAL.
That traction possesses to a certain degree tlie poucr
of fixing the joints of the extremities is not a new idea
in surgery. It was entertained in the last century by
Desault, whose apparatus for fracture of the femur is
described as follows : " This consists, to speak in gen-
eral terms, in taking the points of extension above, on
the tuberosity of the os ischium of the diseased side, and
below, on the malleoli ; in securing the straps or rollers,
destined for making extension, on the two ends of a
strong splint, placetl along the outside of the limb ; and
in converting, so to speak, the pelvis, the thigh, the leg,
and the foot, into one entire and solid piece." ' In
1835 Lesauvage wrote that one of the objects of con-
tinued extension in the treatment of hip disease is to
prevent motion." Mr. histon, seeking to disparage the
use of the weight and pulley in the treatment of hip dis-
ease, said: "All this may amuse the patient's mind, per-
haps, but I do not think any good can come of it further
tlian preventing motion." ' M. Philipeaux writes, "that
in the absence of retentive splints, traction may be em-
ployed to secure immobility of the limb." * Dr. C. Fay-
ette Taylor refers to " the quiet fixation of the joint,
which the splint has been a convenient means of accom-
plishing."' Dr. Louis P>auer says; "Whatever benefit
I have derived from it (extension) is unquestionably due
to its collateral etTect upon fixing the aftected articula-
tion." " .Mr. Thomas, referring to extension, writes : " In
its application it involves, unavoidably, a fractional degree
of fixation." ' Dr. L. M. Yale writes : " When the muscu-
lar spasm is urgent, fixation cannot be secured, save by
the use of a force as constantly acting as that which is
to be overcome, and the agent best adapted to this pur-
pose is traction." * Dr. J. A. Wyeth writes : " Extension
is made by means of the screw-key, until there is free-
dom from pain and a comfortable fi.xation of the limb." "
Dr. N. M. Shafter writes : "When traction exists the pa-
tient has the advantage of that peculiar and perfect im-
mobility which the extension of the long hip splint af-
fords.'""
The fixation of the hip-joint is one of the most difficult
problems in mechanical surgery." In the first place,
this articulation is a ball and socket. Aside from this
^Treatise on Fractures, p. 243. Translated by Charles Caldwell, M.D. Phila-
delphia, 1817.
'^ Arch, sen., p. 280. November, 1835.
^ Lancet, pp. 237, 238. Novenrber 25, 1S43.
* Traite de Thcrapeutique de la Coxalgic, p. 285. Paris, 1S67.
^The Meoicai. Record, p. 290. September i, 1867.
* Lectures on Orthopedic Surgery, p. 282. .Second Kdition. New \'urk, iSuS.
'Hip, Knee, and .^nkle. p. 10. 'I'liird Edition. Liverpool, 1S78.
^The Medical Record, p. 27. January 13, 187S.
''New York Medical Gazette, p. 243. April 17, 1880.
'"Archives of Medicine, p. igS. October, 18S0. The i)pinion has been expressed
by the present writer that ** traction, however applied, is unavoidably accompanied
by fixation," that " the advantages derived from the traction exerted by the hip
splint are tliie solely to the fact that it secures fixation," and that *' fi,\ation is un-
doubtedly one of the principal functions of the long hip splint." New York Medi-
cal Journal, p. 17. July, 18S2. St. Louis Courier of Medicine, p. 370. May, 18S1.
The Medical Record, p. 738. June 26, 1880.
'' In 1828 Sir Charles Bell said : "No instrument has ever been effectual in
keeping the thigh and trunk fixed." London Medical Gazette, p. 139, January
12, 1828.
the difficulty is due, in a great measure, to the fact that
the hip-joint is situated near the centre of the body.
In order to understand the subject clearly, it may be
well to take an elementary view of the relation of the
muscles to the joints, as follows : The muscular appa-
ratus of a joint has a twofold function. It can at will
either move or fix the joint. If the joint be remote
from the centre, the muscles will be more effective in
their control either for motion or fi.xation, because of the
disproportion in size and weight between the part above
and that below the iioint of motion. There is philoso-
phy as well as humor in Dundreary's witticism ; "Why
does a dog waggle his tail ? " Answer. " Because the tail
can't waggle the dog." '" As the wagging of a dog's tail
is not only motion alternately right and left, but also
arrest of motion nght and left, it is clear that motion
and fixation, as effects of muscular action, are correlative,
and if the part below the point of motion is more easily
moved on account of its comparative lightness, it will
also be more easily fixed, and if more easily fixed, dis-
ease attacking the joint will be less serious and more
easily curable. In this lies a partial explanation of the
fact that joint diseases of the lower extremity become
less serious as we pass from the hip toward the phalanges.
Aside from the fact that the hip-joint has a peculiaily
wide range of movement, if the entire limb were no
larger and heavier than the foot, hip disease would not
be more serious than ankle disease. A striking illustra-
tion of this point is the case related by Mr. Hilton,'' in
which the patient had disease of the left knee and the
left hip. Amputation, which was performed above the
knee, promoted recovery at the hip by facilitating the con-
trol of the latter joint by imiscular action. To quote Mr.
Hilton's words : " In fact, I may say the hip-joint was
cured by cutting oft" the leg."
Furthermore, a joint which is situated near the centre
of the body is peculiarly liable to be disturbed by the
movements of other members. The distal phalangeal
joint is not appreciably affected by movements made
elsewhere, but the hip-joint is inevitably disturbed by the
movements of other parts of the body. In the words of
Sir Charles Bell : " There is no rest to it ; every motion
of the body may be said to be accompanied with a move-
ment of the head of the femur within its socket ; even if
the arm be raised, there is a change in the centre of
gravity of the body, and the trunk must be poised anew
upon the hip, as the centre of all our motions. It is re-
markable how the slightest degree of movement in
another part of the body is, as it were, necessarily ac-
companied with a motion of the surfaces of those bones
which compose the hip joint. If ever you should see a
patient suftering with acute inflammation of the hip, you
will see the proof of this ; for every motion of the body
gives extreme pain, and proves an additional source of
excitement anti inflammation. It is this consideration
which leads us to understand the difficulty of curing the
disease." '*
Another most serious obstacle to the successful fixa-
tion of the hip-joint is found in the fact that a reten-
tive splint acts here at a great mechanical disadvan-
tage. If the distance from the acetabulum to the
crest of the ilium were ei[ual to that from the head of
'2 Our .American Cousin, bv Tom T.iylor, .Act I., scene i .
"John Hilton: Rest and P.iin, pp. 29S-J00. London, 1S63. .'imerican Kdi-
tion, pp. 178, 179. 1879.
'^ I^c. cit., p. 138. ;
THE MEDICAL RECORD.
[July 7, 1 88;
the femur to tlie condyles, or if, in iniaginalion. we
were to convert the i)elvis and the vertebrtV into a
single bone, a retentive splint would doubtless be as
eftective in securing fixation as it is when used at the
knee, or when applied to a fracture in the middle of the
shaft of a long bone.'
In view of these difficulties, can we reasonably hope to
secure fixation of this joint by so simple a method as
traction ? That this expectation is not entirely unreason-
able, is indicated by the fact that the most remarkable
result of the application of purely fixative apparatus, viz.,
the relief of pain, is also the result of the application of
apparatus that is purely tractive. The following ob-
servations prove the anodyne quality of the simple re-
tentive apparatus. Dr. Coates, referring to the use of
Dr. Physick's hollow carved wooden splint, which ex-
tended from the external malleolus to the middle of the
thorax and embraced nearly one-half of the trunk, wrote :
" The patient frequently stated that ^le had obtained,
in the night following its application, sounder sleep than
for many weeks or even months previously."' M. Bon-
net, referring to le grand appareil, which embraced two-
thirds of the circumference of the lower limbs and the
lower part of the trunk, wrote : " I have seen the pain
and inflammation disappear as soon as the limb was
brought into position and held immovable." Relating a
case, he wrote : " From the moment of a[)plication the
pains diminished.'" M. Philipeaux, referring to a case
in which Bonnet's apparatus was ap|)lied, wrote : " The
next morning I learned that the patient, who had moaned
incessantly the night preceding the application, had slept
calmly for four hours." ' Mr. E. J. Chance's splint em-
braces the thigh and a large jiart of the trunk, and Mr. E.
Noble Smith si)eaks of '"the almost immediate relief
from jiain which the patient experiences when tlie sjilint
is applied." "
On the other hand, the anodyne etiect of simi)Ie trac-
tion is equally remarkable. It was observed by M.
Blandin that on the application of extension and traction
the acute pains of hip disease " disappear as if by en-
chantment." ° Gustav Ross said that when the weight
and pulley were used in the hip disease of children, " the
pain lessens astonishingly." ' Dr. John Watson, de-
scribing his treatment of a jiatient in the acute stage of
hip disease, said : " 1 had hardly put on the counter-
extension before the girl was entirely free from pain. It
operated beautifully and instantly." ' Dr. E. S. Cooper,
referring to his ingenious device for traction and counter-
traction, writes: •'Often have patients slept better the
first night after its application than they had for many
months previously." "
When we find, as above, that i)ain i.-^ controlled equally
by direct fixation and by traction, can we escape the sug-
gestion that perhaps traction is in itself an eftective
method of securing fixation ? It has been stated as an
objection to this view, that the relief which follows trac-
tion is too instantaneous to be considered as the result
of fixation. Jt is thought to occur before immobilization
could have produced any eftect. In reply it may be
said tiiat the pain of hip disease is composed, to a cer-
tain degree, of extreme apprehension and mental and
nuiscular fatigue, produced by prolonged efilorts to pre-
vent motion, with sudden sharp accessions when motion
is inadvertently made, or when the patient starts in the
act of falling to sleep. Such pain as this is cai)able of
' One of tlie difficulties in the treatment of Collcs's fracture of the radius
from the shortness of the lower fragment. If this fr.igmenl. the carpus, the
carpus, and the phalanges, were one piece the mana;;enieiu of the accident
Le crcatly simplihed.
-Amir. Jour, of Med. Sciences, p. 307, fo-.it-notc, Icbruarx, 1S31.
^Traite des maladies des articulations, vol. ii.. pp. 356, 361. Lyon, 1S43.
•" Traite de tli^rapeiitique de la coxalgic, p. 250. Paris, 1SO7.
■• !•; Nohle Smith ; 'I'lie .Surgery of IJeforniitics, pp. 133-135. London. I
« NLaisoiineuve : De la cosalgie. Tliise de Paris, p. 2.-S. 1844. .Ann.
chir. frail, cl etrangfere. vol. xiii., p. 192- 1845.
' Deutsche Klinik. p. 98. March 4. 1854.
» Am. Med. Times, p. 310. May 11, iSoi
» San Francisco Medical Press, p. 145- July, 1861. Dr. Julius A. Po;
noted the remarkable relief allorilcd by the weight and imlley m a case of 1
ease in an adult (Philadelphia Medical News, p. 537,>. N.iveuiber 11, 1SS2.
arises
meta-
would
8S2.
de la
t has
ip dis-
instant relief or abatement by fixation. 'In certain cases
there is a severe pain not controlled by mechanical treat-
ment, the occurrence of which, sometimes at least, ac-
companies the development of an abscess.
We have seen above that fixation has, by a number of
writers, been recognized as an accompaniment of traction
applied to the hip-joint. We have also seen that clinical
observation rentiers it not improbable that traction acts
as a fixative power, because its first eftect is identical
with that of apparatus which is purely fixative. The im-
portant question arises whether it is demonstrable that
traction secures fixation. This question may be answered
affirmatively. Take two rods of iron or soft steel, of
sufticient length, and form an eye in the end of each by
bending its extremity into a small circle. When the
rods are joined by these eyes they will together resemble
two links detached from a surveyor's chain, and there
will be wide and free mobility at the joint. Then tie the
free end of one link to a stai)le and apply moderate trac-
tion, by means of a weight and pulley, to the free end of
the other. It is seen at once that the mobility which
existed at the joint between the links is absent so long
as the traction continiies.'" Although the immobility thus
produced is liable to be ove'rcome by a competent
disturbing force, it is nevertheless quite sufficient to
relieve the pain of hip disease and to inomote union
in fracture of the long bones. But in the treatment
of hip disease fixation by the weight and pulley is open
to the objection that it necessitates prolongetd recum-
bency, and is liable to wilful disturbance. Discarding
for these reasons the weight and pulley, let us subject
the two links of surveyor's chain to traction in a hip
splint, tying the free end of one to the perineal straps
and that of the other to the leather strap which leads
to the foot-piece. The result of applying moderate
traction by the rack and pinion when the parts are
thus arranged is fixation of a remarkably stable and in-
destructible kind.
It is worthy of note, fuithermore, that when the hip
si)lint is applied to a patient traction is made in such a
manner that fixation is rendered more complete by a
jiart of the apparatus which acts as a brake. The hip
splint is so well known that it does not require a de-
scription here. It is sufficient to say that the apparatus
here referred to has a less flexible upright and pelvic
band tlinn have been found in some forms of the ap-
paratus, and also a bolt and nut connecting the two
parts, by the use of which they can be firmly fixed at any
angle desired by the surgeon. It is jirovided with sus-
pending straps passing over the shoulders, by which the
adhesive plasters and the aftected limb are relieved from
the weight of the splint when raised in walking. It also
has a U-shaped attachment" at the level of the lower
part of the thigh, by which motion is more fully arrested
than by a flexible strap.'"' The i)arts which act as a
biake are the i)erineal strajis. A brake is described as fol-
lows : " An apparatus used for retarding the motion of a
wheel by friction on its periphery." .\s applied to a
patient, the hip splint, wiien traction is exerted, makes
friction on the tuberosities of the ischia and the rami of
the ischia and pubes, these parts representing the peri-
phery of a wheel revolving at the upper end of the femur
t** In this way we arrive at a competent explanation of the efficacy of traction
by tlie weight and pulley in the treatment of fractures, a method the antiquity
of which has been traceil by Mr. J. H. James (.Address in Surgery, Transactions
of the Provincial Medical and -Surgical .Association, vol. viii., pp. 213-216, 1S40) and
A. S. Gohier (Nouvel appareil pour le tr.iitement des fractures dii col du femur, p.
36. Paris, 183s). The explanation which depends on the supposition that trac-
tion places the muscles on the stretch and tiius makes them retentive splints is
open to the objection that traction is powerless to stretch the muscles to a degree
even appioaching the normal lengthening to which they are accustomed in the or-
dinary movements of the limb. If a muscle is in extreme normal conlraction. Its
opponents arc of course relaxed and lengthened, and when the parts are at rest
this potential elongation is so great that traction would be incompetent to stretch
the muscles enclosing a long bone in any degree, still less to give them enough
tension to mialify them for the functions of a retentive apparatus, for the same
reason the etTicacy of traction (continuous e.vtension) in the treatment of fractures
can hardly Iw said to depend on its ability to tire out the muscles whose contrac-
tion produces displacement of the fragments.
11 Described in Tim Mudic.m. Rkcoku, p. 738, June 26, iSSo.
'■■^ Some practical points in the niaiiagemenl of this apparatus have been con-
sidered in the Medical C. incite, pp. 413-413, L>ecember 10. 18S1.
July 7, 1883.]
THE MEDICAL RECORD.
B
through a considerable arc in the plane of flexion and
extension. If friction can be made on the periphery of
this wheel by a process or ofishoot of the femur, motion
of the pelvis on the femur (or of tlie femur on the pelvis)
will be retarded or prevented. The jierineal strains are
a process of the femur inasmuch as they are carried by
the pelvic band, which is inmiovably
attached to the upright, and this lat-
ter is practically of one piece with
the femur, especially if the femur is
held parallel with the upright by the
U-shaped piece attached at the level
of the lower part of the thigh. In the Q
accompanying figure let the circle
represent the pelvis, \ the acetabu-
lum, A B the femur and the upright,
and C D the perineal straps, prac-
tically of one piece with A B and
applied to the ischiatic tuberosities.
\\'hen traction is made by the rack
and pinion, it is clear that motion
at A will be retarded or prevented.
In practice it is found that when
traction is made, in the case of a
patient to whom the hip splint is applied, motion in
flexion and e.xtension is prevented, although it may not
as yet have been arrested by the disease.
Motion in adduction and abduction is also arrested
to a certain degree by this apparatus — adduction by
the circumstance that, as the perineal straps are both
situated on the inner side of the joint, traction is ab-
ductive or in a direction away from the median line ;
while motion in abduction is opposed by the action of
the apparatus as a retentive splint (although its action
as such is feeble), applied to the outer side of the
limb and pelvis, the retentive force being directed from
within outward at the upper part of the thigh, and from
without inward at the pelvis and the lower part of the
limb.
The question here arises, whether an apparatus so well
contrived for the arrest of motion in the hip-joint could
not be used with advantage in appropriate cases m the
treatment of fracture of the femur, a cpiestion worthy of
attention because the hip splint not only secures fixation
but also permits the patient to walk, a point of impor-
tance in the management of ununited fracture. It may
also prove to be useful after osteotomy for deformity of
the hip.
The idea that hip disease requires the same treatment
as fracture of the femur is not new in medical literature.'
M. Bonnet jiresented /e grand appareil for the treatment
of hip disease in 1845, although he had described it in
all its details in 1839, '"'■^ 'i" apparatus for the treatment
of fractured femur."
In the same manner, but with a longer intervening
lapse of time, the complicated apparatus of .\[. Martin
was prescribed by him in 1S50 for fracture of the femur,
and in 1865 for hip disease." Mr. Ford compared hip
disease without an external opening to a simple fracture
of the bone,* and Sir Benjamin Brodie carried the com-
parison further, saymg : " If it (the cartilage) be exten-
sively destroyed without suppuration, the case may be
compared to one of simple fracture ; and if there be suppu-
ration, it may be compared to one of compound fracture ;" '
a statement which drew from ]3r. Alden March this apt
inquiry : " If there be some analogy between the con-
dition of the hip-joint in morbus coxarius, and fracture
^ In 1779 David de Rouen, referring to diseases of the joints, wrote that not.ible
cures are to be effected " by allowing the parts to remain undisturbed in splints,
as in the treatment of fractures." R. Philipeaux ; De la Coxalejie, p. 381. Paris.
1867.
^ M^moire sur les fractures du femur. Gazette M^d. de Paris, pp. 579. 580,
September 14, 1839. T^ite dea maladies des articulations, vol. i., pp. 322-324.
Lyon. 1845.
^ L'Union M»5dicale, D^cembre, 1S50. De la coxalgie, par Ferdinand Martin,
pp. 488-496. Paris, 1865.
* Edward Ford : Diseases of the Hip-joint, pp. 132, 133. Second Edition. Lon-
don, iSio.
* Clinical Lectures, p. 287. Boston Edition, 1846.
of the neck of the bone, why should there not be some
similarity in the mode of treatment?" ''
If we recall the morbid anatomy of this disease, in
which the integrity of the central portion of the bone is
invariably assailed, we can better understand the com-
parison of hip disease to a fracture of the bone, and the
more readily recognize the propriety of treating it by
fixation. If hip disease were synovitis, invading, under
the pressure of reflex muscular contraction, first the car-
tilage and then the bony tissue, it would be right to try
to diminish this jiressure by traction, or any other method
believed to be practicable.' We might even attempt the
difficult combination of traction with mobility, in the hope
that motion without friction would perhaps assist the
process of repair and secure a recovery without impair-
ment of mobility. But the disease is not synovitis. It
is ostitis, beginning in the cancellous tissue, or at the
epiphysal junction, excavating the bone, undermining its
strength, progressing from within outward, and involving
in time all the structures of the joint. In this view it is
clear that the pro|ier local treatment is protection from
the pressure and concussion incident to walking, and the
prevention of motion in the joint. As in a fracture, so
in hip disease, the part should be placed in a favorable
position for '.he action of the natural rei)arative processes
which, aided by appropriate general treatment, are, as a
rule, able to limit this morbid process when it occurs in
parts which, like the ankle, are more easily protected
from disturbance and violence by the voluntary eft'orts of
the patient."
It may be said, in criticism of this precept, that the in-
tention in treating a fracture is to abolish mobility,
which, in a case of hip disease, it is our desire to retain
or recall. In reply, it may be well to state that the
cases of real hip disease which recover with perfect mo-
tion in the joint itself are rare, no matter what form of
treatment or expectancy be pursued. There are, indeed,
many cases in which the friends of the patient errone-
ously believe that motion of the joint has been preserved,
basing their opinion on the evident facility with which
the patient walks. It is a common idea among non-
medical observers that the limb cannot assist in locomo-
tion if there is absence of motion at the hip-joint, while
the truth is, that with a perfectly motionless hip-joint
walking may be very well performed, and even with con-
siderable grace, by reason of the acquired mobility of
the lumbar region of the spinal column, and by the pa-
tient's unconsciously taking advantage of the motion of
the unaffected hip."
It is not unreasonable, however, to suppose that cen-
tral ostitis occurring so near the joint as to produce all
the symptoms of incipient hip disease, may, in favorable
conditions and with treatment commenced sufiiciently
early, be resolved with perfect motion in the joint. Such
cases have been observed. Patients have even been
observed to recover from the third stage, with consider-
able useful motion in the joint. In every case, there-
fore, whether the disease be recent or in the third stage,
the surgeon should try to secure recovery with motion,
and it is important to observe that the treatment herein
described not only prevents anchylosis, if it can be pre-
" Transactions of the .American Medical .Association, p. 503. 1853.
' The pathological objections to this view have been presented in the New York
Medical Journal, pp. 1-17, July. 18S2 ; the mechanical objections in The Medic.\l
Record, pp. 509-512, May 12, 1883.
® Remarkable results from expectant treatment in disease of the ankle have been
obtained by Dr. James Knight, at the Hospital for the Ruptured and Crippled.
Thirty cases have been reported by Dr. T. E. Satterthwaue (Report of the Sur-
gical Committee of the Therapeutical Society, Medical Record, pp. 197-202, .Au-
gust 21. i83o) and Dr. V. P. Gibney (Caries of the .Vnkle in C-hildren, American
Journal of Obstetrics, pp. 434-457. April, 1880), These results have not met the ap-
preciation which they deserve. Dr. Gibney writes (op. cit., p. 451) that in ankle
disease excision '" is rarely ever justifiable." He adds ; " The expectant plan of
treatment, fully carried out, assures us of more results that are perfe<:t, and more
limbs that are useful without the aid ofsupfjort, than does any other plan known to
the profession." These words give appropriate expression to a conservatism closely
allied to that which crowns with honor the memory of Fergusson.
' Mr. Hilton describes one of his patients, who recovered with a firmly anchy-
losed hip-joint, as follows: " She is an excellent dancer, frequently dancing for a
whole evening, and but few persons know, when she sits down, that the right knee-
joint is bent at right angles with the thigh and body, and tucked under the chair
to meet the inconvenience of her fixed hip-joint." John Hilton ; Rest and Pain,
p. 373. London, 1S63. American Edition, p. 221, 1879.
THE MEDICAL RECORD.
[July 7, i88t
vented, by subduing inflammation, but also, if anchylosis
be inevitable, jirovides for the best position of the limb.
The fi.xation which this apparatus secures is of a pecu-
liar quality. It may be compared to the condition found
in some forms of paralysis, when a joint is said to resem-
ble a leaden pipe, which may be bent with suitable force,
but retains with sufficient firmness whatever position it
may be placed in. This "fractional degree of fixation"
is attended with sufficient arrest of motion to allay in-
flammation, encourage the reparative process, and aflbrd
relief from pain ; and yet it is not so inflexible as to pre-
vent the gradual correction of the deformity in obedi-
ence to the unconscious eflForts of the patient to |.>lace
the limb in its most useful position, which is that of
slight flexion with neither adduction nor abduction. This
position permits both walking and sitting with consider-
able facility, although the joint be motionless.
The deportment of the limb under this treatment is
observed to advantage in a case that has progressed so
far that the patient is confined to his bed while the thigh
is in excessive flexion and adduction, and yet not so far
that the structurally shortened muscles are an impedi-
ment to the reduction of deformity. .Almost immediately
the adduction is visibly lessened, and is succeeded in a
few days by abduction, which in its turn becomes exces-
sive, because the direction of the traction is abductive or
away from the median line. But when the patient has
gathered strength from the relief of pain and the ability
to sleep, which are secured by fixation, and begins to
walk with the assistance of the ischiatic crutch ' furnished
by the perineal straps, and with the aid of a high sole
on the shoe of tlie unaffected side, it is seen that the
abduction is, in its turn, gradually diminishing ; and as
the patient resumes active locomotion, still wearing the
splint, the limb assumes a position neither add.ucted
nor abducted, in which it is most favorably situated
for walking.-' And while the limb has been making
thfese changes laterally, it will at the same time be re-
duced from a position of extreme to one of moderate
flexion, in which it is most favorably situated for both
walking and sitting. The favorable position thus ac-
quired is retained without difficulty until recovery is as-
sured.
TWO CASES OF IXCOMPLETE FR.ACTURE OF
THE FOREARM.
By GCV HINSD.\LE, M.D.,
HOL-SE SURGEON IN THE EUSCOPAL HOSMTAL, rHILADELCHlA, lA.
During a service of four months in the surgical dispen-
sary of the Episcopal Hospital, nearly fifteen huntlred
new cases presented themselves. Among these were five
incomplete or '-green-stick" fractures of both bones of
the forearm, one of the radius alone, and one of the
clavicle. TJie patients were all children tVom one to six
years old, excepting two, whose history I will give.
Case I. — Frank B. T , aged thirteen, came to the
dispensary July 8, 1SS2. While standing upon a wooden
stool about eighteen inches high, the legs of which were
loose, he fell upon a hard cellar floor. He had bc£n
reaching high up, holding his left arm in full extension.
In his fall his forearm fell across one of the legs of the
overturned stool, striking upon its posterior surface and
producing the deformity as figured. Although partly
*Thc question of .ixillary or ischiatic support has been considered in The .Mei>-
ICAI. Record, pp. 1-3, July 2, 1S81.
• Cases treated in this manner, in the third stage, have been reported in the II-
lustraled Quarterly of Medicine and Surgery, pp. 45-52, April, iSSs.^
stunned bv the fall, he noticed his arm resting on the leg
of the stool.
Upon presenting himself at the dispensary within half
an hour after the accident he did not exhibit great sufter-
ing. The bones were bent backward at their lower fifth ;
the hand and wrist were not greatly swollen, and motion at
the wrist-joint was good. The deformity was so marked
that before reduction was attempted I obtained the con-
tour of the limb by means of lead ribbon and took the
following measurements, the forearm being flexed at a
right angle with the arm and pronated : External condyle
of humerus to styloid process of ulna. Scinches ; external
condyle of humerus to styloid process of radius, 8f- inches.
Mobility and crepitus could not be obtained and the
diagnosis of incomplete fracture was made. By means
of extension and counter-extension and manipulation the
bones were at once restored to their original form. As
they became straight sna])ping of fibres of bone was dis-
tinctly heard and felt, but complete fracture did not take
place. The forearm was then enveloped in lint soaked
in lead-water and laudanum, and straight splints were ap-
plied to its anterior and posterior surfaces. The wet
dressing was continued a few days until the pain and
swelling, which was slight, had subsided.
At the end of the third week the splints were removed
and a piece of binders' board was moulded to the an-
terior surface of the arm. There was still some tender-
ness at the ulnar side of the seat of injury. The measure-
ments made in the same manner as before were now 9
inches and 9^ inches. The patient was discharged at
the end of the fifth week. Two months later a similar
accident befel him, occasioning almost jirecisely the same
condition as described above, and recjuiring the same
treatment.
Case II. — Esther S , aged sixteen, a weaver, ap-
plied on June 9, 1882. While standing in the mill near
her loom, for an instant she rested the elbow of her right
arm against the wall, her hand being fully extended. She
was instantly struck a sharp, hard blow upon the ball of
the hand by the flying shuttle-box, which forced the hand
and arm backward toward the wall. The patient was
seen about an hour after the accident and found to be
suffering greatly. Both bones at the lower fifth were bent
backward ; the hand was flexed and both it and the wrist
were somewhat swollen and of rather a duskv hue. The
gentlest touch gave rise to such pain that at the patient's
request I asked an assistant to administer ether.
The forearm being flexed at 90° and pronated, the dis-
tance from the external condyle of the humerus to the sty-
loid process of the ulna was found to be S^ inches. Grasp-
ing the forearm near the elbow I then made traction from
the wrist. Both bones were firm, neither crejntus nor
mobility could be obtained. The deformity was then re-
duced by grasping the forearm with the left hand, the
wrist with the right, and making pressure with the thumbs
upon the posterior surface of the arm over the seat of
injury. As the bones assumed their proper shape the
snapping of their fibres could be distinctly felt and heard.
With a great deal of force and firm and gradual pressure,
and by placing the arm upon a plane surface and press-
ing forcibly over the seat of injury, the bones were re-
stored to a straight line. It was quite easy to feel the
bony fibres give way, although complete fracture did not
take place. The arm was then dressed with lead-water
and laudanum and placed on a straight, broad palmar
splint, reaching from the olecranon to the finger-tips ; after
applying compresses at the seat of injury, upon the ulnar
and dorsal surfaces, a bandage was applied. Wet dress-
ings were discontinued after a few days and a shorter
splint substituted. This was laid aside in about four
weeks from the time of accident, and the patient ordered
to rub the arm well with soap liniment.
Five weeks after the accident the arm looked and felt
almost precisely like its fellow, but by passing the hand
along the ulna at about the lower fifth a small ridge of
callus could be felt. Measurement was again made in
July ;, 1883.]
THE MEDICAL RECORD.
the same manner as before and found to be 9 J inches.
No tenderness over the seat of injury. The accompany-
ing cut ilhistrates the defornnty :
In most of the works on surgery very little is said upon
the subject of bent and incomplete fractures. The works
of Gross ' and Hamilton," and an article by John Rhea
Barton/ contain the most satisfactory references.
In young children it is possible for bending of bones to
take place without perceptible rupture of the bony fibres ; '
the outline is curved, while incomplete fracture in older
children usually presents an angular deformity. These
curving bones yield more easily to pressure and even of
themselves show a tendency to resume their proper shape ;
incomplete fractures, however, are usually restored with
difficulty. As for impacted fractures in the forearm, they
usually occur in adults, and by an examination of the
bones the rough line of the fragments can almost always
be recognized. Efforts to elicit crepitus are, in all these
cases, unsuccessful.
As for the treatment in very young children sponta-
neous recovery may occur. It is, however, better to se-
cure the proper outline by firm, gradual pressure, and the
application of splints. Complete fracture may occur in
the effort to reduce the deformity and need not excite
alarm. The case is then transformed to one of simple
fracture. But as this accident destroys the continuity
of the bone, and is apt to be followed by a certain de-
formity, it should, if possible, be avoided.
In regard to the cause of incomplete fracture the pre-
vailing impression has been that it is due to differences
in the proportion of the organic to inorganic el-rnents of
bone at the difterent periods of life. Gray ' quotes
Schreger and Rees, who state that the proportion of the
earthy element increases with age, and Stark ' and Von
Bibra, who state that the proportion is constant. The
later analyses of Mr. R. Tuson," Demonstrator of
Chemistry at St. Bardiolomew's Hospital, confirm this
statement. The analysis was made of equal weights
of long bones of different ages, viz.:
At birth.
Organic matter 35-37
Inorganic matter 64.63
10 years.
32.62
67.38
32.04
67.96
32-94
67.06
The predisposition of young bones to incomplete fiac-
ture must therefore be sought for in physical rather than
in chemical differences. Young bones have a more
spongy texture. I'he proportion of the compact to the
cancellous element is smaller in the young than in the
old. The specific gravity is also less. 'J'o determine
this I took two radii- One was from a child about ten
years of age, and was itself a fine illustration of incom-
plete fracture. Its specific gravity was I-35S; the sec-
ond was from a man forty-five years of age, and its spe-
cific gravity was 1.429 ; while a section taken from the
middle of an adult femur gave 1.600.
There is also a difi'erence in the size and structure ot
the Haversian canals, .-^s the bone grows, the lamella;
increase in number from the periphery inward until as
many as fifteen rings may be counted. The calibre of
^ System of Surgerv-, Fifth Edition. Philadelphia, 1879.
- Report on Deformities after Fractures, Trans. Amer. RIed. Assn., 1855-57.
3 Medical Recorder, 182 1.
* "Without any actual disruption except what may be interstitial and too trivial
to be reckoned ^' (Hamilton ; Deformities after Fractures, Trans. Amer. Med.
j\ssn,, vol. viii., p, 421;.
^ Gray's .\natomy, p. 51. Philadelphia. 1878.
^ Dr. Stark : Edin. Med. & -Surg. Journal, 1845.
^ Human Osteology, p. 3. London : Luther Holden, 1878.
the canals is therefore larger in young subjects than it is
in the aged. It is proper also to state that in growing
bones the Haversian interspaces are more abundant.
It is, I believe, owing to these facts, taken collectively,
that young bones are permitted to bend when an older
and a denser bone would snap.
THE RELATIONSHH' BETWEEN" DIPHTHERIA
AND SCARLATINA.
By GEORGE T. WELCH, M.D.,
KEVfORT, .^ , J.
Most medical authors are at particular pains to contro-
vert the opinion that scarlatina maybe complicated with
diphtheria, and strenuously oppose the clinical experience
of independent observers with an array of arguments,
which might become invincible if nature could be held
in bonds by any charm of words. But not even the
anatomist can map so accurately that some anomaly
may not arise ; while the pathologist constantly dis-
covers the confusions attending upon the invasion of one
disease into the territor)- of another. Medicine would
become an easy art indeed, and every man would be his
own doctor, if but one morbid ill could dispute with life
at a time ; but as Mary Magdalen was possessed of seven
devils, so a crew of noisy complications in some dis-
eases puts the wits to wrangle, and disturbs the judg-
ment. It is certainly the duty of the teachers to simplify
the study of morbid processes, to lop away the tradi-
tions, thin the redundancies, and let in all the daylight
possible upon our science. But to contend that one
disease alone hunts in an epidemic is manifestly absurd.
And the gentlemen who deny the existence of diphtheria
as a complication or sequela of scarlatina, or vice I'ersa,
readily admit that the former complicates measles, or
that it deeiiens the malignancy of typhoid. Where is the
consistency ? What is more reasonable than that diph-
theria should be awakened when the system is profoundly
poisoned with scarlatina, especially since the latter
insidiously ravages the same membranes ? How seldom
does a complication arise in any malignant disease until
the invasion of certain vital structures invites the disease
that usually preys upon that organ ?
All the older writers acknowledged a relationship be-
tween the two diseases. In fact, while diphtheria has had
an authentic history of two thousand years, scarlatina
was never separated from it until within these last three
centuries, nor given a name until Sydenham stood spon-
sor in 1676. We refine ui>on the ancients, but disease
is a gross Caliban that constantly escapes his bound-
aries.
Let us see how some of the best authorities differ.
Says Da Costa, " Diphtheria and scarlatina are certainly
allied but not identical ; for the poison of one leads to a
cutaneous rash, and leaves a protective infiuence against
a second attack ; but often also deafness, suppuration of
the glands of the neck, and dropsy — phenomena which
are not encountered in the other. Moreover the exuda-
tion is not exactly similar in the two diseases. In scar-
latina it is pultaceous and not coherent, and has no
tendency to spread to the respiratory passages."
It is the observation of Squire, in " Reynolds's System
of Medicine," that in diphtheria, while there is no diffused
redness of the skin, sometimes little isolated red spots
are discovered in different parts of the surface, and that
the recurrence of the disease in the same individual, if it
has been once fully formed, is by no means settled con-
clusively in the affirmative. Eurther he states that the
albuminuria of diphtheria occasionally results in anasarca.
Mercatus mentions a rash in some of the Spanish epi-
demics of diphtheria, with redness of the whole face and_
neck. Eothergill describes a rash in the first edition of
his treatise on die disease. -■X-itken, treating of anginose
scarlet fever, declares the sore throat may be of a diph-
theritic character.
THE MEDICAL RECORD.
[July 7, 1883.
Hartshorne tells us that occasionally paralj'sis is a
sequela of scarlatina, and that the paraplegia may exist
for several weeks or months. It is the opinion of Flint
that in some severe cases of scarlatina anginosa the
pharynx offers all the characters of diphtheritic inflamma-
tion. He observed, in consultation with Dr. Brady, of
Brooklyn, a boy who had recently had diphtheria, now
suffering with complete hemiplegia and general dropsy.
After his convalescence his sister was attacked with
scarlatina.
Professor Clark, in his lectures on Diphtheria, has given
the details of a case in which that disease was held in
abeyance during scarlatina and measles, these diseases
following each other rapidly, when the dijihtheria again
appeared, and proved fatal.
Henoch, in his " ]Diseases of Cliildren," vehemently
denies the complication of diphtheria with scarlatina, but
like an honorable observer, a page further on, records the
autopsies of seven cases of scarlatina in which fibrinous
infiltration of the pharynx descended to the larynx ; and
of two cases which showed upon post-mortem examina-
tion diphtheria of the pharynx, and in one, of the cesopha-
gus also.
Dr. L. A. Smith presented to the Pathological Society
of New York the pharynx of a child covered with true
diphtheritic membrane, the little patient in life present-
ing characteristic symptoms of scarlatina.
To these latter 1 desire to add my own observations.
April 30, 1S82, I was called to see Frank T , a lad
of ten years of age, who had had scarlet fever in a light
form two years before. He had soreness and stiffness of
the throat, enlarged cervical glands, inflamed tonsils
which filled the throat almost to suftbcation, and with the
pharynx and half-arches presented a glistening appearance
as though coated with varnish. May ist, the right tonsil
had at the centre a yellowish white spot which increased
gradually in size, the next day appearing on the left ton-
sil, and subsequently upon the uvula, velum, base of the
tongue and roof of the mouth, and into the nasal passages,
accompanied by symptoms of suffocation and impending
dissolution dreadful to behold. May 6th, the exudation
began to be detached, and by the 8th the whole of the
aftected portions of the throat were cleared of the diph-
theritic membrane, and, despite relapses, the patient
finally made a good recovery. So tenacious was this
membrane that sometimes, being dislodged from the
throat, it would adhere to the roof of the mouth with
such persistency that the boy would find difficulty in
scraping it oft" with his fingers. Albuminuria occurred
during the progress of the .disease. There were no
sequela;.
May 2d.' — Joseph L , an infant of sixteen months,
in this family, was attacked with scarlet fever, the eftlor-
escence being dift'used generally over the whole surface.
May 5th, the eruption subsided, when diphtheria super-
vened, the tonsils being rapidly covered with the tena-
cious exudation, which extended both upward and down-
ward, the larynx becoming involved, and the patient
dying on the 8th.
On May 6th and "th, two other children in this family
were attacked with severe scarlet fever, without special
throat symptoms.
For some months subsecpiently isolated cases of scar-
let fever would appear in families a distance from each
other, and in December two cases of diphtheria occurred
in a family three miles from KeyjJort. A child of this
family, convalescing from a light attack, conveyed the
disease to a little girl of three years in a neighboring
family. Five persons were attacked in this family, an
infant of twelve months dying from the disease. Paraly-
sis was a sequela in two of the cases. Other attacks of
diphtheria appeared in this neighborhood, and scarlatina
occurred at the same time in town.
On January 22, 1883, I was called to see a son of
Z C , aged twelve, who passed through all the
stages of a mild attack of scarlet fever. On the 28th,
his two little sisters, Sarah and Grace, two and four years
of age, were attacked with the fever. February sth,
(trace was prostrated with virulent symptoms of diph-
theria, which extended into the nasal passages, the thin,
acrid discharge from wliich excoriated the upper lip,
and acting as a centre of infection, the whole face be-
came involved in a revolting eczematous eruption, which
was with great difficulty subdued. Complete paraple-
gia resulted during convalescence, the child toppling over
whenever raised upon her feet, and finally dragging her-
self by her hands and arms in a sitting posture about the
floor. She recovered completely by the end of April.
On February 5th, another sister, Annie, aged ten,
was prostrated with severe scarlatina, which began to
subside on the fifth day. February 12th she was at-
tacked with diphtheria. On the i6th, false membrane of
considerable density was expectorated. Regurgitation
of liquids and nasal tone of voice were persistent for some
time afterward. In the third week rheumatism of all the
large joints occurred, and desquamation, which had been
deferred, now began.
On February nth, I visited Ceo. A. F , ten and
one half years of age, who had been ill since the day be-
fore. I was struck with the intolerable (etor of his
breath as soon as I entered the room. His skin was
glowing with the characteristic eruption of scarlet fever.
On the succeeding day the brain expended itself in a
fury of active delirium. The body roasted at a dull heat.
The stiffened jaws would scarcely permit an examination
within, but an ash-colored, parchment-like exudation was
plainly discovered. February 13th, nasal passages oc-
cluded, voice hoarse and inarticulate. February isth,
membrane began to loosen, the edges looking like the
frayed finger of a leathern glove. Large pieces, still
tough, having the mould of the glottis, were drawn from
the throat on a sponge probang. These adhered to the
skin like collodion. Upper lip excoriated. Virulent
sores were grouped about the ala? of the nose. The con-
junctiva? became granulated and covered with an ash-
colored deposit. In the meantime the rash had not faded
from the body. Death occurred on the seventh day of
the disease.
February 15th. — Frank F , aged nine, was attacked
with scarlet fever, and made a good recovery, without
any notable departure in the type. C , an infant of
seven months, in this family, was attacked on Febiuary
27th with diphtheria of the most malignant form, speedily
investing the larynx and causing death on the fifth day.
A small ulcer on the face was covered with diphtheritic
deposit. The mother had a mild attack of this disease
about the same time.
February isth. — -I was called to see Mrs. S. D. C ,
a stout, florid lady of fortv, who was almost in a state of
suffocation. Voice indistinct ; liipiids regurgitated through
the nose. An ash-colored diphtheritic membrane invaded
all parts of the throat that could be seen, even extending
to the base of the tongue, and upward into the nares, the
neck brawny, the jjulse swift, tlie temperature exalted.
There was no hopeful presage among all the symptoms.
Ice was used in abundance within and without the tliroat ;
large doses of perchloride of iron frequently exhibited in
milk, though swallowed with increasing difficulty ; rectal
alimentation, wine, lime-water sprayed in the throat ; tlie
room filled with an atmos|)here of steam. On the third
day there was an evident tendency to softening of the
membrane, its edges loosening and having the appearance
of old wash-leather, but the patient was alarmingly near
death, too. A solution of perchloride of iron was used
with an atomizer in the throat, and then twisting about
in the latter a sponge probang dippeii in the perchloride
in glycerine. To my great relief a large i)iece of mem-
brane was detached. It now broke down rapidly under
the use of the atomizer, and enough more was withdrawn
to afford sensible relief from impending death. The pa-
tient was making a fitful and tardy recovery, when, on
the tenth day my attention was called by the nurse to a
July 7, 1883.]
THE MEDICAL RECORD.
scarlet efflorescence which, by the afternoon, covered the
face, neck, shoulders, arms and chest, and to a milder
degree, other portions of the trunk and limbs. Desqua-
mation occurred a few days later. There was incomplete
paraplegia in the third week, which caused great stiffness
in locomotion for some time after. Extensive sloughing
ot the uvula, with severe ulceration of the pharynx tol-
lowed the loosening and disappearance of the diphtheritic
membrane.
At the same time that I visited Mrs. C , I found
her eldest daughter, Lida, aged fourteen, prostrated in
another room with severe scarlatina, and one week later,
Annie, aged three, was attacked with the same disease.
March 14th, Nellie V , an infant aged eighteen
months, was prostrated with severe scarlatina. On the
20th the efllorescence had disappeared at my morning
call, but being hastily summoned in the evening, I found
alarming symptoms of diphtheria had suddenly devel-
oi)ed. On the 21st the inflamed tonsils had nearly closed
all aperture between, and a glistening membrane invaded
all the parts to be seen. Successive layers of this ap-
peared in the throat. March 25th, after a series of dark
days that lengthened despair to the family, the membrane
began to decay. The upper portion broke short off un-
der the use of the \)robang, like a fracture of maccaroni,
showing three successive laj'ers of membrane. A most
letid air arose from the mouth. Alembrane was expelled
from the nostrils ; the excoriation of the lip was very se-
vere. A piece of memljrane, moulded to the circumfer-
ence of the throat, was loosened by coughing and re-
moved with the probang. Dr. Arrowsmith, who kindly
visited the patient in the afternoon and the succeeding
three days, during a short illness I had, reported that at
his first visit he distinctly observed the succession of
layers of membrane in the throat, and brought away
moderately large pieces on the probang, the child being
too exhausted to assist in relieving itself. April 4th
the skin began to exfoliate. An abscess of large size
developed over the larynx. Paraplegia occurred later,
with seeming anresthesia of the skin, and inability to
pass urine at will. The anesthesia was inferred from
the great coolness of the skin, and the child's evident
desire to be warmly wrapped and held near the fire.
Though previously active in walking and running, it was
not able to stand alone until May 4th. During the pro-
gress of the diseases named, I met in other families scar-
latina, and in others diphtheria, which did not present
any of the remarkable symptoms detailed.
These cases go far to prove a relationship between
diphtheria and scarlatina, even if they do not show that
there is but one disease here, preying upon life under
dual names, like a villain of many aliases.
Might it not be the same disease we call scarlatina
when the symptoms are mild and the effloresence well
developed ? scarlatina anginosa when the eruption is ob-
scure and the throat direfully inflamed, with pultaceous
deposits on tonsils and pharynx? diphtheria when the
deposit is organized and extending above and below
with frightful impetuosity ?
There is a tribe of Kurds in Caucasus who dare not call
the devil by his right name, and so the diagnosticians la-
bor to prove a distinction whenever a difficulty arises.
But your writer of pure diagnosis, I take it, is like the
lexicographer who compiles from all known sources and
makes an average of opinions and judgment, and like
him, is forever changing his standard where the ground
is disputed, for opinions vary with their sources and judg-
ment is not infallible.
Truly the lists are not closed here, and no man should
trust to the books when nature opens to him a dreadful
page which he may read as well as another.
It is to this end I have offered the foregoing clin-
ical notes as a contribution to the further study of the
identity of diphtheria and scarlatina, for I am impressed
with the futility of setting up fast boundaries to these
morbid processes. , The action of the morbific principle
in the two diseases (if they be two diseases) is so very
variable in different epidemics, and in different individu-
als in the same epidemic, that no reliable average can
be gathered from the experience of one generation, but,
like the philosophy of many other scientific problems, it
nuist be left to some wiser future.
THE TREATMENT OF SPORADIC CHOLERA.
By J. M. FRENCH, M.D.,
MILFORD, MASS.
My note-book contains the analysis of twenty-five cases
of cholera morbus, occurring during the past three years,
in which three difterent modes of treatment were em-
ployed. The cases were of various degrees of severity,
some mild and some extremely severe, but all character-
ized by vomiting and purging, with more or less prostra-
tion.
The first plan of treatment consisted in the administra-
tion of pepsine, bismuth, alkalies, opiates, and stimulants,
by the mouth, with which was frequently combined the
application of sinapisms and hot fomentations externally.
The second plan was by means of the rectal injection
of starch and laudanum, thirty drops of laudanum being
a medium dose ; and with this were combined any meas-
ures of the first class which might seern desirable.
The third plan consisted in the hypodermic injection
of the sulphate of morphia, one-fourth of a grain being the
ordinary dose. It was usually unaccomimnied by any
other treatment.
The results can best be seen by a brief review ot the
cases :
Case I. — Mrs. H. S ; September, 1880; very
severe ; oral and external measures entirely without avail ;
great prostration ; fatal result feared ; the rectal injection
of starch and laudanum proved promptly successful, and
needed but one repetition.
Case II.— Mr. W. K^ — ; July, 18S1 ; moderately
severe ; oral remedies successful.
Case III.— Mrs. H ; August, 18S1 ; moderately
severe ; oral remedies successful.
Case IV.— Miss A. M ; August, 1S81 ; mild ; oral
remedies successful.
Case v.— Mrs. L. R ; September, 18S1 : quite
severe ; rectal injections promptly successtul.
C.VSE VI. — Mrs. C ; September, 1881 ; very severe;
oral remedies ineft'ectual ; rectal injections speedily suc-
cessful.
Case VII. — Mr. M. K_ ; September, iSSi ; mod-
erately severe ; rectal injections successful.
Case VIII —Mr. McC ■; October, 1881 ; mod-
erately severe ; rectal injection retained but a short time,
and required supplementing by oral and external meas-
ures, administered by the nurse, owing to my absence.
Case IX.— Mr. A. VV • ; August, 1882 ; moderately
severe ; oral measures slowly successful.
Case X.— Mrs. A. VV ; August, 1882 ; moderately
severe ; oral remedies slowlv successful.
Case XL— Mrs. O. W '- ; August, 1882 ; moderately
severe ; oral remedies slowly successful.
Case XII.— Miss E. G ; August, 1S82 ; mild;
oral and external remedies successful.
Case XIII.— Miss M. P ; August, 1S82 ; mild;
oral measures successful.
Case XIV.— Mr. T. F ; August, 1882 ; very se-
vere; rectal injection promptly successful, and no repeti-
tion needed.
Case XV.— Mr. CM ; August, 1882; very se-
vere ; a strong man ; not seen until he was greatly pros-
trated—the disease not checked; hypodermic injection
of one-fourth grain morphia promptly successful, and no
repetition needed.
C.\se XVI.— Mr. J. S ; August, 1882 ; moderately
severe ; rectal injection administered, and repeated ;
lowly successful ; combined with oral measures.
THE MEDICAL RECORD.
[July 7, 1883.
Case XVII.— Afr. C. C ; August, 1882 ; very se-
vere and greatly prostrated ; hypodermic injection
promptly successful.
C.-\SE XVIII.— Mrs. K ; August, 1882; severe;
rectal injection rejected, repeated, and fully successful.
Case XIX.— Mr. C. B. S ; August, 1882 ; moder-
ately severe ; hypodermic injection successful.
Case XX.— Mr. P. C ; August, 1S82 ; mild, be-
cause seen early ; hypodermic injection promptly suc-
cessful.
Case XXI. — Mrs. C ; August, 1882 ; moderate ;
oral measures slowly successful.
Case XXII.— Mr. P. O'N ; August, 1SS2 ; sud-
den and severe attack, with great ijrostration ; being
close at hand, I gave a hypodermic injection, and pre-
scribed strict quiet, as in other cases ; promptly success-
ful, no other treatment needed.
Case XXIIL— Mrs. G. F ; September. 1882 ;
moderate oral measures failed : hypodermic injections
promptly successful.
Case XXIV. — Mr. G. V ; September, 1882 : quite
severe ; hypodermic injection jiromptly successful.
Case XXV. — Mrs. F ; October, 1882 ;, severe and
exhausting, requiring constant care ; hypodermic meas-
ures and all ojiiates refrained from, on account of previous
ill effects of morphia ; oral and e.\ternal measures slowly
successful.
Sum?na?-y. — Mild cases, 4; modeiately severe, 12;
very severe, 9. Cases treated by oral and e.xternal
measures only, 10 ; by rectal injections, S ; by hypoder-
mic injections. 7.
Conclusions. — The first plan of treatment is only
adajned to mild and moderate cases, or those which have
safely iiassed the acute stage, as in severe cases no med-
icine can be retained on the stomach. At best, this plan
requires constant watching, and f^tilures are frequent.
The'second plan is much more effective, but is liable
to need several repetitions on account of inability to re-
tain the injection until absorbed. If not promptly suc-
cessful patients are apt to lose faith in it, and often ob-
ject to its repetition. Hence, it is not fully satisfactory.
1 he third [ilan is speedy, certain, satisfactory. Except
in those cases where all opiates are dangerous, it is
also perfectly safe if properly administered. Very sel-
dom does it need repetition. If taken early, it is the
only treatment needed. On the whole, I consider the
hypodermic injection of morphia as nearly a specific for
cliolera morbus as an\'thing in medicine.
glcports
of hospitals.
Puerperal Eclampsia. — Dr. Burton, in the Medical
Press and Circular, May 30, 1883, says: i. That puer-
peral eclampsia is a motor neurosis associated with loss
of consciousness. 2. That it stands in intimate rela-
tionship to the convulsions of childhood and to ejiilepsy,
3. That only one factor in its production is constant,
vi/,., a peculiar condition of the nervous system that may
be designated as one of "unstable equilibrium,'' and
that this factor is common also to the convulsions of
childhood and to epilepsy. 4. That retention of urinary
constituents when present vastly increases the tendency
to convulsions in pregnancy, but th.at outside the condi-
tions of pregnancy and childhood such retention is but
rarely the cause of convulsions. 5. That nerve-irrita-
tion— shock, emotion, violent pain, uriemic or other mor-
bid condition of blood, etc. — is capable of setting up sud-
den vasomotor spasm of cerebral blood-vessels. 6. That
this spasm of blood-vessels, causing sudden an;i;mia of the
brain, is the cause of the convulsions and of the conse-
quent coma. This view of the etiology of puerperal con-
vulsions leads naturally to the treatment, and in fact fur-
nishes an e.\i)lanation of the success that has attended
the employment of chloroform, ether, chloral, bromide of
potassium, subcutaneous injection of morphia, and blood-
letting.
ST. LUKE'S HOSPITAL. NEW YORK.
(Reported by Henrv Mokh at, M.D., House Physician.)
A case of diabetic coma with aceton.*:mia.
So much has been written pf late in the various medical
l^eriodicals upon the pathology and clinical history of
this somewhat unusual condition, and so little can be
found in explanation of it in the standard works on prac-
tice that I have been led to think that a case as typical
as the following will not be without interest to the pro-
fession at large.
As condensed from my notes the case is as follows :
George A. C , aged nine years, admitted September
9, 1882. Family history negative. Patient was perfectly
well till fanuaiy, 1S82, when it was first noticed that he
had nocturnal incontinence of urine. At the same time
the daily quantity of urine passed began to increase.
This increase became gradually more and more marked,
his appetite became ravenous, thirst unquenchable, and
he soon developed all the well-marked constitutional
symptoms of diabetes mellitus.
On admission he was auKmic and emaciated. Upon
his forehead was the cicatrix of a wound received when
about two years of age. (No history of any cerebral
symptoms following this wound. ) He was i)assing one
hundred and eighty ounces of urine daily. Examination
showed specific gravity 1.044, acid. No albumen and no
casts. Sugar, thirty-two grains to the ounce.
Patient was put upon diabetic diet, and treated with
strychnia snip. gr. ^^, and later with the bromides. Un-
der the latter treatment he seemed to be gradually im-
proving, and by January 28, 1883, was passing only sixty
ounces of urine, with seventeen grains of sugar to the
ounce.
February nth. — Witliout any known cause patient
began to complain of pain in abdomen, and soon became
drowsy and sleepy, and when seen at 6.30 a.m. his res-
piration was rapid but deep ; pulse rapid and somewhat
feeble. He could be roused, and spoke continually of
his abdominal pain. 9.30 a.m.: Pulse, 146 ; respiration,
36 ; temperature, 99°. Surface warm and dry ; pupils
normal and react to light ; no cyanosis ; patient com-
pletely comatose ; the respiration was very deep and full,
the whole chest expanding well.
Examination of urine passed at this time — specific
gravity 1.034 ; acid ; trace of albumen : sugar, 3.45
grains to tlie ounce. With ferric chloride it gave the
dark wine-colored reaction supposed to be due to the
presence of " acetone." At 11 a.m. patient was seen by
the attending physician. Dr. G- G. Wheelock, and the
diagnosis of acetonemia confirmed.
Patient remained in this condition for twenty-six hours,
when he died. There were no distinct convulsions, but
just before death a sliglit twitching of the hands ami face.
At the autopsy, performed by Dr. F. Furguson, noth-
ing abnormal could be detecteil by the naked eye either
in the brain, spinal cord, or any of the viscera.
Since then, however, the doctor has very kindly fur-
nished me with the following microscopical report :
"The kidneys are slightly anxmic — the epithelium lin-
ing the tubules in the cortex is cloudy, fatty in places.
There are a large number of fatty emboli in the vessels
of the kidney extending into the capillaries of some of
the Malpigliian tufts. There are numerous fatty emboli
in the vessels of the lungs. The lungs in other respects
are normal. There is a very small amount of fat in the
liver, evenly diffused throughout the organ and pigment
of the hepatic cells around the central vessels. The
heart fibre contains considerable pigment — the organ in
other respects normal."
Upon reviewing the case there are a few points I
would wish to emphasize.
July 7, 1883.]
THE MEDICAL RECORD.
t. The coma occurred in a case which was not acute,
but seemhigly improving in every way. In this it differs
from the case observed by Drs. Foster and Saundby,'
who conchtde that this condition is more apt to occur in
acute cases.
2. There was a marked diminution in the amount of
sugar in the urine during the coma.
3. The discovery by Dr. Furguson of fat emboH in
the vessels of the kidney and lungs is of interest as bear-
ing upon the mooted question of the lipaimic origin of
the coma. There was, however, no evidence of marked
pulmonary obstruction, nor any congestion of the men-
inges or substance of the bram. (See Edinburgh Maii-
cal Journal, 'Ae\Acnth<iv, 18S2.)
4. We cannot close without referring to the peculiar-
ity of the respiration. \Vhen once seen it can never be
mistaken. It was rapid but very deep ; the whole
chest being fully expanded, but seemingly no relief to
the dyspncea.
^roovcss of ggeXctlicat Science.
A Case of Movable Kidney fixed by Operation.
— The patient, a married woman, aged twenty-seven, had
for three years suffered much from pain and sensation of
weight and dragging in the right hypochondriac and iliac
regions, increased by walking and exertion, gastric
catarrh, and habitual constipation. A movable tumor
was found, and clearly made out to be the kidney. As
no kind of treatment or support afforded any relief, an
operation was determined on. Anesthesia was produced
by bichloride of methylene, and all antiseptic precau-
tions were followed. The patient placed on the left side,
an incision, about sixteen or eighteen centimetres long,
was made in the right lumbar region along the external
border of the sacro-lumbar nuiscular mass, extending
from the last intercostal space to the crest of the ilium.
On cutting carefully through the parietes, the circumrenal
fatty connective tissue was reached. The kidney was not
in situ, but could be felt through the abdominal wall in the
iliac fossa. An assistant pushed it up with his hand and
kept it in position, while the operator, breaking through the
fatty connective tissue, easily discovered the convex border
and the greater part of the posterior surface. The first
suture was put in the convex border ; the needle traversed
the fibrous capsule of the kidney. The circumrenal fatty
connective tissue was raised and drawn into the wound,
through the tissues of the wound directly under the lower
edge of the last rib, and again through the circumrenal
connective tissue. A second suture was applied on the
posterior surface of the kidney, and in the deep tissues
of the posterior lip of the wound. A third suture was
placed in the same way in the anterior surface of the
kidney, at the convex border and the dee]i structures of
the anterior margin of the wound. With these three su-
tures the kidney was held in position. For greater
security, the circumrenal fatty connective tissue of the
lower half of the kidney was united by four sutures to
the tissues of the wound. Catgut sutures were used. -^
large drainage-tube was applied deeply, and a small one
superficially, and the wound was sewed up with seven
points of deep sutures and twelve superficial. The pa-
tient bore the operation well, andjrer subsequent course
was satisfactory. There was no fever, and the urine re-
mained normal. The wound was dressed on the fourth
day, and the drainage-tubes were removed. On the
ninth day it was dressed for the second time. Cicatriza-
tion was complete; the superficial sutures were removed.
On the twentieth day the patient was discharged cured.
She has lost all her former pains, is ])erfectly well, and
the kidney can be felt in its normal situation. — London
Medical Record, May 15, 1883.
* Birmingham Medical Review, Januaiy, 1883.
Derangement of the Muscular Sense in Cere-
bral Disease. — In a recent lecture ( Wiener Medizm.
Blatter, March i, 1883) Professor Nothnagel made some
general remarks on the derangement of the muscular
sense in cerebral disease. The muscular sense is dis-
ordered in the following circumstances: i. When pa-
tients cannot distinguish between weights. 2. When
they have no idea of the position of their limbs, and are
unable to imitate with one limb a movement which has
been made passively with the other. 3. When ataxic
symptoms are present, i.e., when the gait is staggering,
or when the patient cannot use the upper extremities for
such movements as putting in a button. The symptoms
point to morbid processes in the cerebellum, corpora
quadrigemina, pons varolii, thalamus opticus, centrum
ovale, or cortical substance. In the cerebellum the af-
fection is not of the hemispheres, but of tlie vermis, and
Nothnagel is inclined to think only the deeper part of
the vermis ; but more exact knowledge on this point is
wanted. Sideward inclination comes on when the crus
cerebelli is injured. In the corpora quadrigemina, the
seat of lesion seems to be the posterior pair ; in the pons,
we know that the injury must be near the centre, but the
exact spot has not been discovered. Our experience as
regards the optic thalamus is very slight ; one case has
been observed by Hughlings Jackson where weights could
not be distinguished, and F"lourens believes from his ex-
periments that the position of the limbs is not known.
There is not much to say of the centrum ovale, and in
the cortical substance the central evolution is now sup-
posed to be the seat of 'injury, instead of the parietal, as
formerly ; and the more superficial the injury is, the
more will the muscular sense, and not the motility, be
disturbed. Clinically, both extremities are at=fected when
the lesion is in the pons varolii or cerebellum, whilst in
affections of the cortical substance the muscular sense is
disturbed only on one side. Staggering gait seems to
occur in connection with dizziness. In cortical lesions
weights cannot be distinguished, but the ataxic gait is
seldom seen. In some cases of injury to the pons co-ordi-
nation only was disturbed ; in others the muscular sense
also.
Enchondroma of both Lunus with Secondary
Growth in Brain.- — Dr. Churton, in the Lancet, March,
1883, gives notes of the case of a girl, aged eighteen, who
came under his observation for shortness of breath and
severe cough. The left leg had been amputated four
years previously, but the exact nature of the disease was
not ascertained. There had been wasting for si.xteen
months before she came under Dr. Churton. On exam-
ination, there were the usual signs of effusion on the
right side of the chest, and subsequently several ounces
of bloodstained fiuid were removed by the aspirator.
After two or three weeks of frequent headache and vom-
iting, twitchings of the left arm and hand were noticed ;
and after this patient had fits at intervals, remaining un-
conscious for an hour or more. The patient gradually
became worse, and died about two months after her ad-
mission. The post-mortem examination showed a hard,
bony growth of the lower part of the right lung, with
scattered nodules through the anterior part, and also in
the left lung. In the substance of the right cerebrum
was a growth weighing nine drachms, which on examina-
tion proved to be ordinary osteo-enchondroma.
The Picric Acid Test for Albumen. — Dr. John-
son, British Medical Journal, May 7, 1883, gives the
following additional details concerning this test :
It should always be borne in mind that, in testing for
albumen, the picric acid must be in excess. A few drops
of a saturated solution of picric acid in a highly albuminous
specimen will form a coagulum, which is quickly redis-
solved. When urine contains much albumen it should
be mixed with its own volume of the picric acid solution ;
and in testing a fresh specimen, it is better to begin by
adding an equal volume of the test liquid.
lO
THE MEDICAL RECORD.
[July ;, i88:
One difference between picric acid and nitric acid as
tests for albumen is, that whereas an excess of nitric acid,
especially when the urine is heated, will entiiely redissolve
the previously precipitated albumen, no excess of jiicric
acid will redissolve the precipitate which it has once found
in an albuminous solution. Picric acid solution on the
surface of tiie urine is applicable only for the detection
of a minute trace of albumen. For tiiis purpose he ad-
vises that a column of urine four inches in height should
be poured into a six-inch test-tube, and upon this one
inch of the picric acid solution. The result is that the
upper layer of the urine is mixed with about its own vol-
ume of the test liquid ; and if albumen is present, the
stained portion of the urine is instantly rendered more or
less opalescent, and thus contrasts with the unstained and
transparent urine below. If the picric acid solution were
allowetl to flow so gently on to the surface of the urine
as merely to come in contact and not to become mixed
with its upper jiortion, the albumen, if present, would
not be detected, or it would be indicated only after an
interval of some minutes, when the two liquids had be-
come mixed by slow diffusion. There must be an actual
mixture in about equal proportions, and not merely con-
tact of the two liquids, to ensure the action of the test.
The slight opalescence caused by the picric acid solu-
tion in a sample of urine which contains a mere trace of
albumen is always increased by the application of heat.
So that if the flame of a spirit-lamp be applied to the
uiiper part of the opalescent column, this will become
more opaque than the lower part, which had not been
exposed to heat. He now invariably applies heat to a
specimen of urine, which has been rendered opaque, or
more or less coagulated, by picric acid. His chief rea-
son for this practice is to ascertain if peptones ever ap-
pear in the urine. In a paper published in the Journal,
March 31st, he has shown that, whereas the albuminous
precipitate with picric acid is rendered more opaque and
coherent by heat, the precqiitate which picric acid gives
with peptones is entirely redissolved by heat considerably
below the boiling-point.
The microscope alone would serve to distinguish the
precipitate caused by picric acid with peptones, with
urates, and with albumen respectively. The precipitate
recently thrown down with artificially prepared peptones
appears under the microscope quite homogeneous, and
free from solid particles ; but when the precipitate hav-
ing been dissolved by heat, reforms on cooling, it seems
to consist of numerous very minute, apparently globular
particles, in which the so-called "Brunonian movement"
is very active. The microscopic appearances of uric
acid and urates are so well known as to need no de-
scription.
The precipitate produced by picric acid with albumen
presents irregular clusters of granular material, which
appear much larger and more opaque after the applica-
tion of lieat. According to his experience, a deposit of
uric acid and urates is about as rare a result of adding
picric acid to urine as a similar deposit caused by nitric
acid ; and hitherto he has met with no specimen "of urine
in which the presence of peptones has been indicated.
A deposit thrown down by picric acid and redissolved
by heat, may pretty safely be assumed to consist of urates,
but in any case of doubt tiie addition of Fehling's solu-
tion and the microscopic appearances will at once serve
to distinguish between (irecipitated peptones and urates.
DysENTERV AND I.ivER Absce-SS. — 111 a pajjer cm the
relation of hepatic abscess to dysentery. Sir J. Fayrer
{Lancet, May 19, 1883) summarizes his opinions as fol-
lows : I. The so-called abscesses which originate in
local deaths of parenchyma (py:wmia, embolic deposits,
or infarcts) are cavities varying in size from a mere speck
to an orange, containing debris, sanies, puriform matter,
leucocytes, and, finally, pus. They are seen in various
stages of development, and are not necessarily confined
to the liver, but occur in other viscera or regions of the
body. These are truly pyemic. 2. There is a form of
liver abscess co-existent with, and perhaps due to, dys-
entery, which is the result of direct absorption and trans-
ference of pus or septic matter from the bowel to the
liver through the mesenteric veins. Such may be soli-
tary, double, or triple. This is also a very dangerous
form of the disease, though not necessarily fatal, as it is
feared must always be the case in the former variety.
3. Dysentery, malarial fever, and hepatitis may co-exist,
or supervene on each other as effects of common cli-
matic cause ; it seems natural to ascribe the liver ab-
scess in such cases to the dysentery, but it is probable
that they are rather coincidences than consequences of
each other, and that the cause which affects the glandu-
lar structures of the large intestine may determine the
mischief in the liver in certain climates and localities ;
such are obviously very different from those previously
mentioned. 4. The ordinary large and most frequently
single tropical abscess is quite independent of dysentery,
though it may co-exist with or follow it. Each or all of
these forms may, in England, be the result of disease
originally contracted in certain climates.
The Nitrous Compounds in Angina Pectoris. —
Dr. Hay has instituted a series of experimental observa-
tions touching the value of nitric, nitrous, and nitro-
compounds in angina \^sclons {Th'e Practitioner, May,
18S3). He concludes therefrom that nitrous acid in any
combination, whether as an ether or a metallic salt, is
useful in the treatment of angina pectoris ; and that, in
the case of the nitrite of amyl, the action of the acid is
aided by that of the base. On the other hand, all com-
pounds of nitric acid, whether ethereal or metallic, are
without effect, unless it so happen that the constitution
of the nitrate is such that it decomposes in the body with
the liberation of nitrous acid. F"urther, nitro-substitu-
tion compounds have likewise no remedial effect. So
far as at present known, the nitrogen-containing reme-
dies for angina jiectoris may be divided into two classes,
the one consisting of combinations of nitrous acid with
metallic oxides or alcoholic radicals, the other com-
prising a iieculiar class of nitric ethers, obtained from
the higher alcohols, whose decomposition within the body
results in the production of nitrous acid. In both classes
the action of the compound is ultimatel}- dependent on
the nitrous acid present. Typical examples of the first
class are nitrite of sodium and nitrite of ethyl, and, of
the second class, nitro-glycerine. To these classes
might be added another containing such substances as
compounds of amyl, whose action is similar to that of
nitrites. But, limited as this group at present is to com-
pounds of amyl, it is not one to be chosen in the treat-
ment of angina pectoris. The dose required is large,
and the action is not rapidly produced, and disagreeable
after-effects are apt to occur ; and altogether I 'am very
doubtful of its always acting so well as it did in the case
of my patient.
Changes in the Cardiac Nerves in Heart Dis-
ease.— From a number of examinations of hypertrophied
hearts with valvular lesions, Dr. Putjatin [Vtrchow's
Archiv.) concludes that : i. In chronic affections the
nerve-ganglia are affected by an encroachment of the in-
flammatory [)rocess. 2. In cases of early and relatively
slight disease the changes are restricted to hypenumia
and granular degene#ation. In chronic and extensive
affection of the heart there are evidences of interstitial
inflammation with the production of tine connective tis-
sue, while the ganglion cells themselves present appear-
ances of fatty and pigmentary degeneration. In one
case there was entire destruction of the ganglion cells,
with calcification of the tissue between them. 3. Aside
from local trouble in the heart and aorta, changes in the
ganglia may be called forth by chronic constitutional
disease. 4. The above described lesions cannot be
without influence on the physiological activity of the
heart. In this way many of the functional disturbances
July 7, 1883.]
THE MEDICAL RECORD.
II
and even paralysis of the heart, when fatty degeneration
is not present, can be explained. Possibly, also, some
forms of angina are referable to the same cause.
Uskow has also studied the nerves of the heart, in cases
of hypertrophy combined with chronic interstitial ne-
phritis ( Virchow's Archiv). He has found that with the
growth of muscular tissue the medullar); sheath of the
nerves is lost, and a process of nuclear iiroliferation
commences. Should an acute disease sujiervene, then
the changes in the affected nerves assume the character
of an acute parenchymatous inflammation. In the nerve-
cells lying in the course of the tibres, as well as those in
the ganglia of the septum atrioruni, the changes were
confined to thickening of the capsule and increase of
nuclei. The protoplasm itself was unaffected.
The Rapiditv of Cerebral Acts. — Dr. Rene has
made a series of experiments on the rapidity of trans-
mission of impulses through nerves, and the rapidity
with which cerebral acts are performed. He finds {Gail-
lard's /oiirnal) that the intensity of the stimulus has a
direct influence on the rapidity of nervous transmission.
The stronger the stimulus the more rapid the transmis-
sion. The rate of transmission cannot, therefore, be
stated in exact terms, since it is relative, as has been not
unfrequently noted for other kinds of cellular activity.
He has also confirmed the fact, now very generally ad-
mitted, that it is impossible to measure the rapidity of
transiuission in sensory nerves by stimulating different
points of their length, for the rapidity of the resijonse is
not i)roi)ortionate to the length of the nerve traversed.
Thus the response to a stimulus applied to the finger is
often made with a shorter interval of time than a stimu-
lus applied to the dbow or to the shoulder, though the
length of nerve called into play is much greater in one
case than in the other. In a word, it is impossible to
compare the results obtained from different regions. The
most exact method of measuring nervous transmission
appears to be that of response to an auditory stimulus.
The rapidity with which nervous impulses are here con-
ducted he estimates at twenty-eight metres per second,
which is a little lower than the number obtained by other
physiologists. For the rapidity of transmission of mo-
tor impulses Rene gives twenty metres per second, which
is below that of other experimenters. The duration of
a cerebral act he estimates at j|fnr second. In young
infants the duration is more considerable, amounting to
0.090 second. The duration of a reflex act — that is to
say, the time occupied by the entire reflex arc, sensation,
transmission to the cord, including motor impulse and
muscular movement — is 0.15 second.
Cerebral Vacuolation. — -At a recent "^neeting of
the London Pathological Society (British Medical
Journal^ May 17, 1883) Dr. White read a paper, written
conjointly by Dr. Savage and himself, on vacuolation of
the cerebral substance. It was shown that there were
nine causes for holes in the brain : i. Small processes
of sclerosed meninges, in cases of general paralysis,
dipped into and excavated minute portions of cerebral
tissue. 2. In the same disease the sclerosed neuroglia,
by its contraction, might give rise to small cavities. 3.
There might be multiple hydatids in the brain. These
three conditions were very rare, the authors having no
knowledge of the second, wiiile the third was ahiiost
confined to animals suffering from staggers. Several
references to continental authors were given, while the re-
lation of the muslin appearance to the second of the
above was pointed out. 4. The fourth cause was the
dilatation of cerebral vessels giving rise to the " Hat
crible. It was particularly emphasized that this was, in
the majority of cases, of no pathological significance.
5. Shrinking of the cerebral convolutions in some cases
gave rise to holes in the subjacent cerebral substance ;
a very good example of this condition was exhibited.
6. Miliary aneurisms, as Charcot had pointed out, might
give rise to holes in the brain-substance ; some very
marked specimens showing this were exhibited. 7. In
the condition known in Geimany as die Porencephalies
a large gap existed in the brain-substance ; this might
communicate either with the exterior or the interior of
the brain, or both. 8. The Gruyere cheese condition.
This, it was pointed out, was quite different from the etat
crible, for it was due to a dilatation of the perivascular
lymphatic space of His. Of the causes of this dilata-
tion nothing was known ; probably they were local,
and the dilatation was saccular. The authors showed an
example of this condition in which the whole of the brain,
except the lower part of the medulla, was riddled with
cavities exactly like those found in cheese, and micro-
scopic si)eciniens exhibited showed that these holes were
produced by this perivascular dilatation. The shape and
direction of the cavities also corresponded with that of
the vessels. Very few examples of this condition had
been carefully described ; in England only one, by Lock-
hart Clarke, who referred it to the same cause. 9. The
authors showed specimens from two remarkable cases, in
which the kidneys, lungs, liver, heart, and brain all con-
tained holes ; in the kidney, these cysts were due to the
dilatation of either the tubules or Malpighian capsules ;
in the liver they were due to the vacuolation of the he-
patic cells ; in the lungs and brain it was impossible to
come to any definite conclusion as to their origin, but in
both these viscera the cavities contained a peculiar ma-
terial, staining deeply with logwood ; both the subjects
were lunatics. Cases in which there were found only a few
holes, such as patches of softening hemorrhage, were not
considered to come within the scope of the paper. Dr.
Savage said that, in the cases of the two lunatics last re-
ferred to, the changes were certainly not due to changes
produced by preservative fluids after death, as the vacu-
olation was noticed at the necropsy. Both the patients
were general paralytics, but in one the disease was chronic
{three or four years), in tiie other acute (three or four
months). He w-as convinced that the vacuolation oc-
curred under various conditions.
The Local Origin of Malicxant Growths. — iSfr.
Jonathan Hutchinson, in the British Medical Journal,
March, 1883, 'contributes a paper on the nature and
scope of the local influences which induce malignant ac-
tion. "The more we investigate, the more clearly will
we see that all inflammations are really infective, and
that inflammatory processes may pass by almost insen-
sible gradations into those of malignancy." It is not so
much senility of the entire organism as local senility (an
old age of the tissues concerned, which is premature, and
does not correspond with that of the body as a whole)
that is almost always necessary to the production of
cancer, exceptions occurring, however, in cases due to
the influence of inheritance. Tissues and organs which
are just passing out of use are those most prone to de-
velop cancer. As to the inheritance of cancer, it has
been urged that a disease which is capable of inheritance
must be a constitutional one. This is true to some ex-
tent ; but Mr. Hutchinson says that a peculiarity of cell-
structure generally is inherited, not germs, not a blood-
malady, but a special type of cell-organization, permit-
ting with greater ease than in other persons the injurious
influences of local causes. The rodent ulcer of the face
is looked upon by the author as a form of morbid action
which stands half way between common inflammation
and cancer. There is also a distinct proneness pos-
sessed by parts formerly aftected by syphilitic inflamma-
tion to become attected by some malignant growth. In
conclusion, Mr. Hutchinson urges the adoption of his
doctrine of a pre-cancerous stage, where surgical inter-
ference is necessary and ought to be insisted on, before
the growth takes on any definite form except that re-
sembling ordinary inflammation, and before the neigh-
boring lymphatic's are aftected. Without this, he sees
no hope of any improvement in the reduction of the mor-
tality of cancer.
12
THE MEDICAL RECORD.
[July 7, 1883.
The Medical Record
A Weekly yournal of Aledicitie a7id Stirgery.
GEORGE F. SHRADY, A.M., M.D., Editor.
Pl'BLISHED BY
WM. WOOD & Co., Nos. 56 and 58 Lafayette Place.
New York, July 7, 1883.
THE INSANITY OF EPILEPSY.
In the study of epileptic insanity we find much to justify
the view of the pathogeny of the failing sickness pro-
pounded by Hughlings Jackson, namely, that the epilep-
sies are dependent on excessive paroxysmal discharge of
some part of the cerebral corte-x.' Not to dwell on the
fact that the initial symptom of the " grand mal " may
properly be designated as a paroxysmal affection of con-
sciousness, and that light seizures of the " petit mal " are
constituted by abrupt temporary suspension of the con-
scious mental life ; that epileptic attacks often begin with
some strong mental emotion as fear, or anger, exhibitions
of irascibihty or peevishness of hours' or days' duration,
forcing upon us the irresistible inference that, if the fit
begins in the intellectual sphere, and consequently in the
gray matter of the hemispheres, the succeeding physical
processes must begin in the supreme cortical motor cen-
tres, between which and the psychical centres there is
both contiguity and histological solidarity. The truth
has often been pointed out that the sensory, intellectual,
and motor phenomena of epilepsy are interchangeable,
and that an attack of mania may take the place of the
ordinary convulsive paroxysm, the derangements display-
ing themselves in convulsions, not of the muscles but of
mind, to use Maudsley's expression.
" The physical process, in a fit beginning by loss of
consciousness, is a discharge beginning in some of the
nervous arrangements in the highest centres of the brain "
(Hughlings Jackson). This view, which is generally ac-
cepted by those who believe in the modern doctrine of
localizations, explains all the phenomena of the fit and
their order of occurrence mucli better than the older
theory, which finds the point of departure of the paroxysm
in excitation of the medulla oblongata.
A remarkable example of the furor epilcptims taking
the place of the customary convulsive seizure, constitut-
ing what is known as masked epilepsy, is given by Jules
Falret in the Archives Gm. de Medecine. " Francois
L , shoemaker, was for many years subject to epileptic
fits. The attacks, which at first were followed by but shght
alteration of the reason, became more serious and were
accompanied by furious mania. Sometimes the fit was re-
placed by homicidal delirium, as in the following instance :
When he was through with his military service (he had
been a soldier) he returned home and decided to marry.
' Lectures on Epilepsy, by Jackson, in LA)ndon I.anccl, 1879. M-iudslcy on
Responsibility in Mental Diseases, page 41 ct sc(|. )
The ceremony was fixed for October 26, 1841. The 24th
an intense headache came on and seemed to him to be-
token an impending attack. He called a physician who
had formerly treated him for the disease, and demanded
to be bled, an operation which had always given him re-
lief. The physician refused to gratify his request. The
26th, some hrtiirs before the wedding, he was bled by
another physician, but without any diminution of the
pain. During the marriage ceremony Francois was de-
jected and taciturn ; he said nothing but the one word
yes. On quitting the church he was seized with a most
atrocious pain in the head, and when he arrived at the
house of his father-in-law he was obliged to take his bed.
The bed-chamber was adjoining the dining-room where the
wedding feast was being prepared. Then he was seized with
an attack of epileptic madness, and while the persons
who were with him were hunting for cords to tie him, he
precipitated himself naked into the dining-room, with a
shovel, of which he had obtained possession, pursued a
woman who fled before him, threw her down and inflicted
heavy blows on her head. His father-in-law interposed,
when he flew at him and drove him from the house. He
cast himself on the ground before the door, biting the
threshold with his teetli; then he lose with a shoe-knife
in his hand, opened the door with force, crying out that
he would kill them. The first person he met was his
father-in-law, whom he instantly killed. This attack
lasted three days. On the 28th instant his reason re-
turned, but he remembered only the event of his mar-
riage, and nothing of that which came after. He sup-
posed that he had slept all that time. He was at once
removed to the asylum of Clermont, where he still re-
mains.
Lesegue relates similar instances where the fits were
preceded or replaced by the " delirium of impulse.' In
one remarkable case, that of the assassin Thouviot, light
was shed on the extraordinary motiveless nurder of a
young girl, by the subsequent occurrence, while the
homicide was in jail, of two epileptic fits.'
The epileptic paro.xysm is often preceded by grave in-
tellectual troubles. Bellod relates an observation in
which the convulsive crisis was always ushered in by a
state of melancholia, and succeeded by a state of mania.
A remarkable case is recorded by Ball '■' of an ecclesiastic
who had been epileptic for twenty years. Every month
occurred a i)eriod marked by two or three complete con-
vulsive attacks. Each of these periods was preceded, tor
eight or ten days, by a melancholic delirium, character-
ized by ideas of persecution and by hallucinations of
hearing, in which he would hear tiie most shocking blas-
phemies. After the convulsive paroxysms, and several
days of hebetude which followed, he entered on a phase
of bien-iire and satisfaction inexpressible, in wiiicli he
spoke incessantly of his restoration ; liis hallucinations of
hearing had left him, and he was enabled to devote him-
self to his usual religious exercises. This period of bien-
etre would last a fortnight, to be succeeded by a state of
melancholia and another convulsion.
In the event of a crime being committed by an epi-
leptic, the criminal should always have the benefit of the
doubt as to whether he were sane at the time. The deed
* Maudslcy in his works gives many similar instances,
3 l.e^ons sur les Maladies Mentales. Article, " Folic Epileptiquc.'*
July 7, 1883.]
THE MEDICAL RECORD.
13
of violence may, as Ball remarks, be but the first symp-
tom of developing lunacy, or the result of that impulsive,
brutal, badly equilibrated character wliich in an epilejitic
unquestionably diminishes the moral freeilom.'
It is true tliat some epileptics liave been cliaracteri/ed
by extraordinar)' mental activity and brilliancy of genius,
and Mahomet, Swedenborg, Napoleon, have been cited
as examples of epileptics, whose malady did not impair,
possibly may have increased their intellectual power. It
is, moreover, very probable that much which has passed
current among mankind as revelation and as divine, like
Mahomet's visions, was the fruit of genius under the ii\-
re.cl\ov\ o{ \.\\e furor epilepticus. Maudsley sarcastically
intimates that the invention of the modern sensational
novel, with its murders, bigamies, and other crimes, was an
achievement of the epileptic imagination. If epilepsy be
the result of morbid excitation of the supreme cortical
.cells, it is easy enough to trace a kinship, and often a
causal connection, between this disease and any perver-
sion whatever of imagination and genius.
That the general tendency of the epileptic neurosis is
toward mental degradation, amnesia, and dementia, is
proved by multitudes of facts in the experience of alien-
ists everywhere.
It is an interesting circumstance in connection with
this study, tliat epilepsy in the parent may engender the
insane neurosis in the child, and insanity in the parent
may be transmitted as epilepsy to the child. The fact
that insanity is essentially a disease of the ganglia of the
hemispheres, gives great probability to the theory that
epilepsy, which bears such an intimate correlation to it,
is itself due to abnormal modifications (" discharging
lesions") of the supreme cortical cells. Moreover, the
epileptic aura is a sensory disturbance, evidently ema-
nating from some perceptive centre in close relation to
the motor area of a member, and epileptic vertigo — at-
tacks of which often precede for months the convulsive
motor manifestations of the disease — is a phenomenon
affecting the domain of consciousness. It is easier to
understand these phenomena on the supposition that
they are primarily cerebral than that they are primarily
spinal.
In conclusion it should be stated that, in not a few in-
stances, autopsies of epileptics have revealed grave, some-
times gross, lesions of the cerebral hemispheres.'^
THE END OF THE STATE MEDICAL SOCIETIES.
Since February last we have furnished to our readers rec-
ords of the meetings of twenty-six State Medical Societies,
of three national organizations of specialists, and of the
American Medical Association. This certainly shows
that there is much activit)' among American physicians.
Whether this activity has correspondingly enriched the
science of medicine we will not undertake to say. It is
to be borne in mind that although each of the States in
the Union has its own Medical Society, many of these
organizations have hardly more than a nominal existence,
so far as real medical work is concerned. We have re-
ceived several complaints to the effect that the reports
1 " It were as unreasonable to hang a man for not stopping by an act of will a
convulsion of which he was conscious."' — Maudsley ; Body and Mind, p. (>^.
^ vide recent papers by Seguin and Jackson.
of these societies are not interesting nor instructive read-
inc. The charge is in a measure true, yet it will be
found that few State Societies meet without doing some-
thing worthy of note. We trust that we shall not be
accused of sectarian jealousy if we intimate that decidedly
the best work has been done in the New England and
Middle States.
Having watched for some twenty years the growth of
State Societies, we are glad to be able to say that in the
last few years they have been steadily improving. The
meetings are better attended, more papers are read, and
more interest is shown. It must be admitted also that
more dinners are eaten and more excursions are made.
State Medical Societies are very useful agents in the
promotion of nmtual acquaintance and good feeling, as
well as in maintaining that esprit de corps which is so
valuable to the profession. A cordial shake of the hand,
a dinner at the same table, will do more than any by-
laws to secure the proper relations between physicians.
We urge u])on physicians, therefore, an increased inter-
est in their State Societies. The majority of them have
still their potency for good in a very crude and unde-
veloped condition.
A HOUSE DIVIDED. '
It seems that all the defenders of the American Code
of Medical Ethics are not satisfied with the election of
Dr. Austin Flint to the Presidency of the American
Medical Association. The objection (which is made by
a correspondent of the Ne'iv York Medical Journal) is
not that Dr. Flint did not deserve it on personal grounds,
but that he does not stand by the old Code in its en-
tirety. The writer referred to says :
"It is scarcely more than a month since Dr. Flint,
through the columns of your own journal, labored to
break down the force of the restrictive clause in the
Code, and concluded by saying : It is to be hoped that
the American Medical Association will adopt such modi-
fications in the phraseology of this section as will place
restrictions in consultation, not on the ground of doc-
trines or forms of belief, but on separation from and
avowed antagonism to the medical profession. Now,
when it is remembered that, on the ground of doctrines
and forms of belief, we thrust the homceopaths neck and
heels out of the profession, and ourselves created the
'separation' and 'antagonism,' I submit that Dr.
Flint does not leave us a visible leg to stand upon.
Heaven save us from our friends !
" But I am glad to see that Dr. Flint has so far recon-
sidered his views as to be able to sign the required pledge
to sustain the Code as it is. I hope there is in this case
none of that mental reservation referred to by Dr. Flint,
Jr., at the Academy, and so ably exposed by Dr. Squibb
in the article to which I called attention last week, and
that we shall not be mortified next year by any movement
toward a change. I am the more solicitous about this
as I am informed that a great many joined the movement
for re-enacting the old Code in this State in the belief
that our leaders would initiate some action in the asso-
ciation this year looking to revision."
There exists much confusion in the minds of many as
to the real significance of the "restrictive clause " in the
old Code. Some think that it is right as it is, others,
H
THE MEDICAL RECORD.
[July 7. 1 88:
like Dr. Flint, think that it ought to be changed ; and
still others think that as it stands, the clause does not
really forbid consultations with educated and liberal
homoeopaths. There has been a great deal of mutual
congratulation over the fact that no discussion or dissen-
sion regarding the Code took place at Cleveland. But
after all would it not have been better and manHer to
have faced the matter courageously, and shown some
consideration toward the strong feelins, shared, if not
initiated by Dr. Flint, that some change is needed.
So far as the position of the profession before the
world is concerned, we can only repeat that everv week
brings new expressions of condemnation and contempt
for the unwise and timorous policy of tlie Association.
LOCATING YOUNG PHYSICIANS.
The (Seneral Association of French Physicians, which
met in Paris not long ago, has undertaken a project which
is certaijily unique and which promises to be very use-
ful. It proposes to organize a bureau for the purpose
of securing information regarding the most desirable places
in which recently graduated physicians may locate. At
present, we are told, many young men leave college with
no definite idea as to where they had best go. In conse-
quence they often choose a location without fully under-
standing what the prospects will be for them, and have to
wait a long time before a respectable practice is secured,
or perhaps have to abandon the field finally and go else-
where.
It is proposed to obtain, by correspondence and
otherwise, a kind of topographical chart showing where
physicians are most needed and where the best prospects
for new comers are to be found. The association will
also act as agents for those physicians who wish to retire
or sell out, or leave their practice for a time.
The plan is highly commended by the French medical
journals, and we presume that it can be made to work
successfully in France. In this country the difficulty
would be in finding any place where a new doctor is
wanted. With the young American graduate the ques-
tion generally is, not where is there an opening, but
where is the field least occupied. The advice very fre-
cpiently given, therefore, is to go to the place which one
likes best, and there stick till practice comes. Old Dr.
Crosby, of Hanover, used to say for the comfort of his
young pupils : " Whereas once I was young, and now I
am old ; yet have I never seen the intelligent physician
forsaken or his seed begging bread."
THE APPEARANCE OF .\SI.ATIC CHOLERA.
Two months ago some cases of Asiatic cholera api)eared
in Bombay. But little attention was paid to them, and
the English Government, whose general policy is not
unfavorable to quarantine, is charged with neglecting to
take proper precautions against the disease which thus
developed. About a fortnight ago a few cases appeared
in Damietta, a town of about thirty thousand inhabitants,
lying on the east branch of the Nile, between Port Said
and Alexandria. In a few days the disease had spread
with an appalling rapidity, and in the seven days ending
July 4th, over seven hundred deaths were reported.
Cases have also appeared in Port Said, at Rosetta, and
as we write, a telegram reports a first case at Alexandria.
This rapid development of cholera in a very malignant
form, has materially excited some alarm. The disease
having developed on the direct route of Indo-European
travel, the likehhood of its transportation is, of course,
considerable. At the same time, there is less to fear
than was the case seventeen years ago, when cholera
last invaded European and American ports. Since that
time sanitary organization has become perfected, and
the profession has learnt that by quarantine, isolation,
disinfection, and cleanliness, the disease can be either
kept away or greatly limited in its activity.
|lcins of the MVcch.
The Rhode Island Medical Society held its
seventy-second annual meeting at Providence, on June
2 1, 1883. Dr. Job Kenyon, President, in the Chair.
About one hundred members were present. The Trus-
tees of the P"isk Fund stated that no prize had been
awarded for 18S3. Essays were invited on the following
subjects for the year 1S84 : i. "The Origin and Prog-
ress of the Malarial Fever now prevalent in Xew Eng-
land." 2. " Original Investigations in Household Hy-
giene." For the best dissertation on either of these
subjects worthy of a premium, they offer a prize of $300
on the usual conditions. The Library Committee re-
ported that four hundred and nine volumes had been
added during the past year. The following officers were
elected for the ensuing year : President — Dr. Job
Kenyon ; Vice-Presidents — Drs. O. C. Wiggin and H.
G. Miller ; Secretary — Dr. (ieo. D. Hersey ; Treasurer
— Dr. Chas. H. Leonard. A Board of Censors was also
elected, and a Publishing Connnittee. The president
presented a communication from the New|)ort Medical
Society, accompanied by the draft of a law pertaining to
the abolition of the coroner system in this State, and the
substitution therefor of a system of medical examiners,
similar to the system which has worked so well during
the past six or seven years in Massachusetts. This draft
of an act was presented to the General Assembly at the
May Session, referred to the Judiciary Committee, and
lies over until the next meeting of the Legislature. The
profession in Newport, who initiated the movement, ask
the State Society to co-operate in securing the enactment
of this much-needed law. The Society adjourned to
meet in three months at Newport.
The New York. Polyclinic has organized a medical
society of its own, composed of members of the faculty
and graduates of the institution.
The Price of hi.s Blood. — Edward Banks, a colored
man, has begun suit in the Sixth District .Court, before
Justice Kelly, against Dr. Henry J. Garrigues and Charles
J. V. Okerberg, for $250, as the value of eight ounces
of blood taken from Banks and injected into the veins of
Mr. Okerberg. It appears that on February 7th last this
gentleman went to bed in a small, close room, blowing
out the gas. In the morning he was found insensible.
Dr. Garrigues and Dr. Frederick E. Valentine treated
him, and at the suggestion of the former the operation
I
July 7. 1883.J
THE MEDICAL RECORD.
15
of transfusion was performed. The patient recovered,
and now Banks, who furnished the material for the opera-
tion, claims what he considers a fair compensation.
ATedical Department of Yale College. — At the
meeting of the President and Fellows of Yale College,
held June 2 7tii, Dr. Thomas H. Russell, of New Haven,
was ajjpointed a professor in the Medical Department of
Yale College. He will occupy, by vote of his colleagues,
the chair of Materia Medica and Therapeutics, which is
made vacant by the transfer of Professor C. A. Lindsley
to the Chair of Theory and Practice. The latter chair
was made vacant by the death of Professor \V'ilcox.
HusT Of Dr. Kigelovv. — The sculptor, I.aunt Thomp-
son, is at work upon a bust of Dr. Bigeiow, which is to
be placed in the new building of the Harvard Medical
School.
Panic in the Air. — We recently suggested that there
was just now an " epidemic constitution," favorable to
the development of panics. 'Hiis was illustrated last
week by a panic which occurred upon a Fulton Ferry
boat, and which was caused simply by a sudden shower
of rain. Fortunately no harm was done.
Contagious Pleuro-Pneumonia on Staten Island.
— The ravages of pleuro-pneumonia among the cattle on
Staten Island have been increasing, and the Boards of
Health in Middletown, Westlield, Castleton, Smithfield,
and Northfield, are busy with the subject. In two cases
the carcases of the diseased animals, which had been
hastily sold to the butcher by the owners as soon as the
sickness was noticed, without inquiring into the cause,
were found in the meat markets about to be offered for
sale. Upward of forty head have died already in one
town. Stringent efforts will be made to quarantine the
animals.
Hats and Sunstroke. — Scientific hatters, says a con-
temiiorary, are beginning to discover that the liability to
sunstroke when the head is covered with a low-crowned
straw hat is as 100 to i compared with a high-top beaver.
The true summer hat has not yet been invented. When
it does appear it will be a cone-shaped affair, light, and
lined with sponge, and surrounded by a broad brim.
We very much dOubt the important relation above de-
scribed, between hats and sunstroke. High tempera-
ture, exposure, over-exertion, indiscretions in food and
drink, bring on sunstroke without much reference to
high or low crowns, or the popular cabbage-leaf.
Small-pox among the Indians. — A despatch from
Dr. Warren Day, of the Mohave Indian Agency, Arizona,
states that there is a general outbreak of small-pox
among the Arizona Indians. Supplies of fresh vaccine
virus are urgently requested.
The First Vessels of the Season with Yellow
Fever on board arrived at Ship Island June 28th and
29th. They were at once quarantined and disinfected.
The State Board of Health held a special meet-
ing at the Capitol on June 29th. The sanitary connnit-
tee submitted detailed statements of its work under the
laws to prevent the adulteration of food and drugs and
to prevent the sale and use of dangerous illuminating
fluids, especial reference being made to an injunction
-placed upon the sale of what is called "lie tea."
Mr. Erastus Brooks presented the subject of the alarm-
ing increase of pleuro-pneumonia in milch cows on Staten
Island, and asked what aid the Board could give in help-
ing to supiiress the plague and to punish those responsi-
ble for it. The Board passed a resolution calling the at-
tention of the National Commission on Cattle Plagues to
the cases. The Board will meet at Ogdensburg on Au-
gust 9th.
Restrained from Issuing Diplomas. — The College
of Physicians and .Surgeons, of Buffalo, known also as the
Mohawk College and the College of Rational Medicine,
which tried to get a charter from the Legislature last
winter and failed, its true character being shown up, has
recently become involved in a legal complication. It
has prepared about twenty \oung men for graduation, but
at last an injunction was secured from Judge Haight for-
bidding the college to issue certificates or diplomas as a
legally incorporated college of medicine and surgery.
The college claims legal incorporation under the laws of
1882, and the question whether this claim is well-founded
will be argued in court, probably in September. Until
that time no further action will be taken.
It will be remembered that this college stands on
about the same footing as the U. S. Medical College of
this city.
Unfortunate Counter-Prescribing. — A Second
Avenue druggist in this city who attempted counter-pre-
scribing has, along with his patient, come to grief It
appears that he advised a woman who inquired of him
for a physician to take his own counsel for her sick hus-
band, and prescribed for the yjatient, whom he had not
seen, a medicine which the patient took and shortly after
died, in spite of the efforts of some physicians, who de-
clared that he died of poisoning by opium. Everybody
will wish, if this story turns out to be true, that Leman
may receive the extreme penalty of the law for his quack-
ery.
The Tax upon Patent .Medicine ceased on July
ist. Most of what did go into the hands of the Govern-
ment, will now enrich the owners of patent cure-alls.
We trust that they will be able to pay their religious
weekly supporters with increasetl liberality.
The Nu.mber of Phvsician.s in New Y'>rk. City. —
Some special inquiries having been made of us regarding
this, we would say that the total number of physicians
and surgeons in New York State in 1880, according to the
United States Census, was 9,272. This number has now
undoubtedly swollen to 10,000.
In what, for distinction's sake, may be called the
Physician's Medical Register for 18S3-84, a list of only
2,684 names is given, which number represents the reg-
ularly educated physicians in aftiliation with regular
medical societies. The remainder are composed of
homceopaths, of whom there are probably 500 or 600 in
the State, eclectics, and nondescripts.
Syphilis in the Ninth Century. — The Chinese are
first in everything; the Japanese press them hard, and
in the matter of syphilis, seem to have precedence. Be-
tween the years a.d. 806 and 8io, says the British
i6
THE MEDICAL RECORD.
[July 7, 1883.
Medical Journal, an emperor of Japan commanded his
court physicians, Abemanas and Idzumo Kirosada, to
collect in one volume all extant records of native medi-
cine and surgery. A manuscript copy of this work, for
centuries forgotten, although the facts of its origin were
recorded in Japanese historj-, was found in 1S27 by a
priest, in a provincial Buddhist temple. Dr. Scheube, of
I^eipzig, has recently examined this work, and, in an
article published in a recent number of Vircho-d's
Archiv, has shown its undoubted authenticity and its
high value from a purely scientific point of view. It was
written long before Ciiinese ideas had penetrated into
Japan and influenced native practitioners. The most in-
teresting passages are descriptions of local -and general
affections, which clearly prove that syphilis, and several
allied disorders, were well known to the ancient Japan-
ese. Chancroid and phagedenic chancre are clearly de-
scribed, as well as a " swelling on the penis, of the size of
a millet-seed," followed by eruptions, feverishness, pains
in the bones and head, blindness, swelling of the testicles,
and other very familiar symptoms. These were observed
to continue for many years. The passages of this work,
called the " Daidorui Thiu-ho," which relate to the treat-
ment of these symptoms, have not yet been translated
into English. Herbs alone appear to have been used, and
without much success ; mercurial treatment was intro-
duced at a comparatively recent date, from Europe. The
ancient Japanese surgeons do not appear to have recog-
nized the venereal origin of the disease which they describe,
although the "Daidorui" distinctly traces all the secondary
symptoms to " the poison from the affected organ."
Da.mages for the Destruction of Ex.'Vmin.ation
P-APERS. — A recent decision in a Cincinnati Justice
Court will perhaps alarm some of our medical teachers
who think too lightly of the intellectual efforts of medi-
cal students. A young lady medical student, the plain-
tiff, was a graduate of Pulte Medical College for the
year 1883. The examinations at the close of the term
were conducted in writing, and under test conditions.
Dr. Hartshorn, the Professor of Surgery, conducted the
examination on that subject by writing a list of twenty-
three questions on the black-board, and requiring the
students, in his presence, to write the answers. The
plaintifi' wrote about seventeen pages of manuscript in
answering the questions, and handed the same to her
Professor. Afterward, having determined to Iiave the
several results of her examinations published in pam-
phlet form, as an aid to her in starting in her profession,
she called upon the members of the College Faculty
and requested a return of the papers, or copies thereof.
All of the professors so requested returned the papers,
except Dr. Hartshorn, who, instead of giving her the pa-
pers, or a copy, threw them in the fire and burnt them
up. The strange conduct of the Professor could not be
explained satisfactorily, and upon the facts and testimony
relative to the value of the papers, the court assessed
the damages for the destruction of the same at $300.
A Rare Case Indeed. — The Australasian Aledical
Gazette publishes the following account taken from a
New Zealand paper of February 23d : " .\ most extra-
ordinary and painful i)henomenon has lately occurred in
Warsaw. A lady died under somewhat peculiar circum-
stances, which gave rise to a report that her death had
been caused by her husband's ill-treatment. Hence,
several weeks after the interment, her body was exhumed
for post-mortem examination, when it was found that in
the grave a perfectly healthy child had been born. This
gives a startling new meaning to the word 'posthumous.' ''
Upon the above the editor of the Gazette comments
as follows : " This case, though extraordinary, is possibly
true, two similar cases being recorded, one in the
Medical Gazette, vol. xlvi., p. 713, the other in Casper's
Vierteljahrsschrift, 1S61, p. 186. It is more probable,
however, that the woman was buried in a state of sus-
pended animation, and that the birth took place during
her life. If it took place after life had departed, it is
certain it occurred almost immediately after death, and
before the muscular contractility of the uterus had
ceased, the body having been coffined very quickly, and
the child remaining unnoticed prior to burial."
Lister on Listeris.m. — Professor Lister has written the
following letter to Mr. Henry Gray Croly, in response to an
inquiry whether he had given up the spray in operations :
Dear Mr. Croly : I have not given up the use of the
spray, although I certainly regard it as the least impor-
tant part of our antiseptic arrangements. Whatever
other good it may do, it is a very mild form of antiseptic
irrigation, and tends to keep the entourage of the wound,
including the surgeon's hands and instruments, pure.
But if I had not a spray-producer at hand. I should not
on that account omit other elements of antiseptic treat-
ment. I still use the spray in changing dressings, so
long as the wound is not merely superficial. But far
more important than using the spray is it to n^ke a
point of covering the wound with some pure antiseptic
material before beginning to wash the parts which were
covered with the edge of the dressing only, and were
therefore impure. In other words, I believe one of the
commonest causes of failure is dabbing alternately the
impure surrounding parts and the jnire wound with the
same piece of rag, which, though moistened with carbolic
lotion, cannot work miracles.
Believe me, yours very truly,
Joseph Lister.
(Dliituavy.
BEVERLY LIVING.STON, M.D.,
NEW VORK.
It is most sad to have to record the death of one who,
after years of hard work and careful preparation, had just
begun to enter a brilliant professional career. Dr. Bev-
erly Livingston, who died most suddenly and unex-
])ectedly of diphtheria, on June 30th, was born in 1852.
He graduated at the Sheffield Scientific School, at Yale,
and took his medical degree at the College of Physicians
and Surgeons of this city in 1877. He entered Bellevue
Hospital as an interne, and was tiiere for two years. He
then went to Europe, and studied several years in Paris
and in dermany. Returning to this city, he began his
practice here under the most promising circumstances.
He was attending physician to the Nursery and Child's
Hospital, member of the .Vcademy of Medicine and of
the Pathological Society. He had already shown un-
usual attainments as a pathologist, as well as practical
skill as a physician. Personally Dr. Livingston was a
general favorite, and few young men had a wider circle
of friends. In his death the profession has sustained a
loss which all who knew him will keenly appreciate.
For ourselves with our sorrow we can but feel a bitter-
ness at the fate which so ruthlessly cut down in an hour
the labor and promise of years. •
July 7, 1883.]
THE MEDICAL RECORD.
17
|flcpovts of ,s.ocictics.
MAINE xMEDICAL ASSOCIATION.
Thirty-first Annual Meeting, held in Portland, Me.,
June 12, ij, and 14, 1883.
George E. Brickett, M.D., of Augusta, President,
IN the Chair.
(Special Report for The Medical Record.)
First Day — June i2TH.
A biographical sketch of Dr. Alexander Ramsay —
who was a very prominent medical teacher in this State
seventy years ago — written by Dr. Geo. P. liradley,
U. S. N., was presented, and referred to the Publication
Committee.
Dr. S. p. Warren, of Portland, reported a case of
absence of uterus in a married woman, and a case of
cyst in the vesico-vaginal wall.
A committee was appointed to consider the question
of providing a banquet, and, on its recommendation, a
committee, with Dr. J. M. Bates, of Yarmouth, as chair-
man, was chosen to report on the subject next year.
The President, in his inaugural address, paid a fitting
tribute to his predecessors, sixteen of whom are still alive.
He recommended efforts to secure
the establishment of a state board of health, and
A BOARD OF registration.
Stress was laid upon the value of investigations into the
properties of new remedies. The medical schools at
Portland and Brunswick, and the Maine General Hos-
pital were commended, and loyalty to the Code of Ethics
of the American Association enjoined.
Certain proposed amendments to the constitution, in-
troduced by Dr. E. K. Sanger, of Bangor, were acted
upon. Those relating to discipline, and which, if adopted,
would bring into the meetings differences between mem-
bers which are now disposed of by the censors, were re-
jected by a unanimous vote ; and a similar fate attended
those which related to officers and membership. As their
author was not present, there was no voice to support
them.
Dr. O. St. C. O'Brien, of Bristol, visitor to the Port-
land School for ]\Iedical Instruction, reported that the
institution was in excellent condition, and that it pre-
sented unusual facilities for obtaining an education.
Dr. J. G. Pierce, of Freeport, read a paper on
synovitis,
emphasizing the advantages of treatment with the aspi-
rator and elastic bandages.
Dr. a. K. p. Meserve, of Portland, presented an essay
ON ACUTE inflammation OF THE MIDDLE EAR.
A very large proportion of these cases conies to the
general ]<ractitioner for treatment, and it is, therefore,
important that the profession generally should be familiar
with their management. The paper was eminently prac-
tical.
Dr. H. N. Small, of Portland, read an elaborate
paper on
EXTRA-UTERINE FCETATION,
illustrating the subject by a description of a fatal case in
his practice. In the discussion which followed, a num-
ber of members reported cases which they had seen.
One was mentioned in which the fcetus became calcified,
and remained in the abdomen many years — the woman,
meantime, bearing a number of children.
Dr. S. H. Weeks, of Portland, made some extended
remarks on fractures of the elbow-joint. An animated
discussion ensued, some members advocating the rect-
angular position of the joint in the treatment of most
cases, while others favored the straight position, in ac-
cordance with the theory of Dr. Allis. A marked dif-
ference of opinion obtained also with reference to the
time of beginning passive motion.
Second Day — June 13TH.
Dr. O. a. Horr, of Lewiston, visitor to the Medical
School of Maine, reported that the institution maintains
its high standard in all respects. The examinations are
strict and searching, and a diploma is granted to no one
who does not reach seven on a scale of ten. The new
anatomy law has operated to the advantage of the school.
Dr. E. E. Holt, of Portland, read a paper on diseases
of the mastoid.
The Committee on Revision of the By-Laws, appointed
last year, was dischargetl from further service, and its
work was assigned to the Publication Committee.
Dr. a. H. Burbank, of Yarmouth, read a paper on
THE INDUCTION OF PREMATURE LABOR,
in cases where contraction of the pelvis forbids the birth
of a living child at term. He believed this procedure
should be instituted much more frequently than it is, and
recommended gradual dilatation of the os with the digit.
Dr. T- T. Dana, of Portland, introduced
the SUBJECT OF BRIGHT'S DISEASE,
detailing the symptoms of various forms, and illustrating
his points with accounts of several typical cases. We are
justified in a more hopeful prognosis in many cases than
formerly, when the pathology of the disease was less per-
fectly understood.
Dr. J. A. Spalding, of Portland, read a paper giving
an account of the testimony in a trial for alleged mal-
practice, where he was called as an expert.
The necessity of the early removal of an eye which is
the subject of traumatic intlanimation was carefully dis-
cussed and illustrated.
The officers for the ensuing year were then elected.
The annual oration was pronounced by Dr. M. C.
Wedgwood, of I^ewiston, whose subject was
RATIONAL MEDICINE AND QUACKERY.
He spoke of various forms of charlatanry which have
adopted particular names, but dwelt particularly upon
quackery as it is often met with in the regular profession,
displayed by men who prate about their allegiance to
codes, and yet undermine and traduce their fellows.
Rational medicine will achieve its greatest triumphs only
when education of mind and heart and hand are insisted
upon in all its disciples. All exclusive dogmas — allo-
pathy as well as homoeopathy — are based upon error,
while rational medicine embraces every truth from what-
ever source.
Dr. B. F. Sturgis, of Auburn, reported a case of
chronic abscess of the tibia.
Dr. S. C. Gordon, of Portland, the Committee on
Necrology, presented biograjihical sketches of the follow-
ing deceased members : A. Crosby, Waterville ; W. H.
Brown, Bangor ; R. Curtis, Richmond ; J. P. Grant,
Saco ; W. W. Greene, Portland ; \V. Sweat. Hollis ; R.
E. Paine, Camden ; D. M. Tolford, Portland ; and D.
F. Ellis, Brunswick.
Dr. F. H. Gerrish, of Portland, reported
A CASE in which the BL.\DDER WAS DIVIDED BY A
septum,
so that a lithotrite could not be so introduced as to reach
a free calculus, which was easily touched with a catheter.
Lateral lithotomy was performed, and the patient, though
seventy-five years old, did not have an unfavorable symp-
tom afterward.
Dr. Gordon read a paper on the treatment of some
accidents occurring during parturition, devoting especial
attention to lacerations of the cervix, ruptures of the
perineum, and cystocele. The essay displayed great
familiarity with the subject, and abounded in illustra-
tions drawn from practice.
i8
THE MEDICAL RECORD.
[July 7, i88t
Third Day— June 14TH.
The Board of Censors made their report in substance
as follows :
It was recomniendei! that the next annual meeting be
held in Portland, on the second Tuesday in June, 1884.
Orator — Dr. A. L. Hersey, Oxford. Delegates to
other medical societies : New Hampshire — Drs. T. A.
Foster, Portland, and D. L. Lanison, Fryeburg ; Ver-
mont— Drs. W. C. Mason, and R. K. Jones, Bangor ;
Massachusetts — E. H. Hill, Lewiston, and A. M. Pea-
bles, Auburn ; Rhode Island — C. T. iMoulton, Cumber-
land, and J. L. Horr, Cumberland Mills ; Connecticut —
O. St. C. O'Brien, Bristol, and A. J. Billings. Freedom.
Visitors to Portland School for Medical Instruction —
C. A. Packard, Bath, and J. A. Richards, Farmington.
Visitor to Aledical School of Maine- — S. Laughton, Bangor.
It was recommended that Dr. W. H. Simmons' re-
quest, to be allowed to withdraw from the Association, be
granted. It was reported that Dr. C. Seavey, of Ban-
gor, had been tried on charges preferred by Drs. Sanger
and Mayo, and that the charges were not proven.
A large number of applicants for mejiibersliip were
reconmiended, and were at once admitted by vote of the
Association.
Dr. Weeks reported a case of immense sarcoma of
the head, which illustrated the importance of earlv re-
moval of morbid growths. He mentioned some of the
principal features of a case of oophorectomy whicii he had
recently treated, and promised a full report of results at
the next meeting.
The following committees to secure legislation were
appointed in accordance with the recommendations of
the President in his address : On State Board of Health —
Drs. Dana of Portland ; Bates, of Yarmouth, and Weeks,
of Portland. On registration of practitioners — Drs. O.
A. Horr, of Lewistown ; Webster, of .Augusta; O'Brien,
of Bristol ; Walker, of Thomastown, and Smith of White-
field.
The customary votes of thanks were passed to the city
for the use of the rooms, and to various officers ; and the
Association adjourned at noon on Thursday, after a very
pleasant, harmonious, and profitable meeting.
NEW HAMPSHIRE .MEDICAL SOCIETY.
Ninety-third Annual Meeting, held in Concord. June
19 and 20, 1883.
(Special Report to The Medical Record.!
The .Society was called to order at 1 1 o'clock .a.m. The
President, Dr. A. H. Crosby, of Concord, in the Chair.
Prayer was offered by tlie Rev. F. D. Aver, and the
usual committees were appointed for the session b}' the
Chair.
Delegates being present from ^'ernlont, Rhode Island,
and Massachusetts, they were introduced to the Society
and made welcome guests of the association.
.\fter some routine business had been transacted the
proceedings of the Council were read by the Secretary,
from which it appeared they had recommended twenty-
five jihysicians for new members : that only four deaths
had occurred during the past year ; one new district so-
ciety had been chartered ; matters of ethics had been
duly disposed of, and all matters of new business had
been attended to with due regard to the interests of the
Society.
It appeared that they had taken into consideration
the condition of the collections in the Surgeon-Oeneral's
office at \\'ashington, D. C, and offered pertinent reso-
lutions looking toward the perpetuation of these valuable
collections, in urging upon their Congressmen tiie neces-
sity of the Government making an appropriation suffi-
cient to construct a suitable building, with all the ap-
pointments necessary to preserve and protect these
contributions to medical science from a hard-worked and
self-sacrificing profession.
The proceedings of the Council were duly accepted.
At twelve o'clock The President read his annual
address, taking for a subject
the country doctor.
He alluded to the toil and hardships to which their pro-
fessional life led in fitting terms, and comparing their
resources in medicine and surgery with those of their
more favored brethren, who, living near or in the great
centres of population, where every known drug or sur-
gical appliance could be found, and professional assist-
ance could be had at a moment's notice, he said that
their judicious selection of a few standard drugs, and the
mechanical ingenuity they displayed in improvising sur-
gical appliances to meet the wants of an individual case
was a surprise to many a city surgeon, while the results
obtained would fairly rival that attained in the large
hospitals.
His address was listened to with attention, and was
referred to a committee for publication.
Orations by Dr. G. C. Blaisdell, of Contoocook, and
Dr. George W . Hatcli, of Wilton, treated upon profes-
sional labor in general terms, while
AN essay on colds,
by Dr. W. T. Smith, of Hanover, was an interesting
paper upon a familiar subject, but entitled to considera-
tion, as being one to which our attention is so often
called.
The speaker gave a resume of the effects of cold upon
the surface of the body, the shock to the system, and how
its injurious influence was transmitted to the nerve-cen-
tres, and reacted upon organs and tissues at a distance
from the part exposed.
He alluded to the epidemics of influenza that have
passed into histor}', and while freely admitting that the
unsanitary surroundings of the jieople must have had its
influence in jjreparing the system for the easy introduc-
tion of disease, yet the atmospheric influence upon the
skin and air-passages, must have been the exciting cause
of their development.
Dr. Pray, of Dover, presented a long paper upon
variola, of which no brief abstract would do justice, and
Dr. J. .A. W.atson, of Concord, gave a paper
O.N' WATER pollution.
He gave some interesting facts that had been developed
in the State by the Board of Health, and the statistics of
several wells that had been examined and condemned.
He also appealed to all present to investigate into the
condition of the water supply in all cases of a doubtful
character or what appeared to be of mysterious origin,
assuring the members that the Board would be glad to
respond to the assistance of any one wlio had cases of
this character to investigate.
Several other papers were read, and discussions fol-
lowed until late in the evening, the anniversary dinner
having been served at 2 p.m., at the Eagle Hotel.
The Society met at 8 a.m. \Vc(lnesday morning, and
was called to order by the President, when the Secre-
taries of the District Societies made their annual reports,
from which it appeared that they were in a flourishing
condition.
The Treasurer made his report, showing the Society
to be in sound financial condition, having about sixteen
hundred dollars in the bank and current funds.
The election of officers followed, and Dr. Jolm W.
I'arsons, of Portsmouth, was elected President ; Dr. John
Wheeler, Pittsfield, Vice-President ; Dr. D. S. Adams,
Manchester, Treasurer ; Dr. G. P. Conn, Concord,
Secretary; Dr. A. P. Richardson, Walpole, .\nniversary
Chairman ; Drs. A. H. Crosby, C. R. Walker, Concord,
and Dr. G. D. Towne, of Manchester, Executive Com-
mittee.
A board of ten Censors and twenty Councillors was
elected, and a programme for reports and papers was an-
July 7. 18S3.I
THE MEDICAL RECORD.
19
nounced for the session of 1884. Dr. J. S. Billings, U.
S. A., Washington, D. C, and Dr. J. H. Mackie, of New
Bedford, Mass., were elected honorary members of the
Society.
This was followed with discussions and the report of
cases until afternoon, when the Society adjourned to meet
again in this city on the third Tuesday of June, 1884.
OREGON STATE MEDICAL SOCIETY.
Tenth Annual Meeting, held at Portland, Oregon, June
13, 14, and 15, 1883.
(Special Report to The Medical Recoru.)
ADDRESS OF WELCOME — PREVALENCE OF CRIMINAL ABOR-
TION IN OREGON — THE QUESTION OF OPERATION IN
MORBUS COXARIUS OCULAR AFFECTIONS IN CONSTI-
TUTIONAL DISEASES ELECTION OF OFFICERS — SUB-
NITRATE OF BISMUTH AS AN ANTISEPTIC DENTITION
AND AFFECTIONS RESULTING THEREFROM — GUNSHOT
WOUND OF STOMACH SPONGE-GRAFTING.
The Society was called to order at two o'clock. President
Dr. C. C. Strong, in the chair.
The Rev. Dr. F. R. Marvin being present was in-
vited to the platform and opened the meeting with prayer.
Dr. C. H. Wheeler then welcomed the Society to
Portland in a very appropriate address.
Dr. S. E. Josephi, of the Oregon Hospital for the
Insane, extended to the Society a cordial invitation to
visit that institution during the session.
The Executive Board having reported favorably, Drs.
Jas. F. McCormac, Marshfield ; Hannibal Blair, Albina ;
J. C. Whiteaker, Portland ; John S. Stott, Hillsboro ;
Otto S. Binswanger, Portland ; J. A. Fulton, Astoria ;
Chas. E. Bebee, (loldendale ; G. Cooke Lane, Portland ;
D. Raffety, East Portland ; A. G. Avery, Portland, were
elected active members of the Society. Rev. 1". R. Mar-
vin, M.D., was elected an honorary member.
Dr. G. M. Wells then called the attention of the
Society to a case of parametric abscess from which he
had taken that morning a large amount of pus. The
doctor stated that his principal object in speaking of the
case was the fact that it was one of many similar cases
which came under his observation as the result of crimi-
nal abortion, which was practised in this city to an alarm-
ing extent, and lioped the Society might take some steps
in the direction of sujipressing the practice.
Dr. B. A. Owens then presented a case of hipjoint
disease for examination, and asked the Society to recom-
mend a course of treatment. The disease was in the
beginning of the second stage, and fi'om the examination
of pus asjjirated from an accumulation just below the
great trochanter, it was evident that the bone was dis-
eased and that the process of exfoliation was established.
The question of treatment elicited an interesting discus-
sion, r)rs. Wells, Saylor, Blaney, Tyler-Smith, and Owens
reconnnended excision of the bone, while Drs. Givens,
McKenzie, Dodson, Lane, McKenzie, and Fraser ad-
vised rest with extension and counter-extension of the
limb, etc.
Meeting called to order at 10 a.m. June 14th by
C. C. Strong, M.D., in the chair.
Dr. F. B. Eaton read a paper entitled " Diagnostic
Importance of Ocular Aftections in Constitutional Dis-
eases." The paper was discussed by Drs. McKenzie,
Givens, and Lane.
The time fixed for the election of officers having ar-
rived, the Society took up that order of business, the
election resulting as follows : President — Dr. W. H.
Saylor ; Vice-President — Dr. J. W. Norris ; Secretary —
E. P. Fraser ; Member of the Executive Board — Dr. C.
M. Wells.
Dr. Saylor then presented a case showing the favor-
able result of an operation of excision in hip-joint disease.
Dr. Holt C. Wilson read a paper on " Antiseptic
and Aseptic Surgery," in which he called special atten-
tion to the use of subnitrate of bismuth as an antiseptic.
The paper was discussed by Drs. Watkins, Givens,
Eaton. Fulton, and J. R. Smith.
Dr. Josephi presented a paper entitled "The Present
Condition of Insanity throughout the World," giving very
valuable statistics on the subject.
Dr. B. a. Owens read a jiaper entitled " Dentition
and .Affections Resulting therefrom."
The Society then selected the following subjects for
special consideration at its next annual meeting : Dis-
eases of Joints ; Headaches ; Tuberculosis ; Pathology
of Pregnancy ; Uses of Bismuth ; Typho-Malarial Fever.
Meeting called to order at 10 a.,m. June 15th, Presi-
dent C. C. Strong, M.D., in the chair.
A paper was then read to the Society by Dr. J. F.
McCoRMAC, describing a case of " Gun-shot Wound of
the Stomach with Recovery."
Dr. Saylor then read the report of some cases of
sponge-grafting in chronic ulcers with marked success.
Dr. C. C. Strong, President, then read his address
on retiring from the chair.
Dr. W. H. Saylor. President-elect, was conducted to
the chair and read a short inaugural address.
On motion, a committee was appointed to draft reso-
lutions in regard to deceased members.
Portland was selected as the place of the next annual
meeting.
There being no further business the Society adjourned
sine die.
©orrespranttence.
OUR LONDON LETTER.
(From our Special Correspondent.)
THE NEW out-patient DEPARTMENT AT ST. .MARY'S
hospital THE NEW LAW COURTS DR. OLIVER'S
TEST-PAPERS AT THE CLINICAL SOCIETY THE ARIMV
MEDICAL INQUIRY.
London, June 13, 1883.
The new out-patient department of St. Mary's Hos-
pital has been opened. It is a decided improvement on
the old rooms, which occupied the basement and were
mainly lighted by skylights. The new rooms are lofty,
well lighted, and fairly well ventilated. For the latter
purpose Tobin's tubes are placed in every room, and a
large extraction shaft surmounts the central hall. The
outer walls have, here and there, bricks perforated with
conical holes — the large end innermost — the object being
to bring air in without draft. All the passages have their
walls covered with glazed bricks, which will conduce
greatly to cleanliness. Close stoves are at present em-
ployed for warming the rooms. It seems a pity hot
water or warm air was not employed. Cireater uniform-
ity in the temperature would have been thereby attained.
The department is connected with the main building by
a short iiight of steps, which is roofed in, but not closed
in at the sides. This seems a pity, and cannot but prove
unpleasant in winter. It is also a pity that the new
building has not been so arranged as to enter on the
level from the main corridor of the hospital. .As it is,
on entering the hospital you ascend z. short flight of steps
to the main corridor, pass along it, then descend half-
a-dozen steps to the new out-patient department, and
then ascend a flight of steps to the consulting-rooms. The
patients go doion steps from the street, then up a flight
to see the doctors, then doivn again to the dispensary,
and finally vp a few steps into the street.
Architects never seem to consider stairs a disadvan-
tage. At the new Law Courts, the judges— most of whom
are old men — have to ascend about forty steps to their
rooms. No lifts have been provided. The Courts are
also said to be damp, and cases of illness are stated to
have occurred among the officials.
20
THE MEDICAL RECORD.
[July 7, 1883.
At the last meeting of the Clinical Society Dr.
George Oliver, of Harrogate, demonstrated his method
of detecting sugar in the urine by means of test-pa-
pers charged with carmine of indigo and carbonate of
soda. One of these papers placed in a test tube with a
little water and heated gives a blue solution. If a drop
of saccharine urine be added first a play of colors ensues
on heating — purple, red and straw, successively. On
shaking, the colors reappeared in the reverse order.
Heating again brought them out again. A confirmatory
test was applied by dropping in a paper charged with
corrosive sublimate while the indigo solution was still
hot, which immediately gave rise to a blackish green
precipitate. Non-saccharine urine merely gave a trans-
parent green solution with the mercuric paper. Dr.
Oliver claims that his method will detect sugar in any
proportion in the presence of albumen, peptone, pus,
blood or bile ; that it gives no play of colors with uric
acid ; and that it is cleanly and portable. Dr. Oliver
has not obtained the characteristic play of colors with
the indigo test-paper with any other substance but glu-
cose.
The army medical iniiuiry has excited considerable in-
terest. The report is not yet published, bat proof-sheets
have been communicated to The Tunes and an article
on the subject has already appeared in that paper. A
memorandum on the subject by Sir W. MacCorrnac,
which is to be published as an appendix to the report, also
appears in the current number of tlie British Medical
Journal. Some of the charges against the medical de-
partment will probably fail to be sustained, whilst others
refer more properly to the commissariat and military de-
partments. The medical department will, though, doubt-
less be made the scape-goat.
As an illustration of the repute in which the profession
is held by the Government, it may be remembered that,
when votes of thanks were passed by both Houses of
Parliament to the officers engaged in the Egyptian cam-
paign, the name of the chief medical officer was not in-
cluded. The medical profession lias always been treated
badly in the public services. The army, naval, Indian,
and convict medical services have each in turn been the
scenes of shabby treatment to medical men, so history
is but repeating itself now. Lord Wolseley's evidence
seems particularly unsatisfactory and at variance with his
statements in public despatches at the time of the alleged
shortcomings. Lord Wolseley stated that he actually
went into the hospital at Ismailia and grumbled at the
medical officer because the patients were not supplied
with better bread. This gentleman replied that he had
complained to the commissariat, but his lordship seemed
to think that it was the duty of the medical officers to go
out into the bazars and buy bread themselves.
The Parkes Museum of Hygiene was reoj^ened on ,
Saturday morning, May 26th, at its new premises in
Margaret Street. Spee.ches were delivered by Sir Charles
Dilke, the Duke of Albany, and others. In the new
museum many of the exhibits have the great advantage
of being shown in action : for instance, the different vari-
eties of water-closets have had a water supply laid on,
and have been connected with th« drains, so the way in
which the flushing action takes place can be observed.
The Lily of the Valley in Homceopathv. — Some
Western homceopaths have got hold of convallaria, and
having read alt that scientific medicine has to say about
it, are ([uietly appro[)riating the drug themselves. Dr.
Hall recently read a paper on the subject before the
Western Academy of Homoeopathy (the feebler the as-
sociation the more high-sounding the name), at Madison,
Wis. Without giving credit to any one but Dr. d'.\ry,
he tells all about the drug, recommending it in small
and large doses. In palpitations and irritable lieart lie
gives one-thousandth to one-tenth of a droi) with great
success.
OUR PARIS LETTER.
THE alleged wonderful PROPERTIES OF COPPER. —
SO-CALLED SYPHILITIC TEETH NOT PECULIAR TO
SYPHILIS.
Paris, June 12, 1S83. >
There are two men in Paris who have the same hobby,
though they do not ride it in the same direction. That
hobby is copper, and they are both known to your read-
ers. Dr. Burq has for many years maintained that
copper was a specific for cholera, for which it should be
prescribed, not only for the cure of the aftection, but it
should be used continually as a prophylactic. Dr. Burq
founded his theory on the fact that those employed in
the manufacture of copper articles enjoyed a remarkable
immunity from the disease, .\rguing from this stand-
point. Dr. Burq was inspired with the idea that copper
would have a similar beneficial effect on typhoid fever.
He made particular inquiries, and ascertained that dur-
ing the recent epidemic of typhoid fever in Paris there
were only two deaths among the manufacturers of cop-
per articles. Moreover, he learned that in a copper
manufactory in which there were from three hundred to
four hundred workman, only one death occurred during
the last sixty years from infectious disease, and that death
was from small-pox. From this Dr. Burq formulated
the following conclusions, which he submitted recently
at a meeting of the Biological Society : First, there exists
an incompatibility between the salts of copper and the
microbes of infectious diseases ; second, in anticipation
of the preventive inoculations of infectious diseases as
proposed by M. Pasteur, one could be protected by the
administration of large doses of the salts of copper, the
innocuousness of which has been shown by M. M. Ducorz
and Galippe. Dr. Gahppe, it will be remembered, has
for some time endeavored to prove the innocuousness
of copper, but people both in and out of the profession
are rather sceptical about this, and remain under the old
impression that copper is a powerful poison. Dr. Ga-
lippe lately submitted a paper at the Academy of Sciences
in which he asserted that copper was found in large pro-
portion in the nuts of the cocoa tree, from which choco-
late is manufactured. It is therefore erroneous to sup-
pose that the copper found in the latter substance is
added to it for fraudulent purposes.
Another hobby is that of Professor Parrot, who sees
syphilis everywhere, particularly in children in whom, ac-
cording to him, rickets is one of the manifestations of
hereditary syphilis, and he has even discovered syphilis in
prehistoric skulls. Professor Parrot is the great cham-
pion of France of Hutchinson's interpretation of the
lesions of the teeth, which the latter author described as
being characteristic of syphilis, but at a recent meeting
of the " Societe de Chirurgie," where the subject was
fully discussed, Hutchinson's theory about syphilitic
teeth and Parrot's notions respecting the relation that
exists between syphilis and rickets did not meet with
much favor. Dr. Magitot, a well-known dentist, as prin-
cipal speaker on tiie occasion, declared that from his ex-
perience the lesions known as Hutchinson's were not at
all peculiar to syphilis, as they are found in children who
are not syphilitic, but who are the subjects of other
pathological conditions.
The same lesions may also be seen even in animals.
He also referred to several cases in which adults bearing
these lesions have contracted syphilis, which would have
been impossible if they had been already syjihilitic.
According to Dr. Magitot the following are the real
characters of syphilitic teeth : Tiiey are small, deformed, ir-
regular, and slow in making their appearance, but he rather
startled his hearers when he declared that the dental lesions
known as Ilutciiinson's were due to infantile convulsions.
Among other speakers, all of whom rebutted the idea,
Dr. Desprcs asserted that he had seen several children
bearing the dental lesions referred to, but who have never
had neither syphilis nor convulsions. Dr. Despres added
July 7, 1883.]
THE MEDICAL RECORD.
21
that lie had met with one case in a child, whose mother
had jusl recovered from typhoid fever when she became
pregnant, and another who was fed artiticially bore these
lesions. These two cases would seem to suggest tiiat
the malady or state of health of the parents would have
a certain inrtuence on the regularity of the evolution of
the teeth in their oft"spring.
"MEDICAL EDUCATION IN CANADA AXD
CHURCH INFLUENCES".
To THE Editor of The Medical Record.
Sir : Having read an editorial, published in your journal
of April 28th, on " Medical Education in Canada and
Church Intiuences," pern-.it me to say that the writer is
under a complete misconception as to facts. With tlie
sole object of placing you right on the question at issue,
I take the liberty of addressing you.
To begin, you say that the number of students attend-
ing Laval L^niversity, of Quebec, "became fewer and
fewer each year." Now, a reference to the annual an-
nouncements issued by the University prove the exact
opposite; consequently, the reason advanced by )ou for
the establishment of the Laval liranch in Montreal is
not the right one.
Laval University was founded in the city of Quebec
at the request of all the bishops of this province, and with
the understanding that there should be no other Cat/ioi'ie
University established in opposition to her. Later on
Monseigneur Bourget, then Bishop of Montreal, supported
by the professors of the .Montreal School of Medicine, in
affiliation with A'lctoria University, of Coburg, applied to
Rome asking for a Catholic University in Montreal, giv-
ing as a reason that the absence of a university forced
the school into an affiliation with Victoria, and that this
affiliation with a Protestant university was scarcely in
accordance with Catholic precedent, and was absolutely
dangerous from a Catholic standpoint. Rome having
long ago decided that one Catholic university in the Pro-
vince of Quebec was sufficient, and knowing that Laval
had been founded on this understanding, in response to
this application of the bisho|) and professors, issued the
now famous decree of February, 1S76, and it was in
obedience to this decree that the authorities of Laval es-
tablished their branch in the city of Montreal. In the
year following faculties of theology, lavv, and medicine
were formally organized, and all the professors of the
School of Medicine, affiliated with A'ictoria University,
received ajipointments in the new medical faculty of the
Montreal Branch of Laval University.
Shortly afterward, owing to a dispute as to details, a
majority of these same professors separated from Lavil
to continue their school of medicine under its old auspices.
So much for the origin of Laval University in Quebec
and its branch in Montreal.
I now come to your remarks on the legal aspect of the
question.
No action was ever taken by tlie Montreal School of
Medicine to the Privy Council in England. An action
taken before the Superior Court in Afontreal against the
University of Lax-al, some three years ago, may be con-
sidered as discontinued, and as a matter of fact was never
brought up in open court at all. The School of Medicine
did, however, take the legal opinion of Sir Farrar Her-
schel in London, and that is all.
The University of Laval, on the contrary, in order to
set aside all doubts as to the legality of her j^osition in
Montreal, appealed to the Parliament, and in sjiite of
every opposition on the part of the School, a bill was
passed by the Legislature of the Province of Quebec to
set aside all doubts on the subject. This bill received
the sanction of the Lieutenant-Governor, and notwith-
standing a further factious opposition by the School, the
bill was maintained in Ottawa by the Covernor-General.
Therefore, the Montreal branch of Laval University
is not, as you erroneously infer, an illegal body. On the
contrary, its diplomas are strictly legal. The '• College
of Physicians and Surgeons" of this Province has conse-
(piently never had the slightest reason for withholding
his license from bearers of the Laval diploma.
Furthermore, Rome, seeing that they who had made
representation in the first place that the affiliation with a
l^rotestant university was dangerous to the faith of their
Catholic students still continued the said affiliation, and
in addition did all in their power to injure the branch
of Laval opened in Montreal, issued another decree,
that of February, 1883, reciuiring the immediate and com-
plete fulfihnent of the prsvious decree of 1876, and in
addition, ordering that all efforts to injure the LTniversity
of Laval and its Branch, should forthwith cease, and that
all good Catholics should aid in every way possible.
In order to conform to this decree, acknowledged by
all Catholics as obligatory, the Bishop of Montreal has
issued his mandate to the Sisters of the Hotel-Dieu, to
receive the Laval professors and students into their
hospital, in jilace of those of the School of Medicine in
affiliation with Victoria.
The Sisters do not refuse to obey their Bishop, as you
assert, on the contrary they have transmitted his order
to the ])rofessors of the School, declarmg at tlie same
time their intention of abiding by his mandate.
The School again in its turn appealed to all the Bish-
ops of the Province in Council assembled. The Arch-
bishop of Quebec, the Bishoj) of St. Hyacinthe, and the
Bishop of Pembroke were charged by the Council with
the execution of the Papal decree, and are at the pres-
ent moment in Montreal, in furtherance of this object.
Hoping you will, by the publication of this letter, cor-
rect the many errors into which you have doubtless quite
unintentionally fallen, I beg to subscribe myseff', Mr.
Editor,
Your obedient servant,
E. P. Lachapelle, M.D.,
Secretary Med. Fac. Univ. Laval, Montreal, and Treasurer
0/ Coll. r/tys. and Surg., Prjv. of Quebec.
Montreal, May 29, 1883.
[We have considered all the points in the above letter
of Dr. Lachapelle, and must say that he has not con-
vinced us of any material incorrectness in our editorial
of April 2Sth on the above question. It is useless for
Laval to assume any other reason for coming to Mon-
treal than that of extreme poverty in Quebec. It is an
accepted truth that for good prospects in teaching facili-
ties we require an increasing commerce and population,
which bring with them hospital material and wealth to
maintain it : and Quebec, unfortunately, has been losing
ground in both of these respects instead of increasing.
This is an acknowledged fact throughout the whole prov-
ince. It is quite true Laval obtained the passage of
a bill through the Quebec Legislature to give the estab-
lished branch of its university m Montreal the semblance
of legality, but it must not be forgotten that the local
government of Quebec has not the power to set aside
the enactments of the imperial government, and upon
this point rests the illegality of Laval's position. We
also understand that the passage of such a bill in Que-
bec could not have been a very difficult matter, as the
will of the Archbishop of Quebec is law in such matters,
and the government is simply his mouthpiece. The ac-
ceptance of Laval's degree by the College of Physicians
and Surgeons as a legal document may be accounted
for by the majority of its members being also under the
influence of His Grace.- — Ed.]
Sir Henry Thompson on Cigarette Smoking.— In
a letter to The Lancet, Sir Henry Thompson states that
if cigarettes are smoked in a holder with a bit of cotton-
wool interposed they are less injurious than cigars or
pipes. Smoked in the ordinary way, held between the
teeth and smoked nearly to the end, they may be most
hurtful.
THE MEDICAL RECORD.
[July 7, 1883.
MIDDLE GROUND ON THE CODE QUESTION.
To THR Editor of The Medical Record.
Sir : I think that the following editorial from the SVc7c'
York Herald of June 25th, one very similar, which recently
appeared in the Ne7u York Tiiius, and others, which have
appeared in various papers of influence in ditferent parts
of the country, cannot be seen by too many of those of
our profession who are keeping up this, to most i)eoiile,
senseless qiiarrel about a "code " :
"A report comes from a town in Wisconsin that a lit-
tle girl was thrown from a carriage and liad her skull
fractured. An allopathic doctor was called in and treated
the case until the arrival of the family physician, who
was a homceopath. Soon afterward the young patient
grew worse and serious symptoms were developed, which
required special surgical treatment. As the homceopath
made no profession of surgical skill the allopath was re-
called ; but, on finding the former in attendance, obsti-
nately refused to have anything further to do with the case,
on the ground that he could not ' consult with a homceo-
path.' Notwithstanding the earnest entreaties of the anx-
ious parents and the proffered withdrawal of the family phv-
sician, the allopath deliberately abandoned the child in its
critical condition and, so far as he was concerned, left
it to die. He was ' a regular,' he said, and ' must ob-
serve our Code.' Nothing was then left to be done but
to telegraph to Chicago for a surgeon, who fortunately
arrived in time to save the young life.
" For the sake of common decency it is to be Iioped
that this barbarous illustration of the operation of ' the
Code ' is an exceedingly rare one. Yet it is but a logical
effect of the practical working of a theory which subordi-
nates the instincts of humanity to inhuman notions of
medical ethics, and holds tiie saving of iiuman life of less
consequence than the heartless subserviency to a petty
system of professional red tape. If the medical profes-
sion itself does not soon reform its ridiculous and un-
manly ' Code,' then it may be well to inquire whether
the law cannot prescribe a proper penalty for such of-
fenders as the Wisconsin 'regular.' In case of the
death of a patient under such circumstances trial of the
offending doctor for manslaughter might have a salutary
effect."
This discussion is rapidly losing us the respect and
friendship of the press and of thinking people outside the
profession, and transferring it, to a certain extent, to the
honiceopaths, who have not rendered themselves liable
to the same obloquy. Our enemies could not have de-
vised anything more injurious than this. It is useless
for us to attempt to explain to what will soon, I fear, be
considered an outraged public, the status of the question
from our standpoint. They cannot and will not under-
stand our position or our explanations. There are fools
in all professions, and the " Code " is more apt to develop
such instances as the above, among t/uiii, to the damage
of the profession, than to prevent harm by its stringent
regulations.
The ''Code'' refers to a good many [joints, but the
discussion, with unanimous consent, seems to have
narrowed itself down to one point — consultation with
honxBopaths. WsW, consultation with homceopatiis thirty
years ago, was an absurdity, and no respectable physician
thought of it. But the homoeopathy of the present day
is quite a different aftair, and consultation with a well-
educated lionneopath may be as pleasant to the physician
and as profitable to the patient as with one of the regular
school. Dr. Flint, the honored e.xponent of the old Code,
would have us believe that one who consults with a
homceopath connives at fraud. He says, in substance,
let him drop his special designation and call himself simply
physician, and one may consult with him. Well, how
many signs do we now see in New York with the designa-
tion homoeopathic on them ? Very few ; they are rapidly
disappearing. The better class of homceopalhic phy-
sicians are repudiating the designation, so far as it indi-
cates exclusive belief, in a particular dogma, or reliance
on any exclusive system of practice, either shnilia simili-
bus curantnr, or the employment of infinitesimal doses.
They seem to be ambitious to be called simply physicians,
while we, on the other hanti, for some time past, at least,
have been graduallv admitting that the practice of homce-
opathy is not all fraud or humbug ; and that in some
cases medicines do act on the homceopathic principle,
and also that very minute (if not infinitesimal) doses of
many of our drugs when thoroughly triturated in the
machinery of the homceopathic pharmacists, act in many
cases far more pleasantly and satisfactorily than in their
crude form. Witness Ringer's works, now so popular,
and the frequent articles in our journals on minute doses,
from the pens of some of our ablest practitioners. The
absurdities, and worse, the falsehoods of many of the
earlier homceopaths, claiming impossible successes, so
disgusted us that we naturally scouted the whole matter
as fraud and trickery, and did not until of late years give,
if we have yet given, the system a fair clinical test. Our
codes, in all the societies with which I have had any ac-
quaintance, have been a failure. I.et us sweep away all
codes as the easiest solution of this very serious disagree-
ment in the profession. If a physician should so far forget
his selfrespect and the dignity of his profession as to
consort and consult with irregulars and disreputable in-
dividuals, made M.D.s perhaps by the legislature, he
would soon find that he had seriously compromised his
standing with his colleagues, and could be summoned
before the bar of his medical society on the charge of
conduct unbecoming a physician and gentleman, and
punished just as efiectually as if the Code were in exist-
ence— indeed, I think more so.
Our younger and rising men, if they would not lose the
esteem and confidence of their friends outside of the pro-
fession, must stir themselves, and with the aid of their
elaers who are not too old to learn new things, abolish
codes as so much rubbish of a by-gone age. Let the New
Code men abandon their position, and the Old Code men
theirs, and meet on a common platform on which all
gentlemen belonging to the great profession of medicine,
not homoeopathy or allopathy, ought to be able to stand
together.
Harmonv.
THE NEW YORK POST-GRADUATE SCHOOL
AND THE ABUSE OF .MEDICAL CHARITY.
To THE Editor of The Medical Record.
Sir: In a letter signed "'Itis," and published in a re-
cent number of your journal, under the heading " I'oly-
clinics, Post-Graduate Schools, etc., and their Relation
to the Medical Profession," the writer descants upon
" the perversion of charity and the development of
pauperism among patients wlio are amply able to pay,"
and protests " against any institutions whereby his (our)
means of gaining a livelihood are materially and even
seriously compromised. '
As the well-defined charges and statements of tlie
letter may create some misapprehension in medical cir-
cles, it may be proper to state that the New York Post-
Graduate .Medical School has from the beginning of its
career, persistently advocated, and rigidly adhered to a
high standard in the dispensation of its charities, to
which, doubtless, is largely due the material support it
has secured from the physicians of this city and its en-
virons. But the relations of the patients to the school
can best be shown by its printed rules, which are to be
found on the cover of each prescription-book of the In-
stitution.
Rule No. XI. sa\-s : " .\ny person applying for med-
ical or surgical relief, who, in the opinion of the Secre-
tary, is able to pay a reasonable sum for advice and
medicines, shall be so infornieii, and (unless it be a case
of emergency) referred to private sources for them. No
IJerson who is able to pay a reasonable amount for both
July 7. 18S3.]
THE MEDICAL RECORD.
advice and medicines shall be entitled to the benefits of
this institution. The physicians generally shall have
l)0\ver to reject unworthy applicants." Nor is this all.
Each patient is expected to pay for such medicine as is
ordered by the physician, and the average price that has
been paid for each prescription dispensed at the phar-
macy of the School (based on the first one thousand pre-
scriptions, and including those dispensed gratis to the
absolutely impecunious) has been more than sixteen
cents, an average price that would jjrove remunerative
to many of our ordinary city druggists.
Individual opinions may differ as to whether the New
York Polyclinic or the New York Post-Graduate School
are necessary or "unnecessary," but it is a matter of fact,
that medical men from far and from near in our country
have seen fit to patronize them, and in sufficient num-
bers to place their finances on a satisfactory basis.
I am, respectfully yours,
Thomas E. Satterthwaite, AE.D.,
Secretary of the Faculty.
213-215 East Twenty-Third STRKKr.
"CHLOROFORM NARCOSIS DURING SLEEP."
The article with the above title recently contributed to
our columns by Dr. J. H. Girdner has called forth con-
siderable comment. As a continuance of a discussion
of the subject we group the following communications :
To THE Editok of Ths Medical R cord.
Sir : Having read with interest the paper by Dr.
Girdner on the above subject, I beg leave to take issue
with the gentleman, having myself, in a number of in-
stances, produced chloroform narcosis in children, ad-
ministering the same while they were asleep and making
my examination or operating without the child ever hav-
ing been aware of the handling it had received. In one
case I particularly call to mind, a child, six years of age,
having hrematuria in which a polypus was suspected, the
child was anesthetized upon six or seven distinct occa-
sions for examination and operation, and after each
sitting was left sound asleep, not knowing what had
taken place when she again recovered consciousness. I
have also had occasion to employ the aniesthetic during
sleep in a number of cases while house-ph}sician in the
Mount Sinai Hospital in New York.
I am, yours, etc.,
L. E. EoRCHEiM, M.D.
Atlanta, Ga.
7'o the Editor of The Medical Record.
Sir : Kefore the evidence is all in, and the case sub-
mitted to the jury, I would offer the following as a
fragment of " evidence '' in favor of the possibility of
bringing a sleeping person profoundly under the effects
of chloroform without his first being aroused to con-
sciousness. In 1S56 I was requested by my then part-
ner. Dr. I. S. Dolson, of Bath, N. Y., to see with him a
case in which a bright boy, of about four years of age, in
his play had fallen and received quite a severe wound of
the face. To avoid an unsightly scar it seemed very desir-
able to carefully stitch the wound. Voluntary submis-
sion on the part of the child was found impracticable,
and the mother was equally averse to the child's oppo-
sition being overcome by force.
At my suggestion it was decided to try the use of chlo-
roform while the child would be asleep, to aid us in
our work. Accordingly, late the same evening, we again
visited the patient, and found him in the condition de-
sired.
Without delay I stole quietly into his room, the lights
being well turned down, and by gradual approaches I
brought a napkin saturated with the anaesthetic to the
child's face without exciting cough or the contraction of
a muscle. In a few moments the patient was fully under
its influence, and the little operation satisfactorily per-
formed by Dr. D. The child slept quietly through the
night, and wondered the next morning how he came by
the big plaster on his face.
This was the first and last attempt of the kind I ever
made ; and had no other thought than that it would be
practicable in all cases, until the late prominent discus-
sion of the subject in The Recorp. Success in this
direction is only attained bv the most careful and delib-
erate manipulation on the part of experienced physicians,
and even then it seems that some fail, and I have little
confidence in the sensational newspaper reports of burg-
laries committed after the inmates of dwellings had first
been " chloroformed " by the robbers.
Can any one give us a well-authenticated case of this
kind ?
H. C. May, M.D.
Corning. N.V. .
To the Editor of The Medical Record.
Sir : Observing in your issue of .May 26th, Dr. S. Mu-
rill's report of a case of " Chloroform Narcosis During
Sleep," stimulates me to write of a similar case which
occurred in my own practice.
April 30, 1S71, I was attending Walter McF , aged
four years, for morbus coxa:-. An abscess having formed,
and the little fellow having been under treatment for
some time, very naturally had become exceedingly sensi-
tive and irritable. In order to open the abscess, I finally
concluded to try to transfer him quietly from a natural
sleep to a chloroform sleep, and requested the assistance
of Dr. AL .v. Halsted. We were quite successful in the
first attempt, but, another abscess having formed, we were
not so successful in a subseiiuent attempt.
We hear much more about "chloroform narcosis dur-
ing sleep" through the lay press than we do through the
medical journals ; but it is evident that Dr. MuriU's case
and mine, and probably many others not reported, prove
that such a thing is not impossible.
W. F. MoRG.\N, M.D.
Leavenworth, Kansas.
CONCERNING MEDICAL DEGREES IN (;RE.\T
BRITAIN.
To the Editor of The Medical Record.
Sir : If your London correspondent will refer to The
Lancet, May 19, 18S3, page 870 (and throughout that
journal, passim), he will see a critique on a translation
of a German work on practical anatomy, by Donald Mac-
allister, M.B., who, in this article, is always spoken of
as Mr. Macallister. What then becomes of his statement
that I am incorrect in saying that an M.B. is not entitled
to be called Doctor ? l' maintain that he is not. He is
sometimes called Doctor in pure courtesy, and nothing
more, as licentiates of colleges of physicians are likewise.
I do not at all forget that the word physician is used
in a different sense in England from what it is in America.
Your correspondent seems to think that no one is a phy-
sician but a consultant. But any one licensed to practise
medicine is a physician, according to common sense and
the ordinary meaning of the word. He says the posses-
sion of L.R.C.P. does not make the holder of it a phy-
sician. Then there is no meaning in language. You
will see from the following extracts from the register of
the King's and Queen's College of Physicians in Ireland
how far his remarks apply to the licentiates of that body :
" Every candidate before admission as a licentiate
solemnly 'declares . . . that he will not engage in
any trade . . ■ woi compound nor dispense tnedicine
for sale. If he be an apothecary he must, previous to
examination, surrender the apothecary's certificate. . .
By ancient usage in this country, analogous to 'Rev.' in
the case of a clergyman and • Esq.' in the case of a bar-
rister, the title of ' Dr.' has been applied to a physician
as distinguished from that of ' Mr.' to a surgeon."
In the above extract the term physician is obviously
used to denote one who holds the license of the college.
24
THE MEDICAL RECORD.
[July 7, 1883.
and when he receives it the college causes to be put in
the newspapers an advertisement to the effect that ,
having been duly examined, has been admitted a licentiate
and received authority to practise as a pliysUian.
I did not say that '-gentlemen who are only M.B. are
addressed as Mr." What I said was " tlie M.B. can only
call himself Mr." — a very difl'erent thing. Your corre-
spondent should quote more carefullv. If those M.B.s
who, according to him, modestly assume the title of doc-
tor continue to do so after the new bill becomes law,
they will render themselves liable to a penalty of ^20
(vide Lancet, May 12, 1883, p. 849).
Apologizing for trespassing so much on your space,
especially as the whole subject is vox et pririerea nihil,
I am, sir, vours faithfully.
N. V. D. P.-^RKS, RA.Dub., L.K.Q.C.P.I., etc.
.4SHT0N, R. I.
THE LEGAL STATUS OF THE PROSPECTIVE
JOITRNAL OF THE AMERICAN MEDICAL
ASSOCIATION.
To THE Editor of The Medical Record.
Sir : There is a vital point, it seems to me, on which the
Board of Trustees of the American Medical Association,
to which is entrusted the publication of its journal, failed
to give information. If the journal is to assume the place
claimed for it, its publication, with all that appertains,
involves a very large financial enterprise, such as can
only rest securely upon a solid legal basis. So far, if that
body is an incorporated one, I liave not been able to
learn when or where it became such. If it is not, it
seems to me the so-called Board of Trustees, consisting
of a member trom each State, and appointed to start and
conduct the journal, has no legal existence whatever ;
that they utterly lack the power to make the association
or its members financially and legally responsible for its
acts ; and that as such trustees they can neither sue nor
be sued.
I write for the purpose of calling attention to this mat-
ter, fearing we may get into a muddle, ^'ery likely, be-
fore the enterprise is on its feet, it will be found best to
have the association incorporated, or to form a joint-
stock company, under the statutes of the State in which
the business is to be transacted. In sucli a case it will
probably be found that the trustees must live in the
county or State where the business is e.xecuted, and that
a board with a member from each State is not practical.
It may be that I am alone as to my ignorance in this
matter, but I suspect there are many others who would
like information on the subject.
J. W . Ha.mii.tox.
CoLU.MUl s, O., June iS, 1883.
A PERFECTLY DEVELOPED ft[ALE CHILD
WITHOUT A PLACENTA.
To THE Editor of The Medical Record.
Sir : Thinking that a short history of this case may be of
interest to many of your readers, and desiring to learn
from them if any similar case has occurred in their prac-
tice (having searched the te.xt-books in vain), I take the
liberty of requesting sjjace in your valuable journal for its
insertion.
November 14, 1882, I was summoned to Mrs. C ,
a well-formed and healthy woman, aged thirty-eight, a
primipara.
Found the patient suffering from labor pain ; i)ulse,
120 ; s(^me vomiting ; respiration rapid, and considerable
cedema of tiie lower extremities. Vaginal examination
revealed slight dilatation of the os, the vertex presenting.
A specimen of urine was obtained and examined for al-
bumen with negative results. Previous history of patient
very good, having menstruated at the age of fourteen,
and continued to do so regularly without jiain until
fecundation occurred nine months previously.
The pains being unsatisfactory, I left the patient, say-
ing I would return soon, .-^t 11.30 a.m., about one hour
after I left the sick-room, I was called in great haste to
the patient, messenger saying she had a fit. Arriving at
the bed-side found her in a very violent convulsion, which
I learned was the second in half an hour.
Inhalations of chloroform were resorted to, which had
the effect of modifying the severity of the spasm, for the
time at least ; full doses of bromide of potassium and
chloral were administered, but without eflect ; the con-
vulsions returning about every twenty minutes. Repeated
efforts to dilate the os uteri failed, Barnes' dilators and
the douche being frequently applied in vain, the uterus
being anteverted, and the os extremely rigid. At 2 p..m.
a hypodermic injection of sulphate of morphine com-
bined with atropix' sulphas was administered, the bowels
having been previously moved.
A marked diminution of the spasms immediately fol-
lowed the injection, the convulsions not returning up
to 4 P..M., but the patient remained unconscious from
the first convulsion. At 4.30 p.m. had her thirteenth
convulsion. Morphia was again administered hypo-
dermically, but as ix-dema of the kings set in and the
respirations reduced to 14 per minute, the morphia was
suspended and the convulsions returned, the patient
slowly sinking. .•\t 5 p..m. a consultation was iield,
when the case was deemed hopeless. All efforts to
dilate the os had to be abandoned. Distinct move-
ments of the foetus being observed up to 5 o'clock p.ji.,
a request was made to remove the child by Cesarean
section, but was refused. .\t 6.30 p.m., pulse 100 and
feeble ; respiration. 17 ; temperature in the axilla, 99J" ;
patient rapidly sinking until 7.15 p..m., when she died
after her twenty-second convulsion.
In about one hour after the death of the patient I was
requested to take the child from its mother, some scru-
ples on the part of friends demanding the separation of
the child before interment. I accordingly commenced
the operation by abdominal section. On reaching the
uterus careful section of that organ was made, when a
fcetus was observed partly immersed in an inky-black
liquid. An effort was now made to remove the child,
but as something seemed to hold the ftctus firmly, I in-
serted my hand into the cavity of the uterus, when I found
the cord very rigid and unyielding. Having severed this
obstacle, a perfectly formed male child, weighing about
twelve pounds, was removed. Search was now made
for the placenta, but without success. There was no
placenta. The umbilical cord was found attached to the
fundus of the uterus, and the length of the cord did
not exceed four inches.
Permission to remove the uterus for examination was
refused, and as every movement in connection with the
operation was most earnestly and critically watched, I
found it impossible to gain possession even of that por-
tion to which the cord was attached. I did succeed,
however, in dividing ////y particular part, but failed to ob-
serve any marked difference between it and that portion
of the organ previously divided.
The amniotic fluid, which was excessive, measuring,
I should say, over three pints, was exceedingly black,
but in other respects normal.
^'ALENTINE BrOWNE, M.D.
VO.NKERS, N. V.
THE WAY OUT OF THE MUDDLE.
To the Editor of The Medical RiicoRD.
Sir: In The Medical Record of May 19th is one of
the most remarkable articles it has ever been my privi-
lege to read, although accustomed to |)eruse and digest
medical literature for more than twenty-five years.
It is head-lined " Inebriety from Obscure Physical
Causes," by T. D. Crothers, At.D., Hartford, Conn.' He
slates that he had jireviously written an article on the
same subject. If the doctor had been familiar with
drunkenness in its difierent degrees, and had seen its
July 7, ^8Ss.]
THE MEDICAL RECORD.
25
everyday manifestations, he certainly would never have
given expression to thoughts so widely at variance with
the true inwardness of the matter. True, he claims to
have discovered something new, if understood aright,
and presents an array of cases, without names or [jlaces,
to be used in an argument which proposes to remove
the subject from the low plane of drunkenness, with all
its horrible concomitants, to a level much more elevated
and respectable, wlien the inebriate will be no longer
known, as heretofore, but transformed, if not into a lov-
able, at least into a most unfortunate disease-afflicted
person. No doubt this phase of inebriety would be quite
acceptable to all excessive drinkers, who still have one
spark of manhood dwelling in their bosoms.
It is the very thing every one of them would be pleased
to have other people believe; and hence, every one,
without a solitary exception, perhaps, would give some
cause outside of the true one — a love of liquor — to ac-
count for their fallen, degraded condition. This is a part
of human nature, and with the fallen ones of mankind
it seems to be intensified. ^Vho ever heard of an evil-
doer, in any of the ways of transgression in this life, that
did not have an e.xcuse to offer for his waywardness —
somebody or something to blame for the first false step ?
It has been ever thus since the day when father Adam
so far forgot his manhood as to charge the responsibility
to his helpless help-mate, and it doubtless will be to the
end of time.
Now comes an excuse for the drunkard, more satis-
factory to him than imagination could ever have pictured
in his wildest flights of fancy.
Judging from the responses reported to have been re-
ceived from A, B, and C, the doctor's former connnuni-
cation must have been a real godsend, enabling them
to happily find their way out of what had heretofore been
considered an inexplicable difficulty.
\\'ere these views endorsed by the medical profession,
it would give increased charms to the licentious indul-
gence of strong drink, and would atTord all the protection
and encouragement that the most ardent toper could
desire. If they are unsound and without any foundation
in truth, then they cannot be otherwise than detrimental
to the best interests of everv connnunity, and should not
be promulgated broadcast without a challenge from med-
ical men, who view the subject from a standpoint as
ditl'erent as day is from night. Besides, it must be patent
to every one that some unscrupulous doctor may take
hold of this new discovery and ply it to his own selfish
advantage in manufacturing a reputation and coining
monev, under the pretence of being a step in advance of
his medical co-laborers ?
Now every medical man is deeply interested in the
truthful solution of .this question; for, if the views set
forth by the doctor are correct, then the profession was
never so befogged and benighted on any subject since it
hail a beginning. This is a progressive age in all de-
partments of learning. And in this race after something
better and more perfect, medical science, in the past few
years, has far eclipsed all others.
Still it must be admitted that only the threshold of
medical research has been attained, and before the Ultima
Tliiile of medical knowledge shall have been reached there
can be no doubt that many things now held to be settled
. in accordance with truth will be set aside as unwor-
thy, under a stronger and more searching light. With
thoughts altogether impartial every new thing in medicine
should have a fair consideration, and be weighed in the
balance. Actuated by such motives, the attention of
The Record readers is invited to a careful study of the
article in question.
Being reared, and having lived all his life in comnnmi-
ties wheie drunkenness was no uncommon thing, the writer
has had a most favorable opportunity for studying it under
many different circumstances, and in all its phases, not
theoretically, but practically and clmically. The caption,
and many expressions throughout the doctor's article, to
say nothing of the main drift, sound very strangely in-
deed to one thus educated.
He says, for instance, there were "a number of cases
in whom the causes of inebriety were unknown to the
attending physician.'' How strange, when it cannot
possibly be assigned to but one cause, the firm hold of the
liquor habit. Further, that " the inebriate is not an
enemy to society or civilization, but the victim of physical
conditions:" "that inebriety is not a vice but a disease
to be cured by treatment." Eight reported cases are
given in the article published, to prove this proposition,
and to place the subject " above the levels of the theories
of reformers and clergymen."
With an eye single to the development of truth, and
the general welfare of humanity, these cases have been
thoroughly studied and analyzed several times, to see if
there was really anything whatever in them ; and a strict
regard for what appears to be right and proper in the
matter compels me to declare, unequivocally, that there
is no difference between these reported cases and the
thousands of others that have come under my own innnedi-
ate notice, and about which information has been received
from other sources. In other words, these cases portray
a faithful picture of drunkenness, through all ages, from
Noah's fall down to the inesent. Either ail cases of
drunkenness come from "obscure jihysical causes," or
else these reported cases, like all the rest, must be at-
tributed to the true cause, liquor, at first taken for its
pleasurable efTects, growing into a confirmed habit by
repetition, and finalh', getting away with them morally,
mentally, physically, financially, and in every other way
of which it is possible to conceive. No wonder the
doctor's cases were changed from good, intelligent, moral,
trusty persons, to characters directly the opposite. Such
has been the history of intoxicants, where the)' have held
sway, in all bygone time. When a person loses self-con-
trol, and gives way to strong drink, his character under-
goes a complete change ; and he is left an absolute wreck
of former manhood, as every one must know who has
much contact with drunkenness.
It was intended in the begining to give an analysis of
these reported cases, but time and space forbid. Neither
is it necessary, since those who may see fit to read this
article can refer to the number of The Record indicated
and judge for themselves. If they shall do so, the object
of this article will have been accomplished.
It is said, " a whole volume could be filled with such
cases,'' and this is not doubted in the least ; for sixty
thousand drunkards, including laborers, farmers, me-
chanics, merchants, lawyers, doctors, preachers, take
their exit to the unseen world every year. .■\nd the
question is asked : What shall be done to stay this ter-
rible evil ? What the means and remedies ? The an-
swer is given : Abstain from intoxicants of every descrip-
tion, as this is an infallible cure and the only one that
has stood the test of time. To one who has lost self-
control this is not an easy thing to do, by any means ;
indeed, there are many cases so entirely wrecked that it
would be next to impossible for them to emancipate
themselves, unaided, from this terrible habit, which holtls
with a force more vice-like than any other known.
This unfortunate class need help from their sober-
minded brethren. They need treatment, it is true, but
not to rid them of disease produced from "obscure phys-
ical causes." There is no sense in hunting for "ob-
scure causes" when liquor is seen to be wrecking every
one, on every hand, who dares to contest its strength.
The treatment they need, and the only kind that will
meet the case, is to remove them beyond the influence
of this mighty destroyer. How to do this, then, is the
practical question, and one that comes home to every
lover of his race. Many good people are now engaged
in trying to solve this problem.
One way to meet the case, and it appears quite prac-
ticable, is for the general Government to establish one or
more inebriate asylums in every State, or enough, at any
26
THE MEDICAL RECORD.
[July 7, 1883.
rate, to satisfy the demand. Let these asylums be regulated
on the same plan as insane and other asylums, and receive
their patients under the same rules as adopted by those
institutions. Once within the asylum walls the toper
would be free from his besetting vice, and under a little j udi-
cious toning up, in most cases, would soon realize the
true state of the case — a thing not appreciated by him
for weeks, may be for months and years before.
This treatment is in accordance with the doctrine, re-
move the cause and the effect will cease, and it certainly
is a very sound, common-sense princii^le. Should other
e.xpedients be found necessar)- in connection with this
place, the double-cliloride-of-gold treatment — whatever
that may be — could be tried. Not having had any per-
sonal experience with that (jarticular medication, of
course it is not herein endorsed, but it may be said, how-
ever, that reformed inebriates who were subjected to the
treatment speak in the highest terms of its success.
Very likely it acts on tlie principle of breaking a dog
from sucking eggs by giving him, along with them, some
tartar-emetic.
Another plan that will mitigate the evils of intem-
perance is to raise the liquor license so high as to
practically strangle the traffic, and let it die a slow but
tolerably sure death. Failing in these, tiie more radical
plan of prohibition could be tried as a dertiie)- rrssort.
The adoption of one or more of these plans, it is confi-
dently believed, would meet the case, and save further
trouble on the score of the " obscure physical cause "
theory. It is hoped the questions have been answered,
if not to the satisfaction of the doctor, at least in accord
with the dictates of common-sense, which, after all, is a
most excellent guide to follow, and will verv surely lead
one out of the inebriate muddle.
B. F. H.\RT, M.D.
Brownsville. Mo.
Jivmy IJ'^iys.
Official List of Changes of Stations and Duties of Officers
of the Medical Department, United States Army, from
June 23, 1883, to June 30, 1883.
S.MART, Charles, Major and Surgeon. Assigned to
duty ill the office of the Surgeon-Cleneral, L'. S. .^rmy,
and in addition to his duties in the Surgeon-General's
Office will continue to serve as a member of the National
Board of Health. S. O. 147, par. S, A. G. O., Tune 27,
1883.
BiART, Victor, Captain and .\ssistant Surgeon. .As-
signed to duty as post surgeon at Fort Sisseton, D. T.
S. O. 102, par. I, Department of Dakota, June 13, 1SS3.
WiNNE, Charles K., Captain and Assistant Surgeon.
Assigned to duty as ])OSt surgeon at Fort W'infield Scott,
California. S. O. 69, ])ar. i, Department of California,
June 19, 1883.
WoRTHlNGTOX, J.\MF.s C, Captain and Assistant Sur-
geon. Assigned to duty at Cantonment, on the Unconi-
pahgre, Colorado. S. O. 128, par. 4, Department of the
Missouri, June 21, 1SS3.
Everts, Edward, First I>ieutenant and Assistant Sur-
geon. Relieved from duty at Fort CLCur d' .MOne, and
assigned to duty as post surgeon at Fort I.apwai, Idaho.
S. O. 81, Department of the Columbia, June 14, 1883.
Strong, Norton, First Lieutenant and .Assistant Sur-
geon. Relieved from operations of S. O. 42, par. 2, C.
S., Department of the Platte, and assigned to duty with Bat-
talion of Infantry now on duty between Forts Thornburgh
and Bridger, \\'yoming. S. O. S3, par. 2, Department
of the Platte, June 21, 1883.
To be -Assistant Surgeons with the rank of Captain,
after five years' service, in accordance with act of June
23, 1874: Victor Biart, William W. Gray, Louis Brei he-
min, Louis A. LaGarde, Junius L.Powell, .Assistant Sur-
geons, June 6. 1 883. A. G. O., June 25, 1SS3.
BXcrtical Items.
Contagious Diseases— Weekly Statement.— Re-
port of cases and deaths from contagious diseases re-
ported to the Sanitary Bureau, Health Department, for
the two weeks ending Tune 26, 1883 :
Week Ending
Cases.
June 26, 1S83
July 3.1883 o
Deaths.
June 26, 1883 O
July 3>i883 o
> 1)
o.--
* -3
0 =
= 0
0)
a =
CI. Q.
2s
■— r^
72
U
0 II
61
4
0 7
74
6
16
23
A
«
X
c.
rt
ffi
s
■^
■s.
87
39
0
91
20
0
18
1 1
0
22
16
0
Good Advice to Travellers in Need of Medical
Advice. — Dr. C. W. Chancellor, in a recent letter from
Geneva to the Baltimore Day, gives the following excel-
lent advice to European travellers : " I feel I would be
but ill acquitting myself of a duty were I to fail to ad-
minister an admonition to those of my compatriots who
may one day journey into this land, and I hope they will
take heed to what I say, for it is wholesome. I would
strongly advise Americans who contemplate travelling
upon the continent to be very chary of patronizing phy-
sicians recommended by hotel or Ihutrding-house keepers,
concierges, porters, etc., etc., without first having in-
quired of tlieir consul or their banker, or some friend as
to the standing of the party recommended, for it not in-
frequently happens that these parties plot together ex-
clusively as a matter of personal gain, and without any
regard whatever for the well-being or interest of those
whom they advise. It would be well for persons visiting
Europe either to obtain the addresses of competent
medical men in the various cities they propose visiting
before leaving home, or on their arrival to get advice
from some reputable person out of business and above
taking a commission, otherwise tliey may have a tenth-
rate doctor introduced as the ' former physician to the
emperor,' the ' chief of the hospitals,' the 'doctor of the
.American Legation,' or some other high-sounding but
fictitious title, and they may be left. in his hands to be
robbed, maltreated, and perhaps murdered. Travellers,
in fact, should make it a rule to take any other physician
than the one proposed by a landlord or concierge or
courier, unless the medical man thus recommended be a
compatriot, or is endorsed by some disinterested person ;
and they should insist upon having the doctor of their
choice — if they have a choice — really sent for, taking no
excuse for any delay or neglect in regard to the matter.
There are reliable and veritable .American physicians in
nearly all the large cities of Europe whose addresses
can readily be found by consulting the Directory, which
is in the office of every respectable hotel, or by inquiring
at tlie nearest drug-store."
Vates Countv (N. \'.) Medical Societv. — .At the
annual meeting of the Yates County Medical Society,
held in Penn Yan, on Tuesday, June 5th, the following
gentlemen were elected officers for the ensuing year :
President, Benj. L. Holt ; Vice-President, D. M. Smith ;
Secretary, C. C. Harvey ; Treasurer, John .Malone)'.
The New Code was adopted by the Society unanimously.
Asylum Superintendents in Session. — The thirty-
seventh annual meeting of the .Association of Medical
Superintendents of .American Institutions for the Jn.sane
was opened at Xewport, R. I., June 26th. Dr. J. H.
Collender, of .Xashville. Tenn., presided, and thirteen
States, the District of Columbia, and the Provinces of
July 7, 1883.]
THE MEDICAL RECORD.
Quebec and New Brunswick were represented. Dr. H.
R. Storer, President of the Newport ^[edical Society ;
Dr. Foster Pratt, of Kalamazoo, Slich., and Dr. Darius,
of tlie Willard Insane Institution at Ovid, N. Y., were
presented to the Association. It was voted to invite the
members of the medical profession of Newport and the
vicinity, and the surgeons of the navy m that port to
be present at the sessions of the .\ssociation. The fol-
lowing officers were elected : President — Dr. John P.
Gray, of Utica, N. Y.; Vice-President— Hx. Pliny Earle,
of Northampton, Mass. The president then delivered
an address.
Plentifully Supplied with Doctors. — According
to a late estimate, Atlanta, Ga., has one physician to
every 277 of its population, or one to every 156 of its
whites, and one to every 121 of its colored population.
The ^\'ARREN Triennial Prize. — We wish to draw
attention to the Warren Triennial Prize for 1SS6. The
subject for tlie present year was "Chronic Bright's Dis-
ease (parenchymatous and interstitial nephritis);" "The
Nature and Mutual Relations of the Derangements in
the Circulatory and Secretory Organs." No award, how-
ever, has been made. Beyond that fact we are not in-
formed as t'o the character or number of articles pre-
sented for competition. It is to be supposed that the terms
were too restricted to draw out any great number of ar-
ticles. No complaint can possibly be made as to the nar-
rowness of the subject for 1S86. The terms of the compe-
tition are such as to give the widest latitude to literary
or scientific medical men, the prize being offered for a
dissertation on "some subject in physiology, surgery, or
pathological anatomy." The amount of the prize, $450,
and the wide range of subjects, ought to bring QUt work
of a high order of excellence. This is, we believe, the
largest prize offered in this country for general competi-
tion, and the physicians and surgeons of the Massachu-
setts General Hospital are, ex officio, the committee
who have the matter in charge. — Boston Medical and
Surgical Journal.
Resolutions on the De.ath of Dr. James L. Banks.
— .'\t the stated meeting of the New York Pathological
Society, held June 27, 1883, the following resolutions
were unanimouslv adopted :
Wlicreas, It has pleased God to remove from this world
the soul of our late associate, James L. Banks, M.D. :
Resolved, That we sympathize with his family in the
great loss which they have sustained.
Resolved, That we cherish his memory as that of an
intelligent and wise physician, a kind and genial com-
panion, and a conscientious, upright, and honorable man.
Resolved, That a copy of these resolutions be for-
warded to the family of our deceased associate, and that
they be published in the medical journals of this city.
Alfred C. Post', 1
Charles K.. Briddon, t Conunitiee.
John H. Hinto.v, )
Phvsiologv at Oxford. — The sum of $50,000 has
been voted for the erection of a physiological laboratory
for Dr. Bardon-Sanderson at O.xford.
The Harveian Oratio.v was delivered this year
(June 27th) by Dr. Habershon.
Hvpophosphites and Children. — Dr. H. Cullimore
thinks that the hypophosphites should not be given to
children between the ages of four and seven if they are
at all precocious and inclined to too much mental activity.
The Appoint.ment of General .\lexandek. Shai.er
to succeed Professor Chandler as President of the City
Board of Health is well received. It remains to be seen
whether he will have the courage to protect the city's
sanitary interests against the politicians.
The Opening of the Johns Hopki.ns Medical
School. — The trustees of the above institution design
to begin some work in the medical school without wait-
ing for the hospital to be finished. With this purpose in
view, Dr. Remsen has been designated Professor of
Chemistry, Dr. Martin of Physiology, and Dr. Billings of
Hygiene. -A chair on Pathology will be filled soon, and
lectures will begin October ist.
The Philadelphia Polyclinic has with great enter-
prise secured an organ. The ATedical Register will as-
sume the name of The Polyclinic (with a y) and will sup-
ply the long-felt want for a monthly medical journal in
Philadelphia.
The Edinburoh Medical School. — One thousand
guineas have just been voted by the Town Council of
Edinburgh, toward the building fund for the new Medical
Department of Edinburgh University. These new build-
ings, which are nearly comi)leted, are extensions of the
old, and will greatly increase the advantages of the
school.
A Modest Tribute to Pasteur. — The Publicateur,
a journal published in the arrondissement of Meau.x,
contains the following poetical tribute to Pasteur : " M.
Pasteur has the glory of being the first to bring knowl-
edge out of mystery and make it irradiate through the
Department of Seine-et-.Marne ; and every sheep which
grazes upon the fields sings the glory of the master, and
of science ! "
Trichinosis from e.^ting Horse-Flesh. — Several
.Austrian journals report the case of a woman who suf-
fered from trichinosis, caused, it is claimed, by eating
horse-flesh. The subject is being investigated.
Wandering Liver in a Man. — .-Vt the meeting of the
Society of Physicians of Vienna, June 4th, Dr. Felix
Schwarz showed a case of wandering liver in a man, a very-
great pathological rarity. There have been only two
cases in men and thirteen in women reported.
Chlorine Water in Diphtheria. — Dr. Caroline R.
Conkey, of Watertown, N. Y., sends us a very enthusi-
astic description of the value of chlorine water in diph-
theria. She writes : " In a late number of The Medical
Record, Dr. Binz, of Bonn, is quoted as predicting that
a remedy would surely some day be found which should
prove as effectual a specific antidote to diphtheria as
salicylic acid and quinine are to rheumatism and malarial
fever. Such an antidote, I believe, we already possess
in chlorine water.
"The importance of this agent was first brought to my
notice by Dr. Marshall Calkins, of S[)ringfield, Mass., to
whom, 1 believe, the credit of discovering this application
of chlorine water is due. Since then I have used it
with unfailing success in every case of diphtheria that
has come under my notice ; and claim its absolute effi-
ciency in curing the disease, provided, always, it can be
dealt with in the first stage ; i.e., before the membrane
extends into the larynx. My plan of treatment is as fol-
lows : Fresh chlorine water must be made every day
according to the following formula :
IJ. Potass, chlor 3 ij-
Acidi muriatici 3 j-
Aqua; 3 viij.
Into an eight-ounce bottle put the chlorate of potash ;
on this pour; the acid, and cork as quickly as possible to
prevent the escape of the gas. Add the water as hot as
convenient, at intervals. Dose : tablespoonful in an
ounce and a half of water, to be gargled and swallowed
every half hour in a severe case.
"This dose may be swallowed without gargling, if, for
any reason, that is impossible, and may be sweetened
to render it palatable to a child. The interval between
the doses may be lengthened, according to the discretion
of the physician ; in milder cases, being given every one,
two, or three hours, as indicated. When the membrane
extends into the nose or posterior nares, syringe with
the same solution.
"This constitutes mv entire treatment, and its success
28
THE MEDICAL RECORD.
[July 7, 1883.
is invariable. I insist upon the most nutritious diet.
Ever)' two hours nourishment in some form is given ;
and an even temperature of about 70^ F. constantly
maintained in the sick chamber, together with the most
thorough ventilation."
The history of an illustrative case is given.
[While we have no doubt of the efficacy of chlorine
water, it is necessary to remind our correspondent that
clorine water has been used before in diphtheria, and that
the same claims which she makes for it have been made
for a large number of other substances — and still diph-
theria e.xists and kills. We are inclined to think that the
case whose historv is given was one of follicular inflamma-
tion rather than diphtheria. — ^Ed.]
" Muscle v. Brain". " — This popular heading aptly illus-
trates the misconception that prevails in result of igno-
rance of the laws of physiological development. It is a
radical error to suppose that one part of the organism
can be or ever is developed "at the expense" of some
other. One part may be neglected while attention is
exclusively directed to another part, but the fault does
not consist in the overcare of the one, but in the neglect
of the other. It is important to recognize this, because
the phrase "muscle v. brain" would seem to imply that
if we have muscle we cannot have brain. It is needless
to remind those who understand the physiology of the
higher animal life that no such alternative is presented.
Each and every part of the body grows as it feeds. The
point which is too commonly forgotten is that it feeds as
it works, and in that proportion only. If any part is un-
exercised, it cannot possibly be nourished in such man-
ner as to produce full growth and good health. In the
training of youth it is especially necessary to bear this in
mind. To produce good brain tissue there must be
good brain exercise. The work done should not be
sufficient to exhaust the organ, or the faculty of recuper-
ation will be itself weakened and exhausted, and then
the function of repair will lag behind the function of
special activity, with the result of deterioration instead
of progressive development. The work done should
not, as a matter of fact, exceed such limits as regards
quantity or quality as shall suffice to stimulate growth
without exhausting. An overburdened or overworked
brain cannot be healthy, nor can one that is underworked.
Fatigue — we mean mental weariness — should not be in-
curred by the young ; that is, during the period of de-
velopment. The same rule applies to muscle cultivation.
Full exercise without exhausting fatigue is the best, and,
indeed, the only, stimulant of growth. Other things
being equal, the best organism, the healthiest man, will
be one in which both brain and muscle have been de-
veloped side by side by a process of educationary train-
ing in which time and strength have been so utilized as
to affijrd opportunity for growth in every direction, in
what we call mi/rd — i.e., brain function — as well as in
physical strength or muscle function. After the organ-
ism has passed through the stage of growth, and its
several parts have been finally formulated, there may
come a time when muscular activity will so drain the
strength as to impoverish the brain ; but this state of
matters is not reached until long after the educationary
period, and in a well trained organism it will never be
reached at all. — Tlie Lancet.
Transferred Impressions. — Dr. Jose|)h .\. .Stillwell,
of Hrownstown, Ind., writes : " Your editorial on ■ Tele-
pathy,' of May 26th, reminds me of an experiment I
made on a young man with delirium tremens. I was
alone with him in the night. He had stepped out at the
door to a vine trellis and was picking at the vines as if
he was searching for something. I concentrated my
mind on him with a strained effort. He raised from a
partial stooj) and asked me, ' What do you want ? ' Ik-
was about thirty feet away, and could not see me, nor
did I make any noise. He was outside, and 1 in tlie
house. His voice broke my effort for a second or two
when I renewed my attention with all the power of con-
centration I could command. He then in a sudden
move and with some impatience asked me ' What do you
want ? ' again, and turned and did take a step or two to-
ward me, but left his purpose and lapsed off. I again
gave him all my attention, when, like the others, just at
its culmination, or what seemed to be, he gave me his
sudden attention and said, with some vehemence, ' What
are you calling me so much for ? ' This might have all
happened only, but there was such an exact synchronous
motion on his part in response to my intense action, that I
have alwavs felt that I reached his mind with only this
mental act of mine. So much so, that, particularly
when he said ' calling,' I felt an alarm come over me at
my success that disqualified me for further effort. That
was twenty-seven or twenty-eight years ago, when I was
a medical student. Since that I have never met with a
case and surroundings, that I thought justified a renewal
of the experiment. "And while I have never regarded it
as concluding anything, now otter it in this connection."
Broken Thermometers. — In the matter of broken
thermometers, it is evident, we have raised a ghost that
we cannot lay. Dr. G. L. Chapman, of Polo, 111., writes :
" I took my thermometer-case to a jeweler and got a
small hole drilled through the bottom below the cavity
of the case and tied a small black elastic cord securely
to the bottom of the instrument and the other end to a
safety-pin. The cord being attached to the bottom need
not be more than twice the length of the case, and all
disappears when the instrument is returned, if carried in
the upper vest-pocket. The cord is lighter and cheaper
than a chain, and does not wear the pocket ; it does not
require a metallic case and staple to secure its attach-
ment, and is, I think, every way preferable."
An .A.rraign.vent of American Veterixarv Sur-
geons.— -A. person who called himself a veterinary sur-
geon read a paper recently before the Xew York Farmers'
Club,, in the Cooper Institute, on the diseases of cattle
and their treatment by veterinary doctors, whose methods
he condemned. There were, he said, on the farms of
the United States in June, 1882, 10,357,981 horses,
valued at $1,035,798,100; 1,812,932 mules, valued at
$181,293,200; 993,970 o.ven, valued at $49,698,500;
12,443,593 milch cows, valued at $321,089,725 ; 22,488,-
590 other cattle, valued at $562,214,750; 35,191,156
sheep, valued at $527,867,340, and 47,683,951 swine,
worth $476,839,510, making a grand total of the value
of dumb animals on farms in the country, $3,154,821,125.
This estimate, however, the lecturer considered by far
too low, and he felt certain that the value of dumb ani-
mals in the United States was about seven billions of
dollars, judging from the fact that some animals are held
at $50,000, as in the case of Damascus, just sent by
John W. Garrett, of Baltimore, to the K.ing of Italy. It
is a disgrace to the nation, the orator continued, that there
is not one legally chartered, organized, and established vet-
erinary college in the country, ^'eterinary science here
lies deep down in the ditch of ignorance, and the billions
of dollars invested iin animal property, as well as the ani-
mals themselves, are left to the mercies and wantonness
of chance. The country is flooded w^ith bogus diploma
mills, several of which are in this city and other parts of
this State. The speaker went on in the above strain, but
failed to mention wiiere the Xew York diploma mills are.
It is understooil that parties in this city do practically
sell veterinary diplomas, and it is to be regretted that
some definite facts were not given.
The REGiL.vriON of Prostitution. — The .Municipal
Council of Paris has lately addressed a letter to the Prefet,
demanding the immediate confiscation of the Lourcine
and Midi Hospitals, and the abolition of all the maisons
de tolerance in the city and the Department. .More
recently they have voted the suppression of compulsory
examination and treatment of women, and the abolition
of the police des maurs is under discussion.
The Medical Record
A Weekly yournal of Medicine and Surgery
Vol. 24, No. 2
New York, July 14, 1883
Whole No. 662
©viifjiuul Jirticlcs.
INFUSION OF JEQUIRITY, OR LICORICE
BEAN," IN INVETERATE PANNUS,
With a Report of Several Successful Cases."
By EDWARD S. PECK, M.D.,
SURGEON TO THE EYK AND EAR DEPARTiMENT OF THE NORTHWESTERN UlSfl-N-
SARY : VISITING SURGEON TO THE OPHTHALMIC DIVISION OF CHARITY HOSHTAI,,
NEW Y-ORK.
The treatment of chronic granulations and sarcous oiit-
grovvtiis of the conjunctiva and cornea has always been
a chapter of great interest to the physician and the pa-
tient. It has elicited the efforts of the best surgeons of
every country where affections of the lids and eyeball
prevail. In England, Germany, and the United States
clinical work in this department has been displayed from
ditierent standpoints. Within the past few years the di-
rection of applied effort has been in the establishment of
an acute ophthalmia in lieu of the chronic proliferous
catarrh of these structures. Chronic trachoma of the
eyelid and inveterate pannus of the cornea are the re-
sult of the same pathological processes, differing only in
location, but amenable to the same remedial agencies.
It will seem a strange statement, that a structure of so
low an organization as the cornea should be involved
in the same pathological processes as one of so high
a type as the conjunctiva. The cornea serves at once
the function of confining and protecting the contents of
the eyeball, and at the same time of refracting the first
rays of light which are transmitted to the dioptric sys-
tem ; while the conjunctiva, rich in nerves and blood-
vessels, serves merely as a lubricating and protective
layer. ;
It cannot be denied that the inoculation of eyes with
pus of various purulent ophthalmias has taken a more
and more prominent place in ocular surgery. It is well
known that the measure of success of the e.xperiment is,
vv-ithin limits, determined by the activity of the inocula-
tion. The experiments of Critchett, Lawson, and Bader
in London, of Warlomont in Brussels, of Abadie and oth-
ers in Paris, are entitled to highest praise in view of
their successes ; while, at the same time, the procedure
will always be unpopular on account of the severity of
the resulting inflammation and the natural repugnance
of the patient and operator. Such experiments ought to
be conducted only where a large number of trachomatous
patients are aggregated, and when there is a small i)er
centum of operations on the eye.
The report for 1881 of the Ophthalnnc Division of Char-
ity Hospital, Blackwell's Island, gives details of the favor-
able results of si.x experiments in inoculation, conducted
by the author of this paper, the tirst case of the series having
been presented as a contribution to this Society at its semi-
annual meeting in 1881, and published in The Medical
Record, July, 1881. Although I hold to the same opin-
ions as to the efficacy of this treatment, as a last resort
m all cases of inveterate pannus, yet I welcome the
proposition of any new remedy, whether of the min-
eral, vegetable, or animal kingdom, which shall do away
with the immense risks to the patient, the surgeon, and
the nurse, in the establishment of an artificial purulent
^ Abrus precatorius, Linn
= Read before the Vermont State Medical Society, convened in Rutland, Vt.,
June 13, 18S3'.
ophthalmia. Various aromatic infusions, and hot medi-
cated compresses have been used for this purpose, but
they all lack intensity and duration. The present agent,
which I show you in seed and infusion, is known by the
botanical name of abrus precatorius, of Linnjeus' clas-
sification ; the seed is called licorice bean (not the
licorice known in commerce) ; and in Brazil, where it
has been used for years in ophthalmic practice, the seed
is called jequirity (Fr.). The literature, all of which I
have at hand, with the exception of the first article,
written in 1867 in Brazil, is very meagre. This article
was a brief memoir, in the Portuguese language, calling
attention to the dangers connected with its use in eye-
practice. I may add, that I hope not only to secure this
initial article on the subject, but to interest the Secretary
of State at Washington, with the view of procuring all
the native medical and lay testimony upon the use of
the infusion in ophthalmias in Brazil. If we have here
an agent which, in the majority of cases, will prevent
blindness and helplessness as a result of inveterate pan-
nus, it is an object of popular charity to acquaint our-
selves with its history, preparation, and application.
The infusion has .been prepared of various strengths.
That used in the Northwestern Disi)ensary and Charity
Hospital, New Yojk City, was prepared as follows : Take
of the fresh seeds 32, or 3.2 grm. ; macerate in 500
grm. (i6f 3 ) of cold water for twenty-four hours; add
500 grm. of hot water ; when cold, filter, and pre-
serve in well-stoppered, dark-colored phials. When fresh
the solution should be clear and odorless ; after stand-
ing a few days it becomes opalescent, and, what the litera-
ture in every instance fails to mention, it acquires a brack-
ish, mawkish odor. In an experience of seventeen cases
I have found that if the solution be made from old
seeds, or if from fresh seeds and it has stood longer
than two weeks, it loses its irritative character and will
have no effect whatever. I am disposed to think that
an increase of jequirity does not imply an increase of
effect, so that the question of preparation becomes purely
one of pharmaceutics ; that is, as to how much water,
whether warm or cold, and if both, how long shall the
seeds remain in each ? Shall the whole seed be used after
being bruised, or only the cortex, cotyledon, or gemmule ?
The liability to fermentation is so great that it has been
proposed to use a germicide in the solution — as salicylic
acid, hydrate of chloral, or carbolic acid — a proposition
to which, I think, a good chemist would object.
The rationale of treatment is that which obtains in in-
oculation, viz. : the establishment of an active purulent
ophthalmia in place of a chronic, granular ophthalmia,
with a view to carrying off the products of the granular
conjunctivitis or keratitis : to such the name jequiritic
ophthalmia could very properly be given; The first
recent clinical use of jequirity was made by de Wecker,
of Paris, whose report was published in the Annales
iV Oculistiqiie, for July and August, 1882. A translation
of this report appeared in The Planet, a new medical
gazette of New York, in January, 1883. Moura Brazil
published an article on the treatment of acute and
chronic granular conjunctivitis with jequirity in the
Annales d' Oculistique in November, 1882, in which he
detailed experiments on rabbits and patients ; he found
that granulations of the conjunctiva became diminished
and sometimes were obliterated. Moyne followed with
a paper on artificial purulent ophthalmia produced by
abrus precatorius, in the Boll. d'Ocul., vol. v.. No. 3,
30
THE MEDICAL RECORD.
[July 14. 1883.
November, 1882. He was the first experimenter in Italy.
Tlie patients were three children, in one of whom the
trachoma was entirely removed in twenty days ; iti the
other two the process was milder, but met with a like suc-
cess. The cornea was not pannous in any of the cases.
Simi had an article in the same journal in December,
1883. Jequirity infusion was used on two patients ; in-
flammation and discharge followed, and on the twelfth
day the process was complete. On one eye in total, on
another in partial staphyloma, there was no change
whatever. In the second patient tlie granulations were
decreased, and the patient affirmed improvement in sight.
Terrier detailed his use of jequirity before the Soc. de
Chirurgie, seance du 13^ Decembre, 18S2, in a case of
trachoma; purulent conjunctivitis followed, but the
granulations did not disappear.
The first published use of jequirity in this country, so
far as I can learn, was by Dr. Gruening, whose sketcli of
two cases may be found in The Medical Record, March
17, 1883. These cases were admitted to the ophthalmic
services of the Mount Sinai and German Hospitals of
New York, and were perfect successes.
Dr. P. Callan has used the infusion at the New York
Eye and Ear Infirmary on three cases without any effect.
His cases, so far as I know, have not been published.
An exceedingly interesting article from the pen of Mr.
Charles Rice, associate editor of AV?^' Remedies, New
York City, appeared in the June {1883) number of that
journal, giving the curious history of the seeds, as well as
the botanical and pharmaceutical properties of the ]ilant.
My own experience of seventeen cases comes next ; and,
aside from the two cases q{ Dr. Gruening's and three of
Dr. Callan' s, I know of no other use of the infusion in
ophthalmic practice in this country.
It will be observed that Mr, Rice describes a difierent
preparation of tlie infusion from that given above, which
is the method followed out by Wecker and Gruening.
The symptoms formulated by Mr. Rice are more severe
than any of my cases developed. All of my patients
were treated in the following way : Once a day the solu-
tion was applied to both inner lid-surfaces with a camel's-
hair brush ; the application is painless; two drops were
ordered to be instilled into the eye every three hours ;
and all the patients who would devote the time and
thought to the applications, applied compresses through-
out the day and a part of the night. In a majority of the
cases alteration was noticed within thirty-six hours, and
consisted in an acute conjunctivitis followed by dis-
charge, and the deposit of a croupous membrane upon
their inner surfaces. The lids were swollen, and the
eyes sustained the characteristic symptoms of an acute
blennorrhoeic conjunctivitis. Within from four to six days
the inflanuiiation began to abate, the infiltration of the
lids to subside, and the membrane to disappear in shreds.
The process of repair was hastened by one daily applica-
tion of a five-grain solution of nitrate of silver, while a
saturated solution of boracic acid was used at frequent
intervals to keep the surface as clean as possible. The
success in some of the cases was marvellous. The cases
first undertaken were dispensary patients, three in num-
ber, every one of whom was cured of long-standing
pannus. Two private patients, one very young, the
other in middle life, were likewise cured — all five within
a fortnight ; the other twelve succeeded in a less degree,
while the conditions of treatment were better fulfilled
than obtained with the first five, these twelve being con-
fined to a hospital with a complement of staft" physicians
and trained nurses.
The following conclusions are formulated from an ex-
perience of seventeen cases :
First.— '\\\Q infusion must be ixoxw fresh seeds, trans-
parent, odorless, kept from air and light ; and must not
be used after the deviilopmcnt of an odor, or later than a
fortnight after its preparation.
Second. — The ophthalmia induced by jequirity is sti ictly
croupous ; is limitable in severity by the assiduity and
regularity of the applications, and is not determined by
the strength of the infusion.
Third. — The cornea runs no risk of perforating ulcer,
and can suffer no more than a transient desquamation of
epithelium.
Fourth. — Corneal and in some instances conjunctival
granulations from one year to twenty years of existence
are successfully removed, with but little pain and little
discomfort, in from ten to twenty-one days.
Fifth. — A dense white opacity of the cornea, even of
recent standing, remains unaffected by the infusion of
jequirity.
It will be observed that in some respects these con-
clusions differ from those of Wecker, but essentially they
are the same.
The following cases are here represented in tabular
form :
Case I.
Patient.
Male, aged twenty-
eight ; occupation, carpen-
ter ; treated at North-
western Dispensary. Im-
provement . in vision
twentyfold.
Diag tun is. Trea tmeni.
Pannus and conjuncti- Infusion of jequint>- be-
vilis granulosa for ten gun March 4th. AppHca-
years. Vision in either tions painless, but irritat-
eye, finger-counting at ing. On third day profuse
four feet. blennorrhoea, both corneae
covered with a deposit of
sarcous tissue. On fifth
day comes began to clear;
discharge less. On tenth
day discharge ceased. On
fourteenth day patient was
dismissed with V = '*/oo in
each eye. ;
Case II.
Woman, aged twenty- General, dense pannus
five; chambermaid ; treat- for t^velve years. Inversion
ed at Northwestern Dis- of four lids, due to fibrous
pensary. Improvement in scars on their inner sur-
right eye thirty-fold; left faces. Stubby and vicious
eye fifteenfold- growth of lashes ; bands
of symblepharon of both
eyeballs. Upper lids had
been operated on with
benefit for entropion.
V= finger-counting at two
and four feet.
Girl, aged eleven : treat-
ed at Northwestern Dis-
pensary. Vision in each
eye quadrupled.
Lad. aged eighteen ;
occupation, apprentice to
a decorative painter ; pri-
vate patient. Vision in
each eye doubled.
C.ASE^III.
Partial thin pannus ;
cornea steamy, not fleshy;
trachoma like frog's
spawn on all four con-
junctival surfaces.
Case IV.
Infusion of jequirity be
gun March 3d. Applica-
tions painless, but during
treatment eyes became
painfu 1. On secon d day
free discharge, increase of
pannus ; later patient was
led to the dispensary. On
tenth day cornea clear.
V = ""/^o with either eye.
Infusion of jequirity be-
gun March 28th. Little
blennorrhoea and little pain;
infusion continued rAenty
days. Cystic bodies of
trachoma (?) removed from
all the conjunctiyal surfaces
by the infusion.
Superior pannus of both Infusion of jequirity be-
eyes for more than ten gun April ist. Mucous dis-
years ; trachoma of all the charge at the end of second
lids. Righteyc, V = ^"/--j: day. Lachr>'mation, spasm,
left eye, V = 2('/j^
'Case^V.i
Female, aged fnrly-
seven ; had always lived
Inferior pannus of right
eye for a number of years,
at home ; since widow- extending up to the hori-
hood a housekeeper ; pri- zontal diameter of the cor-
vate patient. Improve- nea. V = finger-counting
ment in V = eightfold. at eight feet.
Male, aged twenty-
three ; shovcler of sand ;
treated at Charity Hos-
pital. Improvctnciit in
V = right eye, doubled ;
left eye, none.
Male, aged forty ; la-
borer : ireatcd at Charity
Hospital. Improvement
in V, doubled.
Lad of seventeen years;
worker in a plaster-mill ;
treated at Charity Hos-
pital. Improvement in V,
right eve, none ; left eye,
threefold.
Case VI.
^- Diffuse, dense pannus
for five months ; trachoma
for seventeen years. Right
eye, V = '/^q ; left eye,
^ ^ Veo-
CASK'iVU.
and photophobia considera-
ble. On tenth day right
eye had V = ^o/^^, left eye
had V = 20/50.
Infusion of jequirity* be-
gun May 23d. On the third
day the cornea was covered
with new vessels ; blennor-
rhuea profuse ; strips of
muco-puRilent discharge ;
no pain : no smarting ; lids
infiltrated and shiny. Oa
nineteenth day V = 5*/:o*
Infusion of jequirity be-
gun May 20th. Reaction
slight ; some discharge on
second day ; continued for
eight days. On twentieth
day, for right eye, V = Veo*
for left eye, V = Vso*
Dense, fibrous pannus Infusion of jequirity be-
for thirty years. Right gun May 20th ; reaction
eye, V = Vho- slight. On twentieth day
Case VIH.
Macula: of both corneae, Infusion of jequirity be-
with recurrent moderate gun May 20th. On second
I>anniis for five years.
Right eye, V = =0/^0 : left
eye, V = i^o-
day slight diNchargc ; on
third 10 eighth day in-
crease of discharge. On
twentieth day, for right
eye. V = 2%o : for Tef^
eye V = »%o.
July 14, 1883.]
THE MEDICAL RECORD.
31
Paiietit.
Male, aged twenty-
ei^ht ; occupation, mu-
chine-tender ; treated at
Charity Hospital. Im-
provement in V = double
0n each eye.
Lad of twelve years ;
was at school at the Cath-
olic Protectory for eigh-
teen months : treated at
Charity- Hospital. Im-
provement in V ; right
eye none ; left eye quad-
rupled.
Male, aged fifty ; la-
borer ; treated at Chanty
Hospital. Improvement
in V := double for each
eye.
Male, aged twenty-two;
stoker ; treated at Charity
Hospital. Improvement
in V = double for right
eye ; none for left eye.
Case IX.
Diagjiosis. Treatment.
Slight, diftuse pannus; Infusion of jequirity l>c-
and superficial keratitis gun May 20th ; reaclmn
for nineteen months, slight. 0\\ twentietli day.
Right eye, V ^ 20|^^ . \^{^ for right eye, V = 20^^^ .
eye, V = ^o/^^^. for left eye, V = 20;^^_
Case X.
Dense pannus crassus
of both eyes ; profuse
discharge ; blepharo-
spasm, and photophobia:
duration, e i g h teen
months. Right eye, V =
inability to count fingers
at six inches : left eye, V
= Voo-
Case XI.
A recurrent thin sarcous
pannus for eight years in
both eyes. Right eye,
V = 27,30 ; left eye V =
"780*
Case XII-l
A dense, inveterate
pannus of each whole
cornea for eight years.
Right eye, V = V.,oo'.
left eye, V = -%oo.j
Infusion of jequirit>' be-
gun May 20th ; reaction
slight ; some conjunctival
chemosis and infiltration
of lower lids. On twentieth
day, for right eye, V = ilie
same ; for left eye, V =
Veo-
Infusion of jeqiJirity be-
gun May 20th. On twen-
tieth day, for right eye. V
= ao/gg : for left eye, V =
/40-i
Intusion of jequirity be-
gun May 20th. On twen-
tieth day, for right eye. V
'"/aoo; for left eye, \- =
20/
Infusion of jequirity be-
gun May 2oth. On twen-
tieth day, for right eye, \'
= ^/flo ■ ^'■^^ left eye, V,=
'/ho-
Case XIII.
Male, aged thirty-six : A variable pannus cras-
longshoreman ; treated at sus for eighteen years ;
Charity Hospital. Ini- very dense on entering
provement in V, for right the hospital. Right eye,
eye = double ; left eye = V = '/eo '• 'eft eye, V =
= treble. Voo-
Case XIV.
Female, aged thirty- ' Right eye : A variable Infusion of jequirity bc-
five; domestic; treated pannus crassus in supe- gun May 20th; Reaction
at Charity Hospital. Im- rior portion of cornea ; slight. On twentieth day.
provement moderate. dense leukoma of the in- for right eye, V = finger-
ferior portion of cornea, V counting at two feet; leu-
= perception of moving koma untouched ; left eye
objects. Left eye : Leu- unaffected by the infusion.
koma corneae, phthisis
bulbi : total blindness.
:Case XV.
Female of thirty years ; Pannus of both cornea;; Infusion of jequirity be-
scullery - m.iid ; treated granular conjunctivitis of gun May 24th. Reaction
at Charity Hospital. Im- four lids for several years, severe, beginning on third
provement of V = tenfold Right eye, V = ^/ooo ; left day. Blennorrhtea, swollen
in each eye. eye, V = *°/200- Hds but no pain. On four-
teenth, for right eye, V =
3o/3^,;forlefteye, V = 3iy^^.
Cass XVI.
Female, aged twenty- Pannus of upper cornea ^ Infusion of jequirity be-
two ; prostitute; treated of left eye for five years, gun May 20th. Reaction
at Charity Hospital. Im- Syphihlic cachexia ; pa- slight. Patient not obliged,
provement of V = four- tient anaemic and scarred;
fold. looked old. V = 20/,.^^^^.
except for treatment, to _
to bed. On twentieth day
Case XVII.
Male, aged twenty- Dense pannus ot both Infusion of jequirit>' be-
five : laborer : treated at upper corner for many gun May 20th. Reaction
Charity Hospital, Im- years ; patient syphiUtic, not severe ; began on
provement in V, right though had never had fourth day, and continued
eye = eightfold ; left eye iritis. Right eye. V= two weeks. On twentieth
= fourfold. '%(,„; left eye, V = Vioo- day, for right eye, V =
=»/;,„ : for left eye, V =
20/
I am under obligations to Dr. Amory Chapin for as-
sistance in the care of the cases treated at the North-
western Dispensary ; also to Drs. Battle and Leip/.inger,
House-Surgeons at Charity Hospital.
S3 West Fiftieth Street, New York.
The Artificial Cultivation of Vaccine. — A prize
of $500 is offered by the Company of Grocers, London,
to any one who will describe "a method by which the
vaccine contagium may be cultivated apart from the ani-
mal body in some medium or media not otherwise zymotic
— the method to be such that the contagium may by
means of it be multiplied to an indefinite e.xtent in suc-
cessive generations, and that the product after any num-
ber of such generations shall (so far as can within the
time be tested) prove itself of identical potency with
standard vaccine lymph." Competitors must send in
their treatises on or before December 31, 1886, and the
award will be made not later than May, 1887.
THE INABILITY TO DISCRIMINATE BETWEEN
RLGHT AND WRONC; DISGUISED BY AU-
TOMATISM.
Illustrated by the Disasters to the Brain, Trophic
AND Functional, Arising from Chronic Alcohol-
ism.
By T. L. WRIGHT, M.D.,
BELLEFONTAINE. O.
A RECENT e.xperience with respect to a trial for murder
in one of our large cities has impressed upon my atten-
tion the importance of a clear understanding of the full
significance of the questions so often propounded by
lawyers when applied to criminals : " Could the prisoner,
in your opinion, discriminate between right and wrong?
Did he know, when he committed the act, that he was
doing wrong ? " The importance of a perfect familiarity
with all the terms in these questions, as applied to ascer-
tained facts in criminal cases, is the more apparent when
it is remembered that they contain what the courts in
England and America insist shall be considered as the
real and only test of legal responsibility — the power of
discriminating between right and wrong.
In order to prepare the expert for the ijuestions indi-
cated, it is usual to furnish him with hypothetical cases,
wherein one side will claim a certain regular chain of
sequences in the conduct of the accused, all pointing
directly to the crime. The answer to the question in
such an hypothesis, most likely, is that the prisoner prob-
ably did know how to distinguish right from wrong. The
other side, with equal ingenuity, will furnish an hypotheti-
cal case wherein there are supposed to appear certain
breaks, and unreasonable intervals, and inconsistencies,
in the same chain of sequences. The same witness will
decide that, in such contingencies, the prisoner did not
know how to discriminate between right and wrong —
leaving the case at last just where it was when the expert
was called in to testify.
I hope to indicate that a certain regular series of se-
quences in approaching a criminal act, and made too in
the interest of such act of criminality, is not of itself and
necessarily proof positive that the criminal lias sufficient
mind to discriminate between right and wrong. Nay, I
will endeavor to show that an unusually pertinacious and
cunning approach to an act of criminality may even point
to the presence of brain disease, which, in the form of
some delusion dominating motive and will, proves by its
unyielding obstinacy the absence of reason and the in-
efficiency of evidence, and may thus presuppose a men-
tal defect which is incapable of discriminating between
right-and wrong.
1 hope to make it appear that the knowledge of right,
abstractly or automatically and in cold reason only — and
the knowledge of wTong abstractly and by mere habit or
rote — may be present, and yet the power of discriminating
between the two, the power of using the reason and
sensibihties in a comparison or analysis of the elements
of right as relates to the elements of wrong, may be
wholly absent, wholly destroyed. So that it is possible
to have an abstract idea of right without feeling it, and
an abstract idea of wrong without feeling it ; and there
may exist an utter incapacity to enter into the mental
process of discriminating between the two so as to apply
the results of such a discrimination to determining the
character of conduct.
In illustrating these propositions, which I prefer thus
to foreshadow rather than gradually approximate unto, I
will consider some of the effects of alcohol upon the
nervous system. I will in the first place, and in some
detail, speak of alcohol as a destroying element — wreck-
ing in many instances the integrity of the nerve-centres
and of the nerve-tissue otherwise. I will then proceed
to consider briefly a more common effect of alcohol,
namely, its power of inhibiting nervous function ; where
the actual mental phenomena — those of paralysis Qi func-
tion— must appear very similar to the mental phenomena
32
THE MEDICAL RECORD.
[July 14, 1883.
associated with deterioration and wreckage of nerve
st/iictiire.
Dr. Stearns, of Connecticut, says truly that many of
the insane are rendered so through grief, business dis-
asters, and other analogous causes. Yet of the whole
number of persons suffering from grief and financial re-
verses, very few become insane. There must pre-exist
some neurotic proclivity to the final mischief. So in
chronic alcoholism there nmst also be a similar predispo-
sition to insure the full eftect of alcohol upon the tissues
of the brain.
It is now the generally received opinion that about
seventy-five per cent, of the cases of paralytic dementia
have a history of alcoholism. Dr. Crothers claims that
the percentage is as high as eighty-nine. Therefore, to
fully appreciate the power of alcohol in wrecking the
brain and thus depraving its functions, it is only necessary
to observe closely the morbid appearances and changes
which are most commonly observed in those who die of
paralytic dementia.
" The nature of the most obvious initial change in the
brains of the paralytic insane is a hyperplasia of the con-
nective tissue." Certain minute changes observed in the
cerebral substance of one who had suffered from this form
oi disease were owing, according to Dr. Maudsley, to an
increase of connective tissue.
In regard to the particular kind of connective struct-
ure which is formed through the influence of alcohol, it
will be proper to make one or two remarks. Alcohol is
recognized as an element more prone than any other to
excite the proliferation of the fibrous tissue, not onlv in
the brain but throughout the entire system. Few struct-
ures, Dr. Bartholow remarks (" Practice of Medicine,'' p.
•844), " escape the trophic infiuence of alcohol when it is
habitually introduced within the body." The kidneys, the
stomach, and the liver, all exhibit an hypertrophy of the
connective tissue ; " and the neuralgia of the brain also
undergoes hyperplasia."
The peculiar nature of the fibroid adventitious struct-
ure produced under the influence of alcohol is strik-
ingly exhibited in its subsequent changes. In the kid-
neys, for example, the alcoholic influence induces
■interstitial hypertrophy ; but finally the hypertrophied
tissue contracts, just as ordinary scars following burns or
wounds contract. This contraction of the hypertro-
phied tissue produces interstitial nephritis. In the liver
this contraction of fibrous tissue, confining and squeezing
the true gland-structure among its meshes, produces he-
* patic sclerosis or hob-nail livei-. In the brain a similar
contraction produces a \ariety of disturbances in the con-
dition of the capillary circulation and the nerve-fibres and
nerve-cells. " As a consequence of the exuberant in-
crease of the hvpertrophied tissue, the nerve-element, as
well as the delicate capillaries, are injured or destroyed,"
says Maudsley.
Of course, such a serious interference with the normal
condition of the true nerve-cells implies a corresponding
decay and deflection of mental function. It is easy to
conceive of the impossibility of mental activity in healthy
relationship with natural surroundings when the struct-
ures^ upon which such activity relies for projection —
when the nerve-cells — are obstructed in function by the
mechanical encroachment of an aggressive foreign sub-
stance.
But the injury done to the nerve-cells does not depend
exclusively upon the pressure occasioned by hypertrophy
of neighboring structure. The final contraction of the
intrusive connective tissue, by a process of strangulation
of the smaller blood-vessels, induces a failure in the
proper nutrition of the nerve-element. From this defect
in nutrition there often ensues various forms of cell-de-
generation. Nerve-cells, for example, may undergo fatty
degeneration. Becoming unfitted for i)hysiological ac-
tion, they may be absorbed, and in their place " fine
clastic fibres contract, get closer and closer together,
and remain as the constituent tissue of a cicatrix, which
sometimes causes considerable deformity. Whole sections
of nerve-substance have been replaced by a relatively
small quantity of an unyielding, compact, dry tissue."
The same authority says, in another place : " As the
process of hyperplasia goes on, the circulation is shul^
ofT, and the brain becomes anremic. Pigmentary de-
generation of the ganglionic cells of the brain is observed
in the various forms of paralytic dementia, as also are
calcareous degeneration of the same class of cells. . . .
In connection with the hypertrophied tissue are amyloid
and colloid corpuscles, calcareous and fatty granules, all
being products of retrograde metamorphosis" (Mauds-
ley : " Pathology of Mind." pp. 511-512).
In the same direction. Professor Loggia, of Palermo,
Italy, says : " When we bring to our aid the microscope,
we begin to see and to understand the intimate fibro-
cellular and interstitial alterations. It is by this means
we succeed in determining the vascular and perivascular
lesions of the cerebral substance, the colloid and cistoid
degenerations, as well as the lesions of the nerve-ele-
ment— cells, tubes, and neuroglia — which have, according
to the most accurate investigations, undergone great
transformations in this disease." '
But there is still to be considered another important
nerve-complication which is also brought about by the
toxic power of alcohol — a complication having a very in-
timate relationship with the moral nature of man, and,
of course, with the solution of the problems of this essay
in particular.
Besides the cells and centres ministering to sensation,
ideation, and motion, and besides the various avenues to
and from these centres, there exists in the brain a large
and important class of nerve-fibres known Sl?, fibres of
association. To save time and space, I will here adopt
the language of some authorities as found in their works
on the subject.
Dr. Spitzka speaks as follows : " Many years ago at-
tention was called to the presumptive physiological role
of certain arched fibres which are known to unite adjoin-
ing as well as distant cortical areas with each other.
. . . I should, if asked to point to the chief factor on
which the higher powers of the human brain depend, lay
less stress upon the cortical development as such than
on the immense preponderance of the white substance
due to the massive associating tracts. Both projecting
and associating fibre masses increase in nearly a geometri-
cal progression as we pass from the lower animals to
man ; but the ratio of progression of the associating
fibre masses exceeds that of the projecting tracts. There
are certain convolutions which are almost exclusively
connected w\\\-\ fibrce arcuatie — that is, with associating
tracts — and which enjoy but little direct connection with
the bodily periphera. Such cortical areas and their sub-
sidiary associating tracts, bound into the higher unity of
the entire hemisphere, constitute the substratum of the
metaphysician's ego. A disturbance of the intricate rela-
tions which are involved in the material basis of the ego
must be accompanied by a disturbance of the ego, or may
even render an ego an impossibility."
On this subject Dr. Maudsley remarks: "The hab-
itual co-ordination of thoughts and feelings is the basis
of consciousness and personal identity. When co-ordi-
nation of function in the brain is overthrown, the con-
sciousness of personal identity and responsibility are also
destroyed."
Pertinent to the same subject, and also showing a fur-
ther step in advance in the discussion of our main topic,
are the words of Seppilli :' " We must remember that
cerebral activity is manifested under two distinct aspects
— that of the conscient and of the inconscient. The con-
scient activity, or consciousness, is constituted of knowl-
edge possessed by the ego of its own acts — that which
happens within itself, which happens in its relations with
the external world. On the contrary, in the inconscient
» Alienist and Neurologist, July. 1882, p. 343.
^ Ibid, -Vpril, 1882, p. 169. Translated by Workman.
July 14, 1883.]
THE MEDICAL RECORD.
33
activity of the brain, denominated also automatism, all
those actions enter in which the dX" takes no part nor
is aware of any ; but tliese are combined and directed so
as to resemble' those which the ego perceives, wills, and
directs." '
It is therefore evident that the perfectly harmonious
activity, or consent, of all the healthy nervous attributes
and capacities is the one essential requisite to the dis-
play of sound mental function ; and as such attributes
and capacities are so held in activity through the integ-
rity of the nerves of association, any disturbance or
obstruction in the exercise of the functions of those
nerves must give rise to serious defects in mental opera-
tion. When the interchange of nerve-influence between
the various centres concerned in thought is free and un-
embarrassed, there is present in the mind a vivid sense
of personal importance and individualit\'. The feelings
of rights, duties, cares, and responsibilities are active,
and they control all the serious avocations of life. This
ever-present sense of responsibility, while it exacts duties,
also confers power and dignity to character, and im-
plies the freedom of the will. The sense of responsibility
demands untrammelled freedom of conduct, assumes the
weight of accountability, and challenges retribution.
There is in the mind an acute sense of its ability to dis-
criminate between right and wrong.
But in chronic alcoholism the free interchange and
equilibrium of nervous association does not obtain. It
is overcome by the intrusion of hypertrophied interstitial
tissue upon the nerves of Meynert. And especially are
these nerves of association injured, both in office and
structure, by the final contraction of the connective tis-
sue, which, by strangulation, annihilates their function.
Very important considerations of medico-legal interest
are interwoven with the tendency of alcohol to impair
brain tissue. It is easy to conceive of the unstable will,
the impaired will, the imbecile will, when the conscious-
ness of personality is weakened and the feeling of re-
sponsibility is lost in consequence of injury to the fibres
of association. It is also easy to conceive that the power
of discriminating between the qualities of right and wrong
must be weakened when consciousness is defective.
Unless the feeling of personal identity is clear and on the
alert, it is impossible to apply personality with distinct-
ness to conduct ; impossible to perceive the relations of
personality — the relations of the ego — to either things or
acts ; impossible to bring self into normal relationship
with exact ideas of right and wrong.
It is conceded by all whose authority is of any weight,
that one of the earliest symptoms pointing to the pro-
gressive paralysis of the insane is a marked change in
the disposition. There is a change in the moral nature ;
not a change indicative of true vice, and exhibiting a
reckless disregard of the principles of morality, but a
change indicative of an inability to comprehend those
principles, and founded, indeed, upon physical damage
to the nerves and centres of association — those nerves
and centres upon which the sense of morality is based,
and through which the moral nature must find utterance.
There was a person within my knowledge who had
been a steady drinker. He was honest and was a hard
laborer. He suddenly began a course of stealing. It
was not like ordinary theft. He would deliberately take
and carry away with him things notoriously the property
of near relatives and neighbors. He made no attempt
at explanation. He claimed these articles to be his own,
simply because they pleased his fancy. An infant whose
associative organs have not been exercised displays the
same ignorance of personality as relates to the person-
ality of others. It cries for and claims as its own any
shining toy which happens to engage its attention.
The person alluded to finally died in an insane asylum,
demented. He could, without doubt, tell very well what
*" The brain must always remain the e5;sential organ of the manifestations of
the ego and the me — the moderator and the supreme arbiter of the acts of life." —
Loggia.
was the abstract idea of right as well as of wrong. They
were ideas which had become habitual or automatic with
him by life-long use. But practically his nervous organs,
functioning the moral nature, having been injured, he
could not make an active discrimination between right
and wrong. K\\ feeling or sense of right and wrong was
destroyed through the ravages of alcohol. He was in-
capacitated, by trophic changes in brain-tissue, from
bringing \\'\^ conscious ego\\\\.o relationship with the moral
principles of right and wrong. And this is the difTerence
between the automatic or abstract knowledge of right
and wrong, which is to some extent always present, and
the conscious and responsible capacity to discriminate be-
tween the two principles. In the infant, the fibres of
association had never yet been brought into play. In
the paralytic dement, they had suffered destruction.
But in the insane criminal, the fact often stares the in-
quirer in tlie face that the conduct of the accused is
consistent tliroughout with the theory of depravity ; that
all the steps in the crime were those evincing rational
design. This is, indeed, a serious point of consideration.
For it not infrequently happens that atrocious criminals,
exhibiting the attributes of fine reason and wicked perti-
nacity, soon after show such indications of insanity as to
leave no doubt of their entire irresponsibility.
Certain considerations carefully noted may throw
some light upon these undoubted facts.
Habits of thought are actpiired slowly and painfully.
It is not necessary to advert at length to the difference
between man and the lower animals. The former ac-
quires by long and laborious experiment a habit of men-
tal activity fitted for his exalted sphere ; while the latter
are born with instincts sufficient for their lot in life.
The tedious repetition of sensations, perceptions, con-
ceptions, and the motor activities becomes at last a
habit which it is impossible to dispense with. Mental
and even motor life becomes in time mere repetitions
of certain long-enacted powers which are applied to
the usual phenomena of living.
The power of walking erect was acquired with much
consideration, balancing of the body, and mental calcu-
lation. But at length the acts of walking, running, and
jumping become by use strictly automatic, requiring no
nice calculation, no exercise of the judgment or will in
their performance. The undoubted insane walk and run
well. Yet no one would claim that because an insane
man can perform the act of walking well, an act in its
abstract nature requiring judgment and nice calculation,
he is therefore not insane, but is in possession of fine ,
powers of judgment and discrimination. There is, there-
fore, such a thing as automatism, which may mislead the
convictions as to the actual present mental capacity of a
person of questioned sanity.
There are many other courses of nervous action of a
more strictly mental or moral nature which may become
autor|iatic, as well as a merely motor capacity. The
mature mind, like a bird of prey seeking its food, often
comes to intellectual conclusions with wonderful direct-
ness and speed, and that, too, from the most remote and
unexpected quarters. It is said that when the quarry
falls in some deep glen, amid tremendous cliffs and
mountain peaks, instantly the eagles flock from remote
and hidden places and gather there. This has been as-
cribed to a mysterious form of impenetrable instinct.
The fact is that birds of prey are of grand vision, and
they are always upon the watch. The moment tha.t a
victim sinks, the watchful sentinel nearest^ by starts into
life, and with rapid wing rises into the air ; this move-
ment is at once seen by others farther away, and they
too fly aloft and follow the course of the first. And
thus, in a few moments, the intelligence goes far and
wide — like that from the smoke and torch upon the hills
of the Norsemen when an enemy appears.
So the human mind acts. What was once slow and
anxious training, what was once pursued in regular steps
and over difficulties, becomes by practice instinctive and
THE MEDICAL RECORD.
[July 14, 1883.
automatic. The alphabetical order of reasoning no
longer obtains. Small tilings are taken for granted. An
immense number of jiositions are habitually assumed ;
and in ordinar}' life the mental processes, like eagle-
flights, are grand movements from point to point, from
headland to headland of thought, not lingering to go
through the tedious routine of detailed mental activity.
And thus men not only sane, but men insane, live, and
think, and reason, automatically, in common circum-
stances. It is when some morbid delusion or hallucina-
tion intrudes that very considerable exceptions are ob-
served. When we reflect that in the ordinary life of the
insane the delusion is not always uppermost in the
mind, we must perceive that, in so far as everv-day busi-
ness is concerned, there will usuallv appear the auto-
matic phenomena and conduct of men in general.
When the delusion of insanity takes precedence, there
must of necessity be an absence of even automatic regu-
larity in mental activity. So long, however, as the
delusion does not intrude, it may be impossible to deter-
mine from the conduct of even an insane person that
he cannot discriminate between right and wrong ; for
automatism calls for no active or real process of dis-
crimination. The mind is acting in the groove of habit.
All rational thought, even automatic, is piimarily
founded ujion evidence and reason ; and while it may
therefore be modified and changed by reason or evi-
dence, a delusion founded upon disease cannot be
modified or changed except through changes in the dis-
ease itself. Of course, changes in a morbid process in
the brain are beyond the competenc}' of reason or evi-
dence or will.
The truly alcoholic mind, therefore, is powerless to
discriminate between the properties of right and wrong,
because it finds itself to be the victim of unusual and
untried circumstances, which it can neither define nor
correct by the appliances of evidence and reason. It
is needless to point out the fact that where evidence
and reason cannot come discriminatioti is impossible.
Many truly insane criminals are adjudged sane and
responsible because their automatic and common life
resembles the similar life of rational minds : while the
ignorant ciieat and pretender is acquitted because he
shams under all circumstances and upon all subjects.
Having considered alcohol as an agent destructive of
the integrity of nerve-tissue, and having noted somewhat
in detail the effects of such nerve-disintegration upon
the mental and moral faculties, we are in a position to
determine, with considerable distinctness, what would be
the effects of a to.xic agent which — by inhibition of ner-
vous function, as by ansesthesia — would render such
nerve-function inoperative or defective. For it must
be admitted that the suspension of nerve-function from
a toxic agency will present the same phenomena as
where a similar suspension or destruction originates in
any other cause — as, for instance, degeneration of nerve-
cells and disruption of nerve-fibres.
Now it is well known that alcohol is an agent which
produces an;\;sthesia in some degree in every instance
where it is taken into the system. We have heretofore
been discussing alcohol as it affects certain constitu-
tions predisposed to its destructive action upon brain-
tissue. Such trophic effects are not the rule. They are
comparatively infre(|ucnt. Hut we now come to view
a common or universal impression by alcohol upon the
brain and nervous system of man ; and we infer, from its
disastrous effects upon the few who suffer from it in
structure, its equally calamitous effects upon those who
suffer from it in function.
We will not be specific upon the various properties of
alcohol as a disorgani/.er of tiie sensibilities. But the
fact may be stated that alcohol always depraves or de-
stroys sensation. This may become ai)|)arent in the
production of true an;esthesia or insensibihty to ordi-
nary sensation. Alcohol may also, by its toxic quali-
ties, induce morbid, unnatural, and misleading sensations,
and it may cause sensations to become localized in cer-
tain parts of the organism and absent in other parts.
The same confusion in the relations of sensation to
perception which exists when the sensibilities are de-
stroyed by deterioration of nerve-structure, exists also
when the' sensibilities are functionally impaired or de-
stroyed. In either contingency there can be no accu-
rate or reliable perceptions induced. Of course there
can be no association of clear and normal ideation, and
no certain knowledge or consciousness respecting the
actual being and relations o{ the self — the ego. In addi-
tion, if the obtunding of the sensibilities continues for a
long time through habitual drunkenness, the abnormal
state of the sensitive powers becomes constitutional and
hereditary, upon the principle of the stnicluralisation
of function, with its opposite when circumstances are
favorable.
But it is time to stop — to turn our eyes from the still
opening vistas of our subject. It is enough to add that
the anaesthetic state partakes largely of the nature of
the magnetic condition, wherein personality is divorced
from normal consciousness and wherein man non est
animi compos.
CASE OF SUCCESSFUL OPERATION FOR THE
PERMANENT CURE OF RUPTURE.'
By ROBERT W. JOHNSON, M.D.,
BALTIMORE, MD.
The frequency of hernia and the dangerous position
of those who are so unfortunate as to own one have
made investigation and experiment into the permanent
cure of this deformity one of the most prolific themes
in surgery.
Probably, if we leave out the excellent and popular
truss which girds up the loins of so many of our fellow-
citizens, in no department of the jjrofession can we find
more labor lost if nieasiued by actual results.
The various means adopted in inguinal hernia, and the
various engines, if I may use the term for some of the more
cumbersome apparatus, have so far met the approbation
of that partial jury alone, the inventor, but have been pro-
nounced by the sterner court of the public : " Tried in
the balance and found wanting."
The more prominent methods of invagination, as
Gerdy's, Signorini's, Wutzer's, Wood's of London, Wood's
of Cincinnati, Dowel's, Chisolm's; Dzondi's trans-
plantation, as practised in a single instance by Jami-
son of Baltimore ; local irritation with compression by
Belmas, Pancoast, ^'elpeau, Armsby, and Riggs — .all
have either sunk into a merited oblivion or appear in
treatises to be lilted at by the author. Heaton's method
of injection seems popular now, and with some right, as
numerous successes are reported and but few, if any,
deaths.
The corkscrew arrangement of Mr. Spatton, of the
North Staffordshire Infirmary, has also met with success
in his hands. The majority of these operations apply
only where there is an inguinal canal ; when the hernia
is an oblique one, and not when the two abdominal rings
are dragged into immediate juxtaposition.
With the absence of this canal the difficulty of cure in-
creases, for practically we have a door into the abdomi-
nal cavity at which the external ring is at best but a
drowsy sentinel. Take away the canal and you rob the
operator of his field of action.
Mrs. L. S. C , aged forty-three, married twenty-two
years, six of whose twelve children live, first noticed a
small tumor in her right groin, tliirteen years ago, one
month after the biith, a difficult but normal labor, of her
fifth child. This from time to time gave her pain, but was
not reduced. After her next labor the tumor increased in
size to a hen's egg, and was reduced by Dr. Blackman,
of Virginia, who applied a truss for the first time, two
' Read before the Clinical Society of llaltiniorc, Md.
July 14, 1883.]
THE MEDICAL RECORD.
35
years after the appearance of the hernia. This gave her
ease and retained the bowel until the summer of 1881,
when the strap having broken she failed to have it fixed,
and was rewarded for her negligence by the return of her
old enemy with reinforcements. Her physician being un-
able to reduce it, sent for another physician of this city,
who reduced it and applied a truss, which failed to retain
it. Coming down again, and being apjiarently irreducible,
her doctor called in a surgeon, who reduced it and applied
a truss ; but, as she e.xpressed it, before he got into his car-
riage it was out again. I mention these different at-
tempts by different men to show how impossible it was to
keep it up with a truss. The case soon after fell into
the hands of Dr. Girter, who attended the woman re-
ligiously for some time until her frequent demands wore
out his patience, and knowing that 1 was particularly in-
terested in herni;e, kindly asked me to see it with him,
she having previously had Mr. Willms to see her twice
with the hope of fitting a truss. Finding that 1 was willing
to take the case. Dr. Girter handed it over to me in
April, 1882, having called my attention to an apparent
cyst, which he had frequently tapped with the intention of
setting up adhesive inflammation.
I found on examination an entero-epiplocele about the
size of a goose-egg, coming out through the conjoined
orifice of the external and internal ring, passing to the
labium majus. My finger entered through the ring the
abdominal cavity, the walls of which were much relaxed
from her numerous pregnancies. At the lower end of the
tumor could be felt the cyst, and near it an almond-
shaped body, which the patient insisted increased in size
during her menstruation, a fact 1 myself could never
verify andjjressure of which would give the peculiar nau-
seous pain of pressing an ovary.
There was but little trouble in reducing the rupture
and as long as the supine position was maintained it
would not reappear, but whenever the calls of family or
nature forced her to leave her bed, back would come the
gut, and in spite of renewed trials of trusses, in which Mr.
Willms' skill was again elicited, the pain of all of them
forced her to remove the pressure, which, although she
sometimes endured, did not retain the bowel.
Among other trusses I had one shaped like a horse-
shoe, so that the permanent contents of the sac, which I
considered irreducible, should not be pressed on, but the
gut alone retained. All was in vain.
In the hope that time might accustom her either to
the use of a truss or the presence of the r\ipture in the
labium, I attended her from April to November, going
sometimes as often as twice a day. Finally recognizing
the fact that she could not be so hampered and prevented
from earning a living or taking care of her children, and
confessing that I was heartily sick of these monotonous
visits, I suggested operating, pointing out the danger and
stating the possible chances of recovery. After con-
sulting with her husband and carefully considering the
matter herself, she asked me to operate. There was no in-
guinal canal, so invagination was impossible. For the
same reason Heaton's method of astringents was discarded.
The only thing I saw to do was to reduce the gut, cut
down, and tie the sac close to the external ring, and to
give her every chance I determined on antiseptic pre-
cautions.
On November 28th, assisted by Drs. Gerter, Moah,
Schaeffer, and Blumer of Utica, N. Y., I operated under
-ether. For a half hour previous the spray played in the
room.
Having reduced the gut, with its characteristic farewell
gurgle, I cut down on a grooved director until I reached the
sac, which was, as I had expected, thickened from its long
sojourn there. Convincing myself that there was no gut
in the sack I ligated it near the external ring with cat-
gut ligature, passed around with an artery needle. This
was a fortunate procedure, for just at that moment the
alcohol in the lamp caught, rendermg it unfit for use dur-
ing the rest of the operation.
Cutting out the piece below the ligature I did not open
the peritoneal cavity. Having removed the lower part
of the sac and checked hemorrhage by torsion I brought
the edges of the wound together over a drainage-tube,
including in the uppermost suture the stump of the sac
and dressed with antiseptic gauze. Opium, gr. j , to put
splints on the bowels, which acted spontaneously on the
morning of the operation, and quin. sulph., gr. iij., were
given. There was some vomiting from thi ether, but
that was not enough to strain my ligatures of the sac.
Diet was principally light and fluid.
Except in the course of the drainage-tube the wound
healed by first intention. At no time was there nnich
discharge. Fain was confined to the wound, no tender-
ness on pressure except in the immediate zone of inci-
sion. Opium and quinine were given occasionally. Re-
moved the sutures on the fourth day ; drainage-tube a
few days later.
At no time did her tem|ierature, taken twice daily,
reach 100° F. I did not allow her to get up for nearly a
month after the operation, in order that the parts might
get accustomed to their new relations without straining
the soft inflammatory tissue near the wound. I have
removed her corsets, and to prevent any compression of
the parts have suggested shoulder-straps for her clothes
as far as possible. I have kept a truss on her and will
do so to make security doubly sure, though 1 think the
external ring is now jiretty well blocked up. I did not
find any ovary in the sac, as her history and almond-like
body led me to think jjossible. The ovular body was, I
think, thickened omentum or inflammatory deposit of
some standing. I am not casuist enough to think the end
justifies the means, and I should have been as much
ashamed to present my patient here on her legs as a
specimen of her on a plate if I thought my operation un-
justifiable. She knew its danger — that at best it might be
successful and may be unsuccessful. On the other hand,
she recognized that her condition in life would not ]iermit
her to be bedridden — that palliative means had had a fair
trial. She chose the operation with its attendant danger,
and asked me, rather than I her, to perform it.
The best test of my opinion of it is that I would do it
again under the same circumstances. I consider it
probably the most dangerous of the operations for per-
manent cure. I would prefer Heaton's or another where
there is an inguinal canal. Of course the truss, when
practicable, while only a palliative, is far superior to any
chances of permanent cure by operation. What effect
the spray had I cannot say, as it was not complete. Clean-
liness I can vouch for as the best ally I had.
An Obituary Comment. — It is rare that one observes
the peculiar type of mind which permits itself to indulge
in witticisms at the expense of the dead. A recent writer
in T/ie Lancet, however, who possesses this peculiarity,
commenting upon the death of Dr. George M. Beard,
says, epigrammatically, that he expended most of his at-
tention upon matters which ordinary men did not think
worth paying any attention to. Dr. Beard's studies, thus
alluded to, covered such subjects as trance or hyimotism
in its relations to evidence, and various problems in mor-
bid and what may be termed " border-land " psychology.
Dr. Oliver Wendell Holmes, who, some years ago, specu-
lated upon these same things, anticipated the criticisms
thus made by the kindly writer over the water. " There
is," says Holmes, " just on the verge of the demonstrable
facts of physics and physiology, a nebulous border-land
which what is called 'conmion sense' perhaps does wisely
not to enter, but which uncommon sense, or the firm ap-
prehension of privileged intelligences, may cautiously ex-
plore, and in so doing find itself behind the scenes which
make up for the gazing world the show which is called
Nature." We do not know that anything could better offset
The Lancet's ungenerous estimate of the kind of work
which occupied, after all, only a fraction of the late Dr.
Beard's attention. — Medico-Legal Journal.
36
THE MEDICAL RECORD.
[July 14, 1883.
PROBABLY A CASE OF TUMOR OF THE CERE-
BELLUM.
By EDWARD SWASEY, M.D.,
LIMERICK, ME.
Although I am unable to veiify by post-mortem ex-
amination the diagnosis of tumor of the cerebeUum in
the following case, )'et I think its history, symptoms,
and the quite sudden death of the (latient were so charac-
teristic of a cerebellar lesion that the case is worthy of
record.
Mr. B- , farmer, 36 years of age, married, and always
in good, robust health until the past winter. His fan)ily
history is good ; a brother, however, died in early man-
hood of consumption. He denies any venereal taint.
During the past winter he has been conscious of fail-
ing health and strength, and thinks he is fifteen or twenty
pounds lighter in weight than usual, but attributes this
to unusually hard work during the fall months. No defi-
nite symptoms appeared, however,' until about January
ist, when he began to have occasional attacks of vertigo,
or, as he described it, "a rush of blood to the head." It
was most noticeable when he would rise from a horizon-
tal or sitting posture ; it would last but a moment or two
and then pass off. At times during an entire day he
would be free from this trouble. This has been gradu-
ally increasing in frequency and becoming more pro-
nounced in character, as not infrequently it was followed
by some headache, mostly frontal and jsarietal.
This has not been very severe or troublesome. About
four months ago, or two weeks after the foregoing symp-
toms commenced, stomach trouble began to appear in
the form of atomic dyspepsia. There was partial loss of
appetite, a coated tongue, foul breath, bowels at times
constipated, but before they had alwa)s been very regu-
lar ; generally some distress after eating, followed by
eructation of gas, and very frequently the vertigo and
severe headache would come on and remain until the
stomach was emptied by vomiting. They would then
immediately pass off and he would be comfortable.
He had been under the care of two other physicians a
greater portion of these four months, who had treated
him for dyspepsia, but he had received very little or no
relief, and he says the symptoms have been slowly but
surely increasing. He has slept well, and has been free
from troublesome dreams. Four weeks ago, in addition
to all these symptoms, he commenced to stagger in walk-
ing. He has had, during the present week, some occip-
ital headache, but it has not been very persistent or
severe.
Such was his past history up to May 4, 1883, when I
first saw him professionally. His complexion had the
appearance of good health, and he believed he would be
"all right" if I could cause the stomach and bowels to
perform their functions. The tongue was covered with
a dirty white coat, except at the edges, which were clean
and red ; pulse 60, full and regular ; examination of the
lungs and heart negative. He was up and about the
house. I gave him a powder of pepsin, bisnnith, cin-
chonida;, and ginger to take after meals ; also a mild
tonic of wine of iron, nux vomica, and Fowler's solution.
I gave a iiow(5er of calomel and jalap to take as the state
of the bowels should require. 1 considered it a case of
derangement of tlie digestive track, and gave a favorable
prognosis. On the 6th the appetite had inijiroved as
well as his digestion and strength ; no vomiting, the
bowels had moved slightly, but the head-symptoms were
not in the least improved. To continue the treatment,
and to assist the bowels to a free evacuation by the use
of an injection. 1 directed that he take short rides and
walks, and to be out of doors as much as (jossible.
On the 8th, the condition about the same, but the
dizziness, staggering, and headache were certainly in-
creasing; the latter symptom was still more frontal and
parietal than occipital. On returning home from a near
neighbor's on the day previous, so pronounced were these
symptoms that he would have fallen but for a fence near
at hand, and from here he was assisted to his home by a
neighbor.
He had tried to ride, but the jolting and jar had af-
fected his head unpleasantly and caused headache. Fear-
ing that these symptoms had a more serious import than
I had at first attributed to them, I subjected the patient
to a more careful and searching examination.
The urine was normal in quantity, slightly acid reaction,
specific gravity 1.020, free from albumen, but the phos-
phates were quite abundant ; no microscopic examination.
There had never been any tedema of ankles or under the
eyes. The eyes \vere perfectly normal in appearance,
no nystagmus, pupils normal and responded equally to
light ; vision for near and distant objects normal. There
had been occasionally, at times of dizziness, dyspepsia,
but it was transitory. There had never been any trouble
in the hearing, and the tick of a watch was heard four
feet distant, and equally on either side. The tongue was
protruded in a straight line, still covered with the dirty
white coat. The facial muscles acted normally. No
sign of weakness in arm or hand muscles. He was re-
quested to fiilly extend the arm and carry it well back,
then, with closed eyes, to bring forward the hand and
touch the tip of his nose with the tip of index finger.
This was done accurately with the right hand, with the left
there was deviation of half an inch.
There was no anesthesia of face or extremities. The
lower extremities were not tested for ataxic movements.
The patellar reflex was normal. No pains in any part of
the body, save the headache. In rising from a sitting
posture he would have fallen backward, but the side of
the room, three feet distant, saved him. He was assisted
to gain his equilibrium, but when he stood witVi feet to-
gether there was a swaying motion of the body, but no
tendency to retropulsion, or to fall in any definite direc-
tion. With the eyes closed these movements disappeared,
and the body was stationary. He walked almost exactly
like a drunken man. With eyes fixed on a distant ob-
ject he would start forward, feet wide apart, and the body
swaying and tottering about. He crossed and recrossed
two rooms in this way without assistance. It brought on
some headache, and he was glad to sit down. He felt
quite comfortable after a short time, however.
I now came to the conclusion that this patient had a
very interesting but a very fatal brain lesion, and that it
was probably a tumor of the cerebellum. I gave him
the iodide of potash in five-grain doses, and the bromide
in ten-grain doses, with a liberal amount of water, three
times a day ; and ordered a blister to nucha. On the
loth, no special change, except that the iodide had de-
ranged the stomach, as there was almost complete ano-
rexia and a foul breath. The bowels were constipated,
but would move by the use of powders and injections.
The stools were "clay-colored." There was increased
headache, and a disposition to remain in bed. To stop
the iodide, but give the bromide and continue the stom-
ach powders and the tonic.
On the 1 2th, while rising from bed to dress in the morn-
ing he fell, striking his face against the bed-frame, causing
quite a wound on the cheek. There was no loss of con-
sciousness, had never seen spasms or jerkings of muscles
in any ]>art. He sleeps well.
On the 14th, no special change in his condition ; mind
perfectly clear. He has more headache, but sleeps well.
He walks now only with the assistance of his wife. I
had him walk alone, however, and the same gait described
above was ]>resent. The expression of the eyes w'as that
of a drunken man while he was walking, but not after-
ward. There was not the slightest odor of alcohol about
him, and his mind was perfectly clear. I had him take
a pin between tlie thumb and fingers of either hand, and
then try to touch their heads together, with arms fully
extended. In this there was hardly any deviation from a
perfect coaptation.
Has had more occipital headache than formerly. I
July 14. 1883.]
THE MEDICAL RECORD.
^7
noticed for the first time to-day some irregularity of the
pulse, but there was no definite rhythm noticed. The
bowels respond tp medicines somewhat better, and the
stools arc normal in appearance.
I was asked by the patient's mother fcr my opinion
of her son's condition, and I told her that I took a very
gloomy view of his prospects ; that I was quite positive
that he had trouble of the brain, which would before long
prove fatal, but I could not tell her how long before fatal
symptoms would appear ; possibly weeks might intervene,
but 1 thought not, but when they did appear he would
probably have still more severe headache, but I thought
the mind would remain clear to the very last, antl that
he would die quite suddenly. I thought there was little
to do in way of medication, e.xcept to treat symptoms.
That afternoon I met my brother. Dr. William B. Swasey,
in considtation, and he took a more hopeful view of the
case, regarding it as derangement of the digestive organs,
and that the vertigo andJieadache were de|)endent upon
this. He advised the use of lime-water and milk, and to
keep the bowels open by use of calomel. During the
examination the patient was in bed, and was laughing
and joking, and said that his head was perfectly free from
pain just then.
On the i6th I saw the patient at 10 a.m., and found
him with head and shoulders rais d on pillows, the body
and face bathed in perspiration, severe occipital head-
ache, and this was increasing. He still could place the
tip of finger on the nose quite accurately. The pulse
was 58, and irregular ; respiration 25, and regular ; no
sighing. These symptoms commenced about two hours
before my arrival. He had slept well during the night.
I noticed slight nystagmus for the first time, and the
pu]iils were in constant motion, they were so sensitive to
the light. The mind was clear and it remained so to the
very last. The occi[)ital headache was excruciating. The
speech was unaffected, though he had some difficulty in
swallowing, from a thick secretion of the throat ap-
parently. I promised to see him again that day, but
warned the family of the near approach of death, and
thought he would not live through the day. I ordered
the bromide to be given freely, but in statetl doses every
half hour for the headache, and a blister to nape of neck
for the same purpose. .\n hoiu' after m\- departure he
rapidly became cyanotic and died, free from spastn or
convulsions. The wife told me that the heart beat very
rapidly just before death. 1
Unfortunately 1 could not obtain an examination of
the brain, but as a substitute for this I will briefiy review
some of the recent literature of cerebellar lesions, and
the reader must with me be content to draw his own con-
clusions repecting the lesion in this case.
My friend. Dr. L. Putzel, of New York, in reviewing
the literature of this subject in the past five years, makes
these statements : ' " Nothnagel is of the opinion that
le^ions whose effects are restricted to one cerebellar
hemisphere can not be diagnosed, but this view is con-
trary to that of various other authors, so that the ques-
tion MUist still be regarded as sub judice.
" I-)isturbances of co-ordination (tottering gait) and
vertigo are characteristic of cerebellar disease, but these
symptoms may also occur in other aftections of the
central nervous system, and cannot, therefore, be re-
garded as pathognomonic. The diagnosis must de-
pend upon the combination of positive and negative
symptouis.
■' Nothnagel believes that the tottering gait and vertigo
are always due to an aft'ecion of the middle lobe of the
cerebellum ; he acknowledges, however, that in excep-
tional instances the middle lobe may be implicated, al-
though these symptoms are not obsei vcd."
In a foot-note to Dr. E. C. Seguin's lectures on " Lo-
calization of Spinal and Cerebral Diseases," " 1 find this
additional statement concerning; Nothnasel's conclusions :
• Ziemssen's Supplement, edited by Dr. George L. Peabody, p. 550.
• Mei iCAL Record, August 24, 1878, p. 143.
" In the large majority of cases the upper extremities
remain free from incoordination."
My friend. Dr. L. K. Holt, of New York, has recently
recorded an interesting case of tumor of the cerebellum,
which I will briefly review :'
.\ girl, four and one-half years of age, had been in
declining health for six months previous to December
II, 1883, when she was first seen by Dr. H. She had
been listless and indisposed to any exertion, subsequently
had some fever every other day. She vomited frecpiently,
had neuralgic pains in forehead and ep'gastrium, and occa-
sionally pains in the extremities. There was complete
anorexia, and the bowels became obstinately constipated.
Occasionally pain and rigidity in back of r.eck. Three
months before she was first seen by Dr. H. she began to
stagger in walking, which symptom gradually increased
until "she walked like one drunk," and was brought to
the Dispensary in her mother's arms. More recently
severe occipital headache had occurred. .\t time of exam-
ination, she had a heavily furred tongue and fetid breath.
The body was balanced awkwardly, rocking to and fro.
Reflexes normal, and there was no decided incoordina-
tion, no facial or ocular jjaralysis, pupils normal, no de-
viation of tongue, mind unaffected. ■' On December i5th
there was a very marked degree of ataxia of both upper
and lower extremities. " She was as liable to fall in on«
direction as another; no jerking movements, and closing
eyes made no difference in movements. She improved
under the use of tiuinia (for there was a history of chronic
malarial poisoning) for one week, then the former symp-
toms returnetl with increased severity, and she died sud-
denly on January 4th. The mind remained clear to the
last, there was some thickening of the speech a day or
two before death and some trouble in swallowing. 'Au-
topsy revealed "'a tumor occupying the situation of the
inferior vermiform process of ihe cerebellum, but it was
three or four times larger in .-ize than the piocess, and it
had encroached upon the fouith ventricle." ^
Dr. Holt gives Nothnagel's conclusions, and in ad-
dition to those alieatiy qui tec), I will give the following :
The incooidination from lesion of vermiform process
is sufficiendy characteiistic to be distinguished, in most
if not all cases, from that of posterior spinal sclerosis.
Its pecnliaii;ies are a swa)ing movement of the body in
walking, the le.s widely separated, the feet raised but
slightly, a stag^erin:.', a rocking to and fro, and a final
falling in an)' direction. Closing the e)es may or may
not inciease the difficult)-. '1 he spasmodic character of
the movements is usually wanting. The group of symp-
toms so closely simulates those of alcoholic intoxication
that one of Nothnagel's [laiients was several times locked
up by the police for drunkenness.
Vertigo is often an eaily symptom, and may be the first
noticed, but it is of no diagnostic importance unless
associated with incoordination. The optic is more fre-
quently involved than the other nerves of special sense.
Vomiting is wanting in the stationary and degncrative
lesions, but is a more common symptom in abscess,
hemorrhage, and tumor. In many case=, especially of
tumor, we have occiintal neuralgia as a i)roniinent
symptom.
I might review other interesting cases that I find on
record, "but space forbids, and they would but tend to
strengthen the conclusions to which Nothnagel has
arrived.
Railro.ad Surgery seems likely in time to develop
into a specialty of itself We are told {Chicago Medical
Weekly) that organizations have been formed by the
surgeons of at least three large coin|>anies: The Chicago,
Rock Island & Pacific, the Pennsylvania Central, and
the Wabash, St. Louis & Pacific. The surgeons of the
latter company recently held a successful meeting at
Fort Wayne.
1 Mklical RLCUBf, March 31, 1883, page 342.
38
THE MEDICAL RECORD.
[July 14, i8Sj
A CASE OF DISLOCATION OF THE HIP-TOINT
IN WHICH THE HEAD OF THE FEMl'R LAY
IN THE ISCHIO-RECTAL FOSSA.
By THEODORE R. VARICK, M.D.,
MEDICAL DIRECTOR AND SCRGEON TO ST. FRANCIS HOSPITAL. AND Sl'KGEON TO
JERSEY CITV CH.\BITY HOSPITAL, JERSEY CITY, N. J.
Charles B , a German, aged thirty-si.x, was ad-
mitted to St. Francis' Hospital, Jersey City, October 10,
1882, on account of a dislocation of the hip-joint, sus-
tained forty-eight hours prior to admission. The acci-
dent occurred from jumping from the deck of an ice-barge,
of which lie was captain, to the wharf ; a distance of
eight feet. How he alighted it was impossible to ascer-
tam, either from the patient himself or from his friends
who brought him to the hospital. At the time of the
accident the boat lav opposite the wharf at Barrvtown,
N. Y.
Ineffectual and persistent attempts had been made at
reduction before his admission. On inspection the thigh
was found to be fle.xed at an obtuse angle with the abdo-
men and abducted. A marked depression was observed
over the seat of the great trochanter and the head of the
bone lay in the ischio-rectal fossa, impinging strongly
'On the rectum.
In the presence of Drs. I. E. Culver. T. I. M'Louglilin,
B. A. Watson, and W. W. Yarick of the medical and sur-
gical staflf, and Dr. H. A. Long, assistant surgeon, the
patient was fully anresthetized, and reduction effected by
tirmly fixing the pelvis, and tlexing the leg on the thigh,
and the thigh on the abdomen ; the limb was adducted
and rotated toward the mesial line. The effect of these
manipulations was to throw the head of the bone into
the great ischiatic notch. F'rom this position, by external
rotation and abduction, the head of the bone was made
to pass into the obturator foramen. The limb was next
rotated inward, abducted, and gradually extended, which
caused the head of the bone to slip into the acetabulum
with an audible snap.
I have been unable to find any record of a case in
which the head of the bone lay in this location. The
nearest approach to it are the reports of four cases of
dislocation into the perineum, as follows : Dr. Amblarce
(quoted by Hamilton), in 182 i, records a case in which
the precise location of the head of the bone is not stated.
Professor Pope, in tile Sf. Louis Medical and Siui^ical
Journal, July, 1850, mentions a case in which " the head
of the bone was both seen and felt below the skin, and
raising the raphe of the perineum." Willard Parker, in
the New Yo?k Journal of Medicine, March, 1852, reports
a case where the ■' head of the bone could be both seen
and felt projecting beneath the skin of the raphe in the
perineum." Dr. E. W. Hadder, in the British American
Journal, March, 1861, also reports a case in which " the
head of the bone was found under the arch of the ])iibes,
the neck resting upon the ascending ramus.'
Medicine anii Politics. — The Chicago medical in-
stitutions, judging from the complaints often made,
suffer more from politics than those of most other cities.
The County Hospital in particular is cursed bv political
management, says the Weekly Revie^v, and indirectly
figures in most of the local political camjiaigns. It is
under tlie control of the Board of County Commission-
ers, and as a sample of its local importance the writer
remembers when one of these commissioners had thir-
teen of his own or his wife's relatives engaged in some
capacity about the buildings. Not within the memory
of the oldest inhabitant has the warden of the institution
been known to have been selected on account of any
peculiar capacity or experience in such a place.
Something similar miglit be related of this city, where
the city's charitable institutions are made to support a
crowd of political heelers.
^vonvcss of IHcdicaX J«ciencc.
A New Method for the Detection of Sugar ix
THE Urine. — At a recent meeting of the Clinical Society
of London, Dr. Oliver gave a demonstration of the
rnethod he employs for the detection of sugar in the urine
by means of test-papers. The test-papers were charged
with the carmine of indigo and carbonate of soda. When
one was dropped into an ordinary half-inch test-tube,
and as much water poured in as just covered the upper
end, and heat applied, a transparent and true blue solu-
tion, resembling Fehling's in appearance, was obtained.
(A transparent solution could not, at the meeting, be
produced from the London water. The characteris-
tic reaction with grape-sugar was, however, unimpaired).
If with the paper one drop of diabetic urine had been
added, shortly after the first sjmmer, a beautiful series
of color-changes appeared : first violet, then purple, then
red, and finally straw-color ; while, on the other hand,
one drop of non-diabetic urine induced no alteration of
color. The colors returned in the inverse order on shak-
ing the tube, which allowed the air to mingle with the
liquid. Reheating restored the colors again. Confir-
mation of the presence of glucose was obtained by drop-
ping in a mercuric chloride paper, while the solution was
still quite hot, after the complete development of the
indigo reaction. Then there was produced immediately
a blackish green precipitate. No such precipitation oc-
curred when a drop of non-saccharine urine was under
examination by the indigo test ; then the blue solution
was merely turned into a transparent green one. This
test, as Dr. Oliver pointed out, discovers (a) the normal
sugar ; {b) the varying proportions of sugar which fill in
the gap between the normal amount and that wluch
characterizes diabetes mellitus, as in liver-derangements
and vaso-motor disturbances ; (c) diabetic proportions.
It possesses the following advantages over Fehling's test :
I. It will detect sugar in any proportion in the presence
of albumein, peptone, blood, pus, or bile, and as readily
as in ordinarv diabetic urine. 2. It gives no play of col-
ors with uric acid. 3. It possesses portabilitv, cleanli-
ness, and stability. Moore's, Trommer's, and Boettger's
bismuth tests are all inferior in delicacy. — British Medi-
cal Journal, May 19, 1883.
A New Properlv of the Red Blood-Corpuscles. —
At a meeting of the Italian Medical Association {Annali
Univ. di Med.) Dr. Fano related his experiments with
peptone, and spoke of the rapid cessation of the reac-
tion of peptone in the blood. He demonstrated the
transformations of peptone absorbed by the digestive
tract or transfused into the blood-current, and how pep-
tone may be transformed and stored up bv the morpho-
logical elements of the blood. The transformation con-
sists in a process of dehydration, by which the peptones
are changed into coagulable albuminoids. The active
elements of this transformation are the red corpuscles
which, assimilating the peptones that enter into the cir-
culation, increase the specific weight. It is probably
to the potash salts which the red corpuscles contain that
this dehydration of the peptones is due, by which they
are transformed into globulin. F"or this process to take
place, the presence of o.\yha;maglobin is an indispen-
sable condition. The stored-up albuminoids serve as a
reserve supply of aliment, which is given up to the tis-
sues as required.
The Blood-vessels of the Spinal Cord. — Dr.
Adanikiewicz (Centralbl. fiir die Med. IViss.) says that,
when the vertebral arteries are injected, the bulk of the
injection finds its way to the cerebellum, and only a small
portion enters the vessels of the medulla oblongata and
of the cervical cord. The vertebro-spinal arteries are
disiributed to the spinal cord. The branches of these
divide and ramify as far as the roots of the fourth and
fifth cervical nerves, then anastomose and form one sin-
July 14, 1883.]
THE MEDICAL RECORD.
39
gle stem. Their branches are the arteria sulci distrib-
uted to the fissures, and the arterire radicinaa, which
spread laterally to the anterior roots. The so-called ar-
teriiv vertebro spinales posteriores spring from the verte-
l)ral between the dura mater and the cord itself, and
take their course between the anterior and posterior
roots as far as the fifth cervical nerve, anastomosing with
other vessels and their own branches. The arteri;is pene-
trantes, so-called by the author, are the largest branches
of these, and penetrate the posterior roots. The spmal
cord itself is not supplied by branches of the arterix ver-
tebro-spinales ; it derives its blood from a considerable
number of vessels — spinal arteries so called— branches
of the intercostal, lumbar, and sacral, which enter the
spinal canal beside the roots of the nerves. Adani-
kiewicz points out arteries (arteria; magnre spinales)
running deeply with the anterior nerve-roots. Each root
of the brachial ple.Kus has pretty constantly its own arte-
rial twigs. Great variation is observable in the arteria;
spinales anteriores ; each artery gives off an anastomos-
ing branch. The distribution of the arteri;e spinales
posteriores corresponds very closely with that of the an-
terior. While the anterior form one continued chain of
anastomoses in the anterior fissure, there are two such
chains on the posterior surface (anastomoses laterales et
posticK). The veins on the surface of the spinal cord ex-
ceed the arteries in capacity. On the anterior aspect
there are three principal venous trunks, of which the
largest traverses the anterior fissure, the other two ac-
company the anterior roots. The blood passes from
these to the median, lumbar, and sacral veins. The au-
thor notes more especially : i, the abundant supply of
blood-vessels possessed by the spinal cord ; 2, the un-
usual number'and extent of anastomoses which the spinal
vessels establish. These conditions readily relieve local
disturbances of the circulation by affording increased col-
lateral circulation. The same circumstances e.xplain
why myelitis occurs most frequently where the anasto-
moses are most feebly developed, and where an injection
penetrates least readily into the middle portion of the
dorsal region of the cord.
The ExTERN.^r, Application of S.'^licylate of Sod.a
IN Acute Rheumatism. — Mr. Whiteley, in T/w Lancet,
March, 1883, gives short notes on six cases of acute
rheumatism, which benefited greatly from the external
use of a lotion of salicxlate of soda to the affected joints.
The strength of the solution varied from 15 gr. to 20 gr.
to the ounce. To those joints to which it was applied,
relief followed very quickly, while those joints to which
it was not applied were not relieved like the others.
FiLARl.AL H.'EMATo CHVLURIA. — Dr. S. Mackenzie re-
cords the case of a soldier, a native of Madras, but born
of European jjarents, who, after arriving in England,
found that his urine became increased in quantity, tur-
bid, slimy, and by degrees ciuite milky. A little later he
was seized with a sudden violent pain, extending from
the left loin to the left testicle, and was admitted into
the military hospital, and thence transferred to Dr.
Mackenzie's care. The urine averaged one hundred and
twenty ounces in daily quantity, its specific gravity was
about 1. 010, neutral or faintly alkaline, and contained al-
ways some albumen, but no sugar. The urea averaged .6
per cent. Ether readily removed the milky color. It de-
posited blood, triple phosphates, rarely oxalates, bacteria,
and embryo filaria; sanguinis hominis. The blood, at
night contained numerous filaria;, the maximum being
reached at midnight, but they were absent during the day.
By inverting the order of his life, so that he slept by day
and was up at night, this condition of things altered too,
and the maximum of filari;e in the blood was then at
noon. After being under observation some time, patient
got a chill, had a rigor, followed by signs of pneumonia
at the left apex. This was followed by abscesses at the
root of the neck and left shoulder-joint, which were
opened. From the date of this illness the urine ceased
to be milky, and the filaria; disappeared from the blood.
The patient ultimately died, with empyema of right side
of chest. The kidneys were slightly enlarged, and in
early stage of suppurative nephritis. The mucous mem-
brane of the bladder was thickened, covered with mu-
cus, and contained extravasations. The abdominal lym-
phatics were carefully dissected, and found to be greatly
dilated. The thoracic duct was dilated below and ob-
literated above. The lymphatics of the left kidney were
especially dilated, and contained calculi. No trace of
the parent worm could be discovered. No communica-
tion could be traced between the dilated lymphatics and
the urinary passages. — London Medical Record, May 15,
1883.
Swallowing of Shot and Insufflation in the
Treatment of Ileus. — In three cases with well-marked
symptoms of invagination of the bovvel (Gazz. Med. Ital.
Lomb., Feb. 10, 1883), Dr. Pedrini, after other reme-
dies had failed to relieve, made the patient swallow five
or six bullets and four pounds of No. 3 shot, at the same
time using prolonged and repeated insufflation of air by
the rectum. In each case the success of this treatment
was complete, relief being quickly obtained, and the pa-
tient making a good recovery.
Tapeworm a Cause of .Aphasia. — Dr. Armangu6 re-
lates {Journ. de Med. et de Chir. Prat.) the case of a
woman of sixty who was seized with vertigo, and a few
days later lost the memory of words for some days.
After the expulsion of a tapeworm there was no return
of her nervous troubles. He quotes a case of aphasia
in a child cured by the ex|Hilsion of numerous trico-
cephali, published by Daniel Gibson ; and a case of
aphasia coinciding with tasnia, published by Siedel.
The editor adds a case of reflex hemiplegia and hemi-
anaesthesia, with convulsive seizures, in a little girl of
twelve, cured b}' expelling a ta;nia, observed by Langer
in Germany.
Decoction of Lemons in Malarial Fevers. — Dr.
Maglieri [Gior. di Clinica e Terapia, March, 1883) has
obtained quite as good results with this simple remedy
as with quinine. He finds it efficacious in acute and
chronic malarial aftections. Given four hours before the
onset of a fever, it averts the paro.xysm. This it did even
in cases in which quinine had failed. In malarial cachexia
the general health improved, and the liver and spleen
were much reduced in size.
Chvliform Effusion int<t Serous Cavities. — A
number of cases of this kind have been collected by
Perice and Veil {Jourtial de Med. et de Chir. Prat.). Veil
relates a case of ascites, with milky eflusion. The fluid
contained a large amount of albumen, and, under the nu-
croscope, showed numerous fatty granules, and a small
proportion of leucocytes. A postmortem examination
showed traces of peritonitis, and gummy deposits in
the liver. In two other cases the milk-like fluid was not
found at each puncture, the fluid being sometimes clear.
Veil believes that the origin of' the fat is from the trans-
formation of pus, which dies and then becomes emulsified.
Is there a Catarrhal Ulcer? — In the Berliner
klinische. Wochenschrift,Ve:h\u-i.ry 19 and 26, 1SS3, Vir-
chow combats the teaching of Niemeyer, that in acute
and chronic catarrh, ulceration or superficial erosion of
the mucous membrane of the larynx may occur, and that
the inflamed mucous membrane is then in a condition
analogous to the denuded cutaneous surface after the
rupture or puncture of a blister from a blistering plaster.
At the same time, Niemeyer describes follicular ulcera-
tion. Virchow holds that from the mucous membrane
in catarrh there is simply an excessive flow of its normal
secretion, as maybe seen in the nasal membranes. This
secretion, flowing from an unimpaired surface, is the es-
sential feature of catarrh, so much so that the phrase
" dry " catarrh is meaningless to the author, a contradic-
40
THE MEDICAL RECORD.
[July 14, 188:
tion in terms. Catarrhal ulceration is equally unintelli-
gible to Virchow. A child, he observes, may have an
irritating discharge of mucus from the nostril, which may
accumulate about the nostiil and lip and cause inflam-
mation and ulceration thereof; but the ulceration being
on the skin, and not on the mucous surface, cannot be
correctly termed catarrhal. The ulceration of the l.xr-
ynx in phthisis is not catarrhal. The pavement epi-
thelium which extends from the lips to the cardia, with
the exception of a small spot at the border of the larynx,
is not the seat of ulceration. Parts of the mucous tract
that are lined with cylinder epitheliinn are not thus ex-
empt from ulceration, as may be often seen in the intes-
tines after ]iersistent diarrhtea, and in other parts where
glandular follicles exist. Virchow recognizes only as ca-
tarrhal the secretion flowing from a simple nuicoas sur-
face, and repudiates the application of this epithet to any
secretion from glandular structures.
EXPERIMKNTAL jMeNIXGEAL HEMORRHAGE. M. Bon-
not has published some experiments (I-ondon Lancet,
May 12, i8S3),on the eftects of injecting fluid blood be-
neath the dura mater in dog?, with a view of reproducing
the sym[)toms of meningeal hemorrhage. Some of the
animals were, others were not, under the influence of
an;i;sthfc;ics. The eftects did not ap|)ear immediately,
but a c itain period, termed by Hannot the latent |)eriod,
intervened between the moment of the injection of three
to five cubic centimetres of fluid blood and the first signs
of impaired function. The second period was the pe-
riod of painful excitation. Soon afterward tonic convul-
sions were observed, characterized by convulsive phe-
nomena and resiiiratory syncope. The respiration was
at first accelerateij, but soon suddenly ceased. General
convulsions of all the muscles then occurred, and a vio-
lent attack of o|)isthotonos was brought on. The heart
at first [ireserved its rhythm, but, if respiration did not
recommence, either spontaneously or induced by artifi-
cial means, death supervened, evidentl}' from asjjhyxia ;
but if the respiratory process is jnaintained, the animal
may recover, after exhibiting for a longer or shorter pe-
riod the symptoms of coma, the coma being longer in
proportion to the amount of blood injected. Thus, with
fifteen cubic centimetres of blood mjected beneath the
dura mater, anaesthesia was complete and the coma was
protracted for a long time. During this comatose anaes-
thesia the respiration was usually irregidar, internut-
tent, and analogous to that form which is known as the
Cheyne-Stokes respiration. The jienod of tcuiic con-
vulsions was always short ; it suiierveueil more readily
if the animal was rendered ana;sthetic by chloral, and
es|>ecially if the subikiral mjcctiqns had been made rap-
idly, so as to produce an iunnediate change of pressure
in the brain. In no case was -M. Bonnot able to obtain
evidence of paralysis.
Absorption by the Perito.vku.m. — Maft'ucci's experi-
ments {Giornale Inicniaz. delle Scieitze Med.) were under-
taken with the object of determining whether, besides the
diaphragm, there are other absorjHive points of the ab-
dominal cavity, or whether it is an absorbing surface in ail
its extension. From experiments on dogs he arrives
at the following conclusions : 1. The diaphragm, great
omentum, broad ligament, gaslro-hepatic and gastro-
splenic ligaments, the folds of Douglas, the meso-rcctum,
and exceptionally the mesentery, are absorptive of( orpiis-
cular fluids. 2. Where absorption of these lliutls lakes
place, tiiere is a modification of structure in the peiuc-
neum, in the epithelial lining, as well as in tlie subjacent
tissue ; in the diaphragm there are lymphatic lacuna', m
the rest of the peritoneum lymphatic follicles, which, Irom
these experiments, receive their physiological impor-
tance, hitherto conjectured only. 3. Corpuscular fluids
are taken u)) by the lumbar and aortic glands, those of
the hilum of the liver and spleen, and of llie curvature
of the stomach. 4. These fluids, absorbed by the dia-
phragm, are [joured as much into the more complex
glands of the mediastinum, as into the system of follicles.
5. Comparing the abdominal cavity, and also the medi-
astinum, with the general anatomy of the lymphatic
system, in the dog, the first as well as the second may
be justly considered as a lymiiliatic gland with the re-
spective follicles.
Is there ax .\kachnoid jMemukane ? — Dr. Tukes
is of 0|)inion that a separate arachnoiti membrane does
not exist, and that the theory of a subarachnoid space
should be given up. In ])lace of this he would describe
the brain membranes as twofold, the pia mater and dura
mater, and two spaces, the subdural and intrapiamatral
spaces.
The Si.mple.st .Method of Detectixg Tubercle-
Bacilli. — Finding the staining methods of Koch, Au-
frecht, Ehrlich, Balnier and Frantzel too complicated
and slow. Dr. Zenkevitch recommends {Mediz. Obozr.,
February, 1883) the following plan as simple, quick, and
eftectii-e. .\ lump of sputa is crushed and rubbed be-
tween two cover-glasses ; then the glasses are separated
and allowed to dry in the air ; after warming over the
flame until the material becomes slightly brownish, the
preparation is washed in water and put for one or two
minutes in the staining-fluid, which is a saturated solu-
tion of fuchsin in aiiilin water (2 c.c. of anilin to 50 c.c.
of water). Then the pieparaiion is again washed in
water, and placed for one or two minutes in alcohol con-
taining nitric aciil (one drop of acid to each 10 c.c. of
alcohol). It remains now to once more wash it in wa-
ter, dry in the air, warm over flame, and mount it in
Canada balsam. The author states that this process of
preparation makes the bacilli as clearly and brightly visi-
ble as Ehrlich's (or any other) methoil does. According
to his description, a free bacillus, as a lule, has a length
equal to one-fourth or one-half of the diameter of a red
blood-corpuscle, the longest specimen^ being equal to
three-fourths or even to the whole diameter. The longest
rods contain from three to five intensely stained round
granules (spores). Fuclisin stains also free spores, which
are seen either isolated or groupej in colonies. The ex-
amination of the colonial spores allows all the stages of
development of the microphyte to be traced from the
form of granule to that of rod. Like ISalmer, Frant-
zel, and others. Dr. Zenkevitch found the bacillus only
in phthisis. No rods were tletected in the sputa of the
patients with acute or chronic bronchitis, emphysema,
or croupous pneumonia.
Meiucal .Advertising in the Xorthwest. — Dr. A.
W. Parsons, of Brainerd, Minn., writes: "In your issue
of June 9th last I notice an editorial which reflects upon
the professional probity of certain surgeons in the North-
west. I leel assuretl that the large majority of medical
men m this portion of the country most heartily endorse
your sentiments, but they will assuredly resent any in-
ference that the practice of self-laudation is as common
in this section as your notice would assume. It is a
lamentable fact that certain practitioners, in all portions
of the country, do not hesitate to divulge to the public,
through the columns of their local papers, the results of
their skill when such results redound to their credit. But
I am sure that a careful ac(|uaintance with the medical
men of the Northwest woukl siiow you that the practice
of quackery an<l self-praise does not exist among them
to any greater degree tiian in otlur and older localities.
Indeed, I feel calleil upon to state that tlie majority of
physicians whom I have met during a two years' residence
in the vicinity of St. Paul and Minneapolis, have im-
pressed me with the belief that the rapid growth and
wonderful development of this new country have been no
more than commensurate wiih the advance in medical
and surgical science, and tlie prevalence of professional
intelligence, courtesy, and integrit)."
July 14. 1S83.]
THE MEDICAL RECORD.
41
The Medical Record
A Weekly youriial of Medicine a}id Surgei'y.
GEORGE F. SHRADY, A.M., M.D., Editor.
Pt'BLISHKD BY
WM. WOOD & Co., Nos. 56 and 58 Lafayette Place.
New York, July 14, 1883.
ACONITIA: ITS USES IN NP:URALGIA.
Attention has been again called to this valuable alka-
loid by the interesting articles of Dr. Laboide in late
numbers of ihe. Journal de Tlierapeutiijiic.
Aconitia (which exists in the root of the aconitum na-
pellas in the proportion of about one drachm to twentv-
si.x ])ounds) has been especially made the subject of study
by the late Prof. Gubler, whose monograiihs on this
medicament are of great practical utility. Cnibler was
one of the tirst to insist on the importance of tiiis remedy
in the treatment of trigeminal neuralgia.
Aconitia is found in commerce under two distinct
forms ; the amorphous and the crystallized. The latter,
which is somewhat stronger and more reliable, is the
best known, and is generally prescribed under the name
of Duquesnil's aconitia.
Not to dwell on the toxic effects of this powerful al-
kaloid, which is only safe in very minute doses, we may
sura up its therapeutical actions by the observation that
it seems to have a si)ecial selective influence on the ex-
tremities of nerves of sensation, which it paralyzes.
This elective affinity is especially manifest iu the case of
the fifth pair of nerves.
The beneticial effects of this medicament in neuralgia,
in general and facial neuralgias in particular, have been
attested by a multitude of observers, among whom we
may mention Oulmont, Seguin, Fraiiceschini, Merck,
and Laborde. (jubler is fond of narrating an incident
which occurred in his jiractice. It concerned a patient
on whom Nelaton had practised resection "of all the
branches of the tri-facial " (!). The pains continued to
be just as atrocious and just as i>ersistent as ever. The
patient, reduceil to despair, and ready to conunit suicide,
was treated by (iubler with aconitia. Seven milli-
grammes a day of Hottot's aconitia was administered m
granules with the most marked relief, and by persever-
ance in this remedy a complete cure was effected.
Laborde, in the Jonnial de Therapeutique above re-
ferred to, i)ublishes reports of six cases of neuralgia,
mostly of the fifth pair, in all of which marked benefit
was obtained from aconitia ; in some the benefit was
permanent. In all these cases the medicine was given
by mouth. He makes use of the granules of Duquesnil
containing one-fourth of a milligrannne. One granule is a
sufficient commencing dose, and he advises that the dose
should not be repeated under four hours. Generally the
second granule ,\yj)l give relief, if the first fails to benefit.
A safe and efficient way, which we have often tried, is
the following, which is in accordance with the directions
laid down by Dujardin-Beaumetz : Dufpiesnil's aconitia is
ordered — the one-fourth of a milligramme granules. Of
these the patient is ordered to take one granule every
three hours, till eight have been taken during the twenty-
four hours. It is seldom that there is occasion to go any
farther. Generally tlie second or third causes comjilete
disappearance of the pain. Given in this way, we do not
exceed two milligrammes a day. If this iloes not relieve
it is vain to jjush the remedy farther. Sometimes after
the second or third granule a little tingling of the tongue,
and pricking of the skin of the face, with constriction of
the mouth are experienced. Patients sometimes com-
plain that their head feels " hoop bound " for a time.
There is no doubt about the superlative excellence of
this medicament in all so-called congestive neuralgias,
as we have notes of obstinate cases of sciatica which
have proved amenable to treatment by aconitia. It is
one of the remedies that should be first tried in severe
sciatica and lumbago, a frigore.
Even in the case of symptomatic facial neuralgias, as
well as protopathic, the pain is often alleviated by aco-
nitia, as 1 -aborde has shown.
GREEK OR (lERMAX— WHICH?
A COLLEGE graduate, prominent in the profession, said
to us recently : "If I could exchange my knowledge of
Greek for German, it wouUl be worth everything to me
now. It is mortifying to be dependent on others for
information as to what is going on in the great medical
centres of the old world."
Our friend sijoke the sentiments of multitudes who, in
their collegiate days, spent in acquiring a knowledge of
Greek the time which would have made them proficient
in any one of the modern languages. Amid the cares of
a busy life they have no leisure now^ for the (Jerman
granunar and le.xicon.
Charles Francis Adams, Jr., in the annual oration be-
fore the Phi Beta Kappa Society at Harvard recently, had
the courage to advocate a radical change in the course
of studies pursued at that L'niversity. It is seldom at
college conunencements that so much wholesome truth
is told. He asserted that the traditional college course
does not fit the graduate for the duties of life, but diverts
him from them. He appealed, in confirmation of his
charge, to the experience of his great-grandfather, his
grandfather and his father, also to his own experience,
and that of his brothers. John Adams, the second Pres-
ident of the United States, had learned what Greek was
taught at Harvard, and at the age of forty-two was
appointed ambassador to Fiance. They did not talk
(;reek in France, and he found himself in an awkward
predicament from ignorance of the language. The same
was afterward true of John Quincy .-^dams, and of Charles
Francis .-^dams. and had been true of the orator. He
maintamed that the study of Greek had been a hind-
rance and a waste of time to every liberally educated
member of the family, and that this experience has been
by no means exceptional. The same time devoted to the
study of the modern languages would be of more ad-
vantage, though the speaker did nyt object to Latin,
42
THE MEDICAL RECORD.
[July 14, 1883.
since Latin is the parent of most of the European lan-
guages.
As for the vaunted discipHne obtained from the study
of Greek, it is no more than can be acquired from the
study of German; he thought that Plato and the vener-
ated names of Greek literature were greatly overesti-
mated by tradition, and that the study of the Greek
grammar was a total waste of time, and that as an intel-
lectual exercise it would be just as beneficial to the
student to memorize Kant's " Critic of Pure Reason."
In short, Mr. .\dams considered the Greek worship as
fetich, and would reorganize college education by leaving
out Greek and substituting German and French. .\11
certainly that is valuable in those old writers, Plato and
Aristotle, etc. (and there is very much that is rubbish),
could be obtained through the medium of a translation.
For young men intending to enter the medical pro-
fession, it is a pity to waste a year of study and spoil a
good pair of eyes over Greek declensions and dialectic
variations, and in trying to get the hidden meaning of
authors who give no more practical thought than can be
obtained from the masterpieces of English literature,
while the Continental languages still remain unknown,
and the whole broad field of physical science remains
une.xplored. The radical change which Mr. Adams so
eloquently urges must soon come.
BOOKS OR BACKGAMMON.
Despite the fact that Wood's Medical Library Series cir-
culates largely in the West, it is said that the benighted
physician still lives, in some ]jarts of that vast indefinable
region, who speaks of .^stley Cooper as the -'greatest
living surgeon '' — whether he votes regularly for Andrew
Jackson is not known. Several years ago we met with
a practitioner out " West," doing a comfortable business
(so he said), whose hbrary consisted of only two books,
Hartshorne's " Essentials," and Druitt's " Vade Mecum.'
He had chosen wisely and well, but his enthusiasm for
knowledge was somewhat too moderate. Lhifortunately
he had a strong predilection for certain games of chance,
which, if they demand much time of their votaries, confer
little discipline.
We think there are few in the profession who so little
feel the responsibilities of the vocation which they have
chosen as did our Western confrere, who notwithstanding
the fact that he was liberally supplied with self-confi-
dence, must not seldom have found himself msufficiently
prepared for the serious duties before him ; this we say
without any disrespect for the eminent authorities whom
he was in the habit of consulting. His case is, perhaps,
not widely dissimilar to that of many who buy books
and take journals which they never read. Better the
" Essentials of Medicine," w'ell studied, than all of Ziems-
sen, ke|)t simply to ornament the shelves.
The great body of medical men throughout the country
are, we feel assured, men who, feeling the gravity of the
tasks which they daily undertake, seek all the liglit thev
can get. They are diligent students of all the great
masters in medicine and surgery. They have no lime
for whist or for lounging. The more work they have to
do the more time they must find to read and meditate.
Preparation for their daily duties must be made, if the
midnight lamp nuist be burned. '"Phey must diligently
con their medical journals, for they need the experience
of others to guide them. Moreover, they must record
their own experience, much of which is too valuable to
lose. Thus, and thus only can they discharge their obli-
gations to their constituency and to societ)', by assimilat-
ing the best thoughts of the age, and by helping on the
car of progress.
MEDIC.-\L EDUC.VriO.N' THE FUNDAMEXT.^L F.\CT IX
MEDICAL ETHICS.
At the last meeting of the .American Medical Associa-
tion, Dr. A. L. Gihon, U.S.N., read a paper upon the above
title, at the close of which he submitted the resolutions
given below. They were promptly rejected by the
Association. It seems incredible that temperate and
sensible men should tail to acknowledge that Dr. Gihon's
views are in the main correct ; and that what our pro-
fession most needs, and should most work for, is better
educational requirements. The resolutions presented are
somewhat radical, and their author would doubtless have
made more impression if he had suggested, at the begin- h
ning, less sweeping reforms. V
It ma\- be questioned, also, whether the American
Medical Association can carry out any serious medico-
political measures, so long as it is an unchartered body
with a shifting membership and without legal status.
We print the resolutions, which are at least very sug-
gestive, in full :
Resolved, That the Section in State Medicine urges
upon the Association the necessity for at once taking
steps to exclude unqualified members from the profession,
by refusing fellowship to illiterate, ignorant, and incom-
petent graduates.
Rcsohed, That the .\ssociation be recommended to
authorize the Section in State Medicine to act as a Stand-
ing Committee on Medical Education, the several elected
members being required to communicate without delay
(i) with the several State medical societies and the Legis-
latures of the States they respectively represent, with the
object of creating State Boards of Medical Examiners,
where such are not already in existence, whose certificate
shall be necessary to the issue of a license to iiractise
medicine in that State ; and (2) with the authorities of
every regularly organized medical college in the State,
which has not already taken such action, urging upon
them, First, the reciuirement of a proper preliminary edu-
cation of matriculants, to embrace at least a knowledge of
English orthography and grammar, the etymology of the
more common (heek and Latin derivations and the funda-
mental rules of arithmetic, to be ascertained by a writter^
examination, preserved for reference ; and. Second, greater
care in ascertaining the fitness of candidates for a degree,
by making their final examination in part a written one, to
be kept on record and accessible for inspection by State
Boards of Medical Examiners, Boards of Censors of Medi-
cal Societies, or other authorized persons requiring infor-
mation as to the professional iiualifications of graduates.
Resolved, That in the opinion of the .American Medi-
cal Association, medical colleges should confer upon
•iraduates the dei^ree of Bachelor in Medicine, such
graduates to be eligible to the degree of Doctor in Medi-
cine zx. the end of three years, after having given satisfac-
tory evidence of their qualification to the Board of Cen-
sors of the State Medical Societv.
July 14, 1883.J
THE MEDICAL RECORD.
43
Resolved, That Article II. of the plan of organization
of the .\merican Medical Association be amended by
this additional proviso :
Provided, That every permanently organized State,
County, or District Medical Society entitled to represen-
tation in this Association shall be required to appoint a
Board of Censors, who shall rigidly scrutinize the literary
and professional qualifications of every candidate for
membership therein, and hereafter no delegate shall be
admitted to a seat in this Association who shall not have
received the certificate of such a Board of Censors or of
a State or X'ational Board of Medical Examiners.
THE NEW T.\RIFF ON DRUGS .^ND CHEMIC.XLS.
On July ist the new tariff regulations went into effect.
Nearly forty per cent, of the entire number of listed ar-
ticles comes under the head of drugs and chemicals.
Hence the present change will have some effect upon
tiiose who mai<e and dispense medicines. Heretofore a
duty of 20 per cent, has been charged upon chemicals,
and a duty of 40. per cent, ui^on medicinal preparations.
Under the new tarift" they are all placed at 20 per cent.
The general effect of this change will be favorable to
manufacturers of drugs and chemicals on account of the
reduction of the tax upon the articles used in manufacture.
The retention of quinine upon the free list has, says
Mr. n. C. Robbins somewhat dolefully, destroyed its
manufacture in this country. The United States, he
says,consumes 1,600,000 ounces annually, of which one-
half is imported, when it should all be made here. Not
being manufacturers, but consumers, we can hardly see
the force of this logic.
Among the more common articles on which the duty
has been lessened, we present the following list.
Unit.
Rate.
Akticle.
Old.
New.
Glycerine, crude
Value an
dlb.
30 per cent.
2 cents.
Phosphorus
Value and lb.
2oper cent.
locents.
Castor oil
G^iUon.
$1.00.
80 cents.
Croton oil
Pound.
$I.OO.
50 cents.
Oil. fl a .\ s e e d, lin-
seed, cotton seed.
Gallon.
30 cents.
25 cents.
Mineral waters.
a r t i fi c ial, imita-
d qt.
3 cents plus
P'ree.
25 p. c.
30 per cent.
5 cents.
Boracic acid, pure..
Pound.
Potash, chromate and
bichromate
Pound.
4 cents.
3 cents.
Copperas
Pound.
Viu per cent
»/„, p. c.
Magnesia, medicinal
carbonate
Pound.
Pound.
6 per cent.
134 per cent
5 cents.
I cent.
Soda, caustic :..
Zinc, o.xide of drv.^.
Pound.
1%. cents.
1J-4 cents.
Oils, essential, e.\-
pressed, n. o. p. . . .
Gallon.
20 percent.to$i.oo.
25 per cent.
Officinal medical
preparations
Value.
40 per cent.
25])ercent.
Barks, beans, etc.,
ground or refined.
V.ilue.
20 per cent.
10 per cent.
Chloroform .
Pound.
$1.00.
50 cents.
Opium, preparations
of, n. 0. p
Pound.
$8.00.
$10.00.
The increased duty on opium refers only to its ]>repa-
rations.
Besides the above, a considerable number of articles
have been placed upon the free list.
The results of tlie new tariff as regards consumers
ought to be a slight reduction in the price of many drugs.
It will, however, be some time before the public finds
any noticeable difference.
Ucius of the 'amccTi.
The Bovlsto.n' Prize, of $200, for the best essay on
" Measles, German Measles, and .\llied Diseases,' has
been awarded to Dr. P. M. Braidwood, of Birkenhead,
England.
Medical Education vs. Medical Ethics. — The
Bellevue Hospital .Medical College announces itself as
adhering to the old Code, but requires no preliminary
examination of its matriculants.
Dr. J. H. Tho.mpson, of Rome, Italy, is on a short
visit to this city.
Dr. Spina, Koch's opponent, has been nominated
Professor of (General and Experimental Pathology at
Prague. This may be considered an endorsement of the
value of Spina's work.
Porro's Operation was performed by Dr. Parrish in
Philadelphia recently, upon a dwarf. The patient sur-
vived for several days, bat finally died.
Yellow Fever Trans.mitted r,v Despatches. — It is
stated that one of the ofticials of the Foreign Depart-
ment at Paris has caught the yellow fever through a de-
spatch sent from Brazil. One of the daily papers wonders
if it was a telegraphic despatch.
Experi.mental Inocul.ation with Syphilis. — It is
stated that Dr. Cory, the Director of .\nimal Vaccina-
tion at the Vaccine Establishment, London, England,
has inoculated himself with syphilis while making experi-
ments on himself as to whether syphilis can be communi-
cated from one body to another through vaccination.
One would have thought that the possibility of transmit-
ting syphilis by means of vaccination was sufficiently well
established without any further experiments, and cer-
tainly one would have supposed Dr. Cory could have
had no doubt of the fact. At all events, if reports as to
his sufferings from the inoculated disease are true, he
must be thoroughly well convinced of the fact that at
least one of the means of getting syphilis into the system
is by means of vaccination. It has been officially stated,
however, that " the result of transmitting the infec^on of
syphilis was not attained without departing in essential
respects from the Board's instructions to public vaccinat-
ors and from the recognized practice of all vaccinators."
The Su.mmer Sanitary Inspectors have been ap-
pointed by the City Board of Health. The total number
appointed was fifty, and work was begun on July 9th.
We observe a large number of nesv names upon the list.
New brooms sweep clean, and there are some reasons
for thinking that some change will not be disadvanta-
geous.
Yellow Fever.— Infected vessels have appeared at
Galveston, Pensacola, Ship Island, and at date one is
on the way to this port from Havana. No cases have
yet occurred, however, except on the vessels, h de-
spatch says : There are two vessels at Ship Island in
charge of the Surgeon of the Marine Hospital Service,
who established himself in the quarters of the late Na-
tional Board of Health yesterday, and one vessel at Gal-
veston and two at Pensacola are under orders to proceetl
44
THE MEDICAL RECORD.
IJuly 14. 1883.
thither. There has been undisguised bitterness of feel-
ing between the retiring officers of tlie National Board
and the incoming agents of the Marine Hospital Service,
and the lalter, when they took charge, found the quaran-
tine station at Ship Island gutted of all conveniences and
properties. Even the steam despatch boat, Day Dream,
iiad been sent away, but she has since been discovered
tied up to the levee at New Orleans and taken possession
of by the Treasury De|iartment. The officers of the
National Board have had her u]i for sale for the past few-
weeks, but they were unable to obtain a purchaser.
Upon the withdrawal of the inspection service of the
National Board the Sanitary Council of the Mississippi
Valley assumed charge of the same, it being decided at
several up-river points that certificates of the Marine
Hospital Service would not be recognized.
Dr. H01..MES will deliver the address at the opening
of the new building of the Harvard Medical .School, Oc-
tober 15th.
A MoNU.MENT TO Fabricius is to be erected by the
citizens of .\cquapendente, Italy.
The Third Intern.ation.^l Congress of Anti-
Vaccixationists will meet in Berlin this summer. New
\ ork sends three delegates.
The Ninth Annual Meeting of the Tri-State
Medical Societv will be held at Indianapolis, Septem-
ber 1 8th, 19th, and 20th. Especial efforts to make this
meeting a success are being made by its energetic officers.
The Late Dr. Beverly Livingston. — .\t a meeting
of the Medical Staff of the Northern Dispensary, held
July 6, 1SS3, the following resolutions were adopted :
^ U'hureas, We learn with profound sorrow of the death,
at the outset of a promising professional career, of our
late associate, Beverly Livingston, M.D. ; therefore be it
Resolved, That in the death of Dr. Livingston the
medical profession loses a worthy member, the Northern
Dispensary an efficient aid, and the members of the staff
an associate whose genial qualities and untiring zeal will
long be remembered.
Rcsol-ced, That our most sincere synipalliy be e.\tended
to the family of our late associate.
Resolved, That a copy of these resolutions be pub-
lished in The Medical Record and transmitted to the
family.
A. K. Pray, M.D.,
C. I). Havward, D.D.S.,
R. W. Glassford, M.D.,
Committee.
The Progress of the Cholera Epide.mic. — The
number of deaths from cholera have, U[) to time of wriiin",
been as follows :
M Daniiclta. \x. nclgliWrliig towns.
July 3d 124 43
July 4th Ill 63
Julystli 116 63
July 6th loi 52
July 7ih 98 60
JulySth 96 61
July 9th 87 9
'J'lie number of persons killed 1)\ the disease at Damietta
(July I nil) now amounts to about twelve hundred, or
•over one-twenty fifth of the |)opulation. It has been
very malignant, but has so far been confined almost
entirely to the natives. The disease is travelling up
tlie Nile, having already reached Shirbin, a small vil-
lage thirty miles above Damietta, Mansurah, a town
twenty miles bevond, Menzalen, and Samanoud, the last
a small village only seventy miles below Cairo. It may
possibly ha\e reached Cairo by the time tliis appears.
Some cases have been reported at Alexandria. The
disease was due in Eg\ pi in 1877, having appeared regu-
larly every twelve vears since 1781, spreading always to
the west and taking about two years to exhaust itself.
In all previous instances the epidemic, has developed
energy among the oriental races, whence it has spread to
Europe. The exodus which has taken place from Egypt
is likely to carry the infection to the adjacent towns of
Syria, and particularly to Beyrout, whence it may spread
to any point on the Mediterranean. A number of vessels
from Bombay, carrying pilgrims to Mecca, are expected
at Geddah, and it is likely that the epidemic will be
brought by them. .Ml the European Governments have
established strict quarantine regulations as to vessels
coming from Egypt except England. The Sanitary
Council of Constantinople, in order to prevent the intro-
duction of cholera, have resolved to ask the Porte to re-
quest the Egyptian Government to prohibit refugees from
starting for the Turkish coasts, anil to inform that Govern-
ment that if any refugees do arrive at ]iorts belonging to
Turkey thev will not be allowed to land. Sanitary cor-
dons have been drawn around some of the infected towns.
S%cuiau5 and JXoticcs.
Medical Essays, 1842-18S2. By Oliver \Vendell
Holmes. Boston : Houghton, Mifflin & Co. 1883.
This volume embraces nine essa\s, most of w-hich are
more or less familiar to our readers. They vary some-
what in merit and interest.
The essays on "Homoeopathy and its Kindred Delu-
sions " will always remain the most brilliant and masterly
criticism that has ever been made of the development of
medical isms. As a contribution to the subject of the
value of human testimony also, no one can read it with-
out being instructed. We mistake — there is the world
of the pig-headed, of the unteachable Philistine — and be-
sides (we crave jiardon) there are the ladies-^to these
two classes Dr. Holmes's essay is unintelligible ; hence
our 'pathies and our jjatent medicines.
The essay on " The Contagiousness of Puerperal
Fever " is of another character, and illustrates the capa-
city of the author for dealing with scientific questions.
The issue for which Dr. Holmes contended with so
much earnestness and effect is now a dead one, but dead
because all agree with what Holmes laid down in 1843.
The essay entitled " Medical Currents and Counter-
currents " is a iHingent criticism upon the i)ractice of
overdosing, and a philosophical analysis of why we give
and when men take medicines. But, although this chap-
ter contains much that is witty and instructive, the sub-
ject of therapeutics now-a-days is looked iqion from a
somewhat different standpoint than it was twentv-five
years ago, since which time the physiological school has
develo|)ed.
Of the remaining essays those on "Bedside Instruc-
tion " and "The Young Practitioner '' are perhaps the
best. They especially illustrate the relations of our
author toward medicine.
There is no transcenilcntalism about Holmes. He
July 14, 1883.]
THE MEDICAL RECORD.
45
preaclies coiiiiiioii sense, humanity, and small doses. He
pleads for a knowledge of human nature as well as of
the human body, for sound observation as well as for
study. He has a little feeling of antagonism toward the
jjresent tendency to cultivate the medical sciences ; a
feelrng which Trousseau showed when he said : " Good
heavens, gentlejnen, a little less science, a little more
art ! " Dr. Holmes is the essayist par excellence of the
practitioner. We fear that, as regaids pure science, he
is a bit of a Philistine himself, and it is somewhat inter-
esting to find that our author, who has attacked non-
conductive didness all his life, now shows a trace of it
himself in his relations to medical progress. For it
is certain that the advancement of medical art is not in
the hands of our great and successful practitioners, but
with the patient workers who are trying to follow natine
into her last hitling places.
Brain-Rest. By J. Leonard Corninm;, M.D. New
York : G. P. Putnam's Sons. 1S83.
Dr. Corning has given us a little work which is of con-
siderable interest. It is written with evident care and in
a scientific spirit. The author preaches the value of
securing brain-rest by regular sleep at |)roper hours. He
describes his own device for carotid compression, and
mechanically regulating the cerebral circulation, with all
of which our readers are familiar. Dr. Coming's discus-
sion of pathology of "brain-exhaustion," with its cerebr.il
hyperemias and anemias, appears to us to be a tritle ama-
teuiish. We might say the same regarding some of the
the.apjutical parts. On the whole, however, the book is a
very creditable and suggestive contribution to the impor-
tant subject with which it deals.
Transactions of the IVTedicai. Association of Mis-
souri, at its Twenty-fifth Annual Session, held at
Hannibal, Mo., May 16, 17, and 18, 1882.
This year's report gives a marked increase in member-
ship since the last meeting. The president's address is
devoted mainly to the e.xposure of quackery and the
several classes of "quacks," with which the State is ap-
parently pregnant. Very little in this direction can be
accomiilished by such means. We would advise an
application to the State legislature through a properly
ap|)ointed connnittee, as the true means of working out
the reform needed. Consiilerable good work is, how-
ever, shown to have been performed during the year,
much of which is indeed commendable.
Transactions of the Medical Association of Geor-
gia. Thirty-third Annual Session, held at Atlanta,
Cia., April 19, 20, and 21, 18S2.
Much praise is tlue to the secretary of the Society, k.
Sibley Campbell, M.D., for his untiring efforts in secur-
ing the handsome appearance of the volume before us.
We have no doubt, from the many very valuable articles
oP general interest to the [jractitioner contained in the
text, that a sufficiently large number of copies will be
disposed of to leave a balance in the treasury. The
finances of the society are, we regiet to say, in a poor
conduion, due, however, to the carelessness or unwilling-
ness of members to support its interests by paying their
just dues. This cannot be too severely censured. The
book is handsomely printed on fine toned paper and ele-
gantly bound in cloth for permanent use.
Sixty-Ninth .Annual Report of the Trustees of the
Massachuseits General HosPIiai. and McLean
Asylum. Boston, 1882.
From a comparison with the previous year's work, the
report shows a slight increase in the number of patients
treated at the Hospital, together with the receipt of
several munificent donations, which, from the treasurei's
report of the finances, owing to numerous improvements
in the way of building, etc., during the year, were not
among the least to be desired. At the Insane Asylum a
similar increase in patients is noticed, but also a relatively
larger percentage of recoveries than for several years
previous. Altogether, both institutions are in fair and
prosperous circumstances. Superintendent Cowles is to
be commended for the earnestness manifested in his work.
Transactions of the Ohio State-, M kdical Society.
Thirty-sixth .Annual Meeting, hekl at Columbus, June
14, 15, and 16, 18S1.
This volume opens with the report of the Transactions
of the society, the address of welcome being delivered by
Mayor Peters. Following this and comprising the body
of the work, are the rei)orts from the several de|)artments
of medicine, together with a mnnbcr of excellent papers
on subjects of general importance to the profession,
many of which will be read with profit.
Fourteenth .Annual Report of the Presbyterian
Hospital in the City of New York, for the Year
1882.
The present report covers a period of nineteen months.
The total number of patients received during this time
is 1.918 ; during the past year, 1,202, or nearly double the
number treated for the year ending .April, 18S1. An ex-
traordinary laige number of accident cases is also tioliced,
and owing to the great increase in these directions, the
duties of the medical slafl' have been unusually severe.
The superintendent's report is in the highest degree
creditable. The finances of the institution are seen to
be at an ebb and need replenishing ; this should meet
with prompt action from the pioper <piarters.
The New York Instiiution for the Improved In-
struction OF Deaf Mutes. By I). Greenderger,
Principal. Repiinted fiom ihe Archives of Otology,
Vol. -XII., No. I, .March, 1883.
This pamjihlet gives an exhibit of the workings, etc., of
the institution, for the benefit of those devoted to this
speciall)-.
Annual Report of the Managers of the Western
Pennsylvania Hospital for the Insane. Dixmont,
1882.
Fro.m this report we find that there were treated during
the past year 768 patients, male and female ; showing
an increase of 173 over the previous year. There were
discharged 267, and 46 died, giving a decrease in the
corresponding rate of mortality.
Sixth .Annual Report of the Board of Health of
the State of New Jersey, 1882.
This extensive and carefully prepared volume leads one
to presume that the' duties of the board have been un-
usually onerous during the past year. The mortality,
we notice, shows a considerable increase (5,130) over the
previous year, due, in a great measure, it is believed, to
the exceptionally severe summer and winter. The re-
port, moreover, goes very extensively into the sanitary
condition of the State, the sewage, malaria, etc., an ex-
cellent exhibit of the duties to be [lerformed, and which,
it is hoped, will not be overlooked.
Eleventh Annual Report of the New York Infant
Asylum. January, 18S3.
Judging from the annual re[)ort, the duties of the past
year have been remarkably arduous. The management
has, however, been admirable, and the exhibit of the
Medical Board is in every respect very gratifying. A
steady increase in the number of patients is noticed, and
the usual assistance and shelter has been rendered to
friendless women. The jjrofessional labors of Dr. Kate
Parker, resident physician at Sixty-first Street, are worthy
of the highest commendation. Undoubtedly, however,
the greater part of the .work of this institution is unwritten
and unappreciated by the community at large. Never-
theless, as an object of Christian charity, no one of our
hospitals or asylums is more eminently deserving of the
widow's mite.
46
THE MEDICAL RECORD.
[July 14, 1883.
Fifth An'xual Report of the Connecticut State
Board of Health, for the Fiscal Year Ending
November 30, 1882.
From the elaborate volume at hand, an amount of labor
and zeal in sanitary affairs is shown that is truly com-
mendable. It is evidently the intention of the board to
devote untiring energy in this direction toward improv-
ing the sanitary condition of several localities. Some
original work may be expected during the current year.
Annual Report of the Director.^ and jMedical
Board hf St. Michael's Hospital. Newark, N. J.
January i, 1883.
Beside.s the large number of cases treated, an impor-
tant feature of the past year's work is the re-establish-
ment of the eye and ear clinic, and we are glad to say,
with satisfactory results.
Lectures on Medical Nursing. By J. ^VALLACE
Anderson, M.D. Lecturer on Medicine, Royal In-
firmary Medical School, and Physician to the Royal
Infirmary Dispensary, Glasgow. Second Edition, pp.
224. Xew York : Macmillan & Co. 1883.
The fact that this little work is already in its second
edition would seem to be sufficient evidence of its prac-
tical usefulness. Besides the immediate care of the sick
and attention to the several details of nursing, not only
in a general manner, but also in special conditions and
diseases, all of which, moreover, is exceedingly well pre-
sented, the employment of numerous therapeutic
measures, cold in various forms, blisters, injections,
'eeches, etc. ; the examination of the pulse, the urine,
the temperature ; administration of stimulants, nar-
cotics, etc., and their indications, all receive the must
careful consideration. A series of questions also sup-
plement each lecture. In short, every minute detail of
the clinical history of medical nursing, and its practical
application, is presented in an exceedingly interesting
manner ; and to those who purpose making this subject
a study, the work will prove not only instructive but a
highly valued friend. Indeed, we doubt not that many
general practitioners will find this book bolli interesting
and suggestive.
The "^'ANDYKE Brown" Poems. By Marc Cook.
Edited by his wife. Pp. xviii., 225. Boston : Lee &
Shepard. New York : Charles T. Dillingham. 1S83.
For the thoughtful physician who has come to regard his
lifework in its broadest sense, as peculiarly a study of hu-
mariitv, this unpretentious volume will possess a pathetic
and more than passing interest. Apart from the portrait
of the author which faces the title-page, and which pre-
sents that vivacity of intellect and sanguine tempera-
ment which so often are painfully combined and intensi-
fied by prolonged pulmonary disease, it does not require
a great amount of professional acumen to read between
the lines of the poems which follow, as plainly and surely
as from a temperature-chart, the varied phases of the
one-sided struggle for life.
The profession is already well acquainted with the his-
tory of the case of Mr. Cook, as embodied in his little
treatise on " The VVilderness Cure " (William Wood \:
Co., New York. 1883), and his well-known article on
" Camj) Lou," published in Harper s Magazine for May,
1881, each of which were evidently written while the au-
thor was filled with new hojie by the delusive invigora-
tion of rest and the stirring air of the Adirondacks. Lit-
tle more than a year from that time found him in his
grave, another pitiful instance of the sarcasm of fate.
This collection of his stray poems, gathered and (ilaced
in permanent form by those who knew and loved him
best, should plainly be viewed as an afteclionate tribute
to his memory, rather than a bid for notoriety. Read
with the charity which in the nature of the case it de-
mands, this book cannot fait to be appreciated.
Mr. Cook's chief claims to excellence as a poet are a
sprightly and easy versification, and an aptitude, espe-
cially in his serious attem|ns, of enveloping each poem
as a whole in the atmosphere, as it were, of his own pe-
culiar mood ; thereby not only fascinating the attention
of the reader, but bringing him to that intimate sympathy
with the subtler shades of the writer's mind which is so
rarely attained. Like all young writers he is crude, and
like all young writers he at times shows the intluence of
older minds upon his style. Thus, one may easily find
instances when he reminds us forcibly of Holmes, Whit-
tier, Bret Harte, and Aldrich. In our opinion, his style,
notwithstanding an obvious individuality, closely resem-
bles that of Aldrich. There are several of Cook's po-
ems, notably "L'Envoi, " -'Her Cross," and "Aw-aiting
the End," of which either Aldrich or Bret Harte might
be proud. As was only natural for one whose innate
sensitive disposition was accentuated by disease, his po-
ems show him alternating between the most extravagant
buoyancy and the blackest depths of despair. Thus,
with a knowledge of his sad history, one reads his crisp,
bright society sketches, and his easy flowing, well-han-
dled humorous efforts, with as mournful an interest as
the verses which express his earnest and manly thoughts
as the gloom of his near future overpowers him. Here
there is nothing of the lugubrious wailing of the lovelorn,
fledgling poet, but the simple outpouring of a breaking
heart.
Lectures on Cataract : Its Causes, Varieties, and
Tre.atment. Being Six Lectures Delivered at the
AVestminster Hospital. By George Cowell, F.R.C.S.
With Illustrations. I^ondon : Macmillan & Co. 1883.
This treatise is meant for the use of students, and dis-
cusses the subject in an attractive style.
A New Depariurk in the Theory and Practice of
Medicine. By C. A. Hardv, M.D., Graduate of the
University of Pennsylvania. New York : P. O'Shea,
45 Warren Street. 1SS3.
It would be impossible for us, in the small space allotted,
to enter into the several details and arguments promul-
gated by the various theories presented. The author
says : " For over thirty years I have entertained the
belief that the nerve-force was some form of electricity
or galvanism ; that there was more than muscular or me-
chanical action in the heart-throbs ; that nervous mani-
festations indicated some form of magnetic force besides
the functional action of the organs." Regarding the
nerve-force or vital principle, he likens the brain to a
magnetic ]iile, in the cells of w-hich the nerve-force is
produced by the action of oxygen upon the constituents
of the blood ; and in conjunction with which, also, the
spinal cord and ganglia and the sympathetic system act
as reservoirs for storing up and distributing it. The
heart and circulation of the blood is then taken up, the
constant motion and action of which is also supposed to
be controlled and regulated by the nerve-force generated
in the brain-cells, and the derangement of which is fol-
lowed by disease. The double long and short beat of
the heart is, moreover, compared to the positive and neg-
ative actions of electricity. In support of these theories
numerous arguments and well-founded reasons are oftered,
most of which will admit of deep study and examination.
Chill and its consequent fever are also shown to be due
to derangement or great vital depression of the nervous
forces, and the subsequent reaction. Upon this principle
the treatment of typhoid fever is presented, for which
method the author claims the highest satisfaction. Ma-
larial and yellow fevers, and diphtheria, which latter he
regards as an erysii>elas of the mucous membrane, are
also interestingly considered. The chapter on contagion
is not the least important. This theory rests upon that
applied to the circulation of the blood. Erysipelas and
its cure, the action of snake and other poisons, rabies,
hydrophobia, etc., are also entered into with much ear-
nestness, together with antidotal and other treatment.
Dyspepsia and various gastric affections of the mucous
membrane are further noted.
July 14. 1883.]
'THE MEDICAL RECORD.
47
^U-pnvts of J'ocictics.
VERMONT STATE MEDTCAL SOCIETY.
(Special Report for The Medical Record.)
The Semi-Annual Meeting of the Vermont State
Medical Society was held at the Hardwell House, in Rut-
land, June 13th and 14th. The meeting was called to
order at 1 1 a.m. by the Secretary, Dr. J. S. Richmond,
the President and Vice-President not being present.
Dr. Ch.^rle.s L. Allen was called to the chair.
The Board of Councillors reported favorably on the
application for membership of si.xteen gentlemen, and
they were duly elected.
Dr. J. M. Currier offered the following :
Resolved, That the Publication Committee be in-
structed to insert in future issues of the "Transactions"
of this Society the names of the members of the Society.
Adopted.
The Society then adjourned.
The Society was called to order at 1.30 p.m.
The following was offered by Dr. Fo.x :
Resolved, Tliat this association learns witli regret of
the
DEATH OF DR. CVRUS PORTER,
one of Rutland's most worthy and oldest practitioners,
and we hereby tender our heartfelt sympathy to the
family of the deceased.
Adopted, and a copy ordered to be furnished to the
family of the deceased and the press.
Dr. C. L. Allen was appointed to prepare an
obituary for the annual meeting.
Dr. Pond exhibited his
SPHYGMOGRAPH
with mirror attachment, showing the pulse on a screen
by reflected light ; also reported cases of heart disease,
including mitral, aortic, tricuspid, atheromatous disease,
with characteristic traces of each and photographs of
post-mortem appearances. He also exhibited a rare
specimen of atheroma of the arch of the aorta, having a
pulse like " Kussmaul's," caused by a longitudinal block-
ing up of the innominata ; also a case of crushed head
and brains in which almost every variety of pulse-trace
was seen, tracings of diphtheria, mild and malignant,
meningitis, typhoid fever, etc.
The Chairman introduced Dr. A. J. Long as a dele-
gate from the Medical Society of the State of New York,
and he was invited to participate in the discussions.
Dr. Charles S. Cavfrly read a well-prepared paper
on "Tubercle liacillus of Koch."
Dr. a. T. Woodward presented
A COMIUNATION SPECULUM
of his own construction, for e.xamining the rectum and
female urethra, also a modification of the " Smith-
Hodge " pessary which he has recently made.
In the discussion which followed Dr. Woodward's
paper, Dr. Kidder claimed that there was no danger in
dilating the female urethra, that he had repeatedly
dilated it its whole length, and had had no other trouble
than temporary paralysis ; that dilatation with the fore-
finger will cure tenesmus.
Dr. Woodward earnestly protested against more
dilatation than was absolutely necessary. The meatus
only should be dilated ordinaril)'. There is great danger
of cystitis, paralysis, etc., from full dilatation into the
bladder.
An obituary notice of Prof. S. W. Thayer, late of Bur-
lington, prepared by Dr. H. H. .'Vtwater, was read by
the Secretary.
An obituary notice of Dr. R. \V. Clark, late of
Georgia, was read by Dr. F. Rugg.
Dr. Edward S. Peck, of New York City, read an
interesting paper on the
USE of JEQUIRITV in CASES OF INVETER.A.TE PANNUS
OK THE EYEP.ALL,
based on an experience of seventeen cases (see p. 29).
The Society then adjourned to 7 p.m., at which time
Dr. C. L. Allen read a paper on
OLD AGE,
of which the following is an abstract :
Life, death ; enjoyment, suffering; liealth, sickness —
these are the never-ceasing objects of care and solicitude
with every member of the human family. To secure the
former and avoid the latter is the never-ending struggle
of humanity. Individually or collectively, whatever is
undertaken in the material world, whatever is manifested
in the moral world, is but the evidence of this struggle —
a struggle which will continue as long as sickness, suffer-
ing, death, are realities.
To live, to live happily, to live for a long time are
the most universal desires of mankind. Yet there are no
objects toward the attainment of which efforts are more
blindly or less efficiently directed. To live happily, we
may perhaps say, requires no effort or foresight on our own
part. To live happily, without thought or care, may be
the lot of some, but connnonly it is the result only of
long, well-directed, and unwearied labor, and hence really
enjoyed by but few. To live for a long time requires
such a rare combination of mental, moral, and physical
qualities that only an occasional example is found.
The efforts of science have not yet been able to break
the impenetrable seal which conceals the secret of life.
We perceive life, we prove it, we enjoy it ; its nature re-
mains unknown, its essence beyond reach. But its prin-
cipal acts, its most important phenomena are known
and appreciated. These phenomena constitute the most
solid basis fbr the study of man, in his totality, in his
succession, in his growth, and in his decline. They show
us that the life of man is one continual progression, and
not only that, but a progression onward and upward, and
of progression onward and downward.
The life of man has been variously divided into periods,
or "ages," according to the object, fancy, or caprice of
those who made the divisions. Several divisions were
mentioned. The evolution of the human organism is not
accomplished in all with the same degree of rapidity.
There are old men at thirty years of age. On the other
hand octogenarians are young and flourishing, by the
yigor of their constitutions and the proper regulation of
appetites and (lassions. The concatenation of acts by
which life operates is invariable, but the rapidity of their
succession is varied by a crowd of circumstances, some
inherent in the being himself, others exterior to him.
At each period of life there is a corresponding form of
health, a general manner of living. Idiosyncrasies change,
temperaments alter, vital movements concentrate toward
different cavities at different ages.
The infant is, as it were, a living sponge. The tisnies
are all soft, delicate fibres saturated with moisture,
readily and rapidly losing or gaining in weight by the sim-
ple subtraction or addition of water. No organ or func-
tion escapes change as the necessary result of age.
The changes produced by age were then described as
found in the bones, muscles, ligaments, skin, and hair.
Then were noticed changes in weight, stature, digestion,
nutrition, the ability to endure variations of temperature ;
changes in the circulation, including hffiniatosis, and in
the respiration. The effects of age were exhibited in the
lymphatic system, in the nervous system, in the senses,
in the intellect, in the reproductive function, and their
organs. All these changes are in a constant progression
in one definite direction. Connnencing as near to a liquid
condition as is compatible with life, it terminates in al-
most complete solidity. If death is the natural result of
these changes, if they must all take place in a limited dnie.
48
THE MEDICAL RECORD."
[July 14, 1883.
can we know the limits of that time? Is there any defi-
nite period which is the iiliysiological term of a man's
existence? How many vears ought a heaUhy man, with
a sound constitution, to hve ? Xature is parsimonious
in her hibors, furnishing us with infinite variety of indi-
vidual development, but with unity of type and design.
Each class has its peculiar mode of evolution ; each
species has its definite period of existence ; each stage
of development bears a definite ratio to the whole
life of the animal. Among mammals, to which class man
belongs, the natural duration of life is from five to eight
times as long as the period of growth (Hourens). By
this standard the duration of man's life should be at least
one hundred years, and ranging from that to one hundred
and sixty or two hundred )'ears. Instances were given
of longevity ranging from one hundred and fifty to one
hundred and seventy-five years.
But whether life be short or long, whether accident,
disease, or physiological decay be its termination, death
is sure to come — Death, the greatest m}'Stery of nature ;
death, that phantom without a body, whose name alone
stiftens us with terror ; death, that horrible image of
, destruction, the idea of which, like a harpy, comes to in-
fest all the courses of the banquet of life. ATorals aside,
man is certainl)', in respect to his organic life, bound by
a law of destiny more dire than that to which other ani-
mals are subject. Although of an inferior rank, they at
least have pain without reflection, death without fore-
boding, an end without fear and without regret. With
enlightened and intelligent man the thought of death is
often present, openly or secretly, and the more often and
more openly the older he grows. To the young man
death seems so far oft", and the cares, the duties, the joys,
the incessant whirl of business are so engros^ing that he
has little thought and less fear of death. But to the aged
man, whose mind has been enlightened by education, by
reflection, by observation, by experience and contact
with other intellects, the thought unceasingly recurs, and
almost always with tenor. Yet this fear of death is not
simply the feebleness of age'or weakness of mind. It is
the instinct of preservation implanted in us by nature
herself, which repulses the idea of destruction, and which
acquires in the aged a power more despotic than in ear-
lier years. In vain does the body waste; in vain do in-
firmities, cruel and painful, show themselves ; in vain
do the resources of the economy become exhausted ;
in vain does philosophy eternally repeat that life is
fatiguing and vapid, that it is a heavy burden, that it
is a tissue of weariness and evil, that it is a sombre
tableau of misery and anguish. The old man accepts
it all ; he wishes still to live. Why does man so de-
sire to live — so fear to die ? Simply on account of his
ignorance of what may be after death. We have no
direct, sensible physiological evidence, even of existence
after death, to say nothing of the modes or relations of
that exi->tence. It is true that the vast majority of men
believe that to this short, material life succeeds another
life, freed from organic molecular disaggregation, a life
without relations with the constructive atoms of the ma-
terial world ; a life without change, without end, without
death. But, revelation aside, neither reason, nor anal-
ogy, nor experience, nor the memory or testimonv of
men ; neither inductive evidence, nor the action of the
laws and metamorphoses of nature can enlighten us in
the least upon this great subject. .Ml is unknown, for-
ever unknown ; forever there is the silence of the tomb.
Tliis awful mystery may perhaps conceal the mysteries
of another life, but the veil which covers it is as sombre
as it is impenetrable. We walk by faith, by desire, by
hope. We feel confident that Xature, however inflexible
and implacable her laws, will not deceive us. She has
given us intelligence, high aspirations and hopes, unlimited
cravings for improvement, for perfection. She has im-
planted within us an innate desire, a powerful instinct,
which e.xcites us to hope for something [lermanent, some-
thing everlasting, beyond and above this finite world.
If the few short days we live here are all of our existence,
why inspire us with a chimerical incjuietude concerning a
future never to be realized ? Why poison all our joys by
the sad reflection that they are so soon to end? Why
embitter our davs by t%e gloomy conqiarisons of what we
are with what we proudly hoped to be, of what we have
with what we fondly wished to possess ? No, Nature,
ever attentive and provident for all her cieatures, will
not cheat her most cherished children. If in a material
and physical point of view science cannot demonstrate
a future existence, neither can it demonstrate the con-
trary. Hence we are free to rely upon moral, upon
psychological proofs. Proofs of sentiment, the natural
tendencies and aspirations of man, evidences of the
heart — these amount to almost if not complete moral
certainty. For the individual, in this life, we have
growth, maturity, decline, and decay. In the next, we
hope for progress, ever onward, ever upward, improve-
ment upon improvement, development following de-
velopment in a never-ending series. For the race the
progress here is always onward and upward ; there is no
decline, no decay. Perfectibility is an attribute of hu-
manity, and each generation of mankind is becoming
happier, wiser, and better, and enjoying life longer than
its predecessor.
Life is short but the list of diseases is long. Old age
and disease appear to be twin brothers, forever insepar-
able. The contrast between the diseases of early life
and old age were dwelt upon. Then the pre-requisites
of a long life enumerated ; but these being only partially
under the control of the individual most concerned, are
not elements in the real problem to be solved. For the
man approaching or passing the epoch of the plenitude
of his [ihysical forces, to him who, having arrived at the
highest pinnacle of organic energy, can hereafter only go
downward, the iiuestion, urgent, momentous, engrossing,
is. What can now be done to prolong life, to retard the
rapidity of descent down the slope of life, to smoothe the
pathway so that the descent may be without shocks and
jars, without pain and sorrow ? The learned, amiable,
and good Reveille-Paeise la)S down four universal and
all-important rules : ist. Know how to grow old ; 2d,
Know one's self ; 31!, .-Xriange wisely the habits of life ;
4th, Combat disease at its commencement. To these I
would add another cciually conducive to long life, and
more important than any in its bearing upon the happi-
ness of the aged : J^iiU 5///, Have education, general
intelligence, culture.
As age advances the well-trained intellect, the richly
stored, highly cultivated mind feels no weariness, but
enjoys quietly and f'ully the fruits of his former labors.
How often, in my intercotirse with the aged sick or ail-
ing, have I had occasion to notice the dift'erence in the
happiness of two of equal age, placed in circumstances
almost identical, both endowed originally with good con-
stitutions— the one educated, cultivated, enjoying scien-
tific research or philosophic meditations, the other not
ignorant, indeed, but pleased with only light, transitory
or sensational literature ; the one contented, happy, and
a source of pleasure to all around him, the other fretful,
morose, complaining, neither enjoying life himself nor
allowing others to do so ; the one retaining intelligence
clear and unsullied to the last moment, ihe other gradu-
ally losing his mental faculties long before death occurs.
How beautiful, how sublime is the sight of the aged
man of culture, enjoying his " i>/iitm cum djgnitate ! ' He
has lived, he has tlourished, he has i)layed his part, per-
haps, in public affairs, and now, respected and revered
by all, he can pass serenely along the downward current,
happy in the enjoyment of his intellectual faculties, in
the remembrance of his early achievemei.ts, in the hope
of a more brilliant hereat"ter.
The Executive Committee made the following assign- »
nient of subjects for the annual meeting, to be holden at
Montpclier, October 10 and 1 1, 1883 : •' Liver," Dr. S. S. %
Clark, St. .Vlbans; "Blood-stains,' Dr. E. S. -Munger, Put-
July 14, 1883.]
THE MEDICAL RECORD.
49
ney ; " Localization of Cerebral Symptoms, " Dr. X. H.
Towsley, Rutland, and Dr. John M. Currier, Castleton ;
" Obstetrics," Dr. H. R. Jones, Benson ; " Physicians'
Testimonials, " Dr. O. VV. Sherwin, Woodstock ; " Lo-
calizing Bullets" (new method). Dr. S. J. Allen, W. R.
Junction ; Obituary Notices : " Dr. Cyrus Porter, late of
Rutland," Dr. C. L. Allen, Rutland ; '" Dr. J. O. Cramp-
ton, late of Winooski," Dr. Richardson, Winooski ; " Dr.
John L. Chandler, late of St. Albans," Dr. O. P\ Fassett,
St. Albans.
The thanks of the Society were voted to the gentlemen
who had presented papers. At 9 P. M. there was an ad-
journment to the banquet.
The jjhysicians and druggists of Rutland entertained
about fifty members of the Society at the banquet. The
large dining hall of the Bardwell was filled to its utmost
capacity by the doctors and elite of the city. The ban-
quet was elaborate and sumptuous, .\fter the feast Dr.
L. M. Bingham, President of the Society, led oft" with a
speech and introduced the toast-master, Dr. C. L. Allen.
Sentiments and speeches followed until a late hour. On
Thursday the doctors and druggists chartered a special
train of cars and took the Society and other invited
guests to the West Rutland Marble Quarries. On their
return, by special invitation of President Merrill, they
visited the Howe Scales Works.
At 1.30 P.M. the Society was called to order and
listened to a lecture by Prof. J. L. Little, on Bigelow's
method of crushing and removing stone from the bladder.
Prof Little exhibited instruments and detailed a recent
successful operation on a patient seventy-seven years old.
Dr. Little has operated for stone in the bladder si.xty-si.x
times, seven times by Bigelow's method. His shortest
time for operating, fifteen minutes ; longest, one hour and
forty-five minutes. He says Bigelow's is the safest opera-
tion.
The thanks of the Society were tendered Dr. IJttle.
Dr. E. S. Peck, of New York, was made an honorary
member of the Society.
THE ARMY MEDICAL MUSEUM AND LIBRARY.
The following resolutions were adopted ;
Whereas, It is well known that the interest and ad-
vancement of medical science in the United States have
been largely promoted by the valuable collection of
specimens in the Museum of Military Medicine and
Surgery of the Medical Department of the United States
Army, as well as by its magnificent Library of rare and
valuable books and by its numerous publications ; and
believing that all national works of this sort that so emi-
nently contribute to the interests of humanity and to
the welfare of our people should be protected and en-
couraged by the Government and people of this country ;
therefore.
Resolved, That the State Medical Society of Vermont
will e.xercise all proper infiuence with Congress to provide
for the Library of the Surgeon-General's office and .'^rmy
Medical Museum an adequate appropriation to allow for
the erection of a suitable fire-proof building for the safe
and permanent preservation of the said materials, which
are now exposed to constant danger from fire and loss.
Resolved, That we also urge upon Congress the pro-
priety of said Museum and Library being continued under
its present management, and that we earnestly recommend
that the Library be maintained separate from the Con-
gressional Library.
Resolved, That we further' petition Congress to make
suitable pecuniary provision for completing the publica-
tion of the "Index Catalogue " of the ]>ibrary of the
Surgeon-General's office.
Resolved. Thiit a counnittee be appointed to convey to
Congress the views of this Society upon the matters here-
inbefore set forth, and that each member of our Society
be requested to use his infiuence vvitli the delegation in
Congress.
Resolutions of thanks of the Society were voted to the
physicians and druggists of Rutland, for their reception
and entertainment, to the proprietors of the Marble Quar-
ries, the Howe Scales Works, and to the several railroads
for courtesies received.
(Tovvcspciiulcuce.
OUR LONDON LETTER.
(From our Special Correspondent.)
LORD WOI.SELEY AND THE ARMY MEDICAL INQUIRY
THE OXFORD PROFESSORSHIP AND VIVISECTION.
London, June 20, 1883.
The Army Medical Inquiry Report continues to excite
interest and criticism. The closer Lord Wolseley's evi-
dence is examined the more unjust does it appear.
During the campaign he officially expressed his satisfac-
tion with the medical service in his telegrams and de-
spatches. .\fter the campaign is ended he officially re-
peats the substance of verbal complaints he made in
Egypt, most of which ought to have been made to an-
other department. It is really not putting his action in
a false light to say that he appears to have been some-
what double-faced. The most charitable supposition is
that his lordship's head has been turned by his peerage
and his pension, and the opposition to the latter has
doubtless not improved his temper.
It was manifestly unfair to contrast the army hospi-
tal at Cairo with I.ady Strangford's. The former was
dependent upon army oflicials for supplies of every de-
scription, which could only be procured through the ordi-
nary channels. The latter was supported by private
resources and its sick attended by a civilian medical
staff. The son of a London physician — Dr. Sieveking —
went out to work in its wards.
The necessary funds for building a physiological labor-
atory, etc., at Oxford have been voted by a very narrow
majority (3 in a meeting of 193 members of convoca-
tion) on Tuesday last, June 4th. The opposition was
partly on the score of economy (_;^io,ooo being asked),
but mainly on the ground that vivisections would be per-
formed. The opposition to vivisection is plainly on the
increase. It is, of course, chiefly in non-medical circles
that this is the case, though it is an interesting fact that
a pamphlet on the subject for private circulation was
lately issued by a distinguished army surgeon, in which
the author — Dr. C. A. Gordon, C.B. — maintains that no
discovery has ever been made by vivisection that has
ever proved of direct service in medical treatment that
could not have been made without it. Dr. Gordon
states that he commenced his study of the subject as one
prejudiced the other way and that he has arrived at his
conclusions through a dispassionate investigation of the
literature of the subject. I think your readers will agree
with me that the total abolition of vivisection is an event
not to be desired. The restrictions that have been placed
upon it in this country are no substantial detriment to real
scientific investigators and were fully called for by the
needless cruelties that have been perpetrated in the
name of science. I could name at least one well-known
physiologist in this country who is utterly callous as to
inflicting lumecessary pain on animals, who only employs
anjesthetics to keejj the animals quiet and prevent them
from biting, scratching, or otherwise annoying him, and
who confessed before the Royal Commission on Vivi-
section that he had no feeling whatever for the animals
he tortured. I refer to Dr. Klein. Some experiments
on scorpions, made by Mr. C. Lloyd Morgan in Ger-
many and deliberately described by him in Nature (Feb-
ruary I, 1883), were revolting in their cruelty. Mr.
Lloyd tortured them in various ways to see if he could
induce them to commit suicide. Amongst other ways
he placed them in burning alcohol, in concentrated
sulphuric acid, and burnt phosphorus on them, etc.
50
THE MEDICAL RECORD.
[July 14. 1883.
Mr. Lloyd admits himself that the phosphorus experi-
ment was sickening. It is difficuh to see what scientific
vahie such brutaUties can possess. It is such men and
such deeds that bring odium on scientific and humanly
conducted vivisection by such men as Foster, Sander-
son, etc.
DOES THE RETENTION OF DE.A.D TEETH IN
THE JAWS EXERT AN UNFAVORABLE IN-
FLUENCE ON HEALTH?
To THE Editor of The Medical R cokd.
Dear Sir : The above (juestion is the heading of a let-
ter by Dr. Samuel Se.vton in your issue of May 12, 1S83,
to which, if you will kindly allow me the space, I beg to
answer.
In ninety-nine cases out of every hundred I should sav
yes, they do " exert an unfavorable influence on health,"
and for the following reasons : It is a well-known and
generally understood fact that the dentine of a tooth
(which forms the bulk of the tooth-structure) and the
enamel receive their nourishment from the pulp ; that
the amount of organic material in dentine is about
twenty-eight per cent., and that of the enamel from three
to five per cent. When the pulp is destroyed the
nourishment of this organic portion is cut off entirely,
with the possible exception of a very limited amount,
which may be furnished from the periosteum through the
cementum, which surrounds the root ; consequentlv the
death of the organic portion of the dentine and enamel
must necessarily follow. This dead substance remains
as a part of the tooth-structure to constantly decompose.
In the structure of the tooth the organic portion is imited
directly from the periosteum to the pulp, through the
cementum and dentine alike. Consequently the dead
and putrefying portion in the dentine is constantly in con-
tact with the organic portion of the cementum, which is
still living ; that, under circumstances which determine
an excessive flow of blood to the part, such as a severe
cold, a blow upon the tooth, or a severe wrench in biting
upon some hard substance, excessive absorption of the
putrefying portion by the living takes place, I hardly
think will admit of a doubt. No matter how perfectly
the dead pulp may be removed and the canal filled, this
condition still exists. The fact, however, is that the
pulps cannot be perfectly removed from one-half the
teeth where it is attempted, but a portion is left in the
canals to putrefy and assist in the disturbance which too
often follows, .\nother feature of the case is that not
one-tenth of the teeth in which the [)ulps are dead is
any attempt made at their removal. If any one will
consider for a moment the number of people who have
no dentistry done, and those who have it poorly done as
compared with those who have the best dental services
it is possible to obtain, they will, I think, readily admit
the truth of the above statement.
The conclusion then is, that no pulpless tooth is abso-
lutely sure to not make trouble. From the most perfect
operation of removing the dead pul|) and filling the can-
als (which by the way, should never be done with gold)
to those where the entire dead pulp is allowed to remain
in the teeth, there is more or less of a periosteal irrita-
tion, which is almost constant. It is true that the tooth,
or teeth, may not be painful, but some remote part, such
as the eye, or the ear, may be effected, or a neuralgia ex-
tending over the side of the face and head may be the
result. Many cases like these have come under my ob-
servation, where the most perfect dental work had been
done. In many cases, however, pulpless teeth, after
treatment, are kept in the mouth for many years, and
render good service without apparently producing any
pain or distress whatever. Others will, upon tlie slight-
est provocation, become sore and very jjainful. This,
however, in most cases can be sufiicienily overcome
by proper treatment, to warrant their retention, pro-
vided they are very useful. But when, after consul-
tation, it is determined that the irritation produced by
such teeth is more injurious to the patient than can be
overcome by their service in mastication of food or
otherwise, in my judgment they should be removed at
once. I might'cite many cases bearing directly upon
this subject.but for the present the above will suffice.
I am, very truly yours,
Frank Abbott, M.D.
aa West Foktieth Street, New York, July 9, 1883.
MEDICAL M.\TTERS IN NEBRASKA.
To the Editor of The Medical Record.
Sir : You have doubtless received ere this a summary of
the proceedings of the Nebraska State Medical Society,
which met at Lincoln recently. In many respects it was a
success, but as to any exposition in medical science it was
lamentably deficient. Reports of sections were called
for by the President, and for the most part answered by
the Chairman of Committee in an avowal of ignorance
that he was on the committee. Dr. Mansfelde, Perma-
nent Secretary, made an e.xception to this, in the pres-
entation, with notes, of a four-pound cystoid kidney. Dis-
cussions on diphtheria and hysteria were rambling and
profitless — the report of a case of aconite-poisoning
proved to be no such thing, and the only paper read (on
vaccination) was a history and very incomplete. Discus-
sion revealed the fact that non-humanized virus is in dis-
repute, and chiefly by reason of imperfection in the virus ;
but anything looking toward remedy of this was not ef-
fected. No action was taken in regard to ethics, in dis-
pute at the National .\ssociation, but a strong supporter
of the .'\ssociation's action stated in a large gathering, that
the sooner all code was abolished, the better. This I be-
lieve to be the general drift. The Committee on Medi-
cal Legislation reported informally that their efforts came
to naught. In reality, those having it in charge were
not the peers of homceopaths in the matter of lobby. The
leading man is but a respectable fossil.
Being in hearty sympathy with the good work you
have done, looking toward the elevation of the standard
of medical education, I would like to note the advent
of another medical school — in this West, to wit, the
Medical Department of the University of Nebraska
at Lincoln. It is in many respects a still-birth, for
although the State Medical Society met almost in the
shadow of this university building, no mention was there
made of the same, while many seemed to think for
the present it would not amount to anything. The So-
ciety, in its rounds, visited the Home for the Friendless
(inaugurated last January), wherein the new school finds
its hospital. This building is quite beyond the city limits,
and at the time of our visitation, while not seeing any
patients, we were told there was one There is no ex-
cuse, in the light of education, for the school at all, and
I take it the only incentive is that which too commonly
exists : the furtherance in position of local medical men,
who become associated with it. The Medical School at
Omaha is fairly established, so its promoters inform us,
but the position you took toward the same was unde-
niably just. The establishment of these schools is her-
alded by the press and public, even as they do any new
institution, in a very gross and material way. Too often
these are institutes, cure-all establishments, but all aflame
with their disinterested greatness. It is the spirit of
" boom," which at present is soul and body of our social
fabric.
A feature of this year's State Society meeting was the
simultaneous gathering of the homceopaths. While no
reference was made in our meetings to distinctive posi-
tion, our neighbors were brim full of it, and placed them-
selves on record. In striking contrast is it with the atti-
tude exhibited at Albany by the .New York homoeopaths
in their recent annual meeting. Their President, Dr.
Mitchell, stated in his address that " our doses can vary
from the largest old-school potion to the iiighest of our
July 14, 1883.]
THE MEDICAL RECORD.
51
infinitesimals," tJTat the regulars "use our drugs in their
true relation to disease," "understand the methods of
palliation better than we do," and, moreover, that "there
are cases where our law fails, or is inap\ilicable." Com-
menting upon which the S/>ri//gJieM (Mass.) Republiian
said, "It is plain if Dr. Mitchell fairly represents his own
school, there is no longer any necessity for its separate
existence." Here Dr. T. C. Duncan, of Chicago, in what
is termed the address, stated, that " the difference be-
tween the two schools is as wide as ever." "Judging
the future by the past, the union of the two schools is far
remote," while "union could be brought about only in
the recognition of their principles." Perhaps Dr. Duncan
does not fairly represent his brethren ; still, it is probably
not their desire to sink distinctive titles at least, for witli
most of them this would be an appalling disaster.
Yours,
Nebraska.
THE QUESTION OF INEBRIETY AND DIS-
EASE.
I'o THE Editor of I'he Medical Record.
Sir : That advocate, par excellence, of the disease theory
of inebriety, Dr. Crothers, again t;omes forward in a late
number of The Record, with a synopsis of cases, from
which he deduces what he believes to be facts in support
of his views. I see in none of them anything but a re-
petition of the old story of deficient will-power in the
presence of an evil. His first case is that of .\. B ,
a prominent physician, by the way, who had graduated
with honors, fell through the ice into the water, which
event was followed by pneumonia, and this in turn by a
condition of nervousness, for the relief of which he began
the use of spirits ! Verily, his knowledge of materia
niedica must have been meagre ! Of course, his " nerv-
ousness " gradually required larger doses, and as spirits
was the best sedative he could find, notwithstanding his
efficient medical training, he became a confirmed in-
ebriate— a coward, finally, in principle and in morals, for
he endeavors to throw the blame from himself in that he
says " his inebriety began from some physical condition,
and that through the treachery of friends he was made
worse." He finally landed in prison, where, in the ab-
sence of his scientific remedy for nervousness, he seems
to have recovered both from it and his inteni|)erance.
Dr. Crothers thinks the pneumonia was followed by acute
asystolism. This may be so, though it is hypothetical,
and the treatment certainly questionable.
The second case, C. O , was also a medical student
of long training, and for some time professor tn a med-
ical college. One day he became "accidentally (?) in-
toxicated," and soon after was forced to resign, went
from bad to worse, and finally brought up in an insane
asylum, a lunatic from the excessive use of spirits. It
transpires, however, that two years before he became
" accidentally intoxicated " he had habitually made use
of brandy for the production of sleep. It is a singular
circumstance that, though a medical professor, he failed
to find any remedy so effectual for this purpose as brandy.
This gentleman too, seems to be blind to the true cause
of his weakness and says, " his inebriety began from
neurasthenia and heart exhaustion." The third case,
that of a theological student, runs about the same course,
and ends with the same sort of an apology. "He began
to use spirits in the seminary for a tonic, used it quite
freely while supplying his pulpit, but always at night."
These are only a few of the doctor's synopsis of cases,
and while I say nothing of the palpable fact that they
represent an entirely exceptional class of inebriates, we
can even in these selected cases plainly see the moral
forces at work in their causation.
We have been told of heredity as being active in the
production of drunkenness. That this is a prolific cause
I do not fioubt, but that it is wholly, or even in a great
degree a physical heredity, I do not believe. The ine-
briate is an inheritor, to some extent, of his forefathers'
special curse ; not of this particular sin necessarily, but
rather of the atmosphere in which his progenitors lived,
of the moral conditions which surrounded them, of the
general depravity of tone which as a rule marks the
homes where are reared the young inheritors of the pa-
rents' weakness. The child reared in the home where
profanity is daily used and where no regard is had for
good morals is very likely to grow up in conformity with
his teaching ; that one born into the home of the ine-
briate, subject to such environments as surround him
there, will do the same. The heredity of influence and
surroundings is a potent factor in the production of
inebriety.
But suppose for a moment we allow that inebriety
is always a disease, may we not with e(iual propriety as-
sume that all sin — or that we are used to call sin — has a
physical basis ; that what we have heretofore regarded as
a deficient moral status has really its origin in some con-
genital or acquired moral defect ? Is it not as reasona-
ble to suppose that an act by which one person commits
violence upon another, or takes that which is not his
own, has its origin in a physically diseased condition, as
that this is true of the person who commits violence upon
his own mind and person by subjecting them to the over-
whelming influence of intoxicating drinks or narcotizing
drugs. It seems to me that this is the legitimate con-
clusion, though the logical result of the argument would
be that all action, right or wrong, has a physical basis,
healthy or diseased, but for which in either case the in-
dividual IS not responsible.
Dr. Crothers dwells frequently upon what he calls
"obscure" causes. I confess they are so when viewed
as he views them. It is doubtless true that obscurity
will be thrown around any study when we try to bend
facts connected with it to any single idea. We can study
inebriety neither as moralists nor scientists wholly, but
must be prepared to recognize the fact that some cases
depend upon one cause, some upon another. That there
are cases of inebriety that depend upon |)hysical causes
I am ready to admit, and have done so ; but to say that
" it is always a disease " is a dogmatism without even the
redeeming quality of truth.
J. B. Stair, M.D.
Spring Green, Wis.
FiSKE Fund. — The Trustees of the Fiske Fund, at the
annual meeting of the Rhode Island Medical Society,
held at Providence June 21, 1883, announced that they
had made no award on the subjects proposed for the
present year. They propose the following subjects for the
year 1884 : i. " The Origin and Progress of the Malarial
Fever 'now Prevalent in New England." 2. "Original
Investigations in Household Hygiene." For the best
essay on either of these subjects worthy of a premium
they offer the sum of $300. Every competitor for a
premium is expected to conform to the following reg-
ulations, viz.: To forward to the Secretary of the
Trustees, on or before May i, 1884, free of all ex-
pense, a copy of his dissertation, with a motto writ-
ten thereon, and also accompanying it a sealed packet,
having the same motto inscribed upon the outside, and
his name and place of residence within. Previously to
receiving the premium awarded the author of the suc-
cessful dissertation must transfer to the Trustees all his
right, title, and interest in and to the same, for the use,
benefit, and behoof of the Fiske Fund. Letters accom-
panying the unsuccessful dissertations will be destroyed
by the Trustees, unopened, and the dissertations may be
procured by their respective authors if applications be
made therefor within three months. Job Ivenyon, M.D. ,
River Point ; Oliver C. Wiggin, M.D., Providence ;
Horace G. Miller, M.D., Providence, Trustees. Charles
W. Parsons, M.D., Providence, Secretary of the Trustees.
52
THE MEDICAL RECORD.
[July 14, 1883.
^ew ^iistvxvmcnts.
TONGUE DEPRESSOR AND NASAL SPECULUM.
By D. H. GOODWILLIE, M.D.,
NEW YORK.
Figure i represents a new tongue depressor with the
following description, viz. :
The portion that touches the tongue is concave, and
as the base of the tongue is nearly always conve.x, it
fills up this concavity when first placed on it. When
pressure is made on the tongue it flattens out under the
depressor and produces a vacuum in the concavity, thus
holding it firm upon the tongue, which can now be drawn
forward, or laterally, witliout any discomfort to the patient.
When the tongue is depressed sufficiently, then let the
shank, which is slender, rest on the lower incisor teeth.
Fig. I. — Tongue Depressor and Speculum.
The handle is held to the depressor by a thumb-screw,
and is so arranged as to hold it on either side, or in
front of the chin. In some cases the handle can be so
placed as to come under the chin, and so make the de-
pressor self-sustaining. The depressors are of two sizes,
for adults or children.
The advanta};es are that it depresses well the base of
the tongue, and holds it securely by the suction power,
and without any discomfort to the ])atient.
The handle is conveniently held by operator or patient,
and to one side of the mouth. It can be easily keiit
clean.
Fig. 2. — Folding Tongue Depressor.
Fig. 3. — Folding Pocket Dci>ressor.
Figure 2 represents a folding tongue depressor, iiaving
two sizes.
Figure 3 represents a folding pocket depressor, liaving
two sizes.
The nasal speculum is only introduced here to show
the best way of using it. A description was given of it
in The Medical Record some time since. The instru-
ment is made by Geo. Tiemann & Co., N. Y.
A MODIFICATION OF TORINO'S OPHTHAL-
MOSCOPE.
By J. B. McMAHON, M.D.,
NEW YORK.
Some five years ago Dr. Loring brought to the notice of
the profession an ophthalmoscope, carrying fifteen lenses
on a disk and four on a movable quadrant. In the num-
ber of possible combinations and the ease with which
their values could be read, nothing was left to be desired.
In none of the forms of
this instrument hitherto
in use has it been practi-
cable to rotate the quad-
rant without moving the
instrument from the eye
and so interrupting the
examination.
To obviate this difii-
culty, and, at the same
time, by a slight altera-
tion in the arrangement
of the lenses, to get a
much more efficient "fine
adjustment" has been the
object aimed at in the
instrument to which I
would call the attention
of your readers.
The instrument has the
ordinary tilting mirror.
The main disk, as in
Loring's, has an aperture
and fifteen lenses, rang-
ing from, -+- 1 D. to-^ 7 D.,
and from — i D. to — 8
D. The second disk has
four lenses, ± .5 D, -I-
— 16 D., and an aperture
arranged as shown in
Figure 2. The cut indi-
cates also the five small
holes in which the i)in of the centring spring plays. This
disk serves as a cover for the first, its own lenses being
protected by a metallic sector, partly cut away {vide
Fig. i).
The main disk is revolved by means of a milled edge
the second, by a milling raised on its posterior surface
just within its edge. Both
disks are centred. The
centring springs, one of
which is seen in Fig. i,
surrounding the thumb-
screw, secure a perfectly
smooth, uniform, and in-
dependent motion of the
two disks.
The instrument is light
and compact. Its mech-
anism is simple. The
glasses are efficiently
covered. .\\\ the nu-
merous combinations can
be obtained without removing it from the eye, and with
as much ease ami cert.ainty as in using the single disk
ophlhalmoscoije.
For ordinary work the main disk suffices. If, how-
ever, a nicer determination of an error of refraction be
desired, a slight movement of the second disk, in either
direction, increases or diminishes, by a small refractive
interval (.5 D), tlie i)ower of the lens of the main disk
that^ in use, thus afiording a true " fine adjustment."
In doing this, the finger is slipped from the milling on the
edge of the first disk, to bear lightly on the milling and
posterior surface of the second, and so rotate it, the
motion being a very easy one.
July 14, 1883.]
THE MEDICAL RECORD.
53
The use of the combinations in which the J;i6 D
lenses take part is quite simple. For example, the revo-
lution of the main disk gives + 7 D. A movement of
the second gives +7.5 D. Both disks can now be ro-
tated simultaneously, still in the same direction, the re-
sulting combination being + 8 D. The higher com-
binations are obtained as in Loring's, by a continued
revolution of the main disk. The reading of their
value is practically the same in both instruments.
As so much depends on the accuracy of the mechanism,
it is but just to add that Meyrowitz Brothers, after the
expenditure of nuich time and labor, have succeeded in
making the instrument at once handsome and reliable.
A PRACTICAL AND SIMBLE WAY TO ATAKE
THOROUGH APPLICATIONS OF POWDER
TO THE POST-NASAL REtilON.
By T. HAMILTON I5UKCH, M.D.,
-CLINICAL ASSISTANT, THROAT DEI'ARTMRNT, MANHATTAN EVK AND EAR HOSPITAI .
Finding difficulty in some cases of making thorough a|j-
plications of powder to the post-nasal region, without
covering a great deal of unnecessary sound tissue, I have
had Reynders & Co. make me two thin bulbous-pointed
hard-rubber tubes about three and one-half inches long,
and in diameter tapering from one-fourth of an inch at base
to one-third of an inch at apex (the dimensions will de-
pend upon the size of the nares, and it would be well to
take these measurements for the largest size) and per-
forated at the end ; one with an opening looking directly
forward, and the other with three openings, one looking
forward and one at each side looking backward.
The terminal opening in the latter being one-half as
large as the other two. The object being that the stream
of powder will be diverted and an equal amount directed
through the side orifices, thereby covering as much of
the upper pharynx and post-nasal region as is desired.
The tubes can be adaiUed too, and made with a thread
so that they can be screwed upon the stopper part of the
powder-blower.
This instrument is very simple and practical, and, if
■desired, patients can be fitted with the proper size antl
instructed how to introduce it and follow treatment at
home.
It is not too much to say that the old way of deluging
the whole nasal tract with powder does very often more
harm than good. It is hoped by the aid of these tubes
to render the application of powder more scientific than
heretofore. The accompanying illustration will give a
better idea of the instrument than my article.
New York, June 29, 18S3.
The Medico-Leg.^l Journal. — We have received
the first copy of this new journal. It is published under
the auspices of the Medico-Legal Society and contains
papers read before that body. It has a well-filled edi-
torial department. Being the only journal of this
character in the English language, it may naturally ex-
pect success. The first number promises well.
^mxtj iiutX Slauij 3Xcxiis.
Official List of Changes of Stations and Duties of Officers
of the Medical Department , United States Army, from
June 30, 1883, to July 7, 1883.
Heger, a.. Major and Surgeon. Relieved from the
further operation of paragraph 9, S. O. 55, C. S., De-
partment of Texas, and will return to his station, Fort
Clark, Texas. S. O. 69, par. 2, Department of Texas,
June 25, 1883.
Havard, Vai.ery, Captain and Assistant Surgeon.
Assigned to duty with expedition to complete the survey
of the country west of the Rio Pecos, Texas. S. O. 68,
par. 8, Department of Texas, June 22, 1883.
Rayiviond, Henry I., First Lieutenant and Assistant
Surgeon. Granted leave of absence from July 14, 1883,
to September i, 1883, with permission to go beyond sea,
and resignation accepted to take effect September i,
1883. S. O. 150, A. G. O., June 30, 1883.
Official IJst of Changes in the Medical Corps of the Navy
for the week ending July 7, 1883.
Leach, T. W., Medical Inspector. Detached from the
U. S. S. Tennessee, and as Fleet Surgeon of the North
Atlantic Station, and placed on sick leave.
Rhoade!?, a. C, Medical Ins[)ector. Detached from
the Naval .\cademy and ordered to the U. S. S. Tennes-
see, and as Fleet SurL;eon of the North .\tlantic Station.
"^taxcxa %Xtms.
May the Profession defy Public Sentiment? — An
answer to the question which heads these remarks pre-
supposes the profession to be as one man having to do with
the great public. No one among the public can gainsay
the firmness and independence of the profession as a
whole, in the matter of observance of the standard of
ethics which it set up some forty years ago. No one,
moreover, but will admire its faithfulness to that stand-
ard. Is it not time, however, to inquire whether the al-
most universal condemnation and ridicule which the
public is showering on that standard does not suggest a
necessity for its revision with a view to conforming it to
the spirit of the age, with which spirit the expressions of
public opinion show it to be in conflict ? And does not
the persistence of the .American Medical Association, in
refusing to recognize the public sentiment in this matter,
suggest a suspicion that its firmness and independence
have degenerated into obstinacy ? — The Aledical Age. -
Dr. H. p. Strong, one of the most prominent physi-
cians in Wisconsin, for thirty years a resident of Beloit,
died in that city on June 20th, aged fifty-one. Dr.
Strong had received many honors in his own home,
among them that of having held the office of mayor for
five years. During the war he was surgeon of the nth
Wisconsin Regiment. As a member of the State Medi-
cal Society he had filled the offices of secretary and of
president, and at the time of his deatli he was a member
of the Wisconsin State Board of Health. Dr. Strong
was a brother of William B. Strong, President of the
Atchison, Topeka and Santa Fe Railroad, and of James
W. Strong, President of Carlton College, Minnesota.
The Position of the Naval Medical Service as
Regards the Code of Ethics. — In concluding a paper
on " Medical Education " before the meeting of the
American Medical Association, Dr. A. L. Gibon made
the following remarks, which define his position as regards
the Code of Ethics, a position which he states receives
the approval of the Surgeon-General of the Navy : " It
54
THE MEDICAL RECORD.
[July 14, 1883.
is almost an insult to the intelligence of the members of
the Association to explain that this paper ('Medical
Education the Fundamental fact in Medical Ethics ') is
not intended as a sectarian attack upon the organic law
of the American Medical Association, but as this inter-
pretation has actually been given to it by over-sensitive
partisans, I deem it proper to reaffirm my loyalty to the
code to which I have subscribed, without, however, sur-
rendering the right, which in common with every intel-
ligent man I claim, to criticise what I may think objec-
tionable, and to call attention to the inconsistencies of
its avowed adherents who, attempting to observe its
letter, injure its spirit. I fail to see why honest advocates
of its principles should be placed in an attitude of
' rebellion ' for merely defining these principles by the
more liberal light of this day. The code properly in-
terdicts any admission of the orthodoxy of the professors
of exclusive dogmas, whether of homoeopathy, allopathy,
hydropathy, or the like, but it nowhere prohibits the in-
telligent physician giving his advice to whomsoever may
seek it, esjiecially when emergencies and the dictates of
humanity demand. No one can more energetically dis-
countenance than myself the impossible co-treatment of
any case of disease by an educated physician and a
charlatan, empiric, quack, or ignoramus however regular,
but it is quite another matter when one's opinion is
solicited in the interest of suflering humanity. I have
yet to hear of any one of our profession soliciting an
opinion from any of these, and without such an inter-
change of views there can scarcely be considered any
consultation in the sense of the clinical co-operation
properly denounced by the code. Any narrower assump-
tion will, as I have endeavored to sliow in this paper,
necessitate the ostracism of these your famous colleagues
who have associated as fellow medical members with
homoeopaths and eclectics in the professional work of the
National Board of Health, State boards of health, boards
of medical examiners, etc., and I feel assured that the
overwhelming sentiment of the American Medical As-
sociation will sustain the liberal interpretation I have
here given the code."
Vivisection in Fr.\nce. — Not long ago Professor
Brown-Sequard, in lecturing at the " College de France,"
decided to have, as is customary with him, a public
demonstration showing the anjesthetic action of carbonic
oxide on the larynx. For this purpose he had provided
a small monkey. Without administering anajsthetics,
Professor Brown-Sequard was about to begin his experi-
ments when a lady suddenly arose and with her umbrella
knocked the weapon out of the hands of the astonished
scientist. The lady was at once ordered to leave, but
declined, and said that she would repeat her action as
the only possible protest, so that at least the " barbarous
methods of vivisection " should not pass in silence. The
usher was equally unsuccessful in appeasing her, and it
was only at the instance of a gendarme specially sum-
moned that she consented to leave, which she finally
did, accompanied by two of the professor's pupils to the
"Commissariat de Police" for mutual explanations.
The Paris National, in reporting the circumstances, says
that the action of the lady was a little too severe, but
thinks that France might at least, like England, limit
vivisection to classes for original work, and forbid its
public displays.
Parasitks in the Lungs. — Dr. Thomas Mann, of
Portland, Oregon, writes for information regarding a
curious case in which the patient coughs up parasites
from the bronchial tubes. The trouble has lasted for a
year. Twenty-eight have been coughed up witiiin two
weeks. They are couglied up generally along with nui-
cus and blood. The young ones have black heads and a
thick white body about one-fourth of an incli long. The
mature specimens are longer. The history of the case
is as follows : Patient, female, aged twenty-one ; native
of England ; well developed ; weight, one inindred and
twenty pounds. Came under observation just one year
ago, November 26, iSSi. Arrived that day direct from
England, sufferint; from sore throat and nostrils ex-
coriated; breath fetid and offensive ; pain in chest just
below right and left clavicle ; whole length of sternum
and muscles of the neck sore to the touch ; ulcer on
right side of upper part of larynx to the right of epiglot-
tis. All these symptoms have continued. In addition
there was menstrual irregularity with hemorrhage from
the air-passages at menstrual periods. This, however,
is corrected.
Treatment thus far, after trying various remedies with-
out permanent good result : On November 14, 1882, I
gave inhalation of terebinthina to anaesthesia. On No-
vember 15th two parasites were coughed up, but with so
much pain that carbolic acid was substituted as an in-
halation, at times using hot water as a vehicle. From
twelve to sixteen hours after this one or more parasites
are coughed uj). When mature ones are coughed up
they come in pairs, and pairs are sometimes followed by
from two to four young ones. The sputa, I might state,
in wliich the parasites come up smells very strong of
turpentine. T-he carbolic acid inhalations do not seem
to be followed with such good eftect. The patient is in
good condition and attending to business. Dr. Mann
has consulted Cobbold, but without getting any light.
Large Doses of Morphia. — Dr. J. A. Rafter, of
Holton, Kansas, writes : " In your issue of May 5th ap-
peared an article in regard to morphia poisoning, which
has been pretty regularly ' sat down ' upon nearly every
week since. The dose of morphia supposed to have been
taken was something like six grains. Ages of the men,
I believe, not stated. A year ago I was treating a case
of dysentery ; had tried almost all of the usual remedies
with unsatisfactory results. The case continually grew
worse, and was in an extremely critical condition. Being
sent for in great haste one day, on my way to the house
I stopped at a drug store and got (by weight) six grains
of acetate of morphia and thirty grains of oxalate of
cerium, determined to give it a trial (tliough I had been
using small doses of morphia sulph.). The powders were
in separate packages. I took from each what I needed —
about two-thirds grain morphia and eight grains cerium —
Charts No. 2, with directions to give one, and if distress
was not relieved in an hour to repeat. I then stowed
the larger ])ack'ages away in a stand drawer in an ad-
joining room. Called again three hours afterward, found
that a mistake had been made in giving the powders.
The large ones had been administered instead of the
small — oxalate first, and an hour after the morphia. Pa-
tient completely narcotized ; respiration two and one-half
per minute, and the poisonous eflfect of the drug as well
marked as I cared to see it. At once I gave an emetic,
following it with strong coffee and belladonna. I admin-
istered good-sized doses of the tincture (ten or twelve
drops), and repeated often ; probably gave a drachm in
all. .\lso gave shower baths and made every exertion
possfble to rouse my patient ; at length succeeded, and,
perhaps it is needless to say, he was troubled no more
with dysentery. As this case was my own father, and
his age over seventy-one years, at that time, I did not
regard the case as Dr. Phelps does Dr. Willians's article,
' very funny.' "
Hydrophobia and the Bite of the Common Skunk.
— Dr. Howard Jones, of Circleville, O., writes : " Upon
careful inquiry throughout some of the Western States, I
have collected the histories of fifty-two cases of bites
from the common skimk — mephitis mephitica. Assum-
ing these cases to have been accurately related to me,
they may be classified as follows : Whole number of
persons and dogs reported bitten, 52 ; number of per-
sons bitten, 25 ; number of dogs bitten, many several
times, 27. Whole number of persons and dogs that died
from these bites with symptoms of hydrophobia, 8 ; num-
ber of persons that died from these bites with symptoms
July 14, 1883.]
THE MEDICAL RECORD.
55
of hydrophobia, 7 ; number of dogs that died from these
bites with symptoms of rabies, counting a dog that was
shot to prevent doing injury, i. The above cases may
be again divided into two classes, and each of these may
be subdivided as follows : A — i, number of persons bitten
while attacking skunks, 16; 2, number of persons attacked
by skunks and bitten, 9. B — i, number of dogs bitten
while attacking skunks, 27; 2, number of dogs attacked
by skunks and bitten, o. The number of persons tliat
died witli symptoms of hydrophobia out of the sixteen in
subdivision i of class A = 0 ; the number of persons
that died with svmptoms of hydrophobia out of nine in
subdivision 2 of class A = 7. The number of dogs that
died (or was killed) with symptoms of hydropiiobia, out
of the twenty-seven in subdivision i, class B=i. From
the above considerations the following conclusions may
reasonably be drawn : First. — All skunks are not rabid,
or, if they are, only about fifteen per cent, of their bites
inoculate on men and dogs considered together ; while
of men bitten, twenty-eight per cent, inoculate and prove
fatal, and of dogs bitten, only about four per cent, inocu-
late. This difference in susceptibility between men and
dogs evidently does not exist, and the difference in per
cent, of inoculations must be accounted for in another
way about to be suggested. Second. — VVhen a skunk
departs so far from its natural habits as to make an at-
tack with its teeth w-ithout any provocation, it is fair to
suppose that it is suffering from some disease which has
largely changed its nature. This conclusion is strength-
ened by the fact that out of the twenty-five persons bit-
ten while endeavoring to make angry or kill the skunks
(in most instances the animals were in steel-traps), not
one suffered any other effects from the wound save the
ordinary soreness ; while of the nine persons that were at-
tacked by skunks and bitten (in most instances the persons
were asleep upon the ground when bitten), seven died
with symptoms of hydrophobia, making a mortality of
nearly eighty per cent. It may be added that the dog
mentioned in division i, class B, which was killed on ac-
count of his having rabies, probably attacked a skunk
suffering with the disease. That the bite of the common
skunk is, under certain conditions, dangerous, and even
extremely fatal, there can be no doubt, and there are
many reasons for believing that the disease is identical
with rabies in the dog or hydrophobia in man."
The Physicians of New York. City and New York
State. — " The Medical Register" for 1883, just issued,
gives a list of 2,684 physicians living in the State. The New
York City list contains 1,661 names. According to this,
the number of (medically) registered physicians in this
city is nearly two-thirds of tlie whole number in the
State.
The number of Brooklyn physicians in the list is 510.
One hundred and twenty-six of those in the New York
list are serving in the hospitals and asylums.
Is Tendency to Death during Parturition Hered-
itary ? — Dr. VV. Henry Day, in a letter to the Lancet
asks this question and cites some cases which seem to
prove the affirmative. In one case, a mother, grand-
mother, and great-grandmother all died in their first
confinement.
Chloroform Narcosis during Sleep. — Dr. W. A.
Mansfield, of Cliampaign, 111., referring to Dr. Girdner's
article on this subject, writes {Chicago Medical Revie'u<)
that he has recently successfully chloroformed a young
man during sleep. He produced profound narcosis.
The man did not know that the experiment was to be
tried.
Medical Gems from "English as She is Spoke."
— A work entitled the "New Guide of Conversation in
Portuguese and English" has recently achieved a very
wide celebrity. The author, Signor Pedro Caroline, has
set forth Portuguese idioms, phrases, and anecdotes with
their English equivalent, as he regards it. The result
has been most extraordinary and amusing, the more so
as the book is evidently written seriously and in good
faith. We append the following formula :
" For to Visit a Sick : How have you passed the
night ? — Very bad. I have not sleeped ; I have had the
fever during all night. I feel some pain every where
body. — Live me see your tongue. Have you pain to the
heart? Are you altered? — Yes, I have thursty often. —
Your Stat have nothing from trouble some. — VVliat I may
to eat? — You can take a broth. — Can I to get up my
self? — Yes, during a hour or two. — Let me have another
thing to do ? — Take care to hold you warme ly, and in
two or three days you shall be cured."
The following comes under the head of Anecdotes .
"A physician eighty years of age had enjoied of a
health unalterable. Theirs friends did him of it compli-
ments every days : Mister doctor, they said to him, you
are admirable man. What you make then for to bear you
as well ?• — -I shall tell you it, gentlemen he was answered
them, and I exhort you in same time at to follow my ex-
ample. I live of the product of my ordering without take
any remedy who I command to my sicks."
The American Association for the Advancement
of Science holds its thirty-second annual meeting at
Minneapolis, Minn., August 15th, i6th, and 17th. Pro-
fessor C. A. Young is the President-elect.
Bequest for a new Medical College. — The late
Dr. Eliphalet Clark, of Deering. Maine, bequeathed
several valuable lots of land with which to found a
medical college.
The Consistency of our Medical Laws. — The
Legislature of the State of New York has decided that
"no person duly authorized to practise physic or surgery
shall be allowed or compelled to disclose any information
which he may have acquired in attending any patient in
his professional character, and which information was
necessary to enable him to prescribe for such patient as
a physician, or to do any act for him as a surgeon. "It
is difficult to reconcile this pronouncement," says the
Medical Press and Circular, " with the fact that in New
York any physician is liable to be clapped into jail and
fined $50, if he does not give public notice that his
patient is suftering from infectious disease."
We quite agree with our contemporary in this view.
The obligation put upon medical men to notify, without
compensation or return of any kind, the existence of in-
fectious disease is an encroachment upon individual
liberty which we trust the profession will in time resent.
Women Doctors for India. — The project for intro-
ducing medical women into Bombay is now fairly estab-
lished, upward of forty thousand rupees having been al-
ready subscribed for this purpose. The Hindoo Patriot
states that the scheme includes the bringing out of women
doctors from this country ; the establishment of a dispen-
sary for the poor; medical education for female students,
through the Grant Medical College ; and, finally, the es-
tablishment of a hospital for women and children.
Dr. Shoshee Bhoosur Mookes Gee is the name of
the President of a new Homoeopathic Medical College
recently founded in Calcutta, India. The name carries
with it a mystical significance well calculated to attract
the transcendental.
The Extension of Vice. — Professor J. Edwards
Smith has devoted a year to the study and discovery of
adulterations in homceopathic medicines ! When adul-
teration strikes the attenuated and gossamer fabric of
the si7n. sim. cur. materia medica, we may well believe
that vice reaches every fibre of our social system.
Digestion and Condiments. — How digestion is af-
fected by such condiments as salt and vinegar has been
studied by M. C. Hasson, and the results presented in a
paper read before the Academy of Sciences, Paris. Taken
in moderation these condiments are useful. They pro-
56
THE MEDICAL RECORD.
[July 14, 1883.
mote the secretion of the ga.stric juice. But if they are
indulged in to excess they irritate the coats of the stom-
ach and render the food more indigestible. The propor-
tion of salt should not exceed 5 to 10 grains to 0.5 kilo-
gramme of meat, and of acid t to 4 per 1,000.
Yellow Fever at Vera Cruz. — For some months
yellow fever has prevailed extensively at Vera Cruz, es-
pecially among the Americans and Europeans. It is
said that one thousand deaths have occurred within the
past two months.
Dr. a. W. Foot has just been elected Professor of the
Practice of Medicine in the Irish College of Surgeons.
Medical Schools for Wo.men in Canada. — Our
Canadian brethren have a penchant for medical women.
A Medical College for Women has been organi/etl in
Toronto, and a second one, it is said, is likely soon to
be established. A similar college is likely to be organ-
ized in Kingston.
The Delaware State Medical Society held its
annual meeting at Wilmington June 12th. Dr. Robert
M. Hargadim, of Felton, was elected President ; Dr.
Willard Springer, Vice-President ; Dr. George W. Mar-
shall, of Milford, Secretary; Dr. J. W. Sharp, Treasurer.
Driving out a Quack. — .\ man, calling himself Dr.
Hale, of Edinburgh, came to Wheeling, W. Va. , a short
time ago and began to deliver lectures and practise
medicine. He also distributed a paper of a low charac-
ter, called Health and Home. He was promptly driven
out of the State by the Board of Health.
The Hypodermic Injection of Ammonia. — The
value of intra-venous injections of ammonia has been at-
tested. The following case sent us by Dr. Willis Cum-
mings, of New Canaan, Conn., seems to show that ammo-
nia may be equally valuable given hypodermically. We
regret that our correspondent did not assure him-
self more positively whether the sun or alcohol had
the most to do with his patient's prostration. Dr.
C. writes : " Was called to see a young man said
to be overcome with the heat. Found him in a stable
lying on his back, in a perfectly relaxed and apparently
anaesthetic state. Was unable to arouse him by pinch-
ing, slapping, shouting, or pounding his feet. He had
been drinking largely of cider brandy in the morning,
after which he took a long ride in the sun, wearing a silk
hat. Had been unconscious about an hour and a half
before I saw him, which was about 3.30 p.m. Found
pupils slightly contracted, head cold, under jaw slightly
fallen, extremities cold, and also the whole body, partic-
ularly the epigastric region ; respiratory movements
hardly perceptible to the eye, but little more so to the
hand. Heart-beat greatly reduced in force, though pulse
was about 100 and very weak. Before I came ammo-
nia had been applied to nostrils and rubbed on back of
neck. Cold douches to head, and rubbing extremities
had been tried. After using the ordinary means of treat-
ment and getting no satisfactory results whatever, I put
four or five drops of ordinary water of ammonia to about
a teaspoonful of water, and gave ten drops of this solu-
tion hypodermically in the left arm. Within five min-
utes he was conscious. Before coming to, his cervical
muscles twitched a little, and the upper thoracic muscles
seemed to contract slightly, making him expire freely
with a short, full inspiration. Within the next ten min-
utes he was walking with the aid of a friend, fully restored
to consciousness and able to swear at the pain in his
arm. Of course there was a pretty active inflammation
at the seat of puncture from the needle. .Altogether it
was less than ten minutes between the time that he
seemed to be at the point of death and the time he was
on his feet. He was kept in the shade for about two
hours, when he got into his wagon and rode off, a little
dazed, but perfectly conscious, especially of the red spot
on his arm."
Dealing in Pauper Corpse.s. — The Chicago Grand
Jury has presented to court a strong condemnation of
the'practice of selling corpses which prevails in that city.
It is thought the communication will result in putting an
end to the traffic in the bodies of paupers which has con-
victed the county undertaker. The competition for this
position was so great at the meeting of the Conmiis-
sioners recently, that one party offered to bury paupers
for §1.23 each' The demonstrators of anatomy of the
various medical colleges of the city, as well as other men
eminent in the medical profession and thoroughly ac-
quainted with the subject, have requested such a change
in the system as would give the colleges, in pro rata
quantities, the material to which they are entitled, the
colleges promising to insure the county from expense by
paying such prices for the materials as will cover the cost
of its transportation to them, and they suggest that any
balance arising to the credit of the county be applied to
the better care of those bodies that must be buried.
ADULTER.vnoNS IN Lard. — It is openly admitted by
the lard-dealers of Chicago that all lard is adulterated
from ten to fifty per cent. In all but the worst grades
the adulteration is harmless, being oleo-margarine, cotton-
seed oil, vegetable oils, and tallow.
The First Post-Mortem in .A.merica. — Dr. J. R.
Quinlan, gives an account of the first post-mortem made
in America. It dates twelve years earlier than that
which occurred in Massachusetts, and has been sup-
posed to be the first : " At a Provincial Court, held at
Patuxent, for the Province of Maryland, September 23,
1657, whereas, it is thought requisite that a view be
taken of Henry Gouge, who is suspected to have been
brought to an untimely death by his master, John Dan-
dey, and whereas it is conceived that this cannot be had
so conveniently in time, as by a competent jury to take
a view of said corps, the Court doth order that Mr.
James Veitch be hereby empowered to go to the place
where the said Henry Gouge was interred, and to call
so many of the neighbors as conveniently can be pro-
cured, with two cliirurgeons viz : Mr. Rd. Afaddocks
and Mr. Emperor Smith, and after said neighbors and
the two chirurgeons have taken a diligent view of the
said corps, then the said chirurgeons, in the view of those
present, are to take off the head of said corps, and, after
diligent vic~a' and search, to signifie, under their hands,
how they find said head and corps, are to cause the said
head to be carefully lapped up and warily brought to
the Court, with what convenient and possible speed as
may be." The return of this jury, rendered to the court
September 24, 1657, runs thus : " Whereas, according to
the order of the court, we have proceeded and diligently
viewed the head of the corps of Henry Gouge, and laid
open to us by the chirurgeons, which was ordered by the
court to view and lay open to us. We detest (sic) un-
der our hands that we can see nor find nothing about
the said head, but only two places of the skin and flesh
broke on the right side of the head, and the skull perfect
and sound and not anything can or doth appear to us to
be any cause of the death of the said Gouge, and also
we do detest that we did endeavor what possible in us
lay, to search the body of said corps and could not pos-
sibly do it, it being too noysome to us all and being put
at first into the ground without anything about it, as the
chirurgeons and the sheriff can satisfie you, this is the
truth and nothing but the truth as witness our hands and
seals, this 24th day September, 1657. And according
to tlie order we have delivered the said head in the
hands of the sheriff."
Intra-Uterine Vaccin.-vtion. — Dr. Truzzi vaccinated
a number of pregnant women during the last three months
of gestation, with a view to determine the protection, if
any, afforded to the child. The results were negative, as
the children were all successfully vaccinated a few days
after birth.
The Medical Record
A Weekly jfournal of Medicine and Surgery
Vol. 24, No. 3
New York, July 21, 1883
Whole No. 663
©vigimil ^vticlcs.
ON THE PATHOLOGY AND TREATMENT OF
CERTAIN FORMS OF NERVE-WEAKNESS."
By C. L. DANA, A.M., M.D.,
PROFESSOR OF PHYSIOLOGY, WOMEN's MEDICAL COLLEGE OF THE NEW YORK IN-
FIRMARY, MEMBER OF AMKKICAN NEUROLOGICAL ASSOCIATION, OF NEW YORK NEU-
ROLOGICAL SOCIETY, PHYSICIAN TO CLASS OF NERVOUS DISEASES, NORTHEASTERN
DISPENSARY. [
As every physician knows, chronic functional nervous
disorders of the neurasthenic and hysterical kind are
most difficult to treat with success or even satisfaction.
They are apt to be set down as "cranks" and nuisances,
the victims of a morbid imagination. This is certainly
not a correct or charitable view. Hypochondria, hys-
teria, neurasthenia, " irritable spine," nervousness, are
diseases having a somatic basis as truly as has insanity.
And it seems somewhat strange that while every one ad-
mits the physical basis of mental disease, physicians are
reluctant to admit it for these milder, but most distress-
ing and obtrusive disorders.
Before taking up the subject of treatment, permit me
to discuss, as briefly as possible, the subject of tlie nature
and proper classification of these neuropathies.
Nomenclature. — As regards nomenclature, every one
has doubtless felt dissatisfied with the term neurasthenia,
and especially with its ordinary translation (which is an
incorrect one) of nervous exhaustion. Neurasthenia
means rather nerve-weakness ; and, perhaps, a still more
e.xplicit and significant translation is nerve-enfeeblement.
We cannot get rid now of the term neurasthenia, how-
ever, and it is not desirable ; but it is desirable and pos-
sible to give it a much more definite meaning than it has
yet had.
I believe that we should use the term nerve-weakness
or nerve-enfeeblement, as a general one to include all
the different functional neuropathies that are character-
ized by a diminution in the force-generating centres of
the nervous system. It should include, therefore, hys-
teria, mild forms of nerve weakness known generally as
nervousness, more pronounced and localized forms known
now as spinal irritation and tieurasthenia proper, it
should include also such disorders as certain forms of
hypochrondriasis — which the older authors used to look
upon with reason as the hysteria of man.
Etiology. — These various neuropathies have certain
common methods of development which can be classified
as follows :
1. A person inherits or acquires (by overwork, ex-
cesses, etc.) a neuropathic diathesis. Some special excess,
powerful excitement or injury then induces a train of
morbid symptoms characteristic of some form of nerve-
weakness.
2. A person of neuropathic antecedents has some
slight but chronic local disease (dyspepsia, uterine, ova-
rian or prostatic irritation, etc.) ; this, acting as an irritant
sets up a train of morbid nervous symptoms. This gene-
ral disturbance reacts and makes the local trouble worse.
The causes thus work in a vicious cycle.
3. Direct, excessive, constant exercise of the nervous
centres and mechanisms may lead to an increase of
functional irritability with accompanying weakness, or
eventually to absolutely less functional activity and
1 Read at a meeting of the Practitioners' Society of New York, May 4, 1883.
power. Continued disuse of previous actively used func-
tions may lead to impairment in their power also, as we
see sometimes in persons who have abandoned their
special work or business.
All cases of chronic functional nervousness, neuras-
thenia as usually described, hypochondria, and hysteria
will be found, I think, to have an origin in one or more
of the foregoing ways.
Fundamental changes, anatomical and chemical, in
nerve-weakness. — Modern physiology throws some light
upon our conceptions of the essential changes in the
various forms of functional nerve-enfeeblement.
Thus we can say with some confidence that underly-
ing these disorders there are the following conditions :
1. An imperfect tissue nutrition and metamorphosis, a
kind of tissue-dyspejjsia which results in making the
nerve- molecules unstable.
2. Coincidently there is often, if not always, some
derangement in vascular supply. This vascular change, I
venture to say, is always an anaemia or a venous hypere-
mia; true hyper^emia is not present, except incidentally
and temporarily in chronic functional nerve-weakness,
since it is always the correlative of increased functional
power.
3. Some permanent chemical changes are very likely
present. These changes cannot be great as regards the
nerve-elements themselves, for all tissues, as long as they
act and preserve their identity, must have about the same
composition. I doubt if the balance of the chemist will
ever tell us what are functional diseases. But the chemi-
cal products of tissue activity may be altered, as shown
by the character of the excretions.
Referring now to the disturbance in the tissue nutrition
of the nerve-centres, the view that the nerve-molecules
arc in an unstable condition is, I believe, a helpful one,
although it may seem somewhat transcendental.
A nerve-centre may be compared (as was suggested by
the late Professor Clifford) to a house of cards which is
being constantly built up and as constantly knocted
down in every functional act. Normally this house of
cards has a certain relative stability and is only toppled
over by its legitimate stimuli. But in the neuropathic
state the foundations are less broad, the superstructure
more frail and less lofty. It is knocked down more easily,
it recovers itself more slowly ; perhaps it can hardly be
built up again at all. It is unstable. With such an illus-
tration we can perhaps refer to "molecular instability"
and have it convey a just notion of a real pathological
condition.
Physiology of 7ierve-weakness. — Tlie nerve-centres
being in the morbid condition just described, give rise to
certain vital phenomena which may be described under
the head of the physiology or physiological pathology of
nerve-weakness.
These phenomena may be tentatively classified as fol-
lows. I would not aflirm that the divisions are exact or
mutually exclusive :
1. A condition of irritable weakness.
2. A condition of absolute weakness.
3. A condition of lessened resistance to the passage of
nerve-impulses.
4- A condition in which the higher and inhibitory
centres are weakened in power or entirely "shelved off."
I. The condition of "irritable weakness" — an excel-
lent though ancient term. If you partly cut off the blood-
supply from a nerve, then irritate it, the response will be
58
THE MEDICAL RECORD.
[July 21, 1883.
unusually ready but weaker than normal. The anaemia
has increased the nerve-irritability. The nerve prays for
blood as Romberg has said. But if you diminish the nu-
trition of the nerve in any way, it will pray to have its
food restored. The prayer conies readily but is short
and weak. So it is with nerve-tissue anywhere in the
body. Conceive the nervous system to be represented by
a tuning-fork with strong, thick blades. When this is
struck sharply it responds with a loud and long vibra-
tion. If now the blades are worn down till they are very
thin, they respond to even a feebler blow, but the re-
sponse is less vigorous and lasting. So it is with this or
that part of the nervous system in functional nerve-en-
feeblement.
2. The condition of absolute or almost complete weak-
ness. Here the nervous centres are really exhausted.
They respond not only more feebly but less readily, or
perhaps not at all. Such a complete e.xhaustion rarely
affects the whole system, but rather certain parts, certain
neuro-mechauisms. Sexual impotence illustrates it ;
while sexual weakness illustrates the preceding phase of
irritable weakness.
3. A condition of lessened resistance in the nerve-cen-
tres, so that impulses flow over from their natural chan-
nels. .\ slight stimulus causes a dozen reflexes instead
of a single one (as we see illustrated in nervous individ-
uals) ; or a simple sensation awakens a dozen active feel-
ings (as in hysteria) ; impulses pass up from the viscera
or from different parts of the body into consciousness,
flowing beyond their natural channels, as in hypochon-
dria ; the patient seems to feel some of the functional
acts of his intestines or his liver. This condition is neces-
sarily present in over-irritable and unstable centres.
4. A condition in which higher and inhibitory centres
are lessened in power. When general enfeeblement at-
tacks the nervous centres it affects those higher and last
evolved first. Yet these have important functions in
keeping order and harmony among centres below. Rea-
son, judgment, the power of making choice being weak-
ened, the emotions are left more active and less con-
trolled. Such a condition helps to increase the func-
tional disorder in nerve-weakness.
Lest you think this " shelving-off" theory (though, of
course, not original with me) a somewhat fantastical one,
let me give an illustration to show that we do have con-
trolling centres : Make a cross section of the medulla of
a rabbit 3 ctm. above the point of the calamus scriptorius,
an^i the spinal reflexes below will become disorderly and
demoralized. Make the section 2 ctni. higher and the
spinal reflexes continue normal and orderly ; you have
not, in the latter case, cut off from the spinal cord its
controlling centre. It cannot be doubted that there are
similar regulating centres in the human body.
Symptomatology. — The symptoms pertaining to ner-
vousness, neurasthenia, hypochondriasis, hysteria, would
fill pages.
In analyzing them, it appears to me very helpful if we
look upon the body as a mass of physiological machin-
ery, of which the nerves are the motive and regulating
power. For the function of the nervous system is, in a
word, to set free and to regulate the energies of the body.
Regarding the living body, then, as a compound of many
neuro-mechanisms, we can divide them up as follows ;
1. Simple and conijiound muscular neuro-mechanisnis.
2. Sensory niechanisjiis, general and special.
3. Vascular, secretory, and trophic neuro-mechanisms.
4. Neuro-mechanisms of vegetative life.
5. The iisycliical mechanisms.
It is, I believe, unwise and confusing to attempt to
separate, physiologically or even clinically, the disturb-
ances of the sympathetic from those of the cerebrospinal
system. They are anatomically and functionally closely
united.
With the above as a basis, we may make the following
analysis of the chronic functional disturbanceSj of the
nervous system :
1. Irritable or absolute weakness of the simple cranial
and spinal muscular neuro-mechanisms : e.g., twitchings.
2. Excessive, perverted or weakened activity of the
compound muscular neuro-mechanisms : e.g., contrac-
tures, convulsions, paralyses, muscular weakness.
3. Corresponding disturbances of the {a) general sensory
mechanism : e.g., hyperssthesia, neuralgia, anaesthesia,
spinal irritation ; {b) of the special sensory mechanism :
e.g., disturbances of sight, hearing, etc.
4. Disturbances of the vascular mechanism : flushings,
migraine, pupillary disturbance, anremias and h)'per3Bmias
of organs.
5. Disturbances of the secretory and trophic mechan-
isms.
6. Disturbances of the neuro-mechanisms of vegetative '
life: ^.^^., cardiac (palpitations); respiratory (sense of
suffocation) ; gastric (dyspepsia, boulimia) ; intestinal
(constipation, insufficient secretion, dyspepsia); hepatic;
sexual.
These mechanisms are for the most part compounds
of some of the others, hence their distinct separation
is made largely on anatomical grounds.
7. Disturbances of the psychical mechanism : loss of
co-ordinative power, inability to concentrate the mind or
to use it continuously, morbid fears, emotional disturb-
ances, impaired will-power, etc.
Classification . — It would be very fortunate if we could
definitely assign the various forms of nerve-weakness to
their proper category. This is not possible, however,
since the different forms run into each other, and it is only
the most pronounced cases which can be isolated and
stamped as being of a particular class and no other.
Neurasthenic persons are certainly nervous; hysterical
persons often show plain evidences of a general nerve-
enfeeblement ; hypochondriacs may be also somewhat
hysterical.
I venture, however, to lay down some distinctions :
Thus in ordinary nervousness there is simply an in-
creased " irritability with weakness " of some or all of the
nerve-mechanisms. The sensibilities are more acute,
the reflexes more active. There may be some disturb-
ance of the bodily functions, e.g., dyspepsia, palpitations,
neuralgias, insomnia. But these are not permanently
localized, so that they in turn act reflexly and steadily
increase the general trouble.'
In that form of disease which has been described by
Beard and others as neurasthenia, or nerve-enfeeblement
proper, we have, in addition to various general nervous
symptoms, special and quite permanent disturbances of
function. The brain is decidedly enfeebled in some of
its functions ; the condition is so pronounced that doubt-
less vascular changes have ensued which react upon the
disease to increase it. Or the stomach or sexual organs
are crippled in the same manner.
A case is not one of neurasthenia proper unless the
disease has specially localized itself upon some organ or
neuro-mechanism to such extent that the local disturb-
ance is a locus morbi reacting upon the general system.
The distinction thus made is arbitrary, but a useful one,
and I put it forth till a better is presented.
It follows, of course, that hysteria is only a neuras-
thenia. It is, however, markedly separated by the fact
that it is much more, in its clinical aspect, a brain dis-
ease, a psychopathy, although the spinal cord becomes
also involved. I also believe that all the phenomena
can be explained on this view. Hysteria is char-
acterized : I, by the excessive irritability of the nerve-
centres, culminating generally in convulsions ; 2, by the
extreme sensibility of the sexual reflexes ; 3, by enfeeble-
ment of the higher psychical powers, the result being
excessive activity of the emotions ; 4, by a morbid self-
concentration upon the bodily sensations. By virtue of
' Many persona, cspeci.illy Americans, are " nervous," but are yet in good
health. In these there is an increased irritability or functional activity of the nervft*
centres it'ithout the lutakness. fj Theyjare^nervous but have not the disease "ner-
vousness."
July 21, 1883.]
THE MEDICAL RECORD.
59
her peculiar psychical condition a hysteric is constantly
throwing herself into senii-niesmeric states. Hysterical
spasms, pains, paralyses, perversions of sense, are very
analogous to those produced artificially in iiealthy persons
susce|)tible of the hypnotic influence.
Hypochondriasis is still more pronouncedly a brain
disease, though sometimes only a symptom of a general
nerve-enfeeblement. Here we have also some of the
features of hysteria — a morbid self-concentration, a mor-
bid susceptibility to visceral impressions. But there is
not the exaggerated irritability of hysteria, nor is there
so great an enfeeblement of the higher psychical [low-
ers.
I present here the provisional classification above
indicated :
I. Nervousness. — Characteristics : A general irritable
weakness of brain, etc., cord, special neuro-mechaqisms
not seriously and chronically affected so as to react and
increase the chronic trouble.
H. Neurasthenia (nerve-enfeeblement proper).— ^-Char-
acteristics : I, irritable weakness of nerve-centres and
mechanisms ; 2, or absolute weakness ; 3, a localization
of the disease in various neuro-mechanisms, causing
special (gastric, sexual, etc.) forms of neurasthenia, which
react to keep up the disease. The phenomena of les-
sened resistance, of enfeebled controlling centres enter
into the disease more or less.
HI. Hysteria (a neurosis and psychosis combined, but
more the latter). — Characteristics : i, a "shelving-off" of
higher controlling powers ; 2, greatly increased irritabil-
ity (with weakness) of lower centres, especially (a) emo-
tional, [b') spinal reflex, culminating in convulsions ; 3,
localized disturbances of various neuro-mechanisms (mo-
tor, cardiac, gastric, sexual, etc.), these disturbances
being more acute, more variable, more pronounced than
in neurasthenia proper ; 4, special irritability of nerve-
centres to sexual stimuli.
IV. Hypoclumdriasis. — Characteristics: i, special sen-
sitiveness [i.e., increased irritability) of emotional and
perceptive centres to visceral and sensory impressions
(morbid self-concentration) ; 2, lessened resistance and
overflow of visceral and sensory impulses.
The foregoing will I fear seem somewhat recondite.
It may be asked : Is there any good in knowing when
a hysterical woman comes into your office that her nerve-
molecules are in a too explosive condition, and that the
top-centres of her brain are functionally sliced ofl ?
It appears wise to try and see as deeply as possible
into the intimate nature of disease. Thus some of the
practical conclusions from the previous analyses are that
over-activity of a nervous system may signify weakness
rather than strength ; that such over-activity in one part
may mean simply that another part is weakened, the
check-reins dropped ; that true hypertemia does not
characterize the nerve-centres in chronic forms of ner-
vousness, neurasthenia, etc., since it is the correlative of
increased functional power.
TREATMENT.
In discussing the subject of treatment I shall refer
only to the treatment of the classes which I have de-
scribed as the nervous, and the neurasthenic proper. It
is intended not to go over the whole subject, but hav-
ing outlined certain general principles to call atten-
tion to some special measures with which I have had ex-
perience.
General principles. — The points of attack in the
treatment of the neuropathies under discussion are : i,
the general condition of health and general nutrition of
the body ; 2, the nutrition of the nervous system and
the neuro-mechanisms specifically ; 3, specific medica-
tion ; 4, the treatment of local sources of irritation, cere-
bral, spinal, gastric, intestinal, genito-urinary, vascular
(this may include surgical measures) ; 5, mental treat-
ment.
It is an accepted principle in the general treatment of
most chronic neuropathic disorders that there should be
two periods, one in which sedatives should be employed ;
in the other stimulants and tonics. A nerve made over-
irritable by antemia, can be quieted by giving a drug
which directly lowers the irritability, steadying the unsta-
ble molecules , or, by enriching the blood and thus
removing the irritant. It is found practically that often
the sedatives and tonics can be given together.
Another most important principle in treatment, is the
necessity for change of therapeutic method. No drug
and no special measure should be kept up continuous'y.
There should be intermissions from all treatment if pos-
sible, and the disease should be successively attacked by
various remedial agents.
A third important factor is the treatment by measures
diverted to the afferent nerves, calling into play the re-
flex inhibitory and other mechanisms.
I present here the various therapeutic measures to be
employed in the treatment of nerve-weakness in its gen-
eral and localized forms :
Hygiene. — Muscular exercise, massage, Swedish move-
ments, climate-cure, moist and warm localities, sea-voy-
ages, simple removal from ordinary surroundings. Men-
tal hygiene : Amusements, change from ordinary tasks,
the discipline of cures and special hospital establish-
ments. Diet : Such as is best digested, slight excess of
fats and nitrogenous food.
Internal medication. — Sedatives : Bromides, chloral,
[laraldehyde, hydrobromic acid, lupulin, camphor, Scu-
tellaria, cyprip;edia, digitalis, stigmata mais, valerian,
gelsemium, conium, opium, cannabis indica, asafcet-
ida, hydrocyanic acid, ergot.
Tonics and stimulants : Phosphorus, strychnine, arsenic,
zinc musk, cenanthic ether, caffein, thein, coca, salicin,
quinine, alcohol. The various aromatic and simple bit-
ters, mineral tonics, iron, act indirectly as tonics. Nitrous
oxide.
Surgical Measures.
External Medication. — Tonic : Electricity — general
electrization, faradic, galvanic, static, special electriza-
tion of intestines, urethra, sexual organs, spinal cord,
brain. Nerve-vibration.
Hydrotherapy. — Tonic : Cold douches over body or
spine, cool to cold baths, plain or medicated ; sea or
river bathing ; acid, aromatic, and sulphurous baths ;
baths with stimulating friction, and use of oils, aromatics
(myrrh, riie, savine, rosemary).
Sedative : Turkish or Russian baths ; warm baths,
80° to 95°; hot baths, 95° to 120°.
Revulsives and Inhihitants. — Blisters, seton, sparks of
static electricity, hot iron, acupuncture, ignipuncture,
aquapuncture ; cold (ice-bags) ; heat. Moxa;.
Regarding the sedatives which may be used in nerve-
enfeeblement.
The bromides here take the first rank. Every one is
familiar with their value. Some statements about them,
however, will bear repetition. They should be given
generally in larger doses than is ordinarily done, viz.
gr. XXX. to gr. xl. or 3j. The physician should under-
stand that bromization is often the thing needed, not
simply giving bromides. Bromization will secure thera-
peutic results, when simply giving bromides is of no effect
at all. A convenient test for bromization is in many cases
the production of faucial anaesthesia, so that the finger
or a pencil can be thrust into the back of the throat
without provoking reflexes. The bromization need not
be kept up long, but may need to be repeated. It has
seemed to me beneficial to put a patient through a
•'storm" of bromides just as is done in epilepsy.
Much larger doses of bromide can be taken and the
drug can be kept up longer by giving digitalis, or cod-
hver oil and iron, or coca at the same time. One pa-
tient who was only comfortable when nearly bromidized,
felt less depressed while chewing coca leaves. A frail
and somewhat anasmic patient of mine takes gr. xl. of
bromide three or four times a day with iron, oil, quinine.
6o
THE MEDICAL RECORD.
[July 21, 1883.
and digitalis, and does not seem to suffer seriously from
bromide depression.
The most powerful bromide is the lithium salt. But
this is expensive and not always obtainable. Bromides
are more powerful in combination, and one of the best
combinations is, I think, that devised by Dr. Beard, and
known as " Bromidi comp." The formula is as follows:
5. Brom. sodium,
Brom. potass.,
Brom. calc '"'ii gr- •^■
Brom. lithiffi gr. v.
lod. potass gr. ijss.
Fowler's solution gtt. ij.
Tr. capsici gtt. j.
Aqua q. s. ad 3 j-
M. Sig. — One dose.
Acne is to some extent prevented by drinking large
quantities of water with each dose and by the addition of
Fowler's solution.
If bromide of sodium be dissolved in carbonic acid
water, 3 ss. to a tumbler of the water, it makes a mix-
ture very much like Saratoga Geyser, and New York
ladies will drink it with much satisfaction. It is an im-
provement on the bromides with Vichy, as suggested by
Dr. E. C. Seguin.
Hydrobromic acid. — For a year and a half I have been
using hydrobromic acid quite extensively as a substitute
for the bromides.
I find that it is a sedative like the bromides, that it
does not produce acne nor constipation, nor does it often
disturb the stomach. It may be substituted for the bro-
mides in milder cases, even in treating epilepsy. It is
convenient, because it can be given with iron, quinine,
and other tonics. The objections to it are that in order
to get powerful sedative effects one must give it in dis-
agreeably large doses. The ordinary so-called Fothergill's
solution has a strength of three percent, of the pure acid,
and it is altogether too weak to have much sedative effect.
The doses which I usually employ are from 17], xl. to 3 ij-
of the ten per cent, solution. I have given " ij. four
times a day without causing any but sedative effects.
With some persons the bromides do not act well.
They will even increase irritability and cause insomnia.
For these a very efficient sedative is one suggested by
Dr. Beard," of which the formula is as follows :
5. Fluid extract scuUcap,
Fluid extract cypripedii,
Fluid extract blue cohosh.
Fluid extract lupulin ai 3 j.
Fluid extract cannab. ind 3 jss.
Sig. — One drachm dose. The cannabis indica can
be omitted.
The value of ergot is well known. It sometimes in-
creases the sedative action of the bromides, especially
when there is venous hyperemia at the bottom of the
trouble. In the insomnia occurring in certain cases of
hypochondria, hysteria, and melancholia, and in con-
gestive headaches, it acts when even chloral and bro-
mides fail.
Yet on the whole, ergot has not a very wide range of
usefulness in chronic nerve-weakness, and its value, given
alone, according to my experience, is not great.
Caffein is not generally considered a sedative, but in
the first homceopathic dilution I have known it to re-
lieve an obstinate case of insomnia with bad dreams. In
other cases it has failed.
Paraldehyde is a new hypnotic recently introduced by
Cervello, and tested in numerous cases by Morselli.
It is claimed to be an excellent and safe hypnotic, acting
like chloral upon the brain, but rather stimulating the
heart. It seems to be a good hypnotic, perha|)s not so
' During Ihe summers of 1881 and 1883 I look ch.irgi: of Dr. Hcird's practice
during his absence in Europe. He kindly gave mc access 10 fiis pri\-atc formulae,
and described some of ^his special therapeutic methods. Hence my frequent ref-
erence to them now.
powerful as chloral, except in disagreeably large doses.
In two cases it appeared to have a general sedative and
anodyne effect. A nervous, hysterical woman, who had
been taking it, said she had not felt so well for a long
time. The dose is from 3 ss. to 3 ij-
Hyoscyamia is not a very trustworthy drug, and need
rarely be resorted to in the nervous troubles of the kind
under consideration.
The olcate of aconitia and aconitia internally, but es-
pecially the former, are often very useful in relieving
some of the neuralgic pains. Nothing special need be
said about the other sedatives, chloral, cannabis indica,
etc.
To7iics and stimulants. — Of the tonics and stimulants
to the general system I have nothing especial to say.
One of the best of the bitter tonics issalicin in rather large
doses. A formula which is not particularly original is
the following :
5. Acid, hydrobromic. dil., lo;^ or 3^,
Tinct. ferri muriat.,
Acid, phosphor, dil aa 3 j.
Strychnia sulph gr. J
Salicin 3 jss..
Sig. — One drachm t.i.d.
The drugs which especially affect the nutrition of the
nervous system are the following :
Arsenic.— in cases where the nervous troubles are
kept up by a prostatic or urethral irritation the following
formula was used by Dr. Beard :
IJ. Liquor potas. arsenit lU v.
Tinct. cantharid fll ^.
Tinct. hydiastis TTl x.
Tinct. nuc. vomic TI], x.
Tinct. cannabis indica TT], x.
Aquas q. s. ad 3 j-
Sig. — A teaspoonful.
I have had prepared and used in several cases^the
liquor brom. arsenic, of Dr. Theo. Clemens, but have
not been able to get any good results from it.
Zinc. — This may be given in a formula which includes
a number of the zinc salts, as follows :
IJ. Zinci bromid.,
Zinci valerianat.,
Zinci lactate aa gr. j,
Zinci phosphid gr. ^^.
Extr. belladon.,
Extr. nucis vomic aa gr. \.
Ft. one capsule.
The belladonna and nux vomica may be added or left
off in accordance with the indications.
This combination is, I think, more efficacious than the
single salt, yet I cannot say that I have used it often
enough to speak dogmatically regarding it.
Coca is a very useful medicine if a good quality can
only be got. It temporarily brightens up a patient. It
is only palliative however. Dr. Beard several times told
me that it had greatly disappointed him.
Caffein, in my experience, has not been of much ser-
vice as a nerve-stimulant.
Damiana I have been disappointed in. Dr. Beard
told me he had found it of about as much value as so
much water. Possibly samples differ. Celerma, in my
opinion, is a humbug.
In the treatment of old-standing nervous disorders of
the class in iiuestion, 1 have learnt ihat there is little to
be expectetl from nerve-tonics. Only rarely is our work
brightened by a meteoric success apparently due to these
medicines alone, except tlie cases where there is ana:mia
or chlorosis, and where large doses of iron often act re-
markably well.
External medication. — Static electricity lias markedly
helped cases of hypochondria, hysteria, and general nerve-
weakness. It is not so useful, however, as other forms
July 21, 1883.]
THE MEDICAL RECORD.
61
of electricity in most cases of nervousness and neuras-
thenia proper.
General electrization by the faradic and galvanic cur-
rents, it is well known, acts as a tonic to the nervous
system and to the general nutrition of the body. My ex-
perience is that this electrization ought to be given ofteiier
than is usually done, e.g., every day or even two or three
times a day. This is the view also of many German elec-
tro-therapeutists. It is known that electricity by improv-
ing the nutrition allays irritability and acts as a sedative.
But I think it is demonstrated that by the " polar method "
and by special electrodes we can undoubtedly get specific
sedative effects on the brain and cord at each application.
In cases of unilateral chorea I have in numerous in-
stances applied a large stabile anodal electrode to tiie
scalp over the region of the motor convolutions, the
cathode is held in the hand of the opposite and affected
side. A current of two to eight Stoehrer's cells has
been allowed to pass for about five minutes. In this
way I have produced distinct amelioration in the choreic
movements lasting for about twenty-four hours.
I have not had an opportunity of using anodal galvanism
of the brain alone in cases of mental irritability and weak-
ness, but others have done so, and Althaus especially re-
commends the measure most enthusiastically.
In some forms of very severe chronic headache, strong
anodal galvanization with the foot on the cathode will,
I believe, prove beneficial.
I have had made a special electrode by which 1 can
get the anodal effects upon the spinal cord. The spi-
nal electrode is a long narrow sheet of brass, tempered
so that its shape can be changed. This is covered with
sponge. It is placed over the spine, covering the whole
length, and the indifferent electrode held in the patient's
hands. Before turning on the current the superficial or
skin reflexes of the thorax are tested ; then a strong cur-
rent of twenty-five or thirty cells is passed, and the reflexes
tried again. If the irritability of the spinal cord is really
reduced by the anode, the reflexes which are purely spinal
would be less easily elicited. This has proved to be the
case in some cases but not in others.
We have, I think, in electricity, an agent by which
direct sedation of the over-irritable nerve-centres can be
obtained. In a case of irritable sexual weakness with
premature emissions, the ])atient after a few applications
of my spinal electrode was greatly improved, thougli
electricity had been tried before for a long time in vain.
I have here a special appliance for tlie treatment of
sexual nerve-weakness. It was devised by Clemens, of
Frankford, and was used upon a most obstinate case of
impotence, a case which had been in the hands of many
prominent neurologists in New York. The patient rap-
idly recovered and is now a new man. This which I
know to be a fact is my excuse for showing the appa-
ratus, which apparently has a good deal of hocus-pocus
about it.
It consists of a zinc cylinder made to enclose the penis,
with a funnel attached so that it can be filled with Rhine
wine or weak alcohol. The positive pole is connected
with it, and the negative pole, which is attached to a very
large electrode, is placed over tlie spine. It is to be used
three times a day for five or six minutes, a current of five
to eight cells being employed. It is supplemented with a
set of magnetic apparatus which seems to be of subsidi-
ary importance. There is no doubt that the patient gets
the sedative effects of the galvanic current very thor-
oughly. I am at present treating a case with it. The
patient, who is a very intelligent man, in fact a doctor
himself, was very decidedly improved, and is indeed now
almost well.
Hydrotherapy. — As a stimulant and tonic we adminis-
ter general cool and cold baths, medicated or otherwise ;
general tepid baths, gradually making them cooler ; local
baths of various kinds ; cool and cold douches, hot
douches or jets, and alternately hot and cold douches or
jets; baths with massage or electricity.
Cold baths increase the oxidation of tissue and thereby
act as a stimulus to nutrition. They increase the flow
of urine. Reflexly they may relieve congestions and in-
hibit pains. Cold baths act as a tonic to irritably weak
nerve-centres by thus relieving congestion, improving
nutrition. Cold baths are invaluable to the nervous and
neurasthenic when the general system is strong enough to
react.
In sexual neurasthenia, with emissions, where the ir-
ritability is more prominent than the actual . loss of
power, cold sitz baths once or twice a day, or cold
douches are indicated.
Cold douches to the back are of help to cerebral as-
thenia, with insonmia, morbid fears, hypochondriasis.
Persons who cannot endure cold baths at first can be
made to do so by beginning with tepid or cool water,
and gradually lowering the temperature. Medicating
the baths with salt and alcoliol, or aromatics, adds to
their effect.
Warm baths. — These also may be local or general.
VVarm baths relax the blood-vessels, weaken the heart-
beat, increase diaphoresis, lessen the amount of urine
passed, act sedatively upon the nervous system. The
sedation is that of exhaustion, however. Warm baths are
to be used temporarily and intermittently, therefore.
I have known warm baths at night to help greatly in
relieving insonmia. I have not known much benefit to
come from Russian or Turkish baths.
Electrical baths furnish a good way to apply electriza-
tion. They are not in high repute among electro-thera-
peutists. In my very limited experience they have acted
well.
Revulsives and inhibitants. — Of tliese, the cautery
applied at the back of the neck and along the spine often
gives excellent results in cerebral or sexual nerve-weak-
ness. It stands at the head of counter-irritants.
After the cautery come blisters. Large blisters spread
thin or in spots, so that they keep up a slight vesication
for a long time, are one of the best forms.
Of the value of acupuncture, ignipuncture, the electric
brush or moxa, the seton, I have nothing to say. If
there is reason to suspect cerebral or spinal venous hy-
perfemia, counter-irritants ought to be freely used.
They are often also very potent in arousing dormant
or enfeebled jentres, or dispelling unpleasant symptoms,
acting perhaps by reflex inhibition ; I have, therefore,
referred to them as " inhibitants."
Dry cups. — A patient of Dr. Beard's, who suffered from
a most exaggerated anthrophobia, was treated for some
time with little success. He went home finally, and
being a mechanic, made himself a kind of air-pump with
large cups attached. These he applied upon himself daily
and with the result of becoming almost well. Dr. Beard
had one of these appliances made and had used it con-
siderably. At the time of his death he had an article
prepared giving his results. It liad helped a number of
cases, but by no means all. A patient of my own — a
neurasthenic with hypochondriacal symptoms — dated his
steady improvement from a systematic cupping which I
gave him.
Massage. — Massage alone does not give much success.
It is a luxury in therapeutics. Some neurasthenics can-
not endure it. The masseur, if experienced, can tell
after a few trials whether he can help the i>atient.
The IVeir-Mitchiil treatment hy isolation, rest, massage,
electricity, and overfeeding, is oftener applicable to wo-
men than men. The majority of male neurasthenics are,
I think, not benefited by it, or, at least, will not sub-
mit to it. I believe that its good results are chiefly
from the psychical effects of a rigid system of eating and
living.
Biet. — Dr. Beard, just previous to his death, had been
studying the subject of food, and had written a chapter
upon the philosophy of diet, based on the principlesof
evolution. In it he announced the following very orig-
inal views :
62
THE MEDICAL RECORD.
[July 21, 1883.
" First, living beings feed on that which is below them
in the scale of development.
" Second, the best food for man is that which is jast
below him or nearest to him in the scale of development.
" Third, food is difficult of assimilation for man in pro-
portion toils distance below man in the scale of develop-
ment."
The following propositions he also announced as veri-
fiable : " First, the earth feeds on gases ; fruits and
cereals feed on the earth ; the lower animals feed on
fruits and cereals, and on other animals ; man, therefore,
should feed mainly on the lower animals, with a small
projwrtion of fruits and cereals. Second, in proportion
as man grows sensitive through civilization or through
disease he should diminish the quantity of cereals and
fruits and increase the quantity of animal food."
According to this theory and the doctrine of evolu-
tion the best food for nervous invalids would be as fol-
lows : beef, mutton and lamb, fowl, eggs, milk, fish, butter,
wheaten bread.
In discussing the above theory Dr. Beard brings evi-
dence to show that monkeys are good eating, that man
is good food for man, and that cannibals are the
strongest and healthiest of savages !
\Vithout discussing this subject now, it has been
generally admitted that a nitrogenous diet is best for
those of unstable nervous energy. We can explain this
from the fact that nitrogenous food has more to do with
structure and nutrition, non-nitrogenous with function,
or discharge of energy. In the nervous we want a food
that will give more stability to cell and axis-cylinder, and
not a foodwhich feeds the function and really increases
instability. To return to an old simile, the nervous sys-
tem may be compared to a delicately vibrating rod
fastened at one end. Normally, vibrations take place
without waste of the metal of the rod, or of the tissue of
the nerve. In the case of this latter, however, over-vi-
bration, too persistent vibration, and other causes finally
wear away its textures. It becomes, so to speak, thinner,
weaker, yet it vibrates more readily and delicately, just
as does the rod when made thin.
The object of radical curative treatment is to make
the nerve more, so to speak, solid. Nitrogenous food
supplies tissue to the wasted nerve, and thus helps to
do this. Fatty food is also essential, because fat also is
a constituent of nerve-tissue, and a help to nerve-action.
I believe, however, that too much stress may be put
upon s])ecial diets, and that after all a mixed diet of thor-
oughly digestible and palatable food is often quite as good
as a sjiecial diet, unless some special gastric or intestinal
trouble be present. The nervous system is not the only
thing that has to be dieted.
Mental therapeutics. — I am profoundly convinced of
the prominent place of mental influence in the therapeu-
tics of functional nervous diseases. " The most power-
ful single remedy that can be used in the treatment of
neurasthenia is the mind," was an aphorism of the late
Dr. Beard, and all experience acknowledges its truth.
Witness the success of faith-cures. I have seen a hyp-
notic fall very nearly lifeless when told to shoot himself
with a stick which he thought was a loaded pistol. This
mental therapeutics is the mainstay of charlatanry and
the backbone of many a genuine professional success.
Some persons are spoken of as born physicians, and I
conceive it is because they have the tact and skill to
manipulate the psyche of their patients. Such skill is
particularly needed in treating chronic functional troubles.
" It is not everybody," says Holmes, in describing Dr.
Kittridge, " that enters into the soul of Mozart's or Beet-
hoven's harmonies ; and there are vital symphonies in
B flat and other low, sad keys which a doctor may know
as little of as a hurdy-gurdy player of the essence of those
divine musical mysteries." One must get a menial gri))
upon the patient, and if the patient is intractable he had
belter have a change of environment.
It will not do in treating the undervitalized neurotic
to scoff at his troubles, or to try and "bulldoze" his
symptoms. He must be persuaded that you understand
his case, appreciate the reality of his suifering, and] made
to feel that you can help and perhaps cure him.
The application of remedies must be made also, so
that some psychical stin)ulus, if possible, shall be min-
gled with their administration. It is not an easy thing
to touch the stops and strings of an enfeebled nervous
system so as finally to evoke harmonies. He who suc-
ceeds is more than a specialist, he is a true physician.
DISTURBANCES OF THE SEXU.A.L ORGANS
IN THEIR RELATION TO AFFECTIONS OF
THE EYE.'
By henry S. OPPENHEIMER, M.D.,
OPHTHALMIC AND ALRAL SURGEON TO THE BELLEVUE HOSPITAL (OUTDOOR DE-
PARTMENT}, ETC., NEW YORK.
It has been said that every specialist exaggerates the
importance of the diseases coming under his own obser-
vation and treatment. Doubtless many reasons could be
advanced why this should be true. To one who had not
thought over the subject of this paper, or had had little
experience with the disturbances of which it treats, it
could well seem rather far-fetched to trace connection
between the sexual and the visual apparatus or their affec-
tions. I hope, however, to convince any skeptic on the
subject that there is more than simple coincidence in the
occunence of such, and I expect to show that almost
every tissue of the eye is at times subject to change pro-
duced by certain conditions of the sexual organs ; from
the superficial and transient coloring of the skin of the
eyelids during the menstrual period of many women, to
disturbances of circulation in the retina and optic nerve
of so serious a nature as to produce complete blindness.
The study of the subject is connected with some difficulty,
and this will explain the limited literature of the subject,
as compared with its importance. Patients' statements
(always to be taken cum grano) are particularly unreli-
able in this class of cases. It is not easy, and far from
pleasant, to ask a girl, or woman, who comes for trouble
of the eyes, about the condition of her sexual organs.
Even with men the seeker after truths of this description
is apt to be treated as inquisitive. The patient cannot
see the use of the inquiry, and is apt to avoid a doctor
who asks such irrelevant questions. In all disorders of
the sexual system women are much oftener sufferers than
men. The functions of menstruation, gestation, and lac-
tation in the normal, healthy woman are of such magni-
tude and importance in her life, as compared with the
sexual functions of the man, that naturally, due to the nor-
mal and abnormal, physiological and pathological changes
in these functions and organs, the female sex furnishes a
much larger number of the cases to be treated of here
than the male. In the statistics prepared by Dr. Ludo-
wigs' there were, out of 5.507 eye jjatients treated at
Dr. Mooren's clinic in Diisseldorf, in 1880, of sponta
neous troubles of the eye coming on after the years of
puberty, 67^^ per cent, women to 32-^- per cent. men.
There were naturally excluded from this calculation all
cases of traumatism, of which men were the most fre-
quent victims, and also all syphilitic affections. This per-
centage, however, is general. In certain affections of
the eye there is a much greater preponderance of women.
Of Basedow's disease there were 2 women to o men ; epi-
scleritis, 9 to 2 ; deep keratitis, 20 to 5 ; punctate kera-
titis and iritis serosa, 7 to o ; myodesopsia, 21 to 8 ;
vitreous ojiacities, 12 to 4 ; hyperajmia of nerve or re-
tina, with hyperajmia of the meninges or irregular menses,
36 to 7 ; amblyopia and metrorrhagia, 5 to o ; asthen-
opia from anieniia, 40 to 5.
By these figures we see women in the proportion of
from two to eight to one man. Eye affections can be pro-
duced either bv reflex, nervous irritation, started in some
^ Read before the ICist River mAh
3 Arch, of Ophlhal, vol. .\i., No. i
, May 9, J883.
July 21, 1883.]
THE MEDICAL RECORD.
63
part of the sexual organism, or by changes in the circula-
tion ; or by both in the same individual. Irritation of cer-
tain kinds in one part of the nervous system can produce
reiie.x disturbances of various kinds in the most distant
part of the organism. Given an irritation of an afferent
nerve, no one can te)l where the reflex symptoms shall
show themselves. A man steps onto a rusty nail, which
produces the slightest punctured wound of the foot. In
consequence of this injury he shall have tonic contrac-
tions of his risorius, niasseter, and tenii)oral muscles, and
clonic spasms of difi'erent muscles of the trunk and limbs,
joined to such exquisite hyperesthesia of nerves of or-
dinary and special sensibility that a draught or a noise
shall bring on a convulsion. This picture is familiar
enough to us under the name of tetanus, and prepares us
a little more for this statement: From irritation of the
genital apparatus you can have spasm of the orbicularis
muscle (blepharospasm), spasm or paresis of almost any
muscle of the eye proper, affections of the conjunctiva,
of the cornea, of the sclera, of the iris (mydriasis), of the
ciliary nuiscle, of the choroid and vitreous, of the retina,
of the optic nerve, and of the brain. Of this last, how-
ever, I mean to speak only incidentally, as it may be
necessary to illustrate my subject. Of changes in the
circulation I will speak later.
Spasm of the orbicularis muscle (blepharospasm) has
been attributed of late, by most authors, to reflex origin.
As early as 1810 Fautrel (Sedillot's_/(;7^r;/a/ Gen. de Med.)
notices spasm of the lids so often accompanying chorea.
He claims that all his choraic patients were onanists.
Wendt (in his book on " Kinderkrankheiten," 1835)
holds the same opinion. Michael i^Graefe-Saemisch,
vol. iv.), speaking of the etiology of these clonic spasms,
says: "Increased predisposition is created by excesses
in venere et Baccho, strong excitement." Ziemssen'
thinks the statements of these patients too unreliable to
found a positive opinion as to the cause of chorea thereon.
Hermann Cohen (Archives of Ophtha!., vol. xi.. No. 4)
says : " I find so frequently the note in my journal, ' Con-
fesses excessive onanism,' in cases of chronic blepharo-
spasm (9-12 per 1,000 in 30,000 patients) that I cannot
deny the probability of the connection between the spasms
and onanism." There are cases on record in which the
spasm occurred only when the patient attempted to
speak and was spoken to.
Diseases of the conjunctiva, usually of a most stubborn
kind, are not uncommon from these causes. Fbrster
{Graefe-Saemisch, vol. vii.) mentions having seen a num-
ber of such in confessed onanists, from twelve to twenty
j-ears of age. They were mainly catarrhal and tracho-
matous inflammations with persistent hyperajmia. In
this connection he calls attention to the intractable cases
of pharyngeal catarrh, so often met in patients with sper-
niatorrhcea.
H. Cohen (loc. cit.) gives six such cases, one of which
had been treated for five years by himself and others with
applications of copper sulphate and other astringents. Two
of these patients were commercial travellers, who noticed
in the morning, after having committed sexual excesses,
great redness of the margin of the lids and of the conjunc-
tiva. I have myself seen two similar cases in young men
about town. I thought, however, that in their cases the
loss of sleep and consumption of champagne was suffi-
cient to explain the conjunctivitis.
Inflammations of the cornea are very much influenced
by changes in the sexual organs. Parenchymatous kera-
titis shows itself more frequently at puberty than at any
other period of life. Mooren •' relates the case of a
woman, twenty-eight years of age, who had never men-
struated. She had a parenchymatous keratitis since she
was fifteen years of age, much aggravated every four
weeks. By strong emmenagogues an insignificant men-
struation was induced a few times in succession, and
" she was freed of her pain and photophobia as if by
' Handbuch, vol. xii., 2.
* Arch, of Ophthal., vol. xi., No. 3.
magic.
I can recall the case of a French-Canadian
girl, twenty years of age, under my care at the New York
Eye Infirmary during my resident surgeonship there, who
had a keratitis and still showed extensive |50sterior syne-
chia (I believe she was in Dr. Derby's division). She
had violent exacerbations of her trouble at each period.
I had overlooked the cause at the first exacerbation, but
had my attention called to it by the nurse, who saw me
puzzling over it. I may say that I observed this connec-
tion closely afterward, and in order to economize time and
avoid tiring you with details 1 can give it as my experience
that there is hardly any disease of the eye, or a wound
after any operation in menstruating women which I have
not seen influenced, more or less, during the monthly flow ;
orrather just before the beginning of the flow. I have seen
wounds take on such alarming inflammatory action during
this period that I am very careful now to ascertain the
time when this is expected before operating. I would
not operate for cataract at such a time as to have
the catamenia appear during the healing process ; unless
there were some special reason for urgency.
Mooren ' tells the case of a woman, forty-five years of
age, who had a retroflexion with a tumor of the cervix
uteri. When she began being treated for this her right
eye became affected with an episcleritis. Every touch of
the cervix and every insertion of a pessary aggravated
the episcleritis. This was cured and remained so for
a year. Then fresh uterine trouble brought on an
episcleritis in the left eye, which grew worse on each
local application to the uterus. I have observed a
vigorous German woman, of about the same age,
who had a mimic spasm of the right side of her face
for years. This was complicated at times by trifacial
neuralgia and a sclero-keratitis of the same side. This
woman volunteered to me the statement that she had
noticed severe exacerbations of the pain and eye trouble
during her periods. (I presented her at that time to the
Ophthalmological Society.) When I lost sight of her
her spasms and eye trouble had been relieved very
much, but not completely, by antirheumatic remedies
and massage.
The iris is never, so far as I know, inflamed by reflex
irritation. In septic or puerperal metastatic attacks, how-
ever, it is usually implicated in the purulent inflamma-
tion ; which has, as a rule, its beginning in the ureal
tract and extends connnonly to every tissue of the eyeball
and even to the cellular tissue of the orbit. There are
cases, however, of such irritation in which the muscular
structure of the iris is affected, either by paresis or spasm.
I refer to the cases on record of mydriasis (dilatation of
the pupil) which is due either to irritation of the sympa-
thetic nerve, or to paresis of the twig supplying the iris
from the oculomotorius. These cases may be uni- or bi-
lateral. Parametritis, of which I shall speak later if the
time permit, endometritis, retroflexion, and hyperesthe-
sia with scanty menstruation are among the causes given.
While interne in Charity Hospital I treated a young
woman for granular vaginitis. The pupil of her left eye
dilated at times without evident cause. She had no
trace of brain trouble, goitre, or aneurism, for which I
examined her carefully.
Her vision was not affected at the time. I examined
the eye by the ophthalmoscope ; but I do not think that
my experience with the instrument was sufficient then
to make my opinion reliable. I thought the fundus was
normal. The connection between the vaginitis and the
mydriasis did not occur to me at that time. Mooren "
saw one case of myosis (contraction of the pu])il) in a
woman, sixty-eight'years of age, whose uterus had been
prolapsed for vears, without paralysis of the legs or
bladder. She had also a slight atroj^hy of the optic nerve.
The ciliary muscle may be partially or completely par-
alyzed by irritation of the genital organs. Miss N ,'
twenty-four years of age, practised onanism since she was
2 Loc. cIt.
3 From Mooren, loc. cit
64
THE MEDICAL RECORD.
[July 21, T883.
fifteen years of age. Her power of accommodation has
decreased from year to year. Her labia minora were
unusually large, her clitoris was prominent and so excit-
able that amputation was advised.
A South American woman who had masturbated since
her early youth had complete loss of accommodation.
In both of these cases the genitals were so excitable as
to give rise to great dyspnoea at times. A single woman,
thirty years of age, had the same symptoms produced by
intense irritation of the mucous membrane of the vulva
from acne pustules and the constant scratching provoked
by them. Pregnancy and lactation are held by several
authors to be the cause of accommodative asthenopia.
Hutchison ("Oph. Hosp. Rep.," vol. vii.) thinks it not in-
frequent.
T/ie 7'iirt'ous humor is usually affected in connection
with diseases of the choroid or retina, so I shall speak of
it only in connection with these tissues.
Hyperesthesia of the retina has been observed \ery
often in cases of parametritis. In the three cases just
mentioned with deficient accommodative power this
hyperesthesia was very marked. The South American
woman could hardly bear the lustre of the eyes of other
persons. A fourth, a French woman, could hardly enter
an illuminated room. After the cauterization of one of
these sensitive, papillary swellings she had at the mouth
of her urethra, and the use of bromide for some time, her
eye troubles disappeared. In another wojuan a rupture
of the perineum and descent of the uterus seems to have
been the cause of hypera^sthesia and spasm of acconuno-
dation. She had four children, and the birth of each
seems to have aggravated the condition of the perineum
and eyes. A girl, twenty-one years of age, with infantile
uterus was a victim of this same trouble. Mooren says '
it is most often met with in congenital stenosis of the
orifice of the uterus and can be caused by inflammation
producing alteration in the shape or dimensions in any
part of the genital tract.
From retinal hyperesthesia we come naturally to
photopsia, which may be, at times, only an increase of
the same irritation. H. Cohen ' records seven cases,
four men and three girls, addicted to onanism. \\\
were between the ages of fifteen and thirty-one. Each
one of these gave a history of subjective perce[nions
of light, such as the sensation of dazzling by some bright
moving figure, as a window, for instance, or bright rings,
or dots, or stars, or snowtlakes. In all these cases the
eyes were in other respects normal, all having V=i, or
over. In all but two both eyes were affected, and the
dazzling vanished when the eyes were closed. Most of
them complained of neurasthenia, insonniia, and pollu-
tions.
Strictly speaking this need not necessarily be a retinal
trouble. An irritation of any part of the fibres of the
optic nerve will produce these subjective symptoms.
This point of irritation may be anywhere from their periph-
eral expansion in the retina, along the optic tracts, the
ganglia, the cortex of the occi|)ital lobe, the cerebellum,
or the olivary body in the medulla, to all of which points
fibres have been traced by recent investigators. Tliere-
fore, unless other symptoms (herdsymptomc) will indicate
it, it is always im|)ossible to say exactly where the point
of irritation exists. 1 will not mention here retinitis as
due to pregnancy, because usually albunnnuria exists in
these cases. We are certain, however, that (iregnancy
predisposes to both these troubles and I have no doubt
every one present has seen them.
Two very interesting cases of retinal detachment
(Mooren) will end my remarks on retinal troubles. In the
first, a few years after marriage the introduction of a
speculum, for the removal of some prominent Nabothian
follicles, produced violent pain in the back and legs and
obscuration of sight. Later, injections of warm salt-
water produced inability to move the legs, ice-cold ex-
* Loc. cit.
' Loc cit.
tremities from the hip down, objectively as well as sub-
jectively, while the upper part of the body was very hot.
She was often absolutely blind for a few minutes at. a
time. A large detachment of the retina was observed,
and seemed to be the result. The patient had, however,
before this time sclerochoroiditis posterior in one eye and
exudation in the other choroid. The second patient,
unmarried, had always had scanty and painful menstrua-
tion. General health good. In her right eye she had
an anesthetic retina with reduced vision and field, and
a rosy injection around the papilla. The left eye showed
atrophy of the optic nerve and partial detachment of the
retina.
In the choroid we have a condition of chronic inflam-
mation, which seems to be caused by uterine disorders.
This has been denied. I have now under observation a
dispensary patient with this choroidal picture, who has a
chronic metritis. I can find no other apparent cause for
her choroiditis. A second patient, a lady at the climac-
teric, who IS myopic \, has aggravated choroiditis and vit-
reous opacities since her molimina began to be irregular.
Now as regards the optic nerve, we have on record
all grades of changes which seem to be produced,
either by reflex irritation, or vascular changes in the
uterus or ovaries. These can show themselves func-
tionally in all degrees, from the slight narrowing of the
field, or the least reduction of vision or color sense by
weak illuminations, to the fulminating attacks of blind-
ness by the sudden cessation of the menses, or a phle-
bitis of the central retinal vein.
Samelsohn [Berl. Klin. Wochenschrift, 1875) tells of
a woman, twenty-one years of age, whose standing in
the water with bare feet caused a sudden menostasis.
She complained of an unpleasant pressure behind the
eyes the same evening. Within the month she was com-
pletely blind. Samelsohn thinks it was a transudation
into the orbit compressing the optic nerve. The oph-
thalmoscope showed engorged veins. The woman's
sight returned in a week. Congestion of the optic nerve
in cases of chronic uterine trouble has been observed
very often. These may terminate in recovery, or atrophy
of the nerve.
Since Rokitansky has made his contribution to the
study of chronic congestion, it is easy to understand
how a chronic hyperemia can cause an atrophy. He
describes a condition which he insists is the result of
hyperemia and not of inflannnation. It is a deposit of
new, gelatinous, connective tissue ; which in time be-
comes fibrillated, then contracts, and becomes cicatricial,
destroying the nerve-tissue in the course of this con-
traction. This process he has observed in the brain
and in the spinal, olfactory, and optic nerves. If, as we
have seen, the physiological flux can produce such
changes in a woman's eye, it must follow that any of the
chronic engorgements of the pelvic tissues and sinuses is
certainly capable of producing a chronic congestion of
the optic nerve. Displacement and flexions of the
uterus, chronic engorgement of this organ, and the exten-
sive venous network filling the pelvis, from inflamma-
tions or what not, can thus become causes of eye-
troubles. Let us look for a moment at the venous
connection between the parts. We have the spinal
veins, carrying four longitudinal columns of blood the
whole length of the spinal canal, from the foramen
magnum to the coccyx. These veins ramify and com-
numicate in all directions. They have no -oalves. They
connect with the uterine and iiampiniforni plexuses and
the ovarian veins through the lumbar and sacral veins.
K\. its upper end this column of blood is joined to the
vertebral and inferior cerebellar veins, and the occipital
and petrosal sinuses.
Thus we see that the cerebral, the spinal, and the pel-
vic venous system of a woman is practically continuous.
Hence, we have the almost universal backaches and
headaches in woman, with the most trifling menstrual
disorders, and, in fact, in those whose catamenia are nor-
July 21, 1883.]
THE MEDICAL RECORD.
65
mal, as far as we can tell. We know thai both the origin
and the course of the optic-nerve is in great part super-
ficial, and therefore easily accessible to disturbances
from irregular circulation in the meninges. Many facts
of the clinical jiicture have been given, although neces-
sarily short and imperfectly.
Lastly, I desire to call your attention for a moment
to the fact that Graves' disease (exophthalmic goitre)
has been considered by some authorities as having its
origin through reflex action in disturbances of the sexual
system.
We know that women are much more subject to the
disorder than men : Emmert counts one man in ten,
Von Graefe makes it one in seven, Mooren one in thir-
teen, Geigel one in seven, Von Dusch about one in five
(11 in 57.5).'
The only writer who has these proportions reversed,
so far as I have looked, is Chvostek, an Austrian army
surgeon. He naturally saw more men than women. If
I make a grand average of all these it gives us about one
man to eight women. Laycock calls attention to the
fact that old women (after the menojaause) never have
Basedow's disease. Other arguments are that frequently
the thyroid gland enlarges in girls at the time of puberty.
H. Cohen (loc. cit.) has recorded one such case in which
a regularly recurring exophthalmos during the menstrual
period was verified by measurements.
r'- These facts warrant us in concluding that Basedow's
disease is influenced by sex and some changes and dis-
turbances of the sexual organs. Freund, who has made
an exhaustive study of some of these diseases states that
in the last ten or twelve years he has not examined a
single case of morbus Basedowi in women without find-
ing a parametritis in the contracting stage. Fiirster (loc.
cit.) gives an account of one case which seems to show
that the female sex does not exclusively show this disease
in consequence of sexual excitement. The case is so ex-
traordinary a one that I thought it would be interesting to
give it here translated in full. "In July, 1866, I saw a
clerk, twenty-four years of age, with exquisite morbus
Basedowi. Pulse 120, strong cardiac impulse, moderate
swelling of the thyroid gland, with pulsation in it, and
considerable protrusion of both eyeballs. The last
symptoms brought him to me. The symptoms dated
back three weeks, and appeared suddenly. He gave
the following history : ' About the middle of June he
struggled for about half an hour with a girl in the eflbrt
to have connection ; but her energetic resistance pre-
vented the consummation. He so overexerted himself
with this eflfort that he finally felt very faint and had to
take several glasses of Madeira to restore him partially.
The violent heart action which began during the struggle
has continued since. Two days later he first noticed the
prominence of his eyes, which has steadily increased
since then.' Both epididymes were painful and swollen.
Professor Freund, who also examined the patient, corrob-
orates this. Quinine, in large doses, was ordered and
moderation in the exercise of the sexual function ad-
vised. The patient departed and presented himself
again nine months later. He stated that the exoph-
thalmos and violent heart action had gradually subsided
after taking about 9.00 of quinine. However, in Octo-
ber (four months after the first appearance), the former,
and in December (six months), the latter symptom had
begun to show itself again. I found in April, 1867, es-
sentially the same condition as in July, the exophthalmos
even increased. The patient looked well, felt strong, and
had retained a good appetite. No sign of an.-emia had
developed. The inquiry into his sexual behavior was
evidently disagreeable to him. He went off and I have
not seen him again."
Finally, gentlemen, I should have liked to say some-
thing about a most troublesome class of cases, which are
the terror of ophthalmologists. If I were to undertake
* Satller in Graefe-Saemsch.vol. vi-^
to tell you a tenth of all the symptoms of which they
complain, I should have to detain you too long. The
most careful examination rarely shows objective basis
for the violence of the symptoms complained of. Pho-
tophobia, pain on using the eyes, pains in various
parts of the eyes and orbit, changing in character, but
always of the most hyperbolical severity, inability to
wear their glasses, etc., are at the bottom of the
long tale of woe. These pains are never so severe as
to prevent attendance at the theatre or ball and rarely
intrude themselves when there is pleasant company in
the house. The name of the disorder is kopiopia hys-
terica. For fear it should prejudice you against the fe-
male sex I will read you a case from Forster (loc. cit.) in
your own sex. " A married man, thirty-seven years of age,
with a long list of the most pronounced symptoms and no
lesion to explain them, admitted that his sexual capacity
had very much decreased. Coitus barely once a month,
never a firm erection, inimissio penis always problemati-
cal, ejaculation usually took place without it. The man
had strikingly small testes and a thin, milky discharge
from the urethra." Forster says that this case is not sin-
gle, only that the patients' statements are usually unre-
liable on the subject. He suggests that one obtains
more reliable data from their wives, who seem more
carefully to note the difference between the past and the
present. Kopiopia hysterica in women is almost always
connected with a lesion in the pelvis ; which Prof. Freund,
who first noticed it, and who gives a most interesting
clinical and pathological picture of it in his publications,
calls " parametritis chronica atrophicans." I can do no
better than to close with a cpiotation from Mooren :
"According to my own experience," says he, "I would
say that of all the eye aflPections of choroid, retina, optic
nerve, etc., there are none which are not influenced
either by the normal or pathological workings of the
uterus."
189 Second Avenuk, New York.
AN ERYTHEMATOUS ERUPTION FROM CHLO-
RATE OF POTASSIUM.
By henry W. STELWAGON, M.D.,
PHYSICIAN TO THE I'HILADELPHIA DISPENSARY FOR SKl.N DISEASES, ETC., PHILA-
DELPHIA, PA.
The subject of " medicinal eruptions " has received con-
siderable attention during the past few years, and at the
hands of several writers has been exhaustively pre-
sented.' The excuse, therefore, of reporting fresh exam-
ples must lie either in the fact that the observation is
one respecting a drug heretofore unsuspected, or that
the eruption is characterized by unusual features. So far
as I can ascertain, the chlorate of potassium has not
been recorded as capable of causing cutaneous disturb-
ance, and the former reason, therefore, is answerable for
this communication. The patient— a male— in whom
the eruption was observed was suftering from secondary
syphilis, and had been under treatment for several
months. The symptoms of the disease were of a mild
type, and treatment had consisted in the administration
of small doses of the corrosive chloride of mercury.
About this time a few mucous patches showed them-
selves in the mouth. The stick of nitrate of silver was
used, and tablets of potassium chlorate ordered, several
daily ; these were to be allowed to dissolve in the mouth
slowly. Four days later the gentleman returned, much
annoyed and worried concerning a fiery erythematous
and papular eruption, which had made its appearance
over the trunk and neck, especially well marked on the
upper part of the back. There were no subjective symp-
toms. The eruption was similar in character to that of
erythema multiforme, and of this nature I was inclined to
'BehrCTd; Zur .■UIg. niai;nost!k der Arzi.ei Ausschlage : Berlin. Win. Wochs.,
p. 714, vol xvi , 1870. Morrow ; On Drug Exanthemata : X. Y. Med. Jour., p.
224, vol. xxxi., 1880. Van Harlingen : Medicinal Eruptions; Arch.. Derm., p.
337, October, 1880.
66
THE MEDICAL RECORD.
[July 21, 1883.
consider it. The possibility of its being due to the mer-
cur)' was entertained, but as this had been taken oft' and
on for several months without any such result before,
and as, moreover, the dose had been very small, the idea
was dismissed. At this time, the potassium chlorate, as
a cause, was not even considered. Treatment with the
mercury was continued. The tablets had all been used,
and as the mucous patches had disappeared they were
not renewed. In two days the eruption was gone. Si.x
weeks later several mucous patches were again seen.
These were cauterized and attention called to renewing
the tablets. Three days afterward the patient returned
with an eruption the same in character as before ; the
trunk and neck were involved, and several slightly raised
erythematous spots were seen on the legs. The chlorate
was immediately suspected, and its discontinuance or-
dered. In less than forty-eight hours the eruption had
subsided. Since this outbreak the patient has, at my so-
licitation, twice used the tablets for a few days, and at
both times its action on the skin followed. The tablets
consisted of five grains each, and it required but fifteen
to twenty to call forth the eruption. A similar rash has
been recorded as occasionally following the use of mer-
cury. The case here mentioned has suggested the
idea that, in some of these instances, the eruption may
have been due to the chlorate of potassium ; as is well
known, this is frequently employed to modify or les-
sen the action of the mercury on the mouth, and also
for the purpose of influencing mucous patches. At all
events, this possible action of the chlorate, as related in
the above case, is well worth bearing in mind.
■ , SURGICAL FRACTL'RE OF THE FEMUR.
By G. p. HACHENBERG, M.D.,
AUSTIN, TKX.
A SHORT time after the close of the late civil war the
Surgeon-General of the United States army directed to
be made to him army surgical reports of cases that might
be of sufficient importance to incorporate into the " Med-
ical and Surgical History of the War of the Rebellion."
Of the number of cases I reported, whether from some
oversight or of a disapproval of the surgical treatment
of the case, my report of a surgical fracture of the
femur did not make its appearance in the work among
the operations of the lower extremities.
As the case was one of a formidable nature, and at-
tracted at the time the attention of surgeons of both
armies, I deem it of sufficient interest to place it on
record, even at this late day.
In 1862-3, when in winter quarters at Buckhannon,
W. Va., some of the surgeons of the brigade directed
my attention to a Sergeant P , of the Fust Virginia
Infantry, who was shot with a musket-ball, through both
thighs, fracturing the right femur, a little below the
lesser trochanter, the ball being lost in the same limb.
The case was generally considered as a suitable one for
amputation at the hip-joint. As I had iierformed that
operation a few years previously in civil practice, the
patient was advised to place himself under my care.
l''ollowing this advice he sent for me, recjuesting my ser-
vices. ."Mthough he was confined at his home, about
fifteen miles outside of our lines, from the general in-
terest that was felt in the case 1 concluded to run the
risk to reach him and perform the operation. It was
strictly a volunteer duty, as the patient was never
officially assigned to me.
By the aid of a guide 1 reached my patient in safety.
I was there met by a neighborhood physician. I found
the patient in bed, much emaciated, with the right tiiigh
enormously distended and here and there perforated
with fistulous openings. The ball passed through the
left upper thigh (inflicting a wound that had healed up
when I saw him) and penetrated the rigln tliigh at
Scarpa's triangle and fractured the femur.
He was wounded in a skirmish with the enemy, nine
months before the time I saw him. He fell into their
hands and was e.xamined by quite a number of their
surgeons, but from the unfavorable prognosis of the case,
no operation was attempted. His friends finally got
permission to take him home, and to do so he was car-
ried one hundred miles on stretchers. Not long after-
ward he was taken to a United States hospital at Wheel-
ing, Va. Here, according to the patient's statement, he
was e.xamined by more than fifty visiting surgeons, and
they, like their Confederate confreres, deemed it best not
to operate on him, and under unfavorable prognosis he
was held under a strictly surgical conservation. He
gradually got weaker, as the suppuration and inflamma-
tion extended itself in the leg, and was finally, permitted
to return to his home.
Taking into consideration the condition of the patient
I concluded not to amputate, but to enter into a dis-
section in search of the ball. By a careful palpation, I
detected an ill-defined fluctuation, anterior to the upper
third of the thigh. It took in a space nearly the size of
my hand. The patient was placed under the influence
of chloroform. I made here an incision in line with the
femur into the deep fascis, and entered a large abscess.
I carefully removed its contents, which was about a pint
of sanious pus and a few spicula; of bones that had
exfoliated from the mam bone. With my fingers I care-
fully explored the parts in search of the ball, and finally
passed my finger into a sinus that terminated on the out-
side of the femur, where I detected by the touch a sharp
projection of the ball. From the lower end of the longi-
tudinal incision I made a transverse incision to the right,
about six inches long. This gave me ample room to
reach the ball and the necrosed bones. These incisions
had necessarily to be extensive to correspond with the
morbid enlargement of the limb. I applied bullet-for-
ceps to the ball and made firm traction for) its extir-
pation. But it was so firmly imbedded in ossification that
I could not move it in the least. Persisting in my
efforts to get it out, I broke and bent two bullet-forceps
in the attempt, which were all the instruments of the
kind I had with me. Here a painful crisis presented
itself. There was but one question at issue, and that
was that the ball and all foreign material in the limb had
to come out and, owing to the condition of the patient,
very quickly too.
To meet this terrible emergency I placed my left knee
as a fulcrum under the hip-joint, or rather somewhat a
little in advance of it, and struck the knee of the affected
limb a sharp, firm blow, causing a fracture of the bone
at the place where the ball was imbedded. This surgical
fracture was easily effected at the proper place, owing to
the presence of the ball and necrosed bones. I was
now able to pick out with my fingers the ball, which was
in two pieces, very much flattened out, and with the
same facility removed all necrosed bones. I cleansed
with care the entire wound with tepid water, and closed
it up as the patient emerged from the influence of the
chloroform, thus giving him more or less pain to favor
reaction. Drainage from the cavity of the abscess was
established, and to the outside of the wound I applied
light compresses saturated with a weak solution of Labar-
ratjue's disinfecting liquid. The shock that followed
the operation gave us much anxiety. For many weeks
he was in a most critical condition, but being kept under
a stimulating and sustaining treatment, finally conva-
lescence was established, though long and tedious.
The cure terminated with considerable shortening of
the limb, as might be expected, both from the original
gun-shot fracture and the subsequent surgical fracture
that was treated by position and not by splints. As I
left the patient in an extremely e.xhaus^ed condition,
barely alive, so to speak, I advised the attending physi-
cian not to resort to splints, but to maintain the limb in
the best and easiest position he could with the least ta.\
to the patient. It was the life of the patient we strug-
gled to save, and not the limb at the risk of life.
July 21, 1883.]
THE MEDICAL RECORD.
67
progress of ^MicaX Jicicnc^.
The Influence of the Electric Light on the
Human Eye. — In discussing the value of any particular
source of artificial light, says Professor Mauthner ( IVii-zi.
Alli^em. Med. Zeit., No. 10, 1883), three qualities should
be especially regarded : i, the steadiness of the light ;
2, the strength of the light ; 3, its composition. From
its complete failure in point of steadiness, the arc-light
must be at once rejected from the category of lights suit-,
able for the human eye. The incandescent lamp, on the
other hand, deserves a prominent position. As regards
its strength or intensity, it also fulfils all requirements,
since it can be modified or intensified at will. The
comiiosition of the lights habitually used hitherto has
shown a preponderance of yellow rays. In the electric
light, however, the short-wave rays predominate — i.e., the
violet rays. To the human retina, blue or violet tints
are more agreeable than yellow, and hence from its
composition, as well as from its steadiness and adapta-
bility, the light of the incandescent lamp is especially
adapted for the use of the human eye. Distinctness of
vision and the perception of color are both increased
under the electric light — facts which might be theoreti
cally held to involve an overstrained retina. Such a
theory is not, however, borne out by practical e.xperi-
ence ; it is only where the light employed is unsteady
that any ill effects have been observed. It may be con-
sidered as an established axiom, that the brilliancy and
composition of any light are as nothing, in respect of its
value as an illuminating medium for ordinary uses, com-
pared with its constancy and steadiness. In the incan-
descent lamp no combustion takes place, and hence no
consum|>tion or vitiation of atmospheric air is induced.
From a theoretic point of view, therefore, no objection
can be raised against the use of the incandescent electric
lamp. Its full value as an illuminator is, however, not
yet ascertained.
Abdominal Inunction during Pregnancy. — Dr.
Burke, in the New England Med. Monthly, says: "In
the last three or four months of pregnancy all women
suffer discomfort from the distention of the abdominal
walls, which I have found greatly relieved by the free use,
at least once a day, of some unctuous material, as vase-
line or sweet lard, and in many cases the formation of
the lineae albicantes is prevented."
The Secretions in Morphia Poisoning. — Dr.
Marme, of Gottingen, communicates {^Deutsche Alcd.
Wochensch., April 4th) a paper on his investigations of
the urine and other excretions in morphia poisoning,
undertaken partly on patients, partly on animals. He
finds that morphia can be recovered unaltered from the
urine when the amount taken is not less than one-seventh
grain daily. When larger doses are taken, it is found
also in the fasces. Instead of morphia. Dr. Marine some-
times found " oxydimorphin " in the excretions and in
the tissues, and he found by experiment that this sub-
stance was present when a poisonous dose had been ad-
ministered in very small quantities at a time, and the
symptoms resembled those of the abstinence stage of
morphia intoxication. From his experiments Dr. Marme
has formed the opinion that morphia may be left otT sud-
denly in very strong well-nourished individuals, but that
in weakly persons it is necessary to diminish the dose
gradually.
Extirpation of the Larynx. — Dr. Miilier reports
upon this subject in the Gaz. Med. de Stradwurg. In
April, 1881, extirpation of the larynx was performed by
Professor von \Viniwart;;r for an adeno-carcinoma of the
larynx, with diffused epithelial infiltration. There was
no return eleven months after the operation. The patient
did not use her artificial larynx, finding that deglutition
was impeded thereby. She wore a fenestrated tracheal
canula, communicating by the opening with the pharynx
and provided with a mouth at its external orifice. She
breathed quite freely and could swallow both liquids and
solids with ease. Articulation was almost without sound,
but was sufficiently distinct for her to be heard and un-
derstood. Of the forty-three cases of extirpation of the
larynx hitherto published, thirty-two have been under-
taken for carcinomatous, six for sarcomatous growths,
and two for tertiary syphilis. Of the six performed for
the removal of sarcomata in only one has the growth re-
turned, the other patients up to this time havingremained
free six years, two years, seventeen, fifteen, six, and four
months respectively. In the removal of carcinomata the
prognosis is less favorable ; of the thirty-two cases pub-
lished, there are only two in which the patient has re-
mained free eleven months, the frequency and rapidity of
tlie return being almost always due to the great extent of
the lesion and invasion of the neighboring parts. The
mortality, moreover, is much influenced by septic pneu-
monia, this having been the cause of death of nearly all
the patients who have succumbed in the course of the
first few days after the operation. To avoid the entrance
of foreign bodies into the air-passages. Dr. von Winiwarter
brings the anterior wall of the oesophagus over and in
front of the trachea, and fixes it with sutures to the cuta-
neous wound. To avoid septic pneumonia, the parts are
dressed with iodoform and covered with iodoform gau/e.
Practised early, in the absence of glandular infiltration,
and with the employment of iodoform to remove the
danger of septic pneumonia, extirpation of the larynx
would appear to be a more hopeful procedure than is
generally supposed.
Nitrous Oxide as an An.esthetic in Labor. — Dr.
Tittel gives a report {^Wiener Med. Blatter, March 15th)
of over fifty trials which he has made of the inhalation of
nitrous oxide gas in parturition. He employed it chiefly
in primiparag with very severe pains, and found a diminu-
tion of the suffering in every case. He found it acted
better when given in the first stage, as its effects lasted
into the second, and quiet inhalation was more difficult
when it was attempted to be given in the second stage.
The pulse was generally retarded, and the foetal pulsa-
tions, on the contrary, generally accelerated. The pains
were in many cases increased in strength and frequency,
and Dr. Tittel found this action of the gas very service-
able in multipara with few and weak pains. Vomiting
was arrested in four cases by the inhalation of the gas,
and the only evil results which were observed were two
cases of convulsions, one hysterical and the other true
epileptic.
Mel.«na Neonatorum. — Dr. Epstein, of Prague, dis-
cusses this subject in the Allgem. Wiener Med. Zcit., and
points out that the occurrence of hemorrhage from the
stomach and intestines of new-born children is by no
means uncommon. He considers that a distinct disposi-
tion to hemorrhage from various organs must be recog-
nized as belonging to the first few days of life. This
disposition is made manifest or increased, when either
disturbance of circulation, or disease of vessels, or of the
blood itself, is present. The notable alteration in the
circulation which takes place at birth must therefore be
regarded as a principal cause of the hemorrhage, and es-
pecially in cases of |)rotracted labor, or of children born
in a state of partial asphyxia, or of weakly children with
atelectasis of the lungs. Various conditions have been
found in the gastro-intestinal mucous membrane : hyper-
ajmia, hemorrhagic erosions, ulcerations, and actual
hemorrhage. In many cases, where the mucous mem-
brane of the stomach has been found sprinkled with
small ecchymoses, small rounded ulcers have been dis-
covered ; and these have by some authors been regarded
as the real cause of metena neonatorum, the ulcers them-
selves being brought about by thrombosis or embolism
of the gastro-duodenal vessels, secondary to thrombosis
in the umbilical vein. This is probably, however, the
68
THE MEDICAL RECORD.
[July 21, 1883.
rarest cause for the hemorrhage ; the most common
cause being the hyperremia and temporary congestion of
the finer capillary vessels. Although ulceration may
take place with extreme rapidity after birth, it would ap-
pear that it is usually of intra-uterine origin ; and several
cases are recorded where such ulceration has led to
actual perforation of the intestine or stomach. Another
group of cases is formed by those of children infected
with septic diseases or the subjects of hereditary sjphilis.
In the latter cases the hemorrhage may be the only evi-
dence of the disease, the liver being found free from any
syphilitic mischief In the cases in this group, the jKOg-
nosis has been clearly shown to be unfavorable. About
half of the cases end fatally, and the immediate cause of
death is usually the hemorrhage itself A few cases,
however, recover with marked rapidity.
Cervical Pachymeningitis. — Charcot {Le Progris
Med. No. 19, 18S3) describes a case of paralysis due to
cervical pachymeningitis. He points out that such cases
pass through three stages: i, the neuralgic period, char-
acterized by severe pains and sense of constriction in tiie
chest, a stage which lasts four, five, or six months ; 2, the
paralytic period in which paralysis occurs, accompanied
by muscular'atrophy ; and 3, the spasmodic period, in
which the lower limbs are affected by a spasmodic para-
])legia, the result of a transverse myelitis with descending
degeneration of the lateral columns. The pathology of this
aftection is an inflammatory thickening of the dura mater,
which may involve to some extent the nerves passing
through it and the adjacent end, but in the main the symp-
toms are due to the compression of the inflamed mem-
brane. Such cases occur independently of any diathesis or
specific cause, often as the result of living in a damp
place. Ultimately recovery may take place. In the case
quoted this occurred partly spontaneously, j^artly as the
result of treatment which chiefly consisted of the actual
cautery over the seat of the disease. Afterward there
remained great contraction of the hamstring muscles,
but these were divided subcutaneously, and by electricity
and friction the patient recovered so far that he could
walk about the hospital and go the distance of a mile with-
out nuich fatigue.
Laparotomy in the New-Born. — At a recent meet-
ing of a medical society in Vienna ( W'iener Med. Blatter,
Dr. Felsenreich showed a child, two weeks old, on
whom he had performed a radical operation for the cure
of umbilical hernia. The birth had been easy and natu-
ral, and the child itself was strong and healthy, with no
other malformation. A tumor of the size of a lemon was
situated in the abdominal wall, the umbilical cord being
attached to its summit. The separation between the
recti muscles was eight centimetres long and four centi-
metres broad, and contained intestines and the margin of
the liver. Twelve hours after birth the operation was
made in the usual way, tiie hernial sac being attached to
the edge of the skin-wound, which was closed by twelve
silk sutures, and dressed with iodoform. The operation
was completed in twenty minutes, without much sign of
pain on the part of the child, which took the breast im-
mediately afterward, and had a normal stool on tlie second
day. The progress of the case was very satisfactory
throughout, although the healing of the skin was some-
what slow.
Invisible Cutaneou.s Per.spiration in Healthy and
Febrile Children. — Dr. Eckert, in the Vralc/i, pub-
lishes the results of her observations on thirty healthy
children from two to fourteen years of age, and on twent)-
seven suffering from various febrile diseases. Tiie age
of the febrile children varied from eighteen months to
tliirteen years. The conclusions at which the author lias
arrived are summed up thus: a. Fot healthy children. — i,
invisible loss of water by the skin in children proceeds
with greater energy than in adults ; 2, tiie loss is greatest
in children of younger age (under five years), and gradu-
ally becomes less as age, height, and weight advance ;
3, all conditions being equal, any rise of barometric press-
ure increases loss of water by the cutaneous surface,
while any increase of the humidity of the surrounding air
inhibits invisible perspiration, b. For febrile children. —
1, in the febrile state invisible perspiration is augmented ;
2, in enteric fever, the greatest loss of water by the skin
coincides with the period of maximal _ mean daily tem-
perature, afterward invisible perspiration decreases with
the fall of febrile temperature, and in the period of con-
valescence it descends considerably below the normal
level ; 3, similarly, in the course of relapsing fever, there
is observed more or less considerable increase in invisi-
ble perspiration during the attacks ; having reached its
maximum at the time of crisis the amount of evaporation
rapidly falls, though during the first twenty-four or thirty-
six hours after the crisis it remains still rather increased
above the standard. During the apyretic intervals and
after the termination of the disease cutaneous loss of
water falls below the usual level ; 4, in scarlatina invisible
perspiration is considerably increased.
Trophic Disturbances of the Skin in Ataxia. —
Drs. Ballet and Dutil report {Le Progres Medical, No.
20, 1883) three cases of a sort of ichthyosis of the skin
of the anajsthetic or hyper^sthetic regions in tabes.
The skin was usually reddened, lax, thrown into folds,
and the epidermis was increased in amount and some-
times desquamating. They summarize these results in
the following propositions : i. In tabes we may observe
permanent trophic disturbances of the cutaneous system.
2. These trophic disturbances are very different in ap-
pearance and evolution from those hitherto described.
The skin-eruptions (herpes, etc.), ecchymoses, and even
perforating ulcer, are the effects of simply transient and
accidental phases. Ichthvosis is, on the contrary, a
dystrophy of slow evolution, apparently progressive,
like the lesions of bone. 3. This dystrophy is mani-
fested by a kind of thickening of the skin, with more or
less deepening of its color, laxity of the integuments,
desquamation of the epidermis, the debris of which
sometimes accumulate so as to form true scales on the
surface of the skin. 4. The regions in which these
changes are observed are also those in which marked
disturbances of sensation may be found, ligluning-pain,
anajsthesia, hyperesthesia to cold, to pricking, some-
times to simple contact. The extremities are the parts
generally attacked. The skin of the back of the hand
may come to resemble the skin in pellagra. 5. The
loss of the nails and their alterations, as described by
Jotfroy, Pitres, Roques, and Dorneaux-Juron, seem to be
examples of this cutaneous dystrophy, affecting the
matrix of the nail.
Galium Aparine as a Remedy for Chronic Ul-
cers.— Dr. Quinlan (British Medical Journal) has
treated cases of chronic ulcer with great success, by
means of poultices made from "Cleaver's" {galiuin
aparine). It has been, he states, used with the most
marked success in the following manner. Grasping in
the left hand a bundle of ten or twelve stalks, with a
scissors held in the right hand, the bundle is cut into
pieces about half an inch long. These are thrown into
a mortar, and pounded into a paste. This paste, which
has an acrid taste and slightly acrid smell, is made up
into a large poultice, applied to the ulcer, and secured
with a bandage. It is renewed three times a day. Its
action appears to be a slight, steady stunulant, and
powerful |>romoter of healthy granulation. Its eflect in
one most unhopeful case was decisive and plain to all.
Healthy action ensued, and has since steadily continued ;
and, after a month of treatment, the two ulcers have
been reduced to considerably less than half their original
size. A difficulty at once suggests itself as to its general
employment, viz., that in winter and spring it is not to
be had at all. It appears, however, that this difficulty
can be effectually met by the mctliod of ensilage, by
July 21, 1883.]
THE MEDICAL RECORD.
69
means of which green food for cattle has for the last few
years been kept perfectly sweet and fresh by burying it
in silos under the ground. This plan is generally known,
but all particulars about it can be learned in the pamphlet
of Mr. Thomas Christy, F.L.S. (Christy & Co., 155
Fenchurch Street, London, E.C.). In the case of the
galium, the process would consist of catting the herb
very fine, ramming it down by screw-pressure into a
glazed eartlien ware jar with an air-tight cover, and bury-
ing it in the ground. Thus secured t'rom air, moisture,
and heat, it would be likely to keep through the winter.
This plan, if successful, might be extended to other
pharmaceutical herbs ; for Dr. Quinlan has always had
the idea that green herbs are more powerful than dried
ones. Indeed, the late Mr. Donovan, of Dublin, used to
maintain that, to make tincture of digitalis properly, the
alcohol should be brought to where the fo,\glove was
growing, and the live plant plunged into it.
Imperforate Hymen Persistent in Labor. — In the
British Medical Journal, M.3.y 12, 1883, Dr. Edwards
describes the following case : At 11 p.m., April 25, 1883,
he was called to see S. O , primipara, aged thirty-two,
said to have been in labor since Monday morning, the
23d ultimo. He found the patient suffering from severe
"pains." On digital examination, he was somewhat sur-
prised to find that the orifice of the vagina was com-
pletely closed by a tough membrane. Anteriorly, it was
comparatively thin, and attached to the edge of the
vaginal orifice, whence it sloped gradually backward
until, at the posterior wall, it was attached an inch and
a half from the orifice. Here it was very thick, and
gave the same sensation to the finger as the walls of the
vagina itself The fcetal head could be easily felt through
the tissue, which was perfectly lax, resisting all efforts at
rupture with the finger. Having decided to give the
uterus time to do its best, he left, calling again at 4 a.m.;
but, though the pains had been strong and frequent,
things were much in the same condition. By sawing
with the nail at the thinnest part, he eventually got the
end of his finger in, and tore the hymen by drawing the
finger backward, until about half way across, but he
could not manage it farther. He then waited an hour, in
the hope that the remaining half would not be sufficient
obstruction to delivery; but, ''pains" becoming short
and slight, he put on a forceps, and delivered without
difficulty. The patient went on satisfactorily. This case
is medico-legally interesting, as showing that one single
act of copulation, in spite of the seeming difficulties of
the case, sufficed for impregnation.
Cystotomy by a Modified Lateral Method.— Mr.
Reginald Harrison writes to t\\e. British Medical Journal
that the selection of a method for opening the bladder
should have reference only to the object to be attained,
or the contingencies that may arise. If, for instance, we
desire merely to introduce the finger into it, as a prelim-
inary to extracting a small stone, the median operation
answers perfectly ; while, if a larger stone, or an unknown
quantity of anything has to be dealt with, the lateral in-
cision will, as a rule, be preferable. It has been advanced
by those who favor the median incision, which is practi-
cally an urethrotomy, that it is both simple and safe ; its
admitted disadvantage lies in the comparatively small space
it provides for manipulating and extracting ; while, on
the other hand, the lateral incision, though affording more
room, is considered to be attended with an increased
risk and a greater degree of difficulty, so far as its per-
formance is concerned. The median operation need not
necessarily involve anything more than the opening of
the membranous urethra. The completed lateral opera-
tion further includes the division of structures constitut-
ing the neck of the bladder : and it is to this part of the
proceeding that any increased risk or difficulty is to be
attached. A little reflection shows that it is possible to
closely assimilate the lateral with the median operation,
that is to say, to disi)ense with the incision, not to the
staff, but along the staff, should it be found, on explora-
tion with the finger, that the additional room which the
latter (lart provides is unnecessary for the object in view.
It need hardly be said that this modification of the lateral
method, where it is found, on digital exploration, to be
feasible, frees the operator from executing the only por-
tion of the operation to which any increased risk is at-
tached ; while, on the other hand, he has the conscious-
ness that, should it turn out to be necessary, he can, by
the completion of the deep incision along the staff, avail
himself of all the advantages which are conceded by sur-
geons to the lateral method of opening the bladder.
The Oxytocic Action of Quinine. — Dr. Hartigan,
in the British Medical Journal, June 2, 1883, says that,
in three different cases he had to discontinue the use of
quinine, because it brought on "labor-pains," though the
doses used were small, varying from three to five grains.
In one of these, during a previous pregnancy, another
medical man used quinine, and discontinued it for a sim-
ilar reason. All three were in fair general health, suffer-
ing only from slight malarious fever, and had never
aborted. One case has come under his notice in which
abortion took place, without apparent cause, after a ten-
grain dose of quinine. The patient was the mother of
several children, had not previously aborted, was in good
health, and took the quinine to cure facial neuralgia.
This action of the drug is known to the Chinese, who
take it for the purpose of producing abortion, following
its use by copious draughts of hot tea. Quinine certainly,
in some cases, increases the menstrual flow.
Hysterical Trance. — Dr. Rosenthal reports an in-
teresting case of hysterical trance in which a country
practitioner declared death to have ensued. A looking-
glass held to the mouth did not show any moisture, and
melted sealing-wax dropped on the skin caused no reflex
movements. Rosenthal, who was accidentally present,
found the skin pale and cold, the pupils contracted and
insensible to light, the upper and lower extremities re-
laxed, the heart's impulse and the radial pulse impercep-
tible. Auscultation, however, showed a feeble, dull, and
intermittent sound in the cardiac region. No res|)iratory
murmurs were audible. All the muscles of the face and
extremities res[)onded well to the faradic current. Al-
though the patient had been apparently dead for thirty-
two hours, he thereupon informed the relations that it
was only a trance, and recommended that attempts at
resuscitation should be perseveringly followed. On the
following day he received a telegram to say that the pa-
tient awoke spontaneously twelve hours afterward, and
gradually recovered her speech and movements. Four
months afterward the patient called upon him, and in-
formed him that she knew nothing of the commencement
of her attack of lethargy ; that she had afterward heard
the people about her talk of her, but had been utterly un-
able to give the slightest sign of life. Two years after-
ward she was still alive and tolerably well. Rosenthal
appropriately likens this condition to that of " night-
mare," where, in spite of distressing sensations, the
dreamer is unable to call for help or to make any move-
ment which might save him from some imaginary im-
pending danger.
Effects upon Local Temperature of Nerve-
Stretching.— Dr. Redard has determined, from experi-
ments upon dogs and rabbits, that the temperature of a
leg falls 1° to 2° C. immediately upon stretching the sciatic
nerve. Exceptionally there is at first a slight rise, fol-
lowed speedily by a lowering of the heat of the part. It
is worthy of note that the temperature of the opposite
leg also falls slightly, a fact which would go to show that
nerve-stretching exerts some influence upon the central
nervous system. The temperature of the sound side
rises to the norn.al in a few days, while that of the other
side requires months for its restoration. — Centralbl. fiir
Chirurgie, April 21, 1883.
/O
THE MEDICAL RECORD.
[July 21, 1883.
The Medical Record:
A Weekly yojtrnal of Medicine and Surgery.
GEORGE F. SHRADY, A.M., M.D., Editor.
Published by
WM. WOOD &. Co., Nos. 56 and 58 Lafayette Place.
New York, July 21, 1883.
CONCERNING HOSPITAL INTERNES.
The letter of a late resident in one of our metropolitan
hospitals brings up some questions which are not often
discussed. They are eminently proper ones and can be
viewed consistently from several stand-points. There is
no doubting the fact that the relations at present exist-
ing between the visiting and house staffs of many of our
large charities could be much improved by a better ap-
preciation of mutual obligations.
It is too often supposed by the visiting physicians and
surgeons that their whole duties are performed when the
patients are simply prescribed for, and the necessary di-
rections to such an end are given to the resident. By a
large majority of men holding hospital appointments little
else is done. The consequence is that the house staff
becomes careless, apathetic, and shiftless. There is not
that interest in the cases which they would, under other
circumstances, gladly feel, not that incentive to study,
which is always associated with the reception of new
ideas with the opening up of new iields of inquiry. .\x\
interesting practical teacher always develops earnest
and energetic learners. The steel and the flint are made
for each ofher, and when each fulfils its function there is
no trouble in getting the spark. But there are men in
this city who occupy positions in some of our large hos-
pitals who make no pretence at teaching ; who feel no
more concern for the resident than for the chief nurse.
Hence the cause for just complaint on the part of our
correspondent. The interne has a right to feel that some-
thing is due him in the way of practical and painstaking
instruction at the bedside. There are many ways of do-
ing this, but the nearer the student can get to the patient
the better. There is nothing like feeling disease, so to
speak. The house staff should have the fullest opportu-
nities for tliis sort of study at the bedside, and under the
direction of the attending physician or surgeon. It should
be an education of the senses as well as of the intellect.
As no one can get too much of such training nothing can
be wasted on the student. No one feels a pulse intelli-
gently, listens to a rale or murmur, appreciates a crepitus,
recognizes a cast, passes a catheter, or even opens an
abscess without learning something more each time.
But how few of our hospital teachers care to take this
trouble goes without the saying. There is altogether
too much catering to the ordinary medical student, too
much ambition to feed large clinics, too much of a de-
sire to secure interesting cases for the amphitheatre to
allow of that more practical and profitable teaching in
the ward, and in actual contact with the patient, which
every student who wishes to treat disease finds sooner
or later to be a fundamental necessity of his medical
education. When so much is done by wholesale and
long range, when patients are seen only through an opera
glass, and the student merely told what he shoujd hear
and see, there is, of course, considerable difficulty in
bringing the producer and consumer together. But the
hospital interne has gone through this kind of instruction,
he knows how little there is in it, and has a right to ask
for better opportunities.
We should be sorry to say that this neglect of the in-
ternes was the rule, we hope it is not. We know that
there are many hospital teachers who are doing this kind
of teaching quietly and efficiently, and with very satisfac-
tory results. But on general principles the foundation of
the complaint of the e.\-resident is a good one, and there is
a great chance for the necessary improvement. The show
of benefits is retroactive all around. Patients are better
cared for, visiting physicians and surgeons become more
attentive, internes more zealous, science more advanced,
and the reputations of the hospitals better established.
It is not our intention to do more than allude to one or
two points in the e.x-resident's letter. Certainly a ver}'
important one is that which refers to the necessity of
giving necessary instruction to gentlemen who are to ad-
minister ana?sthetics. We are surprised to learn that this
is not done more universally. To know how to admin-
ister an an<esthetic properly is high art. It requires
knowledge in the first place and experience in the second
place. From all accounts, those who administer anaes-
thetics, have as a rule neither of these advantages. Next
to that of the operator himself, the administrator of ether
or chloroform has the greatest responsibility of any
around the table. In view of this fact, acknowledged by
all experienced surgeons, it is certainly strange indeed
that the junior assistant should be selected for this duty
and that too without any other instruction than he can
pick up from his own experimental endeavors. This cer-
tainly should not be. The most experienced man of all
should be selected for this duty ; in fact it would be
wiser and better to have an anssthetizer attached to
each hospital. But the least of all that can be said when
nothing better can be done, is that the juniors should be
most carefully instructed before being intrusted with lives
of patients during the critical periods of formidable sur-
gical operations. And yet such is done in almost every
large hospital in this city, and under the eyes of the most
experienced surgeons. One is almost made to think
that the administration of ether is a matter of very little
consequence, that deaths do not occur from carelessness,
and that the patient has little if any right to careful and
skilled treatment during a time of utter helplessness and
dangerous probabilities. Our correspondent does not
put the case a whit too strongly, in urging a radical
change in our ordinary methods of ether administration.
THE PROFESSION'S GREATEST NEED.
If we were to ask the average practitioner in city or
country what was the greatest single obstacle to his
progress, he would doubtless say, a field too much oc-
cupied. It is the constant appearance of new men,
July 21, 1883.]
THE MEDICAL RECORD.
71
young, eager, and hopeful, which cuts off here and there
the extension of his practice, and which threatens to
narrow down that which he already possesses.
Protection against a horde of superfluous rivals is
what the general practitioner, who is himself well
equipped and competent, most needs.
How can he secure this protection ? There is but
one way which is at all practicable, and that is by elevat-
ing> the barriers, so-called, which now mark the en-
trance to the medical profession.
If every college in New York State was obliged to give
a four years' course, if the graduates and outsiders were
obliged to submit to an examination by a Board before
they could get a license, should we have ten thousand
doctors in this State with only three thousand fit to go
in the Green Book ?
Now, since there is in our State, as well as in most
others, an evil so palpable, so obtrusive, so pernicious,
that not an educated physician fails to see and feel it ;
and since there is also a partial remedy for it at least,
we say that the profession ought to devote its strongest
energies to applying this remedy, to elevating the status
of medical education, and to keeping incompetent excess
from its ranks. Here is " something worth fighting for,"
as our contemporary of Buffalo has well said.
The practical result of changing the old Code to the
new Code, or the reverse, will now be trivial. Doctors
wil act as their characters determine them to act. The
President of the American Medical Association says
that the by-laws of that association permit consulta-
tions with irregulars, others think they do not. He (the
president) thinks these by-laws should be changed ; the
Judicial Council think not. The matter as it stands is
in an admirable state of comple.xity.
Meanwhile we say to our readers and to physicians
everywhere, work for what most aflects your daily bread ;
protect yourselves by reforming the methods of educat-
ing and licensing medical students, by laying a hand
upon the colleges, and saying, '' We protest against
college professors growing rich on the fees of these half-
educated, two-term doctors whom you turn abroad every
year to compete with us."
In the light of the real needs of the profession few
things could be more scandalous, than that medical
colleges should advertise themselves as supremely ethical
when they have not the courage to sustain long courses
or even to demand preliminary examinations. Tlie
matter is in a nutshell. There is money in being or-
thodoxly ethical ; but a three-term course, a careful
educational system, is expensive.
THE PRODUCTION OF HEAT IN THE BODY.
A DISCUSSION of certain heat problems is particularly
appropriate at this season. The investigations of Helui-
holtz, Dulong, Frankland, and Banal have shown quite
definitely the source, amount, and loss of heat in the
animal body, in other words, the heat-balance during the
twenty-four hours. The unit usually employed now in
these measurements is the " Calorie," which is the amount
of heat required to raise one kilogramme of water one de-
gree Centigrade. An adult man breathes in daily about
ten thousand quarts of air, of which one-fifth is oxygen.
This oxygen is distributed through the body, firing the
different tissues. It is at last thrown off in union with
C, as C0„, of which the amount is 878 grammes daily
(Scharling), and in union with H, as water, 13,615
grammes daily. The total amount of heat produced by
this chemical action of the inspired oxygen is estimated
by Helmholtz to be about 2,050 calories. It is an amount
of heat that would raise 4,200 pounds of ice-cold water
from 32° F. to 33.8° F.
But besides this, it is estimated by Dulong that about
twenty-five per cent, more of heat is produced from other
sources, i.e., from the food. . This makes a total of 2,550
heat units produced daily by an adult man who is not
engaged in muscular work.
The heat thus produced is almost entirely lost by
radiation and conduction (seventy-three per cent.) and
by evaporation of sweat (14.5 per cent.) from the skin.
Only about ten per cent, is lost by the lungs, and two
per cent, by the excretions and the introduction of cold
food and drinks.
The difference, however, between the amount of
heat produced during a day of rest and one of work
is very great, and the figures are suggestive, if not in-
structive at this particular time. During active muscu-
lar work the amount of heat developed by an adult is
more than half as much again as when one is at rest.
The ratio can be best expressed as follows : A man
sitting quietly in his room, indulging in no excessive
vituperation against obtrusive flies, generates about one
hundred heat units (calories) an hour. If he falls asleep,
this amount sinks to forty or fifty calories per hour. If
he wakes up and insanely attempts to chop wood, the
amount rises to one hundred and fifty calories or more
per hour.
The hygienic deductions to be drawn from the fore-
going are : Keep the body quiet, and the skin active.
It is a fact, which should be mentioned here, that large
draughts of water do not necessarily produce diaphoresis
unless the water is hot. The absolute cooling effect of
a large tumbler of ice-water is trivial. In raising it to
the temperatifre of the body the equivalent of about ten
units of heat is abstracted.
THE DIAGNOSIS OF MOVABLE KIDNEYS.
It is an evidence of the minuteness and care with which
modern medical science attacks the various problems
before it when we find a whole book devoted to the di-
agnosis of " I'ectopie renale," or misplaced movable kid-
ney. Dr. Frederic Buret is the author of such a work,'
and it is a contribution of practical value to physicians.
Although less than one hundred cases of movable kidney
have been, so far, reported, it is a trouble which is no
doubt much more frequent than is supposed. Such is
the opinion of Buret, and Dr. William Roberts, and others,
and it is strongly supported by the investigations of Op-
polzer, who in a series of five thousand five hundred pa-
tients found that twenty-two had movable kindeys, giving
a proportion of one in two hundred and fifty. It is not
improbable, as Roberts says, that many cases of obscure
abdominal pain and of gastro-enteric disturbance are due
' Du Diagnostic de I'Ectopie Renale, par le Dr. Fr(;d(!ric Buret, Au.\ liureaux
du Progrfes M^dicale, pp.93. Paris, 1883.
T
72
THE MEDICAL RECORD.
[July 21, 1883.
to this cause. Movable kidney occurs in women much
oftener than in men, the proportion being as six to one.
It is generally an acquired trouble. and its existence is
due chiefly to parturition, tight-lacing, sympathetic renal
congestion during menstruation, and violent exercise or
injury. The most prominent symptoms are, a dragging
pain in the loin, and gastro-intestinal disturbances, ner-
vous symptoms, hysteria, and hypochondriasis may also
be provoked by it. Epigastric pulsation is often present,
but the only certain evidence of the trouble is, of course,
the presence of a movable tumor which can be felt.
The chief value of Dr. Buret's work is in the collection
of cases which he has made illustrating mistakes in diag-
nosis. These cases, fifty in all, he divides into three
classes : ist, those in which no tumor was recognized,
and no idea of the real trouble was obtained ; 2d, those
in which a diagnosis was vaguely formulated ; 3d, those
in which a tumor was discovered but its nature not re-
cognized.
In the first class he cites fifteen cases. These had
been treated as cases of crural, or lumbo-abdominal neu-
ralgia, of renal colic, hepatic colic, embarras gastrique,
hysteria, and chronic peritonitis.
In the second class, the trouble had been mistaken for
"abdominal tumor," and "affection of the liver." Moxa;
were applied in some cases and operation suggested.
In the third case, a diagnosis was made of biliary ob-
struction, enlarged liver, tumor of right lobe of the liver,
cancer of the liver, enlarged gall-bladder, biliary calcu-
lus, cancer of the pylorus, displaced spleen, and ovarian
cyst.
The list thus given sufficiently illustrates both the in-
ventive imagination of the doctor and the various symp-
toms which renal ectopia may produce.
SEXUAL ADVERTISEMENTS.
Some time ago we called attention to the fact that cer-
tain enterprising medicine-vendors were hiring men to
promenade Broadway, bearing dorsal and ventral pla-
cards, which announced the virtues of a Certain drug in
sexual weakness. The erotic procession referred to ap-
peared then, as it does now, strikingly suggestive of the
ancient orgies of Priapus ; but it was only a sign of the
times.
The Americans are the most advertising of all nations,
and it is to be expected that helps for the erring and
erythritic should nor be left out. Nevertheless, a line
should be drawn, and we submit that remedies for sex-
ual disease are now being forced before the public to an ex-
cessive, disgusting, and injurious extent. A person walk-
ing one of the side avenues of this city is liable to have
thrust into his hand the card of a gonorrhcea specialist, or
the advertisement of a safe, sure, and speedy cure for
certain sexual ills. Telegraph poles and fences are pla-
carded with condensed but significant descriptions of
choice measures in urethral therapeutics ; our larger con-
cert gardens, in which beer and music are dispensed to
the temporary comfort of the flesh, contain upon their
programmes notices of potent "urethrines" and pocket
syringes. As for the press, we have already commented
on the drift of the religious impulse as evidenced by
the advertisement of gonorrhoea cures in tlie religious
weeklies. The secular papers have long been filled with
every sort of sexual advertisement.
Perhaps all this is part of our evolution and cannot
be helped ; nevertheless, it might be worth while making
a little effort to check it. It is injurious to public mor-
als and public health, this constant obtrusive forcing for-
ward of sexual drugs and the sexual system. Besides,
decent men and women would like to be able to look at
a fence or a telegraph pole without finding the cut of
"The Perfect Syringe " focussed on their retina. There
is a law against committing nuisances, which perhaps
Mr. Comstock might interpret to the public's advantage
here. |
THE NATURE OF PEPTONE, AND ITS FORMATION OUT-
SIDE THE DIGESTIVE TRACT.
Dr. Alexander Poehl, of St. Petersburg, in an inau-
gural thesis, has presented the results of his researches
into the nature and formation of peptone. Some of the
results which he announces are novel and deserve con-
sideration.
Poehl investigated different tissues and fluids of the
body in order to discover whether peptone could be
found outside of the gastro-intestinal tract. His results
confirmed what had already, to some extent, been shown,
that peptone does exist in these places. Thus, it is
found in appreciable quantity in the blood, in urine,
sweat, sputa, the fluid of ovarian cysts, in hydrocele, in
cancerous tissue, in the pus of cold abscesses, and in
pleuritic exudation. Poehl found peptone in sixty-five
per cent, of the specimens of urine obtained from two
hundred and thirty-three febrile cases in Eichwald's clinic.
He found it in cases where the urine was neutral or al-
kaline, thus disproving, as he thinks, the view that it is
the result of a digestive action occurring in that fluid.
He also found that normal filtered acid urine had no
peptic acid when brought in contact with albumen.
In order to explain the presence of peptone in these
various fluids, Poehl undertook a series of experiments
for the purpose of finding whether there was not some
peptic ferment in the tissues themselves. His results
corresponded with his expectations. Fresh macerated
kidney, acidulated and placed in solution with albumen,
displayed a peptic action, considerable peptone being
produced after a few hours. The same result was ob-
tained with lung-tissue and with pieces of the small and
large intestine. Poehl concludes, therefore, that the
tissues of the body all (!) have some peptic power. In
croupous pneumonia the ingenious hypothesis is offered
that the ferment of the lung-tissue digests and dissolves
the exuded fibrin. In confirmation of this view he cites
the fact that in croupous jmeumonia peptone is present
in considerable amount in the urine. Our author also
brings some evidence to show that not only animal but
vegetable tissues have this digestive power. He seems
to have experimented himself only with lettuce leaves,
however, and it must be confessed that he draws his
conclusions from a rather small series of experiments.
A chapter is devoted to the methods of turning pep-
tone back into albumen, a process which is no longer
new.
Poehl offers some original suggestions as to the real
nature of peptone and the peptonizing process. There
July 21, 1883.]
THE MEDICAL RECORD.
7Z
have been three views held by physiological chemists as
to this matter.
Thiry considered albumen and peptone to be simply
isomeric. Herth, also Loew and Bokorny, consider the
albumen, into which peptone is turned back, a " poly-
merization-product " of the latter.
Most physiologists, however, have of late held that the
peptonization of albumen is simply a hydration and
doubling-up of the proteid molecula. All admit that a
certain amount of chemical action takes place.
Poehl contends, however, that peptonization, or, in
other words, gastric and tryptic digestion, is a purely
physical process, and consists simply in a soaking of the
albumen with water to its utmost capacity. He finds
that the ease with which the different albumens are di-
gested or peptonized is in proportion to the rapidity
with which this capillary imbibition takes place.
His view is based upon the fact that chemical analysis
reveals no characteristic difference between albumen and
peptone, and that the optical properties of the two bodies
are also entirely alike. This latter fact he thinks could
not be true if the two bodies possessed any real chemical
differences.
news jof i\xc im^^\\.
Suing for a Degree of Doctor in Medicine.— A
medical student, Mr. Jacob M. Davis, applied for a
mandamus to compel the Faculty of the Baltimore Col-
lege of Physicians and Surgeons to confer on him the
degree of M.D. Mr. Davis alleged that the Faculty re-
fused to graduate him after he had attended a two years'
course of lectures, on account of his parents, and not
for any personal unfitness on his part. It was urged by
his counsel, C. Dodd McFarland and H. M. Tiralla,
that even if the objection to parents was a valid reason
for rejection, it should have been made when he entered
as a student. Mr. John. T. Morris, for the F'aculty, said
the Faculty may not have known of the ground of objec-
tion earlier. He contended that the act of the Faculty
could not be inquired into by the court. Judge Phelps
said a mandamus ought not to be granted when there is
a remedy by suit, and hence it was denied.
An Epidemic of Glanders. — The State Veterinarian
of Illinois reports that glanders is prevalent among the
horses in nineteen counties in that State. He claims to
have been prevented from killing the animals afilicted,
the attorneys of the owners contending that he could
only resort to this measure after the governor had issued
a proclamation declaring the glanders epidemic. The
Attorney-General is now e.xpected to give an opniion as
to the powers of the State Veterinarian under the State
laws.
Eight more Assistant Sanitary Inspectors were
appointed by the City Board of Health this week.
The Progress ofthe Cholera. — The probability that
cholera would reach Cairo, which we suggested last
week, turns out to be realized. On July 15th the dis-
ease appeared in a suburb of Cairo, and on the i6th
several cases were discovered in the city itself. The
number of deaths in Damietta has fallen to about thirty
or forty a day, simply because the population has flown
or has already been destroyed. The disease has been
steadily going up the Damietta branch of the Nile. It
has appeared in a few outlying towns. The efforts to
limit it by military sanitary cordons have been failures,
because the lines were broken through. Some of the
soldiers themselves have been attacked by the disease.
Cholera has appeared among the British troops at Malta,
and caused great consternation. The English are trying to
justify their alleged negligence in the matter of quaran-
tine by throwing the blame on the medical officers. There
is said to be great difference of opinion among the Indian
Government's medical advisers as to the question of hu-
man propagation of the disease, and the utility of quaran-
tine. This is mere cavilling and casuistry, however,
since there is no question that the weight of medical
opinion throughout the world is in favor of the view of
the utility of quarantine, and a government should ac-
cept the safest view, not the one most acceptable to its
mercantile interests.
Dr. John A. Warder, of North Bend, O., died on
July 14th in the seventy-second year of his age. He was
a prominent member of the American Forestry Con-
gress, and the author of several works on fruit-growing
and tree-culture.
Royalty at a Medical Society. — The discovery of
the bacillus appears to have lent additional dignity and
social favor to medicine. The Emperor William has
deigned to apply his imperial and presbyopic eye to a
microscope in order to see these organisms. And re-
cently the Prince of Wales and Prince Lucien Bonaparte
attended a conversazione given at the rooms of the Lon-
don Medical Society on the occasion of the opening of
an addition to the old buildings The annual oration
was delivered this year by Dr. Edward Lund, of Man-
chester, who discussed and advocated Listerism. His
Royal Highness, with great judiciousness, waited until the
oration was over, and then came in to the sound of music.
A number of interesting objects were shown. Among
them were some microscopic specimens shown by Dr.
H. Gibbes, including the fungoid growth or organism,
producing what is popularly known as the salmon dis-
ease (this preparation being illuminated by a cleverly
arranged adaptation of the incandescent electric lamp) ;
the bacillus tuberculosis in sputum, magnified 1,350
diameters ; the bacilli found, in cases of typhoid fever,
magnified 1,200 diameters ; the bacillus anthracis and
spirilla vibrionis. Other parasites specially affecting the
lower animals were shown by Dr. Cobbold, and Dr.
Francis Warner lent apparatus for obtaining graphic
records of the movements of various parts of the body,
and for enumerating these movements and their combin-
ations. The honorary librarian, Dr. Allchin, had se-
lected for exhibition some books from the valuable col-
lection of old works belonging to the society, which
comprises many dated in the fifteenth and sixteenth cen-
turies from the library of Dr. Sims. Among these was
the manuscript diary of the Rev. John Ward, in one of the
fifteen volumes of which, under date of the years
1661-63, the writer had made the following entry:
"Shakespeare, Drayton, and Ben jonson had a merry
74
THE MEDICAL RECORD.
[July 2 1, 1883.
meeting, and it seems drank too hard, for Shakespeare
died of a 'feavour' then contracted." Another interest-
ing work was Dr. Mead's imperfect reprint of the '• Resti-
tutio Christianismi " of Michael Servetus, in which that
ardent theologian and observant doctor illustrates an
argument by a reference to the passing of the blood
from the right side to the left through the lungs.
The Legal Value of Human Blood — A Curious
Suit. — A novel law-suit has recently been decided in the
District Court of this city. Last February, a man went
to a hotel, engaged a room, went to bed and blew out
the gas. He was found in a condition of advanced as-
phyxiation, and lay for hours in an unconscious condition.
Drs. Garrigues, Valentine, and Anderson were summoned
to attend him, and after consultation decided that the
only way to save the man's life was by transfusion. The
proprietor of the hotel was accordingly instructed to hunt
up a healthy subject who was willing to undergo the
operation, and a colored porter, named Edward Banks,
was called upon. The proposed subject was by no
means inclined to serve at first, but when he was told
that only about eight or ten ounces of blood would be
needed, and that the blood would be paid for at the rate
of ten cents a drop, his cupidity overcame his fears, and
he submitted his arm to the instixinient. Dr. Garrigues
drew eight ounces and transfused it into the arm of the
patient, who rapidly convalesced. Banks afterward
served the patient as nurse, and claims that he was so
overcome by a sense of the obligation which he owed to
his preserver that he promised to reward him to his satis-
faction. All that Banks received, however, was a five-
dollar note in discharge of all obligations, and accord-
ingly he brought suit for $250 which his counsel claimed
was the value of the blood at the price agreed upon, 10
cents a drop, together with the value of the nursing given
the sick man by the plaintiff". It was estimated that an
ounce of blood contained 240 drops, and S ounces at 10
cents a drop would thus be appraised at $192, the value
of the attendance, etc., bringing the bill up to iJ25o.
The examination showed that the promise to pav 10
cents a drop was given in a joking way by one of the
physicians, that the plaintiff was a poor man, and that
he was nursed by his wife after the first day. Decision
for the defendant.
Yellow Fever. — Reports of cases being brought to
American ports are constantly printed. At date of
writing, however, no case seems to have eluded the
vigilance of the quarantine officers.
Dr. Thomas F. Scott, the oldest and one of tlie most
eminent physicians of Petersburg, Va., died lately,
aged eighty years. He was a nephew of General
Winfield Scott and an uncle of General P. B. Starke.
He was a member of the Virginia Medical Association
and was widely known.
A Physician's Self-Destruction. — Dr. Lee Pinks-
ton, residing about fifteen miles from Montgomery, .A.la.,
committed suicide recently, by placing a double-barrel
shot-gun to his head and discharging it. He was suffer-
ing from mental aberration, caused by giving one of his
children a fatal dose of morphine for quinine some time
ago.
Pasteur has offered to go to Egypt and study the
cholera. Since the Pasteur-Koch controversy patholo-
gists will want Pasteur to refurbish his old-fashioned
methods a little before undertaking new fields of investi-
gation.
Dr. Heneage Gibbes has been appointed to the
Chair of Physiology and Histology at the Westminster
Hospital. His microscopic work is too well known to
call for comment.
The American Ophthalmological and Otological
Association held its sixteenth annual session at the
Hotel Kaaterskill, beginning July iSth.
Dr. Donald McLean, of Ann Arbor, has been ap-
pointed Surgeon-in-Chief of the Michigan Central System
of Railroads.
Dr. \y. E. Quine, late of the Chicago Medical Col-
lege, has been elected to the Chair of Practice of Medi-
cine in the College of Physicians and Surgeons of Chi-
cago.
Professor Alfred C. Post has been formally re-
quested to resign from membership in the American
Medical Association on the ground that he has signed a
paper stating that he is opposed to the present Code of
Medical Ethics of the .American Medical Association.
Dr. Post has for years sustained the reputation of be-
ing one of the best surgeons in the country, as well as
being a gentleman of very extensive learning, and of the
purest personal character.
It is evident now, however, that he is not a really good
man.
The New York Post-Graduate Medical College.
— Dr. Charles L. Dana has been appointed to the Chair
of Diseases of the Mind and Nervous System. Dr. J.
Leonard Corning has been appointed Lecturer on the
same branch.
Dr. W. T. Belfield has been appointed Assistant
Patliologist to the Cook County Hospital.
The Supporters of the Old Code in the State
OF New York. — The Council of the New York State
Medical Association for Upholding the National Code of
Ethics has issued a circular, dated June 21st, in which
the numbers of those who uphold the old Code in the
various counties of the State are given as follows : Al-
bany, 40 ; Alleghany, 14 ; Broome, 28 ; Cattaraugus, 14 ;
Cayuga, 20 ; Chautauqua, 26 ; Chemung, 21 ; Chenango,
46; Clinton, 27; Columbia, 14; Cortlandt, 22; Dela-
ware, 16 ; Dutchess, 40 ; Erie, 107 ; Essex, 14 ; Franklin,
15; Fulton, 10; Genesee, 15; Greene, 17; Herkimer,
25 ; Jefferson, 23 ; Kings, 14S; Lewis, 11 ; Livingston,
II ; Madison, 19 ; Montgomery, 16 ; Monroe, 53 ; New
York, 742 ; Niagara, 25 ; Oneida, 58 ; Onondaga, 66 ;
Ontario, 21; Orange, 18; Orleans, 16; Oswego, 20;
Otsego, 15; Putnam, 7; Queens, 44; Rensselaer, 74;
Richmond, 11 ; Rockland, 9; St. Lawrence, 13; Sara-
toga, 27 ; Schenectady, 12 ; Schoharie, 12 ; Schuyler, 12 ;
Seneca, 21; Steuben, 18; Suffolk, 18; Sullivan, 17;
Tioga, 19; Tompkins, 13; Ulster, 19; Warren, 18;
Washington, 10 ; Wayne, 24 ; Westchester, 44 ; Wy-
oming, 12 ; Yates, 9.
July 21, 1883.1
THE MEDICAL RECORD.
75
^jevcrrts of ^ocxetus.
NEW YORK PATHOLOGICAL SOCIETY.
Sfa/eJ Meeting, May 23, 1883.
Alfred C. Post, M.D., President, pro ton.
Dr. Saiterthwaite presented, in behalf of a candi-
date, a specimen o( ptilinonaty tuberculosis with marked
thickening of the pleura, slight endocarditis, and acute
nephritis.
Dr. Ferguson presented, in belialf of a candidate, a
specimen illustrating subinvolution of the uterus.
Dr. Satterthwaite, from the Committee on Micro-
scopy, reported that the tumor presented by Dr. Robert
Newman, at the stated meeting held February 28, 1883
(see Medical Record, vol. xxiii., p. 331), was carcino-
matous.
Dr. Ferguson presented a specimen of
ANEURISMAL DILATATION OF THE HEART AND MITRAL
stenosis FIBROID INDURATION.
It was removed from the body of a man twenty-seven
years of age, a native of Germany, single, and a clerk by
occupation. Both his parents suffered from rlieumatism,
and his father, he said, died from asthma. Three years
ago the patient first suffered from rheumatism, and at
that time and ever since has been troubled with dyspncea
and cardiac palpitation. Three weeks previous to his
admission into the New York Hospital, on March 12, 1883,
his palpitation and dyspncea became so aggravated that
he was unable to attend even to light work. At the
same time he began to suffer from a severe cough, the
expectoration being scanty, white and frothy, and at
times streaked with blood. His general condition was
poor, and his respiration was much embarrassed. The
apex beat was in the mammary line and sixth space.
There was a sound, presystolic and systolic in character,
heard most distinctly at tlie apex, and transmitted to the
right toward the sternum and axilla on the left side. The
prtecordial area of dulness was greater than normal.
He was put on tonics and stimulants, and imi)roved con-
siderably, although he constantly complained of pr;B-
cordial pain. In the latter part of March and during
the month of April he was allowed to sit in his chair, and
at times to walk about the ward. His cough almost en-
tirely disappeared, there was no dyspnoea except on ex-
ertion, and his heart-action was considerably improved.
While in the hospital, temperature ranged between
99° and 102°; his respiration was slightly accelerated,
and his pulse, feeble and easily compressible, ranged be-
tween 80 and 140 beats per minute.
The latter part of April he began to feel very weak,
and was more closely confined to his bed and chair, but
did not need any special attention. On May 2d, at 6 a.m.,
he died suddenly, without aggravation of the symptoms
of which he complained since his admission.
Autopsy was five hours after death. There were one
hundred and seventy-five cubic centimetres of bloody se-
rum in the left pleural cavity, and seventy-five cubic centi-
metres of fluid similar in character in the right pleural
cavity. There were old adhesions all over the surface
of the left lung. Both lungs were congested and cedema-
tous and deeply bronzed. The heart is large ; the ante-
ri'or wall of the left ventricle is bound to the pericardium
by a firm band of connective tissue. The left ventricle
is enormously dilated, and the left ventricular wall, in
places, is less than one-eighth of an inch in thickness,
and at the apex there is a portion of the left ventricular
wall where the endocardium and pericardium are sepa-
rated only by the interposition of a thin layer of fat.
Posteriorly the ventricular wall is much thicker, being
uniformly nearly one inch. The papillary muscles are
much hypertrophied. The right ventricle is moderately
dilated ; the valves on the right side of the heart are
normal. The segments of the aortic valve are slightly
thickened and retracted. There is stenosis of the mitral
valve, admitting only a cylinder one-half inch in diameter.
The endocardium is markedly thickened, and throughout
the entire left ventricular wall there is increase of the fi-
brous tissue between the muscle-cells (fibroid induration
of the heart), es|)ecially marked where the ventricular
wall is thinnest, except at the apex, where there is no
muscular tissue to be found. There is atrophy of the
fibre-cells and much pigment arranged around the poles
of their nuclei. The cells in places contain a small
amount of fat, but generally the transverse stria; are
well preserved.
Dr. H. Knapp presented a specimen of
MELANO-SARCOMA OF the CHOROID.
The eyeball was removed a few days ago, from a man
of about fifty-eight, who two years previously had noticed
a cloud in the centre of the visual field of his left eye.
The cloud became more intense, was perfectly black in
the course of some months, and spread toward both
sides, so that six months after the beginning he could see
objects only in the upper and lower parts of his field of
vision. An oculist diagnosticated detachment of the
retina. In a year the sight in his left eye was completely
destroyed. He consulted several oculists : the diag-
nosis was detachment of the retina. When he came to
Dr. Knapp, two weeks ago, the external appearance of
the eye was normal ; the fundus not to be illuminated ;
sight lost, the ayeball tension moderately increased ; other
eye healthy. From the symptoms, Dr. Knapp thought
the diagnosis of inelano-sarcoma behind the detached
retina in the posterior part of the choroid was about as
sure as it could be without directly seeing the tumor.
The enucleation proved the diagnosis correct : a fiat,
slightly nodular, black growth occupies the posterior
third of the choroid, encircles the optic nerve. The
retina is united to its surface, thence passes through
the vitreous contracted into a cord, and attaches itself to
the posterior diaphragm of the eye ciliary processes,
zonula zinnii and posterior capsule of the lens. Dr. Knapp
pointed out the typically clear clinical history of the case.
During the first six months it must have been possible to
recognize the tumor directly with the ophthalmoscope ; in
the last stage the diagnosis was secured by the increased
eyeball tension in connection with the detached retina.
Dr. Garrish asked why Dr. Knapp diagnosticated so
confidently a nielano-sarcoma of the choroid without
mentioning the possibility of a retinal tumor. He asked
further at what age choroidal sarcoma was observed.
Dr. Knapp said that the intra-ocular tumors, with rare
exceptions, were either gliomas of the retina, or sarcomas
of the choroid. Glioma of the retina was a disease of
childhood, no authenticated cases having been observed
beyond the age of twelve years. Sarcoma was inet with
in young persons, though rarely ; in middle life it was
commonly unpigmented and past middle life pigmented.
Dr. Beverly Livingston presented a specimen
which illustrated
multiple uterine fibroids.
It was removed from the body of a colored woman aged
thirty years, who was admitted to the Home May 21,
1883. The patient on admission, in the afternoon, did
not complain of any severe pain. In the evening a dif-
fuse swelling of the left lower extremities was discov-
ered, extending from the lower third of the thigh to the
tips of the toes. The skin was thick, of a livid color ;
there was marked pitting on pressure, and at numerous
points the sense of fluctuation could be detected. On
the internal surface, just above the ankle, there was a
large circular ulceration, the edges of which were irregu-
lar, and the base had a grayish color. There were a
number of bulla; filled with blood-stained serum upon
the lower third of the leg, and one very large one cover-
ing the entire dorsal surface of the foot. The right limb
76
THE MEDICAL RECORD.
[July 21, 1883.
was cedematous and pitted on pressure. Pulse, 120;
respiration, 30; temperature, ioiy^^y° F. Urine, yellow,
cloudy, acid ; specific gravity, 1012, and contained seven
per cent, of albumen, hyaline and granular casts, but no
sugar. Heart and lungs not examined, because of the
great size and feebleness of the patient. Diagnosis,
erysipelas of leg.
March 22, 18S3. — About 9.30 a.m., as the doctor
was going through the ward, pulse, 90 ; respiration, 22 ;
temperature, 98.2°; a few minutes later the doctor
was summoned, but on arriving found the patient dead.
Autopsy, sixteen hours after death. Bod)' well nourished ;
rigor mortis well marked ; lower extremities mark-
edly cedematous. Woman very fat. Some discharge from
vagina; pericardium normal. Heart: Ceased in dias-
tole ; tissue soft, fatty, and pale ; cavities dilated ; aorta
showed commencing atheroma, otherwise healthy. All
the valves normal. Right lung : Pigmented on surf.ice,
irregular congestion ; cedema and congestion in pos-
terior portion of lower lobe. Left lung: Pigmented on
surface ; one small thrombus in posterior part of lower
lobe ; cedematous and congested like the other. Ab-
dominal cavity — spleen : Not enlarged ; post-mortem
softening. Right kidney : Two small and one large cyst
at upper end ; very fatty ; cortex irregular and granu-
lar ; capsule partially adherent. Left kidney : Large
cyst, holding one-half ounce of clear fluid in lower por-
tion of kidney, which occupied whole thickness of organ ;
large, irregularly congested ; on section granular appear-
ance of cortex ; capsule as in the other. Liver: Small;
on section fatty and softened, partly due to post-mortem
change.
The uterus was enormously enlarged and contains nu-
merous fibroids, the largest of which is evidently calcare-
ous. One was distinctly intramural. The walls of the
uterus were very much thinned, the inner surface was of a
grayish color, and emitted an exceedingly offensive odor.
Within the cavity were two or three small fibroids, only
very slightly attached to the uterus, and undergoing the
process of softening. The external os was small, probably
would not admit the little finger. The uterus contained
a little over one quart of very offensive pus.
The leg did not contain any pus at all, it was simply
cedematous, and in the hasty examination made he did
not discover any thrombi in the veins.
APOPLEXY FATTY LIVER.
Dr. Robert T. Newman presented the liver removed
from the body of a man who died suddenly May 12th.
The patient, so long as he could recollect, had sutt'ered
from derangement of digestion. Ten years ago he had an
apoplectic stroke, was unconscious for a few days, the
mouth was drawn to one side, and he was paralyzed upon
one side, but subsequently regained his intellectual facul-
ties entirely, and also fully recovered his motion. About
sixteen weeks ago he was again found unconscious, and
it was supposed that he had had another apoplectic stroke.
When Dr. Newman first saw him, his abdomen was im-
mensely enlarged, but there was no evidence of accumu-
lation of fluid. The patient's stools were clay-colored,
he suffered from diarrhoea, his urine was loaded with bile,
and parts of the body were slightly jaundiced. Percus-
sion gave evidence of enlargement of the spleen. .\t that
time Dr. Newman was not able to find any evidence of
paralysis, although the patient was unable to move him-
self in bed. Defecation and micturition were voluntaiy.
He died suddenly eight days afterward from what aiii)eared
to be, from the description given, an apoplectic stroke.
During life, so far as auscultation and percussion went, the
heart seemed to be normal ; at the autopsy, only a very
limited one being permitted, the liver was removed, and
found on microscopical examination to be fixtty. It was
increased in size, the gall bladder was empty, and there
seemed to be some stenosis of the common bile-duct.
Dr. Saiterthwaite remarked that the liver seemed to
be of the nutmeg variety, and apparently indicated that
there was some obstruction of either the cardiac or the
pulmonary circulation ; probably also there was some in-
crease of connective tissue, as was usually the case with
this lesion.
The Society then went into executive session.
THE PRACTITIONERS' SOCIETY OF NEW
YORK.
Stated Meeting, May 5, 1883.
James B. Hunter, M.D., President, in the Chair.
Dr. Beverly Robinson presented a patient with
deflected nasal septu.m — obstructed breathing)
— adenoid growth in the larynx.
The patient was a young woman who had been sutfer-
ing for a year and a half from obstruction in the left nos-
tril, for which she had recently applied for treatment.
There was a suspicion of her having had syphilis. The
nasal septum was deflected to the left, so that the air
could not be drawn through the nostril of that side.
There was a small adenoid growth in the vault of the
pharynx. The patient was considerably more deaf, to
the ticking of a watch, in the right ear than in the left.
The points of interest were, that despite the obstruction
and the adenoid growth in the pharynx, the patient's
voice was not at all aftected, and that the ear affected
was on the opposite side from the obstructed nostril with
its deflected and ulcerated septum.
Dr. Sexton examined the drum-heads and found evi-
dence of an old inflammatory change which had prob-
ably occurred some years before, when the patient had
had an attack of scarlet fever.
Dr. C. L. Dana read a paper entitled
THE N.A.TURE AND TRE.\TMENT OF CERTAIN FORMS OF
chronic NERVE-WEAKNESS.
[The paper is published in full on p. 57 of The
Record.]
The paper being open for discussion Dr. H. F.
Walker said that he had used the fluid extract of coca
considerably. He had found it to act far better with
men than with women, a fact which he was inclined to
attribute to the more extensive use of tea by women.
Dr. Hunter said that he had once imported some of
the fresh leaves, having been told by gentlemen who had
lived in South .\merica that these alone were of any
value. They had given good results.
Dr. Beverly Robinson had used a good deal of the
Mariani wine of coca, and thought that it had acted very
satisfactorily. He happened to have met M. Mariani
several years ago, and had been led to place confidence
in the genuineness of his preparation.
The speaker had used
hydrouro.mic acid
in two conditions : that of vertigo, presumably from
stomach trouble, and that of dyspepsia. Its use in stom-
achal vertigo he had taken from a suggestion by Woakes.
He had employed the Fothergill solution.
Dr. \*. P. GiENEV, referring to the
prognosis
in these conditions of nervous invalidism, asked if these
patients ever got well. In his experience the cases
were most untractable, and however one helped them
they were apt to tall back to their former condition.
Dr. Dana said that he had once been inclined to take
a very gloomy view of the prognosis. He did not know
that now he could recall cases of pronounced and long-
standing neurasthenia proper which he was sure had per-
manently recovered. He thought the prognosis better,
however, than Dr. Gibney was inclined to paint it. He
believed that almost^ every patient could_be greatly im-
July 21, 1883.]
THE MEDICAL RECORD.
n
proved and life made more comfortable to him. Some
cases, undoubtedly, got well.
Dr. Kinnicutt said that in his experience these cases
do improve, and even become to all intents and purposes
well, continuing so for several years. He thought, how-
ever, that there was always a tendency to relapse. K
case in ])oint had occurred in his experience recently.
Dr. Polk said that he supposed the nature of the
troubles that go under the name of neurasthenia had
never been very definitely made out. He asked if any-
thing of importance had been written on the subject aside
from the work of Beard.
Dr. Gibney said that it was the same old group of
symptoms which had been known for a long time. In
women we are apt to call it spinal irritation, in men
nervous prostration. Some authorities called it hyper-
£emia, etc.
Dr. D.-vna said that m the first part of his paper he had
discussed this question and endeavored to throw some
light upon it.
So far as the literature was concerned, the subject had
been treated by Bouchut, of Paris, in a work entitled
" Du Nervosieme," published in 1877, and by MiJbius,
of Leipzig, in a work entitled " Nervositiit," published in
1882. Erb also discusses it, and of late years many Ger-
man writers (Glax, Burkart, etc.) had been studying the
special forms of neurasthenia.
The speaker thought it would be long before we knew
the morbid anatomy or chemistry of nervousness and
chronic nerve-weakness. We could speak, however,
much more definitely about its morbid physiology, and he
had ventured to make a contribution to that subject.
Dr. Sa.muel Sexton referred to a case where he had
used coca with benefit. He had found it difficult to get
patients to take large doses of hydrobromic acid on ac-
count of its powerfully acid taste.
Dr. Hunter said that with reference to those cases of
nerve-prostration and hysteria which were submitted to
the Weir-Mitchell treatment, he had observed that even
in patients who were improved, the symptoms often re-
turned soon after passing from the treatment.
ONTARIO MEDICAL ASSOCLVITON.
Annual Meeting, held at Toronto, June 6 and 7, 1883.
{t'rom our Canadian Correspondent.]
Dr. J. E. Graha.m, of Toronto, read an exhaustive
paper on
THE BACILLI OF PHTHISIS.
The paper treated fully of the question in its present
bearings to medical opinion. From a careful analysis of
forty cases in Dr. Graham's own practice he concluded
that the bacilli are constant in cases of true phthisis.
In some cases where they are not found at first, repeated
examinations would reveal them. The second point of
importance in the paper was that its author leaned very
much in favor of the view that phthisis is contagious.
He strongly recommended antise|)tic inhalations and
everything which was of any real value in sustaining the
powers of the system.
Dr. J. Ferguson remarked that of 2,509 cases, the
statistics of which he had collected, the bacilli had
been found in 2,417. Of the cases in which the bacilli
had not been found sufficient care was not taken, as in
many of these cases fesv e.xaminations of the sputa were
made. After making all due deductions for error there
seemed to be some relationship between the numbers of
the bacilli and activity of the disease. Further he believed
that phthisis is really a contagious disease ; but thought
observers might be led into error for the following rea-
sons : I, Phthisis from its very nature would be likely to
have a long incubation period, and thus the true source
of infection might be overlooked in many cases ; ?, that
the germs seemed, from carefully conducted experiments,
to lose their vitality soon after their ejection from the body
in which they were produced ; 3, few germs are contained
in the ex])ired air, 3-et if this be concentrated and passed
through a cage holding small animals these can be ren-
dered tubercular in this way ; and 4, in many cases these
i^erms came in contact with persons of sufficient power
to resist them, just as in the contagion of other diseases.
With regard to treatment he held : i, that rest was of
great importance, as the lungs had not so much work to
perform ; 2, good nourishment of every kind ; 3, elevation
to a height of about 4,000 feet ; 4, antiseptic inhalations,
which ought to be kept up almost constantly ; and 5,
isolation of the patient from sleeping with others in the
family, or too close intimacy.
Dr. I. H. Richardson agreed in the view that phthisis
was possibly one of the most contagious class of diseases.
Dr. Burt, of Paris, exhibited a patient who had been
a very severe example of
trau.matic tetanus.
The wound from which the disease originated was on
the lower front part of the forearm. He practised com-
plete insulation of the forearm by a thorough dividing
of the nerves supplying it. The patient made an ex-
cellent recovery.
Dr. Strange, of Toronto, read a paper on
aceton.emia.
He thought that the presence of acetones in the blood
was the cause of the coma in diabetes. He referred to
the hopelessness of diabetic coma, and expressed the de-
sire that ere long we would be in a better position regard-
ing treatment.
In the discussion that followed Dr. J. Ferguson held
that the coma was not due to acetones in the blood, and
further that the acetones did not depend upon the sugar
condition of the urine for its existence in the system.
Jaksch, of Vienna, has found acetones to exist in the
blood in febrile states of the body, in cases of carcinoma,
and in hydrophobia. Frerichs, of Berlin, from an exam-
ination of four hundred cases, concludes that, i, the
nerve-centres are not the real cause of tlie coma ; 2,
that the changes in the blood do not sufficiently explain
it ; 3, that urtemia is not the cause, as coma is found
without ur;i3mia ; 4, that fat emboli is not the cause, for
in some cases of coma no evidence whatever existed to
show that emboli had anything to do with the trouble ;
and 5, that acetonemia is not the cause of the coma.
Frerichs regards the necrotic changes in the kidneys as
the real cause of the coma.
Dr. J. Ferguson read a paper on
the liga.mentum teres in its relation to hip-joint
disease.
He showed that the ligament prevented undue rotation
of the leg outward ; and secondly, that if of normal
length it prevented the femur coming in contact with the
acetabulum. In a normal hip-joint there is a slight in-
terval between the femur and the os innominatum. Thus
the pelvis is suspended from the thigh bones by the round
ligaments. Should these ligaments be lengthened or rup-
tured from jumping or wrestling severe trouble may ensue.
He gave an instance of a case where hip-joint disease
was in its early stage. The boy had been greatly ad-
dicted to jump'ing from high i^laces. The patient died
of pneumonia; on a careful dissection of the joint the
round ligament on the affected side was found slightly
ruptured and lengthened, permitting the head of the
femur and the acetabulum to come into close apposition.
Dr. McPhedran showed
A case of true prurigo,
which he was treating with very good results by the hypo-
dermic injections of nitrate of pilocarpine. As much
as one-grain doses had to be given before diaphoresis
could be produced.
78
THE MEDICAL RECORD.
[July 21, 1883.
@omxsp0ndcucc.
OUR LONDON LETTER.
(From our Special Correspondent,)
CHOLERA IN EGYPT- — THE HARVEIAN ORATION BY DR.
HABERSHON MEDICINE AND RELIGION THE SUMMER
SESSION THE COMING ELECTION AT THE COLLEGE OF
SURGEONS.
London, June 30. 1SS3.
Some alarm has been caused by the report that an out-
break of cholera has occurred in Egypt. Later intelli-
gence seems to show that many of the cases are rather
cases of typhoid, and that no genuine epidemic of Asiatic
cholera has taken place.
The Harveian Oration at tlie College of Physicians for
this year was delivered on Wednesday last, 27th inst.,
by Dr. Habershon. After referring to the successive dis-
coveries made by physiologists in different ages, Dr.
Habershon spoke of Darwin and struck a different note
to most of his predecessors when he maintained that
though Darwin's facts are true, his deductions are not.
Dr. Habershon is not alone in this. Many distinguished
scientists do not accept Darwin's deductions as ne-
cessarily true. It is in fact but a theory. One of our
weekly journals has, however, seen fit to call Dr. Haber-
shon to account for his statements and also because his
oration had a religious bearing. It is unfortunate that
paragraphs of this description should promote the idea —
already too prevalent amongst the public — that medical
men as a body are opposed to religion. This popular
fallacy is very widespread and at times gives rise to curi-
ous statements. Not long ago I heard a gentleman
state that he only knew two medical men who took any
interest in religious matters, although he was in a position
which brought him in immediate contact with a large
number of the prominent jiractitioners of London, "a
gentleman who was present at the time, immediately cor-
rected him by naming half a dozen others, amongst whom
was Dr. Habershon, long well-known for his activity in
this direction. It is not long since Dr, Lauder Brunton
produced a volume on " Religion and Science," and Dr.
Mortimer Granville — who not long ago was conducting
The Lancet — has just produced a volume on " Some Dif-
ficulties of Belief." Perhaps a more important example
is that of the work done by Dr. Chance, who, on account
of his great Hebrew scholarship, is serving as a member
of the company of the revisers of the Old Testament.
The summer session is now drawing to a close, and
doctors as well as their patients are discussing the great
question where to go? Another indication of the season
is seen in the publishers' lists, where books on spas are
numerous. Within the last few days several books of
this description have appeared.
The coming election (next week) of two Fellows to
seats in the Council in the College of Surgeons promises
to be an exciting one. The candidates are fairly equal
as to merit, but the question of allowing country Fellows
to vote by proxy or by voting papers is a burning one
and will probably decide the election. The .►Xssociation
of Fellows of the College of Surgeons has brought press-
ure on the candidates to elicit their views on this im-
portant question. The justice of the demand made by
the provincial Fellows seems self-evident.
Sea-.sick.ness and its Treatment. — Dr, G. L. Wal-
ton, in an article on this subject {Boston Medical a/ut
Surgical Journal), argues against the value of bromide
of sodium as recommended by Beard. In brief, his
view is that in small doses the bromide is useless, in large
doses it may be dangerous. The author brings very lit-
tle evidence to illustrate his views and quite ignores tlie
very large number of cases where the bromide does give
vast relief.
THE INTERNES OF THE HOSPITALS— DO
THEY DERIVE AS MUCH BENEFIT FROM
THE SERVICE AS THEY SHOULD ?
To THE Editor of The Medical Recokd.
Sir : The clinical advantages given to the medical student
of this city arc inadequate, and not in proportion to the
immense amount of clinical material at hand.
There is seldom a time in the course of his college
life when a student without special advantages can get the
opportunity of examining a case of disease at his leisure
after it has been demonstrated by the professor in charge.
Take for example a medical clinic. There are perhaps
sixty or eighty students seated at various distances from
the pit. A patient is brought in, the professor asks his
questions, makes his diagnosis, outlines the treatment,
and the case is sent out. There is usually no time for
the students to ask questions or to examine the case for
themselves. The case passes from their view, and they,
if at all skeptical, do not feel sure that the diagnosis is
correct. No explanation is given as to why certain rem-
edies are given in preference to others just as efficacious.
In my mind, it would certainly be of greater advantage
to the student to have one case thoroughly explained to
him, giving the why and wherefore of questions asked
and drugs prescribed, and then allowing him to examine
the patient. Under the present arrangement it is per-
fectly possible, as was some time ago stated in one of
our journals, for a student to pass three years at a medi-
cal college and graduate without having been near or
questioned a single sick person.
The question I wish to ask, is this : " If the clinical
advantages of the college student are so slight, do the
Internes of our hospitals receive as much advantage from
their positions (won by hard work) as they have a right
to expect ? I do not think they do. In such a matter
a great deal depends on the character of the interne.
But leaving that out of consideration, I ask, " Do the at-
tending i^ihysicians and surgeons give their staff as much
clinical instruction as they should ? I think all who have
experience in such matters will agree with me that they
do not. The clinical advantages of the hospitals are very
great, and in some of them they are taken advantage of
to a limited extent. But in how many of them is it cus-
tomary for the attending physician or surgeon to give the
staff regular clinical instruction ? It is certainly a rare
thing to have a short lecture delivered on an ordinary
case during the daily rounds with the attending physician.
It does not seem to occur to the majority of them that it
is their duty to give such instruction as often as it is pos-
sible. It is true that once in a while a few remarks are
made on a ca.^e which is interesting either on account of
its rarity or its severity. But such things are of no prac-
tical value to the young man just starting out in practice.
All ordinary cases are dismissed with a few words and
their treatment is relegated to the gentleman at the head
of the staff.
And how often is such a young man capable of treat-
ing the majority of cases unless he have received previ-
ous instruction from some one of experience ? Because
a person is intelligent and has a mind well stored with
facts, it does not follow that he can apply these facts to
the best advantage without a certain amount of guid-
ance. But there is another side to the matter of in-
structing the staff. It is their duty to at least appear to
enjoy and appreciate whatever it may please the attend-
ing physician to tell them.
One cannot expect a teacher to persevere long if his
audience plainly show that they are bored. This is a
trait more often found in the junior members of the staff.
They are very apt to think that they know everything
worth knowing and fhat it is hardly worth while to take
up their time telling them things of apparently so tri-
fling importance. These are the men who, after they
have been in the routine of practice for a few years, re-
gret the neglect of such advantage in the past.
July 21, 1883.]
THE MEDICAL RECORD.
79
Even the nurses in our training schools receive in-
struction in matters in which every physician should be
proficient, but in which no instruction is given.
I refer to making and applying poultices, fomenta-
tions, stupes, blisters, in giving sponge-baths without
endangering the patient's condition. No instruction is
given in cupping and leeching. Where is there a young
l)hysician who can show their patients' friends or rela-
tives how to change a sheet so as to disturb the patient
the least ? It may be said that the physicians of this
city do not need to know such things. This may be true
in a measure, but not all people, even in large cities,
can afford to have a trained nurse to do them.
But the majority of physicians, graduates of the city
colleges, are scattered over the South and West, and a
country practitioner who cannot show his country nurses
how to do these things is certainly wanting in his duties
toward his patients.
Such things, trifling as they may seem, are practically
of more importance to the country practitioner than a
thorough knowledge of pathological appearances at au-
topsy. For, how often is a post-mortem examination
made in the country ? Hospital men, at least, should
know how to do all these things.
Instruction in giving anesthetics is practically un-
known in this city, strange as it may seem. In hospi-
tals the junior-assistant usually administers the ana;s-
tlietic. He may or may not have given it before entering
the hospital. He has usually never seen it given except
perhaps in the amphitheatre. He has not the remotest
idea what symptoms indicate danger, but he gradually
gains this by a sad experience. Under the present sys-
tem there is great danger to the patient and a great
waste of time and anaesthetics. I think all operating
surgeons will agree with the assertion that ether and
chloroform should be administered by a person specially
trained and ai)[)ointed for that purpose, or at least by
the senior assistant, who has had six months in which to
learn something about it in a practical way.
Respectfully,
An Ex-Resident.
MEDICAL ADVERTISEMENTS.
To THE Editor of The Medical Record.
Sir : The criticisms of The Record uiion the practice
of religious journals publishing advertisements of secret
medicines promi)ted me to write to the managers of the
Western Methodist Hook Concern, Cincinnati, O., in re-
gard to the loss to the income of their publications which
they have sustained by their refusing to publish medical
advertisements of any kind. There are published by
this concern four papers, viz.. The Western Christian Ad-
vocate, Cincinnati, O. : Northwestern Christian Ach^ocate,
Chicago ; Central Christian Advocate, St. Louis, and
Christian Apologist, Cincinnati, O. From all of these
papers such advertisements have been excluded for three
years. In answer to my inquiry they state that they lose
annually several thousand dollars, and that during the week
that my letter was received they refused such an advertise-
ment, for the publishing of which they were ofiered one
thousand dollars. They add, furthermore, that to exclude
such advertisements does not pay financially. Be it said,
though, to their credit, the present management have no
idea of departing from their present course. I only send
you this item to show that to the rule there are some ex-
ceptions. It is to be hoped that the e.xample of the few-
religious papers that refuse to advertise a disreputable
business, will be followed by others. And once these
journals practise consistency, a great check will be put
upon the actions of those ministers who so flippantly en-
dorse such medicines. Evidently there is a brighter
day dawning for the honorable practice of medicine, and
since, as a profession, we are trying to educate the laity
above a belief in faith cures, patent medicines, etc., is it
anything more than just that we should ourselves flee
from the very appearance of evil ?
Please allow me a few questions and thoughts upon the
subject of medical advertisements in our own journals.
Is it not a fact that to the readers of medical journals it
has become almost obnoxious to see upon every page,
and often half a dozen times on a page, such as this,
'■ Beware of imitations," "Specify our make," and scores
of other such admonitions ? As though one were upon
the brink of ruin and did not know it. Then the list
of adjectives which appear in our advertisements com-
pare favorably as expressing superlative worth with the
laudations of the patent medicine vender. Do we not
condemn patent medicines because they are advertised
to cine almost every disease ? And yet if we believe our
own advertisers I can cure nearly all of the ills that flesh
is heir to, with a few samples of mineral water, for
instance, conditional only, as one professor says in his
advertisement, " that it be taken in time." Can we with
consistency, as long as we permit such things in our jour-
nals, say to the patent medicine advertisement in the
religious paper, "Out, damned spot?" If these things
are objectionable would not the manufacturers remedy
the evil if the publishers declined to publish these adver-
tisements ? I would not presume to speak for any one
else, but I would order A.'s pills just as often if he did not
in his advertisement tell me in every other line to do so,
and I would have as much confidence in their efficacy if a
certain doctor had not said, "They are incomparably the
best."
Please say to the manufacturer who is inclined to be
exuberant in his praises of his goods, and to the phy-
sician who is already great enough to not need to ad-
vertise himself by thus publishing what may be nothing
more than the pleasant effects of a good dinner — say to
them, in the language of the boy upon the street, even
though his language may not be strictly a;sthetic, " Give
us a rest." T.
MiLLBURY, O.
"A RARE CASE INDEED."
To the Editor of The Medical Record.
Sir : An article under this title in the July number of
The Medical Record, page 16, gives a case of extru-
sion of a fcetus after burial of the mother ; and the com-
mentator offers as a reason for this unusual occurrence
either that the woman was buried in a state of suspended
animation or that the fcetus was extruded immediately
after death, leaving us to infer that uterine contraction
is necessary to expel a fcetus. In legal medicine this
interesting subject has received nmch attention, and per-
haps the best remarks upon it are to be found in " Tidy,"
vol. i., pages 71-72 (Wm. Wood & Co.) : " It is import-
ant to note that the development of gases in the body
has been known to produce certain effects closely simu-
lating vital acts. Probably gaseous distention is the
usual cause of the occasional movements of a corpse,
such as its turning on the side after it has been 'settled'
in the coffin. Again, it is recorded that the pressure
of the gases generated in the abdomen has been suffi-
cient to force f»ces from the bowels, urine from the
bladder, and even a fcetus from the uterus (Case 73).
Dr. Aveling records a series of six cases collected from
medical literature, where delivery is said to have oc-
curred spontaneously after death. In one of the cases
it is stated that the child was born alive. It is certain
that, as a rule, this spontaneous post-mortem delivery
results from the pressure exerted by the gases developed
in the abdominal cavity, although another explanation
of this unusual occurrence has been suggested."
" Tidy " here refers to the theory of post-mortem con-
tractions of the uterus.
The author also refers to a case of inversion of the
unimpregnated uterus from the pressure of gases devel-
8o
THE MEDICAL RECORD.
[July 2 1, 1883.
oped after death in the abdominal cavity. It is perhaps
hardly necessary to add that the development of gases
of- decomposition may be very great within a few hours
after death.
I am, sir, etc.,
W. H. Taylor, M.D.
New Bkdford. Mass.
HOT WATER IN THE TREATMENT OE IN-
FLAMMATION OF MUCOUS MEMBRANES.
To THE Editor of The Medical Record.
Sir : In your issue of June i6th, you quote, from the
Medical Age, Dr. Ritzy's method of treating throat
troubles with hot-water gargles. I have used hot water
as a gargle for the past six or eight years, having been
led to do so from seeing its beneficial effects in gvne-
cology.
In acute pharyngitis and tonsillitis, if properly used at
the commencement of the attack, it constitutes one of
our most eftective remedies, being frequently promptly
curative. If used later in the disease, or in chronic cases,
it is always beneficial, though perhaps not so immediately
curative. To be of service it should be used in consider-
able quantity (a half pint or pint) at a time, andy/w/ as
hot as the throat will tolerate. I have seen many cases
of acute disease thus aborted and can commend the
method with great confidence.
I believe it may be taken as, an established fact, that
in the treatment of inilammations generally, and those of
the mucous membranes in particular, moist heat is of
service, and in most cases hot water is preferable to steam.
All are familiar with its use in ophthalmia and con-
junctivitis, as also in inflammations of the external and
middle ear, and I feel confident that those who employ
it for that most annoying of all slight troubles to prescribe
for, viz. : a cold in the head, or acute coryza, will seldom
think of using the irritating drugs mentioned in the books,
nor of inducing complete an.-esthesia with chloroform m
preference to the hot-water douche. It is important to
recollect, however, that to be eftective in aborting this
disease, it must be employed durmg the first stage of
hyperajmia.
Nor is the urethral nmcous membrane any e.xception to
the general rule. Cases of urethritis and gonorrhoea are
benefited or cured by its use when applied at the com-
mencement of the inflammation. In the cure of gleet, I
know of no other agent so often serviceable. Where
there is no stricture, almost any case of gleet wall yield in
a short time to the use of the hot-water douche followed
by mild astringents.
Keep in mind the principle of its curative action, viz. :
the removal of hyperemia, and the local sedative influ-
ence, and there will be found few cases of inflammation of
mucous membranes where it will not, at some stage of the
disease, promote a cure.
George R. Shepherd, M.D.
Hartford, Co.nn., July 12, 1883.
The .'\ntiVivi.section Agit.ation-. — .\ recent number
of the Contemporary Review contains an article on tlie
anti-vivisection agitation by the celebrated physiologist,
Dr. E. DeCyon, and a reply by Mr. Hulton. The former
gives several examples of wholly dishonest use made by
the anti-vivisectionists of England of diagrams and garbled
or distorted sentences from his " I'hysiologische .Metho-
dik." Of course that was to be expected, but it makes the
deed none the less disgraceful. When a party profess to be
actuated by such high and lofty humane views as do these
agitators, it certainly is most contemptible that they should
use such dishonest means to prejudice the communitv.
Cyon also shows that of the two Oerman leaders against
vivisection one knew absolutely nothing about the sub-
ject, and the other was actually insane, as is now known,
when he attacked physiological experimentation so bit-
terly.— Weekly Medical Review.
'^txo lustvixiixcnts.
PREMATURE DELIVERY FORCEPS.
By STOYELL C. P.\RS0NS, M.S., M.D.,
ATTENDING SURGEON TO NORTHEASTERN DISPENSARY, DEPARTMENT DISEASES OP
WOMEN.
On several occasions, having to use forceps in prema-
ture delivery, with the misfortune of having the instru-
ment slip off four to si.\ times during the necessary
manipulation, I thought it necessary to try and over-
come the difficulty if possible, and after a successful ex-
perience of three cases with my forceps, as illustrated by
accompanying woodcut, I think I have accomplished my
object.
Dr. Brickel's, being about the only one of any merit,
are excellent where the head is in the inferior strait, but
in the superior they are at times applied with great diffi-
culty on account of the handles being comparatively
straight or without the pelvic or cradle curve, as used by
Dr. Sawyer, of Chicago. On being applied and tension
made, the power is exerted in the line of the axis of the
superior plane, thus forcing the head against the pubis
and retarding instead of aiding delivery. As before
stated, tension being made, the blades do not hold se-
curely on account of their having a slight outward flare
at the tip, thus weakening them where the greatest power
of assistance is required. To obviate these difficulties, I
have continued the original curve of the fenestra inward
to the tip so that the power of resistance is equal through-
out the entire blade, and the head once fairly inserted
within it, it is impossible for it to slip, except by breaking
or bending in consequence of poor material. The han-
dles I give the cradle or pelvic curve, thus enabling the
operator to introduce the same with less difficulty and
exert all tension or force in the line 'of the axis of the
pelvic canal. My thanks are due to Messrs. Shepard &
Dudley, 150 William Street, New York, for their kind-
ness in furnishing designs.
The forceps weigh two hundred and forty-two grammes
and are illustrated by the accompanying cut, w-hich is
executed one-fourth scale.
Jivtuij and gtciuwi |lltnus.
Official List of Changes of Stations and Duties of Officers
of the Medical Department , United States Army, from
July 7, 1883, to July 14, 1883.
Baily, E. I., Colonel and Surgeon. In addition to
his present duties to take charge of the oflice of Medical
Director, Military Division of the Pacific, during the
absence of the Medical Director. S. O. 64, par. 2,
Military Division of the Pacific, June 30, 1883.
Sutherland, C, Colonel and Surgeon, Meilical Di-
rector, Military Division of the Pacific. Granted leave
of absence for one month with permission to ajiply to
the Adjutant General of the Army for extension of two
months. S. O. 64, par. i. Military Division of the Pacific,
June 30, 1883.
Campbell, John, Lieutenant-Colonel and Surgeon,
Medical Director Department of the South. Leave of
absence on surgeon's certificate of disability granted by
S. O. 50, Department of the South, May 21, 1883, ex-
tended one month on surgeon's certificate of disability,
with permission to leave the Department of the South.
S. O. 156, par. 7, A. G. O., July 9, 1883.
July 21. 1883.]
THE MEDICAL RECORD.
81
Peri.kv, Harry O., Ca|)tain and Assistant Surgeon.
Assigned to duty at Fort Pembina, D. T. S. O. 118,
par. I, Department of Dakota, July 5, 1883.
Official List of Changes in the Medical Corps of the Navy
for the week ending July 14, 1883.
Green, E. H., Past Assistant Surgeon, granted leave
of absence for one month.
Griffith, S. H., Past Assistant Surgeon, granted leave
of absence for one month.
Hudson, A., Medical Inspector, Assistant to Bureau
of Medicine and Surgery, granted leave of absence for
one month.
STeXedtcat Stems.
Contagious Diseases — Weekly Statement. — Re-
port of cases and deaths from contagious diseases re-
ported to the Sanitary Bureau, Health Department, for
the two weeks ending July 14, 1883 :
Week Ending
■J
>
1
>>
fe"
>
•3
u
o.S
II
•g.
%■
F
>
h
H
73 1 U
A
0
tn
>•
Cases.
uly 10, 1883
I
13 i 42
4
81
20
0
0
ulv 17, 18S1
0
18 38, 4
68
23
0
n
-
Deaths,
i
Tulv 10. iSS"?
I
(S
12
4
4
TO 1 I -2
0
0
July 17,1883
I
10
7
21
16
0
0
Medical Practice in England. — The Students
Journal says: "There are great complaints in profes-
sional circles, both East and West, as to the scarcity of
money. 1 hear that many of the West End physicians
find their incomes this year very seriously reduced in
consequence of the general depression in trade and the
straitened circumstances of many of the landed proprie-
tors of the country. Every one is obliged to be content
with smaller fees, and unfortunately there are fewer of
them."
An Anesthetist is the latest medical title. It has
been bestowed upon a medical officer of the Chelsea
Hospital. An anajsthetist may be described as a person
who e.xcites no feeling.
The Trichina in Chicago Pork. — In the present
agitation over trichinous pork and adulterated lard, the
investigations made some years ago by Dr. W. T. Bel-
field, and Mr. H. F. Atwood, of Chicago, may be cited.
They examined the pork in the various packing-houses
of that city, and found trichina; present in eight per
cent, of the specimens, the parasites averaging about
20,000 to the cubic inch. These gentlemen believe
that infection of human beings with trichina; is very
much more common and less injurious than is commonly
supposed. They have made the interesting discovery
that a small portion of sulphurous acid dissolved in the
brine in which hams are pickled will kill all the trichinx.
Nervous Constipation. — In nervous constipation
the Rivista di Bologna recommends the following pill :
5. Pulv. ferri sulphatis o.io (gr. i4-)
Aloes soccotrinas 0.05 (gr. f )
Ext. belladonna; 0.005-0.01 (gr. i^j-l-)
From one to four of such pills may be taken during the
day. Should intestinal atony be suspected, the extract
of belladonna is to be replaced by ext. nucis vomicae,
o.oos-o.oi (gr. ^-^-\).
Suicide in Europe. — According to Legoyt, the num-
ber of suicides to each million inhabitants in the various
countries of Europe is as follows: Germany, z6i ; Den-
mark, 257; Switzerland, 215; France, 160; Austria,
121; Belgium, 87 ; England, 69 ; Holland, 45; Russia,
30 ; Italy. 37(27?); Ireland, 21; Spain, 17. In almost all
of these countries suicide by strangulation is preferred.
In Germany, of 100 cases of suicide, 64 were cases of
strangulation ; in Austria, 47 ; in Hungary, 60 ; in Den-
mark, 77 ; in Russia, 73. Second in favor to strangula-
tion stands drowning, a method, however, practised less
in France than elsewhere. Poisoning is not employed
much except in Ireland and Italy. Suicide by means of
the gas from charcoal occurs more frequently in jiropor-
tion in France, and especially in Paris, than elsewhere. —
Gior. Int. delle Scietize Med.
Winter at Catania. — The advantages of Catania as
a winter resort have as yet received but little attention,
although the climate is by medical climatologists claimed
to be one of the finest. Dr. Ughetti recommends the
place on account of its uniform temperature (mean for
the year, 18.5°, mean for the winter, 13.1°), with its
slight and graded oscillations, its freedom from winds,
and because of the number of serene days without rain,
fog, or snow. The atmospheric pressure also varies but
little (from 768 to 750). — Gior. delta Soc. It. d'lgiene.
The Physiology of Si,eep. — M. Vulpian in his
lectures upon the vaso-motor system seems to have
demonstrated that the present popular theory of cerebral
anaemia causing sleep is not correct. He argues first
that insomnia is a frequent attendant of general ana;niic
conditions. The idea that drowsiness after meals is
caused by derivation of blood to the stomach and in-
testines is disproved, he says, by looking at the turgid
countenance and throbbing temporals of the sleeping
gourmand. Vulpian was never able to produce sleep by
compressing or ligating arteries that supply the enceph-
alon, nor by galvanizing the cervical sympathetic, and
thus producing cerebral ana;mia. He e.xamined the
membranes of the brain of numerous animals whom he
had placed under ana;sthetics or hypnotics. In none of
them was there any notable change in the vascular sup-
ply. He concludes that the vascular supply has nothing
to do with the causation of sleep ; that any slight
ana;mia which may accompany this condition is a result,
not a cause. M. Vulpian furnishes no substitute for the
theory he destroys. He simply considers sleep to be a
habit of the nervous system of relapsing into a state of
torpor.
The most generally accepted theory now is probably
that of Prof. Preyer.
The Death of the Rev. Chas. W. Calhoun, M.D.
— Rev. Charles W. Calhoun, M.D., a medical missionary
of the Presbyterian Church, stationed at Tripoli, Syria,
died about three weeks since at Shevcifat, Mt. Lebanon.
He was the only son of the late Rev. Dr. S. H. Calhoun,
and was educated at Williams College, Union Theologi-
cal Seminary, and Bellevue Medical College. He was a
native of Syria and an intimate acquaintance with the
Arabic tongue gave him easy access to the hearts and
homes of the people. About a year since he was sub-
jected to a series of vexatious persecutions from the
Turkish authorities at Tripoli, and since then he has spent
most of his time travelling among the villages. One of
the insults heaped on him was the removal of the sign
on his office. The American Minister at Constantino-
ple, Gen. Wallace, was requested to demand redress for
this act from the Turkish Government, and almost at
the same time with the news of his death came a tele-
gram stating that an apology had been demanded.
Habitual Constipation. — In the British Medical
Journal Dr. J. Mortimer Granville offers three prescrip-
tions which he claims are generally applicable to the
treatment of all the well-recognized forms of habitual
constipation. He sees three forms of the disease, one
due to deficient peristaltic action, one due to deficient
82
THE MEDICAL RECORD.
[July 21, 1883.
glandular secretion, and one due to intemiption of the
habit of periodic evacuation. For the relief of the hrst
form he prescribes :
5- Sodre valerianatis gr. xxxvj.
Tincture nucis vomicae li],. Ix.
Tinctureu capsici Til,, xlviij.
Syrupi aurantii 3 iss.
Aqua ad 3 vi.
M. Ft. mistura. Sig. — Tablespoonful in water half an
hour before meals.
For the second form :
I> , Aluminis 3 iij-
TincturHe quassia 3 j.
Infusi quassife o ^'j-
M. Sig. — Dessertspoonful after meals.
For the third form :
5 ■ Ammonia carbonati " j.
Tincturje valerians? 3 j.
Aqua; camphors 3 v.
M. Sig. — Take ounce as directed on arising from bed.
Dr. Granville insists upon a regular hour for going to
stool, at least to make an effort at evacuation. He pro-
poses to establish in this way the normal habit, and thinks
aperients in habitual constipation do no good. One
naturally inquires, when reading the above, what is to be
done if two or even all three of these forms are united.
F.\CTS FOR Our Religious Weeklies. — Prof A. B.
Prescott says that the use of patent medicines without a
knowledge of their composition does injury to the health
of the people, for the following reasons : i, they may, and
in fact sometimes do, contain powerful or poisonous
articles unsuspected ; 2, they always may be, and often
are, inert, and become a false reliance to the neglect of
other and due measures in the (iare of health ; 3, they
are liable to be changed in composition, so that any ex-
perience of their effects as they are purchased at one
time is not conclusive as to the same named articles pur-
chased another time ; 4, it is submitting health to the
treatment of a distant and irresponsible stranger, and
learning to hazard health in an apparent game of chance ;
5, they are trusted to act as antidotes to disease in the
sense in which no medicines can antidote disease ; 6,
they favor e.xcessive recourse to medication and thereby
increase the resort to physicians.
The Treatment of Acute Goitre with the Bini-
ODIDE OF Mercury. — Dr. Mouat, of Bengal, was the first
to notice specially the value of the use of biniodide of
mercury in combination with the rays of the sun in the
cure of goitre. His practice was to use the niwcury as
an ointment of three drachms to a pound of lard ; a por-
tion was rubbed in an hour after sunrise, the patient
afterward sitting with his goitre well exposed to the sun
as long as he could endure it. After this a fresh layer of
ointment was carefully applied, and in ordinary cases a
single application was sufficient. Of the value of this
treatment in India there can be no question. Surgeon-
Major Albert A. Gore, reports {Dublin Jour7ial of Medi-
cal Science) thirty cases which he successfully treated in
this way.
Professorships at Cambridge. — Dr. Michael Foster
has been elected to the newly established Chair of Physi-
ology, at Cambridge. Dr. Alexander .Macalister, of Dub-
lin, was elected to the Chair of Anatomy, and Professor
Humphrey has been appointed to the Chair of Surgery.
In Phthisis and Bronchitis, Renzi and Rimuno re-
l)ort good results from the inhalation by spray of iodo-
form dissolved in turpentine.
Phenoresorcin is the name of a mixture composed
of carbolic acid sixty-seven per cent, and rcsorcin thirtv-
three per cent. The addition of ten per cent, of water
makes a fluid which can be diluted p. r. n., making a
powerful antiseptic wash.
Something Worth Fighting for. — A State board of
examiners, the greatest need of the medical profession in
the State of New York — a "mixed board" the only
efficient one attainable under present conditions. — Buffalo
Medical and Surgical Journal.
The Poisonous Properties of the Castor Bean. —
Dr. R. S. Harden, ol Waverly, N. Y., writes : " Upon
reading the account ol poisoning from eating castor
beans, in The Medical Record of June 30, 1883, 1 was
reminded of my own (personal) experience with the
bean. While a medical student at Bellevue in 1872, our
professor of materia medica. Dr. McCready, picked a
handful of the beans while passing through the hospital
grounds and during his lecture upon cathartics he passed
them around among the class, facetiously remarking that
if any of us were in need of physic we could eat some of
them. Not requiring a cathartic, but simply out of
curiosity, I ate one bean, the results were very surprising
and alarming. I vomited and purged violently all night,
and purged during niost of the next day, being so e.x-
tremely prostrated that I was very much alarmed for fear
of a fatal termination of my experience with the pro-
fessor's innocent castor beans."
Our Alarmist Conte.mporary, The Lancet, makes
the extraordinary statement that " it would be dilficult
to imagine a more powerful apparatus for conveying dis-
ease than a book." Our esteemed but over-earnest con-
temporary goes on to picture the circulating library as a
chamber of insuppressible horrors, and borrowed books
as containing the promise and potency of the most deadly
contagions. The question follows. Is it better to live
illiterate or die of the measles, whooping-cough, chicken-
pox, mumps and all the other ills to w'hich flesh is heir, and
circulating libraries are testators to? If the Lancet had
only taken the trouble to give its alarmed imagination a
rest, and had consulted some of the facts, it would have
found that the question of contagion by books has been
carefully studied, in this country at least, and very little
made out of it. The Lancet has got into a condition
of sanitary erethism, and is bound to make its readers
uncomfortable. We are reminded of Punch's verses,
which might very well be directed against
"th.^t dreadful journal.
" It warns us in eating, it warns us in drinking,
It warns us in reading, and writing, and thinking ;
It warns us in foot-baU, foot-race, eight-oar "stroking,*'
It warns us in dancing and cigarette smoking ;
It warns us in wearing red socks and shampooing.
It warns us in taking champagne and canoeing,
It warns us of drains in our snug country quarters,
It warns us of fever in mineral waters,
It warns us in everything mortal may mention,
But — what gives rise
To but little surprise,
Nobody pays it the slightest attention."
The last is certainly wrong, as regards our valuable
contemporary, however, since its views are always widely
quoted, being always forcibly put forth.
In Pruritus of the Genital Organs, Scavenzio
recommends local hypodermic injections of morphine.
Beer in the Paris Hospitals.- — The Frogres Medical
(June 9) criticises a rather arbitrary circular which M.
Quentin, the Director of the Assistance Publique, has
just issued to the directors of the Paris hospitals, with
instructions to comnumicate it to the medical officers.
In this he declares that the consumption of beer in the
hospitals has for some time past so increased as to be-
come a very serious charge upon the budget and derang-
ing its equilibrium. This abuse, as he terms it, he can
no longer permit, for beer he declares to be neither a food
nor a medicinal agent, and therefore it must from this
date cease to be furnished as one of the current articles
of diet, and only become procurable by means of excep-
tional prescriptions of the chefs de service under the sur-
veillance of the Central Administration. The Progres
disputes the assertion that beer is neitiier food nor medi-
July 21, 1883.]
THE MEDICAL RECORD.
83
cine, and states that the medical officers find it of great
vaUie in the treatment of disease, and regards it as some-
what surprising that the Director should have issued this
decree (which really means almost entirely stopping the
use of beer) merely for economical reasons, without con-
sulting the medical body as to its propriety. If economy
is the object in view, there is said to be ample means of
accomplishing it in the hospital administration, which is
far too numerous. The hospital physicians have also
signed a protest against the withdrawal of the beer.
Nevertheless, it is abundantly demonstrated in America
that beer is not an essential to a diet list of a hospital.
Successful Operation for Strangulated Inguinal
Hernia on a Man Eighty-one Years Old. — Dr.
H. S. Hendee, of Louisville, N. Y., writes: "On June
6th I was called to an adjoining town to visit a well-
known citizen, Mr. A. A •. Found him suffering from
strangulated hernia, and had been in that condition for
fifty hours. At once attempted its reduction, but
failed. Gave chloroform, with the hope that under its in-
fluence parts might relax and reduction follow, but with
the intention if reduction failed, to operate. Dr. C. P.
Kirby of this place was called, and gave efficient aid.
After making proper, but ineffectual efforts to reduce the
hernia, the operation was at once commenced. The
opening was made to the bowels and ring, with very little
loss of blood, not exceeding half an ounce. The bowel
was highly discolored. Dividing the ring was but a mo-
ment's work. The bowel was carefully sponged and re-
turned to its place. Three deep ligatures united the
wound. Carbolic acid lotions were applied ; morphine
internally. By June 20th the patient was practically well.
The points which make this case worthy of note are,
first, the age ; second, the time which elapsed after the
strangulation and before the operation, showing, as
it does, that age and lapse of time need not deter the
surgeon from making the operation. "P
Politics and MEDiciNE.-^The Dayton, O., Board of
Health has discharged the Health Officer, Dr. Thos. L.
Neal, and appointed a vigorous Democrat, Dr. A. H.
Iddings, in his place. The Dayton Journal adds that
" it was the deliberate opinion of the Board that the
sanitary condition of their party demanded a Demo-
cratic doctor."
The American Medical Man Abroad, and how
He is Regarded. — A correspondent of the Cincinnati
Lancet and Clinic writes home regarding the status of
American medicine abroad, giving perhaps a rather one-
sided view of it. He says: "They know one thing at
least, and that is that medical diplomas can be bought in
our country, and that almost every American has one of
them concealed somewhere in his inside vest-pocket.
' How are the Doctors Philadelphia progressing ? ' 1
heard one of them remark to a friend of mine the other
day. ' Finely,' he said, ' the American Government
issues them to us as passports, and they thus serve as an
easy means of identification, besides serving as a medi-
cal diploma.' 'You don't say so,' he replied, and [irob-
ably went off to communicate the fact to Bismarck.
They get the idea that bushel loads of these bogus med-
ical diplomas, or D. P. (Doctor Philadelphia;), as they
call them, are sold to the highest bidder, that most of
our colleges engage in traffic with them by the fact that
these quack professors advertise their institutions in the
German papers, probably intending to attract the back-
door German candidates to our shores. No wonder
their faith in our colleges is shaken somewhat ; no won-
der they look with suspicious eye on the title of M.D.
(Genus Americanus). Here is another sample of their
thoughts. One of the most celebrated gynecologists of
this city thus addressed the class one morning: 'Gen-
tlemen, I present you a case of abortion of not unfre-
quent occurrence in this part of the country, our Ameri-
can neighbors, however, annually have six tliousand
abortions, besides a large number that never reach
publicity.' The German students look amazed and sur-
prised, and if perchance an American is present, he is
eyed to see how an abortionist looks. Is the medical
profession in .\merica so steeped in wickedness that a
German professor allows his students to infer that every
practitioner practises abortions, and that it is just as
common a thing to have an abortion as a broken leg or
a case of tuberculosis, for instance ?
Another Case of Transposition of Viscera. —
Dr. G. Frank Lydston, of Chicago, sends us the follow-
ing account of a case of transposed viscera : " J. M ,
twenty-four years of age, barber by occupation, con-
sulted me a short time since with reference to a slight
attack of bronchitis, and stated casually that his heart
was ' on the wrong side.' On examination, I found that
his statement was correct. The heart occupies precisely
the same relative position upon the right side that it
ordinarily does upon the left, the apex being in the right
fifth intercostal space. There are no evidences of car-
diac hypertrophy, and the valves are apparently per-
fectly normal. The chest is perfectly symmetrical, there
being no more than the normal disparity of measure-
ment of the two sides. The lungs are normal, and no
causes of cardiac displacement involving either an in-
crease of weight or extraneous pressure are present.
No dyspnoea is complained of, and the patient is to all
appearances in perfect health. At my first examination,
he had just climbed several flights of stairs, in preference
to waiting for the elevator, but was not at all inconve-
nienced thereby. The abdominal viscera are in their
normal jjositions, a point to which I will call especial at-
tention, inasmuch as such cases are usually accompanied
by a transposition of the liver and spleen. Niemeyer
states that in dextro-cardia the liver usually occupies
the left hypochondrium and the spleen the right. Tak-
ing the various features of the case into consideration, I
think we are warranted in the conclusion that it is an
instance of a quite rare anomaly, ' congenital dextro-
cardia.' Pathological displacements of the heart are, of
course, not infrequently seen, as the heart is a very
movable organ, and slight causes may suffice to displace
it, but the present case is certainly quite rare."
Sir John Hill again. — A correspondent informs us
somewhat dogmatically that the epigram on Sir John
Hill, quoted by us recently, was not written by Garrick,
but by Samuel Foote. Our authority was that of Mr.
John Timbs, and we shall have to abide by it until a bet-
ter is given.
Sir John Hill was one of the quasi-charlatans of the
eighteenth century, a man of immense ability and indus-
try, but of a waspish temper and irrepressible impudence.
He was consequently the victim of many epigrams. A
" Hilliad " was even written, in which Sir John was de-
scribed as
" A wretch devoid of sense and grace,
The insolvent tenant of uncumbered space."
Another witty individual, who had been called "a
wooden-headed booby " by the distinguished doctor, re-
torted with the following verse :
" The worst that we wish thee for all thy vile crimes,!
Is to take thy own physic and read thy own rhymes."
Some other friendly poet^caught up thejast andjwrote
the following :
'■ No ! let the order be reversed,!
Or else unlashed his crimes ;
For if he takes his physic first
He'll never read his rhymes."
The Reward of a Good Action.— Those who do
not believe in a readjusting hereafter should read the
story of the good doctor of Lyons : As Dr. Monnet, the
good man referred to, was passing along the streets one
cold day last January, he saw a drunken man fall down and
seriously injure himself. The benevolent physician hur-
ried to the fallen and stupefied man, helped him up, and
84
THE MEDICAL RECORD.
[July 2 1, I i
led him to a neighboring drug store, where he bound up
his wounds and gave him a soothing jTOtion. Scarcely
had he finished his work when the drunken man turned
and struck him violently in the face. The doctor left in
disgust, but as he was hurrying on his way the druggist
came running after him with a bill of one franc and
eighty centimes for the medicine given to the patient. The
doctor refused to pay it and went his wav. Some days
after the doctor received two official letters, one calling
on him to pay the druggist's bill, the other summoning
him to court to testify with regard to his drunken pa-
tient. The doctor, who was a busy man, neglected both
letters. He was soon after visited by a bailiff and com-
pelled to pay a fine of forty-eight francs and also for the
prescription, a total of forty-nine francs eighty centimes.
Worse than all, the scandal aroused by the visits of
the police so damaged his reputation before a prospective
father-in-law that he missed "un beau marriage."
The Bacillus Tuberculosis may have killed many
men — it has made two, Koch and Spina.
B.\ciLLUs Lepr.?;. — Cornil has recently demonstrated
the presence of bacilli in leprous tissues, and announces
that he has found a new staining reagent by which the
decomposition bacteria can be differentiated.
Ger.man vs. French Surgery. — -The Medical and
Surgical Reporter calls attention to the alleged de-
cadence of French surgery and quotes Verneuil's refuta-
tion thereof as follows : '• If we appear to have thrown
back operative surgery to the second rank, this has been
in order to advance surgical therapeutics into the first
rank. If we have shown but little eagerness to extirpate
cancers of the laryn.x and uterus, to e.xcise the oesoph-
agus, the pylorus, or the lung, to tie the aorta, etc.,
this has been because our G.allic good sense has enabled
us without difficulty to foresee the inevitable destiny of
these extravagant vivisections, and that it appears to us
of no utility boasting to-day of that which will be rejected
to-morrow. If in our surgical wards, we greatly hesitate
to transport the results obtained in laboratory experi-
ments, that is because we do not assimilate man with
batrachians and rodents, or even with the mammalia, the
most elevated in the animal scale." For all this, the
Frenchman does not make out his case. The chief con-
tributions not only to operative surgery, but to surgical
pathology and therapeutics, have come in late years from
other countries than France.
A Method of Rendering the Skin Insensible ix
Operations without Chloroform. — M. Jules Guerin
read a note at the Academic des Sciences upon a method
of rendering the skin insensible in those operations
which do not admit of chloroform by iniialation, and
cited a case in which he had employed it to advantage.
A lady, aged sixty years, consulted him three months
ago for a tumor in the right breast of eight years' stand-
ing, which, on examination, proved to be scirrhus. The
general health was bad, bronchial and cardiac troubles
were manifest, and the kidneys were not in a very satis-
factory condition. However, the operation was urgent.
Chloroform having been considered dangerous, M. Guerin
applied around the tumor a circular layer of Vienna
paste, limited by a double band of diachylon. .\\. the
end of twenty minutes the caustic was removed, leaving
in its trace a black ribbon-like line. The knife was then
applied, and the tumor removed without the patient feel-
ing the slighest pain, and who did not seem to be aware
of the operation. The results were all that could be de-
sired.— Medical Press.
The Treatment of Warts. — Vidal recommends
bandaging the wart-covered hands in tiannel and green
soap. After a number of applications the warts become
softened and can easily be removed.
The Sound in the Diagnosis of Gastric Diseases.
— Leube calls attention to the very vague methods now
in use for determining the different forms of gastric
trouble. He recommends the use of the soft sound for
the purpose of more careful investigation. A healthy
stomach should be completely empty seven hours after a
moderate meal. By the sound we can determine whether
it is really empty at this time. Specimens of the gastric
juice can also be obtained, and its acidity tested.
Chronic Constipation. — Cascara sagrada, in doses
of twenty minims three times a day, is said by many ob-
servers to be very efficient in the treatment of obstinate
chronic constipation.
A Substitute for Iodoform in the Treatment of
Wounds. — Professor Ferd. Petersen, of Kiel, claims
that zinc oxide is just as good as iodoform in the treat-
ment of wounds, that it is not so poisonous, and is
cheaper.
The Title of Doctor and M.B.— Dr. N. O'D. Parks,
of Ashton, R. I., writes: " I trust you will pardon me
again troubling you to make more plain how prepos-
terous is your London correspondent's contention. The
sole ground on which the right to the title of doctor
is claimed for the M.B., is that it is a University degree.
On that ground, above all others, the claim is most un-
tenable. Nobody ever hears, for instance, of a B.D. or
LL.B. arrogating to himself the right to be called doctor,
and there is no valid reason why a special privilege
should be conceded to an inferior degree in medicine
which is not accorded to the corresponding degree in
law or divinity, both of which take precedence of the
medical degree. There is one way, and one only, in
which an M.B. can acquire the right to the prefix Doc-
tor, and that is by proceeding to the higher degree of
M.D."
Concerning the Registr.ation of Regular Prac-
titioners AND THE Medical Register. — .'^ corre-
spondent sends us the following : "In your issue of July
7th, it is stated that, ' In what for distinction's sake may
be called the Physicians' Medical Register for 1SS3-84,
a list of only 2,684 names is given, which number repre-
sents the regularly educated physicians in affiliation with
regular medical societies (italics mine). The remain-
der are composed of homoeopaths, eclectics, and non-
descripts.' The above statement is incorrect for the
following reasons : First, it mentions the Physician's Med-
ical Register, as if its list were an official one, which,
as I understand, it does not claim to be ; second, the list
does not include all regularly educated physicians in af-
filiation with, and in good standing in the Regular Med-
ical County Society, or the .Academy of Medicine ; third,
it is controlled by a 'private organization,' claiming
the privilege of permitting or refusing registration to
whom it will — the latter in cases where, to the best of
my knowledge, it has not even attempted to allege, much
more to prove, as cause for such refusal anything derog-
atory to the character or ability of such applicants for
registration."
To Stop Hiccough — Dr. W. E. Shaw, of Cincinnati,
Ohio, writes : " I noticed the item by Dr. Martin Burke,
in Thf. Record, of the 30th ult., ' To Stop Hiccough'
by compression over the lower ribs. I have used compres-
sion successfully in (juite a number of cases of persistent
hiccough. The idea is not original, but w-as given me by
my preceptor. Dr. W. P. Kincaid, of New Richmond,
Ohio, about 1870. His methotl was to place the tips of
the fingers of both hands in position of complete supina-
tion against the abdominal muscles, at the lower and
outer junctions of the epigastric with hypochondriac re-
gions. With the finger-tips in this position, firm and very
gradual pressure was to be made backward and upward
against the diaiihragm. This pressure should be con-
tinued for some little time after the diaphragm has ceased
its spasmodic contractions, when the fingers should be
very gradually withdrawn."
The Medical Record
A Weekly yournal of Medicine and Surgery
Vol. 24, No. 4
New York, July 28, 1883
Whole No. 664
©vininal Articles.
THE STATUS OF PROFESSIONAL OPINION
AND POPULAR SENTIMENT REGARDIN(;
SEWERGAS AND CONTAMINATED WATER
AS CAUSES OF TYPHOID FEVER;
WvYH Allusions to a Paper bv Dr. Alfred I,.
, Carroll upon this Subject.'
[By GEORGE HAMILTON, M.D.,
PHILADELPHIA, PA.
In the discussion following a lecture upon this subject
before the College of Physicians, March 7th, by the
writer, the pre-eminent sanitary engineer, George E.
Waring, declared " that the sewer-gas theory in regard to
typhoid fever was, in the opinion of sanitarians, exploded."
This declaration is in opposition to the teaching and
recommendations of not a few engineers, who insist
" that every effort should be made to exclude the gas
from dwellings, regarding it as the general, if not the sole
cause, not only of typhoid, but also of scarlet fever and
diphtheria." This doctrine and these recommendations
are in accord with the opinions, and have gained the
support of a large majority of physicians. Many pro-
fessors and editors of medical journals coincide with this
view, and successfully impress its alleged correctness
upon the minds of the inexperienced student and prac-
titioner. Recently there appeared in a medical journal
a paragraph from a somewhat prominent physician to
this effect : "Is it not surprising and incomprehensible
that there can yet be found physicians who deny the
agency of sewer-gas in causing typhoid fever, diphtheria,
and scarlet fever ? " When it is stated that the writer of
this quotation is one of the most positive in regarding
sewer-gas as the efifective agent in giving origin to the
diseases named, may we not imagine another and greater
surprise when he learns that this cherished and popular
theory is exploded !
The paper upon sewer-gas, by Prof. Frank H. Hamil-
ton, published some months ago in the Popular Sricnce
Monthly, with its numerous quotations, cannot be re-
garded as antagonistic to the opinions heretofore and at
present held by many j^hysicians, sanitarians, and the
public generally. The special object of that paper was,
in fact, to devise more reliable measures to exclude from
houses this asserted source of disease ; and, to accomplish
this object, scientific plumbing, with improved apparatus
erected in an annex, outside of the residence, was rec-
ommended. EfTorts to exclude the gas are unceasing
up to the present moment ; neither is this strange, in
view of what has just been stated. Whether the typhoid,
the scarlatinal, or the diphtheritic germ, or some special
quality of the gas itself, dependent upon peculiar sub-
stances finding entrance to the sewers, and subjected to
various degrees of warmth and moisture, be the supposed
noxious agents in question, is immaterial ; for, practically,
to admit the gas is to admit one or all of these agents ;
to exclude the gas is to exclude them. Attempts have
recently been made to underrate the agency of sewer-gas
in causing typhoid fever and other diseases. Efibrts in
this direction are, doubtless, made by those who frankly
confess that the reports of the Board of Health of this
city. New York, and elsewhere, are strongly in opposition
' See Medical Record of June g, 1883.
thereto. Nor is this all ; for a large majority of prac-
titioners, who have had the most frequent and abundant
opportunities to observe the origin, development, and
progress of typhoid fever, either withhold their assent to
the current views upon this subject or positively deny
that sewer-gas is the sole cause of this fever, or that it
exceeds all other agencies, combined, in its production.
In this connection, does it not seem passing strange that,
while the Trousseaus, the Niemeyers, the Murchisons,
the Bristowes, the Flints, the Jacksons, and many others
of similar experience and capacity, entertain doubts in
regard to certain points pertaining to the origin of ty-
phoid fever, and exjjress their opinions in relation thereto
with calm, philosophic, commendable reserve, many
others, of different (qualifications and temperament, find
no difficulty of this kind, but, on the contrary, armed
cap-d-pic, are alwa}'s ready and eager to solve any ques-
tion in regard to this subject ? Unfortunately, these at-
tempted solutions are too often merely bold, positive
assertions, having no real basis of support, as is exempli-
fied in the declaration by some, " that the families located
in the wealthy and fashionable parts of Philadelphia and
New York, are most liable to attacks of typhoid fever ; "
while the reports of the Board of Health of both cities
sliow, on the contrary, that the suburbs exhibit by far
the largest number of cases. This accords perfectly
with the testimony of the late distinguished Professor,John
K. Mitchell, quoted in my paper of the 7th of March,
who, in consultation, informed the writer and the late
Dr. Louis P. Gebhardt, "that he seldom saw cases of ty-
phoid fever except on the outskirts of the city," where
water-closets were scarcely known. One of the chief
embarrassments of those who would fain be wise above
that which is written, is to account for the greater preva-
lence and fatality of this disease in the country, and to
avoid this difficulty, coftte que cofite, a reason for this
must be given. To escape the dilemma in which they are
placed, the drinking-water in the country is declared to
be contaminated from the adjacent or remote privy.
Now, this assertion should, if believed, inspire far more
dread than the sewer-gas theory ever did, even in its
palmiest days, long before the recent decree that it had
been exploded was announced. What must now be the
state of mind of the laborious farmer and family in reflect-
ing that to his own negligence or stupidity is he indebted
for this sad condition of his household ? But the mis-
chief does not end here ; for what, it may rationally be
asked, is to become of the thousands upon thousands of
our citizens who, every summer, gladly visit the country
and seek boarding with the farmer, or select for a season
the accommodations furnished by cottages or hotels, many
of them for the express purpose of escaping, as they de-
clare, the heated and impure air of the city, and the
contaminated water of the Schuylkill, receiving, con-
stantl)', as it is said, an immense amount of impurity from
Manayunk, and many other points nearer to Fairmount?
As is well known, not a few of the country people, on
visiting the city, alarmed by the exaggerated reports of the
condition of the water, abstain as far as possible from
its use. But admitting the supposition, and it is nothing
more, to be true as to contamination of the water in the
notably beautiful rolling country of the counties around
Philadelphia, how are we to explain the fact that, at un-
certain intervals, a severe epidemic will suddenly ap-
pear, fever sometimes, dysentery at other times, and
will just as suddenly disappear, and neither of these
86
THE MEDICAL RECORD.
[July 28. 1883.
diseases again be seen to any extent for one or several
years ; precisely as has often occurred in this city and
elsewhere ? To suppose that the water has thus suddenly
changed from purity to impurity, and again as suddenly
to purity, , without perceptible or conceivable cause,
either by the family physician or the family, is simply
absurd.
Such a statement as was made in the discussion alluded
to, regarding the condition of what were termed country
towns in New England, can liave but limited apphcation,
and is completely at variance with the contents of a let-
ter from a prominent physician in a New England State,
who, after inquiry in reference to outbreaks of typhoid
fever, had replies from about fifty practitioners in that
State to this etl'ect, that the rural sections suffered by far
the most from epidemics of typhoid fever. Anyone who
has travelled over the rural sections of New England
could not have failed to observe the generally good con-
dition of the farms, whatever he may have noticed of an
exceptional character in some places. But why go from
■our own city or vicinity ? Have we not in this city, or
within an hour's journey, numerous factories and densely
peopled districts, notorious, when compared with the
country, for their filthiness ; with cesspools and innumer-
able privies almost in contact with dwellings ; and, in
many cases, from the porous nature of the soil, filled to
repletion, thus affording every opportunity for the contam-
ination of the water in comparison with the countrv ?
To show how delusive \)lausibly written accounts of the
origin and spread of typhoid fever maybe, let the follow-
ing suffice : A woman, after nursing a relative during
several weeks, returned, after the death of the patient, to
her own residence, distant three miles. In a few days
she was prostrated with typhoid fever, the disease of the
relative. In succession one after another was attacked
until four out of seven members of the famil} were down
with the disease, one death ensuing from perforation.
In the discyssion of the paper one of the speakers
thought there could be no difficulty in accounting for the
attacks of the last three patients, as the dejections
from the bowels of the first patient were (probably) cast
down in such way as to admit of drainage into the
drinking-water, and that thus the typhoid germs were re-
ceived into the stomachs of those last attacked. But,
unfortunately for this solution, the drainage descended
from the source of the water to the outhouse.
In another family of eight persons, quoted in the lec-
ture of March 7th, seven were attacked with the fever, all
of them dangerously, except a colored servant. As in
the forjner case the disease did not originate upon the
premises. A son had been sent into Maryland — distance
forty miles — and after remaining there several weeks was
brought home, affected with typhoid fever ; and in suc-
cession his two brothers, two sisters, and last of all, his
father and the servant were attached. The dwelling was
upon the slope of a hill, and, as in the former case, the
drainage descended from the water in the direction of the
outhouse ; so that contamination of the water in either
instance was impossible. Typhoid and scarlet fever,
diphtheria and dysentery may not, under favorable con-
ditions, be contagious ; but under opposite conditions, as
when these diseases are malignant, and the i^atients
crowded together — for example, three in the same room
— as occurred in the family just alluded to, they are re-
garded by an immense majority of the most able, unpre-
judiced and experienced physicians as eminently con-
tagious.
Colonel Waring, to his credit be it said, was conmiend-
ably conservative in the discussion, not disposed to be
dogmatic, and, in regard to this special point, said that
" the literature of the subject seems to prove that typhoid
fever in the country is due to drinking-water which has
become contaminated," knowing, doubUess, full well
that a score of probabilities are powerless when con-
fronted by a single irrefutable fact.
To revert for a moment to sewer-gas, it appears from
the remarks of one of the disputants to be now placed in
a worse position than ever ; for while it is admitted to be
the vehicle for conveying typhoid germs, when it contains
them (?), it is also declared to be " the most potent cause
of the typhoid state." The importance of this statement
will at once be appreciated when we call to mind that
the typhoid condition is the almost invariable concomi-
tant of the latter stages of nearly all dangerous and fatal
diseases, whether acute or chronic. During the discus-
sion repeated appeals were made on behalf of cleanliness.
But who ever heard of any one, who had the least regard
to the amenities of life, opposed to cleanliness? for is it
not said to be " akin to godliness ? "
The criticisms by Dr. .\lfred L. Carroll upon my lec-
ture of March 7th, published in The Medical Record of
June 9th, are, the writer thinks, rendered in great meas-
ure nugatory by certain uncontroverted and incontro-
vertible facts above stated ; yet special notice will now
be taken in reference to some points in the critique.
The diagnosis of typhoid fever is declared by Dr. C.
to be unsettled. But why so ? Is it because it has been
known to appear suddenly upon a mountain-peak in
Tennessee or Western Virginia, in their almost pi'istine
condition, far removed from sewers, or " the walled-up
and leaching privies of cities or of filth)' villages," where
some mav sav it should not have appeared; or, on the
other hand, in the filthiest of cities in Asia and Africa it
rarely appears, despite the filth and stench for which they
are noted. The diagnosis depends upon no contingent,
exceptional features in its history. Who that has ever
read Touis, Andral, or Chomel, or Bartlett in our own
country, and, in an especial manner, the works of that
master-mind in medicine, Austin Flint, Sr., could say
that the diagnosis of this disease is unsettled ? Like
very many other affections, either from idiosyncrasy, or
complications, doubts may arise ; yet this militates not
against its normal aspect, one of most singular and
pronounced character, so that he who is familiar with
the disease will incur slight risk of a mistake in diag-
nosis. Error as to frequency and fatality in town or
country is impossible, if statistics are consulted.
Dr. C. asserts that sanitarians have not ascribed prom-
inence to sewer-gas as a cause of typhoid fever. The
facts above stated on this point prove the contrary. Ac-
cording to Dr. C. a majority of cases of this disease have
been accurately traced to contaminated food and water;
yet in my own extensive experience not one such case
has (to my knowledge) ever occurred, and those reported
are probably in the same predicament as those alluded to
in the discussion as referable to contaminated water. The
term sewer-gas is said to be misinterpreted, but is it not
just as definite in signification as the terms spring-water,
sea-water, river-water, mountain air, etc. ? Next it is
declared that "the filth of the country is atrocious com-
pared with that of the city, and that for one source of
filth in the city there are three in the country ; and that
one prolific cause of this may be found in the numerous
unventilated vaults.' In reply to this sum of abomina-
tions of the country and villages, compared with a city,
the writer nuist declare that, after ten years of practice
in the country, he has seen nothing that could present
the shadow of a parallel to the statement just made. On
the contrary, a walled, unventilated well was scarcely
ever seen in the rural section where he practised, but in
lieu thereof a simple fosse, not very deej), was dug, and
from time to time the contents covered with fresh earth
and in the fall or winter removed to the fields. This
then is just the condition that Dr. C. regards as involv-
ing only slight danger, while the walled-up, unventilated
privy is a nuisance worthy of the severest denunciation.
Where then do we find these dangerous wells in great
number ? As every one knows, in the cities, and in
many cases, as in Philadelphia and New York, reaching
to tens of thousands.
In my lecture it was stated that in " not more than
one house out of five could any sign of sewer-gas be
July 28, 1883.]
THE MEDICAL RECORD.
87
detected. This, of course, had reference, to the city,
not tiie country. While Dr. C. is quite excusable for
this oversight, his thrust at the country physicians, in
declaring that very few of them care to learn ho'iC> to
look for the causes of disease, may not be regarded
in so favorable light, especially when we reflect that
Trousseau designated the country physician as in the
best position by far to discover the origin, develop-
ment, and progress of typhoid fever ; and truth coni[)els
me to assent to this declaration. In forty years of city
practice no such opportunities for observing the origin
and character of the disease were afforded the writer as
during his ten years of country practice ; and this may
well appear from the fact that, in city practice, only one
case in a family has occurred — three families alone ex-
cepted, in two of which two, and in the third family, four
persons were affected. In this connection it may be
stated that in the course of twelve months four cases of
intestinal perforation occurred in my practice.
Dr. C. most truly informs us, " that facts are more
forcible than words ; " and what sane man can object to
this forcible truism. Let us, however, put to the scru-
tiny a fact or two adduced : "Agricultural laborers,'' he
tells us, " do not spend all their time in the fields," for
they need sleep, and, thus far, very good. 15ut when he
asserts that " as a class they carefully exclude all venti-
lation from their rooms," we must dissent. Mo codo. The
most laborious and exhausting work of the laborer is
•during the hot weather of the harvest-time, and, as a
rule he is apt to retire early in the evening. But, unfor-
tunately, the room of the laborer is very often in the
upper story or garret, and this very frequently is without
ceiling, and the rays of the sun pouring down upon the
roof during the long days of summer, renders the atmos-
phere of the room in a measure stifling ; and, instead of
excluding the air, he longs for the excessive heat of his
room to pass away, as experience tells him it will, just
as the night passes away, and the well-known refresh-
ment of the morning iiours draws near. In this connec-
tion it should be noted, that when epidemic dysentery
prevails (in the country), many of the attacks are attrib-
uted to the excessive change of temperature from the
early night to the morning hours, causing (during sleep)
sudden and violent retrocession from the cutis to the
abdominal organs. Healthy young males are said by
Dr. C. to be especially prone to attacks of the fever,
and here, we think, he is right, although in opposition to
the view of Dr. F. H. Hamilton ; but if, as he asserts,
■fragile women are better able to resist infection than
strong women or men, it is contrary to general experi-
ence; for debility, no matter how produced, increases the
liability to such infection or contagion ; while it must
be confessed that males or females of moderate physical
■conformation, if healthy, Support acute diseases better,
and are more likely to escape a fatal termination than
the rugged and over-sanguine. Facts that have the
appearance of causes are alluded to, but these, although
constantly brought forward, can have, and should have
but slight influence in determining questions of serious
importance ; for one proven, irrefutable fact, in contra-
vention, outweighs a score of them.
About two columns of The Record are taken up with
-a list of houses in which typhoid fever or diphtheria oc-
curred. Every one of these houses, whether large, ele-
gant, and furnished with conveniences, or small, and of
an opposite character, had this in common, that in regard
to filth, in one form or another they were simply abom-
inations, and hence, were just the places (as many think)
for an outbreak of these diseases, of which six were
typhoid fever ; and let it be borne in mind that Dr. C.
has excluded cases where contaminated water might be
thought to have had some influence in causing these out-
breaks. But what of all this ? If eleven cases of typhoid
fever, as stated above, could occur in only two houses,
having no such abominations of filth, nor of contami-
nated drinking-water, why may they not occur in houses
such as Dr. C. describes ? for, beyond all question, filth
should confer no exemption from these attacks. Dr. C.
intimates that persons who are habituated to the influ-
ence of agents productive of typhoid fever are seldom
quite well, and, on the contrary, my experience is that
young and healthy men are, especially in the country, at-
tacked despite their actual good health.
In connection with, and conclusion of this subject, the
writer must again put on record the testimony of Dr.
John Syer Bristowe, President of the Society of Medical
Oflicers of Health, confessedly one of the most sagacious
observers and logical thinkers of the day, who writes as
follows: " If we look to the remarkable influence which
simple variations 0/ temperature and peculiarities 0/ sea-
son exert on the mortuary returns, in respect both of
the number of deaths and the character of the fatal dis-
eases, and compare therewith the comparatively small
effect on the death-rate of even one of the most fatal
of the zymotic diseases, or with (he insignificant influence
of deaths from enteric fever, diphtheria, and other aftec-
tions, over which sanitary science is supposed to exert a
specially valuable injluence, we can scarcely avoid see-
ing that, on similar grounds, the deaths saved directly
by the sanitary labors on which we are engaged must,
under any circumstances, be so few annually as to pro-
duce no distinct and unmistakable effect on the mortuary
rate."
This sincere and ingenuous avowal of opinion by one,
not only distinguished as an author and teacher, but
who, in his exalted official position, had every oppor-
tunity to scrutinize all facts regarding outbreaks of
typhoid fever, scarlet fever, and diphtheria, as bearing
upon the question of their prevention, may well be com-
mended to the serious consideration of those who, for
years past, have positively promised the extinction of
these diseases, under certain impossible conditions, yet
with no other result than that just presented by the above-
named conscientious and eminent authority in medical
science.
THE TREATMENT OF ECZEMA IN PRAGUE.
By ROBERT B. MORISON, M.D.,
BALTIMORK, MD.
Since the introduction by Professor Pick of medicated
gelatines for the treatment of various skin diseases, there
has been a most decided advance in the simplicity of
such treatment and the results have been correspond-
ingly good. Jarisch ' said of chrysophanic acid gelatine,
introduced a year ago : " The problem is solved of re-
taining the favorable action of chrysophanic acid upon
psoriasis, and at the same time of eliminating any in-
jurious secondary effect."
For more than a year eczema has been treated in the
dermatological wards under Professor Pick in Prague,
by the so-called medicated gelatine bandage, and an in-
teresting article on this subject was read by Professor
Pick'' before the \'erein deutscher Aertze, January 26,
1883. The difference in treatment of this disease be-
tween Vienna and Prague is striking in the extreme. In
Vienna there has been no change made since the great
Hebra gave the rules which are so universally followed.
With the exception of the introduction of napthol by
Kaposi, and which is used only in his wards, tar still
holds the chief place in the Vienna treatment of eczema.
Though being far from criticising the excellent results
obtained from this agent, I could not but be struck with
its uncleanliness and disagreeable odor. As one passes
through the wards in Vienna the patients are seen lying
upon beds between two blankets, which, from the con-
stant use of tar, have become so impregnated with it
that the picture is anything but an agreeable one. Add
to this the patient himself, covered often with a thin
layer of this dirty-looking mass from head to foot, and
1 Centralblatt fiir die gesammte Thei-apie, Heft I. 1883,
* Prager Mediclnische Wochenschrift, No. 6, 1883.
88
THE MEDICAL RECORD.
[July 28, i88j
one reali/:es that such treatment can only be used as a
dernier ressori.
The importance of tar, however, being recognized by
every dermatologist, it has been the desire of each one
to obtain from it some essential ingredient which they
hoped could be used as effectively and yet do away with
its unpleasant application, but unfortunately neither the
resinone, or resinin, or carbolic acid, or any of the other
products of distillation contain all its virtues.
Even naphthol, so highly praised by Kaposi, and which
certainly has some virtues, has not been able to take the
place he first hoped it would.
This latter drug is now used almost exclusively in sca-
bies alone, and even in this disease great care must be
taken not to produce an inflammation leading to ec/ema
from its universal application. The intensity of inflam-
mation which it sometimes i>roduces, and which far e.\-
ceeds the application of tar itself, throws it entirely out
of the field as a rival of the latter. This is the conclu-
sion which all authors have arrived at after a somewhat
prolonged trial since its introduction.
The general laws laid down by Hebra in the treatment
of eczema were sootliing applications in the acute stage,
tar in the dry stage, and uiacerating applications in the
chronic stage.
.\ patient was powdered with some inert powder until
the acute inflammation and moist stage were passed,
then tar applied and a cure accomplished.
The amount of labor and nursing required to treat
the patient thoroughly according to these rules, to sav
nothing of the time lost by the patient when in the hos-
pital, where it was necessary he should be, was very
great. In chronic cases the time was lengthened so
much the more because it was first necessary to render
the disease acute by the various macerating applications
before the regular treatment could be entered upon.
That the results of this treatment, however, were most
excellent could not be denied, but that it left nothing to
be desired was far from the opinion of the author him-
self who was always trying to improve upon it.
The efficacious action of tar is generally conceded to
be due to the mechanical protection which it aftbrds to
the skin and to its antiseptic qualities. There is so much
chance for a mycotic appearance to be engrafted upon
the moist stage of eczema (e. madidans), that it is one
of the strongest arguments for the application of a drug
if it has antiparasitic or antiseptic properties. Recog-
nizing to the fullest extent this important property of tar,
and being unable to find in any of its derivations a sub-
stitute for it. Professor Pick conceived the idea of sup-
plying its place with some other medicine, which also
possessed antiparasitic and antiseptic qualities.
For three months I have been studying closely and
critically, through the kindness of Professor Pick, his
gelatine treatment of this disease, and 1 have been
greatly struck with the simplicity of its application, its
cleanliness, and its most excellent results. Instead of
the troublesome use of powders and salves, which in
Vienna must be applied at least twice a day, the patient
in Prague has immediately wrapped over his diseased
parts linen bandages smeared with unguentum saponis
containing five or ten per cent, salicylic acid. This is
applied in any stage and left in situ for a week.
.\fter the bandages are applied they are covered witii
what is known as tricot, and which is manufactured, in
various sizes and at small expense, especially for Pro-
fessor Pick in England. A patient thus dressed is able
to go about his work with no inconvenience to himself,
and no injury to his clothes, .-^fter a week's time he ap-
pears at the hospital, the bandage is removed, and the
disease examined. If it is found necessary, from the still
remaining intlammation and induration, a fresh bandage
is applied and left on for another week. Then the gela-
tine is applied in the following manner : A portion of a
mass made by dissolving fifty grammes of the jiurest gela-
tine in one hundred grammes of distilled water, and
which has been allowed to cool previously, is melted by
putting it in a cui> and placing the cup in hot water. To
this is added the required strength of salicylic acid, usu-
ally five per cent. When sufficiently cool this mixture
is painted upon the diseased parts with a painter's brush
made of bristles, such as is used in applying tar. The
layer of gelatine is made about as thick as a sheet of
writing-paper, and after it has dried is gently covered
with a minimum quantity of glycerine spread on with the
hand.
The use'of glycerine is found to be necessary to ren-
der the gelatine la\er jiliable and to prevent its con-
tracting, which it otherwise would do with considerable
force ; sufficient to irritate the skin. It is also worthy of
note that it is not ])racticable to mix the glycerine with
the gelatine before it is applied, as it prevents its har-
dening sufficiently and renders it sticky. It takes a very
small quantity only of glycerine, after the gelatine has
dried upon the skin, to render it soft and pliable. A
few trials teach the mirse the amount required. This
use of glycerine obviates the only bad effect which the
gelatine can possibly have. With such a gelatine ban-
dage a patient seldom feels the slightest itching, the dis-
eased |5arts are seen through the transparent layer, thus
rendering the progress of the disease visible without the
removal of the application, and, what is much more
agreeable to the patient, an ordinary bath removes all
traces of it. So easy is this method of treatment that the
patient can make his own applications in most cases, and
there is no fear of a too strong action to be produced by
the drug. In many cases of chronic eczema the applica-
tion of this medicated gelatine is made immediately
without the previous use of the above-mentioned linen
bandages. Also in acute eczema, especially in crusta
lactea, this rule may often be followed. There is no rea-
son why the medicated gelatine should not be immedi-
ately applied in any cases of eczema at any stage ; but
experience has shown that salicylic acid first applied in
the moist stage of acute eczema in the form of salicyli-
cated soap ointment for a period long enough to reduce
the inrtanmiation, rendej'S the use of medicated gelatine
more prompt in its results.
Through the kindness of Professor Pick's assistant. Dr.
Strach, I have been able to obtain the history of the fol-
lowing cases, which, among many others, I have person-
ally watched :
Case I. — Y. D , a man, aged fifty-eight, book
agent, enteied the hospital May 23, 1883. suffering from
chronic eczema. This had tioubled him for ten years ;
it first began with intense itching, and the skin soon be-
came chronically inflamed from scratching. Also suf-
fered from constipation. The patient is a large, well-
built man, but somewhat pale and thin. On both legs,
extending from the toes to a little above the knee-joints,
the skin ^s livid, somewhat tense, and here and there cov-
ered with easily removed crusts, leaving a moist surface
exposed, the skin of the thighs on both sides thick-
ened, and in some places covered with pustules and ves-
icles. The corresponding situations upon the arms show
the same changes. On the day of entrance was ordered
a ten per cent, salicylic acid soap plaster, made accord-
ing to method above described. On the 2Sth salicyli-
cated gelatine smeared upon all the diseased portions,
except the knee-joints, which still retained the plasters.
On the 30th all the plasters were removed and the pa-
tient sent out so far cured that he could himself apply
further treatment at home.
C.'\SE II.- — M. K , aged fourteen, daughter of a
shoemaker, entered the hospital March 6, 1883, suffer-
ing from eczema capillitii. A year ago the \)atient came
to this hospital for the same trouble, and was sent home
cured after ten weeks' treatment with white ointment and
tar. This attack has existed fourteen days. The scalp,
esi)ecially the i)osterior portion, is covered with a thick
mass of crusts, piled upon each other so that the hair is
closely matted together. The skin of the ears tense and
July 28, 1883.]
THE MEDICAL RECORD.
89
inflamed, moist and painful. On the 7th salicylicated
soap plaster was ordered ; internally, cod-liver oil. On
the 15th tar was applied to the scalp, while the forehead
and ears were treated with salicylicated plaster, and this
was done in order to compare the two methods con-
jointly. This treatment was continued until the i8th of
the following month. In the meanwhile the plasters on
foreiiead and ears, having performed their required work,
were removed, salicylicated gelatine applied in their
place, and the disease cured. The scalp treated with
tar was still quite inHamed, and though better, had not
progressed as favorably as the other parts. At this time
the tar was discontinued and salicylic acid used in its
place. On April 30th the patient was so far cured as to
be sent from the hospital.
Case III. — J. L , wife of a house-porter, entered
the hospital April 4th, suffering from eczema universale.
The patient has had the disease on both feet for two
years, which began to spread to other parts four weeks
ago. Home treatment was used, and also white oint-
ment and tar, which was ordered by a physician, without
any change for the better. She is a large, fat, well-nour-
ished woman. On the forehead was a papular efflores-
cence, on the face a vesicular eruption, which in places
was covered with crusts, exposing when removed a moist
surface. The same appearances on the neck, legs, arms,
and trunk. On the loth was ordered a ten per cent,
salicylicated soap plaster.
On the 18th, plasters taken oft'; skin found much less
inflamed, and only in some places was the epithelial re-
generation imperfect. To such places fresh plasters were
again applied, while a five per cent, salicylicated gelatine
was ordered for the rest of the body. On the i6th, the
patient was so far cured as to be sent from the hospital
with instructions how to apply the gelatine at home.
Case IV. — A. F , wife of a shoemaker, aged twen-
ty-seven, entered the hospital March 20, 1883, suffering
from eczema chronicum faciei. The patient had suffered
for three years. It began during pregnancy, disappeared
just before birth, and came on again while nursing. Was
treated in this hospital a year ago with white ointment
and tar. The eczema is situated upon the face and fore-
head, extending behind the ears and slightly into the
hair, also upon elbow-joints and knees. Was ordered to
be applied ten per cent, salicylicated soap ointment im-
mediately to all the diseased parts. This was changed
twice in two weeks, and the condition of the patient
much improved. Gradually increasing doses of Fowler's
solution of arsenic were ordered, but after two weeks was
discontinued on account of the gastro-enteritis which it
caused. The third week after entrance salicylicated gel-
atine was applied, and on May ist the patient was dis-
missed cured.
Case V. — W. K , a girl, aged twenty-two, entered
the hospital, suffering from eczema impetiginosum uni-
versale. Was immediately ordered ten per cent, salicyl-
icated soap ointment, which was applied in the following
manner : The toes and fingers were closely wrapped with
short, narrow bandages, smeared with the ointment ;
legs, arms, and trunk with longer and wider bandages,
while the head and face were completely covered in the
same way. Over this was drawn the closely fitting tricot
bandages, made to fit all the irregularities of the body by
the skilful use of a few stitches. Thus covered com-
pletely, with only holes left for eyes, nose, mouth, etc.,
she could lie comfortably in a clean bed, or be dressed
and wander around the wards. On the 23d, the soap
plaster was removed and reapplied to all parts, except
the face, which was painted with a five per cent, salicyli-
cated gelatine. On May 14th, the infiltration had so
far disappeared that the plaster was taken off and the
gelatine applied everywhere. On June 9th, it was found
advisable to reapply the plaster to the knees and elbow-
joints, and these were easily kept in place by slightly
overlapping them with the gelatine. On the nth, all
plasters were removed, and the treatment confined to the
use of gelatine. On the r4th, the patient was dismissed
cured.
The most satisfactory results, however, both to patient
and physician are obtained in the chronic cases which
appear so frequently at dispensaries. For instance, in
cases due to varicose veins, I have seen the greatest
benefit follow it. Instead of taking the patient into the
hospital, he is simply bandaged and sent off, to return in
a week's time. Nothing could be simpler, and it is satis-
factory in the extreme.
In trying this treatment, there are a few points in the
method of application which it is necessary to insist upon.
The salicylic acid must be thoroughly well mixed with
the soap ointment whilst warm, and this must be spread,
when at about the consistency of butter, evenly upon
short linen bandages, which should not be more than one
and a half inch in width, and even much narrower when
applied to fingers or toes. The ointment should not be
in a thicker layer than the back of an ordinary table-knife,
and should be spread fresh every time it is used. It is
well not to mix up too large a quantity of the ointment,
as upon standing it hardens and is more difficult of ap-
plication.
The gelatine should be prepared by dissolving in dis-
tilled water and heated in a porcelain crucible. After
stirring thoroughly it is allowed to cool, and forms a cake,
which takes the form of the crucible. This cake can be
kept for any length of time in paper, and the necessary
quantity broken off every time it is to be used.
The salicylic acid must be ke|)t separate from it, and
only added to the gelatine when it is melted. The mix-
ture should not be painted upon the skin unevenly or in
a thick layer. When properly applied it can be torn from
the skin in quite large pieces, and it comes off without
pain to the patient, or irritation to the disease. It sounds
like the tearing of tissue-paper, and when thus torn off
looks as if the patient was having his epidermis removed
by force.
Any holes or rents in the gelatine covering may be re-
paired from time to time by a fresh application. The
indications for the renewal of the whole covering are
when it has worn off or after a bath.
After having seen as many as a hundred cases of ecze-
ma treated by this method, I consider it fully equals the
old tar treatment in the results obtained, and that it far
surpasses it in the simplicity of its application and in its
cleanliness, a quality which recommends it immediately
to the patient.
With its introduction. Professor Pick has made a great
advance in the treatment of this most common of all skin
diseases, and it is worthy of a most thorough trial in the
hands of others.
The Medical Voyage of Life. — First year : icterus
neonatorum, hyperkinesis intestinalis, and vaccination.
Second year : dentition, croup, cholera infantum, and
fits. Third year : diphtheria, whooping-cough, and bron-
chitis. Fourth year : scarlet fevei', worms, and men-
ingitis. Filth year : measles. Now half the children
are dead. Seventh year : nnunps. Tenth year : chorea
and typhoid fever. Fifteenth year : hyperassthesia sexu-
alis. Sixteenth year : spermatorrhoea, chlorosis, and
spinal irritation. Eighteenth year : blennorrhcea ure-
thralis. Twentieth year : bubg, alcoholic cephalalgia,
vertigo. Twenty-fifth year : matrimony. Twenty-sixth
year : insonmia de infanto. Thirtieth year : dyspepsia,
nervous asthenia. Thirty-fifth year : pneumonia. Forty-
fifth year : lumbago, presbyopia. Kifty-fifth year : rheu-
matism, alopecia. Sixtieth year : amnesia, deciduous-
ness of teeth, bony arteries. Sixty-fifth year : apoplexy.
Seventieth year : amblyo|)ia, deafness, anosmia, general
dyskinesis, atonic digestive tract, rheumatismus de-
formans. Seventy-fifth year : finis.
An Ear-ring. — A convention of Otologists. — Puck.
90
THE MEDICAL RECORD.
[July 28, 1883.
THE SIGNIFICANCE OF THE TRANSMISSION
OF SOUND TO THE EAR THROUGH THE
TISSUES IN AURAL DISEASE.'
By SAMUEL SEXTON, M.D.,
NEW YORK.
So long as the parts of the ear concerned in sound trans-
mission remain in a normal state, sound may be said to
almost exclusively reach the auditory nerve by means of
their action, and since im|nilses of sound are thus ]5rac-
tically excluded from all other channels (tissues) of trans-
mission, the confusion which would otherwise arise is
avoided.
Disease, however, may give rise to changes in the
transmitting mechanism, owing to which vibratory im-
pulses are but imperfectly conveyed in the natural way,
i.e., by aerial conduction, and then it is that the auditory
nerve takes cognizance of sounds hitherto excluded from
it by the jieculiar arrangement of the transmitting ap-
paratus ; these unpleasant and strangely sounding un-
dulatory vibrations are received through the osseous,
muscular, and otiier tissues.
This altogether anomalous hearing, which may exist
for a time continuously, or may be interrupted, as it were,
by almost normal hearing, is dependent for the most part
on the passage of sound to the ear through both aerial and
tissue media at the same moment. Owing to the increased
intensity of sound, thus partly heard coming through the
better conducting medium of the tissues, an extremely
confusing and disagreeable «ffect is produced, and the
definition of an exclusively aerial transmission is wanting.
As is well known to otologists, hearing may thus be-
come a very painful experience ; if the patient then hears
his own voice autophanously he feels that it has been
much altereil, or is not intelligible to others; indeed, it
seems to be unrecognizable to himself even. The dis-
comfort may be increased, if such a thing be possible
where the physical and mental distress is almost unbear-
able, by the tinnitus aurium arising from the circulatory
movements taking place near enough to the ear to be
heard. Loud noises, such as the jiassage of railway
trains, street trucks, the action of machinery and the like,
owing to the better transmission of their more profound
impulses through unaccustomed media of approach, fall
upon the nervous centre of audition like a blow and thus
give rise to dysacousnia.
It being doubtful if the perceptive sense of hearing be
increased by labyrinthine inflammation, we may suppose
that so-called hyperesthesia of the auditory nerve con-
sists in the painfulness of the impression made by sound
ou the perceptive centre. If this be true, inflanmiation
of the perceptive filaments of the auditory nerve in the
labyrinth alone would scarcely be expected to increase
the hearing power. On the other hand, it would be
difficult to determine what degree of labyrinthine inflam-
mation was necessary to impair the perceptive functions.
Labyrinthine inflammation, viewed from a clinical point
of view, is doubtlessly nearly always consecutive to mid-
dle-ear disease, but whether existing independently or in
conjunction with middle-ear trouble, the transmission of
sound would be more effectually performed by means of
aerial conduction as regards intelligible perception. In
middle-ear disease, however, the tuning-fork would be
better heard through the tissues inversely to an increas-
ing defect in aerial transmission, but not necessarily bet-
ter heard, however, on account of labyrinthine defects.
Even if the perceptive apparatus w^ere alone affected
tlie tuning-fork would be best heard by aerial conduction,
since the transmitting ai)paratus affords the better con-
duction and at the same time interferes with osseous con-
duction. But cases of labyrinthine disease alone are rare,
and it is difficult to establish the fact that no middlt-
ear disease coexists in any given instance.
1 Read before the American Otological Societ)*, July 17, 1883.
CONCLUSIONS.
I. When the vibrating tuning-fork, placed on teeth or
vertex is better heard through the tissues on one side, it
simply indicates that the better ear excludes wholly or
in part such (tissue) transmission, but it does not prove
that the auditory nerve in either ear is affected.
(Of course, if the nerve of audition be gravely af-
fected, sound will not be heard by any method of con-
duction.)
II. If the conductive mechanism is absent or greatly
damaged in one ear, while the other remains more or
less normal, aerial transmission will be found to be in-
effectual ,in the diseased ear, while the tuning-fork al-
lowed to vibrate as before will, tlierefore, be best heard
in the diseased ear, and its vibrations will be almost
entirely excluded from the healthy ear.
III. In deafness fiom labyrinthine disease, pure and
simple, the middle ear being normal, the tuning-fork
would be best heard, if heard in any degree, by aerial
conduction, because bone conduction would be ex-
cluded.
(In those extreme cases where destructive disease of
the nerve has taken place, impulses of sound may be ap-
preciated irrespective of either the transmitting or laby-
rinthine structures ; thus the deaf-mute is conscious of
the sound of thunder, artillery, drums, stamping with the
foot upon a floor, and the like.)
IV. If the above deductions be true, we may conclude
that the tuning-fork is of less value than has been sup-
posed in the differentiation of aural disease.
A CASE OF HODGKIN'S DISEASE.
By W. U. TAYLOR, M.D.,
MOOERS, N. V.
In September, 1882, a child was brought to my office by
its father, who gave the following history : L. M ,
nine years of age ; French ; scholar ; was in usual health
("never very strong") until June, 1882, when she was
poisoned by some vine while picking strawberries. Her
face and hands were badly swollen, and before the swell-
ing went down erysipelas set in, lasting about two weeks.
Soon after this some enlarged glands were noticed just
back of each ear. These grew rapidly and others ap-
peared below on eacli side of the neck and in each
axilla and groin. They grew rapidly in s))ite of treat-
ment until I saw the case, and, in fact, to its termi-
nation.
On examination the cervical, axillary, and inguinal
glands were found enlarged, a dozen or more in each
region, varying in size from that of a pea to a hen's egg,
the largest bemg in the right axilla. In her left groin
there was an enlarged duct the size of a lead-pencil and
about three inches long. All the glands except the pa-
rotids were freely movable ; were firm, elastic, and with-
out fluctuation. The parotids were enlarged, so that at
the first glance I thought the child had mumps. On
opening the mouth the tonsils were found greatly en-
larged so as to fill the isthmus of the fauces and prevent
the use of the smallest laryngoscope I had. The bron-
chial glands were ap|)arcntly enlarged, respiration being
stridulous. The liver and spleen w'ere enlarged, there
being flatness on j)ercussion from the fourth rib to the
umbilicus and the lower border could be plainly felt and
its position seen. The only resonance was in the left
inguinal region. The pulse was rapid and feeble, respi-
ration shallow and frequent ; skin dry and hot. Pulse,
respiration, or temperature not noted at this time : ap-
petite variable ; bowels regular at i)resent, but is subject
to attacks of diarrhoea ; urine scanty and high-colored.
Measurements at this date were : around the head at the
upper lip and angle of jaw, i 7 inches ; around chest, at
lower border of sternum, 24 inches.
The child living at a distance, it was not seen as often
as I wished. It was ordered iod. potass, with syr. iod.
July 28. 1883.]
THE MEDICAL RECORD.
91
iron and citrate of iron and quinine, and an ointment of
iod. amiiionium, to be rubbed upon enlarged glands and
over the abdomen.'
October 3d and 7tli. — There was apparent improve-
ment in its general condition. Able to go up and down
stairs ; plays about the house ; appetite good ; slight
diarrhrea, checked by chalk mixture.
October 12th. — Has spasmodic cough, at times at-
tacks of "croup ; " pulse, no; temperature, 100°; had
high fever the day before ; said to have " taken cold."
Examination of the chest gave negative results, the
tracheal rales obscuring any others. Measures : around
head, 174- inches; chest, 24^ inches; at nintli rib, 25
inches ; at navel, 24^^ inches.
October 1 7th. — Very weak ; confined to bed ; jnilse,
130 ; respiration, 24 ; temperature, 99^°.
October 21st. — Weaker; extreme dyspnoea; unable
to lie down ; complains of pain about the heart ; urine
very scanty ; on standing it seems composed of urates
alone ; no albumen found by either heat or nitric acid ;
specific gravity not taken. Given infusion digitalis, 3 ss.,
to be repeated in six hours. Measures : Face, 18 inches :
chest, 26 inches ; navel, 26^ inches. Cough paroxys-
mal ; very severe.
October 24th. — Increased dyspnoea; has '^boring"
pains in throat, dorsal region, and colic pains in abdo-
men ; cedema of right arm and leg.
Died of exhaustion, October 27th, at 2 a.m. The
pain and dyspnoea continued until death. Patient was
conscious until a moment before slie died, though drowsy
from effects of anodynes. The treatment conjisted of
use of iod. potass., syr. iod. iron, citrate iron and qui-
nine throughout the case. Cod-liver oil was given a
short time, but causing nausea, was stopped. Concen-
trated diet ordered, but not carried out, the child having
about what it wished. The inunction of iod. ammonium
ointment was continued until it caused so much irrita-
tion as to prevent sleep. It was not used after October
17th.
During the first two weeks there was marked improve-
ment in the general condition, but none in the glands,
the enlargement progressing steadily until death oc-
curred.
The child was about the house and ate at the table
until October 17th. After that there were several days
when she was apparently better.
Authorities seem agreed as to the unfavorable termi-
nation of these cases, and it may be said of them as
Dr. C. was wont to say, in lecturing upon "croup" :
" Gentle-MEN ! If you have a case of in/e mem-BRAN-
ous croup — and it gets -well— it's not CROUP ! "
SYPHILITIC MAMMARY DISEASE.
Report of a Case of Inherited Syphilis — Re-
moval OF Mammary Tumors by Thomas' Method
— After Treatment by the Iodides.
By CHARLES C. F. GAY, M.D.,
SURGEON TO THE Bt'FFALO {n. V.) GENERAL HOSMTAL.
I HAVE recently had under observation a case of so much
interest to myself that I have thought report of it would
be of interest also to the profession. Miss C. M ,
aged nineteen years, came under my charge on March
7, 1883. She is an only child ; her health had been
good until four years ago, when she began to have pain
in both mammary glands ; more especially the left one.
The glands were well developed.
During these four years she had been a great sufferer.
The left breast became so sensitive that the weight of
the bedclothes upon it could not be borne. Her men-
struation was regular and in no way influenced the pain
of the mammary gland, either to lessen or increase it.
A day or two before the patient came to me, she was ex-
amined by the gynecologist of the hospital, who reported
the hymen unruptured. There was no question raised
whatever against the virtue and morals of the patient.
She was well educated, cultivated, and refined. Her
left breast was hard, nodular ; felt like scirrhus and
would have been so pronounced, I am quite sure, had
her age been forty-five instead of nineteen years. The
breast was so excessively tender to the touch, that it
could not well be examined without ether ; the nipples
were retracted. At a consultation, the tumors were
pronounced non-malignant, but removal was advised.
•T'he young woman stated that eighteen years ago her
father had a cancer cut out from liis throat ; but as the
father was still living, this statement of the nature of his
ailment was regarded as apocryphal, and did not contri-
bute toward a diagnosis of cancer in the case of the
daughter. There appeared to be three or four tumors
of the size of a hickory nut in the left, and one of smaller
size in the right breast. The patient was extremely
anxious to have these tumors removed as soon as possi-
ble, and had travelled a considerable distance in order
to have an ojieration performed, and as removal was de-
cided upon at the consultation, the ]iatient was, on March
14th, etherized, and Thomas" method for removal of
benign tumors employed. This method consists in mak-
ing a semicircular incision around the lower lialf of the
circumference of the breast, in the crease formetl by the
junction of the gland with the chest, dissecting up the
gland and turning it inside out. This being done, ex-
amination showed that the tumors so nuich involved the
gland itself, as to necessitate removal of the greater por-
tion of it. The integument was replaced, secured by
sutures, and the wound treated antiseptically with the
boro-glyceride.
In three weeks there was no union, nor signs of union,
in any part of the wound; it looked and smelled like a
syphilitic ulcer, and the tendency to disintegration pre-
ponderated over the process of repair. Diagnosis of
syphilis was made, and the iodides of mercury and pot-
ash employed at once. In four days the whitish stroma
was removed, and in its place red and healthy granula-
tions appeared; the offensive odor was dispelled, and in
three weeks more the wound was closed. After our pa-
tient left for home, search of the hospital records was
made for the father's case and his record found, from
which I learned that he entered the hospital with syph-
ilis when our ])atient was a child just four months of
age. He remained only a few days, but returned again
four times during a period of two years. He entered
the hospital twice for syphilis, once for secondary, and
once for tertiary syphilis. It is fair to conclude, that
this man had the primary lesion months before his
first entrance to the hospital, and long before the birth
of the child. His disease was recognized as syphilis at
that time by the attending surgeon, and the record ac-
cordingly made. There is no record of cancer nor of
removal of a cancerous tumor. The innnediate effect of
the anti-syphilitic treatment employed, in case of the
young woman, proved the correctness of the diagnosis,
and it was confirmed and corroborated by the hospital
records. The records furnished sufficient evidence to
establish the fact that the disease was inherited ; that the
poor child was conceived in sin and endured suffering in
consequence thereof. The mother was pregnant but
once, and her health had been iiniiaired for a long time.
The conclusion is, that the husband communicated the
disease to the wife, and she in turn gave it to the child
in embryo ; that the taint remained latent for a period of
years, and at length manifested itself in the .mannnary
glands. If one could have diagnosed the disease and
have treated the patient for specific disease, the mam-
mary tumors might have been dispersed and an ojjera-
tion forestalled. This, however, is conjectural only. The
operation resulted in substantial benefit. The right re-
covered soon after the performance of the operation upon
' New York Medical Journal, vol. xxxv.. p. 337, 1882.
92
THE MEDICAL RECORD.
[July 28, 1883.
the leff breast. Whether it were neuralgic induration or an
affection arising from sympathy with disease of the left
breast, I have no means of judging. I am led, however, to
suspect that in an occasional instance the so-called " neu-
ralgic indurated breast," and the "painful breast" of au-
thors, might be classed under the head of syphilitic mam-
mary disease.
progress of HXctticuI J^cicncc.
Acute Anasarca without Albuminuria in Preg-
NANXv. — The following case is related by Dr. M. H.
Rendu in La France Mhlicale of .April 19, 1883. .A
woman, twenty-two years of age, pregnant for the second
time, suffered greatly from fatigue and anxiety while
nursing her first child, who was sick with meningitis. She
took cold, as she supposed, one night toward the end of
the child's sickness, and had repeated chills with lumbar
pains and general weakness. Soon a persistent head-
ache supervened, accompanied by nausea and anorexia,
but without vomiting. About five days later the patient
noticed that her legs were swollen, and the anasarca in
a short time became general, but was especially marked
in the eyelids and breasts. The pulse was no; tem-
perature, 103.5°. The urine was scanty, less than thirty
ounces being passed in twenty-four hours, was red in
color and deposited urates in abundance. It contained,
however, no trace of albumen, although daily examina-
tions were made for a month. The other organs seemed
healthy, the heart was normal, and there was no history
of recent scarlatina. The patient was placed on milk
diet and diuretic remedies, but continued to grow worse
until it was feared that oedema of the brain would ensue
and give rise to eclampsia, or that the patient would die
from pulmonary cedema. It was then decided to bleed
the woman, and accordingly between nine and ten ounces
of blood were taken. At the same time numerous punc-
tures with a fine needle were made in the swollen vulva
and legs, giving exit to an abundant (iow of serum. Im-
provement at once set in, and every trace of cedema had
disappeared in two weeks.
Diagnosis of the Different Forms of Urethral
Discharge. — Dr. Fiirbingerthusdistinguishestlie different
discharges taking place from the male urethra (Cen/ralb.
fur ktin. Medkin, April 21, 1883). Spermatorrhea is
a loss of seminal fluid which occurs during defecation
or at the completion of micturition. The condition,
which is much more common than is ordinarily supposed,
is not a final stage of pollutions, but is caused most
frequently by gonorrhcea and sexual abuses. Sperma-
torrhcea becomes azoospermatorrhcea when for any cause
(usually from epididymitis) the testicles cease to pro-
duce spermatozoa. Prostatorrhcea is the discharge, some-
times continuous, sometimes only during defecation and
urination, of the prostatic secretion. It is a rare con-
dition, and is a symptom of chronic prostatitis, usually
of gonorrhoeal origin. Trethrorrhcea ex libidine is a
phenomenon occurring usually in ana'un'c and nervous
individuals. It consists of a scanty discharge, without
orgasm or ejaculation, accompanied by intense sexual
excitement and strong erection. The last discharge to
be considered is gleet.
Of these five processes two are easily recognized.
Spermatorrhcea is evidenced by the i)resence in laro-e
numbers of spermatozoa (a few here and there signify
nothing), and urethrorrhcea is readily recognized by its
characteristic mode of onset. The secretion of the
latter is the product of the urethral glands and Cowper's
glands. It is clear, stringy, and contains but few epithe-
lial and round cells. A very abundant discharge points
to azoospermatorrhasa. The absence of pus-corpuscles
also points to the same condition, though their pres-
ence has no weight on the other side, as urethritis
may e.xist at the same time. In such cases the presence
of the specific secretion of the seminal vesicles must be
determined. If one finds a jelly-like substance resem-
bling in shape grains of sago, that is conclusive ; but if
this is not found, it may be that it is in solution, and may
then be precipitated by a strong alkali. The secretion is
allowed to stand for a time, and then a clear drop is placed
in a watch-glass, and a drop of caustic potash added. If
now the drop shows a thick white cloud, or streaks, it is
evidence that the secretion contains seminal fluid. If
this process shows that we have not to do with azoo-
spermatorrhcea, there still remains the differential diag-
nosis between prostatorrhcea and gleet to be deter-
mined. In the latter the discharge is very scanty ; in the
former, digital examination reveals great tenderness on
pressure of the prostate gland. Indications of pros-
tatorrhcea are : i, the presence, unfortunately not con-
stant, of numerous amyloid bodies ; 2, numerous typical
cylinder cells, especially when in the double layer ar-
rangement of glandular epithelium ; 3, the large Bolt-
Cher's crystals. The presence of the latter is ascer-
tained by mixing a drop of the secretion with a drop of
a I per cent, solution of phosphorated ammonia upon
an object glass. In about an hour numerous large, ex-
ceedingly beautiful crystals are formed. The secretion
of the prostate, the author insists, is not clear, odorless
and thick, as usually stated, but is thin, of a milky
cloudiness, and possesses the characteristic odor of sper-
matic fluid. •
An aid to diagnosis is also Ibund in the time of the
appearance of the secretion in the urine. The first and
last portions are to be separated from the principal flow
of the urine. The presence of the secretion in the
first portion points to glee't ; in the first and second por-
tions to prostatorrhcea ; in the third portion to azoo-
spermatorrhcea. The latter appears in the form of nearly
transparent, thick, stringy masses, and sometimes also in
the shape of sago grains.
A Rare Form of Imperforate Anus. — Dr. Ra-
monet relates the case of a child, three days old, who
was brought to him on account of imperforate anus.
There were up to that time no symptoms of strangulation
of the bowels. The perineum presented a perfectly plane
surface without elevation or depression to indicate the
point at which the rectum terminated. But at the upper
and posterior part of the scrotum, at the median raphe,
there was a small orifice through which a litde meconium
escaped. A sound introduced into this orifice could be
passed backward just beneath the integument to the
point at which the anus ought to be. The operation
showed that there was no deviation of the rectum ; it
was well formed and ended in tlie normal situation. The
anus, instead of opening directly, formed an elbow be-
neath the skin and terminated with a fistulous opening
at the root of the ^cioium.— Revue MMcale, May 12,
1883.
Resectio-n of the Wrist. — From a careful study ol
upward of sixty cases of resection of the wrist, Dr. G.
Nepveu is not led to think very highly of the operation
as regards either the cure of the disease or the restora-
tion of function of the joint [Revue de C/iirurgie, May,
1S83). The following conclusions are formulated by
him : 1 . Resection of the wrist is not usually dangerous
to life, especially when performed under antiseptic pre-
cautions. 2. A good result is sonielimes obtained in the
cure of the local disease and restoration of function.
3. This is, however, rare, occurring in not more than one-
fourth of the cases. More freiiuently the cure of the
disease is incon)|)lete and the restoration of fiinction but
partial. 4. A more grave termination is not uncommon ;
sometimes death ensues, and sometimes, owing to non-
arrest of the disease, amputation is required. 5. One
cause of this want of success in resections of the wrist is
that tlie operation is often undertaken in unfavorable
cases. The operation is contra-indicated in osteitis and
July 28, 1883.]
THE MEDICAL RECORD.
93
in synovitis with tubercular deposits. 6. To obtain the
best results as regards the usefulness of the joint, as
little as possible of the bone should be removed and the
periosteum should be preserved as far as the conditions
of the case will permit. 7. An operation should never
be had recourse to until all conservative therapeutical
measures iiave proved unavailing. Such measures are
immobilization, compression, counter-irritation, prolong-
ed antiseptic lotions, etc.
Immunity of Copper Workers from Contagious
DisE.-vsES. — At a recent meeting of the Socictc'de Biologic
of Paris, Dr. Burq presented an interesting communica-
tion upon the immunity enjoyed by workers in copper
during epidemics of cholera and typhoid fever {La Tri-
bune Mi'dicaU, April 29, 18S3). He stated tliat of forty
thousand such workmen, two only died during each of the
epidemics of typhoid fever in 1876 and 1883. F'urther-
more, the statistics of a society of three lunidred mem-
bers, all copper workers, showed that during the entire
period of the existence of the organization (sixty-four
years) there had been but three deaths from epidemic
diseases among its members.
Syphilitic Liver in a Boy. — Dr. Teissier relates the
case of a boy, fifteen years of age, who came untler his
care suffering from ascites ; there was also diarrhuja and
a slight cough. The diagnosis was made of tuberculosis
of the jjeritoneum, intestines, and lungs. Paracentesis
was periformed several times and the child was put upon
a tonic and diuretic treatment, but he sank rapidly and
died. At the autopsy there were no tubercles discover-
able in any of the organs or serous membranes. Of all
the viscera, the liver alone showed any changes. It was
rather small and presented upon its surface yellow nod-
ules, hard as a stone and covered with a fibrous enve-
lope. This latter sent out white fibrous prolongations,
following the course of Glisson's capsule, and giving to
the liver a lobulated appearance. Examination, both
macroscopical and microscopical, showed the case to be
syphilis of the liver, and this was further confirmed by the
statement of the parents that the child had acquired "a
disease" from his nurse. — Lyon Medical, May 13, 1883.
Chronic Myocarditis and Diseases of the Co-
ronary Arteries. — Cases frequently occur — more par-
ticularly among well-to-do people, more rarely in the
poorer class of persons over middle age — in which death
occurs suddenly, without previous symptoms, excepting,
perhaps, a feeling of constriction or ])ain at the cliest.
Dr. Carl Huber ( Virchows Archiv) gives a number of
such cases in which the cause of death appeared to be
sclerosis of the coronary arteries, and subsequent chronic
myocarditis. The consequences of this myocarditis are
aneurism of the heart, thrombosis, dilatation, and hyper-
trophy. The clinical symptoms are angina pectoris,
stenocardia, and asthma. These symptoms generally
occurred in paroxysms some months before death,
generally after excitement, either bodily or mental,
several times after dinners. In some there was irregu-
larity or intermittence of the pulse, occasionally cardiac
bruits ; sometimes there was a sudden giddiness with
temporary loss of consciousness on stooping, walking
quickly, or going up stairs. The attacks were some-
times also accompanied by symptoms of collapse. Death
sometimes occurred almost at once, but at other times
several minutes, hours, or even days elapsed, during
which time there were the symptoms of cerebral apo-
plexy, paralytic conditions, and alterations in the cardiac
rhythm. The peculiarity of this cardiac affection is that
it has nothing whatever to do with endocardial or ])eri-
cardial disease, but depends on arterial sclerosis. Car-
diac apoplexy, the author considers, is a condition to be
reinstated in its old place as a well-marked disease, like
cerebral apoplexy. It sometimes occurs in young in-
dividuals, the general cause of such occurrence being
alcoholism or syphilis.
The Effects of Disease on the Size of the
Heart. — This subject has been investigated by Dr. Spetz
{Deutsches Arcliiv filr klin. Medizin.). He finds that
in typhus there is no characteristic change in the dimen-
sions of the heart and the large vessels ; the same is the
case in puerperal pyemia. In phthisis the heart is di-
minished, and especially the left ventricle. The right
ventricle is often somewhat diminished, but not in pro-
portion to the diminution in the weight of the bod)'. It
is sometimes even hypertrophied, but not as a rule. The
ratio between tlie depth of the left ventricle and the
circumference of the aorta is diminished, and as this is
not compensated for by hypertrophy of the muscular
walls of the ventricle, there is a diminution in the ar-
terial tension. Consequently the pulse in phthisis is soft
and small. In cancer the depth of the left ventricle is
still more diminished than in phthisis, and the right ven-
tricle is affected almost as much as the left. In granu-
lar kidney, both ventricles increase very much, but
especially the left. The aorta is not correspondingly
dilated. In consequence of this the tension in the ar-
teries is very greatly increased. In myocarditis, also,
the heart is dilated and hypertrophied, but the left and
right ventricle are almost equally affected. In chronic
emphysema both ventricles are much dilated, with very
little thickening of the muscular walls. Both ventricles
are nearly equally affected. The pulse is full, but small
and languid
Mode of Reproduction of the Liver. — While
conducting some experiments upon the spleen of a dog,
Dr. Tizzoni accidentally wounded the liver at the edge
of one of its lobes. Six months later he discovered a
tumor at the exact point where the wound of the liver
had been made. It had all the gross ap|)earances of the
liver-substance. A portion was treated with bichromate
of potassium and alcohol, and then numerous transverse
and longitudinal sections were made. From a study of
these the author arrived at the following conclusions : i.
Under certain circumstances the liver may be repro-
duced at the point where it has been wounded ; there is
a new formation of hepatic cells and biliary ducts. 2.
Unlike what occurs in the spleen, the great omentum
adherent to the wound in the liver does not take part in
the reproduction of the substance of the organ, but serves
merely as the stroma in which the newly formed tissue
arises and is developed. 3. The new tissue arises from
the pre-existing hepatic cells, which, by cellular multi-
plication, send out offshoots which penetrate into the
epiploon like the prolongations of an epithelial tumor in
the connective tissue of the skin ; the hepatic cells pre-
sent numerous nuclei, sometimes as many as twelve,
which are deeply stained by carmine. 4. Some of these
cellular prolongations have a light centre and assume
the appearance of bile-ducts, while others are filled with
protoplasm and nuclei, and resemble then the hepatic
cellules. 5. The newly formed hepatic cells, which re-
semble histologically the old ones, have that in common
with the hepatic cells of the embryo that they remain for
a long time separated by true lacunas filled with blood.
6. The acinous disposition is wanting, but large blood-
vessels, especiallv veins, and biliary ducts can be seen.
The author concludes from this that the regeneration of
the liver is in all points identical with the embryonic
development as described by Remak and KOlliker.—
Journal de Medecine de Paris, April 28, 1883.
Naphthaline in Frost-Bites. — Dr. Lindenbaum
has employed this remedy with success in a number of
cases of frost-bite. The dressing is usually changed
every seven to ten days. In some instances the patients
complained for two or three hours after the application
of severe sticking pains, caused probably by small crys-
tals of naphthaline. As far as the author's experience
will permit him to judge, the same remedy is equally
beneficial in burns. — .% Pelersburger Med. Wochen-
schrift, June 2, 1883.
94
THE MEDICAL RECORD.
[July 28, 1883.
The Medical Record:
A Weekly Journal of Medicine and Surgery.
GEORGE F. SHRADY, A.M., M.D., Editor.
Published by
WM. WOOD & Co., Nos. 56 and 58 Lafayette Place.
New York, July 28, 1883.
"THINGS WHICH [CANNOT BE SHAKEN."
Under the above heading the readers of a popular
religious weekly have lately been entertained with a
series of articles by an eminent theologian, who showed
the apjilicability of this text to the dogmas which he
professed. As medical men we are especially interested
in knowing how far the text may be applied to the
therapeutic doctrines which we hold.
To go at the subject in sermon-like fashion, we ought
first of all to premise that much has been taught as
medical truth which has been shaken, and shaken to
pieces. Secondly, we might show that much is still
taught in physiology, pathology, therapeutics, which will
probably be shaken. Thirdly, we should consider the
things which cannot be shaken.
Under the first head would come all absurdities which
have characterized medical practice in the past, of which
we will only mention the doctrine of the four humors ;
the psora theory of constitutional diseases ; the doc-
trine of signatures ; in short, all the crudities and abom-
inations in theory and practice which were the ofi'spring
of ignorance or superstition.
The second head we hardly dare touch upon for fear
of being called iconoclastic. There is much in current
medical teaching which we venture to affirm may possi-
bly be shaken. Thus, in physiology, we do not think
that the functions of the cortex cerebri, of the basal
ganglia, of the cerebellum, of the vasomotor nerves, of
the spleen, the current theories of menstruation, the
haematopoietic functions of the blood, vascular glands,
and the spinal marrow, etc., are yet settled, so that im-
portant modilications may not yet be made in the views
now held. In pathology it will doubtless be proved that
false ideas are now prevalent as to infiammation, tuber-
culosis, the pathogeny of infectious diseases, etc.
In therapeutics how much will escape the condenma-
tion of future criticism none can tell. Our best text-books
are full of untruths, partial truths, and exaggerations.
It is so in regular medicine, and it is so in homoe-
opathy. Refer to any drug in any treatise on materia
medica — calomel, antimony, arsenic, aconite, phosphorus,
etc., and you will find medicinal virtues ascribed that
have never been realized, and much that is as fanciful as
the "provings" of the infinitesimals.
We come now to our third and last head. While we
would express ourselves with due modesty and caution,
we affirm that the great body of medical doctrine, outside
of therapeutics, is "unshaken as the sacred hills." There
is no room for doubt as to the origin, insertion, and uses
of the flexor longus pollicis ; that gastric juice has a sol-
vent action on food ; that the ligature of a bleeding ves-
sel stops hemorrhage. Our concern now is principally
with therapeutics, for it is there that we brethren of one
family disagree. It is because there is so much that can
be shaken that there are so many divisions in medicine.
As far as medicine is an exact science there is no ra-
tional basis for differences of opinion. There are no
sects or pathics in science, nor will there be in thera-
peutics when the actions of drugs and their relation to
diseased states of the economy are definitely known.
Truths must everstand as firm as mountains. What we
want above all things is to get at facts. Some medical
tenets may be accepted provisionally as probable ; here
we must act to a certain extent " by faith." With regard
to others we have a tolerable degree of certainty. There
are numerous medicaments whose physiological effects
have been sufficiently determined to warrant dog-
matism with regard to them. Under such and such cir-
cumstances, certain positive results will be obtained.
The same may be said of their therapeutical effects, as
determined by clinicalexperience. Among these drugs
we may specify bromide of potassium, chloral, belladonna
(in part), digitalis, nux vomica, opium, ergot (to some
extent), and many cathartics. With regard to the action
of anesthetics, there can be no doubt practitioners of
all schools utilize ether and chloroform when the urgent
•indication is to relieve violent pain or spasm or to pro-
duce anaesthesia for a severe surgical operation.
If we were all as fully agreed on the actions and uses
of other medicaments as we are on the actions and uses
of those just mentioned, and especially the bromides,
when we wish to depress reflex spinal irritability, opium
and anaesthetics when we wish to relieve pain or pro-
duce insensibility, we are certain that there would no
longer be any sects in medicine. Progress in thera-
peutics is fast tending in this direction. It is no use
ignoring the fact. We are learning more of pathological
states, of etiology, of accurate diagnosis, and our knowl-
edge is fast being reduced to system. Disease being only
morbid physiology, physiology aided by etiology is be-
coming the intelligent guide of the therapeutist. What
shall restore the disordered organ to its normal state, if
any restoration be possible ? How far may hygiene con-
tribute toward this end ? How far medicine ? This is the
problem for which we are seeking exact data. Earnest
workers in all lands are contributing to our knowledge.
The past twenty years have witnessed a great advance.
The "regular" of to-day who has kept up with the age
might find little common ground with the " regular " of
a bygone generation. What shall be the final outcome
of this movement toward more complete knowledge and
therapeutic unity and harmony ?
THE THERMOMETER IN THE DIAGNOSIS OF STOMACH
DISEASES.
So.ME time ago M. Peter made some investigations into
the changes in surface-temperature in lung diseases. He
claimed that by careful measurements slight changes in
temperature could be observed over the seat of con-
gestive or inflammatory foci in the lung tissue. By his
July 28, 1883.]
THE MEDICAL RECORD.
95
method an earlier and more certain diagnosis of phtiiis-
ical troubles could, in the investigator's opinion, be
made. Not much use has been made of M. Peter's
observations, either to refute or confirm them. The cost
of sufficiently delicate instruments, the difficulty of mak-
ing a sufficient number of examinations, and the prob-
lematical value of the results explains this.
Not discouraged, however, M. Peter is continuing his
investigations, and now directs his attention to variations
of surface temperature in diseases of the abdominal
viscera. Some preliminary reports have been made in
the Gazette des Hopitaux. These refer to diseases of
the stomach. There is no doubt that differences in the
condition of this organ cause corresponding changes in
the cutaneous surface over it. This is so strictly the
case that careful observations have detected a constant
difference in the temperature of the skin over the
pylorus from that of the fundus. .This difference varies
between .1° and 1° C, or from \ to nearly 2° F. The
normal surface temperature over the stomach, as deter-
mined by Levin and by Peter, was from 34.9° to 35.9°
C. (94.6° to 96.5° F.). It is higher in the morning,
sinks toward noon, rises for the first three or four hours
after meals, then sinks. M. Peter has thought that by
studying these local variations he can obtain great help
in the differential diagnosis between simple neuralgic
and inflammatory conditions of the stomach. In a case
of gastric ulcer, he found the temperature over the
stomach to vary between 37° C. (98.5° F.) and 38.2° C.,
that'' in the axilla being 36.8° to 37° C. In a case of
alcoholic gastritis, he found it to vary between 36.8° and
37° C. On the other hand, in gastralgia, he found very
little change from the normal, that change occurring
only in the most excessive exacerbations of pain.
The distinguished Frenchman seems to be unaware
that this subject has been investigated to some extent
before, and with interesting results. In 1879 Levin
wrote an article entitled " La Thermometrie de la
Region Stomachale," in which he stated, among other
things, that the local temperature in dyspepsia (after eat-
ing) and in cancer and dilatation of the stomach was
increased 1° to 2° C. above the normal.
So far, the results of this kind of surface thermometry
have been small. Yet they tend to show that there is a
definite temperature relation between the stomach and
the skin over it.
THE READING OF MEDICAL BOOKS TO JURIES.
The propriety of reading medical books to a jury has
been often questioned, and the courts of many of the
States refuse to allow it. In a recent case in Wisconsin
it was held that such books could not be read nor ex-
tracts be given therefrom by physicians from memory,
nor could they be read by counsel on the argument. In
"Rogers' Expert Testimony" it is stated that evidence
of this kind is not admissible in Indiana, Maine, Mary-
land, Massachusetts, Michigan, North Carolina, Rhode
Island, Wisconsin, California, and New Hampshire, and
is admissible in Iowa and Alabama.
The case above referred to was a trial for murder, and
the Court said, " The effect of the evidence given, under
objection, by Dr. Cody was to put before the jury as evi-
dence what the medical v;orks laid down as evidences of
strangulation. If this may be done indirectly by the oral
testimony of the person wlio has read the medical works,
it would certainly be a much safer rule to permit the
books themselves to be read to the jury, as being better
evidence of the fact. We think the learned Circuit
Judge also erred in permitting the counsel for the
State to read the medical authorities to the jury in the
opening of his argument. It is evident they were not
read by way of illustrating the argument of the coun-
sel, but to give the jury a clear view of what such med-
ical writers laid down as the evidence of strangulation.
The jury must have understood that the extracts read to
them were so read for the purpose of having them con-
sidered in determining the question of fact whether the
deceased came to her death by strangulation."
THE RIGHTS OF CORONERS TO HOLD INQUESTS.
The extent of a coroner's right to hold an inquest has
come before a Pennsylvania Court for decision, in a case
where the family of the deceased strenuously resisted the
attempt to hold an inquest, and insisted that the circum-
stances of the death made an inquest not only unneces-
sary, but an outrage.
The facts were that the deceased was an old man
about eighty years of age and had been ill for several
days, but was under the care of Dr. Atlee, a reputable
])hysician of the city of Lancaster. The deceased died
in his own house and surrounded by his family.
The disease was paralysis, and when the coroner,
against all remonstrances, persisted in the inquest, the
verdict brought in was "death from a paralytic stroke."
Upon the trial the main question litigated was whether a
coroner was a judicial officer in the sense that he was
the only judge of the propriety of exercising the func-
tions of his office. The Court repudiated this theory of
a coroner's duties, and held that an inquest could only
be properly held where there was a reasonable ground of
believing that death was caused by violence or some
other unusual means.
It was further stated that if an inquest could be held
in a case like that stated, it would be permissible to
make a post-mortem examination, an idea " i)reposterous
and abhorrent to all the finer emotions of human nature."
A bill was presented to the Legislature of this State
for the abolition of the coroner's office and the substitu-
tion of a board of medical experts.
The tendency seems to be setting strongly toward the
opinion that a coroner's inquest is of comparatively little
importance in determining the correct causes of deaths
by violence, and if in addition to this it is found that cor-
oners claim the right to hold inquests at their own sweet
will, without regard to the circumstances of the case, it
cannot certainly be long before the Legislature will abol-
ish the whole system.
THE THIRD BLOOD-CORPUSCLE.
Much attention has been paid to the so-called third blood-
corpuscle, or hajmatoblast, by various physiologists, and
especially by Schultze, Hayem, Norris, Hoffman, Bizzo-
zero, and lately by Carl Laker and Friedr. Rauschenbach.
Bizzozero's views are now quite well known. He be-
lieves that the blood of cold and warm-blooded animals
96
THE MEDICAL RECORD.
[July 28, 1883.
contains blood-disks, with parallel surfaces, one-half or
one-third smaller than the red blood-corpuscle. Hayem
describes them as small biconcave disks, of a slightly
yellowish color. Laker recently confirms Hayem's view
as to their shape, but thinks the yellow color artificial.
Norris, like Hayem, considers them biconcave, but doubt
has been thrown over the accuracy of his observations
because he describes them as of nearly the same sliape
and size as the red blood-corpuscle.
The actual number of these bodies, as well as their
physiological importance, must be very much greater than
has been hitherto supposed, if we may believe the more
recent investigations. Norris estimates that his colorless
corpuscles rank in number between the white and red.
Bizzozero does not venture any estimate. Laker, who has
devised some special methods of coloring and studying
them, counted in one field 180 blood-disks or haimato-
blasts, 44 red, and 9 white corpuscles ; in anotiier field
the ratio was 830, 270, o. This estimate, however, can-
not give a true idea of their actual proportions in the
blood.
It is as yet impossible to say whether these corpuscles
precede the red or follow them in their development.
Their function has of late been studied with special ref-
erence to their relation to the process of coagulation. The
prevailing view regarding the origin of the fibrin-factors
has been heretofore that of A. Schmidt's, viz.: that while
fibrinogen exists in the plasma, the fibrinoplastin and fer-
ment are contained chiefly in the white blood-corpuscles ;
these latter dying, give up their factors, and fibrin is
formed. Hoflinan has claimed that in coagulation 71
per cent, of the white corpuscles are used up and de-
stroyed.
Landois antl others iiad, however, shown that the red
corpuscles are also apparently concerned in fibrin-build-
ing, and Hayem has recently been arguing that the ha5-
niatoblasts, not the white cells, are the chief contributors
to the process. Three investigators, Laker, Bizzozero,
and Rauschenbach, now come to his support, and cite
evidence to show that the hrematoblasts do play this im-
portant part. It is found, for example, that proplastic
fluids like that of hydrocele, which contain fibrinogen but
not the other factors of coagulation, do not coagulate
when the fluid f'rom the spleen or lymphatic glands, so
rich in leucocytes, is added, but do so on the addition of
the little blood-disks.
The evidence so far shows that the blood contains a
third corpuscle, which plays a part in the process of
coagulation ; also that the factors in coagulation are de-
rived not from any of the different blood-elements alone.
'Ihe extremely important part which fibrin and its
factors play in septic fevers, when it is often rapidly de-
veloped with great rapidity and in extraordinary amounts,
niakes the study of its origin an interesting one. Recent
exparimental studies of Maissurians {" Inaug. Diss.,"
Dorpat) upon the changes of the coagulability of blood in
fever have shown this very strikingly. The importance
of the coagulation process in its relation to ojierative
surgery lends a further interest to the investigations
into its ultimate nature.
^jeujs ot tUc 'WiccU
The Honor of Knighthood has been offered to Dr.
Pitman, Registrar of the Royal College of Physicians.
The Influence of the DocroR in Health Re-
sorts.— " Each winter resort," says John Richard Green
in " Stray Studies," " brings home to us the power of the
British doctor. It is he who rears pleasant towns at
the foot of the Pyrenees, and lines the sunny coasts of
the Riviera with villas that gleam white among the olive
groves. It is his finger that stirs the camels of Algeria,
the donkeys of Palestine, the Nile boats of Egypt. At
the first frosts of November the doctor marshals his wild
geese for their winter flitting, and the long train streams
off, grumbling, but obedient, to the little Britains of the
south."
Bro.mide of Sodium in Sea-sickness. — Mr. T. M.
Kendall reports {British Medical Journal) the results of
his treatment of two hundred cases of sea-sickness. He
confirms the views of the late Dr. Beard, that bromide of
sodium is the most efficient of all remedies. He found
that in doses of ten grains, three times a day, it was ef-
fectual. Mr. Kendall condemns the too indiscriminate
use of oranges, lemons, champagne, and brandy.
A Post-Gradu.^te Schooi, in Philadelphia has been
organized in connection with Jefferson Medical College.
The New Michigan Medical Registration L.wv,
which was approved June 6th, will go into effect on Sep-
tember 6, 1883. It allows all persons who have been in
practice for five years, or who are regular graduates from
legally incorporated medical colleges to register at the
county clerk's office. It is made a misdemeanor for any
person to practise without registering. The supervisor
is required to make annually a statement of the number
of physicians in his district. There appears to be lack-
ing any machinery for carrying out the law efficiently.
The Medical Age says : " The profession were given no
opportunity to be heard on it during its passage, and
although it was introduced by a physician it is eminently
laymanlike in its construction. The hand of the lawyer
is, moreover, very conspicuous in the absence of the
faintest shadow of it. It is clear, from the careful pe-
rusal we have given it, that the number of doctors in
Michigan cannot be increased after December 6th next,
and untit the act has been amended so as to permit of
such increase. It is expressly provided that all registra-
tions shall be made during the three months following
the date on whicli the act takes effect (September 6th to
December 6th), and no provision is made for those who
may wish to commence practice in the State subsequently
to December 6, 1883. This may have been designed by
the framer of tlie bill. l!ut whether a design or a blun-
der, all future graduates and students of our Michigan
medical colleges, as well as all graduates and students
from the colleges of otlier States and countries, will, it
aijpears, be obliged to settle elsewhere than in this State
while the provisions of our new medical act remain oper-
ative.
Telei'honic Connection between Hospitals and
the Attending Staff. — The treasurer of St. Bartholo-
mew's Hospital, London, has completed arrangements
with a telei)hone company with a view of placing the
[jrincipal hospitals in London in direct telephonic com-
July 28, 1883.]
THE MEDICAL RECORD.
97
munication with the surgeons and physicians belonging
to those institutions. The scheme proposed is that the
various hospitals should be made the centre of communi-
cation, that the telephone company should connect the
large hospitals with the nearest telephonic exchange,
free of any charge, the company being remunerated by
the payments to be made by the surgeons and physicians
for connecting their private residences with the ex-
change.
Examinations in State Medicine. — The Royal Col-
lege of Physicians intends to institute an examination in
State Medicine.
Dr. John A. Octerlony has been appointed Pro-
fessor of Obstetrics and Diseases of Women and Chil-
dren in the University of Louisville. The universit\- is
to be congratulated.
The Drake Medical Society is the title of a new
and enterprising organization recently established in
Cincinnati, O.
How TO Deal with Cholera. — The Lancet takes a
very positive and hopeful view of our ability to cope
with cholera. It seems strange that the disease should
so persistently spread when disinfection will so promptly
stop it. The fact is, the Laticei is too sure of its state-
ments. Cholera can be checked, but it cannot always be
at once stopped by any method if it once gets a strong
foothold. Our contemporary says ; " What, however,
we do assert, is that medicine, as a preventive art, in its
dealings with the germs of disease, ought to be able to
grapple instantly and successfully with cholera. We know
that it is propagated solely through excreta, and that
water is the great carrier of the infective germs. Obvi-
ously, if the excreta of a cholera patient are allowed to
dry in contact with the air, they may float away in the
atmosphere, and the air will then become infected ; but
in a primary sense it is the water to which we must look.
In any case, it has been demonstrated that, provided all
the excreta from a cholera patient are instantly de-
stroyed— not merely disinfected — the disease will not
spread. The malady can no more develop de novo than
a plant can grow without seed. It is no use waiting un-
til the disease has effected a lodgment in our midst. \i
choleraic dejecta have passed into the sewers before the
nature of the disease has been recognized, as is most
likely to happen, the seed has been already sown broad-
cast, and the production of a crop of cases in some lo-
cality— it may be seemingly far from the first case, but
in connection with it — will be inevitable. The only ef-
fectual safeguard against the epidemic we desire to avoid
is to begin at once to destroy all diarrhoea stools, lest
too late they may be found to have been choleraic ! As
a matter of precaution we ought always to destroy the
stools of fever and diarrhoea. It is wanton recklessness
to allow them to pass into the sewers. This is how dis-
ease is spread and perpetuated, when it should be
stamped out. Whatever disinfectant we employ should
be used at once, and of strength sufficient to accomplish
the object in view. These are hints which should be re-
duced to practice without delay."
The Sanitary Institute of Great Britain will meet
at Clasgow, September 25th to 29th.
Gold Medal to Dr. Brown-Sequard. — The Royal
College of Physicians has awarded the gold medal,
founded in memory of the late Dr. Baly, as a mark of dis-
tinction in physiology, to Dr. Brown-Sequard.
Dr. Benjamin Bali, has been elected a member of the
Academic de M6decine.
.\mbulance Service in Philadelphia. — The com-
mittee on Medical Charities of the Philadelphia Society
for organizing charity, says the Philadelphia Medical
Times, announced at a recent meeting that steps had
been taken to supply all the police-stations with hand-
ambulance wagons, and before very long every station-
house will be supplied. In some of the stations they have
been already in active use for nearly two years.
The New Jersey State Dental Association held
its annual meeting at Asbury Park, July iSth and 19th.
Iowa Vital Statistics. — The Secretary of the State
Board of Health has just tabulated his returns for 1882.
The number of births reported for the year was 7,753 ;
marriages, 5,282 ; deaths, 10,059 ■ still-births, 225. Scott
County reports the birth of 22 pairs of twins, leading the
State, but Marion and Warren Counties, lying side by
side, return 20 each. Clark is the only county rejiorting
triplets. Despite twins and triplets the death-rate is un-
usually larger than the birth-rate, an ominous condition
of affairs.
The Bristol MedicoChirurgical Journal is the
title of a new provincial journal, published under the
auspices of the Bristol Medico-Chirurgical Society, and
edited by J. Greig Smith. It contains a large amount of
original matter, is well illustrated, but printing and paper
are not quite up to British standards.
Prosecuti.ng Irregular Practitioners in Canada.
— At the triennial meeting of the College of Physicians
and Surgeons, Province of Quebec, held at Quebec, July
nth, the president reported that systematic proceedings
had been undertaken to prosecute violations of the med-
ical act. Forty-nine suits were instituted, of which
thirty-five were successful.
The College of Physicians and Surgeons of this
city has sustained a loss in the resignation of Professor
Dalton from the Chair of Physiology. It is understood
that the resignation is due to Professor Dalton's ill
health. He is succeeded by Dr. John G. Curtis.
The Central .'Association of Bohemian Physicians
held its annual meeting at Kommotau on July 14th. Pa-
pers were read by Professors Chiari and Breiskey, and
others.
The Anatomical Bill, legalizing the use for scientific
purposes of dead bodies, has failed in the Georgia Legis-
lature. The Register says that bodies will now be scien-
tifically snatched.
Coroners in Connecticut. — The Legislature of Con-
necticut has passed a law requiring that coroners in
that State shall hereafter be attorneys-at-law, familiar
with criminal practice and medical jurisprudence, and
that one such person for each county shall be recom-
mended by the State's attorney for such county to, and
be appointed by, the judges of the superior court to
98
THE MEDICAL RECORD.
[July 28, 1883.
hold his office for the term of three 3-ears, and until an-
other shall be duly appointed in his stead, unless sooner
removed from office for cause. And the said coroner is
required to appoint for each town of the county " an
able and discreet person, learned in medical science, to
be medical examiner." Upon these officers is devolved
all the duties in detail which have hitherto not been ex-
ercised by coroners under the old regime, and such as
are common throughout the United States outside of this
commonwealth.
The Hospital Chapl.\ins have been withdrawn from
the Paris hospitals despite some very earnest pro.tests.
The Count de Ch.ambord. — Germany and France
have united over the body of the sick king, but have not
agreed as to his condition. Professors Billroth, Dratsche,
Wiener, and Bamberger came all the way from Germany
to view him, and Vulpian, with other eminent Parisians,
have been in consultation. It is agreed that he is obese,
has a fatty heart, and gastric derangement. Some have
said that he was suffering from phlebitis.
Dr. W. B. Rizner, a prominent physician of Cleve-
land, O., dropped dead in his residence in that city on
July 2 1 St. He was fifty-nine years of age. He was the in-
ventor of a mechanical finger used in microscopy, and
President of the Cleveland Microscopical Society.
The Hunter's Point Nuisances. — The Governor
and the State Board of Health have for some time been
quietly collecting evidence against the various Hunter's
Point factories, and on the 24th thirty-two of them were
surprised with an order forbidding any further stench-
making manufactures. The penalty for disobedience is
$1,000, and two years' imprisonment.
OToiTcsponclcncc.
OUR PARIS LETTER.
contagiousness of phthisis — the league against
vivisection — asylums for children — nachtel's
ambulance System — count de chambord.
Paris, July 16, 18S3.
Dr. Dehove, who was appointed temporarily to take
charge of the late Professor Lasegue's wards at " La Pitie "
Hospital, lately delivered a most interesting clinical lec-
ture, in which he endeavored to demonstrate, by cases
under his inunediate care, as well as by other examples, the
correctness of the view so steadily gaining ground that pul-
monary phthisis is contagious. According to him " tu-
berculosis is aht'ays due to contagion, and that no one
becomes tuberculous unless he receives from the exterior
the germ of the malady, the bacillus of tuberculosis."
The lecture was published in the Sfwaine Medicale, where-
upon Dr. Henry Bennet, whose name is so intimately
connected with the subject of phthisis, endeavored to re-
fute the conclusions of Dr. Debove as being too positive,
and pointed out the dangerous consequences of such a
theory, which, if true, the disease would be worse than the
plague, and each tuberculous patient would have to be
treated like the lepers of old, that is, he would have to
be completely isolated from the rest of the world to pre-
vent contagion. Social intercourse would be simply im-
possible and the inconveniences to the individual himself
and the risks of his presence anywhere would be so great
that it would be as logically a charity, almost a duty to
kill him as would be done with animals affected with
rinderpest. Fortunately, however, adds Dr. Rennet,
clinical experience proves that such a doctrine is
absolutely false. According to his own personal expe-
rience, extending to nearly half a century, during twenty-
four years of which period he has had almost unpre-
cedented opportunities of observing the malady in all its
phases, he is forced to the conclusion that Dr. Debove
simply misinterpreted the cases that came under his
notice. The subject of the contagiousness of pulmonary
phthisis was also fully discussed last winter by the Medi-
cal Society of Mentone, of which Dr. Bennet was Presi-
dent, and the members unanimously concluded that,
admitting the possibility of the contagion of tuberculo-
sis, it was so only in exceptional cases and under very
special circumstances. That there was no danger of
living with tuberculous patients even in the same room,
provided the latter be well ventilated, but a person in
health should on no account sleep in the same bed with
a consumptive patient.
A league against vivisection is being organized in Paris,
of which Victor Hugo has been elected Honorary Presi-
dent. The society, at present, is composed principally
of ladies, newspaper writers, and literary characters, and
the list of the members which has as yet been published
is not a very long one.
Two new asylums for rickety and otherwise deformed
children are to be established in the most populous dis-
tricts of Paris, under the patronage of the Municipal
Council. These institutions, which are to be designated
"Ecoles-dispensaires," will partake of the character of
an infirmary and a school where the children will have
the medical or surgical attendance required by their
condition, and at the same time receive the education
suited to their age and mental capacity.
The ambulance scheme for street accidents, submitted
more than two years ago by Dr. Nachtel to the munici-
pal authorities of Paris, has only now received official
sanction. The entire plan proposed by Dr. Nachtel is
to be carried out, but it will perhaps take three years at
least before we see anything of it.
Long ere this reaches you the Count de Chambord,
one of the noblest princes that ever lived, will perhaps
be no more. His malady seems to be of such a com-
plex nature as to defy the diagnostic powers of such men
as Billroth, Drasche, and Bamberger, who have been
summoned to Frohsdorf, the Count's residence, to meet
the regular medical attendant. Dr. Meyer, in consulta-
tion. Although they have been more than a week in at-
tendance, they are not yet fixed as to the precise seat or
nature of the malady before them. The seat, however,
is said to be in the gastric region, where a tumor is felt,
but the nature of the latter has not yet been ascertained.
But, judging from the symptoms present : inappetence,
frequent vomiting, and rapid emaciation, the tumor is
evidently of a malignant character. This opinion has
been emitted by the consultants, but they still hesitate
between cancer and simple abscess, and even retro-
cedent gout has been mentioned in the nomenclature of
the diseases from which the illustrious patient is said to
be suffering. The medical men are, however, agreed as
to the extreme gravity of the case, and everything seems
to portend a fatal issue, the accomplishment of which is
only a question of a few days, or, perhaps, only hours.
The medical men in attendance are all foreigners, and it
has been remaiked that no physician or surgeon has
been summoned from Paris.
[According to a cable despatch. Professor Vulpian
has examined the distinguished' patient and has failed to
find anv tumor. — Ed. ,
American Hosi-iiai.s.-.-.M. Poncet.'in Lyon Medical,
says " that nowhere has he seen in Europe a finer outfit
than that of the New York Hospital and the Boston City
Hospital. If no country can compare with France in
ease and comfort, it is nevertheless true that in relation
to certain hygienic conditions we ought to imitate what is
done elsewhere, and especially in America."
July 28, 1883.J
THE MEDICAL RECORD.
99
llcports of .Societies.
AMERICAN OTOLOGICAL SOCIETY.
Sixteenth Annual Meeting, held at Hotel KaaterskiU,
Catskill Mountains, July 17, 1883.
Morning Session.
The Society was called to order at 10.30 a.m., by Dr. J.
S. Prout, of Brooklyn, N. Y., Vice-President, the Presi-
dent, Dr. J. Orne Green, of Boston, Mass., being ab-
sent on account of sickness in his family.
Business Committee — Drs. E. Dyer, of Pittsburg, Pa.;
E. W. Bartlett, of Milwaukee, Wis., and F. B. Loring, of
Washington, D. C.
Committee on Membership — Dr. E. Dyer was addeti
pro tern, to this committee, because of the absence of Dr.
H. G. Miller, of Providence, R. I.
The Treasurer, Dr. J. Y. B. Vermyne, of New Bed-
ford, Mass., read his report, which was referred to Dr. G.
Strawbridge, of Philadelphia, for auditing, who subse-
quently reported that the accounts were correct.
Dr. Bartle'it, Chairman of the Business Committee,
announced the bulletin. The first paper was read by
Dr. W. W. Seei.y, of Cincinnati, O., entitled
A case of primary epithelioma of the auricle —
REMOVAL OF THE ENTIRE AURICLE BY THERMO-CAU-
TERY.
The patient was a male, sixty years of age, who, si.x
years ago, was bitten on the ear by a rat. The wound
never healed, but finally developed the growth removed.
During the last year it had increased in size rapidly and
bled easily on irritation. The original wound was near
the summit of the helix. The tumor was removed by
means of the thermo-cautery, the hemorrhage being only
slight. The entire surface of the stump was covered with
a thick layer of powdered boracic acid, and the patient
was sent home within five weeks with a perfect scar.
Dr. Seely regarded primary epithelioma of the auricle as
rather rare. .Although in this case the thermo-cautery
acted well, he thought that the knife with torsion of the
arteries was a preferable method. He also believed that
under the boracic acid treatment the healing period of
the wound was reduced at least one-half.
Dr. Knapp, of New York, thought it rare for epitheli-
oma to arise from trauma.
Dr. Seely thought it generally accepted that epitheli-
oma might be due to trauma, and asked what Dr. Knapp
would regard as the cause in cases of epithelioma of the
lip supposed to be due to using clay-pipes, etc. •
Dr. Knapp said that the pipe might produce constant
irritation of the lip, but he thought that it was not exactly
traumatism.
Dr. Seely regarded it as the perfection of trauma. The
special point of interest in his specimen was its occur-
rence in a region where neither traumatism nor epitheli-
oma is likely to develop.
INVITED GUESTS.
Dr. Strawbridge, of Philadelphia, introduced Drs.
Andrews and I.. Webster Fo.x, of Philadelphia, and they
were invited to attend the meetings of the Society.
A paper "On the Intermittent Perception of Sound,
as Conveyed through the Air and the Cranial Bones, with
a Brief Summary of the Results of Treatment in Chronic
Aural Affections with Impaired Hearing," by Dr. J. h.
Andrews, of Clifton, Staten Island, was read by title
and referred to the Committee on Publication.
Dr. Andrews then read a paper on
THE RECOGNITION OF BRAIN COMPLICATION IN AURAL
AFFECTIONS,
which contained the clinical histories, together with the
record of five autopsies, after death from brain disease
secondary to ear disease, under his own observation.
Special attention was directed to the condition of the
eye, and in all his cases the ophthalmoscope revealed
either papillitis or a hazy, slight cedematous appearance
of the optic-nerve disk, very valuable corroborative evi-
dence of a cerebral complication, especially where the
other symptoms were obscure. Dr. Andrews believed
that most oi^hthalmologists would endorse the statement
that optic neuritis and central vision of | J were not* in-
compatible. The existence of a cloudy disk in cases of
ear disease should excite suspicion, and he believed that
the condition of the optic-nerve disk furnished evidence
which has not received the attention it deserves. In the
majority of reported cases the condition of the eye is
only incidentally referred to. In one case there was a
cerebral abscess whicii Dr. .Andrews thought had un-
doubtedly existed for twelve years. It was also a sig-
nificant fact, in connection with cerebral localization,
that abscess secondary to ear disease is usually in
the medullary substance and seldom in the cortex.
The significance of special sym[)toms, as vertigo, vom-
iting, headache, more continuous and less paroxysmal
than with brain tumor, cedema over the mastoid, etc.,
were considered. Fever was very often absent. The
sight was most affected on the side of the brain lesion.
Dr. Kipp, of Newark, N. J., had published a number
of cases in which eye-.symptoms were present, and also
stated that Dr. Knapp had since published several. Dr.
Kipp's published cases preceded those reported by Zaufel.
Dr. Seely, of Cincinnati, had examined the eyes with
the ophthalmoscope in cases of suppurative middle-ear
disease, but so far with negative results, and he thought
that definite results had not yet been obtained in that
direction.
Dr. Strawbridge, of Philadelphia, said that after Dr.
Roosa directed attention to this subject at the last meet-
ing, held at Newport, he had examined the eyes of all his
patients suffering from suppurative middle-ear disease,
but without satisfactory results. He had also made an
analysis of the urine and had frequently found large
quantities of albumen present when brain complication
existed.
De. Kipp said he had continued his observations
and had found, in cases in which meningitis is present,
that there was almost always a change in the fundus
something like optic neuritis ; something between cedema
and actual inflammation of the nerve. The change had
been claimed only for those cases in which cerebral com-
plications existed.
Dr. Andrews said he alluded only to those cases in
which brain complications were suspected. In all his
reported cases he had examined the urine with negative
results.
Dr. Seely did not donbt that, in cases of actual brain
complication, more or less evidence would be found in
the fundus oculi, but in such cases the ocular symptoms
are less important than in those where the question of di-
agnosis is doubtful, or in the cases of suppurative middle-
ear disease as they are generally seen. He had seen
two or three cases in which there were marked changes
in the eye on the side of the aflected ear, but these
passed away and he was left in doubt whether there was
very much aftection of the brain.
Dr. Kipp believed that optic neuritis might exist with
ear trouble and pass away as the cerebral affection
ceased.
Dr. Bartleit, of Milwaukee, regarded ophthalmo-
scopic examination as very valuable in the acute stage
of meningitis. A slight cloudiness of the fundus indi-
cated that degeneration of the parts of the brain involved
has not yet taken place, but when the degeneration has
begun the appearances in the eye disappeared, sight im-
proved, etc. For the alienist, therefore, such e.xamin-
ations were important.
Dr. Sexton, of New York, asked if the ophthalmo
scope had been found of service as ajmeans of diagnosis
lOO
THE MEDICAL RECORD.
[July 28, 1883.
where other symptoms have not been prominently ob-
served, especially in fatal cases of meningitis and cere-
bral abscess.
Dr. K.IPP had examined many hundreds of cases of
otitis media, and had not found any cases with eye
symptoms in which there were not other symptoms of
brain complication.
Dr. Knapp thought that the ophthalmoscope some-
times gave most valuable evidence, more so than could
be obtained from the patient. In one of his published
cases the cedema was very slight, while the pain and
other subjective symjitoms were marked and had existed
for some time ; but as soon as the symptoms became severe
and pointed toward a fatal termination, the optic disk
was swollen first upon one side and then upon the other.
The recession of the ocular appearances had guided him
with regard to allowing the opening made in the mas-
toid to close, and in just these cases ophthalmoscopic
examination had been of great value. When the optic
disk gets normal, and tlie discharge from the mastoid is
slight, he thought the opening could with safety be left
to close, and he thought he had, in this way, abridged
the period of healing materially.
The paper was further discussed by Drs. Sexton,
Strawbridge, Seely, Knapp, and Kipp.
A paper by Dr. Sexton, of New York, entitled " Ex-
ternal and Internal Inflammation of the Mastoid, with
Cases," was read by title and referred to the Conunittee
on Publication.
Dr. Read J. McKay, of Wilmington, Del., then re-
ported a case of
ACUTE desquamative IXFLAM.NtATION OF THE EX-
TERNAL AUDITORY CANAL ACUTE OTITIS MEDIA
MASTOIDITIS AND CHRONIC MENINGITIS RECOVERY.
Dr. Charles H. Burnett, of Philadelphia, read a
paper entitled
A CASE OF MASTOID DISEASE ARTIFICIAL PERFOR.^TION OF
the BONE TE.MPORARY RELIEF DEATH FROM PY.EMIA.
The paper contained an account of a case of chronic
purulent inflammation of the middle ear inducing gen-
eral increased vascularity of the pyramidal jiart of tem-
poral bone, hyperostosis of the outer wall of the mastoid
groove without necrosis. The mastoid cavity became
filled with cheesy debris, and this furnishing a py;emic
source of embolism, was followed by embolism of a
chronic form, as shown first by abscesses in the lung
and then by infiltration of the liver with abscesses.
Dr. Burnett also expressed the opinion that the oper-
ation of trephining the bone is comparatively unattended
with danger, and affords the one slim chance of escape
from death in cases of true mastoid disease, which nuist
necessarily furnish an embolic source for the products of
inflammation, purulent, and cheesy debris pent up in the
mastoid cavity. In such cases there are the chances of
death from embolism, while there are none from the
operation. In the case reported by Dr. Burnett, the
patient survived the mastoid operation two weeks, and
the wound nearly healed, when the man was seized with
a chill and rapidly sank from embolic hepatitis.
These jiapers gave rise to an extended discussion con-
cerning trephining the mastoid when involved as a com-
plication in middle-ear disease.
Dr. Strawbridge, of Philadelphia, had never per-
formed the operation upon the living subject. He had
seen about five thousand cases of purulent middle-ear dis-
ease during the last twelve years, and had not had occa-
sion to trephine a single mastoid. Nor had he had but
a single death, which occurred in a child six montiis old,
that died a few hours after he first saw the case. In study-
ing the subject he had been struck with the very small per-
centage of cases in which pus was found after the bone
had been trephined. He would like to ask if the absence
of pus was not evidence that the operation had not been
ndicated.
Dr. Knapp, of New York, said that the ma,stoid had
been trephined with marked benefit in quite a number of
cases in which pus was not found. Such cases had been
reported by Hartmann and also by himself. His firm
conviction was that, when chronic middle-ear disease,
even without suppuration or perforation, was attended
with more or less obstinate constant pain which has its
origin in the mastoid process and radiates from there
over the corresponding half of the face and side of the
head, trephining the mastoid is indicated.
Dr. Sexton, of New York, had not seen so many cases
requiring opening of the mastoid as had been mentioned
by several authorities, as Buck, Schwartze, and others,
and only a very few in which he had thought the opera-
tion might be necessary, without some further evidence
than tlie iiain in the mastoid. He thought there might
be danger in attributing too much importance to pain as
a symptom in these cases. With regard to operative pro-
cedure it had occurred to him to have the opportunity
to liberate the pent-up secretion through the posterior
wall of the auditory canal, and he thought that, in a large
majority of cases, pointing takes place in that direction
rather than toward the brain. He regarded early con-
stitutional treatment as especially important, particularly
by the use of the sulphide of calcium, of which he seldom,
of late, had given more than one-tenth of a grain at a dose,
and frequently a much smaller quantity, repeating it per-
haps every one or two hours. Of course the liberation of
pus when formed was a well-established surgical proced-
ure and must not be ignored.
Dr. Theobald, of Baltimore, said that his experience
had been similar to Dr. Strawbridge's, and so far he had
opened the mastoid only upon the dead subject. He
did not believe that the indications for performing this
operation occurred very frequently. Early constitutional
and local treatment he thought would have cured most
of the cases in which the mastoid had been opened. He
regarded leeches as exceedingly serviceable.
Dr. Kipp, of Newark, N. J., thought that the opera-
tion was essentially harmless, and believed it to be bet-
ter to operate and not find jms than to allow the case to
go on and the patient die with pus in the mastoid cells
where by an operation it could have been removed. He
maintained that there were cases in which suppmation
occurred in the mastoid, irrespective of constitutional
treatment.
Dr. Bartlett, of Milwaukee, had not found it neces-
sary to trephine the mastoid. He had relied on poultices
applied every half hour, as hot as the patient can bear,
and had seen several cases in which pointing took place
within twelve hours, and the pus was then let out with
an ordinary scalpel, cutting through into the mastoid.
Dr. Strawbridge corroborated Dr. Bartlett's experi-
ence concerning the value of poultices.
Dr. Burneit thought that poulticing could not pro-
duce much etTect upon the mastoid cells if the external
wall of the process is intact.
Dr. Jones, of Chicago, thought no general rule could
be laid down, but that each case must be treated inde-
pendently, according to conditions ))resent.
Dr. E. E. Holt, of Portland, Me., had ha'd forty cases
of mastoid disease in two thousand cases of ear disease
of all kinds. He had not perforated the mastoid, and
had not had but three deaths, all of which could be ex-
plained without reference to the condition of the mas-
toid. He had used leeches more than any other measure,
unless it was incision.
The subject was further discussed by Drs. Sexton, Bur-
nett, and K.na)>p.
Dr. E. E. Holt, of Portland, Me., then read a paper
in which he reported a case of
teratoid tumor of both auricles,
having a clinical history of recurrent fibroid. The pa-
tient was a woman, twenty-nine years of age, of light
complexion and good average health. These morbid
July 28. 1883.]
THE MEDICAL RECORD.
lOI
growths were of unusual interest in the following respects :
I, they promptly followed perforation of the lobe and
wearing of gold ear-rings ; 2, they have repeatedly oc-
curred during a period extending over twenty years ; 5,
they have undergone remarkable change in structure.
In proof of this latter assertion a portion of a letter
was read from Dr. John H. Ripley, of New York, w-ho
had removed the tumors several times, and who stated
that they contained nothing but dense interlacing fibrous
tissue. An exhaustive examination of the recent growths,
by Dr. Edward Preble, of Portland, Me., determined,
however, that the said tumor contained germinal matter
in abundance with the following tissues, namely : myxo-
matous and adenoid tissue, giant cells, fibroplastic tis-
sue, loose areolar tissue with infiltrated fat, innumerable
elastic fibres, fine and coarse fibrous tissue, hyaline re-
ticular and fibro-cartilage, smooth muscle, fragments of
large blood-vessels, well-developed skin with corium,
papilhe, rete niucosum and epidermis, hair-follicles, hair
and sebaceous glands, together with certain unclassifiable
structures.
Drs. E. D. Spier, of ]5rooklyn, and John Van Duyn, of
Syracuse, N. Y., were
PROPOSED FOR MEMBERSHIP,
after which the Society adjourned to meet at 7.30 p.m
Evening Session.
The Society was called to order by the Vice-President,
Dr. J. S. Prout.
Drs. L. Webster Fox, of Philadelphia, and Swann M.
Burnett, of AVashington, D. C, were
proposed for member.ship.
Drs. Murdoch, of Baltimore ; Williams, of Boston ;
and R. H. Johnson, of Philadelphia, were introduced and
invited to remain in attendance.
AMENDMENT TO THE BY-LAWS.
Dr. John Green, Chairman of the Conmiittee on
Membership, offered the following : The first by-law, re-
lating to the election of members, shall be amended so
as to read "after the report of this committee has been
received, and at the same meeting," etc.
Dr. Sexton, of New York, presented a patient who
had formerly been under his care for
CHRONIC INFLAMMATION OF THE MASTOID CELLS WITH-
OUT perforation of THE MEMBRANA TYMPANI.
When under his treatment the case was complicated with
ozena.
This case opened the discussion again on the question
of trephining the mastoid, which was participated in by
Dr. Gruening, of New York, who a«"gued very stiongly in
favor of the operation, Drs. Kipp, Bartlett, Theobald,
Burnett, Sexton, and Webster.
Dr. E. E. Holt, of Portland, Me., then read a paper
entitled
observations on the HEARING POWER IN DIFFERENT
conditions,
in which was given the results of examination of four se-
ries of cases : I, twenty-four cases of chronic non-sup-
purative otitis media from private practice ; 2, twenty-
four machinists ; 3, twenty-four boiler-makers ; and 4,
twenty-four persons with normal ears.
The hearing power was tested by the voice, tick of a
stop-watch, tuning-fork, and Koenig's rods, and the
average age ratio of bone to aerial conduction and the
audibility of Ktenig's rods in three series of tests were
compared with each other and with the normal ear. It
was ascertained that th» ratio between bone and aerial
conduction diminishes in a corresponding degree to that of
the hearing power for the voice, and that the average
audibility for the upper limit of Kcenig's rods was quite
equal to the average normal of 40,000 V. S., as deter-
mined by Dr. Blake ; therefore the conclusion was drawn
that the loss of hearing in the machinists and boiler-
makers was due much more to a defect in the conduct-
ing than in the perceptive part of the organ of hearing
for the following reasons : i. Because of history or pres-
ent condition of catarrh of the middle ear and naso-pha-
rynx. 2. Because the tuning-fork when placed vibrating
in the centre of the teeth, was heard louder and longer
in the more affected ear, and the sound of it was invari-
ably increased by pressing on the tragus and closing the
meatus. 3. Because, had there been any considerable
disease of the labyrinth, they would not have responded
so nearly to the normal average audibility for the upper
limit of Kcenig's rods, since such an astute observer as
Dr. Blake, who has made extensive use of them, has never
had a case of labyrinth disease without a " marked loss of
hearing for the Koenig's rods."
In regard to hearing in a noise, several of the three
series of persons made a voluntary statement that they
could not hear better in a noise. These were carefully
tested in a quiet place and then in a noise, and in every
instance there was no improvement of hearing in the
noise ; on the other hand, when the voice was used at
the same time it was not heard quite as well in the noise
as in a quiet place.
Dr. Kipp, of Newark, N. J., read a paper entitled
ON the association of aural disease with simple
sparkling synchisis of the vitreous humor.
In six of the seven cases of synchisis of which he has
record aural symptoms were present ; in the seventh
case it is not known whether or not ear trouble existed.
In five of the cases the synchisis scintillans existed in
only one eye, and in two of these the ear of the same
side only was affected ; in the other three both ears were
diseased. In four of the cases the ear-trouble was
probably situated in both the middle ear and the nervous
apparatus. In one case there was chronic suppuration
of the middle ear, which had been preceded for years by
impairment of hearing without otorrhoea. In the sixth
case there was absolute deafness of the one ear since
infancy. Otological literature contains no record of
similar cases, and the author thinks that the association
of the two affections in his cases may have been merely
accidental. They are published with a view of inducing
others to examine their cases of synchisis for aural trou-
ble, and thus settle the question.
The paper was discussed by Dr. VV. S. Little, of
Philadelphia, and Dr. Webster, of New York.
A paper by Dr. Charles A. Todd, of St. Louis, on
'* Anomalous Sebaceous Gland in Immediate Proximity
to the Auricle," was read by title and referred to the Com-
mittee on Publication.
Dr. Sexton, of New York, then read a paper (see
p. 90) on
the significance of the transmission of sound to
the ear through the tissues in aural disease.
It was discussed by Drs. Burnett, Holt, Andrews, and
Kipp.
Dr. Sexton then exhibited fourteen photographs of
various forms of ear affections ; also two ear-syringes,
together with a hooked curette for removing foreign
bodies from the ear, where it is necessary to use forceps.
Dr. H. Knapp, of New York, read a paper on
obstinate purulent desquamative otitis media,
in which he reported a case that was finally cured. He
laid special stress upon the fact that when there is
desquamative otitis media palliative treatment produces
only temporary benefit, and that to effect a cure it must
be converted into an acute case that will produce a
condition that can be cured. The case was a new con-
firmation of views which he expressed before the Society
two years ago concerning the treatment of granulations
and polypi. He then stated that in cases of diffuse
I02
THE MEDICAL RECORD.
[July 28, 1883.
granulations, and broad sessile polj'poid excrescences
he abstained from destroying them by caustics or sharp
instruments, because these procedures are likely to de-
stroy essential parts of the drum-cavity, and terminate in
replacing the mucous membrane by cicatricial tissue,
thus bringing about an unpleasant condition known as
sclerosis. The only reasonable plan is to change the
condition of the parts, and this he accomplishes by instil-
lations of warm water and keeping the parts moist by
applying cotton steeped in glycerine. A somewhat pro-
longed discussion followed on the question whether or
not a new drumhead is ever actually formed after being
destroyed by disease.
The Society then went into executive session, and
afterward adjourned to meet in 1884.
New Members — Dr. W. S. Little, of Philadelphia ; Dr.
B. E. Fryer, U.S.A., Fort Leavenworth, Ks.; Dr. R.
O. Born, of New York ; and Dr. J. A. Lippincott, of Pitts-
burg, Pa.
President — Dr. Charles H. Burnett, of Philadelphia,
Pa.; Vu-e-President — Yix. J. S. Prout, of Brooklyn, N. Y.;
Secretary and Treasurer — Dr. J- J- B. Vermyne, of New
Bedford, Mass.; Committee on Membership — Drs. John
Green, of St. Louis, Mo.; H. G. Miller, of Providence,
R. L, and \. Matthewson. "''P-roklyn, N. Y.
AMERICAN OPHTHALMOLOGICAL SOCIETY.
N^ineteenth Annual Meeting, held at Kaaterskill, N. Y.,
July 18 and 19, 1883.
Wednesd.w, July 18 — First D.\y — Morning Ses-
sion.
The Society was called to order at 10 .\.m. by the Presi-
dent, Dr. Henry D. Noves, of New York, who made a
few congratulatory remarks and then appointed the fol-
lowing committees:
Committee on Bulletin. — Drs. F. B. Loring, of Wash-
ington, and E. W. Bartlett, of Milwaukee.
Business Committee. — Drs. Jolin Green, of St. Louis ;
E. Gruening, of New York ; O. F. U'adsworth, of Boston ;
S. Theobald, of Baltimore, and E. Dyer, of Newport.
The Treasurer's report was read and referred to Dr.
David Webster, of New York, who subsequently re-
ported that all the accounts were correct. The report
was adopted.
CANDIDATES FOR MEMBERSHIP.
The following were nominated : Drs. Charles S. Turn-
bull, of Philadelphia ; Miles Standish, of Boston ; J. L.
Thompson, of Indianapolis ; W. T. Bacon, of Hartford ;
Stephen O. Ritchie, of Washington, and John Van Duyn,
of Syracuse.
NEW MEMBERS.
The following were elected : Drs. B. E. Fryer, U. S. .\.,
of Fort Leavenworth, Ks. ; J. A. .Andrews, of Clifton,
Staten Island ; L. Webster Fox, of Philadelphia ; J. A.
Lippincott, ot Pittsburg ; J. L. Minor, of New York ;
and E. E. Holt, of Portland, Maine.
INVITED GUESTS.
The following were invited to attend the sessions of
the society: Drs. T. Y. Sutphen, of Newark, N. J. ; R.
H. Johnson, of Philadelphia ; Miles Standish, of Boston,
and Swann M. Burnett, of Washington.
The Secretary, Dr. R. H. Derby, of New York, read
the resignation of Dr. Thomas J. Morton, of Phila-
delphia, which was accepted.
INFLUENCE ON REFRACTION OF FOUR YEARS OF COL-
LEGE LIFE ; ILLUSTRATED BY STATISTICS OF THE LAST
FOUR CLASSES GRADUATED FROM AMHERST COLLEGE.
-A paper on the above subject, sent by Dr. IIasket
Derby, of Boston, was read by Dr. Miles Standish, of
Boston.
The author had been able in 254 instances to trace the
refraction through the whole term of four years. The
examinations were all jiersonally conducted with glasses,
and in the majority of cases, certainly in all doubtful
ones, with the ophthalmoscope. The results given are
those obtained by glasses. The use of atropine was
entirely impracticable, as the students could not have
been allowed even temporarily to be disabled from the
active prosecution of their studies. Dr. Derby followed
the example of Emmet and Loring in stating degrees of
ametropia as slight as O. 5 D., and included nothing
less. The averaa:e ase of those examined was at
entrance 19 years, at graduation 23. The number of
cases was small, it is true, but it is one of the few at-
tempts yet recorded to trace the movement of refraction
among the more highly educated during this particular
period of life and for a continuous term of years.
The general results were, hypermetropia at entrance,
39, at graduation, 47 ; myopia at entrance, 90, at
graduation, 120; emmetropia at entrance, 125, at
graduation, 87.
.Analyzing the ametropia he found under the head of
manifest hypermetropia, of which there were 39 cases at
entrance, i changed to myopia, 2 diminished, 27 re-
mained stationary, and 9 increased in amount.
Of the myopia there were go cases ; 32 remained
stationary, 58 increased in amount.
The observations concerning emmetropia possessed
peculiar interest, the results somewhat militating against
theories that have found general acceptance. There
were at the time of entrance 125 cases of emmetropia.
Of these 86 remained emmetropic, 10 developed hyper-
metropia, and 29 developed myopia. The average
age of those thus developing myopia was very nearly
nineteen at entrance, twenty-three at graduation. The
average myopia developed amounted to nearlv i D.
(0.982).
So far as these figures go they tend to show, first, a
large amount of myopia, even in this country among the
educated classes. The author said it was difficult to
compare Dr. Loring's figures with his own, because Dr.
L.'s statistics were based upon observations made be-
tween the ages of six and twenty-one, and liis observa-
tions were made between the ages of eighteen and
twenty-three. But all researches at the latter age go to
prove that one-half, or very nearly, of the educated
community is myopic in this as well as in other countries.
Moreover, contrary to the impressions so long enter-
tained, myopia may be acquired at or near twenty years
from the same causes that produce it at an earlier age,
and it may continue to progress until the course of study
is completed.
The pa|)er was discussed by Drs. Webster and Mitten-
dorf, of New York ; (iruening, of New York (who di-
rected special attention to the use of the term dioptric,
urging that some unitorm mode of spelling be adopted) ;
Carmalt, of New Haven ; Little, of Philadelphia, and
Hutchinson, of Utica.
SO.ME IMPROVEMENTS IN INSTRUMENTS AND APPLIANCES
FOR CATARACT OPERATIONS.
Dr. Russeli. Murdoch, of Baltimore, read a paper
with the above title. He exhibited an ophthalmostat, or
a self-holding eye-forceps, and an eye-speculum, which
were modified from those exhibited to the Society in
1874. The distinguishing features of the S])eculum were
" absence of spring and set screw." The change in the
ophthalmostat was such tliat it seized the conjunctiva in
a vertical fold, and rotated the eyeball without dragging
it, and the substitution of three little hooks for one
pair, which secured greater steadiness.
The new instruments consisted, first, in the combina-
tion ofGraefe's knife, end to end, witli Wecker's scissors.
Second, a combination of iris forcejjs with tlie cysto-
tonie and shell spoon. The advantages claimed for
these instruments were that an assistant is dispensed with,
July 28, 1883.]
THE MEDICAL RECORD.
103
and that seven instruments are reduced to three in per-
forming the modified linear extraction of cataraqt.
Dr. Murdoch also exhibited a bandage which could be
quickly made and easily applied.
Dr. Gruening, of New York, thought that outside of
the limits of civilization such complicated instruments
might be useful, but that within the limits they should be
discarded entirely, and that a cataract operation should
not be undertaken without an assistant. Concerning the
bandage, he said, an ordinary flannel bandage could not
be replaced by anything which had yet been brought
forward. No bandage can produce the pressure that
can be applied by the use of the flannel roller. It is
necessary to immobilize the eye, and this cannot be
done by any substitute for the ordinary flannel bandage.
The President remarked that he had had some ex-
perience in the use of the little forceps in fixation, and
had long ago discarded the instrument, because it did not
give so much control over the eye as one might imagine.
He had reached the conclusion that the operator's hand
should guide the forceps.
Dr. Murdoch remarked that he was well aware the
gentlemen in New York could obtain an assistant at any
time, but he thought there were occasions outside where
it was impossible to secure an assistant, and that the in-
strument had been devised especially to meet such emer-
gencies.
Dr. Theob.'\ld, of Baltimore, believed that the eye
could not be inmiobilized by any bandage whatever
which was at all permissible, and that there was a decided
objection to the long flannel bandage, especially during
hot weather.
Dr. Gruening said he would not insist upon the flan-
nel bandage, but that he would insist upon the long band-
age, and of late he had used gauze, dipping it into water
before applying it. He believed that the eye could be
perfectly iuunobilized if the bandage were properly ap-
plied. The first thing to be done is to fill up the orbital
depression, so that when the hand is placed over it the
brow and the bridge of the nose are not felt, but that the
hand rests entirely upon the pad, and upon that pad press-
ure with the bandage can be made which will render the
eye entirely immobile.
Dr. Theobald thought if Dr. Gruening would apply
the bandage in the manner described to his own eye he
would find that the eyeball had not been rendered im-
mobile.
Dr. Henry S. Schell, of Philadelphia, reported a
case of
TUBERCLE OF THE IRIS.
The patient was a boy nine years of age, who applied
for treatment at the Will's Eye Hospital, August 29, i88r.
The left eye had been painful for four days, and exhibited
the general signs of ordinary plastic iritis. Atropine
.- nd mercurial ointment were prescribed. On the i6th
of September no efl"ect had been produced by the treat-
ment. In the latter part of October the boy came to
the Children's Hospital suffering from well-marked cox-
algia in the second stage. There was a distinct history
of phthisis on the mother's side. The left eye was still
somewhat painful. The pupil was immobile, and there
was a ring of circumscribed injection, and projecting from
the nasal side of the pupillary margin was a small yellow-
ish-white nodule the size of a pin's head and tinged with
Pjfk. This nodule gradually increased in size. The
hip-joint disease progressed The eye was enucleated,
and was examined by Dr. G. B. Lawrason, of New Or-
leans, who reported that it consisted of two or three tu-
bercular masses embedded in inflammatory product.
The tubercles seemed to have developed in the organized
inflammatory product, which nearly filled the anterior and
posterior chambers.
The President said that within the last year a case
had been under observation in New York which illus-
trated the difficulties in diagnosis. The patient was four
years of age, and the gross appearances presented by the
eye were absolutely indistinguishable from a glaucoma-
tous condition or a metastatic choroiditis. The patient
continued under observation for several weeks without
much progress in the disease. The eye was then enu-
cleated, and tubercular disease was found to be the true
nature of the lesion. It was felt at the time by those
who examined the patient that, in some cases, the differ-
ential diagnosis between glaucoma and tubercular disease
is impossible.
TUBERCULOSIS OF THE CILIARY MUSCLE AND IRIS.
Dr. O. F. Wadsworth, of Boston, reported a case vf
the above character occurring in a girl three and a haU
years old. Dr. Hasket Derby, of Boston, saw the patient
when the process had lasted two weeks, and regarded it
as a case of kerato-iritis. The pupil contracted and re-
mained so in spite of atropia ; the cornea was hazy ; the
lids were natural. Afterward, when Dr. Wadsworth saw
the patient the cornea was hazy, the conjunctiva was
moderately congested, there was no marked ciliary con-
gestion, there was good anterior chamber, and the pupil
was of good size. The patient died about six months
afterward. The eye after it was removed contained a
mass about six millimetres in thickness. The vitreous
was replaced by serous fluid, there was nothing of the
lens to be seen. The iris and choroid were in place and
behind the mass. Microscopical examination, made by
Dr. Ernst, of Boston, revealed that the growth was tuber-
cular in character, and he was also able to demonstrate
the presence of bacilli. There was no evidence of pul-
monary disease. It was learned late in the history of
the case that the father and the fatlier's brother died of
[ihthisis, and that other members of the family were sub-
ject to bronchial attacks, so called.
The paper was discussed by Drs. Prout, of Brooklyn,
and Webster, of New York.
Dr. S. F. McFarland, of Oxford, N. Y., read a paper
which contained
A personal EXPERIENCE WITH PRISMATIC GLASSES.
During his boyhood he had a slight divergence, occur-
ring and disappearing at times, although seldom sufficient
to attract attention. Still he had the full use of his eyes,
could judge of distance as well as others, and was even
expert in the sports of youth requiring binocular vision.
He had no inconvenience dliring his studies, always en-
joying the greatest comfort during the most severe and
protracted application. During the autumn of 1862 he
contracted typho-malarial fever in the army, and after
recovering from this he found that he had lost the full
and comfortable use of his eyes, which continued with the
usual pain and annoyance attending a futile effort to use
both eyes in conjunction, and he was compelled finally to
discontinue reading almost entirely until in January, 1866,
he consulted Dr. H. D. Noyes, who gave him plain
prisms of seven degrees each, bases inward, for distance,
and eight degrees each with plus thirty-six spherical for
reading. At that time he had been nearly three years
unable to obtain binocular vision even for a moment, but
at once he was able to see distinctly. He has never dis-
continued their use, they have been varied from time to
time, but he has always adhered to the prisms. He
suff'ers the inconvenience that he cannot maintain con-
tinued binocular vision, but can obtain and retain it long
enough for an iridectomy, or the extraction of a cataract,
and even during very protracted operations, although at
the expense of pain and very distressing lassitude fol-
lowing the effort. Without the prism he could not do
these things, inasmuch as slight differences in distance
would not be appreciable. With bifocal sphero-pris-
matic glasses he is able to do all his office work without
changing, and with a reasonable amount of comfort.
Dr. R. J. McKay, of Wilmington, Del., said that a
music teacher came to him in September, 1879, who,
while standing directly in front of his class and moving
I04
THE MEDICAL RECORD.
[July 28, 1883.
his eyes from right to left extremely without moving his
body, weakened the external recti. Dr. McKay or-
dered prisms with the bases external, which the patient
had worn ever since with comfort for distance only.
Dr. O. F. AVadsworth, of Boston, then read a paper
ON THE APPARENT CURVATURE OF SURFACE PRODUCED BY
PRISMS.
The phenomenon is very familiar that when we look
through prisms with the bases inward, with a plane sur-
face, the surface appears convex, and with the bases out-
ward the surface appears concave. He had not met with
any exception to this phenomenon, and the communica-
tion was intended to explain it, and was the theory which
had been worked out by Dr. Pierce. It was illustrated
with diagrams.
Dr. S. W. Burnett, of Washington, on invitation, pre-
sented a specimen of
tubercle of the choroid,
accompanied with the clinical history of the case, which
occurred in a colored girl fifteen years of age.
Dr. J. A. Spaulding, of Portland, Me., then read a
paper in which he reported a case of
sympathetic neuro-retinitis.
The author first referred to the able works of Mauthner
and Kneis, whose views are so diametrically opposed,
the latter believing that the so-called cases of svmpa-
thetic neuro-retinitis are open widel)' to criticism. It
seemed desirable, therefore, to publish, and thus to ofier
to careful criticism, every case of apparent sympathetic
inflammation of the retina and optic nerve (either alone
or conjoined), and above all does this appear necessary
when we have, as at present, to offer one in which so far
as accurate and repeated examinations have availed, the
retina and optic papilla of one eye underwent inflamma-
tion after an injury to its mate, while at no time from the
beginning of the case were there ever any visible signs
of inflammation of any portion of the uveal tract. The
patient was a Danish woman, fifty-six years of age, and
healthy in every respect. On January 6, 1883, she was
struck in the eye by the horn of a cow, which rendered
her at once and forever totally blind in that eye. The
patient saw a flash of light and then tlie sight was gone.
Eleven weeks after the injury to the right eye the pa-
tient, much reduced in health on account of the ])ain and
irritation in the right eye and its neighborhood, came to
Dr. Spaulding for consultation. On March 30th, about
four weeks after first seen, the right eye was enucleated
on account of the excessive pain from which the patient
was suffering. The operation was followed by excessive
hemorrhage, which could not be checked by pressure or
hot water, and only ceased after ligature of the artery
deep in the orbit, and of a second one which appeared
to spring from a band of connective tissue uniting the
globe and upper eyelid. The case subsequently pro-
gressed favorably, and the patient was sent home. No
medicinal treatment was adopted. The result appears
to justify the opinion of the truly sympathetic nature of
the neuro-retinitis in the left eye, for the sight gradually
returned to the remaining eye. 'l"he pain in the head
disappeared with considerable rapidity. July 14, 1S83,
examination with the ophthalmoscope revealed nor-
mal left eye, vision |g. The enucleated eye was lost.
The presence of this neuro-retinitis with total loss of
vision in the eye five weeks after an injury to the
other, and without any other visible or possible cause,
such as idiopathic iritis, .syphilis, cerebral lesion, etc., in-
dicates the sympathetic nature of the disease. Iritis
was excluded in any form as the possible cause of the
difficulty in the left eye.
Dr. VVeu.ster, of New York, said he had reported two
cases of sympathetic neuro-retinitis in which he enucle-
ated the eye giving rise to the trouble and with excellent
results. The neuro-retinitis subsided, and tlie eve re-
covered with much better vision than existed before the
operation was performed.
Dr. Prout, of Brooklyn, said, concerning the hemor-
rhage in Dr. Spaulding's case, that in one instance, after
resorting to various methods unsuccessfully, he arrested
the hemorrhage by digital pressure with the finger in the
orbit.
Dr. Mittendorf, of New York, had employed sponge-
pressure, that is, applying a good-sized, soft, moist sponge
over the orbit, and securing it with a roller bandage after
enucleation, to be worn for twenty-four hours, then
changed and worn for the next twenty-four hours, and
he had never experienced any trouble from hemorrhage
or from infiltration of the lids or the orbital tissues.
Dr. H. W. Williams, of Boston, said he had never
had any difficulty in arresting hemorrhage by means of
the sponge-tent, and was unable to see how it is possible
for hemorrhage to go on if the orbit was properly plugged
in that way. However, since he had adopted the circu-
lar suture of Bowman, he did not recollect of having had
a case where it was necessary to apply the sponge-tent.
Dr. Prout thought the removal of the tent would be
exceedingly painful.
Dr. AVilliams remarked that the patients did not like
it at all, but the pain could be reduced to its minimum
by removing the sponge very quickly.
Dr. Dyer, of Newport, while in charge of an army
ward, had between two hundred and twenty-five and two
hundred and fifty cases of enucleation, and in not . a
single one did lie experience any annoyance from hemor-
rhage. He always used a large sponge from which ice-
water was gently squeezed into the orbit, rarely for more
than ten minutes, and afterward applied a double thick-
ness of linen, covering it with one thickness of bandage.
Dr. Green, of St. Louis, referred to a case in which
ice-water and digital pressure had been employed with-
out success, and finally he tamponed the orbital cavity
with a narrow strip of linen and made external pressure
with a bandage, which controlled the hemorrhage. The
tampon was allowed to remain twenty-four hours, when
it was removed without difficulty by a process of un-
ravelling, as it were. He subsequently learned that the
patient had a liemorrhagic diathesis.
Dr. Knapp, of New York, referred to a procedure for
avoiding hemorrhage after enucleation, and it was to
keep close to the sclerotic. If this jjrecaution is ob-
served there will be very little danger from hemorrhage. ■
The most profuse hemorrhage occurs when the optic
nerve is cut, because we are likely to go into the natu-
rally cavernous tissue of the organ, but the division can
be made without undue loss of blood by pressing the
speculum into the orbit and allowing the eyeball to pop
out, as it were, which will facilitate the division of the
nerve and removal of the ball very materially.
The President had never had but one case of seri-
ous hemorrhage which required digital pressure. He had
had one case of enucleation of the eyeball for a tumor
in the antrum, and in which the bleeding was so profuse
that it was necessary to tampon the cavity with the ordi-
nary kite-tail tampon made of pledgets of lint. The
tampon was effectual and was readily removed.
The paper was further discussed by Drs. W. W. Seely,
of Cincinnati, and V. HuUer, of Montreal, Canada.
Dr. David Webster, of New York, then reported
thirty-five cases of cataract extraction.
They included all the cases which he had had, good
and bad, from tiie beginning, and all the operations were
performed at the Manhattan Eye and Ear Hospital. A
brief clinical history of several of the most interesting
cases was given. Thirty-one different patients were oper-
ated upon — males, 20; females, 11. Their ages varied
from thirty to eighty-three years. Under forty years of
age there were 2 ; between forty and fifty, 3 ; between
fifty and sixty, 9 ; between sixty and seventy, 9 ; between
seventy and eighty, 6 ; above eighty, 2. Twenty-eight
July 28, 1883.]
THE MEDICAL RECORD.
105
eyes were operated upon while the patient was under
ether. Of these, 23 were successes, 2 partial successes,
and 3 failures. Seven eyes were operated upon with-
out the use of an anaesthetic ; 5 of these did well, and 2
were failures. The method of operating known as " Von
Graefe's modified " was used in all cases in which it was
practicable ; where a preliminary iridectomy was done
the incision for the extraction of the lens was made in the
same position as in the other cases. Preliminary iridec-
tomy was performed in 6 cases ; 4 by himself, and 2 by
another surgeon. In only i case of the 35 was there
loss of vitreous, and this was the only case in which
the scoop was introduced into the eye for removing the
lens, and in 3 cases there was dislocation of the lens
into the anterior chamber during the preliminary iridec-
tomy. In I case iridodialysis was produced during the
operation, and in i case the iris fell before the knife on
account of premature escape of the aqueous, and was cut
through. In all these cases in which accidents occurred
during the operation the eyes recovered with good sight.
In 3 cases the cornea was thin and flaccid, and became
wrinkled or collapsed after evacuation of the lens. In
8 cases there was hemorrhage from the iris immediately
following the iridectomy. In 4 cases a considerable
quantity of soft lens matter was left in the eye. In i
case some inflammatory reaction was noted during re-
covery ; this eye did well. In 4 cases there was iritis.
Sloughing of the cornea occurred in i case, panophthal-
mitis in 2 cases, and in i there was irido-cyclitis witli
sympathetic inflammation of the fellow eye. A secondary
iridectomy was performed in 2 cases, in both resulting in
a clear pupil, but in one failing to restore sight on account
of deeper disease. Keratonyxis for pupillary membranes
was performed in 7 cases, and in all successfully.
The successes, taking the results of all the cases, com-
plicated and uncomplicated, were 27; partial successes,
2 ; failures, 6. Dr. Webster believed, however, in jus-
tice to himself and cataract statistics, he ought to exclude
the cases of e.xtensive corneal opacity, a case of detacli-
ment of the retina, and one other case with vitreous and
perhaps deeper complications. The figures would then
stand : successes, 27 ; partial successes, i ; failures, 2.
By success he meant the standard adopted by Dr. Knapp,
namely V. -^J'^ ; partial success, ability to count fingers ;
failures, nothing more than perception of light.
The paper was discussed by Drs. Heyl and Straw-
bridge, of Philadelphia ; Theobald, of Baltimore, and
Carmalt, of New Haven.
Dr. W. W. Seelv, of Cincinnati, then read a paper
entitled
NOTES ON OCULAR THERAPEUTICS.
He directed attention, first, to the use of yellow oxide
of mercury in external ocular troubles. Ten grains to
the ounce of the vehicle is the best for all purposes.
The less bichloride the preparation contains the less pain
produced by its application. A practical point with re-
gard to the use of yellow oxide and vaseline in conjunc-
tival affections where there is profusion of tears, such as
washes the salve out, was to substitute eserine or the bi-
chloride in solution, to contract the bloodvessels. The
strength of the bichloride solution that seems to answer
every purpose is one grain to sixteen ounces of water.
Such a solution is entirely painless, and has often, in his
hands, set aside an acute catarrhal conjunctivitis of a
violent type, after from one to three or four thorough
drenchings of the conjunctiva. In corneal affections he
uses a four-grain solution of eserine once a day, and be-
lieves that it acts altogether better than more frequent
applications, either of the same or of a weaker solu-
tion. This remark applies to all classes of cases.
For the reduction of intra-ocular tension eserine has,
for him, done away entirely with paracentesis.
Every one has met with cases of iritis in which atro-
pia does not seem to act promptly and satisfactorily,
possibly because of the extreme vascularity 0/ the iris.
In such cases, instead of making paracentesis and ex-
tracting blood, he instils once a day a few drops of a four-
grain solution of eserine. The habit of instilling eserine
once a day in iritic cases has become a routine practice
with him, the patient at the same time using the mydri-
atic in the ordinary manner. In more than one case
had he seen adhesions let go after the combined use of a
myotic and mydriatic that had resisted the latter alone.
Iritis is the only disease in which he employs a mydriatic
as a fundamental remedy.
Eserine is the remedy par excellence in corneal affec-
tions. In cases in which mydriasis is necessary the lat-
ter can be produced perfectly, and still tlie satisfactory
effects of the myotic be maintained. This is illustrated
in suppurative inflammation after cataract operations,
formerly so unsuccessfuly treated by heat and atropine.
Dr. McKay, of Wilmington, had used yellow oxide of
mercury with very favorable results in conjunctival
troubles.
Dr. Gruening, of New York, said the alternate use
of mydriatics and myotics for breaking up adhesions was
not entirely new. He had resorted to this method as
long ago as 1868. He regarded the use of eserine in
iritis as an extremely dangerous practice.
Dr. Knapf, of New York, thought the alternate use
of eserine and atropine was advantageous in some forms
of iritis, especially the serous variety. Again, where
there is increase of pressure which produces intense pain,
as in certain cases of glaucoma, the pain is consider-
ably relieved by one drop of eserine. In serous iritis
the pressure is sometimes intense, and he thought that
eserine could be so regulated as to prevent the noxious
effects of the drug.
Dr. Seely said he did not speak of the alternate use
of eserine and atropine, but wished simply to speak of
the use of eserine once a day for the purpose of contract-
ing the "blood-vessels," of course maintaining mydriasis
by atropine. He had never seen a case in which eserine
had produced iritis.
The paper was further discussed by Dr. Kipp, of
Newark, Dr. Knapp and Dr. McKay.
The Society then adjourned, to meet at 8 p.m.
Evening Session.
The Society was called to order by the President.
The Minutes of the Morning Session were read and
approved.
Dr. W. F. Mittendorf, of New York, then read a
paper on
the treatment of detachment of the retina.
During the last three years he had treated several
very extensive detachments of the retina, occurring in
patients that had only one useful eye, the other being
entirely blind or absent. Although no new remedy or
new method had been used, it was the combination of
the different plans devised for the treatment of this affec-
tion, and the mode of administering the remedies that
had led to the success.
After briefly referring to the causes of detachment of
the retina, the author stated that the object of the
treatment must be, first, to keep the eye as free as pos-
sible from all irritating influences, which is best done by
closing both eyes, or by putting the patient into a dark
room ; second, to keep the eye as quiet as possible, and
to avoid all accommodative eftbrts, and for this purpose
the eye must be kept under the influence of a mydriatic ;
third, to place the absorbents in the most favorable
conditiour— this is accomplished by means of a pressure
bandage, and he had found elastic pressure procured by
means of a rubber bandage to be of the greatest as-
sistance ; fourth, to hasten the absorption of the ef-
fused fluid, if this be the cause of the detachment — this
can be accomplished by the use of jaborandi or pilocar-
pin. He had given a hypodermic injection of one-
io6
THE MEDICAL RECORD.
[July 28, 1883.
fourth to one-sixth of a grain of pilocarpin early in the
morning, and then kept up the diaphoresis by the use of
an infusion of jaborandi leaves, from forty grains to one
drachm to twelve ounces of water, administered in wine-
glass doses during the afternoon and evening. This
treatment should be kept up for three or four weeks.
He had not seen a single case in which the remedy ad-
ministered in this way had to be discontinued on account
of unpleasant symptoms.
If the detachment complicates a specific choroiditis, or
if It follows a serous iritis demanding specific treatment,
this may be used at the same time with the other reme-
dies mentioned. In these cases the disease yields, as a
rule, sooner than in other cases, an'd it will not be neces-
sary to push the pilocarpin to so great an extent.
Dr. Mittendorf then reported in detail three cases, all
of which were successfully treated. They tended to
show: I, that in marked detachment of the retina the
energetic use of jaborandi and pilocarpin will do good,
especially if the patient can be kept under the influence
of the drug during the entire day and for a period rang-
ing from twenty to thirty days ; 2, that the elastic jiress-
ure bandage must be used at the same time ; 3, that
the patients must be kept upon the back for most of the
time ; and 4, that the use of atropia, which is employed
without causing any inconvenience to the patient, should
likewise not be neglected.
The paper was discussed by Drs. Gruening, of New
York ; Little, of Philadelphia : Andrews, of Clifton, Staten
Island ; Webster, of New York ; Theobald, of Balti-
more, and Spaulding, of Portland, Me., who spoke of
operative treatment in these cases. He referred to a
suggestion made by Mooren that an attempt be made to
remove the eflusion by means of the hypodermic syringe.
Having a case on hand, he tried the operation. Al-
though he succeeded in removing a considerable quan-
tity of the subretinal eflusion there was not much im-
provement except temporarily. He suggested that the
method might be cultivated by placing a piece of rubber
tubing between the needle and the tip of the no/zle, thus
making an instrument somewhat similar to that used in
the treatment of soft cataract. At least he thought that
some form of aspiration might be made applicable in
these cases.
Dr. William S. Little, of Philadelphia, then re-
ported
TWO C.'iSES OF CONGENITAL ECTOPIA LENTIS, ONE SYM-
METRICAL, THE OTHER NON-SVMMETRICAL.
The first case occurred in a man twenty-three years of
age. The non-symmetrical position of the lenses in
this case w-as of interest, and the question arose as to
what influence glasses which the patient had worn might
have had in producing divergence in the left eye, which
is now going on, the right eye doing the work. The
immunity for three years and freedom from trouble
favored strongly the ojiinion that the glasses had not
entered as a factor in the etiology of the divergence.
A sketch of a case by Dr. J. M. Taylor, which oc-
curred in the practice of Dr. C. S. Turnbull, of Philadel-
phia, was also presented. The patient wore glasses with
comfort for more than a vear, when he was accidentally
killed.
Tiie paper was discussed by Dr. Mittendorf, of New
Vork, who related the history oi a case.
Dr. Ceorge T. Stevens, of New York, then read a
paper on
THE EMPLOYMENT OF NITROUS OXIDE AS AN AN.tSTHETIC
IN OPHTHALMIC OPERATIO.NS.
He had eniployed it in operations about the nasal
duct, iridectomy, cystotomy, and similar short opera-
tions, and believed that it possessed several advantages,
such as being less dangerous, unattended with nausea
and other symptoms which are incident to the use of
ether, and that it demanded for its administration far
less trouble than ether or chloroform. He thought it
doubtful if it could be relied upon for cataract opera-
tions.
The President had employed it more or less during
the last ten years, and stated that the oxide had the ad-
vantages claimed for it to a certain extent. He had,
however, noticed two features : first, there is apt to be a
good deal of rigidity on the part of the patient in some
cases ; second, it is apt to be attended with a great deal
of venous congestion which gives rise to considerable
hemorrhage in wounds about the eye.
Dr. R. H. Derby, of New York, had employed the
nitrous oxide preliminary to prolonged anajslhesia with
ether, and with very gratifying results.
Dr. Buller, of Montreal, said that for some time
nitrous oxide was used in the Moorfields Hospital in
London, but with unsatisfactory results. He had re-
sorted to the primary anesthesia produced by ether with
exceedingly gratifying results.
Dr. Albert G. Heyl, of Philadelphia, then pre-
sented
A CONTRIBUTION TO THE OPERATIVE TREATMENT OF
GLAUCOMA.
After giving the ordinary method of treatment em-
ployed, and detailing the history of a case which had
been under his observation, and in which he had resorted
to operative treatment, he recommended the following
plan as a modification of that which he had employed.
It was to ligate the frontal artery and then open the
supra orbital artery and allow a few ounces of blood to
escape, and then close the vessel with a ligature. He
discussed at considerable length the physiological basis
of the operation, and said that he wished simply to place
upon record a piece of clinical experience which he
thought would shed some light upon the condition of
acute glaucoma. The patient upon whom he operated
was suftering from chronic glaucoma when he saw him,
but the case had been one of acute glaucoma in its in-
ception.
Dr. Webster, of New York, recalled a case in which
a California surgeon advocated the ligature of the carotid
early for glaucoma, performed the operation once and
cured his patient.
The President slated that the natural history of acute
glaucoma nmst be considered before deciding with refer-
ence to the influence produced by any modification of
the circulation by operation.
Dr. Seely, of Cincinnati, said it should be borne in
mind that the influence of the Californian operation was
directly the reverse of that suggested by Dr. Heyl.
Dr. Gustavus Hay, of Boston, then made a communi-
cation on the
ASTIGM.VnC PENCIL.
It was discussed by Dr. Knapp, of Xew York.
Dr. Charles J. Kipp, of Newark, N. J., then reported
cases of
SARCOMA OF THE CHOROID WITH INTERESTING CLINICAL
FEATURES.
The first case was that of a woman seventy years of
age, first seen six weeks before the eye was removed.
Sight had been lost only a few months. There was no
pain, nor was there any sign of inflammation of outer
parts of the eye. In the outer half of the eye behind the
lens was seen a large white mass of round form, on the
surface of which were numerous liemorrhages. The
retina was detached in the inner half. The diagnosis of
intraocular tumor was made and enucleation advised.
Four weeks later symptoms of secondary glaucoma de-
veloped, and after the patient had endured the pain foi-
two weeks she consented to have the eye removed. The
operation was not attended by accident, and the wound
healed rapidly. On examination of the eye a large dark
tumor was found which nearly filled the eye, and which
had started from the outer half of the choroid. It was
July 28, 1883.]
THE MEDICAL RECORD.
107
covered in part by the retina, and extended anteriorly to
and involved the ciliary body. It c«nsisted of si)indle-
shaped cells, and contained nuich pigment.
The second case was that of a man thirty-four years of
age, who was first seen seventeen months before enu-
cleation was performed. At that time the anterior parts
of the right eye were apparently quite healthy. On the
nasal side of the eye a semi-globular protuberance was
seen to project nearly to the visual axis ; ujiward and
downward it extended ajiparently nearly to the vertical
meridian. Anteriorly it did not reach quite to the ciliary
processes. The tumor was of a greenish-red color, and
was covered by transparent retina ; its surface was
smooth, and its vessels were distinctly visible. The re-
tina was slightly detached at the base of the tumor, but
nowhere else. The optic disk was very pale and its
margin slightly blurred. The other parts of the choroid
and retina presented nothing abnormal except an
atrophic patch in chord below disk. Tension was nor-
mal ; visual field defective in outer half, and much con-
tracted upward, downward, and inward. The other eye
showed numerous atrophic spots in choroid and pigment
deposits in retina. From the patient it was learned that
twenty years ago he had had a severe attack of some eye
disease which seriously impaired the left and somewhat
the right eye, the one now containing the tumor. Since
then his sight remained the same until two months ago,
when he noticed that his right eye failed. The disease
from which he suffered twenty years ago was doubtless a
choro-retinitis, the results of which were plainly visible
in both eyes. Seventeen months later the patient was
seen again. There was now great pain, and the eye i)re-
sented the usual symptoms of secondary glaucoma. The
eye was enucleated and the wound healed rapidly. On
examination the tumor was found to have started from
the choroid in the region of the macula lutea. It was
very large. The retina was detached completely. The
microscopical examination of the tumor showed it to be
a spindle-celled melano-sarcoma.
The third case was that of a woman forty-one years of
age, who was first seen fifteen months before the eye was
enucleated. At the first examination nothing abnormal
except a prominence and opacity of the retina at macu-
lar region was found. The retina for a space of about
two diameters of the optic disk was grayish, and the re-
tina veins here were dark in color. The sunnnit of the
prominence was best seen with a -I- 4 dioptric glass. The
retma was not detached, neither over the prominence
nor anywhere else. The eye was as it had been prac-
tically blind for some months. The case was seen from
time to time for two months, during which period no
marked change in the eye was observed. Thirteen
months later she was seen again. She had the secondary
glaucoma, which had come on about two weeks before.
The eye was enucleated and the wound healed rapidly.
On examination a large tumor of irregular form, and
with very broad base was found, which originated in the
region of the macula lutea and from there spread over
the optic.
The fourth case was that of a woman forty-two years
of age. Sarcoma of the ciliary body and iris. Secondary
glaucoma was present when the patient was first seen.
The tumor did not extend to the choroid, and the mi-
croscopic examination showed that it had probably origi-
nated in the connective tissue of the ciliary muscle. It
was composed of spindle-cells and contained much pig-
ment. Five years after the operation there was no re-
lapse.
Dr. Kipp also read a paper describing a case of very ex-
tensive ossification of the choroid occurring in a young
man who, when first seen ten years ago, had a chalky
cataract, to which the pupil was everywhere adherent.
As there were at that time no syniptoms of irritation of
the eye, and the case was hopeless so far as sight was
concerned, no treatment was advised. The boy had
been born with the cataract, according to the mother's
statement. Ten years afterward the eye became painful
and presented when then seen the api)earance of irido-
cyclitis. The eye was removed, and on examination the
osseous plate lined the inner side of the choroid and as
far as the ciliary processes.
The communication was discussed by Dr. Howe, of
Buffalo, who presented a specimen, the President, and
Drs. Mittendorf and Webster, of New York.
Dr. S. Theohai.d, of Baltimore, then read a paper on
TRITURATION OF THE CORTEX.
He reported two cases in which this operation was
practised in connection with preliminary iridectomy to
hasten the development of slowly ripening cataracts.
The operation consists in a kneading or bruising of the
anterior cortical layers of the lens by pressure on the
cornea after iridectomy and while the anterior chamber
is still empty, and is in accordance with the suggestion
put forth by Professor Fiirster, of Breslau. The tritura-
tion was done with the angle of the strabismus hooks,
and in the first was imiierfectly performed. In the second
case the ojieration was performed with the smooth end of
the Bowman tortoise-shell cataiact spoon, which seemed
better adapted to the purpose. In the first the operation
was followed by but slight change in the condition of the
'ens. In the second case, however, a very rapid de-
/elopment of the cataract ensued. In each case there
occurred a sufficient amount of iritis to cause slight but
persistent adhesions between the iris and lens at the
pupillary angle of the coloboma, and in the second case
it was found by oblique examination a day or two after
the operation that near the cut edges of the iris the pig-
iient layer had been detached tVom the muscular coat in a
manner which was quite peculiar. That the iris shoidd
be more or less bruised as well as the lens, however care-
fully trituration be performed, appears unavoidable, and
the risk of exciting inflammation in this manner seems the
chief objection to the procedure. It would appear, how-
ever, that Professor Fiirster has not had serious trouble
from this source, as he makes no special reference to it
in his paper.
Dr. Gruening, of New York, had performed the
operation twice during the last year. In the first he per-
formed large iridectomy upward and with the angle of
the strabismus hook triturated the lens in the area of the
pupil only. No iritis followed, and the lens became com-
oletely opaque within one week. He extracted it three
veeks later with very good results. In the second case
he performed iridectomy upward and again treated the
lens only in the area of the pupil, and in four days the
lens was completely opaque. He thought there were
certainly cases in which the operation was indicated, and
was attended with great gain.
Dr. Kipp said that he performed the operation some
time ago, the lens became opaque, and four or five
days afterward it cleared up again.
Dr. Mittendorf, of New York, thought the opera-
tion was indicated, especially in certain cases in which
two cataracts were forming, and his experience in the
operation had been equally favorable with that reported
by Dr. Gruening.
Dr. Knapp, of New York, had performed the opera-
tion once ; but it did not seem to hasten the ripening of
the cataract.
Dr. Wadsworth, of Boston, had performed the
operation once in a patient eight years ago. There
seemed to be no eflect at all, so far as ripening of the
cataract was concerned. He thought that probably in
some cases maturity of the cataract might be hastened
very much by the method, while in other cases probably
the result would be very slight.
The President had operated eight times, and in seven
cases had subsequently performed extraction. In one
case marked iritis developed, but did not interfere with the
subsequent recovery, and extraction was entirely satis-
factory. He hoped to make a communication upon the
io8
THE MEDICAL RECORD.
[July 28, 1883.
subject which would embrace the history of all his cases,
with remarks.
Dr. Gruening remarked that by the area of the pupil
he meant the new pupil, including the coloboma.
The paper was further discussed by Drs. Webster, of
New York; Fox, of Philadelphia ; Dyer, of Newport, and
Theobald, of Baltimore.
The Society then adjourned to meet at 9 .a.m. Julv 19th.
Second Day — Thursday, July 19TH.
The Society was called to order at 9 a.m. by tiie Presi-
dent.
The Treasurer moved that the annual assessment be
five dollars. Adopted.
VASELINE cerate A CONVENIENT BASIS FOR OINT.MENTS
INTENDED FOR APPLICATIONS TO THE EYELIDS.
Dr. Theobald, of Baltimore, read a brief paper on
the above subject, in which he stated that he had been
using with much satisfaction for several months, both in
private and in hospital practice, as a basis for ointments
intended for application to the eyelids, a cerate made of
yellow wa.x and vaseline, which is prepared without diffi-
culty by melting the wax and vaseline together by gentle
heat, and stirring the mixture until it hardens, combining
one part of yellow wax with four of vaseline, which pro-
portion gives the ointment sufficient firmness, except,
perhaps, in very hot weather, when the proportion of
wax may be increased to one to three. Dr. Theobald
also exhibited a specimen of ointment of the yellow-
oxide of mercur)', containing two grains to one drachm
of vaseline cerate, which, though prepared nearlv four
months since, and kept with no special care, still re-
tained its bright yellow color and had undergone no ap-
preciable change. He had been told that cerates pre-
pared by vaseline were in use, but was not aware that
attention had been called to the convenience of employ-
ing them in the manner suggested.
Dr. H. Knapp, of New York, then read a paper in
which he reported a case of
BLINDNESS FROM RETINAL THRO.MBUS IN CONSEQUENCE
OF FACIAL ERYSIPELAS.
There is on record a certain number of cases of blind-
ness in consequence of facial erysipelas. Their symptoms
vary considerably. There is lack of ophthalmoscopic
examinations during the first stage of the aftection. Not
long ago Dr. Knapp had the rare opportunity of observ-
ing such a case almost from the beginning to the end.
Mr. E. F , forty years of age, had lived in the tro-
pics, had had syphilis with secondary and tertiary symp-
toms which were aggravated when his business called him
north. On March 20, 1883, while in New York, he had
an attack of erysipelas which began upon the nose, pro-
ceeded to the pharynx, cheeks, and orbits. The patient
was under the care of Drs. Gulecke and Schottke, who
kindly allowed Dr. Knapp to publisli the case. The
erysipelas progressed, and on Afarch 28th he was totally
blind in both eyes. Reserving a detailed discussion of
this case for publication in the " Archives of Ophtlialmol-
ogy," Dr. Knapp restricted himself to the following re-
marks :
First. — The blindness was produced by compression
of the central retinaj arteries and subsequent thrombosis
of the retinal veins, both having been directly observed
with the ophthalmoscope one day after the occurrence
of the rapid, almost sudden loss of sight.
Second. — The ophthalmoscopic appearances observed
from beginning to end showed no neuro-retinitis, but the
successive stages of a thrombosis.
Third. — The degrees of the swelling of tlie orbital tis-
sue or the establishment of collateral circulation from
the choroid permitted the return of a limited How of
blood into the retinal arteries, which, however, was im-
peded by the blocked veins, leading to renewed extrava-
sation to the thrombosis and shrinkage of the arteries,
and finally to atrouhy of the optic nerve.
./^?;//-M.— Perivasculitis played no, or only an unim-
portant part in the patiiology of this case.
Fifth. — The white segments in the veins and arteries
were white thrombi and not hypertrophy of the walls of
the blood-vessels.
Sixth. — -The thrombus was present in all probability
also in the orbital veins, but tlid not, as in other cases,
extend to the cerebral sinuses.
The paper was discussed by Dr. Kipp, of Newark,
who stated that the cases in which he had seen the con-
dition described by Dr. Knapp, the retina and its imme-
diate vicinity was in a state of inflammation or, at least,
opaque, but not between the veins ; by Dr. Knapp, who
thought that the segments of the veins becoming white
could be used as a diagnostic symptom of embolism ; by
The President, who had seen a case in which the process
was confined more particularly to the optic nerve, with
swelling and neuro retinitis, and subsequent atrophy and
nearly absolute blindness ; and by Dr. Seelv, of Cincin-
nati, who had seen a case in which iodoform used as a
dressing had produced facial erysipelas in three distinct
instances.
Dr. Kn.app felt certain that the iodoform had no un-
favorable influence whatever in his cases.
Dr. W. H. Carmai.t, of New Haven, Conn., read a
paper on
changes in refraction resulting FRO.M .\ BLOW.
R. A. S , twenty years of age, student in the sopho-
more class in Yale College, myopic since twelve years
of age, consulted liim on October 23, 1882, stating that
while practising in the gymnasium the day before, he had
fallen violently forward, striking his right eye upon a bolt
projecting from the tloor. The blow was sufficiently se-
vere to give rise to disturbance that obliged him to keep
quiet for the remainder of the day and evening, neither
going about nor studying. But at the lime of his visit
he felt quite well again, except with reference to his eye,
wearing liis glasses habitually for all purposes of vision,
near or far. He now felt an uncomfortable sensation in
looking through his right glass, and could see much bet-
ter at a distance without it, better, indeed, than he remem-
bered ever to have seen before without glasses, but for
all that he had a very confused sensation when looking
with both eyes either with or without glasses. Four
months afterward he was again consulted, when he found
on ophthalmoscopic examination that there was no
conus at the nerve, nor other evidence of retino-choroidal
trouble. By oblique illumination no opacity of the lens
was detected. On the following day he saw, at Dr.
Carmalt's suggestion, Dr. Loring, of New York, in con-
sultation. To summarize the facts of this, to his knowl-
edge, unique case, it seemed established that in a case
of myopia of very considerable and nearly equal degrees
in the two eyes, one was reduced by the impact of a
blow to a condition of astigmatic myopia which resolved
itself finally into a cross astigmatism without any loss of
acuity of vision or range of accommodation. After en-
deavoring to account for the mechanism of this change,
five possibilities presented themselves : i, a change in
the shape of the cornea ; 2, a diminution or shortening
of the axis of the globe ; 3, a displacement or dislo-
cation of the lens backward ; 4, a change in the relative
position or arrangement of the lenticular fibres ; 5, a
preexisting spasm of accommodation, the tonicity of
which iiad been released by the paralytic effect of the
blow.
Dr. Carmalt excluded, as did also Dr. Loring, change
in the length of the eyeball, also dislocation of the lens,
also the previous existence of spasm of accommodation.
The remaining alternative caimot be urged from any
knowledge we have of such a condition having been posi-
tively determined. It is urged rather as a refuge, all the
other explanations having been disproved or not being
July 28, 1883.]
THE MEDICAL RECORD.
109
satisfactory. Is it not possible that a sudden and vio-
lent impulse could have shaken and so displaced the
denticulate articulations of the lens fibres that they be-
came fastened in a position to correspond to (or cause)
the error of refraction indicated above ?
The paper was discussed by Drs. Knapp, Noyes,
Seely, Webster, Buller, McKay, and F. B. I.oring.
Dr. E. VV. Bartlett, of Milwaukee, Wis., then read
a paper entitled
A FURTHER MODIFICATION IN CATARACT EXIRACTION.
The modification proposed is to make the preliminary
iridectomies in certain difficult cases, one upward and
one downward. Dr. Bartlett then reported two cases
which illustrated the modification. The modification was
suggested in difiicult cases only, as when the eye is very
prominent, when the iris does not react to atropine or
attachments have formed between the iris and capsule,
when the one eye has been lost and the least amount
of risk should be taken with the other eye, and when the
patient is very infirm and danger from shock is very
great, and when the cataract is maturing very slowly. In
such cases this modification gives the patient a better
chance of securing a certain amount of sight than the
method of making the whole operation at one time.
Dr. Gruening, of New York, then read a paper
entitled
Bf.EPHAROPLASTV ACCORDING TO THE ENGLISH METHOD.
A young man sustained an injury of the face by the ex-
l)losion of a petroleum lamp. As a result of the mishap
the integument of almost the whole forehead, the right
temple, the right cheek and corresponding half of the
nose was changed into dense cicatricial tissue. The up-
per lid was wholly everted and its free border attached
to the supra-orbital margin. To correct the deformity
the lid was detached from the orbit, the neighboring tis-
sues undermined, the deep scar exsected, the free
border of both lids brought in apposition and united by
free sutures. The surface of the wound measured 40
mm. in the vertical, and 55 mm. in the horizontal direc-
tion. In order to cover the defect a flap was trans-
jjlanted from the inner surface of the left arm and placed
upon the wound. The flap was prepared according to
Wolfe's suggestion, i.e., deprived of its subcutaneous cel-
lular and adipose tissue. After careful coaptation of the
flap to the edges and the surface of the wound gold-
beater's skin and a bandage were used to maintain the
flap in its position. No discoloration, no displacement
of the flap ensued ; it united firmly with the wound, and
the ectropion was corrected. To-day, i.e., nine months
after the operation, the flap measures 15 mm. in the ver-
tical, and 30 mm. in the horizontal direction. The
shrinkage took place during the first four weeks after
the operation. No further shrinkage during the last
eight months. The result is very satisfactory, and would
not have been obtained by any other method.
The paper was discussed by Drs. Wadsworth, of Bos-
ton ; Kipp, of Newark, and .Andrews, of Staten Island.
Dr. McKay, of Wilmington, then reported a case of
LOSS OF AN EYE FROM SEWER-GAS AFTER EXTRACTION OF
A CATARACT.
John H , a (lerman brewer, sixty-one years of age,
was operated upon April 16, 1882, for senile cataract,
without an anaesthetic, by Graefe's method of linear ex-
traction. The upward operation was performed satisfac-
torily, and without any accident whatever. He counted
fingers immediately after the operation. The eye was
covered with absorbent cotton and a light flannel press-
ure bandage without the further introduction of a my-
driatic. Three and a half days after the operation the
bandage became somewhat loosened. This eye was ex-
amined, and atropia was introduced. The incision had
closed, the cornea was clear, the pupillary field dark, and
vision, tried for a moment, was verv encouraging. The
patient subsequently developed symptoms of some gen-
eral disease, evidence of contamination of the atmos-
phere by sewer-gas was detected, and finally the eye was
lost, as Dr. McKay believed, in consequence of the poi-
soning of the general system produced by this noxious
agent.
Dr. McKay also reported a case of
SYMPATHETIC NEURO-RETINITIS OCCURRING; DURING
PREGNANCY.
The patient was twenty-six years of age ; she had been
married ten months. In infancy she had scarlet fever,
since which time the riglit eye had been weak. Five
years ago the eye was treated .for a painful inflammation
by an oculist in Philadelphia, but during the last two
years it had not annoyed her. When Dr. McKay saw
tlie patient the eye was in a quiescent state of chronic
irido-choroiditis with partially occluded pupil and dense
opacity of the vitreous. She complained of her left eye,
and reported that after a week's crocheting a sudden pain
was felt in it while looking at a white wall. She was
tlebilitated by malarial and pulmonary troubles and was
three months advanced in pregnancy. Ophthalmoscopic
examination revealed hypermetropia and a faint opacity
of the deep portion of the vitreous, with decided conges-
tion of the ojitic disk and retina, and within two weeks
the appearances of sympathetic neuro-retinitis were fully
manifested, and vision was reduced to counting fingers
six to eight inches in a dimly lighted room. After three
months' treatment in a darkened room, with a dark band-
age over her eyes, and the occasional use of a solution
of atropia to prevent iritic adhesions, inunctions of mer-
curial ointment to the temples, several leechings to the
left temple, and a general sustaining and tonic treatment,
she improved in general health, and the vitreous opacity
as well as the exudation of the optic nerve and retina dis-
appeared, and she recovered good vision. Her pregnancy,
Dr. McKay thought, greatly modified the course of the
sympathetic neuritis favorably. The ophthalmoscopic
appearances of retinitis albuminuria were looked for re-
peatedly, but never were found, and the fact of her vision
not being again impaired while she had general anasarca,
which developed later in the progress of the case, enabled
him to regard it as a case of neuro-retinitis.
Dr. L. Howe, of Buftalo, then read a brief paper
and presented a specimen which illustrated
the DIFFICULTIES IN MAKING A DIFFERENTIAL DIAGNO-
SIS IN GLAUCOMA.
The patient was four months old. When first seen, two
months of age, a yellowish reflex was noticed in the inte-
rior of the eye which had been previously somewhat red-
dened, and vision, so far as could be determined, was
much impaired. Increase of tension was scarcely per-
ceptible, but after some hesitation it was regarded as
-+- I. After enucleation it was found that the entire
vitreous had contracted into a small cone as a result of
previous inflammation, and that the apex touched the
retina, having its interior filled with a semi-purulent
yellowish substance.
Dr. E. E. Holt, of Portland, Me., then read a paper
entitled
COMMOTIO RETIN.«, OR SOME OF THE EFFECTS OF DI-
RECT AND INDIRECT BLOWS TO THE EYE.
Dr. Holt reported four cases. In two of these the pa-
tient was struck more or less directly by a stick of wood,
in one by a round rod or cane, and in the other by a flat
piece of coal, striking the forehead, nose, and cheek, not
hitting the eye itself. In three cases recovery was un-
interrupted. In one there was a relapse. Vision was
reduced to a perception of light for four days, after
which it began to return, and in the course of two weeks
became nearly normal. Relapse then occurred and
vision sank, but not so low as it was after the receipt of
tlie injury, and recovery with a perfect eye took place
no
THE MEDICAL RECORD.
[July 28, 1883.
much more slowly than at first. Ur. Holt gave a de-
tailed history of this case and also of one of the others.
The President remarked that Dr. Holt had reported
four cases manifestly dissimilar in character. From a
thorough study of the affection referred to he had be-
come convinced that commotio retina; is a phenomenon
which had been entirely explained upon the supposition
of a fissure running through the optic foramen of the
orbit, and is almost entirely mythical when taken by
itself.
Dr. Seely, of Cincinnati, thought the subject could
not be dismissed so summarily as Dr. Noyes had sup-
posed. He had reported one case which could not be
e,xplained away so readily, because a single application
of electricity restored a vast amount of vision, and there
was no explanation of the extreme lowering of the vision
from which the patient suftered.
Dr. Kipp refened to a case in which there was a
fracture and subsequent blindness, and suit was l)rought
for damages. The question which arose was whether
the case was one of congenital blindness with diver-
gence, or was it due to injury. On further examination
of the patient and the surroundings he discovered that
the mother had the same condition in the corresponding
eye, and taking this into considr-ration he concluded that
the blindness was not due to the injury.
The paper was further discussed by Drs. Gruening,
Knapp, Wadswortli, and McKay.
A paper entitled " Two Cases of Ophthalmoplegia
Externa, .\ssociated with Disease of the Optic Nerves
from Brain Tumor, with an Account of the Post-mortem
Examination," by Dr. Charles Steadmax Bull, of New
York, was read by title and referred to the Committee
on Publication.
injury to the eyes by hanging.
Dr. F. B. Loking, of Washington, said that since the
series of experiments reported by Dr. Dyer, he had seen
no communications concerning the effect produced upon
the eyes by hanging, except the case reported by Dr.
Green, of St. Louis, which was not corroborative. He
iiad had opportunity to observe one case, which he
wished to place upon record. In that instance both
eyes were affected, although one was not affected so
markedly as the other.
Dr. Green remarked that his case was not corrobora-
tive of Dr. Dyer's conclusions in a certain sense, but he
did not consider it valuable either as corroborative or
otherwise, because the time limited for examination after
the execution was too short, not being more than one
hour.
Dr. Howe, of Buft'alo. referred to one case in which
he examined the eyes thirty-five minutes after the execu-
tion, and was unable to see any change.
Dr. R. H. Derby, of New York, referred to three
cases which he had already reported in whicli there were
marked changes in the eye produced by hanging.
COLOBOMA OF THE CHOROID.
Dr. McKay, of Wilmington, wished to place on record
three cases. In one there was coloboma of the iris.
Two cases occurred in children, aged respectively seven
and ten months. The other occurred in a woman twenty-
eight years of age. In the child seven months of age
the coloboma of the iris occurred.
Dr. Theobald, of Baltimore, presented an additional
modification of his bandage, which he regarded as a sub-
stantial improvement. It consisted in cutting the eye-
piece biasing in order to prevent the tendency to wrink-
ling.
Dr. Mittendorf called attention to a new method
of applying remedies to the eye, namely, in the form of
impalpable powders or triturations. He presented sev-
eral specimens of remedies prepared in this way.
The President remarked that he had employed hom-
atropin prepared in this way, and had been well pleased
with tlie preparation.
Dr. Jones asked if this method was preferable to the
disks prepared by Savory cSc Moore.
Dr. VVadsworth, of Boston, spoke of the loss of
power in a solution of eserine. Recently he had found
a solution which was three years old, and it still worked
perfectly well.
Dr. Seelv, of Cincinnati, said that for ordinary pur-
poses he preferred an old solution of eserine to a fresh
one.
The following ofticers were elected for the ensuing
year: President — Dr. H. D. Noyes, of New York ; Vice-
President — Dr. William F. Morris, of Philadelphia ; Sec-
retary and Treasurer — Dr. R. H. Derby, of New York ;
Publication Committee — Drs. E. G. Loring and D. B. St.
John Roosa, of New York.
The place of holding the next annual meeting is
Kaaterskill, N. Y., and the time the third Wednesday in
July.
The Society then adjourned.
.Ai'inu and iXaun iXcius.
Official List of Changes of Stations and Duties of Officers
of the Medical Department, United States Army, from
July XX, \Z%i,to July 21, 1883.
Magruder, D. L., Lieutenant-Colonel and Surgeon.
Medical Director Headquarters Department of the Mis-
souri. Granted leave of absence for one month, with
permission to apply for an extension of one month.
S. O. 145, Deiiartment of the Missouri, July 12, 1883.
Elbkey, Frederick W., Captain and Assistant Sur-
geon. The leave of absence granted on Surgeon's cer-
tificate of disability, by S. O. 26, A. G. O., January 31,
1883, further extended six months on Surgeon's certifi-
cate of disability. S. O. 162, A. G. O., July 16, 1883.
Powell, Junius L., Captain and Assistant Surgeon.
Assigned to duty at F'ort Columbus, N. Y. H. S. O.
130, Department of the East, July 18, 1883.
Richard, Charles, First Lieutenant and .Assistant
Surgeon. Assigned to duty at Fort Adams, Newport,
R. I. S. O. 130, Department of the East, July 18, 1883.
Perley. Harry O., Captain and Assistant Surgeon.
Assigned to duty at Fort Pembina, D. T. S. O. 118,
par. I, Department of Dakota, July 5, 1883.
Official List of Changes in the Medical Corps of the Navy
for the week ending July 21, 1883.
Scott, Horace Brow-n, appointed as .\ssistant Sur-
geon.
Rush, Charles W., Assistant Surgeon, promoted to
Past -Assistant Surgeon.
Diehl, Oliver, .\ssistant Surgeon, promoted to
Past .-Assistant Surgeon.
Bry,\n, J. H., Assistant Surgeon, promoted to Past
Assistant Surgeon.
Gatewood, J. D., Assistant Surgeon, promoted to
Past Assistant Surgeon.
White, C. H., Surgeon, detached from the Lacka-
wanna, and placed on waiting orders.
Heffinger, -A. C, Past Assistant Surgeon, detached
from the Lackawanna, and granted leave of absence for
three months.
Wooi.vERToN, T., Surgeon, detached from the Naval
Hospital, Philadelphia, on July 31st, and granted leave
of absence for one year, with permission to leave the
United States.
Mr. Alfred Roberts, Surgeon to the Prince Alfred
Hospital, New South Wales, has received the honor of
knighthood.
July 28. 1883.]
THE MEDICAL RECORD.
Ill
^edicnX Items.
Contagious Diseases — Weekly Statement. — Re-
port of cases and deaths from contagious diseases re-
ported to the Sanitary Bureau, Health Department, for
the two weeks ending July 24, 1883 :
^
■a
Week Ending
V
in
3
>
*o
u
V
>
o.S
S
0
D.
>
1-
•a
«
F
0
*a3
H
^
OJ
U
>:
u
Cfl
>•
Cases.
July 17,1883
0
18
38
4
".^
23
0
0
Tulv 2d 1885
0
16
39
7
87
12
0
0
Dm/As.
Tiilv 17 l88^
I
10
7
^
?I
16
0
0
Tulv -"d i88-?
0
A
TI
5
'9
in
0
0
Hardlv Ever — Bruken.^ — Dr. F. H. Darby, of Mor-
row, O., writes : " I secure my thermometer case in the
upper vest pocket, by wrapping it three or four times
around near the shoulder with a common half-inch No.
00 rubber band. If the pocket is wide divide it in two
compartments by a pin or a few stitches, the other side
can then be very properly used for a pen-holder, comb,
or pencil. For cheapness, the cost being a pin and a
rubber band, simplicity, and facility of changing from one
vest to another, we submit the above, if you will par-
don egotism, as being //te very best of all.
How Patent Medicines Pay. — The Milwaukee Sen-
tinel in a very sensible article on "Patent Medicines,"
truthfully says : " It is advertising that is the secret of suc-
cess in the ca.se of patent medicines, if there is any secret
about it. There is not a patent medicine which is supe-
rior to the preparations provided for by the standard medi-
cal publications. It is much simpler, however, for the
person who wants a medicine, to buy a bottle of patent
medicine, good for every human ill, than go to a physi-
cian. By advertising a patent medicine extensively and
persistently the people are brought to recognize certain
common and simple sensations as evidences of a disease
which this particular remedy will cure. About all that
is required to succeed in the patent medicine line is
money and nerve to use it in advertising. It makes no
sort of difference what medicine it is — the combination
of drugs is the item of least importance. It is well, per-
haps, to put the drugs, if any are used, in spirits, so that
a man can take his whiskey with a clear conscience —
indeed, with a sense of his own worthiness in taking care
of his health. Occasional changes in the name of the
medicine and of the maker are desirable, for after a few
years the public demands something new. The same
medicine may be used, but a change of name and of the
character of the illustrations is demanded. After a long
run of a patent medicine as a cure for lung troubles, a
new run may be established by calling it a remedy for
stomach troubles. When a fortune has been made out
of lung pads, they can be cut down in size and another
fortune made out of them as kidney pads."
Violent Hemorrhage fro-m the Left External
Auditory Meatus following \ Cold Abscess — Sub-
sequent Rupture of the Left Internal Carotid,
causing Death in a Few Seconds. — Dr. R. B. Davy, of
Cincinnati, reports the case of a little girl three years of
age suffering from restlessness, coated tongue, sore throat,
and slight fulness of left side of neck. In the act of ex-
amining the throat (the child resisting) an abscess of
the left ear broke and discharged about a teaspoonful of
reddish pus. After a few hours violent hemorrhage
from the ear set in, and in the course of two days fully
a quart of blood had been lost. Most of this quantity
was discharged at two bleedings, the pillows being
stained only with small spots in the intervals. The
hemorrhage ceased spontaneously and for nearly a week
the ear discharged pus, gradually losing its reddish cast.
The ear was examined with reflected artificial light and
the membrana tympani found to be intact. The child
was improving, though very pale. On the tifth day after
the last hemorrhage another, quite as violent as the first,
occurred. The ear was now plugged with a bit of
sponge, which checked the bleeding. Simultaneous
with the plugging there appeared a swelling about the
size of the longitudinal half of a hen's egg extending from
the left mastoid process downward and forward. This
swelling increased in size until late in the afternoon, when
the plug was forced out of the ear, the blood spurting at
least a foot from the child's head and the swelling be-
neath the ear diminishing in size. The ear was now
more firmly plugged and ice-bags applied to the swelling
which had returned inmiediately. The next day the
swelling was perceptibly smaller and had a leathery feel
on firm pressure ; but the third day afterward it again
increased in size, and showed signs of suppuration,
though there was no jjointing externally. On the fol-
lowing afternoon the left internal carotid ruptured in the
mouth, and the child bled to death in a few seconds.
The post-mortem revealed at the site of the swelling a
deep-seated abscess whose contents had come in contact
with and injured the coats of the vessel in question,
causing them to give way. The loss of blood during
the fatal hemorrhage amounted to but little over half a
pint. Careful inquiry was made but no history of
hemorrhagic diathesis was obtained, and the doctor con-
cluded that the first hemorrhage had been caused by
ulceration of the coats of the jjosterior auricular artery.
The case will be reported in full in the Cincinnati Lancet
and Clinic.
The Rods and Cones in the ninth layer of the retina
have generally been considered to have an important
function in vision. Dr. Borysikiewicz has recently as-
serted that they are entirely absent in the eyes of
tigers and leopards wOiich he has examined. Yet these
animals have acute vision.
Case of Cutaneous Calculus. — Dr. G. W. H. Kem-
per, of Muncie, Ind., sends us the following report : "On
May 9, 1878, I removed by incision one of these rather
rare morbid specimens. The patient, a lady, aged fifty-
five years, stated that about twenty years previously a
small tumor developed in the right eyebrow, and gradu-
ally grew to the size of a hazel-nut. She had experienced
no pain from it until the last year before its removal,
when its presence became rather annoying, and at times
caused neuralgic pains by pressure upon the supra-or-
bital nerve. It probably began as a sebaceous cyst and
eventually was transformed into a calcareous mass. I
was uncertain of the character of the tumor until my knife
came in contact with the stone. It is of an oval shape,
rough surface, and weighs at this time seven grains. No
further trouble was experienced after its removal."
Tonsils by the Bushel. — Dr. W. N. Williams, of
Indianapolis, Ind., writes : " In the discussion on Dr.
William C. Jarvis's paper, ' Tonsillotomy without Hem-
orrhage,' read before the American Medical Association
at its late session in Cleveland, O., you report Dr. J. P.
Thompson, of Indianapolis, Ind., as saying, ' He did not
intend to overestimate in the least, but believes that,
without exaggeration, he has excised two bushels of ton-
sils,' etc. (see page 667, Medical Record, June 16,
1883). The italics are yours, Mr. Editor. Suppose we
figure on that statement a little. A bushel contains
2,i5o|- cubic inches (see ' Ray's Practical Arithmetic,'
page 83. One thousandth Edition). Discarding the frac-
tions, we have 4,300 cubic inches in the two bushels.
Assume that each tonsil would occupy a space of one-
half cubic inch, it would require 8,600 tonsils to fill out
112
THE MEDICAL RECORD.
[July 28, 1S83.
his measure of two bushels. Now, if the doctor excised
one tonsil each day in the year, it would have required
twenty-three years, six months, and twenty-five days to
have completed the job. If his instruments were in good
order, and he really felt well, and excised a pair of ton-
sils each day, he could have done it in the little matter
of eleven years, nine months, twelve days and a half
If Dr. Thompson has really excised two bushels of ton-
sils in his practice, how many bushels have our other
specialists excised ? Speak out, gentlemen, or acknowl-
edge by your silence that the championship of .America
in tonsil-cutting belongs to Indiana. It may be if some
other gentlemen were to file their broad axes, grind their
hand-saws, spit on their hands and sail in, that they could
capture the champion's belt at the next meeting of the
American Medical Association."
Chloroform Narcosis during Sleep. — Dr. Hunter
H. Powell, of Cleveland, O., sends us the following case
bearing upon the subject of chloroform narcosis during
sleep : " On June 15, 18S3, I was called to see a boy four
years of age, who had fallen upon a piece of glass and
cut the palm of his right hand badly, 1 found liim asleep
and determined to try the exiieriment of chloroforming
in tliat state, as I had been interested in the various
articles bearing upon the subject which have lately ap-
peared in The Record. I took my time about it and
found no difficulty in getting him fully under its influence,
examined the wound for bits of glass, put in necessary
stitches, and put on the required dressing before he be-
came conscious. I believe this will become a popular
method for administering chloroform to children and am
surprised it has not been resorted to more frequently. By
it we save the littlle ones from the fright with accom-
panying excitement experienced by many of them at the
first approach of chloroform, a gain certainly to be de-
sired for the sake of child, mother, and doctor."
The ATethods of Monthly Nurses. — Dr. Alexan-
der, in a series of articles in the Medical Times and Ga-
zette on the management of parturition and the puerperal
state, remarks on the habit of nurses of having each some
special point wliich she considers of importance in the
management of labor cases, and which, in her ignorance
of the true principle involved, she is apt to overdo, or to
do wrongly. For instance, one dreading hemorrhage
will compress every uterus ; another will drench every
woman with cold water, etc. He says the best plan of
finding out these faults is to " blow up" the nurse gener-
ally when troubles arise that we cannot get at the origin
of, and wherever she in her self-defence shows herself to
be most zealous, it is there we must look for the errors
that are producing the mischief.
An Analysis of Indian Tea. — Water, 5.849 per
cent.; extract, 37.800 per cent.; total ash, 5.790 per
cent. ; ash soluble in water, 3.667 per cent. ; ash insolu-
ble in water, 2.123 psr cent. ; ash insoluble in acid,
0.149 Psr cent. ; insoluble leaf, 50.100 per cent. ; tannic
acid, 13.040 per cent. ; theine, 3.240 per cent.
The Insane Asylums of Italy. — Italy has sixty-two
insane asylums, which contain 17,471 insane inmates; of
these, 9,000 are men, 8,471 are women. Since 1877,
the number of admissions has been constantly increasing.
.■Vbsence of Vagina, Uterus, Ovaries — Enormous
Distention of Urethra, without Incontinence. —
Dr. James F. Ferguson, Visiting Surgeon to the Charity
Hospital, N. Y., relates the history of a prostitute ad-
mitted October 25, 1881. Father was consumptive; mother
died of pulmonary hemorrhage. The patient was the
tenth child. She denied all previous venereal trouble.
Althougli eighteen, had never menstruated, nor did she
give any history of vicarious phenomena. She noticed
a pimple on the posterior commissure at the time of
admission, followed by a discharge, with scalding on
micturition. There were three small chancroids in the
posterior commissure. The chancroids were touched
with carbolic acid and dressed with iodoform. On|the
29th of November, the parts having healed, a further
e.xamination was made, when no vagina was found ;
the meatus urinarius and urethra were very much en-
larged. The sores above mentioned prevented an earlier
examination. The labia are well developed. An ex-
amination was made bv Dr. Ferguson, with Dr. Walter
R. Gillette and Dr. E. S. Peck. They failed to find a
uterus or ovaries. Investigation was made bv the finger
in the urethra; also bimanual touch through the rectum,
and by sounds. The outer portion of the urethra was
greatly dilated ; she did not have incontinence of urine.
She was well developed — breasts well formed, also the
nipples. The mons of normal size. The labia nymph.e
and clitoris presented the usual appearance. In this
very remarkable case the unusual feature is exhibited
of a urethra largely distended, with no incontinence of
urine. — The Planet, New York.
Report ok a Case of Cyanosis in which the In-
terauricular and Interventricular Septa were
Both Deficient. — .\ correspondent has sent us an in-
teresting report under the above title, but has omitted to
affix his name. We shall be pleased to hear from him.
Echinococci in the Liver of a Camel. — .A large
camel from the Central Park was brought to the hospital
of the Columbia Veterinary College almost in a state of
collapse. No previous history was obtained. The ani-
mal was only in the building for a few hours. At the
necropsy the principal lesion worthy of note was found
in the liver, which was filled with hydatid cysts, which
resulted from the migration of the larvae of the taenia
ecchinococci. These cysts were in various states of
retrograde change. Some were almost calcareous, some
in a suppurative state, and some neai'ly cystic. The
hooklets diagnostic of this lesion were easily demon-
strated.— Joiirn. of Comp. Medicine.
A Case of Transmission of Tubercle from the
Human Species to the Domestic C.\t. — In the culture
of medical science in these days the question of the
transmission of tubercle from animals to man is proposed.
I take the liberty of narrating a fact referable to a dia-
metrically opposite problem, namely, the transmission of
tubercle from man to animals. The case was that of a
cat, two years of age, which died tuberculous after hav-
ing repeatedly eaten the expectorated matter from a lady
who died soon after of phthisis. On my first visit, by
request of the owner of the cat, the animal presented a
cadaveric appearance, with a physiognomy of suflering,
and stitf and lustreless hair. For some time previous
it was noticed that it had lost its natural beauty and
vigor, lost appetite and suftered from severe cough and
other symptoms which threatened a fatal termination.
The cat died and I made a post-mortem examination
which verified my diagnosis. It was true tuberculosis.
On opening the thoracic cavity I found white nodules of
irregular form disseminated throughout the entire sub-
stance of both lungs, isolated or confluent and varying
in size from millet seed to a giain of corn. I found
some of these tubercles on the costal pleura, some on
the pericardium, and, note the circmnstance, only one (of
the size of a grain of wheat) on the right side of the heart
near the apex. I did not have time to e.\amine these
nodules microscopically. Examined thus superficially I
found variation in their consistency, some hard and cal-
careous, others soft and containing pus. Will these data
be sufficient to prove the cat tuberculous ? I believe so.
(G. Brezzo in 11 medico Veierinariio). — Journ.of Comp.
Medicine.
Denver, Colorado. — There are more physicians in
Denver in proportion to the population than in any
other city in the Ignited States, s.ays the Denver Medical
Times. .\ Aficroscopical Society has recently been
organized and a Woman's Hospital established.
The Medical Record
A Weekly JoiLrnal of Medicine and Surgery
Vol. 24, No. 5
New York, August 4, 1883
Whole No. 665
©vigiual Jivticlcs.
ON SOME RECENT ADVANCES IN THE SUR-
GERY OF THE URINARY ORGANS.
Being the Address on Surgery delivered before
THE Fifty-first Annual Meeting of the British
Medical Association, at Liverpool, on August
I, 1883.
By REGINALD HARRISON, F.R.C.S.,
SUKGlfON' TO THE LIVERPOOL ROYAL INFIKMAKY.
(Special for The Medical Record.)
Mr. President and Gentlemen :
The honor of addressing you on this occasion having
been conferred upon me by your Council, I cannot
enter upon the task that is before me without e.xpressing
my consciousness of inabihty to accomplish it in the man-
ner I would desire. This sense of insufficiency is by no
means lessened when I look at the names of those who
have preceded me ; when I remember the interest with
which I, in common with you, listened to their words ;
and when I consider how completely abreast this great
Association is kept by means of iXi Journal with every-
thing relating to the advancement of surgery. On the
other hand, long connection with this Association gives
me the assurance of having to address a sympathizing
audience, one disposed to overlook defects in any honest
endeavor to set forth the advancements made in our
art.
Surgery, I need hardly tell you, has long been culti-
vated in the new city which has now the honor of re-
ceiving you. The hospitals of Liverpool and their rec-
ords show that the same ardor prevails here as elsewhere,
both at home and abroad, while its position as a school
of surgery indicates that it has entered not unsuccess-
fully into honorable rivalry with its competitors. But it
may be asked, especially by those visiting I^iverpool for
the first time, Are there no traditions here ? Are there
no footprints of those who have left behind them works
which place us in their debt, and which will render their
names famous wherever and as long as surgery is known ?
It seems to me that one advantage connected with the
itinerant character of our meetings is, that places sug-
gest references to local celebrities of the past whose works
cannot be thought over without advantage. In our
desire to push forward, we sometimes forget to look
back, and to reflect upon that which has been achieved
and how it was brought about. Such reflections cannot
fail to be of service in reminding us that surgery is not
entirely of modern creation, that we have a few distant
relations whose connection it is desirable to keep up,
and that there still remain links which associate us with
the great ones of the past. These links connect us, not
here alone, but everywhere, with the names of Park and
Alanson, to whose work I now wish for a moment to
refer.
Henry Park was surgeon to the Royal Infirmary from
1767 to 1798. I cannot do better than quote a passage
which our local historian. Sir James Picton, has selected'
as paying a deserved tribifte to his memory : " In the
latter portion of the last century, when a vigorous flash of
originality seemed to light up the annals of surgery.
Park, of the Liverpool Infirmary, may be said to have
* Edinburgh Review, October, 1872.
accomplished the first act of conservative surgery. His
patient being a sailor, to wliom the loss of a foot and leg
would have been tantamount to the loss of his means of
getting bread, determined him to make the experiment
of simply excising the diseased part, the knee-joint, and
retaining the foot and leg. This lie did so successfully
that, to use his own words, the patient some years after
the operation ' made several voyages to sea, in which he
was able to go aloft with considerable agility, and to
perform all the duties of a seaman ; that he was twice
shipwrecked, and suffered great hardship without feeling
any further complaint in that limb.' This was a crucial
test of success, that should have stamped the operation
as one of the greatest surgical triumphs of the time ; but,
like so many other great strides taken in that age of ex-
treme vivication, it was in advance of its fellows, and
was destined to be arrested for the better part of another
half century."
I need not on this occasion dwell on the claims that ex-
cision of the knee-joint has to be regarded as one of the
recognized operations in surgery. Though there may be
differences of opinion in reference to the circumstances
indicating it, there can be no doubt that it will for ever
remain as a brilliant memorial of the surgeon whose
name is associated with it.
Of Mr. Alanson, Park's colleague, and surgeon to the
Royal Infirmary from 1770 to 1794— whose work has
been aptly referred to by Mr. Sampson Gamgee' as
" one of those forgotten surgical classics which I would
venture strongly to impress on the attention of my
younger brethren "—I will speak in the following pas-
sage from the Presidential Address of the late Dr. Vose,
delivered on tiie last occasion this Association met in
Liverpool : "To Mr. .'\lanson, formerly a surgeon to our
Royal Infirmary, we are indebted for many important
suggestions, made at a time when the science of hygiene
was but little regarded anywhere. His remarks upon
the ventilation of hospitals', the use of iron bedsteads,
the necessity of frequent whitewashing, and the establish-
ment of sanatoria in the pure air of the country for con-
valescent patients, testify to the correctness of his pro-
fessional judgment and to his zeal for the welfare of his
fellow-creatures. It is by his treatise upon amputation,
however, that the memory of this gentleman, as an origi-
nal thinker in surgery, has the strongest claims to our
gratitude and regard. He tells us that among upward
of forty amputations performed upon the old system,
which had come under his notice, ten died of tetanus,
two of bleeding, three from mortification, four from ex-
hausting suppuration ; while eighteen experienced hemor-
rhage, and nearly all had excessive fever. Most of the
patients suftered'from exfoliation of bone— conical stumps
or wounds that would not heal. After the adoption of
his improved method of procedure he had the satigfaction
of being able to announce that out of upward of thirty
amputations, taken indiscriminately, which were per-
formed at the Infirmary, not one died, and none had
secondary hemorrhage, while in a month after operation
the wound was either altogether or as nearly as possible
healed in all the cases.
As is well known, in Alanson's method of amputating,
provision was made for the covering in of the bone, after
its section, by the integuments.
Such, then, are illustrations of the useful work which
was being done by surgeons in this comparatively modern
"Transactions International Medical Congress, 1881. vol. li., p. 35=-
114
THE MEDICAL RECORD.
[August 4. 1883.
city about one hundred years ago. Gratitude for im-
provements the value of which is still fully and freely
acknowledged justifies the foregoing brief references to
the work of these distinguished men.
The selection of material for presenting to you to-day
has occasioned me no little anxiety. Following imme-
diately upon an address which will for ever render our
jubilee year memorable — an address in which justice was
done by the distinguished representative of surgery from
Ireland to the great subject of surgical progress generally,
whilst its prominent features were forcibly brought out, I
may well hesitate where to tread.
In considering the position of surgery as detailed in
Dr. Stokes' admirable address, the thought naturally oc-
curs that its diffusion is as remarkable as its progress.
Compare, for example, the condition of surgery prior to
the existence of our .\ssociation with its position as set
forth in the columns of our own Journal, or in those of
the other great representative of medical opinion in this
country — the Lancet. In the former period departures
from the ording,ry routine of surgical procedure were
confined to a few hands, and the benefits resulting from
improved methods of treatment were shared in by a very
limited number. Now, no sooner is a method of treat-
ment or an operation proved to be efficient, than it is
taken up and practised wherever scientific surgery can
reach ; the peer is no better off than the peasant, and
the cottage hospital rivals in its successes its more pala-
tial representative.
So beneficently catholic is our profession that it hails
with the greatest satisfaction, not only the discovery of new
means of relief, but the adaptation of others to a form
which permits of their more general adoption and useful-
ness ; while, on the other hand, it regards with suspicion
all methods of treatment which unnecessarily restrict or
conceal that which was intended for the common good.
I propose to occupy the remainder of the time at my
disposal by a reference to some of the more recent ad-
vances and work in connection with the surgery of the
urinary organs.
Commencing with the kidneys, we are at once struck
with what surgery is doing for them. Until quite recently
the diseases of these organs were regarded as belonging
almost exclusively to the province of the physician, and
probably they would have remained so had preventive
medicine obtained fuller development.
A more extended acquaintance with the pathology of
the kidney has brought to light conditions in which the
work of the physician requires to be supplemented by
that of the surgeon. Pain arising from an undue mobility
of the organ, tumors, deposits, hemorrhages, and collec-
tions of fluid within it — all these morbid states are now
recognized as capable of relief or cure by fixing, opening,
or extirpating the abnormal or disordered organ ; whilst
numerous illustrations have .already been afforded of the
successful removal of stones from positions where they
must have ultimately led to the disorganization of the
kidney in which they had become impacted.
It would be premature at present to endeavor to formu-
late anything like precise rules in reference to the appli-
cation of the various operations on the kidney to which
I have briefly referred ; they are at present comparatively
new to us, and we must occupy ourselves in cautiously
moving in the direction they indicate, and in collecting
experience rather than in drawing conclusions other tlian
very general ones.
Among many valuable contributions to the literature
of this subject which have appeared, I would include one
by Dr. R. P. Harris,' of Philadelphia, which contains an
analysis of one hundred cases of neplirectoiny. From
this, as well as other communications which have more
recently been published in this country, we may draw at
least three conclusions of value, so far as the operation
of extirpation of the kidney is concerned. These are —
* American Journal of the Medical Sciences, July, 1882.
First. — That nephrectomy has been the means of sav-
ing many lives under circumstances where no other
method of treatment was likely to be of service.
Second. — That this operation has been practised in
cases where the probability of a successful termination
appeared to be very remote.
Third. — That a method of eflecting the removal of the
organ different from that which was selected, or a pro-
cedure less heroic, might, in some instances, have tended
to increase the chances of success.
In these directions then — in selecting cases for opera-
tion, in rejecting others as unsuitable, and in determin-
ing relatively to the case in question the best method of
procedure — I take it that good work has yet to be done.
It appears to me that among the difficulties we have
to contend with in the application of nephrectomy, two
stand out prominently : i, the kidney it is proposed to
remove may be the only one ; 2, the opposite organ may
be similarly affected, though in a less degree, yet sufficient
to interfere with those compensatory changes being car-
ried out which are essential when one excretory organ
has to supply a lack of service on the part of another.
The literature of this subject will already be found to
illustrate the class of difficulties to which I am referring.
The lesser proceedings, which include the exploration
of the kidney, and the removal of calculi and of pent-up
fluid, are necessarily attended with a diminished risk, and
have already proved of much value.
In undertaking a new class of operations, we must
bear in mind the past history of many methods of treat-
ment, now justly regarded as successes, but which sev-
erally had a very unpromising commencement. Look
at the unsatisfactory position held by ovariotomy only
within a period represented by the memory of the ma-
jority of us here present to-day. Yet the high dignity
to wliich it has been raised in the rank of surgical opera-
tions, by the skill and enterprise of Sir Spencer Wells,
Keith, and others is frankly and fully admitted by the
whole medical world.
In the treatment of certain affections of the bladder
we shall find that much progress has been made, and
that the way has recently been opened for prosecuting
other important advances. These will be chiefly illus-
trated by the modern practice of lithotrity and the treat-
ment of tumors and intracystic growths.
Till a few years since the removal of stone from the
bladder by crushing had been conducted on the lines
laid down by Civiale some half-century ago. Though
this method of proceeding has included amongst its ad-
vocates, past and present, surgeons of eminence, it can-
not be said that as then practised it was either gaining
ground or confidence. Indeed, I think I may say there
was an increasing tendency to limit its application and
to substitute lithotomy in all cases but those of the sim-
plest kind. The mortality consequent ui)on the reten-
tion of broken calculi witliin the bladder was sufficient to
induce all but the most ardent admirers of lithotrity to
hesitate to give it the preference over a proceeding in
which, whatever might be the risks, there was at least a
guarantee that the wliole of tlie stone had been removed.
While the surgical mind was thus to some extent in
doubt as to the limits to which the crushing operation of
stone might safely be pushed, two important communi-
cations followed rapidly upon each other. That both of
them should have emanated from .America merely indi-
cates that the desire to advance the art of surgery is not
limited to the old country, but is a natural outcome of
advancing civilization and humanity.
The first of these papers was by Dr. Otis, of New York,
who demonstrated beyond all reasonable doubt, and in a
manner which had not previously been attempted, that
the male urethra was capable of safely receiving far
larger instruments than were generally employed. F"ol-
lowing upon this, and probably influencing the views of
the author, came Dr. Uigelow's paper on the removal of
stone from the bladder by crushing and withdrawing it at
August 4,
1883.]
THE MEDICAL RECORD.
115
a single operation ; the latter communication clearly
showing that the bladder was tolerant of much more pro-
longed manipulation than had previously been believed.
It ainiears to me that the originality of Higelow in no
way detracted from the importance of the work that had
previously been done in this country and elsewhere, or
compromised the acumen of those who were most inter-
ested in the progress of this department of surgery.
That Bigelow's method of procedure is a great step in
advance — that it has extended the limits of lithotrity and
curtailed those of lithotomy — there cannot be the least
doubt. But to suppose that it is capable of universal ap-
plication, or ever likely to be so, is as unreasonable as
to suppose that the art of surgery in no way differs from
the art of administering Holloway's pills. But does the
lithotrity of to-day represent the finality of its perfection ?
I trow not. When we consider what chemistry, elec-
tricity, and other agencies are doing — how physical force
is in many directions being supplanted by other means —
can we doubt that there are yet improvements in store
in the methods of effecting the destruction of concretions
within the body ? Nay, are there not already significant
indications that such improvements are nigh at hand?
Is it likely that the fruit of the labors of Garrod, of Wil-
liam Roberts, of Ord, of Vandyke Carter, and others has
been alreafly gathered ? May not a more perfect knowl-
edge of the physical and physiological laws which regu-
late the production of concretions in the human body
result not only in enabling us more surely to prevent
them, but to destroy them ?
Considering the great activity that has within recent
years been shown in demonstrating the preventable
nature of many diseases and the energy that has been
displayed in grappling with them, it seems remarkable
that no adequate steps should have been taken to ame-
liorate the hygienic condition of certain parts of this
country where tiie amount of calculus disease is exces-
sive and the inhabitants consequently are exposed to an
i]iordinate risk of contracting it. The admirable address
by iVIr. Cadge before our Association at Norwich, in
1874, furnishes abundant data for the further prosecution
of inquiries of this kind.
I cannot help thinking that if it could be shown to be
even probable that the dogs, cats, rabbits, or frogs of the
aforesaid districts were inconvenienced in a like manner
with their owners, the matter would long ago have been
forced upon our legislature with all the exaggeration that
usually characterizes agitations of this kind.
Though surgery has invariably shown itself equal to the
circumstances and emergencies with which it has been
called to cope— though the prevalence of stone in a dis-
trict has alway,s been compensated for, as far as this is
possible, by the appearance of those most competent to
deal with it — these are no reasons why such conditions
should be permitted to continue. Had time or occasion
offered, I think it would not be difficult to prove that
circumstances, either fortuitous or by design, have been
found to exercise a marked mtluence in diminishing or
increasing, in certain places, the tendency to calculus
disease.
One word in reference to lithotomy before I leave the
subject of stone. There is no great operation in surgery,
I believe, which furnishes more successful results than
this. Taking the experience of the two hospitals in this
city with which I have been associated, 1 find there have
been within my recollection one hundred and two cases
of lithotomy in persons of all ages, but chiefly in children,
and operated on either by my colleagues or by myself.
In only five of these cases could I ascertain that a fatal
result followed. My late esteemed friend, and our
former associate, Mr. Southam, speaking of his own ex-
perience of lithotomy at Manchester, informed me that
he had operated one hundred and twenty times, and
could only recall one death. In the great majority of
the Liverpool cases the stones were not exceedingly
large, and I have no doubt that many of them might
have been removed by lithotrity. I question, however,
whether the small mortality these figures indicate would
thereby have been still further diminished, even if the
calculation were made on a basis corresponding with the
most successful statistics in lithotrity that have hitherto
been obtained.
Passing to tumors of the bladder, it is not surprising,
seeing what has been done for tumors of the ovaries,
uterus, and intestines, by Sir Spencer Wells, Keith, Law-
son Tait, Treves, and others, that growtlis occupying the
interior of the bladder should have received special
attention. Though the literature relating to this subject
has been of a somewhat fragmentary character, such
compilations as Stein's recent work, " A Study of Tumors
of ihs Bladder," conclusively show that some gratifying
results have already been attained in both sexes. The
great distress connected with this class of growth, the
uncertainty as to the precise nature of the affection, in
the first instance, and subsequently the kind of symptoms
that accompany it, have naturally suggested the employ-
ment of means having for their object their removal by
operation.
Sir Henry Thoin[)son has done good service in giving
prominence to the employment of digital exploration of
the bladder, and in furnishing illustrations of the great
advantage that this proceeding is capable of affording in
suitable cases.
From a consideration of some of the extremely valua-
ble records which have been published by various sur-
geons, where the bladder has been opened for the re-
moval of tumors, it appears to me that it might have
been better had the operative proceeding terminated
with the detection and exploration of the growth by the
finger. The chief dangers which experience has shown
to be liable to attend the performance of this class of
operations are :
1. The chance of rupturing a bladder, the coats of
which have been rendered less resisting than natural.
2. The provocation of a hemorrhage which it has been
found difficult to control.
3. An incomplete removal of the growth.
On the other hand, an examination of many tumors of
this kind, of which villous growths or tufts furnish the
best examples, shows that there is nothing in their con-
nections or relations which need necessarily interfere
with their complete removal. Precise information as to
the presence and attachments of these growths we may
now obtain with comparative safety. Whether their re-
moval is to follow upon their discovery will be matter for
further consideration.
With the view of extending our knowledge of these
growths, a committee of this association is occupied in
collecting information relating to them. The report of
this committee, will, I hope, lorm the basis of an inter-
esting discussion in the pathological section which will
be opened by Mr. Paul.
I now come to speak of the prostate, and I shall do
so in reference to the part it takes in obstructing mictu-
rition, for the reason that it is this symptom which in
some form or other brings the patient under our care.
It appears to me that enlargement of the prostate is
specially interesting to us in relation to its earliest and to
its most advanced forms, and it is to these points that I
shall more directly refer.
If we take the obstructive disorders of the urinary ap-
(laratus, and inquire what feature of them is most detri-
mental to the associated parts, the answer undoubtedly
will be, the misdirection of the muscular force that is
thereby entailed. How can we explain the structural
alterations which take place behind the obstructed point,
and which manifest themselves in difterent ways, except
as the results of urinary retention and retrograding press-
ure ? How frequently do we find, in cases of stricture
or enlarged prostate, that the whole of the apparatus be-
hind the primary constriction consists of little else than
1 dilated saccules and tubes ! Is not this back-pressure go-
ii6
THE MEDICAL RECORD.
[August 4, 1883.
ing on, though it may be imperceptible, from the mo-
ment that impediment arises to the escape of urine from
the bladder ? The more we study animal mechanics,
either in their physiological or pathological application,
the more can we appreciate the truism that force is never
lost ; if it is not permitted to act for good, it nmst be
productive of evil ; if it is not exerted toward the legiti-
mate fulfilment of a normal act, it must inevitably exer-
cise a corresponding pressure in an abnormal direction.
Whenever I see in tlie post-mortem room an ordinary
specimen of dilated kidney, tortuous ureter, or sacculated
bladder, associated with an enlarged prostate or a stric-
ture, the expression "misdirected force" almost involun-
tarily escapes from me.
Such considerations as these have long led me to be-
lieve that our treatment of prostatic stricture commences,
as a rule, far too late ; we delay until the bladder shows,
by the formation of a pouch or a saccule behind the
prostate, the first bad influence of back-pressure before
we seek to rectify it.
I have endeavored to prove how much good may be
done by the adoption of judicious mechanical treatment
on the appearance of indications that the prostate is
commencing to obstruct micturition, and I have founded
my suggestion upon a condition which maybe seen illus-
trated in any museum — viz., one in which, though the
gland has become large, obstruction has not been known
to occur. An extended adoption of this practice has
convinced me that the pressing symptoms connected
with an enlarging prostate may be kept in abeyance by
the timely emplo3'ment of those principles of treatment
which are generally recognized as being applicable to
any tubes within the body which are threatened with oc-
clusion, and are within our reach.
In the more advanced forms of prostatic enlargement,
where the bladder has been converted into a receptacle
little better than a chronic abscess in which urine stag-
nates, surgery has done much to afford relief.
When the comfort that catheterism is capable of afford-
ing has ceased to be effectual, other plans of establishing
a drain for the urine are at our disposal. It is not neces-
sary that I should discuss the various means of efiecting
this ; let me, however, say a few words in reference to
two which have more recently come under notice ; these
are — first, incision into the bladder from the perineum,
and secondly, paracentesis through the enlarged gland.
For the purpose of securing a more or less permanent
channel for the escape of urine from the bladder, other
than that by the urethra, I must admit that following the
practice of Syme, and to some extent of Edward Cock,
I have a decided jjreference for an incision through the
perineum, on the twofold ground of safety and comfort.
We have had numerous examples of the great advantage
that cystotomy is capable of aftbrding for bladder affec-
tions, dependent on a large prostate — none perhaps more
striking than the case narrated by Mr. Lund, on the
memorable occasion of the meeting in London of the
International Medical Congress. The paper closes with
this observation : " I have thus placed on record this
case, unicjue in its character, and interesting and encour-
aging in its results, with the hope that should a similar
case occur to any surgeon now present, he will not hesi-
tate to give his patient the chance of benefit from a
course of procedure so simple in its nature, and so likely
to be followed by temporary, if not permanent, benefit." '
1 may be permitted here to submit to your notice a
method of puncturing the bladder through the enlarged
prostate which has aftbrded very gratifying results. It
consists in passing the trocar through tlie gland, and re-
taining it in the perineum, so as to aflbrd a permanent
as well as a convenient drain for the urine. I should
have had more diffidence in commending this operation
to your notice had it not received the ajjproval of our
distinguished associate. Professor (iross, wlu)se contribu-
* Transactions International Mcdic.ll Congress, vol. ii .
tions to the surgerj- of the urinary organs are held in de-
servedly high repute on both sides of the Atlantic.
Though the primary object of cystotomy, as usually
practised, is merely to place the bladder at rest, by pro-
viding a continuous drain for the urine as well as the
products of cystitis, it occurred to me, as it had already
done to others, that it would be possible to extend this
proceeding, with the view of removing those barriers to
micturition which the hypertrophied gland so frequently
presents.
It was to meet conditions such as these that Mercier
introduced and practised division of the prostatic bar by
means of a cutting instrument introduced along the
urethra. This plan, though admirable in its conception,
was open to the objection that in its execution it was
necessarily uncertain, there being no means of ascertain-
ing with certaintv that the section was confined to the
obstruction to be removed. On carefully considering
the position of matters, as well as the proposals that had
been made, it appeared to me more reasonable to at-
tempt to divide the prostatic obstruction at the neck of
the bladder from an opening made into the membranous
urethra, than by means of instruments which had to tra-
verse the whole length of the canal. I have recently
brought under notice a case ' in which I thought it desir-
able to explore the prostatic urethra from an opening
made in the perineum, through which I was enabled
to divide with precision a prostatic barrier. The division
of this portion of the gland was followed by complete
restoration of the jiower of micturition, and has so far
proved of permanent advantage.
The proceeding which I have thus put into practice
seems first to have suggested itself to Mr. Guthrie, but
I cannot find that he ever employed it ; that it is not
identical with the somewhat extensive incision of the
prostate as for lateral lithotomy which was practised by
Sir William Blizard is at once obvious. Its aim is to
divide the obstruction — and the obstruction alone — by an
opening so planned as not to expose the patient to un-
due risk ; while, at the same time, it is capable of afford-
ing the greatest amount of room for manipulation by an
extension of the incision, should this prove to be neces-
sar\\
I need hardly observe that a proceeding of this kind
should be undertaken before the bladder has passed into
a condition of confirmed and irremediable atrophy ;
otherwise, though we may succeed in removing an ob-
stacle to tlie introduction of the catheter, our prospect
of restoring the power of micturition will be as hopeless
as it has proved to be under somewhat similar circum-
stances where the operation of lithotomy has been un-
dertaken.
It is impossible to avoid the conclusion, from their
examination after death, that many atonied bladders
might have been prevented becoming so by the timely
removal of the obstruction by which a condition of per-
manent paralysis was induced and maintained.
The oi)erative treatment of the enlarged prostate,
when it obstructs micturition to a degree that cannot be
met by judicious catheterism, is yet, I believe, open to
considerable improvement.
Though the literature relating to either complete or
partial excision of the prostate is very limited, there is
much in it of promise. In one case, where I extirpated
the whole gland for malignant disease, the benefit that
followed far exceedetl my expectations. It was that of
a middle-aged man, who, by reason of a carcinomatous
prostate, was threatened with a speedy and painful death.
I cut down upon the gland in the median line, and suc-
ceeded in enucleating it tolerably cleanly with my finger.
I saw this patient eight months afterward in very fair
health, and quite able to go about his business. So far
he has enjoyed an immunity from the symptoms which
induced me to perforin this operation, and though his
' British Medical Journal, June 9, 1883.
August 4, 1883.]
THE MEDICAL RECORD.
117
disease is a malignant one, we have every reason to be
content with the results obtained.
Then we have numerous examples where considerable
masses of the prostate have been removed with very great
advantage in the course of operations on the bladder.
Amongst these I would specially mention an important
case by Mr. Bickersteth ; and, more recentlv, another
by Dr. John Ashhurst, of Philadelphia, in which the whole
of an enlarged third lobe was successfully removed.
Cases such as these seem to favor the hope that oper-
ative surgery will be found capable of affording more re-
lief to exceptional instances of this kind, and of extending
to the large prostate the treatment which in some degree
is applicable to other deep-seated growths.
Passing to the urethra, I would again take the opijortu-
nity of adverting to the value of Otis's work in regard to
the dimension and dilatability of this canal ; if he had
done no more than contribute to the improvement of
lithotrity — and this cannot be questioned — we should still
be largely in his debt. I cannot, however, follow him in
his views relating to the performance of internal urethrot-
omy as a means of treating stricture of the urethra. My
impression is that this operation is losing instead of gain-
ing ground in the opinion of tliose who have had ample
opportunities of judging fairly of its merits. That it is an
operation fitted for the treatment of stricture in its early
stage is a conclusion [ am disposed to take exception to,
on the ground that it is neither necessary nor safe as
compared with other methods. I believe that the early
stage of stricture may be successfully combated by the
employment of thorough cleanliness combined with the
judicious use of dilatation, as we are accustomed to prac-
tise it in this country.
If internal urethrotomy gave a greater inununity than
other operations from a recurrence of stricture, or did
away with the necessity for subsequent mechanical dila-
tation, then, perha|)s, with the view of avoiding other
risks to which all persons suftering from stricture are li-
able, we might feel more disposed to employ it. But as
such is not the case, and the risk attending its perform-
ance is not inconsiderable, I cannot concede the im-
portance which is claimed for it by its numerous admirers.
That internal urethrotomy in some cases is a necessity
— as by it we are enabled to render amenable to treat-
ment a stricture heretofore intractable — I am willing to
admit, but to recommend it as capable of effecting a per-
manent cure is quite another thing.
The treatment of impassable stricture of the urethra
has received an important addition by the practice which
Mr. Wheelhouse has introduced, the great credit of which
he seems desirous rather of sharing with his surgical col-
leagues than of appropriating to himself, as I see he al-
ways refers to it as the "Leeds operation." Like other
conditions which may be spoken of as relative to some-
thing else, rather than as fixed or defined, the impassable
stricture is, I believe, gradually becoming rarer, a cir-
cumstance which is largely due to the great improve-
ment that has taken place in the construction of instru-
ments specially adapted to their treatment, amongst
which I may mention the filiform bougies and the tun-
nelled instruments of Gouley, of New York. For the pur-
pose intended, I do not think there is any proceeding
equal to that which Mr. Wheelhouse has introduced, and
I have no hesitation in including it among the improve-
ments to which I am now referring.
Permit me, without apology, in this mechanical age,
where invention after invention for the treatment of
stricture comes upon us with marvellous rapidity, to
claim a moment's consideration for what Mr. Savory has
called the medical aspect of this question. We all know
what irritation is : there is such a thing as irritating a
stricture, either by what passes through it naturally or is
introduced to correct it. Let us not disregard, as a
principle of our treatment, the importance of securing for
the urethra that physiological rest of which the late Hil-
ton wrote so well.
The question may here very properly be asked whether,
in our search for novelties as improvements in treatment,
we have discovered any new diseases, the better manage-
ment of which, by reason of our recent accjuaintance
with them, we may in all fairness leave to our descend-
ants to determine. The admirable Bradshaw .\ddress of
Sir James Paget will no doubt have the effect of quick-
ening our perceptions in this direction.
Though I cannot point to any discoveries of this kind
as aftecting the region which is now occupying our at-
tention, I may note one gratifying result of extended
clinical and pathological investigation : I refer to the
juster assignment of symptoms to the causes producing
them — symptoms which not very long ago were looked
upon as constituting independent diseases. But if we
have not discovered any new diseases, we must remember
that varying circumstances may at one time add inten-
sity to some disorders and considerably modify the prog-
ress of others. I have a strong impression that the
times through which we are passing, characterized as
they are by the production of great and continuous nerve-
tension, have brought into prominence a state of brain-
strain which is apt to show itself in any organ which may
happen to be deranged or is overtaxed.
A recent author seemed rather to conclude that ten-
sion of this kind was most injuriously shown and felt by
our American cousin, while the liritisher, for some rea-
son or other, was less injuriously influenced in this man-
ner. Whether this is so or not I am not prepared to de-
cide, but I am disposed to believe that purely nervous
aft'ections — affections associated, as far as we can deter-
mine, with no obvious structural alteration — are more
common than they used to be. That they occasion much
distress and cause persons who suffer from them to be
unduly apprehensive will be generally admitted. Nay,
further, by their mimicry of more certain diseases, they
induce a condition of suspense which is often intolerable.
It is well, too, to bear in mind that the interpretation of
symptoms, as also their prevention and amendment, are
frequently to a large extent dependent on a recognition
of the possible existence in a patient of exaggerated
nerve-tension.
Before an audience of this kind it would be presumptu-
ous on my part to indicate in detail the many improve-
ments that have taken place in the treatment of the
surgical disorders of the urinary organs ; further, where
there have been so many contributors toward this prog-
ress it would be invidious in me to particularize.
Let me, however, in common fairness, say one word
in reference to the advance that has been steadily made
in the construction of the appliances used for these pur-
poses.
I can remember some instruments which five-and-
twenty years ago, or even less, were then regarded as
improvements, but have now passed into obscurity or to
the shelves of the museum. In no department of ap-
plied mechanics has greater perfection been obtained
than by the surgical mechanician, and nowhere is this
better illustrated than in the instruments employed in
the treatment of urinary diseases.
It seems almost ungenerous, after referring to several
proceedings of an operative kind, the doing of which
entail pain and involve risk for the sake of advantages to
follow, that I should allow to pass unnoticed the work of
those who have removed the one and lessened the other.
In chloroform and anaesthetics we have a priceless boon,
without which surgery would long ago have been at a
stand-still, and many persons now living in comfort and
enjoyment would ere this have ceased to exist. I am
not old enough to remember the pre-anaesthetic age, and,
therefore, am unable to draw a contrast which will be a
vivid one to some of the ' elder brethren ' I am address-
ing to-day. I am reminded, however, of an incident
bearing upon such a contrast, which with your permis-
sion I will briefly relate.
Some two years ago a sea captain, a patient of mine,
ii8
THE MEDICAL RECORD.
[August 4, 1883,
and by no means a bad amateur doctor, on returning
from sea, told me somewhat gleefully that he had suc-
cessfully i>erformed amputation. \Miilst his ship was at
Ruruta, an uncivilized island in the South Pacific, a poor
native got his arm entangled in a sugar-ciushing machine.
As there was no doctor on the island, my friend the cap-
tain was summoned, and at once recognized the neces-
sity for removing the shattered fragments of the limb.
The shrieks and struggles of the powerful aboriginal
were most fearful. Recognizing the necessity for taking
steps to save the man's life, the captain hurried off to
his ship, and returned with the necessary implements,
and, in addition, a quart of the newest and most potent
rum. In the absence of chloroform he induced his ]>a-
tient to swallow this fieiy compound, wineglassful after
wineglassful, until intoxication was induced, and subbe-
quently profound alcoholic insensibility. Then the tour-
niquet was applied and amputation successfully per-
formed. Recovery rapidly took place. So pleased was
the savage with the effect of anesthesia that he subse-
quently offered to let my friend cut off some of his toes
provided that the process of inducing insensibility was
repeated.
Ne,\t in importance to chloroform and anesthetics are
those means which have been recently promulgated for
diminishing some of the greater risks contingent u])on
■wounds and surgical operations About antisejitics, I
desire to speak in no uncertain terms. Though our
views may not be unanimous, though some of us may
be skeptical about the import of germs and of sprays
and other details, can we doubt that when the surgical
historian of the nineteenth century has to recount the
men as well as the measures that have favorably in-
fluenced the progress our art has made, the name of
Lister will occupy a conspicuous place?
I have now done : it has not been my ambition to hold
up to you a golden calf, to attempt to dress it in flowers
of rhetoric and to ask you to worship it. I have rather
endeavored to remind you of some of the directions
in which surgery is now travelling and to estimate in a
measure the pace at which it is going. It is impossible
to engage in a work of this kind without being fully con-
scious that though our art is an imperfect one, it is dis-
tinctly a progressive one. In the course of your visit to
this, whicli has been aptly referred to as the second city
of the empire, you will find almost all the arts and
sciences laid under contribution for the development of
commercial enterprise. Tlie activity displaved in the
development of trade and commerce will probably sug-
gest the inquiry whether we are equally progressive,
whether we are in correspondence with the times in
which we li\'e.
There need, however, be no hesitation in asserting that,
whether we are regarded as i)reventers of disease, or as
practitioners of surgery or of medicine, every one of us
in his daily practice carries with him a proof that year
by year something additional is contributed by our pro-
fession to the comfort and the life of man.
Danger ok Ergot in Loco.motor .\t.\xia. — Dr. J.
Grasset relates the case of a patient, thirty-eight years of
age, sutYering from progressive locomotor ataxia, to whom
Charcot gave ergotine in doses gradually increased from
four grains to fifteen grains daily. When tlie dose had
reached the latter figure the i)alient became, wilh but
slight warning, totally paralyzed; sensibility at the same
time was markedly diminished, .^s soon as the drug
was stopped the paralysis quickly disappeared, leaving
the original trouble slightly increased. The author re-
calls the investigations of Tuczeck into the changes in
the posterior columns in ergotism ; those would indicate
that ergot will not only not cure ataxia, but can even,
under certain circumstances, induce sclerosis of the pos-
terior columns. In any case, great care should be used
in the administration of ergot in this disease.
ON FORSTERS OPERATION FOR RIPENING
IM .M.VTURE CATARACT.
Hv HEXKV IX NOVES, M.D,.
NRW YORK.
The rule is founded upon long experience, and is in the
main sound, that a cataract should not be extracted until
it is wholly opaque. So long as a patient can count fin-
gers it is held not proper to operate. To this rule ex-
ception is made in the case of cataracts which progress
with great slowness, and as they mature exhibit a deep
amber or mahogany hue, or sometimes only a smoky tint
and seem to have no cortical layers. Such cataracts are
very hard and uniform, and never become so deeply
opaque as to make it impossible for the patient to count
fingers within a foot's distance. It is good practice to
extract such lense.s, and they generally do well. But for
the commoner forms of cataract, in which opaque and
transparent parts are intermingled, permitting the fundus
to be illuminated with the ophthahnoscope and giving
back a red reflex it is the recognized rule to postpone
operating imtil the lens has, as the phrase is, grown ripe.
The reason is that the lens separates from the capsule im-
perfectly, and leaves a residuum of semi-transparent
material which evades expulsion and may bring on serious
inflanunation, either in the iris or in the capsule, or in
both. Fortunately it is seldom that cataract begins at
the same epoch or progresses at the same rate in each
eye. Hence a patient usually has one cataract ready
for removal before useful vision has ceased in the other
eye. To all this good fortune does not occur.
It will be inferred tiiat tlie writer approves of operating
for cataract when one eye is fully ready for its perform-
ance. There is scarcely any dissent from this approval
at the present day, jirovided the second eye begins to be
seriously im|)licated in the disease. It is, however, not
superfluous to call attention to this point, because the
feeling exists among the laity, and to some extent among
physicians, that an operation should not be done until
the patient is quite blind in both eyes. Formerly the
proportion of failures was so considerable and the rigor
of after treatment was such as to make the operation a
serious matter, and hence the inclination to wait for
complete blindness in both eyes. As stated, the judg-
ment of ophthalmic surgeons is in favor of operating so
soon as one eye is ready, and in case the second eye
begins to e.\hibit cataract. This is the general judgment,
notwithstanding what is known respecting the occasional
occurrence of sympathetic inflanunation in the fellow
eye.
In one eye the lens may be decidedly opaque, but the
broad shadow at the edge of the pupil shows that its
superficial layers are semi-transparent and sticky, while
in the other eye the irritative symptoms wliich often at-
tend the beginning of lenticular opacity make work
diflicult, although there may remain the capacity to read
ordinary print. On the other hand there may be little
dificrence in the degree of opacity in the two eyes.
Again, the patient may have lost one eye through ac-
cident, or some other disease than cataract, and in the
remaining eye lenticular changes have begun.
When the patient can no longer do fine work, such as
sewing, or writing, or reading ordinary print, or cannot
follow his occupation, he may for months or years retain
vision sufficient to count fingers at one foot. During this
period he can feed and dress himself, and may walk
about in safety. But he finds his situation most trying.
The great trouble is want of occupation, and many com-
plain bitterly of the tedious idleness which they have to
endure.
It will be readily appreciated that weariness of mind
may act unfavorably on the stale of health, and inasmuch
as predictions as to the rate of progress of cataract can-
not be made with any definiteness we leave a patient
small consolation when we tell him it is better to wait
August 4, 1883.]
THE MEDICAL RECORD.
119
for the lens to ripen, than to take the risks of failure by
a premature operation.
It was once a common practice, now less frequently
resorted to, to perform iridectomy some weeks prior to
extraction, to diminish the risks of the operation. I have
noticed that immature cataracts appeared to grow opaque
more rapidly after the iridectomy than they did before.
This incidental effect has not been kept in view as an
indication for the operation, but it deserves mention.
It has been ])roposed to bring about full opacification
of cataract by discission of the capsule witii a needle. It
would appear that this proceeding might justly be em-
ployed in view of the e.xperiences of the late Mr. Jacobs
of Dublin, who favored the treatment of senile cataracts
by discission alone. But surgeons have seldom adopted
the needling operation either to ripen or to cure senile
cataract. As a means of cure the proceeding calls for
too much time, as a method of ripening cataract. It is
apt to be ineftectual and as I have verified by experience
it is not devoid of danger.
Mooren ("Fiinf Lustren Ophthalmologischer Wirk-
samkeit," 1882, page 207) gives his experience on this
point to the following effect. That in all cases of arterial
sclerosis, and whenever there is undue tension of the
globe, no operation for artificially ripening cataract should
be performed. If done, glauconiatous complications will
be almost certain. In other cases Mooren resorts to the
following method. An iridectomy is first made, and the
greatest care must be given to the avoidance of puinllary
adhesions afterward. About three weeks afterward he
opens the cajjsule, not with a needle but with a Graefe's
knife for about three-fourths its diameter from above
downward, and takes the utmost pains to avoid luxation
of the lens. For two days the patient is kept in bed.
Ripening ensues in from a few days to a few weeks,
according to the quality of the lens. Great respect is
due to Mooren's opinions on such a subject, because he
has had an uncommonly large experience with cataract.
He reports (p. 211) having performed two thousand
three hundred and thirty extractions by what he calls
the scleral incision. It is also to be said that the tech-
nical skill and the judicial capacity which he possesses
will greatly surpass what ordinary operators can claim.
It is to be desired that the least danger should be in-
curred in all operations in the eye, and the method of ar-
tificially maturing cataract now to be described seems
worthy of cultivation.
Within two vears Professor Forster, of Breslau, Ger-
many, has published an account of a method for bring-
ing about the maturity of cataract which seems worthy
of imitation. His proceeding was made known to the
Ophthalniological Congress of Heidelberg in 1881, and
afterward announced in the International Congress of
London in 1S82. He has also written about it in Ar-
chives of Ophthalmology, vol. xi.. No. 3, p. 344, 18S1.
He performs iridectomy upward, and while the anterior
chamber is empty strikes or rubs the cornea with the
convexity of the iris forceps or with the conve.x portion
of a strabismus hook. In doing this rather firm pressure
is made ujjon the lens as it now lies against the cornea,
and the friction is chiefly confined within the area of the
pupil and of the coloboma. The nianceuvre is similar to
that commonly employed for expelling blood from the
anterior chamber, but the pressure is deeper. Neces-
sarily care must be taken not to dislocate the lens and
not to cause prolapse of vitreous. The instrument which
I have employed in all cases but one has been a Daviel's
silver curette or a narrow spoon of hard rubber.
The movements are mostly in a rotary direction, and
are continued for perhaps a minute, but I cannot pre-
tend to say for how long time they were kept up, any
more than I can tell how much pressure was employed.
(The mantjiuvre has been entitled trituration of the lens,
but this surely is a stronger word than the facts warrant.
It were better, perhaps, to speak of it as massage or
compression.)
My experience extends to eight cases, which are sum-
marized in the following table :
0 II
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So
In all cases the subjects were above sixty years of
age. Four were females, three were males. In one
female both eyes were operated on at an interval of ten
months. In this patient alone did any serious reaction
take place — and this occurred in both eyes, and at both
operations for ripening, and also at the extraction of the
lenses. When her first eye was operated on severe
iritis followed Forster's method (Case 2), and numerous
posterior synechia; occurred. The extraction was done
three months later, and was not as normal in its per-
formance as I could have wished. For this reason, as
well as because of the irritable condition of the eye, the
healing occupied a long period (forty-three days), a
dense membrane formed in the pujiil and iridectomy be-
came needful. The ultimate result, V = 4|;, was good.
The patient desired to have the other eye treated, and
better fortune attended the operations, but it was evi-
dent that she was unusually prone to inflammatory re-
action. The result in this eye is yet incomplete, because
a thin pupillary membrane remains to be divided
(Case 6). In one other case, viz.. No. i, iritis, with
few synechia; took jjlace, but no jirejudicial effect wz.?,
thereby {>roduced. The period of confinement after
Forster's operation varied from seven to seventeen days,
the average was 9.4 days. In one patient. Cases 2 and
6, cataract had for four years been in the stage which
prevented "working" sight. In other patients the
period which had elapsed since they could see to work
was from a few months to a year. The exact period
was not always obtained.
I20
THE MEDICAL RECORD.
[August 4, 1883.
The time required to mature the cataract varied from
five days to three months. The long period occurred in
two patients, viz. : in Case i and Cases 2 and 6.
The latter, who had the most severe experience, had
cataracts which were devoid of all cortical opacity, and
the ripening jirocess was slow. Cases 3, 5, 7, and 8 had
abundant cortical opacity, and the effect in them was
prompt and without unpleasant reaction. In none of
the cases did the lens seem to swell or did any glauco-
matous symptoms arise. It would not be prudent to say
that such mishaps might not take place, the presumption
is that swelling of the lens would occur, and if so, glauco-
matous complications would be expected. It is, how-
ever, safe to state that such accidents are far less likely
than after Mooren's method of incising the capsule.
It will be observed that in no instance was the extrac-
tion done sooner than two months, while in some cases
it was not done until six months after the accelerating
iridectomy. The postponement was not in all cases be-
cause of unreadiness of the cataract. An increase in
opacity was in all cases noted as ensuing immediately,
but the rate of increase was not always alike. It did not
show itself chiefly upon the anterior surface of the lens,
but seemed to come up from the deeper layers. It did
not appear to depend on direct disintegration of the
lens-fibres or of the capsular epithelium, but rather it
may be conjectured, on disturbance of the suspensory
ligament. It was mucli more regular and evenly dis-
tributed than the opacity which takes place after a trau-
matic interference, by a needle or by a foreign body.
It is too much to expect of an operation that it should
never present a shady side, and this larger experience
will doubtless bring out. I have heard a case verbally
reported which was followed by iridocyclitis and loss of
the eye, and we know that iridectomy alone is sometimes
followed by loss of the eye. I have stated that, in two
of my operations there was some reaction on the part of
the iris. It follows that the operator must not venture
with a heavy hand, and must confine his friction to the
centre or the cornea, while the moderate experience
already collected indicates that FiJrster's proceeding
merits further trial.
ON THE TREATMENT OF NON-SPECIFIC UL-
CERS OF THE LEG.'
By smith baker, M.D.,
WHITESBORO*, N. Y.
To engage successfully in the treatment of ulcers of
the leg, whether indolent or irritable, requires a most
exact appreciation of the system as well as the local con-
dition.
General or specific debility from any cause, near or
remote interference with the local blood-supply, irritation
of the nerves proceeding to the part, mechanical or chem-
ical irritation of the part itself, are all important factors
in the etiology of cutaneous ulceration, and are just as
important in retarding progress toward recovery.
AV'riters upon this subject generally recognize this
more or less, as a cursory survey of tlie more recent
literature reveals.
Thus, whether it be Christopher Heath's' opium,
arsenic, and potassium iodide treatment : or the skin-
transplanting and grafting plan of Drs. Hamilton" and
Bryant ;' or the subcutaneous resection of the irritable
and irritating nerve, as taught by .Mr. Hilton ;' or the
local application of emollient and nutritive substances, as
suggested and practised by Dr. Cowen ;" or Mr. Holt's'
plan of removing all hypertropliic tissue, elevating the leg,
sealing liermetically, and attending strictly to the general
health ; or that of Dr. Uraithwaite," which consists in apply-
ing lead lotion, plus a small proportion of carbolic acid,
' Kcad before the Oneida County Medical .Society. ' Practitioner, 1869.
^ New Vork Medical Journal, 1871. * British Medical lournal, 1872.
' Rest and P.iin. New York, 1879. • l,ondon'l,ancct, 1872.
" Urailhwaitc's Retrospect, 1873. "British Medical Journal, 1873.
and exposing several hours to the air ; or the exercise,
poultice, chalk and lard treatment of Dr. Spender ;' or
that by Dr. Mandelbaum • by scraping the surface, apply-
ing iodoform, and following with equal parts of mer-
curial and soap plaster ; or the pure-rubber bandage
treatment of Dr. Martin ; or the combination of the
latter with the local application of liquor carbo-detergens,
as carried out by Mr. Hutchinson ; ^ or the use of a satu-
rated solution of potassium chlorate, as advocated by Dr.
Rochester ; there is in each an attempt to apprehend
the etiology as well as the indications for treatment.
Yet many general practitioners seem to fail in this
respect. Thev apparently forget that the application of
caustics when the system is already debilitated, the giving
of tonics when there is every evidence of good health
save the local affection, the effort to secure resolution
by attention to the special locality where the nervous or
circulatory system is at fault, is in each case an endeavor
to accomplish the impossible.
This is suggested by reference to one of my earlier
cases.
C.A.SE I. — A buxom, hardworking widow, aged forty,
mother of five children, and of no particular constitu-
tional taint, received a blow on the inner aspect of the
right leg, which in five weeks after had resulted in an
ulcer 2t1- X 4 ctm., having a dry surface, and so sensitive
as not to allow of tlie application of the softest poultice.
A weak lotion of carbolic and hydrocyanic acids, glycer-
ine, and water, freely applied and covered with oiled silk,
relieved the pain at once, and b}' touching edges with
silver nitrate and painting vicinity with tr. iodine, heal-
ing to the extent of one-half was secured in twenty days,
and nine-tenths in twenty days more. At this point,
however, it resisted all efforts until the fourth month,
when it healed of itself.
Now in this case there were three months required,
three-fourtlis of which time was lost time simply because
bandaging was not adopted and the slight cedema of the
adjacent subcutaneous connective tissue kept down —
thereby relieving the skin tension, and permitting a
reparation of the local nutritive processes. This case
may be contrasted with the following :
Case II. — An unmarried, scrawny woman aged forty,
with catamenia still regular, a hard-working weaver, had,
during most of the time for eighteen years suffered from
an ulcer of the left leg, with a thin edge and irritable sur-
face, and quite as much from the different plans of treat-
ment proposed and carried out by many doctors. Five
applications of galvanism (positive pole to the ulcer)
plus the alternate use of potassium permanganate and
potassium chlorate lotions, and the daily wearing of a
well and snug-fitting elastic stocking soon enabled her to
assume her duties, and secure a healed leg in addition.
The indications to clean and support the part, and to
encourage a better nutrition, were here met as the result
attests.
C.\SE III. — Married woman, aged forty-nine, house-
wife, motiier of several children, who at the age of
fourteen suffered a severe strain and some injury of the
lumbar region, wliich was treated by two years in bed,
sixteen setons, anil innumerable blisters to the back !
Since then she has had a frequently recurring, irritable
ulcer on the right leg, which is always preceded by pain
in, and tenderness over, the lumbar vertebra, and fre-
quently by pain in left ovarian region, with dysmenorrhtea
and profuse leucorrha-a. These ulcers have always de-
fied the efforts of the neigliborliood surgeons, and after
long sieges have healed of themselves. She came to me
with a recently ulcerated surface of 8 ctm. in diameter,
surrounded extensively by eczema, and which had been
preceded as usual by several weeks of backache. The
use of ergot and jiotassium bromide internally, and of a
weak carbolic acid lotion externally, secured resolution
in about three weeks. This case seems to show, as
1 London Laficet, 1873.
' .Mcdii
' Medical Abstract, 1877.
cal Times and Gaictlc, 1878.
August 4, 1883.]
THE MEDICAL RECORD.
121
Charent' says, "there is nothing better established in
pathology than the existence of trophical troubles con-
sequent on lesions of the nervous centres or of the
nerves."
Case IV. — An P^nglishwonian, aged ninety-three, the
last child of a consumptive family, the mother of seven
children — two of whom were delivered with forceps, and
all but one of whom have died of tuberculosis — herself a
lifelong sufferer from neuralgic troubles, also from severe
deafness for fifty years, and from complete prolapsus uteri,
for forty years, had at the age of seventy-six a severe ill-
ness, which was followed by a three years' standing ulcer
of the left leg, which at the end of this time healed sponta-
neously. Five years after she took to crutches (aged
eighty-four), but otherwise enjoying her usual health.
Two years ago she accidentally injured the inner aspect of
the left leg, and got, in due time, under domestic care, as a
result, a large, irritable, indolent ulcer, which resisted all
treatment for weeks, but finally healed under the use of
salicyhc acid in vaseline. Nine months since, however, it
broke out again, and after three months was found to be
3^ X 6i ctm., and so sensitive that a breath of air caused
intense suffering. .\n attempt to use a Afartin bandage
was hopelessly frustrated bv her whimsical repugnance to
its use. A severe prostration from diarrhcca supervened,
and after this for weeks, although a multitude of plans
were faithfully tried, there was no progress toward re-
covery. Finally, by simply alternating a lotion of potas-
sium permanganate with one of potassium chlorate, the
ulcer has, three months since, entirely healed.
In this case the extremely low vitality and interference
of the patient nearly negatived all efforts at treatment.
The result under the circumstances may be considered a
happy one.
.\nd it is equally true that lowered vitality from any
cause may favor the development of any case of non-
specific ulcer of the leg ; while subsequent irritation,
whether from mechanical or chemical sources, may be the
means by which the cutaneous necrobiosis is kept u)).
Hence treatment may be considered as properly con-
sisting ot giving tonics when needed, and especially will
galvanism, phosphorus, and strychnia be found indicated
in a large proportion of cases ; or of allaying nerve-irri-
tation or irritability by exhibiting opium, potassium, bro-
mide, or ergot ; and of attending strictly to hygiene,
which includes specifically cheerful surroundings, exercise,
and good food.
As regards local treatment, there are only two impor-
tant indications, namely, cleanliness and protection.
For what do the various lotions and applications more
than to clean the sore of the discharge that has become
decomposed and consequently irritating, and to prevent
further decomposition from taking place? and what does
the bandaging or strapping more than to protect the sore
from engorged blood-vessels and edematous adjacent
tissue, or from external irritants of all kmds ?
Hence what can be better for local treatment than to
order the surface cleansed thoroughly at bedtime with a
weak solution of potassium permanganate, alio in the
morning with a medium solution of i)Otassium chlorate,
and after having covered it lightly with absorbent cotton,
to have drawn on over all a weU and snug-fittiiii^ elastic
stocking, with instructions to go about the usual labor
using the limb freely but not senselessly ? At any rate,
in nine-tenths of cases this, according to my recent ex-
perience, seems to be all-sufficient; while in the other
one-tenth a few days rest and ])reliminary treatment with
the same lotions and a pure-rubber bandage seems to be
equally necessary.
This plan of treatment is simple, and perhaps not con-
vincing. But I am satisfied that in this plan lies the dis-
posal of the whole class of non-specific ulcers, securing a
minimum of suffering and loss of time to the patient, and
a maximum of credit to the profession.
L.ectures on Diseases of the Nervous System. 1879.
THE TREATMENT OF CHRONIC BRONCHI-
TIS.
I!v T. J. YOUNT, M.D.,
r.AFAVBTTE. INU.
"Winter cough ' has been known for untokl centuries.
Nebuchadnezzar no doubt had this disease, for the phy-
sicians after dosing him with villanons decoctions, nau-
seous infusions, and diabolical extracts, turned him out to
grass. They did not find a single si)ecific or panacea
in all the medical literature of their forefathers for chronic
bronchitis. The chronic bronchitic then, as now, was a
victim to be pitied.
During the winter and spring months he sits in the
house, in a snug corner near a roaring fire, huddling to-
gether his skin and bones lest they get separated and
lost. He sits there in his corner with liis cuspidor handy,
morose, dejected, and irritable to those around him. His
face is pinched and his color yellow, he eats little and
sleeps less, worried and worn out with cough. In the
summer, like the ground-hog, he comes from his hole,
wrapped up in a thick ulster with fur collar, and cap
drawn down over his ears, and his feet encased in large
arctic overshoes. He walks slowly and swears rapidly
at his ill-luck in having such a disease. He likes to tell
how he feels and gives all the blame for his illness to the
weather and his liver.
The chronic bronchitic, like the white corpuscle, is of a
very migratory character, migrating from one physician
to another and travelling t"rom one end of the earth to
the other. It is seldom that you see a patient that has
not been treated by at least half a dozen physicians, and
he rarely tarries long with any one, but seeks new fields
and medicines. In the treatment of this disease we must
support our patient, ease cough and pain, promote di-
gestion and appetite, and render substantial aid during
an acute attack.
Suppose, now, you are called to see a patient during
an acute attack, where there is a swollen condition of
the bronchial mucous membrane, with scanty secretion,
harassing cough, urgent dyspnoea, and great pain. He sits
upright, face livid, pulse weak and rapid, and the respira-
tion shallow and frequent. He begs in Heaven's name
for a moment's relief — for just five minutes' rest and
sleep. You have all seen him.
Relieve this sufferer now and he is your life-long friend
and patron. You must act, and act promptly or all is
lost. You are like the man in Texas, who, when he
wanted a revolver, wanted it awful bad. Just so with
you : you want to help the patient, and you want to help
him very bad. Suppose you give him a dose of mor-
phine, that would surely ease him, but the probabilities
are that it would be permanent, and you could no doubt
next day read his obituary notice. Opiates act first on
the hemispheres, by dulling their sensibility ; this dulling
of sensibility extends to the medulla oblongata, which
becomes paralyzed and your patient dies, simply be-
cause the carbonic acid in the blood fails to irritate this
centre of respiration and have it call on the expiratory
muscles to assist in throwing off this accumulated car-
bonic acid poison. If it is, therefore, not safe to give
opiates or chloral, what will you give ? We must rely on
respiratory stimulants, good ones that will not fail us.
There are three well- known stimulants that are consid-
ered perfectly reliable and potent, viz. : atnmonia,
strychnia, and belladonna. Of the preparations of am-
monia, I prefer the aromatic spirits, or the carbonate.
In very serious cases, twenty drops of the aromatic s|)irits,
or ten grains of the carbonate, with twenty drops Squibb's
compound spirits of ether, given hourly or every half-
hour, affords great relief. If the heart is feeble and
rapid, ten drops tincture digitalis should be added
once in two hours. If they are nervous and want rest,
give bromide of annnonia in one-half or one drachm
doses as often as is needed. Rokitanski first found
that strychnia was a potent respiratory stinuilant. T.
122
THE MEDICAL RECORD.
[August 4, 1883.
Lauder Bmnton, J. Milner Fothergill, and H. C. Wood
have long recognized str)'chnia as a very reliable and
rapid stimulant. Fothergill, in severe cases, gives as
large as one-tenth grain doses of strychnia every four
or five hours, and oftener if necessary. He says des-
perate cases demand desperate remedies. His favorite
prescription for ordinary acute attacks is ;
5. Ammon. carb gr. v-x.
Tr. nucis vom TH, x.
Tr. scillffi 3 ss.
Infus. serpent 3 j.
M. et sig. — Take every three or four hours.
He adds ten minims tincture digitalis to this mixture
if the right ventricle is weak. Belladonna is also a reli-
able stimulant. It is of special value where there is gen-
eral want of tone, giving rise to profuse night- and day-
sweats. You have all given atropia for night-sweats of
phthisis, and you have noticed that the patient, while ben-
efited by the arrest of the sweats, was also greatly ben-
etited in his breathing, breatliing less rapidly, taking
deeper breaths, and less dyspncca in walking about. In
some cases where it is absolutely impossible to get relief
from severe pain in the side by other means than opiates,
give atropia, and morphia combined.
I have often given persons suffering from a mild attack
of chronic bronchitis the muriate of pilocarpine, in one-
tenth to one-twenty fourth grain doses, every hour or two
with great benefit. It has many advantages over ipecac
and squills. It is pleasant to take and does not nauseate.
It is very prompt in loosening the phlegm, distressed
breathing, and annoying cough. It has a decidedly stim-
ulating action on the skin, mucous membranes, heart, and
kidneys. Fothergill's father always taught him "never
to give squills until the skin is moist and the phlegm
loose, and always to give ipecac as long as the skin was
hot and phlegm tough." If such is a safe rule, and Foth-
ergill says it is, then we ought to use pilocarpine in all
acute stages of disease of the bronchial mucous mem-
brane with great advantage. Inhalations and sprays
may often be used with benefit. I have derived the
most benefit in my own case from sprays of benzoate of
soda, ten to twenty grains to one ounce, followed by pro-
longed sprays of compound tincture of iodine, ten to thirty
or forty drops to one ounce. These used in this manner
three times a week generally result in a decided arrest
of the profuse secretions and start up a healthy action.
Sprays of nitrate of silver, carbolic acid, tannic acid,
potassiB chlorate, and zinc sulphate can be used, either in
sprays or inhalations, with benefit where the secretion is
too profuse. The application of irritating liniments and
solutions often scatter and relieve pains like magic. Mv
favorite application is :
IJ . Tr. iodini = ss.
-rEtheris sulphurici 3 ij.
01. tiglii 3 ij.
M. et sig. — Apply as directed.
Where the patient is suffering from an acute pain in
the side and is feverish and nervous the application of
an ointment composed of acidi salicylici, 3 ij. ; morphia
sulph., gr. j. ; acid, oleici, 3 j. ; adeps, 3 ss. should
be made. — Applied three or four times a day or oftener,
until relief is aftorded. By this application you avoid
giving opium by the stomach, wliich as a rule destroys the
appetite, impairs digestion, and renders the liver inactive
by arresting the normal secretions and perverting their
healthy action. In cases of chronic bronciiitis, where the
secretions are scanty and dry, full doses of iodide of am-
monia, say of twenty grains, three times a day. By com-
bining the iodide of ammonia with copaiba, cubebs,
eucalyptol, or arsenic you ])roduce a decided effect upon
the secretions, often arresting them and having a decided
curative action. The liver should also be looked after
in tiiis climate, and its action should be assisted by an
occasional dose of calomel, podophyllin, or elixir wahoo.
Quinia in tonic doses, taken for weeks, is of decided
benefit. Fellows' compound syrup of hypophosphites,
containing, as it does, quinia, with potent nerve-tonics, is
a valuable preparation.
Gardnei-'s syruji of hydriodic acid, a non-irritant
preparation, containing it is claimed, ninety-nine per
cent, of iodine, has a decided curative effect on this dis-
ease. I have used it on myself and many patients, and
have experienced almost immediate benefit by the arrest
of the profuse secretions and cough. The only objection
to it is the strong and pronounced metallic taste which
invariably follows its prolonged administration, causing
loss of appetite and consequent debility.
It should be given in teaspoonful doses three times a
day at the commencement, and gradually increased to
two or three teaspoonfuls three times a day well diluted
in Burgundy wine, porter, or water. In my own case
I have had the most prompt and decided benefit from
Declat's syrup of nascent phenic acid. It is pleasant to
take, and its action has in my hands been very pro-
nounced. It should be given in larger doses than the
directions on the bottle. I experienced no benefit
until I had taken six drachms three or four times a day.
Under the six-drachm doses in one ounce of whiskey or a
wineglassful of HofTs malt, my light, harassing cough was
relieved, the exhausting night-sweats ceased, the appetite
improved, and sleep was rendered natural. In fact,
under ten days" administration of the acid, more rapid
and permanent improvement was made than ever before
in any previous attacks. Its administration in such large
doses should not be persisted in longer than two weeks
at a time : then it should be suspended a week or ten
days, and commenced and kept up as before, gradually
lessening the dose as the disease disappears. I have
often prescribed this syrup in obstinate coughs where
relief was not obtained by the ordinary remedies, and
have had good results.
To obtain good results you must give the syrup of the
nascent phenic acid, and you must give it unsparingly.
You will get no appreciable results from half a table-
spoonful, and may be compelled to give it in two table-
spoonful doses. In cases where there is great debility
and no appetite, great advantage may be obtained from
taking frequent egg-nogs or milk punches. These may
often be preceded by a wineglassful of HofFs fluid malt,
etc. When there is great despondency and nervous
prostration, decisive advantage may be had from ext.
cannabis ind., gr. ^-j.; ext. hyoscyam., gr. ij.;
quinia sulph., gr. ij.; taken three or four times a day.
The sleeping-room and bed should be warm on arising
and retiring, for the reason that the chill from getting
into a cold bed and getting up in a cold room gives rise
to severe and prolonged coughing. It is also a good
idea to take a good alcoholic night-cap before retiring,
as it tends to produce sleep and quietude. Patients
with chronic bronchitis should not take alcoholics before
going out into tiie cold air, lor the reason that alcohol
dilates thie capillaries in the skin and makes the patient
more liable to take cold. If he wants a drink let him
take it after he comes into the house. He should wear
flannel underclothes the year round, and during the cold
and changeable weather should wear a chest-protector.
It is advisable that the patient should take a trip to
some equable and mild climate, such as San Antonio,
Los .Angeles, .Aiken, S. C, or Xew Mexico, during the
cold spring and winter months. New Mexico is to be
preferred above all as the sanitarium of the world tor
lung and bronchial disorders. Let he who doubts this
statement go and see for himself, and he will return a
healthier and better man.
The Creator in his all-wise and all-powerful mind saw
that sufferers from chronic bronchitis needed a special
habitat, he therefore gave unto the world and the suf-
ferer the United States, because it had New Mexico in
it, that one State created for no other purpose than in-
valids.
August 4, 1883.]
THE MEDICAL RECORD.
123
^i-jogvcss of |]E(XMical ^cijruc^.
Facet's Disease of the Nipple. — Dr. Duhring re-
ports in the July number of tlie American Journal of the
Medical Sciences two cases of I'aget's disease of tlie
nipple, which he holds is not an eczema, but a peculiar
disease with a malignant tendency. It must be distin-
guished from eczema, which it resembles, and from ordi-
nary cancer, which it is altogether unlike in its earlier
stages. It seems to occupy a ground having the charac-
ters of both diseases. The report is interesting as show-
ing the natural history of the affection. This is peculiar.
The course of the process is emphatically chronic. In
both instances, moreover, the progress of the disease was
insidious as well as slow. Nothing of a malignant nature
was suspected until after the lapse of five and ten years
respectively. The itching, which eventually became such
a marked symptom, was in both cases insignificant until
the affection had existed several years. It may be said
not to have manifested itself until after the process had
been well established. In this respect the disease dif-
fers decidedly from eczema, where itching is one of the
first signs noted. The circumscribed, sharply defined
outline of the lesion, and the slightly elevated border,
are also symptoms which do not obtain in eczema. The
brilliant color of the lesion is striking, and is moie
marked than in eczema. The absence of the " eczema-
tous surface," characterized by appreciable discharge or
by vesicles, pustules, or puncta, coming and going from
time to time, and tKe absence of exacerbations, so usual
in eczema, may also be referred to. A point to which
attention may also be directed is the infiltration, which
is firm or even hard, but is not deep-seated. It is rather
superficial. In eczema, un the other hand, it is soft.
The pains coming on later in the course of the disease,
and the indurated, lumpy, or knotted lesions within the
gland structure, of course point strongly to the malig-
nant or cancerous nature of the disease, the existence of
which cannot be doubted.
Chauffage of the Genital Organs in Venereal
Disease. — Following in the line of Chauveau's experi-
ments in weakening virus by heat. Dr. Aubert suggests
that the virus deposited upon the skin or in the tissues
may be modified by raising the temperature of the part
to 108° or 109°. He remarks u])on the cure of parony-
chia sometimes obtained by immersing the finger in hot
water, and suggests that we might avert by this means
the consequences of snake-bite, dissection wounds, or a
suspicious coitus. M. Aubert has made a few experi-
ments in this direction with chancroidal pus. He ex-
posed a part of this pus for twelve hours to a tempera-
ture of about 109°, while the rest was preserved at the
ordinary temperature. Inoculations with the warmed
pus were without result, but a chancroid followed the in-
troduction of the other. He therefore concluded that
chauffage destroyed, or at least rendered innocuous the
chancroidal virus. The author has as yet made no ex-
periments with the virus of syphilis or gonorrhcea. He
suggests that the high temperature is the explanation of
the subsidence of syphilitic manifestations during the
course of typhoid fever or other febrile disease. He
further asks if the fact that chancroid is not developed in
the interior of the body and never passes beyond the su-
perficial lymphatic glands, may not be explained by the
destruction of the virus by the heat of the deeper tissues.
—Journal de Medecine de Paris, June 2, 1883.
Hydatid Cvst in the Biceps Muscle. — The follow-
ing case, only three similar ones having been previously
recorded, is reported by Dr. Picque {Journal de Mede-
cine de Pans, May 26, 1883) : -'^ vvoman had noticed a
tumor on the anterior part of her left arm for about ten
years, but it was of small size and never occasioned any
pain or inconvenience. Suddenly, about two months be-
fore the patient came under observation, the tumor be-
gan to grow rapidly until it had attained the size of a
child's head. It was elastic, fluctuating, of regular con-
tour, movable upon the subjacent tissues, and not adher-
ent to the integument. The humerus was unaffected,
the radial pulse was normal, and sensibility was but lit-
tle changed. There was no pulsation in the tumor, nor
any other sign of aneurism. The axillary glands were
not enlarged. The diagnosis lay between a cold abscess,
a hjematonia, or a hydatid cyst. Upon puncture of the
tumor a quantity of pus was evacuated in which were
found the characteristic hooks. The treatment con-
sisted in a free incision, followed by scraping the walls
of the cyst with a sharp spoon, and was successful in its
results.
Periodicity of Certain Symptoms in Hepatic Dis-
ease.— Dr. J. C)'r (Journal de Medecine de Paris, June
2, 1883) says that although various writers have re-
marked upon the periodicity of some particular important
symptom (pain, jaundice, vomiting, etc.), in disease of
the liver, the observations have been isolated and so few
as to attract little notice. He has collected upward of
forty cases, occurring in his own practice, in which some
symptom, usually pain, [(resented a more or less marked
intei'mittency ; often the same symptom returned with
most striking regularity. This periodicity was peculiar,
in that it was in most cases uninfluenced by quinine, but
disappeared under treatment directed to the hepatic dis-
order. From these observations he draws the conclusion
that the periodical element in hepatic symptoms has a
greater importance than has hitherto been attached to
it. And he states that often in doubtful cases, as has oc-
curred in his own experience, the determination of the
fact of intermission in one or more of the symptoms may
be of great value as an aid to diagnosis.
Contusions of the Brain and Spinal Cord. — The
late lamented Dr. John A. Lidell, in an elaborate paper
on this subject in the American Journal of the Medical
Sciences, July, 1883, discusses the clinical history, diag-
nosis, prognosis, and treatment of this large and very
important class of injuries. While much is said in our
text-books on the subject of cerebral concussion — of its
dangers and of its importance — but small if any mention
is made of the contusions of the brain which so very
often complicate the concussions, and impart to them
whatever of gravity, be it much or little, that they may
chance to possess. And still less mention is made of
the contusions of the spinal cord. No wonder, then,
that bruises of the brain-structure and of the spinal-cord
substance occur much more frequently than is generally
supposed, that the relationship which exists between
these injuries and concussions is not well understood,
and that the bruises of these organs often escape even
all suspicion during life. That slight or even moderate
concussions of the brain sometimes, perhaps not unfre-
quently, occur witliout being complicated with contu-
sions of the brain, the author does not doubt. Contusion
of the brain is, therefore, he believes, not synonymous
with concussion of the brain ; but, at the same time, all
the evidence now collected tends to prove that the se-
vere instances of cerebral concussion are always compli-
cated with cerebral contusion. Concussion of the brain,
however, derives its chief importance from the fact that
It is very often associated with contusion of the brain ;
and, in examining a case of cerebral concussion, the
question of most importance for the surgeon to decide is
whether or not cerebral contusion is also present. These
are points of doctrine which practically have much in-
terest for patients as well as practitioners, because of
the influence they are likely to exert in the direction of
procuring a correct diagnosis, and, consequently, a wise
treatment For in the disorders of no other parts of
the body is it more true that an accurate diagnosis begets
a wise plan of treatment than in tliose of the brain and
spinal cord.
124
THE MEDICAL RECORD.
[August 4, 1 88;
Chancre of the Tonsil. — The following case is re-
ported by Dr. Hue in La France Mcdicale of May 31,
1883. A man, thirty-seven years of age, of unusually
good health, had complained for about six weeks before
admission to hospital of slight jmin upon the right side
of the throat in swallowing. This pain gradually in-
creased in intensity, and at the same time a swelling ap-
peared in the right submaxillary region. He did not
trouble himself much about it, but continued to work as
usual ; soon, however, he began to have poor nights, he
was troubled with headache, had fever, a general feeling
of malaise, and sometimes slight \'ertigo. Upon tlie right
tonsil was seen an ulcer about the size of a ten-cent i)ifce,
with sharp-cut edges, marked by a red border with a yel-
lowish-gray centre of iiregular surface, emitting asanious
discharge. The tonsil was enlarged, and indurated about
the base of the ulcer. There was a characteristic agglom-
eration of the maxillary glands upon this side, of about
the size of a pigeon's egg, but varying according to the
conditions of repose and external warmth. The cephal-
algia was more violent during the night than during the
day, and occupied only the right side of the head. The
diagnosis wavered for a time between epithelioma and
chancre, but was finally settled upon the latter. Aiipro-
priate treatment was pursued with some benefit, but
without success in preventing the appearance of second-
ary symptoms.
Sudden Death at the Beginning of ChlokoforiM
Inhalation. — Dr. Janovitsch Tschainsky relates in Mcd-
izmski IVestnik, Nos. 12 and 13, 1883, the case of a
peasant, twenty-eight years of age, upon whom he was
about to operate for the removal of a lupoid growth
from the under lip. Hardly had the patient taken two
whiffs of chloroform when respiration ceased and he was
dead. The necropsy revealed fatty degeneration of the
wall of the right ventricle, while that of the left appeared
to be normal. The reporter attributed the death to
psychic causes, the dread of the opeiation. He relates
several similar cases, among which was that of Cazenave.
In this case the surgeon desired to operate upon a very
nervous patient without chloroform, and in order to de-
ceive him held a bag of jnire air before his mouth ; he
breathed four times and died. Desault, being about to
cut for stone, drew his finger-nail across the perineum to
indicate the line of incision. The patient in his alarm
gave a shriek and died.
The Feeble Influence of Iodine over Malarial
Fevers. — There have recently appeared numerous re-
ports from medical men in various parts of the world,
reciting the virtues ot iodine in the treatment of malarial
fevers. It is t.ue that these do not all agree as to the
exact degree of reliance that may be placed on this
agent as an antiperiodic. There are, however, those who
claim for it an efficacy not less than that of Peruvian
bark, as far as the immediate control of the attack is
concerned, and even greater than bark in preventing
its recurrence. It must be confessed, however, that the
results reported by various observers do not entirelv
agree. Here we find an assertion that in chronic mala-
rial poisoning iodine does its work most effectually ;
there, that its value is nil ; in another ai tide we find that
it is recommended to render [jermanent the cure that
(juinine has begun ; in still another, that it is given in
combination with quinine, arsenic, etc. On the other
iiand, we find that by some, antiperiodic i>roperties are
denied to iodine. Attracted by the testimony in its fa-
vor, antl with the desire to definitely ascertain the (low-
ers of iodine as an anti-malarial remedy, in view of the
ease of its administration and of its comparatively small
commercial value, Drs. I. E. Atkinson and Hiram Woods
availed themselves of the opportunity of treating malarial
fevers afforded at Bayview Asylum, Baltimore, during the
late summer and autumn of the past year (1882), and
they record-the results in the July number of the Ameri-
can Journal of the Medical Sciences. Their ex|)eri-
ence leads them to draw the following deductions
as to the use of iodine in acute malarial poisoning :
I. In intermittent fever it has some feeble influence in
controlling the paroxysms. 2. It takes usually from three
to eight days to exercise this influence. 3. In cures ef-
fected there is great danger of a relapse ; certainly as
great as with Peruvian bark. 4. It is certain to add to
any existing diarrhoea or nausea, and is liable to cause
each if they do not already exist. 5. In remittents, its
effect, if any, is seen in a slow and gradual reduction of
temperature, and this reduction is liable to sudden inter-
ruptions. 6. In both forms of malarial fever it is infin-
itely inferior to either cinchonidia or quinine ; certainly
as regards the innnediate control of the fever, and as far
as we are able to judge, as regards relapses also. 7.
From an economic point of view, the slowness and un-
certainty of its action makes its use in hospital practice
fully as expensive as Peruvian bark. 8. There seems to
be ground to believe that it can cause albumiriuria. 9.
In the large majority of cases of ordinary acute malarial
poisoning it has no influence whatever.
Congenital Cardiac Cyanosis. — The following case
was reported to the Societe Anatomique de Paris by Dr.
Toupet (Le Progrc's Medical, June y, 1883). The pa-
tient, seven years of age, had been the subject since
birth of cyanosis. The face and extremities were blue,
the eyes jirominent, and the nails enormously hypertro-
phied. The temperature was 96.5", the respiration
rapid and labored. Tlie heart was greatly enlarged, and
a loud blowing murmur with the first sound was audible
at the level of the third costal cartilage near the left
border of the sternum. During the four years that it
remained under observation the child passed safely
through measles and whooping-cough, but finally died in
an attack of pulmonary congestion. Upon opening the
chest the heart appeared to lie nearly in the median line,
owing to the greater size, of the right ventricle. The
right auricle was ot normal size and well formed, while
the left was merely rudimentary. The aorta was greatly
dilated up to the origin of the left subclavian artery,
where it resumed its normal dimensions. The pulmon-
ary artery was seen alongside of the aorta and only
about one-fourth of its size. The walls of the right
ventricle were very thick, the tricuspid valve seemed
healthy. The infundibulum was separated from the
right ventricular cavity by a sort of partition pierced by
an opening the size of a small goose-quill. The mitral
valve was normal. The interventricular septum pre-
sented a solution of continuity at its upper part large
enough to admit of the introduction of a finger. The
aorta arose exactly at the septum, opening into both ven-
tricles. The valves in the inter-auricular septum closing
the canal of Botal were not adherent, and were pierced
also by two openings the size of a crow-quill. The
lungs were congested but presoited no trace of tubercles.
Enlargement of the Bronchial Glands .\s a
Cause of Irritation of the Pneumogastric Nerve.
— Dr. Edward T. Bruen, in the July number of the
American Journal of the Medical Sciences, discusses the
effects of enlargement of the bronchial glands in produ-
cing reflex irritation of the pneumogastric nerve. The
difliculty in the diagnosis of sucli cases consists in sepa-
rating them from cases of early phthisis. One must rely
mainly on the absence of the combination of physical
signs required to render the presence of incipient jihthisis
certain. These are impaired percussion resonance, some
form of bronchial breathing, possibly fine moist rales
and increased vocal resonance. The last two physical
signs are not present in cases of bronchial enlargement.
Pain in the back and disturbance of the respiratory
rhythm are not often present in phthisis. Hysteria,
uterine, or spinal disorder ma)- be eliminated by careful
examination. J'inally, the beneficial results of treatment
may be appealed to to sustain the theory of tlie etiology
of the cases.
August 4, 1883.]
THE MEDICAL RECORD.
125
I-ESIONS OF Periphkrai. Nerve-Trunks. — In the
July number of the Ameruan Journal of the Medical
Sciences, Dr. Weir Mitchell publishes an interesting pa-
per on nerve-lesions, illustrated by five recent cases,
which he has very carefully noted and studied. Nothing
which we know as yet explains all the clinical phe-
nomena of these interesting cases, and, in all probability,
some of the variations in the symptoms observed are to
be attributed to dirt'erences in the character of the dis-
order affecting tlie nerve-trunks, or even to the nature of
the causes originating the active pathological condition.
In one of the cases, among the various points of inter-
est none exceeds in value the abrupt extension of the
areas of lessened sensation which was seen after section of
the median and radial nerves. This was not to be ac-
counted for upon any knowledge which we now have of
the peripheral distribution of nerves, since in one case the
dysMslhesia spread tar beyond the region tributary to the
nerve stretched or cut; and, in the other, in some direc-
tions did not cover the whole regions usually affected
after radial nerve-sections. Generally speaking, the
symptom is to be considered as one of the many forms of
shock. A sudden injury to a nerve already morbidly al-
tered gives rise to an inhibition of function in certain
closely related centres. The disturbance might be in
the direction of motor or of sensory inhibition, and both
forms are among the rarer phenomena of nerve-wounds
from ririe-balls. The fact itseilf is less surprising than its
permanence, nor is it easy to comprehend the precise
nature of an influence which may act on such varied
functions, and act so persistently. In a case of section
of the infra-orbital nerve for facial neuralgia, the remark-
able feature was the fall of temperature, a symptom ex-
ceptionally rare in any form of neuritis, whether of in-
ternal or traumatic origin.
Eaki.y Cerebral Symptoms ok Tuiserculosis in the
AduI-T. — Dr. Daremburg relates at some length in die
Archives Generates de Mcdecine for June, 1S83, the liis-
tories of four cases of tuberculosis in which the actual
onset of the disease was preceded for several years by a
very noticeable change in disposition. The patients,
who were of a lively and amiable disposition, attentive
to their friends and families, and interested in all that
was going on about them, became morose and sullen,
neglected their business and displayed an unwonted irri-
tability and peevishness. No cause could be discovered
to account for this change of character. In the course
of a few years the symptoms of tuberculosis manifested
themselves, and the patients eventually all died of tuber-
cular brain affections. From a study of these cases the
author concludes : That when in an adult there is ob-
served a marked change in character, consisting espe-
cially in a general apathy and a notable indisposition for
study or work, for which no cause can be determined,
there is reason to suspect the possibility in the future
of the development of tuberculosis. The prognosis is
yet more grave if there be an hereditary predisposition
to this disease. And further, when once the existence
of tuberculosis becomes established a fatal termination
from tubercular meningitis may be looked for.
Passage of a Lumijricoid Worm through the
Ear. — Dr. Paul Dagand writes to the Journal de Mede-
cine et de Chirurgie Pratique for June, 18S3, concerning
an epidemic of measles occurring during the first quarter
of the present year. In every case he observed a pecu-
liar complication in the presence of a large number of
lumbricoids, which were discharged from both the mouth
and the rectum, sometimes to the number of fifty or
more. He was called in haste, one day, to see a child
suffering from measles and secondary pneumonia, from
whose ear the father said a worm was coming. The
child had complained for two day of violent earache,
and Dr. Dagand, upon his arrival, discovered a piece of
a worm, about a line in diameter, in the external audi-
tory canal. A piece about two inches in length had
already been torn away, and the attempt to remove the
rest was successful. The entire length of the lunibricoid
was about five inches. The worm had a[)parently passed
up through the Paistachian tube and perforated the
drum. ■ There was an otorrhcea for some days, which
gradually disappeared. When seen two weeks later the
child was well with but slight impairment of liearing.
Rheumatismai- Conjunctivitis. — Dr. Maurice Per-
rin, in a previous conununication to the /Vcademy of
Medicine of Paris, related a number of facts tending to
prove the existence of a form of conjunctivitis due to
rheumatism. This resembles, especially in the rapidity
of its development and the gravity of its symptoms,
gonorrhceal ophthalmia. He has now collected {Journal
de Alidecine et de Chirurgie Pratique, June, 1883) a
number of cases of different observers, which would seem
to establish without doubt the existence of this variety
of conjunctivitis, in which the integrity of the cornea is
seriously endangered in spite of the most skilful treat-
ment. This aft'ection is sure to be confounded with
gonorrhceal ophthalmia whenever there is any urethral
discharge, even though the latter is not specific. The
rheumatismai conjunctivitis is not always purulent, and
may, in a less degree and without changing its nature,
affect the form of simple catarrhal conjunctivitis. To
the treatment by nitrate of silver in mitigated stick or
in solution, it is well to add frequent lotions or spraying
of the eye with alcohol and water of the strength of one
part to four.
Experimental Keratitis anu Stricker's Theory
of Inflammation. — Dr. J. L. Minor, of New York, in
a brief paper in the July issue of the American Journal
of the Aledical Sciences, claims the establishment of the
immigration theory ; because the pus cells are similar in
appearance to the white blood-corpuscles ; they can be
traced from the corneal periphery to the point of irrita-
tion ; and having also gained access to the corneal tissue
through the eschar, they are most abundant immediately
around this centre, where we can still recognize dead,
but intact, corneal corpuscles. The corneal corpuscles
show signs of proliferation some time after the cell im-
migration has set in. And this proliferation gives rise,
not to pus-cells, but to new corneal corpuscles, and they
are strictly limited to the zone surrounding the dead
corneal corpuscles ; whereas leucocytes, or pus-cells, in
abundance, can be found in various parts of the cornea,
at a distance from this point.
Alimentation of Infants affected with Thrush.
— When new-born children, affected with thrush, refuse
to take the breast or the bottle. Dr. Wiederhofer {Jour-
nal de Mcdecine de Bordeaux, June 10, 1S83) advises
the pouring of milk by means of a funnel through the
nasal fossie. This mode of alimentation is not difficult.
When the milk enters the pharynx it provokes reflex
movements of deglutition and is propelled into the
stomach. The author has been enabled by this means
to nourish infants for three and four weeks in succession.
The same procedure is useful in children born before
term, in whom there are no spontaneous movements of
deglutition.
Salt Water Excursions in the Treatment of
Asthma. — Professor Miinter, upon the strength of his
personal experience, recommends a daily excursion of
three or four hours' duration upon the water as affording
a remedy of the greatest value in certain cases of asthma.
He regards it as very useful also in ana;mia, and remarks
upon the longevity and excellent health of seafaring
people as confirmatory of his experience. — St. Peters-
burger Med. IVochensc/ir., June g, 18S3.
A Daily Edition of the Peoria Medical Monthty was
published by its enterprising editor during the session of
the Illinois State Medical Society.
126
THE MEDICAL RECORD.
[August 4, 1883.
The Medical Record
A Weekly yoiirnal of Medicine and Surgery.
GEORGE F. SHRADY, A.M., M.D., Editor.
Published by
WM. WOOD & Co., Nos. 56 and 58 Lafayette Place.
New York, August 4, 1883.
THE MEETING OF THE
15KITISH MEDICAL ASSOCIATION AND OUR
CABLED REPORT.
In the present issue we have the pleasure of presenting
by cable despatch the report of the meeting of the Brit-
ish Medical Association, held in Liverpool, England,
during the past week. In connection with this report
we are also enabled to publish in full the admirable ad-
dress on surgery, delivered before the Association on
Wednesday, by Mr. Reginald Harrison, of Liverpool.
\Ve take a special pride in so doing, as we are thus en-
abled to bring within the reach of our readers, in the
shortest possible time, the doings of an Association in
which the American profession is very much interested.
To such as read the report, and the able address
to which reference has already been made, we believe
it will be quite apparent that the end justifies the
means. At least, our readers are enabled to secure
very much in advance of the arrival of the English
journals the publication of the proceedings of this
model Medical Association, and learn with the least
possible delay what business it transacted during the
past few days.
It may not be unpardonable, in connection with
the cabled report itself, to allude with satisfaction to
some of the possibilities of medical journalism in this
country. We have demonstrated, we believe, the fact
that a scientific medical meeting in Great Britain can be
accurately reported and published in New York within
a few hours after the final adjournment has been an-
nounced. This too, we are assured, is the first time
in the annals of telegraphy that the report of a medi-
cal meeting has been cabled. But ordinary telegraph-
ing of medical meetings is now so common, and even
daily editions of medical journals so frctjuent, that we
have a becoming i)ride in believing that our readers are
prepared for any novelty which may combine enterprise
with utility.
As will be seen, the meeting was largely attended and
considerable interest was manifested in its proceedings.
Tiie addresses before the general sessions, as well as
those before the sections, were duly appreciated as cred-
itable productions. Mr. Harrison's address speaks for
itself. The address of Dr. Creighton on Pathology, as a
candid exposition of the present status of a s[)ecial depart-
ment of our science, was fully representative as to learn-
ing of author and scope of subject. But we shall have
an opportunity of presenting this address in full in a future
issue.
Of course many topics, having more or less reference
to the government of the Association, were discussed in
the meetings of the Council and general session, but
those having reference to state medicine and profes-
sional relations will be of more or less interest to the
medical men on this side of the Atlantic. Ethical ques-
tions bother our English cousins as they do ourselves.
The same problems regarding proper ethical associations
present themselves there as here, and the same indefinite-
ness of conclusion and hesitancy of positive and decided
action manifest themselves. But these questions always
gain in importance by discussion, and the general medi-
cal mind is gradually becoming prepared for the adoption
of broad, liberal, and consistent principles.
The reports of the Sections, which will be presented in
full to our readers in due time, will show how nmch ot
useful work was done during the afternoon sessions, not
only in the number and value of papers presented, but in
the earnest and instructive discussions which they called
forth. The importance of some of these is foreshadowed
in our cable despatches. How different indeed from
similar exhibits in the sections of the .American Medical
Association.
The Meeting of the British Medical Association, to
use the words of our correspondent, " was admitted to
be one of the most successful yet held. " This could
hardly have been otherwise, considering the extensive
preparations made to that end, the admirable organiza-
tion of the Association, and its extensive working capa-
bilities. It is safe to say that no medical or scientific
body equals it in these respects. There are peculiar
facilities offered to such an end which do not exist
elsewhere than in Great Britain. Take, for instance, the
American Medical Association as the corresponding
medical organization in this country. By comparison
with that in Great Britain it suffers in every way. In the
latter country the profession is compactly associated in a
comparatively limited area. Its main interest centres in
London. There are its leading medical journals and its
leading medical influences. This medical centre is
within easy range of every part of the kingdom. The at-
tendance of the best men can always be secured without
much sacrifice of indiviilual time, and with comparatively
small personal inconvenience. In this country the Na-
tional .Association has a membership necessarily widely
scattered, has, so to speak, an ever-changing and float-
ing constituency, and there is little, if any, stability to
its organization. But this is more by way of hoping for
what may be than what is.
Socially our English brethren, on occasions like tlie
present, generally manage to make the most of surround-
ings. There is one feature in their entertainments, they
are not pecuniarily burdensome to the local organiza-
tions, as extra expenses are divided among individual
members. This is also a matter worthy of more ex-
tended imitation among those of our medical brethren so
criven to entertain and to be entertained. There does
not seem to be any lack of enjoyment on these oc-
casions, nor of suinptuousness in the character of the
banquets, due to the fact that each individual is willing
to discharge his own indebtedness. The gathering at
August 4, 1883. J
THE MEDICAL RECORD.
127
the soir6e on Wednesday evening was unusually large,
numbering fully three thousand guests, and including
a large proportion of ladies.
It is gratifying to note the national interciiango of
courtesies at the annual banquet on Thursday evening.
The honored president of the American Medical Asso-
ciation, Dr. Flint, worthily represented his countrymen
in his admirable toast to the British Medical Associa-
tion, while Mr. Ernest Hart paid, in eloquent terms, a
fitting tribute to the distinguished guests who graced the
occasion. Nothing could be in better keeping with the
spirit of fraternal professional feeling existing between
the two countries, nor better represent the cordial recip-
rocity of good will and generous emulation in the higher
professional pursuits. Each year the opposite shores are
being brought nearer together, and even now we feel
pulse-throbs along the wire.
CONTAGION AND QUARANTINE.
The situation in regard to the yellow fever is considered
quite satisfactory, notwithstanding the fact that the dis-
ease is " knocking at the door " of many of the Northern
as well as Southern ports. The action taken by the
New Orleans authorities in requesting the Governor to
order all infected vessels out of the Mississippi River,
and to allow no more such vessels to enter its mouth or
come up to the quarantine station, is regarded as one ol
the most important events that has occurred in connec-
tion with the efforts of the Government in preventing the
yellow fever's introduction into that port. Governor
McEnery at once telegraphed to the Surgeon-Cieneral of
the Marine Hospital Service to ascertain whether vessels
turned out of the Mississippi quarantine would be re-
ceived at the Ship Island Refuge Station, and was
promptly informed that all infected vessels would be re-
ceived there. This action at once obviates all necessity
for the continuance of the inspection service of the
"Sanitary Council of the Mississippi Valley" at Mem-
phis, Vicksburg, etc., which has created some dissatis-
faction amongst steamboat lines assessed by the " Sani-
tary Council" to keep up the inspection.
Medical officers have been stationed at London and
Liverpool, England, for the purpose of informing the
Government as to the condition of said ports, anti to
make sanitary inspections of all vessels sailing to United
States ports, notifying the Government by cable when-
ever an infected or suspicious vessel departs for the
United States. Dr. Robert Mainegra, of New Orleans,
has been appointed Sanitary inspector for the port of
Vera Cruz, Me.\ico, and is now on his way to that place
to perform similar duty. Pending his arrival, the consul
at Vera Cruz has been requested to cable the departure
of all vessels from that port. Dr. Burgess has been on
duty at Havana as Sanitary Inspector since July ist.
The consuls at other ports where infectious diseases pre-
vail, as well as those mentioned above, have been di-
rected by the Secretary of State, at the request of the
Secretary of the Treasury, to inform all out-going ships
to ])ut in at Ship Island, or Sapelo Refuge Station, be-
fore proceeding to their port of destination, for the
purpose of being inspected, thereby saving detention, as
they will be ordered there by the municipal authorities
if they attempt to enter any Southern jiort.
The Secretary of the Treasury decided a few days ago
that the quarantine law of April 29, 1878, is again in
force, the law repealing it having been a temporary law,
which expired by limitation on June 2d last. This de-
cision is of the utmost importance, as it relieves the ap-
prehension that has been felt regarding the powers of
the Government in controlling ([uarantine. The law as
it now stands, with the power given at the last session of
Congress " to maintain (juarantine [stations] at points
of danger,"'gives us the best and most powerful quaran-
tine law we have ever had. Acting under this decision,
the Secretary directed the Collector of Customs at Boston
to enforce the law and regulations against the British
steamer Bavarian with a cargo of Egyptian rags, which
was expected to arrive at that port. The regulations re-
ferred to are as follows :
" Until further orders, no vessel from any port of the
Black Sea, or the Sea of -Azof, conveying any rags, furs,
skins, hair, feathers, boxed or baled clothing or bedding,
or any similar articles liable to convey infection, nor any
vessel from any port of the Mediterranean or Red Seas
having on board such articles coming from Southern
Russia, shall enter any port of the United States until
such articles shall have been removed from the vessel to
open lighters, or to some isolated locality, and the^vessel
disinfected and thoroughly ventilated ; and the suspected
articles shall be disinfected, either by chemical agents
and exposure to free currents of air, or by burning, as
shall be determined in each case by the Surgeon-General
of the Marine Hospital service.
" The certificate of the State or municipal quarantine
officer of health may be accepted as satisfactory evidence
of compliance with these regulations on the part of the
vessel."
A sanitary conference was held at h'ortress Monroe
on July 28th, to consider the question of establishing a
national quarantine station near the Capes ; there were
present Surgeon-General Hamilton, U. S. Marine Hos-
pital Service ; Dr. Smith Townsend, President of the
Washington Board of Health ; Dr. George H. Benson,
Health Connnissioner of Baltimore; Dr. J. G. Cabell,
President of the Board of Health of Richmond ; the
Health Officer of Norfolk and Newport News ; Hon.
H. Libby, Member of Congress; Colonel Loder, Com-
mander Fort Monroe ; Captain Evans, U.S.N. Light-
house Inspector; General Grover, Member Norfolk
City Council ; the Mayors of Newport News, Portsmouth,
and Norfolk, and many other prominent men of the
various towns in the vicinity. After a full discussion of
the subject it was decided to establish a National Quar-
antine Station at Fisherman's Island, some twenty miles
from Norfolk, near Cape Charles ; and pilots were in-
structed to take all vessels from foreign ports there for
inspection. By the establishment of this station all
cities on the Chesapeake are protected from the ap-
proach of infected vessels. Heretofore Baltimore has
permitted such vessels to come up to her quarantine
station and take care of them there, but the fear of panic
has decided the Health Commissioner to join in urging
a national quarantine station between the Capes where
all infected vessels can be cared for without endanger
128
THE MEDICAL RECORD.
[August 4, 1883.
ing Baltimore. The Revenue vessels and hospital
steamer John M. Woodworth will also be on guard at
the Capes to prevent vessels passing up the bay until in-
spected.
A NEW THEORY OF THE NATURE OF BRIGHT'S DIS-
EASE.
Professor Se.mnol.a, of Naples, has for some years been
studying the subject of Bright's disease with the view of
demonstrating the humoralistic origin of the disease. At
the International Congress in London, two years ago,
he propounded the view that nephritis is corisecutive to
an albuminous dyscrasia — a view which Gubler had al-
ready suggested before him. Semnola's theory was re-
ceived with respect, but gained no adherents. Recently
this industrious student came all the way to Paris and
laid before the Academie de Medecine the results of his
further investigations. In brief, he has injected or trans-
fused into the blood of various animals different kinds of
albumen, and he tinds that the effect is first to produce
albuminuria, then nephritis, the results varying witii tlie
kind of albumen. He also states tliat in Bright's disease
there is a general transudation of albumen, this substance
being found in the bile (where it does not exist in health),
in saliva, and various other secretions and fluids. The
cause of renal albuminuria, therefore, is to be looked for
in thq, blood. Here the normal serum-albumen, which
does not easily transude, becomes changed and passes
into the urine. In so doing it sets up the different in-
flammatory and degenerative processes which character-
ize the kidneys in Bright's disease. Professor Senmola
found in his experiments that the form of albumen which
is most apt to transude and cause irritative trouble is tlie
ordinary egg-albumen. This stands at one end of the
list, serum-albumen at the other.
Professor Senmola's e.vposition of his views was re-
ceived with great applause by the Parisian academicians.
No discussion, however, followed. It was not stated
whether there were any practical deductions to be made
from this dyscrasic hypothesis. The inference is, how-
ever, that egg-albumen should be forbidden and serum-
albumen prescribed as an article of diet.
LUPUS AND TUBERCULOSIS.
Dr. J. DouTRELEPONT, of Bonu, has e.xamined seven
cases of lupus with the view of determining the presence
of the bacilli tuberculosis. In the diseased tissue of all
of these cases the organisms were found, though in vary-
ing atnount. The investigator conchides, therefore, upon
this and certain clinical grounds, that lui)us is a tubercu-
losis.
Dr. Demme has also investigated this subject and has
found the tubercle bacilli in the nodules of lupus nodo-
sus and in lupus serpiginosus. He also argues therefrom
the identity of the two diseases. On the other hand, a
writer, presumably Spina, in the IVie/ur Medizmische
Zeitung, takes an entirely different view and asserts that
the presence of these bacilli simply shows that they are
not pathognomonic of tuberculosis, or that, though differ-
ent bacilli, they take the same staining. The writer in
question arrays all the clinical and pathological evidence
possible against the view of the identity of the two dis-
eases.
HOW TO SLEEP ON A RAILROAD TRAIN.
Many weary persons have tried to solve this problem,
and have tossed about for hours in restless disappoint-
ment.
Dr. Outten, a German physician, has applied the laws
of physiology to the matter and announces {Allg. Cen-
tral-Zeitung) a satisfactory solution of it all. If a person
lies down with his feet toward the engine, the movement
of the train tends to draw the blood from the brain to
the feet, cerebral an;\jmia is produced, then sleep. If,
on the other hand, the person lies with his head nearer
the locomotive (as is the custom in (iermany), the move-
ment of the train produces a cerebral hyperemia incom-
patible with sweet repose. Dr. Outten has verified his
view with many experiments.
Dr. O.'s directions are hardly needed in America,
where the berths of sleeping-cars are generally made up
so that the position is as indicated by physiology and
our German confrere. In this connection, however, we
would say that many persons are unaware of the fact
that additional comfort and better sleep in travelling can
often be obtained by judiciouslyusing the bromides.
THE YELLOW FEVER AND ITS CONTROVERSIES.
There has for some time been much lack of harmony
among the sanitarians of the Mississippi ^'alley. The
discord has been intensified since the National Board
of Health gave up control of quarantine. The Sanitary
Council of the Mississippi Valley, the Louisiana State
Board of Health, the United States Marine Hospitall
Service, and the New Orleans City Board of Health have
been the active participators in the sanitary dissensions.
The quarrel, though unfortunate, has perhaps had one
good result : it has forced the authorities to be extremely
alert against the yellow fever, lest the reproach of allow,
ing that disease to get into our ports be made against
them.
It appears, however, that matters have become a little
too personal and acrimonious. On July 20th Governor
McEnery, of Louisiana, issued the following proclama-
tion :
" In accordance with the preamble and resolution of
the Louisiana State Board of Health, adopted July 12,
1883, a copy of which is hereto annexed, and in consid-
eration of the imminent danger that the city of New Or-
leans, the State of Louisiana, and the Mississippi Valley
are now in from the arrival at quarantine of infected ves-
sels, any unnecessary intercourse between the Missis-
sijjpi quarantine station and other quarantine stations
and the city of New Orleans is hereby strictly prohib-
ited, and any permission for that purjjose heretofore
granted is hereby revoked. The laws of Louisiana and
the rules and regulations of the Board of Health must be
rigidly enforced and obeyed in this and all respects while
danger continues. Intercourse between the (juarantine
stations and New Orleans must be under the exclusive
control of the Board of Health, i invoke the vigilance
and co-operation of all good citizens during this season
of threatened calamity. This order will be communi-
cated by the Board of Health to all persons concerned
therein."
Shortly after this, the Louisiana State Board of Health
held a meeting and unanimously passed the following
resolutions :
August 4, 1883.]
THE MEDICAL RECORD.
1 29
Whereas, Dr. J. H. Rauch, the Secretary of the ]ioard
of Health of the State of IlHiiois, has recently visited
New Orleans and directly interfered and tanijiered with
the heakli operations of the State 15oard of Health of
Louisiana ; and
Whereas, Since the dissolution of the National Itoard
of Healtli there has been an eflbrt made by illegal bodies
to assume to perform its pernicious functions and mis-
chievous tendencies ; be it
Resolved, That the President of this Board be and he
is hereby requested to respectfully suggest to his Excel-
lency the Governor of Louisiana to confer with his Ex-
cellency the Governor of Illinois on the propriety of con-
fining Dr. J. H. Ranch to health operations within his
own State, and to instruct liim to cease his designing ef-
forts to impair public confidence in the State Board of
Healtli of Louisiana.
This is a rather severe snub to the energetic Illinois
official ; It at least does the injustice of not saying that
he is Secretary of the Sanitary Council of the Mississippi
Valley ; and evinces, we fear, the need of some moral
sanitation in tlie great Southwest.
This Sanitary Council has undertaken to continue
part of the work of the National Board of Health, acting
in antagonism to the Marine Hospital Service. It has,
however, been beaten in the various measures it has
adopted, and has had to give up its steam-launch.
IXcxus of the 5^\ccU.
The Journal of the American Medical Associa-
tion.— The first two numbers of this Weekly have come
to hand. While fully appreciating the difficulties under
which tiie editor, Dr. N. S. Davis, has labored in starting
a new medical journal, we confess to some disappoint-
ment at the result. The first number contains the ad-
dress of the President of the Association, which has been
published in full by several journals, lay and medical,
two months ago. This should have debarred it, accord-
ing to the rules which governed the publication of the
Transactions, from appearance in the official journal, and
would appear to ebtablish the precedent that those
papers which, in violation of the rules, have already been
l)ublished elsewhere, will ultimately find a place in the
official Transactions. Both numbers are largely made
up of the doings of the Association. There are also de-
partments for progress of medical science, news, reviews,
correspondence and editorials. We bespeak for this
enterprising periodical all the success which it may
deserve, and welcome the veteran Editor to the higher
walks of medical journalism.
American DERMATOLO(iiCAL Association. — The next
annual meeting will be held at Lake George, August 29,
30, and 31, 1883. Dr. R. W. Taylor, of New York,
President, and Dr. .Arthur Van Harlingen, of Philadel-
phia, Secretary.
Dr. H. N. Heineman, of this city, has Ijeen elected
Professor of the Piinciples and Practice of Medicir.e at
the Woman's Medical College of the New Vork In-
firmary.
Mount Sinai Hospital. — Professors .A. L. Loomis
and A. Jacobi have resigned as visiting physicians to this
institution, and have been made consulting.
The Indiana State Board of Health is a failure,
according to the Port \\'ayne Journal of Mediial Sci-
ences. The provisions of the law are not so much for
the benefit of the public health as of the politicians,
lioard of Healtli failures are becoming unjileasantly nu-
merous.
Pasteur off for Egypt. — M. Pasteur Jiaving of-
fered to organize a mission for investigating the cholera
in Egypt, the Hygiene Commission has endorsed the
scheme. The mission will consist of M. Roux and M.
Thuillier, of M. Pasteur's laboratory, M. Strauss of the
Eaculty of Medicine, and M. Nolaco. M. Pasteur has
written to Lord Granville to solicit the grant of facilities
to the mission in Egypt.
The Ophthalmological Sociefv of Gre.« Brmain
held its third annual meeting on July 6tli, electing Mr.
Jonathan Hutchinson President.
The Cholera continues to be confined to Egypt,
being particularly severe at Cairo. Between three hun-
dred and four hundred deatlis are reported daily. It is
believed that many more deaths from cholera occur in
Alexandria than arc rejiorted. The English, who reject
quarantine as interfering needlessly with connnerce, have
undertaken their system of inspecting incoming vessels
and disinfecting those having disease on board. It is re-
ported that cholera exists in Rio Janeiro. Precautions
against the importation of Egyptian rags are being taken
by the authorities in American i)orts.
The Louisville Medical News.- — Dr. L. S.
McMurtiy has retired from the News, and is succeeded
by Dr. H. A. Cottell, formerly one of its editors.
Dr. Francis Delafielu has been elected full Pro-
fessor of Principles and Practice of Medicine, College of
Physicians and Surgeons, New Vork.
A Sanitarv Convention. — Our Western brethren
revel in sanitary conventions. One is to be held at
Muskegon, Michigan, under the auspices of the State
Board of Health, on Thursday and Friday, August 23
and 24, 1SS3. The objects are the presentation of facts,
the comparison of views, and the discussion of methods
relating to the prevention of sickness.
The Death of Dr. Geo. H. Fisher. — Dr. Fisher,
son of Dr. George J. Fisher, of Sing Sing, N. Y.,
died suddenly, July 23d, at Baltimore, Md., aged twenty-
nine years. After receiving his preparatory education
at the military schools of Dr. Holbrook and the Mt.
Pleasant Academy, he was graduated at the Medical
Department of Columbia College in 1878. Dr. Fisher
practised his profession for some time in connection
with his father, and afterward at Round Hill, Conn.
On the 22d of February last he was married to Miss
Florence Jobbins, of Brooklyn, and in the following
April went to Baltimore, Md., in the interest of a
New York mercantile house. He remained in Balti-
more until the time of his death. Dr. F'isher retired
to his room in usual good health on the evening of
July 23d, and at an early hour of tlie morning was found
dead in his bed, his spirit having passed away apparently
without a struggle. The profession will deeply sympa-
thize with the distinguished father of the deceased in his
deep affliction.
I30
THE MEDICAL RECORD.
[August 4, 1883.
The London Hospital School. — Mr. Jonathan
Hutchinson has resigned his position as senior surgeon,
and has been appointed Emeritus Professor of Surgery.
Dr. Tidy has resigned his position as Lecturer on
Chemistry.
The Universitv of Colorado announces the open-
ing of a Medical Department at Denver, with iirelimi-
nary examinations and a four-years' graded course. We
trust that the effort at higher medical education is a sin-
cere one and will prove successful.
Ethics in Vermont. — A member of the \'erMiont
State Medical Society is shown by a correspondent of
the A^<;w York Medical Journal, to have advertised a
•'.sure cure " in a local paper. The State Society in its
ardor to keep out New York delegates, forgot to look at
home.
Politics \t: the Ger.man Hygienic Exhiuitiox. —
The German correspondent of the MfdUal Press and
Circular gives the following account of some of tiie true
inwardness of the German Hygienic E.xhibition. Speak-
ing of the Presidents of Sections in the Exhibitions, and
of the fitness of the appointment of Professor Guret, of
Berlin, as President of the Section of Field Hvgiene, the
special correspondent of the Allgemeine Wiener Med.
Zeitung goes on to say that, if the choice in tliis case
was in every way suitable, it has aroused a decidedly dis-
agreeable feeling of surprise in medical circles to observe
that the choice of Presidents of Sections has fallen upon
some not in the first rank, whilst a Virchow and an
.\ugust Hirsch have only received appointments as mem-
bers of the Sectional Committees. 'J'he reason why
\'irchow, the first hvgienist — a man to whom the city of
Berlin is so much indebted, and of whom it is proud —
was not placed at the head of the committee (in case he
had not the choice of being so, and declined it) can only
be found in political causes. " But what grounds have
caused the setting aside of Professor Geh. Med. Rath.
August Hirsch ? August Hirsch is esteemed in profes-
sional circles as one of the first epidemiologists, and out-
side the scientific world he has been only once spoken
of. That was when he returned from Russia, three vears
ago, from a journey of investigation into the plague at
that time rife in that country — a journey undertaken at
the instance of the Imperial Clovernment. He had sent
in his report to the proper authorities, the Lnperial
Health Office, and awaited their decision. As this was
too long in coming, and as the Health Oftice made no
sign of noticing his work, he witiidrew it and jjublished it
at his own expense. This procedure later on cost Director
.Struck a very uncomfortable quarter of an hour in the
Reichstag, and therefore it may well be said that since
that time Herr Hirsch has not been a persona grata in
the higher regions. Such reminiscences cannot be often
enough freshened up. They afford in the present case,
and in still higher degree for our own epigonen, a small
but valuable measuring-staff, which will aid us in forming
a judgment of persons and of the movements of tlie
times."
Supposed Suicide ok k Vou.ng Physician. — .\ very
sad event was the sudden death last Sunday of Dr. Milli-
gan Patchin, of this city. ^Vhile engaged in cleaning and
examining a pistol it went off, with a fatal result.
^fitisTx Medical |tssociatioti.
FIFTY-FIRST ANNUAL MEETING.
Held in Liverpool, Tuesday, Wednesday, Thursday, and
Friday, July 31, August 1, 2, and 2,, 1883.
(BY DIRECT C.\BLE TO THE MEDICAL RECORD.)
TuESD.w, July 3rsT — First Day — Morning Session.
The opening exercises of the Association consisted of
Church service at 10.30 a.m., held at the Pro-Cathedral.
A sermon was preached by the bishop of Liverpool.
The cathedral was crowded. The music was inspiring.
The responses were those of heartfelt welcome. The
sermon was eloquent, and the venerable and scholarly
clergyman dwelt at length on the intimate relation exist-
ing between the physician and his patient, the moral
obligation of the former to the latter, the dignity and
paramount importance attached by the Christian religion
to the human body, and the zeal and devotion thus
called forth for untiring efforts in behalf of its healthful
preservation.
One thousand members were present, together with a
large number of .\mericans and other foreigners.
First Day — Afternoon Session.
The first general meeting of the .Association was held in
the College, Shaw Street, at 3 p.m. William Strange,
M.D., Senior Physician to the General Infirmary, Wor-
cester, President, in the Chair.
Dr. C. (;. Wheelhouse, of Leeds, Chairman, pre-
sented the
REPORT of the COUNCIL,
in which important topics requiring the action of the
Association were set forth. Among the items of busi-
ness liable to give rise to much stormy discussion were
The Medical Act Amendment Bill, which involved eligi-
bility to registration in the Medical Register as a medical
practitioner, unless, in addition to the licence of the
General Medical Council, he shall be attached subse-
quently to one of the universities or medical corporations,
and be authorized to register the title so acquued.
The Parliamentary Bills Committee of the Associa-
tion had proposed the above qualification, to which
some of the branches of the -Association had already
manifested a vigorous opposition, and were prepared to
argue against the restrictions involved in the proposi-
tions.
The Homceopathic question startled our brethren here
as manifestly as it did those of the American Medical
Association ; but when the book was opened, the same
knotty problems were found on page after page, and
they seemed no nearer solution than in our own country,
especially when it was learned that they had a close re-
lationship to lawyers and the High Chamberlain.
The Bill requiring
notification of infeciuous diseases
will create as much dissension here as did the ques-
tion of the abuse of medical charity in New York, and
there was no well-grounded prospect that the question
August 4, 1883.]
THE MEDICAL RECORD.
131
was any nearer a satisfactory answer in one case tiian
it was in the other. The law requires every medical
practitioner attending on, or called in to visit any per-
son suffering from any infectious disease, to forthwith
fill up, sign, and deliver or send to the medical officer
at his office a certificate or declaration stating, etc. In
one instance, at least, the Town Council appointed as
their medical officer of health a honuropath, and the sig-
nificant question had been asked, \Vas it likely that such
a man could expect active support from the medical pro-
fession, or that they would report their cases to a man
who was a homosopath ? The energies and anxieties of
the medical profession throughout the United Kingdom
are likely to be taxed to their utmost for a satisfactory
answer.
First D.w — Evening Session.
The Association met at S p.m. The meeting was
largely attended ami the audience listened attentively to
THE ADDRESS OF THE PRESIDENT-ELECT,
A. T. H. Waters, M.D., F.R.C.P., of Liverpool.
'I'he President of ihe Association, next delivered his
address, confining himself to a review of the progress and
prospects of medical science. During the past few years
no science had made greater strides, or had more largely
increased its following in earnest and determined workers.
.fs a striking evidence of this was the continued pros-
perity of the Association, its increase in membership, and
its extension of influence. Not only was the spirit of
progress manifested in every department of original re-
search, but it had infused itself in the work of the gen-
eral practitioner, who was eager to receive and adopt ad-
vanced views and imi)roved practices. He also sketclied
somewhat in detail the various advancements that had
been made in the different departments of medicine, not
only in Great Britain but throughout the civilized world,
and argued that the prospects of the future were never
more promising, with a field constantly enlarging, and with
continued increase of earnest and determined workers.
After the adoption of a resolution of thanks, formally
seconded, to the President for his address, and the trans-
action of some miscellaneous business, the Association
adjourned to meet at 11 a..m., August ist.
Wednesday, August ist — Second Day.
The second general meeting of the Association was
called to order at 11 a.m. by the President, Prof.
Waters, of Liverpool.
The special order was the
ADDRESS IN SURGERY,
which was delivered by Reginald Harrison, F.R.C.S.,
Surgeon to the Royal Infirmary, Liverpool.
(For the address in full, see page 113 of this number
of The Record.)
The speaker was listened to with profound attention
by a large audience, and at the close received a hearty
applause, followed by a resolution of thanks, with a
second, expressing a high appreciation of the ability and
character of his disconrse.
It was then arranged to hold
THE NEXT annual MEETING
at Belfast, Ireland, under the presidency of James Cum-
ing, M.D., F.K.Q.C.P., Prof, of Theory and Practice of
Medicine, Queens College, Belfast.
This was in accord with an invitation received from
the profession of Belfast at the semi-centennial meeting
held in Worcester, England, last year.
WORK IN SECTIONS.
Among the papers and discussions before the Sections
noteworthy mention is made of the following :
Section in Public Medicine. — T. Pridgin Teale,
M.D.,F.R.C.S.,of Leeds, President. Paper "On the In-
jury Done to the Health of the Young by the Present Sys-
tem of Education," by Martin Johnson, Esq.
A communication on •' The Sanitary Condition of
Liverpool" gave rise to a stirring discussion, and was
especially interesting at the present time, in view of some
apprehensions whicii have been manifested since the out-
break of cholera in Egypt. The authorities and the pro-
fession were on the alert, and it seemed very improbable
that the disease would succeed in making an ingress
into that port.
Section in Ophthalmology. — T. Shadford Walker,
M.R.C.S., of Liverpool, President. Discussion on tests
for color-blindness, opened by Dr. W. A. Brailey, of
London, who was followed by Dr. Snellen, of Utrecht.
The subject was discussed with special reference to the
acuity of vision and color-sense in students and sailors.
Section in Fsyc/wloi^y. — T. L. Rogers, M.D., of
Rainhill, President. Discussion on the employment of
the insane, opened b)' Dr. D. Yellowless, of Glasgow,
P'irst Vice-Prebident of the Section. The general tone
of the discussion was in favor of discriminate employ-
ment of this class of unfortunates.
SOIREE IN THE EVENING.
The President and Local Committee gave a soiree in
the Art Gallery, at which three thousand guests were
present. The affair was entirely successful.
Thursd.iy, August 2D — Third Day.
The third general meeting was called to order at 10
A.M. by the President, Professor Waters, and was de-
voted entirely to business matters pertaining to the
Association.
WORK IN SECnONS.
The day was spent chiefly in work in the various Sec-
tions which were largely attended and noteworthy papers
were read and subjects discussed as follows :
Section in Diseases of CkilJren.—SAMV'E.h Jones Gee,
M.D., F.R.C.P., of London, President, delivered an ad-
dress which consisted in a historical sketch of the litera-
ture of children's diseases. Beginning with the ancients
he referred especially to Hippocrates' description of
mumps, and next spoke of Rhazes as the author of the
first treatise on the subject of diseases of children. No
addition was made to our knowledge until the appearance
of Glisson's book on rickets in the seventeenth century.
The speaker also alluded to Lydenhain's description 0/
132
THE MEDICAL RECORD.
[August 4, 1883.
measles, scarlet fever, whooping-cough, and St. Vitus'
dance. In tiie last century, croup, acute hydrocephalus,
and the eruptive fevers were especially referred to, and in
the present century the study of morbid anatomy and the
methods of physical examination of the living subject.
Sectio?! in Public Medicine. — Dr. Norman Kerk, of
London, read a paper on "The Present Position of the
Habitual Drunkards Movement."
Dr. C. R. Drysdai.e, of London, read a paper on "The
Mortality of the Rich and the Poor," in which he com-
pared the mortality of total abstainers with that of mod-
erate drinkers.
Dr. Francis Imlach, of Liverpool, read a paper on
" Quarantine," and Dr. Stocker, late Government Emi-
gration Inspector at Queenstown, on " The Sanitary
Condition of the Mercantile Marine." The autiior of
the last paper made special reference to the inspection
of ships in America as being very complete, and also re-
ferred to the import of rags as a probable means of con-
veying infection.
Captain Douglas Galton, C.B., F.R.S., read a paper
on " Hospital Construction." The author reviewed the
subject thoroughly and maintained that hospital buildings
should be of the simplest kind ; that they should not be
built on the supposition that they can remain as enduring
structures, and for the reason that they are very liable to
become dangerously infected.
A portion of the day was set aside for visiting
PLACES OF LNTEREST
including the docks, some of the large steamships, art
galleiies, public halls, hospitals, and public libraries.
liANyUET LN THE PHILHARMONIC HALL.
In the evening a public dinner was given at Philhar-
monic Hall.
Over four hundred members were in attendance, and
numerous guests. Dr. Austin Flint, of New York, was
present, and was received with great ajjplause when he
])roposed in most cordial terms and in behalf of the
American Medical Association the toast: " To the P.iit-
ish Medical Association."
Mr. Ernest Hart, editor of the British Medical Journal,
proposed with ready and expressive words the toast,
"To our Visitors," which was responded to by Dr. Fen-
wick, of Montreal, who hoped that on some future occa-
sion the British Medical Association would hold a
meeting in Canada, where it would meet with a licarty
reception.
Friday, August 3D — Fourth Dav.
'i'he Association met in general meeting, at 10 a.m.
and was called to order by the President. After the
transaction of some routine business the
address on pathologv
was delivered by C. Creighton, M.D., formerly De-
monstrator of Anatomy, Cambridge University. 'I'he
si)eaker showed how diseases such as cancer and
tubercle acquired an autonomy and assumed an indi-
vidual existence in the bodies of those m whom they
took origin and subsequently infected. The address was
listened to with marked attention by a large and appreci-
ative audience throughout its entire delivery.
The author received a cordial vote of thanks for his
address.
The concluding general meeting was held at 2 p.m.,
when hearty votes of thanks were accorded to the local
officers, with an interchange of congratulations, and thus
terminated most successfully the fift\--first annual meeting.
In the evening the Mayor of Liverpool gave z. soiree
at the Town Hall, where were entertained a brilliant
gathering of ladies and gentlemen made up of members
and guests.
Arrangements were perfected for numerous excursions
to places of interest near Liverpool, to take place on
Saturday, August 4th, for the members and their friends.
^etiicxiTs and Notices.
Die An.*;mie. Von S. Laache. Universitaats-Programn
fiir das 2 Semester, \l
Christiania : Die Malling-
sche Buchdruckerei. 1883.
The very elaborate monograph before us presents the
results of a long series of investigations by Dr. S. Laache,
made under the direction of Professor J- Worm Miiller,
of Christiania. It contains so much that is new and val-
uable that we shall take an opportunity to discuss it
fully at another time.
A Treatise on Therapeutics : Comprising Materia
Medica and Toxicology, with Especial Reference
to the Ap[)lication of the Physiological Action of
Drugs to Clinical Medicine. By H. C. Wood, M.D.
Fifth Edition, revised and enlarged. Philadelphia :
J. B. Lippincott & Co. 1883.
The exhaustion of the fourth edition of this work in six
months is a very emphatic evidence of its value and ap-
preciation by the public. Its merits have frequently
been extolled in these columns and we need add noth-
ing now. We would suggest that the chapter on elec-
tricity should be revised by an expert ; and that it would
be very desirable to have something about diet-cures,
climate-ciues, hydrotherapy, and movement-cures in a
book which is a treatise on therapeutics. We trust
that the author may have an opportunity to make these
additions in another six months.
On the Relation of the Chest Movements to
Prognosis in Lung Disease, and on the Application
of Stethometry to Examinations for Life Assurance.
By Arthur Ransome, M.D., M.A. (Cantab.). With Il-
lustrations. Pp.100. London : Macmillan & Co. 1882.
The author has devised an ingenious set of instruments
by which the upward, forward, and outward movements
of the chest-wall are measured and registered. With the
aid of this, he has determined some interesting physio-
logical facts, and has also, as he thinks, obtained data by
which more exact diagnosis, and especially prognosis in
lung disease can be given. The author is modest in his
claims for stethometry, and what he does claim is sup-
ported by a large number of tabulated observations. His
results are confirmed independently by Drachmann, of
Copenhagen. The author has evidently expended
great care and labor upon his work, which is beautifully
printed.
Dr. W. S. Little, of Philadelphia, writes : "Please
make the following correction in the report of my paper
on Congenital l'",ctopia Lentis, read at the meeting of the
.\merican 0|)hthalinological Society, appearing in your
journal July 28, 1883. For divergence \i\^-x'i& ■titzA de-
tachment of the retina from hemorrhage."
August 4, 1883.]
THE MEDICAL RECORD.
133
©oiTCBpoudcncc.
HOVVTO PROCURE THE BEST POSSIBLE PHYSI-
CAL CONDITION AFTER PARTURITION.
To THK Kditor of Thr Mkdical Record.
Sir : In the issue of your highly esteemed journal, for
June 30th, I find a rather severe and, in my opinion,
unwarranted criticism on my paper entitled " How to
Procure the Best Possible Physical Condition after Par-
turition," read before the New York Academy of Medi-
cine, Section of Obstetrics, April 26, 1S83. My critic
charged me with having advised to close all wounds, sup-
pressing all lochia, and conveys the idea that I advocate
a sort of " kolpokleisis " after parturition. The doctor
evidently labors under a misapprehension in regard to
what I did say. I desired to call especial attention to
the beneficial effects of strictly hygienic and antiseinic
measures before, during, and after parturition ; as they
have proved in my hands, as well as in those of Tarnier,
of Pans, Barnes, of London, Braun and Spaeth, of Vienna,
Thomas, Lusk, Barker, Wiley, Munde, J. E. Taylor, and
many others in this city, to be the only safeguards against
those manifold diseases which were formerly collectively
termed " childbed fever," and claim in this city alone about
five hundred victims annually, many of whom would live
to-day, had they been attended by antiseptic aiid hygienic
measures instead of acting under the old rule of " beware
of meddlesome midwifery." The secretions and excre-
tions of the parturient must also be kept in as normal
condition as possible.
The touch-me-not plan having proved a rather dan-
gerous one even among the " Indian Squaws," who
cannot avail themselves of the advances in science and
art, the gentle artificial dilatation of the cervix uteri
during labor pain ; the careful pushing back of the ante-
rior labium oris externi uteri, the use of chloroform or
chloral hydrate when indicated, the rupturing of long de-
laying tough membranes, the compression of the fundus
uteri before and while the child is being born, the ad-
vantages of Orede's method of expressing the placenta,
but, contrary to Dr. Mac Gaughef s advice, without even
a little tension on the cord, is, by no means, an overrated
measure — as proved by my own and that of many able
accoucheurs, among whom Professor Carl von Braun,
of Vienna, under whose supervision over one hundred
thousand children were born, where the method had
been most successfully applied. As to checking profuse
post-partum hemorrhages, and to control the uterus un-
til it had firmly contracted after parturition ; the sewing
up of extensive lacerations of the perineum, immediately
after labor, etc.; upon these points the doctor seems to
agree with me ; he finds no fault with the advice to use
the binder after the placenta and the secundnies are
born, although it has been discarded long ago in the
Vienna lying-in wards ; the immediate application of the
child to the mother's breast as soon as she had some rest
and refreshing sleep, and been made comfortable, is also
approved of by niy critic. But now, mirabile dictu .' I
am taken to task by the learned doctor for unnecessarily
interfering with nature and the natural post-puerperiuni
physiological processes, and he charges me with going
too far when I remark that a little hemorrhage after par-
turition is a dangerous thing and should be arrested, etc.;
and he lays stress upon my remark, used in a figurative
sense, of course, in answer to Dr. Cari>enter's question,
that not a single drop of blood should appear after the
completion of the third stage of labor, and that napkins
removed should be perfectly free from color, etc.
In regard to this question I desire again to reiterate
what I did actually say, and it was this — that Housmann's
reliable experiments, in 1868, instituted upon rabbits, by
injecting fluids taken from persons who died of infec-
tious peritonitis, inevitably caused the death of pregnant
animals ; even healthy pus injected into the genitals of
animals shortly before or soon after labor, if their vaginal
or the mucous membranes of their uteri 7i'cre ivounded or
eroded, caused ahcays pycemia or septiccemia and death;
thus showing conclusively the great susceptibility to in-
fections, with consetiuent fatal results, during the puer-
peral state. Especially those suffering from primary endo-
metritis and vaginitis during pregnancy, are then usually
liable to attacks of parenchymatous metritis or metro-
phlebitis after childbirth. Even catarrhal secretions,
according to Braun, cause ulcerations of the denuded
mucosa, which becomes the gate of infection and the
starting point of phlegmonous inflanniiations of peri-
and para-metritis, etc. Many cases of puerperal fever
undoubtedly originate from the absorption of the foul stuff
of decomposition from retained blood-clots, portions of
retained placenta, the membranes, purulent matter
formed in utero, and from 7vounds and bruises and subse-
quent gangrene of the tissues of the genital tract, where
the puerpera takes the poisons of her own making, says
Barnes. Now, with these facts before us, I ask is
it not unjustifiable and, to say the least, ungenerous that
Dr. MacGaughey says, " As for examining the genital pas-
sages of all puerpera after removal of secundines, and
directing that all slight lacerations should be promptly
closed, the advice is very good on i>aper, but very awkward
and difficult and often very unnecessary at the bedside.
Besides, the 'meddlesome midwifery' of exposing all wo-
men, and of closing slight lacerations or wounds, would in-
volve more, much more, danger to the patient than letting
them alone." I will, for the satisfaction of the doctor,
quote the highest authority in Europe upon this jwint of
the controversy which my critic, not I, has invUed.
Braun says : " Slight lacerations of the perineum, or
wounds made by episiotomy, are closely united by serres-
fines or, if extensive, by metallic sutures ; bruised wounds
of the vagina should be pencilled with pure tincture of
iodine, muriated tincture of iron, thymolized oil, or, ac-
cording to Fehling, with salicylic powder (one to five of
starch) applied two or three times daily. Under this
treatment they usually heal in from three to five days. "
Regarding the prevention of the least hemorrhage
post-partum, I will quote Barnes, of London, certainly
as good an authority as there is to be found anywhere.
He says : " To obviate hemorrhage postpartum is to op-
pose septicremia.' I therefore always give, in accordance
with the late lamented Prof. Elliot's advice, which I
learned from him in 1866, in Bellevue Hospital Medical
College, one drachm of Squibb's fluid extract of ergot
(or Wyeth's), even in natural labor, after its completion,
and I repeat the dose, given in sugar water, on account
of the nasty taste of the stuft', until the uterus has firmly
contracted, and it becomes evident that no portion of
the placenta, the membranes, or oi blood, has remained in
the vagina or the uteriis. The least hemorrhage from the
genitals, again says Braun, is treated " by the applica-
tion of iodine, persulphate of iron, hot-water injection,
the silver wire or carbolized silk ligature." I shall con-
tinue to adduce proofs — not arguments, but undisputed
facts — to convince Dr. MacGaughey that it is a good ad-
vice to close up even slightly lacerated wounds after par-
turition, and thus prevent bleeding and septic infec-
tion. When I speak of thus treating wounds, I do not
mean to close either the uterine or vaginal canal beyond
where it is injured, leaving room enough for the shed-
ding of the degenerated lining membrane of the uterine
cavity and cervical canal, which cause the lochia, and
ought to be colorless and not cruenta, which means
bloody. If they become so there is danger of puerperal
fever, which can be avoided if all wounds are treated as
stated above ; nay, according to Prof. Fallen, of this
city (now, I understand, of London, England), even a
lacerated cervix had better be sewed up soon after par-
turition than to be left to nature.
Does not Prof Fallen's advice require exposure of the
parts ? Does not immediate perineorraphy reijuire the
same ? But, however, I think I have already taken up
134
THE MEDICAL RECORD.
[August 4, 1883.
too much of the valuable space of The Record to re-
fute the uncourteous remark of Dr. MacGaughey, when
he, in a scientific criticism, uses the words ''too ridicu-
lous, a work of supererogation^' and other not very
complimentary epithets on subjects about which he
seems to have a great deal to learn yet.
I am very respectfully, j-ours,
Rudolf Tauszky, M.D.
THE DISEASE QUESTION IN INEBRIETY.
To THE Editoi; of 1'he Medical Record-
SiR : The courteous criticisms of my article on " Ob-
scure Causes of Inebriety," by Drs. Hart and Stair, in
Nos. 661 and 662 of The Record, tempt me to make
some suggestions.
The question cannot be solved by argument, because
it is one of accurately observed facts and their meaning.
Like any other question in physical science, we must
have all the facts before we can reach any clear conclu-
sions.
We must accurately study and record the physiologi-
cal and psychological symptoms, or phenomena of ine-
briety, and from these histories will appear the laws and
forces which govern its origin and progress.
When such a study is made of a large number of
cases, by many persons who are more or less competent
to judge, in different parts of the country, covering a
period of years, their conclusions, when unanimous on
certain points, are the best authority, and are entitled to
great consideration. Conclusions reached in any other
way are open to question and doubt. If the asserted
fact tliat inebriety is always a disease, cannot be sustained
by clinical evidence it is an error. It is equally er-
roneous to deny the disease theory, unless such nega-
tions are supported by study of cases. We have repeat-
edly urged our critics to send clinical histories of cases,
that seemed to sustain their views ; or cases where the
early stage was one of vice and sin, pure and unmistak-
able, but no one has responded so far.
For over twenty centuries inebriety has been con-
sidered a physical disease, and as a student of this phase
of mental disorder we are fully conscious that the bor-
der lines of its study have hardly been touched. The
wide ranges of the unknown before us are far more im-
pressive than any present knowledge of the subject, or
opinions of to-day.
If my critical friends will rise above the dogmas of
to day, and examine inebriety independent of all theory
or popular notion, its magnitude will silence all doubts,
and the great ocean of the unknown will stretch out be-
fore them, where each may be a discoverer, untroubled
by the notions and theories of others.
Respectfully yottrs,
T. D. Crothers, M.D.
Harti-ord, Conn.
HOW TO ABORT TYPHOID FEVER— A CRITIC
CRITICISED.
[We insert the following letter in order to give altera
pars a hearing. We must add the criticism that
the writer makes only assertions, and entirely fails to
prove anything whatever. A long series of carefully
noted clinical observations can alone prove anything as
regards the power of a remedy to shorten or modify a
disease of so variable a type as typhoid fever. — Ed.]
To Tmc Editor of the Medical Record.
Sir : In the Medical Age of June 10, 1883, is an article
criticising an article in The Medical Record, which
article was criticising the Age for using very strong
language toward any one who said he could abort or cut
short typhoid fever. The Age winds up its article by
saying : " Dr. Davy now has the floor." Thanks for his
liberality. The Age accuses The Record of summing
up the results of the recent research and debate in
France in rather a "pessimistic spirit." That old legend
no doubt flitted across The Record's mind when he
soliloquized to himself! again the mountains labored!
with minute results. The Age does not appear to be
impressed in tliat way, for he says, " the debate strength-
ened the rational therapeutics of the disease." If the
Age would prefi.x ir to rational (irrational) he would be
much nearer the truth ; for if it was the rational system
of treatment, why such pessimistic conmients.
What the immortal Jenner did for small-po.\ has been
done for typhoid fever ; it has been demonstrated in
over one hundred cases, and extending through five
years of time, that that much dreaded disease is amen-
able to the proper treatment, and that an attack can be
broken up and the disease cut short after passing the
forming stage. Patients treated according to the here-
inafter given plan, have been able to be up and about
their rooms from the twelfth to the sixteenth day of
medication, and some out riding on the eighteenth day.
The fever leaving them, some as early as the fourth, and
some as late as the eighth day, depending upon the
severity of attacks and faithfulness of nurses. The above
good results have been attained by the use of the fol-
lowing i)rescriptions and plan of treatment faithfully car-
ried out :
Prescription No. \.
5. CohothediK compound 3 iv.
Sig. — Thirty drops every four hours in two tablespoon-
fuls of water.
Prescription No. 2.
5 . Quinidia sul grs. xx.
Camph. pul grs. vi.
Ginger pul grs. iii.
M. Ft. cht. No. 6. Sig. — One powder every four
hours alternating with. prescription No. r. Plan of treat-
ment as follows :
First. — Prescriiition Nos. i and 2 nuist be given on
time, alternating each other, two hours apart, not omit-
ting any doses ; if patient is asleep, wake him up ; thus
keep up medication until the temperature reaches within
one-half degree of the normal line ; then you may stop
medication at 10 p.m. and begin at 6 a.m. After the
normal line has been reached and held for two days,
you may drop to four doses of each powder per day for
four days ; after which you can drop to three doses of
each \)er day, until the patient is able to be put upon
full diet. Patient should be sponged oft' with tepid
(slightly alkaline) water each evening, until the tempera-
ture has reached 100° F., or as long as it feels grateful
to the sick.
Second. — Temperature of room must not fall below
68° F. regulated by a good thermometer.
Third. — Patient must lie quietly (not sit) in bed until
all tenderness, gurgling, diarrhcea is gone ; talking,
laughing, or exertion retards the healing of bowels and
should be avoided.
Fourth. — For the extreme weakness or profuse per-
spiration which sometimes sets in when the fever is
rapidly declining, use the best old rye whiskey, made
slightly bitter with gentian or cimicifuga, and give from
one to two teaspoonfuls, as is necessary.
Fifth. — For diarrhcea use fl. ex. guarana in ten- to
fifteen-drop doses every three or four hours, and brom-
ides for delirium. \x\y complication which may arise
must be met by attending physician. Diet : Milk, toast,
hard-boiled eggs, rice, crackers, coffee, lemonade.
To abort tyi)hoid fever, give Prescriptions i and
2, alternating each other every two hours (i.e., each in
their place every four hours). Patient nnist lie down
and be quiet from one to three days, owing to the sever-
ity of the attack, and take at least five doses of Prescrip-
tions I and 2 per day for the first two days, then slowly
diminish in number of doses as patient improves.
Auo^ust 4, 1883.]
THE MEDICAL RECORD.
135
Ere this you have asked in your own minds what is
cohothedra compound ? As per analysis by Professor
Powers, it is as follows {i^erl'at. et liierat. ) :
" Phii.adki.phia College of Pharmacy,
14s North Tenth Street. Founded, 1821.
Philadelphia, November 25, 1831.
jf. A. Dax'V, F.stj., Troy, Ohio:
Dear Sir— The substance submitted to me for analysis has been
examined with the following result : It is a bright reddish-yellow
liquid, having an aromatic odor, a pungent taste, an acid reaction,
and contains (i) 78 per cent, by volume or 71.3 per cent, by weight of
absolute alcohol ; {2) 0.9098 per cent, of nitrous f titer, corresponding
to 21.8 per cent, of spirit of nitrous ether of the United States Phar-
macopoeia; (3) a small amount of the alk.aloid morphia or morphine
(too small for quantitative estimation) ; (4) very sm.all amounts of the
volatile oil of caraway and of resinous and coloring matter.
Resi^ectfuUy yours.
Fred. B. Powers,
Professor of Analytical Chemistry."
The resinous and coloring matter found by the \>xo-
fessor is from the saturated alcoholic tincture of coho-
thedra, which composes the body of the compound, which
seems to have no alkaloid. The compound now contains
a small amount of carbonate of ammonia, which is used
in prei)aring the cohothedra, which addition changes the
color to red.
Cohothedra is indigenous to the United States, flower-
ing in July ; and is perennial.
The Age desired the knowledge and plan of treatment
by which such good results were obtained, and as he was
so gentlemanly in his last criticism, to withhold it from
him would be unkind.
The Age now has the floor.
Fraternallv yours,
' J. O. Daw, M.D.
Springfield, Ohio.
BIBLICAL ETHICS vs. PERCn'ALS ETHICS.
'I'o THE Kditor of The Medical Record.
Sir : P'rom what has been said of late in the medical
journals and in the daily press with regard to the nature
and necessity of different codes of medical ethics one
would imagine that physicians are a different order of
beings from common men, and that they need a special
and peculiar standard of morals by which to regulate
their conduct. The old-fashioned idea of right and wrong
seems to be lost sight of in most of the discussions. It
seems to be taken for granted that there is need for a
special standard of ethics for the physician, a standard
which he himself has made and which does not apply to
other men or other professions. The physician is not
to ask. Is my conduct right and just according to the
standard by which other men regulate their conduct ? but
Is my conduct in accordance with the Code of Medical
Ethics ?
Now in other professions and callings most intelligent
men in this day hold that there is a code of ethics, com-
monly called Christian or Biblical, which binds all men
and which is equally applicable to all under all circum-
stances, in all professions, in all ages. It is a code which
is founded in right and justice. And, furthermore, any
code of ethics which is not founded upon the principles
of right and wrong as set forth in the Bible, and which
does not conform to its teachings in this regard, should
not be accepted as a rule of conduct. The teachings of
the Bible and the dictates of an enlightened conscience
are in harmony. Any code of ethics which leads a man
to violate his conscience or do that which the word ol
God or his conscience tells him is not right and just is
not to be obeyed.
In that portion of the world called Christendom Chris-
tian ethics nuist sooner or later prevail, even among phy-
sicians. Since the Reformation of the sixteenth century
the fundamental principle of ethics, as applied to all men,
no matter what their calling or profession, centres in the
Golden Rule, "As ye would that men should do to you do
ye also to them likewise," Luke vi. 31, and "Thou shalt
love thy neighbor as thyself." To love thus and to act
thus is the sum of human virtue.
Allow me to offer the following brief code of medical
ethics as derived from the Bible. Does the physician
want more than this standard by which to regulate his
conduct ?
I. — Duties of Physicians to Their Patients.
The physician should treat his patient —
1. Wii'h charity or love. — " Love worketh no ill to his
neighbor ; therefore love is the fulfilling of the law," Rom.
viii., 10. "Let all your things be done with charity,"
I Cor. .xiv., 14. "Above all things have fervent char-
ity," I Peter iv., 8.
2. With coiiscietitiousncss. — " He that walketh up-
rightly walketh surely," Prov. x., 9. "That which is
altogether just shalt thou follow," Deut. xvi., 20. "What
doth the Lord require of thee but to do justly," Micah
vi., 8. " Herein do I exercise myself to have always a
conscience void of offence toward God and toward men,"
Acts xxiv., 16.
3. With faithfulness.— "■'Ddm'g faithfully whatsoever
thou doest to the brethren, and to strangers," 3 John y.
4. With honor. — "Exact no more than that which is
appointed you," Luke iii., 13. "See that none render
evil for evil unto any man ; but even follow that which is
good, both among yourselves and to all men," 2 Thess.
v., 15. ".'\bstain from all appearance of evil," 2 Thess.
v., 22.
5. With patience. — "Be patient toward all men."
"Let ])atience have its perfect work," 2 Thess. v., 14.
6. With cheerfulness. — " A merry heart doeth good
like a medicine," Prov. xvii., 22. " A merry heart mak-
eth a cheerful countenance," Prov. xv., 13.
7. With candor.—'' A man that flattereth his neighbor
spreadeth a net for his feet," Prov. xxxix., 5. "Where-
fore putting away lying, speak every man truth with his
neighbor," Eph. iv., 25.
8. With helpfulness.— ''B\x\. to do good and to com-
municate forget not," Heb. xiii., 16.
9. Without boasting. — "Let another man praise thee
and not thine own mouth ; a stranger and not thine own
lips," Prov. xxvii., 2. "The Lord shall cut off flattering
lips and the tongue that speaketh proud things," Ps.
xii., 3.
II.— Duties of Physicians to Each Other.
Physicians should treat each other —
1. With justice. — " To do justice and judgment is niore
acceptable to the Lord than saciifice," Prov. xxi., 3.
" And what doth the Lord require of thee but to do
justly," Micah vi., 8. "The way of the just is upright-
ness," Is. xxvi., 7.
2. With peaceablcness.—'' Let us therefore follow after
the things which make for peace," Rom. xiv., 19. "Be
at peace among yourselves," i Thess. v., 13. "He will
surely reprove you if ye do secredy accept persons," Job
xiii., 10. " Blessed are the peacemakers," Matt, v., 9.
3. With unselfishness.— "-Look Viot every man on his
own things, but every man also on the things of others,"
Phil, ii., 4.
4. Not meddlesome.— "¥or, brethren, ye have been
called unto liberty, only use not liberty for an^ occasion
to the flesh, but by love serve one another," Gal. v.,
13. " Happy is he that condemneth not himself in the
thing which he alloweth," Rom. xiv., 23. "Who art
thou that judgest another man's servant? to his own
master he standeth or falleth. Let every man be fully
persuaded in his own mind," Rom. xiv., 4, 5. " Why is
my liberty judged of another man's conscience," i Cor.
X., 29.
5. With getter OS ity.— ''The liberal deviseth liberal
things; and by liberal things shall he stand," Is. xx.Kii., 8.
"The liberal soul shall be made fat," Prov. xi., 25.
6. With ho tie sty. — "Ye should do that which is hon-
est, though we be as reprobates," 2 Cor. xiii., 7. " Pro-
vide things honest in the sight of all men," Rom. xii., 17.
7. With considerateness.—-'He that despiseth his
136
THE MEDICAL RECORD.
[August 4, 1883.
neighbor sinneth," Prov. xiv., 21. "Be patient toward
all men," Thess. v., 13.
8. Not (Quarrelsome. — " Where envy and strife is, there
is confusion and every evil work," Jas. iii., 16. "And
be at peace among yourselves," 1 Thess. v., xiii. " Not
of the letter but of the spirit, for the letter killeth, but
the spirit giveth life," 2 Cor. iii., 6.
9. The golden rule. — " Therefore all things whatso-
ever ye would that men should do to you, do ye even so
to them,'' Matt, vii., 12. "Be kindly affectioned one to
another, with brotherly love, in honor preferring one
another," Rom. xii., 10. " Finally, be ye all of one mind,
having compassion onr of another : love as brethren ; be
pitiful ; be courteous, " i Pet. iii., 8.
III. — Duties of Physicians as Citizens.
" Submit yourselves to every ordinance of man for the
Lord's sake ; whether it be to the king as supreme ; or
unto governors, as unto them that are sent by him for
the punishment of evil-doers, and for the praise of them
that do well. For so is the will of God that with well-
doing ye may put to silence the ignorance of foolish
men. As free, and not using your liberty as a cloak of
maliciousness, but as servants of God. Honor all men.
Love the brotherhood. Fear God. Honor the king,"
I Peter ii., 13-17. " Finally, brethren, whatsoever things
are true, whatsoever things are honest, whatsoever things
are just, whatsoever things are pure, whatsoever things
are lovely, whatsoever things are of good report : if there
be any virtue and if there be any praise, think on these
tilings," Phil, iv., 8.
"Thou shalt love the Lord thy God with all thy heart,
and with thy mind, and with all thy strength. This is
the first and great commandment, and the second is like
unto it. Thou shalt love thy neighbor as thvself."
^Vill not a diligent study of Christian ethics enlarge
the understanding and elevate the feelings even better,
perhaps, than a study of Dr. Percival's disquisitions ?
Very truly yours,
Ci.ERICUS.
CoxALGiA AND SUBCUTANEOUS OsTEOTo.Mv. — In a pa-
per in the July number of the American Journal of the
Medical Sciences, Dr. H. R. Wharton records eight cases
of coxalgia followed by marked deformity, in which
eleven subcutaneous osteotomies of the femur were per-
formed. The results obtained were most satisfactory,
not only as regards the immunity from danger in the
operation, but also as regards the correction of the de-
formities and restoration to use of comparatively useless
limbs. The amount of constitutional disturbance follow-
ing the operations was insignificant, as little, or even
less, than that which follows a simple fracture of the
femur ; in no case was there excessive hemorrhage at
the time of operation, nor did there follow in any case
marked febrile reaction or suppuration ; the wounds
healed as ordinary tenotomy wounds, and by the end of
tlie first week were generally found entirely closed, so
that further dressings could be dispensed with. The fa-
cility with which the wounds healed in these cases can
only be explained by their subcutaneous character, for
although by the operation a compound fracture of the
femur is jiroduced, it must be remembered that the orig-
inal puncture, which is made down to the bone by Mr.
Adams's knife, is small, and that when the saw is intro-
duced and cuts the bone, the wound is entirely filled bv
its shank, by blood and by dust from the sawn bone, so
l>revcnting the admission of air to the deeper parts. The
results of reported cases bear strong testimony to the
general safety of the o|)cration, and there is no doubt
that the selection of proper cases, and care as to the po-
sition at which tlie section of the bone is made, will ren-
der this operation one of the safest in surgery. The pa-
per concludes with a full and careful discussion of the
various details of the operation.
^au gnstrxinxcuts.
A NEW SADDLE-CRUTCH.
By J.\MES R. TAYLOR, M.D.,
NEW YORK.
It consists of a small saddle so arranged that it can be
worn without inconvenience inside of the clothing. A
pair of suspenders are attached to the saddle on each
side, which terminate in steel hooks that are adjusted to
the tops of the crutches. When the suspenders are
fitted to the patient these hooks reach up to within
about two inches of the axillae, where the ends appear
outside of the clothing, and are the only parts of the ap-
paratus visible. The saddle is well padded to fit the
perineum, and of such form that the patient rests upon
it without discomfort while sitting.
When the crutches have been placed in the suspender
hooks and the patient walks, the weight of his body is
carried entirelv upon the saddle, and without the crutches
reaching the axilla;, so that no discomfort is experienced,
even in taking long walks. He swings easily between
his crutches, taking long steps if he chooses, and, if
otherwise strong, the weakness in his legs will not pre-
vent him from exercising all that is necessary. The
saddle-crutch possesses special advantages over the or-
dinary crutches, because the weight of the body is borne
by the well-cushioned pelvic bones resting upon a com-
fortable saddle. While designed by nature for the pur-
pose, the inconvenience and suffering attending exercise
upon ordinary crutches with the weight of the body sus-
pended upon cross-heads in the axilhv, is gotten rid of ;
and because the danger of injuring the axillary nerves
and blood-vessels is avoided.
The device is designed for use with ordinary crutches,
in all cases of lameness of the lower extremities neces-
sitating artificial aid in walking, and has been employed
with satisfiictory results by several patients, male and
female, who have suffered from fracture.
The Poison of Lizards. — Drs. Mitchell and Reichert
find that the full-grown lizard will bite, and cause a wound
that may prove fatal. Unlike that of other reptiles, its
saliva is alkaline, not acid. .\ little injected into a
pigeon caused the death of the bird (which was long, fat,
and plump) in less than nine minutes.
August 4, 1883.]
THE MEDICAL RECORD.
137
^trmrj miA ^tauij 3Ti.nD5.
Official List of Changes of Stations and Duties of Officers
of the Medical Department , United States Army, from
July 21, 1883, to July 2S, 1883.
Sutherland, Charles, Colonel and Surgeon, Medi-
cal Director, Military Division of the Pacific and Depart-
ment of California. The leave of absence granted by
S. O. 64, Headquarters Military Division of the Pacific,
June 30, 1883, is extended two months. S. O. 1C8,
A. G. O., July 23, 1883.
Baily, Joseph C, Major and Surgeon. Assigned to
duty as Post Surgeon at Fort Concho, Texas. S. O. S7,
Headquarters Department of Texas, July 19, 1883.
Appel, a. H., First Lieutenant and Assistant Surgeon.
Granted leave of absence for two months, with permis-
sion to apply for an extension of one month. S. O. 30,
Headquarters Military Division of the Atlantic, July 20,
1883.
Official List of Changes tn the Medical Corps of the Navy
for the -week ending July 28, 1883.
Gatewood, J. D., Past Assistant Surgeon. De-
tached from the New Hampshire and ordered to hold
himself in readiness for sea service.
Leuch, Philip, Assistant Surgeon. Detached from
the Receiving-Ship Franklin and ordered to the New
Hampshire.
Scott, Horace B., Assistant Surgeon. Ordered to
the Receiving-Ship Franklin, Norfolk, Va.
McMurtrie, D., Surgeon. Detached from the Re-
ceiving-Ship Franklin and granted sick-leave.
Whiting, Robert, Past Assistant Surgeon. Granted
one month's leave.
ipcediciil Itcnxs.
Contagious Diseases — Weekly Statement. — Re-
port of cases and deaths from contagious diseases re-
ported to the Sanitary Bureau, Health Department, for
the two weeks ending July 31, 1883 :
Week Ending
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Tulv 2d. 188^
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A New Theory of the Circulation of the Blood
IN The Arterial System. — A Spanish physiologist, Dr.
Ramon Turro, has put forth an ingenious theory as re-
gards the mechanics of the arterial circulation, and we
venture to offer an analysis of his views to your readers.
The leading ideas are that the elastic fibres in the arterial
walls cause dilatation rather than contraction — which
latter is the result of the muscular action, and that the
muscular walls of the arteries help to propel the blood
along.
Turro first exposes what he calls the fundamental
error of the reigning theory of the circulation, i.e., that
arterial elasticity causes diminution of the calibre of the
tube.
It is the muscular and not the elastic tissue, says he,
which causes retraction of the canal, as can be proved by
removing a small piece of an artery and destroying the
vitality of its muscular elements. What is the result ?
The elastic tissue causes dilatation of the tube, although
there is now no pressure to oppose its contraction. On
the other hand, elasticity if it acts in the direction of ar-
terial retraction cannot be brought into play until the
pressure of the blood has distended the vessel. Now,
this pressure, if it really^existed, would seriously injure
the delicate tissues in the same way that the violent in-
troduction of a large cylinder would do. But the arterial
system is not distended ; on the contrary, it is contracted
by the tonus of its muscular tissue, which is equivalent
to saying that its elastic tissue tends to reopen the con-
tracted vessels.
He then tries to prove that even without the presence
of muscular tissue in the arterial walls the vessels could
not be distended by the pressure of the blood. The sec-
tional area of the base of the cone which represents the
arterial system is eight hundred times as great as that of
the summit or aorta (Vierordt). Can we, therefore, he
says, suppose that the capillaries or base of the cone can
be so contracted as not to admit one eight-hundredth as
much blood as might enter at other times without caus-
ing distention ? The theory states that arterial tension
is caused by peripheral resistance ; if the resistance did
not exist this tension would be impossible. Very well,
this resistance does not exist ; on the contrary, that part
of the arterial system which ought to be the smallest is
precisely that which is the largest.
It is undoubtedly true that if the vessels tended to
close, as the theory affirms, the force of the heart would
be insutticient to drive the blood through them. This
has been proved by experiments on contractile tubes.
Nor is this all. If the conditions supposed by the me-
chanical theory to exist did so, the heart would have the
weight of the whole organism to raise, for movements of
elevation and depression are observed in all parts of the
body synchronously with the heart's beat. In resume vi^
see that elastic tissue does not exist in the sense of ar-
terial retraction, 1st, because it does not act at all ; 2d,
because, although the arteries have elastic walls, they act
as if they had none ; 3d, the supposition being true, the
force of the heart would be inadequate to drive on the
liquid column. After this general refutation of the me-
chanical theory of the circulation, Turro attacks Marez's
theory in particular. According to Marez if we lessen
peripheral resistance, the arteries send on the blood
more easily, so that with augmentation of the venous
How we have diminution of arterial tension and increased
activity of the heart's beat. Now these conclusions of
Marez are negatived by the experiments of Ludwig,
Thirz, Czon, e'tc. (called vitalistes, in contradistinction
to Marez and his followers, who are cs.\\cd mechanicistes),
experiments which proved that blood-pressure could be
raised at the same time that the frequency of the heart's
beat was increased. The vitalistes have shown that
when vascular paralysis is produced, stasis supervenes,
because there is no force to drive the blood on to the
heart, which seems to become feeble on this account.
If the mechanical theory of the circulation were correct
the vessels ought to urge on the blood and increase the
venous flow, peripheral resistance being diminished.
Instead of this we find the arteries more dilated than
when we supposed them distended by eccentric pressure,
the venous flow unchanged, and the rate of the heart's
beat diminished.
Marez states that when arterial tension augments, the
arteries above corresponding to the capillaries are
gorged with blood. Now this arterial tension is only an
ens rationis, besides, the application of the douche
shows, that when the blood cannot pass along the capil-
laries- as easily as before, the muscular tissue of the
higher arteries relaxes (it is the artery which enlarges,
and not the blood which distends it) and makes large
channels for it. These changes of diameter are due to
vaso-motor innervation. If we accept Marez's theory
we must admit that the condition of the small vessels is
138
THE MEDICAL RECORD.
[August 4, 1883.
opposed to that of the large ; the muscular tissue, how-
ever, of large and small vessels is continuous, hence the
state of the peripheral circulation is in equilibrium with
that of the arteries supplying the capillaries. To sum
up, we find that the energy of the heart augments and
diminishes with the venous flow, but we are not yet ac-
quainted with the true mechanism which modifies its
rhvthm. Since the elastic tissue is retracted the more
that the calibre of the vessel is diminished, we see that
we have two forces at work, one tending to close, the
other to reopen the canal ; dilatation, then, is elastic ten-
sion which becomes free. Thus, while the theory af-
firms that the elastic tissue retracts because it has been
distended, we say that it does so because it has been
pressed together by the rhythmical action of the muscu-
lar elements. The blood having passed that part of the
circulatory system where it is urged on by the cardiac
systole alone, reaches the arteries possessed of muscular
tissue, which contract behind the wave. Thus a slow
vermicular movement creeps along. Another important
factor is the elastic tissue, which dilates spontaneously at
the place that the muscular tissue relaxes, and allows the
blood to move along more freely.
Tonicity is a cohesion of the contractile plasma and is
in inverse ratio to the quantity of blood which nourishes
the muscular fibre. As soon as the flow of blood is di-
minished, the vessel contracts and adapts itself to the
lessened stream. This adaptation is due to the nutritive
modification of the fibre. Contraction and dilatation are
only two phases of the mechanism of nutrition. The
vessel will maintain itself in a permanent state of toni-
city at a determined degree as long as a repairing assimi-
lation will compensate for the incessant disassimilation
which takes place in its contractile substance by the for-
mation of new products due to its combustions. When
equilibrium is disturbed by an excess of nutrition, tonus
will be weakened by the nutritive relaxation of the mus-
cular elements ; when there is an insufiicient amount of
nutrition, movements of contraction will take place
which may continue up to post-mortem contraction.
When the flow is suspended the same disassimilation
goes on, or the nmscular substance coagulates and uses
u(i its own substance to repair waste until its power is
exhausted and it yields to the elastic tension. The con-
tracted condition found in rigid muscle is only a devel-
opment of the tonic cohesion normally present. Con-
tractility resides in the muscle plasma — elasticity in its
envelopes (sarcolemma, perimysium). The activity of the
heart is also regulated by its nutrition ; its energy nmst
necessarily become less when less blood reaches it, be-
cause then its tonicity increases, its substance becomes
impoverished, and its contractions become weaker each
time. Cardiac rhythm is increased or retarded with the
venous flow — energy is in inverse ratio to acceleration.
It is in the chemical activity of the muscular substance
of the heart that we must seek the secret of its rhythm.
Since the arteries contract when the amount of blood
circulating in them diminishes, we must admit that there
are rhythmical contractions, because the heart sends the
blood on intermittently. The artery conducts onward
the powerful impulsion imparted to it by the iieart. How
do the vessels dilate ? The vessel or portions of vessels
which are half bloodless retract in virtue of the increas-
ing tonicity by which the plasma exhausts itself in pro-
ducing contractions ; but as contraction increases the
elastic tissue is retracted and opposes resistance greater
or less according to the contraction, like a spring. The
blood exercises a pressure on the walls of the vessel for
the reason that they are retracted. This pressure and
elastic tension assist in passage of blood-plasma through
the Tessel, which being nourisiied, relaxes. Circulation
is more active in brain than in crural artery, which seems
to indicate that it is richer in muscular elements. The
kidneys, spleen, etc., have rhythmical contractions which
urge on tiie blood, so that we may speak not only of one
circulation, but of several.
Itch in the Cat. — A correspondent of the British
Medical Journal, Dr. John Reid, writes as follows re-
garding a case of " acarus " in a cat : "The cat in ques-
tion, when seen for the first time (it being a stray cat),
was greatly emaciated, and died on the following night
(January 5, 1883). The hair on one side of the face and
neck, including the ear, was matted so as to resemble
one large scab. The itch-insect and eggs were detected
in large numbers. The cat's liver contained many ab-
scesses of the size of a pin's head ; the lungs, etc., ap-
peared to be normal Does the cat infect children,
etc. ? do these infect the cat ? or is there mutual
infection ? ''
Eleci'rical Fi.ANNEt. FOR Rheum.\tism. — .\n elec-
tric curiosity which will soon be in the hands of charla-
tans has been invented by a Dr. Claudet. It is a flannel
to cure or alleviate rheumatism. It contains, per kilo, one
hundred and fifteen grammes of the oxides of tin, copper,
zinc, and iron. A series of threads of this fabric is im-
pregnated with these metallic products, and each series
is alternately separated by raw threads. The flannel
thus prepared constitutes a true dry pile. It is said to
develop electricity by simple contact with the body, or
better still, with the prodiKts of perspiration.
A Novel Method of Re.moving a Foreign Body
FROM THE GLsoPHAGUS. — Dr. Neuman was called to see
a horse which was choking ; the animal had been eating
carrots. Dr. Neuuian was unable to reach the foreign
body witli his hand. The horse's mouth was then opened,
and held open by a mouth siieculum. Then a common
water hose, which was at hand, was passed through the
speculum down the cesophagus until the foreign body
was reached. The water was turned on full force, and
the obstruction ^\i:>.\>'^iz.ie.i^.-t-Jouriial of Comp. Medicine.
Tal.mage on Doctors. — We all like to be patted on
the back once in a while, and brother Talmage does it
in the following very vivid and unexaggerated manner:
" Encourage all physicians. You thank him when he
brings you up out of an awful crisis of disease ; but do
you thank him for treating the incipient stages of disease
so skilfully that you do not sink as far down as an awful
crisis ? There is much cheap and heartless wit about
the physician : but get sick, and how quickly you send
for him. Some say doctors are of more harm than good,
and there is a book written, entitled, ' Every Man His
Own Doctor.' The author ought to write one more
book and entitle it ' Every Man His Own Undertaker.'
Do you think physicians are hard-hearted because they
see so much pain ? Ah, no ! The most eminent sur-
geon of the last generation in New York came into the
clinical department of the New York Medical College
when there was a severe operation to be performed upon
a little child. The great surgeon said to the students
gathered around him : ' Gentlemen, there are surgeons
here who can do this just as well as I can. You will ex-
cuse me, therefore, if I retire. I cannot endure the
sight of suftering as well as I once could.' There are so
many trials, so many interruptions, so many exhaustions
in a physician's life that I rejoice he gets so many en-
couragements. Before him open all circles of society.
He is welcomed in cot and mansion. Children shout
when they see his gig coming, and old men, recognizing
his step, look up and say, ' Doctor, is that you ?' He
stands between our families and the grave, fighting back
the disorders that troop up from their encampments by
the cold river. No one ever hears such hearty thanks as
the doctor. Under (;od he makes the blind see, the
deaf hear, the lame walk. The path of such is strewed
with the benedictions of those whom they have be-
friended. Perhaps there was in our house an evil hour
of foreboding. We thought all ho|)e was gone. The
doctor came four times that day. The children put aside
their toys. We walked on tip-toe and whispered, and at
every sound said, ' Hush ! ' How loud the clock ticked !
August 4, 1883.]
THE MEDICAL RECORD.
139
and, with all our care, the banister creaked. The doctor
stayed all night and concentrated all his skill. At last
the restlessness of the sufferer subsided into a sweet,
calm slumber, and the doctor looked around to us and
whispered, ' The crisis is past.' When, propped up
with pillows, the sick one sat in the easy chair, and
through the lattice the soft south wind tried hard to blow
a rose-leaf into the faded cheek, and we were all glad, and
each of the children brought a violet or a clover-top from
the lawn to the lap of the convalescent, and little Hertha
stood on a liigh chair with the brush smoothing her
mother's hair, and it was decided that the restored one
might soon ride out for a mile or two, our house was
bright again And as we helped our medical adviser
into thfi gig we saw not that the step was broken or his
horse sprung in the knees. For the first time in our life
we realized what doctors are worth. In some of our
minds among the tenderest of our memories is that of
the old family physician."
The Cure of Onychia and Ingkowinc. Toe-Nail.
— Dr. M. A. Veeder, of Lyons, N. Y., communicates the
following : " For the cure of onychia and ingrowing toe-
nail tlie following plan is simple and effective : Destroy
the fungous granulations by means of strong carbolic
acid, or silver nitrate, and then press back the diseased
tissue away from the sharp edges of the nail by means
of a piece of the ordinary felt-plaster so much used for
corns, which is to be applied as follows : Get a piece
large enough, such as that used for bunions if need be,
and cut it the size of the exposed surface of the nail.
Afoisten the adhesive surface of the plaster, and apply
it directly to the surface of the nail, pressing the margins
of the felt firmly against the diseased parts surrounding
the nail. It should be held in place until dry, when it
will be found to be strongly adherent, and it may then
be covered by a bandage, as a means of exerting. still
further pressure on the diseased parts. This dressing
may require to be renewed repeatedly, at intervals of
several days. The length of time recjuired for a radical
cure depending upon the extent to which the nail has
been disintegrated, the cure not being complete until
the parts destroyed are replaced by a fresh growth of
nail substance."
The Growth of Children. — Some inquiries have
been made by Dr. George W. Peckham, of Milwaukee,
Wis., regarding the growth of children. The data were
collected in Milwaukee. It seems that the density of
po|)ulation acts upon growth by affecting the health con-
ditions, and by making the struggle for existence more
intense. The greater height of males than females he
finds is due to two causes ; First, the arrest of growth of
lower extremities in girls of about fourteen and a half
years, boys experiencing no retardation in their growth ;
second, the falling off of the rate of growth in the bodies
of girls at about the fifteenth year, and the termination
of their growth at about the seventeenth year.
Who would not be a Doctor? — Quite a number of
our young men are studying for the medical profession.
We do not wish to deter them from this laudable pursuit,
for a physician's calling is one of the most honorable, en-
nobling, humanizing, and useful in the world. But all is
not gold that glitters, and the following are some of the
sweets of a doctor's life : If he visits a few of his pa-
tients when they are well, it is to get his dinner ; and if
he does not do so, it is because he cares more for the
fleece than the flock. If he goes to synagogue regu-
larly, it is because he has nothing else to do ; if he doesn't
go, it is because he has no respect for the Sabbath nor re-
ligion. If he speaks reverently of Judaism, he is a hypo-
crite ; if he doesn't, he is a materialist. If he dresses
neatly, he is proud ; if he does not, he is wanting in self-
respect. If his wife does not visit you, she is " stuck up ;"
if she does, she is fishing for patients for her husband. If
he has a good turnout, he is extravagant ; if he uses a
poor one on the score of economy, he is deficient in ne-
cessary pride. If he does not write a prescription for
every trifling ailment, he is careless ; if he does, " he de-
luges one with medicine." If he makes parties, it is to
soft-soap the people to get their money ; if he does not
make them, he is afraid of a cent. If his horse is fat it is
because he has nothing to do ; if he is lean, it is because
he isn't taken care of. If he drives fast, it is to make peo-
ple believe somebody is very sick ; if he drives slowly, he
has no interest in the welfare of his patients. If the pa-
tient recovers, it is owing to the good nursing he re-
ceived ; if he dies, " the doctor did not understand his
sickness." If he talks much, "we don't like a doctor to
tell everything he knows," or, "he is altogether too fa-
miliar ;" if he don't talk, " 7C'e like to see a doctor sociable."
If he says anything about politics " he had better let
it alone ;" if he don't say anything about it, " we like to
see a man show his colors." If he does not come imme-
diately when sent for, "he takes things too easy ;" if he
sends in his bill " he is in a terrible hurry for his money."
If he visits his patients every day, it is to run up a bill ;
if he don't, it is unjustifiable negligence. If he orders
the same medicme, it does no good ; if he changes the
prescription, he is in league with the druggist. If he uses
any of the popular remedies of the day, it is to cater to
the whims and prejudice of the people, to fill his pockets ;
if he don't use them, it is from professional selfishness.
If he is in the habit of having frequent consultations,
it is because he knows nothing ; if he objects to having
them, on tlie ground that he understands his own busi-
ness, " he is afraid of exposing his ignorance to his supe-
riors." If lie gets pav for one-half his services he de-
serves to be canonized. Who wouldn't be an M.D.? —
The Hebreiu Standard.
The Empress of Germany. — The wife of the Amer-
ican Minister at Berlin, Mrs. Sargent, in a letter describ-
ing a call upon the Empress, said : " Her Majesty sur-
prised me by asking about my daughter Lizzie. She had
heard that Lizzie began the study of medicine in Cali-
fornia, and was now continuing it in Zurich. ' We are
much interested in medicine,' the Empress added, and
then spoke of the civil war in America and the Franco-
Prussian war, saying that the Germans had gained much
valuable information from the Americans as to the treat-
ment of sick and wounded soldiers, which was put to
good use in their last war."
A Case of Glosso-laeio-pharyngeal (or Bulbar)
Paralysis with the Lesion in the Cerebral Hemi-
spheres.— Dr. C. K. Mills, at the June meeting of the
College of Physicians of Philadelphia, said that the pres-
ent was a good opportunity to put on record an observa-
tion on cerebral glosso-labio-pharyngeal paralysis. It is
well-known that this affection is usually attributed to de-
generation of the cranial nuclei ; in fact, it is often called
" bulbar paralysis." A patient presenting the oral, labial,
lingual, and pharyngeal symptoms of this disorder, had
died about two years before at the Philadelphia Hospital.
E.xamination showed no lesion of pons or medulla. Along
the outer border of botli lenticular nuclei, and extending
into the external capsule and claustrum, were long, nar-
row, and somewhat irregular areas of degeneration ;
softened or broken-down districts surrounded by walls of
harder, darker tissue. Kirchoft" and others had since re-
ported similar cases, but up to the time of making the
observation he had never seen such a case reported.
The Sixth and Seventh Cranial Nuclei. — At a meet-
ing of the College of Physicians of Philadelphia, June
6th, Dr. Harrison Allen called attention to the curious
apparent discrepancy between the anatomical and phy-
siological relations of the sixth and seventh cranial nuclei.
He said : " The cranial nerves at their nuclei of origin
and in the course of their intrinsic fibres may be involved
in diseased action. It would seem to be more than a
coincidence that the nuclei of the ninth, tenth, and elev-
enth nerves are arranged in a definite series, forming the
trineural fasciculus ; and that the nerves themselves are
I40
THE MEDICAL RECORD.
[August 4, 1883.
associated in function. But this line of reflexion is use-
less when applied to the nuclei of the sixth and seventh
nerves. These nerves appear to have no function in
common, and yet they arise, in part at least, from the
same nucleus. In their range of variation they have no
relation with one another ; nor in any animal known to the
writer does the sixth nerve si)ring from the facial trunk, but
always (in variations from the human type) from the third.
The third, fourth, and sixth nerves are naturally associ-
ated ; but no reason is assigned for the withdrawal of the
nucleus of the sixth from the mid-brain ; where the nuclei
of the third and fourth nerves lie, to the hind-brain, where
it is in association with an alien, namely, the seventh.
Associated paralysis of the third, fourth, and sixth nerves
is common ; but paralysis of the sixth and seventh is rare.
Human Parasites. — Dr. George Sutton, in an article
in the Cincinnati Lancet and Clinic, gives the following
list showing the principal parasites which infect the hu-
man system :
Microzymes. — Micrococci: Probably of small -pox,
cow-pox, measles, scarlatina, varicella, erysipelas, syph-
ilis, gonorrhoea. Bacilli : Probably of typhus fever, ty-
phoid fever, tuberculosis, anthrax, leprosy. A'ibrio. Fi-
larla : Probably of elephantiasis. Spirillum : Probably
of relapsing fever. Bacteria : Probably of septiciumia.
Entozoa. — \'ermes — Cestoda : Probably of ta;nia el-
liptica, ttenia flavo punctata, ti\;nia medio canellata,
taenia nana, t;"enia solium, t;tnia bothriocephalis canda-
tus, taenia bothriocephalis latus. Nematoda : Probably
of ascaris lumbricoides, ascaris mystax, oxyuris vermi-
cularis, tilaria medinensis, dochmius duodenalis, tricho-
cephalis dispar, trichina spiralis. Trematoda : Probably
of monistoma, distoma.
Epizoa. — Insects — Acarus scabei. Pediculida : Prob-
ably of pediculus capitis, pediculus vestimenti, pediculus
tabesentium, pediculus pubes originalis. Pulix : Probably
of pulix irritans, pulix penetrans. Ixodia : Probably of
ixodes americanses, Ixodes numarias, ixodes erenatus.
Undoubted vegetable parasites and their diseases. —
Microphites — Achorion schonleinii : Probably of favus.
Trichophyton tonsurans : Probably of porrigo scutulate.
Microsporon andonini : Probably of porrigo decalvans.
Microsporon mentagrophites : Probably of mentagra.
Microsporon furifur : Probably of tinea chloasma.
Sea-Bathing. — At the present time, when the sea-
bathing season is about to commence, it may be useful
to recall the chief general indications and contra-indica-
tions which respectively sanction and forbid bathing in the
sea. " Shall I bathe ? " This is a question which thou-
sands of health-seekers will be asking of their doctors
during the next few weeks. While the stimulus of a
fresher air, of change of scene, and of new occupations,
together with rest from accustomed work, aie the ele-
ments from which the weakly, the worn, and the worried
reap physical and mental restoration in a sojourn on the
sea-coast, it is unquestionable that bathing in the open
sea is, in itself, a powerful restorative agency, which
liianypersonsmay employ with very great advantage. The
universal experience of our race, through unnumbered
ages, has shown the value of sea-bathing in both prevent-
ive and curative medicine. A good rule, laid down by
an experienced physician, is this : In all cases showing
impaired functional powers, without any manifestation
of inflammatory symptoms — in short, in those cases in
which the exhibition of alteratives and tonics is indicated
— sea-bathing, may, with proper precautions, be resorted
to ; it is contraindicated in persons of plethoric habit of
body, in cerebral congestion, in organic disease of the
heart, in aneurism, and in all persons who liave the in-
ability safely to encounter a comparatively severe shock ;
while it is also to be forbidden at certain periods in
which the female constitution is not prepared for the ap-
plication of powerful remedies. Because it tends, in
certain conditions of impaired health, to cause determin-
ation of blood to the viscera. Bathing in the open sea is
generally unsuitable for persons disposed to congestive
disorders of the lungs, kidneys, liver, and brain. Albu-
minuria, advanced anaemia, and a liability to hemoptysis,
are also conditions with are usually accepted as contra-
indicating sea-bathing. It is hurtful to bathe babies in
the sea ; children under two years of age are too young
to bear with advantage the comparatively severe shock
of a cold sea-bath. In old age, when the bodily powers
are unequal to a vigorous reaction, sea-bathing may do
much harm, especially in the subjects of extreme arterial
degeneration. In suitable cases, and under proper pre-
cautions as to time of bathing and duration of exposure,
a daily bath in the open sea is a valuable restorative.
In individuals who are fairly robust, it is a stimulant al-
terative and tonic, promoting appetite, tissue-change,
and excretions, and bracing up the nervous, vascular, and
muscular systems. Sea-bathing is especially useful as a
powerful and unsurpassed tonic in delayed convales-
cence from acute diseases, in many chronic affections,
and in persons whose strength has become enfeebled by
injurious excesses, by mental strain, or by unhealthy oc-
cupations.— British Medical Journal.
AwAV WITH THE Spoon. — A contemporary proposes
to get rid of the use of " spoonfuls " as doses by the fol-
lowing expedient : " Let each bottle (vial) be provided
with a strip of paper pasted on, which strip is accurately
divided with as many lines (marks) as the bottle contains
doses to be taken, the lines to be numbered, beginning
with the topmost, and let the directions read : Take one
eighth (fourth, twelfth, etc.), part, etc., as the direction
shall run, or, perhaps better, take one division, etc. The
strip to reach from the bottom of the bottle (vial) to the
top of the liquid, not farther."
Professor Virchow and the Swiss Pill. — Professor
Virchow has fallen under the displeasure of the Congress
of German Physicians, a society which meets annually to
take' cognizance of medical ethics and allied matters.
He has been charged with giving a testimonial to a
secret remedy, the pilula; helveticae of a Dr. Brandt, of
Schafthausen ; and doubtless many of our readers have
themselves received the laudatory notices whicli accom-
pany these famous " pills," the distribution of which has
not been limited, ^'irchow, in a letter to the Berliner
Medizinische Wochenschrift, marvels at the amount of
displeasure which he has apparently incurred. He says
that he received some of the pilula; helvetica last win-
ter, with a letter from Dr. Brandt asking him to give
them a trial. Some time afterward came another appeal,
and, being himself in the need of such a remedy, he tried
their effect on himself. The result was so satisfactory
that he penned a few lines to the inventor, which the
latter forthwith published without Virchow's sanction,
pleased, no doubt, when such testimony came from
so high a quarter. From that time Virchow has had no
peace — letters and circulars, signed and unsigned, have
been addressed to him complaining that he was violating
the ethical law in giving a testimonial of a secret remedy ;
and this has culminated in the remonstrance addressed
by the chairman of the conunittee of the Aerzte-verein-
bund. The committee also procured an official analysis
of the pills, which, however, only went to show that their
composition was nothing very extraordinary. Virchow
denies that he ever gave a testimonial at any time for
these or any other pills. He withdraws from the Bund, and
appeals from its arbitrary action to his medical brethren
at large to pass a judgment free from the paltry and nar-
row trades-unionism which characterizes this act.
ANSWERS TO MEDICAL CORRESPONDENTS.
Dr. S. W. C, Imua : Yes, two grains of sirjchnia was a large dose
for that baby.
No, his convulsions were not entirely due to teething.
No. it does not make any difference if you did pass second in your
class when you graduated ; the law will hold you just as responsible.
Yes, before a jury it would perhaps be a mitigating circumstance
that you had graduated without ever seeing a case ; but the father of
the child could not prosecute your medical college.
The Medical Record
A Weekly Journal of Medicine and Surgery
Vol. 24, No. 5
New York, August ii, 1883
Whole No. 666
(Dvioituat Articles.
THE PRESENT ASPECT AND FUTURE PROS-
PECTS OF MEDICINE.
An Address Delivered at the Fifty-first Annual
Meeting of the British Medical Association.'
By a. T. H. waters, M.D., F.R.C.P.,
SKNIOR THYSICIAN TO THE ROVAL INFIKMAKV, AND PKOFRSSOR OF MEDICINE IN
UNIVERSITY COLLEGE, LIVERPOOL, PKESIDSNT OF THE ASSOCIATION.
Gentlemen : I esteem it an honor of no common kind
to be elected President of the British Medical Associa-
tion, and to be called upon to take the chair at one of
its annual gatherings ; and to me the honor has a special
value, for 1 can look back on many years of close rela-
tion with the society ; it has been the means by whicli
I have formed friendships whose importance I cannot
overestimate, and its meetings have been among the
most interesting circumstances of my life. Your kind-
ness, therefore — the kindness of my fellow-residents and
of the Association at large — in placing me here to day,
deserves my warmest thanks, and will always be held in
grateful remembrance.
Twenty-four years have passed since the Association
met in Liverpool to celebrate its twenty-seventh anniver-
sary. These years have been marked by the uninter-
rupted i)rosperity of our society, by a large increase in
our numbers, and an increasing interest in the jiroceed-
ings of our annual gatherings. With reference to our
success, it may, perhaps, be sufficient to say that, whereas
at that time and up to the year 1866 we numbered about
twenty-three hundred members, we are now ten thousand
strong. May the future progress of the society be ever
in accordance with its experience of the past ; and may
he who shall open its next session in this city be able to
say, with as much truth as I can to-day, that the Associa-
tion has increased in strength with its increased years.
But, gentlemen, while we congratulate ourselves on
the success of our efforts in connection with this large
Association, let us never forget that we are all members
of a still larger body — that we belong to the great com-
monwealth of medicine, which knows no distinction of
race, or clime, or people ; and that, while it is our duty,
and should always be our aim, to promote the special
objects for which our society was founded, our highest
duty and our noblest aim should be to foster the general
interests of medicine, and to endeavor to advance it as a
science and as an art ; and, in the few remarks which I
have to address to you on this occasion, I purpose to
dwell, very briefly, on some of those points which seem
to me worthy of our attention with reference to the pres-
ent condition and future prospects of our profession ; for,
although there are many topics of local interest to which
I might refer, all that relates to Liverpool — its medical
history, its hospitals, its school of medicine, its University
College, its public buildings, its river, and its docks — has
been so well treated of in some recent numbers of our
Journal, that any further observations on the subject are
altogether unnecessary.
When last we met, in Worcester, we celebrated our
jubilee, and it was well to look back on the period which
had elapsed since our society was founded, and to refer
with satisfaction to the good work which it had done, and
^ Held in Liverpool, July 31, and August i, a, and 3, 1883
the progress which medicine had made during the previous
fifty years. And while echoing to-day all that was then
so ably expressed, 1 think it would be well if we were to
consider that we have now entered on a new phase — that
we have taken, as it were, a new departure, and that
with the great advantages we possess we should, as a
society, and also as a profession, strive to develop our
science more rapidly in the future than it has been de-
veloped in the past, and that our progress should be
more marked in all that relates to the higher aspirations
of our calling.
Nor are there wanting signs which point to the jn'ob-
ability of such a consummation. We now see a higher
standard of medical education insisted on ; we see, on all
sides, the inductive method of investigation brought to
bear on the great problems of medicine ; more and more
we see dissatisfaction with our ])resent uncertain and in-
exact knowledge ; and we cannot doubt that the obser-
vations which are being carried on, and especially those
which are being conducted under the auspices of our
Collective Investigation Committee and of the Society
for the Cultivation of Medicine by Original Research,
will before very long bear fruits, and lead to generaliza-
tions of the most important kind.
To my mind there is nothing in the present aspect of
medicine more satisfactory, or more likely to raise it
from the region of empiricism and place it on a higher
scientific level, than the endeavor now being made to
lender our knowledge more definite and exact ; and if I
were to point to one circumstance which, in my opinion,
has, probably more than any other, contributed to this
result, I should say it was the introduction into our prac-
tice of instruments of precismi. These have furnished
us with means by which the senses may be placed in
immediate relation with the actual phenomena of disease,
and these phenomena are sometimes of so simple a char-
acter, and yet so indicative of the general morbid state,
and require so little mental analysis, that the very tyro*
can almost read their significance.
No more important step was ever made in practical
medicine than that of the application of physical princi-
ples to the diagnosis of diseases of the chest. In what
condition would now be our knowledge of diseases of
the lungs, had the researches so largely associated with
the name of Laennec never been made ? In what con-
dition was the knowledge of cardiac diseases before the
investigations and experiments of the i>hysiologist gave
us definite information with reference to the movements
of the heart, the action of its valves, and the causes of
its sounds? The differentiation of lung and heart aftec-
tions by the aid of physical inquiry, the possibility of
making an exact diagnosis without investigating one sin-
gle general symptom, constitute a triumph for medicine
which is not to be surpassed in the practical application
of scientific principles in any other department of hu-
man knowledge; and we must not forget that this marked
advance has been achieved in a comparatively short space
of time, for it was not till 1819 that Laennec gave his
observations to the world.
What can be more striking than the results of physical
inquiry in pulmonary or cardiac diseases? Let us sup-
pose a student in medicine following, for the first time, a
competent teacher through the wards of a hospital.
He sees him stop at the bedside of a patient suffering
from one of these aflections; he watches him as he
makes his examination ; he hears a few leading ques-
142
THE MEDICAL RECORD.
[August II, 1883.
tions put, he sees a few gentle blows struck; a brief
application of the stethoscope ; and then, without any
hesitation, the (ihysician, turning to his class, tells of the
nature of the case — that there is consolidation of a
lung ; effusion into the pleura ; disease of a particular
valve of the heart, hypertrophy of its walls, or degenera-
tion of its fibres. He speaks of the mode of origin of
the affection, the course it will probably take, and the
issue that will come. Our student is struck with aston-
ishment at the apparent facility of the diagnosis, and the
rapidity with which it has been made. He watches the
progress of the disease, and he finds becoming devel-
oped the conditions which were foretold ; and (if, unhap-
pily, the case terminates fatally), on a subsequent day,
following his teacher to the post-mortem theatre, he sees
the body of the patient submitted to examination ; he
sees revealed by the scalpel the condition which exists.
He sees that there is consolidation of a lung; eflusion
into the pleura , valvular disease of the heart ; hyper-
trophy of its walls, or degeneration of its fibres ; he sees,
in fact, a verification, in its minute details, of the diag-
nosis that was made, and he is apt, perhaps, at once to
conclude that medicine is one of the most exact of the
sciences.
It would be well if in all departmentsof medicine there
were the same facilities for exact diagnosis as in diseases
of the heart and lungs ; but what the application of
acoustic principles has done in these affections, the ap-
plication of chemical principles, and the use of the mi-
croscope, the ophthalmoscope, the laryngoscope, and the
sphygmograph, have in a measure done for the diseases
of some other organs. And may we not hope that, with
reference to the diseases of the nervous system — the most
obscure of all which come under the notice of the physi-
cian— -the researches of the present day, and the attempts
now being made to clear up our knowledge of the phy-
siology of the brain, and to localize its various functions,
may be followed by results which will add largely to our
powers of differentiating nervous affections, and of suc-
cessfully treating them ?
Again, in referring to instruments of precision, let me
observe how important are the results which have followed
the use of that instrument which, when the Association
last met here, was scarcely ever used in this country,
but which is now the constant companion of every prac-
titioner— the clinical thermometer. How valuable is
the information which it gives ! How intimately does it
place that important factor of fever — increased temper-
ature— under our observation ! Without attempting to
discuss the relations of heat to the other phenomena of
fever, I may observe that, in a large number of cases of
disease, the measure of the temperature is undoubtedly
the measure of the danger ; and that the immediate re-
cognition of its rise to an inordinate extent is the first
step toward the application of means on which the life
of the patient may depend. Were this the proper occa-
sion, I should like to dwell on the great value which the
scientific use of the thermometer has been, and is likely
still further to be, to the practical physician. Not only
has it enabled him to recognize conditions of hyper-
pyrexia fraught with extreme peril, and thus to use at the
right moment measures for reducing temperature which
have been followed by the most beneficial results ; not
only has it afforded a means by which the constant at-
tendant on the sick can ascertain the development of
serious symptoms ; but its further application, and the
recognition, by its use, of the special oscillations of tem-
perature which characterize some diseases, have enabled
the physician to differentiate between affections in which
other means of diagnosis have been insufficient ; wliile,
by still more extended observations with the instrument,
we shall perhaps be able to explain, more fully than we
now can, the causes which underlie the variations of tem-
perature which are so marked a feature of some affec-
tions ; and possibly this knowledge may influence bene-
ficially our treatment of them. And, in referring to this
subject, I cannot refrain from alluding to the fact that it
was a Liverpool physician, Dr. Currie, who, early in the
present century, was the pioneer in the use of cold ap-
plications to the surface of the body in the treatment of
fevers; and, although Currie' s practice fell into disuse,
the merit of initiating a method of reducing temperature,
which the use of the thermometer has enabled us in the
present day to place on a more successful basis, may, I
think, be fairly claimed for him.
How often has the use of the laryngoscope enabled the
practitioner to recognize the true bearings of certain
laryngeal symptoms, and to differentiate between organic
disease of the larynx and the results of pressure from a
thoracic tumor ! How often has it enabled him to de-
cide on the nature of a laryngeal growth, and the possi-
bility or otherwise of successful medical or surgical
treatment ! How much do we not owe to the introduc-
tion of the ophthalmoscope — an instrument which has
literally thrown a flood of light on the afieclions of the
eye, and may be said, indeed, to have revolutionized the
whole practice of ophthalmic medicine ; while, by enab-
ling us to recognize certain conditions of the eye, and to
interpret their significance with reference to other morbid
states, it has materially aided the work of the general
physician.
The sphygmograph is an instrument which, though
largely employed in hospital work, has not hitherto found
its way into general use. It cannot be said to have had
much influence on our practice ; but I think we often
derive important indications from it with reference to
the state of the arterial system and the degree of arte-
rial tension which exists ; and possibly by a more fre-
quent employment of it we might be able to recognize,
at an earlier stage than we now can, those manifestations
of incipient disease which frequently pass unnoticed, and
therefore untreated. Further, in certain acute diseases,
the sphygmograph often gives indications which are im-
portant in regard to prognosis. The hyperdicrotism of
the pulse, as shown by the instrument, ma}' indicate the
extreme gravity of a case which other symptoms fail to
point out.
I am glad to see that in the Section of Medicine a dis-
cussion is to take place on the subject of arterial tension,
and I hope that some valuable information may be eli-
cited from it. I believe that important results may be
expected to follow from more exact observation on the
condition of the arterial system.
The great results which have followed the application
of physical principles to the recognition of disease, con-
stitute the common-places of medicine of the present day ;
and perhaps I ought to offer some apology for dwelling
upon them ; they are, nevertheless, the great facts of
medicine, they are the facts to which we can point as
showing the scientific basis of our art, and their value
can be appreciated only by those who are engaged in the
practical application of therapeutics. They are, more-
over, the main guarantee which we have for progress in
the future ; for who shall doubt that the next half cen-
tury will be more fertile in the production of instruments
of precision, and in bringing scientific principles to bear
on the work of the physician, than that which has just
passed ? Who shall doubt that as the result of the more
rigid application of the inductive method of research, and
more careful and combined clinical investigation, our
powers of generalizing on disease, and of diflerentiating
between the variations which it presents, will be largely
increased ; that diagnosis will be more easy, and treat-
ment more successful ?
In considering the standpoint of medicine, we should
always bear in mind that medicine must be judged by the
therapeutic results which it achieves ; and in proportion
as we can show that the researches of the physiologist, the
pathologist, and the chemist, and the application of scien-
tific principles, have enabled the physician to deal more
successfully with disease, to anticipate its development,
to recognize its earliest symptoms, to mitigate its severity,
August 1 1, 1883.]
THE MEDICAL RECORD.
143
and reduce its rate of mortality, so do we establish for
our art a claim on the confidence and gratitude of man-
kind ; and in this respect the present state of medicine
shows no slight advance on the past, and i)romises a more
rapid progress in tlie future. The past five and twenty
or thirty years — not to go further back — have been
marked by the general develojjment of views with refer-
ence to many diseases, such as have largely and bene-
ficially influenced our treatment of them ; and as I took
an illustration of the value of physical investigation from
diseases of the chest, permit me to refer again to some
of these aftections in speaking of the question of treatment.
With regard to the affection which we term pneumonia,
have we not seen the introduction into practice of a mode
of treatment which has deprived the disease of much of
its teiror, and greatly reduced its mortality? Whatever
be the views which we entertain of the nature of pneu-
monia, the important fact remains that we may enumer-
ate among the successes of medicine of the present day
a large reduction in the mortality from the affection.
Again, the recent development of the practice of tap-
ping the chest in pleuritic effusion, an operation com-
paratively rarely performed thirty years ago, is, in my
opinion, a very marked improvement in tlieraiieutics.
Those who have carefully watched the progress of metli-
cine in this matter, know full well how great have bcfii
the changes which have taken place within the last
quarter of a century, and especially since the introduction
of the aspirator. It is impossible to refer to all those to
whom we are indebted with reference to this subject, but
Trousseau, as a pioneer, and Bovvditch, whose large ex-
perience and satisfactory results exercised so beneficial
an influence, I must not pass over ; while there are
many in this country to whom we owe no less a debt of
gratitude. There is, perhaps, from the facility with
which tapping may be performed, and the almost entire
absence of risk when it is properly performed, a fear that
it may sometimes be resorted to unnecessarily. But, from
what I may term a somewhat large experience in the opera-
tion, I can speak with confidence of its value and safetv
m both acute and chronic effusions ; and I cannot but
think that, as the result of the early [jerformance of the
operation, we shall see, every year, fewer of those cases
of deformed chest which so freciuently follow neglected
pleuritic effusion.
. How satisfactory have been the [jractical results which
have followed the researches that have been made,
within the past half century, into the nature of continued
fevers! It is now about forty years since Stewart
(whose recent loss we have to deplore) published his in-
vestigations in typhus and typhoid, and showed their
distinct and separate individuality. Other laborers have
since worked in the same field, and have established,
beyond a doubt, the facts which he then demonstrated,
the knowledge of which has largely tended to the pre-
vention of these affections, and enabled us to trace to
their source many outbreaks which, in former times,
would have, been involved in mystery. Nor can we
point, perhaps, to any one circumstance which has had a
more beneficial influence on the treatment of these
diseases than the recognition of the pathological changes
by which they are characterized. The precautions
which we consider imperative during convalescence in
the one disease — precautions which may be, in large
measure, neglected in the other, are but the outcome of
the careful investigations which have been made into the
morbid changes by which the two affections are attended.
.\nd if we have abandoned the idea that these fevers
can be cut short by any measures, or the admmistration
of any drug ; if we have no faith in any specific line of
treatment, and are, for the most part, content to watch
our patients carefully, and to guide them, as it were,
through their attacks, this is not scepticism — it is the
result of a more intimate knowledge of these tliseases, of
a better acquaintance with their natural history, and a
better appreciation of their pathological changes. We
wait for further insight into their essential nature, and we
are not without hope that fresh discoveries will give us
increased power, in regard both to their prevention and
their treatment.
It is impossible to enumerate the various affections in
which there is a marked improvement in treatment, and
those which I have referred to nuist be considered simply
as illustrations o£ my position ; but while I speak with
satisfaction on this subject, I must not forget to mention
that, in the midst of many successes, we have instances
of, I will not say actual, but comparative failure. Our
knowledge of the pathology of some affections remains
very imperfect, and our therapeutics are in some respects
very unsatisfactory. Although rheumatic fever is one of
the most common diseases, it must be confessed that we
are ignorant of its pathology. During the past few
years there has been introduced into practice a mode of
treating the disease by the compounds of salicylic acid,
which has met with general adoption, and has been
largely successful. I can add. the testimony of my ex-
jjerience in its favor ; but still, with all the opportunities
which we possess of studying the affection, we are as yet
unable to give any satisfactory explanation of its essential
nature.
.A.gain, how unsatisfactory is the knowledge we possess
with reference to the pathology of diabetes ! We have
long recognized its clinical features, and we are often
able to modify its course, and mitigate its symptoms ;
but of its real nature we are ignorant, and nothing has
tended to show this more than the discussion recently
carried on at one of our societies. But this confession
of our ignorance is one of the most promising features of
our day, it is that which gives us assurance that every ef-
fort will be made toward increased knowledge in the
future. Whence comes this want of success in the inves-
tigation of the nature of diabetes ? We have approached
it from the physiological side, from the chemical side,
and from the pathological side, and have failed. Can
we hope that by combined observation of its clinical
features, of its life-history, and its relation to families and
individual peculiarities we may elucidate its nature?
May we hope that it is one of those subjects which will
l)e inquired into, and the problems of which will be
solved by the labors of our Collective Investigation Com-
mittee ? I recommend it to their consideration.
.A.nd here I must express the great satisfaction with
which, in common, I am sure, with every member of the
Association, I have seen the establishment of this Col-
lective Investigation Committee, how strongly I feel that
it is capable of accomplishing most valuable work, and
how much I think we are indebted to Professor Hum-
phry for initiating the movement. Doubtless, a large
part of the work of the committee will consist in collat-
ing facts with reference to specific diseases ; but there is
one line of inquiry which, I trust, will receive from it a
share of attention. I mean the consideration of the
l)oints of difference between functional disturbances.and
the early symptoms of organic affections. How difficult
is it sometimes to say, when some slight symptom pre-
sents itself, and when no objective signs of organic dis-
ease can be discovered, whether that symptom indicates
incipient structural change or mere functional disar-
rangement ! Upon the right appreciation of the phe-
nomenon, however, the safety of the patient may de-
pend ; for, although we stand almost powerless to arrest
the course of confirmed structural changes, there can be
no doubt that, could we recognize the earliest steps in
these changes, could we see clearly the points of de-
parture from normal conditions in various chronic and
hitherto incurable maladies, we might do much to check
these alterations of structure, and prevent the further
progress of the disease.
In an investigation of this kind, our hospital work is
comparatively useless. There we are brought into rela-
tion, for the most part, with disease already well marked
—disease which has produced its easily recognizable re-
144
THE MEDICAL RECORD.
[August II, 1883.
suits ; and if patients present themselves with slight
symptoms, they perhaps soon recover, and are lost sight
of. It is in the daily work of private practice that ob-
servations such as I have referred to can alone be satis-
factorily made ; and it is, therefore, to the great bulk of
])ractitioners throughout the country that we must look for
aid in this matter. It involves a lengthened study of each
individual case ; a close watching, ifot for weeks or
months, but for years; and perhaps the facts gathered in
a lifetime might be but few. It relates to the considera-
tion of subjective symptoms which we cannot accurately
estimate with our present physical means, but which are
intimately associated with individual peculiarities and
idiosyncrasies, and often form the most important ele-
ments in our diagnosis, prognosis, and treatment. It
may be that, with more refined iriStruments of precision
and greater scientific knowledge, we shall bring many of
these symptoms within the range of [jliysically recogniza-
ble facts ; but, in the meantime, inquiries such as I have
referred to may materially aid us.
But, gentlemen, of all the questions which now engage
the attention of the pathologist and physician, there is no
one which surpasses in importance that which relates to
the dependence of certain diseases on micro-organisms.
The subject is one of the greatest possible interest, and
frauglit with bearings of a practical character w^hich al-
ready have had. and are doubtless destined still further to
have, a vast influence on the prevention and treatment
of disease The establishment of the fact that pebrine,
chicken-cholera, and splenic fever depend on the pres-
ence of specific microbes, and that relapsing fever has
associated with it, if not indeed causing it, a like organ-
ism, must be classed among the most striking discover-
ies of the present day, and undoubtedly mark an epoch
in the history of pathological science ; while the gradu-
ally accumulating evidence that tuberculosis is the result
of a parasitic element seems likely to lead to its being
placed in the same category as those affections the pa-
thology of which appears now to be clearly established.
Moreover, the brilliant results which have followed the
process of attenuative culture of the virus of some of the
affections to which I have referred, and the ])rotective
influence of vaccination by these attenuated fluids, as
carried out by Pasteur, lead us to hope that, by further
researches in the same direction, we may yet discover
some means for checking the ravages of tuberculous and
other allied diseases, as certainly as the great discovery
of Jenner has enabled us to check the ravages of small-
pox.
Nor is it possible, [lerhaps, to jftiint to any single fact
in connection with the practical ajjplication of science
which is more striking than that of the relation of disease
to minute organisms. The whole subject has been
evolved from the researches of a few naturalists who
studied the smallest of living beings. What possible
use, might it not have been said, could in\estigation of
this kind have in reference to the maladies either of man
or the lower animals ? And yet we have seen that these
studies of minute life have led to the prevention of a
disease which threatened to destroy the source from
which we derive one of our sta|)lc products of manu-
facture ; they have been largely instrumental in check-
ing the ravages of a malady which is so fatal among the
flocks and herds of various countries ; they have led to
the introduction into the practice of surgery of a mode
of treatment, the beneficial effects of which it is not for
me to dilate on ; and, lastly, it seems likely that they will
materially alter our views with reference to some of the
most serious diseases to which mankind is subject.
These facts tend to show on how wide a basis the
science and art of medicine rest, and how closely their
advance is mi.xed up with, and dependent upon, the procu-
ress of other sciences. In truth, there is nothing in the
whole range of nature which the physician may not make
use of for the purposes of his work.
Of the many problems whicli await solution in con-
nection with the subject which I have just considered,
no one is more pressing than that of the dependence, or
otherwise, of pulmonary consumption on the bacillus
which has been so largely found, not only in the morbid
deposits which result from the disease, but in the ex-
pectoration of phthisical patients. Should it be found
that in all cases of genuine tubercular phthisis the bacil-
lus tuberculosis is present, and should future researches
show that the disease is caused by the parasite, a solid-
ity will be given to the pathology of the affection, and
perhaps tlie therapeutics of it will be materially aided.
Speaking from clinical experience, I cannot but conclude
that the disease to which we give the name of phthisis
has more than one mode of origin. Further investigation
will perhaps clear up the doubt which exists on this
point ; and here I should like to observe that there are
some affections of the lungs which closely resemble, in
their clinical features, acute phthisis, and yet which, un-
der careful treatment, do not go on to a fatal issue. Of
such cases I have now seen several. Their general
symptoms, their physical signs, their temperature-ranges
made me conclude that I had to deal with cases of acute
pulmonary tuberculosis, and I have expected a fatal re-
sult, but recovery has taken place. These cases occurred
before attention was directed to the presence of bacilli
in the sputum of phthisical patients, and no examination
of this secretion was made. In instances of a similar
kind, we shall now be able to use this method of investi-
gation, and i)ossibly it will afford a valuable means of
differential diagnosis, and enable us to give, in cases
where the bacilli are absent, a more favorable prognosis
than the general syini)toms would otherwise warrant. I
may say, in regard to the cases to which I have referred,
that they were treated bv free nutrition, generally the
exhibition of quinine, and a somewhat liberal quantity of
alcoholic stimulants.
The great point which remains to be decided, and
which I hope the discussion which will take place at this
meeting will help to decide, is, whether the so-called
bacillus tuberculosis is the cause, or the consequence of
the tuberculous disease.
I have spoken of the advance wliich medicine has made
as the result of the ai^plication of scientific principles, and
an improved knowledge of physiology and pathology ;
and I would further remark that the past years have been
fertile in the introduction of substances which are of the
highest value to the physician in the actual treatment of
disease. The bromide compounds, chloral, croton-chloral,
the various forms of pejjsine and pancreatine, the salts of
salicylic acid, may be emimerated, among others which
the chemist has furnished for our use ; and, while we may
perhaps feel that he will best serve the ends of medicine
who shall teach us how to employ most successfully the
remedies we already possess, and w-hile we w'ould depre-
cate the incessant desire for the introduction of new
chemical compounds, let us by no means discourage the
laudable ambition of enriching our Pharmacopceia with
agents of sterling value. We must never forget that, in
addition to the usefiil drugs to which I have already re-
ferred, the present age has given us, by the agency of the
chemist, means by which we can annihilate the pangs of
the most painful maniinilations of surgery, and obviate
the tortures formerly incidental to all operative proce-
dures.
In the face of such a fact as this, we may be i)ardoned
if we express a doubt whether we have arrived at the
limit of our therapeutical discoveries, and whether we
may not hope that the labors of the chemist will, in the
future, give us new elements for our use, or that some of
those compounds which now possess only a scientific
interest may, in course of time, jiass into the hands of i
the practical physician, and add to his powers of con- j
trolling certain forms of disease.
It is not for me to speak of the triumphs of modern
surgery, and the successful results which have followed
the application of scientific principles in this great de-
August
II. 1883.]
THE MEDICAL RECORD.
145
partment of medicine. We are apt, perhaps, to conclude
that it is here that the most striking advances have been
made ; but I venture to think that, in proportion to the
difficulties which have had to be solved at the hands of
the physician, medicine pure has made a progress as
great as that which has characterized the sister art of
surgery, or, indeed, any other art in which science has
been brought into practical application. Consider how
ditficult are the problems which disease presents ; the
complexities of organic life ; the many peculiarities and
tendencies of each individual man ; the inherited liabili-
ties ; the subtle influences of habit, of diet, and of cli-
mate ; and those social and moral forces which exercise
so great a power on the varying conditions of civilized
life ; and then say whether it can be expected that we
shall be able readily to arrive at grand generalizations on
disease. In the great progress which has been made dur-
ing the past fifty years, we have the strongest possible
indication of increased progress in the future. The
labors of each generation will correct some errors of the
preceding one, and will carry us somewhat nearer to the
truth ; but the temple of medical science can never be
crowned. Each addition to our knowledge will but point
out to us fresh fields for labor — new subjects for investi-
gation ; and we may rest assured that the demands which
will be made on the practitioners of medicine will ever
be increasing, as it shall become more aiiparent how inti-
mately their labors, and the sciences on which medicine
depends, are associated with the well-being of mankind.
.\nd there is, I think, a favorable circumstance in con-
nection with our profession at the present time which is
likely not only to have a beneficial influence on its ac-
tual advance, but with reference to the estimation in
which it will be held by the public at large. Resting, as
it does, on a basis of scientific observation, and depend-
ing for its progress on scientific researches, it will meet
with more and more recognition in proportion as it ap-
peals to a public which is more and more scientifically
educated ; and we now see that physical science is assum-
ing, more and more, its proper position in the education
of the young. While 1 would express a hope that, in
the general education of the people, and especially of
those who are in the higher walks of life, the cultivation
of literature in its widest sense will always maintain a
due prominence, I trust that the movement which is now
so perceptible, with regard to the teaching of physical
science, will continue to meet with that support which I
think it so fully deserves; and in connection with this
subject I cannot but express the satisfaction which I, and
I am sure I may say we all, have felt in seeing rise up,
in the various great centres of population in this king-
dom, those institutions for higher education which add
so much to the teaching power of these centres. The
movement is really a comparatively recent one, and we
in Liverpool were somewhat backward in it ; but a few
years ago, some of those who had long felt the want which
existed, determined to make a strenuous effort to give to
this city what Manchester, Birmingham, and other cities
had already provided for themselves. Relying on the
liberality of the public of Liverpool, an appeal was made
for the foundation of a college in which the higher
branches of the arts and sciences should be taught.
That appeal was largely responded to, and now I see in
our midst a college, with a staff of professors, which I
trust is destined to do a work which will reflect honor on
itself, and credit on those who founded it. It is true
that, as yet, the organization of the institution is not com-
plete, and that a further sum of ^50,000 is wanted, in
order that the full advantage of affiliation with the new
Victoria University may be reaped. But we are sanguine
that this amount will soon be forthcoming, and that the
position of equality with Owen's College with regard to
university degrees will be assured.
The School of Medicine, so long known in connection
with the Royal Infirmary, has now become the Medical
Faculty of the College.
Since we met in Liverpool, as I have already said,
nearly a quarter of a century has elapsed ; and by the
craps which time has made in our ranks, and the fact
that the Association is now reassembled here, we are re-
minded, that while individuals pass away, societies and
communities may remain. I trust that the time is far
distant when our society will show any symptoms of de-
generacy or decay ; but in its very magnitude and its
great prosperity there exists an element of danger. I
have, however, the strongest possible conviction that the
wisdom of the Association guiding and directing its ex-
ecutive body, which shall be at once the representative
and the reflex of the whole constituency, will conduct
the society safely through the dangers and difficulties
which may beset its path. United, we are all-powerful.
.■\cting in unison, and animated with one feeling for the
progress and well-being of our profession, there is no
subject in connection with its scientific, its political, or
its social aspect which we may not grapple with, and
grapple with successfully. As year by year rolls on, we
may hope that our numbers will increase, until at length
it shall be a very exceptional circumstance in this coun-
try for a member of our calling not to belong to the
British Medical .\ssociation. In concentrating, as we
may then be able to do, the whole force of the body
medical on any given object, we shall exercise a power
which may either compel nature to reveal her innermost
secrets, or influence a government in the legislation of
the state.
But time warns me that I must bring my remarks to
a close. Looking to the results which have been
achieved, I feel warranted in saying that, with our pres-
ent advantages, and working from our present standpoint,
we have every reason to believe that the progress of
medicine in the future will be marked by more rapid
strides than those which have characterized it in the
past ; and, standing here to-night, I can look forward,
with confidence, to the time when a future president of
the Association, inaugurating the centenary of its birth,
shall speak with triumphant voice, and in glowing lan-
guage, of the advances which our profession shall have
made. He shall tell of improved methods of research,
and new instruments of diagnosis. He shall speak of
the important generalizations which the collective inves-
tigation of disease, carried on for fifty years, has led to.
He shall point to the greater facilities with which the
differentiation between functional disturbances, and the
early symptoms of organic disease may be effected. He
shall, perhaps, be able to show how many affections
which ultimately lead to great alteration of structure, and
eventually to a fatal issue, have their origin in functional
disarrangements neglected in their beginnings, and grad-
ually inducing changes which at length become irreme-
diable ; and thus he shall show how closely physiology
and pathology are connected. He shall, perhaps, be
able to point to the establishment of the true pathology
of those diseases which from recent investigations appear
to be dependent on the presence of micro-organisms, of
tuberculosis, and other allied affections, and, as a result
of this, he may possibly tell that, by the adoption of a
practice analogous to that which has had so marked a
result in reference to splenic fever and chicken-cholera,
and which has rendered famous the name of Pasteur, an
almost complete immunity is enjoyed from those terri-
ble maladies which have hitherto in large measure baffled
the skill of the most accomplished physicians.
And, gentlemen, among the many changes which, I
venture to think, these revolving years will bring, may
we not hope, that, with the higher status as a science
which medicine shall have attainedjUnd the higher esti-
mation in which the profession shall be held, will have
come a fuller recognition of the claims of its members to
some of the higher honors of the State, and perhaps the
president of that occasion, or some of those who may
listen to his words, may belong to that upper branch of
our legislature to which hitherto no practitioner of art
146
THE MEDICAL RECORD.
[August II, 1883.
has reached. The votaries of medicine want no other
encouragement than that which comes from advancing
their own science to stimulate tliem to the highest exer-
tion for the general weal, but it cannot be doubted that
both in the interest of the public, and \n reference to the
l^romotion of the health and well-being of the people,
the presence of medical men in the House of Lords
would strengthen the powers of that House and benefi-
cially influence legislation.
But if tlie results to which I have alluded, and the ad-
vances which I have ventured to foreshadow, are to be
realized, if medicine is to be raised from the region of
empiricism, and to be placed on a higher scientific level,
and if we in this country are to take our part in the re-
searches by which the great problems now awaiting solu-
tion are to be determined, then must all unwise legisla-
tive restriction on the work of the physiologist and
pathologist be withdrawn ; then must all measures which
fetter the action of the original investigator be removed ;
and I trust that, by tlie labors of the society which has
been established for the cultivation of medicine bv orig-
inal research, a more enlightened public opinion will be
formed, which will aid in bringing about these results.
Medicine must more and more proceed on the lines
of exact observation and careful scientific inquiry ; and
in connection with this it is satisfactory to know that one
of our great guilds is about to devote a portion of its
means to the encouragement of work such as I have re-
ferred to : and I trust that our own society will be able
yearly to devote larger sums than at present to a like
cause.
-•^nd now, gentlemen, in conclusion, permit me, in the
name and on behalf of the local members of the Associa-
tion, to bid you all a cordial welcome to Liverpool. Our
Association is now so numerous and so powerful, its
meetings offer so many features of interest and attrac-
tion, that, wherever they may be appointed to be held
we look forward widi confidence to large and influential
gatherings ; but we desire that this meeting shall not only
be successful in a scientific and professional point of
view, but shall also be rendered interesting and agreea-
ble to all who may honor us with their presence. We
cannot show )0u grand architectural monuments mel-
lowed by age and famous in the annals of history, such
as characterize our metropolitan towns; we cannot take
you to classic halls like those which give so great a
charm to the visits which we pay to our university cities ;
but we trust that in traversing the different parts of this
great centre of connnerce, and in visiting the docks
which line the shores of the .Mersey, you may see some-
thing that will interest you ; and that when your tem|)0-
rary sojourn among us shall be over, you may feel that,
not only have you assisted at a successful anniversary of
the British Medical Association, and contributed to the
promotion of those objects for which it was founded, but
that your visit has been one of satisfaction and of pleas-
ure.
The Chloral Hydrates. — Mr. Joseph Bennose,
Lecturer on Practical Chemistry in Bishop's College,
states that what is usually jirescribed as croton chlonil
is really a butyric chloral. He says : To show clearly
the relation existing between the acids — acetic, crotonic
and butyric — and their aldehydes and tri-chlor derivatives
we may formulate them as follows :
Aldehyde. Cliloral.
CII.,.COH CCL.COM
CH3(CH)COH CCl3.(CH).,COH
CHj(CH2).jC0H CCl3(CHj)jCOIl
'l"he hydrates of the first. CCI. C (OH) H., and of
the third, CCI, {CPI.X C (O H\ H, of these chlorals
only are in use in medical i)ractice ; and although this
has been pointed out many times since 1876 we still find
the latter more frequently prescribed by the wrong name,
croton chloral hydrate, than by the right one butyric
(or butyl) chloral hydrate. — Canada Medical Record,
February, 1883.
Acid.
Acetic CH,. coon
Crotonic... CHjtCHljCOOH
nutj-ric CH3(CH„).,COOH
ON THE AUTONOMOUS LIFE OF THE SPECI-
FIC INFECTIONS.
Being the .Address in Pathology Delivered before
THE British Medical Association at Liverpool,
August 3, 18S3,
By CHARLES CREIGHTON, M.D., M.A.
LONDON. ENGLAND.
'Mr. President and Gentlemen : I have unusually good
reasons for prefacing my address with an apology. I
cannot claim to speak from the fulness of experience
which has given so much value and distinction to the ad-
dresses that have been delivered before the Association,
and I have a subject assigned to me which demands ex-
perience and a mature judgment in no ordinary degree.
Pathology is a growing science, its aspects are constantly
changing, a single year's work brings us a multitude of
new and often puzzling facts ; and although the issues
are of the most momentous kind, not even the wisest and
most judicial minds in the ])rofession can always see
their way to a clear and definite opinion.
But, amidst all this uncertainty, there is one central
and guiding principle in the doctrine of disease which
we may hold fast to. It is the physiological principle,
or the idea that diseased states of the body are but modi-
fications of healthy states, deviations from the beaten
track, perturbations of the normal life, shortcomings of
the physiological standard. Thus, even in so formidable
a malady as diabetes, we are still within sight of the line
of health ; there may be a physiological glycosuria ; and
that fact, as Dr. Bence Jones says, proves to us that the
disease is only a little way distant from health. " Here,
as elsewhere," says that eminent chemist and pathologist,
" there is no definite limit where health ends and disease
begins." To find the proper physiological analogies for
diseased processes is the task of modern pathology ; and
I do not think that there is, in the whole range of science,
any better kind of intellectual exercise than to exi^ose
the working of the ordinary laws of structure and func-
tion under the mask of disease. The physiological idea
is, indeed, the hope and inspiration of pathological
science, as it is also of medical practice. But there is
no reason why I should attempt to say again what has
so often been well said before. Members of the Associa-
tion who heard Professor Michael Foster, at the Cam-
bridge meeting, discourse on the "Relations of Physiol-
ogy to Patholog\-," will not have forgotten how he juoved
that the difference between these two sciences was merely
a superficial difference, whether as regarded method or
subject matter. We shall, most of us, also recall Pro-
fessor Huxley's lucid exposition before the International
Medical Congress, of the " Connection of the Biological
Sciences with Medicine,'' wherein he showed that pathol-
ogy was that branch of biology which concerned itself
with perturbations of the normal life.
That view of pathology is one that we all share ; and
as I have endeavored, according to my opportunities, to
work out physiological analogies of disease in particular
instances, I shall not be suspected of any want of sym-
pathy with the general principle. But I am none the
less confronted with the difficulty that a great deal of
pathology api)ears to be quite difterent in kind from any
physiology known to us. What are the physiological
analogies of the infective and constitutional diseases, and
how large a jxirt of pathology do the diseases of that
class stand for ?
There is, I believe, a serious difficulty here, and a
difficulty that made itself felt in the very first system of
physiological medicine that was given to the world.
Broussais was the author of the first attempt at a physio-
logical sclieme of disease ; and it was only a year or
two ago that Professor Charcot was claiming for his
brilliant countryman the credit of having broken down
the dualism of health and disease, and of having eradi-
cated that old and jiernicious habit of regarding disease
as a separate entity. But Professor Charcot said no-
August II, 1883.]
THE MEDICAL RECORD.
147
thing of the rock on which Broussais is generally ac-
counted to have made shipwreck. The author of the
first physiological medicine was thorough-going, and it
was because he endeavored to be comprehensive and
consistent that he failed. He left out no great disease
from his physiological scheme, not even typhus nor
Asiatic cholera ; they were all perturbations of the nor-
mal life, and a good many of them were forms of gastro-
enteritis. Professor Charcot may be right in claiming
the i>liysiological medicine of Broussais as tile example
for all subsequent times ; but it is quite certain that it
served also as a warning to those who ne.xt took tlie
physiological medicine in hand. They were careful to
ligliten the ship by throwing overboard Asiatic cliolera,
typhus fever, and, in fact, the whole of the acute and
chronic infections. Just about the time when the
thorough-going system of Broussais had provoked the
inevitable reaction, Professor Henle had made his sug-
gestion about minute i)arasitic organisms being the causes
of the specific infective diseases ; and it is curious to
read, at a distance of forty years, in the first volume of
the German Archives of Physiological Medicine (p. 88),
how (jriesinger, one of its sponsors, promptly availed
himself of the parasitic hypothesis of Henle in order to
account for all tiiose diseases which had been prudently
omitted from the physiological programme.
But I venture to say that, when we congratulate our-
selves upon the physiological basis of pathology, we do
not always reflect how much of disease is thus excluded
from the class of disturbed physiological processes, and
how small a fraction remains to fill the physiological
categories. There are several passages in Sydenham's
works in which he gives his estimate of the proportion
that the species of disease — the morbi typo iiuluti — bear
to the rest ; he estimates diseases of a specific type at
two-thirds of the whole ; and it will be admitted, I think,
when we look abroad as well as at home, and we read
history as well as contemporary records, that this es-
timate shows his fairness of mind and his sense of pro-
portion.
The serious difficulty, then, which I spoke of — the
difficulty that must have been present to the mind of
Broussais, and must occur more or less to every one — is
that a physiological medicine, which leaves out the larger
and more formidable half of disease, is hardly worthy of
tlie name. The doctrine that morbid processes are after
all merely perturbations of normal processes, or, as
Hunter said, "a perversion of the natural actions of the
animal economy," is the great principle of scientific
pathology ; but we shall have to speak less enthusias-
tically of it, if it should appear that it has no place for
the long list of infective diseases — for plague, for cholera,
for yellow fever, for typhus, for small-po.x, for leprosy,
for syphilis, for cancer, for consumption. If the physio-
logical idea is to be good for anything, it ought to be
good for those ; for they are the real difficulties of path-
ological science, and the real opprobria of the medical
art.
I am sanguine enough to believe that the physiologi-
cal doctrine will one day be shown to be as large in its
application as it is rational and hopeful in its spirit. It
is for that reason that I have decided to use this public
opportunity that has come to me — and come to me most
unexpectedly, and, I feel, most undeservedly — in order
to speak of certain aspects of the specific infections,
which are perhaps not the aspects most commonly
brought before us at present. One would wish to think
of these diseases, strange and terrible though they be, as
still joined in continuity with the common disorders of
structure and function ; and I am accustomed to express
for myself this connection by a formula, which has no
other value than belongs to a mode of thought or a form
of words, but may still serve as a convenient or empiri-
cal standing ground for those who seek to observe a cer-
tain unity and sequence in their study of disease.
I shall endeavor, then, to discover some relation be-
tween common aberrations of structure and function and
the specific infections, or a relation between disordered
states of the body and the self-existent species of dis-
ease ; and I shall make this attempt with two or three
representative instances. It will be convenient to be-
gin with cancer, for the reason that the suggestions that
I have to make arise most naturally out of the study of
cancer.
Cancer is an infection, although its infective power
does not extend, except in heredity, beyond the indi-
vidual body in which the disease takes its rise. I do not
forget that some pathologists consider cancer to be no
more than an overgrowth of epithelium. But we shall
find it difficult to explain to a patient with cancer that
he is suftering merely from an overgrowth of his epithe-
hum. All the world knows what cancer is, and no micro-
scopic analysis will ever persuade men that cancer is any-
thing but the devouring thing, the implacable enemy that
the common eye sees it to be. What the microscope
does show us, is that a cancerous tumor has not always
been cancerous. If we take any of the common seats
of cancer — the stomach, or the uterus, or the breast — we
shall find that the disease may be traced back to a point
at which it comes withm the category of structural and
functional irregularities. I say structural (j^^f/ functional,
because it seems to nie that if we attend only to the
structural features of the disorder, as some of our Ger-
man colleagues are content to do, we are likely to miss
the central idea of the deviation from the normal. In
the favorite seats of cancer, the secretory function is not
always or altogether what we often take secretion to be.
Under certain circunistances, solid products, or cells,
form part of the secretion, and those cells do not always
get carried off, as the cells do in an ordinary catarrh, by
discharge from the surface, or by way of the lymphatic
drainage, but they may stagnate and accumulate in the
deeper textures of the organ or part. So far, there is
nothing in the morbid process for which we may not find
close physiological analogies. In some of the secretions
of the invertebrata, and even in certain glands of the
higher animals, the secretion retains its solid or cellular
character for a considerable time. Again, the heaping
up of the solid or by-products of secretion, in the spaces
of the underlying connective tissue, is found to occur in
the breast as a perfectly natural incident.
Still further, the free space of a gland may_ become
filled with cast-off epithelial cells ; or the epithelial lining
may be raised into wart-like growths. Even a whole
gland, like the breast, or a whole lobe of the gland, may
be uniformly affected in the way of overgrowth, produ-
cing an adenomatous condition, or the condition of simjjle
glandular tumor. There is nothing cancerous in all this ;
we are still within sight of the line of health. The can-
cerous element comes in usually after a particular tmie
of life, and it consists in the implication of other tissues
than the glandular or secreting structure, whose irregulari-
ties were the exciting cause. F.pithelial cells that have
not been used for secretion can become mischievous as
infecting cells, and if we now- examine the region of dis-
ease, we shall find the marvellous spectacle of an epi-
thelial kind of structure springing from the tissues around,
where there is no epithelium naturally ; a little later, the
same epithelial pattern is, as it were, carved out of the
parenchyma of lymphatic glands, or of the liver, or in
the deeper layers of the skin, or even in still more unex-
pected places. The pattern of this widely distributed
structure is always the same in a given case, and there is
always something in it which reminds us of the primary
seat of glandular disturbance. An intelligible disorder of
structure and function, not without its close analogies in
physiology, has acquired a kind of individuality or in-
dependence, and a power to reproduce itself throughout
the body ; or, in other words, it has become a ravaging
cancer.
I shall not delay here to go into the particulars of this
extraordinary process, or to enter upon controversial
148
THE MEDICAL RECORD.
[August II, 1883.
matters. I take cancer as a striking instance of a dis-
ease which may be traced along the track of physiological
perturbations for a certain distance, after which it be-
comes what all the world knows it to be — a semi-inde-
pendent life, an imperium in imperio, a power inseparable
from the general life of the body, compatible even with
blooming health for a time, bat in the end sure to gain
the mastery.
In taking a full and fair view of cancer, of its i)hysio-
logical beginnings, and its ultra-physiological course, we
cannot but admit that there is some truth in that hard
saying of Paracelsus : " In such a disease, a man is him-
self and another, he has two bodies at one time, enclosed
the one in the other, and yet he is one man." This
kind of Platonic mysticism is not what one would choose
to import into exact science. But we are bound by a
regard for facts ; and I do not see how the facts of can-
cer, whether they be microscopic or clinical, can be done
justice to unless we admit that a state of the body may
be raised to the power and dignity of a life of semi-inde-
pendence. I purpose speaking, in the sequel, of this
semi-independence under the name of autonomy ; and I
shall endeavor to show, in the case of two or three other
representative infective diseases, how a perturbation of the
physiological life has acquired its autonomy, or what the
pre-autonomous stage of those infections may have been.
This doctrine of acquired autonomy and the pre-au-
tonomous stage is the formula in terms of rt'hich I would
express the relation between ordinary perturbations of
structure and function and the specific infections, the re-
lation between disordered states of the body and the
self-existent species of disease.
If cancer has always been the great popular instance
of a disease enjoying a kind of life of its own within the
body, consumption hardly yields to it in its relentlcssness,
and it far exceeds it in its prevalence. Is it possible, in
the case of consumption, to show that a wasting infec-
tion has arisen out of common disturbances of the phy-
siological life ? Before so critical an audience, I shall
not have the hardihood to speak of consumption in gen-
eral— of the disease about wliich so great masters in
pathology as Laennec and Virchow have differed widely.
But there is a form of tubercle, the bovine form, in which
the facts are much less ambiguous, and much easier to
deal with, and, as it happens, more famihar to myself;
and for bovine tubercle, or, as it is sometimes called, the
pearl disease, I shall venture to inquire whether the small
beginnings of it may not be found in a certain kind of
disturbance of ruminant nutrition, just as we find the
pre-cancerous stage of cancer in certain irregularities of
the apparatus and process of secretion. Those begin-
nings would correspond to what I have called the pre-
autonomous stage ; while the autonomous life of the
disease, as a semi-independent thing, would be shown in
its infectiveness.
Bovine tubercle is a more complete example of infec-
tion than cancer. It is a constitutional disease, pervad-
ing the whole body ; it is likely to end in wasting and
cachexia ; it is very liable to be inherited by the off-
spring; it can be given to other animals, by inoculation
or by feeding, in experiments, and probably also by
accident ; and there are recorded cases, in veterinary
practice, which lead us to think that it hangs about a
stall, or spreads from stall to stall by volatile contagion.
There is, in fact, no disease, in human or veterinary
pathology, that shows a more complete autonomy ; it is
constitutional, hereditary, infective, and contagious.
The pearl disease is peculiarly a ruminant malady,
and it is curiously limited within the ruminant order
itself. It does not occur in the sheep, nor, as far as we
know, in the deer ; and by far the larger number of cases
are found in the domesticated bovine species, in which
it is, indeed, much too common. I have been on the out-
look for specimens of it among the animals that die in
the Zoological Gardens in London, and my experience
hitherto has been curious and suggestive. I have
hitherto found the peculiar anatomical characters of
this form of tubercle in only three species : the eland, a
large South African antelope, like a cow ; the nil-ghau,
a large Indian antelope, whose name means " the blue
cow;" and the prong-horned antelope, from America,
another of those half-way animals between the bovines
and the antelopes, which the late Mr. Forbes, the pro-
sector at the Zoological Gardens, took much interest in
as a transition species. It is certainly a remarkable
thing that those antelopes, which resemble the bovines
so closely in zoological characters, should resemble them
also in their liability, under confinement, to a distinctive
kind of new formation. This kind of tubercle is not only
an affair of the ruminant order, but it is an aftair of a
small group of ruminants, mostly belonging to one
genus.
What, then, are the distinctive anatomical characters of
this distinctively ruminant disease ? The morbid anat-
omy of bovine tuberculosis has been written with as little
reference to theory or preconceived opinion as could be
wished. It has been, in great ])art, observed by those
whose business lies with cattle ; and the popular names
of the disease in all countries will show us how it has
presented itself to the common observer. The various
names show that it is primarily an affection of the serous
membranes; the Germans have called it the " pearl dis-
ease," from the rounded whitish nodules attached to the
abdominal and thoracic surfaces ; the French have named
it "poinmeliere," from a fancied resemblance of the
nodules to clusters of potatoes ; in England, it has been
called "the grapes;" and, in Scotland, "angle-berries."
I am merely repeating the language of all authorities,
including Professor Virchow, when I say that the disease
is primarily one of the serous membranes — a growth of
multiple nodules, usually small and flattened, often sus-
pended by a stalk, and sometimes as large as a cherry or
an apple. These are the beginnings of the disease ; but
it extends from the serous membranes, by infection, to
the lymphatic glands, which become changed into the
same mortar-like substance that is found m the degener-
ated nodules. The lungs, also, are very apt to get in-
fected, as they so often do with new formations of a sar-
comatous nature ; and the infection may, in the end,
reach most of the organs, as well as the bones and joints,
causing the animal to die of general cachexia and
wasting.
Such is the usual sequence of events where the disease
is originally acquired ; but in the cases of inheritance —
and these are now estimated at more than one-half —
there may be some departure from this order ; in them,
the formations in the lymphatic glands, lungs, and other
viscera, may be more conspicuous than the serous-mem-
brane nodules ; but even in the inherited disease, the
pleural or peritonea! surfaces will usually show charac-
teristic traces of the primary new formation. Some al-
lowance must be made for certain modifications in the
order and distribution of the disease, when it is commu-
nicated directly to the offspring by a sire or dam which
had acquired it ; and it is all the more necessary to be
clear on this point, since, at the present day, the heredi-
tary taint would seem to be so widely distributed through-
out the bovine stock as to obscure somewhat the original
characters of the disease. In what I have to say, I must
speak of the disease as it is primarily acquired, and as it
is described in the earliest writings, and by its popular
names.
It starts, then, as a multiple nodular condition of the
abdominal and thoracic serous surfaces, it acquires the
character of a constitutional disease, it goes all through
the body, it passes directly to the offspring, it may be
inoculated upon healthy animals or comnumicated to
them by feeding, and it is not improbable that it passes
by volatile contagion. The infectiveness within the ori-
ginal body, and the faculty of passing to other animals,
is what I would call its autonomous life, and I would
look for its pre-autonomous stage in the iieculiar groups
August II, 1883.]
THE MEDICAL RECORD.
149
of multiple nodules on the serous surfaces. What then
is the origin of these nodules, in what relation do they
stand to any known disorders of ruminant nutrition, or,
rather, of the nutrition of those ruminants that are closely
confined, artificially fed, and over-milked ?
I am not aware that the suggestion which 1 have to
make has occurred to any one before, and I put it for-
ward, therefore, with some diffidence. This suggestion
arises out of a consideration of the forms and favorite
seats jaf the 1 od iles, and of their structure, and degen-
erations. One cannot helji observing that these multiple
nodules are especially apt to grow in the seats of fat-
formation, and to assume the external form of deposits
of fat, either the stalked and pendulous form, or the flat-
tened form of confluent lobules or patches. Now the
bovines are somewhat peculiar in the way in which they
lay on fat. They have not so much of subcutaneous fat
as the sheep or the pig, but they are very apt to have in-
ternal formations of adipose tissue, sometimes in situa-
tions where one would imagine that it could serve none
of the ordinary purposes of fat. Besides the common
deposits of fat about the abdominal organs and in the
thorax, there may be lumpy masses of it even on the
pleura covering the ribs, and on the diaphragm ; and, 111
highly fed animals it is not unusual to find a lobulated
layer of the same tissue all over the surface of the spleen,
and even on the surface of the liver. It can hardly
escape us that those serous surfaces which are invaded
in the course of this excessive fat-forming habit, are just
the localities wiiere the pearl nodules are found. There
is, indeed, one rather important exception to this rule,
namely, the borders and surfaces of the lungs. I cannot
say whether a border of fat ever occurs round the margins
of the lungs in cattle, as it occurs round the spleen and
liver, or under the pulmonary pleura, a^^ it is found under
the costal pleura ; but, if that should be the case, the
analogy with the pearl disease would be complete, so far
as situation goes ; otherwise, we must explain the nod-
ules of the pulmonary pleura on the hypothesis of
secondary infection. As regards form, the resemblance
between the physiological and the pathological forma-
tions is most striking ; in both cases we may And either a
finely lobulated stratum of translucent tissue, or coarser
lumpy masses, or pendulous nodules.
But, after all, the diseased nodules of the serous mem-
branes are not fat, or, at all events, they are not com-
posed of adipose tissue throughout most of their extent.
They are not multiple iipomata ; but it would be strictly
correct to describe them as multiple fibromata, or sarco-
mata, with a deficient blood-supply, or rather as a multi-
ple tumor-formation, containing a mixture of those two
kinds of tissue, growing in the seats of fat-formation, and
assuming the lobulated, or lumpy, or pendulous forms of
the sub-serous fat.
I do not tiiink that 1 have gone beyond the facts in
this statement of the naked-eye characters of the pri-
mary new growths to which the bovines are so liable,
and I cannot help thinking that there must be some con-
nection between them and vicissitudes in the nutrition of
those animals as manifested in that tissue wliich would he
most affected in nutrition, namely, the fat-tissue. The
facts may be explained in two ways, both of which may
be applicable, although I would regard one of them as
more probable than the otlier. Either the formations
on the serous membranes are atrophied or degenerate
masses of fat in which the blood-supply has failed to a
great extent, or they are radically new growths which
have sprung up in the old lines of fat-formation, or where
fat may once have been. The description in a veterinary
text-book of retrogressive clauses in the multiple Iipo-
mata of the serous membranes, reads very much like a
description of some of the bovine tubercles tiiat we
meet with ; the oily contents of the fat-cells disappear,
the connective tissue hardens and thickens, calcareous
matter is deposited, and a mortar-like substance takes
the place of what once was fat. But there is another
and perhaps better way of accounting for the fact that
the morbid growths are found in some of the favorite
seats of the internal fat, and in its peculiar shapes. It is
a well-known zoological characteristic of the bovines
that their fat is naturally apt to come and go from time
to time, in the wild state according to the ])eriodicity of
the seasons, and in the domesticated state according to
a multitude of artificial practices in the management of
dairy and farm stock. Nothing can be more artificial,
for example, than the conditions whicli cows in town
dairies are subjected to : the close confinement, the
unnatural feeding, and the excessive milking. It is quite
conceivable that an animal, under those circumstances,
and more especially when it is growing old, would depart
from its natural fat-forming habit, and put on, instead, an
embryonic kind of tissue, which is neither fat nor any-
tliing else of a physiological kind, although it occupies
the old seats of adipose tissue, runs into the familiar
mould, as it were, and grows to the old pattern.
Whether we take the one explanation or the other, or
the two together, there is, I think, a pretty strong chain
of evidence that bovine tubercle begins as a disorder of
nutrition. It is oftenest acquired by animals that are far-
thest removed from their natural conditions — by cows im-
prisoned in town dairies ; and the disease that those
animals are so jieculiarly liable to begins as a kind of
multiple morbid growth, which occupies the very seats of
the internal fat, and runs into its very shapes. Now,
the abdominal and thoracic fat is precisely the tissue that
might be expected to show the effects of malnutrition in
the way of structural changes. The tubercles are simply
collections of embryonic tissue in which the formation of
blood-vessels has been inadequate, and in which degen-
eration has inevitably followed ; and any one who has
studied the development of fat will readily admit that the
same embryonic cells growing in the particular localities
might have become fat-cells if the blood-supply had been
sufficient.
Whether I have indicated truly or not the circum-
stances in which we should seek for the beginnings of
this peculiar kind of new growth, I am confident, at
least, that we must look for these beginnings in some
physiological disorder or other within the small group of
ruminants, and not elsewhere. Disordered nutrition ap-
pears to me to be able to account for this kind of mul-
tiple tumor disease, just as I believe that disordered
secretion can account for the beginnings of cancer.
Disordered nutrition shows itself in various ways within
the body ; but there is only one tissue that it specially
aftects, and that is the adipose tissue, just as the glandu-
lar tissue is the proper seat of secretory disturbances.
In the one case as in the other, the disorder of function
finds a structural expression ; it acquires length, breadth,
and thickness ; or, in other words, it results in a tumor.
The functional disease thus acquires the degree of in-
dividuality which may be ascribed to a tumor, and that
must be the beginning of its life of semi-independence
within the body. In both cases, the pre-autonomous
stage is a common disorder of structure and function —
of secretion in the one case, and of nutrition in the other ;
and each goes on to acquire the mysterious power of in-
fection. But they become autonomous in different ways,
or under difterent circumstances. I have already spoken
briefly of cancerous infectiveness, and I have elsewhere
endeavored to trace the connection between it and the
antecedent glandular disturbances. In bovine tubercle,
I should ascribe the infectiveness to the iiitiltifUcity of
the primary nodules, and to the fact of their being seated
on the serous membranes, which are so fundamental a
part of the lymphatic system. Multiple tumors of the
serous membranes are favorably situated for infecting
the lymphatic glands, and the infection of the lymphatic
glands is only the beginning of an autonomous career.
Professor Virchow has shown, in his great work on mor-
bid growths, how the lobules of abdominal fat may be-
come multiple stalked Iipomata, each lobule becoming a
I50
THE MEDICAL RECORD.
[August II, 1883.
kind of individual tumor and growing as such ;, and he
adds the following remarkable words: "There is no
doubt that this kind of multiplicity does not differ alto-
gether from what we find in malignant tumors or in an
infective dyscrasia ; '" and if that can be said of multiple
lipomata still retaining the proper structure and nutrition
of fat, it can be said, with even greater truth, of those
multiple growths of the abdominal and thoracic surfaces
which we have good reason for taking to be rather the
degenerations or substitutes of the fat.
There is one other point to be noted in connection
svith bovine tubercle. It may or may not be primarily
■due, as I have supposed, to an error of nutrition in the
abdominal and thoracic deposits of fat, but its morpho-
-logical characters are certainly peculiar, and they belong,
*in a sense, to the bovine organization. If 1 may so
■speak, it has sprung out of bovine soil, and the marks of
nts bovine origin never quite leave it, even when it is set
up in the bodies of animals widely removed from the
ruminants. A mere condition or state of the ruminant
body can be abstracted, as it were, from all other rum-
inant conditions, and made to live in another body ; and
that is an extreme instance of what is meant by the
autonomous life of the specific infections, orof the semi-
independent e.Kistence of the species of disease.
Having presented cancer, and one of the varieties of
rubercle, in this light, I shall next inquire whether the
formula 01 an acquired autonomy may not be applied to
a third great disease, representative of another class of
infections, I mean small-[)ox. Small-pox may be looked
at from more than one point of view without losing sight
of its main features. Our great English dermatologist,
Willan, looked upon smalKpox as a skin disease ; but
Willan was also one of the first to investigate the history
of small-pox epidemics throughout the world, and he was
not likely, therefore, to underrate its importance as a
pestilence. Hebra also ranks smalhpox among the cu-
taneous disorders, and the authorities of the Allgemeine
Krankenhaus at Vienna have given practical effect to
Hebra's doctrine so far as to place the small-pox wards
under the department for diseases of the skin ; and I
can testify, from an experience of the Vienna small-pox
w-ards, tliat the disease does not lose any of its contagi-
ous power by being classified among skin diseases. An
experience gained under those circumstances is apt to
make an impression, and, from that time, I have never
ijuite been able to think of small-pox except as an ill-
smelling condition of the human skin which one person
may impart to another. It is a skin disease which has
been reproduced with the greatest accuracy and fidelity
in millions of copies for hundreds of years, and the ex-
traordinary closeness of the mimicry has given rise to the
opinion that the disease is really the uniform effect of
some unknown poison. But the anatomical structure
and evolution of the pock is too elaborate to be the
simple and direct effect of an intrinsic poison ; it is not
like a flea-bite or like the nettle-rash which comes out in
some peculiarly constituted persons after eating shell-
fish, or, as I liave known, even from eating a single
wholesome strawberry. The pock is a complicated af-
fair, and there is a history written in it, a history of
characters acquired bit by bit, as in the evolution of liv-
ing things, a history which has been transacted within
the body ; and the stages of this history are run through
with more or less completeness in every case of the
communicated disease. The papules had developed
fluid in their summits, they had grown in a peculiar way
to the breadth, the original centre had become a distinct
depression, and in the course of this evolution certain
partitions had been formed in the interior of the pock.
Further, the pock is more deeply rooted in the skin than
most skin diseases known to us ; for its base goes down
to the vascular layer of the corium, and, when it scabs it
leaves a considerable defect of substance (more particu-
larly in those localities such as the face, where the vas-
cular layer of the corium is well developed), a peculi-
arity among skin diseases which can hardly be matched
unless it be in some of the tropical forms of " impetigo."
This skin disease is ushered in by much constitutional
disturbance or fever ; and, as in some other skin diseases
which are not contagious, the fever abates when the
eruption has come out, and the subsequent constitu-
tional disturbance is exactly in proportion to the number
of the pocks.
The remarkable thing is that all this complex of ana-
tomical structure, of stages of evolution, and of charac-
teristic fever, should have preserved its unity and individ-
uality through so many transmissions, in all sorts and
conditions of men, and in all parts of the world. The
disease possesses what I would call autonomy in a high
degree, and, from that point of view, it becomes a matter
of no ordinary interest to inquire into its pre-autonomous
history.
Professor Hirsch, in his " Handbook of Geographical
and Historical Pathology" (a work which we are soon to
have in an English dress), concludes an elaborate review
of the historical evidence about small-pox, with the
opinion that we have to go to tropical countries, to Hin-
dostan and to the interior of Africa, for its original seats,
and to go back to a remote antiquity to find the begin-
nings of it. Lichlenstein, one of the early explorers of
Africa from the southern end, found small-pox to be prev-
alent w-herever he penetrated to, and he found it among
tribes who professed to have got it from nations still far-
ther from the sea. According to Pruner, the disease is
peculiarly an African disease. We may take it, there-
fore, that small-pox was originally a disease of the black
skin, and it is in keeping with that historical and geo-
graphical induction to find that the black-skinned races
are by far the most susceptible of the disease even now-
adays, when it is set up only by contagion.
It is impossible to speculate to any purpose on the rise
and development of small-pox out of some common and
frequent disorder of the black skin under such influences
as tropical heat and moisture, or under the peculiar con-
ditions which obtain among the swarming populations of
tropical countries. One naturally thinks of a complex
form of " febrile lichen," a skin disease which Dr. George
Gregory admits that he could not always diagnose from
small-pox ; and if we imagine a widely prevalent kind of
febrile lichen to follow somewhat the same development
that Willan describes in a remarkable case of lichen
agrius, we should have a not very remote analogy for
what I sliould call the pre-autonomous stage of small-
pox, both in the structural characters and in the consti-
tutional fever. We are, at least, justified in thinking of
some form of tropical skin disease, widely spread within
a certain zone, very apt to recur in the individual, and
with each recurrence to become more inveterate and to
develop a more complex structure. Given a number of
people suffering from such a cutaneous disorder at one
time, and some great migration or invasion, and we shall
probably have the circumstances under which the skin
disease would become communicable, would pass by
contagion to tlie skins of those who had never incurred
the disease by natural causes, and pass all the more easily
to them if they belonged to an entirely different race, or
presented the ordinary contrasts of civilization and bar-
barism, of white skin and black.
I do not say that it is an easy thing to construct the
circumstances under which this disease of the black skin
acquired, what I would call, its autonomy. It was prob-
ably a gradual process ; its semi-independence must
have been hardly won and slowly consolidated, until, at
length, it was ready to start on its devastating campaigns.
Small-pox has been a disease on so stupendous a scale
that it must seem to be mere hardihood to speak of it as
a condition of the skin, originally acquired in the tropics,
which has been (jassed on from one body to another.
Rut, even if history and geographical distribution had
told us nothing, the loathsomeness, the peculiar odor,
and the no less peculiar scars of small-pox, might of
August II, 1883.]
THE MEDICAL RECORD.
151
themselves suggest another skin than ours ; and I have
seen too many instances of tlie minute mimicry that goes
witli every infection to feel any surprise that a disease
which is native under a tropical sun should impress upon
its victims in every country something even of the pri-
mary ethnological characters.
And now let us compare the autonomous disease, as
we know it, with the original skin disease out of which it
nnist have grown. The contagious small-pox is dis-
tinguished by what Sir Thomas Watson calls " the very
<:urions fact" that it generally occurs but once in a per-
son's life. "In this," says Watson, "the contagious
disease ofifers a remarkable contrast to inflammations,
which, having happened once, are, for that very reason,
more apt to happen again ; " and he goes on to show the
impropriety of ranking small-pox under the head of cu-
taneous diseases ; it would " more rightly be called a
blood disease." But there need be no antagonism be-
tween the view of small-pox as a cutaneous disease, and
the view of it as an infection.- This formula of an ac-
quired autonomy, and of a pre-autonomous stage, which
I have been recommending as a sort of nostrum for our
intellectual ditticulties, appears to nie to be a means of
reconciling those antagonistic opinions which have arisen,
not so much in connection with small-pox, as in the con-
troversies about some other infective diseases, which are
supposed still to develop de novo from time to time.
Small-pox, in its iire-autonomous stage, would be pre-
cisely that kind of skin disease which, having happened
once, is, for that very reason, more apt to happen again ;
it would recur in the same spots, as in the early stages
of leprosy, and it would become more rooted and more
inveterate each time it came back. The inveteracy of
this morbid condition of the skin, due in part to neglect,
would be its tirst step toward acquiring that remarkable
power of semi independence within the body, which I
have been endeavoring to illustrate under the name af
autonomy ; it is this acquired power which enables it .0
pass to another person's skin as an individual state of
the body, which can be, as it were, abstracted ; and its
individuality is proved by the best of all tests of what
constitutes an individual — the test of parentage ; for the
skin disease that springs up in the contaminated body is
exactly like the skin disease which must have been
originally acquired. But the infected or. impregnated
body runs through all the stages of the malady — (lapule,
vesicle, pustule, scabbing, and scarring — in rapid suc-
cession in two or three weeks, and it is thenceforward
done with that particular form of skin disease (or ever.
The autonomous form of the disease is a brief abstract
and chronicle of its whole protracted development or
evolution ; it sums up the past, and just as it sums up
the past, so it anticipates the future.
Small-pox appears, then, to be a clear case of a mor-
bid condition of the body, namely, a cutaneous condition,
which has been enabled to lead a kind of independent
life. But smallpox is one of those diseases that always
pass directly from one body to another, and the direct
succession of cases does not appear ever to have been
broken. There is, however, another large class of infec-
tions, corresponding to Pettenkofer's division of the exo-
genous contagia, which are not only able to subsist for
long periods outside the human body, but which even
require a certain amount of external putrefaction in order
to make them potent. Cholera is one great example of
a disease of the exogenous group, and yellow fever is
another ; and I shall ask your attention for a few minutes
to some facts relating to the latter disease ; for here, at
least, it must seem as if we had got quite away from com-
mon disorders of structure or function, and into an abso-
lutely separate region of disease, where the physiological
princi[)le docs not serve us.
Yellow fever is one of those maladies in which historical
and geographical facts are of even greater imi)ortance
than microscopic or chemical, and liardly less important
than clinical ; and, as 1 have been lately occui)ied in
turning into English the German sentences of Professor
Hirsch's treatise on "Geographical and Historical Path-
ology," I have had occasion to reflect upon the more
salient facts in the history and geography of yellow fever.
The first point that strikes one is, that it appeared in the
seventeenth century as a new disease ; for more than a
century after the Spanish conquest of America, and for
many years after the first English and French coloniza-
tion in the West, there was no yellow fever, and, when it
did come to Guadaloupe and Barbadoes, it was recog-
nized as something quite different from the ever-present
malarial fever. The next point is, that there is something
quite peculiar in its geographical distribution. At the
present day, we are apt to think of yellow fever as the
fever of the Gulf of Mexico and lirazil ; but it had been
the scourge of Philadelphia, and even of New England,
for many years before it broke out in New Orleans at all
(1796); and its first a|)pearance at Rio was in 1849. In
reading Bancroft's treatise on this disease, published in
1811, it is curious to notice how much yellow fever has
shifted its ground ; it has always remained true to certain
shipping-places in the West Indies, but the other great
centres m Bancroft's time have absolutely ceased to be
the seats of yellow fever ; and some of the places that are
among the worst seats of the fever now are not even
mentioned in Bancroft's pages. In fact, it is not latitude
and longitude that explains the peculiar distribution of
the disease. There is only one thing that covers its his-
tory and its geography and the remarkable changes in its
distribution, and that is the slave-trade. Disregarding its
occasional and widely ranging excursions, and confining
the attention to the localities where it is or has been, at
one time or another, endemic or repeatedly epidemic,
these are found to be the creeks and wharves and low
shipping-quarters of the ports of debarcation of the slave-
trade, together with a few much less endemic, but not less
significant spots in Spain and on the west coast of Africa —
the places to which vessels engaged in the contraband
slave-trade had gone on their return voyage. The single
exception to this curious rule is Peru ; but Peru is hardly
an exception, when we bear in mind the many points of
resemblance between its coolie trade across the Pacific
and the old African slave-trade.
It was an inquiry into the disastrous outbreak at Bar-
celona in 182 1, in which five thousand persons died,
that gave the first clue to the connection between yellow
fever and the slave-trade. The circumstances were in-
vestigated by Dr. Audouard, for the French government,
and the same physician was sent again in 1823 to inquire
into a more limited epidemic at a small port in Biscay.
The facts were very much the same in the two outbreaks ;
ship-carpenters, engaged in repairing vessels that had
arrived some time before from the West Indies, were
seized with a prostrating illness, which they attributed to
putrid emanations from the bilge-water, and they became
the first victims of an epidemic which proved to be yellow-
fever.
Dr. Audouard found that the vessel which started
the infection in the 1S23 epidemic was a slaver; and, on
recalling the facts of the Barcelona outbreak two years
before, he found that the two vessels chiefly concerned
in it were also slavers, in proof of which, he said, they
might still be seen with the irons for securing the slaves
fixed in the planking of their holds. It was ascertained
also that one of them had had an extraordinary amount
of dysenteric sickness and mortality among her human
cargo on the previous voyage. He calculated that about
sixty Spanish vessels had been engaged in this contraband
trade in 1S20, that they had taken out about fifteen thou-
sand slaves from Africa to the West Indies, and had re-
turned to Spain with merchandise before going down to
the African coast for their next cargoes. This was, in
fact, the time of the irregular slave-trade, when the ves-
sels were not adapted for it, and the crowding and sick-
ness on board was at its worst ; and this period corresponds
to the remarkable outburst of yellow fever, both in
IS2
THE MEDICAL RECORD.
[August II, 1 88 J,
America and Spain and on the west coast of Africa,
from about 1790 to 1820.
It is a perfectly well-known fact, admitted equally by
I.ind and Bancroft, that the slaves on board a slave-ship
did not suffer from yellow fever, although they suffered
much from dysentery and from what used to be called
the " horrors of the middle passage ; " so that a slave-
ship would arrive at her destination with no contagious
fever on board, but saturated with the filth of her human
cargo. The facts discovered by Dr. Audouard in two Span-
ish outbreaks suggested to him a general theory of yellow
fever ; it was a peculiar form of typhus due to emana-
tions from the putrid dysenteric discliarges of the negro,
•ind the fever owed its well-marked specific type to the
tact that the matters which excited it could be traced to
the negro body. There was something, he said, quite
peculiar in the negro's constitution, and it was not sur-
l)rising that the discharges from his sick body should be
able, when fermented, to produce in otliers a typhus
fever of a peculiar type.
Dr. Audouard's papers were comnumicated to the
French Royal Academy of Sciences, and accepted for
publication. The Academy, however, did not adopt his
opinions, and they pointed out, after the manner of
academies, that his facts related to only three slave-ships
and to only two outbreaks. But the author had shown
that a great part of the West Indian trade with Spain
was carried on by ships engaged in the contraband slave-
trade, and that the same circumstances which led to the
epidemics investigated by himself must have arisen often
at all the Spanish ports where yellow fever was an almost
annual occurrence. Not only so, but the whole history
and geography of yellow fever in America was on his
side; seaports where cargoes of slaves had been landed
year after year had presumably become saturated with
the peculiar filth of the trade, and it is just the landing-
l)laces and shipping-quarters of those ports that are the
foci of infection. In some of them, such as \'era Cru/,,
the poison seems to have become jjeculiarly fixed in the
soil, so as to defy all attempts at getting rid of it. But
in the great cities on the Atlantic seaboard of the United
States, the fever was practically eiadicated soon after
the importation of negroes ceased. During the sixteen
years after that date (1S08), yellow fever appeared only
seven times in thediflerent ports of the Union, whereas in
the sixteen years preceding the abolition of the traffic it
had broken out fifty-eight times.
In the Spanish seaports also, the great epidemics of
yellow fever are an almost forgotten tradition. l!ut in
Brazil they are of recent date, the first of them as re-
cently as 1849, and Brazil was then and had been for some
time the great market for the African slaves, when the
ports of other countries except Cuba were closed to them.
A still more unlooked-for confirmation of Dr. Au-
douard's theory may be discovered in the establishment
of yellow fever in the seaports of Peru within quite re-
cent times ; the first outbreak having been at Callao and
[.imain 1853. An account of it was sent from Lima to
tlie Edinburgh Medical Journal by Dr. Archibald Smith,
who says: "The first cases of the Lima fever were vul-
garly attributed to the excessively crowded shiploads
landed at Callao of |)oor and sickly Chinese, who were
ill-fed, ill clothed, and badly cared for on the voyage
from their native country. But," he adds, " I, as a prac-
titioner, could not trace any symptoms of this fever to
them." ikit Dr. Smiths objection to the popular ex-
planation of the yellow fever in Peru is precisely the
strongest argument in favor of it ; the Chinese, like the
negroes, did not sufter from yellow fever, and they are
said, indeed, never to take it on shore ; but they suffered
from those dysenteric and other non-contagious ailments
which were the antecedents of yellow fever. The dis-
ease, since that time, has ai)peared at various other ports
on the I'eruvian coast ; its outbreak at one of ihem, in
1868, was .so sudden that the populace attributed it to an
earth(iuake ; but a communication sent to the French
Foreign Office more reasonably connects it with the
Chinese immigration, which, as the report says, has pro-
foundly changed the sanitary condition of the whole Pe-
ruvian coast.
But there is another argument for Dr. Audouard's the-
ory, which he makes hardly any use of. It is the immu-
nity of the negro from yellow fever, notwithstanding his
great liability to cholera and the common forms of typhus,
including ship-typhus. This immunity is perhaps not so
striking now, when the negro blood is less pure, but all
the earlier authors were much impressed by it. Thus,
Doughty, who saw much of yellow fever in Jamaica at
the beginning of the century, says : " In the natives of
Africa the constitution appeared to me as secure against
yellow fever as a person who has had the small-pox" —
and he might have said the yellow fever itself — " is against
its recurrence." Fenner, a more recent authority in New
Orleans, says : " It is a well-established fact that there
is something in the negro constitution that affords him
a protection against the worst effects of yellow fever,
but what it is I am unable to say." Mr. Clarke, the
author of a paper on the " Topography and Diseases of
the Gold Coast," in the first volume of the -'Epidemio-
logical Transactions,'' says : "I have heard and read of
negroes taking yellow fever, but in no case did it happen
at Sierra Leone during its prevalence in 1S37, 1838,
1839, 1847 ; nor, so far as I understand, in 1859 ; and
no example of it occurred to any of my medical brethren
in the course of their practice." This is certainly a re-
markable testimony, when we consider that ninety-nine
hundredths of the ])opulation of Sierra Leone are negroes.
And to show that this is the immunity of negro blood,
and not of acclimatization, I take the most remarkable
experience of all, that of the French expedition to Mex-
ico from 1862 to 1866. There was a heavy mortality
from yellow fever among the motley gathering of troops
at Vera Cruz in the summer of 1S66 ; not only the
French soldiers, but Arabs from .Mgiers, Indians from
the interior of Mexico, and Creole troops from the West
Indies, were decimated by it ; whereas, in a body of four
hundred negro soldiers from the West Indies, there were
only three cases, with one death ; and in a black regiment
of five hundred men, raised in the Soudan and Nubia,
there was not a single case.
If, then, we put together the facts of this remarkable
disease : when we consider that its advent into the world
coincided with the rise of the slave-trade ; that its habitat
is or has been the ports of debarkation of the slave-
trade, and those places in Simin and the West Coast of
Africa to which slave-ships went on their return voyage :
that its exacerbations have coincided with the most law-
less period of the negro traffic : that it gained a footing
in the ports of Brazil in 1849, when the slave-trade flowed
into that channel ; and that it has become endemic sub-
sequent to 1853 on the Pacific coast of South America,
in tliose parts of Peru which were the seat of an infamous
coolie traffic — we can but see in all this concurrence of
testimony a proof that Dr. Audouard was right in de-
scribing yellow fever as a peculiar form of typhus, origin-
ating in all its endemic centres in the filth of slave-ships,
just as he showed that it had so originated, as a matter
of fact, in two of the Si)anish outbreaks. But if that
evidence should not be enough, we have only to add
the fact that the negro cannot take the disease, although
it rages most in the very quarters where negroes live.
The yellosv fever still lurks about the wharves and ship-
ping quarters of towns where cargoes of slaves used to
be landed (e.g., the barracoon at Havana) ; and every
few years, when the weather is at the hottest, it rises
into a pestilence, as if it were the ghost of the slave-trade
walking. But it passes by the negro, as if it recognized
the ties of blood ; and I want no other tact than that to
prove that even this infection, belonging to the exogen-
ous group, is but one step removed from perturbations of
the normal life, and that it carries with it the indelible
stain of its origin.
August II, 1883.]
THE MEDICAL RECORD.
153
The connection between yellow fever and the dysen-
teric and other discharges of the negro body is only a
part of tliat general connection between dysentery and
typinis which has often been noticed in wars and famines.
U formed the subject of a debate, in 1861, before the
Epidemiological Society, in which the late Dr. Murchison
gave an outline of the argument that he afterward main-
tained with so much learning anti research in his treatise on
"Continued Fevers." The celebrated cases of jail-fever,
in which jirisoners brought up at the assizes gave typhus
to the judges and counsel and jury, are full of jtatho-
logical interest; and it may be well, at the present day,
to recall the fact, which arrested the attention of Lord
Bacon, that the prisoners were not suffering from typhus
themselves. But we need not go farther back than
twenty years ago, or farther away than the city of Liver-
pool, for proofs of the de novo origin of a specific fever ;
no more striking proof was ever given of the genesis of
typhus out of dysenteric and other filth than in the case
of the Egyptian frigate which came from Ale.xandria to
the Mersey in 1862 to be refitted. There were four ium-
dred Arabs on beard, who had suffered a good deal from
diarrhoea and ilysentery ; they had met with rough
weather all the way from Alexandria, and the hatches
had been battened down for two or three weeks continu-
ously. When the ship arrived in the Mersey, the 'tween
decks were in a disgusting state of filth, and the pilot who
took the vessel up the river remarked to his wife when
he went home that that ship would be heard of again. He
was himself the first victim, for he was seized with a fatal
form of hemorrhagic typhus about a week afterward.
More than one hundred of the crew were on the sick-list,
chiefly from dysentery, but it was carefully ascertained
that none of the cases were typhus. Most of the Arabs
went to a public bath in their filthy state, and in a few
days typhus broke out among the bath attendants.
Some of the crew were admitted into the Southern Hos-
pital for various non-contagious disorders, and there also
typhus broke out.
All the facts of this most interesting case were com-
municated to the Epidemiological Society by the late Dr.
Duncan, medical officer of health. It was Dr. Duncan's
opinion, and also Dr. Cameron's, the present President
of the Medical Section, that the outbreak was clearly
traceable to the Egyptian ship and her filthy crew, but
that it was not traceable to pre-e.xisting cases of typhus,
whether on the voyage or in Ale.xandria before sailing.
There is one other class of cases which I shall just
mention — the cases in which the mere contact of human
beings in an average state of health and cleanliness sets
up various epidemic disorders among the inhabitants of
remote islands, where strangers rarely come. Mr. Dar-
win, in his narrative of the voyage of the Beagle, quotes
instances of this in the South Seas, on the e.xcellent au-
thority of Williams, the missionary ; and it is to typhus
that Mr. Darwin compares these cases. " It would almost
appear," he says, " as if the effluvium of one set of men
shut up some time together was jioisonous when inhaled
by others, and possibly more so if the men be of dit^erent
races."
I shall take one other illustration of the doctrine of
ac(iuired autonomy, and I shall take both the facts and
the doctrine from Sir Thomas Watson. The English
troops that served in Egypt in 1801, under Sir Ralph
Abercrombie, suffered much from the ophthalmia of that
countr)', which is always brought on by exposure to cold
after being heated, by the glare of the white and parched
ground, by the dust in the air, and such-like causes pe-
culiar to the climate of Lower Egypt. No one, in those
days, thought that Egyptian ophthalmia was a specific
infection. But some of the English soldiers returned
with it uncured, and it soon became contagious in the
home garrisons ; and it was found, after a lapse of eight
or nine years, that there were no fewer than two thou-
sand three hundred and seventeen soldiers pensioners
upon the public bount)- from total blindness in conse-
quence of ophthalmia. Those who knew the disease as
it occurs in Egypt denied that it was contagious, and
those who saw it in England w-ere as i)ositive that it was
contagious. Watson reconciles the two views. He says
that " there is nothing absurd nor unlikely in the sup-
position that diseases may first arise from some other
source, and then become capable of spreading by conta-
gion ;" and he says elsewhere: "My own creed upon
the matter is this — that the disease may, and often does
arise, indei^endently of contagion, from the agency of
ordinary causes of inflanmiation : and that, having so
originated, it acquires contagious properties, which de-
velop themselves only under circumstances that favor
the propagation of most of the contagious complaints."
A parallel to the Egyptian ophthalmia of i8oi may be
found in certain cases of syphilis described by Baron
Larrey in his surgical history of the same campaign.
The Alexandrian syphilis, which the French troops con-
tracted largely, was peculiarly free from " grave symp-
toms," and "easily cured;" but it proved very "obsti-
nate and difficult to destroy" in those who brought it
back with them to France. .,
In choosing to speak of infective' diseases from a
standpoint which is not the dominant standpoint of the
time, I fear that I have laid myself open to the charge
of taking advantage of a public opportunity in order
to get a hearing for a somewhat peculiar view ; but the
words which I have just quoted from Sir Thomas Watson
will show that this doctrine of conmion disorders ac-
quiring specific i)ower has not been absent from the
thoughts of those who lived in the philosophical iieriod
of medicine. Nothing would be more agreeable than to
adduce other instances of the same kind from the his-
tory of medicine, and I especially regret that time will
not permit me to say something of this principle of au-
tonomy as it was held by the thoughtful and talented
writers who were known in Germany fifty years ago as
the Natural History School. But in anything that con-
cerns tlie natural history of disease, we may go direct
to Sydenham, who was the author of the phrase, and in
Sydenham we shall find a very explicit statement of the
doctrine of an'acquired autonomy and a pre-autonomous
stage in the specific diseases. Sydenham uses the lan-
guage of the humoral pathology of his time, but that mat-
ters little. The humors, he says, may, under certain
circumstances, be raised to the dignity of a substantial
form or to a species, a specific disease being one that
takes its rise in the specific exaltation or specification of
some juice of the body; and he expressly mentions the
antecedent condition of the humor before it had put on
its species — antequain hanc induerat speciem. If I have
preferred to speak of the acquired autonomy of a disease,
and of its pre-autonomous st.ige, I mean no more than
Sydenham means here, as the context of the passage
would show.
Sydenham compares these species of disease to the
species of animals and plants, only that their life is an
integral part of the general life of the body ; and as we
have an origin of species for animals and plants, it is
natural to think of the origin of disease species. But
there is a difficulty in the latter which the Darwinian
problem is free from. In the origin of s]5ecies we are
dealing with individual things, each with its well round-
ed, independent life ; but where is the individual life in
disease ? In my humble opinion, the germ will not serve
our purpose, for, according to the great Darwinian anal-
ogy, the germ is always a part of the individual, and al-
ways presupposes the individual. The germ, or the
sperm, is no doubt a peculiarly important part, and it is
charged with the most marvellous representative powers,
but it is always representative of the individual, and it
derives its powers from the individual. Such, at least, is
our only analogy.
If, then, we must have the individual to start with, be-
fore we can apply the " origin of species " to disease, we
come back to the old question, how a morbid state of
154
THE MEDICAL RECORD.
[August II, 1883.
the body can become a semi-independent thing, how it
can exist, not in absolute independence of the body, but
autonomous within it, an iinperium in iiiiperio. This is
the perplexing question which I stated at the outset with
reference to cancer, a disease which, in the popular esti-
mation, is almost synonymous with a semi-independent
life ; and I quoted the words of Paracelsus : " In such a
disease a man is himself and another ; he has two bodies
at one time, enclosed the one in the other, and yet he is
one man." 1 have spoken to several metaphysical
friends of the difficulty of conceiving how a mere state
of the body, a complex or integrated morbid state, can
become an individual existence with the power of prop-
agating itself; but I cannot say that I have got anything
satisfactory out of them. We shall probably have to
settle tills question within our own science as a part of
the subject-matter of pafhology. Pathology is indeed
varied enough in its subject-matter. It studies disease
on many sides, as the founder of this Association planned
that it should be studied — the side of its anatomy and
its physiology, of its geography and its ethnology, of its
history and its natural history. Its aspects are as vari-
ous and attractive as the fruit trees in the Mohammedan
paradise. But there is nothing in all this boundless field
of inquiry that is more likely to occupy the mind of the
profession for years to come, as it has occupied it in
times past, than the difficulty ot conceiving how a state
or condition of the body can become a species of disease.
THE PRACTICAL TREATMENT OF ABDOMI-
NAL HERNIA.
By W. B. DeGARMO, M.D.,
NEW YORK.
I.
The following remarks on abdominal hernia are placed
before the profession with the sincere hope that they may
lead, in some instances at least, to the better treatment
of these affections, and to the more thorough study of a
part of this subject, now much neglected.
It is probable that no subject within the domain of
surgery has received more thoughtful and careful study
than that which has been bestowed upon the surgical
treatment of hernia from the days of Hippocrates to the
present time. It is in the writings of Hipj^ocrates that
we find the first account of this affection that is in any
degree correct. In later years it is described in the
works of Celsus, .Antoninus, Galen, Oribasius, ^-Etius,
and Paulus /ICginetus. the latter in the seventh century,
and those first mentioned prior to that date. From that
early period up to the jjresent time we find pioniinent
among other writers the names of Albucasis, Roger de
Parma, F'ranco, Benedictus, .Ambrose Pare, Fallopius,
Vesalius, Scultetus, Percival Pott, Scarpa, Lawrence,
and Sir Astley Cooper.
In our own time the works of Wood, Dowell, Heaton,
and others, relating to special operations or methods,
will hardly bear favorable comparison with some of those
earlier writings.
In the writings of the authors mentioned, and from the
ably written articles on hernia contained in the standard
works on general surgery, we can obtain accurate knowl-
edge of the anatomy, pathology, and surgical treatment
of these affections; in fact, so faitiifully did Sir Astley
Cooper study the subject tliat very little new material
has been added to it since his time. The study of
the management of and operation upon strangulated
hernia lias been exhaustive, and all teachers of suigcry
endeavor to impress their students with the importance
of a thorough understanding of this branch of the sub-
ject. Many ingenious operations have also been devised
for its radical cure, most of which receive stronger en-
dorsement by their authors than by more impartial
judges.
.Ml of this is good in the line in which these studies
have been pursued, and beneficial in many instances,
but they are of little service to the average patient
suffering from, perhaps disabled by, a neglected hernia,
who has not strangulation, nor the time, money, or in-
chnation to attempt to obtain a radical cure. It is to
this latter class that I desire to call the attention of the
profession, and it is for their relief that I ask for a more
rational treatment of hernia. It surely is as much the
physician's duty to prevent strangulation as to relieve it
when present. To treat disease only after it has arrived
at its most dangerous stage is not, and should not be, in
this instance, the practice of the conscientious physician.
In this country there are at a safe estimate five mil-
lion persons suffering from some one of the various
forms of abdominal hernia. In spite of poor treatment
a few get well, others manage by their own ingenuity to
prevent an increase in the bulk of their hernias, others
by accident get something nearly suited to their cases ;
but a great majority of this vast number are growing
worse every year until wholly or partially disabled, and
many are saved from death only by timely and judicious
surgical aid.
I speak advisedly when I say that the greater part
of this suffering is entirely unnecessary, and due to the
fact that when patients of this charact'er apply to that
source from which thej' should naturally expect and
obtain relief, they are most frequently referred by their
physicians to persons ignorant of the requirements of
the case, who attend them on a purely speculative basis.
It is a crying shame that these numerous cases, so de-
serving of relief, so susceptible of alleviation in the
hands of the [professional man, are still neglected by the
majoritv of practitioners, who shift all responsibility to
the druggist, instrument maker, equally incompetent
truss vender, or allow them to drift into the clutches »f
that chief of charlatans, the self styled " rupture doc-
tor," who is ever ready with his testimonials of cure to
exact an exorbitant fee from his easy victim.
It would be a poor surgeon who should leave the ap-
plication of splints in the hands of the manufacturer, and
devote years of study in trying to remedy the bad results
sure to follow such practice, and yet this is done in cases
of hernia. It needs no statistics, however, to prove that
there is more danger to life, and of disability in an ordi-
nary hernia, than in an uncomplicated fracture of the
humerus, allowing that both are equally neglected. Wh7
this difference in practice in the two cases ? Why is the
one dismissed with scarcely a second thought, while the
other receives the surgeon's most careful attention?
The answer, I believe, may be found in the prevailing, but
certainly erroneous idea, that for a ])erson afflicted with
hernia there is positively no cure, and probably no relief.
To inform a patient suffering from hernia that no re-
lief can be obtained, sending him oft' to buy a truss,
thus dismissing the case, is doing that person a very
great injustice, and the writer has seen most unfortunate
results following this common practice. On the con-
trary, the sufl'erer should be informed of the importance
of remaining under the observation of his physician, and
carefully instructed in the jiroper use of the necessary
appliance.
An eminent authority across the water has truly
said : " The expediency of judiciously pursuing the
mechanical treatment of every variety of hernia cannot
be too strongly urged ui)on the laity by the profession.
In both sexes it should be carefully conducted the mo-
ment that the slighest protrusion shows itself. Whether
the hernia occurs in infancy, youth, at middle age, or at
later periods of life, if properly watched and judiciously
supported, it usually gives but little trouble ; in many
cases it is even cured. But, on the contrary, if it be neg-
lected, increase in bulk, and sooner or later diseased
states of the rupture, often leading to the death of the
individual, will almost infallibly occur.'"
' Holmes* System of Surgery, vol. ti., p. 676.
August 1 1, 1883. J
THE MEDICAL RECORD.
155
Percival Pott, writing in 1779, recognized the impor-
tance of giving these cases early and careful attention in
order to secure the best results. It is to be regretted
that the writings of this and other authors have not made
a deeper impression upon the general profession. He
says : " There are many circumstances attending ruptures
which will require freiiuent assistance in order to render
a cure more probable, and there are many ruptures in
persons of mature age which will admit of perfect cure
if properly and judiciously managed from the first." '
The remarks of the same author upon the charlatans
who thrive upon this class of cases is, it is to be re-
gretted, still applicable: "it has in all times, from the
most ancient down to the present time, rendered those
who labor under it subject to the most iniquitous frauds
and impositions. No disease has ever furnished such a
constant succession of quacks as ruptures have." In
this, as in other instances, those branches of practice
overlooked or neglected by reputable and educated
physicians are the fields in which (|uackery best thrives.
By keeping these cases within the profession, and bestow-
ing the same amount of time and study upon them now
given to surgical cases of even less importance, methods
of treatment would improve, results now considered im-
possible would be attained, and sufferers will not, as
heretofore, be obliged to submit to the impositions of in-
competent and dishonorable persons.
As the limits of this article will not admit of a detailed
account of the ]iroper treatment of each variety of hernia,
I shall at present make only a few such suggestions as
are applicable to all cases ; at a later date I intend mak-
ing some observations on the best practical methods of
treating each form, in order to secure the greatest num-
ber of cures, and the maximum amount of improvement
in those considered incurable. In order to form an
opinion in any degree correct upon which a prognosis
may be based, it is important at the outset to get a full
history of the cause, development, and past treatment of
each individual case. A hernia produced suddenly by
heavy lifting, violent coughing, or other similar causes, is
far more susceptible of cure than one coming on gradu-
ally with a relaxed and flabby condition of the abdominal
parietes, and a distinct hereditary predisposition. Hered-
itary predisposition will be found an important factor in
some cases. The writer has under observation one family
in which nearly every male member for four successive
generations has been afflicted with inguinal hernia ;
another family where in three generations almost all of
the female members have suffered from either umbilical,
inguinal, or femoral hernia.
The exact cause of this predisposition is, I think, left
for future study to determine. Sir Astley Cooper
believed it due to the width or shape of the bony pelvis,
but, after accurate observations under favorable con-
ditions I am unable to endorse this view, having found
by diagrams representing the exact shape of a section of
the pelvis, taken from several members of the same family
in which hernia was undoubtedly hereditary, that they
did not on comparison show any striking resemblance in
size or shape.
By a thorough search for the immediate cause of a
hernia much may be accomplished in many instances,
especially if the case be a recent one, as, if the cause be
found to be one which may be removed, the chances of
complete cure are thereby greatly enhanced. For ex-
ample, if a person has recently produced a hernia by
straining at stool, due to constipation, this cause must be
removed at once, and then with suitable treatment, im-
mediately apphed, there is more than a mere chance of
complete recovery. The same remarks apply with equal
force to cases of stricture and to children suffering from
congenital phimosis.
The writer has seen several instances wherein the
latter has produced the most rebellious hernias, which
^ The Chirurgicial Worlcs of Percival Pott, vol. ii., p. 48.
have entirely recovered when the cause was removed.
At the Children's Hospital, London, Mr. Kempe found
in fifty consecutive cases of congenital phimosis, thirty-
one cases of hernia which had developed since birth.
Improvement began in every instance as soon as cir-
cumcision was jierformed, and in five cases immediate
cure of the hernia resulted.'
One of the most obstinate scrotal hernias the writer
has ever had to contend with was caused by vesical cal-
culi in a patient over fifty years of age. After the
operation for the removal of the stone the hernia so far
improved as to enable him (contrary to advice) to go
days at a time without his truss and still no protrusion
occurred.
The variety and condition of the hernia should re-
ceive careful consideration. It is quite essential in in-
guinal hernia, for instance, to 'determine with certainty
whether we are treating a direct or an oblique protru-
sion, as in the former the centre of pressure used for its
retention should be at the external ring, while in the
latter it is of the first imjiortance that it should be worn
over the internal ring. The methods of diagnosis are
so fully given in all text-books on surgery as to make
their mention here unnecessary, and their treatment will
be taken up later.
Is the hernia reducible? In the majority of cases it
will be so found ; in a few, attempts at reduction will tiot
be attended with success. Do not decide this point
hastily, however, and thereby consign your patient to
the lifelong danger, discomfort, and disability sure to
result from irreducible hernia. In order to illustrate
the importance of this statement the following case is
cited :
E. C , merchant, aged thirty-eight, consulted me,
September 10, 1879, respecting a very large scrotal hernia,
which had not been reduced for six years. Originally small
and easily controlled, it had arrived at its present con-
dition through the use of inferior trusses, bought of the
druggist to whom his physician had sent him, selected
and applied according to his own judgment. Now,
after having abandoned all support for several years, it
has been pronounced, by four physicians, irreducible
hernia, and is so troublesome as to unfit him for busi-
ness. In character it is an entero-epiplocele, the largest
part of the protruding mass being omentum, which in
places appears firmly adherent.
Gentle but constant taxis, with hips elevated, was con-
tinued for one hour. No perceptible effect was pro-
duced, and the patient was instructed to return to his
hotel and remain in bed twenty-four hours, the diet to be
the lightes; possible.
September nth. — Taxis again employed for about
half an hour, and with better results, about one-third of
the mass being returned. Kfforts at reduction discon-
tinued, patient instructed to remain in bed as before.
September 12th.— After twenty minutes' trial entire
mass gradually returned within the abdomen. A suitable
retentive aijpliance was adjusted, and instructions given
that should colic, nausea, or vomiting occur, it was to be
removed at once and the hernia allowed to descend ;
patient to remain in the recumbent position, .\bout
one hour later discomfort in the umbilical region was ex-
perienced, soon followed by vomiting. Support removed
and greater portion allowed to descend, after which un-
pleasant symptoms soon subsided. No further attempts
at retention were made on this day.
September 13th.— Hernia reduced with very little dif-
ficulty, and retained for three hours before discomfort
was occasioned.
September 14th.— Support worn six hours, and on the
following day all day.
Four months later I made the following note in my
case-book : " Improvement in this case rapid, and to an
unexpected extent ; hernia never descends, even under
' The Lancet, July 27. 1878.
156
THE MEDICAL RECORD.
[August II, 1883.
light pressure. Attends actively to his business, and ex-
periences no inconvenience either from his hernia or the
appliance worn." This case has been given in full be-
cause it clearly illustrates three very important points, viz.:
First. — That an apparently irreducible hernia can, in
some instances at least, by judicious and persistent taxis
be returned to the abdominal cavity.
Second. — That extreme caution is absolutely essential
to the safety of the patient, after as well as during re-
duction.
Third. — That great improvement is possible, under
favorable conditions, even in extreme cases ; that the
patient can be brought from disabilit)-, suftering, and the
constant dangers of strangulation, to a condition closely
approximating a cure.
In employing taxis only the most gentle manipulation
is admissible, and the patient should not be subjected
to any amount of discomfort. The necessity of closely
watching the case after reduction can not be over-esti-
mated ; omentum after a long residence outside of the
abdominal cavity becomes hardened and changed in
character, so that when returned it acts upon the peri-
toneum as a foreign bod)'. Petit has recorded a death
due, as was found post mortem, to peritonitis produced
by returning and keeping within the abdomen omentum
which had long been protruded.
These hernias of long standing are worthy of the sur-
geon's most careful and persistent attention, and when
this is given, he will frequently be rewarded by the most
gratifying results. g*^
M. Thiry, in a carefully written paper read before the
Royal Belgian Academy of Medicine, arrives at the fol-
lowing conclusions :
First. — Old hernias of large extent, constituting a va-
nety of eventration, are susceptible of reduction in most
cases. EJ
Second. — The large volume of a hernia is never a con-
tra-indication to its reduction, although it necessitates the
adoption of certain precautions, and the employment of
considerable time.
Third. — The diminution in the capacity of the ab-
dominal cavity in old iiernias is never antagonistic to a
slow, methodical, and progressive taxis.
Fourth. — By slowly re-entering the abdominal cavity
the extended parts gradually resume their former places.
Fifth. — The best method of reduction is " compressing
taxis," whicli consists in only restoring organs to their
natural position after they have been relieved by press-
ure of any vascular engorgement. Those organs which
effected an exit last should be first replaced.'"
In attempting the reduction of these old hernias con-
sidered irreducible, it is best that the patient be fully
informed at the start of llie importance of having the pro-
truding viscera returned to the abdominal cavity, other-
wise he may become impatient under the confinement
to bed.
In hernias of this class, when strong pressure is neces-
sary to retain the mass after reduction, great trouble is
sometimes ex|)erienced in keeping the skin beneath the
pad in a healthy condition. To accomi)lish this, strict
cleanliness of the appliance as well as of tlie person is
absolutely essential, combined with sucii local medication
as tiiay be indicated. In the hands of the writer the fol-
lowing powder applied bencatii the pad on a thin layer
of absorbent cotton has |)roven more efficient in action
than any other means resorted to for hardening the skin
and keeping it healthy :
^, Amylum ^ iv.
Creta gallica 3 ij.
Alumen ust 3 i.
Acidi boraci 3 ij.
Acidi carbolici,
01. limonis fiH . ; ss.
Ft. pulv.
' Bulletin dc L'Acadi5mtc Royalc dc Mddccinc dc Belgiquc, vol. .\v., \o. 6.
The parts should be thoroughly washed every night,
and freshly powdered absorbent cotton placed beneath
the pad every morning for the first week that the support
is worn. Tlie results will fully compensate for the extra
trouble involved.
The writer in his earlier experience in the treatment
of hernia, had the importance of employing these precau-
tions impressed upon him by the following circumstance:
The case was an extremely obstinate oblique inguinal
epiplocele, and very strong pressure was required for its
retention. After the adjustment of the appliance, which
was perfectly successful in its retentive action, the gen-
tleman failed to present himself for examination on the
following day as requested, and at the end of one week
I was asked to see liim at his house. I found that he
had experienced no great amount of discomfort, but on
removing the support on the night previous, the skin
had adhered to the pad, and he iiad removed a piece of
the integument which had sloughed away, corresp'onding
in size with a silver half-dollar, leaving the subcutaneous
tissues completely exposed. Suitable dressings were
immediately applied, but with the most careful attention
the patient was confined to the recumbent position for
three weeks before the process of healing by granulation
was complete, and for this amount of discomfort and de-
tention from business he had only himself to blame for
disobeying the instructions given him.
The Di.\gnostic Significance of Im.mobii.itv of
ONE Vocal Band. — Dr. J. Solis Cohen, in a jiaperin the
July number of the American Journal of the Medical
Sciences, points out : First, that laryngoscopy may some-
times be the sole or most efficient means of diagnosis in
affections located exterior to the larynx ; and second, that
a liability to error might often be incurred, were we to
place too exclusive a reliance upon the objective symp-
toms, as presented by the image seen in the laryngo-
scopic mirror. From a study of cases under his observa-
tion he conchides : I. That whenever the left vocal band
is immobile in abduction, or in the cadaveric position
(positions in which the patency of the glottis is not inter-
fered with), and there is cough or dyspnoea (or both),
without cardiac or pulmonary lesion to account for these
symptoms, we are justified in suspecting aneurism of the
aortic arch ; and difficult deglutition will be almost cer-
tainly confirmatory of the diagnosis, notwithstanding the
absence of tumor, pulsation, thrill, and bruit. The only,
and exceedingly improbable source of error, would be
intrathoracic neoplasm. 2. That anchylosis of the crico-
arytenoid articulation may fairly be suspected in cases
of immobility of one vocal band, not referable to me-
chanical interference with the transmission of nervous
force; unaccompanied with evidence of central or local
nervous disease : and in which failure to respond to ap-
propriate treatment will warrant us in excluding muscular
atrophy. But the diagnosis can be finally established
only by the application of direct pressure to the affected
arytenoid cartilage. 3. That whenever one vocal band
is immobile in the cadaveric position or in abduction,
and there are no otlier signs or symptoms to assist the
diagnosis, anchylosis being eliminated, we should not be
satisfied with a diagnosis of neuropathic paralysis ; but
should keep the jiatient under observation with a view to
detecting the earliest manifestation of aneurism, consoli-
dated lung, or otlier mechanical cause for the impaired
innervation.
Western Criticis.m. — Bellevue Hospital Medical Col-
lege, while ostentatiously proclaiming in her announce-
ment her fidelity to the Code of Ethics, places no
restrictions on the admission of students to her classes,
other than that involved in the price of her tickets. It
is, of course, much more important that a physician be
etliical than that he should be at all prepared by pre-
vious education to take up the study of medicine. Creat
is reform ! — Medical Aire.
I
August II, 1883.]
THE MEDICAL RECORD.
157
The Medical Record-
A Weekly yoitrnal of Medicine and Surgery.
GEORGE F. SHRADY, A.M., M.D., Editor.
Published by
WM. WOOD & Co., Nos. 56 and 58 Lafayette Place.
New York, August 11, 1883.
THE GERM THEORY OF TYPHOID FEVER
AND THE TREATMENT OF THIS DISEASE
BY SALICYLATE OF BISMUTH.
The tendency of the age is undoubtedly to account for all
the contagious febrile affections, as well as many chronic
diseases, by the hypothesis of a specific microphyte, whose
ravages constitute the pathogenetic element. This ten-
dency is exemplified in the theory, recently formulated,
and ably supported by Klebs, of Prague, and Eberth, of
Zurich, as to the etiology of typhoid fever.'
According to these pathologists typhoid fever is due
to a peculiar microbe which presents itself in the form of
rods or filaments, some of which contain spores. Between
the rods and tlie filaments transition forms are observed,
which make it probable tiiat the latter are derived from
the former.
These micro-organisms have been found by Klebs, in
accordance with the period of the disease from which
death resulted, in the following localities : i, in the in-
testine, first in the glands of Lieberkuhn, later in the in-
terglandular tissue and in Peyer's patches, still later in
the submucous cellular tissue, and even in the muscular
layer ; 2, in the mesenteric glands ; 3, in the spleen ; 4,
in the lungs (the parts aftected with hypostatic i>neumo-
nia) ; 5, in the brain.
He has also found them in abscesses complicating ty-
phoid fever, in ulcerations of the laryn.v, in the kidneys,
the myocardium, etc. In these various sites he has de-
tected the same microbe, and in numerical abundance
proportioned to the disorder of function of the organ
where the bacillus has been found. Klebs has made
many cultures of the microbe, and has inoculated ani-
mals with the final product, reproducing in hares, pigeons,
guinea-i)igs, etc., the characteristic anatomical lesions of
typhoid fever.
Eberth, of Zurich, after an independent series of inves-
tigations, has found in the lymph-organs of the abdomen
— intestinal mucous membrane, mesenteric glands, spleen
— certain rods whose characters correspond with those
noted by Klebs. These rods have, in fact, been identi-
fied with Klebs' bacilli.
Klebs gives a graphic resume of the march of this
malady. The bacillus typhosus, or its spores, are taken
into the mouth and pliaryn.x in the au' of resi)iration and
* Bulletin gen. de Therapeulique, June 30, 1883, Desplat's article, to whicli \\e
are indebted for this summary.
are carried to the stomach with the saliva or food. Ar-
riving in the small intestine they produce by their multi-
plication a diffuse catarrhal inflammation, and commence
to penetrate the mucous membrane. This anatomical
stage corresponds to the period of incubation of the dis-
ease, a period characterized by anore.xia, ])rostration, and
a slight febrile movement. .\t this epoch the disease is
still local ; it is not till later, when the bacillus has ef-
fected an entrance into the blood and has invaded the
organs, that we witness the second "classic" stage, the
stage of infection, characterized by fever, cerebral symp-
toms, etc. At the same time the intestinal inflammatory
process concentrates itself on Peyer's patches, which
finally become necrosed and eliminated. The microbes,
moreover, may multiply in the spleen, brain, lungs, and
produce there grave disorders.
It sometimes happens that the bacillus first undergoes
development in the lungs ; the disease then commences
as a pneumonia (typhoid pneumonia) ; at the autopsy
the intestinal lesions (when they exist) are more recent
than the pulmonary lesions.
The primitive lesions of the intestine are not always
in such direct relation to tlie secondary lesions of other
organs, that to the intestinal alterations, however exten-
sive and profound, corresponds a proportionate pertur-
bation of other functions of the economy. The autopsy
often demonstrates that the intestinal ulcerations may be
most marked and grave, at tlie same time that the gen-
eral infection mav have been almost nul ; such are the
cases described as typhus ambulatoriusfix walking typiioid.
On the other hand, with general infection and serious con-
stitutional symptoms, the local intestinal lesions may be
inconspicuous or wanting. In a word, typhoid fever
comprehends two distinct diseases ; the local intestinal
lesion, and general infection with localization in dift'er-
ent organs. These two factors of this complex disease
are synchronous in a part of their duration. The first
precedes the second, and the latter is in full evolution
while the lesions of the former are undergoing reparation.
The germ theory of typhoid fever is far more probable
than the chemical theory ; in fact, we can imagine no
chemical ferment or " poison '' which is capable of pro-
ducing such phenomena, while the liypothesis of a coti-
tagium vivurn, infinitesimal in its commencement, pul-
lulating in the system, antl invading important vital
organs, which are robbed by it of their life-sustaining
oxygen and pabulum, till the environing conditions are
no longer favorable for the maintenance of the parasite,
well explains all the striking phenomena of the disease.
Moreover, important inductive evidence is every year
making the microphyte theory less an hypothesis and
more a fundamental fact in pathology. The inoculation
experiments of Klebs, above alluded to, constitute the
kind of proof now demanded.
Almost all [(athologists being convinced of tlie germ-
inal origin of all contagium, there is a dominant desire
on the part of therapeutists to attack the microbe by
suitable germicides in the alimentary canal or in the
blood, to prevent Us multiplication and eftect its destruc-
tion. There is very general agreement that we are not
yet in possession of any sure and safe means of combat-
ing the germinal maieries nwrbi when once it has effected
entrance into the blood. No one has more clearly shown
^58
THE MEDICAL RECORD.
[August II, 188;:
this than professor Germain See in a late lecture. '
Quantities of any known antiseptics, such as would be
necessary to rid the blood of the parasitic contagium
would be to.\ic and speedily fatal to the organism. This
is notably the case with such germicides as bichloride of
mercury, chlorine, iodine, carbolic, and even salicylic
acid. Salicylic acid, the only acid seriously to be
thought of in this connection, has never yet been given
in sufficient doses to arrest typhoid fever in its march, or
even materially to modify its evolution. Professor See
has known of a rheumatic patient who. while taking ten
grains every two hours of salicylic acid for several days,
was nevertheless attacked by typhoid fever, which pur-
sued its usual course.
Being then debarred from any safe and certain chemi-
cal antidotes against the morbific bacillus when it has
pervaded the system, our therapeutical efforts are diverted
to other indications, such as the support of the vital
forces in the struggle in which they are engaged. Hut
can we do nothing to effect the destruction of the disease-
germ while it is in the alimentary canal, before it has
penetrated the tissues or gained the circulating fluids ?
Not a few distinguished therapeutists have answered this
question in the affirmative, notably Gueneau de Mussy,
Herard, Hallopeau, Liebermeister. Wunderlich, and in
this country Dr. James C. Wilson and Roberts Har-
tholow.'' The treatment of the last two autliorities is es-
sentiallx' identical. Calomel is given in full purgative
doses several times during the first week. This is ex-
hibited for a double purpose, to restore heat production
and to destroy typhoid germs in the intestine. Iodine is
given tiiroughout the disease in combination with car-
bolic acid, or as Lugol's solution. Bartholow's formula
is two parts tincture of iodine to one of strong carboHc
acid ; of this from one to three drops every three hours
during the day and night." By this medication it is in-
tended to arrest the muUiplication of germs in the intes-
tine and prevent fermentation.
Professor Henri Desplats, of Lille, is favorably kiiDwn
by his numerous theses on the antisejitic treatment of
fevers, especially by a memoir publishetl last year on the
treatment of typhoid fever by carbolic acid. After long
experimentation with various salicylates in typhoid fever,
he has found in the salicylate of bismuth the great desid-
eratum. It is sparingly soluble, and therefore is more
likely than most medicaments to escape absorption in
the stomach and to reach the diseased intestine. It
moreover has an energetic action on the organized fer-
nients, and is a bactericide of great power. Taken dur-
ing the prodromic period, when the infection is jnuely
intestinal, the microbes not having entered the blood and
tissues, its efficacy is greater ; in Dr. Desplats expe-
rience it has even liad a marked abortive action. Thus,
out of twenty cases reported by him, eleven (or more
tlian one-half) treated in the first stage were cut short in
four or five days under the free use of salicylate of bis-
muth. At least this is the belief of the i)rofessor, who
gives the particulars of these cases with great minuteness,
* Trailcment dc la Kifevrc typhoidc, Paris, 1883.
f ^li^iJr Wilson on Continued Kcvcrs, p. 228. New York. William Wood & Co.
Also an able statement of Wilson's and Bartholow*s antiseptic mclliod of tre;»ting
typhoid fever in the New York Medical Journal, vol. xxxvii., page 298,
^ Boston Medical and Surgical Journal, February 1, 1883,
showing that the patients had all the characteristic symp-
toms of the disease with varying degrees of severity. In
four cases the bismuth salt had a very decided moderat-
ing effect on the temperature, but the disease was pro-
longed by complications. In five cases, all of which
were very grave, the action of the medicament was nul.
The ordinary dose was about a scruple. This was re-
peated sufficiently often, so that the daily quantity taken
should equal about six grammes (or about one drachm
and a half). In some instances, where the fever-heat was
excessive, the salicylate was given in one full dose of
three, or even six drachms, but these large doses proved
somewhat depressive. The medicament is not unpleas-
ant to the taste and is easily borne. In short, the peru-
sal of this article seems to justify the hope that in the
salicylate of bismuth we have a new medicament of very
great antiseptic value.
PREHISTORIC SURGERY.
In a paper read before the Surgical Section of the Fifty-
fifth Convention of German Naturalists, Dr. Tillmanns
presented some interesting conjectures concerning the
state of surgical art in the stone age {Centralblatt fur
Clnnirgie, June 23, 1S83). He first reviewed the sur-
gery as practised at the present time by peoples sup-
posed to occupy the same plane of development as pre-
historic man in the stone age. Then, from articles found
in the caves of the men of this age, he formed his con-
clusions concerning their surgical practice. Among the
peoples still living in the stone age he reckons the Aus-
tralians, the South Sea Islanders, and the Esquimaux.
Dr. Miklucho-Maclay has given an account in the Zeit-
schrift fiir Ethnologic of castration and ovariectomy as
practised among the Australians. He states that girls
are robbed of their ovaries in order that they may serve
as " hetaiva " to the young people. Tlie operation is
performed through an incision by means of sharp flints,
on each side parallel to Poupart's ligament. The oper-
ation looking to the sterilization of men is performed by
cutting away the under wall of the urethra from the
meatus to the scrotum. This is done by means of a
knife formed of a splinter of quartz set in a handle made
of the dried sap of an indigenous tree. The South Sea
Islanders trephine for injuries of the brain or skull. A
T-shaped incision is made through the scalp and the
bone scraped away with a splinter of glass. The opera-
tion i.s fatal in about one-half of the cases. In case of
recovery the liole is covered with a thin piece of cocoa-
nut shell. If the brain is found to be injured the de-
stroyed ])ortion is replaced with a piece of the brain of
a recently killed hog. This procedure is said to pro-
mote recovery. The natives of Tahiti possess a large
surgical armamentarium, consisting of flints, bistouries
made of shark's teeth, sharpened bones, etc., similar to
those found in the caverns of the stone age. They make
saws also from shark's teeth. The Esquimaux produce
abortion by pressing or striking against the womb with a
whip handle. They also use the sharpened rib of a wal-
rus or a seal, which they guard with leather and introduce
into the vagina to puncture the membranes.
Much has been learned of the o])eration of trephining
in prehistoric limes from the researclies of Prunitires and
August II, 1883.]
THE MEDICAL RECORD.
159
Uroca. The former found a so-called "rondelle," an
oval piece of bone, one and one-half by two inches in
diameter, taken from the parietal bone, in the excava-
tions at Lozere. Such " rondelles " were worn as amu-
lets. They were taken from the skulls of those who in
life had survived the operation of trephining. Such men
were regarded as holy. After their death fragments of
bone were taken from about the trephined part and
worn as charms. Many skulls showing this treatment
were found. The operation seems to have been per-
formed by scraping away the bone with a flint, as the
oblique edges of the hole in the skull would indicate.
THE ALLEGED CURABILITY OF TUMORS BY THE PA-
RENCHYMATOUS INJECTIONS OF OSMICACID.
Some time ago we had occasion to comment upon a re-
port published by Dr. Delbastaille concerning the favor-
able results obtained in the treatment of tumors by the
injection of osmic acid. The cases referred to were
observed at Winiwarter's clinic in Liege. A soft sarcoma,
the size of a child's head, seated upon the right side of
the neck, after an unsuccessful attempt at extirpation,
was treated by the daily injection of three drops of a one
per cent, aqueous solution of hyperosmic acid. After
fourteen days the new growth was softened and dis-
charged through the wound in the skin. In a month the
tumor had entirely disappeared without any unfavorable
local or general symptoms. Equally favorable results
were obtained in the case of a multiple lymphoma,
cervical adenitis, and a sarcoma near the shoulder.
Upon the strength of this report, the late Professor
Bruns, of Tubingen, was led to make a trial of the remedy
in a number of instances. The cases are reported at length
by Dr. Pfeilsticker in the Med. Correspondenzblatt dcs
Wilrttemb. Aerzt Landesve7eins oi Vi2.y T,\, 1883. There
were four cases of multiple tubercular lymphomata, one
of malignant lymphoma of the neck, and one of a sar-
coma, the size of a man's head, upon the left side of the
chest. Unfortunately, not the slightest effect was ob-
served in a single case, even after long-continued trial
of the hyiierosmic acid injections. The procedure was
painless in most instances. The only obvious result,
however, was the matting together of the tumor and the
neighboring tissues, thus increasing the difficulty of ex-
tirpation by the knife. This want of success is explained
by the strictly local action exerted by the acid. It
causes a necrosis of the tissues at the point of injection,
but produces no change in the surrounding parts.
Evidently modern surgery commands better methods of
dealing with neoplasms than the hypodermic injection of
osmic acid.
FAVORABLE RESULTS OF TRAINING UPON THE SENSE
OF COLOR.
It has been stated by Magnus and others that color
blindness is capable of correction by means of special
training. And this seems not at all improbable, reason-
ing from analogy, since other senses may be developed
to such a wonderful degree in certain directions by care-
ful education. An observation made recently by Dr.
W. Kroll is of interest in this co\\x\qq.\ao\\ {Deutsche Med-
uinal-Zeiiung, June 7, 1883). He examined a large
number of men in Crofeld and its vicinity, but found
only 0.6 per cent, affected with color-blindness. The
usual proportion is three per cent, of all examined.
The principal industry of Crofeld, for nearly two cen-
turies, has been the manufacture of silk stuffs and velvet,
and it seems reasonable to attribute the low percentage
of color-blindness among the inhabitants to the education
of their sense of color perception consequent upon their
occupation. It would be easy to pursue these investiga-
tions further among operatives in print works and in
other places where colored materials are manufactured
in this country, and the results thereby obtained might
prove to be of interest, and would certainly have a real
practical value.
^civs of the xlSVcch.
Concerning Aconitia. — Dr. J. O. Tilton writes us to
know if the granules of aconitia (^ grain Duquesnel)
administered accordmg to directions given in an editorial
article in this journal, July 14th, are safe. We have seen
nothing, and we are able to find nothing which would lead
us to fear any unfavorable results from this drug given
with the precautions which we have urged, namely: not
to take more than \ milhgramme at a time, and not to re-
peat the dose oftener than once in three hours, and not to
exceed 2 milligrammes (^^j,^ grain) a day. Granules of
aconitia, containing 5 J 5^ grain, are sold in our drug stores.
These granules contain somewhat more than \ milli-
gramme, and should be used with more caution. We
have prescribed these granules in several instances with
good eflects, directing one granule every four hours till
some tingling of the tongue, pricking of the face, or
tightness about the temples, was experienced. Gener-
ally decided amelioration has attended these symptoms,
which indicate that the physiological effect of the alka-
loid is being realized. In fine, it cannot be claimed that
^¥s g""^'" aconitia is in any sense a poisonous or a dan-
gerous dose, and we should not hesitate to repeat it
every four hours till either the pain is subdued, or till
some or all of the minor toxic phenomena above men-
tioned are felt, watching the actions of the medicament,
and being ready at any time to interrupt its administra-
tion, as we would do with any powerful remedy.
The Addresses before the British Medical As-
sociation.— We have the pleasure of presenting in the
present issue the addresses of Drs. Waters and Creighton,
delivered before the British Medical Association last
week. These comprise, with Mr. Harrison's address
(published last week), all those delivered before the
General Meeting of the Association. Both articles will
be read with interest on this side of the Atlantic, and
will amply repay the extra space given them. Dr.
Creighton's able exposition of his subject, and the ar-
guments used in support of his views will be especially
interesting and instructive to advanced pathologists and
earnest students in the higher professional studies.
The Choler.a.— The news from Egypt is becoming
less alarming. It is said that some of the leading
physicians of Smyrna do not regard the scourge as
cholera. By last report there were thirteen deaths in
Alexandria, and the number of cases of the disease was
decreasing: m the interior.
i6o
THE MEDICAL RECORD.
[August II, 1883.
New York Post-Graduate School. — Dr. A. H.
Smith has been elected Professor of Clinical Medicine
and Therapeutics, dividing the former chair with Dr. T.
E. Satterthwaite, Professor of Pathology and Clinical
Medicine. Dr. Alex. J. C. Skene, of Brooklyn, has been
elected Professor of Gynecology, dividing the chair uith
the present incumbent. Professor B. F. Dawson.
Our Cable Despatches. — We beg to return our
thanks to the numerous subscribers who have sent us so
many kind congratulations regarding our cablegrams of
the recent meeting of the British Medical .Association.
The Atlantic Steamship Service. — A deputation
of the British Medical Association and several members
of Parliament called recently upon Mr. Joseph Cham-
berlain, President of the Board of Trade, and asked him
to appoint a committee to consider the inadequate medi-
cal and sanitary management of .Atlantic steamers. They
commented strongly upon the want of proper precautions
on emigrant vessels, from which a large annual sacrifice
of life resulted. They suggested that ship-owners be
compelled to increase the pay of ship surgeons, and that
the American Government be requested to contribute a
small sum toward the expenses of vaccinating passengers
on board of vessels. .Mr. Chamberlain replied that he
intended to introduce in Parliament, in 1S84, a bill deal-
ing with the subjects mentioned and amending the sliip-
ping act.
The German Poliklinic of the State of New
York. — We are informed that some of the German
physicians of this city, have organized a Poliklinic (witii
an i). It is located on Sixth Street.
©orvespfondencc.
OUR LONDON LETTER.
(From our Special Correspondent.')
IHE cholera — THE WATER-SUPPLY OF LONDON — .MEDI-
CAL HONORS IN LONDON AND DUBLIN THE CASE OF
DR. BLADES THE LATE DR. STEWART.
I^.VDON, July ?8. 1883.
Contrary to exijectation, cholera has continued to
spread in Egypt. The Government are doing what they
can to arrest its spread, and iiave just sent out twelve
civilian medical otticers to the affected district. Mean-
while a conference of medical officers of health on the
subject has been held and arrangements made in readi-
ness in case cholera should unfortunately reach our
shores. The ])ossible advent of cholera has again re-
vived the question of a purer water-supply for London.
We still drink only filtered river water in London
mostly from the Thames — and although the companies
now have their intake higher up tlian London, the river
is still not wholly free from sewage contamination from
towns liigher up the stream, although of late years great
efforts have been made to lessen its pollution from such
sources. There seems to be not the faintest chance of a
water-supply for London from any purer source so loui;
as the supply rests with the water companies. ^Ve shatl
have to wait, first, till tile next session of Parliament for
the London .Municijial Bill; second, for a purchase by
the new municipality of the companies' works and rights ;
third, for the construction of a conduit from a purer
source. Meanwhile, while not improving the quality of
the water, several of the companies have taken advan-
tage of their parliamentary powers to largelv increase
their rates, which, by the way, may probably prove an
advantage from a sanitary point of view, as it will direct
the attention of the ratepayers to the general subject ot
ijOndon water-suppl}-.
Two more baronetcies have just been given to London
medical men. viz., to Dr. Andrew Clark and to Mr.
Prescott Hewett. The former is the Premier's medical
attendant, and has one of the largest practices in London
as a general physician, having the repute of realizing over
twelve thousand guineas a year. He has written on pul-
monary diseases, especially on " Fibroid Phthisis," and
lately delivered an important address on " Renal In-
adequac}'." Dr. Clark is an enthusiastic advocate of the
temperance cause. He is at present senior physician to
the London Hospital, and is very popular with his stu-
dents. Dr. Clark is, if not the most eloquent, one of the
readiest sjieakers in the profession. For getting up and
delivering a lengthv impromjitu speech on any subject
he is — within the profession — probably unequalled.
Mr. Hewett holds an equally important position on
the surgical side of the profession, being senior surgeon
to St. George's Hospital, holding several appointments
to the Royal family, and is an important contributor to
"Holmes' System of Surgery.'' Mr. Hewett enjoys an ex-
tensive consulting practice among the elite of fashion at
the west end.
Some Irish honors recently proffered have given less
satisfaction. The lesser dignities of knighthoods have
been offered to Surgeon (jeorge Porter and Dr. Banks,
both of Dublin. The latter promptly declined the honor
as not commensurate with his professional position ; the
former has, after deliberation, finally accepted. The
feeling among the profession in Dublin is very bitter on
the subject, and a deputation of medical men has waited
on the Lord Lieutenant who told them he could not inter-
vene in the case of honors awarded by the Crown.
The recent apparently arbitrary dismissal of a police-
surgeon for his alleged neglect of a constable suffering
from obscure diabetic symptoms terminating fatally, con-
tinues to excite attention, and T/te Lancet has started a
memorial to the Home Secretary on the subject.
One of the latest losses to the London profession by
death is that of Dr. .\. P. Stewart. Dr. Stewart i)ractised
as a general physician at tiie West End for forty-three
years, and was a very widely known member of the pro-
fession. Very early in his career he wrote a lengthy
paper in which he differentiated typhoid and typhus fever,
and to a large extent anticipated Sir W. Jenner's later
but more complete researches. But Dr. Stewart did not
follow up the clue he had obtained, and thus did not ac-
quire the fame and position which might have been his.
He was on the staff of the Middlesex Hospital for many
years, and at the time of his death Consulting Physician to
that institution. He also lectured at the school on ma-
teria medica and medicine successfully. He held im-
portant offices as a member of the British Medical As-
sociation, and after being for many years one of the
secretaries to the Metropolitan Counties' Branch (a post
in which he was succeeded by Dr. Farquharson, now
M.P.) was presented with a handsome testimonial sub-
scribed among the members. He was once offered the
presidency of the Branch but declined it. Dr. Stewart
was one of those of whom it can be truly said that he
sought not the material rewards of his jirofession. His
practice was never extensive. He was nevertheless be-
loved by all with whom he came in contact. His man-
ner was genial and attractive, his character consistent
and upright. He was well-known for his interest in all
religious movements, and he made an attentive study of
the revised version of the English Testament. He was a
Scotchman by birth, and distantly related to the family
of the Prime Minister. Had Dr. Stewart been more en-
ergetic and businesslike he might have reaped a richer
harvest in practice, but he w.as not pushing, and even
declined to lecture at the College of Physicians when
asked to do so a siiort time since.
August 1 1, 1883.]
THE MEDICAL RECORD.
161
gv00vcss of ^cdicat Science.
Salicylate of Soda in Diarrhit.a. — In an article
on the pathology and classitication of the various forms
of diarrhcea, and on the indications for the employment
of salicylate of soda in this affection, Dr. Calleza con-
cludes as follows: i. The products of the putrefaction
of the contents of the intestinal tube are the sole cause
not only of a number of varieties of idiopathic diarrhcea,
but also of many secondary diarrhu;as, in which the pre-
existing disease has engendered a predisposition to de-
composition. 2. Salicylate of soda is the most efficacious
agent for preventing putrefaction in the intestinal tract
without interfering with the normal digestive jirocesses.
It should always be employed when the stools have a
putrid odor, especially if this character has been noted
from the commencement. 3. Two or three doses of
fifteen grains each per diem are sufficient for the speedy
cure of strictly idiopathic diarrhcea. 4. In the second-
ary forms of the disease (which are far less common) a
trial may be made of the salicylate rather as a prophy-
lactic measure than with the hope of any marked thera-
peutic effect. 5. In syphilitic and phthisical diarrhcea,
in that accompanying visceral abscess, especially of the
liver, and in dysentery, salicylate of soda has produced
the best results.- — Lyon Medical, May 20, 1883.
The Use of Coffee in Strangulatkd Hernia. —
Dr. Antonio Sarra relates that he was called one even-
ing to attend a man, sixty-three years of age, suffering
from a strangulated femoral hernia. The patient was
nearly moribund, there was no appreciable radial pulse,
the face was pinched, the extremities were cold, and the
attempts to vomit were almost incessant. Happening
to remember the report of a similar case relieved by
coflee. Dr. Sarra ordered an infusion of this substance to
be employed as a drink and also externally, and then
took leave of the patient, warning the family that death
was inevitable unless a prompt amelioration ensued.
Upon returning early the next morning he was surprised
to find his patient in perfect health. The man stated
that soon after taking the coffee he experienced a feeling
of warmth and returning strength, then a large quantity
of gas was expelled above and below, and when he put
his hands upon the tumor it at once slipped back into
the abdominal cavity, much to his astonishment as well
as joy. — Lyon Medical, May 20, 18S3.
Cardiac and Pulmonary Symptoms Dependent
UPON Gastro-hepatic Troubles. — In an exhaustive
memoir upon this subject, embodying the results of a
large number of observations. Dr. Barie concludes as
follows : I. Certain dyspeptic conditions arising from
the stomach, intestine, or bile-ducts react upon the car-
dio-pulmonary apparatus and occasion morbid phenom-
ena, which may be divided into four clinical groups : A.
In the first form the heart alone is afl'ected, as evidenced
by palpitation and intermittence of the pulse. B. The
second form is characterized by phenomena affecting both
the heart and lungs. There is more or less oppression
in breathing, amounting sometimes to orthopnuea and
threatened suffocation. It appears almost immediately
after eating and ceases when the process of digestion is
completed, coming on again after the next repast. The
cardiac troubles consist in dilatation of the right side,
secondary tricuspid insufficiency sometimes following.
There is a hruii de galop, which has its seat in the right
heart, and also an accentuation of the diastolic sound at
the level of the pulmonary artery, indicative of increased
tension in the lesser circulation. During the attacks of
dyspncea there are observed a small, soft, and compres-
sible pulse, cyanosis, coldness of the face and extremi-
ties, and sometimes even slight haemoptysis. C. The
symptoms arranged under the third group resemble very
closely angina pectoris. D. In the last form the phe-
nomena are scarcely noticeable ; there is a little oppres-
sion in breathing after meals, and examination reveals a
slight accentuation of the second sound at the pulmon-
ary orifice, but there is no trace of dilatation of the
heart. These varieties may be entirely distinct or
tliere may be a combination of the symptoms of several
forms. 2. These different phenomena are the conse-
quence of a reflex action starting from the seat of diges-
tive disturbance. The pulmonary capillaries are thrown
into a state of spasmodic contraction, causing suddenly
an exaggerated tension of the pulmonary system, and the
right heart, struggling against this obstruction ahead,
becomes first dilated and then hypertroi)hied. 3. Ex-
perimental physiology has demonstrated that this reflex
action takes place wholly in the sympathetic system ;
nevertheless, clinical observation permits one to believe
that the pneumogastric nerve is not entirely unconcerned
in the production of these reflex symptoms. 4. These
cardiac and pulmonary phenomena are observed to oc-
cur only with the milder dyspeptic troubles, and are
never met with in the course of the more serious alTec-
tions involving tissue changes (chronic inflammation,
organic degeneration, etc.). 5. The above -described
symptoms are met with usually in individuals whose ner-
vous system is most impressionable. Women are more
often aftected than men (in the proportion of three to two
according to the author's observations). Chlorosis and
hysteria are predisposing causes. 6. The dyspeptic con-
ditions giving occasion to these cardio-pulmonary symp-
toms are, as regards the stomach, simple idiopathic
catarrh, and dyspepsia consequent upon tuberculosis,
kidney disease, uterine at^ections, and heart disease ; as
regards the bile-ducts, catarrhal jaundice, biliary calculi,
etc. 7. The prognosis, as a rule, is not grave, but the
phenomena are subject to a recurrence in persons who
are careless on the subject of alimentary hygiene. When
the primary cause persists for a long enough time (as,
for example, in impaction of a calculus in the bile-duct)
and the dilatation of the heart is extreme, tricuspid in-
sufficiency may be produced, and the patient may finally
succumb to cardiac disease. 8. An exclusively milk
diet is the only efficacious remedy. It works wonder-
fully well in gastric dyspepsia, but its action is indiffer-
ent and inconstant when the liver is the cause of the
digestive troubles.- — Journal de Mcdecine dc Paris, June
9, 1883.
The Biliary Capillaries. — The precise histological
structure of the capillary network of bile-ducts in the
lobules of the liver has not been satisfactorily settled. Is
there a special epithelioid lining to these minute chan-
nels or not ? M. Kanellis has communicated to the
Academic des Sciences a note of some investigations
made on the livers of rabbits with the aid of injections
of nitrate of silver. The conclusion at which the histol-
ogist arrived {London Lancet) was to the effect that there
does exist a flat, thin, tesselated epithelial lining of
the ultimate biliary canaliculi, and that the larger ducts
possess a coat of prismatic cells. This observation is
believed to afford grounds for a belief in the existence
of a distinction between the biliary and glycogenic func-
tions of the liver ; the epithelium of the biliary chan-
nels presiding over the functions of bile secretion, while
the hepatic cells proper are devoted to the formation of
glycogen. When the small size of the intralobular biliary
capillaries is borne in mind, the determination of the
presence or absence of a special epithelial lining, even
with the aid of injections of argentic nitrate, will cer-
tainly not seem to be an easy matter, especially when
we remember that an inference in histology is seldom or
never a matter of direct observation. The distance, too,
between such cells of doubtful existence and the genuine
hepatic tissue is so infinitesimal that the relegation of
one function to one structure must be an act of discrim-
ination of so delicate a nature that we do not think much
weight ought to be attached to the suggestion offered.
l62
THE MEDICAL RECORD.
[August II, 1883.
The Causation of Musical Cardiac Murmurs. —
Asaresult of observations extending over a considerable
jjeriod of time, Professor Schrotter communicated to the
Vienna Medical Society {Allgcin. Wien. Med. Zett., No. i,
1SS3), his views on the causation of musical murmurs heard
over various parts of the heart's area. Following Ham-
ernik, he regarded the fine, musical, high-pitched note
sometimes observed over the left ventricle as due to the
abnormal tension of one or more chorda: tending, and
demonstrated in illustration thereof the heart of a man
of forty, in which a fine, tendinous thread traversed the
cavity of the left ventricle. In some other cases, how-
ever, viz., those of musical murmurs heard over the
aortic area, similar conditions have been observed, es-
pecially in perforated aortic valves, a thin, tendinous
thread corresponding to the free edge of the valve be-
ing left free to vibrate in the current of blood. Such
perforated valves are not uncommon, but it is only in
the cases where the thread-like margin is able to be
vibrated that the musical sound is produced.
Test for Iodine in the System. — Dr. Starke
makes use of the following test to ascertain whether his
patients have followed his directions when he prescribes
iodides. It might also be made use of by a physician
to learn whether a patient has taken iodides against
his wish. He lets the patient spit on a strip of white
paper and then spreads some calomel over it, or he
sprinkles calomel on any sores that the patient may
have. The calomel turns bright yellow if there is any
iodine in the system.
Calomel AND Micro-Organisms. — Dr. Vassilieff has
published some interesting researches concerning the
action of calomel on the contents of the intestines
{Zeitschr.fiir Physiol. Chemie). He alleges that lie has
proved that this drug leaves the gastric, hepatic, and pan-
creatic secretions absolutely unchanged. But it ])re-
vents certain processes of retrogressive metamorphosis
and putrefaction, by destroying bacteria and micrococci
naturally present in the alimentary canal. Hoppe-Sey-
ler has rightly attributed the bright green color of
calomel stools to the presence of unaltered bile in the
fKces. Under normal conditions the coloring matter of
bile is destroyed in the process of digestion. But Dr.
Vassilielil" argues that calomel ijrevents this destruction,
and the coloring material remains to give to the ftces
their peculiar hue under these conditions. The pancre-
atic secretion is peculiarly complicated, and particularly
liable to very rapid decomposition, with the consequent
formation of indol and allied products. Calomel en-
tirely prevents this change, and also alters the charac-
ters of the gases evolved in the process of pancreatic
digestion, especially diminishing the evolution of car-
bonic acid. Experiments on artificial pancreatic diges-
tion proved that, when calomel was mixed with pancre-
atic juice, ]jroteids, starch, and fats were all acted upon
in the usual manner, trypsin, amylopsin, and steapsin
being unaffected by the drug, but indol, long recognized
as a jjroduct of decomposition, is not formed. Dr.
Vassilieff, in a further series of experiments, found
that this prevention of decojii position was due to the
distinctly aseptic and antiseptic properties with which
calomel is endowed. He discovered that it prevent-
ed the formation of bacteria and micrococci in food re-
moved from the intestines and freed from these micro-
organisms, and that it also destroyed them where they
were present. Dr. Vassilieff administered fifteen grains
of calomel to a dog, in two equal doses, and killed the
animal a few hours after the second dose. The contents
of the intestine were collected and analysed with cverv
precaution. No indol or jshenol could be found, but
much leucin and tyrosin, generally destroyed at an early
stage of digestion, were detected. This experiment ap-
jjears to have been repeated more than once. Other
experiments, with cheese, showed that calomel prevents
butyric acid fermentation.
Crede's Method. — The value of Crede's method of
expelling the placenta has recently been tested by com-
parative trials. Fehling used Crede's method in ninety
cases. The placenta was left to come away itself in
ninety-five cases. The following were the results : In
the first series (Crede's method) the average loss of blood
for each patient was five and one-half ounces. The time
before the placenta came away averaged 7.7 minutes.
In the second series the average loss of blood was six
and seven-tenths ounces. The time before expulsion
was 13.4 minutes. In eighty-five of the ninety cases
treated by Crede's method the membranes came away
entire. In ninety-one of the ninety-five cases left alone
the membranes came away entire. — Ohio Medical Jour-
nal.
Treatment of Infantile Gastro-Enteritis. — From
observations made in the Children's Hospital, at Pesth,
Dr. Epstein concludes {Prager Medic. Wocheris.) that a
liquid diet, poor in fatty matters, is the basis of treat-
ment of gastro-enteritis in young infants. He recom-
mends particularly an albuminous lemonade, obtained
by beating up the white of an egg with a pint of water,
previously boiled, the resulting mixture being then care-
fully filtered. At the Pesth hospital this is prepared
fresh three times daily, and is kept in a bottle well
corked and placed on ice. In a word, all precautions
are taken to prevent the introduction of micro-organisms
into the sxstem. Nursing from the breast should be com-
pletely stopped for the first few days. Every three hours
two ounces of milk at a lukewarm temperature may be
given to the child, either with the bottle or by spoonfuls.
The child should not be put back to the breast until the
loss of flesh, which is considerable at first, commences to
diminish. Again, when at the commencement there is
violent vomiting and rejection of yellowish curds, Ep-
stein washes out the stomach daily, for from eight to fif-
teen days, by means of the oesophageal tube. As regards
direct remedial measures he employs the following potion :
5 . Sodse et magnes. benzoat 3iv.
Sp. villi gall 3 ss.
Aqua; 3 vj.
M. Sig. — Teaspoonful every two hours.
Congenital Diverticulum of the Left Ven-
tricle.^ — A rare and curious example of cardiac abnor-
mality has been recorded by Dr. Gibert {Le Progres
Medical, June 9, 1883) as occurring in an infant who
lived to the age of ten months. The child was born
with a ventral hernia, the abdominal wall being defective
in the middle line from the umbilicus upward. A large
pulsating vessel was noticed to be present together with
the hernia, and as time went on this vessel increased in
size till at the time of death it was as large as the finger.
On examination it was found that the diaphragm was
also defective, so that the pericardium opened into the
peritoneal cavity, and projecting into the abdomen was
a pouch-like diverticulum, connected with the apex of
the left ventricle, with muscular walls, and internally
marked by fieshy columns like the ventricular cavity
itself. This diverticulum was thirty-eight millimetres in
length, and shaped like the finger of a glove. Dr. Gibert
suggested that the non-closure of the ventral wall was
probably due to the |)resence of this cardiac deformity.
But the converse hypothesis, that the pouching of the
ventricle depended on tlie defect of the diaphragm and
abdominal wall, seems to be held by Dr. Blanciiard, who
made a further dissection of the specimen, for he speaks
of it as being the congenital formation of a kind of true
infundibular form of aneurism of the apex of the left
ventricle — a fact the more curious, because at that
period of life the left ventricle only plays a very subor-
dinate part, and this protrusion of a iwrtion of its wall
cannot therefore be attributed to an excess of internal
pressure. However, we are not aware that in any re-
corded case of pericardial deficiency a similar ventricular
AusTust II, 1883.]
THE MEDICAL RECORD.
163
aneurism has been observed. Dr. Peacock, who refers
to several casesof defect of the pericardium, inchiding the
classical one referred to by Baillie, makes no mention of
such an abnormality in his work on " Malformations of
the Heart."
Grubs in the Intestines. — No insect, jiroperly so-
called, has ever been proved to take up a permanent
abode in the human alimentary canal. Their presence,
whey they were found, was accidental, as when swallowed
on a piece of meat upon which the eggs had been de-
posited. But occasionally larvas may give trouble. Dr.
Wacker {Med. and Surg. Reporter') has published the
case of a boy, aged twenty-one, with colicky pains, ful-
ness in epigastrium, constipation, and frequent fits of
nausea and tendency to syncope, especially when in a
close atmosphere, such as that of his cottage or a stable.
Dr. Wacker prescribed some Hunyadi Janos water, to be
taken every morning on an empty stomach. On the
third day a vast mass (over two litres) of larva;, partly
alive and partly dead, was passed from the rectum. The
patient at once recovered, feeling no more unpleasant
symptoms, even when in a hot room. On examination,
the grubs were found to be larva; of a common dipterous
insect, anthemyia ciiniculitue, closely allied to the house-
fly and blue-bottle fly.
Vessels and Nerves. — The nervous system domi-
nates not only the yihysiology but also the pathology of
the highest animal organisms. This fact is a corollary
to at least two important principles — the indivisibility of
physiology and pathology, and the supreme importance
of the neural tissue in all the superior classes of animals.
The truth and the value of these considerations can re-
ceive no better illustration than the all-powerful influ-
ence of the neural apparatus in the production of disease
of the various tissues. A careful and valuable series of
experimental researches on the influence of the nervous
system in the causation of disease of the vessels has been
contributed to a recent number of Virchow's ^rir/z/z' by
Dr. I^ewaschew, of St. Petersburg. The conclusions at
which this experimenter arrives are definite, and corre-
spondingly easy of comprehension, especially in the light
of what we already know concerning the origin of tissue
changes as the result of neurotic lesions. The method
of investigation is worthy of mention. Generally the
chief nerve-trunks of the hinder extremities of dogs were
the parts subjected to irritation by means of a solution of
muriatic or sulphuric acid. It was found that rabbits and
cats were unfit for this continuous form of stimulation,
because the action of the acid on the exposed nerve-
trunk brought about gangrene and, as a strong stimulus was
wanted, milder means could not be employed. The ob-
server then noted chiefly the vaso-motor changes which
ensued. But the most important part of the research
consisted in the examination of the various vessels which
received their nerve supply from branches of the irritated
nerve-trunk. The most satisfactory results were ob-
tained from the sections hardened in picric acid and
stained with logwood. The alterations were most ad-
vanced in the smaller vessels — in those provided with a
good coat of muscular tissue. The duration of the con-
stant irritation was variable, some animals being exam-
ined, after a few months, whilst others lived for a year
and a half or more. The microscopical examination of
the vessels of the limb experimented on was compared with
that of those of the other limb, which had been under
precisely the same conditions, with the exception of the
special form of irritation. No change was detected in
the unirritated limb. It must first be mentioned that
the pathological changes found in the vessels of the limb
operated upon were not equally distributed over all parts
of the vessel, but the areas of disease, of varying si/.e,
were separated by areas of sound tissue. The investiga-
tion of the arteries of animals in which the sciatic nerve
had been stimulated a moderately short time, or in the
least affected vessels of those animals in which the stim-
ulation had endured for a lengthened period, resulted in
the detection of alterations chiefly of the adventitious
coat. New formation of vessels, with the presence
around them of a great number of indifferent cells, was
observed ; and this process was seen to extend itself more
or less into the muscular tissue, whereby the bundles of
plain muscular tissue were separated from one another.
In vessels which had been irritated for much longer
periods, a development of connective tissue which had
undergone fibrillation and had displaced and destroyed
the middle coat was witnessed. In brief, the changes
detected were those of periarteritis, mesarteritis, and end-
arteritis, in the order here mentioned. Such inflanuna-
tory alterations are of great im])ortance in the production
of aneurisms, and the bearing of these recent experiments
on vascular pathology is too evident to need a long de-
scription. The ascertained relation between the patho-
logical processes in nerves and the diseases of the ves-
sels suggests an explanation of the frequent disease of the
cerebral vessels. The similarity of the lesions described
above to those which have been delineated by various
histologists need not lead to the conclusion that all
fibroid vascular diseases are the result of nerve irritation ;
it must ever be borne in mind that a variety of causes
may produce identical results. — The Lancet.
A Three-Barrelled Penis. — Dr. Luxardo describes
a rare anomaly of the penis which he observed in a young
man under treatment for gonorrhrea. The meatus pre-
sented three openings, which corresponded to as many
distinct urethral canals. The upper one gave passage
exclusively to seminal fluid, the lower one to urine. The
middle tube apjieared to comnuinicate with the lower
one. The gonorrhoea afiected only the two inferior
canals. — L' Union Medica/e, No. 54, 18S3.
A Case of Primary Monomania. — The circumstances
connected with the trial of Guiteau brought prominently
to notice a peculiar form of insanity, the so called pri-
mary monomania. In view of the professional interest
attaching to this variety of mental disease, the publica-
tion of the case reported by Dr. C. B. Burr, of the East-
ern Michigan Asylum, in the July issue of the American
Journal of the Medical Sciences', is timely, and attracts
attention on account of the resemblance it bears to that
of Guiteau. Disregarding the moral traits of these two
individuals, their cases are strikingly similar. In contra-
diction of the oft-repeated assertion that the execution of
an insane criminal now and then has a deterrent effect
upon others of like propensities, Dr. Burr's case may
well be cited, inasmuch as his homicidal assault was
made less than five months after tlie hanging of the mur-
derer of the President, and in face of the strong popular
sentiment against the so-called " cranks " and lawless
fanatics. There are few more striking illustrations of
the impotency of moral and legal measures to restrain or
control a morbid impulse than is attbrded by this case.
A Case of Cardiac Ano.malv. — Dr. Horace Grant,
of Louisville, reports in the July number of the American
Journal of the Medical Sciences a remarkable anomaly
of the human heart, interesting not alone from its strik-
ing singularity, but as well from its clinical importance.
In a post-mortem examination of a mulatto girl, sixteen
years of age, the right ventricle was found to communi-
cate directly with the aorta ; no pulmonary artery was to
be seen attached to the heart. The left auricle was
normal ; the left ventricle presented only one-half the
usual attachment of the aorta. In a word, both ventri-
cles opened with equal freedom into the aorta. At the
pericardial attachment to the aorta two arteries were
given oft", each about one-fourth of an inch in diameter ;
they passed right and left backward from the front of the
aorta, and evidently supplied the blood to the lungs.
This curious anomaly is discussed in connection with
the clinical symptoms observed during life.
164
THE MEDICAL RECORD.
[August II, 1883.
^cuicms and Jloticcs.
Handbook of the Diagnosis and Treatment of
Diseases of the Throat, Nose, and Naso-Pharvnx.
By Carl Seiler, M.D., Lecturer on Laryngoscopy,
at the University of Pennsylvania, etc., etc. Second
Edition, tliorouglily revised and greatly enlarged.
With seventy-seven Illustrations. Small octavo, pp.
295. Philadelphia : Henry C. Lea's Son & Co. 1883.
This edition is twice as large as the first, containing new
methods and much original matter. While making ex-
tensive additions to the wood-cuts, it would have im-
proved the work to have omitted more of the old ones.
The position of the mirror shown in Fig. 3, resting high
upon the forehead, instead of a perforated reflector over
the eye, is probably an oversight or a relic of the author's
abandoned methods, since it is entirely at variance with
laryngoscopy as now practised. The author's ingenious
utilization of electrical incandescence for laryngoscopy
and rhinoscopy has paralleled if not preceded the in-
vention of a somewhat similar instrument by the French
electrician, Trouve. His convenient disposal of the va-
rious forms of laryngeal paralysis by employing the fre-
quent symptom " aphonia" is hardly justifiable. Even
a division of paralyses constructed upon modified symp-
toms, as aphonia, dysphonia, and altered voice, must
prove inferior to one based upon motion. Attention is
attracted to an original anatomical feature in the lar\nx,
a cartilage described as running along the edge of the
cord on a line with the processus vocalis. It only oc-
curs in the female, and we fail to find it mentioned in
the literature of the subject. The anaisthetic effect of
nitrate of silver applied in full strength to mucous mem-
branes is a therapeutical point first discovered by the
writer. There are several wood-cuts of instruments shown
for the first time in book-print. Among them we ob-
serves the Burgess blow-pipe, recommended for the
practice of atomization, also a very useful automatic hy-
draulic air compressor.
We do not agree with the author in taking exception
to text-books which refuse to recognise the existence of
ulcers due to catarrhal changes in epithelia. His explana-
tion of hypertrophic changes in chronic coryza, produced
in part by catarrhal proliferation of cells, does not com-
pletely harmonize with tliis statement. Undoubtedly, the
abrasion caused by the constant removal of adherent inspis-
sated mucus may result in perforation of the nasal septum.
This passive condition is, acurately speaking, no njore an
ulcer than the erosion caused and kept up by the pressure
of a markedly deviated septum. The chapter on "catch-
ing cold" is a well-arranged and ingenious explanation
of this common phenomenon. Decided preference should
be given to the section devoted to diseases of the nose.
New and original ideas are constantly presented to the
reader, and the matter is conveniently and attractively
arranged. Nasal medication receives ample attention,
the surgical treatment of diseases of the nose being more
fully considered on account of the positive result obtained.
A galvano-cautery apparatus, convertible at ])leasure
into a galvanic or faradic battery, is probably the most
interesting of the author's inventions.
Among the illustrations is a powerful sewing-machine
electric motor, recommended as a convenient substitute
for the surgical engine. Jarvis' ojjcrations are advocated
by the author. Some of the new wood-cuts representino-
hypertrophic changes in thenares seem to have originated
more in the draughtman's memory than from clinical ex-
perience, judging from the appearance of Figs. 49, 56,
and 57. A number of the wood-cuts, however, are well
and correctly executed. Taken in its entirety, the work
may be considered as one of the most satisfactory and
complete manuals on this subject. There is abundant
evidence that it is not an effort of mere compilation, but
also the result of original thought and careful investi"a-
tion. The faults of omission and commission are not
numerous or serious, and are more than counterbalanced
by the merits of the work. The simplicity of the style
and freedom from technicalities recommend the book to
the beginner, and the valuable information, represent-
ing the experience of a well-known authority on dis-
eases of the throat, makes it a desirable addition to the
library of the advanced reader.
Handbook of Electro-Therapeutics. By Dr. Wil-
helm Ere. Translated by L. Putzel, M.D. With
thirty-nine Wood-cuts. New York : William Wood
& Co. 18S3. Wood's Library of Standard Medical
-Authors.
The publishers have done a good service by presenting
a translation of this book to .American readers, since it
is probably the best work on the subject of electro-
therapeutics, considered especially from a scientific
standpoint, yet published. A certain amount of hum-
bug has always surrounded the therapeutic application of
electricity, and it is refreshing to find an author who en-
deavors to measure everything as much as possible by
physical and physiological law. Very nearly one-half
of the jjresent work is devoted to electro-physics, electro-
physiologv, electro-diagnosis, and general electro-thera-
peutics. These parts are particularly good. Few prac-
titioners yet appreciate the value of electricity as a help
to diagnosis and prognosis ; and no doubt Erb's work
will do something to call the matter to their attention.
Some of the principal things which the author insists
upon are the use of galvanometers, of large electrodes,
and of the polar method. Under special electro-thera-
peutics the author tries evidently to give a fair estimate
of the value of electricity in each disease. Every elec-
tro-Uierapeutist, however, when he becomes a writer, is
apt to become biassed in favor of the potent agent con-
cerning which he discourses. Erb has not entirely es-
caped this fault. Furthermore, we might complain at his
too ready acceptance of cases reported by such quasi-au-
thorities as Neftel, llenedikt, and Clemens.
A Treatise on LvsANrry in its Medical Relations.
By William A. Hammond, M.D. New York: D.
Appleton & Co. 1SS3.
The appearance of numerous works upon insanity during
the last two or three years is a striking evidence of the
increased interest everywhere taken in this subject. The
works of Voisin and Luys in France, of Krafft, Ebring and
Arndt in Germany, as well as of three treatises published
almost simultaneously in America, are sufficient proofs of
the fact referred to. The present work of Dr. Ham-
mond's is likely to attract particular attention, both be-
cause of its being the first American work upon insanity,
and of the well-known ability of its author. Dr. Ham-
mond has the faculty of presenting every subject whieh
he touches in a clear, interesting, and positive manner, so
that the reader can hardly fail to be impressed, and (at
least if non-expert) to be decidedly aftected by his views.
In the preface of his work the author states the opin-
ion which he has expressed with luuch positiveness be-
fore, that the ordinary conception of insanity is much too
narrow, that a slight mental aberration is as truly insanity
as is acute mania. .Many persons, however, with but
slightly unhealtliy minds are, he believes, responsible.
He would, therefore, make a division practically between
"medical" insanity and legal insanity. The point thus
made is a most important one.
It may be remarked, however, that the attempt to in-
clude under the technical term " insanity" all individuals
whose minds deviate markedly from the normal, would
oblige us to include nearly all constitutional criminals and
a vast number of persons with inherited or acquired
neuropathic constitutions, the " cranks," the markedly
eccentric and the moral imbeciles, e.g., Pascal, Samuel
Johnson, Henry Bergh, and Dr. Tanner. We would be
deluged indeed with this medical insanity. It may be
August 1 1, 1883.]
THE MEDICAL RECORD.
165
questioned, therefore, whether it would not be better to
give to this class another name, indicating that their men-
tal impairment is differently accentuated. Yet, after all,
the question is not of fundajuental importance. In time,
society will learn to treat all bad and all eccentric men,
as well as all insane men, as really sick men.
Dr. Hammond begins his treatise with a section on
the Physiology and Pathology of the Human Mind. His
psychology is of the simplest kind. This is a merit
which few others liave attained, and it is attained at the
expense of some inaccuracies. The mind, says our au-
thor, is a compound force, made up of perceptions, in-
tellect, emotions, and will. We confess that this sim))le
analysis disturbs our previous psycliological views a good
deal. Perception, according to the author, is the
force which places the individual in relation with exter-
nal objects. Its seat is thought to be in the oj^tic thala-
mus. It is the starting-point of ideation ; it is not in-
lierently associated with consciousness.
It is evident that the writer has confused the terms
perception and sensation ; and we think that mental pro-
cess can be explained without the use of the latter term.
Indeed, of the two we might better abandon the term
"perception," as the elder Mill did.
Sensation is the simplest form of consciousness. A
simple sensation is the consciousness of a single senso-
rial impression. Only brutes and infants have it. Our
sensations are generally the compound of a number of
sensations — sensation -clusters, so to s]ieak. Perception
is the process by which a fresh sensation is united to or
correlated with previously registered impressions. By
its aid ideas are formed, and ideation and ratiocination
take place. Neither percejition nor sensation are lo-
cated in the thalami, for they are associated with con-
sciousness, though doubtless these ganglia are closely
associated with the elaboration of the ingoing impulses
which are the raw material of the mental phenomena in
question.
The definition of will as a special mental force is per-
haps practically necessary, though the tendency at pre-
sent is to do away with the word and substitute that of
"volition," which indicates action rather than special
power or choice. There is no such thing as free-will,
which, as Arndt says, '' is the shibboleth of the ignorant ;
and a will not free is no will at all." What is known
as will is rather the resultant of certain antecedent
forces which can not always be analyzed.
We have discussed this part of Dr. Hammond's work
at perhaps undue length. We have felt justified how-
ever, in so doing, because his psychological divisions are
made the basis of his future classification and symptom-
atology. The fact that they are not rigidly accurate is,
therefore, important to point out.
The remainder of the section in question is devoted to
such subjects as the Inflnence of the Mind upon the
Body, Eccentricity, Idiosyncrasy, Genius, Habit, Tem-
perament, Constitution, Hereditary Tendency, Age, Sex,
Race. Much more space than usual, and perhaps than
is needed, is devoted to these various subjects. We con-
fess, however, that we do not ourselves regret it, since
they are written in an attractive style and show the re-
sults of a most extensive reading, observation, and
thought.
The second section contains two chapters upon
the Nature and Seat of Instinct. The discussion of
the nature of instinct contains a good many quota-
tions which are interesting but inconsequential. The
author's own definition and view are unquestionably cor-
rect. His attempt to locate instinct in man in a particu-
lar part of the nervous centres can hardly be considered
successful. Instinct is the expression of a nervous
mechanism whose paths and centres are probably exten-
sive, and not to be definitely circumscribed. We might
make the same criticism of the section uiwn Sleep, viz.,
that it is an unnecessarily long, though an instructive one.
We are surprised not to find among the numerous au-
thorities quoted the name of Preyer. While the author
has undoubtedly established the fact that in sleep there
is a cerebral anxmia, he strangely enough still insists
that this an:emia is the primary cause of the condition.
The blood-vessels, however, are the servants of the ner-
vous system and cannot decrease in calibre except at its
bidding.
The last section is upon the Description and Treatment
of Insanity. We find that before reaching it we have
already exceeded our allotted space. We can only say
now, therefore, that though much elaborated and im-
proved it is based luainly upon the chapter on insanity
in the author's work on " Nervous Diseases " (earlier edi-
tions). There is no doubt that, whatever its deficiencies,
it will give the general practitioner a clearer idea of insan-
ity than he can get from any other text-book in the
English language.
We can, on the whole, heartily commend Dr. Ham-
mond's book to our readers. While the author is not a
trustworthy guide in all the subjects upon which he
touches, yet his errors are not dangerous, and the book
in its entirety is so broad in scope and so rich in mate-
rial that it will be an education for the physician who
reads it.
Insanity : Its Causes and Prevention. By Henry
Putnam Stearns, M.D. Pp. 248. New York : G. P.
Putnam's Sons. 1883.
This work is not a scientific treatise intended for phy-
sicians alone, but is rather a contribution to a most impor-
tant branch of sociology. It consists of a series of essays
upon the nature of insanity, the various factors which
produce it, and finally upon its prevention. The essays
are pleasantly written, and contain in some instances
evidences of considerable researcli. In most cases, how-
ever, the chapters are simply the impressions and opin-
ions of a man of wide experience, rather than the results
of special study and investigation. The tone of the book
is throughout healthful and sensible, and we should be
very glad to know that the work is widely read, for it
certainly deserves to be.
La Circulation du Sang. Exanien critique de la
Theorie Regnante. Sur le Mouvement Circulatoire du
Sang, et Essai sur la Theorie par laquelle on doit la
remplacer. Par le Dr. Ramon Turro. Traduit de
I'espagnol par Jules Robert. Paris : O. Berthier.
1883.
The author endeavors to prove that the arterial walls
have an independent rhythmical contraction which as-
sists in the propulsion of the blood.
A History of Tuberculosis, from the time of Syl-
vius to the Present Day. By Dr. Arnold Spina,
First Assistant in the Laboratory of Professor Stucker,
Vienna. Translated, with Notes and .'\dditions, bv Eric
E. Sattler, i\f .D. Cincinnati, O.: Robert Clark & Co.
1883.
The publishers state that the first five chapters of this
book are a free translation, with a few notes and addi-
tions, of the first of the very valuable work of Dr. Ar-
nold Spina, which has just appeared in Germany. Every
careful medical reader of to-day knows that Spina is the
most formidable critic and opponent of the theory ad-
vanced by Koch concerning the Tubercle Bacillus. To
these chapters Dr. Sattler has added two which contain
an account of the investigations of Koch and of the va-
rious subsequent experiments of other investigators ;
also a full description of the latest experiments of Dr.
Spina, in which he claims to have disproved Koch's theo-
ries, together with Koch's reply. The book, therefore,
gives the position of the combatants down to March,
1883, and is a monograph of 184 pages, well printed
upon good paper. It is one of the most concise resumi's
of what has been said concerning the pathological ana-
tomy and histology of tuberculosis.
1 66
THE MEDICAL RECORD.
[August II, 1883.
I
^viuy mid llnuy |Xaiis.
Official List of Changes of Stations and Duties of Officers
of the Medical Department , United States Arviy, from
July 28, 1883, to August 4, 1883.
TuRRiLL, H. S., Major and Assistant Surgeon. Granted
leave of absence for one month, to commence September
I, 1883. S. O. 77, Department of the Platte, July 26,
Official List of Changes in the Medical Corps of the Navy
for the week ending August 4, 1883.
Coles, J. W., Surgeon, ordered to the Naval Hosijital,
Philadelphia, Pa.
Marsteller, E. H., Passed Assistant Surgeon, de-
tached from the U. S. S. Hartford and granted sick-
leave.
Bransford, J. F., Passed Assistant Surgeon, detached
from the Naval Acadeniy and ordered to the Hartford.
BoGERT, E. S., Medical Inspector, detached from the
Navy Yard, Norfolk, on .\ugust 30th, and ordered to
the U. S. S. Trenton, September ist.
TiREBEE, N. McP., Passed Assistant Surgeon, detached
from the Navy Yard, Norfolk, on August 30th, and or-
dered to the U. S. S. Trenton, September ist.
Gatewood, J. D., Passed Assistant Surgeon, ordered
to the Trenton, September ist.
Kidder, B. H., Surgeon, detached from the N.aval
Station, Port Royal, and ordered to the Navy Yard,
Norfolk, August 30th.
I^lctUcal 4^tcms.
Contagious Diseases — Weekly Statement. — Re-
port of cases and deaths from contagious diseases re-
ported to the Sanitary Bureau, Health Department, for
the two weeks ending August 7, 1883 :
rt
Week Ending
Cases.
July 31, 1S83..
August 7, 1883.
Deaths.
July 31, 18S3..
August 7, 1883.
(A •..
o.S
U
s
■Ji
43 29 (
46 I 32
52
49
12 17
12 i iS
How, IN a Crowded Profession, Bangs got a
Start. — The little village of Millbrook was disturbed in
its calm serenity by the advent of two new doctors.
Now there will be more sickness, people said, for so
many doctors must find work to do. From time im-
memorial Millbrook had never had so many physicians
before. Not that three medical men migiit not be well
supported, for Millbrook and vicinity numbered twenty-
one hundred inhabitants ; and is it not a (social) law of
nature that every seven hundred people must support
one doctor ? Four doctors, however, were one too
many, and only the strongest and fittest would survive in
the struggle for existence.
Brown and Bangs were the new-comers : Brown from
the important medical college of Grande Moiuagnc ;
Bangs from the little onc-horse-power concern of Cam-
pcrdown. Brown had the most titles. He was an A.B.
and an U.D.M.C., the last two letters meaning master
of surgery. Bangs had done no good work at college,
but had somehow managed to get through with a diploma
in classic sheepskin, and in Latin, signed by ten profes-
sors, which hung in his office in an elegant frame.
Brown's friends said that Bangs could never succeed, for
in medicine, as in Sabbath-school library books, it is al-
ways the good boy and good student that is rewarded,^
while the bad boy that shirks his lessons and "slopes"
examinations comes to grief. Besides, Bangs' diploma,
coming from such a school, would be no help to him,
while Brown's Grande Montague diploma would power-
fully recommend him to favor. So Brown's friends
thought, and so it seemed to Brown. Moreover, it was
known to a few that Brown had written a prize thesis of
great merit on " Pityriasis V'ersicolor," which contained
some original drawings, and in which the parasitic origin
of this cutaneous affection was ably maintained. He
had also made some personal investigations, while a hos-
pital interne, of that curious insect the sarcoptes homi-
nis, in which the habits and habitats of the parasite were
well described. As a therapeutic measure he had pro-
posed the ingenious plan adopted by hunters in the case
of wolves, of smoking the little animal out of his haunts
by the fumes of burning brimstone aj^plied to the orifice
of entrance. There was, however, nothing especially
new in this medication (as was very properly pointed
out by the faculty), sulphur having been for more than a
hundred and fifty years, from empirical considerations,
employed against this common pest of mankind. Brown
was well grounded in the general principles of therapeu-
tics, but he had not yet learned that while sound theo-
ries are very necessary in applying them to practice,
you have the whims and caprices of the patient to con-
tend against, and that you never really have diseases to
treat, but only sick people. Symptom treating, he be-
Heved, was irrational ; you must seek out the diathesis,
and '• go for " it ; find the point of departure of the mor-
bid phenomena, and attack it, rather than the symptoms,
which would disappear with the disappearance of their
cause. This is very good theory, but is not to be fol-
lowed too rigidly. If Bangs had any theory of thera-
peutics, it was that symptoms are the key to disease, and
the physician's highest art is to attend to and treat symp-
toms. A furred tongue generally requires an evacuant ;
pain calls for an anodyne; dianhcea a corrective or an
astringent. Bangs had pored earnestly over certain
treauses on "Specific .Medication,'' believed a thousand
or more unproved and very doubtful statements con-
tained in them, and thought himself on the path of
progress.
Brown believed that his services would be in demand,
and that he might "select" his patients and patrons.
Bangs was willing to take "anything and everything that
came along," and improve every opportunity to " rush
in where angels might fear to tread." It was a boldness
and an impudence that very often in this misconstructed
world give success. To cut short our tale, Brown did
not obtain a foothold in Millbrook, and left discouraged
iu less than six months. Yet he might have succeeded
but for two circumstances. Do you wish to know what
these were ?
He had not been in Millbrook many weeks when, one
stormy evening, late in autunm, a messenger came in
hot haste for a i)hysician — one of the Wilsons, of Dog-
town, ten miles distant. The weather was cold, and the
road very muddy. There was a sick child in Dogtown,
and the case was urgent. Dr. Grimes would not go on
account of the roads, and Clay, the homoeopath, had
declined for the same reason. Brown, too, declined,
when he was informed that the pay was doubtful. He
would not expose himself to such inclement weather
"with an uncertainty before him." Here he made a
grave mistake, as we shall see. Bangs was summoned,
and in five minutes time was ready, equipped, and in his
saddle. In one hour and ten minutes he had gained the
cottage of his patient. It was a case of typhoid fever,
and the sick girl had been suffering from a prolonged
August II, 1883.]
THE MEDICAL RECORD.
167
attack of epistaxis. Bangs plugged the nostrils (he
fortunately had a flexible catheter in his pocket) and
stopped the hemorrhage. He came the next day and
the next, and so on, and the little patient eventually re-
covered. His brilliant surgical operation of tamponing
the nostrils (which had never before been performed in
that part of the country) gave him great repute in Dog-
town, and henceforth lie could claim all the families of
that rural district as his. This was an excellent start for
Bangs, and one that he well improved. The fever proved
epidemic in Dogtown, and that very year Bangs scored
one hundred and fifty visits to that distant agricultural
settlement. This professional work, at three dollars a
visit, gave his small family for a long time a comfortable
support.
"Aunt Jane Hopkins,'' as she was familiarly called,
was a spinster of large influence in Millbrook. Brown,
who early in his professional career had been honored by
being consulted by this mistress of gossip, had severely
offended her by making light of the back-ache, the side-
ache, and a host of neuropathic troubles. He had re-
commended a diet treatment for her dyspepsia, when
Aunt Jane knew that she needed medicine. He had
even called her neurasthenic ailments hysterifot m ! and
had counselled greater firmness of will.
Aunt Jane gave him up in disgust, and called i}i
Bangs. Here was just the man who could enter into
sympathy with her infirmities, and who had a specific for
every symptom. She was " doctored " for " womb
trouble," and "spinal irritation," and "dyspepsia," and
"liver complaint," and finally got well after taking six
different kinds of medicine daily for eight weeks !
Henceforth Aunt Jane acted as though her principal
mission in life was to sound the praises of her favorite
physician. Those who know anything about the ele-
ments that usually constitute village society, can well
appreciate the benefit that Bangs derived from such pjr-
sistent advertising among the gossips of Millbrook.
In short, Bangs' bread was soon "buttered on both
sides," and Brown, as before said, left discouraged.
'Indications and Contra-indications for the Usk
OF Digitalis in Mental Diseases. — Dr. Pedro Ribas,
in an article published in the Revista fretiopatica Barcelo-
nesa, gives the following as the indications and contra-
indications for the use of digitalis in mental diseases :
Indications. — i. In acute mania with anajmia, dilated
pupil and feeble heart-beat. 2. In chronic mania of
tranquil form, especially in those cases characterized by
hallucinations of sight and hearing. 3. In hypochron-
driacal mania, especially where thoracic and pulmonary
troubles are com]3lained of. 4. In suicidal mania and
melancholia. 5. In religious ecstasy and fear. 6. In the
melancholy and depressive stage of general paralysis, es-
pecially if anasmia be present. 7. In simple, primary
dementia.
Co7itra-iiidications. — i. In acute, violent mania. 2.
In simple, chronic melancholia. 3. In cataleptic ecstasy.
4. In most forms of general paralysis.
Dr. Ribas, as will be seen, draws some fine distinctions.
— El Siglo Medico, April i, 1883.
The Different Kinds of Quacks. — -According to
the Gazette Hebdomadaire the genus of the quack varies
in France with his nationality. It may be interesting to
know that the American quack, as he flourisheth abroad,
is "high in color, loud in voice, noisy and impudent."
That is the role he usually plays also in this country, but
he does not confine himself to it. In his great versatility
he adapts himself to the peculiarities of his dupes. We
have seen him pale, of smooth and delicately modulated
voice and exceedingly demure. The Spanish quack
abroad is, we are told, " mystic, sombre, the crucifix in
hand, always ready in prayer." That lay has not been
worked here to any great extent, and it might be made
to pay. " The Dutch impostor, writing his consultation
with a flask of urine in hand, as in the famous ' Dropsical
Woman' of Gerard Dow," would scarcely be adapted to
the genius of this country. There are some, however,
who are favorably impressed through the urine. But the
kind which carries the palm abroad, and is the peculiar
abomination of the French profession, is the (German
quack, "surrounded with piles and electric apparatus ; a
professor of occult physical science ; who cures with the
same spark pulmonary tuberculosis and cerebral debil-
ity ; a distinguished lecturer and the apostle of a newly
discovered art." The latter quack should emigrate.
Untold wealth awaits him here. The arrant, blatant, ig-
norant quack is beginning to lose his grip as our people
grow more intelligent, and the "occult" would catch
them. They have much more faith in the incomprehen-
sible than they have in that which is reasonable. The
theological quack has cultivated this weakness very suc-
cessfully, and there is no reason why the medical quack
should not find it profitable.
The .Action and Therapeutic Uses of Aconitine. —
I.aborde has an elaborate article upon the above subject.
His experience with aconitine in neuralgia is favorable
but not many cases are cited. — Tourn. de Therapeut., May
25, 1883.
Napelline as a Substitute for Morphine. — Napel-
line, an amorphous alkaloid obtained from aconite root,
has been successfully used by Laborde to relieve neuralgia
pains, and as a substitute for morphine in a case of the
morphine habit. It was given hypodermically in doses
of from one to four centigrammes in the twenty-four
hours. — Journ. de Therapeut.
The Value of Color and of Music in the Treat-
ment of the Insane. — Dr. H. Sutherland refers to
Tonga's suggestion that different colors may be used ad-
vantageously in the treatment of the insane, and to Dr.
Claye Shaw's view that music might also be utilized in
the therapeutics of mental disease. He says : In my
own experience, the efficacy of such therapeutic agents
has been found to depend upon the previous education
of the patient and the various crises of his disorder ; a
change to a more cheerful room, associated with pleasant
reminiscences, often exercising a marked influence for
the better on the course of the mental disorder. — British
Med. Journ., May 5, 1883.
The Therapeutic Value of the Water of
LouRDEs. — Drs. Labadie, Lagrave, and Derignac, give
an interesting account of a patient, a woman aged forty-
five, not neuropathic, who suffered from a double otor-
rhoea, followed by symptoms of meningitis, epileptiform
attacks, contractures, paralyses, atrophy, mental and sen-
sory disturbances. She was treated for meningitis with-
out success. After being in the hospital for nine months,
she went to Lourdes and was immediately cured secun-
dum artem. The case illustrates the diagnostic value of
faith-cures. — Archives de Neurologie, May, 1883.
The Treatment of the Filthy Insane. — Schiile
discusses the measures best adapted to preventing and
remedying the filthy practices and habits among the in-
sane. It is very necessary to break up these habits and
secure cleanliness whenever possible. Moral treatment,
special appliances in the way of beds, hydrotherapy, fara-
dization, coercion in some cases, are the measures re-
commended. The use of sedatives, medicinal and me-
chanical tonics, are generally indicated. Non-restraint
should not be carried too is-t.—Alli;. Zeitschr. f. Psych.
u. Fsycli.-Gerichtl. Medic, xxxvii., 6.
Hypodermic Injection of Cold Water in Sci-
atica.— Dr. Pollak has communicated to the St. Louis
Medical Society a case of sciatica, in which he injected
ice-cold water hypodermically deeply into the tissues,
with the effect of speedily alleviating the pain. The re-
lief was \z.%'img.— Philadelphia Medical Reporter, Febru-
ary 3, 1883.
i68
THE MEDICAL RECORD.
[August II, 1883.
Nerve-Suture. — Johnson cites fifty-two cases of
nerve-suture which he has found in literature, to which
he adds some cases communicated to him jjersonally.
He has jjerformed sixteen experiments in nerve-suture;
uniting in tliese cases the totally dissevered ends of a
sciatic nerve with a catgut suture. He recommends
nerve suture as deprived of all danger. In fifty-two cases
of the operation in man there was no bad result, and
nervous conduction was established w-ith comparative
rapidity. Indirect suture is preferable to direct. Kauf-
niann, in 1880, successfully transplanted a dog's sciatic
nerve in the human being, and from experimental results
Dr. Johnson believes that this example should be fol-
lowed in cases where indicated. He leaves to future
experimenters to determine whether nervous conduction
is established most promptly and thoroughly by suture,
or, as was proposed by Vanlair, by placing between the
severed ends a tube of calcined bone [A^ordiski Medicin.
Archiv, Band xiv., No. 31). — Weekly Medical Review.
Medical Practice in Persia. — Dr. C. J. Mills, an
English physician who has resided for fifteen years in
Persia, has recently written an interesting work entitled
"The Land of the Lion and the Sun." Some of his
medical experiences are given. The author had the
privilege of attending Persians in their illness. At first
he was astonished at receiving no emoluments, but found
out that his servants pocketed his legitimate fees. One
day a poor patient sends him some money inclosed in a
handsome purse. The doctor returns the money, but
keeps the purse. Then a rich man hears of this, pays
the doctor in money, and puts it, too, in a handsome
bag. The doctor keeps the money, and very much to
the disgust of his patient, sends back the jnirse. A well-
to-do baker has a cataract, and our medico cures Iiim and
receives about four pounds for his fee. When the Per-
sian regains his sight he insists that he is still blind,
worse than ever, demands back the money, and is clam-
orous for an additional sum for an indemnity. The
medico knows him to be a rascal, and suddenly flourishes
an amputation-knife before the blind man, who at once
runs away as fast as his legs can carry him. Demands
were constant for quinine, and the doctor had been par-
ticularly instructed to distribute it freely when cases re-
quired the febrifuge. But the cry for quinine became so
constant that the author was certain that it was obtained
under false pretences. Then, as a rule, he administered
it in solution, or if his servants wanted it he put it in a
dry state in their mouths. Then the cry for quinme di-
minished. In the case of his servants, it was the legiti-
mate nwkadel, or perquisites of office they were after.
They collected the quinine and sold it.
\Vhat the Abuse of Medical Charitv has Done
FOR f^NGLisH Physicians. — .A correspondent of the St.
I^ouis Courier of Medicine, writing upon the subject of
the status of English doctors, says: "The social po-
sition of die whole medical profession in England is
much lower than it ought to be. The distinctions lav-
ished on other professions are very rarely conferred on
medical men; but the ))rofession has itself to thank to a
great extent for this difference. The amount of gratui-
tous work done by the profession in no way raises it in
the public esteem. It is well known that it is not per-
foniied from motives of charity, but for the position
which is gained by being attached to a hospital staff, and
the hopes of a good practice ultimately accruing tiiere-
from. This custom of gratuitous services to the hos-
pitals has grown on the profession, and many a young
physician and surgeon now is exhausting himself in mind
and body by attending patients gratuitously at hospitals
whose incomes are in some cases much greater than his
own. This injustice the public, as represented by the
people who support the hospitals, in nowise wish ; they
would be quite willing that the first charge on the in-
comes of the hospitals should be to adetjuately remuner-
ate the medical men who attend upon the sick. But any
reform in this direction must emanate from the heads of
the profession. No profession can be expected to rise
in social position when kept in a state of penury; and
this i)overty-stricken state of the medical profession, as it
is in England, is a great deal due to the action of those
who hold the highest position in it. They preach to the
younger members, who are getting nothing from their
hospital appointments, to keep up the dignity of the pro-
fession by never taking from a private patient less than
their guinea or two guinea fee, when the same patient
can see men of the greatest reputation and obtain their
advice for the same amount. The senior men with high
reputations ought never to take less than five or ten
guineas ; there would then be a chance of the junior
members of tlie profession sometimes obtaining a pa-
tient."
Medicine in Japan. — A recently jiublished oflicial
report gives the number of physicians who have passed
satisfactory examinations in medicine and surgery at
1,625 ; those who have not undergone such examina-
tions, 769 ; those who have pursued their profession
from the time when there was no system of examina-
tion, 30,700; oculists, 502; surgeon-dentists, 124; ac-
coucheurs, 417 ; bone-setters, 86; licensed apothecaries,
415 ; those who have been in practice from the time
when there were no license regulations, 6,426 ; govern-
ment principal hospitals, 3 — branches. 19 ; public prin-
cipal hospitals, 192 — branches, 40; private principal
hospitals, 202 — branches, 11. It will be seen from the
above that by far the larger number of practising phy-
sicians are still unlicensed, and probably practise accord-
ing to the old Chinese system. It must be borne in
mind, however, that the regulations requiring physicians
to pass an examination in anatomy, physiology, materia
niedica, pathology, practice of medicine and surgery, and
obstetrics, and to take out licenses to ])ractise, only came
into vogue a few years since, and did not affect those
already in practice for three or four years. Medical
schools are now increasing in number, and consequently
the number of students educated in Western medical
sciences. The last annual report of the Medical Depart-
ment of the LTniversity of Tokio shows the actual number
of students as follows: medical students, 169 (course
conducted by German professors) ; those following the
same course in the Japanese language, 760 ; pharma-
ceutical students, 71 ; making a total of 1,000. There is
one licensed physician to about every 22,000 of popula-
tion, and one unlicensed to every 1,200 ; or one phy-
sician, licensed or unlicensed, to ever)' 1,109. — Corre-
spondent of Philadelphia Medical Times.
The Aim of Liberal Homceopathy is well set forth
in a recent issue of the Halinemannian Monthly, which
says : " A few years ago the editors of the New York
Medical y/wt-j- dropped from the title of their journal the
distinctive word ' Honueopathic; ' now they boldly urge
the renunciation of the word as applied to our school of
medicine. If we are emancipated from the thraldom of
sect, we shall not only save our school from imminent
dissolution, but shall also become an integral part of the
medical profession of the day, honored as true, broad,
liberal, progressive physician.s. But if we cling to a
name which by no means represents the catholicity and
spirit of the new school, we are doomed to annihilation ;
and more, we become the common enemy of all allo-
paths and also of all progressive homoeopaths. The
neutral ground upon which a lasting truce is to be con-
summated is the common acceptance of the dual action
of drugs. No one denies that ipecac in one dose will
vomit, and in another will allay vomiting; therefore no
one will contend with anotlier if only this plain truth is
adopted as the universal motto of the medical profession."
Treatment ok Painful Throat. — A correspondent
asks what is the best treatment for cases of "sore throat,"
so called, in which there is much steady pain, some dys-
phagia, and hardly any signs of congestion or swelling.
The Medical Record
A Weekly yournal of Medicine and Surgery
Vol. 24, No. 7.
New York, August 18, 1883
Whole No. 667
CDviijinat g^rticlcs.
THE CORPORA QUADRIGEMINA.
With Remarks Conckknino the Diagnosis and Lo-
calization OF Lesions Affecting Sight.'
By AMBROSE L. RANNEY, M.D.,
NEW YORK.
The aqueduct of Sylvius [iter e tcrtio ad qiiartuni ••en-
triciilum) is covered on its superior and dorsal aspect bv
two pairs ot rounded eminences, mainly composed of
gray matter, called tiie corpora or tubercula tiuadrige-
mina (the so-called ^^ nates" 3,\\<\ '' tcsles cerebri"). A
median groove separates these parts. Anteriorly, a
transverse white prominence (the posterior commissure)
limits this groove ; behind, it is continuous with the
velum by means of a small median strand of longitudinal
fibres, called \\-\t frenulinii veli. The pineal gland which
projects backward and downward from the posterior wall
of the third ventricle overlaps the anterior portion of this
groove, resting between the two upper quadrigeminal
bodies (the nates). In fishes, reptiles, and birds, these
bodies are two in number, and are called the optic lobes.
They are also hollow in these species. In the human
fcetus they are developed early, and form a large part of
the cerebral mass. The anterior tubercles are (.larker in
color and less prominent than the posterior. Laterally,
each tubercle is prolonged upward and forward into a
prominent strand of white substance, the brachium or
arm of the corresponding tubercle. The brachia are to
be regarded as fasciculi sent to each tubercle from the
corte.x cerebri by means of the corona radiata. They
may also be considered as affording a communication
with the optic thalamus. The upper or anterior brachium
passes between the inner geniculate body and the poste-
rior e.Ktremity of the optic thalamus, or the pulvinar,
where it may be demonstrated to join one of the roots of
the optic tract, of which it really is a continuation. This
is more apparent in some animals than in man. The
lower or posterior brachium loses itself underneath the
inner geniculate body, which is situated at the side of the
upper end of the crus cerebri.
The upper quadrigeminal bodies, or nates cerebri, are
covered externally with a thin layer of nerve-fibres, called
the " stratum zonale.''' This constitutes the only place in
the brain where fibres of the first projection system of
Meynert are exposed to view upon its exterior. Beneath
this may be seen a layer of gray matter, called the " stra-
tum cinereum," which is thicker at the prominent part
of the tubercle than at its margins, and which contains
numerous nerve-cells of small size. Beneath this, again,
lies a layer of nerve-fibres which are arranged in longi-
tudinal bundles, the so-called " stratum opticum" These
fibres are continuous with the upper branchium and the
optic tract. Scattered nerve-cells are found between
the bundles of which it is composed. Finally, between
the stratum opticum and the gray matter which surrounds
the aqueduct of Sylvius, a layer of nerve-fibres, derived
from the upper fillet or stratum lemnisci, may be demon-
strated. This layer is thickest at the margins of the tu-
bercle and thinnest at the median line, where a few ol
* This article formed a part of my course of lectures during the winter of i382-
83 before the students of the Medical Department of the University of the City of
New York. 3
its fibres decussate. This gradual thinning is to be ex-
plained by the passage of some of its fibres to the optic
layer, and some to the gray matter surrounding the
aqueduct of Sylvius (Tartuferi).
The lower qjiadrigeminal bodies, or the testes cerebri,
are composed almost entirely of gray matter formed of
numerous small and some large nerve-cells. A thin
layer of the fillet separates the gray nucleus of this body
from the gray matter surrounding the aqueduct of Syl-
vius. A connecting band of gray matter unites the gray
nuclei of the two bodies. Transverse fibres of the fillet
bind this gray commissural band both superficially and
deeplv. Those lying superficially are continuous, in
liart, with the branchium of the lower quadrigeminal
body, and in part, also, with the fibres of the lower fillet ;
the fibres of the lower fillet are described by Meynert as
being continuous with the brachium of the opposite
side. If this continuity really exists, the communication
is probably an indirect one by means of interposed nerve-
cells in the gray matter.
'The posterior commissure of the third ventricle, which
lies above the upper end of the aqueduct of Sylvius,
seems to be a direct continuation of the commissural
fibres of the fillet which have been mentioned. It ap-
parently springs from the tegmentum, and, after decus-
sating, appears to traverse the substance of the thalamus,
and then to radiate in the white substance of the hemi-
sphere of the cerebrum. A few of its fibres are connected
with the pineal gland; some also probably act as com-
missural fibres between the thalami.
This hasty and somewhat imperfect resume of the
anatomy of these bodies will enable us to intelligently
consider some of the views which have been advanced
respecting their probable functions, and the effects of le-
sions within their substance.
Functions of the Corpora Quadrigemina. — Among
the investigators who have devoted special atten-
tion to these bodies may be prominently mentioned
Adamuck, Knoll, Budge, Hensen, Voelkers, Flourens,
Schin", Ferrier, McKendrick, Gudden, and many others
of note. Some have observed the efl'ects of their re-
moval in animals ; others have studied the results of
stimulation of their superficial and deep parts ; while a
few have recorded the results of destruction of the optic
apparatus and certain convolutions of the cerebral hem-
ispheres, as possessing a peculiar bearing upon points in
dispute regarding these bodies. From these difterent
sources a mass of evidence has been accumulated which
appears in some instances to lead to contradictory con-
clusions. It is only by comparing the views of the inves-
tigators mentioned, and bringing to bear upon the sub-
ject what is also taught us by anatomical research, that
the web may be partially disentangled.
The connection of the anterior quadrigeminal bodies,
or the nates cerebri, with the optic tract and the sense of
sight appears to be far more intimate than that of the
posterior lobules, or testes cerebri, as was first pointed
out clearly by Gudden. This observer found that the
extirpation of the eye on one side of a young animal was
followed by a degeneration and atrophy of the natis
cerebri and its brachium ; the testis and its brachium re-
maining unalteied. This view is apparently sustained
also by the fact that the mole has the testes cerebri
largely developed, whereas the nates cerebri are markedly
atrophied. Adamuck believed that he had clearly dem-
onstrated the existence of a centre within the nates which
I/O
THE MEDICAL RECORD.
[August 18. 188;;
presided over those movements of the eye and pupil which
are essential to the accommodalion of -nsion for near
objects, as well as the co-ordination of all ocular move-
ments. Knoll found, however, tiiat reflex contractions
of the pupil remained after removal of the corpora quad-
rigemina ; and Hensen and Voelkers have been appa-
rently successful in mapping out the topography of the
centres which preside over ocular and pupillary move-
ments with greater accuracy than their predecessors.
They were able to produce at will, by carefully applied
electric stimulation in the region of the floor of the aque-
duct of Sylvius, independent movements of the eve and
pupil. In the dog, upon which animal these experi-
ments were made, a centre which governed the accommo-
dation of vision ' was found to be situated in the posterior
part of the third ventricle near to the aqueduct, while a
centre for pupillary contraction and one a4so for its dila-
tation were found in the front part of the floor of the
a(pieduct of .Sylvius, the former lying in the median
plane and the latter more to the sides. The same ob-
servers state that a centre, which governs those muscles
of the eyeball which are supplied by the third cranial
nerve, can be found in the floor of the aqueduct, imme-
diately behind that which presides over pupillary con-
traction. Whether we accept these statements as dem-
onstrated or not, we know positively that such centres
exist somewhere, and are so associated in their action
that, when the eyeballs are directed inward and down-
ward, as for near vision, the pupils are at the same
time contracted ; and when the eyeballs are directed up-
ward and returned to a state of parallelism, the pupils
are dilated to a corresponding extent. On the contrary,
when the eyeballs are moved sideways in unison, the
pupils remain unchanged. A most positive proof that
the pujiillary movements are not of a psychical nature is
aftbrded by the evi^eriments of Adamuck, who produced
movements of both eyes by stimulation of the corpora
quadrigemina of either side, and who also observed that
the pupils were at the same time made to perform their
proper movements. When, however, the corpora quad-
rigemina of the two .sides were sejiarated by a median
incision, stimulation of the centres of either side caused
movements of the correspondihg eyeball only. In both
experiments, changing the seat of stimulation caused
modifications of ocular movements.
It was only after Knoll had shown that the rellex
movementsof the pupils remained after complete excision
of the corpora quadrigemina, and the discovery of Hen-
sen and Voelkers that the effects of stimulation of these
bodies, as first practised by .-Vdamuck, were not uniform
until the underlying parts were directly reached, that
discrepancies between these observers were exi)lained.
To determine the true relations which these bodies
bear to the special sense of sight is perhaps one of the
most difficult problems in physiology.
Flourens and many subsequent observers have shown
us that unilateral extiri)ation of the corpora quadrigemina
in mammals and birds leads to a blindness of the oppo-
site eye ; and even when the cerebral hemispheres are re-
moved witliout disturbing these bodies, that an apparently
crude vision still remains. We have many experiments,
however, to show that destruction of certain convolutions
of the cerebrum also produced the most profound effects
upon vision in spite of the undisturbed action of the (juadri-
geminal bodies. When we discussed the oi)tic thala-
mus," it was .also stated that many clinical observations
pointed toward the existence of a centre within that bodv
which in some way modified or ])resided over visual im'-
pressions. We know also that lesions within the so-called
"internal capsule" of the cerebrum frequently produce
most serious impairment of vision, and conjugate devi-
ation of the eyes.
' This centre tnanifcstcd an apparent control over thcr/V/ary muscle only and
created alterations in the anlcro-posterior measurement of the crystalline lens of
the eye.
^ This lecture was published in the Journal of Ner\ous and Mental iJisciscs
April, 1883. '
Now, how are we to explain, theoretically, such con-
tradictory phenomena? What views are we apparently
justified -in holding (from the standpoint of our present
knowledge upon the subject) regarding the relations of
the cerebral cortex, corpora quadrigemina, corpora geni-
culata, optic thalami, and internal capsule of the cere-
brum, to the fibres of the optic tracts and the external
organs of sight ?
I think we are justified in attributing to the cells of the
cerebral cortex or the external gray matter of the hemi-
spheres alone our conceptions of the external world, as
portrayed to us by means of the sensory nerves and the
special senses. IVo matter how many collections of gray
matter may be interposed along the course of the nerve-
fibres which convey these impressions to the cortex (each
of which may possibly help to modify them\ there is
no argument which has yet been advanced which tends
to overthrow this general law. Every image cast upon
the retina, every sound-wave which enters the external
ear, every odoriferous particle which reaches the nose or
is placed upon the tongue, every manner of form by
which we are brought into direct or indirect relation with
surrounding objects during life, becomes a conscious im-
pression only by aftecting in some unknown way the
cells of the cerebral cortex. Here, the image thrown
upon the retina becomes to our mind the picture actually
seen ; the sound wave becomes the musical note ; the
contact of the odoriferous particle is transformed by the
brain-cells found in its external gray matter into a sense
of smell or of taste ; objects become recognised as smooth
or rough, hard or soft, heavy or light, only when these
silent workers become thrown into activity by some sen-
sory impulse carried to the convolutions of the brain by
means of nerve-fibres.
We have reason lo believe that the fibres of the optic
nerve reach the gray matter of the convolutions of the
cerebrum by different routes, and that each bundle meets
(somewhere in its course) an interrupting mass of gray
matter, with the cells of which the nerve-fibres become
associated, and from which cells they are subsequently
prolonged to those of the cortex. This is the common
method of arrangement of all nerve-fibres, after they en-
ter the substance of the brain or spinal cord, to which
the optic fibres are no exception. The interrupting cells
of the optic fibres are comjirised chiefly within the optic
thalami, the corpora geniculata, and the corpora quadri-
gemina. Stilling believes that a bundle of fibres can be
traced to the corpus subthalamicum, and another to the
medulla oblongata. The so-called " basal optic ganglion
ofMeynert" is thought by some to be also connected
with a slender fasciculus of the nerve.
When speaking of these interpolated masses of gray
matter and their controlling action upon all impulses
sent to the brain, .Michael Foster makes use of the fol-
lowing words, which I (juote on account of their applic-
ability to the subject under consideration :
" .\11 day long and every day, multitudinous afferent
impulses from eye, and ear, and skin, and muscle, and other
tissues and organs, are streaming into our nervous sys-
tem ; and did each afferent impulse issue as its correla-
tive efferent motor impulse, our life would be a prolonged
convulsion. .\s it is, by the checks and counter-checks
of cerebral and spinal activities, all these impulses are
drilled and marshalled and kept in orderly array till a
movement is called for ; and thus we are able to execute
at will the most complex bodily manceuvres, knowing
only 7C'hy, and unconscious or but dimly conscious hojv,
we carry them out."
The study of the course of the individual fibres of the
optic nerve in the region of the optic chiasm (Fig. i)
is rendered particularly difticult by the curved direction
which they take ; hence the relative proportion of the
longitudinal and decussating bundles is still a subject of
dispute among authorities upon thai subject. Stilling
states that inter-retinal fibres, which have no cerebral
connection, can be demonstrated, while other authors
ALi^i;ust i8, 1883.]
THE MEDICAL RECORD.
171
deny it. Some assert that all of the fibres, which are
prolonged into the optic tract, decussate in man, as they
are known to do in the lower vertebrates anil some
mammals, but pathological observation tends to confute
this view. Charcot advances the somewhat attractive
theory that those fibres of the optic nerve which do not
decussate at the chiasm are continued along the optic
tract of the corresponding side and eventually decussate,
probably within the substance of the corpora quadrige-
niina, after which they are continued into the internal
capsule of the opposite hemisphere. He sustains this
theory on pathological grounds ; since many recorded
cases, where lesions of the internal capsule have been
associated with symptoms referable to the optic nerve,
have apparently demonstrated that heniiaiwpsia ' never (?)
occurs. This coidd not be the case without a second
decussation, ]irovided the view be considered tenable
that a comi)lete decussation does not occur at the chiasm.
The following diagram will make this a|)parent :
D, i:y>:b.ill.
OpUC tr.i
Inrcrnal capsule.
(Left hemisphere.)
Internal capsule.
(Right hemisphere)
Fig. I. — .V diagram dcsigued to show the course of fibres within the optic
nerves, and some of the more important relations of the same. .\. A', A", and
D, J)', D", fibres which do not cross at the chiasm, hut probably do at the corpora
quadrigeiniiia. C, C. and \'>, H', fibres which do decussate at the chiasm. The
relations of these fibres to the " internal capsule" of the cerebrum is also shown.
This portion of the cerebral hemisphere is shown to be in relation with the fibres
distributed only to the opposite eye: hence, lesions within it tend to produce
" crossed amblyopia." The relation of bundles within the chiasm is made
apparent. The fibres of the chiasm which connect the two eyes directly [inter-
retinal fibres), and those which connect the two cerebral hemispheres direcdy
(inter-cerebral fibres), are not shown, because they have no bearing upon symp-
toms, even if their existence is to be considered as demonstrated.
It is known that destruction of the retina in the dog
gives rise to a degeneration of nerve-strands in both
optic tracts. The chiasm of the cat has been divided
without destroying vision, thus warranting the inference
that the decussation at that point is incomplete. All the
experiments which have been made to determine the
relation of the cortex cerebri to vision are in favor of an
incomplete decussation, because the sight of both eyes
has been impaired by unilateral lesions. .\ large number
of cases have been reported where lesions affecting one
optic tract have produced hemianopsia of both retinae.
Possibly the corpora quadrigemina preside over other
functions in addition to the special sense of sight.
Flourens was the first to notice that injuries of the cor-
pora quadrigemina of one side produced peculiar phe-
nomena, called "-forced movements^^ and that the com-
plete removal of these bodies caused inco-ordination of
movement. These experiments have been repeatedly
verified. \\\ the frog, the removal of the optic lobes
causes an almost entire loss of the power of co-ordina-
' A term used synonymously with hetntofiia. ; but a preferable one, since it sig-
nifies a bliitdtifss 0/ t^WfT-zia// (lateral) cf the retina.
(ton of movements required to preserve its balance ; but
it can still perform a variety of movements where co-or-
dination is demanded, such as swimming, leaping, etc.
.Schiff has attributed these effects, however, to injury of
deeper parts (crura cerebri). We have already con-
sidered i)henomena which are somewhat similar when
the cerebellum was under discussion ; and we have as
yet no positive knowleilge of the physiological connec-
tions between the optic lobes and the cerebellum.
The sense of sight has a marked eft'ect upon co-ordina-
tion of movement, as we all know. Dizziness often
follows the close inspection of a water-fall, or the rapid
tlicrht of objects before the eyes. The effect of extreme
elevation from surrounding objects frequently produces
marked disturbances of e(iailibrium. These facts seem
to sustain the belief that the optic fibres must be closely
associated with the cerebellum, pons Varolii, or crura,
and the discovery of Flourens is an additional argument
in its favor.
Finally, it is believed by some that a centre which
presides over the secretion of sweat is situated some-
where in the region of the optic lobes.
EFFECTS OF LESION.S OF THE OPTIC CENTRES AND OPTIC
NERVE.S.
In connection with the discussion of the corpora
quadrigemina and the probable course and distribution
of the nerves of sight, it seems to me an appropriate
time to mention some interesting phenomena pertaining
to vision which have an important bearing upon the lo-
cahzation of intracranial lesions. Before doing so, how-
ever, it will be necessary to hastily review a few impor-
tant facts which are essential to a complete understanding
of the subject. The optic apparatus maybe said to com-
prise the following parts :
1. Certain cortical centres, which act as the interpret-
ers of visual sensations transmitted to the convolutions
by means of the nerve-fibres within the white substance
of the cerebral hemispheres. These centres probably
transform all impulses (which start originally as retinal
impressions) into conscious visual perceptions.
2. Nodal masses of gray matter, with which the optic
nerve-fibres are intimately associated before entering
the white substance of the cerebral hemisiihere. These
masses include the corpora quadrigemina, the corpora
geniculata, the corpus sub-thalamicum, the optic centre
of the thalamus (I.uys), the basal optic ganglion (Mey-
nert); and probably some centres situated within the
medulla oblongata. It is not possible to speak with
positiveness concerning the seat of all the interpolated
masses of nerve-cells associated with the optic nerve-
fibres. Possibly some important ones may have been
omitted, whose existence and function will be clearly
demonstrated by future research. These interrupting gan-
glia probably exercise a modifying influence of some kind
upon the impulses which are conducted to them from
the retinae ; and subsetiuently atlow them to pass to the
cells of the cerebral convolutions so altered or material-
ized z.-!, to be readily transformed into conscious percep-
tions of external objects recognized by the eyes. It is not
known what the special function of each of these inter-
rupting masses is, nor can it be determined except through
a more complete knowledge of cerebral architecture and
pathology than we now possess.
3. Nerve-fibres linthin the optic nerves and the optic
tracts, the latter being the prolongation of the former
behind the chiasm (see Fig. i). These fibres convey all
impressions made by objects external to the body upon
the retina; by means of the organ of sight, to the interrupt-
ing masses of gray matter mentioned above. The waves
of light, which^enter the pupil and fall upon the retina,
create in the. structural elements of that membrane (prob-
ably in the so-called " rods " and •' cones of Jacob ") im-
pidses which are conveyed by means of the optic fibres
to the interrupting ganglion-cells, and then to the convo-
lutions of the cerebral hemisphere where these impulses
172
THE MEDICAL RECORD.
[August 1 8, 1883.
become sight-impressions. It is evident, therefore, that
anything which tends to interfere with the perfect con-
ducting power of these fibres will impair the power of
accurate conception of external objects revealed to us by
means of vision, because the cortical centres are cut off
from their retinal connections ; hence the study of the
course of the nerve-fibres and the relations of the nerve-
tracts to surrounding parts becomes of vital importance
to the advanced neurologist (the diagnosis of many cere-
bral and intercranial lesions resting entirely or in part
upon optic phenomena which are to be interpreted from
an anatomical standpoint alone).
4. The retina, and its various structural elements.
This membrane constitutes the peripheral portion of the
nervous optic apparatus. It is the only place in the body
where the nervous system is so exposed as to admit of a
direct examination, since we can see it by aid of the oph-
thalmoscope, and thus study its diseased conditions as
well as its appearance in health. Physiologically, it is to
be considered as the sensitive plate from which the de-
tails of outline and color of external objects, are tele-
graphed to the convolutions of the cerebrum. Many of
the wonders of its construction were given you during
the previous winter's course. Time will not now permit
me to repeat them.'
The experiments of Flourens, already quoted, tirst de-
monstrated that a crude sense of vision remains in animals
which have been deprived of their cerebral convolutions
above the level of the corpora quadrigemina, and many
subsequent observers have attested to tlie accuracy of his
conclusions. These experiments point to some functions
within the masses of gray matter that are associated with
the optic libres, which bear a close analogy to those of tlie
cortical cells of the so-called " visual area" of the hemi-
spheres. We are forced to accept the view that these
ganglionic masses take cognizance of visual impulses in
an imperfect way, although the cerebral convolutions
seem to be essential to a complete transformation of
visual impulses into sight-perceptions. Section of the
optic fibres after they leave the brain invariably destroys
sight, thus proving that the retina itself has no inherent
power of interpreting visual impressions which are cast
upon it.
Fig. 2. — A diagram designed to show some of the relations of the optic nerve-
fibres to surrouiiding parts. K, frontal loljes of ccrclirimi ; I', parietal Iol)c : T,
temporo-sphcnoidal lobe ; S. fissure of Sylvius : K. fissure of Rolando: (1. occi-
piL-il lobe ; C, cerebellum : M, medulla oblongata : 1, corpora quadrigemina : 2.
optic tracts : 3, optic chiasm ; 4, optic nerves ; 5, olfactory nerve : 6. motor oculi
nerve ; 7, trigeminus ncr\-e ; a, basis cruris ; /% tegmentum cruris. The circles in
the parietal lobe represent the cortkat -.'isuai cfHtres of FerrUr ; the diamonds
in the occipital lobe, the iVr/A-rt/7//jMrt/r<'«/r^r<>/'vl/i/«-t. The ccrebcllinn and
pons Varolii arc shown as if separated from the cerebrum, tn order to maltc the re-
lations of the crus to the optic tnicts apparent.
Now, from what has been stated, we can classify
lesions which may aft'ect or destroy the visual function as
follows :
1. Lesions of the retina, or of some of the other struct-
' See pages loi to 146 of the author's work, The Applied Anatomy of the Ner-
vous System. New York : I). Applcton & Co. 1881.
ures of the eye which prevent the formation of images
within it.
2. Lesions of the optic nerve, anteriorly to the chiasm,
at which point the decussating fibres have crossed each
other.
3. Lesions of the optic tracts and the chiasm, or of parts
so adjacent to them as to create pressure upon the optic
fibres.
4. Lesions of those ganglionic masses whose connection
with the optic fibres has been demonstrated by anatomical
or pathological research.
5. Lesions of certain regions of the cortex cerebri, which
have been shown to be in intimate association with vision.
6. Lesions of the internal capsule of the cerebrum ; or
of such parts of the medullary centre of each hemisphere
as contain fibres connected with the " visual area" of the
cortex.
The first set of causes of impairment of vision belongs
properly to the province of the oculist rather than of the
neurologist, although there is one condition which should
always be sought for when cerebral disease is suspected,
viz., neicro-retinitis, or the so-called -'choked disc.'' The
evidences of this condition are afforded by the ophthal-
moscope alone, because vision is not impaired in the
early stages. Its existence is recognized early by tor-
tuosity of the veins of the fundus of the eye, swelling of
the optic nerve, and obscureness of the margin of the
disc ; later, the outline of the disc becomes unnaturally
sharp and distinct, the nerve atrophies, the vessels be-
come very small, the fundus is unnaturally pale, and vi-
sion is impaired. This condition is always (?) bilateral,
although it is not uncommon to note a marked difTerence
in the severity of the changes in the two eyes. Special
attention is called to this disease of the eye, because it is
now considered as one of the most reliable signs of con-
ditions of the cerebrum which tend to produce a gradu-
ally increasing pressure, particularly of tumors ; and in
the second place, because its existence is liable to be over-
looked, since vision is not impaired early. The various
phenomena which are due to paresis of ocular muscles,'
and which have often the most positive value in defin-
itely localizing cerebral disease, cannot be considered
under this set of symptoms or in this connection, be-
cause they do not govern in any way the sense of sight,
although they assist the eye to focus images of objects
upon the retina. My friend, Dr. VV. C. Ayers, has lately
made a valuable contribution to medical literature in the
form of a brochure upon the value of the ophthalmo-
scope as an aid in general diagnosis," which may well be
consulted by all who desire the latest information in re-
gard to the utility of this instrument, and the intimate
relationship which exists between the eye and the body,
as revealed by clinical study.
The second set of causes of impairment of vision
(lesions of the optic nerve anteriorly to the chiasm) in-
cludes ciiiefl)' those conditions laithin the orbit which
create pressure upon, or destruction of, the optic nerve
after it leaves the cavity of the cranium. It is evident
from the diagram (l''ig. i) that the impairment of sight in
this case will be confined exclusively to one eye. The
phenomena produced by disease within the cavity of the
orbit upon sight must, of course, depend upon the amount
of injury done to the optic nerve. Blindness of one eye
indicates, as a rule, some exciting cause outside of the
cavity of the cranium ; if it occurs in connection with
hemiplegia, or hemianxsthesia, however, a lesion of the
internal capsule may be suspected, as shown in Fig. i.
Remember that either amblyopia or total blindness of
one eye never occurs in connection with pressure upon
the optic nerve-fibres either at the chiasm or behind it,
and that some form of paralysis must coexist with these
symptoms if the internal capsule be diseased.
We come now to the third set of causes, viz., lesions
1 These will be found by consulting the author's work. The .Applied Anatomy
of the Ncr\'ous .System. New York. iSSi.
* .\merican Juurnal of the Medical Sciences, (_)ctobcr, 1S82.
August
1 8, 1883.]
THE MEDICAL RECORD.
173
of the optic tracts and chiasm. This set includes not
only actual lesions of the nerve, but also pressure-effects
exerted upon the optic fibres by lesions of adjacent
structures. Before we pass to the consideration of the
diagnostic symptoms of this condition, it is important
that we review some of the relations of the optic chiasm
and the optic tracts.
If we trace the optic nerve-fibres from behind forward,
we find that the optic tracts appear to arise from the optic
thalami, the superior quadrigeminal bodies, and the cor-
pora geniculata. As they leave the under surface of
the thalami, they make a sudden bend forward and curve
around the crura cerebri in the form of a flattened band
(Fig. i). At their anterior portions the tracts become
closely attached to the crura, and, in the region of the
tuber cinerium, an accession of fibres to the tracts may
be demonstrated. Before the chiasm is reached the
tracts become more cylindrical in form.
The optic commissure, or chiaim, is about one-half of
an inch long in its transverse measurement, and lies
uijon the olivary process of the sphenoid bone. The in-
ternal carotid arteries lie in close relation with it at the
sides, and the anterior cerebral arteries, with their com-
municating branch, are so disposed as to constitute what
might be called a loop about the optic nerves. The clin-
ical bearing of this fact will be discussed later. Henle
reports a few remarkable instances where the chiasm was
wanting, the optic tracts being continued without inter-
ruption to the eyeball of the corresponding side ; but
these abnormalities are so rare as to be of no practical
importance from a clinical standpoint.
We are now able to study the diagram which I draw
upon the blackboard, and to properly interpret the clini-
cal deductions which may be drawn from it. It is in-
tended to portray the effects of localized pressure upon
the optic chiasm and optic tracts, as well as those of de-
structive lesions of the same and of the " internal cap-
sule " of the brain, figs, i and 2 will assist us in fol-
lowing the details of this diagram, as they are somewhat
similar.
Now, this diagram is admirably adapted to portray the
mechanism of one peculiar symptom, and the use to which
it may be employed by the neurologist in definitely de-
termining the seat of the disease-lesion which is creatnig
it. I refer to ^' hemianopsia," or blindness of one lateral
half of the retina. The term " hemiopia " is often em-
ployed to express the same condition, although it is to
my mind a poor one, since it simply means '' half-vision,"
and thus fails to express the idea intended.
[The description of the various types of hemianopsia
which followed in the course of the lecture has been
omitted, because the text which accompanies the dia-
gram covers all essential points. The author has also dis-
cussed the clinical bearings of this subject very fully in
his work, " The Applied Anatomy of the Nervous System,"
D. Appleton & Co., New York.]
The following steps are commonly employed to de-
tect the existence of this symptom : Request the patient
to close one eye by pressing the lid down with the finger,
and to so direct the open eye as to concentrate its gaze
upon some fixed object near to it. [I usually hold up the
forefinger of my own hand within a foot of the patient's
open eye, and tell him to look steadily at it.] Having
done this, take some object which is easily seen (such as
a sheet of white paper) in the unemployed hand, and
move it to the right and left of the object upon which the
patient is gazing, and also above and below the object,
asking the patient, in each case, if the two objects are
seen simultaneously and with distinctness, and notice
upon which side of the fixed object the patient cannot
perceive the moving object. It is self-evident that the
retina is blind upon the side opposite to that upon which
the moving object is lost to sight (see Fig. 3).
The most common form of hemianopsia is that in
which the nasal half of one eye and the temporal half of
the other is blind ; this condition bemg the result of
pressure upon, or actual destruction of, one of the optic
tracts.
When the chiasm is affected, we meet the bi-nasal type.
There is still one more form which is occasionally en-
countered, viz., the bi-iemporal type. This has been
interpreted by an autopsy made upon a case entrusted
to the care of Professor H. Knapp, of this city. It must
be evident that the chances would be extremely small of
ever encountering a bi-lateral lesion which would affect
only those fibres of the optic chiasm, or optic tract,
whicli supply the temporal half of each retina, and, at
Fig. 3. — Diagram explicative of hemiopi.1 (Seguin). The shaded intra- and extra-
ocular parts, A and B, indicate the obscuration in right lateral (or homonymous)
hemiopia. as caused by lesion 3. so placed as to destroy one optic tract. In that tract
are two sets of nerve- fibres, one represented by a dotted line supplying the nasal
half of right retina, the other fibres by a broken line supplying the outer or tempo-
ral half of the left eye. As visual lines cross in the eye the obscuration of the half-
fields is the opposite. Lesion No. 1. anterior to chiasm, produces bhndness of
inner half of each retina, and consequently bi-temporal hemiopia. Lesions No. 2,
pressing upon the sides of the chiasm, injtire fibres supplying the temporal half of
each retina, and cause bi-nasal hemiopia. C Q, corpus quadrigeminum, in
which Professor Charcot believes a second partial decussation takes place. I C, in-
ternal capsjle containing, on Charcot's hypothesis, all the fibres coming from the
eye of the opposite side. 4. Lesion of internal capsule injuring all the fibres con-
nected with the right retina, and causing amblyopia of the right eye.
the same time leave the decussating fibres intact. How,
then, are we to account for the fact that this form is
sometimes met with ? In the preceding portion of this
lecture I called your attention to a i^eculiar arrangement
of the arteries in the region of the optic chiasm. Now,
it has been shown that atheromatous degeneration of the
" circle of Willis '' (a peculiar arrangement of blood-ves-
sels at the base of the brain) so impairs the elasticity of
the arteries as to create a type of injury to the chiasm, so
limited in its extent as to impair only the fibres distrib-
uted to the temporal halves of the retinK, and thus to
create bi-temporal hemianopsia.
We may, therefore, summarize the clinical significance
of this peculiar form of blindness as follows :
((Z.) The homonymous or crossed variety indicates
le.sions affecting the optic tract.
(b.) The bi-nasal variety indicates a lesion pressing
upon the central portion of the chiasm.
{c.) The bi-tcmporal variety indicates atheromatous
degeneration of the circle of Willis. Possibly (?) sym-
metrical lesions of the outer part of the chiasm might
also cause it. I am not aware that the view of Charcot,
1/4
THE MEDICAL RECORD.
[August 1 8, 1883.
that a decussation of the optic fibres takes place within
the substance of the corpora quadrigemina, is as yet sus-
tained by a recorded case of bi-teniporal hemianopsia
produced by a circumscribed lesion within the optic
lobes.
(d.) Finally, lesions of the l/itcnml i-apsule are often
associated with iuublycpia. or indistinct vision confined
to one eye.
The bi-nasal, and also the bi-temporal varieties, are
due (as a rule, at least) to lesions confined to the a7i-
ierior fossa of the cranium ; hence we sometimes find
the olfactory nerve of the side corresponding to the seat
of the lesion simultaneously aft'ected, and creating anos-
mia (loss of smell) with or without subjective odors.
If the lesion be situated withm the middle fossa of the
cranium, the optic tracts will be affected, thus caHsing
crossed hemianopsia ; while the motor nerves of the eye
may be simultaneously pressed upon, as they pass
through that fossa on the way to their foramen of exit
from the cranium (the sphenoidal fissure), thus produ-
cing more or less im]iairment of the movements of the
eyeball of the same side. The value of these comiilica-
tions cannot be over-estimated, when they exist, because
they are of the greatest aid in diagnosis, and often enable
the skilled anatomist to positively determine the seat of
the lesion.
Fig. 4. — .\ diagr.tin of ihc base of the br.un, designej l<» >how the purls ;ulj:l-
ccnt 10 the optic nerve-tracts .ind irhiaMii. The nerves are rc[>resented by their
respective nuinljers : II., optic; III., motor oculi ; IV., trochlcans ; V., trigemi-
nus : \'I., abducens ; C, cms cerebri of each heniisphcrc ; /'. infundilmhini, the
pituitary- body being cut ofT to show the optic t:liiasui : it, the corpus albicans
(maniillary luhercle) ; r, external geniculate l>ody ; /. internal geniculate body.
The dotted hue which crosses the pons \'arulii, connecting the roots of (he fifth
nerves, is fiubler's line, an important guide, since lesions of the /."«r in front of
it causes " crossed facial paralysis." Lesions in the region of the irui may ni-
volve the tliird and second nerves sinnillaneously. Lesions about llir chiasm may
press upon the corpus striatum « ilhiu the mass of the cerebrum. The crus com-
prises both the motor and sensory tracts of the trerehrinn (sec Kig. 5>.
The foiirtli set of causes of impairment of vision (ac-
cording 10 the classification which we have previously
adopted) comprises all diseased conditions which are
limited exclusively to those ganglionic masses through
which tile o[)tic fibres pass in order to reach their con-
nections with the convolutions of the cerebrum. If we
confine ourselves to this strict limitation, we are forced
to admit that little can positively be said resjjecting
them which will bear upon intracranial diagnosis, because,
to my knowledge, there are no recorded cases where evi-
dences of cerebral disease have been confined exclusivelv
to these regions. There are some symptoms, however,
that may coexist with disturbances of vision when lesions
exist in the region of the middle fossa of the skull ; these
may prove of assistance in deciding as to the seat of the
lesion. Among them maybe enumerated: 1. Crossed
paralysis of the " t/iird verie and body'' type, a condi-
tion characterized by hemiplegia and paralysis of the
motor-oculi nerve of the opjiosite side. 2. Crossed
paralysis of the " olfactory nerve and body " type, a con-
dition characterized by hemiplegia and loss of smell in
the opposite nostril. 3. J/emipU^ia, or loss of the
power of voluntary motion in one lateral half of the body.
4. Hcmianiesthesia, or a loss of sensation in one lateral
half of the body. 5. ^/^.r/V j-vot/A'wj, indicating an im-
pairment of co-ordination of muscular movements.
The first of these points positively to a lesion of the
crus cerebri, if unattended by other symptoms. But, if
evidences of disturbance of the optic tract (crossed
hemianopsia) exists simultaneously with this form of
crossed paralysis, it indicates that the lesion is large
enough to interfere also with the optic nerve as well as
the motor-oculi fibres within the crus and the motor tract
of the crus. The symptoms of this variety of crossed
paralysis ' are so well defined as to render it almost im-
possible to mistake them.
The second condition may occur when the lesion is
sufficiently large to create pressure upon the nucleus
caudatus or other motor i)arts of the brain, thus causing
hemiplegia of the opposite side ; and, at the same time,
to injure the olfactory nerve, thus causing anosmia (loss
of smell) in the nostril of the corresponding side. Of
course the optic tract or chiasm must be involved simul-
taneously when hemianopsia also exists. The tests
for anosmia " have already been given in previous lec-
tures.
VISUAL AREA
MEDULLA
Fig. 5. — A diagram designed to show the general course of tibres in the
"sensory" and "motor tracts," and their relation to certain fasciculi ot the
optic nerve-tracts (modified from Seguin). S, sensory tract in posterior region
of mesocephalon. extending to O and T, occipital and temporal lobes of hemi-
spheres : ftL motor tract in basis cruris, extending to P and F, parietal and (part
of; frontal lobes of hemispheres ; C Q. corptis quadrigeminum : O T, optic thal-
amus ; N L. nucleus lent'cularis ; N C, nucleus caudatus : i, the fibres forming
the "tegrnentum cTuris" (Meynert): 2, the fibres forming the " basis cruris "
(Meynerl) : rt. fibres of the optic nerve which become associated with the "optic
centre" in the oplii: thalamus, and are subsequently prolonged to the "visual
area " of the convolutions of the cerebrum : h. optic fibres which join tlie cells of
the "corpora quadrigemina," and arc then prolonged to the visual area of the
cerebral cortex.
Hemiplegia may occur in connection with hemianop-
sia when the lesion is of sufficient size to affect any part
of the so-called " motor tract" simultaneously with the
oiitic nerve-fibres. The motor paralysis is on the side
oi)|}Osite to the lesion, because the fibres of the motor
tract decussate at the lower part of the medulla. Flechsig
has shown that, in rare cases, exceptions to this general
rule are to be explained by an abnormality in the decus-
sation of the motor fibres. Hemiplegia is seldom ob-
served in connection with hemianopsia alone, since the
olfactory, motor-oculi, trigeminus, and facial nerve-roots
are especially liable to be simultaneously involved (see
Fig. 2). This explains the mechanism of the four varieties
of " crossed |)aralysis" which are encountered, the hemi-
plegia being on the side opposite to the lesion, and the
symptoms produced by paralysis of the cranial nerve
being confined to the side corresponding to the lesion.
> See author's work on The Applietl Anatomy of the Nervous System.
•J Op. cit.
August 1 8, 1883.]
THE MEDICAL RECORD.
175
Heiniatiossthesia indicates some disturbance of the
nerve-fibres of tlie so-called '■^sensory tract," the loss of
sensation being confined to the lateral half of the body
opposite to the lesion which causes it, because the sen-
sory fibres decussate in the spinal cord. In cerebral
hemiansesthcsia there is more or less insensibility to
touch, pain, and temperature, and also abolition of mus-
cular sensibility with complete retention of electromotor
contractility. 'I'he mucous membranes of the eye, nose,
and mouth are also anaesthetic. Now the upper portion
of the sensory tract lies in the posterior regions of the
crus cerebri and the internal capsule and crus, and is in
close relation with the posterior basal ganglia. The
fibres of the optic tract may be likewise affected si-
multaneously with lesions of the following parts :
the crus, the internal capsule, the optic thalamus,
the corpora quadrigemina, the geniculate bodies, and tlie
medulla. It has been already stated that lesions of the
internal capsule are often associated with amblyopia, but
not with hemianopsia. Fig. i will make tlie probable
explanation of this fact intelligible. Our ability to defi-
nitely locate lesions of the sensory tract, or of the ganglia
connected with it, is, as yet, imperfect. It is only by the
careful study of associated symptoms that conclusions
can be arrived at.
Ataxic manifestations, occurring in connection with
evidences of impairment of the sense of sight, open a
wide field for speculation. The |)roxiniity and intiiuate
structural relations of the cerebellum with the oinic lobes,
basal ganglia, crus, and medulla, suggest the possibility
of cerebellar lesions when these two symptoms are
present to a marked degree. The subject is too com-
plex for discussion here. It will be more intelligible after
the cerebellum has been considered.
The fiftli set of causes of impairment of vision previ-
ously tabulated, will now be consitlered. Within the past
i^w years the attention of physiologists has been directed,
by some remarkable results of experimentation upon the
convolutions of the cerebral cortex, toward the view that
certain convolutions of the cerebrum were essential to
perfect visual perceptions. To Flourens and some of
the older observers, who had remarked that the removal
of portions of the hemispheres, or serious injury to them,
created blindness, the loss of sight appeared to be tem-
porary. The fact (?) was explained in various ways, un-
til Goltz called attention to the error of supposing that
no permanent imperfections of vision remained after ex-
tensive injuries to the cerebral hemispheres. This
author showed that the permanent results of such in-
juries might escape notice unless special care was used
in the examinations of the animal. The peculiarities
of the permanent impairment of vision are manifested
only when the animal is subjected to tests which had
been invariably potent before the cerebral injury. Thus
the dog, from which portions of the cerebral hemispheres
had been removed, fails to recognize his food by sight ;
when he is threatened by a whip he is not cowed ; he is
no longer aft'ected by objects which caused him to be
violently excited before the mutilation ; he makes no re-
sponse to the extension of the hand of his master for tlie
paw ; and yet this animal can see to avoid objects and
to perform all varieties of movement, as well as in his
natural condition, .\nother striking characteristic of this
impairment of sight is, that under educational exercise
recovery takes place. The dog may again be taught to
fear castigation and to shrink at the sight of the whip ; to
recognize his food ; to obey the motions of his master's
hand, etc.
Two interpretations of these phenomena have been
suggested. The first is, that the animal has imperfect
visual perceptions, so that objects appear misty or as it
seen through a gauze. Goltz suggests that they may ap-
pear as if all the colors were washed out, thus depriving
food, dress, etc., of their characteristic appearances.
The second interpretation supposes that the memory of
past visual impressions is effaced, so that the animal tor-
gets the pain of the lash, the taste of the food, the fea-
tures of his master, the tricks which have been laboriously
taught him. The first view is that of Ooltz, who con-
siders that the animal has to learn to use his imperfect
visual |3erceptions before his intellectual faculties (which
are presumed to be unimpaired) can respond to them in
a proper way. The second view is that of Munk, who
speaks of this form of imperfect vision as " psychical
blindness," in contrast to "absolute blindness," which
is the result of destruction of the optic fibres. The con-
dition of the animal resembles that of the new-born.
Retinal impressions have no associations connected with
them. During the period of recovery the animal has to
acquire a new memory, as it were.
With this distinction clearly in mind, we are prepared
to discuss the views of F"errier, (jolt/, Munk, laiciani,
Tamburini, Yeo, Dalton, and others respecting the exact
seat of the visual centres within the cortex cerebri.
Goltz, in his experiments upon dogs, was unable to re-
cognize any distinct areas which presided exclusively
over visual impressions. He insists that disturbances of
general sensibility accompanied the impairment of vision
produced by destruction of the convolutions, and that
the results depended upon the amount of brain-substance
removed or destroyed. He found, however, that the
locality operated upon influenced the phenomena which
followed, and that recovery would take (ilace if the in-
jurv was not too extensive. Goltz destroyed the brain
by making a hole, or a number of them, through the skull,
and using a forcible stream of 'water to wash away the
brain-substance. The faults of the method may account
for the negative results obtained by it.
Ferrier investigated the subject chiefly upon the mon-
key tribe (the nearest approach to the human race) and
arrived at conclusions of a more positive character. This
observer was led to adopt a more certain way of limiting
the injury done to the cortex than that of Goltz. His
conclusions may be thus summarized : When the "angular
gyrus," or a convolution of the parietal lobe, so called
from its shape, since it forms a sharp angle (see Fig. 2),
was destroyed upon one side only, the vision of the op-
posite eye was destroyed for a time, but it eventually re-
gained its powers. If the angular gyrus of each hemi-
sphere was simultaneously destroyed, the loss of sight was
permanent and both eyes were equally affected. Hence
it would appear that each hemisphere is in some way
connected with both eyes, because unilateral destruction
of this convolution does not create permanent blindness,
as it would do if the opposite hemisphere did not come to
its relief Dalton has lately confirmed the views of Ferrier
by experiments made upon dogs, thus tending to confute
the view of Goltz that the effects of cortical lesions de-
pend more on their extent than on their position. The
animals operated upon by this observer remained perma-
nently blind, although the lesion was unilateral.
Munk has confined his experiments chiefly to the
occipital lobes of the cerebrum, and has endeavored to
demonstrate the existence of a " visual area," diftering
in position and of much wider extent than that of Fer-
rier (Fig. j). He maintains that certain parts of this
region can be shown to preside over limited portions of
the retina, and that blindness of circumscribed spots in
the retina can be artificially produced. He states that
the " absolute blindness " thus created is commonly asso-
ciated with " psychical blindness," from which the animal
may recover by proper exercise and training, provided
the whole visual area is not destroyed. This author
attributes the recovery to a deposition of new visual
experiences in the rest of the visual area.
Some observations which have lately been made in
support of the view that the occipital lobes of the cere-
brum are more directly associated with the mental facul-
ties than the frontal lobes arc of special interest to those
who agree with Munk regarding the seat of the visual
area of the cortex. At present, however, the subject
must be regarded as unsettled.
176
THE MEDICAL RECORD.
[August 1 8, 1883.
The fifth set of causes of impairment of vision, pre-
viously tabulated, has been discussed in part in connec-
tion with the others. We have a mass of clinical as well
as experimental evidence to show that destructive lesions
situated within the posterior one-third of the internal
capsule cause hemianesthesia on the opposite side of the
body. As regards vision, the symptoms which sometimes
exist are especially noteworthy. There appears to be
developed on the anajsthetic side a partial blindness of
the eye (aw/>fyopia),and the field of vision for color is
remarkably contracted, as first pointed out by Landolt.
In the normal eye the field for blue is the largest ; next
comes that for yellow ; then orange, red, green, and violet
have fields of gradually diminishing size, the last being
perceived only by the most central parts of the retina.
Now, in connection with hemian.tsthesia caused by cere-
bral lesions, the perception of violet first disappears, then
for green, and later for orange. In some cases yellow
and blue can be perfectly recognized ; but in the higher
degrees of anajsthesia all colors merge into an uniform
sepia tint. Another important fact has been pointed out
by Landolt, viz., that the eye on the same side as the
lesion participates, though to a less extent, in the loss of
color-perception.
Now, if the eyes be examined with the ophthalmo-
scope, no evidences of organic lesion of the retina or
degeneration of the optic nerve can be detected until
the disuse of the organ has induced atrophic changes.
It is noteworthy that hemianopsia does not occur, a fact
which Fig. 3 will help to explain. I'Vom statements
which have been made in preceding pages, we are forced
to conclude that this peculiar type of blindness is never
caused except by lesions which are situated or act below
the cortex. It is more commonly met with in connecr
tion with hemijjlegia than hemiano|)sia. The eflects of
lesions of the internal capsule upon other nerves of spe-
cial sense will be considered later.
Clinical deductions drawn from precedi?ig pages. —
Amblyopia of one eye can result from lesions involving
the optic nerve in front of the chiasm, or from lesions of
the internal capsule. If from the latter, the field for
color-perceptions will be found to be markedlv con-
tracted or color-vision will be wanting ; both eyes may
be affected, the most marked changes being found, how-
ever, in the eye op|)osite to the seat of the lesion. We
have not sufficient data for positive clinical deductions
respecting lesions of the visual area of the cortex in man.
The blindness of the opposite eye appears to be abso-
lute, while it lasts, in all animals upon whom the experi-
ment has been tried.
Hemianopsia only occurs when the optic tracts or the
optic chiasm are pressed upon or destroyed by lesions in
the region of the base of the cerebrum. It is evident,
therefore, that the trephine cannot aflord relief of this
symptom. When syphilitic gummata may be suspected,
the prognosis is extremely favorable if active treatment
be employed. The variety of hemianopsia indicates the
seat of the lesion with great exactness.
U paralysis (in any of its forms) coexist with hemi-
anopsia, a valuable guide will often be afforded in deter-
mining the extent of the lesion.
Crossed paralysis of the " olfactory nerve and body
type " indicates a localized pressure which is chietly ex-
erted upon parts 'tvithin the anterior fossa of the skull.
The motor tract is probably involved by upward pressure
upon the caudate or lenticular nucleus, or the fibres of
the internal capsule ; thus accounting for the hemiplegia
of the opposite half of the body. The olfactory nerve,
which lies near to the 0|nic chi.ism, is afi"ected by press-
ure in the downward direction, and the optic chiasm or
tract may be simultaneously involved ; hence, a loss of
smell in the nostril on the same side as the lesion niav
coexist with some form of hemianoi^sia, as well as with a
crossed hemiplegia.
Crossed paralysis of the " motor-oculi nerve and body '
type indicates a lesion situated within the crus cerebri.
If hemianopsia be present in connection with this con-
dition, it i)roves conclusively that the optic tract, which
lies in close relation with the crus, is simultaneously af-
fected by the lesion. We find, therefore, that the eye
on the same side as the lesion is blind in its temporal
half if the optic tract be involved ; that it can no longer
be turned toward the nose or made to act in parallelism
with the opposite eye ; that the pupil is dilated ; and
that the upper eyelid droops over the eyeball, giving it
a sleepy appearance. On the side opposite to the lesion
the eye is blind in its nasal half, and the body is hemi-
plegic. There are few conditions which are of greater
chnical importance than this type of crossed paralysis,
because the seat of the lesion is positively indicated. {
Choked disc is a common symptom of lesions of the
base of the cerebrum, and of any intracranial disease
which produces a gradually increasing pressure. It is
specially diagnostic of tumors. It is not associated with
impairment of vision until late, so that it is often unsus-
jiected when present. The ophthalmoscope is necessary
for its detection. It may coexist with hemianopsia, and
is always bilateral. It is a positive contra-indication to
trephining
Lesions at the base of the skull may cross the mesial
line, and still involve only one optic tract. If this oc-
curs, the hemianopsia will be accompanied by other
symptoms of diagnostic importance, no longer confined
to one side. Double anosmia, general paresis or com-
plete paralysis, general anajsthesia, and paralytic symp-
toms referable to both eyeballs might be thus produced.
Lesions of this character are more liable to affect the
chiasm of the optic nerves than the optic tracts ; in
either case, however, hemianopsia would result, and its
type would be a reliable guide to the seat of pressure
(see Fig. 4).
Crossed paralysis of the " facial nerve and body type "
is not as liable to coexist \vith hemianopsia as the two
forms previously mentioned. The reason for this is a
purely anatomical one. The symptoms of facial par-
alysis are too involved to be given here in detail.'
Uncomplicated hemianopsia indicates that the effect of
the lesion are confined to tlie optic tracts of chiasm, and
that no pressure-etfects are exerted upon the motor or
sensory projection tracts, or adjacent nerves.
Aphasia sometimes coexists with hemianopsia. I have
met with two instances of this kind. In one there was
slight paresis of the left side, tending to prove that
aphasia can occur with lesions involving the right hem-
isphere. Both were cured with specific treatment. We
must attribute the development of this complication to
pressure upon parts in the neighborhood of Broca's
centre.
Lesions confined to the crus cerebri seldom create im-
pairment of any of the special senses excepting that of
the sight. These cases are not associated with impair-
ment of intellect or of speech. It has been claimed that
severe lesions cause paralysis of the bladder, but I have
never encountered it. Many jioints of interest pertain-
ing to lesions of the crura will be considered later in the
course.
Fef.di.nt, Svi'nii.iTic Infants. — .-Vt I'Hopital des
Enfants Assistes in Paris, where many of the waifs and
foundlings of the city are cared for, a unique feature has
been introduced by M. Parrot, consisting of a nursing
service for syphilitic infants. The nurslings draw their
nourishment directly from the teats of the ass, to which
they are presented five times during the day, and three
times at night. They thrive under this treatment, and
seventy per cent, live, while almost all formerly died when
fed from the bottle {Boston Medical Journal). After all,
why should they not thrive ? Would they not have been
nursing asses' milk if they had been imbibing from the
maternal mamma ?
' They arc fully discussed in the author's work on The Applied Anatomy of the
Nervous System.
August 1 8, 1883.]
THE MEDICAL RECORD.
177
THE CHANGE OF MEDICAL OPINION IN RE-
GARD TO THE CAUSE AND RECENT EX-
TENSION OF MALARIA.
By CHARLES P. RUSSEL, M.D.,
SANITARY INSPECTOR OF THE NEW YORK HEALTH DEPARTMENT, FORMERLY RFt.l'^-
TRAR OF VITAL STATISTICS.
The most remarkable change in professional opinion,
based upon long-accepted doctrine with regard to the
cause of any particular disease, is to be found in the
modification of their views by medical men, within recent
years, upon the production of malarial disorders. Tra-
dition, for centuries, usurped in this direction, as in many
more, the domains of fact and of proof, which, in some in-
stances, have now been fully conceded, but in others
still present only a dubious claim to our recognition.
Such appears to have been the history of those condi-
tions or influences which have been supposed for centu-
ries to be the primal and essential factors in the devel-
opment of malarial diseases.
Probably the earliest monograph extant upon this
subject is the famous one by Lancisi, entitled " De
No.xiis Paludum EfHuviis," published in Rome in the
beginning of the eighteenth century. Lancisi's investi-
gations were extensive and searching, and his conclusions
seemed so irresistible that they were adopted by scientific
men at once, and have since maintained, until within a
very brief period, an assured place as truths in profes-
sional literature. Those who subsequently published
medical works which needed to include diseases of a mi-
asmatic character, accepted without question or farther
investigation the opinions inherited, so to speak, from
the learned Roman author. Thus they passed from
hand to hand as the years rolled on, and finally reached
our period, bearing such emblems of authority as to
challenge and disarm criticism. During the lapse of
time some few additions were gradually made to the sup-
posed knowledge upon this subject, all of which, how-
ever, had their foundation in the original assumption,
namely : that malaria essentially depends upon circum-
stances existing in the simultaneous operation of air,
moisture, and a certain high range of temperature, caus-
ing vegetable decomposition.
Of later years, while not denying the necessity of these
conditions, a new and attractive theory led many observ-
ers to endeavor to go still farther back, and discover the
remote or ultimate cause of these, as well as of all zymotic
affections, in minute particles called germs, having special
shapes and characters peculiar to each individual disease.
Hence what is dignified with the title of the "Germ
Theory." Now, what are germs ? The ordinary mind
cannot even conceive of their form or nature. But what
is called the scientist (or, in this case more properly, ex-
perimentahst) has a large number of them in his "mind's
eye," but none in his laboratory, they being, as far as we
yet know, so immeasurably small as to elude observa-
tion under the most powerful microscope magnifying
thousands of diameters.' They may be regarded as the
minute and evanescent ghosts of defunct vegetable and
animal molecules, and yet many of them have received
polysyllabic names. They are presumed to represent
something akin to atoms of diseased matter.
In this connection 1 may be permitted to quote the
following remarks of W. Mattieu Williams, F.R..\.S.,
F.C.S., upon the address, in 1871, of Sir William Thom-
son before the British Association, treating of atoms :
" After hearing all these oracular utterances concerning
* Pettenkofer is quite positive as to the manner in which disease-germs operate.
According to him, a germ, in order to produce disease, must not only find a sus-
ceptible subject, but must also meet with that subject in a favorable locality and at
a proper time ; and as disease-germs are not generally very loiig-hved, the vast
majority' of them are extinguished without encountering such essential conditions.
Otherwise the human race would speedily disappear. The Chief of the Micrograph-
ical Department of the Paris (Observatory has recently announced a more wonderful
discovery than any found hitherto with regard to germs. It seems that he has
succeeded in enumerating them as follows ; Their number in each cubic metre of
the atmosphere of Paris amounts in winter to 7,000 ; in May, to 12,000 : in June,
to 35,000; in August, to 23,000: in October, to 14,000; and in November, to
8,000 ! — St. James' Gazette. The indefatigable Professor Hallier, of Jena, Ger-
many, has observed in hydrophobic saliva a characteristic germ, upon which In:
has conferred the name of Lyssophyton.
atoms, the unsophisticated listener will be surprised
to learn that no human being has ever seen an atom
of any substance whatever ; that there exists abso-
lutely no direct evidence of the existence of any such
atoms ; that all these atoms, of which Sir William Thom-
son speaks so confidently and familiarly and dogmati-
cally, are pure figments of the imagination. He will be
still further surprised to learn that the bare belief in the
existence of ultimate atoms as a merely hypothetical pro-
bability is rejected by many of the most eminent of sci-
entific men, and that among those who have disjnited the
idea of the atomic constitution of matter is the great
Faraday himself ; that the question of the existence or
non-existence of atoms has recently been rather keenly
discussed ; and that even on the question of the permis-
sibility of admitting their hypothetical existence, scientific
opinion is divided ; and that such a confident assumption
of their existence as forms the basis of this part of the
President's address is limited to only a small section of
mutually admiring transcendental mathematicians."
This arraignment of the atomic theory applies with
equal force to the germ theory and to its supporters.
.•\ssuming vegetable decomposition to be an essential
element in the production of malaria, a number of inves-
tigators have employed much time in endeavoring to
discover specific germs, only a few of which, it has been
assumed, introduced into the system, usually by inspira-
tion, would almost certainly multiply a million-fold, and
manifest their jjresence by well-known and characteristic
symptoms.
Some twenty years since. Dr. Saulsbury, an American
physician of the West, created quite a sensation in the
jirofession by the announcement that he had discovered
the veritable germ of malaria. He christened it '■'■ pal-
mella." At first glance he seemed to have actually
demonstrated a fact. But it is unnecessary to enumerate
his experiments, as they have since been proven to be
valueless and absurd. About the same time similar ob-
servations in certain malarious districts of Europe, es-
pecially in the historical miasmatic regions of Italy, were
announced, but with equally negative results. Dr. Ba-
Icstra was quite confident that some spores and sporangia
of a little algoid plant, which he found in the air over-
lying the Pontine Marshes were the long-sought for things.
Two French observers, Lemaire and Gratiolet, made
a similar discovery after examinations of one of the most
unhealthy marshes of Sologne, in the shape of " spherical,
ovoid, and fusiform spores, and a large number of pale
cells," which were afterward shown to be products of
vegetable putrefaction, existing in most swamps, whether
innocuous or not. Quite recently two other observers —
Krebs of Prague, and Tommasi Crudeli of Rome — were
certain that they had finally traced the infinitessimal
being into its lair. They conferred upon it the name of
bacillus malariw. They injected it into rabbits, dogs,
etc., and maintained that the result in these animals was
undoubted malarial fever. Their investigations were
undertaken in the .\gro Romano during 1S79. They
examined minutely the lower strata of the atmosphere in
the district mentioned, together with its soil and stag-
nant waters. In the air and soil they found a micro-
scopic fungus, consisting of numerous movable shining
spores, of a longish, oval shape, and nine micromilli-
inetres in diameter. This fungus they generated in vari-
ous kinds of soil. The fluid matter thus obtained was
filtered and repeatedly washed ; and the residuum left
after filtration was introduced under the skin of healthy
dogs and rabbits. The microscopical particles remain-
ing after washing considerable quantities of the surface
soil were employed in similar manner. It was affirmed
that all the animals experimented upon developed typical
malarial fever, showing regular intervals and lasting
various lengths of time up to sixty hours. There was
likewise observed an increase of animal temperature,
during the shivering fits, up to 42° C, the normal tem-
perature being from sS"" to 39° C. The animals so af-
178
THE MEDICAL RECORD.
[August 1 8, 1883.
fected were described as exhibiting acute hypertrophy of
the spleen, similar to that noticed in human patients suf-
fering from the same trouble — and in the spleens of the
diseased animals a large number of the characteristic
fungi were present. More lately Drs. Marchiafava and
Valenti of Rome have affirmed that they detected the
bacillus malarias in human subjects, in a more advanced
stage than in the animals experimented upon by Krebs
and Tonimasi Crudeli.
According to a still more recent assertion of Tomniasi
Crudeli,' results of farther pathological investigations
show that tlie bacilli may always be detected in the
blood during the febrile invasion ; but that during the
crisis they disappear, leaving only spores. According
to the researches of Laveran, extended and corrected by
Richard, the blood in malarial fever contains, during the
accession, spherical organisms developed in connection
with the red globules, and furnished with filaments ; also
certain curved and pointed bodies, which are only in-
fected and deformed blood-corpuscles. The i)ignient
granules of malarial blood are produced in the red cor-
puscles during the growth of the organisms. I have
cited these somewhat hyper-scientific and conflicting
accounts of assumed discoveries, not to discuss them par-
ticularly, but to remark that their fallacies have been
detected, and that such examinations, though interest-
ing, bring us no nearer to a solution of the question,
What is the nature of the malarial cause I All of the
different substances and forms, however minute and un-
known before, discovered thus far in malarious localities,
may be and have been found as well in districts perfectly
salubrious.
In the August (1876) number of the Popular Science
Monthly I published a brief account of the views then
entertained almost universally as to the conditions from
which malaria was regarded as springing, views in which,
at that time, I concurred. Since then, however, I have
been forced to materially modify my opinions on this
subject. During a conversation some icw years since
with the late Dr. Hayes, the Arctic explorer, I was sur-
prised to learn that malarial disease was not unknown in
certain .Arctic regions where the summer temperature
almost never rose above 60° F., with an average for
the warmest month of only about 45°. Dr. Hayes him-
'The latest publication by this gentlemau, who is a Deputy u .lie Italian Pai-
liament, and, so to speak, the present apostle of the theory which ascribes the
production of malaria to a ferment consisting of germs, tenned bv hira schi-o-
myc'etts bacillairei, is a report, dated .March 18, 1S83. 10 the Italian Ministsr'of
Agriculture, Industry, and Commerce, upon proposed legislation, having In view
tlie general suppression of malaria throughout Italy, but more especially In tlie
Roman Campagna. He appears to regard so herculean an undertaking as feasi-
ble under administrative pressure. His plan would involve an extensive concerted
system of thorough cultivation {cullures inttnsivfs) and drainage, for the de-
struction and prevention of said ferment, which, as he avers, can be set free only
under three indispensable conditions, viz. : "i, a temperature of about 20° C.
(68° F.) : 2, a moderate amount of soil humidity : 3, the direct action of the
oxygen of the air upon those portions of the soil containing the malarial fer-
ment ; and should but one of these conditions be wanting, the development of
malaria is suspended." Hesldcs these extensive agricultural measures of relief
he insists also upon tlic universal administration of arsenic in prescribed doses and
solid form to the farm-hands throughout the malarial regions of the country- He
does not even suggest any means of enforcing a scheme caUing for arbitrary r idi-
cal changes m the various agricultural systems pursued by an immense number
of farmers, fruit-growers, herders, etc. He questions the efficacy of quinine as a
prophylactic, although few of our army surgeoni. who employed It for that pur-
pose during tlie War of the RebelUon, will, I judge, be found to agree with him
In my capacity at that unic as the Medical Inspector of the Fiftli (Reguhir) Corps
of the Army of the Potom.iC, I had occasion to observe the prophylactic effects of
quinine, not only in my own person, but in that of very many otliers I need
scarcely add that most of tlie numerous and fatiguing campaigns of tliat .-irmv
were conducted during the hot season, in ri-gions fully as malarious as almost any
of Italy, 'runimasi Crudeli likewise dllTcrs from the generality of so-called
authorities in restricting the rise of the malarial ferment to merely a few leet per-
pendicularly [" four or five metres").
He gives examples of large numbers among the equine and Ixivlne species
having suffered severely from m.alana. .Strangely enough, his experiments
and those of Marchiafava and CubonI, with the malarial lermeiit infecting the
human system, have been conducted, so far as I am aware, almost exclusively
upon dogs and rabbiLs, animals which are not proven to suffer from malarlai Inva-
sion m the regions referred to. I have myself seen some fine English huntlni:-
dogs imported into Rome, and constantly used for the chase in the niilirious
hunting grounds of the Campagna and Pontine Marshes without siifferlnir
any ill effects wliatever. The hares and rabbits of Italy equally escape such
attacks, if their appearance indicates .anything. Moreover, those who per-
form experiments upon the rabbit know, that on acconiu probably of the
exceedingly timid nature of that beast, it exhibits, when handled, a 111 irked
rise in animal temperature. Another singular fact, gravely set forth liy Tonimasi
Crudeli, IS the necessity of obtaining blood only from persons suffering with /<fr-
nUtaus Jncr, in order to produce intermment symptoms in tlie lower aiilinals
Thus he confesses that, altliough lie had made extensive prepar.itlons for such ex-
periments during the year 1882, he refrained from trying iheiii. because not a
single case of f,trnu:u,us /.Ttr was received during that period into the Roman
hospitals.iHc hopes to be more fortunalc, however, witliin llie picsent year
self had treated several cases of intermittent fever among
the natives there. This disposed at once of the tradition
that an average summer temperature of at least 59°
F. is one of the essential factors in the causation of such
disorders.
Investigating the subject more thoroughly, I found
many instances of the occurrence of malarial diseases in
other places where vegetable decomposition was, to any
great extent, impossible ; and very many more instances
exist, as everybody knows, of spots where all the so-
called conditions for the production of the malarial poi-
son have always been present without such poison ever
having manifested itself ; and others still, in which, under
similar circumstances, it has appeared only at rare inter-
vals. The doubts thus excited were subsequently cor-
roborated during a professional connection with several
cases of mill-dams alleged to have produced malaria, one
of which I will allude to hereafter. Within a few years
the assumption of the truth of the convictions upon this
subject entertained by most physicians and hygienistshas
been the basis for a war upon mill-dams in the Middle and
Eastern States. Assuming that the exposure periodically,
by drawing off water, of lands contiguous to a stream, and,
in fact, forming a portion of the river-bed when the mill-
dam was full — such drawing off of a certain quantity of
water laying bare a considerable area of submerged
ground covered with vegetable growth — and that the ac-
tion of the summer sun upon such vegetation must in-
evitably create malaria — there could be little question as
to the deleterious influence of any mill-dam within certain
latitudes upon the health of the neighboring comnninity.
But, unfortunately for this theory, there are thousands of
mill-ponds, witliin the specified regions of average sum-
mer temperature, presenting every prescribed condition
for the creation of malaria, in whose vicinity chills and
fever have always been unknown as much as yellow fever
or the plague.
In this connection it is proper to recall the fact that
since the United States Census of 1S70 there has been
particularly noticed an evident extension of the subtle
miasmatic influence over regions previously exempt from
it within the Middle and New England States. The ad-
ditional effect of this disease-wave upon the naturally
malarious site of New York City alone in this period
was exhibited in the fact that from 186S to 1872 the
number of annual victims to these fevers increased three
hundred and fifty per cent. It is well known that in places
previously exempt from them miasmatic fevers occasion-
ally appear and disappear without there having taken
place any perceptible changes in the relations of the soil.
Sometimes such fevers assume a widely epidemic or pan-
demic character, appearing to have broken loose from
their native haunts in order to invade a great extent of
territory. Thus, as Hertz and Proust inform us, the
continent of Europe %vas almost entirely overspread by
such pandemics in 1558, 1678, and 1679; from 1718 to
1722 ; from iSoS to 181 1; from 1824 to 1827, and from
1845 to 1848. That the cause of malaria being thus
disseminated is equally mysterious with that of most epi-
demics few will venture to deny.
AV'hen inquiring why malarial fevers should prevail for
any considerable time in a given region, we must divest
our minds of preconceived notions, and examine th«
matter judicially. We shall thus find that a variety of
different circumstances seem to be connected with the
prevalence of such diseases in different localities ; and
these last may be classified as follows :
I. Essentially Malarious Districts. — Here, as far as
known, malaria has always existeci, and analogousl)'
always will. Manhattan Island, together witii its sur-
roundings— Westchester County, Northern Long Island,
and Eastern New Jersey — i)resent the most familiar ex-
amples. While in some portions of these territories the
existence of swami)s and overflowed lands does aiipear
to bear a positive relation to malarial affections, and
their drainage does seem to be followed by a diminution
August 1 8, 1883.]
THE MEDICAL RECORD.
179
of such diseases {never, hoivever, by their entire suppres-
sion), in otlier instances the drainage of such places has
been succeeded by a positive increase, rather than a sub-
sidence of miasmatic troubles. We are, tiierefore, placed
in a dilemma as regards the influence of drainage in ex-
terminating malaria. On the other hand, whether in
miasmatic regions or elsewhere, I do not presume to
deny that thorough drainage has a beneficial effect upon
the general public health, when we consider the large
category of diseases. But this result proves nothing as
to the cause of malaria.
2. Non-malaricus Districts. — Here malaria has ap-
peared only occasionally, and at irregular intervals and
with a limited period of e.vistence ; for, according to its
previous history in such territories, its disappearance
sooner or later was inevitable. Dr. Oliver Wendell
Holmes' admirable description of similar events in
various portions of New England during colonial days
substantiates this fact. New York State, New Jersey,
and Pennsylvania are largely exempt from endemic
malaria, but have been afflicted from time to time in
certain parts with invasions of pandemic malaria. We
are entirely ignorant of any laws governing these erratic
outbreaks.
3. Elevated lands, even lofty mountains and extensive
dry sandy plains, where none of the so-called conditions for
malaria can he discovered in simultaneous operation, hut
7L'herc malaria is virtually constant. — Such instances are
very numerous, and stagger even the most ingenious of
the swamp and germ theorists. To these gentlemen it
may seem almost sacrilege that any intelligent reader and
observer should become an iconoclast as to the idols which
ages of study have built up for all future worship — never-
theless, so it is ; and it is significant that some of the most
distinguished scientific men have lately abjured the ortho-
dox opinions in regard to the essential conditions for tlie
production of malaria. In a cause cclcbre tried at Pitts-
field, Mass., in October, 1882, on account of an indictment
brought against the owners of a mill-dam for creating
malarial fevers, Dr. Paul A. Chadbourne, President of
the Massachusetts Agricultural College, and ex-Presi-
dent of Williams College, testified that, as a professor
in the Berkshire and Maine ^ledical schools he had for-
merly lectured upon the nature of malaria. He then
believed it to be of gaseous character, due to heat and de-
composition of vegetable material, but he had since en-
tirely abandoned that theory, and adhered to no opinion
whatever, based upon sufficient facts to make it valuable,
as to how malaria arises.
In the same case. Dr. Charles W. Chamberlain, Secre-
tary of the Connecticut State Board of Health, and
a gentleman who, from very extensive observations
throughout his own State, is familiar with this subject, as
far as present knowledge will allow, after admitting that
he had formerly held the marsh and germ theories, ac-
knowledged that he had recently given up both.
A similar complete change in opinion was avowed by
Dr. Francis Bacon, ex-Professor of Surgery at Yale Col-
lege ; by Dr. N. G. Kierle, of Baltimore, Lecturer on
Pathology in the College of Physicians and Surgeons of
that city ; by several of the principal practitioners of
Berkshire County, Mass., and by a dozen well-known
physicians from other portions of the country.
The vast importance of a positive or negative ex-
pression of opinion by distinguished experts upon the
subject in question may be better understood when it is
stated that the interests of several thousand manufacto-
ries run by water-power, in Massachusetts alone, were in-
volved in the decision of this case, an unanimous one by
the jury in favor of the mill-dam.
Although medical men with the reputation of those
above mentioned find it proper to abjure long-cherished
convictions, which from careful observation and logical
inference have become untenable, and are forced to
.acknowledge themselves as ignorant of the ultimate
causes of many affections as were Celsus and his cotem-
poraries eighteen centuries ago, nevertheless, the rapid
strides accomplished in other branches of medical in-
quiry encourage us to anticipate trustfully the time when
we shall be gratified with a comprehension of the invisi-
ble, mysterious, and ever-active agencies which engender
the various zymotic diseases.
BENZOATE OK SODIUM IN THE TREATMENT
OF ACUTE GASTROINTESTINAL DISEASES.
BV WILLIAM P. WATSON, A.M., M.D.,
PHYSICIAN FOR DISEASES OF CHILDREN TO THE CENTRAL DISPENSARY, JERSEY
CITY, N. J.
During the past year I have been very favorably im-
pressed with the rapid, as well as satisfactory action of
the benzoate of sodium in the treatment of acute tlysen-
tery, cholera morbus, intestinal colic, crapulous and
flatulent and other allied morbid conditions of the ali-
mentary canal.
Whether this result is due to its alkaline reaction, or
to its disinfecting action on the morbific gases from the
decomposing ingesta, or to its stimulating action on the
liver, I will not now undertake to demonstrate. That
it does give quick and permanent relief in such conditions
I have carefully noted in more than twenty instances.
The following typical cases are selected from my case-
book:
Case I. — Acute Dysentery. — Mrs. G , aged thirty-
one, usually enjoying good health, had colic, looseness of
the bowels, vomiting, great thirst, and no desire for food
for three or four days, and not being relieved by diarrhoea
mixtures, cholera-drops, etc., sent for me. I saw her at
nine o'clock in the evening, when she was suffering with
severe headache; little abdominal tenderness on palpation;
mouth and fauces dry; very thirsty, but retaining liquids
swallowed only a few minutes, and during the last twenty-
four hours complaining mostly of an unavoidable desire
to go to stool, at which, however, there was only mucus
and blood accompanied by violent tenesmus. Prescribed
the following mixture, the dose to be repeated every
half hour until relieved :
5 . Sodii benzoatis 3 j.
Elixirii simplicis ^ ij.
M. S. — Two teaspoonfuls at a dose.
On the following morning she told me that soon after
taking the first dose she was greatly relieved, and that
she had taken only four doses when the pain and bear-
ing down while at stool were entirely gone.
The stomach did not reject the medicine at any time,
and she had not taken it since midnight, after which she
rested quite well for several hours. Bowels still loose,
but discharges are feculent. No tenesmus. Not much
thirst. Left the following prescription :
IJ . Pulv. opii ij- gr-
Pulv. camphor 3j.
M. et in cap. iv. div.
S. — Take one capsule after each passage. To have
only boiled milk and toast, and, if very thirsty, iced car-
bonic-acid water as the only drink.
On the following morning, I found her sitting up in
bed. Said she was all right, except a little weak. No
movement from bowels since six o'clock last evening.
Ordered her to have half a tablespoonful of Boudault's
wine of pepsin, with ten drops of the dilute nitro-muri-
atic acid, three times a day for one week, at the end of
which she came to my office to say that she had had no
further trouble.
The use of the benzoate of sodium in the above case,
and in three others of a similar nature, was as surprising
to me as it was gratifying to the patients. In a very few
hours an attack of acute dysentery was changed to a
simple diarrhoea, which yielded kindly to a few small doses
of opium and camphor.
Case \\.— Cholera Morbus. — Mr. A-
i8o
THE MEDICAL RECORD.
[August iS, 1883
healthy young man, was taken at midnight, following a
very indigestible dinner, with nausea and colic, soon fol-
lowed by profuse vomiting and purging, which continued
until five o'clock in the morning, when I found him with
his knees flexed on his abdomen, which was very sensitive
to pressure, face pale, pulse small, and a frequent de-
sire to defecate. I immediately gave him fifteen grains
of the benzoate of sodium in a tablespoonful of simple
elixir. This was retained about fifteen minutes, when he
vomited quickly, and without that very disagreeable gag-
ging sensation in his throat which attended previous
similar acts. In a few minutes he took half the quantity,
when I left instructions to repeat the same every hour if
required.
When I visited him again, at five o'clock in the even-
ing, he was sitting up in bed eating poached eggs on
toast. Said he was feeling all right, that he had not taken
any of the medicine since eight o'clock, and was going
to business in the morning. A few days later I saw him,
and he told me that he had had no further trouble.
In several cases of this description the ben/oate of
sodium acted equally well — no other medicine being re-
quired.
C.\seIII. — Intestinal Colic. — In this case, representing
a class in which I had usually given inhalations of chloro-
form or hypodermics of morphine, I was somewhat doubt-
ful about the proiiriety of using the benzoate of sodium ;
yet, recognizing colic as due to spasms of the nmscular
tissue of the intestine caused by flatulency, and having
seen such remarkable results from its use in analogous
cases, and especially after the statement of the patient
that " morphine aflects my head so," 1 determined to
use it.
Mrs. W , aged thirty-five, anremic, poorly nour-
ished, occasionally has attacks of colic after any indis-
cretion in her diet.
When I saw her, at four o'clock in the afternoon, she
was lying on her side with knees drawn up toward tho-
rax, and frequently crying out with pain, " All over my
stomach.''
I learned that two or three days ago she was taken with
vomiting and diarrhoea, which had been mostly relieved
— -the former since noon, and the latter since morning —
by domestic remedies, and that she had jiassed no urine
for twenty-four hours, during which time the paroxysms
of pain had been gradually increasing in frequency and
severity. She would not permit me to use the catheter, or
even to carefully examine the abdomen, on account of the
pain caused by any change in her ]iosition. I gave her
fifteen grains of the benzoate of sodium in a tablespoon-
ful of simple elixir, and instructions to repeat half the
dose every hour if necessary. Visited her again at
nine o'clock in the evening, when she told me that
in a few minutes after taking the medicine she was
greatly relieved ; that she passed plenty of water in
about one hour afterward, and did not take any more
of the medicine until eight o'clock, when, having a little
pain over the umbilical region, she repeated half of
the first dose and had had none since. On tlie following
morning I found that si.-; had rested well during the
night, without any recurrence of the colic. Ordered her
to take, for a few days, half a tablespoonful of Boudault's
wine of pepsin, with ten drops of dilute nitro-miuiatic
acid three times a day, and heard nothing more from her.
In the bowel complaints of children, where the pas-
sages are greenish, lumpy, mucoid, and frequently streaked
with blood, I have repeatedly seen them changed to their
natural color within a few hours after commmencing the
use of benzoate of sodium, in hourly grain doses for each
year of age, and that, too, without even dieting the
child.
How TO Cure Sore Throat.— Mrs. Disraeli told the
Queen, "When Disraeli has a sore throat I cure him by
putting my arm round his neck and keeping it there all
night."
EMPYEMA — DOUBLE INCISION WITH
THROUGH DRAINAGE— RECOVERY.
By M. ALLEN ST.A.RR, M.D.,
LATE HOUSE-PHVSICHN BEU.EVUE HOSPITAL, ATTENDING PHYSICIAN NEW YORK
DISPENSARY.
The methods of treatment of empyema recommended
by various authorities differ widely, and the statements
made by each are so positive that the practitioner is of-
ten in doubt as to which method to follow. A decision
can be most readily reached by comparing the results of
the various operations as they are reported from time to
time. It is now acknowledged that in most cases aspira-
tion alone will fail to relieve the condition permanently,
and that a free exit must be afforded to the pus collected
in the pleural cavity. It is the object of this article to
recommend a double incision with through drainage, and
to demonstrate its advantages over the method of a sin
gle incision. The case reported illustrates most of the
points of interest to be noted :
Hannah S , aged six, was admitted to Bellevue
Hospital December 5, 1881, and assigned to the fourth
medical division. Dr. H. F. Walker, attending physician.
She had recovered from scarlet fever in October, but
during November had suffered with headache, gastric
disturbance, and general anasarca, due to a nephritis
which had developed during the fever. These symptoms
subsided during the latter part of November, at which
time the urine increased in amount. But with the sub-
sidence of the symptoms of nephritis a new set of symp-
toms developed. The child began to complain of pain
in the left side, coughed a good deal without expectorat-
ing, and had a well-marked fever which was always
worse at night. Her mother noticed that she could not
lie on the right side, and that the left side became tender
and swollen. On admission the child was thin, poorly
nourished, fretful, and had a temperature of 102°; pulse,
140 ; respiration, 40. The heart was displaced, its apex
being in the fourth intercostal space, one-fourth inch to
right of the sternum ; the left side of the chest bulged
outward, measuring one-half inch more than the right
side in circumference at the level of the nipple, and all
the physical signs of pleuritic effusion were present.
Puncture with the hypodermic needle drew greenish pus.
The upper level of the eftusion corresponded with the
space of the scapula.
On the 6th aspiration was performed, eleven ounces
of pus being removed, with the result of relieving the
dyspncea, and bringing the heart apex about one inch to
the left of its former position. By this procedure the level
of the fluid was lowered to the seventh rib posteriorlv.
The child was put upon cod-liver oil and iron, and an e.x-
amination of the urine having shown the jiresence of al-
bumen in small amount, with a few blood-globules and
hyaline and granular casts, the white drink (pot. cit. et
acet. inf. digital. m\.) was ordered w-ith a view to increas-
ing its amount.
By the 15th the fluid had returned to the level of the
spine of the scapula, though the general condition of
the child had improved in spite of the hectic fever. The
temperature reached 101° or 102° every night, and was
not aftected materially by the administration of quinine
given ])er rectum, as it could not be retained in the
stomach. During this time the daily amount of urine
had increased from fifteen to thirty ounces, but it always
contained albumen. Aspiration was again performed,
the level of the fluid being reduced to the ninth rib by
the removal of eight ounces of pus. Same treatment
was continued, inf. scoparii being substituted for inf.
digital, in the white drink.
On the 29th the pus had again risen to the middle of
the scapula, and it was evident that the child was suc-
cumbing to the hectic fever. Her general condition was
poor, she was very weak, pale, thin, and fretful ; her ap-
petite was capricious, milk being the only article of diet
which was always digested; her bowels moved irregu-
August i8, 1883.]
THE MEDICAL RECORD.
181
larly ; she passed about twenty-eight ounces of urine
daily, and there was no ascites or anasarca. Aspiration
having failed to afford permanent rehef. Dr. Walker con-
sidered an operation necessary, and kindly intrusted it
to me.
On the 30th the operation was performed under ether.
-■Ml antiseptic precautions were observed, and the method
of Lister was carried out in every detail. An incision
was made in the seventh intercostal space, one-half
inch external to the inferior angle of the scapula, with a
scalpel, and a director having been introduced, the o|)en-
ing was enlarged with a probe-pointed bistoury until it
was three-fourths of an inch in length. Tiirough this
opening forty ounces of pus was evacuated. A long
probe was then introduced into the opening, and passed
downward and forward to the lowest limit of the [lieural
cavity. Its point being felt in the ninth intercostal space,
about one inch external to the mammary line, was cut
down upon and brought out. A medium-sized, fenestrated,
rubber drainage-tube was then attached to the probe
and drawn through from the first to the second incision.
Each end of the tube was secured by a safety-pin, and
projected an inch from each incision. The length of the
tube was about five inches. At the time of the first in-
cision an intercostal artery was cut and considerable
blood was lost. The hemorrhage was at first arrested
by a serrefine, and later, as all attempts to seize the ar-
tery failed, by the introduction between the ribs of a
piece of compressed carboli/ed sponge. Full Lister
dressings were then applied.
During the operation air entered the pleural cavity at
each insijiration, but as a good spray of carbolic was
continuously directed upon the whole chest the possibil-
ity of sepsis was prevented. As the operation was being
concluded the child's pulse, which had been growing
feeble, ceased, and respiration stopped. Artificial respira-
tion was kept up ; nitrate of amyl being held to the nos-
trils, hypodermics of whiskey or digitalis were adminis-
tered, and a hot rectal injection of whiskey and water
was given. She revived slowly under the action of these
stimulants, and two hours after the operation was quite
comfortable, thougii very weak. Pulse, 120; respiration,
40 ; temperature, 98^°. Seven hours after the operation
it was necessary to renew the dressings, as they were
soaked with ijus. This was done under the spray. Dur-
ing the following twenty-four hours the child's condition
was critical. She slept only a few minutes at a time,
vomited frequently when awake, and seemed to be grow-
ing weaker. She was nourished by milk and brandy in
small amount, frequently given, both by the stomach and
by the rectum. The dressings were changed once, and
were found to contain considerable pus. Temperature,
A.M., 98°; P.M., 99°; respiration, 30; pulse, 120.
On January ist she seemed much more comfortable ;
did not vomit, retained milk, beef-tea, chicken soup, and
brandy, and had a natural movement of the bowels. The
amount of pus on the dressings was much less than be-
fore. The tube was washed through with a solution of
permanganate of potash in both directions, a small
amount of pus being washed out. p.m. temperature, 99°.
The heart apex is now in its normal position. The child
has no pain in the chest, coughs much less, and respira-
tion is regular — 30 per minute. The lung has expanded,
and vesicular breathing and normal voice are heard down
to the level of the seventh rib behind.
Up to January 20th the child's condition improved
steadily. Her digestion was good, and she gained much
flesh and strength. Her bowels moved regularly, and
she passed about thirty ounces of urine daily. The
chest was dressed daily with one exception, and the dis-
charge of pus decreased steadily until only about an
ounce was found on the dressing, and about a drachm
was washed out. A solution of salicylic acid, one per
cent., was used in washing out the tube, and the dressing
was always done under the spray. The lung expanded
well, and at no time was there any sacculation of pus,
the drainage being perfect. When the child sat up the
discharge ran out of the anterior and inferior end of the
tube, and when she lay down, the superior and posterior
end being then lower, it ran in that direction. Only
twice during this time did the temperature rise above
100° : once when the dressing was not renewed, and
once when a small abscess formed on her left thigh.
Between January 2 2d and February 3d the child
went through measles, having contracted it in the ward
from another child. She suffered a good deal from the
attendant bronchitis and laryngitis, and at one time had
a temperature of 105°. During this period the discharge
was very scanty, but the side was dressed daily as usual.
After her recovery from measles, and until February i8th,
her general condition was improving, but the discharge
showed a tendency to increase, about an ounce being
found on the dressing every day, and the p.m. tempera-
ture rising to 99^^ or 100° every night. It was thought
that the heavy Lister dressing was acting as a fomenta-
tion. In place of it a light pad of oakum, bound on by a
few turns of gauze was applied, and a solution of carbolic
acid (one part to ninety) was substituted for the solution
of salicylic acid to wash out the chest. The result was
good. The temperature at once decreased at night to
98^° or 99° ; the discharge became less, and on March
ist it was resolved to remove the drainage-tube. At
this time the only remains of the formerly distended
pleural cavity, to be found by physical e.xamination, was a
small narrow area between the two openings. The lung
had expanded, and the side had slightly retracted so as
to measure half an inch less than the right side in cir-
cumference, the chief deformity noticeable being the
sinking of the left shoulder when she stood up. The
tube was pulled through the jjosterior opening into* the
chest, being first attached to silk ligatures'at its posterior
extremity, so that it might be replaced if necessary. It
was then pulled out of the inferior opening half an inch
daily until the 6th, when it was finally removed, the dis-
charge having entirely ceased.
On the 4th both openings had closed completely. On
the 20th physical examination showed heart in normal
position ; slight dulness, with distant vesicular breathing,
and slight diminution in voice sounds below the ninth
rib behind, and below the seventh rib in the axilla on the
left side. Under regular gymnastic exercise the deform-
ity has entirely disappeared, and both shoulders are at
the same level. On forcible inspiration the left side ex-
pands one-fourth inch less than the right side. The child
is in good general condition, is up and plays about all
day, has a good appetite, normal stools, and passes
thirty ounces of urine daily, which still contains a small
amount of albumen and a few hyaline and granular casts.
She was discharged from the hospital, but kept under ob-
servation for three months, during which time she re-
mained in perfect health.
In connection with this case there are several points
to be noticed. It would have been well to operate at
the time of the second aspiration, the result of the
first aspiration showing that this means was inadequate
to cure the empyema. Operation in these cases should
be performed early, as the hectic fever, if allowed to go
on, weakens the patient constantly.
The existence of nephritis did not seem to affect the
result, and hence should not interfere with the operation.
The danger of collapse is less if the pus is evacuated
slowly. In this case the necessity of stopping hemor-
rhage prevented me from closing the posterior opening
while the anterior one was being made, and allowed
a too rapid escape of pus. It would be advisable to ap-
ply the dressings as soon as the operation is completed,
■and let the pus soak into them gradually. The drainage
by means of two openings was far better than could have
been secured by one alone. In this case it mattered
little whether the patient was in an erect or recumbent
posture, pus never collected in the cavity. This seems
to be the great advantage of this method over all others.
l82
THE MEDICAL RECORD.
[August 1 8, 1883.
AVhen one has washed out a chest through one open-
ing, and seen how a change of position of the patient will
prevent or facilitate a free discharge, as the case may
be, he cannot fail to ajipreciate the advantage of two
openings, with the possibility of washing out the cavity
in either of two directions. Perfect drainage is the ob-
ject. It can only be secured by two openings, one of
which shall be at the lowest point of the pleural cavity
when the patient is standing, and the other at the lowest
point when he lies down. Otherwise, during at least ten
of the twenty-four hours, the drainage is imperfect, if the
patient is not confined to one position in the bed. The
Lister dressing is important as long as the surface liable
to absorb septic matter is extensive, but when a small
sinus alone remains its weight and thickness seem to
make it unsuitable, and a lighter dressing favors healing.
If the measles had not delayed the result three weeks,
and if the light dressing had been applied two weeks
earlier, it is reasonable to conclude that the drainage-
tube could have been removed five w-eeks after the
operation, instead of ten weeks, as was the case. The
result of gymnastic exercise in correcting the deformity
which followed the operation was very satisfactory.
It may be concluded from this case, that through
drainage is eminently successful in the treatment of
empyema in children, and that it has decided advantages
over every other method.
^vor\vcs5 of picdical Science.
Articul.ar Ganglion of the Knee. — Dr. Nicaise
reports, in the Revue de Chirurgie for June, 1883, the
case of a man who jiresented himself for the removal of
a small tumor situated upon the outer side of the knee.
The tumor was the size of a small nut, somewhat flat,
irregularly lobulated, soft, fluctuating at certain points,
and irreducible. It was of slow growth, and slightly ad-
herent to the skin and underlying tissues. The joint
was in no way involved, and the movements of the knee
were perfectly free. A positive diagnosis was not made,
though the author was inclined to regard the new growth
as a sebaceous cyst. When removed the tumor was
found to contain a gelatinous liquid resembling the vit-
reous humor of the eye. The walls were irregular, pre-
senting here and there little recesses forming a sort of
secondary cysts. The inner surface was lined with flat
epithelium, outside of which was a cellular shell, inter-
woven with elastic fibres and presenting in places a
fibrous formation, due probably to irritation produced by
movements of the tumor.
.■\CUTE Scoliosis. — The following case of acute lateral
curvature of the spine is related by Professor Desines in
r Union MiJicali-, No. 54, 1S83, as confirmatory of the
theory of Duchenne of Boulogne concerning the nature
of this affection. A young woman, twenty years of
age, was attacked with typhoid fever of mild type, not
accompanied <3y any grave cerebral symptoms, and from
which she recovered in about three weeks. During con-
valescence her husband noticed that she did not stand
as straight as before. The deviation increased grad-
ually, without causing any pain, until she was finally led
to consult M. Despres. E;xaniination showed a lateral
curvature of the spine in the dorsal region with con-
vexity to the left. The lumbar spine was normal, as the
affection was of too recent date to permit of the forma-
tion of a compensatory curve in this region. The con-
dition present was declared by the author to be atrophia
des spirales lombaires on the left side. The atrophy
had undoubtedly followed the typhoid fever, as it is
known that nuiscular degeneration occurs in the course
of this malady. The results of treatment were most
happy, a very great amelioration being observed after
only eight days. The treatment consisted in faradization
of the weakened muscles over the convexity of the cur-
vature, repeated every dav, in exercises, and in slight
mechanical support. The gymnastic treatment con-
sisted simply in trapeze exercises, or raising the body
from the ground by the arms. M. Despres does not
regard apparatus as of any therapeutical value in this
condition, but uses it merely as a support to be worn in
the intervals of active faradic and gymnastic treatment.
Inflammation of the Thyroid Gland in Diph-
theria.— Dr. Brieger relates two cases of diphtheria
complicated with thyroid inflammation {Centralblait fur
KUnische Medicin, June 23, 1883). The first case was
that of a girl, eighteen years of age, who, when first seen
on the seventeenth day had no fever. Two days later,
while the diphtheritic membrane was still present, she
had tolerably high fever with pain and swelling of the
thyroid gland. There was aphonia and dyspnoea. Anti-
phlogistic measures proved of no avail, but considerable
relief was aftbrded by poulticing. Twenty days later an
incision was made at a point of fluctuation, and about an
ounce and a half of pus evacuated. Under careful treat-
ment the patient recovered. In the second place, that
of a woman aged thirty-two, the inflammation was
aborted by energetic antiphlogistic treatment and leech-
ing in the early stage. In both cases the thyroiditis sub-
sided before the local diphtheritic process. The author
believes that the glandular inflammation was directly
traceable to an invasion by the diphtheritic microbes.
ACLTE CEdema of the Glottis. — Dr. Rabere related
the following case, seen by himself and Dr. Laylavoix,
to the Societe de Medecine et de Chirurgie {Journal de
Medecine de Bordeaux, June 24, 1883). A man, sixty-two
years of age, of vigorous health, without history of pre-
vious laryngeal trouble or syphilis, was taken with slight
chills one evening after working in his garden. The
next day he was a little hoarse and felt a slight soreness
in swallowing, but was otherwise well. The hoarseness
and difficulty in deglutition had increased the following
day, and in addition there was a little dyspnoea. That
evening he was siuWenly awakened in a most threaten-
ing attack of suffocation. Examination showed a swelling
and induration of the aryteno-ei)iglottidean folds, but no
other trouble in the throat could be made out. Active
treatment by counter-irritants, leeches, and emetics pro-
duced but slight amelioration, and upon a second attack
of urgent dyspntea it was decided to perform trache-
otomy. The operation was i)ostponed when the urgent
symptoms subsided, but a third attack of complete suflb-
cation, during the momentary absence of the attendants,
resulted fatally. No cause for the oedema could be dis-
covered, except cold, as the man had always enjoyed
excellent health. There was no reason to suspect renal
trouble, but unfortunately no examination of the urine
was made.
Flax as a Dressing for Wounds. — Dr. Makuschina
writes in Vratch, No. 12, 1883, concerning flax as a
cheap and convenient surgical dressing. She prepares
it in the following way : Small bundles of flax are boiled
for three hours in ordinary lye-water, and then left to
soak in the same for eight or ten hours. After that it is
washed five or six times in clean water, dried, and combed
out. It loses about twenty-five per cent, in weight, and
is a perfectly w-hite, soft material, much more hygroscopic
than before being so treated. It is several times cheaper
than absorbent cotton, fn Russia at least. Dr. Anton
Schmidt, of Moscow [Centralblait fiir Chirurgie, June
30, 1883), also recommends the use of flax. He says
that it possesses an advantage over absorbent cotton in
that it does not become matted when wet, thus retaining
the secretion about the wound. By the addition of cor-
rosive sublimate, iodoform, or carbolic acid an excellent
antiseiJtic dressing may be prepared. In military sur-
gery also it recommends itself by the compactness in
which it may be carried, taking up much less room than
either cotton or jute.
August 1 8, 1 883. J
THE MEDICAL RECORD.
183
A Remarkable Case of Ascites. — Dr. Antonio
Lanini relates in Lo Sperimentale, vol. li., No. i, a case
of ascites occurring in a man thirt)'-foiir years of age, in
which paracentesis was performed ninety-two times from
Ai)ril, 1878, to December, 1882. During this period
over three hundred and eighty gallons of fluid were with-
drawn from the abdominal cavity without any apparent
loss of strength on the part of the patient. The cause
of the ascites was not clear, for careful examinations
made immediately after the removal of the fluid could
detect nothing abnormal in the abdomen. There were no
signs of obstruction to the ))ortal circulation, and the
normally secreted urine contained no albumen. The
author thinks that there was an irritable condition of the
peritoneum, resulting from an inflanniiation of this mem-
brane, from which the patient suffered in 1878. There
had never been any fever since the subsidence of the
peritonitis. Diuretics, cathartics, counter-irritation, di-
aphoretics, strong compression of the abdomen, all were
tried without success. This patient was related to an-
other man, also under Dr. Lanini's care, on whom in
the course of twenty years phlebotomy had been per-
formed five hundred times, and cupping thirty times, be-
sides the application in the intervals of two thousand
leeches.
Peritonitis and Peritonism. — In observing a case
of acute peritonitis, rapidly fatal, in a young man who
had swallowed some orange-pits. Professor Trastour re-
called the distinction established by Gubler in 1877 be-
tween peritonitis and peritonism. By the latter term
is meant the totality of grave refle.x phenomena some-
times observed in a patient suffering from peritonitis.
These symptoms are (Jroduced through the agency of the
great sympathetic, and are often overwhelming in their
violence. Peritonism is not dependent upon the intens-
ity of the original inflannnation. A light peritonitis may
be the occasion of the violent symptoms of peritonism,
while, on the other hand, an extensive purulent inflam-
mation of the peritoneum may give rise to no general
reflex phenomena. The treatment of peritonism consists
in the administration of alcohol, chloral, and especially
of opium in large doses. The latter may be given in
fractional doses, aggregating fifteen grains in the twenty-
four hours, its effects, of course, being most carefully
watched. — Revue MedicaU, June 23, 1883.
Perisplenitis and Pleurisy in Typhoid Fever. — ■
Simple pleurisy, w'ithout pulmonary lesion, is supposed
to be a rare complication of typhoid fever. Guillermet
has collected a number of such cases, and seems to agree
with another observer who regards simple pleurisy as
rather common in typhoid fever, and who attributes it to
the marked tendency to serous inflammation which ex-
ists in this disease. The observations of Dr. Merklen
{^Revile Afcdicale, June 23, 1883) lead him to advance a
more rational pathogenesis. He states that the spleen
in typhoid fever is not only the seat of a passive conges-
tion, but is also a centre of inflammatory irritation which
may involve the capsule. This may determine by con-
tinuity a localized or general peritonitis, whence the in-
flammation may spread to the diaphragmatic pleura. In
this way he would explain the origin of simple pleurisy,
and not by a preference of inflammation to seek the ser-
ous membranes.
Typhoid Fever and Pregnancy. — Dr. Martinet
concludes a paper with this title as follows : i. Typhoid
fever is rare in pregnant women. 2. It determines abor-
tion in about one-half of the cases ; the more surely,
the less advanced is the pregnancy. 3. The lightest forms
may produce abortion. 4. This complication arises
usually in the course of the third week, and sometimes
at the beginning of convalescence ; it causes no recru-
descence nor return of fever. 5. Puerperal accidents are
the exception. 6. The immediate causes of abortion are
unknown ; elevated temperature, active or passive.
uterine congestion, and changes in the blood, although
seemingly the most probable, cannot be regarded as the
causes in all cases. 7. The treatment for the fever and
the miscarriage is the same as for each condition alone.
L' Union Mc'dicale, Nos. 52 and 53, 1883.
Poisoning from Diseasf.d Meat. — Dr. Ruysch re-
ports the poisoning of about two hundred persons in the
town of Heesch, Holland, who had eaten the flesh of a
cow that had died in giving birth to a calf, also the flesh
of the still-born call and of another dead calf. All who
had eaten the meat were taken ill and three died. They
suffered from severe gastric symptoms, chills, fever, head-
ache, and great depression, so that the physicians sup-
posed at first that they had to do with an epidemic of
typhoid fever. Others presented the symptoms merely
of gastro-enteritis. The nature of the poison in the flesh
could not be clearly determined, as none of the animals
had died from an infectious disease. — Centralbl. filr Kliti.
Med., June 9, 1883.
A Hitherto Undescribed Neurosis. — Dr. Wernicke
relates the case of a man, twenty-five years of age, who
suffered from tonic si)asms of the voluntary muscles
{CenUalhl. fiir Klin. Med., June 9, 1S83). The af-
fection differed from tetanus in that each convulsion
was of shorter duration, the contractions were weaker,
and the spasms did not involve the entire body but
only single groups of muscles at a time. The convulsions
were painless and recurred at frequent intervals, but
ceased during sleep. They involved the muscles of res-
piration, but left free the upper extremities and the ter-
ritory supplied by the cranial nerves with the exception
of the right platysma myoides muscle. The patient had
a club-foot from a spastic contraction of the left gastroc-
nemius muscle of fifteen years' standing, otherwise all
the functions of body and mind were normal. No cause
for this affection was determinable. The only remedy
which had produced even a temporary amelioration was
curare. The convulsions, slight in the beginning, had
gradually increased in intensity and in the number of
muscles involved. The author regarded the tonicity of
the convulsions as indicating a spinal origin, since cerebral
spasms are of a mixed tonic and clonic character, as in
epilepsy. As to the question whether this slowly pro-
gressive disease was dependent upon a palpable lesion of
the cord (sclerosis), or whether it was a disease in which
the changes in the cord were unrecognizable by any
means yet at our disposal, he declared for the latter, and
designated it as a neurosis. Two brothers of the patient
suffered from a similar comiilaint. The father had had
syphilis.
The Treatment of Basedow's Disease. — From an
experience in upward of seventy cases, and fortified by
the unanimous observations of Von Dusch, Eulen-
burg, Meyer, Erb, and others, Dr. Chvostek is led to
regard the rational employment of galvanism as the
most important part of the treatment of Basedow's dis-
ease. He recommends the following method to be pur-
sued : I, the ascending constant current applied to the
cervical sympathetic, on each side, for at the most one
minute ; 2, the same to the spinal cord (the anode at
about the fifth dorsal spine, the cathode high up in the
cervical region) ; 3, through the occiput (one pole at
each mastoid process), and in certain cases also through
the temples, a constant current, for at the longest one
minute, and so weak that the patient can feel but the
slightest sensation of burning. Sometimes also local
galvanization of the thyroid gland with a weak constant
current for about four minutes, the current to be re-
versed at the end of each minute. The applications
should be made every day if possible. As a rule very
good results were obtained, even in the most severe
cases a cure or marked improvement being recorded.
In three cases deatli resulted from excessive aniemia or
complications.— C<-«/r<z//^/. fiir Klin.\ Med., June 23,
1883.
1 84
THE MEDICAL RECORD.
[August i8, 1883.
A Loud-Sounding Heart Murmur. — Dr. Herman
Tittinger describes a peculiar murmur, characterized by
the distance at which it is audible (it can be distinctly
heard through the bed-coverings), by its stability (it is
but slightly influenced by the intensity of the heart's
action), and by its character (it is composed of both a
primary and an accessory sound). Together with the
murmur is perceived a widely propagated tremor. This
phenomenon occurs only with rupture of the valves or
of the chordae tendinre in immediate connection with
them. The primary murmur is caused by insufficiency
of the valves, the secondary sound by the flapping of the
loose valves and chordae tending in the returning blood-
stream. A diastolic murmur indicates a rupture of the
semilunar valves, while a systolic sound points to the
(nuich less frequent) lesion of the mitral valve. — Cen-
tralbl. fiir Klin. Med., June 9, 1SS3.
Epilepsy caused bv Intestinal Worms. — The fol-
lowing case is reported by Dr. Windelschinidt in the
Allgem. Med. Central-Zeitung of June 9, 1883. K wo-
man, forty years of age, had suflFered for si.x vears from
convulsions, epileptic in character, which were steadily
increasing in frequency, until finally the attacks appeared
every evening as soon as she lay down, lasting several
hours and returning again toward morning. Upon ques-
tioning it was ascertained that she was troubled with
large numbers of ascarides in the rectum and vagina.
Vaginal and rectal injections of a bichloride of mercury
solution were ordered, and in five days the attacks had
wholly ceased. They returned once again upon the re-
appearance of the worms, but ceased after a few injec-
tions, and have never since troubled her.
Cystic Tu.mors of the Tongue. — Dr. Clehe divides
lingual cysts into four varieties, viz. : serous, mucous,
hydatid, and dermoid cysts. The serous tumors are
situated ordinarily on the under surface and at the base
of the tongue. They contain a clear, transparent fluid,
and are lined u|5on their inner surface with pavement
epithelium. The mucous cysts are found in the situation
of the mucous glands, at the tip, sides, and between the
tonsils. They contain a stringy fluid with crystals of
cholesterin. Hydatid cysts (cysticerci, echinococci)
are developed in any part of the tongue. Dermoid cysts
are very rare and are always found in the median line of
the organ. These are formed by a pushing forward of
the blastoderm through the branchial fissure. Serous
cysts arise from erectile tumors or from retained secre-
tioiL Mucous tumors are of inflammatory origin caused
by my.\angoitis leading to partial obliteration of the
ducts. Severe symptoms arise only from inflammation
of the sac. Hydatid tumors are the only ones that
attain any considerable size, the others remain small and
only interfere slightly with speech and mastication.
They are always chronic in their course. The treat-
ment of all forms of lingual cysts is the same. It con-
sists either in transfixion by a piece of silk, which is left
in situ and causes suppuration, in puncture, with or
without subsequent injection of an irritating fluid, or in
partial or total extirpation. Dr. Gohe prefers the latter
procedure as being the least likely to cause trouble and
the most radical. — Ceniralbl. fur Chirursie, lune 27
1883. •"
The Clay-Colored Stools in Jaundice. — Professor
Gerhardt states that the clay-colored stools in icterus
contain a great number of needle-shaped crystals ar-
ranged in bundles. Sometimes the quantity of crystals
is so great that the fecal mass seems to be in great part
made up of them. Their shape is suggestive of tyrosin,
but mixed with the needle-shaped crystals here and there
are little spheres resetnbling leucin. The fasces, when
stirred up with water, settle in four layers. The upper
layer is tiiin, milk-white, and consists almost wholly of
fat (Irops. The three other layers (flaky, watery, and
sediinentitious) contain the crystals in nearly eijual pro-
portion. Some of the clinical tests also show the
presence of tyrosin. Since only colorless stools contain
these crystals, there can be no doubt that their presence
is in some way connected with icterus. But whether it
is due to the continued action of the gastric juice in the
intestines, or to the action or non-action of the pancreatic
juice without the addition of bile, or whether it is a result
of the decomposition of the ingesta in the intestine, are
questions which the author leaves unanswered. He also
suggests, without deciding the question, that this quan-
tity of tyrosin in the intestine may be accountable for
the appearance of the same substance in the urine. The
white or whitish gray color of the stools proceeds from
the presence of either fat or these tyrosin crystals. —
Deutsche Medicitial-Zeitung, July 5, 1883.
Treatment of Wounds of the Bladder. — Dr. Jul-
liard had the misfortune to make a rent nearly five inches
long in the posterior wall of the bladder, while breaking
up adhesions during an ovariotomy. Fifteen sutures
were inserted, and the wound healed by first intention.
The two serous surfaces were brought into apposition,
care being taken not to include the mucous membrane,
so as to avoid infiltration of urine alongside the threads
into the connective tissue. Cat-gut sutures were em-
ployed, and a catheter was left in the bladder, so as to en-
sure perfect drainage of urine, and thus avoid any stretch-
ing asunder of the edges of the wound. — Centi alhlaft fijr
Gyndko/ogie, July 7, 1883.
Treatment of Erysipelas. — In four cases of ery-
sipelas Dr. Bogusch employed hypodermic injections of
resorcine in a five per cent, aqueous solution. The in-
jections were made along the border of the erysipelatous
part, at a distance of about three lines from each other,
the point of the needle being directed toward tlie dis-
eased spot. In each case from thirty to seventy injec-
tions were made, and no other treatment was resorted to.
The temperature fell rapidly and the spread of the dis-
ease was arrested. Dr. Tusbin employed hypodermics
of bichlorhydrate of quinine in five cases of erysipelas.
One or two injections sufficed. The reddened parts
were painted with camphorated and carbolized oil. He
never observed any ill effects to follow the injections,
though others have reported numerous abscesses and in-
durations. This double salt of quinine, apart from its
great solubility, is therapeutically in no way superior to
the sulphate. — Lyon Midical, June 17, 1883.
Dietetic Tre.\tment of Nutritive Disorders in
Infants. — Dr. Biedert has treated a number of cases of
infantile digestive disorders without drugs, by means of a
strict regulation of the diet. The diseases thus treated
were dyspepsia and dyspeptic diarrhoea, chronic catarrh,
extreme atrophy (tabes meseraica), ulcerative enteritis,
cholera infantum, and one case of supjjosed epidemic
dysentery. The children were most carefiilly watched,
and the greatest care observed in carrying out the minute
details of treatment. From the results obtained the
author feels himself justified in recording the following
deductions (Centralblaii fiir Klinische Medicin, June 16,
1883) : 1. A surprisingly large number of gastro-enteric
disorders in infants stand in such close relation with the
quality and insufficient (juantity of food, that the diseases,
even in the most serious cases, may be cured solely by the
administration of a suitable diet. 2. The quantity of food
given is of the greatest moment. 3. The nourishment must
often be given in greatly diluted form. 4. The propor-
tion of albumen to fat plays an important role. The
digestion of albumen is facilitated by mixing it with a
much larger proportion of emulsionized fat than is found
in cow's milk — that contained in human milk being the
proper amount. 5. It should not be forgotten that at
times there is a diminished absorption of fat, in which
case it should be greatly reduced in amount, or, in order
not to interfere with the digestion of albumen, slightly
reduced to a proportion midway between that of human
milk and cow's milk.
August i8, 1883.]
THE MEDICAL RECORD.
185
The Medical Record
A Weekly Joiirnal of Medicine and Surgery.
GEORGE F. SHRADY, A.M., M.D., Editor.
Published by
WM. WOOD &. Co., Nos. 56 and 58 Lafayette Place.
New York, August 18, 1883.
PROGRESS IN THE REGULATION OF MEDI-
CAL PRACTICE.
The reports of the quarterly meetings of the lUinois
State Board of Health generally furnish some interest-
ing reading. The last report, covering the meeting of
June 29, was no exception ; and we give here some of
the facts which were there presented, since they have
much more than a local interest.
It appears that during the last quarter, certificates to
practise medicine and surgery have been given to one
hundred and ninety-two persons, while twenty-eight ap-
plications were refused. These latter applications were
chiefly from "cancer-doctors" and from "natural physi-
cians," one of whom wished "to travel through several
States in order to cure their diseases, such as tape-worms,
diseases of the stomach, skin, etc."
The secretary states that the resolution previously
made to recognize the diplomas of the Indiana Eclectic
College is likely to be revoked, owing to doubts about
that college's honesty.
Measures are being adopted for the securing one
common E.\amining Board on preliminary education for
all the medical schools of Chicago. This would be a
step forward which is to be greatly desired, and which
should be attempted in other States.
An effort was made during the past quarter to secure
the passage of a law which would get rid of advertising
and lecturing quacks. Tlie following bill was drawn up,
and we insert it here :
" I. Be it enacted : That it shall be unlawful for any
person or persons, professing to heal the sick or to re-
move deformities, to publish or otherwise set forth in the
State of Illinois their powers, promises, or claims by any
advertisement, card, circular, hand-bill, pamphlet, book,
writing or lecture in the manner usual to the chronic or
private disease specialist, or to solicit practice by agents
or otherwise, in any but the ordinary methods of reputa-
ble physicians.
" 2. That it shall be unlawful for any person or persons
to furnish or sell, or to advertise for sale, any instrument,
appliance, apparatus, drug, nostrum, operation, or other
device, for the prevention of conception, for the procur-
ing of abortion, or for any other criminal or immoral
purpose.
" 3. That each and every violation of this act, in any
of its provisions, shall be punished by a fine of not less
than fifty dollars nor more than five hundred dollars, or
by imprisonment in a county jail for a period of not less
than thirty days nor more than three hundred and si.xty-
five days, or by both such fine and imprisonment."
The bill passed to its second reading, and would prob-
ably have become a law if the I.,egislature had not ad-
journed sooner than was expected.
The class of persons whom it was intended to affect is
well shown by the specimen letter which the secretary
received from a correspondent in Farina, 111. :
" Sir — Our village was visited a few days ago by a
' specialist ' from Indiana calling himself Dr. Pickett. He
came here to sell -marriage guides,' etc., and to give
private lectures. He was also a pretended piirenologist
and gave charts. His private lectures were given to men
and women separately, and in his last lecture he ofTered
for sale a recipe or appliance of some kind which he
warranted to 'prevent conception.'"
Dr. Rauch also reports the unearthing of another di-
ploma mill. It is situated in the beautiful city of Mil-
waukee, Wis., and is called the " Milwaukee College of
Medicine and Surgery." It claims to be legally incor-
porated, but it grants diplomas after attendance upon
one course of lectures.
The re))oit concludes with various facts regarding the
existence and prevention of contagious diseases in the
State.
HOW TO MAKE PHOTOGRAPHS EASILY AND CHEAPLY.
Until recently medical men who wished to have a pic-
torial record of important cases were to a greater or less
degree prevented by jjersonal inability, or incidental in-
conveniences.' Photography by means of the "dry
plate " has placed within the reach of the profession the
means of securing a picture of any case, and this with
but small outlay for apparatus and materials.
An outfit for taking photographs four by five inches
can be purchased for ten dollars, and by substituting an
imitation Dallmeyer lens for that of the outfit the ex-
pense need not much exceed fifteen dollars.
With such an apparatus pictures can be obtained
amply sufficient for the record of cases.
Dry plates can be bought by the dozen, kept for any
length of time before and after exposure, and developed
at leisure.
A dark room for developing the plates can be extem-
porized by any dark closet, or in default of that, the
operation can be performed by night. The light in the
dark room must be non-actinic, and is secured by a
lantern with red glass.
Photographic dealers supply a small manual giving all
of the details. They are, in brief, as follows : The case
is properly focussed on the ground glass of the camera,
which is then replaced by a slide containing the plate.
The lens is uncapped for a few seconds, and as far as
the patient is concerned the process is finished. At this
stage the dry plate may be sent to a photographer for
development and printing ; but if not, and preferably
not, it is taken to the dark room, placed in a pan, and a
solution of oxalate of iron poured over it. When the
picture conies out sufficiently, it is washed with a few-
changes of water and placed in another pan containing
hyposulphite of soda.
' How to Make Photographs : a Manual for Amateurs. By 'I. C. Roche,
edited by H. T. .'Anthony. Illuitrated. New York : E. & .H. T.; Anthony.&
Co., 591 Broadway, 1883.
i86
THE MEDICAL RECORD.
[August i8, 1883.
The hyposulphite dissolves off the undecomposed bro-
mide of silver, and " fixes " or renders permanent the
•image. The negative thus produced will yield an in-
definite number of pictures by the printing process.
Prixtin'g. — Silver : A strip of sensitized silver paper
is placed on the negative in a printing frame and exposed
to the light. It is then soaked in a solution of chloride
of gold, or "toned," and finally "fixed" by placing it
for a few minutes in hyposulphite of soda solution. It
then appears as the conventional photograph. Cyano-
types, or blue prints, will serve for many purposes as well
as silver prints, and can be made much easier. Any paper
can be coated with a solution containing one part of
ammonia citrate of iron, one part red prussiate of potash,
and eight of water, dried and exposed as in the former
case. Tlie resulting print need only be soaked in plain
water, when it appears as a bright blue.
Glass positives or transparencies are made by expo-
sure in the printing frame and developed in a manner
similar to the dry plates. They can then be used in the
n)agic-lantern. It is important in photographing a case
to have the subject properly lighted. This can best be
done by placing the sitter at a window having a full view
of the sky. There will then be too high a light on the
window side. But by means of a sheet of white wrapping
paper as a reflector, the light can be so proportioned as
to make an exceedingly good picture.
Micro-photography. — Some excellent micro-photo-
graphs have been made by medical men. The same prin-
ciples are involved in their production as in the ordinary
photograph. The source of light may be a kerosene
lamp, so arranged as to illuminate the microscopic slide
by means of a bull's-eye condenser. Those who are in-
terested in the subject can find an excellent article by
Dr. R. L. Maddox, in The British Journal of Photo-
graphy Almanac for i88j.
There yet remains an interesting point to consider in
regard to the subject of photography by medical men,
and that is as a recreation.
It can be asserted with confidence that there are few
pursuits which may yield more agreeable recreation to
the average professional man than the practice of pho-
tography. There is a peculiar fascination in placing the
white exposed plate in the developing pan and watching
the picture resolve itself out of nothing. It is akin to
magic and loses nothing of its interest by repetition. By
means of instantaneous plates the infant smile can be
registered, and thus the ))ersonal interest of the operator
can be extended to other members of the family. Country
practitioners and those spending vacations in the country
can bring back with them any pleasing landscape that
may come under their observation.
It may be said, finally, that photographic amateurs as a
rule never lose their interest, mainly for the reason that
there are so many unsolved subjects which offer means
of unlimited study.
WATER FOR INFANTS.
With the exception of tuberculosis, no disease is so
fatal in infancy as the intestinal catarrh of infancy, oc-
curring especially during the hot summer niontlis, and
■caused, in the great majority of cases, by improp^'r diet.
J'herc are many uijon whom the idea does nol^secni to
have impressed itself that an infant can be thirsty with-
out, at the same time, being hungry. When milk, the
chief food of infants, is given in excess, acid fermenta-
tion results, causing vomiting, diarrhoea, with passage of
green or greenish-yellow stools, elevated temperature,
and the subsequent train of symptoms which are too fa-
miliar to need repetition. The same thing would occur
in an adult if drenched with milk. The infant needs,
not food, but drink. The recommendations of some
writers, that barley-water or gum-water be given to the
little patients in these cases, is sufficient explanation of
their want of success in treating this affection. PurQ
water is perfectly innocuous to infants, and it is difficult
to conceive how the seeming prejudice against it ever
arose. Any one who Uas ever noticed the avidity with
which a fretful sick infant drinks water, and marks the
early abatement of febrile and other symptoms, will be
convinced that water, as a beverage, a quencher of
thirst, as a physiological necessity, in fact, should not be
denied to the helpless members of society. We have
often seen an infant which had been dosed ad nauseum
for gastro-intestinal irritability, assume, almost at once,
a more cheerful appearance and rapidly grow better when
treated to the much needed draught of water. If any
one prescription is valuable enough to be used as routine
practice it is — " Give the babies water."
HABITUAL NOSE-BLEEDING AND ITS TRE.^TMENT.
Clinically we may classify attacks of nose-bleeding
under three heads : There are, first, the accidental and
incidental attacks, which are common to all ; second,
there are the frequent and severe attacks which are liable
to occur in cases of hsmalophilia, leucasmia, scurvy,
morbus maculosus, etc., and in local disturbances where
there are polypi, vascular hypertrophies, etc. But, be-
sides these, there are cases, and every practitioner sees
them, where the patient suffers for years from attacks of
nose-bleed, and where no especial constitutional or local
cause seems to be present. A number of German ob-
servers have been studying this condition, and recently
Dr. O. Chiari gives in the Wiener Medicinische Zeitung
a summary of their opinions, with some conclusions of
his own. These latter are founded upon considerable
personal study and have a practical bearing, so that we
venture to present them here. Dr. Chiari believes that
in most cases of what he terms " habitual nose-bleed,"
not dependent on injuries, catarrhs, polypi, etc., the
hemorrhage comes from a circumscribed locality in the
nose, which can generally be seen and reached. He
has studied the history of twelve cases of nose-bleed,
nine of the patients male and three female ; most of them
were young, the age varying between fifteen and twenty
years. All had suffered from epistaxis for a series of
years. The attacks occurred sometimes daily for a
period, in other cases weekly or monthly. They differed
in violence ; in some cases being slight, in others alarm-
ingly persistent. All the patients suffered from their
trouble, there being such symptoms as headache, weak-
ness, auivmia, mental annoyance, etc. The attacks were
sometimes brought on by sneezing, blowing the nose, or
slight mechanical violence ; but oftener they occurred
spontaneously, and sometimes even during sleep. In two
cases only did the hemorrhage come from both nostrils.
August 1 8, 1883.1
THE MEDICAL RECORD.
187
Now Chiari states that in all his cases the source of
the bleeding was a circumscribed spot, generally about
the size of a millet-seed, which could be seen on the car-
tilaginous septum near its junction with the bony septum.
By pressure upon this point bleeding could be stopped.
He directed treatment to this point alone, applying gen-
erally the galvano-cautery, but sometimes the lunar caus-
tic. Five cases were cured positively ; five more did not
return to his clinic ; two were improved.
The position of tlie bleeding-point upon the nasal sep-
tum was confirmed by Hartniann's observations, and
Chiari states that in twenty-two out of twenty-five obser-
vations it was found there. The ease with which the
hcmorriiage is controlled by properly applied compres-
sion, and the possibility of curing the trouble, make the
observations of Chiari of especial interest.
DR. RUSSEL'S PAPER ON MALARIA.
Within a few years malaria has become a bugbear, so to
speak, in the Middle and Eastern States. Unlike other
zymotic troubles in our vicinity, it is always with us on
Manhattan Island and its surrounding regions. But its
gradual and uninterrupted march into Connecticut and
Massachusetts of late years, with entire disregard for
those local conditions formerly considered as essential
factors in its development, has led to renewed investiga-
tions into its causes and peculiarities. Therefore every
contribution to such studies must possess a special value.
For this reason we call attention to the article by Dr.
Charles P. Russel in the present number of The Med-
ical Record. Dr. Russell is well recognized as an au-
thority in matters of vital statistics, hygiene, and public
health, and his views upon so interesting a branch of
these subjects should command attention, notwithstand-
ing that they seem to be in conflict with the traditional
ideas of the profession, and even with the important dis-
coveries, alleged to have been made more lately, of spe-
cific disease-germs.
Without in any manner endorsing Dr. Russel's opin-
ions, we must acknowledge that they are supported by
those of many other well-known medical men.
The Victim of Irregular Practice. — An inquest
was held, July 26th, in the case of a woman who had died
suddenly on July 17th. The jury found that death re-
sulted from septicaemia, and e.xpressed the opinion that
it is the duty of the authorities to protect the public
against unauthorized practitioners of medicine. Deceased
was attended by Edward R. Duffy, who has had consider-
able practice but who calls himself a student of medicine.
Dufi'y is not registered with the Health Department.
Obstetric Progress. — In a discussion by the Ob-
stetrical Society of Washington on the induction of prem-
ature labor, one of the speakers remarked that he had
heard a professor of obstetrics tell his class that he " be-
lieved the time would come when fashionable women
would have their children at any time that suited their
convenience during the last four weeks of pregnancy."
What will the fossils who used to maintain that there was
such a thing as "meddlesome midwifery "_say to this? —
Obstetric Gazette.
%tms of tTic 'S^ccli.
The Cholera and Yellow Fever. — The meagre
reports received at Washington during the past week
would indicate that neither yellow fever nor cholera has
made any progress toward obtaining a footing in the
United States since our last issue of The Record. The
two yellow-fever ships in quarantine at the Capes — " Cape
Charles quarantine station " — are i eported by Surgeon
Henry Smith, of the Marine Hospital Service, as clean
and free from disease, the Andeau ready to take on a
cargo, and the California only waiting for supplies before
sailing for Liverpool. There are no infected vessels at
the Pensacola or Mississippi quarantine stations, all such
vessels having been sent to Ship Island, where they are
undergoing the cleansing process necessary for their puri-
fication. The reported escape of two men from Ship
Island has been officially denied, Passed-Assistant-Sur-
geon John Godfrey stating that they were from Cat Island
and had never been in quarantine at that station. In
fact, the crews of all vessels in quarantine, as well as all
employees of the various stations, are mustered twice
each day, so that escapes are difficult and would be dis-
covered in a few hours. Before ships are permitted to
leave quarantine their masters are furnished with a " dis-
charge certificate " as follows :
" This is to certify that has been
discharged from quarantine witii permission to proceed
to sea or port of destination. In my professional opinion
no danger need be apprehended in allowing said vessel
to discharge her cargo or ballast and reload for sea. But
in no case will this certificate be held to allow the entry
of any vessel until after examination and permission of
the local quarantine authorities.
Surgeon U. S. M. H. S., in charge.
A weekly report of vessels remaining, arriving at, and
departing from the various quarantine stations is made
to the Surgeon-General. This report gives the name of
the vessel, date of arrival, where from, destination, cargo,
condition of vessel, condition of cargo, number and sani-
tary condition of crew, number and sanitary condition of
passengers, disease, number of cases, number of deaths,
treatment of vessel and cargo at quarantine, date of de-
parture of vessel from quarantine, and remarks. This
report is signed by the officer in charge and forwarded
weekly to the Surgeon-General's office. .\t foreign ports
the sanitary inspectors, in addition to forwarding cable
messages upon the departure of infected or suspected
vessels, are required to send weekly abstracts of bills ot
health issued to all vessels bound to United States ports.
These abstracts show the number of bill of health, date,
name of vessel and rig, destination, sanitary condition of
vessel, sanitary condition of cargo, sanitary condition of
crew, sanitary condition of passengers, sanitary condition
of port, and remarks. Under " remarks " a statement is
made whether vessel had been at an infected dock, num-
ber of hours or days in port, and such other facts as may
be of importance. At the bottom of the blank are spaces
for showing the number of deaths from yellow fever,
cholera, and small-pox during the week. This blank is
1 88
THE MEDICAL RECORD.
[August i8, 1883.
signed by the sanitary inspector of the Marine Hospital
Service and forwarded weekly to the Surgeon-General.
Despatches from Vera Cruz of the 3d inst. state that
the steamship City of Puebla sailed from that port for
New York, and the steamship Statesman for Brazos on
that day. Also despatch from Havana the 6th gives
notice that the steamer Amethyst left four cases of yel-
low fever at that port, and sailed for Boston on the 4th.
A barque arrived at Washington docks, Sunday last, di-
rect from Trinidad, but had no sickness on board. She
was spoken at the mouth of the Chesapeake, down at the
Capes, and permitted to come up, as she was healthy and
loaded with asphalt.
The Consul-General at Cairo, Egypt, in an official
letter to the Secretary of State under date of July 5,
1883, reports that cholera had broken out in a few ad-
jacent towns, the fact being first made public on June
20th, when it prevailed so extensively in the town of
Damietta, a place of thirty-five thousand inhabitants,
that concealment was no longer possible. The disease
was officially pronounced true Asiatic cholera, but its
source unknown. The general belief among the more
intelligent citizens, including many physicians, was that
it originated in Damietta, and resulted from the lack of
proper sanitary regulations in that province. It apjjears
that many cattle have been dying of late with a disease
resembling epizootic ; that their carcases were thrown
into the Nile and adjacent canals leading into it ; that
the poor people fed upon these diseased animals and un-
ripe fruit, and that cholera broke out among them from
this cause. He further states that the towns of Man-
sura, Serbin, and Samanoud are similarly afflicted, but
that the Egyptian Government is actively engaged in
staying the epidemic by establishing sanitary cordons
about the infected districts by competent officials, with
every hope of arresting the disease.
On the other hand, the Consul at Smyrna, under date
of July 13th, claims that the disease in Damietta is not
Asiatic cholera, but is some other disease and is due to
the unsanitary condition of the province. Be this as it
may, the fact that it is not confined to Damietta, that it
is gradually e.xtending its area, and that the well-fed, well-
cared-for British troops are among the sufferers, gives us
every reason to regard the disease as a dangerous visitor
and one that should be kept out of the country.
A letter from C. E. O'Hara, treasurer of the " Seymour
Paper Co.," of New York, was received by Surgeon-
General Hamilton recently, saying, " The problem with
us is the future of the Alexandria (Egypt) rag business.
We shall buy no rags for a long time to come, but what
is the limit of time when it will be safe to move the rags to
a market. An opinion from you on this point would be
valuable, but I presume you are not prepared to give it.
I have thought the matter over and can see no light. It
may be of interest to you to know that five thousand
to six thousand fo/ts of rags are exported annually from
Egypt, and nearly all come to the Lfnited States. . . .
Of course all these rags must be i)ut under the ban be-
cause a small portion, perhaps a ton, may be infected.
If there is no outlet for them, most of them will be saved
until the markets are open, and why not the infected
with the others ? The true remedy would be for the
Egyptian Government to have the entire stock burned
(paying for them first) ; but they won't do this, as it will
benefit only the people of other countries, we may sa\
England and the United States only, no other nations
using more rags than they produce."
Surgeon-General Hamilton suggested dumping all rags
into chlorine vats at Alexandria, before shipment, this of
course would necessitate the presence of a trusted officer
of this Government to see that the work was properly
done. It is obvious no limit of time could be fixed when
rags gathered in an infected country could be safely re-
ceived into the United States.
(Dbituavri.
JACOB S. MOSHER, M.D.,
ALBANY, N. Y. i
Dr. Jacob S. Mosher, a distinguished physician of Al-
bany, N. Y., was found dead in his bed on Monday
morning last. Around him lay books and papers, and
the lamp above his head was still burning. Death was
evidently sudden, painless, and without a struggle.
He was born in Coeymans, I^farch 19, 1834. He
graduated at Rutgers College in 1853, and had the de-
gree of Master of Arts from that Institution. He entered
the Albany Medical College, from which he received the
degree of Doctor of Medicine in 1S63. Early in the en-
suing year he entered the corps of volunteer surgeons
for New York troops, and was attached to the Army of
the Potomac as it lay before Petersburg. He was sub-
sequently made Assistant State Medical Director of the
State of New York, and went on duty at Washington.
From 1869 to 1873 he was Surgeon-General on the staff"
of Governor Hoffman. Since graduating, Dr. Mosher
settled at Albany, where he practised, except from 1870 to
1876, during which time he was Deputy Health Officer of
the port of New York, first under Dr. Carnochan, and after-
ward under Dr. Vanderpoel. At the expiration of his
term of office he spent a short time in England. Then
he returned to Albany, and since that tim has attended
to a large and remunerative practice, lie became a
valued member of the Albany County Medical Society,
and was its President prior to Dr. N. L. Snow, the pres-
ent incumbent.
In the hospitals of Albany he was a faithful worker.
So, too, it was with the Albany Medical College, of
which for several years he was the right-hand man. He
was Dean of the College of Pharmacy, of which he was
one of the originators, and was President of the Alumni
of the Albany Medical College.
Since 1866 he has been a member of the Board of
Trustees of the State Normal School, and has fulfilled
his duties with his usual care and thoroughness. He was
also a Trustee of the Albany Female Academy. In 1878
or '79 he was President of the Young Men's Association.
At the time of his death he was President of the Local
Board of Health.
Dr. Mosher was literary in his tastes and had collected
a fine library. His fancy ran toward engravings and
etchings, of which he had a great many, and his judgment
in regard to them was considered excellent. One of his
" hobbies," as he once told the writer, was epics, and of
the great religious poems of all ages and all countries he
sought to have the best and choicest editions. In every
respect he was a man of culture and refinement.
Dr. Mosher was married December 30, 1863, to Emma
S., daughter of Jesse Montgomery, of this city. She died
in 1879, leaving four sons and one daughter, who survive
their parents. The oldest, "Monte," as he is called, is
a student in Union College.
Dr. Mosher was a member of St. Paul's Episcopal
Church, a member of the Alpha Beta Kappa Society,
and also ranked high in the Masonic Order, belonging
to Master's Lodge No. 5.
August 1 8, 1883.]
THE MEDICAL RECORD.
189
^euicius muX Jlcitices.
A Practical Treatise on Impotence, Sterility, and
Allied Disorders of the Male Sexual Organs.
By Samuel W. Gross, A.M., M.D., Professor of the
Principles of Surgery and Clinical Surgery in the Jeffer-
' son Medical College, etc., etc. Second Edition, thor-
oughly revised. With sixteen Illustrations. 8vo, \>[>.
176. Philadelphia: Henry C. Lea's Son & Co. 1883.
Dr. Gross has been so long known to the profession
that this little work will derive value from the high stand-
ing of tiie author, aside from the fact of its passing so rap-
idly into its second edition. This is indeed a book that
every physician will be glad to place in his library, to be
read with profit to himself and, it may be, with incalcu-
lable benefit to the patient. Besides the subjects em-
braced in the title, and which are treated of in their
various forms and degrees, sjiermatorrhcea and prostat-
orrhtea are also fully considered. In regard to impotence
and spermatorrhcea, usually ascribed to functional causes,
the author considers these affections as due to reflex
disturbances of the genito-spinal centre, and that they
are almost invariably dependent upon some lesion of the
prostatic urethra. The work is, moreover, thoroughly
practical in character, and will be especially useful to the
general practitioner.
Handbook, for Hospitals. By the State Charities
Aid Association. i2mo, pp. 263. New York : G. P.
Putnam's Sons. 1883.
The present is the second edition of the above w^rk.
carefully revised and enlarged, in which all the general
and internal minutia; essential to hospital management
and discipline, vi/., the care of the sick, of the insane,
the institution itself, hygiene, disinfection, pauperism,
the distribution of public funds, and the establishment of
village hospitals and of isolated cottages for infectious
cases are presented, not only with completeness but
with interesting detail, which will prove of service to all
— the public at large as well as to the profession — who
are either directly or indirectly interested or engaged in
hospital work.
A Treatise on the Diseases of the Eve. By J. Soel-
berg Wells, F.R.C.S., Doctor of Medicine of the
University of Edinburgh ; Professor of Ophthalmology
in King's College, London, etc., etc. Fourth Amer-
ican from the Third English Edition, with copious ad-
ditions. Edited by Charles Stedman Bull, A.M., M.D.,
Lecturer on Ophthalmology in the Bellevue Hospital
Medical College ; Surgeon to the New York Eye and
Ear Infirmarv, etc. Illustrated with two hundred and
fiftv-seven engravings and six colored plates. To-
gether with selections from the test types of Professor
E. Jaeger and Professer H. Snellen. 8vo, pp. 846.
Philadelphia: Henry C. Lea's Son & Co. 1883.
The work of Dr. Wells is so well known throughout the
medical profession, that it scarcely needs especial com-
mendation. The present edition appears in less than
three years since the publication of the last American
edition, and although the original text is not very mate-
rially altered, yet, from the numerous recent investiga-
tions that have been made in this branch of medicine,
many changes and additions have been required to meet
the present scope of knowledge upon this subject. Hence
it may be well to mention in what respect this edition
ditlers from its predecessor. The chapter on Diseases
of the Lids is augmented by descriptions of Landolt's
Method of Blepharoplasty, and by the editor's Method of
Treatment of Depressed Scars of the Face. In Diseases
of the Conjunctiva, an entirely new section on Purulent
Conjunctivitis of New-born Children has been added,
together with one on Membranous Conjunctivitis. Diph-
theritic Conjunctivitis is also greatly increased by the
addition of new matter. Sattler's views on the nature
of Trachoma have also been added to the section on
Chronic Granular Conjunctivitis. Under Diseases of the
Iris and Ciliary Body, a new section has been inserted
on the Comparative Physiological and Therapeutical
Value of Mydriatics. Tire chapter on Sympathetic Oph-
thalmia has been enlarged, containing the discussion be-
fore the London International Medical Congress as to
the seat of the lesion being in the optic nerve, together
with the views of Mooren on the same topic ; also ad-
ditional notes upon the value of Optico-ciliary Neurot-
omy. The opinions of Priestley Smith and Brailey upon
the Nature and Causes of Glaucoma have been embodied
in the chapter on that subject. In the chapter on Dis-
eases of the Vitreous Humor, the value of the magnet in
the removal of particles of steel or iron from the eye re-
ceives greater consideration. The recent observations
of Hughlings-Jackson on Optic Neuritis in Intracranial
Disease are embraced in the chapter on Diseases of the
Optic Nerve. Valuable additions are also noticed in
Diseases of the Ocular Muscles. The editor's own
views are furthermore introduced in the various sections
throughout the work.
A -critical examination at once shows the fidelity and
thoroughness with which the editor has accomplished his
part of the work, and he is eminently deserving the
thanks of the profession. The illustrations throughout
are good. On the whole, this edition can be recommen-
ded to all as a complete treatise on diseases of the eye,
than which probably none better exists.
A Text-Book of General Pathological Anatomv
AND Pathogenesis. By Ernst Ziegler, Professor
of Pathological Anatomy in the University of Tubin-
gen. Translated and edited for English students by
Donald MacAlister, M.A., M.B., Member of the Royal
College of Physicians ; Medical Lecturer of St. John's
College, Cambridge. New York : William \Vood &
Co., 56 and 58 Lafayette Place. 1883.
This volume, containing 355 pages of reading matter,
with 117 illustrations, is a part of the work being written
by Professor Ziegler, and constitutes the seventh of the
series in Wood's Library for 1883. The established rep-
utation of the author places the work at once in the
catalogue of valuable contributions to recent medical
literature. It exhibits strongly the personality of the
writer, a feature worthy of special commendation. Pro-
fessor Ziegler advocates doctrines which may not be
readily accepted, but they are not unreasonable, and it
should not be argued, because of the difference of opinion
on certain technical iioints, that his conclusions are ne-
cessarily faulty. They are given concisely and indepen-
dently, and, by reason of their possessing these charac-
teristics, are additional material worthy of careful study
and comparison. To facilitate such work the translator
and editor has, in an acceptable manner, given in brack-
ets the views entertained by many of the most eminent
observers on the points where Ziegler has advanced new
theories. TJ.-e translation seems to have been done
well, and the annotations make an important part of the
book. As a whole, the volume is another excellent one
in the series for 18S3. The second part — on Special
Pathological Anatomy— is in course of publication in
Germany.
The Medical Register of New York, New Jersey,
and Connecticut, for the Year ending June i, 1883.
William T.White, M.D., Editor. New York : G.
P. Putnam's Sons. 1883.
This annual volume presents its usual appearance, and
is under its usual able editorial management. It contains
the names of 5,969 physicians, distributed in the States
of New York, New Jersey, and Connecticut. The New
York City list contains 1,661 names, forty more than last
year.
For a long period this book has been accepted as an
authoritative register of the regular profession of New
190
THE MEDICAL RECORD.
[August 1 8, 1883.
York, New Jersey, and Connecticut, and in order to
maintain such a reputation the greatest care should be
taken on the part of editor and co-laborers to make it
accurate and impartial. We notice one or two omissions
in this regard, which, it is to be hoped, are simply acci-
dental ; otherwise the work is everything it should be.
The Bacteria. By T. j. I!urrii-i,, Ph.D., of Spring-
field, 111.
This is the title of a pamphlet giving a complete but
concise account of the nature, kinds, and effects of the
different bacteria. It is the best monograyjh on the sub-
ject we have seen, and is highly creditable to American
science.
Medical Econo.mv During the Middle .^ges : A
Contribution to the Historvof European Morals, from
the Time of the Roman Empire to the Close of the
Eourteenth Century. By George F. Fort. New
York : J. W. Bouton. London : B. Quaritch. 1883.
Under the above somewhat delusive title, the author
has written a kind of history of medicine. It is
called "Medical Economy," because it deals with med-
icine more especially in its relation to law and society.
As the full title shows, the book covers more than the
middle ages. It takes up medicine at the time of the
Ptolemies, traces the growth of the Ale.xandrian and
Roman schools, and subsequently the progress of
medicine down to the fourteenth century. The book
shows a vast deal of erudition and research, if one may
judge by the numerous references. It is not w'ritten,
however, in so coherent and attractive a manner as it
might be. In fact Mr. Fort has a bad literary style. There
is a great deal in it, however, that physicians will find
curious and interesting. Typographically the book is an
excellent specimen of English work.
The Sanitary Engineer, Vol. VII. 4to, pj). 620. Xew
York : Henry C. Meyer. 1S83.
The seventh volume of The Sanitary Engineer in-
cludes the twenty-si.\ weekly issues from December 7,
1S82, to May 31, 1883. Among the articles of perma-
nent value may be mentioned " Letters to a Young
Architect on Heating and Ventilation,' by Dr. J. S.
Billings, U.S.A.; "Steam Fitting and Steam Heating,"
by "Therinus" (a series — illustrated); "The Edison
System of Wiring Buildings for the Electric Light"
(illustrated) ; illustrated descriptions of the sanitary ar-
rangements in the residences of Cornelius ^'anderbilt,
Esq., the Berkshire .Apartment House, Home for .\ged
Females, and the Duncan Office Building ; " The
Steam Heating Companies in New York " (illustrated
description of); full abstract, with illustrations, of the
records in the McCloskey Patent Suit for Trap \'entila-
tion ; " The New York Water .Supply," a series of
articles on the suppression of waste of water, giving the
experience of European cities in attemi)ting to deal with
this problem, the practice now in vogue there, and the
situation in American cities — these articles will be
found of great value to water works authorities and all
who are interested in this question ; a discussion of
the various projects for increasing the water supjily
of New York, including the Croton Aqueduct scheme,
ai)pears in almost every number in this volume ; " .At-
lantic Coast Resorts," a rej^ort by E. W. Bowditch, C.E.,
to the National Board of Health ; " National Hoard of
Health," Congressional Debates on the ; " How the
Plumbing Law is Enforced in New York," a description
of the methods employed by the department ; " Germs
and Epidemics,'' by Dr. John S. Billings, U.S..\. ;
♦' Malaria " (a series), by (jeorge M. Sternberg, Sur-
geon U.S.A. ; "Lead Burning," ajjparatus and process
described ; " Gas-Fitting in an Office Building,' de-
scription of work in Afills Building ; " American Prac-
tice in Warming Buildings by Steam," by the late Robert
Briggs, M. Inst. C.E. ; a paper read before the Insti-
tution.
There is also the current information of the operation
of the food adulteration laws ; record of rulings and pro-
secutions, and copies of laws. The weekly and monthly
mortality table of the principal cities of the United
States, together with a large amount of home and for-
eign health notes.
OToiTcspcincTcncc.
COPPER AND CHOLERA.
To THE Editor of The Medical Record.
Sir : The occurrence of a case of cholera in London
makes the tliree thousand miles of Atlantic Ocean be-
tween it and New York seem but a slight barrier. The
apprehension already felt since its appearance on the
shores of the Mediteranean is at once increased. It is a
scourge, according to the Tribune, \\\\\z\\ "has defied the
medical science of the present century." It is true that
the epitaph of many victims might read, "physicians'
skill was vain;" nevertheless may it not be said that it
has saved many others ?
Incidentally the Paris correspondent of The Record
of July 7th has referred to a part of Dr. Burq's theory
in regard to the use of copper in cholera, that of giving
it internally. Slight, if any, mention is made of it in
the treatment of cholera as set forth in text-books, ency-
clopedias, and general works of medicine, although it is
now more than thirty years since Dr. Burq has advocated
it and regarded it as a valuable, if not an unfailing rem-
edy."
In his experiments with copper in 1S48, at which time
he made the discoveries which led to the introduction
into medicine of the external and internal use of metals
as therapeutical agents, he found that copper was effica-
cious in allaying spasms ; from this, coupled with the
fact that workers in that metal almost always experience
an immunity from cholera, he obtained the idea of using
it in the severe cramps of that disease in the epidemic of
1S49. His treatment consisted in placing plaques or
disks of copper over the stomach as well as the internal
administration of the sulphate.'
Rostan, in his " Lemons Clinique sur le Cholera," says
that the use of the copper armatures was almost always
attended with success.'
The fact that the copper workers escaped cholera is
recognized in Paris by chefs of that industry : scientists
and savants of France, Italy, Sweden, and Russia. It
was confirmed by the results of the investigations of the
prefecture of the police after the epidemic of 1865-66,
as well as by the reports of M. Levy in 1S67, M. Ver-
nois, in 1869 and 1874.
Dr. Panchon says that an impregnation of the system
with the dust of copper obtained by workers in it has in-
sured an immunity in all the epidemics of cholera, a
preservation not less certain than vaccination in small-
pox.
It might be added, in passing, that artizans in these
metals also escape typhoid fever. A society of bronze-
workers, during a period of thirty-six years, lost no mem-
ber from typhoid fever. In the epidemic of this disease
in 1876, only two deaths occurred among thirty thousand
workers in coi)per, and it was a noteworthy fact that
these two had to do only with large pieces.
It has not been recorded, so far as 1 am aware, that
insufflation of copper-dust has been practised as a pro-
phylactic measure in cholera epidemics; but Dr. E. Mail-
het,*a physician in the East, having read Dr. Burcj's arti-
cles on the use of copper in cholera, when an epidemic
broke out near where he was stationed, caused belts of
the metal to be worn over the abdomen as a preventive
1 Dcs Origtncs de la Metollotherapic. Oa2. dcs. Hop., tSSz, p. 532.
3 Ibid., November, 1849.
[bid.. Avril. 1880, p. 299. Compt. Rend. d. .Soc. Hiol.. 1879.
b-. Mailhct: Cholini rt Eiiiploir ilu Cuivrc ; G.-IZ. des Hop., 1877.
" Ibid
* E
August 1 8, 1883.]
THE MEDICAL RECORD.
191
measure. Six hundred ])ersoiis were thus fortified. In an
adult population of three thousand, one hundred weic
attacked with cholera and cholerine, but not one of those
who wore the copper plaques were among the number,
nor was any old woman who wore a s iiall scapiilaiie of
copper of the dimensions of half a franc.
These facts and results are certainly very suggestive,
and deserve more consideration than they have received,
judging from the little that has been said or written about
them. Perchance the very simplicity of the measure has
caused it to be overlooked or set aside as contrasting too
niarked'y with the gravity of the disease.
(iRACE PeCKHAM, M.l).
5 I.lviNr.siiiN Place, N. V,
THE ELIZABETHAN DRAMATISTS AND
LATER POETS ON THE PRINCIPLES AND
PRACTICE OF PHYSIC.
'I'o THE Editor oi- The Medical Record.
Sir : It occurred to the writer that a brief compilation of
excerpts bearing (or seeming to bear) on medical prac-
tice, from the works of the dramatic contemporaries of
the great sovereign poet (those lesser lights around the
central sun), also those of some of the poets of the
seventeenth and eighteenth centuries, miglit be worthy
the attention of members of our profession. If it show
naught else, it will serve to make manifest how important
an element and factor physic has ever been both in life
and literature ; being, as it were, woven and immeshed
in the warp and woof of this our mortal life. Hence an
historic and literary, in addition to the intrinsic and
scientitic, interest attaches to medical practice. Fur-
thermore, unquestionably it is good for us as practition-
ers occasionally to step outside the exclusive boundaries
of the strictly scientific aspects of physic, and to regard
our art from other and different stand-i)oints. For medi-
cine (in its largest and most catholic sense) is so inter-
woven with human weal and woe, that it is as impossible
as it would be undesirable to separate it from the great
general currents of life and thought.
First comes great Mari.ow with his " nughty line : "
I. INSOM.NIA.
" So that for want of sleep and sustenance
My mind's distempered."
— Mari.ow : UdwarJ II.
2. I.NSAMTV.
■• yet they do act
•Sucli antic and such pretty htnaeies
'I"iiat s]>ite of sorrow they will make you smile."
— Df.kkick.
3. PV.K.MIA.
" conveys infection
Danijcrons to the heart."
— JiiH.N Fi.iyrcHEK ; I^nth/iil Slu-pliciJesi.
4. Sk.mi.ity and Lunacv.
' (jrows lunatic and cliildish for his
lon.
-'riio.MAS Kvi>.
5. AK'riiRIAl. .\N1> Ve.NAL ClKCUI.ATION.
" M) blootl flew out and back again as fast . .
— Bkaumont ani> Flktchkk : I'liiUiiley.
6. Dissection Rooms.
" For the) are able to putrify it, to infect a wliole region."
— MlbDI.ETON : yhn \\':Uh.
7. HVGIKNE.
" I'll walk to get inr an ajipetite ; 'tis liut a mile."
— Massingi.k.
8. S.\!^C;i:|NEOlS ClKCL:L.\ TIO.N.
■' What an elasticity in her veins and arteries."
— .Sir Rk hard Steele ; The Comljitt Cui/'l,-.
9. .-Adiposity.
, " E.xercise w ill keep me from being pursy."
— .Massinger: A A'nv IK.ii' lo /'■'.!-.
^ 10. SURtiERV.
■'Why, sir, there are above five hundred surgeons in town."
— Georgk Farquh,\r: liic ('oiisl,uit Couple
II. I'HVSIC.
"you have broke the patent meiticitie cliest. that was to keep
them all alive."— MoRT'ON : ^Speed the Plough.
(N.n. — 'J'his excerpt is interesting as being an early reference tu /<*/(«/ medicines!)
12. Lache.sts.
" I eat snakes, my lord, I cat snakes."
— DekkER; TheMouestW.
(N.B. — The homttiopaths have a remedy iheycall lachesis. supposed to he made
from serpent-poison ; and in the back towns nf Italy vi/ier-broth is still occasion-
ally used.)
13. CEI'IIAI.OTKII'SY.
"and offer luke-warm blood of new-born babes."
— M.\RLow ; Dr. Foustu^.
14. Botanic Physic.
" What herbs hast thou ? "—Middleton : The Wileh.
15. Pkegnancv.
, '^her niidwives, her nurses, her longings every hour."
— Ben Jonson : The .-\lehemhi.
16. AOfE-CAKE AMI .SpleNOTOMV.
"your spleen ; out with it,
I know you're like to burst."
— CiEO. FarqI'HAK: The Coustunt Couple.
17. ViNUM Ol'Il.
"and the opiate that brings me sleep."
— TlI. MORTON: Speed the /'lough.
18. Constipation.
" When will your costiveness have done, good madam ?•"
— Cartwrioht; 'J he Ordhniry.
19. Qi-At KERV.
me, like Mr. Wegg, occasion-
JOHN Case, a ciuack of James 11. 's tir
ally dropped into poetry. He [)ut the fo
Ify dropped into poetry. He [)ut the lollowing distich over his door,
b> means of which, it is said, he m.ade more money than ever Dryden
dill by all his poetry ;
" Within this place
Lives Doctor Case."
20. Lact.\tion f.t. " Botti.e-Babif-S. "
" When thou shalt breed thy child, nurse it with thine own paps."
— Marlow.
21. Al>OPLEXV.
" Flat on the ground and still as any stone,
A verv corpse, save yielding forth a breath."
— Thomas Sackvii.le (A. I). 1559)-
22. Ginseng (piiuit.x- t/uingue/olium).
" Here s, pnnnax too. My pan akes, I am sure, with kneeling down
to cut 'em."- Middleton': Jhe Witch.
( N B — I'his dni", on which Dr. Piffard, of New York, lately prepared a
valnible paper, is to-day, and lias been for centuries, the Chinese panacea. It
sells in Peking for its weight in gold.)
23. .Amaurosis.
"O dark, dark, dark, amid the blaze of noon."
— Milton : Samson .Agoitistes.
24. Pregnancy.
"I have heard that great-bellied women do long for things that are
rare and dainty."— Marlow.
25. lODOFOR.M AND ASAKCETID.V
'• your Stench it is broke forth "— JONSON : .-Mchemht.
26. Cinchona.
"And yet more medicinal is it than moly."— Milton : Comus.
27. Cardiac Hypertrophy.
" Into the solid heart "—Fletcher.
28. .AfTOPSY.
[Cadaver, log.)
"Yet send me back my heart and eyes."— JNO. DoNNE.
29. Mammary .Abscess.
" But why that bleeding bo.som ? "— PoPE.
30. LE^JCORRHCE.^.
^' it was a weakness in me,
But incident to all our se.\."
— Milton : Sarmoii .Igomstes.^
31. SVPHII.IS.
"He'll feel the weight of 't many a day."— Cowley.
32. Luxation of Lnferior Maxilla.
"with gaping moutii." — SpENSER.
33. Locomotor AtAXY.
" Obliquely waddling to tlie mark in view."— Pope : The Dunciad.
34. MORPHI.\ Si i.riiATE.
" the virtue of this magic dust."— MlI.ToN : Comus.
35. Ophthalmia Tarsi.
" Have you your ointments ? "—.MiI'OLETON : The Witch.
36. Anasarca.
" I fondly thought he could not live a year.
But now his dropsv's better.''
— INCHHAI.I) ; T.very Que Has ll:s I-.iull.
37. ACONITE.
" among the rest a small unsightly root
But of divine effect."— Milton.
192
THE MEDICAL RECORD.
[August 18, 1883.
38. Bronchitis.
'' and his cough,
Not the least chance for that to take him ofE" — Lnxhhaid.
39. PODAGKA.
" Sir Tristram Testy worn with age and gout.
Within all spleen, and flannel all without" — Ibid.
40. Be.\sti.y Remedies.
" Learn from the beasts the physic of the field." — Pope.
F. Kradxack, M.D.
211 East Eighty-sixth Street, N. V.
TAYLOR'S METHOD OF EXTRACTING CAT-
ARACT.
To the Editor of The Medical Record.
Sir : There has been much said and written of late in
reference to a new method of extraction of cataract, in
which the incision is made wholly within the cornea, and
without excision of the iris ; and there seems to be an
impression that Galezowski is the originator of this
method. As the meed should belong to him who has
really earned it, and especially for such a valuable con-
tribution to ophthalmic surgeiy, I draw your attention
to the fact that Dr. Charles liell Taylor, of Nottingham,
England, is the real originator of this operation.
In the London Medical Times and Gazette of Febru-
ary 12, 1876, it states that at a meeting of the Clinical
Society on January 28th of that year, under the head
of "A New Operation for Cataract," "Dr. Charles Bell
Taylor, of Nottingham, introduced patients who had
undergone extraction of cataract by a method which he
had adopted in favorable cases since 1865. The lens,
he said, was removed through a small flap, the base of
which occujsied a position about midway between the
horizontal diameter of the cornea and the corneo-scle-
rotic junction. The wound healed readily. There was
no subsequent astigmatism, and as there was no trace of
the operation a kw weeks after its performance, the
lower section, on account of its greater convenience, was
selected. The patients introduced were said to be av-
erage examples, had central and movable pupils, and all
trace of the operation was so completely effaced that it
was impossible to say whether the flap had been made
upward or downward, or that the patient had undergone
an operation.
'' Dr. Taylor stated that the highest amount of visual
acuity obtainable after extraction was secured in this
way, some of the patients declaring that they saw as
well as ever in their lives before."
Further on in the proceedings of the society, Dr. Tay-
lor took occasion to specify the kind of cases in which
the operation was performed without an iridectomy :
" Where the pupil dilated well under the influence of
atropia there should be no iridectomy. When tlie pupil
did not dilate well with atropia, and where there were
adhesions, or when it (the iris) became wounded during
the removal of the lens there should be an iridectomy."
Dr. Macnamara in discussing the cases of Dr. Taylor,
said : " the results of the operation were splendid." He
thought that excision of the iris was generally uncalled
for in the extraction of cataract, certainly in those cases
where atropine dilated the pupil.
Dr. Watson congratulated Dr. Taylor upon the re-
sults in his cases, and said he " could detect no trace of
the opeiation upon the cornea except by means of a
magnifying glass."
Dr. B. Carter had seen so many of Dr. Bell Taylor's
beautiful results that he " could cpiite endorse Mr. Wat-
son's last statement." At the same time he thought that
removal of the iris left the eye in a better condition for
healing. He discouraged the operation without iridec-
tomy, and claimed " that the optical results were never
below the standard obtained in the cases withotit iridec-
tomy."
In my own practice I have followed the suggestions
of Dr. Taylor since reading the proceedings of the so-
ciety in 1876, and have been gratified with the results.
One gentleman, seventy-seven years of age, who was
operated on three years ago, writes me and says he sees
as well as he did twenty years ago. Another gentleman
wrote me of his wife, who was sixty-seven years of age when
I operated on her eyes four years ago, and says that
" she can see to read, and thread a fine needle." I have
operated on as many as seventeen successive cases in
the manner described by Dr. Bell Taylor without a sin-
gle failure, and with the most gratifying results in every
case.
I own that I owe my success in this line of practice
to Dr. Taylor, and hope the honors may rest where they
belong.
L. W. Wright.
Columbus. O., August S, 1883.
"ikxmvs aucX S^i^nij |leujs.
Official List of Changes of Stations and Duties of Officers
of the Medical Department, United States Army, from
August 4, 1883, to August II, 1883.
Magruder, David L. , Dieutenant-Colonel and Sur-
geon. Leave of absence extended one month. S. O.
89, Military Division of the Missouri, August 4, 1883.
McParlin, Thomas A., Lieutenant-Colonel and As-
sistant Medical Purveyor. Relieved from duty in charge
of the purveying depot in San Francisco, Cal., to take
effect September i, 1S83, and will then proceed to New
York City and relieve Assistant Medical Purveyor, Eben-
ezer Swift, of the charge of the purveying depot in that
city. Assistant Medical Purveyor McParlin will transfer
all funds and public propertv in his possession to Medical
Storekeeper Henry Johnson, who, until further orders,
will perform the duties of Acting Assistant .Medical Pur-
veyor, at the purveying depot in San Francisco. S. O.
183, par. 5, A. G. 6., August 9, 1883.
FoRWooD, ^VlLLIAM H., Major and Surgeon. To
proceed to Fort Washakie, ^Vyoming, and Fort Ellis,
Montana, on public business and return. S. O. 87,
^Military Division of the Missouri, August 2, 1883.
Woodward, Joseph J., Major and Surgeon. Leave
of absence granted on account of sickness, by S. O. 34,
extended six months. S. O. 179, .\. G. O., August 4,
1883.
Banister, John M., First Lieutenant and Assistant
Surgeon. Relieved from duty in the Department of the
Missouri, and assigned to duty in the Department of the
East. S. O. 183, par. 5, A. G. O., August 9, 1883.
Carter, William F., First Lieutenant and Assistant
Surgeon. Relieved from duty in the Department of
Texas, and assigned to duty in the Department of the
East. S. O. 183, par. 5, A. G. O., August 9, 1883.
Kane, John J., First Lieutenant and Assistant Sur-
geon. Relieved from duty in the Department of the
Missouri, and assigned to tiuty in the Department of the
East. S. O. 183, par. 5, A. G. O., .\ugust 9, 1883.
BvRNE, Charles B., Captain and .Vssistant Surgeon.
Relieved from duty at Fort Craig, N. M., and assigned
to duty at Fort Lewis, Col. S. O. 161, par. 3, Depart-
ment of the Missouri, .-August 6, 18S3.*
Lauderdale, John V., Captain and Assistant Sur-
geon. Granted leave of absence for two months, to take
effect on or about the 15th instant. S. O. 90, par. 2,
Department of the Missouri, .\ugust 6, 1883.
Owen, W. O., Jr., First Lieutenant and Assistant
Surgeon. To proceed from Vancouver Barracks to Fort
Walla Walla, W. T.,and report to the commanding officer
of the latter post for temporary duty. S. O. loi, De-
partment of the Columbia, July 27, 1S83.
August
i8, 1883.]
THE MEDICAL RECORD.
19:
Official List of Changes in the Medical Corps of the Navy
for the week ending August 1 1 , 1883.
Gatkwood, J. D., Passed Assistant Surgeon. Orders
to tlie Trenton revoked and ordered to the Kearsarge.
Scott, Horace B., Assistant Surgeon. Detaciied
from tile Receiving Ship Franklin at Norfolk on the 30th
inst., and ordered to the Trenton on September ist.
Austin, A. A., Passed Assistant Surgeon. Detached
from the Richmond and waiting orders.
21tX cell cat Items,
Contagious Diseases — Weekly Statement. — Re-
port of cases and deaths from contagious diseases re-
ported to the Sanitary Bureau, Health Department, for
the two weeks ending August 14, 1883 :
■ -3
[Week Ending
>
3
a
yphoid Feve
carlet Fever.
erebro - spin
Meningitis.
easles.
iphtheria.
1
F
I
H
H t/3 : U
^
"
CO
>
Cases.
August 7, 1S83
1
46 j 32 1
53 1 28 2
AQ
1A
0
0
August 14, 1883
0
36! 25
0
0
Deaths.
August 7, 1883
I
10 2
3
T7.
iS
0
0
August 14, 18S3
0
10 4
2
16
• s
0
0
The Question of the Legal Rights Conferred bv
the Possession of Medical Diplomas. — Dr. Rauch,
Secretary of the Illinois State Board of Health, says, in
his last quarterly report : " This occasion may be taken
to offer a word or two of comment upon the impression
which obtains in certain minds concerning the sacred
rights of 'legally-chartered colleges,' and the virtues
which inhere in anything called a ' diploma,' no matter
whence it emanates. The latest forni in which this has
found expression is as follows : ' If a physician be such
by virtue of the laws of the State of New York has the
State of Illinois power to disqualify him for practise ?
If she should attempt this, there can be but little ques-
tion that an issue will be taken in some case for final
presentation at the bar of the Supreme Court of the
United States.' The question in the above is based
upon an erroneous impression as to the rights, privileges,
and immunities which medical colleges can confer with
their diplomas. The assertion which follows, and which
seems intended to forestall answer to the question, is
based upon want of familiarity with important facts con-
nected with the medical profession in Illinois. To cor-
rect this latter, it is only necessary to point out that in
the enforcement of the Medical Practice Act in this
State, hundreds of physicians, who were such by virtue
of the laws of New York or of other States, have been
disqualified from practice in this State during the I'ast
six years ; and that scarcely a day — never a week —
passes when one or more such physicians are not so dis-
qualified and leave the State [vide the reports and records
of the State Board of Health, /(?w/ot). The error as to
the rights conferred by the diploma of a college chartered
in accordance with the laws of any given State — which
is, probably, what is meant by ' a physician by virtue of
the laws,' etc. — has been corrected more than once by
the courts, and in the publications of this Board. While
it is true that every man has a natural right to follow out
the bent of his inclination, and to be a clergyman, a law-
yer, a doctor, a scavenger, a peddler, an auctioneer, just
as he may choose, it is not true that a man can practice
any of these professions or occupations except he does it
upon such terms as the law imposes ; and the law can
impose just such terms upon any one of these professions
or employments as the legislators in their discretion deem
best for the interest of the community. .A. legally-char-
tered medical institution in New York, or in Wisconsin,
or in Missouri, or Massachusetts, may graduate its 'stu-
dents' and endow them with diplomas conferring upon
them the rights and privileges of doctors in medicine —
subject to the laws, not only of the State but of the com-
munity in which they practise. But when such 'physi-
cians' enter Illinois to ])ractise, they must conform to the
Illinois law. The right to practise medicine is not a
constitutional right, nor a right inherent in the law of
nature, nor an absolute right conferred by a college,
vi'hether specially chartered or otherwise. It is a statu-
tory right, subject to the control of the Legislature ; and
the Legislature of this State has prescribed the terms and
conditions upon which it may be exercised in this State.
Among these terms and conditions is one to the eftect
that the practitioner, if a graduate, shall present the
diploma of a college in 'good standing' ; and it devolves
upon this Board, by the terms of tlie law, to determine
what colleges are, and what are not, in ' good standing.'
Only the graduates of such — with exceptions not perti-
nent for consideration in this connection — may practise
medicine in Illinois, no matter what rights the laws of
another State may confer in that State. It has seemed
necessary to say this at the present time — without any
reference at all to Springer of Hardin, and the President
of the St. Louis Eclectic — for the reason, among others,
that it is a matter of importance to the student of med-
icine, intending to practise in this State, that he pursue
his studies at colleges which comply with the require-
ments of this Board."
That Judicious Council. — In referring to the clause
which the Judicial Council of the American Medical
Association had inserted on the slip which delegates were
obliged to sign at the late meeting, and which was but a
covenanting anew with the Code of Ethics, the Phila-
delphia Medical Times says: "We cannot, however,
close without a word of praise for the dexterity which
was shown in so strangling all ethical rebels that none
of them succeeded in crossing the sacred .-J^^sculapian
threshold, and the shades of Hippocrates suffered no dis-
honor or distress over unseemly bickerings and disput-
ings." The Canada Lancet ventuies to predict that
" this attempt at coercion will be followed by a reaction,
which will have the directly opposite eftect of what was
intended.".
Lemon-juice and Ovsters. — -Many popular usages
in ordinary life have been adopted either by instinct or
from empirical notions, and thus it is a common prac-
tice to use lemon-juice with raw oysters. It apjjears,
however, from the researches of M. Certes, a distinguished
microscopist and biologist, that this practice is not only
a matter of taste, but that it has its utility, as lemon-
juice has the property of destroying the animalcules wliich
infest the stomach of oysters. The moral to be drawn
from this is that oysters must be cooked, or, if eaten raw,
should be accompanied by lemon-juice to avoid the pos-
sible evil consequences of parasiticism. — Lancet.
The Functional Independence of each Cere-
bral Hemisphere has been demonstrated by Dumontpal-
lier in the following experiments : An hysterical epileptic
woman was hypnotised by pressure upon the vertex.
She was told to take up the knitting which was laying by
her side. She took it with both hands and commenced
knitting. A pressure upon the left parietal bone arrests
the motion of the right hand, while the left continues to
work. The like eftect is produced on the left hand,
when the right parietal is pressed upon. Pressure upon
the crown of the head causes her to awake. Conse-
quently central pressure causes equal reflex action upon
both hemispheres, while lateral pressure aft'ects only one
hemisphere, the opposite of the pressure. He provoked
'94
THE MEDICAL RECORD.
[August 1 8, 1883.
illusions, hallucinations unilateral or bilateral. Another
patient is hypnotized by a look. He places the tips of
lier finger upon her lips, and stays her arm as if about to
throw a kiss. She maintains that position with a smil-
ing expression of the left side of her face. At the same
time he brings her right arm into the position, as if want-
ing to repel some unpleasant object. She retains this
attitude, the right side of her face assumes the e.xpression
of horror, while the left side smiles. The firm angered
features of a commander are seen on the right side, those
of gentleness and benevolence on the left side. In this
experiment the muscular action of each side has excited
in the contralateral hemisphere a sentiment or an image
which manifested itself in the same side of the face.
The Code of Eihics. — Referring to the pledge
exacted of members who presented themselves for regis-
tration as members of the American Medical Associa-
tion, the Peoria Alcdical Monthly says : " The wliole
thing was an insult to the members of the Association,
especially to those who had previously attended. It
looked very nuich like applying the gag to keep the
mouths of any opponents to the Code closed. It cer-
tainly gained no fiiends for the Code party, and really
alienated many who were not ]ireviously opposed to it."
PROSTrruTioN IN' Fr.^nce. — In a recent work by M.
Armand Despres, of the Paris Faculty, devoted jninci-
pally to statistics, and written in opposition to tiie recog-
nition and licensing of the social evil by the State, the
following figures are given {Medical and Surgical Re-
porter): There are in France 15,057 registered |)rosti-
tutes, 7,859 belonging to maisons de tolerance, which
number 1,328 ; 7,198 prostitutes are what is termed en
carte — they live in their own rooms and appear at cer-
tain stated times (once monthly) for examination. Be-
sides this prostitution recognized by the law, there is
another, the individuals exercising it escaping as best
they can the attention of the police. The number of
free prostitutes is thought to be about 41,000. M. Des-
pres asserts that where prostitution is regulated by the
.State, and the danger from infection thus obviated, mar-
riage IS thought of later in life, and increase of popula-
tion reduced to a minimum.
ST.vriSTics «F Consumption. — Dr. Playter, of To-
ronto, has gathered facts in regard to consumptives
from 250 doctors. Their replies showed that the aver-
age age of patients was twenty-seven ; 46 per cent, were
males, 54 per cent, females, and 28 per cent, were mar-
ried. The average size of the chest was 31^ inches;
the chest of persons of the same average height, 5 feet
3^- inches, would usually average 37 inches. About 55
per cent, had light hair and eyes, two thirds did indoor
work, had slept in small rooms, and wore no flannels.
Only 46 per cent, had consumiitive ancestors, and a
majority were of nervous temperament.
The Predictions ok Guiteau. — -The following curi-
ous paragraph, which is decidedly sensational and but
partly true, is being circulated by English pai)ers : ■' It is
well known that Guiteau, the assassin of Prchident (Jar-
field, when upon the point of being condemned, made a
prediction of sundry recompenses which would fall upon
those who had contributed to his condemnation. Struck
by a powerful malediction, its ettects would promptly
overtake them. That prophecy, says our correspondent,
is being accomplished with startling rapidity. The wife
of the attorney of the Corkhill district, who displayed so
much ardor in the pursuit of Guiteau, died immediately
after his condejmiation. So died Surgeon-General
Barnes, whose deposition was most hostile to Guiteau.
Dr. Noble Young is also dead. Porter, the judge, whose
• charge ' was so violently pronounced against the crim-
inal, is in shattered health and incai)able of duty.
The marshal Henry, the bailiff Stahl, the detective Mc-
Elfresh, Perry Corson, the guard, and Jaines Leonard,
the prison coachman, are destitute. The Rev. Mr.
Hicks is pursued by defamation. Dr. Grevy has been
killed in an asylum for the insane. Dr. McDonald is
troubled on account of his administration of Ward's
Island, and is the subject of Government inquiry. The
sergeant. Mason, has been for a long time in prison,
while his wife and a lawyer are fighting over some thou-
sands of dollars subscribed by the enemies of Guiteau.
The wife of one of the jurymen (Hobb) has died, .and
the juryman Mike Scheban has been struck by madness.
Thus ends for the present this ' tale of woe."'
Medicine at Prague. — Dr. Councilman writes to
the Maryland Medical Journal : "At present there is a
great rivalry and a degree of hatred, difficult to overesti-
mate, between the Germans and the Bohemians. It has
finally reached such a pitch that the latter refuse to have
anything to do with the (lermans, refuse to learn their
language, and this fall they will have a new university, in
which all the lectures will be given in Bohemian. As
the Bohemians have never been very celebrated for their
scientific or literary acquirements, and as no one would
learn their langu.age, even for the sake of being professor,
the number from whom their professors nmst be chosen
is necessarily a limited one. Strieker's assistant in
Vienna, Spina, who lately has written an article on the
poor, much maligned tubercle bacillus, an article which
almost rivals the classic production of Schmidt on the
same subject, has been called to the chair of General
Pathology, and the other chairs will also soon be filled.'"
Singular De.^th-Rate i.n Penitentiaries. — The
death-rate in the principal penitentiaries or prisons in
the country furnishes a notable feature in the report of
Dr. Gill, of the Illinois Prison, the variations in the dif-
ferent institutions being almost incredible. Thus, among
New York prisons, while at Sing Sing the yearly deaths
from one thousand inmates number, as stated, a trifie
less than seven, at Auburn it is given as twelve, and at
Clinton over twenty. The lowest rate named is three in
Wisconsin, and the highest, seventy-seven, in .Mississippi.
The practice of " letting ' convicts for work on mines
and railroads is declared to cause fearful death-r.ates"in
several Southern States, but, on the other hand, the New
Hampshire figure is forty-eight. The rate in Massachu-
setts is given as fifteen, in Maine the same, in Vermont
twenty-five, and in Connecticut fifteen. Pennsylvania
has six in the western and fourteen in the eastern district.
The Hu.mbug of Consultations. — A certain well-
known physician, who enjoys thedistinction conferred bya
titled name, was recently called into the country for con-
sultation with the [lersonal attendant on a noble lord.
After a stay proportioned to the gravity of the case and the
social importance of the illustrious patient, the eminent
physician departed for the station, mutual satisfaction
having resulted from the visit. While pacing the plat-
form, however, the centre, we may be sure, of concen-
trated village admiration and awe, the great light of
modern medicine was suddenly confronted by a breath-
less but much beliveried minion of the sick nobleman,
who, with many apologies uttered in his master's behalf,
begged the .\[.D. Bart, to supi)lement the directions he
had already given with iiifi>rmation respecting the merits
of grapes as an article of diet for the invalid. The re-
quest was received with a gr.acious bow given in approv-
ing recognition of the thoughtful nature of the applica-
tion, and then ensued a siiectacle of sublime significance.
For about a minute the eminent one slowly paced in
pondering thoughtfulness, and then gave forth, as a result
of full consideration of an important, nay, vital, problem :
"Tell his lordship that he may eat grapes, but 'white ones
only ; be sure and impress this upon him — that he must
on no account touch any others ; white ones, and no
more than six per day." The fast-coming express just
then approached the station, and while the great one
sped away to the London anxiously awaiting him, the
awe-struck servant returned to tell the tale, how the vast
Aiio-ust iS, 1883.]
THE MEDICAL RECORD.
195
intellect of the mighty consultant could even disciiuiinate
between the harmless influence of white grapes and the
poisonous i)roperties of colored ones. This little narra-
tive was conuiiunicated to me by "one who knows" on
Sunday last ; and it has seemed to be worth repeating as
an examiUe of the relinenient to which the humbug of
consultation may extend. It is palpably clear that any
such exiiibitiou as that described above could ever be
indulged in with one intent only, and that the magnifica-
tion of the exhibitor's claims to knowledge. — London
Medical News.
Anothkr C.4SE OF Tikjmskn'.s 1)isi-:ase. — Dr. Schiin-
feld, assistant-surgeon in the German army, has re-
ported a case of this disease, concerning which we wrote
a short time ago. Hitherto the number of cases reported
has been ver)' ^^w, and most of them were confined to
one family. .Schiinfeld's case was that of a young re-
cruit who was bitten in the leg by a dog, very severely,
six years before. The fright and injury were thought to
have been the active cause of the disease.
CoNXERNiNc; Par.\site.s in the Lungs. — Dr. R. \'an
Santvoonl, of New York, writes : " Your correspondent,
Dr. Mann, of Portland, Oregon, will find in the London
Lancet, of March 31, 1S83, page 532, an article by Dr.
Maurer, of Amoy, China, on " Endemic Ha'moptisis,"
which may be of service to him in connection witli his
reported cases of " Parasites in the Lungs." The "En-
demic HKuioptisis" of Dr. Maurer is also of parasitic
origin, but the parasites in his cases were represented in
the sputum by ova only, the adults being found post-
mortem in the air-passages, and differing apparently from
those coughed u|) by Dr. Mann's patient."
j\[oiST Hands. — Mr. H. A. Smith writes, in the
British Medical Journal : Moisture of the hands (local
hyperidrosis) is a purely functional disorder of the skin,
due to disturbances of the nervous system. Stout
women, generally servant girls, suffer from it, although
the fair votaries of the ball-room and members of good
society, together with those of lithe and nervous habit,
occasionally come under notice. It may or may not be
attended with pain and infiammation, dysidrosis or fetor-
osmidrosis, or, more rarely, pigment-chromidrosis. As a
rule, the axilla and feet sympathize more or less. As the
condition appears to be due partly to abnormal vascular
conditions, but mostly to irritability or undue stimulation
of the vaso-motor nerves, probably of central origin, the
following lotion will be found exceedingly useful :
5. Liq. plumbi subacetatis 3 iij.
Sp. vini methylati 3 J-
Aqua rost'e ad 3 x.
Eiat lotio.
The lotion to dry on, and the hands subsequently to be
dusted three times daily with powder composed of equal
parts of calamine and starch-powders. The patient
should wash the hands always in cold water, and well
dry them, and should avoid malt and all fermented
liquors, pickles, spices, tea, and coffee (taking cocoa),
and be sparing in the use of sugar. The lotion failing,
she should wash the hands thrice daily with carbolic acid
soap m soft water, in which half a dram of extract of
belladonna has been previously dissolved, and take a
pill containing valerianate of zinc, two grains ; quinine,
one and one-half grain ; and extract of belladonna, one-
fourth grain, with conf. rose q. s., t. d. s. A mixtme (if
any tingling or burning in the fingers) containing bromide
of potassium, digitalis, and a vegetable tonic, will complete
the treatment. The belladonna, besides causing vaso-
motor paralysis, contracts the unstripped muscular fibres
surrounding the arterioles going to supply the sweat-
gland, and carbolic acid has a benumbing effect on the
nervous filaments supplying these and the papilhe of the
skin proper.
A New Hospital at Chicago is to be built by the
Rush Medical College.
The Position of the American Medical Associa-
TioN. — We cannot refrain from penning our dissent to
the decision of the American Medical Association refus-
ing to take any stejss looking toward a revision of the
existing Code of luhics of that body. The pietition of
the St. Louis Medical Society was eminently proper, and
we believe should have been adopted ; but instead of
being allowed discussion, it was (iromptly tabled, althougli
by not a very heavy majority. We believe we voice the
sentiments of a full majority of the reputable, regular
profession in this country to-dav, in saying that the Code
of Ethics can and ought to be so revised as to be made
a living law instead of the dead letter it now is. Many
who talk the loudest in its favor are the most flagrant
offenders against its spirit ; such w-ill always vote against
a revision, for in its stilted language and anticiuated and
sometimes ambiguous construction they can always be
able to escape the penalty of its violation, and to them-
selves, at least, excuse their wrong doing. — Peoria Medi-
cal Monthly.
The Recent 'Meeting of the American Medical
Association at Cleveland, while generally profitable to
those in attendance, was not without its disagreeable
features, and it is with the hope that they may be avoided
in the future that we call attention to some of them now.
It certainly is not expecting too much of the Committee
of Arrangements that they should see to it that delegates
are at least provided with suitable lodgings. This was
not done at Cleveland, so we are informed, but many,
left to shift for themselves, experienced great difficulty in
finding accommodations, and then, in the matter of regis-
tration, delegates were kept waiting, closely packed, for
hours for an ojiportunity to sign their names, when pro-
vision should have been made by which it could have
been done in much less time. There was diflicidty also
in obtaining information as to the departure of trains and
in securing tickets, and the situation was truthfully de-
scribed by one agent, who said, " I have had experience
with a good many conventions, but I have never yet
seen one where there has been such poor management
as at this." Now the fault lies entirely with the Com-
mittee of Arrangements. This conniiittee, we are told,
was not at all harmonious in its workings, but was di-
vided by differences of opinion which, in one instance,
led to a personal encounter between two of its members,
and so, from lack of harmony among themselves, the as-
sociation was made to suffer. It seems that the com-
mittee, either willingly or unwillingly, surrendered to the
ipse dixit of one of their number, and that he, swelled
out of all proportion with a false estimate of his own
wisdom and importance, undertook the management of
everything, and, as might be expected, many things were
left undone which would have added to the comfort and
pleasure of the delegates. — Weekly Medical Rei'iew.
Plaster -OF- Paris Pessaries. — Dr. K. V. Dawson
states that he has made use of plaster-of-Paris, moulded
within the vagina, with the most decided success, in two
cases of displacement of the uterus (Neici York Medical
Journal). The first case was that of a woman suffering
from anteversion and a very aggravated prolapse of the
left ovary. She was placed in the kuee-chest posture,
and pledgets of absorbent cotton, each with a string at-
tached, soaked in a mixture of plaster-of-Paris and water
of about the consistence of gum, and partially squeezed
out, were placed in the posterior fornix of the vagina
and around the vaginal portion of the cervix, and held in
position. The vagina was then cleaned out, in a few
moments the cast had hardened, and the patient went
away with instructions to withdraw the instrument should
it cause pain. When she came back at the end of three
days she said she had experienced great relief. On re-
moving the plaster pessary, the mucous membrane with
which it had come in contact, instead of being irritated,
as one might have expected, was found to have been
benefited by its presence ; it was firmer and less irritable
196
THE MEDICAL RECORD.
[August 18, 1883.
than before, and the prolapsed ovary had evidently been
sustained. The second case was one of retroflexion, in
which the pessary acted not only as a harmless agent,
but seemed to give all the uterine support desired. The
instruments were removed, ])laced in fire to burn out the
cotton, and dipped into wax or paraffin for the purpose of
making them impervious to tlie secretions and to render
them more durable. This method of supporting the uterus
commended itself for the facility with which it could be
applied, for cheapness and accuracy of adaptation.
St. I.ouls Medical Society and the Code. — On
June 23, 1883, Dr. Atwood introduced the following,
which was adopted by the St. I^ouis Medical Society,
after some considerable discussion :
"Whereas, Ki the recent session of the American Med-
ical Association, a preamble and resolution were offered
for the consideration of said Association, purporting to
represent the sense of the St. I.ouis Medical Society
upon the propriety of preparing a new code of ethics, or
altering and changing the existing code in accordance
with the present relations of the profession, and
'^IVhereas, In said preamble the assertion is made that
' the Code has accomplished all it was designed it should,
but at i)resent many of its features are obsolete and not
adapted to our wants. The necessity of an early revision
is very apparent, is loudly called for in all parts of our
land, and cannot be repressed much longer.
The time has come when the loud and very soon uni-
versal call will have to be heeded ; ' and
"Whereas, The St. Louis Medical Society did not in-
struct, 'That the Committee be authorized to prepare a
code of ethics which in their view will meet the wishes
of the jjrofession, and submit the same to the meeting of
1884 ; ' therefore,
^'Resolved, That the St. Louis Medical Society distinctly
re|)udiates the statements contained in said preamble,
antl again expresses its fealty to the existing code of
ethics as a time-honored and most suitable fundamental
law ot the profession, and s[)ecially deprecates any action
calculated to reflect upon its loyalty to those principles
which have heretofore secured immunity from the machi-
nations of schismatics within or enemies without. — .\. H.
Oh.m.4.m.n'-Dumes.\il, JNLD., Rec. Sec."
Concerning the Two Bushels of Ton.sils and
Other AfArrERs. — Dr. J. S. Thompson, of Indianapolis,
Ind., writes : " In your journal, dated July 28th, Dr. AV.
N. Williams of this city indulges in some facetious and
would-be learned remarks at my expense, and quotes
'Ray's I'ractical .Arithmetic' to show how many tonsils
it takes to make a bushel. It will be remembered that
in the discussion ot Dr. Jarvis's paper on 'Tonsillotomy
without Hemorrhage,' I remarked that I believed that I
had removed two bushels of tonsils and no hemorrhage
followed, and that I considered the instrument of no use
whatever except in cases of purpura hemorrhagica, or
similar rare ones. Did any one present suppose lor one
moment that I had measured them ? Had I been the
essayist, of course I should have been more exact ; but it
was an off-hand remark, intended simply to show that in
a great number of cases, in a twenty-three years' practice,
no case called for any other instrument than a chisel-
shaped guillotine, the inventor and maker of which have
long since been in their graves. Now, let me say a few
words concerning new instruments and modifications of
old ones. Is it not natural that when one invents one
of these, he very soon finds more cases on which to use it
than do others ? Look, for instance, at the multiplication of
ophthalmoscopes during the last twelve years '. Why, one
cannot go to London or other cities without finding inven-
tors' names given to them that one never even heard of be-
fore. -And so is it inmodilicationsof operations, some one's
name must constantly be associated with this or that in-
cision or mode of [Jrocedure, when its importance is in-
significant beyond measure. For my part, i expect to
go on excising ' scirrhous ' and other forms of tonsils to
the end of my days without the slightest hesitation what-
ever ; and I have not the least doubt that when the re-
ports are all in it will be found that as many deaths from
hemorrhage follow the extraction of a tooth as the exci-
sion of a tonsil."
How to Sleep on a Train. — Dr. Henry R. Stout of
Jacksonville, Fla., writes: " In The Medical Record for
•August 4th, in the article, ' How to Sleep on a Railroad
Train,' is it not a mistake to place the person with the
feet toward the engine ? I have tried both ways, and
have found, and have advised others with equal success,
that to sleep with the head toicardihe engine would insure
sleep. The rapid forward movement of the train forces
the blood to the extremity furthest from the engine. It
IS possible that this position causes a more rapid return
of blood to the heart, but it is hardly reasonable, I think,
that it would cause a hyperremic condition of the brain."
A Useful Suggestion Regarding Catheters. — Dr.
Hiipeden calls attention to the danger of infection attend-
ing the use of catheters as at present constructed. The
defective and dangerous portion of the instrument is the
blind end beyond the eyes. The most careful cleansing
may fail to destroy or remove all infectious matter from
this part, and thus some disease may be communicated
to the next patient upon whom the instrument is passed.
To obviate any such risk it is only necessary to fill uji
with some solid material this blind extremity. — Centralblatt
fiir Chiruri^ie, July 7, 1S83.
The Prevention of Bed-sores in Nervous Dis-
eases.— Dr. Thomas Browne, of the Royal Navy Hos-
pital, Great Yarmouth, asserts that bed-sores can be pre-
vented even in the worst forms of general paraljsis. Dr.
Browne offers no specific, but states that very careful
nursing, frequent washing, change of clothes, the use ot
pads, water-beds, and special attention to diet are the
measures to be employed. Bed-sores, he says, no longer
occur in the Naval Hospital at Yarmouth. — Nashville
Med. Joiirn., June, 1883.
Concerning the Inocui..\tion of Lvmph.atics and
Blood Capillaries. — Dr. Theobald Smith, of the Ana-
tomical Laboratory of Cornell L^niversity of New York,
writes: "In The NIedicvl Record of June 16, 1883, an
abstract is given of a communication to the Academic
des Sciences of Paris, in which Dr. Guerin, supported b}'
experimental evidence, maintains the inosculation of
lymphatic and blood capillaries. The abstract is prefaced
by the remark that Mascagni and Sappey also hold this
view. Lately my attention was called to the Compies
Rendus of June 11, 1883, which includes a memoir by
Sappey on this same subject, in whicli he, however, gives
up his former position. .V unique method of demonstrat-
ing and studying both the lymph and the blood channels
in the same microscopic field — the latter fading away as
the former come into view — led him to abandon the
theory of inosculation. He says: 'Sustained by these
new and precise facts, and no longer by simple induction,
I conclude that there is no room for admitting this com-
munication ; the lymphatic vessels at their origin are
everywiiere hermetically closed.* Curiously enough, the
prominent English journal of science, Nature, for June
28th, p. 215, incorrectly reports Sappey as having demon-
strated by actual observation ' the intimate union of the
radicules with tiic blood-vessels which had long been as-
sumed on general grounds.' "
Carrving the Clinical Thermometer in the Pa.n-
TALOONS Pocket. — Dr. D. S. Clark, of Rockford, 111.,
writes : " The most convenient way to guard a clinical
thermometer against accident that I have ever tried or
heard of is simply to carry it in the pantaloons pocket,
just as a knife is carried. I usually devote the left-hand
pocket to this sole purpose. Let any physician try this
plan and he will prefer it to every other. Now- will phy-
sicians inform us as to the best method of keeping hypo-
dermic syringes in working order?"
The Medical Record
A Weekly Journal of Medicine and Surgery
Vol. 24, No. 8
New York, August 25, 1883
Whole No. 668
COviainal ^^vtidcs.
ROUND SHOULDERS, OR ANTERO-POSTE-
RIOR CURVATURE OF THE SPINE.
By CHAS. F. STILLMAN, M.S., M.D.,
NEW YORK.
" Round shoulders " is one of the most prevalent deformi-
ties, and yet very little attention is paid by surgeons to its
treatment, although it is amenable to curative measures
with as little discomfort as any other prominent deformity.
An inquiry into its anatomical and physiological
characteristics affords a clue to the treatment, that l)eing
the portion of the subject which more directly concerns
us in this paper.
The spine, viewing it from the side, is a column com-
posed of twenty-four segments, upon which rests the head,
and to this column in its dorsal region is also attached
the thorax, and secondarily the upper extremities. The
normal line of the spuie is a compound curve, and it is re-
tained in this shape by muscles disposed along its course,
acting as do the stays to a mast, and opposing the effect
of the weight of the head as a constant gravital force
to increase the curves. When the normal degree of
tonicity does not exist in these muscles, this increase in
the curves is found and is further exaggerated in the
region of the neck and shoulders by the tendency of the
upper extremities and thorax forward, and by this for-
ward tendency we obtain the contracted chest, the
separated and protruded shoulder-blades, and the bent
and stoopmg shoulders, all characteristic of the deformity
in this region., ^jJUJ^
But as the line of direction must be maintained, when
the head drops forward the lower part of the trunk also
projects itself, giving rise to the appearance of flat nates,
and causing it to appear as if the dorsal region projected
very much backward beyond the normal line, as in Fig. i.
The most common cause to which this deformity can
be ascribed is muscular weakness, the inability of the
back to recover the erect position after it has been re-
laxed. Relaxation of the back is the position of rest
assumed by the trunk when the superincumbent weight
is to be more fully borne upon the bodies of the vertebra;,
and we then rely upon the ligamentous bands and at-
tachments rather than muscular force to keep the body
in this less fatiguing position ; thus relieving the muscles
from all necessity of the contraction which is required if
the trunk be maintained erectly. In this position of rest
the spine curves backward in the shape of a bow, from
the sacrum to the head, the centre of the bow being in the
middle dorsal region, the bodies of the vertebras being
crowded togetiier throughout the whole extent of the
spine (see Fig. 3), and the muscles not exerting their con-
tractile force.
When the erect position is again assumed, the muscles
should restore the normal spinal curves so that the head
and upper portion of the trunk, with their appendages,
become supported in the proper line of direction (Fig. 2).
But if the muscles lack tone or are fatigued, or the
patient is indolent, the position of rest becomes habitual
and we have the production of round shoulders as the
result.
There are various degrees and forms of the deformity,
dependent upon the age of the patient, the length of the
spine, the regional muscular development, the sitting
habits, etc. ; but these are sufficiently known to every
practitioner not to require description here. The pro-
jection forward of the head and nates is not found to the
same extent in every case, but seems to be compen-
satory— to permit the line of direction to be passed
somewhat anteriorly to its normal position, in order that
the body may be properly balanced while in the vertical
position.
The treatment which concerns us most directly in this
jiaper, may be considered under two heads — mechanical'
^wA physical.
The mechanical treatment consists in the use of prop-
erly devised apparatus for the restoration and retention
of the normal curvature, and the mechanical problem,
this involves resolves itself into the reduction of the
dorsal curve, since the cervical and lumbar are merely
compensatory and will tend to regulate themselves.
We have already noted the fact that the exaggeration
Fig. I. F'g 2.
of the curves of the spine produces undue pressure upon
the bodies of the vertebra in the dorsal region, and we
must, therefore, turn our attention first to placing the
spine in such position as will tend to separate the
bodies and transfer pressure to the other surfaces of con-
tact in the normal degree. To effect this we utilize the
principle of gravity as an extending force. When the
patient assumes the horizontal position upon a table so
arranged as to have its padded edge under the shoulder-
blades, as in Fig. 3, and then allows the head and upper
extremity to gradually fall backward and downward, we
have produced a series of curvatures exactly opposed to
those exhibited by the round shoulders. You will ob-
serve, as the patient's head and shoulders descend, a
gradual obliteration of the condition of round shoulders
and a reproduction of the normal curves of the spine.
The bodies of the vertebrae become freed from the
crowding to which they have been subjected, and a
physiological and true extension of the parts is effected —
198
THE MEDICAL RECORD.
[August 25, 1883.
the traction-force being the superincumbent weight, the
cervical spine being placed in a state of extension by the
weight of the head, and the dorsal spine in extension by
the weight of the head, the neck, and the upper extremi-
ties. This combined weight, augmented by gravity, is
simply tremendous as a traction or tractive force, and pro-
duces a true backward physiological extension. Do not
confuse the words traction and extension, or substitute
one for the other. Traction is the force which produces
extension. The former is a cause, the latter an effect ;
the former is an active agent, the latter is a condition ; or
in other words, extension is a result of traction, and is the
effect produced upon a joint by traction. The words
are not synonymous, and should not be so employed.
This principle of backward traction, by the weight of the
upper extremities, is one which we have been utilizing
lately, as a most satisfactory factor for the production of
extension in Pott's disease, as we not only obtain as
Fig. 3.
much extension of the spine as we can by suspension (or
traction by the lower extremity), but we obtain this in a
backward direction, which enables us to apply leverage to
obliterate the deformity to a more satisfactory extent than
ever before, and with less discomfort to our patients.
We have now, by the use of the table, obtained great
improvement in the condition of the deformity, and the
question arises, how are we to retain this improvement
when the vertical position is again assumed, as the jios-
terior spinal muscles are impaired and have not sufficient
power to hold the spine in its restored curves.
Although in slight or recent cases this can be accom-
pHshed by simple methods, yet a brace will often be a
necessity in severe cases, and it is easy for us to con-
struct one upon the principles which govern the reduc-
tion of the deformity.
We must strive to keep the patient in a state of hyper-
erectness until the muscles have contracted and been
exercised and invigorated sufficiently to render the use
of a brace unnecessary, and if we glance at Fig. 3, and
turn it in such manner that the supine figure will appear
vertical, it will be seen that the figure is more erect than
normal, i.e., hyiJer-erect, and this position (of the
dorsal, not the cervical si)ine) is necessary to tlie devel-
opment of the impaired muscles as well as for its effects
upon the spine itself.
Now, how to keep this position with a brace. It may
be, to some extent, done with a strong back-frame,
fashioned to the hyper-erect shape and put in position
and secured while the patient lies upon the table in the
extension position. This frame may be made of some
metal which can be bent by the hands of the surgeon,
but it must necessarily be made of such heavy inatorial
as to be too cumbersome for general use, for it must be
sufficiently firm to withstand the tendencies of tlic de-
formity, as it matches strength of material against the
tendency of the superincumbent weight to fall forward.
I must impress upon you the importance of having
this frame fashioned to the hyper-erect shape, for if so
made, and well secured to the body, the forward ten-
dency of the body and the exaggeration of the dorsal
curve are to some extent prevented by the strength of
material and shape of the splint.
A second and much more satisfactory method of util-
izing the backward traction in the formation of a brace
is one constructed on my adjustable lever plan- — the
fulcrum, F, to be over the sacrum — the resistance, R, to
be greatest just below the central region of the dorsal
'curve, and distributed all along the spine below this
region, and the power, P, to be the forward tendencies of
the upper extremities and head (Fig. 4), so that while the
body is maintained erectly no force is exerted upon the
spine at any point ; but the least tendency to rounding
the shoulders brings a power to bear exactly opposed to
the power of the deformity, which increases automati-
cally in proportion to the extent of the deformative
force.
To construct a brace so as to bring the force to bear
under these conditions we place a girth, provided with a
sacral projection, about the hips (Fig. 5). From the upper
edge of this hip-girth springs a pair of padded strips, one
on each side of the median line, so as to avoid the spi-
nous processes, and these strips extend upward to the
middle dorsal region (Fig. 5). So far the brace is a sub-
stitute for the table, but to give it efficacy we must sup-
ply a frame for backward traction as a substitute for the
backward force exerted by the weight of the upper ex-
tremities when the body is in the traction position (see
Fig. 3). To effect this, a light steel frame moulded to
the shape of the back and extending from the sacrum to
the cervical vertebra; is attached at its lower extremity
to the hip-girth (as in Fig. 6) and there provided with a
ratchet which admits of its being secured at any angle.
The upper extremity of this frame is secured to the body
by means of chest and shoulder-bands (Fig. 7), which
buckle in front to a firm leather chest-//(j'/'f, the use of
which jiermits us to avoid the constriction and discom-
fort attending the use of bands passing around the chest
without such intervention.
The action of the brace (Fig. 7) is, as you see, that of
a lever, exerting its force in such a manner as to dis-
tribute its pressure along the spine and not at any one
point; the dorsal centre being the point of greatest
pressure, and the sacrum the least, the intermediate
pressure being so graduated as to decrease from the
dorsal centre to the sacrum. We thus see that direct
pressure is provided to the greatest degree where it is
needed most, i.e., at the dorsal centre, and in the least
degree where it is needed the least, over the sacrum ;
and there is thus no portion of the spine below the dor-
sal centre without direct supjiort. This support and for-
ward pressure is jusi in proportion to the backward angle
August 25, 1883.]
THE MEDICAL RECORD.
199
of the brace-frame and the forward tendencies of the
deformity. In the beginning of the treatment this brace-
frame may be secured at a considerable angle (Fig. 6),
but as improvement ensues this may be lessened, until
it lies flat upon the padded strips (Fig. 7) and becomes
in its action a mere spinal support instead of a lever.
This brace makes an extremely effective and com-
fortable instrument, and can be made to exercise any
desired degree of power on the deformity. But there
are many cases which do not require so pronounced an
instrument as this — cases in which the youth and iunna-
Fig. 6.
turity of the patient have not as yet allowed the jmrts to
become perpetuated m the abnormal curves to such an
extent as to demand its use.
Such cases require merely a light, strong, comi)ound
spring, or pair of springs, which will act supplementary to
the impaired nuiscles of the back, and if we can adapt
this spring power to the form so that it will not be appar-
ent to an observer that the patient is wearing an aid of this
kind, so much more successful will we be in our practice.
We must remember that this class of deformities is unat-
tended by pain, and it is therefore desire for symmetry
which brings them to you ; so that if an unwieldy spring
makes a protrusion along the course of the spine it would
be an objection to treatment in the eyes of the patient.
But it is possible, by incorporating into an ordinary well-
fitting corset, a /(?;> of compound springs, one on either
side of the median line, to provide against the objection
which attends the use of a single spring. The under
springs are somewhat longer than the corset and are
provided with pads at their ex-
tremities so as to allow suffi-
cient grasp of surface to prevent
the edges of the pads from dig-
ging into the flesh when the
body is laced down to the springs
(see Fig. 8). The upper springs
extend to the neck and are con-
nected to the chest-plate in
front as in the lever brace.
The only springs which we have
used heretofore in the profession
to combat round shoulders have
been fashioned in an exaggera-
tion of the normal curves of the
spine — a shape which would
tend to increase and intensify
the abnormal curves which are
symptomatic of the deformity.
To make round-shoulder springs effective, however,
the curves of the under spring should be the reverse of
the curves of the deformity — opposing apex to apex.
Thus the curve of the deformity and the curve of the
combating spring should be so placed in contact with
each other that when the centres are together and the
curves drawn tightly toward each other there will be
reduction in exaggerated curves of the spine as well as
the curves of the spring.
The curve of the back springs are opposed to the
curves of the back (see Fig. 9) before the stays are
brought together, but when the corset is tightened and
secured to the figure (Fig. 10), its action is to flatten the
dorsal curve in direct proportion to the strength of the
springs.
For males, corsets are not so applicable for obvious
reasons, and we therefore provide the springs with girths
in such a manner as to be as effective for the purpose in-
tended. So much for the mechanical treatment.
The physical treatment next engages our attention,
and by this we mean the employment of such exercises
and movements during the mechanical treatment as will
conduce to the permanent cure of the deformity after
the braces and corsets are thrown aside.
It is necessary in the first place to have a table, al-
though a lounge or couch could be made to answer,
the surface of which is padded or so covered as to be
comfortable to the jiatient. This table should be a low
one, so as to divest the patient of all fears of falling while
undergoing treatment, and on such a table when the
patient places himself there in the extension position —
the edge of the table coming to the central dorsal re-
gion and the head and upper extremities hanging over —
you will see that the chest has partially resumed its nor-
mal shape, that it has lost its contracted look, and that
the shoulder-blades tend to approach each other. To
Fig. 9. Fig. 10.
approximate these it is necessary to clasp the hands to-
gether behind and under him — and at first this is almost
an impossibility. When undergoing this process it would
appear as if the skin and tissues of the anterior of the
thorax were stretched as much as their structure would
allow, and that posteriorly the soft parts were redundant.
Dumb-bells of various weights are now taken in the
hands and a series of rapid lateral movements practised
which still further expand the chest. There are also
quite a number of calisthenic exercises which are of ad-
vantage if practised in the backward traction position,
but they must be employed with care and moderation, as
their expanding effects are so powerfully augmented by
gravity that they may strain the tissues painfully and- thus
delay treatment. A most useful agent is also found in the
rubber-cord. Of these tliere should be two, fastened by
detached hooks and staples to the floor in such a manner
as to draw the hands beyond each other, the resistance
of the muscles to the contractility of the rubber consti-
tuting a most valuable agent for developing the chest if
formulated into a series of exercises.
This backward traction position may seem harsh exer-
cise to be daily indulged in by your patients, but it is the
most efficacious plan of physical treatment, and will do
the most good in the shortest time. There are, however,
many lighter forms of exercise which may be utilized.
One which can be si^ecially recommended for other
than the backward traction position is one in which the
200
THE MEDICAL RECORD.
[August 25, 1883.
chest is expanded by the bod)- falling forward as much
as the rubber cords grasped by the hands will allow,
the feet not being moved and the head prevented from
falling forward with the rest of the body (and thus the
hyper-erect position maintained) by means of a w-ooden
bar placed between the teeth and connected to a gym-
nastic frame by cord or wire. This is very serviceable
also, in strengthening the muscles of the neck.
There are also certain postures which are of them-
selves beneficial, and should be recommended to your
patients for their adoption.
The y?>j-/ is in regard to sleeping. Have both bolster
and pillow removed from their usual place under the
head, and have one or both placed under the shoulder-
blades. This brings the head a little below the level of
the dorsal region and curves the spine in direct reversal
to the curves of the round shoulders ; and as, during
sleep, relaxation of the spine ensues, the posterior spinal
muscles are permitted to recover some of the contrac-
tility they lose during the day if proper supports be not
worn.
The secoiiii is that of reclining (not upon the back but
upon the front of the body) during the day for reading
or resting, the patient lying at full length and resting on
the elbows. This is a favorite position with children and
should be encouraged, as, if steadily practised, it is a sure
preventive of the deformity But many parents, instead
of encouraging this trait, rebuke their children for it, and
sharply order them to get up from the floor. If they
could only be made to understand that it is one of the
greatest helps to symmetrical development they would be
more inclined to encourage its practice.
THE UNITED STATES MEDICAL SERVICE.
By captain R. W. SHUFELDT,
MHDICAL COKrS, U. S. AKMV.
When I speak of the United States Medical Service it
is to be understood that the Medical Corps of the Army
and Navy alone are referred to, the writer having little
personal knowledge of the organization and government
of tlie United States Hospital Marine, so that it would
be through chance only that if anything we have to say
here is found in the sequel to apply with equal force
and pertinency to them.
With the Army and Navy of course it is different ; the
medical staff of the former being known to me as one of
its members, and one who has performed the majority
of such duties as are met with during the first seven
years' service, and the schedule which forms the com-
plete list is by no means as brief and simple in character
as one might imagine. Connections of another nature
have allowed me the opportunity to meet, and in many
instances form lasting friendships with members of the
'medical staff of the Navy, and from the first impressions
made on my youthful mind, while serving in the capacity
of a young warrant officer aboard a man-of-war, during
the year of 1S64, by the surgeons of the fleet, memor-
ably by Dr. Cassin, nephew of Cassin the naturalist, till
such days of later years as those passed under Dr.
^\'ales' personal tuition and guidance, to my present
commission, have been of the happiest nature. So that,
through this and other means, some opportunity has
been afforded me of learning something of this service
likewise.
Some of the questions I wish to call to the attention
of the profession, and touch upon as best I may in an
article that nuist necessarily be as brief as this one, were
presented to my mind by an editorial that api)eared in the
Philadflph'ui Medical Tunes of .May 7, 18S1, entitled
"The United States Naval Medical Service," and sev-
eral kindred articles that have appeared here, there, and
elsewhere since. As the subjects to be discussed will
be taken up in the order as they appeared in this edi-
torial, it will be necessary for a clear understanding of
the questions presented to quote here the entire first two
paragraphs of the remarks made by the editor of the
Medical Times, leaving his two remaining columns to be
handled in another way. He says : " It is probable that
there is no medical government service in the world, the
requirements for admission to which are more severe
than is the ordeal through which the medical candidate
for naval honors must pass in this country. We are
credibly informed that twelve aspirants have been before
the examining board now in session without one having
succeeded. So far as a good deal of experience teaches
us, we should say that the standard is even higher for
the Navy than it is for the Army. Most of our readers
will no doubt agree with us, however, that when once in
the Navy a physician almost always disappears entirely
from public sight, whereas in the Army not rarely he
rises to a first rank among scientists. The doings of the
medical staff of the Navy, what are they ? A few reports
lying upon book-shelves — pitiful pamphlets alongside the
invaluable tomes that have come from the Surgeon-Gen-
eral's office at Washington. Not only is this true of
medical works proper, but also of scientific publications
other than medical. Where is the Dr. Coues of the
Navy ? Yet the abundant leisure, the months of floating
in the tropics, the wide travel, aftbrd both stimulant and
opportunity for natural history research."
The fact that the editor of the Medical Times holds
the opinion that the standard for entrance in the medical
corps of the Navy is higher than it is in the Army, does
not surprise me in the least. Nor is he to blame, for it
is a very general, and I may say, an entire!)' erroneous
one. It no doubt has arisen from the fact that the ex-
amination in the Navy is so arranged that it extends by
custom or law through a full week, whereas in the Army
a candidate may complete his examination successfully
in from three to five days, depending altogether on how
long it takes the board to satisfy themselves as to his
fitness. The not unusual circumstance, the Times brings
forward, of twelve young men failing before the Navy
board, and still no successful candidate, is by no means
a criterion, for instances have occurred in the Army
where the sequence ran in between the thirties and for-
ties before a successful candidate was found, and it
stands to reason that if three medical gentlemen com-
posing an examining board cannot ascertain the calibre
of a man in from three to five days, they certainly will
not do it in seven, or a month either as for that matter.
Opportunity was afforded me, when I first entered the
corps, for comparing the questions asked in examination
for entrance to both services, and the impression was
made upon me then that there was little or really no dif-
ference in their general character. In the .\rniy the
board is guided somewhat by the contents of the auto-
biographical letter that the candidate is obliged to write
the first day of his examination, wherein he states what
his general course of study has been up to the time of
his appearance before the board. As an instance, in my
own case, on my entrance examination I was requested
by the board to submit to them for inspection specimens
of skins of birds and mammals that formed a part of a
collection I had made as a young man ; they asked to
see, likewise, colored drawings I had made of die same,
as well as a set of marine charts that I had drawn to
obtain an apjiointnient as draughtsman in the United
States Naval Hydrographic Office a year or two before.
As the charts had passed me, and the specimens of birds
had also been pronounced favorably upon by Professor
Albert S. Bickmore, who was then in charge of the Mu-
seum at Central Park, New York, and had given me the
appointment as naturalist to one of the Arctic expedi-
tions then forming, I complied with the request of the
board with more confidence than I might have under
other circumstances. It would have been difficult, too,
to have found expression for my delight in finding upon
the very threshold of my new career such positive evi-
dence that such pursuits were encouraged in the medical
service of the Armv.
August 25, 1883.]
THE MEDICAL RECORD.
201
Once in the corps of either service, after a certain
length of time an officer is expected to pass a second
examination before the examining board, the object
ostensibly being to ascertain whether the officer is quali-
fied for promotion or not. In former times in the Navy
this examination was competitive and an officer could
gain rank by it, but I believe such a pernicious feature
as that must have been has now been done away with,
though exactly how it is managed in these days I am not
informed, but not long ago a surgeon of the Navy told
me that under no circumstances did it threaten an officer's
conniiission in any way.
In the Army this second examination is arranged on
a widely different jilan. Substantially the law says that
after the first five years of an army medical officer's ser-
vice, or what amounts to the same thing, after he has
passed into the grade of captain, which he does by act of
Congress at this time, he is liable to be called upon at
any time to appear before the regular examining board
to be examined as to his fitness for promotion. Should
he be found in any way deficient a second trial is given
him, after the expiration of a year ; failing again, his re-
signation is requested.
When one conies to think of the effect that such a
specification as this would have upon the mind of one
engaged in the study of medicine, and the vast field of re-
search that that means in our day, he will be struck at
once by the fact that it aftbrds drawbacks far more
harmful in its ultimate efi'ects than even the old competitive
examination of the Navy. Speaking from my own per-
sonal experience witli this second examination, I can say
that during my first five years the impression had been
made upon me, through conversation with many older
medical officers, all of whom, as far as known to me, had
been successful at this trial, that it was a matter of not
much consequence, did not last long, and really was sort
of a form to examine more into the question as to whether
or no an officer had proved himself generally fitted for
the service ; an examination of his record. Many others
held another view — showing that minds were divided on
the question of its utility — that may be summed up in
the expression given to it by one of the number, that " it
was a sieve to catch the bad rats," just as if medical
officers were not amenable to trial by courts martial as
any other staft' officer for violations of the regulations
of the service ; or that a thing should exist that in its
workings was harmful to the many while it acted with
doubtful certainty in eliminating the few objectionable
ones. Moreover, it is not believed that the Govern-
ment ever intended to place such a power as this in the
hands of a board composed of members of the sanie
corps; still one's mind is harassed with the doubt if its
object be to take a second look at an officer's attain-
ments, when he sees medical gentlemen holding contract
as acting-assistant surgeons at military posts appear
before the board for examination for commission, be un-
fortunate in the attempt, yet return to their duties at mili-
tary stations with the same responsibilities. This is not
said as bearing at all upon the efficiency or non-efficiency
of the gentlemen as a whole, for the writer holds many
of them among his best tried friends, and in not a few
instances members could be chosen from among their
number that would be of the highest honor for any medi-
cal corps in the world to claim them as its own.
My mind had been lulled to a certain degree of security
by what has already been cited above, in fact I was upon
scientific duty in the Army Medical Museum at Washing-
ton, when the summons to this second ordeal reached me.
I had made no special preparation whatever, so after
a brief but exciting struggle of three hours failed. Com-
fort was dealt out to me that far abler men than mysclt
had met the same fate and that it formed one of the
episodes in the early life of Dr. Flint, of New York. It
hardly seemed that this latter fact was anything to boast
of, or proved the efficiency of the scheme to fulfil its
purpose, if it had any. Before leaving New York, where
the board held its sessions, I met eight or ten medical
officers of about my own date of entry into the service,
who were there on the same mission as myself. Some of
these gentlemen had passed, others had not been quite
so fortunate, and still others had not yet been before the
board and had been " cramming " there for three or four
months. Naturally when we met the subject of the con-
versation turned upon the examination, and to make the
matter brief, the unanimous verdict was that its effect
was a bad one ; that these efiects may be prolonged over a
period of from ten to fifteen years, as the law does not
specify that one shall make his appearance positively at
the end of the first five. h. number of such instances
are on record. The writer was doubly impressed with all
the discussions that took place at these meetings, because
he had just failed himself and now stood with the addi-
tional responsibility of a young family about him, with
the fact staring him in tlie face that at the end of another
year, should the same result follow, he would be asked
to resign. Let us devote just a few words, however, to
the chief drawback caused by this examination, and in
fact the only one that interests the Government, whose
aim it is to keep an efficient medical staff of the Army.
A young man is found qualified and enters the medi-
cal corps. As the prejjaration for his entrance examina-
tion has no doubt been trying, the first impulse after
becoming accustomed to the novelty of freedom he at
first experiences is to rest for a month or so ; then fol-
lows a reading of the journals so generously furnished
by the Surgeon-General's office ; then a taking up again
of his old text-books as cases commence to present
themselves. Six or eight months glide by, when a never-
out-of-the-mind fact, his second examination, conmiences
to operate. In the mean time, no doubt, he has, as all
professional men do, made a choice in the fiivor of some
special subject or branch of his profession or undertaken
some original line of research — perhaps because a uniform
can never change the bent of a man's mind or human
nature, however tightly it may be buttoned around him,
as the history of numberless cases will vouch for. He
may be in the very act of cutting a section for micro-
scopical work, when it suddenly dawns upon his mind
that very soon he is to be examined and the board may
not touch upon this subject at all. This thought is fol-
lowed by another, that he perhaps, if then called upon,
could not give a very lucid explanation of the " cause
of pitch of musical sounds." He rushes to his works on
physics ; this subject barely opened when the first one
comes up again, and the board may not care about the
" pitch of musical sounds," but about the " date and in-
cidents of the battle of Crecy," then the long vista of his-
tory is almost hopelessly scanned ; but the board may
not question him in history, although it is their preroga-
tive to do so. W. the end of an hour or so we find him
leaning back in his chair, almost helplessly gazing at the
four or five long rows of books before him, in a condi-
tion of mind totally unfitted for study, his tissue dried
up on the slide, and the scalpel on the fioor, or else he
wanders out, and unless of cast-iron nerve, seeks other
means, not professional, to drive this bugbear away, even
for only a brief space of time, and yet this education of
his mind may be kept up for years — receiving a sudden
shock every now and then when he learns that some of-
ficer of undoubted ability has failed. Can any one de-
vise a more perfect break to professional progress and
excellence than this ? anything more vicious in its op-
erations, more certain to produce an irritability ot mind
and temper, a ranker poison to the hopes of a well-bal-
anced education ? Let any one — I care not who he is, or
what position he holds — know positively and without re-
serve that at the end of some indefinite time he is to be
examined, and perhaps his livelihood placed at stake,
upon all branches of his many-faced profession and nu-
merous not exactly specified collateral subjects, and he
may be able to have some faint taste of the effect, but
hardly appreciate it.
202
THE MEDICAL RECORD.
[August 25, 1883.
About a year ago, Surgeon J. H. Bill, U. S. Army, an
earnest and able chemist, who for a long time was a
member of the Army Medical Examining Board, pub-
lished an article in The Record,' which shows better the
utter hopelessness of the situation, far better than any-
thing that could ever come from my pen, or that I would
ever hope to attempt. Dr. Bill presents his readers in
this article with between twenty or twenty-five of the
easiest questions his mind could suggest, and such as
were propounded to candidates before the board, and as
they are to illustrate a certain subject, they are ail either
physical or chemical. Now, easy though they be, and
that depends much upon how the reader takes them, I
will guarantee to make outJiTe thousand such lists, con-
taining an equal number of questions, and equally easy
upon these subjects alone ; not only that, but an equal
number for anatomy, physiology, toxicology, hygiene,
surgery, practice of medicine, obstetrics, materia medica,
science, history, literature, medical jurisprudence, the eye
and ear, and some half a dozen or more others. It is
thus that doubts and complications arise in the mind of
the student exactly where to begin. The beautiful vistas
so aptly opened in the remainder of Dr. Bill's admira-
ble article, and the advantages it points out accruing
from a course of study in chemistry and jjhysics, are
equally applicable to like pursuits in several of the
branches I have enumerated above.
Now that the writer has run safely through this hit-or-
miss gauntlet, having passed at his second trial, he is free
to confess that this second examination is the greatest
drawback that the medical officer has to contend with,
and it constantly risks injuring many a mind. On gen-
eral principles, I do not believe in examinations, to any
great extent, any way. Of my six years' college course
those studies that were not followed by an examination
at the end of the term have always been better remem-
bered and of the greatest service to me, and I doubt not
but that this has been the experience of others.
Professor Huxley has so much to say upon this sub-
ject " that is wholesome, ))ertinent to the question, and
bears upon what we will have to say in a moment, that
I will take the liberty of quoting quite extensively from
him. He remarks that : " Examination, thorough, search-
ing examination, is an indispensable accompaniment of
teaching ; but I am almost inclined to commit myself to
the very heterodox proposition that it is a necessary evil.
I am a verj' old examiner, having, for some twenty years
past been occupied with exammations on a considerable
scale of all sorts and conditions of men, and women too ;
from the boys and girls of elementary schools to the can-
didates for honors and fellowships in the Universities.
I will not say that in this case, as in so many others, the
adage, that familiarity breeds contempt, holds good ;
but my admiration for the existing system of examination
and its products does not wax warmer as I see more of it.
Examination, like fire, is a good servant, but a bad
master. I by no means stand alone in this opinion.
Experienced friends of mine do not hesitate to say that
students whose career they watch, appear to them to be-
come deteriorated by the constant effort to pass this or
that examination, just as we hear of men's brains becom-
ing affected by the daily necessity of catching a train.
They work to pass, not to know ; and outraged science
takes her revenge. They do pass, and they don't know.
I have passed sundry examinations in my time, not with-
out credit, and I confess I am ashamed to think how
very little real knowledge underlay the torrent of stuff
which I was able to pour out on paper. In fact, that
which examination, as ordinarily conducted, tests, is sim-
ply a man's power of work under stimulus, and his ca-
pacity for rajsidly and clearly producing that which, for
the time, he has got into his mind."
' A Pica for .•» More Thorough Study of Chemistry in Medicine and the Arts, by
J. H. HiU, M.D., Surgeon U. S. Army. Medical Kecobi>, vol. 22, No. 7. August
J2. 1882. p. 175.
" Science and Culture and other EssayB, by T. II. Iluvley, p. 67. 1882.
Then after setting forth much more that is true of ■
the question, he concludes with this paragraph : f
" No doubt a great deal is to be done by careful selec-
tion of examiners, and by the copious introduction of
practical work, to remove the evils inseparable from ex-
amination; but, under the circumstances, I believe that ex-
amination will remain but an imperfect test of knowledge,
and a still more imperfect test of capacity, while it tells
next to nothing about a man's power as an investigator.''
So much for the standards of the examination of the two
services, and so much for the examinations themselves.
Turning again to the editoiial of the Aledical Times,
we find t' at the remainder of the article, both such parts of
it as we have quoted above and the unquoted portion, es-
sentially calls attention to two things. The first of these
is — Why is it that naval medical officers so seldom arrive
at any degree of prominence, and of a consequence the
naval medical corps is not a celebrated one, and rarely
produces large standard works upon scientific and pro-
fessional subjecfs ; whereas the medical corps of the
Army, not rarely has an officer of distinguished scientific
or professional ability appear in its ranks, and as of a
natural conseijuence the medical corps of the Army has
become famous throughout the world, and the immense
number of its publications are ranked as standard and
classical works, both in medicine and science ? The
second question, to which the reader's attention is called,
is the cause or especial reason for these things.
The Times confines its discussion of the causes for this,
in a desultory sort of a way, to the naval side of the ques-
tion, suggesting two reasons — the first, " that salt air is a
veritable lotus-flower, soothing into an irresistible indo-
lence him who breathes its miasm ; " the second, the short
length of time that the Surgeon-Oeneral of the Navy holds
his position. Both of these reasons bear with them a
great deal that is true.
In the first case it is not so much the soothing influ-
ence of the salt air, as it is that "a rolling stone gathers
no moss ; " the exceedingly cramped space that one has
to work in aboard ship, the limited appliances and
books, the action of salt water and air in destroying
these, more or less motion of the ship at nearly all
times, the noise and excitement in port, and all such
matters are eminently antagonistic to long ana pains-
taking research, from which alone flow such volumes as
the editor of the Medical Times so complimentarily
alludes to as having been produced by medical officers
of the Army. It might be asked. How is it, then, that such
explorers as Darwin (" Five Years at Sea in the Beagle "),
Wallace and Bickmore ("In the Malay Archipelago"), and
numberless others, have i)roduced such beautiful works
as the result of their explorations? It must be remem-
bered that these gentlemen start out thoroughly equipped
for the work, that the ship is practically given up to their
collections, and tlie books are written at home during
the many years of quiet life that follows.
With reference to the short term of office of the Sur-
geon-(jeneral of the Navy, as being one of the causes
militating against the production of extensive scientific
work in the corps, the editor has evidently hit one of the
principal nails on the head, and his (luestion — " How long
would any business enterprise thrive whose management
was changed every year or two?'' — is easily answered.
We may say here, too, that little risk was attached to his
prediction, and it has since proved true, as to what the
history of the medical cor|)s of the Navy would do under
the wise regime of Dr. Wales. This able thinker and
author, at once gatiicred those about him of his corps,
who had shown special aptitude for either medicine or
science, upon some occasion or another, and the effect
was immeiliately apparent in the birth of the Naval
Medical and Surgical Society of Washington, with its mu-
seum and the scientific and professional jjapers of numer-
ous medical officers, all of which will pass Dr. Wales'
detail down into the history of the medical corps of
the Navv, as one of the most advanced and highest
August
25. 1883.]
THE MEDICAL RECORD.
203
of its epochs, and one to which his name will be forever
linked.
When the editor of the Medical Times asks the ques-
tion, as he does in the paragraph we have quoted, "Where
is the Dr. Coues of the Navy ? " it seems to carry with it
that such geniuses are the creation of the Army or the
Navy, per se, whereas such by no means is the case. The
Navy has been, so far, unfortunate, notwithstanding the
fact that they employ the same means that the Army does,
in not having captured such a mind to add lustre and
fame to their corps, for it is through the scientific works
of such men that any organization becomes famous ; or,
indeed, known at all. Is it surprising that when we
have a board composed of three or four cultured men,
sitting almost continuously throughout the year, and in
that time examining from one hundred to two hundred
young men, graduates of medicine, and often of the high-
est classical universities in our land ; in short, having the
pick of the best material of such a vast country as ours,
that they should occasionally find a genius in their net ?
Never lose sight of the fact that Dr. Coues would have
been Dr. Coues anyway ; that Dr. Billings would have
been Dr. Billings anyway, and so on for such lights as
our Drs. Woodward, and Otis, and Beaumont ; and, un-
doubtedly, I could have added Dr. Flint, but he slipped
through the meshes, though he has been Dr. Flint any-
way. Such minds are the outcome of our civilization,
and they are no more the property of the .<\rmy than they
are of our noble country at large. .^11 the .'Vrmy can do
— or, jjerhaps, I had better say the Government — is to
see well to it, for the credit of our country, that the soil
on which she places such men is adapted to their growth
and not to their death ; or, what is almost as bad, if not
actually worse, where they become distorted and stunted
shrubs, of no credit to anybody. That the Government
does not always do this Dr. Coues himself will tell you."
It is the bristling front of our entrance examination
that guards the portals to our corps, like Leonidas did
the Thermopylsean pass, that makes it possible to add
such men to our number, and it is a matter in the hands
of the Government afterward whether the country gets
the greatest amount of good out of them. Remove this
safeguard and the countless horde of Persians would in
a twinkling annihilate our fame, and our little body of
three hundred and a few odd would smk out of sight
and be no more heard of than an equal number chosen
at large over our vast frontier.
Emerson has shown us, as only he could, how such
geniuses are produced ; ^ and Huxley clearly defines their
rarity when he tells us " but a small percentage of the
population is born with that most excellent quality, a de-
sire for excellence, or with special aptitudes of some sort
or another. jMr. Galton tells us that not more than one
in four thousand may be expected to attain distinction,
and not more than one in a million some share of that
intensity of instinctive aptitude, that burning thirst for
excellence, which is called genius. Now, the most
important object of all educational schemes is to
catch these exceptional people and turn them to
account for the good of society. No man can say
where they will crop up ; like their opposites, the
fools and knaves, they appear sometimes in the palace
and sometimes in the hovel ; but the great thing to be
aimed at — I was almost going to say the most important
end of all social arrangements — is to keep these glorious
sports of nature from being either corrupted by luxury or
starved by poverty, and to put them into the position in
which they can do the work for which they are specially
fitted. Thus, if a lad in an elementary school showed signs
of special capacity I would try to provide hmi with the
^ A Criticism, by Dr. Elliott Coues, in the Nuttall Ornithological Bulletin. Cam-
bridge, Mass., vol. viti.. July, 1883, page 166, on Contributions to the .Anatomy of
Birds, by R. W. .Shufcldt, M.D. [etc.], author's edition, extracted (in advance)
from the Twelfth Annual Report of the late United States Geological and Geograph-
ical Survey of the Territories (Hayden's). 8vo, title and pp. 593-806, Pj^**^*
i.-xxiv., many woodcuts in text. Washington : Government Printing Ornce,
October 14, 1S82.
2 Conduct of Life, p. 113 et seg.
means of continuing his education after his daily working
life had begun ; if, in the evening classes, he developed
special capabilities in the direction of science orof draw-
ino- I would try to secure him an apprenticeship to some
trade in which those powers would have applicability.
Or, if he chose to become a teacher, he should have the
chance of so doing. Finally, to the lad of genius, the
one in a million, I would make accessible the highest
and most complete training the country could afford.
Whatever that might cost, depend upon it the investment
would be a good one. I weigh my words when I say
that if the nation could purchase a potential Watt, or
Davy, or F'araday, at the cost of a hundred thousand
pounds down, he would be dirt-cheap at the money. It
is a mere commonplace and everyday piece of knowledge
that what these three men did has produced untold mil-
lions of wealth, in the narrowest economical sense of the
word." '
Quite recently an officer expressed his surprise to me
that Dr. Billings ever made the renowned bibliographer
that he is. " Why," he said, " when I first knew him he
was doing scarcely anything except looking at fungi
through a microscope!'' "Sir," I could only reply,
" your surprise is no greater, probably, than that of many
other officers of every branch of the service, who have ^
said of Dr. Coues, in the early days of his scientific work,
that ' he was working to the detriment of his profession,'
and many other such sentiments, when Dr. Coues to-
day fills with the highest credit the chair of anatomy, the ^
study which is the foundation of all medicine, in a uni-
versity that nearly every year supplies one or two young
officers to the medical corps of the Army and Navy."
For the growth of medicine and science let us do all
we can to prevent the rendering axiomatic of Dean .Swift's
famous phrase, " When a great genius appears in the
world the dunces are all in confederacy against him."
It is impossible to tell, from such biological studies as
a young man may take up in the early part of his career,
where they will land him ; and it is more than likely that
a great deal of his work will come to be of practical
utility — some day. To support this one has to think but
for an instant, and the intelligent physician and scientist
not at all, what the knowledge of the anatomy of mam-
mals, birds, reptiles, or, in fact, any of the lower orders
of vertebrates has done for our science of medicine.
It will be granted that a knowledge of the anatomy of
the form operated on is essential before many of those facts
could be demonstrated that require such delicate manip-
ulation, and upon which nearly all of our great truths in
physiology depend. Let any one take either of those
magnificent volumes of Dr. Flint or Dr. Dalton and clip
out, with a pair of scissors, all such parts as where a
knowledge of the anatomy of the vertebrates is required
in some way or another, or where our knowledge of
some physiological truth has been obtained through such
media, and note the shrinkage. We all know that our
science of medicine hangs upon the four fundamental
branches of anatomy, physiology, chemistry, and physics.
Now what would become of this science if the experi-
ment I have just mentioned could be applied to all such
literature back to the days of Aristotle ? Simply that the
science of medicine would travel backward half that dis-
tance itself, to put the mildest construction on it.
In conclusion let us wish that during these long days
of peace the many changes required in the medical ser-
vice of the Navy may be brought about, such as the es-
tablishment of their actual rank by act of Congress, as it
is in the Army, so that a medical officer may command
in his own sphere of action, and that the term of surgeon-
generalship be made for a longer term of years— for rea-
sons we have already set forth.
It is to hoped, that with us in the Army, the re-
quirements of the first examination be, if anything, made
still more rigid, more searching into the moral, mental,
' Science antl Culture, p. 90.
204
THE MEDICAL RECORD.
[August 25, t!
and physical attainments and conditions of the candi-
dates presenting themselves ; in short, of so severe a
nature as to annihilate the second examination, and ren-
der the necessity for its very existence useless ; that
the present retirement bill, or any other act of Congress,
will ever operate so as to prevent the Surgeon-General
from holding his office for a less period than twelve or
fifteen years, and that he will be chosen, as heretofore,
for his executive ability or professional and scientific at-
tainments ; that encouragement will always be extended to
those who have shown special excellence and progress in
professionalor scientific work. And one other matter which
my space has not allowed me to refer to, is that the day
is not far distant when we will see a separate, beautiful
in point of design, and substantial edifice shielding our
many thousand volumes of valuable professional books,
our chemical laboratory, and a museum of surgery, medi-
cine, and comparative anatomy, of which Eric Erichsen
has said, after he had reviewed it in its present tumble-
down building : " Ah ! gentlemen, we have nothing like
this in England ! "
TREATMENT OF TYPHOID FEVER.'
By I. P. KLINGENSMITH, M.D.,
DERRV STATION, PA.
EX-PRESIDENT WEST.MORELA.ND (P.\.) COUNTY MEDICAL SOCIETY.
The object of this paper is not to enter into the history,
pathology, and etiology of the disease in question, but to
bring before the Society a method of managing typhoid
fever as employed in my practice during the past two
years, and which has yielded most satisfactory results in
the cases in which it has been carried out. In order to
economize time and bring the subject more fully before
you at once, I will proceed to sketch the plan of treat-
ment briefly :
When I find the patient to have typhoid fever, or when
his symptoms indicate that the disease is about to de-
velop, I order him to bed and put him on a liquid diet
consisting of milk, beef-tea, or animal broths. I then
order the following mixture, as recommended by Bar-
tholow :
IJ . Tr. iodinii 3 ij.
Acidi carbolici 3 j.
M.
Of this mixture I direct three drops to be given in a
wineglassful of iced or cold water, three times daily, after
meals, and which is continued until convalescence is well
established. As a rule this medicine is well borne by
the stomach, and occasions no disgust on the part of the
patient. Partly for its favorable influence upon the skin,
for the sake of cleanliness, and also the slight influence
upon the temperature, the patient is sponged twice daily
with equal parts of alcohol and water, or in some cases,
where more grateful to him, with tepid water.
When I find the evening temperature to reach 103° F.
quinine in large doses is administered, upon a falling
temperature. I usually direct at least thirty grains to be
given, one-half the quantity at 5 a.m., and remainder
if deemed necessary at 5.30 or 6 a.m.
This quantity, as a rule, will lower the temperature
from 2.5° to 3.5° for the next forty-eight hours, after
which it may be found necessary to repeat the medicine.
In a few cases where the temperature has reached 106°
F. I have given ([uinine amounting to fifty and even sixty
grains, succeeding most happily in reducing the tem])era-
ture without any sustenance of injury to the patient.
For the relief of the headache in the early stage of the
disease I find the following to answer the indications :
IJ. Quiniffi sulph gr. ij.
Ex. belladon gr- i
M. et ft. in pilula. Sig. — One pill every three or
four hours.
' Read before the Weslmoreland Couuty (Pa.) Medical Society, May i, 1883.
Alcohol is not often indicated until after the close of
the third week, unless by reason of the habits of certain
patients it may be necessary throughout the attack. In
the event of heart-failure it must be administered accord-
ing to the exigencies of the particular case. A majority
of patients do well without taking it at all. Should the
diarrhcea become excessive I direct a pill as follows :
5- -Argenti nitratis g""- ^•
Pulv. opii gr. j.
M.
To be given every four hours until brought under proper
control. On the other hand, should obstinate constipa- M
tion intervene, I never hesitate to give a dose of calomel, ■
unless there are reasons to suspect serious intestinal
lesions, in which event the bowels may be emptied by
enemata.
To prevent hypostatic congestion of the lungs, the
patient is turned upon his side from time to time. As
an invariable rule from the recognition of the disease the
patient must maintain the horizontal position until con-
valescence is well established.
During the sickness the patient should have a compe-
tent nurse, whose duty it is to attend to the punctual
administration of the medicines and diet. A liquid diet,
consisting of milk, beef-tea, or other animal broths, must
be given every two or three hours. Perfect quiet must
be maintained in the sick room, all visitors being posi-
tively excluded. The room should be kept darkened,
all pictures and paintings removed from the walls, and
the medicines kept out of sight of the patient. Perfect
ventilation must be secured. To avoid establishing a
focus of contagion, the dejections must be systematically
disinfected immediately after being voided.
The total number of cases treated by this plan is fifty-
two, with a recovery of all. Of the cases, twenty-eight
were severe, the temperature in three reaching 106° F.,
and in the other twenty-five 103.5° '^ 104°. In three of
the cases a mild attack of rheumatism set in during con-
valescence. In two cases a severe relapse from indiscre-
tion in diet prolonged the disease. The average duration
of the severe cases was about thirty days, and of the
milder about twenty-six days.
You will observe that the remedy employed is
iodine in combination with carbolic acid, which no
doubt prevents the multiplication of germs in the intes-
tines, checks fermentation, and maintains an antiseptic
action in the blood. Also the judicious administration
of quinine in doses sufficient to control the temperature.
The success attending this plan of treatment in my
hands encourages me to continue it further ; and, in
conclusion, I will say in its behalf that any who may give
it a fair trial will be favorably impressed, and feel that
they have put a different complexion on the statistics of
mortalitv.
The Sale of Impure Cream of Tartar. — A convic-
tion was recently had in the Court of Special Sessions of
this city for a violation of the Food and Drug Adultera-
tion Law of 1 88 1, in the sale of an impure article of
cream of tartar. Only a small fine was imposed ; but as
the cream of tartar had not been sold as a drug but by a
grocer in the course of his trade, it was thought of suffi-
cient importance to appeal. This was done, and not
long since the conviction was reversed, the Court holding
that where the defendant proved that he had bought the
cream of tartar sold by him from a dealer in the open
market ; that before buying it he had inquired for the
best article, and had been told by the dealer that what
he purchased was the best ; that -he paid the highest'
market price for it, and believed that he was purchasing
a pure article and the best, and that he sold it believing
it was a pure article. Under these circumstances no
criminal intent or criminal negligence had been made out
and no offence proved.
August 25, 1883.]
THE MEDICAL RECORD.
205
PEROXIDE OF HYDROGEN IN PURULENT
INFLAMMATIONS OF THE EYE.
By Le ROY POPE WALKER, M.D.,
HOUSE SUFOEON NEW YORK EVE AND EAR INFIRMARV.
I'OR ihe introduction of peroxide of hydrogen in opluhal-
mic practice, we are indebted to Landolt, who, after an
extended and careful trial proves it to be of undoubtedly
great value.
In a very able paper on the subject {Archives (T Oph-
thalmologie, September and October, 1882) he gives
a large amount of highly mteresting information con-
cerning the properties of hydrogen peroxide which it
would be well for those wishing to try its effects to read.
"Peroxide of hydrogen (H^O,) is ordinarily prepared
by the action of dilute acids on tlie peroxides of the .alka-
line earths. The hydrated peroxide of barium is decom-
posed by dilute sulphuric acid, so as to form sulphate of
barium and peroxide of hydrogen. The solution ob-
tained in this way contains three per cent, of its weight
of pure peroxide of hydrogen, and is sufficiently strong
for medical purposes. The dilute solution is a clear,
colorless, inodorous liquid, with a taste something like
that of cress" (Ophthalmic Revie^v).
It is said to retain its properties unaltered for years,
if kept at a temperature below 70° F. and well pro-
tected from light. It should also be wall stoppered, as it
rapidly deteriorates if exposed to the air. One of the
peculiarities of hydrogen peroxide is the readiness with
which it yields free oxygen.
Pus is one of the many substances remarkable for the
energy with which it causes the liberation of oxygen.
Hydrogen peroxide is also a powerful agent in prevent-
ing and arresting fermentation. " It is probable that
the peroxide of hydrogen when subjected to the catalytic
action of bacteria, reacts upon them and renders them
inert. Excellent results have been obtained in the treat-
ment of wounds by this substance."
For the eye it has special advantages as an antiseptic ;
for, unlike many other so-called antiseptics — -notably
carbolic acid, bichloride of mercury, alcohol, salicylic
acid, etc. — it can be used without danger, and of suffi-
cient strength to be effective.
" When the solution is applied to a conjunctiva af-
fected with purulent inflammation, a froth, resulting from
its catalysis by the secretion is instantly produced. The
inflammatory products are not destroyed by it, but their
physical condition is so altered that they are readily re-
moved from the inflamed surface and all septic action
arrested, the micro-organisms in the pus being killed
by the nascent oxygen. The conjunctiva, examined ten
minutes after the api)lication, is found covered with a
layer of fibrin which will again catalyse the solution.
After two or three applications the exudation is nuich
diminished, and with each repetition the froth becomes
less and less until it is hardly formed at all ; pathological
secretion is then at an end."
The application produces a sensation of pricking and
burning, amounting often to severe pain, which, however,
soon passes off. It has been found speedily eff'ective in
purulent conjunctivitis, in which boracic acid and iodo-
form had been tried without result.
In cases of corneal ulcer, with purulent infiltration, its
action has been surprisingly good. In fact, it has been
my experience that it is much more potent in corneal
processes than affections of the conjunctiva. Landolt's
method of using it is to instil a few drops of the solu-
tion into the conjunctival sac two or three times in an
hour, at intervals of ten or fifteen minutes, bringing the
solution thoroughly into contact with the affected surface.
I have found it fully as effective when used once in
two hours, instilling a dozen to fifteen drops at a time,
and much less irritating than when used after the manner
of Landolt, for it is to a certain extent an irritant, and
its too frequent application may prevent the beneficial
results which it is desired to obtain. I also take the pre-
caution to thoroughly cleanse the parts with a saturated
solution of boracic acid, before again using it, and if this
is not sufficient I remove the layer of fibrin with a delicate
pair of forceps.
In purulent ophthalmia;, after an abatement of the
secretion, I have found it best to discontinue the use
of the hydrogen peroxide, as its action is now nil, and a
return to its use should not be made unless there be a
return of the jnirulent secretion.
Landolt has met with very great success with this
remedy in the treatment of suppuration of the lachrymal
passages, and considers it vastly superior to bichloride
of mercury, boracic acid, etc.
The subjoined cases, will, 1 think, go far to prove the
efficacy of peroxide of hydrogen in ulcerative and purulent
jirocesses in the eye. A solution was obtained in April,
1883, by Professor H. D. Noyes, and at his suggestion I
first tried it in a number of cases in his service. Since
then I have had the opportunity of observing its good ef-
fects in cases occurring in the practice of other members
of the stafl", and by their courtesy I am enabled to present
the following notes :
Case I. (Hospital No. 7,026). — J. R , male, aged
thirty-five ; admitted June i, 1883 (service Dr. Callan).
General health good. Examination showed a large ser-
piginous ulcer in the centre of the cornea. Pain and
great photophobia. Ordered hot applications constantly
and a solution of atropia (grs. ij. to 3J.) t. i. d.
Second day. — Corneal process extending, and threaten-
ing to perforate. A Saemisch section was done, carrying
the knife entirely across the cornea, and through the
centre of ulcer.
Seventh day. — Eye showing no signs of improvement,
a solution of hydrogen peroxide (one per cent.) was in-
stilled every two hours, and atropia t. i. d. ; heat con-
tinued.
Ninth day (second of hydrogen peroxide). — Process
arrested, and edges of ulcer clear cut and surface clean.
Patient entirely free from pain.
Thirteenth day (third of hydrogen peroxide). — Ulcer
healing rapidly. Injection disappearing.
Fourteenth day (fourth of hydrogen peroxide). — Pa-
tient left hospital, with directions to occasionally use
solution of peroxide of hydrogen at home. Came back
three weeks later to report. Ulcer entirely healed, and
only a small macula remaining, as evidence of previous
trouble.
Case II. (Hospital No. 7,757).— A. C , male, aged
twenty; admitted June 22, 1883 (service Dr. Moore),
with a gonorrhceal ophthalmia of left eye, of forty-eight
hours' standing. General health fair. Both lids much
swollen and bathed in pus ; chemosis marked, and cor-
nea slightly hazy. Right eye immetliately sealed with a
watch-glass, for protection. Lids of affected eye were
touched with a ten-grain solution of silver, and a one per
cent, solution of peroxide of hydrogen was instilled every
half hour. Atropia (grs. ij. to |j.) t. i. d., and ice com-
presses constantly.
Second day. — Secretion much diminished, swelling,
and tension of lids less, and corneal process arrested.
Solution of hydrogen peroxide now instilled every hour.
Third day.— Swelling of lids steadily decreasing; che-
mosis much less and secretion reduced fully one-half;
cornea clear. Patient free from pain. -A saturated so-
lution of boracic acid has been injected between lids
every half hour. Solution of silver continued once
daily.
Fifth day. — Patient is now able to open eye to a lim-
ited extent, and swelling of lids, chemosis, and secretion
rapidly disappearing.
Ninth day. — Solution of hydrogen peroxide discon-
tinued, as secretion had entirely ceased, and cornea re-
mained clear. Is now able to open eye fully one-half.
Cold, silver, and atropia continued.
Thirteenth day.— The solution of silver, grs. x. to § j.,
changed to a solution of grs. v. to ? j. Ice applied four
206
THE MEDICAL RECORD.
[August 25, 1883.
times daily, for half an hour at a time, instead of con-
stantly, as heretofore. Atropia twice a day, and solution
of boracic acid injected between lids once every three
hours. Injection of conjunctiva nearly all gone.
Eighteenth day.— Ice discontinued and a cold solution
of boracic acid substituted, to be used t. i. d. Solution
of silver (grs. v.) continued, to prevent granulations.
Twenty-second day. — Patient discharged entirely
cured. Cornea without a blemish.
Case III. (Hospital No. 8,086).— D. G , male,
aged fifty; admitted June 30, 1883 (service Dr. Callan),
with a central ulcer of cornea. Patient run down and
suffering from chronic malarial poisoning. Was put on
use of hydrogen peroxide (one per cent.) immediately,
instillations every three hours, atropia(grs. ij. | j.) t. i. d.,
and quinia; sulph. (grs. v.) twice a. day.
Third day. — Ulcerative process arrested and evi-
dences of repair beginning. Patient free from pain.
Fifth day. — Patient left hospital, well on way to com-
plete recovery.
Case IV. (Hospital No. 8,168).— A. VV , female,
aged twenty-nine : admitted July 5, 1883 (service Dr.
Moore), with a gonorrhceal ophthalmia of both eyes. In
right eye ophthalmia of three, and in left of two days'
duration. General health goo^. Lids of both eyes tense
and much swollen ; abundant secretion; chemosis marked,
especially in right eye ; cornea of right eye hazy ; cornea
of left eye clear. Fmding great difficulty in everting
lids, and owing to pressure on cornea, a double cantholy-
sis was done immediately, followed by free hemorrhage,
which was encouraged. The lids of both eyes were
touched with a ten-grain solution of silver, and ice com-
presses ordered constantly. Atropia (grs. ij. to 3 j.)
t. i. d., and solution of hydrogen peroxide (one per cent.)
instilled in both eyes every hour. Every half hour a
saturated solution of boracic acid was injected between
the lids.
Second day. — Secretion much less and swelling of lids
reduced ; no pain ; cornea of right eye slightly more
hazy ; cornea of left eye clear ; chemosis in both eyes
nmch the same.
Fourth day. — A small ulcer developed in right eye,
but haziness, which two days previous had been rather
diffuse, now limited and of superficial character ; cornea
of left eye clear and chemosis nearly all gone ; very
little secretion, and swelling of lids much reduced. Solu-
tion of silver discontinued in left eye.
Sixth day. — Ulcerative process confined, but the hazi-
ness again extending over upper portion of cornea of
right eye. Ice changed to hot applications, and hydro-
gen peroxide (three per cent.) instilled hourly. Left eye
steadily improving ; no secretion ; lids of normal thick-
ness, and patient is able to open her eye.
Seventh day. — In right eye secretion much increased
by heat, but ulcer looks better and is not extending.
The slight haziness observed day before gone. Left eye
doing as well as possible ; ice continued occasionally.
Twelfth day. — Ulcer in right eye much improved and
secretion rapidly disappearing ; swelling of lids and
chemosis less ; silver discontinued. Left eye practicallv
well, only a slight injection remaining.
Seventeenth day. — No secretion from right eye. Xo
chemosis, and swelling of lids all gone. Ulcer shows
signs of healing. Able to open eye one-half. Heat,
atropia, and hydrogen peroxide continued.
Eighteenth day. — Conditions much the same. Solu-
tion hydrogen peroxide discontinued. Boracic acid solu-
tion (saturated) injected between lids every hour.
Twentieth day. — Ulcer nearly well ; very little injec-
tion ; able to open one eye fully. Heat applied twice a
day; atropia, t. i. d. and solution boracic acid four times
daily. Left eye entirely well.
Twenty-first day. — -Ulcer healed, and only evidence of
disease remaining is a slight conjunctival injection. All
treatment stopped.
Case V. (Hospital No. 8,418).— M. J , female.
aged twenty-five ; admitted July 13, 1883 (service of Dr.
Minor), with a suppurative keratitis of left eye, involving
entire cornea, result of burn from chloride of lime.
General health good. A Saemisch section was made,
carrying cut entirely across cornea, thereby liberating a
large quantity of pus, which entirely filled lower two-
thirds of anterior chamber. A solution of hydrogen per-
oxide (one per cent.) was ordered instilled every two
hours ; hot applications constantly and atropia (grs. ij. to
3J.)t.i.d.
Second day. — Cornea, which yesterday it was feared
would slough away as a whole, now shows signs of clear-
ing and the patient is free from pain.
Third day. — Corneal suppuration is arrested and is
gradually clearing, especially in upper and outer margin.
Ninth day. — The cornea has steadily cleared and the
iris is distinctly visible through upper half Instillations
of [hydrogen peroxide continued every two hours and
atropia and hot applications as before. ■
Tenth day. — Lower portion of cornea is now clear ■
and there only remains a small central spot that is
cloudy. Injection rapidly disappearing and the patient
is able to open her eye fully.
Twelfth day. — Very slight injection remaining and eve
well.
FOREIGN BODY IN THE TRACHEA OF AN
INFANT EIGHT MONTHS OLD — TRACHE-
OTOMY—RECOVERY.
By a. SCH.VPRINGER, M.D.,
NEW YORK.
James M , eight months old, of 345 East Sixtieth
Street, was brought to my office on June 6, 1883, on
account of alarming dyspnoea which had supervened
suddenly the same morning while he was eating a slice
of an orange. The child had first been taken to a neigh-
boring drug store, where a dose of syrup of ipecac was
administered. This brought about vomiting, without,
however, relieving the dyspncea. When first seen by me,
the child was cyanosed. Both inspiration and expiration
were labored. Auscultation over the trachea revealed
a rattling sound both on inspiration an expiration. The
latter was brought to a sudden stop, a peculiar click.
The rattling was perceptible to the touch also. These
signs left no doubt as to the presence of a movable ob-
struction in the windpipe. After a few ineffectual at-
tempts to remove it by inversion, the child's condition in
the meanwhile becoming more and more alarming, I per-
formed tracheotomy, assisted by Dr. A. Fridenberg and
Messrs. Tynberg and Schulmann, students of medicine.
The child was given a few whiffs of chloroform. The
hemorrhage was slight, but one vessel requiring to be
secured. The trachea was scarcely opened when the for-
eign body was expelled through the perforation by a fit
of coughing. It proved to be an orange-pit. Regularity of
respiration not becoming re-established after the lapse
of a few minutes, a flexible catheter was introduced and
a small quantity of blood and mucus removed by aspira-
tion. In about twenty minutes the child had so far re-
covered that I could proceed to close the wound. I
first united the lips of the tracheal incision by a few silk
sutures, and carried the ends of the threads through both
the upper and lower angle of the integumentary incision,
which I closed by a separate row of sutures. I avoided
including the mucous membrane in the tracheal sutures.
Catgut, which would have been preferable to silk, was
not accessible. The wound healed by first intention,
with the exception of the angles where the threads of the
deep sutures had been led out. These could be removed
after the lapse of a few days. The little one has been
well ever since.
The interest of this case centres in the fact that there
is no record, in this country at least, of so young a child
having survived tracheotomy for the removal of a foreign
body.
236 East Si-vtieth Street.
August 25, 1883.]
THE MEDICAL RECORD.
207
ON THE TREATMENT OF EPILEPSY."
By professor DUJARDIN-BEAUMETZ,
ME^ISKR OF THE ACADEMY OK MEDICINE, AND PHYSICIAN TO THE HOPITAL
ST. ANTOINR, I'ARIS, FRANCE.
C.ENTi.EMEN : I devote this lecture to the treatment of
that most formidable of the neuroses — epilepsy. When
we survey the numerous remedies which have been pro-
posed for this disease — remedies often uncertain and in-
eflficacious — we easily comprehend the discouragement
and despair of many physicians who have pronounced
epilepsy incurable ; moreover we see why the ancients
attributed a divine origin to this affection, for to them
the words morbus sacer, morbus liivinus, testified sulH-
ciently that the disease was generally above the resources
of their art. But this feeling of discouragement ought
no longer to e.xist. We have already found in the bro-
mides a remedial agent which enables us to cure one half
our epileptic patients, and we may be permitted to in-
dulge the hope that some day we shall find a remedy still
more powerful, which shall give us complete mastery of
the disease. For tliis end we shall labor, and with all
zeal.
It may almost be said that every medicine under
heaven has at one time or anotlier been prescribed for
epilepsy. Do not then expect from nie an enumeration
of this long list of medicaments ; I shall merely touch
upon a few of them to lay particular stress on such as
expetience has proved efficacious. To give some system
to my exposition, I shall divide the treatment of epilepsy
into two parts : first, general treatment ; second, treat-
ment of the attack. In order to grasp the principles
of the general treatment it is necessary to enter some-
what into details respecting the pathogeny of this affec-
tion. Sometimes epilepsy is manifestly dependent on a
lesion of the nervous system, it is then symptomatic ;
sometimes no lesion is apparent, and we call the epilepsy
essential.
As for symptomatic epilepsy, experimental phy.siology
and clinical observation have given us certain proofs of
the influence of lesions of the nervous system on the
development of this neurosis. Brown-Secpiard by his
curious experiments on guinea-pigs has shown us that
epilepsy may be produced by section or ablation of the
sciatic nerves, and what is stranger and still more inex-
plicable, that this experimental epilepsy aflfects not only
the animal so mutilated, but also its offspring, so that
epileptic guinea-pigs, in consequence of lesions of the
sciatic nerves, ever afterwaril have epileptic progeny.
The same symptoms are produced in certain lesions of
the spinal marrow or cerebrum. Westphal rendered
guinea-pigs epileptic by blows on their heads. Hitzig,
Eulenburg, and Landois by irritating the motor cortical
centres of animals by mechanical and chemical agents,
and by electricity, brought on attacks of epilepsy. Points
have been localized in the cerebro-spinal axis whose ex-
citation prodnces epilepsy, and Albertoni and Koloman-
Balogh have given precise directions in this regard.
Roberts Bartholow has gone even farther, and in a pa-
tient the surface of whose brain was denuded to some
extent, he has produced epileptiform convulsions by ap-
plying electricity to the exposed cortical substance."
Clinical observation strikingly confirms these experi-
mental facts, and the annals of medicine contain a vast
number of cases where wounds and irritations of nerves
have determined epilepsy, and where it has sufficed to
remove the vicious cicatrix, or the foreign body embedded
in the tissues, in order to obtain a permanent cure. In
other instances the epilepsy has resulted from injuries or
compressions of the cerebral substance, by spiculaj of
* Translated (by permission) from .idvance sheets for The Medical Record by
E. P. Hurd, M.I)., Ncwburyport, Mass.
2 Brown^S^quard : Researches on Epilepsy, its Artificial Production in Anim.i]s,
and its Ktiology, Nature, and Treatment in Man, Boston, 1857 ; Pietro Albertoni ;
Influence of the Cerebnim in the Production of Epilepsy, Milan. 1S76 : Roberts
Bartholow : Experimental Investigation into the Functions of the Human Brain,
Am. Jour. Med. Soc, .A.pril, 1874; Westphal: Berhner klinische Wochcn-
schrift, Nos. 24 and 39, 1871 ; Vulpian : Epilepsy in the Guinea-pig after Section
•of the Sciatic Nerve.
bone, by abscess, by tumors ; the removal of the bony
splinters or the disappearance of the tumors has brought
about complete cure.
It is in cases of this kind that the application of the
trepan in the treatment of symptomatic epilepsy gives
good results. Extolled by the ancients in an empirical
fashion, the trepan has of late years found its legitimate
place, a place, in fact, of such importance that we have
seen in .\merica an eminent surgeon perform this opera-
tion for the cure of epilepsy twenty-three times in five
years, and obtain seven complete recoveries. Echeverria,
in his interesting statistics, gives the results of one hundred
and forty-five cases, ninety-three of which were perma-
nently cured by the trepan.'
In the same group we place anti-syphilitic medication,
for oftentimes the relation which exists between this neu-
rosis and syphilis is explained by the presence of gum-
mata, or bony tumors compressing the brain and spine,
and it is tpiite clear, as Fournier and Dreschfeld have
shown, that in cases of this sort the specific is the
proper treatment for the neurosis. In this same cat-
egory we must place epileptiform convulsions due to the
presence of worms in the intestines, and which disapjiear
with the expulsion of the offending cause. In this group,
too, we nnist place those cases of epilepsy connected
with troubles of the genital functions, for the relief of
which Marshall Hall pro[)Osed castration.
It was formerly maintained that epilepsy results from
a chronic inflammation of the brain and spinal cord ; a
variety of epilepsy even was described under the name
of plethoric epilepsy. Morgagni, Fothergill, and others
defended this doctrine of the constant intiammatory origin
of epilepsy, hence their antiphlogistic treatment, which
consisted in blood-letting and the most powerful deriva-
tives, such as cauteries, blisters, and setons. This kind
of treatment is now a thing of the past ; it gave no cer-
tain results of any value, and was based on a hypothesis
which the recent anatomo-pathological researches on es-
sential epilepsy have not confirmed.
We know that since the labors of Schroeder-Van der
Kolk and Echeverria, the post-mortem disclosures in
deaths from epilepsy have generally been alterations of
the medulla oblongata, characterized by an intercellular
albuminous exudation and capillary ectases. It may,
however, be reasonably affirmed that these lesions are
the consequence rather than the cause of attacks of epi-
lepsy. Nevertheless, the rachidian bulb has a predomi-
nant part in epilepsy, and it is by modifications of its
functions that we best exi>lain the convulsive paro.xysms.
The first phase of the attack, that which corresponds
to the initial outcry, to the loss of consciousness, and to
the tetanic contraction of all the muscles of the economy,
would seem to result from an excitation of the medulla
oblongata, sufficient to cause sudden anaemia of the cere-
brum and of the bulb itself. Next comes the asphyxia,
consequence of this tetanic state, and the passive con-
gestion of the cerebro-spinal axis which it produces.
Next in order is a period of reaction, in which the
accumulation of venous blood in the encephalon and
spinal cord determines clonic convulsions everywhere,
the respiration is stertorous, the face is blue, the attack
terminates with exhaustion of the nervous centres impli-
cated. In these phenomena the medulla oblongata is
principally concerned, and the therapeutic indication is
plain ; every medicament which tends to diminish the
excitability of the medulla oblongata, and the cerebral
anremia which results from it, is ap|)licable to the treat-
ment of epilepsy. But before beginning the considera-
tion of the physiological treatment of epilepsy, I will say
a few words about the empirical treatment.
Certain simple herbs have enjoyed a great repute in
the treatment of epilepsy, and the common people have
accorded heroic curative virtues to a number of indigen-
* Trepanning in Epilepsy, Boston Medical and Surgical Journal, 1872 : Eche-
verria : .Arch, de Med, de Paris. 1S7S, t. ii., p. 529 : J. Mason Warren : Boston
Medical and Surgical Journal, 1867.
208
THE MEDICAL RECORD.
[August 25, 1883
ous plants which deserve a brief mention here, as their
anti-epileptic properties have been endorsed by certain
physicians.
Galium vernni and galium mollugo ("white cheese
rennet," " yellow ladies' bedstraw," are the familiar
names) are reputed as having quite special virtues in
the treatment of epilepsy, and we are frequently referred
to the observations of Jourdan and Miergues, fils. I be-
lieve that even now certain religious communities in
France treat this disease with the expressed juice or an
infusion of this plant.
Valerian is also an ingredient of a great many anti-
epileptic preparations, and its employment in this disease
is supported by a respectable number of eminent names.
I will pass rapidly by hyoscyamus, vaunted by Storck
and Hufeland ; daffodil, employed with success by Du-
frenois, Vieillechese, Delonchamps ; bitter orange leaves,
counselled by I. archer ; peony, extolled by Portal, to de-
vote a moment's consideration to belladonna, which, before
the introduction into therapeutics of the bromides, was one
of the medicaments the most depended on in the treatment
of epilepsy, supported, as it was, by the authority and ex-
perience of Trousseau. Belladonna is given in the form
of pills, each containing one sixth of a grain of the
powder and one-sixth of a grain of'the extract ; dose,
one pill morning and evening the first month, and every
succeeding month you increase the dose by one pill a day
till you arrive at the enormous dose of twentv pills night
and morning.
All these medicaments, belladonna included, are to-day
completely abandoned ; tliey have had to yield their
place to more active and more certain medicines, and I
have only mentioned them here because they belong to
the history of the therapeutics of epilepsy. By the side of
these vegetable substances we must place the mineral
remedies wliich have been prescribed for the falling sick-
ness ; these are especially certain metals, such as silver,
copper, and zinc.
What physiological action can these metallic sub-
stances have in the treatment of epilepsy ? We cannot
say ; possibly we must invoke, in explanation, the strange
phenomena of metallotherapy observed in accordance
with Burq's method. However this may be, silver is ad-
ministered in the form of pills of the nitrate, and in doses
sufficiently large and sufficiently prolonged to ]iroduce
discoloration of all the tissues. They tell a story of an
aide-de-camp of King Louis Philippe, who had been
cured of his epilepsy by this treatment, but whose skin
was changed to a deep blue. I myself saw, twenty years
ago, a man transformed into a negro (blue man they called
hmi) by the internal usage of nitrate of silver, but who,
notwithstanding this kind of poisoning, was not cured of
his disease.
Copper is administered in the form of ammonio-sul-
phate of copper, and is given in the dose of ten centi-
grammes a day in capsules. Zinc is given in the form of
oxide ; Herpin is the most zealous advocate of treat-
ment by this remedy. Out of thirty-six patients treated
by oxide of zinc he obtained twenty-eight cures ; the
dose given was ten centigrammes three times a day, gradu-
ally increased till six grammes were taken in the twenty-
four hours. Like the vegetable treatment above de-
scribed, the metallic treatment of epilepsy has gone out of
vogue, and to-day it is to the bromides that everyone has
recourse.
When Balard, in 1826, discovered bromine, and the
striking resemblances between this substance and iodine
were pointed out, it was proposed to substitute the first
medicament for the second, and it was in the treatment of
syphilitic affections more especially that the substitution
was made. From 1840 to 1S50, in the Hopital du Midi,
the physicians attached to this hospital, and in i)articu-
lar Ricord, employed bromide of potassium in the place
of iodide of potassium. The first labors recording the
results of this treatment, and showing the physiological
and therapeutical properties of the bromide were made
by two internes of the hospital, Rames of Aurillac
and Huette, of Atontargis. The thesis of Rames ap-
peared April 25, 1850, and that of Huette several weeks
after. Five years ago (in 1878) George Huette, in an
excellent monograph on bromide of potassium, showed
us the progress made in the usage of bromide of potas-
sium since the first experimental and clinical studies of
his father in 1850. Those early investigations, while
clearly setting forth the physiological, therapeutical, and
even toxic effects of tiie bromide, made no mention of
any application of the drug to the treatment of the
neuroses, and in particular to epilepsy.
The year following ].ocock, taking up a discovery,
made several years before by a German, Otto Graf, who
had noted in himself a marked depressant action follow-
ing the use of large doses of bromide of potassium, and
in particular, sedation of the genital functions, for the
first time applied these data to the treatment of hystero-
epilepsy and of epilepsy, and out of fifteen cases treated
by the bromide recorded fourteen cures. The name of
Locock ought to be immortalized in the history of med-
icine ; he deserves the gratitude of the whole human
race, because in consequence of his happy discovery of
the use of bromide of potassium in epilepsy, he has en-
abled us to cure one-half our cases.
After the labors of I^ocock came those of Radclifi'e,
Brown-Sequard, and especially of Williams, showing that
one could in five months diminish in a marked manner
the number of attacks in a given number of epileptics.
From this moment, bromide of potassium has been almost
exclusively employed in the treatment of epilepsy, and
the memoirs of Voisin, Legrand du Saulle, Falret of
Lasigue, etc., in our country, show the beneficial results
which may be expected.
Consult these documents, examine the statistics fur-
nished by these physicians, and you will see that in more
than half the cases we may favorably modify the condi-
tion of epilei)tic patients. I say modify, and not cure,
for I range myself on the side of those who contend
that a complete and permanent cure of real epilepsy by
the bromide treatment is rare, without being, neverthe-
less exceptional. But it is possible, in one case out of
every two, to cause the attacks to disappear, on condi-
tion always, of prolonging indefinitely the medication ;
and this is no small blessing. The bromide is, then (in
the words of Legrand du Saulle), the muzzle of epilepsy,
rather than a definite curative medicament.
How ought you to institute the bromide treatment ?
Which bromide ought you to choose ? What are the in-
conveniences of this medicament ? How long ought
you to continue the treatment ? These are questions
which I must now answer.
But I must first of all say something about the phys-
iological action of the bromides. Already, apropos of
diseases of the heart, I referred to the action of bro-
mide of potassium on the economy, and 1 need not re-
peat what I then said. All physiologists are to-day
agreed in conceding to the bromide a sedative action
on the cerebro-spinal axis, and in particular on the me-
dulla oblongata. Jf any point is under dispute, it is not
whether this substance has an elective action on the
rachidian bulb, but whether this action is primitive or
secondary. Some, as Germain S6e and Binz, maintain
that the bromide acts first on the heart, and consecu-
tively, by producing an;cmia, on the bulb ; others, on
the contrary, affirm that the heart is affected secondarily ;
that it is only intiuenced because the medulla oblongata
has been first depressed. This depressant action on the
excito-motor power of the mesocephalon is of marvellous
applicability to epilepsy, since we have just seen that in
this neurosis it is excitation of the rachidian bulb which
determines the congeries of symptoms which character-
ize eiulepsy, and this i)hysiological action explains why
suspension of the convulsive attacks follows the use of
the bromide.
In the bromides what is the active principle? Is it
August 25, 1883.]
THE MEDICAL RECORD.
209
the bromide, or is it the base ? This is a question which
has been much studied, and which seems to us to-day to
be solved. The bromide plays a considerable part in
this depression of the bulbar functions, but the base does
not by any medns remain inactive or inert. And this it
is which explains tlie difference of action of the dift'erent
bromides. We know, especially since the labors of La-
borde, that the salts of potash have a nuich more marked
depressant action than the salts of soda, and that they
have a toxic effect on the heart in particular. Already,
when treating of purgatives, I showed you the difference
which exists between the salts of potash and of soda ;
there is the same difterence between chlorate of potash
and chlorate of soda, as Laborde has shown ; also be-
tween bromide of potassium and bromide of sodium, the
first being more active than the second, while on the
other hand the sodium salt is better tolerated than the po-
tassium salt.
I have made many trials of bromide of sodium in epi-
lepsy, and notwithstanding the considerable doses ex-
hibited, 10 to 12 grammes (150 to 180 grains) a day, I
have never succeeded in arresting attacks either of
petit-nial or grand-mal by this salt. I have, therefore,
been astonished to see in Hammond's remarkable work
on " Nervous Diseases, " that this eminent neuropathol-
ogist gives the preference to bromide of sodium in epi-
lepsy.'
By the side of bromide of potassium we must place
bromide of ammonium, which has a still more powerful
action than the first ; then bromide of calcium, with which
I have never experimented, but which is nmch employed
in America, and especially by Hammond. The latter,
while giving the preference to bromide of sodium, con-
siders bromide of calcium superior to the potassium salt ;
one gramme producing a sleep which is calm and re-
freshmg. His vehicle of administration of the calcium
preparation is syrup of the lactophosphate of lime.
I have enumerated the alkaline bromides, of which the
most employed is assuredly bromide ofpotassimn. These
bromides are often associated in prescription, a mode of
administration called the inixed bromides.
There are other bromide compounds which are some-
times given, as the bromide of zinc and bromide of cam-
phor. Theoretically, the zinc bromide should be a good
preimralion, since zinc oxide possesses anti-epileptic
properties, as we have before seen. Bromide of zinc is
used in England and America in the form of a syrup.
Hammond speaks highly of this salt in epilepsy.'
Introduced into therapeutics by Deneffe, of Brussels,
and investigated chemically by Clin, therapeutically by
Bourneville, bromide of camphor has been employed in
the treatment of hysteria and epilepsy, and although fa-
vorable results have been obtained at the Salpetriere, yet
this preparation has not come into general use. Thus
far the bromide of potassium remains the medicament
the most active and most employed in the treatment of
epilepsy.
How shall bromide of potassium be administered ?
Although it has been attempted to introduce this salt by
the hypodermic method and by enema, these tentatives
have been promptly abandoned, and for the reason, as
I told you when treating of diphtheria, that bromide of
potassium has an irritant and even caustic action. We
are then restricted to the alimentary canal as the only
practical way of introduction, and when given it should be
diluted with a considerable quantity of water ; the dra-
gees, granules, and compressed pills containing bromide
should be discarded. I should add that when you are
* Hammond on Nervous Diseases, p. 806. Paris, 1879.
'W. A. Hammond: The Therapeutic ij sage of Calcium Bromide. New V'ork
Med. Jour., 1872, and Hull. gen. dc Therapeuliqne, 1872 ; also, Hammond on
Diseases of the Nervous System, p. 886, Hammond's formula for broi
»s as follows
bromide of zinc
U. Kromidezinc grammes iij. (or gr. xlv)
Syrup simplicis grammes .xxx. (i fl. oz.)
M. Dose, — Ten drops three times a day. The quantity to be gradually in-
creased till thirty drops or more are given at a time, ?:ach dose should be welt
diluted with water before Uking, as it is apt to offend the stomach.
forced to increase the dose of this salt, as in epilepsy
trenerally, you should require the patient to partake
freely of milk, in order to avoid the gastrointestinal irri-
tation which results from the prolonged use of the bro-
mide in large doses.
The quantity of bromide which ought to be adminis-
tered daily is very variable. From twelve to fifteen
grammes a day have been given ; the medium dose, in the
majority of cases, is eight grammes. This dose cannot be
given from the first ; you must begin with smaller doses, as
one gramme morning and evening, and gradually increase
the dose till you have obtained complete control of the
disease. Voisin thinks that we should regard as the maxi-
mum dose that which determines abolition of the reflex
sensibility of the pharynx. I believe that this is an ex-
cellent rule in the case of hysteria, but not in epilepsy,
and that in this disease we must not only attain aboli-
tion of pharyngeal rertex irritability, but we must, if oc-
casion demand, push the administration of the remedy
even farther, till we have stopped the attacks. But it is
absolutely necessary to have a bromide preparation
which is chemically pure, for \^oisin has shown that the
impurities of this salt considerably modify the therapeuti-
cal effects which it produces.'
These large doses of bromide, given for therapeutic ef-
fect, are not without danger. They determine in certain
patients a train of symptoms which in some instances
have been grave enough to cause death, and to which
the name broniism has been given. PSesides the incon-
veniences mentioned in my lecture on hysteria, and
which are the acne eruption, the disagreeable odor of
the breath, the peculiar unpleasant taste of the saliva,
there are certain nervous manifestations of a grave kind,
such as I lately observed in one of my patients who had
taken in oiie day thirty grammes (a troyounce) of bromide
of potassium. These symptons consisted in a remarka-
ble depression of the vital forces. The patient could
not stand, could not make the least movement without
difficulty. Intelligence was impaired, and there was
aphasia and amnesia.
This state, in which the patient is plunged into a physical
and moral brutishness the most deplorable, persists till
elimination of the bromide by the various emunctories
has taken place.
These inconveniences of the bromide treatment are
again and again experienced by the epileptic patient,
who finds himself often in a sad dilemma ; either he must
desist from the use of the remedy and see his fits come
back, or persevere in the treatment, notwithstanding the
depression of all his faculties and forces. Believe me,
he will generally choose the latter as the lesser evil, rather
than sufter those terrible attacks which are to the epilep-
tic a menace always suspended over his head.
But it is especially in the delirium of action, which
makes the epileptic a criminal without his knowing it,
that it is necessary to employ the bromide in massive
doses in order to overcome the mania which impels him,
unconsciously, to deeds of violence. Nothing, in fact,
is more curious than to see in the wards of our lunatic
asylums men enjoying their intelligence and their reason
who have committed, and would still commit, the most
astounding murders, if their maniacal propensities were
not kept in check day by day by immense doses of bro-
mide.
How long should you continue the bromide treatment
of epilepsy ? Often a very long time, and even during the
' The purity of the bromide salt is a point of capital importance. It ought es-
pecially to be free from the iodide. To determine the presence of iodide of potas-
sium, dissolve the suspected salt in starch water, add a few drops of nitric acid,
and if there be any iodide of potassium present you will obtain a blue color from
the formation of iodide of amyl. Lambert's method is even more delicate. Dissolve
the bromide in a solution of potassium permanganate ; if the bromide is pure the
solution keeps its violet color, while it takes a yellowish tint if there are any traces
ot iodine present. According to Lambert a chemically pure solution of potassium
bromide when treated by HCI, should evolve a few bubbles of COi- Treated by one
gramme of benzine, and a few drops of bromine water, it ought not to give a rose
color. Treated by HNO3 and nitrate of baryta, it ought not to turn yellow
(Adrien : Researches on the Chemical Composition of Preparations of Bromide of
Potassium, Hull. gen. deTher., t. Ixxvii., 1870: Lambert; How to Detect the
Presence of KI in Bromide of Potassium, Bull. gen. de Ther., t. Ixu., p. 503, 1867).
2IO
THE MEDICAL RECORD.
[August 25, 1883.
entire life of the patient. When, moreover, you have
obtained the full benefit of the drug, and have witnessed
complete cessation of the attacks, you must not leave off
abruptly the medicine, but must keep on with it for sev-
eral years, gradually diminishing the dose, as Legrand du
Saulle has advised.'
Under the influence of bromide medication, thus car-
ried out, we witness mitigation, diminution in frequency,
then disappearance — first of nocturnal then of diurnal
attacks ; then the vertiginous paroxysms and the aura
cease, symptoms which most resist the bromide treat-
ment. These favorable results you will, as I said, obtain
in one-half your cases. But you can often anticipate what
will be the result of the bromide treatment by deter-
mining the cause of the epilepsy. Here Voisin has given
us valuable hints. The epilepsy which results from mal-
formations of the cranium or cerebral tumors is rebellious
to the bromide, while the functional and hereditary neu-
rosis is amenable to this treatment. Sex has no influence
one way or the other.
Such, gentlemen, are the leading indications and
methods of the bromide medication in epile])sv. If not
absolutely and certamly curative, this medication, never-
theless, represents a real therapeutic progress when we
consider the unsatisfactory nature of the treatment of
olden times. 1 ought to add, as an item of interest in
this connection, that experimental physiology has con-
firmed ordinary clinical results ; I allude to the recent
curious experiments of Albertoni, who, after prolonged
administration of the bromide to animals was not able to
induce in them expeiimental epilepsy by irritating the
cerebral cortex, although after giving atropine under like
circumstances such convulsive attacks could easily be
provoked."
Other remedies which act on the medulla oblongata, or
on the muscular system, have been prescribed in epilepsy,
such as picrotoxine, bromide of gold, curare, and nitrite
of sodium.
Curare or wourari has been tried hypodermically in
epilepsy by Voisin and Liouville ; the etiects are not
sufficiently encouraging to warrant continued use of this
medicament, notwithstanding the more recent trials of
Edlefsen and Kunze. Picrotoxine, the active principle
of cocculus indicus, has been made the subject of study
by Brown-Sequard, Glover, Bonnefin, Vulpian, and
others. These researches show that picrotoxine has an
elective action on the medulla oblongata, and may even
determine a veritable experimental epilepsy. Planat has
utilized this special selective action of [licrotoxine in the
treatment of epilepsy ; I have myself experimented with
it, but have not obtained favorable results except in al-
coholic epilepsy — which will get well of itself if the pa-
tient will jjractise abstinence from alcohol. Vulpian has
also tried it without any success. Add that picrotoxine
is very poisonous, even in small doses, and we ought
to conclude that this medicament should have a very
humble place in the treatment of epilepsy.
Finally, Huchard has recently advised the association
of digitalis with bromide in the treatment of epilepsy,
and claims good results from the combination.
Thus far we have been occupied only with the general,
or pharmaceutical treatment of epilepsy ; it remains to
speak of the hygienic treatment, and of that of the at-
tacks.
If hygiene has not a preponderant part in the treat-
ment of epilepsy, nevertheless it is not without influence
' His nilcs .ire as follows : W'c will suppose a case apparently cured. During
the first year— fifteen days of each nionth with the bromide every d.ay in the usual
dose, and fifteen days with the bromide every other day. In the second year— fif-
teen days of every month with the bromide every third day, and fifteen days with
tlie bromide every day. In the third year — fifteen days of every month with the
bromide everj- day, and fifteen days with the bromide every fourth day. In other
cases (and this is now his habitual method), after the patient has gone one year
-without an attack, bromide treatment six days in the week. After fifteen months
of freedom from attacks, bromide five days in the week. After eighteen months,
bromide four days in the week. At the end of two years from the last attack bro-
mide <Jnly three days in the week [Traitcmcnt ct Curabilitt^ dc I'Epilcpsie, by Le-
grand du Saulle).
5 Albertoni, Action de quelques Medicaments .sur I'ficorcc ccrebrale .^ propos du
I'raitemeni de TEpilcpsie.
on the production of the attacks. Here, as in hysteria,
the question of marriage comes up for consitJcration.
Ought an epileptic to marry ? It is well to bear in mind,
and to urge upon your clients, when they consult you in
reference to the marriage of an epileptic, that epilepsy,
with all its gravity, is not necessarily and fatally heredi-
tary, and in giving this opinion you can fortify yourself
by the authority o{ professor Last^-gue, than whom no
one is more qualified to judge on questions of this kind.
In fact, Lasijgue denies the hereditary nature of epilepsy.
This is a matter of considerable importance, and hold-
ing this view we are enabled to tone down somewhat the
sombre colors in which such a union would otherwise be
invested.
If continence does not play an important part, it is
not the same with venereal excesses, which have a most
decided influence in the production of attacks. Mastur-
bation is most pernicions to epileptics, and destroys, in a
certain measure, the effect of the treatment by bromides.
Epileptics should live in the country and avoid crowded
assemblies, political gatherings, concerts, shows, and the
like. You must often have remarked that theatrical exhi-
bitions are frequently interrupted by attacks of epilepsy,
and this for the reason, principally, that the bad air and
the heat of the apartments are deleterious to epileptics.
The alimentary regimen has a certain influence on the
falling sickness. First of all, the alcohols are them-
selves a cause of epilepsy, and you are not ignorant of
the studies of Magnan as to alcoholic epilepsy, and in
particular that form of epilepsy which is produced by
absinthe ; it is proved that these nerve-excitants produce
epilepsy in men and animals ; you ought then to interdict
the use of alcoholic beverages to your patients.
You ought also to advise a diet which shall contain
nitrogenous substances in very sparing quantity. It
seems, in fact, proven that a vegetable diet diminishes
in a marked manner the number of attacks, while an
azotized diet considerabl)' increases them ; the epileptic,
then, should be strictly vegetarian. To sum up the
rules of hygiene, the epileptic patient should live much
in the open air, be very moderate in sexual indulgences,
take a great deal of exercise, abstain from spirituous
liquors, and li\ e almost exclusively on vegetable food.
As for the treatment of the attack, it consists in
placing the patient in a horizontal position, and loosen-
ing any part of his apparel which may cause constriction
of the neck or thorax. It is generally customary to
place some hard substance (as a clothes-pin) in the
mouth of the patient to prevent biting of the tongue, a
means which has not been very successful ; the foreign
body, if too resisting, breaks the teeth of the patient,,
and if too little resisting, is liable to be bitten off in the
struggle, and to find its way to the throat or windpipe
of the patient, causing suffocation.
Certain measures have been advised to prevent the
convulsive seizures, such as the energetic flexion of the
great toe, compression of the temjioral regions, of the
infra-occipital hollow, etc. Others have counselled by
various compressions to prevent the aura from spreading ;
Rozier has even devised a special instrument for this
purpose. All these means are only of use in certain^
exceptional cases where the epileptic has iiremonition
of his attack by sensations of aura which precede the
convulsive seizure by a brief interval. It has also been
proposed to employ during the paroxysm, hypodermic
injections of apomorphia, inhalations of bromide of ethyl,
and nitrite of ainyl. Bourneville has given us some
interesting facts relating to the two last medicaments,
but these inhalations have not come into general use.'
^Magnan : Kpilepsic Alcootique, Action speciale de I'Absinthe. Compt. Rend,
dc la Soc. Hiol., t. xiii., Paris, 1869 : Rodel : Troubles Caused by the Abuse of
Alcohol and of Absinthe. Gaz. Mi^d. de Lyon. t. xvi.. pp. 590-502. 1S64 : Du-
jardin-Hcaumetz ; Art. Absinthe, in Dict.de Ther., iSSa ; John Nicrsin ; Influ-
ence of Food and Hygiene inEpilep.sy, West Riding Lunatic Asylum Med. Re-
ports, 1875 ; liournevillc ct Oilier : Recherches siir l'.\ction physiologicjue du Kro-
murc d'Kthyle dans I'liysti^rie ct I'Kpilcpsic, Clazette M^d. de Pans, No. 35.
1880 ; Bourneville ; Du Nitrite d'Amyle dans rEpilepsic. Soc. dc Biol., Ju«e,
1875.
August 25, 1883.J
THE MEDICAL RECORD.
211
This finishes what I deemed important to say relative
to the treatment of epilepsy, and the beneficial influence
of therapeutics in tiiis terrible disease. In the next lecture
1 shall consider chorea and its treatment.
^voflvcss of |]t1c(Tical s^cicncc.
Irregular Work worse than Overwork. — At the
present time, when we hear so much of the evil conse-
quences of what is rather loosely termed "overwork,"
the following remarks of the British Medical Jounial,
July 14, 1883, seem quite apropos : " 'Overwork,' prop-
erly so called, is not so likely to occur, or if it occur
to do mischief, as irregular or disorderly activity. If"
there be not sufficient time for recuperation in the course
of work, exhaustion nnist take place. If the work done
be of such a nature as to put an undue strain on any one
faculty, harm may be done, although the brain as a whole
may not be severely taxed. If the supply of brain-food
be insufficient to enable the recuperative faculty to com-
pensate by food for consumption in use, there must be
exhaustion. If work be exacted when any indication of
exhaustion is present, it is nnpossible that injury shall
not be inflicted. It follows that educators have especial
need of care to avoid engaging the brains of their pupils
in work for more than very short periods, and to provide
intervals during which there may be rest of the centres
specially taxed. Much may be done by changing the
kind of work frequently. We are of opinion that no
growing child should be kept longer than half or at most
three-quarters of an hour at one task, or even the same
description of work. Again, the great centres of relation
should not be overtaxed. Vision, hearing, the speech
centre, and the centre specially concerned with written
language, whether in writing or reading, should not be
wearied. Brain weariness is the first indication of e,x-
haustion. The faculty of ' attention ' is perhaps one of
the most easily vulnerable of all the parts or properties
of brain-function. It is the faculty which most readily
becomes permanently enfeebled, and when weakened en-
tails most trouble in adult life. In children it is difficult
to catch and fix the attention. No effort should be spared
to secure this fixity of thought ; but in order to avoid
weakening the power of ' thinking ' — as distinguished
from ' thought-drifting ' — the teacher should not strive,
or desire, to hold the attention by any effort on his j^art
longer than it is voluntarily given by the child. The
slightest indication of exhaustion should at once be met
by a change of task. If these hints, general as they are,
can be reduced to practice, we think there is little fear
of ' overwork ' or harm from brain activity. Desultory
and insufficient work is more to be feared by far than
' overwork,' because the brain, like every other part of
the organism, grows as it feeds, and it can only feed as it
works."
A Renal Form of Typhoid Fever. — Dr. Didion
has chosen this subject for an inaugural dissertation, and
comes to the following conclusions. Typhoid fever pro-
duces a renal congestion, which plays an important part in
the course of the disease. Albuminuria is almost constant,
but generally slight and temporary ; when abundant, it
is a sign of true nephritis. The real inflammation is both
parenchymatous and interstitial, and produces certain
characteristic symptoms, such as asthenia, stupor, dryness
of tongue, oedema of the face and legs, lumbar pains, cu-
taneous eruptions (pemphigus, ecthyma, boils), and an
alteration in the urine, which has a reddish color and the
odor of boiled bread ; in the dejiosit, red and white blood-
corpuscles are found, as well as casts ; the urine contains
a large quantity of albumen. The diagnosis can easily
be arrived at by the above-mentioned symptoms. The
termination is often fatal, either from asthenia or urEemia.
As to the treatment, Bouchard recommends carbolic acid
and the salicylates, Polli the suljihites, Klebs the ben-
zoate of potash. Leeches, mustard poultices, and cup-
])ing in the lumbar region are useful ; but blisters, even
with the addition of camjihor, must be avoided. In cer-
tain cases, the disappearance of the symptoms is accom-
panied by abundant diuresis, which ought, therefore, to
be favored if possible ; but all diuretics are not equally
good, those which possess irritating properties must be
avoided. The best in these cases is milk, pure or mixed
with water. Whatever may be the way in which it acts
on the kidneys, it is always well borne, and its action is
double ; it increases the secretion of urine, and hastens
the elimination of toxic principles, without producing any
irritation, even in the most acutely inflamed kidney. Sub-
cutaneous injection of pilocaqiine might perhaps be use-
ful ; in one case, when the skin was dry and burning hot.
Dr. Didion injected twice daily one-sixth of a grain of
pilocarpine, and under its influence the skin became
moist and abundant sweat was produced ; the tongue
also was less dry than before ; the temperature fell in
two days from 105.8'' to 98.6° F. ; but three days later
the patient died, after the temperature had once again
reached 104° F. New investigations are necessary be-
fore we can arrive at definite conclusions. As for the
cold baths, Gubler thinks that they are contra-indicated
in case of nephritis, but Libermann considers their use
as surely beneficial in spite of it. Several patients who
had been subjected to that treatment did not complain
of any inconvenience, and cold lotions rapidly applied to
the trunk and limbs with a sponge seem to relieve the
patient, lower the temperature, and re-establish the func-
tions of the skin. All these advantages must be weighed
against the danger of a renal congestion ; but further ex-
perience alone can show which treatment is most advan-
tageous.— British Medical Journal, July 14, 1883.
Albuminuria following Cutaneous Irritation. —
Dr. Mihran has investigated this subject, and formulates
the following projiositions : i. Cutaneous excitement, by
whatever means produced, may give rise to albuminuria.
2. The amount of albumen, which, in such a case, can be
almost at once detected, will vary according to the de-
gree of e.\citement, the energy of the exciting agent, the
extent of surface acted on, and the duration of the ex-
citement. 3. The duration of the albuminuria will also be
determined by the same conditions ; in most cases it is
transient, but, under the influence of extreme peripheral
irritation, it may persist, along with an alteration in the
organic structure involved. 4. Albuminuria proceeding
from cutaneous excitement depends proximately on a
disturbance of vaso-motor innervation. — Journ. Cut. and
Vener. Dis., July, 1S83.
A New Method of Applying Pressure to En-
larged Testicles. — In the Lancet for July 7. 1883,
Dr. Corbett describes a simi)le method of applying press-
ure to enlarged testicles, which is calculated to do away
with many of the objections against the ordinary plaster
strapping. He prefaces the explanation of his [ilan by
saying that he derived the idea from a homely source,
nothing more or less than seeing the means employed
for encasing a football ; barring that, instead of having
the encasing material made of leather, he had it made of
india-rubber — such as one sees in the construction of the
balls in spray producers, etc. The cases he recommends
should be made of different sizes and thicknesses, and
oval in shape. The means of tightening the cases and
applying the pressure would be identically the same as in
the football cover— ;.<;•., by lacing. There should be an
opening at the neck of the case to allow the passage of
the cord. This opening would be surrounded by a ring
(interrupted) of leaden wire, to ensure its patency and to
prevent pressure on the structures of the cord. The
leaden wire ring being interrupted, its softness would of-
fer no obstacle to its easy adjustment round the neck of
212
THE MEDICAL RECORD.
[August 25, 1883.
the enlarged gland. With a supply of such cases, the
treatment of an enlarged testicle would ofl'er but little
difficulty. It would simply mean the selection of a rub-
ber case of the right size and thickness, and capable
when laced up of exercising a steady equable pressure
on the enlarged organs, and applying the case to the
testicle and lacing it up. If considered necessary, the tes-
ticle could first be enveloped in a thin layer of cotton-
wool. This would prevent any possibility of the skin
being nipped or chafed by the lacing. As the gland re-
duces in size a smaller case would be applied, and thus a
steady pressure kept up until a cure was elTected. The
above plan has the advantages of simplicity, neatness,
and quickness in its application to recommend it. It in-
volves no elaborate apparatus, and does away with
many, if not all, of the objections connected with the
operation of strapping with plaster.
A Case of Tracheocele. — .\ mercliant, twenty-nine
years of age, of previous good health e.xcept for an attack
of rheumatism, acquired a bronchitis with severe cough.
After a severe attack of coughing he suddenly noticed a
small tumor, the size of a hazel nut, just above the ster-
num. In three days this had increased to the size of a
pigeon's egg, and incommoded respiration and degluti-
tion. The tumor remained stationary for three weeks,
when it suddenly opened and discharged blood and pus,
and became much reduced in size. It grew again slowly
for a time, but remained smaller and softer than before.
It was larger during e.xpiration and diminished again in
size during inspiration. Upon compression a fine crepi-
tation could be felt, and the tumor disappeared. The
treatment consisted in permanent compression of the her-
nia by a sort of truss, and resulted in a cure after the ex-
piration of six weeks. The patient, however, became
the victim of chronic asthma, from which relief could
only be obtained by constantly increasing doses of mor-
phine. From a study of^this case, and twelve others, re-
ported by different observers. Dr. Detis arrives at the
following conclusions; i, the causes of the affection are
bodily exertions of any sort; 2, the principal symptoms
are enlargement of the tumor during expiration, disap-
pearance of the same under compression, and a muffled,
squeaking voice ; 3, the prognosis is favorable ; 4,
treatment is purely local and consists in steadily main-
tained compression. — Centralbl. fur Chirtirgie, July 7,
1883.
Bathers' Cr.\mp. — Some recent bathing fatalities
have again drawn attention to the important subject of
bathers' cramp. If the nature and causes of this dan-
gerous afTection were more generally known, it is prob-
able that many deaths from drowning in the bathing
season might be prevented. Cramp is a jjainful and
tonic muscular spasm. It may occur in any part of the
body, but it is especially apt to occur in the lower ex-
tremities, and, in its milder forms, it is limited to a single
muscle. Pain is severe, and the contracted muscles are
hard and exquisitely tender. In a few minutes the
spasm and pain cease,leaving a local sensation of fatigxie
and soreness. When cramp affects only one extremity,
no swimmer or bather, endowed with average presence
of mind, need drown ; but when crami) seizes the whole
of the voluntary muscular system, as it probably does in
the worst cases, nothing, in the absence of prompt and
efficient extraneous assistance, can save the individual
from drowning. Although the intimate nature of mus-
cular cramps, and the jirecise mode in which they are
established, are still unknown, experience has furnished
us with sufficient data on the subject to enable us to re-
cognize the chief conditions of their causation. These
conditions are : a peculiar individual susceptibility or
idiosyncrasy ; the shock of cold applied to the general
surface of the body ; prolonged muscular exertion ; and
forcible and sudden muscular exertion, especially in the
direction of the extension of the extremities. There can
be no doubt about a liability to muscular cramp being
an individual peculiarity. The disorder is especially apt
to arise in persons of irritable temperament. While
cramp has been met with in all ages, sexes, tempera-
ments, and climates, it has been observed that it occurs
far more frequently in warm climates than in cold, and
chiefly in the hottest of warm climates, and that persons
of middle age suffer most from the aftection, and men
more so than women, and the robust and vigorous more
so than the weakly. Neither can there be any doubt
that the shock of cold applied to the surface of the body,
especially when the body is unduly heated, is the com-
monest determining cause of the worst and most exten-
sive forms of bathers' cramp. On this fact is founded
the common prejudice against bathing when the body is
much heated. Many fatal cases have illustrated this
point. Only a short time ago, a robust soldier, who was
an expert swimmer, rowed in a boat, upon a sultry even-
ing, to a deep pool ; here, with his body glowing from
muscular exertion, he plunged into the water with the
intention of taking a refreshing bath, when he was im-
mediately seized wuth general muscular cramp, so that
the poor fellow was at once drowned. That mere pro-
longation of muscular exertion, as in continued swim-
niing, and forcible and sudden muscular exertion, par-
ticularly in the extension of the extremities, as in
swimming with very vigorous and rapid strokes, are,
respectively, efficient and frequent determining causes
of cramp, familiar experiences to every swimmer. These
muscular conditions, however, usually give rise only to
the slighter and more localized forms of cramp. Serious
cramp is a peril which menaces most persons with highly
developed muscles. Its most powerful and most avoid-
able cause is the sudden immersion of the body, when its
surface is highly heated, in water of a relatively low tem-
perature.— British Medical Jourtuil, July 14, 1883.
The .\BSORrTioN of W.^terv Solutions by the
Skin. — From an examination of this subject {Ann. de
Dermatol, et de Syph. ), Dr. .\ubert concludes the follow-
ing : I. Substances dissolved in water may make their
way through the epidermis without producing any visible
external lesion. 2. Nevertheless, the essential condition
of such penetration appears to be a break in the epider-
mis where it is prolonged into hair-sheaths, and along
the included portions of the hairs themselves. 3. In
fact, according to our observations, this penetration takes
place exclusively in hairy parts. 4. It is promoted by
whatever causes the hair to be pulled about, as, for in-
stance, friction with the moist or dry hand, or unusual
size, stiffness, and length of the hairs. 5. A delicate in-
tegument and thin cuticle afford unfavorable conditions,
on account of the less vigorous growth of hair on parts
thus endued. Total absence of hair is likewise a con-
dition eminently unfavorable to absorption. 6. Hence
we may infer the possibility of introducing soluble sub-
stances into the circulation by causing them to penetrate
the epidermis in small quantities, either with or without
the aid of baths. To effect this, friction with the palm
of the hand would have to be applied forcibly over a
large surface, and especially where the skin is hairy.
The only possible unpleasant effects would be a moder-
ate degree of intiammation, manifested in a little redness
and smarting about the roots of the hairs. 7. Simple
immersion in a bath, however prolonged, could not be
relied on to effect the entrance of even the smallest
quantity of a solution through the skin.
Recial Examination for Vesical Calculus. —
Professor Volkmann states that after the patient is com-
pletely anaesthetized one hand should be placed over the
pubis, introducing the forefinger of the unoccupied hand
into the rectum. In this manner it is easy to grasp a
stone with the upper hand, especially in lean subjects.
Sometimes it is possible to pass a ligature around the
abdominal walls inclosing the stone. In vesical papillo-
niata and myxomata with long pedicles, this ligation
might be of use. — Archiv fUr Chirurgie.
August 25, 1883.]
THE MEDICAL RECORD.
21
The Medical Record
A Weekly yournal of Mediciyie and Surgery.
GEORGE F. SHRADY, A.M., M.D., Editor.
Pliblisuku bv
WM. WOOD &. Co., Nos. 56 and 58 Lafayette Place,
New York, August 25, 1883.
THE HYGIENE OF DOG DAYS.
The oppressive heat of this season is alluded to by Vir-
gil, who ascribes to the baneful influence of Sirius corpo-
ral languishnient and disease.'
How to keep strong and well when the thermometer is
90° in the shade and there is not a breeze, and the at-
mosphere is full of moisture ; when the appetite flags and
digestion languishes, and toil is irksome, is the perplex-
ing question.
By common consent for the inhabitants of cities, for
all men of business and all professional men, this is the
holiday season, and nothing in the economy of nature is
more appropriate than that citizens should fly to moun-
tainous regions of the country, or the seaside for cool-
ness, invigorating air, rest, and recreation during this
trying period, when the air of our crowded cities is rank
with decomposition and corruption.
Not to dwell on the jieril to the cerebro-spinal system
of excessive heat ; and it is a matter of frequent observa-
tion that exhaustion of nervous energ)', phlegmasias and
even death are thereby produced — not to dwell on the
relaxation of the muscular system, of the perspiratory
system, and the venous congestions which all experience
to a greater or less degree, the digestive organs are un-
doubtedly the most exposed to danger. Over-eating,
and the eating of improper food are sins of dog days as
of all other periods. A considerable portion of the hu-
man race have not self-control when impelled by appe-
tite, and never learn self-control by the dearest bought
experience. Green fruits and green vegetables are in the
market. There is little desire for ordinary food, but
these new products of the soil, though generally imma-
ture, are palatable and appetizing. The weakened stom-
ach is oppressed by a burden which it cannot digest, and
embarras gastrique, enteritis, or cholera morbus re-
sults. Happy the summer gourmand if, warned by a
diarrhcea, he practises abstinence in time to escape
worse evils.
So patent is it to every physician that a large part of
the physical ailments of dog days are due to indulgence in
green fruit and vegetables, that all citizens — those that
stay at home to swelter during the hot weather, and those
1 iflnetd iii., 141 :
^ Sinquebat, dulcis anim;LS, aut zgra trahcbant
Corpora ; tunc sterilis exurcrc Sirius zgros.
Also X., 274 :
lUc Siteni morbos que ferens morcalibus aegris.
that frequent the watering-places — cannot be too much
cautioned as to the danger of much indulgence in the
good things with which their tables, at this season of the
year, are loaded. If, as at a medical bancjuet we once
attended, the green corn could be labelled cholera the
green peas colic, and the lobster salad, despair of a Ja-
ded stomach, or\\y \.\\q simple truth would be told, how-
ever much it might seem like a stupendous joke. If the
.appetite be poor, the powers of the stomach are enfee-
bled, and should not be taxed. Food of an easily digest-
ible character should be eaten, such as stale bread, oat-
meal, pure milk (if obtainable), rice, a little fresh fish or
tenderloin, broiled, not fried, chicken-, veal-, or mutton-
tea, with a little soda biscuit, cooked ripe fruits in mod-
eration. Heavy boiled dinners (fit only for the "tough
stomachs of reapers") ; rich puddings and jjastries, salads,
green legumes, fried meats, and animal food generally,
should be either not indulged in at all, or eaten very
sparingly.
Frequent ablutions form an important part of the
hygiene of warm weather. The whole body should be
bathed with lukewarm water twice daily, and if there be
sufficient constitutional vigor to stand a cold bath, this
will prove very invigorating.
Will it do to take a cold plunge while perspiring ? This
question has been answered both negatively and affirma-
tively. The common impression has been that a bath
taken during active perspiration is likely to be injurious ;
therefore a hygienic rule has been established forbidding
cold bathing at such times. This is a rule, however,
which is transgressed by' laboring men and farmers with
impunity, and it is well known that in the European
hydrotherapie establishments it is advised as preparative
for the cold douche that the patient should take vigorous
muscular exercise before the douche, in order to induce
sweating ; and it is at the period of greatest muscular
activity that the cold plunge or douche is taken. It is
maintained that the greater the difference between the
temperature of the body before the douche and that of the
water the more active the reaction will be. It is perhaps
safer to follow the traditional opinion ; at all events, the
cold douche should be short. There is no question that
the free external use of cold water is a powerful promoter
of tone, and that many a vigorous literary man and ac-
countant owes his robustness during the summer months
to regular habits of cold bathing. Sea bathing is espe-
cially recommended to those who are in a situation to
enjoy this uncomparable hygienic luxury.
The air in dwelling-houses should be made as whole-
some as possible, and all ill-smelling nuisances in the
vicinity should be speedily abolished. Foul smells may
not contain disease-germs, but they certainly offend the
respiratory and digestive organs. The windows of sleep-
ing apartments should be kept constantly open.
The daily tasks should be lightened in correspondence
with the diminished capacity for hard work ; opportuni-
ties for recreation should be improved, and sleep should
be abundant. An hour of sleep after dinner is invaluable
to most hard working men.
Such are some of the hygienic rules applicable to dog
days ; they will perhaps be less heeded by busy physi-
cians at watering places, to whom, as to farmers, this is
a harvest season, than by intelligent citizens generally.
214
THE MEDICAL RECORD.
[August 25, 1883.
CONCERNING THE VALUE OF EXAMINATIONS.
Those who read the very interesting paper by Surgeon
Shufeldt in the present issue will be impressed with the
truth of much that he says regarding the real value of
examinations as tests of knowledge actually possessed.
These examinations are, as Huxley very truly remarks,
the necessary evils of our existing system of education.
But that they utterly fail in very many instances of ac-
complishing their real purpose goes without the saying.
The failure to pass is often due to absolute ignorance on
the part of the candidate. When there is no question on
this point the examination serves its real purpose. Too
often, however, the trouble is with an examining board
which adopts too arbitrary a standard, or imposes too
exacting conditions. There is great need of drawing the
dividing line somewhere between these extremes.
It has often been said with much truth that the prize
men in college do not, as a rule, make much of a show
in after-life. They belong to a class now becoming c]uite
numerous, who study to pass an examination rather than
to gain knowledge. " They do pass, and they don't
know." On the other hand, the scholar at the foot of his
class, who scrapes through by so-called blind luck, often
surprises every one by his ultimate successes. But ordi-
nary examiners never appear to dream of such possibilities,
nor are any practical efforts made to ascertain the real ex-
tent of that groundwork of knowledge upon which future
success in any calling must depend. An approach is made
in that direction in the searching character of the Army
and Navy examinations, but that is all. It may, and
doubtless does, serve to keep out incompetent men, but
it cannot always bring lo the front and develop those
whose best work is ahead of them. That examining
board would certainly be a wise one whicii could, under
all circumstances, be able to separate the chaff from the
wheat. But while this may be considered impossible it
must nevertheless be acknowledged that there is great
room for reform regarding the accepted method of ex-
amination even in the Army and Navy. There should
certainly be an attempt to approach a more practical
standard, an endeavor to bring out the qualifications
which shall best meet the real requirements of every-
day life in camp, on the field, or in hospital. At ))resent
there appears to be more danger of shutting out many
good men who would be destined to ornament the corps
than of admitting ignoramuses who would be liable to be
dropped at their second examination.
The second examination is right enough in its place, but
its real aim should be to measure the qualification of the
candidate according to the bent of his future usefulness to
the service. Proficiency in one line of study should offset
a lack of it in another. Thus each one could be placed
properly to bring out his best talents and be encouraged
to inirsue a line of study before and after his second ex-
amination best suited to his taste and capabilities.
F,\-en Surgeon Bill himself, if subjected to an examina-
tion to-day, might pass better in chemistry than cither in
anatomy or surgery. And yet it would have been ([uite
a mistake to have rejected him on tliat account. On
the other hand, we have not heard that the late Geo. A.
Otis, whose masterly " Surgical History of the War of tile
Rebellion " is a monunient of talent and industry, was
nnich of a chemist.
glciuB of the ^JCCll.
The Progress of Yellow Fever. — The appearance
of yellow fever among the marines at the Navy Yard,
near Pensacola, has given rise to much speculation as to
the manner in which the disease found entrance. Nothing
definite has yet been ascertained, as those in authority
are not disposed to stop to inquire /ww it got there until
they have perfected their sanitary arrangements for pre-
venting its spread. At the present writing seven cases
are reported to have occurred among them by Dr. Owen,
the medical officer in charge. Outside the reservation
great activity has been manifested by the health authori-
ties of Pensacola, supplemented by the Marine Hospital
Service; immediate steps were taken to quarantine the
reservation by land and water by placing a sanitary cor-
don around the infected camp, thus cutting ofif all per-
sonal communicatiou between the reservation and the
outside world. With an efficient quarantine and other
sanitary measures it is believed the disease will be con-
fined within its narrow limits. Last week two cases of
fever of a suspicious nature, with one death, were re-
ported from Ocean Springs, Miss., a point nearly oppo-
site the Ship Island Quarantine Station. The house in
which they occurred was at once disinfected and isolated
by a sanitary cordon, and up to the present writing no
further appearance of the disease has been reported. Dr.
Austin, of New Orleans, regards the cases as very sus-
picious, but will decide against their being yellow fever
if the disease does not spread — a thing not likely to oc-
cur if properly guarded by those in charge of the sanitary
cordon, etc.
Considerable opposition to the location of the Cape
Charles quarantine station, at Fisherman's Island, is still
manifested by the Baltimore pilots, notwithstanding the
fact that it is more convenient for them than for the Vir-
ginia pilots, who have offered no objection whatever, but
on the contrary have aided the quarantine officers from
the first in bringing foreign ships to anchor opposite the
station. A few days since the Governor of Maryland
issued an order instructing the Baltimore pilots in this
matter, so that their opposition is confined to newspa-
per attacks instead of overt acts of insubordination as
formerly. The station is now in good running order, and
all foreign vessels are inspected before being allowed to
proceed up the bay. Everything is satisfactory at the other
United States quarantine stations : the one at Sapelo, on
the coast of Georgia, designed as a place of refuge for
infected vessels bound for any port between Charleston,
S. C, and St. .A.ugustine, Fla., has as yet had nothing
to do.
Consular reports continue to indicate no increase in
the fever at foreign ports. At Cardenas, Cuba, but four
or five cases, and no deaths, are reported in the town for
the week ending .\ugust iith, and "no yellow fever
among the shipping." At .Matanzas there were four
cases and two deaths in the city ; none reported in the
shipping Previous reports of yellow fever at Colon
(Aspinwall) have been contradicted by the Consul at
that place. At Vera Cruz the disease continues in gftat
violence. A cable despatch of the r^th instant states
that tlie steamer Alexandria cleared for New \'ork on
August 25, 1883.1
THE MEDICAL RECORD.
215
the nth , and a second despatch, dated the 14th, that
the steamer Bernard Hill cleared on that day for Balti-
more. A third despatch, dated the 20th, announces the
departure, on the 17th, from Vera Cruz of the steamer
City of Washington for New York. These steamers
will of course be carefully inspected, and quarantined if
necessary.
Immediately upon the appearance of yellow fever at
Pensacola Navy Yard a large supply of disinfectants and
a half-dozen hospital tents were ordered by Surgeon-
General Hamilton from the supply on hand at New Or-
leans. An additional number of tents were asked for by
the Pensacola Board of Health, and twenty more sent
them on the 21st instant. In order to insure safety a
house-to-house inspection of Pensacola was ordered and
commenced on the 21st instant. The following de-
spatches from Pensacola and Fortress Monroe to Sur-
geon-General John B. Hamilton give the latest yellow
fever news up to the hour of going to press :
Pensacola, P'la., August 20th. — No new cases at tlie
Yard to-day. Pensacola perfectly healthy. Will com-
mence inspection to-morrow. Will give you progress
every day. Cordon perfect and under my personal
supervision. Has performed good service already ; ar-
rested thirteen persons. Cordon seventeen miles long,
well protected by swamp and water, and all possible
landings guarded. John B. Guttman, President Board
of Health.
Pensacola, August 20th. — Board of Health request
that I ask you to send twenty hospital tents. Reported
eight cases and three deaths. J. M. Tarble, Collector.
Pensacola, August 20th. — No new cases at Navy
Yard for last forty-eight hours. Eight cases and three
deaths reported to date. Villages of Warrenton and
Woolsey perfectly healthy. Fever confined to Y'ard hos-
pital. Surgeon Owen in critical condition. White,
Attending Assistant-Surgeon.
Fortress Monroe, August 20th. — Spanish steam-
er Navarra, from Havana and Cienfuegos to Baltimore, in
ballast, etc., ordered in quarantine to-day. One suspi-
cious case of fever, rest well. Will detain her several
days for developments. Henry Smith, Surgeon.
The following brief history of the Norwegian bark
Salome, is furnished by Surgeon Henry Smith, of the
Marine Hospital Service, in charge of Cape Charles
quarantine station : " Norwegian bark Salome, spoken
by the Revenue steamer Ewing, off the Capes, August
15th, directed to remain at her anchorage in Lyme Haven
Roads until boarded and inspected by United States
quarantine surgeon. Was inspected at 6.30 a.m., the
i6th, and ordered to quarantine station for observation,
disinfection, and fumigation, and to allow no communi-
cation whatever until further orders. This vessel left
Cardiff, Wales, February 6, 1883, for Vera Cruz, Mexico,
with a cargo of patent fuel, arriving there April 25 th,
with a crew consisting of eleven persons, all on board
well. The health of the men remained good until the
cargo was discharged, when, on June loth, ordinary sea-
man Soren Aslagsen was taken down with yellow fever
and died in three days of black vomit. The captain liad
the fever June r6th, but recovered, and the entire ship's
crew were taken down in rapid succession. After ob-
taining ballast, the Salome sailed from Vera Cruz, June
26th, for Galveston, Te.xas, intending to take on a cargo
of cotton-seed cake and oil ; was not allowed by the
authorities to go beyond the inner quarantine, and or-
dered to the outer quarantine tlie next day. She arrived
at the Galveston quarantine, July ist, and the day fol-
lowing M. E. Nielsen, first mate, and brother of the cap-
tain, was taken with the fever and died July 4th. A
passenger named Guerre, a Frenchman, and of New
York, who took passage at Vera Cruz, was attacked
July 2d (the same day as the mate), and died July 4th.
The last death was that of Ole Tobiasen, a seaman, who
was taken sick July 8tli, and died July 14th, the day af-
ter sailing from Galveston, of black vomit, and was buried
in the Gulf of Mexico — making a total of four deaths.
. . . An additional unacclimated seaman was shipped
at Galveston two days before putting to sea ; all were
found comparatively well upon arrival of the vessel at
the Capes — thirty-one days having elapsed since the last
death or case of any kind, the last man shipped having
thus far escaped. She was disinfected and fumigated at
Galveston. The Salome, which has caused so much anx-
iety because of her disastrous experience, I believe en-
joys the distinction of being the first infected vessel to
arrive with yellow fever at our shores in the present
year."
The Progress of Cholera. — But little if any progress
has been made in the march of cholera during the past
week, and the precautionary measures adopted by vari-
ous countries, give hope that it may be kept at bay for
another year.
A letter to the State Department from the Consul-
General of the United States at Lisbon, Portugal, dated
July 20, 1883, says : " Certain sanitary measures of a
precautionary character have been taken by the Portu-
guese Government against the introduction of the Asiatic
cholera, at this time a fearful epidemic in Egypt. F'rom
the 5th of the present month, by a ministerial decree —
of which I have the honor to enclose a printed copy —
the Egyptian ports of the Mediterranean were declared
infected by cholera and all the Red Sea ports were de-
clared suspected. The danger of infection at this port is
not great, as Portuguese intercourse with the ports men-
tioned may be said to be confined to the monthly arrival
at Lisbon of a steamer of the British India Company.
The Spanish Government has imposed similar vigorous
measures upon vessels arriving from the English ports,
and a portion of the Madrid press has advised that until
similar restrictions are imposed in Portuguese ports upon
such vessels, an embargo be laid on all persons entering
Spain by land from Portugal. Beyond the measure re-
ferred to above, no others have been taken by His
Majesty's Government, as far as I am informed by the
competent authorities. It is said that concert of action
is contemplated by certain of the European powers as
regards the continental ports of Central Europe, and that
stringent measures are under consideration as regards
intercourse with the ports now so painfully affected. The
quarantine here is not rigorous, being of seven days only,
while vessels from South American ports are subjected
to eight days' detention and seclusion."
The following is a translated copy of the " Ministerial
Decree" referred to in the foregoing letter :
2I6
THE MEDICAL RECORD.
[August 25, 1883.
" In consequence of information received, and in con-
formity with advice of board of health, all ports of Egypt
on the Mediterranean are declared infected with cholera
morbus from June 20th last ; and also ports of the Red
Sea, both Egj'ptian and Ottoman, are declared sus-
pected. Lisbon, July 5, 1SS3."
The United States Consul at Copenhagen, Denmark,
under date of July 20th, transmits to the State Depart-
ment the following notice relative to the measures taken
against the introduction of contagious diseases in that
kingdom :
[Translation.^
" Notice is hereby given that the regulations in Sec-
ond Section I. of the Law relating to measures against
the introduction of contagious diseases in the kingdom, of
July 2, 1880, will be enforced with regard to ships coming
from all parts of Egypt until further notice is given.
"In consequence of information received that the
cholera is now prevailing in Egyptian ports, and as this
disease seems to have a very considerable circulation, the
Regulations in Second Section No. I. of the law relating
to measures against the introduction of contagious dis-
eases in the kingdom, of June 2, 1880, will, until further
notice, be enforced with regard to ships coming from, or
which have been in communication with any of the ports
of Egypt, or which may have received persons from, or
have had persons on board from such a ship.
" This regulation will be enforced at once, and is here-
with brought to the notice of all whom it may concern.
"The Ministry of Justice, July 4, 1883.
" (Signed) J. Nelle.man."
The United States Consul at Odessa, Russia, in a let-
ter to the State Department — July loth — says :
"I have the honor to report that from the 13th inst.
all vessels arriving at this port are to be subjected to
seven days' quarantine, on account of the cholera epi-
demic now existing in Egypt."
The following is a list of the United States Sanitary
Inspectors on duty at foreign ports, with a copy of their
instructions :
At Liverpool, England. — William Kelly, ALD., Robert
Jones, M.D., J. Oliver, M.D.
At London, England. — Joseph Higham Hill, M.D.
At Vera Cruz, Mexico. — Robert Mainegra, M.D.
At Havana, Cuba. — Daniel M. Burgess, M.D.
Instructions.
The Sanitary Inspector is required to visit and inspect
all vessels bound for any port of the United States, and
in case of the departure of infected vessels, notification
of the same should be transmitted by telegraph in case
the vessel is a steamer, and by mail if a sailing vessel ; he
will be governed in sending cable despatches by the rules
for the same herewith enclosed (being an abbreviated or
cipher message) ; he will make an abstract, weekly, of
all bills of health issued at his port of all vessels bound
to the United States. This report shall show the name,
rig, and nationality of vessel, date of sailing, number of
the crew, number of passengers, condition of crew, con-
dition of passengers, present sanitary condition of the
vessel, previous sanitary condition of vessel, and sanitarv
condition of the jiort.
All infected ships should be instructed to put in at
Ship Island or Sapelo Refuge Station before proceeding
to their port of destination in the United States, thereby
saving detention, as they will be sent there by the health
officer of any Southern port they may attempt to enter.
The object of the inspection is to keep the Surgeon-
General of the Marine Hospital Service informed of the
departure of infected vessels for the United States, in
order that he may notify the port of destination of the
probable time of arrival of such vessel, so that precau-
tionary measures may be taken to prevent the introduc-
tion of contagious or infectious diseases.
Every effort should be made to keep thoroughly in-
formed of the sanitary condition of the port, and notify
the Surgeon-General, without delay, of any danger that
may be apparent.
Sanitary Condition of Washington, D. C. — Tiie
health officer of Washington, Dr. Smith Townshend, has
made a request of the District Commissioners to expend
$500 in placing the city in a good sanitary condition.
Although Washington looks clean with its wide streets
and beautiful jmrks, there are not a few by-ways and
vacant lots which are teeming with filtli. and need the
attention of a sanitary inspector.
The Post-Mortem Examination of the Late Jacob
S. Mosher, of Albany.— The autopsy on the late Pro-
fessor Mosher was held by Drs. Samuel B. Ward, Albert
Vanderveer, N. L. Snow, John B. Stonehouse, William
Hailes, Jr., Willis G.Tucker, and Maurice J. Lewi, coro-
ner's physician. The result was announced as follows :
" We, the physicians who were present at the autopsy
on the body of the late Dr. Jacob S. Mosher, are unani-
mously of the opinion that death resulted from heart
failure, the consequence of degeneration of the coronary
arteries, and of acute endocarditis." The further opinion
of the physicians is that the disease was of probably not
more than ten days' duration, and was probably caused by
overwork. Death was instantaneous and painless. The
brain weighed a little over fifty-nine ounces, a very un-
usual weight. The gray matter, the residence, so to say,
of the mental powers, was extraordinarily abundant. All
the other organs were in an excellent state of preserva-
tion.
American Dermatoi.ogical Association. — The
seventh annual meeting will be held at the Sagamore
House, Green Island, Lake George, on Wednesday,
Thursday, and Friday, August 29th, 30th, and 31st.
Papers will be read by the following gentlemen : Dr.
Piffard, "Treatment of Acne;" Dr. Hyde, "A Study
of the Coincidence of Syjihilitic and Non-Syphilitic
Affections of the Skin;" Dr. Graham, "General Ex-
foliative Dermatitis ; " Dr. Stelwagon, " Imjjetigo Con-
tagiosa;" Dr. Robinson, " Alopecia Areata; " Dr. Duh-
ring, (i) "On the Value of a Lotion of Sulphide of
Zinc in the Treatment of Lupus Erythematosus," (2)
" Report of a Case of Ainhum with Microscopic Exami-
nation ; " Dr. Atkinson, " A Case of Multiple Cachectic
Ulceration ; " Dr. Sherwell, (1) "Pseudo-Psoriasis of the
Palm," (2) "Malignant Papillary Dermatitis;" Dr.
Bulkley, (i) " A Hitherto Undescribed Vegetable Para-
site Found on the Human Skin,' (2) "A Clinical and
Experimental Study on Pruritus ;" Dr. Van Harlingen,
" Experiments in the Use of Naphthol."
August 25, 1883.]
THE MEDICAL RECORD.
'7
Reports of J^ocicties,
NEW YORK PATHOLOGICAL SOCIETY.
Stated Meetitig, June 13, 1883.
George F. Shrady, M.D., President, in the Chair.
Dr. V. P. GiBNEY presented, in behalf of a candidate, a
specimen of
BILATERAL CONGENITAL DISLOCATION OF THE HIP ASSOCI-
ATED WITH SPINA BIFIDA.
Dr. B. a. Watson presented a specimen of
PRIMARY SCIRRHOUS CARCINOMA INVOLVING THE RIBS,
ADJACENT CONNECTIVE AND MUSCULAR TISSUES, THE
PERICARDIUM, AND THE HEART-WALL.
He was enabled to present this specimen by the cour-
tesy of Dr. Walter Rae, of Jersey City, who attended the
patient during the latter part of his illness, and supplied
the following history : Michael E. S , thirty-six years
of age ; born in Ireland ; laborer; healthy man of erratic
and somewhat dissipated habits. The patient informed
Dr. Rae that during the epidemic of yellow fever which
prevailed in Memphis in 1873 ^^ ^^''■■^ living in and un-
able to escape from the pest-afflicted district. He fur-
ther adds, " I did not expect to survive this epidemic,
and consequently during its continuance I was constantly
drunk and frequently imbued with other vices." He
gives a vague and unsatisfactory history of a supposed
chancre, followed by some inflammation of the inguinal
glands, from which he thinks he suffered during this
period ; and although no treatment was employed there
has been a complete absence of any cutaneous complica-
tions or other tertiary symptoms. With the disappear-
ance of the epidemic we are informed that Mr. S-
abandoned his protracted spree, although he continued
the daily use of alcoholic stimulants, but in such a
quantity as to rarely produce intoxication. He began
to complain in the early spring of 1882 of a sharp inter-
mittent [lain, which he located in the heart. This pain
gradually increased in severity and frequency, and was
soon supplemented by a slight dyspncea. Both the pain
and dyspncea were frequently excited and always intensi-
fied by physical exertion. The disease had progressed
with so much rapidity, that he found himself comjielled,
in the early part of the ensuing August, to abandon the
performance of all labor. The pain, at the commence-
ment of the illness vi3.s principally felt in the cardiac
region, but it gradually ascended, until just previous to
the death of the patient it was located in the left shoulder
and upper portion of the humerus. The pain, which had
been previously intermittent, became about December ist
continuous, and was described by the patient as being of
a " pulling or dragging character." There was observed
about the same time some unusual prominence of the
upper portion of the sternum, which continued to in-
crease until the fatal termination of the disease. The
cough, which heretofore had been slight, became at this
time so troublesome that the patient sought relief in the
use of medicine. There was no important change noteil
in our patient's symptoms, although he was gradually be-
coming weaker, until about February i, 1883, when it
was observed that anasarca had made its appearance m
the feet and ankles, which soon extended to the legs,
thighs, scrotum, abdomen, etc. The lower extremities
soon became so much distended that it was thought
proper to freely incise the integument, which operation
was followed by a profuse flow of serum. The patient
had been unable to sleep in the recumbent position for
two weeks prior to the making of these incisions, but
subsequently he was able to resume the ordinary postures
and secure the much-required rest. There appeared
soon after this a severe pam in the left popliteal space,
which continued some time, and seemed to be neuralgic
in character and reflex in its origin. The left upper ex-
tremity is now oedematous, although the right is normal.
The relative conditions of these parts remained the same
during the life of the patient. During the last three
weeks of life the patient suffered from a profuse prune-
juice or bloody expectoration. The autopsy was made
thirty-six hoars after death. The rigor mortis marked ;
considerable general emaciation ; left upper extremity
cedematous ; right side of the chest is flattened laterally ;
bulging anteriorly of the upper portion of the sternum
and thorax ; this tumor is trapezoidal in shape ; involves
the upper portion of the sternum ; extends slightly above
its superior border, downward from this point three and
one-half inches ; its breadth is also three and one-half
inches in the upper part and two inches at the lower
border ; it covers one inch of the sternal portion of the
left clavicle and extends above the same half an inch ;
the right sterno-clavicular articulation is barely covered
with this morbid growth ; bones within the tumor are
diseased and the integument covering it is perfectly
healthy. The right lung contains a large abscess and is
much broken down, with pleuritic adhesions over its en-
tire surface. The liver, kidneys, stomach, and spleen
are healthy.
The morbid growths were referred to Dr. William H.
Welch, of Bellevue Hosjiital Medical College, for exami-
nation, who reports as follows : " The specimen consists
of a lung [left], the heart, and a portion of the thoracic
wall with the ribs. The lung shows a few spots of broncho-
pneumonia, a small hemorrhagic infarction in its anterior
border, emphysema of moderate extent along its borders,
old pleuritic adhesions, and moderate hypostatic oedema
and congestion. There are a few small nodules in the pe-
riphery of the lung, which may possibly be small, second-
ary, cancerous nodules, although they appear more like
pneumonic foci. The specimen is not sufficiently hard-
ened to obtain satisfactory sections to determine this.
The external surface of the heart presents in various
places diffuse and nodular yellowish-white growths,
which, in places, have invaded the muscular substances
of the heart nearly to the endocardium. The most ex-
tensive of these growths surrounds the large vessels at
the base of the heart, particularly anteriorly and to the
right. This trrowth extends down so as to have invaded
...
deeply the right border of the heart and the posterior wall
of the left ventricle. At the apex of the heart is a nodule
about an inch and a half in diameter. There are other
nodules over the surface and in the muscular substance
of the heart. The valves are not abnormal, except a
little atheroma of the aortic and mitral valves. The
microscopical examination of the new growths of the
heart reveals a stroma of fibrous tissue enclosing alveolar
spaces filled with epithelial-like cells. The structure is
that of carcinoma. The adjacent muscular tissue is
fatty. The portion of the chest-wall, including the bone, is
infiltrated with the same kind of new growth as that in-
volving the heart."
The diagnosis, made by Dr. Welch, constitutes the
title of this paper, while the chief interest of this speci-
men is found in the infrequency of the occurrence
of primary cancer in these organs, and the extreme
difficulty with which the nature of the disease is de-
termined before an autopsy is made. It would un-
questionably be very interesting to determine (if it were
possible) the point at which this disease originated before
we alluded to the literature of this subject ; but I fear it
cannot be done in this case with either satisfaction or
certainty. It is nevertheless thought that the history in
this instance justifies the exclusion of the question of the
origin of the disease within the bones or soft tissues of
the thoracic wall. In the first stage of the disease the
patient complained of a pain which he located below
and to the inner side of the left nipple. The first phy-
sicians to whom he applied, and some of this number are
justly regarded as, eminent men in their profession, ob-
served functional disturbances of the heart and various
2l8
THE MEDICAL RECORD.
[August 25, 1883.
morbid sounds, which caused them, without an exception,
to diagnose aneurism. The swelling and pain which
finally appeared in the upper part of the sternum belongs
to a later stage of the disease. The origin of this dis-
ease may therefore have been in the mediastinum, peri-
cardium, or heart-wall ; but neither the specimen nor
history enables us to fix it more definitely, notwithstand-
ing the chief morbid deposits are found in the heart. The
relative infrequency with which this disease occurs in the
heart may be inferred from the following : ' " Thus in
Kohler, in 9,118 autopsies, and in Tanchon, in 8,289 au-
topsies, cancer of the heart was observed six times by
each ; in Willigk, in 4.547 autopsies (of these 477 cases
of carcinoma), cancer of the heart was observed nine
times, and of the pericardium seven times. Most fre-
quently carcinoma of the heart is secondarv, either de-
veloped by extension from neighboring organs (medi-
astinum, cesophagus, etc.) or occurring as a metastatic
deposit, and here frequently following the course of the
vein ; thus we may see it extending from the lung along
the pulmonary veins into the left auricle, or along the
vena; cava: into the right auricle.'' Neimeyer'^ says:
" Cancer of the heart is very rare, occurring only in gen-
eral cancerous infection, or by extension from the medi-
astinum or pericardium. It forms circumscribed tumors,
usually of the medullary, or else of the melanotic kind,
which project either inward or outward, and mav sprout
into the cavity of the organ." Dr. Thomas B. Peacock
says : '' " Cancerous deposits in the heart are of more
common occurrence than tubercle. Dr. Walshe, writ-
ing in 1846, says that he had readily found twenty-five
cases recorded ; and more recently, in a paper in the
' Pathological Transactions,' I collected tiie particulars of
fort)--five, including in this number two which had fallen
under my own notice. The earliest jjublished examples
of the disease were, I believe, those of .Andral and Bayle,
in 1824." Delafield says : * " Carcinoma of the heart as
a primary tumor is very rare. Nodules secondary to
growths in the mediastinum or other regions are more
common.''
Dr. VV. M. Carpenter remarked, with reference to
Peacock's statement that '• cancerous deposits in the
heart are of more common occurrence than tubercle,"
that so far as tubercle was concerned, he had seen at the
auto|)sy room at Bellevue Hospital, several cases of gen-
eral miliary tuberculosis in adults, iluring the last winter,
and almost without exception miliary tubercles existed in
either the pericardium or the endocardium or both, and
in nearly as large proportion of the cases in the cardiac
muscle. He had not observed secondary cancerous
growth with anything like the same frequency in the
heart.
Dr. C. \. I.EAr.E presented specimens of
CHRONIC DYSENTERY CAU.SED BY THE IRRITATION FROM
AN ACCUMUI.ATIO.N OF BO.NE-S AND NUTSHELLS LODGED
IN AN AB.N'ORMAL DIVERTICULUM AT THE LOWER END
OF THE SIG.MOID FLEXURE OF THE COLON, WITH ULCER-
ATIONS AT THE SEAT OK IRRITATION, WHICH CAUSED THE
LADY TO BE AN INVALID FOR OVER THIRTEEN YEARS
RECOVERY AFTER THE RE.MOVAL OF THE SOURCES OF
THE IRRITATION AND HEALING OF THE ULCERATIONS,
with the following history : Mrs. M , aged twenty-six
years, was in i)erfect health until thirteen years ago, when
her father purchased a house in one of the most expen-
sive parts of Xew York City, and lived there bct'ore the
neighborhood had been built. It was subsequently found
that the previous occupants had left in consequence of
frequent outbreaks of malarial fevers, the endemic
character of which soon became manifest in the family of
Mrs. M , causing hepatic and other chronic troubles
never to be fiilly recovered from. At that time Mrs.
* Zicmssen's Cyclopa:di.i of the Practice of Medicine, vol. vi., p. 287 el scq.
_ ^ Neimcyer's Tcxt-lwok of Practical Medicine. Translated from the Eighth
Edition by Drs. Humphrey and Hackley. «
^ Reynolds* .System of Medicine, vol. iv., p. 169, 1877.
* Post'Murtciii Ex&. and Morbid Anatomy, p. 113.
M had a low form of fever for nearly a 3'ear, and
only partially convalesced after a change of residence.
The structural change in the liver had left an obstructive
circulation of the veins emptying into the portal, and
whenever constipation occurred she suffered from local
venous congestions and peripheral nervous irritations of
the uterus, vagina, and rectum, and pains along the
courses of the crural and sciatic nerves. A year after
marriage she was delivered of a feeble child, with open
foramen ovale, which died in three days. .4fter a tedious
convalescence she again conceived, passed nine months of
great discomfort and exhaustion in consequence of her
stomach and liver trouble, but at term gave birth to a
large, perfect child. Last summer while at the sea-side
she had a return of her dysentery, causing great depression,
and although occasionally checked temporarily, it would
reappear without any known provoking cause. The dys-
entery lasted until April 5, 1883, when, after having had
twenty-eight movements in the previous twenty-four
hours, she sank in a collapse so nearly fatal that restora-
tion only followed after the most vigorous efforts, by
lowering the head below the pelvis to send all the blood
possible to tlie brain, by thoroughly washing out the
bowels with warm water to free the ulcerations of the
colon from all irritating mucus, then following by rectal
alimentations of beef-extract, brandy, chickenbroth, and
hot water, while nothing was given by the stomach.
These procedures soon caused the patient to be out of
immediate danger, the passages from the bowels to be
checked, the vomiting to cease, and a rapid gain in
strength. The rectal alimentation and hot water soon sup-
plied the necessary nutriment, while the irritable stomach
was prepared for digestion by copious draughts of warm
water, to be vomited until it was well freed from the ac-
cumulated tenacious mucus contained in the stomach.
To relieve the probable ulcerations finely powdered wil-
low charcoal was given in teaspoonful doses to a gill of
water thrice daily. The rapid increase of strength in a
week enabled the patient to digest light diet when given
by the mouth, and the improvement continued until faces
accumulated in the rectum and caused a return of the
old neuralgic pains along the course of the nerves leading
from the sacral plexus. These pains were particularly
increased in severity just before a movement, as the freces
passed the posterior rectal walls ; after each movement
from the bowels or passage of rectal douche, the tenesmus
and pain were so severe that for an hour it was almost
unendurable. There was also a jiain situated at the upper
part of the rectum which Mrs. M described as her
old pain in the back, of years' duration, and which had
been so annoying as to prevent walking with ease, or
even riding in the most comfortable carriage. This pain
in the back, Mrs. M stated, for years had been ex-
ceedingly severe after any jolting, so much so that, al-
though in apparent health otherwise, she was forced to
renounce all such pleasures.
The general symptoms with the i)ainful fissures of the
anus caused him to suspect chronic ulceration of the ali-
mentary canal, probably of a tuberculous character,
and that several of the ulcerations at the colon were
below the sigmoid flexure, where under an anresthetic
they might easily be brought into view. He therefore
proposed that so soon as strength would permit a
thorough examination be made, which was done on
the iith of May, when the painful fissure of the anus
and ulcerated rectal lacuna, with a large varicose ulcera-
tion four inches up, were thoroughly cleansed of tena-
cious mucus and gently touched with pure nitric acid.
The serrated ulcerated edges of the remnants of the hy-
men were dissected off, and dilatation of the meatus urin-
arius effected to remove the exposed peripheral nerves.
He dilated the os uteri and cleansed out the tenacious
mucus, then gently applied nitric acid to the cavity.
After neutralising all excess of acid with the bicarbonate
of soda, and washing off the external parts with warm
water, and emptying the bladder, she easily came from
August 25, 1883.]
THE MEDICAL RECORD.
219
under the influence of ether. Haifa grain of morphine
was given, and to the external parts warm water dress-
ings were ajiplied.
On the following and several successive days we
were very nnich disappointed to find that the old pain in
the rectum and left iliac region had rather increased tiian
otherwise ; the urine was drawn off for a few days by
catheter. All pain except that in the rectum and back
had entirely disappeared on the fifth day, when dysen-
tery again reappeared, accompanied with pain exceed-
ingly severe and running from the crecum down the
thigii along the course of the sciatic nerve. On the
iSth he visited her, prepared to give the anaesthetic to
further examine and see the result of former treatment,
but her great depression and weakness from the continued
dysentery caused a postponement until the following day.
May 19th, when ether was again given, and all the ulcer-
ated parts previously treated were found to be in a good
condition, enabling him to make a more extended exam-
ination up the colon. The largest size duck-bill and
cylindrical speculunis were each used and all jjarts ex-
posed to view. Above the varicose ulcerations were
found in a healthy condition. Thinking that he had not
reached the point of pain continuing after the first oper-
ation, he thoroughly dilated the anus, drew down the rec-
tum, and after digital dilatation of its walls, passed u])
to the lower part of the sigmoid flexure, when he entered
a cul-(le-sac about two inches in depth, inlo ivhich he
passed his forefinger, and came in contact with several
sharp, hard foreign masses lodged in the cavity. This
cavity proved to be an artificially formed diverticulum at
the lower end of the sigmoid flexure, and contained one
bone an inch in length and five other irregular-shaped
bones, one being triangular, having exceedingly sharp cut-
ting edges. There were also other small foreign masses.
All these were easily removed after dilating the mouth of
the diverticulum, and are presented to the Society this
evening.
The three larger bones he found, thanks to Professor
W. K. Parker, F.R.C.S., London, to be the radius and
bones of the manus, and the sharp triangular bone of
the digit of a bird of the size of a quail (" Encyclop.
Brit.," ninth ed.). As Mrs. M' stated that she had not
eaten birds for months, and as the pain in the back had
been of years' duration, and entirely ceased after their re-
moval, he surmised that these bones had been arrested at
a weak ulcerated part of the bowels when she had her orig-
inal fever and diarrhoea, thirteen years before ; that from
the frequent straining this diverticulum had formed at the
inferior end of the sigmoid flexure, where a normal pouch-
ing exists, and by the tension had increased ; that these
bones had been the sources of irritation, and were pre-
vented from being extruded by a subsequent and partial
invagination of the bowel above, and were the cause ot
the dysentery. These conclusions are strongly fortified
when we consider that the original pain in the back and
colon neuralgia and the tenesmus entirely disappeared
after the removal of the sources of irritation.
Dr. Leale also presented three
AXILLARY GLANDS,
which he had removed from a patient from whom he re-
moved a cancerous breast one year ago, and the wound
healed entirely. This woman nursed a patient from
whom he removed a cancerous breast three years ago.
At the time she nursed the lady she had no trouble
whatever with her breasts, but about two years afterward
the scirrhus developed and was removed.
Dr. F. N. Otis presented a specimen of phosphatic
calculus removed by lithotrity, and used Bigelow's evac-
uating apparatus with a great deal of satisfaction so far
as results were concerned. It had occurred to him,
however, that if a less expensive instrument could be
devised, which was efficient, it might and would be
acceptable. He did not think that Bigelow's instrument
could be improved. But after spending considerable
time with a view to improving Clover's instrument, the
idea occurred to him that an instrument acting on the
same principle as Bigelow's might be constructed some-
what differently, be of much smaller size and less expen-
sive. The result of his labor had been
AN EVACUATING INSTRUMENT WITH AN INDEPENDENT
AIR-CHAMBER,
which he had used experimentally with great satisfac-
tion. [It was exhibited to the Society.]
Dr. Otis also presented one entire skull and a part of
another, sent to him from the Army Medical Museum at
Washington for an opinion concerning the nature of the
disease that could have produced the manifest localized
loss of bony tissue. There was evidence of loss of the
diploe ivithout any loss of the external table, a simple
sinking in of the external table, leaving apparent eleva-
tions with alternating dejiressions, which is not found
with any disease other than syphilis.
Dr. I.eale remarked that it would be interesting to
know from whence the bones came, as they might aid in
solving the question of Dr. Jones concerning the exist-
ence of syphilis in this country before the advent of the
white man.
Dr. Otis was of the opinion that most, if not all of
the prehistoric syiihilis would turn out rather fanciful.
Dr. L. Emmett Holt presented a specimen of
INTUSSUSCEPTION,
with the following history :
A plump well-nourished child, aged two and a half
months, was brought to his dispensary clinic on Monday,
June II, 1883. The child, the mother stated, had been
quite well until Sunday evening. The bowels had been
regular, and she had given it nothing but the breast.
She had partaken herself quite freely of cabbage at
noon, and to this in part she attributed the child's indis-
position. It was taken at first with vomiting, which had
continued ever since ; first the contents of the stomach
and afterward a thin greenish fluid was ejected. The child
was restless during the night, nursed but a few moments
at a time, and slept very little. She had during the day,
Monday, four quite large stools, which consisted princi-
pally of blood mixed with a little mucus. Straining
and pain seemed to accompany the movements. On
examination he found the child rather drowsy and list-
less ; the clothing was stained with the greenish fluid
she had been vomiting all day. The prostration was not
specially marked. The rectal temperature was 103^° F.
Unfortunately the examination of the abdomen was not
recorded, if indeed one was made. The case was re-
garded as one of dysentery with a considerable amount
of gastritis, and simple remedies were prescribed. He
directed the mother, however, to report to him the follow-
ing morning. She did not do so, and the case had quite
passed out of his mind, when she came in on Thursday
for a death-certificate, saying that the child had died
early Wednesday afternoon.
She gave the following account of the case after her
visit to the dispensary : The vomiting persisted up
to the morning of the day of her death. For nearly
twenty-four hours before, the vomited matters were
of a brownish color and had a very bad, but not
a fecal odor. After Tuesday morning absolutely
nothing passed the bowels. The abdomen became
very rapidly distended with gas ; and the extremi-
ties cold. The child was restless, tossing from side to side
much of the time. On Tuesday evening it was taken
with a convulsion, which was repeated during the night.
The following day the child died in convulsions after an
illness of a little more than sixty hours. No other med-
ical advice was sought.
From the history given he made a diagnosis of un-
doubted intussusception and refused to grant a certificate
without an autopsy, which was finally permitted. As noth-
ing bearing upon the case was found in the other organs
2 20
THE MEDICAL RECORD.
[August 25, 1883.
he confined himself to the examination of the abdomen.
Before opening this, careful exploration was made by
palpation to discover, if possible, any tumor. From the
great tympanites it was out of the question. On opening
the cavity the small intesunes, distended with gas to a size
equal to that in a healthy adult, filled the wound. A small
amount of" reddish serum was found in the peritoneal
cavity without odor, perhaps a couple of ounces in all.
The lower part of the large intestine was empty and follow-
ing this up he found, a little to the right of the spine and
lying quite closely against it, in about the region of the
hepatic flexure of the colon a tumor about two inches long
and one inch in width. The tumor was tightly held down
by the mesentery. The intestine was healthy in its ex-
ternal appearance, not even showing much congestion.
No evidence of peritonitis was discovered. The tumor
after removal w'as found to be perfectly solid to the
touch. An unsuccessful attempt was made to force
water through the obstruction from both directions.
The distal extremity of the tumor was rounded, and
showed a slit-like opening a little to one side of the
middle. This was believed to be the ileo-c»cal valve, as
was afterward demonstrated. A probe was passed with-
out much difficulty through the whole tumor, entering
this opening. No orifice corresponding to the vermi-
form appendix could be found. The intussusception was
exceedingly tight. A traction force of several pounds was
required for its reduction, and some of the longitudinal
muscular bands gave way before complete reduction was
accomplished. The invagination began at the ileo-c:T;cal
valve, about two inches of the ileum passed through this
into the cascum, which itself then was invaginated into
the colon and then the colon into itself. The invaginated
part then was composed of two inches of ileum, the
cajcum, and six inches of the colon.
One point of interest attaching to the case is the age
of the child. Of somewhat over ninety cases of intus-
susception reported by Smith and West only three oc-
curred in the first three months of life. From three to
twelve months is the most frequent period. Nearly one-
half their cases occurred between those ages.
The small size and the somewhat unusual position
would have made the diagnosis of the tumor somewhat
difficult, even before the great tympanites developed.
The general symptoms, however, were so characteristic
as to leave no room for doubt as to the nature of tlie lesion.
From the difficulty experienced in the reduction post
mortem it would ajjpear that injections during life would
not have been likely to succeed.
Dr. Leale referred to an autopsy which he made on
the body of a child less than one month old, in which a
similar condition was present, induced apparently by a
dose of castor oil.
The Society then went into executive session.
Antihelios. — Dr. MacCormac, of Belfast, has re-
cently written a short article with the above title. Hav-
ing called attention to the unexplained innnunity from
sunstroke enjoyed by Hindoos and .Vfricans the writer
proceeds to make what he apparently believes to be an
original suggestion. .Mthough the cooling of lieated air
sup|)lied to chambers is no new tiling, yet we cannot but
re-echo the suggestion made by the writer mentioned.
By mechanical power the hot air of tropical climates
might be drawn through ice cliambers or other coolino-
apparatus, and then sent into the tlwelling ai)anments,
workshops, barracks, tents, hospitals, factories, churches,
assembly-rooms, and sick-rooms. Wind, water, steam
hand, or Mouchot's sun-engine might each find its ap-
jiropriate application under difierent circumstances. Dr.
MacCorniac regards such an arrangement as more thor-
ough and enjoyable than the tatties and punkahs of
India. The importance of temperance in food and drink
is wisely insisted upon ; without this, coolness would not
suffice to prevent the effects of intense heat. — Lancet.
PRACTITIONERS' SOCIETY OF NEW YORK.
Stated Meeting, June i, 1883.
Beverley Robinson, M.D., President pro tem. in
THE Chair.
Dr. V. P. GiBNEV read the history of a
CASE OF costo-vertebral periostitis, dorsal region,
TRAUMATIC.
The speaker said : The case I am about to present fur-
nishes some interesting points from a diagnostic point
of view. Such cases I believe to be rare, and hence my
excuse for placing it on record. Often a vertebral osti-
tis (called by one or two authorities in orthopedic surgery
with remarkable persistency a spondylitis) develops in a
child and a fall or sprain is reported as arising from
trauma — it doesn't make any difference how long the in-
terval. To find, I think, one of these chronic bone-lesions,
central in its incipiency, following i-^j-c-Zy upon an injury,
is certainly, in my own experience, very rare. Acute
peripheral lesions I do find, and the connection betweeu
cause and effect is quite close.
The little girl whose case forms the text for these re-
marks is nine years of age, and she came under my
observation on January 24, 1883. She was decidedly
nervous, and from the general bearing of her mother I
concluded that she was entitled to this diathesis.
Her complaining for the past four weeks had had the
spine as the objective point. On examination I found
a small cyst-like body, not any larger than a split peanut,
lying over the transverse process of the eleventh dorsal
vertebra, left side, and to all appearances overlapping
the articular end of the tubercle of the rib. This small
tumor was sessile, was subtegumentary, and was con-
nected, I believe, to the periosteum. The soft tis-
sues immediately adjoining were infiltrated to a mod-
erate extent, and the localized tenderness was quite
marked.
The patient stooped very awkwardly and I began to
suspect some disease in the body of the vertebra. There
was no tenderness on concussion, and the spinous pro-
cess did not participate in the deformity.
The history enabled me, apart from the signs, to elim-
inate any chronic bone disease in the diagnosis. While
in perfect health she experienced one day, four weeks
before this visit, a pain in her back wliile lifting her
elder sister. She remained in bed next day, so much
soreness did she feel, and kept her bed for one week.
The pain was very acute at times, especially on move-
ment.
One of my assistants, in whose opinion I always place
much confidence, leaned to ostitis of rather an acute
nature, and I determined to apply an apparatus as a
matter of jirecaution. Pending the making of the same
I ordered a counter-irritant and put on a roller with cot-
ton-wool beneath.
On February 20th 1 find that it feels and looks more
cyst-like and a hypodermic needle is introduced for ex-
l)loration. This little operation is unsatisfactory, on
account of the fright of the girl, and I get only a little
blood and lose the patient's confidence.
When 1 saw her again it was March 31st. An abscess
had formed in the meanwhile, had opened, and there
was now a small sero-purulent discharge therefrom. The
brace was removed and a poultice was ordered.
On .A.pril nth the opening was larger, and through it
protruded a mass of granulation tissue which required a
caustic.
On the 17th I found projecting througli the opening,
a small shell of bone, evidently exfoliated from the tuber-
cular process or the rib.
The subsequent history is briefly told. The ulcer
healed in a few days. I kept her under observation a
couple of weeks longer, and finding a complete cessation
of all signs and symptoms, discharged the case.
August 25, 1883.]
THE MEDICAL RECORD.
221
Dr. Henry F. Walker read a paper entitled
A CASE OF IMPERFECT DEVELOPMENT OF THE PARIETAL
BONES OF AN INFANT.
The speaker said : In January, 1883, I attended a
priniipara in confinement. She was the wife of a man of
good physique, but was herself frail and of a very nervous
temperament. Neither parent gave history of previous
illness or marked diathesis. The labor was prolonged
but perfectly natural, and completed without assistance.
The caput succedaneum was quite pronu'nent on the
vertex to the child's right. It was rather larger than
usual, but not larger than one sees without anxiety.
I assured the mother that in a few days the child's head
would assume a normal form.
On my subsequent daily visits the child was usually
sleeping, lying on the back, and was not disturbed. Ten
days after its birth the nurse said that the mother was wor-
ried because the child's head still showed marked de-
formity. I then examined it carefully and found that the
parietal bones were imperfectly developed. The sagittal
suture and the sutures between each parietal and the oc-
cipital bone were as perfect as usual, and the fontanel
was not of unusual size. But parallel to the sagittal suture
in each parietal bone, about three-fourths of an inch from
the median line, was a space where the only covering of
the brain seemed to be fleshy tissues. This allowed a
protuberance of the cranial contents. The tumor on
each side was three inches long vertically, the left was
three-fourths of an inch and the right one inch wide,
while the projection above the general surface was nearly
half an inch. The bordering edges of bone could be
easily determined, while the firm bone uniting in the
sagittal suture and which divided the spaces could be
clearly felt. The child was born at full term and no
occasion for arrest of development could be found.
I gave a guarded prognosis. While I continued in
daily attendance on the mother no change was percepti-
ble. Two months afterward I was asked to inspect and
pronounce upon the child's condition. 1 found that the
bony formation on the right side was nearly perfect. The
head was a little protuberant there, but the bony case
was quite firm and resistant, though evidently thinner
toward its centre. The smaller space, that on the left,
was completely filled. The bone, however, had here
united at an acute angle, making a sharply defined ridge
three-eighths of an inch in height above the general sur-
face. Had it not been for this ridge, the absolute proof
of the correctness of the original diagnosis, 1 might have
been inclined to think that I had mistaken double hema-
toma for the tumor from non-developed bones. But the
bony ridge seemed to me proof positive of the correct-
ness of my first opinion.
At three months the child was well, though with a head
of slightly peculiar form.
In response to the query whether the condition
might not have been a haematoma, Dr. Walker said
that he had had that possibility in mind all the time, and
the evidence seemed to him conclusive that it was not
one.
Dr. F. p. Kinnicutt reported a
CASE OF diabetic coma.
[This will appear later in The Record.]
Dr. H. F. Walker said that a few years ago he had
a case in which albuminuria and glycosuria seemed to
alternate. The patient finally died of Bright's disease.
Dr. Kinnicutt said that he had recently obsexved
another case of diabetes in which the
nervous SYMFfOMS
were very marked. The patient was a lady who liad
had the disease for seven or eight years. During that
time she had frequently had attacks of paresis involving
different portions of the body. She had first three succes-
sive attacks of facial paralysis. The first attack developed
very suddenly with no other symptoms and the paralysis
seemed to be peripheral, since the muscles in the upper
part of the face were affected as much as those in the lower.
The symptoms lasted for only about a week when they
disappeared almost entirely. A few weeks later a facial
paralysis on the other side of the face appeared. This
also rapidly improved, and was followed by a third attack.
A short time ago, without any warning, she suddenly de-
veloped a left hemiplegia aff"ecting both the upper and
lower extremities and face in a very marked degree.
This did not improve ; it lasted about ten days, when the
patient suddenly had an attack of syncope and died.
She was a very large person with, jirobably, a fatty heart.
Referring to the subject of diabetic coma, he said that
as to
prevention
it is well known that the attacks are more apt to occur
after great physical exertion. Patients sometiiues de-
velop them after being brought to a hospital from a
long distance. They also occur when the sugar has
fallen in amount.
Dr. McBride said that he had not seen any case of
diabetic coma, but he should be very much inclined to
make use of
venesection with arterial transfusion.
He had seen such brilliant success with this method
occurring in coma from poisoning by illuminating gas
that he felt great confidence in its efficacy in diabetic
coma. With the perfection now obtained in the tech-
nique of transfusion, especially arterial transfusion, the
operation is almost entirely devoid of danger, and is one
which every physician should be able to perform.
Dr. Kinnicutt said that he had tried transfusion, al-
though it had not been iJreceded by venesection.
Dr. McBride thought venesection should first be
jiractised. Arterial transfusion was preferable because
it was less dangerous. The radial artery is usually
selected and the blood transfused toivard the heart. In
cases where the blood has been transfused toward the
periphery thrombi have resulted.
Dr. C. L. Dana reported his experience with
paraldehyde as a hypnotic and anodyne.
Tlie introduction of paraldehyde by Cerville, of Pa-
lermo, and its use by Morselli, of Turin, and others was
referred to. A specimen of the drug was shown. It is
a transparent colorless liquid, with a penetrating odor
and taste, suggesting Hoffman's anodyne. Its formula
is C.Hj^O,. It dissolves slightly in water, but mixes with
it very readily. Dr. Dana had been unable to procure
any in the city, and it was made for him out of Merck's
aldehyde, by Dr. Chevaillier, Lecturer on Chemistry at
the Woman's Medical College of the New York Infirmary.
He first tried it on a pup six months old, giving it a
gramme by the mouth. The animal was at first much
excited, running around and stumbling as if intoxicated.
It showed no signs of pain or gastric disturbance. Its
intelligence was not greatly disturbed ; it would come
when called. Pulse ran up from 130 to 200 ; respiration
was 20 to 24 and labored. In about twenty minutes it
lay down and went to sleep. Pulse, 140 ; respiration,
slower (18), and with labored inspiration. The animal
was easily roused, walked around, then went to sleep
again. Slept about two hours.
Having demonstrated its innocuousness, the drug was
prescribed in a number of cases. Notes were given of
thirteen ; nine times it was given for insomnia, twice for
its general sedative effects, twice as an anodyne in neu-
ralgia. In six cases it acted very well as a hypnotic, in
two it was helpful, in one it failed. Large doses {i.e.,
above three grammes) were not prescribed. Given in
sciatica and supraorbital neuralgia it caused relief of
pain temporarily. As a general sedative in " nervous-
ness " it acted remarkably well in one case, and gave
THE MEDICAL RECORD.
[August 25, 1883.
some relief in the other. The dose was 3 ss. to 3 j- well
diluted ; there were no bad after-effects.
Dr. Dana thought that it was a somewhat less sure
and powerful hypnotic than chloral. It was also more
disagreeable to the taste. It had the advantage of being
safe, of having no bad after-eftects. It would probably
prove useful in those cases where chloral fails, or is for
any reason contra-indicated. .\t present it is rather ex-
pensive.
Dr. McBride asked what were the objections to
chlor.^1.
Dr. Dana said that chloral was not without danger ;
that it was disagreeable, and that some persons could
not take it. In fact, he had investigated the value of
paraldehyde largely because he had a patient who had
attacks of insomnia. Cliloral i)roduced sleep, but made
him sick all the next day. Bromide of potassium kept
him awake unless used in large, long-continued doses.
Dr. McBride thought that chloral could be used with
greater freedom than had been supposed. He had given
it in pneumonia with dilatation of the heart in doses of
one hundred and si.xty grains in twenty-four hours (with
digitalis), and he had lost in a great measure the dread
which he had had of its evil effects. He usually gave it,
if indicated, in typhoid cases. In some obstinate cases
of insomnia, chloral in doses of five grains with 3 ss. of
bicarbonate of soda (as suggested by .Mitchell), was often
successful.
Dr. Kinxicltt had given one hundred and twenty to
one hundred and forty grains of chloral a day to a boy of
fourteen, suffering from a very violent chorea.
Dr. McBride had used chloral hypodermically sev-
eral times in convulsions, and it seemed to him to be the
remedy for convulsions. He used a solution of one part
chloral to four parts water, injecting a syringeful. It had
never produced any abscess. The speaker had also
found
. SMALL DOSES OF CHLORAL IN" UR.EMIC DVSPNiJiA
very efficient. Three to five doses generally secured
relief. He had found it even better than morphine.
(Co VVC5P Li n (1 cucc.
OUR C.AN.ADA LETTER.
(From our Special Correspondent.)
MEDICAL SCHOOLS FOR WO.MEX — PROVINCIAL BOARD OF
HEALTH FOR ONTARIO — SUM.MER SESSIONS QU.iCKERV
IN MEDICINE.
Toronto. Canada.
For some time there has been a good deal of agitation
in favor of medical colleges for women. This has grown
out of what IS called the Kingston trouble. During the
session of last winter several ladies were attending the
medical school in Kingston. Exception was taken by
those ladies to some remarks made by the lecturer on
physiology. The men in the class became noisy and
made statements that greatly offended the ladies. For
some time the work of the school was at a standstill.
The students threatened to leave the school. After some
negotiations between the students and professors the
matter was adjusted by the latter agreeing to give sepa-
rate instructions to the men and women. This ditficidty
made it api)arent that co-education would not work, and
so both Kingston and Toronto are on the eve of organ-
izing a college for the fair sex. Dr. Lavell has been
chosen as Dean of the former, and Dr. M. Barrett of the
latter. It is expected that both schools will be opened
for lectures this coming winter. There has been a good
deal of talk about the usefulness of having women edu-
cated in medicine for the purpose of sending them out
as missionaries to foreign lands. This may seem very
tine, but after all it is the question of dollars and cents
that is at the bottom of the whole move, both on the
part of the medical men agitating the schools and the
ladies who wish to secure medical qualifications. There
cannot be any doubt in the minds of all who think calmly
on the matter, but that these young female doctors will
locate on our streets and in our villages and towns,
whereas those who go abroad, as medical missionaries,
will be about as numerous as the Howards and Pea-
bodys. The move is certainly very unpopular with the
medical profession at large in this country.
The Provincial Board of Health for Ontario was estab-
lished a little more than a year ago by an Act of the local
Legislature. In the short time that it has been in ex-
istence it has done much good work. One of the leading
objects it has had in view is the establishing of local boards
to take charge of matters of public health over small areas.
One point, however, must be regretted, that the salaries
of the gentlemen on the board are not sufficiently large
to enable them to give their whole time to sanitary mat-
ters, instead of dividing it between the duties of public
office and private practice. The smallness of the salaries
at present granted should be protested against.
Several of the Canadian medical schools have organ-
ized a summer session. So far these have been very
successful, and in future they will form a prominent part
of the education of medical students. The class of lec-
tures given are distinctly practical, and on parts of the
work that could not receive sufficiently full attention
during the winter months. This form of summer work
will have a great influence in raising the standard of
medical education.
At the recent meeting of the College of Physicians and
Surgeons, a good deal of discussion took place on the
question of quackery. A'arious remedies were suggested,
among which might be mentioned the plans of asking
Government to grant no patents for proprietary reme-
dies, or imposing a heavy tax upon such preparations ;
or, again, of having an inspector appointed, who would
condemn all worthless compounds. Perhaps the best
plan was that of compelling the manufacturer, under
heavy fine, to print distinctly on the wrappers the exact
composition of the mixture. This would certainly kill
most of the nostrums for sale in this country. Another
burning question was, what to do with a nondescript and
apostate class of practitioners, who advertise special
cures, and fill the columns of our dailies with cases suc-
cessfully treated. No doubt some action similar to that
taken in Britain, would [Jrove wholesome — of removing
the name from the register of any person who advertises
a remedy of special virtues, the secret of wliich he keeps
to himself. It is to be hoped that fearless action will be
taken soon with this class.
"COPPEK .-WD CHOLER.\."
To THE Editok of The Medical Record.
Sir : There api)ears to me another explanation of the
immunity enjoyed by workers in copper and brass than
that suggested by Dr. Peckham in your issue of August
i8th, namely, the fact that in most cases mineral acids
especially sulphuric acid is more or less used by them,
and that they come into contact with acid salts in much
of their work, .\nyone who has liad occasion to visit
a brass foundiy has seen the pickling-vats in which, with
the aid of this acid, castings are deprived of the "skin"
of oxidized metal and fused sand, after coming from the
moulds. He may also have noticed that in many of the
processes of brazing or soldering joints, mineral acids
are' used to give a bright and clean surface. This is es-
pecially the case when electro-plating or hand-plating is
carried on.
It is not difficult to understand that in one way or
another these acid substances gain an entrance to the
alimentary canal, and that they there prevent the devel-
opment or destroy the vitality of cholera-germs.
As an opinion of the power of mineral acids to pre-
vent the development of cholera, allow me to quote
August
.5. 1883.]
THE MEDICAL RECORD.
223
Surgeon Eli McClellan, of the U. S. Army, one of the
authors of the Government Report on " 'I'he Cholera
Epidemic of 1S73 in the United States," p. 32 : "The
ex|)erience of the writer is strongly corroborative of the
beneficial results which may be obtained from the use of
sulphate of iron and dilute sulphuric acid as prophylac-
tics during an epidemic of cholera." In another work,
intended for popular use ' Dr. McClellan writes as fol-
lows : " When the specific poison of cholera has been
swallowed and comes in contact with healthy gastric
juice, the latter, by virtue of its acidity, utterly destroys
the poison. If, however, the gastric juice has not its
normal acid reaction, then the specific poison, meeting
only alkaline fluids, is able to reproduce itself," etc.
He subsequently '" advises the use of a mixture of one
ounce of sulphuric acid to a gallon ot water as a disin-
fecting solution for " cholera stuff " and soiled clothing;
and also says (p. 94), " A mixture of aromatic sulphuric
acid and laudanum is about the most efficacious [prophy-
lactic] which can be employed."
If we accept the opinion of so able an authority re-
specting the value of sulphuric acid as a preventive of
this disease, is it not easier to account for the immunity
of copper-workers, who use it almost constantly in their
art, than to presume that the metal itself affords the pro-
tection.
F. A. Castlk, M.D.
102 East Fifty-seventh Street, New Yokk.
gtvmii and ilauy 2Xcius.
Official List of Changes of Stations and Duties of Officers
of the Aledical Department , United States Army, from
August II, 1883, to August iS, 1S83.
Baxter, Jedediah H., Chief Medical Purveyor, United
States Army. To proceed to San Francisco, Cal., via
St. Louis, Mo., on public business connected with the
Medical Dep-artment, and on completion thereof will
return to his station. S. O. 185, par. i, A. G. O., August
II, 1883.
Baknett, Richards, Captain and Assistant Surgeon.
Granted leave of absence for one month on surgeon's
certificate of disability. S. O. 149, par. 2, Department
of the East, August 10, 1883.
Burton, Henry G., Captain and Assistant Surgeon.
Relieved from duty at Fort A. Lincoln, D. T., and as-
signed to duty at Fort Assinniboine, M.T. S. O. 141,
par. I, Department of Dakota, August 11, 1883.
Benham, R. B., First Lieutenant and Assistant Sur-
geon. Relieved from duty at Fort Assinniboine, M. T.,
and assigned to duty at Fort A. Lincoln, D. T. S. O.
141, par. 2, Department of Dakota, August 11, 1883.
Official List of Changes in the Medical Corps of the Navy
for the week ending August 18, 18S3.
Bright, George A., Surgeon. Temporary duty at
Naval Rendezvous, Philadelphia, Penn.
Neilson, John L., Surgeon. Temporary duty on
Receiving-Ship Franklin, Norfolk, Va.
Martin, William, Assistant Surgeon. Navy Yard,
Pensacola, Fla.
Diarrhcea in Infants. — Dr. Lewin has found great
success in the treatment of diarrhcea in young infants by
giving them soluble albuminate of tannin, made by adding
white of egg to a solution of tannin ; the white of egg
must be previously beaten up with some water. — Ther.
Gazette.
1 Wood's Household Practice' of Medicine, vol. ii., p. 8i. Ne
Wood & Co. 1880.
* Loc. cit., p. go.
pXccTical Items.
Contagious Diseases — Weekly Statement. — Re-
|)ort of cases and deaths from contagious diseases re-
ported to the Sanitary Bureau, Health Department, for
the two weeks ending August 21, 1883 :
Week Ending
>
>
'0
■a
1
"3
'i-s
o.S
II
1
0
■c
si
g
0.
1
H
H
(«
u
^
Q
en
>
Cases.
August 14, 1S83
53
45
-'8
36
20
0
0
0
0
August 21, 1883
0
32
3
^4
Deaths.
1
Anp'nst lA 188'^
0
10
4
2
16
15
0
0
A II crust 21. I 88"?
0
II
14
3
10
15
0
0
Pasteur's Pension. — On the 12th inst. the bill in-
creasing M. Pasteur's [lension from 12,000 to 25,000
francs, with reversion to his wife and children, passed the
French Chamber without a division. In rejjly to certain
dissentients, M. Paul Bert cited the English grant to
Jenner, and scouted with warmth the charge of sordid
motives brought against Pasteur.
The Treatment of Tremor. — According to M.
Feris, of Brest, veratiia has the property of causing
various kinds of tremor to disai)pear, and that in the
space of ten days or a fortnight. It has been employed
in disseminated sclerosis, alcoholism, and adynamic
states. The dose is four pills |)er diem, each containing
half a milligramme of the alkaloid.
French Tre.a.tment of Croup. — Dr. Jules Simon
treats croup as follows : As soon as the malady is diag-
nosed he touches the throat with lemon-juice, or a solu-
tion of muriate of iron every two hours. Every three
hours he washes the part affected with a solution of borax
(two drachms to the ten ounces). At the same time the
atmospliere of the room is charged with atomized phenic
solution, a stimulant nourishment is given, and three to
five drops of tincture of iron administered every three
hours. When dyspnoea becomes apparent an emetic is
to be given, but if the symptoms are not relieved trache-
otomy must be performed without delay. The results of
the operation are not, however, very satisfactory, as
when the child is under two years a fatal termination is
the rule, whereas above that age one out of five recovers.
The after-treatment consists in placing a piece of tarlatan
over the canula, warming the room, and administering
beef-tea and tincture of iron. The removing and clean-
ing of the canula should be done by an experienced per-
son, it might be definitely removed after the eighth or
tenth day. M. Simon considers that chlorate of potash
is of little use in croup.
The Extent of Cross-Examination of Medical
Witnesses. — The courts of Pennsylvania are more strict
in regard to the proper extent of cross-examination of
witnesses than those of this State. It was held not long
since in a Pennsylvania suit that a physician called as an
ordinary witness in a case involving the question of pro-
tessional negligence, could not be cross-examined as to
his knowledge as an expert. In this State considerable
freedom of cross-examination is allowed, and questions
of this character would, no doubt, be admissible.
The Right of Preventing Persons from Attend-
ing Funerals. — A curious case involving the right to
prevent persons from attending a funeral was recently
decided in Rhode Island. The facts were that the
plaintiff's wife had been enticed away from him by the
defendants, and while absent from him she had died ; the
224
THE MEDICAL RECORD.
[August 25, 1883.
defendants conducted the funeral services, and refused to
allow the I'laintiff to see her body or attend the funeral.
Suit was then brought for damages against the defendants.
The Court refused to sustain the action in the following
opinion : " We find no ground, either in reason or au-
thority, for holding that any person has a right to enter
the possessions of another without his consent for attend-
ing a funeral. It is suggested that the public nature of
funeral ceremonies implies a license : but such license,
if one arose in this case, was revocable, and was clearly
revoked by the subsequent conduct of the defendant as
set out in the court. It is also suggested that the wrong-
doing of the defendants in enticing away the wife raises
a license of which the plaintiff may avail himself under
this court ; but we think that the right of the husband
in this regard was at most a right to have the custody of
the body of his wife, and to order the funeral ceremonies
himself in his own possessions, and that the license, if
any was impHed, was to enter the premises of the de-
fendants for the purpose of assuming such custody and
removing the body for that purpose. But in this case
there is no allegation of demand for the body or refusal
to deliver the same ; the only allegation being that the
plaintiff was prevented from attending the ceremonies
which were proceeding under the charge of the defend-
ants."
Iodoform in the Treat.ment of Leucorrhij;a in
Children. — Dr. Weissenberg claims excellent results in
the treatment of vulvo-vaginitis in girls by iodoform
{Mc'iiiorabi/ii'tt, June 9, 1SS3). His method is the fol-
lowing : The child is bathed for the first few days in
lukewarm water, and the vagina is syringed out two or
three times a day with lukewarm infusion of chamomile.
When the inflammation is somewhat reduced by this
treatment, usually after three days, the vagina is dried
with salicylated cotton on a uterine sound, and then an
iodoform pencil is passed up above the hymen. In two
days, after a bath, this procedure is repeated, after which
the cure is in most cases complete. Instead of the pen-
cil, iodoform in powder may be strewn in the vagina,
with sometimes better results.
Infanticide and Abortion in the Hawaiian Is-
lands.— When the Boston missionaries first settled
among the natives they found infanticide practised to an
alarming extent, mothers deliberately smothering, strang-
ling, or burying alive their newly born. Mrs. Judd, the
wife of that Dr. Judd to whom the Hawaiians owe their
present form of government, mentions the frightful ex-
tent to which infanticide was carried in 1828, and records
a case under her own observation, where a mother was
known to have buried alive eight out of ten children
born to her. Civilization, however, has somewhat re-
fined the native taste, so that abortion has superseded
the more barbarous method, and the manner in which
they induce it is w^ell worth relating. The unfortunate
woman is placed upon her back on the floor, and the
officiating Kahuna, or medicine woman, taking a stone
in either hand, proceeds to knead and squeeze the abdo-
men, endeavoring to get the uterus between the stones.
Next she gets ujjon her victim's abdomen with her knees,
and walks all over it, so to speak. Tiiis violence gen-
erally brings on flooding, and in a short time abortion,
but alas ! frequently at the expense of the patient's life,
though in one case which was cited to me dumb-bells re-
placed the stones in the operation, great violence being
done, and yet the woman went on to term and gave
birth to a healthy child. — Dr. Heffinger in Boston
Medical ami Surj^ical Journal.
The London "Times" on the Modern Mf.dical
Student. — Commenting on the fact that one of the
members of the Royal Family presided at the graduating
exercises of St. Thomas' Hospital, the Times says:
"The medical students of to-day will be the practitioners
of a few years hence; the men on whose care and skill
the preservation of precious lives must fre(iuently de-
pend", and who will become, in an infinite number of
matters, the most confidential and most trusted advisers
of all classes of the community. Everything which ele-
vates them in their own eyes, which renders them more
conscious of the importance of the duties they will be
called upon to discharge, and more zealous in preparing
to discharge tiieir duties thoroughly, is so much direct
gain to the conmiunity. And it may be that such con-
sequences will in some degree flow from the countenance
and the favor of Royalty. Thirty years ago the medical
student was a familiar character in fiction, and both
Charles Dickens and Albert Smith, according to their
several lights, described the aspects under which they
were accustomed to regard him. Bob Sawyer will re-
main as a tyjje of a class as long as English literature
endures ; but he is a type of a class which has long
ceased to exist. The medical students of to-day can
hardly be said to present any salient characteristics, or
to differ in any appreciable degree from the student of
any other profes.sion, unless it be that there are few
others in which the examinations are of equal severit)' or
of equal range, or in which such laborious preparation
is necessary for the attainment of success. The mere
riotousness of youth, the natural exuberance of the
years from seventeen to twenty-one, has found outlets of
which Bob Sawyer had no knowledge ; and athleticism,
volunteering, and bicycles have superseded tavern or-
gies and nocturnal mischief."
An Active Principle of Ergot has been obtained
by Gehe &: Co., Paris. It is called ergotinin, and it is
said to have very powerful hemostatic properties. It is
very expensive, however, one gramme costing about forty
dollars.
A Bon-Mot of Ludwig. — Professor Ludwig, the well-
known physiologist, of Leipzig, is one of the i^w German
professors who can say a bright thing occasionally. Some
time ago. Professor Marey, of the College of France,
was paying a visit to the German universities, and called
upon Ludwig, w'ho paid him the honors of the institu-
tion. Marey showed himself particularly surprised at
the great size of the frogs which were submitted to ex-
periment. "That ought not to surjjrise you," said Lud-
wig. " In France you have the big Marey (swamp), but the
little frogs ; we have the little marais, but the big frogs."
A Novel Laryngoscope. — Dr. Thomas Dimock
writes as follows to the Therapeutic Gazette : " One of
the best methods for examining the throat without the aid
of the ordinary laryngoscope is the following : Bring the
patient near a good light of any kind, and after the mouth
has been opened place on the tongue a depressor, then
request the patient to yawn. The larynx will inuiiedi-
ately rise up and every part necessary to be seen will be
brought fully info view. The nose should be held, as
this compels breathing through the mouth. Thus the
velum pendulum palati is raised, the anterior and poste-
rior pillars become widened, exposing the back of the
tonsils and pharynx. The tongue nmst be pressed down-
ward very gently, as it always resists harsh treatment."
The question naturally occurs. Suppose the patient will
not yawn ?
Small-Pox, Petroleum as an Ectkotic. — Dr. Ka-
nenski states that he has obtained excellent results, even
in the confluent form of small-pox, by painting the skin
with a solution of petroleum in olive oil, one to three
or four. — Przeglad Lekarski. T/ier. Gazette.
A New Use for Chloral Hydrate. — B. Bonatti
recommends chloral hydrate in combination with senna
as a rapid and safe drastic cathartic. He prescribes :
IJ . Infus. sennit fl 3 x.
Chloralis hydratis gr. xxiv.-l.
Syrupi fl 3 j.
With this he obtained an action where cotoin and
jalap had failed. — D. Med. Zeitung. Pharmaceutische
Centralhalle. Thcr. Gazette.
The Medical Record
A Weekly yoiLvnal of Aledicine and Siwgery
Vol. 24, No. 9
New York, September i, 1883
Whole No. 669
©vioiual Articles.
ATONIC DYSPEPSIA.
By J. MILNER FOTHERGILL, M.D.,
EDINBURGH, SCOTLAND.
HONORARY M.D. Rl'SH MEDICAL COLLEGE, ILLINOIS, ASSOCIATE FELLOW OF THE
COLLEGE OF PHYSICIANS OF PHILADELl'HIA.
Dyspepsia is a malady which presents itself under various
aspects. In one case there is great irritability of the
digestive organs, they are easily upset by any unsuitable
food, by exposure to cold, or by any great emotion ; in
another the digestive organs are enfeebled by venous en-
gorgement, as in the gastric catarrh of valvular disease,
or a failing heart ; in another case there is simply want
of tone in the digestive organs with a defective or ca-
pricious appetite. These are three well-marked varieties ;
there are others equally marked which need not be
alluded to at present.
When the dyspeptic patient presents himself or licr-
self before the physician, the first thing to be done is to
know something about the family history, the history of
the individual, the occupation, the opportunities for tak-
ing food, the condition of the teeth, and the state of the
bowels. One is just as important as another. An elabo-
rate plan of treatment may be rendered entirely futile by
omitting to ascertain the condition of the teeth, which,
perhaps, is such that efficient mastication is simply a
physical impossibility. Without some rectification of this
defect all the rest is useless, no matter how elaborate.
On the other hand, it is well to investigate the family his-
tory, and learn how far the family is one in which dis-
eases are developed which are linked with failure of the
nutrition. If such family maladies exist, then the case
will probably be comparatively intractable, as contrasted
with a case where the family history has other associa-
tions. Then the history of the individual is important.
If he be one who has lived long, where inappropriate
food has been taken for a lengthened period, such as a
stock-rider in Australia, or out West, who lives on damper
with salt pork, relieved by tinned provisions, imtil the
digestive organs have been thoroughly upset ; then the
case will require time for the organs to recover them-
selves. In another case the individual will have endured
great mental tension for a considerable time without any
failure of the nervous system ; but the digestive organs
have given in. Thus in one case, well known to me, the
patient underwent two years of the most intense strain
in Wall Street, his nervous system did not suffer in the
slightest, but his liver had almost lost its power of dealing
with albuminoids. Another for seven years worked hard
building up a business in Russia, with the result that he
is a confirmed dyspeptic, with a colon very readily
offended. A third carried all before him as a civil ser-
vant in India, but has now for some years been laid
upon the shelf an incurable dvspeptic — or, at least, no
one has been able to endow him with the capacity to
digest enough to enable him once more to work. It is
eminently desirable, then, in all cases, to ascertain dis-
tinctly what kind of a case you have to deal with. The
occupation is scarcely less important, for if a city man,
the ranges of food, through the middle of the day at least,
is restricted to the viands of restaurants, most of which
are unsuitable to a dyspeptic. Or the patient is con-
nected with a large house of business and must take
"what is going," that is, what is provided for the inmates
generally. In these last two cases the dietary becomes
the difficulty.
Having cleared the case of all such elements, and
formed a fair conception of what its surroimdings are,
the indigestion may be approached directly. The first
matter is to ascertain what amount of pain is produced
by the digestive act, its time in the digestive process,
and whether or not much flatulence is coexistent. When
an ulcer is present the pain is set up almost synchronously
with the introduction of food into the stomach, as soon as
the contents become acid from the flow of the acid gastric
juice. Here the line to be taken is clearly that of trying
to put gastric action in abeyance and trust to the pan-
creas. Milk sheathed with an alkali, with or without
some biscuit powder, will probably pass readily through
the stomach without producing much suffering, and be
digested successfully in the intestine, and in order to save
the stomach the patient may be fed per rectum to a con-
siderable extent for a time. Physiological rest so being
aff'orded to the stomach the healing of the ulcer is favored
and, in many cases, is readily accomplished.
In other cases the pain is not experienced until we
believe the food is passing through the pyloric ring, and
intestinal digestion is being inaugurated. What do we
do in such a case ? There are two lines open to us
which may be combined in practice: (i) we may try
what can be done by suitable food and some pepsin, to
secure complete disintegration of the contents of the
stomach so that theyjshall not irritate the duodenum ; (2)
we may stimulate the action of the liver and give liquor
pancreaticus. And by such measures we can probably
do the patient a great deal of good. At the same time,
a sufficient time must be given to the taking of food ;
while the patient should be relieved from worry, as by
leaving his or her business or occupation for a time,
thus giving the medicinal treatment a fair chance.
And now a few words may be said about the resort to
artificial digestive agents. Of the extreme value of these
agents in strengthening our hands when dealing with in-
digestion there can be no two opinions, and Dr. William
Roberts, F.R.S., ought to be held in aftectionate remem-
brance by every dyspe|)tic,'both those who require these
agents actually and those who might come to require
them.
But it seems to me, from a recent experience, the ten-
dency is to resort to these agents at once, instead of en-
couraging the natural eftbrts and holding the artificial
agents in reserve. For instance, a few days ago a youth
came up from the midlands, who had been put upon arti-
ficially digested milk and milk porridge, but with whom
no attempt had been made to foster the digestive act.
To such artificially digested food had been added phos-
phorus and strychnine, while nothing had been done to
secure proper action of the bowels. On explaining that
the line which suggested itself to me was that of encour-
aging the natural processes, instead of doing the work for
them, the father of the patient, a farmer familiar with
the varied outcomes of i)auperism, showed his compre-
hension of what I was driving at by remarking, " Not to
make a pauper of his stomach. Doctor, eh ? " which meant
that the stomach was weakened by having its work done
for it. Now this was precisely my own view in familiar
phrase. In such cases, the proper practice, in my opin-
ion, is to encourage the natural powers, giving such food
as shall least tax them. This is a good line to take; and
226
THE MEDICAL RECORD.
[September i, 1883.
then if the case does not move forward, to give some
artificially digested food, once, or perhaps twice a day
(in order to nourish the body) ; pursuing the old line at
the same time. But if this resort to artificially digested
food were forced upon me, I should regard it as indicat-
ing a reduction of the body expenditure to the minimum.
The patient ought to be sent to bed. Warm in bed, the
need for hydrocarbons is small ; at rest the tissues require
little repair. In bed the amount of food required for the
body needs is much less than when up and about. A
patient remarked to me some time ago, " I can't eat
enough to feed me properly, and if I did I could not di-
gest it : " What was to be done? He was sent to bed,
and then " tiie body expenditure" fell below "the body
income " and the surplus went to add to the body weight.
What are our means of encouraging the natural powers ?
First the digestive act \n the gastro-intestinal canal,
and secondly in the liver. And this involves the ques-
tion, What is it which needs improving, the assimilation
of hydro-carbons or the assimilation of albuminoids, or
both ? This is a matter too little insisted upon. Too
commonly, action is taken rather blindly, and malt-
extract (diastase), or pepsin, or pancreatic preparations
prescribed without that discrimination which is so desir-
able. My own rule, so far as it is formulated, and it
needs some corroboration (possibly some correction), is
taking the following direction : When the patient is
spare and too thin, then starch and sugar are indicated ;
and diastase should be added to farinaceous matters.
•Surplus sugar is laid down in the body as fat — /.£"., within
the storing capacity of the organism. Then when there
is any tendency to glandular degeneration, and that
growth of lowly connective tissue spoken of commonly
as tubercle, the indication is some fat which can be as-
similated, of which cream, butter, and cod-liver oil are
the most digestible forms. When it is desirable to in-
crease the power of assimilating fat, there are several
measures which may be adopted, singly or together.
There are agents which stimulate the llow of bile, which
emulsionizes fat so that the pancreatic secretion may
further act upon it, and the most useful of these is ipe-
cacuanha. Ether has been found to stimulate the flow
from the pancreas and so aid materially in the assimila-
tion of fat. It might be given with liquor pancreaticus
and cod-liver oil. Sometimes when cod-liver oil is not
assimilated, it is well to resort to the following plan. The
oil is observed unchanged in the stools, en masse; never
having been divided into an emulsion. Here it is well
to remember that a fatty acid helps in the emulsionizing
of fat. So give some castile soap, say two grains, with
two grains of dried ox-gall, in a pill, about two hours
after a meal, when the contents of the stomach are pass-
ing into the duodenum. The fatly acid and the bile
assist the natural efforts, and then the assimilation of fat
is often materially aided.
At other times the liquor pancreaticus, guarded with
an alkali (which may be potash or magnesia, and not
necessarily the nauseous bicarbonates of soda), given as
Dr. Roberts directs, is of great service. Probably all
the constituents of our food — starch, albuminoids, and
fats — are digested by this agent. Or some of the com-
pounds containing several, or, indeed, all of the digestive
agents may be used with success. If the medium is acid
then pepsin is efficient ; if the medium is alkaline, then
the diastase and the jiancreatic ferments are efi'ective.
In very acute conditions it may become necessary to
give milk and milk-gruel, already largely digested by the
addition of liquor-i)ancreaticus ; or these may be given
at times, with ordinary milk and selt/.er-water, or lime-
water at other times in the day. Such are conditions
where there is much gastric irritability with vomiting,
and a tongue denuded of epithelium, or seen to be cov-
ered by a growth of young ei)ithelium. This condition
is not uncommon in the course of phthisis, and when it
shows itself it requires its own peculiar treatment, all
others being abandoned, for the time at least. Here the
line to be taken is that of alkalies and bismuth, with or
without some hydrocyanic acid. Whenever the tongue is
raw or bare, then alkalies are to be given, and acids care-
fully eschewed. If the reader has doubts about the last,
let him just try the experiment with his eyes open, and
watch it. It will not be long before the results will be
apparent to him. Bismuth with soda in calumba is the
old and well-known combination for such state ; and
with it the milk dietary just described may be combined.
More commonly, however, a less grave and acute con-
dition is found, where the state of the tongue is just the
opposite, viz., covered with a layer of dead epithelium.
Here acids are not only unobjectionable but are very
useful. Indeed, soda sulphate with some acid is the
combination which gives the most satisfactory results.
Under this the tongue soon cleans, the appetite returns,
and the stools are of a normal color. When the primae
vias are once more acting normally and in a healthy
state, then, and not till then, may some chalybeate be
given. But as long as the liver is in any way disturbed,
chalybeates are useless, and usually disagree. When the
appropriate time comes, then iron is useful ; but how-
ever impatiently the time is awaited, it is well to be pa-
tient. To resort to iron prematurely is a very common
mistake. Sometimes when the tongue is placed in a
side light, a yellow shade can be detected, and so long
as that remains so long must chalybeates be withheld.
It is necessary in all cases to keep the bowels open.
There is no treating indigestion satisfactorily so long as
the bowels are loaded with fa;ces. The bowels must
be swept out freely, and then kept open ; and, if neces-
sar)', a sharp purgative must be given from time to time.
Especially is this necessary with female patients, who dis-
like being purged (as it pulls them down), and who are
very liable to allow themseh^es to become constipated.
The reader, perhaps, thinks it quite unnecessary for me
to insist on the bowels being kept properly open. But
it so happens chat to find patients, who have been under
very judicious treatment in every other respect, but whose
bowels have not been attended to, is far from an infre-
quent occurrence. Either the medical man has paid too
slight attention to the matter, or the patient has failed
to carry out the orders, or, may be, both. Anyhow, the
fact remains, and so does the indigestion for that mat-
ter, and the case is truly incurable until this is rectified.
It is easily done, as a rule, by adding the requisite dose
of laxative to the pill I am about to describe. It is well,
however, to keep short of purgation, else the pill is aban-
doned, and its other eflects lost. So keep on the short side a
little, and let the patient take some laxative water the first
thing in the morning, if indicated. But a good many pa-
tients dislike this water in the morning, and then it is well
to prescribe two pill forms, one more sharply laxative
than the other, and let the patients take one of each
daily, or otherwise vary them according to their require-
ments. This does not give much trouble, and that is a
matter agreeable and acceptable to the patient. Pills
can be kept out of sight, and people, as a rule, object to
be regarded as invalids. Besides, no little matter, pills
are tasteless, and when the medicine has to be contin-
ued for weeks or months, if that medicine be nauseous
the patient conceives a mortal repugnance to it.
When the symptoms of acute discomfort show them-
selves during and after a meal, then a dose of pepsin
often makes matters comfortable (.McKesson & Rob-
bins' pepsin pill is most convenient), or a second may
be indicated if the meal contain much meat. Such im-
mediate measure is excellent, while the following pill
is taken before meals, steadily and continuously. There
are many hepatic stimulants, as mercury, arsenic, eu-
onymin, baptisin, iridin, leptandrin, etc. But it may
be questioned if any of them is so efficacious as ipecac-
uanha. .\ century of experience tells of the utility of
ipecacuan in indigestion. It was a constituent of the
dinner-pill of the last century. Not only does it stimu-
late the liver, and so be useful in cases of indigestion
September i, 1883.]
THE MEDICAL RECORD.
227
where there is either bile acids formed in excess or
lithates present (that is, the peptones which find their
way into the (lortal vein from the intestinal canal and
which, converted into proteids, are elaborated into the
albumen of the liquor sanguinis by the liver normally,
are transformed instead into bile acids or urates ; the
patient loses flesh, and on a flesh dietary only makes
more bile or more lithates, without gaining weight), but
ipecacuan is a " pepsin-persuader '' from its action on
the gastric lining membrane with its multitudinous glands
and follicles. Ipecacuan combines properties, indeed,
as does no other agent, in my opinion. Then there is
often atony, either general or in the bowel, and for this
strychnia is an admirable remedy. Perhaps, too, flatu-
lence, for which a carminative is indicated. Then there
is the vehicle, which may or may not be a laxative, ac-
cording to the case. The pill would stand then some-
what as follows :
5 . Strychnix gr. ^'^
Pulv. ipecacuan §■'• f
Pulv. piper, nig gr. jss.
Ext. gentian gf- j-
Yes, there it is ! How familiar it does look ; and
what a lot of my patients are taking that pill with Pil. al.
et myrrh., or Pil. coloc. co., according to their neces-
sities ! Once or twice a day before meals steadily fol-
lowed out for weeks, with a pepsin pill, or maybe two,
at dinner or other substantial meal, and a regulated
dietary of farinaceous matter with milk. Steam-cooked
cereals with milk, and a little fish or fat bacon to follow
for breakfast. Lunch, a biscuit and milk, or a milk-
pudding (made 'unthoiit an egg), with some stewed fruit,
with a glass of wine. Then a walk before lunch and a
rest on the sofa after. For dinner, some white meat
witli the milk-pudding and a glass of wine, with pleasant
cheerful society. Perhaps, if the patient be hungry in the
night, some milk and malt extract, gently warmed and
kept under a cosy (which both keeps it warm and un-
tainted by the air of the bedroom), to be taken in the
small hours of the morning. A bracing locality and free-
dom from toil and worry.
This is about what I generally advise, and it seems to
suit the patients, or else they tell me falsehoods and pay
their fees m vain. Such, indeed, is the broad plan with
dyspeptics suftering from inability to digest their food.
Only the measures are to be fitted together in each case,
as Opie mixed his colors — with brains !
A SERIES OF TWELVE OVARIOTOMIES.
By MATTHEW D. MANN, A.M., M.D.,
FROKKSSOR OF OBSTETRICS AND GVNBCOLOGV UNIVERSITY OF BUFFALO ; FELLOW
OF THE AMERICAN GYNECOLOGICAL SOCIETY.
Ovariotomy lias become so common that one is almost
forced to make excuses for publishing a case or even a
series of cases unless they mount up into the hundreds.
Although the various steps of this operation are now
nearly settled, there are some points still in dispute.
These can only be decided by experience, not only of
each operator for himself, but by the careful study of the
results obtained by others, and it is to this end that I
make this report.
The twelve cases were, with the exception of the first,
operated upon within the space of fifteen months. Of
these nine recovered and three died ; of those which died,
the first (No. 5) was almost moribund when the opera-
tion was begun. Her pulse was 140 and temperature
103°. She had had suppuration of the cyst for a num-
ber of months and the cyst contents were very fetid
and contained gas. She had been tapped three times,
the pus, however, antedating the first tapping, and there
was a small fistula opening into the abdominal cavity which
emitted a clear fluid and at times gas and pus. The sac
was attached over nearly the whole abdominal parietes
and was so decomposed that in separating the adhesions it
tore and let some of the contents into the abdominal
cavity. This was carefully washed and sponged out and a
glass drainage-tube introduced. She rallied for the first
twenty-four hours, but soon the temperature rose and she
passed into a condition of violent mania and died forty-
eight hours after the operation. She was operated upon
at her home in the country and I saw her but once afterward.
The second fatal case (No. 6) was a cyst of the
broad ligament, I diagnosed the probable nature of the
tumor by tapping before operating, but decided to oper-
ate as the cyst seemed thick and very tense, and the
patient was eager for relief and the diagnosis at best uncer-
tain. The contents were like spring water and contained
only a slight trace of albumen. The operation was very
simple, there were no adhesions and no blood lost. The
incision was very short and the pedicle long and the
tumor was removed without disturbing either ovary.
Everything was so favorable that there seemed to be no
possible way in which a bad result could occur. She
did splendidly for the first week and then developed
symptoms of septic jjeritonitis and died on the twelfth day.
The cause of deatli in this case I cannot but attribute to
hospitalism. She was operated on in the Buftalo (General
Hospital ; she had a private room and nurse, but in the
same building, about the same time, there had been sev-
eral cases of septic disease (puerperal fever, etc.). I can
see no other reasonable explanation of the cause of death.
No blame can be attached to the hospital or its manage-
ment, for no general hospital is, or ever can be, a projier
place for abdominal surgery. I find it recorded that out
of one hundred and forty-two cases operated on in four
of the leading London hospitals, there was an average
mortality of sixty per cent., while in two hundred and
ninety-six cases the same year at the Samaritan Hos-
pital, a small special hospital, under Mr. Spencer Wells,
the mortality was only twenty-two per cent. A certain
allowance nmst be made for the S|)ecial skill of the one
operator, but this alone could hardly account lor the
great disparity in results.
In justification of this operation as against tapping, I
will say that the cyst when emptied weighed over three
|)Ounds and would undoubtedly have refilled ; moreover,
the diagnosis of cysts of the ligament by the peculiar
character of the fluid has been shown to be unreliable.
The lesson taught by this case was still further en-
forced by the next (No. 7). This was in every way
promising, no adhesions of any moment and the patient's
general condition was good. The earUer period of
convalescence \vas very favorable ; the temperature re-
mained nearly normal and the pulse generally below
ninety, until the eighth day ; she then had a slight chill ;
vomited several times, and felt very weak and uncomfort-
able, the temperature fell to 97 and the pulse went to
n8 ; from this time on she steadily failed. The tem-
perature kept near the normal line, sometunes below,
but the pulse went to 1 10-120 and diarrhoea set in.
Transfusion was tried. Dr. Long of this city generously
furnishing the blood, and Dr. Charles Cary, who has had
considerable experience in this procedure, kindly lent me
his aid and superintended the operation. The o|Jeration
was by the mediate method. The blood was withdrawn
from the arm of the donor by an aspirator and forced
into the arm of the patient without allowing it to come
in contact with the air. In this way it was only a few
seconds out of the veins. The canuhe of an Aveling's
apparatus were introduced into the veins of both parties
before the aspirator was attached. The effect of the
transfusion was but transitory and she died exhausted on
the fourteenth day after the ovariotomy. There was no
pain but the vomiting kept up and the large dejections
were persistent. The mental faculties were unaflected.
The autopsy did not throw much light on the cause or
nature of the disease. There were a few ounces of blood,
serum in the abdominal cavity, and several feet of the
small intestine were as black as ink. There were also
spots of discoloration on the stomach and large intestine.
Nothing else wrong. Union of the wound complete ; no
228
THE MEDICAL RECORD.
[September i, 1883.
clots and no evidence of peritonitis. I cannot but think
that the trouble was septic in its origin, and attribute it to
the same cause as the other, but tlie symptoms were not
those we generally associate with septica:niia. However
this may be, it served to impress most forcibly on my
mind the fact that a general hospital, no matter how well
cared for, is no place for ovariotoni)'.
The point has been made that double ovariotomy is
more dangerous than where only one ovary is removed.
In three of these cases (Nos. 2, 3, and S) I removed both
ovaries and all recovered. In No. S the supravaginal
portion of the uterus was also removed. An interesting
point in this latter case is that this patient, although she
survived the removal first of a fibrous polypus from the cer-
vix and then of double ovarian tumors with the uterus, is
now about to succumb to cancer in the vagina.
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It will be noticed that Case 9 had reached the great
age of seventy-seven years. It is generally thought that
such an age is a contra-indication to an operation, but
statistics do not support this idea. In the last edition of
his work on ovarian tumors (1882), Sir Spencer Wells,
in speaking of the results in this operation as modified
by the age of the patient, says : " The small mortality
shown in patients below the age of twent)--five and above
the age of sixty, and the comparatively high mortality
between those ages, except from forty to forty-five, are re-
markable." The number of cases on which he bases his
percentage of mortality between sixty and seventy years
of age is forty-five, with thirty-seven recoveries (eigiity-two
per cent.), while above seventy he has had but two cases,
one of which recovered at seventy-seven. In 1853 Atlee
reported a case aged seventy-eight, in which the opera-
tion was successful. Thus we have four cases with three
recoveries. My patient seemed to be in perfect health,
aside from the tumor, and was very anxious for relief.
The tumor had been growing only eighteen months and
had reached a great size. I could see no good reason for
not operating and the result justified this view. Although
the operation was rather severe and long (an hour and a
half), owing to the difficulty of securing all bleeding points,
she stood it well and made a rapid recovery.
In the earlier cases I used the drainage-tube for a
slight indication, but I found so much annoyance from
its use and so much difficulty in closing the sinus left by
it, that I discarded it after the fifth case. Still I can
readily imagine a case where its use might be un-
avoidable. In Case 4 there was considerable ascitic
fluid outside the tumor, and I should be inclined to con-
sider this a good reason for the employment of a tube.
A large oozing surface after an enucleation, as in Case
2, would also be an indication, and its use 111 this case,
I have no doubt, had a large influence in promoting the
recover)'. I have used the simple glass-tube, slightly
curved, and carried to the bottom of the cul-de-sac.
The method of treating the pedicle is now so nearly
settled that but little need be said about it. I have
always tied and then severed the tissues, either with
scissors or latterly with the thermo-cautery. For liga-
tures I have used the raw silk well carbolized. That
the silk is absorbed I do not believe, as I have once or
twice seen silk whicli had remained in the abdomen for a
long time unaltered. For adhesions, I either divide with
the cautery alone or tie first ; if the tissues are very vas-
cular, with catgut, or if they are very large, with silk.
The length of the incision I have never considered as
having much influence on the result. Operations in
which the incisions are long will always make a worse
showing than those with short incisions, but the reason is
not in the length of the incision but in the conditions
which make the long incision necessary. My rule has
been to begin with a short incision and to enlarge it as
much as necessary as I proceed.
An article of this kind at this time would not be com-
plete without some words about antiseptics. I began
with antiseptics, spray and all, and my first case was
done under tile carbolic spray. But soon after this I lost
a case of or>i)horectomy {Ainefican Journal of Obstetrics,
October, 1S80) from what I believe to have been car-
bolic poisoning. This made me afraid of carbolic acid,
and I dropped the spray for a time. After I had lost
three cases in succession, I began to inquire very care-
fully for the cause, and thinking that perhaps the use of
the spray would belter my results 1 began it again, using,
however, boroglyceride (1-20) rather than carbolic acid.
The last five cases were done under this spray, and as
all recovered I am inclined to attribute something of the
result to its use. There is one symptom which some-
times follows it and which I have seen noted elsewhere,
which is very alarming unless its cause is understood.
In Case 1 1 the pulse and temperature remained nor-
mal, but there was a very unaccountable and marked
dryness of the tongue and mouth. This continued, not-
September i, 1883.]
THE MEDICAL RECORD.
229
withstanding brandy, potas. chlorat., etc., and ceased
suddenly on the third day. That it was due to the boro-
glyceride I am sure, as others have noticed the same
thing after its use. For hands, instruments, hgatures,
and sponges, I have used carbolic acid, and as a dressing
boroglyceride cotton held in place by a flannel bandage,
rather than adhesive straps.
The preparatory treatment has been the simplest
possible, a thorough cleansing of the bowels and a bath,
nothing more. To dose a patient with quinine and opium,
and thus upset the stomach and disturb the nervous sys-
tem just when a great call is about to be made on them,
always seemed to me to be unphysiological and irrational.
The after-treatment has likewise been simple, oiiium in
some form enough to quiet all pain and restlessness, but
no more than is absolutely retiuired. Brandy and ice,
if iitdiiated, not as a routine practice, milk and food as
soon as the patient wants it, generally on the second day,
at lirst in small (luantities every two or three hours. The
bowels are moved on the seventh or eighth day, as soon
as the stitches are out, by a simple laxative and enema.
The results have not been as good as some operators,
notably in England, have obtained ; but the reasons for
the failure in the fatal cases have, I think, been clearly
given.
MASTOID DISEASE— .■\RTIFIC1AL PERFORA-
TION OF THE BONE— TEMPORARY RELIEF
—DEATH FROM PYAEMIA.
Bv CHARLES H. BURNETT, M.D.,
PHILADELPHIA, PA.
This paper contains an account of a case ot chronic
purulent inflammation of the middle ear, inducing gen-
eral increased vascularity of the pyramidal part of the
temporal bone, hyperostosis of the outer wall of the
mastoid portion, and a thinning of the sigmoid groove,
without necrosis. The mastoid cavity became filled with
cheesy debris, and this furnishing a pyasmic source,
embolism of a chronic form ensued, as shown first by the
abscess in the lung and then by the pyremic infiltration
of the liver resulting in a vast number of abscesses. The
operation, it will be seen, gave temporary relief to the
acute aural and mastoid s)'mptoms, but, of course,
had no effect upon the pyemic element in the case, be-
cause of the great chronicity in this latter respect. An
early operation, perhaps years before, might have i>re-
vented the accumulation of cheesy masses in the mastoid
antrum and the consequent occurrence of pyemia.
History.— ■]a.mes B ■ ; thirty years old ; born in
Ireland ; a weaver, was admitted to the Presbyterian
Hospital, Philadelphia, April 11, 1877. His aspect was
phthisical but he stated that his health had always been
good until within ten weeks, when he was admitted to a
hospital for "pleurisy." He remained there seven weeks,
when he was dismissed cured, as he was told. Immedi-
ately tbllowing his sojourn in the aforesaid hospital his
right ear became painful and sore to the touch, the auricle
stood out from the head and the pain in and about the
ear was so great as to deprive him of sleep. After en-
during this suffering for two weeks he was admitted to
the Presbyterian Hospital, where I examined him, and ob-
tained the above history, on April 13, 1877. M this
time his right auricle was standing far out from the head,
the mastoid region was red, boggy, and tender on liard
and deep pressure. His pain was chiefly and constantly
in the mastoid ; but at times there was a dart of pain
into the right temple. .■\n offensive, thin, transparent
yellowish matter flowed copiously from the painful ear,
and e.Kamination revealed a largely perforated mem-
brana tympani and a macerated and tender auditory
canal with granulations on the posterior wall. The watch
could be heard only in contact. The patient stated that
this ear had been aft'ected for many years with discharge
and that at times he had attacks of pain and soreness
similar to this, but that no attack had been as severe as
this last one. His pulse was 88 ; appetite good ; secre-
tions normal, no cerebral symptoms. Four leeches
were now applied to the mastoid region and four or five
ounces of blood were drawn. This gave but slight relief,
and at bedtime, a few hours later, he was obliged to
have one-eighth grain morphia sulph. to get rest. He
awoke from time to time with pain, and obtained some
ease with two-eighths grain more of morphia.
April 14th. — The next morning his face was flushed ;
pain in mastoid very severe ; pulse, 86 ; temperature,
98-I ; tongue coated : headache and malaise great.
Afternoon : pain increasing in the mastoid ; latter very
tender, especially at its tip ; appetite fair ; bowels open ;
no cerebral symi)toms. At four P.^r. the patient was
etherized, and after making an incision in the soft parts
one-fourth inch behind the auricle, I perforated the
outer mastoid wall with S. H. Buck's conical drill, three-
fourths of an inch above the tip of the process. The
severed branch of the posterior auricular artery was
lio-ated. No pus issued from the opening thus made in the
bone, but the cellular structure of the mastoid was easily
reached through this opening and the cells toward the
antrum were broken by a probe, thus affording an exit for
retained pus. The periosteum was dissected freely from
the mastoid but no disease of the outer table of the bone
was found. .\ simple greased tent was now put into the
wound thus made and the patient put to bed to await
recovery from the ether narcosis. Beef-tea and milk
ordered, and morphia if pain continues.
April 15th. — Appetite good; pain generally less, though
the neck was sore and stift", probably from bruising at
operation. Mastoid incision suppurating and mastoid
tip tender. Some frontal headache, but the great i)ain
in the temple and the mastoid had gone.
April 1 6th. — I ordered six grains quinine daily ; tent
removed and poultices placed over the mastoid opening.
Pus issues from the artificial opening in the bone.
Patient sits up in bed and looks and feels much better.
Has had no cerebral symptoms.
April 1 7th. — Ligature from artery comes away ; patient
comfortable.
April iSth. — Some fever this morning, with photo-
phobia and intolerance of all sounds. One-eighth grain
morphia at night.
April 19th. — Patient appearing weak and sleepless, gets
a milk-punch every three hours, and quin. sulph., gr. ijss.,
every four hours, with morph. sulph., gr. \, two or three
times in the night.
April 20th — This morning has less fever and less pain ;
discharge free and purulent, from mastoid opening and
from the meatus. Urine contains no albumen.
April 2 1 St — Less fever and no pain; discharge from
wound diminishing.
April 2 2d-2 3d. — Appears to be getting well ; wound
in mastoid healing.
April 24th. — Ten days after operation is able to get up
and dress himself and walk about the ward ; stimulants
stopped. In the evening began to complain of general
malaise ; his temperature rose and his pulse became more
frequent ; tongue dry.
April 25th.— Remains in bed ; whiskey and quinine re-
sumed, pulse full and bounding ; temperature, 104.6° ;
bowels confined ; whiskey stopped and a fever mixture
given ; wakeful and nauseated all night.
April 26th.— Tongue dry and brownish; constant
nausea and vomiting ; complains of pain in region of the
liver. Violent chill in afternoon. Is taking brandy and
soda, and two and a half grains quinine every three
hours.
.•\pril 27th.— Tongue is better, but still complains of
nausea and pain in stomach and over the liver; fever
continues. Discharge from the wound and ear less,
very little pain and soreness in mastoid, wound nearly
healed.
April 28th. — Bowels inclined to be relaxed through
the night. Temperature, 104^ ; delirious during night.
2.qo
THE MEDICAL RECORD.
[September i, 1883.
April 29th. — Tongue dry and brown ; pain and tender-
ness in hepatic region great. Hiccough, vomiting, and
dehriuni. Pulse more rapid and weaker ; respirations
very rapid ; coma. Death at 1.30 a.m. on April 30th.
Post-mortem examination, fifteen hours after death. —
The omentum in proper position, but darkened by venous
congestion and at its upper and right hand side thickly
studded with flakes of recent lymph. The stomach was
marked e.xternally by patches of lymph over the fundus
and at its pyloric end was adherent to the under surface
of the liver. The duodenum firmly adherent to con-
tiguous viscera and so softened as to be torn in attempt-
ing to remove it. The liver was covered externally with
peripheral abscesses, like yellow spots, varying from one-
fourth of an inch to one inch in diameter. The spleen
contained no abscesses. The liver was found tilled with
disseminated abscesses throughout its parencliyma. The
left lung was normal excepting the presence of small ab-
scess on outer side of lower lobe, one-half inch in diameter,
surrounded b)' hardened zone, the whole one to one and
one-half inch in diameter. Brain : The cerebral surface
of the temporal bone of the diseased side was slightly
darker than its fellow, and the dura mater not so adherent
as on the normal side. The tympanic cavity and mastoid
cells were filled with a cheesy mass ; the ossicles were
present ; membrana tympani largely destroyed. There
was great hyperostosis of the outer table of the mastoid
portion ; it was half an inch thick at a point three-fourths
of an inch behind the external auditory meatus. There
was no necrosis of any part of the temporal bone ; no sign
of phlebitis, nor of thrombosis in the sinuses of the brain,
nor in any of the veins leading from the t\mpanum. The
cheesy mass in the mastoid cells was l)ing against the
mastoid surface of the bony gutter in which runs the lat-
eral sinus, but there was no necrotic spot in this bony
channel. Numerous evidences of extensive chronic dis-
ease in the temporal bone were found, consisting in the
great thickening of the outer wall of the mastoid, as
stated already, and in a thinning of its inner wall where
in contact with the sigmoid sinus. The nutrient vessels
and the canals conveying them in this region of the tem-
poral bone were much wider and larger than on the
healthy side. It seems highly probable that the embol-
ism occurred by the way of the lateral sinus, in conse-
quence of the morbid changes in that region, just nar-
rated.
Conclusions. — i. This man died of py;i;mia induced
by long continued purulent disease in the middle ear and
mastoid cavity. The embolic elements passed by the
brain to lodge in the lung and liver, an unusual course
in pyaemia from ear disease. 2. The operation of tre-
phining or perforation of the outer mastoid table is
strongly indicated in such cases. It has no effect what-
ever in hastening a fatal issue, even if it had no effect in
preventing it, as sliown in this case, as the man recovered
from the operation to die of pyaemia. 3. When fistulous
openings exist in the upper back part of the bony audi-
tory canal, as in this case, it becomes worthy of our con-
sideration whether we should not follow the indication of
nature and make a larger opening at such a point, espe-
cially as we may in such cases suspect hyperostosis of
the outer wall of the mastoid. 4. The safety of the
operation on one side, and the great dangers of a con-
cealed pyajmic nidus in the mastoid, in chronic purulent
otitis media, on the other hand, should incline us to re-
gard, in many cases, a prompt opening of the mastoid
wall as the one great chance of saving the patient's life.
How TO Get Back ? — A correspondent from tjie dis-
pensary department of the New York Infirmary for
Women and Cliildren reports an individual of the Cimex
hctiilarius, or common bed-bug, found perched upon
the external os of the cervix uteri in an abundant
vaginal catarrh. The insect was removed and was un-
mistakably identified.
A FATAL CASE OF TYPHLITIS WITHOUT
RECOGNIZABLE SYMPTOMS.
By JOSE M. FERRER, M.D.,
NEW YORK.
The desire to contribute, however slightly, to the general
fund of information on the subject, together with certain
features of practical interest, must form my apology for
putting the following case on record.
S. J. M was a stout, healthy girl, nineteen years
of age. Despite a history of phthisis on both sides of
the family, no constitutional taint of weakness marred
her perfect physiological life, .\side from rubeola and a
few trifling ailments in her earlier life, she had never been
sick.
I was called to see the patient about midnight on
Saturday, June 2, 1883. She had been visiting her friends
all day, and on her return home nothing unusual was
noticed, except that she complained of slight headache
and of being tired out. At 6 p.m. she ate no dinner and
seemed exceptionally quiet. After dinner she laid down
on the lounge, and, as I learned after her death, called
for a blanket, saying she felt cool, as the windows were
open, the evening being warm. About 8.30 p.m. she
commenced to vomit, at first but sparingly, and almost
simultaneously she was taken with a severe pain in the
epigastric region, which she localized b\- placing her
hand on the " pit of her stomach." The vomited
matters were almost entirely bilious. There seemed to
be reflex irritation of the rectum, for she tried to go to
stool twice, passing very little. Palpation and percus-
sion of the abdomen revealed nothing special. The pain
seemed to abate somewhat after one drachm of the
U. S. solution of morphia, and there was no vomiting
for about an hour. Later, another drachm was adminis-
tered, but was vomited almost immediately. Despite
counter-irritation of the abdomen, emesis continued at
intervals. When I left her she seemed more quiet, the
symptoms abating. A warm poultice was applied and
she fell into a doze.
Sunday, June 3d. — I called about 9 a.m. and found
the patient more comfortable. She complained of sore-
ness about the epigastrium, but said she did not have the
pain like the previous evening. The sore and tired feeling
were attributed to her continued efforts at vomiting. I
asked about the menses and she said they were " all
right." I asked if she had any pain down the bottom of
the abdomen, and she said no. 1 again palpated the
abdomen all over but discovered nothing, and caused
some discomfort. No tympanites; no signs of a hernia.
Pulse, 90. Temperature not taken, as there was no ther-
mometer at hand, but there was evidently no fever. Aus-
cultation of the chest with negative results. She did
not give indication of being very sick. She insisted on
sitting in a chair by her "bed for a while, and walked
across the room two or three times to the/(5/ de chambre.
Through the day she vomited considerable quantities of
bile, and some teaspoonfuls of beef-tea which she had
taken. In the evening her temperature was 38|° C,
and pulse 90 to 100. She looked pretty well, and, order-
ing a sponge-bath and a large poultice, which she kept
on all night, 1 left her.
Monday, June 4th. — I saw the patient about 9.30 a.m.
She seemed in good condition. Had slept part of the
night. Temperature, 100^ F.; pulse, 90. She still com-
))lained of some soreness of the abdomen but no pain,
and more like a sense of weight ; she said, " It feels so
heavy.'' All vomiting had ceased. She sat in a cliair
for a while, and did not seem to desire absolute rest.
She received some friends in her room that afternoon and
spoke cheerfully witli them. ^\ hen in bed she lay
covered with a blanket and coverlet. Her cheeks now
became flushed and she had nnich thirst. In the even-
ing when I called her temjjerature was 103° F. and pulse,
120. This was the highest record at any time and oc-
curred only on this one evening. Vomiting not present ;
September i, 1883.]
THE MEDICAL RECORD.
231
pain not spoken of. No tympanites. Lips parched and
face flushed ; urine high colored. She seined some-
what apprehensive, and wanted me near her, bi.t appeared
at the same time good-natured, and even smiled. Fear-
ing to induce vomiting anew, no quinine was ordered.
Only sponge-baths and cold lemonade when she should
want it.
Tuesday, June 5th. — At 9.30 a.m. temperature had
gone down to ioo|° F. and pulse to 100. The flush
had faded from ' the face. Emesis had not recurred.
The sense of weight was only referred to on repeated
questioning. The respirations began now to be quick-
ened, thoracic, and not deep. No morbid signs in the
chest. Condition remained about the same through the
day, with same range of temperature, and pulse varying
from 100 to no. The lips were parched and glossy. In
the afternoon she commenced to have a clammy perspira-
tion, and the e.\tremities were cool. In the afternoon,
also, tympanites developed, but moderate only, and flatus
was voided, later there was some hiccough and the respi-
rations continued quick. With all this, her condition did
not manifest the imminent peril in which she was. She
walked from her bed to another room. In this room
she walked from the bed to a chair across and sat down,
after a while she moved again to a lounge ; and, though
not talkative, followed the conversation and answered
opportunely. She no longer mentioned the pain or sore-
ness. There had been no vomiting that day or the day
before. That evening the temperature was, as in the
morning, ioo^° F., and pulse no and weak, respirations
about 30. The room was close and warm. She tossed
about in bed a great deal. I left her at 10 p..m., as she
said she was going to sleep, and asked me to call early
in the morning, she was then bathed in a cool sweat, but
seemed in fair condition. During the night she had
three movements, passing a very small amount of fiuces
highly colored with bile. She had refused all nourish-
ment.
I was summoned hastily at about 3 a.m. on Wednes-
day, June 6th, and found the patient going rapidly into
collapse. Once previous to my coming, and twice sub-
sequently, she vomited large quantities of dark-brownish
pseudo-stercoraceous matter. She had hiccough, cold
e.Ktremities, small pulse, and other signs of collapse. Dr.
Satterlee was called in consultation, but there was little
to be done at such an hour. It was evident she was in
articulo mortis. She complained of vertigo, the bed's
turning around, etc. ; she began to wander and soon be-
came unconscious. Despite active stimulation, she died
in collapse at 4.30 a.m.
Post-mortem examination, by Professor Delatield,
eight hours after death, Dr. Satterlee and myself being
present. The body was well nourished and external in-
spection revealed nothing special. Rigor mortis present.
Only the abdominal cavity was e.xamined. The evidences
of a general acute peritonitis were discovered at once.
The stage was an early one, the bright arborescent con-
dition of the vessels being still preserved. There were
some delicate fibrinous adhesions forming. At the bot-
tom of the abdominal cavity there were probably two
ounces of purulent serum. The intestines were full of
gas.
On pulling up the casciun into view, the vermifonn
appendix was discovered free in the abdominal cavity,
and acutely inflamed. It was increased in size to prob-
ably four times its original diameter, and was about four
inches long. It felt hard to the touch, and remained
erect. Its posterior and interior aspect presented a yel-
lowish, sloughy appearance. Here, then, was the original
cause of the trouble. Further inspection revealed a
small mass of hardened faeces, about the size of a small
bean, as the foreign body. There was no perforation
proper, but the walls of the appendix were softened and
infiltrated with pus.
Remarks. — There are several asiiects of the case that
merit consideration and study.
To commence with the etiology. Here was "a small
mass of hardened fieces about the size of a small bean "
impacted in the vermiform appendix. Examination
failed to discover any foreign nucleus to this mass. Its
own consistent hardness was sufficient to strangulate the
appendix, or at least to cause a most marked inflaumia-
tion thereof.
Now, in the healthy subject frecal matters find their
way in and out of the appendix without inconvenience.
And for a purely fxcal mass of sufficient hardness to
cause an acute inflammation, we would predicate marked
constipation, particularly if we excluded the possibility
of the little mass hardening i)t situ without causing
previous symptoms. Such, indeed, is the view held by
all writers on the subject. To quote one : " Most fre-
quently,"says Bauer ("Ziemss. Cyclop.," art.," Infl. Proc.
in the Right II. Fossa."), " we meet with irregularities of
the bowels ; either constipation has existed for a long time,
or this has alternated with diarrhcea, until finally obsti-
nate constipation has become established." " It is true,"
Bristowe says (" Reynolds' Syst. of Med.," art., " Dis. of
Ca3C. and App. Verm."), that "the concretions
consist obviously of the admixture, in unequal pi'opor-
tions, of ordinary fecal matters, and of the secretions
from the mucous membrane of the appendix, and have
obviously formed in the situation m which they are found,
either round a nucleus of solid matter which has been
first precipitated and concreted there, or round some
comparatively small body of extraneous origin." Here
we find no direct allusion to constipation as a primary
cause, but it is fair to conclude that the inference flows
from the well-known fact that "one of the physiological
phenomena of this portion of intestine is that its contents
become more solid and remain a long time in it," and
that " there are a number of circumstances which may in-
duce the contents to remain for a much longer period
than usual, and in connection with this to become very
hard" (Bauer, loc. cit.). Else, how ex|)lain the ''nucleus
of solid matter which has been first precipitated and con-
creted there ? " Constipation, then, is presupposed when
we do nofdeal with the impaction of extraneous bodies.
But, according to her own statement and that of her
family, this girl did not suffer from constipation ; and the
slight amounts she passed during her short illness were
of the ordinary pasty consistency, while the necropsy re-
vealed the caecum and colon remarkably free from f;\;ces.
Was this particular -bit of such hardness that the ap-
l)endix could not get rid of it, as it does of other matters,
it possessing normal tonicity, the girl being in perfect
health ? And if so, why should it have differed from the
rest, which was voided naturally and seemed of ordinary
consistency ?
I can ofter no explanation, and merely state the fact
that, without a previous history of constipation, a little
mass of hardened fasces without a foreign nucleus was
found impacted in the cascal appendage, having caused
it to become acutely inflamed, that an acute general
peritonitis resulted therefrom, and the patient died.
The general process in the peritoneum was by exten-
sion, no perforation proper having occurred. After re-
citing several cases, Dr. Copland ("Diet, of Prac. Med.")
says : " From the history of these and other cases,
which have occurred to me and several of my medical
friends, it may be inferred that inflammation, affecting
primarily the cffical appendage, is most frequently brought
on by hard substances having escaped into it ; and that
the inflammation rapidly extends to the peritoneum, giv-
ing rise to the exudation of albuminous lymph, to adhe-
sion of its opposite surfaces, and of the appendix to ad-
joining parts, and to gangrene of this process."
Finally, all authorities are agreed that typhlitis occurs
much more freciuently in males than in females. The
foregoing case is offered to add to the statistical record
of typhlitis in the female.
Clinical history. — It is in the history that we find pe-
culiarities. And it bears out the experience which is
THE MEDICAL RECORD.
[September i, 1883.
daily increasing and becoming more recognized, that a
patient may appear to be but slightly ill while suffering
from a fatal peritonitis.
Speaking of diseases of the cecum and its appendage,
Dr. John Kurnc says ("Royal Med. and Chir. Trans.,"
vol. XX. ) : "The diseases in question are, nevertheless,
of frequent occurrence, are always dangerous, often
fatal, and characterized by a train of symptoms so pe-
culiar and marked as to render the recognition of them
certain and not difficult." In view of the foregoing case,
1 would take issue with tiie last broad statement. P'orthis
girl gave absolutely no manifestations of typhlitis during
life. Contrast the vivid picture given by Copland (loc.
cit.) — who, according to Bartholow [Amer. Jour. Med.
Scien., October, 1866, art., "Typhi, and Perityphl."),
has written the best article on the subject, and which
account is an exponent of the typical history, accepted
as such by all practitioners — with the blank presented in
this history. "Very acute pain," he says, "tumefac-
tion, and tenderness are complained of upon the inva-
sion of this form of the disease, first m the right iliac
region, and subsequently more or less over the abdomen,
with excruciating tormina, obstinate constipation of the
bowels, a very frequent, small, or contracted pulse, heat
of skin, dry tongue, great thirst, sometimes with numb-
ness of the right leg, or pain shooting down the thigh,
and retraction of the testicle. Vomiting comes on sooner
or later, and is often, at one period or another, attended
by the discharge of matters from the small intestines — at
least in the cases I have seen. The patient at last be-
comes restless, his countenance sunk, and a fatal termi-
nation takes place, generally from the third to the sixth
day, preceded by the symptoms ushering in dissolution
from intestinal peritonitis."
Bauer says (loc. cit.): "The diagnosis rests most
prominently on the painful tumor in the region of the
ca;cuni, and further, on the previously existing symp-
toms, and the symptoms of circumscribed peritonitis
which are subsequently developed in connection with
the tumor." Burne (loc. cit.) says practically the same
thing.
In the present case there was no apparent constipa-
tion. Discomfort, pain, or tenderness were Jiever once
localized in the right iliac region. Even upon direct
questioning, jiain anywhere in the lower portion of the
abdomen was denied. On the contrary, whenever she
complained at all, even in the beginning, it was about
the epigastric region, and never anywhere else. Pal-
pation, often performed during her illness, revealed no
local tenderness, but rather a generalized discomfort.
Neither was a tumor of any description discovered. No
such "painful tumor near the ciecum," as dwelt on by
Flint (" Prac. of Med. ") and described in Jackson's " Let-
ters to a Young Physician," was present. And, tnore-
over, the autopsy proved that none such could have been
felt, there being no tyiihlitis stercoralis (accumulation of
f;eces), the appendix being behind the ca;cum, it being
the only organ markedly enlarged, and there existing no
salient perityphlitic deposit.
Now, in this case, again, there was no distinct posi-
tive history of peritonitis itself. With regard to the
pain, we are taught to expect it as a rule, violent, con-
tinuous, increased by the slightest jjressurc, and relieved
only by opium. Exquisite tenderness we count on.
And our mind pictures the patient lying motionless on
his back, with his knees drawn up, an anxious expres-
sion on the face ; the slightest interference with the
abdomen causmg agony, even the weight of the bed-
clothes being resented. Fever, with a temperature of
105° !•'., or more ; pulse, 120 to 130. We look for
t)'inpanites early, and usually get vomiting. Great gen-
eral prostration is the rule. \ow, what did we have ?
Pain there was, but only in tiie beginning, and ap-
parently localized about the stomach. It was not com-
plained of for the last two days. "Sometimes," says Dr.
Warden ("Reynolds' Sys. of Med.,' art. "Perit."),'" that
cardinal symptom, jiain, upon which such emphasis has
been laid, ■ .liy obtains at the outset ; and notwithstand-
ing its subsidence the malady goes on."
Tenderness and increased pain on pressure were not
present to any great extent. Witness the number of times
palpation and percussion were permitted, for the last
time, on the eve of her death, and this with slight dis-
comfort only. The abdominal muscles were not re-
laxed, and never did she lie with knees drawn up. She
had a large poultice on all night and part of the next day,
and was always covered with a blanket and coverlet
which rested on the abdomen.
The pulse was 90 and thereabouts, except on the second
evening and at the last, regular and of good quality.
Warden (loc. cit.) says : "The pulse is not always, how-
ever, a sure guide, as most serious attacks may be pro-
gressing under all conditions of the arterial circulation ;
and even pain on pressure — the most trustworthy of all
individual symptoms — is not invariably to be relied upon,
because it is not uniformly commensurate with the amount
of lesion which really obtains."
The highest temperature occurred on the second even-
ing, the thermometer marking 103° F., certainly not a
high record for the intense and sthenic peritonitis dis-
covered post-mortem.
Tympanites occurred only on the afternoon of the last
day, and then not prominently.
For the last two days all vomiting had ceased.
But it is in the toui-ensetnble of the disease-picture —
the deportment, expression, prostration, etc. — which
serves as an index to the laity, and which is of wondrous
aid to the physician himself, that marked lines failed to
convey the actual condition of the patient.
There was no Hippocratic countenance, only a rela-
tive degree of seriousness compatible with simple malaise.
The patient did not seem to desire absolute rest. On
the contrary, she moved about from the bed to the cham-
ber, from bed to chair, from chair to lounge, from room
to room, and this even until a few hours before death.
She did not seem much prostrated, except at the last,
and altogether her general condition did not indicate
her impending dissolution. She was sick but three days
and eight hours.
We may conclude with the words of Prof Thomas
("Dis. of Wom.," fifth edition, p. 494) : "With reference
to general peritonitis, it may be stated that, on the one
hand, it, of all diseases, may declare itself by the most
numerous and characteristic symptoms, or, on the other,
run its fearful course with the greatest obscurity, so as to
mislead the most careful diagnostician, even up to its
latest stages."
Prognosis. — Under the circumstances an uncertain
prognosis only could be given, and there were not the
elements for a fatal one till very late in the disease.
Treatment was entirely symptomatic. But it is more
than doubtful that any treatment would have availed, the
cause being not removable.
43 East Thirtieth Street.
Thk Tonc;ce at the Vault of the Pharynx. — Dr.
J. J. Buchanan, of Pittsburg, Pa., writes : •' Three cases
have been recently reported in The Record of persons,
who are able to explore the vault of the pharynx with
the tip of the tongue. From the absence of any known
record of similar cases the inference was drawn that such
instances are rare. The following additional case has
since come under the observation of tiie writer: W. M ,
male, student, about twenty-three years of age. in the
course of a laryngeal examination developed the fact
that he could easily i)ass his tongue behind the velum
palati. He was able to outline the vault of the pharynx
and the ])osterior narcs and to move forward a probe
passetl along the fioor of the nasal cavity. The frenum
w^as poorly developed, but he could give no history of its
section."
September i, 1883.]
THE MEDICAL RECORD.
233
ON THE ArANAGEMENT OF CASES OF IRITIS.'
By CHARLES J. KIPP, M.D.,
NF.WARK, N. J.
In the treatment of all of the different forms of iritis,
from whatever cause, the chief indication is to secure
complete dilatation of the pupil, and to maintain the
same for some time after all inilammatory symptoms
have disappeared. If the case is seen within a few days
after the first symptoms have manifested themselves, a
few drops of a one per cent, solution of the sulphate of
atropine instilled four or five times in intervals of five
minutes, will generally break up any adhesions which
may have formed between the pupillary margin and the
anterior capsule of the lens, and produce a widely
dilated, round pupil. After this result has been ob-
tained, the instillation need be repeated only sufficiently
often to maintain the dilatation, which is usually accom-
plished by four to six instillations daily.
If, as is very rarely the case, the instillation of the
sulphate of atropine produces symptoms of poisoning,
such as redness of skin, dryness of mouth and fauces,
great thirst, a quick and weak pulse, palpitation, head-
ache, ischuria, etc., the passage of the atropine into the
])harynx should, if possible, be prevented by pressing
firmly on the lachrymal sac each time the drug is in-
stilled, and if this is not successful in preventing the
poisoning, some other mydriatic must be substituted.
The sulphate of duboisine, the sulphate of hyoscyamine,
daturine, or the hydro-bromate of homatropine may be
used for this purpose. Of these the duboisine is probably
most extensively used, as it is more certain in its action
on the pupils than the others ; but unfortunately it is apt
to produce constitutional disturbance in the very cases
which have an idiosyncrasy against atropine. Duboisine
and hyoscyamine should be used in solution containing
not more than two grains to the ounce. Homatropine
I have used somewhat extensively in children, and have
never seen symptoms of poisoning follow its use. Its
effect on the pupil is, however, much more transient
than either of the other mydriatics mentioned, and it is
therefore necessary to repeat the instillation very often.
I have generally employed it in one or^ two^per cent,
solutions.
The prolonged use of any one of the mydriatics here
mentioned occasionally produces considerable irritation
of the conjunctiva and inflammation of the integument
of the lids. In some cases I have seen a well-marked
follicular conjunctivitis and an inflammation of the skin
of lids and cheek closely resembling erysipelas follow
their use. In such cases it is best, if it can be safely
done, to suspend the use of mydriatics altogether for a
while, and to apply a one per cent, solution of nitrate of
silver, or sulphate of zinc to the conjunctiva, and an
ointment of the oxide of zinc, or the acetate of lead to
the skin until the irritation has subsided, and then to re-
sume the same or some other mydriatic. If all of the
alkaloids mentioned cause irritation, a strong, well-fil-
tered watery solution of the extract of belladonna may
be substituted. Notwithstanding the disadvantages here
mentioned of atropine, I think that on the whole it is to
be preferred to all other mydriatics.
In cases of iritis of long standing, in which the tissue
of the iris is swollen and infiltrated, and the pupil much
contracted, the one per cent, solution of the sulphate
of atropine, instilled in the manner described, will, hou-
ever, not only occasionally fail to make much of an im-
pression on the pupil, but will in some very rare cases
even increase the irritability of the eye. Under such
circumstances it is advisable to instil the atropine solu-
tion not more than five or six times daily, and to employ
at the same time other measures to diminish the conges-
tion and swelling of the iris. Of the various measures
used for this purpose, none has, in my own hands, given
1 Read before the Medical Society of New Jersey, j
more satisfactory results than local abstraction of blood
by means of four to eight leeches applied to the temple.
In many of my cases in which, before the application of
the leeches, atropine failed to act, complete or at least
partial dilatation followed the leeching, and this took
place often before the instillations were resumed. In
localities where leeches are scarce, or in cases where it
seems desirable to avoid the disfigurement resulting
from the little scars, Fischer's plan of making a single
leech do the work of many may be tried. It consists in
making a long incision in the side of the leech after it
has well filled itself. It is said that a leech thus treated
will take from one to two ounces of blood if the wound
in its side is kept free from clots. After the application
of the leeches the patient should be kept in bed, or
should at least remain quietly in a darkened room for
twenty-four hours, or longer. If only slight improvement
follows the leeching, it can, if necessary, be repeated
several times, at intervals of several days. In cases in
which the leeching is contra-indicated by marked anae-
mia, a considerable reduction in the congestion and the
swelling of the iris is sometimes brought about by the
action of a brisk cathartic, and the continued application
of hot-water compresses to the eye. In some cases in
which leeching had had but little eflfect, I have seen
dilatation of the pupil follow shortly after the patient
had taken a Turkish bath. The measures here men-
tioned will in the great majority of cases of iritis, if the
case is not of more than a week's standing, suftice to break
up all or at least most of the posterior«ynechia3 ; and
when this has been accomplished the back bone of the
disease is broken, and nothing remains to be done but
to keep the pupil dilated for some weeks after all circuin-
cornal injection has disappeared, and to prevent the
patient from using his eyes during this time.
But, if after a fair trial of these remedies no marked
improvement in the condition of the eye is apparent, or
if at any time gummy tumors begin to grow out of the
iris, some form of mercury should be administered. In-
unction with blue ointment or the oleate of mercury is
to be preferred in most cases ; but, if there are objec-
tions to its use, the bi-chloride, the proto-iodide, calomel,
or blue pill may be prescribed. In whatever form the
mercury is given, great care should be taken to avoid
salivation. As a rule, the use of this remedy should be
continued only till the swelling of the iris has subsided
and the exudation in' the anterior chamber has been ab-
sorbed. After that, the iodide of potassium may be
given. In former years I used mercury much more fre-
quently in iritis than I do now, having gradually learned
from experience that atropine, leeches, and warm fomen-
tations will in most cases break up the synechias, if they
can be broken up at all by any means outside of surgical
procedure. I have even treated without mercury quite a
number of cases occurring in persons who had previously
had constitutional symptoms of syphilis, and all recovered
with the pupil intact and the sight unimpaired. I have
also seen a very large gunnna of the iris disappear under
the iodide of potassium ; but it is only fair to add that k
did not prevent the development of other gummata in
the same eye some months later. I mentiop this merely
to show you that mercury is by no means imperatively
called for in iritis occurring in syphilitic patients. Unless
other manifestations of syphilis are present at the time,
the iritis will require no other treatment than the non-
syphilitic variety ; but, if constitutional symptoms are
present, they should of course be treated in the usual
way. I never withhold mercury if I think that the con-
dition of the eye demands it, but I do not give it in any
case simply because the patient tells me that he had a
chancre. In such a case I at once search for symptoms
of syphilis, and if any are found I treat them either with
mercury or iodide of potassium ; but, if no other mani-
festations are present, I treat the iritis in the same way
as I would in a patient who has never had syphilis.
For the relief of the pain which is so frequently pres-
234
THE MEDICAL RECORD.
[September i, 1883.
ent during the early stages of an iritis, the repeated ap-
pHcation of leeches to the temple is sometimes advisable,
even if the pupil is widely dilated ; and this plan is to be
especially recommended in cases in which morphine does
not act pleasantly. Morphine, with or without the sul-
phate of atropine, should always be given in sufficient
doses — either hypoderniically or by mouth — to allay pain
and produce sleep at night. The hydrate of chloral will
answer for the milder cases. During the last few years
I have often given the salicylic acid in medium doses
with gratifying results in cases of iritis accompanied by
much pain in and around the eye, and especially when
symptoms of rheumatism were either present or had pre-
ceded the eye trouble. Should this remedy fail, quinine
may be tried, either alone or in combination witii mor-
phia. In my own hands, quinine has been especially
useful in cases of iritis associated with gonorrhoia. If
the pain is due to an increase in the tension of the eye-
ball (a symptom not unfrequently seen in severe cases of
so-called serous iritis), and none of the remedies men-
tioned give relief, paracentesis of the anterior chamber
should be resorted to. The opening is best made with a
lance-shaped knife or a broad needle, at the outer margin
of the cornea, great care being taken that the instrument
is not pushed far enough in the chamber to wound the
iris or the capsule of the lens. If necessar)-, this little
operation may be repeated daily for several days. In
nearly all cases of iritis, considerable relief from pain is
also obtained from the application to the lids of cloths
wrung out of warm water or a warm solution of morphine
and atropine. In a few cases the application of iced
cloths will be found more soothing to the eye, and the
choice between the two may therefore be left to the
patient.
Rest in bed m a darkened room, although perhaps not
essential to complete and speedy recovery in the milder
forms of iritis, should be insisted upon in all cases in
which there is much pain, cedema of the lids and ocular
conjunctiva, much exudation in the anterior chamber, or
a marked increase of tension. In cases of great se-
verity, some relief is also occasionally obtained from
gentle diaphoresis ; and, as no harm can possibly be done
by stimulating the cutaneous secretion, remedies produc-
ing this effect may be given in combination with any of
those otherwise indicated. Jaborandi, or its alkaloid
pilocarpinum, I have occasionally used with apparent
benefit in cases in which there was much cedema of the
ocular conjunctiva and much e.vudation in the anterior
chamber ; and also in cases with marked increase of
tension — cases, in fact, in which the infiammation was
not confined to the iris, but extended, in all probability,
to the ciliary body and the choroid. Of late I have
given the pilocarpin exclusively by hypodermic injection.
Tiie iodide of potassium, in five to twenty grain doses,
is also very efficacious in the same class of cases. An
iritis occurring in the course of other diseases — such as
syphilis, gonorrhoea, rheumatism, gout, diabetes, small-
pox, and so forth — requires no other treatment than that
outlined here, care being taken, however, to select for
internal use only such remedies as are known not to
have an injurious effect on the general disease. That
the general disease is to be treated in the usual way is
self-evident.
As long as the eye is at all irritable, all close work
should be strictly prohibited, even if but one eye is af-
fected ; and in order to guard against relapse as much as
possible, only a very cautious use of the eye should be
permitted for some months afterward.
With regard to the treatment of the results of an iritis,
my advice is not to interi'ere unless the pupil is excluded
— that is, the entire pupillary margin is fastened to the
lens ca])sule. In this condition the iris is soon bulged
forward by the fluid effusion between it and the lens cap-
sule, and secondary glaucoma follows. As soon as the
bulging of the iris is noticed, a large jjiece of iris should
be excised. No other treatment will be of any avail.
An iridectomy may also be made in cases in which nu-
merous and broad posterior synechia appear to be the
cause of relapses of iritis, although this operation is by
no means a sure prevention. Of the several operations
devised for the purpose of breaking up posterior syne-
chias, without excising iris tissue, I will only say that
none but the most skilful operators should undertake
them ; of their value I am in doubt. Various modes of
treatment have been suggested for preventing relapses,
and I have tried them all, only to be disappointed in
them all. Relapses will occasionally occur in spite of all
the remedies recommended.
ULCER AND FISSURE OF THE RECTUM.
Bv F. W. SMITH, M.D.,
DEMONSTRATOR OF A.NATOMV, SYR.^COSE (n. Y.) UNIVERSITY MEDIC.U, COLLEGE.
Some recent experience in treating diseases of the rec-
tum leads me to think that few diseases of equal impor-
tance are so apt to be wholly overlooked by the general
practitioner.
I believe that in the female many cases of supposed
uterine or bladder trouble, or obstinate constipation,
or perhaps chronic diarrhcea, have been unsuccessfully
treated, when, if a proper examination of the rectum
had been made at the first, the patients could have been
saved months, and perhaps years of painful suffering.
In the male it is not impossible to mistake rectal disease
for beginning cystitis, vesical calculus, enlarged prostate,
or urethral stricture. And these mistakes are made not
infrequently and by good physicians, not because they
are incompetent to make a diagnosis, but rather because
of carelessness, or perhaps because their attention is not
often attracted by patients afflicted with rectal disease.
For some reason a physical exploration of the rectum is
rarely thought of unless symptoms point almost posi-
tively and exclusively to its disease, while the uterus
and urethra are frequently subjected to the most rigid
examinations when no symptoms point to local trouble,
either functional or organic, with a view of determining
if there is not some local derangement which may,
through reflex irritation, be the cause, perhaps, of an
irritable cough or some other complicated disorder the
origm of which is difficult to understand.
The most common disorders met with in the rectum
are ulcer and fissure, and although trifling in point of
size and pathological relations, they are of great practi-
cal importance both on account of the excessive amount
of local pain and the constitutional disturbance and irri-
tation to the nervous system which the patient may suf-
fer. As illustrating some of the striking phenomena
which are presented by the above-named disorders, I
will report three cases such as are liable to fall into the
hands of any practitioner, and which are only a fair sam-
ple of others which have come under my notice.
Case I. — November, iSSi, there appeared at my
office for treatment a Mr. O , a young man twenty
years of age, apparently of strong and vigorous constitu-
tion, who said that until his present trouble began he
had never been sick for a day.
About two }ears before he came to me he commenced
to have pain of a severe lancniating character, which he
located principally about the neck of the bladder, but
sometimes darting backward to the sacrum or radiating
down the thighs. At first the pain was only occasional,
occurring once or twice during the day or night, the jiar-
o.xysms gradually becoming more frequent until his pain
was almost constant.
Defecation became very painful and difficult, notwith-
standing that during much of the time the bowels moved
frequently and the stools were soft.
Perhaps his most distressing trouble was his almost
constant desire to urinate, which act also excited no lit-
tle pain. For more than a year he had been obligeii to
pass his water as often as every hour, night as well as
September i, 1883.]
THE MEDICAL RECORD.
235
day. About six months before he came to me he un-
derwent an operation for stricture of the urethra, and
although his urethra was made proper size, none of his
unpleasant symptoms were reUeved, but continued to
grow worse, and when he came to me he was indeed in
a pitiful condition. The countenance was pale, anxious,
and careworn, and his expression indicative of constant
suffering.
The constitutional disturbance and irritation to the
nervous system had been very great, and his condition
was such that his father and brother expressed to nie
fears that his mind was even beconung affected. I ex-
amined the rectum and found two large ulcers situated
about two inches above the margin of the anus, one an-
teriorly, oblong in shape, and occupying a space a little
smaller than a silver ([uarter. The other, about half the
size of the first, situated posteriorly. Both presented
much the same appearance. They were deep, with edges
sharply defined.
After stretching the sphincter moderately, I touched
the ulcers lightly with the nitrate of silver and prescribed
suppositories of iodoform and belladonna to be used at
night. The young man returned the next day, saying
he had not spent so comfortable a twenty-four hours in
more than two years.
I continued the above treatment, moderately stretch-
ing the sphincter two or three times a week, and at the
end of two months he was relieved of all his unpleasant
symptoms and the ulcers healed.
Case II. — Mrs. R , twenty-eight years of age, has
the appearance of being strong and healthy, and is a
woman of good habits. Has had three miscarriages,
one at the fourth month and two at the sixth month of
utero-gestation.
I first saw her on the morning of September lo, 1882,
when she was threatened with another miscarriage at
about the sixth month. She was extremely restless and
had been having periodical pains for the past ten hours,
with now and then a little hemorrhage.
I began to think abortion inevitable and to think of
the safest and best means of hastening along the work
which had evidently already begun, but being naturally of
a conservative disposition, 1 made haste slowly. I inquired
carefully into her previous history, to see if I could find any
possible cause for this as well as her former miscarriages ;
but in my efforts to this end I failed completely, except
that I obtained a history of obstinate constipation, with
painful defecation and the occasional passage of a little
blood, which trouble extended back over a period of
more than three years. I began to suspect that my pa-
tient had disease of the rectum, the examination of which
might reveal the cause of her present trouble. Introdu-
cing into the rectum my index finger, I found the sphinc-
ter muscle in rigid contraction, also three fissures about
equally distant from each other, and extending upward
from the margin of the anus for about two inches. I
stretched the sphincter moderately and touched the fis-
sures lightly with the nitrate of silver and gave no opiate
or sedative of any kind. Returning the next day, I
found her very comfortable ; her pains had ceased al-
most immediately after my operation of the day previous,
and with no treatment other than attention to the rec-
tum she went on to full term, and on December 20th she
gave birth to a strong, healthy male child, weighing ten
pounds.
Now, I firmly believe that the fissure and spasm of the
anus, from which this woman suffered, were the cause of
lier three previous miscarriages, and I have not the slight-
est doubt that she would have aborted this time had not
she been relieved of the old irritation and exciting cause.
Case III. — Miss B- , aged twenty-two years, came
under my treatment in September, 1883. She gave a
history extending back over a period of more than two
years. Her most distressing trouble was painful and
prolonged menstruation. She was troubled much with
chronic constipation, frequent micturition, and almost
constant pelvic pain. She was also very anaemic and
suffered from' headache and extreme nervousness.
About a year before she had undergone an operation
for stenosis of the cervix uteri, but had obtained no relief.
I instituted a careful examination, and aside from a
general hyperemia and hyperesthesia, the uterus and its
appendages were in a normal condition.
Exploration of the rectum revealed an irregularly
shaped ulcer, a little larger than a dime, situated ante-
riorly about two inches above the anal orifice. With no
treatment other than attention to the rectum, and the use
of a ferruginous tonic, she was in a few weeks restored
to good health.
In the treatment of the above named rectal troubles,
I have had much the best success by moderately stretch-
ing the sphincter from time to time at intervals of three
or four days, in connection with some local application,
than by either the operation of forcible dilatation or in-
cision, and the former method has the advantage of being
less formidable to the patient.
EARLY ENGLISH MEDICAL AND SURGICAL
LEGISLATION.
By MYRON T. BLY, Esq.,
ROCHESTER, N. V.
A DRAFT of a proposed act, introduced in the early part
of the present session of the Legislature, "authorizing''
people to employ whomsoever they think fit as medical
attendants, smells strongly of " A Bill that Persons being
no Common Surgeons may administer medicines notwith-
standing the Statute," enacted by Parliament in the thirty-
fourth year of the reign of " our most-dread sovereign
lord, Henry VIII.," just about three and a half centuries
ago. Thus doth history repeat itself, for what is legisla-
tion but history compacted and crystallized ? The old
English statutes mark epochs of progress in the trades
and manufactures, in political economy and science, in
the learned professions, and what shall we say of their
preambles ? Between the " whereas " and " wherefore "
of those sturdy acts is frequently found the only insight
obtainable into contemporary history. The facts are not
always reliable to be sure, but they are generally as
reliable as any facts which can be obtained from other
sources.
It may have been from a lack of inclination, or from a
feeling that interest would not warrant it, or from a lack
of space in their crowded works, that writers on medical
jurisprudence have failed to treat, as it deserves, the sub-
ject of medical police. It can scarcely be said that the
subject is not included in medical jurisprudence, for it
is. It is perhaps a branch ; if so, it has arrived at a stage
of development which entitles it to a treatment of its
own. There is enough material for a work on medical
police — a work which might be made valuable to the
legal and medical profession and invaluable to the legis-
lator and political scientist. If such a work is ever writ-
ten, an account of the early English legislation will not
only be the natural beginning (unless the writer chooses
to delve into the older material of the continental conn-
tries) but will also be one of the most instructive chap-
ters. It furnishes the key to all the legislation enacted
since, both in England and America, commencing with
the " act for the appointing of jihysicians and surgeons,"
passed in the year 151 1, the third year of King Henry
■VIII. The first era of legislation looking toward the
regulation of the practice of physic and surgery, extends
to the thirty-fifth year of Henry VIIL, and during this
period no less than seven statutes at large were enacted.
Dr. Ordronaux, in his " Jurisprudence of Medicine,"
speaks of " the earliest statute " as " a draft of an act of
Parliament of 9 Henry V., a.d. 1422." Nowhere else
have I found any allusion to such an act. None of the
authorities on English statutes refer to it, and it is not
given in Ruff head's " Statutes at Large" — an acknowl-
236
THE MEDICAL RECORD.
[September i, 1883.
edged authority. Moreover its terms are- suspicious, it
provided that no one sliould practise physic unless he had
studied in a university and was at least a " bachelor in
that science." If such a statute ever existed, how is it
that its provision was afterward so completely undone,
and why has it taken centuries of legislation to get back
again ? Paris and Fonblanque have given just a little
discussion to police laws in their medical jurisprudence,
although finally dismissing it as " but little matter of pro-
fessional interest." They refer to a petition presented
to Henry V., in which was set forth the advancement
made on the continent in regulating the practice of medi-
cine, and perhaps what Dr. Ordronaux calls a statute
was a portion of this petition.
As to the Act of 15 11, there is no doubt of its authen-
ticity. It is constantly referred to by later acts and it
seems to have been maile the basis of all future legisla-
tion. It is an epoch-marking statute. \Vhen the Gov-
ernor and Council of the colony of New York, in i 760,
came to frame the first medical police regulation enacted
in America, they evidently had this first English statute
in mind.
The preamble set forth a truly outrageous state of
affairs, alleging that " the science and cunning of physick
and surgery is daily within this realm exercised by a great
multitude of ignorant persons, of whom the great part
have no manner of insight in the same ; some also can
read no letters on the book, so far forth that conunon
artificers, as smiths, weavers, and women, boldly and
accustomably take upon them great cures and things of
great difficulty, in which they partly use sorcery and
witchcraft, partly apply such medicines as be very noxious
and nothing meet therefore, to the high displeasure of
God, great infamy to the faculty, and the grievous hurt,
damage, and destruction of many of the king's liege peo-
ple." Consequently the ban of the law was laid upon
" smiths, weavers, and women," and all persons were
forbidden to practise physic or surgery in London or
seven miles around, unless examined and admitted by the
Bishop of London or Dean of St. Paul's, assisted by four
chosen physicians or surgeons. In other parts of the
realm practitioners were to be examined by the bishoii of
the diocese, assisted, if he chose to call such, by exjie-
rienced professionals.
This Act was subject to great abuse in the bishoprics,
by reason of the supreme discretionary authority in-
vested in the bishops. It remained unchanged until
1522, when the Act was passed incorporating the jihysi-
cians of London. The king had already issued letters
patent to that body in 151S, for the " due exercising and
practising of the Faculty of Physick and the good min-
istration of medicines." This patent was ratified and
enlarged by the statute, which recited a necessity for
practitioners to be " profound, sad and discreet, groundly
learned, and deeply studied," and therefore the work of
examining and admitting them was turned over to the
corporation — a proceeding which undoubtedly made can-
didates •' sad " enough. The governing body consisted
of eight " elects " vested, among other things, with the
power of examining in London persons wishing to i)rac-
tise in any part of tiie realm.
Very early in its history the " Faculty of Physick " in
London began to assume a powerful legal status. In
1540 its authority was made more autocratic by the Act
" For Physicians and their privileges," which was pro-
cured through a petition which the corporation transmit-
ted to Parliament. The petitioners knew how to excite
a lively interest in their prayer, reciting that " divers of
them many times having in care some of the lords of
your most honorable council." The argument was so ir-
resistible that henceforth physicians were exempted from
keeping " watch and ward and to be chosen to the ofiice
of constable." The corporation was authorized to ap-
point four of their number to have "full authority and
power, as often as they shall think meet and convenient,
to enter into the house or houses of all and every apothe-
cary to search, view, and see such apothecary's wares,
. . . and all such drugs and stuffs as the said four per-
sons shall there find defective, corrupted, and not meet
nor convenient to be ministered in any medicine for the
health of man's body, the same four, calling to them the
warden of the said mystery of apothecaries, shall cause
to be burnt or otherwise destroy the same."
Having made this simple disposition of the adulterated
drugs question, this Act of 1540 closed by prescribing
that, "forasmuch as the science of Physick doth com-
prehend, include and contain the knowledge of surgery,''
duly admitted physicians "might practice and exercise
the said science of Pliysick in all and every his mem-
bers and parts." This latter clause fairly illustrates the
position which surgery occupied, as a profession, at this
time. It was more of a vulgar than a learned profession.
In 1513 a statute at large exempted the "wardens and
fellowship of the craft and mystery of surgeons en-
franchised in the city of I,ondon, not passing in number
twelve persons," from jury and constable service and all
matter of office. In 1530 it was found necessary for
Parliament to enact that surgery was not a "handicraft,"
thus exempting surgeons from certain restrictions per-
taining to handicraft men. The first statute, however,
strictly pertaining to surgeons was passed in 1540, the
thirty-second year of Henry VIII. If we may believe
the preamble of this Act, there were abiding in London
"men of great experience as well in speculation as in
practice of the science and faculty of surgery," but un-
fortunately there were two distinct companies exercising
the science, one called the barbers of London and the
other the surgeons of London. The barbers' company
was incorporated by letters patent of Edward IV. The
surgeons' company was unincorporated, and therefore the
two companies were made one under the title of
" Masters or governors of the mystery and commonalty
of barbers and surgeons in London." The new corpora-
tion was invested with the autocratic powers which had
previously been bestowed on the physicians' company,
such as the summary " punishment and correction as
well of freemen as of foreigners, for such offences as they
or any of them shall connnit or do against the good
order of Barbery or Surgery." Lender such a power as
this, offenders against good practice were summarily
thrown into the common jail, and at a later date Par-
liament was obliged to restrict the power of these cor-
porations and correct the abuses which had arisen.
One of the clauses of this statute of 1540 allowed the
surgeons to take yearly the bodies of four executed male-
factors, " for anatomies," which number was increased
to six in the time of Charles II., "provided they be af-
terward buried." Another clause recited that as persons
exercising surgery at the same time exercised " barbery,
as washing or shaving and other feats," whereby infection
resulted, therefore no one " using barbery or shaving "
should " occupy any surgery, letting of blood, or any other
thing belonging to surgery, drawing of teeth only ex-
cerpt."
It was not until the eighteenth year of George II.
that a statute was passed giving a modern recognition of
surgery. It repealed the .\ct of 1540 and disconnected
the surgeons and barbers. Henceforth surgery was free
from the incubus of "barbery." It is thus seen that
legislation relating to physicians was far in advance of
that concerning surgeons. An illustration of the enlight-
ened view with which the judges regarded the profession
of the physician is found in the decision of one of the
first cases arising under the statute of 1541 : A man
was prosecuted for i)ractising contrary to the provisions
of that Act, and the Court decided that " practising phys-
ick " involved three things : " First, In judging of the
disease and its nature, the constitution of the patient, and
many other things. Second, in judging of the fittest and
properest remedy for the disease. Third, in directing
and ordering the application of the remedy to the dis-
ease." ^
September i, 1883.]
THE MEDICAL RECORD.
237
We have presented a brief view of the early English
medical and surgical legislation. All of its important
features are found to have been tlie work of the first
thirty-five years of the reign of Henry VIII. Henry him-
self was the last person whose mind was calculated to
originate and develop such legislation. It must be as-
cribed to the activity of a far greater mind — that of Car-
dinal Wolsey — "one, that by suggestion, ty'd all the
kingdom."
progress jof l^^ctticaX J>cieuce.
An Easy Method of Posterior Rhinoscopy. — The
importance of visual inspection of the nasopharynx and
l)Osterior nares in all local diseases cannot be (juestioned.
Ordinarily such examinations are attended with various
difficulties. Dr. Walshani {Lcutcet, July 28, 18S3), de-
scribes a simple method of overcoming these difficulties,
admitting, however, that a somewhat similar procedure
has for years been practised by some .\merican special-
ists : A piece of soft red rubber tubing, about one-eighth
of an inch in diameter, is introduced into one nostril,
and pushed very gently along the floor of the nose till
it presents just below the soft palate. It is then gently
seized with a forceps, drawn out through the mouth, and
loosely tied across the upper lip to the end protruding
from the nose, the elastic tube being stretched just suffi-
ciently to loop upward and forward the. soft palate, and
draw it well away from the posterior wall of the pharynx.
The looping of the palate on one side is often sufficient ;
but a better view is obtained by passing a tube through
the other nostril and looping up the soft palate of that
side in the same way. The posterior nares and naso-
pharynx can now be examined with the ordinary laryn-
goscopic mirror with the greatest facility. One hand
only is required to hold and direct the mirror (the stem
answering the purjjose of a tongue-depressor), the other
hand is consequently free to perform any manipulation
or operation that may be required. The tubes serve as
a good guide, as they can be followed in the mirror
winding round the upper surface of the i)alate, and so
into the respective choaniu. The introduction of the
tube causes hardly any discomfort or annoyance to the pa-
tient. Care, however, should be taken in passing the
tube to let it only just jjiesent below the soft palate, as
otherwise, if it is pushed further, it may impinge upon
the lower pharynx, and is then apt to produce a tickhng
sensation and desire to vomit. When the examination
is finished, it is better to withdraw the tube through the
mouth rather than through the nose, and when the nasal
end is just about to drop into the pharynx to give it a
sharp whisk forward. If it is withdrawn through the
nose, the mouth end trails along the tongue, causing a
tickling of its posterior part. In place of the red rubber
tubes, the American surgeons referred to use flat tapes
or narrow bandages for tying up the palate. These have
necessitated the use of various instruments for passing
them, such as the Eustachian catheter, Bellocq's sound,
etc. The advantages of the red rubber tubing are that
it is soft, non-irritating, and possesses just sufficient re-
sistance to enable it to be passed through the nose by
itself, thus dispensing altogether with the use of an in-
strument, the passage of which, as for instance in plug-
ging the nares, is, as is well known, a source of much
discomfort and annoyance to the patient.
Good Remedies out of Fashion. — In an address
on this subject, recently delivered by Dr. C. J. Hare, the
lecturer made some interesting observations on emetics
and bleeding (British Medical Journal, July 28, 1883).
In former tunes it was not unusual to commence the treat-
ment of many diseases with the administration of a dose
to procure vomiting. And although the remedy might
then be given sometimes indiscriminately and according
to routine, only those who had seen the effects of emetics,
properly and judiciously given, could conceive the bene-
ficial effects they sometimes jiroduced. In the early stage
of an attack of croup, it was by no means unusual to
give an emetic of tartarized antimony or of ipecacuanha.
And it was in accordance with the recorded experience
of some of the best authorities and most practical men,
and quite consonant with his own experience too, that
symptoms which presented the most certain augury of a
severe attack were by these means cut short, the hoarse
voice resumed its natural character, and the feverish
symptoms were in a few hours relieved. He knew quite
well that a great fear was entertained by some as to the
depressing effects of emetics. IJut the fear was theoreti-
cal, and not practical, and those who had had most ex-
perience in the administration of them best knew how
groundless the fear was. In diphtheria, too, he had
seen the false membranes wliich were out of the reach of
local remedies, and which the patients coughed and
coughed in vain, and utteily exhausted themselves to
<Tet quit of, readily brought up by the action of vomiting,
to the immense relief of the sufferer. " In suffocative
bronchitis," the lecturer continued, " the effect of eme-
tics is sometimes magical, and by their administration in
such cases not only is immense relief given, but I am
certain that lives are saved. You are called to a pa-
tient who has been ill a few days, with increasing dysp-
noea ; she is sitting up in bed (I draw from nature), for
to lie down is impossible ; she is restless and tossing
about ; the lips, and indeed the whole face, blue ; the
eves watery and staring ; the pulse quick and small ; the
cough constant ; the expectoration seini-transjiarent and
tenacious ; over every square inch of the chest, front
and back, from apex to base, you find abundance of
rhonchi ; moist, sonorous, and sibilant ones in the upper
part of the lungs, and muco-crepitant or mucous rales
toward the bases. Ammonia and stimulants, right and
good in their way perhaps, in such a case are too slow
in their action ; the patient is, in fact, more or less
slowly, more or less rapidly suffocating. An emetic of
twenty-two grains of ipecacuanha in an ounce of water
is given ; in ten or fifteen minutes the patient vomits
and brings up a huge quantity of that tenacious mucus,
and the whole aspect of the case is altered ; the dis-
tressed countenance is relieved ; the breathing is at once
quieter; and the patient is able, for the first time for the
past twenty-four hours, to lie moderately low in bed, and
to get some sweet refreshing sleep. The patient is, in
fact, rescued from the extremest peril, and in this case,
and in many similar ones too, I believe, from otherwise
most certain death. Of course, in such cases the eme-
tic is not given for its effect on the stomach, but for its
collateral effect in mechanically clearing out the enor-
mous amount of secretion which accumulates in the
bronchial tubes, and which the patient is otherwise quite
incapable of getting quit of ; and thus the half-choking,
almost asphyxiated condition is changed for one of com-
parative coiiifort, and time is gained for the action of
other appropriate remedies. No doubt the secretion
may, and often will, accumulate again ; and I have not
hesitated again in bad cases to repeat the same good
remedy ; but it is a fact, and a very positive one too,
that, quite contrary to what those who have had no ex-
perience iu the plan suppose, the system rallies instead
of being more depressed under the action of the remedy.
There is a class of cases in which the right heart is en-
gorged with blood, and in which the only hope of rescu-
ing the patient from death is by bleeding. A nian of
middle age (I again draw from nature) has considerable
chronic bronchitis, with some congestion of the lungs,
and, like many other unwise i)ersons, he goes to a
southern watering-place instead of remaining in his room
and in an uniform temperature. Becojiiing worse, he
determines to return home, and travels on a cold spring
day ; his dyspnoea is so much worse on the journey, that
his friend and the fellow-passengers doubt whether he
238
THE MEDICAL RECORD.
[September i, 1883.
will arrive home alive ; and when his carriage meets him,
it is with the greatest difficulty he is conveyed to his
house, and got into his drawing-room. You are at once
sent for, the message being that the patient is dying, and
when you arrive you find that that is the fact. He is
sitting in a chair (to lie down is impossible for him), his
face is blue and swollen, his lips purple, the eyes suffused
and staring, his heavy gasping breathing you have only
too distinctly heard and recognized as you ascended the
stairs, and when you see him you find his chest heaving,
and each short gasping inspiration followed by a long
wheezing and moaning expiration ; his lungs are full of
moist, sonorous, and mucous and submucous rhonchi, and
scarcely a trace of vesicular respiration is to be heard,
and he is pulseless. He looks to you beseechingly, and
gasps out, in scarcely articulate words, that he is dying.
This is but too true. Now, the treatment for such a
condition at the present day is ' to pour in stinuilants '
(though the patient can scarcely swallow). Brandy and
water are given, and ammonia, and perhaps ether; then,
if the patient live long enough to have them made, mus-
tard poultices are applied to the chest, and to the calves,
and to the feet, and the patient is fanned, and the pa-
tient dies. Something has been done, but that which
true pathology — and, indeed, common sense, unshackled
by prejudice, custom, and fashion — would dictate, has
been left undone. Appearances have been saved, but not
the patient's life. The fact is, that here the danger lay
in the right side of the heart being gorged with blood, so
that it was impossible for its stretched and distended
walls to contract and to propel forward the thick and
blackened blood. Relieve that poor oppressed, dis-
tended heart, and all may be well. Open one of those
veins which are, with every systole of the heart, tending
to carry more and more blood to this already distended
right ventricle, and all may yet be well with your patient.
Sometimes this blood-letting, in extreme cases, is no
easy matter ; it may be necessary, before you can
eftectually open the vein, to place the ]iatient's arm in
warm water, so as sufficiently to distend the vein ; and
even when the ligature has been efficiently applied, and
the vein well opened, you may have to press and squeeze
and rub upward the arm before a drop of the thick and
tarry blood will flow. 15ut, when it does flow at length
freely, what a marvellous change may you see take place !
— the breathing becomes quieter, deeper, and less noisy,
the haggard face resumes the appearance of tranquillity,
the blueness of the skin is replaced by a more natural
tint, the pulse becomes more and more distinct, and, in
a word, the choked-up heart is set free."
Splexectomv. — Dr. A. Blum has recently written an
article upon the subject of excision of tlie spleen [Ar-
chives Gc'nerales de Medecine). His conclusions, based
upon a study of the recorded cases, are that while the
operation of splenectomy is practicable and is compatible
with complete recovery, it is so often fatal from hemor-
rliage or shock that it is but rarely indicated. He con-
siders that it is not justifiable in cases of splenic cysts,
because they can be cured by other and milder measures ;
or in cases of hypertrophy, whatever its cause, or in
cancer of the organ, on account of the very liigh mor-
tality. But he points out that in cases of movable spleen,
with marked and severe symptoms, the operation is
comparatively easy and successful; while in cases of her-
nia of the spleen following an injury the removal of the
herniated portion is so successful that the surgeon is fully
warranted in undertaking it.
The Action of Piperidin. — This substance has been
exi)erimented with by Fiiess. The results of liis re-
searches are given as follows by the Lancet, July 28,
1883: If a dose of i)iperidin be subcutaneously injected
into a frog, after a short i)eriod of unrest the animal re-
mains remarkably quiet and no longer moves wlien the
foot is pinched, and that this is not due to lesion of ijie
muscles or to paralysis of the motor nerves is shown by
the vigorous movements that are made if the sciatic
nerve be stimulated by an induced current. Paralysis
of the sensory nerves must therefore be the cause of the
lack of response of the animal to sensory stimuli, and
the question arises whether it is the nerve or the centre
that is paralyzed. The loss of reflex excitability takes
place about ten or twelve minutes after the injection of
one milligramme of piperidin, and is so complete that
even its contact with the eye fails to elicit any response.
Recovery of the sensibility occurs at the expiration of
twenty-four hours. It has been rendered probable by
Kronecker's and Stirling's experiments that a single
shock is insufficient to excite a reflex action, and that at
least two are required, which must be separated by a
a short interval only. In his experiments with piperi-
din, however, Fiiess found that the time which elapsed
between two shocks in order that a reflex movement
should be induced was not altered, but only that the
shocks must be much stronger. Hence he arrives at
the conclusion tiiat it is not the centre which is acted
on by the piperidin, but the conducting agent — the nerve.
The paralysis of the sensory nerves only occurred in
those parts of the body to which the blood impregnated
with piperidin was distributed ; in any part of it pro-
tected from the action of such blood the sensory fibres
retained their function. Further experiments demon-
strated that the part of the sensory nerves on which
piperidin acts is their peripheric termination. All the
experiments proved that neither the muscles nor the
motor nerves were in any way affected. Other results
observed after the subcutaneous injection of one milli-
gramme of piperidin were that the frequency of respira-
tion fell to one-half the normal amount— that is, from
60 to 36 and 30 per minute. I^arge doses led to the
Stokes' phenomenon, respiration being interrupted for
two to four minutes, after which the frog made from
three to four deep respirations. In regard to the car-
diac beats, their number similarly fell to about two-thirds
ofthe normal, from 54 to 34 per minute. Fiiess further
made some observations on the action of piperidin on
warm-blooded animals, but did not find that its effects,
in the rabbit at least, were nearly so well marked, even
though fatal doses were administered, and this he attrib-
utes in part to the circumstance that piperidin oxidizes
with extraordinary rapidity in the body. The frequency
of respiration was considerably reduced, the number
falling from 200 to 48 per minute, while the cardiac
beats rose from 220 to 340 per minute, so that it would
appear that the vagal centre was paralyzed. ' The pupil
became widely dilated, and the heart, when death oc-
curred, was arrested in systole.
Anterior Lux.'iTiON of the Phalasge.s. — In a paper
presented to the Societe de Medecine of Paris, Dr.
Thorens takes issue with Boyer, who has denied the pos-
sibility of forward dislocation of the phalanges (Z' Union
Midicale, July 22, 1883). He cites several cases re-
corded by others and one seen by himself. He con-
cludes therefore : i . That forward luxation of the pha-
langes is possible. 2. It can occur only after rupture of
the anterior and of one lateral ligament. This par-
tial dislocation is accompanied by a certain degree of
torsion. 3. Complete anterior dislocation can occur only
after the rupture of tiie anterior and both lateral liga-
ments.
Prevention of Ophthalmia in the New-Born. —
Dr. Credd returns again to the subject of ophthalmia neo-
natorum, treated by him in former publications, and
urges his colleagues for tlic tliird time to adopt his
method for the prevention of this disease and the blind-
ness so often resulting therefrom. He [iroves the value
of his treatment in a few words. It is shown by statis-
tics that, whereas formerly a large proportion (I'lfteen per
cent.) of new-born chiklien suffered from this affection,
often so serious in its consecjuences, tlae number speedily
diminished after the introduction of his method, until
September i, 1883. J
THE MEDICAL RECORD,
239
finally, for a number of years, no cases at all were seen.
Regarding ihe etiology of the affection he states : i.
That ophthalmia neonatorum is a disease caused by a
specific virus identical with that of gonorrhoea. 2. The
poison, contained chiefly in the secretion of granular va-
ginitis, finds access to the conjunctiva during the period
of expulsion of tlie child. 3. Normal vaginal secretion
never causes the specific conjunctivitis. 4. Protracted
delivery, early rupture of the membranes, and the large
size of the child, increase the danger of infection. The
author reviews the methods of prophylaxis formerly prac-
tised. These may be classed under two heads, the one
seeking to obtain the desired result by disinfectant in-
jections into the vagina, the other applying remedies to
the conjunctiva of the infant. The first way was barren
of results, and the best effects of the second are only ob-
tained, the author says, by his procedure. This consists
in wiping the eyes with a clean, wet rag, and then intro-
ducing, by means of a glass rod, one drop of a two per
cent, solution of nitrate of silver into each eye. He has
never seen any unfavorable reaction follow this little
operation. This method has been practised in all the
lying-in institutions and foundling asylums of Austria
since the beginning of the year, and Crede hopes to see
it become general everywhere, both in hospital and pri-
vate practice. — Ceniralblatt fiir Gyndkologie, July 28,
1883.
The Action of Alkalies on Bile. — Some researches
have been made recently by Lewaschew and Klikowitsch
on the subject of the influence of alkaline agencies on
the composition of the bile. The experiments were made
on dogs with permanent fistula; leading to the gall-blad-
der. No canula was used, however. For twenty-four
hours previous to the beginning of the experiment neither
food nor drink was administered. It was found that arti-
ficial and natural mineral waters had a similar action on
the secretion of bile. For some time after the adminis-
tration of the alkaline waters the quantity of bile flowing
from the fistula was diminished. This effect was prob-
ably due to the increased flow of bile into the intestines.
After this initial period the flow from the gall-bladder
became more than the normal. The normal amount had
been previously measured. Artificial waters exercised
the same influence on the quality of the bile as the natu-
ral waters ; but diff'erent results were obtained with waters
of different degrees of concentration. Thus, carbonate
of sodium had a more rapid, powerful, and lasting influ-
ence on the composition of the bile than sulphate of so-
dium. Solutions of weak strength were more powerful
than those of higher concentration. Hence, those min-
eral waters whose principal constituent was carbonate of
sodium had the greatest influence on the composition of
the bile, especially when the carbonate was not present
in a high degree of concentration. The higher the tem-
perature of the fluids ingested, the earlier and more
marked were the effects. — Centralblait fiir Klin. Med.
The Hvpodermic Injection of Blood. — In the Ai-
chivio per le Scienze Alediche, vol. vii., 1883, Dr. Carlo
Bareggi presents a resumi of a prize essay written by
him and published in Milan in 1882, upon the subject
of the hypodermic injection of blood. His conclusions
were derived from physiological experiments upon ani-
mals and clinical investigations in disease. Various
methods were practised, and blood from different sources
was used, but the best results were obtained with defi-
brinated blood taken from the same species as that of
the receiver. In the human subject a donor was selected
who was perfectly healthy and free from any hereditary
diathesis and, if possible, younger and of the same sex
as the receiver. If more than six ounces of blood was
desired it was obtained by venesection, but when a
smaller amount than three ounces was wanted it was
taken by means of a wet cup in the palm of the hand.
In the earliest experiments he employed an ordinary
Pravaz syringe, but later, in order to avoid the great
number of punctures and the increased danger there-
from, he made use of an instrument similar to that em-
ployed by anaton)ists for injecting the minute blood-ves-
sels and lymphatics.
The author sums up the results obtained, as follows : i.
Hypodermic injections of blood in amounts of one gram
are absolutely innocuous. When greater quantities are
used, the injections are relatively harmless according to
the regions of the body in which they are practised and
the method employed. The parts of the body which best
tolerate the injections are indicated in the original
memoir, where also the best method of operating is de-
scribed in detail. 2. In man, hypodermic injections of
blood are always followed by a slight febrile movement,
varying in duration from a few hours to, at the most, two
days. 3. The red globules of homogeneous blood, de-
fibrinated or not, injected into the subcutaneous connec-
tive tissue, are absorbed, in part at least, unaltered, and
pass into the general circulation. Their course is from
the lymphatic spaces in the connective tissue into the
lymphatic vessels leading from the part, through the
glands met with on the way (unless these are in an ad-
vanced stage of fibro-adipose degeneration or in some
other way profoundly altered), and thence into the re-
ceptaculum chyli and thoracic duct. They were found
in the principal lymphatic trunks of the part twenty min-
utes after the injection was practised, and even after
three days, numbers of them in a good state of preserva-
tion were encountered in the thoracic duct. The greatest
number was met with twelve hours after the injection, but
even after fifteen days, quantities of red globules, but
little changed, were seen passing from the cellular tissue
into the circulation. Absorption of the mass of injected
blood proceeded rather slowly in individuals in whom the
circulation was sluggish, especially in those in whonr there
was considerable subcutaneous adipose tissue, but more
rapidly under normal conditions of the heart's action and
in persons in good general condition. The red globules
were unchanged after remaining many days in the cellu-
lar tissue, except in cases in which there was considerable
febrile reaction. 4. Hypodermic injections of blood are
capable not only of arresting the jirogressive deterioration
in the quality of the circulating fluid, caused by insuffi-
cient nourishment or repeated losses, but also of increas-
ing, in spite of such persistent influences, the corpuscular
richness of the blood. 5. This increase in the relative
proportion of red globules is equal, or very little inferior,
to that obtained by the administration of ferruginous
tonics in cases in which these remedies are tolerated. The
improvement shows itself very soon after the first injection,
and persists long after the treatment has been discon-
tinued. Together with increased richness of blood comes a
marked improvement in the general nutrition and nervo-
muscular force. 6. To obtain such effects, it is necessary
to repeat the injections several times at intervals of five
to fifteen days, and to inject each time a considerable
quantity of blood. In one case Dr. Bareggi made four
injectionsof 100, 100, 120, and 130 grams (3 to 4 ounces)
respectively in twenty-nine days. The relative propor-
tion of h;emoglobine was more than doubled. In a
second case four injections of 200, 300, 150, and 240
grams (4^V to 9^^ ounces) respectively were practised in
the course of twenty-two days, and the proportion of
hajmoglobine was nearly doubled. 7. If these results
are cempared with those obtained by intraperitoneal
transfusion, it will be seen that they not only equal but
surpass them, and that without any danger to the patient,
and by a method at once easy and inexj^ensive. '• In the
hypodermic injection of blood, therefore, we have a new
and most valuable therapeutic resource. It is especially
adapted to the treatment of those cases of slowly progres-
sive anemia in which the digestive canal is extremely
irritable and unfit for the reception, retention, digestion,
and transmission to the blood of nutritive materials and
medicaments."
240
THE MEDICAL RECORD.
[September i, 1883.
The Medical Record
A Weekly yonrnal of Medicine and Surgery.
GEORGE F. SHRADY, A.M., M.D., Editor.
Published by
WM. WOOD &. Co., Nos. 56 and 58 Lafayette Place.
New York, September i, 1883.
THE PILGRII\rAGE TO MECCA AND THE
CHOEERA IN THE EAST.
At the present time, when the danger of cholera is so
imminent, a little hrocliure with the above title b}' Ur.
Stekonlis, reprinted in Constantinople from the Gazette
Medicah de P Orient, is of peculiar interest. The work
is divided into six chapters, treating respectively of the
holy city of Islam, the pilgrimage, the health of the pil-
grims and of the city of Mecca, cholera epidemics in
Mecca, the origin of these epidemics and the prophylactic
measures taken against their spread. Mecca possesses a
very changeable climate, and is swept with high winds
and deluged with frequent storms of rain. The city is
dirty and scantily supplied with water — from cisterns and
from brackish springs. The water of the holy well in the
temple of El Haram is especially foul, muddy in appear-
ance and saltish to the taste, and containb, according to
an analysis of Erankland, a large amount of organic
matter. The number of pilgrims is variously estimated
at from fifty thousand to one hundred thousand annually.
The number is, however, gradually falling oft", in spite of
the command of the Koran that every one of the faithful
must visit the holy city at least once during his lifetime.
This is due in a measure to the interpretation put upon
the injunction by the sect of the Chafie (the Turks), who
say that it is binding only upon those who have the
means and the health necessary to the journe\-. The
Dutch Government allows none of its Molianimcdau
subjects to start on the pilgrimage unless he can prove
that he possesses means sufficient to defray all the ex-
penses of travel and food. The most wretched and desti-
tute of all the pilgrims, says Dr. Stekonlis, are those
coming from Hritish India. The cost of food and even
of water in Mecca is very great, and those who come un-
provided with money to buy these necessaries sufter
severely, and fall ready victims to disease. Since 1865
the condition of the pilgrims has been greatly ameliorated
by the exertions of the international sanitary commission
at Constantinople. It is now forbidden to slaughter
anunals for food except in certain designated localities
outside of the city; inspectors are appointed whose duty
it is to see that the pilgrims observe some of the ordinary
rules of cleanliness in their lodging-i)laces, and ntunbers
of deep privy vaults have been dug throughout the city.
There is a pilgrims' hospital with sixty beds.
From 1813 to i8Si there were sixteen epidemics of
cholera in the holy city, all of which, with but one ex-
ception (that of 1846), occurred at the time of the annual
pilgrimage. One of the greatest outbreaks of the disease
was in 1881, when it lasted from the middle of September
to the end of the year. Some 5,000 of the 100,000 pil-
grims of that year perished. The disease was carried
from Mecca in all directions by those returning to their
homes, but was kept out of Egypt and Turkey by the
exertions of the health commission. A double quaran-
tine was established for the returning pilgrims. The
first, of fifteen days' duration, was at El Medji, on the
Egyptian boundary, 375 miles from Suez ; and the second,
for forty-eight hours, at Jebel-el-Tor, 125 miles from
Suez. Another quarantine, of ten days' length, was
established at Beyrouth, and all the returning pilgrims
were subjected to a second medical inspection before
passing the Dardanelles. That the cholera in Mecca is
carried thither by the Indian pilgrims there can be no
reasonable doubt. The author states that each of the
great epidemics in that city was directly dependent upon
exacerbations of the cholera in India. In 18S; a quaran-
tine was established on the Island of Camaran, at the
mouth of the Red Sea, for all pilgrims coming from India.
This island lies 150 miles north from Cape laabel-Man-
deb, is eleven miles in length and three and a half miles
wide, and is'plentifully supplied with purejwater. All ships
passing through the Straits of Babel-Mandeb were com-
pelled to go to the island of Camaran. There the pas-
sengers were landed and examined by the medical officers.
If all were healthy, they were allowed to proceed after
five days ; but ships from a place where cholera existed,
or those having cholera aboard,'were detained from ten
to fifteen days. The southern part of the island was re-
served for the healthy, the northern part for the sick.
From July 27th to October 20th, 5,518 pilgrims passed
through this quarantine to Mecca. In spite of these
precautions, however, the disease appeared in the latter
city. The explanation of this failure the author finds in
the fact that the English protested against the quarantine,
and that English shijis bearing pilgrims would not sub-
mit to the detention at Camaran. The English authori-
ties kept the existence of cholera at Aden secret for
thirty-five days, so that Mecca became infected from
ships carrying clean bills of health. Dr. Stekonlis states
that in 1882 the Egyptian pilgrims, for the first time, re-
turned by water, having always before gone home by
caravan through the desert. To this fact possibly is due
the present epidemic of cholera in that country. The
partial success already achieved by imperfect quarantine
of pilgrims going to and returning from Mecca, gives oc-
casion to the hope that greater perfection in the methods
now inaugurated, may succeed in removing this source
of peril to Europe and the' rest of the civilized world.
The author seems to think that the only hindrance to a
perfect quarantine and the prevention of cholera in
Mecca is the refusal of the F^nglish to submit to the
vexatious, but necessary, delays thereby caused.
THE TIME AND MANNER OK WEANING.
The Commission permanente de I'Hygiene de I'Enfance
of tlie Paris .'Xcademy of Medicine offered a jiri/e in 1880
for the best essay on the subject of weaning. None of
the productions offered at that time was deemed worthy
September i, 1883.]
THE MEDICAL RECORD.
241
of a prize, so the committee determined to invite further
competition on the same subject for 1882. Ten memoirs
were sent in in answer to this second appeal, six of
which were regarded as worthy of note, and of these, two
were especially commended. The report of the com-
mittee was made to the Academy at its meeting on June
26, 1883. (This learned Society, it will be remembered,
devotes its entire energies to the advancement of science,
and eschews politics. Hence its regular meetings are
not interrupted from early spring to autumn.) After a
short analysis of each of the essays submitted, the report
closed with a concise summary of the most practical sug-
gestions contained in the approved memoirs. These
conclusions were briefly as follows : Generally speaking,
the child should be fed at the breast during at least the
first year of life. The term weaning should be under-
stood as indicating the time at which the child ceases to
be suckled and begins to be fed with other food than
breast-milk. The weaning of an infant fed at the breast
should be a progressive process, for too rapid weaning is
often attended with fatal consequences. Gradual wean-
ing is best accomplished by supplementing the mother's
milk with cow's milk. This should be given in a bottle,
as the effort of sucking e.xcites glandular secretion, and,
if possible, it should be withheld until the third or fourth
month. After the sixth or seventh month a little farina,
oatmeal, starch, or bread may be added to the animal
milk to make a thin pap. At the end of a year eggs and
butter may be used and bouillon may be substituted for
milk in preparing the gruel. At the end of eighteen
months or two years vegetables and fruits may be allowed,
but meat and wine only after this time. The meals
should be given at regular hours, twice a day to begin
with, and the intervals between the times of nursing
should be increased at first during the night. When
about to complete the process of weaning, it is important
to choose : i, a time at which the infant is in perfect
health ; 2, the interval of calm which separates two
dental crises, as after the cutting of the third group or the
first molar teeth, or after that of the fourth group or the
canines ; 3, a season of medium temperature, as spring
or fall, so as to avoid equally the great heats of summer
and severe cold of winter. All the writers commented
upon the lamentable ignorance of this subject displayed
by the mothers of France (and they might have added, of
the world at large), and suggested that mothers and
nurses should be instructed in the elementary duties of
their station by means either of printed tracts or public
lectures. A valuable suggestion, no doubt, but one
which it is to be feared will prove very difficult of practi-
cal application.
THE QUESTION OF ABUSE.
Dr. Squibb, in the Epheineris, refers to the "abusive
comments" made by some medical journals upon the
action of the American Medical Association at its last
meeting. It is strange that those gentlemen who have
been so active in circulating scandalous charges against
New York physicians, should now complain themselves
of being "abused." No one can deny that a very large
proportion of the profession throughout the country, in-
cluding men of the highest character, and even the Presi-
dent of the Association himself, think that a change is
needed in the Code. When a few men at Cleveland,
therefore, endeavor to strangle all attempts at securing
reform and harmony, they lay themselves open to severe
criticism. The Cleveland meeting was indeed harmoni-
ous, but its effect has been to increase the discord and
bad feeling in the profession. For this reason we, in
common with many other medical journals, have criti-
cised its action as most unwise and short-sighted.
The charge which most journals have now fallen back
upon and content themselves with reiterating, is that the
New York Society is in rebellion. It seems impossible
for some of our contemporaries to understand, in this
connection, one of the simplest principles in law and
right, namely: that a chartered and legally constituted
body cannot in any sense "rebel" against the regula-
tions of an unchartered body without legal status, with
which also the former is only in voluntary relation.
THE MICROCOCCI OF DYSENTERY.
We admire the courageous diligence of Dr. Prior, of
Bonn, who has been studying the micro-organisms m
dysenteric passages. Dr. Prior, by special arrangements
with a docile patient, caught the dysenteric stools in
disinfected bowls, and within five minutes had prepara-
tions under the microscope. In that time, he very truly
says, few bacteria could get in from outside or could de-
velop from within. He used for his examinations only
the purely dysenteric passage, without admixture of fecal
matter.
He found in fresh unstained specimens vast numbers
of the round cocci. They were in active movement, and
were arranged in chains or in pairs, and singly.
They were strikingly like, in size and shape, to the
cocci of pneumonia as described by Finkler; of cerebro-
spinal meningitis as described by Leyden, and ot ery-
sipelas. They were, however, a little smaller and more
delicate than those of pneumonia. They possessed ac-
tive movement.
He also found a few very fine bacilli. The shreds of
mucous membrane which were found in the stools were
thoroughly washed and examined. Here there were also
countless micrococci, but no rods.
In order to compare these appearances with those of
health or of other diseases. Prior e.xamined a number
of the stools from healthy men and from patients suffering
with tuberculous diarrhcea, typhoid fever, and simple in-
testinal catarrh. He found micrococci and bacilli here
also, but the former in extremely small numbers com-
pared with those in dysenteric stools. On the other
hand, the bacilli were very much more numerous.
Experiments with staining fluids were made in order to
see whether the cocci could be differentiated in this way.
They colored beautifully with gentian violet and Bis-
marck brown, but had no special stain and could not be
doubly stained.
Examinations were made of the diseased intestine, Iresh
specimens, and those preserved in alcohol, and Miiller's
fluid being used. The micrococci were found not .only
in the tissue-juice, but in the tissue itself.
The blood was examined a number of times, but noth-
ing abnormal discovered.
The similarity between the micrococci of pneumonia,
242
THE MEDICAL RECORD.
[September i, 1883.
cerebrospinal meningitis, erysipelas, and dysentery is, to
Dr. Prior, a very suggestive fact. To us it appears that
the attempt to find a pathological unity or consanguinity
between these diseases is rather strained.
Prior does not pretend to say that the organisms he
describes are the cause of dysentery. He intends, how-
ever, to make some gelatin-cultivations of them, and
then inoculate the younger generations. He e.xpects to
be able to show that dysentery will be produced.
NOT ENOUGH MEDICAL COLLEGES.
Our brilliant, but infrequent (being quarterly), con-
temporary, the Fori Wayne Journal of the Medical Sci-
ences., reasserts its view that there are not too many med-
ical colleges in the country. It does not now, however,
go quite so far as to saj' that we need more. Following
its able editorial upon the present beatific state of med-
ical education, especially in small western cities, is this
notice :
" The medical college of Fort Wayne was closed out, a
few days ago, by the constable selling all of the furniture
and illustrations in the entire concern to satisfy a judg-
ment against the institution."
We are pained to observe that our contemporary
'seems rather pleased than otherwise at the collapse of
this institution, although it leaves the country one pre-
cious college the less.
The history of medical institutions at Fort Wayne is
onlj' a repetition of what has occurred over and over
again in other places. Medical men, not content with
achieving success by the quiet method of ordinary prac-
tice, desire to be professors ; and thereupon they organ-
ize a school. The institution cannot take in all the
ambitious doctors in the town ; therefore, discontent and
jealousy ensue. A rival college is organized, good feel-
ing is disturbed, bitterness and quarrelling arise, and the
harmony of the profession broken.
Now, is all this necessary for the sake of cruilely edu-
cating a ie.\s medical students? We think not, although
it grieves us, in saying so, to controvert our excellent
and too infrequent contemporary of Fort Wavne.
The Presbyterian Hospital, New York.. — Arrange-
ments are now being made for increasing the capacity of
this hospital and thereby extending its usefulness. The
governors are contemplating the erection of a new pa-
vilion, and also the appropriation of some of the spare
room in the executive building for extra beds. A new
passenger elevator has been erected in the main build-
ing, and a new ambulance, which is claimed to be the
best made and most complete one in the cit)', has been
recently jjresented to the institution. Since the establish-
ment of the ambulance service in this hospital the mun-
ber of acute surgical cases has increased to such an
extent that the wards are constantly crowded to their ut-
most capacity. The attending staff proposes to utilize
this material for free clinical instruction to students and
practitioners during the coming fall and winter.
Typhoid Fever in Country Resorts. — It is re-
ported that typhoid fever has shown itself in several
country resorts.
^eiiTs ixf tlic ^xEccli.
The V^acatiox of Physicians and the Health of
New York. — The health of New York is very good, con-
sidering the season. This may be probably due to the
fact that a large number of invalids have been sent to
the country to recruit. At least the larger majority of
fashionable physicians do not consider it worth while to
remain in town for purely business purposes. Those
only who are sick need the physician, and the physician
needs only the sick. Both being temporarily separated
are now enjoying a rest. With the coming fall, both
will doubtless return to work with renewed vigor. The
latter is often needed more by the doctor than the pa-
tient in these days of active competition in practice.
The New President of the Health Board of this
City is giving great satisfaction by close attention to
business and energetic endeavors to initiate practical re-
forms in his department. He is constantly in his office
and gives personal attention to details.
The Tri-State Medical Society will meet in F-ng-
lish's Hall, at Indianapolis, on September 18, 19, and
20, 1883, commencing at 9 a.m. Excursion rates have
been secured on the following railroads: C, C, C. &
I. ; Cin., Indianapolis, St. Louis & Chicago ; Cin., Wa-
bash & Mich. , Indianapolis & St. Louis ; I., B. & W. ;
Wabash, St. Louis &: Pacific ; Indianapolis & Vincennes ;
J. M. & I. ; Pitts., Cin. & St. Louis ; Vandalia, Evans-
ville & Terre Haute ; Ft. Wayne, Cin. & Louisville.
The New Denison, Grand, Bates, and Brunswick have
reduced their rates for the occasion, and -everything
promises a very large attendance. Many papers of great
interest will be presented. For further particulars ad-
dress Thos. B. Harvey, ^[.D., Indianapolis, Chairman
of Committee of Arrangements. Dr. Wm. Porter, of
St. Louis, is President, and Dr. G. W. Burton, of Mit-
chell, Ind., Secretary.
Getitng the Best of a Quach. — A quack with many
aliases but generally known as the Indian .Medicine Man,
was recently prosecuted by the Illinois State Board for
violating the Medical Practice .'X.ct of that State. The
quack was accustomed to give public exhibitions of his
quackery at different towns in the State. On one such
occasion at Decatur complaint was made against him, a
license which he had fraudulently obtained was revoked,
and he was placed under bonds of $500 for each viola-
tion of the law in the shape of an exhibition. He gave
but two of the latter and then decamped.
The United States Medical College — Decision
BY THE Supreme Court. — We are in receipt of the de-
cision handed down by Judge John R. Brady of the Su-
preme Court, in relation to the case of the so-called
United States Medical College, represented by Dr. Rob-
ert A. Gunn and otiiers. The charge against this Insti-
tution, it will be remembered, was that the defendants
were, under the act of June, 1SS2, illegally acting as a
corporation without authority, and were exercising privi-
leges and franchises not granted to them by law. It had
previously been determined that the act of 184S, for the
formation of charitable, literary, scientific, and benevo-
lent societies, under which the defendants set up their cor-
September i, 1883.]
THE MEDICAL RECORD.
243
poration, did not provide for or authorize the incorpora-
tion of medical colleges to give instruction, issue di-
plomas, etc.; and that the law of 1882 did not legalize
the incorporation. In this view Judge Brady also con-
curred. In rendering this decision it was held that the
law of 1882 related to scientific and literary colleges
and universities, and not to medical colleges, since such
language was not employed in the wording of the Legis-
lative act, it being presumed that that body was advised
of medical colleges, etc., in the premises. Judge Brady's
concluding remarks are worthy of note, viz.: "The
courts of this State cannot be too scrupulous in examin-
ing the asserted right of any college to graduate matricu-
lates with the degree of doctor of medicine, and to grant
them diplomas conferring such degree. The high and
responsible duties of a doctor of medicine, relating as
they do to suffering humanity, and life itself, and reiiuir-
ing for their proper discharge a high order of culture, ex-
perience, and capacity, there should not be the slightest
doubt about the due and legal incorporation of every
college or society assuming the power to confer upon
him the necessary degree, and thus enable him to prac-
tise as a physician and surgeon."
Preparing for Cholera in Paris. — At a meeting
of the Municipal Council of Paris, on July 27th, a grant
of four hundred and eighty thousand francs was voted to
provide for the construction of a temporary hospital for
cholera patients in the event of an outbreak of that dis-
ease. The buildings are to be erected on one of the
bastions of the line of fortifications, and will provide ac-
commodations for two hundred patients. Should tlie
cholera not put in an appearance the hospital may be
used for the reception of small-po.\ patients, or of those
suffering from other contagious diseases.
Professor William Osler, of McGill Medical Col-
lege, Montreal, has been elected a Fellow of the Royal
College of Physicians of London, England. Dr. Osier
has held the chair of physiology in the above college for
many years, and has done much good work in original
investigation. He is at present general secretary of the
Canada Medical Association. He is a young man yet,
and is to be congratulated on the honor of attaining to
the F.R.C.P. solely as the result of his scientific labors.
Changes in Medical College Professorships. —
The following are some of the new appointments to profes-
sorial chairs, which we find mentioned in our e.vchanges :
Professor Parvm has been tendered the Chair of Obstet-
rics in the Jefferson Medical College, recently made va-
cant by the resignation of Professor Wallace. The
vacancy in the Faculty of the University of I^ouisville,
made by Dr. Parvin's resignation, has been filled by the
appointment of Dr. John A. Octerlony. Dr. Roswell
Park, of Chicago, editor of the Medical Review, and con-
nected with the Chicago Medical College, has recently
been called to the Chair of Surgery in the Medical De-
partment of the University of BuiTalo, N. Y.
The Code in St. Louis, and How a Recent Of-
ficial Statement is Contradicted. — At the meeting
of the American Medical Association, in Cleveland, Dr. S.
PoUak, member of the St. Louis Medical Society, offered
a resolution to the effect that a committee be appointed
for the purpose of revising the code of ethics, and that
this committee "be authorized to prepare a code of
ethics which in their view will meet the wishes of the
profession, and submit the same to the meeting of 1884."
At a subsequent meeting of the St. Louis Medical Society
a resolution was adopted repudiating the action of Dr.
PoUak, and expressing the fealty of the Society " to the
existing code of ethics as a time-honored and most suita-
ble fundamental law of the profession," and deprecating
" any action calculated to reflect upon its loyalty to
those principles which have heretofore secured immunity
to the machinations of schismatics within or enemies
without." Thereupon Dr. Pollak published, in the St.
Louis Medical and Surgical Journal, a certified copy of
an extract from the minutes of the meeting of the St.
Louis Medical Society of June 2, 1S83. At this meeting
it was resolved unanimously that the delegates of the
Society to the meeting of the American Medical Associa-
tion " be requested to move for the appointment of a
committee of one member from each State, for the pur-
pose of taking into consideration the propriety and ad-
visability of a revision of the code." The delegates were
further instructed to invite the delegates from the State
of Missouri to join with them in presenting this resolu-
tion to the American Medical Association. Dr. Pollak
appears to have had the best of the argument thus far.
Meeting of the Virginia State Medical Society.
— The fourteenth annual meeting of the Medical So-
ciety of Virginia will be held at the Rockbridge Alum
Springs, Va., commencing on Tuesday, September 4,
1883. It will be an important meeting, as the Consti-
tution and By-Laws of the Society, and resolutions for
the government of the organization generally, will be
considered. The Springs Company offers free hotel accom-
modations to the delegates, and the railroads are selling
tickets at greatly reduced rates to those desiring to attend
the meeting. Several papers of presumable scientific
value are promised by gentlemen in and out of the State.
Gaillard's Medical Monthly. — Our esteemed
contemporary, Gaillard's Medical Journal, has returned
to its old form as a monthly, after appearing weekly for
eighteen months. The reasons for this change are stated
to be the wishes of its subscribers, as well as the fact that
there is now no monthly medical journal published in this
city, while of weeklies there are several.
The Progress of the Yellow Fever. — During the
past week there has been but little increase of the
scourge at the Pensacola Navy Yard, and hopes are en-
tertained that the disease has been arrested by the
sanitary precautions which have been inaugurated by
those in charge, only four new cases (the wife and
daughtar of Dr. Owen, Paymaster Brown, and Lieuten-
ant Whipple) having developed since our last report,
and two deaths, that of Assistant Surgeon Owen, U. S. N.
and his wife. The villages of Woolsey and Warrenton,
located upon the reservation, and populated by the lower
classes, have had several cases of yellow fever and one
death. At the request of Lieutenant Commander Welch,
of the Navy Yard, who feared an epidemic in these villag-
es. Surgeon General Hamilton authorized the employ-
ment of five sanitary policemen to make a house-to-house
inspection, for the purpose of placing them in a good
sanitary condition, and discovering any cases of yellow
244
THE MEDICAL RECORD.
[September i, 1883.
fever that might be secreted by the inhabitants. He also
authorized the employment of an expert physician to take
care of such sick poor who might be afflicted with the
disease, in case an epidemic occurred, and were too sick
to be transferred to the quarantine hospital, the inten-
tions being to remove all sick as soon as possible from
among the well. On .August 22d, quite an excitement
was created in the city of Pensacola, by the officially re-
ported occurrence of two cases of yellow fever on Pala-
fox Wharf, and many of the citizens took flight. .Acting
Assistant Surgeon White telegraphed the fact to the
Surgeon General Marine Hospital Service, who directed
that the cases be immediately removed to the hospital
on Santa Rosa Island, and to disinfect the premises,
destroy the bedding and clothing of the men. On the
following day one of the men who were removed to the
quarantine hospital died ; an autopsy was held by Sur-
geon Murray and Assistant Surgeon I^eonard, who pro-
nounced the disease from which he died to have been
" pernicious swamp fever," and that the other one, who
was still living, was suffering from the same disease and
not from yellow fever. This diagnosis would seem to be
borne out by the facts subsequently learned regarding
these cases ; it appears upon investigation that the two
cases of supposed yellow fever were deserting sailors
from the bark Dagmar, from Limerick, who arrived at
Reed's sailors' boarding-house, on Palafox Wharf, on
August 17th, after three weeks spent in the country,
hiding in the swamps and awaiting the departure oi their
vessel. The Dagmar sailed from a healthy port, brought
a clean bill of health, made a long voyage, and was not
detained at quarantine, as she was in a good sanitary
condition, and there was no occasion for detention. The
vessel cleared for Dordrecht, on -\ugust 17th, the day
these deserting sailors put in an appearance at I'ensa-
cola. The house-to-house inspection at Pensacola has
been completed, and the city is now considered to be
perfectly healthy and free from yellow fever. Hospital
tents, disinfectants, experienced medical men, are on
the ground, in case yellow fever should appear. Re-
ports from Vera Cruz, Mexico, continue to come in, show-
ing that the disease is still very fatal among the ship-
ping. Sanitary Inspector Mainegra telegraphed on
.August 24th, that the steamers City of Merida and Dis-
coverer cleared from that port on August 23d, bound for
New York. Sanitary Inspector Burgess, in his abstract
of bills of health ending August i8th, reports the steam-
ers Alabama for Key West, Saratoga for New York,
Cristobal Colon for New York, Ellie Knight for Key
West, City of Alexandria for New York, sciiooner
Damietta for Key West, and bark Maria for New York,
having sailed during that week. He also reports forty
fatal cases in Havana during that period.
The Johns Hopkins Hospital. — It is said that the
medical department of the Johns Hopkms University,
of Baltimore, will probably be opened about October ist.
Two of the university professors, Dr. Remsen and Dr.
Martin, have been assigned, respectively, to the chairs
of chemistry and physiology.
The Annual Report of the National Board of
Health, for 1881, has been delayed unavoidably, but
made its appearance this week. ^
Surgeon Burgess telegraphs that the mate of the Span-
ish bark Suiciro, which sailed for New York on the 23d inst.,
was put ashore at Havana, suffering from yellow fever.
Forty deaths from yellow fever occurred at Havana last
week.
A DESP.^TCH from Colon (Aspinwall) states that there
is no yellow fever at that place this year, and that the
port is in a good sanitary condition.
Assistant Surgeon Guiteras, U. S. N., has reported
for duty at the Pensacola Navy Yard, and has just sub-
mitted his report of inspection of the port of Vera Cruz,
Mexico, to the Surgeon-General. We hope to give some
items of interest from it next week.
The Annual Report of the Surgeon-General of
THE Navv, for 18S1, has just come from the hands of the
Government printer. A notice of its contents will appear
soon.
Special Surgical Appliances to those Disabled
IN the Military and Naval Service. — Congress hav-
ing appropriated a small sum for furnishing special surgi-
cal appliances to those disabled in the military or naval
service, Surgeon-General C. H. Crane, U. S. A., is de-
sirous of obtaining authentic information regarding all
existing cases of severe and unusual injuries. -As no
money commutation is authorized, only such cases need
be presented as offer a fair prospect of being relieved by
surgical or mechanical appliances. Artificial limbs and
apparatus for disabled limbs being otherwise provided
for, by law, the injuries here in view are almost exclu-
sively those aftecting the head, face, or trunk. As trusses
are furnished under special legislation, hernia, when not
complicated with other injuries, is not to be understood
as covered by this appropriation t'or special appliances.
As the appropriation is small, it is proper that it be ex-
pended onlv on the most meritorious cases. It is there-
fore not intended to furnish appliances which are ordi-
narily within the means of the individual, nor those that
are of a character so perishable that it would be difficult
to keep up the supply. Regard is to be had chiefly to
the severity of the injury, and the ability of the sufferer,
unassisted, to procure relief.
The St.^te Medical Society of Wisconsin will hold
an adjourned session at the Court House in the city of
Milwaukee, commencing on Tuesday, September 4,
1883, at 8 P.M.
Death fro.m Chloroform in Olean, N. Y. — A col-
ored man, aged thirty-two years, died suddenly in Olean,
N. Y., while under chloroform, which was being adminis-
tered to him for amputation of the toes. From the evi-
dence at the coroner's jury it appears that every care
was used to guard against a fatal result. But a very
small quantity of the drug was used. Death was evi-
dently caused by heart failure.
Advertising Surgical Operations. — We are receir-
ing from day to day slips from newspapers sent us by
subscribers detailing the wonderful exploits of surgeons
in diflferent parts of the country. They form very amus-
ing reading, and show that the ignorance of the lay press
regarding the importance and rarity of such operations is
only equalled by the shameless audacity of the adrer-
tisers.
September i, 1883.]
THE MEDICAL RECORD.
245
^cincius and 3)oticcs.
Inquiries into the Human Faculty and its De-
velopment. By Francis Galton, F.R.S., Author
of " Hereditary Genius." 8vo, pp. 380. New York :
Macmillan & Co. 1883.
Such as have read the author's work on " Hereditary
Genius" will be prepared to appreciate in some degree
the scope of the present one. The title itself is sugges-
tive of a wide range of study, and considering the pains-
taking endeavors of the author, it is a very api)ropriate
one. The inquiries are much beyond the range of simi-
lar ones on the nature and conditions of man's mental
relations, and show a tendency to dive far below the or-
dinary level of scientific investigation or metaphysical
study. It opens to the student of man a field many parts
of which have heretofore been but little explored. Curious
and instructive facts are brought out, which may serve as
valuable data for future theories of mind-working, and for
the proper appreciation of the influences of the develop-
ment of the higher faculties upon the advancement of
the race.
The work is made up of a number of papers scattered
in various iniblications, and althougli by condensation
and interpolation the subject-matter has been worked
into a consistent whole, traces of its fragmentary origin
still remain. This gives it more of a suggestive than
encyclop;edic character, and excuses the omission of much
of that statistical detail of facts which would otherwise
appear to be necessary. Although the reader is often-
times made to feel that in many instances only the corner
of the curtain is lifted between what is known and what
is possible to be known, he is constantly surprised to find
how broad the border-line is, and how conscientiously
and thoughtfully it has been explored by the writer.
In all his studies the author has taken a wide grasi).
He deals with the manifestations of human intellect and
character on a large scale and in their relations to the
universe. Consequently he is given to grouping his facts
from many and difterent sources, and basing his conclu-
sions upon ample statistical demonstrations. Take, for
instance, the subject of composite portraiture, so intensely
interesting to every student of human constitution and
human character. Here he proves that there are general
characters belonging to the same type of face which can
be consistently combined in a single portrait. Members
of families show this correspondence in a striking degree,
and while particular features may differ there is generally
present what is called a family resemblance — a something
which places the individual in his family group. The
principle of composite portraiture eliminates slight differ-
ence by bringing out the stronger features, and hence a
consistent picture of the family type. The manner in
which this is done is interesting and suggestive, especially
to a medical man given to the study of the faces of dis-
ease, the evidences of constitutional power, and the ap-
preciation of racial peculiarities in their broadest sense.
Photographs of each individual are taken exactly the
same size and exactly full-face. These photographs are
superimposed in book-form so that the difterent features
exactly correspond with each other. The book of portraits
is then fi.xed and focussed, and by turning the leaves with
regularity and rapidity a combination of these portraits is
made upon one plate, each component portrait heliiing
to make a single well-defined composite picture. The
author's remarkable success in this line is evinced not
only in the composite portraiture of family groups, but
of other types in individuals with no consanguineous ties.
For instance, there are composite portraits of six and
nine cases of tubercular disease, respectively, composite
portraits of one hundred and fifty cases, respectively, of
the so-called healthy type, and numerous other instances.
According to our author there appears to be no actual
limit to the combinations which can be made under the
circumstances. This certainly opens up a wide field for
the study of disease, not only in its bearings upon the
face, but upon other parts of the body. What might not
be gained by accurate photographic representations of
deformities and their composite portraiture in settling
upon some absolute standard for comparison. Indeed,
the wide application of this method would necessarily
suggest itself to the medical man intent ujjon study-
ing disease and its various manifestations on a compre-
hensive scale.
Carrying out the same idea the author attempts to ap-
ply it to the study of man in all those leading mental
and bodily faculties which make him a factor in the
great scheme of human evolution. Hence we find our
author discussing the propriety of anthropometric in-
quiries in order to determine their eugenic relations to the
human family ; in fact, advocating all such measures as
may tend by methods more or less mathematical to
measure the amount of energy, force, and vitality in
large numbers of men. and thereby establish standard
types. As preliminary to these ends he studies the
various faculties of energy, sensitivity, character, and
mental imagery. Some very curious and suggestive facts
are brought out in these studies which it would Iiardly be
necessary to detail here. It is sufficient to say, however,
that they are capable of being summarized into general
principles of great value and extended application.
The number of exceedingly interesting data which the
author presents regarding mental imagery in reference to
number, forms, color, perceptions, and word associations
deserve a passing reference. By large correspondence
and extended inquiry he proves that a certain class of
individuals possess the power of recalling persons and
scenes before their mind's eye which is truly remarkable.
Not a few can bring up an image in imagination in all its
perfections of size, shape, and solidarity. This is a
faculty possessed by inventors, artists, and others, and, like
many similar mental peculiarities, is strongly hereditary.
Again, many persons have the same visionary associa-
tions as regards numbers. The latter to some appear
before the mind's eye in tabulated arrangement, to others
in wavy lines, each wave occupied by a particular number.
With colors the same curious arrangement oftentimes
obtains, and to the visualizing sense in some persons they
are associated with particular letters, particular sounds,
or even particular ideas. Beyond a certain point it can
be easily imagined that positive hallucinations must result.
The development of mental faculties, in all their rela-
tions, individual and cosmic, has been, as quite well
shown by our author, the combined results of natural
selection and natural evolution. , Man is, after all, noth-
ing but an insignificant factor in the universe, and simply
and irresistibly does his part in carrying out the scheme
of advancing civilization, of perfect organization, and
higher development. As a part of the whole he is forced
to be a consistent worker. It is quite surprising, in view
of our author's facts and deductions, to see how little man,
as an atom, an individual, can control what, for the want
of a better name, we may call his destiny. Admitting
modifying influences upon character or organization they
are only operative to a limited extent. This is certainly
an encouragement to do our best under all circumstances.
Still it can hardly be expected that a man with the char-
acter of a fox can be made into one with the guileless
disposition of a lamb. The difticulty of constructing a
silk purse from a pig's ear is well enough appreciated by
every one who has tried the experiment. Nature is one
thing and nurture is another thing. Our author contrib-
utes some very interesting corroborative proof in regard
to these points in his histories of twins. Notwithstanding
some twins have been widely separated, have had dif-
ferent surroundings, and been subjected to different edu-
cational training, they have been known not only to have
the same bodily ailments at the same time, but to experi-
ence simultaneously novel sensations, mental and bodily,
and even to think upon the same subject at the same
246
THE MEDICAL RECORD.
[September i, iJ
^j-
time, using almost the same words to express their ideas.
These, with other facts, help our author to the conclusion
that illness and death are necessary incidents in a regular
sequence of constitutional changes beginning at birth, and
upon which external circumstances have little or no
effect, or, as our author still more strongly puts it : •' In
cases where the maladies of twins are continually alike
the clocks of tlieir two lives move regularly on at the
same rate, governed by their internal mechanism. When
the hands approach the hour there are sudden clicks,
followed by a whirring of wheels ; the moment that they
touch it the strokes fall. Necessitarians may derive new
arguments from the life histories of twins."
These deductions very naturally prepare the way for
a discussion of theocratic influences upon man's destiny,
as may be manifested in the objective efficacy of prayer.
Some very curiously suggestive statistics are presented
on this point, proving that man's will is not God's will,
and that faith without works is dead. In other words, no
proofs are presented to show the purely objective efficacy
of prayer in preventing sickness, in hastening recovery,
in staying a pestilence, in changing the seasons, stopping
a drought, or checking a flood. Whatever may be said
of his view of the question the facts upon which his de-
ductions lay are very interesting.
Enough has possibly been said of this truly interesting
and instructive book to give the reader an idea of its
purpose and scope. If not so systematically arranged
as regards its subjects as might have been expected, there
is this excuse to be offered, that each component part is
complete in itself, each subject has been carefully worked
over before as a separate article, and, as previously re-
marked, the author has done his best to make a proper
connection between them. The reader is left free to
make his own deductions, and arrange his arguments as
may best suit his purpose in view of the facts presented.
In a general way we may assume that the work will be
valued mostly for the interesting facts it contains rather
than the positive strength of many of the arguments used.
In fact, not a few of the latter are loosely presented and
illogical. Aside from the idea that the development of
man is a part of the grand scheme of evolution, all else
appears as mere conjecture. We confess that we cannot
understand the subject further, and no arguments of the
author have increased our light. But his facts will re-
main, the labor in their arrangement will be appreciated
by scientist and philosopher, and his views will be sug-
gestive if some of his arguments are wanting in conclu-
siveness.
Poisoning from Blue Stockings. — Dr. C. C. Stock-
ard, of Columbus, Miss., sends us the following : " In vour
issue of November 25, 1882, is the report of a case of
' Poisoning from red Stockings.' 1 have just seen a case
ot poison from stockings of a different color. W'illie -M ,
aged eight years, iiad been going barefoot during the
summer up to the latter part of July, when he accom-
panied his father on a trip to Tennessee. He was absent
two or three weeks and during tliis time wore navy blue
stockings. A few days before returning home there
appeared on his legs, from just above tlie knee down, a
number of red elevations which developed pustules in
three or four days and presented the appearance of
ecthyma. The pustules were much thicker on the left
than on the right leg, and there were several also on the
back and chest. These were further advanced than those
of the legs, and I regarded them as of similar nature to a
cro]) of small furuncles which he had been having before
leaving home, and on account of which he had taken tlie
trip. He returned improved in general health and suf-
fered only from tlie legs ; so that I think there can be no
doubt about the stockings being the cause of the ecthy-
matous eruption. In the case reported inTHE Record tlie
poison was found to be a salt of tin used in setting the
dye, but in my case I am unable to say what the poison-
ous principle was."
Reports jof J^ocictics.
NEW YORK PATHOLOGICAL SOCIETY.
Stated Mect'uig, June 27, 1883.
George F. Shrady, M.D., President, in the Chair.
PUERPERAL THROMBUS ENDARTERITIS DRY GANGRENE.
Dr. R. E. Van Gieson presented portions of the right
femoral, the right popliteal, and the left femoral artery,
with a portion of the left femoral vein, with the lollow-
ing history, by the attending physician, Dr. J. A. Jenkins,
of Brooklyn : Mrs. H. H , thirty-two years of age,
of delicate frame and health, free from all specific taint,
was first treated in 1876 for subinvolution of the uterus
and cardiac disturbance from mitral insufficiency. In
1878 she passed through a normal confinement and made
a good recovery, without increase of cardiac difficulty.
In 1880 she had an attack of rheumatism with severe
precordial pains, dyspncea, and pulmonary congestion,
from which she slowly recovered after several weeks' ill-
ness. Since that time she has been more or less under
medical care, and at various intervals has taken prepara-
tions of digitalis for the reUef of difficulty caused by the
heart lesions. During the last pregnancy preceding
her death she enjoyed unusually good health and was
quite free from circulatory disturbance, and altogether
free from the renal complications not unfrequently ob-
served during the latter stages of gestation.
On April 25, 1883, she had an easy normal delivery,
the child weighing about seven pounds, and fairly well
nourished. Some three hours after the birth she had
several attacks of syncope, apparently hysterical, relieved
by stimulants and anodynes. The following morning she
was comfortable and free from all pain ; there was no
rise of temperature during the attack. With the exception
of debility and want of appetite, she did well until May
8th, when her temperature rose to 101°, reaching 102°
on May loth, accompanied with slight tenderness over
the uterus. This disappeared after the administration of
quinine and opiates, and turpentine stupes.
May 15th.— Had a severe attack of palpitation and
dyspncea, continuing with intermissions some three or four
hours. The following five days she had again improved,
and on May 20th declared herself strong enough to go
down to her meals. During the night she was taken
with a severe burning pain in the right foot and leg.
May 2ist. — The pain continues. Temperature in the
mouth, normal. The right foot and toes are extremely
cold to the touch and ecchymosed. The right leg and
thigh is colder than upon the opposite side, and the seat
of burning, stinging pain. Fair pulsation in the femoral,
but faint in the popliteal space.
May 2 2d. — Discoloration of the skin has extended to
the ankle, and complete blackening of the skin over the
lesser toes.
May 23d.- — Was examined in consultation with Dr. R.
E. Van (iieson. Right leg : lesser toes sloughing ; skin on
dorsal and plantar aspect of the foot of a dark mahogany
color; external aspect of the leg discolored in spots;
the skin tense, but not (edematous ; the whole leg is ex-
quisitely tender to the touch. The left leg is tender, but
nowhere discolored, and extremely painful to the touch.
Both extremities are cold. The right femoral has mod-
erate ])ulsation, but is not compressible ; the left fem-
oral pulsates very feebly ; it is diflicult to determine
whether, indeed, it pulsates at all. There is no pulsation
in either limb at the internal malleolus. The patient
lingered in great pain, but little relieved by large doses
of opiates, until May 29th, when death was welcomed as
a release from her intense suffering.
Permission was granted to examine tlie limbs only.
Necroscopy, May 29th, 5 p.m. — Both crural canals and
right popliteal sjjace examined. On the right side the
September i, 1883.]
THE MEDICAL RECORD.
247
tissues in Scarpa's triangle are more adherent than in
health, the sheath of the femoral vessels is thickened, the
cellular tissue is abundantly infiltrated with serum. The
vein and artery adhere firmly, requiring careful dissection
to separate them. The right femoral vein contains a
clot completely filling the vessel and partially organized.
The right femoral artery from a slight distance above the
origin of the profunda to some four inches below this
point is filled with a firm laminated thrombus, adherent
and organized, the adventitia and media are very much
thickened, the intima is of a dull color, corrugated and
reddened. The left femoral space showed the same
condition of things in a less degree. There was less evi-
dence of inflammatory action in the immediate vicinity
of the blood-vessels, the vein and artery were adherent.
The left femoral contained a clot, not adherent, appar-
ently not organized, and not completely filling the vessel.
The artery is smaller, less thickened than the right, and
contains a small central fibrinous thread, not obstructing
entirely the lumen of the vessel. The coats of the right
popliteal are thickened, the intima lustreless, the lumen
not obstructed.
The question which arises in connection with this case
is whether or not the gangrene has anv relation to the
puerperal state. Endarteritis to this e.xtent, completely
occluding the lumen of a large vessel, is uncommon.
He had seen but one similar case, which occurred in a
male, and was not associated with any disease of the
heart whatever. In that case gangrene began in the hand
and extended up to the elbow-joint without forming a
line of demarcation. The patient was seen by Dr. Mar-
koe, who i^ronounced it a case of idiopathic endarteritis.
Dr. Van Gieson had him under observation for some
time after that, but finally he escaped from his obser-
vation and he never learned what the ultimate result
was. Phlegmasia dolens is a common enough condition
after parturition, but it is not limited to the puerperal
woman. The question is whether the condition of things
that gives rise to puerperal phlebitis might not also give
rise to inflammation of the artery by e.xtension of the in-
flammator}' action ; or whether some condition of the
ovarian veins might not produce the same result. It
was the o])inion of the attending physician in this case
that the cause of the gangrene was an embolus arising
from detachment of a vegetation from the valves of the
heart. Emboli, however, rarely obstruct vessels of this
size, and although that may have been a factor in the
etiology, Dr. Van Gieson was not inclined to give it the
weight which the attending physician had attached to it.
Thus far he had been unable to' find a similar case.
He was not inclined to attach the condition of the ves-
sels to the puerperal state in the relation of cause and
effect.
Dr. Gerster said the specimens seemed to show evi-
dence that the assumption of the physician with whom
Dr. Van Gieson saw the patient was probably the correct
one. He thought that in the presence of a cardiac le-
sion, such a possibility of embolic obstruction was very
probable. The size of the vessel thus occluded is small
in the majority of cases, but there were cases on record
in which the embolus was quite large, sufliciently so to
completely obstruct vessels of considerable size. The
view that inflammation beginning in the veins and ex-
tending into the artery did not seem to be borne out by
the ordinary exi)erience of surgeons. It is well known
that not only simple adhesive inflammation, but a much
more violent process, even of a septic character, involv-
ing the vein, is not usually transmitted to the arteries,
and if transmission does finally occur, the arteries are in-
volved at a very late period in the disease, and in most
cases only after extensive destruction of tissues has
taken place.
-Another argument which seemed to support the em-
bolic theory was the fact that tlie gangrene came on so
rapidly. True arteritis obliterans is a chronic process,
the walls of the vessel presenting an uneven appearance,
with hard nodules scattered throughout the coats, so that
the lumen of the artery does not retain its cylindrical
shape, but presents different diameters at different por-
tions of the vessel. In this instance, however, there
was, so far as the cylindrical shape of the channel in the
artery was concerned, a normal appearance, and there
was arteritis, such as is usually seen after embolism has
occurred. The characteristic changes of true arteritis
obliterans Dr. Gerster thought were absent.
Dr. Beverly Livingston referred to a case in which
the patient died sixty-two days after delivery, at the
Nursery and Child's Hospital. The woman had swell-
ing of both legs, and he was able to trace the femoral
artery and veins to the spot where the clot was arrested.
On the left side the obstruction began at Poupart's liga-
ment and extended downward in both vessels until it
reached the posterior part of the thigh, and also extended
into the profunda. On the right side the thrombus ex-
tended downward about five inches. His impression
was that there was no cardiac disease. The case was
one of complicated labor, the patient being delivered of
twins, and the second child was delivered with instru-
ments about six hours after the birth of the first child.
Dr. Ferguson referred to two cases in which thrombi
were found in the aorta. One case had already been
reported to the Society. The second was that of a fe-
male patient who had been in the hospital for about five
months, and presented all the ordinary symptoms of
chronic diffuse nephritis. The heart was enormously
enlarged, but there was no other evidence of valvular
lesion. The arteries were atheromatous, especially the
aorta, and attached to the posterior wall of the abdom-
inal aorta was a clot. The entire clot was about five
inches long, tapering at each extremity, and was attached
to the wall of the vessel to the extent of from half an
inch to an inch. Its central portion was completely
broken down, but the external portion of the thrombus
was quite completely organized. In neither of these
two cases was there any evidence of valvular lesion of
the heart.
Dr. Van Gieson said he wished to bring forward two
points in connection with his specimen. First, was the
obstruction consequent upon the puerperal state? Second
was it a mere accident of the puerperal state ? With the
remarks made by Dr. Gerster he agreed in the main,
and was ready to concede that a very extensive inflam-
matory action might remain constantly in the vicinity
of an artery without aftecting the vessel itself. That
is well recognized. But the question arises whether an
embolus is necessary to the production of this condition
of things within an artery ; whether or not the death of
the intima which always precedes the formation of a
thrombus, is necessarily caused by an embolus. He
said no, there are other causes. There are conditions of
the blood, the nature of which we do not know, which
do produce death of the intima, followed by the formation
of a thrombus. The question therefore is, whether this
death of the intima is caused by the inflammatory lesion
per se, through lack of nutrition in the artery itself, or
whether it is caused by irritation produced by an embolus.
In this case a large artery was completely obstructed. If
the embolus produced the obstruction it must have been
arrested somewhere in the vicinity where the inflamma-
tion was produced, or there nmst have been transmitted
from the place wiiere the inflammation was produced an
inflammatory action which extended upward to the point
where the vessel was occluded, because at that point the
coats of the vessel were permanently thickened. He did
not believe that it was necessary to assume that because
a person has valvular disease of the heart, an embolus is
necessary to cause this condition of affairs ; for he had
seen the same condition produced in the brachial artery
where repeated and careful examinations of the heart
failed to elicit the slightest evidence of cardiac disease.
He did not deny that embolism was a conunon cause of
the condition developed in his case, but that it was the
24S
THE MEDICAL RECORD.
[September i, 1883.
universal cause he did not believe. He thought there
was in the blood of anremic, chlorotic women, who had
long suffered from disease of the heart, to which was su-
peradded the exhaustion of child-bearing, a condition of
things which might produce obstruction of the artery
without necessarily supposing that an embolus is carried
into the circulation. So far as the pathology of phleg-
masia dolens is concerned, it is very obscure. That such
a condition of things as would produce phlegmasia dolens
might also produce arteritis of this kind he thought was
scarcely probable. That was merely conjectural on his
part. The view that intlammation had extended from
the vein to the artery was also conjectural, and the
theory merely occurred to him for a moment while he
was reading the history of the case.
Dr. Beverly Livingston presented
TWO HEARTS FRO.M CASES OF CYANOSIS IN NEW-BORN
CHILDREN.
Case 1. — A male child, two days old, that I had under
my care while interne in Bellevue Hospital. The labor
had been normal ; child breathed and nursed well at first,
but on the morning of the third day, he was suddenly at-
tacked with arrest of respiration, and irregular action of
the heart ; the face became very blue, and in a few
seconds the whole body was intensely cyanosed ; now the
child as rapidly lost the blue color and turned red, and as
the breathing and pulse became normal the skin assumed
its natural color. The attack lasted about one and one-
half minute. During the day the child had six similar
ones, about one hour between them, the last attacks were
more severe than the first, and lasted about two minutes,
artificial respirati^ had to be employed to bring the
child out of them, but after the sixth nothing would
cause the heart and respiration to start again ; between
the attacks the child seemed perfectly well. These at-
tacks of cyanosis came on without cause or warning,
there was no muscular spasm accompanying them.
Physical examination gave the lungs as normal ; the
heart a murmur at the base and another at the apex,
both systolic. The diagnosis was an open foramen ovale
and some disease of the tricuspid valve.
Autopsy. — The right heart was found very much dis-
tended with blood, the left heart nearly empty. The
foramen ovale was not open, but tlie ductus arteriosus
was. The mitral and tricuspid valves were fringed with
the usual reddish, semi-transparent nodules, over which
there is so much dispute. The lungs showed numerous
small regions of collapse. The other organs were
normal.
Case H. — A male child, born normally, of a healthy
mother, at the Nursery and Child's Hospital on May 25,
1883. For the first four days the child was perfectly
well ; then suddenly he was found to be cyanosed, with
shallow, irregular breathing, and irregular pulse ; under
treatment the child revived, but soon relapsed, this oc-
curred several times the first day {.May 29th), during the
ensuing three days the child had similar attacks, but did
not recover at any time sufficiently to nurse, and re-
mained cyanosed ; it gradually lost strength, and died on
June I, 1S83. Auscultation during life had given a systolic
murmur, heard loudest at the apex. No diagnosis was
made. It was supposed the mother had overlain the
child during her sleep.
Autopsy.— 'V\\(i. boily was of a dusky red color all over.
On removing the sternum the heart seemed enlarged, but
this enlargement was found to be due to the distention
of the right side by dark clotted blood. The left side
was empty. The foramen of Jiotal was widely open, as
was also the ductus arteriosus. The mitral and tricuspid
valves presented the usual fringe of reddish, semi-trans-
parent nodules. The lungs were entirely collapsed ex-
cept the right apex, which was partially expanded.
These two cases of cyanosis do not show any malfor-
mation, or change in the heart due to disease, that would
cause the cyanosis. It is true that in the sec:ond case
the foramen ovale was found very widely open, and the
blood-clot passed from the right to the left auricle ; still
it seems to me the cause of the cyanosis lay in the disturb-
ance of the circulation due to the collapsed lungs, and
not to the open foramen ovale or ductus arteriosus. In
the first case the attacks of cyanosis seemed to depend
much more on the irregularity of the respiration than on
the action of the heart. Henoch' particularly refers to
diseases of the lungs as a cause of cyanosis, and open
foramen ovale and ductus arteriosus, and similar remarks
are made by Cadet de Gassicourt,' Meigs and Pepper,
and others.
As to the meaning of the little nodules on the edges
of the mitral and tricuspid valves, I must say I do not
beheve they are of an infiammatory origin, for out of 136
autopsies on children between still-births or a few hours
up to three and a half years, I have never failed to find
them when I looked for them, and generally the younger
the child so much the more pronounced are they. It
m.ay be objected that most of these children died of dis-
ease, having had more or less fever, but that could not
account for the cases dying from the effects of operative
midwifery, etc., unless one insists that in these cases
they had been fcetal endocarditis, which I cannot admit,
neither can I accept the idea of Parrot,' first announced
by Luschka,* and lately brought forward again by Hen-
och,' viz., that these nodules are the result of rupture of
the intravalvular blood-vessels, causing a h;ematoma,
which in the course of time underwent absorption and
gave, as a result, these semi-transparent nodules ; but I
rather incline to the idea of Richard Pott" that they are
remains of the fcetal valve, and are not due to any path-
ological process. They are composed of a collection of
the normal elements of the valve, and do not appear
microscopically like the deposits of an endocarditis.
The explanation of the systolic murmurs is difficult,
for the only point of resemblance is the open ductus ar-
teriosus, while the open foramen ovale in the second
case might explain matters. It would not do so in the
first, and I am loth to believe the fringes of nodules
could have interfered with the closing of the valves.
Some authors (Cadet de Gassicourt) think the passage
of blood through the ductus arteriosus can cause a bruit,
so this may have been the cause of what was heard.
That there were bruits I am sure, but I am unable to
give a good explanation of what caused them.
Dr. Livingston also presented a specimen illustrat-
ing
CONGENITAL PULMONARY STENOSIS.
The patient was a female child, aged one year eight
months, admitted in .April, 1S82, to the Nursery and
Child's Hospital for heart disease. On admission she
was a fairly nourished, pale child, with good appetite,
regular bowels, normal urine, and parents gave a history
of congenital heart disease. She was not cyanotic, she
was short of breath, jjreferred to remain quiet in a chair,
her fingers were not club-shaped at the ends, nor was her
abdomen enlarged.
Physical examination gave the lungs healthy. Heart,
a murmur, systolic in character, very loud, heard with
greatest intensity about tiie junction of the fourth left
rib with the sternum, could be heard nearly with the
same distinctness at apex, was heard to left of ape.x-beat,
which was in the sixth interspace, and could be heard in
the back between the scapuhu. There was a distinct
fremitus when one placed the hand over the prxcordial
region. The abdominal organs were normal. The diag-
noses were : i, trouble with the aortic, most likely re-
gurgitation ; 2, mitral, a double murmur. I am resi)OU-
sible for the last.
On June 20, 1882, the child developed ulcero-meni-
* Kindcrkrank.. y. 383. ^ Traitrf Oinujue d. Mahdics de TEnfance, t. ii., p. 48.
' Arch, de PhystoL, No. 4, a. 5, 1874. * Virchow .^rchiv., bd. xi., heft a.
* Loc. cil. * Jahrbuch Rindcrhcilk., b. xiii., s. 29. ,
I
September i, 1883.]
THE MEDICAL RECORD.
249
branous stomatitis, and six days later died of septarmia,
the stomatitis having been of a mild nature.
Autopsy. — The lungs were normal. Heart was hyper-
trophied, and the left side dilated. The three semilunar
valves of the pulmonary artery are grown together so as
to leave a round hole two millimetres in diameter to allow
the blood to pass to the lungs, and on one side there is
a small vegetation which must also have been an obstacle
to the current of blood. The foramen of Botal was en-
larged and open, the inter-auricular septum was very
much thinned and there were some small holes through
it, so it had a cribriform appearance. The mitral and
tricuspid valves were normal. The ductus arteriosus was
not examined. The liver presented the abnormality of
having no gall-bladder, there being only one duct, and
that led directly into the duodenum ; the transverse fis-
sure divided the liver in two nearly equal halves. The
other organs were normal.
This is one of those cases in which there is sufficient
obstruction to the blood leaving the right heart to cause
the foramen ovale to remain oi)en, and still there was not
sufficient cyanosis to have called attention to it. The
blood must have mi.xed freely enough through the fora-
men ovale, and still cyanosis was not produced, for the
lungs were in good condition and the blood was well
oxidized. This case supports the theory I put forward
in the cases of cyanosis, that the cyanosis was due to ob-
struction to the circulation in the lungs, not to the mix-
ing of the dark with the red blood. The autopsy explains
the bruit that was heard.
Dr. Livingston further presented a specimen illustrating
CONGENITAL COM.MUNICATION BETWEEN THE RIGHT SIDE
OF THE HEART AND THE BEGINNING OF THE AORT-^i.
This heart was removed from the body of a male child,
three months and tsventy-seven days old, he was born in
the Nursery and Child's Hospital, March 25, 1882, of
healthy mother, was a strong, healthy child, and never
gave any symptoms of heart disease. Being put on arti-
ficial food he got entero-colitis in July, and died on the
28th of that month.
Autopsy. — Lungs healthy, thymus gland large. Heart
enlarged. On opening the aorta, just at its commence-
ment and on the right side, a communication was found
leading into the right heart ; above and below the tri-
cuspid valve it was closed by a part of this valve, and
most likely no blood passed through it. The valves of
the aorta are only two in number, but were sufficient to
close the opening. The mitral and tricuspid valves were
noimal, on the mitral are plenty of those semi-transparent
nodules referred to in the other cases.
Dr. Livingston also presented specimens derived from
a case of
HEREDITARY SYPHILIS.
Male child, born in the Nursery and Child's Hospital
May 8, 1883, appeared healthy at birth, but poorly nour-
ished. On May 28th he developed an eruption consisting
of blebs on an inflamed base, they appeared first on the
soles of the feet, palms of the hands, and between the
fingers, in afewdays similar blebs appeared upon the limbs,
body, face, etc.; after the contents of the blebs became
purulent they dried up and left thick yellow scabs. There
were successive crops of this eruption. Soon the anus
became fissured and presented mucous patches, fis-
sures appeared at the angles of the mouth and an ulcer on
the median line of the hard palate. Sprue developed,
snuffles appeared, and the child died of asthenia, June
I2th, just five weeks old. The child was bottle-fed. The
mother gave no specific history, but spoke of having had
sore eyes. The glands were not enlarged. Child was
treated by inunctions of mercurial ointment.
Autopsy, June 13th, 3.30 p.m. — Child poorly nour-
ished, length nineteen and one-half inches. Hair well
developed all over head. The remains of tiie pemphi-
goid eruption on the feet, legs, thigh, back, hands, arms,
and on the face around the mouth. Lungs commencing
catarrhal pneumonia in the posterior and lower portion,
numerous ecchymotic spots in the anterior portions.
Heart : foramen ovale open, mitral and tricuspid valves
show the small semi-transparent nodules. Spleen firm,
Malpighian bodies prominent, 2\ inches long, \\ wide,
T thick. Liver congested and was resistant, but could
not see any change. Bones : the fennn- presents at the
apex and lower line of ossification a marked yellow line,
which is described by O. Haab ' as due to syphilis, and
he claims it to te a change in the basement substance
of the cartilage due to infiltration with small cells, so
causing a degenerative change but no true pus ; the
epiphysis can in this way be separated completely fron-»
the diaphysis. In the specimen I present, under the
microscope no infiltration of round cells can be seen but
rather a molecular change.
(To be continued.)
©ovvcspancTciTcc.
OUR PARIS LETTER.
(From our Special Correspondent.)
THE VALUE OF BLOOD-LETTING IN PNEUMONIA — CRE-
MATION IN FRANCE — SANITARY REFORMS IN FEAR OF
CHOLERA THE EFFORT TO PREVENT THE ABUSE OF
TOBACCO — HONOR TO PASTEUR AND BREAL DE.\TH
OF PROFESSOR PARROT.
Paris, August lo, 1S83.
Professor Hardy lately delivered a clinical lecture at
the "Charite" Hospital, on the advaptages of bleeding
in some cases, a remedy, he said, that was too nuich
neglected now-a-days, and stigmatized as absurd and
dangerous the practice of blindly following fashion
and routine in medicine. Eor his part he has found it
an invaluable remedy in certain forms of pneumonia, the
very cases in which in his student days he was taught to
employ it, and after a practice of nearly forty years, he
saw no reason why he should give it up. At the same
time he would not have it understood that he would em-
ploy venesection in every case, any more than he would
any other remedy unless clearly indicated as in the fol-
lowing example : A man thirty-seven years of age, and a
gardener by profession, was admitted to his ward with
lobular pneumonia of right lung, and pleuro-pneumonia
of the left side, of four days' standing. The constitution of
the patient was apparently good, though he had had two
attacks of pneumonia previously, the first in 1S69 and the
second in 1879. On the day of his admission the patient
was bled to four hundred granmies in the morning, and
the same repeated in the evening, and no medicine was
prescribed beyond a little gum julep and tisane. On the
third day a slight improvement had taken place in all
the symptoms, but the patient was nevertheless bled to
two hundred and fifty grammes, which afforded further
relief, and the improvement continued steadily. On the
fifth day the respiration and the other physical signs were
normal, the patient began to eat and drink as usual, and
he left the hospital a few days after, completely cured
and without any other medication.
There exists in France a society for the propagation
of cremation ; but this manner of disposing of the dead
meets with so little favor amongst our neighbors that it
is questionable whether it will be adopted in this coun-
try. The society, however, is using its best endeavors
to point out the' advantages that would accrue to the
public health by the adoption of cremation, instead of
interments, particularly daring epidemics of infectious
diseases. A petition to that effect, and signed by emi-
nent men, has been submitted to Parliament by the
Societe de Cremation, of which M. Koechlin-Schwartz
is president ; and one member of the society, M. Cadet,
^ Virchow's Archiv, b. 65. s. 366. i
THE MEDICAL RECORD.
[September i, 1883.
who is also a deputy, has proposed that, were cholera to
break out, cremation should be made compulsory. This
is evidently impossible ; but there w-ould be no valid
reason why cremation ovens should not be built in two
or three cemeteries as an experiment, and a means of
testing public feeling in the matter. The substitution of
incineration, or any other mode of disposing of the dead,
for burying will be a work of time, as deeply rooted preju-
dices are not so easily overcome.
If cholera has not yet made its way in this country,
the fear of its doing so has aroused the French from their
wonted apathy, and sanitary reforms are being intro-
duced on all sides, while others are in contemplation, so
that Paris, at least, will at no distant period compare
with any other city in the civilized world. Among the
reforms proposed are the enlargement of the hosi)itals
now in existence and the erection of others for infectious
diseases, as well as an asylum for the aged, and another
for incurable children, which are to be built outside the
walls of the city, and for which the Municipal Council
has granted a sum of 3,000,000 francs.
The French society against the use of tobacco has
petitioned the Chambers to increase the duty upon to-
bacco, with the view- of limiting its use as much as possi-
ble. But however advantageous this measure may be to
the revenues of the State, I hardly think it would be of
much service in improving the moral and physical condi-
tion of the population, which the society has in view, as
it is a well-known fact that the more a thing is forbidden
and the greater the restrictions put on it the more it will
be sought and indulged in. Experience has shown this
in regard to spirits, which, notwithstanding the heavy
dut}' levied on it, is more than ever consumed in various
forms. The practice of smoking among youths, which is
growing to an alarming extent, seems to be the great care
of the society, and although heavily taxing tobacco may
limit its use to a certain extent yet it is evident that this
measure is msufficient to prevent its abuse, and in order
to produce some effect in that direction the sale of to-
bacco to children must be strictly forbidden ; parents
themselves should set a better example, and every possi-
ble means should be taken to instruct the people con-
cerning the deleterious influence on the system of tobacco
and alcohol, the two greatest curses of civilized life.
On the occasion of the jubilee of the University of
Zurich the diploma of honorary doctor was conferred on
MM. Pasteur and Breal, tlie well-known French savants.
Dr. Alfred iVaquet, the distinguished chemist, but bet-
ter known for his political position in the French Parlia-
ment as Deputy, has been elevated to the Upper House
as Senator.
Professor Parrot died on the 5th instant, at his resi-
dence in Paris, at the comparatively early age of fiftv-
three, and after an illness of only two months. Dr.
Parrot began his studies in medicine in 184c), and passed
successively through the grades of Interne, Doctor of
Medicine, and .'\grege, which latter lie attained in i860.
In 1876 he was promoted to Professor of the History of
Medicine ; and in 1S77 was appointed Physician to the
Asvlum of the " Enfants .\ssistes."
One Excuse for Quick. Treatment. — One u( the
Vienna surgeons was one day called in hottest haste to
see the little son of a well-known .\ustrian count. On
reaching his patient he found a trifling scratch on the
child's hand. Sitting down and writing a prescription
he gave it to one of the servants with instructions not to
lose an instant, but to bring the medicine as soon as
possible. "And is the danger so imminent, then?"
asked the countess. '• No, not that," rei)lied the Pro-
fessor; "I only feared lest the wound shouUl be entirely
healed before the servant returned."
The Best Method of Keeping a Hvpouermic
Syringe in working order is to try it every day.
^exxr Jnstvuincnts.
A NEW MOUTH GAG.
By \V. THORNTON PARKER, M.D..
ACTl.SG ASSIST.INT SURGEON, UNITED STATES AKNU .
In a recent case of strychnine poisoning, it was with the
greatest difficulty that I was able to nitroduce a stomach
tube, owing to the patient's violently grinding his teeth.
The tube was finally bitten in two soon after reaching the
stomach, and thereby rendered perfectly useless. There
being but this one tube in the hospital, the operation of
the stomach pump was brought to a speedy termination.
It occurred to me at that time that some sort of mouth-
gag for making the operation of emptying the stomach
more certain should accompany each stomach pump. I
have, therefore, devised a simple mouth-gag, made for
me by Messrs. Geo. Tiemann & Co., New York, which I
believe will be found very desirable for use with the
stomach pump. It is made of hard polished rubber and
separates the teeth sufficiently to perant the safe passage
of the largest stomach tubes. A strap confines it securely
and the patient cannot expel it from the mouth. It is to
be hoped that it will prove to be of service.
Fort Elliot, Texas, May, 1SS3.
^tnuy and ll^auij |tcius.
Official List of Changes of Stations and Duties of Officers
of the Medical Department, United States Army, from
August 18, 1SS3, to August 25, 1S83.
Clements, Be.nnett .A., Major and Surgeon. Re-
lieved from duty with the Army Medical Examining Board,
New York City, N. Y. S. O. 193, par. ii, A. G. O.,
August 22, 1883.
MiDDLETOX, J. V. S., Major and Surgeon. Relieved
from duty at Fort Hays, Kan., and assigned to duty at
Fort Leavenworth, Kan. S. O. 169, par. 2, Department
of the Missouri, .\ugust 18, 1883.
Williams, Joh.v W., Major and Surgeon. Granted
leave of absence for one month, on Surgeon's certificate
of disability. S. O. log, par. i. Department of the Co-
lumbia, .\ugust 8, 1883.
Bartholf, John H., Captain and .\ssistant-Surgeon.
Assigned to temporary duty at Vancouver Barracks, W. T.
S. O. 109, par. 2, Department of the Columbia, August
S, 1883.
KiMBAi.L, James P., Captain and .-Kssistant-Surgeon.
Relieved from dutv in Department of the Platte, and to
proceed to New York City and report in j^erson to the
President of the .Army Aledical Examining Board for
dutv as a member of that board, -t'ice Surgeon Clements,
relieved. S. O. 193, par. 2, .\. G. O., .August 22, 1883.
FiNi.EY, J. A., Captain and .Assistant Surgeon. Re-
lieved from duty at Fort Concho, Tex., and assigned to
duty at Fort Stockton, Tex., as Post Surgeon. S. O.
lot, par. I, Department^of Texas, August 16, 1883.
September i, 1883.]
THE MEDICAL RECORD.
251
Official List of Changes tn the Medical Corps of the Navy
for the week ending August 25, 1883.
Austin, A. A., Assistant Surgeon. Ordered to Naval
Hospital, New York.
Craig, T. C, Assistant Surgeon. Detached from the
Naval Hospital, New York, and ordered to the U. S. S.
Minnesota.
Crawford, M. H., Passed Assistant Surgeon. De-
tached from the U. S. S. Pinta and placed on sick leave.
WiLLSON, VV. G. G., Passed Assistant Surgeon. De-
tached from the Minnesota and ordered to the Pinta.
White, Charles H., Surgeon. Ordered to the I^fu-
seum of Hygiene, \Vashington, D. C.
Bryan, J. H., Passed Assistant Surgeon. Detached
rom the Museum of Hygiene and ordered to the Mianto-
nomoh.
GuiTERAS, D. M., Passed Assistant Surgeon. Ordered
to the Navy Yard, Pensacola, Fla.
itlecUcul items.
Central Separation in Placenta Pr.«via. — Dr. J.
M. Ward, of Cornelia, Mo., has, during thirty years' prac-
tice, met with three cases of central implantation of the
placenta, which were attended successfully, as well as an
equal number of partial cases. In his experience, he
mentions that examination will show the placenta sepa-
rated for a short distance around the internal os, but
that hemorrhage occurs only with "the pains ; hence he
advises that the finger be introduced and the placenta
peeled off as far as the finger can reach from around the os,
after which he tampons until the pains become expulsive.
In this view the doctor states that central separation and
the tampon gives a good chance for the child, and does
not materially impair the chances for the mother. In
the second stage the tampon is removed and the follow-
ing advised : either {a) to peel off the remaining placenta
on one side, to rupture the membranes, turn the child,
and deliver by the feet; or(/') after having peeled oft" the
placenta on one side, to rupture the membranes and
bring the fore edge of the placenta through the os, and
hold it against the side of the vagina until the head en-
gages. By this procedure about four inches of the cen-
tral portion of the placenta is reached, leaving two inches
of the circumference to maintain foetal life and circula-
tion. This, he advises, should be done early, by which
means full dilatation is permitted, with no more lacera-
tion of the curling arteries.
How to Keep the Hypodermic Syringe in Order.
— One of our subscribers, G. E. A., writes : " Your
correspondent of last week desired to know how to keep
his hypodermic syringe in working order. The following
has been my experience. Of course the best way with
any and all instruments is to use them. Next to that,
inspect them regularly once a month — not only look at
them, but look at them with an oiled rag and piece of
chamois skin, more carefully in summer than in winter.
In considering hypodermic syringes, aspirators, etc., the
instrument should be regarded in two parts — the bar-
rels and pistons, which require the icet treatment, and
the needles and wire, trocar and canula, wliich require
the dry treatment. If the piston-leather is old and worn
out it should be renewed ; but if only dried and loose
from non-use, draw a little warm water into the syringe,
then, placing the finger over its end, slowly press the
piston downward through the water, which will be seen
to pass between the piston and sides of the syringe.
The water will now be both above and below the piston,
and will cause its leather to swell quickly and make a tight
joint. In order to keep it so discharge the water from both
ends of the syringe, and treat in the same manner with
glycerine, which, being hydroscopic, keeps the piston-
leather in good condition. Moreover, pure glycerine will
not become rancid, as will oil, etc., nor will it interfere
with any chemicals used hypodermicall}-. In the larger
syringes a harder fat like mutton tallow will often cause
the piston to work better than oil or glycerine. If the
piston should have become so tight that it is impossible
to make the glycerine pass above it, invert the syringe in
glycerine or put a few drops around the piston-rod, and
then slowly press it downward. The glycerine will fol-
low into the upper chamber and will ply back and forth
with the piston and keep it in order. The test for a tight
piston is to put the finger over the end of the syringe,
and quickly pull up the piston-rod, when, if tight, a
vacuum will be formed and the piston return to fill it.
The 'dry treatment' for the needle consists in blowing
out all liquid from them by several quick strokes of the
piston, while the needle points upward, so that no fluid
from the syringe enters it ; if used but seldom, let this
be done in the hot, dry air just above the lamp or gas.
After removing the needle from the syringe replace the
wire. Should the morphia gradually form a crust upon
the inside of the needles, hot water may be drawn through
them, or a cjuicker and more thorough way is to secure
from Tiemann & Co., or other instrument maker, a yard
of hypodermic wire (uncut), fasten one end, thread the
needle upon the other, and then with a few long strokes
it is quickly cleared. When one allows his patient to
sufter ten or fifteen minutes' extreme pain while fixing his
hypodermic syringe, or, as I have seen, a patient almost
lose his life because his piiysician's stomach-pump would
not work, it seems duty and but little trouble to inspect
for a few moments, the first day of each month, those in-
struments which ought to be kept in order."
Dr. W. N. Williams, of Indianapolis, Ind., says :
" Place a piece of soft rubber between the needle end of
the syringe and end of the case, thick enough with a cor-
responding piece at opposite end of case to make it
fit the case snugly, then fill the syringe with water both
in fro?it and behind the packing, place in case and the
syringe will be kept water-tight and ready for use
even if it is not filled oftener than once in ten days. I
should be glad to hear of a better way if there is one."
Another Three-Barrelled Penis. — Dr. E. B.
Ward, of Greensboro, Ala., writes: "Seeing the article
headed ' A Three-Barrelled Penis ' in The Record of
August II, 1883, brought to mind a similar case of mine.
A young gentleman called at my office for treatment, and
on examination I found that the same anomaly occurred
in this case as the on; mentioned by you, /.f., the meatus
presented three distinct openings. Not only was this
anomaly of the penis confined to him, but his two other
brothers presented the same rare specimens of malfor-
mation."
The So-called Abortion of Typhoid Fever and
the Investigation of Pretentious Claims. — Dr. E.
Ruthven Young, of this city, writes : " Having long
been an eager and instructed reader of The Record, in
perusing its number of May 26th, I came across, to
me, a rather unsatisfactory article, headed, ' A Confident
Correspondent.' In it you will readily see, by reference
to your file, that a Dr. Davy, of Ohio, takes a decided
exception to an article published in a February number
of the Medical Age. The writer of this latter seems to
have made in it the assertion that ' Typhoid fever is a
disease which is uncontrolled and uncontrollable, and
any one who says he can abate an attack or cut short
the disease after it has passed the forming stage is either
a . knave or a fool! Dr. Davy, in his short comment on
this, says, after a reference to poor Galileo as being badly
used for his great discovery, that ' within the next five years
typhoid fever will be controlled almost as easily as re-
mittent or marsh fever.' God grant he may be right in
this, for if so, surely we will have a weapon second only
to Jenner's vaccination. Further, he says 'a patient can
THE MEDICAL RECORD.
[September i, 1883.
be gotten into a convalescent condition in from four to
six days after the following symptoms are fully developed :
temperature, 105°; pulse, 100 to 120 ; nervous symptoms
with delirium well marked ; tongue dry and cracked ;
articulation indistinct ; bowels tympanitic, tender, and
gurgling ; diarrhoea of ochre-colored stools, etc. Ninety
per cent, of such cases can be gotten up and about in
12 to 18 days by pj-oper medication.' Now, Mr. Editor,
such an assertion attracted me at once. Having read
widely concerning typhoid, and never having heard of
anything so nearly approaching a specific as this seemed
to promise, I determined to avail myself of the profes-
sional courtesy of Dr. Davy and obtain this valuable
knowledge. Yet even then it struck me as ]ieculiar that
the doctor should stop so suddenly and give the world of
physicians no clue as to what this ' proper medication '
was. What a pity such knowledge existed and the pro-
fession not have it and their suft'ering patients its benefit !
In answer to my anxious letter of inquiry, I received a
letter from which I give sufficient extracts for my brothers
in ignorance to learn as much as I did : ' Dear Doctor,
etc. — We have never given the chemical working formula
to any one. We have spent much time, hard study, and
money in obtaining our knowledge, and as some chem-
ist has to prepare the compound, we thought it but
right to retain the formula. Any one desiring the thera-
peutical knowledge and sufficient of its chemistry, so that
they may handle cases of typhoid fever just as intelli-
gently and successfully as we have done or can do, such
information will be cheerfully given. The medicine will
be manufactured by & Co., and sold at two dollars
a pint.' Now, Mr. Editor, where are our much-talked-
of ethics? To which class does this compound belong,
patent or proprietary? Perhaps it may be valuable, but
as a ' secrect nostrum ' it will never be respected or
used by our noble brotherhood of i>-He physicians."
Medical Men i.v Paris. — The Paris correspondent
of T/u- Lancet states that a list of the members of the
medical profession, practising in its various branches in
Paris and its environs, has been drawn up under the
orders of the prefect of police, and consists of 1,915 doc-
tors of medicine, 12 doctors of surgery, S3 officiers de"
sante, 43 foreign medical men, 1,500 sages-femmes, 845
pharmaciens, and 95 veterinary surgeons. The list is to
be posted up at each police station for the benefit of the
public, and at the same time to act as a check upon those
who have no right to practise. Among the foreign med-
ical men authorized to practise in France, ten obtained
their diplomas or degrees at the Faculty of Jena, the
others in various universities of England and Germany.
Among the doctors of medicine there are two ladies, one
French and the other Russian. This list would give an
average of one medical man to about 1,100 inhabitants,
the population of Paris being estimated at 2,239,928.
The following interesting information has also been ob-
tained by the prefecture a propos the above list. The
senior medical man, according to age, is M. Segalas, who
was born in 1792, and took his degree in 1S17. Next
in seniority conies Dr. Ricord, the celebrated syphil-
ographer, who was born in 1800, and took his degree in
1826. The oldest sage-femme is established at Bourg-la-
Reine, in the Department of the Seine. She obtained
her diploma in 1815, since which she has continued to
practise without any interruption. She declared at the
l)refecture of |)olice that during the sixty-eight years slie
has been in practice, she had, on an average, 100
accouchements a year, so that she has during that period
brought 6,800 children into the world.
Treatment OF Genu Valgu.m by the French Sur-
geons.— Dr. .'\. J. Steele writes concerning the above
subject {St. Louis Courier of Medicine') as follows :
".\t Lyons I was warmly received by MM. Molliere,
Robin, and Delore. All had done original work in the
matter of genu valgum or knock-knee, and I was anx-
ious to learn more of their investigations and treatment.
Delore is more especially interested in and is teaching
obstetrics and gynecology, but several years since he in-
vestigated the subject of in-knee, and proposed as a
method of treatment fracture through the epiphyseal
junction both of the femur and tibia. This is done by
manual force over the edge of the table. The limb be-
ing thus straightened, is put up in starch or plaster-of-
Paris dressing, and the patient allowed to be up and
about ; union occurs in an improved position. He re-
ports cases thus treated and cured. But I do not find
that his professional brethren are very generally adopt-
ing this method, many preferring in the young subject
to employ mechanical appliances worn for a long pe-
riod, and thus gradually straightening the limb. In the
youth and young adult, M. Robin breaks the femur
above the epiphyseal junction with an osteoclast of his
own devising. M. Molliere, surgeon-in-chief of the H6-
' tel-Dieu, has in many cases adopted this method very
satisfactorily. He showed me in his wards several cases
that had undergone the operation, some still in the starch
dressing, and others with it removed, all doing well and
with no untoward results. At his kindly suggestion M.
Robin applied his instrumentto the limb of a cadaver in or-
der to illustrate its action to me. It was an adult subject,
and the femur was broken very readily with his osteo-
clast just above the condyles. On cutting down upon
the part the periosteum was not, at least on the ante-
rior part of the femur, broken, though the bone was frac-
tured entirely through. In badly united fractures, and
in anchylosis of the knee and hip-joints, the same instru-
ment has been used by them to break up the part and
allow of improved reposition."
Shall Doses. — Dr. Thorowgood says regarding the
use of small doses: — "I have come to the conviction
that the doses of many medicines, as set forth in books,
are often needlessly large, when we seek, not an elimi-
nant or evacuant effect, but a gradual alterative or spe-
cific action from the remedy. There is probably no
medicine regarding the definite action of which physicians
agree better than iron ; but is it necessary for the cure
of facial neuralgia to give an insoluble powder like the
hydrated oxide of iron in a dose ranging from thirty
grains up to three or four drachms ? The subnitrate of
bismuth, another insoluble powder, has been given for
the relief of gastric pain in such large doses that, after
death, large, hard, black masses of concrete subnitrate and
sulphide of bismuth have been found blocking the intesti-
nal canal. The gentleman who made the post-mortem
said the masses he removed looked like lumps of metal."
As to calomel, he has seen marked beneficial results
from the administration of doses of one-third of a grain,
and he has found patients do much better with doses of
two minims of tincture of aconite than with doses of five
to fifteen minims as prescribed in the British Pharma-
copoeia. He also advises small doses of liquor arsenicalis
for the relief of spasmodic asthma, and he has seen ex-
cellent results from the persevering use of small doses
(one-fiftieth) of a grain of strychnia in promoting the
restoration of exhausted nerve-function, " while larger
doses do but add to irritation and eventually increase
the exhaustion." Tincture of nux vomica taken in
doses of one to two minims, fasting every morning, he
has found useful in the cure of chronic constipation.
A Curious Instance of Fear of being "Buried
Alive " lias just been brought to notice by the proving
of the will of Major Andrew Gammell. This gentleman
deposed that a sum of one hundred guineas, free of legacy
duty, should be paid to Mr. Barnard Holt, F.R.C.S., or
failing him, some ctiually eminent surgeon, as a fee for
surgical examination of his body after death.
Bartholow's "Practice." — It has been stated that
Bartholow's " Practice of Medicine " is being translated
intol Chinese for the benefit of the physicians of the
Celestial empire.
The Medical Record
A Weekly Journal of Medicine and S^irgery
Vol. 24, No. 10
New York, September 8, 1883
Whole No. 670
©viQiuat l^vticlcs.
INTESTINAL INDIGESTION.
By J. MILNER FOTHERGILL, M.D.,
LONDON, ENGLAND.
[associate fellow of the college of physicians of PHILADELl'HIA.
A PRACTICAL distinction may be drawn between gastric
and intestinal dyspepsia ; indeed, has been drawn be-
tween the two. In order to make this discrimination we
follow the tiine^of each part of the digestive act. When
discomfort commences immediately after the introduction
of food into the stomach, we regard the stomach as be-
ing the seat of the malady, as when there is a gastric
ulcer present, for instance, or great irritability. When
feelings of discomfort are quickly experienced, and after
some lime the food is vomited, little affected by the di-
gestive act, and mixed with much mucus, then we sus-
pect that there is gastric catarrh present, and that the
food, rolled over and over by the muscular action of the
walls of the stomach, becomes covered with a layer of
mucus, through which the gastric juice Cannot penetrate.
The offending mass is at last rejected by vomiting, or is
passed into the bowels and got rid of by purgation.
Hut at other times the symptoms complained of carry
with them other interpretations. When there is little
discomfort, either pain or flatulence, experienced until
some considerable tiiue after a meal, then we suspect
the malady to lie ratlier in the duodenum and its relations,
than in the stomach itself. For instance, a little time
ago a gentleman from Ireland presented himself with
this association of symptoms. He was over fifty years
of age, strongly and broadly built, had lived well, even
freely, and never knew anything of indigestion until
within the last year or so. Since then he has had evi-
dences of gouty indigestion with acid eructations, and
considerable lithates in his urine. There is also some
enlargement of his liver. But the significant symptom
of all, to my mind, is this — his discomfort comes on from
one to three hours after meals. Now we know as yet
very little of the prodromata of cancer of the stomach be-
fore the familiar, well-recognized condition is established
of pretty constant pain, little relieved by vomiting, acid-
ity of the stomach, constipation, emaciation, with the
development of the cancerous cachexia, and in time,
especially when pyloric, the development of a tumor.
There is, however, a stage anterior to this. Any one
who has been able to keep a patient under observation
for considerable periods knows how far from rare it is for
chronic dyspeptics to die with unquestionable cancer of
the stomach. Nor is it difficult to conceive that such
should be the case — disturbances of function preceding
organic changes ; just as failure of functional power in
the brain may pass away under appropriate measures ;
or, under other circumstances, pass on into that condition
commonly spoken of as " softening of the brain," that is,
of organic change. Probably no one can always be sure
what the resultant outcome of a distinct failure of brain-
power may be. So with the stomach. A long history of
functional disturbance culminates in organic disease. But
when a well- nourished man, who has never known what it
was " to have a stomach," begins to suffer from acid dys-
pepsia, and has pain from one to three hours after a meal,
then the suggestion of cancer of the pylorus forces itself
upon one. Little relief had been afforded by the ordi-
nary bismuth mixture, and this was not without its sig-
nificance. The case will be watched carefully to see
what its further development may be.
The pylorus is in firm contraction for some time after
a meal, so as not to allow tiie contents of the stomach to
escape until fairly acted upon by the digestive fluid, and
then it relaxes and allows the contents to escape into
the duodenum. Why pain should be experienced until
the ring relaxes is not quite clear ; but the pain of py-
loric cancer certainly is not particularly linked with the
introduction of food mto the stomach, as is that of gas-
tric ulcer, and is not specially experienced when the
ring is closed. As the case progresses the pain is more
continuous ; that is, when the ring is relaxed and con-
tracted alike. Then there was the freedom from all
gastric trouble till that time of life was reached when
cancerous growths becoiue common. There was, also,
the negative results from appropriate treatment. The
tout ensemble of the case was, to my mind, that of com-
mencing cancer of the pylorus. The case was one of
much interest ; the more that a curious case of indiges-
tion and vomiting, sometimes of blood, came indirectly
under my notice some time ago, where opinions had va-
ried, within narrow limits, and which turned out ulti-
mately to be an ulcer situated within the pyloric ring
itself.'
More commonly pain with fulness is complained of
from one to one-half hour or more after meals, i.e.,
at the time when the food is passing out of the stomach
into the duodenum, when we may fairly believe the fol-
lowing to be the case. Normally the acid contents of the
bowel, when passing into the duodenum, are mixed with
the alkaline bile to the extent not only of neutralizing their
acidity, but of positively rendering them alkaline, so that
the pancreatic fluid may be operative. But in those
cases of duodenal dyspepsia it would seem that the al-
kaline tide from the liver is insufficient to perform this
neutralization, and the pain and discomfort follow, the
duodenum resenting the presence of an acid fluid.
Whether this pain is due to this acid irritation solely, or
there is muscular spasm set up thereby, may not yet be
afiirmed, the observations made so far being scarcely suffi-
ciently minute. (The difficulty of making minute observa-
tions, when they have to be made through the medium of
the patient's sensations, are self-apparent to anyone.)
When, however, the pain and discomfort come on at the
time the food is passing into the duodenum, and are re-
ferred by the patient regionally to the duodenal area, and
at the same time the stools are defective in bile, then duo-
denal dyspepsia is the probable cause of the symptoms.
If, beyond this, a pill of o.x-gall with castile soap, some
two hours after a meal, is beneficial, and the addition
of liquor pancreaticus sheathed by an alkali gives de-
cided relief, then the diagnosis of duodenal dyspepsia
is fairly established.
It would also be well to put the patient upon a diet-
ary of farinaceous material and milk, so as to do away, to
a great extent, with acid gastro-pepsin digestion, and de-
velop alkaline intestinal trypsin digestion. The farina-
ceous material, with milk, might be guarded by some
prepared chalk or calcined magnesia, to neutralize gas-
tric acid digestion. By such means the acid condition
of the duodenum is removed, and with it the discomfort.
Milk sheathed with an alkali is just as much indicated in
a case of duodenal dyspepsia as it is in the condition of
gastric ulcer, where it is desirable to get the food through
254
THE MEDICAL RECORD.
[September 8, 1883.
the stomach with as little disturbance of that viscus as
possible.
By the light of recent physiology such cases are be-
ginning to be apparent, and it is possible to discriminate
them, partly by their semeia, but still more by the effects
of treatment. Duodenal dyspepsia is linked with those
cases where fats are not assimilated, and where cod-liver
oil passes the anus en masse. In such cases the ox-
gall and castile soap, taken an hour or so after a meal,
gives relief in time, and enables the oil to be emulsion-
ized, and after that to be taken up by the lacteals. This
kind of case conies but comparatively little under the
notice of the consultant, and it is to the observant family
practitioner we must look for the record of these cases,
and the effects of treatment. A sufficiency of cases only
to furnish a strong surmise have come under the notice
of the writer. If his readers will help by the publication of
a few well-marked cases the diagnosis, and with it the
rational treatment, duodenal dyspepsia will probably
soon become a recognized matter.
Intestinal indigestion is also seen under other circum-
stances, viz., Ucntery. This word is old-fashioned, but is
not obsolete. Here the food, but little changed by the
digestive act, is voided per anus a brief while after being
taken. The stomach passes the food into the intestines,
and they sweep it along to the place of exit too speedily
for any real digestion and absorption to take place.
Lientery is found with children who may have had measles,
with the low muco-enteritis which is apt to follow that ex-
antheni, or in cases of mesenteric disease. Frequently
large quantities of acid mucus are voided with the un-
digested food. Here alkalies with catechu or hematoxylin
are indicated, with the inevitable milk dietary.
In tiny children an hyperassthetic condition of the in-
testines is often seen, where the ordinary vermicular
movements cause pain, the child crying the peculiar long
abdominal wail, corresponding with the vermicular twist
acting on the bowel, the seat of the muco-enteritis. The
movements of the intestines may be felt through the thin
abdominal walls, with or without flatulent distention. The
stools smell sour. Here again alkalies are indicated, as
prepared chalk with tincture of cardamom, or the bicar-
bonate of potash with cajeput oil ; both useful combina-
tions. Here the indications for treatment point to the
neutralization of the acid formed in the intestine, together
with the administration of a carminative of some kind
(carminatives allay the energy of the intestinal peristalsis,
and relieve painful vermicular action).
Such conditions are as much intestinal dyspepsia as
they are anything else, as the digestive act is both pain-
ful and inefficient. It must be remembered that the
different ferments of the pancreas are all alike only opera-
tive in an alkaline medium, and that in the presence of
an acid they are inert. Consequently when the alimen-
tary tract IS acid, whether by acid formed in the stomach
or formed below the stomach, or from the chyme bein"
acid because the natural alkali in the bile is deficient,
then the digestive ferments of the pancreas are killed and
wasted. In the child, indeed, digestion is far more pan-
creatic than gastric ; and such acidity of the bowel is
very pernicious. When the acidity is greatest low down
in the bowel it is well, as Prout jJointed out, to use the
fixed alkalies (chalk and calcined magnesia), which are
not converted into soluble salts in the stomach, but which
pass along the intestines and neutralize acid all along the
alimentary tract. But such acidity is not confined to
infants, and is seen in adults. The question of how far
a little mercurial, especially as gray-powder, is useful in
such conditions of acidity may be raised. Some authori-
ties are in favor of such medication, and certainly in
those cases where the acidity appears due to deficiency
of the alkaline salts of the bile, it would recommend itself.
Of course, with very delicate children, not being congeni-
tally syphilitic, caution is requisite in prescribing mer-
curials ; but at the jsresent day the caution is so excessive
that mercury is avoided altogether by some practitioners.
To eschew mercurials altogether is fanaticism, therapeu-
tic fanaticism, nothing more.
There are other conditions of intestinal dyspepsia
less commonly encountered, which may just be alluded
to. In a case of confirmed indigestion, due to long
sustained overwork in establishing a commercial enter-
prise in Russia, which came under notice lately, the dis-
comfort was referred to the transverse colon, and was
mainly experienced about three hours after a meal.
Sweet things and sour things, all seasoning whatever,
were an offence ; while, as the patient said, " I don't eat
enough to nourish me, and if I did, I should not digest
it ! " His complaint was a just one. However, he did
improve sufficiently to revisit Russia; but at Kief he
caught dysentery, and just managed to get back to Eng-
land before being completely prostrated. The attack
was not a severe one, for a healthy uerson at least,
and there was no thickening of the colon, that either
Sir Joseph Fayrer or myself could detect ; but the un-
comfortable sensations referred to the transverse colon
were very troublesome, and being about persistently.
Gradually they declined, and now the patient is again
making headway, still having to be very particular about
his dietary. If such cases scarcely fall under the head-
ing "indigestion," they do, however, come under the
heading " dyspepsia," and they require a most careful
dietary. In this particular case small quantities of liver-
stimulants only were required, as much bile in the
faces irritated the bowel not a little.
Cases like this may easily be mistaken for gastric in-
digestion, if the observation as to the time after a meal
when the discomfort is experienced be not properly
made. In my former article on "Atonic Dyspepsia,"
the methods of treating primary gastric indigestion were
laid down. Here it may be said that the liver requires
to be roused, and bile supplied to the chyme, either by
increasing the flow from the liver, or by giving ox gall
in pill, either with or without castile soap, until a suffi-
cient natural flow is secured. By such means, and by
the exhibition of liquor pancreaticus and fixed alkalies
much may be done for those cases of dyspepsia which
lie below the pyloric ring ; in other words, for dyspepsia
in the alkaline area of the alimentary canal. How far
the pancreas can be stimulated by either, as first sug-
gested by Balthazar P'oster, and approved by a Medical
Commission in the United States Army, in cases where
the assimilation of fat is deficient, is a matter of practice
which calls for more attention. But by the use of hepa-
tic stimulants, which includes the rational resort to
mercury, alkalies, and artificial pancreatic secretion, and
an appropriate dietary, much may be done where intes-
tinal digestion is painful or is imperfect. The main
thing to be done is to discriminate what is amiss, and
then how may it be remedied. For both, perfect famili-
arity with the digestive act, its divisions, and the time
after taking food when each occurs, is absolutely re-
quisite. When it is found out where the difficulty occurs
then the appropriate measures can be adopted. And it
may be the symptoms are not experienced in the abdo-
men at all when the malady lies below the pylorus.
When imperfectly digested products are poured into the
portal circulation the main complaint may be psychical,
as lowness of spirits, oppression, or panphobia, occur-
ring two or three hours after a meal. Or may be lithates
are freely formed, and, in some cases, irritability and
discomfort in the urinary passages are set up as soon as
these inal-products reach the bladder. In such cases
alkalies with some pancreatic preparation will often give
much relief, especially if at the same time the dietary be
strictly regulated ; and hepatic stimulants are certainly of
service.
Dr. Charles Fremont Dight, assistant to the Chair
of Pathology and Practice of Medicine in the University
of Michigan, has been elected Professor of Anatomy and
Physiology in the Medical College at Beirut, Syria, .\sia.
September 8, 1883.]
THE MEDICAL RECORD.
255
ON THE PECULIAR APPEARANCE OF THE
INITIAL LESION OF SYPHILIS AT THE EAR-
LIEST PERIOD OF ITS DEVELOPMENT.'
By R. W. TAYLOR, M.D.,
SURGEON TO CHARITV HOSPITAL, NEW VORK ; PROFESSOR OF VENEREAL AND
SKIN DISEASES IN THE UNIVERSITY OF VERMONT.
The importance of the early recognition of the initial
lesion of syphilis is so great that any facts tending to en-
lighten us in this direction are of more than ordinary
value. In the American Journal of Syphilog^raphy and
Dermatology iox ]w\)-, 1S71, I published the description
of the appearance of an initial lesion of syphilis, as ob-
served on the first day of its evolution. These appear-
ances were such that scarcely any one would have sus-
pected that the seemingly insignificant spot was really the
starting-point of syphilitic infection.
From that date until May, of this year, I had not met
with a similar case, but at that time a second one came
to my notice. I shall, therefore, give the details of these
two cases, which i)resent clearly marked features of the
hard chancre, which had also been observed years ago by
my friend the late Professor William Boeck, of Christiania,
as he informed me in an oral conmiunication, but which
have not, I believe, until now, been described by any one
but myself. In connection with the description of this
peculiar appearance of the hard chancre at its earliest
period of evolution I will try to jiresent the other appear-
ances which it usually presents, since by this course more
completeness to the general picture is gained. In addi-
tion,I shall speak briefly of the appearance of the initial
lesion of syphilis in children in its very earliest days.
The first case is transcribed nearly verbatim from the
journal before mentioned.
M. M , a native of Poland, came to the New York
Dispensary, January 17, 1870, and presented a peculiar
lesion on the penis. Upon the inner aspect of the right
lip of the meatus urinarius was a spot about the size of
the heads of two pins, which presented a silvery appear-
ance. The spot was not at all elevated, but directly
continuous, without any elevation or fissure wdth the sur-
rounding membrane, and there was no fissure, however
slight, to be seen through the spot itself, even with the
aid of a magnifying-glass. I thought tliat perhaps the
man had cauterized it with nitrate of silver, but he de-
clared that he had not interfered with it at all. He
stated that he had for the first time observed the spot
that morning. It was evident that the lesion consisted
in some change produced in the superficial epithelial
cells of the part. Professor VV. Boeck, of Christiania,
being present at the examination, remarked tliat he had
seen the initial lesion of syphilis once or twice before be-
gin in this manner upon the penis, and that he had often
observed it to commence in this way in the mouths of
children. In two succeeding days the area of the silvery
patch increased very little, and in four days a small amount
of induration could be distinctly felt, since the parts were
so accessible to careful manipulation. In a week a dis-
tinctly marked indurated nodule was formed, which very
much everted the lips of the meatus. The inguinal gan-
glia had by this time become perceptibly hard and swollen.
When the nodule, which though no larger than a small
pea, but which was very firm in consistence, had existed
about a week, the epithelial scales which covered it were
cast off", and a very slightly grayish exulcerated surface
was observed, the granulations of which were very small,
and it was covered with a very scant viscid secretion.
This indurated ulcer remained in a sluggish condition for
six weeks, when a roseola erythema of fauces and gen-
eral malaise supervened, which were treated by mercury
and disappeared quite rapidly. For two years the man
had various lesions, but owing to persistence in treat-
ment he was cured, and has since been well.
On May 20, 1883, a gentleman, who shall be nameless,
• Read before the American DermatologicalJ Association, atj Luke George, Au-
gust 30, 1883,)
came to me in great anxiety and fear regarding a suspi-
cious connection he had had the night before. He was
a man forty-four years of age, who since his marriage,
twenty years previously, had had no intercourse with
strange women, and had been true to his wife. His
recollection of the night previous was a hearty dinner
and much champagne ; and in the morning he awoke in
a brothel in the arms of an aged siren. Though as-
sured most solemnly by this woman that she had no dis-
ease, he became greatly worried and sought me to deter-
mine whether he had contracted any venereal trouble.
I frankly stated his probable dangers in gonorrhcea, chan-
croid, and syphilis. So great was his anxiety that he
came to me for examination every day, and suflfice it to
say he did not contract the two local forms of contagion.
On the twelfth day, absolutely nothing abnormal having
been observed on his penis up to that time, I saw a
small oval spot of a glistening silvery appearance on the
dorsum of the glans penis midway between the meatus
and the balano-preputial furrow. This small spot was
of about the size of three small pin-heads, and was dis-
tinctly visible at all times, since the j^repuce was very
small and barely covered the base of the glans. Re-
calling my experience with the afore-described case, I
informed the gentleman that he had very probably con-
tracted syphilis, and that his domestic quarantine must
still be rigidly followed for fear of infecting his wife.
The patient's fears were such that I had almost daily
opportunity to observe the development of this lesion.
Its course was briefly as follows: The silvery spot in-
creased in area slowly. Its surface was pertectly un-
broken, and during its early days it could be distinctly
seen that the morbid process was superficial and con-
fined to the epithelial layer ; moreover, there was no cir-
cumferential hyper:\;mia. Thus increasing, at the end
of ten days the spot occupied an area of a line in diame-
ter, and was round. From this time on deeper changes
were observed, thickening of the upiiermost layers of the
mucous membrane was distinguishable in about fifteen
days, and sharply marked parchment induration was
clearly felt on the twentieth day. Swelling of the inguinal
ganglia was discovered on the eleventh day. The sil-
very appearance of the nodule was well marked until
about the fifteenth day, at which time it might have been
mistaken for a papule of lichen planus. From this date
onward the silvery gloss grew less, redness appeared
over the surface, and in twenty days from its appear-
ance the chancre was typical in its appearance — a
smooth exulcerated surface, sharply defined margin, and
an abrupt elevation. On July 13th, an erythematous
syphilide came out over the epigastrium and abdomen,
and in a week it covered the whole body.
The point of interest of these cases consists in the
peculiar, localized, silvery appearance of the mucous
membrane of the glans penis, which were soon to be the
site of the true Hunterian chancre. The importance of
the early recognition of the nature ot this lesion is well
shown in this case, since it is very probable that a person
who had never before seen it, would have regarded it as
insignificant, and would not have prevented the gentle-
man having intercourse with his wife. The practical con-
clusion is this, that at its evolution the initial lesion of
syphilis may appear simply as a small, unelevated, silvery
spot, seated in the mucous membrane, without any inflam-
matory areola. This spot may thus remam superficial
and free from ulceration and induration for nearly two
weeks, after which time, and even before, it may increase
in development and assume the appearances of a typical
indurated chancre. In this connection I may add that
there are two other appearances presented by the initial
lesion of syphilis at its earliest period. The first appears
simply as a minute, sharply rounded, excoriated spot, the
surface of which is neither elevated nor depressed, and
appears like a most superficial erosion of the epithelial
cells of the mucous membrane. Generally these spots
are of a sombre red color, which later on may become
2.S6
THE MEDICAL RECORD.
[September 8, 1883.
coppery red, and usually are not the seat of hyperemia.
Their future course is one of extension on the surface
and in depth. In somewhat rare instances numbers of
these spots, from three to as many as a dozen, may appear,
and then we have the multiple herpetic form of chancre of
Dubuc. The third and last of the earliest appearances
of the initial lesion of syphilis is in the form of a small,
slightly elevated papule, having a dry unbroken surface.
This forni of chancre, i\\e papule s'eche of Lancereaux, is
mostly seen in persons having short prepuces, and in those
who have none, or but the rudiment of one. It begins
in this subacute, indolent, and insidious manner, and may
run its whole course without any ulceration or excoria-
tion, or it may follow the course of the indurated nodule,
or become transformed into the parchment-like chancre.
It is needless to add that it is important to bear these
peculiar appearances in mind, as by so doing and by
acting on the warning given by them, much misery may
be spared.
In this connection I may add that I have several times
in my life confirmed the statement of Professor Boeck, to
the effect that in children the initial lesion often begins as a
very minute, shining, and silvery spot, similar to those just
now described. I well remember an instance of a child,
infected by its wet nurse, at the tip of whose tongue, a
little to the right side, was a minute linear spot, which
appeared as if cauterized by the pencil of nitrate of
silver, and which went on to form a large indurate nodule,
which was followed by syphilis. Also I can now picture
in my mind a small spot, such as I have now fully de-
scribed, on the lower lip of an infant, which later on be-
came an enormous Hunterian chancre. The practical
indications of these facts are obvious.
OBSERVATIOXS ON THE ACTION OF NEW
REMEDIES.
By W. S. GOTTHEIL, M.D.,
NEW VOFK.
In December, 18S2, at the suggestion of my visiting
physician. Dr. J. J. Reid, I began a series of observations
on the therapeutic results obtainable from certain drugs,
to which professional attention has more recently been
drawn. As House Physician of the second medical divi-
sion at Charity Hospital, a large field for study was open
to me, and considerably over one hundred cases were
recorded. These experiments lasted from December i,
1882, to April I, 1883, and were made with the following
drugs :
1. Convallaria maialis, fluid extract.
2. Manaca, fluid extract.
3. Eucalyptol. .
4. Yerba santa, fluid extract.
5. Chekau, fluid extract.
6. 01. gaultherise (in rheumatism).
7. Lippia Mexicana, fluid extract.
8. Quebracho, fluid extract.
The first one of the list, the lily of the valley, is the
most important, and at the present moment far the most
interesting one of the series. I shall therefore give, in
somewhat fuller detail, the account of the results ob-
tained with it.
1. Convallaria. — The cases treated with this drug
numbered fifteen in all, there being nine cases of organic
heart disease, five cases of cardiac failure from various
causes, and one case of Bright's disease. Tiie prepara-
tion used was the fluid extract.
Case I. — Hannah B , aged forty-three ; mitral re-
gurgitation, marked hypertro|)hy, and jtrobably dilatation,
dizziness \. pain and palpitation very marked ; pulse, 84,
very irregular, both in force and frequency ; respiration,
48 ; temperature, 98^°. January 20th : Convallaria,
fluid extract, gtt. x. t. i. d. January 24th : Pulse about go,
but so irregular as to be almost uncountable ; jiains
same ; occasional attacks of cardiac asthma ; conval-
laria, gtt. XX. t. i. d. January 27th: Pulse, 105 ; no im-
provement ; convallaria stopped ; ordered tr. dig. gtt. v.
t. i. d. January 31st: Pulse, 84 ; unimproved ; tr. dig.
gtt. X. t. i. d. February loth : Somewhat easier; pulse,
96; same. February 21st: Pulse, 90, still as irregular ;
tr. dig. gtt. XV. t. i. d. February 25th : Slight improve-
ment in palpitation and pain ; pulse 84, same ; digitalis
stopped ; ordered convallaria, gtt. xx. t. i. d. February
28th: Pulse, 90, less irregular ; convallaria, gtt. xxx. t. i.
d. March 2d : Pulse, 75. March 4th : Heart rhythm
no better; palpitation and pain much I'elieved ; con-
vallaria, gtt. xl. t. i. d. March 5th : Pulse, 96, irregular ;
convallaria, 3 i. t. i. d. March 7th : Pulse, 90, same.
March loth : Pulse, 90, unimproved; convallaria
stopped.
Case II. — Justin McC , aged fifty-two ; mitral re-
gurgitation ; pulse, 84, irregular in force, feeble, oc-
casionally intense ; dilatation. F'ebruary 28th : Attacks
of dizziness ; convallaria, gtt. v. t. i. d. March 2d : Pulse,
66, stronger, still irregular. March 5th : Pulse, 60 ;
dizziness better ; convallaria, gtt. x. t. i. d. March 6th :
Pulse, 60, as irregular as ever ; general condition — pain,
dizziness, etc.- — much improved. March 8th : Discharged
at request.
Case III. — John J. D , aged thirty-one ; mitral
obstruction, cardiac hypertrophy ; cardiac beat irregular
in force and frequency ; palpitation, dyspncea, etc. ;
pulse, 120. January 25th : Convallaria, gtt. x. t. i. d.
January 29th : Pulse less irregular, but just as frequent ;
convallaria, gtt. xv. t. i. d. February ist: Pulse, 120,
irregular ; feels better ; palpitation somewhat less ;
convallaria, gtt. xxx. t. i. d. February 5th : Pulse, 78,
irregular in force and frequency. February Sth : Pulse,
96 ; much more comfortable ; palpitation much improved ;
no dyspncea ; can go up and down stairs easily. Febru-
ary 22d : Discharged, in fair condition.
Case IV. — Alexander McM , aged twenty-three ;
mitral regurgitation and aortic obstruction ; considerable
hypertrophy, dyspncea, palpitation, pain, cough, and blood-
streaked sputum ; pulse, 80, regular, fairly strong. January
15th : Convallaria, gtt. v. t. i. d. January 19th : Consid-
erable dyspnoea and pain ; phlegm blood-streaked ; pulse,
72 ; convallaria, gtt. x. t. i. d. January 23d : Same ; con-
vallaria, gtt. .XX. t. i. d. January 26th : Pain considerably
better ; palpitation and dyspncea as before ; convallaria,
gtt. xxx. t. i. d. January 30th : Pulse, 72 ; condition same.
February 2d : Pulse, 72 ; symptoms no better. Febru-
ary 6th : Pulse, 84 ; convallaria, 3 i. t. i. d. February Sth :
Pulse, 72 ; i)recordial pain undoubtedly better, but oth-
erwise no change. Treatment stopped.
Case V. — Patrick H , aged twenty-four ; mitral
regurgitation and aortic obstruction ; hypertrophy ; nnich
precordial pain ; pulse, 90, and rather feeble ; dyspnoea,
but especially palpitation and pain. February 27th : Con-
vallaria, gtt. .\. t. i. d. February 28th : Pulse, 84 ; some-
what better ; dyspncea and palpitation as before ; con-
vallaria, gtt. XX. t. i. d. March 2d : Breathing better, and
steadily improving ; less palpitation ; pulse, 96, fairly
strong ; convallaria, gtt. xxx. t. i. d. March 3d : Pains in
side began again ; pulse, 90 ; convallaria, gtt. xl. t. i. d.
March 5th : Much precordial pain ; palpitation undoubt-
edly less ; pulse, 90, small and hard ; convallaria, 3 i- t. i. d.
March 6th : Pulse, 80, uuich improved, full and strong ;
little pain. March 7th : Pulse, 90, good ; general con-
dition fair ; no pain. Discharged at request.
Case VI. — Patrick E , aged fifty-six ; mitral re-
gurgitation and aortic obstruction ; but little hypertrojihy ;
headache ; feet slightly swollen ; urine negative ; pulse,
120, feeble. January 2 2d : Convallaria, gtt. v. t. i. d. Jan-
uary 29th: Pulse, 1 20, fuller ; headache ; swelling gone
down ; much cough ; convallaria, gtt. x. t. i. d, Feb-
ruary I St : Pulse, 132 ; headache bad ; convallaria,
gtt, XX. t. i. d. F'ebruary 6th : Pulse, 96, much improved
in tone ; headache and tightness in head ; convallaria
stopped.
1
September 8, 1883.]
THE MEDICAL RECORD.
257
Case VI L— Rose McG-
aged thirty-six ; mitral
stenosis and insufficiency, aortic stenosis, dilatation, great
dyspnoea, and palpitation ; feet slightly swollen : urine
negative ; pulse, io8, irregular and intermittent ; flutter-
ing and oppression around heart. Treated with digitalis,
caffeine, etc., with slight result. January i8th : Pulse,
100, irregular; convallaria, gtt. x. t. i. d. January 20:
pulse, 66, fuller, but irregular ; flattering somewhat bet-
ter ; convallaria, gtt. xx. t. i. d. January 24th : Pulse,
86, fair ; feels better ; fluttering less ; can rest better at
night ; convallaria, gtt. xxv. t. i. d. January 27th : Pulse,
same, still irregular. February loth : Pulse, 84, fairly
good, irregularity of beat quite unaffected ; little dysp-
ncea or palpitation ; convallaria stopped.
Case VIII. — Theresa K ; mitral regurgitation;
mitral stenosis ; aortic stenosis ; dilatation ; palpitation ;
dyspnrea ; cardiac pain ; severe dyspnoea in spells ; cough ;
phthisis, second stage, etc. ; pulse, 108, moderately
strong. January 20, 1883; Convallaria, gtt. xv. t. i. d.
January 2 2d : Feels very bad ; breathing labored ; vio-
lent palpitation ; much dyspncea and pain in side ; pulse,
120, small ; convallaria, gtt. xxx. t. i d. January 23d :
Pulse, 113, small. January 24th: Pulse, 108, slightly
stronger ; slightly nauseated by drops ; convallaria, gtt.
1. t. i. d. in milk and lime-water. January 27th; Pulse,
108, improving ; cardiac distress unaffected ; vomited
several times last night. Convallaria stopped ; ordered
cerii o.xalas, gr. xx. t. i. d. January 29th : Vomiting
better ; pulse, 104, small ; dyspnoea, palpitation, jiain,
as before; convallaria, 3 '• t. i. d. January 31st: Neg-
ative result ; dyspnoea very bad ; convallaria, 3 ij- t- i. d.
February ist : Nauseated again, the palpitation, dysp-
ncea, and precordial pain entirely unaffected ; conval-
laria stopped.
Case IX. — Charles S , aged forty-two; mitral re-
gurgitation, aortic stenosis, and aortic regurgitation : hy-
pertrophy ; dyspncea marked. January 26th : Pulse, 84,
small and jerking ; convallaria, gtt. xx. t. i. d. January
30th : Pulse, 78, regular ; dyspna;a and]pain unimjiroved ;
convallaria, gtt. xl. t. i. d. February 2d : Pulse, 84 ; but
little improvement ; convallaria, 3 i. t. i. d. February
6th : Pulse, 108, fuller and stronger than before ; pre-
cordial pain somewhat less ; no change in dyspnoea and
palpitation. February Sth : Little result from convallaria,
•ordered stopped ; tinct. dig. gtt. x. t. i. d. February 9th :
Less pain ; pulse, 84 ; tinct. dig. gtt. xx. t. i. d. F'ebruary
1 6th : Pulse, 72 ; dyspnoea marked ; tinct. dig. gtt. xxx.
t. i. d. P'ebruary 23d : Statu quo ; dig. reduced to gtt.
XX. t. i. d. February 27th; Pulse, 78, much feebler; is
a good deal better, but still complains of dyspnoea ; dig.
stopped ; convallaria, gtt. xv. t. i. d. March 2d : Same ;
■convallaria, gtt. xxv. t. i. d. March 5th : Less dyspnoea
and palpitation than at any time since entrance ; con-
vallaria, gtt. XXXV. t. i. d. March 7th : Improvement
marked ; his heart gives the man but little trouble.
Transferred to convalescent help.
Case X. — Charles N , aged sixty-five ; Bright's dis-
ease ; oedema of feet and legs ; nausea, vomiting ; mod-
erate dyspnoea ; considerable cough ; cardiac signs nega-
tive ; lungs, emphysema and chronic bronchitis ; urine,
average daily amount twelve to twenty-five ounces ; mod-
•erate amount of albumen, hyaline and granular casts.
January i8th : Urine, twenty-one ounces; elimination
by skin and bowels with slight result. January 2 2d :
Getting steadily worse; urine, twelve ounces. Jan-
uary 23d : Pulse, very rapid and irregular ; convallaria,
gtt. XV. t. i. d. January 24th : Pulse is uncountable
at wrist; urine, fourteen ounces; oedema very painful,
punctured and bandaged ; convallaria, gtt. xxx. t. i.
d. ; heart-beat, 108. January 26th : Urine, seventeen
ounces; somewhat easier; pulse, 100, Patient died
January 27th.
Case XI. — Lizzie H , aged twenty-eight ; phthisis,
second stage ; much enfeebled by successive hismoptyses.
February 23d : Pulse, 96, very small mdeed ; convalla-
ria, gtt. X. t. i. d. February 2Sth : Pulse, 118, somewhat
stronger ; convallaria, gtt. xv. t. i. d. February 28th :
Rapidly improving ; pulse, 96, still feeble ; convallaria,
gtt. xxx. t. i. d. March 3d ; General condition satisfac-
tory ; pulse considerably stronger, 102. March loth :
No further results. Patient discharged at request.
Case XII. — Constantine Z , aged thirty-two ; acute
articular rheumatism ; no pericardiac or cardiac lesion ;
convalescence ; pulse almost imperceptible, and varying
for days between 114 and 160; temperature normal.
Digitalis and ordinary cardiac tonics tried — no result.
January 15th: Pulse, 130; temperature and respiration
normal; convallaria, gtt. v. t. i. d. January i6th : Pulse,
140. January i 7th : Pulse, 156 ; convallaria, gtt. x. t. i. d.
January 18th: Pulse, 140, very feeble; convallaria, gtt.
xv. t.i. d. January 19th: Pulse, 120, somewhat stronger ;
convallaria, gtt. xxv. t. i. d. January 20th: Pulse, 102;
undoubtedly better and stronger. January 22d: Pulse,
90, regular and full ; convallaria, gtt. xxx. t. i. d. January
23d : Pulse, 78, good. January 25th : Pulse, 80. Jan-
uary 26 : Pulse, loS, and slightly weaker ; convallaria,
gtt. xl. t. i. d. January 27th: Pulse, 80, fair; conval-
laria, 3 i- t. i. d. January 30th : Pulse, 102, regular and
good. February ist : Pulse, 80. Discharged.
Case XIII. — Henry H , aged thirty-eight; melan-
cholia ; excessive feebleness of heart-beat ; no physical
lesion or symptom ; pulse, 96-108. January 23d: Con-
vallaria, gtt. XV. t. i. d. January 25th: Pulse, 80, much
fuller and stronger ; convallaria, gtt. xx. t. i. d. January
30th : i'ulse, 90, excellent ; convallaria, gtt. xxx. t. i. d.
February 2d : Pulse, 84, full and strong ; no other
effect.
Case XIV. — John R , aged fifty ; acute alcohol-
ism ; very shaky; pulse, 77, exceedingly feeble, almost
imperceptible at the wrist; first sound of heart hardly
audible with a stethoscope. January 23d : Convallaria,
gtt. XX. t. i. d. January 25th : Pulse, 72, same ; con-
vallaria, gtt. xxx. t. i. d. January 26th : Pulse, 80,
slightly better ; convallaria, gtt. xl. t. i.d. January 27th :
Pulse, 60, not improved at all to day ; convallaria, 3 i-
t. i. d. January 30th : Pulse, 60, very feeble indeed ;
convallaria stopped.
Case XV. — James S -, aged forty-eight ; phthisis,
third stage ; very serious hrenioptysis ; pulse, 66, very
feeble, hardly perceptible at the wrist. January 15th :
Temperature, 98^^° ; respiration, 30 ; convallaria, gtt. x.
t. i. d. January r7th : Pulse, 80, improving; feels
stronger; no more blood in sputum. January 19th:
Pulse, 96, much stronger. January 22d : Patient had
another severe hemorrhage ; pulse, 66, very feeble.
January 23d: Pulse, 72, almost imperceptible; conval-
laria, gtt. XX. t. i. d. January 24th : Pulse, 70 ; respira-
tion, 24 ; temperature, 99° ; pulse still very feeble ; con-
vallaria, gtt. XXXV. t. i. d. January 26th : Some improve-
ment ; convallaria stopped and other treatment resorted
to.
And now a brief resume of results : There were nine
cases of organic heart disease, in most of which consider-
able hypertrophy had already occurred, or dilatation had
even taken place. In six of these cases a moderate ef-
fect was obtained from the remedy ; in three there was
no result. In none of the cases in which irregularity or
intermittency of the pulse was marked did convallaria
aftect the heart-rhythm. It has been claimed that con-
vallaria is more adapted for cases of functional than f^or
cases of organic heart disease ; but the amount of relief
which some of the above cases obtained was very con-
siderable, and I cannot but look upon the drug as an
occasionally valuable agent even in the most advanced
forms of cardiac disease. The results obtained in the
remaining six cases were not much better than those
from the first nine. Five of these cases were cases of
cardiac failure from acute disease, from hemorrhage, or
from depraved general conditions. Of these five, one
only was not benefited at all ; and in several cases the
results were very satisfactory.
I found it necessary, however, in most cases, to give
2^8
THE MEDICAL RECORD.
[September 8, 1883.
doses considerably in excess of the ordinary ones. Several
cases took 3 i. of the fluid extract t. i. d. without bad ef-
fect; one case, No. VIII., took 3 ij. t. i. d., and was
nauseated by it ; but the patient had been suffering from
chronic gastro-catarrh before, and it is possibly unfair to
attribute her vomiting to the drug alone.
One word as regards the diuretic etlects of convallaria.
I am sorry that I did not have the urine measured in all
the cases from day to day. In the only case in which
that was done, No. X. — one of advanced disease of the
kidneys — the amount of urine was not increased, and the
dropsy was not affected. But there was certainly no very
marked diuresis caused by the drug in any case, for it
would surely have been brought to my notice.
2. Manaca. — Twelve cases were treated with this drug
— all cases of chronic rheumatism. In the cases which
were benefited the heat and swelling rapidly disappeared
from the joints ; the pain on motion of the limb and con-
sequent disability soon became better. In almost all
cases I began with the usually prescribed dose — five,
ten, fifteen drops — but was obliged to increase it to two
drachms, or half an ounce, before any decided effect was
observed. The preparation used was the fluid extract
prepared by Parke. Davis & Co.
Case I. — Chronic rheumatism. Dose, 3 i. to 3 ij. t. i. d.
Began to improve on fourth day; under treatment one
month ; recovered completely.
Case II. — Chronic rheumatism. Dose, 3 ss. t. i. d. Be-
gan to improve on sixth day ; under treatment thirteen
days.
Case III. — Chronic rheumatism. Dose, 3 i. t. i. d.
result ; under treatment nine days.
Case IV. — Chronic rheumatism. Dose, 3 i. t. i. d.
result ; under treatment sixteen days.
Case V. — Chronic rheumatism. Dose, 3 ij. t. i. d.
gan to improve in three days ; good result ; whole time
of treatment eleven days.
Case VI. — Chronic rheumatism. Dose, 3 ss. t. i. d. No
result ; under treatment ten days.
Case VII. — Chronic rheumatism,
four hours. No improvement at al
live days.
Case VIII. — Chronic rheumatism
Improvement began in five days ; gootl results
treatment fourteen diys.
Case IX. ^ — Chronic rheumatism. Dose, 3 ss. t
gan to improve in three days ; good result
treatment eight days.
Case X.. — -Chronic rheumatism. Dose, 3 ij. t. i. d.
Joints began to get better in five days ; time of treatment
twenty-four days ; very good result.
Case XI. — Chronic rheumatism. Dose, 3 ij. t. i. d.
Improvement began in two days ; excellent result ; time
of treatment eighteen days.
Case XII. — Chronic rheumatism. Dose, 3 ij.to r ss.
t. i. d. Improvement began on third day and continued
to a certain extent, and then stopped.
Of the twelve cases of chronic rheumatism, seven re-
ceived very marked benefit from the drug ; one was
moderately relieved, and in four cases no effect at all was
perceived. 1 regard the drug as certainly worth a trial,
at least in these very common and often very trouble-
some cases.
3. Eucalyptol. — My attention was drawn to the use
of eucalyptol in cases of phthisis, chronic bronchitis, etc.,
by a writer in the Berl. Klin. Wochenschrf. of last year,
who recommended it both internally and by inhalation
in these cases. Fifteen cases in all were observed ;
Merck's preparation of the drug was used. It was
claimed that it lessened the cough and expectoration,
diminished fetor, etc.
Case I. — Phthisis, third stage. Dose, gtt. x. t. i. d., and
inhaled. Relief began on second day, and continued
sixteen days, as long as drug was continued.
Case II. — Phthisis, second stage. Dose, gtt. v. t. i. d.
No effect at all ; took eucalyptol seven days.
No
No
Be-
Dose, 3 ij. every
: under treatment
Dose,
ij. t. i. d.
; time of
i. d. Be-
; time of
Case III. — Phthisis, second stage. Dose, gtt. v. t. i. d.
Improvement began on second day, and continued until
her discharge — six weeks.
Case IV. — Phthisis, third stage. Dose, gtt. v.-xv. t. i. d.
Relief began in five days, and continued to a moderate
degree during the two weeks of treatment.
Case V. — Phthisis, second stage. Dose, gtt. v. t. i. d.
Relief began on third day, and continued till she was
transferred, three weeks later.
Case VI. — Phthisis, third stage. Dose, gtt. v.-x. t. i. d.
No result at all. Took eucalyptol seventeen days.
Case VII.— Asthma and chronic bronchitis. Dose,
gtt. v.-x. t. i. d. Relief began in two days, and continued
during time of treatment — one week.
Case VIII. — Phthisis, second stage. Dose, gtt. x.
t. i. d. Relief in two days ; continued for two weeks.
Case IX. — Phthisis, third stage. Dose, gtt. x.-xxx.
t. i. d. No result. Took eucalyptol for ten days.
Case X. — Phthisis, third stage. Dose. gtt. x.-xxx.
t. i. d. No improvement at all. Took eucalyptol two
weeks.
Case XI.. — Phthisis, third stage. Dose, gtt. v.-xx.
t. i. d. No effect till he had taken drug a week ; then be-
gan to improve, and continued doing so during remaining
time — two weeks.
Case XII. — Phthisis, third stage. Dose, gtt. v.-xx.
t. i. d. Began to improve in three days, but drug soon
lost all effect.
Case XIII. — Phthisis, second stage. Dose, gtt. v.-
xx. t. i. d. Began to be relieved by second day ; continued
so for two weeks, and then drug lost its effect.
Case XIV. — Phthisis, second stage. Dose, gtt. x.
t. i. d. No result. Took drug for ten daj's.
Case XV. — Phthisis, third stage. Dose, gtt. v.-xxx.
t i. d. No result from eucalyptol. Treated two weeks.
Fifteen cases, then, in only four of which the patient
was distinctly benefited. Four cases were relieved to a
small extent, and seven cases were not affected at all.
Still the cases that did well under it obtained marked re-
lief It seems to be of most use in cases with very
abundant muco-purulent expectoration.
The inhalation of the vapor from a respirator contain-
ing a sponge upon which a few drops of eucalyptol can
be poured is undoubtedly a valuable method of adminis-
tration of the drug.
4. Verba Santa. — A large number of cases were
treated with this drug, which has been much vaunted as
a stimulating expectorant. There were 41 cases ob-
served in all, 30 of them cases of phthisis, second and
third stages, and the rest bronchitis with asthma and
emphysema, Bright's disease, etc. I cannot say that the
results have been in any way encouraging. In only 9
cases was any real benefit observed ; in 11 a moderate
amount of relief was obtained ; 21 cases were not
affected at all. Nay, more than that, in a very large
number of cases — 17 in all — gastric derangement, nau-
sea, and vomiting were caused by the drug. I cannot,
therefore, look upon yerba santa as a very important ad-
dition to our list of expectorants.
5. Chekau. — This drug belongs to about the same
class as the one last considered, and can hardly be looked
upon as of much more value. Twenty-one cases were
treated with it, most of them cases of chronic cough from
phthisis, bronchitis, etc. In only 8 cases was marked
relief in the cough and expectoration afforded by the
drug ; in 2 or 3 a slight effect was noted ; in the re-
maining II cases there was no result at all. In 3 cases
the medicine disagreed, caused nausea and vomiting,
and had to be stopped. The fluid extract was the prepa-
ration used, and tlie dose one drachm to half an ounce
t. i. d. Here, then, is a result which is hardly more en-
couraging than that obtained with yerba santa.
6. Oleum Gaultheria-. — This drug was carefully tried
in four cases of severe subacute rheumatism with moder-
ate success. The doses used varied from five to ten drops
three or four times a day, and no other treatment what-
September 8, 1883.]
THE MEDICAL RECORD.
259
soever was employed. In all four cases much relief was
obtained from the drug ; in all of them the swelling, the
pain, and the local heat soon diminished, and the pa-
tients were shortly convalescent ; but in every case, also,
a certain amount of disability was left which the drug did
not relieve, and for which recourse had to be had to fric-
tions, massage, etc.
7. Lippia Mexicana. — Twelve cases were treated with
this expectorant, of which the fluid e.xtract was given in
half-drachm to half-ounce doses t. i. d. A somewhat
better result was obtained than was done with the other
two expectorants tried. In seven cases out of the twelve
the harassing cougii was markedly relieved, enabling pa-
tients to obtain a comfortable night's rest who had pre-
viously been able to get it only by a free use of nar-
cotics. Five cases were not aflected at all ; but in no
case was there seen the disagreeable gastric disturb-
ances caused both by yerba santa and chekau. 1 look
upon it, therefore, as a remedy of some value for the
relief of an often very distressing symptom.
8. Quebracho. — Excellent results were obtained with
the fluid extract of this drug. Nine cases were observed,
and in all of thern save one great relief was obtained
from the dyspnoea. The cases comprised ones of
asthma, valvular cardiac disease, Bright's disease, chronic
bronchitis, and phthisis, and in all but one case of
phthisis respiration became easier, the blueness disa])-
peared from the finger-ends and the prolabia, and the ]3a-
tient's general condition became very much better. The
doses used were half a drachm to two drachms t. i. d.
A CONTRIBUTION IN FAVOR OF COTTAGE
HOSPITALS— REPORT OF TWO INTEREST-
ING SUR(;iCAL CASES.
By \V. L. ESTES, M.D.,
MEDICAL SUPERINTENDENT OF ST. LUKE'S HOSPITAL, SOUTH BETHLRHEM, PA.
The essay on "Cottage Hospitals," published by Dr.
Burdett, excited so much interest in this countr)', and these
enterprises or charities were so highly advocated gen-
erally by our medical press, that the following short statis-
tical report of the one of which the writer has charge may
prove of interest to the profession, and is given for what
it may be worth.
St. Luke's Hospital, situated in South Bethlehem, was
opened in 1873. The first year 69 patients were treated.
Last year, 1881-82, 692 patients received treatment.
Beginning in an ordinary two-story brick cottage, it is now
grown to the dimensions of a brick pavilion (opened only
last year), built upon the most approved modern pavilion
hospital plan, and |iossessing every convenience of a
metropolitan hospital, also two wooden buildings after
the ordinary country style of architecture, having an
aggregate capacity of forty beds. The pavilion has two
wards, of twelve beds each, and is used for acute surgical
cases ; one wooden building, having a capacity of eight
beds, for women's diseases; and the other wooden build-
ing, with eight beds, for isolation. Since the opening of
the pavilion, from November 21, i88t, to November 21,
1882, there have been 43' major operations performed,
with 2 deaths, or 4.8 per cent. The operations were, 20
major operations, with 2 deaths ; 9 major exsections,
with no death. The remaining 14 were miscellaneous,
and no fatal result.
The amputations were as follows : i at wrist-joint, re-
covered ; 2 of forearm, both recovered ; 3 of arm, all re-
covered ; 8 of leg, I death; 2 at knee-jonit, both recov-
ered ; 3 of thigh, I death ; i at hip-joint, recovered.
Total, 20 cases, 2 deaths.
The death after amputation of the leg was from delirium
^ There were actually 53 major operations, but as 10 of these (rt"//«('<i^w«-r)
were done on cases in absolutely hopeless conditions, merely to render the few
hours the patient might possibly live as bearable as possible, tliey are not counted
in the above enumeration. Recl<oning these, there would be 53 major operations,
with S deaths (3 of the hopeless cases had each two limbs torn off, requiting
imultaneous amputations;, making 15.12 per cent.
tremens on the tenth day ; that after amputation of the
thitfh, from septicasmia. The amputation was done for
compound comminuted fracture of the leg after a pro-
longed attempt had been made to save the limb. The
patient was already suffering from septicremia when
operated upon. He never rallied from the condition,
and died about twelve days after the amputation.
The resections were : 2 of tarsus, 2 of tibia, i of knee-
joint, 2 of femur, i of hip-joint,' i of ribs (for empysema) ;
all recovered. Total, 9 cases, 9 recoveries.
Of the amputations 2 were done for diseased condi-
tions. The hill-joint amputations ; 18 were after inju-
ries. Of these, 15 were primary or immediate, and 3
were secondary or intermediate (done during active in-
flammation and suppuration). With scarcely a single
exception, in every case of amputation from injury, there
had been excessive hemorrhage before the patient arrived
at the hospital.
Except the resection of the knee-joint all of the exsec-
tions were for diseased joints and bones. In all these
cases the modified Lister dressing was employed, that is
to say, thorough cleansing of the limb at the seat of opera-
tion, disinfection of the skin and wound — if there was
one- — with five per cent, solution of carbolic acid ; hands
of operators and assistants disinfected with the same so-
lution, as were the sponges, instruments, etc., used dur-
ing the operation. Afterward a full Lister dressing was ap-
plied, and removed only when soiled or the temperature
of the patient rose. In the whole series of cases there
was not a single case of gangrene, nor of osteomyelitis,
nor phlebitis, nor erysipelas. Not a single case of sec-
ondary hemorrhage. The average time in the hospital
was 28.3 days.
Among the operations there are two which appear to
be of sufficient interest to publish.
Case 1. — George R , nine years of age, admitted
February 6th. Five months before admission the patient
was struck by a locomotive, and besides severe internal
injuries, sustained a fracture of the left femur in the up-
per one-third of the shaft. In a written statement of his
treatment after the fracture, his physician said he had tried
first extension and counter-extension, and then a plaster-
splint, without being able in either case to retain the frag-
ments in proper apposition. He sent him to the hospital
to be treated for ununited (?) fracture of the femur. On
admission the patient was a bright, sturdy little fellow, well
grown for his age, well nourished, and best family his-
tory. He used crutches, and carried the lower extremity
in a limp, helpless manner. Toes inverted, pointing to-
ward the dorsum of the right foot. He could, by leaning
far over, bring the sole of the foot to the ground, but
could not bear any weight on the foot without pain.
Examination of the affected limb showed an enormous
projection in the upper femoral region, on its external
aspect — hard, resisting, not movable, not separable, and
no crepitus ; acetabular motion perfect, extremity moved
as a whole; two and a half inches shortening. Nekton's
line showed the trochanter major slightly higher than
normal, and it also projected externally more than
normal. It was evident the fracture had united, but in
a very bad position.
The parents of the child readily consented to an
operation. A short time after his admission this was
accordingly undertaken. A curved incision was made
over the projection, beginning just below the greater
trochanter and extending about three and a half inches
downward in the longitudinal axis of the limb. Convexity
of incision downward. The incision was carried through
the periosteum, which was carefully stripped off, and the
bone cleared, when the exact state of the deformity was
manifest. The fracture had been about one and a half
inch below the trochanter minor; the upper fragment
1 This case after\vard required amputation of the thigh. The operation (exsec-
tion) was done several days after the injury, which was crushing of the condyles
of the femur and disintegration of the knee-joint : performed because the pauent
refused amputation. The soft tissues of the lower third of thigh had been sn
badly injured that he was obliged to have the amputation afterward.
26o
THE MEDICAL RECORD.
[September 8, 1883.
was rotated inward and drawn slightly upward by the
iliacus and psoas muscles ; the lower fragment was
drawn upward and outward by the muscles of the tliigh,
and they were allowed to unite in this position, the ap-
position being the lower outer side of the upper and the
inner edge of the lower fragment. The union was so
firm that it was necessary to use a saw to separate the
fragments. A wedge-shaped piece was removed from
the knuckle-like projection of bone, firm manual exten-
sion was employed to draw the lower fragment into place,
which was readily effected. It was with the greatest
difficulty that the upper fragment could be reduced, and
almost impossible to retain it in place. Good apposition
was finally obtained, however, and by means of two
double bands of thick silver wire passed through two
holes drilled obliquely through the end of either frag-
ment they were retained in apposition. The incision
was brought together, large drainage-tube introduced,
and Lister dressing applied, after the usual five per cent.
ac. carbol. solution syringing. While the patient was
still under the anaesthetic, a plaster-of-Paris splint was
applied to the whole extremity, with iron brackets over
the wound. For a number of days the little patient suf-
fered agonies from spasm of the femoral muscles. This
gradually ceased, however, and he made a slow but com-
plete recovery. He was discharged from the hospital
with no deformity, one inch shortening, and walking
well with assistance of a slightly elevated shoe. I have
recently received a letter from his father saying he walks
about three miles a day to and from school, has dis-
carded his raised shoe, and knows no difference between
his two limbs.
Case II. — .-Mbert B , aged thirteen. Phthisical
mother. " Hip-joint disease " for five years. Was seen
first about one year before the last admission, at which
time he entered the hospital, and exsection of head of
femur was performed. He improved very much after
this, but after three months the upper end of the shaft of
the femur had to be exsected. The sinuses still persist-
ing after the operation, he was re-admitted into the hos-
pital October 13, 1882. .\fter a consultation it was
decided to amputate at the hip-joint. The boy was ([uite
anajuiic, and the urine had already a small amount of
albumen in it. The liver and spleen were enlarged ;
heart and lungs normal. It was particularly desirable in
this case to avoid much loss of blood, and knowing that
one of the principal bugbears of amputation at the hip-
joint is hemorrhage, I was at a loss at first how to pre-
vent it. I finally hit upon an expedient which acted
admirably. I have noticed that in ap|.)lying Ksmarch's
bandage and retentive band for operations high up on
the thigh, the reason why the band did not prevent the
blood from flowing back into the limb was that the point
of resistance ojiposite to it, when it should constrict, was
a resilient one, and the pull of the band was in a meas-
ure counteracted by the elasticity of the tissues of the
opposite side. So I reasoned if a firm non-resilient sub-
stance be interposed between the band and the opposite
side, the whole force of the elastic constriction will be
exerted on the limb to be operated upon.
On October 17th the operation was performed. As
soon as the jiatient was an;usthetized I applied a loti:^
Lisler splint to the sound limh and side, put on Ksmarch's
bandage as usual, the retentive band being applied
tightly in a figure of 8 around the groin, just below the
anterior superior spine of ilium, over the opposite side,
and so return ; in short, just as ordinarily done for high
operations. I then had the patient drawn down until
his buttocks were on the edge of the foot of the table,
laid the end of the splint attached to the good limb and
side on a high stool, and the jiatient was firmly and
evenly sujiported, while not a drop of arterial blood was
lost during the operation. The flaps were formeil after
the Guthrie manner. Though it was necessary to cut
almost under the retentive band, it held on firmly, and
did its work faithfully to the last. Besides the removal
of the entire limb, the whole acetabular rim and part of
the ramus of the pubis had to be removed. So tedious
was this part of the operation that the patient's strength
began to flag, and I was obliged to stop the operation
before all the dead bone was removed from the pelvis.
The lower and inner parts of the flaps were nicely ap-
posed, a large-sized drainage-tube introduced, and, ex-
cept a space left open on the external aspect, flaps
brought together throughout whole extent.
Boy's highest temperature was on the fifth day, and
was only loi" F., produced, perhaps, by eating too
much solid food. Notwithstanding a large amount of
cicatricial tissue, the flaps united rapidly and well ; in two
weeks, except where the drainage-tube had been, and
two or three openings of old sinuses, the wound was
healed. He was out of bed in two weeks. Three days
later he was walking about the wards. His general con-
dition was much improved at once. Except two or three
sinuses, through which the dead bone left near the aceta-
bulum is making its way in bits to the outer world, he
has a well-healed stump, and feels perfectly well.
gvoovcBS of g^Xedical J>cicncc.
A Method of H.astening the Anesthetic Actton
OF the Ether Spr.^v. — The ether si)ray is employed
frequently at the Hopital St. Louis in Paris for the pro-
duction of local an;¥sthesia. A little procedure, first in-
dicated by Dr. Letamendi, of Barcelona, but not hitherto
utilized in practice, is employed by Dr. Vidal to shorten
the duration of the process of congelation. It consists
in making a slight prick with a needle at the point upon
which the spray is directed, at the moment when the skin
assumes a purplish hue, and when the ether commen-
cing to solidify assumes an oily consistency. The little
puncture made at this time excites a reflex constrictive
action of the vaso-motor nerves, the blood is driven from
the part, and the skin becomes white, .'\nother method
of hastening the process consists in placing little wads of
lint about the part, thus increasing the surface of evap-
oration.— Revue Medicale, June 30, 1883.
Tuberculosis from Cont.^gion. — Dr. J. Lindmann
relates, in the Deutsche Medieinische Wochenschrift of
July 25, 1883. two cases of tubercular ulceration follow-
ing circumcision. In the first case, in which there was a
family history of phthisis, the ulceration healed only after
a long time, and was followed by caseous adenitis. Then
Pott's disease of the spine was developed, accompanied
with symptoms of myelitis, and finally the child died from
acute pulmonary phthisis. In the second case, there
was no hereditary history of disease. This child, after
suffering from enlarged glands and an osteitis of the wrist-
joint, finally recovered and remains in good health at the
present time. The ulcerations in both cases presented
all the characteristics of tubercular ulcers. The children
were circumcised according to the orthodox ritual of the
Hebrews, in which the circumciser, after cutting oft' the
prepuce and tearing the mucous layer with his nail, takes
a swallow of wine and sucks the bleeding parts. The
operator in these cases belonged to a family almost all
of whose members suffered from phthisis. He himself
had been ill for some years, and died from tuberculosis
shortly after performing circumcision in these two cases.
Dr. Lindmann regards the disease in the related in-
stances as undoubtedly arising by contagion from the
phthisical operator.
The Therapeutical Value of Arbutin. — Although
arbutin is no recently discovered substance, it is only of
late that it has been proposed to the medical profession
as a remedy of value in the treatment of diseases of the
genito-urinary organs. This is probably due to the fact
that the earliest experiments were made u])on the healthy
organism, and were not unnaturally negative in their re-
September 8, 1883.]
THE MEDICAL RECORD.
261
suits. More recent investigations into the action of this
gkicoside in disease would seem to indicate that we have
here a remedy of no inconsiderable importance, and one
whicli may bo advantageously substituted for the bulky
infusion of uva ursi. In a notice of this substance in the
Centralblatt filr Klinische Medicin of July 7, 1883, Dr.
H. Menche states that he has found it in many cases to be
a most efficient diuretic. It is given for this purpose in
doses of about twelve grains per diem, but may be ad-
ministered in much larger quantities without producing
any unpleasant effects. In catarrh of the urethra or
bladder, larger doses are advised (forty-five to sixty
grams a day). It is e.\creted in part as hydrochinon,
and since injections of a one or two per cent, solution of
this latter substance are said by Brieger to be most effi-
cacious in the cure of gonorrhoea, the author suggests
that we might in this way avoid the use of the syringe,
the topical remedy being contained in the urine. .-Xrbutin
exists in the form of fine white, needle-shaped crystals,
unchanged by exposure to the air. It is readily soluble
in water, has a slightly bitter taste, and no odor. The
easiest mode of administration is in the form ot powder,
which may be dissolved in a tablespoonful of water. It
is somewhat expensive, the present price in Germany
being in the neighborhood of three dollars per ounce.
The Changes Occasioned in the Adipose Tissuks
BY Inflammation. — From a number of ex|)eriments
made upon dogs, Dr. Sklifosowsky formulates the follow-
ing conclusions: i. In acute inflammation of the sub-
cutaneous adipose tissue the changes in the fat-cells
consist in a shrinking and subsequent disappearance of
the investing membrane ; the fat drops are absorbed and
their place supplied by serous cavities. 2. Similar
changes also take place in acute inflammation of other
parts, as the pericardium, omentum, etc. 3. In chronic
inflammatory processes, the retrograde changes of the
fat-cells are expressed by hypertrophy and division of the
nuclei, and through swelling and subsequent segmenta-
tion of the protoplasm. 4. The fat is absorbed through
the lymphatic vessels, but whether absorption occurs also
through the walls of the blood-vessels is doubtful. 5. In
limited inflammation of the subcutaneous connective
tissue, no functional disturbance on the part of the heart
or lungs was caused by fatty embolism of the blood or
lymphatic vessels. — Centralblatt filr Chirurgie, July 14,
1883.
Pneumonia without Fever. — Although in aged or
cachectic individuals it is not very uncommon to see a
pneumonia run its course without any noteworthy eleva-
tion of temperature, such an occurrence under other con-
ditions is rare. Dr. Mazzotti reports a case of this kind
in a robust and well-nourished porter, sixty-three years
of age. The patient was suddenly seized with sharp pain
in the side, cough, and bloody expectoration. Physical
examination revealed the presence of a croupous pneu-
monia involving the left lower lobe. During the entire
course of the disease, which terminated favorably, the
temperature never exceeded 99.5°, and reached this height
but once, being normal the rest of the time. A similar
case has been recorded by Koranyi. — Centralbl. fiir
Klin. Medicin., July 14, 18S3.
Primary Tubercular Arthritis. — Dr. Arnaud con-
cludes an article of some length in the July number of
the Revue de Chirurgie, as follows : i . Tuberculosis of the
synovial membranes may be primary and independent of
any osseous lesion, or secondary to the development of
tubercles in the epiphyses. 2. Primary tuberculosis mani-
fests itself in the synoviaj under the two anatomical forms of
ordinary gray granulation and of elementary microscopic
tubercle. The latter always accompanies the granular
form, but may exist independently of any tubercular lesion
visible to the naked eye. 3. Synovial tuberculosis has
been chiefly studied in fungoid growths, but it can be de-
lected also where no fungoid changes are present, as in
fistulous tracts, or wherever the neoplasm maybe developed
by inoculation. 4. The tuberculous nature of a chronic
arthritis may easily escape detection unless the naked eye
examination be controlled by the aid of the microscope.
It would be well always to make a thorough anatomical
and histological examination in every case of arthritis, in
order to determine the comparative frequency of the tuber-
cular aflfection. 5. Finally, the author expresses his con-
viction that a certain number of cases of white swelling
and chronic arthritis, fungoid or otherwise, hitherto at-
tributed to scrofula, rheumatism, or unknown causes,
will be found upon more careful examination to be tuber-
culous in their nature.
Trephining for the Relief of Traumatic Epilepsy.
The following case was related to the Surgical Society
of Paris by M. Demons, of Bordeaux {Revue de Chirur-
i^ie, July 10, 1883). A man had fallen two years before,
striking his head. He was unconscious for three days,
there was an ecchymosis of the scalp, he stated, on the
right side, and a paralysis of the left arm and right leg
was present for some four or live months. From that
time until shortly before coming under observation, he
was perfectly well, except for occasional headaches. He
was then suddenly seized with repeated attacks of epilepsy,
recurring every fifteen minutes, with left facial paralysis,
and subsequently with hemiplegia of the same side.
The epileptic attacks becoming more frequent and of
greater violence, and the intellect becoming clouded,
M. Demons decided to trephine. After some hesitation
regarding the seat of injury, the trephine was applied to
the right side over the fissure of Rolando. As the opera-
tion proceeded a crack was seen in the skvill, and in the
arachnoid was found a little cyst the size of a pea. This
was removed, and the surface of the brain was scraped
where it seemed to have undergone some alterations. A
Lister dressing was applied, and the wound healed
readily. The epileiisy and hemiplegia disappeared at
once, and had not returned at the time of the report, a
month after the operation.
Abscess of the Posterior Spinal Region in the
New-Born. — Dr. Gu^niot relates two cases of abscess in
the vertebral region (one in the neck and one in the
back) in children of two and four weeks of age respec-
tively {Centralblatt fiir Chirurgie, July 21, 18S3). A
diagnosis was made by himself and several other sur-
geons of spina bifida. The location of the abscess exactly
m the median line, its slight change in size upon crying,
and the absence of redness or cedema of the skin gave
occasion to the error. The mistake was discovered only
after an exploratory puncture. The author states in this
connection that abscesses may form in young children in
any situation. The slight increase of volume in crying
is 'owing to a fulness of the veins caused thereby. The
absence of the ordinary oedematous swelling of the skin
covering deep abscesses is not uncommon in infants.
This fact he explains by the late development of the
superficial venous plexus.
Treatment of Malignant Pustule bv Injections
OF Iodine.— Dr. Richet relates two cases of malignant
pustule treated by injections of tincture of iodine. One
died in forty-eight hours, while the other recovered after
eight injections of the tincture diluted with two parts of
water. In both cases inoculations of animals with pus
from the pustules were followed by fatal results. Inocu-
lauons with the blood of the first patient were also fatal,
while the blood of the second caused no infection. The
author concludes from these cases that when the infec-
tion is general, when the blood contains the specific
bacilli, local treatment is useless. But, on the other
hand, if injections at the periphery of the pustule are
made before the disease has spread from its point of ori-
gin, a cure may be ohtw\e.i.— Centralblatt fiir Chirurgie,
July 21, 18S3.
262
THE MEDICAL RECORD.
[September 8, 1883.
Surgical Treatment of Dupuytren's Contrac-
tion.— In a brochure on Dupuytren's contraction of the
pahiiar fascia and its treatment, Dr. Chevrot describes a
method pursued by Busch in the correction of this de-
formity. A triangular tongue of skin is dissected up
from the pahn, the base of the triangle resting in the
crease which separates the contracted finger from the
hollow of the hand, and the ape.x terminating at the point
of greatest prominence when the finger is forcibly ex-
tended. The base of the triangle is left attached while
the rest of the flap is dissected up, as much of the con-
nective tissue as possible being raised with the skin. All
the contracted bands of the aponeurosis are divided, un-
til complete extension of the finger is obtained. The
flap of skin retracts, leaving a triangular space in the palm
uncovered. The edges are approximated as far as pos-
sible, and a compress applied. A retentive splint should
be applied and maintained until the cure is completed.
If this method is pursued the danger of wounding the
sheaths of the tendons is reduced to a minimum. — Bulle-
tin General de Therapeutiqiie, July 15, 1883.
The Permanent Bath in the Tre.\t.ment of Sur-
gical Diseases. — In cases after operation in which the
ordinary antiseptic dressings cannot be conveniently
applied, owing to the location or other conditions of the
wound, Dr. Sonnenburg advises a return to the perman-
ent bath. He has met with considerable success by this
treatment after operations upon the urethra, rectum, or
uterus, or in lithotomy. In the after-treatment of ampu-
tations or resections he has found it also useful. The
addition of antiseptic substances to the water of the bath,
he considers to be unnecessary. — Centralblatt fiir Gyna-
kologie, July 21, 1883.
Ether in the Treatment of Sore Throat. — Pro-
fessor Contalo employs an ether spray in the treatment
of pharyngitis. The applications are made several times
a day, according to the gravity of the case. Under their
influence, it is claimed, the temperature falls, the vessels
contract, and the local condition is speedily improved.
In two cases a fibrinous exudation was detached and not
reproduced. Ether, according to the author, deserves a
trial in pharyngeal diphtheria, not only as an antiseptic
agent, but also because the pain is thereby gjeatly
diminished, and the taking of nourishment facilitated.
Two cases of pseudo-membranous pharyngitis were suc-
cessfully treated by this method. He insists especially
upon the rapid lowering of temperature following the ap-
plications of ether spray. — Journal de Mcdecine de Paris,
June 16, 1883.
Adenoid Growths in the Pharynx. — The follow-
ing are the conclusions arrived at by Dr. Pesson in a
thesis i^resented to the Faculte de AFedecine of Paris
{Journal de Medecme de Paris, June 16, 18S3). i. In
the upper part of the pharynx, at the junction of the
vault and the posterior wall, and between the orifices of
the Eustacliian tubes, there is an agglomeration of closed
follicles which constitute (adopting the expression of
KiJlliker and Luschka) a true tonsil. 2. This gland is
liable to hypertrophy like the tonsils, and then presents
the appearance of a cluster of vegetations. These vet^e-
tations, already described by a number of writers, are
seen usually during the first twenty years of life. Like
the lymphatic tissue in general, their natural tendency
is to atrophy. 3. These adenoid growths give rise to
various troubles of respiration, phonation, and hearin".
Children who suffer from their presence, breathe through
the mouth and actpiire thereby a stupid expression ; they
complain of frequent headaches, snore during sleep, and
are sometimes awakened in the night by asthmatic attacks.
The tone of the voice is muffled and faint, and the ar-
ticulation of nasal words (in I-'rench) is difficult. Hear-
ing is often impaired through middle ear disease. These
troubles, wliich often discourage the physician by their
obstinacy, disappear spontaneously upon the removal of
the third tonsil. At the same time the deformity of the
thorax, described by Lanibon and Robert, and attributed
by them to hypertrophy of the tonsils, is observed. A
careful study of the facts leads to the belief that this
symptom is really due to the adenoid vegetations in the
pharynx. 4. These growths often determine a chronic
catarrh in this region, which is too often referred to a
diathesis, but which, like all the other symptoms, can
only be cured bv treatment directed to the vegetations.
5. Observation leads also to the opinion that deaf-mutism
depends in certain cases upon the presence of these
adenoid vegetations. Consequently, an opportune diag-
nosis may lead to the prevention or even cure of deaf-
mutism from such cause. 6. Hypertrophy of the third ton-
sil maybe diagnosed by posterior rhinoscopy or by digital
examination. 7. The treatment of these vegetations and
of the symptoms dependent upon them consists essenti-
ally in the extirpation of the enlarged gland.
Myxcedema and Beriberi. — Dr. Basil Feris regards
beriberi and myxcedema as identical, each being character-
ized by a more or less general anasarca, together with
disturbed function of the nervous system. The exciting
causes are the same in each disease, namely, humidity and
rapid changes of temperature. He proposes as a com-
mon designation the term neuro-vascular hydroparesis,
or more simply hydroparesis. — Revue Medicate, July 21,
1883.
Treat.mextof Suppurative Phlebitis. — Dr. Demons
related the following case to the Bordeaux Medical
Society, as showing the curability of suppurative phlebitis
if energetically treated {Revue Mcdicale, July 21, 1883).
A man cut the veins of his neck w'ith a razor. A sup-
purative phlebitis followed, and symptoms of pyaemia
declared themselves. In the presence of such an other-
wise hopeless condition. Dr. Demons determined to slit
up the veins, which he found full of pus. He scraped
them and cauterized the lining membrane with a ten per
cent, solution of chloride of zinc. An antiseptic dressing
was then applied, and the patient recovered. Since then
the author has learned that veterinary surgeons sometimes
excise the jugular vein in similar conditions, and he
thinks that such an operation might be preferable to the
one performed by him in the case reported.
Epistaxis Arrested by Hot-Water Douche. — Dr.
J. H. Stuart, of Minneapolis, sends us a report of the
following case : "On July 14th last I was called to see
a laboring man, about thirty years of age, who had been
bleeding at the nose for nearly twenty-four hours. The
epistaxis seemed to have been caused by' sitting in a
draught of air, in the evening, with a portion of his clothing
left off, whicli produced a stuffiness in the nares. Vari-
ous remedies had been used, but with no relief, and the
loss of blood was sufficient to produce a very perceptible
impression on his pulse, accompanied by a feeling of
faintness. Having determined to try the value of hot
water I took with me apparatus for douching the nose,
and having procured a pitcher of warm water (not as hot
as I desired) I passed it in a continuous stream through
the nares. The hemorrhage seemed to be checked for a
while at least, but soon the bleeding side was filled by a
clot, and again it showed itself both posteriorly and an-
teriorly. I procured another pitcher of water as hot as
I thought could be borne and douched the nose as be-
fore. I continued the douche until the water escaping
was almost free from any stain of blood — using perhaps
a gallon. After this there was no bleeding, not even the
formation of a clot in the nostril ; but the patient, breath-
ing freely through both sides, went to bed about 10 p.m.
and sle|)t till morning without any return of hemorrhage
whatever. It is true I endeavored after each douching
to throw a solution of tannin into the posterior nares,
but I attributed little or no benefit to this procedure."
September 8, 1883.]
THE MEDICAL RECORD.
263
The Medical Record:
A Weekly Journal of Medicine and Stir gery.
GEORGE F. SHRADY, A.M., M.D., Editor.
Published by
WM. WOOD &. Co., Nos. 56 and 58 Lafayette Place.
New York, September 8, 1883.
THE PATHOLOGY AND TREATMENT OF ME-
TRIA, OR SO-CALLED PUERPERAL FEVER.
Metria, the gynecological, and, in this instance, proper
name for the so-called puerperal fever, has recently been
the subject of three very instructive, as well as interest-
ing papers, read before the British Medical Association.
There is scarcely a question but that the term metria
should be substituted for " puerperal fever." Dr. Thor-
burn justly remarks that "puerperal fever" does not cover
the ground, for it is almost impossible to include epidemic
puerperal fever under the same classification as the more
sporadic forms ; and again, the use of the term precludes
the inclusion of cases of metria caused by zymotic dis-
eases. Regarding this he says, as is well known, that the
poisons of scarlatina, erysipelas, or typhoid fever may
sometimes cause in puerpera symptoms scarcely distin-
guishable from those of puerperal fever ; yet Mathews
Duncan and his followers, who wish to make puerperal
fever a disease siii generis, do not include zymosis with
septicemia or in their list of etiological factors. Again,
a puerpera who has scarlatina which can be distinctly
diagnosed, has scarlatina ; but a woman who has sudden
rigors, intense tympanites, high temperature, and rapid
death, with subsequent clear proof of scarlatinal infection
— with perhaps the occurrence of the typical rash m the
hour of death — has |)uerperal fever or metria caused by
scarlatina. Zymotic diseases may occur in puerperal
women without causing puerperal symptoms, and should
be then designated by their proper names; but when, with
that zymotic affection, puerperal symptoms manifest
themselves, shall we confine our nomenclature to one or
to a combination of the two ? Clearly the latter, and
metria is then the proper designation.
Precisely the same causes are at work whether scar-
latina or erysipelas be sporadic or epidemic, and may in
the latter case produce a severe and fatal epidemic
analogous to what occasionally occurs in hospital, more
rarely in private, obstetric practice. Arguing from this
point of view, Dr. Thorburn thinks that there would be no
difficulty in conceiving how a tolerably definite train of
symptoms ensuing from the action of septic or zymotic
germs in the hyperfibrinated blood of a puerperal woman
may, in some cases, take on a uniform character and
epidemic virulence. Clearly another name than puer-
peral fever is needed, and if we need another what is
better than metria ?
As regards the pathology of metria, the two points ar
stated by Dr. Lombe Atthill as admitted by all. First,
under certain circumstances puerperal women are liable
to be inoculated with septic material conveyed to and
deposited in the vagina by the hands of attendants and
other agencies, when proper precautions against this in-
fection have not been adopted ; the disease produced
by this inoculation being frequently a source of one of
the forms of metria ; and second, puerperal women may
be the victims of auto-inoculation, the poisonous material
originating within their own bodies from the decomposi-
tion of blood-clots and placental remains after parturition.
The disease thus produced Dr. Mathews Duncan prefers
to call " sapramia " — or a result of the absorption of putrid
material — distinguishing it from " septicemia, a disease
produced by organisms which, when conveyed to the blood,
multiply indefinitely in it ; " Dr. Duncan holding that or-
ganisms resulting from putrefaction do not survive, far
less grow, in the blood. The merits of the last proposi-
tion we will not now discuss ; indeed, we rather doubt if
it has any.
In addition to these two forms of metria Dr. Atthill
asks if there are not two other forms which it may not be
possible to guard against. First, a form of auto-infection
occurring under special conditions and not preventable by
antiseptic precautions, but happily preventable in many
cases by other therapeutic measures. This form occurs
in cases of continued uterine relaxation, thus leading to
the second of the varieties already mentioned. The
uterus does not properly contract, blood-clots are re-
tained in its cavity which decompose and thus produce
the disease. This condition of the uterus also favors the
formation of other clots than those directly resulting \
from parturition, and the sinuses being kept open, favor
the absorption of septic material. Though antiseptic
measures are powerless here, the enemy can be combat-
ed by the administration of ergot, continued after labor
until the desired eflect is produced. As is well known,
this condition of relaxation occurs most frequently after
rapid deliveries. A consideration of these, we may say,
facts, has led Dr. .\tthill to believe that a relaxed con-
dition of the uterus — doubtless caused in a great measure
by the great mental distress — is one of the causes of the
frequent occurrence of metria in unmarried women.
Clearly in these cases the prime cause, viz., relaxation of
the uterus must be combated by oxytocics. The mor-
tality among this class of patients is very great, and in
the absence of hitherto successful means of staying it,
it is advisable that this remedy have a thorough trial. It
is important to remember, however,' that many cases of
uterine rela.xation will yield to persistent kneading, one
hand being placed on the abdomen, and the other intro-
duced into the uterus.
A late paper by von Swiecicki {Ccntralbl. f. Gyndk.,
No. 16, 1S83), m which he expresses the opinion that
persons engaged in obstetric practice should not per-
form post-mortem examinations, or dissect, or if they do
should quarantine themselves from the lying-in cham-
ber for a certain length of time, has been followed by a
free expression of opinion. Lohlein takes exception to
v. Swiecicki's arguments, believing that proper antiseptic
measures are all that is necessary, and Fritsch, in com-
menting upon Lohlein's paper, practically agrees with
him {Centralbl. f. Gyndk., No. 23, 1883). It would
264
THE MEDICAL RECORD.
[September 8, 1883.
seem, however, that antiseptic precautions alone are not
a sufficient safeguard. Lohlein and Fritsch have had, it
is true, exceptional good fortune, but recent experiments
have shown that micro-organisms are not so easily de-
stroyed by antiseptic agents, and we doubt much if sim-
ply washing the hands in antiseptic solutions will obviate
the risks of inoculation after handling septic material ;
and the adoption of Dr. .\tthill's rules is by far the safest
method. Students attending the patients of the Rotunda
Hospital in Dublin, are not allowed to dissect or make
post-mortem examinations, or attend a hospital contain-
ing patients suflering from infectious diseases ; and be-
fore examining any patients they are required to wash
their hands in a solution of carbolic acid. During the
first six and a half years of his mastership in the Rotunda,
these precautions sufficed to prevent anything like an
epidemic of puerperal septicaemia.
The treatment of puerperal sepsis is but little, if any,
more satisfactory than its pathology. When several cases,
coming with shorter intervals, occur in a hospital, there
is but one method to be pursued. The patients must be
removed, the wards disinfected, the l^oors and walls
washed with strong disinfecting solutions, and everything
else thoroughly disinfected, .-^s to the choice of a disin-
fecting material, it would seem that corrosive sublimate
is the most certain in its effects. In private practice
prophylactic cleanliness, thorough emptying of the uterus
after delivery, and the insurance of uterine contraction,
are the best and only safeguards so far as the woman is
concerned. It is scarcely necessary to reiterate the cau-
tions as to the cleanliness of instruments and the hands of
the accoucheur. When, however, by any mishap, the
puerperal woman is seized with the disease, our main re-
liance must be placed in quinine, intra-uterine injections,
opium, and stimulants. .\t present, cases of puerperal
sepsis are extremely liable to take on a remittent form,
and quinine must be given in full doses. In .\merica
and other countries where the malarial element is pre-
dominant, the dose of three to four grains every three
or four hours, recommended by Mr. Thomas .More Mad-
den, is scarcely less than child's play. It is important to
remember that a given amount of any drug is not a dose
unless it has the required effect. It may also be stated
quite positively that the day for depletion in these cases
has passed. As a rule, they assume an asthenic type
and need stinmlation. Intra-uterine injections are of the
utmost importance, but caution is required in their use,
and to employ a syringe which is not perfectly clean is
worse than useless. Lastly, the bowels should not be
neglected, and it is imi)ortant that they should act, and
thoroughly, before the patient is fully under the intluence
of the opium, in case that drug be employed; for in these
cases it is extremely difficult to re-establish peristaltic
action after it lias once been paralyzed.
THE PROPER CARE OF THE EYES OF THE COMI.VG
GENERATIO.V.
In connection with the late address of Mr. Charles
Francis Adams on " A College Feticii," and our recent
editorial, " Greek or German — Which ? " it niav not be
entirely foreign tojnake a few remarks on the subject of
the German Alphabet from a hygienic point of view. The
systematic examination of the eyes of school-children
might lead one to suppose that the youthful Teutonic eye
is presbyopic, hypermetropic, ametropic — anything except
normal. Diirr found the average myopia among the schol-
lars of a Hanoverian school to be 31.7 per cent. Reich
found an average of ^^ per cent, in another school. Nor
is the solution at all difficult to one who has turned from
an English to a German book printed in the abominable
text of the latter language. German authors are in-
clined to attribute this to the position during writing,
bad light, etc. These may be factors, but they do not
seem to have thought of their outrageous letters, and still
more outrageous script. Every one acknowledges the
importance of the German language, especially in scien-
tific studies. But why should American children, and
adults, for that matter, be compelled to gain their first
.knowledge of that beautiful and expressive language by
poring over its crooked, " sich ahnlichen " letters ? The
grammars, dictionaries, and general literature are printed
in this text, and nothing else, so far as we are concerned.
All, or almost all of the German books used for instruc-
tion in this country are printed here, and is there any
reason why they should not present a respectable ap-
pearance in English type ? Surely there is every reason
that they should. The myopic eye turns from the neat
and inviting page of the Berliner Klinische Wochen-
schrift — or any other German journal — to the bewilder-
ing fog of the dictionary printed in .\merica, and figura-
tively groans. Here is room for a needed reform.
The proper care of the eyes o the coming generation is
of vital moment. School boards and teachers have it in
their power to banish this evil from our schools. Let
them do it, and our bookmakers will take the hint.
ENGLAND .\ND THE CHOLERA.
The English are beginning to show signs of displeasure
at the comments of the Continental press upon the
cholera in Egypt and the responsibility of Great Britain
for its outbreak in that country. Lord Granville has
recently addressed a communication on this subject to
the Minister of Foreign Affairs of France. In this note the
principal accusations of the foreign press against England
are summed up as follows : i. The origin and mode of
propagation of cholera are well known and well under-
stood. 2. Quarantine is the recognized and succesful
means of preventing the spread of the epidemic. 3.
Cholera is always brought by ships coming from India.
4. Her Majesty's government has profited by its situa-
tion in Egypt to compel the Egyptian government to
relax the only precautious known to prevent the spread
of the disease, in order that British conunerce may not
be impeded. 5. Her Majesty's government has con-
sequently deliberately introduced the cholera into Egypt.
To all this Lord Granville answers by a general denial :
The origin and mode of propagation of cholera is as get
undetermined ; quarantine is valueless as a preventive
measure ; cholera is not brought to Europe by vessels
from India ; and lastly, although not believing in quaran-
tine, England has done nothing to interfere' with the
regulations of the Egyptian government in this regard.
The British Foreign Office request that its communica-
tion be given publicity in order that misapprehensions
regarding England's conduct in this matter mav be re-
September 8, 1883.]
THE MEDICAL RECORD.
265
moved from the mind of Europe. We doubt, however,
whether Europe will accept the views of the British
ministry on the nature of cholera. But the symptoms of
irritation are not confined to official quarters. The
Medical Press and Circular grows angry at its brother
of the Wiener Medizinische Zeitiing for si^eaking in a
disrespectful manner of England's remissness. It quotes
at some length from the offending article in question,
and concludes in a somewhat excited strain, as follows :
" The article contains more, much more, of this hys-
terical nonsense. The writer, if he ever had any wits,
has plainly been erschreckt out of them by the schwarzem
Gast ~i>om Ganges und Bramapulra. It is not necessary
to make further comments on such a ridiculous produc-
tion, in which imagination and spleen have performed
the duties tiiat ought to have devolved upon reason, and
which would have been unworthy of notice on our ])art
had it not received an official stamp as an editorial."
In spite of dignified official utterances and somewhat
less dignified journalistic ])rotests, the world will probably
persist in the belief tliat England has not done her whole
duty in respect to the cholera in Egypt.
THE CURE OF CHOLERA BY COLLODION.
During the recent epidemic of typhoid fever in Paris,
the number of remedies proposed for the cure of this
disease was legion. Volumes were written to prove that
this or that method was certainly infallible, and that all
that was needed to stamp out the epidemic was a gen-
eral conformity by the profession to the views of the
writer. In spite of these valuable discoveries, however,
the epidemic went on. The tin)e is now ripe for the
publication of sure cures for cholera, and we shall soon
be so abundantly provided with never-failing remedies
that the fame of the " Sun mixture " will pale by com-
parison. Among tlie first to enter the field is Dr. Arsene
Drouet in Le Courrier Medical of July 28, 1883. The
method is very simple, and consists merely in the appli-
cation of collodion to the abdomen. He says that
nature, when she essays to cure cholera, does so by de-
termining a perspiratory crisis, and collodion acts in a
similar fashion. After its application it irritates, by
reason of its constructive action, the nerves of sensibility
whose terminal filaments lie in the skin of the abdomen.
Thence a reflex inhibitory action is exerted in the motor,
vaso-motor, and secretory nerves, and there follows an
injmediate arrest of vomiting and alvine discharges.
Then, little by little the blood returns to the subcuta-
neous capillaries of the abdomen, the surface becomes
warm, and finally a profuse perspiration breaks out,
carrying with it the maieries morbi. As a beverage, the
jiatient is allowed cold ^vater or seltzer. By this method
Dr. Drouet claims to have cured two hundred cases of
cholerine and thirty cases of true cholera. The favorable
reaction commences within ten minutes and proceeds
with a rapidity so extraordinary that it must be seen to
be believed. Cholerine is always cured by a single ap-
plication of collodion within five hours. Severe cases
of undoubted cholera require two or three applications,
at intervals of one hour, and are only cured in from six
to seven and a half hours. The first coating is made
with ordinary contractile collodion. A piece of coarse
cheese cloth or mosquito-netting is stretched tightly
across the abdomen, and over this the application is
made. When the contraction becomes painful the film
of collodion is removed by pulling oft' the cloth, and then
a second application is made of flexible collodion which
has still contractility enough to produce the desired
effect. This method is not new, and has singularly
enough been discovered by four observers in diflerent
countries and at different times. In conclusion, the
author suggests that the inhabitants of countries ravaged
by cholera be instructed to carry about little phials con-
taining collodion, and to paint their own abdomens upon
the earliest symptoms of the dread disease declaring them-
selves. Further, if this treatment be practised on board
ship, every case of cholera could be cured at once, and
there would be no more need of quarantine.
We can only express our surprise that Dr. Drouet did
not hasten to Egypt upon the earliest tidings of the out-
break of cholera in that unhappy land, and there demon-
strate the value of his method. Aside from the sweet
consciousness of having saved the lives of untold thou-
sands of Egyptians, and of having in all probability
averted the scourge from Europe and America, he would
have achieved a fame beside which that of all others of
the world's heroes would liave paled. A grateful world
would have loaded him with riches and honors, and his
name would liave been cherished by all coming genera-
tions to the end of time. Perhaps, however, he was un-
willing to rob Pasteur of the glory of discovering the
microbe of cholera.
H^MATEMESIS FROM WASHING OUT THE STOMACH.
In 1881 Bouicli pointed out the advantages of washing
out the stomach in cases of simple ulcer, reporting at the
time a patient, very cachectic, with constant rejection of
food, both liquid and solid, who had had several hajnia-
temeses, and who rapidly gained flesh and strength and
digestive ability after the commencement of the wash-
ings. Bucquoy had already reported, in 1880, a case of
simple ulcer, in which washuig out the stomach arrested
the vomiting. Kiissmaul had also reported similar good
results, and, as is well known, Debone has treated a
large number of cases in this manner.
In spite of these favorable cases, in which no mention
is made of hrematemesis, Germain See, in his work on dys-
pepsia, looks upon this procedure unfavorably, as he be-
lieves that there is a risk of destroying a vascular wall and
thereby producing hemorrhage, or of re-opening an imper-
fectly formed cicatrix, and provoking a new hemorrhage.
Cornillon has recently reported a case whicli seems
to bear out these views of See {Le Progres Med., No. 17,
1883). An alcoholic person, who for ten years had suf-
fered more or less from epigastric pain and vomiting,
consulted Cornillon about two years after vomiting a
quantity of clotted blood. Cornillon introduced about
a quart and a half of water into his stomach, and found,
on siphoning, that it contained a substance similar to
black coffee. On repeating the washing, there was less
of the black substance, but when water was introduced
a third time, it returned distinctly reddened, and con-
taining a number of clots. When the washing was re-
peated two days later, there was quite marked haema-
266
THE MEDICAL RECORD.
[September 8, 1883.
temesis. Cornillon attributes the hemorrhage to the
quantity of water, and the force with which it was intro-
duced, and he doubts the ]jropriety of this measure in cases
of recent ulcer, for fear of dislodging a clot and thus pro-
voking hemorrhage.
RE.'^DING OF MEDICAL BOOKS IN COURT.
Reference was made in these colunms a short time
since to the rule in vogue in the courts of a large number
of the States, forbidding the reading of medical books to
the jury, in criminal cases.
This rule had an illustration in a Michigan court a
short time since, where a verdict was reversed because
the counsel on one side had succeeded in a device to get
the book before the jury. The facts were these : On the
cross examination of a physician who was testifying for the
defence, he was asked if he was acquainted with a cer-
tain book. He replied that he had heard of it, but had
not read it. He was then asked whether it was con-
sidered good authority, and he said it was. He was
then requested to read a certain paragraph during the
recess of the court. When the court convened agam he
was recalled, and counsel reading from the book the
paragraph to which his attention had been called, asked
him whether there w-as a case reported of taking sulphate
of zinc, followed by vomiting, purging, and death? As
this was what the paragraph stated, the evident purpose
of the question was to put the passage from the book in
this indirect manner before the jury instead of reading
from it directly. The question having been allowed by
the judge and answered by the witness, the Appellate
Court held the error to be sufficient for a reversal.
THE DEGENERACY OF THE FRENCH INDIVIDUALLY
AND .^S A NATIO.N, AND WH.\T TOBACCO IS .AC-
COUNTABLE FOR.
A SUCCESSOR of the late lamented Trask has appeared
across the water in the person of Dr. Decroix, who raises
his warning voice against tobacco, and threatens his fel-
low-mortals with ruin — physical, moral, and mental — if
they do not rise in their might and stamp out the weed.
In a communication recently presented to the .Academy
of Medicine of Paris, he takes a most gloomy view of the
future of the French race, and incidentally of the rest of
mankind. He says that the death-rate in France greatly
exceeds the birth-rate, and that the population of the
country is steadily decreasing. It is becoming difficult
to find recruits for the army who are physically fit for
military service, and the average stature of the individual
is constantly becoming lower. Morals are becoming lax,
and crime is growing more preralent. Physical beauty
is rare, and mental alienation and idiocy are increasing
at such a rate that the asylums are unable to contain all
the unfortunate victims. The cause of all this moral and
physical decay he finds in the use of alcohol and tobacco.
The picture he draws of the baneful influence of these
poisons, the latter especially, upon the social body, is one
fearful to contemplate. This it is that effaces the lines
of beauty in the countenance and in the form ; this it is
that degrades the intellect and corrupts the moral nature.
Here is to be found the active cause of sterility, or if by
chance a baby is born, this is the demon that robs it of
its mother's milk, the fiend that chokes with its damnable
nicotine the lacteal springs that lie deep down within the
maternal breast. It kills one-half of all who see the light
of day before their little lives have spanned a semicircle
of the year.
Spain was once the mistress of the sea, the pfoud ruler
among nations, the queen of poetry and song, the home
of chivalry and valor, rich, proud, beautiful, wise, vir-
tuous, and renowned. It sent its fleets to the far West
to explore the new land, and to bring back its treasures
of gold and silver and precious stones. The stately ships
returned, laden not only with all the riches of Eldorado,
but also, alas 1 with the " panacea of the Indies," the
noxious weed — tobacco. From that period dates the
decadence of that once glorious nation. The habit of
smoking the poison spread with fearful raiiidity over the
devoted country. It seized upon the king and the peas-
ant, the holy bishop and the humble donado. Lords and
ladies all smoked and smoked until the once fair land
was enveloped in nicotine-charged mist, and the glory
of Spain was but a thing that is gone. And this is the
fate in store for luckless France. Tobacco was the cause
of the disasters of the Franco-German war, and tobacco
will be the occasion of far greater evils still to come.
Undoubtedly, tobacco has much to answer for. Its in-
jurious effects upon growing boys are quite evident, and
it is truly a saddening sight to see children hardly six
years old pulling away on the cheap and nasty cigarettes
which have recently descended upon us like one of the
plagues of Egypt. But to claim that Spain's decay resulted
from the use of tobacco, and that France will owe its in-
evitable fall to the same cause is, to say the least, an
extravagant assertion. It is a pity that apparently earn-
est men, advocates of temperance in material things,
should so often themselves be intemperate in words.
Nothing good or lasting was ever accomplished by false-
hood, and nothing good or lasting can result from its
twin brothers, exaggeration and distortion of facts.
Jlciuis of the MUd'^.
Progress of the Yellow Fever. — During the past
week no cases of yellow fever have been reported in the
United States outside of the Pensacola Naval Reservation
and the Government ijuarantines. Only five new cases
and three deaths at the navy yard have been reported,
and the house-to-house inspection of the adjacent vil-
lages of Woolsey and Warrington, as well as the inspec-
tion at Pensacola, have discovered no hidden cases, so
that hopes are entertained that the disease has spent its
force and will soon disappear. There is much suffering
among the people of the villages (squatters), who are un-
able to i>rovide themselves with the necessities of life,
and many appeals have been made in tlieir behalf for
aid out of the Epidemic Fund, but the Department has
decided that only those in hospital or under treatment
are proper beneficiaries of the fund. Governor Bloxhani
also states that he is unable to help them, as there is no
appropriation for the purpose, and thinks as they are on
the Government reservation and quarantined by the
Government, that it ought to take care of them.
The report of .■\cting .Assistant-Surgeon Fitzhugh Fin-
ney for the past week shows twelve vessels in quarantine
September 8, 1883. J
THE MEDICAL RECORD.
267
at Ship Island and nineteen cases of yellow fever and
five of ague, with three deaths from the former disease.
Reports from Sapelo quarantine show no transactions,
no infected ship having put in at that station. At Cape
Charles quarantine a vigorous inspection is kept up by
Surgeon Smith who boards all foreign vessels, whether
from infected ports or not.
Sanitary Inspector Burgess telegraphs from Havana
the departure of the following named infected vessels
for the ports stated : Bark Doce de Juno, for Brunswick,
Ga. ; Spanish bark Christiana, for New York.
Thirty-two deaths from yellow fever occurred at Ha-
vana during the week ending August 24th, and there is
still considerable yellow fever in the city, but very little
among the shipping. It has been officially reported that
the Captain-General recently issued an order forbidding
the Consul to issue bills of health and directing the local
board (sanitary) only to give them. No attention will be
paid to this order by the United States Consul, as no faith
can be placed in the sanitary report of the local board,
particularly as their " fumigation" of vessels consists in
giving to the master a four-ounce vial of mild fumigant
for which he is charged ten dollars, and which the master
throws overboard !
To form some idea of the sanitary condition of Cuba
the following translation of an article which appeared in
the Matanzas Correo de la Tarde (Evetiing Mail), of
August iSth, is lierewith presented. The first paragraph
was difficult to translate, because in the editor's effort to
be ironical he forgot his logic — however, it will pass :
" It is often said, and generally believed, that Cuba is
not healthy, and yet the facts are that this description
cannot be more unjust or untrue, because if there ex-
ists in every other town the same noxious elements
which are apparent here (Matanzas), and if all could
show the same proportion of mortality, a proportion
which, without exaggeration, is much below the average,
— it deserves the name of being very healthy : and yet
it is strange, all things considered, that a single soul lives.
"Picture to yourself a city which is bounded on one side
by the marshes of the Yunuiry, whose deadly miasma is
daily swept over it by the breezes which generally blow
from that direction, and on the other side by a bay into
which a great deal of organic matter is deposited by the
currents of the two rivers. Picture to yourself other
marshes which exist behind the suburbs of the town.
Picture again to yourself a provision market always dirty,
and surrounded by a sewer which continually gives forth
bad odors. Go on picturing to yourself that in the centre
of the town there exist many streets full of cesspools and
filthy ditches, and on every two or three corners piles of
offal. Picture to yourself, again, that on the banks of one
of its rivers, which is the city's chief source of connnerce,
one sees immense sheets of stagnant water, covered by a
greenish scum, and which renders a communication with
the above houses almost impossible. Picture, lastly, to
yourself that from the milkman at one corner ot the
street to the fisherman at the other, whose strident yells
distract and annoy us — that from the butcher behind his
counter, awaiting his victims, to tlie fruit and vegetable
dealers wandering through the streets — that from the most
elegant caf6 to the humblest grocery store, they can in
spite of all law sell us a ' cat for a hare,' as the vulgar
say — and in face of all this, dispute the statement we have
expressed above.
" The vigor with which the question is treated in the
capitals of Europe is unknown to us — as our condition
is inconceivable to them. They cannot understand that
possessing laws, as we do, exacting as their own, we should
permit them to become dead letters from the indifference
with which they are treated. But for that would they
sell us the adulterated milk, which does not kill because,,
like Mithridates, we are used to poison ? Would our streets
otherwise be filled with numberless pedlers, free from
the danger of molestation,^ offering us for sound, rotten
fish ? And others offering as harmless fruit ripened by
fire ? And still others offering for sale tainted flesh which
they bring in their filthy trays? But for this marked in-
difference would so many vagabond dogs wander througli
our streets, and so many horses be attacked by suspicious
coughs? It is necessary, therefore, that this lamentable
state of affairs should be remedied for the good of all and
the satisfaction of our own conscience. And would that
our humble words, which have no tendency except the
common weal, might carry this conviction to certain
minds."
Sanitary Inspector Mainegra reports by letter that the
sanitary condition of Vera Cruz is much improved, owing
to copious rains with thunder and lightning refreshing
and purifying the atmosphere. He states that the type
of the fever has been very fatal, the mortality even
among private cases being about thirty per cent. As
there is no reports made by the authorities, he was un-
able to get at the whole truth, but thinks it would show
a still greater mortality. He gives the following figures :
Deaths in 1882, 72; in 1883— January, i ; February, i;
March, 7 ; April, 16; May, 90; June, 261 ; July, 200^
August, up to i6th, 38. He regards all vessels sailing
from Vera Cruz infected, and if bound to any Southern
port, advises them to put in at Ship Island or Sapela
Sound quarantine station for inspection.
The U. S. Consul at Tampico, in a despatch to the
Secretary of State says : " 1 have the honor to report
that the authorities of this port have, since the ist of this
month (August), established a quarantine of eight days
against, all vessels arriving from Vera Cruz and from
other infected ports — that term to be reckoned for ves-
sels arriving from Vera Cruz, from the date of departure
tiierefrom. This port and vicinity enjoy good health to
this date, and there is no suspicion of plague, cholera,
vomito, or contagious distemper whatever in this district."
The United States Consul at Matanzas, Cuba, in
transmitting his weekly consular report of the sanitary
condition of that place says : " The sanitary authorities
all combine to withhold information from me ; liowever,
sufficient cases of yellow fever exist to seriously infect
the port and make watchfulness a necessity, and strict
quarantine a matter of wisdom. The Captain-General
has issued orders forbidding Consuls giving Bills of
Health, transferring that duty to local sanitary boards,
and I would suggest that if any foreign vessel enters
without my Bill of Health, that the penalty prescribed
by law be enforced."
In answer to a despatch of inquiry sent the Consul at
Saint Thomas, W. I., he states that there has not been a
case of yellow fever at that place for the past two years.
268
THE MEDICAL RECORD.
[September 8, 1883.
There were twenty-nine deaths from yellow fever at
Havana last week.
Progress of Cholera.— The department of State
has received and transmitted to the Treasury deiiartment
despatches from the U. S. consul-general at Constanti-
nople, dated July 19-21, in regard to the cholera in
Egypt and the sanitary condition of Constantinople. He
sa^'s that when the cholera was rejiorted in Dainietta it
created the greatest alarm in Constantinople, and strin-
gent orders were immediately issued to exclude it from
the country, as well as to combat its ravages if it suc-
ceeded in getting a foothold. All arrivals from Egypt
were required to undergo quarantine at the entrance of
the bay of Smyrna. The limited accommodations at
Beirout and Bouria were enlarged, but the panic-stricken
refugees from Alexandria came in such numbers, that
the quarters soon became insufficient to accommodate
them ; .Tnd as each day brought fresh arrivals, the suffer-
ings ot tlie jieople from exposure to the burning sun and
the chilly niglit dews became very great, and threatened
to create the very evil it was intended to guard against.
The arrivals at Beirout were the greatest sufferers, and
the authorities were finally compelled to telegraph to
Alexandria to give warning that no more refugees could
be received, or would be allowed to land. But while
the sanitary administration were employing the best
means their resources admitted of to prevent the intro-
duction of cholera, the orders from tlie palace for the
cleansing and disinfection of Constantinople were tot-
ally neglected, as was also the case in the provincial
towns. The most elementary measures of ]irecaution
had not even been commenced, after the cholera
existed at Damietta for over a month. The ditch drain-
ing into the Golden Horn, which drains about two
square miles of land thickly built up and densely popu-
lated, receives, through a thousand tributaries, all the
sewerage of that large district. It is an open stream of
filth, and its noxious gases spread with every breeze to
distant quarters. This pestilential ditch still yawns and
befouls the atmosphere of Pera, and other quarters fac-
ing the Golden Horn. While the authorities are dis-
cussing measures to improve the sanitary condition of
the city, the streets remain unswept, the sewers clioked
and overflowing, or open, and indescribable filtli and
garbage go on increasing in open si)aces the accumula-
tion of years. The consul-general says that, as under
these circumstances it can scarcely be expected that
Constantinoi)le will escape a visitation of cholera, it is
his duty to call the attention of our sanitary authorities
to the necessity for taking promiu precaution against its
importation into the United States. There are several
classes of goods tiiat originate in the East, that have
been active agents in the introduction of infectious
diseases — hides and skins, rags, rugs, and carpets, and
woollen, cotton, silken, linen tissues and embroideries,
mostly old and worn. It will be no safeguard that
these goods reach the United States through Kurai)can
ports, unless there is evidence that the packages have
been opened and disinfected before reshipment. Danger
is especially to be apiirehended from rugs, which come
from remote parts of Asia. It is well known that when
tlie plague has prevailed in Constantinople, the ba/.ars
where these goods are sold were centres of infection.
Russia has virtually put the whole world in quarantine
as regards her southern jiorts, as an order has been is-
sued that all vessels passing the Dardanelles, under
whatever flag, shall be subjected to quarantine on arrival
at any of the Black Sea ports.
The consul-general encloses tables giving the number
of deaths from cholera in Egypt, to July istli, as 2,932,
of which Damietta had 1,740, and Mansourah 825, and
says, considering the density of the population of the
delta of Egypt and the habits of the inhabitants, the rates
are not extraordinary. The outbreak of the cholera is
sufficiently accounted for by the condition of the towns
infected. Before the epidemic appeared a cattle plague
of exrreme virulence had been raging for some time, and
such of tiie infected animals as were not slaughtered for
food were allowed to die of the disease, and after being
skinned, their carcasses were thrown into the river and
canals, whence all the drinking water is drawn. The
hides, after drying, were stored in the villages to be sold.
In some i)laces carcasses were tied to the banks of the
river to attract fish and render their capture easier, and
these fish, feeding on putrefied flesh, were sold for food.
The water in many of the canals is almost stagnant, and
has become putrid from the number of carcasses thrown
into them. Everything seems, to have been done to
create and jiropagate cholera, and it is quite useless to
seek its origin in India, when such abundant causes for
its generation exist in every part of the Delta. Since
the military cordons have been established around in-
fected places — either through ignorance or from malevo-
lence— they not only do not allow any one to pass out,
but they allow nothing to pass in, not even provisions
or medicines. Meanwhile the dwellers in these plague-
stricken jilaces are without food and medicines, and it is
not to be wondered at that they should eat the carcasses
of animals that have died of disease, preferring to risk
the chance of cholera rather than incur the certainty of
death from starvation. The wonder is, not that there is
cholera in Egypt, but tiiat the mortality is not much
greater than reported.
The consul re|)orts the population of some of the
principal towns of Lower Egypt, according to the recent
census, as follows; Cairo, 368,108; Alexandria, 208,-
778; Port Said, 16,560; Suez, 10,913; Tantah, 33,725 ;
Damietta (where the cholera made its first appearance),
34,068 ; Rosetta, 16,671 ; Mansourah (second place at-
tacked), 26,784; Zagazig, 19,046; the whole of Egypt,
6,798,200.
Sanitary Inspector Hill, stationed at London, Eng-
land, in his abstract of "Bills of Health," states that the
British steamer Newcastle City ''left port in a dirty state,
with 335 tons of rags and paper-stock (200 tons British,
35 Parisian, 80 Russian, and 20 Dutch) for Boston; and
that the British steamer Canada carried 120 tons of rags
obtained from Northern Prussia." He also states that
deaths in London from choleraic diarrhcea number six
to eight each week.
At a meeting of the Board of Health, held at Gibraltar
on August loth, it was decided that all arrivals from
Syria and from the Ottoman ports be subjected to a
quarantine of twenty-one days.
Proclamation. — By His Excellency Sir John .Miller
Adye, Royal .\rtillery. Knight Grand Cross of the Most
September 8, 1883. J
THE MEDICAL RECORD.
269
Honorable Order of the Bath, Knight Commander of the
I^egion of Honor, and of the First Class of the Military
Order of the Medjidie, Lieutenant-General of Her
Majesty's Forces, Governor, Vice-Admiral, and Com-
mander-in-Chief of the City and Garrison of Ciibraltar,
etc., etc., etc.:
Whereas in and by a certain Order, bearing date at
the Court at St. James's on July 13, 1830, and made
by His late Majesty, by and with the advice of His Privy
Council, to regulate and provide for the performance of
Quarantine at the Garrison and Territory of Gibraltar,
it is among other things ordered that the Order or Orders
from time to time made by the Board of Health of Gib-
raltar, in pursuance of the said Order of His late
Majesty, for carrying into etTect the Regulations and
Provisions thereof, shall be duly published at Gibraltar by
Proclamation.
And whereas the said Board of Health having made
the Order hereinafter following, the same is hereby pub-
lished and proclaimed in pursuance of the said Order of
His late Majesty in manner following, viz : That all
arrivals from Syria and Ottoman Ports be subjected to a
quarantine of twenty-one days.
Given at Gibraltar, August 10, 1883.
By Command, Gifford, Colonial Secretary.
Official reports up to August 31st, show that there
have been 27,318 deaths from cholera in Egypt since the
outbreak, this includes 140 among the British troops sta-
tioned there.
Official reports from Shanghai, of July 23d, received
by the State Department, announce the fact that " the
cholera had assumed an epidemic form at the Port of
Swatow, but while many deaths had occurred in conse-
quence, they were confined entirely to the shipping and
native population. Hong Kong has declared Swatow
an infected port, and strictly enforced quarantine regu-
lations against vessels arriving from there." The Consul-
General called a meeting of the Consular body to take
action for the protection of Shanghai by the enforce-
ment of quarantine regulations, and he was requested
to communicate with the Chinese officials, asking their
co-operation in the enforcement of the regulations of
1874. Nearly all the cases occurring at Shanghai have
also been among the shipping and natives — those dying
among the foreigners were mostly sailors.
Dr. Henry Maudsley is visiting this country. He
stays but a short time and is travelling very quietly,
being desirous of obtaining rest and health.
Sanitary Reforms in Toronto. — The people of
Toronto are becoming awakened to the real value of
preventive medicine. Dr. Oldnght, Chairman of the
Provincial Board of Health for Ontario, and Dr. Can-
niff, health officer for Toronto, have been busy lately
looking into matters of public health and reporting upon
unhealthy localities and nuisances. Policemen have
been detailed in pairs to make a thorough inspection of
Toronto. They are authorized to go into houses, stables,
yards, cellars, factories, schools, etc., and are provided with
blanks to make reports on in the event of any unhealthy
condition being found. Although Toronto has taken tlie
lead in this matter, other cities are moving in the same
direction. Much good nmst follow so systematic a
course of investigation. The Committee on Public
Health of the Ontario Medical Association urge strongly
that hygiene be taught in all the public schools in lieu of
less important subjects.
CoNVALF.sCENT HoMES IN CANADA. — Considerable at-
tention is being directed to convalescent homes, both in
connection with the general hospital and for sick chil-
dren. In the case of the latter a neat summer resort has
been erected on the island about a mile from Toronto.
Here the little invalids are removed from all noise and
disturbance and get the benefit of the cool I>ake Onta-
rio breeze. More of such places are required through-
out the country in healthy, open localities, instead of
large, dreary hospitals in busy, crowded cities. There is
ample room for them, and abundance of means to sus-
tain them. It requires but the stimulus to be given in
this direction and we shall soon have many of these
suitably located convalescent homes.
An Epidemic of Dysentery. — The Mississippi Val-
ley Medical Monthly ilAt.es that an epidenuc of dysentery
is now prevailing at Byhalia, ^{iss., about twenty-five
miles from Memphis. Si.xty or seventy deaths have re-
cently occurred in that vicinity, and considerable alarm
prevails. It is rumored that some neighboring towns
have instituted quarantine for protection.
Meeting of German Naturalists. — -The fifty-si.xth
annual meeting of the Society of German Naturalists and
Physicians will be held at Freiburg, on September i8th,
19th, 20th, and 2ist.
New Hospitals in Paris. — The Municipal Council
of Paris has recently voted a credit of $600,000 for in-
creasing the hospital accommodations of that city. The
sum of $400,000 is to be devoted to repairs and additions
to already existing hospitals, while the balance of $200,-
000 will go toward the erection of a hospital for the
treatment of chronic diseases, a small-pox hospital, and
a children's asylum for incurables. The entire cost of
these three new hospitals, when completed, will aggre-
gate about $2,250,000.
The Eighth Annual Meeting of the American
Gynecological Society will be held in Philadelphia, at
the Hall of the College of Physicians, on Tuesday, Wed-
nesday, and Thursday, September i8th, 19th, and 20th.
Papers are expected to be read as follows : " Superinvo-
lution of the Uterus," by Dr. Joseph Taber Johnson, of
Washington ; " The Importance of Cleanliness in Surgi-
cal Operations," by Dr. R. Stansbury Sutton, of Pittsburg,
Pa. ; "Some Points Connected with the Subject of Dys-
menorrhcea," by Dr. C. D. Palmer, Cincinnati ; ''An Un-
usual Form of Abdominal Tumor," three cases, by Dr.
Thaddeus A. Reamy, of Cincinnati ; " Is p:xtirpation of the
Cancerous Uterus a Justifiable Operation ? " by Dr. A.
Reeves Jackson, of Chicago ; "A Biographical Sketch of
Dr. Nathan Smith, Founder of the Dartmouth Medical Col-
lege" (being the President's address), by Dr. Oilman Kim-
ball, of Lowell, Mass.; "The Management of Accidental
Puncture and other Injuries of the Gravid Uterus as a
Complication of Laparotomy," by Dr. Charles Carroll
Lee, of New York ; "A New Method of Operating for
Fistula in Ano," by Dr. Edward W. Jenks, of Chicago;
" Ergot : The Use and Abuse of this Dangerous Remedy,'
2 70
THE MEDICAL RECORD.
[September 8, 1883,
by Dr. George J. Engelmann, of St. Louis: "Congeni-
tal Fissure of the Female Urethra with Extrophy of the
Bladder," and " Menstruation after Extirpation of the
Ovaries," by Dr. Henry F. Campbell, of Augusta, Ga. ;
" Remarks on Chronic Abscess of the Pelvis," by Dr.
William H. Byford, of Chicago. A discussion on " Death
after Labor " will be opened by Dr. Campbell.
(Co vvcsp 0 n ([ en c c.
FEMALE MEDICAL EDUCATION FROM A WO-
MAN'S STANDPOINT.
To THE Editor of The Medical Record.
Sir: In response to your Canada correspondent, in
your issue of August 25th, allow me to say that
" He either fears his fate too much,
Or his deserts are small,"
who feels it necessary to his own safety as a practitioner
to decry the medical education of women.
In your correspondent's statement that " exception was
taken by those ladies to some remarks made by the
lecturer on physiology," I can see nothing to indicate
that those same ladies, or ladies in general, are, therefore,
unfit subjects for the study or practice of medicine ; nor
can I see in the fact that " the men " (your correspondent
makes a nice distinction in not calling them geniUineii)
" in the class became noisy and made statements that
greatly offended the ladies," any special or superior fit-
ness on their part.
It is not worth while to argue the point whether co-
education will or will not work, when we see conspicuous
instances of its success increasing around us ; but we
pass on to his gravely expressed foreboding that '• there
cannot be any doubt in the minds of all who think calmly
on the matter, but that these young female doctors will
locate on our streets, and in our villages and towns."
And pray what if they do ? Will the public morals be
wrecked in consequence ? The social scientist, if he
"think calmly on the matter," will doubtless tell us so-
ciety is better for a young woman " locating on our
streets " to practise legitimate medicine, than if forced
by the closure of all avenues of respectable work she
"walk" that same street for bread. Our friend shows
lack of knowledge of the number of women who have
gone out as medical missionaries, of the constantly in-
creasing call from the mission fields for more workers,
and of their great usefulness there. A letter written me
in 1880 by a former pastor, a prominent Presbyterian
divine, contains this statement : " 1 have a friend in
India, a medical missionary, who has had much success,
having had five thousand cases among the Indian women
in ten years." Surely that woman has found her work,
and is doing God and humanity better service than by
devoting her immortal energies to making rick-rack trim-
ming for her dresses.
In answer to the scathing remark that "it is all a
question of dollars and cents with the ladies who wish to
secure medical qualifications," I can only say that when-
ever society reaches that happy stage of gallantry to our
sex that the tradesman and artisan refuse to accept from
us an equivalent of "dollars and cents" for their work
and their wares, doubtless the percentage of women who
practise medicine from ])hilanthropy, pure and simple,
will more nearly approximate that of the men in the
profession who decline all fees.
" The move is very unpopular with the profession at
large in this country." I would suggest tliat our pro-
gressive physicians are not opposed to it, but willing to
see it stand or fall on its own merits. Its unpopuhirit)-
is mainly among those whom Charles Reade so aptly de-
scribes as " pig-headed beyond belief."
That it is not unpopular with the laity, who, after all,
are the true arbiters in the matter, is shown in the amount
of work women are doing throughout the land.
From the nature of things the practice of women must
be more limited than that of men has been. We seek
only the privilege of treating the ills of our own sex, and
in the field of gyn;i3Cology and obstetrics who shall deny
that we have fit place.
In accordance with that sure law of supply and de-
mand, just so long as sensitive women prefer to consult
competent physicians of their own sex for the ills
peculiar to their sex, just so long will the demand be met
by competent ladies, educated, if not in Kingston or
Toronto, then in New York, Philadelphia, Ann Arbor,
Syracuse, Paris, Vienna, etc. The world moves.
C.A.ROi,iNE S. Pease, M.D.
Troy, N. Y.
^Umicius and iUiticcs.
Treatment of Diseases of Infancy and Childhood,
with over four hundred Formula; and Prescriptions, as
exemplified in the services of Drs. A. Jacobi, J. Lewis
Smith, Alonzo Clark, Austin Flint, W. A. Hammond,
A. L. Loomis, W. H. Thomson, J. H. Ripley, T. Gail-
lard Thomas, J. R. Leaming, F. Delafield, L. A. Sayre,
C. R. Agnew, L. Duncan Bulkley, Beverley Robinson,
R. W. Taylor, G. H. Fo.x. F. N. Otis, A. A. Smith,
E. C. Seguin, F. A. Burrall, E. G. Janeway, F. H.
Bosworth, A. H. Smith, C. E. Billington, G. M. Lef-
ferts, etc., etc., and in the Hospitals of New York City.
By Charles H. Goodwin, M.D. New York: C. H.
Goodwin, M.D., 245 West Fifty-third Street. 1883.
The success which we pred'cted for the author's previous
manual on treatment of heart and lung diseases has been
realized, and has led to the preparation of this com-
panion volume. This excellent little book is not a mere
jumble of formula; thrown together hap-hazard, but is a
systematized and well-ordered collection of the favorite
prescriptions of some of the best-known physicians
in this city. Each subject is prefaced by a short ex-
planation of the rationale of the treatment followed.
While heartily disapproving of the use of ready-made
prescriptions, we still think that the publication of for-
raulfB such as this book contains is of value as giving in
brief the matured views of men of wide experience in
the treatment of disease. Such a book as this is natu-
rally usetl for the most part as a ready reference manual,
and we think its value in this respect would have been
greatly enhanced by an index arranged alphabetically
instead of by groups.
Tran.sactions of the Medical Society of the State
of Pennsylvania at its Thiity-fourth Annual Session,
held at Norristown, May 9, 10, and 11, 1883. Vol.
XV. Pniladelphia : Published by the Society. 1883.
This volume is excellently printed in clear type and
neatly bound in cloth. It contains a number of good
papers on a great variety of topics. One hundred pages
of the Transactions are taken up with reports of very
little interest from the County Societies. The volume
also contains the circular of the Society for Instruction
ijr First Aid to the Injured, of New York City, which
was ordered by the Society to be printed after the re-
[)ort on Surgery.
Physiological Cruelty ; or. Fact vs. Fancy. An
Inquiry into the Vivisection Question. By Philan-
thropos. 8vo, pp. 156. New York : John Wiley &
Sons. 1S83.
In this work the author has presented the chief estab-
lished facts and the principal arguments on the subject
of vivisection. I'he text is, in general, quite accurate in
September 8, 1883.]
THE MEDICAL RECORD.
271
detail, without evidence of partizanship, and is well
worth the attention of the profession. Certain of the
more obvious statements whicli have appeared in print
,are touched upon ; but, as a rule, the numerous popular
questions raised upon this matter, and the various re-
sults arrived at are avoided. An appendix is also added
containing further information on special points.
^Icpovts ot Societies.
STATE MEDICAL SOCIETY OF VIRGINIA.
Fourteenth Annual Session, held at Jiockbridge Alum
Springs, Va., September 4, 5 and 6, 1883.
(By Telegraph to The Medical Record.)
The Fourteenth Annual Meeting of the Medical Society
of Virginia convened in the ball-room of the Grand
Hotel, Rockbridge Alum Springs, Rockbridge County,
Va., at half-past eight Tuesday evening, September 4th,
the President, Dr. Wm. D. Cooper, of Morrisville, in
the chair.
Rev. Dr. J. J. I.afferty, of Richmond, Va., opened
the meeting with prayer.
The Naval Academy band from Annapolis, attached
to the hotel for the sunuiier, played at intervals during
the evening.
The address to the public and profession was delivered
by Dr. K. Edgar Chancellor, of Charlottesville, and
was devoted to consideration of
THE different MINERAL WATERS OF THE WORLD.
He stated that out of the 876 natural mineral waters
of the United States, only 300 had been properly anal-
yzed and classified, and in the course of his address showed
plainly the points of difference between natural and arti-
ficial mineral waters. He pointed out the manner in
which the pure water is changed to mineral waters in the
ground, and closed with the reasons for the natural pro-
duction of hot or thermal waters.
Besides the Society members, a large number of ladies
and gentlemen, guests at the hotel, were in attendance.
The Committee on Nominations reported 39 names
of physicians for election to fellowship, all being afterward
duly elected by the Society.
On \\'ednesday, September 5th, the Society met in the
ballroom of the Rockbridge Springs Hotel, at 10 a.m.,
and, after opening the session, Dr. Wm. D. Cooper
read the Annual Address of the President, his subject
being
THE INDIVIDUAL RIGHTS OF PHYSICIANS,
in the course of which he pointed out the very limited
protection afforded the profession by the State of Vir-
ginia, and gave some exceedingly valuable suggestions
concerning the proper mode of action for redress.
Dr. John R. Whe.\t, of Richmond, then read the re-
port on Advances in Anatomy and Physiology, and con-
fined himself mainly to a consideration of
THE anatomy AND PHYSIOLOGY OF THE MALE URETHRA.
He stated his belief that the surgery of the urinary
passages will have made marked progress when it has the
boldness to give the
PREFERENCE TO THE USE OF STRAIGHT INSTRUMENTS
OVER CURVED SOUNDS, CATHETERS, ETC.
Dr. a. M. Fauntleroy, of Staunton, made an ex-
haustive report on Advances in Chemistry and Pharmacy,
considering fully the possibilities of the
ARTIFICIAL MANUFACTURE OF A NUMBER OF VALUABLE
DRUGS
which now are only obtained in nature. He believed
that the day was not far distant when quinine would be
manufactured by the chemist without the necessity of
handling cinchona bark. He recommended the use of
the tonka or vanilla bean as being by far the best method
of subduing or
COVERING THE ODOR OF IODOFORM.
The report was concluded with a detailed description of
the properties and employment of convallaria maialis.
Dr. M. G. Ellzev, of Washington, read the report
on Advances in Obstetrics and Diseases of Women. He
advised against
THE TOO COMMON USE OF STYPTICS IN THE UTERUS,
and made an eloquent appeal for
LESS FREQUENT EMPLOYMENT OF FORCEPS.
He spoke against the growing institution of private hos-
pitals for women, and believed that they were often no
better and sometimes not as good for lying-in purposes
as a room in a comfortable home. He laid down cer-
tain rules as regards
PERSONAL DISINFECTION ON THE PART OF THE
OBSTETRICIAN,
strongly urging greater care in this respect. He believed
that pessaries are often unnecessarily employed, and re-
lated a recent case of death following
BLOOD-POISONING PRODUCED BY ULCER.ATION FRO.M A
PESSARY
introduced in i860.
Dr. Wm. H. Coggeshall, of Richmond, Va., made
a report on Advances in Diseases of Children, making
special mention of
THE SUCCESSFUL TREATMENT OF CANCRUM (,)RIS WITH
SUBNITRATE OF BISMUTH,
by Dr. McGuire, of New York. He described the mode of
reducing congenital pliimosis, when stenosis does not exist,
by manipulation, as practised by Dr. Willard, of Philadel-
phia, and after an extended account of the present treat-
ment of children's diseases, closed with a brief recitation
of the points of relationship between membranous croup
and diphtheria. The paper will appear in a future num-
ber of The Medical Record.
Dr. McDonald, of West Virginia, desired that the
subject of each paper should be discussed, and after an
informal debate, it was decided that any member who
wished could speak upon any part of the papers read.
Drs. McDonald, Parker, Hume, Field, and others dis-
cussed some of the points presented in Dr. Ellzey's
paper.
In the evening Dr. Thomas H. Howard presented
for the inspection of the Society
a large NUMBER OF BONE SEQUESTRA,
weighing from half a grain to half a drachm each, which had
exfoliated from the external table of the skull after fract-
ure during a period extending over four years. The
female patient from whom they were taken is now living
and in good health, over fifty years of age. The doctor
gave a full history of the case, which was peculiar, every
piece of bone being
EXTRACTED THROUGH THE EAR.
There was no history of traumatism except that the pa-
tient received a lightning-stroke a year before the first
piece of bone was discovered.
Dr. Ellzey read a volunteer paper on
THE THER.\PEUTIC QUALITIES OF THE RAWLEY SPRINGS
W.\TER,
slating that the peculiar chalybeate water of this spring
was not duplicated anywhere else in America, the only
locahties where a like combination can be found are at
Schwalbach and Tunbridge Wells in the Old World. He
gave a clinical report of a number of cases of depraved
and impoverished blood conditions relieved and cured
by the use of this water.
272
THE MEDICAL RECORD.
[September 8, 1883.
NEW YORK PATHOLOGICAL SOCIETY.
Stated Meeting, June 2 7, 1 883.
George F. Shrady, M.D., President, in the Chair.
(Continued from p. 249.)
Dr. Ferguson presented a specimen of
aneurism of the heart.
Tlie patient was a male, fifty-four years of age, a na-
tive of Ireland, married, and a clerk by occupation.
Both his parents lived to old age, although his mother
was troubled with asthma for many years. He was quite
well until April, 1882, when he began to suffer from
shortness of breath, and at times cardiac paljntation.
These symptoms, however, were not severe until one
month previous to his admission into the New York
Hospital on the 31st of March, 1883. Then he became
quite weak, his feet began to swell, and he jiassed but a
small amount of urine. He suffered from severe dysp-
ncea, cardiac palpitation, irritability of the stomach, and
ocular disturbance, together witii a cough accompanied
by a frothy mucous expectoration. He gave an alcoholic
history. On admission he was fairly nourished, feet and
legs cedematous, cardiac action and respiration labored.
The heart-sounds were roughened, but there was no
bruit. He was passing twelve to sixteen ounces of urine
a day.
Under treatment the first few days in the hospital his
condition improved. Later on in the month of April he
complained of great weakness, his respiration being
much embarrassed and his legs, scrotum, and penis
very cedematous, his abdomen was also distended with
fluid. Stimulants and diuretics gave him only tempo-
rary relief
The first week in May he was aspirated, sixty-three
ounces of fluid being removed from the peritoneal
cavity. After respiration his breathing was much re-
lieved and he was passing at the time twenty-five to
thirty ounces of urine a day. His dyspnoea continued at
times slight but occasionally very severe. On the 17th
May he was again aspirated and 108 ounces of clear serum
drawn from his peritoneal cavity, without any relief to
his respiration or heart action. He was delirious at
times and suffered greatly from dyspnoea. His heart
action was weak and irregular, ranging from eigiity to
ninety beats in a minute, his respiration forty to fifty,
and his temperature 99°, or normal. The urine con-
tained considerable albumen and tube-casts of the
granular and epithelial variety.
At the post-mortem examination there were 3,400 c.c.
of clear serum in the pleural cavity. There was no
evidence of peritonitis. In the right pleural cavity
there were 1,350 c.c. and in the left pleural cavity 1,300
c.c. of clear serum. The kidneys are not much reduced
in size ; their capsules are not adherent ; their surfaces
are smooth except the presence of a few small cysts.
The organs in the recent state were much congested.
The markings were obscure and the epithelium lining
the convoluted tubules throughout, and the straight
tubules in places, had undergone fatty metamorphosis.
There were many atrophied glomerules, and thickened
vascular walls, as well as tube-casts both in the cortical
and medullary portions of the organ. The heart is lar^e ;
all its cavities, especially its left ventricle, are dilated.
The left ventricular wall is hypertrophied, except ante-
riorly near the apex, wliere it is very thin and made ui)
almost entirely of fibrous tissue.
In this location the ventricular wall is about one-
fourth of an inch in thickness, and is lined by a clot of
fibrin firmly adlierent to the wall of the heart and is
similar to the clots found in aneurisms. The endo-
cardium of both ventricles is thickened, and the left
ventricular wall throughout contains a great deal of
fibrous tissue. _The interventricular septum is normal.
The muscular fibre of the heart on microscopic examina-
tion did not contain fat.
Dr. Gerster presented the uterus and apjiendages
removed from a woman thirty-seven years of age, who
had suff'ered for about one year from profuse menorrhagia
and continuous metrorrhagia. The patient had never
been pregnant, but had been married four years. She
had not reached the menopause. The menorrhagia and
metrorrhagia were believed to be due to uterine fibroids.
Her general condition became seriously reduced, and at
times she was so weak that upon slight exertion she
would faint. All the ordinary means had been resorted
to for producing involution of the fibroma without avail.
Finally Dr. Tauszky, under whose care the patient had
been, kindlv referred her to Dr. Gerster, and on exam-
ination he found in the median portion of the abdominal
cavity a hard, solid tumor, about the size of the uterus in
the seventh month of pregnancy, freely movable in all
directions, and smooth over its entire surface. There
was evidence of a slight amount of ascites. From ab-
dominal jialpation and the fact that the vaginal portion
freely followed movements imparted to the tumor, it was
thought probable that the swelling occupied the uterus
itself The ovaries were not detected by palpation. It
was evident that the woman would soon die unless re-
lieved in some way, and it was determined to give her a
chance by attempting to remove the tumor entirely by
the abdominal section. Accordingly, after preparatory
treatment, the operation was performed on June 7th.
The preparatory treatment consisted in the use of laxa-
tives with rectal and the methodical use of vaginal injec-
tions of an antiseptic fluid. The patient was etherized
and a small incision made in the abdominal wall some-
what below the umbilicus and in the median line. The
tumor at once presented itself, and on introducing the
fingers into the abdominal cavity the ovaries were readily
felt attached to it. The neck of the uterus was found
rather slender, and Dr. Gerster thought it would not be
difficult to secure it as a pedicle; the tentative incision
was therefore extended upward to two and one-half inches
above the umbilicus, with a view to everting the tumor as
rapidly as possible, and then close at once temporarily
the upper part of the incision by silver-wire sutures,
leaving an opening in the abdominal wall only sufficiently
large to enable him to treat the neck of the tumor, thus
guarding against the protrusion of the intestines. An
elastic ligature was thrown about the broad and round
ligaments and the tube, .\nother elastic ligature was
applied centrally toward the uterus, and the intervening
tissues were divided by the actual cautery. This was
done on both sides. Having thus secured the vessels lead-
ing to the tumor he placed an elastic ligature about the
neck of the growth itself 'and clamped it with lead. The
tumor was now cut away at some distance above the
ligature with a small amputating knife. His first idea
was to strip up the peritoneum and to place an elastic
ligature beneath it, but the pedicle was so small that he
decided to treat it like the pedicle of an ovarian tumor.
The cut surfaces were seared with the thermo-cautery,
iodoform was dusted over the stump, and the pedicle was
dropped into the abdominal cavity. Except the blood
which was lost from the tumor itself, not a droi) of
hemorrhage occurred save that from the external incis-
ions which was exceedingly slight as it was promjitly con-
trolled. No blood whatever entered the peritoneal
cavity. The tumor having been removed, and the pedi-
cle treated, the temporary sutures in the abdominal
walls were removetl, the edges of the peritoneum stitched
together by a continuous catgut suture, tlie edges of the
abdominal incision brought together by deep silver
sutures, and the ordinary antiseptic dressing applied.
The patient's pulse, which before the operation was
rather weak, varying from 90 to 96, rose to 108 during
the operation, and, after the an;csthesia ceased, to 116 to
118, and remained at this high rate. She complained
from the very first, after cominj; from under the influence
i
September 8, 1883.]
THE MEDICAL RECORD.
^-n
of the anesthetic, of extreme thirst, which Dr. Gerster
regarded as a very ominous symptom. The temperature
was normal up to a few hours before death. The patient
did not at any time complain of pain, and there was no
tympanites; up to twelve hours after the operation there
was no nausea or vomiting, but subsequently nausea was
present until death occurred. The patient died in col-
lapse with a thready pulse, but no pain whatever, the
respirations remaining normal nearly to the end. At
the aulopsy the abdominal incision was found nearly in
a normal condition, union by first intention had occurred
throughout except at the lower angle, where about three
drachms of purulent fluid had collected. The incision
through the peritoneum had completely healed by first
intention. The bowels were found in the same coll.tpsed
condition that they were in at the close of the operation.
The peritoneum itself was normal. The pedicle was
absolutely unchanged. The ligature which had been ap-
plied to it was in the position in which it was left. There
was no evidence whatever of inflammatory process with-
in the abdominal cavity. The uterus, containing a large
fibroid tumor, together with the pedicle, altogether
weighing seven pounds, the cervix, and a portion of the
vagina were presented. Dr. Gerster believed that death
was due to the ansmic condition of the patient, and the
shock of the operation probably hastened by the other-
wise not high fever due to suppuration of the external
wound. He believed that the formation of the jjurulent
fluid which was found at the lower angle of the abdominal
incision was due to septic infection ; for complete anti-
sepjlic precautions had been taken, all instruments and
utensils used had been disinfected, also the hands of all
the assistants and of the nurses ; but he was convinced that
while he was closing the external incision some fault in
tlie management of the sponges must have been connnit-
ted. It was in the external incision that the suppuration
occurred, as shown by the autopsy, either the sponges or
the hands of the nurses who assisted at this stage of the
operation, of both, had not been rendered antiseptic.
The Society then went into executive session.
AMERICAN DERMATOLOGICAL SOCIETY.
Seventh Annual Meeting, held at Lake George^ August
29, 30, and 31, 1SS3.
Wednesday August 29TH — First Day — Morning
Session.
The Association met at the Sagamore House, and was
called to order at 10.30 o'clock by the President, Dr. R.
\V. T.-WLOR, of New York, who welcomed tlie members
with a few appropriate remarks and then proceeded im-
mediately to the scientific business.
The first paper was read by Dr. H. G. Piffard, of
New York, on
THE TREATMENT OF ACNE.
The term acne was restricted to inflammatory aflections
of the sebaceous glands. This aftection never begins,
and relapses never occur, without sufticient cause, and
the first indication is to seek for and, if possible, remove
the etiological factor, whether gastric, intestinal, uterine,
etc. It is only partly true that it is an incurable disease.
It IS subject to repeated relapses. It can be cured tem-
porarily quite easily ; its course may be aborted and
often shortened. Dr. Piff'ard then related the history of
a case occurring in a patient who suffered from ovarian
trouble, the removal of which was followed by a cure of
the acne. He also referred to a case of chronic in-
curable organic uterine disease in which a severe acne
existed that persisted despite treatment, and stated that
in such instances all that could be reasonably expected
was temporary alleviation.
Acute acne vulgaris. — The drug which he had ad-
ministered internally with the most satisfactory results
was the calx sulphurata, in small doses to be discon-
tinued as soon as good effects are manifested. Next in
efficacy was the bromide of arsenic in doses of from yJ-g-
to Jjj- of a grain — a one per cent, alcoholic solution ad-
ministered in doses of from one to two minims (not drops)
in a wineglass of water upon an empty stomach. As the
acne imjiroves lessen the doses. He had found the
former drug most serviceable in the lymphatic variety
and the latter in acne of the florid type. External treat-
ment : depletion by incision and bathing with warm
(not hot) water ; in simple cases puncture the papules,
and puncture each fresh papule as it appears. The next
external application recommended was frequent bathing
with very hot water. In the pustular variety the pus-
tules should be punctured, the contents squeezed out,
and the jjarts bathed with hot water to reduce the conges-
tion. Other external applications mentioned were sooth-
ing agents, such as belladonna and stramonium — bella-
donna liniment mixed with benzoated lard, sometimes
ammoniate of mercury ; fluid extract of stramonium,
made from fresh leaves gathered in the autumn, incor-
porated in benzoated lard in the proportion of 3.i- to 3 j.
Subacute acne vulgaris. — Internal treatment by the
use of calx sulphurata, but in much larger doses than
in the acute form, and continued until the physiological
action of the drug is manifested by increased activity of
the eruption, perhaps by increased number of the lesions,
and perhaps by a tendency to suppuration. In oc-
casional cases he used mercury (corrosive sublimate),
iodide of potassium, and ergot. In external treatment
the principal indication is the employment of applica-
tions which produce an irritant or substitutive inflamma-
tion, such as green soaj), sulphur, biniodide of mercury,
corrosive sublimate, which act as irritants and are fol-
lowed by hyperemia with swelling, etc. When the ac-
tion has reached a proper limit, discontinue the remedy
and permit the parts to return toward the healthy state.
The strength of these applications must be varied accord-
ing to the effects produced ; it is well to begin with ap-
plications of moderate strength.
The author of the paper then referred to the views of
the Vienna and French schools, and to the jiractice
of English and American dermatologists.
With regard to ergot, as reconunendeil by Dr. Dens-
low, of New York, given in doses of twenty to thirty
grains twice or three times a day and continued for sev-
eral weeks he had seen some cases in which benefit fol-
lowed its use.
Comedones. — These yield only to mechanical treat-
ment. Remove them by pressing upon the surrounding
skin, and if the sebaceous plug does not readily come
out, enlarge the mouth of the duct with a fine needle.
Acne indurata, whether acute or subacute, may be
regarded as an aggravated acne vulgaris, and the princi-
ples of treatment are substantially the same as in acne
vulgaris. The most striking results he had seen follow
the use of ergot had been in this form of the disease.
Dr. Atkinson, of Baltimore, had used the sulphide of
calcium faithfully, but had failed to obtain the favorable
results, which from time to time had been reported. He
had used ergot, but also without noteworthy benefit.
Whatever of benefit he had obtained had been by the use
of local applications, together with such remedies and
measures as were indicated to correct or remove those
disorders, gastric, intestinal, uterine, etc., which were
generally supposed to be causes of this local inflam-
mation.
Dr. Van Harlingen, of Philadelphia, had used with
considerable benefit, in eight or ten cases of comedones,
the following smeared over the elevations : Officinal acetic
acid, two parts ; glycerine, three parts ; and kaolin, four
parts.
Dr. W. T. Alexander, of New York, had used calx
sulphurata with considerable benefit, but usually only in
the pustular variety. On the other hand, he referred to
a case in which the remedy, administered in small doses
four times a day, exhibited lack of power to arrest sup-
?74
THE MEDICAL RECORD.
[September 8, 1883.
puration. The only good effect he had seen follow the
use of ergot, was a seeming diminution of the redness,
but only so long as the drug was being taken.
Dr. Sherwell, of Brooklyn, did not employ the sul-
phide of calcium. He had obtained sufficiently good
results by the use of external applications with the use
of internal remedies, especially ergot. He had found
cannabis indica of great benefit in acute forms of the
disease tending to the pustular state. He associated
acute pustular acne with menstrual disturbances very
decidedly, and always employed ergot — moderately during
the period, more pronounced between the jjeriods, es-
pecially just before and just after the occurrence of one.
He could speak with certainty of the beneficial effects
produced by this drug in this form of acne occurring in
females, and had thought benefit followed its use in
males. In the rosaceous form of acne he had found
ergot especially beneficial. He regarded its use as em-
pirical, in all probability : at least, did not accept Dr.
Denslow's views that it acts upon the muscular tissue of
the skin.
Dr. Grah.\m, of Toronto, had found cal.x sulphurata
useful in suppurative diseases, whether acne or the forma-
tion of abscess.
The President said that the interest in the paper
centred upon the more or less importance of local and
constitutional treatment. He wished to again jiut on
record his belief that curative influence is exerted only
by loc.%1 measures, and that internal treatment is merely
subsidiary. As regards the reciprocal relations between
acne and uterine affections, he had not yet reached any
definite conclusions. That they existed at the same time
in the same patient was well recognized, but he had not
yet become satisfied as to whether the acne actually was
caused by the uterine disorder.
In the treatment of acute acne he had placed great
reliance upon alkalies and diuretics ; one or two drachms
of Rochelle salt with thirty grains of the acetate of potash
in a wineglass of water three times a day. In the hy-
perffiinic form he always obtained benefit by this med-
ication, and also in the indurated variety. Besides
puncture, recommended by Dr. Piftard, he had been
accustomed to apply liquor hydrarg. pernitratis — one to
eight of water — once or twice a day. He had also used
with marked benefit, in that form, also accompanied with
rosacea, one-half ounce of chrysarobin to one ounce of
flexible collodion ; pencil the patches. The use of this
remedy necessitates sequestration of the patient for some
time. He had also obtained benefit in the treatment of
acne indurata by the use of Donovan's solution, pushed
until ten or twelve drops are taken at a dose, three times
a day.
In his hands ergot had not cured a single case. It re-
lieves the hyperaimia but has no effect upon the indura-
tion. In the various forms of acne he had obtained the
most gratifying results from the use of mercurial ointment
— one to eight of vaseline — or ointment of biniodide of
mercury.
Dr. Stelw.^gox, of Philadelphia, had obtained good
results from the use of a lotion comjjosed of sulphate of
zinc, 3j. ; sulphuret of potash, 3 j- ; water, 3 iv.
The President and Dr. Sherwell had used this lo-
tion with good results. The President had used an oint-
ment of iodide of zinc, five to thirty grains to one ounce
of vaseline or lard, with excellent results.
Dr. Graham, of Toronto, then read a paper on
GENERAL EXFOLIATIVE DERMATITIS.
The author of the paper first directed attention to the
significance of the term, and then made brief allusion to
the literature of the subject. He had collected thirty-
four cases, of which eleven terminated fatally, ten recov-
ered entirely, and in seven the recovery was partial or
the result was not known. In eight cases the disease
ran an acute course, not lasting longer than a few weeks,
and in twenty-five it was chronic, lasting for months or
years. He had had under observation four cases, two of
which were of a chronic character, and two were acute
and recurrent. In the third case the seizures occurred
at various seasons of the year, and in the fourth case
the first three took place in summer and the fourth in
March. In both the disease ran a very similar course,
except that in the latter there was at the beginning a
vesicular eruption, whereas in the fourth no such lesion
occurred.
It is probable that many cases of general exfoliative
dermatitis have been mistaken for scarlet fever. The
principal features of the disease may be considered
under three heads : (t) general hypevsemia ; (2) general
exfoliation of the epidermis; and, (3) severe constitutional
symptoms appearing at various times throughout the
attack, and in many instances a tendency to a fatal re-
sult. In some cases preceding the hyperremia and
exfoliation there is a serous exudation. From liis ob-
servations, the author of the paper agreed with Dr. Bax-
ter and Dr. Jamieson in the opinion that the term general
exfoliative dermatitis may be applied to all the cases
which are generally described under the names pityriasis
rubra, and pemphigus foliaceus, as well as to other cases
which cannot be classed with either. There are two
principal sub-divisions of the affection : i, acute ; 2,
chronic. Of the latter there are two varieties : (i) in
which hyperremia and exfoliation exist, and it might be
called dermatitis exfoliatum rubrum ; (2) in which a
serous exudation, in the form of bullae, precedes the
exfoliation, and this might be called dermatitis bullosa
et exfoliatum. The former variety would include pity-
riasis rubra and the latter pemphigus foliaceus. The
acute form, although often single, has a strong tendency
to recur, influenced by season or outward circumstances.
The recurrences may be accounted for from individual
peculiarities.
Dr. Hardawav, of St. Louis, had under observation
one case of five years' standing, which manifested some
improvement under the internal use of the tincture of
iron ; all other methods of treatment having failed. He
had seen one quite acute case ; another occurring in an
infant ; another occurring in a young lady, of neurotic
family, and since the attack she had suffered during the
last seven years from frequent occurrences of bright
hyperamic spots, varying in size from that of a silver
dollar to that of the hand, exceedingly hot and throbbing
to the touch, and -li'ithoui exfoliation.
Dr. Atkinson, of Baltimore, thought it impossible to
describe a distinct disease that could be called pityriasis
rubra. Again, it was desirable to find some name to
apply to certain cases, and he thought general exfolia-
tive dermatitis was as good as any, perhaps. He be-
lieved that there is a very wide range in these cases, but
that the disease always depends upon trophic neuroses,
the nature of which we do not understand. Some cases
answer to pityriasis rubra ; others give patches which
are undoubtedly eczematous ; and then there are chronic
cases of exfoliative dermatitis. He regarded it as im-
portant to remember that the skin of certain individuals
manifests a marked tendency to become inflamed as the
result of the internal use of certain drugs; for example
there is a well-marked eruption produced by quinine.
Dr. G. H. Fox, of New York, a])proved of what Dr.
Atkinson had said concerning the advisability of includ-
ing all forms of dermatitis under the general name, and
thought it was fallacious to endeavor to make a differen-
tial diagnosis clinically. As to pityriasis rubra and ec-
zema, however, he believed there were reasons for
making a distinction, and, in many of the cases of general
desquamation which are spoken of as exfoliative derma-
titis, there is an eczematous process which involves
the mucous layer of the skin, and is not a disease of
the vascular supply or a primary disturbance of the
nervous system, as is pityriasis rubra. He thought Dr.
Graham had done well in associating the acute and
chronic cases.
September 8, 1883.]
THE MEDICAL RECORD.
275
Dr. p. a. Morrow, of New York, believed the disease
to be neurotic in character, and in two cases had seen
decided benefit produced by arsenic.
Dr. Shekwell thought an exception should be made
with reference to pemphigus fohaceus, as it was suffi-
ciently distinct in character still to be entitled to retain
its original name. He accepted Dr. Graham's first divi-
sion, but not the second.
Dr. Piffard thought there were three quite distinct
affections: (i) pemphigus foliaceus ; (2) pityriasis rubra;
(3) dermatitis exfoliativa. He admitted that it was
sometimes difficult to make a difterential diagnosis, but
that fact could not be used as an argument in favor of a
general name.
Dr. Gr.-\h.^m said he had doubted the propriety of
placing pemphigus foliaceus under the head of general
exfoliative dermatitis, but at the same time the two con-
ditions had so many features in common that he had ven-
tured to do so.
The Presidf.nt regarded the further study of the three
affections mentioned by Dr. Piffard as very important.
He then called attention to two cases. The first oc-
curred in a woman thirty years of age, a widow, the
mother of one child, and a suft'erer from chronic malaria,
who had _/?/?<•[•« attacks, produced by taking either quiiune.
cinchonine, or elixir of calisaya. The second case oc-
curred in a boy nineteen years of age, who had been
under observation five months. The patient had been
exhibited to the New York Derniatological Society, and
a history, so far as then given, had been published in
the July number of the present year of the Journal of
Cutaneous ami Venereal Diseases. The interest in
the case centred in the question whether or not the
condition of the skin depended upon syphilis. It was
the most remarkable case of exfoliative dermatitis he
had ever seen, and was surrounded with grave doubt
concerning its etiology. Dr. Taylor's description of
the case was accompanied by several photographic illus-
trations.
Dr. Stelwagon, of Philadelphia, then read a paper
on
IMPETIGO CONTAGIOSA.
The author of the paper first referred to the individual
nature of this affection, and the correctness of the views
advanced by Tilbury Fox. He believed there was no
evidence that the disease is in any way related to ring-
worm ; also that it does not follow contagious pustular
affections as claimed by Dr. Hyde, of Chicago ; further
that a pustular disease cannot be modified by a conta-
gious disease ; nor, in case that such a modification
might be produced that the modification could propagate
itself. If the disease is not a modification of some other
affection the conclusion must be reached that the pro-
cess is an independent one, and the individuality of the
disease must be admitted. The eruption has contagious
properties. He doubted the truth of the idea that it is of
fungous nature. In five hundred microscopic examina-
tions he had been unable to find the fungus described by
Dr. Piffard except in three instances, and regarded the
fungi when found as in all probability adventitious. The
view that the affection is a general systemic disease with
cutaneous manifestations seemed to him to be the most
tenable that could be offered. This view is sustained in
a measure by the writings of Tilbury Fox, and there are
several reasons which support the theory. Aggregated ex-
perience proves the existence of prodromic symptoms,
and ordinarily it runs a short but definite course. The
eruption is auto-inoculable, which explains the existence
of new patches. There are several facts which are
against the supposition that the disease follows vaccina-
tion. The author's conclusions were : i, that it is a
separate and distinct disease ; 2, that it is not parasitic ;
3, that it is not related to vaccination ; and 4, that it is
an acute systemic disease with cutaneous manifestations
and probably due to a specific poison.
Dr. Hardaway regarded the fact that the disease oc-
curs epidemically as a strong argument in favor of its
being an independent affection.
Dr. Atkinson felt very uncertain concerning the indi-
vidual nature of the disease.
Dr. Rohe, of Baltimore, did not recollect that he had
seen a case during the last two years. That the pus of
impetigo contagiosa is inoculable he was quite sure ; that
it is inoculable upon healthy individuals ; and that succes-
sive inoculations become weaker. He had been unable
to find a fungus. That it is an independent disease he
was moderately certain ; but that it is found only after
contagious diseases and in individuals who are not in
good health, as suggested by Dr. Hyde, he did not be-
lieve, vet what the exact nature of the disease is he did
not know.
Dr. G. H. Fox thought all would agree that the pus
is inoculable, that it does not depend so much on the
character of the soil as on the character of the pus ; and
that the peculiar pustules which result are not to be
classed as pustular eczema. He thought Tilbury Fox
was unwise in giving the affection a new name. He
had generally studied it as a disease of the skin ; but re-
garded the suggestion that it is constitutional as worthy
of attention. Dr. Fox was also inclined to doubt the
proposition that it has no connection whatever with
vaccination ; but exactly what the relation is he was un-
able to say. With regard to pediculosis, it might not
produce an eruption, but certainly it would cause the
spread of one.
Dr. Graham had always regarded impetigo contagiosa
as a distinct disease, and was inclined to agree with Dr.
Stelwagon concerning its nature.
Dr. Piffard preferred to go back to the old name.
He had a series of cases in different families, and in
every instance the first in each series appeared shortly
after vaccination, and the other cases followed. As to
its parasitic nature he was still inclined to hold to that
view, although no one had found a definite parasite in
the vesicle ; fungi had been found in the crusts only, and
several who had found fungi had found different ones.
He found, at the time he made his observations, a per-
manent fungus, the same as he found in vaccine, and
similar ones have not been described in connection with
any other form of disease. If it was a common crust
fungus he should be forced to give up the connection of
the disease with vaccination. A point in favor of its
parasitic nature is the fact that it is cured so readily with
parasiticides. He had not regarded it as a self-limited
disease, but thought the explanation given by Dr. Stel-
wagon was a very ingenious one.
The President was a firm believer in the individuality
of the disease. He could not regard it as a systemic
affection. The existence of a prodromal fever was e.x-
ceedingly doubtful. In sixty cases he had observed, the
disease began locally about the face or nails in every in-
stance, and afterward different parts of the body were
inoculated. He thought the systemic reaction could
be easily explained by the existence of an eruption.
He believed it spreads by immediate contagion. He be-
lieved the disease originated in some form of pus which
lodges upon the skin, then develops a pustule, and from
this it is communicated to others, or to other parts of the
body.
Dr. Fox had had cases which did not yield readily to
treatment, and had remained obstinate for two or more
weeks.
Dr. Stelwagon said that sometimes several weeks
were required to get rid of the disease.
Dr. Rohe said he did not wish to endorse the view
that the disease is systemic, the same as scarlet fever,
etc., but simply wished to say that he regarded it as inoc-
ulable locally.
Dr. Hardaway had not seen the disease associated
with vaccination.
The Association then adjourned to meet at 8 p.m.
276
THE MEDICAL RECORD.
[September 8, 1883.
Wednesday — First Day — Evening Session.
The Association was called to order at S p.m. by the
President.
Dr. Atkinson, of Baltimore, then read a paper en-
titled
A CASE OF MULTIPLE CACHECTIC ULCERATION.
The case occurred in a female child, mixed white and
black, without any evidence of syphilis, and the effect of
mercury, ergot, and scurvy, as well as diabettjs, could be
excluded. The symptoms summarized were, papillation,
vesiculation, followed by superficial destruction of tissue
and progressive ulceration which destroyed all the tis-
sues, even the bones. At no point did gangrene in mass
occur. It was not entirely symmetrical. Motion and
sensation were impaired, but there was not complete
paralysis of either. There was no evidence of itching or
pain. Distinct symptoms of vaso-motor disturbance
were not observed. Dr. Atkinson thought there could
be no doubt that his case belonged to the group named
by Oscar Simon multiple cachectic gangrene, and that
it was one of the trophic neuroses.
Dr. Van Harlingen reported a case of trophic neu-
rotic gangrene occurring after amputation of the thigh.
The President reported two cases seen with Dr. W.
H. Draper, at the clinic at the College of Physicians and
Surgeons. The first was a puny child, six months old,
that had an ulcer upon the back which began as a water-
blister. Despite treatment it extended and became very
large, destroying the skin down to the muscles. Under
generous diet and tonics it ultimately recovered.
The other case occurred in a woman thirty years of
age, married, who had never had children, and never had
taken ergot. She came with each finger on both liands
in a bluish congested condition, but no bulla: existed.
There was swelling of the tip of the nose and ui)on it
was a bulla, which broke down into an ulcer, involving
all the tissues down to the cartilages. The patient lost
fully one-half of every finger, the thumbs escaping. She
finally recovered. The only etiological factor that could
be reached was excessive indulgence in buckwheat
cakes.
experiments in the use of naphthol.
Dr. Van Harlingen read a paper with the above
title, in which he gave the conclusions reached by Kaposi,
who introduced the use of the remedy, together with a
commentary containing his personal ex])erlence in its
use. He had found it of great service in scabies, also of
some value in the treatment of psoriasis. In parasitic
skin diseases naphthol is of but little use, while in eczema
and hyperidrosis it is entirely without value.
Dr. Fox had used the remedy externally in almost
every case where he could possibly employ it, and had
become convinced that it falls far short of taking the
place of tar. In a few cases of eczema of the scrotum
and anus he had obtained very satisfactory results from
the application of a five per cent, ointment. For psori-
asis of the scalp and face the ordinary white ]>recipitate
onitment had served most satisfactorily.
Dr. VVigglesworth, of Boston, thought Kaposi did
not use naphthol as much as formerly. His own experi-
ence corroborated that of Dr. Fox.
Dr. Hardawav had found it very nuich inferior to
chrysophanic acid in psoriasis and eczema. In the fis-
sured and squamous eczema of the i)alms of the hands
and fingers he had used a fifteen per cent, ointment with
good success.
Dr. Stelwagon thought it inferior to white jnecipi-
tate ointment for psoriasis of the scalp ; regarded it as
very efficient for scabies, and was of the impression that
it is now scarcely used in Vienna except in the treat-
ment of this aft'ection.
Dr. Piffaru regarded naphthol as a dangerous rem-
edy.
The President had used it with good results in sca-
bies, but in psoriasis it had proved inefficient.
Dr. G. H. Fox, of New York, then read a communi-
cation, entitled
A TRIP TO TRACADIE (lEPROSY),
together with propositions submitted joindy by himself
and Dr. Graham, of Toronto. Tracadie is in New
Brunswick and has a lazaretto where lepers reside.
During this summer he had visited the place, and so
also had Dr. Graham, of Toronto, under the direction
of the Dominion Government. The lazaretto has at
present 24 inmates, ii males and 13 females, and is
under the charge of Sisters of Charity. The disease as
seen was partly of the tubercular and partly of the mac-
ular variety, and there were three cases which were not
leprous. Some of the cases showed a peculiar skin dis-
ease that appeared to be syphilitic in character, although
there were no marked lesions of syphilis. As to the
white scales, so often referred to, he was struck with one
fact, namely — that both forms showed shining silvery
scales, very much as found in psoriasis, except not hav-
ing the peculiar circumscribed form. Many of these
patients had papular eczema, which gave them much
annoyance. Most of the patients, with the tubercular
form especially, presented marked ulceration of the hard
palate ; in one case there was perforation. Many of
the cases presented a well-marked form of dactylitis,
without the suspicion of syphilis, but with enlargement
of the bones of the toes in one case. Those who had
ulceration of the hard palate had also laryngeal trouble,
either the peculiar wheezing or complete aphonia. The
following were the propositions submitted as a joint com-
munication by Drs. Fox and Graham :
First. — Leprosy is a constitutional disease, and in
certain cases appears to be hereditary.
Second. — It is undoubtedly contagious by inoculation.
Third. — There is no reason for believing that it is
transmitted in any other way.
Fourth. — Under certain conditions a person may have
leprosy and run no risk of transmitting the disease.
Fifth. — It is not so liable to be transmitted to others
as is syphilis in its early stages. There is no relation
between the two diseases.
Sixth.- — Leprosy is usually a fatal disease, its average
duration being from ten to fifteen years.
Seventh. — In rare instances there is a tendency to re-
covery after the disease has existed many years.
Eighth. — There is no valid reason for pronouncing the
disease incurable.
Ninth. — Judicious treatment improves the condition
of the jiatient, and often causes a temporary disappear-
ance of the symptoms.
Tenth. — There is a ground for the hope that an im-
proved method of treatment will in time effect the cure
of leprosy, or at least that it will arrest and control the
disease.
Dr. Fox admitted that he iiad )et to cure his first case,
but he did not believe that leprosy is an incurable dis-
ease. The treatment adopted in the New York Hospital,
consisting in the use of cliauhnoogra oil, and large doses
of nux vomica, had afforded a degree of success, and he
read a letter received from a patient which showed that
the disease in his case had at least been non-progressive
for some time.
There is no evidence that either physicians or nurses
have acquired the disease by attendance upon those af-
fected with it.
Dr. D. B. Simmons, who had had a large experience
in the treatment of this disease in Japan, was invited to
open tlie discussion. He thought it exceedingly difficult
to study leprosy in lazarettos. According to his observa-
tion, and the view is fully recognized by the Japanese,
the disease manifests itself /irst in the face, and by a
peculiar blushing or lividity of the features, especially
after taking wine, etc. The development of tliis peculiar
September 8, 1883.]
THE MEDICAL RECORD.
277
appearance is at once sufficient to drive the person im-
mediately into exile. Next tlie an:esthetic symptoms
usually are most prominent, anassthetic spots, without any
other manifest change in the condition of the skin or
existence of other symptoms of the disease. Then the
disease shows itself sometimes upon the ears, sometimes
elsewhere, with exacerbations at times, sometimes with
fever, bleeding from the nose, etc. His own opinion was
that it is decidedly hereditary, but it is exceedingly diffi-
cult to reach facts bearing upon this question, because
of tlie prompt exiling of any member of the family who
develops the first peculiar symptoms, and subsequent
denial that the disease ever existed in the family. He
did not regard it as either contagious or infectious, and
it is not regarded by the Japanese as contagious. The
duration of the disease is exceedingly variable. He had
never succeeded in curing a case, nor had he seen a case
that had been cured, but almost without exception every
patient might be benefited by treatment. Strict atten-
tion to hygiene, diet, and cleanhness, aided By the in-
ternal and external use of copaiba had yielded the most
favorable results he had obtained.
Dr. Rome said that, if the disease is spread by con-
tagion, there is a marked difference in the susceptibility
of different persons to its influence ; a much more marked
difference than exists with reference to any other con-
tagious disease.
Dr. Wigglesvvorth had studied the disease in Norway
and Spain as well as in the East, and could corroborate
Dr. Fox's views concerning the non-communication ol
the affection to physicians and nurses. His view was.
that while it is inoculable, it is but faintly, if at all, con-
tagious, and not at all infectious. Nor did he see any-
thing in the direction of 7C'/iife patches to suggest the
existence of the disease.
Dr. Graham regarded the disease as inoculable and
infectious. He was also inclined to believe that the
disease is hereditary, although no case in Tracadie con-
firmed that belief. He had noted a decidedly marked dif-
ference in susceptibility of different persons, as illustrated
by one family especially in Tracadie.
Dr. Piffard accepted the ten propositions. He also
referred to one instance in which a physician took the
disease and died of it. He thought it was utterly im-
possible to determine in any given case whether the
disease is due to heredity or to infection.
Dr. Sherwell, of Brooklyn, then read a paper on
facet's disease, or malignant papillary derma-
titis.
He had had two cases, and these with those recorded
by Paget, Butlin, Morris, Thin, and Duhring made 27.
He had recorded his first case, the first published in the
United States, in the January number of the Journal of
Cutaneous and Venereal Diseases. The author of the
paper gave the following conclusions :
First. — The subjective symptoms, itching, burning,
are those of an eczema, and not those of an ordinary
carcinomatous affection, but they are more marked than
in an ordinary case of eczema.
Second. — The objective symptoms are like those of
eczema ; the discharge is absolutely similar to that of
catarrhal affection of the skin, stiffens linen, and
forms crusts entirely indistinguishable from those of an
impetiginous eczema. The color of the surface is per-
haps occasionally more livid, but the border is, in his
opinion, not more sharply defined than is common in
that trouble. The somewhat elevated appearance of the
patch simulates e.xactly the acutely macerated and swol-
len conditions of the lower epithelial layers we so fre-
quently find in eczema. Sir James Paget compares the
appearance to that of a balanitis, an apt illustration.
Third. — The disappearance of the nipple is spoken of
by Henry Morris as a " melting away," a very acceptable
term.
Fourth. — The "malignant papillary" feature, as de-
scribed by Thin, was a marked element in his first case ;
much less in the second. It is a very diagnostic point,
and would of itself, lie thought, instantly resolve any
doubts as between it and true eczema.
Pifili, — The extreme length of time may be noted in
his cases, before the appearance of anything like positive
evidence of carcinoma. It will be noticed that Sir James
Paget gives the limit, as to this, as two years. In Dr.
Sherwell's first case twelve years elapsed from attack to
death, the latter event not seeming in any way connected
with the skin lesion ; in the second case considerable
over the time mentioned by Paget had already passed.
The Association then adjourned to meet at lo a.m.,
Thursday, August 30th.
Thursday, August 30TH — Second Day — Morning
Session.
The Association was called to order at ten o'clock.
Dr. 1. E. Atkinson, of Baltimore, Vice-President, in the
Chair.
Dr. Wiggleswortii, in behalf of Dr. White, presented
the statistical report, which was accepted. On motion
by Dr. Taylor, a vote of thanks was extended to Dr. Wig-
glesworth for his most valuable services in performing
the work which Dr. White, Chairman of the Committee,
had been prevented from doing by reason of absence in
Europe.
Dr. p. a. Morrow, of New York, then read a paper
on
the pathogenesis of drug eruptions.
Under this head are included all eruptions caused by
either the internal or external use of drugs. There is a
difference of opinion as to whether these eruiitions should
be classed among physiological or among toxicological
effects. A large proportion of drug eruptions are the
expression of the physiological action of the article used.
The term pathogenesis is employed with reference to the
close relationship which exists between physiological and
pathological effects. Dr. Morrow discussed at consider-
able length the difficulties encountered in attempting lo
distinguish between the two effects, and especially when
influenced by individual susceptibilities and other modi-
fying circumstances. He then passed to a review of the
theories which had been advanced in explanation of the
phenomena, such as that a large proportion of these
eruptions are produced by the elimination of the drug
through the skin, special affinity for cutaneous structures,
dynamic action of drugs, all of which had been proved to
be fallacious. This was followed by a discussion of the
theory of the neurotic origin of drug eruptions, which he
believed best explained the phenomena in each case.
The paper closed with a reference to the broad meaning
of the term idiosyncrasy, as, after all, anomalous erup-
tions are determined by the individual rather than by the
drug. The nervous element predominates in persons
who have an idiosyncrasy.
Dr. R. \V. Taylor then read a paper entitled,
polymorphous changes observed in the tubercu-
lar syphilide.
The paper was based upon a case of syphilis present-
ing rather early tubercular eruption, described in the
books as non-ulcerative tubercular syphilide. The
eruption was general, symmetrical, copious, and had the
characteristics of the secondary eruption, but besides, all
the deep-seated peculiarities of the tertiary eruption, so
that, in order to place it in its chronological relation, it
would be called what the French denominate the inter-
mediate eruption.
The patient was a male, forty-seven years of age. Dr.
Taylor gave a detailed description of the changes which
took place in the eruption, and illustrated them by plates,
colored upon photographs. Atone period in the case,
the eruption appeared strikingly like psoriasis, and sub-
sequently the appearances of psoriasis rupioides, as illus-
278
THE MEDICAL RECORD.
[September 8, 1883.
trated by McCall Anderson, and maintained by Fox, a
condition wliich might give rise to the suspicion that,
what those authors had called psoriasis rupioides, is only
a late form of a papular or tubercular syphilide.
The points of interest in the case were the following :
Fust. — Its resemblance to psoriasis.
Second. — The colloid degeneration of some of the
tubercles concomitantly with the increase of the granula-
tion tissue in others.
Tliird. — The degeneration of the colloid tissue into
pus, and the formation of bulke.
Fourth. — The evidence offered that true bullas may
appear in a syphilitic subject, though they result from
degeneration of tissue, rather than from eft'usion of serum
and pus, as occurs, as a rule, in simple pemphigus.
Fifth. — The development of tubercles having thick,
imbricated, conical, epidermal crusts appearing like
rupia.
Sixth. — In the suggestion offered by these lesions, that
perhaps the psoriasis rupioides of authors is more or less
dependent upon syphilis.
Seventh. — The formation of true rupia crusts from the
bulla; above spoken of.
Eighth. — The fact that the non-ulcerated tubercular
syphilide may be the starting-point of severe and e.\ten-
sive gummatous intiltration.
Dr. H.-\rd.\way related the history of a case of psoria-
sis rupioides, as described by McCall Anderson, occurring
in a non-syphilitic patient. The only departure from the
appearance of ordinary simple psoriasis was the heaped-
up condition of the scales. The mother of the patient
had ordinary psoriasis vulgaris.
Dr. .VrKiNSON remarked that Dr. Taylor's paper was
also interesting as showing the power of syphilis to as-
sume nearly all phases and simulate almost all diseases.
PSEUDO-PSORIASIS OF THE PALM.
Dr. Sherwell read a paper on the above subject, in
which he said that in using this title he inferentially and
necessarily included those lesions invading the structures
anatomically analogous, the plantar surfaces. As to
whether a psoriasis, pure and simple, ever occurs in the
regions named, he had steadfastly maintained the nega-
tive.
In conclusion, he would sav that he believed a squa-
mous eruption upon the palms (excluding eczema, etc.),
resembling psoriasis, always to have a syphilitic diathesis
for its base, or one of its bases, and to be prima facie
evidence thereof. He did not think, however, that if it
could be decided, any great change in the general treat-
ment would be eftected, but he did believe that an erup-
tion of this nature, in this location, would always in the
physician lead him intuitively to the employment of
Donovan's rather than Fowler's solution. But even here
again the result of treatment would evidently not be di-
agnostic proof. Dr. Sherwell had seen one case, pre-
sented to the New York Dermatological Society by Dr.
Bulkley, which almost convicted him that his belief was
erroneous, but several of the members expressed grave
doubt concerning the absence of syphilis. Dr. Sherwell
then gave the history of a case.
Dr. \V. T. Alexander, of New York, then read a pa-
per on
PSORIASIS AFFECTING THE PAI..MS,
in which he gave the histories of three cases of the dis-
ease occurring in non-syphilitic patients. The paper
was illustrated by photographs. Discussion on these two
papers was oi)ened by Dr. Graha.m, who reportetl two
cases of psoriasis of the palms, the only ones he had ever
seen, occurring in non-syphilitic patients.
Dr. -Morrow stated that while psoriasis is extremely
rare upon the palms, and while it jirobably never occurs
independent of its development upon other parts of the
body, yet clinical facts prove that it may develop upon
the palms. He had seen a number of cases of psoriasis
of the palms in non-syphilitic patients.
Dr. Taylor saw the three cases reported by Dr.
Ale.xander, examined the patients, but was unable to find
any evidence of syphilis. He had not seen psoriasis of
the palms or the body that did not exhibit psoriasis of
the nails first. That simple psoriasis can affect the
palms he thought there was no doubt. He thought,
however, that it had never been seen confined to the
palm.
Dr. Morrow had seen a case in which the disease was
confined to the palm.
Dr. .\le.\axder said he had been struck with the
evanescence of psoriasis of the palm, and perhaps that
was the reason why it was seen so rarely upon the palms.
He cited a case in which it appeared and disappeared
within a few days without treatment.
Dr. Sherwell said that to prove negative was far
more ditificult than to prove positive syphilis, and congen-
ital syphilis also formed a part of his theory concerning
psoriasis. He had seen simple psoriasis, and then the
patient contracted syphilis, and soon afterward psoriasis
of the palms developed so repeatedly that he must still be-
lieve palmar psoriasis has a syphilitic basis. It might be
that the syphilis gives the psoriasis a change, so that it
appears in the palms ; that view he was prepared to
accept.
A paper entitled
A STUDY OF THE COINCIDENCE OF SYPHILITIC AND NON-
SYPHILITIC AFFECTIONS OF THE SKIN,
and sent by Dr. Hyde, of Chicago, was read by Dr.
Wigglesworth.
The more precise and exact the study of the symptoms
in syphilis, the more clearly will be recognized two facts
which are strictly related : 1. Syphilis much more re-
sembles other diseases in its career and its subjection to
accidental influences than has been commonly supposed
and taught. 2. When syphilis precedes, coexists, or fol-
lows other pathological conditions, its unity is preserved,
and it rarely undergoes itself, or induces in other diseases,
such a modit'ication as distinctly changes the type of the
resulting symptoms. The first statement was supported
by the follouing propositions ; the second required clin-
ical demonstration :
(a) .\llowance being made for a wide field of distribu-
tion of its lesions, the study of one hundred consecutive
cases of syphilis will convince an unprejudiced observer
that such cases resemble each other as closeh' as do a
similar number of consecutive cases of pneumonia, ty-
phoid fever, or chronic interstitial nephritis.
(b) Syphilis is no exception to the general rule that
the patient of greatest vigor best endures its penalties.
(f) Syphilis acknowledges subjection to the great ac-
cidents which commonly and evidently work changes in
all disease-processes in man.
((/) Syphilis, like other diseases, may lurk obscurely
in the system, but everything said and done, it must be
betrayed by syphilitic symptoms, or we cannot admit its
existence.
{e) Vulgar belief to the contrary notwithstanding,
cases of syphilis, like those of other diseases, are readily
separable into three well-known groups: (i) mild, be-
nignant or self-limited, requiring no treatment ; (2) the
grave, malignant, when treatment can have little or no
effect ; and (3) those falling between these two extremes,
where judicious treatment is capable of turning the scale
in one direction and injudicious treatment in the other.
(/) There is no specific treatment applicable to every
case of syphilis, which can be safely employed to the
exclusion of all others.
In what followed the author of the paper proceeded
to show how far clinical evidence supported the second
of the two general propositions, that which recognizes the
unity of syphilis displayed in fairly typical symptoms in
the subject, who are affected with other diseases more
particularly involving the skin. Yarieties of suborrhoea
and comedo are probably found in more frequent co-
September 8, 1883.]
THE MEDICAL RECORD.
279
existence with syphilis than the other disorders of secre-
tion. Erythema, urticaria, eczema, herpes, the several
forms of acne, impetigo, ectliyma, furunculus, anthrax,
and the varieties of dermatitis frequently occur in sub-
jects of an active syphilis. Herpes zoster he had not
seen in a syphilitic subject. To the subject of the co-
incidence of psoriasis and syphilis the author of the
paper directed special attention, and gave, with very
great detail, the histories of two cases.
The Association then adjourned to meet at 8 p.m.
Thursday — Second Day — Evening Session.
The Association was called to order at 8 o'clock by
Dr. ATKiNSOisr, Vice-President.
The President, Dr. Taylor, read a paper entitled
THE PECULIAR APPEARANCE OF THE INITIAL LESION OF
SYPHILIS AT THE EARLIEST PERIOD OF ITS DEVELOP-
MENT. [See p. 255.]
A paper by Dr. Duhring, of Philadelphia, on
THE VALUE OF A LOTION OF SULPHIDE OF ZINC IN THE
TREATMENT OF LUPUS ERYTHEMATOSUS,
was read by Dr. Stelwagon. Dr. Duhring had used
this lotion with marked benefit in the inflammatory su-
perficial forms of the disease, either discreet or contki-
ent patches, whether recent or of longer duration. He
did not claim for the remedy any specific power over
the disease, but in several cases it was the only remedy
tolerated by the skin. The following fornmla for the
lotion was given :
9. Sulphate of zinc,
Sulphuret of potash aa grs. xxx.
Rose water 3 iijss.
Alcohol 3 iij-
M.
If this strength agrees with the skin, the quantity of
the two active ingredients may be increased. The ap-
plication may be repeated twice or more times in twenty-
four hours, the skin being cleansed each time with soap.
Dr. Piffard was astonished to hear that so many
remedies had been employed in the treatment of a case
of lupus, because it seemed so well settled that, in order
to get rid of lupus, it must be destroyed. The methods
of destroying it, which, in the majority of cases, act most
successfully, are first, the use of the curette followed by
cautery, frequently the actual ; and second, scarification.
Doubtless the lotion would benefit certain cases, but he
was unable to understand how it could effect a cure.
Dr. Alexander had, at present, a case under treat-
ment in which he had practised scarification three or four
times, and the first operation was followed by the disap-
pearance of one patch of the disease ; but since tlien
the only effect produced was to make the patches worse.
Dr. Van Harlingen said that he saw one of Dr. Duhr-
ing's cases, and certainly very marked improvement fol-
lowed the use of the lotion.
Several of the members failed to see how the lotion
could produce much eft'ect on such a disease as lupus.
Dr. Fox, of New York, had secured his best results in
the treatment of this disease by the local application of
pure carbolic acid. Paint it over the part at intervals of
a week or ten days, perhaps more frequently. In three
cases he had succeeded in effecting a complete cure of
the disease. The frequency of the application will de-
pend on the rapidity with which the skin peels off and
leaves a smooth surface ready for another application.
He had not found that it aggravates the disease at all.
He had also obtained beneficial results by the internal
use of phosphorus, and thought that, perhaps, a judi-
cious use of both remedies might secure still better results
than had yet been obtained by either alone.
Dr. Stelwagon said that scarification aggravated the
disease in Dr. Duhring's cases; that pure carbolic acid
was applied without effect ; and that they were benefited
by this lotion only, which was applicable chiefly to the
superficial variety of the disease.
Dr. Piffard said that the dermatitis referrred to by
Dr. Stelwagon and Dr. Alexander after scarification, oc-
curred as a matter of necessity, but that it did no harm.
Scarification should be performed with great thorough-
ness, and the dermatitis which follows is of great advan-
tage. It is substantially the treatment recommended by
Hardee, namely, to excite a sufficient amount of new in-
flammation to strangulate new lupus cells.
Dr. Hardawav believed strongly in scarification and
multiple puncture. He had treated one case success-
fully, however, by electrolysis.
A paper by Dr. Duhring, of Philadelphia, entitled,
report of a CASE OF AINHUM WITH MICROSCOPIC EX-
AMINATION,
was read by Dr. Stelwagon. The case was one which
came under the observation of Dr. George B. Weston,
of West Virginia, and to him Dr. Duhring was in-
debted for the specimen with the notes. Only a few
cases of this disease had been reported in this country,
and with reference to them the conclusion had been
reached that it was caused by the application of a ligature.
The patient was a negro, and the specimen consisted of
one of the toes. The microscopic examination was made
by Dr. Henry Wile, of Philadel])hia, who examined it
with great care, and reached tiie conclusion that the
principal changes which existed were those that indicated
general inflammatory condition.
Dr. Sherwell had treated many patients coming
from Jamaica, San Domingo, but especially from Turk's
Island, and had made inquiry concerning this affection,
and had been led to the conclusion that it is due to
traumatism from the application of a ligature around the
toe ; lazy negroes apply a ligature, and become subject
to what is known as " ring-toe."
Dr. Hardawav, of St. Eouis, read a paper in which
he described
a PECULIAR PAPILLARY ERUPTION.
It occurred in an otherwise healtliy developed brunette
upon the left cheek and both hands, and had existed at
least a year, but gave no special inconvenience. The
size of the papules varied from that of a grain of wheat to
that of a split pea, and they were non-pedunculated. The
eruption was discreet, of a dull lemon color, and of pel-
lucid appearance. The papules were solid to the touch,
gave the appearance of having liquid contents, but noth-
ing could be obtained by puncture, and nothing could be
squeezed from the papules. The eruption disappeared
under treatment, without leaving any trace whatever. He
had had five cases. The treatment for the most part had
consisted in the use of a tar and mercurial ointment. All
the cases were chronic. There was no evidence whatever
that it was contagious.
Such an eruption as described by Dr. Hardaway had
not been seen by any of the members of the Association.
LYMPHANGIOMA CUTIS WITH DERM.VIOLYSIS.
Dr. J. E. Graham, of Toronto, reported a case illus-
trated with photographs. Mrs. L , twenty-one years
of age. When five years old a tumor appeared in front
of the elbow, which gradually extended upward and
downward. The history from that time had been one
of constant increase, and the growth had increased very
rapidly during the past year. Its presence had not pro-
duced inconvenience. On the anterior surface of the
arm the integument hangs down in bag-like pouches,
which changes in color as the arm hangs or is raised.
The papillary layer of the corium is hypertrophied, and
the skin presents deep furrows. There is brown pigmen-
tation near the elbow, and a few black hairs exist on the
surface. The entire growth has a peculiar velvety feel.
There is thickening of the skin, but no induration what-
ever. At the middle of the forearm there is a small tu-
mor, which feels like a mass of blood-vessels beneath the
28o
THE MEDICAL RECORD.
[September 8, 1883.
skin. The arm can be made smaller by pressure, and
especially the small tumors, of which there are two or
three. The tumors are not painful. The aft'ected arm
is almost as strong as the other. It is possible that the
small tumor first seen existed at birth, but had been un-
recognized. Dilatation of the lymph-channels was the
probable pathological lesion.
Dr. Fox had seen one case which would bear compari-
son with Dr. Graham's.
Dr. Atkinson had seen one case which was almost
identical with that reported by Dr. Graham, e.\cept that
the growth was situated higher up upon the arm. He
thought there was dilatation with new growth of the chan-
nels, and regarded such a case as affording striking proof
of the inaccuracy of the view put forward by Dr. Formad
concerning the nature of tubercle, as we do not get tu-
bercular inflammation in these cases, where it is well known
that the lymph-channels are obstructed.
Dr. Piffard thought it practicable to remove the
growth in sections by the use of the galvano-caustic liga-
ture.
Dr. Atkinson thought the probable cause of the dis-
ease would remain, and that removal of the growth would
be followed by a return of the affection.
Dr. Sherwell referred to a case of general lymphan-
gioma.
The Association then adjourned, to meet at 9.30 a.m.
on Friday.
Friday, August 31ST — Third Day.
The Association was called to order at 9.30 a.m. by
the President.
The first order of business was the induction of newly
elected officers. Dr. R. W. Taylor, of New York, who
had been re-elected President, thanked the Association
for the continued honor in electing him as the presiding
officer for the ensuing year, spoke of the prosperity of
the Society, and the amount of good work which it had
performed.
The newly-elected Vice-Presidents were Dr. Arthur
Van Harlingen, of Philadelphia, and Dr. J. E. Graham,
of Toronto ; Secretary, Dr. W. T. Ale.xander, of New
York ; Treasurer (re-elected). Dr. George H. Rohe, of
Baltimore.
The remainder of the session was devoted to the ex-
amination of microscopic sections, prepared by Dr. Henry
Wile, of Philadelphia, which accompanied Dr. Duhring's
paper on " Ainhum," and also illustrated Paget's disease
or malignant papillary dermatitis.
The Association then adjourned to meet at West Point
on the last Wednesday in August, 1884.
^awMi ^jcms.
Official List of Changes in the Medical Corps of the Navy
for the week ending September i , 1883.
Walton, T. C., Surgeon. Detached from the Pow-
hatan, and ordered to the Naval Academy, Annapolis,
Md.
Simon, W. J., Surgeon. Detached from the U. S. S.
Constellation, and placed on waiting orders after com-
pleting temporary duty as member of a Board at Annap-
olis, Md.
McClurg, W. a., Passed Assistant Surgeon. De-
tached from the U. S. S. Dale, and ordered to the Naval
Academy.
Oliver, Assistant Surgeon. Detached from
S. Constellation, and ordered to the Naval
DiEML,
the U. S.
Academy.
Jones, M. D., Passed Assistant Surgeon. Ordered to
temporary duty at the Naval Hospital, Washington, D. C.
Smctticat items.
Contagious Diseases — Weekly Statement. — Re-
port of cases and deaths from contagious diseases re-
ported to the Sanitary Bureau, Health Department, for
the two weeks ending September 4, 1883 :
Week Ending
Cases.
August 28, 1883
September 4, 1883
c
"rt
>
1
■0
'0
>
o.E
ft)
j::
i
0.
1
a.
Si
2iS
S
■a
F
1
H
H
t/3
u
U
<n
>
I
63
4i
2
22
28
0
0
0
67
32
8
19
27
0
0
Deaths.
August 28, 1883
September 4, 1883.
17 1 8
24 I 2
8 j 14
I 21
Chloroform Narcosis during Sleep. — The evi-
dence regarding this iioint is still accumulating. Dr. W.
E. Ground, of Toledo, O., sends us a report of two
cases in which he produced anaesthesia during sleep.
One was in a child eighteen months old, the operation
being that of the removal of a pebble from the ear ; the
other was in a child at the breast. The latter was appa-
rently experimental in character.
The British Cholera Doctors. — The twelve medi-
cal men who have been selected for service in Egypt in
the cholera districts by the F'oreign Office, with the advice
and assistance of Sir Joseph Fayrer, will, on arrival, report
themselves to Surgeon-General Hunter, M.D., and place
themselves under his orders. They will be paid at the
rate of ;^ioo per month, with travelling expenses.
Fly-P.-^pers. — In Prussia the sale of poisonous and
arsenical tly-papers is only permitted to chemists and
those who are authorized to deal in poisons. Such per-
sons even are only permitted to sell them under the same
regulations as must be observed in the sale of all poisons.
These regulations require that a poison certificate be
given with them, and also that the word " poisonous "
be stamped on them.
A Druggist Sentenced. — Lacombe, the French
wholesale druggist who was accused of fraudulently sub-
stituting sulphate of cinchonidine for sulphate of quinine,
which he supplied to the Paris hospitals last autumn, has
been sentenced to a year's imprisonment and fifty francs
penalty, and is also called upon to pay for the advertise-
ment of the judgment in a dozen French journals.
Grindelia Robusta for Asthma. — Dr. Boinbelon
(Bergen on Riigen) recommends the smoking of ciga-
rettes, the tobacco of which has been saturated with the
resin of grindelia robusta, to asthma patients, whether
they are smokers or not. The tobacco must also be
well impregnated with saltpetre, which will facilitate its
combustion and the development of smoke. If the pa-
tient is unable to smoke himself, the fumes are blown
toward him. — Zeitschr. d. Allg. oster. Apotheker Vereins.
Ther. Gazette.
Another Medical College. — The University of
Niagara is about to start a medical department. The
course of study is to be four years, and each course of
lectures will continue for six months. The studies will
be graded, and satisfactory examinations must be passed
by the student before proceeding to a higher class. The
examinations are to be conducted by a board of five
medical men unconnected with the faculty of the depart-
ment, to be appointed yearly bv the trustees. The new
college will be located at Buffalo, and the lectures will be
delivered temporarily at the Hospital of the Sisters of
Charity until a suitable building can be erected. The
first session will begin on October loth. j
The Medical Record
A Weekly yournal of Medicine and Surgery
Vol. 24, No. II
New York, September 15, 1883
Whole No. 671
©riginaX Jutrticlcs.
NERVOUS INDIGESTION.
By J. MILNER FOTHERGILL. M.D.,
LONDON, ENGLAND.
ASSOCIATE FELLOW OF THE COLLEGE OK I'HVSICIANS OF PHILADELPHIA, PA.
Some relations of indigestion connected with the ner-
vous system may now be discussed. First, it may be
well to consider reflex indigestion.
Reflex indigestion is a malady of women, for it is in
women we see reflex disturbances best exemplified. Wo
know that nausea and vomiting are the outcomes of a
vesical calculus, or a pregnant uterus in the early months,
or of a blow upon the testes. So ovarian irritation will
often set up gastric symptoms, usually taken for primary
indigestion. The ovary may be swollen and tender, or
it may be fixed near the pubic brim by adhesions.
When in front there is pain on emptying the bladder ;
when on the side, especially the left side, there is pain
on emptying the bowels. From this centre may radiate
disturbances of many parts. The extreme frequency of
reflex dyspepsia from a tender ovary on the one hand,
ind the great neglect of the condition in medical litera-
ture on the other, must be my explanation for going into
this subject somewhat fully.
The patient is usually a comparatively young woman
with pallor in her features and general anaemia ; but by no
means necessarily so. Her complaint is of indigestion
coming on soon after taking food, often with nausea and
loss of appetite, less frequently with actual vomiting.
Yet the tongue is clean ; sometimes it has a slight coat-
ing ; rarely is there any rawness or approach to the bare
tongue of gastric irritability. The tongue puts the ex-
perienced observer on his guard. Pressure is made over
the region of the ovaries, and when it is made over the
tender ovary pain is produced — a sickening pain, giving
a feeling of faintness, and reflected in the patient's fea-
tures. Usually she asks to sit down. In a well-marked
case the following symptoms, sometimes a few only but
often all, are manifested, much depending upon the
patient's intelligence and readiness to answer : First,
then, if there be pain produced on defecation, there will
be reflex constipation, the pain inhibiting the vermicular
action of the bowel. Then there will be found " pain
under the heart " as women term it. This is mtercostal
neuralgia w'ith the three tender spots of Valleix, one at
the left apex, a second at the outer edge of the left
scapula, about the middle, and a third at the foramen of
the posterior rootlet of the nerve, usually the sixth.
I have written elsewhere '' waves of nerve-perturbation
may arise in an ovary and traverse a series of nerve-
fibrils until they reach the peripheral endings of an inter-
costal nerve, where they are felt as gusts of neuralgic
pain." F'urther experience merely strengthens this view.
There will usually, too, be that pain and weight at the
vertex with depression or lowness of spirits, and ten-
dency to cry, the outward indications of cerebral aiutniia
of the posterior lobes, found with irritation in the lower
bowel and the generative organs. Then there is anorexia,
indigestion, and in some cases vomiting. Such is the
real pathology of those cases of so-called subacute gas-
tritis in young females, where obstinate vomiting goes on
for weeks, resisting all treatment of the stomach, scofliiig
at bismuth, hydrocyanic acid, oxalate of ceiium, and
all remedies of value in morbid conditions of the stom-
ach ; where the patient is greatly reduced, the friends
almost distracted, and the physician worried out of his
life. Yet a year or two afterward, on asking after the
object of all this anxiety, it is found she is well and prob-
ably married. This vomiting may have gone on for a
considerable time and been interpreted as gastric catarrh,
or gastric ulcer, and treated as such — without satisfac-
tory results. Then there is also some pelvic matters
which clinch the diagnosis. The uterus is reflexly filled
with blood, is turgid and vascular, and consequently
there ismenorrhagia with leucorrhcea. Orgasm is readily
produced by slight friction, or occurs spontaneously in
sleep ; and this irritability conmnmicates itself to the
adjacent bladder-centres in the cord, and there is in-
ability to retain the contents of the bladder. Further,
there are commonly times of great itching with heat or
dryness in the fundament, and often in the vagina also.
Such are the features of a well-marked malady, which,
however, has not yet found its way into our text-books.
Word by word, indeed letter by letter, I learned to spell
it out among my hospital out-patients ; but the trouble
brought with it its reward in the power to detect, and
consequently to treat correctly, a very common malady,
little influenced by measures directed at one or other of
the outcomes of the condition, yet often tractable to
appropriate measures. Those who have taken the pains
to master the malady in all its details testify to the ad-
vantage they gained in practice therefrom. It is a con-
dition commonly unsuspected. It frequently lies at the
bottom of the dl-health which, when coexistent with an
old apex consolidation, is taken for commencing phthisis ;
and when profuse night-sweats are added to the effects
of the indigestion, the weakened lung-apex may and
often does break down. How often this misinterpre-
tation has wrecked the peace of a family, it becomes not
me to say. I am concerned more with the matter of my
own familiarity with morbid conditions than other men's
shortcomings. But since the malady has been clear to
me I at least have been able to avoid mistakes which,
previous to that date, occurred with myself in connnon
with others ; and it is in consequence of my experience,
past and recent, that I urge so strongly upon my readers
the desirability of grasping this well-marked, if often un-
recognized malady.
Tlie sex, and often, too, the age of the patient, should
put the physician on his guard. If the tongue also be
normal or only slightly coated, and free from the appear-
ances associated with gastric irritation ; then the exami-
nation of the patient ought to be conducted on tlie lines
just laid down. It travels over some very delicate
ground for both physician and patient; and therefore
must be conductetl with every consideration for the pa-
tient's feelings. Yet enough can be gleaned from the
most difficult patient to cross-examine, usually at least
to determine the nature of the case. Sometimes it is
possible to state her case to her, including her most in-
ward feelings in a manner which makes the patient feel
as if in the presence of a magician.
Having made the diagnosis, the treatment suggests itself.
A blister over the tender, or otherwise oftending ovary.
Bromide of potassium, the drug par exielknce in all reflex
affections, and sulphate of soda or magnesia for the consti-
pation. If there be also night-sweats then some atropine,
say from a seventy-fifth to a twenty-fifth grain at bed-
time. Then if there be much sickness it may be well to
282
THE MEDICAL RECORD.
[September 15, 1S83.
give some bismuth, with or -without hydrocyanic acid and
soda, but this is only ancillary to the other treatment.
Usually some injections of alum water are required for
the leucorrhoea. A rational treatment indeed, founded
on the nature of the malady, and, presto, the intractable
patient gets well, to the unfeigned delight of all. Some-
times the result is not so satisfactory as to time, while in
those cases where the morbid ovary is bound down by
adhesions, relief is all that is i)ractically attainable. But
the bulk of cases readily do well, with gratitude on the
part of the patient, and with credit to the physician.
Xow some other matters may be mentioned. First
comes the effects of mental strain and worry upon the
digestive organs ; second, the effects of mal-products of
digestion upon the brain ; and lastly the combination of
the t'vo.
On this wide subject general remarks are all that are
jiossible, as the individual necessities of each case have
to be and must be studied, for successful treatment, and
what these are only becomes visible when the case pre-
sents itself before the physician. Those seeking further
information will find it in my work on " Indigestion and
Biliousness."
First as to the effects of carking care upon the assimi-
lative organs, they have been recognised by writers,
medical and other, since the dawn of literature. '-Lean,
hungry men '' have been regarded as the type of the
brain-worker, including the conspirator. While the rubi-
cund visage of the well-fed man has ever been looked
upon as indicative of an easy mind. Such generalizations
are broad and true ; but the subject admits of closer
handling in the light of the present day.
In "this madly striving age" the pressure of business
absorbs so much of the daily store of energy that the
digestive organs are robbed of much of the I'is nervosa
that belongs to them, and, therefore, are only capable of
digesting light food. Of old when anything uncommon
had to be done, a good foundation was laid, as mater-
familias e.xpressed it, by a substantial breakfast ; some-
thing in excess of the wonted fare. Whether such prac-
tice is successful in the present day is a matter for
question. Probably the experiment is rarely tried among
others than Vakoots or Indians. Then when the work
was over an extra bountiful fare was provided, the hunts-
man's supper. This was all very well for men wlio were
out in the open air, in the chase or war ; but it is not a
safe practice at the present time, except witii those whose
digestive organs are unimpaired, and retain much of their
primitive Anglo-Saxon capacities.
The rule of the present day is rather in the opposite
direction, viz., to have a very light meal after any special
demand upon the system, possibly with some alcohol,
though on this last the right of private judgment is brought
to bear more than on any other matter connected with
health. A few illustrations will demonstrate what it is
desired tp convey. One of our leaders of scientific medi-
cine, one of the least fanciful of men, commonly lunched
on a beefsteak, eating and enjoying the fat. liut experi-
ence taught him that whenever more wearied than usual
it was prudent to leave the steak-fat and take butter in-
stead. When tired he could not digest the beef-fat, which
he enjoyed as a rule. A lady well known to the writer
has always to be \ery careful about what she takes when
lired, else a severe attack of indigestion will be experi-
enced. After a long walk, or its ecpiivalent, a light ineal
alone is permissible, or compatible with comfort, and
one of McKesson & Robbins' pepsin pills is in request.
Some fried fish after a long walk set up severe dyspep-
sia with delirium, and left behind great susceptibility in
the digestive organs for months after, requiring the great-
est care in diet, and a medicinal course for its removal.
An American lady presented herself one day with con-
firmed dyspepsia, dating definitely from a certain long,
tiresome drive, followed by a table d'hote dinner at Ge-
noa, which, being hungry, she enjoyed She was quite
of my way of thinking when my views were laid before
her. Frequently cases come under notice where tiring
evening work, as a Sunday evening service, is met by an
unusually good supper — the house-wife's treatment. This
may have been all very well in the days of yore, but it
certainly is not well at the present time. A light meal
and a little wine, as Timothy has wisely counselled, are
the proper method of meeting the emergency in our day.
What can be digested without drawback under ordinary
circumstances will not be satisfactorily digested when the
system is exhausted either by bodily or mental toil.
The effects of acute emotion in upsetting the digestion
are thoroughlv recognized ; in fact, anorexia is so set up,
and the food which would not be digested is not taken.
But we are still far from comprehending fully the more
chronic effects of wearing care or anxiety. Yet the fact
must be recognized that where the mind is greatly exer-
cised, while the body is insufficiently exercised, the diet-
ary must be regulated accordingly. A plate of ponidge,
oatmeal, cerealine, or hominy, with a pint of cream, and
some stewed fruit to finish off with for breakfast. For
lunch, some well-buttered mashed potatoes, with biscuit
and butter and a glass or two of milk. For dinner some
boiled fish, followed by some chicken or game, and a
milk-pudding made without an egg, and digestive bis-
cuits and butter (with just a nip of cheese as a flavoring
agent for those who can eat cheese), with a glass or two
of good French wine or its equivalent. Such is the
dietary, or ought to be, of the man who has much brain-
work to do. And further, he should allow himself plenty
of time over his meals. It is bad economy to save time
by cutting it oft' the meal-time. And such is the dietary
that must be enforced when the brain-worker has made
himself a patient. The use of pepsin to aid the natural
digestion was given in the first article and need not be re-
ferred to again (see The Medical Record, Septem-
ber 1, p. 225). Then there should be a sufficiency of
sleep to rest the wearied organism. A day of work
followed by another day of play in every twenty-four
hours, is the order of the present day, and to secure
this the time for meals is cut down to a minimum, and
the hours of sleep curtailed to an injurious extent. But
the experiment will be found a failure ; it is not among
the potentialities. The busy brain-worker must learn to
see that he cannot tax his system at will ; if he will not
be told he will be made to comprehend the subject.
And he may depend upon it — whether these remarks are
acceptable or not — it is much better to take care in time
than to do the mischief and have to take the care when
partly disabled. My counsel to such patients is as fol-
lows : " You had better adopt the habits of an inv.alid in
order that you may not become one. You had better
take care before you break down than wait till you break
down and are compelled to take care of yourself with
your working-power crippled !"
The preventive treatment of neurosal indigestion is
quite as important as its palliative treatment when once
established. The lines are the same in both, viz., to
give easily assimilable food, rich in fat, and containing
albuminoids, but in sjiaring quantities ; to allow a proper
time for meals, and a sufficiency of sleep. Beyond this
there is the matter of phosphorus. Phosphorus and fat
in combination are the food of the brain par excellence ;
and to this dietary, rich in fat, it may be well to .add
phosphorus in pill, or better still in the synip of the
hypophos))hites. Yet when all this has been done, and
the latest revelations of physiology worked out by the
chemist are placed at the patient's service by his phy-
sician, there comes that indispensable factor which the
patient alone can do, viz., take proper care of himself.
When I look round on the men I know, whether in the
profession or out of it, which are those who are steadily
holding their own, accomplishing huge quantities of
work, yet with their energies unimpaired and their work-
ing power as good as ever ? They are those who do
not add a day's pla\- to a hard ilay's work ! Men who.
after a hard day of work, take their dinner quietly and
September 15, 1883.]
THE MEDICAL RECORD.
283
slowly — not bolting it to rush off to the theatre or other
place of amusement, as a billiard-table, perhaps. Who
spend a (juiet evening in intellectual pleasure, unbend-
ing the bow, while adding to their stores of knowledge :
and going to bed early, to sleep in a cool bedroom, in-
stead of breathing a hot, vitiated atmosphere till nearly
midnight, gul|)ing down some indigestible mass like a
lobster salad, and then, quite late, lying down to sleep —
to leave a wearied system to digest the late supper.
This is an aspect of nervous indigestion which is
worth pondering over. The physician can first digest
the matter himself and then expound it to iiis patients.
There is another matter, too, which needs more general
recognition.
Of old, as said before, the more work the more meat.
" Work goes in at the mouth." The fact tliat an under-
fed animal, man or beast, could not accomplish much
work was vividly realized : and the hard-headed northern
farmer had his farm laborers eat at his own table. l!ut
the converse is not so absolutely certain. Meat will
not necessarily give strength, i.e., if it be not digested.
Constantly patients — not with primary indigestion, for
that pretty well regulates matters itself — suffering from
malassimilation come under notice, who have been eat-
ing all tlie animal food they can get down, under tlie im-
pression that this is the plan to adopt. Probably, if a
married man, his wife has been aiding and abetting him in
his pernicious efforts to acquire strength. They have
studied the advertising columns of the newspapers, and
read of " Iron and Quinine Wine" (an admirable tonic
in mere asthenia or debility), and have added that to the
meat dietary ; and yet the patient grows visibly weaker
and feebler under the regimen. When the liver is not
workmg well nothing will further derange it more cer-
tainly than a chalybeate.
In these cases the albuminoids which reach the liver by
the portal vein are not elaborated and passed forward as
the serum albumen of the liquor sanguinis, but are thrust
downward as bile acids or lithates. "To feed the patient
is to feed the disease," as the old phrase ran. To crowd
the liver with albuminoids by a meat-dietary, the nat-
ural digestive powers being helped by artificial digestive
agents, is still further to embarrass it. The attempt de-
feats itself. The mal-products of assimilation find their
way into the blood and act as toxic agents, enfeebling
the mental processes, involving the mind in gloom, and
depriving the unhappy individual of all pleasure in life,
till death becomes positively attractive. Such are the
untoward outcomes of the delusive attempt to gain or
rather to regain strength of mind and body by a highly
nitrogenized dietary. Yet the proper treatment of such
a case is met by prejudice, by preconceived opinions.
Your wisely regulated dietary is described as "starving
the patient !" You strive to sweep out the nitrogenized
waste by a mercurial followed by some sulphate of soda ;
this is "too reducing!" You are liable to be scoft'ed
at as an antiquated quack-salver, who has no right to
exist outside of a museum for antiquities. How many
women do I know now wearing widow's weeds, who
might still have had husbands and bread-wmners had
not the present murderous age of stuffing overmastered
prudence, and the lessons of physiology and clinical
medicine been set at nought !
Whether such regimen is old-fashioned or in advance
of the times, matters little. It will have to be adopted.
The capacities of the liver will have to be appraised;
and if Dame Nature, knowing better than we perhaps do,
attempts to balance matters by cutting down the appe-
tite, it is not well to thwart her by bitters. If a man
feels unequal to his work, it may be wise at times to cut
his coat according to his cloth. It may not always be
prudent for a man to whip himself up to an ideal of
energy and working-power, as if he was a steam-engine.
The increase of Bright's disease in our day may not be
entirely accounted for by our increased acquaintance
with it and the means of its detection. Over-work, if
Clifford Allbutt is to be believed, and overcramming
with meat, if some others of equal authority are to be
credited, have much to do in ui)setting the liver first and
damaging the kidneys afterward, to say nothing of the
lithiasis, cholasmia and toxic oxalates which belong to
this condition of secondary indigestion, while the rela-
tions of glycosuria to over-taxation of the nervous system
are now well recognized. This may be an unacceptable
doctrine, but it is to be feared it is true and well-founded.
AN OPER.VnON FOR THE REMOVAL OF
THE THYROID GLAND IN PARTS.
By WILLIAM FULLER, M.D.,
CKAND RAPIDS, MICH.
The attention of the physician is freciuently called to
thyroid enlargements, not only on account of the deform-
ity occasioned by them, but by the troublesome and
even dangerous inconveniences which are developed in
some cases. Siujple hypertrophy involving the entire
gland and of moderate dimensions commonly subsides by
regulating the general system, the administration of
iodine in some form together with local counter-irritation
over the swelling by means of tr. iodine co. or ung.
hydrarg. biniodidi.
In otiier cases, presenting partial enlargements which
project as tumors on the side or in the middle of the
neck, and in some cases in svhicli the entire gland is en-
larged, the above remedies are inadequate. The tumors
are either large cysts or composed of a collection of a
great number of minute sacs from the size of a flaxseed
to a pea and containing fluids of various color and con-
sistency. Internal medication and counter-irritation has
no appreciable effect upon them. Puncture of the sacs
and drawing off the fluid is only temporary and may be
done for information as to the nature of the case. Gal-
vanism applied to the skin is of no benefit, but by means
of needles introduced into the tumor I have succeeded
in diminishing and softening it up somewhat. I gen-
erally use a small trocar canula in order to allow of the
escape of gases formed by electrolysis, and from four to
twelve cells of the Galvano-Faradic Company's battery.
A small abscess formed in a few instances, which was of
no moment, as the pus found exit through the puncture
or was evacuated by the knife. I have practised the in-
jection, by the hypodermic syringe, of tr. iodine co. in a
number of cases, and by its persistent use attained some
success, but not what I had hoped for from favorable
reports that I have read. In one case, in which the en-
largement was great, I injected from fifteen to thirty
drops of tr. iodine every week for three months at a
time, desisting for a short time only when symptoms of
iodism were developed. I continued this treatment with
few intervals for about two years, when it was interrupted
by the woman becoming pregnant. I also tied the
superior thyroid arteries in this case, which immediately
softened and reduced the swelling to some extent. The
size increased during the pregnant state, as it had done
on previous occasions. It is now about one-half its
former size and remains stationary. I iiave seen injec-
tions of tr. iodine, practised a number of times upon thy-
roid enlargements in horses, eftect a cure in every in-
stance. The method was to puncture the gland deeply
with a penknife and to force into it, with a metallic
syringe, from one to two ounces of the simple tincture at
once. The result was swelling, sloughing of the gland
substance, suppuration, and recovery in about two weeks
with little or no scar. I should be afraid to try this in
the human subject on account of the situation and im-
portant relations of the tumor.
I injected ergotine on one occasion, the effect was
immediate, the patient turned very pale, fell down, be-
came cyanosed, respiration gasping, and he regained
consciousness slowly and with difficulty. I think that I
used a solution of three grains anil injected slowly.
284
THE MEDICAL RECORD.
[September 15, 1883.
Cysts evacuated by the trocar soon refill, and in my expe-
rience injections into them are of little use, but I have
succeeded in removing them by free incision into the sac
and the use of means to excite suppuration. I have
found this process to be tedious and troublesome and
will relate two cases in illustration of the results ob-
tained.
A- young man, aged eighteen years, much debilitated,
and having a pale cachectic appearance, had a swelling
just above the upper end of the sternum, which seriously
interfered with respiration and obstructed the passage of
food. I punctured it with a trocar and drew off about
half a pint of pale reddish tluid, made an incision into
the sac at once, and though not aware of dividing a vein,
I was surprised by a rather profuse flow of venous blood,
which I think came from the rupture of small vessels lin-
ing the sac. However, the hemorrhage was immediately
checked by the introduction of a sponge saturated with
strong liq. ferri perchlor. The sac was quite large and
the finger could be passed freely behind the upper end of
the sternum and the clavicular articulations, and laterally
under the sterno-mastoid muscles. Its relations could
be easily distinguished, viz., the innominate and carotid
arteries, trachea, and oesophagus. Some swelling and
fever were present on the following day ; the sponge was
removed and the sac washed out, twenty grains of
quinine were administered, and the neck was enveloiied
with cloths wet in a solution of ammonia chlor. The
swelling and fever subsided, and suppuration was estab-
lished in a few days. A large-sized drainage-tube was in-
serted and the sac was frequently cleansed with the
solution of ammonia chlor. The sac contracted and
discharged a sero-pus for about two months. Smaller
drainage-tubes were substituted and, lastly, the opening
was allowed to heal up, as the discharge became reduced
to a very small quantity. After a lapse of a few weeks
the swelling and tenderness returned, a yellow and fetid
pus was discharged, and drainage was again resorted to,
with injections of tr. iodine, saturated solution of iodo-
form in ether, a saturated solution of zinci chlor., and
many other remedies at various times, with the view of
establishing a healthy action or destroying the secreting
surface, but without avail. Finally, when I had almost
despaired of closing the troublesome tract, it became in-
fested with maggots. I let them alone for a few davs,
since their presence did not appear to trouble him and
then cleared them out with a strong solution of plumbi
acet. The tract healed up at once, has remained so for
over two years, and the young man enjoys robust health.
Just what function maggots may be designed to serve in
the economy of nature, I will leave it to the reader to
form his own opinion, but I would suggest that by de-
vouring sloughs and flesh endowed with little vitality,
, they serve to cleanse the wounds of animals, and by
crawling into deeper parts they form channels for the
discharge of fluids and thus become an important factor
in Nature's system of providing for the healing of wounds
by drainage and cleanliness, the principles upon which
the success of the surgical art depends. 1 once saw a case
in a horse turned to pasture on account of two large
callous tumors on his shoulders. They were eaten out
clean by maggots and scarcely a scar was left to mark
their situation.
The second case was a girl aged twelve years, pale,
sallow, and debilitated. Breathing was difficult upon
the slightest extra exertion in walking or in going up
stairs, and she was affected with occasional attacks of
spasmodic croup. There was a swelhng at the root of
the neck since she was a year old, having the appearance
of a large goitre. Upon puncture it proved to be an
abscess, and was drained ; but, contrary to my advice, a
small drainage-tube was inserted. During two weeks
she suffered from a high fever, which partially subsided
when the discharge became more free. She was hi'Hily
nervous and afraid of surgical instruments, and the case
coming under my immediate care, I introduced a seatan^le
tent into the small opening, and after distending it in-
serted a large tube. All febrile action presently sub-
sided, the appetite improved, and she gained rapidly in
her general health. Her breathing improved and she
was allowed to (ilay in the open air with other children,
which her former condition prohibited. I applied many
things to the cavity of the sac with the view of irritating
and destroying the secreting surface, such as tr. iodine
CO., cantharides, ung. hydrarg. biniodidi, argenti nit.,
pure nitric acid, iodoform, saturated solution of zinci
clilor. in alcohol, solid zinci chlor., actual cautery, and
other things too numerous to mention. The sac was
rebellious to all treatment, recovering its former con-
dition after each application. Finally I introduced a
gold drainage-tube five-eighths of an inch in diameter, so
as to expose the whole surface freely to the air and for
cleanliness. The secretion was very much diminished
in a short time, and in the course of a few months the
sac became healed to the integument around the tube,
which was then removed. The present condition is an
opening about half an inch in diameter leading into the
sac, which is contracted into an irregular cavity about
the size of a walnut and lined with a membrane resemb-
ling the mucous membrane of the larynx, with which,
however, it does not communicate. She has, since the
sac was freely discharged, developed from a stunted and
puny girl into a robust young woman. It is about two
years since the sac was opened, and from the experience
that I have had of these cases I conclude that the treat-
ment of them is very tedious and dangerous, unless very
free drainage is maintained.
I have removed solid tumors of the thyroid gland
four times. In the first case I removed the tumor with
its sheath, successively tying all its attachments before
dividing them as the dissection proceeded. The opera-
tion was comparatively bloodless, but tedious, so that
the patient was a long time under chloroform. The
wound was not approximated until suppuration was es-
tablished, and an uninterrupted recovery took place,
leaving only a linear scar. Tliis case has been reported
in the Detroit Lancet, December, 1S78.
Upon a study of the blood-supply to the thyroid gland
it will be observed that the larger vessels rest upon the
sheath of the gland and run within the processes which
separate its lobes. The superior thyroids are distributed
upon the surface and the inferior arteries enter the pro-
cesses near the trachea, along which they are distributed,
and also to the posterior surface. Tlie gland substance
is supplied by numerous small vessels which pierce the
sheath in the course of the larger vessels; consequently,
if an incision is made through the sheath and the gland
is separated from the inner surface of its capsule, no
large vessel is divided and very little hemorrhage is en-
countered. If the finger is isassed around a lobe which
is left in situ there is little or no bleeding, since the
hemorrhage is restrained by the pressure of the surround-
ing tissues. After a time a ligature can be tied around
the base of the lobe and it may be removed by the knife,
or without a ligature tlie lobe may be broken oft" and a
piece of sjjonge saturated with strong ferri perchlor. can
be pressed against the stump, which will effectually re-
strain the blood. There is no advantage gained by in-
jecting iron into the substance of a lobe before removal.
A portion of the gland, or the whole of it, may be re-
moved at a time in this manner with comparatively
little loss of blood, and the operation is attended by little
pain and shock.
One assistant only is reciuired, which, however, is not
necessary, and the operation is robbed of its formidable
aspect. I have operated in this way upon three patients,
two of them died from other causes than any incident to
the metliod emi)loycd for the removal of the tumor. A
ship carpenter, aged thirty-five years, had an enormous
goitre, the circumference of the neck measuring 27^
inches. The tumor projected beyond the chin, which
rested upon its upper surface, it covered the upper part
September 15, 1883.]
THE MEDICAL RECORD.
285
of the sternum and the clavicles as far as the shoulders,
large veins coursed over its whole surface, and especially
in front. There were two large perpendicular trunks
about the size of the thumb running parallel about two
inches apart and united in the centre by a transverse
trunk of the same size so as to form a letter H. There
was a strong bruit heard all over the tumor, the neck
and head were much congested and bluish, the eyeballs
prominent, and he wore an expression of great anxiety.
His voice was crowing and he had frequent attacks of
spasm of the glottis. Kxpiration and inspiration both
were prolonged and difficult as well as deglutition. There
were bronchial rales over both lungs. This growth had
steadily increased, notwithstanding that he had used
many remedies, external and internal, by the advice of
many physicians. His case was indeed desperate, and
apparently beyond hope. He implored assistance at
any risk, desirous of submitting to an operation, though
informed that he would more than likely die before it
was completed. Under these circumstances his urgent
request could not be refused and I determined to oper-
ate, which I did with the assistance of several medical gen-
tlemen of this city. Chloroform was not administered, nor
were the tissues very sensitive on account of the stretching
of the nerves. A curved needle was passed under the large
transverse vein crossing the neck, and ligatures were ap-
plied on each side of the median line. An incision was
made under the chin about two inches long in the middle
line and another below near the sternum, their depth
extending through the capsule of the gland. These were
quickly made as the bleeding was profuse, and the fin-
gers were thrust from above and below until they met
along the trachea behind the mass. Two buckskin lig-
atures of large size were passed through the channel
made by the fingers and were tied over the mass on
either side as far apart as possible, and stitched to the
integument to prevent them from slipping. Buckskin
was used because I thought that it would be less liable
than hard cords to cut into the friable tissue of the tumor,
besides it possesses a certain amount of elasticity. The
incisions above and below were now connected and the
trachea exposed. The hemorrhage at this stage was
small in amount, partly due to the faintness of the patient.
The gland substance protruded through tlie wound, a
large portion was removed and I was surprised to find
that as the pressure was relieved in front of the trachea
the respiration became more difficult. This tube was
flattened by lateral pressure and not crushed back against
the spinal column as I supposed. The patient was much
exhausted, consequently 1 opened the trachea and intro-
duced a rubber tube of half an inch calibre and six
inches long, of sufficient length to reach between the
trachea and the integument, and through which he
breathed easily. He sat in a chair leaning back during
the operation, and sustained himself with great fortitude.
He was put into bed and a sponge wet in warm water
was placed over the end of the tube. He passed a very
comfortable night, breathing and sleeping quietly, his
countenance looked pleasant in the morning, there was
no fever, and his appetite was good for tea, toast, and an
egg for breakfast. The ligatures were loosened, and as
there was no bleeding they were removed. I found that
the gland was easily separated from its sheath with very
little hemorrhage and pain. I loosened a lobe in this
manner, broke off its attachment near the trachea, and a
piece of sponge saturated with liq. ferri perchlor. was ap-
plied to the stump. In two days the whole or nearly all
of the tumor was removed, a lobe or two at a time, as the
patient's feelings would permit. The cavity was kept
clean by frequent washing with a weak solution of am-
monia chlor. Subsequently his spirits and appetite con-
tinued good, he partook freely of beef-tea, eggs, whiskey
sling, etc. His temperature ranged from ioi° to 103 ,
tongue was clean and moist, and the bowels moved oc-
casionally without medicine. This hai)py state of aftairs
continued up to the tenth day after the operation, when
the neck had contracted nearly to its natural size, the
sterno-mastoid muscles showing plainly, and the wound
was granulating and secreting a healthy pus. At thisjunc-
ture the night nurse unfortunately got drunk, and at 8
A.M. next morning I found my patient out on the floor
in a cold room, with the tube displaced. He was almost
strangulated and in a violent chill. He never recovered
from this chill and the shock of fear. The wound immedi-
ately took on a dry appearance with no activity, and he
gradually sank and died upon the sixteenth day after the
operation. There was difficulty of swallowing two or
three days before his death, food and drink coming out
at the tracheal wound.
My next case was a lady of sixty-two years. She had
a hard, immovable tumor, situated in the region of the
thyroid gland, and was suffering from extreme dyspncea,
which had been steadily increasing upon her for some
months. The tumor appeared to be of a cancerous
nature, was firmly adherent to the larynx, and was about
the size of a goose's egg. I made an incision into it
about three inches long in the middle line of the neck.
There was considerable hemorrhage, which was staunched
by pressure and perchloride of iron, after which I re-
moved a portion of the gland as in the above case. This
was at 3 P.M., and the respiration was somewhat relieved,
but at I A.M. it was so difficult that I was forced to per-
form tracheotomy, which was a very difficult operation
under the circumstances, the trachea being flattened
laterally and pushed out under the left sterno-mastoid
muscle. It was found with difticulty by thrusting a small
trocar in difterent directions through the tumor. I in-
troduced a piece of rubber tubing, which was changed
frequently and kept clean as in the previous case. She
also died on the sixteenth day after the operation from
exhaustion and congestion of the lungs, the course of
her case being about the same as in the previous one.
One great difficulty encountered in these cases was
the impossibility of preventing fetid gases and fluids
from entering the trachea, although the greatest care
was taken to obviate it. This was the reason that I re-
frained from opening the windpipe immediately in the
last case. I think that this cause contributed largely to
produce the unfavorable results.
The following case had a more successful termination :
A horseshoer, aged about thirty-eight years, had an en-
largement at the root of the neck, which had been in-
creasing in size for three years, and for six months it
interfered with his breathing, especially in stooping, so
that he was obliged to relinquish his business. In July
last, while walking on the street, he had an attack of
vertigo, a sudden increase in the difficulty of respiration,
and a sensible enlargement of the tumor. He came into
my office in a state of great alarm ; there was a strong
pulsation of the carotid and apparently of the tumor,
which simulated aneurism. It was about the size of the
closed fist and situated on the left side extending from
the clavicle to the upper border of the thyroid cartilage.
I concluded that it was an effusion of blood within the
thyroid sheath, and punctured it with a small trocar,
drawing off about an ounce and a half of dark -colored
blood, which relieved the tension and the difficulty of
breathing. A cold compress and bandage were applied
and he was given eleven drops fluid extract digitalis
every two or three hours until the heart's action was
quieted. He sent for me in about two weeks and stated
that he had suffered from fever and chills for a week,
and that his neck felt sore to the touch, with a throbbing
in the tumor. There was a tympanitic note over the
seat of puncture, and upon introducing the trocar again
there escaped a fetid gas and bloody pus, which was
evacuated freely by the knife. Introducing the finger, the
lobes of the enlarged thyroid gland could be felt. These
were separated from the capsule, broken off near the tra-
chea and into small pieces, so that by squeezing the sac
the debris was ejected through the opening. Small pieces
of sponge with a string attached to each and saturated
286
THE MEDICAL RECORD.
[September 15, 1883.
with liq. ferri perchlor. were inimediatel)' introduced and
checked the hemorrhage. The sponges were removed
next morning, the cavit)- washed out with a sohition of
ammonia chlor., and a large drainage-tube introduced.
The operation required no assistant and was done at
once when the opportunity presented, without exciting
the patient's mind by making him aware that any im-
portant operation was in progress. Cleanhness and free
drainage constituted the treatment, with the exception
of one twenty-grain dose of quinine. His fever subsided
after the operation, and as he felt well no note was taken
of his temperature. The cavity slowly contracted by
granulation, and recovery was complete in about six
weeks. There is a small nodule on the right side of the
neck and a little thickening in front of the trachea, but
the breathing is free and the tumor on the left side has
entirely disappeared.
ON THE TRE.A.TMENT OE PALPITATION'S OE
THE HEART.'
By professor GERMAIN SEE,
MEMBER OF THE ACADEMY OF MEDICINE, MEMBER OF THE FACULTY OF MEI>
ICINE, PHYSICIAN TO THE HOTEL DIEU, PARIS, FRANCE.
Palpitations consist in an increase of the activity,
though not of the energy of the heart." From an etio-
logical point of view they may be ranged under four
heads : i. Nervous laalpitations ; 2, Physico-dynainic pal-
pitations ; 3, Anajmic palpitations ; 4, Toxic palpitations.
I shall treat of all these species of palpitations, but
not exactly in the order given, and for convenience will
begin with the last, which I have called
TOXIC PALPITATIONS.
The first care of the physician when he finds himself
in presence of a patient who has, or fancies he has, real
palpitations, should be to examine into the daily hygienic
and dietetic habits of the patient. The abuse of tobacco,
the immoderate use of tea, cofiee, alcohol, may produce
palpitations with or without arythmia, as well as inter-
mittences. If, in order to obtain prompt abandonment
of the abuse, it is generally sufficient to warn patients of
the danger which menaces them, it is no less true that
sometimes one meets stubborn resistance in the case of
inveterate smokers and drinkers, to whom the vicious
habit has become a passion and almost a necessity.
In tliese cases it is necessary to proceed by a gradual
process of withdrawal, and especially where the pro-
longed use of tobacco has created a sort of habituation —
a veritable accommodation in the organs and functions,
which it would be dangerous suddenly to suppress.
There are a great many smokers whose easy and health-
ful digestion depends on the cigar or pipe which they
smoke after meals ; others find the best remedy against
constipation to be a pipe smoked on an empty stomach;
others maintain that their brains will not work to advan-
tage without the customary smoke. It is precisely these
individuals who become subjects of palpitations, and if you
would treat them successfully you must not too suddenly
and completely wean them from tobacco. Better by far
limit the quantity of tobacco than to impose on them
absolute deprivation, which, moreover, it is very difficult
to enforce. All that you need do, in order to obtain a
* Tr.inslatcd. by permission of the Professor, for The Medical Record, by E.
P. Hurd, M.IJ., Newburyport, M.iss.
'■' [Professor Siie makes a distinction between the ataxic and the arythinic forms
of heart disease, which he still further distinguishes from intcrmittences. Palpita-
tions are ataxic manifestations, and arc characterized by accelerated juilsations.
Arythmia is disorder of rhythm, and the disturbance may pertain to the order,
number, and dviration of the pulsations. In the case of iiuermitlcnces the normal
and for the most pan regular scries of beating is from time to time (and more or
less periodically] interrupted by a momentary arrest of the heart's action. If the
pulsations arc irrecular, it is arythmia. If they appear to be more intense and
rapid, we call them palpitations. In true intermittence the heart's action may t»e
more intense, wc can hardly say, however, that there is deviation of rhvthm ; we
notice only the pauses at the end of every 4, 5, and 10 pulsations. Houiflaud calls
these arrests or hesitations of the heart_/rt/jr j/^/j ;faiix pas. In practice these
different kinds of abnormal functional working of the heart arc often confounded,
and it is true [as Professor .See admitsj that palpitations often coexist in the same
patient with arythmia and intermittence.]
cessation of the palpitations, is to transform abuse into
moderate use.
It is much easier to arrive at the suppression of the use
of tea and coft'ee. It is more difficult to procure an abate-
ment of alcoholic excesses, which, by the way, seldom
and only for a brief period, manifest themselves by palpita-
tions ; they soon terminate in degeneration of the heart.
PHVSICO-DYNAMIC PALPITATION.^.
When, after an earnest inquiry, you have succeeded in
eliminating from the group of probable causes the influ-
ence of poisons and of substances which trouble the
action of the heart, the duty of the physician will be to
investigate the state of the heart, its orifices, its valves,
its proper texture, its lining membrane.
It is deserving of remark that it is precisely the larval
affections, that is to say, those which do not produce any
abnormal murmurs, as is the case with simple dilatation
of the lieart, which oftenest give rise to palpitations. In
these cases digitalis finds its proper place ; it tones up
the delibitated heart and gives regularity to its beats.
DIGITALI.S IN THE PALPITATIONS OF ORGANIC DISEASE.
When we are concerned with hypertrophies conse-
cutive to valvular insufficiency or constriction of the
orifices, there is a first question to answer before we can
decide on the treatment. Is this hypertrophy sufficient
or not to compensate for the obstacle to the outflow of
blood in the case of constriction of the orifice ? is it suf-
ficient to enable the ventricle to clear itself, in the event
of regurgitation from leakage of the valves? If so, that
is to say, if the hypersarcosis is sufficient to enable the
heart to fill the arteries, digitalis is useless, without being
positively dangerous, unless by long continuance in its
use.
Let us take an example : In Corrigan's disease (aortic
insufficiency) the left ventricle constantly grows thicker
and stronger by reason of the extra work imposed on it
in propelling into the aorta the regurgitant blood, as well
as that coming into its cavity from the auricle. As long
as there is no venous stasis in the lungs, or oedema of
the lower extremities, one may take it for granted that
the hypernutrition of the ventricle is sufficient to over-
come the disastrous effects of the reflux. ^Vhy then pre-
scribe digitalis ? Wait a while, the time will come, with
almost absolute certainty, when, unhappily for the patient,
the action of the heart will be troubled. There will be
palpitations which will necessitate the use of digitalis,
and in this case you are not to fear the eftect of the
drug, even if the heart's impulse suggests exaggerated
energy ; it is but the semblance of increase of energy.
On the other hand, digitalis does not do harm when given
for the hypertrophy itself Heretofore it has been gen-
erally believed that hypertrophy may be excessive, and
render one liable to danger from active congestion of tlie
brain or lungs. This is a mistake, and it is as much as ever
if the hypersarcosis is sufficiently pronounced to eftectually
overcome the obstacles to the outflow or regular pro-
gression of the blood. No one has ever seen active cere-
bral congestion result from exaggerated afflux of blood
t8 the brain by reason of a hypertrophied heart. In the
mechanical diseases of the heart you have not active but
passive congestions, the heart having no longer sufficient
contractile force to enable the blood to pass through the
capillaries and veins. Therefore there is no absolute
contra-indication in this disease to the administration of
digitalis.
The indication for digitalis, however, becomes very
plain if dyspncea or cedema comes on, showing that the
heart is flagging in its work of blood-distribution. The
same may be said of palpitations arising from hyper-
trophy in general. Suppose, for example, that you have
a case of coni|)ensatoiy hypertrophy, accompanied with
palpitations, in a nephritic patient (this would be a rare
event, for arythmia would be the rule) ; you may without
September 15, 1883.]
THE MEDICAL RECORD.
287
hesitation prescribe digitalis. In spite of affirmations
which have recently been made respecting the danger of
these hypertrophies and the part wliich has been attri-
buted to them in the production of uraimic cerebral ac-
cidents, digitalis does not augment the hypertrophy ; the
function of the hypertrophy is that of a moderator, and
digitalis can in no way render harm.
There are certain palpitations due to hypertrophy
where digitalis is of less utility. I refer to hypertrophies
attending adolescence ; sometimes these result from dis-
placements of the heart by faulty chest-conformation.
These hypertrophies are attended with palpitations ; but
it is also noteworthy that young men may sufter from
palpitations from other causes, and that these palpita-
tions may be about as troublesome and persistent as
those which result from hy))ertrophy. Onanism is a
fruitful source of such functional palpitations. As to
the diagnosis, the hypertrojihies I am speaking of may be
known by augmentation of the volume of tlie heart, as
shown by increased dulness, and displacement downward
of the apex of the heart. These signs coexisting with
palpitations would suggest that we have to deal with the
hypersarcosis of adolescence ; in other words, with a sort
of exaggerated and jsrecocious development of the heart
muscle, and this is about the only kind of cardiac hyper-
trophy which frequently gives rise to palpitations without
necessary degeneration or atrophy of the myocardium.
Now in these cases digitalis is not needed, if there be
faulty conformation of the thorax ; a well-directed course
of gymnastics is far preferable. If there be no thoracic
mal-conformation, digitalis may be tried, and if the pal-
pitations be not quieted in the course of a few days you
must find some other remedy : bromide of potassium and
chloral often render real service in these cases. I have
not seen any good from hydrotherapy.
I have now an important remark to make respecting
the usage of this medicament. During these late years
some authorities have been very precise in their statement
of the indications and contra-mdications of this eminently
useful remedy. They have recognized in its therapeutic
applications certain inconveniences, dangerous and even
mortal effects. What has troubled them the most has
been both the prolonged action, and the slow, tardy
action of the drug. This only goes to show their igno-
rance of the slow, and at the same time cumulative, efiect
of therapeutical doses of this medicament. More than
twelve years ago I divided medicaments, from the point
of view of their promptitude and duration of action, into
two classes ; the one slow and cumulative, of which digi-
talis is the type ; the other of medicines, like the salts of
soda and potash, whose action is immediate, but which
are as rapidly eliminated. In this last category may be
ranged salicylic acid and the salicylates, which act with
astonishing promptness, and undergo elimination almost
as soon as they are absorbed. Is it a fault of these reme-
dies— of some that they stay too long in the economy,
of others that they leave it too quickly? It suffices to
know these important peculiarities, that we may avoid
inconveniences by not allowing digitalis to accumulate
too much in the organism, and by not suppressing too
soon the salicylates.
Apart from these peculiarities of action digitalis has
no grave inconveniences except the difficulty of toler-
ance by the stomach. The immediate effects are more
to be feared than the consecutive effects, which are less
often seen. I have observed the latter, and I will tell
you under what circumstances. In a great number of
patients affected with cardiac lesions, whether of the
valves and orifices or of the myocardium, chronic endar-
teritis and atheroma of the arteries exist. This degener-
ation of the blood-vessels occurs in advanced age in
spirit-drinkers and in persons affected with Rright's
disease. Gall and Sutton even regard arterial sclerosis
as the rule in chronic interstitial nephritis. In all these
cases the eftects of digitalis may be nil, or even hann-
ful. I will show vou how : The action of digitalis is
manifested in an augmentation of the energy of the
heart and of the tension of the blood-vessels, in a word,
in a more active circulation. Now if the blood-vessels
are detjenerated, if the elasticity of the middle coat of
the large and medium-sized arteries is compromised, if
the muscular tunic of the small arterioles is invaded, the
latter have lost their power of contraction, and the
former their elastic retraction, and the peripheral circula-
tion is impeded. Here digitalis is inefl'ectual ; it may be
injurious in compelling the blood to accumulate in parts
the farthest removed from the heart, as in the lower ex-
tremities, where it remains stagnant in the veins, and
infiltrates the tissues. This, then, is the most plausible
explanation of the dangers of digitalis. Apart from these
conditions, it does not occasion any inconvenience, un-
less in the event of mal-administration. It may, for
instance, be given in too large doses, and in too small
doses, just as other active medicines — chloral, bromide,
salicylic acid, etc., of which one is so apt to err in the
dose. Too much timidity or too much rashness ; no sure
and rigorous convictions ; no confidence in established
e.xperience — here vou have the personal bias of not a
few who are clamorous for new methods of treatment,
or carpers of the old.
CONVALI.ARIA M.MALIS.
I have been talking of digitalis and the indications for
and against, according to my usual custom the last few
years, of treating this medicament in my lectures, and so
far have overlooked the fact that we have in convallaria
maialis (called muguet in French, lily of the valley in
English) a remedy far superior, and in every case per-
fectly harmless. In paliiitations of the physico-dynamic
order, the extract of convallaria succeeds marvellously.
I make only one reservation. In the hypertrophies of
adolescence (hypertrophies de croissance) I add the me-
dicament most suitable to modify the tissue of the cardiac
muscle ; I refer to
IODIDE OF POTASSIUM.
One of the most useful remedies for palpitations due
to hypertrophy is iodine. According to jNEagendie and
other distinguished physicians it constitutes the most
certain means for reducing the volume of a hypertrophied
heart, and for removing the dangers resulting from this
hypernutrition. According to this theory the iodide
would be a bad remedy, doing more harm than good, for
the hypertrophy is salutary and corrective, and the only
means whereby an obstacle can be overcome. Happily
it has no power to el^ect the denutrition of the heart
muscle. I have employed iodide of potassium in a con-
siderable number of diseases of the heart, with hypertro-
phy perfectly defined and strictly compensatory, and in
all these cases the heart lost neither force nor volume.
Far from that, the action of the iodide, which is so use-
ful in cardiac dyspnosa, seems equally to aid the central
peripheral circulation ; the heart, far from losing energy,
seems to gain in contractile force, which is always a de-
sirable condition. So, then, the idea that iodide of potas-
sium causes, in any sense, atrophy of the cardiac muscle,
is erroneous. It benefits the hypertrophies of the pe-
riod of growth as well as compensatory hypersarcosis.
It is no less true that it may prove remedial in other car-
dio-pathies with palpitations, but without dyspnoea.
AN/EMIC AND DIATHETIC PALPITATIONS.
• I come now to a ([uestion in therapeutics which seems
easy of solution. I refer to the treatment of iialpitations
•of an;i;mic or diathetic origin. It is so easy to cure
anemia with iron, or the arthritic diathesis with alkalies,
that the remedial indications of these palpitations of
blood origin seem hardly to merit serious discussion.
Nevertheless, if the problem be closely scanned, its
complexity will be recognized.
In the class of diathetic anemias, as for instance, in
tuberculous or cancerous anajmia, palpitations are fre
288
THE MEDICAL RECORD.
[September 15, 1883.
quent. They have, however, neither signification nor
duration, and do not furnish any special indication of
treatment ; nay, more, iron is bad for the tuberculous, as
well as for the cancerous ; digitalis is worse than useless,
for it takes away the appetite and adds the evils of ina-
nition to the constitutional ancBinia. I do not speak of
palpitations of gouty origin ; they are far from being
proved, at least if by the term gout we iniderstand lithx>-
niia.
How is it with the true anaemias? We will suppose the
case of a young woman who has become anremic in con-
sequence of severe flooding. We will suppose a man,
previously vigorous, who has lost too much blood from
hemorrhoids. Both complain of palpitations, and of be-
ing easily put out of breath. Iron will infallibly increase
the hemorrhages, the an.-emia, and the palpitations.
Hcemostatic remedies are first demanded ; when you
have stopped the blood losses the palpitations will dis-
appear.
What good, on the other hand, will iron do in the case of
an individual whose dietary is insufficient, whose meagre
rations bespeak misery and poverty ; who breathes, it
may be, confined, vitiated air? Iron can do nothing for
the anaemia of inanition, or even for the anaemia of (iro-
fessions which are attended with insufficient aeration.
The cause must be removed before a cure can be real-
ized.'
Another kind of anremia with grave palpitations, neces-
sitating special care, and seeming to call for iron, is that
which is consequent on seminal losses. Much, however,
as iron seems to be indicated in these cases, it is seldom
that it is of any marked efficacy. Every day, almost, we
see patients emaciated, with sunken eyes, pale earthy
countenance, complaining of inability to do mental work,
of great muscular debility, generally, too, of pains in the
back, and of palpitations coming on without any obvious
reason, and which are not aggravated by walking, even
on rising ground. These individuals are melancholy,
constantly brooding over their seminal losses, whicli may
or may not be accomjianied with sexual impotence.
They have been formerly masturbators, and are suffering
the consequences of their folly. They suffer from palpi-
tations (the result of sperm-waste) and can hardly be per-
suaded that they have not serious disease of the heart.
If, confounding this sort of debility with the globular
an^mias^ we give iron, with — it may be — hydrotherap)-,
we shall very soon find our mistake. In fact, we are not
concerned iiere with simple modification of the number,
form, or composition of the red globules (in which case
iron would have magical efficacy), we are concerned with
a condition of general enervation and failure of nutri-
tion. Without recommending the local treatment by ureth-
ral injections, astringent or sedative, which are of no use,
and tend injuriously to fix the attention of the patient on
his over-sensitive genital organs ; without recommending
cauterizations of the membranous or prostatic urethra,
in accordance with the superannuated and dangerous
l)ractice of some surgeons, we may formulate in this
manner the results of an experience which dates back a
gfeat many years, during which we have been engaged
in earnest professional work.
Iron, unless we except the potassic tartrate, is with-
out eff"ect. Hydrotiierapy is generally ill-borne ; warm
douches and warm baths do harm ; bromide of potassium
debilitates the patient too much ; antispasmodics are dis-
appointing. This is the treatment which has succeeded
best in my hands: i. One gramme (15 grains) of iodide
])0tassinm, to be taken in two doses daily after meals. 2.
\Vitheach dose of the iodide, three pills, containing eacii 15
centigrammes (nearly 3 grains) of aqueous extract of
ergot, and 2 centigrammes (i grain) of alcoholic extract
digitalis. These two medicaments have a marked deores-
' Tlie physician is often called upon lo give mcdicme when it would be better to
t;ive food. One of the hardships which he is constantly obliged to encoutucr, is to
treat diseases arising from in.al-nutrttion, when he cannot control tlie dietary of the
oaticnt. — ^Tkans.
^ I.CS ana:inies hypoglobulaires ou heteroglobulaircs.
sant action on the reflex excitability of the spinal cord. 3.
A regimen consisting principally of meat, fish, and vege-
tables, to give strength and repair waste. 4. Red astrin-
gent wines in moderation. 5. Abstinence from mineral
waters, effervescent waters, spirituous liquors generally —
especially beer — tea and coffee, and tobacco. 6. Ablu
tions in tepid water in the morning. 7. Moderate phys-
ical and mental labor. 8. Strict avoidance of sexual ex-
cesses; avoidance of absolute continence.
I have dwelt thus lengthily on the treatment of semi-
nal emissions on account of the practical difficulties
which are encountered in these cases, and on account of
the frequency of these complaints.
I finish the consideration of anremias with palpita-
tions by some hints as to the treatment of chlorosis.
In this disease we witness the almost certain triumph
of iron. Under the influence of this remedy — even
though the case may be an inveterate one — we see rapid
diminution of the weakness, sensory troubles, and breath-
lessness. The palpitations also abate, though slowly.
There is, however, an inherent difficulty in this mode of
treatment ; the ferruginous medication must be contin-
ued a long time, under penalty of losing all the benefits
derived. It must, moreover, be re-enforced by a sub-
stantial dietary regimen, and by the practice of hydro-
therapy, which succeeds marvellously in these cases.
But if the physician relax the rigor of the treatment all
is lost; and yet he is sometimes obliged to compromise
with his patient, who dislikes the medicine, who does
not react well after the douche, or who does not tolerate
the jirolonged use of chalybeates. It is especially when
the true palpitations predominate (I refer to the true
in contradistinction to /j-cz/^/i^-palpitations, and ijseudo-
cardiodynias) that the means indicated end in failure.
In these cases digitalis is contra-indicated ; it troubles
the digestive functions and destroys the appetite. Bro-
mide of iiotassium causes a real enfeeblement after long
continuance in its use. Arsenic sustains better the
forces, but has no action on the palpitations. Iodide of
potassium promotes menstruation and facilitates respira-
tion, but does not coiTect rhythmical trouble of the
heart when this trouble is due to poverty of the blood in
globules or hreinoglobin.
This is the way I treat such cases. I cite the instance
of a young girl, extremely chlorotic, who was referred to
me for treatment by a distinguished London jihysician.
My prescription was as follows: i, Four times a day
take 100 grammes of raw beef or mutton (i)referably
the latter), divested of fat, scraped and mixed with
broth or pea-soup ; 2, besides the raw meat, fish (fresh
or salted) may be indulged in, and farinaceous vegeta-
bles ; 3, for drink, water may be taken with a little
brandy or wine ; 4, daily ablutions of the whole body
with fresh water; 5, sojourn in the country, and in a
hilly region. I insisted on these details, which I con-
sider very important. I recommended the raw meat be-
cause it is easy of digestion, and because the azotized
principles of the muscular substance support the vital
forces very much better than a milk and vegetable diet,
and because the flesh and blood of beef and mutton
contain iron combined with other princi|)les.
Nervous palpitations. — We arrive at the diagnosis of
these palpitations by way of exclusion, having eliminated
the possibility of valvular or other cardiac lesions, and
toxic and other alterations of the blood.
Having decided respecting the nature of the p.-ilpita-
tions, new difficulties .arise. Are they of the order of
reflex nervous palpitations? .Are they the expression
of a general neuropathy, of a psychical trouble, or of a
simple functional i)erlurbation of the moderator or motor
nerves of the heart ? These questions must be answered
before a rational system of treatment can be devised.
It will not do to content one's self with vague theories of
spasm (how high soever the authorities by whom those
theories are supported), nor in i)ractice will it do simply
to ring the changes on antisi>asmodic remedies.
September 15, 1883.]
THE MEDICAL RECORD.
289
(a) Reflex palpitations. — Palpitations of reflex origin
are neitiier so frequent nor so well demonstrated as one
might imagine. Does the affection seem to be one of
the digestive organs ? About the only dyspeptic troubles
that cause palpitations are the neuro-vascular dyspepsias
and the verminous affections ; the flatulent dyspepsias
and the intestinal meteorisnis act mechanically by dis-
placing the heart and disturbing its functions, and are
hardly to be taken into account. The true nervous dys-
pepsias are more difficult of cure, and the resulting pal-
pitations are as obstinate as their cause.
The nervous disorders and the palpitations which are
due to the presence of t?enia in the intestines are perplex-
ing, and the treatment is disappointing till the existence
of the parasite is diagnosticated ; the neuro-cardiac phe-
nomena all disappear with the expulsion of the worm.
Palpitations of reflex origin may result from perturba-
tions of the genital organs, or lesions of the womb.
Palpitations often affect pregnant women, women suf-
fering from amenorrhcea or uterine fibrous polypi ; they
may depend on a reflex irritation from the spinal cord,
causing constriction of the vessels, and changes in the
intravascular pressure, troubling, possibly, in this manner
the rhythm, or normal frequency of the pulsations. (The
above is more a matter of theory than of demonstration.)
True nervous palpitations affect the hysteric, the hypo-
chondriac, the neuropathic, or their source is of a jisychi-
cal nature (emotions, etc.) ; or else they constitute a
trouble of innervation without determined cause. To
this last category belong palpitations called essential pal-
pitations.
(b) Hysteric palpitations. — Is it a case of hysteria or
hypochondriasis ? If the palpitations are not really
subjective, i.e.., are real and audible to auscultation, it is
necessary before all to remove the mechanical causes,
such as tympanites, flatulent dyspepsia, which press the
diaphragm upward and displace the heart, or trouble its
functions. If it be impossible to explain the palintations
by reflex action or mechanical causes, if they are strictly
nervous, they come very near to being of the psychical
kind (or even of the kind called essential), and the
physiological mechanism and treatment would be the
same. In fact, all palpitations belong exclusively to the
domain of physiology, and cannot be treated seriously
and scientifically till their intimate nature is understood.
Are they of the nature of spasms ? Antispasmodics are
indicated ; but what antispasmodics ? Valerian, musk, as-
safcetida, camphor, orange-flowers, amber, the succinates?
But who, I ask, has ever known any of these drugs to cure
those continued grave palpitations which begin and are
perpetuated without known cause ? Is the heart ever sus-
ceptible of spasm — that is to say, of a contraction — either
exaggerated in force or exaggerated in duration ? In the
first case exhaustion would soon take place ; in the sec-
ond, death. Suppose, however, that those precipitate
beatings, which are not spasmodic, are the expression of
excitation of the nerve-centres by a physical or moral
cause. In this case the excitation can only act through
the intermediary of the spinal cord ; but the spinal cord
causes the blood-vessels to contract, it also determines
an increase of vascular tension, but not palpitations.
All these palpitations are, on the contrary, veritable
paralysis of the par vagum or moderator intra-cardiac
ganglia. When these are fatigued or exhausted, a con-
siderable disorder results ; in fact, an enormous accelera-
tion of the heart's pidsations. The treatment ought to
be based on these data ; indeed, empiricism did so base
it before any explanation was sought.
These palpitations have been treated : i. By digitalis,
which augments the heart's energy and the vascular ten-
sion, and slows the pulsations. It is a powerful excitant
of the moderator system of nerves. 2. By bromide of
potassium, which moderates the peripheral circulation,
and in this way, or perhaps directly, diminishes the ex-
aggerated activity of the heart. If the palpitations are
kept up by external sensory impressions acting reflexly on
the heart, bromide diminishes the intensity of those sensory
excitations by moderating the reflex spinal irritability.
3. Another remedy is veratrine, of which I shall speak
when I come to treat of those grave palpitations which
constitute the basis of Basedow's disease, and which
seem to exhaust the heart and the patient. 4. Hydro-
therapy, which in these cases is a method which is use-
ful or dangerous according to the way in which it is
applied, and according to the susceptibility of the ])a-
tient.
Iron, despite its tonic power, is not of utility when ad-
ministered for these palpitations, for the reason that they
are not of hajmic origin. Iodide of potassium exas-
perates their intensity. This salt, indeed, improves the
working power of the heart, but does not give tone to
the paralyzed ganglia. .Arsenic is preferable, but is not
always sufficient.
We have never obtained any benefit from warm or
cold baths or other hydrotherapic methods, nor even
from mineral waters.
The sedatives — opium, belladonna, aconite, hydrocy-
anic acid — have always seemed to me to increase rather
than diminish these paretic palpitations. This is easily
understood. Belladonna, among others, paralyzes the
moderator nerves and ganglia. The difference of action
in these cases between the jjaralyzers and excitants of the
moderator system of the heart — between belladonna on
the one hand and digitalis on the other — suffices to
justify our views of the paralytic nature of nervous palpi-
tations, whether psychic or essential.
(c) Palpitations called essential {chrome palpita-
tions).— There are some patients, females especially, who
have palpitations for years, and after being long tormented
by them, finish by living quite in harmony with the per-
manent disorder of their heart. I saw a short time ago a
woman thirty-two years of age who had these functional
perturbations for fifteen years, and to such an extent that
on counting her pulse I reckoned 140 to 150 pulsations
a minute, with occasional intermittences. Every kind of
treatment having failed, the patient had given up all
medication. She was in good health ; the heart had not
undergone either hypertrophy or dilatation. This fact
adds to the proof— already ample— that palpitations do
not exhaust the heart, and that even under the most dis-
couraging circumstances we are warranted in giving a
faTorable prognosis.
A CASE OF TEARSTONE IN THE CANALIC-
ULUS OF THE LOWER EYELID.
By CHARLES J. KIPP, M.D.,
NEWARK, N. J.
Concretions, both fungoid and calcareous, are so very
rarely found in the lachrymal passages, that the publica-
tion of the following case seems desirable.
Alfred B , eight years of age, was brought to me
for advice as to a painful swelling of the lower lid of his
left eye. His parents stated that this eye had been
" weak " for some years, but that the swelling had de-
veloped only within the last eight months.
This swelling was found to extend from the inner
canthus to the punctum lachrymalis, and to involve the
free edge of the lid. It was about the size and the shape
of a French bean, and quite hard to the touch. The
skin over it was red and cedematous, and the caruncle,
the semi-lunar fold, and the conjunctiva of the whole
lower lid were swollen and injectad. The lower punctum
was transformed into a nipple-shaped projection, about
a millimetre in height, on the summit of which was a
large crater-form opening, and was situated much farther
from the inner canthus than normally, the canaliculus
having nearly double its usual length. Pressure on the
tumor caused a few drops of a whitish puriform liquid to
escape from the punctum, which did not, how«ver, materi-
a^y diminish the size of the swelling. Exploration of the
290
THE MEDICAL RECORD.
[September 15, 1883.
canaliculus by means of No. i of Bowman's probes showed
it to contain a stony concretion.
All doubts as to the nature of the affection having been
removed by this exploration, I advised an operation for
the removal of the obstruction, and consent having been
given, I introduced a small Weber's knife into the canalic-
ulus and split it in its entire length. An oval concre-
tion of about the size of a pea was found lying loosely in
the distended canaliculus and was lifted out without any
difficulty. The mucous membrane lining the canali-
culus was red and much thickened, and coated with thick
pus. A probe could readily be introduced into and
through the lachrymal sac from the canaliculus, and
pressure over the region of the lachrymal sac failed to
cause mucus or pus to escape from the sac into the canal-
iculus, thus showing that it was in a healthy condition.
The distended canaliculus was thoroughly cleansed, the
wound kept open for several days, and the patient di-
rected to apply cold compresses to the lid. Under this
simple treatment the tumefaction speedily disappeared,
the wound closed, and two weeks after the little opera-
tion the eyelid was no larger than that of the opposite
side. Since then there has been no return of the disease
and the eye has ceased to be "weak."
The concretion was found to be of a grayish color in
its outer layers, which were of a softer consistence than
the nucleus, and were readily removed from it by a stream
of water. The microscope showed this layer to be com-
posed of pus-cells. The nucleus itself was of a whitish-
yellow color, and was so hard that it required a pretty
strong knife to divide it. It measured si.x millimetres in
length and was about four millimetres thick. One half
of the concretion was given to a chemist for analysis, who
rei)orted that it was composed of lime and magnesia, and
carbonic and phosphoric acids, and some fatty substance.
Examined microscopically, after decalcification the con-
cretion was found to consist of a close network of very
fine fibres, resembling in appearance very closely those of
leptothrix buccalis. They could not, however, be stained
blue by iodine.
From this description of the concretion it will be seen
that it differed from those heretofore described by various
authors in this, that in addition to the leptothrix ele-
ments it contained an unusually large quantity of earthy
salts.
Masses of leptothrix have been found in the lower
canaliculus by v. Graefe," Forster.'and Narkiwiecz-Iodko' ;
and in the upper canaliculus by Schirmer,* Del Monte,'
and Gruening." In several of the cases a number of
concretions were found together, and in all were the con-
cretions of a cheesy consistence. Although the fungoid
nature of these concretions was pointed out by v. Graefe
as early as 1854, it was not till 1S69 that Waldeyer,'
Cohnheim,' and Leber,' demonstrated that this fungus
was a leptothri,x. The identity of the plant found in the
canaliculus with that of leptothrix buccalis is, however, not
yet fully settled, I think, as in none of the cases except
Gruening's could the fungus be stained blue by iodine.
The only attempt to cultivate the fungus was, as far as I
know, made by Gruening, who found, forty-eight hours
after placing fragments of the concretion in glycerine, that
they were surrounded by filaments of penicilium which
extended to a layer of penicilium spores floating on the
surface of the glycerine.
Fungoid concretions are, however, not the only ones
found in the canaliculi, as is shown by Pagenstecker's *
case, in which a stone containing no leptothrix was re-
moved. \V'hether in the tearstone removed by Des-
marres," leptothrix formed the basis of the concretion is
1 Archiv. f. Ophthalmologic, bd. i., p. 284 ; also bd. .w., p. 324.
2 Ibid., bd. XV., p. 318.
^ Klinische MonaLsb. f. Augcnheilkunde, bd. viii., p. 78.
* IbiJ., bd. ix., p. 248.
'' NaKcl's Jahrcsberichl, 1872, p. 434.
* Archives of Ophlh.ilmologj' and Otology-, vol. iii., p. 17.
' Arch. f. Ophthalmologic, bd. xv., p. 318-342.
" Archives of Ophthalmology and Otology, vol. ii., p. 219.
* Annal. d*Ocuhstiquc, viii., p. 85.
not known ; otherwise it very closely resembled the one
here described.
How the leptothrix gets into the canaliculi is not
known, but it seems not improbable that it is accident-
ally introduced into the puncta, the same as other foreign
bodies, such as cilia, bits of straw, and the like, which
are occasionally found here. To persons who are in the
habit of wetting the edges of the lids with saliva for the
removal of crusts, etc., such an accident might happen
readily enough.
As regards the diagnosis of concretions in the canaliculi
but little need be said. The introduction of a fine blunt-
pointed probe into the canaliculus, after the punctum has
been somewhat dilated by a conical probe, will in all
cases and in all stages settle the diagnosis at once. The
only affection for which it could possibly be mistaken,
after it has given rise to inflammatory swelling of the
tissue surrounding the canaliculus, would be a furuncle —
a verj' rare affection in this part of the lid — and thus it
will be readily distinguished by the history, by the elonga-
tion of the canaliculus, and the enlargement of the punc-
tum.
The treatment pursued in the case above reported is
the one to be recommended for all cases.
REPORT OF TWO CASES OF STRAiN'GUL.ATED
FEMORAL HERNIA WITH OPERATIONS-
RECOVERY.
By ALFRED NORTH, M.D.,
WATERBURV, CONN.
Case I. — Mrs. John H , of Waterbury, aged forty-
two ; has borne six children ; health always good. A
tumor about the size of an almond appeared in the right
femoral region about two years ago, with 5» marked
symptoms at the time of its appearance. Patient sup-
posed it to be an enlarged gland. One year ago the
patient was suddenly seized with severe colicky pains on
retiring to bed. The pains were chiefly in the right in-
guinal region, lasted two to three hours, then disap-
peared. .Slept soundly after this, and woke next morn-
ing well. During the last j'ear the tumor has caused no
inconvenience. Noticed that on standing much or lift-
ing, it grew longer, but after a night's rest returned to
its former size. It has never been reduced since its first
appearance. It has recently acquired about the size of
an English walnut.
I was called to see the patient first on Sunday morn-
ing, June 24th. She had been suffering since 2 a.m.
with severe nausea and vomiting. The matter vomited
was rather greenish in color, but free from fecal odor.
Bowels had not moved for several days. Features some-
what pinched.
On examination I found a tumor of the size of an
English w.alnut in the right femoral region, and traced
its neck up under Poupart's ligament. It yielded no
impulse on coughing and no resonance on percussion.
Slight reduction effected by prolonged taxis, but nothing
further could be accomplished. Ordered opium and
camphor, aa gr. j. q. 4 h., and ice-bag over tumor. Pulse,
120; temperature, 100°. p..m. : Morning symptoms ag-
gravated. Bowels have not acted. Matter vomited has
fecal odor and appearance and (to patient) a fecal taste.
Temperature, iooi°; pulse, 120. Pills continued. Soap-
suds enemata ordered.
Monday, June 25th. — Symptoms increased in severity.
Vomiting persistent, but not stercoraceous to-day. Pain
more severe. Bowels have not moved. Tympanites of
abdomen. Ordered enema of ol. oliv;i;.
Tuesday, June 26th. — Patient seen by Dr. Axtelle in
consultation. Temperature, 101^° ; pulse, 120. Face
more jiinched ; eyes sunken and dull ; cheeks hollow
and flushed. Bowels have not acted. Vomiting of bile-
stained fluid with slightly (ecal odor is persistent.
It was decided to give ten grains of calomel with sod;e
September 15, 1883.]
THE MEDICAL RECORD.
291
bicarb., to be followed in four hours with two ounces of
ol. oliva; and one pint of soapsuds per rectum and to be
governed by the result as to the question of operative
procedure. lo p.m.: Temperature, 102"; pulse, 125.
Bowels have not moved. Patiisnt worse and sinking.
Gave full turpentine enema in knee-chest i)osition. This
escaped in ten minutes without a trace of fecal matter.
Decided to operate at once. At 12 p.m. the patient was
etherized and I proceeded to operate with the assistance
of Dr. A.xtelle. Seized the tumor firmly and cut ob-
liquely from the external abdominal ring, downward and
inward about two and one-half inches, the point of stran-
gulation being at the junction of the upper and middle
thirds of the incision. The skin having beeii separated,
all tissues beneath were carefully cut upon a director
until the hernial sac was reached. This was about tlie
size of an English walnut ; its body was perfectly non-
adherent, but the neck was adherent entirely around.'
These adhesions were carefully broken and cut upon the
director. At this stage the neck of the sac, which had
been drawn out, was accidentally torn through on the
proximal side of the constricting band. The entire sac
was then carefully opened by the fingers and a knuckle
of intestine about the size of a walnut was found stran-
gulated, of a blackish-red color and adherent to the sac.
This was carefully separated by the fingers.
The strangulated knuckle had the appearance of initial
gangrene, but on close examination the results were seen
to extend across the line of constriction. Sponges satu-
rated with warm water were applied to this and soon its
vessels became more injected and its color redder. Ev-
erything was thoroughly cleansed, the intestine returned,
and the index finger swept around the opening, but no
adhesions were found. The hernial sac was then seized
and put on slight tension. The neck of the sac was
stitched across with cobbler's stitch and the ends firmly
tied, then brought back and tied on the opposite side,
so as to include the entire neck by the latter loop. The
sac was then excised beyond ligature.
The external wound was closed in the ordinary man-
ner with silk sutures, a drainage-tube extending through,
and dressed with a compress and bandage. It was neces-
sary to inject half an ounce of brandy hypodermically
during the operation to reinforce the heart's action, which
became very weak.
The operation occupied two hours, and the patient was
removed to bed at 2 a.m. with pulse 100 and temperature
99^°. Hot bottles of water were applied to feet and
sides ; ordered small pieces of ice in the mouth if she
complained of thirst, (rave twelve minims of Magen-
die's solution of morphia hypodermically.
Wednesday. — 7 A.M.: Temperature, 104"; pulse, 116;
respiration, 14. Slight tympanites; no pain; features
less pinched ; feels better. No vomiting on coming out
of ether. Decided to treat as after ovariotomy. Or-
dered the following enema every six hours :
5 • Quin. sulph gr- V.
Acid, sulph. aromat gtt. v.
Liq. opii cotnp gtt. xl.
Spts. vini Gallici ? ss.
Beef-juice 3 jss.
M. Sig. — Enema every six hours.
Abdominal ice-water coil applied. No nourishment
to be given by mouth. 2 p.m.: Temperature, 103^° in
vagina; pulse, 116. No nausea. Looks and feels better.
8 P.M.: Temperature, 103^° per vaginam ; pulse, 116.
Condition and treatment same.
Thursday, 28th. — 5 a.m. : Did not sleep during night.
Temperature, 104° by vaginam ; pulse, 120. Gave ten
minims of Magendie hypodermically. After this she slept
four hours. Ordered two drachms of iced milk by mouth
every two hours. 6 p.m. : Temperature, 103° per vagina.
Flatus escapes freely by bowel and mouth. No nausea,
^ The constriction was found to be the neck of the sac
no pain. Pinched look disappearing from face. Retains
milk and beef-tea.
P"nday, June 29th. — 9 a.m.: Temperature, ioii-° by
vagina ; pulse, 90. Begins to call for food. No nausea.
Nutritive enemata continued every six hours. Abdom-
inal coil still on. Slept five to six hours during night.
Eyes brighter and face less pinched. Bowels passed a
thin, aqueous, yellow, fecal fluid at 9.10 a.m. To take
half an ounce of milk or beef-tea by mouth every half hour.
6 P.M. : Bowels moved again. Slept during day. Tem-
perature, ioi^° by vagina. Good appetite.
Saturday 30th. — 11 a.m.: Temperature, 100^° by va-
gina. Quinia and sulphuric acid omitted from enemata.
One ounce of nourishment to be taken by mouth every
half hour. Slept well. 6 p.m.: Temperature, 101°.
Doing well.
Sunday, July ist. — 10 a.m.: Temperature, 99^° per
vagina. Sle|)t well ; api)etite good. 6 p.m. : Tempera-
ture, 99^^° by vagina; 98^-"" by mouth. Bowels moved
at II A.M. Coil taken off for the first time; appetite
good. Doing well.
Monday, July 2d. — 8.30 a.m. : Temi)erature, iooi-° by
vagina ; 99^-° by mouth. Coil off all night ; slept well.
Nourishment by rectum stopped ; appetite good.
Tuesday, July 3d. — 9 a.m. : Temperature, 100° by
vagina. The wound has been washed out four times
daily with solution of carbolic acid. To-day the tube
was taken out and wound dressed with balsam Peru.
Suppurating moderately. Slept well. Ajjpetite not so
good ; tongue coated and bowels fiatulent. Ordered
mist, rhei et sodx, 3 ss. every six hours.
Wednesday, July 4th. — Temperature, 98^^° by mouth.
Bowels have not acted. Doing well. Nourished entirely
by mouth.
Thursday, July 5th. — Pulse and temperature normal.
Appetite good. Sleeps well. Two actions of bowels
since last call ; as bowels are constipated ordered a dose
of rhubarb.
Friday, July 6th. — Temperature, 98*° ; pulse, 84.
Bowels acted three times after taking rhubarb. Doing
well. Wound suppurating, but healing fairly well.
July 1 2th. — Wound almost healed. Bowels normal.
Appetite good. Sleeps well. Looks and feels well.
Sits up to-day for first time.
July 18th. — Wound healed and patient up and walking
around.
July 2 1 St. — Patient perfectly well, and to-day went to
Peekskill, N. Y., to visit friends.
The two points to which I desire to call attention in
this case are : first, the returning to the abdominal cav-
ity of intestine at such an advanced stage on the way to
gangrene ; and second, the manner of obliterating the
hernial sac.
Case IL — G. F , German, aged fifty-two : al-
ways healthy until ten years ago ; has been a caster
in a metal foundry for past twenty-five years.
Patient states that about once a year for the last ten
years he has been suddenly attacked with severe pains in
bowels of a crampy character — with severe vomiting, last-
ing twenty-four to forty-eight hours or longer (patient
attributed these attacks to the fumes from molten spel-
ter, which is a kind of impure zinc containing copper,
iron, arsenic, etc., he being constantly exposed to these
fumes). Aside from this has always been well. Has
never had hernia or any tumor of any kind.
Patient was taken in the manner described above about
noon of Saturday, January 21, 1882. Attack was so
severe that he had to leave work. During — or before —
this attack a tumor appeared for the first time in the left
femoral region. He stoutly affirms that the tumor had
not existed previous to attack. I was first called to see
patient early Sunday morning, January 22d. He then
stated that he was suddenly attacked about noon of the
previous day with severe cramps in bowels and vomiting,
which was very severe and persistent, affording relief for
but few minutes. 'I'hese paroxysms had continued all
292
THE MEDICAL RECORD.
[September 15, 1883.
night without sleep. Had not sent for a physician be-
cause he supposed the attack to be Uke the previous
ones and due to the same cause. Thought he had been
in same condition many times before. When asked if he
had ever had hernia or a tumor of any kind in groin, he
positively stated tiiat he had not. Not finding a satis-
factory e.vplanation otherwise for the symptoms, 1 made
a thorough physical e.\amination and found in the left
- groin, apparently at junction of inner and middle tliirds
of PouiJart's ligament, a tumor about two-thirds the size
of an English walnut, which yielded no impulse on cough-
ing, no resonance on percussion, apparently solid and hav-
ing the feeling of glandular tissue. I should certainly have
regarded it as an enlarged gland in the absence of the exist-
ing symptoms. As it was, I regarded it as a iiernial protru-
sion, and ordered an ice-bag to be applied to it, and one
grain of opium to be taken every four hours. Taxis failed.
Called again at 6 p..m. and found the symptoms all
much increased in severity. Features markedly pinched;
vomiting stercoraceous ; bowels had not been moved,
although repeated large enemata had been administered
since previous call. I urged an operation, as I had
found all efforts at reduction to be fruitless, but patient
replied that he did not want "to be cut up alive.'' Ene-
mata, ice-ba^, and opium continued.
At 3 A.M. on Monday morning was summoned to pa-
tient in haste, and found that stercoraceous vomiting
had continued all night, pain and prostration were very
great. He was begging for an operation or anything
that would relieve him. .\ssisted only by my student
and the feeble light of two kerosene lamps, I proceeded
to the operation. Patient being etherized, a final effort
at reduction was made, but failed. Then proceeded to
operate in the usual manner. The skin being cut
through, the deeper tissues were carefully and slowly
separated upon a director. Hernial sac having been
reached, the peritoneum was found to be perfectly nor-
mal, absolutely free from thickening or infiammation, and
the hernia to be recent.
On careful search, the point of constriction was found
to be at Gimbernat's ligament. This was carefully cut
upward and inward as far as deemed necessary, but fail-
ing still to reduce, it was cut a second time. A second
attempt at reduction failing, I introduced the point of
the index finger and stretched the opening until reduc-
tion was readily accomplished. The index finger was
then introduced into abdominal cavity and swept en-
tirely around, but no adhesions found. The hernia was
reduced en masse, the sac not being opened.
The wound was closed with silk sutures, the sutures
being deep, and an attempt being made to pass them
through the margins of the ring and thus eftect a radical
cure. This latter point probably failed. Xo drainage-
tube was used. A compress and bandage as usual.
For the first four days the wound seemed to be healing
by first intention. At this time it was found that a deep
abscess had formed. This was freely opened and a
drainage-tube mserted. Treated subsequently after the
ordinary manner of open wounds. Treatment as to food
and anodynes was such as is ordinarily adopted after
abdominal surgery. Improvement was gradual after
recovery from shock of operation. Flatus escaped from
bowels immediately after operation. .Appetite gradu-
ally returned and nausea soon disappeared. Bowels
did not act till fifth day and then with no cathartic.
Discharged patient as cured on February 7th.
Ordered a truss for him on February 20th, which he
has been wearing since.
July 27, 1883. — Patient has been wearing the Otto
elastic truss from time of recovery until July 4, 1883,
when being on vacation from work and su|)posing the
truss to be only necessary during labor, he removed it
and left it off three or four days. During this time the
hernia reap[)eared again for the first time. The truss was
replaced and has kept the hernia in place since, but it still
returns on removing the truss, especially when he coughs.
progress of ^etUcal <i>cicuce.
Stenosis of the Pvi.orus Relieved by Digital
Dilatation. — The following case was reported by Pro-
fessor Loreta to the Academy of Sciences of Bologna :
The patient, a man forty-seven years of age, had sufiered
for the greater part of twenty years from imperfect diges-
tion, distention of the stomach, sense of w^eight, and oc-
casional vomiting. In 18 78 he was admitted into the
Bologna Medical Clinic, and treated for ulcer of the
stomach. Relief ensued, but only for a short time.
F.ructation, a burning feeling in the throat, vomiting of
undigested food, sometimes mixed with blood, increasing
emaciation, and pallor of the skin and mucous mem-
branes were noted. The man subsisted on a little milk.
The distended stomach gave a clear note on percussion
from the fifth rib to the umbilicus. Microscopic exam-
ination of the riuid drawn by pump from the stomach
yielded no evidence of organic lesion. On palpating
the emptied stomach, a tumor could be felt in the pyloric
region, with smooth and elastic surface, but not very well
defined limits. As the patient was steadily sinking, it
was determined to resort to operation. The stomach
was first washed out with an alkaline solution. The in-
cision into the abdominal wall was commenced a little
to the right of the linea alba, and extended outward and
downward for six inches ; the lower angle was an inch
and a quarter from the ninth right costal cartilage. The
omentum was extensively adherent by old inflammatory-
exudations. These were separated very slowly and
carefully from the abdominal wall and from the surface
of the stomach. This viscus was then drawn out through
the wound, and the operator felt the pylorus much en-
larged and of fibrous hardness. In the space between
the two curves of the stomach, and at a distance of an
inch and a quarter from the pylorus, an opening was
made into the viscus with a stout pair of scissors through
a transverse fold previously raised. The opening into
the stomach was extended two inches and a half, and
■f-shaped forceps were used to arrest bleeding from the
edges. The right index-finger was then passed into
the stomach toward the pylorus, which was completely
closed. The finger failed to pass into the duodenum,
in spite of considerable pressure and combined lateral
and rotatory movements. The left index-finger was then
introduced into the stomach and used to fix the pylorus,
while strong and renewed pressure was exerted to push
the first phalanx of the right index into the narrow and
contracted pylorus, which was then drawn forward to
the external wound. Along the right inde.x-finger the
left one was also introduced into the pylorus, but these
attempts failed to pull one finger from the other in spite of
much force, sustained as long as possible. .After resting,
the operator resumed his efforts and dilated the pylorus,
though he only succeeded in doing so very slowly, and
by employing very great force. The dilatation was con-
tinued to about three inches. The stomach wound was
then sutured with carbolized silk, the viscus replaced in
the abdominal cavity, and the external wound closed with
seven silver sutures. The patient was returned to bed
thirty-three minutes after the commencement of the
operation. On regaining consciousness he complained
only of thirst and of a slight burning sensation at the
wound. Small pieces of ice were given from time
to time. In tlie afternoon the patient complained of
weakness and hunger, and relished the yelk of an egg
beaten up with Marsala wine, given in teaspoonfuls every
half hour. The temperature throughout the day was
98°, pulse 72, respiration 26. 'l"hc same kinti of diet
was continued. The third day after the operation the
bowels acted after an enema, the fourth day some broth
and light paste were allowed, the fifth day some chicken,
the sixth day bread was added to the diet. On that day
the bowels acted spontaneously. The wound was first
September 15, 1883.]
THE MEDICAL RECORD.
293
dressed on the eighth day, and five sutures removed.
The incision had healed by the first intention. The two
remaining sutures were removed on the eleventh day.
The thirteenth day after the operation the patient's diet
consisted of coffee and milk, bread, roast chicken, roast
beef, eggs, and wine. He was out of bed for two hours
and a half on the sixteenth day, and rapidly gained flesh
and strength. Two days before the operation the man
weighed one iiundred and twenty-two pounds, and gained
about thirty-three pounds in six weeks. He continued
to enjoy perfect health when presented to the Bolognese
Academy after the lapse of five montlis. Professor
I-oreta subsequently performed a similar operation in
another case, and with equally good result; but in this
instance he experienced much less difficulty in dilating
the pylorus. — The Lancet, .August i8, 1883.
The Capillary Pulse. — Quincke and others have
called attention to a rhythmical dilatation of the capil-
laries, occurring synchronously with the heart-beats, in
certain morbid conditions, or even in certain individuals
in a state of ai)parent iiealth. This pulse is seen most
readily under the finger-nails, and has also been observed
in the retina. It is most marked in slightly an;i;mic per-
sons, and especially in sufferers from aortic insufficiency,
though in neither case is it of constant occurrence. Dr.
Albert Ruault, writing in La France A/edica/e o( Auguit
4, 1883, mentions a method by which this jjhenonienon
may be conveniently studied. The head of the patient
is firmly held m a suitable light, and then the forehead is
rubbed for an instant by the flat of the finger-nail. If,
now, the patient is the subject of a capillary pulsation,
the wliite spot in the forehead will become reddened at
the moment of cardiac systole, and at the same time the
integument will be visibly elevated. M. Ruault observes
that this phenomenon is nearly constant in cases of aortic
insufficiency when the heart beats regularly and forcibly,
but it is usually absent if the heart-action is irregular and
feeble. Recent researches of Franck have shown tliat
the mean arterial pressure in aortic regurgitation, so far
from being diminished, is equal to, or greater than the nor-
mal. This indicates that the arterial system is in a state
of tension. Now, says the author, if a momentary vaso-
motor paralysis be produced by drawing the nail across
the forehead, the blood will be forced into the network
of dilated capillaries at the moment of systole, and the
skin will be reddened with each pulsation. This phe-
nomenon is only met with in those pathological condi-
tions in which there is an increased cardiac impulse, and,
at the same time, a general arterial contraction. Aortic
insufficiency, arterial sclerosis, and certain forms of ana:
mia are the conditions noted by the author as those in
which the frontal capillary pulse is most readily observ-
able.
Rise of Bodily Temperature after Simple Frac-
tures.— Dr. Grundler has been making a series of ther-
mometric observations in patients suffering from uncom-
plicated fractures, and found in every case but one of
those examined, a rise of from 2° to 4° F. above the
normal. The degree of fever is in proportion to the size
of the broken bone, and to the degree of extravasation.
The highest temperature observed (102.5°) was in a case
of fractured femur, and the lowest (100.5°) '" fracture of
the forearm. The rise began on the evening of the first
day, and reached its highest point on the evening of the
second to the fourth day. — Cetitralblatt fiir Chirurgie,
August II, 1883.
A Post-mortem Cataleptiform State. — Brown-Se-
quard states that he has observed a peculiar cataleptiform
condition in the muscles of the legs in pigeons, after
having made a cross section of the cerebral hemispheres,
the optic thalami, the cerebellum, the medulla oblongata,
or the cervical portion of the spinal cord. It occurs
likewise after a crushing of the head. In a short time,
usually in less than fifteen minutes after death, the con-
dition manifests itself, so that the leg will remain fixed in
any position in which it may be placed, even though it
be opposed to the force of gravity. It has nothing to
do with rigor mortis, and comes on earlier than that. It
is produced most speedily after the head has been
crushed. Neither the spinal cord, nor the motor nerves,
nor the terminal motor plates are concerned in its pro-
duction. There is rather, according to the author, a di-
rect action of the central nervous system upon the
muscles, the nature of which he hopes, by further investi-
gations, to elucidate. — Centralhl. fiir Klin. Med., August
18, 1883.
Recovery after the Passage of a Ramrod through
the Brain. — Dr. (j. Fisher reports an instance of re-
covery after severe injury to the brain, which recalls
the well-known case of Dr. Harlow, of Vermont, in
which a tamping-iron was forced through the head by a
premature explosion. In this case, an iron ramrod was
discharged during the loading of a gun. It entered the
back to the right of the fourth dorsal vertebra, passed
upward along the ribs, and through the muscles of the
neck, and forced a passage thro\igh the skull and the
brain, projecting out nearly twelve inches from the left
side of the head. An incision was made in the neck,
and the ramrod was forced back by a hammer and ex-
tracted through the wound thus made. The patient re-
covered, but lost the sight in the right eye. A ramrod
being propelled in the same direction through a dead
body, it was found that in its course through the neck no
important nerves or vessels were injured. The instru-
ment passed through the right optic foramen, tore the
optic nerve, and passed through the fissure between the
frontal lobes. The destruction of brain-substance in
this region was only a little over an inch in extent, and
was confined to the anterior portion of the left frontal
convolution. .According to our present knowledge, such
an injury should cause no motor or sensory disturbances.
The author apprehended the appearance in time of in-
sanity as the result of the accident. — Centralbl. fiir Klin.
Med., August 18, 1883.
Eucalyptus in the Treatment of (jAngrene of
the Lungs. — Dr. Bonamy relates the case of a man,
about fifty years of age, who was admitted to hospital
suffering from cough, dyspnoea, and fever. A few days
after admission the fetid odor of his breath became so ex-
treme that it was necessary to separate him from the
other patients. There was dulness in the axillary line
on the left side over the middle portion of the lung. At
this point there was tubular respiration and crepitant
rales were audible at the end of inspiration. The sputa
consisted of a black matter, detached portions of which
were swimming in an abundant serous fluid. The cough
was incessant, and the odor intolerable. A diagnosis
was made of gangrene of the lung of superficial extent.
The patient was first put upon a mixture containing car-
bolic acid, but no improvement following, this was re-
placed by tincture of eucalyptus. In two days after the
last prescription the odor of the breath was much less of-
fensive, and in less than two weeks the patient was cured.
— Le Courrier Medical, .August 18, 1883.
Treatment of Granular I. ids. — Dr. Arnoux claims
to have met with great success in the treatment of gran-
ular lids by the following simple method ; The lid is
everted and wiped dry with a piece of blotting-paper.
The granulations are then touched very lightly with a
crystal of sulphate of copper, and immediately after a
smooth cylinder of zinc is passed over them. Then the
conjunctivais carefully dried again, and, as far as possible,
the impalijable black powder, which remains after the
operation, is removed. The lid is then replaced, but
not allowed to touch the ball of the eye for a mumte or
two. No subsequent cold applications are necessary, as
there is little reaction if the operation be delicately \^e:t-
ionn^d.—Gazetia Medica di Roma, August i, 1883.
294
THE MEDICAL RECORD.
[September 15, 1883.
The Medical Record
A Weekly youmal of Medicitie and Surgery,
GEORGE F. SHRADY, A.M., M.D., Editor.
Published by
WM. WOOD & Co., Nos. 56 and 58 Lafayette Place.
New York, September 15, 1883.
PATHOGENY AND TREATi\[Ei\T OF APO-
PLEXY.
The old word apople,\y (Greek, a stunning blow or
shock) has been retained by most writers on internal
pathology to represent a congeries of symptoms due to
serious interruption of the encephalic circulation. Though
formerly, owmg largely to the influence of Rochoux,
limited to interstitial hemorrhage, and consequently ap-
plied to the rupture of blood-vessels in any organ of the
body, it'now denotes, in the usage of the best authori-
ties, the sudden suspension of cerebral action produced
by an internal cause affecting the circulation (vascular
rupture, congestion or anjemia) and acting directly on the
encephalon.'
Rochou.x's numerous observations as to the pathogeny
of apoplexy had led him to conclusions more positive and
rigorous than his i)redecessors, Morgagni and Hoffmann,
had ventured to entertain. The latter recognized in
cerebral hemorrhage the principal, but not the onlv cause
of apoplexy ; there had been cases in the experience of
these older pathologists (and Morgagni may be said to
be the founder of pathological anatomy) where the ne-
cropsy revealed nothing but an excess of serum in the
ventricles, entailing, in their judgment, paralysis from
pressure ; other cases disclosed no appreciable post-mor-
tem lesions, and it was found necessary to admit the
existence of " nervous " or " essential " apoplexies.
The dominant influence of Rochoux and his anatomo-
l)athological studies for a time threw doubt and discredit
on the so-called essential apoplexies, and it was held that
intra-cranial hemorrhage, or intense congestion with
hemorrhagic tendencies, was always the antecedent of the
true apoplectic ictus. The first work in whicli public
attention was directed to arterial thrombosis as a cause of
localjgangrenes and softenings was that of Hodgson, on
"Diseases of the .-Vrteries," published in 1814. Later,
and within our own epoch, came the valuable discoveries
of Virchow, Panum, and Lancereaux, relative to embolism
and^thronibosis, and other causes of local ischiemia ; and
now to apoplexy from hemorrhage or from hypenemia
vvejniust_add apoplexy from'ansmia. Of still later date
is" the startling discovery of Charcot and Bouchard that
cerebral hemorrhage owes its mist fretjuent origin to the
presence in the'arterioles of the cerebral hemispheres or
basal'ganglia, of miliary aneurisms, the result of chronic
periarteritis and softening of the middle coat.
' Schtiuenbcrger.
However various the conditions which give rise to the
apoplectic seizure, they are all reducible in last analysis
to some circulatory disturbance. The heart under hy-
pertrophy or excitement may send too much blood to
the brain, and arterioles or capillaries may give way, and
an interstitial extravasation disorganize nerve-tibril and
nerve-protoplasm by the very fluid destined to nourish
their histological elements. This accident is more likely
to take place if the encephalic vessels are enfeebled from
malnutrition or disease ; and endarteritis and periarte-
ritis with resulting calcareous and atheromatous degenera-
tions, and multiple miliary aneurisms, favor the produc-
tion of hemorrhage. .Vll inflammatory and degenerative
lesions of the endocardium and blood-vessels also pre-
dispose to the formation of clots, constituting emboli or
thrombi, which may cause sudden obstruction of some
intra-cranial vessel, with all the ensuing apoplectic phe-
nomena.
Asa typical example of apoplexy, we will take a case of
hemorrhage into the left corpus striatum. \n important
motor ganglion, a halting-place, as it were, for the rein-
forcement and co-ordination of all voluntary impulses
emanating from the cortex, a ganglion, moreover, in
which all the muscular groups of the body have their re-
presentative elements, is all at once deprived of blood
by rupture of its nutrient artery. So far it is in the same i'
condition as though its arterial supply had been cut off
by an obturating clot. In both cases function must
cease, and necrobiosis occur, except so far as collateral
circulation may restore the loss. In the hemorrhagic
form there is a double lesion, the interrupted circulation
and the extra-vascular clot, irritating, lacerating, and
compressing nerve-tibrils and nerve-cells. Hence the
"shock" resulting from hemorrhage is generally more
conspicuous than the shock from infarction (by autoch-
thonous or migrating clots). Certainly in the one case
an initial coma is the rule, in the other it is the exception.
There is right-sided motor, perhaps also for a time
sensory hemiplegia, and there may be aphasia, whether
from interruption of the channels of transmission of the
voluntary influx destined to the muscles of phonation and
articulation, or from involvement of Broca's convolution.
According to McLane Hamilton, the face will be para-
lyzed on the same side as the arm and leg. There is also
coma, which is generally temporary. What causes the
sudden loss of consciousness ? This is a problem over
which physiologists have wrestled. The best explanation
we can give is that the local paralyzing lesion has refiexly
inhibited the liemispheres also. It is the radiation to
the conscious intellectual centres of the basal irritation.
As for the frequency of apoplexy, it is one of the most
common causes of death in old people. The liability pro-
gressively increases from twenty upward ; cases under
twenty are very rare. Of sixty-nine cases collected by
Rochoux,' fifty were beyond the fiftieth year. What
percentage of people in advanced life actually die from
apoplexy it is difl'icult to determine, deaths from this
disease being recorded in city registers as deatlis from
paralysis (a term by no means synonymous with apoplexy,
though in jjopular usage regarded as such), and sudden
death from heart disease being every day (for want of
an autopsy) referred to apoplexy.
^ Rochoux : Rechirches sur TApoplexic. 1814.
September 15, 1883.]
THE MEDICAL RECORD.
295
The most unobjectionable classification is as follows :
I, Congestive Apoplexy ; 2, Hemorrhagic Apoplexy ; 3,
Isch;vinic or Necrobiotic Apoplexy. The pathogeny
of tile last two forms has already been touched upon.
In congestive apoplexy there must be sometliing more
than simple cerebral hyperemia to account for the
symptoms ; there must be an absolute stasis in the capil-
laries and veins, during which rupture is imminent.
The pathological condition, then, producing coma, resolu-
tion, and paralysis, is one of suspension of function from
interruption of the nutrient circulation, assisted, it may
be, by pressure of the engorged blood-vessels on nerve-
centres and conducting strands.
The old division of serous apoplexy may as well be
banished from internal pathology, as it is doubtful if
serous effusion alone ever gives rise to a|)oplexy.'
As accurate diagnosis is essential to exact treatment,
so it would seem desirable that the physician when called
to a case of apoplexy should know what kind he has
to treat. Is it congestive, hemorrhagic, or ischemic ?
He has (we will suppose) ruled out narcotism, alcoholic
intoxication, syncope, and hysterical as well as epileiitic
coma. When the coma soon subsides without leaving
paralysis, it may be inferred that the attack was of the
congestive kind ; the march of the affection points out the
diagnosis. Moreover in apoplectiform congestion, as
Racle'"' has shown, the jugulars and veins of the face
are distended, the whole brain is engorged with blood ;
the symptoms are generally cephalalgia, obtnseness of
the senses, enfeeblement of the muscular functions, but
true paralysis is wanting.
Between apoplexy from hemorrhage and apoplexy
from an intravascular clot the diagnosis is more diffi-
cult, for the symptoms of the two forms are often
identical. If the patient is old, and has beady, calca-
reous arteries, the presumption is that arterial thrombosis
is the cause. The presumption is strengthened if, as
before indicated, and as Todd, Trousseau, and Alexander
Robertson long ago pointed out, there has been sud-
den complete hemiplegia without loss of consciousness.
The presence in the patient of the tuberculous or
cancerous cachexia would favor the hypothesis of throm-
bosis. A limitation of the paralysis to one arm, a leg,
or to the face would indicate vascular infarction rather
than hemorrhage. Recamier laid down some rules of
diagnosis, to which unfortunately there are very many
exceptions. Contracture of the paralyzed members,
antesthesia of the same parts, and enfeeblement of the
intelligence, pertain to hemorrhage ; complete resolution
of the paralyzed members, conservation of sensibility
and intelligence, to ramolissement. According to Char-
cot, aphasia belongs almost exclusively to ramolissement.
Embolism is more conuuonly met with in young patients
and in the great majority of cases coincides with valvular
disease of the left heart ; it conies suddenly without
prodromata, the paralysis is hemii)legic, the peripheral
arteries are healthy, and there are often signs of obstruc-
tion in other viscera, notably the spleen, which is enlarged
and painful.^
Such are some of the diagnostic points, but, as before
1 Flint : Prac. Med., p, 576.
' C.uide Clinique, 1S66, p. 94.
3 Jaccoud : Path. Interne, t. i. , p. 148.
said, there will be many cases where you cannot be cer-
tain in your diagnosis.
Only one or two points connected with treatment de-
mand consideration here. Prophylactic treatment can do
but little to prevent the manifestation of the more serious
forms of apoplexy. We are as powerless to retard ather-
omatous degenerations as we are to arrest senile decay.
The patient with hypertrophied heart and diseased arteries
should lead a quiet, temperate life. Remedies, such as
purgatives, salines, and veratrum, which diminish arterial
tension, may be indicated as prophylactics whenever
there is reason to fear apoplexy. The same remedies
are also indicated at the time of the attack. Cold ap-
plications to the head are also of utility, and the same
may be said of warmth to the feet ; sinapisms may be
applied to the extremities if due caution be exercised.
Bleeding should never be employed in the grave forms,
and it is only indicated, and that, perhaps, rarely, in the
congestive form. Sometimes venesection may be the
speediest means of reducing high arterial tension, and
preventing hemorrhage. Purgatives may always be tried
in congestive apoplexy, and very generally they will be
found to be beneficial. When there is reason to believe
that hemorrhage has taken place, there are no medica-
ments by which we can with certainty moderate or arrest
the sanguineous extravasation. If an artery have under-
gone occlusion we can neither promote removal of the
clot, nor prevent the resulting necrobiotic softening.
There is no sufficient evidence that the large doses of
ergot and bromides, too indiscriminately used in all
cases of apoplexy, do any good, and the same may be said
of the free use of strychnia for the resulting paralysis.
KERN'S CATAPLASMATA IN THE TREATMENT OF
LYMPHO-SARCOMATA.
In an article published in The Record last spring we
mentioned some facts regarding the efficacy of Kern's
poultices in lyinpho-sarcomata. We have since had
many inquiries regarding the matter, and therefore take
pleasure in presenting the substance of a lecture upon
this subject delivered by Professor Busch, of Bonn. Pro-
fessor Busch recounts the failures which he had expe-
rienced in treating malignant sarcomata with the knife,
by electrolysis, and by injections of various kinds. He
had learned to recognize the value of K.ern's cata-
plasms when a young physician in the military hospi-
tals, where he had often seen obstinate buboes melt
away under their use. These cataplasms are composed
of one part mustard-flour to five parts of black soap,
the whole being enclosed in a gauze bag, and applied
daily over the tumor for four or five hours or longer.
A very intense irritation, amounting almost to an erysipe-
las, is produced. The sarcomatous tumors, if fresh,
soften and disappear. The results of this treatment are
best shown by giving the history of a case of progres-
sive lympho-sarcoma as described by Professor Busch :
" The patient, a very powerfully built man of thirty-five,
had noticed in the beginning of July a hard swelling be-
neath the left angle of the lower jaw. He used water ap-
plications, presuming it to be a tonsillitis. But as the
tumor grew he sought medical advice, and at first inunc-
tions of mercurial ointment, linseed poultices, arnica, and
296
THE MEDICAL RECORD.
[September 15, 1883.
poppy-seed were applied. On August 13th I was called
in to examine the patient and was frightened to see the
appearance of the man, who two months prior had been in
the best of health. An immovable tumor extended from
the middle line of the neck to the vertebral column,
from the inferior maxillary bone to the internal half of
the clavicle. The larynx was pushed to one side of the
middle line and the sternal extremity only of the stcrno-
cleido-niastoid muscles was discernible. The pulsa-
tions of the carotid could not be perceived at its proper
place, as it was surrounded on its wliole course. The
pains of the occipital region and vertex, so characteristic
in these tumors, were felt by the patient. They were
occasioned by the great stretching of the posterior au-
ricular and occipital magnus nerves. The voice had be-
come somewhat hoarser, as the result of pressure upon
the pueumogastric or recurrent nerve. With these symp-
toms, and in the presence of the very rapid growth of the
tumor, I could only express my ojiinion that in all prob-
ability the patient's life would be terminated within a
few weeks. K I advised any remed\', it would be the
poultices of Kern. Possibly they would not benefit a
great deal in this case, and should this be the case
in a few days they would be discontinued. Next day I
took my_vacation-trip and left the 'patient in charge of
Dr. S , who relates to] me the_^succeeding events.
The patient endured the poultice (one to five) very well,
so that (instead of having it applied, like the other pa-
tients, for four to five hours) he let it remain upon the
tumor for_twelve hours. In the [evening the cauterized
region was Jcovered with vaseline and cotton and mor-
phine given internally. Already on August 27th, four-
teen days later, an evident diminution of the tumor and
greater mobility was ascertained. The cataplasmata
_were continued for four weeks and iodide of potassium
(5 to 200) given per os. After the tumor had completely
disappeared, small quantities of iodoform were brushed
upon it. 1 saw the i)atient, whom I did not suppose to
be still among the living, on October 3d, cured."
Professor Busch is inclined to attribute the powerful
action of this remedy to the er3'sipelatous irritation pro-
duced by it. Professor Binz, to whom he communicated
this view, thought that the oil of mustard, penetrating
the softened skin, might also be a factor. At any event,
the result appears as undeniable as it is extraordinary.
It is not likely tliat all cases even of fresh tumors would
have so happy a termination. It is not stated whether
the tumor returned.
POWDER OF BEEF-BLOOD AS AN ALIMENIARV
PRINCIPLE.
Our ideas of nourishing invalids with irritable and weak
digestive jiowers have been somewiiat revolutionized of
late years by the remarkable results of Debove and Du-
jardin-Beaumetz with their methods of forced feeding ;
and they have clinically demonstrated tliat proper nour-
ishment plays no unimportant part in the therapeutics of
certain chronic and convalescent states. The indications
for forced feeding are presented very frequently in prac-
tice, nuich more frequently, indeed, than many will allow.
Though the cases in which Dujardin-lieaumetz and
D6bove have obtained^their best results have been phthis-
ical, the splendid results obtained by Weir Mitchell and
Playfair with systematic feeding, show that its application
is not limited to that class. Many cases of hysteria,
anaemia, chlorosis, and convalescence from acute dis-
eases and organic affections are accompanied by loss of
appetite and even disgust for food ; due in great part
to the fact that the stomach has become so unaccus-
tomed to the presence of food that it has partially lost
its digestive power, the best restorative of which is food
in small quantities frequently repeated. As the normal
bulk of food cannot be retained or digested, the quantity
must be decreased, while the nutritive \alue must be cor-
respondingly increased. For this [lurpose we have the
various meat-powders, etc., many of which are valuable,
though in some cases none can be relished, or even re-
tained, on account of their insipidity and, to some, slightly
nauseous taste.
Excellent results have been obtained from the use of
dried beef-blood. Recently Guerder, of Paris, has
made an extensive trial of the dried beef-blood, made,
however, by a new and improved process. Its advan-
tages over powdered meat are : it is much cheaper, is
superior to it in alimentary properties, representing seven
times its own weight of fresh blood, and it exercises a
more pronounced stimulant action on digestion and on
the general orcranism. Whether this stimulant action is
due to the extractive matters of the dried blood, to its
salts, or to the large proportion of iron contained in it,
cannot be positively stated. It is highly probable, how-
ever, that the iron constitutes an important factor, as its
proportion of 0.30 part per 100 is sufficiently large to
represent medicinal doses of iron.
It is quite certain that the reputed indigestibility of
blood is without foundation, as the blood-bread in com-
mon use in Sweden is highly nutritious and easily di-
gested, as are the blood-puddings eaten in other coun-
tries.
Debove and Dujardin-Beaumetz have not had good
results from the use of dried blood. Guerder attributes
this want of success to the large quantities which they
administered, and their faulty methods of preparing it.
Indeed, their results with his preparation have been
eminently satisfactory, fluerder had administered it in
51 cases. Of this number, 44 took it well, and without
inconvenience, for several weeks. Three convalescents
from typhoid fever were unable to retain it at all, wiiile
to the remaining 4, all chlorotics, it was disagreeable,
producing unpleasant sensations in the stomach, and
was sometimes vomited unchanged after several hours.
While there is, of course, no fixed dose, we should be
careful that the stomach is not imposed upon. A large
spoonful may be given three or four times a day to chil-
dren, with a little cold coffee, and two or more spoonfuls
to adults. I'epsin may be added if it causes gastric dis-
turbance. If the patient takes other food, the blood
should be taken with it, preferably in a co/J liquid, and,
if necessary, disguised by some aromatic, as heat devel-
ops its peculiar taste and causes difficulty of absorption.
Although excellent results have been obtained from its
use in chlorosis, convalescence from acute diseases, etc.,
its effects upon i)hthisical patients have been most re-
markable. When the disease was not far advanced there
was invariably an early increase of strength, weight, and
September 15, 1883.]
THE MEDICAL RECORD.
297
appetite. It is desirable that it be still further used, in
order to determine, as nearly as possible, its exact value,
and certainly, with Cuerder's results, it is wortli the trial.
Guerder's method of preparing the dried blood is as fol-
lows: Fresh beef-blood — sheep's blood is undesirable,
having a very unpleasant odor — is defibrinated and cooked
for five hours on a water-bath, then slowly dried in a cur-
rent of warm air at a temperature of io4°-io8° F.
This demands at least three days, as every trace'of moist-
ure must be removed in order to prevent decomposition.
In this connection we may also speak of another arti-
cle— highly nutritious, easily digested, and retained, and
but little used — viz., raw eggs. The only objection to
their use is the individual objection of the patients, and
this only before the tirst is taken — for they seldom ob-
ject afterward. The egg may be broken into a glass,
care being taken that the yolk is not broken, a little salt
and pepper added, if desired, and the patient takes it.
He scarcely has the trouble of swallowing, for it goes
down of itself We have seen patients retain easily and
even relish a raw egg, who could retain nothing else,
more than si,\ hundred being taken in one case within
three or four months. It goes without saying that the
egg should always be carefully selected ; and, indeed,
for fear that one which has seen its best days should dis-
gust the patient, it were better to prepare it out of his
sight.
EXPULSION OF THE RELIGIOUS ORDERS FROM THE
fe PARIS HOSPITALS.
The Government of France has for some years been en-
gaged in a crusade against the church, and has sought
by every means in its power to supiiress its ministers
and to i)lace difficulties in the way of the practice of re-
ligion by believers. As long as its efforts were confined
to the expulsion of the religious orders and the secular-
ization of the schools, the matter was one of but little
concern to medical men, however much they might as
individuals be amused or shocked at French ideas of
liberty. But, being emboldened by the success of their
measures in banishing religion from the schools, the
members composing a majority of the Assembly have now
turned their attention to the hospitals. They first passed
a decree abolishing the office of chaplain in all the hospi-
tals. This was done on the plea of economy, and it was
asserted that the patients would by no means be de-
prived of spiritual consolation, as, if a request were
made to that effect, the nearest parish priest would be
summoned. But their subsequent action in driving out
the sisters showed plainly enough that they were not
actuated by motives of economy. Their design was to
render as difficult as possible all access of the ministers
of religion to the sick and dying in the hospitals. Every
medical man, no matter what his particular belief or un-
belief may be, knows from experience that the quiet of
mind resulting from the consolations of religion often
exert a most beneficial influence upon the sick, and it
cannot but be regretted that the French authorities have
seen fit to reject this adjuvant to medical skill and nurs-
ing. As stated above, a further decree has been promul-
gated, removing the sisters from the hospitals and supply-
ing their places w-ith salaried nurses. To those wlio
know the value of good nursing and have occasion to see
the efficiency of the sisters of different orders in the va-
rious hospitals under their care, this move of the French
Assembly seems little short of brutal. Whatever may be
thought of the danger of permitting priests to exercise
their vocations in the French schools and hospitals, cer-
tainly the integrity of the Republic can hardly be im-
perilled by allowing inoffensive sisters to nurse the sick.
Even the authors of this measure have themselves been
forced to bear unwilling testimony to the worth of these
devoted women. At a recent meeting of the Conseil de
Surveillance de 1' Assistance Publique, the question of
the secularization of the Hopital Necker came up in the
order for the day. But it was decided to retain the sis-
ters for the present, because of the possibility of an epi-
demic in the city. As sooa as this danger is over they
must go, and M. Quentin engaged to supply the places
of a hundred religious by an equal number of lay nurses
before the end of the year. The French ministers are a
little too intemperate in their anti-clerical zeal, and both
doctors and patients will have cause to deplore the un-
wisdom of the secularization of the hospitals.
THE ANTISEPTIC ACTION OF DRUGS WITHIN THE
BODY.
The parasitic theory of disease is one that appeals most
temptingly to the imagination of the therapeutist. Once
the particular parasite is found upon whose presence in
the organism the manifestations of any given disease de-
pend, experiments will speedily determine what drugs
are poisonous to it. Then, these two factors being given,
what can be more easy than the solution of the problem
of cure ? It is only necessary to give the remedy in
quantities sufficient to kill the parasite, and our patient
is cured — provided, of course, that the microbe has not
had time to produce irremediable organic lesions. When
the disease is a local one and admits of the direct appli-
cation of the antiseptic agent, this dream may be realized.
Indeed, empiricism has often, in such cases, anticipated
the deductions of science, and we find the explanation
of the action of long-used remedies in the power they
possess of destroying certain low forms of organic life.
But in the treatment of systemic or internal diseases of
parasitic origin a more complex problem presents itself.
If the tuberculous patient carried his bacilli about in a
bottle or a test-tube instead of in his lungs or other
organs, their destruction would be a very simple matter.
But when it comes to killing the micro-organisms which
are scattered about in various inaccessible organs and
tissues of the body, the dose of the required remedy
must be so great that we run the risk of killing the pa-
tient as well as his parasites. Koch has determined by
experiment that corrosive sublimate is fatal to the
anthrax bacteria when added to the culture fluid in the
proportion of i part to 200,000. If given in the same
proportion to the mass of blood in a man weighing one
hundred and thirty pounds, it would require at least two-
fifths of a grain in a single dose. Binz endeavors to
show that a proportionate dose may be given by intra-
venous injection to animals without fatal results. He
therefore takes issue with those who have denied the
possibility of destroying micro-organisms within the body,
without, at the same time, endangering the life of the
298
THE MEDICAL RECORD.
[September 15, 1883
ixitient. The value of Binz's experiments is, however,
questioned by Buchner {Cetitralhlatt fiir Klinische Medi-.
ciii, July 14, 1S83). The latter claims tliat corrosive
sublimate in the proportion of i part to 200,000 of the
animal fluids is fatal to the organism, and he refuses to
accept the conclusions of Binz in disproof of his assertion.
Corrosive sublimate, he says, enters into chemical com-
bniation with the albumen of the blood, forming an al-
buminate of mercury. This substance, although remain-
ing in solution, is less readily diffusible and less capable
of endosmosis, and hence there is no certainty that it
becomes equally distributed in all the tissues. Further,
the bichloride, by its transformation into albuminate of
mercury, is robbed of a great part of its poisonous action.
This is indicated by the less jrritant action, and therefore
the less immediately injurious effect upon the cells, of the
latter salt when injected hypodermicall)'. Buchner has
found that double the quantity of albuminate of mercury
is required to produce the same effects upon bacteria as
are caused by a given amount of the bichloride. He
does not deny that certain diseases are cured by the
internal administration of antiseptic remedies, such as
quinine, bichloride of mercury, salicylic acid, etc. l^ut
he asserts that they act, not as antisejitics, but in sojue
other way, [jossibly by increasing the power of resistance
of the organism to the action of the specific parasite.
He says that were quinine to act as an antiseptic within
the tissues, it would require in the average individual a
dose of at least three ounces. Arsenic, again, possesses
feeble antise()tic projierties, yet its action in small doses
in malaria is undoubted. It cannot be due to its poison-
ous action upon the malarial bacteria, and must, there-
fore, be owing to some specific effect whereby the tissues
are enabled to resist and throw off the jioison. The
author concedes that there ma\' be some relation be-
tween the property possessed by a drug of destroying
micro-organisms outside of the body, and its known value
as a remedy in disease, but he denies that the action in
the two cases is the same. He thinks tliat newly dis-
covered antiseptics should always be given tentatively in
parasitic diseases, and believes that thereby many valu-
able specifics may be added to our list. But the attemjit
to secure an antiseptic action of any drug within the
body is not only useless, but fraught with danger to the
lite of the jjatient.
IIIE RECORDS CABLE REPORT OFTHE BRITISH MI 1)-
IC.\L ASSOCI.'\TION.
The British Medical Journal contains the following
appreciative notice of The Record's cable report of the
meeting of the British Medical Association. " The New
York Medical Record publishes in its number of Au-
gust 4th an excellent summary of the proceedings of the
recent meeting of the British Medical Association at
Liverpool, forwarded by daily despatches through tele-
graphic cable. The outlay on this enterprising re|)ort
must have been considerable, and wc may refer to it with
satisfaction, not only as an admirable example of jour-
nalistic enterprise, but as a striking evidence of the
strong and growing leeling of sympathy and international
interest which characterizes the relations of the pro-
fession in Great Britain and America. The Mkdic.m,
Record speaks in terms of the most courteous compli-
ment and congratulation of the organization of the Brit-
ish Medical Association and its results, and refers with
special satisfaction, and in eulogistic terms, which we re-
cognize gratefully without reproducing, lo the words in
which the health of our guests was proposed at the an-
nual dinner, and the warm friendship felt and shown to-
ward our American guests."
KAIRIXE— THK L.\TEST RIVAL OF QUININE.
This new antipyretic agent has as yet attracted but little
notice in this country, although it has for some time been
the subject of investigations by our German confreres.
It was discovered about a year ago by Dr. Fisher, of
Munich, who states that it is the hydrochloride of oxy-
ethylquinolinehydrid. If there is anything in a name,
there ought to be no doubt of the value of the remedy,
but this is a busy world, and life is short, so the name
has been mercifully changed to kairine. The testimony
thus far collected, concerning the properties of kairine,
is somewhat conflicting. Dr. Girat has experimented
largely with it on animals, and has found its lowering
effects upon temperature to be very constant. It also
slows the pulse and diminishes the number of respira-
tions. He administered the drug hypoderniically, and
states that the member into which the injection was
passed became paralyzed. Tiie sensibility of the part
was blunted, passing sometimes to complete anssthesia.
Elimination occurs, in part at least, by the kidneys, and
is tolerably rapid, the presence of the substance in the
urine being determined within twenty -five minutes after
its administration. The urine acquires a dark green
color. According to Dr. Girat's experiments, the toxic
dose is said to range between one and two grains to the
pound of the weight of the animal. Dr. Filehne {^Ber-
liner Klinische Wochenschrift, .\prll 21, 1883) concludes,
from observations made by him in disease, that kairine
is a most valuable febrifuge, effective in all conditions
accompanied by elevated temperature. He has em-
ployed it with success in typhoid fever, acute articular
rheumatism, septicemia, phthisis, and pneumonia. He
recommends its use tentatively in commencing doses of
seven and a half grains per hour for four hours, or until
the temperature has fallen to 100"^ F. The dose is then
lowered to three or four grains, to be again increased
when the temperature begins to rise. It is stated that
by carefully experimenting during the first day, the proper
dose may be ascertained for each individual, which may
then be adhered to in the subsequent treatment. These
favorable effects have not been recorded, however, by all
observers. Professor Riegel reports most unsatisfactory
results in the treatment of pneumonia by kairine {Allge-
meine Medicinische CenlralZci/ufig, Jaly 28, 1S83). He
was unable to obtain any notable reduction of tempera-
ture by four hourly doses of seven and a half grains each,
and even larger amounts were often ])owerless to pro-
duce the desired eflect. Even when he succeeded in re-
ducing the temperature nearly to the normal, it often rose
again in spite of repealed doses of the remedy. .\s re-
gards the pulse, it was by no means reduced in frequency
as the temperature fell, and, furthermore, it was much
weakened. -\n improvement in the subjective sensations
[September 15, 1883.
THE MEDICAL RECORD.
299
of the patient, as described by Filehne, was not met
with, but, on the contrary, there was repeatedly observed
such a depression, amounting ahnost to collapse, that it
was necessary to discontinue the kairine and resort to
stimulants. The same effect has been noticed by Seifert.
Professor Riegel concludes that kairine is a dangerous
remedy, in pneumonia at least, chiefly because of its de-
pressing action upon the heart, and he cautions against
its use in asthenic forms of the disease. It is evident
that further trials are necessary before the exact value of
this new substitute for quinine can be determined, and it
is doubtful whether it will be able to maintain the high
character as a safe and certain antipyretic which the
early experimenters claimed for it. In fact, few new
remedies answer fully to the expectations of their intro-
ducers.
THE WISCONSIN STATE MEDICAL SOCIETY AND THI',
ISOLATION OF CONSUMPTIVES.
As will be seen in the opposite column, the Wisconsin
State Medical Society, during its annual session last week,
passed a resolution virtually declaring consumption to
be an infectious disease, and urging the necessity of the
proper isolation and disinfection of those suffering from it.
This action will be regarded, we believe, as somewhat
premature. Phthisis is, to be sure, now considered by
pathologists as a tubercular infection, and the possibility
of its very occasional contagiousness is not to be denied.
But the profession is by no means yet prepared to accept
the view that the disease is actively or dangerously con-
tagious. Medical societies, therefore, by intimating that
it is so, do an act that is sensational, weak, and injurious
to their prestige.
The American Pharmaceutical Association held its
annual meeting at Washington, D. C, on September 10th,
nth, and 12th, the President, Charles A. Heinath, in the
chair. Mr. Sloan, from the Committee on Drug Market,
submitted a report containing statements and tables re-
viewing the fluctuations of the market for the year, and
stating, among other things, changes made in the tariff on
drugs. Mr. J. W. Colcord, of Massachusetts, offered a
resolution directing the Committee on Legislation to
ask Congress to appropriate $25,000 for the introduction
of foreign medical plants into this country, and for the
propagation and care of home plants. He said that the
climate of the United States presents peculiar advan-
tages for the growth of many foreign medical plants, and
that Dr. I>oring, Commissioner of Agriculture, favored
the proposition. The Ebert prize was awarded to J. U.
Lloyd, of Cincinnati. The following officers were elected
for the ensuing year : President, W. S. Thompson, of
Washington ; First Vice-President, Dr. Charles Rice, of
New York ; Second Vice-President, T. H. Misi, of New
York : Third Vice-President, E. W. Runyon, of San Fran-
cisco ; Treasurer, Charles A. Tufts, of Dover, N. H. ;
Permanent Secretary, J. M. Maisch, of Philadelphia ;
Reporter of Progress of Pharmacy, C. L. Diehl, of Louis-
ville, Ky.
The Annual Meeting of the Wisconsin State
Medical Society. — This meeting was held at Milwau-
kee, September 5th, 6th, and 7th. Dr. Mason, of Mil-
waukee, First Vice-President, was in the chair. About
sixty members were present. An unusually large num-
ber of papers was read. The officers elected for the
ensuing year were : ,Dr. Dodson, of Berlin, President ;
Dr. E. W. Bartlett, First Vice-President ; Dr. Jenkins,
Second Vice-President. Dr. Reeves was continued in
his office of Permanent Secretary and Treasurer.
The Society took official action in regard to the matter
of color-blindness, urging that there be some legislation
by the State regarding it.
The Society al.=o passed the following resolution :
'■'■Resolved, That in consideration of the advance as to
a knowledge of the causes of consumption and of the
now known infectious character of the disease, we use
all the means in our power to have the phthisical mem-
bers of families as much as possible separated from the
healthy members, and also that we recommend the State
Board of Health to take means to have such persons
separated from intimate association with the well in our
public institutions."
During the session. Dr. F. A. Marsden was suspended
for having distributed patent medicine circulars.
The Society adjourned to meet on the first Tuesday
in May, 1884.
The well-known Anatomist, Pacini, recently
died at Padua.
The Floating Hospital of St. John's Guild has
closed its work for this season. Forty-tour excursions
were made, on which 29,189 children and mothers were
carried. The greater number of these were sent by
dispensaries and the Board of Health.
The Twelfth Annual Session of the French As-
sociation FOR THE Advancement of Science, Medi-
cal Section. — This Association held its annual meeting
at Rouen, August i6th, 17th, and i8th. The Honorary
President of the Medical Section was M. Verneuil ; the
President, M. Duplouy, of Rochefort. Among the more
prominent persons present were Drs. Huchard, Landow-
sky, Yoisin, and Jolly. -A paper was read by M. Pineau
" Upon a New Fact Regarding the Transportation of
Typhoid Fever." M. Deshayes reported a unique case
of " Herpes Zoster following the Right Fifth Nerve, and
accompanied by Neuralgia." M. Huchard read an elab-
orate paper upon '' Hemoptysis Occurring in Rheumatics
who are not Tuberculous." M. Gallard introduced a
discussion upon the " Theory of Menstruation." M. Gal-
lard read the history of a curious case, which he consid-
ered "Tetanus of Gastric Origin." The patient, who
suffered from persistent dilatation of the stomach, was
subject to convulsive attacks of the limbs, the face and
trunk not being involved. These attacks ceased under
treatment of the gastric condition. MM. Audrien and
Raoul Bravais presented a communication upon "Anti-
microbic Medication ; " under the name of' anti-epidemic
granules," they presented some pills composed of
"monosulphure de magnesium anhydre." These they
claimed, when taken in proper doses, would remove the
susceptibility to infectious disease. M. Mallez showed
the Society a " Surgical Pantograph," by which the size
300
THE MEDICAL RECORD.
[September 15, 1883.
and contour of a body could be measured. M. Lan-
dowsky read a paper upon the therapeutics of " Piscidia
Erythema," but communicated nothing new. M. ^ oism
made a plea for the use of the hypodermic method of
giving medicines in nervous and mental diseases. M.
Tessier tried to show that " typhoid fever "' varied in
amount (at Lyons) in accordance with the rise and fall
of the subterranean or well-water. AI. Cerne reported a
case of "Spontaneous Gangrene in a Patient with Poly-
uria and Phosphaturia." The subject of " Alternating
Diabetes " was brought up and cases where there was, at
different times, glycosuria, polyuria, azoturia, were cited.
M. Jolly read a paper upon " The Primary Function of
the Phosphates in Living Beings."' M. Gouguenheim
read a paper upon " The Indications for Tracheotomy
in Tubercular Laryngitis," in which he took the ground
that the operation was rarely needed, and only in certain
cases where there is rapid caries or infiltration. M.
Beauregard read a paper showing the favorable results of
" Osteotomy in the Treatment of Genu Valgum in In-
fants." He had never had any consecutive accidents in
doing this operation.
The International Medical Congress. — We have
received a letter from Dr. Lange, Secretary-General of
the International Medical Congress, which meets at
Copenhagen next August, in which we are informed that
the General Organizing Committee, formed for the pre-
paratory work, is composed of the following members,
living either in or near Copenhagen : President, Professor
P. L. Panum ; Secretary-General, Professor C. Lange ;
Secretaries, Dr. O. Bloch, Dr. C. J. Salomonsen, and
Surg.-Gen. Joh. Moller ; Honorary Treasurer, Professor
E. Hansen Grut ; besides the presidents and special com-
mittees of the Sections, viz. ; Anatomy, Professor Chievitz ;
Physiology, Professor P. L. Panum ; General Pathology
and Pathological .Anatomy, Professor C. Reisz ; Medi-
cine, Professor F. Trier ; Surgery, Professor Holmer ;
Hygiene and State Medicine, Dr. E. Hornemann ; Mili-
tary Surgery and Medicine, Director-General of the Medi-
cal Department of the Army Salomon ; Mental and Ner-
vous Diseases, Professor Steenberg ; Obstetric Medicine
and Surgery and Gynecology, Professors Stadfelt and
Howitz ; Diseases of Children, Professor Hirschsprung ;
Ophthalmology, Professor E. Hansen (irut ; Diseases of
the Skin and Syphilis, Professor Haslund ; Diseases of
the Ear, Dr. VV. Meyer ; Diseases of the Throat, Dr. ^V.
Meyer. The special committees formed for the aforesaid
Sections have, when they found it useful, completed their
number by members living outside Copenhagen, partly in
Denmark, partly in the other Scandinavian countries.
The Organizing Committee is now at work preparing a
programme.
Dr. Calvin Ellis has resigned his position as Dean
of the Harvard Medical School. Dr. H. P. Bowditch, it
is said, will be elected in his place.
The Canada Medical Association held its annual
meeting at Kingston, Ont., September 5th, r)ih, and 7th.
The Enolish Cholera Mission to EcvFr. — Letters
received from the medical men sent out from England to
Egypt are, says the British Medical Journal, very dis-
couraging. It does not seem lihely that sanitary meas-
ures for the prevention of future outbreaks of cholera can
be adopted for a long time to come. It is claimed that
cholera has been in Egypt since 1865, and that cases oc-
curred near Damietta last May. Antecedent to cholera,
there had been an epidemic disease among horses, typhus
carbunculosis, so called, and next bovine typhus, which
killed its thousands. The difficulties of carrying out effi-
cient sanitation are found to be enormous. The habits
of men, women, and children are such as habitually to
defile their habitations and the surrounding ground. .\s
to the Medical Department, it has been found to be in a
far worse state than could have been expected. The
registers of deaths in the villages are made out by the
barber ; the cases, in a large proportion, are never seen
during life, and the barber enters whatever disease comes
first to his imagination and his pen. The Egyptian medi-
cal officers are, as a body, found to be wretchedly paid,
and very incompetent ; cowardice and neglect of duty
are very rife among them. They have not the confidence
of the fellaheen, who seldom seek their advice, and the
Arabs never, without exception. The hospitals are
wretched, tumble-down hovels, filthy in the extreme, and
the beds not less so. The lunatic asylum at .\bbassieh
is filthy beyond description, and its management inde-
scribably bad.
Association for Diseases of the Respiratory
Organs and Climatology. — A meeting for the purpose
of organizing the national " Association for Diseases of
the Respiratory Organs and Climatology," will be held
in the parlors of the Academy of Medicine in this city
(12 West Thirty-first'Street), on Tuesday, September 25th,
at 10 A..M.
College of Midwifery, N. Y. — The following
changes have been made in the Faculty : Dr. Sarah E.
Post has been appointed Professor of Physiology in the
place of Dr. John Alsdorf. who has taken the chair of
Diseases of Pregnaney and Parturition. Dr. Henry F.
Hessler has been appointed Professor of Clinical Mid-
wifery and German Instructor in Obstetrics. The ses-
sions have been extended to six months — three months
of didactic instruction, and three months of clinical
work.
New Brunswick. Medical Society. — This Society
held its third annual meeting at St. John recently, when
about fifty members were present. The following offi-
cers were elected : President, Dr. Vail ; First Vice-
President, Dr. Walker ; Second Vice-President, Dr. Pat-
terson ; Secretary, Dr. (}. M. Duncan ; Corresponding
Secretary, Dr. Coleman ; Treasurer, Dr. Nevers. Dr.
Steves, of St. John, proposed that a New Brunswick
quarterly medical journal be established under the aus-
pices of the Society. The next meeting will be held in
St. John, in July, 18S4.
The Atlantic Journal of Medicine is a new
monthly journal recently started in Richmond, Va., and
edited by Drs. Robert B. Stover and Henry G. Houston.
The Cholera Epidemic in Egypt seems to be at an
end. During its whole course — that is, in about three
months — it has destroyed nearly thirty thousand lives.
Professor Schwalbe, of Kiinigsberg, has been called
to Strasburg.
September 15, 1883.]
THE MEDICAL RECORD.
301
^cwicxus and lloticcs.
Transactions of the Medical Society of the State
OF Tennessee. Fiftieth Annual Session, iield at
Nashville, Tenn., April 10 and n, 1883.
This year's report has appeared with commendable
promptitude, wherein it contrasts favorably with that of
last year and with society reports in general. The
volume contains several ])ai>ers of interest and of re-
freshing brevity, and also the code of ethics of the
Anieiican Medical Association. The society contains
three hundred and thirty-eight members, and has lost
three members by death during the year.
Report of Proceedings of the Illinois State Board
OF Health. Quarterly Meeting, held at Si)ringfield,
111., June 29, 18S3.
The Illinois State Board of Health is doing a good work
in seeking to rid the State of quacks. Its efforts hither-
to have been productive of good results, and judging
from the secretary's report, presented at this meeting, it
intends to keep up the fight until all the travelling and
advertising charlatans have sought refuge in other less-
favoreti localities. Further than this, tlie board endea-
vors, by the only means in its power, expostulation with
the offenders, to discountenance the practice of giving
medical testimonials concerning the virtues of various
nostrums and patented surgical appliances. May the
good work go on.
Transfusion : Its History, Indications, and Modes
OF Application. By Charles Egerton Jennings,
L.R.C.P. London : Bailliere, Tindall & Cox, 20
King William Street, Strand. 1883.
In this little volume of sixty-nine pages the author has
called attention to certain cases where transfusion would,
as a rule, afford only temporary benefit, as well as to
those in which this measure is demanded on the part of
the practitioner, and is generally attended with success.
His remarks are also supported by clinical experience
and by statistics. In addition, the methods of applica-
tion (illustrated), and the favorable conditions necessary
to the operation are also presented, together with the
immediate causes of failure, the several attending dan-
gers, and the means of avoiding them.
Transactions of the Michigan State Medical So-
ciety for the Year if
No. 3, Vol. VHI. Lan-
The eighteenth .Annual Meeting of the Michigan Medi-
cal Society was held at Kalamazoo, Mich., May 9 and
10, 18S3. The usual business of annual meetings was
transacted, the usual papers read, and the usual ani-
mated discussion over points of order held. The volume
before us contains, in addition to the scientific papers,
an amusing squib in verse by Dr. E. B. Ward, the title of
which is "Pro Bono Professionis."
Bacteria and the Germ-Theory of Disease. By
Dr. H. Gradle, Professor of Physiology, Chicago
Medical College. 8vo, pp. 219. Chicago: ^V'. T.
Keener, 96 Washington Street. 1883.
This volume comprises a series of eight lectures on the
above subject, delivered at the Chicago Medical College
by the author. The subject is, moreover, very fairly
handled in each essential point. Beginning with the re-
lation of the germ-theory of disease to the animal sys-
tem, the examination and the cultivation of bacteria,
fermentations, putrefaction, are then dealt with, followed
by the action of bacteria in digestion, inoculation of
germs, the germicide treatment, etc. Surgical infection
is then taken up in its various forms. The chapter on
tuberculosis, its infectious character and its inoculabihty,
is not among the least interesting. The fevers, diph-
theria, syphilis, and various local diseases, also receive
attention. Finally, the importance of the germ-theory
of diseases in its relation to the future is considered.
The work is altogether one of undoubted interest, not
only from the great importance of its subject, but chiefly
from the large amount of original work done, and the
completeness with which it is presented, even in minute
detail ; the latter being especially prominent, when it is
remembered that most of our published information on
this topic is, as a rule, in the form of abstracts from for-
eign journals.
Excision of the Knee-joint, with Report of Twen-
ty-eight Cases. Illustrated by Thirteen Photo-litho-
graphs and Wood Engravings. By George Edge-
worth Fenwick, M.D., CM., Professor of Surgery
McGill University; Surgeon to the Montreal General
Hospital. 8vo, pp. 68. Montreal : Dawson Broth-
ers. 18S3.
Dr. Fenwick. regards the operation of excision of the
knee-joint as undeserving of the disfavor into which it
has fallen, and he endeavors in this httle volume to gain
for it somewhat more consideration at the hands of his
professional brethren than it now receives. His cases
are comparatively few — twenty-eight in eighteen years —
but the results are exceptionally good. Indeed, had
other surgeons met with such uniform success, the opera-
tion would never have needed an apologist. The au-
thor's method of operation consists briefly in sawing oft"
only so much of the joint surfaces as is absolutely neces-
sary, preserving the epiphyses as far as possible. The
articular end of the fenuir is rounded and made to fit
into the hollowed-out head of the tibia. The surgeon's
personal attendance to the after-treatment is insisted
upon. It is to this method of section of the bones that
the author attributes much of his success, and he hopes
to see its general adoption in order that others may share
in his good fortune, and unite with him in upholding the
reputation of this operation.
The Principles and Practice of Medical Juris-
prudence. By the late Alfred Swaine Taylor,
M.D., F.R.S., Fellow of the Royal College of Physi-
cians of London. Third edition. Edited by Thomas
Stevenson, M.D. (London), Fellow of the Royal
College of Physicians of London, etc. 2 vols., Svo,
pp. 1,359. Philadelphia: Henry C. Lea's Son & Co.
1883.
No one need doubt at the present day that Taylor's
work is the leading one on medical jurisprudence in the
English language. It was quite fortunate for JDoth medi-
cal and legal professions that the author in his last
edition brought his treatise so thoroughly up to the times
and so carefully and judiciously interpolated all the lead-
ing cases and decisions pertaining thereto. It was in that
respect more than an improvement on the previous edi-
tion, as it was essentially revised from beginning to end,
while much valuable matter was added under the head
of poisons, wounds of throat, blood-stains, cicatrices,
asphyxia, abortion, infanticide, insanity, and life insur-
ance. Thus the work was left by its author at the time
of his death. The task of subsequent revision has been
undertaken by the former colleague of Dr. Taylor, Dr.
Stevenson, who has shown himself in every way fitted
for the task. He has evidently gone over the te.xt with
great care for the purpose of adding new facts of evidence
under their res|3ective headings, while steadily keeping in
view the necessity of not increasing the number of images.
This has compelled him in many instances to curtail
some of the chapters, notably those on medical evidence.
The chapters on iioisoning have been in many parts
entirely rewritten, the necessity for which can be readily
understood bv the recent advances made in this depart-
ment of forensic medicine. New and illustrative cases
have been added in many other deiiartments. The
editor has very wisely used his i)rivileges of adding facts
without in any wav interfering with the author's views re-
garding the main principles upon which all proper medi-
^02
THE MEDICAL RECORD.
[September 15, 1S83.
cal evidence is lounded. The volumes are published in
good style.
Anatomv, Descriptive and Surgical. By Henry
Gray, F.R.S., Fellow of the Royal College of Sur-
geons, etc., with Introduction on General Anatomy
and Development by T. A. Holmes, M.A. Cantab.
AVith drawings by H. V. Carter. Edited by T. Picker-
ing Pick, Surgeon to St. George's Hospital. New
American from the Tenth English Edition. To which
is added Landmarks, Medical and Surgical, by Luther
Holden, F.R.C.S., with additions by W. W. Keen,
M.D. 8vo, pp. 1,023. Philadelphia : Henry C. Lea's
Son & Co. 1883.
This well-known work comes to us again as the latest
American edition from the tenth English edition. As its
title indicates it has passed through many hands, has re-
ceived many additions and revisions. Consequently the
publishers are content to issue it more as a reprint than
as an improved edition. There is good reason for the
latter course, as the work is not apparently susceptible
of more improvement. Taking it all in all, its size, man-
ner of make ui', its character of illustrations, its general
accuracy of description, its practical aim, and its per-
spicuity of style, it is the anatomy best adapted to the
wants of the student and practitioner.
^'cpovts of s,ocictics.
STATE MEDICAL SOCIETY OF VIRGINLA.
Fourteenth Annual Session, held at Rotkbridgc Alum
Springs, Va., September 4, 5 and 6, 1SS3.
(Continued from p. 271.)
After the transaction of society business at the session
of Thursday, September 6th, Dr. J. J. Chisolm, of Balti-
more, Md., read a paper on
THE RE.MOVAI, of FOREIGN BODIES IN THE EAR.
He stated that the little bony projections on the exterior
surface of the drumhead have often been mistaken for for-
eign bodies, and the attempt to extract them on the part
of the general practitioner has produced disease and
permanent deafness. To illustrate the common occur-
rence of attempts to remove these ossicles for extrane-
ous bodies he cited several cases which had come under
his notice. He believes that there are numerous cases
of individuals living many years with foreign bodies in
the ear without knowledge of the fact, and stated that
most instances of inflammation of the ear were due more
to injudicious attempts at removal than to the presence
of the body itself. He had never seen, in all his expe-
rience as a specialist, a case of foreign body in the ear,
not interfered with by another person, which he was un-
able to remove by tlie careful use of a syringe and warm
water. In all instances of leguminous or other foreign
bodies that increase in size by the absorption of water in
the ear, he recommends
THE FILLING OF THE CAVITY WITH ALCOHOL TO I'RODUCE
SHRINKAGE liEFORE THE USING OF THE SYRINGE.
He uses pure alcohol.
Dr. Spiers Gihson, of Staunton, exhibited
AN EXTENSION AND SUSPENSION SPLINT
of his own invention for treatment of fractures of Ion'
bones.
Dr. L. McLane Tiffany, of Baltimore, Md., read a
paper on
PLASTIC SURGERY OF THE PACK,
and after careful description of the anatomy of the face
he instanced the different plastic operations of that por-
tion of the body. He referred to the peculiarity of the
fact that the facial bones will often not become necrosed
when denuded of their covering, diftering from the bones
of the trunk and extremities. He stated that he always
adopted the old-fashioned method of marking off the
flap before cutting in plastic operations, preferring tinct-
ure of iodine for that purpose.
He employs hot water as a haemostatic almost invaria-
bly in surgery of the face, and uses iodoform and absorb-
ent cotton on all granulating wounds of that part. He
employs only the simple interrupted suture by means of
silver wire. He laid great stress upon the necessity of
bringing together the lips of all wounds of the face, sim- ^
ply in apposition without the slightest tension ; and ^
stated that he always makes a flap for the hare-lip
operation, contrary to common usage. He gave full de-
tails of his mode of operating in the mouth. Dr. Tiffany
exhibited several large plates and photographs of cases
illustrative of his paper.
Dr. John N. Mackenzie, of Baltimore, Md., read a
paper on
DEFLECTION OF THE NASAL SEPTU.M
and its treatment. He believed that a tendency to this
condition was frequently inherited. The condition nar-
rows the nasal orifice and increases the pharyngeal open-
ing, and the irritation by reflex action on the vasomotor
nerves often causes aural disease. Ozaena is frequently
produced from the condition by the air remaining in the .
nasal cavity imperfectly changed and putrescence invited.
He described the present form of modification of replace-
ment of deflected bony septum, which has for the past
few years been known as Steel's modification of Adams'
operation, and showed that Dr. Bolton, of Richmond,
Va., some years before Steel's paper on the subject, de-
scribed the identical method in his own practice in an
issue of the Richmond Medical Journal. Dr. Mackenzie
was emphatic in his advice to the members to look
closely after the sequels which follow the condition
named, and stated that it was his invariable rule to begin
an examination of the throat and ear with a careful ex-
ploration of the nasal passage and retro-nasal space.
Dr. J. \. \\'HnE, of Richmond, showed a selection of
instruments and dilators for operating on deflected nasal
septum and made a few remarks upon the operation, giv-
ing his reasons for his
EMPLOYMENT OF SEATANGLE BOUGIES FOR HOLDING
THE SEPTUM IN PLACE
after replacing. He related the details of cases in which
he had lately used Seller's galvano-cautery for ulcer of
cornea in pannus and granular lids as well as deflected
septum. Dr. Wright also showed a small mass of what
appeared to be iron-ore, taken from the nose of a lady
over forty years of age, the history of the case show-
ing that the foreign body was introduced in early child-
hood.
Russian Bahies. — A correspondent of the New York
World, speaking of Russian babies, describes as follows
what one sees in the house of a Russian peasant : He
looks curiously at one odd little bundle laid upon a
shelf, another hung upon the wall on a peg, a third slung
over one of the main beams of the roof, and rocked by
the mother, who had the cord looped over her foot.
" Why, that is a child ! " cries the traveller, with a feeling
similar to that experienced on treading upon a toad which
was supposed to be a stone. " Why, what else should it
be ? " answers the mother. Having learned so much in
so short a time, the inciuisitive traveller wishes to inform
himself about the habits of the creature in the bundle ;
but his curiosity being somewhat dampened by the ex-
treme dirt of tiie little figure, he inciuires of the parent
when it was washed. "Washed?'" shrieks the horrified
mother, '' washed ! what, wash a child ? You'd kill it."
September 15, 1883. J
THE MEDICAL RECORD.
303
(£0 rvcsp 0 n tlen c e.
THE GERM-THEORY IN ITS RELATIONS TO
MALARIA.
To THE Editor of The Mfdical Record.
Sir : Almost siniultcfneously with my recent article in
The Medical Record (August 18, 1883) upon the unre-
liability of any theory yet advanced as to the ultimate
cause of malaria, I find two papers pertinent to the same
subject in the Popular Science Monthly for September.
One of these deals with the germ-theory of disease, being
a lecture delivered before the Chicago Philosophical So-
ciety by Professor H. Cradle, M.D. The other, by Pro-
fessor A. F. A. King, ALD., entitled, " Insects and Dis-
ease— Mosquitoes and Malaria," being the abstract of a
paper on "The Prevention of Malarial Disease,' read
before the Philosophical Society of Washington.
Permit me to briefly review some portions of these two
articles.
S])eaking of the "destroyers" which cause disease.
Professor Cradle remarks : "They are no longer invisi-
ble creatures of our own imagination, but with that om-
nipotent instrument, the microscope, we can see and
identify them as living beings, of dimensions on the [ires-
ent verge of visibility. The study of these minute foes
constitutes the germ-theory."
From this quotation I presume the doctor employs
the term " destroyers " as equivalent to " germs." He
acknowledges, however, that they are only of dimen-
sions " on ike present verge of visibility " by the micro-
scope. I agree with him there, if he means that
they have not yet been actually seen with any degree of
certainty. Still he proceeds to say that the germ-theory
" has substituted a tangible reality for idle speculation
and superstition, so current formerly in the branch of
medical science treating of the causes of disease." He
says truly that " obscure chemical changes, of which no
one knew anything definitely, or ' impurities of the
blood,' a term of similar accuracy and convenience, were
accused, while with regard to contagious diseases medi-
cal ignorance concealed itself by the invocation of a
'genus epidemicus.' The germ-theory, as far as it is
applicable, does away with all these obscurities."
I cannot at all subscribe to the last dogmatic assertion.
I am quite sure that there are many zymotic affections
(that class to which the germ-theory is peculiarly appli-
cable) in whose study " medical ignorance " has no other
alternative than simply to recognize and acknowledge
" impurities of the blood," whose character has not \et
been demonstrated ; or to invoke a " genus epidemicus "
as the only explanation, however unsatisfactory, yet af-
forded, for a sudden outbreak and wide extension of
some particular disease. As an example I may cite
diphtheria.
Professor Cradle asserts that bacteria belong to the
loivest order of fungi. He remarks that " no error has
retarded more the progress of the germ-theory than the
false belief that the bacteria of putrefaction are identical
with the germs of disease." What, therefore, may it be
asked, are identical with the germs of disease ? and must
not germs be regarded as fungi ? — or if not, what are
they ?
Dr. Cradle goes on to say that "in order to prove the
bacterial origin of a disease two requirements are neces-
sary : First, we must detect the characteristic bacteria
in every case of that disease ; secondly, we must repro-
duce a disease in other individuals by means of the
isolated bacteria of that disease. Both these demonstra-
tions may be very difficult. Some species of bacteria
are so small and so transparent that they cannot be
easily, if at all, seen in the midst of animal tissues. This
difficulty may be lessened by the use of staining agents,
which color the bacteria differently from the animal cells.
But it often requires long and tedious trials to find the
right dye. The obstacles in the way of the second part of
the proposition mentioned are no less appalling. Hav-
ing found a suspected parasite in the blood or flesh of a
patient, we cannot accuse the jiarasite with certainty of
being the cause of the disease, imless we can separate it
entirely from the fiuids and ceils of the diseased body
without depriving it of its virulence. In some cases it is
not easy, if possible, to cultivate the parasite outside of
the body ; in other instances it can be readily accom-
plished. Of course, all such attempts require scru-
pulous care to prevent contamination from other germs
that might accidentally be introduced into the same soil."
By employing the expression " other germs " in the
foregoing paragraph he can imply nothing else than that
bacteria are germs, although previously he has expressly
insisted that they are not.
Then bacteria-rods "form seeds or spores, as they are
termed." Considering the minuteness of bacteria, and
the consequent infinitesimal size of their spores, "which
germinate again in proper soil," we are led to inquire
once more. How about the germs? Almost every
microscopist is familiar with the several forms of bacteria,
as far as known. They exist universally, in the atmos-
phere high or low, in waters shallow or deep, in vege-
tables and in animals. They present no special peculiar-
ities to designate disease. Those found in the tongue-
scrapings of healthy persons cannot be distinguished
from others existing in the blood and tissues of the vic-
tims to zymotic disorders.
Professor Cradle says : " When we experiment with an
isolated disease-producing germ, it causes always one
and the same affection, if it takes hold at all." Has the
doctor ever succeeded in obtaining any such remarkable
results with isolated germs? If so, the problem is
solved.
As regards Pasteur's observations, Professor Cradle is
not so sanguine as some others. He remarks that
"Pasteur's own account" of the results of some of his
experiments are " dazzling. But a repetition of his ex-
periments in other countries, by his own assistants, has
been less conclusive. \.\\ Hungary the immunity ob-
tained by vaccination " {i.e., against anthrax) " was not
absolute, while the protective vaccination itself des-
troyed some fourteen per cent, ot the herds."
"Yet, though much of the enthusiasm generated by
Pasteur's researches may proceed further than the facts
warrant, he has at least opened a new path which prom-
ises to lead to results of the highest importance to man-
kind." Let us trust that such may be the case. Thus
far, however, it does not seem that Pasteur has demon-
strated anything more as to what are germs, than did
Jenner, the practical results of whose investigations re-
quired no theory to substantiate them.
In the second article referred to. Dr. King attempts to
prove that mosquitoes are the chosen carriers of the
malarial germs, and insert them into the human system.
He remarks : " Viewed in the light of our modern ' germ
theory ' of disease, tfie punctures of proboscidian insects,
like those of Pasteur's needles, deserve consideration as
probable means by which bacteria and other germs may
be inoculated into human bodies so as to infect the blood
and give rise to specific fevers." Here, in the same
way as Dr. Cradle, he speaks of " bacteria and other
germs."
He goes on to say : "With our present knowledge of
the ' germ theory ' one would hardly dare, even once, to
plunge an inoculating needle into the blood of a yellow-
fever or typhus-fever patient, whether living and coma-
tose, or recently dead, and then withdraw it and plunge
it into his own blood or the blood of other persons; yet
this is exactly what the mosquito is doing in nearly every
vellow-fever epidemic, and what, perhaps, the flea is
doing in the filthy jails and ships infested with typhus."
Now the profession are almost unanimous in rejecting
the idea of personal contagion in yellow fever — so, if
any germs are responsible for that disease, the mosquito
304
THE MEDICAL RECORD.
[September 15, 1883.
must extract them from some other source than the in-
fected human body. It may possibly be otherwise with
regard to typhus fever, which is well known to be in-
tensely contagious. So with some other communicable
diseases. j\[alignant pustules are occasioned by stings
of tlies which must have acted as vehicles for the con-
taminating element. .\ case was recorded in 1793 by
Penada, an Italian physician, where a human being was
seized with hydrophobia communicateil by the bite of an
insect. Bollinger remarks (" Ziemssen's Cyclopsedia '')
that certain parasites, as fleas and lice, which are nourished
by the dog, may transfer rabific poison to human beings
and other animals by means of their blood-drawing ap-
paratus. We can scarcely doubt that tlies convey small-
pox ; and an apparently authentic instance of vaccination
by the medium of a tiea was reported in the London
Lancet, June 22, 1S72.
No one pretends that intermittent fever is contagious,
although of the pernicious variety. Even the enthusiastic
Tommasi Crudeli has never, so far as I am aware, enter-
tained any such notion. But if liis theory be allowed,
that malaria may be transmitted from one individual to
another by the injection into the latter from the former
of what he terms the malarial ferment (only, however,
that taken horn pernicious cases), then it might readily be
supposed that malaria could be carried from its terrestrial
haunts to human beings, or from an infected person to a
well one. Still, I am inclined to believe that this musical
and rapacious insect, even if he invades our bed-cham-
bers laden with the malarial ferment of Jersey (which by
the way should need no coloring under the microscope),
must be acquitted of any otiier crimes of poisoning than
that of which we all have known him to be guilty. How-
ever, no one can deny that he is a pestiferous scamp.
\'ery respectfully yours,
Charles P. Rlssel, M.D.
4 West ijStk Street, New Vokk City, August 25, 1S83.
PRACTICE IN NORTH ME.XICO.
To the Editor of The Medical Record.
Sir : It may not be uninteresting to my confreres to read
something about medical affairs in this country, and about
my professional experience during four and a half years
of arduous work in the city of Monterey. The profes-
sion in this city is well represented by a number of phy-
sicians, graduates of the different medical schools of
Mexico. 'I'hey are generally well educated ; possess a
good classical education, before being admitted to the
study of the profession, and a very fair theoretical knowl-
edge. The text-books used at the medical schools are
almost e.xclusively French works, translated into Span-
ish. Their practical experience they have to acquire, to
a great extent, by years of practice and observation, the
hospitals in the former Spanish-American colonies being
far inferior to those of Europe or the larger cities of the
United States, and, in consequence of this, the clinical
instruction is rather limited. The Government cannot af-
ford such large appropriations of money as are necessary
to keep them in lirst-rate order, and it is well known
that heavy expenditures are required for the proper
maintenance of these important establishments, which
are the pride of other civilized countries. Moreover,
the old Spanish, or rather Moorish slyle of architecture
is not adapted for hosi)itals, and affords but little comfort
to the patients within their walls. The low lloors, con-
setiuent dampness, imperfect ventilation, ecjually imper-
fect protection against the inclemency of the weather
and absence of all provision for warming the rooms are
certainly serious objections. Only the poorest classes
therefore voluntarily resort to them. But the profes-
sional men of this country, as a rule, are highly intelli-
gent and imbued with the earnest will and desire to con-
tinue their studies, even after they have received their
degree of Doctor. They study and work assiduously,
and, in this way, attain a standard of ability, whicii de-
serves high praise. Their gentlemanly deportment makes
it an easy task to keep on friendly terms with them and
to obtain even their friendly support and co-operation.
I speak of .Monterey only, as I have no experience con-
cerning these matters in other parts of Mexico. The
population of the north of Mexico is a mixture of Indian
and Caucasian blood. Dr. Gonzales, of this city, a
gentleman distinguished for his high scientific attain-
ments, has told me that in the State of Nuevo Leon no
man of pure Indian blood could be found. Within three
centuries the amalgamation of the races has become
complete. But the offspring of the two races represent
in appearance mostly the Indian type. The e.\cessive
use of alcoholic liquors is but rarely observed. Their
dress is plain, but not without taste. Their way of cloth-
ing themselves in winter is altogether insufficient. They
simply wrap a blanket around themselves, but do not
put on thicker underwear, and thus expose themselves
to many diseases. I speak of those of the humbler
walks of life, because the wealthier classes live almost in
the same way as we of the more northern latitudes. It
is true the winters are generally mild, yet they are some-
times sufficiently cold to require careful protection. The
cities and smaller towns of Mexico are built in the old
Spanish style, the houses are imperfectly ventilated, and
those of the poorer classes often not ventilated at all ;
the floor is not or is hardly elevated above the streets
and is made either of a kind of cement or of the soil
stamped and beaten down, so as to make it more even
and solid. When this country was settled by the Span-
iards, the towns were laid out with the view of having a
running stream of potable water close by, so that, in case
of an attack or siege by hostile Indians, the inhabitants
had that most necessary element within easy reach. In
consequence of this, the site of towns and villages is fre-
quently found in valleys, which do not present the con-
ditions for salubrity, which are sought for in our time.
The Spanish colonists soon found out that in this
country it was necessary to irrigate lands in order to
insure a crop at all times, and thus, up to this date,
agriculture is principally carried on on irrigable lands.
It is hardly necessary to mention the well-known fact
that irrigating ditches are the most fecund sources of
malaria. The water runs in tliem for a few days ; then
it is directed into others, leaving the bed of these arti-
ficial rivulets exposed to the ardent rays of a Southern
sun. Add to this the imperfect drainage of many yards
and corrals : the fact that many houses are without priv-
ies, and the difficulty of getting rid of the oftaland refuse
inevitably produced by a large accumulation of human
beings, and it becomes evident that the atmosphere is
not always the purest, nor the conditions for salubrity
the best. The climate of the north of Mexico, for the
rest, is most agreeable. We do not have to endure
the excessive heat in summer which prevails in Northern
cities, nor the severe colds in winter. I might recapitu-
late in saying that the conditions for health would be
very good hail not man done some things to produce the
contrary eft'ect, anil had left undone others of not less
importance. As it is, diseases are not infrequent and
the mortality is not by any means trifling. 'J"he official
statement gives the latter 966 out of a population of
39,406 during the year 1880. Statistics of a later date
I have not at hand. The most frequent diseases are
those produced by malaria, the manifestations of which
are manifold, from the simple intermittent to the tbrmid-
able, pernicious, and all the diti'erent shades of remittents,
for which so many names have been invented, but which
I shall embrace in that class, as I wish to avoid confu-
sion, and as my experience has taught me that the same
disease may jiresent itself, as to the outward symptoms,
in a diflerent way in different patients, and that compli-
cations occur in one case that fail to make tiieir ajipear-
ance in others. Even in diflerent years these diseases
dift'er in their symptoms and malignity, while the charac-
ter of the remittent still cannot be denied if the proper
September 15, 1883.]
THE MEDICAL RECORD.
505
use of the thermometer is resorted to. The intermit-
tents prevail nearly the whole year round ; even in
winter they do not cease, for the reason, probably, that
if there are a few days with a temperature which hardly
ever descends to the freezing-point, they are succeeded
by warm days, during which we are made aware of the
fact that we live in almost a tropical country. They are
but rarely malignant, but most stubborn, and I have
found myself repeatedly obliged to insist upon a change
of residence for some time, in order to overcome their
tendency to return. Masked intermittents are very fre-
quent, such as neuralgia of one nerve or a group of
nerves. I have had even some cases in which epilepti-
form convulsions look jilace, which had been treated
already as cases of real epilepsy. A careful examination
of these cases convinced me that they were manifesta-
tions of malaria ; percussion showed considerable increase
in size of the spleen, and the convulsions lasted much
longer than they do in e))ilepsy ; besides, the attacks did
not come on suddenly and almost without premonitory
symptoms, but after a preliminary stage, with consider-
able gaping and stretching, jjains in the limbs, etc. The
use of quinine revealed the real character of the disorder,
and stopped the attacks which previously had resisted
the use of bromide of potassium, etc. In Texas I had
the opportunity of treating a similar case before, and
therefore 1 had no unknown enemy to combat.
It would be tedious to enumerate all the different dis-
guises under which one meets intermittents in a Southern
country. The large majority of cases yield readily to a
judicious treatment ; but there are always some which
leave a state of marasmus behind. Undoubtedly, in
many it is consequent upon imperfect alimentation, since
the poor are really ])oor in this country ; but in other
cases the disease itself produces a long, protracted state
of anajmia, consequent upon the extensive destruction
and insufficient reproduction of the red-blood corpuscles.
I have had the opportunity to examine the blood of such
patients and found the white corpuscles considerably in-
creased in number, although not by any means a|3proach-
ing the proportion existing in leucaemia. Twice I have
had an opportunity to observe mental derangement
in consequence of protracted intermittents. They both
succumbed after months of suffering. I have seen so
much of intermittents in Louisiana and Texas that it
appeared ,to me strange that only here, in Monterey, I
should meet with cases of this kind. The fact was known
to me that mental diseases may follow in the wake of
protracted intermittents from the time that I read Grie-
singer's classical work in 1S69, but I found only here the
opportunity of observing it personally. As stated above,
my efforts to overcome the disease were totally in vain.
The experience of Collin, according to his work on fe-
vers, seems to have been similar to mine.
Edmund Goldmann, M.D.
Monterey, Mexico, August 18, 1883.
^ciu instruments.
How AN Impacted Peach-Stone was Dislodged
FRO.M THE GisopHAGUS. — Dr. J. S. Prettyman, of Milford,
Del., writes: "Was consulted August Sth, as to what
should be done in the case of an old man who had swal-
lowed (or rather half swallowed) a peach-stone, which
had lodged about the middle of the cesophagus. He
could swallow nothing, and the tube seemed to be com-
pletely occluded. I advised rectal injections of lobelia
intlata. The consultant. Dr. J. O. Pierce, of this town,
administered ounce doses of the tiuid extract every filteen
minutes until three ounces were thus used. The patient
then was so urgent to go to the water-closet, that he
was permitted, when, under active emeto-catharsis, the
stone came up and he cried out in great joy, ' Doctor, I
have got it.' The stone was a very large one and was
so tightly packed in the tube that it would have been iin-
possible to force it down without serious injury. No
other apparent effect followed the use of the medicine."
ir
?^i
AN IMPROVEMENT IN CLINICAL THER-
MOMETERS.
By W. R. LEONARD, M.D.,
NEW YORK.
The accompanying cut shows a registering indestructible
magnified index clinical thermometer. It is similar in
construction to one described by me in The
Medical Record of August 24, 1878: "The
contraction of the bore of this thermometer is so
extremely minute as to obviate the necessity for
any air-speck whatever, and then no ])ossible de-
struction of the index can take place, as an index
is formed at every observation by this peculiar
construction itself cutting off the entire column
above it from the bulb portion below it. Thus
we may, if we choose (no necessity exists for so
doing), shake the entire column (index included)
into the bulb and every time we warm the bulb
a new index is formed for us by the contraction
itself." The iniiirovement that I desire to draw
attention to in this thermometer is the etching
of the observatory corrections in combination
with the scale upon the stem. When thermome-
ters are examined by comparison with a standard
instrument it is almost invariably the case that
some slight errors are found to exist in the scale,
and these errors are set down on a certificate
which is supplied with the thermometer, and
which is numbered and marked in accordance
with the numbers and marks on the thermometer,
to insure identity therewith. Now, when the
thermometer is used and an exact reading is de-
sired, a certificate or a copy thereof has to be
consulted and the errors added to or subtracted
from the observed scale reading. This is a
troublesome oi^eration, as it involves reference
to the certificate of correction, which jjossibly
may not at the time be within reach or may be
lost. To obviate this difficulty Mr. James J.
Hicks of London, England, has patented the
device of etching or otherwise marking the errors
on the thermometer-tube itself, as shown by the
accompanying cut at a, a, a, a. The corrections
as shown in the drawing are 94.0, 100.4, 105.0,
iio.o. In this case this thermometer may be
called absolutely correct as it only varies -f--]V°
at no and this verification is from the Kew Ob-
servatory. In this instrument the correction is in the shape
of an addition, but in some cases they will be in the form
of subtractions, when the sign minus is employed. The
number and monogram or other sign of any examination
office at which the thermometer has been compared
with the standard instrument may be applied to the ther-
mometer. By these means the thermometer carries with
it the corrections found to be necessary, thereby greatly
enhancing its utility, as the correct reading can be at
once obtained by reference to the thermometer alone.
These thermometers are manufactured by Shepard &
Dudley, New York.
The Incurability of Congenital Color-blind-
ness.—Referring to an editorial on the subject of color-
blindness in The Record of August nth. Dr. B. Joy
JeftVies writes, calling attention to the fact that it is al-
most universally conceded by ophthalmologists and ex-
perts that congenital color-blindness is incurable. He
refers to the contrary view held by Favre of Lyons,
France. Dr. Jeffries agrees in urging the value of edu-
cating the color-sense among the children of public
schools.
3o6
THE MEDICAL RECORD.
[September 15, 1883.
Official List of Chaiii^es of Stations and Duties of Officers
of the Medical Department, United States Army, from
September i to September 8, 1883.
Shufeldt, Robert W., Captain and Assistant-Sur-
geon. Granted leave of absence for three montiis on
surgeon's certificate of disability, with permission to
leave the Department of the South. S. O. 204, par. 3,
A. G. O., September 5, 1883.
\Vak.e.man, W. J., First Lieutenant and Assistant Sur-
geon. Assigned to temporary duty at Fort Sidney, Ne-
braska. S. O. 92, par. 2, Department of tlie Platte, Au-
gust 28, 1883.
Official List of Changes in the Medical Corps of the Navy
for the week ending September 8, 1SS3.
DiEHL, Oliver, Passed Assistant Surgeon. Detached
from the Naval Academy and ordered to the U. S. S.
Quinnebaug, European Station, per steamer of 15th ult.
Anderson, Frank, Passed -Assistant Surgeon. De-
tached from the U. S. S. Quinnebaug, on reporting of
his relief, and srranted leave of absence for three months.
ItXctlical items.
Contagious Diseases — Weekly Statement. — Re-
port of cases and deaths from contagious diseases re-
ported to the Sanitary Bureau, Health Department, for
the two weeks ending September 11, 1883 :
Week Ending
Typhus Fever.
Typhoid Fever.
>
%
0
■y
in —
. <^
U
V
.i.
■5.
s
X
0
0.
£
>
_0
>
Casts.
September 4, 1 883
September 11, 1883
0 1 67 32
0 1 83 36
8
3
19
60
27 00
21 00
Deaths.
September 4, 1SS3
September 1 1 , 1883
I 24
0 27
2
7
8
2
I
6
21
IS
0
0
0
0
The Literary Status of the BoheiMian Nation. —
Dr. N. ^Veidenthal, of Cleveland, O., writes : " In a re-
cent issue you quote from a letter written by Dr. Coun-
cilman, of Baltimore, in which he makes a rather sweep-
ing statement regarding the scientific and literary status
of the Bohemian nation. If the doctor were a trifle
better informed on this subject he would certainly modify
the statement referred to. He is evidently not aware
that Rokitansky and Skoda, whose names will always
occupy an important place in the history of medicine,
were Bohemians ; that Oppolzer, one of the greatest
teachers and clinicians of his day, was a native of the
same country. Professor Arlt, the distinguished eye
specialist, of Vienna, Professor Albert, who was recently
called to the ciiair of surgery at the same university, and
Professor Czerny, of Heidelberg, are all Bohemians.
Professor Bamberger, of Vienna, is a native of Prague,
but perhaps should not be included in tliis list, as 1 be-
lieve he is not a Czech, but a German Bohemian. Pro-
lessor Seegen, one of the leading autliorities of the pres-
ent day on balneology, is also a native of that city. I
will not touch upon the non-medical side of the question,
as that is of less interest to our profession. In medicine
alone I miglit have given a longer array of names, but have
deemed it sutticient to give a few which have ac<iuired a
world-wide celebrity. It would surely be unreasonable
to e.xpect a small country like Bohemia to produce as
large a number of illustrious men in any department ot
science or letters as countries with ten times its popu-
lation. While I do not sympathize with the Czechs in
their persecution of their German fellow-citizens, and
consider the division of the old university of Prague to
be in many respects an unfortunate occurrence, I do not
like to see injustice done to any nation."
Dr. Abernethy and the late General Dix. —
In the biography of the late General Di.\, written by his
son, Morgan Dix, which has just appeared, is an account
of an interview with the celebrated Dr. Abernethy. It
will interest our readers especially, since it is known that
the wisdom of the physician's advice carried General Dix
from dyspeptic youth into eighty years of robust life.
General Dix gives the account himself: "He received
me with great civility, heard a few words of the story,
and cut me short as follows : ' Sir, you are pretty far
gone, and the wonder is you are not gone entirely. If
you had consulted common sense instead of the medical
faculty you could probably have been well years ago. I
can say notliing to you excepting this : You must take
regular exercise, as much as you can bear without fa-
tigue, as little medicine as possible, of the simplest kind,
and this only when absolutely necessary, and a moderate
quantity of plain food, of the quality which you find by
experience best to agree with you. No man, not even a
physician, can prescribe diet for another. " A stomach
is a stomach ; " and it is impossible for any one to rea-
son with safety from his own to that of any other person.
There are a few general rules which any man of common
sense may learn in a week — such as this : That rich food,
high seasoning, etc., are injurious. I can say no more
to you, sir ; you must go and cure yourself.' "
A New Method of Diagnosing Cancer. — In the
Journal de Medicitie, of Brussels, Dr. W. Rommelaere
publishes a series of clinical observations illustrating a
new fact in the pathology of cancer. He finds (in thirty-
four cases) that in persons subject to cancer the amount
of urea daily eliminated progressively diminishes until it
is below twelve grammes. By studying the urea elim-
inated in cases, for example, where doubt exists between
gastric ulcer and cancer, a diagnosis can be made. In
twelve cases of gastric ulcer the daily urea elimination
was about twenty-five grammes.
A Nail E.mbedded in the Brain. — In an autopsy
on a patient dying in one of the Vienna hospitals, there
was found in his brain an iron nail covered with rust,
which to all appearances must have been there since
early childhood. The man was about forty-five years of
age, a bookbinder, and always passed for intelligent.
Negative popular evidence, however, is of but little value.
The man, at regular intervals, had epileptic attacks, and
post-epileptic mental phenomena while in the hospital.
— Medical Press and Circular.
Danger Lurking in Soda W.\ter. — The public an-
alysts of Montreal and Toronto, Drs. Edwards and Ellis,
have been examining samples of soda water, and report
that in the majority of cases lead and sometimes copper
is present. Dr. Edwards examined twelve samples pur-
chased in Montreal and found lead or copper in ten of
them. Five contained both lead and co|)per, and five con-
tained lead only. In some samples only " traces " of the
metals were found, while in otiicrs the water was "largely
impregnated" with one or both of the metals. Dr. Ellis
in twelve samples of Toronto soda water found only
three which were free from lead. No mention is made
of the presence of copper. The quantity of lead varied
from .07 of a grain to .5 of a grain to the gallon, the
average of nine samples being .32 of a grain. All of
the above samples were taken from foimlain cisterns,
bottled soda water being invariably found free from me-
tallic impurities. — Sanitary Engineer.
September 15, 1883.]
THE MEDICAL RECORD.
307
A Formula kor Use in Irregular Heart Action.
— In a discussion upon heart disease before the Boston
Society for Medical Iniprovemeiit, Prof. Bowditch said
that lie had found the following formula of great service
in relieving even the most serious cardiac affections.
He had used it for the last twenty-five years:
IJ,. Pulv. digitalis gi- x-
Pulv. colchici sem gr. x.\.
Sodii bicarbonatis gr. xxx.
M'. et div. in pil. No. 20.
These are to be taken three or four times daily at fust ;
subsequently to be reduced until only one is taken at bed-
time; the treatment to be continued for three to nine
montlis. — Boston Medical and Surgical Journal.
Thk Pollution of Water at Summer Resorts. —
The /Mbany Argus reports the prosecution of F. G.
Crosby, proprietor of the Crosby Side Hotel, Lake
Ceorge, for draining the sewage from his premises into the
lake. Suits were brought against him under a recent
law which forbids, under ))enalty of $300 for each
oft'ence, depositing or allowing to flow into I-ake George
any sewage or other polluting matters. The complain-
ants withdrew the prosecution upon Mr. Crosby's agree-
ing to tear u|) the drains in their presence, which he is
said to have done. Complaints of a similar nature have
been lieard from other quarters, notably from tourists in
the Catskills.
Dangerous Sugar of Milk. — The American Insti-
tute of Homoeopathy is becoming alarmed because of
impurities discovered in sugar of milk. At its last meet-
ing it resolved that any sample of sac. lac. yielding a
residuum, after incineration, of more than i \ milligrannne
to each 10 grammes should be considered untit for houKeo-
pathic use. This is right. Any impurities existing in a
greater proportion than 15 to 100,000 must be exceed-
ingly dangerous, if not absolutely fatal.
Treatment of Lichen Ruber uy Unna's Oint-
ment.— Dr. Bockhart reports the cure of a case of lichen
ruber in three weeks by the use of Unna's ointment.
This is composed of one part corrosive sublimate, twenty
parts carbolic acid, and live hundred parts diachylon
ointment. — Centralbl. fiir Ckirurgie, August 11, iSSj.
More Trouble in the London Hospitals. — For
some time past there have been heard smothered com-
plaints of the autocratic government insisted on by the
matron of the King's College Hospital, and her aggres-
sive attituile is said to have caused much justifiable dis-
content among students and staff. At length, however,
the resignation of the matron was insisted on, and, after
prolonged refusal, received. All of the head nurses, who
sympathized with the matron in her opposition to the med-
ical statf of the hosiiital, deserted their posts and left the
building as soon as the fact of the matron's resignation
was announced. In commenting on this occurrence, the
Medical Press and Circular says : " That the lady would
cling to her position as long as possible is to be ex-
pected ; but what is really incomprehensible is that her
subordinates should so far forget the traditions of charity
and duty as to make the forced resignation of their
principal an excuse for their own withdrawal from
the wards without previously giving notice of the inten-
tion. All honor, be it added, to the nurses who, not-
withstanding the absence of pretensions claimed by
' lady ' nurses, remained with true womanly pity at their
posts beside the beds of suffering patients, the while
their cultivated ' superiors ' followed in the wake of the
indignant matron. Spite of the temporary inconvenience,
the authorities of King's may congratulate themselves on
a good riddance of women who could be guilty of so
grave a dereliction of duty."
A New Journal in Mexico. — h. new recruit in the
ranks of medical journalism lias appeared in Mexico under
the title of the Rcvista Midico-Qidrurgica. It is to be
published three times a month, and its first issue bears
date of August loth. In its English prospectus it claims
to be " the first publication ol its kind in the Republic
of Mexico which has such a broad spread circulation so
much in the country as abroad." It is to consist mainly
of selections from foreign journals, and its first issue
contains a number of good abstracts, chiefly from French
and German sources. The editors are Drs. V. Blay, T.
Noriega and J. Robles. We welcome our young con-
temporary and wish it a long and prosperous life.
Report of a Fatal Case of Intestinal Obstruc-
tion following Peritonitis. — Dr. Edgar A. Mearns,
sends us the history of a case of the above character.
"The patient, ayoung managed nineteen, had had general
]>eritonitis four years before. Since then he had suftered
from occasional attacks of abdominal pain and constipa-
tion. The last and fatal attack came on July 30th and
continued eight days. He was obstinately constipated.
Large doses of castor oil, combined with copious rectal
injections were given. There was no fever nor tympa-
nites and no great pain. Vomiting was jiresent, and on
the fifth day it became stercoraceous. On the sixth day
an injection of warm water and oil was passed high up
into the large intestine. It brought away hardened
faeces. The vomiting ceased temporarily and it seemed
that the obstruction had been overcome. Next day
vomiting returned, however, and the patient died from
exhaustion. An autopsy revealed the intestines matted
together by the old peritonitis. The site of the obstruc-
tion was a tangle of united loops of intestine in the small
gut, about the middle of the ileum. The vitality of this
portion of the intestine was destroyed before death ; and
the loops were so tightly bound together by strong fibrous
bands that the gut was perforated at each attempt to
separate the coils by the most careful dissection. The
gangrenous condition was produced by pressure in one
of the loops, which was greatly dilated and hypertro-
phied by partial closure of the gut at the point of union
of the loops of intestine. There was an accumulation
of faeces in one of them, the outlet of which was sten-
osed. During the jirogress of this case the question of
attempting to afford relief by the operation of laparot-
omy was discussed. The autopsy showed that laparot-
omy, if performed, should have been done early ; and,
even so, the intestines would probably have been irrepar-
ably damaged in forcing the faeces past the constriction,
so that the probability of success would have been
slight. As the sequel proved, the condition was relieved
without operation ; and had relief come a little sooner,
while the patient was vigorous, he might hare been
saved for another occasion. Dr. Henry B. Sands re-
cords in The Medical Record, vol. xxi., p. 429, April
22, 1882, the result of a laparotomy done upon a precisely
similar case, as follows : ' The patient was a man -about
thirty, who had suftered from acute obstruction for a week
before the operation. No exact diagnosis could be made.
When the abdomen was opened, the intestinal coils were
found extensively adherent to one another, in conse-
quence of former peritonitis ; and a careful search failed
to discovei- the nature or seat of the obstruction. The
abdominal wound was closed, and the patient died soon
afterward from exhaustion.' "
A Remarkable Case of Compound Comminuted
Fracture of the Frontal Bone, with Recovery. — •
Dr. L. Tibbets, of Rockford, III, sends us the following
history. A young man, aged twenty-nine, weight one hun-
dred and twenty-eight pounds, was working at an emery
wheel, fourteen inches in diameter, and revolving three
thousand times a minute, when it suddenly burst, and a
fragment struck him on the left half of the frontal bone.
He fell down and was unconscious and quiet for about
ten minutes ; then violent muscular movements appeared.
The frontal bone was depressed, the brain visible and
pulsating. Four persons held him while Dr. Tibbets
removed eight large fragments of the bone. Tiie patient
3o8
THE MEDICAL RECORD.
[September 15, 1883.
was then more quiet. Hemorrhage was profuse, the
brain membranes, longitudinal sinus, and a branch of the
middle meningeal artery being lacerated. The wound
was bandaged, and the patient carried home in a hack.
" On the way home," says Dr. Tibbets, " he vomited blood
several times, and after arriving, I gave him chloroform
to quiet him while removing other pieces. One piece
of the orbital plate, also a piece of the internal angular
process of the frontal bone and orbit weighed one drachm.
The number of pieces removed was nineteen, weight of
largest (two of same weight) was one drachm. One
piece was found on the opposite side of the shop, forty
feet from where he stood. The combined weight of all
the pieces found and removed was five drachms twenty-
five grains. Hemorrhage was controlled by twisting the
meningeal branch, and powdered persulpliate of iron ap-
plied to tlie brain surface where the vessels were torn,
and the wound left open until all oozing stopped, which
was three hours. At two places on the left lobe, anterior,
there were seen protrusions of brain matter about three-
eighths of an inch in diameter. The wound was crucial
shaped, extending from the root of the nose toward the
middle of the left frontal bone. The flaps of skin were
drawn together and a rubber drainage-tube inserted.
Fluid e.xtract of ergot 3 j-j and codeia, ^gr., were ordered
every three hours. Some hours later he became
conscious and would answer questions. Slept well
that night. Next morning he could speak, take nourish-
ment, and sit up. Temperature normal. Carboli.(ed
cloths were kept upon the wound. By the fifth day he
was able to sit up half the time in a chair. At no
time after the injury did he complain of any pain.
The highest i^oint of temperature reached was 102°,
and this only for one or two dajs. P"or three weeks
after injury he complained of seeing double. Though
after this, his sight became normal and mind clear. I
gave him examples of figures to add, columns five figures
in length and nine in number, to test his memory and
condition of mind. He added these readily and correctly.
He sat up most of the time. In two months he walked
over a mile. He had then been keeping books for the
company for three weeks. I tested his sight, and found
in each eye vision norn)al. He recently moved to
Oneida, N. Y. Before leaving was able to transact busi-
ness, as before injury. There was left a depression
in forehead, when the bone was taken out, but, on pres-
sure, it seemed quite hard. I have seen reported but
one case similar to this, in ' Krichsen's Surgery,' page
2S7, when there was a comminuted fracture of frontal
bone, where there were twelve pieces of bone ; patient
died on the ninth day. These recoveries are considered
very doubtful. I have not seen, or been able to find
a case reported, parallel with this, both for extent of
injury and perfect recovery."
The Nervk-Centre.s for Uterine Contr.actioxs.
— Dr. Dembo claims to have discovered the ganglia
concerned in the production of contractions of the ute-
rus. He says they are situated in the anterior wall of
the vagina, and are independent of the spinal cord. —
Centralbl. f. Gyndkol, August 11, 1SS3.
The Use of Atropine and Morphine hefork .\n-
;esthe.sia. — Dr. Aubert, of Lyons, lately forwarded a
paper to the Biological Society of Paris oa the .\dvanta-
ges of Combining Atropine with Morphia in Hypodermic
Injections, in the following circumstances : i. In all
cases where injections of morphia are indicated, the
analgesic action of the morphia being then considerably
increased by the addition of atropine. 2. As an adjuvant
to the anaesthesia produced by chloroform or ether. 'I'he
nauseating etilects of the substances are at the same time
suppressed, which by the eftorts of expectoration may, in
syphilitic subjects, be attended with great danger to the
surgeon or to his assistants. 3. The tolerance of the
morphia is so increased by its association with atropine
that it could be administered even a few minutes after a
meal without any fear of the supervention of vomiting.
In the discussion that followed M. Poncet observed that
all the means which tend to palliate the inconveniences
of chloroformization have the effect of prolonging to a
dangerous degree the anaesthetic sleep, which he considers
undesirable, as it is preferable for the subjects operated
on to recover their senses as soon as possible. Dr.
Brown-Sequard then remarked that the employment of
atropine has precisely for efiect the diminution of the
soporific action of morphia. — Louisville Medical JVe'ivs.
Confidence in the Profession. — The following
story, told in connection with a terrible outbreak of
cholera on board an emigrant steamer, illustrates a re-
markable degree of confidence in the profession. The
deaths on board were so numerous that, for the purpose
of indicating to the boatswain employed in removing the
dead for burial, a cross was chalked against the berths
where the corpses lay. By mistake, the fatal mark was
attached to a berth where the inmate was engaged in a
sound sleei>. On the boatswain seizing him by the legs
for removal, the intended victim called out loudly that he
was not dead, but asleep — a remonstrance which drew
from the old Scotch sailor the rejoinder, " Tut, tut,
mon ; the doctor knows better than you;" and who
forthwith proceeded to endeavor to execute his commission.
Tongue Depressors. — Dr. W. S. Gee, of Hyde Park,
111., writes : " The article on the above heading, in a re-
cent issue of your indispensable journal, calls to mind the
statement of an old ph\sician that ' many an instrument is
uselessly modified merely for the sake of having the in-
ventor's name attached.' This should be qualified in
most cases, no doubt, but it is evident it is fitting occa-
sionally. It has been my experience and observation
with these instruments that most of them are not practi-
cally safe. I have used many different kinds and have
decided on tiiis course : For office use I have a glass rod,
eight inches long and one-fourth of an inch thick with
smooth rounded ends. This is easily cleansed, giving the
least possible danger of transferring diseases. Is easily
used, does not gag the patient, and in every way is more
agreeable. When the necessity for the use of this instru-
ment arises away from the office it is easy and fitting to call
for a teaspoon, and I am sure an intelligent patient prefers
this to a depressor taken from the pocket, which naturally
enough excites his curiosity (silent, perhaps) to know
when and where it was used last. If an examination of
the throat with the laryngoscope is desired, Sass' is a
useful one. A little more practical simplicity in our in-
strument makers is desirable."
A Large Familv. — The Madrid Estafettc states that
a Spanish gentleman, Sefior Lucas Nequeiras Saez, who
emigrated from his native land to America seventy years
ago, recently returned to Spain in a steamer of his own,
and brought with him the whole of his family, which con-
sists of no fewer than 197 souls, sons-in-law and daugh-
ters-in-law not included. Sefior Saez has been three times
married. His first wife had 11 children at 7 births, his
second had 19 children at 13 births, ami his third had 7
children at 6 births. The youngest of this family of 37 is
aged nineteen; the eldest, who is seventy, has 17 chil-
dren, of whom the first-born is forty-seven. Of Seuor
Saez's 23 sons, all of whom are living, 13 are married, 6
are unmarried, and 4 are widowers ; and of his surviv-
ing daughters, 9 are married. The granddaughters num-
ber 34, and of these 22 are married, 9 are unmarried,
and 3 arc widows ; and of the 45 grandsons, 23 are mai-
ried, 1 7 are unmarried, and 4 are widowers. There are
also 45 great-granddaughters, and 39 great-grandsons, of
whom 3 are married. Sefior Saez has never tasted wine
or any alcoholic licpior, and lives chiefly upon a vege-
table diet, with but little salt. In spite of his ninety-
three years, he is still hale and hearty, and makes a
point of walking briskly for at least three hours every
dav.
The Medical Record
A Weekly yoiLrnal of Medicine and Snrgery
Vol. 24, No. 12
New York, September 22, 1883
Whole No. 672
©viijinal ;^vticlcs.
CONGESTIVE INDIGESTION.
By J. MILNKR FOTHERGILL, M.D.,
LONDON, ENGLAND.
ASSOCLVTE FELLOW OF THE COLLKGE OF PHYSICIANS OF rHILADELHILA.
There are two conditions where indigestion is due to
vascular congestion : one acute, the other chronic.
Acute congestive indigestion is often an alarming con-
dition ; so much so that death from exhaustion is imminent
in manv cases. When it is due to an irritant poison,
death often is the result ; but cases of irritant poisoning
will not be included in this sketch, though the treatment
here given applies after the specified measures for the par-
ticular poison have been adopted. The main indications
of acute congestive indigestion are vomiting (especially
when anything is taken into the stomach), and a red
irritable tongue. There is usually a good deal of ex-
citement present, though this may be masked by the ex-
haustion which is soon induced. In consequence of the
rejection of all food, including liquid matters, the fauces
are dry, and much thirst is experienced. The conse-
quence is the patient craves for fluids and swallows them
eagerly, with the result of their speedy rejection by the
irritable stomach. The condition is one which requires
a very steady hand on the reins, as well as considerable
professional knowledge, for its successful management.
\\\ the first place it is well to make sure that the case
is not one of reflex vomiting from some irritation in the
pelvis, as a pregnant womb, or an irritable ovary, es-
pecially if the patient be a young woman. Reflex
vomiting does not carry with it any rise of temperature,
and, what is certainly equally important, does not alter
the aspect of the tongue. When vomiting occurs with a
clean normal tongue, it is clearly not connected with
primary disturbance in the alimentary canal. This is a
very important matter, and forms a trustworthy broad
guide in practice to the line of investigation to be
taken in order to clear up the nature of the case ; and
here correct diagnosis gives the clue to the approjiriate
measures to be adopted. Still, practically, there ought to
be no difficulty in making the diagnosis betwixt reflex
vomiting and congestive indigestion. Taking the tongue
as the guide, the mucous lining of the stomach is vascular,
and that organ, bodily, irritable, and ready to resent the
intrusion of any fluid. The thirsty sufferer gulps down a
quantity of fluid, only for it to return almost as soon as
down. The stomach is tender to the touch ; and is con-
tracted— in all probability, for exact physical examination
is impracticable. The bowels are constipated because
they receive little or nothing from the stomach. Dlarrhiea
may be present as a troublesome complication.
In such a condition the great problem to be solved is
how to feed the patient ? It is quite clear that exhaus-
tion is not far distant ; and that the measures taken
shall be prompt and effective. No medicine is retained,
so it is impossible to soothe the stomach by opiates
given internally. Of old there were two courses open :
(i) to raise a blister quickly over the stomach and
dust the raw surface with morphia ; and (2) to throw up
a starch enema containing a dram of laudanum. Now,
fortunately, the hypodermic syringe supplies us with a
ready means of bringing the system, and with it the
stomach, under the influence of opium or its derivatives.
And in employing the syringe a cautious boldness is in-
dicated. A full dose should be given at once ; timidity
suggests small doses repeated at short intervals. My
own preferences are in favor of a dose which will probably
procure sleep. After a few hours of sleep the stomach
will be found much less irritable. At the same time an
enema of pancreatized milk gruel, or of baked flour
and jieptonized beef-tea, might be administered when
the patient is beginning to come under the influence of
the opiate. If this can be given without much disturb-
ance, and the enema is retained during the sleep, the
patient will awaken considerably refreshed.
If necessary both manoeuvres may be repeated. If
the thirst be great, then chips of ice may be given to the
patient to suck, and as the cool moisture passes over
the fevered fauces relief is given. The room should be
darkened, and the nurses should be as quiet as mice in
their movements and sjiaring of speech ; while whisper-
ing should be absolutely forbidden, for it is far more dis-
turbing than speech. Watchful, deft-handed attendants
are desirable, who can place a cloth moistened with
vinegar or salvolatile, as circumstances require, over the
aching brow without any unnecessary disturbance of the
patient.
Such should be the line of treatment in what may be
called critical states. As soon as the stomach is some-
what quieted down it is well to give a small opium pill.
This might consist of one grain of opium in powder
made up with half a grain of extract of opium. Such a
trifle will scarcely offend the stomach, and is retained.
If, however, the presence of even this trifle is resented,
and the pfll is thrown up, then make a lesser pill still,
say one-fourth of a grain of morphia, by preference the
muriate, with half a grain of the extract of opium. If
the stomach have been at all soothed by the hypodermic
injections, probably this will be retained. If not, ad-
minister an hypodermic injection, and when the patient
is coming under the. influence of it, try the little morphia
pill again. If it is retained, then the local sedative ac-
tion of the opium is secured, and this once achieved the
after-treatment of the case becomes simple. It is in the
treatment at this critical stage that the knowledge, the
patience, and the resources of the physician are most
taxed ; when the patient is in much suffering, and per-
haps thereby rendered unreasonable ; while the relatives
are almost beside themselves with apprehension on the
one hand, and eagerness to be of some service on the
other. Once the little mite of a pill is kept down, then
the corner is turned in all probability.
The line on which the physician must proceed is dis-
tinct enough and intelligible enough ; but it is easier
described than followed out in practice. The patient
craves for drink ; the friends are anxious to give it ; but
the contracted, irritable stomach resents the presence of
any bulk of anything fluid or other, and ejects it ; the
attempt having only further irritated the stomach, while
no good end has been served.
Once having placed the pill successfully in the stom-
ach, where it has remained, then the case moves on.
The ice may now have a food-value attached to it, by
freezing milk and giving a chip from time to time to be
sucked. Or some rose-water containing some sugar, or
other sweet and palatable fluid may be frozen and chips
be given to the patient from time to time. But this
must be done cautiously and no acid enter into the com-
position of the frozen'fluid on any account. Acids, even
;io
THE MEDICAL RECORD.
[September 22, 1883.
vegetable acids, though agreeable to the palate, are in-
jurious to the irritated mucous membrane.
How long a hypodermic injection and a nutritive
enema must be continued, at bedtime, mainly depends
upon the circumstances of each case. When small sips
of milk can be retained, and frequently taken, then the
necessity for these measures is materially reduced. But
the quantity taken at once must be kept very small ; if
vomiting be again set up, the steps nuist be cautiously
retraced. The tiny opiate may be continued at bedtime
for some time, even after a mixture is practicable. Bis-
niuth with an alkali and a little solution of morphia, or
some plain laudanum, or other galenical preparation,
may be given twice or three times a day, and soothes the
mucous membrane famously. Such is the line to be pur-
sued patiently and cautiously ; whether there be simple
gastric disorder, or the condition come on in the course
of some other malady, as typhoid fever. One great mat-
ter scarcely enough thought of is the amount of curdling
of the milk which may go on in the stomach. It too
firm a curd be formed it does not properly dissolve again,
but remains a source of irritation to the stomach. When
vomited the condition of matters is readily revealed. But
if the curd pass downward it may escape notice. Should
masses of hard curd be found in the motions, the milk
must be mixed with some farina and a fixed alkali, like
prepared chalk or calcined magnesia, be added, w^hich
will prevent the formation of too firm curd. When the
firm curd is formed, it involves not only the wasting of
the milk as a food, the patient being no better for it, but
the greater matter, viz., irritation of the bowels till diar-
rhcea may be set up, or even some nnico-enteritis. Fre-
quently, indeed, is it necessary to give a more potent
alkali than lime-water with milk when too firm curdling
is found, and then the chalk or light magnesia can be
stirred into the milk with a little biscuit powder if desira-
ble, just before the patient drinks it.
But whatever is given let it be in small (quantity at orxe,
else the irritable, contracted stomach will certainly reject
it.
An acute condition of congestive indigestion is found
along with alcoholic excess under two totally different
circumstances. Plrst, after a debauch where the alcohol
has been so concentrated that the mucous lining of the
stomach is congested, almost inflamed. There is thirst
and fever, and the sufferer drinks greedily, the fluid being
retained only a very brief time. Then it is well to give
the patient milk and soda-water, the carbonic acid gas
acting as a local sedative. The little mite of a pill (men-
tioned above) may be given also, twice or three times in
the twenty-four hours. As to how far the patient may
have some effervescing beverage containing alcohol is a
matter to be determined betwixt the patient and the
physician in each case.
Then, at other times tlie case is rather as follows :
The patient is acutely ill and is being plied freely with
brandy and water, or its alcoholic equivalent, under the
impression that exhaustion will thus be averted. But
the tongue gets redder and the stomach more irritable
and the bowels more tympanitic, until it is only too clear
that the alcohol is producing acute congestion. Then
the alcohol must be withdrawn, however strongly the
general condition may seem to require it, tor the gas
evolved in the stomach and bowels presses up the dia-
phragm and not only prevents its descent, but the pres-
sure embarrasses the heart. Indeed, the elastic pressure
of the gas im|)edes both the respiration and the circula-
tion, and conse(iuently the alcohol is doing more harm
than its stimulant effect counterbalances. Unless the al-
cohol be promptly stopped, under these circumstances
the patient will probably sink. If there be no other
remedy feasible the alcohol may be administered per
rectum. (Probably the subcutaneous injection of strych-
nine would maintain the action of the centres of the cir-
culation and the respiration as effectually as alcohol could
do.) This last aspect of the relations of alcohol, given
medicinally, to acute gastric congestion is often over-
looked ; yet the condition is not so very rare ! So much
then for acute congestive indigestion.
Chronic congestive indigestion is found with all mala-
dies which impede the blood-flow in the portal circulation.
Consequently it is found with failure of the right ventricle,
whether this be consequent upon a mitral lesion, leading
to pulmonary congestion, or there is present some con-
dition aftecting the lungs generally, as emphysema or
cirrhosis. Or it may be some hepatic condition which
gives rise to the portal congestion, as cirrhosis or can-
cer. The effect is to produce fulness of the gastric
venules, with a catarrhal condition of the stomach while
the gastric juice is diluted, and therefore diminished in
potency. The prominent sensation complained of by
the patient is " sense of fulness," even when the stomach
is empty. ^Vhy this sensation should be found with this
fulness of the gastric veins, it is not easy to say, but the
fact remains. The difficulty of digestion in all such cases
is very great, and the management of the condition no
easy matter. The impeded blood-flow affects the arteri-
ales and the gastric fluid is sparingly formed, and is of
enfeebled energy, being diluted from the venous fulness,
and eftusion resulting therefrom. Yet the nutrition of
the heart and the respiratory muscles must be maintained,
else it is clear the patient wall soon sink. The food
must consist of the blandest and most easily digested
material, containing no solid materials, which would only
be covered with a layer of mucus as it is rolled over and
over by the movements of the stomach.
Milk and seltzer water, beef-tea or chicken broth with
some biscuit powder, must form the dietary if the case is
very serious. If the dyspepsia be slighter, then some
milk gruel, milk puddings (made without an egg), or
even white boiled fish may be sufficient. As improve-
ment is made, the dietary may be made even more sub-
stantial, and nice thin sandwiches made wirii potted meat,
stewed fruit and cream may be permitted. As to alco-
holic fluids, if they agree and help the patient to eat and
digest, there is no valid reason why they may not be al-
lowed. Then as to direct medical treatment : at times
some astringent, as compound kino powder, may be
indicated by a catarrhal condition.
But the treatment par excellence is the relief of the
venous congestion ; and the stomach is needed for
a good deal of medicine, as well as food. There is
the filling of the arteries and the emptying of the
veins, the improvement of the arterial blood-pressure,
for which digitalis and its allies are available. The in-
crease in the blood-pressure produces a freer flow of
urine, and that is good — as well as a good indication of
the medicine is acting well. As in all cases of right-side
embarrassment the respiration is impeded, it is well to
add some respiratory stimulant, as strychnia for instance.
Such respiratory stinnilant usually adds much to the
efficiency of the stimulant to the circulation ; and digi-
tahs is rarely, if ever, indicated where the addition of
strychnia is not also suggested, and the combination gives
the best possible results. In some cases too, where digi-
talis does not suit tlie patient, the addition of strychnia will
at once produce good efiects. (This is a matter of such
importance in practice, in my experience, that I beg the
reader to give the subject his best attention. Some time
ago I was called to a case in the country, where digitalis,
potash, and scoparium with elaterium had been given, with
the result that the dropsy was rising, in a case of mitral
stenosis. It was quickly apparent that the respiration
rather than the heart was failing, and anunonia with
strychnia was substituted for the potash, with almost
magical effect ; and the new direction has been main-
tained. All that has been said about the venous conges-
tion, of right heart embarrassment, and its effects upon
the gastric venules, was well pronounced in the case.)
By such means, together with a smart cathartic once or
twice a week, wliicii drains so much water away by the
bowel, the condition of venous congestion is greatly re-
September 22, 1883.]
THE MEDICAL RECORD.
311
lieved. And a smart cathartic means a full dose of the
agent adopted, which may be a pill of one-sixth of a
grain of elaterium, or a powder of one-tenth of a grain
of elaterium with ten grains of compound scammony
powder. The good of such a full dose is to secure its
acting freely. This is what Dr. King Chambers says :
" In all forms of dropsy the eftect which you desire to
produce by remedies is strikingly dependent on the con-
dition of the alimentary canal. Where the portal system
is congested, I have given that strongest of purgatives,
elaterium, in doses gradually augmented up to three
grains, without any of the vigorous hydr.igogue action
naturally following, and then, by applying a few leeches
to the anus, so as to disgorge the abdominal veins, half a
grain has produced excessive purgation with reduction
of the dropsy." The reader may think the doses of
elaterium here spoken of as certainly heroic. But when
a patient is water logged in venous fulness, the effect of a
brisk cathartic is very different from what it is on a healthy
person. There may be some risk of exhaustion or syn-
cope at the time of the catharsis to be guarded against
by free recourse to stimulants, if necessary, but the im-
mediate after-effect is a sense of distinct relief.
Stimulants to the circulation, with respiratory stimu-
lants, improve the circulation, while free catharsis re-
lieves the venous fulness ; these are the great measures
to be adopted in chronic gastric congestion leading to
indigestion — i.e., measures addressed to the circulation.
Then the dietary must be adapted to the state of the di-
gestion, and some artificial pepsin may be very useful to
help the dilute, feeble natural pepsin in the work of di-
gestion.
Gastric catarrh is not, however, always the effect of
venous congestion, and then astringents are clearly indi-
cated. But when it is the outcome of obstruction to
the circulation the cardinal measure to be adopted is the
improvement of the circulation, upon which the gastric
catarrh is relieved.
CIRCULAR RESECTION OF THE INTESTINE,
AND Consequent Uniting by Sutijre, with the His-
tory OF Two Cases.
By EDWARD J. ILL, M.D.,
NEWARK, N. J.
Abdominal surgery has within the past ten or fifteen
years received the attention of the most eminent surgeons,
and nevertheless many points are still so unsettled that
every contribution, be it ever so slight, should be re-
ceived by the profession with interest.
Especially is this the case in operations upon the
stomach and intestines, and every experience ought to
be carefully recorded, so that deduction may be made and
guide us in further researches. These operations have
many enemies, and the results of those who operate will
be watched with the greatest interest, and probably closely
criticised.
It will be the province of this paper to speak especi-
ally of circular resections of the intestines for cases of
gangrene from strangulated hernia, not including wounds
of the intestines produced by accident, or where during
the progress of other abdominal operations it has become
necessary to remove a piece of intestine, nor the wonder-
ful achievements gained from resections of the pylorus.
Ramdohr removed a piece of intestine (small intes-
tine probably) two feet long, and united the ends by
suture, in a case of gangrene from hernia, as early as 1727,
and with good result. Tliis was followed ten times, up
to 1836, by French, English, and German surgeons, with
the following results : five were cured completely, two
had an artificial anus, and three died. From 1836 to
1875 '' seems nothing was done in this line, and it is due
to Langenbeck (1875), Kuester {1877), and Czerny
(1878), to have revived this important operation. Since
then the operation has been done thirty-four times, with
twenty deaths, making in all forty-four operations and
twenty-three deaths. This, after a collection of cases by
Mandelung and Rydygier, in November, 1881. Since then
I have found notes of one case by Rydygier {Berlin. Klin.
Wochenschrift, September, 1SS2), which was successful,
and another by Dr. Q. A. Aman, in December, 1881
{Schmidt's Jahrbiicher, 1881, p. 286), which was fatal.
A third case was reported by Dr. H. O. Marcey, of
Boston, Mass., who operated in 1881, and to whom I am
much indebted for the notes of his case. The case proved
fatal.
The cases reported by Dr. G. D. Beebe, of Chicago ;
R. S. Sutton, of Pittsburg, Pa., and Wm. A. Byrd, of
Quincy, 111., do not properly belong to the scope of this
paper, though the results, especially of the latter two, are
very gratifying.
To this I should add two cases of my own, of which
one recovered and the other was fatal. This makes a
grand total of forty-nine operations and twenty-three
deaths, or forty-nine per cent.
Case I. — Strangulated hernia, seven days' standing, re-
section of large intestine, fecal fistula, cured. Mrs. S.
M , born in Russia, twenty-four years of age, widow,
and mother of two children, aged seven and five respec-
tively. Shortly after the birth of her first child she no-
ticed a lump in the left groin, which she never entirely
lost.
On .\pril 2, 1883, she suddenly felt a pain in the left
inguinal region, for which she sought medical advice.
On the fifth day theieafter, late in the evening, she
was taken to the German Hospital of this city, where I
found her in my ward on the next morning. The patient
had a large swelling in the left groin, painful on pressure,
of bluish-red discoloration, fluctuating, no impulse during
cough, and no tympanitic resonance on percussion. She
has not had a movement from the bowel since April 2d,
and vomited mucus on the morning I saw her. She
seemed very much depressed mentally. The pulse was
120, and temperature 100°. Alvine injections brought
away very little fxxes. Hot poultices were applied, and
the house physician directed to get some of the history,
just detailed, from the patient's friends, as it was difficult
to understand her. The patient remained quite comfort-
able until the evening, when she showed signs of prostra-
tion, and a hypodermic syringe brought away some bad-
smelling reddish serum. I decided to o])erate the next
morning by opening the tumor and finding its contents.
April 9th — the patient was etherized, and after nicising
the skin the subcutaneous tissue was found infiltrated with
a yellowish-gray matter of slightly fecal odor. 'N'ery
soon I entered the hernial sac from which the fecal
odor was penetrant. A piece of grayish-looking gangre-
nous large intestine, which was perforated, was found.
It was a femoral hernia and the stricture so severe, that it
was difiicult to introduce even the tip of the finger. After
dilating and cutting the stricture somewhat it was found
impossible to draw the gut down. I decided to do
laparotomy, take the gut from its confined position, cut
the diseased portion off, and unite the ends by suture. I
had been fully prepared for thi*both by getting all things
ready for this formidable operation, as well as by making
myself familiar with its technicalities by operating suc-
cessfully upon lower animals.
The wound at the hernia, the sloughing intestine, and
the sac were thoroughly washed with a two and one-half
per cent, solution of carbolic acid.
An incision three inches in length was now made in
the median line, just as in ovariotomy. The small
intestines were highly inflated and very congested, but
there was no general peritonitis. The gut which en-
tered the canal was soon found, all the firm adhesions
separated with the finger, the gut withdrawn and brought
out at the wound in the median line. It was found that
the gangrenous part was the lower part of the descending
colon, and the mesentery just implicated. The perito-
neal covering of the intestine in the neighborhood of
:i2
THE MEDICAL RECORD.
[September 22, 1883.
the constriction was very much inflamed. A small
opening was made into the mesentery, and two clamps
were placed upon the healthy part of the gut to prevent
the contents from escaping. The gut was now cut
through quickly with a pair of scissors about one-half
inch from the dead portion at one place, some of the
constricted portion being left.
The hemorrhage was severe, and the clamps being rather
in the way, they were now removed and the ends of the
gut tirnily held by my friend, Dr. Kornemann. to whom I
am nnich indeb:ed for his careful assistance in this case.
Fourteen ligatures had to be ai)plied to bleeding vessels.
I had great care exercised so as not to produce any
laceration of the mesentery or separation of it from the
intestine, which would produce gangrene, as has been
shown by the researches of Professor iMandelung in a
paper read before the Tenth Congress of German Sur-
geons in April, 1881. I now commenced placing sutures
of finest silk (which had previously been boiled in a five
per cent, solution of carbolic acid) with fine, non-cutting,
slightly curved needles. The first stitch was inserted
into the intestine close to the meso-colon and just in-
cluding this. The second stitch was placed in the same
position on the other side of the gut. The next just
opposite the insertion of the meso-colon, and the rest
midway between the two extremes, until about thirty
sutures were applied and as close to each other as pos-
sible.
The mode of inserting the sutures was such as to catch
up the peritoneum and muscular coat, and not to include
the mucous membrane. At the place where the tissue
was inflamed the stitches tore through easily, and double
thicknesses of the silk were used.
The gut was returned into the abdominal cavity after
this, and the former had been thoroughly cleansed of all
blood, a drainage-tube placed into the retro-uterine cul-
de-sac, and the wound closed with eight deep silver wire
sutures. This was covered with silk protective and care-
fully prepared iodoformed cotton. The lower wound
was thickly covered with iodoform and cotton placed
over it. Temperature after the operation was 98°; pulse,
116; and respiration, 24. To prevent vomiting, one
teaspoonful of hot water was given every fifteen minutes
for twelve hours after the operation. In the evening,
pulse, temperature, and respiration remained the same,
but the tongue was dry and brown, skin moist, and
patient complained of colic-like pains. There was slight
tympanitis and occasional eructations of gas.
Hot barley-water was given during the night, and the
patient regained quite comfortable.
April loth. — At 6 a.m., eighteen hours after operation,
the patient passed the first flatus, which was followed by
an almost continual discharge all day. The eructations
ceased and tympanitis disajipeared, and there were very
few colicky pains.
About 9 A.M. the dressing was changed, and about
seventy-five grammes of grayish nuiddy-looking fluid re-
moved from the drainage-tube. There was no unpleas-
ant odor to this, still the tube was rinsed with a solution
containing carbolic acid f.5, soda chlor. 5.0, and water
500.0. and dressing reapplied.
The lower wound was rinsed with two and one-half per
cent. sol. of acid, carbol., and covered with iodoform and
cotton. During the day milk and beef-soup were given
in small and frequent doses. In the evening there was
neither a rise in temperature, pulse, nor respiration,
though the jjatient felt very weak, and larger doses of
nourishment were given.
April nth. — Dressing changed, and ten grammes of
light straw-colored fluid removed from the drainage-tube.
Gases still passed by the anus and gave no jjain. The
patient was nourished as during the night, and at 2 v.m.,
fifty hours after operation, the patient had an abundant,
soft, natural-looking movement from the bowels, with but
little pain. A second movement occurred two hours
later, which was very painful and streaked with a little
fresh blood. A third movement followed at 6 p.m.,
and small doses of morphine were given to quiet the
bowels.
April 1 2th. — The evening temperature rose to ioof° ;
pulse and respiration were the same as before.
April 13th, 9 A.M. — Patient has a desire to evacuate
the bowels, and cannot be kept from straining. Dress-
ing was changed, and still a small quantity of fluid re-
moved from the drainage-tube. Morning and evening
temperature loo^^".
April 14th. — Patient spent a restless night and had
much straining. On changing the dressing quite a quan-
tity of fluid feces had escaped on the left side of the tube.
This was five days after the operation. Patient's tongue
was very dry, as was also her skin. Temperature 100^^ ;
pulse, 116; and respiration, 26. At this time I was
utterly at a loss what to do about the drainage-tube ; to
remove it would probably allow faces to enter the ab-
dominal cavity and kill the patient, nor was there any
object in keeping it there any longer. The skin about
the drainage-tube was thoroughly rinsed with two and
one-half per cent. sol. of acid, carbol., and in the evening
the same thing was repeated ; but I was still meditating
about the drainage-tube, which seemed to me a " nolle
me tangere."
April isth. — The quantity of f;eces which escaped this
A.M. w-as still larger than yesterday. I had decided to
introduce through the glass drainage-tube a smaller and
shorter one of soft rubber. This was done without any
difficulty, but a large quantity of faces followed the tube.
Patient was very comfortable, and flatus were always
passed per viam naturalem.
Ai)ril i6th. — Dressing changed; drainage-tube re-
moved, as it was filled with faices, and wound well rinsed
with two and one-half per cent. sol. of acid, carbol.;
two silver sutures removed, and iodoform dusted over
the whole wound. Temperature was ioi^°, and pulse
varied between 120 and 130.
April 17th. — There was no reaction following the re-
moval of drainage-tube. Two small abscesses formed
along two silver sutures and these sutures were removed.
In the evening warm water was injected into the rectum
with an irrigator. After a pint had been injected the
water came Irom the fistula.
April iSth. — The last stitches were removed to-day.
Patient partakes freely of beef-soup, milk, finely chopped
beef, and toasted bread. During the night patient passed
several scybala per anum.
April 19th. — Patient's temperature rose to 103° with-
out any definite cause. The fistula carefully cleansed,
and again covered with iodoform. Patient again passed
fieces by the anus.
From April 20th to April 25th the condition remains
the same, except that the temperature came down to 100°.
May ist. — The quantity of faces from the fistula de-
creases as the quantity voluntarily passed by the anus
increases.
May 2d.— No discharge from the fistula, and a well-
formed passage by the anus.
Nothing more can be added to this already somewhat
lengthy history, but that no bad symptoms followed the
last date, and patient was dismissed cured entirely about
fifty-one days after the operation, and remains so to this
day.
Case II. — Strangulated inguinal hernia, operation,
cure ; strangulation recurs, eight inches of small intestine
gangrenous, resection, peritonitis, death. F. K ,
fifty-seven years of age, iron-worker, German, has suf-
fered for four years from a right inguinal hernia, and for
sixteen years from chronic gout, resulting in great de-
formity of hands and feet. I'.arly in the evening of July
7, 1883, the ruiJture came down, and could not be re-
duced by the patient. He did not seek advice until July
8th, when he was sent to the German Hospital by my
colleague. Dr. F. Schmasher, who requested me to
operate. The patient was relieved by ordinary herni-
September 22, 1S83.]
THE MEDICAL RECORD.
ii3
otomy, the sac not having been opened. The patient
niade a good recovery until July 20th, when, at 2 a.m.,
the rupture suddenly reappeared during exertion of turn-
ing in bed. Pains gradually increased. 1 saw him at
10 A.M. He was greatly prostrated, had a temperature
of 102°, and his abdomen was tender and tympanitic.
Taxis was applied without effect, and at 10 a.m. I
operated to relieve the stricture. This time 1 was
obliged to cut the sac, and, to my astonishment, I found
the gut black and without the usual lustre. I cut the
stricture and left the gut /;/ situ to recover ; if such was
not the case, to remove the gangrenous portion as soon
as I was prepared.
3 P.M. — The patient had been vomiting fecal matter in
large quantities since the cutting of the stricture. The
gut was re-e.vamined and found to be in the same condi-
tion as in the morning, and 1 resolved to resect the gan-
grenous portion and unite the ends by suture. The gut
was carefully drawn down through the inguinal canal, and
eight and a half inches of small intestine removed. From
the ap]:)earance of the healthy gut it was apparent that
general peritonitis had already set in. The mesentery
was ligated in toto, and the gut united as in the first
case, except that a double row of fine silk sutures (Czer-
ny) were used. From twenty-six to thirty interrupted
sutures were used, and only three vessels ligated.
During the operation the gut became greatly distended
and iKn|)le, partly from the slight constriction above and
partly from the force which had to be applied in bringing
the gut out to be conveniently handled. A rubber drain-
age-tube was inserted to the abdominal cavity and the
wound treated with iodoform. Patient w'as given mor-
phia soon after he came to from the anaestliesia. Tem-
perature, 102°; pulse, 126. He was greatly relieved
from pain, vomiting of fecal matter recurred but once,
eructations were frequent. He was treated the same as
the foregoing case, excepting that morphine was given him
for his peritonitis. During the following night patient
suffered much from tympanitis and colic-like pain in the
neighborhood of the womid.
July 2ist. — At 7 A.M. temperature was 103" and
pulse 132. Patient continued same as in the night.
There was no great discharge from the drainage-tube,
and brandy was ordered in large doses ; ice-bags placed
upon the abdomen. At 1 1 p.m. temperature was 105^ ; the
first flatus passed, tympanitis grew less, and eructations
ceased. Wherever hypodernnc injections of morphia
were given ecchyniotic spots appeared.
May 22d. — -At 7 a.m. the patient suddenly got a severe
watery diarrhoea, which was ejected with such force that
the fluid passage reached the foot of the bed. Tem-
perature was losf, pulse hardly perceptible ; hands grew
cold, coma set in, and death ensued at 10.30 a.m., forty-
two hours after operation.
A post-mortem examination was made at 12 m. The
gut was firmly united by fibrinous adhesions, and was
situated in the neighborhood of the right inguinal ring.
General ]5eritonitis was present, which caused the death
of tlie patient.
ft seems to me proper to analyze these two cases, to
compare with others of a similar nature and to draw
deduction, which may throw light upon future cases ; for
I believe the operation not only justifiable, but its range
of application wide, and every surgeon may be called
upon to do it and without great preparations. To illus-
trate this 1 should say that in the brief time of seven
years I have been called ujion to operate for strangu-
lated hernia twelve times, and three times the gut was
gangrenous. Of course, there cannot be any great
preparatory treatment, which is always of so great im-
portance in capital operations, except, I should say,
that all antiseptic precautions, especially about the liga-
tures and sutures, should carefully be observed. As to
where the operation shall be done ; whether the gut
be dragged down through the hernial opening and there
cut off, or shall lai)arotomy be performed?
In Case I. I was unable to drag the gut down ; the
tissue was so infiltrated with fecal matter that I was
afraid of infection and troublesome hemorrhage should
I make large incisions into Poupart's or Gimbernat's lig-
ament.
In Case II. this could be done to some extent, but the
inconvenience occasioned by operating in a small space
and the congestion of the gut produced by the constric-
tion at the opening made the operation a great deal more
difficult. Section at the median line is quickly and
easily done, the gut handled readily, the peritoneal cav-
ity cleansed with perfect safety, and drainage well estab-
lished if thought prudent. I shall hereafter always pre-
fer laparotomy. Concerning the resection of the gut
itself Before the gut is cut some preventive will have
to be taken to keep its contents within. Some- — liillroth,
Gussenhauer, and others — recommend digital compres-
sion, to which I can only agree ; while others advise the
use of forceps (Kocher) or clamps (Rydygier), and still
others ligate with catgut or silk. I think digital com-
pression best, because the same assistant can keep the
intestines in general from prolapsing, and will also be
able to adjust the two ends of the intestine.
In describing the operation in Case I., I have said
that I left part of the constricted gut. I shall be care-
ful hereafter to cut away all the diseased portions, as the
sutures cannot be relied upon in cedematous and swol-
len tissue. The greatest care must be exercised not to
strip the gut of its mesentery, as gangrene of that part of
the intestine will surely follow, as was shown by Mande-
lung and Rydygier in their experiments upon animals.
If the mesentery is gangrenous it must be removed by
triangular excision, the vessels ligated, and the edges
brought together by suture ; if not, it may be ligated en
mnssf and separated from the intestine by cutting close
to the part to be removed ; or else the vessels may be
ligated separately. I have preferred to ligate in toto
before cutting oft' the intestine in Case II., and found this
to work admirably. The intestine must be cut across
at right angles to its axis unless one severed end is
smaller than the other and would therefore not adapt
itself. In tliis case it must be cut across at an acute
angle to the axis and the insertion of the mesentery, thus
affording a greater circumference.
Sutures. — Concerning the material the operators dif-
fer in opinion. Czerny, Billroth, and Mandelung prefer
carbolized silk, while Shede, Dittel, Riedinger, and
Rydygier prefer carbolized catgut. From statistics pub-
lished by Mandelung and Rydygier, there does not seem
to have been any difference as to the result, which was
used. There is no doubt that silk is easier handled than
catgut, and does not produce any more irritation, |)ro-
vided it be thoroughly antiseptic. It becomes absorbed
readily, although not so quickly as catgut, and would
from this cause be more reliable.
Ho7v io apply the suture. — Upon this rests the success
or failure of the operation to the greatest extent ; it mat-
ters little, it seems to me, whaf material is used, as I have
said before.
After section of the gut. the mucous membrane, if it
protrude too much, may be cut off so as to be on the
same height with the serous covering. I have not
found this necessary in my two cases. To begin with, I
have applied two sutures to tiie intestine, one on each
side of the mesentery and close to the mesentery, then on
the side of the intestine directly opposite to the mesen-
tery, then stitches midway between these two extremes,
and so forth until all sutures are applied. This method
will most likely bring the parts best into apposition.
The sutures must be applied so that it will bring serous
surfaces together. This can be done by enclosing in
the suture the peritoneal covering and muscular coat
only.
Czerny very ingeniously has practised the method of
applying a second row of sutures over the first (Etagen-
naht), so as to imbed the first one between two peritoneal
;i4
THE MEDICAL RECORD.
[September 22, 1883.
surfaces, thus preventing completely the escape of intes-
tinal contents into the cavity of the peritoneum.
Mandelung has used, with success, small plates of asep-
tic cartilage after the fashion of buckshot suture.
Jome Joppe, Xussbaum,' and Rydygier," first apply
a continual suture, and over this an interrupted one.
Dr. H, O. Marcy, of Boston, has also applied a continu-
ous suture. This certainly can be done quicker than the
interrupted suture, but should one stitch tear, the whole
work will have been useless.
I will not lengthen this paper by describing the difier-
ent forms of invagination and following suture as was
practised by Jobert and Mandelung, since it was not
followed by good results.
The question naturally arises, how many patients die
from a gangrenous gut due to strangulated hernia. I
have taken pains to ask a number of prominent physicians
in this neighborhood, to whom I am much nidebted for
then- ready answers, what their experience was m this
line. They have kindly furnished me with records of
twenty-nine cases, of which twenty-five died, or eighty-
six per cent. ; this being an increase in deaths of thirty-
seven per cent, over the operated cases, which certainly
would show how justifiable the operation is, even in its
infancy.
Out of the four cases which have recovered with an
artificial anus, one recovered even from this spontan-
eously.
DOUBLE SALPIXGO-OVARIOTOMY— RECOV-
ERY.
Reported BY W. R. PRYOK, M.D.,
ASSISTANT G\'>;EC0L0GIST to ST. ELIZABETH'S HOSPITAL, NEW YORK.
History. — The patient is thirty-two years of age and
married. She began to menstruate when sixteen years
of age, and did so regularly up to the time of her marri-
age, ten years ago. Before and during her marital life
she has suffered a good deal at each menstrual epoch.
She has had two children, and two miscarriages ; her last
pregnancy resulting in a miscarriage about three years
ago. Her present trouble dates from that time. For
six weeks after this abortion she bled almost continuously,
and at the same time suffered very acute pain in her
pelvic organs. The symptoms were thought to be due
to a laceration of the cervi.x uteri, which existed, and
for which an operation was successfully performed by
Dr. Watts. The bleeding ceased, but she remained in
bed for over two months longer, with all the symptoms
of severe pelvic inflammation. She improved a little,
sufficiently to get up and walk about the room, but soon
she had a relapse and was again confined to bed for many
weeks. For the past three years this woman has con-
tinued in this way, alternately confined to bed with the
most intense pelvic pain, which was relieved only by large
doses of opiates ; or up, scarcely able to walk, and every
effort greatly increasing her suffering, she at last arrived
at that point where life was made bearable by opium
only ; and she readily and eagerly accepted the proposi-
tion of an operation.
Examination. — The patient is thin, but in better health
than we would expect to find her after hearing her his-
tory. The uterus was perfectly movable antero-posteri-
orly, but its mobility was very much restricted laterally,
especially on the left side, in which direction it was
slightly drawn. The left l'"allopian tube could be dis-
tinctly felt as an enlarged and thickened cord, and most
exquisitely sensitive to i)ressure. The ovary also of that
side was very tender. There was not so much sensitive-
ness developed on pressure in the right ovarian region,
but one could distinctly feel the ovary greatly cnlari'ed.
On examining her with Sims' speculum, we found a good
deal of free pus in the \ i^ina. TJiis was wiped away,
* Billroth and Liicke, Dcut.sche Chirurgic Liefer. 44, p. 136.
J* Hcrlincr Klin. Wochenschrift, p. 620. No. 42, 188 1.
and she was again examined in the dorsal position.
Placing her in Sims' position again, we found that more
pus had entered the vagina, but no fistulous opening
could be seen. On making gentle pressure in the region
of the left tube, pus was seen to ooze from the os ex-
ternum in considerable quantities. As the pus was quite
fluid and not mixed with tenacious mucus, and as there
were no signs of metritis or endometritis, we naturally
came to the conclusion that the Fallopian tubes were
the seat of a purulent inflammation.
The operation was performed by Dr. W. Gill Wylie
at 3.30 P.M. A Sims uterine repositor was placed into
the uterus, and gentle upward pressure was made with it,
thus greatly facilitating reaching the uterus and its ap-
pendages from above. Tlie primary incision was short,
not more than three inches, being more exploratorj' than
otherwise ; it was subsequently enlarged. After the skin
all the tissues were divided upon a broad director, and
the abdominal cavity entered to the left of the linea alba-
We found the left ovary prolapsed and somewhat adherent
low down to the wall of the true pelvis, with the tube
firmly adherent to the ovary. The right ovary also was
adherent, but the tube of that side was free. The liga-
tures used were of silk, and two were applied on each
side of the structures to be removed. This was rendered
necessary by the extent and vascularity of the adhesions.
In passing the ligatures we used a full-curved round
needle, about two and one-half inches long. After
tying off, and removing the left ovary and tube, the
stumps were held up for a few moments to make sure
that no bleeding was going on, touched with Paque-
lin's tliermo-cautery, the ligature cut short ; and the
stumps returned. The same method of procedure was
employed with the right appendices uteri. Having re-
moved all free blood and clots from the pelvic cavity,
and again examining the stumps for bleeding, the ab-
dominal wound was closed with silk sutures.
The following extremely useful precaution was taken
in this case : As soon as the abdomen was opened sev-
eral temporary silk sutures were passed through each lip
of the wound, and including all the tissues from skin to
peritoneum, thus preventing the stripping back of the
peritoneum from the muscles when the hands are passed
into the abdominal cavity. Should this accident occur
it is usually impossible to prevent the sutures tearing
through the peritoneum when we endeavor to close the
abdominal wound. After the operation a carbolized
dressing was applied. Operation completed in an hour.
First Day. — Patient slept till 7 p.m., then awoke with
some abdominal pain. Pulse, 90. 9.30 p.m.: Has been
asleep since 7.45. Vomits very little. Pulse, 92. 11.30
P.M.: Has slept most of the time since 9.30. Slight pain.
Hiccoughs occasionally, and has a little eructation of
watery material. Temperature, 99° ; pulse, 94 ; respira-
tion, 16-18. Sleepy. 11.45 p.m.: Increase of pain, oc-
curring spasmodically.
Second Day.— 4 A.M.: Slept steadily up to 1.30 this
morning. Since then she has awakened occasionally.
Temperature, 99^°; pulse, 100; respiration, 20. Com-
plains of thirst and slight chilliness. General condition
excellent. Is quiet and mind calm, being disposed to
drowsiness. 10.30 a.m.: Temperature, 100° ; pulse, 92.
12 .M.: Temperature, 99^°; pulse, loS ; respiration, 10.
3 P.M.: Temperature, ioo|^ ; pulse, 100. For the first
time allowed her to have nourishment — koumiss in 3 j-
doses. 8 p.m.: Temperature, ioif° ; pulse, 118. Kou-
miss in 3 ij. doses. 10 p.m.: Temperature, ioi|°.
11.30 p.m.: Temperature, 101°; pulse, 118. Since the
operation fourteen ounces of urine have been drawn ;
she has taken ten ounces of koumiss, and has received
gr. ijss. morphia, hypodermically. In the past twenty-
four hours she has not vomited once, and has had but
little pain.
Third Day. — 10 a.m.: Temperature, 100°; pulse, 96.
3.30 P.M.: Temperature, 99.^°; pulse, loS. 5 p.m.:
Temperature, 99^° ; i)ulse, 92. Midnight : To-day she
September 22, 1883.]
THE MEDICAL RECORD.
315
has taken nearly four pints of koumiss without in the
least forcing herself; has received gr. jss. morphia, hvpo-
dermically ; and fifteen ounces of urine have been drawn.
Only once has she had pain. No vomiting.
Fourth Day. — 10.45 a.m.: Temperature, 98^'"; pulse,
84. Commenced giving her the ex|)ressed juice of beef-
steak cooked rare. 6.45 p.m.: Added pancreati/,ed milk
to her ;«c7/«. 8.30 p.m.: Temperature, 99°; pulse, 88.
Midnight : Dressed the wound to-day, under the sijray.
The first dressing was found but slightly stained by blood,
and was perfectly aseptic. Firm union existed along
nearly the whole line of incision. To-day she has re-
ceived less than gr. j. morphi;i3. Drew sixteen ounces
of urine. Abundance of koumiss, beef juice, and pan-
creatized milk taken.
Fifth Day. — ioa.ai. : Temperature, 98*°; pulse. So.
10 P.M. : Temperature, 99^°; pulse, xo8. After this the
temperature never reached 99°.
Eighth Day. — Sutures removed. Line of union un-
broken except at one point in the centre where there
was some ectropion of the skin. To this raw surface ap-
plied iodoform dressing.
Tenth Day. — Simple enema given, followed by a large
and painless stool, the first movement since the opera-
tion.
Si.xteenth Day. — Out of bed. Morphia has been grad-
ually decreased, and was entirely stopped to-day without
any bad results except a slight exhibition of temper on
the part of the patient.
Thirtieth Day. — On making an examination to-day,
we find the following condition of things : The uterus is
freely movable in every direction. Douglas's cul-de-sac
is occupied by a knuckle of intestine which can easily
be pushed up. On each side, running from the uterine
stump of the tubes, and apparently terminating at the
posterior vaginal wall opposite the os externum, is a firm
fibrous band which is slightly sensitive to pressure.
These, I think, are the result of a slight inflammation,
which took place on the second day, when her tempera-
ture first reached ioif°. Beyond this, and the absence
of the organs removed, no indication of an operation
exists.
Thirty-first Day. — Patient is menstruating. The flow
is slight, and she has less pain than at any of her pre-
vious menstrual epochs. She has certain nervous symp-
toms, such as are often seen in women at the meno-
pause.
Remarks. — The diet of this patient for the first few
days is mentioned, because I think that it is one of the
most important factors influencing cases of laparotomy.
P"or the first twenty-four hours the woman received noth-
ing into her stomach, except, occasionally, a teaspoon-
ful of iced water. Had she been given, as is often
done, milk and beef-tea ad libitum, her stomach, irritable
as it was after the etherization, would most certainly
have been markedly disturbed, and the efforts at vomit-
ing would have defeated us in what we strive to obtain
in these cases, viz., perfect rest of the abdominal organs.
What little vomiting she did was more regurgitation than
vomiting, as it was done without effort or nausea. When
we did begin to give her nourishment, it was in gradually
increasing quantities of the easily assimilated koumiss
and peptonized milk. The quantity of morphia adnnnis-
tered may seem excessive ; but the eft'ect produced ii|ion
this hahituiic was not more profound than would follow
the taking of gr. j. opii t. i. d. by a person unaccustomed
to its use.
, 107 East THiRTV-FiFrH Street, New York.
To Disguise the Taste of Medicines. — Bitter and
nauseous salines are best taken simply diluted with iced
water. A mouthful or two of iced water, before or after
the dose, to blunt the sense of taste, and the dose be-
tween them in a wineglassful of iced water, renders it
easily taken by most persons. — Squibb' s Ephcmcris.
gr00rcBS of ITKtccticnt Jictencie.
Prolonged Suspension of Vitality following the
Hypodermic Injection of Morphia and Atropia. —
Dr. Alexander reports the case of a woman, thirty-seven
years of age, upon whom an operation had been per-
formed for the removal of the left ovary. At noon, four
days after the operation, she became very excited, and
disturbed the dressings of the wound, so twelve minims
of the hospital solution of morphia and atropine were in-
jected. This represented three-fifths of a grain of mor-
phia and one-fortieth of a grain of atropine. At one
o'clock she became livid, and a nurse injected another
five minims of the solution before the house-surgeon ar-
rived. When he came he injected ammonia, gave brandy
enemata, used artificial respiration, and applied electricity
without effect. At 4 p.m., the nurse was laying the
woman out, but Dr. Alexander came in and determined
to proceed with artificial respiration, galvanism, and
frictions. Up to 5.30 p.m., only a spasmodic breath
every quarter of an hour, and a feeble beat of the pulse
every now and then, could be detected. At 7 p.m., a
nurse poured some coffee into the patient's mouth, and
she suddenly fell back as if dead, but by turning her over
on her side she was made to vomit. By nine o'clock the
respirations were beginning to be more frequent and the
pulse stronger ; she soon became conscious after this,
and recovered perfectly. — Boston Medical and Surgical
Journal.
Poisoning by Carbolic .\cid. — Mr. E. R. Williams
relates the following case in The Lancet of August 18,
1883. A young girl, seventeen years of age, was ad-
mitted to hospital, having, it was stated, two or three
hours previously taken poison, the nature of which, how-
ever, it was impossible to learn. She was completely
anassthetic, her muscles relaxed, eyelids closed, pupils
dilated and inactive, skin cold and clammy, with large
drops of perspiration running down the cheeks, tempera-
ture lowered, respiration feeble and shallow, the pulse at
the wrist imperceptible, and the action of the heart feeble
and intermittent. From this extreme state of collapse,
by means of subcutaneous injections of ether, galvanism,
etc., she gradually recovered. Careful examination re-
vealing nothing as to the nature of the poison, it was
deemed advisable to give her one-eighth of a grain of
apomorphia subcutaneously. In fifteen minutes she ex-
pelled, with a gush, about five ounces of a dark-colored
liquid, smelling strongly of carbolic acid. Having now
ascertained what the poison was, the stomach-pump was
used, and some olive oil injected. This she soon vom-
ited, together with a little more of the same dark colored
fluid. The urine passed was of a dark brown color and
gave the usual tests for carbolic acid. The fa5ces were
also of a dark color. With the exception of some sore-
ness of the mouth and throat, together with a little pain
in the epigastrium, she recovered without a bad symp-
tom, and on the fifth day after admission was discharged.
It was subsequently ascertained that she had taken about
one ounce and a half of the common crude carbolic acid.
The Traction Suture.— Dr. Oscar H. Allis recom-
mends the following device {Annals of Anatomy and Sur-
gery, September, 1883) to obviate the tendency of
sutures to cut their way out when there is considerable
tension of the skin at the edges of a wound : After dry-
ing the skin thoroughly, he applies strips of adhesive
plaster passing from the margin of the wound in the di-
rection in which the sutures are to hold. Tlie needle is
then passed deeply through both plaster and skin, and
before the sutures are tightened, an assistant approxi-
mates the margins of the wound by pressure from his
hands. Sutures employed in this manner, the writer
claims, have a firm hold upon the plaster, e.xert their trac-
tion upon a large surface, are less irritating and harmfiil,
;i6
THE MEDICAL RECORD.
[September 22, 1883.
and will continue an efficient action much longer than
the ordinary integument sutures.
Lymphatic Discharge from the Nose in Leuco-
CYTH.EMIA. — Dr. Cornil relates the case of a patient suf-
fermg from leucocyth.tmia who had a discharge from the
nose of a thick, transparent, glairy fluid. It flowed slowly
but constantly, and was neither thin like the discharge of
a commencing coryza nor opaque like that of a more ad-
vanced nasal catarrh, but contained a large quantity of
white corpuscles. The patient did not sneeze nor were
there any tickling sensations in the nose. At the autopsy
the mucous membrane of the nasal fossx was seen to be
smooth, without ulceration, but thickened in places.
The thickened parts presented a gray color on section.
They were formed by an infiltration of the connective tissue
with a mucous, transparent fluid, like lymph. It was this
leucasmic infiltration of the Schneiderian mucous mem-
brane which was the cause of the nasal lymphorrhcea. —
Revue Medica/e, August 11, 1883.
Tre.atment of Corneal Opacities. — Dr. ivrichel
recommends sulphate of cadmium, of the strength of two
and one-half grains to the ounce of mucilage, as an ap-
plication to opacities of the cornea. A camel' s-hair brush,
dipped in this wash, is ajiplied to the centre of the spot
and retained in contact with it for a few seconds. At
first the application is made once a da}-, but after a while
is repeated two or three times in the twenty-four hours.
When the ])ain grows less, the strength of the solution
may be increased to five grains or even seven grams
to the ounce. When the opacitv is of recent formation
it rajiidly disappears under this treatment, but wlien it is
of old date the applications must be long continued. —
Revue Medicale, August ii, 1883.
The .Morbid .•\njvto.mv of Iodoform Poisoning. —
Dr. A. Hoepft' found, post-mortem, in four cases of death
from iodoform poisoning a condition of fatty degeneration
of the heart, liver, and kidneys. The process was only
beginning in some, but far advanced in others. The
author tlien instituted a series of e-vpeiiments upon rats,
guinea pigs, and labbits, administering to them subcuta-
neous injections of iodoform in oily solution. In every
case he found parenchymatous inflammation of the heart,
liver, and kidneys. These e.\periments, however, do not
serve to e.\plain the peculiar cerebral symptoms observed
in man after poisoning by this substance. — Allgem. Med.
Central-Zeiiuiig, August 8, 1883.
Extra- Uterine Pregnancy, with Retention of
THE FuiTUS for Seven Years. — A woman, thirty years
of age, during the second month of pregnancy, was sud-
denly seized with violent pains in the lower part of the
abdomen, followed by syncope, cold extremities, and
vomiting. These symptoms indicated the commence-
ment of a peritonitis, which lasted for three weeks. The
pregnancy then proceeded without any further accident.
About two weeks before the expected time the pains of
labor began, and recurred with regularity and increasing
frequency. Even the os began to dilate. Suddenly,
after three days, all the pains ceased, the os closed again,
and the patient resumed iier ordinary avocations. ' She
experienced a little inconvenience at first from an abun-
dant secretion of milk. Six weeks later menstruation
was re-established, and for seven years the courses ap-
peared with perfect regularity, and the woman enjoyed
excellent health. At the end of this time another attack
of peritonitis confined the patient to lier bed for several
weeks, during wiiich illness she passed a quantity of hair
mixed witii the f;\;ces. Five months later she began to
pass little bones with her stools, and in the course of
three months very nearly a complete fojtal skeleton was
thus collected. The bones were perfectly clean of the
soft ])arts. They were in a more advanced stage of
ossification than is normal in a child at term. <At the
time that this case was rep.orted to the .Anatomical So-
ciety of Paris by Dr. De Hrun the woman was in excel-
lent health and still jjassing one or two perfectly formed
bones with eacii stool. — Lc Progrcs Medical, June 30,
i88j:
The Radical Oper.^tion for Hernia. — Fromacare-
ful study of upward of four hundred cases. Dr. Leisrink
arrives at the following conclusions: i. The radical
operation should never be attempted for the cure of re-
ducible hernia. 2. In the case of very large and painful,
or of otherwise incapacitating hernias, the operation is
justifiable. 3. Old and feeble persons and very young
children should not be exposed to the risks of this opera-
tion. 4. The radical operation is indicated after the re-
duction of strangulated hernia, unless for any reason it be
desired to keep the canal open. 5. A radical cure is verj'
seldom obtained ; yet (6) the condition of the patient is
usually greatly bettered by the operation. 7. In every
case a truss shojild be worn after the operation. 8. The
radical oi)eratio'n Hiould always be performed under the
most strict antiseptic precautions. — Deutsche. Medicin.
Zeitung, July 26, 1883.
Apoplectiform .Attacks in the Course of Loco-
motor Ataxia. — A man, forty-seven years of age, pre-
senting the svmptoms of locomotor ataxia (lightning pains,
diplopia, ataxic walk, vesical and rectal disturbances, etc.)
suddenlv lost the use of his right arm and also the power
of speech for the space of ten minutes. Four weeks
later similar attacks, involving the entire right side, re-
curred twenty-two times in twenty-four hours. Each
time the power of speech was lost, though the patient
was perfectly conscious and could think correctly. Only
once was ataxic aphasia (using the wrong words to ex-
press well-known objects) observed. A second patient
was suftering only from the initial symptoms of tabes
dorsalis. This man suddenly lost the power of speech
without any [laralysis or disturbance of the intellectual
functions. In tile evening of the same day a second at-
tack occurred, in wiiich consciousness was lost for a pe-
riod of three-quarters of an hour. Professor Bernhardt
states that these attacks were not to be referred to a
commencing progressive ])aralvsis with ataxic symptoms,
nor were they due to syjjhilis, heart disease, alcoholism,
or any other like condition. — Deutsche Medicin. Zeitung,
July 26, 1S83.
Phosphate of Codeia. — Dr. Fronmiiller employs the
phosphate of codeia for liyijodermic injection. He says
that it possesses the advantage over the muriate and sul-
phate of being much more soluble {Memorabilien, July
16, 1883). The substance crystallizes in slender four-
sided columns, is white in color, and of a bitterish taste,
and is soluble in four parts of water. Its action is very
like that of morphia, but it is milder, and the symptoms
of poisoning (such as great weakness, intense headache,
bilious vomiting, etc.), are much less often encountered.
It seldom causes local irritation when subcutaneously in-
jected. The dose shoukl be at least double that of
morphine. The phosphate of codeia is especially reconi-
nVnded in the case of women and children.
The Prevention of Sea-Sick.ness. — In a communi-
cation addressed to \he British Medical Journal of August
1 1, 1883, Dr. J. Henry Bennet claims to have discovered a
preventive remedy for sea-sickness in tlie ingestion of
strong coffee. He says that some j'ears ago, while trav-
elling from Paris to London, having some time to spare
before the sailing of the steamer, he entered a restaurant
and drank two cups of cafe noir. To his astonishment
he was not ill at all during an unusually rough passage
of the Channel, and he was induced to refer his immunity
to the action of the cofiee. Subsequent exjierience con-
firmed this belief. In order to obtain the desired effect,
the coftee should be taken long enough before starting to
allow of its absorption. Dr. Bennet has always found
this simple remedy of great value in short voyages, but
he is unable to say whether its influence would continue
for a greater length of time than a few hours.
September 22, 1883. J
THE MEDICAL RECORD.
0^7
The Medical Record
A Weekly yoHrnal of Alcdlcine ajid Surgery.
GEORGE F. SHRADY, A.M., M.D., Editor.
Published by
WM. WOOD & Co., Nos. 56 and 58 Lafayette Place.
»
New York, September 22, 1883.
IRREVERENCE AND QUACK ADVERTISE-
MENTS IN RELIGIOUS JOURNALS.
Our religious contemporaries, with a few conscientious
and commendable exceptions, still persist in their old
policy regarding medical advertisements. Indeed, they
are adroitly e.xpanding this peculiar line of industry, so
as to include the balder and grosser swindling schemes,
which ]3romise the guileless reader a phenomenal return
on an infinitesimal investment. They should certainly
be congratulated on the enterprise which enables them
to present in a single copy such multifarious opportuni-
ties for the subscriber to refresh his mind, body, and
estate. How the editors of these journals have rendered
their consciences as elastic as their advertising columns
must remain a matter of conjecture.
They can no longer plead ignorance as an excuse, for
the expressed opinion of the medical press and the medi-
cal profession has been so decided and unanimous, that
these gentlemen must know that, as far as the medical
nostrums they advertise are concerned, many of them
are for disgustingly inuiioral purposes, and all of them
are swindles of the most despicable and pernicious kind.
If these gentlemen claim that the papers would not pay
without this class of advertisements, they are simply
serving " Mammon " for the glory of God. It would be
interesting to know to which of the two masters they are
more devoted. Most educated people are willing to ac-
cord them the benefit of the doubt ; but there may very
likely be some unsophisticated individuals of a more or
less heathen persuasion who would be quite at a loss to
. decide whether the salvation, whose joyful sound these
journals proclaim, is to be considered from a religious
or medical point of view. Well may these benighted
"innocents" inquire of our editorial Fergusons, "Which
is the bust, and which is the pedestal ? " What a comfort-
ably adjustable conscience that must be which will not
allow a church fair to swell its assets by raffles and
dancing, yet permits a journal to increase its income by
a more palpable species of immorality. This peculiar
kind of piety cannot help but remind us of the familiar
anecdote of the grocer deacon and his clerks, which we
might appropriately paraphrase to suit the times, and
imagine our clerical confreres making their rounds
through the composing-room somewhat as follows :
" Well, Thomas, have you finished ' Yours for
Health ? ' " Yes, sir."
" And you, Richard, have you set up the Great In-
dian Secret for the Afflicted }[' " Yes, sir."
" Henry, have you completed that Blood Purifier ? "
"Yes, sir."
" Theti let us have prayers."
A short time ago there appeared in one of these
medico-religious sheets a report of a prayer-meeting at
which the editor was present. In the course of the meet-
ing a young man stated that he had lost his situation be-
cause he would not mark goods above their real value.
He would not have to sell them, he must merely label
them. He preferred to avoid an appearance of evil, and
so, though he could ill afford it, resigned. Our brother's
remarks thereon were fairly redolent with adulation.
Their gist was, " Well done. Take no thought for the
future, for the Lord will provide." Ah, friend, you may
not label goods falsely, but you advertise them, knowing
their labels to be false. The youth at the prayer-meeting
would not allow a mote in his eye. Cast the beani out
of thine own eye: the Lord will provide. "But you
don't indorse your advertisements ? " No, we should
hope not. But had your young friend said to his worldly
employer, " I cannot mark your goods falsely, but if you
will label them and give me some printed price lists, I
will go on the street and hold a gospel meeting and dis-
tribute your lists with my tracts. I will not indorse your
cheat, but I will advertise it," would you not have
shattered his sophistry, and condemned this act as much
as you lauded the other ? Alas, sirs, " your actions do
belie your words."
Now, brethren, let us follow out your policy a little
further. We will suppose, with all reverence, that Christ
had delayed his coming until the present century. Would
you not deem it a most painful incongruity to see the
Epistles of Paul interlarded with patent medicine adver-
tisements ? Is not the dignity and responsibility of your
trust essentially the same as his ? Would you not recoil
with horror at the idea of beholding the tablet erected
reverentlv for the loved ones you had lost defiled with
the fulsome bait of the sharper and abortionist? Yet,
because the tablet takes the form of an obituary notice —
a tribute less lasting, jierhaps, but surely as tenderly
sacred to the bereaved — why is such an insult any less
heartless or apparent ?
If you are convinced you are justified in allowing
these advertisements to appear in your columns, why do
you not urge the universal apiilication of your rule of
conduct ? Any patent medicine firm would print your
whole paper if they could monopolize the advertising
space. But why stop here ? Let all the printing of
the Church be done by these firms. If it is right
and proper that Sunday-school lessons, hymns, ser-
mons, the Scriptures themselves, should appear in your
columns besprinkled with pile remedies and vermifuges,
why not everywhere ? It is perfectly practicable ; try
it. Think of the increased usefulness of your Boards of
Publication, had they only to furnish the copy and not
the cash, to the printer ! Some peoi)le with antiquated
notions might feel a little squeamish about using a Hair
Restorer Hymnal or a Kidney Cure Testament in their
devotions, but your papers are rapidly eradicating such
old-fashioned ideas of propriety. Advise your poorly
paid ministers to free themselves and their church from
debt by alternating the "usual notices" with extracts
from your papers at so much per extract. They would
;i8
THE MEDICAL RECORD.
[September 22, 1883.
merely proclaim from the pulpit what you give as Sunday
reading at home.
Now, you may declare yourselves shocked and term
all this an irreverent tirade, if you please. The irrever-
ence is yours, not ours. Your family physician may tell
you of a shock from another quarter. We believe there
are few men but what revere, or at least respect, reli-
gion, pure and undefiled ; but any attempt to spread
simultaneously the work of the gospel and the work of
the world, the flesh, and the devil, can onlv e.xcite dis-
gust. Can a journal, any more than a " temi>le," be-
come in any sense a " house of prayer," while its outer
court is but a "den of thieves?" Has the progress of
the age permeated the Pilgrim's Progress of to-day, or
have you forgotten the simple story of the " Prince of
Dreamers." We wonder what honest John Bunyan
would think of the manner in which these modern jiil-
grims pass through Vanity Fair, on their way to the
Celestial City. Our old friends, Christian and Faithful,
when besought by the merchants to buy their wares, put
their fingers in their ears, and raised their eyes aloft,
crying, " Turn away mine eyes from beholding vanity ! ''
Our esteemed contemporary pilgrims, whilst zealously
saying, "We will have none of your wares," add '-We
have been told your wares are evil and cannot indorse
them, but give us of thy lucre, and we will advertise
them." Would there were more John Bunyans alive
to day !
A CITY OF MEDICAL SOCIETIES.
During the month of October the medical work of so-
cieties in this city begins. We give below a calendar
showing the extent to which this work has now developed.
There are registered in New York City altogether twenty-
seven working medical societies, besides two societies
devoted to public health, one to general science, one to
microscopy, and two to veterinary medicine. There are
also four alumni associations, one of which is very active
in encouraging medical work.
A large number, indeed the majority, of the societies
mentioned below are limited in membership, and hold
their meetings at the houses of the members. Their ob-
jects are the promotion of friendly intercourse as well as
of medical science.
The medical societies of this city have nearly all been
the growth of the last twenty years. Of those now or-
ganized, not half a dozen e.xisted previous to 1S60. lie-
tween 1863 and 1870 ten societies, now existing, were
organized, and in the succeeding decade nearly as many
more.
While some of these local societies are weak and in-
active, this cannot be said of the great majority, and the
general eflfect of the e.xistence of the numerous organiza-
tions has been most excellent. In no city can there be
found so many physicians who are on such amicable
terms with each other, nor does any other city produce
so many contributions to medical science.
October ist.— jVIedico-Chirurgical Society of German
Physicians ; Morrisania Medical Society. October 2d.—
New York Obstetrical Society ; New York Neurological
Society. October 3d.— Medico-Legal Society. Octo-
ber 4tb.— New York Academy of Afedicine. October
5th. — Practitioners' Society. October Sth. — New York
Ophthalmological Society. October 9th. — East River
Medical Association ; New York Surgical Society. Oc-
tober loth. — Pathological Society ; Society of Medical
Juris|irudence and State Medicine. October nth. —
Harlem Medical Association ; New York Laryngologi-
cal Society. October 12th. — Yorkville Medical .Associ-
ation. October 13th. — Medical and Surgical. Oc-
tober isth. — Medico-Chirurgical Society of German
Physicians. October 16th. — Medical Section .Academy
of Medicine ; New York Obstetrical Society (Private).
October 17th. — Northwestern Medical and Surgical So-
ciety. October i8th. — New York Academy of Medicine.
October 19th. — Roman Medical Society. October 22d.
— New York County Medical Society. October 23d. — ■
New York Dermatological ; New York Surgical Society.
October 24th. — Pathological Society. October 25th. —
Obstetrical Section .Academy of ^[edicine ; Harlem
Medical Association ; Clinical Society. October 26th. —
Yorkville Medical .Association ; New York Society of
German Physicians. October 2 7th. — Medical and Surgi-
cal Societv.
BOVIXE VIRUS .\XD COMMERCIAL ENTERPRISE.
Some of our \Vestern countrymen have been quick to
appreciate the fact that there is money in the bovine
virus business if conducted in a certain manner. The
St. Louis Aledical and Surgical Journal states that a
firm was organized in September, 1882, for the purpose
of supplying "pure bovine virus." In March, 1883,
there being considerable small-po.x in the city, the Board
of Health awarded to this company the contract for sup-
plying the virus. During three weeks over ten thousand
vaccinations were made, but without a single perfect
success ! The contract was at once annulled, but it is
evident that if there had been an active epidemic, the
consequences would have been most serious. It was
afterward learned that the vaccine farm was under the
direction of a dry goods merchant !
The lesson is obvious. There is a temptation to make
a purely conmiercial venture of the preparation of bo-
vine virus. The increasing popularity of this form of
virus in the United States makes it doubly important
that great care should be taken by physicians and health
boards to know about the methods of its preparation.
THE LEPROSY COLONY IN TRACADIE.
Leprosy is a disease but seldom met with in this coun-
try, and the cases seen from time to time in some of our !
large hospitals are too few in number to furnish sufficient
data upon which to base any conclusions as to the origin
and mode of propagation of the malady. It is said to 1 !
prevail to a considerable extent in some of the Scandi-
navian colonies in Wisconsin ; but in Tracadie, a small
parish on the Gulf coast at the mouth of the Miramichi
River, in New Brunswick, it has existed for upward of '
sixty years. An interesting account of this settlement, '
and of the lepers' hospital there situated, was published
in the Catholic World of May, 1877. The writer was -^
not a physician, and his observations possessed more of 'i
a social and religious than of a medical interest. Other
notices of a similar character have been published since
September 22, 1883.]
THE MEDICAL RECORD.
319
then in various periodicals, but none of them has added
much to our knowledge of the etiology of the disease.
A correspondent who visited Tracadie during the past
summer sends us a report of what he learned there con-
cerning the origin of the disease in that settlement, from
which we take the following condensed account :
The first settlers in Tracadie were the I.e Bretons,
who went there about the year 177S. They lived with
the Indians, upon the coarsest and most meagre fare,
and suffered great hardships, yet none of that name has
ever had leprosy. The scourge first appeared in 1820 in
the person of Ursula Landry, who, with her sister Isabel,
came to Tracadie in i 798. They married two brothers
by the name of Benoit. Popular tradition says that Ur-
sula contracted the disease by washing the clothes of
some French sailors, who were lepers, some time before
she came to Tracadie. This explanation of the origin
of leprosy in the colony is, however, far from satisfac-
tory, as it is hardly to be supposed that twenty-two years
could have elapsed after exposure to contagion before
the disease should manifest itself Ursula died in 1828.
The second victim was her sister Isabel, and the third
was Frangois Sonier. This man affirmed that he con-
tracted the disease by carrying Ursula's coffin, the sharp
edge of which cut his shoulder, and then inoculation was
effected by matter running from the corpse. Francois
Sonier was ill a number of years, and his father's house
was the rendezvous for the young people of the neigh-
borhood. Several of these were afterward attacked
with leprosy. P'rangois attempted once to go to Cape
Breton to consult some person there who had quite a
reputation for curing ulcers, and on the way stopped at
the house of one Savoy. A member of the family, Mary
Savoy, washed the clothes of the bed in which he had
slept, and afterward herself contracted the disease. It
was not until a number of persons who were intimate
with the Soniers had contracted leprosy that public at-
tention was drawn to it. Then the lazaretto on Sliel-
drake Island was established (1844).
There are at present twenty-four patients in the hos-
pital, all coming from within a radius of twenty-five miles
from Tracadie. From a study of the records, which have
been carefully kept since the nuns took charge in 1868,
it is seen that the average stay in the hospital was five
years. If to this is added two or three years as the dura-
tion of the disease prior to the entrance of the patient
into the lazaretto, we have an average duration of lep-
rosy of seven or eight years. One patient, however, has
been in the hospital for twenty-four years, and another
for fourteen. So it would appear that the course of the
disease is very variable as regards time.
Our correspondent spent a great part of his time in
studying the mode of origin of the leprosy in this place.
There are four possible ways, he states, in which the
origin and spread of the disease may be accounted for,
viz., heredity, endemic influences, contagion, and here-
dity and contagion combined. Although the general
opinion of writers on leprosy is that it is propagated by
hereditary influences, yet in no case reported in Tracadie
can this be satisfactorily proved. In every instance there
was abundant opportunity for contagion, so that the part
played by heredity alone could not be determined. The
theory of endemic origin is disprovedjby the fact that the
same conditions of race, habits, mode of living, etc.,
exist in other places along the coast where leprosy is un-
known. The theory of the spread of the disease by con-
tagion is supported by many incontestable facts. Peter
Noel came from a perfectly healthy family. He slept
during one summer with a man in the advanced stages
of leprosy, and in a few years became himself a victim
of the disease. A man by the name of McComb,
living in a settlement some fifty miles distant, where
leprosy was unknown, came to Tracadie and worked for
some time in a lumber camp. He returned home a
leper, and died. James McCirath caught the disease
from Michael Gould. Peter McGrath slept with James,
became leprous and died. Peter lived for a time with the
Drysdale family. Seven of Drysdale's children fell vic-
tims to the malady. It is a matter of common observa-
tion that unless the patients are early removed to the
lazaretto, others of the family are attacked ; and again,
if the sufferers remain at home, but strictly isolated from
the rest of the fanuly, the disease is less liable to spread.
Finally, it is impossible to account for the rapid propaga-
tion of the leprosy in families previously healthy, except
on the theory of contagion. On the other hand, facts are
not wanting which seem to oppose this presumption.
Women have been employed in the hospital for years,
washing the clothes of the lepers and scrubbing the floors
of the wards, yet they have never themselves become
leprous. Neither the Sisters nor the medical attendant
have contracted tlie disease. The case of one man is
related who had lost three wives in succession from lep-
rosy, yet he escaped. Other instances are on record of
children, born in the lazaretto of leprous mothers, and
growing up within its walls, who have remained healthy.
But these negative facts, however numerous, have much
less weight than a few positive ones. Of a number
of persons exposed to any contagious disease not every
one is attacked. The attendants in the hospital, further-
more, observe every precaution, exposing themselves as
little as possible to direct contact with the patients, and
living in light and well-ventilated apartments away from
the wards.
The following are the conclusions arrived at by the
correspondent from his observations of the leprosy as it
exists in Tracadie : i. The origin and early spread of
the disease cannot be explained on the theory of hered-
itary transmission, although this theory may in part
account for its further propagation. 2. Although en-
demic influences, such as climate, mode of life, diet, etc.,
may be strong predisposing elements, they are in no case
the sole cause- of the disease. 3. Leprosy in Tracadie
was imported from without, and, finding there favorable
conditions, was propagated from one person to another
by contagion. Finally, leprosy may be regarded as one
of the least contagious of diseases, and one which will
only spread under a combination of favoring circum-
stances such as were found in Tracadie.
The lazaretto is clean and kept in perfect order, and
everything is done by the Sisters to ameliorate the sad
lot of the inmates ; but the building is gloomy at the best,
and resembles more a prison than a hospital, and it
would be a great boon to the suffering patients could a
new and more commodious structure be erected. The
writer speaks in most grateful terms j^of the courtesy
!20
THE MEDICAL RECORD.
[September 22, 1883.
shown him while in Tracadie, and desires to acknowledge
his indebtedness to Dr. Smith, the Rev. Father Babi-
neau, the Rev. Mother St. John, and Mr. Young, for
much valuable assistance rendered him in his study of
the disease. The value and importance of the work
done in this humble way in an obscure and wretched vil-
lage on the shores of the Gulf of St. Lawrence, cannot
be over-estimated. To the untiring vigilance of the
physician and the nuns in searching out and sequestrat-
ing every new case of leprosy occurring in the village
is doubtless due the fact that it has not ere this spread
to other and distant places. For admitting the con-
tagiousness, in however slight degree, of the disease,
there are numbers of fishing villages all along our coast
in which the condition of the inhabitants would seem to
invite its approach, and once it had gained a foothold we
would have Tracadies enough at home, and there would
be no occasion to go abroad to study the leprosy. There
is now good cause for the hope that the disease may
eventually be stamped out in New Brunswick, and thus
a danger, slight, but none the less real, to ourselves will
be removed.
THE HIGH TEMPERATURE OF FEVERS.
The opinion has been current for some time tliat the es-
sentials of fever, such as increased pulse-rate, disturbance
of the cerebral functions, and, later, certain parenchyma-
tous degenerations, were the direct consequences of in-
creased bodily heat. This widely accepted doctrine is now
opposed by Dr. Unverricht. He says that although these
so-called febrile symptoms are generally found associated
with an elevated temperature, they are not therefore neces-
sarily caused by it. Different kinds of fever are accom-
panied by varying degrees of cerebral manifestations.
Thus a temperature of 103.5° in septic poisoning is
associated with great depression of the nervous system.
In relapsing fever, on the other hand, a patient bears easily
107° or more. The author cites numerous accurately
observed cas;s to prove that a temperature of over io8°
is not of itself fatal. He does not regard Litten's experi-
ments in proof of the evil effects of high temperatures as
conclusive, and opposes to them the observations of
Volkmann, which go to show that high fever in aseptic
conditions may be unattended with danger. Since, there-
fore, this point is still unsettled, Dr. Unverricht thinks
that in the treatment of fevers the question should
always be considered whether the harmful effects pro-
duced in greater or less degree by all febrifuge remedies
will not outweigh the advantage hoped fcjr in reducing
the temperature. In fact, he thinks that in certain
instances fever may be regarded as a process tending to
the advantage of the organism. There is little doubt that
since the introduction of exact thermometry into medi-
cine, temperature variations have received a rather undue
amount of attention. It is so easy and simple a matter to
detect pyrexia and at once prescribe a febrifuge. Pulse
observations and other valuable indications have been
correspondingly neglected since the thermometer be<'-an
to assert its claims. But while this much may be readily
conceded, we are certainly not prepared to fully endorse
Unverricht's opinions. In the ordinary run of febrile
affections a high temperature must still be regarded as a
symptom significant of danger. And even if the severity
of the individual case need not be gauged by the ther-
mometer alone, the wary practitioner well knows and
appreciates the meaning of excessive pyrexia. It is
nature's warning that damage, if not already done, may
be confidently expected. And from a therapeutical
point of view it is quite clear that to be thus forewarned
is, in a measure at least, to be forearmed. Expectancy,
which is but a misnomer for helpless inaction, is there-
fore to be deprecated in all such conditions. And we
must emphatically oppose the view which sees in fever
nature's effort at restitution, and not a morbid process
with destructive tendencies.
C.^RDI.iVC VERTIGO AXD ANGIXA PECTORIS.
Sympto.matic, or cardiac vertigo, is an affection which,
according to Germain See, is not uncommon in cardiac
affections, being more frequent in aortic insufficiency, is
so common, in fact, that when vertigo occurs in the
course of heart disease we need, as a rule, look no far-
ther for its cause. This fact suggests also that in cases of
obstinate and distressing vertigo the heart should always
be examined, especially if extreme pallor, a prominent
symptom of aortic insufficiency, be present and will not
yield to medication. In these cases M. See affirms that
iron is absolutely indicated, though in many cases, on the
contrary, iodide of potassium is indicated and gives ex-
cellent results. In these cases there are also observed
the characteristic pains of angina pectoris coming on
every few months, another prominent, though not con-
stant, symptom of aortic incompetence. The anginous
pains should of course be combated by hypodermics of
morphine, the administration of chloral, or inhalations
of nitrite of amyl during the access, and by bromide of
potassium and digitalis, or convallaria, during the inter-
vals.
It is interesting in this connection to notice the con-
clusions of \V. Allen Sturge (Brain, October, 1882), re-
garding the etiology of angina pectoris. Having selected
a typical case and minutely detailed each symptom as
given by the patient, he concludes that the local attack
on the heart is due to an organic modification in the sub-
stance of the cardiac muscle itself, or some change in the
heart acting on the terminal filaments of the cardiac
nerves ; a commotion spontaneously developed in the
gray substance of the sympathetic ganglia of the cardiac
plexus, this being transmitted to the spinal cord and
brain ; a commotion spontaneously developed in the
cervical sympathetic ganglia, which give off branches to
the cardiac plexus, or in the ganglia of the vagus ; a
spontaneous commotion in the part of the gray substance
of the cerebrum, which may receive 'impulses coming
from above and below ; a spontaneous conmiotion in
the parts of the gray substance of the cord in communi-
cation with these ganglia by means of bands of nervous
substance passing from the cord to the great sympathetic.
Of course a great number of observations are neces-
sary in order to place these scarcely more than theoret-
ical causes on the sound footing of etiological fact. This
is recognized by the author, but he is of the opinion — in
which most authorities concur — that in the greater num-
ber of cases of angina pectoris associated wth organic
September 22, 1883.]
THE MEDICAL RECORD.
321
lesions of the heart or great vessels, the primary irrita-
tion probably takes place at the periphery of the cardiac
nerves. Dr. Sturge admits, however, that there are cases
of angina pectoris which are due to spontaneous lesions
of the nerve-centres. Trousseau long ago pointed out
the relation between angina pectoris and epilepsy. The
paper, though far from conclusive, as the author admits,
gives evidence of careful observation, and is an impor-
tant contribution to our knowledge of this affection.
THE GASTRIC ULCER AND ITS RELATION TO CANCER
OF THE STO.MACH.
Despite considerable study and numerous experiments,
our knowledge of the origin of gastric ulcer is still far
from satisfactory. Cohnheim, indeed, succeeded in
causing an ulceration of the mucous membrane of the
stomach by artificially|produced embolism and thrombosis
of minute gastric vessels. These sores had the form of
the typical ulcer of the stomach, but were not chronic and
slow of healing as the latter comuionly is. Other ques-
tions of interest, and, as yet, unsolved, are the mode of
cicatrization of the ulcer and the relation, if relation there
be, between chronic ulcer and carcinoma of the stomach.
In a brochure, recently published in Leipzig, Dr. Gus-
tav Hauser endeavors, through eighty octavo pages and
with the aid of seven plates, to clear up the mystery, and
to demonstrate satisfactorily the processes of destruction
and repair of gastric ulcer and the subsequent develop-
ment of cancer. He attributes ulceration of the nuicous
membrane to an infarction caused by permanent obstruc-
tion to the circulation in the fine arterial twigs passing
from the submucous to the mucous layers of the stomach.
This obstruction may arise from the lodgement of an em-
bolus, from thrombosis or from the rupture of one of these
arterioles. The resulting ulcer is chronic only when there
is actual disease of the blood-vessels occurring prior to,
or at the same time with the infarction. For then the
formation of new vessels necessary to the healing process
becomes impossible. The more or less chronic course
is directly dependent upon the severity of the disease in
the vessels. The size of the ulcer is in proportion to
the extent of infarction and also to the number of arteri-
oles affected. Any disease of the arteries may give rise
to this condition, but atheroma and fatty degeneration
seem to play the most important role, at least in advanced
age. The healing process begins by a sort of puckering
together of the base of the ulcer, by which the edges are
approximated and close adhesions formed between the
mucous membrane and the parts lying beneath it. If
the ulcer is extensive, with its base formed of a neighbor-
ing organ adherent to the stomach, the cicatrization is
not complete, but the mucous edge becomes fixed to
the muscular layer or to a greatly thickened connective
tissue. This process, the author states, is attended with
an enormous hypertrophy and proliferation of the glands
immediately about the ulcer. At the same time the
normal glandular epithelium becomes transformed into
cylindrical epithelium. The hypertrophy of the glands
is due to the increased supply of blood during the pro-
cess of cicatrization, aided by the diminished resist-
ance of the surrounding connective tissue. The glands
are excited to increased action, and at the same tune
the physiological resistance of the supporting connec-
tive tissue is wanting. Regarding the development of
cancer in the cicatrix of an old gastric ulcer, the author
asserts that such a process may take place. Large
ulcers, which never become entirely cicatrized, are es-
pecially prone to cancerous degeneration. The disease,
he says, begins in the lumina of the glands at the edge
of the ulcers which have undergone the changes described
above. The abnormal growth of the glandular epithe-
lium continues and finally takes on a malignant charac-
ter. Between a cancerous growth of the glandular epi-
thelium and an abnormal hypertrophy of the same there
is a difference only of degree. In either case, says Dr.
Hauser, the causal conditions are the same, viz.: an irri-
tability of the secreting epithelial cells, due to the increased
flow of nutrient material, and a diminished resistance of
the supporting connective tissue. He relates the history
of a case upon which he bases his belief that carcinoma
of the stomach may arise from disease of the peptic
glands independently of any embryonic germ. As con-
firmatory of Dr. Hauser's view of chronic ulcer being
dependent upon disease of the vessels, may be mentioned
two cases related by Dr. iMattei [Deutsche Medizinal-
Zeiiung, July 5, 1883). No sufficient cause could be
determined during life for the formation of the ulcers.
At the autopsy there was found an amyloid degeneration
of the liver and spleen, and a similar change in the gas-
tric vessels had given rise to the ulceration.
^^citis of tlxc 'SGlccU.
Pasteur's Investigation of the Cholera in Egypt.
— The scientific mission to Egypt to investigate the chol-
era epidemic, for which a grant of 50,000 fr. has just
been obtained by M. Pasteur from the French Cham-
bers, consists of MM. Roux, Thuillier, Straus, and No-
card. M. Pasteur has formulated a set of rules for the
guidance of his party, by means of which he hopes to
guard against infection. All articles of food and drink
must be boiled and then ke|n in heated vessels. Fruit
must be washed in boiled water before being eaten. A
two-per cent, solution of carbolic acid is to be used for
washing purposes.
Increase of the Paris Hospitals.— The Municipal
Council has voted three million francs to be expended
in increasing the hospital efticiency of the city. Two
millions are to be expended upon the large hospitals al-
ready existing. One million constitutes the first instal-
ment for the erection of a hospital for contagious diseases,
one for chronic diseases, and one for juvenile incurables.
The International Hygienic Exhibition at Berlin
has closed, but it has been decided to establish a iierma-
nent Museum of Hygiene in that city.
Another New Medical College.— The Medical
Department of Niagara University is the title of a new
medical college recently organized in Buffalo, N. Y. It
requires attendance upon a three years' graded course,
and aims to exemplify the higher education. Judging
from the announcement, not much is exacted in the
way of preliminary education, although something is re-
quired.
322
THE MEDICAL RECORD.
[September 22, 1883.
Professor Gerhard Leopold, of Leipzig, has been
called to fill the vacancy as Professor and Director of the
Royal Institute for Midwives at Dresden.
A New Building for the Xew York City Health
Board. — A movement is on foot to secure a new and
."^parate building for the City Health Department.
Medical School of Harvard Universitv — One
Hundredth Anniversary. — The celebration of the one
hundredth anniversary of the establishment of the Medi-
cal School of Harvard University, and dedication of its
new building, will take place on October 17, 1883. The
following is the programme : I'art I. (.-Vt the Massachu-
setts Institute of Technology, Huntington Hall, at ii
o'clock A.M.) : Address by the President of the L^niversity ;
Oration by Emeritus Professor Oliver Wendell Holmes ;
Presentation of a portrait of Professor Holmes and a
bust of Professor Henry J. Bigelow. Part H. (.^t the
Medical College, Boylston Street) : Prayer by Rev. A. P.
Peabody, D.D.; Dedication of the new building to the
purposes of medical instruction ; Reception of subscribers
to the building fund, and invited guests, by the Medical
Faculty ; E.xhibition of the building.
De.\th of Dr. F. A. Pickeit, of Redkord, N. Y. —
Dr. F. A. Pickett died on the morning of the 6th inst.,
after an illness of three weeks with typhoid fever. He
graduated at the L-niversity of New York City in 1S79,
when twenty-four years of age, after which he removed to
Redford, N. Y., where he practised until his death. He
left a large and lucrative business by his sad and untimely
death.
Prizes for New Remedies in Typhoid Fever. —
Acting Assistant J. M. Main, of the Marine Hospital
Service, reports from Brownsville, Te.xas : " The Medical
School of the city of Mexico has called a convention of
physicians to determine the properties and uses of simaba
cedroni — its pharmacology, chemical analysis, and physio-
logical action— demonstrated by e-xperiment, with a view
of ascertaining its usefulness in the treatment of typhoid
fever. A prize of $500 is oftered for the best thesis on
the subject ; also a premium of $500 for the best thesis
on ihe usefulness of pulque in typhoid fever. Pulijue is
a refreshing beer from the heart of the maguey (Ag-ai'e
Jile.xicaua). The President of the republic has ap-
pointed a sanitary commission which is to meet first at
Vera Cruz during the present month. Its object is to
consider and discuss questions of hygiene, disinfection,
and prophyla.xis."
Yellow Fever. — At Vera Cruz there were nineteen
deaths from yellow fever during the ten days from
August 20th to 30th.
No case of yellow fever has appeared in the city of
Pensacola, the disease having been confined to the
Naval Reservation.
Acting .\ssistant Surgeon J. M. Main reports, under
date of September 3d : " Yellow fever has broken out at
Tlacotalpan, and is spreading in a northerly direction.
It has not reached Tu.xpam. Tuxpam has enforced
quarantine against all infected ports and inland cities.
Typhus fever has appeared recently at Zacatecas. The
death-rate is said to be ninety per cent. Small-pox is
very fatal at Progreso ; mortality 52.5 percent. Yellow
fever has appeared at Campeachy, carried there by a
Norwegian vessel. M Real del Monte tyjihus fever is
prevailing, mortality being ninety per cent."
Sanitary Inspector Daniel M. Burgess, of the Marine
Hospital Service, reports from Havana: "There were
708 deaths in this city during the month of August. Of
the decedents 152 were by yellow fever, 19 by typhoid
fever, 3 by bilious fever, 23 by intermittent, remittent,
and pernicious fevers, and i by diphtheria. During the
week ending September 7th there were 18 deaths by
yellow fever, nearly all of them being among private
citizens. The reduction in the mortality by yellow fever
is not from any tendency in the disease to cease to
spread, but from the want of material for it to feed upon,
and the mild type of the epidemic or endemic. Some
wharves are very dangerously infected, and all vessels
which go to them and stay over three days are almost
sure to suffer and become dangerously contaminated.
Within the last two weeks whole crews of vessels laying
at those wharves (liable to have yellow fever) have either
had it while the vessel was there or soon after leaving.
The navy and army have suffered very much, and the
few remaining ones who have not had it continue to fall
sick."
Death of Louise L.^teau. — The death is announced
of Louise Lateau, the Belgian stigmatisee, of Bois
d'Haine. She was thirty-three years and seven months
of age at the time of her death. Her case excited con-
siderable interest at one time, and she was subjected to nu-
merous medical investigations. Virchow, it is said, was
asked to see her, but was unable to do so. On every
Friday, it was said, she fell into a state of ecstasy, and
blood flowed from the stigmata in her hands and feet.
Dr. Louis F. Pelton, of Mount Kisco, died on
Monda)', leaving a widow and two sons. He was gradu-
ated from the Xew York University Medical College, in
1S47.
An Unpleasant Experience. — Dr. William E.
Beardsley, of Brooklyn, was recently called to attend a
woman who was suftering from dyspnoea. He adminis-
tered some aromatic spirits of ammonia, and, no relief
ensuing, was about to repeat the dose, when the patient
fell back dead in iiis arms. The husband, crazed with
grief, rushed upon the doctor exclaiming, " Did I call
you here to murder my wife ? " and proceeded to do his
best to murder the doctor. The man was a stout Ger-
man, and Dr. Beardsley was considerably bruised in the
encounter, and might have received very serious injuries
had it not been for the timely intervention of others in
the house.
The L.\te Dr. J. D. Trask, of Astoria, N. Y. — It
is seldom that tiie death of a physician is looked upon as
a public affliction by the community in which he has la-
bored. So it was, however, in the case of the late la-
mented Dr. Trask. The rich and poor crowded the
church to pay their last tribute of respect to one who had
served them so faithfully during life. The stream of
mourners continued to file past the casket until long after
dark, and even after the congregation had left the church
many came to bid farewell to the dead who had been un-
able to attend the funeral services earlier in the day.
September 22, 1883.]
THE MEDICAL RECORD.
0^0
The scene throughout was one provocative of many sad
reflections. There was an intensity about the grief of
those present that is very rarely witnessed. Tije several
departments of tiie City Ciovernment, the Citizens' Com-
mittee of Fifty, the Law and Order Society, and various
other bodies were represented, besides which several dis-
tinguished members of the medical profession from New
York City and other parts of the State were present-
The big bell of the Church of the Redeemer and the fire
bell were tolled at minute intervals during the afternoon
and up to the time of the commencement of the service.
As an author, practitioner, citizen, and Christian he did
his work effectively, quietly, conscientiously, and for the
work's sake. It would be well if such could be said of
all of us.
American Academy of Medicine. — The annual
meeting of the Academy will be held at the New York
Academy of Medicine, 12 West Thirty-first Street, New
\ork, on Tuesday, October 9 (three o'clock p.m.), and
Wednesday, October 10, 1883. — Richard J. Dungli-
SON, Secretary.
A Gold Medal to W. H. Schieffelin & Co., of
New York. — .\mong the awards announced to exhib-
itors at the Holland International E.xhibition at Amster.
dam was a gold medal to Messrs. W. H. Schieflelin &
Co. for their soluble pills and granules. This is a special
distinction for their reliable preparations, as the award
was made after a careful analysis of specimens of
Messrs. Schieflelin' s manufactures by the Government
chemists.
The Assocl\tion of German Physicians and Natu-
ralists held its fifty-sixth annual session at Freiburg, be-
ginning September 17th.
Copper and Cholera. — M. Bailly, of Chambly, has
adduced evidence that copper is not a prophylactic
against cholera as asserted by M. Burq. An experience
of sixteen years in connection with a factory where work-
men are largely employed in copper lias shown that the
employees are not exempt from cholera, tyiihoid fever, or
other infectious disease.
Slightly Premature. — The Chicago police have cer-
tainly not been carefully instructed in the signs and to-
kens of death, as the following incident will show : A man
named Lewis Lacy entered a street-car in that city a few
days since in a drunken condition and refused to pay his
fare. The conductor threw him oft' the platform, and
seeing lie did not move, told the driver to whip up, and
the car rattled away and the conductor escaped. The
police patrol was called, the body was put in a wagon,
taken to the morgue, and placed on ice, while a large
force of police were sent in search of the fleeing conduc-
tor. After being a short time on ice the body began to
show signs of life, and in the course of half an hour Lacy
was able to walk to the police-station. An examina-
tion showed he was not seriously hurt, and that his state
of temporary coma was due wholly to liquor.
Death of Dr. Sylvester F. Mixer. — Dr. S. F.
Mixer, of Buffalo died on September 17th. Dr. Mixer
was born in Morrisville, Madison County, N. Y., De-
cember 27, 1815. He graduated from the Medical De-
partment of Yale College when twenty-six years of age,
and immediately began the practice of his profession in
Buffalo. Six years later he took the degree of M.D.
from the College of Physicians and Surgeons in this city.
He was a prominent member of the Buffalo and Erie
County Medical Societies, and the American Medical
Association. From 1858 to 1874 Dr. Mixer was Attend-
ing Physician to the Buffalo City Hospital. He then be-
came Consulting Physician to the same institution.
Professor M(jnch, of Kiew, lias been ordered to
Egypt to study the cholera.
Professor Bizzozero has received the Riberi Prize of
20,000 francs for his investigations into the physiology
and pathology of the blood.
Yellow Fever has appeared at (Juaymas, Mexico.
The French Assocl\tion for the Advancement
OF Science — -Medical Section. — We reported some of
the work of this meeting in the last issue of The Record.
At the meeting, August 20th, M. Burot made a com-
munication upon the " Variations of the Chlorides in the
Urine." He showed an apparatus for the easy and rapid
quantitative measurement of these chlorides. It con-
sisted of a graduated tube and 'inpette, a solution of
nitrate of silver (28. 40 grammes per litre), and a solution
of chroniate of potassium. M. Onimus sent a communi-
cation upon a case of " Infantile Pseudo-paralytic Con-
tracture." The patient had in all the extremities mus-
cular tension, exaggerated reflexes, and contractures.
All the members could be moved, but the effort was
attended with ataxic chorea-like movements. No atro-
phy was present. Onimus referred the lesion to the
upper part of the pons. M. Apostoli read a paper upon
the " Electrical Treatment of the Ovarian Pain in Hys-
terics." M. Boucheron opened a discussion upon " The
Pathogeny of Retinal Detachment." He referred espe-
cially to the rheumatic theory of its origin. M. Bouchut
called attention to the " Relation between Intercostal
Neuralgias and Angina Pectoris." He related the his-
tory of three patients suffering from intercostal neuralgia
who were suddenly seized with angina pectoris. Other
instances illustrating tliis transfer of morbific action were
given. M. Verneuil presented a learned but not par-
ticularly instructive paper upon "Traumatic .\uto-inven-
lation." M. Nepven read a paper in which he claimed
that micrococci were always present in the fluid of the
peritoneal sac in strangulated hernias. Antisepsis should
be applied accordingly. M. Leudet read a paper ujion
"Ulnar Neuritis caused by Repeated Contusions in fol-
lowing Certain Occupations." Carpenters, in planing,
dyers, calico-printers, and shoemakers were especially
liable to this trouble. M. Maurel read a paper upon
"Normal and Pathological Albuminuria." He presented
a somewhat original division of the albuminous fluids of
the body. They are, he said, of two kinds : Those
which are colored violet, and those which are not so
colored by a solution of copper sulphate in potassa. In
the latter class are the albumens passed in the urine
during the acute fevers. In pathological albuminuria, or
Bright's disease, the albumen passed is colored violet by
the solution referred to.
324
THE MEDICAL RECORD.
[September 22, 188^
Reports of J>ocictics.
AMERICAN GYNECOLOGICAL SOCIETY.
Eighth Annual Meeting, held in Philadelphia, Fa. Sep-
tember 18, 19, and 20, 1883.
Tuesday September iSth — First Dav — Morning
Session.
The Society met at tlie College of Physicians and was
called to order at lo o'clock by the President, Dr.
Gil.man Kimball, of Lowell, Mass.
MEMBERS PRESENT.
The following answered to the calling of the roll by
Dr. Frank P. Foster, of New York, "Secretary : Drs.
Kimball, of Lowell ; A. H. Smith and Parvin, of Philadel-
phia ; Barker, Polk, and Emmet, of New York ; Mann, of
Buffalo ; Johnson, of Washington ; Wilson and Howard
of Baltimore; Reeve, of Dayton, O.; Ingham, of
Philadelphia ; Jackson, of Chicago ; Reamy, of Cin-
cinnati; Van de ^\■arker, of Syracuse, N. Y.; Camp-
bell, of Augusta, Ga.; Byrne, of Brooklyn ; Duer, of
Philadelphia ; Byford, of Chicago ; Palmer, of Cincin-
nati ; Sutton, of Pittsburg ; Battey, of Georgia ; Chad-
wick and Lyman, of Boston ; Goodell, of Philadelphia ;
Gillette, of New York ; Browne, of Baltimore : Reynolds,
and Baker, of Boston ; E. Wilson, of Philadelphia.
The address of welcome was dehvered bv Dr. Edward
DuER, of Philadelphia.
invited guests.
The Council reconmiended the following : .-Mfred
StilU-, M.D., President Philadelphia College of Phvsi-
cians ; William U. Welch 1\LD., President Philadelphia
County Medical Society ; Richard A. Cleeman, M.D.,
President Philadelphia Obstetrical Society ; James
Tyson, M.D., President Philadelphia Pathological So-
ciety; Robert P. Harris, M.D., of Philadelphia; I. R.
Page, Al.D., and Robert T. Wilson, M.D., of Baltimore.
The first paper was read by Dr. Joseph Taber John-
son, of Washington, D. C, on
SUPERINVOLUTION OF THE UTERUS.
Sir James Simpson described this disease over thirty
years ago, and stated that his patients remained fully un-
cured. Dr. Johnson introduced the subject, with the
hope that discussion might follow which would throw-
light upon a hitherto obscure class of cases. Barnes be-
lieves that this condition is uncommon. One writer lias
found it to occur in about one per cent, of all cases.
Dr. Cole, of San Francisco, has seen many of these cases,
It must be difterentiated from atresia of the uterus.
Simpson claims that it may occur in the same connection
as undeveloped uterus and other processes not involvino-
an iiiHammatory process. The e.xtent may vary from the
slightest shortening to entire obliteration of the uterus and
ovaries, as has been reported by Whiteliead. The term
implies that superinvolution only occurs after the pro-
cess of involution has been set in progress by the empty-
ing of a uterus once occu|)ied by some mass or body
which has produced its increase in size beyond the nor-
mal point, as, for instance, after cases of hydrometria,
pyroinetria, hydatids, or removal of the ovaries, uterine
tumors, as well as upon the conclusion of utero-gestation
or abortion.
Dr. Johnson then related the history of four cases
occurring in his own practice, and concluded with a brief
summary of the literature of the subject, so far as he was
familiar with it. The points on which all writers on this
subject agree are that excessive involution does occur
from some cause ; that electricity should be tried ; and
that in the great majority of cases it is incurable. I
Dr. Barker, of New York, suggested, with regard to the
term superinvolution, that it might with propriety be used
in all cases where retrograde process has taken place to an
e,xtreme extent from any cause, as fibroids, acute uterine
catarrh, etc. With regard to frequency, he thought it a
difficult jioint to decide, but, for himself, was inclined to
the opinion that it occurred quite as frequently as indi-
cated by the author of the paper. In the large majority
of cases no benefit can be given by treatment. One
practical point was not referred to by any writer, so far as
he had seen, and that was with reference to the class of
cases which could be benefitted by treatment. When-
ever he found superinvolution of the uterus associated
with evidence of arrest or defective ovulation, very little
could be effected by treatment. On the other hand,
cases associated by evidence of any active ovulation,
he thought could be cured sometimes, and the proof
had been in the fact that the symptoms had disap-
peared, pregnancy ensued, etc. The symptoms which
gave evidence of the existence of ovulation, associated
with this condition of the uterus, were disturbances of
the vascular and nervous systems at or near the men-
strual period, such as intense headaches, flushing of
the face and congestion of the eyes, pelvic pain, and
sense of dragging, with nausea and vomiting, etc. The
point he made was that superinvolution associated with
functional activit)' of the ovaries might be benefitted by
treatment. Galvanism was one of the prominent agents
which he had employed.
Dr. Reeves Jackson, of Chicago, thought the question
of difterential diagnosis between superinvolution and the
occurrence of premature climacteric was a difficult one
to decide in some cases, and cited the history of a case.
Whether or not the condition is one originating in the
uterus was regarded by him as a question of great practi-
cal importance. If there is functional activity in the
ovaries it may be assumed that the small size of the
uterus does not depend upon disturbances ot its own
vascular and nervous supply, primarily.
Dr. Van de Warker, of .Syracuse, thought the cases
might be divided into those which show the cervix
only involved and those in which the condition affected
the body of the uterus as well. There are cases in which
involution is confined to the cervix, the proof of which,
can be found in certain cases of laceration of the cervix
when the posterior lip is very much atrophied and the
anterior lip in very nearly its normal condition. He
thought Dr. Johnson's first case was one of that char-
acter.
Dr. H. p. C. Wilson, of Baltimore, thought it ex-
ceedingly rare to meet with the condition described in
the paper by Dr. Johnson. He was able to recall only
two or three cases of superinvolution in women who
have borne children, or had miscarriages or premature
labors. He thought that in the cases in which the ova-
ries existed in the normal, or nearly normal condition,
and were normally active, benefit might follow treatment.
Dr. B.in'EV, of Rome, (ia., said that in the majority
of cases in which he had performed the operation with
which his name had been associated, superinvolution of
the uterus had followed, and in quite a number of cases
It had been extreme. In many of the cases the uterus
was apparently healthy at the time of the operation. He
thought the question of superinvolution was one affect-
ing the ovaries rather than the uterus ; it is want of
proper ovulation.
The discussion was continued by Dr. Byford, of Chi-
cago, Dr. Campbell, of Georgia, and closed by Dr.
Johnson. _
THE importance OF CLEANLINESS IN SURGICAL
OPERATIONS.
Dr. R. Stansuurv Sutton, of Pittsburg, Pa., read a
paper on the above subject, in which he gave a review
of ideas and theories entertained from time to time since
Galen tauglitdown to the present, concerning the real na-
September 22, 1883. J
THE MEDICAL RECORD.
325
ture and treatment of this important class of cases. The
germ-theory received a large share of attention, coupled,
and justly so, with the name and method of Mr. Lister.
The conclusion reached by the author was that the best
success in the treatment of surgical wounds came chiefly
from cleanliness rather than from the use of antiseptics,
technically speaking. Special personal attention must
be paid by the surgeon to all the details, regulation
and preparation of assistants and nurses, preparation of
instruments and ligatures, exclusion of sponges, etc.
Dr. S. D. Gross, of Philadelphia, was invited to open
the discussion. He thanked the Societ)' for the compli-
ment e.\tended, but declined, for the reason that he came
to listen and to be instructed.
Dr. Lusk, of New York, thought that for the greatest
number of operations the spray could be used with posi-
tive advantage, and cited four cases, all complicated, in
which he operated in Bellevue Hospital with satisfactory
results under unfavorable circumstances.
Dr. Wilson favored the use of spray to render the air
of the operating-room antiseptic, but did not continue it
during the performance of the operation.
Dr. Campbell, of Augusta, Ga., referred to surgery as
practised in the days before the antiseptic method was
brought forward, and he was of the opinion that, all in
all, about as good results were obtained then as now.
Cleanliness was observed then and care in the perform-
ance of the operations.
The discussion was closed by Dr. Sutton, after which
the Society adjourned to meet at 3 p.m.
First Dav — .Afternoon Session.
The Society was called to order by the President.
Drs. R. 11 Maury, of Memphis, Tenn.; Wm. E. Mose-
ley and Wm. P. Chunn. of Baltimore ; and Samuel D.
Gross, of Philadelphia, were elected
INVITED GUESTS.
Dr. Albert H. Smith, of Philadelphia, then read a
paper on
hot water IN secondary hemorrhage after pelvic
OPERATIONS,
in which he stated that while the general value of this
agent had been recognized since attention was first es-
pecially directed to it by Dr. Emmet, of New York, who
gave Dr. Pilcher, of Detroit, credit for the original sugges-
tion, and while it received constant employment in the
larger cities, he had been impressed with the idea that in
other localities its specific action had not been fully appre-
ciated. Dr. Smith had used it with great advantage in
hemorrhage occurring with pregnancy, and also in post-
partum hemorrhage. It may be used as a prophylactic
against hemorrhage in every case of labor, and also against
local absorption. He regularly employed it in hospital
practice for this purpose, injecting the vagina with water
at a temperature of 115° to 120" P., sufficiently impreg-
nated with some disinfectant, in every case of labor, sim-
ple or complicated, and continued the injection until the
water returned without tinge. To its use after plastic ope-
rations especially he wished to direct attention. In sec-
ondary hemorrhage from opening of large vessels we have
in the hot-water douche a means for its control of which
he wished to make special mention. Dr. Smith then re-
ferred to cases reported in a lecture recently published
from Dr. Skene, of Brooklyn, and expressed himself sur-
prised, in the first place, that Dr. Skene had found that
the hemorrhagic diathesis prevented the performance of
operations, and more surprised that he had been unable
to control hemorrhage during operation. Dr. Skene
had ignored entirely the virtues of the hot-water douche.
Dr. Smith was perfectly satisfied that it would arrest
hemorrhage in cases precisely like those reported by
Dr. Skene, as well as in manv other cases in which
bleeding of an alarming character occurred. He then
related the history of cases in which he had used this
agent with most satisfactory results. He wished to di-
rect attention to three points : i, the great advantage of
the hot-water douche over all means for arresting sec-
ondary hemorrhage ; 2, its entire efficiency as a hemo-
static where it can be carried to the source of the hemor-
rhage ; 3, the simplicity of its application.
Dr. Reamy, of Cincinnati, briefly referred to the merits
of this remedy, and said that for some time it had been
his custom to have a stream of hot water running over
the surface during the perineal operation, instead of using
sponges.
Drs. Chadwick, of Boston, Goodell, of Philadelphia,
and H. P. C. NV'ilson, of Baltimore, spoke of the efficacy
of the hot-water douche as a hemostatic.
Dr. Campbell, of Augusta, Ga., indorsed what had
been said in favor of the hot-water douche. So far as
post-partum hemorrhage was concerned, he had relied
upon iodine, as recommended by the late Dr. Trask, for its
control — one part of tincture of iodine to three or four of
water, and injecting it into the uterine cavity. Dr.
Campbell also said there were two kinds of hsemostatics ;
one which acts on the calibre of the bleeding vessels,
causing them to contract and so arrest the bleeding, the
other acting chemically on the blood, and so plugging up
the lumen of the bleeding vessel. The first kind is of ser-
vice in post-partum hemorrhage, the second answers only
for the arrest of hemorrhage in cases where it is neces-
sary to produce a clot to obstruct the circulation.
Dr. Goodell referred to the efficacy of hot vinegar
as a hemostatic.
Dr. Mann, of BulTalo, referred to a case in which he
was unable to control the hemorrhage with the hot-water
douche.
Dr. Goodell thought Dr. Mann's case was one in
which it should not be expected that the hot water would
arrest the hemorrhage. [Cutting of the circular artery in
cancerous tissue].
Dr. Barker asked what hemostatic shall be used when
the delay of fifteen or twenty minutes for the hot water
to act could not be permitted without imminent risk of
losing the patient's life. He was not prepared to answer
the question. He had used in one such case the gentle
application of cotton, wet in Squibb's fluid extract of
ergot, and sinii)ly threw it out as a suggestion, that it
might also possibly be of service in other cases.
The discussion was closed by Dr. Smith.
Dr. C. D. Palmer, of Cincinnati, then read a paper
entitled
SOME POINTS CONNECTED WITH THE SUBJECT OF DYS-
MENORRHCEA.
That this condition is mechanical in its origin is one
of the most natural conclusions. In a certain proportion
of cases obstruction in the uterine canal exists, and in
the region of the external os most frequently. But the
interest in the paper centred in the arguni'ents to prove
that the disease is not mechanical in character, but a
functional disease, essentially a neurosis. Dysmenor-
rhoea occurs without any abnormal condition of the uterus
which can be detected. There are instances in which
well-defined abnormalities of the uterus exist, and yet
there is no dysmenorrhea. There are cases of stenosis
without menstrual pain. There are cases of well-defined
flexion and yet no dysmenorrhoea. Other points similar
in character were made by the author of the paper. In
all cases treatment should be purely constitutional until
the necessity for local exploration becomes apparent and
justifiable. The dysmenorrhosa expresses a fault in the
nervous system at large, and local treatment may be
united to thorough attention in that direction, but the
cases requiring it are very rare after thorough general
treatment has been tested. Iron when the flow is scanty
and lacks color ; arsenic when the flow is prolonged
and too frequent. The virtues of iron may be increased
326
THE MEDICAL RECORD.
[September 22, 1883.
by the addition of mix vomica, phospiiorus, etc. Elec-
tricity may be of service, especially in the partly neurotic,
spasmodic, rheumatic forms of the disease. He had
used a combination of bichloride of mercury and iodide
of potassium with good results, independent of any spe-
cific disease. Two remedies he directed special attention
to : I, concentrated tincture of ciniicifuga racemosa in
moderate doses three days prior to the jferiod and con-
tinued in smaller doses throughout the flow ; 2, tincture of
Pulsatilla given in a similar way. Dilatation is indicated
only in the neurotic spasmodic forms, and then after
failure of medical and constitutional treatment. If
stenosis of the canal exists, it may be opened up by in-
cision ; and if it does exist it should be opened up before
secondary complications caused by it are developed.
Dr. Ch.\d\vick., of Boston, said that he had listened to
the paper with great satisfaction, because it contained
much the same teachings which he had been accustomed
to give for several years. He had been gradually giving
up the belief in structural constriction of the cervical
canal, and consecpiently the belief in obstructive dys-
menorrhcea.
Dk. Barker, of New York, regarded the subject as one
of great interest and importance, and liad listened to the
paper with much pleasure. In most respects he was in
thorough accord with Dr. Palmer, and rose merely to
supplement the paper with some new points concerning
treatment. He believed that mechanical obstruction, as
a cause of dysmenorrhcea, existed in only a small per-
centage of cases. That it does exist in some cases, he
thought all were convinced. On the other hand, patients
who have had dysmenorrhcea until they became mothers
have had the dysmenorrhosa return just as badly as before
when menstruation has been re-established ; and, there-
fore, as had been stated by Dr. Chadwick, while dys-
menorrhea and mechanical obstruction may co-exist,
they do not necessarily bear the relation of cause and
eftect. He believed there are two forms of dysmenor-
rhcea— one dependent upon the uterus itself, and the
other ovarian. Either form may be painful, but he be-
lieved that by careful inquiry a differential diagnosis
could be made between them. In the uterine form there
are cases which do not depend on obstruction, and which
are yet attended by great pain up to the time of the flow;
but as soon as the flow begins the pain ceases, and the
patient is comparatively easy during the remainder of the
period. In such case he regarded the pain as due to an
effort of the uterus to get rid of the plethora by rupture
of capillaries, etc. These two forms occur both in ple-
thoric women and in those whose general condition is
the ideal standard of health.
With regard to treatment for these varieties he fully
agreed with the author of the paper concerning the efii-
cacy of iron ; but the preparation which he had usually
inescribed had been the lactate, three to five grains three
times a day, generally associated with chlorate of potash.
This treatment is begun about ten days before tiie men-
strual period should appear. Another remedy, which is
almost specific in uterine dysmenorrhcea, is apiol ; but to
get its good effects its use should be begun at least hco
days before the period should return, and kept u]) in the
period. Give two capsules, usually, after each meal.
There is another class of cases in which the flow is
unattended by pain until it has continued for two or three
days. These patients are usually strong, of full habit,
complain of headache, vertigo, imperfect vision, etc.,
previous to the period. These belong to the ovarian
variety, and here he uses the bromides, preferably the
bromide of sodium, beginning about a week before the
I^eriod and administering from ten to fifteen grains in
tlie middle of the forenoon, afternoon, and at bedtiiiie.
Apiol IS also serviceable in these cases.
The further discussion of Dr. Palmer's paper was post-
poned until the reading of i)apers had been completed.
The Society then adjourned to meet at 10 .-v-.m. on
H'ednesday.
Wednesday, September 19TH — Second D.w — Morn-
ing Session.
The Society was called to order at 10 .\.m. by the
President.
Dr. Oilman Kimball, of Lowell, Mass., President,
then delivered the annual address, which consisted of a
biographical sketch of dr. NATHAN SMITH, FOUNDER
OF THE DART.MOLTH MEDICAL COLLEGE,
the genius, indomitable will, untiring energy of whom, the
speaker believed, had done more for practical medicine
and surgery than that of any other single individual in
this country. With regard to his connection with the
subject of ovariotomy, he was the second to perform it
successfully in this country, the operation taking place at
Norwich, Vt., in July, 182 1. It was as truly original as
was the first performed by McDowell, and simply by
priority of date was McDowell distinguished beyond dis-
pute as the father of ovariotomy. It was not Dr. Kim-
ball's purpose to raise any question as to the justice of this
claim, now acknowledged throughout the civilized world.
While listening to the memorial address by Professor S.
D. Gross, at the unveiling of the monument erected to
McDowell, it occurred to him that something more might
justly be said than to merely chronicle the fact by saying
that Smith had the courage to follow in the footsteps of
McDowell.
The President then gave a biographical sketch of Dr.
Smith, who was born of respectable parents in Massa-
chusetts, September, 1762. From this point the speaker
traced the career of the subject of his discourse through
his school days, entrance upon his professional work, and
his subsequent labors as a physician and surgeon, in which
were exemplified " the eagle's eye, the lion's heart, and
a woman's hand."
The address closed with special reference to the oper-
ation of ovariotomy, and the opinion was expressed that,
in point of absolute merit. Dr. Nathan Smith is entitled
to the same honors which have been bestowed upon
Ephraim McDowell.
.•\fter a few com|ilimentary, and to a certain extent
critical remarks by Professor S. D. Clross, of Philadelphia,
Dr. Reamv, of Cincinnati, read a paper entitled
A RARE FORM OF ABDOMINAL TUMOR.
The author of the paper related the history of three
cases. The leading features as presented in the first
case, seen in consultation, in July, 1S7S, were the follow-
ing, as they existed in a patient thirty-eight years of age,
married fifteen years, sterile, and in ordinary good health
up to three years ago, and who was supposed to be suf-
fering from ovarian tumor. The growth was abdominal,
in fiont of the intestines, cystic, and contained fluid. It
had no connection with either the uterus or its appen-
dages, and no special change was produced in the con-
dition of the abdomen whether the patient was in the
upright or horizontal position. The fluid, removed by
tapping, was red and contained blood-corpuscles, both
in good condition and broken down. The paper closed
with a brief reference to the scanty literature of the sub-
ject— namely, tumors of the omentum, and the three
cases reported belonged to the variety of bloody. Mi-
croscopical examination revealed tiie tumor (the speci-
men presented) to be sarcoma.
Dr. C. C. Lee, of New York, thought the cases be-
longing to the group described by Dr. Reamy were very
rare, and tliat the possibility of diagnosticating sarcoma
of the omentum before induration had occurred had not
been established. He could conceive that if the general
rule of tapjii.ig was established this class of cases woulil
become mucli better known than at present.
Dr. Sutton, of Pittsburg, thought it impossible, be-
forehand, to determine whetlier, in any given case of
tumor of the omentum, the disease was sarcomatous or
carcinomatous. But if the tumor contains fluid, he
September 22, 1883.]
THE MEDICAL RECORD.
327
thought it dangerous practice to use either the aspirator
or trocar. If the surgeon feels justified in opening the
belly to obtain fluid for examination, use the hypotlerniic
syringe. Besides, Dr. Sutton believed, in the present
stage of surgery, that the operator is justified in discard-
ing all punctures and in opening the abdomen by an
exploratory section. If it is believed that the tumor is
malignant after the opening has been made, the best
surgery is to close the wound without interfering with the
growth.
Dr. Campbell, of Augusta, Ga., thought that such
growths were apt to be pedunculated, and that it was
well, therefore, to remove the tumor and give the patient
an additional chance.
Dr. ReAiMv believed that, all things considered, tap-
ping is a justifiable procedure, at least for the relief of
symptoms. In two of his cases the operation was fol-
lowed by recovery, and he believed it to be as well to
tap as to cut the belly open.
A paper by Dr. Jenks, of Chicago, on
A NEW METHOD OF OPERATING FOR FISTULA IN ANO,
was read by title.
Dr. H. F. Campbell, of Augusta, Ga., then read a
paper on
CONGENITAL FISS0RE OF THE FEMALE URETHRA, WITH
EXTROPHY OF THE BLADDER.
A case was reported, and the interest centred in the
question, When is the proper time to operate ? It is a
matter of quantity of tissue and space. He held that
after puberty the operation might be performed with pros-
pect of better result than if performed with the present
limited quantity of tissue and space. The jiatienl was a
young female child.
Dr. Browne, of Baltimore, related the history of a case
with calculi, occurring in a child eight years of age. He
projjosed to perform the supra-pubic operation, and re-
move the calculus, but the family postponed it and the
child died.
Dr. Mann, of Buffalo, narrated a similar case to that
reported by Dr. Campbell, and in which he advised op-
eration at once, which was performed by Dr. Minter,
of Buffalo, and with completely satisfactory results.
Dr. T. Addis Emmet, of New York, then read a paper
entitled
A STUDY OF THE ETIOLOGY OF PERINEAL LACERATION,
WITH A NEW METHOD FOR ITS PROPER REPAIR.
During the last twenty years the author of the paper
had given more thought to this subject than to any other
likely to be brought before the Society. He had reached
the conclusion that simple laceration of the perineum,
extending even through to the sphincter, but not involv-
ing it, produces no inconvenience after the parts have
once healed, except by the disturbances occasionally
found of a reflex character from the presence of cica-
tricial tissue. It has been frequently observed that the
disturbance after laceration of the perineum is not in
proportion to the extent of the injury ; also that the
perineum has been lacerated for years without causing
inconvenience ; on the other hand, it has been equally
puzzling to explain the amount of suffering attending the
slightest degree of injury; and again, that the same
kind and amount of suffering is experienced when no in-
jury of the perineum has been received.
Notwithstanding the many modifications of Baker
Browne's operation. Dr. Emmet believed that no one had
relieved any of this class of patients by simply uniting the
tissues which had been lacerated, and no more. Si>/>'i
portion of the posterior vaginal wall inust be engaged in
the line of union in order to secure any benefit. The true
condition of the parts he regarded as a rupture of the pel-
vic fascia reflected over the muscles of the vaginal outlet.
and that to afford relief this fascia must be restored as
nearly as possible to its original position.
In the operation it is useless to carry denudation so
far externally as is often done. It should be limited to
the true osteum vagina;, and the jierineum should be
further strengthened by bringing forward a transverse
fold of the posterior wall of the vagina, even if there is no
rectocele. The mistake should be avoided of taking too
much of the posterior wall. The essential features of the
operation are as follows : Make two transverse crescentic
denudations, an outer one with concavity looking back-
ward and an inner one with the concavity looking for-
ward. To establish the situation of these crescents, three
tenacula are to be employed. With two of these instru-
ments the open mouth of the vagina is to lie brought to-
gether by inserting the points at the level of the upper
limit of the remains of the hymen, one on each side.
The points thus seized would mark the extremities of the
anterior crescent, and while tliey are held together with
the instruments the third tenaculum is to be inserted in
the posterior vaginal wall in the median line, at a point
that could be drawn forward to meet the two former
without giving rise to undue tension. This point would
mark the centre of the jiosterior crescent. The denuda-
tion having been eftected, the two crescentic denuded
patches are to be stitched together. This has the effect
of drawing the tissue of the perineum upward so that the
vertical rent in the median line will be much shortened,
and can now be closed with a few sutures, the last step
not being essential.
The ])aper gave rise to a considerable number of ques-
tions, which Dr. Emmet answered, and illustrated his
plan of operative procedure upon the black-board. The
discussion of the paper was postponed until the after-
noon session.
The Society then adjourned to meet at 3 p.m.
Second Day — Afternoon Session.
The Society was called to order by the President.
Dr. Emmet's paper being before the Society for dis-
cussion, the author gave a brief resume of his views as
follows : Laceration of the perineum does not produce the
trouble which is attributed to it. It is never lacerated as
it seems to be ; there is no such tissue there. The tis-
sue in front of the rectum is frequently thicker than be-
fore the injury. No such body exists as the perineal
body as it is represented in the books, and as operators
strive to restore. The injury is more apparent than real.
He held that even if the laceration of the perineum is
not repaired the injury can be best repaired by bringing
together a certain portion of the posterior wall of the
vagina just at the entrance of the vagina, where it joins
with the soft parts. He further held that we may ex-
clude, in performing any operation, everything with ref-
erence to the external organs of generation outside of
the line of the hymen around the vagma. The fascia,
forming two sulci, is as important to keep up the peri-
neum, the posterior wall of the vagina against the ante-
rior wall, as a pair of suspenders is to keep the seat of a
pair of pantaloons in place. By his operation, bring-
ing a fold of the posterior wall of the vagina up, we
restore the attachments and support, and may let the
perineal injury go entirely, if the operator chooses to do
so ; it matters little whether or not stitches are intro-
duced. The special feature was the part which the pel-
vic fascia plays in supporting these parts, and that the
perineum has little or nothing to do with it. Whenever
a condition is seen in which the posterior wall of the
vagina is not in contact with the anterior wall, we might
be sure that ihafaseia is not in proper condition.
Dr. Reamy, of Cincinnati, thought that if this opera-
tion was to be substituted for the one so admirably de-
scribed by Dr. Emmet in his book, it was a comfort to
know that he had had an opportunity to undo the great
328
THE MEDICAL RECORD.
[September 22, 1883.
evil which he had done. He conduded from Dr. Em-
met's last explanation, as well as from the paper itself,
that Dr. Emmet believed all the perineal tissues down to
muscles amounts to nothing. If this is true he should
not be surprised to see some child born with all these
parts lacking. He asked Dr. Emmet if he had not found
any number of superficial lacerations where stretching of
tlie posterior wall of the vagina does not exist, the sei>ara-
tion from the deeper tissue is not great, and yet the
posterior commissural junction of the labial walls on both
sides up to the entrance of the vagina are lying above
the circle of the hymen as it exists in the virgin state ?
He was unable to see how the proposed operation could
do more than dispose of redundancy of tissue in the pos-
terior wall of the vagina in a limited number of cases,
and could not agree with Dr. Emmet if he recommended
it as a substitute for his former operation for this in-
jury.
Dr. Frank P. Foster, of New York, denied entirely
that the perineum has anything to do with the support
of the structures above it, when all the parts are in a
normal condition. He thought there was not a single
instance in anatomy where an organ rested upon any-
thing beneath it. What the perineum will do, and often
does do, but what it does not do normally, is quite an-
other question. But it does not by any means follow
that the perineum has no function.
Dr. SuiTON thought that any operation for lacerated
perineum that did not have for its object the speedy res-
toration of the perineal body could not stand in the
light of the teachings of the last ten years.
Dr. Emmet said he expected it would be stated that
he had denied the existence of the perineum, although
he had endeavored to explain how it was lacerated and
drawn to each side like the separation of a curtain. He
did not deny the existence of the perineum, but simply
denied that any such surface exists as we have been led
to believe, and which operators have aimed to build up.
He thought the gentlemen would not disagree so much
with him as appeared when they could have the oppor-
tunity to study his paper leisurely and carefully.
Dr. C. C. I^ee, of New York, then read a paper on
THE MANAGEMENT OF ACCIDENTAL PUNCTURE AND OTHER
INJURIES OF THE GRAVID UTERUS AS A COMPLICA-
TION OF LAPAROTOMY,
in which he gave the details of seven cases of this rare
complication — all he could find in medical literature —
including one that had occurred in his own practice.
From them he deduced the following conclusions :
First. — The pregnant womb may be punctured or
otherwise wounded during laparotomy without necessarily
causing abortion.
Second. — Miscarriage seems with a priori and from
clinical evidence to depend upon injury of the uterine
contents, not of the womb itself, however severe.
Third. — If the former has certainly occurred. Cesar-
ean section is indicated and should be promptly per-
formed. In this case the utmost care must be subse-
quently taken to secure thorough drainage from the
uterine cavity.
Fourth. — If the uterine walls alone are injured, the
wound is to be treated on general principles. If a deep
puncture or incision, it must be sutured with the minut-
est care, with exact coaptation of the edges. For this
purpose fine silk sutures, rendered antiseptic, are the
best. If a nick or superficial puncture, it must not be
ligated, for ligatures cut ijuickly through uterine tissue ;
if too small to be sutured, the bleeding points must be
lightly touched with the tiiermal cautery until oo/ing has
ceased. Good surgery and the dictates of humanity
alike demand that under such circumstances a chance of
survival be given the child as well as the mother.
The paper was discussed by Drs. Wilson, of Baltimore,
Garrigues, of New York, and Byford. of Chicago.
Dr. a. Reeves Jackson, of Chicago, then read a
paper entitled
IS EXTIRPATION OF THE CANCEROUS UTERUS A JUSTI-
FIABLE OPERATION ?
The purpose of the paper was to discuss the single
question in view of the facts known to us. His conclu-
sions were as follows : He had endeavored to show : i.
That diagnosis of uterine cancer cannot be made suffi-
ciently early to insure its complete removal by extirpa-
tion of the uterus. 2. When the evidence can be estab-
lished, there is no reasonable hope of effecting a radical
cure, and other methods of treatment offer far less dan-
gers than excision of the entire organ, and are equally
effectual in the amelioration of suffering, retarding the
progress of the disease, and prolonging life. 3. Extir-
pation of the uterus is highly dangerous, and neither
lessens suffering — except in those whom it kills — and
does not give a reasonable promise of recovery, and
should not be adopted in modern surgery.
Dr. Van de \Varker, of Syracuse, explained how he
had sloughed out the uterus by means of chloride of zinc,
and exhibited microscopic sections which he believed
illustrated that tissue not the seat of cancerous infiltra-
tion had been reached. He had operated in this manner
in eight cases and with gratifying results.
Dr. Em.met, of New York, said that the author of the
paper had fully expressed his own convictions concern-
ing this operation. He had oiiposed the operation from
the beginning.
Dr. Baker, of Boston, said he was a believer in the
local origin of cancer, and therefore that operative meas-
ures were of great advantage. He explained at some
length his method of operating without removing the
uterus, and several of his patients still lived, now at least
five years after the operation was performed, and are
apparently well. We thought that sufficiently early diag-
nosis could be made in many cases as to allow of com-
plete removal of the disease. He thought that the cases
in which complete removal — extirpation of the uterus —
is justifiable were few in number.
Dr. Palmer, of Cincinnati, endorsed Dr. Jackson's
paper.
Dr. Sutton, of Pittsburg, thought the operation justi-
fiable, and described difterent methods of operating, as
practised by Schroeder and Martin.
Dr. Jackson, in closing the discussion, said that in
performing this operation the operator was like the game-
ster who stakes what he does not own, the life of his
patient against the heaviest of odds.
OFFICERS FOR THE ENSUING YEAR.
President — .-\lbert H. Smith, Philadelphia ; Vice-Presi-
dents— James R. Ciiadwick. Boston ; Samuel C. Busey,
Washington ; Secretary — Frank P. Foster, New York ;
Treasurer — Matthew D. Mann, Buti'alo ; Members of
Council— ■'Y . G. Thomas, Ford\ce Barker, New York ; T.
A. Reamy, Cincinnati ; R. S. Sutton, Pittsburg ; R. B.
Maury, Memphis.
The Society then adjourned to meet on Thursday, at
the close of the Executive Session.
[To be concluded.!
The Numerical Strength of the Profession i.n
Paris. — The Revue de Th'crapeutique gives an exact cen-
sus taken of all the practitioners in Paris at the present
time. There are in Paris and the connnunes of the de-
partment of the Seine, 1,915 doctors of medicine, 12 doc-
tors of surgery, 83 officicrs de sante 43 foreign doctors,
1,500 mid wives, S45 pharmaciens, and 95 veterinary
doctors. One of the oldest doctors in Paris is M. Ricord,
born in 1800, and made a doctor in 1826. These figures
are, of course, exclusive of the host of illegal practition-
ers of all kinds to be found in Paris.
September 22, 1883.]
THE MEDICAL RECORD.
STATE MEDICAL SOCIETY OF VIRGINIA.
Fourteenth Annual Session, held at Roekbridge Alum
Springs, Va., September 4, 5 and 6, 1883.
(Concluded from p. 302. )
The newly elected President, Dr. J. Edgar Chancel-
lor, of Charlottesville, being in the chair, the afternoon
session, September 6th, was opened by Dr. S. K. Jack-
son, who read the report on
ADVANCES IN THE PRACTICE OF MEDICINE.
He said that although Huxley has dated the advance of
medicine as occurring eight centuries ago, scientific
medicine can be hardly said to have made much prog-
ress until the discovery of oxygen, and showed how much
benefit the profession has derived from the young science
of biology. By the advancement of the germ theor)',
the i)athology and therapeutics of all diseases of para-
sitic origin have been revolutionized in the past few
years, and the study of the difterences between germi-
cides is one of the most important questions of the day
in practical medicine. For years mercury has been em-
ployed for the destruction of epizoa;, but the profession,
imtil within a comparatively late interval, did not know
how much good in the destroying of entozoa; was being
done by its administration. Dr. Jackson proffered the
law "that no organism can live in its own excreta — that
the jiroducts of its life-processes become poisonous to it,
stop its ravages, and destroy its hfe." He believed that
it is only as a germicide or antidote that quinine is to be
used, without reference to any other therajieutical or
physiological (|uality it may possess. He spoke in favor
of Koch's discoveries, announcing his full belief in their
practical im]jorIance. Concluding, he gave some very
interesting mortality statistics of the city of Norfolk, Va.,
showing the diminution in its death-rate from medical
attention.
Dr. Dabney, of Charlottesville, said that " tubeicular
bacilli " are not yet proven, as the same micro-organisms
have been found in many other jilaces. He also in-
stanced the fact that at the Brompton Hospital for Con-
sumptives over fifteen thousand patients were treateil in
twenty years, and during that time there was no case of
tubercular disease occurring among the attendants.
Dr. Wni. C. I)abney, of Charlottesville, read a volun-
teer paper entitled,
THE PRESENT ASPECT OF THE BACILLUS TUBERCULOSIS
QUESTION.
He did not believe in the value of Koch's so-called dis-
covery of the bacilli of tubercle, in the face of the con-
tradictory testimony offered by so many other observers.
Lichtheim and Cramer have found micro-organisms, be-
having ]5recisely like Koch's bacilli with staining fluids,
in the fecal discharges of healthy individuals ; Spina
claims to have found similar organisms in pus from a
rabbit's thigh, formed after traumatic injury ; Echile has
found bacilli in purulent discharge from the ear, and
Rosenstein has found them in the urine. Koch says
that the bacilli are present in the incipiency of tubercu-
losis, and are its essential cause, while Spina slates that
they are only found in caseous tubercular deposits that
have been exposed to the atmosphere, and do not cause
the disease. Koch's experiments have been mostly per-
formed on the lower animals, rats, rabbits, and guinea-
pigs, and Dr. Dabney points out the fact that the inocu-
lation of these animals with various substances is liable
to lead to caseous infianniiation and tuberculosis.
Dr. Chas. M. Shields, of Richmond, read the re-
port on
ADVANCES IN OPHTHALMOLOGY AND OTOLOGY,
in the course of which, after dwelling on some of the
advances in the physiology of the eye, he mentioned the
investigations made in Dr. Hirschberg's clinic, bearing
on sympathetic ophthalmia, in which after the enuclea-
tion of four eyes which had been subjected to the oper- •
ation of neurotomy from two months to four years before,
the ciliary nerves were found to have reunited. He
thought that neurotomy should not be adopted as a sub-
stitute for enucleation unless the patient could be under
occasional observation afterward, so that the eye could
be enucleated if the cornea again becomes sensitive.
The operation of trituration of the cortex of the lens in
incipient cataract, to hasten its maturity, was favorably
commented upon. The use of antiseptic precautions in
cataract was advocated, but the spray of carbolic acid
should be used before the operation to disinfect the air
of the room. He does not use it during the operation
because of its liability to dull the instruments, these lat-
ter being disinfected in alcohol. An addition to the
therapeutic agents appropriate to the treatment of iritis,
is the sulphate of eserine, used after the manner of Dr.
Seely to contract the blood-vessels of the iris, while my-
driasis is still kept up by atropine. It was also recom-
mended in the supijuration following cataract extractions,
the pupil being kept dilated here too by atropine. In
peripheral ulceration of the cornea, eserine is becoming
popular, and as a treatment for acute glaucoma its
merits are better recognized. The electro-magnet for
removal of metallic substances from the vitreous and
ciliary bodies, the hydrobromate of homatropine for tran-
sient dilatation of the pupil for ophthalmoscopic exam-
ination, and the value of nitrite of amyl in amaurosis
resulting from large doses of quinine were all mentioned
at length. Passing to otology and laryngology, the re-
porter advised sulphide of calcium in doses of from one-
sixth to one-fourth grain every two or three hours, in
inflammation of the external auditory meatus and furun-
cles of the meatus. He had also found it useful in mas-
toid disease, but liberated pus when found to exist. The
use of special instruments in removing foreign bodies
from the ear was deprecated, as the larger proportion of
them could be removed without hh.rm by the syringe. In
suppurative intlammation of the middle ear, the dry
method of treatment had been found the most eftec-
tual. Powdered boracic acid is blown into the canal
until it is filled, and kept in place by a bit of cotton,
after preparing the ear by cleansing it with borated cot-
ton instead of the syringe ; this mode of treatment often
curing old cases of otorrhcea in two or three applications.
The reporter advised the plan of Schalle in treating
many cases of nasal and post-nasal catarrh, which is to
apply powders of nitrate of silver and calcined magnesia,
in the proportions of i to 6, i to lo, or i to 15 parts,
to the nasal and post-nasal cavities. He closed by stat-
ing his belief that hypertrophic nasal catarrh was never
permanently cured, until the redundant tissue had been
removed, either by Jarvis' snare or the galvano-cautery.
Upon the conclusion of his jiaper Dr. Shields exhib-
ited a sample of the new remedy for granular lids and
pannus, abrus precatorius, or jequirity seeds, at the same
time giving reasons for his belief that the seeds were not
such a new article and great rarity as is commonly sup-
posed.
Drs. Parker, Jackson, and White discussed the paper,
the latter reading a monograph upon the subject of
jequirity, in which he gave the testimony for and against
the drug, concluding "that its value has been clinically
demonst'rated to exist, and that it appears as if the pro-
fession has in its hands a remedy for that disgrace of eye
surgery, granular ophthalmia.
Dr. J. A. White, of Richmond, read a volunteer
paper on
INJURIES TO THE EVE,
illustrated by reports of a number of cases. So little is
said concerning these affections in the text-books, that
the detailed cases reported by Dr. White were of extreme
interest and value, those illustrative of concussion and
compression being especially so. One of the cases was
peculiar for the rapidity of blood-absorption in the eye.
330
THE MEDICAL RECORD.
[September 22, 1883.
The patient, a boy of fourteen years, was struck in the
eye by a stone July ist ; treatment by muriate of
pilocarpine, for hemorrhage into the vitreous, began on
the 4th ; on the 6th, the vitreous was perfectly clear
from blood ; probably one of the most rapid absorptions
of the kind on record, as the time occui)ied is usually
from three to six weeks. Another remarkable case was
that of a boy twelve years of age, who was struck with
great force on the eye when the lids were closed, by a stone
from a " gravel-shooter," rupturing the anterior capsule,
without cataract following the injury. Dr. White stated
that this result was almost unique, he had never seen a
similar instance in fifteen )-ears' eye practice. The iris
was somewhat torn, and the e.\uding blood acted as a
kind of plug to prevent opacification of the lens sub-
stance by the aqueous humor He concluded with some
very practical remarks on the stretching the zonula of
Zinn, and dislocation of the lens, with cases.
Dr. George Ben Johnston, of Richmond, presented
a report of forty-seven cases of
URETHRAL STRICTURE TRE.ATED BV INTERNAL URE-
THROTO.MV.
He claimed this operation as the surest method of cur-
ing stricture in the male urethra. The main features of
his treatment are thorough division of the stricture and
persistent local treatment for a long time afterward. He
stated that many of his cases were re-e.xamined froju
four months to four years after cutting, and no contrac-
tion was found.
Dr. W. F. Barr, of Abingdon, chairjnan of the Com-
mittee on Advances in Hygiene and Public Health, did
not report in full, but made an apology to the Society in
writing, in the course of which he pointed out the facility
with which any person is able to practise medicine in
the State of Virginia, by the simple payment of a license
fee, and mentioned the ineftectual eftbrts made in past
years to procure remedial action from the Legislature.
The Secretary read a preamble and series of resolu-
tions presented by Dr. \V. G. Rogers, of Charlottesville,
which were unanimousl}- adopted, in favor of the Society
appointing a committee to petition the Legislature at it's
ne.xt session to make it a penal offence for any druggist
to refill a prescription containing opium, morphia, or any
other narcotic poison, for any person, without the special
order of a physician to that effect, on account of the in-
fluence in producing the " opium habit " and its kindred
affections which the habit of indiscriminate prescription
refilling, at present so common, has so often brought about.
Dr. Rawlev Martin, of Chatham, read a volunteer
paper devoted to a description of an
EPIDEMIC OF DIPHTHERIA IN PITTSYLVANIA COUNTY,
occurring during the summer and fall of 1S82. The
origin of the epidemic was never found, although care-
fully searched for, and it seemed to have arisen sponta-
neously. All the cases were developed either alom^
small watercourses, or near places wiiere rank vegeta-
tion was most abundant, although one of tlie worst cases
occurred in a private house, where the best sanitarv con-
ditions possible existed, miles away from any point of
contagion. Decided croupal symptoms were generally
absent, and many cases died after all throat affections
had subsided. No adults suftered from severe sym|)toms
and tlie children attacked who died were between three
and twelve years of age. Nursing children suffered from
symptoms of an erysipelatous character. The oiiidcmic
subsided as suddenly as it had begun, and was followed
by a general outbreak of follicular pharyngitis. A full
dose of calomel at the beginning of a sthenic case of the
disease invariably modified its course, and alcohol was
one of the best remedies in all instances. A number of
cases were saved by rectal alimentation. Sanitary con-
ditions seemed not only to be of little use, but where
they existed the symptoms were most malignant.
Dr. Wm. H. Coggeshall, of Richmond, gave
reiter's theory of diphtheria,
which is simply that the disease is caused by the fibrin-
destroying function of the liver not being properly ful-
filled, and, as a natural sequence, calomel is indicated for
the restoration thereof. Dr. Reiter gives twenty grains
at gnce, and ten grains every hour afterward, until half
an ounce of the drug is taken.
Dr. Bedford Brown, of Alexandria, read a paper
based upon his
thirty years' personal experience in diphtheria.
He thought, from his observation, that two of the
gravest symptoms in this disease are the peculiar erratic
decline of the heart's action and the almost correspond-
ingly rapid decline in the number of red corpuscles in the
blood. His experience has taught him to believe thor-
oughly in the non-identity of membranous croup and
diphtheria. It seemed to him very often that the cases
where fever remained when the local symptoms began to
abate succeeded the best. He recalled the time when
diphtheria was considered a malignant type of a local
disease. One of the very great favorites in local treat-
ment then was a mixture of myrrh, creasote, and turpen-
tine. He pointed out the different modes of using mer-
cury. Formerly emetics were given, and then mercury in
large sedative doses ; in later times we give the latter in
sinall, frequent, alterative doses. Quinine has held
favor for use in this disease longer than any other drug,
certainlv for over a c[uarter of a century. He thinks that
the paralytic eft'ect of the diphtheritic poison on nervous
systems can best be retarded by alcohol. He never saw
a serious case recover where alcohol was not used. His
experience has taught him that if belladonna, ergot, or
digitalis cannot stay the paralvzing eftect of the poison
on the heart through the sympathetic system nothing else
will. Such powerful agents as bromine and carbolic acid
should be used locally with great caution. Dr. Brown
always pays the greatest attention to the digestive organs
during an attack of diphtheria, as in every serious case
such organs are more or less in a condition of paralysis,
and it often becomes a vital question as to how the pa-
tient shall procure enough strength from food to support
the powers of life. He sustains the patient by means of
dilfusible stimulants, gives them plenty of fresh air and
digestible food, and believes in the great importance of
keeping the nose and throat as clean as possible. For
this latter purpose he uses with an atomizer, listerine, i
oz.; aq., 4 oz.; Labarraque's sol., ^ 07..; carbol. acid, 6
drops. Internally, tinct. ferri chlor., 2 dr.; chlor. pot., i
oz.; tinct. nuc. vom., 20 drops ; tinct. digitalis, 4^ dr.;
aq., 2.} oz.; one teaspoonful every two hours.
Dr. Dabney said that he had seen cases occur where
excellent sanitary surroundings were present, and was
positive that peritonitis had been a sequela of diphtheria
in his observation.
Dr. S. B. Morrison, of Rockbridge, never saw a case
that was not constitutional in origin, but believed also in
the constant use of local treatment. His own observa-
tion had taught him that the diphtheritic poison can re-
main quiescent in one place for years, and then break
out suddenly. He thought that all our remedies should
be used at shorter intervals in the disease than is the
present practice, and that where the vitality of an indi-
vidual is strong the disease cannot be contracted, not-
withstanding full and frequent exposure. He had no
doubt but that the germ of typhoid fever and diphtheria
was the same, with a diftcrcnt manifestation in each case;
and strongly believed in complete isolation of the patient
in the latter disease.
Dr. St. Pierre Gibson, of Staunton, believed that
peritonitis may be produced by diphtheria, citing a case
in point ; and had no doubt about the fact that the poi-
son of diphtheria may linger in mountain regions for
years without sign, and then suddenly become endemic.
Dr. A. M. Fauntleroy, of Staunton, cited a case to
September 22, 1883.]
THE MEDICAL RECORD.
OJ'
show its peculiar contagious or infectious properties,
which had occurred in his own practice. A child dying
from diphtheria at a distance was brought home, its body,
packed in ice, lying for a few hours before burial in a
room. A day or two afterward a strong, healthy servant-
girl cleaned up the floor with warm water, where the ice
surrounding the body had melted and dripped, and within
a short space of time developed a malignant case of the
same disease. In another instance a boy stopped over
night at a house where diphtheria hail occurred some
time before, and the next day entered an asylum for deaf
mutes, where thirty-two cases of the disease appeared in
a few days. He had often found general disturbance be-
fore any appearance of local lesion. He thought local
treatment was mainly important, because the membrane
present becomes, after a time, putrefied, and, of course,
if left alone the putrescent poison would be carried into
the circulation by the lymphatics. This was the reason
for the local employment of disinfectants. He found
one of the most unpleasant concomitants of the disease
to be the inability of the patient to ingest food, and in-
stanced one case of recovery where tlie child was fed for
three weeks through a tube. The local application he
preierred was a combination of Monsel's solution, car-
bolic acid, and glycerine, applied with a brush. For in-
ternal treatment he used chlorate of potash, large doses
of tincture of iron, five-grain doses of quinine, and un-
stinted whiskey.
Dr. William Selden, of Norfolk, during forty years
of practice, had never known abetter systemic form of
treatment than the chlorine made from muriatic acid and
chlorate of potash according to " Watson's Practice,"
first edition. Of this he uses one-half drachm to four
ounces of water, and has never seen a case die under
such treatment. For local application he employs, alum,
two drachms ; salicylic acid, one drachm ; sulphur, one
drachm, with enough glycerin to bring the mixture to the
consistence of honey, applying with camel's-hair brush.
This may be styled the general Norfolk treatment.
Adjournment to 7.45 p.m.
Evening session opened at the time appointed, the
President, Dr. J. Edgar Chancellor, in the chair.
Invitations were read from Rockbridge Alum Springs,
Blue Ridge Springs, and Rawley Springs, asking the So-
ciety to accept the hospitalities of each place for next
year's meeting, .^fter full resolutions of thanks had been
voted to the Rockbridge Springs Co. for their hospitality
of this year (all delegates having been received free of
charge during the session), the invitation from Rawley
Springs was accepted. An invitation from Alleghany
Springs was received too late to be voted upon.
Dk. A. M. F.'vuNTLEROY, of Staunton, read a paper,
by invitation, on
THE THERAPEUTIC VALUE OF ROCKBRIDGE ALUM WATER.
He gave a full description of the ten springs located
at the place of meeting, and fully described the great
value of the water in scrofulotic and syphilitic disorders,
the difterent waters being extremely alterative and deob-
struent in their action, and particularly valuable in many
instances in dissolving tubercular deposits. In cases of
dyspepsia the water of one or more particular springs di-
minishes the acid secretion from diseased gastric tubules,
and in torpidity of the liver it restores the normal activity
of that organ, probably through the presence of sodium
sulphate held in solution.
The President, Dr. J. Edgar Chancellor, delivered a
short address upon the therapeutical employment of the
Rockbridge alum waters, enumerating several serious
cases of strumous disease in his practice which were en-
tirely cured by their use.
Dr. J. Marion Sims, of New York, Honoraiy Fellow
of the Society, by letter greeted his fellow members, and
sent his best wishes for the success of the Society.
Dr. J. J. Chisholm, of Baltimore, made a few prac-
tical remarks on diphtheritic eye troubles.
Dr. L. McLean Tiffany, of Baltimore, in the course
of his remarks upon
TRACHEOTOMY IN DIPHTHERIA,
Stated that in his opinion, while the operation neve^"
cures the disease, but simply relieves one oppressive
symptom, it never kills the patient. He thought that it
is almost impossible to decide just when the difficulty of
breathing comes from the top of the windpipe, this indi-
cating the value of the operation. He never had been
able to exactly determine when the obstructing mem-
brane was above the sternum and when it was below the
conmion point of opening; and related the particulars of
a peculiar case where he opened the trachea just before
death, and found the windpipe so completely plugged
with diphtheritic exudation that neither a tracheotomy
tube nor a probe could enter.
Dr. L. B. Edwards, of Richmond, mentioned a case
where tracheotomy relieved dyspnrea, although the
membrane was below the point of opening.
Dr. W. W. Parker, of Richmond, begged the
younger members not to become discouraged when they
lose a patient from diphtheria, as he did not believe that
any physician saves all his cases of that disease.
Dr. J. N. Mackensie, of Baltimore, stated that one
of the after-eftects of diphtheria not generally men-
tioned is adenoid growths in the post-pharyngeal space.
He believed that the simplest treatment for the disease
is the best, and relied mainly upon steaming for local
treatment. He thought the later German topical appli-
cation (one to two grains bichloride of mercury to one
pint of water), was excellent.
Dr. R. I. Hicks, of Casanova, mentioned a peculiar
instance where a diphtheritic jiatient associated with
many persons in the same locality without the produc-
tion of another case of the disease.
Drs. Patterson, \Vhiting, Craddock, and others, discussed
the subject of diphtheria and related a number of cases.
Dr. S. K. Jackson, of Norfolk, by request, described
his method of preventing
CHOLERA INFANTUM.
He gives the following preparation to any child that is
liable to contract the disease : sulphite of soda, hyposul-
phite of soda, bicarbonate of soda, each 32 grains, aro-
matic syrup of rhubarb, 2 ounces. One teaspoonful or
less, according to age, every two hours each morning,
until two or three doses are taken. He claimed never
to have had a case of the disease in his practice since
using the preparation.
The remainder of the session was occupied in trans-
acting Society business, and after deciding upon ma-
larial fever as the topic for general discussion at the next
meeting, the Society adjourned to meet at Rawley
Springs, in September, 1S84.
There has never before been a meeting, in the history
of the Society, so remarkably well attended and so re-
plete with interest and instruction to the members, as
that of 1883. Among the visitors present, Drs. Chisholm,
Tiffany, and Mackensie, of Baltimore, Md., may be men-
tioned as having assisted greatly to make the session one
of extreme practical value.
The officers elected for the ensuing year were : Pres-
ident—V)x. J. Edgar Chancellor, of Charlottesville ; First
Vice-President — Dr. S. B. Morrison, of Rockbridge ; Sec-
ond Vice-President— V)x. J. \. Graybill, of Amsterdam ;
Third Vice-President— V)x. Bedford Brown, of Alex-
andria ; Fourth Vice-Presidcnt—V)x. S. K. Jackson, of
Norfolk ; Fifth Vice-President— X)x. J. M. Estill, of
Tazewell C. H. ; Sixth Vice-President— 'Dx. T. J. Pret-
low, of Jerusalem ; Recording Secretary — Dr. R. B.
Cabell, Jr., of Richmond ; Corresponding Secretary —
Dr. Hugh Taylor, of Richmond ; Treasurer — Dr. R. T.
Styll, of Richmond ; Executive Committee— Dr. W. W.
Parker, of Richmond, chairman ; Drs. Black, Cunning-
ham, Claibourne, and Cleaves ; all other committees
holding over.
33'-
THE MEDICAL RECORD.
[September 22, 1883.
CovTcspondcncc.
SUPPORTS TO THE PELVIC ORGANS.
To THE Editor of The Medical Record.
Sir : In studying various branches of surgery we are
compelled to consider minutely the relations of various
organs to one another, and many of them, such as arte-
ries, veins, and nerves, are of great interest, inasmuch as
they are directly concerned in many operations, and are
the object to be reached or avoided, as the case may be,
by the surgeon. Again, we study the relation, of organs
constituting the thoracic, abdominal, and pelvic viscera,
that we may detect with accuracy certain pathological
conditions, and at the same time determine the cause
and select a method of treatment.
It Seems to nie that in no branch of surgery is this lat-
ter class of relationships so important as in that pertain-
ing to diseases of women.
Do not understand me to say that a derangement in
the situation of the pelvic organs is of more moment as
regards the life and comforts of the patient than that of
any of the, thoracic or abdominal organs, but that the
importance to the surgeon is in exact ratio with the fa-
cility with which abnormalities can be detected and
treated, is a matter which I believe is generally appre-
ciated.
Among the many disorders described by gynecolo-
gists, and the numerous causes to which they are attrib-
uted, there are some which I believe to depend upon
conditions which have heretofore been unnoticed, or, if
noticed, regarded of such slight value as to have escaped
mention. These conditions are involved in the construc-
tion, relation, and action of the interfemoral and iscliio-
rectal regions, the nates, and the obturator internus mus-
cles.
Respecting the ischio-rectal region, we have situated
on either side of the rectum the ischio-rectal fossa,
bounded internally by the sphincter ani, levator ani,
and coccygeus muscles ; externally by the tuberosity of
the ischium and the obturator fascia, which covers the
inner surface of the obturator internus muscle ; limited
in front by the perineal body, and behind by the lower bor-
der of the gluteus maximus muscle, and the great sacro-
sciatic ligament. Each fossa is hlled, in Uie healthy
state, by a mass of adipose tissue of a triangular shai^e,
with its base directed downward and restmg upon the
integument of this region.
Each mass will measure one inch transversely, one and
a half incii antero-posteiior, and two inches in length.
Now, when we consider the location, relation, and
magnitude of the two bodies, and comi)are them in these
various respects witli the perineal body, it is reasonable
to suppose that eacii of the three perform a similar func-
tion ; but before describing this, I wish to speak of the
interfemoral region.
We iiave covering the adductor group of muscles of
either thigh a thick layer of tat, increasing in thickness
as it approaches the perineum, and in the well-formed
female sufficiently abundant to closely approximate the
thighs. It will be noticed also that these accumulations
of fat are controlled jirincipally by the adductor mus-
cles, and can be elevated and brought lirnily together at
the will of the jierson.
I know of no simpler way of demonstrating the action
of these parts, tiian by calling attention to the piienom-
enon which takes place in an effort ma<le by an indiviilual
to prevent an untimely discharge from the bowels or blad-
der.
This consists in expelling the air from tiie lungs, hnnly
adducting the lower limbs, and rotating them outward.
By expelling the air from the lungs, the pressure within
the abdominal cavity is diminished.
The adduction of the thighs is a very im]iortant act.
nasnuich as it presses the interfemoral masses of adipose
tissue firmly together, and upward against the perineum,
and having combined with it the outward rotation, pro-
duced partly by the lower border of the glutic maximus and
the obturator internus muscles, we have the nates brought
firmly together and pressing upon the ischio-rectal re-
gion. Thus the whole floor of the pelvis is raised, and
the organs wedged upward near the l3rim and against the
sacrum. By the contraction of the obturator internus mus-
cles (which means an approximation of its extremities
ant/ an increase in thickness), we have a pressure exerted
directly upon the sides of the pyramidal-shaped mass of
fat contained within the ischio-rectal fossa, and indirectly
upon the sphincter ani and levator ani muscles, and the
capacity of the pelvis diminished.
Through this combination of forces we have a condi-
tion produced which relieves the sphincters and the mus-
cles of the perineum from the strain brought upon them
by the pressure from above.
The mass contained within the rectum is elevated, the
urethra is tirmlv compressed, and thus an expulsion of
either fa;ces or urine prevented.
Now, that we have considered the gross anatomy and
physiology of these parts in a healthy state, we can in
very few words explain a few pathological conditions re-
sulting from a deficiency of fat composing these supports.
Let us take, for example, a woman somewhat emaci-
ated, or one whose peculiarities of constitution are un-
favorable to the accumulation of fat, and we have the
supports afforded by the region under consideration to
a greater or less degree, and in many cases entirely
wanting. The obturators, glutis, and adductors may con-
tract, but the supports from the nates, ischio-rectal, and
interfemoral regions are so deficient that they (the mus-
cles) have nothing to act upon, and consequently the
muscles forming part of the floor of the pelvis have the
whole burden thrown upon them.
There may or may not have been a relaxation of the
muscular system, but from the very fact that the pelvic
muscles are continually exerting themselves, a lax con-
dition must inevitably follow. Then comes the sensation
of dragging and weight in the pelvis. Pain in the back
and loms. Rectal and vesical irritation ; great fatigue
and weakness ; leucorrhoea, and other signs of conges-
tion ; and later, after the muscles have lost their tone
from the constant exertion, we have prolapsus, and the
whole catalogue of displacements of the pelvic organs.
Another example of interest is afforded by a subject
with a justo-niajor pelvis. There may be in this case a
sufficient quantity of fat, and the muscular system in a
state of perfect health, but that the support given by
both will be to a great extent lessened will be readily
perceived when we take into account the fact that the
frequent concomitants of the abnormally capacious ])el-
vis are very long necks to the femurs, giving great
breadth to the hips, and carrying the shafts of the femurs,
on a level with the perineum, very widely apart.
There is also a large outlet to the pelvis, with diverg-
ing rami of the pubes, separating the adductor muscles
at their origin. Now, should there be suflicient fat to fill
the space between the muscular portion of the thighs, it
would be so heavy that, should the person attempt to
walk or stand any length of time, the excessive weight
would tire and drag down the muscles supporting it, and
allow the pelvic organs to settle as previously described.
In this way we account for man\- distressing sensations
conii)lained of by apparently healthy and robust women.
In consideration of the foregoing hurried and super-
ficial elucidation of the subject, I trust that in future
there may be some attention, at least, given to the su|)-
port of the pelvic organs by —
First. — The interfemoral adipose pillars.
Second. — The fat of the ischio-rectal region.
Third. — The prominence of the nates.
Fourth. — The physiological thickening of the obturator
internus muscles.
.\s regauls the treatment of disorders accompanying
September 22, 1883.]
THE MEDICAL RECORD.
and resulting from a loss of these supports, much de-
pends upon the attention given to the general system.
All jiessaries, or artificial supports of any pattern,
should be of sufficient size to compensate for the loss of
tissue, and yet not large enough to cause pressure of
such a degrc-e as to prevent the reproduction of fat.
If possible, a support should be made of vulcanite
(hard rubber), from a plaster of Paris cast taken of the
vagina while distended, and as nearly as possible in a
normal position. A support of this kind will fit ac-
curately, and will conseejuently be sustained in position
by a certain amount of atmospheric pressure.
In case of the justo-major pelvis, the patient will
accomplish much by lying upon the back, and adduct-
ing the thighs against some power acting as an abductor ;
such as a spring hoop placed between the knees, or an
elastic strap attached to either knee, and to the sides of
the bedstead. Don't apply these forces of abduction below
the knees, or you will produce knockknee ; as I came very
near doing in one case. By this manceuvre there is no
weight brought upon the floor of the pelvis while the
limbs are separated, and by the exercise to the adductor
muscles they will become sufficiently powerful to sustain
and control the interfemoral adipose pillars.
Very respectfully,
Frank W. Haviland, M.D.,
I.ate Resident .Surgeon Brooklyn City Hospital,
Brooklyn, N. Y.
r 210 West 125TH Street. Nkw York.
^inuB autt Jlauy 21cixi5,
Official List of Changes of Stations and Duties of Officers
of the Medical Department , United States Army, from
September 8 to September 15, 1883.
Barthoi.f, John H., Captain and Assistant Surgeon.
Station changed from Fort Lapwai, I. T., to Vancouver
Barracks, W. T. S. O. 123, par. 2, Department of the
Columbia, September 6, 1883.
Banister, J. M., First I>ieutenant and Assistant Sur-
geon. Assigned to duty at Fort Adams, R. I. S. O. 170,
par. 3, Department of the East, September 10, 18S3.
Official List of Changes tn the Medical Corps of the Navy
for the week ending September 15, 1883.
Beardsi.ey, G. S., Surgeon. Detached from the
Galena and placed on waiting orders.
LiPPiNCOTT, George C, Passed Assistant Sargeon.
Detached from the Galena and placed on waiting orders.
Percy, H. T., Passed Assistant Surgeon. Detached
from the Naval Hospital, Norfolk, Va., and ordered to
the U. S. S. Galena.
Bright, George A., Surgeon. Detached from Naval
Rendezvous at Philadelphia, Pa., on September 30th,
and ordered to the Galena, October ist.
Urquhart, R. a., Passed Assistant Surgeon. Ordered
to the Alert on October 6th, and on the arrival of that
vessel at Yokohama, Japan, to be detached and to report
for duty at the Naval Hospital at that place.
Simons, M. H., Passed Assistant Surgeon. To be tlc-
tached from the Naval Hospital, Yokohama, Japan, on
the reporting of his relief, and ordered to the U. S. S.
Alert.
To Preserve Surgical Instruments. — The follow-
ing formula is recommended by Professor Olmstead, of
Yale College. Melt together si.\ to eight parts of lard
to one of resin, and stir until it is cool ; it can be thinned
-w'nh coal-oil or benzine. Applied to a bright metallic
surface it effectually protects the polish, but the surface
should be both bright and dry, as it will not prevent the
continuance of oxidation already begun.
^Hedicat ?tcms.
Contagious Diseases — Weekly Statement. — Re-
port of cases and deaths from contagious diseases re-
ported to the Sanitary Bureau, Health Department, for
the two weeks ending September iS, 1883 :
Week Ending
>
3
0
0
>
'0
.a
a
69
i4
S
ti
0
36
38
Cerebro - spinal
Meningitis.
1
V
.a
J5
0.
a
><
E
in
>
V
fa
>
Cases.
September 11, 1883. ...
September 18, 1883
3
3
60
22
21
19
0
0
0
0
Deaths.
September 11, 1S83
September 18, 1883
0
0
1
27 i 7
13} 14
2
3
6
2
15
14
0
0
0
0
IVfEDiCAL Women for India. — The Indian Medical
Gazette thinks that the project, now being agitated in
England, of sending out medical women to India is a
visionary one, intended to meet a want which does not
exist. Something practical is really being done in India,
however. A philanthropic citizen of Bombay, Mr. Kit-
tredge, has collected a sum of 26,975 rupees, and got the
promise of 13,554 rupees more, for the purpose of paying
the salary of one or two lady doctors who are intended
to have a hospital and dispensary established for them
in Bombay, and do their best to otbain practice among
native ladies in that city. A wealthy Parsee gentleman
has offered a lakh of rupees for the purpose of founding
a hospital in connection with this movement, and a large
and influential committee, representing every seetion of
the community, has been organized for the purpose of
promoting the objects in view.
A Standard of Qualifications for Insurance
Examiners. — The medical examiner of " the Catholic
Knights of America" says that he will accept no creden-
tials signed by any physician whose diploma is not rec-
ognized by the great universities of America. All others
will be regarded as incompetent to conduct the examina-
tion of applicants to the ranks of these knights. The
next question to be determined is, which are "the great
universities of America ? ''
The Couvreuse, or Mechanical Nurse. — The Lan-
cet gives the following description of the ingenious con-
trivance known as the couvreuse, or artificial nurse. It
was in 1878 that Dr. Tarnier, when visiting the apparatus
devised by M. Odile Martin, for artificially hatching and
rearing chickens at the Jardin d'Acclimatation, suggested
that a similar method might be applied with advantage
to infants, especially in cases of premature birth. Two
years elapsed, liowever, before any attempt was made to
carry out this proposal ; but in the course of the year
1880 a couvreuse was made, and brought to the hospital
of the Maternite. This is a plain wooden case or box,
measuring about 2 ft. S in. by 2 ft. 4 in., and 2 ft. 4 in. in
height. The box has a double covering, the space be-
tween being filled with sawdust to retain the heat, and is
divided into two parts. The lower half contains a reser-
voir, which holds about sixty litres of water, and is fed by
a patent boiler that stands outside the box, and is warmed
by an oil-lamp ; or hot water may be used \vithout re-
course to the lamp. The ui)per portion of the box forms
a warm chamber, where a little basket or cradle is placed,
large enough to hold two infants. From an opening at
the side, this cradle may be withdrawn, while the top of
the box has a double glass covering, so that the children
and the thermometer Tying by their side can be constantly
534
THE MEDICAL RECORD.
[September 22, i<
watched. If the water used in the first instance is cold,
it takes a long time to attain the required temperature ;
but once this is done the lamp need only be relit three
or four times during the course of the day. It is best to
warm the apparatus while the infants are being fed or
washed. The temperature withm the couvreiise is gen-
erally maintained at 86' F., and though the contrast on
withdrawing the child to be fed or washed is very great,
amounting often to 30° F., colds are not so frequent as
among the infants nursed in the ordinary manner. .Alto-
gether the expeiiment is considered so successful, that it
IS proposed to sui)ply all the hospitals of France with a
couvreuse, and there is every reason to anticipate good
results from this measure. Nor is this all. .-X small
portable couvreuse is now about to be tried, which could
be carried by hand from house to house. .After this we
shall probably have perambulators constructed on the
same model. Although no very careful experiments
have been made with respect to the ventilation within
the couvreuse, yet this is evidently sufficient. .Apertures
are made in the lower portion of the box, the fresh air
travels over the hot-water reservoir, and is thus warmed
before it reaches the child. The increased temperature
within the couvreuse insures a constant current of air,
though the child is protected by its cradle and clothes
from any draught.
OXALURIA AS A Cause OF Spermatorrhcea.— Dr.
W. H. Dickerman, of Olean, N. Y., sends us the fol-
lowing communication bearing upon the etiology of sper-
matorrhcea : " While there is a diversity of opinion as to
the cause of spermatorrhcea and its local symptoms, it
certainly must be conceded that there is an abnormal
condition of the nervous system manifested in every such
case. Crystals of oxalate of lime are invariably present
in the urine of such persons, and as it is generally con-
ceded that free oxalic acid in the circulation is jjoison-
ous to the brain and spinal cord, we have a possible
cause which should not be overlooked. .As an illustra-
tion of this condition, the following case is related. A
patient, Mr. S. W , aged twenty-nine, presented him-
self for treatment about one year ago. He had been
laboring under great mental weakness for several months,
and complained of a dull pain and a sense of uneasiness
in the occii)ital region. He said he had frequent noc-
turnal seminal emissions. There was great irritability of
the neck of the bladder, and frequent micturitions day
and night. The passage of a sound revealed hyper^es-
tliesia along the prostatic portion of the urethra and at
the neck of the bladder. He denied ever having prac-
tised masturbation or indulged in excessive venery.
He was greatly emaciated. The urine contained in sus-
pension a milky, tenacious, gelatinous substance, and
upon microscopical examination many spermatozoa were
discovered. Crystals of oxalate of lime were present in
abundance. Taking into consideration that in the oxa-
late of lime diathesis (oxaluria) there is a chronic poison-
ing of the brain and spinal cord, due to minute particles
of oxalic acid in the circulation, I regarded the sperma-
torrhcx'a as of only secondary importance, and put the
patient upon dilute muriatic acid treatment. In two
weeks he returned and said he was well. .An examina-
tion of his urine confirmed his statement, and he has not
been troubled since. As a cure resulted under the acid
treatment in so short a time, I was forced to believe
that in this case there was no other cause than the oxa-
luria."
Otitis Media Purulentia and Mastoid Compi.ica-
TioNS. — Dr. M. E. Alderson, of Russellville, Ky., calls
attention to certain cases, primarily of headache and
acute pain in the ear, accompanied by discharges, which,
as he justly states, do not always receive the necessary
careful examination, but are too often dismissed with a
few general directions, and thus, after a time, result in
serious consequences. In treating these cases, the usual
plan by injections of astringent and sedative solutions
he considers to be insufficient. Regarding the radical
treatment by trephine, aside from the shock involved,
especially in delicate subjects, he finds the results from
this procedure by no means certain. The following
conservative method is recommended by him, exempli-
fied by the accompanying case : Mrs. , aged thirty-
three, has complained of headache for the past three
years, which has become more persistent, until finally
recurring every two or three days, and with increased
severity. Has been treated for nervous headache by sev-
eral physicians, and with only temporary relief. Purulent
inflammation of both ears had existed for some time,
and the external meatus was now covered with layers of
thick pus, causing considerable distention and thus add-
ing to the intensity of the pain, which was present on both
sides of the head and face, more especially over the mas-
toid cells. .After thorough cleansing with the probe and
absorbent cotton, there was discovered by the speculum
granulating mucous membrane and tieshy-looking mem-
brano tympani. No polypi existed, and the hearing of
both ears was good. For the pain, which was very acute
and neuralgic in character, a mixture of aconite and gel-
semium was ordered — a few drops q. 4 h. Locally, the
entire external canal was packecj with powdered boracic
acid, previously mixed with calendula and carbolic acid,
and thoroughly dried, the whole then being covered with
absorbent cotton. This was allowed to remain for three
days. The packing was then removed, the canal care-
fully dried, and the application renewed. To the mas-
toid process a fly blister was also applied once a week
and kept discharging freely. Under this treatment
amelioration of all the symptoms followed, and the final
results were entirely satisfactory.
Filth Diseases in Rural Districts. — Dr. A. L.
Carroll, of New Brighton, N. Y., writes : " Sir : On my
return from Europe, my attention has just been drawn
to a paper by Dr. George Hamilton, published in your
issue of July 28th, commenting upon an article of mine
on ' Filth Diseases in Rural Districts.' I have ap-
parently been so unfortunate as to fail to make myself
understood by Dr. Hamilton, or even to attract his care-
ful reading ; for I cannot discover in my own article the
words which he |)laces in quotation marks, nor do I think
that many of my statements legitimately bear the inter-
pretation which he gives them. I have no desire, how-
ever, to enter upon a controversy touching the etiologi-
cal researches which abound in English sanitary literature,
or the occasional difficulties of diagnosis which all vital
statisticians and registrars dei)lore. Afy only present
object is to clear myself from the totally unwarranted
imputation of making a 'thrust at the country physi-
cians.' If Dr. Hamilton will honor me by again re-
ferring to my article, he will see that I made the more
comprehensive statement that ' very few physicians in
this country' have cared to learn the methods of sanitary
inspection ; and the context will show him that the fault
is imputed to our medical schools, most of which utterly
ignore the teaching of hygiene, and graduate family prac-
titioners well qualified, it may be, to treat disease after it
has arisen, but without instruction how to detect the in-
sanitary conditions under which their patients may be
living.''
The Championship qv America in Tonsil-Cutting
does not belong to Indiana, says Dr. Tauber, of Cincin-
nati, O., but to New York. It was stated to nie that Dr.
Lewis Elsberg, of New York, has excised more than
11,000 tonsils ; this would be, according to Dr. \Villiam's
calculation, over two and one-half bushels.
Two Cases of .Absinthe Poisoning. — Dr. .Albert S.
Adler, of Lordsburg, N. M., writes: ".A few nights ago
I was called upon to attend two individuals who had been
drinking heavily, and were now in convulsions. Hasten-
ing to their place of abode I found that one of the pa-
tients, a woman, in anjepileptiform convulsion — uncon-
September 22, 1883.]
THE MEDICAL RECORD.
335
scions, small pujiils, and frequent and small pulse. The
other was also unconscious, but not then in spasms. All
tpiestions in regard to poisoning were altogether refuted
by the other inmates of the house. I was about to re-
sort to some stronger means in order to relieve tlieir suf-
ferings, when the young girl, returning suddenly to com-
plete consciousness, claimed that she and her male
friend had partaken of over a quart of some alcoholic
liqueur, tlie principal part of which was absinthium. The
epileptic convulsions had commenced half an hour prior
to my arrival, and, as before stated, lasted in the girl but
a short time during my presence ; they had been more
vehement and frequent in her because she had taken a
larger quantity. The man was restored to his senses by
slapping his face with wet towels. These cases of epi-
lepsy are of more frequent occurrence than generally
supposed. Magnan (' De I'alcoolism, des divers forms, du
delire alcooliipie,' etc, Paris, 1874, and ' Annal. Medic.
Psych.,' 1874, p. 302), was the first to describe the danger
of absinthe drinking. His experiments on animals, as
well as observations on nian, have demonstrated that it
was not the alcohol which brought forth the spasms, but
that the absinthium was the source of the vehement
symptoms. Alcohol occasions deliriutn and tremor,
absinthium these two and epilepsy in acute alcoholism.
Small doses of wormwood given to animals have the ef-
fect of producing tremor of the muscular system, dizziness,
and in a surprising manner upstarts of individual mus-
cles, in larger doses a complete formed epilepsy. In
man, besides the alcoholic delirium, epilepsy is noticed.
Among three hundred and seventy-seven persons ad-
dicted to the use of alcohol, Magnan found, in 1870, but
tliirty-one ei)ileptic cases, and in 1871, among two hun-
dred and ninety-one, only fifteen. In France it is re-
garded by the legal authorities as a poison, and only
allowed to be sold in drug-shops. Magnan comes to the
conclusion that if epileptic attacks happen in acute alco-
holic-|)oisoning, it was only in absinthe drinkers, and that
acute alcoholism without epilepsy, but with tremor of any
degree, was but seen in persons partaking freely of wine
or whiskey."
A NEW Bo.ARD OF Health has been appointed by
the city council of Cincinnati, O. There are six mem-
bers. Five are saloon-keepers, and the sixth is a so-
called doctor, a frequent patron of the saloons, advertises
to cure the opium iiabit, restore lost virility, etc. The
Cincinnati Lancet is unable to see why so much medical
wisdom was injected into the board.
Two Cases of Aneurism Exhibiting Unusual
Physical Signs. — Dr. VV. S. Cheesman, of Auburn, N.
Y., sends us the following : '• While an interne in Helle-
vue Hospital, I had under observation, for some three
months, a case whose history was as follows : Patient, a
man, aged forty-nine, well muscled, and apparently
hearty. Contracted syphilis in 1865. In October, 1878,
he strained his back while lifting, but recovered. About
three months later he over-indulged in liquor, etc., and
liain in the back shooting around the abdomen and down
the thigh conmienced, and in a day or two he observed
a pulsation in the abdomen. All these symptoms per-
sisted. About a year later he detected a swelling be-
hind the episternal notch, which caused pain and dysp-
noea. He soon suftered from dizziness, pain in the head,
flashes before the eyes, and some difiiculty in swallowing.
As will be at once supposed, these sets of symptoms had
separate causes. Repeated physical examinations made
it almost certain that the patient had two aneurisms, one
of the lower thoracic or upper abdominal aorta, the other
of the innominate, each giving rise to its own physical
signs. The aneurism of the trunk imparted an irresisti-
ble heaving impulse to the lower part of the left chest,
over which area a low, blowing murmur was heard. The
aneurism of the neck was palpably evident behind the
right sterno-clavicular articulation as a pulsatile tumor,
over which a blowing sound was heard loudly. It gave
rise to much inspiratory stridor, a pressure-effect purely,
the laryngoscope revealing nothing abnormal to account
for it. An occasional cough had the aneurismal note,
but the voice was natural. A curious pulsation was oc-
casionally communicated to the larynx and the tongue.
Every now and then the thyroid cartilage would rise and
fall synchronously with the pulse of the aneurism, and
when at these times the patient opened his mouth, the
tongue was seen to pulsate backward and forward. How
this motion was imparted to these organs was never
ascertained. On auscultation of any part of the chest,
one could hear a loud ronchus during expiration, which
ronchus intermitted, the intermissions corresponding to
the cardiac diastole. It was supposed that pressure on
the trachea or a bronchus was made by one of the aneu-
risms, that this pressure was increased by the contraction
of the thoracic cavity during expiration, and that the
calibre of the air-tube was so much lessened at the acme
of the aneurismal expansion, that a momentary ronchus
was then produced. The patient improved, and was
finally discharged at his own request. He re-entered
hospital four months later, remaining a week. The phy-
sical signs were unchanged.
"On June 30, 18S3, a laborer, aged forty-three, ap-
plied to me for relief of a hoarseness of three months'
standing. He was nearly aphonic, and there was much
dyspnoea. The laryngoscope showed the left vocal chord
paralyzed in abduction. The right chord crossing the
middle line in attempts at phonation occasionally met
its fellow, and sound resulted. Looking down the trachea,
there was distinctly apparent, near its bifurcation, a pul-
sation which narrowed the lumen of the tube, and at the
same time moved it somewhat from left to right. Over
the upper sternal region a small area of dulness was
made out, and here a double blowing murmur could be
heard The heart was displaced downward and to the
left. A thrill was felt in the subclavians. The cough
was markedly aneurismal. No history of syphilis or
strain. Aneurism of the arch compressing the trachea
was diagnosticated, and a gloomy prognosis given. Both
opinions were verified about a month later by the pa-
tient's dying suddenly in the night with a tremendous
hemorrhage. I regret that in my absence from the city
no post-mortem was made. The physical signs which
gave these cases their interest, and which I have not
hitherto seen described, were : ist, the pulsation up-
ward of larynx and tongue ; 2d, the intermitting ronchus
in Case I. ; and 3d, the pulsation observed near the bi-
furcation of the trachea in Case II."
Impurities and Organisms in the Air of the Com-
pressed Air-Chamber. — In a communication addressed
to The Record, Dr. Arthur J. Wolft', of 66 Capitol Ave-
nue, Hartford, Conn., late A. A. Surgeon, U. S. A., calls
the attention of all who have occasion to use compressed
air for the propulsion of various substances into the air-
passages, to the danger thereby incurred of forcing dis-
ease germs into those organs. He states on the strength
of experiments recently conducted by him that: i. By
the use of the compressed air-chamber, as at present
constructed, we cannot avoid the access of impure air
to the throat and air-passages. 2. The confined air-
space affords the most propitious conditions for an enor-
mous increase of the various spores, bacteria, fungi, etc.,
contained in the air of the room from which the supply
is derived. 3. The mere mixture of this air for a
short time with any solution that may be used in the
spray apparatus, even having the most perfect antiseptic
qualities or being in itself eminently a microbicide, is
insufficient to sterilize it. 4. The use of this air is in it-
self, in certain cases, effective in producing an increase
of the throat trouble. The author demonstrated the exist-
ence in the air-chamber of carbonic acid and chlorine
in large quantities, when the air from a room in which
these gases had been liberated was pumped into the re-
ceiver. The presence of micro-organisms was deter-
00^
THE MEDICAL RECORD.
[September 22, 1883.
mined by the following experiment : Having brought the
pressure in the condenser to indicate tiiirty-five pounds,
he slowly passed the air through a series of three bottles,
the sides and bottoms of which were smeared with gly-
cerine. The glycerine being then removed and placed
under the microscope, the presence was discovered of a
great number of spores of cryptogams, bacilli, bacteria,
micrococci, pollen of certain plants, indeterminate
masses, and mineral particles. He discovered one va-
riety of microbe in particular, about •j-j'Troth of an inch
in length, which resembled the bacillus tuberculosis very
closely in appearance and in the peculiarity of staining.
The author ]3ro|)oses in subsequent experiments, by iso-
lation and cultivation according to Koch's method, to
determine the question of the identity of this bacillus
with that which the modern theory recognizes as the
cause of tuberculosis. He showed by further tests that
the air was not purified by passing through the supply
tube containing various antiseptic solutions, such as
iodine, mercuric chloride, zinc chloride, (piinine, etc.
Dr. Wolff concludes with a descri]ition of the method
employed by him to sterilize the air before it ])asses into
the condenser. He passes it through a series of U-tubes
filled with fine iron wire heated to redness. It is subse-
quently conducted through a bulb, loosely packed with
absorbent cotton saturated with a solution of corrosive
sublimate (1-500), and is then ready for use. The large
measure of success which he has met with in the treat-
ment of diseases of the respiratory organs he attributes
in great part to the precautions taken to force only puri-
fied air into the air-passages. It is his desire to present
these facts to the profession in order that they may re-
ceive thoughtful consideration, and that others may be
led to adopt greater precautions to guard their patients
from the probable dangers of the compressed air appa-
ratus.
The American Medical College Association. —
The Southern Practitioner reports the death at Nash-
ville, Tenn., on the 20th ult., of the American Medical
College Association. It announces the cause of death
as '• The Bellevue Stab." This reference is, evidently,
to the famous advance and precipitate retreat of Belle-
vue Hospital Medical College, a couple of years ago, on
the question of an advanced standard of medical educa-
tion. Bellevue was loud in her demands for a higher
standard, and in the fulness of time went up to possess
the land. But she soon discovered that she had been too
previous, as it were. She is of " the-old-flag and-an-ap-
propriation " style of patriot, and was loud for advance
as long as the cry seemed popular and was likely to draw
students. When, however, the students refused to fol-
low, she quickly sounded the retreat, and thus, as our
contemporary intimates, gave the death-blow to the
movement to improve medical education in this country.
But it is cruel to open these old sores, and more especial-
ly at this time, when P.ellevue is so faithful to the Code of
Ethics. Her new announcement llies the ethical colors
on her mast. How long, in the light of past experience,
will they thus ostentatiously tly ? The size of her next
year's class may have an effect in determining the answer
to this question.' — Medical Age.
LoNGEViTV IN the DIFFERENT State.s. — A Student of
the reports of the tentii census has compiled a table for
the Boston Commonwealth for the purpose of showing in
\yhat State or States one has the best chance for a long
life. New Hampshire seems to him to be the favorite
refuge of green old age, for lie finds that one-seventv-
fourth of the inhabitants are at least eighty years old.
The proportion among native white males is I'in 80, but
the environment in New Hampshire seems to have been
even more favorable to the preservation of life in the
other sex, for the proportion among native white females
is I in 58. Other New England States do not contain
quite so many old persons, the average proportion for the
six being i in 134. Coming to New York, he finds that
for one person who has reached the age of eighty there are
161 who have not been so fortunate, and in the three
Middle States the average proportion is i in 182. .\s he
goes southward he discovers a greater preponderance of
young blood, for in six South Atlantic States the average
proiiortion is i in 203. The Gulf States afford a less
attractive shelter for the aged, for the average is i in 300.
In Texas, where so many worthy persons die with their
boots on in the ])rime of life, only one octogenarian can
be found in a group of 497 citizens. The average rises
again in the interior States east of the Mississippi, but in
the great lake States it falls to i in 263, a good old age
being attained with the greatest difficulty in the wealthy
and prosperous State of Illinois. In seven States west
of the Mississippi River the aged rarely appear, for the
average proportion is i in 453. In Iowa a crop of 334
persons yields only one who has reached the age of four-
score ; in Minnesota, Nebraska, and Kansas only one of
these aged citizens can be found in a group that would
yield two in Iowa, and in Colorado 1,150 inhabitants
must pass in review before an octogenarian comes in
sight. The old are even more rare in Nevada, but in
California and Oregon the proportion is nearly i in 500.
If the inhabitants of the whole country could be assem-
bled in two hundred and twenty-seven groups, it would
be possible to place at the head of each group one patri-
arch of eighty or more years. So our student, assuming
that long life is the inalienable right of those who reside
in New Hamjishire. \'ermont, and Maine, cries : " Flee
to the mountains of New England for health and lon-
gevit}' ! "
Italian English. — The proprietor of the Hotel de
Bellevue at Pompeii, as a means of attracting English
custom to his house, has issued an advertisement couched
in the following extraordinary terms : " That hotel open
since a few days is renowned for cleanness of apartments
and linen, for exactness of service and for excellence of
the true French cookery. Being situated at proximity
with regeneration, it will be propitious to receive fami-
lies whatever which shall desire to reside alternately into
this town to visit the monuments newly found and to
breathe thither the salubrity of the air. The establish-
ment will avail to all the travellers visitors of that sepult
city and to the visitors (willing to draw antiquities) a
great disorder and expensive contour of the Iron-whay.
People will find equally thither complete assortment of
strange wines, and of the kingdom, hotel and cold baths,
stables, and coach-houses, the whole with very moderate
prices. Now all the application and endeavors of the
host will tend always to correspond to the taste and de-
sires of their customers, which will acquire without doubt
to him into that town the reputation whom he is am-
bitious."— The Caterer, London.
To Disinfect Water for Hypodermic Use. — \
sure but, so far as we are aware, little practised method
for disinfecting water for hypodermic use is to boil it.
It is not sufficient that the water be boiled when the
hypodermic solution is made for the case bottle ; it
should be boiled on the spot. The requisite amount is
put into a teaspoon, a ligiited match is held under it,
and the lluid injected while warm. If the practitioner
prefers, as many do, to make the solution p.r.n., the re-
quired amount of the drug or a pellet may be placed in
the spoon, reduced to a powder — better still placed in
the water anil reduced — and the lieat applied, the in-
creased temperature favoring the solution. In this man-
ner bisulphate of ([uinine may be used without any acid-
ulous accessory, and without the unpleasant eft'ects so
often seen after hypodermics of c[uinine.
Oil of Wintergreen (salicylate of methyl) diluted
with an equal quantity of olive oil or soap liniment, ap-
plied externally to the joints affected by acute rheuma-
tism, gives prompt relief, and, from its pleasant odor,
is very agreeable to use. — The Quarterly Therapeutic
Hez'ieu'.ji
The Medical Record
A Weekly Journal of Medicine and Surgery
Vol. 24, No. 13
New York, September 29, 1883
Whole No. 673
(Dvioiiuil Jivticlcs.
THE RECOGNITION OF CEREBRAL COM-
PLICATION IN AURAL AFFECTIONS, BY
MEANS OF THE OPHTHALMOSCOPE.'
By J. A, ANDREWS, M.D.,
NEW VOKK. )
Case I. — Otitis media purulenia chronica;
of middle lobe of cerebrum ;
abscess
death. — G. J , house
painter, aged twenty-four, had scarlet fever when twelve
years old, since which .time he has had more or less
purulent discharge from his ears. While descending a
ladder, December i8, 1S78, pain developed suddenly in
his right ear and corresponding side of the head. On
reaching home, he went to bed ; during the night he
vomited ; he thought it was an attack of fever and ague.
Next morning he was dizzy and vomited. Took gr. xv.
of quinine in the morning ; at noon he felt worse and
sent for his physician, who prescribed Kalium brom. for
the head symptoms, and ox. cerium for the vomiting ; in
the evening of the same day the doctor's attention was
attracted to the patient's ears, because of pain referred to
depth of right ear. Temperature, 103°; pulse, 100; resp.,
30 per minute. I saw patient three days subsequently :
he was conscious and talked intelligently. H. D. R. E.,
watch adconcham ; acumeter, i" ; L. E., watch ad con-
chani ; acumeter, 4" ; quite deaf for conversation. R.
E., slight purulent discharge ; drum membrane has a
small perforation in its antero-inferior part ; calibre of
external auditory canal much lessened in consequence
of swelling of its lining tissues. L. E., no discharge ;
no e.vidence of active disease in this ear. Double optic
neuritis. R. E., counts fingers at six feet ; L. E. V.,
^. December 24th, saw patient at 9 p.m. ; two hours
previous to my visit his condition had assumed a marked
change ; the pain in the right side of the head was in-
tense ; he vomited ; temperature, 101° ; pulse, no and
very feeble ; he was drowsy, and passed his urine invol-
untarily ; easily roused from drowsy state, when he con-
versed rationally. December 25th, 2 p.m., patient died
in coma. No paralysis, no convulsions.
Autopsy.' — -Right external auditory canal filled with
healthy-looking pus. Extending from the tympanic \)or-
tion of the Gasserian fissure outward into the external
auditory canal for four mm. but not involving the ossicles,
the bone was ulcerated. The communication with the
brain was made at the point of ulceration just referred to,
this being eftected through a small fissure in the centre
of the ulcerated bone. The dura mater overlying the
ulcerated bone was also ulcerated and separated from the
bone by offensive-smelling pus ; pia mater congested and
numerous ecchymotic foci ; the middle and anterior
foss.-e contained pus ; brain normal in consistence. En-
cysted abscess in middle lobe of cerebrum ; brain sur-
rounding abscess cedematous ; sinuses and internal ear
normal. These conditions refer to the right side of the
brain. The left temporal bone was not dissected, but
there were no changes in the meninges overlying the
temporal bone on this side.
Patient's mother informed me that two years after the
scarlet fever he took cold in his ear and suffered a great
deal with his head. He had headache at times for
* Read before the American Otological Society, July 17, 1S83.'
several years. Inasmuch as the abscess was encapsuled,
and death occurred a few days after the development of
cerebral symptoms, we may justly refer the interval of
ten years between the attack referred to by his mother
and December i8, 1878, as the period of latency.
The above case is an exception to the law which Toyn-
bee endeavored to establish, i.e., that each of the cen-
tres of the ear had its peculiar division of encephalon to
which it communicated disease : inflammation of the
meatus audi. ext. extending to the lateral sinus and cere-
bellum.
Case II. — Otitis media purulcnta chronica; optic
neuritis ; phlebitis sinus lateralis dextra ; meningitis
of convexity; death. — P. H -, aged forty-two, clerk,
had had purulent discharge from both ears for eight
years, which had never been treated. Three years ago
there appears to have been an acute exacerbation and
he was treated for inflammation of the brain, but the ears
received no attention. Since this attack, patient states
that he has enjoyed good health, but, on close question-
ing, I elicited the fact that for some time after the acute
e.xacerbation referred to, he had headache, which was gen-
erally so slight that he did not think it was " significant."
July S, 1879, I was requested to see him. He had been
confined to the house for two weeks, during which time he
had been very irritable, and had severe pains in the head ;
the headache was diffused, and at times referred to the
right side of the head. There had been no paralysis,
nor convulsions, but he vomited during first week of his
present trouble. For the first two days he had illusions
and delirium ; temperature had not been above 100.5° F.
On occasion of my first visit I found patient sufiering
with severe diftuse pain in the head : purulent discharge
from right ear ; discharge very oft'ensive ; removal of the
discharge revealed bottom of the canal filled with granu-
lation tissue ; right optic neuritis ; left disk hazy, veins
large and dark-colored, but not tortuous. R. V. = tsVu ^
L. V. = \%. Intensely sensitive induration extending in
course of right internal jugular vein.
July 6th. — Swelling of the neck very marked ; face
pufly. Right processus mastoideus not sensitive to the
touch, but patient was rendered dizzy and confused by
a light tap on this part. Chills four times during day.
July 7th. — The right mastoid was entered, no pus
found, but there was a sharp hemorrhage which stopped
spontaneously. He expressed himself as reheved by the
operation and slept for three consecutive hours after it.
July 8th. — Puffinessof the face much diminished ; tem-
perature at 9 a.m., 101.3° F- ; pulse, 95 ; respiration, 20
per minute. 2 p.m.: temperature, 103'" F. ; pulse, 95^
respiration, 26 per minute. 9 p.m. : temperature, 104.2°
F. ; pulse, no; respiration, 32 per minute.
July 9th.— Suddenly he became unconscious, and
death occurred in coma. No convulsions.
Autopsy. — .Ml the sinuses contained some fluid blood ;
right superior petrosal and lateral sinuses contained red
coagula, loose in superior petrosal but adherent in lateral
sinus. The venous wall of lateral sinus on right side is
thickened, its surface brown in color and the bony wall
separating the sinus from the mastoid cells is ulcerated
at three different points at which offensive smelling pus
was seen between venous and perforated osseous wall.
Right internal jugular vein contained a disintegrated
thrombus. The tegmen tympani was very thick. The
dura mater covering tegmen tympani and the adjacent
portion of bone on right side was deeply congested, and
THE MEDICAL RECORD.
[September 29, iSSj
numerous small red points (liemorrliages) were seen.
This condition was confined to the i)art3 just mentioned
and was not evident in any other part of the dura mater.
Subarachnoid space and meshes of pia mater covering
convexity of cerebral hemispheres and upper surface of
cerebellum contains a moderate amount of sero-purulent
exudation ; the exudation extended down sides of brain
and most abundant on right side, but at the base ol the
brain it was less abundant. The nuicous membrane of
tympanic cavity was swollen, tumefaction extending into
the mastoid cells.
Case III. — Otitis media purulcnta chronica ; menin-
gitis, optic neuritis ; recovery. — J. E , aged nine-
teen, has had purulent discharge from left ear for eigh-
teen months. Short and stout in stature, strumous
scars on face directly in front of left ear, also on neck of
corresponding side. Right ear has never discharged.
He had never been under treatment for his ear trouble.
The discharge from the ear has been profuse until about
a week ago, since which time it has been scanty. I saw
the patient November 16, 1880, six days after the de-
velopment of threatening symptoms. The left ear con-
tains a large polypus springing from the superior surface
of the external auditory canal, at about the junction of its
cartilaginous and bony portions. Removal of the poly-
pus, which was very vascular and had a broad attachment,
showed the bone beneath to be exposed and rough.
There were also two polyps springing from the tympanic
cavity ; these had such a slender pedicle that they came
away while the snare was being applied. Their removal
revealed pulsation at the bottom of the canal, and after
repeated efforts with the catheter pus was blown through
the perforation in the membrana corresponding to the
point where the pulsation was noted, but, owing to the
swelling of the canal, the perforation could not be seen.
Pharynx very much congested, and secreting thick
mucus. Left membrana tympani was incised, consider-
able pus coming away, much more than was expected
from the appearance of the drum membrane, which did
not appear bulged forward in any part that was visible.
.Mastoid process red and painful. Severe headache ; the
pain was general, but at times it was most severe on left
side of head and in forehead. Temperature loi^ F. ;
pulse, 85 per minute. He was very restless ; he vomited
half an hour before I visited him. He complained of not
seeing a certain picture on the wall. Left eye, marked
optic neuritis ; right eye, retmal veins enlarged but not
tortuous, disk very red but not (-edematous ; no other
change in fundus.
An incision over left mastoid showed the bone to be
inflamed but firm. No improvement followed this oi)er-
ation, and thirty-six hours subsequently the mastoid was
bored into : a small anjount of blood, with a trace of pus,
escaped from the opening. The cortical plate of tlie
mastoid was very thick. A warm solution of kalium
permanganatis injected into the external auditory meatus
readily escaped through the opening in the mastoid,
which passage I kept free by means of a drainage-tube.
There could be no doubt in regard to the immediate
result of the operation. He recovered from the influence
of the ether rapidly, and in half an hour afterward fell
into a ([uiet sleep which lasted for nearly four hours.
On awakening there was less headaclie, and patient asked
for some warm milk, of which he partook with relish.
November i8th. — Patient passed a quiet night; liis
sleep was interrupted, but he did not sufter from pam in
the head. Temperature, 100° F. ; i)ulse, 80 per minute.
There is a free discharge from mastoid. 1 did not ex-
amine ijatient's eyes the morning following the openin"
of the mastoid, but f did so on the morning of the fourtii
ilay after the operation. The left disk was less cedeina-
tous and the veins less full and not so dark looking, but
tile improvement was not striking.
December 6th. — Patient has been steadily improving ;
there is only occasional headache, and then very sliglit.
There is a marked change in the appearance of the left
optic disk ; it is only slightly obscured, but the retinal
veins are still fuller than normal. The right disk is now
swollen and the veins are large and tortuous.
Patient passed from my care in February, 1S81, about
two months and a half after the beginning of the trouble.
The left optic disk was then hypenemic, the veins much
less in size than when seen two weeks previously ; the
opening in the mastoid was closed. There was still a
slight discharge from the ear. Right nerve is still some-
what obscured, but its improvement is very manifest.
The patient was absent from New York until May 2d. I
saw him on the 4th ; the discharge had ceased since
March. The left optic disk appears normal (?), the right
disk is slightly hyperKniic. R. E. V. = -|f| ; no improve-
ment with glasses; L. E. V.=^Sii; right visual field
normal ; left visual field slightly contracted.
I have intentionally omitted many of the details of this
case, and record only what I considered the essential
features. The diagnosis of cerebral complication was
believed to be confirmed by the ophthalmoscopic examin-
ation. 1 saw the patient for the last time in December,
1881. At that time there was, I thought, no abnormal
change in either fundus, but the visual field of the left
eye, therefore, on the same side as the ear affected, was
slightly contracted.
Case IV. — Otitis media pur ulenta chronica; abscess
of the brain ; death. — In the early part of the summer
of 1879, '^frs- •''^ ' aged thirty-one, consulted me on ac-
count of distressing subjective noises in her right ear, and
difficulty of hearing. At the bottom of the right external
auditory canal were two medium-sized polypi ; immedi-
ately in front of these growths the posterior and superior
surfaces of the canal were ulcerated for a considerable
extent outward. The left drum membrane presented
the appearance ol having been the seat of a perforation.
She stated that she had had a purulent discharge from the
right ear for about thirteen years ; there had been a dis-
charge from the left ear, but this hatl ceased spontane-
ously after a few weeks' duration. She suffered pain at
times in the right ear. I advised the removal of the
polypi ; but when she was told that the discharge from
the ear would not stop so long as the growths were al-
lowed to remain, she seemed rather agreeably surprised,
and said : " Why I have always been told that it was not
right to stop a running ear." She further told me that
during the past winter she had lost her young son, then
living in New Jersey, who was said to have died of in-
flammation of the brain. I asked if he had had any ear
trouble, and she replied, "Onlj' a running." This had
followed scarlet fever and had, at the time of his death,
existed nearly two years. " But," she said, " I was ad-
vised to let it alone." In regard to her son's condition
just before death, I elicited the following: "The boy
complained of pain in his head [ear ?J for several weeks
before his death ; he was unconscious for three days be-
fore he died ; a blister was applied behind his ear, but
this part [mastoid ?] was so sore that poidtices were
ordered." This case seems plainly to have been one of
middle-ear disease, terminating fatally from extension
to the brain.
Mrs. K consented to the removal of the polypi,
and this was followed by quite active inflammatory reac-
tion, which, however, was promptly subdued by local de-
pletion, etc. There were no visible changes in the optic
nerve. After eight days' treatment she went to Chi-
cago ; I therefore lost sight of her until soon after her
return, in iVovember, 1879.
December 2d I was reiiuested to see her. On her
way from Chicago, tinee weeks before, she took a severe
cold ; she had had almost constant pain in the head for
upward of two months, especially severe for tlie past five
days, and was referred to the right side of tiie head.
Facial paralysis had occurred on the right side, and there
was vertigo. I found her suffering violent pain in the
right side of the head and at the depth of the riglit
external auditory canal ; oflensive purulent discharge es-
September 29, 1883.]
THE MEDICAL RECORD.
339
caped from the right ear. Vomiting ; temperature, 102.8°
v.; pulse, 95. Afastoid not tender on pressure, nor does
percussion cause vertigo or pain. There is beautifully
developed neuro-retinitis in right eye ; no changes in
left eye ; counts fingers at about ten feet with right eye.
Sth. — Patient is delirious.
7th. — Patient comatose; no convulsions. She died
after having lain in coma for si.\ hours.
Autopsy. — Corresponding to the point of ulceration in
the external auditory canal, referred to above, a sinus
was found extending into the antrum mastoideum. The
roof of this cavity was destroyed by caries; pus to the
amount of half a fluid ounce lay upon the carious bone.
The dura mater overlying this collection of pus was
very much thickened, but not perforated. In the right
hemisphere of the brain a large abscess was found, filled
with greenish thick pus ; the surroimding brain substance
was cedematous, but not disorganized ; the abscess was
encapsuled, but had ruptured into the brain, in all proba-
bility only a short time before death. 'I'he sinuses con-
tained dark-colored blood, but no clots. The right lat-
eral sinus was unchanged.
The foregoing cases have been presented, not because
they exhibit any remarkable or unusual features that
have not already received notice in literature, but they
are offered more with the intention of eliciting discussion
on a subject bearing upon which the writer does not find
nmch satisfactory data in literature.
The cases of cerebral abscess tabulated by Gull, Ru-
dolph Meyer, Wreden, Lebert, and others, furnish no
facts which enable us to judge of the frequency or actual
presence of signs of intra-cranial disease by the appear-
ance of the fundus oculi. In the majority of instances
in which reported cases of cerebral diseases, secondary
to an aural affection, appear in literature, the eye is
merely incidentally alluded to, i.e., the state of the pu-
pils, the presence of photo[>hobia, or the condition of the
sight. In many instances the question of an intra-ocular
lesion was dismissed with the observation that the vision
was l-g-. The writer believes that most oi)hthalmologists
will endorse the statement that optic neuritis and central
vision Iji are not incompatible. I have seen such cases,
and I have now under my notice the case of a physician
with advanced atrophy of the optic nerve, and central
vision IJj, but whose visual field is very much contracted.
Then again, when the ophthalmoscope has been used,
the record reads : " One or both optic disks appeared
obscured and the vessels enlarged." Now the writer be-
lieves that it is just such cases that should excite our
suspicion of an intracranial complication in ear disease
— especially purulent otitis media — -in which other signs
of extension of the trouble to the brain are obscure.
To what extent, in the cases under consideration, an
(zdema of the optic disk should influence our mode of
treatment in regard to an operation upon the mastoid
is, in the absence of sufficient evidence, necessarily an
open question ; but from a careful study of cases in
which the mastoid has been opened, the operation does
not appear to be a dangerous one when intelligently per-
formed ; and the writer would, without waiting for pro-
nounced neuritis, accept the condition of the oedema of the
optic disk in the cases under discussion as an indication
for opening the mastoid ; and if not with the expectation
of liberating pus, at least to establish free drainage from
the middle ear. The procedure is certainly consistent
with a good surgical principle and is not likely to add to
the pre-existing mischief. '„
Not until quite recently has attention been directed to
the importance of examining the fundus oculi in aural
affections. AUbutt, Kipp, Knapp, and Zaufal are the
pioneers in this valuable work of furnishing evidence of
the importance of an ophthalmoscopic examination in
the class of cases under consideration. AUbutt' and Kipp'
1 Thomas C. AUbutt : On the Use of the Ophthalmoscope in Disease of the Ner-
vous System and of the Kidneys, etc., pp. 322, 323, 334.
^ - Arcliives of Ophthalmology, vol. viii., pp. 75 and 148.
have each reported two cases of otitis media purulenta
with optic neuritis, in which recovery took place, and
Zaufal' has also recently recorded a case of a student,
sixteen years of age, with ])urulent otitis media, and optic
neuritis, which latter condition was observed to rapidly
recede after trepanation of the mastoid, and the patient
made a good recovery.
Acute otitis media does not commonly prove fatal ;
the pain in and about the ear often being so intense as
to almost completely obscure the symptoms of any brain
complication which may exist. The patient generally
recovers from the acute symptoms, and there may remain
impaired hearing and a purulent discharge from the ear,
which latter may continue, if not treated, for weeks and
months, and even years, when an acute exacerbation oc-
curs, and the patient dies with the post-mortem evidence
of abscess of the brain ; the abscess, in many instances,
having been formed at the time of the first attack of ear
trouble, some years ])reviously. This was evidently the
fact in Case I., cited above; however, this is not an
isolated case. Otological literature abounds with records
of cases of cerebral abscess, which exhibited a long
period of latency. In acute abscess there is, as a rule,
little or no period of latency, and the disease ends fatally
in a few days, the abscess in such cases not being encap-
suled. Meyer" states that the earliest appearance of a
capsule is at si.x or seven weeks, and Huguenin demon-
strated distinct evidence of the capsule not earlier than
twelve weeks. The chronic abscess is characterized by
a prolonged period of latency, which intervenes between
the early congestive stage and that of the development
of the purulent formation. Often the latency is inter-
rupted by a slight degree of headache, which symptom
obtained in Case I., and is often confounded with digestive
disorders, and escapes scrutiny on that account. The
duration of the latency varies from a few weeks to sev-
eral months.
As far as I have been able to ascertain, the longest
attested duration of brain abscess is that case observed
by Harlin," in which the traumatism occurred twenty-
six years before death. In another case, reported by E.
Schott,* abscess of the brain followed an injury sustained
twenty-one years before. In the first case cited in this
paper the abscess had, in all probability, existed ten
years. The period of latency once being disturbed, the
end of the disease is soon reached. Headache was the
initial symptom in two-thirds of Meyer's cases of abscess
of the brain, therefore somewhat more frequent than in
brain tumors, where, according to Ladame," it ushered
in the phenomena of the disease in one-third of the
cases.
The intensity of the headache varies greatly : in one
case it is almost unnoticeable, in others it excites e.xces-
sive complaint by the patient. Generally it increases
with the duration of the disease, and is more continuous
and occurs less in paroxysms than the headache of brain-
tumors. The headache is sometimes accompanied with
fever, but this is very often absent, even in the terminal
stage. A case reported by R. Deutschmann, in a recent
number of Graefe's Arch, fiir Oph. (Bd. xix., Abth. i.,
1883, p. 292), is a striking illustration of this fact. The
case was one of abscess of cerebrum with choked disk ;
meningitis basilaris and perineuritis, also neuritis inter-
stitialis optica, but at no time elevation of temperature.
We find vertigo, and less frequently vomiting, and seldom
convulsions or paralysis. It is a significant fact in con-
nection with cerebral localization, that the principal seat
of abscess of the brain, secondary to ear disease, is in the
medullary substance, seldom in the cortex; which fact
may account for the absence of certain nervous phenom-
ena in these cases.
In regard to the clinical phenomena of thrombosis of
'Wiener Med. Presse, 1881, No. 46, p. 1452.
= Zur I^atholoEie des Hirnabscesses, Inaug. Diss. Zurich.
2 Quoted by Kruns, Handbuch der Chirurgie.
* IJeber Gehimabscess. Wurzburgcr med. Zeltschr., u., p. 462.
5 Symptomatologie und Diagnostic der Hirngeschwiilste, Meyer, op. cit.
340
THE MEDICAL RECORD.
[September 29, 1883.
the transverse sinus, the symjitoms of a painful cedenia
over the mastoid of the affected side, to which attention
was first directed by Griesinger, is of diagnostic vakie.
Schwartze (Arch, fiir Ohrenheilkunde, vi., p. 219) con-
siders this symptom unreliable, but Wreden confirms the
cedematous swelling in the region mentioned as a symp-
tom of phlebitis of the lateral sinus, and the cases reported
by Rammel, Kolb, Taylor, Moos, J- Orne Green, and
others, support Griesinger's view. However, this symp-
tom is not a constant one.
Phlebitis of the cavernous sinus declares ifself by a
congestion of the vein whicli empties into it, the oph-
thalmic, and its branches. As the result of this conges-
tion there is cedema of the eyelid, conjunctiva, forehead,
and nasal mucous membrane, entoptic phenomena, and
diminution of sight (Wreden'). These symptoms may,
in the beginning of the disease, exist on one side only,
but this will only be for a short time, since the disease
soon spreads to the corresponding sinus of the opposite
side. Congestive papilla alone would not necessarily
furnish us with positive evidence of the locality of the
obstruction since Sesemann ' has shown that the superior
and inferior ophthalmic veins do not empty the largest
quantity of their blood into the cavernous sinus, but into
the facial veins ; therefore, when symptoms of obstruc-
tion show themselves, viz., cedema of the eyelids, fulness
of the frontal veins, and exophthaliiuis, they are to be
explained, not by a simple thrombosis of the sinus caver-
nosus, but by the presence of thrombi at the same time
in the ophthalmic and facial vein.
The internal carotid artery, surrounded by the sympa-
thetic plexus, and the sixth nerve, ]iass through the
cavernous sinus, and the third and fourth nerves and the
ophthalmic division of the trigeminus are found on its
outer wall. We can, therefore, readily anticipate the
local phenomena which would be developed in conse-
quence of pressure of the inflamed sinus upon these
nerves.
An inflammation of the cavernous sinus, is, in the
majority of instances, accompanied by meningitis, and
writers have heretofore attributed the phenomena of an
affection of the oculo-motorius to meningitis ; but Wre-
den describes two cases of phlebitis of the cavernous
sinus (1. c, cases 9 and 10, pp. 95-96), which, notwith-
standing the absence of meningitis, sliowed familiar signs
of irritation and jiaresis in the areas of the oculo-motorius
and other cerebral nerves. Symptoms of disease m the
region of distribution of the trigeminus, occurring in phle-
bitis of the cavernous sinus, declare themselves most
frequently in irritation and paresis of the ophthalmic
branch ; the second and third division of this nerve
show these symptoms only exceptionally. Irritation of
the ophthalmic branch gives rise to one-sided headache,
sometimes sharply circumscribed, its greatest intensity
being in the forehead and over the eyes.
Wreden's cases seem to invalidate Griesinger's [Arch.
d. Heilkunde, iii., p. 446) declaration that the headache
is due not to the affection of the sinus, but to the con-
comitant meningitis. Fixed, one-sided, circumscribed
headache is, consequently, of differential diagnostic value
in an affection of the cavernous sinus, because it proves
irritation of a single branch of the trigeminus ; while dif-
fuse ijain, spread out over the whole half of the head,
speaks more in favor of the coexistence of meningitis of
the median cranial fossa, wiiereby the second branch of
the trigeminus (before its passage through the foramen
ovale), or even the Gasserian ganglion, is involved.
Phlebitis of the superior longitudinal sinus is charac-
terized by repeated and violent hemorrhage from the
nose, which Wreden considers very significant when ac-
companied by epileptiform convulsions. This latter
symptom is referred to capillary hemorrhage in the corti-
* St. Petersburg Med. Zeitschrift, xiii.
' Kinil ScsenKinn : Die (^rbitalvcncn dc* Menschen und ihr 2u5atnmenhang
mit dcii obcrll.lchlichcn Vcncn des Kopfcs, Arch. £. Anat. u. PhysioL u. wisscii-
schaftl. Med., 1869, p. 159.
cal substance of the posterior cerebral lobes, produced
by obstruction to the venous circulation of the surface of
the brain (Wreden).
Phlebitis of the superior petrosal sinus, although pro-
ducing no very characteristic symptoms, would give rise
to great congestion in the labyrinth of the ear, with sub-
jective noises and deafness, which is explained by the
fact that the vems of the labyrinth terminate in this
sinus.
In phlebitis there is almost always a marked febrile
movement, and pya^mic svmptoms are the rule in this
condition. In Case II., cited above, chills were fre-
quently repeated, and the temperature rose rapidly and
with very slight remission. In ^V^eden's case of phle-
bitis of the cavernous sinus the initial stage was very
short. On the first dav the temperature rose and with-
out remission to a morning temperature of 102.2° F., and
gained in a few hours the maximum of 103.82° F. Such
a sudden rise of temperature to a height of 39°-4o° C,
and more immediately on the first day, Wreden consid-
ers particularlv characteristic of the beginning of the fever
of an encephalic complication in purulent ear aftections.
.\nother valuable point in the differential diagnosis of the
initial period of the fever, of encephalic complication, in
inflammation of the ear, is that it rarely begins with a
chill, even when, as Wreden observed in one case, the
temperature was 104.18" F. ; whereas in the fever of
phlebitis of the cerebral sinuses and meningitis diftu.sa,
usually the reverse is the case.
It is of importance that all cases of ear disease with
suspicious but obscure symptoms of a cerebral compli-
cation should receive a careful ophthalmoscopic exam-
ination, and efforts be made to determine its value as an
aid to diagnosis in the disease under consideration, and
also to ascertain to what extent it should influence the
treatment of the ear affection.
In Case III. (the writer's), the cerebral lesion was on
the left side ; the left eye was the first to become affected,
and the first to recover (in the sense that there was no
visible change in the optic disk or fundus oculi) and yet
its sight alone was impaired. Mr. Nettleship has recently
alluded to two cases (they are not reported in full), in one
of which a tumor in the posterior inferior part of the right
anterior lobe occasioned severe pain, chiefly on the right
side of the face and head, with simultaneous double papil-
litis, and early extreme defect of sight in the right eye,
but no failure of vision in the left eve till a year later.
In the other case, the only lesion was softening of the
under surface of the left frontal lobe, with atrophy of the
left nerve. There was rapid blindness of the left eye
without changes, and papillitis of the right without failure
of sight. The left disk slowly became atrophied, the
right recovered.
From the few accumulated facts it appears that the
sight is most affected on the side of the lesion ; and that
papillitis with other symptoms of brain involvement is
valuable corroborative evidence, and we also have some
proof in the few cases of recovery, after neuro-retinitis
and other signs of brain disease secondary to an ear
affection, that the optic disk is, so to speak, a sort of in-
dicator for the condition of the brain. Hut in the present
state of the vexed cjuestion of the cause of the papillitis, it
cannot be said that it tells us much of the locality of the
cerebral lesion. \'on Graefe's view of venous stasis and
the theory of vaso-motor disturbance, are not su|)ported
by post-mortem evidence. Prof T. Leber has more re-
cently advanced a plausible view that the essential part
of the transmission is taken by eftusion of fluid into the
sheath of the nerve, which did not act by simjile mechani-
cal pressure, since its quantity was often small, but by its
phlogogenic properties. Leber, therefore, explains the
origin of papillo-retinitis in cerebral diseases by assum-
ing that the intra-cranial inflammation i>roduces serous
eftusion wliich passes into the optic nerve-sheath, and
excites irritating action on the papilhv: and neighboring
parts of the eye.
September 29, 1883.]
THE MEDICAL RECORD.
341
THE TREATMENT OF SCIENCE BY THE MIL-
ITARY METHOD.
By professor ELLIOTT COUES,
LATE OF THE MEDICAL CORPS, U. S. ARMV.
The above heading looks professional, does it not ? As
if science were to be treated by some ajiproved method,
like any other disease. But that is not exactly wiiat I
mean. Science is far more capable of treating a mili-
tary method as it deserves than is any military method
likely to turn physician for the benefit of science. The
military method of treating science is the method adopted
by dunces the world over in trying to investigate what
they do not understand, and cannot be made to comjire-
hend. It commends itself by its simplicity, energy, and
efficiency. It consists in taking the man who shows
symptoms of being scientific out and hanging him in a
red tape halter ; if he kicks agamst being strangled it
knocks him in the head with an official club, and says :
"What a brave boy am I ! " And all the rest of the
dunces api)laud the lynching. I do not see anything
else to recommend the method. I never heard of any
one wlio was cured of his science in this way. It is too
heroic treatment — not a reasonable "kill or cure"
method. It is all kill and no cure. It is what the liter-
ary dunces applied to Keats when they tried to cure him
of his poetry. The universal mother took her poor child
back to her kindly arms, and kissed away his tears.
Tragedy like this is rare indeed — rare as are " these
glorious sports of nature," as Huxley styles them, who
make such tragedy possible. But the princii'le — the
plan and method of treatment — is alwavs one and the
same, here, there, and everywhere ; it is today, was yes-
terday, will be to-morrow, in civil as in military orders,
applied alike to science, art, and letters. Applied to
quivering flesh and shuddering spirit by that thing which
has neither body to kick nor soul to damn — I mean tlie
Confederacy of Dunces. It is simple, energetic, and
effective, as 1 have said ; but this kind of heroic treat-
ment is open to serious objection. For it is the heroism
of the Dunce. And what a brave boy he is, to be sure !
I cannot imagine how the preceding paragraph ran oft'
my pen. I did not mean to speak of dunces — I never
knew one who was not abimdantly able to speak for him-
self, and the sound of his voice is fajniliar, if not musi-
cal. My idea was to say something about the relations
between scientific and military aftairs ; about the posi-
tion which I think the Army and Navy ought to take
regarding scientists who are in military service ; and es-
pecially about that curiosity known in the medical coriJS
of the Army and Navy as a " second examination," or
"examination for promotion." What I have to say is
mainly prompted by Captain K.. W. Shufeldt's article,
entitled "The United States Medical Service," in a re-
cent number of The Record. I hope Dr. Shufeldt will
follow up the subject. I like his way of putting it. He
has a good sound case, and his vein will bear workmg.
Granted, with Professor Hu,xley, that exammation, thor-
ough and searching, is an indispensable accompaniment
of teachmg, it does not follow that examination which
has nothing to do with teaching is indispensable. In the
latter case, it seems to me not even a necessary evil, but
simply a nuisance, and no nuisance can ever be neces-
sary. This second examination in the Army or Navy,
of course, does not profess to teach anything. Does it
learn anything, or discover anything ? If an officer
" skins through " by hook and by crook, is he not just as
well off" as one wlio sails through by luck, pluck, and
force of circumstances ? His position in the Army is
not affected appreciably. He goes back to duty, and
nothing has been lost or gained. If he is plucked, he
goes back just the same, and makes it his duty to cram
and come up again. He crams, comes up, passes, and
knows no more or less than he did before, and is no
better or worse doctor. To cram knowledge is not to
know ; crammed knowledge is invariably disgorged as
soon as the crisis is over, not digested and assimilated,
and made a living power, as all real knowledge is. The
man's consuming power, not his productive power ; his
capacity for containing, not for retaining ; his menial en-
durance, not his mental armament — these are what have
been tested. And this is the very test that some of the
best men should not be obliged to endure, for they are
the very ones least fitted to undergo such an ordeal.
The man of mediocrity stands a better chance than they
do, and generally passes a better examination.
The thing doesn't hurt the one as it hurts the other ;
and there are men — few, it is true, but there are men —
whom to hurt seriously is to- kill ; whom to wound in
spirit is to destroy. And that man is just the one who is
worth the rest of the regiment. He is the one who lacks
the heroism of the dunce. He is tlie one who demon-
strates the military method of treatment, where scientific
treatment should have been given instead, by turning
the drama of examination into a tragedy. The possi-
bility of such a grave contingency as this is enough to
condemn the whole system.
The second examination has its merits, as " a sieve to
catch the bad rats." I am satisfied that this is its princi-
pal merit, and its only recomiftendation. This raises the
question, however, whether rat-catching is a dignified or
desirable occupation for any army officer, under what-
ever name and style it may be pursued. To call it and
treat it as a medical examination strikes me as the mili-
tary method in full bloom — one of the most military
methods that could be devised. The military method is
the method of brute force, in its most brutal and forcible
exhibition. It is applicable to insurrections, and rebel-
lions, and revolutions of nations, but it does not apply
to rat-catching. Nobody ever caught a rat by brute
force — not even a rat-terrier could do that. He is in-
stinctively strategical ; and his instinctive strategy is
simply the scientific treatment of the case. The military
method is in order after the rat is caught — not before.
A rat, and especially a bad rat, is a|)t to be an old gray
rat, whose science is quite equal to any test that can be
devised by an examining board. In this case it is ten to
one on the bad rat, as against the man I described in
the last paragraph.
Since the examination proves futile in the rat's case,
and dubious or even dangerous in the man's case, let us
see if it is not also entirely superfluous in any case. The
militarv idea is, that the examination determines an of-
ficer's fitness for the position he holds, and for promo-
tion to a higher position in due course. But that is
absurd. It does nothing of the sort. It simply demon-
strates an officer's fitness to pass an examination — abso-
lutely nothing more. His fitness for his position, or his
unfitness, is perfectly well known before. He has been
in the service at least five years, perhaps ten or fifteen.
He has been busy telling people whether or not he is fit
for his position every day of his life during that period.
He has built and furnished his house, for better or worse,
and hundreds of his brother officers know it perfectly
well when they see it. So do a thousand soldiers. In
short, he has made his reputation, whatever it is. It is
all abroad ; it is in the air — pshaw ! there is not a clerk
in the surgeon-general's office but knows well enough
how that officer " stands." Individually, of course, no
clerk, no soldier, no line-officer, is as good a judge of
the man's fitness for the position as any one of his medi-
cal examiners. Collectively, however, judgments of the
rank and file is absolutely conclusive ; nothing that he
can say to his examiners, nothing that he fails to tell
them, nothing that they can tell the surgeon-general,
alters the case one iota. How should it, indeed ? How
should a conversation held for an hour or two with his
examiners, when he is probably under strain and stress
of mind, and of all hours in his career the least likely to
appear himself, bear upon that silent, stealthy, steady
inquisition he has endured for years ? The latter is the
examination that tells the true story ; if his thousand and
342-
THE MEDICAL RECORD.
[September 29, 1883.
one examiners consider him fit, he is fit, and there is the
end of it — or ought to be. And if, after all that, the
Board says he is unfit, why, the Board is doubtless mis-
taken— that is all.
Depend upon it no Board is going to find out any-
thing about a candidate that everybody did not know
before, excepting his ability to pass an examination
under every possible disadvantage. If the Board differs
with public opinion, the result may be mischievous, even
dangerous ; if it agrees with public opinion, it is at best
an elegant superfluity.
I will go one step further, and say, that almost any
officer of the medical corps is a better judge of his own
proficiencies and deficiencies than any Board can expect
to become under the present system of examination. He
knows himself a great deal better than they can find him
out, and could give a stricter, sounder, and more reliable
account of himself under almost any other method of
being called to account than the one now in vogue.
And an officer of the medical corps of the army is almost
invariably a man who would tfo if, too, fairly and squarely,
saying just where he felt weak and where strong, just
what opportunities he had had, and just how he had im-
proved them, and just ^vl^at he needed, moreover, to
enable him to reflect the most credit upon himself and
his corps, and do his patients the most good — all of
which he is scared out of doing the moment the exam-
ination-battery opens fire on him.
I think, therefore, that this examination business is in
the first place dangerous, in the second dubious, thirdly
futile, fourth superfluous — in fine, a military method of
treating science, when what it ought to be is a scientific
method of treating a specific military contingency. That
it is occasionally amusing, however, I can easily show.
Some ten years ago, holding then substantially the same
theories upon the subject that I have here voiced, I was
ordered before the Board. I had been nine or ten years
in the service, mostly spent, as usual, in the West and
South. I had some reputation, such as it was, as a
scientist ; none at all in the profession of medicine, for
which 1 never had any fancy or any ambition, and in
which, consequently, I never displayed any special ajni-
tude or excellence. I had doctored people to the best
of my ability, cut off their legs and arms occasionally,
taken care of government property, sent in regular
reports, and obeyed orders — always in an automatic
and perfunctory way, with my head full of other things
in which I took a vivid, resistless, and irrepressible
interest. I was at the time writing some books at
the Smithsonian in Washington, and expected to con-
tinue to do so indefinitely — and, in fact, I have done so
ever since. The order came without warning — though
if I had been told to expect it every day for five years
before, it would not have made any difference, I suppose.
I voted the whole thing a bore ; and being very busy
i.ideed, wanted to get rid of it as soon as possible. I
could not i)Ossibly have spared the time to do any
craumiing, had I been given opportunity to do so, and
should never have been better prepared than I was at
the moment. I did not expect to be thrown, J confess,
but 1 knew perfectly well the Board could ilo so if they
wished to; so I reasoned that 1 had better make it as
pleasant as possible for the gentlemen I was to meet by
not troubling them to i)ut too many questions, the re-
plies to which might not aftect them agreeably. In fine,
I was disposed to waive answers altogether, and so leave
the Board quite free to act at its own discretion. I went
to New York immediately, and had a good time for a
few days with some oflicers who were there on the same
errand, and then presented myself After passing the com-
l>liinents, and having some pleasant chat, " the trouble
began." One of the gentlemen asked me about rheu-
matism and Bright's disease. I said that I did not know
whether the blood was acid or alkaline in the former
disease, nor how to cure it ; and that I had never seen
a case of Bright's disease. -Another asked me what I
thought of somebody's theory of jihthisis. As I had
never heard of the theory or its author, I said very truly
that I did not think much of it, but presumed it had its
merits. Another asked me about some delicate opera-
tion upon the eye, and I said I had never operated upon
the eye, and never expected to. Things began to look
queer, and it was odd-or-even whetlier I could make my
theory of examinations work in that particular instance.
But when it came the President's turn to interrogate me
I felt easier ; for I knew by common report that he was
going to ask me what an aspirator was, and I had taken
the trouble, that very morning, to hunt up one and mas-
ter its mysteries. The contrast between my bold alid
cheery reply to this momentous question, and my pre-
vious remarks on other topics, was too much for the
gravity of my examiners, and there were five gentlemen
grinning at one another like Cheshire cats in a moment.
The aspirator finished the interview ; and taking a hint
from the President, with alacrity 1 bowed and withdrew.
A few days afterward I received a letter from the Sur-
geon-General, informing me that the Board had found
me qualified for promotion, but that I had apparently
not kept up with the progress of medicine. Why, bless
my soul, I could have told General Burns that, if he had
asked me, instead of sending me to New York to prove
it to four army surgeons by hunting up an aspirator !
What puzzled me was, how did they discover that 1 was
qualified for promotion ? Excepting the aspirator, I had
not given the slightest sign of knowing anything about
my profession, to say nothing of keeping up with it.
But I reflected that that was the Board's business to dis-
cover, and how they did it was a conundrum I was not
obliged to answer. Remembering, also, that I could
catch up with the procession at any time 1 wanted to. I
lighted a cigarette with the Surgeon-General's communi-
cation, and thought no more about it.
But now, what were the actual facts in this case ?
How came the Board to make a favorable report on
such an unfavorable basis? I take it, sinqily this: the
report was not based upon anything that transpired in
the examination-room, except in so far as a friendly rap
over my official knuckles was given, to save the Board's
official conscience. If I had passed even a tolerable
examination, the report would have been the same,
minus the rap. I had simply presented myself in pro-
pria persona, and the report was wisely, justly, and cour-
teously based upon what I was, not on what I happened
to say or not say in that brief hour. My theory was
proven : the examination was a nullity in my case, and
properly so. Why ? Because my examiners did wfi/ apply
the military method to the treatment of science, having
discrimination enough to apply the correct, which is the
same as the scientific, method to the treatment of a mili-
tary contingency. It was, in short, a piece of dunce-
business we were about, they and I ; and we both got
out of it by rising superior to it.
Some one may rise to object, at this point, to my un-
gracious way of remarking upon what was, according to
my own showing, great forbearance on the part of my
examiners, and great good luck for me. I think I recog-
nize the sound of the objector's voice. It is a familiar
one, not a musical one. No " forbearance " was shown
me ; the case did not require, nor indeed admit it ; it was
simply decided on its merits.
Take another case. I was recently conversing with a
medical officer who had been thrown. It pained me to
see the effect it had upon the man. Not that it hurt
him in anybody's estimation but his own, or is likely
ever to do him any ostensible injury — nobody cares a
straw about such things but the man himself Nor did
he — or could he — complain that the examination was
not fair and just, or thit he had not filled fairly and
justly. So much the worse ! It was a refined piece of
wanton crueltv to which he had been subjected, leaving
him not even the vantage-ground of complaint whereupon
to settle the affair between his woundetl spirit and him-
September 29, 1883.]
THE MEDICAL RECORD.
343
self by abusing his examiners, and proving himself an
injured man. I knew this gentleman intimately, having
served with him, and in fact been his patient more than
once. His reputation, if not a brilliant one — as it would
become should opportunity offer — was enviable. He
was liked and respected by his associates ; he enjoyed
the confidence and resi)ect of his patients ; was zealous
and faithful in the discharge of his medical and military
duties ; kept a good hospital ; kept his accounts straight.
He was sound, mentally and morally ; not very strong
physically ; scrupulously nice, even over-sensitive, on a
professional or personal point. Very well : he is or-
dered before an examining Hoard to plead a case of self-
defence, counsel and client in one ; a case upon which
grave consequences appear to him to depend. He
proves unequal to that emergency, and is advised that
he may try it on again pretty soon, and nuist make it go
next time, or go himself. Six or eight years of examina-
tion creditably sustained at the hands of a thousand self-
appointed inquisitors go for nothing.
This officer, I contend, has been both wronged and
injured. He has been wronged, by being subjected to
needless cruelty, issuing from a cast-iron system, too hard
and military to be applicable to the requirements of his
case. He has been injured, too — injured mentally and
physically — stung to the quick, wounded where he
lives, in his very marrow. Without regard to the human-
ities, viewing him simply as a physiological mechanism, he
has been put to a wrong purpose, and in handicapping
him in this way, the service is crippled to the extent to
which this particular cog in the wheel has been bruised
and bent. All tlie boring and cramnu'ng he can do will
be no offset to the deterioration the machine has suffered
in being set to do a needless piece of work — " pass an
examination." If I, or any other officer who had served
with this one, and knew him well enough to give an
intelligent and reliable account of him, had been asked
to testify, we should unquestionably have done hiiu
that justice which, it seems, he was imable to do himself
This was probably a case the reverse of my own ; one
which- — through no fault of the examiners — hinged upon
a pernicious system, based ujion a radical dunce-theory.
It were far better, I think, to satirize the theory, and
kick the system out of court, as I did, when I was satis-
fied that it would never do to let it be applied to me.
Since Dr. Shufeldt has adduced his own case with an
audacious candor and confidence I cannot sufficiently ad-
mire— enough to send the cold-cree]3s down the spine of
any well-regulated military man — I feel free to speak of
it also. Now that he is out of the woods he can aftord
to laugh ; but I suspect that the worst use he could have
been put to, next to hanging, was that which he was put
to when he was sent before the board. In the first place,
needless pain was inflicted — always a stupid and un-
scientific thing to do. Secondly, he spent a year in
grubbing a lot of old text-book bricks out of the cellar of
his mind's house, and polishing them off for his examiners'
inspection. That was so much time wasted, to say
nothing of the mental friction required to think clearly
with a load of useless bricks in the upper stoiy. No
mind works well when encumbered with unnecessary
facts. Library shelves were made for a purpose : and,
as old King George III. used to say, the greatest law-
yers know no more law than the rest — only they know
where to find the law. I cannot suppose that Dr. Shu-
feldt is any better officer or any better doctor for having
succeeded in an examination, any more than I su|3posed
him the contrary when he did not succeed. Nothing is
proven either way, excepting the ability to work under
stimulus, as Huxley says.
Knowing Shufeldt as intimately as I do — and I have
for some years watched his career with special interest —
I should say he was the last man who needed stimulus
to work. He is whip and spur enough to himself; one
upon whom the lash of the military method should never
be suffered to fall ; for when it does fall, as it did at his
first examination, the service suffers specifically to the
extent to wiiich he is injured himself The medical corps
loses exactly what it costs Dr. Shufeldt to catch up with
his examiners and get himself in working order again ;
for all the eftective energy he spent in that affair was
simply wasted, and the corps gains nothing in return.
To pass or not pass an examination is nothing per se.
What Shufeldt needs is neither stimulus nor discipline.
He needs an opportunity, not an examination, in order
to be put to the best use the army can make of him. So
long as any man is voluntarily a member of an organiza-
tion, civil or military, certain regulations and restrictions
must be enforced in his case ; but the greatest good to
the greatest number is likely to come when rules are
best adapted to the individual. It is the military method
again, instead of the scientific, when all rules bind alike
on all persons. The wisest discipline leaves the widest
margin for individual idiosyncrasies ; the right solution
of the personal ecjuation solves the general iiroblem. To
make a square peg fit a round hole is as impossible as
the quadrature of the circle. One of two things must
happen. Either the peg wears round, and sinks into the
hole at last, or it stays square, works loose, and is gone.
Nothing but friction during either process.
If I am not greatly mistaken. Dr. Shufeldt was cut out
for a scientist, and has the requisite qualifications to be-
come a great naturalist. I think I recognize the spark
that is in him. If it is there, and no mistake, nothing can
extinguish it, and I thank (lod every day of my life that
there are men in the world whose inner light, like Cireek
fire, can burn under water, if needs must be. The prac-
tical question is, not whether such fire can be put out,
for that is impossible, but what is to be done with it ? Is
it to be a producer or a consumer? Either is possible,
equally possible, I almost said. Let it produce, and
the world is the wiser and richer ; for ideas are born in
that kind of fire, and ideas are imperishable, and rule the
world absolutely. Let it consume — well, ask Keats, for
example, 7C'hat it consumes.
On my theory that this young naturalist has the spark,
he does not belong to the army. On the contrary, the
army belongs to him, and nothing that the army can give
him is too good for him. He never ought to know a
" commanding officer." He never ought to hear sick-
call blow. He never ought to see a patient. He never
ought to put on a cocked-hat, and strap a sword on —
that is, if mv theory is correct. Give him only the ne-
cessary conditions of environment, and prove me wrong
if am wrong. If I know anything, I know a naturalist,
and I know what a naturalist needs — what a naturalist
must have — what a naturalist will have, in or out of the
army.
But, you say, this Dr. Shufeldt, is he not an army sur-
geon, paid by the Government to perform medical duty ?
Why should an exception be made in his case ? He is
not hired to be a scientist, he is hired for a doctor. What
business has he to be writing books instead of attending
to the sick and wounded of the army ? What is all this
long, rambling tirade about sparks ? What is this man
driving at anyhow ?
My dear sir, I will tell you what I am driving at. I
am driving at you. I do not recognize your face, but
the sound of your voice is familiar and unmusical. I see
that you have a red-tape halter in one hand, and an offi-
cial club in the other. I see that you are a brave boy,
but you belong to the Great Confederacy. You have
the heroism of the dunce. You are the "Treatment of
Science by the Military Method."
Smithsonian Institution. W^ashington,
September i, 1S83.
To Remove Water from Alcohol. — If gelatine be
suspended in ordinary alcohol it will absorb the water ;
but as it is insoluble in alcohol that substance will re-
main behind, and thus nearly absolute alcoliol may be
obtained without distillation.
344
THE MEDICAL RECORD.
[September 29, 1883.
MANCANESE AS A STIMULANT OF THE MEX-
STRLJAL ORGANS AND AS A REMEDY IN
CERTAIN FOR^rS OF AMENORRHiEA AND
MENORRHAGIA OR METRORRHAGIA.
By FRANKLIN" II. MARTIN, M.D.,
CHICAGO, ILL.
Since Ringer and Mussell, of London, called the atten-
tion of the profession to the gratifying results obtained in
experiments performed by them {Lancet, January 6, 1883)
in the treatment of certain forms of amenorrhea by per-
manganate of potash, 1 have taken advantage of every
opportunity that has been afibrded me, both in dispensary
and private practice, to satisfy myself as to the action
and efficacy of the new remedv in that direction. I have
been more than gratified with tlie result. I have found
that manganese will not only relieve certain t'orms of
amenorrhoea, but also of inenorrhagia and metrorrhagia.
It is, of course, unnecessary to say manganese, or any
other one remedy, cannot be expected to relieve all cases
of amenorrhcea or menorrhagia, when each is de|)endent
upon so many ditTerent causes. As amenorrhcea is only
a symptom, not a disease, it would have been nnich more
satisfactory if Ringer and Mussell, in their little article,
had mentioned with greater explicitness the peculiar
forms of amenorrhea in which they found their remedy
to exert its great inlluence.
From mv observations I have been led to consider
manganese in any form a direct stimulant to the uterus
and its appendages. It may exert this influence by act-
ing as a direct vasomotor nerve-stimulant to tlie vascular
system of the parts, and in consequence of the improved
circulation directly increase the tone and nutrition of the
organs, or it may exert us whole force through stimula-
tion of the sexual nerve-ganglia, or even possibly the
sexual nerve-cenires, thereby bringing the organs to their
normal state of action. At any rate, its action is prompt
and direct. In bringing the uterus and appendages to a
normal state of menstrual tonicity, when the lack of tone
is dependent upon some previous depression of innerva-
tion, manganese, in my opinion, certainly has no equal.
Even when the cause of the depressed innervation is
still acting, this remedy will exert its stimulating power
over the menstrual mechanism. In consequence of
phthisis, menstruation had not occurred in a young
woman, eighteen years of age, for four months. Experi-
mentally the manganese was given in connection with
her other treatment. Menstruation occurred within a
week. Another young woman, twenty-four years of age,
with an aggravating digestive trouble of some years' stand-
ing, had become verv irregular — flowing profusely for a
week or two, then scantily for an equally irregular time,
again followed, perhaps without any warning, by a profuse
flow or as likely a complete cessation. This state of af-
fairs had been going on for more than a year. There
was no pain with the flow. She was very weak and an;e-
mic from the eftects of indigestion and loss of blood.
This patient was given two grains of the permanganate
of potash, dissolved in one-half glass of hot water every
night on retiring. It was kindly received in this way by
the irritable digestive organs. In a very sliort time there
was a decided im[)rovement in the menstrual trouble, and
the patient has since menstruated throe times normally.
In young girls who are irregular in the early months of
menstrual life, where it is simply caused by the natural
weakness of the partially developed organs of generation,
or where, from an overworked nervous system, the organs
are robbed of their natural nerve force, this remedy seems
to possess the stimulating properties requisite to bring
them into healthy action. A remarkable case of this
kind was that of a young girl who had menstruated once.
Eight months had passed, and the menstrual flow had
failed to appear again. The mother of the girl, being
alarmed, sought advice. The [lermanganate was given
in two-grain doses twice a day. Within a week the girl
menstruated the second time in her life. In two other
cases of "missing" in young girls, without any apparent
cause, or any other symptoms, the remedy given in the
same doses a few days before the next regular period was
expected, stimulated the organs to a normal flow. The
action of the manganese was so prompt in these cases
that I am convinced it was no mere coincidence.
It is well known that from exposure to cold the weak-
est organs of the body are the ones most liable to suffer.
A woman, who, when exposed to cold, inniiediately suf
fers suppression, cessation, or excess of the menstrual flow,
will invariably be found to possess susceptible and weak
menstrual organs. In cases of this kind, viz., suppression,
cessation, or excess of the menstrual flow, caused by
" catching cold," with no other apparent cause, the most
gratifying and prompt results are obtained from manga-
nese. The above variety of cases are of so frequent
occurrence that in them I have had numerous oppor-
tunities to test the new remedy, and I have yet to see it
fail, in either amenorrhcea or menorrhagia, when due to
the irritation of cold alone. In several cases where the
flow was a week or ten days overdue, from " catching
cold," the permanganate was given in large doses, and
its almost magical eflfect demonstrated by the flow ap-
pearing within twelve hours.
Although I have had greater opportunities for testing
the value of manganese in amenorrhcea than in menor-
rhagia or metrorrhagia, I have received unmistakable evi-
dence of its power in the latter forms of menstrual trouble.
Menorrhagia and amenorrhcea in their outer manifes-
tations are exactly opposite in nature, but they are very
often dependent upon the same causes. When the cause
is anajmia, or any depressing constitutional disease pro-
ducing a perversion of the functional activity of the men-
strual organs, and this perverted action consists of an
irregular or excessive flow, this condition will as readily
succumb to the stimulating eft'ect of manganese as when
the opposite condition exists. The following cases are
of interest : A woman, aged twenty-six, sought advice for
excessive and irregular flowing. She had been married
two years and had one child, twelve months old. The
child was large and strong, the mother physically slight.
The mother nursed the child. For ten months she had
stood the strain very well, when she commenced to fail,
suddenly grew weak and an:emic, and began to flow ex-
cessively. This continued with but a few short irregular
remissions until I saw her at the dispensary. She was
given two-grain doses of the permanganate of potash four
times a day, at the same lime all other treatment was with-
held. In three days the patient returned saying that the
flow had stopped the next day after receiving her medi-
cine. I then discontinued the manganese, prescribed
iron and nourishing food, and she continued to improve.
By digital examination nothing abnormal was found in
the above case. Another case was that of a large, stout
woman, thirty-five years of age, who came to the dispen-
sary suffering from menorrhagia. Her menstrual periods
were regular as to time but the cpiantitv of blood was
alarmingly excessive and would last for two weeks. She
was married, had three children, the youngest three
years of age. This abnormal condition of menstruation
had been coming on by degrees for a year. The uterus
was a little enlarged, and soft to the touch, otherwise, by
physical examination, nothing abnormal. Four days
before the expected flow she commenced taking the
permanganate in two-grain doses three times a day. Men-
struation came on at the expected time, and after a
normally free flow for four days passed ofl" naturally.
Before the next period the same treatment was repeated,
with the same marvellous result.
I have been particular to give here only typical cases.
In a number of other cases I have received very gratify-
ing results, and I am myself convinced that in properly
selected cases others will be able to obtain like results.
Although manganese, like the allied metals, nickel,
zinc, iron, and silver, has a direct influence on the blood
as a tonic in aiKemia, chlorosis, etc., it cannot be pos-
September 29, 1883.]
THE MEDICAL RECORD.
345
sible, in my opinion, that its peculiar influence on the
catamenia can alone depend upon that virtue. To influ-
ence the organs of menstruation by acting as a general
tonic, would necessarily be a slow process, and the eff'ect
would be very gradual. It undoubtedly, however, as a
general tonic, has a jiredilection for these organs. This
was noticed and commented upon by W. H. Broadbent,
of London, after experiments performed by him, and
recorded in the '-Proceedings" of the Clinical Society of
London for 1868-69, vol. ii., p. 122: "Manganese,"
he says, " seemed to have a special influence in pro-
moting the return of the catamenia, and nickel a special
property of checking leucorrhoea." But one can readily
see by the character of the cases reported by Ringer and
Mussell, and myself, that manganese nnist have a more
direct mode of influencing the menstrual organs than by
the necessarily slow one of a general tonic. As to what
that influence is, I am not prepared to advance any more
definite opinions than have already been included in tliis
short article. I shall look with great interest in the fu-
ture for the results of other experimenters in this direc-
tion, while personally taking advantage of every oppor-
tunity presented to extend my knowledge on the subject.
In prescribing the permanganate of potash (the most
convenient preparation in which to administer manga-
nese), it will be well to bear in mind a few points of
importance. The preparation has a disagreeable, dis-
tressing effect on the stomach when taken undiluted,
which may be obviated by administering when the stom-
ach is full — immediately after eating — or dissolved in
considerable water. In administering the permanganate
in pill form, it must be remembered that excipients ordi-
narily used by dispensers will produce with the drug
spontaneous combustion. The following basis has been
found to act well : " Vaseline two parts, paratfin wax
one part ; melt, stir till cold, and add kaolin, three parts ;
mix well," roll out, and dust with kaolin {^Lancet, Janu-
ary 13, 1883). Dry gelatin capsules I have found to be
the most [convenient form in which to administer the
remedy.
THE BROMIDE OF SODIUM IN THE TRE.-\T-
MENT OF EPILEPSY.
By J. LEONARD CORNING, M.D.,
\ NEW VOKK.
In a recent lecture by Professor Dujardin-Beaumet/,
published in The Medical Record of August 25, 1S83,
the following sufficiently remarkable statement occurs :
" I have made many trials of bromide of sodium in
epilepsy, and notwithstanding the considerable doses ex-
hibited— ten to twelve grammes a day — I have never suc-
ceeded in arresting attacks either of petit-mal or grand-
mal by this salt. I have therefore been astonished to see
in Hammond's remarkable work on ' Nervous Diseases'
that this eminent neuropathologist gives the preference to
bromide of sodium in epilepsy." To American practi-
tioners, at least, the above statement cannot fail to excite
astonishment ; not that it is at all extraordinary that
there should exist some difference of opinion respecting
the relative therapeutic value of the various bromides,
but rather because the particular preparation known as
the bromide of sodium should have been singled out as an
object of disparagement. Now, if there is one fact rel-
ative to the bromide more thoroughly established than
another, it is the superiority of the sodium salt, and for
this reason, that the prejudicial effects which are so
conspicuous a concomitant of the other bromide prepara-
tions are in great part absent in this (the sodium) salt.
In this connection Dr. W. J. Morton says {vide Dr. Mor-
ton's admirable paper on the " Treatment of Migraine,"
Medical Gazette for July 21, 1883) : " It is a matter of
clinical experience that larger doses of bromide of so-
dium may be tolerated for months without evidences of
the bromide rash and without failure of the health."
" On the contrary, a patient thus treated gains flesh, eats
well, and has good color." " For instance, M. B ,
treated for epilepsy, has taken 90 grains of bromide of
sodium daily for one year and is the picture of health."
This is a viultiim in parvo of the whole question. We
give the bromide of sodium, not because we expect to
prevent the attack with more certainty than with the po-
tassium salt, but because we hope to avoid the inevitable
disadvantages to general health which are the result of a
considerable and prolonged employment of the latter
preparation.
But Dr. Dujardin-Beaumetz tells us that he has not
succeeded in arresting the attack with the sodium salt.
Now if there is one fact more thoroughly established than
another, it is the ability of the sodium salt to arrest the
epileptic seizure, not alone for weeks and months, but
even for years. Thus my friend. Dr. M. Josiah Roberts,
of this city, has recently communicated to me the history
of a case in which he succeeded in reducing the number
of attacks from two or three a week to only one every
three or four months for three years, by the use of the
sodium salt ; and doubtless the result might have been
materially improved had the patient paid due heed to
general prophylactic measures.
I have employed the sodium both in epilepsy of adults,
as well as in that of young children, exhibiting the remedy
in far larger doses than could have been possible had the
potassium salt been employed, and not only was the at-
tack satisfactorily arrested but the general health of the
patient showed substantial improvement, as proven by a
considerable gain in weight. This was particularly true
of a boy of fifteen years, who before treatment often had
as many as four attacks in a single day. When I first
saw this patient he was suffering from the bromide rash
and his mental condition bordered on dementia, he had
been treated with heroic doses of the potassium salt.
Appetite was poor and general appearance of patient
emaciated in the extreme. Owing to the sickly appear-
ance of the boy his family had discontinued the use of all
medicine, and the tits had returned with all their former
severity. I ordered the bromide of sodium in forty-grain
doses three times a day, and put the patient on eggs and
milk. At the end of three months there had been an
actual gain in weight of nearly twenty-five pounds, and
the number of fits had been reduced from an average of
about three a day to two or three a month. So great
was the change in the mental and bodily condition of
this boy that his own mother who had been separated
from him during treatment hardly recognized him. Be-
sides the above case, which is sutticiently striking, as
exhibiting the remarkable constitutional effects of the
remedy, I can recall several other instances in which I
have had occasion to witness the wonderful effects of the
bromide of sodium in epilepsy. As a matter of course
some sort of attention should be paid to dietetics and
general hygienic rules ; but the same may be said with
respect to almost any other remedy which has been em-
ployed in epilepsy. There is, therefore, no doubt that in
bringing the bromide of sodium prominently before the
profession in connection with the treatment of epilepsy.
Dr. Hammond merits the gratitude of all who are inter-
ested in the therapeutics of this most frightful disorder.
As to the lack of success attending Professor Dujar-
din-Beaumetz's attempts with the bromide of sodium, I
can only find in them one of those unaccountable excep-
tions, which, if not refuted promptly, is calculated to
mislead those whose experience with the remedy in
question is as yet limited. This seems to me the most
charitable view to take of the case. To those, however,
who have become intimately acquainted with the matii-
fold advantages of this wonderful remedy, not only in
epilepsy but in very many other neuroses, it must of
necessity cause no little astonishment that a gentleman
of such prominence as Dr. Dujardin-Beaumetz deservedly
is, should at this late day, question the efficacy of such a
well-established remedy as the bromide of sodium.
346
THE MEDICAL RECORD.
I [September 29, 1883.
SOME REMARKS ON CANCER.
By JOHN FERGUSON, B.A., M.B.. L.R.C.P.,
ASSISTANT DEMONSTRATOR OF ANATOMY TORONTO SCHOOL OF MEDICINE.
Thoroughly convinced that carcinoma is a local dis-
ease, and arises de 7iovo as the result of some form of
injury or irritation to the part that becomes affected, I
began a series of researches in the year 187S. The re-
sult of these investigations 1 shall now briefly detail.
It is quite needless to say that cancer is of the epithe-
lial type. There is nothing abnormal in the fact of its
being epithelial, but in the fact that the epithelium
occurs where it should not, and is arranged after a
manner differing from that of normal tissue. There is
evidently a date previous to which a tumor that ulti-
mately becomes cancerous is not cancerous, in other
words that there is a pre-cancerous period to such new
formations. When and where to draw the e.xact bound-
ary line between the condition that is yet benign, and
that malignant, devouring state called a cancer, is not
easily defined. Another question of great difficulty, yet
of great importance, is, why the same knid and extent of
injury, as far as we can judge, acts as the initiative
which produces this dread disease in one perbon while
it fails to do so in another.
The answer to this question I think we are to seek
in what I shall call a constitutional tendency. 1 am
strongly of opinion that this tendency in different dis-
eases has not received due attention. A child is born
free trom any disease, yet with an inherited tendency to
some form of ailment in one or other of its tissues. If
this tendency to take on diseased action be marked in
the case of the secreting glands, and particularly if this
tendency exist in the epithelial elements, we have the
main conditions necessary for the production of a cancer.
There may be several existing tendencies in the epithe-
lial cells of the skin and glands ; still, as regards the
genesis of cancer, I think the rapid multiplication of the
cells is the most potent factor.
One fact to which I have paid much attention is that
a cancer is not infective until the definite structure of
this new formation has been evolved. Thus, so lon"^ as
the secreting tubes of the affected gland are packed with
epithelium, but no epithelium can be detected in the
tissue outside of the tubes, while no alveoli are found
filled with these cells, there is no infecting power to
neighboring parts and adjacent glands. I make this
remark very advisedly. While the secreting tubes are
thus blocked up and filled with epithelium, but none
found in the gland tissue, we have what may be regarded
as the strictly local stage of the cancer growth. Once,
however, the disease has advanced so far that the epithe-
lial cells can be discerned in groups througliout the (^land,
there is no further safety from infection.
Another point of great moment is from what element in
the gland does tlie cancer take its origin. To this I an-
swer unhesitatingly, the epithelium. U we take a cancer-
ous breast, which the surgeon has removed, keeping well
clear of the diseased tissue, with the idea of preventin<r
its return, then, after carefully preparing a great many
sections of the tumor, we shall find that a section taken
from the truly cancerous part will reveal all the histo-
logical characters of the disease; a section nearer the edge
of the tumor often shows these conditions in a less
marked degree ; a section still farther out shows them still
less definitely : and so on gradually, till all that can be
detected as wrong is simply the secretory tubes crowded
with epithelium. Follow in this manner, taking section
after section, gradually proceeding to the outer parts of
the tumor, and finally we reacii healthy tissue. Should
the removal be complete, and no neighboring portion of
the body have become affected previous to the extirpa-
tion of the diseased mass, freedom from a return will
likely have been secured. During the past five years I
have examined twenty-three cancerous niammaj, and with-
out exception found the above law to hold good. What
does this argue ? It seems to me that the only conclu-
sion we can draw from this is that the diseased process
begins in those tracks and channels that are lined by
epithelium ; and from these, as starting-points, invades the
connective tissue of the gland.
The following case came under my notice : A young
woman was delivered of an illegitimate child in December,
1882. About three weeks after she had an abscess in the
left breast from exposure to cold. This I opened freely
and it soon healed. In June she came to me, saying
that she could not sleep for the pain of this breast. The
pain steadily grew more intense, and I advised her to
have it removed. Going out of the city for a short time
for her holidays, she died of some actue abdominal
trouble. I succeeded in getting the diseased breast for
examination, and shall state briefly what I found. Nearly
three hundred sections were examined. Throughout the
entire gland the ducts were full of proliferated epithe-
lium, while only in one small portion could the true ap-
pearance of cancer be found. This was about one inch
from the point where the abscess had been incised.
This was the most advanced part of the disease, and it
was here only that the epithelium could be found in the
inter- and periglandular connective tissue. Had this
woman died a little sooner, no cancer tissue would have
been found ; had she lived a little longer there is every
reason to think that the whole gland would have been
more or less infiltrated.
Another point of great moment is the infectiousness of
cancer, .\lthough, as I have shown, cancer arises from
some injury done to a part by which its normal elements
are deflected into an abnormal arrangement of them-
selves, still after a time it loses its purely local nature
and steps out into neighboring parts. It has long been
observed that cancer affects the lymphatic glands lying
near it, and on that side toward which absorbed ma-
terial passes. In what way the glands become infected
is a question that lies at the bottom of a long series of
important facts, both pathological and therapeutic.
Lymphatic glands above the seat of some irritation
often become enlarged. As an example we might men-
tion that of a boy who bruises his foot, and as a conse-
quence of this the chain of glands in the femoral and in-
guinal regions become enlarged and painful. But as
soon as the source of trouble in the foot is removed, and
a little rest obtained, the tender and swollen glands be-
come normal. It is not so in cancer. Once the glands
have begun to enlarge, say in the axilla, the removal of
the diseased mamma will not suffice. In this case a set
of pathological changes are started which do not spon-
taneously stop. This points to the fact that it is not a
simple irritation of the glands. The truth is that the
same kind of changes are established in the gland that
previously existed in the breast. Take one of these
axillary glands and subject it to a most thorough micro-
scopic examination and we find what we found in the
cancerous breast. The secreting tubes are crammed
with proliferating epithelium, presenting the same appear-
ance as to size and arrangement of nuclei which was no-
ticed in the parent source of infection. In more ad-
vanced stages of the disease in other sections of the same
gland, or in sections of other glands, these epithelial cells
can be detected passing beyond their proper limits and
invading the walls of the secreting tubes ; still further ad-
vanced, they can be found outside of the tubes in the
gland tissue, and a little more and the alveolar arrange-
ment of the cells and inter-glandular connective tissue
is seen. Here is a set of events by which a new forma-
tion, or sort of new existence, is established within the
animal body. By sowing apple-seeds varieties of apples
are obtained ; but by grafting, these varieties are per-
petuated. A sort of species of tissue arrangement was
originated in the breast as the result of the injury in-
flicted upon it ; or, as the consetjuence of long-con-
tinued irritation. Once this kind of tissue species is
September 29, 1883.]
THE MEDICAL RECORD.
347
formed in the mammary gland it is conveyed to the
near lymphatic glands, on the principle of grafting ; when
tissues have run into the carcinomatous mould there is a
very strong tendency to reproduce themselves ; and it
matters little where they may be planted, if they take
root at all, it is only to develop a cancer.
From the examination of nineteen very suspicious can-
cerous breasts, it does not appear that there is much
tendency, if any, to affect the lymphatic glands, until
that stage of new life is reached when the epithelium is
distinctly abnormally situated. It is not until these cells
are found without the secreting ducts and grouped in
the connective tissue that we find any power to cause in-
fection of the glands above. The nineteen cases just
mentioned were in the very earliest stages of diseased
action when the ducts were packed, but no alveoli
formed. The appearance, however, so far as it went, was
such as invariably occurs in the growtli of a typical can-
cer. Most of these specimens were obtained from cases
where death had taken place from some other affection ;
a few only where the mamma had been removed on the
ground of suspicion. The great probability, indeed cer-
tainty, is that these breasts were cancerous in the early
stage, judging both from clinical and microscopic char-
acters obtaining in each. The only part in the evidence
wanting to confirm their cancerous nature was the ab-
sence of definite aveoli containing groups ol cells.
In another group of cases in which there was enlarge-
ment of the axillary glands, a microscopic examination
of the new formation in the breast always revealed the
true characteristics of cancer. This showed that in order
to infect the glands the disease in the breast must have
advanced to that stage, at least, when the epithelium is
found in the connective tissue outside of the walls of the
ducts, in a locality where it should not exist, and is ab-
normally arranged.
There is some jieculiarity about cancerous epithelium
which we may never be able to fully determine. It has
a tendency all its own, so that when it is planted in a
structure, as yet healthy, it has the power of producing
diseased action, and this I think in two ways : First, by
the ])roliferation of the diseased cells carried from the
affected to the non-affected parts ; and secondly, by ex-
citing a diseased action in the epithelium of the part
to which the infecting material is carried. This is what
we might call the intrinsic quality of the epithelium from
a cancerous gland. According to some of our great
pathologists, there is no such thing as a cancer cell ; ac-
cording to others there is a difference in the so-called
cancerous epithelium and that which is healthy. By
these latter the epithelium is regarded as larger, more
varied in form, and with larger and more distinct nuclei
and nucleoli. The results of all my own observations,
takmg the great average of cells, is in favor of the latter
view. Setting aside all microscopic distinctions, how-
ever, there is some vital property which, existing in cer-
tain epithelial cells, pre-eminently entitles them to be
called cancer cells. We cannot under the microscope tell
what spermatozoon would be capable of transmitting
syphilis, and' yet such a power may be resident within it.
At what period of the life of a new formation, destined
to become cancerous, the elements of which it is com-
posed acquire infecting power, we do not at present
know. A few experiments may help to settle this ques-
tion. A breast was removed in which the cancer con-
dition was well marked. As stated at the beginning of
t'.iis article, different sections gave different results. In
some the ducts only were so crowded with epithelium, in
some these cells existed outside of the duct-walls, and
in some the aveloli and cell-groups were found. From
that part of the diseased breast which yielded a good
sample of cancer tissue I placed a number of grafts in
the parotid and submaxillary glands of three young dogs,
and awaited the results. The dogs grew, and in two out
of the three cancer developed in the glands so treated.
From the same breast, but from parts that did not yield
the cancerous arrangement of tissue, but simply an ac-
cumulation of ejiithelium in the ducts, portions were
taken and planted in the same glands of three other pup-
pies of the same litter. In none of these did cancer
make its appearance, even at a period long after that at
which the disease appeared in the two of the first group
that were experimented upon. One of the first three be-
came distinctly cancerous in eight months, the other in a
little over ten ; while of the three last pups, none showed
any symptoms after a lapse of more than two years.
What, we might ask, is the infecting material in the
case of cancer ? Is it the fluid from the diseased part,
the connective tissue debris, a new cell, or the epi-
thelium ? That it is not a new cell may be answered at
once ; for no new special cell belongs to the life history
of cancer. On the other hand, it seems almost a cer-
tainty that the materies morbi for the spread of the
disease is not from the connective tissue in any way.
Take the example of cancer in the breast once more,
and we find that the axillary glands may be very much
enlarged at a period when the most careful and repeated
microscopic examinations of the mamma reveal no
evidence whatever that its connective tissue is breaking
down. The most searching examinations also fail to
show that anything likely to have come from the connec-
tive tissue can be found in the lymphatic channels. It
seems, again, that it cannot be due to any fluid, pure and
simple, unless it contains floating in it some solids from
the cancer-growth. In the exiieriments performed on
the pups, where a portion of the cancer was taken free
from epithelium in alveolar spaces in the tissue, no can-
cer was produced by engrafting. Now, it can hardly be
supposed that a section from the same tumor would
not contain the same juices throughout, although the
arrangement of the cells and fibrous tissue differed in
different portions. That it is in all probability the epi-
thelium that is the active agent in causing the appear-
ance of cancer in neighboring glands seems to me
almost to follow from what I have next to state. In no
case have I been able to find any evidence of enlarge-
ment in the lymphatic glands prior to the date at which,
when the cancer is removed, free epithelium can be
found wandering, so to speak, in the connective tissue.
When this stage has been reached, and not till then,
have I been able to find in the lymphatic vessels or
glands anything resembling the epithelium found in the
alveoli of a cancer. After this date, however, such
wandering epithelium can be detected.
One more remark, and I have done. There seems to
be some strange change going on in the tissue of a i)art
which is becoming cancerous ; and up to a certain point
it is benign, beyond this malignant. It is, in other words,
acquiring a new power and existence of its own. For a
certain period the ovum is only a mass of protoplasm
endowed with vitality ; by and by it comes to have a
separate life of its own, independent of the parent, and
possessing peculiarities which it in turn is capable of
transmitting. It does not appear that the epithelium in
a cancer has acquired infecting power until the alveolar
condition has been attained, or, at all events, until the
epithelium is found in the connective ti": ue.
The Relief of Toothache. — Dr. Kenneth W. Mil-
lican suggests the following convenient method {British
Medical Journal) : " It is a modification of a method
recommended by Professor Babaieff to the Caucasian
Medical Society. Melt white wax or spermaceti, two
parts, and when melted add carbolic acid crys'als, one
part, and chloral hydrate crystals, two parts ; stir well
till dissolved. While still liquid, immerse thin layers of
carbolized absorbent cotton-wool, and allow them to dry.
When required for use, a small piece may be snipped off
and slightly warmed, when it can be inserted into the
hollow tooth, where it will solidify. The ease produced
by this simple method is really very great."
348
THE MEDICAL RECORD.
[September 29, 1883.
^i*o0vcss of ^cdtcaX .Science.
Treatment of Fistula in Ano. — Dr. Poingt claims
that any fistula amenable to treatment by the elastic lig-
ature may be cured by simple drainage of the fistulous
tract. The drainage-tube is inserted by means of a sty-
let passed up the tract from the external opening. At
the end of two or three weeks the drainage-tube falls out,
after having destroyed the superficial wall of the fistula.
A granulating surface of small extent is left, which raji-
idly heals by cicatrization. The procedure is wholly
painless, and the j^atient may pursue his ordinary avoca-
tions during the entire course of the treatment. The
operation is never followed by any of those serious com-
plications sometimes seen after the cutting operation. —
Le Courrier Medical, July 28, 1883.
Treatment of Pseudarthrosis of the Tibia. — Dr.
Y. Guermonprez relates in the Bulletin General de
Therapcutiquc, July 30, 1883, a case of ununited fracture
of the tibia cured by means of successive slight irrita-
tions of the opposing surfaces of bone, occasioned by
the moderate use of the member. He concludes that in
cases of this kind walking within appropriate limits is
not injurious, and may even be conducive to a cure.
The limb is to be steadied during use by means of stift",
well-fitting splints closely bandaged to the parts.
Decoction of Lemon in the Treatment of Inter-
.mittent Fever. — Dr. Maghen states in the Gioruale di
Clinica e Terapia for March, 1883, that he h.is obtained
excellent results in the treatment of intermittent fever
and the malarial cachexia by a decoction of lemons.
The remedy was recommended to him by another phy-
sician, and he tried it first in some old inveterate cases,
without, however, anticipating any remarkable results.
The decoction is prepared as follows : A lemon, as fresh
as can be obtained, is cut up into small pieces and put
into an earthen vessel. Three glassfuls of water are
poured in and boiled down to one glassful, which is then
to be strained through a linen cloth and cooled in the
open air. As a result of his trials of this remedy, the
author arrives at the following- conclusions : i. Decoc-
tion of lemon, employed in malarial affections, gives re-
sults equal, and even superior, to those obtained from
quinine. 2. It not only cures when quinine does, but
even in those cases in which the latter remedy is useless.
3. It is equally effective in cases of chronic malarial
cachexia. 4. It presents none of the disadvantages of
quinine (irritation of the mucous membranes and tinnitus
auriimi). 5. Its administration is possible even in ca-
tarrhal conditions of the digestive tracts. 6. In addition
to these advantages it possesses the further recommenda-
tion of cheapness. In commenting upon these conclu-
sions, Dr. Kahn {Bulletin General de Therapeutique.
July 30, 1883) states that the natives of French Chiiana
employ with success the decoction of lemons to ward oft' a
threatened attack of chills and fever.
Pri.marv Peptonuric Diabetes. — Dr. Quinciuard de-
scribes in La Tribune Mi'dicale of .August 5, 1883, a
morbid condition, characterized often by emaciation,
thirst, polyuria, and marked cachexia. Examination of
the urine shows it to be of low specific gravity, abundant
in quantity, not precipitating by heat or nitric acid, but
deviating the plane of polarization to the left. Millon's
reagent produces an intense red coloration, and a precip-
itate is thrown down by tannin, mercuric chloride, chlo-
rine, and iodine. All these reactions denote the presence
of peptones. The urine should be examined inunedi-
ately after having been voided. The subjects of this
condition present the same clinical picture as do those
suffering from diabetes mellitus. The cause is not al-
ways easily determined, though a sudden chill or livelv
emotions may be mentioned as probable causes. There
is a defect ol assimilation, from which ensues a general
disease, a true dystrophy. It is well known that pep-
tones are excreted by the kidneys under certain circum-
stances, the condition being then a secondary ])eptonuria.
But the cases seen by the author are stated to have been
instances of primary peptonuria. There is another con-
dition also in which peptonuria supervenes upon true
diabetes mellitus, but this is very different from the dis-
ease under consideration.
Antisepsis in Ovariotomy and Battey's Opera-
tion.— In an article with the above title, appearing in
the Virginia Medical Monthly for August, 1883, Dr.
Battey presents the records of eighteen consecutive cases
of ovariotomy and of Battey's operation. They were
performed under strict antiseptic precautions, including
the spray, and all terminated in recovery. While not
believing that the spray or the use of carbolic acid in gen-
eral is essential to success, the author thinks that weak
solutions can do no harm, and that their use may serve
to guard the patient against any slight imperfections in
the details of cleansing. -And he therefore says that he
is content to hold them as valuable assistants in abdom-
inal surgery until their utter uselessness has been more
conclusively shown. He further says that his experience
has been uniform upon one point, namely : that when a
patient has been operated upon at her home and left to
the care of her family physician, convalescence has been
unduly slow and unsatisfactory.
Rectal Administration of Salines. — The following
is the plan pursued by Dr. W. Jaworski in the treatment of
disorders of the large intestine (Memorabilien, July 16,
1883) : In cases in which there is irregular action of the
bowels (constipation alternating with diarrhoea, or either of
these conditions alone), when palpitation reveals the pres-
ence of impacted fecal matters and points of tenderness in
the large intestine, and when the stools are mixed with
mucus, he uses injections of a two and a half per cent,
solution of soda of increasing temperature. An ounce
and a half of ordinary crystallized soda is dissolved in
three pints of warm rain water, and as much of this as
possible is injected into the rectum, and retained by the
patient for about five minutes. This is done every day,
at least five injections being practised. They have the
effect of cleaning the bowel of the masses of mucus.
Then at least five more injections are given of the same
solution, with the addition of a tablespoonful of common
salt. These are given only every second day. After
the rectum has been well cleaned, and little or no mucus
is seen in the stools, the author uses enemata of warmed
Karlsbad water, to every bottle of which, in cases of ob-
stinate constipation, a tablespoonful of sulphate of soda
is added. It is advisable during the treatment by ene-
mata, to intermit for several days at a time in order to
ascertain what progress has been made. Where there is
atony of the rectum it is well to give injections of pure
cold water, with or without the addition of common salt,
and -these are recommended also in the after-treatment.
The diet should consist chiefly of meat and milk. In
cases of habitual constipation, without catarrh or any ap-
parent lesion of the large intestine, the author begins at
once with enemata of sulphate of soda. The first injec-
tions are warmed, and contain about two tablespoonfuls
of Glauber's salt in three pints of water. Instead of pure
water, the salts may be dissolved in Karlsbad water with
advantage. Each day the water is used colder, and
chloride of sodium is usually added to it. A mixed diet
(excluding starchy food) is ordered. When a clearing-
out of the entire intestinal tract is sought, a glass or two
of cold soda-water, with a little sour wine, is ordered. In
feverish conditions, or wlien the stools contain streaks of
blood, very cold solutions of Glauber's salt and chloride
of sodium are advised. The advantages of the rectal ad-
ministration of the salines are summed up by Dr. Jaworski
as follows : i. The patient is spared the disagreeable taste
and the nausea so often following the taking of salines. 2.
Such a strict regulation of the diet is unnecessary, and the
1
September 29, 1883.]
THE MEDICAL RECORD.
549
salts may be given even after a full meal. 3. The entire in-
testinal tract is not uselessly irritated, but the remedy is
locally applied, and acts for the most part only on the
diseased portion. 4. The dose can be more easily regu-
lated, for when salines are given by the mouth, the
amount that reaches the rectum or acts upon it in any
way is a very uncertain quantity. 5. The local effects of
heat or cold may be obtained, together with those of the
medicines employed, when the latter are given by enema.
Cephalalgia of Adolescence. — Dr. R. Blache de-
scribes a form of headache, of not infrequent occurrence
in individuals of either sex from twelve to eighteen years
of age, which lie thinks is deserving of recognition as a
distinct morbid entity. It is not constant, but recurs
with great frequency, and is evidently increased by men-
tal effort. The pathogenesis of this form of cephalalgia
he sees in a complex of altered nervous function, dis-
turbances of the circulation, intellectual effort, and in-
sufficient aeration acting during the period of puberty.
The treatment consists in an active life in the open air,
the use of suitable glasses if there are any defects ol
vision, and, above all, the absolute cessation from all
mental work during a prolonged period. — Archives Alid-
icales Beiges, July, 1883.
Retarded Union of Fractures in Diabetes. — In
a communication addressed to the Academy of Medicine
of Paris {Bulletin tie I'Acade'mie, July 29, 1883), Dr.
Verneuil related the histories of several cases in which
the union of fractures occurring in diabetic subjects was
delayed, imperfect, or entirely absent. He referred to
the theory of Bouchard, who classes diabetes among the
disorders attributable to a retardation of the nutritive
processes, and he thought that the cases observed by
him were corroborative of this view. For the repair of
wounded tissues is a form of nutrition, and any delay or
fault in the reparative process implies a corresponding
defect in the function of nutrition.
A Case of Amaurosis Treated by the Percuteur.
— There is a little instrument, called the percuteur,
recently invented by Dr. Mortuiier Granville, by means
of which a number of taps in regular and very rapid suc-
cession, and of varying intensity, can be given to any
part of the surface of the body. Dr. Granville's theory
of pain is that it is due to abnormal vibrations in a sen-
sory nerve, and he explains the action of the percuteur
in the cure of pain and of other symptoms by the theory
that it induces a new and orderly set of vibrations in the
nerves to which it is applied. Dr. W. Carter relates a
case in the Liverpool Mcdico-Chirurgical Journal for
Jul}', 1883, in which the application of this instrument
was followed by the most striking benefit. He is not
prepared to accept Dr. Granville's theory of the action
of the percuteur, nor is he inclined to assert positively
that his case was cured by it, but leaves his readers to
form their own conclusions. The patient was a man
forty-five years of age, of excellent physique, free from
any taint of syphilis or hereditary disease. About five
weeks previously he was seized, without any premoni-
tory symptoms, with a headache, located chiefly in the
temples. The following day the pain was worse, and
was accompanied by a little chilliness and general
malaise. Several times during this day he observed a
dimness in the right eye. On the next day he was forced
to go to bed by the severity of the pain in the head. On
the fourth day he was totally blind, and exjierienced
great pain in the eyeballs when moving them from side
to side, but not when he moved them up and down. By
the end of the week all pain in the head and eyes had
disappeared, but the amaurosis persisted. Several care-
ful ophthalmoscopic examinations revealed no abnor-
mality. The pupils were dilated and but slightly respon-
sive to light. Leeches were applied behind the ear, and
iodide of potassium and solution of the perchloride of
mercury were administered internally. His condition
remaining unchanged, Dr. Carter directed that the per-
cuteur be a|5plied daily for five minutes to the eyeballs
and temples respectively. At the end of a week the pa-
tient was able to pick his way through the ward without
assistance, and at the expiration of a month was able to
read coarse print and to walk briskly through a crowded
street without a guide. He was again submitted to an
ophthalmoscopic examination, when it was discovered
that he had commencing cataract in each eye. The
author, while feeling no more certain that this lesion was
a result of the treatment than that the restoration of
sight was attributable to the same agency, is yet inclined
to thmk that the rapidly successive taps on the globe of
the eye so modified the structure oi the lens as to lead
to the production of cataract.
The Variation and Disappearance of Cardiac Mur-
murs.— Dr. E. Hyla Greves writes in the Liverpool Med-
ico-Chirurgical Journal for July, 18S3, concerning the
variations and changes so often observed in certain cardiac
nunmurs, dependent on definite organic lesions. He re-
lates the histories of several cases, from a studv of which he
draws the following conclusions : i. Although nunmurs
are among the most constant of the |)hysical signs of heart
disease, still their presence does not necessarily indicate
the existence of incurable lesions, nor their absence that
such lesions are not present. Jn forming a correct diag-
nosis and prognosis of any case, therefore, too much re-
liance must not be jjlaced upon the presence or absence
of murmurs, but other symptoms must receive careful
consideration, for often on them alone is it possible to
form a correct diagnosis. 2. The presystolic murmur of
mitral stenosis, the most typical of all murmurs, oc-
casionally disappears, the lesion still remaining. Mitral
regurgitant murnnirs, when due to simple relaxation of
the heart's muscle, and dilatation of its cavities and
orifices, as in chlorosis and general febrile conditions, in
most cases completely disappear under appropriate treat-
ment. 3. Tricuspid regurgitation is occasionally a tem-
porary condition, due to bronchitis, etc., and when the
cause is removed this condition is recovered from, as is
indicated by the disappearance of the murmurs. 4.
Aortic systolic murmurs, due to a permanent lesion at
the aortic orifice, may undergo changes in their intensity,
but never completely disappear. 5. Aortic diastolic
murmurs in certain extremely rare cases have been known
to disappear. In these cases a systolic aortic bruit is
always present and remains persistent, thus indicating
the existence of the lesion. 6. Pulmonary systolic
murmurs are persistent when due to an organic le-
sion ; but if non-organic, may disappear temporarily or
permanently.
Removal of Wens without the Knife. — Dr. Car-
reaux removed a fatty tumor the size of a pigeon's egg
from a young girl's foot by the following method, recom-
mended to him by an old lady of his acquaintance.
Frictions were made three times a day over the tumor by
a mixture containing equal parts of hydrochloric acid and
turpentine. The application was prolonged until the
patient complained of a severe smarting. Then a plaster
of hyoscyamus and mercurial ouitment was spread over
the part. The applications were made in this manner
for eight or ten days, when signs of commencing inflam-
mation appeared. They were then discontinued. A
slight eschar formed at the most [irominent part of the
tumor, and being thrown oft', left a small oiJening through
which the contents of the tumor were gradually extruded.
When the sac was empty the walls became adherent
through inflammatory exudations, and the cure was com-
plete in a month or six weeks. The author regards this
method as of value when the patients dread the knife,
and when the tumor is small, but advises against its em-
ployment in the case of large tumors, owing to the danger
of septicemia arising from suppurative inflammation of
the walls of the sac. — Journal de Me'decine de Paris,
August II, 1883.
350
THE MEDICAL RECORD.
[September 29, 1883.
The Medical Record
A Weekly Journal of Medicine and Surgery.
GEORGE F. SHRADY, A.M., M.D., Editor.
Published by
WM. WOOD & Co., Nos. 56 and 58 Lafayette Place.
New York, September 29, 1883.
THE PREVALENCE OF TYPHOID FEVER.
Thk Sanitary Superintendent, Dr. Walter DeF". Day, has
submitted to the Board of Health a report on typhoid
fever as it at present exists in this city, which, though
brief, contains points worthy the careful attention alike
of the medical profession and the public. It is gratifying
to learn that this disease is now being carefully studied
by the sanitary authorities with a view to its causation,
the degree of its contagiousness, and the prophylactic
measures best calculated to control its prevalence ; and
although the report now before us is only preliminary,
the importance of care in the disinfecting and removal of
excreta is plainly shown. Where, in repeated instances,
there being no sanitary defects to account for it, live or
six cases have occurred in one family coincident with
neglect in the disinfecting and removal of excreta and
soiled clothing — these having been allowed to remain for
hours, throwing off their exhalations to be breathed by
the sick and well housed together — there appears to have
prevailed either lamentable ignorance or gross careless-
ness in the use of simple preventive measures. The
theory of typhoid fever being conmiunicated through the
discharges from a patient suffering with the disease is
now generally accepted, and on this subject the public
should be informed. It is clearly the duty of every med-
ical man to do something more than advise disinfection
in a general way. He should explain fully just what is
necessary to be done, and the best manner of doing it
if he would accomplish without exception the entire
object of his mission.
The increase in the number of cases of typhoid lever
daily reported to the Sanitary Bureau during the present
season is assuming a grave importance. We learn from
Dr. Day's report that during the month of July there
were 93 cases reported, against 40 for July, 1882, and in
August there were 244, against 96 in August, 1882, while
to all appearance we shall probably have during the
month of September some 300 cases, against i \ 7 during
the corresponding month of last year.
The question very naturally arises, To what is due this
rapid increase of the disease during a season otherwise
remarkably healthy, and in a city where so much has
been done to improve the sanitary condition of dwell-
ings and their surroundings ? \Ve do not remember the
time when our city has been in a better condition as
regards general cleanliness than at present, and yet cases
of what is especially regarded as a filth disease are daily
increasing in frequency. May it be in any degree due to
the scarcity of water and a consequent deficiency in the
flushing of our house-drains and sewers ? Is our drink-
ing-water or the milk we use contaminated with typhoid
poison, or are there meteorological conditions which
we do not fully understand influencing the course and
type of disease ?
We find upon inquiry that our city is not alone the ob-
ject of this visitation. We hear of the same disease ex-
isting on all sides of us in different portions of the coun-
try. Of the 250 cases reported to the Sanitary Bureau
from September ist to the 24th inclusive, we learn that
35 came from the country, and from almost as many
directions. We also learn that on railroad and other
works in different portions of our State, where large
numbers of laborers are employed who live in crowded
barracks, typhoid fever has appeared in a very serious
form.
These facts seem to point to the conclusion that this
tendency to enteric affections is largely influenced by
some general atmospheric or telluric causes rather than
to local conditions, and yet when such general tendency
exists, the disease, whatever it may be, is sure to locate
and spread among localities where cleanliness is neg-
lected and sanitary arrangements are defective. Hence
the importance of careful and thorough inspections, not
only of places where typhoid fever has appeared, but all
places where sanitary defects may be found, with a view
to correcting these defects and preventing disease. The
physician, if he will, can do much toward aiding the Board
of Health in this work, by promptly reporting his cases,
and giving all necessary instructions to the family in each
case, in regard to disinfectants and the general sanitary
care of the sick and well. He cannot too strongly insist
on the importance of absolute cleanliness, the immediate
disinfecting and removal of all excreta, and if he is not
familiar with the most approved disinfectants and the
method of using them, he should lose no time in acquiring
the requisite information. The activity previously dis-
played by the Board of Health in combating small pox
and typhus fever, and the success which attended its ef-
forts, give us reason to hope that the problem how to
stamp out typhoid may yet be solved.
THE MEDICAL COLLEGES AT FORT WAYNE.
We have received a number of letters from reputable
physicians living in Indiana, regarding the medical
institutions at Fort Wayne, in that State.
It appears that there have been two colleges in that
cit)', the Medical College of Fort Wayne and the Fort
Wayne College of Medicine. The former w-as tlie older,
and during its six ) ears' existence it made some effort to
establish a good standard of education. Its ambition
and prosperity were cut short, however, by the establish-
ment of the Fort Wayne College of Medicine. The new
institution was rejected by the .Xmerican Medical College
.'Association on the ground that it "taught immorality."
It was subsequently declared a nuisance by the Mayor's
Court of the City of Fort Wayne. Following this, there
appeared an annual announcement of the college in
question, with an "especial notice, ' which is at once so
ingenious in character and elastic in function that we
print it entire :
September 29, 1883.]
THE MEDICAL RECORD.
351
"Inasnuich as this college is not a member of the
' Association of American Medical Colleges,' the P'aculty
desires to have it explicitly understood that it is in no
respect bound by any of the regulations of that associa-
tion ; that our requirements for an admission to a final
examination for the degree are entirely within tlie control
and discretion of the faculty, and not governed by any
arbitrary dicta ; and that these reijuirements are sub-
stantially as follows, subject to any desirable alteration.'''
The opportunities for " desirable alterations " are then
succinctly enumerated.
Before opposition like this the Medical College of
Fort Wayne, to its credit be it said, collapsed, the loss
not being probably a great one to the higher educational
interests.
In the present status of affairs, it is unlikely that the
earnest student of medicine will travel to Fort Wayne
for educational purposes.
FISH AS FOOD, AND THE UNITED STATES FISH COM-
MISSION.
In a lecture recently delivered by Dr. B. W. Richardson,
at a meeting convened by the British Fish League, the
speaker said that the elements required for the sustenta-
tion of healthy life were the flesh-building, the force- or
heat-producing, the mineral, and the waltery. Most fish
contained all these necessary constituents, some more
than others. Pollack held all the necessary qualities very
equally balanced. But the strongest and most nutritive
fish was sturgeon, which equalled in all the essentials the
best flesh meats. The speaker thought it was a question
whether fish could not be made generally as nutritive
as flesh meats, and he suggested that the Government
should institute an analytical couniiission on the subject.
We have sometimes wondered why the United States
Fish Commission, with its numerous corps of learned
professors, has not made some careful investigations into
the exact food value of fish. P'ish is certainly not so good
a food as flesh, and never can be entirely substituted for
it. It has more water than the ordinary meats, or than
game, and contains more inorganic salts in proportion to
the solids than flesh. Further, it has a small amount of
non-nitrogenous matters, and its nutritive ratio is as 1.2
to I, when the ratio in normal diet is about as i to 3^,
and the ratio in beef is as i to i^.
According to Landois, the nutritive constituents of the
different kinds of foods are as follows :
Beef.
Pork.
Fowl.
Fish.
Hens'
Eggs.
Wheal
Bread.
Water
62.
12.
3-
20.5
2-S
'I
5-
33-
I.
73-
19. 5
1-3
4-7
'•3
76.
12.
4.
6.
2.
73-S
I3-S
12.
I.
41-3
6-3
Albumen
Albuminoids
Non-nitrogenous. . . .
Salts
51-
1.4
The analysis given offish, however, can only be con-
sidered to represent a few kinds. There are great dif-
ferences in food value among the various forms of fish.
Some accurate chemical analyses would be of great in-
terest in studying the question of food fishes. It is very
well agreed that a fish diet may cause disease as well as
support life, that some tribes seem to degenerate and
others to thrive upon this kind of food.
HOW BEQUESTS TO HOSPITALS MAY BE DIVERTED
A CURIOUS case has just been decided in Chicago ad-
versely to the claims of the Woman's Hospital of the
State of Illinois, and the Chicago Hospital for Women
and Children, and aside from this point, which would
make it interesting to medical men, it is remarkable as
illustrating the fact that the intentions of testators are
often absolutely frustrated.
In 1876 Miss Julia R. Newberry died in Chicago, leav-
ing a will, in which was the following provision : " In
event I die unmarried, leaving my mother surviving, I
devise and bequeath to her all my property, both real
and personal, of every kind and nature, upon the express
condition, however, that she devise by will, to be e.xe-
cuted before receiving this bequest, so much thereof as
shall remain undisposed of or unspent at the time of
her decease, to such charitable institution for women in
said city of Chicago as she may select." After the death
of Miss Newberry, her mother refused to take the prop-
erty subject to this condition, saying that this refusal
made the will of no account, and claiming the property
as the only heir-at-law.
Under these circumstances the Woman's Hospital of
the State of Illinois, and the Chicago Hospital for Wo-
men and Children, each claimed that they were properly
designated by Miss Newberry in her will, and asked that
a trust be declared in the property in their favor.
Upon the trial the Court did not decide as to the
legality of the claim of Mrs. Newberry, but decided that
the hospitals had no rights, as the making of a will in
their favor was a condition precedent to Mrs. Newberry's
taking under the will, and as she refused to take there
was no ground ujjon which to rest their claim.
It was also held that the bequest in favor of some
institution for women was uncertain and could not be
upheld, for it was a matter of doubt whether there would
be any property left at Mrs. Newberry's death. The
whole case is an illustration of the uncertainty which
hangs about even an apparently plain provision in a will.
THE PROPHYLACTIC WORTHLESSNESS OF COPPER.
Apropos of some recent correspondence on a theory
advanced by Dr. Burq concerning the immunity of
workers in copper from contagious diseases, it may be
of interest to cite the views of Dr. Bailly upon the same
subject. At a late meeting of the Academy of .Medi-
cine of Paris, this gentleman protested in vigorous terms
against the theory of Dr. Burq, and denied that there
was any prophylactic virtue at all in copper. In fact,
he seemed to regard it as an excellent microbe stiundant,
and to incline to the opinion that these invisible but
deadly organisms waxed fat and strong under its tonic
influence. He stated that at Bornel and Ercuis, in the
valley of the Esche, and at the neighboring hamlet of
Chambly more than five hundred workmen are employed
in the manufacture of various articles from alfc'nide, an
alloy containing ninety per cent, of copper. Yet ty-
phoid fever is almost endemic in this valley, while the
neighboring plateau, where Chambly is situated, is prac-
tically exempt. Out of fifty-three cases of this disease
seen by M. Bailly in this locality, twenty-six occurred
among the copper-workers, and of four deaths, all were
35-
THE MEDICAL RECORD.
[September 29, 1883.
among the workmen, who should, according to Af. Burq,
have been protected by the nature of their occupation.
Similar facts were observed, he alleged, in the case of
other diseases. In 1832 Chambly was decimated by
the cholera, while Bornel, lying but a short distance
away, escaped the visitation entirely. This would, at
first sight, seem to be an argument in favor of the prophy-
lactic value of copper ; but, unfortunately for the theory,
the alft'mde works were not then in e.xistence.
The communication, made by Af. Burq to the Acad-
emy of ^[edicine a short time ago, attracted consider-
able attention, and his conclusions were widely copied
by the public press on both sides of the water. The
facts were convincing as far as they went, and the theory
was so fascinating in its simplicity, and was fathered by
so eminent an authority, that it speedily won its way to
the hearts, if not the intellect of the people. It would
be so easy to wear a plate of copper under the clothing,
and then bid defiance to all epidemics. And the prac-
tice would, furthermore, have an immense advantage
over that of carrying a buckeye in the pocket as a pre-
ventive of rheumatism, for it would rest on a scientific
basis, and would have the very best medical endorse-
ment. Indeed we are surprised that the vacuum in the
advertising columns of our religious contemporaries,
caused by Miss Lydia Pinkham's early demise, has not
already been filled by testimonials of wonderful escapes
from the measles of children wearing the copper pad.
But we have not long to wait before the copper pad ap-
pears, or else our faith in Yankee enterprise is vain. M.
Bailly comes too late with his cold, hard facts, and
while perhaps he may succeed in dismounting Dr. Burq
from his cupric hobby, he will never be able to convince
the world at large that he has done so.
A D,\NIEL COME TO JUDGMENT.
A GREAT reformer has arisen ; an instructor of pur-
blind humanity in the ways of correct hygiene ; a re
buker of his medical brethren. The Popular Science
Monthly, supremely devoted to the inculcation of scien-
tific truths, and the promoter of scientific habits of
thought, is the medium whereby the lucubrations of this
new apostle of medicine (as it should be) are communi-
cated to the human race.
Our professor of the new gospel oi physic — ])ardon us,
we do not mean the nasty stuff which purges, and which
he abhors, but the art 0/ healing — is a vegetarian. Ap-
parently under no circumstances and in no conditions
would he reconmiend an invalid to eat meat. Here he
has almost the entire weight of the medical profession
against him, and the best physiologists ; founded as are
their beliefs on an experience which is overwhelming.'
He is nothing daunted by this, however, and advises
even the debilitated and the consumptive to eschew a
flesh diet.
Our hygienist is, moreover, bitterly opposed to all
•medicines. For the asthmatic a " cold bath " is the most
reliable remedy in the attack ; no internal medication
should be used. The dyspeptic should under no circum-
• See Lorget's Physiology, vol. i.. page 104. for an exhaustive study of this
subject, and a fair statement of the advantages of a mixed over a purely vegctabla
■dielar)'. The facts adduced are starthng and unanswerable.
Stances resort to drugs, " which only momentarily help
one disease by inducing another." We are pleased to
see in the last Popular Science Monthly quite an effec-
tive criticism on this therapeutic nonsense, by Dr. J. R.
Black. " Only a person of superficial knowledge," says
Dr. Black, " of strong physique, and bigoted withal, who
judges all others by his own personal equation, could
discourse thus. Men and women will eat and drink,
either with or without knowledge, what they ought not,
and as a consequence the stomach rebels, and intense
suffering ensues. Only a short time since I saw a woman
who had been writhing every few minutes with terrible
gastric cramps for ten hours. Clearly it was an attack of
acute dyspepsia. To the suggestion of an emetic she re-
plied that a vomit nearly killed her. But another parox-
ysm of cramp led her to e.xclaim, ' Well, anything for
relief! ' In a few minutes she threw up nearly a gallon
of fermenting food that filled her chamber with the tumes
of a fetid sourness worse than that of an August swill-
tub. Half an hour afterward she fell into a calm sleep.
If humans will eat and drink what they ought not, eating
not for need but for pleasure, not as a means but an end,
the physician's duty is clearly to relieve suffering by the
removal of its immediate cause, as by an emetic or ca-
thartic." To this argument, illustrated as it is by an
incident which happens in the every-day e.\perience of
physicians. Dr. Oswald makes no effective reply. In
fact, no reply is possible.
So in regard to the treatment of constipation. It is
not true that all oar patients can attain a cure of this
morbid condition by dieting. Not all our consumptives
are in a condition, even in the early stages, to start off
on an overland journey afoot to California I
As for the treatment of sjtasmodic asthma, it is not the
experience of physicians that tlie inhalation of a little
stramonium smoke [jroduces after effects " worse than
the disease." If any have seen the "vertigo," "heart
spasms," and the "violent Iieadaches," which Dr. Os-
wald describes, we certainlv are strangers to such symp-
toms. Nor in practice do we think that it would gen-
erally be easy to induce our aged asthmatic patients to
try the cold douche, albeit the best remedy, according
to our writer. It would be an easy matter to review all
of Dr. Oswald's writings and mark here, "fallacy;"
there, " crude and not proven ;" there, " impracticable."
There is much in these papers that is clever and in-
teresting, ami there are important hygienic lessons, but
all is sadly marred by the dogmatical and paradoxical
temperament of the writer, who is nothing if not a little
" cranky." If the latter term seem a little harsh, we de-
fend ourselves by saying once for all that we deem any
man a "crank" who vehemently opposes the common-
sense judgments and exjiericnce of mankind.
THE ILLINOIS HEALTH BOARD AND THE AMERICAN
MEDICAL ASSOCIATIO.N.
In the last ijuarterly report of the Illinois Health Board
the Secretary, Dr. Rauch, gives an account of his expe-
rience at the meeting of the American Medical Associa-
tion, which, as he says, he deemed it his duty for several
reasons to attend.
The reasons for his attendance were made manifest by
a discussion which occurred in the section on State Med-
September 29, 1883.]
THE MEDICAL RECORD.
35S
icine. At the conclusion of a paper by Dr. Johnson,
members inquired how the reader could be a member of
a mixed board and also of the American Medical Asso-
ciation. A spirited discussion of the question ensued,
the propounders of the query not only holding that it was
wholly inconsistent with the Code of Ethics of the
American Medical Association, and that no one claiming
allegiance to it could engage in licensing liomoeopaths
and eclectics to practice without forfeiting its privileges,
but implying that the tendency of the work of aboard so
composed was injurious professionally. Other members
of the section strenuously opposed these views, and cited
the admitted results of the board's labors as a sufficient
refutation of the implied strictures. The chairman of
the section. Dr. Pratt, finally disposed of the teclmical
question by referring to the formal action of the Associa-
tion when the same point was sought to be made against
himself. Some years ago, in the preparation of a bill
similar to the Illinois Medical Practice Act, he had, he
said, met in a convention of representatives of the differ-
ent schools in Michigan, including homoeopaths and
eclectics. For this he had been arraigned on a charge
of violation of the Code. The Association then held that
the Code of Ethics could not be violated by any action
of a member which was necessary to the discharge of an
official duty under the law, and that the fact of member-
ship on a representative board did not come within the
purview of the Code of the Association governing the
professional relations of medical practitioners.
The decision of course settled the case of Drs. Johnson
and Ranch. But it is apparent that the decision was
really a concession forced upon the Association, and that
it is not consistent with the stand which that body claims
to assume. P"or what right has a regular Association
physician io take a position where his official duties force
him into consultation and communion with homoeopaths !
And one might very easily ask why the Association, if it
excuses Dr. Ranch, should not also excuse a physician
who consults with homceopaths in the discharge of a pro-
fessional duty under the moral law, which many have
thought more obligatory than the enactments of legisla-
tures.
Now IT IS FiBRINE AND NOT FaT-CrvSTALS. Dr.9
R. Gregg, of Buffalo, has been conducting some experi-
ments on bacteria, and publishes the following remarkable
summary of his labors : By boiling a quantity of healthy
blood he obtained all the forms of bacteria. Then, with
some pure fibrine obtained from a washed clot of blood
and boiling it, proving that it was the threads of fibrine
broken up into pieces and granules that gave the bacteria,
the same results were obtained. Next, some blood was
obtained and rotted under warmth and closely watched
for two months, and here again the forms were obtained
that the fresh-boiled blood gave. From these experi-
ments Dr. Gregg concludes that all the bacteria of dis-
ease are forms of fibrine, and for the general good requests
all investigators to repeat the experimental work and
report to the public the results of such investigations.
Professor Budge, of Greifswald, has recently cele-
brated his fiftieth jubilee. Numerous honors and con-
gratulations were bestowed upon him.
l^citJs of tlxc ^JccTi.
Births and Deaths in New York Citv and Its
Tenement Houses. — Colonel Clark, Secretary of the
City Health Board, made a statement recently before a
Committee of the Legislature with reference to the excess
of deaths over births in this city. He said the reason
the statistics of deaths appeared to be so much larger
proportionately than tliose of births was because there
was no system by which a perfect registration of the
births in the city could be obtained, and that one-third
of the births at least were not registered. This fact ac-
counted for the erroneous statement, made before the
committee and frequently published, that the number of
deaths e.xceeded the number of births in the city. The
tenement-house population of the city — that is, the nuni-
berjiving in buildmgs occupied by four or more families —
aggregated eight hundred thousand, or a trifle more than
one-half the entire population. The average number of
tenement houses erected annually during the past three
years was fifteen hundred. The city in its sanitary gov-
ernment was in advance of any city in the world, and it
was also freer from small-pox and other contagious dis-
eases than any other large city, and for that reason.
Tenement houses were not so healthy as they might be,
but their condition had been very greatly improved
during the past few years, as property-owners found it
beneficial to keejj them in good condition, and now co-
operated very generally with the Health Department
authorities. The rules adopted here in relation to the
plumbing of new buildings were now being adopted very
generally in all the large cities of the country.
Professor Zeisse, of Vienna, Physician to the Gen-
eral Hospital, has been raised to the rank of nobility,
upon the occasion of his retirement from active work.
Zeisse has made many contributions to syphilology.
Dr. Bois-Revmond's Jubilee. — The twenty-fifth an-
niversary of Dr. Bois-Reymond's Professorship will be
held in Berlin, October 25th. A bust of the eminent
professor will be unveiled and a large number of his pu-
pils will present conniieniorative scientific papers, which
will appear in his Archives, forming a Jubilee volume.
Kairin, the New Anti-pyretic. — This drug has
finally been put upon the market by a German firm, the
price being 200 marks per kilogram, which is very much
cheaper than quinine. Dr. Knipping, of Neuwied, has
reported a successful experience with kairin in a case of
puerperal fever.
Murder of a Western Physician. — Dr. A. B. Mc-
Kune, of Council Bluffs, la., was shot and instantly
killed by one Dr. E. D. Cross, of the same city. Dr.
McKune was a well-known physician, member of the State
and local Medical Societies.
Death from an Overdose of Morphine. — Joseph
W. Pilkington, a medical student, died a few days ago ir»
this city from morphine poisoning. He had been in the
habit of taking morphine recklessly to control a malarial
cephalalgia from which he frequently suffered, and it is
supposed that he took too large a dose at last. It is not
thought that the self-destruction was intentional, as there
554
THE MEDICAL RECORD.
[September 29, 1883.
was no apparent motive for suicide. Mr. Pilkington was
twenty-two years old. He was a student in the Bellevue
Hospital Medical College, his home was in Sedalia,
Missouri.
Small-Pox is reported to be prevailing to a large ex-
tent among the laborers on the Georgian section of the
Canadian Railroad.
An Anti-Cholera Pill. — Dr. Fonquet, of Cairo, as-
serts that the following prescription is eflicacious as a
prophylactic against cholera :
IJ. Asafoetid.,
Opii,
Camphor,
Papav. niger aa .06 gramme.
M. Ft. one pill.
The Micrococci of Cholera. — Dr. Stephen Kartulis,
Physician to the Greek Hospital at .'^le.xaiidria, has found
minute round and oval cocco-bacteria in the blood and
discharges of cholera patients, also in some of the filthy
drinking-water used in the infected districts.
Dr. To.msa, of Kiew, has been appointed Professor of
Physiology at Prague.
Austria has in its seven universities 2,418 medical
students. United States has in about ninety medical
colleges some ten thousand students.
The Russian Congress of Physicians and N.\tu-
RALisTS held its annual session at Odessa, beginning
August 18th.
The Parasite of Yellow Fever. — ^Dr. Dominga
Frieze, a Brazilian physician, thinks that he has discov-
ered a parasite in the blood of yellow fever which is the
cause of the disease. Animals inoculated with it died of
yellow fever.
The Collective Investigation of Disease. — The
collective method of investigating disease, which has
been pursued with so much earnestness in England, has
been adopted by the Berlin Society for Internal Medi-
cine.
The National Longevity Union is the modest title
of a sanitary society, which, says the Medical ami Sur-
gical Reporter, has been recently organized in Erie, I'a.
Medicine in Nebr.4Ska. — We have received a cata-
logue containing the annual announcement of a new
medical college at Lincoln, Neb. The educational op-
portunities are most comprehensive and inviting. There
is no charge for tuition, and there is (or was) a regular,
a homoeopathic, and an eclectic faculty.
Threatened Epide.mic of Typhoid Fever. — The
number of cases of typhoid fever in this city continues
to increase weekly. The possibility of an epidemic is
to be borne in mind.
Dr. N. Sapolski, an obstetrician, of Moscow, died
recently of septic;emia contracted while attending a case
of childbirth. He was one of the editors of the Medi-
zinskoje Obosrenje, a monthly journal published in tiiat
city.
Inspection of Furnished Rooms in Paris. — The
police department of Paris has, at the request of the
Municipal Council, instituted a service of inspection of
furnished lodgings. Five regular inspectors and fou.
substitutes have been appointed at a salary of $600 per
annum for the former and $25 per month for the latter.
Each inspector must, on application, furnish a rejiort
upon the healthfulness of any lodging within forty-eight
hours after the ajiplication is received. It is not stated
whether the inspectors are medical men or not.
Night Medical Service in Leipzig. — The city of
Leipzig has voted a yearly grant of $250 to provide for
a night medical service. The fee. to be paid by the city
in case the patient is unable to do so, is set at the modest
sum of $1.50.
The Question of Cremation in Paris. — Acting
upon the report presented by M. Brouardel, the Conseil
d'Hygiene de la Seine has rejected the proposition to
burn the bodies of those dying in time of epidemics, es-
pecially in an epidemic of cholera. The report stated
that the interests of justice, as well as those of jiersons
unjustly accused of ]5oisoning, would be seriously cora-
pron)ised by the adoption of the practice of cremation,
especially in the case of a cholera epidemic. It was
said, further, that cremation would necessitate more
handling of the bodies, and would therefore e.\pose the
living to greater danger up to the moment that the coqjse
was put into the furnace, than would interment. These
objections were thought to overrule the obvious advan-
tages of this method of the disposal of the dead, and the
proposition was therefore rejected.
A Rival Medical College in Beyrouth. — The
French have for some time been seeking to quietly e.x-
tend their influence in Syria, with the view of ultimately
assuming a protectorate over that country in the proba-
ble event of a disruption of the Ottoman Empire in the
near future. As a further step in this plan, they are now
about to establish a medical school with French pro-
fessors in Beyrouth. One hundred and fifty thousand
francs have already been expended in the acquisition of
a suitable building and in the establishment of a chem-
ical laboratory witli all the necessary apparatus. The
school is under the control of the French Government,
and the professors have been selected from the Faculty
de Medicine of Paris. The first session will commence
in October.
Wholesale Poisoning of Convicts. — Over one hun-
,dred convicts in the Connecticut State Prison at Weth-
ersfield were poisoned recently, it is supposed by eating
some corned lamb. All those who ate of the lamb were
seized with cramps and vomiting, while none were at-
tacked wlio liad not eaten the meat. The lamb was
purchased of a Hartford butcher, and is thought to have
been poisoned after leaving his shop. Ptomaines were
probably the cause of the trouble, .■^n analysis is to be
made of both cooked and uncooked samples of the meat.
'J'yphoid Fever in New York. — The city sanitary
superintendent has made a report regarding the preva-
lence of typhoid fever in this city. He states that up to
September ist of this year, tiiere were 539 cases, against
304 for the corresponding period last year. The disease
is not confined to any jjarticular locality, but is rather
distributed generally over the city. Dr. Day calls atten-
tion to the neglect of proper disinfection in typhoid fever,
as shown by the reports of the inspectors. The vital
point in the sanitary treatment of typhoid fever is the effi-
September 29, 1883.]
THE MEDICAL RECORD.
355
cient disinfection of the clothing, bedding, etc., and what-
ever the board can do to impress this upon the medical
profession of the city, particularly at this time, will be an
important factor in controlling the disease during the ap-
proaching winter.
Typhoid Fever in the French Army. — An epidemic
of typhoid fever of severe type has appeared in the mil-
itary barracks of Macon, in the department of Saone et
Loire, situated about forty miles from Lyons. The regi-
ment quartered there has been transferred to camp at
Cluny.
Nominations for Officers of the Medical So-
ciety OF THE County of New York. — At the stated
meeting held Monday evening, September 24th, the fol-
lowing nominations for officers for the ensuing year were
made : Dr. Austin Flint, Jr., nominated as uncompro-
mising adherents to the Code of P2thics of the American
Medical Association, T. Gaillard Thomas, for President ;
Charles A. Leale, for Vice-President ; E. A. Judson, for
Secretary ; P. Brynberg Porter, for Assistant Secretary ;
Henry D. NicoU, for Treasurer; and Drs. Charles Mc-
Burney, Richard H. Derby, Charles S. Wood, Charles
Hitchcock, and Thomas H. Burchard, for Censors.
Dr. F. R. Sturgis nominated for President Dr. S. Oak-
ley Vander Poel, who was willing to represent those who
were in favor of sustaining the State Medical Society in
its action concerning the Code. Other nominations were
made as follows: for Vice-President, Dr. Andrew H.
Smith; Secretary, Dr. Wesley M. Carpenter; Assistant
Secretary, Charles H. Avery; Treasurer, Orlando B.
Douglas ; and for Censors, Drs. F. R. Sturgis, David
■\Vebster, Daniel Lewis, F. R. S. Drake, and Joseph W.
Howe.
Sir William MacCormac and Dr. Lyon Playfair are
visiting this country.
A Canadian Physician to be Knighted. — It is
understood that Dr. Grant, who who has been the per-
sonal medical adviser of Princess Louise during her so-
journ in Canada, will be knighted before the departure
of the Princess for England.
Yellow Fever. — During the week ended September
iSth there were eighteen deaths from yellow fever at
Havana. Mr. E. E. White, United States Consular
Agent for Ponce, Porto Rico, reports yellow fever pre-
vailing in that city, especially among the foreign resi-
dents. Acting Assistant-Surgeon J. M. Main, of the
Marine Hospital Service, reports one case of yellow fever
in the City of Mexico, being an imported case. This, he
states, is the second case which has occurred in the his-
tory of the city, the first case having occurred in 1865, a
correspondent of the New York Herald, who died from
fever contracted in Vera Cruz.
Cholera. — The Consul-General at Calcutta reports
to the State Department that there were eleven deaths
from cholera in Calcutta during the week ended August
4lh, and twelve deaths during the week ended August
II, 1883.
During the week ended August i8, 1883, there was
one death from cholera at Flushing, Netherlands.
In order to protect the Empire from introducing
cholera now spreading in Egypt, the following measures
have been adopted by the Government of Russia : In
the ports of the Black Sea, beginning June 29th : i, to
keep under quarantine for two weeks all the vessels
arriving at any Black Sea port which have no certifi-
cate showing that they are safe from cholera ; 2, to keep
under quarantine for a week all the vessels coming,
with certificate of health, from the Straits of Constantino-
ple and from the Anatoly Coast, and also those having
been under quarantine in foreign ports ; and 3, to have
quarantine exclusively at Odessa, Kertch, Theodosia,
and Batum. In the Baltic ports, beginning July 14th :
I, not to admit to our Baltic ports any vessel coming
directly from Egypt, which will have no certificate
showing that they have been submitted to quarantine on
their way ; 2, to submit to sanitary investigation all the
vessels coming from the other places of the northern
coast of Africa ; and 3, to submit to quarantine for six
days all the vessels mentioned above in case of any
doubt.
News from Pasteur. — M. Pasteur has sent a de-
spatch to M. Dumas, stating that the commission sent to
study the cholera in Egypt has made some very interest-
ins observations of a novel character, and which tend to
o
su|iport his preconceived theories. He promises to
communicate the details by letter.
Prince Bismarck and his Medical Advisers. — An
item is going the rounds, taken from the Allgemeine
Wiener Medicinische Zeitung, which shows the discom-
forts to medical men of waiting upon German princes.
It appears that Bismarck has never cherished any feelings
of regard for his medical attendants ; at any rate, he has
never given expression to them, and it has been his con-
stant habit to dismiss them whenever the fancy took him.
It has often enough happened that he has discharged a
practitioner of ordinary medicine to take up with a
" homoeopath," and sometimes to have both kinds in at-
tendance at the same time. As he has said, "The
method of treatment is of less consequence to him than
the result." Sometimes he has fixed a time for his at-
tendant within which he has required to be cured, or at
least rendered fit for work. If the result has met the re-
quirement, the patient has been content, but he has never
had a word of acknowledgment or thanks for his medi-
cal adviser. When he was Deputy in Frankfort he was
attended by the then Regimentsarzt, now Director of the
Imperial Health Office, Dr. Struck. When he was first
in Friedrichsruhf, Dr. Cohn, of Hamburg, was his at-
tendant. When in Varzin he had a third. In Kissingen
he had consulted Dr. Diruf. His wife is a believer in
homceopathy, as well as a trafficker in a nostrum (made
from magpies' wings) for the cure of epilepsy, and for
some reason — perhaps influenced by his wife — he was
for several years under treatment by professors of the
"School of Homceopathy." Three years ago he re-
turned to the rationalists, and consulted Professor
Frerichs, whom he had consulted many years before ; but
within a short time he had made another change, and
called in the professional man under whose care he now
is. The present favorite is a Dr. Schweningen, 01
Munich. This individual is a young man, thirty-three
years of age, who, starting with brilliant prospects, has
already succeeded in shutting himself out from relation-
ships with most respectable families in consequence of
!56
THE MEDICAL RECORD.
[September 29, 1883.
some indiscretion in connection with the wife of another
medical man, one result of which was that both parties
suffered a term of imprisonment. Bismarck, however,
requires only medicine from his doctor, and the young
man found his moral, or immoral, behavior no bar to the
Prince's favor.
Bismarck suffers from sciatica and tic-douloureux ;
also from various gastric troubles, the result of his indis-
cretions.
The American Public Health Association will
hold its eleventh annual meeting at Detroit, Michigan,
November 13th, 14th, 15th, and i6th. The following
are the subjects chosen for special consideration :
1. Malaria. — Its etiology and the methods for its
prevention in localities or in persons ; its American his-
tory ; its specific particles ; its origin ; the conditions of
its pervasion ; its laws of extension etc.
2. Foods. — Their adulterations ; healthy or deleterious
modes of preservation and the function of legislation
in regard to them. Ascertained facts as to adulterations
in this country. Facts as to canned goods, condensed
milk, artificial butter and cheese, prepared meats, etc.
3. Vital Statistics.- — Methods and results : defects ap-
parent. How far foreign modes of tabulation are to be
followed. Systems of collection and classification. Race
vitality and the care of poinilation as indicated by statis-
tics.
4. The Control and Removal of all Decomposable Ma-
terial from Households. — The mechanical laws, construc-
tions, and appliances relative thereto. The construction
of all inside pipes and their connections, their traps and
siphonage, flushing, ventilation. How they shall be con-
nected with out-door receptacles and yet be free from ill
effect.
^cuicxus and Notices.
A System ok Surgery, Theoretical and Practical,
IN Treatises by Various Authors. Edited by T.
A. Holmes, M..-\., Cantab., Surgeon to St. George's
Hospital, and J. W. Hulke, F.R.S., Surgeon to the
Middlesex Hospital. Third English Edition. In three
vols. New York : \Vm. Wood & Co. 18S3.
With the lapse of twelve years since the last edition of
Holmes' .System, numerous and important advances have
been made in the science and practice of surgery. Within
the period named new principles have been established
and many questions heretofore considered of little mo-
ment in their bearings upon the salvation of life and limb
have invited such extended discussion and called forth so
many facts of experience that the conclusions based
thereon have virtually marked the points of new and rad-
ical departures in treatment. Among these advances we
may notice the influence which the antiseptic treatment
of wounds has had upon the statistics of all operations,
but particularly upon those in dangerous localities, and
usually believed to be attended with extraordinary risks.
Whatever may be the belief in the influence of antisepsis,
in whole or in part, every progressive surgeon has
learned the value of the cardinal principles of cleanli-
ness, local disinfection, and free drainage. In the vol-
umes before us these principles are duly considered, and
the different points in dispute are very judiciously pre-
sented. The same may be said reganling other subjects
of equal importance in their bearings on surgical opera-
tion. Those, for instance, connected with abdominal
tumors and other affections of the abdominal cavity, ne-
phrectomy, rapid lithotrity, operations upon joints ; the
pathology and treatment of injuries of the spine, and also
the exhaustive discussion of the pathology of tumors,
based more particularly upon the labors of the German
pathologists, as well as a critical examination of the dif-
ferent advanced theories concerning the relations of sep-
ticaemia to pyremia. Osteotomy as an operative pro-
cedure in the treatment of deformities is treated of at
length, making, as it does, a new and decided advance
over the more conservative and less effective methods
formerly in vogue. So much for a general review of the
marks of jirogress in an art as shown in this masterpiece.
The main features of the work are preserved, and the
general arrangement is not materially altered. The sev-
eral parts are naturally classified in regard not only to
regions, but according to the apparatuses affected, giving
the best possible opportunities for the thorough study of
a given subject from a special standpoint. Many of the
older authors have passed away, but in each instance their
work remains and is brought up by accomplished editors
to the present standard of positive advanced knowledge.
It has been a pride with each author to do his jjart as
well as possible, and nothing seems to be wanting to that
end, taking into account the length of time required for
the publication of the book and making allowance for
such new facts as may have appeared in the meantime.
Thus it naturally happens that the essay on gunshot in-
juries does not embody the experience of the late Egyp-
tian campaign, a matter of no great importance, however,
considering the other data upon which the article is
founded. The latter remark would hardly apply in the
same degree to the recent views on injuries of the back,
which have been unavoidably omitted, and also as to
many advances in the treatment of fractures, the remedy-
ing of deformities, and many operative methods which
are peculiarly American. But the work as a whole, claim-
ing as it does to represent the English school of sur-
gery, is complete in every respect, and really stands with-
out a rival. It is published in three volumes, instead of
four as formerly, and presents an attractive typographical
appearance. As it stands it represents the original and
latest Holmes' System of Surgery, and contains the most
recent views of the many distinguished authors who first
contributed to its pages.
Transactions of the College of Physicians of
Philadelphia. Third Series. V'ol. VI., 8vo, pp. \ifi.
Philadelphia : P. Blakiston, Son & Co. 1883.
The sixth volume of these transactions is unusually full
of good scientific material and well represents the amount
of working force in the membership of the College. It
contains thirty-one original papers on different topics
connected with medicine and surgery; all have a distinct
practical bearing. It is published in its usual handsome
style, and is a credit to the typographical art.
Training Schools for Nurses, with Notes of
Twenty-two Schools. By W. G. Thompson, M.D.
New York : G. P. Putnam's Sons. 18S3.
This small pocket manual contains a general review of
the nursing system in this country and abroad, with an
account of the different American schools in active oper-
ation. It contains much useful information for all such
as are interested in nurse-training.
The Physician Himself and what he should add
to his Scientific .Acquirements. By D. W. Ca-
• thell, M.D. Third Edition. 8vo, pp. 208. Balti-
more : Gushing & Bailey. 1883.
This readable and instructive book has, in a very short
space of time, advanced to its third edition. It is full of
valuable suggestions regarding the proper pecuniary and
social relations which should be maintained between
physician and patient. Every physician who is in doubt
as to the course he should pursue in obtaining business
and keeping it, will read the work with much profit.
September 29, 1883. J
THE MEDICAL RECORD.
357
Reports of Societies.
AMERICAN GYNECOLOGICAL SOCIETY.
Eighth Annual Meeting, held in Philadelphia, Septem-
ber 18, 19, and 20, 1883.
(ConcIuJcd from p. ^2^.]
Thursday, Septemher 2oth — Third Day — Morning
Session.
The Society was called to order by the President.
The first paper was by Dr. H. F. Campbell, of Au-
gusta, Ga., on
MENSTRUATION AFTER EXTIRPATION OF THE OVARIES.
By general consent the influence of the ovaries in
menstruation has long been recognized, and there was
nothing in his paper which indicated that he would de-
prive them of their very important influence in connec-
tion with this function. Since the introduction of the
operation of removal of diseased ovaries, it has been no-
ticed that menstruation continues in some cases, and this
has been variously attributed to habit, periodical plethora,
and more recently to the fact that in removal of the ova-
ries the Fallopian tubes are not removed, and therefore
the excitor of the menstrual nisys remains. The ovaries,
unquestionably, are the ordinar)' exciters of menstruation.
lUit are they the only excitors to activity in the genital
organs ? Certain cases were cited in which menstruation,
lactation, etc., had been excited by irritation at some re-
mote point, as from a parotiditis, suckling in the unim-
pregnated woman, etc. These cases showed that certain
influences acting through the nervous system were efficient
agents in establishing uterine and ovarian action. Pain
follows amputation, not in the stump but in some portion
of the part amputated, and because the nerve-centre has
been adjusted and adapted to originating such a sensation,
and may not periodical congestion and revival of the
function of menstruation be the result of an original en-
dowment of the nervous system continued for a time, al-
though the organs which are ordinarily the excitors have
been removed ?
Dr. Goodell, of Philadelphia, was disposed to ac-
cept the view that this bloody discharge which, in some
cases, follows removal of the ovaries, may depend occa-
sionally upon irritation of some nervous centre. He
had not removed both ovaries without forced menstrua-
tion appearing within the first five days, and he had at-
tributed this to irritation set up by enclosed nerves. He
was inclined to think that some of the ovarian structure
was left behind in those cases in which so-called men-
struation continued for any great length of time. It is
often diflicult to get the stump of the pedicle down suffi-
ciently low not to leave ovarian structure.
Dr. Emmet reported a case in which he removed both
tubes and ovaries from a woman at the Woman's Hos-
pital, eighteen months ago, and she has menstruated thir-
teen times regularly since the operation ; the only change
in the function being that the flow has continued for only
about three days, whereas before the operation it lasted
a much longer time.
Dr. Garrigues, of New York, said that in studying
these cases the exception should always be borne in
mind — namely, the i)ossibility of the existence of three
ovaries. One exceedingly interesting case was on rec-
ord, where, after removal of two ovaries, the woman
bore a child.
Dr. T. Gaili.ard Thomas, of New York, said he had
not much to say on this subject for several reasons. First,
scientific men have not reached an absolute decision
concerning the influence of removal of the ovaries on the
cessation of menstruation, nor as to the influence of the
ovaries in the production of menstruation. He had re-
moved both ovaries between fifty and sixty times, had
followed the cases as well as possible, and had the im-
pression left on his mind that when the ovaries are present
menstruation is the rule, and after they have been re-
moved menstruation is the exception. He regarded the
bloody discharge which occurs after removal of both ova-
ries, as a metrostaxis. He did not recollect to have ever
seen a case in which regular menstruation occurred for
thirteen months after removal of both ovaries. In his
cases the bloody discharge had been irregular, almost in-
variably of the character of a metrostaxis, usually disap-
pearing after a short time, may continue five or six
months, and in rare instances for one or two years. He
had performed Tail's operation ten or twelve times, and
there had been no difference in the result from that which
followed Battey's operation. All the ovarian tissue is
more likely to be removed in Tail's than in Battey's
operation, and that is the probable reason why men-
struation occurs less frequently after the former than after
the latter. He thought Dr. Enunet's case might be ac-
counted for as Dr. flarrigues had suggested, and sustained
the suggestion by referring to a remarkable case occur-
ring under his own observation, where he found a third
ovary, having removed two, and allowed it to remain.
He did not believe that the Fallopian tubes have any-
thing to do with the excitation of menstruation ; but with
the performance of the function they have much to do.
He had had but a single case in which there was a
paroxysmal discharge of blood from the uterus after re-
moval of both ovaries, and in that instance there was no
such regular intervals as twenty-eight days between the
times of the discharge, and there were none of the regu-
lar symptoms of menstruation.
Dr Mann, of Buftalo, said this bloody discharge might
be explained, occasionally, at least, by the existence of
some disease of the uterus or vagina overlooked. He
had had five cases in which both ovaries were removed,
and in one there was metrostaxis, which continued (or
some time, and finally when he again saw the patient in
consultation an examination revealed distinct cancer of
the vagina.
Dr. Campbell said, in closing the discussion, that he
did not wish to deny that the ovaries are the common
excitors of menstruation, but merely to suggest may it
not, after removal of the ovaries, be due to other causes
than habit, periodical plethora, or the fact that the Fal-
lopian tubes are not removed, and depend upon the
action of some nerve-centre endowed to act, and continu-
ing to act, for the performance of a certain function
although the chief organs through which it manifests this
power have been removed ?
The Society then adjourned to meet at 3 p.m.
Third Day — Afternoon Session.
The Society was called to order by the President, and
the first paper was read by Dr. William H. Bvford, of
Chicago, entitled
remarks on chronic abscess of the pelvis.
The author of the paper spoke first of the different
situations in which pelvic abscess may occur, the most
common being in the connective tissue of the broad
ligaments. He then called attention to the directions in
which the pus is likely to discharge, the impediments
with which it may meet, and which may change entirely
the course of the discharge ; to the quality of pus, laudable
at first, but when the abscess becomes chronic contain-
ing an admixture of serum and blood. Dr. Bytord
studied with minuteness and detail the changes which
occur in the lining membrane of a chronic pelvic abscess,
at first like that of an external ulceration and finally the
cavity is lined with cicatricial membrane, and with the
loss of the granulation character of the inner surface pus
is no longer produced. The changes occurring in the
lining membrane might aftbrd an indication for treat-
ment. When in the granulating condition the granula-
tions may become exuberant, and form fungoid masses,
>5S
THE MEDICAL RECORD.
[September 29, 1883.
and if these redundant masses are not removed they will
give rise to and maintain pyremic fever. In a chronic
abscess, therefore, remove all these masses by scraping
the inner surface with a dull curette or finger-nail ; and
there is no danger in this procedure, because the walls
of the abscess are usually quite thick. A case, the notes
of which had been furnished by Dr. D. T. Nelson, Ad-
iunct Professor of Gynecology, was then reported, in
which this method of treatment was adopted with excel-
lent results. Dr. Byford discussed at some length the
methods of opening these abscesses, the difficulties
encountered and the liability to refilling unless the
cavity or cavities have a free opening for the exit of the
pus.
Dr. T. G. Thomas, of Xew York, thought Dr. Byford
had rendered great service by examining minutely the in-
ternal surface of these cavities and following out the
peculiar changes which take place. There was one
point to which he wished to refer in connection with the
subject in general, and that was concerning the propriety
of searching for these abscesses. This point had been
brought forward by the late Dr. Rrickall, Dr. Munde, and
Dr. Lyman. He wished simply to say on this point,
that he believed there is no more dangerous process in
gynecology than to go seeking for these collections of pus.
If it can be ascertained by conjoined manipulation that
there is pretty positively pus in the pelvic areolar tissue,
if we know exactly where to look for it, and if it can be
distinctly discovered, then, and only then, should this
e.xploration be made ; but made without pretty positive
knowledge on this point, verj' evil results will follow.
He had employed the aspirator only as a means of diag-
nosis, and regarded it as a bad method of treatment,
because a free opening should be made. His routine
practice had come to be to cut into the abscess freely
with Sims' long knife, and insert a small glass tube pro-
vided with a perforated flange so that it can be secured
in position with sutures. When the abscess is large he
stuffs the cavity with tow saturated with iodoform, re-
peats it in twenty-four hours, and thus goes on tmtil
cure is effected. He had not had any experience in the
use of the curette, as recommended by Dr. Byford.
Dr. Goodell, ot Philadelphia, regarded the method
of treatment by the use of the curette as novel, but thought
it might be an admirable way of effecting a cure. In the
majority of instances the cases of pelvic abscesses he saw
were of long standing, and there were more or less of
fistulous openings. His method of treatment was first,
if there is an opening from above, to pass in a long
uterine sound and see if there can be established a com-
munication with the vagina. If so, an opening is made,
a drainage-tube inserted, and in that way he had suc-
ceeded in curing many patients. Other plans which he had
tried had been irrigation with solutions of permanganate
of potash, carbolic acid, etc., and injection with a much
stronger solution of carbolic acid than is used for pur-
poses of irrigation. With reference to aspiration, he had
occasionally resorted to it, and while he was not satisfied
that it is very good, he did not think it is quite so bad as
Dr. Thomas was disposed to regard it.
Dr. Su'iToN', of Pittsburg, had seen Ksmarcli scrape
out pelvic abscesses at his clinics in Kiel, and he thought
that this clinic might be regarded as an exponent of the
surgical clinics of Europe. But the curette was not used
with tile view of removing the long granulations men-
tioned by Dr. Byford.
Dr. Campiseli., of Augusta, Ga., spoke of the special
beneficial influence which the tartrate of iron and
potassa exerted upon chronic abscesses. Except for the
source from which the recommendation came with ref-
erence to curetting the inner surface of an abscess, he
would not feel disposed to favor the plan.
Dr. Byford, in closing the discussion, said that the
chief purpose of his i)a|)er was to call attention to a few
points, and esi)ecially to the changes which take place in
the lining membrane of chronic abscesses.
Dr. G. J. Engelmann, of St. Louis, .then read a
paper on
ERGOT : THE USE AND ABUSE OF THIS DANGEROUS DRUG.
He believed that it is never necessary to use ergot in
obstetrics. The use of the drug he would limit to the
non-pregnant womb. It is not the question how it may
be used, but the fact that it is used very generally, and
its bad effects are not appreciated which makes it
desirable that it should be stated authoritatively that the
drug does much more harm than good and that its use
should be discarded entirely.
Dr. Johnson, of Washington, said that in his study of
this subject he had been made aware of the fact that
ergot is not used by physicians so generally and to the
extent which he once thought it was, or to the extent
which Dr. Engelmann says it is used. He had not found
physicians w-ho use the drug in the first stage of labor
and thought that such a statement was erroneous.
Dr. Campbell invariably gave ergot after the birth of
the child, and believed that it was important, and should
almost always be used after the administration of chloro-
fonn.
Dr. Albert H. Smith, of Philadelphia, regarded the
use of ergot in obstetric practice as an unmitigated evil.
He did not believe that it is needed under any circum-
stances, and is always capable of doing harm, and gener-
ally does do harm. Its use in the third stage of labor
might not be rejirehensible, but in only a very few cases
could it be used with benefit.
Dr. Elwood Wilson, of Philadelphia, was astonished
that Dr. Engelmann should recommend the banishment
of ergot from obstetric practice. He doubted very much
if any man present would be willing to approach a case
of placenta piajvia without the use of ergot. He had
seen thirty-two cases of placenta previa, and had used
ergot liberallv and with excellent results. He was also
surprised to hear Dr. Engelmann state that ergot was of
no use in post-partum hemorrhage. Dr. Wilson regarded
it as of immense use in this tomplication of labor. The
difficulty is that the ergot is given too late and in too
large doses. He regarded the use of ergot in the third
stage of labor as very important, and had it at his com-
mand in all cases.
Dr. Engelmann said he feared he had been misunder-
stood. He did not mean to discuss the possible limits
for the use of ergot, or refer to a scientific distinction for
the proper indications for its use. He meant simply that
it is a dangerous drug, does a vast amount of mischief,
and from the fact that it is a powerful factor in stimulating
uterine contraction, other measures less dangerous and
which will accomplisli the same end with equal efficiency
should be substituted for it.
The following paper was read by title :
A theory to explain the RELAX.4TI0N OK THE V.l-
GINA AND PERINEU.M DURING LABOR,
by Dr. James R. Chadwick, of Boston.
Dr. Goodell, of Philadelpliia, offered complimentary
resolutions concerning the efficient services of the retir-
ing treasurer, Dr. Paul F. Munde, which were unani-
mously adopted.
The Presidknt then introduced the President-elect,
Dr. Albert H. Smith, of Philadelphia, who made a few
appropriate remarks, after which the Society adjourned
to meet m Chicago on the last Tuesday in September,
1884.
Better than Condurango. — It seems that New Or-
leans has been enlivened by the dean of a medical col-
lege there, who diagnosed and treated an ulcer of the
gums about a young lady's tooth as cancer. Having
failed to atTect a cure, the case passed to a dentist, who
extracted tlie tooth and let the "cancer" get well. A
true victory for nature. — .5'/. Louis Med. Jour.
September 29, 1883. J
THE MEDICAL RECORD.
)59
©orrcspoiutcuce.
OUR PARIS LETTER.
THE THERAPEUTIC AND PROPHYLACTIC VIRTUES OF COP-
PER REPORT OF THE FRENCH MEDICAL COMMISSION
ON CHOLERA.
(From our Special Correspondent.)
Paris, September 5, iSSj.
At the meeting of the Academy of Medicine of Paris,
which was hekl on the 21st ult., Dr. Bailly read a paper
giving an account of his experience of tiie therapeutic and
projihylactic virtues of copper, as recommended by Dr.
Burq, in various affections, particularly in cholera and
typhoid fever, in which latter maladies the metal was
considered to be a specific. Dr. Bailly is practising at
Chambly, a small town in the Department of Oise, and
I send you an abstract of his paper, which will at the same
time serve, in some measure, as a reply to the interesting
letter of Dr. Grace Peckhani, headed " Copper and
Cholera," and which was published in The Record of
August 1 8th. Dr. Bailly stated that the medication by
copper was submitted by various physicians to serious
trial during the cholera of 1S66, and the results were so
deplorable that it appeared that a method so deceiving
was doomed, and that thenceforth it would be relegated
to the arsenal of retrospective therapeutics as a mere ob-
ject of curiosity. Dr. Burq, however, having revived the
subject, Dr. Bailly thought it opportune to refute Dr.
Burq's assertions with the following arguments :
\l Chambly there are upward of five hundred persons
employed in the manufacture of articles of " aftenide," an
alloy of which copper forms nine-tenths. If Dr. Burq's
theories are correct, these people ought to enjoy a cer-
tain immunity against cholera or typhoid fever, but dur-
ing the twelve years he has been in medical charge of the
manufactory he has found that this is not the case. In
an epidemic of typhoid fever Dr. Bailly attended 53 per-
sons affected with the malady, of whom 26 were em-
ployed in the cop|)er manufactory, and whose bodies
were consequently well saturated with copper ; of this
number 4 ilied, all of whom were well "coppered." As
regards cholera, Dr. Bailly states that in 1832 Chambly
was decimated; of 1,400 inhabitants, 87 perished. In
1849, ''^s '^^^ ejjidemic caused 47 victims. About a
mile from Chambly, at a place called Bornel, there was
not a single case of cholera, but this immunity could not
be attributed to the virtues of copper, as at that time the
copi)er manufactory that is now at the latter place did
not then e.xist. Dr. Bailly enters into further details,
which, for want of space, cannot be reproduced here. I
must therefore refer Dr. Grace Peckham and others in-
terested in the question to the Bulletins of the Academy
of Medicine. I may, however, observe that Dr. Burq
is perhaps singular in his theories, as I am not aware that
nietallotherapy, as he terms it, has made much progress
in the profession, whether in this country or elsewhere,
at least according to his ideal of the method. Indeed,
the idea cannot be said to have originated with Dr. Burq ;
as, so far back as 1832, a Dr. Meray, of Paris, vaunted
copper in cholera, and his report of the efficacy of the
metal in this disease caused such a sensation that on in-
quiry it was found that the results were greatly e,\aggerated.
No further importance was attached to the report and
nothing more was heard of the marvellous effects of cop-
per until about thirty years ago, when Dr. Burq took
up the subject, and he has patronized it ever since,
but, as I have already said, almost single-handed, for
one never hears of its employment by any other prac-
titioner, at least as recommended by Dr. Burq. At a
previous meeting of the Academy of Sciences, Professor
Vulpian was cited as one of the partisans of Dr. Burq's
doctrine of nietallotherapy, but as he was not present
on the occasion he wrote a letter to the Academy repu-
diating such an imputation in the following terms : " No
well-established clinical fact has authorized me to admit
the preservative or curative influence of copper in the
treatment of cholera. If copper had any real efficacy, it
is probable that it would have been made known in all
the countries where cholera reigns, and particularly in
those parts of India where the malady is endemic." On
another occasion, taking jiart in a debate on Dr. Burq's
method of nietallotherapy in hysteria and other nervous
affections. Professor Vulpian stated that he was not able
to speak more favorably of it in these cases. Dr. Burq
has responded to Dr. Bailly's communication at the
Academy of Medicine, but as he has advanced nothing
new or important, I need not trouble your readers any
further on the subject.
According to official information received from Egypt,
the cholera is evidently on the decrease. The Council
of Hygiene at Alexandria rejwrts that the number of
deaths from the disease during the two months that have
elapsed since the outbreak of the epidemic, amounted to
twenty-seven thousand among the natives, and olie hun-
dred and thirty among the English troops.
The French medical mission that was sent to Egypt
to study the nature of cholera has reported that the
disease with which it had to deal was incontestably
Asiatic cholera, and that the discoveries already made
are of a nature that will tend to subvert almost com-
jiletely the theories in vogue as to its origin and i)ath-
ology.
The theory of the contagious and parasitic nature of
cholera is evidently gaining ground in the profession,
but the following incidents would seem to militate
against either idea. Among the passengers of the
Peluse, condemned to quarantine at Alexandria, was an
infant that had lost its mother from cholera, but the in-
fant was not in the least affected, and was still alive and
well when the vessel reached Marseilles, although it had
been suckled by its mother within a few hours of her
death. When the body of a sheik who fell a victim to
the disease at Cairo was being prepared for the funeral
a number of fanatic Mussulmans rushed up and drank of
the water with which the body was washed. If the con-
tagious or parasitic nature of cholera is correct, surely
few or none of these jieople could have escaped con-
tracting the disease.
ON THE THERAPEUTIC EFFECT OF IODO-
FORM AND ETHER IN THE TREATMENT
OF SORE THRO.\T.
To THE Editor of The Medical Record.
Sir : I am tempted to ask a little space to call especial
attention to two paragraphs of "foreign gleanings" that
appeared in the last issue (Septembers, 1883) of The
Record. They are the results of clinical observations on
the part of experts, and their experience and statements
confirm my own clinical observations and experience,
published one year before either of the foreign contribu-
tions appeared in print. ' While the title of my article
refers only to ulcerated tonsils, the accounts of the cases
cited gave full descriptions of sore and ulcerated surfaces
of surrounding structures. The value of ether in com-
bination with iodoform — to which I called attention — is
now of additional interest to therapeutists. The testi-
mony of the foreign observers forms a good addenda in
support of my views and observations. " Ether in the
treatment of sore throat : Professor Contalo employs an
ether spray in the treatment of pharyngitis. Under its
influence the temperature falls, the vessels contract, and
the local condition is speedily improved. In two cases
a fibrinous exudation was detached and not rejiroduced.
Ether, according to the author, deserves a trial in pharyn-
geal diphtheria, not only as an antiseptic agent, but also
because the pain is thereby greatly diminished, and the
^ Clinical Observations on the Use and Value of Iodoform in the Treatment of
Enlarged and Ulcerated Tonsils, New England Medical Monthly, June 15, 1882.
36o
THE MEDICAL RECORD.
[September 29, 1883.
taking of nourishment j^cilitated." "A method of has-
tening the anajsthetic action of the ether spray : Dr.
Vidal, at the Hopital St. Louis, in Paris, shortens the
duration of the process of congelation by the ether spray
in the following manner : Ataking a slight prick with a
needle at a point upon which the spray is directed. The
little puncture made at this time excites a reflex constric-
tive action of the vaso-motor nerves, the blood is driven
from the part, and the skin becomes white."
The observations and clinical ex))erience of Drs. Con-
talo and Vidal account for and explain the rationale of
the success which I have attained in the treatment of
ulcerated and inflamed tonsils and inflammation of con-
tiguous structures by the combined application of ether
and iodoform in the form of spray. The value of iodo-
form in the treatment of inflamed and ulcerated surfaces
is now too well known to need more than mention. The
little iiunctures claimed by Dr. Vidal as " hastening the
anaesthetic action of the ether spray " find a parallel in
the ulcerated points of tlie inflamed surfaces, both of
tonsils and surrounding mucous membranes. I think 1
am not exaggerating in claiming that iodoform and ether
combined, and applied locally in the form of spray, may
fairly be regarded as a specific in the treatment of sore
and ulcerated throat, tonsils, and contiguous structures.
Morris H. Hexrv.
581 Fifth Avbnle, New York.
WHITE LE.\D P.JiINT .\S .\ I.OC.\L DRESSING
IN ERYSIPEL.'\S.
To THE Editor of The Medical Record.
Sir: In your issue of Ajjril 14, 1883, an article from
the Lancet urged the employment of white lead paint as
a local dressing in erysipelas, and this article called forth
several comnninications, all testifying to the usefulness
of the carbonate of lead.
In the number of The Record published on .August
18th, another article, from the Lyon Medical, records
four cases of erysipelas which were successt'ullv treated
with hypodermic injections of resorcin.
Unfavorable or negative results are seldom published,
but the tbllowing cases, reported briefly t'rom my notes,
may not prove uninteresting, as the treatment includes
the use of both of the remedies which are so highly
spoken of. Although I had occasion to treat some
thirty-five cases of erysipelas this summer, most of them
were of the cellulo-cutaneous and cellular varieties,
which demanded free and numerous incisions, and in
which tlie depending upon milder measures would have
led to disastrous results. Several of the cases, however,
were of the cutaneous variety, and among these two
seemed to present an opportunity for the fair trial of
carbonate of lead. One of the two receiving also injec-
tions of resorcin.
Case I. — .Alice H , aged thirty, who had been
operated upon a week previously for the removal of
enlarged lymphatic glands of the neck, was sent to the
erysipelas ward on .May 16, 1883, with a cutaneous ery-
sipelas, which included the right ear, and jvhich had
extended anteriorly half way across tlie cheek, and pos-
teriorly to the back of the neck ; involving tlie integu-
ment as far down as the vertebra prominens. Blebs and
vesicles had appeared only upon the helix of the ear
when the disease had first manifested itself two days pre-
viously. The record of the vital signs is not of sufficient
significance to be reported here. White lead paint, which
I had carefully prepared myself with linseed oil, was
spread thickly over the involved portions of the skin, and
at the same time the followMng internal treatment was
commenced : Tincture of the chloride of iron in half-
drachm doses, well diluted with whiskey and with one-
fourth of a grain of morphine added, every three hours.
Five-grain doses of sulphate of quinine every three
hours, and each dose to be i;iven in the interval between
two doses of the iron. Rochelle salt in sufficient quan-
tity to keep the bowels open. It may be well to men-
tion that the paint, after being applied, was covered with
gutta-percha tissue for neatness sake.
.May 17th. — Erysipelas showing no tendency to further
extension. Pain very much less than yesterday.
May iStli. — Erysipelas limited. Little pain. Internal
treatment stopped.
.May 19th. — Erysipelas extending rapidly along the
cheek, and upward on the scalp. Temperature elevated
in the morning, but reduced promptly by sponge-baths
and quinine. White paint applied to beyond margins of
diseased area.
May 20th. — Erysijielas extending more slowly. Lead
paint removed and internal treatment recommenced.
May 2 1 St. — Erysipelas leaving the parts first attacked,
but extending down the front and sides of the neck. Fo-
mentations of hot lead and opium wash, and carbolic
acid solution (i — 40) in equal parts are employed lo-
cally.
May 2 2d. — Erysipelas decreasing at all points.
May 23d. — Improving with great rapidity.
May 2Sth. — Discharged cured.
Case II. — .Ann McC , aged fifty-eight. Brought
to the hospital on May 25, 1883, suffering from idio-
pathic cutaneous erysi]ielas. The patient is not rational
and cannot give a reliable history.
The skin over the entire face, with the exception of
the chin, is very much swollen, and hyperirmic. The
ears are involved. Blebs and vesicles cover all of the dis-
eased surface. Much constitutional disturbance exists.
No local treatment is resorted to at first. The intended in-
ternal treatment is substantially the same as in case No.
I. As patient has passed no urine for five or six hours
after entering the hospital a catheter is inserted into the
bladder, and an ounce and a half of turbid urine drawn.
This urine is found to contain about fiftv per cent, by
volume of albumen, and a few granular casts.
The patient is now to take one drachm of bitartrate of
potassium well diluted, and half an ounce of infusion of
digitalis every four hours. .And in case of a rebellious
stomach poultices G»-er the kidneys are to be substituted
for the above.
May 26th. — Vital signs nearly normal. The erysipelas
appears to be stationary. Less than three ounces of urine
having been passed in the last twenty-four hours, dry
cups are applied over the kidneys for fifteen minutes.
Patient again cupped six hours later.
May 27th. — \'ital signs normal, erysipelas stationary.
Yesterday's cupping has been partially successful, as
twenty-four ounces of urine have been passed in twentv-
six hours. This urine, however, contains about sixty per
cent, by volume of albumen, and is loaded with granular,
epithelial, and hyaline casts. Blood is also present.
May 28th. — Erysipelas extending rapidly down the
back of the neck. Vital signs normal. Urine in nearly
normal amount since last note. The scalp, which is now
cedematous, and the back of the neck, are enveloped in
moist oakum, covered with oiled silk.
June 1st. — The erysipelas has rapidly departed from
the face, but is travelling down the back with greater
speed. The aff"ected portions of skin to the left of the
spinal column are painted over with tincture of iodine,
and on the right side hypodermic injections of a five
per cent, solution of resorcin are made into the sub-
cutaneous connective tissues, in the hope of destroying
the micrococci which fill the lyniphatics in the advancing
line of the disease. The injections, of two minims each,
are made about a ipiarter of an inch apart, half an inch
or more ahead of the whole advancing line on the right
side of the spinal column, between the eighth dorsal ver-
tebra and the right shoulder. There is now almost no
urine excreted by the kidneys.
June 2d. — The erysipelas has continued straight on
down the back without any check whatever from the
local treatment. The aflecied portion of skin to the
September 29, 1883.]
THE MEDICAL RECORD.
361
right of the spinal coUimn is covered with collodion, and
a thick layer of white lead ))aint is spread iii)on the cor-
responding left side. Patient very stupid. Almost no
urine.
(une 3d. — The erysipelas has extended about two
inches lower on each side of the spinal column, and is
creeping toward tiie sides of the chest. All of the more
recently diseased surface is washed with a saturated soUi-
tion of sulphate of iron in the morning, and as the disease
is still I'rogressing at evening, collodion is substituted.
There is probably as much reason in trying to control
tlie local lesion as there would be in endeavoring to stop
the eruption of scarlet fever by the use of the same
remedies.
June 4th. — Patient dies quietly at 3 a.m. The result
of the autopsy in this case was e.xtremely interesting, but
as it had no jjarticular bearing upon the efficacy of white
lead paint, or of resorcin, in controlling erysipelas, I will
omit the descriiition of it.
Robert T. Morris, M.D.
Bellevue Hospital, New York Citv.
^vnxQ l^cius.
Official List of C/niiii^es of Stations and Duties of Officers
of the Medical Department, United States Army, from
September 15 to September 22, 1SS3.
Campbei.i,, John, Lieutenant-Colonel and Surgeon,
Medical Director, Department of the South. Granted
leave of absence for fifteen days. S. O. 94, par. 2, De-
jiartment of the South, September 13, 1883.
Alexander, Charles T., Major and Surgeon. On
being relieved from duty at. the United States Military
Academy, October i, 1883, to report in person to the
Commanding Cleneral, Department of the Missouri, for
assignment to duty. S. O. 211, par. 7, A. G. O., Sep-
tember 14, 1883.
Alexander, Charles T., Major and Surgeon.
Granted leave of absence for four months, from October
I, 1883. S. O. 213, par. I, A. G. O., September 17,
1883.
Gibson, Joseph R., Major and Surgeon. Relieved
from duty in the Department of the East, October i,
1883, and to report by letter to the Commanding General.
Department of the South, for assignment to duty. S. O.
211, par. 7, A. G.O., September 14, 18S3.
Horton, Samuel M., Major and Surgeon. Relieved
from duty in the Department of the Platte, October i,
1S83, and to report in person to the Commanding Gen-
eral, Department of the Missouri, for assignment to duty.
S. O. 211, par. 7, A. G. O., September 14, 1883.
Meacham, Frank, Major and Surgeon. Relieved
from duty in the Department of the East, October i,
18S3, and to report in person to the Commanding Gen-
eral, Department of the Platte, for assignment to duty.
S. O. 211, par. 7, A. G. O., September 14, 1883.
Smith, Andrew K., Major and Surgeon. Relieved
from duty at Willett's Point, N. Y., October i, 1883, and
assigned to duty at U. S. Military Academy, West Point,
N. Y. S. O. 211, par. 7, A. G. O., September 14, 1883.
Taylor, Morse K., Major and Surgeon. Relieved
from duty in the Department of the East, October i,
1883, and to report in person to the Commanding
General, Department of the Missouri, for assignment to
duty. S. O. 211, par. 7, A. G. O., September 14, 1883.
WoLVERTON, William D., Major and Surgeon. Re-
lieved from duty in the Department of Dakota, October
I, 1883, and to report in person to the Commanding
General, Department of the East, for assignment to
duty. S. O. 211, par. 7, A. G. O., September 14, T883.
Appel, Daniel M., Captain and Assistant Surgeon.
Relieved from duty in the Department of the Missouri,
October i, 1883, and to report in person to the Com-
manding General, Department of the East, for assignment
to duty. S. O. 211, par. 7, A. fi. O., September 14,
1883.
Merrill, James C, Captain and .'\ssistant Surgeon.
Relieved from duty in the Department of Dakota, Octo-
ber I, 1883, and to report in person to the Commanding
General, Department of the East, for assignment to duty.
S. O. 211; par. 7, A. G. O., September 14, 1883.
MuNN, Curtis E., Captain and Assistant Surgeon.
Relieved from duty in the Department of tlie Missouri,
October i, 1883, and to report in person to the Com-
manding General, Deiiartment of the East, for assign-
ment to duty. S. O. 211, par. 7, .A. G. O., September
M, 1883.
Maus, Louis M., Captain ami .Assistant Surgeon. Re-
lieved from duty in the Department of the Missouri,
October I, 1883, and to report in person to the Com-
manding General, Department of Dakota, for assign-
ment to duty. S. O. 211, par. 7, A. G. O., September
14, 1883.
Patzki, Julius H., Captain and Assistant Surgeon.
Relieved from duty in the Department of the South,
October i, 1883, and to report in person to the Com-
manding General, Department of the PLast, for assign-
ment to duty. S. O. 211, par. 7, A. G. O., September
14, 1S83.
Price, Curtis E., Captain and Assistant Surgeon.
Relieved from duty in the Department of the East,
October i, 1883, and to report in person to the Com-
manding General, De[)artment of Dakota, for assign-
ment to duty S. O. 211, par. 7, A. (;. O., September
14, 1883.
Vickery, Richard S., Captain and Assistant Surgeon.
Relieved from duty in the Department of the Platte,
October i, 1883, and to report in person to the Com-
manding General, Department of the Columbia, for as-
signment to duty. S. O. 211, par. 7, A. G. O., Septem-
ber 14, 1SS3.
Weisel, Daniel, Captain and Assistant Surgeon.
Relieved from duty in the Department of the East,
October i, 1883, and to report in person to the Command-
ing General, Department of the Platte,' for assignment
to duty. S. O. 2 1 1, par. 7, \. (i. O., September 14,
1883.
Appel, Aaron H., First Lieutenant and Assistant
Surgeon. The leave of absence granted July 20, 1883,
extended one month. S. O. 211, par. 10, A. G. O., Sep-
tember 14, 1883.
Brewster, William B., First Lieutenant and Assist-
ant Surgeon. Granted leave of absence for two months,
from October i, 18S3, with permission to apply for an
extension of four months. S. O. 107, par. i, Military
Division of the Missouri, September 15, 1883.
Strong, Norton, First Lieutenant and .Assistant Sur-
geon. Now on duty in the field near Fort Thornburgh,
Utah, to accompany command to Fort Douglas, Utah,
and there await further orders. S. O. loi, par. 2, De-
partment of the Platte, September 17, 1S83.
Salicylate of Soda in Phle«masia Alba Dolens.
—Dr. Vigar has met with success in the treatment of
several cases of milk leg by salicylate of soda. He gives
it in doses of one drachm per diem. He states that in
all the cases in which he has tried the remedy the pa-
tients were able to leave their beds in less than three
weeks, and all recovered perfectly without any cedema or
nodosities on the leg. — El Siglo Medico.
?62
THE MEDICAL RECORD.
[September 29, 1883,
I^lcctical Items,
Contagious Diseases — Weekly Statement. — Re-
port of cases and deaths from contagious diseases re-
ported to the Sanitary Bureau, Health Department, for
the two weeks ending September 25, 1883 :
Week Ending
V
>
3
>
■o
'o
a
>,
>
u
Cerebro -spinal
Meningitis.
s
5
X
0
a.
£
1
>
Casts.
September 18, 1883
September 25, 18S3
0
0
^9
84
38
29
3
7
3
5
22
4
2
2
19
17
12
0
0
0
0
0
Deaths.
September iS, 1883
September 25, 1883
0
0
13 14
12 2
0
0
Re.moval of Kidney and Galt.-bladder. — Dr. Lan-
genbeck, at the recent meeting of the CJernian Surgical
Congress, showed a woman, aged thirty-four, from whom
he had removed the gall-bladder successfully. Two
years before she had had a floating kidney removed.
Treat.ment of Simple Chancre by Heat. — A mem-
ber from Lyons read a communication before the Acad-
emic de Medecine on the treatment of simple chancre
by heat. As the results of his experiments he was led
to consider that the employment of an elevated tempera-
ture was an excellent means of annihilating the virus.
The author recommended that a hip-bath should be given
between 104° and 107°, and borne for several hours.
He believed that this treatment would suffice to destroy
the virus in twenty-four hours. In any case it was cer-
tainly the best treatment of phageda;nism and those
chancres complicated with phimosis that no dressing can
attain. It is needless to add that the doctrine of M.
Pasteur as to the cause of virulent diseases has suggested
this treatment. — Medical Press and Circular.
Incised Wound of the Knee-joint ; Pvarthrosis ;
Ulceration of the Articular Cartilages ; Re-
covery IN Five Months. — Dr. R. C. Van Wyck, of
Hopewell Junction, N. Y., sends us a carefully written
history of a case of the above kind. The patient was a
delicate, scrofulous boy, eleven and a half years of age.
He accidentally received a deep transverse cut just
above the left patella from the fall of an axe. The
wound opened the knee-joint, but it was not attended to
for over a week. Conse<iuently suppuration set in, the
opening iiealed, but the ])us burrowed. A large abscess
formed about the joint and finally penetrated it. Inci-
sions had to be made on both sides of the joint and into
the popliteal space in order to secure free drainage.
Bed-sores developed, and the patient was reduced al-
most to a moribund condition. 15y free drainage, thor-
ough cleansing of the wound, and proper diet, the pa-
tient began to improve. Dr. Van Wyck ascribes the
favorable turn in tiie disease to the use of syrup of hypo-
l)hosphites. .\s the boy convalesced a modified Still-
man's splint was applied.
The Ether Douche or Lavement for thk Relief
OF Pain.— Dr. C. H. Hughes speaks favorably of the
use of lavements of ether for the relief of headaches and
neuralgias. — Medical Times.
The Oath which the German Midwife is obliged
TO take is as follows : " I swear by the Almighty and
Allknowing God, that I will practise the midwife's art
to the best of my skill and ability, helping rich and poor
with equal readiness. I will conduct myself as a true
and conscientious midwife. So help me God \ "
Changes in the Strength of Some of the Of-
ficinal Preparations in the New Pharmacopceia. —
The Virginia ^Medical Monthly^ iiearing that Dr. Squibb
declines to follow the directions of the new Pharmacopoeia
regarding the strength of certain preparations, reads that
gentleman a lecture. It says that "it looks over-officious
in him to confront national opinion, confuse both doctor
and druggist, and risk, perhaps, human life by obstinacy.
By such a course as he is pursuing in this matter, he will
do others injury, and himself no good. He will confuse
everybody. If Dr. Squibb is the authority, let us author-
itatively know it, as a profession ; if the United States
Pharmacopoeia is the authority, let us be in accord on
the subject where absolute harmony is essential. Be-
cause of such statements as he is making, or has pub-
lished, and because of the action of local pharmaceutical
societies throughout the country, we may do some good
by suggesting to each doctor to ask his druggist whether
he is following the revised U. S. Pharmacopceia or Dr.
Squibb."
A Hint for New York City Authorities. — The
municipal authorities of Berlin have adopted regulations
forbidding the erection of houses over seventy-nine feet
in height and having more than five lodging floors ; at
present they are built with seven or eight stories.
The Surgery of Vienna differs widely from that of
America. There is not nearly so much acute surgery, if
I may be allowed the expression ; that is, fractures, dislo-
cations, and general mash-ups are not common, due
partly to the fact that the railroads are better managed
than with us, the staging and scaffolding around buildings
much more securely erected, the buildings themselves
more substantially built, and partly, perhaps, to the fact
that the people themselves are naturally cautious, and that
as they are punished for being run over, they take pains
to keep out of the way of vehicles. Tumors of all kinds,
carious and tuberculous processes of the bones, deformi-
ties, joint diseases, and hernia, are very common. — Cor.
Maryland Med. Jour.
To Detect Adulterations in Olive Oil. — Accord-
ing to the Moniteur de la Pharmacie cotton-seed oil,
when used as an adulteration or substitute for olive oil,
may be detected by the following test : Put one part by
weight of the oil to be tested in a test tube with two
parts of pure colorless nitric acid, shake thoroughly for
thirty seconds, and then let the test tube stand for five or
six minutes. At the end of this time the oil will rise
above the acid. If the olive oil is unadulterated it will
be of a light gray color with a yellowish tinge, but cotton-
seed oil will assume a dark brown, almost black, coftee
color. Varying shades from a golden yellow to brown,
according to the proportions of the admixture, will be
produced in adulterated oil. By this method it is possi-
ble to detect the presence of five per cent, of cotton-
seed oil.
The Rapid Increase in the Popul.^tion of Chi-
cago.— In a paper read before the Chicago Medical So-
ciety and published in the Medical Journal and Examiner
for September, 1883, Dr. Henry (jgdon reports the birth
of five sets of trii)lets in that city within a period of five
months. Not content with that, he supplements his
paper with a report of two other cases of triplets born in
the vicinity.
A Practical Medical Examination. — The London
Medical Ne-U's relates an instance in which a candidate
was treated with unusual consideration by his examinefB.
Requested by one of the latter to cut down on and tie
the subclavian artery, the candidate did as directed, but
could not at once find the vessel. Irritated, seemingly,
by his failure, the examiner urged him to " Pick it u|),
sir ; there it is, right under your nose," and on the can-
didate mildly suggesting that this particular structure was
a cord of the brachial plexus, the second examiner jires-
cnt lifted it and divided a nerve. Examiner No. i then
September 29, 1883.]
THE MEDICAL RECORD.
3^3
at once repudiated having called this the artery, which, he
attirnied, was another adjacent structure. Proceeding,
therefore, to raise it and cut it through, he exhibited it
in commencing triumph, which quickly collapsed as an-
other nerve appeared in section. The candidate was
passed.
How TO Keep the Hypodermic Syringe in Order.
— Dr. William H. Morse, of this city, describes the fol-
lowing method of keeping the hypodermic syringe in
order. It is, he says, " the very best," the syringe being
always ready and in good order even if it has not been
used for months. The method, besides being simple, is
inexpensive : " Unscrew the bowl of your syringe, take
out the piston-rod, unscrew the hni<er piston leather and
take it off, then put in its place a small piece of chamois
skin, and replace the leather and screw it tight. Now
trim the chamois to the size of the bowl, and replace the
piston, and the work is done. You will observe that you
have only placed a bit of chamois between the tivo i)iston
leathers. -You now have a syringe which is in working
order the mo?nent water is introduced."
A Curious Verdict in Regard to an Injury of
THE Eye. — In a recent case in a Pennsylvania court a
large verdict was obtained for an injury to the eye, which
had apparently healed, but which might possibly become
serious. The judge said " the cornea of the plaintiffs
eya was cut in three places, and the iris became attached
to the lower branches of the corneal injury. The power
of the eye was permanently weakened, but its condition
has remained unchanged for the last twenty months,
while subjected to the severest tests, aud during this
time the plaintiff was able to work from eleven o'clock
P.M. till seven o'clock a.m." Under these circumstances
the Court held that a large verdict based upon a pos-
sible subsequent inflammation was excessive, and di-
rected that a new trial should be had, where the actual
and not the possible damage should be considered.;
The Origin of Malaria. — Dr. Daniel Parker, of
Calvert, Te.xas, sends us a communication in which he
protests against the views recently enunciated by Dr.
Charles P. Russel in The Record, in an article on
"The Change of Medical Opinion in Regard to the Cause
and Recent Extension of Malaria." He thinks that there
are very few careful observers who will agree with the
statement of Dr. Chadbourne, there quoted, that he
" adhered to no opinion whatever, based upon sufficient
facts to make it valuable, as to how malaria arises." Dr.
Parker says : " The statement that malarial disease oc-
curs where vegetable decomposition is, to any great ex-
tent, impossible, may be answered by saying that such
places are probably influenced in this respect by atmos-
pheric currents, water supply, or some at present un-
known conditions, and that a thorough investigation of
each locality in the light of its peculiar surroundings
would be about as likely to prove as to disprove the
time-honored theory. The counter-statement that 'very
many more instances ' exist ' where all the so-called con-
ditions for the production of malaria have always been
present without such poison having manifested itself,'
may be reconciled by supposing that some factor, in ad-
dition to the simultaneous operation of air, heat, and
moisture causing vegetable decomposition, is necessary
for the production of malaria, or that in such localities
certain conditions, with which we are at present un-
acquainted, exist prejudicial to the existence or activity
of malarial poison. Neither of these explanations in-
validates the accepted theory. If called on for facts
in support of the theory in question, I should hardly
know where to commence. The literature and experi-
ence of the ]5rofession teem with them. To say that ex-
posure of the unacclimated to paludal emanations at
certain seasons of the year, in certain localities, is fol-
lowed by malarial disease, would convey much the same
idea to any one of experience in such matters, as to say
that exposure of the unprotected to yellow fever atmos-
phere is followed by yellow fever. The relation of cause
to effect is not more marked in one instance than in the
other. This is not a revelation of scientific or profes-
sional research, but a matter of common observation. A
large majority of the intelligent laymen in malarial dis-
tricts can predict with a near approach to certainty
whether a given locality will be healthful or otherwise,
and they will all base their prediction on the exposure or
non-exposure of the particular locality to emanations
arising from vegetable decomposition, as determined by
proximity to swamps or alluvial lands, and influenced by
atmospheric currents, elevation, etc. To say that no
such thing as a malarial germ exists, because no one has
seen such an object, is simply to say that in this direc-
tion research has attained its utmost limits, and that
there is nothing more to be learned. This is cutting off
investigation precisely where we have reason to hope for
the grandest discoveries, and needs only to be mentioned
to show how entirely it is opposed by the experience of
the profession, and by the spirit of progress vvhicli ani-
mates such workers as Pasteur, Koch, Belfield, and
others."
The Relief of Cramps. — A correspondent of the
British Medical Journal suggests for the drug-treatment
of painful cramps the following, subject to the peculiar-
ities of the patient : Ext. hyoscyami, gr. iij. ; camphor;e,
gr. ij. ; morphia; bromidi, gr. ^, in a pill at bedtime.
This pill has succeeded perfectly in a recent case. An-
other correspondent suggests small doses of bichloride of
soda.
Arsenic as a Prophylactic against Malaria.—
Experiments have been carried out in Italy, under the
direction of Tommasi-Crudeli, to ascertain the prophy-
lactic value of arsenic against malaria. The results
liave, says a correspondent of the British Medical Jour-
ital, been quite favorable. The number of persons
l)laced under arsenic was 455 ; 401 men and 54 women.
Of these, 250 were victims of chronic malarial poison-
ing, 115 had been recently infected, and 90 were in fair
health. There were cured, or, if well, there remained
free from attacks, 338 ; 43 were not benefited ; and in
74 the result was doubtful. He particularly notes that
of the 90 who never had had any malarial fever, only
nineteen per cent, were attacked in this unhealthy year,
and those attacked only had slight fevers readily yielding
to quinine. The treatment was begun with one lamel
containing two milligrammes, about the one thirty-fifth
of a grain, of arsenious acid daily. After four days, a
second lamel was given, and so on, until four were taken
each day. In a few cases, the dose was increased to
seven lamels, about one-fifth of a grain, daily, and ap-
parently with better results.
Philadelphia Diplo-mas in Australi.\. — The Rev.
R. V. Danne, of Melbourne, stated that he desired to be-
come a missionary, and attended a few lectures oft' and
on at the Melbourne Medical School. He then sailed
for America, and returned in nine months armed with a
diploma from the Medico-Chinirgical College in Phila-
delphia. On the strength of this he sought registration
as a regular physician, but was rejected. The diploma
was said to have been a gem, and couched in the most
wonderful Latin.
A Well-meant Ende.4vor to Relieve Suffering.
— A Chicago correspondent o( the A tla/ita Medical Reg-
ister relates the following incident : " A physician living
on the South Side was recently called in to catheterize
the bladder of a man said to be dying from kidney dis-
ease and suffering from retention. On his arrival he
found the patient comatose, and in the care of two fe-
male physicians of the homoeopathic persuasion, one of
whom had been vainly endeavoring to reach the bladder
with a female catheter, which she tendered him on his
arrival, alleging as the cause of her failure that she was
564
THE MEDICAL RECORD.
[September 29, 1883,
not accustomed to catheterize the male bladder. Saying
that he had an instrument of his own which he was used
to, he drew off twenty-four fluid ounces, and retired with
a firm conviction that this was one of those events which
make one smile even in the presence of death."
A New Form of Aspirator. — .\n aspirator has re-
cently been devised by M. Creuzan, of Bordeaux, which
is worked without piston or stop-cocks. It consists es-
sentially of a large caoutchouc bulb, which, by means of
a special arrangement of valves, may serve as an aspira-
tor or an injector. A glass cylinder is attached to the
bulb, so that the nature of the tluid ni.iy be readily deter-
mined. There is no possibility of air entering the cavit)'
from which tiie fluid is to be removed, and the instrument
possesses the further advantage that the operator requires
no assistant, but can readily hold the trochar in position
with one hand and the aspirator with tlie other. Any
quantity of fluid may be removed by simply compress-
ing the bulb without detaching the instrument from the
needle.
An .\dvance in Ophthai.mologv. — In a recent case
of vitriol-throwing in France the victim, M. de la Roche,
suffered a total loss of eyesight. But a morning journal
of Paris gravely states that the medical attendants have
succeeded in replacing his burned organs by the eyes of
a rabbit and that he now sees perfectly.
How TO Keep the Hypodermic Syringe in Order.
— Dr. W. B. M , of Vedalia, La., advises the sub-
stitution of "green-packing,"' such as engineers use, for
the old i)iston leather in the syringe. The instrument can
then be neglected for some time arid yet be ready for
use. -A "Subscriber," from Chicago, writes that by get-
ting one of Fowler's hard-rubber syringes, with hard-rub-
ber pistons, no trouble is ever e.xperienced.
Iodoform .4nd Erysipelas. — Dr. C. G. Roehr, of
Ledyard, Wis., writes in reference to a statement by Dr.
Seely, of Cincinnati, that iodoform caused erysipelas, as
follows : " I think some two years since 1 saw in some
(ierman journal that, owing to the great increase in ery-
sipelas, iodoform had to be given up in surgical dress-
ing. I have seen antiseptics, including iodoform, tried
thoroughly, and have seen a number of the so-called
cases of erysipelas, and found them to be simply cases
of erythema or dermatitis venenata. By experimenting 1
have lound that it can be cured by qintting the use of
the iodoform. I have caused and cured it in this way
a number of times on the same patient — and it occurs in
possibly one per cent, of all surgical cases. This is what
our professors call idiosyncrasy, and we have the same
result in the use of arnica and a number of other drugs."
TRE.'iT.MENT OF THE Opium Haeit. — Dr. A. W . Jack-
son, of Wurtsboro, N. Y., writes us that he has been
quite successful in treating cases of the opium habit by
applying the following measures : First, ciieerful surround-
ings, and plain, wholesome, assimilable food. Second,
unceasing watchfulness on the part of the friends and
attendants of the patient. Before the treatment is com-
menced, the patient should he put in as good a condi-
tion, physically, as possible. In an old case, commence
the treatment by cutting off two-thirds of his daily sup-
ply of morphine. If he had been taking twelve grains
per day, prepare the following [jrescription :
IJ. Morphi;e sulijhatis grs. Ivi.
Ext. belladonniv: solid grs. xij.
Quiruie sulphatis grs. xxxv.
Capsici pulv grs. iij.
Ft. in mass et in pilul. No. 42 div.
S. — One pill ter in die.
Also give about eight to twelve drops cone. tr. avens
sativcX in a wineglass of warm water ter in die. Also
a glass or two of old ale during the twentv-four hours.
Milk punch can be given also, as the appetite will be
found very difficult to manage. The supply of pills be-
ing calculated to last for two weeks, it becomes necessary
to renew them at that interval. At each renewal cut
off a given amount of the mor|)hine until the pills contain
only the belladonna, quinine, and capsicum. Continue
with them for a month or less, and it will be found that
they can then be dispensed with, and any good tonic
substituted. The faradic current may be used also with
advantage.
.\merican Catarrh. — Dr .Morell Mackenzie gives
this name to a naso-pharyngeal catarrh which he found
so prevalent in this country, tliat he calls it "a national
complaint.'' He ascribes it to the universal prevalence
of i^us/, in city and 'country. We do have plenty of dust
everywhere, but less in winter than summer, while the
" American catarrh " is far more frequent and obtrusive
in the winter. Therefore, we fear that Dr. Mackenzie is
too narrow in his etiological theory. The following is
the doctor's somewhat highly colored description of
the too' atmospheric distribution of American soil :
" Owing to the immense size of the country, and its
sparse rural population, the country roads have not,
as a rule, been properly made, and except in some
of the older States, are merely the original prairie
tracks. In the cities, notwithstanding the magnificence
of the public buildings, the splendor of many of
the i^rivate houses, and the beauty of the parks, the
pavement is generally worse than it is in the most neg- ■
lected cities of Europe ; such indeed as are only to be
found in Spain or Turkey. It must be recollected also
that, whilst in the decayed towns of the Old World there
is very little movement, in the .\merican cities there is
a ceaseless activity and an abundance of traffic. Hence
the dust is set in motion in the one case, but not in the
other. The character of the dust, of course, varies
greatly according to the locality. In some parts, it is a
fine sand ; in others an alkaline powder; whilst in the
cities it is made up of every conceivable abomination,
among which, however, decomposing animal and vege-
table matters are not the least irritating elements. .An
idea may, perhaps, be formed of the state of the atmos-
phere from a consideration of the fact that in many cities
the functions of the scavenger are quite unknown."
The Tre.\tment of Cramp. — Surgeon Robert Man-
ners Mann writes in the British Aledical Journal:
" There is no remedy I have found to answ'er, except
the raising the head of the bed. I cause two bricks to
be placed under each leg, or a block of wood of the same
thickness as two bricks. Patients who have suftered at
night, crying loudly with pain, have found the above plan
an immediate, certain, and permanent relief."
BoRACu: .Acid. — Dr. Squibb writes of boracic or, more
projierly, according to the nomenclature of the late Phar-
niacopteia, boric acid, as follows : "If the powder be
needed, as is generally the case, it should be specified in
the prescription. The powder should be very fine, and
should be white and light, and entirely ftee from parti-
cles when rubbed between the finger and thumb, feeling
very like powdered soap. It is only such powder that
answers well in eye surgery or general surgery for dress-
ings, and solutions are also best made from it. .A satur-
ated solution contains about nineteen grains to the ounce, ~~
and from ten grains in the ounce to saturation it is used '
as an eye-wash or to granulating and suppurating surfaces.
It is a very bland and soothing application, both in pow-
der and solution, relieving irritation and arresting sup-
puration. It is a potent antiseptic, much less expensive
than salicylic acid, and it is odorless and more easily
managed than carbolic acid. It is probably better than -.
either to preserve hypodermatic solutions. In surgical
dressings it has the great advantage over carbolic acid
of not being irritant nor poisonous. But not being vola- i
tile it does not deodorize the air.'' — Epiieincris.
The Medical Record
A Weekly yournal of Medicine and Sitrgery
Vol. 24, No. 14
New York, October 6, 1883
Whole No. 674
©viaiual Articles.
METHODS OF MEDICAL INSTRUCTION.
Introductory Address Delivered to the Students
OF THE Medical Department of the University
OF the City of New York., October 2, 1883.
By HERMAN KNAPP, M.D.,
PROFESSOR OF OPHTHALMOLOGV ; SURGEON OF THE N. V. OPHTHALMIC AND AUKAL
INSTITUTE ; LATE PROFESSOR AT THE UNIVERSITY OF HEIDELBERG.
Gentlemen : Which is the best method of medical in-
struction ? Evidently that by which the student learns
most. So long as students differ in aptitude to learn,
owing to differences in mental capacity, attentiveness,
energy, perseverance, preliminary attainments, and in
bodily health and strength, fitting them for more or less
prolonged labor — so long as such and other differences
exist among the students, one and the same method
cannot be the best for all. For the student it is of the
greatest importance to select that school and follow that
method which is best adapted to his individual qualifica-
tion ; whereas the school has to consider the character
of the students who make up its classes. If there is
more or less homogeneity among tiie students the course
of instruction can be correspondingly uniform, but if
there is great diversity the means and modes of instruc-
tion must be so numerous and varied as to furnish suitable
opportunities for all.
Now, if there must be a mutual adaptation of student
and college, the one will require of the other certain
qualifications without which a working together for a
given purpose is impossible. The student must possess
a certain stock of general knowledge, and the college
must command, first, a sufficient corps of well-qualified
teachers, and secondly, a collection of auxiliary means
and material of instruction, large and varied enough to
meet the legitimate demands of every student. Among
these means of instruction I will mention spacious
rooms and abundant material for dissecting ; an anatom-
ical museum ; chemical, physical, jihysiological, micro-
scopical, pharmacological, and pathological laboratories :
dispensaries ; hospitals ; autopsy rooms ; and last, but not
least, a large and well-appointed college building, which
encloses a part of the mentioned institutions, and which
is located at a convenient distance from the others, for
instance, the hospitals, so as to make it the centre, the
starting- and rallying-point — in short, the home of the
student.
If we examine the manner in which medicine, at the
present day, is taught in different countries we can dis-
tinguish two systems, which may be termed the European
and the American.
It is quite remarkable that each system, with national
subdivisions, bears the stamp of the political development
of its country.
The European method is planned, regulated, supiwrted,
and controlled by the political government. The Stale
allows nobody to enter upon the study of medicine unless
he has had a collegiate education carried on under an offi-
cial programme. When the student presents himself at the
medical school for matriculation he must have his certifi-
cate of maturity in hand. Then he has to go through a
systematic course of professional study for at least four
years, after which he must pass a final examination before
a State board, and receives his license from the State au-
thorities. The degree of M.D. is an academic honor,
which in some countries is obligatory, in others optional.
The medical schools, with all their appurtenances, are
State institutions. The professors are appointed and
salaried by Government, and are held responsible for the
efficient teaching of all the dei)artments of medical science
and art in which the candidates for the license of practice
are examined. The different schools of one or several
countries, for instance all the universities of the (ierman
Empire and of the German-speaking provinces of Austria,
Russia, and Switzerland, are brought up to the same
standard. The student is at liberty to begin and com-
l)lete his curriculum at one school, or to change as often
as he pleases, only not during the course of a term. He
can select also at his option that State board before which
he desires to pass his fractional or entire examination.
His license entitles him to practise in any part of the
country. Of late, international agreements permit licen-
tiates of medicine of one country to practise in another,
subject to the laws of that country.
The American inethnd of medical instruction differs
widely from the European. It is the child of the free
institutions of the country, letting everybody make of
himself what he can, restricting his ambition by no bar-
riers, asking few or no preliminary questions. The Amer-
ican medical students come from different stages of so-
ciety and culture, one from the plough, another from col-
lege. Some of our colleges are inferior, others equal,
and others — for instance. Harvard and Yale — superior
to the German "gymnasium." He presents himself at
the medical school, saying : " I am willing to work, to
work hard. Will you take me as I am ? " The schools,
with a few exceptions, answer cheerfully : " You are wel-
come."
The young man matriculates and receives a little card,
the programme of lectures and clinics, which informs him
that eight or nine hours of instruction are provided for
him every day. He goes to work with a will. During
the first weeks he attends all of them, but when the in-
terest of novelty and the enthusiasm for a high cause are
gradually toned down by the hard daily labor, he chops
off a goodly number of branches from the luxuriant pro-
gramme. Next year, and perhaps the year after, he comes
again and fills in what before he had left out. After three
years' study under the guidance of a regular physician
and after the attendance of at least two regular courses
of lectures at a recognized college, each course of no
less than twenty weeks' duration, he has to pass an ex-
amination in seven branches : anatomy, physiology, chem-
istry, materia medica, obstetrics, surgery, and medicine,
before the seven professors, constituting the regular faculty
of the school. If he passes this examination to the satis-
faction of said professors he receives from them the de-
gree of M.D., which lawfully licenses him to practise all
the departments, general and special, at any place in the
United States. Most of the Canadian medical colleges,
as far as I can learn from their announcement catalogues,
are arranged on the same plan. This plan was in opera-
tion in England for a long time, until the " Medical Act"
in 1S58 abolished it. Since that time the English medi-
cal student is no longer apprenticed to a practitioner, but
has to undergo a preliminary examination in the classics,
mathematics, history, and French, has to be at the medi-
cal school four full years, and is finally examined and li-
censed by one of the boards authorized by government.
?66
THE MEDICAL RECORD.
[October 6, 1883.
Let me now sum up the characteristic features of the
two systems :
1. The Europea?!. — A liberal preliminary education ;
four years of professional study ; examination and license
by a board authorized by government.
2. The Amerieaii. — Requirements of preliminary ed-
ucation very modest or waived altogether ; a three years'
tutelage under a practitioner : during that time tiie attend-
ance of two regular courses, each no less than twenty
weeks, at a recognized medical school ; the one-class lec-
ture system (i.e., no graded instruction, but the second
course a repetition of the first), a written examination in
seven topics ; approbation and license by the seven pro-
fessors constituting, as a chartered private corporation,
the regular faculty.
If I have presented the two systems correctly and am
asked which is the higher, I unreservedly declare myself
for the European, and doubt whether there is any one
in this assembly who would differ from me ; at least I am
sure that I speak the mind of every one of the teachers
at tile University of the City of New York. But, gen-
tlemen, we are not responsible for tlie existence of the
American system, we have not made it ; it is, as I said
before, the child of the free institutions of this country.
The European system is the higher, is the higher still,
and toward it we are tending. Will it always be so ?
No, most positively no ! If the American method of
medical instruction is the outgrowth of the American po-
litical constitution, it must grow and develop with it.
The American constitution is the highest that has ever
been framed, so sublime that it will take centuries yet
for the people to become worthy of it. By giving every
man equal rights of opinion, speech, and action, it takes
away all barriers of individual development from the
lowest position to the liighest. I am not digressing from
my subject, for the scientific progress of a nation de-
pends in a great measure on its political condition. The
science of man, anatomy and physiology, is the highest
of all the sciences, and its application to the art of heal-
ing puts on it a divine crown. England had a free con-
stitution before any of the modern European nations. In
the last century it brought forth men like Harvey, Jenner,
Abernethy, Astley Cooper, John Hunter, Thomas Young,
and many others, whose names are registered in the
history of civilization as benefactors of mankind for all
time to come. They began to collect facts, founded hos-
pitals, museums, and libraries whose treasures are still to-
day inexhaustible sources of information for the most
erudite scientist as for the tyro. These men learned
and taught what they knew in .schools conducted exactly
like our own.
Then came the emancipation of Gallic thought at the
time of the great revolution in 1792, and the French
became the leading natio°n in politics, taste, art, and sci-
ence until 1S70. When I began my medical studies,
in 1851, the text-books recommended at the German uni-
versities were prevalently translations from the French,
and every one of us who aimed at a higher than an aver-
age position in life thought it incumbent upon liimself
to study, after his examination, at least six months in
FVance, which meant Paris. When, fifteen years later,
I visited again the medical school of that magnificent
city I found that the text-books in the hands of the
French students were to a great extent translations from
the German, while in Germany the translations from the
French had almost disappeared. The great French phy-
sicians, Bichal, Eaennec, Magendie, Louis, Diipuytren,
Nelaton, and many otiiers, had disappeared and had not
been re|)laced by men of equal eminence. Schools and
collections iiad been neglected. The glittering tliird
empire, despotic and hypocritical, erected on the hor-
rible crime of tlie 2d of December, 185 1, had laid, it
seemed, iron fetters on the minds of one of the most
gifted nations that the earth has ever produced.
(jerinan thought imperceptibly look the ascendancy in
directing the march of European culture. To what
strength the despised and ridiculed German people had
unostentatiously grown up was demonstrated by the crisis
of 1870, when the gigantic but hollow balloon of French
glory burst like a soap-bubble before the breath of the Ger-
man army. The German successes, gentlemen, were not
obtained by the chance of the moment — great events never
are, they are the result of slow growth and long prepara-
tion. Shall I tell the younger members of my audience
what was the origin of this astonishing rise of the Ger-
man nation ? It is expressed by a few words which
King Frederick William III. of Prussia spoke in his in-
augural address at the foundation of the university of Ber-
lin in 181 7: "We have," said the king mournfully,
"been humiliated and depressed in every respect, our
country is ransacked and impoverished, our population
reduced to nine millions. We must try to gain what we
have lost in material strength by the development of
mental power." And as the university of Berlin — which
to-day is, perhaps, the most active centre of scientific
movement — was founded in a truly national spirit, so
schools of all kinds and degrees sprang up throughout
Germany by the hundreds and thousands. You all have
heard the proverbial sentence which, in 1871, was echoed
from one end of the globe to the other, that the Franco-
Prussian war was decided by the German schoolmaster.
Many of the men who have rendered the German medi-
cal school famous are still living. I therefore refrain
from mentioning their names. Any one who has not
been in Europe for ten years will be astonished at the
immense progress observable in the medical departments
of the German universities. The completeness and mag-
nificence of the institutions surpass all expectation.
Anatomy, physiology, chemistry, physics, the branches of
natural history and pathology, the different departments of
medicine, even the so-called specialties, have all their
separate institutions, the smallest of which can compare
in size with the average American college. On inquiring
what was the cause of this recent rapid development, I
learned that by the governments of the different States
one-half of the money received from the I'rench as war
indemnity, had been used for military purposes, the other
half for the universities. You see they are still true to
the traditions of the old King of Prussia.
When will America come to take the lead in medical
affairs ? Will she ever ? Gentlemen, I am convinced that
so much as the European civilization is above the Asiatic,
so much will the American outrank the European. The
Asiatic castes hindered the development of individual
talent, and the European society, with its odious distinc-
tions of common people, gentry, nobility, and royalty,
is only a faint photograph of its Asiatic prototype.
An immense soldiery is used as much for the perpetua-
tion of aristocratic prerogatives as for national defence.
In our, my adopted, country each man can elevate him-
self as high as his physical and mental means will permit,
no classes privileged by birth stand in his way, and, be-
sides, he has elbow space enough to spread in every
direction. If Europe has the advantage of an old culture,
of museums, libraries, collections of art, and all kinds of
scientific institutions, America gives her sons one advan-
tage worth more than all the European treasures : ait
unbounded opportunity. To all of \-ou, gentlemen, she
offers a successful career.
Although I have unhesitatingly said before that the
European system of medical education shows a higher
standard than the American, I am sure that an Ameri-
can medical college is better suited to your requirements
than a EuroiJean. The European system is not all per-
fection ; it has its disadvantages as well as the American,
and it behooves me to point them out so far as I can.
The luiropean system is stereotyped, and strangles
many a mind of an original and initiative turn. The
preparation of a European medical student requires thir-
teen years. From his sixth to his tenth year he is in the
grammar school, from the tenth to the nineteenth year
he is in the "gymnasium," where most of the time is
October 6, 1883.]
THE MEDICAL RECORD.
1^7
devoted to I.atin and Greek. He would be much better
prepared for the profession of medicine if he gave more
time to modern languages, mathematics, natural history,
chemistry, and physics. In the four years of profes-
sional study he has to proceed so systematically and at-
tend so many lectures, that often enough his patience
is worn out by the theoretical exposition of a subject be-
fore any allusion is made to its practical importance. It
wearies him ; he becomes inattentive and plays truant.
Let me illustrate this by an e.xample. Zoology is one of
the obligatory studies in Germany. A frientl told me
that when he was at WUrzburg, the lecture on zoology
was froin one to two o'clock every day, immediately after
dinner. One hot summer day, while the professor was
lecturing on whales, he fought a desperate but unsuccess-
ful struggle with Morpheus. The professor's words grew
faint and fainter, like distant bells, till at last he fell asleep
and only awoke when the bell was rung just in the midst
of the professor's closing sentence, of which he caught
only the last part, viz., " and therefore the whalers always
place themselves on the left side of the animal." Vou
do not know, said my friend, how much annoyance that
nap has given me. I could not ask the professor, and
since that time I have asked hundreds of people why it
was that the whalers always try to get on the left side
of the whale, but up to this day I have not yet received
a satisfactory answer. Whetlier this story was original
with my friend or not, I do not know; but it suggests the
first advice, gentlemen, which I venture to give you :
Do not sleep during a lecture.
If I were still young, I would read a Uttle less Greek
and try to get over my zoology before I entered a medi-
cal college. You must not think, however, that I con-
sider the study of the classics, Greek in particular, as
useless or superfluous. I do not think that a liberal edu-
cation is complete without Latin and Greek. Apart
from the intrinsic beauty and educational importance of
the classics as a means of trainmg the mind, Greek and
Latin words form so large a part of our scientific vo-
cabulary, and Latin is still daily so much used in i)re-
scriptions and medical literature that no physician can
get along without them. But I protest against the inor-
dinate time devoted to them in the European and also in
the American colleges. That that time could be em-
ployed on more important subjects, is tersely expressed
by these words of a German satirist : " If the Romans
had been obliged to learn Latin as we are, they would
never have found the time to conquer the world." It is
said of the Germans that they think their time unlimited,
and waste it in preliminaries. A German author, for in-
stance, who wants to describe the history of a city, begins
with the creation of the world. Permit me to recall to
your mind that Washington Irving has done the same thing
regarding this glorious metropolis, and that the American
academic colleges are not a whit better than the Ger-
man. Take Harvard as an example. The average age
at which a boy enters the academic department is eigh-
teen or nineteen years, and his brain nnist be pretty well
stocked with Latin and Greek to make the entrance pos-
sible. To acquire the college degree costs four years
more, during which his mind is fed again chiefly with Latin
and Greek. After this college education he proudly en-
ters the medical department, where he has to spend
another four years. Then he would like to travel and
see how they cure people on the other side of the Atlan-
tic. All this, if his health be not broken, may make him
a model student, but he will be a pretty old boy before
he earns the first dollar, and circumstances may make it
highly desirable for him to earn a dollar or two, or three,
before he gets very old.
- As to preliminary knojiiledge, it matters little where
and when it is acquired. I consider it necessary, gentle-
men, to know Latin grammar enough to write sim|>le sen-
tences correctly, and to read easy prose — for instance, C;e-
sar — without much preparation; to know Greek enough
to be acquainted with the general spirit of the language.
with the laws of the formation and derivation of words.
It is horrible to read in print oi prodromata glaucomce, of
the fenestriim ovalis, and the like. In mathematics the
principles of algebra, plain and solid geometry, and trigo-
nometry with logarithms, are indispensable. In natural
history, chemistry, and physics only the rudiments are
needed, for these sciences, so far as they have a practical
bearing on medicine, will be thoroughly taught in the
medical colleges — at least they are in this one. I regard
it as self-evident that every medical student must be fully
conversant with the English language ; and it would be
very useful if he could read German and French with-
out effort. Those of you who have not had the good
fortune to learn these preliminaries in younger years I
advise most earnestly to do so later, and to devote a cer-
tain time to it every day.
Ifoui to arratige your professional studies to the best ad-
vantage. Here comes in the question of the superiority
of a graded course over the one-class lecture system. To
advance from the simple to the complicated, from the
lower forms to the higher, is decidedly a good educational
principle, and for the exact sciences, mathematics for
instance, no other method could be advocated. But in
sciences such as medicine, in which a vast, I may say the
greater amount of knowledge has to be acquired, not by
reasoning, but by experience, it is a positive advantage
to lead the student from the first day straight to the
field of observation. There at once his attention is en-
gaged, his interest awakened, his sympathy with human
suffering incited, and the desire to help becomes a pas-
sion. Correct diagnosis is fascination, healing the purest
happiness. Thus from the very beginning the student
will become enthusiastic in his profession ; and enthusi-
asm is the mightiest stimulus to work. It is objected
that a young student cannot fully understand a clinical
demonstration. This is true, but he will be able to un-
derstand some, and if the teacher be good, even a good
deal of it, so that the student may, in one clinical hour,
gather more useful information than from a text-book in
ten hours. Are text-books, are lectures unnecessary ?
By no means. Text-books have to be studied faithfully,
and with patience and leisure, because they are the com-
plete and well-arranged repositories of our stock of
knowledge, of which the richest and best conducted
clinic can impart only fragments. Lectures, gentlemen,
are the easiest and most impressive way to acquire the
greatest amount of information in the shortest time. An
harmonious combination of all the means of instruction
is the best manner of learning. The clinic will show you
the object of your studies ; it puts the questions which you
have to solve, and is the mightiest incentive to scientific
work. The sick-room will drive you to the lecture-room
and to the laboratories, the chemical, physical, physio-
logical, and pathological workshops where you have to
try your hands on lifeless objects until you have ac-
quired sufficient skill to manage the ailments of living
human beings. The operating theatre demonstrates the
importance of the dissectlng-rooin and of the collection
of instruments and apparatus. The disorders of the ner-
vous, visual, and acoustic organs will urge you to visit
the cabinets of electricity, optics, and acoustics.
Use them all, gentlemen, all the means of information.
Do not pass the whole day in the lecture-room and the
evening in " quiz ' classes, as by so doing you may at
the end of your studies be able to pass a brilliant ex-
amination in writing, but unable to distinguish intoxica-
tion from apoplexy, scarlet fever from nettle-rash, a
gathering in the ear from meningitis. On the other
hand, do not lounge the whole day in dispensaries and
hospitals, observing symptoms and witnessing operations.
This plan is too apt to lead to unreasonable empiricism,
whose votaries are satisfied when they have filled their
note-books with prescription formulas of cough-mixtures,
anodynes, nerve-tonics, alteratives, hypnotics, cosmetics,
antipyretics, and purges. While at the college, employ
the chief part of your time to learn how to diagnosticate.
?68
THE MEDICAL RECORD.
[October 6, 1883.
Almost everything else you can learn at home. To be-
come a good diagnostician, which is the next thing to be-
ing a good physician, requires a teacher and abundant and
well-selected clinical material, which you cannot expect
to find in the first years of your practice. Weakness in
diagnosis does more harm than all other shortcomings
together. Without a correct diagnosis, a trustworthy
prognosis and a judicious management of a case are
impossible. Gentlemen, the diagnosis and the prog-
nosis, not the treatment, make the physician, in the eyes
of the public. I emphatically repeat these well-known
truths, warning you not to neglect the scientific founda-
tion of the art of healing while collecting a set of recipes,
nine-tenths of which are useless. Do not fight symp-
toms with drugs before you have carefully searched for
the cause of the symptoms. The poorest pathologist al-
wa3's prides himself on iiis therapeutical greatness. I'here
is, in every science, a mythological part which is handed
down from generation to generation, whose disbelievers
formerly were crucified, now are ostracized. Shall I tell
you where the mythology of medicine is stored up ?
In the handbooks of materia medica, allopathic as well
as homa;opathic. But do not think me a nihilist. If I
believe that nine-tenths of what is said of the virtue of
drugs is myth, I am convinced that the last tenth is a
blessing to mankind.
I have ventured to give you only some general advice
how to study, leaving the special arrangements to the
teachers of the different subjects.
I come to the last part of my address : JF/iat cppor-
tunitics for your studies does this college offer you ?
It offers all you can desire, and more than an\' one of
you can make use of. Chemistry and physics are well
taught, and I am happy to say, that Professor Draper
lays more stress on physics than is commonly done. Its
importance is at least equal to, in my opinion greater than,
that of chemistry. In anatomy, not to speak of the
teaching, the material and facilities for practical work are
unsurpassed. All the other branches receive due atten-
tion. The large general hosjiitals, Bellevue and Charity,
in which the clinics are held, are before our door, and
contain eighteen hundred beds, which are always oc-
cupied.
Other hospitals of a more special character are near at
hand and equally at your service for clinical instruction.
The dead houses of Bellevue and Charity hospitals fur-
nish abundant and freely available material in that most
important of all the auxiliary departments of medicine,
pathological anatomv. The different laboratories con-
tained in the new wing of the college building, inaugurated
last year, have proved a great success, and invite your at-
tendance and appreciation. You receive there gratui-
tously private instruction for which in Europe you would
have to pay high prices, as the assistants of the European
schools make their living more or less from such courses.
Every branch of medical study, theoretical and practical,
is taught in this college. What else can you desire ?
The opportunity is given, it is for you to avail yourselves
of it. You are at liberty to map out your own path of
instruction, to gather much information or little. The
freedom of learning is as fully granted here as at any
German university. You are considered as men ripe
enough to judge for yourselves, and select what is best
for every one of you. The college-bred scholar has only
to look over the catalogue to lay out for himself a sys-
tematic graded course of three or four years' duration.
The German student does the same. The scientifically
less prepared, but mentally no less strong student, may
choose the practical metiiod, gather all the information
which the clinics and lectures afford, and fill in what he
lacks in theoretical knowledge during the evening and
the vacation. Though, perhaps, he will not greatly ad-
vance the science of medicine, he can doubtless become
a competent physician and a successful practitioner. The
European universities do the same as our schools. They
exclude nobody from availing himself of all the resources
Ihey possess. They matriculate and promote everybody
without distinction, and at the same rates, which is hon-
est enough. It is not the medical departments of the
European universities that demand a certificate of ma-
turity ; it is the State that refuses admission to the final
examination by which the license to practise is granted
if the candidate cannot produce a college certificate of
maturity and evidence of four years' professional study
at one or several universities. Whether in this country,
sooner or later, the State will or will not take the final
examination of the physician in hand is not for me to
guess at. Thus far the licensing power is granted to the
medical schools, and the time will soon come when you
will have to present yourselves ready to answer questions
in the seven topics.
Se-i'en topics I Are there only seven topics in the
vast domain of medical science? If you say there are
seven chief branches, the remainder are "specialties" of
which the candidate need know nothing, you are mistaken.
There are no specialties ; the human body is an har-
monious whole, nothing can be left out or set aside as
serving a special, extraneous purpose, not even a tooth.
The scheme of examination by speaking of seven branches,
means that the whole of medicine is classified in seven
larger divisions, each of whicli will have to be subdivided,
but none of the subdivisions must be ignored. The fac-
ulty desire it to be understood that all the subjects that
are on the iirogramme are worth knowing and of import-
ance. They desire it to be understood that all branches
of medicine — may they be taught by the regular professors
or may they, for the sake of convenience and efficiency
of instruction, be placed in the hands of special teach-
ers— will be examined into according to their respective
dignity. Some of these so-called specialties have ac-
quired an extent of theoretical and practical significance,
not inferior to some of the seven branches. I will men-
tion, for example, ophthalmology, which is commonly re-
garded as a part of surgery, but which has acquired such
an importance in internal medicine that Nothnagel, pro-
fessor of tlieory and jiractice at Vienna, said last year that
no medical man should be licensed who could not handle
the ophthalmoscope. It will not do, gentlemen, to march
so directly toward the programme for your M.D. that
you leave unnoticed vast domains of the science and art
of medicine, because yoa think they will not be subjects
of exannnation. I'he specialties will come tmder the
head of one or other of the seven branches and be ex-
amined by the official teacher of that branch, the ques-
tions to be formulated either by the professor or by the
special teacher. In ophthalmology, for instance, two
questions will in future be regularly given to each candi-
date for M.D., the one by the professor of internal med-
icine, the other by the ])rofessor of surgery. Skin diseases,
nervous and mental diseases, ear diseases, throat dis-
eases, etc., are all most important parts of medicine. Pa-
tients aiTected with them will demand your services daily.
By requiring sufficient knowledge in these branches, and
providing you with the means of obtaining it, the faculty
does you a favor and a service, for which you will bless
it all your life.
Let me now say a word about post-graduate instruc-
tion. Those who want to go beyond the requirements
for their diploma will find ample opportunity to do so
in this college, and in the difterent hospitals and other
institutions of this city and this country. He, however,
who feels the sacred fire in him will not be afraid to cross
the ocean in order to i)erfect himself in Europe. Let
full liberty jirevail in all this, let every one choose and
act for himself, and let it be recognized that we must
and shall have physicians in this country to whom the
management of the most important diseases may be en-
trusted with the same confidence as to the first European
authorities. This city certainly will not lack such phy-
sicians, according to the stubborn law which governs the
relation between labor and reward. This law throws the
best men where work is best Rewarded.
October 6, 1883.]
THE MEDICAL RECORD.
369
Ten years ago I was consulted by a Boston physician
for a serious ophthalmic difficulty. I advised him to stay
in New York and have his eyes treated. He asked me,
quite astonished : " Why, haven't we as good physicians
in Boston as you have in New York?" I replied with-
out feigned modesty : " No, sir, and you never will have ;
for talent, like merchandise, has a tendency to seek the
best market." He understood, stayed, had his eves
cured, and soon afterward settled in New York himself.
Gentlemen, as civilization advances with the progress
of science, the retiuirements of a candidate will be greater
from year to year. The faculty of this college have the
earnest desire, and make every effort in their power to
advance the standard of proficiency of the students. Last
year they added the laboratories and section teaching,
this year they have founded the College Dispe7isaiy\ in
which the students have an opportunity to make them-
selves acquainted with the milder and more common forms
of disease, for which people are not admitted to hos|)itaIs.
You see, gentlemen, there is every opportunity afl'orded
for a thorough medical education. What method you
pursue is indifferent, only follow it up. In learning lan-
guages there are also two methods : i, the systematic,
which begins with the declension of nouns and goes reg-
ularly through all the chapters of grammar, etymology,
and syntax, before the pupil reads the simplest book ;
and 2, the praetieal mulhod, which begins with sentences,
from the start, and deduces the rules of grammar from
examples in speaking and reading. This method has a|)-
propriately been called the natural, for it is the way in
which the child learns its own language. Who can say
which of the two methods is the better ? The systematic
is more adapted to the scholar, the natural preferable
for the requirements of practical life. Jn both methods,
however, a given amount of work has to be done. There
are in the P^nglish language, for instance, thirty-six thou-
sand words which have to be committed to memory in
some way or other. This recjuires time and work. The
same in medicine. Its large stock of knowledge can be
acquired only by hard and persistent labor. If any one
of you thinks himself ca[)able of getting a sufficient knowl-
edge of the essential parts of the theories and practice of
medicine during two college courses of twenty weeks
each, he is fundamentally mistaken. I advise every one
of you, in the name of the faculty, so to arrange your cur-
riculum as to attend three full terms at the college, a
winter and a summer course making one term. The old
philosophers held it to be the highest maxim, " Know thy-
self ; " Carlisle says, in modern times the maxim shoulil
be, " Know thy work and do it." Both are good maxims.
Gauge your own faculties, examine the task before you,
plan your work carefully, begin without delay, and do
not stop till you have reached the end.
This, gentlemen, reminds me that it is time for me to
stop, and for you to begin.
The Secret of Longevity. — A French medical man,
who has just died at the age of one hundred and seven,
pledged his word to reveal the secret of his longevit)-,
when no more, for the benefit of others. It was stip-
ulated, however, that the precious envelope contain-
ing the recipe for long life was not to be opened until he
had been buried. The doctor's prescription, now made
known, is simple enough and easy to follow, but whether
it is as valuable as he pretends is extremely doubtful. He
tells his fellow-men that if they wish to live for a century
or more, they have but to pay attention to the position
of their beds. " Let the head of the bed be placed to
the north, the foot to the south, and the electric current,
which is stronger during the night in the direction of the
north, will work wonders on their constitutions, insure
them healthful rest, strengthen their nervous system, and
prolong their days." It is, he adds, to scrupulous atten-
tion to the position of his bed that he ascribes his lon-
gevity, the enjoyment of perfect health, and the absence
of infirmitv.
REPORT OF A CASE OF ACUTE FATTY ATRO-
PHY OF THE LIVER, WITH POST-MORTEM
EXAMINATION.
By S. C. chew, M.D., "
PROFESSOR OF THERAPEUTICS AND CLINICAL MEDICINE IN THE UNIVERSITY OF'
MARYLAND.
The following case is reported as a typical instance of a
malady of not very frequent occurrence, in which the
diagnosis, though attended with some difficulty, was
made during life, and completely verified by a post-mor-
tem examination.
J. G , a most faithful and exemplary member of
the medical profession, was engaged in his usual duties
until Sunday, July 15, 1883, when he suffered from a
severe attack of gravel, the calculus passing apparently
along the left ureter.
To relieve the pain he inhaled in the course of Sunday
morning about three ounces of chloroform without much
benefit, the sutlering returning as soon as the influence
of the anaesthetic passed away. In the afternoon his
friend and medical attendant, Dr. W. F. A. Kemp, was
summoned to see him, and immediately administered a
hypodermic injection of morphia, witii the effect of at
once relieving his pain and giving him sleep.
On the following day he was free from pain and at-
tended to his professional duties, as he did throughout
the week and until Wednesday, July 25th, though he
spoke of feeling badly, and to those who saw him he ap-
peared far from well.
On Thursday, the 26th, he went out in the morning,
but came home with a severe chill, which was followed
by fever, in wliich the temperature rose to 103.5°. Per-
sistent nausea and vomiting occurred, with pain in the
back, chest, and limbs, and oppression of breathing.
The symptoms being like those of remittent fever, his
physician prescribed for him the sulphate of quinia to-
gether with the salicylate of cinchonidia, under which
the temperature fell to 99°, but in other respects his
condition remained nearly the same for the two follow-
ing days.
On Saturday, the 28th, the pain in the chest and op-
pression of breathing suggested the possible existence of
a central pneumonia, as yet not extending to the sur-
face so as to be detected by the ear; and under these
circumstances I was kindly invited by Dr. Kemp to see
the case with him. The nausea and vomiting were still
continuing, tiie ejected matter consisting chiefly of mu-
cus and watery fluid without any discolorations ; tem-
perature 103°. There was a slight icterode hue of the
skin and conjunctiva. The patient, though evidently
suffering from pain and oppression in the chest, was
calm and uncomplaining. A very careful auscultatory
examination made by both Dr. Kemp and myself showed
no sign of pneumonia. The symptoms still appearing
like those of malarial fever of a remittent type, it was
decided to continue the use of quinia in somewhat larger
doses. On the following day, Sunday, the 29th, the
nausea and vomiting had diminished, and the tempera-
ture was 98.5°.
On Monday, the 30th, the patient expressed himself
as feeling better, and read the newspaper in the morn-
ing, but occasionally some wandering of mind was ob-
served, and in the evening the jaundice was more
marked.
Tuesday, 31st. — In the morning some degree of som-
nolency was apparent ; the jaundice was still deeper,
and the temperature had fallen to 97-5°- Percussion
over the liver appeared to show some lessening of the
area of hepatic dulness, but as the abdomen was very
large and fat it was impossible to pronounce positively
from this method of investigation as to whether the liver
was diminished in size or not. At 5 p.m. it was found
difficult to arouse the patient, and at 8 p.m. the stupor
was still deeper. This condition continued all night.
o/^
THE MEDICAL RECORD.
[October 6, i88:
Wednesday, August ist. — At ii a.m. the patient was
profoundly comatose, and it was impossible to arouse
him. The bladder had been evacuated involuntarily,
and some blood had been passed from the urethra, not
diffused through the urine apparently, but staining the
sheet in spots. On passing a soft catheter into the blad-
der, urine to the amount of about two ounces was ob-
tained, which was healthy in appearance, contained no
blood, was of normal specific gravity, and showed no
albumen when tested with heat and nitric acid.
The diagnosis of the case appeared now to lie be-
tween four affections : first, pernicious remittent fever ;
second, yellow fever ; third, urasmic coma ; fourth,
acute fatty atrophy of the liver.
The first of these diseases was excluded by the con-
sideration that quinia had been freely given, and that
under its use perfect apyrexia had occurred.
The occurrence of yellow fever in a single sporadic
case was impossible in the highest degree, as no instance
of the disease has been known in Baltimore this year,
and the summer has been remarkably cool, and not of
that continuously elevated temperature which seems ne-
cessary for the development of yellow fever.
The suspicion of a renal origin of the symptoms, sug-
gested by the coma and the constant recurrence of nau-
sea and vomiting, was negatived by the result of the
examination of the urine.
There remained, then, the fourth alternative — acute
fatty atrophy of the liver ; and after fully weighing all the
facts in the case, the opinion was formed that this would
be found to be the organic disease upon which the svmp-
toms of the case depended.
The patient died comatose about 6 p.m. August ist.
On the afternoon of the following day a necropsy was
made by Dr. J. E. Michael, Professor of Anatomy in the
University of Maryland. The lungs were found to be
hypostatically congested, especially in the lower and
posterior parts, but no pneumonic change was present.
The heart was soft and largely overlaid with fat ; its valves
and orifices were healthy.
The abdominal jiarietes contained a very large amount
of fat, as did also the omentum.
The stomach contained a good deal of dark fluid, evi-
dently consisting in great part of altered blood, and
resembling the black vomit of yellow fever.
The kidneys were dark in color, somewhat mottled,
and surrounded with an unusually large quantity of fat ;
but they were not organically altered.
The liver occupied not more than one-half of the space
which it would be expected to fill in the abdomen of a
man as large as was the subject of the examination.
When removed from the body, it weighed exactly 31^
ounces, or about one-half of its normal weight, which, in
such a subject, should have been about sixty ounces.
In the only case of acute hepatic atrophy reported by
Dr. Murchison, in his work on " Diseases of the Liver,"
that of a young girl aged nineteen, the organ is said to
have been " extremely small, weighing only 28 ounces,
or exactly one-half of the standard weight for the girl's
age."
In a case recorded by Professor Flint., Sr., which was
also one of a young female, aged twenty-one, the liver was
reported to be much reduced in volume, weighing 29
ounces.
Now, if these weights, 28 and 29 ounces, indicate a
very remarkable reduction in the size of the liver in
young females, as they certainly do, the weight of 31.V
ounces, as met with in the liver of a large man, would
show proportionately fully as great a diminution of its
normal bulk.
This alteration of the size of the liver excluded entirely
the diagnosis both of remittent and of yellow fever, for
in both of these diseases the liver is either larger, or, at
any rate, not smaller than natural ; while it is generally
of a bronze hue in the former disease, and of a straw-
color in the latter.
In consistence the organ was very soft and friable, and
it presented the appearance of being much congested,
being dark in color, but not of the deep ochre or rhubarb
hue described by some observers. A portion of it was
examined with the microscoiie by Dr. J. E. Atkinson,
Professor of Pathology in the University of Maryland,
and was found to have lost almost every trace of normal
liver structure.
A certain amount of connective-tissue was present,
but no hepatic cells were discoverable, and in their
place large quantities of oil-globules and granular matter
were found.
The small amount of urine obtained before death was
alkaline in reaction and contained some bile-pigment ;
crystals of triple phosphate were visible under the micro-
scope, together with a few hyaline casts. An examina-
tion for leucine and tyrosine gave negative results, but
the absence of these products did not affect the diag-
nosis, for, as is remarked by Dr. Murchison, " the detec-
tion of these crystalline bodies in the urine of a case of
jaundice may be said to clinch the diagnosis of acute
atrophy of the liver, but the failure to detect them must
not exclude acute atrophy from the diagnosis."
The verification by the post-mortem examination of
this case of the diagnosis of acute fatty atrophy of the
liver was complete. The case was acute, for until seven-
teen days before his death the patient was attending to
his usual duties, not suspecting the existence of disease.
The change in the liver wz.^ fatty, as shown by the de-
struction of its normal tissue and the presence of a very
large quantity of oil-globules. The change was atrophic
in character, as the organ was of only about one half of
its normal weight.
Two circumstances, the sex and age of the patient,
rendered this case one of especial interest. The disease
is much more common in females than in males ; of 3 1
cases collected by Frerichs, 22 were females. The age
of the subject of this report was about sixty, whereas a
large portion of those attacked with the disease are under
middle age. Of Frerichs' 31 cases 26 were under thirty,
and all except two under forty.
Little or nothing is known of the originating causes
of acute atrophy of the liver, nor of the primary changes
in the nutrition of the organ which lead to an acute fatty
degeneration. The malignant jaundice of the older writers
was believed to be sometimes superinduced b)' mental
emotions of a depressing kind, the patlicmata mentis of
Cullen, especially fear and grief. Sometimes, according
to Sir Thomas Watson, it has been produced b\' great
bodily sufi'ering, or by a severe surgical operation, or per-
haps by the dread which attended it. When resulting from
nervous influences, it is observable, he remarks, that the
cases " are often fatal, with head symptoms, convulsions,
delirium, or coma supervening upon the jaundice." It
is highly probable that in such cases the structural dis-
ease upon which the symptoms depended was that
which later observations have shown to be acute fatty
atrophy of the liver ; and it is conceivable that in the
case here reported the severe pain attending the passage
of the renal calculus may have first started the morbid
action by which the nutrition of the liver was fatally
deranged.
Ovariotomy ix a Child Eight Years Old. — Dr.
Duchanip recently performed ovariotomy in a child
eight and one-half years of age. The cyst was tapped
and about a quart of lemon-colored fluid extracted. Then
the tumor with the left ovary and Fallojiian tube was re-
moved. The operation was easily performed, and the
child made a good recovery. The author recalls other
cases in which the operation has been performed on
young girls, and in which the favorable issue has shown
the wisdom of operating thus early, and of not waiting
until the tumor has grown to such a size as to endanger
the life of the child. — Journal de Mid. et de C/tir. Prat.,
September, 1883.
October 6, 1883.]
THE MEDICAL RECORD.
ZT'i-
A CASE OF EPITHELIOMA ORIGINATING IN
ABSCESS OF THE LACHRYMAL SAC.
From T})f. Practice of Dr. C. R. Agnew and Dr.
D. Webster.
By DAVID WEBSTER, M.D.,
PROFESSOR OF OVHTHALMOI.OOY IN THE NEW YORK I'OLVCLINIC.
Mr. K , a Connecticut farmer, had lachrymal ab-
sces.s at the age of forty-five, and was always afterward
troubled with stillicidium, or a " watery eye." He con-
sulted an eminent ophthalmic surgeon in 1872, thirteen
years after the occurrence of his attack of acute dacryo-
cystitis, and was advised to have an operation performed
for opening his tear-passage, but neglected to attend to
it. So the disease was without treatment until Jauuar}'
14, 1S75, when Mr. K' came to New York and put
himself under our care. He was then sixty-one years of
age, and the lachrymal disease had existed for fifteen or
sixteen years. There was a tumor of the size of a Lima
bean over the tear-sac, and on its surface was an ulcer
covered with a scab. Pus could be squeezed from the
lachrymal sac. The eyeball was red, and there was
some superficial vascular keratitis. There was no pain
in or about the tumor, but "a little trifling itching."
The vision of the eye was -j-J.
We made a diagnosis of probable epithelioma, and
Dr. Agnew removed the growth with a knife and placed
it in the hands of Dr. Elijah A. Maxwell for microscoiiic
examination.
Dr. Maxwell reiiorted as follows :
"January 26, 1875. — I have examined microscopi-
cally the specimen, and herewith append what has been
disclosed. The growtli has a connective-tissue stroma
made up of moderately large, sinndle-shaped, nucleated
cells ; next, an infiltration of numerous round cells, re-
sembling granulation tissue in form and arrangement of
cells, and found most numerously in the central portions
of the tumor, while the mam bulk of the growth is made
up of distinctly epithelial elements, showing the follow-
ing varieties of cells. They were ovoid, polygonal, con-
oid, at the borders serrated, all with a large nucleus
almost filling the cell and containing numerous nucleoli.
Patches were found at the borders presenting the same
appearances as the endothelium of lymph spaces, and
giving one the impression of the probability of growth
in this direction. It is, in my opinion, <zri epitliclial cai-
cinoma of the small-celled variety."
February 22, 1S75. — The wound made by the removal
of the tumor has entirely healed. There is still pus in
the lachrymal sac.
Dr. Agnew now slit up the lower canaliculus and
passed a narrow, probe-pointed knife down through the
nasal duct to the nose. The passage was kept open by
probing for a time and then the patient was allowed to
return home.
October 21, 1876. — In about two weeks after the pa-
tient ceased to visit us two little nodules appeared in the
same position from which the original tumor had been
removed. They are now of the size of a small split pea
each. The eye is the seat of chronic conjunctivitis and
a glairy-looking pannus, as though there might ulti-
mately be epithelial trouble of the cornea. The palpe-
bral conjunctiva of the upper eyelid also looks threaten-
ing-
Mr. K was advised to have the two recurring
growths removed, but declined to have them interfered
with at that time.
We did not hear from him again until September,
1883, when his nephew called at our office and com-
pleted his history. He stated that after the patient
called upon us for the last time the growth increased
rather rapidly, and became painful, always worse on
taking cold. After about two years it had grown to a
considerable size, and he placed himself under the care
of a cancer doctor who put on a cancer plaster and
" drew it out by the roots." The operation extended
through some weeks and was very painful, but the tumor
was effectually destroyed, the site healed leaving a deep
depression, and the growth never returned.
The patient died of typhoid pneumonia in March,
1881, after an illness of only eight days. It was his
third attack of pneumonia, the first having occurred
about fifteen years before his death, and the second
within a few years of the first. There was no family his-
tory of cancer.
z66 Madison Avenue.
THE DIAGNOSIS AND HYGIENE OF TYPHOID
FEVER.
By E. HOCHHEIMER, M.D.,
ASSIST.ANT SANITARY INSPECTOR NEW YORK HEALTH DEPARTMENT.
Having been assigned by the Board of Health to the in-
vestigation of the sanitary conditions attending or causing
typhoid fever, several circumstances regarding its etiology
and diagnosis have forced themselves upon my notice,
to which, as they differ somewhat from generally received
opinion, it appears advisable to call the attention of the
profession, especially at the present time, when the dis-
ease is encountered with such unusual frequency.
Judging from the clinical picture of typhoid fever as
usually given in the text-books, its diagnosis would seem
an easy matter. The malaise which precedes its advent,
the chill which marks its onset, the headache, epistaxis,
diarrhcea, abdominal tenderness, ileo-ca;cal gurgling,
roseola, tympanites, enlargement of the spleen, cough,
appearance of the tongue, and, above all, the peculiar-,
regular remissions and exacerbations of the fever, make
up a group of symptoms which stamp the features of a
disease easily recognizable and not to be mistaken.
Whatever may be the cause, whether the above descrii)-
tion is a mere generalization, or whether there is some-
thing about the climate and hygienic condition of this
city which materially modifies the appearance of the
symptoms, I shall not stop to speculate. The fact, how-
ever, remains, that in the great majority of cases as at
present met with, the task of arriving at a positive opin-
ion is by no means an easy one. As a rule, this is not
accomplished until the second or even the third week ;
and it is not magnifying the difficulty of making a diag-
nosis to assert that, in most instances, there is none of
the exanthematous or zymotic diseases which it is so
hard to recognize early. And yet this early recognition
of the disease is of the highest importance, for many rea-
sons : it will aid the attending physician to discover
the conditions producing or assisting to cause the dis-
ease, lead to the use of proper precautions to prevent its
spread, direct the correct line of treatment, and enable
him, in- uncomplicated cases, to foretell its natural course
and duration, and thus keep the friends and relatives
from expecting imiiossibilities, and dooming themselves
to inevitable disappointment.
The disease ordinarily begins in a manner resembling
an attack of malarial fever. The patient complains of
weariness and inaptitude for exertion, and there is gen-
erally more or less elevation of temiierature. There
may be a chill, but this is the exception and not the
rule ; the same is true of the epistaxis. The condition
of the intestinal action is variable : in many, diarrhoea
is present, while in probably an equal number the
movements are natural or the patient is even constipated.
The appearance of the tongue is equally uncertain :
sometimes it is coated, sometimes dry, sometimes almost
normal. The coaling, when present, may be white, yel-
low, or brown, and situated at the base, at the sides, at
the tip, or in the centre ; in short, it shows nothing more
than is to be seen in any fever or inflammation. Ab-
dominal tenderness is a more constant symptom, but not
by any means met with in every case ; in some instances
it is probably present, but the patient's mental hebetude
prevents its being appreciated. The cerebral symptoms
are very irregular : while many subjects complain of
)72
THE MEDICAL RECORD.
[October 6, i<
headache, or a sense of fulness across the forehead, oth-
ers do not deviate in this respect from their usual condi-
tion. The "characteristic temperature curve " of the
first week will seldom be observed.
The above hasty glance at the more common mani-
festations of the disease in question would apparent!}'
leave us in a very uncertain state of mind, in the first few
days of the sickness, as to the nature of the patient's
complaint. This is undoubtedly true, except where
there has been another case of typhoid fever in the house
shortly before, the diagnosis must be mainly made by ex-
clusion. But the darkness is not so profound as it may,
at first sight, appear. In the first place, there is the fe-
ver, more or less continuous ; secondly, in addition,
there are generally one or more of the other symptoms,
and in this disease, to borrow a phrase from homceop-
athy, it is especially necessary to have in view " the to-
tality of the symptoms ; " thirdly, any case of " malarial
fever" which persists longer than three days in spite of
sufficient administration of qumine should excite suspi-
cion of typhoid ; and lastly, there is a symptom which is
peculiar and so constant that it may almost be regarded
as pathognomonic, the roseola.
The time at which these spots appear varies ; the}' may
be met with as early as the third day or not until the end
of the first week. Xor are they always, strictly speaking,
on the abdomen ; they occur sometimes on the pubes, or,
perhaps most commonly, over the lower ribs. Neither
are they always confined to the trunk ; in exceptional
cases they invade the extremities as well, and this with-
out any apparent relation to the severity of the attack.
In size they are from the one-thirt)'-second to the one-
sixteenth of an inch in diameter, depending upon the
character of the skin, being smaller in young subjects
and in those who have delicate skins. The same remark
applies to their elevation above the surrounding integu-
ment ; they may be not at all raised, or elevated almost to
papules. They are smooth, and, when they are most
pali-table, in running the finger over them but a slight re-
sistance is encountered. In color they are brigiu red,
and thtty disappear completely on pressure, showing again
quite promptly when the pressure is removed, the rapidity
of their reappearance deiiending of course on the activity
of the circulation. In number they vary within wide
limits ; there may be only one spot in the course of the
disease, or, as stated above, there may be an eruption
covering the greater part of the body and coming out in
successive crops. But whether they be few or many,
their presence is almost constant, and, if carefully looked
for, particularly during the second week, they will be
found in probably no less than ninety to ninety-five per
cent, of all cases. In short, they are so peculiar and
characteristic that they cannot fail to be of the highest
diagnostic value.
The bronchitis, which generally shows itself at the end
of the first week, is likewise one of the most constant
symptoms ; and wliile, of course, it may be accidental,
taken in connection with the other symptoms it may
assist in arriving at a conclusion in doubtful cases.
As to the sanitary conditions under which typhoid fever
occurs, a few words must suffice. While it cannot be
denied that in many, perhaps the majority of cases, no
particular defect can be discovered, still in a very large
number obvious cause can be found. Prominent among
these may be mentioned untrapped or unventilated waste-
pipes, leaky discharge-tubes, sewers, or soil-pipes, lack
of water in the water-closets or school-sinks, and foul-
smelling, badly cared-for privy-vaults. Where more than
one case has occurred in a house, one or more of the
above conditions will rarely be absent.
It would appear almost an impertinence on my part to
say anything with reference to tlie precautions necessary
to prevent the s|)read of the disease, and yet so frequently
do both my colleagues and myself see them neglected, that
it may not be out of place to call particular attention to
them. It is apparently well established that the materies
morbi lies in the discharges from the bowels, and only
becomes active after they have undergone a certain
amount of decomposition or fermentation. The process
of prevention is therefore simple and direct ; all that is
required is to thoroughly and speedily disinfect the stools
or anything that has been soiled with them. Copperas is
very good for this purpose, and has the advantage of be-
ing cheap and odorless. A solution of this should always
be kept in the chamber or bed-pan, and when the pa-
tient has a movement of the bowels the vessel should
be emptied at once and well rinsed and have some of
the dismfectant again put into it. If the patient's linen
or bed-clothes should accidentally be soiled, they should
be changed at once and disinfected ; for this purpose hot
water is excellent, and the solution of chlorinated soda,
known in the laundry under the name of Javelle water,
is to be comtnended. The patient's undergarments, etc.,
should not be washed with the clothing of other members
of the household. It is hardly necessary to add that to
sprinkle carbolic acid or to strew chloride of lime about
the sick-chamber is, to say the least, of doubtful utility.
The practice of keeping the discharges for the doctor^s
inspection is a source of danger, and, except in rare in-
stances, it should not be countenanced. These measures
cannot be begun too early ; the attending physician
should not be content with giving general directions, but
should lay down strict and minute instructions for disin-
fection, and by daily inquiry see to it that they are com-
plied with.
207 East Fii--tv-Sev'esth Street,
POISONING BY SULPHATE OF ATROPIA.
Successfully Treated with Hypodermics of Sul-
ph.a.te of morphi.\.
By LLEWELLYN ELIOT, M.D.,
ASSISTANT I'HYSICIAN CENTRAL DISPESS.^RY WASHINGTON, D. C; DEMONSTRATOR
OF ANATOMY UNIVERSITY OF GEORGETOWN,
C.\SES of poisoning by atropia are becoming of frequent
occurrence, more especially since the appreciation and
application of its therapeutical effects increases. Oph-
thalmic troubles, rheumatism, pertussis, dysentery, the
sweating of phthisis, poisoning by opium yield to its
proper administration as if by charm. The dose for
internal administration has been stated to range from
.0005 gm. to .003 gm. (j4-j gr. to ^L gr.). Tike many
other valuable remedies it is often abused. The follow-
ing case was seen, in conjunction with Drs. J. I. Dyer
and J. S. Harrison, during my service as Resident Phy-
sician to the Washington Asylum Hospital of this city.
Mary H- , white, aged forty years, born in Ireland,
was admitted to hospital on December ii, iSSi, for
treatment for "double iritis" of short standing. She
gave a history of frequent exposure and attacks of alco-
holism and rheumatism, but nothing pointing to syphil-
itic taint. She was directed to use a solution of atropia
sulphate, .133 gm. to 32 c.c. (gr ij. to 3 j.), applied night
and morning ; the strength of this solution was on De-
cember 16th increased to .266 gm. to 32 c.c. (gr. iv. to
3J.). No im|)rovement following, she was on Decem-
ber 28th ordered potassium iodide, i gm. (gr. xv. ) three
times a day : emplast. cantharid., .025 mm. (i in.)
square, to each temple, besides the following :
5.. MassK hydrargyri 8 gm. (gr. xij.)
Tiilv. opii 133 gm. (gr. ij.)
M. Ft. pil. no. xij. Sig. — One three times a day and
continue until salivation appears.
On December 30th the blistering was repeated ; on
January 3, 1882, salivation appeared, for which she was
ordered a wash of potassium chlorate, tincture of myrrh,
and water.
From the commencement of the administration of the
mass, hydrarg. until profuse salivation the iritis steadily
improved, so much so that she assisted in a small way in
October 6, 1883.]
THE MEDICAL RECORD.
i72>
the ward duties. On January igtli, at 7.30 a.m., she
took by mistake a teaspoonful of the atropia solution,
.266 gm. to 32 c.c. (gr. iv. to 3J.), making her dose
.033 gm. (gr. ss.). In a short time she complained of
lightness of the head, and "feeling foolish;" nothing
was thought of it, the mistake not being known. At
9.15, an hour and three-quarters afterward, symptoms
of atropia poisoning develojied. Pupils dilated, vision
diminished, accelerated respiration, constriction of the
throat, difficult deglutition, pulse 116, but weak. At
9.20 a hypodermic injection of morphia sulpliate, .022
gm. (gr. ^), was administered; at 10.20 it was repeated ;
at 10.50 a third was given, pulse, 96. At eleven o'clock
the thermometer in the axilla registered 96^° Fahr. ; pulse,
96 ; respiration, 3 per minute, with marked symptoms of
morphia poisoning. An electric battery was applied
and in a few minutes another was brought into use. She
responded. At 12.30, being placed upon the floor,
she was subjected to violent shaking and flagellations at
intervals. Her condition began to improve, at 4 r.M.
she was given a few swallows of tea, for this strong cof-
fee was substituted. At 9 she was put to bed. Her
mind was not clear. During the following day her only
trouble was partial loss of memory with muscular sore-
ness. From this time she continued to improve ; her
sight being restored, she was discharged some weeks
later. Nothing more was heard of lier for some months,
when in a drunken fit she jumped into the canal and
was drowned.
The points of interest in tlie history of this case are,
the complete cure of the iritis, the antidotal eflects of
morphia sulphate, the slowness of the respiration (3 \)er
minute), and the subnormal temperature (96I Fahr.).
There can be no doubt as to the temperature, since it
was taken with different instruments several times, for
fear there might be some znistake in the reading or
registering.
ADENOID VEGETATIONS OF THE PHARYN-
GEAL VAULT,
And Their Relation to Middle-Ear Disease.
By R. E. SWINBURNE, M.D.,
SURGEON TO THE HARLEM EVE, EAR, AND THROAT INFIRMARY, NEW YORK.
I PROPOSE to call attention to a class of cases that
are comparatively common, accompanied by many un-
pleasant symptoms, and followed at times by quite
serious results, yet frequently not recognized by the at-
tending physician. Meyer, of Copenhagen, first called
attention to this disease, and since then its symptoms,
clinical history, and the histology of these growtlis have
been so thoroughly studied and are so well understood
that I shall not dwell long upon those points. The
symptoms will depend upon how much respiration and
phonation are interfered with, the amount of secretion, and
to what extent the ears are involved. The nose is the
natural respiratory channel, and no child will go about
with its mouth constantly open when free nasal respira-
tion is possible. In proof of this I cite the tact that in
every case coming under my observation, in which a suc-
cessful operation has been performed for the removal of
vegetations, the patient lias subsequently kept his or her
mouth closed when at rest, although previously it hail
been constantly open. Phonation is very much hindered,
especially in the pronunciation of the nasal consonants m
and n. The term dead, applied to the voice by Meyer, de-
scribes it best and has been universally adopted. When
the obstruction is considerable the nostrils are small,
their walls thick and the nose compressed from side to
side giving it a characteristic appearance. In a healthy
and normal subject the anterior nasal openings are the
smallest parts of the canals, and consequently when an
extra amount of air is required the nasal wings are ex-
panded and the orifices distended, but in these cases there
is non-development from disease. If the children arc
old enough they will expectorate the secretion, but if not
it will be swallowed and coughed up, and this is not un-
frequently the cause of a cough that resists all expecto-
rants and anodynes. Sometimes it accumulates in such
(luantities as to interfere with respiration and wake the
little patient several times during the night with a severe
coughing spell.
Patients with a large amount of this adventitious tissue
in the superior pharynx have a sallow complexion, which,
together with the open mouth and compressed nostrils,
gives them a characteristic distressed and idiotic expres-
sion, more pronounced if there is much deafness. So
jjeculiar is the physiognomy in these cases that I have
frequently been able to make a diagnosis from it alone
as the patient entered my office or the infirmary, and in
no case has my first opinion been proven erroneous by
further examination.
All observers report this condition as existing in chil-
dren of from five to fifteen years of age mucli oftener
than at any other period ; my own records show them in
patients of from three to twenty-six years. A positive
diagnosis can only be made by pharyngosco))ic, rhino-
scopic, or digital examination. Examination of that
part of the pharynx below the soft palate frequently
gives valuable information as to the condition of the
membrane above, from the strings of mucus and crusts
dropping down, the ]iresence of enlarged glands on the
posterior wall, and hypertrophied palatal tonsils ; the
naso-pharynx may, however, be almost entirely filled with
vegetations without a trace of the trouble existing in
the lower pharynx. The necessity of examining the
whole surface anteriorly and posteriorly is therefore
obvious. Pharyngoscopic examination sometimes re-
quires considerable time and patience to determine ac-
curately the condition in unruly children, and in such
cases the ])arts should be examined by passing the finger
behind the soft palate. In this way the whole space can
be explored with ]ierfect satisfaction to the surgeon and
without danger to the patient, nor is this a painful manipu-
lation. I usually make a digital examination in cases
that readily permit of an examination with the jiharyngo-
scope, in order to obtain more precise knowledge of the
existing condition. My experience enables me to con-
firm the statement of Meyer, that the best place for ob-
serving this class of cases is among ear patients. He
says ("jMedico-Chirurgical Transactions," p. 191. London,
1870): "Among 102 cases of adenoid vegetations 72
suffered from disease of the ear. .^mong 2,000 chil-
dren of the public schools of Copenhagen (the majority
being between ten and fifteen years of age), he found 20,
or one per cent, of dead pronunciation, and in all met
with adenoid vegetations." At the Harlem Eye, Ear,
and Throat Infirmary, since its organization in January,
1882, up to September, 1883, 179 patients suffering from
middle-ear disease applied to me for treatment, and of
these 27, or i in 6^, had adenoid vegetations; 148 ap-
plied on account of throat and nasal afflictions, and of
these 15, or i in 10, had this trouble, making a total of
42 cases among 325 throat and ear patients. Twenty-
seven of the 42 cases of vegetations, or about three-fifths,
had diseased ears. Of the 27 ear cases there were per-
forations in one or both drumheads in 14. While there
was this large percentage of adenoid growths of the vaults
there were only 7 cases of hypertrophied palatal tonsils,
one-sixth as many as of the former.
Hypertrophied' palatal tonsils have from time imme-
morial almost been looked upon as a cause of middle-ear
disease and volumes have been written about it, while
the more common and important subject of hypertro-
phied pharyngeal tonsil has been entirely overlooked,
simply because surgeons did not employ the pharyngo-
scope, and conseciuently were of necessity entirely igno-
rant of the condition of the membrane above the palate.
In my experience enlarged palatal tonsils is only a part
of a general catarrhal condition of the upper air-passages,
is, in the great majority of cases, accompanied by ade-
374
THE MEDICAL RECORD.
[October 6, 1883.
noma of the vault, and is very much less common than
the latter. Among the patients who applied for treat-
ment of middle-ear disease, not accompanied by adenoid
vegetations, there was well-marked naso-pharyngeal ca-
tarrh in nearly every case. My patients suffering from
catarrhal throat affections almost invariably tell me that
at difieient times they have been somewhat deaf, had
tinnitus aurium and other common symptoms of otitis
media, but it soon passed off and they considered it a
trifling matter. If the hearing power of patients suffer-
ing from nasal catarrh be carefully tested it will frequently
be found less than normal, although the subject is en-
tirely unaware of the defect. Careful inquiry and study of
these cases has convinced me that middle-ear disease not
secondary to and the result of disease of the naso-pharynx
is uncommon, and that the pharyngoscope and rhino-
scope are as essential as the otoscope in making a cor-
rect diagnosis and applying proper treatment. I feel I
have not done my duty to any patient that applies to me
for treatment of a middle-ear aftection until the nose and
superior pharynx have been tlioroughly examined. Ui^on
this point Politzer says ("Diseases of the Ear," p. 303) :
" Experience teaches that when the naso-pharyngeal af-
fection ceases the consecutive inflammation subsitles, but
that in a number of cases the inflammatory sweUing and
secretion in the middle ear continue, with the develop-
ment of all the consequences I have already enumerated.
On the other hand, in primary, or even in secondary af-
' fections of the niiddle ear, the inflammatory process,
especially the swelling of the Eustachian tube, is main-
tained and recovery hindered by complication with or
continuance of a naso-pharyngeal aftection. From this
may be seen the importance of minute examination of
the naso-pharynx and the emijloyment of rational treat-
ment for the removal of an existing naso-pharyngeal af-
fection as one of the principal conditions for aftecting a
favorable result in the numerous obstinate cases thus
complicated." The aural disease accompanying adenoid
vegetations of the pharyngeal vault is said to have been
produced in three ways : First, by the pressure of the
growths upon the mouths of the Eustachian tubes ; sec-
ond, by their interference with the circulation of air
through the nose ; and third, by an extension of the in-
flammation to the middle ear. My own belief is that it
is caused almost, if not entirely, by an extension of the
inflammation, during an attack of acute naso-pharyn<^eal
catarrh to which patients in this condition are predis-
posed.
Patients present themselves with aural catarrh and
purulent middle-ear disease as the result of nasal catarrh
many times more frequently than they do with these
troubles in connection with adenoid vegetations. All of
the cases of acute middle-ear disease accompanied bv
adenoid vegetations that have come under my observa-
tion, have also had acute pharyngitis. In the great mass
of these cases, applying on account of the ear complica-
tion, the vegetations are so small as not to press on the
tubes at all, and do not interfere with respiration suffici-
ently to prevent the proper amount of air reaching the
middle ear. The question now arises, whether opera-
tion for the removal of the vegetations is advisable oi-
not. No ill eflfects have followed operation in any of my
cases, and I believe none need ever occur if properly
performed, but, on the contrary, the ears and general
health may be very seriously damaged if left to nature.
These growths must, of course, be approached either
through the nose or through the mouth from behind the
soft palate.
There liave been five methods proposed for ihcir re-
moval, and used with varying success : i, the curette ;
2, caustics ; 3, galvano-cautery ; 4, the wire looii, wiiicli
may be either the galvano-cautery loop or the ecraseur ;
and 5, the forceps. The only difficulty experienced in
removing a hypertrophied pharyngeal tonsil is its inac-
cessibility. The nostrils are narrow and slit-shaped,
through which only the smallest instruments can be
passed, and any manipulation in these cavities is always
accompanied with considerable pain, so much so that
children especially are unable to maintain the quietude
necessary for the successful and easy performance of the
operation. A very large percentage of these cases are
also accompanied by hypertrophic rhinitis, which still
further encroaches upon the calibre of the canals. In
many instances it is simply impossible to pass any instru-
ment through one nostril, on account of a deviation of
the septum or an exostosis. Although the passage
through the mouth is large the obstacle that has always
been experienced is the spasmodic action of the soft pal-
ate, which instantly takes place upon the slightest irrita-
tion of tlie pharynx, thereby cutting off all communica-
tion. Palate retractors have been devised and employed,
but they have all hitherto required the use of one hand
for their manipulation, a f;rct that very seriously aftects
their utility. The method of passing strings through the
mouth behind the palate, out of the mouth and then ty-
ing the ends over the upper lip is a very useful proced-
ure, but does not counteract the action of the levator-
palati muscle and consequently is not an entire success.
The desideratum has been an instrument that will at
once keep the mouth open, the palate retracted, and
overcome the action of the levator-palati muscle. These
objects are obtained by the use of the instrument made
for me by J. Reynders & Co. It consists of a mouth-
gag, differing from Whitehead's only in the absence of
a tongue depressor and the addition of a palate retrac-
tor. The palate retractor, devised by myself, is a broad,
flat hook with a small round shaft, having a thread upon
its whole length and a nut. To the mouth-gag I have
added a bar with a slot and slidebolt. When the gag
is properlv placed in the mouth the bar will be just be-
neath the upper incisor teeth and parallel to them.
After the gag has been inserted between the teeth and
opened, the retractor is to be hooked behind the palate,
drawn forward, the stem inserted in the slot, the bolt
shoved beneath it, thus firmly holding it in place, and
finally the nut on the stem is to be screwed up. I have
used this instrument in fifteen cases of adenoid vegetations
of the pharyngeal vault and find it to be all that is desired.
In doing this operation I always give ether, because, first,
it is quite painful ; second, in children it is sometimes
difficult to see the throat, and always impossible to operate
there witiiout restraining them by force ; and third, there
is no objection to it. The curette w'as Meyer's instrument,
but he distinctly states {o\>. cit.) : " One operation rarely
succeeds in removing all of the vegetations, so that it
often requires to be repeated. When the vegetations are
of soft structure I employ cauterization with the solid ni-
trate of silver. In some few instances neither the opera-
tion nor the after-treatment by the use of caustics and the
pharyngeal douche has succeeded in removing all traces
of the vegetations." He also reports severe reaction,
which in some instances resulted in [lerforation of the
drumhead.
This metliod of treating the aflection was original with
Meyer and used by him more than by any other surgeon.
Therefore, after reading the above opinion of it by its
author, no further argument will be necessary to con-
October 6, 1883.]
THE MEDICAL RECORD.
375
vince us that it is not all that is to be desired. The second
and third methods — namely, destruction by caustics and
cautery — act upon the same principle, differing only in
degree. .After a considerable experience with such caus-
tics as the saturated solution of chromic acid, sulphate
of copper, the tincture of iodine, etc., I have entirely
abandoned them, convinced they are useless in any con-
siderable hypertrophy. The galvano-cautery I have em-
ployed in a number of favorable cases, but have never
succeeded in curing any of them. It is a very painful
procedure, difficult to perform in adults, almost impos-
sible of accomplishment in children, and requires several
ap|)lications, extending over a period of weeks ; serious
damage to the healthy parts is unavoidable and the cau-
terization is always followed by a good deal of inflam-
matory reaction. In my opinion this treatment should
never be employed in the naso-pharynx, although for the
treatment of the extreme hypertrophies of the tissue cov-
ering the turbinated bones it has afforded me better re-
sults than any other agent. With the aid of a speculum
and ivory slide, introduced by Dr. E. S. Shurley, of De-
troit, the turbinated bones can easily be cauterized with-
out endangering the healthy parts, and in my hands
many cases have yielded to this plan of treatment that
resisted all others. The fourth plan is either the galvano-
cautery loop or the cold wire snare.
Before the introduction of the Jarvis snare I removed
post-nasal growths with an ecraseur mounted with copper
wire, but found great difficulty in getting it through the
nose and over the tumor, simply because it would bend
whenever it impinged against the solid parts, and of
course the same is true of the platinum wire, but the
steel wire will spring over a tumor without bending, thus
permitting the surgeon to draw it down to the base or
pedicle, and by turning the nut cut it off. The Jarvis
snare is a single round tube that can be readily turned
in the nostril, while the cautery loop of necessity con-
sists of two tubes, making it much wider and of course
requiring a correspondmgly larger space to be turned
in. The former will cut off anything one is required to
remove here, and as it is cheap and always ready, while
the latter is both costly and troublesome, I much prefer
the snare. The modification of the Jarvis snare for use
behind the palate, introduced by Dr. Bosworth, is supe-
rior to any other with which I am familiar, but the ob-
jection to it is the tediousness of the operation to both
surgeon and patient. Large growths can be removed in
this way without trouble, but the smaller ones in chil-
dren of from three to ten years of age, who come under
the care of the aurist on account of the accompanying
ear disease, are very difficult to treat by this method.
Many of them are simply broad, flat cushions, attached
to the vault without any constriction at the base, and to
which it is almost impossible to attach a snare even in
adults who will tolerate the pain and discomfort, but in
children it is still more difficult, for they resist as much
as possible. Removal of these growths by the snare
through the nose is generally much more difficult than
through the mouth.
We now come to the consideration of the fifth method
— the forceps. Dr. Cohen, in his book " Diseases of the
Throat and Nasal Passages," p. 262, says: "When the
vegetations are large and the parts can be educated to
quietude under manipulation the growths can sometimes
be seized with properly curved force[)s and be torn ofl' or
crushed off as the case may be."
This is as favorable an opinion as any one can give,
unless the movements of the palate can be controlled.
With the mouth-gag and palate retractor I have shown
you, properly curved forceps, and the patient fully
anaesthetized, the whole growth can be removed while
the patient is recovering from the anaesthesia. Every-
thing that can be taken hold of with the forceps should
be removed, and then the index finger should be passed
behind the palate and any shreds or small pieces found
are to be scraped off with the finger-nail. This opera-
tion is adapted to all cases, but especially to those in
which the vegetations are small, and in children who will
not tolerate operative interference. The great advan-
tages of it are, that it is radical — that is, the vegetations
are all removed at one operation, there is never any in-
flammatory reaction, and it can be performed in less
time than any of the other operations. There is no
more hemorrhage in removing them in this way than in
any other, and it ceases spontaneously as soon as the
operation is completed.
Most of these cases are accompanied by hypertroiihy
of the tissue covering the turbinated bones, and in those
cases I apply the galvano-cautery to them after the pa-
tient has been anaesthetized, but before removing the
adenoid tissue. If this hypertrophied erectile tissue is
not destroyed, the patient will still be unable to breathe
through the nose, and I have not yet found any agent
that acts so promptly and efficiently here as the cautery.
Although there is always considerable inflammation fol-
lowing the use of the cautery, I have never yet seen any
harm result from its use in the nose.
I wish particularly to call attention to the dift'erence
between its use in the nose and the naso-pharynx. In
the nose the healthy parts can be protected, the applica-
tion limited, and it is entirely under the control of the
surgeon. In the naso-pharynx the healthy parts are seri-
ously damaged, the mouths of the Eustachian tubes
frequently more or less burned, resulting in acute inflam-
mation of the middle ear, and all of the serious conse-
quences so liable to follow. I very frequently employ
the galvano-cautery in treating hypertrophic troubles of
the nose, and have never seen any evil results from its
use, but, on the contrary, have obtained very decided
benefit in every instance.
The first case I operated upon in this way was S. C.
B , aged six, with chronic aural catarrh, hypertrophy
of the turbinateds, and pharyngeal tonsil. He was referred
to me by Dr. Ira B. Read, who kindly assisted me in the
operation. The patient was etherized, the turbinateds
cauterized, and the vegetations removed with the for-
ceps, the mouth and palate being controlled by the in-
strument I have shown you. I did not see the boy again
for some three weeks. At this time his mouth was firmly
closed, although it had been constantly open before the
operation, and upon examination the superior pharynx
was found entirely free from vegetations, while the tur-
binateds were so much reduced in size as to permit of
free nasal respiration. The ears were also very much
improved, and have since given him no trouble. The
mother volunteered the information that the bad odor of
the breath, and all the other unpleasant symptoms from
which he had suffered so long, had entirely disappeared,
and she considered it a very successful operation.
Since then I have operated in this way fifteen times,
and in only one case failed to remove the whole mass at
one operation. In this patient there was a small piece
left just back of the septum, and although it was so small
as not to interfere \vith resi)iration, I removed it with
the nail of my index finger. The final result of this case
was a perfect cure.
Paralysis following Simple Catarrhal Sore
Throat. — Dr. Lentz reports in the Gazette Medicale de
Strasbourg for Sei^tember i, 1S83, two cases of catarrhal
sore throat followed by grave visceral lesions. In the
first case there was albuminuria, and in the second
paralysis of the lower extremities and retention of urine.
From a study of the cases he concludes as follows : r.
Simple catarrhal sore-throat may be followed by grave
phenomena, such as albuminuria or paralysis. 2. It
seems to be in some cases the manifestation of miasmatic
poisoning. 3. The paralysis is the result of a direct and
specific action of the virus, upon which depends also the
sore throat, and is not, as claimed by some, due to weak-
ness following acute disease.
376
THE MEDICAL RECORD.
[October 6, 1883.
^ro0vcsB ctt ^XcdicnX .Science.
Croton-Chloral in the Treatjient of Pertussis.
— In a paper read before the Kentucky State .\[edical
Societ\' [American Practitioner, August, 1883), Dr. W.
C. ^Vebb speaks very highly of croton-chloral in whoop-
ing-cough. He has treated a large number of cases with
this remedy, and claims to have obtained a cure in nearly
every instance within two weeks. The drug must be
given in large and continued doses to obtain the best re-
sults. To a child one year old he gives one grain of
croton-chloral every four hours. Children from ten to
twelve years of age will bear two grains at a dose. After
the lirst week the cough is generally so much improved
that the remedy may be given less frequently. It is, of
course, necessary to watch carefully the efiects of the
drug, so as to avoid the production of toxic symptoms.
Intestinal Obstruction caused by a Calculus. —
Dr. Magnin relates in the Journal de M'edecine et de
Chiriirgie Pratiques, for August, 1883, the case of a
lady who, for several days, had suffered from obstinate
constipation, and complained of violent pain in the ab-
domen. Purgatives of various kinds were administered,
during five days, without efiect, except to induce bilious
vomiting and increased pain. At the end of this time
the obstruction was relieved by the passage of a calculus
the size of a duck's egg, of ovoid shape, and rough on its
surface. The composition of the mass was the same as
that of biliary calculi.
Tre.^tment of Warts by Calcined Magnesia. —
Various contributors to recent French periodicals have
been relating their experiences in the treatment of warts
by the internal administration of calcined magnesia.
They all report favorably concerning it. The plan is to
give seven or eight grains of magnesia per diem, and a
cure of the disfigurement is said to be obtained in the
course of one or two months. Dr. Lucas Chami^ionniere
{Journ. de Mcd.ct dc Chir. /'nz/., August, 1883) suggests
the trial of this same remedy in the case of epithelioma,
and thinks that^ possibly we might obtain equally favor-
able results in this affection also.
Reflex Paraplegia. — Dr. Thomas Oliver relates, in
the Liverpool Medico-Chirurgical /'ourna! {or July, 1883,
two cases of paraplegia associated with morbid conditions
of the genito-urinary apparatus, which would seem to be
confirmatory of the theory of the reflex nature of paralysis
in certain cases. The first patient was a man, forty-six
years of age, of temperate habits, and without any his-
tory of venereal disease. He was working one day in a
garden, when he suddenly experienced a severe pain in
the back, which became so intense that he started for
home. Before proceeding far, however, he began to
stagger and soon lost all power in his legs. A fortnight
later he was brought to the infirmary in a condition of
complete paraplegia. He still complained of pain in the
back, and at night there was subsultus tendinum, during
which the pain was .more severe. There was difficulty in
passing water, and the flow would sometimes be suddenly
arrested. Exploration of the bladder with a sound gave
negative results. The urine contained a iiuantity of pus,
and on a few occasions he passed a little blood. There
was no rigidity of the muscles, and the plantar and patel-
lar reflexes were normal. A localized area ofdulness,
extending from the eleventh rib to the crest of the ilium
was detected, which was also extremely painful on press-
ure. A renal calculus was suspected, and a long needle
passed into the right kidney came in contact with a hard
gritty substance. Under the influence of rest and
remedies administered for the relief of pain, the patient
recovered the full use of his limbs, and has remained
well. The second case was that of a lady, twenty-eight
years of age, who had comijletely lost ail power in her
legs. Sensation was normal, and there was no muscular
rigidity. Vaginal examination revealed the existence of
retroflexion of a heavy uterus, the lifting up of which was
painful. As she had not menstruated for three months
there was a possibility of pregnancy. Complete return
of power in the limbs followed treatment of the uterine
condition. The loss of power was stated not to be
hysterical. Dr. Oliver concludes, from a study of these
and other similar cases, that (jaralysis may be purely reflex
in character, and he thinks that the term reflex paraplegia
should be retained in our classification of diseases.
Cardi.\c Ectopia. — Considerable interest was mani-
fested at a recent se'ance of the Academie de Medecine
of Paris, by the exhibition of a case of pregnancy at the
ninth month, by M. Tarnier. The woman was a secun-
dipara, and the sternum was bifurcated at the lower part,
so that the beats of the heart were seen to take place
immediately beneath the skin of the epigastric region.
It was stated that the ventricular part of the heart could
be seized between the fingers ; by palpation over the
upper part of the notch the contractions of the auricles
could be detected. Apparently the diaphragm does not
exist at the site in question. M. Marey said that this
specimen of teratology would no doubt permit a verifica-
tion in man of observations made upon the heart of
animals. M. Beau had explained the beat of the heart
as due to dilatation under the influence of the afflux of
blood at the time of the ventricular systole. According
to him the apex of the heart contracts during the diastole.
In the case of ectopia, on the contrary, it was easy to
perceive that the ventricle was soft during the diastole
and hard during the systole ; in the latter period the
apex of the heart strikes the thoracic wall. — London
Lancet.
Surgical Intervention in Tumors of the Blad-
der.— In a memoir read before the Societe de Chirurgie
of Paris {La France Medicale, August 4, 1883), Dr.
Bazy sums up the indications for operation in vesical
tumors, as follows: i, in the case of a pediculated
tumor, an operation is justifiable whatever the functional
troubles may be ; 2, when the tumor is sessile, an oper-
ation should be deferred until functional troubles present
themselves ; 3. when the sufl'ering is intense, and death
is inevitable from the results of pain and hemorrhage,
entire ablation of the organ should be practised, a hypo-
gastric fistula being formed. The contra-indications are
classed under four heads : i, the generalization of the
neoplasm , 2, close adhesions to other organs — the most
that could be done in such case would be the establish-
ment of a permanent fistula ; 3, diffuse infiltration of
the walls of the bladder by the new growth — in such a
case a fistula, if established, would be speedily closed by
the neoplasm ; 4, acute nephritis or advanced secondary
degeneration of the kidneys. A commencing lesion of
slight extent might be arrested by operation upon the
bladder. The best mode of operating, the author thinks,
is by hypogastric section. This gives a large opening
into the bladder, is seldom followed by anv immediate
evil results, and is the most convenient location in which
to establish a permanent fistula. Hemorrhage is at first
a little abundant, but it cjuickly ceases. Extravasation
of urine is not to be feared, but of course, free drainage
should always be provided for. Perineal section is much
less suitable, except in a very small proportion of cases.
Parosteal Sarcoma of the Radius. — The follow-
ing case is related by Mr. Henry T. Butlin in The Lancet
for August II, 1883 : A strong, healtiiy-looking man was
admitted to hospital on April 8, 1882. On the radial
side of the left forearm, about midway between the elbow
and the wrist, was a tumor as large as a small fist, but
lobed and elongated. It presented toward the frsnt, as
well as on the outer side. The tumor was tense, fluctu-
ating on the outer side, but firm toward the front ; the
skin covering it was stretched, but not discolored. In
the axilla was one enlarged gland about the size of a
October 6, 1883.]
THE MEDICAL RECORD.
zn
small nut. The man said that for four months he had
been conscious of the presence of a lump in the forearm ;
but it had grown very slowly, and without pain, and
therefore had not prevented him from pursuing his occu-
pation, until about six o'clock on the previous evening,
when suddenly, without warning and without any evident
cause, it began to enlarge, and in less than half an hour
had doubled its previous size. The enlargement was ac-
companied with excessive pain, which at once rendered
him incapable of continuing his woik, and compelled him
to seek advice. The diagnosis was sarcoma of the radius,
probably subperiosteal, which had enlarged from sudden
hemorrhage. He was put to bed, the arm laid on a
rest, and cooling lotions were applied. But the pain
continuing unabated, it was decided to operate. An
Esmarch's bandage was applied, and then a free incision
was made into the tumor. A large quantity of clotted
blood was turned out, but the bone, contrary to expecta-
tion, was nowhere bare. It was decided, in spite of the
apparently malignant character of the tumor, not to am-
putate, but to scoop out the new growth and endeavor
to save the limb. This attempt was successful, and
though two small recurrent tumors have since been re-
moved from the cicatrix, the patient has a useful arm,
and has remained ffee from any apiiearance of the disease
in other parts. IVficroscopical examination showed the
tumor to be a spindle-celled sarcoma. Mr. Butlin
thinks that a parosteal sarcoma is much less malignant
than a subperiosteal tumor of the same nature, and he
regards the attempt to save the member in such cases as
certainly advisable.
Adonis Vernalis as a Heart-Tonic and Diuretic.
— This plant has been for a long time in use in Southern
Russia as a popular remedy in the treatment of dropsy,
but has not hitherto been submitted to scientific investi-
gations made with a view to determine its physiological
and therapeutical action. Professor Botkin has recently
employed it extensively in his clinic at St. Petersburg,
and Dr. Bubnoft presents a report of the results obtained
(^AUgemeine AlediiiniscJie Central-Zeititng, July 28, iSSj).
It was found to be of value in those cases of dropsy only
in which there was pre-existing cardiac disease. After
the administration of adonis vernalis the heart-beats were
much strengthened, the size of the organ was diminished,
and its tones were much louder. The systolic nuirmur
of aortic stenosis especially was intensified. The heart's
rhythm became more regular, and the pulse slower and
fuller. The daily excretion of urine was increased largely,
sometimes rising from ten or twelve ounces to eighty or
ninety ounces in the twenty-four hours. In cases in which
there was no actual lesion of the kidneys the albumen
and casts disappeared. The subsidence of cedema w-ent
hand-in-hand with the increase in the amount of urine
excreted, and at the same time the secondary symptoms
depending upon cedenia of various organs disappeared.
The patients expressed themselves as feeling much bet-
ter. The remedy was given in an infusion of the strength
of 3 j. to 3 vj., to which two drops of oil of peppermint
were added. The dose of this infusion was a tablespoon-
ful every two hours.
A Dynamic Theory of Cholera. — Dr. John Chap-
man writes to the Journal de Medecine de Paris, of Au-
gust 25, 1883, giving his views concerning the nature
and treatment of cholera. He regards the disease as
consisting essentially in hyperemia of the spinal cord
and sympathetic nervous system, upon which condition
depend all the phenomena observed prior to the stage of
reaction. His treatment consists in the application of
heat to the entire surface of the body, while at the same
time an ice-bag is applied along the spinal column. This
application is continued as long as the symptoms of the
algide stage (vomiting, intestmal discharges, and cramps)
persist. The reaction sometimes becomes excessive, and
then it is necessary to remove the ice-bags and apply
heat to a part or the whole of the spine. He had an
opportunity, during the cholera epidemic in Southamp-
ton in 1865, to test his method in several cases of more
than average severity, and claims to have met with more
than the average success. He advances the following
conclusions as embodying his convictions : i. Although
in exceptional cases cholera may present itself associated
with blood-poisoning, it is not, as a rule, the result of
this poisoning. 2. No proof has ever been forthcoming
of the existence of a cholera poison, and there are strong
reasons for believing that it exists only in the imagination
of certain pathologists. 3. The existence of the so-called
" cholera germs " is equally hypothetical. 4. Cholera
does not travel from country to country. 5. The disease
is produced de novo wherever certain determining con-
ditions exist. 6. There are the strongest reasons for be-
lieving that cholera is neither infectious nor contagious.
(The author admits, however, that the infiuence exciting
the disease, in the centres of a cholera epidemic, may
be felt by those who are not actually attacked. And,
furthermore, since this influence renders all those within
its sphere susceptible, the emanations from cholera pa-
tients, as well as all other impure and unhealthy emana-
tions, may act as exciting causes.) 7. International
regulations, by means of which various governments en-
deavor to resist the invasion of cholera, are of no avail ;
while the development and continuation of the disease
are, in all probability, often favored by the restraint im-
posed by useless, and consequently unjustifiable, quaran-
tine laws. 8. Although the exciting causes of the scourge
are numerous and varied, cholera is essentially, invari-
ably, and exclusively a phenomenon dependent upon
abnormal excitation of the nervous system. 9. The chief
element of a rational treatment of cholera consists in
exercising a powerful and essentially sedative influence
at once uiion the sympathetic nervous centres apd the
spinal cord.
Chloroform Internally Administered. — This an-
assthetic has enjoyed some repute of late in France as a
remedy for the relief of pain when internally administered.
It is prepared for this purpose in the following way :
A flask is about three-fourths filled with distilled water
and an indefinite quantity of chloroform added. It is
then thoroughly shaken at frequent intervals for about
an hour and then set aside. When the upper part of the
mixture becomes perfectly clear it is decanted from the
cloudy deposit formed by the excess of chloroform at ihe
bottom. This " water of chloroform " is of the strength
of about nine parts per thousand. Diluted with an equal
amount of distilled water it has a most happy effect in
the pain or nausea attending the process of digestion in
dilatation of the stomach. Dr. de Beurmann recommends
it also in pain accompanying organic disease of the stom-
ach, in nervous vomiting, and in the vomiting of preg-
nancy. It is of rather agreeable flavor, and may be ad-
vantageously employed in combination with orange-water
as a vehicle for the solution of chloral and other hypnotics,
and also of salicylate of soda. At ordinary temperatures
it is a stable prepa'ratiou, and uninfluenced by the action
of light. — La France Medicate, August 28, 1883.
Treatment of Croup by Sulphide of Calcium. —
In a communication read before the Medical Society of
Rheims {Union Mcdicale du Nor d- Est, August 15, 1883),
Dr. Meunier reported upon a number of cases of croup
treated by sulphide of calcium in doses of three to four
and one-half grains per diem. The remedy was given in
granules of one-tenth of a grain each, one or two gran-
ules every hour. The author regards the sulphides as of
great value in the treatment of diphtheria and croup,
while not being, strictly speaking, antidotal to the specific
poison of this disease. Their mode of elimination, in
great part by the pulmonary mucous membrane, is a
further recommendation for their use. Dr. Meunier's suc-
cess in the cases recorded was not startling, yet was such
as to warrant further trial of the sulphide of calcium in
this disease.
;78
THE MEDICAL RECORD.
[October 6, 1883.
The Medical Record
A Weekly yournal of Medicine and Sjirgery.
GEORGE F. SHRADY, A.M., M.D., Editor.
Published by
WM. WOOD &. Co., Nos. 56 and 58 Lafayette Place.
New York, October 6, 1883.
IDIOPATHIC ANAEMIA OF ADDISON.
It is now almost thirty years since Addison first described
idiopathic ana?mia, or, as it has been called since the ap-
pearance of Biermer's paper, in 1871, progressive per-
nicious anaamia. F.ven at that time, with only one case,
its clinical characteristics, its course, termination, and
post-mortem appearances were so accurately described
that we may accept his description as true to the life
to-day. True, up to the time of Addison's description
(1S55) seven cases of an unknown and undiagnosed dis-
ease had been partially described, but it>is to the great
physician of Guy's that we are indebted for much that
we know of its clinical history.
A most interesting and instructive paper on this sub-
ject now appears in "Guy's Hospital Reports ' (vol. xli.,
1S83), by Dr. P. H. Pye-Sniith, in which he gives the
complete clinical history of a case coming under his care
at the hospital, with tables of all recorded cases up to
the time of the writing. The case reported by Dr. Pye-
Smith lived almost a year after entering the hospital.
The patient, a male, had noticed an alteration in his
complexion about a year before that time, and almost at
the' same time his skin became covered by little blisters,
similar to those produced by stinging-nettles, which pro-
duced Itching and stinging. Dyspeptic attacks, to which
he had been subject, became more frequent, and soon
the well-known symptoms of the disease became well
marked. These, as is well known, are a pallid, yellowish
skin — warm, moist, and soft, with the veins showing
clearly through it on the extremities ; white, pearly con-
junctiva ; pale, sodden, flabby tongue ; great paleness
of the oral and buccal mucous menibrane ; breathless-
ness on exertion ; cardiac murmurs, generally systolic,
bruits being also heard over the axillary, carotid, femoral,
and subclavian arteries, sometimes over smaller vessels,
and, as a rule, a bruit de diabU is heard over the cervical
region. Hemorrhages into the retina, though sometimes
found, are not constant. When they do occur they are
usually very small, and very numerous. The ])ulse is
rapid at the onset, not unfrequently dicrotic, full in the
early stages, collapsing, and compressible ; and the tem-
jierature one or two degrees above normal, though when
death is imminent it may sink to 95° Fahr.
The examination of the blood, however, furnishes, we
may say, the most important clinical symi)tom. The
hremal unit is markedly decreased, as was well shown in
the case reported, in which it was 38.4, being only a
little more than one-third of the normal. This propor-
tion gradually, in some cases rapidly, decreases. The
blood has a pale, thin, watery appearance, and is very
transparent; the coloring matter being reduced in some
cases to only twenty-five per cent, of normal, and the
proportion of red corpuscles may fall below one-eighth,
and when examined they are seen to have lost their
spherical shajie in many instances, are often crenated,
and the coloring matter is irregularly collected either in
the middle of the corpuscle, or eccentrically, and the
tendency to form rouleaux is absent. There are various
other and more rare minor symptoms, such as epistaxis,
vomiting, etc., and there may be anorexia, though this
last is by no means general.
Some of these will be recognized as symptoms occur-
ring in every case of annemia. There is breathlessness
on exertion because the red corpuscles — the carriers of
oxygen to the tissues — are diminished ; and muscular
weakness affecting both the voluntary and involuntary
muscles from the same cause ; coldness of the feet ; pas-
sive exudations : and paleness resulting from the loss or
decrease of hiumoglobin, with functional murmurs in the
heart and great vessels ; and fatty degeneration of the
organs from deprivation of nutrition. It is, however, be-
yond our scope at present to enter into a consideration
of the various annemire which may result either from loss
of the normal constituents of the blood from an apjireci-
able and known cause, or from a diminished increase of
blood-forming material, or from an increased destruc-
tion of formed elements. Two atiections are now recog-
nized which are not dependent upon any of these causes,
but idiopathic or pernicious anemia, and chlorosis, though
having these points in common, are so diff'erent that it is
unnecessary to enter into a ditferential diagnosis in this
place.
Dr. Pye-Smith conveniently classifies auccmia under
three heads : i, Those cases which are secondary and
symptomatic ; 2, cases associated with diseases of the
cystogenic organs, whether or not lucnsmic ; and 3,
idiopathic, primary, or essential anasmia without any
symptoms during life, and without any lesions after death
which cannot be explained as directly due to anaemia.
From the first group of cases idiopathic anajniia is dis-
tinguished by its' severity, malignant character, retinal
and other ecchymoses, and by the increased temperature
and almost invariably fatal result ; and from the second
by the absence of luc;cmia, the structural changes in the
red corpuscles, and the absence of any especial enlarge-
ment of the spleen, or lymph-glands. Though our knowl-
edge of the pathology of idiopathic anajmia is not suffi-
cient to enable us to explain it, we believe that we are
authorized in holding that it depends upon a too rapid
and extensive destruction of red blood-corpuscles. Cer-
tain it is, that we have the evidence of this destruction
and increase of pigment in the deep color of the urine,
in the yellow tint of the skin, and in the saturated tint
of the fat and muscles, the occasional pigmentation of
the serous membranes, and possibly, also, in the excess
of iron sometimes detected in the viscera, which it is
suggested may be derived from broken-down hemo-
globin ; it is possible, however, that it may be due to the
ingestion of iron as medicine.
Age, sex, and occupation seem to be of but little
October 6, 1883.]
THE MEDICAL RECORD.
379
moment in the etiology of this affection ; it is rather
more frequent in earlier adult life, seems to be about
equally common in males and females, and is probably
more frequently seen in the lower classes, and outside of
large cities. The fact that it sometimes comes on with-
out any assignable cause, not only renders its etiology
and pathology obscure, but makes it doubtful whetlier
the sometimes detailed states, as dyspepsia, pregnancy,
privation, and various discharges, are to be regarded as
more than coincidences, though Coupland, in thirty-one
cases, assigns pregnancy and the puerperal state as the
cause in twenty cases, and the remaining eleven to priva-
tion.
As before stated, the evidence furnished by an exam-
ination of the blood is especially valuable. As regards
the white corpuscles, they are, as stated by Wilks so
early as 1857, not materially increased. Occasionally
the)- may seem to be present in larger than normal (]uan-
tity, but this is only due to a transient leucocytosis,
and in several cases the number has seemed even to be
diminished. The red corpuscles, however, may be enor-
mously decreased — are always, in fact, much below
normal, and are pale. The pale, watery condition of
the blood, therefore, is due not only to the diminished
number of red corpuscles, but probably also to a seem-
ing deficiency of hemoglobin. As regards this point
there seems to be a difference of opinion. Dr. F. Will-
cox states {Practitioner, August, 1883) that the hemo-
globin value is largely increased, and Hayem found in
one case that though the color of the blood was dimin-
ished from a normal of one hundred to ten, the number
of corpuscles was only about one-tenth, so that there was
no diminution of hemoglobin in each corpuscle. The
size of the red blood-disks is, however, largely increased,
as stated by Eichhorst, Kohler, and Willcox, sometimes
being so high as 9 nmi. and even 12 mm. This is a
valuable ponit in the diagnosis between idiopathic
anemia and chlorosis, if it be a constant condition, for
although a few giant disks are seen in chlorotic blood,
the average size is markedly diminished. In making the
diagnosis, then, of idiopathic anenna we cannot do
better than quote Dr. Pye-Smith, who gives its charac-
ters as : I, Absence of organic disease and of any recog-
nized and sufficient cause of anemia ; 2, absence of
uterine and ovarian complications ; 3, severe and in-
gravescent anemia ; 4, irregular and occasional pyrexia ;
5, retinal hemorrhage ; 6, diminution of red blood-disks
without iucemia, and presence of small, deeply colored,
red corpuscles ; 7, maintenance of adipose tissue.
The treatment of pernicious anemia, though by no
means gratifying, or as yet well determined, is not en-
tirely futile, for cases do recover. Pye-Smith records
twenty recoveries out of one hundred and thirty col-
lected cases. Imprimis, it may be stated that iron is of
no value in these cases. Though it is a necessary con-
stituent of the blood-coloring matter, it cannot increase
the number of the corpuscles, and in this disease we have
reason for asserting that the addition of younger red cor-
puscles is almost entirely suspended. According to Will-
cox, it seems that iron not only does no good, but is actu-
ally harmful by irritating the stomach and causing vomit-
ing. In this form of anemia we must, at present, accept
one of two theories ; either that the power of corpuscle
formation is suspended, or almost entirely abolished ; or
that the young corpuscles, if formed, have little or no
power to absorb hemoglobin, and consequently do not
reach their full develoimient, and the concentration of
the coloring matter in a few large corpuscles, as claimed
by Willcox, may be due to a compensatory process by
which oxygenation of the tissues may still be carried on,
even with the great numerical reduction of the corpus-
cles. The end and aim of all treatment in these cases
is to increase the number of corpuscles, and since the
administration of iron cannot accomplish this, theoretical
and clinical reasons are against it. Arsenic, however,
may and does, in many cases, produce not only an in-
creased number of red corpuscles, but improves the
general symptoms. Though, as a matter of course, we
cannot suppose that iron is a specific for the disease,
some excellent results have been obtained by its admin-
istration. This and transfusion, with careful diet, seem
to ofter the only hope for the subjects of idiopathic
anemia. Quincke recommends transfusion into the
radial artery, but we do not see that arterial transfusion
is at present to be preferred, except that there is less
danger of introducing air than when a vein is opened.
Five cases have had recovery follow transfusion, and ar-
senic has given still better results, though oftener used.
THE MIDWIFE AND HER RELATION TO THE PHYSICIAN.
The recent efforts made to legalize a State Board of
Examiners for the medical schools, together with the
prompt recognition and suppression by the County Med-
ical Society of quackery in this city, has awakened an
interest in medical education and legislation that bids
fair to elevate the professional standard.
Coincident with this a movement is rapidly spreading
among the larger cities throughout the country for the
employment of intelligent women as nurses for the sick
and to attend women in labor. It may be traced in jsart
to the growing demand for opening a new field and of-
fering women of the better classes increased facilities for
self-support, but chiefly to recent advances in medical
and surgical practice, which require nicer care and closer
observation of the sick than untrained helpers can give.
To supply these needs, "training schools" for nurses
have been established in connection with certain of the
larger general hospitals; while in this city a "College of
Midwifery" has been recently organized.
The author of this paper desires to call the attention
of the profession to this matter, so that the proper rela-
tion of the midwife to the physician may be determined.
The time has come when the profession must concede to
the midwife a legitimate place in the coninumity. A
writer, in the New York Medical Journal of April i4th^
of an editorial on this subject, says : " With the continued
immigration constantly going on, there are now thousands
of poor women who, if compelled to make the choice be-
tween the attendance of a medical practitioner and a re-
sort to some public charity, would find themselves under
the necessity of adopting the latter expedient. Most of
the midwives in the United States are of foreign birth
and training, if they can be said to have been trained at
all, and their ways do not commend them to people of
American birth. Hence many a woman that could have
;8o
THE MEDICAL RECORD.
[October 6, 1883.
afforded her services has shrunk from the experiment
and become a burden on the community. With proper
facilities for their education, and special legislation to
protect them, there is no reason why a class of intelli-
gent, well-educated American midwives should not arise
amongst us. The result of such a change cannot but
prove conducive to the welfare of all concerned. Mem-
bers of the profession who, for one reason or another,
practise obstetrics for fees utterly out of proportion to
the value of the services rendered, will not suffer to any
great extent by the establishment of a class of trained mid-
wives ; for the latter will draw their support rather from
those who now pay no fee at all than from those who are
able to employ even the humblest practitioner of medi-
cine." That the writer's views are correct no one will
deny ; for further confirmation we can turn to France or
Germany, where the midwife is as essential in the commu-
nity as the curate, the lawyer, and the doctor. Her im-
portance has been recognized, and, in order that her
calling may be protected against the invasion of unquali-
fied women, the State erects a legal barrier in the sliape
of a strict examination. If midwives in the United
States were what they should be, or what they are com-
pelled to be in Germany, tliere would be no need of any
special legislative enactment; but unfortunately they are
not. They are as a rule ignorant, and, worse than all,
their ignorance is fearless ; the evil done by their mal-
practice is beyond comprehension. Any physician who
makes a speciality of obstetrics and diseases of women,
and even one whose practice is not extensive in this di-
rection, will be able to relate many cases where, through
the brutish ignorance and stupidity of some midwife, a
woman or her child, perhaps both, have died, to say
nothing of the many uterine diseases traceable to her
mismanagement.
Recognizing these facts, it is time that the profession
should make some effort to elevate the midwife to her
proper position in the community. It is not necessary to
lay open the entire tield of obstetrics to the midwife. On
the contrary, her practice should be strictly limited ; the
knowledge imparted serving to indicate to her not only
how to manage a normal labor, but above all when to
send for a physician, and what to do pending his arrival.
Thus instructed, with proper legislation io protect the
people from incompetency, the midwife's relation to
the physician would be established, and her position in
the conmuinity made useful and necessarv. ^
AX INSIDE VIEW OF A COUNTY MEDICAL SOCIETY.
We have received from a correspondent in Pittsburgh,
Pa., a letter giving a very dolorous account of the state
of medical affairs in that city. We are unfortunately
compelled to believe that tlie recital is very little exag-
gerated. The Allegheny County Medical Society is, we
are told, in regular affiliation with the State and national
associations, yet it contains many members who do most
questionable acts, still professing adherence to the Code.
Says our correspondent : " One of our 'jjopular' mem-
bers advertised for a year in the daily press that he had
resumed the practice of his profession, while some phy-
sicians were not aware that he had ever quit it volun-
tarily. And again for the past year he has been adver-
tising as giving ' special attention to diseases of the eye,
ear, nose, and throat.' Another member, who has been
abroad, upon his return requested the press to announce
the fact with certain additions as a matter of news.
"For several months an advertisement of two lines has
met my eye, to the effect that a physician, who has been
abroad, has reopened his office. And I am told that one
of our specialists, who has a private hospital, has been so
unsuccessful in his operations as to have acquired for it
the name of ' Pittsburgh Abattoir,' in spite of all his self-
laudation.
" As to boasting of cures and remedies, a thing pro-
scribed by the Code, it is far too common to hear mem-
bers of our society not alone boast, but even intimate
that they 'know it all,' and that other physicians are
unfit to treat certain cases.
"Certain of our members keep selected formuls at
favored drug stores, and write for ' my mixture,' etc., and,
it is reasonable to think, exact percentages of those drug-
gists. In one instance, a pharmacist informed me that |
having received a prescription for 'my application No. i;'
called upon the doctor (who has held many offices in the
society) to find out what ' No. i ' meant, and was impo- ■
litely told that 'if he didn't know,, he'd better take it to
•, who did know.'
" Some old physicians attend families by the year, at
ten dollars per head — a practice most unjust to young
physicians, undignified and abominable. There are in
our society ' no-diploma fellows ' and eclectics. One
member, I am reliably informed, practises 'both systems,'
regular and homceopathic. And others examine in lunacy
cases on the same commission with homoeopaths, sign
the same certificate, and justify themselves by saying,
' That's all right ; it's not a consultation.' But it is pro-
fessional association.
" I tell you truly, sir, there are quacks in our county
society, and the thin veil of the Code cannot shield them.
But since the death of the revered Dr. James King, there
seems to b5 not a man in it with stamina to point them
out. .-^nd, to our disgrace be it said, many bright
practitioners, desiring not the association of such men,
are not members of the society ; and some others who
are, contemi)late resigning, the only link that holds them
being the fact that membership here is compulsory lo
membership in State and national societies. To belong
to our society is no lionor. In this county a code should
be individual."
Our correspondent further states that a project is on
foot to start a medical college in Pittsburgh, and he de-
plores the consequences of such an undertaking. "The
Pittsburgh profession," he writes, " is now sadly over-
crowded. There is not a man in this whole community
affluent through the practice of medicine. And many
of us have to struggle for the necessaries of life. I be-
lieve that the American Medical Association, as a matter
of duty to the profession, should cause to be published
widely, systematically, a bulletin to the effect that the
profession is overcrowded everywhere, and to deter as
much as possible further entrance."
The last suggestion of our correspondent reveals the
earnestness of his feelings, which are shared by many
struggling physicians throughout the country. This ques-
tion, however, must be mainly settled by the laws of sup-
ply and demand.
October 6, 1883.]
THE MEDICAL RECORD.
381
THE PRESERVATION OF DEAD BODIES FOR DISSEC-
TION AND OTHER PURPOSES.
-Some recent tests of the various methods of preserving
bodies for dissection and other purposes, have been made
by Surgeon-Major C. Sibthorpe, and reported in the
Iiuliati Medical Gazette. The experiments were carried
on at the Madras Medical College during the winter
session of 1882-83. At this place the thermometer in
the winter season rarely falls below 63° F., and is often
as hish as 72° F. ; hence dissection has been carried on
under great difficulties. But these Mr. Sibthorpe be-
lieves he has overcome. The record of his experi-
ence is as follows :
Two bodies were injected with alcohol ; one of these,
fourteen hours after death, underwent putrefaction so fast
that it had to be rejected ; the other, injected within ten
hours, was under dissection for fourteen days, but not-
withstanding its being kept in a reservoir of alcohol,
the muscles soon lost their color and the tissues sliriv-
elled up.
Three bodies were injected with Wickersheimer's solu-
tion, one of these was under dissection thirty-seven days,
another fifteen, and the third twenty-two. These bodies
had also to be kept in an alcohol bath.
Seven bodies were treated with an injection of boracic
acid and glycerine, which was prepared by boiling one
ounce of the acid into twenty-fuur ounces of glycerine;
about thirteen pints of this being used in each instance.
This solution no doubt preserved the bodies to a certain
extent, portions of one being twenty-six days under dis-
section. In two instances it did not arrest decomposi-
tion, and in most cases decomposition set in early in the
internal organs.
Finally, by far the most satisfactory results were
obtained by following the method first described by
Mr. Howse {Guy's Hospital Reports, vol. xvii., p. 465).
This consists in injecting a saturated solution of
arsenic followed up by the free use of glycerine, which
latter Howse considers the preservative fluid, using the
former for the purpose of preventing the generation of
maggots and fungi.
In making the preparation the glycerine is heated
to boiling-point, when it will take up a large quantity
of arsenic. One pound to a quart was found sufficient.
About one quart and a half of the solution is first
injected, and this injection should be made very soon
after death. Then, in twenty-four hours, one or two
gallons of glycerine are used to complete the process.
Twenty-two bodies, embalmed by this process, continued
in a good state of preservation for twenty-seven days,
and might have been kept longer. No maggots or flies
appeared, no decomposition took place, the muscles
preserved their red color, there was but little odor, and
no dissecting-wounds occurred. Mr. Sibthorj^e believes
that by this method dissecting can now be carried on as
easily and comfortably in warm as in cold climates. The
knowledge of this fact will be appreciated by many of
our medical colleges where late spring or early autumn
sessions are held.
In this connection we may draw attention to a recent
paper by Dr. J. Polak, of Warsaw, who has been study-
ing the same subject. Dr. Polak used first injections
of thymol in glycerine and water, as recouunended by
VirOdtsef, then injections of corrosive sublimate dissolved
in the same substance.
He found, says tlie Lancet, in conunenting on this
paper, that thymol, like sublimate, when used in a suffi-
ciently concentrated form, arrests decomposition of the
whole body by simple injection of the fluid through the
carotid or femoral artery, the corresponding vein being
opened. But he also found that even an advanced
state of decomposition of the limbs was arrested, and
the signs of such decoinposition disappeared under the
use of injections of sublimate, esi)ecially if only spirit
and glycerine and no water were used. The skin be-
came mummified and of a dark brown color, and the
muscles acquired the appearance of smoked ham under
either method, and neither heat nor damp had any de-
teriorating effect. But a much smaller quantity of the
sublimate injection than of the thymol was needed to
produce these results. Moreover, the color of the skin
was longer preserved, and the comparative cheapness of
sublimate renders it, perhaps, preferable. Dr. Polak
points out that the injecting syringes should be of glass,
owing to the action of sublimate on copper. For ordi-
nary anatomical purposes an aqueous solution — i in 300
or I in SCO — is ami)ly sufficient, and is better than chlo-
ride of zinc.
A BLESSING IN DISGUISE.
We have heard it argued in all apparent seriousness that
the human race would have been better off had the medi-
cal profession never existed. It was contended that,
generally speaking, tiie efforts of the physician are di-
lected toward prolonging the lives of the weak, the de-
crepit, and the aged, and thus the race as a whole was
deteriorated. Were there no ph) sicians the weak and
diseased would die, and thus be prevented from trans-
mitting their ills to future generations. But doctors are
a necessary evil, and if the hopes of those who look for
the perfection of the human race rest upon the extinction
of the medical jjrofession, we fear they are doomed to
disappointment. Yet they may find consolation in an-
other quarter. La LLigiene para Todos, of September i,
1883, contains a notice of a small volume written by a
certain Dr. Schwachkopf, upon the benefit to humanity
of the cholera. The learned author proves, by the statis-
tics of the disease during the past ten years, that cholera
attacks only the weak and infirm, the rachitic, the scrofu-
lous, and all those suffering from ills liable to be trans-
mitted to posterity. Looking at the question from this
point of view, he regards cholera as a providential agent
by which the strength and vigor of the race is maintained.
He therefore agrees with the English authorities, though
on somewhat different grounds, in condemning quaran-
tine, the sanitary cordon, and all measures of a like na-
ture. Such measures, he says, are prejudicial to the good
of mankind, they hinder the growth of a robust, clean,
and healthy race, and in so far prepare the way for the
irremediable decadence of nations. " It is to be noted,"
he continues, " that cholera does not remain in the coun-
tries which it visits. As soon as its work of sweeping out
the feeble, the wretched, and the dirty is accomplished, it
passes on. The disease is endemic in India, and to this
fact is to be attributed'the strength and vigor of the Hin-
doos in spite of the misery m which they live." These
!82
THE MEDICAL RECORD.
[October 6, 1883.
views have been disputed by Professor Geistreich, who
says that cholera does not attack the debihtated, but, on
the contrary, carries off the most vigorous of the race.
Notwithstanding tlie differences of opinion between these
learned men, they both agree upon the necessity of keep-
ing the cholera at a distance from the P'atherland. The
one fears that tlie dread disease would carry off" the three
most noble ruins in Germany, the Emperor William, Von
Moltke, and Bismarck ; the other is equally solicitous
about the safety of these three illustrious personages in
the event of a cholera visitation, since he considers them
the strongest and most robust individuals in the nation.
Our esteemed contemporary of Barcelona wonders greatly
at these very original ideas, and seems to have been com-
pletely taken in by the ponderous Teutonic joke of Dr.
Softhead and Professor Strongmind.
THE INJECTION OF ETHEREAL SOLUTION OF IODO-
FORM IN FUNGOID SYNOVITIS.
The treatment of chronic arthritis, and more particularly
of fungous joint disease, as at present practised is, to say
the least, far from satisfactory to either patient or sur-
geon. If, as is by no means improbable, fungoid syno-
vitis is but the first local expression of a commencing
tuberculosis, the importance of a speedy cure is manifest,
even leaving out of consideration the desirability of pre-
serving the integrity of the joint. 15ut to obtain a speedy
cure by the methods of treatment at present in vogue is
impossible. To those believing in the tubercular nature
of these joint aftections, their superficial seat offers great
temptation to try the etlect of local so-called antiseptic
remedies. Many substances have been suggested as
suitable for injection into the diseased joints, and some
of them have been tried with alleged beneficial results.
The late Professor Hueter was an enthusiastic advocate
of intra-articular injections of carbolic acid, but others
who have been led to adopt this method have met
with but indifferent success. More recently Mikulicz
has proposed the injection of a solution of one part of
iodoform to six of sulphuric ether. .Acting upon his sug-
gestion, Drs. Neumann and MUUer, of Karlsruhe, have
treated a number of cases of fungous joint disease by this
method, with, upon the whole, rather encouraging results
[Memorabilie/t, July 16, 1883). The injections were
made at intervals of .''rom four to fourteen days, a Pravaz
syringeful being introduced each time. They were ex-
ceedingly painful, and this was the chief objection to
their use, for though there was some immediate increase
of swelling it soon went down again, and an abscess was
never seen to result. The treatment must, of course, be
begun early in order to obtain the best results. We shall
look for further trials of this method with interest, for
anything that promises to expedite the tedious and exas-
peratingly slow cure of chronic joint disease is worthy of
earnest consideration. The extremely painful nature of
the procedure is certainly a serious disadvantage ; but if
the method is ])roved, on urther experience, to be of
real curative value, this should not militate against its
use. It is probable, also, that some means will be devised
to obviate this irritant action, or some other solvent of
iodoform may be found to be of equal efficacy and at the
same time painless.
itvas 0t tixe "Smcdi.
New Yorr Infant Asylum, Mount Vernon, N. Y.
— It is reported that an epidemic of measles is prevailing
at the country home of this institution, and that the
mortality is unusually large, sixty deaths having oc-
curred within three months in a household of two hun-
dred and twenty.
Yellow Fever. — There were twelve deaths from
yellow fever at Havana during the week ended Septem-
ber 22d. During the week ended September 13th there
were thirteen deaths from yellow fever at Vera Cruz.
Mexican Yellow Fever. — It is proposed to estab-
lish an inland quarantine at Yuma, Arizona, to prevent
the introduction of Mexican yellow fever into the United
States. The fever is reported to be spreading rapidly
upon the Mexican coast, in the vicinity of Guaymas.
Suicide of Physicl-\ns. — Dr. S. Vander Haydon,
of Winfield, L. I., committed suicide on the 15th ult., by
shooting himself. Dr. Vander Haydon had recently ten-
dered his services as surgeon to the French Government,
asking for an appointment with the army at Tonquin.
His application had been accepted.
Dr. R. C. Mullen, of this city, attempted on September
29th to commit suicide by cutting open the right femoral
artery. In this, he failed, and he was taken to St. Vin-
cent's Hospital. Dr. Mullen graduated from Edinburgh
University in 1850, and practised in Michigan for some
time. He had for several weeks shown symptoms of in-
sanity, and had been lodging at station-houses in order
to escape his imaginary foes.
St. Francis Hospital, New York. — At the recent
competitive examination for positions on the house-staff
of St. Francis Hospital, New Y'ork, the fortunate candi-
dates were Dr. T. Theodore Janeway and Dr. J. V.
Kendall.
College of Physicians and Surgeons, New York.
— 'The opening e.xercises of the seventy-seventh session
of this institution took place in the college building, on
Monday evening, October i, 1883, at eight o'clock. The
introductory address was delivered by Professor George
H. Fox, M.D.
American Ac.^de.my of Medicine. — The American
Academy of Medicine will meet in the New York Acad-
emy of Medicine, on Tuesday, October 9th (three
o'clock), and Wednesday, October loth. The address,
by Dr. H. O. Marcy, of Boston, Mass., President, will .
be delivered on Tuesday evening, October 9th, at eight
o'clock, on "The Recent Advances of Sanitary Science;
the Relations of Micro-Organisms to Disease" (illus-
trated by micro-photographs projected upon the screen).
The following papers have been promised for the general
meetings: Dr. L. S. Pilcher, of Brooklyn, N. Y., on
"The Relations of Medical Journalism to Higher Medi-
cal Education in .Vmerica ; " Dr. Traill Green, of Eas-
ton, Pa., on "The Imperfection of Technical Studies as
a Means of .Mental Culture;" Dr. R. S. Sutton, of Pitts-
burg, Pa., on "Cleanliness in Surgery;" Dr. Benjamin
Lee, of Philadelphia, Pa., on "The Value of an Ac-
quaintance with Botany as a Preliminary to the Study of
October 6, 1883.]
THE MEDICAL RECORD.
38-
Medicine;" Dr. Charles Mclntire, of Easton, Pa., "Is
it Fail? A Study of tiie Comparative Political Po-
sition of the Medical Profession in the United States;"
Dr. A. D. Rockwell, of New York, on "The Exact
Value of the Electrolytic Method;" Dr. J. Cheston
Morris, of Philadelphia, Pa., "The Milk Supply in
Large Cities;" Dr. Charles E. Cadwalader, of Philadel-
phia, Pa., "Considerations upon the Public Provi-
sions for the Care of tiie Indigent Insane;" Dr. A. D.
Rockwell, of New York, "The Tate Dr. George M.
Beard — A Sketch." Report of the Committee on Laws
of Medical Practice in the United States and Canada
(Drs. Dunglison and Marcy).
French Reports from the Egyptian Cholera
Commission. — The French, at the first breaking out of
cholera in Egypt, were very furious in denouncing Eng-
land for having allowed the disease to be carried to Egypt
from India.
Recently M. Jules Cuerin announced to the Acade-
mic de Medecine that lie had received reports iVom the
Cholera Commission, in which it was stated very posi-
tively that the cholera was not brought from India but
arose de novo in Egypt.
Obligatory Vaccination in France. — Those inter-
ested in public health have achieved a victory in France.
M. Jules Ferry, the Minister of Public Instruction, has
decided that revaccination shall be made obligatory in
all the colleges and lyceums in France.
Medical Life-Histories. — We have already referred
to the work that Mr. Francis Galton is engaged in, re-
garding the medical and physical history of individuals.
This gentleman has recently announced in the Fort-
7Ughtly Review a plan for obtaining from members of
our profession medical genealogies having the special
aim of tracing the hereditary character both of mental
and bodily qualities. Mr. Galton has already tried the
same plan on a large scale among eminent scientific men,
with very valuable results. The points on which he
wishes information are : race, conditions of life, form
and feature, health and disease, vigor, sensation, artistic
capacities, intellect, and character. He intends to give
^500 in prizes for the best returns, and to publish the
conditions of competition in October ne.xt. The compe-
tition will be open to all medical men. The results of
Mr. tlalton's plan will be watched with great interest.
Dr. Brown-Sequard is a candidate for the seat in
the Academic des Sciences made vacant by the death of
M. Cloquet.
Intern.ational Medical Congress at Amsterdam,
— At this meeting, hekl last month, a number of prominent
medical men, representing Holland, England, Germany,
France, and Scandinavia, were present. The propriety
of holding annually an International Medical Congress
to deal with hygienic questions specially affecting coun-
tries and colonies in the tropical portions of the globe
was also mooted.
Sir Joseph Fayrer, whose long experience in British
India enabled him to speak with the highest authority,
declared that, in his opinion, the colonization of the
plains of tropical countries by Europeans would never
succeed. Alter three generations European families al-
ways died out. Even in the hilly districts of the tropics
it was doubtful whether pure European blood could per-
manently perpetuate itself. Dr. Lewis stated that the
children of English soldiers in India who were brought
up in the hills from five thousand to seven thousand feet
above the sea-level were always more or less unhealthy
and weak in constitution, though if they were sent to
Europe in time they might generally lay the foundations
of robust health.
At the final general meeting, the iiuestion of the founda-
tion of a special school for the training of physicians for
the Colonies in tropical countries was discussed. The
proposal of Professor Vandencoriwt for the establish-
ment of an International Association to deal with the
problem of epidemics was referred to the Special Com-
mittee for further inquiry, with instruction to report the
result to the next Congress, which will be held in the
Hague twelve months hence. The principal members
of this Commission are Professors Vandencorput, De
Chaumont, Lewis, Leroy, De Mericourt, and Da Selva
Amado. — Medical Press and Circular.
The English Cholera Commission. — All the mem-
bers of this commission, except three, have returned to
England.
glcuunus and ITtoticcs,
A Complete Handbook of Treatment. Arranged
as an Alphabetical Index of Diseases to Facilitate
Reference, and containing nearly One Thousand For-
muL-e. By William Aitken, M.D. (Edin.), F.R.S.,
Professor of Pathology in the Army Medical School,
Examiner in Medicine for the Military Medical Ser-
vices of the Queen, etc., etc. i2mo, pp. 444. New
York : Bermingham & Co. 1S82.
This book is a compilation from the last edition of Dr.
Aitken's well-known work on " The Science and Prac-
tice of Medicine," and comprises the chapters on treat-
ment as written by that author. The diseases are ar-
ranged in alphabetical order, with numerous cross
references, whereby the reader is enabled to turn at
once to any desired subject without being obliged to
refer to an index. Under each heading is found a short
definition of the disease, and then follows immediately
the portion on treatment. Dr. Aitken's work is too well
known to require any discussion here. The book before
us is jirinted in clear type, on good paper, and is of a
convenient size for handling.
The Treatment of Wounds : Its Principles and
Practice, General and Special. By Lewis S.
PiLCHER, A.M., M.D., Member of the New York
Surgical Society. With One Hundred and Sixteen
Wood Engravings. Svo, pp. 391. New York : Wm.
Wood & Co. 1883.
This volume, constituting the number for August in
Wood's Library, well sustains the high reputation for
excellence which this series of medical books enjoys.
The entire subject of the treatment of wounds is dis-
cussed in a concise and practical manner, and the lucid
explanations in the text are made still more clear by
numerous well-executed illustrations. The first part of
the work is devoted to a general consideration of wounds
ami their immediate efl'ects, of the physiology of repair
and the character of the influences which are capable of
retarding or perverting reparative action. The subject
of antisepsis is briefly considered, and the mode of ap-
plication of the various antiseptic dressings is described
in detail. In the second part the author treats of spe-
384
THE MEDICAL RECORD.
[October 6, 1883.
cial wounds and wounds of special regions, whether trau-
matic or ijroduced by the knife of the surgeon. In this
part the method of application of the general principles,
enunciated in the preceding chapters, to particular cases
is described. In addition to the table of contents there
is a very complete alphabetical index, by which the
reader is enabled to refer readily to any subject. The
work is eminently practical and thoroughly up with the
times, all the latest methods of treatment of assured
value being treated of in sufficient detail. Especially is
this the case in the chapters on antiseptic treatment, a
department in which the German surgeons have been
notably active. Here we find collected all the most re-
cent modifications as proposed by different operators,
an acquaintance with which was previously to be ob-
tained only by a laborious search through the jteriodical
literature. We cannot but congratulate the readers of
the library on securing so valuable a work as this, which
in itself is worth a large part of the annual subscription
to the series.
The Principles and Practice of Surgery, being a
Treatise on Surgical Diseases and Injuries. By D.
Hayes Agxew, M.D., LL.D., Professor of Surgery in
the Medical Department of the University of Pennsyl-
vania. Vol. iii., 8vo, pp. 784. Philadelphia: J. B.
Lippincott & Co. 1883.
This third volume completes Agnew's Surgery. It is
five years ago since the author commenced his task.
During that period he has not been idle in his leisure
moments. It has evidently been a pleasure to him to
write, considering the faithful and earnest manner in
which he has striven to get the results of his surgical ex-
perience. The work, as a whole, is quite voluminous.
While on general principles we might wish it were less
so, he has nevertheless gi/en us an interesting, instruc-
tive, and exhaustive treatise. We would not undertake
to say how he could curtail it, e.xcept, perhaps, regard-
ing one or two special subjects. But even these are so
admirably presented that we are forced to refrain from
criticism. General surgery is supposed to include every-
thing in the shape of operative treatment of every part of
the body, and in a comprehensive treatise like the one
before us it would probably be a disappointment to
many surgeons if the entire range of subjects were not
discussed. The author is always practical, and from
such a point of view we cannot read too much of him.
Besides, he infuses an individuality in his work which is
highly conuiiendable. Weighing everything according to
the standard of his own exiJerience, he is inclined to be
positive and to the point. This gives to his whole work
true origmality, and makes it proportionately valuable to
the student. The third volume partakes of the general
character of the others, and is consequently an interest-
ing and instructive one. Although appearing to lack
system in its arrangement, we are inclined to believe
that the author adopted the present plan of his last vol-
ume for the purpose of condensing within reasonable
limits all the subjects not previously discussed. But the
mere arrangement is of secondary importance to the sub-
ject matter. Each of the fourteen chapters is complete
in itself, and this is probably all we need to expect un-
der the circumstances. The volume commences with a
discussion of the surgical diseases of the larynx and
trachea, following in turn with sections on diseases and
injuries of the nose and naso-pharyngeal region ; dis-
eases and injuries of the eye and appendages; diseases
and injuries of the ear ; malformations and deformities,
including the domain of ortliopedy ; affections of the
muscles, tendons, burs;e, and aponeuroses ; surgical affec-
tions of the nerves, lymphatic system, skin, and subcuta-
neous connective tissue; syphilis; tumors; diseases of
the mammary glands ; electricity in its application to
surgical therapeutics; operations for nerve-stretching;
and lastly, massage.
Throughout the volume arc scattered a large number
of illustrations — the maiority original — of diseased condi-
tions, surgical apparatus, and surgical instruments. As a
whole these are very well drawn and ]5resent an artistic
appearance. It would be in vain to even enumerate the
various divisions of the different chapters, or even the
different diseases described. It is much easier to ask
one's self the question what is not in the book rather than
what is omitted. But the author is enabled to get over
so much ground by the admirable manner in which he
brings out the salient points of the different diseases and
their treatment. Some, for instance, are treated of in a
few lines, but the reader is made to feel that- this is all
he needs. Other subjects are discussed at greater length,
but are almost invariably accompanied with the author's
idea of what should or should not be done. The rules
of practice laid down are eminently safe and are founded
on common-sense and large experience. Consequently
this volume, with its predecessors, will be abundantly able
to stand on its merits, which are of the highest order and
which will place every purchaser of the set under lasting
obligations to the painstaking and accomplished author.
The volumes will take their place beside the most com-
prehensive, valuable works on surgery in our language,
and withal will remain a credit to American surgery.
A Practical Manual of the Diseases of Children,
WITH A Formulary. By Edward Ellis, M.D., late
Senior Physician to the Victoria Hospital for Sick Chil-
dren ; late Physician to the Samaritan Hospital for
Women and Children, etc. Fourth edition, revised
and enlarged. 8vo, pp. 21 8. New York : Berming-
ham & Co. 1882.
This is a reprint of the latest edition of Dr. Ellis' work
on the "Diseases of Children." As the book is issued
at a low price great pains have been taken to economize
space. The type is small, the lines are not leaded, and
the chapters follow one after the other without any inter-
val. We question whether there is any real economy in
such books, for the injury done to the eyes by reading
several pages of close print without any resting-places of
white more than oft'setts the slight reduction in price
which such an arrangement permits of
The Essentl^ls of Bandaging, with Directions for
Managing Fractures and Dislocations ; for Ad-
MINISTERI.NG EtHER AND CHLOROFORM, AND FOR
Using other Surgical Apparatus, and containing a
chapter on Surgical Landmarks. Illustrated by 136
engravings on wood. By Berkeley Hill, M.B.
Loud., F.R.C.S., etc., etc. P'ifth Edition. Enlarged
and Revised. 8vo, pp. xiii., 341. New York: |. H.
Vail & Co. 1883.
A work, which has so pleased the public as to reach
a fifth edition may be said to have passed almost beyond
the reach of the critic's pen. Besides the essentials of
bandaging, additions have been made which nosv make
Mr. Berkeley Hill's book somewhat of a vade mecum for
the surgical dispensary and surgeon's office. Among the
additions to the fifth edition may be mentioned descrip-
tions of laryngoscopy and ophthalmoscopy, accounts of
Thomas' splints, Croft!s plaster splints, Carr's splints,
and various other improvements in ]Jractical surgery
which cannot fail to be of value to the student.
The explanations of the various bandages and the
methods of appl\ing them, iUustrated by clear and well-
made cuts, the succinct account and rules for the treat-
ment of fractures and dislocations, and the clear descrip-
tion of the surgical landmarks of the body and the useful
ai)pendix giving directions for the treatment of hare-lip,
cleft palate, tajiping, operations for hernia, vesico-vaginal
fistula, and various other operations, make the book the
most useful work of its kind for the student and country
practitioner of which we have any knowledge, while it
will pro\e a valuable addition to the library of the city
surgeon.
October 6, 1883. J
THE MEDICAL RECORD.
38i
'Reports of J>0cictijes.
MEDICAL SOCIETY OF THE COUNTY OF
NEW YORK.
Stated Meeting, September 24, 1883.
David Webster, M.D., President, in the Chair.
Dr. R. E. Swinburne read a paper (see page 373)011
ADENOID vegetations OF THE PHARYNGEAL VAULT AND
THEIR RELATION TO MIDDLE-EAR DISEASE.
Dr. John P. Garrish thought that here, as else-
where, medical men frequently overlooked general symp-
toms and treated the throat and nose as though these
were independent portions of the body. A frequent lo-
cal and e.\citing cause of these troubles in persons pre-
disposed to catarrhal intiamniations was smoking ciga-
rettes. The method of treatment which had given him
the best results was constitutional, consisting in the use
of cod-liver oil, the S)rup of the iodide of iron, and iodide
of potassium, with attention to the general condition,
aided by syringing with some mild astringent or muci-
laginous preparation. He had obtained good results
from the occasional introduction of a bougie and pro-
ducing a certain amount of pressure upon the parts af-
fected.
Dr. F. H. Bosworth said that the more he saw of
throat disease, the more he was convinced the proper
treatment was not in the use of gargles, or sprays, or
washes, but in the employment of such measures as re-
move the organic changes which are the cause of it. In
every case there is organic change in some portion of
the upper air-passages which is the source of the entire
trouble, and he had operated with far more satisfactory
results here than in any other part of the respiratory
tract. He had not used the forceps. He had had some
very bad results from the use of the forceps. He be-
lieved that in the wire snare we have a much more ready
and effectual means than in the forceps. Certainly the
use of the snare is not necessarily painful, and he never
had been obliged to give an anresthetic, except in very
small children. With regard to the galvano-cautery, he
had used it in several cases, and his experience differed
from that of Dr. Swinburne, who says that its use is not
attended by unpleasant results. On the contrary, Dr. B.
knew of no instrument more dangerous in the nose than
the galvano-cautery ; but that it could be used without
unnecessarily burning tissues, Dr. B. believed there was
no doubt. Certainly its use in the anterior nasal cavity
caused pain, and he thought it could not be used at all
without creating intense inflammatory reaction.
Dr. H. H. Curtis said he had removed these growths
with the forceps, the galvano-cautery, and the finger-nail,
and after each of these methods he had seen intense de-
pression follow, like that which occurs not infrequently
after amputation of the uvula. For the removal of the
flat growths which cannot be removed by the wire snare
he resorted to repeated scarifications and spraying the
surface with a saturated solution of iodoform in ether.
To this he added constitutional treatment, especially
iodide of potassium in small doses, sometimes mercu-
rials, and with these measures had obtained his most
satisfactory results.
Dr. O. D. Po.merov thought that a little too much
had been made of these growths since Meyer wrote an
article concerning them about ten years ago. They are
nothing more than enlarged glands, in nearly all cases
the enlargement being due to inflammatory hypertrophy
or proliferation. It is not necessary to always remove
them, for, like the faucial tonsil, they usually disappear
when adult life is reached. So if the existing catarrhal
condition can be removed by ordinary treatment by the
use of spray, which he still continued to have faith in,
he would not remove these growths. Of course, if they
became so large as to act like foreign bodies and obstruct
nasal respiration, they should be removed.
Occasionally these growths encroach upon the Eus-
tachian tube, and he believed that they are a prolific
source of ear trouble. Meyer had referred to one inter-
esting fact, namely, that he succeeded in picking out
twenty cases among two thousand school children in
which he inferred, from a peculiarly sad facial expression
and nasal tones, that there were adenoid vegetations in
the vault of the pharynx. When these symptoms pre-
sent themselves there is no t}uestion about the propriety
of removing the growths. Whenever they obstruct res-
piration certainly they should be removed. With re-
gard to the method of removal, he felt a strong prejudice
against the galvano-cautery, and it seemed to him that
the Jarvis snare was the most efficient means we have.
He had not found it necessary to give ether if the child
is a large one. Dr. Pomeroy thought the weight of
testimony was against removing the growths entirely at
one sitting. The reaction is sometimes serious in char-
acter, and violent inflammation is often developed, which
may extend through the Eustachian tube and produce
severe otitis media. Care should be exercised, when
removing these growths situated near the Eustachian
tube, lest too much tissue be taken away, and a cicatrix
form that may obstruct the entrance to this canal. He
had used the nitrate of silver probe with good results,
but by this method would not remove more than one
growth at a time.
Dr. O. B. Douglas said that if others could use Dr.
Swinburne's instrument as satisfactorily as had the in-
ventor, it certainly would be a boon to the surgeon who
attempted the removal of these growths. He wished to
direct attention to the reflex disturbances produced by
adenoid vegetations in the vault of the pharynx, and re-
lated a case in which the entire trouble jiroduced by
them was referred to the larynx, and when the growths
in the post-nasal region were removed all the symptoms
disappeared, and the voice was restored entirely. He
thought he might dift'er, perhaps, with the author of the
paper concerning the desirability of removing all the
growths at once. At least his experience had been that
too much inflammation follows such an operation, and
therefore he believed it to be desirable to remove only a
portion at one operation.
Dr. Bosworth wished to protest in the strongest
manner possible against the heterodox opinion expressed
by Dr. Pomeroy when he says that unless ear trouble is
present these growths may be allowed to remain. He
wished to say that if these growths are let alone the chil-
dren will have ear trouble, and that it is a most danger-
ous condition to allow to remain in a young person. Un-
doubtedly they will shrivel uj), but shall we wait ten or
fifteen years for this to occur, while during this time per-
haps lasting injury mav be done by them ? He said,
No.
Dr. Pomeroy said he thought he put in a proviso that
if the catarrh is manageable, and the growths are not
troublesome, they may be allowed to remain.
Dr. Bosworth thought that a slight condition of this
kind might produce incurable mischief
Dr. Hoi.combe referred to the former practice of re-
moving tonsils, whereas now only a very few are removed,
and the change had been brought about by the observa-
tion that hypertrophy of the tonsils can be removed
by local applications, and also that there is a tendency for
it to disappear of itself after a while. This had led him
to conclude that many of these adenoid growths can be re-
moved by local applications, and he had used successfully
for that purpose the carbolate of iron, injections of acetic
acid into the body of the growths, etc. He accepted
this method in preference to excision by any means.
Dr. Swinburne said, concerning the reaction follow-
ing the use of the galvano-cautery, that while he did not
think it could be used anywhere in the respiratory pas-
;S6
THE MEDICAL RECORD.
[October 6, 1S83.
sages without producing such reaction, yet inflammatory
reaction which had terminated in any serious trouble he
had not seen. He thought the forceps was not regarded
as the best means of removing these growths unless tlie
palate ean he controlled ; but with the palate, the mouth,
and the patient controlled, the entire growth can be
easily removed, and at once, with the forceps and without
injuring the other jiarts at all, and he had not seen seri-
ous inflammatory reaction follow. The serious inflamma-
tory reaction which others had seen after removal of
these growths he believed was due to the method em-
ployed, or the manner of employing it, and he thought
the objection to their removal at one sitting had no real
foundation. He believed that every case should be
operated upon, because of the liability to the occurrence
of inflammation of the middle ear, caused undoubtedly by
the presence of these growths. He believed that not
only the ear, but the general health is endangered on
account of being obliged to breathe through the mouth.
While these growths, if left to nature, will atrophy more or
less, perhaps in many cases disappear, yet they have been
seen in patients fifty years of age. He had employed
general treatment alone, but had not succeeded in curing
his patients without resorting to local measures.
Dr. O. B. Dougl.^s exhibited
•: A NEW HYPODERMIC .SVRI.VGE,
made by Reynders & Co.. and so arranged that it can be
carried in the pocket with the facility and safety of an
ordinary pocket-knife.
The Society then adjourned.
TRI-STATE MEDICAL SOCIETY OF IXDI.\XA,
KENTUCKY, AND ILLINOIS.
Ninth Annual Meeting, held in Indianapolis, Ind., Sep-
tember 18, 19, and 20, 1883.
(Special Report for The Medical Record.)
The Society met in English's Hall and was called to
order by Dr. J. L. Thompson, Chairman of the Com-
mittee on Programme. A prayer was offered and was
followed by an eloquent address by His F.xcellency,
Albert (J. Porter, Governor of Indiana.
Dr. Thompson then introduced the President, Dr.
WiLLi.AM Porter, of St. Louis, who said that the best
reply to the Governor's eloquent address and to the
salutation of welcome by the morning press was the
three days' work.
the reports of officers and committees
were then heard and accepted. Letters from abroad
were then read by the Secretary : one from Dr. Samuel
CtROSS, emphasizing
THE I.MPORTANCE OF THE TRAINING OF NURSES FOR
TOWNS AND RURAL DISTRICTS,
and one from Dr. L. J. Jones, informing the Convention
of the presence of the distinguished military surgeon, Sir
William MacCormac, at Niagara Falls. Whereupon an
invitation was sent the latter by the meeting, requesting
the honor of his presence at the Tri-State Convention.
A CABLEGRAM,
conveying greetings to the Society from Dr. McKenzie,
of London, who was present at its last annual meeting,
was received.
THE president's ADDRESS
w-as deferred to the first evening session. It was replete
with practical suggestions in relation to the future pros-
perous growth of the Society and inquired what better
superstructure could be built upon the Tri-State as its
foundation walls than the Great \\'estern Medical .Asso-
ciation. The address was referred to a committee, who,
upon submitting its report, recommended a change of
name and an enlargement of the Association's territory.
The name suggested by the committee and finally
adopted by the .Association was
THE MEDICAL SOCIETY OF THE MISSISSIPPI VALLEY.
The name will afford to every mind, American or
European, a definiteness of geographical location and
territory comprised witliin the boundaries of the Associa-
tion.
The territorial limits are marked by great natural
boundaries, the AUeghenies and Rockies, the Gulf and
the Great Lakes.
THE MANNER OF THE ELECTION OF OFFICERS OF THE
ASSOCIATION J
was a subject that came up for discussion. Instead of
the present incumbents appointing their successors, it
was determined that the several members of each State
represented should appoint one member to serve upon a
committee for the election of officers. a
THE OFFICERS ELECTED FOR THE ENSUING YEAR
are as follows : President — Dr. B. N. Griffith, of Spring-
field, 111.; Vice-Presidents— \ix. J. W. Matthews, of
Louisville, Ky. ; Dr. C. G. Commegys, of Cincinnati, O.;
and Dr. J. E. Link, of Terre Haute, Ind.; Secretary-^ ,
Dr. G. W. Burton, of Michell, Ind.; Chairman of the
Committee on Arrangements — Dr. F. L. Matthews, of
Springfield, 111.; Chairman of the Committee on Pro-
gramme— Dr. C. P. Pearson, of Indianapolis, Ind.
It was decided to hold
THE NEXT MEETING OF THE ASSOCL\TION
at Springfield, 111., within two weeks of the middle of
September, 1SS4, the exact date to be given at an early
day.
The names of the Committee on Publication are : Dr.
G. W. Burton, of Michell, Ind.; Dr. \\'m. D. Byrd, of
Quincv, III.; and Dr. H. I. Raymond, of Indianapolis,
Ind.
The programme presented fifty-three papers for read-
ing and discussion before the Society.
TORTICOLLIS,
by Dr. D. S. Booth, of Sparta, 111.
The case related was that of a boy, twelve years of
age, affected with extreme wry-neck, congenital in kind,
not in degree. Subcutaneous tenotomy practised upon
the tendons of the sterno-cleido mastoid and trapezius,
and upon the deep cervical fascia, brought about an ex-
cellent result, and transformed an ugly deformity into
the beauty of symmetry.
TRE.^T.MENT OF COMPOUND FRACTURES,
by Dr. Ap Morgan Vance, of Louisville, Ky.
Shall compound fractures be treated by the open
method, by through drainage, or by occlusion ? If the
wound is closed can the possible formation of pus be
determined before any danger has arisen to the patient ?
Make use of the thermometer as your guide. High
temperature during the first forty-eight hours is not
alarming ; after the second day it betokens pus-forma-
tion. The Doctor's practice was to occlude an ordinary
compound fracture, and then, if pus should form, to es-
tablish drainage.
Dr. Joseph Eastman, of Indianapolis, said : I agree
with the essayist in the belief that compound fractures
may often be reduced to simi)le fractures, but do not
think we could depend upon the thermometer at all
times. I think with Dr. Thomas that the three great
discoveries of medical science within the last century are
vaccination, anaesthesia, and the clinical thermometer.
My experience corroborates that of Dr. Tait, that in
prolonged shock following surgical operations or com-
pound fractures the ])atieiit might go down to death
without the thermometer hanging out the red lantern
signalling danger, but I have never known an instance of
profound shock where the pulse did not beat more and
October 6, 1883. J
THE MEDICAL RECORD.
387
more rapidly until it ceased its pulsations, or until reac-
tion set in. If I resorted to plaster-of-Paris splint for
putting up a compound fracture, I should use the Bava-
rian form, admitting of inspection as often as required.
NERVE-STRETCHING,
by Dr. J. B. Wright, of Olney, 111.
The operation seemed peculiarly adapted to chronic
cases.
Dr. Byrd thought that the rationale of nerve-stretch-
ing in the cure of neuralgias might be explained by
the traction made upon the vertebral end, loosening ad-
hesions and removing thickenings, thus allowing that
part of the nerve-trunk near the vertebral foramen room
for expansion. He laid stress upon the therapeutic
value of extreme flexion of the thigh in sciatic neuralgia.
Dr. R. E. Haughton, of Indianapolis, based his
pathology of neuralgic ))ain upon impaired nutrition of
the nerve, leading to molecular change in its structure.
FR.4CTURE OF OS FRONTIS OF EIGHTEEN VEARS' STAND-
ING,
by Dr. W. S. Havmond, of Indianapolis.
The case cited was that of a woman hit in the forehead
with a stone. Two months afterward had pain in her head
which increased in severity continually. After years of
suffering, an abscess oi^ened in the scalp, and on passing
a probe into the opening of exit of the pus, the frontal
bone imparted to the hand of the surgeon a sensation of
roughness. A depressed fragment, rough, necrosed, and
suppurating, from injury eighteen years previous to the
OS frontis, was removed. It consisted partly of the ex-
ternal and partly of the internal table, and measured
two by three inches. The neuralgia subsided. The ex-
tent of injury, severity of pain, and the duration of the
lesion were remarkable.
Dr. Hobbs, of Knightstown, related a case in which,
owing to a syphilitic necrosis, almost the entire cal-
varium had to be removed at successive operations.
Dr. Eastman drew the lesson that the most desper-
ate cases are worth our best eflbrts, and advocated early
use of the trephine in doubtful cases of head injuries
with untoward symptoms.
Dr. Byrd referred to the use of the trephine in the
cure of ejiilepsy and insanity.
Dr. Thompson had trephined twice in epilepsy at the
time of the war with good results.
Dr. G. V. Woolen, of Indianapolis, said that Dr.
Haymond's results justified the operation. In extreme
cases operate. In simple depression without symptoms
let it alone ; when bad results come, then operate. If
epilepsy, suppuration, and neuralgia supervene, then the
acute symptoms have passed away and no artery will be
found crushed.
Dr. John Comingore said unless the fracture be com-
pound or connninuted, wait. Do not cut down upon a
simple fracture for purpose of diagnosis. In simple frac-
ture with sligiu depression, the brain may accommodate
itself.
.myelitis due to ARSENICAL POISONING,
by Dr. A. W. Brayton, of Indianapolis. Recovery
after ingestion of one ounce of arsenic.
SYPHILITIC INTERSTITIAL KERATITIS,
by Dr. H. M. Post, of St. Louis.
The existence of this disease was established in 1S57,
by Jonathan Hutchinson. The diagnosis of superficial
and interstitial keratitis should be readily differentiated
if we look sharplv at what is before our eyes and use
oblique illumination. In treatment the sheet anchor is
mercury, which is also a tonic in inherited syphilis. If
iritis set in as a complication, forestall adhesions by dila-
tation of the pupil.
Dr. Thompso.n' remarked that at the very inception
of interstitial keratitis what resembled a miniature snow-
flake appeared on the membrane of Desmet. In cases
where the tension is plus, use eserine and maybe also a
double iridectomy will be required. Atropia, if employed
in these instances, may lead to the glaucomatous process.
Dr. Post thought that the indications for atropia or
eserine, as the case might be, was too fine a point to
broach before an association of non-oculists.
Dr. Thompson gave the rule : If tension is plus use
eserine, if minus use atropine. Any one presuming to
jiractise oiihthalmology should be able to tell plus, minus,
and normal tension.
RESECTION AND AMPUTATION : THEIR RELATIVE VALUE,
by Dr. R. E. Haughton. The conditions that decide
between amputation and resection are the situation and
function of the joint, condition of constitution, and con-
dition and nature of the disease. The author of the pa-
per brought forward statistics to prove that excision was
seven times as fatal as amputation in early life. No ex-
cision should be made in extremes of age, nor in phthisis,
in acute disease, or malignant disease of the articular
surfaces. The essayist leaned toward amputation as the
rule. ;
Dr. J. E. Dink, of Terre Haute, advocated resection
of the elbow-joint, even if half the shaft of the humerus
had to be exsected. He declared his belief that preser-
vation of the periosteum has nothing to do with the res-
toration of bone, except keeping open the cavity until
osteal matter forms. In successful transplantation ot
periosteum, medullary matter has been removed.
Dr. Link also advocated resection at the ankle-joint as
preferable to amputation above. As to the knee-joint,
he was not quite clear which alternative he should adopt.
Dr. Eastman said that recent statistics show that re-
section at the knee-joint is much more favorable than
amputation. And why should it not be so, when in am-
putation so much tissue and the large artery and nerves
of the popliteal space have to be severed, whereas in re-
section, by the use of the curvilinear instead of the H
incision, not even the articular arteries need be wounded.
In one resection at the knee-joint he had not used a sin-
gle ligature.
Dr. Thompson remarked upon the numerous sinuses
that are apt to form after resection at the knee. In his
army experience amputation at the shoulder did better
than resection of that joint ; but army statistics, he
thought, did not usually go far enough.
Dr. French, of Missouri, thought that the dangers of
resections had been magnified, but that due discrimina-
tion should be used in the selection of cases.
Dr. Byrd counted it his misfortune to have seen so
many resections in English hospitals, some for extra-ar-
ticular trouble ! All got well 1
Dr. Comingore leaned in favor of excision of joints
at the time of the war, but thought each case must be
treated upon its own merits.
Dr. Haughton challenged any to refute the statis-
tics of Bryant and MacCormac given in his paper. Lon-
don surgeons were becoming opposed to resections.
physiology and pathology of insanity,
by Dr. N. Field, of Jeflersonville.
The brain was an entity. Its pathology should be sim-
ple. Take a common-sense, rational view of any case
in court, and do not allow the lawyers to perplex you by
their artifices.
Then followed two papers on
some mental problems in questions of medical
jurisprudence,
by Dr. C. G. Commegys, of Cincinnati, and
insanity,
by Dr. Hays, of Chicago.
Dr. Hays said the negative character of insanity (nega-
tion of sanity) should be kept in mind. No verbal defi-
nition was possible, because a negation cannot possibly
be defined in positive terms. In idiots the proper treat-
588
THE MEDICAL RECORD.
[October 6, iSS^
ment was the education of the perceptive faculty. Orig-
inal defective perceptions, i.e., incompleteness of original
observation, were the forerunners of dementia. In ma-
nia, monomania, and melancholia, delusion was the
characteristic faculty, a delusion being a false ideational
concept, not a false belief, else, in the religious world,
each denomination would consider the other insane.
The true criterion of insanity was the retention of a false
belief, notwithstanding that sufficient evidence is afforded
to show its falsity. Egotism, e.xalted self-consciousness,
is the essence of a lunatic's mania or melancholia.
SPON'GE-GRAFTIXG,
by Dr. Edw. Borck, of St. Louis.
Sponges to be prepared in acid and iodoform. Sponge-
grafts one line in thickness, covering the wound. Infre-
quent removal of dressings. Care for the granulations.
Useful in recent railway lacerated wounds as well as in
extensive ulcerations.
STONE IN THE BLADDER,
by Dr. H. H. Mudd, of St. Louis.
The aim of the paper was to determine the extent of
dilatability of the bladder compatible with safety, i.e., its
non-rupture. Capacity is desirable for a large quantity
of water in litholapaxy. The dilatability of the bladder-
walls was found to be very great.
THE ANTIPYRETIC TREATMENT OF TYPHOID FEVER,
by Dr. G. C. Smythe, of Greencastle.
Death may result from specific lesions of the disease,
as intestinal hemorrhage or peritonitis from perforation.
But the percentage of mortality from such causes is quite
insignificant when compared with the mortality of typhoid
from hyperpyrexia and the degenerations following. Ex-
cessive heat production and faulty heat elimination, one
or the other factor, will be found, and should be com-
bated by antipyretic treatment. Cold water by eftusion
or baths, or in some form of external application, with
quinine in dose of twenty-five to fifty grains each alternate
night so as to cause marked morning remissions, consti-
tuted the treatment strongly advocated in the first days
of the fever.
DISEASES OF THE FALLOPIAN TUBE, WITH TAIt's OPERA-
TION AS A .MEANS OF CURE,
by Dr. Thomas Harvey, of Indianapolis.
Symptomatology and etiology obscure in the early
stages. One of the most marked symptoms was the oc-
currence of intermenstrual pain, usually on a certain fixed
day. Dr. Harvey was of the belief that this symptom of
intermenstrual pain was caused by a stenosis of the tube
or other obstruction to the passage of the ovule along the
oviduct. The escape at intervals of a limpid or purulent
fluid from the uterus, and the ability to pass a uterine
probe into the dilated Fallopian tube afford a diagnostic
symptom and sign that cannot be readily mistaken in
their significance.
The author cited a case of tubal disease that had been
diagnosticated by different surgeons as hip-joint disease,
spinal curvature, ulcer of stomach, and hepatic colic, and
the unfortunate patient had successively been cupped,
bled, blistered, and made to wear a plaster-of-Paris jacket.
An exploratory incision revealed ovarian disease, the
ovary being brought into view througli a small abdom-
inal incision by elevating the uterus through the vagina.
Dr. Harvey sought to show that Tait's operation should
not be resorted to until other means had failed to make
a cure in disease of the Fallopian tubes. He had fre-
quently injected a sixty-grain solution of silver nitrate
into the dilated tube with good effects.
Dr. J. R. SuTCi.lFFK, of Indianapolis, related a case
of death after intra-uterine injection of copperas, upon
which he was called to make a post-mortem, which re-
vealed the injected fluid in the peritoneal sac.
Dk. Haymond related a similar case from whiteoak
bark injection.
Dr. Harvey declared the cause of death in such cases
to be shock, and not peritonitis or septicaemia.
chloroform in labor,
by Dr. G. V. Woolen, of Indianapolis.
The indications for chloroform were found in its effects
upon the nervous system, relieving pain and shock ; upon
the muscular system, bringing about relaxation ; and
upon the secretory system, stimulating the secretions.
This paper was discussed at length, and brought out the
following points, viz., dangers of chloroform in labor,
degree of anajsthesia compatible with safety, and mode
of administration.
Dr. Harvey would not go beyond the second stage
of anaesthesia, which sufficed to allay pain and effect
relaxation. The third stage of amesthesia arrests labor.
The chloroform should be dropped upon a handkerchief
by an attendant and administered by the patient herself,
and that too only during a contraction.
Dr. John Cha.mbers, of Indianapolis, called atten-
tion to the numerous instances of death from chloroform,
chronicled in the London Lancet during the past ten
years. It was too generally the received opinion among
the profession that authentic cases of death from chloro-
form in the lying-in chamber were exceedingly rare.
Dr. Chambers in his obstetric practice frequently em-
ployed ether, as a safer an;i;sthetic than chloroform, ful-
filling the indications nearly as well as chlorolorm, and
at the same time making it more difficult to plunge the
patient into that state of dangerous anesthesia, known as
the third stage.
NOTES on tracheotomy,
by Dr. William H. Myers, of Fort Wayne, Ind.
The burden of the paper was that tracheotomy should
not be regarded as a dernier ressort. \V'ith Trousseau,
the essayist thought that it was as obligatory to perform
timely tracheotomy as to tie the carotid artery when cut.
Dr. Eastm.an also advocated early operation in cases
of foreign body in the larynx, and related the case of a
child with lodgement of a foreign body in its trachea, on
whom he urged an operation before daylight, but was put
oft' through the remonstrances of the parents, who de-
ferred the operation till eight o'clock in the morning.
The child being raised from its bed in the morning by
the nurse, the foreign body rolled into its larynx and
caused fatal obstruction.
Dr. L. J. Jones, of Chicago, presented a very practi-
cal paper upon
errors of refraction and DEFECTS OF ACCOM.MODA-
TION,
urging their correction and early relief by glasses pre-
scribed by a scientific oculist and optician.
Dr. William Byrd, of Quincy, 111., exhibited a
HUTCHINSON'S INHALER,
with which he had been using an anresthetic compounded
of bromide of ethyl, one part : chloroform, three parts ;
and alcohol, four parts. Had used it in 7S cases, with-
out giving rise to vomiting, retching, or any untoward
symptom ; and had consumed but two and one-half
pounds of the anesthetic, the cases comprising many
capital and tedious operations.
THE LAST AITERNOON SESSION
was held in the beautifully decorated hall of the State In-
sane Institution, upon invitation of the superintendent.
Dr. W. 15. Fletcher. After the meeting a visit to the
wards of the Institution was made by the members of the
Society.
The I'arlsians consume ten thousand horses and
four hundred mules annually. The excuse is that horse-
flesh is good, clieap, and free from disease.
October 6, 1883.]
THE MEDICAL RECORD.
389
(Covvcspourtcncc.
OUR LONDON LETTER.
(From our Own Correspondent.}
THE MEDICAL HOLIDAY HEALTH RESORTS DEATH OF
DR. BERTIER FILS THE APPROACHING WINTER SES-
SION COLD AND WARM WINTER RESORTS — STUDENTS
NUMBERS INTERNATIONAL CONGRESS OF ANTI-VAC-
CINATION I STS.
London, September 24, 1883.
London still exhibits a dearth of doctors, though it must
be confessed that this statement is to be received cidii
grano; just as the more common assertion that "nobody is
in town" is sometimes modified by the cynical addendum
" except three and a half millions of people." These
millions are all sufficiently cared for by a rather over-
stocked profession, and it is only the well-to-do and the
consultants who have left their patients to the care of
their less fortunate brethren or have followed them to
their holiday resorts. Our wealthy patients are, indeed,
scattered far and wide, and the majority will not return
for weeks. Many of them have gone to drink the waters
at the fashionable spas, and books on those " cures" are
the chief representatives of medical literature. Thus
Dr. Despres has issued a medical guide to Contrexeville,
which is noted for its effects on the urinary organs, and,
if we are to believe this local authority, may sometimes
obviate the necessity of lithotrity or the more dreaded
cutting. Dr. Vintras, a Erench physician practising in
London, has published a guide to all the spas of Erance,
which is ably compiled and well got up. A work of
much wider scope and of a more scientific nature is the
"Mineral Waters of Europe," the joint introduction of
Professor Tichborne, the well-known Dublin analyst, and
Dr. Prosser James, of the I^ondon Hospital and the
Throat Hospital. This physician also published lately a
fifth edition of a small monograph on "Vichy and Its
Therapeutical Resources," which first appeared nearly
twenty years ago. Dr. Blanc has brought out a little
book in English on " Aix-les-Bains," a most popular spa,
which has just been patronized by our Princess Beatrice.
Last year the younger Dr. Bertier, of Aix, published an
English medical guide to this resort which was well re-
ceived, and just as I was occupied with this letter comes
the sad news of his untimely decease. He will be greatly
missed by many English invalids who frequented Aix-les-
Bains. He was a native of the place, but he spoke
English fluently, and understood English medicine and
English ways. After taking his degree in Paris his father,
who still practises at Aix, sent him to this country to
acquire our language and prolong his medical studies.
He then began practise in his native town and speedily
acquired a considerable position, his geniality and kind-
ness, together with his talents, making him a favorite.
This season the Princess Beatrice being sent to Ai.x by
her advisers here for some rheumatic symptoms, was
placed under poor Bertier's care. A day or two after
his royal jiatient left he was taken ill with febrile symp-
toms. These soon developed into typhoid, and now I
hear of his death, at the age of thirty-seven. Sic transit
gloria.
Though our dead season is not over there are many
signs that the next session is at hand. The medical
schools are freely advertising their arrangements for
opening on October ist, and no doubt most of the intro-
ductory lecturers for the occasion have well advanced
with the preparation of their addresses. It is a grand
opportunity of speaking to the public. What a pity these
gentlemen do not meet and agree together to send forth
a loud, united protest against the manner in which medi-
cal legislation is burked, or an indignant remonstrance re-
specting professional grievances.
Another sign of the times is the appearance of books
or pamphlets on winter climates. As the summer re-
sorts close those for winter open, and already people are
preparing to follow the swallows, while a few are as ready
to seek the quiet but cold air of high mountain valleys.
The climatic treatment of consumption might have been
expected to receive less attention during the war of the
bacillus ; but at present the fight does not penetrate far
beyond professional circles, and invalids who have
basked in the sunshine of Egypt or the Riviera often
long for the South as soon as autumn's clouds set in.
A further notice of the coming session is forced upon
medical readers by the simultaneous issue of "Students'
numbers'' of all the journals. Not that they seem to be
valued by students, for they only consist of the " regula-
tions" of the examining bodies and a few paragraphs of
trite advice. These numbers are, in truth, mere baits
for advertisers ; these paid-for announcements make up
the bulk of the bulkiest issue for the year, a veritable
farago libcUi as uninteresting as it is useless. Take a
single item in proof of this, one of them gives students
a few words about books, enumerating among those to
be read on one subject more than would be found in a
diligent physician's library.
International movements have invaded medical affairs,
as witness tlie brilliant congresses at Philadelphia and
London. We have also had parodies of these in the
form of an "anti-vaccination congress," and the third of
these strange gatherings has been summoned to be held
at Berne. Many will regret to see that the fanatics of
this movement have the support of Mr. Herbert Spencer.
Philosophers in this nineteenth century seem curiously
constituted. There will of course be an M.P. or two
present, but they do not count for much. Then the ex-
professor, F. W. Newman, is a supporter, but this quon-
dam teacher of Latin has long ceased to possess any real
authority, and seems to seek popularity in all sorts of
unorthodox assemblies of pseudo-scientific pretensions.
His book on the " Phases of Faith" attracted attention
and turned not a few youths into the muddy stream of
scepticism, but it was by no means scientific or even
philosophical. Of course the coming " Congress " opens,
not for inquiry but to advocate the prejudices of the in-
significant minority who make up the '' vaccino-phobi-
acs," as they have been called. Such an assembly may
therefore vote its foregone conclusions in complete se-
curity that it cannot attract much notice from the scien-
tific world. I see no "delegate" from America in the
list which 1 have received. May we conclude that the
people of the States are too well educated to favor the
fanatics ?
Official List of Changes of Stations and Duties of Officers
of the Medical Department, United States Army, from
September 22 to September 29, 1S83.
De Loffre, a. a.. Captain and Assistant Surgeon.
Assigned to duty at Fort Niagara, N. Y. S. O. 1S2, par.
5, Department of the East, September 27, 1883.
Havard, Valery, Captain and Assistant Surgeon.
Assigned to temporary duty at post of San Antonio,
Texas. S. O. 120, par. 10, Department of Texas, Sep-
tember 21. 1883.
Reed, Walter, Captain and Assistant Surgeon. Re-
lieved from duty at Fort Omaha, Neb., and assigned to
duty as Post Surgeon, Fort Sidney, Neb. S. O. 103,
par. 5, Department of the Platte, September 22, 1883.
Shannon, W. C, Captain and Assistant Surgeon.
Assigned to duty at Fort Bridger, Wyoming. S. O. 102,
par. 3, Department of the Platte, September 19, 1883.
Appel, a. H., First Lieutenant and Assistant Surgeon.
Assigned to temporary duty at Fort Warren, Mass.
S. O. 181, par. 3, Department of the East, September 25,
1 88.:;.
390
THE MEDICAL RECORD.
[October 6, i88c
Carter, VV. V., First Lieutenant and Assistant Sur-
geon. Assigned to temporary duty at Washington Bar-
racks, D. C. S. O. 182, par. 5, Department of the East,
September 27, 1883.
Richard, Charles, First Lieutenant and Assistant
Surgeon. Relieved from further duty at Creedmoor,
N. Y., to return to his proper station. Fort Adams, R. L
S. O. 180, par. I, Department of the East, September
24, 1883.
Richard, Charles, First L,ieutenant and Assistant
Surgeon. Granted leave of absence for two months,
with permission to apply for extension of two months.
S. O. 49, par. I, Military Division of the Atlantic, Sep-
tember 25, 18S3.
Wake.max, William J., First Lieutenant and .Assist-
ant Surgeon. Relieved from temporary duty at Fort
Sidney, Neb., to rejoin his proper station at Fort D. A.
Russell, Wyoming. S. O. 103, par. 5, Department of the
Platte, September 22, 1883.
31iXctlicnT items.
Contagious Diseases — Weekly Statement. — Re-
port of cases and deaths from contagious diseases re-
ported to the Sanitary Bureau, Health Department, for
the two weeks ending October 2, 1883 :
c
73
Week Ending
>
M
3
T3
■3
1
■u
^1
S
S
•fl
><
u
*
a
>>
■5
ss
^
U
J3
0.
F
_0
H
H
tn
u
^
U
C/3
>.
Casts.
September 25, 1883
0
84
29
7
4
17
0
0
October 2, 1S83
0
86
26
-»
0
Deaths.
September 25, 1883
0
12
2
5
2
12
0
0
October 2, 1883
0
II
8
3
4
16
0
0
The Social Purity Alliance. — As the college terms
are now beginning and the medical student is abroad, we
can print with propriety, the following interesting notice
from the Students' Journal. Says the editor: "I have
just made a discovery, which I am sure will interest
many readers, which is that a society exists in connection
with University College which the promoters hope will
have a very important effect in extinguishing what is
termed the ' Social Evil.' The society is termed the
' Social Purity Alliance,' the members of which pledge
themselves, if unmarried, to abstain from the gratification
of the animal passions. There is certainly, unless my
observations have misled nie, an extensive field for the
operations of such a society as this among medical stu-
dents. Manv medical students act, when they enter
upon hospital practice, as if the acquirement of the
knowledge of good and evil was part and parcel of their
professional education, and tlie results of their uivestiga-
tions are often very terrible and destructive. While wish-
ing the ' Social Purity Alliance ' success, I fear that the
operations of the society will not have much effect upon
the morals of medical or any other students, altliough the
meetings of the society have been better attended than
the i)ronioters could have expected.''
Medical Department of the New York. Like In-
SURANCK Company. — Dr. Henry Tuck has been ap-
pointed Senior Medical Director of the New York Life
insurance Company, in place of Dr. Charles Wright, re-
cently deceased. Dr. Abel Huntington has been ap-
pointed Junior Medical Director, as successor to Dr.
Tuck. Dr. ]5uchanan Burr has been appointed Dr.
Huntington's successor, as City Examiner.
The Summer Corps of Physicians and Their
Work. — From the report of Dr. E. H. Janes, Assistant
Sanitary Superintendent, on the work of the summer
corps, it is seen that the entire amount of work done
during the two months of service is equivalent to visit-
ing 43,915 houses, 198,932 families, and 6,601 cases of
sickness. This includes not only tenement houses, but
all classes of dwellings occuined by the very poor. Some
visited once and otliers several times each. A great
many of the cases treated were of a very mild type, need-
ing but a single prescription, as is shown by the small
number of deaths occurring, 28 in all, of which 10 were of
cholera infantum, 4 of diarrhoea, i of dysentery, 2 of gas-
tro-enteritis, 2 of diphtheria, i of scarlet fever, 5 of mea-
sles, 2 of phthisis, and i of marasmus. Besides caring
tor the sick, they distributed 17,542 circulars containing
brief instructions on the care and feeding of infants, and
the management of sun-stroke, and 3,293 free excursion
tickets for the floating hospital of St. John's Guild. These
excursions are regarded as an excellent auxiliary to the
etforts of the Board of Health.
Impurities and Organis.ms in the Air of the Com-
pressed-Air Chamber. — Dr. J. Solis Cohen, of Phila-
delphia, writes: "The Record of September 22d has
an abstract, p. 335, on ' Impurities and Organisms in
the Air of the Compressed Air-Chamber.' The writer
seems to have overlooked the fact that sterilization of
the air for the condenser must be superfluous so long as
the air remains unsterilized in the consulting-room, in
the patient's apartments, and everywhere else where he
breathes."
Tardy Action of Pilocarpin ? — Dr. F. W. Ellis, of
New Richmond, Wis., writes, that on January loth he
gave a boy, aged three years, suffering from ascites, a
course of pilocarpin, covering two days. From the nth
to the i6th there was no eft'ect. On the night of the i6th
a fly-blister was applied. On the 1 7th all the character-
istic symptonis of jaborandi appeared ; profuse sweating
and salivation, so that the circumference of the abdomen
diminished two inches.
A Case of Congenital and Hereditary Goitre. —
Dr. G. S. Chalmers, of Alton, III, sends us the following
unique history. He writes : •' A few days ago I was
called to a lady in labor and m due course she was de-
livered of a large boy. There was nothing remarkable in
the iwogress of delivery, except that when labor had pro-
gressed well into the last stage, things almost stood still
with the head firmly wedged in the lower strait. Imag-
ine my surprise to see a well-developed goitre on the
child's neck. The swelling came clean up under the
lobes of the ears and with quite an enlargement over
the windi)ipe. The enlargement felt moderately firm, as
if from simple enlargement. The child seemed cyanotic
at first, and had to be encouraged by cold water dashes
and manipulation before it commenced breathing. And
then it was fully an hour before the color got natural.
As the cord beat quite actively I did not cut it for fifteen
minutes. After this we soon found that if the head was
kept fully extended breathing progressed naturally, but if
the head became llexed, breathing became irregular, and
the face cyanotic. It is now doing well, six days after
delivery, and is a vigorous feeder. The mother is e.x-
ophthalmotic with quite an enlarged neck, and noticeably
prominent eyeballs. I have never seen a case recorded
of congenital goitre. What can be done for a case like
this ? "
The late Dk. Beverly Livingston, of New York.
— Whereas, The Medical Board of the Nursery and
Child's Hospital, receives with deep sorrow the an-
nouncement of tlie deadi of Dr. Beverly Livingston, at
the beginning of what promised to be an association of
unusual usefulness to the institution ;
Resolved, That we, his associates, hold in greatest es-
teem our remembrance of the life and character of our
October 6, 1883.]
THE MEDICAL RECORD.
591
friend, and desire to record our appreciation of his high
attainments and sivill as a pliysician, coming as they
did from an ardent devotion to his selected life work,
and our knowledge of his noble and elevated mind, and
of his generous companionship.
Resolved, That we see in the melancholy event of his
death that our institution, the profession, and the com-
munity are deprived of the influence and example of a
pure, true, and earnest life.
Resolved, That we tender to the family of our late as-
sociate our heartfelt sympathy in their great bereave-
ment ; and that these resolutions be published in the
medical journals of the city.
George G. Wheelock, M.D.,
Edward L. Partridge, M.D.,
Committee.
The Relation of Diphtheria to Contaminated
Drinking-VVater. — Richard Cole Newton, Assistant
Surgeon, United States Army, writes : " The Sanitary En-
gineer, for July 26, 18S3, contains the following para-
graph (page 177): 'In a recent monthly report of the
Connecticut State Hoard of Health, mention is made
of a family in Thonipsonville where there were eight
cases of diphtheria with two deaths. This family lived
in a house with a small back yard containing the well and
privy as usual, but in addition a deposit of tilth a foot
thick on a level, composed of putrefying vegetable waste
and a mongrel mass of nastiness. The ground sloped
to the well and the deposit of filth came close to it.
The windows of the bed-rooms opened on this yard.
The family that moved out had been afflicted with ma-
lignant scarlet fever with several deaths. In quite a
number of (other) instances there were from four to
six cases in one family, or oftener all the members, and
in all that have been carefully studied some sufficient
cause has been found.' This quotation contains an al-
most e.xact description of two establishments in the vi-
cinity of this post. One is known as the Post Dairy
and the other the Butcher Pen, although fortunately
neither place is now used for the pur|)ose indicated by
its name. They are both about two miles away, and in
each the well was sunk in the position most advantageous
to receive the drainage of two large and very filthy cor-
rals (cattle yards). The contamination of the water from
these wells was so marked that it offended sight, smell,
and taste, and yet, because it was cooler than the water
from a creek, which flowed near, the well water w'as
generally drunk by the people of both houses. At the
dairy there lived a widow with four small children, and
two or three servants, one of whom, a young woman,
had a child of four years. About six weeks ago, the
oldest child of the proprietor was seized with diphtheria,
which in succession attacked the entire family of chil-
dren. Three died, and one (the first attacked) recov-
ered. The child of the servant did not contract the dis-
ease, although it constantly played with the others and
lived under the same conditions, except that its mother
would never allow it to drink the well water, which the
others drank freely. At the Butcher Pen, a man, his
wife and two children, one eleven years and one eighteen
months old lived. The father was generally away at
work. The mother and older child had ' chills,' and
four weeks ago the baby, which was still sucking, devel-
oped a case of diphtheria, which went on like the other
cases, but on the fifth day began to improve, and grad-
ually recovered. Although between two and three weeks
have elapsed since the convalescence of the last case
was established, no further cases have shown themselves.
There was not, so far as I can learn, any exposure to
diphtheria on the part of those who suffered from it.
Indeed their isolated position rendered such a thing
quite improbable. No child in the post lias developed
any diphtheritic symptoms. The ' police ' (cleanliness)
of this fort, however, is the special pride of its officers.
As to the treatment, the two cases that recovered re-
ceived less treatment than those that died. Two of the
cases were under my sole care. One, the only son of
the widow, and her especial pride, received every care
that could be bestowetl upon him. I followed, as far
as possible, tlie treatment which I understand Professor
A. Jacobi adopts in diphtheria, including the lime-water
spray, which certainly did this good, that there was no
fetor about the case, which had been very marked in the
preceding ones, where no spray was used. This case
did not die from strangulation (because the child both
spoke and swallowed just before death), but from "heart
failure, whereas both of the other children, if the
mother's account can be reUed upon, died entirely from
' want of breath.' In the boy's case stimulation and
frequent feeding with beef-tea and milk were crowded
from the first. The child at the Butcher Pen was or-
dered a piece of bacon about tlie throat, to be worn con-
stantly. Throat to be swabbed every hour with a solu-
tion of iron and chlorate of potash, and three-fourths of
a grain of cjuinine to be given in solution every two
hours. On the fifth day an almost confluent pustular
eruption (which resembled a confluent variola at end of
first week) appeared all over the throat and parotid re-
gions. The next day an abundant rash, like scarlatina,
showed itself all over the body. The fauces and tonsils
now began to look better. The ulcers on the latter were
smaller and less sloughy, and the case went on to re-
covery. I should add that the treatment was inaugu-
rated by a few small dOses of gray powder and ipecac and
one or two doses of castor oil. This, with the medica-
tion already mentioned, comprised the entire therapy in
the case. I should have attached more importance to
the rash spoken of, if it were not a usual thing on all
children, sick and well, during our long and hot summers.
It is gratifying to note that the well on the dairy prem-
ises has been filled up and the house torn down, and our
post commander is endeavoring to have the same good
work accomplished on the other premises, although un-
fortunately he has no direct control over them."
Some "Cures" for Hysteria. — A writer in the
feuilleton ^i L' Union Me'dicale discourses in an entertain-
ing and instructive manner upon the course and cure of
hysteria. "One is always instructed," says the writer,
"in travelling. It is also a pleasure to observe for one's
self the productions of the soil, the manners of the na-
tives, the color of their umbrellas, and the price of their
clothing. But how much more lively is the satisfaction
when the chances of travel put us in possession of some
precious novelty in the direct line of our researches and
habitual occupations ! This is what has happened to me.
I have made a capital discovery in therapeutics, and I do
not hesitate to announce it at once for the benefit of
humanity, and without taking any of the preliminary risk
of submitting it to the Academic committee on secret
remedies. On a recent trip, I came across one of my
old patients, whom, for convenience sake, I beg to in-
troduce as Madame Lerond. We had not parted on very-
good terms, at which you will not be astonished when you
learn that she is a respectable shopkeeper, of forty years,
who suffered from hysteria of the vaporous form, with
luxuriant manifestations as regards the head, stomach,
intestines, limbs, and of all the organs and functions of
the body generally. Not only had I failed to relieve Mine.
Lerond from her various discomforts, but a cloud had
marked the end of our mutual relations. Voiei comment ;
One day she asked me seriously to tell her frankly, for
the sake of her children, whether she was not threatened
with insanity, and whether she would really ever be well.
After explaining that her symptoms were only those of a
nervous debility, etc., etc., I concluded : ' In fine, Madame,
without ever being very sick, you will always be a little
patraque: I was much pleased with this expression,
which seemed to hit her case very exactly. But my pa-
tient did not see the matter in the same light, and with a
very cold air she told me that the word patraque seemed
392
THE MEDICAL RECORD.
[October 6, 1883.
to her very impolite, and she was not used to being
treated in such a way. I tried in vain to explain that
Littre defined the word patraque as signifying familiarly
a person who was weak and invalidish, and that it was
frequently used in the best society. These arguments failed
to excuse my soi-disant enormity, my patient being equally
unfamiliar with Littre and the best society. I departed,
resolved thereafter not to essay expressions with my pa-
tients imless I was sure they would be comprehended.
Meeting Mme. Lerond on my travels, however, a year
later, I ventured to approach and inquire after her health.
She replied, in a very radiant and satisfied manner, that
she was completely cured. ' I congratulate you,' said I ;
' may I inquire how you secured this happy result .-' ' 'It
was a Russian physician who came to the store last win-
ter, and desired, with much solicitude, to treat me. After
having examined me very carefully, he assured me that
he understood my case exactly, but he could not cure me
at once, as he would have to send to Russia for the re-
medy. He had no confidence in French pharmacists,
but hy sending to Russia he would be absolutely sure of
the purity of the medicine. The remedy having arrived,
I took at first one pill. Next da\- the doctor came to
inquire about its effects. It had not acted well. He
then directed me to take two a dav for four or five days.
I felt myself instantly relieved, and since then have had
neither headaches, nor insomnia, nor bad digestion, nor
weakness.' The storj' was told with the greatest confi-
dence and satisfaction. ' Do you know,' said I, ' Mme.
Lerond, of what this famous remedy consists which has
done you so much good ?' 'I know very well, but I have
forgotten. It was a yellow and bitter — it was — it was —
rhubarb ! ' It was indeed rhubarb that had cured my old
patient of all her ills ; but the rhubarb came from Russia,
and was given b)"- a Russian physician. French rhubarb,
given by a French physician, would never have done it."
The above account reminds the writer of some
other "cures" for hysteria: " One of the best agents
against the gastric and vaporous forms of hysteria is
champagne, but only on the express condition that it
be taken in a cup, not in a glass. I still see a former
hysteric, who passed a dozen years of her life a victim of
her nerves, eating each day but three pieces of barlej'-
bread, and desolating her family with \\itx bizarreries. In
her case it was not a Russian physician, but a religieuse,
who brought about her cure, by simply announcing that
she would die if she continued. She did not continue.
Another case had been for four years the despair of all her
acquaintance. She swung through the whole circle of
physical perversions. The mode of her cure was neither
rare nor curious, for it was simply through the care of a
homccopathic doctor, of whom she still sings the praises,
and who deserves credit for this trait of sagacity — that he
specified, in commencing her treatment, that it would not
last less than an entire year. This was, in fact, the most
powerful and most suitable globule which the homoeopath
used in the whole course of the treatment. And so on
ad infinituvi. An excellent formula against hysteria
would be, I think, the following :
IJ. Diplome de Philadelphie,
Rhubarbe de Russie,
Fumisterie,
Homceopathie, X\\i q.s.
M.— Gild the pill."
A New Journal. — The question whether Philadelpliia
or New York, Boston or Chicago, is the real medical cen-
tre, has been easily and simply decided in favor of the
first-named city by the establishment therein of a new
medical journal. The Medical World. We assert this,
because the World is not an ordinary ephemcris, and
its scheme of organization could not have been evolved
from anything short of a real medical metropolis. The
World has introduced the chromo-era into medical jour-
nalism, and offers four portraits of eminent medical men
yearly to its subscribers. The first four eminent gentle-
men are rumored to be already in Philadelphia sitting
for their pictures. The second four, it is expected, will
soon be on their way, and we know not how soon it will
be before Philadelphia is crowded with eminent gentle-
men demanding lithographic recognition in the pages of
our esteemed contemporary. That the appearance of
the World is a subtle device on the part of Philadelphia
to entice the leaders of our profession into its midst
can hardly be doubted.
CoLOTOMV IN Fr.^nce. — Colotoniy, says the corre-
spondent of the Medical Press and Circular, is an opera-
tion very rare in France, as the French surgeons have
considered it a dangerous and useless operation. M.
Pollaillon brought a case under the notice of the Acad-
emy. The subject was twenty-one years of age, who
had a hernia on the left side since infancy. Two years
ago the hernia became irreducible, and a neuralgia of
the testicle of the same side, which was attributed to the
weight of the tumor. No bandage could be borne under
these circumstances. M. Pollaillon attempted the radi-
cal cure with an entire success. Af. Guerin criticised the
operation of M. Pollaillon, which, according to him, was
not equal to his own, which he practised over forty years
ago, and which consisted in practising a series of subcu-
taneous wounds ; the exudation resulting formed a cica-
tricial tissue which completely obstructed the canal and
thus effected the radical cure of hernia.
Preparing for Scientific Work at the Next
Meeting of the New York State Medical Society. —
We have received a circular letter, which we print below,
from Dr. Hutchins, President of the State Medical So-
ciety. It contains an appeal to the members and dele-
gates of the State Society to supply scientific material
for the next meeting. We can heartily commend the
President's effort in this direction. The circular reads
as follows : " The By-Laws of the State Society provide
that to the Business Committee are left all the arrange-
ments for its scientific work. The Business Committee
is not appointed till the opening of the session, so that
all the control it has over this work is to receive any
papers that may be offered, appoint the hour when they
may be read, and apportion the time to be consumed in
the reading. No authority, under the By-I^aws, is given
to the President, or to any Committee, to secure the pre-
sentation of any scientific matter. The By-Laws tacitly
assume that such material will be offered. Whatever
efforts the President may make, to assure an interesting
and instructive session, are solely on his own motion,
and the disposal of all papers thus secured is at the
discretion of the Business Committee. The President
strongly desires that the session of 1SS4 may be enter-
taining and luofitable to the large number of medical
men who will gather at the capital from all parts of the
State in midwinter, and to this end this circular is ad-
dressed to all the delegates and members of the State
Society, asking their personal interest in providing a
suitable programme for the meeting. It adds materially to
the general interest if all parts of the State are repre-
sented, as thereby are called out the most diversified ex-
periences. The session of the Society is so short that
the attractiveness of the programme is enhanced if the
papers are short, or an abstract thereof prepared for
reading. By this means a larger number of topics can be
presented, and a fuller discussion iiermitted. It is hoped
that this appeal may be seriously entertained by the
delegates and members, and special preparation be made
for the next meeting, worthy of so distinguished a body,
representing such important interests. The President
desires that titles of papers, with names and addresses of
authors, may be forwarded to him at the eiuliest con-
venience. K list of these, in the order of their recep-
tion, will be prepared and laid before the Business Com-
mittee at the opening of the session. This will enable
the Committee to consult the convenience, of authors as
to the time of reading, and contribute to the easy and
full presentation of the Society's work."
The Medical Record
A Weekly jfournal of Medicine and S^t-rgery
Vol. 24, No. 15
New York, October 13, 1883
Whole No. 675
©vioimil ^Vvticlcs.
CASES IN ABDOMINAL SURGERY,
\ViTH Considerations as to the Causes of Death.
By CHARLES K. BRIDDON, M.D., •
SURGEON TO THE PRESBYTERIAN HOSTITAL, NEW YORK.
The following group of cases have come under my obser-
vation during the past few months, and I have thought
them of sufficient interest to present to the readers of
The Medical Record.
Case I. — Double ovariotomy, without adhesions ; death
in ninety-five and a half hours. — Mrs. S. G , aged 45,
married nineteen years, sterile ; began to menstruate when
twelve years old ; has always been regular until the last
year, during which the intermenstrual period has been
sometimes three, on other occasions five and six weeks ;
the quantity has never been in excess. A year .ago she
began to be annoyed with a sensation of cold, covering
an area of about two inches in diameter, situate about
the middle of the front of the right thigh. In a few months
this spot began to be surrounded by a halo of heat, and
then began to be the seat of pain which radiated up and
down the thigh ; lately the same sensations have existed
on the opposite limb. She began to grow stout after
marriage, and two years ago was a woman of massive
proportions, weighing about two hundred and fifteen
pounds. Since then her abdomen increased consider-
ably in size, but she was persuaded it was the accumula-
tion of fat common to some women at the change of life.
She never experienced anything unusual until December,
1882, when she had an attack of colicky pain in the right
inguinal region that passed along in the direction of the
colon ; it only lasted a few hours, and when examined
by her medical attendant he told her she had a tumor.
December 12th. — Patient is a stout, healthy looking
woman, her face looks full and bright, and certainly does
not indicate the existence of serious trouble. Her pulse,
probably accelerated by my presence, is 92 ; respiration,
20 ; temperature, 99°, The abdomen is distended by a
tumor that nearly fills the cavity ; it is most prominent m
front, is everywhere dull on percussion, save a space of
about three inches between the superior limit of the tu-
mor and the sternum, and laterally behind ; the surface
of the swelling is perfectly smooth, tense, and elastic,
non-fluctuant, or I should rather say that the thick ab-
dominal walls render the sense of fluctuation obscure and
uncertain. The configuration is that of an ovarian or ute-
rine tumor ; it fills the abdominal cavity so completely
that it does not rise and fall with tlie ascent and descent
of the diaphragm ; there is no crepitation. From sternum
to umbilicus, 7 inches ; from umbilicus to pubis, 10
inches ; circumference at umbilicus, 48 inches ; three
inches below it measures the same. It is difficult to
measure from the anterior superior spines, on account of
the superimposed fat, but as well as I can ascertain, it is
the same on both sides from those points to the umbil-
icus, namely, loi- inches. It was with difficulty I could
reach the os, which was thrown backward, and I could
not map out the body, but made out that it was ante-
verted.
Examinations of the renal secretion gave the fuUow-
ing results :
February 12th, night : specific gravity, 1.028 ; reaction
acid ; no albumen ; amorphous urates ; bladder epithe-
lium ; no casts. Morning: specific gravity, 1020 ; reac-
tion acid ; no albumen.
February 13th, night : specific gravity, 1.028; reaction
acid ; no albumen ; amorphous urates ; bladder epithe-
lium ; no casts. Morning : s|5ecific gravity, 1.026 ; reac-
tion acid ; no albumen ; amorphous urates ; bladder ep-
ithelium ; no casts.
February 14th, niglit : specific gravity, 1.032 ; reaction
acid ; no albumen ; amorphous urates ; bladder epithe-
lium ; no casts. Morning : s|>ecific gravity, 1.025 ; reac-
tion acid ; no albumen ; amorphous urates ; bladder ep-
ithelium ; no casts.
February 14th, 8.30 p.m., to istb, 8.30 p.m. (24 hours),
passed a little less than a quart.
February isth, 8.30 p.m., to i6th, 8.30 p.m. (24 hours),
passed" a pint and a half
February i6th, 8.30 p.m., to 17th, 8.30 p.m. (24hours),
passed a little over pint and a half.
March nth. — Patient complains of being distressed
for breath. Circumference at umbilicus, 49 inches, three
inches below it is 50 inches. It is impossible to find
the xiphoid cartilage or the anterior superior spines,
but the measurements are conjectured to be as before ;
there is at least two inches of abdominal fat that obscures
the sense of fluctuation. It was only with difficulty I
could draw the os forward, and I found it impossible to
introduce the sound. I aspirated the tumor and with-
drew about four ounces of fluid of the color and consist-
ence of golden syrup ; specific gravity, 1.014; alkaline ;
it coagulated on boiling, and the coagulation was dis-
solved by boiling with twice its volume of acetic acid
(paralbumen). Under the microscope were found epithe-
lial scales and plenty of large granular corjiuscles. She
was advised to keep her bowels regular with compound
licorice powder, and take Buffalo lithia water.
March 28th. — Under the use of lithia the amount of
urine has increased fifty per cent.
April 1st. — Has experienced some pain in the course
of the left sciatic nerve, and a disagreeable sense of press-
ure in the rectum. Regarding the diminution in the
renal secretion as due to pressure, and thinking that if
permitted to continue it might compromise the results of
an operation, early interference was advised, and it was
contemplated to do it one week after the next menstrual
period. Circumstances rendered it necessary to defer it a
month longer; twenty-four hours before the day arranged
for her to enter the hospital a case of erysipelas was found
in one of the wards of the surgical pavilion, and_ it was
determined not to admit her until all traces of this were
got rid ofl".
Patient was admitted to the Presbyterian Hospital,
May 5, 1883. .A spacious room (4,500 cubic feet)
in the administration building that had never been
used, was prepared six weeks before her admission, by
painting walls, ceiling, and floors ; it was well lighted
from the south and east, had ap|)aratus for steam heat-
ing, and an open fireplace. A most thorough quarantine
was established, bedsteads, bedding, etc., were new;
nothing was jiermitted to come in contact with the pa-
tient that had been used in the Hospital Department.
She was directed to have a warm bath every night, and to
have her bowels regulated by compound licorice powder.
Examination of urine for the three days after admission
gave the following average : daily amount secreted 26
394
THE MEDICAL RECORD.
[October 13, 1883.
ounces ; specific gravity, 1.025; reaction acid ; no albu-
men or casts.
May 8th. — Had a light early breakfast, no lunch, an
enema at 2 p.m. Preparations for operation as follows :
No one was admitted to the room who had been engaged
with any case of contagious or infectious disease ; a re-
liable spray of |)ure phenol was used : all instru-
ments ; thoroughly cleansed and disinfected, were im-
mersed in one to twenty solution : ligatures of silk had
been boiled 'in one to twenty ; fifteen large flat sponges
had been thoroughly prepared by cleansing from sand
and fat, and had been kept in one to twenty solutions
for six weeks ; temperature of room was between 75°
and 80°.
Operation, 3 r.M. — Under the influence of ether it was
possible to make a more satisfactory diagnosis. The tumor
was found more movable, it could be lifted bodily up-
ward, and the hands could be insinuated between its
lower surface and the pubes. The uterus was found to the
left and separate from the tumor ; crepitus was also plain-
ly elicited on moving the abdominal walls over the tu-
mor ; fluctuation was doubtful. An incision was made in
the mesial line, commencing about two inches below the
umbilicus and passing downward about six and a half
inches. There was at least two inches and a half of fat in
the superficial fascia ; another layer of fat was found after
division of the muscular aponeurosis — this of course was
seated in the subserous connective tissue, and was very
vascular. After the ligation of all bleeding points, the
peritoneum was opened, exposing the cyst ; this was
found entirely free, there was not a single adhesion. Its
walls were punctured with Spencer Wells' trocar, and
after the evacuation of the largest cyst several smaller
ones were treated in the same manner. The contents were
so viscid as to occupy some time in removal, and when
it was so reduced in size as to permit it, it was drawn
through the opening in the abdominal walls, which were
promptly closed, and maintained in coaptation by my
friend, Ur. Watts, who assisted me. The pedicle was
transfixed and tied on either side with a stout silk liga-
ture, and supplemented by a second encircling the pedi-
cle immediately below the first ; the cyst was severed a
quarter of an inch above the ligature. This large multi-
locular cyst was situate in the left ovary. The right was
found to be imdergoing the same process of degeneration ;
it was occupied by three cysts, united, about the size of
a small orange : its pedicle was surrounded by a ligature
and it also was removed. The two weighed with their con-
tents sixteen and three-fourths ])0unds. The abdominal
opening was then closed carefully with carbolized silk
sutures, one-third of an inch apart, each suture taking up
half an inch of peritoneum. The needles for introducing
these sutures were made so that the punctures were no
larger than necessary for the passage of the silk, and dur-
ing their introduction the abdominal cavity was protected
from the spray and blood from needle-punctures by a
large flat sponge wrung out of warm carbolized solution.
The toilet of the peritoneum was made as comjilete as
possible, in fact it was left free of everything, and almost
dry. The line of incision was covered with a strip of wet
gauze protective, eight layers of freshly carbolized gauze
and macintosh, the whole supplemented by a nicely fit-
ting flannel bandage. The patient was placed in bed
surrounded with hot bottles, and her head enveloped
in a comforter. The House Surgeon, Dr. Freeman, was
directed to let her sip hot water if she had any vomiting,
and to give her occasional doses of tr. opii deodorata
if she had any (lain.
May 9th. — She vomited two or three times during the
night ; thinks the feeling of nausea was diminished by
sipping hot water ; had some i)ain, which required the ad-
ministration of opium ; it has now ceased ; fifteen ounces
of urine removed by catheter during the past twenty-four
hours; temperature has reached 100°.
May roth. — Was much disturbed during the night by a
very heavy thunder-storm. Complains of feeling faint, of
some abdominal pain and a constricted feeling, as of a
band drawn tightly round the hips ; her temperature went
up one degree during the night, pulse 104. Noon to-
day she began to vomit, and the matters ejected soon
assumed the features characteristic of peritonitis. Metal
refrigerating coil was applied to the head ; tube was in-
troduced into the rectum to facilitate the escape of flatus,
and she was put upon aconite and opium. Toward
evening hypodermic injections of bimeconate of mor-
phia were substituted for the internal use of opium, and
she was directed to be led upon peptonized milk and
Leube's solution of beef.
May I ith. — She slept greater part of the night. Vomit-
ing ceased after the use of the bimeconate of morphia.
Only twelve ounces of urine have been drawn during the
past twenty-four hours, and it contained a trace of al-
bumen. There is considerable meteorismus, everywhere
resonant ; no dulness, no fluctuation ; pupils contracted,
face flushed, pulse in the morning 100, went up toward
evening as high as 120, respirations ranged between 13
and 18, temperature ran up to 102°. Toward night she
began to perspire ; the vomiting returned. Hypodermics
of Magendie were ordered every four hours, and twenty
grains of quinine per rectum, .^t midnight she was in a
condition of stupor, respirations sighing and rapid.
May i2th, 3 a.m. — Pulse, 140 ; respirations, 24; tem-
perature, 105°. Extremities becoming cold, hypodermics
of brandy were given, but she gradually sank, regurgi-
tating a thick, green, glairv fluid occasionally, and died at
half-past three.
It is much to be regretted that an autopsy was not ob-
tained in this case, as there are some conditions in the
clinical history that could only have been cleared up by
such an investigation.
I will now relate the history of a case of penetrating
wound of the abdomen that was exposed to many of the
influences that such pains were taken to exclude in the
last case, and that did well in spite of them.
Case II. — Report condensed from a history furnished
me by Dr. H. B. McCarroll, House Surgeon. J. P ,
native of Ireland, car-driver, twenty-seven years of age,
single, was admitted to the Presbyterian Hospital, Sun-
day, May 27, 18S3. Late the previous night, when en-
gaged in a drunken brawl, he was stabbed in the bellj'.
Excited by drink, he did not recognize the fact that he
was wounded, and continued his debauch until midnight.
On awaking in the morning he found something pro-
truding from a wound in his belly, and his friends brought
him to the hospital, twelve hours after the injury. His
condition when seen by the attending surgeon (Dr.
Briddon) was as follows : A large, strong, muscular man,
he lay on his back with his legs drawn up ; his face was
ruddy, suftused from the eft'ects of drink ; his pulse full
and strong, 72 ; respiration, 20 ; temperature, 100°.
He makes no complaint of pain. On uncovering his
abdomen a large mass of omentum was found protruding
from a small j^unctured wound situate a little above and
external to the centre of Poupart's ligament, its appear-
ance somewhat changed by the length of time it had
been prolapsed ; its surface was sticky from effusion of
lymph ; it was ruddy red in color, and opalescent ; it
did not look as if it had suffered from strangulation, but
only from exposure.
Treatment. — It was transfixed with a ligature of car-
bolized silk, which was tied on either side. It was then
cut away, and after slightly enlarging the wound, the
stump was returned into the abdominal cavity, which
was closed with carbolized silk sutures. Small doses of
deodorized tincture of opium were ordered to keep him
quiet, and no other precautions were taken.
June 2d. — A case of erysipelas was found in a bed on
the opposite side of the ward, which was at once re-
moved from the building and placed in a hut used far
the reception of such cases. The patient with abdominal
wound was also removed into another ward.
June 4th. — A second case of erysipelas developed in
October 13, 1883.]
THE MEDICAL RECORD.
595
the ward into which the patient was moved, and at a dis-
tance of seventy-five feet from his bed. This case was
also quarantined, and our patient was moved back into
his old ward, which had been emptied and disinfected.
On the third day his temperature reached iot°; the fol-
lowing day it receded to loo''. His pulse never ex-
ceeded 92 ; in fact he did not have a single bad symp-
tom, local or general.
The sutures were removed on the sixth day, and the
patient was discharged cured on June 29th. He might
safely have been sent out earlier, but it was feared he
might strain the cicatrix if he was permitted to go out
before it was quite firm.
Suppurating adherent cysts ; double ovariotomy ; scp-
ticcemia ; chronic diffuse nephritis ; death in ninety-six
/;o«ry.— Reported by H. B. McCarroU, M.D. Mrs.
L , the patient, was admitted to the Presbyterian
Hospital August 4, 1883. She is forty-four years of
age, married, but has had no children. She enjoyed
remarkably good health until thirty years of age, at
which time she weighed one hundred and seventy pounds.
Menstruation began at fifteen, and her periods were reg-
ular until fifteen years ago, at which time she was told
she had anteversion of the uterus, which interfered with
micturition and was accompanied by cessation of the
menses and the occurrence of delirium and intense pel-
vic pain at the time when the menstrual periods ought to
have appeared. Some months later the uterus was re-
placed, and all the symptoms abated and finally ceased.
I'atient was then quite well, with regular menstruation,
until three years ago, when the periods became irregu-
lar, and one year ago finally ceased. Eight months ago
she first noticed a tumor of considerable size in the
right iliac fossa. It grew rapidly and attained its pres-
ent size in a few months.
Examination. — Patient's general condition is poor.
She complains of severe pain referred to the right lumbar
region, at times extending across the back and down the
left thigh. There is slight cedema of the left leg, fre-
quent severe pains in the lower portion of the rectum,
especially during defecation, and at times there is a dis-
charge of blood from the bowels. Temperature, 99° ;
pulse, 108. Urine : specific gravity, 1.020 ; acid ; no al-
bumen ; quantity per diem, thirty ounces.
Physical examination revealed the presence of three
abdominal tumors ; the two larger were situate on either
side of the median line, separated by a well-marked sul-
cus ; they filled the iliac fossa, reaching about two inches
above the umbilical line ; the third was smaller, more
tense and resisting, and was situate behind the larger one
on the right side ; it bulged the lumbar region. The
tumors were distinctly fluctuant, but the larger ones were
immovably fixed, the hands could not be insinuated be-
neath them, and they did not move during inspiration
and expiration, crepitation could be made out laterally
and above. Uterus anteverted and jammed down in
the pelvis. The following measurements were taken :
from ensiform cartilage to umbilicus, 7 inches ; from
ensiform cartilage to os pubis, 13 inches ; right anterior
superior spine of ilium to umbilicus, G^ inches ; left
anterior spine of ilium to umbilicus, 6k inches ; circu-
lar measurement at umbilicus, 35 inches ; circular meas-
urement two inches below, 35^ inches. A hvpoder-
mic needle was inserted in the tumors occupying the
right and left lumbar regions and the fluid withdrawn
from each contained a number of pus-cells, large and
small. For three consecutive days preceding the op-
eration an examination of the urine was made night
and morning, with the following results :
First day, morning : specific gravity, 1.015; alkaline
in reaction ; no albumen ; the microscope revealed squa-
mous e|)ithelium present. Evening: specific gravity,
1. 018; alkaline; no albumen; contained triple phos-
phates, uric acid, and urates.
Second day, morning: specific gravity, 1.013; alka-
line ; no albumen ; contains some mucus. Evening :
specific gravity, i.o 16 ; alkaline; no albumen.
Third day, morning : specific gravity, 1.020; acid; a
trace of albumen ; pus-cells, uric acid, and squamous
epithelium present. Evening: specific gravity, 1.020;
acid ; no albumen ; contains few pus-cells and squamous
epithelium.
Operation. — Performed by Dr. Charles K.. Briddon,
September 27, 1883, at 3 p.m. Patient under the influ-
ence of ether. An incision five inches in length was
made in the median line and between the umbilicus and
the pubis, when the subserous areolar tissue was exposed,
all bleeding vessels were secured and the peritoneum was
opened to the extent of the wound. It was then found
that the omentum was drawn down in a fan-shaped pro-
cess, adherent by its apex to the lower portion of the
front of the cyst. Outside the lateral limits of the omen-
tum, the cyst was adherent to the abdominal walls by
bands that yielded readily to the pressure of the hand.
The omentum was tied in two places and divided be-
tween. It was then found that more formidable adhe-
sions existed below, and the worst of these existed in the
true pelvis. The larger cyst was now pierced with a
trocar, and when nearly empty of its viscid purulent con-
tents and while it was being drawn through the opening
in the abdominal walls, it was accidentally ruptured. In
spite of the prompt application of large flat sponges,
there is no doubt that some of the fluid entered the cavity
of the peritoneum. The next step was to separate the
adhesions situated in the cavity of the pelvis. These
were most extensive in the very bottom of the cul-de-sac.
They yielded vvithout any great force, but the hemor-
rhage was very free and was arrested temporarily by
sponges, and the pedicle of the larger cyst, which was
found on the lett side, was transfixed with ivory needles
charged with strong, closely twisted carbolized silk, and
the mass was then removed. Attention was then directed
to a second tumor, composed of several smaller cysts, in-
volving the right ovary ; the largest of these, about the
size of a child's head, was reduced by tapping and the
pedicle was secured as on the left side. The sponges
were now removed from the cavity of the pelvis and there
was found quite free hemorrhage from these points deep
down in the very bottom of the cavity. It was very diffi-
cult to control this; the instant a sponge was removed a
pool of blood obscured three points from which it issued,
and when, after several unsuccessful efforts, the points
were secured it was found ecjually difficult to pass and se-
cure ligatures over the points of the forceps ; in fact it
was only done after turning the patient on her side oppo-
site a window, which very much facilitated the manipula-
tions. A thorough washing of the cavity was then made ;
it was several times filled with a hot solution of carbolic
acid, and when completely cleansed, the abdominal
wound was closed with carbolized silk sutures, a large
glass drainage-tube being secured in the lower angle.
The abdomen was covered with borated cotton secured
in position by adhesive straps. Cyst and contents, inde-
pendent of what was lost, weighed nine pounds.
September 28th. — Morning : Temperature, 101°; pulse,
144; respiration, 22. Urine: specific gravity, 1.022;
alkaline ; no albumen. Patient rested comfortably during
the night. The following method for washing out the
cavity was devised ; A long rubber drainage-tube was in-
troduced through the glass tube, one end of which rested
in the cavity while to the other end was attached a small
funnel. The cavity was then thoroughly cleansed with a
solution of boracic acid (gr. xvj. to 3J. of water) and the
fluid was returned on the principle of the syphon. After
cleansing the cavity thoroughly the drainage-tube was re-
moved and in its place was substituted another, with a
piece of lampwick running through its entire length. By
this means thorough drainage could be obtained. Patient
was ordered a diet of milk, mild stimulation, and opium
in sufficient quantities to allay pain. Evening : Tem-
perature, 103.5'^; pulse, 140; respiration, 32. Patient
596
THE MEDICAL RECORD.
[October 13, 1883
somewhat restless, and complains of great thirst. No
abdominal symptoms present. Urine : specific gravity,
1.022 ; acid ; no albumen ; amount jiafted, 28 ounces.
September 29th. — Morning: Temperature, 101°; pulse,
148 ; respiration, 28. Foul odor about the dressing ;
this was removed and the cavity thoroughlv cleansed.
Urine : specific gravity, 1.022 ; no albumen ; acid in re-
action ; urates, triple phosphates, and squamous epithe-
lium present. Evening: Temperature, 103.1°; pulse,
144 ; respiration, 28. Urine contanis a trace of albu-
men ; few pus-cells.
September 30th. — .Vforning : Temperature, ioi.6° ;
pulse, 160 ; respiration, 28. Complains of a slight pain
in right iliac fossa. Evening : Temperature, 105.6° ;
pulse, 160 ; respiration, 28.
October ist. — This a.m., for the first time, casts were
found in the urine; specific gravity, 1.020; acid; con-
tains albumen, hyaline and granular casts. 2.15 p..m.:
Passed into a comatose condition and died.
The folio wing'report of the pathological appearances
has been furnished by the Pathologist of the Hospital,
Dr. T. E. Satterthwaite : The tumors sent for examina-
tion,twoin number, measured, the largerthirty centimetres
in its greatest diameter, the smaller eleven centimetres in
its greatest diameter. The larger contained 3. 000c. c. of
a thick, tenaciou';, yellowish-brown fluid. The larger cyst
had a thick fibrous wall, the interior of which was studded
with papillary growths, the size varying from a robin's to a
hen's egg. The smaller tumor appeared on examination,
without opening, to be similar in character to the large
one, and was multilocular. The fluid removed from
these tumors prior to operation contained numerous pus-
corpuscles, red blood-corpuscles, also the large granu-
lar corpuscles of " Gliige, " and many cylindrical elements.
The specific gravity of the fluid could not well be de-
termined by the uriuometer, on account of the density
and tenacit)'. The fluids were tested for the various
kinds of albumen, but owing to the great amount of pus
no accurate conclusions could be reached. The fluid
removed at the time of the operation presented the same
microscopic appearances as the fluid removed before,
except the cylindrical elements, which were absent. The
fluid removed at the necrojisy was less purulent than that
examined before, but contained more blood.
Necropsy. — By William H. Reslin, M.D., Curator,
twenty-nine hours after death. Body thin. Wound of
operation in good condition. Thoracic cavity : Contents
normal. Abdominal cavity : When the abdomen was
opened no evidence of recent peritonitis was present.
The wound of the operation had united, except at the lower
extremity, where the drainage-tube was introduced. The
peritoneum in the region of, and over the line of incision
retained the glistening appearance of a normal serous
membrane. The pelvic cavit)- contained about thirty cubic
centimetres of bloody serum, but no evidence of recent
peritonitis. There was, however, some thickening of the
])eritoneum, apparently chronic in character. The stumps
from which the tumors had been removed were in good
condition. Liver and spleen normal. The kidneys were
slightly enlarged : weight, 155 grammes ; capsules thick-
ened and adherent, underlying renal surface granular ;
cut surface, pale; cortex slightly thickened. Micro-
scopically the epithelia was found to be involved by
granular and fatty degeneration ; there was also a slight
increase in the inter-tubular tissue. Chronic dift'use ne-
phritis.
Remarks. — What circumstance or combination of cir-
cumstances might be regarded as res[)onsible for the re-
sult in the first case of ovariotomy 1 have not been able
satisfactorily to determine. Previous to the operation
the [Jatient might have been regarded as in the possession
of jjerfect health, though it is true she was disabled by
the bulk of the tumor and suffered much from its pressure
effects. At the operation no adhesions were found. A
minimum of injury was inflicted on the parts involved.
A short incision might have sufficed but for the thickness
of the abdominal walls. There was not a single compli-
cation, unless the implication of both ovaries might be
considered as one. Every recognized precaution agains^t
the known causes of death in such cases was strictly en-
forced to the minutest detail, and yet the patient died.
Up to within the last few years it was considered pru-
dent by many experienced operators to put oft' the oper-
ation until the sufi" rings of the patient demanded inter-
ference. Many reasons were assigned for such delay :
it was considered that the emaciation consequent upon
protracted disease w^as favorable to recovery ; that the
repeated attacks of peritonitis to which such patients are
exposed destroyed the anatomical characters of the se-
rous sac and its ability to resent traumatism by the usual
process of inflammation. It is true that we do see many
cases recover after very jirotracted and necessarily severe
operations, the severance of almost universal adhesions,
the use of almost numberless ligatures, the cautery, rude
handling, and long ex])osure of the sac. We see such
cases progress favorably to convalescence with scarce a
change in pulse or temperature, and when we see a case
where the conditions all unite to warrant a favorable is-
sue turn out badly, we naturally seek for the cause, and it
will probably be by the careful analysis of individual
cases that we shall eventuall)' make out many of the
causes of disaster. Delay is no longer considered as
proper in cases of abdominal tumor. In addition to the
suffering it entails, mental and physical, it exposes the
patient to many of the accidents which belong to such
cases, rupture of the sac, and the very various pathologi-
cal changes, inflammation, suppuration, gangrene, and
twisting of the pedicle, any of which conditions may ren-
der an operation imperative at a time or under circum-
stances that may jeopardize the result. The best au-
thorities recommend an operation as soon as the condition
calling for it is recognized.
Objection has been made to the performance of such
operations in a general hospital. Such objections have
been made by specialists, generally by gentlemen con-
nected with institutions set apart for the treatment of
diseases of women. I certainly would not sanction
placing a woman who has been subjected to an abdom-
inal section in a ward filled with cases of acute surger)' ;
but if isolation is possible, and all modern precautions
are taken, I can see no objection that would not equally
apply to cases of strangulated hernia or penetrating
wounds of the abdominal cavity, some of which, with
protrusion of the viscera, resemble the conditions met
with in the operation of ovariotomy, for instance, those
in which masses of omentum have to be ligated and re-
turned, and yet these cases do well. Are not the pa-
tients in special hospitals exposed to the same evils that
exist in general hospitals ? The wards in which patients
have died of the common consequences of the operation,
be those consequences simply inflammation or those
more dreaded of infectious or contagious character, are
again occupied by the same class of cases. Doubtless
every jirecaution in the shape of disinfection is enforced,
but this does not relieve them of the odium that attaches
to the former. In my anxiety to avoid any preventable
mischief in this case I put oft" the operation for a month
on account of the presence of a case of erysipelas in an
adjoining building; and yet, within a period of a few
weeks, the second case related was admitted and exposed
to the very influences I had so much dreaded in the first
case. The man had been stabbed the night before his
admission ; his omentum had been protruded many
hours ; it was ligated and excised, and the stump was
returned with no other precaution than the use of carbol-
ized silk ligatures and sutures. A few days after a case
of eiysijielas was found within twelve feet of this patient;
he was removed to another ward, where a second case
of erysipelas was found. .\nd yet, notwithstanding these
exposures, he had an uninterrupted recovery ; in fact, he
had not a single untoward symptom.
It is the more to be regretted that we were not able to
October 13, 1883.]
THE MEDICAL RECORD.
397
obtain an autopsy in the fatal case, inasmuch as I have
a lingering suspicion that the condition of the kidneys
would have helped to explain the result. T. Spencer
Wells, in the last edition of his work " On Ovarian and
Uterine Tumors," refers to the influence exercised by
functional disturbances of those organs on the results of
the abdominal section. He expresses his opinion that in
cases where the secretion is scanty the operation is ajn
to be followed by fatal suppression. In another place
he says : "One condition which certainly requires cor-
rection before the operation is undertaken, is that com-
mon one where only a small quantity of highly concen-
trated urine depositing mixed urates in abundance is
passed. If ovariotomy is performed on a patient in this
condition, a serious amount of kidney congestion, with
symptoms almost amounting to urajmic fever, is almost
certain to follow the operation."
Lawson Tait, in his essay on " Diseases of the Ova-
ries," says : "Especial care must be taken to examine
the condition of the urine, for the state both of kidneys
and bladder is a most important factor in the success of
the operation."
Vogel has calculated that a healthy adult ought to ex-
crete per hour one cubic centimetre of urine for each
kilogramme of weight of his body. The |)atient's weight,
without the tumor, was about one luindred kilogrammes,
and her average excretion ought to have been one hun-
dred cubic centimetres per hour, and on referring to the
history it will be found that it was very much below.
The consequence of such a condition would be the accu-
mulation of excrementitious material in the blood, and
among the results of such contamination we find a ten-
dency to inflaminatory affections. Such were the opin-
ions of Osborne and Traube, and their views have been
corroborated by a host of other observers. Erysipela-
tous inflammations of the skin, purulent infiltrations in
the pleural cavities, in the pericardium, less frequently
in the peritoneum, and the localization of the inflam-
mation may be determined by the condition of the part
involved. In the case reported I was in doubt at first
whether the symptoms on the third day were due to urx'-
niia or peritonitis, but twenty-four hours' observation
cleared up the doubt.
The condition of the kidneys, revealed in tlie autopsy
of the last case, was sufficient to account for death. The
scanty secretion of urine during the time she was un-
der observation aroused suspicion, and repeated careful
analyses were made, with negative results — facts unfor-
tunately of too frequent occurrence.
Relief of Internal Strangulation by Alternate
Hot and Cold Applications. — A man, forty-two years
of age, who had some years previously suftered from a
severe attack of peritonitis, was suddenly seized with
violent colic. There was ineteorism, the abdomen was
generally tender on ])alpation, but more especially at a
point a little to the right of the umbilicus. There was
no passage either of fecal matter or of gas from the
bowel, and purgatives, whether administered by the
mouth or the rectum, brought no relief The obstruc-
tion of the bowels continued several days, despite an
active and varied treatment, stercoraceous vomiting set
in and the patient was rapidly sinking. At this time,
all other measures having been tried in vain. Dr. Roux
{Lyon Medical, September 9, 1S83) determined to try
the effect of the alternate application of heat and cold to
the abdomen. An ice-bladder was first applied and re-
tained for an hour, then it was removed and compresses
as hot as could be borne were placed over the abdomen.
These applications were continued every hour through
the day and night. In the evening some gas escaped
from the bowel, and the following morning there was a
■slight stool. A mild purgative was now given and was
soon followed by a copious evacuation, and the patient
speedily recovered.
THE PLACE OE PANCREATIN IN THERA-
PEUTICS.
By J. S. HAWLEY, M.D.,
BROOKLYN, H. V.
The great importance attached to the nutrition of the
sick, in modern medicine, has naturally and very reason-
ably led to the administration of digestive ferments to aid
in the preliminary act of digestion, and also to the adop-
tion of many devices for conforming alimentary sub-
stances to the impaired digestive functions, which attend
all acute and most chronic diseases. This impulse has
been so potent as to force the (jendulum of medical
opinion and practice far beyond the point of equilibrium,
and which at the present time seems to oscillate between
the extremes of scepticism on the one hand and an
easy credulity on the other. The rule which pancrea-
tin is now playing in this important field of therapeutics,
the wide range of its digestive activities, and the extra-
ordinary attention which has been directed to its use by
the late Lumleian lectures by Dr. Roberts, are sufficient
reasons for inquiring into its proper use. It is by no
means uncommon for men even of genius and learning,
who have been fortunate or wise enough to make a step
forward in the treatment of disease or the amelioration of
human maladies, to be carried by their enthusiasm and
the exaltation which attends success to attribute to their
discoveries or improvements an extent of application
which subsequent observation shows to be unwarranted.
This remark is well illustrated in the title given by
Corvisart to the first pamphlet issued by him on the use
of pepsine, " Dyspepsie et Consomption." The very
great control over the processes of digestion and nutri-
tion which his discovery of the use of pepsin afforded,
impressed him with the belief that its influence would be
sufficient to arrest the ravages of consumption.
The question to be discussed in this [saper is not as to
the relative value of different digestive ferments, but, ad-
mitting the value of all, to determine what is the rational
and eftective mode of using pancreatin. The proposi-
tion submitted, and an attempt to prove which will be
made, is, that pancreatin cannot be effectively or use-
fully administered by the stomach, but can only be em-
ployed for modifying foods before they are taken. The
argument will be presented in relation to the anatomical,
physiological, and experimental aspects of the subject.
When we examine the anatomical arrangement of the
alimentary canal, and the order in which the digestive
ferments are delivered to and brought into contact with
the ingested food, we are struck with this peculiarity, that
they are generated and delivered at points remote from
each other. Comparatively recent demonstrations have
shown that the pancreatic fluid possesses three distinct
ferments, viz., amylolytic, proteolytic, and emulsifying.
Now it would seem to be a fair deduction and sound rea-
soning to conclude that if the pancreatic fluid could ef-
fectively perform these several offices upon crude food,
then the salivary and gastric secretions were useless and
in excess of any want of the system. But their presence
is proof of their necessity, and the existence of ferments
lower down in the elementary canal, supplementary to
them, is proof that their action is preliminary, and the fact
that their offices are performed where the next lower fer-
ment cannot reach them is proof of their incompatibility.
So much may be concluded by a priori reasoning from
the anatomical arrangement. The physiological aspect
of the case will be found in harmony with and confirma-
tory of the above. The gastric juice is not only known
to be acid, but its ferment, pepsin, is inert in any other
than an acid medium, while the pancreatic fluid is alka-
line and is inactive in any other vehicle. This one phy-
siological fact is sufficient to show that the two ferments
cannot act together. One otlier physiological fact goes
to establish the same conclusion, that is, the destruction
of the pepsin in the duodenum by the action of the bile.
Herman ("Elements of Human Physiology," p. i74)>
598
THE MEDICAL RECORD.
[October 13, 1883.
speaking of intestinal digestion, says : " Solution of albu-
minous bodies is effected, most probabl)-, by the pancre-
atic juices, as the activity of the gastric juice which reaches
the intestine is destroyed by the bile." Dr. Lucien Cor-
visart, speaking of the pancreatic digestion (Braitlnraite,
No. xxxix.), says: " \Vhen the gastric and pancreatic
juices are separated they act in succession, and thus the
peptone may be doubled ; but when mixed, the action
of each is checked — they neutralize each other. Nature
prevents this contiict, first, by separating the two juices
by the i)ylorus ; second, by the bile, which destroys the
pepsin, as shown by Poppenheim." Certainly the de-
monstrated fact that the activity of the pepsin is arrested
in the duodenum, not only by the alkalinity of its fluids,
but by the direct agency of the bile, is fairly conclusive
evidence of the incompatibility of the two agents which
meet these. But the question still remains, Can pancrea-
\xa pass throiigli tlie stomach, come out uninii)aired, and
in the duodenum take up its office and play the same
rule as freshly secreted pancreatic juice ? In other
words, can pancreatin be usefully employed by admin-
istration by t!ie mouth ?
The extensive use of remedies in which pepsin and
pancreatin are combined, implies a belief on the part of
many physicians that pancreatin can survive the action
of the gastric juice and pass on unharmed into the duo-
denum, where it is free to perform its office. So far
from this being the case, however, there are many rea-
sons for believing that pancreatin is digested in the
stomach like any other proteid. Lehman says, "the
principal constituent of the pancreatic juice is a sub-
stance resembling albumen or casein." Herman (" Ele-
ments of Human Physiolog)'," p. 142) says : " Its spe-
cific constituents are several albuminous bodies, which are
scarcely distinguishable from albumen itself, and to which
many observers ascribe the ferment action " (jiancreatin).
Now it is difficult to understand why a substance of the
nature of albumen or casein should not be digested by
pejjsin, whose sole object and use is to digest albuminoids,
and whose ability to digest that whole range of sub-
stances is well known. But the determination of this
point does not rest upon inference. It has been shown
by Kiihne that "pepsin in acid solution actually destroys
trypsin (one of the constituents of pancreatin) ; trypsin
in alkaline solution does not possess the converse power
of destroying pepsin, which, however, is altogether inac-
tive in an alkaline fluid."
Mr. E. Schetiter, of Louisville, Ky., has demonstrated,
by careful experiments, the fact that pancreatin digested
with pepsin loses its activitj' in respect to all its proper-
ties. From a number of experiments, ingeniously con-
trived for the purpose of demonstrating this, want of
space will permit quoting only two : First, " To a solu-
tion of one-half grain of pepsin, in two ounces of acidu-
lated water, was added two ounces of pancreas liquid,
obtained by rubbing down and beating three ounces of
chopped pancreas with small quantities of water until
after three strainings four ounces of liquid were obtained,
which readily saccharified starch at the temperature of
the air. The pepsin solution containing the pancreas
liquid, after four hours' digestion, was filtered, neutralized,
digested w-ith starch-paste, and tested, but no sugar ac-
tion was obtained." Second, " To two ounces of pan-
creas extraction was added a solution of one fourtii grain
of pejjsin in two drachms of water, acidulated with five
drops of hydrochloric acid, and the mixture treated as de-
scribed before. Neither from the acid nor from the neu-
tralized solution, after digestion with starch-paste, did
I obtain any sign of sugar by Trommer's test ; while
the pancreas extraction, by itself, treated with starch,
had given the most cojiious ))recipitate of oxidulatcd
copper."
To the same effect are the following experiments, made
by Dr. William Roberts, of Manchester, England,' for the
^ Lumlcian Lectures, page 36.
express purpose of determining the question under dis-
cussion :
" I prepared a solution of lactic acid corresponding in
saturating power to the normal gastric acid (2 per 1,000
HCl). To fifty cubic centimetres of this dilute lactic
acid I added five cubic centimetres of a solution of pep-
sin, and five cubic centimetres of an active extract of
pancreas. I prepared a second similar, but substituted
filtered saliva for the pancreatic extract. The mixtures
were then placed in the warm chamber for one hour. At
the end of this period the solutions were exactly neutral-
ized and tested, they were both found to be absolutely
inert, not a vestige of amylolytic nor proteolytic power
had escaped destruction.
" I had an opportunity of testing the same question ir*
a still more satisfactory way. While I was examining the
throat of a patient suffering from an ailment which did not
affect his general health, a portion of the contents of the
stomach was ejected, and fortunately caught in a clean
vessel. This was immediately filtered, and about ten
cubic centimetres of clear acid solution was obtained.
The period of digestion was three hours after breakfast.
One-half of this w-as devoted to testing its saturating
power. It was found to possess an acidity very nearly
corresponding with that of normal chyme. To the re-
maining portion five drops of extract of pancreas and five
drops of filtered saliva were added, and the mixture
■ placed in the warm chamber for one hour, at the end of
that time it was e.xactly neutralized and divided into equal
portions. One portion was tested with a drop of starcii
mucilage and found to be absolutely devoid of amylolytic
power. The other portion was added to an equal volume
of milk rendered slighly alkaline with carbonate of soda,
and was then placed in the warm chamber. Not the
slightest digestive action was produced on the milk in
twelve hours.
" With this evidence before me, I am unable to accept
the conclusions of Defresne and others in Paris, who
allege that saliva and pancreatic preparations can resist
the normal acidity of the stomach in full digestion, and
who recommend the administration by the mouth of jian-
creatic preparations during the period of chymification."
It appears then that the evidence afforded by the an-
atomical distribution of the digestive fluids, by the phy-
siological constitution of these juices, as well as the
conditions under which they perform their functions, and
the results of experimental inquiry, all point to the con-
clusion that pancreatin not only cannot act in the ])resence
of the gastric juice, but is deprived, by gastric digestion,
of all power to perform its functions.
There remains one more aspect of the question to be
considered, viz.. Can ])ancreatic preparations by any de-
vice be protected from the action of the gastric juice in
their passage through the stomach, in such manner as to
preserve their digestive potency intact until they arrive
in the duodenum, where the conditions are favorable for
their action ?
Dr. Fothergill proposes to accomplish this by adminis-
tering ten or fifteen grains of bicarbonate of soda with a
dose of liquor pancreaticus at " the tail of the digestive
act." "This passes it securely through the stomach ;
just as a guard of soldiers sees a merchant convoyed
over an unsettled frontier infested by robbers." Theo-
retically considered this expedient is open to several
objections.
First, the alkali and the liquor pancreaticus are com-
mingled, hence the pancreaticus is as much exposed to
the attack as the alkali ; as if the soldiers who were sent
to guard a company of merchants should mix indiscrimi-
nately with their unarmed charge, an attack upon this
promiscuous assembly would be as likely to prove
damaging to the guarded as to the guards. If the alkali
could be made in some way to surround the pancreatin,
so that the acid gastric juice could be neutralized before
the pancreatin became exposed, more certainty would
attend the device.
October 13, 1883.]
THE MEDICAL RECORD.
399
Second, it must not be forgotten that ingesta of no
kind pass directly tiirough the stomach. It is the nature
and office of the stomach to retain its contents, and to
pour out gastric juice upon them. Under these circum-
stances how long would ten or fifteen grains of alkali
resist the acid of the stomach ? It is proposed to give
the alkali and pancreatin an hour and a half or two
hours after the ingestion of a meal, at " the tail of the
digestive act." Does not the digestive act continue
from four to six hours ? Can " the tail of the digestive
act " be determined ? Does not every fresh ingestion
provoke a fresh discharge of gastric juice ? Certainly
such a procedure, to say the least, must be subject to
very great uncertainties. The stomach is well called an
" acid gulf," " which we have to guard against, else our
artificial pancreatic secretion is useless, of no earthly
avail." It seems more probable that this " acid gulf "
would swallow up any adventurous pancreatin which
should attempt to cross it, than that the rash adventurer
should cross it in safety. But, theory aside, it is claimed
that clinical experience justifies the conclusion. It, how-
ever, should not be forgotten that clinical experience is
invoked in defence of the use of pancreatin, not only
unguarded by an alkali, but actually in combination with
acidulated pepsin, which both Dr. Roberts and Dr.
Fotliergill assert to be fatal to pancreatin. The whole
course of therapeutics is strewn with the wrecks of reme-
dies which have been foisted upon the profession by the
supposed results of clinical observation. Perhaps noth-
ing is more delusive than a fragmentary and ill-digested
collection of clinical facts. The sources of error are too
numerous, and the conditions too complicated, to allow
clinical observations to determine any important con-
clusion until many facts, well observed and carefully
collated, have been brought to bear on the question.
More especially must this be the case when the clinical
observations contravene what are supposed to be well-
demonstrated scientific facts, as in the case under con-
sideration. Science will be of little avail in promoting
the advancement of the medical art, if facts established
by research and observation are to be lightly set aside by
clinical observations short of absolute certainty. It
seems far more reasonable to conclude that clinical
experience will in the end conform to scientific demon-
strations.
But whichever way the progress of observation and
experience may determine this question, pancreatin has
before it a wide therapeutic field. Second only in im-
portance to the promotion of the digestive act within the
organism is the adaptation of foods to the conditions of
disease. The whole subject of the nutrition of the sick
may be influenced by the use of this agent. The patent
fact that the stomach, in common with all other organs
of the body, is impaired by all acute and many chronic
diseases, aftords a wide scope for the use of artificially
digested foods ; but more especially is pancreatin likely
to revolutionixe the vexed question of infant feeding.
The principal obstacle to the successful administration
of cow's milk is alleged to be the density of the coagu-
lum formed by the action of the acids of the stomach
upon the casein of the milk, thereby preventing itsjjroper
digestion. The devices for overcoming this difficulty
have been numerous, but none of them entirely satisfac-
tory. The use of pancreatin preparations appear to
meet this difficulty fully. Dr. Roberts ' ascertained by
many experiments that pancreatin acts with great ra-
pidity upon the casein of milk, and if not fully peptoniz-
ing it, certainly rendering it non-coagulable by heat or
acids. This would seem to leave little to be desired in
the matter of the adaptation of cow's milk to the pur-
poses of infant-feeding. In the case of feeding infants
upon farinaceous substances containing a large prepon-
derance of starch, as they all do, the objection to their
use is deemed to lie in the inability of very young infants
^ I-umleian Lectures.
to saccharify starch, either by the action of the salivary
or pancreatic secretions. This inability to digest starch
has been attributed to non-development of the salivary
and pancreatic functions, which, it is alleged, has been
physiologically demonstrated. But over and above any
demonstrations, such inability might well be inferred
from the fact that infants are constituted to receive, and
the Creator has provided for their use, a food which re-
quires the action of neither salivary nor pancreatic di-
gestion. The salivary secretion, being only diastasic,
finds nothing in the milk to act upon. The gastric juice
is amply sufficient to digest the casein, and as to the fat
in the milk, it does not require the action of the pancre-
atic juice, for all nascent milk is in a perfect state of emitl-
sification. So it appears that the infant is fully able to
digest milk through the action of the stomach alone, and
we may fairly infer that functions would not be provided
for before there was need for their employment. This
amylaceous apepsia of infants has been met by number-
less devices, as is attested by the legion of infants' foods,
which, by methods more or less effective, have been de-
vised to overcome it. The most complete as well as
the most scientific of these methods, is that known as
Liebig's, which consists in saccharifying the starch by
the action of the diastase in malt. This is an expensive
and somewhat difficult process, so much so as to be un-
successful in the hands of the average mother or nurse,
and has consequently fallen into the control of manufac-
turers. But by the use of artificial pancreatic prepara-
tions this conversion of starch is accomplished with the
minimum of trouble and skill. It consists simply in
adding to the cooked food, at blood-heat, the pancreatic
liquid, and allowing it to stand in a warm place one
hour. A process so simple and so effective certainly
seems likely to banish many of the infant foods which
are now urged upon the attention of mothers and phy-
sicians.
The question, "What is the place of pancreatin
in therapeutics ? " may, in view of the facts set forth
above, be confidently answered : Not as a remedy to be
administered internally, but as an agent for adapting
foods to the impaired digestive functions of the sick, and
especially to the preparation of cow's milk and farina-
ceous foods for infant feeding.
THE LATE DR. GEORGE M. BEARD.'
A Sketch.
By a. D. ROCKWELL, M.D.,
NEW YORK.
Mr. President and Gentlemen — The date and place
of a man's birth, some of the details of his earlier life,
educational and otherwise, an enumeration of the amount,
and an estimation of the character of his work — these in
the main fulfil the necessities of the ordinary obituary
record.
All these points have, however, been more or less fully
dwelt upon in the various notices of Dr. Beard that have
been written, and in complying with the altogether un-
expected solicitation of the president that 1 prepare a
brief sketch of my late associate to be read before this
Academy, I shall confine myself rather to what he was
than to what he did. What he did, in the way of pro-
fessional literary work, must be known to all who keep
abreast of the current of scientific research, although few
have any conception of the vast amount of labor that
was accomplished in the short space of his_ forty-three
years. The simple enumeration of his various books,
monographs, pamphlets, and magazine articles, would
consume the time that can well be spared for this presen-
tation, and I shall therefore, as an evidence of his won-
derful industry, ask you to accept my statement that few
of his age in this or any other country, equalled him in
the amount or variety of his literary work.
' Read before [he American Academy of Medicine, October 9. 18
400
THE MEDICAL RECORD.
[October 13, 1883.
Opinions will differ as to the value of some of it, but
that most of it was original, stamped with his own indi-
viduality, and presented in such a clear and lively way
as to compel attention, all must agree. The impulse in
him to work was so strong, that in his waking moments
I do not suppose he was ever absolutely idle ; his mind
was constantly busy, appropriating the facts and casual
suggestion of every-day life, for a possible future use or
reference. However great the pressure of professional
or literary work, he was always ready to drop evervthing
for the purpose of conversing. It made but little differ-
ence whether the one with whom he was in communica-
tion was intellectual or the reverse, he would listen as
long as anything was to be said, and no utterance of
value, or striking manifestation of character, escaped
him.
I have often been amused and even amazed at the
patience and gravity with which he would listen to the
most trivial talk and the most absurd expressions of
opinion, but I soon learned that these not infrequently
constituted the basis of much that was strong and origi-
nal in his writings. The power in him to formulate the
crude ideas of others, seemed to be instinctive.
Much of the wide and deep meaning represented by
common and constantly reiterated e.xpressions, he in
some way drew to a point, and gave to it a " local habi-
tation and a name." As has been well said of him, "he
worked because he loved to work ; not as a slave, but
as a cliild filled with and prompted by filial devotion,
and in the very hour of his dissolution he expressed
the hope that some one would take up his work at the
point he left it and carry it forward, and he whispered
the wish that he might be permitted, as a contribution to
his work, to place upon record the thoughts of a dying
man."
Among many illustrations of his devotion to work, I
recall the fact that soon after the late war, and in the
beginning of our professional relationship, I observed
among his effects an immense pile of manuscript, which
upon inquiry I found to be a work of fiction, written for
want of something better to do, while serving as assist-
ant surgeon in the " Gulf Squadron.'' Parts of it were
intensely interesting, and contained many graphic de-
scriptions of life and character as he saw it, and if pub-
lished would undoubtedly have proven a valuable con-
tribution. He however regarded it as of little account.
Its ])urpose as a vehicle of expression when there was
no s])ecial work at hand, had been served, and he al-
lowed it to become scattered and finally destroyed. Such
was the facility and accuracy with which his thoughts
struggled to the birth in written language, that his pen
was equally ready at his desk or in car or boat, and his
manuscript seldom received a correction ; but the pub-
lisher will not soon forget, nor will I, the sad havoc he
played with the proof-sheets in his additions and emen-
dations.
Perhaps the most striking trait of Dr. Beard's charac-
ter was his humor. With an expression of ])reternatural
gravity, he yet seemed as was said of Jean Paul Richter
" to exist in humor ; to live, move, and have his being
in it." That shallow endowment termed irony or cari-
cature, which often passes by the name of humor, but
consists chiefly in a certain superficial distortion or re-
versal of objects, and ends at best in laughter, found
little place in him. " True humor springs not more from
the head than from the heart," and in Dr. Beard it found
its best expression in his intercourse with those far below
him in the intellectual and social scale, and so the rela-
tions formed with this class became immediately pleasant
and heljtful.
In him was illustrated Carlyle's remarkable statement
that " Hiunor is a sort of inverse sublimity, exalting as
it were unto our affections what is below us, while sub-
limity draws down into our affections what is above us.
The former is scarcely less precious or heart-affecting
than the latter ; perhaps it is still rarer, and as a test of
genius, still more decisive. It is in fact the bloom and
perfume, the effluence of a deep, fine, and loving nature,
a nature in harmony with itself, reconciled to the world,
and its stintedness and contradiction, nay, finding in this
very contradiction, new elements of beauty as well as
goodness."
The reputation for a certain eccentricity which was so
universally accorded to Dr. Beard, was in great measure
due to this element of subtle humor, born with him, for
between the intense solemnity of his countenance and
the thought about to be uttered, there was such an utter
incongruity, that it is not to be wondered at that the
stranger or casual acquaintance should look upon him
as something of an enigma. Therefore it was that few
men in our profession have been so little understood, or
as it might be put, more grossly misunderstood.
One of the most kindly and genial spirits that went in
and out among us, he has been subjected to an amount
of abuse, both public and by private communication,
most unmerited. Amidst it all, he was to outward ap-
pearances as unconcerned as if every shaft was directed
elsewhere than toward himself. Against those who struck
the hardest and with the least provocation, the only re-
venge he ever sought or wanted was the exercise, at
their expense, of a little of his inimitable and quaint
humor ; at times, not unmixed perhaps with a shade of
contempt. On the contrary, a notable characteristic of
Dr. Beard in his estimate of the life and work of others,
was tolerance ; and more than this, he practically held
that no character was ever rightly understood until it
has first been regarded 7iot only with tolerance, but with
sympathy as well. One other element of character which
contributed not a little to this antagonistic feeling, was
a positiveness of statement which, in the minds of many,
could proceed only from intense and offensive egotism.
That Dr. Beard was egotistic, in the sense of placing a
high value on his own interpretation of certain phenom-
ena in physics and psychology, as against the opinions
of non-experts in these realms of science, cannot be de-
nied. It was, however, that egotism that comes from
the consciousness of a clearer and a keener insight, and
no better evidence of its inoffensive character is wanted
than the fact that those who knew him most intimateh',
found nothing disagreeable in the manner of these ex-
pressions of opinion.
As he said of himself, " he never argued, he simply as-
serted." This was the result partly, of a natural disin-
clination to polemics, and partly to a settled conviction,
that the surest path to establish the truth as he under-
stood it, was to boldly and persistently reiterate it.
Many instances could undoubtedly be given, where
those who were in any way placed in opposition to him,
would bear unreserved testimony to the height of his con-
ceit ; and from their standpoint, this judgment would be
correct. On one occasion, he was in court giving testi-
mony in favor of the plaintiff" in a suit for damages. The
defendant's counsel, an astute lawyer, after a severe
cross-questioning, in which in every way, he attempted
to belittle the attainments of the w'itness, suddenly asked
him if he had not been in Oermany lately. The answer
was that he had. " For the purpose of learning, I sup-
pose ? " suggested the lawyer. " Xot at all," was the
answer, " I went over for the purpose of instructing
them."
Not many years ago, in a somewhat celebrated trial,
he had been on the witness stand several hours, and had
sorely tried the patience of the cross-examiners by his
cool assumption of superior knowledge, until in anger
one of them finally said :
"Then it is to be presumed that all authorities who
differ from you in this matter, are in error ? "
" It is to be presiuned that they are,' was the reply.
Some have said that he sought notoriety, and worked
selfishly for his own ends. In regard to this, / write in
remembrance of the time, after our sejiaration, when im-
pelled solely by his ever restless instinct for research, he
October 13, 1883.]
I THE MEDICAL RECORD.
401
neglected every expedient of private prudence, for the
purpose of investigating along lines which could in no
possible way bring in any return, and in this he persisted
until his pracnce, which was his only reliance, was so
nearly ruined, that for the time being he abandoned it
altogether for another tield. He soon returned to it,
however, and with what success is well known. After
his death, there was fountl among his papers, a rather ex-
tensive pile of manuscript, which for a better name,
might be termed a series of autobiographical sketches.
I refer to them here because they illustrate many points
of his character, and especially this tendency to humor-
ous exaggeration of which I have spoken. Any one who
knew Dr. Beard with any degree of intimacy, was aware
that he seemed utterly destitute of any financial sense,
so far as having any appreciation of the value of money,
excepting as a present necessity. Accordingly, there
were times in his earlier professional life, and occasionally
up to within more recent periods, when he was closely
beset by clamorous creditors, until to most people life
would have been a burden. It was during one of these
periods undoubtedly, that the portion of the autobio-
graphical sketches was written, referring to the mutual
relationships of debtor and creditor. A more unique
and quaintly humorous exposition of this relationship I
can well imagine was never before presented. From so
much that is good it is difficult to select, but I will ven-
ture to give one short extract :
" I congratulate myself, that few persons at my time
of life, have succeeded amid severe discouragements, in
honestly acquiring so admirable a band of creditors ; in
that select circle, are found names, of whom, if the world
is worthy, certainly I am not. It is truly worth all the
deprivations and obstacles, and misunderstandings I have
encountered in my pathw-ay through this vale of sorrows,
to have been brought into such an intimate relation, for
next to marriage, debt is the closest of all connections,
and tends to make the parties concerned, thoroughly ac-
quainted.
" It has been said by those who regard themselves as
wise, that you must winter and summer with one, before
you can know him, but I will recommend a shorter and
surer road to acquaintanceship — the getting in debt to a
man or allow him to get in debt to you. Such delicate
relationships, bring out as I have noticed, the finer and
subtler and least suspected qualities of human nature,
that would never reveal themselves to any other test what-
ever ; indeed, no man can be said to know himself, until
he has been either a debtor or creditor.
" Not the least of the charms of the relationship of debt-
or and creditor, if one may judge from his own experience,
it its permanency ; in this feature it is certainly superior
to wedlork, or to any other earthly relation. Marriages
are followed too often by separations, divorces, or at least
by infidelities ; but my creditors, or their representatives,
are never long away, they never sue for a divorce, and
are faithful unto death."
Let it not be understood from this that the subject of
this sketch was indifferent to the claims of others. His
readiness further on when the ability came, to meet these
obligations, is sufficient evidence to the contrary, and I
have alluded to this somewhat delicate matter, that the
testimony of one who knew him better than most others,
might be borne to the essential integrity of his character
in this respect ; and while with the rest of mankind his
imperfections are sufficiently manifest, it is an education,
in this age of greed and gain, and backbiting, to have
held communion with a man, who, so far as all outward
evidences are concerned, seemed altogether free from
envy, hatred, and malice.
Judged by many an accepted standard, he would be
readily enough disposed of, and consigned by self-satis-
fied plodders to the oblivion appointed for all strange
and misunderstood things, but tried by the great law of
culture, which leads every man to become what from the
beginning he was created capable of being, "resisting
all impediments, casting off all foreign adhe.sions, and
show himself at length in his own shape and stature, be
these what they may ;" judged, I say, by this standard,
he represents to his contemporaries, an interesting,
unique and lovable personality.
A CASE OF TARTAR EMETIC POISONING.
Recovery after taking One Hundred and Seventy
Grains.
By JAMES STR.\TTON CARPENTER, M.D.,
RESIDENT PIIVSICIAN Eh'ISCOl'AL HOSriTAL, IHILADELPHIA, PA.
Thomas C , aged twenty-one, employed in the dis-
pensary department of the Episcopal Hospital, was ad-
mitted to the medical ward on the afternoon of June
30th, with all the symptoms of acute antimony poisoning.
It was learned on inquiry, that, mistaking a bottle of tar-
tar emetic for one containing cream of tartar (the latter
having on several previous occasions satisfactorily re-
lieved the constipation to which he was subject), he had
poured out several teasjioonfuls of the drug into a tum-
bler of water, and then drank the solution.
No unpleasant symptoms occurred for a quarter of an
hour afterward, when he was taken violently ill, and
vomited, as he expressed it, "a wash-basin half full."
This was followed by several more attacks of vomiting,
accompanied by a burning sensation, which later in-
creased to violent pain along the oesophagus and in the
epigastric region. When admitted to the ward, half an
hour after taking the poison, he was in a condition of
extreme prostration, amounting almost to collapse, with
coldness of the extremities, a weak, thready pulse, and
the accompanying symptoms of a gastro-enteritis that
were distressing to witness. The contents of the stom-
ach having been thrown off, the continued emetic action
of the drug but served to add to its depressing effect on
the system, and after the most violent and oft-repeated
eff'orts at vomiting, which were followed by the ejection
of a few drachms of bilious fluid, or of mucus mixed
with blood, the patient would sink back thoroughly ex-
hausted.
The full emetic eff'ect of the drug having been ob-
tained, the indications to be met were : First, the ad-
ministration of the recognized antidote, tannic acid ; and
second, the proper remedies for a gastro-enteritis, accom-
panied by a most alarming depression of vital energies.
Copious draughts of the tannic acid solution were accord-
ingly given, and these followed by albuminous drinks, the
deodorized tincture of opium being given for the burn-
ing pain complained of in the abdomen. The ther-
mometer at this time indicated a body temperature of
but 95° Fahr., and the radial pulse, which was scarcely
perceptible, was slow and intermittent in character, and
it seemed as though the hope were not to be realized,
that in the violent vomiting which had first occurred
enough of the poison had been gotten rid of to prevent
a fatal termination.
In addition to internal stimulation with small and fre-
quently repeated doses of spts. frumenti and liq. cal-
cis, external stimulation by means of hot-water cans
and vigorous friction of the chest, legs, and arms with
heated towels was kept up, and it was only after three
hours' unremitting care that reaction was established.
The temperature rose to 99.5°, and the pulse improved
in rate and force. The patient had a typical " rice-water
stool," streaked with blood and accompanied by rather
severe cramps in his legs several hours after his admis-
sion, but this was the only evidence of the intestinal irri-
tation that occurred of that character.
The abdominal pain was largely overcome by the deo-
dorized tincture, of which gtt. cxx. were taken within
two hours, in addition to a hypodermic of morphia. The
distressing thirst was a difficult feature of the case to
meet, but a most grateful drink was obtained by cooling
402
THE MEDICAL RECORD.
[October 13, 1883.
the egg and milk mixture with ice, of which he drank
frequently in small amounts.
At first the urine was scanty and dark-colored, but
contained neither blood nor albumen. The after-treat-
ment was the continuation of the milk diet, with entire
rest in bed for three or four days, when the patient was
discharged cured, and up, to the present time, over two
months since the accident, has experienced no further
trouble.
The amount taken was not less than one hundred and
seventy grains — which I ascertained by afterward asking
the patient to pour from a bottle of the tartrate of anti-
mony and potass, the amount he thougut he had taken,
and then weighing it — a rather imperfect method of as-
certaining the fact, but, when it is remembered the object
the patient had in view in taking the supposed " dose of
salts," the estimate will not appear at all too high.
In this case it may be interesting to note :
First. — The length of time that occurred between the in-
gestion of so large an amount of the poison and the pro-
duction of its first symptoms, as being in accord with the
accepted idea of the action of tartar emetic upon the
centres, absorption being first necessary, rather than its
having any direct local irritant action upon the membrane
of the stomach, and so causing the violent emesis.
Second. — The urine, which, according to some author-
ities, in the beginning of mild, and even of fatal cases,
is increased in quantity, was in the present case almost
suppressed.
Third. — The respirations, which are said to become al-
tered in rhythm by the action of the drug on the respira-
tory centres, were unaltered in character.
Fourth. — There were no disturbances of sensory func-
tion, the ability to appreciate thermic irritants being at-
tested b_v the patient's ready recognition of the elevated
temperature of the hot cans with which his bed was
provided.
Reports of gtospitals.
HOSPITAL OF THE UNIVERSITY OF PENN.
SYLVANIA.
Clinic of WILLIAM GOODELL, M.D..
^:;,j PROFESSOR OF GYNECOLOGY IN THE UNIVERSITY OF PENNSYLVANIA.
ABDOMINAL TUMOR IN A YOUNG GIRL REMOVAL OF THE
OVARIES IN THE TREATMENT OF CONFIR.MED MASTURB.A.-
TION AND OF OVARIAN INSANITV.
Gentlemen : The first patient that I show you is a
young girl whom I have not yet examined. I shall elicit
the history before you.
She is seventeen years of age and single. Puberty
began at the age of sixteen and she has menstruated
three times, the last time being in the latter part of last
December. There have been intermittent abdominal
pains and some nausea.
She has menstruated. This shows that there is no
congenital atresia and that a passage exists. Before the
first menstruation she had a "good deal of pain in the
abdomen," but she did not suffer at the subsequent [leri-
ods. I have asked her about the color of the discharge,
but there appears to have been nothing abnormal about
• that. \Vere there retention of the menses the discharge
would be exactly like tar. By retained menstruation we
mean that the woman has menstruated, but that owing
to some obstruction, either in the neck of the womb or
in the vagina, the blood cannot escape. The fluid parts
are absorbed and when it does come away, it is a thick,
tarry fluid. There has been nothing of this kind in the
present instance. To complicate matters, it a|)pears
tliat she has a tumor. •
^_ The first thing that you should think of in all cases of
suppression of the menses is pregnancy. It is astonish-
ing how many blunders are made on that very point.
Only a short time ago a lady was brought to me from a
very distant city by a kinsman (who wa^ a physician) to
consult me in regard to a tumor, which turned out to be
pregnancy. Had she not been a kinswoman the physician
would probably have discovered the nature of the tumor.
I have had many such cases. Pregnancy is the first
thing that vou should consider in all these cases, no mat-
ter how unexceptional may be the character of the girl,
for all are liable to fall as did David, although he was " a
man after God's own heart." This patient came here
on account of the suppression, and knew nothing about
the existence of a tumor.
Here you see the tumor for yourselves, and the ques-
tion arises as to its nature. If this were i^regnancy we
should look for labor in the latter part of this month, the
menses having stopped in December.
I now turn to the breasts. In pregnancy certain
changes take place in the areolae, with which you are all
familTar. They are, however, not pathognoiiionic, and
depend to a great extent upon the complexion of the
skin. Remember, also, that the excitement of having
the breasts examined will sometimes cause a condition
of the skin resembling goose-flesh, and a supposed en-
largement of the glands of Montgomery. In the pres-
ent instance the breasts are not altered, and they do not
contain milk. Her complexion is remarkably good, be-
ing, in fact, quite florid, but this may be due to excite-
ment.
The tumor is on the right side, movable, somewhat
irregular, and rather high up. I can place my hand be-
low it.
I shall now examine per vaginam. In private prac-
tice my favorite method of examining is to bring the
woman's nates over the edge of a hard mattress and
place her feet on my knees. I find the cervix pushed
away back and I also feel a second tumor, which ap-
pears to be a prolongation of the tumor above. To the
touch this feels like a case of multiple fibroids, but such
a condition in a white girl of this age would be very re-
markable. It would not be so in a colored girl. I find
a central hymen. Still there might be penetration with-
out rupture of the hymen. There are then two tumors ;
one direcdy over the bladder, which is plainly too large
to be the womb, and a second tumor above, united to
the lower one. With the greatest care, I have intro-
duced the sound. The womb is to the left, and appears
to be wholly independent of the tumors. It measures
three inches, but further information I cannot glean, be-
cause she is so restless and nervous that it is impossible
to make a thorough examination. My diagnosis at the
present time is that there is a solid tumor of the womb
or of the ovary, and I think more prob.ably of the latter,
and I fear of a malignant nature. If this tumor were a
foetus, it must be an extra-uterine pregnancy, but extra-
uterine pregnancy should not stop the menses. The
womb evidently has no connection with the tumor unless
it be by a long pedicle. She will not submit to the ad-
ministration of an ansesthetic to-day, but I shall try to
persuade her to return next week and allow us to admin-
ister ether in order to make a thorough examination.
Removal of the ovaries in the treatment of confirmed
tnasttirbation and of ovarian insanity. — Our next pa-
tient has been a great sufterer. She has been bedridden
since May, but for a long time before that was a great
suflferer. She sleeps very little, has constant ovarian and
vesical pain and great distress in the back and pelvis.
The pain radiates from the ovary, down the inside of the
thigh in the course of the genito-crural nerve. She finds
it impossible to walk, and, although well nourished, is a
confirmed invalid. In addition to these symptoms, she
is unp-ble to pass her water, and had to have it drawn by
a physician, until she learned how to introduce the ca-
theter herself. I grasp a fold of the abdominal wall and
you see that there is at least an inch of fat, showing tha^
October 13, 1883.]
THE MEDICAL RECORD.
403
she is well nourished. The expression of the face is that
of health. You may lay it down as a broad rule, that when
there is severe pain in combination with a well-nourished
condition of the body the pain is not due to organic or
structural disease, but is the result of nerve trouble.
There are, however, some exceptions to this rule.
Before sending the patient out, I wish to show you
hypertrophied nymphs and a condition of unnatural
redness which exists about the vulva. These are the
only symptoms that can be seen. (The jjatient was now
removed.)
This is an interesting case. This girl spent over four
years in as many institutions before I saw her, and yet
she is no better. When 1 observed her bright exjiression
of countenance, and her well-nourished condition, I at
once concluded that she was suffering from some nerve
trouble. On making a vaginal examination I found such
marked symptoms that 1 turned to the physician with
whom I saw the case and whispered to him, "This must
be a case of masturbation brought on by mental trouble."
He said that such was the case and that it had been
found out in all the institutions in which she had been an
inmate. There was excessive hyperesthesia of the jiarts,
but no uterine trouble proportionate to the severity of
the symptoms. There was some congestion of the ova-
ries and of the womb. The ovaries were very tender and
could be felt from below, a little enlarged. The nympha:
hung down like dewlaps, and this generally indicates
masturbation by attrition.
The history is that she had an early disappointment in
love. This produced the mental trouble which caused
the exciteme.it of these organs. We are all emotional
creatures, and during the sexual life these organs exert a
great influence over both men and women. Love is not
an abstract idea, not sheer cerebration, but a complex
emotion. It is an alloy made ui) partly of mind, partly
of body. In this case the result of the disappointment
was a shock and congestion to the whole nervous system,
and a shock to those organs so exacting during woman's
menstrual life — the ovaries. She got into the habit of
masturbating and has practised it ever since.
This is a serious case, one of positive disease, and is
not to be sneered at or put to one side with a shrug of
the shoulder. This girl is a terror to her parents, who
are glad to get her out of the house. They have had to
employ nurses without number, and she has worn all of
them out.
What is to be done? Such cases as this one open a
new field for investigation. I purpose to remove the
ovaries. Here is a woman lost to society and a burden
to herself and friends. I do the operation experiment-
ally. Strange' as it may seem to you, the site of sexuality
in woman, as well as in man, has not been positively de-
termined. Even in the eunuchs, who had been so before
the age of puberty, the sexual desires are not wholly
obliterated. On this account the Turks (among whom I
lived for many years) demand not only the removal of
the testicles, but also the amputation of the penis flush
with the pubes. In order not to wet his clothes, every
eunuch has to carry with him a catheter through which to
urinate. We see the same thing illustrated in our streets
to an unpleasant degree by the cattle, for the steers or
young oxen play the part of bulls. Women in whom the
ovaries have never developed possess no sexual feeling ;
but when the ovaries are removed after puberty it is
questionable whether the se.xual feelings are at all in-
fluenced. I know of cases in which keen sexual desires
were not in the slightest degree blunted by the operation.
In explaining such cases, some say that all of the ovarian
tissue has not been removed, or that there may be sev-
eral supplementary ovaries. There is a certain degree
of logic in this reasoning, for abnormal cases of this kind
do occasionally occur, but it is not wholly sound.
Four years ago we had in this building an abominable
case of masturbation, and in the most repulsive-looking girl
I ever saw. She was a patient of one of my colleagues,
who in vain did all he could to quench her inordinate
desires. A consultation was therefore held by several
members of the staff as to the propriety of removing the
ovaries. I objected to this operation in her case for the
following reasons : In the first place, the girl was here
without friends to advise her, and was innately bad ; I
thought also that in the future she might give me trouble
by prosecuting me for having unsexed her, and such a
tale would tell well on a sympathetic jury. In the sec-
ond place, I was not sure that the operation would have
the desired effect of making her a respectable member of
society.
I was asked some time ago by the sujierintendent of
an insane asylum to spay a half-idiotic girl. It was im-
jiossible to keep her under strict surveillance, and the
sexual feelings were so urgent that she was at the beck
of the first comer. She had already borne two illegiti-
mate children. I told him that I should feel humiliated
in removing the ovaries simply " to let copulation
thrive," but I was willing to perform the operation in or-
der to prevent an idiotic offspring, an end which seems
to me legitimate. At the same time I told him that I
must have a written authority from the managers of his
institution that I had their consent, .^fter an interesting
discussion, the managers decided not to give the needful
permission, and so the matter fell through.
Less than a week ago I was called to an insane hospi-
tal to see a case of erotic insanity exhibited by mastur-
bation and foul language during menstruation. I was to
decide whether or not it was best to remove the ovaries.
After a careful investigation, I could not detect any local
disease whatever. There was tenderness of the ovaries,
but no enlargement could be discovered. The girl was
perfectly sane outside of the menstrual period, and was
anxious to have the opeiation performed. The father
and mother have also signified their consent. I told the
doctor that, while I did not feel sure that extirpation of
the ovaries would remove the sexual desires, it was an
operation well worth trying, for, if it did not cure her, it
would prevent her from bringing into the world an insane
oft'spring. Further, that the operation could do no harm,
unless the patient died, and that death in such a case
was so questionable a harm that it would not grieve nie.
I should feel that I had done my duty, and that she and
society were better oft". On the other hand, when I re-
move the ovaries for other causes and the patient dies it
grieves me to the quick. I shall probably perform
oophorectomy in this case next month.
The first case of oophorectomy mentioned in history
was performed for the purpose of abolishing the sexual
feelings. This case may be apocryphal, although it
seems to be as well authenticated as many other accepted
traditions of old-time heroes. It is said that a Hunga-
rian sow-gelder became so infuriated at his daughter's
lasciviousness that he forcibly extirpated her ovaries ;
but history, if my memory serves me no trick, does not
tell us whether or not she was more chaste after the
operation, and this is the point that I am after.
The father of the girl whom I brought before you came
to me and told me that if his daughter would not consent
to the operation, that he and his wife wished me to do it
by force. This incident shows how wearied out they
were with her pains, and aches, and screams, and fancies,
and other hysterical manifestations, whose name is le-
gion. I tbld the girl what her father had said to me, and
added : " You are twenty-three years old and your own
mistress, and I shall not touch you without your free
consent." This she gave me in the jiresence of several
witnesses. I once removed the ovaries by force, but I
shall never do so again, for it is an act that a jury might
take an ugly view of. The case is as follows :
Several years ago, when about to attend a meeting of
the State Medical Society, a physician of the city in
which the meeting was to be held, wrote to me that he
had a case of ovarian insanity which he thought was a
proper one for oophorectomy and requested me to bring
404
THE MEDICAL RECORD.
[October 13, 1883.
i
my instruments along. He took me four or five miles
into the country to a dilapidated hovel, where I saw a
wretched girl just coming out of a violent insane attack.
She was insane all the time, but had frightful exacerba-
tions about the menstrual period, so that for three weeks
in every month she would be beyond all control. I
found on examination that both ovaries were low down,
enlarged, and extremely tender. I considered it a proper
case for operation. The parents, worn out with care and
fatigue, were very anxious to have the operation per-
formed, and at once gave the necessary consent. In the
afternoon we returned, forcibly administered ether, and
removed the ovaries. She has been much benefited by
the operation. All the violent symptoms are gone, but
her mind is weak. Had her parents put her in an insane
asylum she would have got well.
1 have wandered from my subject, but while speaking
of ovarian insanity, let me mention some cases that I
have cured. All of these were accompanied by erotic
feelings.
One was a married lady who about a week before the
menstrual period would begin to be insane and become un-
controllable. These attacks would last for three weeks.
After the paroxysm was over she would be perfectly sane.
She had been to two or three institutions, .\lthough the
physicians in charge of these institutions objected to the
operation, I removed the ovaries. She was restored to
perfect mental and physical health. One of the gentle-
men who had opposed the operation was converted by
this case, and a short tune ago sent for me to come to his
asylum to remove the ovaries in an analogous case. I
could not go at the time, and shortly afterward the pa-
tient died from some acute disease.
The second case was one of those cases lying on the
border-line between insanity and hysteria. She had be-
come alienated from her famil)-, and imagined that her
friends were her worst enemies. She had excessive men-
orrhagia, and had been bedridden for years. I removed
the ovaries, and she got mentally well, while her physical
condition was very much improved.
A third case was that of a lady of most excellent fam-
ily. From an accident she had received a severe mental
and physical shock. This was the beginning of the dis-
ease. Her health began to fail, ovarian turgidity appeared,
and finally ovarian insanity developed. About a week
before the menstrual periods the most horrible hallucina-
tions would take possession of her, and she had mental
fights such as Christian had with Apollyon. Later in the
period she had an irresistible desire to kill a friend to
whom she was most tenderly attached. Then, to save
herself from injuring him, she made attempts to take her
own lite. She also sufiered from menorrhagia, and was
reduced to a condition of the utmost weakness. I was
asked to see the case, and concluded with her physician
that the ovaries were the seat of the trouble. .Alter a
good deal of opposition on the part of the family, the
operation was successfully performed. Before the opera-
ration she could not touch meat because there was blood
on it. Blood vvas on her clothing, in the air, and on
everything around her. Tike Lady Alacbeth she saw
blood everywhere. As she recovered from the et^ects of
the operation it was interesting to watch these halluci-
nations gradually leaving her. Soon she was able to eat
meat, and took large (juantities of it. Now she is no
longer insane ; she is doing well, and is a wonder to all
her friends.
I had another successful case, but at this moment I
cannot recall the particulars of it. Were Dr. ]5aer pres-
ent he would probably remember it.
In view of the fact that the removal of the ovaries has
cured these cases, 1 think that it may do good in this in-
stance. While I am not positive that the sexual feelings
will be eradicated, I feel justified in performing the ex-
periment. As regards the operation, it is performed in
the following manner : A short incision is made below
the navel in the linea alba, sufficiently long to admit two
or three fingers. Each ovary, with its oviduct, is seized,
the pedicle, consisting of broad ligament and blood-
vessels, is transfixed, tied, and cut off. The wound is
closed in the usual manner, but everything is done under
strict antiseptic jirecautions. Although I do not believe
with Tait that the oviducts preside over menstruation, I
always remove them together with the ovaries, because
by doing so I get a longer pedicle, and am less likely to
leave ovarian tissue behind.'
gr00rcss of ptcttical Sctjcucc.
SvPHiLiTic Fever. — Dr. Dutlocq relates in La France
Midicale, of August 30, 1883, the history of a young man,
twenty-five years of age, who was admitted to hospital
suffering from a fever. The attack had begun eight days
previously with headache and vertigo followed by vomit-
ing, after which fever and diarrhoea came on. There
was also epistaxis a few days later. On admission the
patient presented nearly all the symptoms of typhoid
fever : the tongue was white ; there was tenderness on
pressure in the right iliac fossa, though the belly was not
tympanitic ; the spleen was slightly enlarged ; heart and
lungs were healthy. The temperature was 104.7°. The
eruption of rose-colored lenticular spots was confluent
over the abdomen, and very thick over the arms, legs,
and thorax. They were large, slightly elevated, and dis-
appeared momentarily on pressure. It was the great ex-
tent of this eruption that excited suspicion and led to
further examination. A cicatrix resting upon an indu-
rated base was found upon the glans penis, and there were
enlarged glands in the groin. Mucous patches were dis-
covered in the mouth and fauces. The patient was
placed upon ordinary anti-syphilitic remedies, and the
fever and eruption disappeared m about two weeks.
Dr. Durtocq mentions as of diagnostic value in the differ-
entiation of typhoid from syphilitic fever, the early ap-
pearance (third or fourth day), and the abundance of the
eruption.
Manage.ment of L.abor in Copenh.^gen. — Prior to
1877 a purely expectant plan was pursued in the man-
agement of labor at the Maternity Hospital in Copen-
hagen. If delivery was not accomplished within three
hours, then resort was had to extractive measures. Since
September i, 1877, the method of expression has been
employed in every case. In comparing the results ob-
tained in two periods of four years each, by the old and
new methods (1,780 of the former, and 1,559 of the latter).
Dr. Weiss states that : i, the frequency of hemorrhage
occurring during the period of delivery has been markedly
reduced ; 2, retained placenta has been met with much
less frequently since the method of expression has come
into use ; 3, rupture of the membranes has occurred
more often ; 4, post-partum hemorrhage is now of very
rare occurrence. In view of these facts, the author
thinks that midwives should always be instructed to man-
age labor in this wa)-. — Le Courtier Medical, August 25,
1883.
A Candlestick, in' the Uteru.s. — The following
carious case is found related in Le Coiirricr Medical of
August 25, 1883. A woman, aged forty-nine, subject
since puberty to periodical attacks of mania, but with
lucid intervals, was admitted to hospital on account of
an abundant and fetid leucorrhoia. Examination of the
uterus showed a cervix covered with granulations and ir-
ritated by a discharge coming from within the womb. A
sound which was introduced struck against a metallic
body. This was removed and found to be the brass
socket of a candlestick, measuring three-fifths of an inch
* On Septcmtxr 15th the operation of oophorectomy was peHbmied on the sub-
ject of this lecture, in a private room of the University Hospital. The ovaries and
tubes had taken on cystic degeneration. The girl recovered prompUy, but loo
short a time has elapsed to determine the issue of tl»c,"_operation.
October 13, 1883.]
THE MEDICAL RECORD.
405
in length, and four-fifths of an inch in diameter with a
rim one and one-half inch in diameter. This socket
was evidently detached from a candlestick introduced
at some time into the vagina. The last pregnancy
dated back twelve years, so the foreign body could iiardly
have been introduced at that time before the involution
of the uterus. And yet it is difficult to conceive of a
contracted uterus, in a woman past the menopause,
seizing and drawing up into its cavity so large a body
as that described.
The Tuning-Fork in the Treatment of Neural-
gia.— Dr. Rasori uses the tuning-fork in the treatment of
neuralgic pains, applying it while vibrating over the
course of the painful nerve. The sitting lasts about half
an hour, when the patient is usually relieved without
further treatment. He relates the case of a woman who
had suffered from vomiting during tlie neuralgic attacks,
but after the relief obtained by the application of the
tuning-fork she was troubled no more in this way {Cin-
cinnati Lancet and Clinic). The principle of this treat-
ment is the same as that employed by Dr. Mortimer
Granville. He uses an instrument, recently described
in these columns, called the percuteur, by means of
which he is able to make a number of taps in regular
and rapid succession, and of varying intensity to any part
of the surface of the body.
Cure of Obstinate Scrotal Eczema bv Hoang-
Nan. — Hoang-nan is a vegetable substance of repute in
Tonquin as a remedy against rabies, the bite of venomous
serpents, leprosy, and several other grave affections. It
contains nearly three per cent, of brucine and a small
quantity of strychnine. Dr. Barthelemy relates in the
Bulletin General de Therapeuti(/ue of August 30, 18S3,
a case of chronic eczema of the scrotum in which
this substance was employed with most happy effect.
The patient, a gentleman about tifty years of age, had
suffered for ten years from eczema of the scrotuiu,
perineum, and upper and inner parts of the thighs.
He had consulted numerous physicians, and had tried
every conceivable remedy witliout experiencing any relief
Dr. Geneuii, the last physiciay to whom he appHed, hav-
ing read of the efficacy of hoang-nan in leprosy, deter-
mined to try it in this case. The patient commenced
with seven grains per diem, gradually increasing to forty-
five grains a day, in divided doses. While taking these
large doses he felt the physiological effects of the drug
{nuiscular tremors, trisnuis, and vertigo), but persevered
with the remedy, and was rewarded at the end of ten
•days by a perfect cure of his affection. The amounts
taken were larger than had been advised by Dr. Geneuii.
In all five drachms were taken. The patient was seen
eighteen months later, and had then had no return of the
eczema.
Recovery from Locomotor Ataxia. — Dr. Louis
Henry reported the following case to the Victorian branch
of the British Medical Association {Australasian Medical
Gazette, July, 1883): A man, twenty-nine years of age,
of temperate habits, and free from any suspicion of
syphilis, had been suffering for some months from symp-
toms of progressive locomotor ataxia. The distinctive
signs of the disease were well marked and steadily in-
creasing in severity. He was first put upon large doses of
iodide of mercury, but as neither the fulgurating pains
nor any other symptoms were improved after a two weeks'
trial, nitrate of silver, in divided doses of one grain per
diem, was substituted. The patient was anesthetized
and the whole length of the spinal region was cauterized
with the button of the thenno-cautery. The ulcers were
kept open by a covering of a strip of linen smeared with
resin ointment. The patient was further ordered the use
of foot-baths of hot water and common salt three times a
day ; and during his stay in bed was to wear stockings
containing powdered mustard. After about three weeks
of this treatment, the nitrate of silver being gradually
forced to one grain three times a day, the resin ointment
was removed, and the back allowed to heal. The legs
were now massaged twice daily, and a solution of iodide
of potassium, eight grains, and liquid extract of ergot, one-
half drachm, ordered to be taken at 8 p.m. and 3 a.m.,
with the view of allaying the slight pains in the legs and
controlling the emissions, which rarely, but occasionally
still made their appearance. A very marked improve-
ment now began to show itself. The pains in the lower
limbs completely disappeared, the abdominal constric-
tion vanished, the emissions ceased, the walk and gait
became more sure and natural, and the patient regained
sensation in his feet, so that, with his boots on, he could,
when the report was made, feel the divisions in the
wooden ffoor. For the past two weeks he had been
taking eight-minim doses of the liquor strychnia, and
faradization was aiiplied to the spine and lower extremities
by means of a wire brush. The improvement, which
was very evident, would, the author hoped, be per-
manent.
Absence of the Uterus. — Dr. Tschernoguboff re-
lates the case of a woman, twenty-four years of age, well
nourished and of good physique. The labia were of
normal appearance, but the clitoris was very small. The
urethra was so dilated as to allow the finger to i)ass
readily into the bladder. The vagina was very short and
ended in a cul-de-sac. Combined vesical and rectal ex-
amination could detect no trace of a uterus. The woman
had never menstruated nor had she ever had any vicarious
hemorrhages. She had been married six years, but every
attempt at coitus was accompanied with severe pain. —
St. Peter sburger Med. IVochenschrift, August 25, 1883.
A similar case was related by Dr. Stanley O. Warren
at the recent annual meeting of the Maine Medical
Association {Ne'w England Medical Mpnthly, September,
1883). The woman was twenty-five years old, of Eng-
lish descent. She had had an irregular flow of blood,
slight in amount, from the rectum since her eighteenth
year, and thought at times that it had come from the
vagina. She had been married once and was making
l)reparations for a second marriage. Intercourse was al-
ways painful, though sexual desire was present. The
external genitals were normal, but the vagina was but an
inch in depth and ended in a blind e.xtremity. The
ovaries could be detected by rectal examination ; they
were connected by a band of firm tissue which might
have been a Fallopian tube or a rudimentary uterus.
The Liability of Error in Examining for Sugar
IN THE Urine. — The following illustrates with what care
and precaution every urinary examination in regard to
the presence or absence of sugar ought to be made.
Professor v. Heusinger in a late session of the Aerztl.
Verein, in Marbuig, declared that a certain individual
desired to be examined in view of having his life insured.
At the close of the physical examination he was re-
quested to urinate. As he had micturated before entering
the doctor's office he now could pass but a slight amount.
The chemical examination gave a yellow-green precipi-
tate (saccharine). At the examiner's request the man
returned the next morning, and the urinary test pre-
sented a negative result. It turned out after a close
questioning that the individual had suffered for months
with gonorrhoea, and had used injections of sulphate of
zinc. He had passed water and used this injection just
previous to presenting himself for the first examination.
Dr. Fettien, who was then consulted, found that if a
solution of sulphate of copper is added to one of sul-
phate of zinc and tartaric acid and caustic soda in ex-
cess, a blue fluid is formed which contains, besides
the constituents of Fehling's solution, sulphate of zinc.
Added to boiling urine, the zinc is precipitated as a hy-
drate with a grayish-green color and the solution turns
from blue to yellow. If albumen is added the same phe-
nomena are observed, only the fluid above the precipi-
tated zinc is reddish. — Berl. Klin. Wochenschrijt.
4o6
THE MEDICAL RECORD.
[October 13, 1883.
The Medical Record
A Weekly yournal of Medicine and Surgery,
GEORGE F. SHRADY, A.M., M.D., Editor.
Published by
WM. WOOD &. Co., Nos. 56 and 58 Lafayette Place.
New York, October 13, 1883.
THE MEETING OF THE NEW YORK ACAD-
EMY OF MEDICINE, AND THE PROPOSED
AMENDMENTS TO THE CONSTITUTION
AND BY-LAWS OF THAT BODY.
We think this institution, so important in every respect
for the profession of this city, and we may well say for
the country, is to be congratulated on its favorable
progress toward a settlement of those difficulties which
have for a time stopped its scientific work, and even
dangerously imperilled its very existence.
Our readers are aware of the fact that at the meeting,
April 19th, certain resolutions were passed, the main ob-
ject of which was to instruct the Committee on Admis-
sion to report no physician for election as resident fel-
low who is known by the Committee to be in opposition
to the Code of Ethics of the American Medical Associa-
tion. A full report of the proceedings was given in our
issue of April 28th.
The effect of this was to make a new test lor election,
not based on character, acquirements, or professional
standing, but on belief. The resolutions were adopted
by a large majority, at a meeting packed for the purpose,
by inducing every one to be present who could be per-
suaded to vote for it, when no suspicion was entertained
by those who could not conscientiously vote for such a
radical change, that such a movement was to be at-
tempted.
Two weeks before the present meeting the President
sent a letter to every resident fellow, which will be
found on another page, and certain proposed amend-
ments to the Constitution and By-Laws which he deemed
necessary to put the Academy in a good working con-
dition, and to restore harmony and prevent all future
trouble in the Academy. Very soon after, a circular
card was sent to the fellows, which is also reprinted on
another page. We especially call attention to this card,
for we think all will agree that this is the most astonish-
ing document that ever appeared signed by sucli dis-
tinguished names, as regards its audacity of statement
and its English — particularly that of the last sentence.
We are not surprised to learn that many supporters of
the old code at once avowed their intention to vote for
the proposed amendments.
At eight o'clock Thursday evening, October 4th, the
President, Dr. Fordyce Barker, promptly took the chair.
The hall was packed, filling the main room, the room be-
hind and the galleries, and very many were obliged to
stand and quietly kept their places the whole evening.
After the routine business was finished, Dr. Austin
Flint, Sr., rose to a question of privilege and asked leave
to make a personal explanation : He stated that he had
been frequently charged with inconsistency, in private
and in public, in newspapers and in medical journals, and
in other ways, in his action and conduct at two former
meetings of the Academy. When the delegates to the
Medical Society of the State of New York made their re-
port in 1 88 2, he then, at the request of the chief executive
officer, whom at that time it would have been painful for
him to deny any request he might make, moved, with
entire heartiness, as it was in consonance with his own
feelings, that the report of the delegates be accepted, ■!
and that further discussion of the topics and objects to ■
which it referred be indefinitely postponed. He made
the motion in good faith, because he believed that the
discussion of ethics had no place in the deliberations of
the Academy, but properly belonged to another society. 1
At the last meeting of the Academy, he had voted for •
the resolutions of Dr. Austin Flint, Jr., and he had done
so for the very reason that he believed their passage
would have the same effect. He maintained that his
conduct on, both occasions was consistent and in har-
mony, and he hoped there would never again be a dis-
cussion of ethics in the .Academy, either to-night or at
any future time.
Dr. F'lint was listened to with the closest attention and
was applauded when he closed. .
The President said he, and doubtless the Academy, I
had listened with great pleasure tq the remarks of the ;
gentleman whose name was held in the highest esteen>
by the profession, not only of this city. State, and coun-
try, but also abroad where'ver there is a medical lit-
erature. He fully and cordially coincided with the sen-
timents expressed at the close of his remarks, and he
hoped that the action of the Academy at this and the
next meeting would effectively secure the result which
both desired.
It was a favorable augury to see two men of the stand-
ing of the Ex-President and President again apparently
working together for the same end.
A communication from the Council was then read,
disapproving the proposed amendments and recommend-
ing their withdrawal. We have been informed that, in-
cluding the President, there were present thirteen. That
six advocated the foregoing communication and voted
for it. The other six, thinking it of no consequence, as
the Council had no autiiority in the matter, refrained from
voting.
This statement was ready to be made, and the casting
vote of the President on a tie would have been against
the motion. But at this meeting it was found tliat the
statement was not necessary.
Dr. Edward L. Keyes then moved the adoption of the
proposed amendments of the Constitution and By-Laws.
In presenting these proposed amendments, Dr. Keyes
remarked that he had been asked to do so by the Presi-
dent, and that he did so willinglv, not only as a recogni-
tion of the great services the President had rentlered the
Academy, but also because he saw in their adoi)tion an
easy solution of the difficulties with which the Academy
October 13, 1883.]
THE MEDICAL RECORD.
407
was now surrounded, which difficulties would otherwise
inevitably continue. He had always striven to live up
to the old code, he was not a new code man, he had
positively declined to join either party to the controversy
now going on. It was therefore not in the interest of
any faction, but wholly for the sake of peace, that he
now offered the proposed amendments and moved their
adoption as a whole.
Dr. Austin Flint, Jr., moved that the amendments take
the usual course, and expressed the opinion that discus-
sion on them at the present time was uncalled for.
Dr. Alfred L. Loomis seconded the amendments intro-
duced by Dr. Keyes, and said that he did so gladly, for
he was fully convinced that by their adoption the greatest
danger that had ever threatened the Academy would be
averted, and we should ever after be freed from such oc-
currences as had taken place at the last meeting. P'or
the Academy to maintain its prosperity and its prestige,
all matters of ethics and medical politics must be re-
moved from it.
The President, interrupting : Every fellow has the
power of expressing his approval or disapproval of any
sentiments uttered by his voice if he can get the floor, or
his vote, and I venture to suggest that it will better com-
port with the dignity of the x\cademy if all other modes
of expressing either feeling be avoided.
Dr. Loomis, resuming : There were societies before
which such matters properly came, but this was not one
of them. The Academy was for scientific work and
good fellowship, without fear of sharp tactics or bitter
words. If the proposed amendments were carried, it
would be impossible for any further disturbance of har-
mony to take place.
Our limits prevent us from giving more than a very
brief abstract of the wise, temperate, and excellent re-
marks of both of these gentlemen, who spoke to the
point, neither of them making any reference to codes.
Dr. Flint, Jr., disclaimed any desire to delay or ob-
struct the business of the meeting, but again urged that
the amendments could not be acteil upon to-night and
ought not to be discussed. He renewed his motion, and
it was now seconded.
Dr. C. C. Lee moved, as an amendment to Dr. Flint,
Jr.'s, motion, that the Academy resolve itself into a com-
mittee of the whole, for the purpose of discussing the
amendments. Seconded.
Dr. P'lint, Jr., protested that his motion could not be
amended.
The President decided that Dr. Lee's amendment was
in order. It was put, and declared carried. A division
having been called for, the amendment was found to have
been carried by a vote of 135 to 15.
The President then said he considered fairness and
courtesy required him to appoint as chairman one who
stood on the record as having voted with the majority at
the last meeting of the Academy. He should nominate
one known to all as familiar with parliamentary usages,
Dr. Ellsworth Eliot.
The Chairman named Dr. VV. M. Carpenter Secretary
of the Committee of the Whole.
By request the proposed amendments of the Constitu-
tion and By-laws were then read by the Secretary.
Dr. Louis Elsberg moved that when the committee
rise it report to the Academy in favor of the proposed
amendments as a whole. Seconded by Dr. C. F.
Taylor.
Dr. D. B. St. John Roosa thought fairness required
that the President should have a chance to be heard as
to his reasons for proposing the amendment.
Dr. Barker rose and spoke for about a half hour, com-
manding the closest attention and a peculiar stillness for
such a large meeting, except when interrupted by ap-
plause. We regret that we can give but a brief abstract
of his remarks.
He said he had not intended to take part in the
discussion on the amendments, but was anxious to hear
any objections to them that might be raised in a full
and fair discussion. Since the request had been made,
however, he could not hesitate. He repeated his grati-
fication at Dr. Flint, Sr.'s, remarks. When, after the
recent action of the State Society, it was feared that its
action on the ethical question would be brought into the
Academy, Dr. Flint, this renowned man whom he could not
think of except reverently — had introduced a resolution
to postpone the matter indefinitely. The resolution was
carried unanimously, and had worked most successfully,
until the action taken last spring, which had entirely
changed the aspect of matters, and was, he thought,
most injurious, imperilling the prosperity and usefulness
of the Academy, inasmuch as it made two parties, the
contention of which would keep out new members. He
had, therefore, set about devising measures to undo the
injury thus inflicted, and to guard against the possibility
of further mischief of the sort. Without consulting any-
body, but as the result of a careful study of the constitu-
tion and by-laws of similar scientific medical societies in
Europe, such as the Royal College of Physicians, the
Royal College of Surgeons, the Royal Medico-Chirurgi-
cal Society of London, the British Medical Association,
the Academy of Medicine of Paris, and others, he had
prepared the amendments of the Constitution and By-
laws now before us. The ethics of these amendments
were in every respect as high as those of any of the so-
cieties that he had mentioned. He had hoped that for the
sake of the Academy he would have the support of those
who had raised a perpetual monument to their memories
by their liberal gifts in building this beautiful hall, in fill-
ing the shelves above us, and by their long untiring work
for the Academy. He felt that they never would be
willing to see their labors come to nought, and this
property of the Academy, which, the Chairman of our
Board of Trustees said the other evening, amounted to
one hundred thousand dollars, practically ruined. All
know that property devoted to a special purpose most
rapidly depreciates when it fails of its object. He had
been greatly pained when he found that his judgment
was wrong, as he was sorry to say it often was, and that
some of the best of these men were opposed to these
amendments, which he believed so necessary for the
future of the Academy.
This course reminded him of the farmer who saw a
hawk on the ridge-pole of his barn, which he thought
had stolen his chickens, and ran into his house, seized
his gun, and fired at him. The wadding from his gun set
fire to his barn, which was burned with all its contents.
But the story is not ended, and there is another moral.
4o8
THE MEDICAL RECORD.
[October 13, 1883.
^ bystander, who had listened to the story with gaping
nouth and breathless suspense in all its details as to the
ize of the barn, how much it had cost, liow many tons
if hay, bushels of wheat, rye, and corn had been burned,
:xclaimed at the end, " Did he kill the hawk ? "
Dr. Barker then explained his amendments, and an-
wered some objections which had been urged. The
Committee on Education was omitted, simply because it
lad no practical duty or utility ; the Committee on
ithics, because its functions were relegated to the Coun-
;il, and because it abolished an inquisitorial committee
I'hich was always liable to do as much harm as good.
Jnfortunately, there has grown up, from the unhappy
ontroversy now going on, a kind of distinction between
■thics in its highest and best sense and what is techni-
ally called the " code." He would advocate for the
Academy the highest ethics, both in theory and practice,
.nd if any of its fellows were found wanting in this par-
icular, he would adopt a slang phrase of the day and
ay, "turn the rascals oat." The resolutions passed at
lur last meeting made it absolutely inijierative, in the
nterest of the Academy, that in the amendments all
•Uusion to the code should be left out. If this was a mis-
ortune, the responsibility will rest with those who intro-
luced the resolutions.
Dr. Barker then alluded to some other objections,
vhich had been urged.
Dr. Flint, Jr., thought that every one present knew,
)efore the President's explanation, precisely what the
imendments implied — they struck out the Code of Ethics,
ind the other amendments had had to be made to cor-
espond. The report of this Committee of the Whole
vould amount to nothing. It was simply impossible for
he amendments to obtain a three-fourths vote at the
lext meeting. Therefore, their introduction could only
ict as a firebrand. Discussion was wholly unnecessary,
.nd he, and those who thought with him, would not take
)art in it.
The President moved to amend Dr. Elsberg's motion
is follows : Jiesg'ved, That in the opinion of the Com-
nittee of the Whole it is advisable that the amendments
o the Constitution and By-laws proposed this evening be
tdopted as a whole, and that the Chairman be so in-
itructed to report. He also gave notice that he would
lubsequently move that, when the Committee rose, it
ihould report progress, and ask leave to sit again on
October i8th.
[A motion to rise having been made and seconded, it
vas put and declared lost.]
The President again brought up his motion instructing
he Committee, and it was now seconded and declared
;arried. A division having been called for, the motion
vas found to have been carried by a vote of 103 to 34.
On motion the Committee rose, reported [)rogress, and
isked leave to sit again October i8th.
On motion of Dr. II. G. PifTaid, the Committee's re-
juest was granted.
The President then took the chair.
Dr. Flint, Jr., moved that the amendments lie over
intil the next meeting, under the rules. Carried.
The meeting then adjourned.
As the matter stands, the amendments are now in the
lands of the Committee of the Whole, and no motion in
regard to them, or action on them, can be taken by the
Academy until the final report of this Committee.
It now seems nearly certain that so large a number of
supporters of the old code feel it necessary to save the
Academy, that the amendments will secure the requisite
three-fourths vote.
We should think it not at all improbable that all oppo-
sition to the amendments may be abandoned in order to
(prevent the new code party from claiming a victory by
the action of the Academy of Medicine. Weak, timid
generals are very fearful of changing front during the
time of battle. But Dr. Flint, Jr., does not belong to
this class. Like Bismarck, he would not hesitate for a
moment to give up a fight where he has nothing to gain
and much to lose by victory.
The real battle on the "code" is to be fought at the
County Medical Society, October 22d, where Dr. Flint,
Jr., has frankly and squarely made the issue, and put at
the head of his ticket the strongest man possible who
would be sure of nearly an unanimous election, were it
not that the election does not rest alone on the interests
of the society and personal merits.
THE CLINICS OF NEW YORK CITY.
We present in another column a schedule of the clinics
to be held in this city during the coming season. The
total number per week is over one hundred and sixty,
giving an average of about twenty-eight clinics each
week-day.
The clinics in general medicine and surgery naturally
take the lead in number, there being between twenty-five
and thirty of each of these weekly. Eye and ear dis-
eases, children's diseases, gynecology, neurology, come
next in popularity.
Over two-thirds of the clinics have been established
within the past year by the schools for post-graduate
instruction.
New York has about forty public and private hospitals,
with a capacity of over seven thousand beds. There are
twenty-five dispensaries, treating a quarter of a million of
people annually. There is, therefore, abundant material
even for the numerous clinics.
ARTIFICIAL IMPREGNATION IN ITS MEDICO-LEGAL
ASPECTS.
A CASE of much interest to the medical profession has
recently been brought before the civil tribunal at Bor-
deaux. It ai)pears that a certain physician in Bordeaux
advertised widely that he was able to cure sterility in
either sex, and no matter how obstinate. Attracted by
these pretensions, M. and Mine. A., a childless couple,
went to the ijuack and secured his services. The opera-
tion known as artificial impregnation was performed, but,
as the evidence shows, in a bungling and incomplete
manner. Conception did not take place, but on the
contrary, some local injury was done. Despite the
failure the quack claimed his fee, which was the moderate
sum of fifteen hundred francs, and accused the woman
of having attempted abortion. The case was brought
before the court, which not only refused to award the
fee but condemned the operator and the operation.
The decision does not affect the legality of the opera-
October 13, 1883.]
THE MEDICAL RECORD.
409
tion itself, but the judge condemned it as being a pro-
cedure which was unnatural, and which might, if abused,
be a source of danger to society.
Artificial impregnation is an operation which in certain
cases may be justifiable, but which is generally resorted
to with extreme caution by gynecologists. The practi-
cability of artificial impregnation was first shown upon the
lower animals by Spallanzani in 1782. Dehant and
Sims, about twenty years ago began to attempt it upon
human subjects. In fifty-five separate experiments upon
six patients, Sims only succeeded once, and he has now
abandoned the operation. Some French gynecologists
still endorse it.
LATHYRISM.
Toward the end of the last century, Duverney called
attention to the danger of eating wild vetclies, and de-
scribed a paralysis of the lower extremities caused
thereby. Since that time several observers have de-
scribed lathyrism, and in 1880 a paper was presented to
. the International Medical Congress by Dr. Brunelli, giv-
ing the histories of several cases of this affection. At
the meeting of the Paris Academy of Medicine of July
7, 1883, Dr. Proust detailed a series of observations
made by him in an epidemic of the disease occurring re-
cently in Algeria. The first symptoms appeared sud-
denly after a cold and wet night, and resembled those of
a transverse myelitis, viz., high fever, lumbar pains, for-
mication and trembling, motor and sensory paralysis of
the lower extremities and paralysis of the bladder. In
time, these symptoms were succeeded by those of de-
generation of the lateral columns. The patients pre-
sented a very characteristic appearance. Locomotion
was difficult and only possible with the aid of a cane.
There was rigidity of the lower extremities. The feet
were in extension and adduction, it was impossible to
bring the heel to the ground ^and walking was accom-
plished on tip-toe. The patellar tendon reflex was
greatly exaggerated and the ankle clonus was also
marked. The eyes were unaffected and there were no
lightning pains nor any other signs of ataxia.
No autopsies were made, but from the syinptoms ob-
served it is probable that the lesion consisted in a trans-
verse myelitis or a hemorrhage of the cord, succeeded
by degeneration of the lateral columns. The disease
was apparently caused by a species of wild vetch {lathy-
rus cicera), called by the Arabs djilbes, which enters
largely into the diet of the natives. All who were at-
tacked had eaten of this vegetable, while among the
tribes who did not use it there was not a single case.
The immediate exciting cause seemed to be exposure
to cold, and moisture. M. Proust suggested that the in-
jurious effects of the vetch might be due to a mildew.
The disease would then be analogous to pellagra, the
supposed cause of which is the sporisoriiim maidis, a
parasite of Indian corn. Repeated examination, how-
ever, failed to show any diseased condition of the djilbes,
while experiments upon animals would seem to demon-
strate that the poison exists in the healthy plant. A res-
inous substance contained in the grain of the lathyrus
caused death with paralytic phenomena when given to
rabbits. The same paralytic phenomena were observed
by Bourlier in animals poisoned by the ethereal or alco-
holic extract of lathyrus. The prognosis was gener-
ally favorable. In some cases a spontaneous cure was
observed, while in others it was obtained as a result of
treatment. This consisted in the administration of
iodide of potassium internally and counter-irritation with
croton oil or tincture of iodine applied along the spine.
This report suggests the advisability of a careful study
of the physiological action and properties of lathyrus.
We may then possibly find that a potent drug can be
added to the neurologist's armamentarium.
|!Xcivr6 of ttie ^®iCecTi.
A Successful Resection of the Pylorus for cancer
was recently made by Professor Heinecke, of Erlangen.
The New Medical College at Quincy. — A cor-
respondent of the Peoria Medical Monthly, announcing
the organization of a new medical college at Quincy,
111., states that the Decatur physicians are not going to
be behind-hand, and will presently organize a rival insti-
tution. The writer says that the following will go into
the prospectus : " For some time we have been con-
vinced that the obstacles thrown around the pathway to
the medical profession by designing men are altogether
too numerous, and it shall be our endeavor to do what
we can to fill the decimated ranks of the profession, and
in this way help to hold up the hands, enlarge the sphere
of usefulness, etc., of those who have already chosen
this noble profession. We believe it cannot be success-
fully controverted that where members of our profession
are most numerous, there the health of the community
is in the best state of preservation. This being an un-
disputed fact, we shall labor for the good of mankind
by so decreasing mortality, in filling the ranks of our
profession, until we may see in every city and hamlet
throughout this glorious republic of ours, one physician
to every one hundred inhabitants."
A New Medical College in Cincinnati has been
organized under the title of The Medical University of
Ohio.
Concerning Reported Leprosy in Wisconsin. —
We have received a communication from Dr. J. T. Reeve,
Secretary of the Wisconsin State Board of Health, re-
garding a remark made in a recent editorial that leprosy
was " said to prevail to a considerable extent in some of
the Scandinavian colonies in Wisconsin." -This report.
Dr. Reeve states, is unfounded. He thinks it doubtful
if there is at present a single case of the disease in the
State. A few cases of leprosy have been brought into
Wisconsin by immigrants from Norway, but not one case,
as far as can be ascertained by the most careful inquiry,
has ever originated there, and the disease can never be
said to have "prevailed to any considerable extent.''
The Epidemic at the New York. Infant Asylum,
Mount Vernon, N. Y., and the Cause of the Ex-
cessive Death-rate. — Dr. B. J. lUnnett, Health Officer
of East Chester, N. Y., submits the following facts in
reference to the rate of mortality at the Mount Vernon
branch of the New York Infant Asylum : " An epidemic
unquestionably has invaded the above institution, the
nature of which is more a matter of conjecture than ac-
4IO
THE MEDICAL RECORD.
[October 13, 1883.
tual knowledge, I opine, on the part of those who oug/il to
possess definite and accurate opinions, in control of this
institution. On the first day of August last there were
contained in the above asylum 236 children. During
August there were 23 deaths, and during September
2)2, died, a very heavy percentage you perceive. From
the death certificates in my possession it would be a
difficult matter to ascribe this excessive rate of mor-
tality to any particular disease, as each of the cer-
tificates referred to specify from two to five causes of
death under head of chief or determining, and from one
to three of consecutive or contributing causes." This is
a serious charge from a responsible source, which, we
hope, can be satisfactorily explained by the asylum au-
thorities.
Yellow Fever at Hav.\n.\ and Vera Cruz. — During
the week ending September 28th there were nine deaths
from yellow fever at Havana. There were eight deaths
from yellow fever at Vera Cruz during the week ending
September 20th.
The Food Value of American Fish. — Spencer F.
Baird, Commissioner of Fish and Fisheries of the United
States, in noting the editorial in The Medical Record
for September 29th, urging the taking of steps for investi-
gating the food value of American fish says, that this
subject has occupied the attention of the Fish Commis-
sion for several years; and that since 1878 Professor W.
O. Atwater, of Middletown, Conn., has been carrying on,
practically, at its expense, a series of researches far ex-
ceeding in magnitude, and scientific as well as econom-
ical value, any others on the same subject. Professor
Atwater is now in Germany, engaged principally in this
work, which is still very far from being completed. He
has, however, made several partial reports, one of which
was published in the " Proceedings of the .\merican Fish
Cultural Association for 1882." A more elaborate report,
containing the fullest possible data in regard to about
sixty-two species of .\merican fishes, is now in type, and
will appear in a forthcoming volume of United States
Fish Commission reports.
Death of a Member of the French Cholera
Commission. — M. Thuillier, one of the scientists sent un-
der the direction of Pasteur to study the cholera in
Egypt, has himself fallen a victim to the disease. He
was the youngest member of the party, being but twenty-
six years of age. He contracted the disease in the chol-
era hospital of Ghedid, in Alexandria, where he was en-
gaged in its study. His funeral was attended by all the
Europeans resident in the city, the consuls, the medical
corps, members of the other cholera missions, and the
English army surgeons.
The Medicolegal Society held its stated meeting
on October 3d. Prof. John J. Reese read a paper en-
titled " Report of a Toxicological Examination for
Arsenic.'' Mr. Charles Y. Wingate read a paper entitled
" Sanitary Laws relating to Building in New York.''
The Philadelphia Medical Times. — The editorship
of this journal has been changed, and Dr. Frank Wood-
bury has been promoted to the position. We congratulate
the publishers on having secured the services of so ac-
complished and experienced a gentleman.
©Wtuary.
SURGEON GENERAL CHARLES H. CRANE,
UNITED ST.A.TES ARMY.
Brigadier-General Charles H. Crane, Surgeon-Gen-
eral, L^nited States x\rmy, after a brief service of one year
and two months, died suddenly at 6 a.m., October loth, at
Washington, in his fifty-eighth year. His predecessor,
Surgeon-General Barnes, was retired under the act of
the Forty-seventh Congress in August, '1882, and lived
but a short time after his retirement. Surgeon-General
Crane was President Arthur's personal choice, and his
death, so wholly unexpected, was a great shock to him.
.\ few weeks ago he complained of a severe cold, which
irritated his throat and made respiration irksome. He
went about performing his official duties until two weeks
since, when, under theadvice of his physicians, he remained
at home. Two days before his death the symptoms be-
came alarming, though it was not supposed the patient was
beyond the reach of medical skill. Several of the emi-
nent surgeons of the army were in constant attendance,
and though no attempt was made to conceal his condition
from the family or the public, the fatal result of the throat
hemorrhage was a shock to official circles in Washington.
Both Surgeons-General Barnes and Crane were attendants
at the bedside of President Lincoln, and in the pictures
extant of his last moments it is Surgeon Barnes who is
feeling the pulse of the dying President. He was born
in Rhode Island, but was appointed to the army from
Massachusetts on February 14, 184S. After several pro-
motions he was, on March 13, 1865, made Brevet
Brigadier-General for meritorious services during the war
of the rebellion, and on July 28, 1866, was promoted to
be Colonel and .Assistant Surgeon-General, and afterward
Brigadier-General and Surgeon-General, July 3, 1882.
His remains were interred at Shelter Island, N. Y.,
yesterday afternoon, the following distinguished gentle-
men being pall-bearers : Secretary Lincoln, General
Sherman, Admiral Rodgers, Robert C. Schenck, Generals
McFeely, Rochester, Rucker, Drum, Beard, Benet,
Hunter, Holabird, Wright, and Perry, Commodore Fille-
brown. Dr. J. M. Brown, United States Navy ; Mr. Ross
Ray, and Mr. Charles Knapp.
^\cpovts of Societies.
THE AMERICAN ACADEMY OF MEDICINE.
Eighth Annual Meeting, held in New York, October 9
and 10, 1883.
H, O. Marcv, M.D., President, in the Chair.
(Special Report ior The Medical Rkcord.)
The meeting was called to order by the President on
Tuesday afternoon. A number of members from Phila-
delphia, Washington, Boston, and elsewhere were pre-
sent, the whole number of registrations being forty-seven.
The entire afternoon was devoted to reading papers,
having as their general aim the encouragement of a higher
and broader medical education. .\\\ exception was that
of an interesting sketch of the late
DR. GEORGE M. HEARD,
by Dr. A. D. Rockwell. The paper, which is published
in full on page 399 of The Record, described Dr. Beard's
studious habits, his sense of humor, his vigorous self-
assertion, his literary industry, and his tolerance of
others, even the humblest and most illiterate.
Dr. Traill (Jreex, of Easton, Pennsylvania, read a
paper on
the imperfectio.v of technical studies as a means"
OF mental culture.
His theory was that technical studies might give special
skill, the skill of the craftsman, but that they did not and
October 13, 1883.]
THE MEDICAL RECORD.
411
never could really educate a man in the broad sense of
the word. Technical studies, perhaps, fitted a man for
money-winning in many directions, but did not equip the
man best for the needs of a learned profession.
Dr. Charles McIntire, Jr., of Easton, Pa., read a
paper entitled
IS IT FAIR ? A STUDY OF THE COMPARATIVE POLITICAL
POSITION OF THE MEDICAL PROFESSION IN THE UNITED
STATES.
Dr. McIntire showed how full the profession was of
ignorant and incompetent persons, also how politically
powerless and apathetic its members were. He inveighed
against the indifference which both the public and phy-
sicians showed in allowing the country to be so flooded
with persons who were really dangerous to human life
and morality.
Dr. Benjamin Lee, of Philadelphia, read a pa[)er en-
titled
THE value of an ACQUAINTANCE WITH BOTANY AS A
PRELIMINARY TO THE STUDY OF MEDICINE.
He deprecated the neglect into which the study of bot-
any had fallen among physicians and medical students.
The result had been caused by a narrow ultilitarianism,
which made exhibitors and prescribers of drugs rather
than enlightened physicians. The paper gave a historical
review of the progress of botanical study in this country
during the closing years of the eighteenth century and
down to the present day.
Dr. a. L. Gihon, U.S.N., read a paper entitled
TWE HIGHER PLANE IN MEDICINE.
A Standard of preliminary education that will go far
enough to embrace a knowledge of the natural sciences,
and of the structure and use of language ; a graded cur-
riculum of four years ; a rigorous examination lor grad-
uation by disinterested boards ; a three-years bacca-
laureate probationary to the doctor's degree. All these
are not enough, if preceptors, professors, and piiysicians
in general fail to impress upon their pupils that medi-
cine is something more than an art, merely seeking to
relieve individual suffering at so much a head ; that its
wider aim is to banish disease from the earth, prolong
life, develop and improve the race, and thus increase the
total of human happiness ; that there is no grander or
sublimer employment of the intellect than this study
of man and his surroundings, catenated as it is with
every other branch of knowledge ; that he who is really
"learned in medicine" is learned in many things, and
moves in that higher plane which should be the aspira-
tion of every man who presumes to add M.D. to his
name.
For those who are content to look no higher than
the requirements of a daily routine, it were better to
make no pretence of education, but to recognize a class
of general practitioners who can pull a tooth, apply a
poultice, or chance a dose of calomel or castor-oil.
Consign them to the limbiis fatuorum, but do not claim
for them equality and fraternity with educated physi-
cians. The line must be sharply drawn. There can be
no border land_ If the degree of M.D. is to be pre-
sumptive evidence of professional ability, see that it is
the exponent of something definite. Repudiate sham
colleges and sciolist teachers, and relieve the profession
from the burthen of the gross ignorance, illiteracy, and
incompetence which are now its opprobria.
Evening Session.
The President, Dr. H. O. Marcy, delivered his
ANNUAL ADDRESS.
The progress of modern thought was touched upon,
and the query made whether medicine had progressed
at an equal rate with other sciences.
The value of sanitation and the necessity of more ear-
nestly studying and applying its laws was urged. The
impurities of the air were enumerated, and the dangers
encountered in badly ventilated rooms described. The
organic dust in the air was believed to be the cause of
the mysterious "epidemic constitution," so-called, and
to be connected with the spread of disease and of surgi-
cal complications.
The imparities of water were described, and the con-
sideration of soil-pollution in water-supply dwelt upon.
Numerous diseases are caused and distributed by im-
pure water. The soil air was also a source of danger
little considered. The power of these soil and water
impurities has been shown by the disastrous effects of
typhoid fever in Massachusetts. From 1840 to 1880
there were 390,000 cases of typhoid fever, with 40,000
deaths. In the war there were 93,433 deaths from in-
juries, and 186,216 deaths from disease. Of these latter
deaths, 108,666 were from zymotic diseases alone. Be-
sides this there were 1,700,000 cases of diarrhoea and
1,100,000 cases of dysentery. The number of deaths in
i83o in the United States from diphtheria was 38,398 ;
from typhoid fever, 22,905.
The' speaker had made some special experiments with
germicides, and had reached conclusions much like those
of Koch and Sternberg. Corrosive sublimate in a
strength of i to 2,000 was as powerful as carbolic acid
in a I to 20 solution.
The discoveries of Koch regarding the tuberculous ba-
cillus, and its S|)ecific relation to phthisis, were thought
by the speaker to be established. Some conclusions
regarding the bacillus were given.
The disposal of the dead was a problem that needed
attention.
The prospective development of the medical profession
and of medical science were eloquently dwelt upon.
At the close of the address numerous micro-photo-
graphs of the lower organisms were shown.
The Society then adjourned to a supper.
Second Day — Wednesday, October ioth.
A telegram was received announcing the fatal illness
of Dr. F. D. Lente.
ELECTION OF OFFICERS.
The Council reported the following nominations for
officers :
President — Dr. Benjamin Lee, of Philadelphia ; Vice-
Presideiits — Dr. Nathan Allen, of Massachusetts ; Dr.
A. L. Gihon, U.S.N. ; Dr. George F. Shrady, New
York ; Dr. Edward J. Bermingham, New York ; Secre-
tary and Treasurer — Dr. Richard J. Dunglison, of Phila-
delphia ; Assistant Secretary— Dx. Charles McIntire, Jr.,
of Easton, Pa.
The report of the Committee was accepted and the
officers elected.
Dr. J. Marion Sims was elected honorary member.
Twenty-six new Fellows were elected.
Dr. L. S. Pilcher, of Brooklyn, delivered an ad-
dress on
THE RELATIONS OF MEDICAL JOURNALISM TO HIGHER
MEDICAL EDUCATION IN AMERICA.
Dr. Pilcher began by deprecating the somewhat too
radical conclusions announced in some of the papers on
the day before, regarding the absolute necessity of an
academic training in order to be a useful iihysician. It
would not be to the advantage of the Academy to have
such an opinion go out as representing its views. The
speaker instanced Hunter, Cooper, Pare, and Velpeau,
as persons who had brilliantly succeeded as physicians
despite their having been without a classical training.
The speaker also jjrotested against the slurring manner
in which the art of medicine had been spoken of in com-
parison with the science. Harvey had been instanced as
an example of what education, learning, originality, and
skill could accomplish. Harvey, however, was unskilful
in the art of medicine, while his contemporary, Syden-
ham, not a scientific man, was a brilliant physician.
"There is now," the speaker continued, ='a revolu-
412
THE MEDICAL RECORD.
[October 13, 1883.
tion going on in the methods of medical teaching. The
use of technical appliances, laboratory teaching, quiz-
zing, etc., are now a part of the teaching system, so that
now the average medical graduate is crammed to an ex-
tent which was not the case twenty-five years ago. It is
a question, however, whether he is any better physician
than he was formerly. The function and object of medi-
cal education was to make real practical physicians,
those who could relieve pain and cure disease. That
system of education which makes the best physicians in this
sense will be the one finally adopted. Other things being
equal, the person who has first had a good general educa-
tion will have the advantage over others in the end."
The speaker was inclined to think that the increase of
medical colleges was not an unmixed evil, owing to the
effect of competition. The licensing of students by these
colleges was. however, a mistake.
The speaker then took up the subject of medical jour-
nalism. The rapid growth of medical journalism was a
sign of the increased education and mental activity of the
profession. The fact that the great publishing houses
were willing to put their capital into the large weeklies
was an evidence of appreciation of the intelligence and
educational ambition of the profession.
In the discussion of the paper, Dr. Steiner said that
in organizing the Academy the chief object was dis-
tinctly formulated. It was to encourage young meji to
secure a preliminary collegiate education before studying
medicine. He protested against an attempt to discuss
the (jrimary object of the Association as a waste of time.
Dr. Hunt, of Boston, speaking for outsiders, asserted
that academic training was inconse(iuential and useless.
He thought the real reform needed by the profession was
closer adaptation to the methods of science.
Dr. a. L. Gihon, referring to Dr. Pilcher's remarks,
said that Hunter, Velpeau, and Cooper were not grad-
uated in two years, but really had a long and careful
preliminary education.
Dr. Sibbett spoke briefly, defending the aims of the
Academy. The conditions of life and oi)portunities for
education are very different now from those of a hundred
years ago. Of eighty medical men in his county only three
had the degree of A.B. Not five had ever contributed to
medical science or literature, because they were not suffi-
ciently educated.
Dr. J. Cheston Morris, of Philadelphia, read a paper
entitled
THE MILK SUPPLY IN LARGE CITIES.
The importance of milk as a food, the dangers to in-
fant life of its impurities, and the methods of delivering
and of adulteration were enumerated.
The use of sealed jars for the delivery of milk was re-
commended.
There was a great diflference in the quality of the milk
of different kinds of cows. 'I'hus the common native
cow gives I pound of butter to 17 pounds of milk ; the
Devon, i pound of butter to 14 pounds of milk ; Jersey,
I pound of butter to 12 pounds of milk; Durham and
Ayrshire, i pound of butter to 17 pounds of milk. The
Devon cow contains more sugar and caseine, and its
milk is more nutritious. The composition of milk was
given. The total amount of milk annually consumed in
Philadelphia was estimated to be 55,548,417 quarts, or
about two-fifths of a pint daily to each inhabitant. The
cost averaged $100,000 a day.
Dr. a. D. Rockwell read a paper entitled
THE EXACT VALUE OF THE ELECIROLVTIC METHOD.
The writer said he had long ago given up the attempt to
treat malignant tumors by electrolysis. In a case of
epithelioma of the face, however, he had recently ob-
tained an entire disappearance of the growth. In some
cases of intramural fibroids he had had remarkably good
success. An illustration case was cited. In erectile tu-
mors he had had his best results. One operation is gen-
erally sufficient.
The best method of procedure was to connect the
needles with the positive pole and place the negative
pole outside. The resistance is greater, but this can be
overcome by increasing the number of cells. Cystic
tumors can be as successfully treated as the erectile, but
practically the application is less often needed.
Dr. Rockwell's conclusions were :
First. — The success met with in the treatment of
malignant tumors is generally but trivial. In epitheli-
oma, however, when superficial and easily reached, suc-
cess may be had.
Second. — The electrolysis of iuiramural fibroids often
reduces the size somewhat and gives great relief.
Third. — For erectile and small cystic tumors elec-
trolysis is a specific.
Fourth. — Goitres, if small and soft, may be reduced
in size, even by external applications. Even when hard,
electrolysis may be beneficial, but the results are vari-
able.
Fifth. — Hairs can be permanently removed.
Sixth. — In many cases of stricture, relief or cure can
be obtained by electrolysis, but experience is not suffi-
cient to speak of its value positively.
THE report of THE COMMITTEE ON PROGRESS OF MEDI-
CAL LEGISL.^TION
was read by Dr. R. J. Dunglison. The report stated
that the progress made in the past few years had been
most satisfactory. The views of Dr. Miller, of Minne-
sota, were quoted, in which he stated that the laws of
West Virginia, Illinois, Minnesota, and Missouri were
the best. It was stated that considerable disappoint-
ment had been felt as to the success of the registration
law in Pennsylvania and New York. The workings of
the new law in Mississippi, modelled after the Illinois
law, passed in 1S82, had already been very successful.
The attempts of the Illinois Health Board to promote
higher medical education were detailed. A list of the
States which possessed some medical laws was given as
follows : .-Mabama, .Arizona, Arkansas, California, Colo-
rado, Connecticut, Delaware, District of Columbia,
Florida, Georgia, Illinois, Kentucky, Louisiana, Mary-
land, Michigan, Minnesota, Mississippi, Missouri, Ne-
braska, Nevada, New Hampshire, New Jersey, New
Mexico, New York, North Carolina, Ohio, Pennsylvania,
South Carolina, Texas, Vermont, Virginia, and Wyoming
Territory.
Since the last meeting of the Academy laws had been
passed in Delaware, Michigan, Minnesota, and Missouri.
The efficacy of the laws in the different States varied
greatly. The following States have good laws, according
to Dr. Ranch : North Carolina, Alabama, West Virginia,
Illinois, Missouri, Minnesota, New Mexico, Wyoming
Territory, Mississippi, and Louisiana; ten in all. Penn-
sylvania still lags behind, her law being little more
than a registration regulation. New York's law has been
much criticised. It was still thought a good law in the
main by many, but needed a severe penalty for jierjury.
In Alabama the diploma confers no right to practise. In
Arizona, Pennsylvania, and Washington Territory, the
law is siiuply for registration. In .Arkansas a bill for a
medical law failed last year. In Texas and Nebraska
the law is weak and ineftective. In Tennessee there is
no law, and the jjractice of medicine is "free to all." In
Utah there is no medical law except that provision of the
penal code which punishes a physician who is drunk.
Dr. R. S. SunoN, of Pittsburgh, read a paper on the
" Importance of Cleanliness in Surgical Operations."
[The pajjer will appear in full in a subseiiuent num-
ber of The Record.]
Dr. Bush read a paper entitled "A Few Words Con-
cerning Vaccination."
At the close of the reading of the papers, the new
President, Dr. Benjamin Lee, was introduced.
The Academy then adjourned to meet next year in
Baltimore, Md.
October 13, 1883. J
THE MEDICAL RECORD.
413
NEW YORK PATHOLOGICAL SOCIETY.
Staled Meeting, September 12, 1883.
George F. Shradv, M.D., President, in the Chair.
THROMBOSIS WITHOUT EMBOLISM.
Dr. Van Gieson said that at the last meeting of the So-
ciety he presented a siiecimen of thrombosis occurring
after parturition, and then expressed opinion tiiat it was
not due to emboHsm. [See Medical Record, vol.
xxiv., p. 246, September i, 1S83.] Since that time he
had seen a case of very severe phlebitis, affecting both
femorals, with apparent partial obstruction of the fem-
oral arteries, at least the impulse of the arteries was
very much diminished, occurring in a woman sixty-five
years of age ; at the present there is more or less cold-
ness of the lower extremities without any distinct evi-
dence of gangrene. Dr. Janeway had seen the patient,
but his opinion concerning the case Dr. Van Gieson had
not yet learned. He had, however, examined the heart
very carefull)-, and, so far as physical signs go, found it
entirely free from any evidence of valvidar disease or
hypertrophy. The occurrence of this case so soon after
the one reported, and the absence of any evidence of
cardiac lesions, still further inclined him to the belief
already expressed, namely, that obstruction from throm-
bus is not necessarily due to embolism. In other words,
there are cases of thrombus which occur independent of
any mechanical obstruction by embolism ; whether or
not the change occurring in the intima of the affected
vessel might be called inflammatory, he was unable to
say.
Dr. Amidon asked if, in the last case, there was any
evidence of the presence of the contracted kidney of
Bright's disease ?
Dr. V.-vn Gieson replied that repeated examinations
of the urine had failed to reveal any evidence of kidney
disease.
Dr. Amidon said the reason he asked was because it
is well known that, not only in syphilis, but in chronic
interstitial nephritis, the condition of endarteritis oblit-
erans occurs, and he was unable to see why it should not
affect the femoral as well as the cerebral vessels. He
had not, however, observed it in a peripheral artery of a
limb.
Dr. Van Gieson said that he had not, except in the
case referred to at the time he presented the specimen.
The Society then went into Executive Session.
Stated Meeting, September 26, 1SS3.
George F. Shrady, M.D., President, in the Chair.
Dr. George R. Elliott presented a specimen of
SACCUL.4TED ANEURISM OF THE ABDOMINAL AORTA,
accompanied by the following history: The points of in-
terest were its occuarence in a person in whom the other
organs were found in a healthy condition, the healthy
appearance of the aorta above and below the aneurism,
the small size of the tumor, and the absence of specific
disease. Frederick M , German, aged thirty-seven,
married, and a cabinetmaker by occupation, was ad-
mitted into the New York Hospital, July 6, 1883. Family
history bearing on the case was negative ; alcoholic his-
tory was well marked ; there was no evidence of sy|> 
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